WHEN Gov. Arnold Schwarzenegger, on crutches, unveils his expected grand redesign of the state's health insurance system Monday, he must tackle the biggest obstacle to insuring the uninsured: insurance companies.
The governor said recently that California's high number of uninsured residents -- about one in five -- acts as a hidden tax on the insured by forcing them to pay higher premiums, deductibles and co-pays. He has strongly hinted that he favors a system requiring individuals to buy health insurance, as well as assuring coverage for all children in the state (who constitute about 12% of the uninsured).
But he's said nothing about reforming insurance companies or HMOs.
Schwarzenegger's experience with health insurers is not your average citizen's. Anyone as rich as he is doesn't have to worry about medical expenses. He and his surgeon surely didn't have to seek permission for treatment. They didn't have to argue with a cost-control center demanding something cheaper -- such as outpatient surgery. The governor won't fear that his insurer will retroactively cancel his policy or double his premiums because of the surgery.
Not only is Schwarzenegger immune to most people's struggles with insurers, he's also enjoyed nearly $1 million in direct political contributions from them, according to public contribution reports.
It is this political relationship that should worry Californians hoping for real healthcare reform. Insurance companies, after all, will spend whatever it takes and call in every favor they're owed to stop reforms that restrict their profits, curb their extravagant overhead or limit what they can pay their chief executives.
For health coverage truly to be affordable and accessible, the governor and Legislature must force insurers to accept the following rules of fairness:
* A "take-all-comers" rule. Insurers today can deny a health policy to individual buyers in California for almost any reason. In Massachusetts, which recently required all citizens to carry health insurance, insurers have to take all patients, regardless of preexisting conditions. California insurers should be required to do the same.
* Charges set by community, not condition. California health insurers want to insure the healthy, not the sick, so they charge individuals who even \o7might\f7 become sick astronomical premiums. Those who do become ill can see their premiums skyrocket or their policies canceled. It's the opposite of Massachusetts and other states where health insurers must base premiums on broad characteristics such as age and regional healthcare costs -- not on a buyer's specific medical condition. The purpose of insurance, after all, is to spread the risk.
