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With health insurance mandate, there's safety in numbers

We're in this together, and the cost to taxpayers of treating anyone who seeks emergency care, with or without insurance, is far greater than the cost of requiring coverage for everyone.

December 21, 2010|David Lazarus

If more proof is needed about the folly of opposing healthcare reform, take the example of West Hollywood resident Michelle Mindlin, who was diagnosed with ovarian cancer in March and underwent multiple rounds of chemotherapy.

She used to be an executive at Disney. Now she's unemployed and experiencing the same financial squeeze as millions of other people with individual insurance policies.

In March, Mindlin's insurer, Aetna, informed her that her monthly premiums were rising $91 because she'd just turned 55. They went up an additional $83 in October because of, in Aetna's words, "the growing cost of healthcare services."

On Jan. 1, Mindlin's premiums will climb an additional $44 because of "the new healthcare reform law."

These rate hikes represent a 55% increase in Mindlin's premiums over just a few months — and not one of them, according to Aetna, is attributable to her cancer. As of January, she'll be paying $613 a month for health coverage and she'll also have a $5,000 deductible.

In other words, Mindlin will be paying more than $7,000 a year for insurance and will still be responsible for the first $5,000 in annual costs.

"If I don't get work, I don't know how I'll afford that," she told me. "But I'm now uninsurable for individual coverage. I can't switch to a different policy."

If President Obama's reform package remains intact, Mindlin will be able to shop for potentially more affordable coverage in an insurance "exchange" where companies will be prevented from turning people away because of their medical history. But that doesn't go into effect until 2014.

And it might not happen at all if the courts overturn a requirement that nearly everyone buy health insurance.

A federal district judge in Virginia ruled last week that the so-called individual mandate for health insurance is unconstitutional because Congress exceeded its regulatory authority. The Obama administration said it would appeal the ruling.

Without the mandate, many healthcare experts say, premiums probably would skyrocket because most people would simply wait until they got sick before buying coverage. Health insurers, in turn, would probably stop offering individual policies because the marketplace would be rigged against them.

As I wrote on Friday, you can't keep insurance costs down unless you get everyone into the risk pool.

A number of readers disagreed.

Pacific Palisades resident Pat Murphy wrote that the insurance mandate is "part of a radical agenda pushed by progressives that's nothing less than repackaged communism and antithetical to America's foundation."

Craig Lesly said that "opponents are really smart enough to understand that this 'healthcare' legislation was really welfare legislation."

Meanwhile, a reader named Bob had an interesting solution. He proposed requiring anyone who declines health insurance to have a tattoo saying: "Willfully uninsured. Do not treat; do not resuscitate."

I'll say it again: Insurance is about safety in numbers. That's how the business works. If we're determined to have private companies provide our health coverage, and if we want to prevent them from turning anyone away, the only way to keep costs down is to have everyone share the risk.

In Mindlin's case, she was able to receive cancer treatment only because she qualified for financial assistance from Cedars-Sinai Medical Center. She ended up paying about $1,500 out of pocket and the hospital covered the rest of her deductible. Then Aetna's coverage finally kicked in.

You could argue that because Mindlin has higher medical costs, she should pay more for health insurance — kind of like an accident-prone driver paying more for car insurance.

But that's only if you think healthcare shouldn't be equally accessible to all. Then there's only one conclusion: Sick people should pay more.

If, on the other hand, you believe that healthcare is a right and not a privilege, and that the mark of a decent and civilized society is how it looks after those in need, then it shouldn't make any difference who's knocking at a doctor's or an insurer's door. Healthcare should be there for all of us when we need it.

Obama's reform package isn't perfect — a "public option" would have been nice. But a provision preventing insurers from denying coverage to anyone because of a preexisting condition is a very big deal.

That provision is viable only if we all accept that we're in this together, and that the cost to taxpayers of treating anyone who seeks emergency care, with or without insurance, is far greater than the cost of requiring coverage for everyone.

Look at Mindlin. She had a great job with a big company. Then she lost it. She was perfectly healthy until a few months ago. Then she got cancer.

Why is healthcare reform so important? Because Mindlin could be any of us.

David Lazarus' column runs Tuesdays and Fridays. He also can be seen daily on KTLA-TV Channel 5. Send your tips or feedback to david.lazarus@latimes.com.

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