A Day In The Journey

5) Protecting consumers from unscrupulous behavior
The final area for which I will use argue to argue that FG involvement can be and is beneficial even though not directly designated for it is consumer protection from unscrupulous behavior. While the previous point does overlap, I am going to center largely on fraud in this argument. In the first hundred years of the nation, travel was largely limited. It took time to get from place to place, and fast getaways were largely not feasible. With the development of rail travel, this situation began to change. Up until this time, local law enforcement was looked to for providing consumer fraud protection. By the turn of the century, it was becoming more and more obvious that this was an untenable situation. As a result, the Federal Bureau of Investigation (FBI) was established. While we tend to think of the FBI as solving things like cross-state-line kidnappings and serial killer mysteries, the FBI also investigates cyber fraud, government and election fraud, and corporate fraud. As the nation and its business has become more and more connected, a federal organization that has investigative powers has become more and more necessary. Without a strong, consistent, federal involvement, many hustlers would be able to escape prosecution.

Now, having gone through these 5 areas that are not specific, designated roles of the FG and argued that FG involvement is supremely beneficial to American citizens, let me apply the whole kit and caboodle to HCR. It's just what you've been waiting for, I know.

1. Simplicity of Trade
Currently, health coverage is a strange, capitalist wonderland. Don't get me wrong, capitalism isn't a bad thing. When the market for something that should be as ubiquitous as health care becomes a strange, capitalist wonderland, there might need to be some fundamental changes. I use "wonderland" in the hopes of bringing to mind images of Lewis Carroll and his narrative of Alice's unruly adventures. In the realm of health coverage, every state sets its own regulations for who can sell and what can be sold. I am not advocating that get rid of this formula willy-nilly. Neither is the President (WH). Neither do either of the other majority bills (House (HR) bill [also here] and Senate (S) [also here]. The Congressional minority (GOP) have proposed allowing insurers to sell across state lines. I'll get to the pros and cons of that momentarily. This roller coaster of regulations becomes problematic in that there is no standard, foundational set of minimum regulations. Thus both the insured and the insurers have to revamp and retool in each state. Furthermore, each insurer has different combinations of benefits, types of coverage for different premiums, and uses equivocating terminology. This is not the idea situation for a comparison shopper, to say the least. And comparison shopping for health coverage is certainly more vital, with the outcome more essential, than any other shopping we might do. By allowing FG oversight, we are allowing for the creation of a set of minimum coverage standards (that leaves everything else up to the states, notably) and providing an exchange that clarifies comparison shopping for the health coverage consumer.

*As to allowing insurance sales across state lines: as I have thought about this, it seems that the only way this will not turn into a mirror of the credit card "find the state of least regulation and pelt everyone from there" situation is to still have a federally established set of minimum standards and regulations. Thus, you still end up with...federal regulations. Otherwise, allowing interstate health coverage sales is simply an almost total deregulation of the insurance industry that ends up stripping states of their power to set regulations within their borders. This might even have the result of forcing states to refuse to allow health care outlets to accept plans they deem unfit, leading to more state regulations and monies invested in enforcing them. Not really a win for states or consumers.

2. Bolstering private investment
I have previously mentioned that pharmaceutical R&D if often supplemented by FG monies. In the scenario of HCR, this would certainly continue. Another aspect of this bolstering of private investment comes with the mandate attached to the bill. In order to facilitate the removal of denials/exceptions based on pre-existing conditions as well as the ability to drop enrollees, the WH bill, the HR bill, and the S bill call for mandate coverage purchase (with a fine in the form of a tax should one choose not to purchase coverage). This much maligned mandate is actually a bolster to enable insurance companies to function as they're meant to (and, unfortunately don't always). All insurance depends on a risk pool: the bigger the risk pool, the more easily companies will recoup their payouts. Furthermore, the group of Americans who have the highest rate of uninsured (18-34 year olds are by and large going to be far less likely to file claims than the demographics currently most insured. By adding the vast majority of this young demographic into the risk pool, companies will have more liquidity, suffer less risk, and be better able to cover the expenses of the ill (a consideration to be taken seriously as the Baby Boomers have entered the demographic that uses their health coverage the most. Having a larger risk pool is better for coverage providers and more advantageous for those who need coverage payouts.

3. Facilitating consistency of coverage/quality
As in other areas, having minimum set of standards at the federal level is greatly beneficial to society. Requiring all insurance providers to conform to a single set of minimum standards means that no matter which company is providing coverage, the consumer is assured a certain set of coverage and quality standards across the board. This lessens the ability of unscrupulous insurers to game the system by offering sub-standard coverage at ultra-low to those who only discover the coverage and quality gaps when they need coverage the most. Having nationwide minimums means that health care providers are always assured of payment for a given set of circumstances. This reduces the risk for enrollees that claims for treatment they have received will be refused and ensures doctors that basic care costs will always be covered regardless of the insurer with whom they are dealing. A nationwide minimum set of coverage standards sets a consistent foundation of coverage and quality for every insurance purchaser.

4. Protecting consumers from faulty products
The previous point briefly touched on how minimum standards prevent unscrupulous insurers from bilking consumers when their health care is in the balance. When insurance fraud prosecution is limited to each state, fraudulent insurers have the opportunity to move on to another state and perpetrate the same fraud there. Federal oversight makes fraud prosecution simpler and more expansive even when states continue to hold regulating powers. The presence of federal minimum standards places federal resources at the disposability of state needs. The greatest tool offered by the HCR bills is that of the coverage plan exchange. In order to participate in the exchange, insurers must meet minimum standards of coverage as well as provide clearly comparable information on benefits and providers. (For a PDF outline of the plan, including the Exchange, see the address at the bottom of the post. This provides the consumer with clear comparisons and the confidence of all plans being vetted for proper coverage. In other words, faulty insurance products will be significantly avoided through both the inclusion of federal oversight and the creating of insurance exchanges (whether one nationwide exchange or federally-overseen state exchanges).

5. Protecting consumers from unscrupulous behavior
As in the above area, both federal oversight and transparent insurance exchanges will be able to cut down on unscrupulous behavior both by insurers and providers. Of course, these HCR bills don't go as far as they could in eliminating unnecessary charges and fraudulent claims, the simple act of creating more accountability moves farther down that path. Helping the system to move toward less unnecessary testing and away from such a great amount of per-procedure payments will add to progressively eliminating unscrupulous behavior on the part of a percentage of providers (note: I realize that many doctors who do a plethora of procedures don't do so because they are unscrupulous, but the end result is unintentional system-gaming. It is good to move away from a system that encourages this. For an interesting article on how too many procedures is worse for us all not better, read this. It's a little long, but worth it.) Federal involvement also helps states to pursue unscrupulous insurers and the small minority of intentionally unscrupulous health care providers with greater ease (similarly to how it has done so in other areas of fraud, etc.).

All right. I seem to have gotten rather lengthy on this point as well. I hope you can see that merely because something is not a specifically designated area for government involvement (S or FG) does not mean that involvement is not positive and beneficial, even necessary. Further, I feel the need to point out that an application of governmental involvement not being specifically mentioned in the Constitution is no reason to label it "un-Constitutional." A thing is un-Consitutional because it contradicts or breaks the Articles or Amendments of the Constitution, not because it suggest a new application of government roles, in this case, regulating commerce as necessary to improve the system of health coverage in the areas I've outlined above. Each area has historically been deemed a proper one for FG involvement, and each area is a part of the commerce of health care.

Whew. That's certainly quite enough for one post. In our next episode: Are we creating a too narrowly run system with HCR, even....*gasp*...resorting to socialism??? Hm. Perhaps my tone there is a spoiler for my position. haha. Until next time.

PS
Excellent article in the NYT about why something must be done.
Even with a requisite skepticism of the Times, it's quite thought-provoking.
Brief comparo of the three proffered bills
The PDF of the President's plan can be found here: www.barackobama.com/pdf/issues/HealthCareFullPlan.pdf (I couldn't link it the way I wanted, likely because it's the automatic download address. Apologies.