In the
spirit of the flexible nature of this blog I'm going to use it to speak to
something in the political/economic realm in the spirit of explaining something
to my friends and readers, the sticker shock everybody, well almost everybody,
is getting now that the Obamacare insurance exchanges are open. Those prices are so high for reasons just
about anybody who ever worked in insurance can explain easily enough. The last jobs I held before I became disabled
were as an agent in two different insurance companies.
In order to
get that license to sell insurance every agent has to take a licensure exam and
one question will always appear on the entry level exams, what is
insurance? The answer is that insurance
is spreading the financial risk of injury, loss or damage of property or cost
for medical health problems. Now
insurance companies are in the business of spreading that risk for people at a
profit for their owners. The reason behind
the increase we all now have in premiums lies in how insurance companies
traditionally did that in a manner to maximize their profits.
For decades
now the insurance companies had a field day in that respect. Since the 1940s congress forbade itself from
meddling in the insurance market by law.
So the states regulated the insurance industry with the insurance commissioner,
who was generally responsible for regulating the industry being an industry
insider who allowed practices which maximized profits and seldom interfered
with what the companies did.
To start off
with, it is a principle that the more people insured the lower the overall
risk. However, that also means lower
insurance rates. Since profit is
generally a percentage of the premiums, rates need to go up while risk is
driven down. To strike a happy medium
between risks and premiums a number of practices have been allowed. The first is that when a person buys
insurance they are entered into a “pool” of buyers of the same policy. The pool is limited in size to maximize the
premium allowed and the profit derived from the combined premiums in the pool.
However,
without further reduction in risk the premiums would be too high to sustain in
a competitive environment. So Insurance
companies developed certain ways to further reduce the risk they had to cover. Prime among those methods was to refuse to
cover people with re-existing conditions.
By only insuring the healthiest groups of people costs through the
payment of benefits were reduced and insurance companies were able to offer
lower premiums while still gaining some of the highest profit margins in the
business community. They further reduced
costs by refusing to pay out for certain products or procedures and developed
the practice of denying legitimate claims over the years. They also developed ways to eventually force
people who developed chronic health problems off their rolls by moving healthy
people into new insurance “pools” as time went by, thus making the premiums
rise over time to the point that those left in the original pool could no
longer afford their coverage and were forced to leave the pool with nothing.
That is how
the insurance industry worked for decades.
Never forget, insurance companies are NOT charitable institutions, they
are in the business of making profits for their shareholders. So they conduct their business in a way to do
just that. One big exception in how the
industry was run is in the Progressive State of New York, where for decades the
insurance industry ran under a mandated profit margin lower than the rest of
the country along with mandated coverage for certain things. The folks in New York already paid higher
premiums than the rest of the country and will actually see their premiums
reduced under Obamacare, that’s why the President is pointing to New York as an
example of how people will be doing better and paying less, of course they will!
So, now, along
comes Obamacare. It reduces the allowed
percentage of profit by mandate. It also
mandates that those with existing health problems be covered. It also mandates that certain things, such as
birth control and abortion must be provided for free, though nothing is ever
really free, the cost of providing it is still recovered through the premiums
collected. A bone is thrown to the
industry through mandated commissions which will determine what other procedures,
etc. will be paid for by the insurance companies with a mandate to reduce
costs. Those are Sarah Palin’s “death panels.”
Although
this will be done through a progressive calculus concerning an individual's
value to society, the costs under Obamacare will still be high and the
insurance companies will still pass them on to customers through their
premiums. And it appears that the
companies are still permitted to further maximize their profits, which are
still a percentage of the premiums, through the use of smaller “pools” of
policy holders based on carving up states into geographical regions or
localities instead of using the entire state's population as a pool. At least that is what it looked like when my
wife and I went online to find out how much insurance would cost her if she
purchased it through the exchange for our state.
For years those
who had insurance benefited from the aforementioned practices and enjoyed
relatively low insurance premiums, mostly through work. Those practices deliberately excluded
millions who needed help meeting their medical needs, and that was something
which needed fixing. Medicaid helped
many of those people, but more was needed.
Obamacare purports to fix that problem and in doing so ends the free ride
folks had over the years. That, in part,
is why the sticker shock.