No one likes insurance companies very much.
That’s clear from the feedback I got on Thursday's column about how federal reform efforts may affect the health-care sector in Philadelphia.
One e-mailer noted that the Obama measure would require everyone to buy insurance and offer subsidies for those without employer-based coverage to do just that through a health insurance exchange. So insurers will do just fine as they gain more customers, albeit at lower profit margins.
Perhaps, but I think that underestimates the impact of some of the business-practice restrictions that the Obama administration is seeking. Prohibiting insurers from denying coverage on the grounds of pre-existing medical conditions is a long-overdue change, but it does come with a cost.
Will 30 million more customers and generous subsidies be enough to offset that cost? If the federal subsidies are too generous, won’t there be pressure to lower them just as occurred after the adoption of Medicare prescription-drug coverage?
Some readers who identified themselves as either currently working in the medical profession or having once done so pulled no punches when it came to criticizing insurance industry practices. Two who still work with patients worried about the impact that reform will have on their income. One occupational therapist recalled a Clinton-era change in Medicare reimbursement that caused his employer to cut salaries by 25 percent.
Another e-mailer lamented that the pharmaceutical industry seems to be escaping serious reform as none of the bills would permit Medicare to negotiate for lower prices, or adopt price controls as in other countries.
Finally, politics was never far from many of the comments, and I’ll confess that it’s the political aspects that interest me the least.
We have a health-care system that is frustratingly complex. It works pretty well for most people, and not well at all for many of the 45 million uninsured. Moreover, the cost is straining corporate, household and the nation’s budgets.
Change is needed, but I could hear the anxiety in several voices as people wondered if a reform bill will pass, what’s really in it, and how it will affect them.