I admire the spirit in which Sen. Charles Schumer (D-NY) is attempting to build health reform consensus by proposing changes that will be palatable to the America's Health Insurance Plans and its allies. After all, realistically, you can try to ram any reform you like down the throat of an industry constituency, but it's mighty hard to make it work if important players are dragging their feet.
That being said, I'd argue that Schumer's current proposal is simply unrealistic. Bending over backward to please the AHIPs of the world, Schumer is proposing regs that would restrict public health plans--including, presumably, any plans created under a health reform effort--to follow the same rules that private health plans must. This includes requiring public plans to pay claims from premiums and co-pays, rather than a government funding source. And that's the sticking point for me.
Let me re-emphasize, first, that IANAA (I Am Not An Actuary), but it seems to me that if you want different results from a health plan, you pretty much have to fund it differently. Premiums imply underwriting, which implies--let's give it a realistic name--exclusion.
Even if the government health plan doesn't do medical underwriting, forcing it to structure its financial operations like a commercial plan, it seems to me that you simply can't structure it to meet public health objectives. How many decades have we been pushing and pulling and hoping and begging for private health plans to do this? Sure, they've made some progress, but that's simply not where the money is. They're in a short-term game, and public health is an extremely long-term play.
I realize, mind you, that Schumer's gambit is probably just an opening move in a chess game that's far beyond the ken of a non-Hill-type like myself. But in the mean time, let's be realistic. This proposal goes way beyond accommodation to completely giving away the store. - Anne