In 2006 Republican Governor Mitt Romney, together with the overwhelmingly Democratic, and hence veto-proof, state legislature passed the Massachusetts Health Reform Law. It was to be Mitt’s ticket to the presidency. But Mitt’s adversaries tagged him as a bedside Bolshevik and brought him low in the primaries. The hapless Mitt’s effort, however, serves to instruct, since it provides more evidence, if more were needed, that the two War Parties are also near identical twins on domestic affairs. The Reform is now administered with great enthusiasm by Democratic Governor, Deval Patrick, bosom buddy of Barack Obama. And it has been acclaimed in Democratic circles as the precursor of ObamaCare.
The plan was largely devised by the health insurers and then hailed by them since it codified into law their stranglehold on the immensely profitable medical industry and beat back the beast of single-payer. Same thing at the national level with ObamaCare. Now when the banner of single-payer, long very popular in Massachusetts, is raised here, all too often the response is that Reform is already ours. No further change is needed say the opponents of single-payer.
The Massachusetts Reform is at its heart a cruel system since it mandates every taxpayer to have “creditable” health care coverage, and failure incurs a financial penalty at tax time – just when one can afford it least. One may find it impossible to afford “creditable” coverage, as determined by the State, aka the health insurers, and hence end up with no coverage – and a fine to boot. All the while the insurers work most assiduously to game the system in order to minimize the “loss ratio” as they call it. (The “loss ratio” is the percentage of the premiums which is actually expended on care, an expenditure which these insurance ghouls feel is a “loss.”)
But now a growing number in Massachusetts are fighting back by gaming the system themselves, something that was in fact predicted. The people are saying, to the insurance ghouls, “You pretend to cover us; and we pretend to pay the premiums.” So how is the fight being joined? The insurers, ever watchful from the perch of their profit toting computers, were the first to notice that the number of people “jumping” from one insurance plan to another has shot up since the Reform came into being . They quickly informed the Massachusetts Division of Insurance, Health Access Bureau, which with uncharacteristic speed commissioned a study, as Divisions and Bureaus are wont to do. (From this you can begin to detect the amount of bureaucracy that MittCare/ObamaCare requires, not just by the insurance ghouls but also by the state.) You can read the exciting prose of the study commissioned by the Bureau within the Divison here. The Reform forbids discrimination on the basis of pre-existing conditions. This, as it turns out, is a gaping loophole, which the insurance ghouls and their very pricey consultants neglected to close. And through this gap are leaping- the people, an estimated 13,669 of these anti-insurer guerilla fighters as of 2008, the last year for which numbers are available!
How is it done? Simple. The guerillas opt for minimal coverage until they develop an expensive illness – and then they switch or “jump” to a more comprehensive and more expensive plan. Once treated, they jump back to the cheaper plan. Very clever; the pricey insurance company consultants are not the best and brightest after all.
This is not trivial for the insurers as it turns out. At least the spokeswoman for Blue Cross laments that it is costing the insurance ghouls $300 million annually. The dreaded loss ratio may have risen by as much as 1.24% according to the study commissioned by the Bureau within the Division. So now the Massachusetts Democratic legislature and Governor are busy trying to prevent jumps –by confining enrollment to one month per year, potentially leaving many for a year with no insurance. For the pols the people’s gaming initiative must be crushed; it is not fair –to the insurers. The watchful state will make sure that only the insurers can game the system.
An ethical question arises here. If the insurance ghouls can game the system, why cannot the people? One might say that such gaming is unfair to those insured who don’t game the system but fork over the exorbitant premiums which will rise even higher. That is the way the media portrays it(1). But that does not happen right away. First, the insurers’ profits take a hit, and the dreaded “loss ratio” starts to creep up. Next the insurers’ state apparatus moves to stifle the gaming creativity of the people. And of course the insurers then pass the increase along to the insured. After that a new round begins. And the two sides try to outgame one another. But without single payer or a national health service, we shall have a very complex system masquerading as “universal coverage.” In such a complex system there will inevitably be many opportunities for gaming – on both sides. A contest of is inevitable– between the people and the insurance ghouls. And in a few years the same struggle will be joined at a national level with even more complexity as ObamaCare, ever so slowly, becomes the Law of the Land in 2014.
Who will win in this contest? Let the games begin. I bet on the anti-insurer guerillas who will game the system to pieces, which along with the ever increasing costs of a for-profit system, will force upon our elite a single payer or national health care system. And if you give me 10 years, I will give you hefty odds on the bet.
JOHN V. WALSH can be reached at John.Endwar@gmail.com