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High-risk pools

Republicans like to bring up so-called "high-risk pools" as an alternative to health-care reform. They're in the plan Boehner released this morning, they were featured in McCain's campaign proposal, and they're generally popular among people who want to say they're doing something to help the sick but don't want to actually do very much.

A high-risk pool is where a state creates a special insurance pool for people with preexisting conditions and then subsidizes their coverage. About 200,000 Americans are currently in these pools, the costs are high, the coverage varies wildly in quality and the service is often quite poor, as a couple thousand low-income sick people aren't much of a political constituency. To put it simply, if you eventually developed a preexisting condition -- asthma, say -- would you rather a world in which insurers couldn't discriminate against you or a world in which you could send in a form to the state of Missouri and ask if they had any room in their Big Pool o' Sick people?

Thought so. For more on high-risk pools, see Harold Pollack's interview with HRP expert Katherine Swartz.

By Ezra Klein  |  November 3, 2009; 4:26 PM ET
Categories:  Health Reform  
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I think I'd prefer a world where I pay less for insurance because I signed up before I got sick. I just can't wrap my head around the idea that someone who just got diagnosed with cancer should pay the same amount of health insurance as I would when I am totally healthy. If you want to just go single payer and say that everyone gets covered no matter what then I can get on board with that. But I really think that democrats are missing that insurance only works if people have reason to sign up before they get sick. When the individual mandate is trivial then no one cares about signing up before they get that preexisting condition

Posted by: spotatl | November 3, 2009 4:37 PM | Report abuse

Is having a preexisting condition the same as waiting until one is sick to try to get insurance? I don't think so. What if you lose your job and insurance that covered your type I diabetes and now you have to get insurance? Are you gaming the system?

Posted by: srw3 | November 3, 2009 5:20 PM | Report abuse

If I am buying health insurance from a company knowing I am likely to have under 1k in healthcare costs this year (since I have had under 1k in healthcare costs the last several years) then I don't think that I should pay the same amount of insurance as someone who has type 1 diabetes and knows they will need at least 40k of healthcare this year. (number pulled out of thin air)

If you want to go straight single payer and take insurance out of the equation then I'll listen. But otherwise when someone goes in knowing that they are going to need more healthcare I think that they should pay more.

Posted by: spotatl | November 3, 2009 5:37 PM | Report abuse

High risk programs are not going to help us meet what should be the object of any rational health policy: to ensure that everyone has access to medical treatment when it is needed in a manner that does not bankrupt himself, his company, or his country.

It is nonsensical to propose that someone who is deemed too sick to be covered by conventional insurance should "go bare" for six months before being picked up by the high risk pool. The purpose of health *care* is to see that people get treatment, not to protect the insurance industry.

I think the reinsurance idea has more potential. Even better, we could use a risk equalization scheme similar to the Netherlands.

"Insurers get compensation for their high risk patients according to a risk-adjustment scheme. This is paid out of a fund. Employers pay an income-related contribution to this fund. In this way it can be profitable for an insurer to focus and even specialize on people who have a certain physical condition instead of targeting only the young and healthy. This risk-adjustment scheme is essential to create a level playing field for competing health insurers."

Posted by: Athena_news | November 3, 2009 7:31 PM | Report abuse

Yes, AND the Republicans never want to raise taxes, only slash them for the rich, so how much money do you think there would be for a subsidy under the Republicans?

Yes, your family can get insurance in the high risk pool, crappy insurance for $30,000/year.

Posted by: RichardHSerlin | November 3, 2009 8:58 PM | Report abuse

--"[I]f you eventually developed a preexisting condition -- asthma, say -- would you rather a world in which insurers couldn't discriminate against you or a world in which you could send in a form to the state of Missouri and ask if they had any room in their Big Pool o' Sick people?"--

Imagining "worlds" is something children do. This world is what it is, and there won't be any changing it. If Klein means "system" or "set of rules" or "laws", he should say so, but then, of course, his propaganda, buttressed as it is with various euphemisms and vagaries, would be all the more obvious and therefore less ineffectual.

I'm tempted, though, to fantasize a world where people who ask stupid questions are laughed into shame, instead of having their premises accepted as worthy of discussion (and then having them nattered over as though serious.) For instance, how does one go about "develop[ing] a preexisting condition"? One begins to suspect that Klein's thinking is as sloppy as his writing.

Further, both of Klein's "worlds" are based on government coercion, and therefore, the only answer a freedom-loving person can give is, "Neither". End of discussion.

Posted by: msoja | November 4, 2009 6:39 PM | Report abuse

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