Propping Up the Christmas Tree

We are in a series outlining the big ideas that would serve as the foundation for Tim’s proposed healthcare reform plan.  Click here to find the prior posts.

Justine, my wife, loves Christmas trees. So much so that we have ‘several’  of them.  The one that goes in our study is my favorite and has the most character for it holds all of the random ornaments that have been collected over the years.  Most were made by the kids, a few are souvenirs from some family trip. 

Since new trinkets are added every year, but none ever come off, getting this tree to stand on its own becomes more involved every year.  At first a little piece of folded paper shimmed under the front leg, then fishing line tied it to the bookcase.  Ropes and cranes are not far away.

Scrooge here once recommended that we purge the tree of some items before it broke under its own weight.  Well, you’d think was calling Santa Claus out over his obesity given the wrath I received.  Everyone loves every single ornament  (the melted plastic blob of whatever?) – to suggest pulling even one somehow denigrated the Baby Jesus.

And thus, you see our current problem – combining the requirement that everyone purchase health insurance with the burgeoning minimum coverage requirements that makes every insurance plan look like the Coan Kid Tree.  The thing is going to break and then all of the baubles will smash to the ground.

The metaphor is apt because every person with a cause managed to hang their coverage requirement on the Affordable Care Act tree.  Consequently, we have plans that are so expensive that people can’t afford them.  Thus, the idea that getting everyone to buy in so the insurance math would work has backfired.

So as we require everyone to do their part and have insurance (Yes Dude, you have to pay your monthly premium before you buy tickets to that dope music festival out in Portland) we also have to strip many of the ornaments off the required coverage so that people can afford it. 

Remember, we still have Medicare and Medicaid, plus King Timmy is going to reestablish subsidized, state-based high risk pools to help people who have chronic diseases.  Many people left in the group and individual markets will be relatively healthy, so I’d rather them have skinner coverage options if that means we can get the premiums down and cover everyone.

Sure, this is easier to write in a blog post than to actually figure out.  Remember, I am the evil cretin who had to look back at four sets of glaring eyes and answer the question, ‘Which of YOUR CHLDREN’S ornaments, made in pure love, do YOU want to throw in the TRASH?’ 

Every one of these requirements has a purpose for some particular constituency.  This will be hard work, but I’d leave it to the states, just as we do with auto insurance, to define their minimum coverage requirements.  If we are going to make the Guv’s more accountable to figure out the math and face their voters, then I’d give them control over this, too. 


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Tim Coan, ALN’s CEO, writes an insightful and witty blog three times a week about a variety of topics relevant to independent physician practices.

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