Far more compelling than Senator Clinton's article is Singled Out by Jody Miller, a venture capitalist and Matt Miller, a columnist and book writer. Easily classified as upper middle class, and self-classified as healthy, these two entrepreneurial, self-employed folks attempted to get coverage for their daughter and themselves. They ran smack into the basic structure of health insurance and the inherent nature that works against individuals and very small groups:
1. Buying health insurance is voluntary.The combination of these factors leads to "adverse selection" and, in extreme cases, the insurance "death spiral." The Millers recognize that many of the direct solutions, such as community rating, create their own problems. Their solution?
2. Twenty percent of the population incurs 80 percent of health costs.
3. In order to set premiums that reflect actual costs, insureres need between 20,000 and 75,000 people in a pool to generate the necessary predictive models.
4. People who have reason to believe they will have higher health costs have stronger incentives to buy coverage.
The first is to make sure that everybody has access to some form of group coverage; insurance simply doesn't work for the isolated individual ...
Second, everybody has to buy health coverage. If states can require car owners to buy auto insurance, why can't they require all of us to purchase health insurance?
Their analysis of where this leads us politically is one-half of the socio-economic force that will finally make a difference:
As we learned once we started sharing our story, there are a lot more upscale uninsurables out that than you think. The trend toward freelance work among the well-to-do means a powerful new constituency for health reform is taking shape.It is one thing for politicians to address the uninsured out of a liberal-minded generosity to poor workers. That makes for nice speeches. But this is different. If even healthy members of the professional\ class are just an entrepreneurial itch away from discovering they are uninsurable, maybe they will decide it is time to really fix things. And when that happens, perhaps they will fix it for everyone.
Only on that last point, I would take it one step further. We simply can't fix this mess for one group only. Either we will fix it for everyone or we will fix it for no one.