As the Kabuki dance goes on, insurers are licking their wounds but still have visions of sugar plums. One top insurance executive recently told me that he's not worried; insurance companies will make money from health reform whatever happens. After all, they already make good money, even on cash-strapped Medicaid, he told me. Maybe that's why insurers seem to wink at the barrage of criticism politicians are serving up as red meat to the voters. They tacitly support health reform and are eager to count the swelling ranks of indentured beneficiaries who will be subject to their escalating premiums, bureaucratic hassles, and denials of care.
With these conflicting messages and the uncertainty about what health reform will really do, we'd better cool off about ramming these bills through, as Obama insists he will do. Cooling off, however, does not mean squandering the focus on reform we have now, thanks to the president.
What we need is a new direction and real, not phony, harmony. Let patients and future patients have a say, even if they ruffle feathers at town meetings. And let doctors' diverse views be heard, not just those of the American Medical Association, which represents fewer than 20 percent of physicians. Use federal muscle to deliver reform that better regulates and referees the insurance companies so that they are more transparent about the prices they really pay for services and the premiums they charge or the way they deny treatments or claims. Above all, correct the fact that most people have little or no choice of insurer. Insurance companies should face vigorous competition from one another through an open, national insurance exchange where everyone can buy his or her policies in any state from any insurer. That should drive costs down and the quality of service up.
In short, insurers must make their money by offering the best health plans at the best price to people young and old. That's serving their customers—whom I'd prefer to call patients.