If indeed this country can not deliver a good health system without involvement of insurance let’s broaden the options to include not only private insurance companies and the so called public option but a private option as well. This private option would be self insurance or funded Health Savings Accounts (HSA) that could buy high deductible Catastrophe Insurance with tax treatment compared to the so called Cadillac plans. This feature should soften the objection of the libertarians who opposed mandated purchase. Low income people who elect to have the private option could be granted health stamps to fund their HSA’s.
Then, continue the states authority to monitor all health insurance sold or issued in their respective jurisdictions. Continue the states obligation to see that all insurance companies issue policies that have a fair and adequate premium (this will include any public option) as well as have the financial strengths to pay all current and future claims arising out of current claims and newly discovered catastrophic conditions. This would also apply to any federal plans or their sponsored co-ops or other schemes.
Individual risk that our deemed to be so adverse that no premium is adequate could be pooled and assigned to carriers. The assignment similar to auto assigned risk would be based upon each insurer’s prior three year average premium written in the particular state and further factored based upon the quintiles of profitability. These quintiles would be assigned a number of zero through four with zero the least profitable to four the most profitable. To determine profitability 100% minus the loss ratio (claims incurred divided by premiums earned) minus .12 (12% of premium standard for all) would equal percent of earnings. Note, income taxes would not enter into the profitability equations as all health Insurance carriers should be exempt from income tax just as the public option schemes would be. The 12% allowance for administrative cost should be adequate to cover reasonable expenses and motivate efficiencies and innovation. The loss ratios which state insurance examiners will verify every three years will hold steady at 85%+/- if the growth in utilization and hypochondrias holds at current rate which is highly unlikely.
In the event that this country’s health care cost as a percent of the Gross National Product does not decrease by two percent by the tenth year of this law then all health insurance programs except HSA’s should be terminated and a direct repayment of Medicare tax to all wage earners who have paid into the Medicare trust fund.