INSURANCE: `EVERYBODY'S GOTTA BE IN THE POOL'
It doesn't take a rocket scientist, or even an actuary, to see that two major things are necessary for a private-sector solution to the current mess, and both involve public action ("Health care reform: It's insurer vs. insurer," Government, May 4). First, we must move to an all-payer system, where providers may establish their fee schedules, but once set, they must charge the same amount per service to all payers, public and private. Society must say that price discrimination is not acceptable. This will allow insurers large and small, HMOs, PPOs, and TPAs to compete on the basis of utilization review, quality of care monitoring, and old-fashioned service.
Second, if the insurance "concept" is to continue to work through private carriers, but with open enrollment, less underwriting and restrictions on pre-existing conditions, etc., everyone must be required to have coverage. The system will not work if people are allowed to remain outside until they are sick, and then expect "insurance" to pay their bills. For "pooling" to work, everybody's gotta be in the pool.