OPINION — Editorial

When essential isn't

You need this and this and this …

"People who think they know everything are a great annoyance to those of us who do."

--Isaac Asimov

Health care, the insurance for it, how to get government in it (or out of it), who to blame when things go wrong . . . . It can be hard to get your head around all the news coming out of Washington, Little Rock and your doctor's office these days. Even those of us who pay close attention to all things political find ourselves wondering if the next paragraph is going to clear everything up, or only confuse us on a higher level.

It may help Gentle Reader (and disoriented editor) to take everything labeled Health Care one sip at a time. The pols may want you to drink from the fire hose, the better to slip things by you, but that way lies frustration. Your brain will either be petrified or turned to jelly if you try to keep up with everything, all at once. Better to simplify, simplify, as the man said.

Today, let's just think on these things called Essential Health Benefits.

For starters, let's stipulate that they aren't essential.

After the "repeal" implosion last week in Washington, your friendly statewide newspaper ran a story saying the Essential Health Benefits were staying in Arkansas, at least for now. And what are Essential Health Benefits? Those are the minimum benefits that each state tells insurers to put on individual and small-group plans. For example, in Arkansas, your plan has to cover 23--twenty three!--different services.

For example, pregnancy and newborn care. Even if you're a 55-year-old man.

For another example, nutritional counseling for diabetes. Even if you're a 25-year-old woman who runs marathons, teaches health at the local high school, and leads a CrossFit class on weekends.

Why require folks to pay for services they know they'll never need? The simple answer may be: Government always thinks it knows best. Imagine the audacity of the bureaucrat who adds these things to the health-care law and calls them Essential. It reminds us of the Steve Martin character in The Jerk who walks his hallway saying he doesn't need anything in this world, except this. And this. And this. And this.

Does anyone disagree that with every additional government mandate, insurance companies have to raise premiums to keep up?

The folks running the show in the early Obama administration, who wrote the book, or at least the regs, on Obamacare, could be forgiven thinking they could cure everything with another sub-paragraph in the (un)Affordable Care Act. They were social engineers. They were from the government, and they were here to help. And they were going to help you, too, whether you liked it or not. So buy health insurance, you clod, or we're going to fine you until you do.

But even Obamacare only had 10 "essential" demands. Why do we have 23 in Arkansas?

To quote David Sanders, a state senator who is also chairman of the Arkansas Health Insurance Marketplace Legislative Oversight Committee: "Arkansas has some big decisions to make moving forward about insurance. I don't think many people know they pay for in-vitro fertilization." Or minimum hospital stays for childbirth. Or autism treatment. Or children's preventative health care. Or any of the other "essential" benefits that should be optional--if the government would only let We the People decide what kind of insurance we'd like to have, and pay for.

As if we knew what was best for ourselves and our families. Or would that shock the delicate sensibilities of our betters?

If the federal or state government thinks insurance companies need to be forced to offer certain procedures or benefits, then why not require insurance companies offer all of them, but only in one all-inclusive plan as one option for consumers? Then insurance companies could offer other options, like maybe just 16 procedures, or 11, or seven? Then the consumer could pick the one that best fit his needs. Or is that unspeakably reasonable?

It may take 101 steps to untangle the health-care and insurance mess that Americans find ourselves in today. Some of these steps are going to be more like leaps. How keep insurance premiums affordable without forcing young people to sign up for something they might not want just now? How balance the health-care needs of the country with the freedom we should all have as Americans? Even the freedom to make mistakes, such as forgoing health insurance for more ephemeral concerns?

Those are big questions. Big steps.

But before we can take on the big things, let's clear out the little ones. The boardroom folks call it low-hanging fruit. In health care, why not sell insurance policies across state lines? And allow competition to work its magic. Why not block-grant Medicaid to the states, which would not only create more competition, but maybe even innovation?

Another easy step may be to get rid of the requirement that every insurance plan provide the same mandated "essential" benefits for everyone, especially since the same size doesn't fit all. And let the market decide. Instead of an all-knowing government.

Editorial on 03/29/2017

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