Health Transformation Alliance should do America a favor and also represent all those not insured.

Sir, Rana Foroohar writes: “America has a healthcare market that … has almost no price transparency… is controlled by vested interests (doctors, pharmaceutical and insurance companies) who exert monopoly power against the businesses and consumers they are supposed to service, and is highly fragmented and inefficient.” That results in “that healthcare in the US is the most expensive in the world by about 5 percentage points of gross domestic product” “Employers can help fix American health” March 20.

Foroohar quotes James C Capretta with: “The system would work a lot better if all of us could put pressure on doctors and insurance companies to provide more transparency.”

Absolutely. But I have argued that legislators could also provide much help by simply decreeing that, even though health sector suppliers are to be totally free to fix the prices for their services and products, they should not be allowed to use prices that discriminate excessively.

About a decade go I remember thinking: “If when needing medical services I could be sure being charged the same as my insurance company is, I could almost do without an insurance. What I really cannot do is to expose myself to being billed as an unprotected uninsured Per Kurowski.”

So it could be of great help the Health Transformation Alliance to which Foroohar refers, would, to their 4m employees, manage to add the representation of all the uninsured. That could signify much more for the American health sector than any of all other health and insurance plans being discussed in Congress.

Sir, in the health sector insurance companies is like the insured’s lawyers. But just like those who cannot afford lawyers are given legal assistance, the uninsured also need someone to defend them. 

PS. Here is what I wrote on this to FT back in 2009, when Obama-care was being discussed.

PS. And here what I wrote in 2007

PS. Sir, think of it, if Health Transformation Alliance negotiate only on behalf of its 4 million employees then those that are outside of it all, will find prices even higher.

@PerKurowski

Current “pre-existing conditions” would mean nothing when complete genomic sequences enter the health insurance world

Sir, Gillian Tett writes “most consumers have not fully considered the consequences of genetic profiling: is it a good idea, say, to discover through a genetic profile a vulnerability to Alzheimer’s? What will that mean for life insurance policies and data privacy?”, “The importance of socks in the genomic revolution” March 17.

Indeed, imagine if a full genomic sequence is obtainable at a really low price, what stops then insurance companies from offering two plans, one for those who want to present their full DNA result, and one for those who prefer to keep these confidential? What would the differences in premiums be?

In 2000, in the now extinct Daily Journal of Caracas, I wrote an Op-Ed titled “Human genetics made inhuman”. In it I tackled some of the problems to which Ms. Tett refers.

I ended that article with: “suggesting that all insurance companies design a plan which obligates them to issue policies for all of those who undertake a genetic examination. This policy should cover the negative impact and consequence that could arise from anyone getting access to such information.”

Would that suffice? Clearly not, but just the existence of such an insurance, and seeing the premiums charged, could be a smart way for us to allow the market indicate us what kind of social troubles we are getting into. This because clearly what we currently refer to the problems in health insurance with “pre-existing conditions”, would all be baby talk when compared to the societal impacts of genomic sequencing.

I worried about this in 2000, as others must have been worrying earlier, and here Gillian Tett brings it up in 2017. What has happened in this respect during that interval? Has someone somewhere been thinking on how to tackle this formidable societal challenge? Probably not! If so, why? Or is this just another question of those that should not be asked?

PS. In 2015, in a letter to FT, I asked: “What would Gillian Tett say if one of her health record entrepreneurs, by means of an innocent mistake, entered a data that for instance hindered one of her children to enter a university that had decided that the expected longevity of students was good for its funding drives?

If those with good “3bn biochemical letters of human genome” ask insurance companies for rebates, what about the bad?

Sir, in screaming silence I read what Clive Cookson writes about “technologies advancing at extraordinary speed to make possible ultra-precise manipulation of the genome” “Engineered evolution takes another step forward” January 18.

In March 2000, after reading “the government plans to allow insurance companies to use DNA testing to assess whether people are at risk of inheriting serious illness and should pay higher premiums”, I wrote an Op-Ed titled “Human genetics made inhuman”.

In it I expressed many of the concerns about the discriminatory implications of DNA mapping and expressed the view that something needed to be done before any release of DNA information caused irreversible damage. I there suggested “that all insurance companies design a plan which obligates them to issue policies for all of those who undertake a genetic examination. This policy should cover the negative impact and consequence that could arise from anyone getting access to such information.”

But I also admitted: “I know this is only a Band-Aid, but what else can I do? I am not among those that resign and lie down to cry, even though this matter actually would justify just that.”

Now, 17 years later, I have no idea on whether something, anything, has been done to save humans from a release of the information contained in a “DNA sequencing, which reads out all 3bn biochemical letters of an individual human genome [and which can be done] in a few hours for less than $1,000”.

Sir, I ask, if with only $1,000 investment, I can get a test testifying I have a good DNA, and which perhaps allows me to for instance negotiate special favored rates with an insurance company, how will that affect those whose tests indicate a not so good or even a very risky DNA, something that in fact could include me or the ones I love?

Environmental challenges, 1st class robots, 3rd class robots, intelligent artificial intelligence, dumb artificial intelligence, terrorism, nuclear weapons, fast and cheap DNA testing, crazy bank regulators, structural unemployment… and the list of challenges goes on and on. How will a world that spends so much of its very scarce attention span glued to so very attractive juicy fake/irrelevant news stories cope?

@PerKurowski

Should insurance companies hold more capital for insuring “The Unhealthy” than when insuring “The Healthy One Percent”?

Sir you refer to the discussions on the issue of separating of splitting up banks in retail and capital market units, as suggested by The Vickers Reports and the Parliamentary Commission on Banking Standards chaired by Andrew Tyrie, “Banking reform”, December 21. 

That is OK but let me remind you that though there have been many scandals which may have resulted from these two activities occurring under one roof, the current crisis, like for instance the losses in loans to Irish banks, in AAA rated securities, in loans to sovereigns, and in real estate financing in Spain, has absolutely nothing to do with that. 

No!, as long as you are able for instance to be more concerned with interest rates manipulation in The Libor Affair, than you are about the much more significant and perverse interest rate manipulation produced in The Basel Affair with its capital requirements for banks based on perceived risk, you stand no chance of achieving any type of real useful fundamental banking reform. 

As I see it anyone who for whatever reason on purpose ignores what Basel II really did to our banking system is an immoral co-conspirator of The Basel Affair. 

Today The Libor Affair has most probably ended with fines paid and no one really being sure who won and who lost, but The Basel Affair, is still going strong, immorally discriminating as much as always, and perhaps even more, in favor of “The Infallible” and against “The Risky”. 

I wonder what you would have to say if insurance companies were ordered to hold more capital when insuring “The Unhealthy” those with preexisting conditions or belonging to the poorer which now are reported to have a lower life expectancy, than when insuring “The Healthy of the One Percent”. 

That would mean that “The unhealthy” would have to pay even higher premiums than what their unhealthy status would explain and merit; and that the “The Healthy of the One Percent” would have to pay lower premiums than what their healthy status would explain and merit. And my friends that is in terms of access to bank credit, precisely what those regulators in “The Basel Affair” are up to.

But there is a minimum minimorum reform that the US health sector needs for a starter.

Sir, being a foreigner living in the US I have thanks God not needed to get too acquainted with its so heatedly debated health sector; and I pray it stays that way. In this respect I cannot really comment much on Clive Crook’s “Medicare for all may be the best cure” June 15, but yet I feel the need to point out something that to me seems to go against any sense of justice, which is that as I have witnessed, the uninsured are often required to pay many times the price insurance companies pay for exactly the same medicine or treatment.

If beer companies compete that is good for beer drinkers and does not affect those who do not drink beer. But in the case of health services it is obvious that many of the cost reductions negotiated by the competing insurance companies, end up expected to be recovered from those uninsured.

If it was in my hand (perhaps it's good that’s not the case) I would put up a prohibition to charge anyone more than 5% to max 20% over the minimum price offered to any insurance company… and then take  health reforms from there. Not doing so forces millions of uninsured who could pay reasonable fees to either swamp free service emergency rooms, or being financially abused.

Is not cost-discrimination against the uninsured a much worse discrimination than many of those other discriminations being protested so loudly?