Insurance capital can’t figure out insurance

Here’s a quick story about what it means to have “good insurance.”

Like a lot of people in middle age, I have some health issues that occasionally require seeing a specialist. The “good” aspect of my insurance is that those visits are covered.

But it’s not that simple, because nothing is ever that simple.

Getting coverage to see a specialist means I need preapproval from my primary care doctor, despite having never met my primary care doctor. What it really means is someone in the office has to check a box on an electronic form.

It’s not even required in advance. The preapproval can be postdated. All that’s required is that the box be checked by someone, at some point.

Sometimes that step gets missed, at which time I’m charged for visiting the specialist. News that I owe money to my provider arrives somewhere in the blizzard of correspondence that comes to a family of four, each of whom are receiving care at some level, the vast majority of which says “This Is Not A Bill,” which at some point means you stop paying attention.

Anyway, if someone forgets to check the box, I get charged, and if I miss the bill, it goes to a collection agency, which has happened twice in the past year. Suddenly I’m having to explain to some chatbot that I really don’t owe $495, and that my doctor’s office knows that I don’t owe the money, but it requires all kinds of back and forth and long phone calls to get it sorted out.

This is, as mentioned, good insurance. Many people are in a far more precarious position. It’s hard not to think we could do better.

Maybe, for instance, we could have insurance that covers people’s health needs but doesn’t put a private company’s profits as its top priority? It sounds crazy, but such a system is already in use for millions of Americans. The trouble is, you have to be over 65 or fall below a certain income level. Everyone else is out of luck.

Despite insurance industry scaremongering, Americans are huge fans of government-run plans. Just try telling seniors you’re taking away their Medicare and see what kind of response you get. And yet proposing that everyone should get the same consideration that Medicare recipients enjoy gets you labeled a radical. No, it doesn’t make any sense.

The state of Connecticut has in recent years fought over what is known as a public option for health insurance, which is not the same as single-payer, Medicare-style insurance, but would instead operate in competition with traditional health plans and, at least in theory, be able to offer better coverage at a lower price because the profit-making aspect would be removed (along with multimillion-dollar CEO salaries).

It’s not a novel idea — other states have enacted such plans, and a public option was widely discussed in the Obamacare debate before ultimately being shelved ( thanks again, Joe Lieberman). In a state with large Democratic majorities and many lawmakers on the record in support of a public option, it should be ripe territory for a Connecticut version. It hasn’t happened.

Some places are known for exciting industries, like aerospace or microchips. Danbury has hats. Hartford, unfortunately, is known as the Insurance Capital of America, and even though the companies that gave the city that title aren’t as dominant as they once were, they still hold sway on major policies involving their business.

In recent years, those companies threatened — first quietly, and then overtly — that they would rethink their Connecticut homes if we moved ahead on a public option. Even with many Democrats in favor of the plan, the governor joined Republicans in opposing the idea. Democrats could have passed the bill anyway and then tried to override his veto, but they weren’t up for that fight. And so it died.

That doesn’t mean it can’t come up again.

As it happens, one of its strongest legislative supporters, the bill’s author in last year’s session, is today a statewide elected official with newfound prominence. Recently elected state Comptroller Sean Scanlon is picking up the fight for better health insurance, but taking a pragmatic approach.

Scanlon is not pushing for a public option this year. He had a front-row seat to last year’s debacle, and does not want to see the plan fail again. That does not mean, he said in a recent interview, the need has gone away.

In his new position, Scanlon has given up the power to move bills through the General Assembly but gained a louder voice in shaping the direction of state policies. As comptroller, he’s pushing changes to state retirement policies as well as reducing health care costs. But it may be some time before the public option comes back up again.

The concerns about the policy have always been overblown. Private insurance companies would be hired for the logistics, so it’s not like they’d be shut out of anything. Costs are a concern, but keeping people healthy and insured would seem to be a goal worth spending public money on.

It’s fortunate the state has someone like Scanlon in his position who understands the problem. But his term runs concurrent with Ned Lamont’s. It is difficult to see a future for the public option with this governor in office, which means all of us lose out.