California health care

Kevin Drum weighs the ifs, ands, and buts of the proposed California health care plan and comes out sort of in favor of it, largely because it mandates community rating (all members of a community can buy health care on the same terms, regardless of health, age, sex, race, etc.).

That's all fine as long as the "community" is large enough - e.g., the whole state. But, I'm sure if you gave the insurance companies the choice of selecting community size, they would argue the smaller the better, and we would end up with exactly the same thing that happened with mortgage lending -- red lined communities. Obviously, the insurance companies would shun the largely black and poor inner cities by charging much higher rates for city dwellers than for suburbanites.

I don't know how the California plan works, so I don't know whether the insurance companies will be permitted to rate by county or municipality, but even if they can't, I'm sure they will try to find ways to make it difficult for the poor, the sick, and the elderly to get insurance. One obvious way is simply not to open offices in or near places where you don't want to insure people. Another is to make sure that the "on hold" waiting times are longer for people calling from undesireable telephone exchanges than for those calling from desireable exchanges.

There is more than one way to skin a cat.

Kevin decides that some movement in the right direction is better than no movement. He may be right, but if California puts in a plan that collapses of its own weight, it may set us back years in our march towards an ultimate universal, single payer system that rids us of the scourge of health insurance companies.

Count me skeptical.