A central truth in the arduous national debate over health insurance reform legislation, throughout 2009 and up to passage in March 2010, has been the fact that major insurers are unable to provide coverage for the treatment needed by their patients. Either their business model is fundamentally flawed or there is a severe deficit of imagination as to how to implement the business model in a way that benefits all stakeholders.

The intense emotion on all sides of the debate is clearly linked to this problem: the debate was dominate by an extreme division between the views of those who defended the rights of private insurers to avoid paying for care and those who defended the rights of patients, insured or otherwise, to receive fully paid full-spectrum healthcare reform. The one band vehemently opposes any new restrictions on insurers or a shift toward public financing of healthcare, possibly because the insurance industry is not competitive enough in delivering both care and profit; the other refuses to accept that there should be any alternative to automatic full-spectrum care for all people. 

The question that seemed to be absent from the debate was: whatever the reforms look like, how can we actually build a better insurance company? Can new health insurance reforms incentivize the creation of more humane, effective, health-oriented health insurance enterprises? Will cooperatives and non-profit insurers be viable? Use this discussion to explore ideas for creating viable insurance providers that do not refuse care or coverage.

Agreed. As a Self-Employed Professional, this topic strikes a particular chord in personal experience.

In being the sole employee of a small practice/business, I am not ‘entitled’ access to group rates. This has meant for exorbitant rates in coverage.

In order to afford a basic policy, my previous traditional plan had a deductible of $10K ~whereby, in meeting that deductible, they would pay 50% up to a total out-of-pocket of $15K before full coverage. At $500/month for such a policy (which increased by $80-100/month annually), this became impossible to sustain.

To begin the process of inclusive access, provisions must be made for affordable options to the Individual who does not qualify for a Group policy.

A Co’op would seem to provide those of us in such a situation, the ability to join together with other Individuals to gain access to more affordable policies.

Not certain if this seems a viable idea thread, but here goes: Perhaps a Co’op that allows Individuals to join and contribute to some sort of “Collective Health Savings Account” that the Co’op manages/invests and can draw from in covering or subsidizing Members’ expenses to some extent; If there was a formula to cover a certain percentage of medical care required for Members.

This may only be viable to cover a portion of tests and treatments required, however, it could then lighten the load for the more “traditional” insurance coverage/carrier, who could pro-rate Co’op Members’ rates to reflect their ability to cover some of the expenses in an alternative fashion.

This would make the “traditional” policy much more affordable and spread the responsibility for coverage over more than one resource.

Food for thought….?