What is it about this business?

A few weeks ago, I wrote a piece called ‘Tone Deaf,’ which spoke to the health insurance industry’s propensity for shooting itself in the foot, with ever more powerful weapons as time goes on.

That was before the health care reform bill was enacted into law.

But no sooner had the bill been signed by President Obama than health insurers were looking for loopholes to avoid complying with some provisions. 

So, of course, the one that gained the most notoriety had to do with insurers parsing the bill’s fine print and coming up with a justification for not insuring some kids with pre-existing conditions until 2014. 

Despite what the fine print may say and however finely one may parse it, it is obvious what the law’s spirit is for insuring children with pre-existing conditions—that is to say, this is to start in September.  It’s obviously what the bill’s writers meant and what the President had been trumpeting as a major immediate benefit of the bill.

Why, then, of all possible provisions in a 2,000+-page law do health insurers pick this one upon which to make their first play?  Is this business so hopelessly addicted to being considered the bad guy that it has become a self-fulfilling prophecy?   Or is it the thrill of seeing how far it can go?  Or does it get off on the anger such moves engender?

The responses can get pretty angry.

Here’s what Sen. John D. Rockefeller IV, D-W.Va., had to say: “The ink has not yet dried on the health care reform bill, and already some deplorable health insurance companies are trying to duck away from covering children with pre-existing conditions. This is outrageous.”

Another statement had him using the word ‘reprehensible.’

Kathleen Sebelius, Health and Human Services Secretary, wrote to Karen Ignagni, president of America’s Health Insurance Plans, that health insurers should stop looking for “non-existent loopholes.”  Sebelius also said she would be she would be issuing regulations in coming weeks that would clarify that “the term ‘pre-existing condition exclusion’ applies to both a child’s access to plan and to his or her benefits once he or she is in the plan.”

To cause such a needless stir, we must be talking about millions of kids, right?  Well, not exactly. 

According to the Wall Street Journal (and since it appeared in the Journal even the industry’s staunchest defenders will accept it as gospel), the figure is 1% to 2% of the estimated 8 million uninsured children—that is, 80,000 to 160,000 kids.

In referring to these numbers, the Journal quoted Sara Rosenbaum, chairwoman of the health policy department at George Washington University, as saying: “We’re talking nationwide about a handful of children…I can’t imagine why insurance companies are fighting this so hard.”

As the pressure grew, insurers saw the light.  An AHIP spokesman said, “We understand policymakers are contemplating changes to the provisions related to coverage for children, and we will implement any revisions that are made.”

Couldn’t somebody have thought of this before the lawyers got their fangs into the bill?  And if not, why not? 

Hey, Dr. Phil, do you ever take entire industries as subjects on your show?  The health insurance business needs help and while it’s true the business is not a kid, it sure has a pre-existing condition.

There doesn’t seem to be any point in my pretending not to be thrilled by the historic House vote that sent health care reform legislation to President Obama.   

The victory is even more astounding when you consider that just a few short weeks ago health care reform was being pronounced dead upon the election of Scott Brown in Massachusetts, an event that denied Democrats the magic 60 votes they needed to get anything done in the dysfunctional Senate.

Credit for this amazing revivification must go to President Obama for finally—finally!–making an all-out push to get his signature issue passed into law.  Part of the reason that this took more than a year of agonizing twists and turns is that the President was too reticent for far too long.  Yet in the end, he can take pride in the historic victory.

Credit must equally go, however, to House Speaker Nancy Pelosi who pulled off a feat that was deemed impossible—getting the House to ratify the Senate version of health care reform.

Despite the factionalization of Democrats in the House, Speaker Pelosi was able to make it happen.  Bravo, Madame Speaker.  Somehow your persuasiveness and doggedness did not allow the perfect to become the enemy of the good.

It is also so refreshing and even inspiring to see that in the end demagoguery and malicious falsehoods did not triumph.  We shouldn’t expect that the braying from the GOP will stop any time soon, however.  They see political gold in disseminating smears about the bill, but time will tell.

What this shows is that the President and Democrats need to continue pressing their story and the benefits of this bill for millions and millions of Americans.

I find it interesting that while the President used the insurance companies as whipping boys in the last stretch of his campaign to get the bill passed, those same insurers didn’t say ‘To hell with it.’  They protested the ‘vilification,’ all right, but somehow were able to keep focused on the balm of millions of new customers amid the public lashings.

This is by no means the radical bill that the right would have you believe. This is no government takeover of health care. If it was, there would be no place for private insurers in it. A government takeover would be something like Medicare for all and this legislation doesn’t even come close to that.

This bill may not be perfect but it goes a long way toward eliminating the stain of having America be the only major democracy in the world whose citizens were not guaranteed health coverage.  And for that, we can hold our heads higher.

Funny how one election has thrown everything up in the air.

Of course I’m talking about the election of Scott Brown as the Republican senator from the bluest of states, Massachusetts, on January 19. The result has been that Democrats of all stripes are running scared, while Republicans can’t stop crowing about the renewed vigor that Brown’s victory has brought to their party.

I happened to be in Massachusetts the weekend before the election and believe me there was hardly any time for music on any station because the competing ads for Scott and his opponent, Martha Coakley, were going nonstop like some insanely repetitive, yet inescapable, loop.

Brown, as it happens, did not run as a Republican; indeed, he seemed at pains to mention his party affiliation at all.  No, he was an independent. 

One of Coakley’s ads, in fact, identified him as Republican Scott Brown as if this in and of itself was enough in the Bay State to ensure a politician’s defeat.  Sorry, Martha.

But think about it, have you heard much, if anything, about health care reform in the wake of Brown’s victory?  Compared to the nonstop barrage of news that kept coming out of Washington for close to a year, the silence on the issue after the Massachusetts verdict is not a little startling.

Of course, there’s probably a ton of stuff going on in the back rooms of the House and Senate and White House, but any clear sense of direction is not to be found.   Not even in the president’s State of the Union message.

If, as a result of this upset election, nothing or very little comes of nearly a whole year of trying to reform the health care system, there’s no doubt the president will take a body blow.  Even though he did a terrible job of leading the fight on the issue and never truly made it clear what exactly he wanted in the final bill, it is nonetheless the issue that has defined his first year in office.  And if it comes to nothing, what was all the sound and fury about?  And further, what about all the other pressing issues that were back-burnered so that health care reform could take precedence? 

Many people will be only too happy to see the end of any kind of health reform effort, but the fact remains that the system is not going to heal itself and the major problems that were there a year ago are still with us, only worse.

The silence that I referred to above has not only descended on Washington.  There’s been hardly any comment from the health insurance industry, the pharmaceutical business or health care providers.

The first two, in particular, had a lot to gain from reform because they were looking forward to millions of new customers paying premiums and buying prescription drugs.  That promised revenue went a long way toward easing the pain of some of the restrictions that the reform plans intended to put in place.

If some kind of “reform” is salvaged after all, it’s likely to be aimed at making changes that affect health insurance regulation.  Insurers could very well end up being subject to many of the restrictions that were in the grand schemes, but without the palliative effect of those millions of new customers.

Trying to forestall this result might be worth insurers bringing some verbal life support to health care reform now.  In fact, reiterating support of reform could well capture the imagination of the public and politicians to good effect.

Without making some noise now, is anybody going to care what they have to peep about later on?