It is interesting to me that a guy like Obama who talked so incessantly about bringing people together has created an environment in which so many people are now really focusing on what their individual prospects for survival are.

Whomever it was that thought that it was a good idea for Baucus to delay and delay over there in the Senate with respect to their HCR bill, was a political idiot.  Had they gotten that bill out of conference on schedule in early June 2009, the issues around the 2010 election would have been much less of a concern for the House members.  Of course, I have never thought that Baucus was dealing in good faith on HCR.  I think he has always known that his bill had some very potent poison pills; and I think he has probably been very pleased with their effect on the bill's prospects and content so far.

But if this legislation doesn't work - and it will be some years before anyone even knows if it works, because of the delayed implementation of so much of it - I think it far more likely that it will just be rolled back or repealed than that yet another attempt will be made to "fix" it.

My guess is that in the near term, premiums will continue to rise to unsustainable levels, and it will soon become all too clear that having insurance is not the answer to securing access to affordable care.

Here's an example of what's happening now:

When WellPoint's CEO Angela Braly boasts that a 40 year old woman can purchase $1,500 deductible coverage from them for only $156 per month, it's important to see how they define that coverage.

Although Angela Braly didn't state which $1,500 deductible plan has a premium "as low as $156," let's look at the Anthem Blue Cross $1,500 deductible CoreGuard plan as an example. Under that coverage, a 40 year old woman would have to pay twelve monthly premiums, the first $1,500 of In-Network care, the first $1,500 of Out-of-Network care, one-half of allowed In-Network charges after the deductible (coinsurance), 70% of allowed Out-of-Network charges after the second deductible (coinsurance) (Anthem Blue Cross paying only 30% of allowed charges!), an additional $500 per day for up to three days for hospitalization (a copayment on top of the coinsurance!), all maternity care (Anthem Blue Cross paying nothing!), and... well... you get it.

When Anthem Blue Cross promotes this product as a $1,500 deductible plan, they are being so deceptive that it is dishonest. They call these "look alike plans" - it looks like a $1,500 deductible plan, but it isn't. The patient is paying most of the health care costs while Anthem Blue Cross pretends that this is insurance.

The more sophisticated insurance purchaser might look at this plan and recognize that it is almost worthless except that it has an out-of-pocket maximum of $3,500 for the year. So maybe it is worth the premium as a catastrophic plan, limiting losses to $3,500. But look closer. The fine print excludes the deductible from counting towards the out-of-pocket costs, so it is really $5,000, but only for In-Network services. Another $9,000 ($7,500 plus $1,500 deductible) has to be paid for Out-of-Network services as well. So the exposure is the total of monthly premiums, the In-Network $5,000, the Out-of-Network $9,000, all Out-of-Network costs in excess of the allowable charges, and any services, such as maternity care, that are not a benefit of the plan. This is another one of those you're-covered-if-you-don't-get-sick plans.

To show how ridiculous this can be, using the same benefit guide (link above) for a family with a $10,000 deductible plan, the out-of-pocket maximum looks like it is $7,000, but it is actually $17,000 for In-Network services ($7,000 plus $10,000 deductible), plus $25,000 for Out-of-Network ($15,000 plus $10,000 deductible). In addition to this $42,000, the family must pay monthly premiums, all Out-of-Network costs in excess of the allowable charges, and any services that are not a benefit of the plan (no maternity benefits for a young family!).

Angela Braly admits that WellPoint, the largest mega-insurer in the nation in terms of enrollees, cannot control health care costs, and neither can the rest of their industry. Their solution to keeping premiums affordable is to shift more of the health care costs to the individuals and families who need care, defeating the purpose of risk pooling.