As I do most mornings, I grabbed the Wall Street Journal that was tossed on my front lawn earlier this week and I felt as if it was Groundhog Day when I saw this headline on page one, “Health-Plan Choices Shrink.” First thing I thought? Shocker. Back in June, I posted a blog on EBA, “Has the single-payer era arrived?” But, heck, I didn’t expect it to be here for 2017.

More than 30% of the counties in the United States will have a single carrier offering health insurance on the public exchanges, according to a recent Kaiser Family Foundation study. Call me crazy, but this looks like a single payer system. I know, I am getting hung up on the word “single.” Hold on, it gets better. Another 31% of the counties in the U.S. may have only two options. Now I can sleep.

On a year over year basis, in 2016 7% of the counties had one choice and 29% had two choices. The Kaiser study suggests that close to 40% of the current exchange participants will have two or fewer choices. If you are thinking of moving to Pinal County (Arizona), they may not have an exchange option in 2017. Thank goodness for healthcare reform.

Those of us who have been riding the health insurance bus for a while we saw this coming. The carries would go out onto the exchanges, the healthy individuals would not go to the exchange and they would stay on their employer plans. The healthy individuals under age 26 would stay on their parent’s plan (I have one of those healthy individuals that the exchanges should pay me to take). The exchanges would be populated with adverse risk, due to the basic writing of the law. Penalties and incentives are non-existent and there are no incentives for the healthy to come to the exchange, worse yet, there are zero incentives and or rewards for those individuals who have truly taken control of their health.

A death spiral
Let me voice my opinion, once again: Our political leaders did not write a healthcare law. I really do not know what to call it (other than a death spiral), but it is not and never will be a law that will control cost. For me, it was a government control law; they built something that they thought would provide access to all. We never had an access problem; we had and continue to have a cost problem. We wrote a healthcare law that penalizes if you do not have coverage. Why not write a law that penalizes for smoking, morbid obesity, not getting your annual physical, and if are not seeking care for a chronic condition, you should be penalized.

Also see: "In-network deductibles rise 50% in 2016."

What President Obama sees as a solution is the creation of a government health plan. My guess is that they would run it as successfully as Social Security and other government-run programs. But at least he would have his single-payer system. If our government leaders looked at the real issue, they would realize it is not a matter of carries and the plans, but overall health. As we approach 2017, the exchanges continue to be underpriced and the carriers have one of three choices:

One, stay on the exchange and price accordingly for the risk. This is most likely not an acceptable option since our government leaders have the universe convinced that healthcare is already overpriced. The public would hit the streets in protest, remember, healthcare is free for all.

Two, be creative and come up with a compliant plan that incents and rewards the healthy buyers. I’m not really sure how this would work since the government really has the final say on product design, this includes penalties and incentives.

Slideshow
10 healthcare differences between Clinton, Trump
Repeal the ACA. Build upon health reform. Increase consumer choice. Eliminate monopolies. The two candidates are divided on some policy, but there is also common ground in their proposals.

Three, get out and run as fast as you can. Don’t look back, kind of like a scary movie, when the actors always go down into the basement. Run! The private market will be here for years to come. Why not get crazy and do something out of the box, become creative within this space. Work with the employers and employees, create product and develop incentives based on health and care, not healthcare.

A problem, not a solution
If the government wanted to control cost they should have created a program that rewards the healthy and those trying to become healthy. If high blood pressure is in your family and you are seeking treatment to manage and control the condition, you should not be penalized. As a matter of fact, you should be rewarded. If you are a smoker and you have high blood pressure, you should be penalized.

The thing is, the government didn’t create a solution, it created a problem. They created a platform for commercial carriers to buy business, without any thought to sustainability. The result is we now have an increasing part of the U.S. population (more than 60%) that will have two or fewer choices. I wish someone would tell me how the lack of competition and the single payer system translates into success for all.

In less than 90 days we will have a chance to vote. Frankly, it is not going to be Trump or Clinton that has an impact on this issue, it will be the Senators and Congressman. I hope when you do vote come November, you think about the industry that you have spent your life in.

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Vinnie Daboul

Vinnie Daboul

Daboul is currently Partner at Sage Benefit Advisers and the Principal at the Daboul Group.