An individual mandate. Health insurers would love to find a neatly-wrapped individual mandate under the tree—and they're even willing to accept everyone in their plans, regardless of health status, if they get this gift.
The problem is there are just too many elves who don't want this happen.
The individual mandate has fluctuated from DOA in 2008 to a distinct possibility earlier this year. I would say the current odds of an individual mandate in the final health reform bill is somewhere between the chances of an underfed Santa Claus and a White Christmas in Miami.
A best-selling, Oprah-recommended book called "Why Health Insurers Are Important." During the healthcare debate, public insurance proponents and many Democrats have bashed health insurers as an expensive, unnecessary third wheel in healthcare.
Alas, there will be no best-selling, pro-health insurance book that will catch the nation by storm. Instead, health insurers will need to continue to promote their positive work and try to raise their voices above the din of health insurance critics.
That will be difficult—and likely will not happen. It's up to individual insurers to promote their offerings to members in order to gain loyalty. At that point, insurers can take some comfort in at least knowing their members are happy with their offerings.
Those are four items on the top of health insurers' lists, so needless to say it's going to be a disappointing Christmas morning when they see none of these presents under the tree.
What will they get instead? A watered-down health reform package that will not include anything that they despise like the public plan or anything that will rejuvenate the private insurance industry. In other words, insurers will get the health reform equivalent of a sweater rather than a pony or—much worse—an inedible fruitcake.