HLM: Are you a single-payer advocate?
WP: I have never said that. I have said a single-payer system would certainly be better than the system we have now because a single-payer system would have everybody covered, and other countries have shown that they have been able to control costs with a single payer system. Whether that's an ideal situation for the United States, I don't know. But single payer needs to be seriously considered, and it's a shame that it was never given a hearing by Congress during the debate.
HLM: In a New York Times article, former editor of the New England Journal, Marcia Angell, said the individual mandate is a terrible idea because it requires people to buy a commercial product from investor-owned businesses at whatever price the companies set, which she thinks will ensure that health costs would increase faster. What do you think of her logic?
WP: It's true the ACA doesn't give the Health and Human Services Secretary authority to reject extensive premium increases and there's not a new federal agency with that authority. But it does give the secretary authority to point out increases that are in excess of 10% that are unreasonable.
And there are other means. For example, some states are taking action to do just that, such as in California (where a ballot initiative that would give the insurance commissioner authority to reject excessive rate increases awaits signature verification for the November ballot.) Regulators in several other states already have that authority.
HLM: What will insurance companies do if the law is held unconstitutional?
WP: The insurers will probably try to make sure nothing more happens at all, or to hasten the trend to move more and more people into high deductible plans.
Regardless of court's decision, a lot of the industry's focus will be on trying to influence the implementation of laws at the state level in ways that are most beneficial to the industry.
The industry is playing a political game in which they're not saying on the record one way or another what they think about the constitutionality in the law, except in their amicus brief where they said the law doesn't work without the individual mandate. But their political strategy is to get their allies to make the case that the law is not good, not in America's best interests, because if they can persuade lawmakers to oppose the law generally, they'll have a greater chance of influencing the elections in 2012.
They'll be very much involved in electing more members of Congress who would be reliable on votes for the next session. What they want is to have more friends in Congress to strip out those consumer protections. And they?d much rather have Mitt Romney in the White House than Barack Obama. A lot of our premium dollars will be funneled into organizations seeking to influence the elections this fall.