Editorial: Health Care

Health-insurance industry officials have given President-elect Barack Obama good reason to hope that his plan for a national health-care overhaul may actually succeed - but only if Obama is willing to embrace a key strategy he rejected during the campaign.

In effect, two main trade associations declared that Hillary Clinton was right. In her presidential bid, Clinton proposed that all Americans be required to purchase health insurance as a means of keeping costs down. The president-elect, meanwhile, recommended expanding coverage to the uninsured without such a mandate.

Last week, groups representing managed-care insurers and the Blue Cross and Blue Shield plans offered to accept all customers, regardless of illness or disability. That's a potential big victory for consumers, since 10 percent of people shopping for individual insurance policies are turned down now because of preexisting conditions.

But the insurers set a precondition of their own: Whatever health-care plan Congress fashions, it must require that everyone buy coverage.

The insurers' reasoning is simple: Insurance works best when everyone is in the pool. That is, one sure way to drive down the cost of insurance is to spread the risk and the cost of health care among the greatest number of people. On the flip side, the theory goes, some people will wait to buy insurance until they're sick enough to need it - thus raising costs for everybody.

Will the problem of the uninsured be solved just by mandating that all citizens purchase insurance? Not by a long shot. As Obama noted during the campaign, a mandate makes no sense unless insurance is affordable.

The challenge for federal policymakers is to craft a plan that provides subsidies so that the working poor can afford coverage, as well as enact insurance and medical reforms that help rein in premiums.

That's Obama's strategy.

But the insurers are correct that, eventually, everyone must be covered. In return for developing reforms that will make insurance affordable to all, Congress needs to make sure everybody obtains coverage. With almost 50 million people uninsured, that is the goal of health-care reform anyway, right?

The insurers' bid is a potential turning point, nonetheless. Fifteen years ago, the industry funded the "Harry and Louise" television commercials that killed off President Bill Clinton's comprehensive health-insurance reform. So it represents a welcome sea change for insurers to extend a take-all-comers offer that could help pave the way for universal coverage.

Given the president-elect's advocacy for reform and the insurance industry's opening offer, Congress has a green light to get serious about health-care legislation - even with other economic issues taking center stage.

After all, it's about the economy as much as it's about safeguarding Americans' health. With job losses, the ranks of the uninsured are sure to grow. As businesses struggle to cope, their survival depends in part on reducing the burden for providing workplace-based health insurance.