We are always looking for ways to have a bipartisan dialogue about health care reform. Still, sometimes we can't avoid disagreeing with certain policy proposals.  This thoughtful article in Slate (which ran a few weeks ago) helps explain our reservations about proposals that would allow consumers to buy insurance across state lines. Robert Gordon compares what happened with credit cards in the 1980s to what could happen to health insurance. It is a long story, but the short version is that we all send our credit card payments to Delaware or South Dakota because there are little or no caps on interest rates (or other consumer protection regulations) for companies headquartered there. If insurance products could similarly be sold without regard to the insurance laws of the state where the consumer resides, then insurance companies would discontinue doing business in highly regulated states.  

For example, some states have adopted laws that prohibit insurers from charging people with pre-existing conditions higher rates. Other states have limits about how much more an insurer can charge a sick person than a healthy person. These state laws would be moot under a plan that would allow insurers to sell across state lines. Insurers would migrate to states with little regulation and try to attract healthy customers with very low premiums, while charging the sick higher rates than before, potentially leaving more Americans unable to afford health coverage. As Robert Gordon puts it:

Sick people can't get coverage they can afford. It's as though the rafts are reserved for people who already have life preservers. Americans with pre-existing conditions—cancer, asthma, diabetes, and the like—would need to pay even more than they do today. Through no fault of their own, more of them would end up without insurance. Meanwhile, insurers would improve their own profits by offering targeted policies to people with the fewest health expenses. 

There are other aspects of the "across state lines" approach that concern us, and we'll weigh in on them soon. That being said, we are glad to see both parties talking about health reform and looking forward to a debate about how best to make private insurance markets work for all Americans.