Tiering the Government

You may have seen The New York Times' April 17 article on insurance companies "tiering" their pharmaceutical coverage so that for some of the more expensive drugs patients can't use the standard flat plan co-payment, but instead need to pay out of pocket a percentage of the (very high) underlying cost of the drugs.

Alyssa Rosenberg looked into a related issue for Government Executive and found that many of the Federal Employees Health Benefits Program plans are doing this now. Stranger, the Office of Personnel Management seems to have managed to approve these plans without people quite realizing what was happening. It's a reminder, among other things, that when we talk about everyone having health insurance that still leaves a broad range of possible scenarios that hinge on the issue of what "health insurance" amounts to. In other words, how generous will the coverage be? With underlying medical costs soaring, there's tons of pressure to simply save money by making the coverage not-so-generous. But a brave new world in which we all have health insurance but it's bad insurance isn't such an appealing scenario.