The prospects for reforming the U.S. healthcare system brightened this week when the country's top insurers made a significant concession to consumer advocates: They offered to stop basing premiums on a policyholder's
. Although the concession came with strings attached, it removes one of the hurdles facing lawmakers as they struggle to overhaul the system.
Once the main opponents of sweeping reforms, health insurers now insist that they have the same objectives as consumer groups, doctors, hospitals and the government. The lobbying group America's Health Insurance Plans says insurers want universal coverage, lower costs and higher-quality care. Moving past those broadly shared goals, however, the factions continue to fight over many of the details, including whether to let federal health insurance programs compete directly with private industry, whether and how to rate the effectiveness of different treatment strategies, and how to squeeze overhead costs and inefficiencies out of the system.
One point of the whole exercise should be to close the loopholes insurers use to restrict coverage, revoke it or make it unaffordable for those most in need. These include such practices as
after a policyholder files a claim, denying coverage for preexisting conditions when someone applies for a new policy, and raising premiums on those who fall ill. Recognizing the momentum that's building, the insurers have been offering to end some of those practices in return for a requirement that every individual have health coverage. In particular, their lobbyists offered in December not to exclude coverage of preexisting conditions, and on Tuesday, they pledged to stop charging sick policyholders higher premiums than healthy ones pay.