Karen Ignagni and the health insurance lobby wanted the final health care reform bill to require everyone to buy health insurance and not include a public option. What does Karen Ignagni's role...

Karen Ignagni and the health insurance lobby wanted the final health care reform bill to require everyone to buy health insurance and not include a public option. What does Karen Ignagni's role indicate about powerful lobbyists? Do you think these powerful lobbyists help or hurt the legislative process, and why?

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thanatassa | College Teacher | (Level 3) Educator Emeritus

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Most people would agree that the financing of health care in the United States before the passage of the Affordable Care Act was broken. The United States was spending a greater portion of its GDP on healthcare than any other country in the world, and yet still had lower life expectancy and higher infant mortality than almost any other developed nation. 

While the Affordable Health Care Act attempted to remedy that situation, the simplest and most effective solution, namely moving to a single payer system such as the ones found in Britain and Canada, was not even seriously considered, as it would have seriously impacted the profits of private insurers and other companies that make substantial profits from people's illnesses. 

The Affordable Health Care Act as passed was a compromise between the wishes of most Democrats to provide affordable health care for all U.S. citizens, the partisan efforts of the Republicans in Congress to block the ACA, and the health lobby to make sure reform did not interfere with their profits.

Within this system, the requirement for all people to buy health insurance is a simple financial necessity. If the requirement did not exist, people would wait to buy insurance until they got ill, thereby bankrupting the system in short order. All insurance is based on the notion of pooled risk.

The major difference between the U.S. system and that of places such as Canada and Britain is that rather than people paying for health insurance directly via taxes, they are paying for insurance with for-profit companies, and so some of the money U.S. citizens pay for health insurance goes to profits or to things like the $1.58 million Karen Ignagni earned in 2007 or the $30 million annual compensation of Mark Bertolini, CEO of the health insurer Aetna, making U.S. health insurance cost more and cover less than that of most other countries in the world.

While the ACA has helped reduce both the cost of healthcare and the number of uninsured U.S. citizens, continuing lobbying by the health insurance industry and obstructiveness by Republican-controlled state legislatures has made it more expensive and less effective than the original legislation intended.

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