Is Universality the Key to Affordability

Health insurance companies appear to believe so.

The health insurance industry offered Tuesday for the first time to curb its controversial practice of charging higher premiums to people with a history of medical problems. The offer from America's Health Insurance Plans and the Blue Cross and Blue Shield Association is a potentially significant shift in the debate over reforming the nation's health care system to rein in costs and cover an estimated 48 million uninsured people. It was contained in a letter to key senators.

In the letter, the two insurance industry groups said their members are willing to "phase out the practice of varying premiums based on health status in the individual market" if all Americans are required to get coverage. Although the letter left open some loopholes, it was still seen as a major development.

That implicates the key differences between the Obama plan and the Clinton/Edwards-style plans. Obama sought to dramatically reduce the number of uninsured Americans, while Clinton and Edwards argued for unversality and the elimination of free riders - people who would go uninsured until the moment they became ill. It's safe to say, health insurers are emphatically opposed to being required to insure, and take huge losses on, free riders.