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Tuesday, June 16, 2009

Paging Doctor Insurance

I’m reading about President Obama’s attempt to sell health care reform to the nation’s doctors when this quote hit me: “But as the president spoke at the annual conference of the American Medical Association in Chicago, it became clear that one of the major health plans on the table would cost at least $1 trillion over 10 years yet leave tens of millions of people uninsured.”

I wonder why this endless debate always comes back to that word—insurance. Tens of millions of people don’t need insurance. They need doctors. They need nurses and pharmacists.

Yes, obviously, “insurance” is important because we’re worried about how to pay for health care. We’ve become hung up on the insurance model because of two concepts. 1) Health care is something everyone has a right to. 2) Health care costs more than many people can afford.

Does anybody ever to stop to ask if the insurance model is the best way, or even a particularly useful way, to pay for anything that constitutes an ongoing need? Think about the other kinds of insurance you buy—it’s all something you purchase in hope that you’ll never use it.

Life insurance doesn’t pay for your life; it pays other people for your untimely death. Hurricane insurance doesn’t pay for the daily hurricane monitoring of the civil defense system; it pays you to rebuild your house if it blows away. Fire insurance doesn’t fund the fire department; it pays you to rebuild your house if it burns down.

In Hawai‘i, you’re required by law to purchase your own automobile insurance. This way, you can afford the very expensive repair work and medical bills that might come from a bad, unforeseen collision.

But you don’t use auto insurance to buy the car in the first place. You don’t use it to pay for new tires and oil changes and gasoline. “I’ll take a pair of fuzzy dice, please, and some custom aluminum rims—why not? After my $20 deductible, it’s all covered by my auto insurance!” No, it’s strictly worst-case planning.

Number 2, above, is certainly true in the case of catastrophic or incurable illness. Major surgery, chemo, a lifetime of dialysis—extremely expensive. Maybe there is a role for private insurance against these worst-case, unaffordable catastrophes. In a just, compassionate society, there’s also role for private charity and public assistance for people who can’t afford such insurance, but suffer such medical catastrophes anyway.

But the health care reform debate doesn’t make such distinctions. Instead, it seems to want to throw a blanket of insurance over every little appointment and procedure and treat it all as if a lifetime of normal, ordinary interaction with doctors was a tragedy to be insured against, rather than a part of life to be budgeted for. Why? What’s the psychology behind this policy?

The routine physicals, the broken arms, the tonsillectomies—why not just pay the doctor for it, instead of some insurance company? Take responsibility. It’s your health, your body. But Americans have had just enough health insurance, for long enough, to get used to having other people pick up the tab, even for the insurance itself. Notes Reason Magazine, “Even among the uninsured, the enthusiasm for insurance is muted. When [a] Kaiser poll asked uninsured adults how much they would be willing to pay to get coverage, only 64 percent would fork out $100 a month and just 29 percent would pay $200.”

If we applied the American health care model to other unavoidable, major expenses in life—especially what health care is likely to become—then “shelter insurance” would pay your mortgage or rent. Everybody has a right to shelter, but housing is expensive. Meanwhile, an army of legislators, lobbyists, bureaucrats and think tank staffers would argue about whether or not you really need a solid house with a roof. After all, tents would keep out the rain just as well. Plus, you can buy them in bulk, thereby reducing the staggering sum of money this great nation wastes every year on individually purchased housing.

Posted on Tuesday, June 16, 2009 in Permalink

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