July 10th, 2010

Health Insurance 101

Health Insurance 101


This past evening, I was talking with somebody about health care reform, and he mentioned how an acquaintance of his -- a republican (a gay one, no less, itself a concept which continues to baffle me) -- had put forth, as a rationale against health care reform, "nobody should have to pay for anybody else's health care."

Now, aside from revisiting the obvious aphorism about how the measure of a society is how it treats its weakest members, and the idea that a civilized society is distinguished from the savagery of nature by, well, the part about being civilized ... I had to wonder: did it not occur to this ever-so-enlightened person that that's how health insurance already works?

Yes, even at the heart of our deeply flawed patchwork system of private insurers, the idea is incredibly simple and sensible: pool a bunch of people's resources so that when one falls ill or is injured, (s)he can have access to the necessary care. Or in current practical terms, you (and perhaps your employer, to varying degrees) pay premiums to the insurance company, and when the unfortunate happens, the insurance company pays for a good chunk of the necessary care, assuming you are deemed eligible. In principle, this is a great model, although the devil is in the "assuming-you-are-deemed-eligible" details: the troubles with corporate greed engendering creative ways to disqualify people, the backwards incentives borne of the profit motive, and the odd connection of coverage to employment status, to name a few.

I wonder how this person -- who believes nobody should have to pay for anybody else's health care -- would have liked to pay in full, a la carte, for the services I received following my serious knee injury several years ago, had something similar befallen him. I was employed and insured at the time, and I can only begin to imagine how much the whole incident cost my insurance company over the better part of a year -- the x-ray, the MRI, the surgery, the numerous doctor and specialist visits, the physical therapy, and even the Vicodin I was taking for about a week post-surgery, which turned me into an old man nodding off in a chair on my balcony.

In all seriousness, my care probably totaled many thousands, perhaps many tens of thousands of dollars. The bill was collectively footed by my insurance company's large member pool, just as my premiums had helped to pay for countless other people's care. According to this person's statement of principle, however, I should have had to pay the bill myself, out of pocket. Of course, I'm no millionaire, and it doesn't take the brightest person to realize that would have left my finances in ruin. Most likely I would simply have had to forego care altogether, which would have left me unable to walk normally for the rest of my life. And to put things in perspective, my condition was not even life-threatening; had it been, according to this person's views, my choices would have been either financial ruin or death -- or perhaps both.

How would this person have felt about finding himself in such a situation, and being forced to pay out of pocket for any and all medical care? Do you suppose this might somehow force him to reexamine his views? Perhaps he would have taken former Nevada senatorial candidate Sue Lowden's advice and attempted to offer his doctor a chicken?

Here, of course, we encounter several of the many disconnects underlying republican thinking on this issue (although I have to confess this guy's beliefs are rather extreme even by republican standards). A lot of what people have been misinformed into fearing about health care reform -- bureaucracy, "rationing," inefficiency, and "redistribution of wealth" -- are already intrinsic to health insurance on a very fundamental level. Current reforms merely address some of the more egregious inequities and abuses of the system. True reform -- a single-payer system -- would simply be a far more elegant implementation of the same basic "pooled resources" model.

However, that's beyond the scope of this piece. Even the profound lack of empathy for society's less fortunate, exhibited by our gay republican, is tangential to my current point. To borrow from Senator Daniel Patrick Moynihan, people are entitled to their own opinions, but not to their own facts. Failure to think does not release one from responsibility for contaminating national discourse with ill-conceived notions that ultimately hold society back.

Or, in other words, "think before you speak." We'd all be a lot better off.