AMERICAN ISSUES PROJECT

Health insurance: an oddity among insurance policies.

In this excellent article, Steven Malanga of The Manhattan Institute highlights the exceptional nature of health insurance as compared with other types of insurance. When it comes to health services rendered, our culture sees paying the bills out-of-pocket as the exception, not the norm. As Mr. Malanaga points out, most of us carry other types of insurance policies that protect us should a catastrophic event occur - like home insurance, car insurance, life insurance, even insurance on our valuable, sentimental items like jewelry. But, when repairs or updates to those insured items become necessary, we don't call upon our insurance. We understand that everyday repairs due to wear and tear or even renovations that may improve or add value to the insured items are costs that we must bear.

Imagine calling on your insurance when you need a new coat of paint. You wouldn't get very far, would you? Take this one step further, and imagine trying to purchase an insurance policy to cover an event that has already happened. Your house burns down. Can you call and get an insurance police to cover your home and your belongings after the fact? Certainly not. If that were how the system worked, who would pay into the system before the catastrophe occurred? And, where would the money come from to pay for claims? And, imagine those premium rates for any suckers who actually maintained insurance prior to making a claim? (Assuming, of course, that there's anyone would who do this which is highly unlikely.)

You might be thinking, but those are items or goods you're talking about insuring and that they're different than insuring people's health. But, the point is that while the item (or person) that is insured may vary, the nature of insurance is all the same. Despite what Congressman Weiner might think, insurance is a good, just like other goods that are sold in a marketplace. It is a essentially a contract, whose terms consumers should be able to shop around for and negotiate just like with other types of insurance. And, your insurance should be priced according to the coverage that you choose. For example, if you want a policy with more limited protection, then you will pay less for your insurance. Makes sense. If, on the other hand, you want an insurance policy that covers everything - including riskier treatments or holistic medicine for example, then you should pay more.

Or at least that's how the insurance industry should work. The option to customize insurance like we customize or negotiate every other contract we enter into does not exist because of the government placing itself in between the provider and the consumer in what should be a completely private, contractual relationship. As Mr. Malanga points out:

"There are significant [] ways that government mandates treat health insurance differently, at great cost to all of us. Consider this scenario: You don't have home insurance and a big storm comes through and knocks over a tree into your roof. You can't just phone up an insurer, buy coverage and then submit a claim, even if you face financial ruin by not having the coverage. But that's more or less what you can do in health insurance under so-called guaranteed issue rules, in which someone who hasn't purchased insurance and gets sick can't be turned down for coverage. Needless to say, states that have guaranteed issued, like New Jersey and New York, have the highest health insurance premiums in the country because healthy people know they can run the risk of not buying insurance until they get sick. Insanely, the health reform package now on the table in Washington would create a federal version of guaranteed issue.

In auto insurance, some states have given us our own private version of tort reform to keep premium prices low. In these states, a driver can opt out of the litigation lottery when he purchases auto insurance by promising not to sue for pain and suffering if he's hit and injured by another driver. By doing this a policy holder can save hundreds of dollars a year on premiums. And yet for some reason the same option, that is, allowing us to buy a health insurance policy where we agree not to sue a health provider for pain and suffering if a treatment goes wrong, is not available, even though I imagine the cost savings would be enormous."

Government regulators also require us to buy so much more health insurance. In auto coverage, for instance, states will generally mandate that we have certain minimum coverage to compensate anyone we may crash into, but otherwise regulators will leave us alone to decide which options (towing, collision) we want to buy. By contrast, states will require buyers of individual and small group health policies to load up on mandatory coverage, including options that many people don't want to pay for, like fertility treatments. Politicians will often claim that they demand these coverages because they are looking out for our own good, but that's a difficult case to make persuasively when mandates help make insurance unaffordable for many people."

Justifying these regulations by saying the government is looking out for our own good is paternalistic and offensive. People enter into the marketplace and make decisions for themselves day in and day out without any help from the government. Health insurance should not be the exception. I understand that President Obama and many liberals find fault with insurance companies because they believe that operating based on a motive to make profits and fulfill your bottom line is evil. And so it follows that they believe that those evil companies must be reigned in and controlled in order to make the system more 'fair'.

But, this comes at a cost to all of us. If you want to make something more available to a larger group of people and to bring down cost, you don't impose more regulations or restrictions on that item. It is competition among private individuals and companies that brings costs down, increases supply and makes markets more transparent. The federal government has never and is incapable of producing these kinds of effects in a market.

The only way to improve an inefficient and costly market is to put the bargaining power back in the hands of the people and eliminate restrictions - on everything from where the good (in this case, insurance) can be bought from to what is or isn't included for the price. Until then, as Mr. Malanga points out, "insurance costs will continue to spiral."

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*This post originally appeared on http://despinakarras.blogspot.com/. 

 

 


Comments

Don wrote re: Health insurance: an oddity among insurance policies.
on 08-20-2009 7:05 PM

The reason our insurance system works this way is the tax code, created during WW2, rewards employer provided medical insurance plans. This in turn increase overhead costs while eliminating price comptition . . . significantly increasing costs.

There is a way to fix this problem and the other problems our system has, but it requires a move in the opposite direction Obama is going . . .

Billy wrote re: Health insurance: an oddity among insurance policies.
on 08-21-2009 8:14 AM

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Robert wrote re: Health insurance: an oddity among insurance policies.
on 08-22-2009 8:02 AM

All of the discussions that I've heard or read tend to relegate personal responsibility to the back burner, if it is mentioned at all. There seems to be a perception and mindset in Washington, amongst other politicians, that the public isn't, nor should they be, personally responsible for much of anything. No matter the nature of insurance, life, health, auto, home, most folks opt for the minimum coverage that they can obtain, regardless of ability to afford. They understand the need for the insurance, but feel that just maybe they'll get more for the minimal investment, something for nothing. Until disaster strikes.

There have been recent initiatives in Texas (I reside in Texas) by the auto insurers and Department of Public Safety, to go beyond requiring a minimal auto liability coverage, which many drivers ignored, to maintaining a statewide database accessible by law enforcement officers of up-to-date coverage information on drivers. When a law enforcement officer performs a traffic stop the drivers license and insurance card are both validated and if the insurance is not in effect, the driver may find themselves beside the road while the car is towed to jail.

This is only an example of the government attempting to force people to be responsible for their actions. Health needs work much the same way. I know of a number of young workers who are offered health insurance by their employers that refrain from obtaining it. They'd prefer to have the funds available for other needs or desires. I've spoken with several, but this commentary remains "hearsay". Some don't earn enough so that the income goes for basic necessities such as food and rent, not that health insurance couldn't be perceived as a necessity. But others, I can think of two, would much rather have the funds available for bar crawling and I-pods.

The disaster in New Orleans resulting from hurricane Katrina has a number of lessons and examples to draw from. First, the original city was founded on the highest ground in the area, above the average high-water mark. Over the years, apparently, developers thought that they had developed a means of containing the low-lying areas, surrounding them with levees, so as to keep the ground dry. Come on, really now. If no one noticed that over all the preceeding centuries no Native American villages were ever settled long term anywhere along the Gulf Coast, from Texas to Florida, then there's not much hope that today's developers are going to figure out that sooner or later that ground is going to get very, very wet. And the people who choose to live there are going to NEED insurance. But at what premium? The insurance companies are the only ones who seem to realize that it's going to get wet because they won't offer flood insurance for those areas. Who in their right mind would? You guessed it, the government alone. Basically encouraging people to live in a flood plain. "You're not responsible for choosing to live there, so we'll cover you".

Health insurance? Pretty easy fix actually. Open up interstate competition. Tort reform (actual damages, ok, limit claim dollars outside that envelope). Trust people to be responsible for their own good health. And where they're not, oops. That's life. Argue that some folks are incapacitated, poor, and some just plain dumb. OK. Don't we have a Medicaid system they qualify for that needs fixing already? Argue that they don't sign up. Don't hospitals, by law, have a Don't Refuse policy? Aren't local and state governments already on the brink of financial ruin due to public hospitals excessive number of no-pay treatments (amongst oether reasons)? In Texas a majority of no-pays are illegal immigrants. This info from state databases. Hmmm.

I've seen, worked in an emergency room admissions dept, an unmarried mother of 5 kids, aged 1-5, come in to the emergency room at 10:pm on a Saturday night, toss her Medicaid card on the desk and ask that all of them see a doctor. They all had colds. The federal government paid for each of them to be examined, told to take aspirin, drink plenty of fluids, and get some bed rest. Not that the kids should suffer, but isn't treatment for a cold pretty common knowledge? The mother took no responsibility for her children's health. It was someone else's problem.

Until the government recognizes that there is some personal responsibility involved, there is no hope for reform. Until the government recognizes that living involves risk, there is no hope that insurance will be recognized for what it is, risk spreading, not a panacea for all perceived wrongs in this world.

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