Here on TMV, we’ve discussed health care reform (often with a fair amount of heat) up and down, in and out, and every which way. Usually, the threads end up circular, with everybody back at their respective starting places; we’re getting nowhere.
So I’d like to ask a different question (and perhaps go somewhere new): Why are we stuck on the “insurance” model for health care delivery?
Insurance is (or was) intended to off-set risk of catastrophic financial loss from an unexpected event. Very useful if your ship sinks en route from the Far East, and the entire silk inventory is lost… or if somebody throws a cup of java at (and hits) the Mona Lisa… or if you fall down the stairs and break your neck.
The entire concept of insurance has gone right off the rails with health care.
What is unexpected about annual exams? How did the fall flu become a surprise? When did aging stop being a normal, fully anticipated process? Medicare and insurance don’t belong in the same sentence, because barring some unexpected catastrophe, we’re all going to get there eventually.
Where did we turn the corner from risk management (for which insurance is well-suited) to health management (for which it is not)?
When you insure your ship, you don’t expect your insurance company to pay for regular maintenance. When you insure your painting, you don’t expect your insurance company to pay for the extra security — though they will reward you with lower premiums for it. When you take defensive driving classes, your car insurance premiums go down because you’ve measurably reduced the risk of loss due to your own ineptitude — but the insurance company isn’t paying for oil changes to your vehicle.
People are right when they point out that a person’s health is different from a car or a ship or a work of art — but that doesn’t change the definition of insurance. How did we get to such an unworkable impasse?
I suspect (though I don’t know) that the health insurance companies expanded their roles in response to consumer demand. It’s also possible that insurance companies tried to capture a market they had no business entering. However it came about, though, insurance companies have not done themselves (or us) any favors.
We’re thinking all wrong about health care reform. We need a two-tier system: one for protection against catastrophic loss, and another to provide maintenance (health care).
I think insurance should return to doing what it does best, and let’s start talking about how we can help people who can’t afford it handle the costs of actual health care.
‘Cuz they’re not the same thing.