Thursday, February 18, 2010
High-Risk Pools, Pre-Existing Conditions, and Throwing the Sick Under the Bus
I just read an article, and one of the comments, by post LLWillis was so dead-on, I have to repeat it, because I know that sometimes things get lost and articles disappear after a period of time. (But this blog, of course, is forever...)
From LLWillis on Slate.com:
Back to basics. The lifetime cost of healthcare is an insurable risk. The 'universal' part of universal healthcare is that everyone is included, the healthy and the unhealthy, the old and the young, male and female. The natural tendency of the healthy and the young is to opt out, to increase both the pooled risk of others and the individual, mathematically small, risk to themselves. The risk is there over a lifetime. When the need strikes, and its severity, is not predictable at the individual level, but we know what the probabilities are over a lifetime. The premiums for all the healthy people for all the healthy years funds the care for the unhealthy, whenever it occurs. The premiums for all the healthy children pay for the child with leukemia or juvenile diabetes. The premiums paid on my behalf all the healthy years of my life paid for preventive care, minor ailments, my maternity care, and are only now paying for the conditions of age (I am now 60). Not everyone can be so fortunate, or so predictable.
Every insurance plan is designed to avoid 'adverse selection', a pool of insurance risks that is prone to claims in excess of premium income. If the healthy exclude themselves, the insurer responds by rejecting the very expensively sick. This is for the benefit of the insurer; the insured (or more precisely the hapless uninsured) are on their own. The insurer has control, the insured does not.
The lowest cost is achieved by the largest possible pool (universal, mandated, national, single payer). Every alternative that moves farther from that economic principle is increasing the total cost and increasing the individual risk, beyond a person's control, that today is the day he has a major healthcare need, or that yesterday was the day that she was afflicted with a pre-existing condition, or lost his/her employer health insurance. Please note this is an economic argument, not a social welfare argument. It's math. It's dollars and cents.
Full disclosure: I am Canadian, and my family benefits from universal, single payer health insurance. The US can decide for itself whether health is an essential human right. But viewed from where I sit, it is a human catastrophe that some 45 million citizens of the wealthiest country on earth are without access to affordable healthcare, and anyone can be ejected from the system because of a health condition that they have through no fault of their own. It's a mess, but it sure would be nice if you could figure it out. I do sincerely wish you luck. And then get on with the job of reducing the per capita cost of quality healthcare from $7,000 a year to the norm of $3,000 a year in other civilized, industrial nations. (Hint: the two problems are related.)
chant/prayer/mantra: Love is part of our budget.
agape to all,