dotCommonweal

A blog by the magazine's editors and contributors

.

Why should we even have health insurance?

Bruce said:

I agree that this [providers marking up their prices double and triple digits and that part of what health insurance sells is discounts] is a big problem. In addition to preventing price discovery, it makes insurance a requirement even for those wealthy enough self-insure. Id like to see all providers be required to offer any service at only one price, which they must charge everyone. Then we wouldn't need insurance for its supposed discounts.

This brings on an interesting question. Let's pretend that business gets out of the insurance business completely. All insurance becomes "individual"; you go on line or something and you buy your own policy. While we are fantasizing here, let's even imagine that your company pays you each year all that they would have paid before for your health benefits. Let's also imagine that providers start billing at something close to cost and that this billing is fixed like other services in the sense that everyone is charged the same rate for the same service.Would we even need to have health insurance?To me, health care benefits are a form of enforced savings (like Social Security), which is why we would need it even if the market for medical services was like the market for hamburgers. There are some people who don't need to save because they are rich and can "insure" themselves. And it is true that for the most part, most people each year use fewer services than the premiums they pay out. But medical expenses can be severe when they hit (and they will for most people sooner or later). As long as we live in a society that, as a society, will not allow people to die on the streets, I think it is entirely reasonable to require people to have insurance (unless they have independent means.) This is the same rationale, in fact, as the requirement that we have Social Security.

Comments

Commenting Guidelines

"most people each year use fewer services than the premiums they pay out'. I've paid fire insurance for almost 60 years on several properties with no fires but I still won't join the whining Tea Party. .

One reason to not have health insurance would be to rely instead on other people's charity. Isn't it similar to giving money instead if saving it? People tend to save money for their future needs: instead, they could give it away, and hope that on the future day when they have needs and no resources, others will step in and give them what they need. Similarly, instead of taking health insurance and being contractually protected, they could merely give money away, gratuitously, with no promises in return, and hope for the best.In particular, for people who take a vow of poverty, isn't it illogical to have health insurance?

Claire, you're talking about a classic communist society ('from each according to his abilities; to each according to his needs') and we certainly are not there yet. There is a lot of (general) giving to hospitals and clinics and from time to time people will rally to help someone with a medical need. But I don't know if we could do this on a society wide basis, unless the charity extended to the elimination of other wants as well.Regarding vows of poverty, we talk about this at our Franciscan meetings all the time. We don't take vows. We profess. But we profess to live a gospel life and Franciscans believe that this involves poverty. But most of our members are middle class, many with families. What should we give up? What should we consume?But insurance seems clearer to me. One could rely on charity, but in the case of serious illness, one would be risking one's life to do that (just as hundreds of thousands are forced to risk their lives by having chronic illnesses and not being able to have health benefits). Perhaps people that vow poverty include risking their life to embrace poverty. Could that be part of it?

I think that abandoning health insurance is quite similar to giving away one's belongings, and would be a crazy-powerful counter-cultural gospel message of powerlessness by choice. Still, I might dream of it, but I would not give up health insurance out of solidarity with the poor, and I cannot even conceive of depriving my children of health insurance for that reason. (That's why parents rarely become saints: particular love usually gets in the way of universal love, and love for one's children comes to the detriment of love for all).

But wouldn't "giving up" health insurance merely raise premiums for everybody else, and thereby be more selfish than charitable? In any case, if you got really sick, say, with cancer, the cost of caring for you would put a strain and a drain on any charitable organization or organizations. The high costs of chemotherapy, radiation, surgery, blood products, etc. can very quickly run into the hundreds of thousands a week. Pity any charities that came to your rescue under that scenario. Who else could they help after that?

One very important reason to have health insurance available to as many people as possible is that it is conducive to the peace of mind that fosters a concern for the needs of other people. There is nothing particularly salvific about financial or medical insecurity. Most, perhaps all, of us have some insecurity about our health. Dealing with unavoidable medical insecurity is part of trusting in God's love and mercy. But ignoring available ways of reducing insecurity is surely part of what living the Beatitudes would have us do for one another.

I'd like to health 'insurance' that is more akin to insurance, ie protecting people from large unforeseen medical expenses. People pay for their 'hamburgers' out-of-pocket but are protected from catastrophe by insurance. That way we would understand who needs 'society' to support their health and who can afford their daily needs. Now the whole thing is mixed together and compounded with the 'discounts' which insurance companies provide. Its impossible to figure out who is receiving subsidies and who actually needs them.Its different from Social Security which is not actually 'forced savings' but rather an 'intergenerational compact' which works as long as the population is growing but falls apart if it is stable of declining. That also brings up the even more interesting question of wealth as 'security' in old age. Wealth only works as long as there are sufficient numbers of younger people willing to 'do the work'. If not, wealth does not buy anything, because the only thing its 'buys' is the support of the next generation.

That brings to mind last Sunday's reading. "Not that others should have relief while you are burdened,but that as a matter of equalityyour abundance at the present time should supply their needs,so that their abundance may also supply your needs,that there may be equality."

"health insurance that is more akin to insurance, ie protecting people from large unforeseen medical expenses."This model is a bit simplistic. One way to prevent " large unforeseen medical expenses" is to prevent expensive medical problems. Cheap smoking cessation programs can protect some people from large unforeseen expenses for lung cancer treatments. Early detection can decrease the size of the expenditures to treat cancer. I think most people would prefer not to have lung cancer at all, which prevention might accomplish. Choosing between long, difficult treatment of stage iv cancer and shorter, more successful stage i is not that difficult either. So it seems rather odd to craft insurance that chooses late expensive involvement rather than cheaper, earlier intervention.

I don't view having insurance as making a choice between charity (helping-the-unlucky-with-handouts) and insurance (helping-me-and-my-family-with-premiums). When you pay an insurance premium 30% goes to administration and profits and 70 % goes to the unlucky other insurance subscribers. *Either way*, regardless of system whether charity or insurance, others are served as well as oneself and ones own family.

Jim P. --You raise another important moral issue -- what obligation if any do we have to keep healthy? I think there is such an obligation, but where to draw the line (MUST I eat broccoli?) is the problem.)

I thought people did indeed "die in the streets" in the USA -- there was a BBC World program on this recently.

I thought people did indeed die in the streets in the USA there was a BBC World program on this recently.

And you are correct. I guess I should have said that "officially" people are not supposed to be allowed to die in the streets.

On a very traditionalist blog that i read, one person has said that he has written to his insurance agent to cancel his individual health insurance and another has said that she has written to her employer asking to be removed from the company health plan. Several other people have said they are considering withdrawing because they understand that Catholics should not pay premiums for insurance that includes coverage for contraception or abortion.I have suggested that they wait to hear from the bishops since i haven't heard them say that Catholics must go without health insurance rather than paying into these plans. Despite the bishops rhetoric, i doubt very much that they will take that position. However, since the HHS mndate will kick in for some companies starting this August, it would be good if a reporter could ask the USCCB what their position is on this and get the word out before well-intentioned people give up the insurance protection they need. It's sad when you read a woman saying "I have already submitted a request to the company I work for to be taken off of the companys insurance plan. Im placing all my confidence in Jesus, Mary, and St. Joseph."

So it seems rather odd to craft insurance that chooses late expensive involvement rather than cheaper, earlier interventionIts not clear that prevention programs are cheaper. People are healthy until they are sick and prevention programs may not prevent them from getting sick. But it leaves an interesting question: should society be paying for health care for people who smoke? or overeat? or engage in other behaviors contribute to their own bad health? Where does individual responsibility lay?

You don't need insurance if you have a single payer plan. BTW, I enjoy socialized medicine: I recently qualified for VA coverage - full coverage, minimal out of pocket expense, ie, copays for drugs. I recently got new hearing aids that would have cost me $5,000 on the open market, but cost $-0- through the VA. (Thank you, taxpayers!) I also have coverage under the Kaiser Permanente Health Plan of No. California, which is very similar to socmed: the entire system collects premiums from employers, is the employer of all staff (including MDs), and owns all of its own facilities. It also maintains a very high record of quality of service: http://xnet.kp.org/newscenter/pressreleases/ncal/2012/022212ncal_opa_qua.... Considering that it is medicine for the masses, it is surprisingly efficient.My MD, who is a "artner," or whatever the designation is, has a share in the profits. That said, neither he nor any other doctor I have used there has exhibited the slightest hesitation to refer me to in-house specialists, prescribe tests (including some expensive ones, ie, colonoscopy) or, if necessary, to outside facilities or specialists to fill a need that they can't fill locally.Yes, KP is a form of insurance, but it is a lot closer to single-payer than are PPOs or other forms of HMO. Modeling single-payer on the KP plans would be a good first step in implementation.

O don't know anyone who doesn't think prevention is important, but I guess rthe definition of how that gets done may vary. I do think that I knowa few peopel who did "al lthe right" things and stil became very ill; but I also know many who've benefiited -even from the fre classes we've run for seniors on balance.We are overtested and some changes are coming to that.Our State health Rep. a couple of years ago had this advice to take to all lseniors in the State:'Exercise regularly and don't eat crap." (And, Jim, broccoli won't hurt you).Sounded good to me.I do think the Catholic tradition as we discussed om a thread some time back viewed health care as a "right."For poor people who have no insurance now (let's say your family makes a little more than 12 G's in Fla (as I understand ,Medicaid isn't available) and it's the ER or now Urgent Care.We can do better and the law is a big improvement in lots of ways though far from perfect.The problem, of course, is politicization .

"should society be paying for health care for people who smoke? or overeat? or engage in other behaviors contribute to their own bad health? Where does individual responsibility lay?"These are the questions addressed in the original post above. " As long as we live in a society that, as a society, will not allow people to die on the streets" we have assumed responsibility for people who smoke, or overeat, or do any of a number of self destructive behaviors. Irresponsible people, who will not contribute to insurance or pay for health care, yet will prey upon the health care system by their self destructive behavior are a real problem. We have already resolved the issue you raise; the drug addict who shows up at an emergency room will be treated. Encouraging more responsible behavior is the focus of preventive care, and is the next step after committing our society to treating those who could die in the streets.

How about the rationale that taxpayers are ALREADY paying for all healthcare of indigent people and those too cheap to get their own healthcare insurance?Part of the COMMONS of American society is healthcare - just like public schools, libraries, fire and police departments, parks, etc.The 1%ers just love all the infrastructure that taxpayers build and pay for which affords them the opportunity to make their $millions and $billions. That's the kind of socialism they like - along with socializing all the loses of their gambling investments, and privatizing all the profits.It's called "casino capitalism" where the middle class is the sap that picks up the tab!