Subscribe to this BlogAffordable heath care: A right, or a product?
Last month, Sen. Jon Kyl (R-Ariz.) introduced a health-reform-bill amendment that would have prevented the federal government from requiring insurers to offer any particular medical benefits. "I don’t need maternity care," he said. "And so requiring that to be in my insurance policy is something that I don’t need and will make the policy more expensive."
Michigan Democrat Debbie Stabenow zinged back: "I think your Mom probably did."
The left side of the blogsphere loved this. Democrats used it as fundraising opportunity.
Politicians are probably best advised to stick to a rigorous pro-motherhood line. But Kyl's point was really just an extension of a view about health insurance that a lot of Americans hold. Ask yourself how many of these statements you agree with:
- Sue smokes a pack a day. It's only fair that her health care costs (insurance premiums and out-of-pocket expenses) should be higher than a non-smoker's.
- Juan works out and weighs 160 lbs. He should be allowed to pay lower premiums than Dave, who is clinically obese at 230 lbs.
- Anna's daughter has Type 1 diabetes, a condition which isn't caused by any known behavioral causes. Anna's family should have to bear steep premiums and out-of-pocket costs.
- Susan is 60. She should pay many times more for insurance than Janelle, who's 30.
- Nick has cancer and just lost his job, so he needs to buy a new policy. Insurers should be able to turn him down for coverage, or offer coverage that doesn't include treatment for his pre-existing condition.
- Ray is 26, single and very fit, so he doesn't have to see the doctor very often. Since he can carry routine expenses himself, he should be able to buy insurance with a very high deductible that covers only catastrophic costs. Or even no insurance at all.
The more of these you say "yes" to, the more you think of health insurance as simply another consumer product, like houses, cars, clothes, or food; people have different needs, wants and risks, so it makes sense they'll pay different prices for different kinds of coverage. The nongroup insurance market works like this, although not completely. As The New Yorker's Malcolm Gladwell discussed in a 2005 article, this "actuarial" model of insurance is pretty much how car insurance is priced; go ask a 19-year-old male what it costs to insure a Mustang. People with a free-market vision of health-care argue that this model would work just fine for the vast majority of people if the government wasn't already so involved in shaping the market for insurance.
But the more strongly you disagree with any of those statements, the more you tend to see health insurance as a tool for sharing risk. That means healthy people pay for benefits they aren't using, to lessen the financial burden on people with the bad luck to get sick. The health systems in Europe and Canada are all about risk sharing, Gladwell notes, but so is Medicare. And so are the big corporate health plans people say they like so much.
This split between consumerism and risk-sharing goes way back, and it explains many of the big policy difference between Republicans and Democrats, says Jonathan Oberlander, a health-care policy expert at UNC-Chapel Hill. But the lines aren't always so bright.
The Democratic health reform bills in Congress right now mostly push toward greater risk sharing. They force insurers to offer individual coverage without regard to health status, and they require individuals to buy insurance with at least a set amount of benefits. (Otherwise, healthier people might opt out or go for bare-bones plans, driving up premiums for the sicker, more expensive people left in the more-comprehensive plans.) But the bills don't go all the way. The insurance coverage they mandate leaves families with deductibles as high as $3,000, which hurts sick people more than healthy ones. One version lets insurers charge older people four times as much as younger ones, while others keep the ratio at 2-to-1. And another provision gives employers more leeway to charge higher premiums to people who smoke or weigh too much.
Even if a bill passes this year, we'll keep arguing about exactly where to draw the line between consumerism and risk-sharing. That's partly because risk-sharing places a burden on the lower-earning young, unless you are willing to subsidize their costs. (And then the question is: how much?) But it's also because most of us have mixed feeling about this — feelings that I suspect have a lot do with how much we think we control our own health. And that's pretty subjective: My body-mass index is still an overweight 27, even though I ran a marathon this year, so I have a sharp sense of the limits that genes impose on weight loss. Then again, I can't understand why anyone would smoke, so the idea of smokers paying higher premiums doesn't upset me on a gut level.
But the American Cancer Society's Cancer Action Network, interestingly, does get upset about that. The organization supports financial incentives to quit, such as higher taxes on cigarettes. But the people there don't think more expensive insurance is an effective way to change behavior. And when smokers (or others) get cancer, they also want them to get adequate care. So they're against anything that might make it harder for some to get insurance.
Which really gets at the fundamental question behind the consumerism/risk-sharing divide: Is affordable health insurance one of those things that's so important that everybody ought to have access to it, no matter what? In short, should we make it a right?
My idea on health insurance is that everyone should be given a basic level of care (preventive services) at the cost of taxes. Anything beyond that and you would have to purchase a "product" at your own cost.
In your examples, Ray could come with a torn knee, Susan could be taking better care of herself than Janelle's the 30 year-old couch potato.
"Insurance" is all about sharing risk. If health insurance is a consumer product then it should be called something else, like "medical cost agreement".
To those you say that they do not want to pay for sharing the risk other people have and they dont, I am asking them to take a long look at their "life insurance". I have one, I pay dilligently every month and will continue to do so as long as I can, and yet, I don't plan on using it any time soon.
"Michigan Democrat Debbie Stabenow zinged back: 'I think your Mom probably did.'"
In that case, Sen. Kyl's mother might (or might not) have wanted to consider buying medical insurance with maternity care coverage. But Sen. Kyle didn't say that his mother didn't need maternity coverage, he said the he didn't need it.
The Senator could have justifiably "zinged back" with: "Maybe, but don't you think that's my mother's business and not yours?"
Is the right to health care in the constitution or bill or rights???
I think that answers the question…
The founding fathers designed this country so that people would have to earn everything and work hard for their commodities. If you make it a right, you take away what a precious commodity health care actually is. You make it a right then it is given to people that might not have earned their health care. I don't smoke, I don't do drugs, I'm not an alcoholic! Why should I pay for their care?
As Thomas Jefferson once said…
"The democracy will cease to exist when you take away from those who are willing to work and give to those who would not."
It must be something that is EARNED.
It's easy to suggest that folks who smoke or feast on McDonald's every day should face higher premiums than those who are out jogging daily and eating a lean diet. But doesn't jogging have its own risks with gradual long term injuries that lead to knee replacements, or the occasional run-in with moving vehicles? What about the person who engages in high-risk hobbies such as hang gliding or experimental aircraft? Or the regular guy who drinks and drives? Or the driver with the lead foot who embraces excessive speed?
Quite frankly, people from every walk of life either have inherited or assumed health risks that are no less costly than treatment for heart disease or cancer that might be directly linked to smoking. And with the growing disparity in wages in the US, it is more imperative than ever that health care not be for sale only to the highest bidders.
Either insurance companies need to be faced with government regulation so that all Americans have a real opportunity to provide coverage for themselves, or we need a public option. I suspect a single-payer system would be even better in the long run.
People are not commodities and should have the right to healthcare in a democratic country. Too many people are going broke or thrown to the side when they get sick. This is a use it and then throw them out philosophy. The lack a regard for humans/american citizens in US has become criminal. Denying people insurance based on preexisting conditions should be illegal. The tactics used by insurance companies to maximize profits and make Americans suffer should be punishable criminal offenses. Healthcare should be a right given to American citizens so they can thrive and prosper in a democratic society. It is time for the government to step in and Stop the abuses of big insurance companies and giant corporations on its citizens. Enough is enough put an end to the greed and the killing. Impose criminal sentences on all people who are responsible for denying healthcare to us.
No more free rides for the freeloaders. The government should require everyone to get and pay for some or all of their health insurance costs, sooner or later their going to need it. In addition, Health Insurance reform will help get the insurance companies in line and stop them from gouging U.S. citizens and dictating unfair insurance policies (i.e. pre-existing conditions).
I read where it will cost $500,000/year to support just 1 soldier that is sent to fight the senseless war in Afghanistan, $20 billion/yr to support the 20,000 additional soldiers the generals say they need, that's insane! With that much money the government can pay health insurance costs for over 100,000 living Americans.
I would compare healthcare to education. We want education to be available to everyone, we do not want uneducated people, that's gonna be bad for economy, and everything else, hence we have public schools. Is healthcare less important then education? I don't think so. I believe there should be a public healthcare option.
I'd like to also add that the whole idea behind insurance was so that people who weren't wealthy enough to pay out of pocket could get the care that they needed.
I think health care is a right, what the corporate health care industry offers though is a product. To say that health care is not a right is horrible, and you have to think of the consequences. I'd rather pay my part, then leave others to die.
I love what's happening in health care reform. And yes people conciously making bad choices is one thing, but you have to understand this. Women didn't ask to be victims of doestic violence. People don't look for ways to become depressed and stay that way intentionally, not is it their fault. Some parts of this argument are invalid.
I did not ask to be bipolar, and funny enough we are given medications that cause more health problems which others will have to pay for. There are issues that will later have to be resolved here in this new approach to health care, but I'd rather have it and so would many women that can't afford their health care or even get the care they need promptly.
Why should my taxpayer dollars go towards paying for people who are smoking and continue to smoke despite having medical illnesses that are caused by smoking. I am a oncologist and am seeing patients on a daily basis who continue to smoke despite being treated for cancer. This holds true for people with cardiac diseases and emphysema. Smoking related health care costs are easily more than 50% of the nations total health care costs. So WHY the hell is it legal. Is it because our government is corrupted by the smoking lobby? or is it because politicians are afraid to go after this because they would lose votes from the smokers?
To Scott in NE. Let me make this perfectly clear: "You are 100% wrong". Do a little more research into our Constitution.
Scott W – thats quite a stretch – General Welfare = Healthcare? I didn't know that the founding father's had health insurance. They must have skipped over that part in my American History Class.
This is a hard question to answer because I do not think the concept of a "right" is clearly defined.
To start with, do you mean "is affordable health insurance" a basic HUMAN right, or a right as an AMERICAN CITIZEN? And what about the concept of affordable health CARE vs. health INSURANCE? And what is "affordable" and how much care is care?
In any case anything we have a "right" to, someone else then has an obligation to provide.
The believe a better way to word your question would be:
Do you have an obligation to provide available medical care to every person who needs it?
I bet you would get fewer "yes" votes.
Charging a smoker a higher premium should be done simply because s/he has higher medical costs, not because we are trying to persuade him/her to stop smoking. It's like somebody w/ 3 DWIs paying more for car insurance. The risk is higher, thus so are the premiums. Is that really so hard to understand?
We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, PROMOTE THE GENERAL WELFARE…Preamble to the US Constitution. Definition of welfare: HEALTH, happiness, or prosperity; well-being.
We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are LIFE, Liberty and the pursuit of Happiness. Declaration of Independence.
Healthcare is right there in plain sight.
This discussion is so 1950ish.