Bowen: Like it or not, we all need health insurance (column)
September 9, 2017
These days, summer camp is not just for kids. We adults can spend a few days in some forest glen learning to play the dulcimer, or even join an "intentional community" and try for two weeks to get along with perfect strangers.
In that spirit, here is a quick summer camp on a topic most of us avoid like the plague, when we're not complaining bitterly about it: health insurance.
A prudent consumer will surely check the camp counselor's credentials, so here are mine: I have had my bouts with the health care system, one of which ended when the neurologist diagnosed my condition as "a mystery wrapped in an enigma." I also served for many years on an employee health-insurance committee, working with a multimillion dollar plan.
On that committee I got to take heat from colleagues when our plan didn't perform as expected, and to anguish over changes that inevitably advantaged some members and disadvantaged others. In short: Congress, I feel your pain. I understand your gridlock. Campers ready? To help us move this thing forward, here's everything I've learned about health insurance.
First, as an individual or family, don't expect to "make good" on insurance. If you are lucky, you will pay more — perhaps much more — in premiums than you will ever receive in benefits. How is this lucky? Because if you pay more than you claim, it means you are relatively healthy. And anyone who has been on the other side of this equation can tell you that having good health, not just a surplus at the end of the spreadsheet, is hitting pay dirt.
Next, all insurance is socialism. I apologize if that ruins your appetite, but it's a collective, plain and simple. Auto, boat, home, pet, liability, you name it: everyone's premiums go to pay for everyone's troubles. If it seems unfair to give while someone else gets, pretend you're on an installment plan, covering your family's troubles over a lifetime instead of someone else's troubles now.
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Private insurance, whether from our employers or the Obamacare exchanges, is a special equation involving socialism plus the cost of doing business, plus a fee we pay to make other people richer, otherwise known as profit. Single-payer insurance, as practiced in Canada and much of Europe, is socialism plus the cost of doing business plus dag-blasted guvment inefficiency. Would you like to be on a waiting list for major surgery you need right now? Pick your poison.
But premiums went up, you say, under the Affordable Care Act. True; how many costs have not? And consider this possibility: Because the exchanges run as a kind of free market, is there any chance that insurers lowballed their initial rates in order to attract customers? Is there any chance that the first to sign up were the long-uninsured in our midst, those with pre-existing conditions who couldn't get coverage for love or money, and then showed up with a lot of unmet, urgent and expensive needs? While younger and healthier citizens could skip insurance altogether by paying a yearly sum of $695 if they played by the rules, and zero if they didn't get caught? Premiums went up, a lot, and the only surprise is that anyone is surprised.
Finally, a Republican I know has this observation about health care: You can't treat it as a supply-and-demand economy, because nobody ever chooses to get sick. We Americans like to think that our choices drive our fate, but too often the truck just hits out of nowhere and you're sacked with enough bills to ruin what's left of your life.
This is the reason for the dreaded "mandate." You showed up with a physical body, and at some point you will likely need help with it. If we can agree on a system to help each other through the inevitable bad times, it reduces the uncertainties that can worry us half to death.
Congress may be unable to agree, but here is what we all want from health insurance: the promise of medical care for ourselves and our loved ones, without the risk of financial ruin. Some of us like the profit model, others want single-payer; any change in the system means a change in winners and losers. It's a little like summer camp, actually, where the older kids get the cool cabins and the newbies get hazed. At camp, though, we try to put aside our differences for the benefit of the group — at least for the time we are together.
'Asta Bowen is contributor to Writers on the Range, the opinion service of High Country News (hcn.org). She is an author and teacher from northwest Montana, and former columnist for the Seattle Post-Intelligencer.
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