The health care debate is a complicated discussion, right? Well not really, so I have an idea to make it simple, think of your car.
Your car is a large complex machine with many moving parts, sophisticated computers keep things working and the engine must perform every time it is required to do so, not unlike your body.
To protect your financial risk you buy auto insurance and if you are like most people, you have a high deductible to keep your premiums as low as possible. In some parts of the country this coverage is modest in cost and in others quite outrageous mostly because in some areas there is abuse, higher risks and state regulation that all add to the cost. In some cases, this regulation leads to insurers abandoning the state as a place to do business.
This insurance is designed to protect you from unforeseen risk and the costs associated with that risk. The risk may come from external forces or something dumb you did yourself. The people who sell this insurance want to know the risk they are taking so if you are younger and a male you pay more, if you have a bad driving record you pay more, if you have had a number of accidents you pay more or perhaps you cannot get insurance. This is designed to keep costs down for all customers of the insurance company and of course, to minimize the risk the insurance company is taking.
If you have an accident and need repairs, the insurance company and the body shop negotiate over the work needed and the price, but of course, at that point the body shop has padded the bill a bit in anticipation of the negotiated fee from the insurer. In extreme cases, you are at the end of the road, you care is rationed and the car it totaled.
Because this vehicle is a big investment and you depend on it for many things, you take care of it. You have regular oil changes, rotate the tires, fix what is broken and you pay for all that out of your pocket because they are generally manageable costs and you expect them when you own a car. Carrying insurance for this kind of thing even if you could get it would cost too much.
Owning and maintaining a car is an expensive proposition, there is insurance premiums, routine maintenance, repairs, etc. In my case, I estimate that totals about $4,000 a year for two cars.
Now, take all the same facts and apply them to health care and for some reason we cannot be expected to pay for our own preventive maintenance, routine repairs and tune-ups, we need insurance. We don’t expect insurance companies to manage their risk even though when they do so, the healthier customers pay less. If we spend $4,000 to have two cars that’s ok, but if we asked to spend that on our own health it is outrageous. We have a distorted view of what is affordable. Shouldn’t our health come before our car in priority? Across the country, there are strikes over raising a health insurance premium contribution and at the same time, the auto insurance premium goes up just as fast it seems.
Five hundred dollars spent out of pocket on car repairs is the same as $500 spent out of pocket on health care, it is still $500, but $70 for a prescription is unaffordable. I remember a few years ago I wrote an article about a state that mandated coverage for birth control pills. My logic was that such a prescription was not an insurable risk, nor was it especially expensive about $20.00 per month as I recall, or was it even necessary, as there were alternatives. I was taken to task over the article because women should not be expected to pay out of pocket.
What is the difference between paying for a car and paying for health care? The difference is that we cannot be objective about health care, we do not want to spend our money on health care, it is far easier to let the costs float in the void of government or insurance rather than confront them at the point of service. This is why it is easier to raise the payroll deduction then the office visit co-pay even though logic would call for the opposite.
It is also why it is extremely risky to expand coverage before we attempt to change the mindset we have about health care and our role in paying for it.
To understand the health care system, think of it in the context of the car analogy. If health care were a car, the oil companies would decide the size of the engine in your car, the miles per gallon you receive, the number of miles you drive each year, the price of gasoline per gallon and sell you the insurance to cover it all.