Today is my birthday. And as such, I reserve the birthday right to make bold pronouncements about my life. Today, as I turn 27 years old, I say unto the world that I am not a motherfucking car. Robert Tracinski, writing at Real Clear Politics, describes how terrible the Democratic version of health insurance would be:
It is “a campaign of increasingly harsh rhetoric against the insurance industry” that is “intended to drive home the message that revamping the health care system will protect consumers by ending unpopular insurance industry practices, like refusing patients with pre-existing conditions.”
That part about pre-existing conditions gives the game away. Health insurance companies refuse to cover pre-existing conditions for the same reason that you can’t insure your automobile after you crash it. Insurance is a form of financing for the unexpected and unpredictable. It is not a mechanism to force somebody else to pick up the tab for expenses you have already incurred.
Cars generally have two forms of coverage: insurance and warranties. Car insurance doesn’t function like health insurance, because cars are things and people are people. Car insurance largely insures against accidents which cause physical damage to a car. It will not cover too much damage, though; if your car is totaled, the insurance company will just pay out the full value of the car and call it a day. If I switch from Insurer A to Insurer B, Insurer B will not cover preexisting damage that was Insurer A’s responsibility. Insurer B can determine what is and isn’t its responsibility by having the car inspected, usually at little or no cost to the owner, and having the damage differentiated.
Warranties, on the other hand, begin at or near the purchase of the vehicle (its effective “birth”), and cover a variety of potential issues with the functioning of the car. The coverage is strongest at the beginning and weakest at the end, because problems are more likely to crop up as the car is used more and more – and therefore less likely to be the result of a flaw in the design (i.e., a preexisting condition) and more likely to be the result of the driver’s use of the car. After a certain point, warranty coverage terminates altogether, and the assumption is that you will either pay for your repairs for your greatly devalued car out of pocket, or just trade it in and get a new one.
If none of this sounds like your health insurance, it’s because you’re not a goddamn Transformer. And stop asking me to call you Ultra Magnus, you freak.
The purpose of car insurance is to cover liability. That’s not the purpose of health insurance. If health insurance worked like car insurance, the only time you’d ever get anything paid for is if someone else caused you harm (and your car insurance tends to only pay out net money when you’re at fault, not when someone else has caused you harm). The purpose of a warranty is to cover manufacturer fault, which is why it declines in benefits so fast. That’s not the purpose of health insurance. If health insurance worked like a car warranty, we’d have head-to-toe coverage until we hit 18, and then we would only get coverage if our heart or brain stopped until we were 40, at which point we’d have nothing. This is because when you insure cars, you’re insuring what’s commonly known as a replaceable product. As we don’t like in a shitty Michael Bay film, there aren’t extras of us running around when the old ones get too run down or too expensive to upkeep. The problem with the “unpredictability” argument is that it’s not actually relevant to healthcare – a car is a different thing from a human body, which you can tell by trying to make your car feel ashamed for its cellulite. That metal fucker won’t even blink.
Insurance is a form of financing. It is a contract under which a health-insurance company agrees to pay for medical bills that could run into the tens of thousands of dollars, if you are hit by a bus or are diagnosed with cancer, so that you don’t have to pay for those bills out of your savings. For younger people, this means being able to pay for catastrophic care even if you haven’t had time to build up tens of thousands of dollars in savings. For older people, this means not having your retirement savings or the equity in your home get wiped out by an unexpected illness.
So let’s ask the question the left never asks: how is it possible for an insurance company to pay for these giant medical bills? What makes it possible is a whole set of statistical calculations. For every person who needs open-heart surgery or chemotherapy, there have to be a certain number of other people who are paying their premiums but haven’t gotten seriously ill. If the insurance company has gotten its calculations right, the expenses for any one person’s catastrophic care are balanced out by the premiums other people pay “just in case.”
You can see how Obama’s demands undermine this whole system. To ask insurance companies to cover a patient after the tumor is diagnosed is to ask them to take on a known expense. Combine that with another Obama demand: that insurance companies can’t charge higher rates for those who are at higher risk of getting sick. So if insurance companies have to take on a known expense and can’t charge a higher rate for it, how are they going to pay for it? By raising everyone else’s rates, redistributing their wealth to the new freeloaders.
By the way, yes, sick people are “freeloaders”. Just so you know.
Again, this demonstrates a fundamental sickness with this “people are cars” position. Car insurance gets higher the more “illnesses” you’ve had because car insurance covers liability and you’re more likely to be liable for damage to the car based on past behavior. However, the problem with people is that when we get cancer, the likeliest way to get more cancer is to not treat the initial cancer. Higher car insurance rates for bad drivers incentivize better driving; higher insurance rates for cancer patients incentivize better dying. We ask health insurance companies to take on a known expense, because otherwise any break in coverage makes it likely that you will die or go bankrupt from future health problems related to the initial (treatable, manageable and less expensive) illness.
This all makes perfect sense if you think of yourself as a Nissan Sentra, which you might. But a healthcare system which treats a unique, irreplaceable human body like something made on an assembly line, which is exactly what’s being advocated here, is a far scarier, impersonal and threatening system than one which recognizes that we have to keep our bodies running even after a melanoma or a broken leg. It’s not that reform advocates don’t understand how insurance works, it’s that reform opponents don’t know the difference between a living person and the thing they use to drive to work every day. Which one do you want in charge of healthcare?