What about those ads for affordable health insurance?
I, of all people should know better. But every time I hear a radio or television blurb telling me that “affordable” health insurance can be mine by just calling some 800 number, I call and hear the same old story.
If you have to pay for your coverage without the benefit of a company contribution, like I do, you know very well just how expensive it can be. But you should also know it is more than that. And, why it is more is the same reason those ads for “affordable” coverage are so misleading. Here is the deal.
I wrote in Are There Any Good Jobs Left? Career Management in the Age of the Disposable Worker, that in a real sense the American system of health care coverage is one that distributes coverage to people when they need it least (i.e., when they are healthy and have a job) and keeps it from them when they need it most (when sick and out of work). The reason is quite simple. Health care is a private enterprise solution to a pubic issue. As such, it is a system motivated by profits more than health care. When the two conflict, guess which one wins—profits win every time.
Look at it this way. It is expensive to provide health care coverage to people who are already sick and without income. Companies that are motivated by profit, certainly have no incentive to cover people who cannot pay and are already sick. They cannot make money behaving this way. This has historically been known in the business as the problem of adverse selection.
It is helpful to understand that private enterprise has played an important role in developing medicines and treatments for people. So this is not a plea to take the profit out of the system. It is a plea however to resist accepting the outcome of private enterprise as a substitute for public policy. When those two conflict (the public good and private enterprise) in a substantial way, action is required.
Fortunately, that is where we are today. As health care has gotten prohibitively expensive, private employers large and small are anxious to control the burden. As greater numbers of white collar workers feel the sting of job insecurity, they too see the issue as an appropriate focus of public policy. The choir of voices calling for reform is beginning to span the political spectrum.
But we are not there yet. Meanwhile understand that those ads for “affordable” health care are largely private enterprise initiatives that are willing to take you on only if you are relatively young and perfectly healthy. Furthermore, if you become covered and get sick, they are likely to look to jettison your coverage as fast as they can. Good businesses—ones that attract capital and provide good returns—look to control cost. Otherwise, those who run them join the ranks of the unemployed looking for relatively inexpensive coverage but probably won’t be able to find it.
So the next time you are tempted to respond to one of those ads, remember they are on your side as long as they can make a buck.
January 29th, 2010 at 11:16 pm
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