Tuesday, October 07, 2008

Difference between "insurance" and "coverage"

Before I went to yoga, I found myself in a fit of pique over Ruth Marcus' column in the Washington Post today.  And it wasn't because she was saying that McCain had a good idea.  Marcus makes the point that health insurance needs to be decoupled from employer benefits.  I agree.  Working parents, in particular, are often tied to jobs that offer them little professional advancement (and what follows, eventual higher earnings) because the job offers good benefits.  Working mothers are particularly subjected to this kind of double-bind.  

But then Marcus kind of goes off the rails.  She and Paul Krugman, both of whom are hypothetically left of center, are incapable of grasping how the health insurance industry operates and what the flaws are in it that obviate any kind of simple fix, as McCain proposes.  By providing disincentives to employers and employees to stay with employer-negotiated health plans, thousands of people will be forced out into health plans they must negotiate themselves.  Employers are able to get better benefits for their employees because they have leverage.  You and I, on our own facing the big, bad wolf of the healthcare industry, have zero leverage.  

Already the leverage of employer-negotiated health plans is showing strain, however.  Over the last decade, as we've scrambled for health insurance that meets the extreme needs of our son, we've seen items that used to be considered medically necessary become "optional" riders for employers, as a means of competing for contracts and bringing down costs.  These riders, which your employer must agree to, include things like physical therapy, occupational therapy, speech therapy, mental health, prosthetic devices, and durable medical equipment.  I was once told that the enteral feeding button, which provides a port into my son's stomach so that I can feed and hydrate him was a prosthetic device, "just like an artificial leg," and my employer had not purchased a rider that would cover that.  

So throw "medical necessity" out the window when it comes to what's in your health plan's contract.  It doesn't matter if the item would save your life, or even allow you to live, period.  If it's not in the contract, you don't get it.  You have no legal basis on which to argue that it's "medically necessary."

Marcus and Krugman fail to understand the basic difference between "insurance" and "coverage," which is a contractual matter.  We could insure everyone in America with cut-rate, minimal-benefits health insurance pretty easily.  It would be cheap.  What would not be cheap would be the legions of people left stranded without wheelchairs or artificial legs or physical therapy to regain the ability to walk after a car accident.  People with chronic illnesses or disabilities who are told that the drugs they need just aren't covered, and who then are unable to work or function.  People who are told that if they need nutrition through a g-tube, they'd better set some money aside to draft their will.  

The concept of health "insurance" in America may just be out of date.  When you buy insurance, you're deciding how much risk you want to take.  Well, when it comes to your health and well-being, you may decide you feel in a gambling mood while the sun shines, but when the booms sweeps across your stern and knocks you flat, you may feel very differently--staring down a gun barrel of bankruptcy and permanent disability (to mix metaphors).  Why are we a nation of gamblers when it comes to health?  Shouldn't everyone have a chance to recover from illness, accident, and injury, or recover to the extent possible so that he or she can continue to hold a job, pursue dreams, be a contributing member of society?

Both Marcus and Krugman don't understand that if we were to make a shift as radical as McCain's without thinking it through and protecting not only people as consumers, but people as (hello??) human beings, if we make that kind of radical shift assuming that the free market will just solve the problem for us (and oh, how I trust financiers these days), thousands of Americans will suffer, thousands of Americans will die, and thousands of American children will be permanently damaged because the Free Market gods demand blood sacrifice.  

So a "few" people don't get good coverage?  Ruth Marcus doesn't care.  Paul Krugman doesn't care.  John McCain doesn't care.  They want to blame people for doing what people do with insurance: choosing good plans with good coverage.  In their rhetorical calculus, people who don't want to be risk-takers with their health are "over-consuming."  Excuse me, I thought it was insurance.  If our health care as individuals is going to be left to the game of chance that is "insurance" anyone who can't afford insurance (even with tax breaks, which, by the way, do not benefit low-income earners because they don't owe taxes) or who hopes to have access to the cutting-edge health care the U.S. has available (if he or she should need it) is just going to be thrown to the wolves.  

The naivete, even of the left, on matters of healthcare, is stunning.  None of these people who tout these plans and these adjustments know anything about injury, illness, or disability.  They have never had to face those trials, and their failure of compassion is just stunning.


Elizabeth said...

I can tell you're just getting started. Nothing makes me crazier than insurance talk. I'm trying to wade through policies now for my husband's new business -- it all just makes me want to cry, actually. Out of frustration and anger and anxiety. Thanks for starting the dialogue, and where's your op-ed piece! You need to do that!

datbot said...

Great job putting real consequences to abstract issues. One quibble - it seems to me Krugman does get it - http://www.nytimes.com/2008/10/06/opinion/06krugman.html

jeneva said...

Thanks for the encouragement, Elizabeth. I hope you get coverage for Sophie figured out. Sometimes you can get access to high-end plans through a payroll company, if your husband is using one--TriNet is one such. Then you're part of a much larger group, esp. since you live in CA.

br--I did see Krugman's op-ed. I might have read it too fast. And it is entirely possible I am being unfair to America's latest Nobel laureate. When I read his pieces on healthcare, though, he doesn't really articulate a difference between insurance and coverage. Or he articulates a difference only to the point of noting that insurance should have appropriate or better coverage. But I still think that health "insurance" is rapidly becoming an antiquated idea. I liked the question asked in the debate: "Is health insurance a responsibility, a privilege, or a right?" If it's a 'right' (and I would guess that more and more Americans think it is), then it can't be 'insurance' anymore, because that has nothing to do with rights--that's responsibility and privilege. Another point is that taxpayers subsidize medical research in this country through the university system and federal research grants--research that leads to cutting edge treatments and cures that insurers often attempt to deny or exclude from the coverage they offer. It strikes me as unethical that the government has us subsidize this stuff, then can't figure out how to make sure its citizens have equal access to the treatments they've 'paid for' through the tax system.