Imperfect coverage for imperfect victims

How many times has a GoFundMe for health care services popped up on your newsfeed?

How many times have you donated to help someone pay for care related to their health needs?

Why? Which ones warranted a donation and which ones didn’t?

Was it because you knew the person? Was it because they were poor? Or was it because they were the ‘perfect’ victim?

Data suggest that we are most compelled to give to someone who was doing everything ‘right’ and something went wrong. Someone who runs ten miles a day but was struck down with a heart attack. Someone who was wearing a helmet on a bike and hit by a car. Someone who was volunteering abroad and caught a vicious disease.

But are these ‘perfect’ victims the only people who deserve assistance with their health care costs?

We have a blended health care system. We cover the disabled, poor mothers, children and elderly with government-sponsored and privately-administered health care plans.

The rest of us use a private market-based system.

Health insurance coverage does not have to be tied to employment status. In fact, the employment-based health insurance system that evolved in our country was a happy accident during WWII. The US government, afraid of severe inflation seen in Europe post-WWI, instated wage and price controls during the war. With a limited employee pool and strict wage controls, union groups looked for other ways to remain competitive and attract employees. They lobbied for a tax-exemption for health insurance coverage and they succeeded. To this day, we now associate health insurance with employment status.

The ACA/Obamacare/death panels/etc. sought to improve our health insurance market by working within our existing coverage model. It instated regulations on health plans, expanded (in 32 states) Medicaid to the poor childless adults, and offered subsidies to those between 138-400 percent of the federal poverty level to buy private insurance plans through exchange marketplaces.

This was to appeal the existing industries and infrastructures.

It wasn’t perfect and Congress defunding reinsurance and risk corridor programs didn’t help to stabilize premiums, but it helped 20 million additional people gain health insurance coverage.

President-elect Trump now says he wants to allow states to sell insurance across state lines and abolish the ACA (except for the ‘good’ parts like the guaranteed coverage provisions for people with pre-existing conditions and keeping young adults under 26 on their parents health insurance plans).

Do you expect the FDA to make sure the food and drugs you buy are safe? What about smoothies on the internet? What about supplements (which aren’t currently regulated)?

The ACA instated regulations to make sure that the plan you spend hundreds of dollars on a month actually provides you benefits when you are sick. Buying a cheap plan from North Dakota because the state doesn’t ensure that the plan actually covers anything, won’t help anyone. It will drive a race to the bottom and everyone’s plans will be essentially worthless (but cheap). Car insurance is regulated in states and people are required to maintain a minimum amount of coverage to safe guard others on the road. The ACA provided much needed health insurance oversight.

We expect the government to provide services that are a ‘public good’ and don’t necessarily make market sense. Public schools. Clean water. Utilities.

Does health insurance make market sense? I’m not sure.

But I know that no one, even if they are a smoker, or a sky-diver, or a reckless teenage boy, should be dependent on the generosity of his social network to cover his health care costs.

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