Thursday, February 9, 2012

Health Insurance is Consumption not Insurance?

In today's WSJ, in the context of the recent contraceptives mandate, John Cochrane touches upon why health isurance is not insurance at all. Insurance involves paying a small premium to receive a large payout from a small probability event. The large payout comes from the pooling effect of the few that will be hurt and the many that will not. Health service is not a small probability event. Everybody needs health services every day, just like they need food. Some need more, some need less, just like food. Without it people die, just like without food. We don't have food insurance, we have food stamps for the very poor. Otherwise everyone has to pay for themselves.
The real trouble with health insurance may stem from the fact that in the U.S. we get it from our employers. The employer expense is tax deductible - no incentive to save. The insurance is not portable - no preexisting conditions coverage. The co-pays are super low - no incentive to check the doctor's bill.
The other trouble comes from the fact that we, Americans, choose to spend our money on other forms of consumption, rather than health care: video games, cell phones, caramel lattes.
Adding benefits to health care plans means pooling the consumption cost, ie shifting the cost from the small group that will consume the benefits to the rest of us. This applies to all health services: contraceptives, diabetes, cancer treatments, cholesterol screening. Perhaps that is what we want in our rich society, but then what about other "essential" things: dental services, eye care, driving skills, education, beach vacations?
Once you accept health care as consumption, the real question left is how to ensure innovation and efficiency-driven cost reduction through competition. What do you think, patient?

2 comments:

  1. In China, expecially small cities, there are many clinics, which are similar with supermarkets, people can go there to see a doctor and buy medicine without any insurance. However, in big cities, the health insurance starts to get popular, more and more people want to have good insurance. Does this mean health insurance is result of a society's development and modernization?

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  2. I think you hit the nail on its head. As the society grows richer, certain things become entitlements/rights. health care in the very broadest sense seems to be an example of that in the Western world. I can see why hospitalization due to a life-threatening accident should be an "entitlement" of the citizenship, but I do not see why teeth whitening should be too. Unfortunately, in health care almost everything falls between these two extremes. By including many things in the essentials category, we drive price competition out of it, and drive the cost up.

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