Your relationship to the healthcare system

Ezra Klein made an important point about the way we tend to conceptualize our relationship to the healthcare system and health insurance -- in short, we tend to freeze our view of the relationship in the right now, rather than conceiving of it over time and in differing circumstances, which is probably a better way of looking at the issue.

Right now, a majority of Americans have health insurance of some kind. Perhaps you are one of those. Even so, consider the following:

1. Tomorrow you may get laid off from your job. If you do, you will be able to maintain coverage for a short time only if you can afford to pay very high COBRA premiums. You may find this difficult since, you know, you don't have a job.

2. Tomorrow, notwithstanding the fact that you are young and take good care of yourself, you or a loved one may get very sick, may get in a catastrophic accident, and may require extremely expensive medical care. As a result, you may bump up against your health insurance policy's annual limit on benefits. Perhaps you didn't realize the policy had an annual limit. That's a real shame, but so it goes.

3. Tomorrow, an insurance company may tire of paying out so much to care for you or your loved ones' chronic condition, which condition requires expensive treatment. Accordingly, notwithstanding the fact that you have paid your premiums in full, the insurer may drop you. Watching the bottom line and all that. Perhaps you did not think that was legal. It is unless prohibited by your policy, and so it goes.

4. Tomorrow, you may need expensive treatment to help you fight ovarian cancer, or testicular cancer. You just want to live a little longer and maybe see your children go to middle school. But the insurance company would prefer otherwise, and assigns a bureaucrat in its employ to pore over the questionnaire you completed when applying for insurance. Turns out, you neglected to mention the appendicitis and appendectomy you had five years ago. The insurance company and its bureaucrats decide that this amounts to a misrepresentation. True, it's irrelevant to your treatment for ovarian cancer, but it's still grounds for the insurance company to deny coverage and rescind your policy, which they do. No middle school graduation for you. So it goes.

5. Tomorrow, your wife is diagnosed with ALS and will need years and years of care. Fortunately, your employer based insurance covers it and the insurance company (so far) hasn't pulled any antics to deny coverage. Excellent! But you work for a company with five hundred employees or so and next year, that employers' cost for providing healthcare benefits to its employees goes up materially. The HR director inquires of insurance company as to why and the answer is simple -- your wife. The day after tomorrow, you find yourself out of a job on a pretext because your employer cannot bear the increased costs of health insurance that result when the insurance is covering your wife. Bottom line and all that. Yes, it's true that you cannot legally be terminated for this reason, but concocting a pretext is truly child's play.

6. Tomorrow, you may want to leave your current job that provides health insurance for a better one that also provides health insurance, but you have a pre-existing chronic condition (say asthma, or chronic back pain, or high blood pressure, or whatever). You may opt not to change to the better job because you will be denied coverage for treatment of your pre-existing condition for up to twelve months and you and your family cannot afford that. Too bad, but so it goes.

Long story short: you may be reasonably satisfied with your health insurance today. But there is no reason we should accept a system where the tomorrows I set forth above are possibilities. And they are possibilities -- for all of us.

You can see my previous posts on health care here, here, here and here.