Politicians like to couple the adjectives “accessible” and “affordable” with the word “healthcare” when describing the goals of healthcare reform. They say that with reform, all Americans will have health “insurance” and that it will be “affordable”. I’d like to suggest that we eliminate the term “insurance” when talking about healthcare.
Insurance protects us from experiencing an unexpected loss that is greater than our ability or willingness to pay. I spend thousands of dollars a year on home owners insurance to protect me from financial catastrophe if my house is destroyed by fire or an earthquake. I spend thousands more to insure my automobiles against theft and collision. In both cases, I am pooling my money with tens or perhaps hundreds of thousands of other people to protect me from a loss that statistically only happens to a very few those who are insured.
But healthcare is a different kind of animal. Insuring people for healthcare expenses, especially with low deductible plans that cover almost everything, simply doesn’t pencil out and especially doesn’t if we try to affix the word “affordable” to the premiums needed to support such “insurance”. How much would my home owners insurance cost if every covered home would one day burn to the ground? How much would car insurance cost if everyone in the country drove a red Ferrari, and every red Ferrari got totaled? To my perhaps simplistic way of thinking, that is the conundrum of health “insurance”. We are asking for “affordable” premiums that will protect us from the financial burden associated with services that each and every one of us will need; services that will cost hundreds of thousands of dollars over the course of a lifetime. In fact, I’ve read recent statistics suggesting that the average American will need $240,000 just to cover out of pocket healthcare costs not paid by Medicare between eligibility and death. Affordable? I don't think so.
When it comes to discussing healthcare, I think politicians need to start using a word other than insurance, and they certainly need to get rid of “affordable” in the same sentence. Yes, there’s plenty of room to make healthcare “less expensive”. Technology, preventive services, disease management, and process design re-engineering can make healthcare less expensive and more accessible. But no country can deliver affordable healthcare, insured or not, that provides everything than can be done for everyone who wants or needs it. Healthcare reform should not be debated without a healthy dose of “tough love” on basic economics and a whole lot more detail about what we’ll really be getting. And for goodness sake, let’s stop talking about “affordable” insurance. Am I missing something here? I don’t claim to be an economist. I’m just a doctor who gets really confused when people throw around terms that don’t “add up”.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft