Flutterby™! : Health insurance coverage 2009-11-04 17:21:49.400746+00

Health insurance coverage

2009-11-04 17:21:49.400746+00 by Dan Lyke 8 comments

Why we need more choice in what coverages we choose to insure ourselves for: Healthcare provision may require insurers to cover prayer:

The provision was inserted by Sen. Orrin G. Hatch (R-Utah) with the support of Democratic Sens. John F. Kerry and the late Edward M. Kennedy, both of Massachusetts, home to the headquarters of the Church of Christ, Scientist.

I've no doubt that prayer can be a powerful healer for those who believe, but, just like I'd like to opt out of psychology coverage, I'd like a little more choice on what I do and don't end up paying for.

This creates an interesting dilemma. Insurance works by having the healthy underwrite the unhealthy. If everyone pays in, it's cheaper all around.

The problem is that people who are healthy don't expect to become unhealthy. You're wanting to opt out of psych coverage is the perfect example. You are healthy now. You do not foresee ever not being healthy. It's possibly even a gamble you're willing it take with your own health. But it denies the math of insurance.

I'm not sure if I agree with covering prayer - I mean, why should I have to pay for prayers to be said?!? It seems the scope of the provision could be extended easily to other alternative modalities. Maybe it could be used to pay for peyote for psych services performed in a spiritual ritual!

Paid for prayer. Isn't that sort of like prostitution, only more intimate in that it goes to the core of the soul?

Actually, Eric, I'm wanting to opt out of psychological coverage, as distinct from psychiatric coverage. I believe that the practice of psychology has about as much scientific validity as the aforementioned prayer (and in saying that, I don't mean to diminish the power of prayer). So it's not that I can't see becoming unhealthy, it's that I'm uninterested in paying for the possibility that I could be treated by witch doctors in masks, too.

But the other point is the question of spreading the pool: Are we spreading the risk for unforeseen circumstances, or foreseeable ones, and which ones do you want to be paying for? I'm all for spreading the pool when that causes lower overall costs, for instance when we're paying for emergency services and could be paying for preventative care, and for accidents, but I think there's a balance with foreseeable risks that shouldn't fall on the "I pay for everybody no mater what they do or what treatments they believe are effective" side of things.

You just wait until a hex is put on you and you're in dire need of that witch doctor! You just wait...

I guess this strikes at the heart of the debate over nationalized health care (and the FUD we are seeing with the public option). Saying whether or not one treatment modality is "right" or "wrong" for another person assumes that you have a better grasp of both the modality and the person's situation. For some reason, we accept these judgements from our insurance companies. We take up arms when we think our government is making these decisions. Of course, they are through the FDA - but that's another issue.

In differentiating between psychiatry and psychology, you are implying that psychology doesn't really work - that people don't experience benefits like relief from depression by working with psychologists. Are you basing this judgement on scientific skepticism? Is it based on a narrow structure of diagnose and treatment? Maybe psychological conditions are complex in a way that is difficult to diagnose within that structure but is approachable by another human mind. It doesn't seem as scientific but that doesn't mean it's not effect.

Maybe it's a straw-man case, but consider medical science's attitude towards breast feeding when we were young. Doctors specifically told my mother that her milk was inferior to manufactured formula. Doctors now know that in most cases breast milk is far superior to any formula. While I would never say the scientific method is flawed, I would say it is a limited approach. The scientific method assumes the current scope of knowledge beyond the hypothesis being tested is complete and that conducting science can be entirely independent of the human condition.

I am as skeptical of science as I am of other modalities. Maybe I need to see a shrink about that...

In the psychology case, I'm not saying that it doesn't work, just that I've seen no evidence that it's any more effective than the aforementioned witch doctors in masks. Which brings me to

Exactly. Choice demands that I pay for the coverage I'm going to use, no? Otherwise there's no incentive to find inexpensive coverages, and we have the current rush to demand coverage for everything. And since so much of medicine is placebo, so much is what we believe to be effective, it means I end up paying for anything that someone can believe in.

I'm not attempting to defend any particular view of medicine, in fact I'd really like to see the AMA's monopoly on medicine broken and the health care cost problem addressed through a set of tiered providers that'd let nurses or their equivalent do a lot of what we overpay doctors to do right now. And I've defended universal coverage under the notion that there are lots of emergency room situations where we can't demand that health care providers take the time to verify coverage, so we have to have some mechanism for assuming that a base level of treatment will be paid for.

However, I believe that we're bundling far too many things that are either preventable conditions, or are matters of choice, in a way that encourages the overspending we do on healthcare.

I've always wondered if the problem is the disconnect between insurance and coverage. Insurance is designed to pay expenses related to unexpected events. The insurance companies try to come up with formulae to discover what can be expected and balance the cost of that across all insured. Coverage implies that you have some concept of what needs to be insured. If you know what can be expected, then you are reversing the formulae of the insurance company. You are saying "I expect to have this kind of expense". Of course, if everyone was able to fully exercise choice in coverage, your premiums would have to be closer to the cost of those expenses averaged over the amount of time you are paying into the plan. It's essentially financing for medical expenses.

I think there are two viable models for health care: a high-deductible true "insurance" coupled with market forces or a single-payer system which provides standard care for all. The first model assumes everyone will be rational about their health and ignore marketing claims that McDonald's food is part of a balanced diet. The 'rational actor' has been demonstrated to be a major flaw in capitalist economic theory. The second model assumes some people are incapable of being rational about their health. Maybe we can even have a hybrid, like England, where you can get private care if you don't like the standard level of care. We do have options like the first model - but the insurance companies still get nit-picky about what they will actually pay for because of the profit motive.

But I don't think that cafeteria-style plans are a good idea. You end up with people who are healthy in specific ways and not paying in, so the cost continues to pile on the portion of the population who is unhealthy in that specific way. And you continue to have people driven into bankruptcy because they failed to predict their own illness.

I think your insurance vs coverage dichotomy is well taken. Insurance is for the unexpected, but we can classify a lot of that unexpected, and make an awful lot of predictions. The other side, however, is that insurers have a strongly vested interest in preventive activity; it's been a while, but I think I've got no deductible on crack repair or replacement on my windshield, for instance.

And then there's things like vision and dental, which are largely just savings plans and ways to move that money to pre-tax dollars.

I guess I don't have a particular problem with people driven into bankruptcy because of bad decisions. Decisions have consequences, without consequences how do we learn to make better decisions? I have a problem with when those bad decisions spill over and negatively impact a whole lot of other people. That seems to be the current failure of the U.S. health system.

I suppose I should also note that I have a problem with when information is withheld or used in bad faith in making good decisions seem like bad decisions. That too seems to be a big part of the U.S. healthcare system, and there's a lot of insurance sold in the U.S. that doesn't tell the consumer that if they get ill they'll be at the mercy of their states fallback medical system.