The on- and off-line commentary generated by my column last Friday seems to warrant further coverage. National attention this week is almost entirely focused upon the constitutionality of mandating that all U.S. citizens have health insurance. Which -- no matter how you slice it from a cost and spend perspective -- is also a question of allocating risk premiums in a fair and equitable manner.
Just in case there's anyone out there who believes that our countrymen without health coverage doesn't cost us all a fortune, that current percentage of our population over consumes ER services and has zero access to preventative care. Which doesn't even begin to address the matter that ER facilities are, therefore, less available to those insured who require the service.
Incredibly, I've heard people say: "No Insurance, no treatment ... period. Why mandate coverage?" Vast negative economic externalities for everyone aside, it makes me shudder to think about requiring hospital workers to refuse sick and injured citizens and children. That kind of hard line pontification denies conscience and common decency regardless of politics and religion.
More important -- and encouraging -- last week's comments revealed an acceptance that inefficiencies in the market and actuarial risk would inevitably need to be paid for one way or another. I believe that the manner in which the essential variable risk factors are distributed and paid for matters. Not because I'm a fairness wonk, but because lack of transparency gives rise to disingenuous political maneuvering that ends up failing us all. Acknowledgement of variable risk runs to the core of U.S. society. We prove our willingness to help our neighbor daily. But that doesn't, and cannot, always translate to directly paying our neighbor's way.
Sequentially acknowledging systemic healthcare inefficiencies, costs and specific programs to address indigent care are essential to the overall health of U.S. society beyond healthcare per se. But they should not, and cannot, be obfuscated by ignoring and homogenizing individual risk factors.
Thankfully, I can conclude -- as I'm not sure I ever would otherwise -- with the following quote from an email I received today from a Spend Matters' regular:
"You mention that you don't understand why women are deemed less healthy than men, but I don't think that is the crux of the issue. I think the issue is that women have more healthcare needs than men, and those needs are required on a regular basis. As a result, their needs incur more costs. Women have to get annual exams. And after 40 (or younger for some women), they have to get annual mammograms. I know some men, some of whom are far from "healthy", that haven't been to a doctor in years. But women are practically required to go annually (doctors will hold our prescriptions for ransom until we go)--and we often have to go to multiple doctors for different tests. I can see how insurance costs for women may, on average, be higher--even for women who never have children. Insurance companies are businesses. There may be business reasons why rates differ by sex, etc. I agree with you, though, that people who strive for healthier lifestyles should pay less, similar to how people with better driving records pay less for car insurance coverage. I think the worst thing that can happen is to leave this to the government, though. They screw up everything! I enjoy the SpendMatters blog...keep up the interesting reads!"