It had been another week of political turmoil. Ah, sigh. The health care bill had gone down in flames, with recriminations flying. Dare I even write a blog on this freighted topic?
While I do not pretend to have solutions on Medicaid expansion, tax credits, subsidies, mandates and all those complicating details, I do know a thing or two about insuring risks: the pools need to be deep and wide. Cross-subsidization is what makes the whole thing work. Maybe some years you’re healthy and you pay more in premiums than the costs you incur, but then some years you pay less. Sometimes way less because you are ill. You were in an accident. Or your newborn spent time in the NICU.
A risk pool is the ultimate unum. As in, our national slogan, “out of many, one.”
So, yes, there are real issues to contend with, such as how many essential health benefits are we all going to pay for. While there certainly should be a spirited debate about what’s essential for whom and how to pare costs, the underlying selfish mood is more disturbing than the politics (and that’s saying a lot). In the frenzy to lower premiums, some are advocating for essentially individualized risk pools for “me, myself and I.” It’s understandable, right? A man shouldn’t have to be in a pool with a woman, as he would have to cross-subsidize her maternity costs. A young person shouldn’t have to be lumped in with the geriatric set as that would raise her premiums. Each to his own! Pay as you go.
At class last night, I asked my 20 and 30-something students about this. “You’re healthy. Bless you. Does this mean that your health insurance should be priced as if you were the only risks in the pool?”
I think they liked that idea until I inquired if they had parents. Grandparents? A sick child? It’s a continuum, you know. Someday it will be you, my father used to say.
Driving the Washington DC beltway late one evening (speaking of high-risk activities) miles and miles of overhead signs proclaimed this in LED glory: “Silver Alert. Red Cadillac Eldorado. Call 911.”
My eyes anxiously scanned the lanes for the Eldorado. At that moment, I imagined that thousands of drivers on the road that night–regardless of age or gender or politics, and without knowing a single thing about each other as we sped along in our own worlds and vehicles–they were feeling exactly what I was feeling: sudden concern for an elderly driver. Lost.
After the week’s rancorous debate, it was a good feeling, this pang in the breast. The concern that comes from being in the pool together. This unum thing.