The Elephant And Insurance

So here's how it works. If I'm injured or killed in an attack by someoneⁱ riding an elephant, I'm entitled to full payment of medical or funeral costs – even if I'm merely stomped by the elephant. In fact, I get benefits even if I'm stomped by an elephant who isn't attacking. The benefits are lower, but I can count on them. There's a moderate deductible (larger if I'm not within twenty-five miles of my residence) and the insurance is only good in the United States. But it's solid insurance. The government stands behind the companies that issue it.

It has to. According to the new law I have to buy it. Perhaps it's of greater value to those who appear in Aida or work in zoos or circuses, but the cost for them alone would be too great, so everyone gets the insurance. And you never know. Anyway, that's the law.

And that's the way the new health care legislation works – at least to a degree. Everyone is required to buy the insurance or pay a penalty. It doesn't matter if they need or want the insurance. That's the law.

Actually it's contradictory to the concept of insurance, which is little more than gambling. The insurance company is betting on the insured, and the insured is betting against himself. But the payout, if there is one, is supposed to be large enough to cover the risk for which it is designed. As is the case with all betting, the house – the insurance company – will come out ahead. In this case, however, the individual who “wins” will be protected from a large loss. In reality, the government is forcing the individual to protect it from the lossⁱⁱ it would face if it had to pay for his health care. The program, however, forces those in good health, and who would prefer to take the risk of going uninsured, to buy in and, in effect, pay for those more likely to need help. There's a spreading of risks so that they're equalized among all participants. If there were similar equalization of salaries we'd call it socialism. But it's not that. It's more of a method for acquiring a national health service that is paid for without the risk of being accused of raising taxes. From the point of view of the taxpayer, however, it's a distinction without a difference.

Important features of the new health care system include the provision that no one can be excluded because of pre-existing condition, and the cost will be the same for men and women. Notwithstanding the evidence that it costs more to provide health care for women than men, there will be “gender”ⁱⁱⁱ equality.^iv Women will pay no more than men.^v And with programs like Medicare, we are already ensuring that those who don't smoke or drink will help underwrite the costs of those with lung cancer, emphysema, and cirrhosis. Those poor people are already suffering enough from their medical conditions and have had to deal with increased costs from the cigarettes and whiskey. They should have help from the rest of us. If they've worked some, and are eligible for Medicare, they'll get it.

Perhaps that will be viewed as reductio ad absurdum but it's hard not to conclude that obligatory participation is little more than a tax on the healthy and a method of shifting costs to the taxpayer in order to save the government money. Because the word “tax” is viewed negatively, a method has been found to change the label. And for those who elect not to participate, there is a “penalty,” not a “tax.” Well played. The government's done it again!

The case^vi has been argued in the Supreme Court and some time soon we'll learn where the Justices stand.^vii The law, however, seems to be in conflict with previous policy and with American thought. The Court decided that certain issues involved privacy and that individual decisions should be respected. Elective abortion is a matter of choice. It's difficult for a legal layman to understand why the decision to buy health insurance should not be a matter of choice, with that option having become a major factor in the country's thought. The termination of a pregnancy – what some view as the taking of another's life – can hardly be viewed as more private, and more a matter of choice, than the decision about payment for one's insurance policy.

I have health insurance, and there really is no mandate to have elephant-stomping insurance, so I'm in good shape. The principle, however, will have to be decided by the Court. More and more the extent of government intervention in our lives is likely to pop up in a variety of forms, and this is as good a time as any to decide on its propriety.

Next episode: “People Are No Damn Good” – Except me, of course.

i      Hannibal, for example.

ii     The government – or more accurately the governments, since it's usually paid for locally– is ultimately responsible through public hospitals.

iii    We don't say “sex” anymore.

iv    Other insurance is “rated.” Those with increased risks pay premiums proportional to the increased risk. That's business. And insurance companies usually have the option of declining to insure the really bad risks. “Assigned risk” is one answer to ensure coverage of drivers who are “accident prone” (some of whom, perhaps, shouldn't be driving for the protection of the rest of us), but their rates are certainly not the same as safe drivers. And drivers have the option of refusing to buy insurance. In some states this will mean that they don't get driver's licenses, but it's their option, and there is no monetary fine for the choice not to have coverage. Where uninsured driving is legal, the uncovered driver who is in an accident – he lost his bet that he could drive accident-free – will have to pay costs from his own resources.

v     The argument is made that an accident of birth should not affect the cost of insurance. It makes sense. But there are other “accidents of birth” that do affect an individual's standing and choices: intelligence, location of birth and subsequent citizenship and residence, and family income for example. Although we may wish it otherwise, a child born in Bangladesh is more likely to be hungry and poverty-stricken than an American. It may not be fair, but it's the case. Attempts to equalize situations like that and millions more will fail however much we wish their success. And despite what may seem unfair, most firms will not hire someone born blind to be a security guard.

vi     Regarding the new health care law.

vii    Actually, they usually sit.