Friday, February 27, 2015

None of Your Business!

A few days ago I received in the mail a health questionnaire from my insurance company asking me a bunch of questions about my general health, number of prescriptions, health conditions, whether I had visited an Emergency Room in the last year, and what help I needed taking care of myself.  My first reaction was that it was none of their business.  I wanted to ignore it and toss it out.

When I thought about it from an economic understanding point of view, I changed my mind.  Unless I am willing to pay for my own medical costs it is their business.  Not only that, it is everyone else’s business as well.

Years ago thinking changed in America and elsewhere.  It was accepted that people should not have to pay their medical costs.  The employer or the government should cover some or all of the cost.  The result was an economic isolation of doctor and hospital bills.  From a very high level the costs of every office visit, hospital stay, medical procedure and Emergency Room visit, no matter how urgent or trivial, go into a big imaginary pot.  That pot of medical costs is then divided up among all the payers - insurance companies, employers who are self-insured and the government.

From an economic understanding point of view, none of those primary payers has any money of their own; they just administer, process and move around the money they collect from us, as taxpayers, customers and premium payers.  There is no magic money tree to cover any part of those bills.  That imaginary pot is filled with money that gets there indirectly from our pockets.  And as was pointed out very bluntly in the aftermath of the Affordable Care Act, healthy people must be forced into the system to subsidize the unhealthy.  No one is allowed to opt out of coverage that doesn’t apply.  That is the only way to keep the overall costs down.

The only reasonable response then, is that my health and the lifestyle required to maintain it are not only the business of my insurance company, but also of every other citizen.  Do they have a right to tell me that I should be losing weight or eating more fruits and vegetables or exercising more?  It certainly seems like they should.  Do they have any mechanism to enforce that right?  Not yet.  There probably will never be a time when your neighbor is obligated or even allowed to stop you at the checkout and insist you return that bag of chips; but, as the imaginary pot grows out of control, will the government decide that mandatory labels and sage advice not enough and begin to ramp up regulations that become more and more personally restrictive and intrusive?  Transfats and soft drink sizes may be just a start.  That is more likely to happen and something to seriously consider.

Another point that I’ve made in several past examples is that when you give up responsibility, you leave yourself open to losing some freedom.  In this case turning the responsibility of paying your doctor over to others results in having to follow their rules and sometimes fighting with insurance companies or Medicare to receive what you think is due.  It involves confusing paperwork, loss of the ability to buy only the types of insurance you need and eliminates the option of being uninsured. 

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