OPINION: Stop calling our health care pyramid scheme ‘insurance’

March 10--Like Obamacare, Trumpcare, if enacted, will compel health insurance companies to do something crazy: Sell reasonably priced coverage to new customers who already have chronic illnesses or acute conditions.

It's crazy because, even with the annual tax penalties now imposed under Obamacare (the Affordable Care Act of 2010) or the one-year 30 percent premium-increase penalty proposed under Trumpcare (the American Health Care Act, now before Congress), the law requires insurers to enter into deals in which they will almost certainly lose money.

A cancer patient, stroke survivor or anyone else with a condition that costs tens if not hundreds of thousands of dollars a year to treat can buy a reimbursement policy at a fraction of that price. Insurance companies cannot deny coverage to anyone no matter how disadvantageous providing such coverage will be to their bottom lines.

The shopworn analogy is that this is like requiring Geico to sell you retroactive collision insurance after you've just been in a wreck.

Like I said, crazy.

Also popular. Poll after poll about elements of Obamacare have found that substantial majorities -- generally from two-thirds to four-fifths of respondents -- favor allowing those with pre-existing medical conditions to buy health insurance at conventional rates.

Are most people crazy?

No, they're compassionate. Empathic. In some cases self-interested.

They don't want to see the unluckiest among us bankrupted and/or denied vital treatment at clinics and hospitals. They believe people in the richest nation in the world shouldn't have their lives cut short for lack of proper medical care. And if they're not currently among the 1 in 4 adults whose health profiles would make it difficult for them to buy affordable private coverage without the requirement, according to a 2016 analysis from the Kaiser Family Foundation, they worry that one day they will be.

At the same time, however, a substantial majority of Americans don't want to be penalized if they don't buy policies they don't want or think they need. The so-called insurance mandate is by far the least popular element of Obamacare.

Republican U.S. House Speaker Paul Ryan called it "the fatal conceit of Obamacare" in a pro-Trumpcare presentation Thursday in Washington. "The young, healthy person is going to be made to buy health care, and they're going to pay for the person who gets breast cancer in her 40s or who gets heart disease in his 50s," Ryan said with a touch of indignation in his voice. "The people who are healthy pay for the people who are sick."

As if that result were a bad thing. As if we're all not better off sharing the burdens of accidents, disease and deterioration rather than dumping the burdens directly on the afflicted. As if those who are young and healthy today aren't likely in the future to face enormous medical bills they'll be unable to pay without help.

And as if Trumpcare didn't include a financial incentive for young, healthy people to buy coverage that mimics the incentives in Obamacare.

At root, this is a conceptual problem. Health insurance isn't -- can't be -- like auto, home or life insurance in which customers pool their resources to hedge against specific, unexpected misfortune, and companies charge each customer premiums based upon their actuarially determined risk of making a claim. If it were, tens of millions of people, by dint of genetics, circumstance or misfortune, would be unable to afford coverage and would corkscrew into the metaphorical and literal ground.

In fact, health insurance is more like a legal pyramid scheme. New investors -- the young and robust -- buy in today in anticipation of returns in the future. Yes, when they're in their carefree 20s, they end up paying for their elders who have breast cancer and heart disease in a way that piques Ryan.

In my case, I paid my employee's share of health insurance through my 20s and 30s and barely saw a doctor for anything other than routine checkups. It was a terrible deal. My cohort and I shouldered way more than our share of the bills for those sickly folks in their 40s and 50s. But now that we're older, the tables have turned. Most of us of my vintage are taking more out of the system than we're currently putting in.

Thinking of this as "insurance" confuses the issue. The provision of health care services is part of a social compact similar to the compact that requires all of us to help fund public K-12 education even when we don't have kids in public school.

Thinking of this as "insurance" inspires us to funnel this social compact through private, for-profit companies that spend obscene percentages of our collective investment on marketing and swollen executive pay.

Thinking of this as "insurance" makes us think of medical problems as unforeseeable calamities rather than inevitabilities, and it frames decent, available, affordable health care as a privilege, not a right.

Thinking of this as "insurance" delays the day, which I still believe is coming, when we stop pitting the healthy against the sick and when a Medicare-like system covers us all.

That delay? Truly crazy.

The latest Mincing Rascals podcast features Kristen McQueary, John Williams, Steve Bertrand and me bickering about health care, defamatory tweets and state politics.

Donald Trump's secret backup plan to kill Obamacare

Trump the weakling and his latest surrender

GOP's Obamacare replacement could do serious harm

The Republican replacement is even worse than Obamacare

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