July 10, 2014

Health Insurance and Cable TV: Separated at Birth?

The other day, I talked about what might be behind the hatred and vitriol that are flooding comment streams on the Hobby Lobby case. I didn't much think it was about contraception.

In researching that post and in doing lots of other research since the Affordable Care Act was passed, I uncovered what might be an educational opportunity.  It seems that, once you get past complaints about people being required to have insurance, or complaining about all those other, shall we say unworthy  people getting insurance under the ACA (which don't really seem to be about health insurance any more than the contraception argument is), some people are complaining about something they don't understand.

So today, I thought I'd try to make health insurance understandable by comparing it to something else that most of us are familiar with.  Because for most practical intents and purposes, health insurance works like cable TV. (I'm using cable as the example for this post, but it's true of the dish guys and fiber optic guys too).

I mean, think about it: you know which stations you really want to watch, but it's just about impossible to get only those stations; instead, you end up getting 30, 50 or a hundred or more stations in your all-in-one or bundle-of-joy package that you will maybe watch once or twice a year,  along with the 20, 30 or 40 you've convinced yourself you're going to watch regularly.

Why do you get so much more than you want? Because the cable companies would rather give you a bunch of stuff that you have no intention of watching (in addition to what you really want), because it's easier and/or more cost effective for them to do so. Or, if you're really cynical, they do it because they can, because they're giant conglomerates and in some cases monopolies, and they don't give a hoot about you and me. Of course, the cable guys would probably prefer to say that they can deliver better benefits to more people by having everyone have only a limited number of packages to choose from, a couple of sizes fitting most customers, and by sharing the cost across all users instead of individually charging us for what we actually watch.

Now, look at that description above, and replace cable guy with health insurance company, and see if it makes sense. "Better benefits than you need or want, because it's easier and/or more cost effective to do it that way than it is to individually charge us for what we actually use" sounds pretty much like health insurance, right?

(And yes, so does "giant conglomerates" and "monopolies" and "they don't give a hoot about you and me" -- that's one more similarity between the two, sometimes -- but it's kind of off topic).

When it comes to cable TV, I hate the 'more is better' concept. Frankly, I'd much rather pay for what I want than get a bunch of junk that I don't care about, even if it means I pay more.  Most people think that's nuts -- why pay more than you have to? -- but I think it would help me determine what I really want, versus what I think I want, and frankly if I had to pay what it really cost to watch TV, I'd probably watch less and save money.

When it comes to insurance, however, I'm actually OK with paying for more than I need, (or at least more than I hope I need) and sharing the costs with other people. Why? Because doing it this way means I actually end up paying less for what I need/want than I would if I had to pay the full shot myself.

Most folks know that generally, preventative care is 'free' under the ACA and under most plans in most states, either because of mandates that have been around since before the ACA, or because of what's commonly referred to as 'conforming legislation' that brought many state regs up to the level of the new federal regs.

In addition to the preventative care, and no waiting periods for preexisting conditions, and no annual or lifetime limits on a set of 'essential' services, there are other mandated benefits that are covered under most plans.

For example, here's just a partial list of the ones that are covered (at least to some extent) here in NY:
  • home health care
  • second surgical opinion, and second opinion for cancer diagnoses
  • medical conditions leading to infertility, and some infertility treatments
  • reconstruction after breast cancer related mastectomy
  • enteral formula
  • chiropractic care
  • treatment for eating disorders, chemical dependence/abuse and mental health
  • autism spectrum disorders
  • bone density screening and related treatments
  • diabetic education, supplies and equipment

I don't know about you, but I don't have desire to use some of these, or I'm the wrong age, or I don't have the specific illnesses that benefit from the treatments offered.  And I sincerely hope that I won't need to use some of the other benefits on the list  At the same time, however, I understand that lots of people do need these benefits, that some people are particularly passionate about making sure they're available, and that the passion they exhibit can drive legislators to pass laws that translate into benefits that you and I will have to pay for, even if we will never ever use them.

Let's go back to our analogy:
  • Somehow, all the folks out there who are passionate about things like alligator wrestling, hoarding, cooking, decorating, shopping, sports (individually or collectively), movies, history, antiques, guy stuff, girl stuff, animals, kid stuff and everything in between have convinced someone that they deserve air time, (just like the people who are passionate about health insurance benefits have convinced people to cover them). 
  • Someone figured out that it's cheaper if we all get stuck with the whole shebang even if we're not interested (just like the ACA and state insurance regs do). 
  • And the local TV stations have convinced people that we should be able to get them 'for free' (just like preventative care), and that we should all be able to have it all now (like not having to wait for waiting periods to pass). 

When I look at the similarities between health insurance and cable TV, I'm left wondering why we so readily embrace the concept of subsidizing other people's entertainment, but balk at the same process when it's applied to health insurance?

And why we don't see that our own television -- and health insurance -- are subsidized by coworkers or neighbors or family members or complete strangers, so when we complain about people who are getting 'something for nothing' or who are not 'paying their fair share', we're really talking about ourselves?

I'd like to think it's less like the contraception argument and more because people don't know how it works. Do you think maybe this analogy will help?