Reading the Washington Post this morning, I came across a Letter to the Editor by Edwin L. Fountain of Arlington, Virginia criticizing how a health care reform op-ed by Michael Kinsley that had run a few days earlier had labeled the practice of insurers not covering preexisting conditions as "odious":
As a result, in the 14 years since [Clinton's attempt at reform failed], millions more are uninsured, and here we are trying reform again. I'd like to think that if it goes down this time -- when even the insurance companies are on board, promising to eliminate their odious policies about preexisting conditions -- Republicans will pay for having killed it, if indeed they do kill it. But they didn't pay the last time.
Fountain's response, while you may or may not agree with it, puts the entire health insurance/health care debate in its proper context:
There's a Reason It's Called Insurance
What, according to Michael Kinsley, is "odious" about insurance companies' policies on preexisting conditions ["Change We'd Rather Do Without," op-ed, Aug. 28]? People buy insurance against risk, and they agree to pool their risks with other people. In exchange for others paying for the costs of your care if you eventually need it, you agree to pay your share of the costs of theirs. A person with a preexisting condition, however, is not pooling his risk of needing care; he is asking other insured people to pay for his certain costs of treatment. That is no longer insurance against risk. It is cost-shifting.
Your immediate reaction is probably that Mr. Fountain is an insurance industry stooge or stockholder, defending his personal interests, but his points (that I bolded above) are spot on, accurately pointing out the difference between insurance and cost sharing. In pooled-risk insurance, those with preexisting conditions, were they covered, would be taking advantage of those in good health from the get-go. While this may seem unethical, it is true, and to deny that would be foolish, because it points to the solution that Fountain, perhaps somewhat reluctantly, articulates:
If we want to change the concept of insurance so that it is mandated cost-sharing among all citizens for the benefit of all citizens, so be it. But until then, don't castigate insurance companies for policies that are fully consistent with the concept of insurance.
That's the only answer. The idea of health insurance needs to be fundamentally changed to be more of a cost-sharing program or at least one offered as a subsidized public option. As long as there's a public cost-sharing option, I agree with Fountain that private health insurers should be able to continue to operate pretty much as they do now, as true brokers of "insurance," able to deny membership for monetary reasons.
This is how it already works in various other countries, even some with true government-run health care, and it's why we need a public cost-sharing option a hell of a lot more than we need any sort of health insurance reform.