Saturday, March 27, 2010

Cars are not people - Welcome to finite value

Auto Insurance Mandate is a False Argument
Humans are not autos


You’ve likely heard it. “If the government can mandate auto insurance, then why do you say it cannot mandate health insurance?”

There are at least four major differences (and be sure to read number 4, because it is the most critical):

First: The FEDERAL government does not mandate auto insurance. States mandate it. And three states have chosen not to do so. Auto insurance, like health insurance, is a state issue.

Second: The mandate for ownership of auto insurance only covers what the driver might do to someone else. It is liability insurance, not collision, comprehensive, glass, or preventive maintenance. To be like the new FEDERAL health insurance law, auto insurance would have to cover routine maintenance, parts replacements, and just about everything else.

Third: Even though 47 states mandate auto insurance coverage, the average uninsured rate, according to the Congressional Budget Office, is 14.6 percent. (Actually, I believe that estimate is very low, considering that in California and Texas, it exceeds 25 percent.) The uninsured rate in our mostly voluntary health insurance system has held steady at about 15.5 percent or so for a decade.

Four: Auto collision insurance is somewhat like catastrophic health insurance in that it will pay to fix damage from an accident. But it never pays more than the value of the car (there is no limitless benefit).

If an 85-year old man wraps his $3,500 car around a tree, and the car suffers $4,000 in damages, the insurance company pays the old guy $3,500. The auto has a finite value.

If that 85-year old man breaks his bones, and if health insurance worked like auto insurance, the insurance company would give the man three choices: 1) the fair market value of his life in cash, 2) enough money to pay for hospice care until he dies, or 3) pay for assisted suicide.

In the United Kingdom, the value of human life is determined by a formula. For the most ill patients and the elderly, health care regulators decide the value of human life in Quality Adjusted Life Years. If there is not enough economic value in the “repair” of a human life, plans are made to help them adjust to death. In the United States, Oregon demonstrated this principle with 64-year old Barbara Wagner.

Wagner contracted cancer. She wanted to continue to live, and indeed, if she lived in any state other than Oregon, the health system would have given her that chance. Wagner’s doctor prescribed Tarceva, a new chemotherapy drug regimen. Wagner, however, received her health coverage from the Oregon Health Plan – a government health plan. Because of its global budget, Oregon officials notified Wagner that they would not pay for her chemotherapy, but they would pay for either hospice care or an assisted suicide.

Dr. Walter Shaffer, a spokesman for Oregon’s Division of Medical Assistance Programs, explained the realities of the Oregon Health Plan. “We can’t cover everything for everyone. Taxpayer dollars are limited for publicly funded programs. We try to come up with policies that provide the most good for the most people.” Oregon’s health care managers decide, in the end, who will gain relief from pain and suffering, and who will die.

Despite strong bipartisan opposition, President Obama signed the “Patient Protection and Affordability Act” on March 23, 2010. The bill authorizes federal government approved health plans, and will help 68 percent of Americans to receive some form of federal tax subsidy to purchase overly expensive health insurance. Accepting a government subsidy means they will be governed by federal health plan guidelines. Barbara Wagner, were she alive, would tell you what this means.

Health insurance is not auto insurance: So you get the picture. Auto insurance deals with predictable, finite cost. It is a state issue, not a federal issue. And when the cost of the insured item exceeds its finite value, it is cashed out. Why would auto insurance companies cap payments at the value of the auto, and not offer limitless coverage, preventive care, reimbursements for worn out engines and transmissions? Because no one could afford it.

With the stroke of his pen, President Obama has invited you into the world of finite human value.