When I take my car to get its oil changed, they never ask me for my insurance card. Same thing when I get my 60,000-mile service. But go to a doctor’s office or hospital, and it’s a different story.
Some people say that’s the problem. They think the right analogy for health insurance is car insurance. The analogy goes something like this – health insurance has been misused because health insurance should cover catastrophes and not routine maintenance. Car insurance doesn’t cover routine maintenance; it covers a crash. It doesn’t cover the oil change; it covers the fender bender. In the same way, health insurance should cover the health equivalent of a car accident, but not the health equivalent of an oil change.
The analogy has a gut-level appeal. Insurance is insurance. If health insurance worked like car insurance, it would do a better job of keeping catastrophic events from costing people their life savings. If it worked more like car insurance, people putting their health at risk would have to pay a lot more for their insurance. If it worked more like car insurance, maybe we wouldn’t be struggling under the costs of the health care system.
Here’s the thing: I don’t think the analogy works. That is, I don’t think the situations are analogous.
For starters, let’s look at the routine maintenance (that’s not covered). How much routine maintenance is required, and how much does it cost? For cars, this is a question of the individual’s judgment and discretion. If you customize a car such that it requires more frequent maintenance or if you buy a car that requires more expensive maintenance, well, you made your own bed.
For health, though, it’s also a question of the individual’s luck. I have a friend who was born with diabetes. Routine maintenance for him is insulin shots and blood tests. He didn’t do anything to get diabetes, but under the car insurance model of no coverage for routine maintenance, he would pay a lot more than I do. Or take someone born with cystic fibrosis. They require not only more regular maintenance, but lots of specialists – meaning they’d be on the hook for very expensive maintenance. They didn’t pick a BMW, but they have to pay as if they did. The car insurance/health insurance analogy doesn’t work because the car owner got to pick their car (or got to pick not having a car), while people don’t generally pick their disease.
Let’s also look at why we have insurance in the first place. The way car insurance works, my irresponsibility about maintenance will have limited effect on you. If I don’t get routine maintenance on my car, well, that doesn’t have any real effect on your life. It’ll cost me more in the long run, but it doesn’t affect you. If I don’t get routine health care, though, well, that’s going to cost you. When an individual doesn’t get routine health care, they are more likely to end up in the emergency room – and when they get to the ER, we accept them. We take them, we treat them, and we do what we can to get them through the night.
If you show up at a body shop with a broken-down car, we all know what you’ll get if you can’t pay – nothing. And we think that’s fair. But if you show up at the emergency room with your life on the line, and you can’t pay – we’ll cover it. Because that’s the kind of society we are. We think having a good life is fundamental in a way that having a nice ride is not.