The Common Good

Without Health-Care Reform, the Customer Is Always Wrong

091021-cancer-survivorFrom my up-close-and-personal perspective as a cancer survivor, I couldn't agree more with LaVonne Neff's main point: it is the system, rather than insurance corporations, that is to blame for 18,000 unnecessary deaths a year in this country. Of course, it's true that corporations and their management do commit evil, and sometimes illegal, acts, as Neff also points out. But, to riff on the words of Jessica Rabbit, health insurance corporations are bad because they are drawn up that way: their incentive structure is fundamentally broken, and any legal fix can only be partial. This is why I strongly support a "public option."

Corporations mostly work exactly the way they are set up -- to make money. A corporation would be flouting its fiduciary responsibility to its shareholders if it voluntarily sold a cancer survivor like me health insurance. I still need expensive tests twice a year to make sure that my cancer has not come back; if, God forbid, it did, I would need even more expensive treatment. This makes health care starkly different from other things you buy insurance for (if your house burns down, you are not guaranteed to have more fires every six months thereafter for five years, with an increased risk for an even bigger conflagration).

In today's world, entirely private and lightly regulated insurance is a crazy way for our society to make decisions that can mean life and death. If I had lost my job and been uninsured or underinsured four years ago, it would have taken me a lot longer to see a doctor about the symptoms which turned out to be coming from cancer. If I'd been uninsured then, I'd probably be dead now.

Basically, health insurance is a market in which the customer is always wrong -- as soon as anyone files a claim for anything significant, that person becomes a liability for the insurer. It has every motive to deny care if it can, or at the very least discourage the sick person from staying on the plan. Doing this may be morally wrong, but it's literally the corporate executives' job. Dead-wrong incentives are built into the system.

This is why I am an ardent supporter not only of health-care reform, but also of a public option. We should all be able to buy into a health-care system like that enjoyed by members of Congress. (And we should also stem the flow of corporate lobbying money to Congress, which distorts public debate.)

Dorothy Day's quote hits the nail on the head again: "Our problems stem from our acceptance of this filthy, rotten system."

By a cancer survivor praying for health-care reform.

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