Insurance is one thing. The safety net and redistribution are other things. Public goods are also related, yet separate from insurance.
This seems like a noncontroversial statement. Banal, even. But as the Senate takes up the Republican healthcare bill, it is necessary to articulate the difference between insurance and things that are not insurance —at least if the recent waves of brainless snark, media incuriosity and liberal indignation are an indication.
Rep. John Shimkus, R-Ill., was on the receiving end of such a tidal wave in March after he implied the forbidden distinction between insurance and things that are not insurance. Shimkus was criticizing Obamacare’s Essential Health Benefits. EHB regulations bar insurers from selling — and thus bar customers from buying — health insurance plans that don’t cover an Obama-prescribed suite of procedures, drugs and treatments.
The upside of this mandate is that it makes it easier and cheaper for people to get coverage for treatments that would otherwise be more expensive or unavailable. The EHBs can also reduce the number of unpleasant surprises wherein patients learn, only after the fact, that some basic product isn’t covered.
The downside is that it makes it harder to find an inexpensive plan. If you want to buy a plan that covers one drug in every class but no more — thus reducing the cost of your plan — EHBs might make that illegal. If you’d rather self-insure when it comes to laboratory services or mental health and save on premiums, you can’t. One analogy is that Obamacare’s EHBs outlaw stripped-down car models and make you buy at least the mid-range model. This drives up car prices for those who want low-priced models.
Some Obamacare defenders reject that analogy. “Don’t pretend ACA is like making everyone buy a car with a sunroof,” wrote one official at a hospital lobby group. “It makes sure dealers can’t sell you a car without brakes.”
But that’s not true. Every car needs brakes. Obamacare’s EHBs required everyone to buy maternity care and pediatric care. Not everybody needs these. I have friends who don’t own or rent a home — they live on the road. We don’t make them buy homeowner’s insurance.
This sort of thing was what Shimkus pointed out.
Forcing me to buy mental health insurance is best described as paternalistic, for better or for worse. It’s the government saying, “You don’t really want to make that decision, so we won’t let you.”
In contrast, forcing infertile people, single men, lesbians or post-menopausal women to buy maternity coverage isn’t a question of paternalism. It’s forcing people to buy something they do not want and will not use.
The ire over Shimkus’s comment — and the cascade of snark that accompanied it — was the result of a confusion that Obamacare has only made worse. Many people hear that objection — I shouldn’t have to buy maternity coverage with my health plan because I won’t get pregnant — as an argument against helping out poor pregnant women. They assume it is an argument against redistribution or a safety net.
There’s an argument to have, of course, over what role the federal government should play in fulfilling our duty to help mothers and babies who need financial help. But that is a debate over the size, shape and location of our safety net and the extent of redistribution we should have.
Insurance is something completely different. Insurance is about many people, who face uncertainty, pooling their medical risk. Uncertainty and risk are what make insurance make sense — you may face a cost, but you may not, and you don’t know the magnitude. If you know you won’t face a cost or you are willing to bear all the risk yourself, then opting out of insurance is reasonable.
But Obamacare transformed insurance plans into insurance-plus-redistribution plans. By forcing me to buy coverage I won’t use, it subsidizes those who will use it. Again, such redistribution from the low-risk to the high-risk is arguably appropriate. But what Obama and Shimkus’ critics never explained is why redistribution is properly conducted through profit-taking middlemen in the insurance industry.
Asking for nuance and distinction in the coverage of healthcare reform is bit naive, I know, especially if anyone approaches issues of sex. It would be wrong to say Shimkus should have understood the risk of being misunderstood. That wasn’t a risk. It was a certainty.
Timothy P. Carney, the Washington Examiner’s senior political columnist, can be contacted at [email protected]. His column appears Tuesday and Thursday nights on washingtonexaminer.com.
