Can Health Insurance Really Be 'Affordable'?

The public may have to adjust its expectations for health insurance coverage.

June 24, 2009— -- Politicians like to couple the adjectives "accessible" and "affordable" with the words "health care" when describing the goals of health care reform.  They say that with reform, all Americans will have access to affordable health "insurance."

I'd like to suggest that we eliminate the term "insurance" when talking about health care.

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Insurance protects us from experiencing an unexpected loss that is greater than our ability or willingness to pay.  I spend thousands of dollars a year on homeowner's insurance to protect me from financial catastrophe should my house be destroyed by fire or an earthquake.  I spend thousands more to insure my automobiles against theft and collision.  In both cases, I am pooling my money with tens of thousands or perhaps hundreds of thousands of other people to protect me from a loss that statistically only happens to a very few of those who are insured.

But health care is a different kind of animal.  Insuring people for health care expenses, especially with low deductible plans that cover almost everything, simply doesn't pencil out.

It especially doesn't work if we try to affix the word "affordable" to the premiums that would be needed to support such "insurance."  How much would my homeowner's insurance cost if my insurer knew that every covered home would one day burn to the ground?  How much would car insurance cost if everyone in the insured pool drove a red Ferrari, and every red Ferrari got totaled?  That is the conundrum of health "insurance."

We are asking for "affordable" premiums that will protect us from the financial burden associated with services that each and every one of us will use; services that will cost hundreds of thousands of dollars over the course of a lifetime.  In fact, I've read recent statistics suggesting that the average American will spend $240,000 just to cover out-of-pocket health care costs not paid by Medicare between eligibility and death.  Affordable?  I don't think so.

When it comes to discussing health care, I think politicians should start using a word other than insurance, and they certainly need to get rid of "affordable" in the same sentence. Yes, there's plenty of room to make health care "less expensive."

Electronic records, preventive services, disease management, and workflow engineering can make health care less expensive and more accessible.  But no country can deliver affordable health care, insured or not, that will provide access to everything that can possibly be done for everyone and anyone who wants or needs it.

'Affordability' in Health Insurance May Be Flawed Concept

Health care reform should not be debated without a healthy dose of "tough love" on basic economics and a whole lot more details about what we'll really be getting with reform.  And for goodness sake, let's stop talking about "affordable" insurance.

Dr. Bill Crounse is senior director of Worldwide Health for Microsoft Corporation.

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