CDS Column: Health (Insurance) Checkup

It’s December. Insurance month. I spent last night filling out forms for health insurance, and soon I’ll have to go about making my annual car insurance payment. December is no longer just about holidays, it’s now also about paying hundreds (make that thousands) of dollars for something I hopefully won’t ever need. It’s all part of the joy of modern living: Upside — my heart might stop but there is technology capable of kickstarting it again; downside — that technology isn’t free.

When I think about it that way, a couple hundred dollars a month to pay for health insurance isn’t too bad. I mean, if for a couple hundred bucks we were offered the choice between living in medieval Europe or modern New York, I’d take that deal. Medieval Europeans never got such a thoughtful offer, and internet and cable almost amount to the same amount.

And really, that’s basically what we get — forgo modern health care and things become Hobbesian quite quickly: “the life of man, solitary, poor, nasty, brutish and short.” So I guess I want to begin from a place of appreciating what I’ve got. I want to start from there.

My car insurance, my other December insurance bill, isn’t expensive. I’ve got one car, and it’s paid for. I live in the Live Free or Die state, which means I don’t even have to have car insurance if I don’t want to, but I feel like I should, that it’s the adult thing to do. My car insurance is the liability kind, which means I pay roughly $250 a year to protect other people from my negligence. That’s it. Not bad. Every year I get a little older, and every year the cost of protection declines. I’m a (relatively) safe driver, so things haven’t spiraled out of control. It’s a formula I like. It’s also a formula I can afford.

My health insurance, meanwhile, costs almost the same each month as my car insurance costs per year. I am young(-ish), active, a healthy person in their mid-30s. I don’t smoke and, as a man, I’m unlikely to become pregnant, which means most of my current health risk is in unforeseen illness or injury. Over time that will change, but right now I’m a pretty safe bet.

And as a safe bet, I cost several hundred dollars a month to insure. As I grow older my medical risks will climb, which means the cost of insuring me will also climb. That’s a formula I understand, one I can’t do a lot about. I’ve even got a window into how much that risk rises: From last year to this year, my insurance went up 7 percent. Looking ahead to next year, I’m facing another 7 percent increase.

I’m not clear what the exact case is, whether my premiums are climbing because this year my age makes me 7 percent more expensive than last year, or if I’m actually the same risk but health care budgets are expected to expand 7 percent in 2017. Probably it’s some combination of the two, but either way 7 percent seems a lot. The U.S. economy didn’t grow 7 percent this year. I did not get a 7 percent raise for 2017. I doubt even my doctor got a 7 percent raise.

So 7 percent. If this is a trend, we’re in trouble: A 7 percent increase compounded over time would make my premiums double roughly every 10 years. If I pay a nice round $200 a month today, I’ll pay $400 a month at in my mid-40s, $800 a month in my mid-50s, and $1,600 a month in my mid-60s, at which point the government swoops in with Medicare to offer some much needed financial relief.

What a model. If mortgages had the same cost implications no one would buy houses.

And 7 percent is an improvement; 7 percent is actually a slower rate of growth than health care premiums have been on in past years. Somehow we’re doing better, but even as we do better things are growing out of hand.

What to do? I know health care is a hot-button topic, one plagued by talk of death panels and government takeovers, but who wants to be paying $1,600 a month for basic health coverage when they’re 65? Maybe that’s the cost of buying our way into the modern era, of avoiding a time when tuberculosis and cholera were common ailments, but this doesn’t seem normal. It doesn’t seem sustainable. It doesn’t seem like something any of us can do for long.

Health care, however, is a monopoly business: You only have one life. You can’t replace it, and you don’t get another one. And for that life people can make you pay what they want.

President-elect Trump, meanwhile, is talking about repealing Obamacare. He’s promised to replace it with “something terrific.” I hope he does. Obamacare helped slow health care premium growth, but it couldn’t slow it to a manageable level. If Donald Trump can do that, if he can figure out a way to live in the modern era without simultaneously edging us all towards bankruptcy, I will applaud him.

But it is important to realize our modern lives exist within a monopolized industry. Health care is a monopoly business, and as with any monopoly, government has to have a hand. And judges can’t just go trust-busting here like they did with Standard Oil. Health care is a complex new version of monopolization, one built on technology and science as much as the Hippocratic Oath. Doctors and nurses and pharmaceutical companies and hospitals and all of it are diverse actors, a non-traditional monopoly, part of America’s sub-7-percent growth. Figuring out how to unwind its intricacies to make “something terrific” that is also affordable will take nuance, thoughtfulness, a delicate touch.

If Donald Trump can do that, I will applaud him.

The next checkup is December of 2017. I hope to see you then.


This column appeared in the Conway Daily Sun.

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