Here is a prime example of how the news media’s intentional or careless use of words warps public perception and policy.
Yesterday, the New York Times front page story about the GOP House’s health insurance bill noted in its second paragraph that the bill wouldn’t do enough to prevent “discrimination” by insurance companies against those with per-existing conditions. I have seen and heard that term, discrimination, used over and over again to describe the per-existing condition, and I apologize for not blowing the whistle on it long ago.
Using the term, which is usually used in other contexts to signal bigotry, bias and civil rights violations, is misleading and virtually defamatory. Insurance companies are businesses. They are not charities. They are not public resources. If an automobile company turns down an offer of half what a car costs it to make, it is not discriminating against that customer who made the offer. If a restaurant customer says to a waiter, “I have just four bucks, but I want you to bring me a dozen oysters, a steak, and a nice bottle of wine,” the establishment isn’t discriminating against the diner for sending him to McDonald’s.
Insureds with per-existing conditions want to pay premiums that are wildly inadequate for the coverage they know and the insurance company knows they are going to need. Insurance companies are portrayed as villains because they don’t eagerly accept customers who they know will cost them money, often a lot of money. That’s not discrimination. That’s common sense, basic business practice, fiscal reality,and responsible management. The news media and the under-cover socialists among us want to create the illusion that a company not wanting to accept customers who lose money rather than add to profits is a mark of corporate greed and cruelty, hence the use of “discrimination” as a falsely pejorative term, when the fair and honest word is “problem.”
Preexisting conditions are indeed a problem—a problem for those who have them and who are facing catastrophic expenses, a problem for the government that has a legitimate interest in making a large number of citizens’ vulnerability to crushing health care expenses survivable and also in not becoming insolvent, a problem for normal citizens who are healthy, take care of themselves, and don’t see why their insurance should be unaffordable to pay for the insurance of those who are not healthy, a problem for young citizens who don’t think they should be fined (er, taxed, that is—sorry Justice Roberts!) for choosing not to be insured at all.
The discrimination falsehood says, in essence, “You evil insurance company! How dare you refuse to pay for my daughter’s cancer treatments, no matter how much it costs? Have you no heart?”
That’s neither helpful, true nor fair. The reason the Affordable Care Act is in crisis now (whether the GOP bill will be any better is a different issue) is because the pre-existing condition problem is causing insurance companies to lose millions, or, in the alternative, to raise premiums and deductibles to intolerable levels to avoid losing millions. Framing the problem as “discrimination” just warps the debate, and places blame on a convenient but in this case unjust target.
Insurance is based on people paying premiums to cover the possibility of future expenses. The insured gambles that he or she will come out ahead; the company gambles that the income from premiums will exceed the eventual payout. Insurance is not insurance when there is a certainty, not merely a risk, of health care expenses. That would be charity…but insurance companies aren’t charities, can’t be, and should be asked to be.
I don’t know how to solve the pre-existing condition problem. Maybe the government should pay for them. Maybe all our rich doctors should create a pool to cover them, or agree to charge less for their treatment. Maybe healthy people should be penalized for being healthy. Maybe we should take the position that we are responsible for our own treatment. There are lots of possible schemes, all with ethical conflicts and dilemmas attached to them like ticks.
It’s a tough one; I’m glad I don’t have to solve it. But constantly telling the public that the problem is one of bias and discrimination rather than economic reality is irresponsible, dishonest and incompetent.