17 October 2006
Two weeks ago I had an unscheduled trip to the dentist, the result of not looking too closely at what might be lurking in the bottom of that bowl of trail mix. (Whatever it was, it was petrified, and for all I know might have come from the Oregon Trail.) There was much discussion when I arrived, mostly over whether my insurance would cover the repairs. I pointed out that this would not be an issue, inasmuch as I didn't have any.
"Now here's a man who knows how to count," said the dentist.
And I suppose I do. I get three cleanings and one set of X-rays a year, at a cost of somewhere around $350. Dental insurance worthy of the name would cost me rather more than thirty bucks a month, and it wouldn't cover all of that stuff in full. Admittedly, I don't have teenagers in need of orthodontia, and the damage repaired that day didn't require crowns and such, but in the absence of some major catastrophe and now you know why I'm getting three cleanings and one set of X-rays a year I don't really see the need for buying dental insurance, unless I can find something that covers only major treatments, which presumably wouldn't cost so much.
I thought about that while reading this piece by Arnold Kling:
I think that the most important point about health insurance in the United States is that it is not really insurance. [Mark] Thoma says [in this article], "In general, insurance gives us financial protection from unexpected events a tree falls on our house, we have a car accident, we become unemployed, we become sick and need health care, and so on."
But what we call health insurance covers things like new eyeglasses, which is not a rare, catastrophic event. It seems to me that the big market failure in health insurance is that it exists to protect health care suppliers from having to bill patients directly rather than to protect consumers from catastrophic loss. That is, the failure is not in the way risks are managed by insurance companies, but in the very structure of what we call health insurance.
Before we leap to having single-payer health insurance, we ought to change health insurance to something that looks like insurance, not like a scheme to insulate individual consumers from all health expenses.
James Joyner took on this premise and drew some interesting comments:
[Health] insurance has taken on what is the equivalent of auto insurance covering oil changes, tire rotations and spark plug changes. All of those services are relatively cheap compared to fixing a fixing the body from an accident, but everyone needs oil changes, tire rotations and new spark plugs not everyone has an accident. I havenít had a car accident in almost 20 years, my auto insurance likes me, but I have 2-3 oil changes and tire rotations a year.
For the record, my scheduled medical expenses each year (unscheduled ones are, not surprisingly, harder to forecast) run about $2200 a year; actual copayments are around $600. I couldn't tell you how much my actual health coverage costs, though I suspect it's around $3500 a year; I can't help but wonder how much it would be if I were to pick up that $1600 (the difference between the copays and the actual price of the services and prescriptions) myself.
I don't see, though, any great demand to switch to health care that covers only the hyperexpensive stuff, no matter how little it might cost in comparison, and until there's a demand, I have no reason to expect there to be much of a supply.Posted at 6:21 AM to Dyssynergy