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OHPF Day 13

Insurance is a hot topic in many arenas – medicine, politics and family budgets to name a few. Considering the various reasons for which we carry insurance – car, home, disability, life, liability, health – it is only in the latter that we expect to utilize it on a regular and non-emergent, untoward or unexpected experience. Perhaps it is worth reconsidering our relationship with insurance in the health care arena.

Insurance in the majority of circumstances is a guarantee of compensation for a specific loss in exchange for a premium. The event of loss is a probability – something that hopefully will not happen and against which one is safeguarding. It is not utilized in the routine maintenance of those things it is insuring. We make investments in the care of our homes and cars so as to avoid the occurrence of an insurance claim. We update wiring to prevent fires, replace pads to ensure adequate braking to minimize chance of collision. These are costs entirely separate to the insurance premiums that are the responsibility of the owner and, perhaps met with complaint as a budget line item, never enter the consideration of something that should be covered by insurance.

Why is this so different with health insurance? Perhaps in this circumstance we are operating from an alternate definition of insurance itself – a means of guaranteeing protection or safety. Rather than paying the premium to hopefully never be used (a devastating illness, horrific trauma) we expect our health insurance to also serve as a means by which we maintain ourselves to prevent these unfortunate circumstances from occurring. Is this an appropriate expectation? Should the insurance of our health be more than a payout in a catastrophic experience, a sum we hope never to see? Should it an investment in protection, helping us avoid those diseases which are largely preventable or catching at an earlier stage those that are treatable?

Where should the line be drawn? What is the equivalent of an oil change or a brake pad replacement in the human system and should they fall under the umbrella of insurance or be separate and to the personal responsibility of the individual? What are the systemic changes that should be made to better promote health in the first place rather than chase it downstream where costs balloon and vitality dwindles? We have traffic laws and maintenance standards to help prevent motor vehicle collisions – what are the safeguards in place to truly steer us in the direction of health instead of into a crash course with disease?

Spoiler (or perhaps more accurately disappointment) alert – I don’t have the answers for this one, but the shift of inquiry is an interesting place from which to continue discussion. One consideration I pose would be shifting the semantics around the concept. Are we seeking insurance against catastrophe or coverage of all things health? If it is the latter, how much is fair to pay and what should be included? Where do we extend the responsibility beyond the individual and into the system for improved food, exercise, social, work standards that guarantee protection and safety of health.

May we reconsider our definition, expectation and utilization of insurance from a foundation of health, moving toward meaningful reform personally and systemically for guarantees we can take beyond the bank.

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