![\"https:\/\/commons.wikimedia.org\/wiki\/File%3ADoctor_examines_patient_(1).jpg;](\"https:\/\/wp-media.patheos.com\/blogs\/sites\/533\/2016\/08\/800px-Doctor_examines_patient_1.jpg\")
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Insurance: \u00a0a financial product in which a consumer buys a policy promising payment in the event that some risk occurs, and the insurer prices based on the likelihood of that risk occurring, and its likely severity. \u00a0Home insurance premiums are\u00a0based on the risk of that individual house being robbed, or damaged by fire, or storm damage, or the like, and actuaries price that risk based on crime rates in the neighborhood, the proximity of a fire station, the cost to rebuild the house, any valuables disclosed by the homeowner under a special rider, and so on. \u00a0Car insurance premiums are\u00a0based on the likelihood of an individual driver having an accident, due to that individual\u2019s past driving record as well as overall history of people in that rate class, e.g., male teens vs. middle-aged moms.<\/p>\n
Social insurance is something entirely different.<\/p>\n
Social insurance refers to government provision of benefits, commonly funded by payroll taxes, to the general public (that is, without means testing). \u00a0In the U.S., Social Security and Medicare are social insurance programs. \u00a0(Medicaid is a welfare program because it\u2019s means-tested.) \u00a0 Other countries have much wider provision via their social insurance programs: \u00a0medical care for all rather than just the elderly, more extensive disability coverage, including short-term disability, maternity and parental leave programs, and the like.<\/p>\n
And what about the definition of insurance that pundits and politicians tend to use? \u00a0that is, a system of pooling contributions to pay out expenses? \u00a0That\u2019s what we often hear \u2014 that it\u2019s entirely appropriate, for instance, that younger people with fewer claims pay \u201cextra\u201d to subsidize the claims of older people, or that everyone pay extra to fund the costs of sick people coming into the health insurance \u201csystem\u201d for the first time, because \u201cinsurance is all about sharing costs.\u201d<\/p>\n
That\u2019s neither insurance (it\u2019s not based on individual risk) nor is it social insurance (you\u2019re not paying taxes into a system). \u00a0The closest label I can think of, if it were voluntary, would be a \u201cmutual aid society.\u201d<\/p>\n
But what about the structure that Obamacare imposes? \u00a0No individual assessment of risk, very limited ability to assess the risk by risk classification (smoker vs. non-smoker, plus an age-grading that\u2019s only a portion of what true actuarial valuations would provide for)? \u00a0And pay-related contributions up to 400% of poverty line?<\/p>\n
I suppose you\u2019d have to classify that as a hybrid of insurance and social insurance. \u00a0Or maybe you\u2019d label that as privately-provided social insurance. \u00a0It\u2019s kind of a mess, really, and that\u2019s either a Best of Both Worlds or just another reason for the failure of the system.<\/p>\n
And the fact that Obamacare is a messy hybrid speaks to the two key but separate questions about which we need, and don\u2019t have, a consensus on healthcare:<\/p>\n
Who should pay?<\/p>\n
And how should the overall system be structured and the care delivered?<\/p>\n
If we say that Americans should pay for healthcare in proportion to their income, then we want a social insurance system; if we say that healthcare is an expense like any other, that individuals should pay themselves for unless they need financial assistance due to poverty, then we want a true insurance system.<\/p>\n
Then we can discuss whether a single-payer system\u2019s ability to control costs by setting all reimbursement rates unilaterally, and rejecting coverage that is deemed insufficiently cost-effective, balances out the negatives of such a system \u2014 the lack of care when budgets are cut, waits for elective treatment, lack of innovation, and the like. \u00a0And we can discuss whether delivery of healthcare through a private insurance model can be reconstructed in a way that remedies the current seeming intractable cost increases.<\/p>\n
What about Janecare? \u00a0I suppose that, again, is a variant of \u201cmessy hybrid\u201d \u2013 the \u201csocial insurance\u201d component says that everyone pays taxes and gets out of the system the insurance voucher, but the system is run through private providers who, in principle, ought to be able to provide the innovations in healthcare delivery that we need.<\/p>\n
\u00a0<\/p>\n
Image: \u00a0https:\/\/commons.wikimedia.org\/wiki\/File%3ADoctor_examines_patient_(1).jpg; By Unknown photographer [Public domain], via Wikimedia Commons<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"
Insurance: \u00a0a financial product in which a consumer buys a policy promising payment in the event that some risk occurs, and the insurer prices based on the likelihood of that risk occurring, and its likely severity. \u00a0Home insurance premiums are\u00a0based on the risk of that individual house being robbed, or damaged by fire, or storm […]<\/p>\n","protected":false},"author":2209,"featured_media":5217,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[207,356,133],"class_list":["post-6331","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-health-care","tag-health-insurance","tag-healthcare"],"yoast_head":"\n