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Speaking my mind - insurance choices.

Have you ever thought about what you are buying when you purchase an insurance policy? Health insurance doesn't provide you with any insurance of good health. What you are buying is some peace of mind. If a health problem or disaster befalls you or a family member, you have some financial assistance to pay the bills.

You really can't win with any insurance policy; all you can do is "lose less." Month after month you pay out for benefits. If you are sick enough for the insurance to really make a difference, chances are you are really quite ill. You never win by being ill. On the other hand, if you are healthy and never need your insurance, you lose because you have spent all those dollars on benefits you never used.

How can you lessen your loses? If you lead a healthy lifestyle by wearing seatbells, not using tobacco in any form, using helmets, drinking only in moderation, etc., you may get lower insurance rates. That's one way to lose less.

Picking a healthy mother and father also helps. People with a family history full of illness are more likely to have health problems, so their rates are higher. Unfortunately, there's nothing we can do about our family history, so we can't lose less that way.

Buying less comprehensive benefits is another way to lose less. Increasing your deductible helps. The difference between a $100 and a $500 deductible is substantial. If you banked the difference each year you would come out ahead. So you can lose less by gambling more.

How does the "lose less" approach apply to our country's health insurance crisis? It's critical in deciding how we as a society are going to provide health insurance coverage for our citizens. Ideally, our plan would provide benefits for everyone at a reasonable cost. The key to the solution is defining "reasonable cost."

Universal care is a wonderful concept that's easy to support in concept, but when it gets down to what it will cost you and me, some of the idealism begins to fade.

If you lead a healthy life style, are fortunate enough to have healthy parents, and are willing to forego first dollar coverage, you may be able to get good coverage at a reasonable price. Are you willing to sacrifice that savings to finance the insurance for people who voluntarily put themselves at an increased risk of having health problems?

Is it fair to penalize people who try to lead a healthy life, but have the misfortune to have a poor family history? Or to penalize those who, through no fault of their own, suffer from serious (and expensive) health problems?

Our current system equally penalizes people who voluntarily put themselves at an increase of having health problems and those who have problems which they could control. Is this fair or should we have a system that penalizes only those who voluntarily increase their risks of having health problems?

Simply speaking, we could classify people into three groups: A people with a healthy lifestyle, low risk family history, and no illnesses; B people with health problems they had no control over and a healthy lifestyle; and C people who put themselves at an increased risk because of bad lifestyle. (Obviously there will be many overlaps, but bear with me.)

Currently the A people get good insurance rates, and the B and C people either can't get insurance or have to pay an exorbitant rate. The A's are rewarded for good habits, the B's are unfairly penalized, and the C's probably get a good deal considering what they are doing to themselves.

If everyone paid the same rate no matter which group they fit into the A's subsidize the hapless B's and hopeless C's. This plan would be fairer if the C's "paid" for their unhealthy lifestyle so to avoid penalizing the A's and B's. The B's with health problems beyond their control would not be penalized, and the lucky A's would help out the B's.

This approach to health insurance would share the cost of health care fairly while shifting the additional costs to those who generate them -- people who voluntarily put themselves at an increased risk of health problems.

How can we penalize those who are most likely to use more than their share of health services. Dedicated taxes on items detrimental to one's health: tobacco products, alcohol, motorcycles, junk food, etc. Require special licenses for people who participate in high risk activities such as motorcycling without a helmet, sky diving, hunting, etc. (The more examples I list, the more enemies I make, so I'll stop.) Take these fees and taxes and use them to subsidize health care costs.

There are many details best left to the actuarials, but I believe the basic approach is reasonable and fair.
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Title Annotation:health insurance
Author:Sagall, Richard J.
Publication:Pediatrics for Parents
Date:May 1, 1991
Previous Article:Low birth weight and behavior.
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