Health Insurance and Health Care Are Not the Same

The issue is health care. Have you noticed that presidential candidates assume that universal health insurance means universal health care? They use the terms interchangeably. They assume that once the law enables or requires everyone to buy health insurance, everyone will have adequate health care.

But anyone who has been seriously ill or cared for a sick relative knows that while health insurance may be the solution, too often it is part of the problem.

In fact, health insurance and health care are two different products for two different markets. Health insurance is for healthy people. Health care is for the sick. What we need to lead full, productive lives is good health care. Insurance may be one way to get there. But keep your eye on the ball.

Well, you say, automobile insurance works well in this country. We require all drivers to have insurance to cover the expenses of innocent victims.

But think about automobile insurance. Most drivers don't get into accidents. Many people have never been in a serious accident. In fact, insurers can calculate the rate of loss for a large group of people and set premiums accordingly. Statistically, teenagers get into more accidents; their premiums are correspondingly higher. There are a few drivers who are much worse than average whom no one will insure, so they go into a high-risk pool covered by state mandates.

Two other features of automobile insurance are important. First, the insurer's liability is limited: for the victim's car, to the price of a new car, and for the victim, to a fixed amount of money, not whatever it takes to restore the victim to health.

Second, no one's auto insurance covers routine maintenance. That is a predictable expense, part of the cost of owning a car.

There was a time when health was like driving. Illness or injury was sudden, unpredictable and brief. You either recovered, or you died. Medical care was not expensive, and (surgery apart) not terribly effective. Insurance did not cover doctor visits for minor problems or for physicals, any more than car insurance covered routine repairs.