Language check: do you have health insurance, or health care, or neither?

(and, what assumptions are inside those terms?)

In America, access to health care is usually described in terms of having “health insurance”. At the doctor’s office or pharmacy you’re likely to be asked for your “insurance card”, and the crisis in access to medical care is generally discussed in terms of the [fifty million or so] “uninsured Americans”.   However, insurance (meaning, private insurance) is just one of the various ways that health care is provisioned in the U.S., as in other countries.  (See Wikipedia overview of world health-care systems and types).  We also have publicly funded Medicare, care provided directly by employers, direct fee-for-service, indigent care, etc.

So, why do we usually say “insurance” instead of, say, “health care”?  Isn’t care what we’re actually interested in, not the way it happens to be paid for?  But my main point is, might the implications of the term “insurance” implicitly shape how people think about health care in this country, when this is the term that’s constantly used?

It’s true that in technical discussions, there is a concept of “social health insurance” which cover everyone, e.g. Medicare.  However, for most people, the term “health insurance” probably associates with other forms of insurance they’re likely to have,  such as car or home insurance.  What are the characteristics of “insurance”, inferred from these ordinary examples?:

  1. insurance is individual — an insurance policy is a contract between me and a private company.  Me having this policy implies nothing about whether my neighbor has one, or what its terms might be.
  2. insurance offsets future, unpredictable losses — not routine expenses.
  3. insurance is underwritten / actuarial:  policy issuers decide whether to grant a policy, and they set prices and policies based on their assessment of the customer’s risk level.

Now consider the implications for one’s implicit model of how health care works, based on these characteristics:

  1. [health insurance] is individual: access to health care is something that I, individually, negotiate or purchase.  It is not something I have in common with my neighbor, community, or even family member, necessarily.   It is a private asset, not a public good, and there is no community or societal norm describing what, if anything, I should have.
  2. [health insurance] offsets future, unpredictable losses:   health care will be covered for me primarily in the case of a future, unexpected, unlikely occurrence such as an injury or new illness.  Any condition existing at the time the insurance contract is signed will *not* be covered — so, if you are pregnant, have a blood disease, already take a medication for some illness, have a permanent genetic condition, this will not be covered.   Preventive care may not be covered, because it is not unanticipated.
  3. [health insurance] is underwritten / actuarial:  you have no right to health care — you will get it only if a health insurer decides it can cover you profitably.  If you have any existing illness, you most likely will not be “insurable”.  If you do get care, the price you pay for it will reflect your age, location, health history, gender, and any other risk factor the insurer chooses to consider (except for some legally prohibited ones).  If you are unlucky enough to have, say, a congenital condition, or live in a high-health-risk community, or be advanced in years, you may pay far higher premiums to get coverage.

So, by implication “health insurance” connotes a private, atomized, incomplete, non-preventive, discriminatory system that disclaims any notion of social equity or a human right to health, and excludes or financially punishes those with the greatest needs.

I’m just saying.

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