Vail Daily column: The journey from health insurance to health care | VailDaily.com

Vail Daily column: The journey from health insurance to health care

Jacqueline Cartier
Valley Voices

Jacqueline Cartier

Editor's note: Find a cited version of this column at http://www.vaildaily.com.

In the health care debate, while each side demonizes the other, Americans continue to suffer in uncertainty. The debate occurring now should have taken place in 2010, when Nancy Pelosi famously said, "We have to pass the bill so you can find out what is in it, away from the fog of controversy." "Controversy" is code for debate, and there would have been plenty from both sides of the aisle.

Everyone pays for health care in one form or another. While preconditions should be covered because as one leaves, another enrolls, equalizing coverage among all insurance companies, those with preconditions soon discover that the most expensive procedures require a complicated approval process, and once authorized, many of the costly prescriptions accompanying those procedures are exempted.

Insurance companies were concerned they'd be responsible for payment on the disparity between cost of services and allocated amounts of Obamacare. Rather than sustain losses, they pulled out of the riskiest markets and raised prices to remain in others. Yet, are our expectations unrealistic?

We have come to understand health insurance and health care as one in the same; they are not. Health care relates to the quality and availability of medical treatment. Insurance is a method of payment.

Everyone agrees that the ill or injured should receive quality care; that is a different discussion than how it should be paid. The United States offers the greatest health care in the world. Leaders of other countries, including those with socialized medicine, come here for treatment. Health care is not the issue.

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What we demand of health insurance has expanded beyond what is typically covered by other insurance policies; although, in a competitive market, companies have created incentives to attract policyholders. In auto insurance, we see offerings of replacement coverage versus traditional depreciated value. In home insurance, we see added riders included to entice customers. But these are perks only offered to the best clients — those without "preconditions."

Insurance was originally designed to cover unanticipated, potentially devastating, emergencies. Both policyholders and insurance companies were hedging their bets and establishing that balance was a delicate process. No insurance policy was designed to cover everything. You may have the most comprehensive auto policy available, yet it will never include oil changes, brakes or new tires, even though they are critical to the operation of the car; if it did, then the premiums would be so expensive, no one could afford coverage. Sound familiar?

Homeowner's insurance covers the structure in unforeseen events, such as a fire. Anything that might be considered predictable requires a rider, such as flood or earthquake insurance. None include heating or cooling, appliances, flooring, landscaping or general upkeep such as paint. If you own a home, then it is expected that you will absorb the cost of maintaining it.

Yet, we expect health insurance to be all-inclusive. That's simply unrealistic and unsustainable.

Even a national socialized plan has consequences. We've seen countries collapsing under the debt incurred, with heavy taxes curtailing economic growth and people dying on waiting lists; which is why many travel to the United States for treatment.

How do we develop a system that is both compassionate and sustainable? Perhaps we could have a basic plan (catastrophic insurance) covering accidents, plus terminal and degenerative diseases, with a selection of riders to include things such as maternity coverage, wellness visits, substance-abuse treatments, senior care, etc., and then families can assemble a package according to their unique needs and budget.

We might also consider bringing into the mainstream riders that cover lower-cost alternatives, such as homeopathic medicine or natural remedies.

If Congress would allow insurance companies to generate adaptable options, then it could vastly reduce premiums, thus requiring less need for subsidies and people could return to the doctors and treatments of their choice. Your health is personal; let's eliminate strangers in Washington from controlling your family's options.

Jacqueline Cartier is a resident of Avon.

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