Have pity on your health insurance company

I mentioned a Republican representative from our state legislature the other day, the one I heard on the radio. I kind of suggested he might’ve said something that made me a little mad; “pissed off” may have been the words I used. Well, if you don’t want to read a rant on Florida politics, now is the time to bail.

The Florida Legislature is in session for two months of every year, and has been in session for a little over a month now. That means I’ve been slowly grinding my teeth down to smooth, uniform stumps… for a little over a month now. It probably wouldn’t be a bad idea to invest in a mouth guard every spring, like the ones they wear in football. It’ll save me some grief with the dentist down the line.

But I digress.

I love to digress. Have you ever noticed that?

We’re having a little health care debate in Florida, in case you haven’t heard – and I’ll bet you haven’t. Our governor (last year’s winner in the Hooters’ George Hamilton look-alike contest), along with his pals in our legislature, have been hell bent on making health insurance more affordable in Florida. I say that like it’s a bad thing. I don’t mind paying less for the same thing, something nearly as good, or even something that’s good enough. I don’t think that’s what we’re talking about though.

Back to that Republican on the radio on Friday. He was calling attention to the suffering of our health insurance providers in Florida, saddled as they are with laws which make it mandatory to cover over fifty different illnesses and procedures. It’s amazing they can make any money in Florida at all.

Pardon my french, but boo-fucking-hoo.

If I know my party talking points, I’ll wager he even said something like, “we want the citizens of Florida to be able to choose the kind of coverage they want, not some bureaucrat in Tallahassee.” Not to quibble…. No, on second thought, I really do want to quibble. If it’s a law that makes insurance companies provide certain kinds of coverage, it’s not some unelected government bureaucrat calling the shots, it’s the elected representatives of the legislature and the governor. And given the state of Florida politics the last twenty years, it was probably a Republican legislature (with A BIG majority to boot).

(Full disclosure: I’m a bureaucrat.)

So stick that up your quorum.

Of the oft-cited illnesses and procedures we force our downtrodden insurance companies to cover, they (with a capital R) often mention organ transplants, and HIV treatment… like there’s something wrong with organ transplants and HIV treatment. Well, I dove into the law this weekend (something I don’t recommend, by the way) and found a few more things our communist manifesto (aka the Florida Statutes) mandates coverage for (all of which come from Chapter 627… I didn’t have the stomach to read any more):

  • A requirement for the continuation of coverage for handicapped children who remain dependent due to their disability (after they would otherwise be old enough to support themselves).
  • A requirement that maternity coverage must also provide coverage for post-delivery care (for the mother and baby).
  • A requirement that maternity coverage may not limit hospital stays to fewer days than is deemed medically necessary (either by guidelines established by the American Academy of Pediatrics, or the physician).
  • A requirement to provide diabetes coverage.
  • A requirement to cover the diagnosis and treatment for osteoporosis for at risk patients.
  • A requirement to provide coverage for newborn care.
  • A requirement to cover adopted children (in a family plan) the same as biological children would be covered.
  • Requirements regarding breast cancer coverage (may not limit hospital stays, must provide coverage for outpatient post-surgical follow-up).
  • A requirement to cover mammograms for women over 40.
  • A requirement that any policy that covers a child under 18 must provide coverage for treatment of cleft lip and/or cleft palate.
  • Limitations on the period of exclusion for pre-existing conditions.

That’s where I gave up. Reading through the Florida Statutes was even less fun than I thought it would be, but you can clearly see from my partial list (and the aforementioned requirement to cover organ transplants and HIV treatment) the law in Florida is completely unreasonable. What are we, a bunch of sobbing, sentimental pinkos?


Here’s the next thing my fine Republican friend said (who has no idea who I am): “We’re requiring everyone to drive Cadillacs in Florida, when most people can only afford a Chevy.” (Just in case I haven’t been clear, what they mean by that Chevy analogy is coverage that doesn’t cover as much stuff.)

Just so you know, from here on out I’m going to refer to “Cadillac coverage” as “good coverage” and “Chevy coverage” as “cheap” (with out the quotes).

Boy oh boy, I don’t even know where to start on that one. First, why is it that folks still go broke paying for health care despite their Cadillac coverage? (Sorry, I couldn’t resist a primo opportunity for sarcasm.) But that’s not even my biggest concern, or my strongest argument. (I’m losing more and more humility by the minute.) Think about insurance pools and their intended purpose: risk sharing. Think about who is more likely to purchase cheap coverage, besides the people who can’t afford good coverage. I’ll tell you who: healthy people. Hell, I don’t count on ever needing a mammogram, so there’s coverage I don’t need right there. If there’s one thing that Wal-mart has taught us, it’s that a lot of us, regardless of means, will buy the cheaper alternative – regardless of quality. Presumably more people would have insurance due to the lower prices, but will that offset the money pulled out of the pool by people opting out of good coverage, in order to realize savings in their monthly bills? Why is this even a problem? We stop sharing the risk of getting sick, that’s why.

What happens to the cost for that good coverage when only sick people are buying it? If overall we’re siphoning money out of the system by rolling healthy people into cheap coverage (more on that later), how does an insurance company make money on sick people? Simple: it raises their rates. It seems to me that sick people are the ones who are least likely to be working, or working at a high level of productivity, so they’re already the ones in the pool that are most likely to be priced out of good coverage. And what happens to the folks with cheap coverage when they get sick and find their insurance doesn’t cover them? How many employers that provide costly coverage for their employees now will decide on behalf of their employees to buy cheap coverage? We talk about having choice in our “free market” system of health care, but who’s really making the most important choices?

Anyone out there know what a positive feedback loop is?

In effect we have a kind of universal health care system now… paid for by those of us who have insurance. People who don’t have coverage (or insufficient coverage) tend to wait to get treatment because they can’t afford it, and our system won’t pay for it if they can’t – until it becomes an emergency (and much more expensive). That care isn’t free, but it’s hard to collect from a dead person who’s been too sick to work. So those of us who can pay for services ultimately bear the cost… many of us with the assistance of our good coverage. But now we’ll move a bunch of folks to cheaper coverage, betting on A LOT of people signing up who didn’t participate in the system before. But what if the additional people paying into the pool doesn’t offset the money lost by the folks already in the pool being rolled into cheaper coverage (either by their own choice, or by their employer’s)?

I’ll tell you what happens. We’re in trouble.

I desperately hope there’s a hole in my logic here, because this appears to be a done deal.

By the way, I’m sorry for rambling on and on. I know I’ve been a bit repetitive, but what decent rant isn’t? (Not one that’s at all cathartic anyway.)

Give the gift of words.