Community Rating and Living the Unhealthy Fantasy

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Kevin Williamson sums it up well when he writes that “it is a downer to start thinking about the facts when you’re right in the middle of a very pleasurable episode of moral grandstanding, but the facts will still be there when you’re done.”  His subject is the indignation that people who cost more to insure should pay more for insurance if the reason they cost more to insure is the biological reality of their sex:

… maybe the dudgeon here ought not be too high. Yes, you could make a very persuasive argument that women ought not be expected to bear the burden of their higher medical expenses, or at least not the entire burden. But you could also make a pretty compelling case that poor working people in the South Bronx ought not be forced to subsidize the lifestyles of the multi-millionaire vanden Heuvels out in the Hamptons or the multi-millionaire Clintons in Chappaqua (does Mrs. Clinton still pretend to live in Chappaqua?) just to satisfy some gender-studies graduate from Bryn Mawr. The higher premiums charged to women are not rooted in the malice of wicked insurance executives but in the thing that our progressive friends claim to love: science — in this case, actuarial science. The argument for charging women higher premiums may not be persuasive to you, but it has some basis in reality. The argument against doing so has no obvious basis in anything other than preference.

One angle to this argument that I haven’t seen mentioned anywhere is the contribution of our social devolution to this as a difficulty at all.  When the rule — not in the sense of a requirement, but in contrast with the exception — was that most people paired up in marriage, this sort of thing wouldn’t have been an issue.  Economically, people thought in terms of families, and most families included a woman and a man.  So what if it costs more to insure women when their bills are combined with men on a family-by-family basis?

One can also see, in this, how short a jump it is to socialism the moment our sense of society becomes one of individuals mediating their differences using government.  Why should women pay more for health insurance just because they happen to be women?  Why should poorer people pay more for health insurance just because they happened to be born into worse circumstances?  Why should over-eating druggies who smoke pay more for health insurance just because their worse circumstances pushed them into an unhealthy lifestyle?  Wouldn’t it be more fair for us all to equally pay into the system (income-adjusted, naturally) however much it costs to cover everybody?

Williamson’s point is that, yes, we can do that, but it isn’t insurance; indeed, it casts the very idea of accurate insurance as immoral.  We should at least be honest about what we’re doing.

The bigger point, though, is that people change their behavior based on risk, and by padding the world and professing to have removed what is unfair in risk, we open the trap wider for those who are prone to doing what they oughtn’t do.  That includes decisions about what sort of families we build around ourselves, and that one decision has huge implications for everything, most especially our ability to advance in our own lives and across generations.

“Fairness,” it turns out, is hugely unfair to those who want to live healthy lives (in the broadest sense) and move toward a healthier society.



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