File Cabinet

Issues of Insurance

I’m in a health economics course this semester, and I’ve been spending the last few weeks pondering the idea of insurance as a health financing tool.  I’ve never been a fan of insurance – I’m still young and healthy so even in years I’ve had children I’ve paid more in insurance premiums than I would have spent out of pocket.

Basically, insurance is a risk pool.  I put my money in, you put your money in and if something happens to either of us we have the money to pay for it. There are definitely some problems with the way insurance works in real life, but I’m starting to warm up to the idea of a risk pool.

First thought – a risk pool is what Joseph put in place before the famine in Egypt. He didn’t tell each family to save individually, he gathered all the grain so it could be distributed. It had its pluses and minuses – the people were fed and Egypt increased it’s wealth, but the people had to “sell” themselves to Pharaoh to get the  grain back. So the basic idea is supported as “wise,” but maybe there are a few things that need to be worked out to make it fair to everyone involved.

Second thought – while reading in the prophets about the oncoming exile the people were repeatedly told they were being handed over because of their failure to look out for the needs of the poor and most vulnerable. This year was the first time I remember really being struck by this point – I’ve always focused on the angry God because they didn’t “follow the commands” and read that as bad sacrifices or something. But these passages really read about a society that wasn’t doing a good job of being a society.  A risk pool is one way of making sure there is money to meet everyone’s health needs. We have systems for this now – we have Medicaid for the poor children and disabled (in most states it is nearly impossible to get medicaid if you are an adult), and to help ensure prenatal care for women. In fact, over 50% of births are paid for by Medicaid. We have Medicare for those over 65. So we are not opposed to the idea as a community, but I do wonder if we could do it better.

Third thought – health financing is not health care, but every bit of data shows not having financing decreases the possibility a person will get needed care. This is a sticky point, because on the one hand you can say it only hurts the person if they are not responsible enough to get a job and get health care.  But on the other hand, the people most likely to not have a job and need health care are the poor (they have a disproportionate load of health care needs due to a number of factors, and yes one of them is that if you are sick it becomes much harder to stay in school and get a good job). So if they are not able to participate in a productive economy because of health, it does hurt the whole community for them to be stuck in a cycle of poor health – not able to get care – poorer health.  And yes, poor health is linked to an inability to get out of poverty.

So here I am, wondering if a big risk pool for health care is a Christian solution to  our countries health care woes.

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Jennifer Vanderlaan CNM MPH is the author of the BirthingNaturally.net website. She has been working with expectant families since 2000, training doulas and childbirth educators, and midwives. She has worked with midwives in Central America and Sub-Saharan Africa. Her interest in public health grew in 2010, and she is now a PhD student in a nursing program learning to become a producer of knowledge.

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