Health insurance industry to consumers: You’re financially responsible for your behavior

Scott Harrington is a professor at Wharton and “adjunct scholar” at the conservative American Enterprise Institute. Two weeks ago he wrote a Wall Street Journal opinion piece that gave the standard Republican argument against a public option: It will inevitably lead to a single-payer system.

“Private health plans have a strong incentive to spend a dollar as long as the expected savings in payments is at least a dollar,’ he said in that article, justifying the profit motive of private insurance companies. Yes, and we all know how insurance companies save dollars: By finding an excuse to cancel the insurance of patients who become ill and by exorbitantly raising the premiums for small businesses. (See Health insurance insider speaks out.)

Harrington revisits an idea from his earlier article in an opinion piece in today’s Journal: Democratic health care reform may require private insurers to accept all applicants, regardless of health status such as preexisting conditions. It’s interesting how the insurance industry welcomes the idea that everyone should be required to have health insurance, thereby increasing their pool of customers, but they still want the right to “cherry pick” who will be insured.

Senator Kennedy doesn’t want insurers to reward good behavior

The subtitle of today’s piece is “Sen. Kennedy doesn’t want insurers to reward good behavior.” Harrington argues that any plan that prevents the private insurance industry from rejecting applicants or raising the premiums of those who become ill would prevent insurers from rewarding healthy behavior. This will lead to more disease — obesity, diabetes, heart disease, and cancer – and ultimately less health care (due to cost control measures).

According to Harrington, reform proposals from House Democrats or from the committee led Senators Kennedy and Dodd make the following assumption: People cannot control their health, or people “should not be financially responsible for behavior that contributes to poor health, or both.” The insurance industry, on the other hand, believes that both assumptions are false.

Let’s ignore the misinformation about the Democrats (Obama doesn’t support prevention?) and consider the flaw in blaming the consumer — admittedly a very convenient argument for the insurance industry to make.

A cause and effect relationship between a healthy lifestyle and disease prevention (healthism) has not been established by scientific evidence. There is a strong suspicion that those who practice whatever prevention lifestyle is currently fashionable are better educated, more affluent, and initially healthier than those who do not.

Disease prevention is as much an issue of social and economic inequality as it is a matter of healthy lifestyles. To argue that those who become sick should be denied insurance because, after all, their behavior and thus their health was under their control, is not worthy of an egalitarian society.

Cancer, heart disease, diabetes, and an increase in weight happen to many people who believe they are doing all they can to stay healthy. Should they be denied coverage or made to pay more? And what about all those other diseases — Huntington’s, cystic fibrosis, sickle cell anemia — that have nothing to do with what you eat and how much you exercise? What rationale will the insurance industry contrive to exclude them?

If the private insurance industry wins the health care reform battle yet another time, I wonder how many will start to question whether it’s safe to have their genes tested.


(Links will open in a separate window or tab.)

Scott E. Harrington, The ‘Public Plan’ Would Be the Only Plan, The Wall Street Journan, June 15, 2009

Scott E. Harrington, Reform Needs Healthy Life Incentives, The Wall Street Journan, June 29, 2009


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