Saturday, December 19, 2009

Language Shapes Thought

Consider that a choice of a word can shape the entire discussion. George Orwell wrote a lot about this, and not just in his best-known work 1984. 

Today I am thinking about the difference between "health insurance" and "health care."

Insurance is, by definition, intended to deal with something unforeseen, calamitous, that should not happen. Modern insurance began with insuring ships and their cargoes in the 18th century. Ships were supposed to complete their voyages successfully. Some did not. Insurance, to compensate ship owners, cargo owners and investors for losses, benefited trade and commerce. It protected against what "should not happen." You have car insurance and home insurance to protect you against what should not happen.

But it's clear that everyone needs health care at some time in their lives, and that the longer they live, the more they will need. Thus it's not something that "should not happen," it's something that predictably will happen. Granted, exactly what will happen might include some of those things that "should not happen"--severe illnesses that not everyone gets. But we'll all have some need for care.

Insurance is basically the biggest legal gambling business there is. The insurer takes your bet--your premium--and agrees to pay out under certain conditions. The insurer plans on taking in more than they have to pay out (and adding to their take by investing the money they take in) and by careful attention to the details--the legal language in policies, the statistical odds of the risks they are insuring, and how much they charge--keeping more money than they have to give back. Casinos and bookies work the same way. They don't even need to cheat--the odds favor the house.

But everyone will need health care. So the insurers, whose goal is to treat paying claims as something that shouldn't happen (covering events that shouldn't happen), are basically at odds with the insured, who will inevitably need treatment they can't pay for themselves.

And this is the basic, underlying misconception of the whole discussion of "health insurance reform."

The countries that have universal coverage--which is practically all of them except the USA--have health care, not just health insurance. That's a big difference. How many lives would be saved, lengthened, improved by having health care that works for everyone? Apparently we are not going to get the chance to find out.

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