re: #623 Cato the Elder

We can agree to disagree, but I think you may have misunderstood me. I don’t think mental health provisions are superfluous in essence, only that including them by default in everyone’s insurance package is a cost-dragger. Different people are at different risk levels for any sort of medical condition, and actuaries can give each of us, based on our gender, ethnicity, dexterity (left or right handed), work history, and other biographical data points, a life expectancy, and projected probabilities of being affected by various disorders, mental or physiological (women are much more likely than men to suffer from affective disorders, for example). If insurance worked the way it’s supposed to, it would merely calculate a risk profile for each client based on all these variables (plus life-style considerations), and a projected cost spread over a lifetime (or otherwise, the coverage period). Add to that the administrative costs, and you got a premium.

People would have the option to cover themselves for mental health issues, and pay an appropriate premium. But under the current system, people don’t have the prerogative of opting out of such provisions should they deem them unnecessary for themselves, or opting out for hair plug and sex-change coverage. These and many nonsensical provisions are attached to your insurance by default (to throw a bone to state legislatures’ pet constituencies offering such services) for everybody, and they are a major cost dragger.

As for the employer, s/he should have nothing to do with it. It’s really hard to see that unless you’re in the employer’s shoes. My husband owns a small business and has had to deal with insurance from the provider’s end. One of his Russian programmers (married, H1 Visa) thought he was getting paid less than one of his co-workers (single) because he didn’t understand that the cost of insurance was incorporated into his compensation package. He’s married and insuring both him and his spouse (on a very generous plan) cost much more than it did to insure the co-worker who is single. When the cost of insurance was added in, Michael was paying the Russian more than he was paying the co-worker, and even more than he was paying himself (oh yeah, employer gets no insurance; my husband wasn’t covered until I got him coverage through my job).

I am very young and healthy, and I wish my employer, instead of offering me insurance, gave me an equivalent raise instead so I could keep the money they are spending on me in my pocket instead. I’d then buy my own insurance but keep it to the basics instead of the very comprehensive coverage I currently get and I feel I don’t need.

But insurance is just part of the compensation package, and employers are in constant competition for talent and employees. If they don’t offer coverage, they have to make it up to you one way or the other (well, the way to do it would pretty much be by giving you a raise equivalent to the cost of insurance, so you could go buy it yourself.)

It’s what Michael does now with his employees, after he had to explain them how much it cost to insure them, and they asked if they could just get that money into their pocket instead. Both parties were very happy in arrangement: the employees buy personalized insurance and get exactly what they need, and Michael doesn’t have to deal with their paperwork.

That the single-payer option has not been taken seriously in Congress hearings is not a sign of poor argumentation or close-mindedness. It’s simply that such an arrangement is so unpopular with most Americans that Congressmen (of both parties) know it’s not viable. So what’s the point discussing it in Congress? I say Americans are wary of it for very good reasons.