Paying for Joe Pack-a-day

When it comes to logical fallacies, "I don't want to pay for a smoker's health" is the "your argument reminds me of Germany in 1939" of the universal health care debate - the more heated the argument gets, the more likely someone's going to pull it out of their arsenal.  So I'm not surprised to see it pop up in the comments (although I am a little surprised to see a comment thread for a post I wrote over three weeks ago is still getting comments).  But I am surprised that it's such a stock argument because, under any examination, the likelihood that you're paying for a smoker's treatment under universal health care is exactly the same as under our current non-system:  in short, pretty much a certainty.

The old saw gets new life from commenter Conor D, who writes:  "Like I have stated, some guys smokes for x amount of time and gets cancer, he's on his own. Sorry but he chose to get cancer. I'll pay for someone else's cancer bills but not for people who chose it. With universal health care I would have to pay for that guy's treatments."  Now I know the traditional response is for me to appeal to communitarian spirit, or societal responsibility, or the general welfare.  But I'm not going to do any of those things.  Instead, I'll just say "Guess what - you're already paying for them, even without universal health care."

Consider the fictional tale of Joe Pack-a-day.

Joe started smoking when he was 13 - pretty common, since 90% of smokers start before they're 18.  But still, Joe never considered himself an extreme smoker.  Some years he'd be true to his name as a Pack-a-Day man, some years it'd be less.  A few times he tried to quit cold turkey, but that never worked out for more than a month or so.  He knew of smoking cessation programs, but never seriously tried one.  Other than the cigarettes, Joe's been in pretty good shape, without any major health episodes in his life or that of his family.  He's been regularly employed and never been without insurance.  He's tended to work for large companies - companies who used their clout for favorable terms on group health insurance.  Sure, having a few smokers like Joe drove up everyone's premiums a little, but it was spread throughout the whole workforce.

Six years ago, when Joe Pack-a-Day was 44, he got a new job at a new company -- again, a big company with thousands of workers nationwide.  With that came a new benefit plan for his family and new health insurance - in fact, it's a plan with the same insurance company who gives you your health insurance today.  Sadly, this year, the effects of smoking and being around other smokers for 37 years have caught up with Joe.  He's been diagnosed with lung cancer.  (Quick side note:  although lung cancer is the most common association with cigarettes in pop culture, it's far from the only major health problem associated with smoking, which increases the likelihood of a whole host of other cancers, emphysema, hardening of the arteries, you name it.)  Now Joe's one of the lucky ones... not in terms of survival rate, as he's fighting one of the deadliest cancers.  Rather he's lucky in that the cancer is local and hasn't metastized.  Joe's going to pay a lot out of pocket in co-pays, and will need to go through a hellish amount of paperwork, and may even wind up fighting his insurance company.  But ultimately, the insurance company will pick up $143,614 in his medical expenses for that year.

Here's the thing.  Joe hasn't paid $144k in premiums.  Not even counting his employer's contribution.  Not even close.  If he's got an average policy, he's paid maybe half of that, or $72,000.  And this presumes neither he nor any of his family have used any health care in the past six years (ranging from doubtful to borderline negligent when it comes to Joe's kids.)

So where does your insurance company get the money to pay Joe's bills?  That's right - you.

It sounds insidious, but it's actually how insurance is supposed to work (and works in every other industry).  Everyone pays into the pot.  The majority of people paying in are relatively healthy and will only need money paid out in their behalf at a normal, reasonable rate.  The minority are riskier and will need more spent out on their behalf more frequently.  In the United States, 80% of the costs of our health care system are used by 20% of the population.  Sounds extreme, but that's about right.  You need the 80% of healthier folks who are only going to use 20% of the costs to balance out and pay for the others.  Since you never know when you're going to get hit by a truck or come down with a mystery illness beyond your control, it's a pretty good system (...up until the point where the insurance companies begin cherry picking health people and denying claims with little or no provocation to sick people just to up their profits.)

But it's a system in which Connor's still paying for Joe Pack-a-day's lung cancer treatments.  And we don't even have universal health care to show for it.

(Photo credit:  onkel wart on Flickr.)