Why Can't My Health Insurance Be Like My Car Insurance?

Jon George, MD
I have been driving a car since I was 16 years old, which was also when I got my auto insurance under my parents' plan.  It was expensive when I first started out, but as I demonstrated good driving behavior -- avoiding accidents and speeding tickets, I was encouraged by cumulative discounts including safe driver, good student, and multiple car deductions.

But when it came to my health insurance, I first started making payments on it with my first job after college.  Of course, I took the cheapest plan with the fewest bells and whistles and the highest deductibles, but it provided cost containment in the setting of an emergency.  But despite practicing a healthy lifestyle -- watching my diet, exercising, avoiding substance abuse, and maintaining regular physical check ups with my primary care physician, I noticed that I paid the same health insurance premiums as my colleague who consumed large amounts of junk food with a sedentary lifestyle, feeding addictions to cigarettes and alcohol, and non-compliance with his prescribed medications.

So what is the real reason for mounting health care costs in this country? Is it poor management by physicians or a poor health care system?  Why are there no incentives to encourage healthy practices and fines to discourage bad behavior?  Why do healthy responsible patients pay inflated premiums to cover the consequences of unhealthy lifestyles of their neighbors?

What if my health insurance were like my car insurance?  To begin with, I would be required to have health insurance just as any driver is mandated to have auto insurance to drive an automobile.  Sure, it's expensive at the age of 16 due to heightened risk of accidents and careless behavior but with maturity comes gradual decline in premiums with demonstration of safe driving and responsibility.  In addition, various incentive programs exist for a good driving record and scholastic performance which lower the premiums significantly.  Similarly, health insurance would be expensive at the onset, but with healthy lifestyle practices, responsible behavior, and physician endorsement of compliance would come discounts in health insurance premiums. 

If health insurance were like car insurance, I would be responsible for obtaining it as opposed to having my employer supply it for me.  After all, it's my body and my health-why do I expect someone else to be responsible for it? 

If health insurance were like car insurance, I would be able to shop around for the cheapest insurance with competitive rates from multiple vendors to find a plan best suited for my lifestyle.  If health insurance were like car insurance, I would not be denied insurance unless I demonstrated repeatedly offensive and ill-advised behavior.

On the other hand, what if my car insurance were like my health insurance?  My employer would be required to obtain my car insurance, which means I couldn't drive if I didn't have a job.  Everyone would pay the same for auto insurance regardless of driving history.  The system would breed lack of accountability since there would be no incentives for good driving behavior and no repercussions for accidents or speeding.  Sure it would be economical for the irresponsible driver, but only at an exorbitant cost to the safe driver and society as a whole.

There is an urgent need for major overhaul of the health care system in the United States.  While the debated health care reform bill addresses some issues that warrant change, it continues to penalize the delivery of care by cutting reimbursements without providing incentives for healthy lifestyles and quality of care. 
I have been driving a car since I was 16 years old, which was also when I got my auto insurance under my parents' plan.  It was expensive when I first started out, but as I demonstrated good driving behavior -- avoiding accidents and speeding tickets, I was encouraged by cumulative discounts including safe driver, good student, and multiple car deductions.

But when it came to my health insurance, I first started making payments on it with my first job after college.  Of course, I took the cheapest plan with the fewest bells and whistles and the highest deductibles, but it provided cost containment in the setting of an emergency.  But despite practicing a healthy lifestyle -- watching my diet, exercising, avoiding substance abuse, and maintaining regular physical check ups with my primary care physician, I noticed that I paid the same health insurance premiums as my colleague who consumed large amounts of junk food with a sedentary lifestyle, feeding addictions to cigarettes and alcohol, and non-compliance with his prescribed medications.

So what is the real reason for mounting health care costs in this country? Is it poor management by physicians or a poor health care system?  Why are there no incentives to encourage healthy practices and fines to discourage bad behavior?  Why do healthy responsible patients pay inflated premiums to cover the consequences of unhealthy lifestyles of their neighbors?

What if my health insurance were like my car insurance?  To begin with, I would be required to have health insurance just as any driver is mandated to have auto insurance to drive an automobile.  Sure, it's expensive at the age of 16 due to heightened risk of accidents and careless behavior but with maturity comes gradual decline in premiums with demonstration of safe driving and responsibility.  In addition, various incentive programs exist for a good driving record and scholastic performance which lower the premiums significantly.  Similarly, health insurance would be expensive at the onset, but with healthy lifestyle practices, responsible behavior, and physician endorsement of compliance would come discounts in health insurance premiums. 

If health insurance were like car insurance, I would be responsible for obtaining it as opposed to having my employer supply it for me.  After all, it's my body and my health-why do I expect someone else to be responsible for it? 

If health insurance were like car insurance, I would be able to shop around for the cheapest insurance with competitive rates from multiple vendors to find a plan best suited for my lifestyle.  If health insurance were like car insurance, I would not be denied insurance unless I demonstrated repeatedly offensive and ill-advised behavior.

On the other hand, what if my car insurance were like my health insurance?  My employer would be required to obtain my car insurance, which means I couldn't drive if I didn't have a job.  Everyone would pay the same for auto insurance regardless of driving history.  The system would breed lack of accountability since there would be no incentives for good driving behavior and no repercussions for accidents or speeding.  Sure it would be economical for the irresponsible driver, but only at an exorbitant cost to the safe driver and society as a whole.

There is an urgent need for major overhaul of the health care system in the United States.  While the debated health care reform bill addresses some issues that warrant change, it continues to penalize the delivery of care by cutting reimbursements without providing incentives for healthy lifestyles and quality of care.