|Zipperhead, South Street, Philadelphia, 1985.|
A few days ago, U.S. Senator Patrick Toomey (R, Pa.) compared my son to a burnt-down house. Mr. Toomey doesn't know my son and didn't refer to him by name. He was talking - in that abstract way characteristic of aspiring political philosophers - about people with pre-existing medical conditions. My son has a pre-existing condition. Forgive me if I am so bold as to connect the dots.
Comparing a human being to a burnt-down house is of course offensive, but it is also, I would argue, a misleading analogy that takes us places we don't want to go.
Lesson number one, Senator. People are not inanimate objects. They are not blocks of wood. They are not many blocks of wood - 2x4s, floorboards, siding, shingles - all nailed together with those snazzy new nail guns. People are people. They breathe, they bleed.
Really, if you want to float an analogy of writing fire insurance on a burnt-down house, you should probably tie it to selling life insurance to a dead man. Personally I wouldn't go there, but it does make more sense than comparing a dead house to a living person.
As for writing health insurance for people with pre-existing conditions, a better analogy would probably be flood insurance. Again, not perfect, but at its base flood insurance is about restoring and maintaining communities. It is about life.
Nowadays, flood insurance largely comes from the federal government through something called the National Flood Insurance Program. Why is this? Well, here is a little fact that people tend to overlook: Insurance companies are in business to make money. And here is a corollary: If they can't make money in a particular market, they exit the market.
But that doesn't mean that the need goes away. People are still going to want to rebuild. It's easy enough to argue against rebuilding in a flood plain - I still do it occasionally - but a strong consensus has evolved over the years, and so the government has stepped into the void left by the insurance companies.
The same thing has also happened in a number of areas of health insurance. Just look at Medicare and Medicaid. The government stepped in to fill a void.
So let's look at those pesky pre-existing conditions again. Insurance companies really, really don't want to cover them. So what are we going to do, let these people die? This would be the burnt-down house path. There seems to be a consensus against it. Even Senator Toomey appears to be concerned about the optics of just letting people die.
The only way to resolve this tension is for the government to enter the void. This would be the flood insurance path.
There's an interesting lesson in rhetoric here. Compare health insurance to fire insurance, and the logic of your argument is that we should let certain people die. Compare it to flood insurance, and the logic is to support life.
Pick the wrong analogy, and you can easily go down the wrong road.