Faulty Analogy Insurance...

The San Jose Mercury ran this editorial around Christmastime arguing against mandatory health insurance.  While there are many good reasons to oppose such a plan, the article instead ridiculed the idea by making what I suppose the author considered a clever analogy: the affect of “food insurance” on the struggling restaurateur.

Worse yet, even the insurance companies rarely cover the entire cost. Time and again, they refuse to pay the full amount, claiming your menu is overpriced. Which it is -- but that's largely because so many of your customers don't pay.

You might be able to solve this problem if you refused to serve those non-paying customers who lack food insurance. But that would be illegal. The government requires restaurants to seat all people who walk in the door and to serve them a meal -- regardless of whether they can pay for it. As a result, your restaurant loses more and more money each night.

You're angry about the uninsured, because many of them could have afforded to pay for their own meals, particularly if they'd purchased groceries at the supermarket instead of dining out. So, together with other restaurant owners and food insurers, you're working to convince your lawmakers to pass a bill requiring mandatory food insurance. Surely a citizen who has the means to buy food but chooses to get it ``free'' is acting irresponsibly.

Crazy? Of course. But not if you substitute ``health care'' for ``food.''

No, that actually makes it crazier.  Food and dining out are like health care and going to hospitals . . . how exactly?

People have to eat – sometimes up to several times a day – to maintain their physical wellbeing; the person who has seen the doctor least is usually the healthiest and happiest.  People relish the sensual pleasures of food and the dining experience; only mentally ill people enjoy a trip to the hospital.  Restaurants post their menu with prices out front for potential diners to browse and savor vicariously; patients have no advance notice of the price of the tests or procedures that their doctor may order for them, nor any ability to judge whether that will be the last word or the first of many.

But OK, I’ll bite.  Let’s imagine that health care was like food.  In that case it should be a great first date.

BOY: So, where do you want to go?

GIRL: I don’t care; you pick.

BOY: Umm, what do you like?

GIRL: I like most things.  I just don’t want to be someplace all night.

BOY: Well, there’s a little emergency room I know, not too far from here.

GIRL: That sounds good.

BOY: We could go to more of a clinic if you like.

GIRL: No!  I like emergency rooms.

[later]

BOY: That was pretty good huh?

GIRL: That was really fun.  I had no idea I had Hepatitis B.

BOY: Yeah, the look on your face was priceless!  I thought my MRI was fantastic.

[awkward silence]

GIRL: It was nice of you to ask me out tonight.

BOY [stammering]: I was wondering . . . if you weren’t too busy.

GIRL: Yes?

BOY: Perhaps we could go to a hospital next time.  You could get a pap smear and I could get a colonoscopy.

GIRL [huskily]: Oh, Martin. . .

After many nights out of medical care, both necessary and unnecessary, they get married and spend their honeymoon at the Mayo Clinic.  They grow older and more mature, and they finally have to start to face serious issues.  Issues like food, which really is like health care.

WIFE: You look kind of pale, dear.  What’s wrong?

HUSBAND: I’ve been feeling weird all day.  I’ve been kind of shaky and my stomach’s been making odd noises.

WIFE: Oh no!

HUSBAND: I think I might be . . . hungry.

WIFE: Oh Martin – have you been using up your calories again?

HUSBAND: I suppose I must have.  I don’t know how that happened.

WIFE [pursing lips]: Well I guess there’s nothing for it.  We’ll have to take you to a restaurant.

HUSBAND: Ugh!  You know how I hate chefs.

WIFE: Well I can’t do anything about that.  If you would have just used those herbal supplements like I have. . .

HUSBAND: Oh give it rest.  You know those things are sham food.

[later]

HUSBAND: So what did the tests show?

CHEF: Some of the results were inconclusive, but you may indeed be hungry.  Or there may be other factors.  Are you happy in your marriage?

HUSBAND: Yes.  – Of course!  What’s that supposed to mean?

CHEF: I didn’t mean to offend.  Sometimes marital troubles can manifest themselves as so-called “butterflies” in the stomach.  It’s sometimes mistaken for hunger.

HUSBAND: Oh.

CHEF [deliberating]: I’m going to start you on a regime of rice gruel, water and tofu.  I think you’ll find that after a few weeks the hunger will go away.

HUSBAND: Um.  You know, I was reading the other day about a meal that involved roast chicken and . . . um, asparagus?

CHEF [laughing]: Let’s start slow, shall we?  Our restaurant does offer the finest food available, of course, but it’s not clear your case requires anything that expensive.  If you’re still hungry in a week we can do some more tests, OK?

HUSBAND [resigned]: Yes, Chef.

CHEF: Is your insurance information still valid?

So we see.  Food.  Healthcare.  Virtually identical in terms of how we use them, when we need them, and what they cost.  Thus this ridiculously common “food insurance” analogy (not to be confused with the real thing) is totally valid and deserves to be answered seriously.

Not.

- jack*

Comments

[Zenji]

I think you're missing the point of the analogy. Eating in a restaurant and *purchasing* health care are both economic transactions. The analogy could just as easily be about renting a car and paying for a round of golf. The point, in the conservative mind, is always "Who's gonna pay for it?"

The point isn't that the activities are similar in some way, the point is, if you abstracted the health insurance system into a food insurance system, it would look ridiculous, because the poor restauranteur is so obviously getting screwed. I think we are supposed to feel sorry for the poor, struggling insurance industry. *Sob* I weep for their children! ;-)

Frankly, the fact that you can both starve to death AND go untreated for serious disease without anyone so much as noticing in this country is a sign of a series problem in our culture. But that's just me.
No matter who has to pay for the remedy.

[Zenji]

make that a serious problem, not a series problem. Preview good! good!

[jack*]

Going to a hospital is *not* an economic transaction for the patient; purchasing health insurance is. Deciding how much to pay for which health plan (assuming you have any choice at all) is a matter of doing a cost/benefit analysis and finding the money in the budget. For the insured cost is simply never discussed at the doctor's office.

Doctors get paid by insurance companies, not by patients. By trying to blame any unfairness in that transaction on the sick people themselves, as this author does, is disgusting. The fact that it requires such a risible analogy makes it almost not worth the trouble of refuting.

I agree that we accept starvation or untreated illness as economic tradeoffs is a national disgrace. Addressing it with fallacious analogies is an insult.

[Zenji]

But his point is, there are people who can't afford the insurance, and if you make insurance mandatory, he's afraid you will force the insurance companies to cover those people too, even though they don't pay them. People who pay for insurance are not this guy's concern, it's people who can't afford insurance or healthcare who he is concerned with.

He's chiefly concerned that they don't get a free ride. You are absolutely right that this is disgusting, to look at a sick person and say, "Can't pay? Too bad. Hope you don't die!" and that's that. But that is the Right Wing position on the issue, and it's very widespread.

[Elspeth]

Good post.