Psychotherapist Is Unable to Understand What Medical Insurance Is

Writing in today's New York Times opinion section, the psychotherapist and Atlantic contributor Lori Gottlieb offers a shocking first-person account of why the Affordable Care Act is in so much political trouble: It's because many Americans are too stupid and too selfish to understand how health insurance works, on the most fundamental level.

This is not what Gottlieb thinks she's written. She thinks she's written about how harsh and unfair Obamacare has turned out to be for ordinary insurance customers like her. As someone without employer-provided insurance, Gottlieb is facing "the cancellation of my individual P.P.O. policy and the $5,400 annual increase that I would have to pay for the Affordable Care Act-compliant option."

Gottlieb describes this as "a serious burden on my family's well-being," and she is taken aback that when she complained about it on Facebook, only one person gave it a "like." Many people—the "smug insured," she calls them, a la Bridget Jones—expressed a complete lack of sympathy for her plight.

Maybe the reason that Gottlieb's Facebook friends are not sympathetic toward her is that she is thoroughly unsympathetic. Under her new, intrusively excessive policy, she writes, "now if I have Stage 4 cancer or need a sex-change operation, I'd be covered regardless of pre-existing conditions."

Yes, that's right: the oppressive, thoughtless Obamacare rules require everyone to be covered even if they have such weirdo unlikely conditions as ... cancer? As if!

What Gottlieb is discovering, belatedly, is how much it costs to buy real health insurance rather than fake health insurance. Cancer—this should be needless to say, yet it evidently is not—is a definitive example of why health insurance exists. The disease can strike, without warning, at any stage of life. Nobody sets aside money in the household budget as savings in case they might get cancer.

One day, you are an apparently heathy individual with minimal healthcare expenses; the next, you need drugs and high-tech treatments that cost as much as a car or a house or a middle-class family's entire net worth. Or else you will die. (And you may not survive it despite all that.)

The same principle holds for most other expensive health problems. You do not know what will happen to you medically. You can make a guess, based on being young and healthy and safe, that nothing bad or expensive will come your way. Maybe you will even personally be right, but some fraction of the people with your demographic profile who think that way will turn out to be wrong.

In the long run, moreover, everyone will be wrong. In that sense, you do know what will happen to you: You will die. And unless you are planning to die quietly and alone, so that no one finds you till your body is cold, or to die a sudden death so gory and violent that nobody even bothers to rush your mangled remains to the trauma center, you are going to, at some point on your way toward death, receive intensive and costly medical care.

Why, the complainers ask, should the young and healthy be forced to pay for the health care of the old and sick? It might be the single dumbest argument about health insurance. This isn't even the usual greedy antisocial libertarian line of complaint—well, I don't have a kid, so why should my taxes pay for schools? There's no need to invoke social unity or the common good: Young, healthy people are not a separate population from the old and unhealthy. They are the very same people, only at a different stage of life.

And cancer treatment and gender-reassignment surgery aren't the only medical options that Gottlieb wants the freedom to decline. Another thing that's driving up the price of her new Obamacare-mandated policy, she writes, is maternity care. "(Handy for a 46-year-old)," she sniffs.

Age is only part of the reason Gottlieb isn't interested in paying for maternity coverage. The other part is that she has already had a baby. Until recently, she was enrolled in a plan that did provide maternity coverage, which allowed her to get other people—people who were paying higher premiums for the option of having a child, but who were not yet going through the expense of pregnancy and childbirth—to subsidize her own pregnancy and childbirth.

So once she'd collected the benefit, it was time to unload the costs onto the other suckers and get a new policy:

[I]t was in 2011 that I altered mine, dumping maternity benefits so that I didn't have to pay for everyone else's pregnancies. Little did I know I'd end up losing my insurance and paying for everyone else's pregnancies.

See ya! I had my kid. Catch you later, when I need someone to help pay for my menopause treatment.

Let's note that 2011 was after the Affordable Care Act was passed. Gottlieb bailed out of her old plan and into a cheaper, incomplete one at a time when those plans were already doomed. While we're focusing on self-reliance, why should anyone else feel responsible for her bad decision?

[Image by Jim Cooke]