Gambling on Healthcare

Almost every month, the call goes out to those of us in, or on the fringes of, the so-called “jazz community”: So-and-so was in a bad car accident. He has medical bills of $44,000 and NO INSURANCE! We’re organizing a benefit concert to raise money to help pay for his care. Please contribute what you can… 

Many jazz musicians — and writers, and other self-employed folks — don’t have health insurance. The main reason, according to many who forgo coverage, is that it’s “too expensive.” That’s probably true. Health insurance, and health care in general is too expensive — and inefficient, and inequitable, and all the other well known iniquities. That’s a separate issue.

Despite the onerous costs, those who voluntarily decline to purchase health insurance — as opposed to those who are universally denied coverage — either place too little value on a healthy life or, more likely, figure they’ll never be so sick that colleagues must organize benefit events to pay for their care.

When you buy insurance, you’re making a bet with the insurer. In the case of health insurance, when you pay your monthly premiums, you’re betting the HMO that you will get sick and require services that cost more than the sum of your premiums. When you decline health insurance, you’re betting you won’t need medical care — and if you do, it will cost less than the sum of your premiums. For those who seldom, if ever, go to doctors, this premise seems sound. But catastrophes, by definition, strike unexpectedly. Even the healthiest piano player in the world can get hit by a bus or be afflicted with a mysterious virus. Artists who neglect to procure insurance don’t have their priorities straight. Nothing — not the car, the TV, the laptop computer, the condo, the tickets to the movieplex — is worth the gamble.

Pardon the unabashed Grinchiness: If perpetually uninsured people figure it’s worth the risk to forgo health insurance, preferring to purchase other things instead, then they ought not to impose upon their cautious, less reckless friends when lady luck turns petulant. We seem the same selfish, unethical behavior from those who took out so-called “sub-prime” mortgages they had no means to repay: when circumstances turn sour, it’s someone else’s responsibility (like the federal government) to bail them out. Next time you go to Vegas and blow the mortagage money on roulette, see how this line of reasoning works on your neighbors.

Speaking of Vegas, some professional poker players I know, who tend to have a lot more money than my jazz musician friends, self-insure. They think the “vig” (the house edge), or juice, in the form of the insurance company’s immense profit, is too high. The money that they save on monthly premiums goes into an interest-bearing medical fund, and when they need to see a doctor they pay cash.

That’s a neat money-saving trick for those who are well-capitalized. Everyone else must pay on the installment plan, forking over prodigious monthly premiums to Blue Shield et. al. — or be prepared for the consequences when the doctor bill comes.

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