To the Editor: A few counter-arguments to Carol Solle’s letter of the 27th

On comparing car and health insurance, and advocating competition: Car ownership is voluntary, accidents are rare for good drivers, and good driving can be learned. It makes sense for there to be differences in premiums for good and bad drivers, and for degrees of coverage. Illness is involuntary and universal, and can’t be unlearned except for lifestyle changes like smoking and overeating, which are a good idea but not a panacea. Competition in the market leads to cherry-picking, where healthy and young people choose cheap insurance or none at all, while older and less healthy people are forced to pay more or are denied coverage altogether. They often then end up being treated as indigents, their costs being passed on to the rest of us as higher doctor and hospital overhead and higher insurance premiums. This is why coverage should be universal. Car insurance is, after all, for those who choose to drive, and for good reason.

On mandates: If mandates are not imposed, insurance companies can simply refuse to cover expensive treatments, like cancer treatments. Obviously, those companies’ premiums would be cheaper, and people who wanted to gamble on not getting cancer would opt for them. But when some of those people did get cancer, they would probably end up being treated as indigents, as above.

On Health Savings Accounts and high deductibles: These mostly benefit the well-off who can take a tax deduction for HSA contributions and can easily afford out-of-pocket expenses. Lower-income people don’t make enough to itemize deductions, so HSAs are useless to them. And high-deductible plans can backfire if they discourage people from getting preventive care , (like mammograms), leading to more expensive remedial care later.

On tort reform: Torts only make up about 2% of health costs nationally, so tort reform would have a minuscule impact on health costs. Doctors have a financial incentive for performing needless tests, because they get paid for doing them. And malpractice insurers have a financial incentive to whine about tort reform, because what’s 2% of total health costs is 100% to them.

On “the government taking control of 17% of the GDP:” The reason our health care system takes up 17% of GDP is that it’s dominated by private industries that are making higher profits than most of the rest of our economy. The socialized British system takes about half as much of Britain’s GDP. And the British have longer life expectancy and less child mortality, probably because poor people there get health care paid for by universal taxes.

On “cutting $500,000,000,000 from Medicare:” Medicare and other federal health spending amount to a full half of US health spending, but there are industry-protecting laws preventing the government from using this potential bargaining power to force down costs. These programs could, indeed, bankrupt the federal government. But there are only two ways of cutting costs – cut services or cut private profits. Take your pick. The British system sounds pretty good to me.

Chris Nielsen
Shoreline