Johann Hari: Public services and a sweet twist of history

[Briar]

Johann Hari: Public services and a sweet twist of history


...The NHS is, in effect, a very wide health insurance scheme. Everyone pays in through general taxation, and everyone takes out when they need it. Risk is pooled across every resident of Britain. The alternative is some model of private insurance, where risk is pooled among smaller groups: the people who can afford to buy into your private health plan.

Technology is not rendering the NHS model out-of-date; instead, it is rusting up the private insurance model. Why? It is becoming easier and easier to predict who will become ill, and who will – barring accidents – remain healthy. So private insurance companies are responding by insuring the healthy, and offering unaffordably high premiums – or a flat "no" – to the people who need insurance most: the sick or likely-to-be-sick.

There was the first whisper of this shift on British shores last week. Medical insurers Pru Health have set up a system by which people who refuse to allow their attendance at the gym to be monitored, or to wear pedometers, have to pay up to four times as much for the same cover. My fellow stubborn fatties are punished for opting out. Dr Penny O'Nions of health care adviser the Onion Group says this is a harbinger of a private system where "unhealthy people are relegated to the bottom of the pile and high premiums". But the Association of British Insurers says that "such policies are likely to grow".

This has already been taken much further in the US, where private health insurance firms turn away 12 per cent of applicants, and more than 30 per cent of people over 60. This has created a growing class of the uninsurable – people like Cynthia La Morgese, a 29-year-old teacher in California. She works out three times a week, has a vegetarian diet, and practices pilates. There's no history of high cholesterol, high blood pressure, or pretty much anything else in her notes. But three years ago she injured her knee while working out, and when she quit smoking, she took Wellbutrin, an anti-anxiety drug that helps you give up. So that's it. She's out. "I can't get insurance," she says, after trying dozens of companies. "It's horrible."

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More at: http://comment.independent.co.uk/commentators/johann_hari/article3324413.ece