I find myself writing a lot about recent political issues. Things seem to be changing and often in ways that make little sense to me. The possible changes to health insurance are an example. As a recent retiree, I had to abandon my university group health care plan and find something new. Luckily, I now live in Minnesota and have three options. Hopefully, any political changes will not destroy this situation. The pre-existing condition issue is a big one for my own family as several individuals face a genetic condition that predicts a high rate of cancer so the true meaning of “access to health care” matters.
It is with this mind set that I have been thinking about other issues. I just returned from a conference I still attend with other professors. Those others are still working while I am not. My decision to retire was based on several factors – did I have enough money was certainly important. Did I have things I thought were important to do but that would be difficult should I continue to work was another? One factor that most may not consider when reaching retirement age weighed heavily on me. I was holding a work position that many would love to have. My position was not a job that required much in the way of physical capabilities. I had tenure and was making a nice income. My intellect was pretty much intact as far as I could tell and without the responsibility of children I should spend time with, I had more time to devote to my job than younger faculty members. What bothered me was the difficulty I witnessed in young PhDs searching for a good faculty job. These jobs are very competitive and I felt I had had my opportunity. It was time for a new hire to have a chance. I do think more folks should consider this reality. Certain job areas are not going to expand and there is some element of selfishness in hanging on. I felt that I could continue the intellectual challenge of the job without requiring an office or a paycheck. Most days reading and academic writing are still what I spend much of my time doing.
I wonder if changes to health insurance will come to influence the type of decision I made. If health care for older individuals becomes much more expensive and care for those with pre-existing conditions become insanely expensive, why would someone like me give up coverage that prevented any such concerns? A group health plan protected me and my wife. Why risk providing someone else a job opportunity with so much on the line?
I happen to think we make health insurance far too complicated. Simply put, the idea is that the risk for a group must be covered by a charge to all. When some do not contribute because they cannot or some simply feel they owe nothing to others, things become more complicated. The affordable care act tried to prevent those who had reasonable means and decided not to become involved by way of a penalty so some funds went into the overall risk pool. Some states were unwilling to enforce this expectation and maybe the penalty should have been larger. Simple math quickly becomes complex when the system can no longer rely on simple division. Now, the system must find other ways to address the risk pool. Throwing out some who on average can reliably be predicted to be more costly is one such approach. Let them fund themselves or recalculate the risk for this risky group. The issue becomes one of whether such an approach is ethical or moral. If some cannot pay already, note that those in the risky group face far more expensive policies with no hope of covering the cost.
Complexity can be introduced in other anticipated ways. I have raised one I am guessing most have not considered. There are predictable relationships between age, access to health insurance, and employment opportunities. Why would employed and protected older individuals leave the job market to offer a high paying job to others should they not be able to count on health insurance? So much of a democracy depends on trusting the system. So much of a democracy depends on shared goals. Systems begin to break down when it is everyone for themselves.