Everyone is entitled to his own opinion, but not his own facts. Founded by Mark Kleiman (1951-2019)
Real men don’t have mothers
Sen. Kyl (R-AZ) descends into Republican self-parody: it’s unfair to require health insurance to cover maternity care because he’s not likely to need it and therefore he shouldn’t have to pay for it.
Sen. Kyl (R-AZ) descends into libertarian self-parody: Â it’s unfair to require health insurance to cover maternity care because he’s not likely to need it and therefore he shouldn’t have to pay for it.
No, seriously.
No political opponent should ever let John Kyl forget this. And we should make him the poster child for Republican cluelessness and heartlessness about health insurance reform.
Author: Mark Kleiman
Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out.
Books:
Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken)
When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The EconomistAgainst Excess: Drug Policy for Results (Basic, 1993)
Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989)
UCLA HomepageCurriculum Vitae
Contact: Markarkleiman-at-gmail.com
View all posts by Mark Kleiman
He won't need anything that covers heart conditions either.
So by the same logic prostate conditions must not be covered either, right?
Indeed, we shouldn't let the absurdity of Senator Kyl's statement overshadow the absurdity of the amendment he was proposing. Every American will be required by law to buy health insurance…but the insurance companies will have no corresponding legal mandates regarding what they sell? WTF? "The good news is, our discount policy costs just $5/month. The bad news is, it only covers hangnails and eczema."
How on earth would covering senator Kyl with maternity benifit make his policy more expensive? I will sell senator Kyl materity benefit insurance at a very low price indeed.
Per comments at Ezra Klein's post, let the record show that Sen. Kyl has adult children and grandchildren.
And he was once a child, though he seems not to have imbibed of the milk of human kindness.
Somebody please elaborate on Kyl's confusion. Not just rational heartlessness. If he gets to opt out of uterine cancer coverage & I, lacking testicles, can opt out of testicular cancer converage, he can't know ahead of the evidence whether he'll be better off than if neither of us could opt out.
K, logically he'd also opt out of coverage for sickle cell, Downs, chicken pox, allergies, all the risks that b/c of genetics, experience, or chance he doesn't face. Want to live in the resulting USA?
No, Warren, I wouldn't. But I might be pleased to opt out of coverage of whatever it is that's wrong w/ Kyl if it'd complicate his life by a fraction of a cent. Even if I catch it myself. (As it happens, it's not impossible that he & I are in the same plan, & given his age, I assume his health care expenses are or soon enough will be greater than mine.) Problem is, I can see Kyl successfully persuading likeminded constituents that because they don't need X, they'd all necessarily be better off if they (& everyone else) could opt out of whatever X, Y, or Z they want. It's not only depraved, it's stupid.
I seriously don't understand what's wrong with the idea. Why should a couple that do not want a child (assume they have a IUD, vasectomy, etc) be forced to subsidise a couple that do?
Rowsdower, the whole point of health insurance is to spread risk, and costs, around. This means guys are paying for pregnancies (and neither are woman who aren't currently pregnant, and women who will never be pregnant, or – like Kyl's wife – will never be pregnant again). In the same vein, women are paying for prostate cancers, the obese are paying for athletes who tear their ligaments or who fall off of mountains, and athletes and mountain climbers are paying for the problems of the obese. There is zero chance I will ever get sickle-cell, because it's a genetic condition and I haven't got the mutation. Similarly, I have no known allergies, and at my age that means it's fairly unlikely I'll ever visit an allergist. Should I be able to get a plan tailored not to cover sickle-cell or allergists?
If we take Kyl's vision of cafeteria-style medicine to it's extreme, we wind up with a very clever comment that I'll repost from someone styling themselves "Free Lunch" posting to a similar thread elsewhere:
If you customize your insurance coverage perfectly, it is indistinguishable from paying for everything yourself (except for paying the insurance company its rake off).
That clever comment actually misses the point: The point of insurance is to average out your risks, so you can budget for them. If YOU have one chance in 1000 each year of sustaining a $50,000 expense, insurance replaces that with a predictable $50 per year bill, which you can budget for. Somebody else who has a one in 100 chance of the same event gets a $500 bill.
Now, this often has the effect of spreading costs, because each year the 999 people who got the insurance and didn't sustain that expense are handing off money to the one person who got unlucky. But if we all lived a thousand years, it would all average out. And if the premiums are accurately set, there are no net transfers between identifiable groups, because each group is supposed to be paying premiums which on average cover their expenses.
This means that in a properly functioning insurance system, no, men are NOT paying for pregnancies, and women are NOT paying for prostate cancer. But any woman who could get pregnant will be paying for pregnancies, and any guy who still has a prostate WILL be paying for prostate cancer. Based on their probability of that event.
Now, for various reasons involving tax laws we also use 'insurance' to pay for perfectly predictable events like getting your teeth cleaned, and to some extent those actuarial calculations have been deliberately done inaccurately in order to transfer money between identifiable groups. But this isn't insurance, any more than filling my swimming pool is "firefighting", just because the local fire department offers that service because they've got a truck that can carry water.
Senator Kyl has a perfectly valid point. You don't like it because you don't want an insurance system, you want a social benefits system. You're free to want that, and advocate that. But it still remains that it isn't insurance, it's something else.
And, of course, if your insurance is customized perfectly, it is very distinguishable from not having insurance, because while you on average pay for everything yourself, you don't have to worry about sudden, unpredicted expenses.
Brett, I have as much chance of getting pregnant as I do of getting sickle cell. Should I be able to buy a plan that omits sickle cell? And how will fertile women, or sickle carriers, get coverage?
Warren, insurance is a means of coping with incomplete knowledge. To the extent that we have specific knowledge about the impending expenses of a particular person, insurance ceases to be an appropriate model for dealing with those expenses. If you know somebody is going to get sickle cell anemia, insurance is the wrong way to deal with the expense.
Just because a screwdriver doesn't work very well when you've got a nail, doesn't mean that you should call a hammer a "screwdriver", and insist that people use hammers when they really do have screws. You need a screwdriver for screws, and a hammer for nails.
Insurance has it's place. Predictable medical expenses are not that place.
Brett,
Why the implicit assumption that the financial costs of pregnancy and childbirth should be borne solely by the woman? Shouldn't the father share the financial burden, if not the physical one? The issue is not whether men can become pregnant – that's a red herring. The issue is whether men share in the financial obligations involved. GIven the libertarian emphasis on individual accountablility I would think you would agree that they do. Having men pay for maternity insurance accomplishes this.
In fact, the percentage of women who are incapable of becoming pregnant is greater than the percentage of men who are incapable of fathering a child. So if we start handing out these exemptions let's start there.
Sure, the father should share some of the cost. The father, in pretty much every pregnancy I've heard of, is a specific guy, not half the human race. The fact that women aren't pathogenic scarcely is reason to charge guys the cost of random women's pregnancies, regardless of whether they had anything to do with them.
Brett,
I think the word you want is parthenogenetic, not pathogenic. Other than that, the person causing a car accident is usually a specific individual also, but I have insurance in case sometime that person happens to be me.
It used to be that getting coverage for something that was bound to happen was called "assurance" rather than "insurance" – so: life assurance, at least for whole lift policies, since the policy holder was bound to die at some point during coverage. The assurance policy was a bet between the policy holder and the insurer, the holder betting that he/she would die before the actuaries predicted, the insurer betting the other way (and of course paying the actuaries…)
I don't think that terminological difference is used any more.
I am very willing to pay for insurance that covers things that will never happen to me, because I think people's health is a social issue, and the insurance plan can legitimately have a social element. The social disasters caused by the current US health care situation are far more costly than men having to pay for pregnancy care and other 'inefficiencies'.
Bernhard, the spell checker tripped me up. You are, of course, right.
I am, at this point, just defending Kyl on the terminological front. He's right about what "insurance" is. Let's debate social benefits programs using accurate terminology. To paraphrase, everyone is entitled to their own policy preferences, they're not entitled to their own dictionary.
I would also point out that warping the actuarial calculations to provide social benefits is going to have some problems in the context of 'free' (Not yet completely regulated) markets: To the extent the premiums are actuarially unjustified in order to transfer money from one group of insured to another, insurance companies are motivated to load up on the people being charged excess premiums, and ditch the people being charged subsidized premiums.
Unless, of course, the premiums are set accurately, and the subsidy comes afterwards. Which would be my preference. That way the insurance providers have no motive to discriminate, and the nature of what's actually being done is out in the open.
"If you customize your insurance coverage perfectly, it is indistinguishable from paying for everything yourself (except for paying the insurance company its rake off)."
Pretty sure Brett has already driven this point home, but it is VERY much distinguishable. Insurance is (essentially) a way of gambling; you bet so that if bad things happen to you, you receive a payout (that will hopefully partially compensate for that bad event). People are willing to let the house win in aggregate because the payout provides security.
You demand that people buy products that they don't need from a private sector business, and assume that the extra money spent finds its way back into needy hands? Huh?
There's a good argument to be made that insurance used to be risk spreading. But thanks to data mining, computer modeling (statistical and otherwise), rescission and the fact that insurance companies generally only sell their products from year to year, it really ain't any more. Insurance companies now make their money from pretending to spread risk while actually doing relatively little of the sort. (There's some intertemporal risk spreading, but nothing that couldn't be handled in a modern, innovative financial market.)
As I pointed out above, insurance is a response to inadequate information, and ceases to be an appropriate model to the extent we actually HAVE that information. We are entering into an awkward period, where we've got enough information to identify who's going to suffer the illness, but lack enough to cheaply prevent them from suffering it. We should aim to get through it as fast as possible, without doing anything to prevent us from reaching the other side.
That may mean that insurance doesn't work well, but trying to warp insurance into a social benefits program just results in insurance that REALLY doesn't work well. Further, it's a way of hiding costs, and costs generally should not be hidden. We don't make sure the poor don't starve by mandating that grocers sell them food at unprofitable rates, we shouldn't make sure they get health care by doing something similarly stupid.
When the government sets out to provide a benefit to the public, it should do so through general revenues, not by impositions on specific businesses. If a program is for the general welfare, the general public should pay for it.
Bottom line, aside from some basic reforms so that insurance companies actually have to deliver their promised benefits, stop screwing with the insurance industry, and start arguing for the program you really want.
Yet another friend of the fetus, right up to the moment of birth.
He won't need anything that covers heart conditions either.
So by the same logic prostate conditions must not be covered either, right?
Indeed, we shouldn't let the absurdity of Senator Kyl's statement overshadow the absurdity of the amendment he was proposing. Every American will be required by law to buy health insurance…but the insurance companies will have no corresponding legal mandates regarding what they sell? WTF? "The good news is, our discount policy costs just $5/month. The bad news is, it only covers hangnails and eczema."
How on earth would covering senator Kyl with maternity benifit make his policy more expensive? I will sell senator Kyl materity benefit insurance at a very low price indeed.
Per comments at Ezra Klein's post, let the record show that Sen. Kyl has adult children and grandchildren.
And he was once a child, though he seems not to have imbibed of the milk of human kindness.
Somebody please elaborate on Kyl's confusion. Not just rational heartlessness. If he gets to opt out of uterine cancer coverage & I, lacking testicles, can opt out of testicular cancer converage, he can't know ahead of the evidence whether he'll be better off than if neither of us could opt out.
K, logically he'd also opt out of coverage for sickle cell, Downs, chicken pox, allergies, all the risks that b/c of genetics, experience, or chance he doesn't face. Want to live in the resulting USA?
No, Warren, I wouldn't. But I might be pleased to opt out of coverage of whatever it is that's wrong w/ Kyl if it'd complicate his life by a fraction of a cent. Even if I catch it myself. (As it happens, it's not impossible that he & I are in the same plan, & given his age, I assume his health care expenses are or soon enough will be greater than mine.) Problem is, I can see Kyl successfully persuading likeminded constituents that because they don't need X, they'd all necessarily be better off if they (& everyone else) could opt out of whatever X, Y, or Z they want. It's not only depraved, it's stupid.
I seriously don't understand what's wrong with the idea. Why should a couple that do not want a child (assume they have a IUD, vasectomy, etc) be forced to subsidise a couple that do?
Rowsdower, the whole point of health insurance is to spread risk, and costs, around. This means guys are paying for pregnancies (and neither are woman who aren't currently pregnant, and women who will never be pregnant, or – like Kyl's wife – will never be pregnant again). In the same vein, women are paying for prostate cancers, the obese are paying for athletes who tear their ligaments or who fall off of mountains, and athletes and mountain climbers are paying for the problems of the obese. There is zero chance I will ever get sickle-cell, because it's a genetic condition and I haven't got the mutation. Similarly, I have no known allergies, and at my age that means it's fairly unlikely I'll ever visit an allergist. Should I be able to get a plan tailored not to cover sickle-cell or allergists?
If we take Kyl's vision of cafeteria-style medicine to it's extreme, we wind up with a very clever comment that I'll repost from someone styling themselves "Free Lunch" posting to a similar thread elsewhere:
That clever comment actually misses the point: The point of insurance is to average out your risks, so you can budget for them. If YOU have one chance in 1000 each year of sustaining a $50,000 expense, insurance replaces that with a predictable $50 per year bill, which you can budget for. Somebody else who has a one in 100 chance of the same event gets a $500 bill.
Now, this often has the effect of spreading costs, because each year the 999 people who got the insurance and didn't sustain that expense are handing off money to the one person who got unlucky. But if we all lived a thousand years, it would all average out. And if the premiums are accurately set, there are no net transfers between identifiable groups, because each group is supposed to be paying premiums which on average cover their expenses.
This means that in a properly functioning insurance system, no, men are NOT paying for pregnancies, and women are NOT paying for prostate cancer. But any woman who could get pregnant will be paying for pregnancies, and any guy who still has a prostate WILL be paying for prostate cancer. Based on their probability of that event.
Now, for various reasons involving tax laws we also use 'insurance' to pay for perfectly predictable events like getting your teeth cleaned, and to some extent those actuarial calculations have been deliberately done inaccurately in order to transfer money between identifiable groups. But this isn't insurance, any more than filling my swimming pool is "firefighting", just because the local fire department offers that service because they've got a truck that can carry water.
Senator Kyl has a perfectly valid point. You don't like it because you don't want an insurance system, you want a social benefits system. You're free to want that, and advocate that. But it still remains that it isn't insurance, it's something else.
And, of course, if your insurance is customized perfectly, it is very distinguishable from not having insurance, because while you on average pay for everything yourself, you don't have to worry about sudden, unpredicted expenses.
Brett, I have as much chance of getting pregnant as I do of getting sickle cell. Should I be able to buy a plan that omits sickle cell? And how will fertile women, or sickle carriers, get coverage?
Warren, insurance is a means of coping with incomplete knowledge. To the extent that we have specific knowledge about the impending expenses of a particular person, insurance ceases to be an appropriate model for dealing with those expenses. If you know somebody is going to get sickle cell anemia, insurance is the wrong way to deal with the expense.
Just because a screwdriver doesn't work very well when you've got a nail, doesn't mean that you should call a hammer a "screwdriver", and insist that people use hammers when they really do have screws. You need a screwdriver for screws, and a hammer for nails.
Insurance has it's place. Predictable medical expenses are not that place.
Brett,
Why the implicit assumption that the financial costs of pregnancy and childbirth should be borne solely by the woman? Shouldn't the father share the financial burden, if not the physical one? The issue is not whether men can become pregnant – that's a red herring. The issue is whether men share in the financial obligations involved. GIven the libertarian emphasis on individual accountablility I would think you would agree that they do. Having men pay for maternity insurance accomplishes this.
In fact, the percentage of women who are incapable of becoming pregnant is greater than the percentage of men who are incapable of fathering a child. So if we start handing out these exemptions let's start there.
Sure, the father should share some of the cost. The father, in pretty much every pregnancy I've heard of, is a specific guy, not half the human race. The fact that women aren't pathogenic scarcely is reason to charge guys the cost of random women's pregnancies, regardless of whether they had anything to do with them.
Brett,
I think the word you want is parthenogenetic, not pathogenic. Other than that, the person causing a car accident is usually a specific individual also, but I have insurance in case sometime that person happens to be me.
It used to be that getting coverage for something that was bound to happen was called "assurance" rather than "insurance" – so: life assurance, at least for whole lift policies, since the policy holder was bound to die at some point during coverage. The assurance policy was a bet between the policy holder and the insurer, the holder betting that he/she would die before the actuaries predicted, the insurer betting the other way (and of course paying the actuaries…)
I don't think that terminological difference is used any more.
I am very willing to pay for insurance that covers things that will never happen to me, because I think people's health is a social issue, and the insurance plan can legitimately have a social element. The social disasters caused by the current US health care situation are far more costly than men having to pay for pregnancy care and other 'inefficiencies'.
Bernhard, the spell checker tripped me up. You are, of course, right.
I am, at this point, just defending Kyl on the terminological front. He's right about what "insurance" is. Let's debate social benefits programs using accurate terminology. To paraphrase, everyone is entitled to their own policy preferences, they're not entitled to their own dictionary.
I would also point out that warping the actuarial calculations to provide social benefits is going to have some problems in the context of 'free' (Not yet completely regulated) markets: To the extent the premiums are actuarially unjustified in order to transfer money from one group of insured to another, insurance companies are motivated to load up on the people being charged excess premiums, and ditch the people being charged subsidized premiums.
Unless, of course, the premiums are set accurately, and the subsidy comes afterwards. Which would be my preference. That way the insurance providers have no motive to discriminate, and the nature of what's actually being done is out in the open.
"If you customize your insurance coverage perfectly, it is indistinguishable from paying for everything yourself (except for paying the insurance company its rake off)."
Pretty sure Brett has already driven this point home, but it is VERY much distinguishable. Insurance is (essentially) a way of gambling; you bet so that if bad things happen to you, you receive a payout (that will hopefully partially compensate for that bad event). People are willing to let the house win in aggregate because the payout provides security.
You demand that people buy products that they don't need from a private sector business, and assume that the extra money spent finds its way back into needy hands? Huh?
There's a good argument to be made that insurance used to be risk spreading. But thanks to data mining, computer modeling (statistical and otherwise), rescission and the fact that insurance companies generally only sell their products from year to year, it really ain't any more. Insurance companies now make their money from pretending to spread risk while actually doing relatively little of the sort. (There's some intertemporal risk spreading, but nothing that couldn't be handled in a modern, innovative financial market.)
As I pointed out above, insurance is a response to inadequate information, and ceases to be an appropriate model to the extent we actually HAVE that information. We are entering into an awkward period, where we've got enough information to identify who's going to suffer the illness, but lack enough to cheaply prevent them from suffering it. We should aim to get through it as fast as possible, without doing anything to prevent us from reaching the other side.
That may mean that insurance doesn't work well, but trying to warp insurance into a social benefits program just results in insurance that REALLY doesn't work well. Further, it's a way of hiding costs, and costs generally should not be hidden. We don't make sure the poor don't starve by mandating that grocers sell them food at unprofitable rates, we shouldn't make sure they get health care by doing something similarly stupid.
When the government sets out to provide a benefit to the public, it should do so through general revenues, not by impositions on specific businesses. If a program is for the general welfare, the general public should pay for it.
Bottom line, aside from some basic reforms so that insurance companies actually have to deliver their promised benefits, stop screwing with the insurance industry, and start arguing for the program you really want.