Where's Santa Claus

Remember - health insurance is a business


As a child, whenever one of my teeth fell out, I would put it under my pillow at night when I went to bed. The next morning when I looked under my pillow, I would find that the Tooth Fairy had come and taken my tooth and had replaced it with a nice shiny coin. Eventually I learned that it really wasn't the tooth fairy that had left those coins under my pillow, it was my parents. The Tooth Fairy didn't really exist.

On Christmas Eve, I would go to bed early, like a good boy, so that Santa Claus would come and leave me a lot of presents. I would wake up early the next morning and check under the Christmas tree. Sure enough, Santa had brought a lot of nice presents - eventually I discovered that it wasn't Santa Clause that had brought me those gifts, it was my parents. Santa Clause doesn't really exist.

Now, many years later, I find that there are many adults who still believe in Santa Claus. And, they believe that Santa Claus has taken form in the shape of a health insurance company. In some countries he really has, in a sense. But medical care isn't really being provided to the population of those countries by some sort of philanthropic-being with deep pockets filled with money. It is being paid for by the citizens of those countries, themselves, in the form of taxes. Taxpayer supported healthcare is fast becoming the wave of the future. Thailand is working toward this goal. And, the U.S. is starting to consider it also.

For now, though, taxpayer supported health care is not a yet a reality for most of us. Now, we have no other choice but to rely on private health insurers for our medical care needs.

Private health insurers are certainly not philanthropic. They are in business to fill a need, make a profit and remain competitive against their rivals.

If private health insurers become too easygoing in their processing of questionable claims, their claims losses will increase considerably. If this happens, they will be forced to increase their premiums to cover those high claims losses. If those losses force them to increase their premiums too much, they will lose customers. I've seen this happen.

One of the biggest problems is that some people only buy health insurance when they know that they have a medical problem and want the health insurance company to cover the cost of their treatment. They really, honestly believe that the health insurance companies are some form of big philanthropic entity that, after receiving just one small premium, is ready to take over paying their costly medical bills.

I see this often. One person, I will never forget, submitted his health insurance application to me and then, the very next day, called me from the hospital and asked me to tell him his hospital card number. He explained that he needed it because he was about to have an operation. Apparently, he bought the insurance in order to pay for this operation.

I explained to him that most health insurance plans have a 30 day waiting before they will cover treatment for illness. Also, the fact that he had scheduled the operation before he bought the policy very clearly classified his problem as a pre-existing condition. I told him that his operation was not covered.

Unconvinced, he called the insurance company. After they explained to him that his treatment was definitely not covered, he started yelling at them and then hung up. He called them back again a few more times over the next week and yelled at them some more.

When you buy health insurance you are sharing risk with a population of insureds. It is like all of you are putting your money together into one big jar to draw from if any of you have any medical needs. Anyone who puts money into that jar should not be expecting to draw from it, but should gain piece of mind knowing that the money is there for them should they ever need it.


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