Mark Garfinkel's post from 2-27 re insurance

Mark D. Garfinkel garfinkl at
Mon Feb 28 19:53:29 EST 1994

In article <940227124543.74be at VAX.PHR.UTEXAS.EDU>
RHODES at VAX.PHR.UTEXAS.EDU (David G. Rhodes) writes:

>Subject: Re: Mark Garfinkel's post from 2-27 re insurance
	I am flattered beyond all measure! Never before have I been
named in the subject header of a Usenet newsgroup posting.

>The unstated is the most significant factor in your entire argument.
>In the example of 'you exercise, eat right, etc... while I do not and end up
>being sick' there is a voluntary aspect to the argument that _markedly_
>distinguishes it from the case of an involuntary predisposition imposed by
	I think we agree that in many cases there are both environmental
(including voluntary behavioral) factors and genetic predispositions
contributing to a person's health. One of the results of the human genome
project & the efforts to map & measure QTLs should be that this interplay
will become clearer. Elsewhere in the post you quote from, I do mention
that voluntary modifications to behavior may compensate for involuntary
genetic predispositions; such amelioration will be part of the new
medicine, at least for the wiser patients of the better doctors.

>one could envision
>a population of at risk people paying outrageous premiums, essentially
>establishing a savings account to cover the inevitable costs, and a second
>group of relatively risk-free people for whom the 'betting' is a great deal
>which allows them to keep all their money.  For the first group, the insurer
>is dead wood, and they would be just as well off investing in mutual funds
>or the like.
	In principle I agree. If  *any* individual is convinced that
his/her discipline to save an adequate amount of money and that his/her
selection of mutual funds (or other investments) will provide a larger
amount of money for health-care emergency use, then by all means that
person should have the freedom to make that choice.

>The bottom line is that there  _is_ a shared risk
	Depends upon how the actuarial group is defined. If you say that
the risk of heart disease is x% for all adults, then it's shared to one
degree. If you say there is a risk of heart disease for adult men that is
x% and for adult women that is y%, then one could argue that health
insurance for men should be costlier than it is for women. If you sub-
divide adult men by age, then the percentages change for each age bracket,
etc. Problems arises when the actuaries lose sight of just how big
a grouping needs to be for the statistics not to fluctuate radically from
year to year just by random events & sampling. [We've probably all
heard about cases where the group-insurance plan of a 10-employee company
became impossibly expensive when 2 of the employees had C-section
pregnancies, or something similarly complicated in the same year.]

, and to throw
>out those who most need the coverage is like leaving unwanted babies on the
>mountain outside of town.
	No, I don't think I or anyone else had said this. What I know
I said is that costs ought to be proportional to risk, that both
behavioral & genetic factors will be brought into consideration in
assessing risk, and that in a free-market economy one cannot forget
that insurers are *businesses* engaged in the effort, with scrupulous
honesty one hopes, to make profits. They cannot, morally, be coerced
into accepting customers; nor can some customers, morally, be coerced
into paying premiums that unfairly or inappropriately subsidize other

>All of these recent postings have, in my opinion,
>been very strong arguments for the national/universal health care proposals
>(pick whichever flavor you prefer, but just do it).
	No, not clear at all. Just above you made a cogent argument
that some people could do better for themselves by *self*-insurance,
in effect. This is quite the opposite of mandatory participation in a
government-controlled health care system.


Mark D. Garfinkel (e-mail: garfinkl at
My views are my own, which is why they're copyright 1994

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