Re:Interview with Jeff Atwood, Co-Founder of Stack Overflow
by wahern on Wednesday January 22, 2025 @07:00PM
(#42798921)
> How does the concept of health insurance, risk pooling, etc., make sense if there are no lifetime maximums…?
You're right, it doesn't make literal sense. Though we use the term, health insurance, everybody is really talking about medical coverage, period, except for those trying to play semantic games (not pointing to you). Concepts like risk pooling can still be useful, but at the end of the day we're not really talking about insurance, but how to equitably spread the costs and benefits of rapidly advancing medicine.
Social Security is closer to an insurance scheme. Social Security is a deferred life annuity (a type of insurance instrument) that everybody is required to buy, except there's no middleman. Unfortunately, the last time we extended the deferral period to properly account for risk and cost was 1983. When Social Security originally passed it was assumed Congress would regularly change retirement ages; people in the 1930s knew how insurance worked, and knew full well that lifespans would continue increasing, but they failed to account for political friction in having to explicitly update the terms of the program. Other than military pensions, we didn't have much political experience with large entitlement programs (though it's possible the reason they didn't build in an inflation mechanism then is the same we can't do it today).
Medicare was patterned after Social Security, however like SS we don't properly adjust the age nor pay-in as lifespans have increased and medical costs soared; and advances in medicine and expectations of care evolve so quickly these days that I'm not sure its even possible as a practical matter, not while pretending it's truly any kind of insurance.
You're right, it doesn't make literal sense. Though we use the term, health insurance, everybody is really talking about medical coverage, period, except for those trying to play semantic games (not pointing to you). Concepts like risk pooling can still be useful, but at the end of the day we're not really talking about insurance, but how to equitably spread the costs and benefits of rapidly advancing medicine.
Social Security is closer to an insurance scheme. Social Security is a deferred life annuity (a type of insurance instrument) that everybody is required to buy, except there's no middleman. Unfortunately, the last time we extended the deferral period to properly account for risk and cost was 1983. When Social Security originally passed it was assumed Congress would regularly change retirement ages; people in the 1930s knew how insurance worked, and knew full well that lifespans would continue increasing, but they failed to account for political friction in having to explicitly update the terms of the program. Other than military pensions, we didn't have much political experience with large entitlement programs (though it's possible the reason they didn't build in an inflation mechanism then is the same we can't do it today).
Medicare was patterned after Social Security, however like SS we don't properly adjust the age nor pay-in as lifespans have increased and medical costs soared; and advances in medicine and expectations of care evolve so quickly these days that I'm not sure its even possible as a practical matter, not while pretending it's truly any kind of insurance.