Not Clear on the Concept

Speaking of risk (as we were not too far down the page): the health insurance system is broken, and getting more broken every day. Here, in an article by Gina Kolata (one of the best writers on health and medicine ever, IMHO), is an example: Several insurers have changed the system so they are covering only a tiny fraction of the cost of more expensive drugs--not elective-type drugs that a person could easily live without or replace with a cheaper alternative, but life-saving drugs for diseases such as cancer and MS--leaving sick people with monthly bills in the thousands of dollars, in some cases, for their meds.

[T]he new system sticks seriously ill people with huge bills, said James Robinson, a health economist at the University of California, Berkeley. “It is very unfortunate social policy,” Dr. Robinson said. “The more the sick person pays, the less the healthy person pays.”

Traditionally, the idea of insurance was to spread the costs of paying for the sick.

“This is an erosion of the traditional concept of insurance,” [Dan Mendelson of Avalere Health] said. “Those beneficiaries who bear the burden of illness are also bearing the burden of cost.”

Exactly. The whole idea for the insured person of having insurance is to be sheltered from ruinous expense in the event of serious illness or injury. 

The idea of insurance is to spread the risk around. Unfortunately, while spreading the risk around is ultimately a good arrangement for everyone in the risk pool (everybody gets sick sometime), it's ultimately a socialist enterprise. (Ooh, I said the bad word!) But insurance companies are capitalist enterprises--they exist to make a profit. And the way to maximize profit is to avoid paying out. So, you make it hard for sick people to get insurance, and you penalize insured people if they get sick. Basically, the money-making model is to get people to pay in, but get rid of them if you have to pay out. Which is the opposite of the concept most of us are looking for in a health insurance plan. It insures not much of anything.

The obvious solution, then, is a single-payer system that operates to spread the risk across the pool, but not to make a profit. 

What won't be a solution is mandating insurance for everyone without regulating exclusions, increases in premiums or copays, decreases in coverage, etc. This can't be fixed one step at a time. The broken system requires a complete overhaul, and anything less will only exacerbate the problem. Let's hope our new Democratic Congress has the vision to see that clearly.

Risk Reverse

You may have heard about the woman who let her nine-year-old find his own way home on the subway, wrote about it here, and is taking a lot of flak about it. I got involved in the discussion about it on Boingboing. The point I made there and will reiterate here:

There's a book about to come out (full disclosure: I work for the publisher) called Flirting with Disaster, which is about how disasters and their consequences come to occur and can be avoided. In one of the opening chapters, the author talks about perception of risk versus actual risk, and how pervasive media--much more access to much more information--is one of the factors that skews our perception of risk. This is certainly a case in point. Of course we've all heard about every abducted, molested, or murdered child, because we have a zillion channels, 24-hour news networks, the internet, etc. But we don't hear about every car accident that happens, because they're a common, everyday occurrence. Statistically, your kid is probably safer taking the subway than being driven around everywhere. But many people's perception of the relative risk is just the opposite, because it's the unusual that gets the attention, not the commonplace.

So anyway, I decided to do the math and find out exactly how the risks compared.

The most recent year for which I could easily locate both murder rates and vehicle accident death rates was 2006. Rates broken down by age (as well as sex and race) are available on the FBI's site. The Fatality Analysis Reporting System (a joint venture of several government entities) has a neat system that permits you to query their databases to get whatever data you need (click Query and it'll walk you through it).

The data isn't terribly specific: the murder rates don't tell us how the children were killed or by whom--that is to say, not all the child victims were kids on their own being abducted and murdered by strangers. But for the sake of this argument, let's assume they all were. This will yield a higher-than-actual risk of a kid on the subway alone being killed. The auto accident data is a slightly more precise: we can't assume all the kids who died in traffic accidents were being driven somewhere by their parents, but we do know they were all riding in cars at the time, which is to say, being driven somewhere by someone. (Pedestrian victims are a separate category in the FARS data, so those aren't mucking up these figures--the fatalities were all definitely in vehicles.)

I chose ages 5 to 12 years because the murder data groups children in age ranges, and I felt that was the range that took in the ages most likely to be able to go somewhere (not just by subway--could be walking in the neighborhood) on their own. For the traffic accident data, as noted above, pedestrian victims are excluded, and I was able to limit the data to passengers (not that I expect there would be many children age 5 to 12 operating cars--but if there were any, they're excluded here).

Okay, let's do the numbers.

Murder victims age 5 to 12 in the US in 2006:
178
(Interestingly, kids in these age ranges are the least murdered--lots more victims in the younger and older age groups.)

Vehicle passenger deaths age 5 to 12 in the US in 2006:
3,561

So . . . more than 20 times as many kids died being driven somewhere as were murdered by someone. Given that some of those children were murdered by people they knew or were related to, the relative risk of putting a kid in a car is probably even higher.

Well, one might argue, the reason so few children were murdered in 2006 is that parents have become more protective: fewer kids are out of their parents' sight than were in the past. That is to say, overprotectiveness is working. But you can go here to download the same FBI data for 1996, and you'll see the number of murder victims age 5 to 12 ten years earlier was 182--not appreciably different ten years ago. The Department of Justice has a chart showing the homicide victimization rate by age from 1975 to 2005; rate for ages 14 and under has remained flat throughout that thirty-year period.

Certainly one can do a more rigorous analysis than I've done here with a little clicking around, but the bottom line will be much the same: The actual risk to so-called free-range kids is very small. The horror stories on the news and in the papers are the exceptions, not the rules (that's why they are news), and parents would be well advised to worry less about those exceptions and more about vastly more common hazards--so common they seldom make the news.

And isn't a kid who has developed a little independence and problem-solving experience on his or her own better equipped to cope with one of those everyday risks when they occur?