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GUEST COLUMNIST: Insurance shouldn't cover day-to-day repairs to our health

August 21, 2009

By Gregory E. Sharp, M.D.

Guest columnist

As a family doctor, it is not uncommon these days that I am asked “what do you think about health care reform?” I offer the following illustration.

Cars get old and eventually die. “Cash for Clunkers” is about the only consolation for this reality these days. Old cars on our roads are in desperate need of repair and represent a hazard to all of us. Just suppose some of our well-intentioned legislators created a program to assist owners of these cars in getting the necessary repairs to help them run safer and longer. Would our society not benefit from such a benevolent program?

Yet, how quickly would the distinction between major and minor repairs become blurred? Fixing a faulty transmission is critical for the safe operation of a car but is repairing a flat tire any less? Naturally, this program might experience an expansion in services over time.

Naturally, this program would have to set reasonable limits, like only covering cars more than 10 years old. The owner of a 9-year-old car might postpone fixing a crack in the window, or getting those last few oil changes, knowing that once that 10th year came around, all of these problems could be fixed at somebody else’s expense. This would increase the cost of the program, but who could really blame them?

Now consider the owners of 5-8-year-old cars who start to envy their friends who own “seasoned” cars, particularly when they started getting engines replaced and body work done.

So when employers, anxious to attract and retain the best employees, start offering enhanced auto insurance coverage with features like free oil changes, tire replacement and regular car washes, who wouldn’t sign on? And with nice coverage like that, why not take that punctured tire to the dealer for a new set instead of repairing the flat at the tire shop? If you’ve got the coverage, why not get the most out of it?

The reason why is that someone eventually is going to have to pay for four new tires when one repair would have done the job. Initially it would be the auto insurance companies, but they could just turn around and raise their premiums to cover the inflated expenses of what used to be routine maintenance.

The employers, wanting to keep their employees happy, might absorb these costs or rethink that next pay raise, or hold off on that new hire, and perhaps everyone is happy for a while.

But what if auto owners stopped taking care of their cars, knowing that a good mechanic and “great” auto insurance could spare them the consequences of careless maintenance and reckless driving? And why shop around for that new transmission if the copayment is the same? And why wouldn’t the mechanic charge $300 for a $50 repair when the auto insurance covers it?

Eventually the financially stressed employers plead with the auto insurers to restrain the escalating costs, but how?

For starters, they selectively contact with auto shops and dealerships that agree to do the work at lower cost. The mechanics still charge the uninsured $300 for the repair, but in order to secure a steady flow of higher-utilizing and better-paying insured folks, they contract to do the repair for $100. Insurers start limiting coverage on cars with lower reliability ratings or prior accidents and this keeps the premiums reasonable for everyone else. Lastly, they offer more affordable, less elaborate plans that shift more cost onto the employees themselves.

But what about the uninsured, underinsured, or the abandoned cars that remain a safety risk to all the rest of us? You can’t blame them for not affording the artificially inflated repair costs. As the population of these cars grows larger, we all come to realize that something must be done. If only these cars were insured, then our problem would be solved. But would it? The cost is astronomical, and utilization would only continue to climb, exceeding our capacity to handle it. What can be done?

Perhaps it is time to step back and re-examine the situation. Whose responsibility is the care of a car? Is it the politician, the auto insurer, the employer or the mechanic?

Is not the owner of a car best equipped to decide what needs to be done and at what expense it is worth doing?

We don’t insure our cars for routine maintenance because it keeps the costs competitive for all of us. We have deductibles that encourage us to pay for minor repairs when worthwhile or just live with that scratch in the bumper. It makes us slow down, look both ways, and it keeps the premiums affordable for all of us.

And the reason our employers and government don’t pay our auto insurance premiums is because outside of fraud and traffic violations, it’s really none of their business what we do with our cars.

Perhaps we should consider treating our bodies more like our autos.

Sharp, of Woodland Park, is a family practitioner.

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