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Life Health > Health Insurance

Angry actuaries

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In theory, the next two years could be a golden era for all kinds of health policy, including long-term care policy.

Americans have had a pretty good chance to check out the Affordable Care Act system and to see what we like about it, what we hate about it, and what’s mathematically possible.

Related: Trump staff picks straddle establishment-outsider divide

President-elect Donald Trump, and most of the Republicans who now control the House and the Senate, said while they were campaigning that they would fight to replace, and replace, the ACA. Any ACA feature that survives in that environment will have to be very popular, very practical, or, ideally, both.

While the Republicans were campaigning, they talked about expanding the health savings account program. They occasionally mentioned long-term care, and dementia.

Trump, for example, said during a primary appearance in New Hampshire that the country needs to invest more in Alzheimer’s research.

Mike Pence, the vice president-elect, said during a vice presidential debate that a society can be judged by how it cares for the elderly disabled.

One policymaking challenge could be Americans’ chronic lack of understanding of how insurance works.

We have a hard time grasping the reality that small, consumer-friendly tweaks in insurance rules, programs or products can lead to 2,000-page regulations, push the best risks out of the market for coverage, encourage insured people who could handle negative events on their own to file claims, and put enormous financial strain on insurers.

Even agents, brokers and home office workers in lines other than health insurance or long-term care insurance occasionally have a hard time empathizing with the people in charge of keeping health insurance companies from going broke. 

One possible solution could be mobile devices. Somehow, insurers need to get a beautiful, fun game that teaches basic actuarial principles into the world’s app stores.

We already play with apps that teach us to run bakeries and farms, and to escape from angry birds.

Now we need an app that puts us in the position of health insurance company actuaries, underwriters, claim processors and chief financial officers, and teaches us, when we’re on the first, happy level, how to protect a precious pot of capital and surplus from hordes of smart, well-dressed, polite, lovely, passionate people who try to get us to act in ways that will empty the pot.

If we empty the pot, we should move to a more painful level of the game: the liquidation level. There, we should have to confront a courtroom of angry doctors, hospital bill collectors, patients and former employees who are all fighting vicious battles over the pennies the sheriff will get by auctioning off our toaster and our coffee maker.

Once we get through the liquidation level, we should move to the post-liquidation level. There, we should stand in the shoes of the doctors, hospital managers, patients and employees who have to live with random drips of cash, rather than the full payments they are owed, because, when we were on the first level of the game, we were too “kind,” and were too quick to let the pot of capital and surplus run dry.

Allison Bell is health channel editor at Email her at [email protected].


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