Welcome to Ethics Consult — an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case, and then we provide an expert’s commentary.
Last week, you voted on whether it’s ethical for the government to cut health insurance for risky activities.
Cut health insurance for risky activities?
And now, bioethicist Jacob M. Appel, MD, JD, weighs in.
Life insurers generally charge a premium for high-risk behaviors. According to a 2013 article in US News & World Report, hunters pay an additional $500 annual premium, and rock climbers pay $1,500 extra; scuba diving and skydiving can add $2,500 to one’s rates. Health insurers do not always dig as deeply into the personal behavior of policyholders, but some refuse to cover individuals engaged in dangerous activities. In 2006, one major Illinois corporation reportedly sent letters to its employees informing them that any motorcycle-related injuries would result in immediate termination of their health insurance. In contrast, Medicare and Medicaid usually cover all injuries of their clients, regardless of the origins of those injuries.
The primary reason that public health-insurance entities do not exclude these risk-takers is that health insurance no longer functions as insurance — at least, not in the traditional sense. As political historian Edward N. Beiser observed in the article “The Emperor’s New Scrubs” (1994), “health insurance” is a misnomer. The underlying principle behind traditional insurance is the distribution or “pooling” of risk. Although the odds of my house burning down are quite low, the odds of somebody’s home catching fire are reasonably high, and fire insurance evenly distributes the cost of this burden. Everyone pays in; a few unfortunate victims receive compensation. In contrast, the vast majority of Americans will eventually experience