By Carin Berkowitz
Like many, I was personally offended by Senator Pat Toomey’s recent comparison between providing insurance and treatments for people with expensive chronic conditions and asking insurance companies to rebuild burned-down buildings, but I also think Mr. Toomey did harm to a very important debate. When questioning Tom Price, Mr. Toomey said. “There’s obviously a number of Americans who suffer from chronic expensive healthcare needs…I think we agree that we want to make sure those people get the health care they need. Now one way to force it [coverage] is to force insurance companies to provide health insurance coverage to someone as soon as they show up, regardless of what condition they have, which is kind of like asking the property/casualty company to rebuild the house after it’s burned down.” First of all, of course buildings and people are quite different categories of things, but I imagine Mr. Toomey already knows that. Beyond that, however, it was also a badly thought out sort of analogy in ways that are of greater consequence to an informed debate; analogies and comparisons constrain the way we think and the kinds of solutions we can envision, so bad analogies constrain our thoughts badly.
First, one must clarify what Senator Toomey meant. He seems to have meant that asking an insurance company to insure a person with a preexisting, chronic condition is like asking a property insurance company to insure a previously burned-down building (that is not what he said, but we ask property insurance companies to rebuild burned-down buildings that were previously insured all the time, so I am going to assume that was what he meant). But his two supposed equivalents do not hold up: property insurance companies insure buildings that have a host of problems revealed at inspection (bad roofs, cracked foundations, faulty plumbing) all the time! They have always been in the business of doing just that, and have never been given the option of insuring only brand-new, certified-unbroken houses; they would probably go out of business very quickly if they tried to insure only homes without problems. And then there’s the fact that employers don’t offer property insurance among their benefits as a form of compensation, so property insurance companies are not guaranteed a market of so-called consumers who have no choice in providers and whose insurance is constrained entirely by the sort of place at which they work. We could probably find many other differences, too. So Mr. Toomey’s analogy was facile, and in that respect it was also harmful. But even those differences between kinds of insurance and markets don’t capture the point I really want to make here, which is this:
There’s a difference that even a callous person, who talks about health insurance for sick people and burned-down buildings in the same sentence will appreciate: a burned-down building does little work for the society in which it is placed, other than to give the squirrels somewhere to run, perhaps, whereas those sick people from whom Mr. Toomey seems to feel a great deal of sympathetic distance, are also members of society: they work, they raise children, they care for parents, they volunteer, they consume goods (oh, and they vote). So even if one does not feel a moral obligation to regard buildings and people as different, as a guardian of our economic system and our society, which depends on the general health and wellbeing of its citizens, Senator Toomey might want to think twice about his analogy.
I was diagnosed with Crohn’s disease at age 11. I suppose one could even say that I have had to be “rebuilt”—I’ve lost the whole of my large intestine to several surgeries and do need some rather expensive drugs. Since my diagnosis, and through many years of sickness, I’ve gone on to receive a B.A., an M.A., and a PhD; I have had two children, have cared for parents in their times of need; I hold a full time job, teach at a university, and do volunteer work in my community. I am part of Mr. Toomey’s constituency, and like many others who have chronic illnesses and need insurance, a member of the social and economic fabric of this nation.
Mr. Toomey, I am not a burned-down building, and your analogy is a fallacious one that harms the discourse surrounding a truly complicated problem.