If you've been reading a lot about health care, you might have come across a fascinating discussion over health insurance rescission. Rescission is a weird-looking word that describes insurers seeking ways to invalidate your health coverage when you try to take out insurance for expensive health care. The insurance industry claims that this affects no more than one-half of one percent of all cases. Rather than parse that dubious claim, I want to explain how the rescission issue encapsulates some of the absurdities of health care finance, and how we could all understand health insurance better if we simply compared it to a Zombie Armageddon.
But first, some background on health care spending. The blogger Taunter, in a great post, looks at the graph below which breaks down percentage of health care spending by percentiles. If you can't read the graph well, here's what you need to know. That small bar on the far right says that 50% of the insured population uses almost no health care at all. Eighty percent is used by the top quintile of spenders and 22% of health spending comes from the 99th percentile -- that is people with more than $35,000 of medical costs a year. Now here's Taunter, and his graph:
It should be fairly clear that the people who do not file insurance claims do not face rescission. The insurance companies will happily deposit their checks. Indeed, even for someone in the 95th percentile, it doesn't make a lot of sense for the insurance company to take the nuclear option of blowing up the policy...
If the top 5% is the absolute largest population for whom rescission would make sense, the probability of having your policy cancelled given that you have filed a claim is fully 10% (0.5% rescission/5.0% of the population). If you take the LA Times estimate that $300mm was saved by abrogating 20,000 policies in California ($15,000/policy), you are somewhere in the 15% zone, depending on the convexity of the top section of population. If, as I suspect, rescission is targeted toward the truly bankrupting cases - the top 1%, the folks with over $35,000 of annual claims who could never be profitable for the carrier - then the probability of having your policy torn up given a massively expensive condition is pushing 50%. One in two.
any random individual will not lose his health insurance through a rescission
claim. But if you are of the group that actually needs to file a claim it could
be anywhere from 5% to 50% likely. So if I was a shareholder or executive of an
insurance company, and saw that we had very few sick people on our insurance,
I'd be very mad. Why? Because one great way to make money is to keep them on the
roster, collect their large premiums, and then deny them the care they need
when the time comes. Very sick people are probably the easiest to kick off; letting them go before collecting their insurance is leaving money on the table.