Mike Huckabee recently complained that the ban on excluding people with pre-existing conditions from health insurance is like letting people buy insurance on a house that has already burned down. People have focused on the tastelessness of his analogy, but he’s right — if we want to treat health care as “insurance.”
And there’s the problem.

All insurance is a subsidy from the lucky to the unlucky, and it’s always a bad deal for the lucky. If you buy fire insurance, and your house doesn’t burn down — YOU LOSE, SUCKER!

No one will ever voluntarily sell fire insurance to someone whose house is already on fire — not unless they can either exclude coverage for that fire or charge a premium that covers the entire pay-out plus administration costs. No one whose house is not on fire will ever voluntarily buy insurance that covers much higher risks — such as the already burning house — at the same premium. That’s not an abuse or a scam. That’s the free market — the way it’s supposed to work. Insurance is all about sorting risks and protecting those with low risks from having to pay for those with high.

So what about health insurance? Sick people never get care unless healthy people pay for it. (I got called a “communist” for pointing that out at a rally last spring.) If we provide for people through genuine insurance, seriously ill people — especially if we can spot them in advance — will not be cared for. If we are willing to accept that as a society — if we are so blinded by free-market ideology — then we should just admit it and let them die.

Or, we can do it entirely differently. We can simply accept that a certain portion of the community needs medical care in any given year, and we can undertake to provide that care at, effectively, public expense. But that’s not insurance — not really — and I, for one, am tired of having to pretend that it is.

To paraphrase a certain P. Henry: If this be socialism, make the most of it!