As healthcare insurance prices in the US have skyrocketed, despite passage of President Obama’s Affordable Care Act in 2010, many Americans are turning to a new/old solution: mutualized self-help. As reported in the New York Times, many Christian groups in the US are forming their own unregulated insurance pools to pay the medical bills of their members. Nearly 200,000 people in 58,000 households are now paying their medical expenses in this fashion, to the tune of over $20 million a month. They constitute self-organized financial commons for healthcare.
This trend raises some fascinating questions about state/corporate bureaucracies vs. social commons: Which offers the better value? Which is more reliable and satisfying? Could social commons help bring down the cost of conventional insurance while introducing a more human, caring dimension to healthcare?
Reporter Abby Goodnough tells the story of a family that was priced out of the insurance market, and so decided to cover their potential medical bills through a “sharing ministry.” Instead of paying $600 per month for insurance with a $10,000 family deductible, the Doyle family in San Antonio, Texas, now pays $405 per month. They also pay the first $300 for any medical bill they receive, and there is a spending cap of $250,000 for any illness or injury.
The family confessed to its misgivings about entering into such a plan: “What if people don’t pay their share and what if the money doesn’t come in? But that’s where the faith-based part comes in – I’m really going to rely on God.”
Religious faith is a big part of these expense-sharing plans. Many members join because it helps them fulfill a biblical command that people share one another’s burdens, and because the mutual commitment among participants is a reassuring form of human solidarity. The plans themselves often reflect religious moral judgments: no medical payments for injuries caused by driving drunk, for example, or for sexually transmitted diseases contracted via an extramarital affair.
Such conditions make these expense-sharing plans unacceptable to most secular consumers. That said, the “sharing ministries” constitute attractive commons for meeting basic medical needs that the ridiculously expensive and ruthless American marketplace does not.
This is often the case when commons surge in popularity. They fill needs that markets find too expensive or cumbersome to meet. That’s because many markets tend to have massive overhead costs, legal complexities and limited competition and choice; their business models just don't accommodate lower thresholds of service. Self-organized financial commons based on social and religious affinity, by contrast, are quite lightweight and less expensive, but still quite reliable. The social solidarity makes them well-equipped to provide better value more efficiently and in more humane, flexible ways.
Ah, but are these faith-based sharing schemes too risky and unpredictable? A good question. It all comes down to a matter of trust. Do you trust legally sanctioned markets and their bureaucracies (which can be capricious, unresponsive and only nominally accountable)? Or are you better off relying on social communities of goodwill of which you are an active member? Such community act with a certain sense of conviction and reliable reciprocity (even if they have limited resources).
It’s true that expense-sharing ministries may not cover expensive treatments for a serious illness. Or they might run out of money. In a 2001 case, the Ohio attorney general sued a plan whose leaders had sent $15 million on homes, vehicles and excessive salaries. Is the auditing and state oversight of plans adequate?
Still, such abuses seem rare. For their members, the plans provide a way to escape the soaring expenses and faceless complexity of market/bureaucratic systems. What’s not to like about that?
Members of these groups often receive handwritten notes of concern from other members along with their insurance benefit check. If someone has a medical problem that isn’t eligible for coverage, they often ask the community for financial help – and get donations. People learn about the groups through their friends; there is no advertising. It all feels more accessible and responsible than mega-corporations that are structurally beholden to big institutional investors and hedge funds, and overseen by inept federal regulators and legislators bought off by industry lobbyists.
Self-organized insurance pools as an antidote to predatory corporate health insurance? There are risks and limitations, to be sure, but also many attractive aspects. I wonder if there are some worthwhile innovations to explore here.