Should cosmetic surgey be covered by health insurance?

Insurance pools the cost of illness and injury, which cosmetic surgery is not

Question: Should cosmetic surgey be covered by health insurance?
Position‹2 of 3›: No, cosmetic surgery should not be covered by health insurance
Argument1 of 2›: Insurance pools the cost of illness and injury, which cosmetic surgery is not

The argument

Proponents of this position begin from what insurance is for. Pooling risk works because certain events are involuntary, unpredictable, expensive and unwanted. Nobody chooses appendicitis or schedules a fracture, so everyone contributing to a common fund faces roughly the same exposure, and the fund pays out when the thing that nobody wanted happens. Proponents argue that this structure is what makes the arrangement fair: each member is buying protection against a contingency, and the payout follows an event none of them controlled. The argument is that an elective procedure has none of these features. It is chosen, planned, timed to suit the patient and wanted by them. It is, in the relevant sense, a purchase rather than a misfortune, and proponents argue that putting purchases into a risk pool changes what the pool does. The member who proceeds pays only a share of the cost, while the remainder is paid by everyone else, and a person facing a fraction of a price asks for more than a person facing the whole of it. The result is not insurance against an event but a subsidy for a decision, funded by people who did not make it. Holders of the view emphasise that this objection is structural rather than moral. They do not need to claim that wanting to change one's appearance is frivolous, that the distress involved is not genuine, or that the operations should be unavailable. Their claim is that the mechanism of insurance is not the right instrument, because it is designed to spread the cost of things that happen to people. Proponents conclude that the appropriate route is for those who want these procedures to buy them, with credit, savings or a specific product priced to the people who choose it, rather than through a fund assembled for a different purpose.

Premises

[P1]Risk pooling is suited to events that are involuntary, unpredictable, expensive and unwanted, which is what gives members comparable exposure. [P2] An elective procedure is chosen, planned and wanted, so it is a purchase rather than a contingency. [P3] When a pool funds purchases, the member deciding faces only a fraction of the cost while the rest is paid by others, which raises demand and converts insurance into a subsidy. [C] Insurance is the wrong instrument for cosmetic surgery, whatever its merits, and the cost should fall on those who choose it.

Counter-arguments

Critics argue that the account describes almost nothing that insurance actually covers. Much illness follows from choices about diet, exercise, alcohol and occupation, and much covered treatment is elective in timing and in whether it happens at all, yet no one proposes to exclude it on that ground. They also note that the structural objection applies to any pooled benefit and is answered in practice by the ordinary tools of co payments, caps and clinical criteria rather than by exclusion. Others point out that public health systems are not insurance pools at all, so an argument about the mechanics of pooling does not reach the question of what a health service should provide.

Rejecting the premises

[Rejecting P1] Much covered illness follows from choices about diet, alcohol, exercise and occupation, and much covered treatment is elective in timing, so the premise describes little of what insurance actually pays for. [Rejecting P3] The incentive described is managed in every other pooled benefit by co payments, caps and clinical criteria rather than by exclusion. [Rejecting C] Public health systems are not insurance pools, so an argument about the mechanics of pooling does not reach the question of what a health service should provide.