You Want to What?

I love an idea that seems to come out of the proverbial left field.  I love it when an idea seems so novel that you think, "wow, that's an interesting idea."  I especially love it when an idea borrows a practice from one industry and applies it in another. 

Take, for example, the proposal to require liability insurance for gun owners as a solution for gun control. 

Gun control is one of the social issues, much like abortion, where compromise has been increasingly hard to find.  Although a majority of Americans do support some kind of restrictions on gun ownership, a very vocal minority fiercely oppose them, citing their 2nd Amendment rights.  We've wavered through repeated efforts to impose various restrictions, but even in the wake of a number of mass shootings we still don't seem able to get consensus on bipartisan legislation to truly address it.

Mayor Sam Liccardo.  Credit: San Jose Spotlight

San Jose Mayor Sam Liccardo thus got national attention with his recent proposal for a city ordinance to reduce gun violence and its cost on the public.  It's not uncommon for cities to adopt restrictions on firearms, but what makes Mayor Liccardo's proposal newsworthy is the requirement for all gun owners to carry liability insurance (or pay a fee if unable to purchase such insurance). 

Mayor Liccardo says:

We require motorists to carry automobile insurance, and the insurance industry appropriately encourages and rewards safe driver behavior. We tax tobacco consumption both to discourage risky behavior and to make sure non-smokers are not forced to subsidize the substantial public health costs generated by smoking-related illnesses and deaths,

The proposed insurance would apply to any accidental discharge of a firearm, as well as any intentional acts of others who might borrow or steal the gun, but it would not cover intentional discharge. 

Naturally, color the NRA unimpressed.  "Criminals are already ignoring California's more than 800 gun laws, so it's doubtful many of them would rush out and get liability insurance. But, even if they did, liability insurance won't cover criminal acts," said NRA spokesperson Amy Hunter.

The Mayor admits it is not a complete solution and would not end gun violence, but at least it is doing something.  "A mayor doesn't have the luxury of just offering thoughts and prayers... we have to solve problems," he said in a statement.

There have been similar proposals before.  In fact, in early August lawyer Michael Vargas wrote an op-ed in the San Jose Spotlight calling for this very approach, and referenced examples of proposed state and federal legislation that had included it.  Mr. Vargas said:

This raises an important question: why should the cost of gun violence be shifted to gun owners? The answer is simple. Gun owners, like car owners, are the ones who control these dangerous instruments... 

Good public policy demands that we shift the burden of these costs to those who control the instruments (i.e. the guns) of gun violence. Good economic policy demands that we spread the costs among them, so that the costs are born fairly and evenly. 

Mr. Vargas agrees that the proposal would not address illegally obtained guns, but notes that many times guns used in mass shootings are legally obtained. 

Since the analogy to auto insurance is being used, it worth noting that nearly 13% of drivers are estimated not to have such insurance.  And there are drivers who don't register their car, or who drive with no license or on a suspended license.  So having requirements licensing, registration, and insurance only get us so far. 

A bigger problem may simply be that such insurance does not exist and insurers may be reluctant to get into this particular war.  “I would be lying if I said to you that the insurance companies are enthusiastic about this,” Mayor Liccardo told The New York Times.  

Still, to gun control advocates, there must be something delicious about the prospect of gun owners having to deal with the industry that everyone loves to hate.  The insurance industry is already often seen as the bad guys, so let them be the bad guys that strong-arms gun owners.  Those people we especially don't want to have guns probably would not get very good rates from insurers, and owning an assault weapon would be like owning a very expensive sports car when it comes to the cost of its insurance.  

It is financial services solution to a very real public health issue, and that makes it interesting.

Look, I don't think this approach is going to take off.  Nor do I think it would end up being particularly effective even if it did.  But I think it is an audacious approach, an example of non-linear, out-of-the-box thinking applied to a problem that seems to resist more straight-forward approaches.  So, even if it fails, it might help stimulate thinking about approaches around which we might gain consensus.  

Healthcare has developed a wide array of carrots and sticks to try to motivate behavior.  We mandate having insurance (or tried to), we give higher benefits for using preventive services or in-network providers, we charge higher premiums if you smoke or don't participate in wellness programs.  Some of them sort of work, although none of them seem to work anywhere near as well as expected.  

So what's healthcare's version of requiring liability insurance for owning a firearm?

I'm not being literal.  We already have a malpractice liability system that everyone seems to hate, which manages to hamper the way physicians practice without either improving the quality of care or rewarding most of the people who actually suffer from malpractice.  Maybe instead of a liability approach to address sub-standard yet expensive care we should be borrowing from some of the approaches that manufacturers have developed to improve quality, reduce costs, and speed the supply chain. 

You get the idea.

I often write about interesting things happening outside healthcare and then try to apply those lessons to healthcare, because I think too often people in healthcare are too insular.  Most think healthcare is unique, and many tend to look to what others in healthcare are doing for "new ideas.  When it does borrow ideas from elsewhere, its versions rarely delight.  It needs all the outside ideas it can get.

So, to whomever came up with this idea about requiring liability insurance for gun ownership: have you got any other ideas for healthcare?