This Wednesday, 9/21, the Federal Official Gazette published law 14,454, a consequence of the presidential sanction of the bill approved by Congress, which transforms the list of exams or treatments for the purpose of coverage by the complementary health system into an example. , in charge of health plans (before the list was exhaustive). This is a populist and irresponsible decision that ignores and violates the logic of insurance and can have negative consequences for the operation and cost of health plans in Brazil. The exemplary list had been recognized as correct by the Superior Court of Justice.
It must be recognized that the mistaken decision of Congress received enthusiastic support from many segments of society, which condemned the refusal of health plans to reimburse expenses for certain procedures. Such a stance reflects the lack of understanding of how insurance works around the world. The concept of public health policy was confused with that of health plans. The first has to do with State action, which in Brazil is expressed by the SUS. The following is governed by another logic, that of private activity.
Modern insurance was born after the Great Fire of London (1666), which destroyed over 13,000 homes. The basic idea, which is still in force today, was to adopt mutualism, that is, all policyholders pay a certain amount (premium) to protect themselves from risks, especially those associated with transport, property, death, car accidents and other risks. health. Compensation is paid to those who suffer the loss (accident, unforeseen event or unexpected situation), who would not be able to bear the respective losses or expenses alone, except at the cost of enormous personal or business losses.
Fundamental for the functioning of the insurance is to know the risk that will be the object of the insurance. Insurers developed the ability to estimate the insured amount (coverage), which was facilitated by the formulation of the law of probability, attributed to French mathematicians Blaise Pascal (1623-1662) and Pierre de Fermat (1601-1665). Without this, the insurance activity is unfeasible.
Insurance turned uncertainty into risk. Uncertainty is by definition incalculable. The risk can be calculated. Innovation has played (and is increasingly playing) a decisive role in economic development and prosperity. In these more than three centuries, the insurance activity has evolved and become more sophisticated. Law 14,454 represents a huge setback. It creates an unprecedented situation in the world, one in which insurers will only know a part of the insured risk. Therefore, they will not be able to correctly estimate the premium to be charged to guarantee the respective coverage.
One way out, unless the law is reviewed or found unconstitutional by the Federal Supreme Court, is to seek some way, always imprecise, to assess the unknown and additional risk created by Congress. Another way out will be to abandon the health insurance market in Brazil. In the first case, there will be an increase in cost; in the second, the absence of coverage. The insured will lose out on both.
By these and others, it is possible to understand why Brazil does not get rich.
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