A well-said defense of Obamacare

[Sbane]

I read some studies of this online this evening, and I do think, if we just stick with pure community rating, the cross-subsidy issue could indeed be quite burdensome on the young.  I agree in principle with the cycle of life idea.  But if the young can't afford it, it's hard to observe the principle.  I think we may either have to make modifications to the community rating policies akin in some way to how Australia handled it, or just go with means-tested subsidization, which is more straightforward and arguably fairer.  I'm glad the mandate held, but that doesn't solve all the policy problems.

It's the young who have a good job who will have to pay a lot more. If you make less than about 44k, you will get subsidies to pay for your plan. And the rich olds who are getting subsidized are paying more in taxes, though the new tax should have started a little lower. So we do have subsidies built in from rich to poor and from young to old. That sounds just fine with me. You can call it insurance or subsidies or whatever you want but a system that doesn't rely on some subsidies will not survive.

[Sbane]

It is solid only if it were true. Alas it is not. The young will be getting into the business of subsidizing the old, above and beyond medicare. They are being asked to overpay for their insurance. The moral hazard was the nose in the tent, to move them from free riders into subsidizers - from one end of the field to the other. And we still have a dysfunctional delivery system, with not much competition and price policing to boot.

And when I'm old, the young will pay for me.  And when they're old, the new young will pay for them.  It's the fairest way to do it.

A modest proposal which might seem fairer to some conservatives: if you're one of those young free riders, who can afford health care, but chooses not to buy it, then, if you get catastrophically ill -- cancer, car accident, whatever -- you should be denied treatment, and left to die.

That is how it would work if we were all notoriously stingy progressives. 

The conservative way is that we would all voluntarily donate to save the deserving poor patient in such a situation.

Progressives who insanely think that without government-forced healthcare lots of people will be "left to die" need to explain why that didn't happen before government-forced healthcare.

As you probably already noticed, I'm not saying that anybody would be left to die without the ACA. I'm saying that there are several ways of dealing with the free-rider problem of young people who can afford health insurance, but choose not to purchase it. One (my preferred option) would be Medicare for everyone. One (which the ACA offers) would be to penalize them, ofsetting the financial burden these people willingly inflict on the rest of us, and incentivizing them to buy insurance. A third way would be to let people live, or die, with the consequences of their actions. Our current solution is of course charity, which, as so often, actually amounts to tax dollars through the back door.

The point is that young people who can afford health insurance, but choose not to purchase it, can celebrate their freedom of choice all they like, but the reality is that they're imposing considerable hidden costs on the rest of us, who pay taxes and have health insurance.

Anytime people don't buy something they could afford, that's not THEIR fault.  That's the fault of the people offering the product.  Either the product isn't offering value for the cost or it's totally misdesigned for the consumers you're trying to reach.  With health insurance and young people, it's probably BOTH.

Now, the only question we have to answer is WHY are insurance policies SO MISDESIGNED that young people don't want to buy them?  I would say, Look for the answer in the state regulators:  How many state insurance regulators are 20-somethings?

The solution?  Let insurance companies market to young consumers the kinds of health care policies they WILL buy.  Ones that cover catastrophic loss but not, say, all the crap near and dear to progressive hearts, like birth control pills and sex-change surgery.

Wouldn't a plan geared towards the young also cover birth control?

Letting the young buy cheaper plans will mean someone else picks up the tab. So working class 50-64 year olds get f'ed in that case. Hmm maybe the Democrats should have devised Obamacare to screw over these people as they tend to be Republicans anyways. Of course the same people complaining about the young being screwed now would be complaining about the olds being screwed.

[Sbane]

And of course I would have preferred Wydens plan to Ppaca but there is no way in hell that would have passed. Asking people to give up the insurance they have currently? Seems DOA.