Are people who refuse to buy health insurance freeloaders?

[muon2]

Buying insurance is a decision to pool your individual risk with others and share the costs of that risk. Any individual can choose to maintain their own risk. Earlier today I heard a woman on the radio describe how she was uninsured but working and needed an expensive medical procedure. She said the hospital was happy to set up an affordable payment plan to pay off the bill. I've heard similar statements from hospital administrators. She didn't sound like a freeloader.

[muon2]

What about people who can afford health insurance but not a five-digit bill, and choose not to buy health insurance, knowing that emergency rooms will still treat them anyway if they get in a car wreck?

I know one person who fits this description. He is nearing retirement though as opposed to being someone young, and feels it is a waste of money to buy insurance if the hospital won't turn him away if he comes in seriously ill or badly injured without plans for paying. It kind of boggles my mind though since he is socially conservative and actively involved in contributing to community service projects. Perhaps he just happens to be an exception of sorts to the norm?

Everyone else I know without health insurance wants it but feels they cannot afford to buy it.

The person you describe could be in for a shock. You can't just walk away without paying. The hospital will bill you, and if the charge is too steep they will negotiate a payment plan. The only way to avoid payment is for that person to declare bankruptcy. Before the Great Recession half of all personal bankruptcies were for medical bills that could not be covered.

[muon2]

A person who can afford health insurance, but chooses not to buy it? Does such a person exist? I'm sure out of 300,000,000 people that applies to somebody. Not a common circumstance though.

Well I obviously exist, so that answers that question. I do have accident insurance though (that would cover an ER bill in something like a car wreck).

I don't have it because it's cheaper to pay $80 the one or two times a year I have to visit a clinic than to pay a $20 co-pay plus a monthly premium (though my job started offering a cheap plan that would only deduct $25 a paycheck it's still not enough for me to come out ahead.)

Are you going to get health insurance in 2014 or pay the tax?
Also, what if you get a serious medical issue that isn't a car wreck?  Are you OK with bankruptcy?

This illustrates one of the problems in the health insurance market. We've folded wellness care such as regular checkups with major medical. With car insurance I can buy a cheap policy to cover large claims only with a high deductible. It's hard to find an equivalent health insurance policy that only covers high-cost procedures with a high deductible. Part of that is due to state mandates on health insurance coverage that set a minimum standard for a policy.

[muon2]

A person who can afford health insurance, but chooses not to buy it? Does such a person exist? I'm sure out of 300,000,000 people that applies to somebody. Not a common circumstance though.

Well I obviously exist, so that answers that question. I do have accident insurance though (that would cover an ER bill in something like a car wreck).

I don't have it because it's cheaper to pay $80 the one or two times a year I have to visit a clinic than to pay a $20 co-pay plus a monthly premium (though my job started offering a cheap plan that would only deduct $25 a paycheck it's still not enough for me to come out ahead.)

Are you going to get health insurance in 2014 or pay the tax?
Also, what if you get a serious medical issue that isn't a car wreck?  Are you OK with bankruptcy?

This illustrates one of the problems in the health insurance market. We've folded wellness care such as regular checkups with major medical. With car insurance I can buy a cheap policy to cover large claims only with a high deductible. It's hard to find an equivalent health insurance policy that only covers high-cost procedures with a high deductible. Part of that is due to state mandates on health insurance coverage that set a minimum standard for a policy.

At the end of the day, assuming someone has the means, what difference does it really make if they are substantially self insured up to a point (i.e., a high deductible) and have lower premiums, or with a low deductible and higher premiums?  I hear a lot of chat about how youngs should just be forced to get catastrophic coverage, but if they are not cross subsidizing others (an aspect of Obamacare I still find execrable), the additional cost in premiums of broader coverage should be very small, since their actuarial risk is so low. The main advantage of a high deductible regime for those with means, is that their will be more pricing policemen out there, but that hardly seems central to a viable health care structure to me.

It shouldn't be central, but portions of the public expect certain services for their health care. They go to the state and push to have those services mandated on all policies. Before long it becomes impossible to get a simple, cheap policy because there are so many required add-ons. here's the IL list as an example.

[muon2]

A person who can afford health insurance, but chooses not to buy it? Does such a person exist? I'm sure out of 300,000,000 people that applies to somebody. Not a common circumstance though.

Well I obviously exist, so that answers that question. I do have accident insurance though (that would cover an ER bill in something like a car wreck).

I don't have it because it's cheaper to pay $80 the one or two times a year I have to visit a clinic than to pay a $20 co-pay plus a monthly premium (though my job started offering a cheap plan that would only deduct $25 a paycheck it's still not enough for me to come out ahead.)

Are you going to get health insurance in 2014 or pay the tax?

I'll get it since I'll probably get subsidized anyway. I just don't see a point in paying the unsubsidized costs prior to then. Obviously this is one of several major flaws in the current system that the upheld law fixes, so it's a good thing. I mean yeah we shouldn't make it beneficial for someone to stay out of the market as long as the market is private, but as long as it is I don't see any reason to change.

Also, what if you get a serious medical issue that isn't a car wreck?  Are you OK with bankruptcy?

Yeah I'm taking the risk that it won't happen, but I'm not willing to spend even $1000 a year against the remote odds I get cancer. At my age it's not much of a risk. Which of course is part of what's so messed up with the current system and why Obamacare is needed if there is no single payer.

But the Medicaid expansion mandate was thrown out by SCOTUS so for that large population Obamacare now offers little. Obamacare patched some of the holes, but left others. It was trying to protect some types of benefits for certain classes of individuals while scuttling others. It is really quite inconsistent and not at all a substitute for single payer or a Bismarck system.