Who Pays for Health Care?
It strikes me as sort of amazing how increasingly brazen universal health-care advocates are in what they really want. Here, for example, is Dean Baker at The American Prospect:
The simple story is that any effort to establish national health insurance will require some anti-free loader mechanism to prevent gaming. The logic is straightforward. Everyone agrees that we want to get rid of the current practice under which insurers are allowed to charge fees based on people’s health. Under this system, people with serious illnesses either must pay exorbitant fees or are unable to get insurance altogether. (Insurance companies lose money if they insure people with high bills.)
Under a reformed system, we will require a standard fee under which everyone pays the same rate regardless of their health history. However, this creates a situation in which it doesn’t make sense for healthy people to pay for insurance. Why not just deal with minor health related costs out of pocket? You can wait until you get sick and then buy into the system and pay the standard rate.
That works for healthy people, but it would destroy the system because the only people buying insurance would be those with relatively high bills. This means that insurance would be very expensive, which of course encourages more people to play the “wait till I’m sick strategy.” The end result is that the system collapses, because only the very sick would ever find it worthwhile to buy insurance.
Shorter Dean Baker: Healthy people need to be required to pay for the health care of the sick. Typically, this is phrased a little more delicately –"people working together to provide affordable health care for everyone" or the like. But no, these days, folks like Baker and Ezra Klein just come right out and say it: If you’re healthy and don’t want to pay insurance premiums, too bad! The government needs to come and make you pick up the tab.
Universal health care advocates like to talk about the issue in moral terms, but the moral logic here seems extremely questionable. Forcing healthy people to open up their checkbooks whenever someone else gets sick seems mighty questionable. Perhaps I’m an outlier, but I wonder how popular insurance mandates and other requirements would be if, say, top-tier political candidates explained the policy on similar terms — especially when reminded, as Megan McArdle points out, those programs almost always cost far, far more than projected.
