The headline on Shailagh Murray’s WaPo piece is “Young Adults Likely to Pay Big Share of Reform’s Cost,” and of course righties who have seen the headline are quivering with outrage on the burden that’s about to be put on the young folks.
This is what Murray writes,
A 2008 study by the Urban Institute found that more than 10 million young adults ages 19 to 26 lack health insurance coverage. For many of those people, health-care reform would offer the promise of relatively inexpensive individual policies, which do not exist in many states today.
The trade-off is that young people would no longer be permitted to bet on their good health: All the reform legislation before Congress would require individuals to buy at least minimal coverage.
This is the part that has the libertarians so upset:
Drafting young adults into any health-care reform package is crucial to paying for it. As low-cost additions to insurance pools, young adults would help dilute the expense of covering older, sicker people. Depending on how Congress requires insurers to price their policies, this group could even wind up paying disproportionately hefty premiums — effectively subsidizing coverage for their parents.
One of the relatively milder reactions, from one of the unfree thinkers at Reason:
Despite rhetoric to the contrary, government policies tend to take from the relatively poor and give to the relatively wealthy (see the Medicare prescription drug plan for an example). And so it is with health insurance reform, where it’ll be the kids who pay for the rest of us.
The more I wade around in rightie ideas about health care and insurance, the more I think they just plain don’t understand risk pooling.
I share the concern that young people will be required to buy insurance that is too expensive for their entry-level budgets. That’s one of the reasons a public option is so important. On the other hand, at least some of those young, healthy folks will have catastrophic accidents or unexpected illnesses, and their medical care will be paid for by the premiums of other healthy people. And the rest of the young, healthy folks will eventually grow into older and less healthy folks.
But here’s another piece of the puzzle the righties don’t get — the uninsured drive up health care costs. In fact, the uninsured may be one of the biggest drivers of rising health care costs.
Last week the Los Angeles Times published a letter from Dr. Robert W. Robertson Jr., former director of emergency services at Western Baptist Hospital in Paducah, Kentucky. Dr. Robertson wrote,
In 2005, there were 44.8 million who had no medical insurance. In 2006, that number had grown to 47 million. Presently, it is estimated that there are 50 million who have no coverage, and that number will rise to over 52 million at the end of 2010. …
- The uninsured numbers are constantly increasing.
- The unreimbursed expenses incurred by hospitals in treating those ever-increasing numbers of the uninsured are constantly increasing.
- Hospitals must increase their charges in order to cover the ever-increasing costs of treating the uninsured.
- Medical insurance companies must increase the premiums of those they insure in order to pay for the increased hospital charges when their insureds seek treatment.
- Each time insurance premiums increase, another portion of the population opts out of carrying insurance. Individuals or companies reach a point, finally, when they can no longer afford insurance, and individual policyholders or employees of companies which drop their benefits enter into the pool of the uninsured.
- More uninsured people = increased, unreimbursed hospital costs = increased hospital charges = increased insurance premiums = more uninsured people…. The upward spiral is incessant.
The pressure created by the ever-increasing number of the uninsured is the driving force behind the ever-increasing cost of medical care in the United States. That force is unrelenting. It can only accelerate. It has created a system which is unsustainable.
If you want to fully appreciate how unsustainable it is, take a look at these numbers from the Kaiser Family Foundation. The average cost of a family health insurance policy in 2009 is $13,375. If insurance costs continue to rise at the same rate they’ve risen in recent years, by 2019 the average cost of a family health insurance policy will be $30,803.
It follows that to put an end to the spiral, we must choose one of these three options:
- Get everyone insured.
- Allow hospitals to turn away people who don’t have insurance. Of course, that could be any one of us if we lose our wallets in an accident and show up at an emergency room with no identification. Instead of death panels, we’ll have a death lottery.
- Scrap insurance altogether and go with single payer.
My guess is that libertarians will go with Option 2, figuring they can have their insurance information tattooed on their butts. Or, we can have microchips inserted under our skins so the hospital can scan us and determined we’re covered by Blue Cross, or whomever. Because, you know, everybody could buy insurance if they really wanted it. That’s how Reason sees it, anyway:
To me, Reason‘s video presents a great argument for mandates. I have no way to know what percentage of young people are willfully choosing not to get insurance and what percentage cannot afford insurance, but let’s remember how some of them are coping with not having insurance —
They borrow leftover prescription drugs from friends, attempt to self-diagnose ailments online, stretch their diabetes and asthma medicines for as long as possible and set their own broken bones. When emergencies strike, they rarely can afford the bills that follow.
Enough, I say. We’re strangling ourselves with our own selfishness.