The issue of mandatory health insurance has been discussed at length this summer as part of the health care reform debate. Chris M. has a post on his website about the subject. He quoted a newspaper article explaining the proposal to require Americans to obtain health insurance (with subsidies for low income and some middle class families) or face a fine. Then he asked his readers to discuss the issue in the comments, and there are quite a few interesting opinions presented.
One of the analogies presented says that forcing everyone to carry health insurance would be like a person living in a building with pyromaniacs as neighbors having to pay for fire insurance along with everyone else – with no option to move. I can see this argument being valid in the case of someone who works for an employer who only offers one health insurance policy to all of the employees. Premiums in group health insurance plans typically vary by age but not much else. So a non-smoking employee who exercises six days a week and eats vegetables at every meal will have the same premium as a same-age coworker who smokes and is obese. The employer will pay part of the premiums, but it’s very common these days for the employees to have part of the premium deducted from their paychecks. If the employer doesn’t offer any other options (like a higer deductible or an HSA qualified plan), the healthy employee could well become frustrated at paying for benefits she isn’t likely to use. But it’s quite common for employers to offer a couple different choices, with a lower-cost, higher deductible option for people who don’t think they’ll need much in the way of health care.
I don’t buy the argument that people should be able to opt out completely from health insurance. Because no matter how healthy we keep ourselves, the unexpected can still happen. If you’ve chosen to “self-insure” and then you get struck by lightening while walking your dog in the park, who is going to pay your medical bill? If you’re unconscious at the scene, the paramedics will load you up in the ambulance and take you to the hospital. Upon arrival there, doctors and nurses will pour their hearts into trying to restart yours. What if you wake up a few days later in ICU, alive, but very much in debt? Will you declare bankruptcy, leaving the hospital to write off the bill? That leads to higher premiums for the people who do carry health insurance, as hospitals charge more to cover their overhead – which includes bad debt.
The fact is, no matter how careful we are, no matter how healthy we keep ourselves, no matter how many veggies we eat and miles we walk, we never really know what is around the bend when it comes to our health. Accidents can happen to even the healthiest people. Freak illnesses can strike otherwise healthy people. And when these situations arise for people who are uninsured, the cost is eventually borne by those who have health insurance. Yes, the people who take excellent care of themselves are less likely to need medical care. But less likely doesn’t translate to never.
From a personal perspective, we work hard to keep our family healthy. Because we know that we’re very unlikely to need our health insurance for illness, we have a high deductible HSA qualified policy. We’re willing to gamble a bit when it comes to our health care. If something happens to one of us, we’re on the hook for the first $5000. And because we know that our chances of needing health care are low, that’s a gamble we’re willing to take. But our chances of needing healthcare are not zero, no matter how hard we try. Which is why I consider opting out of health insurance all together to be a bit on the irresponsible side (unless you’re wealthy to the point that a policy that covers $5 million in claims isn’t any better than your own bank account).
Chris’ article was in the Health Wonk Review this week, hosted by Healthcare Technology News.