Mark Buehner: I just checked ehealthinsurance.com
For a healthy 23 year old non smoking male, you can get a 250$ deductible with 20% copay and prescriptions with a 5mil lifetime limit for $2316 a yearFor a healthy 63 year old non smoking male you can get the same plan for 10,620$ a year. I’m not sure how many 60 year olds are running around without some sort of health history, so your mileage is certainly going to very. But nominally its already almost 5 times as expensive.

Okay, so it’s already 5 times as expensive. So how would a law that says “1. all citizens must have health insurance (purchasing it privately if they don’t already get it through the government or an employer), 2. health insurers must take all customers 3. they may only base what they charge on the age” drive that up by “an order of magnitude”?

In the individual health insurance market, the old are already paying more because they are riskier. Saying “charge prices based only on health” is very close to what we have now.

Presumably it’s the same product, worth the same to all buyers. If the product is hair relaxer it’s worth a lot more to black people (who can get use out of it) than to white people. So charging the SAME price is discrimination, isn’t it?

Nothing wrong per se with discrimination. My employer makes a product that discriminates between aerosol bioagents and dust. My employer also discriminates on the basis of ability in its hiring.

How about a restaurant that charges more if you eat more? Is that discriminating? Is that a bad thing?

The issue with insurance is the young person and the old person are not buying the same thing. Suppose there are two lotteries. Both offer a thousand dollar prize. One sells ten thousand tickets, the other sells two thousand tickets. Is there a problem forcing young people to buy from one pool and old people to buy from the other pool? After all most people will get nothing for their ticket. The maximum payment is the same. Does it matter if the price is the same? Or if the price for the tickets from the smaller pool is no more than twice the cost of tickets from the larger pool?

“Yes, and who does the tailoring? The insurance companies, of course. And what is the object of their tailoring? Not to extend coverage to more people who need health insurance coverage, of course, but to maximize their profits by collecting premiums from those who are unlikely to need much in the way of healthcare and excluding those who are likely to need it.”

And yet, this drive to maximize profits works just fine for every other form of insurance where a vast majority of people are able to purchase the insurance they need or want. Aside from people placing a larger value on health (thus they should be willing to pay more for it), there need not be any difference between health insurance and every other form of insurance. If insurers are allowed to price according to risk they will be happy to cover high risk people who need insurance (at a higher premium). They maximize their profits by insuring as many people as possible and charging them premiums that reflect their risk. If insurers must charge everyone the same premium then they will seek to exclude those who are high risk to keep the premium down (attempting to mitigate adverse selection). It is discriminatory laws such as community rating that lead insurers to “cherry pick” healthy customers and/or exacerbate adverse selection.

“Requiring an older person to pay more than a younger person for the same insurance coverage is age discrimination.”

It is not. You seem to not understand some fundamentals of insurance. Namely, insurance premiums are directly proportional to risk, period. High risk, high premium. The value of a policy with specific benefits is higher for an older person than a younger person. This is a simple fact you seem to be ignoring. If age is a risk factor, as it is in health insurance, then this is not discrimination. As I have pointed out it is discriminatory to discount the cost of risk for some and increase it for others.

“The benefit is in making health insurance available to everyone (or almost everyone). Now millions are excluded from coverage because they can’t afford it.”

Currently, high risk people pay $Z, low risk people pay $X; some high risk people can’t afford $Z, some low risk people can’t afford $X. By requiring everyone to pay $Y (Z > Y > X), then there will be low risk people who can’t afford the new price $Y but could afford $X. How is making insurance affordable for some but making it unaffordable for others a benefit? Community rating simply shifts the costs from high risk people to low risk people. This discriminates against low risk people, as high risk people receive a discount on their premiums. This is why community rating is always lumped together with a mandate, to ensure that low risk people can’t avoid the cost shifting onto them.

“To make the costs higher for some simply because they are older would be age discrimination.”

Read that sentence again slowly. Now replace ‘older’ with ‘younger’. That is what community rating does. It increases the premiums for younger people above the value of the insurance policy. It decreases the premiums for older people below the value of the insurance policy. This is clearly a benefit to older people at the expense of younger people; this is discriminatory.

“The idea of insurance is to pool the risks.”

Almost, the idea of insurance is to pool unpredictable risks. Pooling predictable risks is cost shifting, not insurance.

“You are engaging in Newspeak.”

While I’ll admit that having to add the explanation of “relative to actuarial value” is clumsy, it is only “Newspeak” to people who don’t understand how insurance works.

“You go into a car agency and find a six-cylinder economy car that is offered for sale at the same price as an eight-cylinder luxury car. The salesman tells you that the prices are the same.”

This is discriminatory against the person buying the six-cylinder economy car. The value of the economy car is $10k, the value of the luxury car is $50k. You want the salesman to sell both for $30k. The purchasers of the luxury car receive a discount against the value of the car, the purchasers of the economy car do not (they in fact pay more than the car is worth). This is obviously discriminatory. If you extended a discount on certain items to white people while charging black people more than some items are worth, this is obviously discriminatory. So why is it that you consider giving old people a discount, while charging young people more than the insurance is worth, to be non-discriminatory?

Charging the same price (community rating premiums) does not change the value of the car (actuarial value of the insurance policy, which equals risk). I wouldn’t respond ‘the luxury car is cheaper’, I’d respond ‘the purchasers of the luxury car are getting a better deal while the purchasers of the economy car are getting screwed’.

It should also be obvious from your example that community rating by itself does nothing to enlarge the pool of insured. The car salesman’s volume will be the same, he loses out on sales of the economy car but gains sales on the luxury car. However, community rating does exacerbate adverse selection; no one would buy an economy car. Again this is why community rating is always paired with an individual mandate. Tyler Cowen’s article was pointing out that the people who had trouble affording the $10k for a car in the first place are really going to be screwed trying to come up with the $30k.

Bryan Caplan has pointed out that mandates in auto insurance are to correct for advantageous selection. The mandate ensures the worst drivers buy insurance, the good drivers already had it. When people talk about a health insurance mandate they assume that new entrants will be low risk (thus “reducing costs for all”), but at the same time complain that high-risk people are priced out of the market. These two opinions are mutually exclusive.

Community Rating, individual mandates, and insurance content mandates, have a myriad of unintended consequences that require much more action to remedy or minimize. It far superior to skip the distorting regulations.

J

For a healthy 63 year old non smoking male you can get the same plan for 10,620$ a year. I’m not sure how many 60 year olds are running around without some sort of health history, so your mileage is certainly going to very. But nominally its already almost 5 times as expensive.

Mark Buehner: Who is subsidizing them right now? Or are 60 year olds paying $30,000 a year in the private market right now?Everyone else! What part of ‘Pool’ aren’t you getting?

The part where I say “private market,” where individuals shop for insurance. As distinct from the employer market.

How much does it cost a 60 year old to get an individual plan, right now?

Everyone else! What part of ‘Pool’ aren’t you getting?

Anyone in any kind of health care pool (i.e., 99.9% of the population) has decisions made for them already. There is something that could save you that isn’t being covered.

Sadly not only is that not always true, its probably not generally true. Most people aren’t routinely denied lifesaving procedures because of the expense. That is a myth. It happens, but much more commonly people are given reems of desperate, life saving procedures every single day, no matter their prognosis. This is one of the reason (a huge one) our healthcare system is expensive. Maybe its worth paying for.

Who is subsidizing them right now? Or are 60 year olds paying $30,000 a year in the private market right now?

As a political matter, it’s quite likely that the older workers will vote that the young people who don’t vote should give them more money. But it’s not good policy.

Great unless its your life theyre putting a dollar sign on. Again, Americans won’t stand for this. Its a political decision.

Anyone in any kind of health care pool (i.e., 99.9% of the population) has decisions made for them already. There is something that could save you that isn’t being covered.

I do think lots of people will be just as stupid as that, saying “I don’t want a value placed on my life!” I think those stupid people should go buy expensive plans. Rational people who know “hey, they are going to be basing the yes/no decision on something, it might as well be something based in science” need to be able to get out.

They charge the pool based on average age. How can you look at our current insurance regime without the context of the pool?

I’m not saying “get rid of Medicare.” If we are going to mandate that adults get coverage before the age of 65, then you can use age as the only determinant. The healthy 21 year old will still subsidize the unhealthy 21 year old, but there are so few of the latter that the former will hardly notice.

Right, and the 60 year olds will be paying 30,000$ a year in health insurance. That isn’t going to happen.

It really isn’t a mystery. As Tyler Cowen said, look at other countries. In Britain, NHS decides only to fund treatments that cost less than (very roughly, and the specific number doesn’t matter for this discussion) £30,000 to extend someone’s life by a year. Given a fixed number of health care resources, such a metric is a great way to get the maximum benefit.

Great unless its your life theyre putting a dollar sign on. Again, Americans won’t stand for this. Its a political decision.

Americans who want the latest and greatest should pay extra for it. Those of us who want normal evidence-based medicine should be able to pay for just that. It’s not one-size-fits-all.

I agree. The statists pushing the latest plans do not.

Mark Buehner: 1. You can do mandates on the young and still have them pay less: make age the sole determiner of your risk profile. All the 20-somethings would pay a fraction of what the 70-somethings pay. Their insurance expenses would rise as their ages rise, but the amount that their birthyear receives in medical spending will also rise.If you did that, older people’s insurance premiums would increase by an order of magnitude. Nobody is willing to accept that.

What in the world are you talking about? Right now in the private market age is used all the time. Even employer-provided plans that don’t look at specific individuals often charge based on age.

I’m not saying “get rid of Medicare.” If we are going to mandate that adults get coverage before the age of 65, then you can use age as the only determinant. The healthy 21 year old will still subsidize the unhealthy 21 year old, but there are so few of the latter that the former will hardly notice.

2. I really wish that we were trying to do cost-control. Time was when the conservatives in America worried about making sure the government was spending money efficiently. BWhat do cost-controls and efficiency have to do with each other? I can say i’m only going to pay a quarter for a hamburger, but i’m just going to end up with a crappy hamburger or no lunch. Thats not efficiency. The problem here is everybody wants to control costs, but nobody knows how to do it.

It really isn’t a mystery. As Tyler Cowen said, look at other countries. In Britain, NHS decides only to fund treatments that cost less than (very roughly, and the specific number doesn’t matter for this discussion) £30,000 to extend someone’s life by a year. Given a fixed number of health care resources, such a metric is a great way to get the maximum benefit.

There are both public and private systems in the United States that do similar things, deciding what will be covered based on science and evidence. It’s the minority, though. Most funding decisions right now happen either via your political power (if you are in a government plan) or your market power (if you are in a private plan). They have nothing to do with good medicine.

The fundamental problem is that Americans want high tech, cutting edge medicine on demand, and that’s expensive!

Americans who want the latest and greatest should pay extra for it. Those of us who want normal evidence-based medicine should be able to pay for just that. It’s not one-size-fits-all.

If you did that, older people’s insurance premiums would increase by an order of magnitude. Nobody is willing to accept that.

2. I really wish that we were trying to do cost-control. Time was when the conservatives in America worried about making sure the government was spending money efficiently. B

What do cost-controls and efficiency have to do with each other? I can say i’m only going to pay a quarter for a hamburger, but i’m just going to end up with a crappy hamburger or no lunch. Thats not efficiency. The problem here is everybody wants to control costs, but nobody knows how to do it. Democrats have some vague notion that somehow insuring more people (on the government dime) will somehow automatically lower costs, which in reality will mean price controls (ala medicare) and exploding deficits. Republicans propose modest measures to encourage competition and relieve regulation (interstate insurance and tort reform) which will do something to lower cost inflation but wont insure very many more people. The fundamental problem is that Americans want high tech, cutting edge medicine on demand, and that’s expensive!

Imagine that, tailoring health insurance to the individual customer so they can get the coverage they want at a price they are willing to pay.

Yes, and who does the tailoring? The insurance companies, of course. And what is the object of their tailoring? Not to extend coverage to more people who need health insurance coverage, of course, but to maximize their profits by collecting premiums from those who are unlikely to need much in the way of healthcare and excluding those who are likely to need it. Unequal pricing is a great tool to achieve this kind of exclusion.

Premiums geared to age would authorize insurance companies to cherry pick their insureds, as they do now. The premiums in many instances would not only be more than the insureds are “willing to pay,” they would be more than they are able to pay. The premiums charged to some would be so high they couldn’t afford to pay them even if they wanted to. A person cannot be required to purchase a policy the person can’t afford. Requiring an older person to pay more than a younger person for the same insurance coverage is age discrimination. Providing that all will pay the same premiums for the same coverage regardless of age is not discrimination.

What is the benefit of charging people the same premiums despite their varying risk profiles?

The benefit is in making health insurance available to everyone (or almost everyone). Now millions are excluded from coverage because they can’t afford it. There are various reasons they can’t afford it. Your proposal would add age to the reasons millions can’t afford health insurance, increasing the premium costs for older Americans. The current proposal would make premiums for equal coverage equal for all, regardless of age. To make the costs higher for some simply because they are older would be age discrimination.

The idea of insurance is to pool the risks. Spreading the risks among different age groups without disparities in premiums will enlarge the pool and achieve this goal more equitably than a premium system geared to age.

When they are young they pay higher premiums (relative to actuarial value) for the benefit of paying the same premium later (now lower relative to actuarial value)/blockquote>

You are engaging in Newspeak. “Equal premiums” becaue “higher premiums” when you add the qualification “relative to actuarial value.” “The same premium” becomes a “now lower” premium when you add the qualification “relative to actuarial value.” “War” becomes “peace.” “Freedom” becomes “oppression.” “Black” becomes “white.” “Up” becomes “down.” Why? Because you have defined it that way.

You go into a car agency and find a six-cylinder economy car that is offered for sale at the same price as an eight-cylinder luxury car. The salesman tells you that the prices are the same. You say he is wrong. The eight-cylinder luxury care is chepaer than the six-cylinder economy car, you tell him, “relative to the value of the car.” “Equal” is “unequal.” “Same” is “different.” Newspeak. Charging equal premiums regardless of age is not discrimination. It is nondiscrimination.

Jeremy, I don’t think you don’t understand the original argument. It was stated by Abdul above that charging people the same premiums even though they belong to different age groups is “unfair discrimination.”

I understand just fine. Community Rating, charging people the same premiums despite different risk profiles (age, etc.), is discriminatory for the reasons I stated previously. I am not discussing health care services consumed. Strictly from an insurance perspective old people are more expensive to insure, period. So by community rating you are extending a benefit of premiums below actuarial cost to old people (or other higher risk groups); that meets the definition of discrimination you presented.

Actually, an insurance policy under the proposed law will confer the same healthcare benefits on all insureds, regardless of age.

That’s what we have in the existing system. Everyone who buys the same policy with the same coverage receives the same benefits. The proposed law does nothing to alter this.

If you want to charge premiums based on age, sex, weight, lifestyles, preexisting conditions, or other factors that are variable over the population, then there will be an endless array of differences.

Imagine that, tailoring health insurance to the individual customer so they can get the coverage they want at a price they are willing to pay. To bad the proposed law goes in the completely opposite direction towards “one size fits all”.

When all people are charged equal premiums regardless of age, the premium structure is nondiscriminatory as to age.

Again, false. The definition of discrimination you provided clearly shows that the premium discount benefit that old people (or other high risk groups) would receive under community rating is discriminatory. The proposed law confers a benefit of discounts on premiums (relative to actuarial value) to old people.

You also failed to answer my previous question. What is the benefit of charging people the same premiums despite their varying risk profiles?

I believe I also heard that under the proposed law dead people won’t have to pay any premiums at all, at least not after they are dead. Do you regard that as discrimination?

You proposed looking at the benefits over the expected lifetime of a person. When they are young they pay higher premiums (relative to actuarial value) for the benefit of paying the same premium later (now lower relative to actuarial value). It should be obvious that not everyone who is young will be able to reap the benefit of paying that same premium “down the road” because they won’t make it that far. I never claimed this was discriminatory, but it clearly does not “benefit all on an equal basis” as you claimed. I ask again, what is the benefit to a young person who pays higher premiums (relative to actuarial value) but doesn’t make it to old age to enjoy the “locked in” premiums (now lower relative to actuarial value)?

J

epluribus: Jeremy, do you believe that Medicare is discrimination because it exacts a tax on all workers but confers benefits only on those who are disabled or over sixty-five?Do you believe that Social Security is discrimination because it exacts a tax on all workers but confers benefits only on the disabled and the aged?Your argument amounts to just another assertion that healthcare insurance premiums should discriminate on the basis of age. It overlooks the fact that young people will evetually become old people, and when they do their premiums won’t be raised simply because of their age.All their lives long they will pay equal premiums regardless of age.Age will no longer be a factor is charging premiums.All will benefit on an equal basis from the requirement that different age groups will not be charged unequal premiums.

That’s the correct argument, not the argument that treating people the same (despite relevant differences) is not discrimination.

In fact, a health person gets back less in expected short-term payments, but he gets back more in the expected future value of the system to him. An older person gets back more in expected short-term payments, but less in expected long-term payments (since he has already gotten some of them and has less of his lifespan left).

In other words, the rebuttal argument is not that to treat people the same is not discrimination but to argue that a relevant difference (difference in expected lifespans, difference in amount of previous benefits extracted from the system, and so on) justifies the, admittedly, disparate short-term treatment.

I buy my older daughter the car she needs but not my younger son the car he does not need. Is this “same” treatment (each gets what they need) discrimination? No, because my son has the future expectation of a car when he needs one and my daughter does not. So this “similar treatment despite relevant differences” is not discrimination because of other counterbalancing relevant differences.

Ricardo: Is your problem the principle that a citizen can be forced to buy something or is the problem that Congress rather than the states is doing the forcing? If it’s the former, states had the authority from beginning of the Republic to require all able-bodied men to own a musket for militia duty — the state did not always provide it. More recently, states have forced their citizens to get vaccinated against various infectious diseases so there is plenty of precedent for this.

First, we are not talking about the individual States, we are talking about the Federal Government.

Secondly, the State (again the individual States, not the Feds) might require such things. I can’t think of what required vaccinations you are talking about. But if there is such a thing I’ll bet that refusal would not result in fines or criminal charges. Most likely it would just be that I would not be allowed to participate in some State program or receive a benefit.

The militia thing? I seriously doubt that it was ever put to the test. What was the penalty for not complying?

No, where does Congress get the power to force us to purchase something? Anything?

If they can force us to buy health insurance can they also force us to buy certain fruits and vegetables? Could they outlaw Capt Crunch and make Wheaties the State cereal and require us to buy it?

Also, what do you think is going to happen when Congress (which is made up of 535 egomanical little tin gods) discovers that they have this power. And you thought earmarks were bad.

Not all young people become old people, plenty die well before that.

Yes, I heard something about that, Jeremy, but thanks for reminding me. I believe I also heard that under the proposed law dead people won’t have to pay any premiums at all, at least not after they are dead. Do you regard that as discrimination?

epluribus: Your argument… overlooks the fact that young people will evetually become old people, and when they do their premiums won’t be raised simply because of their age.

The “they’ll get it back when they’re older” argument isn’t persuasive in my view.

eplubrius, I don’t why should we prefer that an individual’s health insurance premiums remain the same for every year of his or her life. You hinted that social security is nondiscriminatory but that isn’t exactly the kind of model we want to follow in a healthcare plan, is it? Many young people in my generation are highly skeptical they’ll ever see a dime from social security, for example, and they might be right. Similarly, it’s not clear that if a healthy 25 year old subsidizes others’ care by paying much more in premiums than his own coverage would ordinarily cost, he’ll assuredly get a return on that investment later on in life. This seems especially true given that developments in health services are going to make more treatments possible (which will cost more $ in the future) and folks will live longer and longer (which will in turn be more expensive). Thoughts?

Two points:

1. You can do mandates on the young and still have them pay less: make age the sole determiner of your risk profile. All the 20-somethings would pay a fraction of what the 70-somethings pay. Their insurance expenses would rise as their ages rise, but the amount that their birthyear receives in medical spending will also rise.

2. I really wish that we were trying to do cost-control. Time was when the conservatives in America worried about making sure the government was spending money efficiently. But if you even think of bringing this up, the Republicans start shitting bricks about death panels. (Not that the Democrats wouldn’t do the exact same thing.)

A pox on all their houses.

Jeremy, do you believe that Medicare is discrimination because it exacts a tax on all workers but confers benefits only on those who are disabled or over sixty-five?

Medicare satisfies the definition of discrimination you presented.

Do you believe that Social Security is discrimination because it exacts a tax on all workers but confers benefits only on the disabled and the aged?

Social Security satisfies the definition of discrimination you presented.

Whether these policies are a “good idea” is independent from the fact that they satisfy the definition of discrimination you presented. “Senior pricing” in restaurants and “Ladies nights” at bars / clubs are also discrimination … but we still consider them a good idea.

It overlooks the fact that young people will evetually become old people, … All their lives long they will pay equal premiums regardless of age. … All will benefit on an equal basis from the requirement that different age groups will not be charged unequal premiums.

Not all young people become old people, plenty die well before that. Thus, there are plenty of people who will not “benefit on an equal basis”. What exactly is the benefit from “same price for all” in health insurance premiums? If it costs $X to provide health services for the entire insured pool, what is the “benefit” to charging everyone $Y vs. charging some $Z and some $A (A < Y < Z)?

J

My point is incredibly simple: paying older people a higher salary is no more justified than charging young people less for health insurance.

“I recognize that government-provided healthcare insurance is politically impossible in the present environment, and I also believe it would be fraught with many more problems than government-mandated purchase of private healthcare insurance.”

Agreed, but aren’t we trying to mandate being a little bit pregnant? I think THAT is fraught with even more unintended consequences, and quite likely to get us the worst of both worlds. The problem appears to be that American want universal coverage in theory, but they don’t want anything to do with the remedies that make that possible and affordable. Until that changes it seems we’re in for a lot of magical thinking by our political class that could very well create dire economic consequences. Its especially unnerving that they don’t seem to know what they are doing.

“I want to see everybody (or nearly everybody) covered by healthcare insurance and costs reduced, and the proposal presently on the table seems to me to be calculated to do that. “

Now thats entirely untrue. None of the current proposals cover everyone (or even close to it), and none of them reduce costs- at best they shift them which is unpredictable.

“Of course, it’s not perfect, but it’s a whole lot better than what we have now, and the perfect should never be the enemy of the good.”

But what if this isn’t good in any way shape or form? What if it in fact exacerbates all of our current problems and creates new ones? Don’t mistake the appearance of motion for progress! A goal is not a means, and nobody seems to even believe these plans will work dramatically well. There does seem to be some ‘hope by some miraculous force’ this plan will work. There is a cult cargo mentality that we have- ie, because Europeans have universal coverage and lower costs, we can achieve lower costs by crowbarring in universal coverage by any means necessary. It does not follow. We can all eat croissant and drink bordeaux, but that doesn’t make us French.

In a sense, Hillary knew something. Maybe you CANT piecemeal a change like this. There are too many fundamentally connected pieces that everyone is terrified to touch for political reasons. And hence we get this free lunch fantasy.

In the end I DONT see how the bill as currently written wont bankrupt the insurance companies purely due to the preexisting condition problem. Thats not the kind of minor flaw you can live with or fix later. Its the kind of flaw that you look back on and say ‘what the hell were we thinking?’

Black’s Law Dictionary 8th edition defines
discrimination as:

The effect of a law or established practice that confers privileges on a certain class or that denies privileges to a certain class because of race, age, sex, nationality, religion, or handicap.

According to your provided definition, Community Rating is in fact discrimination. The actuarial value of a health insurance policy increases with age. A law that forces all people of all ages to pay the same price for a product that increases in value with age confers a privilege to older people (a discount on health insurance relative to value). Thus the law (Community Rating) confers a privilege (health insurance discount) on a certain class (older people) because of age; it is discriminatory by definition.

J

Epluribus: you still refuse to address my analogy to salary. By your definition, employers discriminate against young people when they pay them less than old people. As I said, I’ll pay the same for health care when I earn the same amount of money. You ignore this. Why?

I’m not a witness here, and I have no obligation to answer your questions. I frankly didn’t get to this little gem because your earlier points were so lame. Can you understand that there is lots of discrimination in life, and lots of discrimination in the law? Some is fine. Some violates the Constitution. Some runs afoul of statutes. If employers discriminate against young people by paying them less for equal work, find a statute or constitutional provision that is violated. If not, accept it. If you will only comply with the healthcare law if all examples of unequal treatment in the business place are eradicated, you are either a fool or you are inordinately fond paying tax penalties.

For many people, the health insurance aid would phase out when food stamps, housing vouchers and the earned income tax credit also end and the personal income tax kicks in.
This structure of incentives would likely discourage many parents from earning a better life for their children. Congress could tweak the subsidies so they don’t phase out so quickly, but then we’re back to very high fiscal costs and subsidies for many families in the higher income classes.

Cowen is invoking the same intractable incentives problem that was pointed out 25 years ago by Charles Murray in his book Losing Ground, with regard to various government subsidies to help people or change their behavior. Cowen also points out, as Murray did long ago and as economists are always demonstrating, the tendency of such programs ultimately to harm the very folks they are supposed to help.

As I said, I’ll pay the same for health care when I earn the same amount of money. You ignore this. Why?

The Left will be so conflicted when they realize the monster they have created.

In other words- we are on the wrong track here. Politically, a substantial penalty for not having insurance is a non-starter even though this is precisely the behavior everyone agrees is costly to the system. Everyone decries the freeriders but nobody has the guts to punish them if they don’t play ball.

If you really want to do this, the only way is to automatically enroll everyone in some sort of social security type regiment so you can garner their wages directly if they aren’t insured. Then you remove tax incentives from the employer end and offer tax credits as the subsidy. The logical end of this type of plan is to require or have the government offer a basic level of insurance for everyone, with private insurance legal and available for bells and whistle plans (you don’t want to wait in line). The political problem with this plan is the left will certainly insist that the ‘basic plan’ ends up being anything but basic. This is another point of cognitive dissonance where Americans (particularly progressives) want everyone to have everything equally but also want the ability to buy what they want when they want it. You can’t reconcile those two urges.

Yes, several million people “out here” believe it will extend healthcare coverage to more Americans who need it and that it will spread the costs more equitably among a larger pool of insured persons. I am one of those several million.

It seems to me (and by that I mean, I have no idea how you can conclude otherwise) that while the bills under consideration will extend health insurance to some of the uninsured (but not all by everyone’s admission), it will certainly create a large incentive for the healthy to get out of the pool banking on saving their premiums now and the insurance companies being required to take them when they get ill. Do we end up with more or less people uninsured?

And clearly adding sick people and subtracting healthy people from the insurance pools will drive up costs.

Is anybody arguing otherwise?

Is it your contention that a building that is only accessable (treating everyone the same) by steps is nondiscriminatory to those that are wheelchair bound?

No. Such a building would violate the Americans with Disabilities Act, an act of Congress mandating equal accessibility to buildings regardless of physical disabilities. The proposed healthcare legislation, if passed, will be an act of Congress mandating equal access to healthcare regardless of age. Next question.

Because medical costs have escalated well beyond the ability of any charity to provide medical services on a reliable basis.

I hear what you’re saying, but it still seems a little odd to find a right based on expense. If food prices go way up, does food then become a right? Are housing prices high enough that a house is a right? I would also point out that these new rights are not only not enumerated, but were specifically not considered to be rights in colonial America – health care was very much a cash and carry business then.

What exactly do people propose as an alternative to the system of mandated emergency care we currently have? If you are hit by a car or experience a heart attack, do you really want to be sitting in the billing department of the hospital while a representative there works through the prompts on your insurance company’s 800 number to verify your coverage…

Indeed, and that is a very good argument for providing emergency care first and talking about payment later. The current debate isn’t about that – it is about establishing a generalized right to health care regardless of ability to pay. To contrast the two approaches, you could imagine a charity system deciding that their limited resources are not best spent on liver transplants for indigent alcoholics, that the obese will have to eat less instead of getting bariatric surgery, etc. OTOH, if health care is a fundamental right, then we can’t really be denying those kinds of things to people just because they can’t pay for them.

Does ANYONE out there see the individual mandate as anything other than a transfer payment to the Baby Boomers?

Yes, several million people “out here” believe it will extend healthcare coverage to more Americans who need it and that it will spread the costs more equitably among a larger pool of insured persons. I am one of those several million.