Requiring people to carry health insurance is one of the ideas being discussed to help bring the cost of health insurance down. We already know that many young, healthy, people choose to not buy health insurance for themselves based on the reasoning that A) they are not going to be sick B) they rather use the money for other things and C) if they do get sick, it will be the type of sickness they can pay for easily out of pocket. If these young, healthy, non-insured were forced by the government to purchase health insurance, their premiums would be used to subsidize the less healthy, older, already insured. Government mandates take from the young and healthy and give to the old and sick, with a wee percentage (5%? 10%? 25%?) going to fatten the profit margins of the insurance companies.
When put like this, of course, it sounds like an awful idea. How dare we even think of doing this to young people?
Well, we dare for one reason: if the young, healthy, uninsured miscalculate and get too sick, they are entitled to get the medical care they need and stick the insured with the bill through hospital and doctor cost-shifting.
Observe: Joe Jock, healthy 25 year old O.S.U. student, chooses not to carry health insurance. One day, walking across High Street, he is hit by a car, breaking both his legs. Ouch! The ambulance takes him to the hospital where they are forced to treat him, despite his not having insurance. The bill? $25,000. Double Ouch! Joe can't pay, of course. Who would? So, the hospital, in order to recoup it's losses, raises the bill for medical care for all it's insured patients. Triple Ouch!
So, when the young and healthy gamble by not having insurance, it is not a pure gamble because they know that if their gamble is a loss, someone else, the insured, pick up the tab. In fact, it's a pretty good deal NOT to have health insurance when you're young, for just this reason. In fact, I went many years without health insurance for just this reason.
We could, of course, change the parameters of the gamble by simply ending all requirements that hospitals treat people who comes through the door without proof of insurance. We choose not to do this because most people wish to avoid the rather unsightly mess a pile of uninsured, broken bodies lying outside hospital ER doors would make under these changes. Imagine, poor, uninsured Joe, dragging himself down the street begging for someone to treat his injured, mangled legs. Fuck off, Joe, you should have bought the health insurance.
Just kidding, Joe. You were young and irresponsible, but we'll get you fixed right up.
So, because it is possible for the uninsured to force others to pay their medical care, it is logical to force the uninsured to carry insurance in order to prevent this from happening.
But, let's look at it in another way, because beating dead horses is what I do.
We require people to carry auto insurance. But not all auto insurance, just liability insurance. If you are uninsured, and hit my car, and do not have the money to pay to fix my car out of your pocket, I am forced to pay for your negligence by paying to have my car fixed myself. That is unfair. So, we passed mandatory liability to prevent it.
What we do not have is forced collision insurance. Collision insurance fixes your own vehicle if you have an accident. If you hit my car, and you do not have collision insurance, and you cannot afford out of pocket to fix your car, you are shit out of luck. Your car does not get fixed. That is fair.
Now, imagine if the government told all auto-body shops that they had to fix all cars brought to their facility, regardless of whether the car owner had insurance or could pay for the repairs or not. The auto-body shops would have to raise the cost of repairs to everyone else in order to stay in business. Under those circumstance, the uninsured motorist would be able to force the cost of a bad gamble (not having collision coverage) onto others. Which is, again, how hospitals are forced to operate. Totally unfair.
But, there is a problem with the above analysis: the insurance company profit. Why should the healthy, uninsured be forced to inflate the profit margins of insurance companies? They should be forced to carry insurance only in order to prevent cost-shifting, not to subsidize health insurance companies.
A government-provided non-profit option for health insurance would prevent this profit-taking. So, if we are going to mandate health insurance, we should also provide a non-profit insurance option. This also insures that we get the full subsidizing effect of the premiums, as well.