[A]ll systems of paying for and providing healthcare suck; all of them suck worse if you’re poor and none of them are especially bad if you’re rich. There is no happy, Disney-movie solution and on many levels, the more lawmakers mess with it, the worse it gets.
Before all this started, if you were poor and didn’t have insurance, you were perfectly free to die in a ditch; if you chose not to, showing up at a hospital emergency room would get you treatment (hospitals are generally not allowed to turn away anyone who is genuinely ill or injured) and a whopping huge bill. Under ACA, you could also die in a ditch or walk into a hospital uninsured, but you were going to be fined in addition to the big bill*; under ACHA, the uninsured get the same two choices and skip the fine, but if they choose the hospital and survive to buy insurance they will pay a 30% surcharge on their premiums — and so will you, if you go more than two months without insurance. This is all very interesting, but if the initial aim was to reduce the number of uninsured citizens who die in ditches, exactly how does either plan accomplish that goal? They don’t, no more than a low-flow showerhead in Seattle or Indianapolis helps droughts in California or a shrinking fossil aquifer in Arizona.
The line I keep hearing is that “everyone has to be insured so the risk pool is large enough,” which will come as a surprise to the statisticians and actuaries who work for insurance companies. It does not take a huge pool to make the risk usefully predictable and there’s a lower limit to the rule that adding more people makes the risk more predictable and therefore allows reducing the amount of “just in case” money the insurer needs to keep for off-the-prediction surprises: you do have to pay all those mathematicians, adjusters, attorneys, salesmen, managers, top brass and support staff — and the investors are hoping for a little profit on the money they have put up to get the whole thing rolling, too. The thing people seem to think they are saying boils down to “if everyone pitched in a dollar, we’d all be able to afford healthcare when we needed it,” a charming sentiment that skips blissfully over what right the rest of us have to demand a dollar from every random stranger.
As always, there’s a footnote:
* The fine is (if I remember correctly) under $2500, which is just about big enough to be insulting and for the the person without two dimes to rub together, might as well be $25,000 or $250,000.
I’m awaiting the first proposal that calls for filling in all the ditches, so no one can die therein.