There is a logical argument behind it; universality is the only way universality works, if you may pardon me the crappy expression.
The problem with non-universal health care is, of course, adverse selection. If people voluntarily buy health insurance the first ones to do so are the ones who need it most, so insurance companies must either charge them a fortune or deny it to them. The insurance company can set a decent rate and allow to anyone to sign up only if EVERYONE signs up, because then people who are very healthy and need little insurance balance out people who get very sick and need lots of it. That’s why a company with 5000 employees can get a way better rate than one person; it’s very likely 5000 people are more or less as healthy, on average, as the average person in the population at large. One person asking for health insurance is suspicious and is likely to be much less healthy.
Unlike, say, fire insurance on your house, health insurance is an area of severely asymmetric information. Nobody really thinks their house will burn down - and it’s very unlikely indeed - so people generally pay the same amount, with some minor differences, and an insurance company has little reason to deny you. But people DO know if they have a serious health problem.
By making everyone get health insurance, the problem of adverse selection is mitigated. It is, really, the only way you can have UHC, and the insurance companies quite correctly stated that it made no sense to force them to sell insurance to any buyer without forcing all buyers to buy insurance. Since the individual must get insurance, adverse selection is not an issue; she isn’t buying health insurance because she’s hiding a disease. she’s buying it because the law says she has to.
I’m not saying the execution of the ACA is ideal or even good, but people having to be a part of it is a necessary part of it. Canada’s system would not work, full stop, if you could opt out of the UHI scheme in return for a tax break.
I understand the math. That’s not my point. My point is that a good solution does not “reward” and give more profit to the bad guys. You may disagree that they are the bad guys, but if you do, I’ll assume you haven’t had many dealings with them.
It’s very clear that the success of the ACA depends on getting young healthy people (who don’t really need health insurance) to not only sign up, but to also sign up for fancy, more expensive policies. If you’re going to spread the costs among everybody and have it work, then you have to include the low-cost people in that spreading.
In an attempt to be very clear, my point was that while you may get more people “covered” by the system, the essential “cluster-ness” of the system as a whole will only get worse if the solution involves giving more money and power to health insurance companies, because they are evil. Simple as that.
As for why they are evil, I would say it is because their final customers (insured people) have no power because they aren’t the decision-makers in most cases; the employers are. To the extent that some of the ACA-generated customers can legitimately choose (and distinguish) between providers, there could be some small benefits from competition. However, given that so much of the system as a whole is rigged in favor of the insurance companies, I’m not particularly optimistic.
I would only have any optimism for a solution that included breaking the unholy power alliance between insurance companies and employers. And no, I’m not saying I know what that solution should be. I just think the ACA ain’t it.
And if you’re reading this and trying to glean my political alignment, you’re bound to be confused. FTR, I am philosophically a (non-anarchist) libertarian who pretty much despises the Libertarian Party. Which basically means that there are no political gatherings where I would “fit in”.
Looking at an economic problem in terms of “good” and “bad” and companies being “Evil” is an excellent way to never solve the problem. Best of luck with that.
I don’t care about your political leanings, I am simply making a point of fact; a universal health insurance problem must be mandatory to all residents of the jurisdiction or it will not work. Private insurance companies could be involved (as in fact they are in countries with pretty good systems, you know) or not. But mandatory inclusion is the backbone of the system, and the ACA had to have it or it simply could not have worked to ANY extent. Forcing people to be a part of it IS a good solution, and in fact is the only option whether or not private insurance companies are involved.
Well, I see Smartass’s point. Running a universal plan through a bunch of untrustworthy agencies is worrying. Can you imagine turning over health insurance to the churches? Ugh!
But yes, a universal system requires universal coverage and universal participation. The funny thing is that the USA already has a system universally paid for–USA Medicare–but those who pay for it are not the beneficiaries. Instead of raising the Medicare tax and covering everyone–the way LBJ wanted to do when the bill establishing Medicare was introduced–they came up with a patchwork system where most Medicare-funding workers’ own coverage was dependent on them purchasing coverage on the market with the money they have left over after paying for Medicare.
True. But looking at commercial enterprises as existing for the sole purpose of making money is also fair, because it’s true. And looking at how this plays out in the context of health insurance tells us that, among other things, this should give them the right to select their customers and/or set rates in accordance with perceived risk, which amounts to the same thing. It also tells us that they should have the right to scrutinize and adjudicate every claim with the goal of minimizing “medical losses”.
And those things are directly at odds with the basic principles of universal health care and its humanitarian objectives, so that they must either be tightly regulated or outlawed entirely, or else relegated to some very small portion of the population that elects to be part of such a system and is financially able to do so. In general UHC and “free market” just doesn’t work, because the free market wants healthy subscribers, not sick ones, and demand is inelastic with price because everyone who is sick wants to get better and deserves the best we can do for them.
You haven’t convinced me that the result would be worse than what we have.
Actually, aside from the weirdness of healthcare (which I’ve looked ahead and seen WolfPup commenting on), that is generally how markets work, and it works as well as anything in the world. The problem, which I THOUGHT I made clear, is that the people being served aren’t the people doing the choosing on how to spend the money. This situation CREATES evil companies. Just like big government CREATES evil politicians.
So, if I’m going to compromise my libertarian values and agree to some kind of UHC scheme, I want the money to pass through good hands and not bad ones. And you can sneer at me all you want, because my approach will reduce the amount of luck required.
Of course, I also won’t go in deluding myself that we’re talking about a “problem” to be “solved”, like “how do we get this here flag mounted on the moon.”
I’m pretty sure I acknowledged this fact. I even rephrased it to demonstrate my understanding. The fact that you’re lecturing me about this again suggests that you’re not fucking listening. So, if you’re not going to listen to me, why should I listen to you?
You’re talking theory; I’m talking about a particular instance. In this country, at the current time, insurance companies have become one of the key problems of our healthcare industry. Passing them more money is not going to make the situation better.
If foxes are eating your chickens, giving the foxes access to more chickens is NOT going to help your egg production. And I apologize in advance if this notion seems naïve to you.