The incomparable Ezra Klein:
But what’s the alternative? No one wants an individual mandate. But the folks who spend all their time trying to solve the first problem Ross describes have concluded that you can’t do it without an individual mandate. After all, why do people get priced out of insurance? The answer, aside from “they’re poor,” is that they’re bad risks. They’re older, or they’re sicker, or they’ve been sicker at some point in the past, or they work at a dangerous job or a job associated with chronic injuries.
If reform simply forces insurance companies to sell to these people, then prices skyrocket for everyone, as the sicker or the older rush into the market, while the young and the healthy hang back. In that scenario, you’ve not solved the problem of pricing people out. You’ve arguably worsened it. If you want to solve the problem of pricing out but you don’t want an individual mandate, you need to think of an alternative to it.
Moreover, it’s simply not true, as Ross says, that the people paying the $750 individual mandate penalty get nothing in return. Far from it, in fact. For one thing, they get access to emergency care, as happens now. For another, they get the chance to come back into the system when they actually need insurance. Someone who puts off purchasing coverage and then tries to buy Aetna’s plan the first time they collapse unexpectedly will not be sold a plan. Having chosen not to buy insurance when they didn’t need care, they can’t buy it now that they do need care. They become the priced out or, in some cases, locked out.
Under reform, these people get the chance to come back into the system when they need coverage. They can’t be discriminated against.
People would probably realize this if they weren’t busy trying to make sure the Democrats didn’t have a legislative success.