Okay, here's the thing: if only sick people have insurance, then everybody with insurance costs more than they put in. In order to make sure there are enough people in the pool, including the mostly-healthy people who don't think they need the insurance, we have to require that everybody have insurance.
I's just (*cough*)
It starts off
But as you and filkertom
point out, it's not like auto insurance where you can opt out of being involved at all. And it doesn't seem fair to tell people, especially people really close to whatever income threshold would trigger subsidies, that they have to go buy something they're not sure a) they can afford or b) is the best use of their money. Why, that would almost be a really perverse kind of tax
, now, wouldn't it -- one where you can choose to pay it to the government ("public option") or some corporation, or just maybe convince your employer to pay it...
Wait a minute ... a tax from those who can afford it, to make them pay into the system, and a subsidy for those who cannot afford it, to let
them into the system. Hmm. There's something familiar about this.
Oh, right -- at that point, since we need universal coverage to make the economics work, we might as well call
it a tax, collect it from those who can afford it, and insure everyone out of that pool!
What's that you say? I've just re-invented single payer
? How curious. I wonder how that happened. I must be spending too much time on the phone with a Canadian or something.Okay, this doesn't quite imply single-payer, since we could still have a system in which everybody is guaranteed to be covered but various corporations could try to attract customers to let them be their designated intermediary, by offering various extras, but I think that would wind up being a race to the bottom as far as anything covered by the public option was concerned, and we'd wind up with insurance companies deciding to leave the basics to the government and only sell the extras ... which, if I understand correctly, is how single-payer works in Canada. And yes, this would shake up the insurance industry something fierce, and pain in turn would ripple out to other parts of the economy, but I think, like lancing a boil or removing a dead and rotting tooth, that's a pain that we ultimately need to get over with for our own good.