The idea behind insurance is that you pay a premium and if things go pear-shaped, there’s a safety net there to catch you. It may not pay everything but it will pay enough that you won’t be ruined. This is true for vehicles, this is true for health care and this is true for the guy who got his crotch insured.
The thing about insurance is that it works best with larger economies of scale. Sure, there are the one-off specialty policies for Bruce Springsteen’s voice or Tina Turner’s legs but the vast majority of insurance policies cover things like health care or vehicle damage. The larger the pot, the lower your premium because the risk gets spread out. That’s why Obama made the “individual mandate” the centerpiece of his health care legislation.
For me, this is the most frustrating aspect of the legal challenge to the legislation. The main challenge lies in the interpretation of the Commerce clause of the Constitution but, like many clauses in the Constitution, this can and has been interpreted many different ways. Pretty much it just depends on how the Court feels the day it votes. And if the court is feeling especially conservative the day it decides this portion of the case, the “individual mandate” disappears.
The problem with the mandate disappearing is that the young and the stupid who think that they are invincible no longer have any pressure to purchase insurance, shrinking the pot. This has two effects. Number one, the pot now contains a greater percentage of people with existing or possible health problems meaning the risk has gone up and the premiums along with it. The second problem is that when one of these young and stupid people ends up in the hospital, the system is forced to eat the costs because they didn’t have insurance. What that really means is that your premiums go up again because the cost of that hospital stay has to be payed by someone.
Like it or not, the law evolves. Prohibition came and went. The Dred Scott decision embarrassed the nation and then was rectified by the 14th Amendment. The point is, it’s a living thing and has to be to cope with the realities of a new era. Baseball did away with the dead ball era, expanded multiple times and even now finds ways to adapt to new conditions. The law does the same as social mores change and our needs evolve. Right now, we need a health insurance system that works and until you can show me a viable option, the individual mandate is the only realistic path.
The Court’s decision is still weeks away and the debate is not going to die out anytime soon. I don’t expect the mandate to survive but as health care costs continue to spin out of control, that decision may end up coming back to haunt the Roberts’ Court like Dred Scott did Justice Taney. Meanwhile, the rest of us might just have to check in with The Boss and see how we can go about insuring at least a body part or two.