Having a healthy debate

The Times’ editorial, “Healthcare law’s day in court,” on March 26 argued that the Supreme Court should uphold the law’s controversial requirement that virtually all American adults maintain health insurance, starting in 2014. It drew a skeptical comment online from reader “TheresaKlein,” who wrote:

“This editorial contradicts itself. First it states that buying insurance is a matter of individual responsibility. Then it states that the law prevents insurance companies from charging people different rates depending on their medical risk. In other words, the law requires you to buy insurance to cover your expected healthcare costs, then ensures that the price you pay for it will have nothing to do with your expected healthcare costs.

“Which, really, is the crux of the matter. The law is not a way of getting you to pay for your personal healthcare expenses. It is a roundabout attempt to force healthier people to pay for sicker people’s healthcare expenses.”

Editorial writer Jon Healey responds:

The same thing could be said about health insurance. The premiums paid by healthy people are mainly used to cover the cost of treating those who are sick, injured or in rehabilitation.

And yet the whole point of insurance is to enable people to take responsibility for medical expenses that they can’t predict or, potentially, afford. If someone knew today what treatments he would require, when he would need them and what the cost would be, he might be able to set aside enough money to cover those costs — assuming he was never fated to spend much time in intensive care or undergo complex surgical procedures. But no one has that kind of clarity about the future.

Insurance coverage effectively enables people to spread their potential medical expenses over time, so they pay a portion when they’re well and a portion when they’re not. Many people wind up paying more in premiums over their lifetime than they receive in benefits, but again, that’s because they couldn’t have predicted how much their “personal healthcare expenses” would ultimately be. It’s better to be in that position than to be bankrupted by medical bills, as are about 20% of the people who file for bankruptcy.

Under the current system, billions of dollars worth of care is provided to people who cannot cover the full cost of their treatment, and those costs are passed on to everyone else. The insurance mandate would start to fix that problem by requiring people to demonstrate the financial wherewithal to afford the care they’re bound to receive.