Health care reform, part two

I'm in the midst of a discussion about health care reform on another internet forum. A point was raised by Paul, the author of my previous thread here, which I think merits mention because focusing on it and thinking about it, and talking about it could change the tenor of the debate.

"Having everyone in the risk pool is not an 'arbitrary' definition of meaningful at all. It is how you make insurance work economically, efficiently.

Let's take a different tack here. We have mandatory auto insurance laws. Illegal to drive without auto insurance. Matter of responsibility and economic efficiency. No partisanship. No significant political opposition to such laws. No opportunity to say that you should be exempt because you have an exemplary driving record and are willing to take the chance. We determined a long time ago the social costs of your personal risk tolerance are too great to allow you the decision to do without.

The same logic applies. When healthy people exclude themselves from the risk pool, economic inefficiency is created, regardless of outcome. When unhealthy people are excluded from the risk pool, the costs of their care don't disappear, rather they are simply exported off the books of insurance companies and onto the books of a different system--either the provider who gets stuck with the bill that the patient can't pay, or the government (which means taxpayers, which means *you*) that has provisions for providing care to such persons.

Because individual insurance companies are allowed to exclude such persons, *all* of us pay bigger hospital bills, and *all* of us pay more taxes.What all of the people shouting about the cost of the health care bill are ignoring is the costs we are all bearing, right now, of the current inefficiency of our system. When they insist that the kinds of changes contained in the proposal will drive up medical costs, they are also ignoring the empirical evidence of every single other western country that making coverage and access universal is associated with lowering overall costs, not raising them. "