But I don’t think the economic incentive is so large that risk sharing through group health insurance is even de facto involuntary, much less technically involuntary.

I’m not necessarily supportive of the tax deduction for employer-sponsored health insurance, but I don’t think we’re thinking about the same concept.

But, 99% of the people who are members of a “group” are employees. Are you claiming that they have a “choice”? I guess they do if you include irrational choices.

That is, it would be irrational for a person to refuse such a policy when they are getting health insurance subidized tax free from their employer. SInce in most cases this is the most economically rational choice to make then yes, I am claiming that they are involuntarily spreading their risk.

If we removed the linkage of health “insurance” and employment then individuals would then be able to make true choices on risk, benefits, and costs. If we continue to link health insurance to employment, then the employees choices are constrained by what is offered by the employer.

I don’t see that you’ve shown group policies to be an involuntary spreading of risk. I have a choice of joining my group, or getting an individual policy, or not having insurance at all. None of those is a false choice; they are all viable choices for different people for valid reasons.

1. Exactly. THe risk of the group is spread across the entire group and all share equally. But if you have an individual plan the risk is only spread to you. In general, a group policy is more expensive for healthy people and less expensive for less heathy people. That is, for healthy people I can virtually guarantee that you can get an individual plan that is cheaper, at least on a pre-tax basis. And, likewise, I can virtually guarantee that if you are a person with a health problem like diabetes or asthma that you will find an individual plan almost impossible to get or to be quite expensive.
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2. One of the main differences between a group policy, such as one you get from your employer, and an individual policy is that as an individual the insurance company can deny you coverage.

3. One of the drawbacks of having a group policy for your insurance is that if you are no longer part of the “group” you will no longer have insurance (save the COBRA arguments because that is a technicality).

Using this information above, one of the key claims you make is not true for a “group” policy: that is, it is not a voluntary sharing of risk and spreading the cost. It is a forced accomodation between your employer and you that only makes sense because you are getting a significant piece of your compensation tax free.

To “solve” the health care “problems” in the United States is actually a very simple solution.

1. Remove the tax free status for employer provided health insurance.
2. Give a tax credit or deduction for all families for their health insurance that is tax neutral.
3. Create a subsidy for people who have problems getting individual insurance because of chronic conditions.
4. Create an insurance policy of last resort for those that cannot get individual plans on the market.
5. Eliminate all regulations that prevent health insurance portability across state lines.
6. Create wellness programs for people in poverty that gives a voucher for age specific health checkups, vaccinations, and maybe even dental care.

By creating markets and creating choice we can get very cost effective types of insurance programs that people really need. THese markets will allow individuals to choose their own risk tolerances and needs. For example, if you are a retired person and live in MN and winter in Arizona or Florida you can pay extra, if you choose, for a policy that would allow you to visit in network doctors in both of those states. Or, if you are healthy you can choose a plan with a large deductible and save on your monthly expenses. THe market would create these products that people want. Right now, the “market” creates products that YOUR EMPLOYER or YOUR GOVERNMENT wants.

By eliminating the link between a “group”, i.e. generally your employer and by eliminating regulations we can also create true portability of your health insurance.

Lastly, by creating smart government programs that help poor people and others considered high risk we can get them to play their true role in the health care industry.

A group’s conditions are most likely considered in underwriting the group’s health insurance plan. At least, they were where I worked. It would be silly to disregard that information if it were legally available. So maybe the group is paying for your diabetes, but you’re paying for someone else’s high blood pressure or cholesterol, and so on.

And that’s really what insurance is: a method to voluntarily spread costs through the group. The government wants to make it not so voluntary.

If you had to get an individual policy you might think differntly. Unlike expensive group policies an insurance company can apply underwriting standards and reject applicants or force them to pay higher costs because of their preexisting conditions.

I really believe that the governments true role in health care should be as an insurer of last resort.

“The benchmarks I am looking at are free time, quality of housing (the US has some of the smallest, least well furnished homes I’ve seen in developed countries, except in the case of the extreme rich) and quality of leisure time”

I guess if you use such selective benchmarks. But then again, this shows the danger of using personal anectodal evidence to make your conclusions. For example, when considering size of housing, the poorest quintile of the US population has as much square footage of housing as the AVERAGE Western European. And, frankly, you cannot be arguing that the housing situation in Europe is better? That is ridicilous. If you look at the equivalent housing situation in the US and Europe you will find that that it is better here.

From personal experience with health care in Germany, France and China, I can say that the quality of care was better in each of those countries than what I get in the states, while prices were substantially lower. Then again, those are mostly simple consultations and broken bones.

One note on “people are richer in this country…”: again, from personal observation, people in comparable countries in Europe (and China!) experience a higher quality of live. The benchmarks I am looking at are free time, quality of housing (the US has some of the smallest, least well furnished homes I’ve seen in developed countries, except in the case of the extreme rich) and quality of leisure time. It is a comfortable belief to assume we have a comparably high standard of living here, but in my personal mirage we’re good, not great.

I can’t speak for other diabetics but as for me I don’t need a subsidy from the government to get quality health care. Sure I was bellyaching about how much I was paying in my health care but that because I work for a cheap company, (don’t tell me to look for another job, I am and I also don’t want to move because of my grand kids, my house and my church).

I get quality health care and live a normal life. Also my Dad and Grand father also didn’t need a subsidy for quality health care. My grand father made it to 90 and my dad to only 82 but his problem was he fell, hit his head and that caused a stroke that made him bed fast.

Not true in many case. My health care plan at work cost me $907.60 as my cost for the plan and that’s just me. We have a $2000 deductible per year, and a 20% copay for prescriptions with a $2600 max deductible per year. As a diabetic of 25 years my out of pocket prescriptions per month is $203. With two trips to the emergency room this year, a liver biopsy, and scoping a knee, plus office visits and blood testing I will reach the $2000 deductible. So my out-of-pocket cost for this year is for medical is projected to be at least $5437.60.

Also dental work has cost me $1200 for my out-of-pocket expense this year so far. I had bridge work done.

Now some of the money is before taxes, i.e. $907.60 my cost for plan enrollment and I put the max of $4000 in an health reimbursement account. But still $6637.60 is not almost nothing for me.

Also I don’t want to hear from people that diabetics is my fault because of my life style. My grandfather had it, my father had it and now me. I was up and on the road riding my bike at 5:30 AM this morning and have ridden 29,584 miles so far this century to combat my disease.

The ones who don’t pay are the poor (government pays) and the people who goes to the ER and then ignore the bills.