One of the great things about living in America is people get to vote with their pocketbooks. We choose between competing products, and if we don't like any of our choices, we can keep our money and go without.
This system has served us well for more than 200 years – it is, in fact, why the U.S. is the most innovative country in the world. Competition, paired with the consumer's right to buy nothing at all, forces companies to offer better products at a lower price.
The one area of the economy, as we've heard again and again, where this system doesn't work so well is in health care – that's because this system doesn't apply to health care. Instead, we've elected to finance most of our health care through a third-party payment system where consumers are isolated from the costs – for most services, we simply pay a small co-payment regardless of which provider or which prescription we choose.
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The solution to the third-party payment system, of course, is to give consumers some "skin in the game" by having them pay for their routine services. The consumer-directed health care movement has gained steam in recent years, and studies show it seems to be working – people actually do spend their own money differently than they spend someone else's, and the result is lower utilization and better results for people on consumer-driven health plans.
Though many people expected health reform legislation would do away with CDHC, that's actually not the case – FSAs may have taken a hit, but it appears that HSAs and HRAs are likely to grow exponentially in the next several years. That's good news for the millions of people who like their health plans and want to keep it, as President Obama told us we could.
The one area, though, where it appears Americans may have lost their right to behave like consumers – the right to vote with their pocketbooks – is in the purchase of health insurance. Until now, health coverage has always been optional – most people believe it's a good idea, but not everyone sees it as a necessity, and these folks choose to spend their money on other things.
Young people are especially likely to make this decision. Rather than transferring the risk of a serious illness or injury to another party, a large percentage of twenty-somethings choose instead to retain the risk – they're willing to take their chances.
Many people who are eligible for a government program like Medicaid, surprisingly enough, also make the decision to remain uninsured. For these people, the program is free, but even at that price, many seem to believe the government plan just isn't worth the cost – more than a third of the uninsured in this country are eligible for a government program but aren't yet enrolled.
So should people be required to purchase health insurance? I don't know. The insurance side of me says yes – that's the only way the "guaranteed issue" part of the bill will work. But it just doesn't feel very American – aren't we supposed to be able to make our own decision in this country without the government telling us what to do?
I guess the problem is that some of the people who argue vehemently against a government insurance plan and protest just as loudly against an individual mandate would still be willing to let the government bail them out if they found themselves with a big medical expense and no health insurance protection – and as long as that government safety net of uncompensated emergency care and medical bankruptcy is in place, we need to do something to make sure not too many people make use of it. Otherwise, those of us who "voted" to protect our finances by purchasing health insurance end up footing the bill.
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