August 16, 2013
A pro-health-care reform protest. (Andrew Harrer/Bloomberg
A pro-health-care reform protest. (Andrew Harrer/Bloomberg

Ready for the absolute worst thing you’re going to see written about the (very real) issue of young, healthy people and the Affordable Care Act? I’m going to make you wait for it, though.

Philip Klein is trumpeting a new “study” that purports to find that buying insurance in the exchanges is a really bad deal for young healthies. Only one problem: the study, by David Hogberg, ignores in his analysis that many of those young healthies will actually use that insurance.

Hogberg seems to understand that even young, healthy people have occasional medical needs; he cites figures that “those aged 18-34 average about 2.7 physician visits per year” and that women in that age group use the health-care system more than men do. And yet he doesn’t account for that at all in his cost calculations. He just looks at premiums, subsidies and the “mandate” penalty for going without. It’s probably true that the healthiest of the young healthies, especially men, can go years between doctor visits (and would do so even if insurance covered everything). But even young healthies get the flu, or sprain an ankle, or otherwise need a bit of medical attention. Some even want regular check-ups just to be safe! Those visits cost money; any proper study of costs and benefits would take them into account.

Oh, I promised you the worst thing. Beyond the small-scale stuff, Brian Beutler on twitter was mentioning the very real possibility that young healthies could wind up with cancer. Hogberg anticipates that — sort of:

In a market without guaranteed issue, consumers run the risk of insurers not selling them policies when they get seriously ill. But that risk is largely gone under the exchanges. For instance, a young person who gets a serious illness in June only has to wait until October to sign up for insurance and then wait until January 1 of the next year to receive coverage. 

Really? Really? That’s your argument? Get cancer (or shatter your spine in a car accident, get bit by the wrong thing, or even break your leg playing ball) and you can eventually start getting coverage for your continuing expenses? And so it’s not sensible to protect against the financial devastation — not to mention real difficulties getting access to top-quality care — you’ll have to just accept in the meantime?

Unreal.

It’s absolutely true that for most young healthies, buying insurance won’t be a big winner. For that matter, most people who buy homeowner’s insurance never suffer a fire or a flood, but somehow you won’t find a lot of financial analysts who will advise against it.

There’s a larger issue here, too. While Hogberg is focused only on the immediate financial incentives for young healthies (which is fine; it’s a real and important question), there’s also a question about the long-term interests of this cohort. Because the one thing that’s going to happen to most young healthies is that they’re going to become older not-so-healthies, and at that point most of them are going to be very happy to have a functioning insurance market. Those who are young and childless may, before all that long, become parents — again, parents who badly want to buy insurance. And those young healthies may even have a major financial stake in what happens to their 40- and 50-something parents; they may care quite a bit that their parents aren’t wiped out financially by health care before they are Medicare-eligible.

Bottom line: there’s just no use looking at the costs of insurance without also looking at the benefits. Whether they’re the short-term direct benefits that actual insurance-holders certainly do claim, or the longer-term benefits involved in having a functioning system.