This is good, but I disagree about the insurance requirement.

Good points, TheLizard, but you left out one important factor, which I went over in the article: risk.

The examples you give of self-paid healthcare (and the analogy to cell phones) work well within reasonable bounds of primary care. They work within the bounds of controllable large charges like, say, a new knee, but only for people who can pony up $25,000 or so out of their own pocket.

They don’t work at all for the really big bills that actually make up the majority of healthcare spending. Your risk of having some disease that sets you back hundreds of thousands or millions of dollars (at the same time that it makes it impossible for you to work) is unknown to you. If think you know it, you are mistaken. You don’t know whether it will happen to you, at what age, how much it will cost, how long it will last, and whether it will leave you debilitated and unable to work.

This is true even if you are not “irresponsible,” you exercise, wear your seat belt, don’t smoke, have no addictions and are in all ways a perfect human being. Maybe you have to do what I have done in 37 years of writing about healthcare and have thousands of people tell you their heart-breaking stories to recognize this. But it’s true.

Your cell phone strategy works fine because there are lots of choices on the market from almost nothing to $800 or so, and lots of different plans. Sure. But would you happily adopt a cell phone strategy that randomly, at any moment, might bankrupt you or even kill you?

So we need insurance to spread the risk. But here’s the problem: The only people who really recognize the risk are the people who are already sick, or have been, or think they are prone to disease. In other words, the really expensive ones. If only they get health insurance, it can never be affordable. We need the contributions of all those folks who think they don’t want or need it because they don’t recognize the very real risk now, or someday in the future when they are in dire need of real and expensive help. We need to spread the risk across the entire population, because our actual risk, whether we recognize or not, and whether we like it or not, is the same: One human body prone to falling apart in expensive ways.

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