Will you be able to game the new health care system?
March 31, 2010Jon Brooks Comments OffI have to admit I have been wondering about this myself. From Philip Greenspun’s Weblog, this March 25 post:
Can I buy last minute health insurance?
It seems as though the 1000-page health care bill is soon to become law. A friend of mine suggested the following strategy:
Consider a family in Massachusetts that earns $100,000 per year. They decide not to pay $20,000 per year for health insurance in 2013 when the bill takes effect (we already have the highest rates in the U.S. (source)). They get fined 2 percent of their income by the IRS, which costs $2,000 per year, plus pay a bit out of pocket for routine checkups. When a family member is diagnosed with cancer and needs treatment, they sign up for health insurance at $20,000 per year. The insurance company cannot deny them coverage based on the preexisting condition that was diagnosed a week before. After the cancer has been treated, they drop the insurance.
What’s the flaw in this strategy?
And here are some replies:
There is absolutely no flaw in that strategy, and you’re by no means the only person to have written about this. There are three plausible hypotheses out there, as far as I can tell: (a) The Democrats are fools, too enamored with their own savior complexes to understand even the most simple manifestation of unintended consequences, (b) The Democrats are crazy like foxes, and know this will bankrupt our health insurance industry, and when that happens we will be forced to have the government step in with single-payer insurance, (c) The Democrats know the bill will be struck down by the courts as unconstitutional (you can’t force private parties into contracts) well before the provisions set in, thereby paving the way for a single-payer system…
Health insurance either needs to be single-payer, or we need a truly free market system. This over-regulated, pseudo-capitalistic, quasi-socialized mess we’ve got now is a disaster. I’m fairly libertarian, but I have to admit that if you’re going to go with the notion that access to a $1M CAT scan machine is somehow a basic human right, then you really need to have a single-payer insurance system.
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One flaw (in the example) is the amounts. A family earning $100,000/year would not be charged $20,000 in premiums; I believe the law caps premiums at something like 8% of income before subsidies kick in and/or the mandate is dropped. So the difference between paying the premium and paying the mandate wouldn’t be so extreme — and maybe not so different from the typical health care expenses for a reasonably healthy family. But the mandate penalty is fairly low so it looks as if gaming the system like this could be advantageous to at least some people. One question will be whether social norms evolve to make doing this taboo — my guess is not, but there will certainly be a big push for it. If it becomes too big a problem, the rules will certainly be revised to forbid it before Blue Cross goes bankrupt.
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