General Discussion
In reply to the discussion: Should women who need maternity coverage pay more for insurance than those who don't? [View all]alc
(1,151 posts)but don't seem to know what it means. We use the word in the sense of how the government may insure (guarantee) a loan - they guarantee it will be paid back and they will pay it if the company (or country) fails to be able to repay it.
But the ACA set up commercial insurance in the sense of a group of similar people sharing risk - a group of people with similar risk pay into a pool, then when a small percentage of them are affected by the risk, they are covered by the money in the pool.
What we want is government to insure (as in "guarantee" that health care costs will be paid. But we are trying to accomplish that from "shared risk pools". I don't want to "share risk" with people who are not like me, just like I don't want my home insurance to cost the same as Romney's or my auto insurance to cost the same as LeBrons or my health insurance to cost the same as someone who could need 10x or 100x as much coverage as me.
If I'm sharing risk with "people like me", then it does matter if I (or they) smoke, exercise, are obese, or can get pregnant. If the government guarantees payment for all citizens, then none of those things matter. The main thing that happens when the government tries to guarantee health care by forcing us into pools is that we get less transparency on how the premiums are used vs what we'd get on how taxes are used. The other thing that happens is that we fool ourselves into thinking about "shared risk" (and we talk about that a lot) rather than health care for all (which is supposedly the goal of the ACA).