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Comment by rajat | Hacker News Reader

Why should the average 20-30+ year old even carry insurance? The penalty is only $250 a year, rising to $750 in a few years. They can't deny you insurance based on pre-exiting issues. So why not just pay the penalty, which can be substantially less than the policy, until you have an issue?

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$750/year is about the cost of so-called "catastrophic" insurance: high deductible, low monthly. Worthless for the kind of chronic ailments that old people suffer, invaluable for things like car accidents or leukemia. Only an idiot would rather pay the fine than buy this kind of insurance.

My understanding is that this type of insurance is not an option under this law.

Catastrophic insurance, with a high deductible, is what I carry. They are going to be grandfathered, but no new policies of this kind will be allowed under this law. An all encompassing health insurance, with the kind of deductible they have legislated, is not cheap.

Ah, I wasn't aware. (Shows what I know about this bill.)

While catastrophic insurance is a good deal for young unmarried people, part of me thinks it's not how health insurance is supposed to work. If you're not spreading the cost of caring for old/sick people among young/healthy people then what's the point?

The other part of me thinks it's just a handout to the insurance industry and people such as yourself shouldn't have to pay a dime for someone else's overpriced cholesterol drugs or 3D ultrasound.

Catastrophic insurance is exactly how insurance is meant to work. If you want to save for medical procedures in your old age, you can get a savers account.

The whole point of insurance is that a big financial hit (caused by your house burning down, cancer, whatever) causes a non-linear amount of suffering. A few dollars (paid by 99 lucky healthy people) isn't noticeable, but the one guy who can now afford his emergency operation is a thousand times happier. Total cost = 100$750. Total happiness = 99 (-meh) + 1 * (OMG I'll see my grandchildren!!!).

I don't like the whole "forced savings" thing. If you get to 80, and can't afford an operation that you probably don't need, and didn't save for it, and your family won't bail you out ... everyone is mortal.

I guess you could say that people don't have the discipline to save. Fine. Tax the young, and give cash to old people. But don't treat health insurance as a pension - why should young people subsidize old people who want expensive (but most likely useless) operations, but not subsidize old people who can live with the fact that they are mortal and would rather have few bucks to spend at the Bingo club?

What do you do if you get a serious condition in your 20s? Not particularly common, but I certainly wouldn't feel good if I wasn't covered for it.

Also, most people literally cannot afford to save up hundreds of thousands of dollars over their lifetime. Nonetheless, this is what they might end up having to pay in medical expenses.

I can't see any hint of a practical or sensible option in what you're saying.

If you get a serious condition in your 20s, that's what you should be covered by with cat- insurance.

If everyone needs "hundreds of thousands of dollars over their lifetime" they are getting too much healthcare. That's my other point - we sink all the money into more-or-less useless operations on old people who are about to kick the bucket.

Healthcare is best directed towards younger people, where it can make a difference. Old people often get stuff that's likely to be net negative (side effects, complications, etc) because the hospitals want to make money off the procedures.

I guess I'm not understanding what this "catastrophic insurance" is supposed to be. If it covers any medical condition that you might get in your 20s -- without charging enormous co-pays -- then it seems an awful lot like regular insurance. I can't see any reason why someone in their 20s would need less coverage than someone in their 70s. You may be less likely to get sick, but if you do get sick, you'll want that coverage even more than someone in their 70s (since you have more to lose).

>If everyone needs "hundreds of thousands of dollars over their lifetime" they are getting too much healthcare.

Eh? I never suggested that everyone needed to spend that amount. But some individuals will, and not just for "useless operations." There are plenty of cancer survivors who are in that degree of debt.

>Healthcare is best directed towards younger people, where it can make a difference.

I hate how the terms of the debate in America are so selfish. In no other country is there any perception that the old and the young are somehow conflicting interest groups in healthcare. The discussion of this issue is a symptom of the bitterness, cynicism, and (frankly) utter insanity brought about by decades of buying and selling healthcare as a commodity. I just can't engage on this point; I'm baffled by it.

> If you're not spreading the cost of caring for old/sick people among young/healthy people then what's the point?

Er, what? Insurances isn't about getting one group to pay for another. It's about paying a premium proportional to the calculated risk that the insurance provider will have to pay out on what it insures against. The fact that the premiums paid by lower-risk individuals ends up paying for the car that higher-risk individuals need is incidental.

It's a very good question.

Of course, if the healthy behave that way, it drives up the premiums for everyone else.

"Why should the average 20-30+ year old even carry insurance?"

Because an accident or infection can run up $50k in costs before you can even put the paperwork through.

Can, but probably won't, and if it does, the average twenty-something doesn't have so many assets that it's a huge loss to declare bankruptcy.

Besides, twentysomethings all* think they're immortal and that nothing bad will happen to them anyway.

*And by all, I mean some.

Surely the main downside to declaring bankruptcy isn't what it does to your present assets but what it does to your future prospects.

That depends on who you are, what you have, and what you want to do. For many people, this would just mean lower credit limits and a delay in house buying plans, if you had any.

The bottom line for me is that, if I were a healthy young person, I would not pay for health insurance under this plan. Actually, when I was a young healthy person, I didn't pay for insurance - I went uninsured from when I was off my parents' plan until I was 29. So did lots of others. The case for buying health insurance is now far weaker than it was then.

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