• Sound Medicine: Why should “young invincibles” purchase health insurance?

    Sound Medicine is a radio show produced by the Indiana University School of Medicine and WFYI Public Radio. In the last few years, I’ve become their go-to guy on health policy. So, for those of you who would find your day brightened by the sound of my voice, enjoy the following:

    Beginning Oct. 1, millions of uninsured Americans will be able to start the enrollment process for insurance under the Affordable Care Act. “Sound Medicine” health care policy analyst Aaron Carroll, M.D., M.S., speaks with Barbara Lewis about why it’s crucial to get the 19 million uninsured “young invincibles” signed up, too. Dr. Carroll explains that “young invincibles” are young adults ages 18 to 34 who don’t have health insurance and don’t believe they need it. Dr. Carroll stresses the need for this demographic because their participation will balance the insurance pool with an equal number of healthy and sick individuals.

    Full audio after the jump


    • A note on the individual mandate that is supposed to bring ‘young invincibles’ into the insurance pool. The IRS confirms that the only way they can collect the penalty is by reducing refunds, see: http://www.irs.gov/uac/Questions-and-Answers-on-the-Individual-Shared-Responsibility-Provision, specifically #25.

      Also, those subsidies aren’t available to young people in most states once they hit about 250-300% of federal poverty, which complicates things as well. See this report by me and David Hogberg: http://www.nationalcenter.org/NPA653.html

      Combined, I think this makes the hope that ‘young invincibles’ will flock to the exchange overly optimistic.

      • What percentage of this demographic currently EARNS 300% of the Federal poverty level?
        What percentage of them have families and SHOULD be providing Healthcare, but are not?
        Why would a single person already earning 3 times as much as the level for benefits give a crap if their refunds are reduced ( slightly ) to help get healthcare for the less fortunate?
        Defending greed and selfishness is what got us into this mess in the first place.

        • Well, the numbers I’ve seen suggest that about half the uninsured are under 200% of poverty, and my very rough analysis is that the ‘sweet spot’ where subsidies are fairly generous/out-of-pocket premiums are fairly modest (those aren’t the same thing, although there’s a lot of overlap) is generally for people under 200% of poverty. So roughly speaking, that means that about half the uninsured aren’t likely to be all that happy with their subsidies/premiums, other than that segment of the uninsured that were previously unable to get any insurance at all because of pre-existing conditions (a small segment of the uninsured).

          • Again, Sean , It sounds like you are talking about a segment of the population that are already using our Emergency Rooms as their primary Healthcare portal. Small premiums and getting a rebate back on your taxes? Where is the downside? Why should there be a problem? Especially as I said before, many of these have children and/or spouses and need the coverage they thought they couldn’t afford before. How about selling them on the fact that if they don’t buy coverage and end up in an ER, and fail to pay the huge bill, their credit rating will be permanently cratered. Less ability to get jobs, loans, etc. You are calling them “young invincibles” ( as are others ) but that is just code for “Someone with no thought for the future” . They NEED this help.

            • Uhh, the term ‘young invincibles’ isn’t meant as a compliment, it’s meant as a disparagement, as mockery.

              You seem to think that young people will fall in line and buy insurance through the exchange (assuming it’s not available at work). I, and just about everybody else on just about all sides of this particular issue, pretty much all believe that it is going to be a tough sell. Some of us believe it will be tougher than others, but you’re probably alone in thinking it will be a breeze.

    • You make a good argument that it is good public policy to have “young invincibles” sign up for coverage.
      However, you should also point out that there are benefits to the young in having insurance. Men may not need checkups but women need reproductive health care checkups and contraceptive Rx regularly. They may not have chronic diseases but they are not invincible (as the label implies). Accidents and injuries are their leading causes of morbidity and a short stay in the hospital can easily bankrupt an individual. (Have you ever seen “Jackass”).

      • Part of the solution might be a waiting period. That is, you apply for the insurance coverage but it does not take effect for some period of time – 1 month, 3 months, 6, months or whatever.

        There could be exceptions for people who sign up as soon as they are eligible, or have had continuous coverage up until the transfer/enrollment.

    • There are no benefits to them for signing up; that’s why they don’t buy insurance in the first place. The vast majority of these young people have health expenses approximating $0 – and things like routine gynecological exams and birth control expenses aren’t of a magnitude or an unpredictability that would make buying comprehensive health insurance anywhere close to rational.

      The ACA needs these people to sign up to succeed. Trying to sell the pretense that the young people really have a lot to gain from insurance isn’t a hard job, it’s an impossible one. “We need your $ for the poor and the old and the sick so pony up” at least has the virtue of not being bullshit.

      • I think about the 20 something guys I’ve known. One got bit by a rattlesnake while hiking. When he came out of the coma, he was in a hospital and had already racked up a bill over $100,000. He didn’t have insurance, because he was young and healthy. Another guy had just changed jobs so he could have health insurance when he got non-Hodgkins Lymphoma and had 6 months aggressive treatment before it went into remission.

        As for women, the CDC says in typical use, the Pill, one of the most effective and common forms of birth control has a 9% failure rate. That’s nearly a 1 in 10 chance of pregnancy.

        And in a non-health case, a few weeks ago, during a rainstorm, a tree fell on my husband’s car. It was insured, so the new roof, new windshields and windows and the loaner car are paid for.

        As the saying goes, shit happens.

        That’s why you need insurance.

        • I completely agree that young people, old people, and everybody in between SHOULD have insurance (I’d quibble over whether they need the type of insurance that Obamacare imposes), but that’s not the same as saying that everybody understands they need insurance. We’ll know in a few months whether the young are willing to ignore their own financial self-interest (at least as most of them perceive it) and buy insurance ‘for the greater good.’ I think economics and history has shown the shortcomings of systems that ask people to ignore their self interest for the ‘greater good.’

          • Young and healthy individuals do not stay young forever. A working exchange guarantees that one can buy insurance even when you are no longer young, single and healthy. It is therefore very much in a young person’s self-interest. Perhaps young people would have a better sense of their own self-interest if right wing shills like Mr. Parnell hadn’t time and resources demonizing every attempt at universal health insurance since the 1930’s.

    • :”A working exchange guarantees that one can buy insurance even when you are no longer young, single and healthy.”

      No, it doesn’t. A working exchange guarantees that an old sick person TODAY can buy insurance. It provides no guarantee whatsoever of a future system providing the same access to today’s young person. Exchanges are not magical future-binders, and there is no explicit or implicit mechanism that creates and funds this promise you apparently believe in.

      There is a promise inherent in the system, and it’s a promise that I am sure is honestly intended by its proponents, but a promise is not a guarantee.

    • The objection hasn’t been to having appropriate insurance per se, but being forced into purchasing insurance coverage options that you do not want or need, with premiums that have been transmogrified into ersatz wealth-transfer mechanisms from the young to the old.

      Having said that – now that that is effectively the only kind of insurance that one can buy – holding your nose, forsaking all of the other equally important things that you could have done with the excess premiums (paying off student loans, saving a downpayment for a home, adequately funding your retirement savings, etc), and buying insurance is the prudent thing to do.

      • Fine, except that critics of the ACA can’t seem to agree on what the problems with the coverage are. One second, it’s too generous and made up “coverage options that you do not want or need.” The next second, it’s so stingy it might as well be Medicaid. It’s either one or the other. The fact that the law’s critics can’t agree on whether the insurance being offered in the exchanges is too stingy or too generous makes me suspect no small amount of BS.

        • Actually, it can be both if the premiums aren’t adequate to cover the total cost of the additional mandates without imposing significant constraints on the provider network that enrollee’s have access to.

          Insurers can no longer compete on certain dimensions of plan design, so they are competing on price by limiting access.

    • Most of my experience with graduate and medical students has been that they rate as very important

      1) access to the meager health services offered through the student health clinic,


      2) the catastrophic plan our university provides them (for which they must pay a premium).

      The latter is mandatory, btw.

      This is obviously not a representative sample of the “young invincibles” ….although my suspicion is they’re also not representative of some isolated sub-group of hyper-responsible young adults, either.

    • Also.

      Shouldn’t participation of young adults in Romneycare predict what will happen under Obamacare? And hasn’t young adult participation in Romneycare been very very good?

      • These guys apparently decided what the outcomes would be before hand, and are not interested in the actual social merit of having affordable healthcare available to everyone.
        Same crap as the House of Representatives is polluted with.
        The argument isn’t for sane social policies.
        It’s not about the role of Government is critical quality of Life issues.
        It’s about profits for already wealthy people, and those who want to emulate them, regardless of what it costs anyone. It’s selfishness.
        It’s called GREED.