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November 29, 2006

My Health

Responding to SEIU's plans to create a health care pool for 18-34-year-olds, Avedon comments:

I like the idea of half the country getting together to create a union that, among other things, negotiates group health insurance for a large swath of people, but I'm not all that happy with the idea of young people being on a separate plan from everyone else who needs it more. It's an easy way out for insurers and it would probably only serve to obscure for young people what the real threats they face further up the line are.

True enough. Andy Stern is pretty sensitive to these issues, and he's been a loud voice proclaiming the death of employer-based insurance and the necessity for a successor, so I'd assume he'd work towards something integrated. I'm also skeptical that the SEIU plan will gain much in the way of applicants -- certainly not half the country. Nevertheless, channeling the young and healthy into a separate risk pool is a bad thing for everyone else.

November 29, 2006 | Permalink


What would be hugely helpful would be health insurance that works like life insurance--the underwriting is guaranteed for a certain time, or for life.

So I can buy life insurance today; if I have cancer 5 years from now, my underwriting won't change. I'd like to be able to buy health insurance the same way.

Posted by: SamChevre | Nov 29, 2006 10:07:50 AM

But the whole problem with the current system, Sam, is that it does work roughly as you describe - if you get in early, you're paying way above your current risk, so as to subsidize care for the sick elderly. So young people don't get in at all.

Although the window of healthy youth is big, it's still a short portion of life - maybe 15 years out of 75-85. Under 20%. Another 20% is childhood - set it aside. So even if you use $0 of care for those 15 years, while paying amount X each year, X needs to be 3/4 of your annual health expenses for the rest of your life. Which is way more than it's worth to young people. As I said over on the other thread, I used no health care for 6-7 years of my life, and paid for 1 year. I gambled and won, but that's because there's no rational, in-market way to get young people into the pool.

I might note that this was part of what made Kerry's plan so great. By taking catastrophic care out of private insurers' hands, it becomes more affordable for all, and brings rates for the young and healthy down to a level that feels like "insurance" - a relatively nominal amount to keep myself covered.

Posted by: JRoth | Nov 29, 2006 10:27:01 AM

What Stern is proposing wouldn't necessarily change the current risk pool; people with health insurance will keep what they have. It's those 18-34 year olds who don't have health insurance that he's targeting.

If this is Union-lite, it's also universal healthcare-lite. People who have been a part of this will be less committed to employer health insurance and more amenable to other ideas, such as a governmental universal healthcare plan.

Posted by: Stephen | Nov 29, 2006 10:29:13 AM

Sigh. When I read about what to do about "young people," I wonder what to do about me (35, going on 36) with poor job security (I work in the chemical industry and a LOT of our jobs are being outsourced to India, China, and Russia)?

I'm lucky in that my wife has health insurance (good health insurance) and far more job security than I do (works for a state university), but at lower pay. If I get laid off, I can go back on her insurance. But if I quit, I can't switch until the next "open enrollment."

What about the people in my situation who don't have a spouse whose insurance they can use? Sigh.

It would be wonderful to get young people who don't currently have insurance involved in some way, but wouldn't some sort of universal insurance be far better? Rhetorical, I know, but I wish we could deal with what is rational on healthcare rather that what is emotional (and coincidentally happens to have massive financial benefits to certain companies).

Posted by: BlazingDragon | Nov 29, 2006 11:02:28 AM

But if I quit, I can't switch until the next "open enrollment."

You might want to check into this. My understanding is that if an employee's spouse loses his/her insurance - voluntarily or not - they can get on the employee's coverage immediately.

I at least know that I did this with my wife's coverage just this year, and we were told by HR that this was pretty common.

Posted by: Stephen | Nov 29, 2006 11:14:40 AM


You say, But the whole problem with the current system, Sam, is that it does work roughly as you describe - if you get in early, you're paying way above your current risk, so as to subsidize care for the sick elderly. So young people don't get in at all.

To my knowledge, that's only true in the group system. If you buy individual insurance, you can be re-underwritten at any time.

Posted by: SamChevre | Nov 29, 2006 11:43:43 AM

Stern is proving again that he's a bit of a visionary. My understanding is that SEIU is negotiating new contracts that will have health insurance run through SEIU. Turning SEIU into a giant insurance agent is a fairly ingenius way of defusing a significant roadblock to health care for all. Expanding beyond SEIU-represented employees through community affiliates is an additional great idea.

What I'd recommend, though, is that Stern keep a few things in mind while building My Life (full disclosure: I'm a bit biased as someone who has spent the last couple years helping build a young people's non-profit in Montana). One of the reasons unions are successful is because they present themselves regularly in people's lives. They don't just have national organizations. They have locals. And the whole system also works more or less democratically, with local elected leaders establishing priorities, etc., etc.

There are already young people's groups trying to form at the grassroots level. Working with them is something I think SEIU could do effectively and would bolster operations on both ends. It would help build an infrastructure that could be truly grassroots in some places and that could eventually fund additional organizing elsewhere.

The only other thing I'd recommend is finding ways to extend beyond the simple services model. Or at least, thinking seriously about what services drive youth interest the most seriously. AARP succeeds not just through insurance plans, but through discounts.

I'm sure the folks at SEIU are already thinking about this stuff and it's great to see such a heavyweight discussing these items.

Posted by: Matt Singer | Nov 29, 2006 1:31:59 PM

Yes, I agree with you Ezra, this gathering of the 'young' into one pool is potentially hurtful toward a longer term plan.

I've commented in Ezra's original post on the Stern plan that the Stern Plan could be morphed by the Dems in Congress into something more universal and resembling single payer.

Posted by: JimPortlandOR | Nov 29, 2006 2:00:48 PM

Can someone explain to me why young people benefitting from a plan detrimental to the rest of the population is a bad thing? Nearly all policies enacted by a Congress with an elderly average age, and a minimum average age of 27 tilt towards favoring the elderly, who also happen to be the job-holders, the wealthy, the people with a gigantic lobbying group (AARP) that tends to promote policies that benefit the elderly above all else. Fuck the old people. I understand that I'll be one one day, while the old people don't have to worry about being young again (or really, for living that long) so they can enact myopic, expensive policies that doom us for the future, and I'm fucking fed up. If you're old enough to die in Iraq, you're old enough to vote against it in Congress (both House and Senate) should your constituents want you to.

Posted by: Kingspawn | Nov 29, 2006 4:23:05 PM

Yeah, it is a bad thing. But, and this may sound horrible, there is a school of thought that we need health care to hit a total, overwhelming crisis point so we can radically restructure the whole system. I personally don't subscribe to this school of thought, but it's out there.

If it hits this crisis point because all the healthy kids are in SEIU's plan, I expect SEIU will be far more amenable to giving up its sweet insurance pool for a solution that benefits a majority of Americans than would a for-profit insurance company selling health savings accounts. This is not only because a union's driving philosophy is "we're stronger when we stand together and take care of each other,"--as opposed to a business's core philosophy of "maximize return for shareholders"--but also because those getting the most benefit will be the working poor represented by SEIU.

Or, to put it another way, if Andy Stern can fix the healthcare system, he's much more likely to actually try and do it than any other powerful institution in the US. If you subscribe to a "we can only fix this system after it collapses" philosophy (which, again, I don't), Andy Stern chrry-picking the kids is EXACTLY what you'd want to see happening right now.

Posted by: theorajones | Nov 29, 2006 4:51:44 PM

old people don't have to worry about being young again (or really, for living that long)

I realize that when you're 22, even being 60 seems tantamount to being about to die, but but actually the average 60 year old today has roughly 20 more years of life expectancy.

In short, you're old for much longer than you're young.

Posted by: fiat lux | Nov 29, 2006 4:56:36 PM

I'm with Avedon and Ezra. I just turned 30, so I'd benefit, but I'd still think it was a better idea if the age range was expanded up, rather than leaving such a swath of folks--many of whom are not in much better positions, job-wise, than the 18-34 set.

And it sucks a lot to not have a spouse's insurance to fall back on. I've had none for years, since my partner's company doesn't offer domestic partner benefits. Just one more reason to be in favor of gay marriage...

Posted by: alsafi | Nov 29, 2006 5:01:26 PM

You "can't cut out a swath of "young people" unless you want to cause the total collapse of the system. The young subsidize the old, cut them out and no insurance for the old except at prohibitive rates. Every health insurer aims for young families as an indicator of economic success for the company. Think flood insurance, the only people who want flood insurance live in flood zones, so you cut out a lot of homeownwers who don't need flood insurance ( live on mountains, in desert, etc) and there aren't enough homeowners who live in flood zone to make it economically feasible ( read profitable) for insurance companies to sell flood insurance, so the Feds step in and offer government insurance.

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