In a previous post I pointed out the adverse effects that would flow to persons of all ages from the inclusion of choice in the replacement for Obamacare. This feature would allow individuals to opt out of comprehensive medical insurance & into a program with cheaper but narrower coverage. In this post I note that choice would consign the elderly into its own high cost ghetto.

Unfortunately, a right to select the extent of one’s medical insurance is a key feature of the Republican proposals to replace Obamacare. Those who perceive themselves to be healthy so that they would need little medical care, particularly younger persons, would likely pick the coverage with the lowest premium.

But, such choice would undermine the fundamental concept that underlies insurance: risk is spread among many, so that only a few make claims at any one time. Each member enjoys a lower cost than to go it alone. The larger the pool of insureds, the lower the premium. If those who perceive themselves to be healthier – the young – may opt into a low premium-low benefit category, the size of the risk pool that includes the elderly – who suffer more health problems – would be smaller. In turn, older folks would pay higher premiums than would be possible. Saddling old folks who are at a time in life when their earning power is lower, or non-existent, would be cruel.

Obamacare itself demonstrates the folly of including choice in a medical insurance program. This well intentioned project is failing precisely because it includes a choice to opt out by paying a prescribed penalty. Too many have chosen this option, thereby reducing the size of the risk pool & pushing the premiums to go sky high and insurers to withdraw. .

Choice is one defect of Obamacare that it’s Republican critics should not repeat in its replacement.

I am a lifelong Republican who is disgusted with the party’s lack of stewardship of the power it has held.

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