This post got more mail and responses than any I have previously written.

The biggest issue was that people felt I was hard hearted, and when I re-read the piece I could see how people would assume that.

So, to clarify, I would never want Kristof’s friend to not get care and die as a penalty. Also, I would prefer him to not have to go through charity care either.

What I would like is to see him on Medicaid and not on my private insurance plan.

Insurance is supposed to be purchased when you don’t need it to pay for expenses when you do need it.

Premiums are manageable because the community as a whole buy policies and the combined premiums pay for the 6% of us who incur about 65% of the claims.

If people can simply join a plan when they get ill two bad things will happen:

1) The number of people who buy policies will go down as a portion of insurance buyers are doing so in case of catastrophe and not to cover routine expenses. This will increase current costs as the percent of people buying today who are sick will go up.
2) The percent of people with extremely high health costs will increase as those who become ill and have no insurance will jump on plans as they get diagnosed. Again, this will have a negative impact on costs.

If people know that waiting to buy a policy will result in having to go on Medicaid if they become ill, then most people will opt to buy a policy. This improves the pool of insured’s and positively impacts the price.