Matt Miller - The Archives
Does Obamacare Hurt The Young?
The Daily Beast, November 17, 2009
It's the latest GOP attack: Obama's plan will force the young and healthy to subsidize the old and sick. But, big corporations are already doing just that.

As part of their multi-front war against health reform, conservatives now accuse Democrats of forcing young Americans to overpay for health coverage so that seniors can pay less. This alleged robbery of America's youth—via rules that limit the difference in premiums that younger and older people can be charged in new insurance exchanges—is said to be further proof of President Obama's radical tendencies. What Republicans don't seem to realize is that Democrats copied this idea from that true hotbed of socialist health care in America: major corporations.

That's right! Though few people ever stop to think about it, big employers in the U.S. are little socialized health republics, in which the young subsidize the old, and the well subsidize the sick, with everyone paying the same premiums for the same coverage. Since most Americans get their health coverage from employers, such coercion and discrimination against youth can fairly be called the American way.

It can also be called common sense. Only those with a warped vision of some Hobbesian health-care "war of all against all" would argue that the best prism through which to view insurance premiums is whether everyone is paying what the free market says they should.

Yes, it's true that in the individual health-care market today, young healthy people can get coverage for less. It's also true that health plans find it highly profitable to sell insurance to folks like this who don't actually need it. But this is precisely what's wrong with American health care, not something to boast about. It's exactly this kind of misguided fetish for markets that, before 1965 and the advent of Medicare, left millions of seniors vulnerable to bankruptcy from medical costs, because private insurers shunned them.

That's why the corporate tradition of socialized premiums and cross-subsidies is such a decisive (and delicious) answer to Republican critics. No young worker at a big American company gripes that they're "overpaying" because everyone at the firm is being charged the same for coverage. But standards for public debate are so sloppy nowadays that any Republican lawmaker or conservative propagandist can get on cable television by decrying this dastardly assault on individual freedom.

It's vital for Democrats to expose this line of thinking as the antisocial philosophy it is. Access to affordable health care at all ages ought to be a matter of course in a wealthy country. Where you stand on this premium question says everything about whether you think a nation is in fact a community, or merely a collection of individuals with no shared obligations who happen to live near each other on a patch of earth.

This latter view has always had more adherents in America than elsewhere. One glum 23-year-old, who apparently resents President Obama's assault on his God-given right to cheaper health-care premiums, told The Wall Street Journal the other day, "I know very few people who are my age who have money to help a 50-year-old person." The fact that very few 50-year-olds with grown kids felt a stake in paying for that young man's public education doubtless accounts for his soaring social vision.

In California, where I live, this atomized view of costs and benefits has helped destroy the Golden State's once-shining schools, as older white people decided they shouldn't foot the bill to educate their younger, browner neighbors. One generation later, California is the poster boy for American dysfunction, a grim harbinger of the nation's future.

But hey, every man for himself!

The paradox on premiums is that Democrats aren't daring to be anywhere near as socialist as the average corporation. When the dust clears in the weeks ahead, Democrats are likely to allow older folks to be charged two to four times as much as younger folks for the same insurance policy in the new exchanges. That's down from seven times, which is the case in many states in the individual market today, but still a far cry from the premium equality championed by the Fortune 500.

Why is the White House countenancing this? Aides tell me it's to assure that young people have greater access to care. The ironies are exquisite, and endless: Democrats now accused of being "socialist" in reality lack the courage to be as progressive as blue-chip companies, many of whom themselves are trying to kill health reform because it's too "socialist." Those seeking fresh evidence that America's political debate is hopelessly confused need look no further.