So either you start regulating behaviors, which I hope this government will never do (but fear they might, since they try to tax everything that might possibly be bad for you, even if it is only bad when overused) and allow insurance companies to charge different prices. Or in the interest of “fairness” you use “community rates” and force insurance companies to charge everyone in the same area the same price — and you incur the same moral hazard problem you have with insurance now, where people make bad lifestyle choices because they know someone else will pay for it. Or you have a government solution whereby everybody pays the same price but some just use more health care than others — socialized medicine — and suffer the drawbacks that come with that.

There’s no perfect solution — as in any market, there must be some allocation mechanism, and someone always winds up short because we live in a world of scarcity. Design for me a system that wil reward incentives for people to make good lifestyle/health decisions, will not charge people with pre-existing conditions that were no fault of their own more than others (without regulating behaviors), and will also not end up raising prices for everybody else or put insurance companies out of business. You can’t.

In one paragraph of my post, I mentioned that I don’t really think it’s exactly fair that an insurance company should be forced to bear the burden of someone else’s previous condition. You obviously disagree with me. What I like about this bill, and why I wrote the post, is that if you are going to make health insurance companies take everybody then they’ll lose money on those people. So you balance that out by allowing them to increase the prices they charge to people who are clearly making behaviorial choices that have costs. That way, my college friend who had cancer pays the same prices as others, and the people who are smoking pay higher prices to help offset those costs. I think that’s a pretty good set-up. Not perfect, but good.

One more thing: the point of these reforms is not just affordability. There are actually several stated goals: increased quality, increased access, increased affordability, and no increase in costs. THAT is what is truly impossible. Obama and Baucus and everyone pushing these plans need to be straight with the American people and tell them straight up that there are TRADE-OFFS. They pretend they don’t exist and they can increase care, decrease payments to those who provide that care, increase access, increase quality, and have no impact on the budget deficit. And whenever anyone points out that they can’t do one of these things, they tweak their plan to accomplish that goal and a previously-met goal falls away. The plans under consideration cover less than half of the currently uninsured. If your goal is affordability, you can impose price controls (or limit payments to doctors, which is what they’re going to do), just don’t pretend that won’t impact quality or accessibility.

I agree completely with your point about incentivizing good behaviors. I also agree with your point about allowing to “charge higher rates to people whose behaviors are resulting in higher costs.” That’s all well and good. But what I’m confused about specifically is non-behavior related costs. Just raise their prices? I thought that’s how it already worked (if the insurers didn’t just drop them altogether). And I thought the idea of these reforms was affordability, even for people who happen to have unpreventable conditions or that do eventually develop them. If you price someone out of the market because of something they couldn’t control, then I think that would be tantamount to telling them “though luck.”

The point is we give people insurance so that when something “unpreventable” happens to them, they are covered. And we allow insurance companies to reward healthy behavior by increasing the potential spread between, for example, smokers and non-smokers. That way, the illnesses that are preventable by responsible behavior are prevented, reducing the costs of health care.

If what you got from my post is that I’m saying “tough luck” to anyone who has an accident, you need to try reading it again, Benjamin. You’re completely missing the point.