Opinion
Comments (0) | | Print

Michael Gerson: Health reform toll will fall too heavily on young people

Published: Wednesday, Nov. 4, 2009 - 12:00 am | Page 21A

As I was talking recently with the founder of a large American corporation, the conversation turned (inevitably) to health care reform. His employees in their 20s, on average, cost the company about $1,500 a year in health bills. Those in their 50s cost at least 10 times more. The effect of proposed health care reform – which limits the ability of insurers to charge higher premiums for older adults – would be, he said, a large shift of America's health care burden to the younger generation.

This is not an unintended consequence of reform; it is the whole purpose. It is not a side effect; it is the main funding mechanism.

Precisely because younger people have lower health costs, reformers want to draft them into the broader health insurance system so their premiums can subsidize the health expenses of older, sicker health care consumers. Thus, in every version of health care reform, the young are required to purchase coverage, on penalty of an "excise tax."

This mandate explains the political coalition behind health care reform. Insurance companies are willing to accept tighter government regulation on matters such as the coverage of pre-existing conditions – but only if they are given guaranteed access to millions of younger, healthier premium payers. Congress gets additional resources from the young to expand insurance coverage, with less need to raise taxes overtly. Advocates for the elderly welcome an intergenerational subsidy that reduces premiums for older Americans.

Amazingly – out of idealism, ignorance or both – people in their 20s remain the strongest supporters of health care reform. They are also the most likely group to wake up the day after passage of Obamacare with a health reform hangover – forced to buy coverage at higher premiums to reduce the cost of someone else's health insurance.

Legislators, perhaps fearing that future anger, seek to soften the blow in a couple of ways. The Senate Finance Committee bill would allow insurance companies to charge older adults a maximum of four times more than young people – reducing premium increases for the young by making the elderly carry more of their own weight. The House bill would set the maximum premium difference between old and young at two to one. This provision, supported by AARP, is likely to increase premiums for the young dramatically.

Both the House and Senate bills also provide subsidies for those with low incomes to make health insurance more affordable. Many of the young would qualify. Many would not. Offsetting the whole cost to the young through subsidies would make health reform fiscally unsustainable – requiring new taxes on other groups.

There are arguments for mandating the purchase of higher-priced insurance by the young. It would, on the bright side, leave less disposable income for nose rings and tattoos. And perhaps the ownership of health insurance, in an ideal world, should be a social expectation, like the ownership of auto insurance.

But this burden on the young comes in a series. The most consequential element of the New Deal – Social Security – has been a large transfer of resources from young to old. The same is true of the Great Society's Medicare program, which has channeled massive spending toward health care for the elderly. Two-thirds of Medicaid spending goes to nursing homes. In 1965, there were four workers paying for the benefits of each retiree. Soon, there will only be two.

In our history, public programs helping the young – say, the Civilian Conservation Corps or the GI Bill – tend to be discretionary and temporary. Entitlements benefiting the elderly are eternal. And health insurance reform adds to the list.

America's 60-year, cross-generational transfer of wealth counts moral achievements. In the 1960s, 30 percent of the elderly lived in poverty. In 2008, that figure was less than 10 percent. And the compassionate treatment of the elderly serves our future interests. The young grow old, with a little luck and patience.

But limited resources require the interests of young and old to somehow be balanced. And a society that consistently shifts burdens from old to young at some point becomes selfish. We are proud to sacrifice for the sake of our parents and grandparents. We are less proud of imposing burdens on our children and grandchildren that diminish their opportunity.

This is the inescapable shame of overwhelming budget deficits. But it applies to health care as well. A nation that views the young as ripe for burdens instead of benefits has itself become old.


hide comments

About Comments

Reader comments on Sacbee.com are the opinions of the writer, not The Sacramento Bee. If you see an objectionable comment, click the "report abuse" button below it. We will delete comments containing inappropriate links, obscenities, hate speech, and personal attacks. Flagrant or repeat violators will be banned. See more about comments here.

What You Should Know About Comments on Sacbee.com

Sacbee.com is happy to provide a forum for reader interaction, discussion, feedback and reaction to our stories. However, we reserve the right to delete inappropriate comments or ban users who can't play nice. (See our full terms of service here.)

Here are some rules of the road:

• Keep your comments civil. Don't insult one another or the subjects of our articles. If you think a comment violates our guidelines click the "report abuse" button to notify the moderators. Responding to the comment will only encourage bad behavior.

• Don't use profanities, vulgarities or hate speech. This is a general interest news site. Sometimes, there are children present. Don't say anything in a way you wouldn't want your own child to hear.

• Do not attack other users; focus your comments on issues, not individuals.

• Stay on topic. Only post comments relevant to the article at hand. If you want to discuss an issue with a specific user, click on his profile name and send him a direct message.

• Do not copy and paste outside material into the comment box.

• Don't repeat the same comment over and over. We heard you the first time.

• Do not use the commenting system for advertising. That's spam and it isn't allowed.

• Don't use all capital letters. That's akin to yelling and not appreciated by the audience.

You should also know that The Sacramento Bee does not screen comments before they are posted. You are more likely to see inappropriate comments before our staff does, so we ask that you click the "report abuse" button to submit those comments for moderator review. You also may notify us via email at feedback@sacbee.com. Note the headline on which the comment is made and tell us the profile name of the user who made the comment. Remember, comment moderation is subjective. You may find some material objectionable that we won't and vice versa.

If you submit a comment, the user name of your account will appear along with it. Users cannot remove their own comments once they have submitted them, but you may ask our staff to retract one of your comments by sending an email to feedback@sacbee.com. Again, make sure you note the headline on which the comment is made and tell us your profile name.

Sacramento Bee Job listing powered by Careerbuilder.com

Quick Job Search

View All Top Jobs
Buy
Used Cars
Dealer and private-party ads
Make:

Model:

Price Range:
to
Search within:
miles of ZIP

Advanced Search | 1982 & Older

SacBee Marketplace

Featured Categories

Legal Worship Education Health View all
Powered by Planet Discover