Ana: If Doug Holtz-Eakin doesn’t believe that young, healthy people would leave the system, he might want to talk to Mitt Romney, who actually studied the situation in the real world when he was reforming the health care system in Massachusetts. It’s not–as Holtz-Eakin suggests–that these healthier citizens would choose between staying with their employer-provided benefits or buying them on the open market. It’s that they would decide to go uninsured entirely–leaving older and sicker people in the employer-provided system. That would make it even more expensive for employers to continue to provide coverage for their workers, accelerating a trend that we are already seeing, in which fewer and fewer companies are providing coverage.
That young, healthy people would choose not to have health insurance was a great revelation to Romney:
… they also found something surprising when Romney began looking at who, precisely, the uninsured were in Massachusetts. Everyone expected the typical profile to be that of a single mother just scraping by or maybe someone with chronic illness–not exactly ideal customers for insurers. Instead, nearly the opposite was true. “It turned out they were largely single males, and they were working,” Romney recalls. “They were eminently insurable. It’s funny how data opens up new insight.”
That was the bit of analysis that changed everything. Gruber ran the numbers at MIT: universal coverage would be expensive, but so would any half-measure. Romney could simply expand the existing system and, by doing so, cover about one-third more people. Or he could cover everyone by including an “individual mandate,” a controversial measure requiring people to buy insurance and offering subsidies to those who couldn’t afford it. The price tag would be about one-third higher. “I began by saying, Well, maybe we could help half the people that don’t have insurance, maybe we could help a third of the people, and ultimately it became, You know what? We could actually get everybody insured!” Romney recalls.