Russ Christman commenting on an earlier post wants to know what we get if we not only mandate that everyone carry health insurance but also restrict their choice of plans to moderately comprehensive insurance which leaves consumers expenses. in the event of illness, at levels that they can afford.

And the answer to this would be that health insurance would become a very boring business indeed. Any insurer that did not actually produce medical care would be limited to trying to contract for high quality low cost medical services, administering payments more efficiently and so on.

It would look almost the same as single payer where the government handles everything.

At the same time this does represent a significant restriction on free choice and part of the population would find that options that they favor, that would be no insurance or High Deductible plans, were no longer available. To quote the immortal champion of freedumb, Dan Hinnah from a thread in the NY Times:

The conflict is between individual rights, to determine what risks we want to take, and the needs of society to insure health care risk.

In this case, it makes sense for single young people to forgo health insurance in favor of other priorities. It seems wrong to force them to buy health insurance to lower the average cost for everyone else.

And Wonks Anonymous does like single young people and thinks that restricting their choices and making them pay for health care for geezers like Wonks Anonymous is not cool. Therefore he has thought very carefully about a plan that would enable these young people to have their choice and behave responsibly at the same time.

Because there is a basic problem here. Even after almost a century of exposure to the brilliant thought of Ayn Rand, we have not yet become a really objectivist society. Much as Wonks Anonymous might favor the idea, you cannot get a Medic Alert bracelet that says: I read Atlas Shrugged. In the event of illness please check my bank balance before treating me.

Like it or not, society will scrape you up off the sidewalk and try to save your life. As a responsible citizen you should make preparations to pay the bill. When you do not carry insurance, you are really opting to self insure and, as an insurer, you need to carry adequate reserves to cover potential claims.

If you were a real insurer, carrying many policies written for folks just like you, your reserves could be tiny. Because, on average, folks like you only rarely have high medical expenses the average medical expenses for a large group of folks like you would be small.

But you are an individual and cannot really depend on the law of averages. Prudent reserves here would need to cover a serious illness and accident. Wonks Anonymous is not an actuary but he would guess that you would need at least several hundred thousand dollars in a secure - that would be low yield - account earmarked for medical expenses.

Unless you are a CEO or the child of a CEO complete self insurance is not an option. So how about catastrophic insurance? Here you choose to self insure for most medical expenses but purchase a stop-loss policy that covers you for medical expenses above say $5,000 or $6,000.

Here your reserves would be significantly lower since your maximum liability would be the amount of the deductible. Because you are an individual you would nevertheless need to carry the amount of the deductible in your secure - that would be low yield - Health Savings Account.

If you cannot come up with the deductible for your health insurance on short notice you are only pretending to be responsible and self-sufficient. You hope that you will not get sick and you know that society will save you sorry posterior if you do.

And it does not end here: Very many of us have chosen to pay for fairly comprehensive group health insurance even when the short run gains were minimal or nonexistent. Now when you get sick it is likely that, after years of smugly commenting on our foolishness and lack of individual initiative, you will want to join the comprehensive insurance pool that you have heretofore scorned.

Of course, by the time that you opt to join you will be nothing but a liability, a burden on the responsible citizens who have been paying in to the comprehensive insurance pool. Your arrival will only add injury to years of insult.

If you want to self insure you should be ready to stick by that decision no matter what. Wonks Anonymous would allow you the option of no coverage or catastrophic coverage, provided that you took steps to accumulate adequate reserves to cover your lifetime medical expenses.

So as not to prevent choice entirely Wonks Anonymous would be prepare to allow all the dear young people who wanted to self insure to make annual contributions to their secure - that would be low yield - Health Savings Accounts equal to amount of their deductible. The Health Savings Account could only be spent on health care until the dear young person became eligible for Medicare. If, at that time that they became eligible for Medicare, the dear young person was show to have any chronic conditions caused by earlier neglect of health care in their youth the Health Savings Account would be forfeit to help pay for these conditions.

So Wonks Anonymous does believe in choice, provided that it is responsible.