2 Plans and Many Questions on the Uninsured (New York Times)

Brandy Coons is what health economists call a free rider.

She may not fully appreciate it, but her decision to go without health insurance, like millions of similarly situated Americans, has become central to the pre-eminent policy dispute of the Democratic presidential campaign. ...

Many free riders are assumed to be young and at little risk of major illness, but they do consume health care. A recent analysis by the New America Foundation, a Washington policy group, found that 16 percent of the patients who received uncompensated medical care in 2004 had family incomes of at least four times the federal poverty level (which would currently be $41,600 for an individual and $84,800 for a family of four).

They accounted for $5.8 billion of the estimated $41.4 billion in uncompensated care that year. Most of it was delivered in hospitals, which are required by federal law to treat patients with emergency conditions, regardless of ability to pay. A vast majority of that care is covered by the federal, state and local governments in a direct cost shift to taxpayers. ...

“By allowing people to stay out, you risk that only the sick will come in,” said Len M. Nichols, director of health policy for the New America Foundation, and a reluctant supporter of a mandate. “Insurers have to protect themselves. Bringing everyone in also lowers costs across the board because the risk pool is wider.” ...