If you are into idealist doing-things-by-ethic discussions, here is something to think about.
From a rational, conservative finances standpoint, no question in most cases if you are young and healthy, it is a better deal to just pay the fine, and plan to pay expenses out of pocket.
However consider this. Health insurance, just like all actuarial-based insurance, is based on leveraging funding from those that are not currently creating expenses to covert he costs of those that are. Safe drivers fund the payouts for accidents, healthy people fund the payouts for health care costs.
That's just how the system works.
What's important is that your premiums are NOT paying for your own care. In fact if you do the math, if you have even just 1 major medical expense it would be many, many years to decades to covert that cost. Rather, your premiums go into a giant pool from which expenses are covered, on a gamble that the income will exceed the expenses.
So the systems have to have healthy people paying in.
What's even more important to consider, that I think most people overlook, is that over the course of your life, at some point you will need medical care. Maybe not today, maybe not in 5 years, but undoubtedly when you are old. Unless you are 100% healthy until you drop dead straight into a grave someplace, you are going to incur medical costs.
And who pays those costs then? Not you, the amount you're paying then as an old person, even though the rates may be higher, is still nowhere near the actual cost. So then you are being subsidized by the young healthy people.
So while you could just wait and pay nothing into the system now while you're young, and gamble on not "needing" it - one could say that you're just being a deadbeat freeloader, planning to live of of the contributions of everybody else later.
You know how people here bitch and moan about folks going to the ER w/o insurance and never paying the bills, driving up the cost for everybody? Pretty much the same thing.
Think of it this way - if you want to "opt out" of the healthcare system... fine, you choice. But don't plan to come back later when you need it, b/c now you're just mooching off of my dime.
Just food for thought...
Except.
You're not considering a number of other aspects of health insurance that also govern what it costs. First, the fact that it's "insurance", not "health care". From a conservative financial standpoint, the ideal scenario is to purchase a high-deductible, low-premium plan that covers catastrophic incidents only. So you pay for your health care out of pocket (perhaps from a tax-advantaged account), and big ticket injuries and illnesses are covered by your insurance. Just like your car. This has a number of benefits beyond the obvious: For one, you're now a direct consumer of health care. It matters to you what things cost, since you're paying for them directly out of pocket. As we've seen over the last 20 years with elective procedures that aren't normally covered by insurance, pricing pressure forces competition and innovation, decreasing the cost to the patient and increasing the quality of service provided for any given price. This is the opposite of what Obamacare does. In fact, Obamacare adds additional services that aren't normally covered by insurance to the list of "required" services, further separating the patient from the actual costs of their healthcare and removing any pricing pressure that may have resulted, while simultaneously increasing the cost of premiums. It also largely outlawed most catastrophic policies. So much for "If you like your policy, you can keep it."
Secondly, competition. Several states have unusually high health insurance premiums. Some of this is for actuarial reasons (small populations with undesirable/costly demographics), some of it is due to state regulations, some of it is due to a lack of qualified insurance companies (decreasing competition). Here's a perfect place where the Federal government could intervene to decrease costs and increase competition -- allow patients to buy health insurance from any company in the US. It's not something that exactly appeals to the Federalist streak in me, but it is right up the alley of "What Commerce Clause?" Democrats. Did Obamacare allow people to buy health insurance from out of state, possibly decreasing costs and increasing patient choice? Of course not.
You touch on actuarial accounting, but neglect a critical aspect of it -- that it's about balancing risk. Yes, the masses cover the cost of the few, but the risky also pay a higher share, reflecting their higher potential costs to the system. Obamacare does the opposite -- it removes the ability to increase premiums or deny coverage for "existing conditions", and severely caps premiums for older customers.
The benevolence argument is a fair one, but it is clearly not the rational choice, given the alternatives. It also ignores that elderly healthcare costs are largely covered by Medicare -- a program that pays out tremendously more money than it takes in, and rather than being financed by "young, healthy people", is basically financed by selling T-bonds and notes to the Chinese and Japanese. And Medicare costs are surging in no small part because they cover anything and everything -- the patients are divorced from the cost of services, so there's little personal financial stake in determining what an appropriate level of care should be. Obama himself has argued that his dying grandmother shouldn't have received a knee replacement shortly before she passed away of cancer. Does Obamacare address overspending on healthcare? Sort of. They put an unelected board of 15 bureaucrats in charge of deciding what is covered, and what insurance companies or the government is willing to pay for it. You say there's a revolutionary new treatment for your illness than has a 50/50 chance of success and a tremendous cost? Yeah, that might not be covered. Good news, though -- there's increasing support on the Hill for abolishing the Independent Payment Advisory Board. The bad news is that abolishing it will likely increase costs -- or at least not hold them down. Moreover, estimates are that Medicare/Medicaid pay out $60 to $100 Billion a year in improper or fraudulent claims. Don't expect those numbers to go down with more customers on the rolls.
Meanwhile, the .gov has spent $650 million dollars on a website that doesn't work and isn't likely to work any time soon. They're estimating it's going to take another half billion dollars to fix it. The super-secret NSA let a temp walk out with thousands of top secret (and incriminating) documents. The IRS stands accused of using its power to intimidate political opponents and of leaking individual's financial data to the public. The Obama Administration missed fully half of the legally-mandated deadlines for the Obamacare rollout, in no small part because they were trying to delay bad news about the program until after the elections. And they're borrowing roughly 45 cents for every dollar they spend. But don't worry -- they've totally got this healthcare thing figured out.
One of the biggest O'care "success stories" makes a lie of your entire argument. They took a law student that was paying for a catastrophic policy out-of-pocket, signed him up on the O'care website, where he found out that he was eligible for a free Medicaid policy with full coverage. Took a young, healthy, insurance customer and turned him into a welfare case.
