In fact, in any large group plan, less than 10% of the covered incur 90% of the cost of claims. Usually due to catastrophic illnesses like cancer, life-threatening diabetes, accident, and other crises. A never-ending battle is the effort by other insurees to force those claimants into a “special group” to reduce costs. The statistical analysis of this measure was that individual premiums would drop maybe 5% or so but the “outcasts”'s cost would actually make it cheaper for them to pay the hundreds of thousands of medical care out of pocket than pay the disastrous premiums they would require.

Then there are the “opt outs”: “I don't need no insurance 'cause I won't get sick so give me the money.” Until they get a serious illness or condition. Or family. Then these lawyers mysteriously appear.

Which illustrates the [nonprofit] insurance concept “shared risk”. Group medical insurance is based on this concept. The larger the group, the bigger the spread of risk. The ultimate humane solution is one-payer, universal insurance.

But forcing insurance on everyone is not the way. A plan like Medicare (which I am, incidentally, being, for all practical purposes, forced to join) with fixed and defined costs and benefits would be perfect. And if you don't join, you are on your own. No one sues Medicare for not forcing coverage if they decline.

In fact, in any large group plan, less than 10% of the covered incur 90% of the cost of claims. Usually due to catastrophic illnesses like cancer, life-threatening diabetes, accident, and other crises. A never-ending battle is the effort by other insurees to force those claimants into a “special group” to reduce costs. The statistical analysis of this measure was that individual premiums would drop maybe 5% or so but the “outcasts”‘s cost would actually make it cheaper for them to pay the hundreds of thousands of medical care out of pocket than pay the disastrous premiums they would require.

Then there are the “opt outs”: “I don’t need no insurance ’cause I won’t get sick so give me the money.” Until they get a serious illness or condition. Or family. Then these lawyers mysteriously appear.

Which illustrates the [nonprofit] insurance concept “shared risk”. Group medical insurance is based on this concept. The larger the group, the bigger the spread of risk. The ultimate humane solution is one-payer, universal insurance.

But forcing insurance on everyone is not the way. A plan like Medicare (which I am, incidentally, being, for all practical purposes, forced to join) with fixed and defined costs and benefits would be perfect. And if you don’t join, you are on your own. No one sues Medicare for not forcing coverage if they decline.