Individual Mandate and Risk Pools

Louise Radnofsky and Stephanie Armour had a piece in The Wall Street Journal that looked at the small and shrinking impact of removing the Individual Mandate (or more accurately, removing the penalty Supreme Court-created tax imposed for not satisfying the IM) on the health coverage providing industry.  The piece is worth the read, but there was one remark quoted at the end that wants a particular look.

“Making the risk pool stable is a vital part” of keeping individual insurance premiums in line with the overall cost to cover a person insured through a larger group or employer, said Andy Slavitt, a top health official in the Obama administration.

You bet. However, in order to stabilize a risk pool, it’s necessary to understand risk pools. A healthy young man does not have the same risks as an elderly man or woman, and so he does not belong in either of their risk pools, either of them in his, and neither of those two in each other’s. A healthy woman of child-bearing age does not share the same risks as a post-menopausal woman, and neither share the same risks as a man of any age. None of those three groups belong in the same risk pool as any of the others.

Health-related risk pools, to be effective and accurate at estimating future health coverage costs and so arriving at reasonable fees for accepting the transfer of the risks involved, need to be reasonably homogeneous.  Belonging to the species homo sapiens is not sufficiently homogeneous.

An Infrastructure Program

In the coming year, the Trump administration intends to push for an infrastructure improvement program for its next major legislative effort.  It’s certainly true that we need much improvement in our roads, bridges, and transportation networks in all mediums, for both economic and national security reasons (bonus points to those who can identify President Dwight Eisenhower’s motivation for pushing the Interstate Highway System like he did).

It’s also true that such a program would be broadly popular among American citizens.

It’s also true that the proposal coming onto offer, rather than being another Federal boondoggle, would only commit $200 billion as seed money, with the States and locals putting up the bulk of the funding and work.

That’s all well and good, but it’s insufficient: the program would remain vulnerable to inflated costs.  To complete the effort and make the overall program more efficient, Congress and President Donald Trump, in parallel with the infrastructure effort, need to get rid of the Federal requirement that contractors pay union prevailing wages instead of competitive wages, and the administration also needs to encourage the States to get rid of their own, similar, requirement.