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Originally Posted by DanaC
The insurance companies gamble that you will never need more treatment than would fall under the copay limit. And you gamble that you might just need a hospital stay at some point.
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Strictly speaking, the insurance companies don't gamble. They are like bookies; they can adjust the rates so that they always come out with a moderate profit no matter who wins or loses. Too many people start losing, they just raise everybody's rates to cover the loss.
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Originally Posted by henry quirk
As I understand it: the point of the fine is to cover those expenses one may incur if using medical resources without insurance.
Leaving aside that one may be able to pay his or her own way without resorting to insurance (out of pocket), at least for the first year might it be the better deal to just pay the fine?
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The point of the fine is to help offset the medical costs of
other people who did buy into the plan, a plan which only works if enough people participate. When you pay the fine, you are not securing any medical care for yourself. You will still be responsible for the entire bill should you become ill. The ER will take a bullet out of you and restart your heart, just as they do now. But they will send you a bill. And just like an uninsured person before Obamacare, you will not get life-saving surgery, you will not get cancer treatment, you will not get therapy to walk again, etc.
It's true that if you do have the means to pay out-of-pocket, you will probably save money by simply paying the fine. But very few people really have those means. They think they do, but they don't truly understand how quickly medical bills can add up. My dad is a soft libertarian who has been playing that gamble his entire life. He has excellent self-discipline, and does indeed live well below his means so that he can keep savings in the five digits earmarked for self-pay medical costs. He did even have to pay out once in a major way when he had an unexpected heart clot and spent a day in the hospital. But he never spent time in an ICU, never got cancer. Had that happened, his 5-digit savings would have been laughable, and he would have been fucked. He shrugs and says, "Well, that's life," and asserts that if he's that bad off he'd be okay with just dying. But my experience is that when face-to-face with death, most people find (too late) that they'd rather stay alive after all.