I'm not sure which circumstance is the more disturbing, the fact that my health insurance is hanging by the thinnest of threads, or the fact that the only reason I have even that faint hope to cling to is that the freedom caucus doesn't think the AHCA bill is horrible enough. They want to chip away the requirements that insurance plans provide comprehensive coverage, thereby fragmenting (and hence weakening) the market even further.
Let us be clear: the individual health insurance market cannot be made viable without a government mandate. This is because there are structural features of health care that make it fundamentally unlike other insurance markets. When insuring an asset like a house or a car, the size of the potential loss is bounded by the value of the asset. If your house burns down that doesn't make it significantly more likely that your next house will burn down too.
Health care is different. The cost centers are much more predictable. 80% of the cost goes to taking care of 20% of the population, mainly the elderly and the chronically ill. Reducing costs is easy: just cut those high-cost people lose and let them suffer or die. And that is pretty much the Republican plan, though of course they don't market it in those terms. But that is the net effect: without mandates, insurers will not -- can not -- cover the old and the sick. It would be economic suicide.
This is not really about insurance, this is about what kind of country we want to be. Insurance is just the mechanism that we use to implement policy. The policy decision we have to make is: do we force the 80% of healthy people to bear the high cost of taking care of the 20% of old and sick people, or do we let those people suffer and die and their families go bankrupt? Neither one of those is a particularly pleasant prospect. Unfortunately, those are our choices. "None of the above" is not an option. (There are other things we can do to lower the cost of health care, like banning tobacco and refined sugar, forcing people to exercise, etc. But those are not likely to be very popular options on either side of the aisle.)
The problem is that when you are young and healthy it is hard to see the percentage in allowing the government to take a big chunk of your hard-earned cash to take care of old sick people whom you don't know and likely will never meet. Why should you care about them? Well, because some day you will be one of them. Even if (especially if!) you don't get sick you will definitely get old. It happens even to the best of us sooner or later.
If you, like me, want to live in a country where we do not throw the old and the sick and their families under the bus, please take a moment to contact one (or more!) of the congresspeople who can actually move the needle on this and urge them to (continue to) oppose the AHCA, especially if you happen to be one of their constituents. There really is a problem that needs to be solved here, but the AHCA is not the way.