Jonathan Chait:

The problem here is that their definition of who would “benefit” is exceedingly narrow. You “benefit,” by his way of thinking, only if your actuarial costs exceed your financial contributions. But that isn’t how most people think about insurance. Insurance isn’t a kind of gamble where you bet you can beat the house by consuming more in medical care than you pay in premiums and deductibles. It’s protection from risk. People like that protection. They will pay to acquire it.

Yeah. I really do think that one thing that’s happened in the continuing reaction to the ACA is that a lot of conservatives have convinced themselves that people don’t really want health insurance after all — that health insurance per se is some sort of liberal hoodwinking of an otherwise sensible popular. As far as I can tell, that’s just simply not true. People do want insurance: old people, sick people, young people, healthy people. And, also as far as I can tell, they don’t just want catastrophic protection; they want comprehensive, “good,” insurance.

Now, it’s true that if it’s too expensive, people won’t buy it — so questions about young healthies and death spirals are perfectly legitimate.

But that legitimate question, as I read a lot of conservatives, seems to have transmogrified into skepticism of the entire idea of health insurance — a refusal to believe the very obvious point that, as Chait says, people will pay to avoid risk.

Example? I see it in several of Ross Douthat’s recent items, including today’s (generally smart) comparison of Medicare Part D and the ACA. I basically agree with him about the rollout comparisons, but when it comes to ACA customers he just doesn’t seem to see that the peace of mind insurance gives people is really a massive benefit, and therefore of course one should expect people to want (within reason) to pay for it.

Or at least that’s how I read Douthat and other smart conservatives.

[Cross-posted at A plain blog about politics]

Jonathan Bernstein

Jonathan Bernstein is a political scientist who writes about American politics, especially the presidency, Congress, parties, and elections.