Coming back from the gym this morning, I encountered an 18 wheeler with a flatbed trailer, stuck on a narrow West Village street, trying to navigate between the fancy cars parked on both sides.  I asked the driver if eyes outside the truck would help.  He was happy to tell me where to look while he steered the truck back and forth in an effort to straighten out the trailer without smooshing anybody's fine examples of German luxry auto manufacturing. 

Of course, I wondered what would happen if I screwed up.  Insurance, I figured.  But then, some people save money on auto insurance by only buying liability coverage, which is what the law generally requires of car owners.  You have to cover the potential liability of you hitting some one or some thing.  If you want to cover the potential liabilities of somebody hitting you or stealing your car, you pay extra and the state doesn't generally care.

Before the Affordable Care Act, the corollary in health insurance was policies with very limited coverage that are being phased out.  Because the insurance company could cap the maximum amount it would spend on the care of any individual or family, it could set lower premiums.  If you insure yourself this way, you save money in the immediate term and if you never require care over the cap, or require care that only costs minimally over the cap out of pocket, you come out ahead.  If, on the other hand, you sustain serious injuries or contract a persistent disease that is expensive to treat, you will find yourself on your own.  Bankruptcy becomes a very real possibility and your unpaid bills are socialized, just like the emergency room visits of the uninsured.

This is, in a lot of ways, the classic Wall Street banker deal.  Profits are collected on trades as they go (in this case, the trade is paying lower premiums) and if there are losses, society is called on to help out.  But the deal is nowhere near as sweet for individuals as it was for Citigroup.  The banks were largely spared the pain of a Chapter 11 Bankruptcy reorganization, administered by a stern judge for the benefit of creditors.  Individuals who go bankrupt due to medical bills incurred after their cut rate insurance cut out, will not be dealt with so gingerly.

The ACA requires people to purchase coverage that won't cut out if things get expensive.  To complain about this is the same as complaining about the individual mandate (which I don't love but have learned to accept).  Society has decided that since society so often has to deal with the consequences of people's health care decisions that we will not allow you to be purposefully uninsured or under-insured.  When Obama said that if you like your plan you can keep it, he apparently failed to anticipate the vocal minority that would say, "I like my crappy plan because it's cheap."  There might be no pleasing those people.  Maybe some day, though, if we carefully document outcomes, we'll be able to show some of them that they were saved from bankruptcy and from the foolish consequences of pursuing short term savings at the expense of long term risk management.  Maybe.