Santa Clara University


Health Care Reform: A Case for the Young and Healthy

By Kari Kjos

This case, by Hackworth Fellow and SCU senior Kari Kjos, raises key ethical questions about health care coverage for the young and healthy, including whether insurance should be mandatory; whether young adult premiums should subsidize care for older, sicker patients; and whether people's lifestyle choices should figure in the cost of their insurance.

Individual Mandate

Imagine a 23 year old named Jim Smith, who recently received his Bachelor's degree. Upon graduating from college, Jim was no longer eligible as a dependent on his parents' employer-covered health insurance plan. Jim recently purchased a high-deductible insurance plan, yet many of his peers in similar situations chose to forgo purchasing health care insurance because they are not expecting to need medical care at their young age. His peers are not making an unusual decision. Today young adults (age 19-26) comprise the largest segment of Americans without health insurance - with 10 million young adults uninsured.1 Uninsured patients cannot be denied access to health care if they end up in an Emergency Room and pose a financial burden to the hospital. Jim heard that the health care reform bill recently passed in the House includes a mandate for individuals to purchase health care insurance or pay a fine, and realizes that many of his peers will be affected by this mandate.
  1. Is it fair for the government to mandate that Jim's peers purchase health insurance they believe they don't need or cannot afford?
  2. Do Jim's peers have a responsibility to purchase health care insurance to ensure that they will not be a financial burden to the medical system if they fall ill?

Young vs. Old

A spokeswoman for California Representative Henry Waxman said the House bill health insurance mandate aims to "level the playing field so that regardless of age, gender, financial or health status, individuals and families are able to afford coverage." To even out the disparity in premium costs between the young and the elderly, the House bill sets a 2 to 1 ratio, which means insurance companies can charge their elderly customers no more than twice as much as their youngest customers. Today, most states do not have a cap on this range, and the elderly may pay up to five or six times as much as the young.2 This bill would force Jim to pay a disproportionately higher premium to effectively subsidize health care for older generations.

  1. Is it fair for young adults, like Jim, to pay more for health care coverage now in the hope that they will have lower insurance costs as they age?
  2. Does Jim have a responsibility to pay higher premiums to subsidize the high health care costs for the elderly?

Healthy vs. Sick

Seven out of ten Americans die from chronic diseases, and nearly three quarters of all health care costs are from treatments for four chronic conditions (cardiovascular disease, cancer, diabetes, and obesity) for the elderly. Yet, many of these chronic diseases are the result of years of unhealthy behavior. Studies show that 80% of cardiovascular disease and diabetes is preventable, 60% of cancers are preventable, and more than 90% of obesity is preventable.3

  1. Should Jim be charged a higher premium in order to lower premiums for Americans who have made poor health choices throughout their lives?
  2. Do healthy members of society have a responsibility to support health care for unhealthy members of society? Does it make a difference if an illness is a genetic disorder or caused by years of unhealthy behavior?
  3. Is it fair to charge higher health insurance premiums to people who smoke? Or who eat unhealthy foods? Or who rarely exercise?


December 2009

Works Cited
1 Holahan, John, and Genevieve M. Kenney. "Health Insurance Coverage of Young Adults: Issues and Broader Considerations." The Urban Institute, 01 June 2008. Web. 18 Nov. 2009.
2 Wilde Mathews, Anna. "Effort to Assist Older Voters May Raise Costs for the Young -" Wall Street Journal: Health. The Wall Street Journal, 10 Nov. 2009. Web. 11 Nov. 2009.
3 Burd, Steven A. "How Safeway Is Cutting Health-Care Costs -" Opinion Journal. The Wall Street Journal, 12 June 2009. Web. 18 Nov. 2009.
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