Would you rather . . .

Would you rather attend a business meeting naked but otherwise prepared or swim in shark-infested waters wearing a container that spurts human blood?

The third Affordable Care Act open enrollment ends soon and many people are Would you rather facing the question – would you rather get health insurance or pay the penalty? Just like the game, this choice is not posing two equal or comparable choices.

Paying the penalty is not enough to motivate a person to get health insurance. For a couple earning less than $480,000 a year – let’s say virtually everyone — the penalty is less than the roughly $6,000 per person that health insurance costs. I won’t address the lower income earners who escape the penalty. So why doesn’t everyone go with the lower cost penalty rather than the much-higher cost health insurance?

Consider this for square one: If you have stuff — a house, a retirement account, a car — and you have medical bills, you would have to sell your stuff to pay your medical bills. And it can go fast for anything even mildly serious (think cancer, head injury, or mysterious rash from your shark-swimming incident). You may have a real fondness for your house and the way it keeps rain and snow off of your head, but it would only be a down-payment on chemotherapy.

If you do not have stuff or you run out of stuff, then you are at the mercy of charity care. Doctors and hospitals do not work for free, and can turn you away for anything but emergency services.

Of course there are those who reject all commerce with people wearing white coats. For them, paying the penalty makes sense and is fine if they promise to change their minds only at open enrollment. No picking them up off of the grocery store floor when they have a heart attack or faint. They will pick themselves up. In short, they cannot guarantee that they will use no medical services and when they do, it will be at the expense of their stuff – which puts you right back at square one.

We need some people paying the penalty. Those funds go to defray other costs of the Affordable Care Act. So ironically, while the ACA is meant to get everyone covered, having some penalty payers softens the blow of all the added costs. The Congressional Budget Office estimates that $2 billion will be paid in ACA penalties for 2015. This at least nibbles at the $32 billion in subsidies helping people to buy health insurance.

I respect the people who have made a rational and informed choice to pay the penalty, and risk their homes. I submit that few people recognize the true choice they are making.

As for me, I’d take the au naturel business meeting over the sharks any day.

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