In this debate, we will compare two different models of private health insurance. To understand the difference between them, consider the following example.
Imagine 100 people are buying the same health insurance plan. 90 people have varying but ordinary levels of health risk, all below a specified high-risk threshold. These people are called “ordinary-risk people.” On average, it costs an insurer $1,000 per ordinary-risk person to cover them. Some cost more than $1,000 and some cost less. 10 people have health risks above the specified high-risk threshold. These people are called “outliers.” On average, it costs an insurer $5,000 per outlier to cover them.
Under uniform-premium insurance:
Insurers charge everyone the same premium, based on the average expected cost of ordinary-risk people. The government pays insurers the additional expected cost of covering outliers. In the example above, all 100 people would pay a $1,000 premium. For each outlier, the government would pay the insurer the additional $4,000 needed to cover their expected $5,000 cost.
Under risk-rated insurance:
Insurers charge each person a premium based on that person’s expected healthcare costs. The government gives outliers a subsidy to reduce how much of their higher premium they have to pay themselves. In the example above, premiums among the 90 ordinary-risk people would vary according to their individual risk, averaging $1,000 across the group. An outlier expected to cost $5,000 would be charged a premium of approximately $5,000, and would then receive a government subsidy to help them pay this premium.
Under both models, insurers cannot refuse to insure someone because of their health risk, individuals' risk status can be reassessed at different intervals according to the particular insurer, and the government provides the same overall level of financial support for outliers under either model.
(This debate is basically asking, once outliers are taken out of the equation, should we socialise costs or individualise costs in private health insurance?)