The health care law’s imposition of a mandate requiring all Americans has led to one of the greatest drawbacks of liberty in the 21st century, arguably, I’d say, alongside the earliest versions of the Patriot Act, and some provisions of the law that remain active to this day.  It is largely due to the mandate that Republicans have called for the repeal of the health care law.  Understandably, the Republicans hate the idea of a mandate (except for the times they themselves proposed it).  I agree with them that the mandate is bad news.

Even though I’m against the mandate, the rationale the Democrats (and the health insurance industry) had for proposing it was sound, even if the solution sucked.  Something had to be done about the denial of coverage based on pre-existing conditions.  The former status quo could not be kept up forever.  This is because I think there is a obligation for a society to make sure that all of its citizens can be treated for whatever medical conditions they might have.  Call me an idealist or dreamer if you want.  I prefer to think of it as being truly pro-life.  And besides, for many pre-existing conditions, the patient didn’t ask for it.  I certainly didn’t ask for Crohn’s Disease or asthma.  A colleague at work didn’t ask to have type 1 diabetes.

That said, there is a lot of sense in the idea that just because some people have a condition that will cost more over the lifetime of the patient, that everyone else shouldn’t have their premiums raised through the roof to cover those people.

So what ought to be done, assuming the law is repealed or the mandate ruled unconstitutional?  Recently I have been considering the Republican Party’s solution to pre-existing condition denials: high risk groups.  They already exist in many states.  For example, mine has one and it’s mandated by state law.

The trouble with high-risk groups as they currently exist is that they are notoriously expensive.  In the case of my colleague, she found out her monthly premium in one would be about $800+.  That is simply out of reach for many families; as a home owner, it certainly was for her.

The primary reason, of course, is that the people in such plans generally have such a high actual or projected cost associated with them.  But the other side of it is there are fewer people in them.  It’s simple: Less revenue + higher costs eventually translate into higher premiums for the whole pool.  I found that out this year when the premiums for my employer plan were raised for those exact reasons.

With that said, I’d be interested in hearing opinions from our readers about an idea I had to solve the problem of state high-risk groups and their limited enrollment: a national high-risk pool.

Now, I know that some conservatives will grumble and complain about any aspect of health care being handled at a national level, but if high-risk groups are going to be seriously considered as a proposal if the mandate fails, and especially if they ever wish to implement their version of health care reform nirvana (which does away with most government health care programs), it may be necessary to have the biggest pool possible to keep the costs of being in a high-risk pool relatively sane.

I wish I could say more right now about what the impact of such a solution would be, but coming by the numbers won’t be easy.  I can probably find out (or extrapolate) easily enough how much people already in high-risk groups cost, but not everybody with a bad pre-existing condition is in an existing state-based HRG.  Most are in either private plans or more populous ones like Medicaid or Medicare.  And not everyone on those plans has a pre-existing condition that might be subject for denial.

However, I will do some digging and see if I can come up with an idea of how well the idea would work.  If/when I do, I’ll post a follow-up.  For now, if any one in here has a better idea of the numbers than me, feel free to speak up!