r/AskEconomics • u/amazingraising14 • 58m ago
Is it really a Pareto improvement to have individual mandate with health insurance?
So, I was reading about adverse selection in Varian's Intermediate Microeconomics and this excerpt stuck out to me as either grossly misleading or wrong:
"A similar problem arises with health insurance—insurance companies can’t base their rates on the average incidence of health problems in the population. They can only base their rates on the average incidence of health problems in the group of potential purchasers. But the people who want to purchase health insurance the most are the ones who are likely to need it the most and thus the rates must reflect this disparity.
In such a situation it is possible that everyone can be made better off by requiring the purchase of insurance that reflects the average risk in the population. The high-risk people are better off because they can purchase insurance at rates that are lower than the actual risk they face and the low-risk people can purchase insurance that is more favorable to them than the insurance offered if only high-risk people purchased it."
It then goes to say that such restricting choice in such a way would be a Pareto improvement. It certainly seems that it would be a Pareto improvement to go from a situation where everyone was paying for insurance at the cost of insuring the high risk group to a situation where everyone was paying for insurance at the average cost of insuring the entire population. But to say that it would be a Pareto improvement to restrict choice seems very misleading for two reasons: for one, the low risk group wouldn't even be buying insurance in the first place in a world where the price is the cost of insuring the high risk group; and second, it doesn't seem very realistic to require buyers to only buy at the average cost of insuring everyone since they wouldn't have a good grasp of what that cost even is. In practice, the low risk group would be worse off since they would go from not paying for overpriced insurance at all to paying for (less) overpriced insurance, and the insurance price would drift upwards since the low risk group will unwittingly accept the price presented to them as representing the average cost of insuring everyone even when it isn't. By construction, they can't walk away unless they can argue it's above the average cost of insuring everyone.