Dealing with health care "free riders"

This from Dafydd ap Hugh at Big Lizards:

...if we have an unenforced system of health insurance, what happens when somebody without any insurance gets terribly sick or injured -- or worse, his child does. Given that Americans will not stand by and watch someone die from an easily treated disease or injury, the reality is that those free riders will, in fact, be treated. Maybe they'll be billed afterwards, but they can declare bankruptcy and weasel out of even that small bit of personal responsibility.

Similarly, Americans will never countenance senior citizens living on the streets or children growing up illiterate or otherwise uneducated: We have no stomach for willfully forcing people to pay a draconian, perhaps even fatal, price for stupidity... even less for making children pay the price of their parents' stupidity.

Without some solution to the free-rider problem, we cannot move to a system of full liberty.

The problem is in one clause of one sentence above. "Given that Americans will not stand by and watch someone die from an easily treated disease or injury, the reality is that those free riders will, in fact, be treated. Maybe they'll be billed afterwards, but they can declare bankruptcy and weasel out of even that small bit of personal responsibility."

So here's the suggestion:

1. Amend the bankruptcy rules so that only a certain dollar value of health-care debt, X dollars, can be eliminated via bankruptcy;
2. Set X high enough to cover the deductable of any reasonable insurance;
3. But also set X far too low to allow an uninsured patient to shield himself from the consequences of health-care debt by using bankruptcy to wipe it away.

For example, if a typical catastrophic health-care insurance policy had a $5,000 deductable -- normally paid by your health savings account (HSA) -- then X, the dollars of health-care debt you can discharge via bankruptcy, could be set to $5,000. If you have insurance, you're covered; if you only have catastrophic care, but your HSA is depleted (or non-existent), you can declare bankruptcy and discharge $5,000... which is your deductable. That way you won't be socked with life-altering bills, if you're at least somewhat responsible.

But if you've taken no insurance at all -- you're a smart-ass kid who thought he would never need it -- then you may end up with $90,000 of treatment debt, of which only $5,000 can be discharged under bankruptcy. That means you're going to have to agree to some payment plan for the other $85,000, or be taken to court and lose everything you own.

And there are other suggestions as well.