Fundamentally, I am skeptical about the age extensions because they actively discourage self-reliance, something that is sadly lacking in the U.S. today. (Give a man a fish . . .)

But more importantly, won't the age extensions just make health insurance more expensive for everyone else and harm especially those twenty-somethings like myself who are taking care of themselves (either because they are responsible or because their parents can't or won't)? If mommy and daddy want to continue to baby their adult children, they should have to (and probably would) pay full price for the kids' insurance.

I absolutely agree with Mr. Cohen that the real solution is to focus on affordability of health care in general.

I agree heartily with Billy Amon: any policy that gives young people access to quality, affordable health coverage is a step in the right direction. Many young people lack health insurance, not because they don’t want to have health insurance, but because they don’t have a job that offers coverage or they can’t afford a policy on the individual market. Also, too often “affordable” insurance available on the individual market is barely worth the monthly expense due to high out-of-pocket costs and excluded services. The purpose of insurance is to 1) give people access to care and 2) protect them from financial harm when they get sick. If insurance doesn’t fulfill these conditions and people end up with medical debt and constrained access to care, there is product failure.

I disagree with J.P. Wieske’s contention that young people are better off getting onto their own policies ASAP. Most of the individual market plans designed for young, healthy people include significant cost-sharing, limited primary care, and low coverage caps. In other words, it’s coverage that doesn’t pass the litmus test for product failure: this kind of insurance barely helps people access affordable care and it won’t protect them financially in the case of serious illness.

Wieske’s organization, the Council for Affordable Health Insurance, has an 8-point “Common sense solution” to health care reform, available here: http://www.cahi.org/cahi_contents/resources/pdf... It promotes access to “affordable” health insurance. “Promoting a regulatory environment that fosters choice” and “limiting mandated benefits” are cited as two policy goals. Rather than helping people, I believe that both of these policies would erode access to comprehensive, quality insurance. “Mandated benefits” are defined as particular health conditions that insurers are required by law to cover. For instance, 46 states and DC require insurers to cover diabetes treatment. See related article here: http://www.ncsl.org/programs/health/diabetes.htm. Where a diabetes mandate does not exist, insurers can, and do, completely exclude coverage for diabetes. Uncovered diabetics have to cover their health care costs on their own

Other mandated benefits include mammograms may require coverage for breast cancer, mental health, HIV/AIDS, fertility treatments, etc. While mandated benefits may marginally drive up the cost of health care premiums, many analysts argue that they are insignificant cost-drivers compared with insurer profits or lack of access to early preventative care for people with dual-diagnosis chronic conditions. A number of reports have shown that mandated benefits have a small effect on overall premium costs, including an industry study from 2006 that found mandates increase premiums by an estimated 5%. Industry study available here: http://bulk.resource.org/gpo.gov/hearings/109h/... When mandates don’t exist and people are left uncovered for necessary services such as mammograms or diabetes treatment, they still have to pay the costs out-of-pocket, which are much more expensive than a small premium increase. The purpose of insurance is to spread risk over a large population of both healthy and unhealthy people; mandates help to do exactly that so the sickest among us aren’t unduly burdened by health care costs. It’s important that young, healthy people are part of large group insurance pools because it helps to drive down costs for the entire pool.

Having access to “affordable” insurance is not enough. People also need access to quality, comprehensive insurance that provides real coverage and real access. Offering insurance policies targeted to young healthy people segments the insurance market and drives up costs across the system. The only way to lower premiums significantly, even for healthy people, is to cut back on covered benefits. Thus, while young people may be paying lower premiums, they are also getting less quality products.

Having more bad choices on the insurance market doesn’t help anyone. Allowing young adults to remain on their parents policies is a decent solution to increase insurance coverage among this group. However, this is a stop-gap solution that doesn’t address the broader systemic problem of spiraling health care costs. As a society we need to figure out how to contain costs and craft policy solutions that promote access to affordable AND adequate, comprehensive insurance.