A thought occurred to me. I didn't know what to do with it, so I'm putting it up for comment.

The essence of the debate over the so-called “public option” in health insurance seems to come down to a philosophical question of how one wants to live one's life.

The problem is that life is a complicated connective web of issues. For example, many of us believe that a lot of people want to live their early years paying less for health insurance because they haven't yet learned that later on, these things will matter. And they may not have planned well. The problem, we fear, is that they will be on our doorstep later saying, “Help me. I planned badly. But I am worthy of pity.” And there will be many of them. Too many. And it will be hard to remember or accept that they elected this.

But the desire of those of us who want universal care is not, contrary to what the others might think, to enslave an unwilling population. Our assumption is that for every person added to the pool there is a risk as well as a source of income, and that if things are priced right it really makes very little difference how many people in the pool as long as it is generally large enough to overcome certain anomalies that happen with very small pools—such as those one sees right now inside plans bought by a family or small company. Once the pool is of a large size and consistently administered over a lifetime things work fine. The problem comes if people are allowed in and out because they can dodge the expense or risk while enjoying the benefits.

And we're a society now where everything is online, and in the future access to information will be even easier. Perhaps we'll have Google and Wikipedia and other things that project an image into our sunglasses, continuously offering us information as we walk around, like how Robocop sees the world. Information could be on the web for all to see (perhaps in real time, but certainly at hospital check-in time) that this was a person deserving of no care or pity—that such would be incompatible with their elected way of living their lives.

So what would happen if instead of requiring people to opt into health insurance, we offered people the option of irrevocably choosing to live without government health insurance, including without the right to enter a hospital for emergency care, in exchange for lower taxes. So the set of people who wanted this product from society would mutually select when they came into adulthood, before they knew too much about how their life would play out, to enter a society that either did or did not have this. Everyone would be either in or out of health insurance—the cost and the benefits—no exceptions, no opportunity for subsequent change. Opportunity and responsibility in its cold, hard form. Two worlds to choose from, everyone free to take either, but a choice of lifestyle they must commit to for a lifetime. And everyone would know who was in and who was not.

There's obviously an issue that some of us are already adults. It's a thought exercise. For simplicity here, assume we're not talking about ourselves, but rather the society we might have been born into.

Also, children can't yet choose, so could be handled in any of several ways. We could decide that children would have to live with whatever their parents had chosen. (A reduced set of benefits could be contrived for children of “mixed couples.”) Alternatively, we could decide we were going to have universal health insurance for children and only allow adults to opt out, so then even the opt out folks would be taxed enough to handle their share of everyone's children.

Not allowing people to opt out of universal health insurance for kids might not be as unfair as it might seem at first, since it helps to give everyone in our society a fair start. But also, and importantly, it seems to me that it's the Republicans who seem to want, disproportionately, to opt out and they are also the ones who seem, again disproportionately, to favor public policies that lead to out-of-control population growth. It might give them motivation to care about how many children were born.

I wonder whether, if offered in this way, it would lead to everyone being happy. I wonder how many people who started off full of bravado about doing it on their own would make it through life without regrets. I wonder whether if the others insisted on helping when there was no other option for someone who had opted out, they would be laughed at or appreciated. I wonder if we could co-exist with people under such different terms.

It's probably not doable at all. But it seemed worth pondering.