This is an archived article that was published on sltrib.com in 2017, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

These days, millions of Americans are reading in the paper about how the price of their health insurance might skyrocket. If they can get it at all. And there is nothing they can do about it.

Many years ago, some public officials read in the newspaper I worked for, in an article I wrote, that the cost of providing health insurance to a sizable group of public employees was about to go up considerably. And there was nothing they could do about it.

The county commissioners who read the article knew that even though I hadn't been smart enough to spell it out. What I had told them, in a paragraph or two way down in the story, was that the board of the county's semi-independent parks and recreation district had voted to drop the insurance carrier that the whole county used for all its thousands of employees and buy coverage for just the district's smaller cohort of workers, at a much lower cost per employee, saving the taxpayers money.

Smart, no?

Well, the county administrator said, yes and no.

He predicted, accurately, that when the county got the bill for the next year of health insurance for the remaining county workers, it would be up. A lot.

That was because when the parks district left the county's pool, many dozens of younger, fitter employees went with it. People who ran around in the fresh air, tending parks and coaching soccer. Even the office staff was buff. They were a crew who paid their premiums but made few expensive claims. Usually nothing more drastic than a broken wrist or a twisted ankle. Or, sometimes, a birth.

That's why the district was able to get a better deal than they had had as part of the county system.

The remaining pool of county workers was an older, much more sedentary lot. People who sat all day, recording deeds, assessing tax rates, reviewing zoning applications, eating donuts, all the while developing severe arthritis, diabetes, skin cancer, heart conditions. The expensive stuff that drives health care costs, and health insurance rates, up and up some more.

I don't recall if the added cost to the county ate up the savings realized by the parks district. But it was enough to encourage the county commission to make the parks district, and a few other semi-independent agencies, a little less independent in such matters going forward.

This, on a much smaller scale, is what House Speaker Paul Ryan has in mind for the American people if, as seems increasingly unlikely, his American Health Care Act actually becomes law.

The key part of it is the bit that provides cover for Ryan's deception that health insurance policies under his plan will provide more coverage at less cost than the Obamacare he is hot to replace. It does so for some people because it creates a structure that prices old, poor, sick people (like the county) out of the market and can then offer cheaper plans to younger, richer, healthier folks (like the parks district).

It is the exact reverse of the philosophy of the last 70 years, the one that, through Social Security and Medicare, transfers wealth and the benefits of wealth from the young to the old.

It is, of course, possible that we've carried that a little too far, as life expectancy increases and the generation that is most likely to vote is the one that benefits from the status quo. I know my father felt that something was out of balance when his Medicare gall bladder surgery was basically free (except for the fee to have a TV in his room) while the birth of his first grandchild left her young parents in significant debt.

Ryan's plan also betrays a total lack of understanding of what health insurance, or any kind of insurance, is. You get lots and lots of people to pay in, enough so that the vast majority of them don't need to draw any benefits, at least for a long time. That creates a pool of cash that can afford to pay for the bypass surgeries, car wrecks, biopsies, etc., that a minority of them will need.

Medicare works that way. Democrats hoped Obamacare would work that way. And it still could, if the Republicans hadn't spent the last seven years nibbling off its fur.

Civilized nations, of course, have long since gone to variations on the single-payer system, maximizing the contributions used to pay benefits. Because that's the way it adds up, for everyone.

George Pyle, a Tribune editorial writer, has approximately 1,740 days remaining before he is eligible for Medicare. gpyle@sltrib.com