One of these things is not like the other

This is more a focus group than a real sample size, but in 2008 the General Social Survey asked 35 respondents aged under 30 both if they had health insurance and whether they had ever injected drugs. Three of them said they had injected drugs, all of whom didn’t have health insurance at the time.

injected

I have a feeling that when health care wonks were crafting and projecting out the effects of Obamacare in 2008 through 2010, they put a lot of thought into whether the newly insured young people that would be brought into the system through the law would be less healthy than the currently insured. But I’m guessing that they didn’t put much thought into whether they would be at greater risk for drug abuse. That is, the problem isn’t just that insurance expanded and insurance paid for addictive drugs. The problem is that as a state approaches insuring 100% of its younger population, the marginal person being insured is a higher and higher risk for abuse.

To put it another way, let’s say you have a distribution of propensity to purchase insurance among young people:

PercWithoutSubsidy

At one end are folks who, either out of health needs or economic advantages or predispositions, are extremely likely to purchase insurance no matter what. At the other end are people who are definitely not going to purchase insurance unless it’s done for them.

graph222

Assuming there’s some correlation between likelihood of having troubles with drugs and likelihood of getting insurance, you get something like this:

Graph666

It’s not just that the insurance, if it’s more subsidized or uses stronger incentives to get young people to sign up, gets more people with access to drugs that are liable to abuse. It’s also that the last people to be added into the system are also the ones that the system is least equipped to handle.

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