Tag: insurance

Miss Manners’s Advice for President Obama

A reader writes to Miss Manners to complain that often she can’t find a seat at a bookstore coffee shop, even though she’s a paying customer and some of the people seated seem not to be buying anything. She suggests that it is obvious that this is not the way to manage a coffee shop in a bookstore and asks Miss Manners how she can politely get the seat she wants. Miss Manners responds:

If you want to manage a coffee shop, Miss Manners suggests you first talk to those who do.

She goes on to explain that bookstores may “do better selling books by being a neighborhood center than they would by checking to see that the tables are occupied only by people who are eating and drinking.” But in any case, the bookstore managers are likely to have a better sense of this than customers who have not invested in the business.

That’s good advice for the Obama administration: If you want to manage a bank, an insurance company, an automobile manufacturer, or any other company, you might try talking to people with expertise. Better yet, you might even let those with skin in the game manage their own companies. If they make mistakes and the government doesn’t bail them out, bad managers will soon enough be weeded out.

More on that Massachusetts ‘Model’

Amid reports that the Obama administration, congress, and some conservative groups still consider Massachusetts to be a model for health care reform, the New York Times reveals that despite assessing insurers and hospitals, raising the penalty on noncompliant businesses, increasing premiums and co-payments for consumers, and raising the state tobacco tax, the program’s financing remains unsustainable.

Massachusetts has significantly reduced the number of people in the state who lack health insurance. However, it has not achieved, nor does it expect to reach, universal coverage. (The best estimates suggest that more than 200,000 state residents remain uninsured). And, significantly, roughly 60 percent of newly insured state residents are receiving subsidized coverage, suggesting that the increase in insurance coverage has more to do with increased subsidies (the state now provides subsidies for those earning up to 300 percent of the poverty level or $66,150 for a family of four) than with the mandate.

The cost of those subsidies in the face of predictably rising health care costs has led to program costs far higher than originally predicted. Spending for the Commonwealth Care subsidized program has doubled, from $630 million in 2007 to an estimated $1.3 billion for 2009.

Now the state is turning to a variety of gimmicks to try to hold down costs, including possibly cutting payments to physicians and hospitals by 3-5 percent. However, the Times quotes health reform experts who have studied the Massachusetts system as warning “the state and federal governments may need to place actual limits on health spending, which could lead to rationing of care.”

The more one looks at the Massachusetts “model,” the stronger the argument for keeping the government out of health care.

More Praise for Cochrane’s ‘Health-Status Insurance’

This time, it’s coming from Reihan Salam at Forbes.com:

Choice and Security: Professor John Cochrane’s advice to President Obama

Last week, at a White House forum on reforming health care, President Obama issued a challenge to advocates of less government control of the medical marketplace.

“If there is a way of getting this done [i.e., reforming health care] where we’re driving down costs and people are getting health insurance at an affordable rate and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I’d be happy to do it that way.”

More to the point, Obama added that he’d be just as happy to pursue an approach that involved more government control as well, and that seems to be the tack he’s taking…

Congressional Republicans have criticized Obama’s approach, and they’ve been particularly hostile to the idea of a new public insurance plan. They argue that Obama’s reforms will eventually lead to a nationalized health care system. But as of yet they’ve failed to offer an alternative that meets Obama’s criteria for a successful health care reform.

Enter John Cochrane, an economist at the University of Chicago Booth School of Business. Professor Cochrane has long advocated a proposal he calls “health-status insurance,” an approach that could guarantee long-term health security while also freeing medical insurers to compete for customers. To most health care reformers, this sounds like a contradiction in terms.

Cochrane’s paper is, “Health-Status Insurance: How Markets Can Provide Health Security.”

Schism in the Church of Universal Coverage

On the Diane Rehm Show last week, I predicted that all the lovey-dovey coalition-forming by the Church of Universal Coverage would fall apart as soon as people started talking about actual reforms instead of vague principles.

Today, The New York Times reports:

Two labor unions have pulled out of a broad coalition seeking agreement on major changes in the health care system.

The action, by the American Federation of State, County and Municipal Employees and the Service Employees International Union, shows the seeds of discord behind the optimistic talk at a White House conference on health care this week.

It also illustrates the difficulty of reaching agreement on two of the knottiest issues in the health care debate: whether to offer a new government-sponsored insurance option, and whether to require employers to help pay for employee health benefits.

I made a similar prediction in this op-ed, where I urged that a new government-sponsored insurance option and mandates are two of three proposals that must be blocked at all costs. The third: price controls.

There Ain’t No Such Thing as Market-Based Universal Coverage

Over at The Corner, Harvard Business School professor and Manhattan Institute scholar Regina Herzlinger urges conservatives to support universal coverage – but in a market-oriented way. That is an absurdity. Once the government adopts a policy of universal health insurance coverage, a free market is impossible and the casualties begin to mount.

As a model, Herzlinger points to Switzerland, “which enables universal coverage without any governmental insurance through this system.” Switzerland requires all residents to purchase “private” health insurance; dictates the content of that insurance; and dictates the price. As I explain in a recent Cato paper, once the government controls those decisions, you’ve got socialized medicine.

My colleague Mike Tanner observes that the Swiss government’s power to control the content of “private” health insurance allows special interests to lard up people’s health insurance with their services – whether Swiss consumers want them or not:

The expansion of benefits has driven up the cost of insurance…As Uwe Reinhardt has noted, “Over time, the growth in compulsory benefits has absorbed an increasing fraction of the consumers’ payment, thus compromising the consumer-driven aspects of the Swiss system.”

Tanner also reports that the government’s power to dictate health insurance premiums is harming the sickest Swiss:

Evidence shows that the community rating requirements are…leading to the over-provision of care to the healthy and the under-provision of care to the sick. In addition, the prohibition on risk management discourages the development of new and innovative products.

In this Cato paper, University of Chicago business school professor John Cochrane explains how such price controls harm sick patients and suppress innovative new products.

Herzlinger is an extremely passionate and knowledgeable advocate of market-based health care. But when it comes to universal coverage, readers of National Review are better counseled by the magazine’s editors, who write:

to achieve universal coverage would require either having the government provide it to everyone or forcing everyone to buy it. The first option, national health insurance in some form or other, would either bust the budget or cripple medical innovation, and possibly have both effects. Mandatory health insurance, meanwhile, would entail a governmental definition of a minimum package of benefits that insurance has to cover…

Republicans should go in a different direction, proposing market reforms that make insurance more affordable and portable. If such reforms are implemented, more people will have insurance.

Some people, especially young and healthy people, may choose not to buy health insurance even when it is cheaper. Contrary to popular belief, such people do not cause everyone else to pay much higher premiums. Forcing them to get insurance would, on the other hand, lead to a worse health-care system for everyone because it would necessitate so much more government intervention. So what should the government do about the holdouts? Leave them alone. It’s a free country.

Herzlinger is correct that “it is 2009, not 1992.” If we want America to remain a free country in 2009 and beyond, we must reject universal coverage.

Has He Read the Book?

At yesterday’s White House Summit on Health Care Reform, President Obama had this to say:

If there is a way of getting this done, where we’re driving down costs and people are getting health insurance at an affordable rate and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I’d be happy to do it that way.

Well, Mr. President, may I recommend Healthy Competition: What’s Holding Back Health Care and How to Free It for a detailed proposal for how to accomplish this without turning one-seventh of our economy and some of our most important, personal, and private decisions over to the tender mercies of the federal government.

Of course, as my colleague Michael Cannon points out, no one who supports free market proposals to drive down costs and give consumers greater choice of providers and insurers was actually invited to the summit.

The ball is back in your court, Mr. President.

In Defense of Gouging

Kevin Drum writes,

There are lots of things to hate about our current medical system, and all of us have our own favorite things to hate. This is mine: the fact that the system massively overcharges you if you’re uninsured, and they do it just because they can. If you’re uninsured, you’ve got no leverage, no alternatives, no nothing. So you get screwed. It’s like the shopkeepers who charge twenty bucks for a pair of flashlight batteries after hurricanes. Maybe it’s the free market at work, but if so, that’s all the worse for the free market. In the healthcare biz, it just doesn’t work.

I see it’s time to roll up the sleeves.

First, let’s look at price gouging after a hurricane. I admit it — in a free market, that’s precisely what happens. People get charged much higher prices. And I actually don’t mind calling it gouging.

But do you know what happens when a disaster strikes in an unfree market? Forced appropriation by the politically well-connected. Instead of higher prices for everyone, you get free stuff for a privileged few — and nothing, or very little, for everyone else.

Let’s use the proper term here as well: theft. In a free market, you see gouging. In an unfree one, you see theft.

How this is an improvement is beyond me. Gouging, remember, is the first step toward its own remedy. Gouging is temporary. Gouging encourages everyone to return to the status quo ante, and it does so in the most direct way possible, by paying people until the goods are cheap again. The worse the gouging, the faster the return.

By contrast, theft actually discourages a return to normalcy. Few will bother producing under harsh conditions when, if times get tough, the state just appropriates and rations everything anyway. Life’s going to be miserable in a disaster. It’s the nature of the beast. But we do have a choice in how miserable it’s going to be, and for how long.

I’d suggest that the many, many regulations on U.S. health care actually make the unfree market the better analogy here. The government is already the dominant player in the health care industry, and it already sets prices to a degree unappreciated by the general public. Indeed, it’s difficult for consumers with low-deductible, employer-provided insurance (the “good” kind) even to consider the price of their health care, let alone to comparison-shop. The situation is still worse for those with government-funded health care. These are the beneficiaries of our mostly unfree market.

Should we be surprised, then, when the full price — that is, the price paid by the uninsured — keeps rising with no end in sight? There’s certainly a problem here, but it’s not a market problem.