Topic: Health Care & Welfare

My Afternoon with Milton & Rose

I had the fortune to work for the Republican leadership of the U.S. Senate from 1999 to 2003.  I got to run around on the Senate floor, act important, give senators advice, and watch them routinely reject that advice.  It was great fun. 

The highlight of my tenure as a Senate staffer was easily the the afternoon that I shuttled Milton and Rose Friedman from their hotel to the Senate and back again. 

It was May 9, 2002, the day that Milton was honored both at the White House and at the Cato Institute’s 25th anniversary gala for his lifetime of service to the cause of human freedom.  When I learned he would be in D.C., I opportunistically arranged a meeting between him and half a dozen senators so that Milton could share his ideas about health care

Some cute memories stand out.  I had to ask my two passengers to buckle up.  When we arrived at the Senate, Milton and Rose – each standing about 5’2” tall – practically got stuck when they tried to step through the metal detector at the same time.  I tried not to laugh as an enormous Capitol policeman repeatedly patted down the diminutive, apologetic, and 90-year-old Nobel laureate to find whatever deadly weapon Milton was trying to smuggle into the Capitol. 

After Milton and the senators discussed health care, Sen. Don Nickles (R-OK) brought up the farm bill that the Senate had just passed.  He and Milton had a lengthy exchange wherein Milton denounced the bill as a throwback to Soviet-style economic planning.  On our way back to the hotel, I explained that Sen. Nickles had raised the issue to needle another senator, who sat right next to Milton at the meeting, had voted for the farm bill, and who uncomfortably stared at his hands throughout the entire exchange.  Milton was unconcerned about the senator’s discomfort, asking only, “Why did he vote for that??”

That day in 2002 was the only face time I got with Milton and Rose.  (Another highlight of my career came in 2005, when Milton wrote a blurb for a book that I co-authored.) Nevertheless, ever since he passed on Thursday, I can’t help feeling that I lost a great friend.  Just another one of his gifts, I suppose.

Rest in peace.

An Update on Health Care Trends

The Washington (state) Alliance for a Competitive Economy announces a new briefing paper on health care trends.

In 2005, an estimated 54.6 percent of health care was funded by private sector spending, a slight increase from the 54.3 percent reported in 1995. In 2015, private sector spending is projected todecrease to 52.5 percent. While the percent of funding from the private sector remains relatively stable, the source of private sector funds has shifted from out-of-pocket payments to private health insurance. In 1970 out-of-pocket payments made up 33.2 percent of health care spending, decreasing to 12.3 percent ofspending by 2005.

The paper refers frequently to Crisis of Abundance.

Havighurst on Healthy Competition

In the most recent issue of the health policy journal Health Affairs, Duke law professor Clark Havighurst reviews Healthy Competition, authored by Mike Tanner and me.  I believe the full review requires a subscription, but here are some excerpts:

“One of the book’s most interesting and original policy ideas would have Congress allow consumers to select a health plan regulated by a state other than their own…

Healthy Competition provides extensive and creative suggestionsfor expanding the role of cost-conscious consumer choice in both Medicare and Medicaid…

“Other provocative libertarian ideas laid out in the book include the authors’ argument that federal regulation of prescription drugs and medical devices may cause more deaths than it prevents. In this case, they provide persuasive responses to concerns that an unregulated market would wreak havoc on patients, observing how private researchers and other groups already certify or otherwise test and confirm the safety and efficacy of prescription drugs for various off-label uses.

“Finally, the authors strongly criticize policies that foreclose a market for transplantable organs, citing evidence that relatively low payments would increase the supply of organs, saving thousands of lives…

Healthy Competition…is a valuable challenge to the health policy community to take health policy debates to a moral plane where consumer welfare and individual freedom are given more than just lip service.”

Havighurst does have criticisms of the book, such as that it “ignores the challenging practical problems of integrating [health savings accounts] with various kinds of health insurance.” 

I found that part odd, since Healthy Competition spends some ink discussing how the rigid insurance requirement makes HSAs unworkable for many consumers.  We argue that Congress should eliminate that requirement entirely, which “would allow anyone to combine an HSA with their existing coverage, instantly making HSAs a feasible option for millions” (p. 70). 

In fact, I’ve always regarded that proposal as eminently compatible with the suggestions that Havighurst and Mark Hall have made about integrating HSAs and managed care