Clive Crook on the Massachusetts Plan
Clive Crook writes (note: link probably will expire in a month),
How to do national health reform worthy of the name? First, and most important, create a level playing field tax‐wise for individuals and firms, so that nobody has a financial incentive to prefer employer‐provided insurance to the individually purchased kind. You could do this by extending Connector‐style tax relief to all taxpayers, or by abolishing it for employers. Abolition would be better. It would raise a lot of revenue (which will be needed in my plan) and would jolt people into changing their insurance arrangements.
Second, the free‐rider problem makes the case for an individual mandate compelling, in my view. Massachusetts is right about that. And the mandate, in turn, makes health subsidies for the poor, which would be desirable in any case, unavoidable.… But to avoid the enormous problems of enforcing and administering the mandate … give everybody a voucher sufficient to buy stripped‐down, Connector‐style coverage.
Third, impose one other global restriction on insurance companies: If they offer a policy to anyone, they must offer that same policy to everyone, regardless of age, sex, current health, and other risk factors. Again, the Connector has provisions of this kind. This would preserve the risk‐pooling feature of private insurance, while still allowing vigorous competition on price and offering.
I strongly disagree with the third point. As I pointed out here, it is these sorts of regulations that aggravate the problem of the uninsured in the first place. Force insurance companies to offer the same policy to everyone at the same price, and naturally health insurance will be a bad deal for young, low‐risk people. Like Massachusetts, you will end up with a problem of such people being uninsured. As I said in my talk, the Massachusetts plan at best solves a problem that was created by regulation in the first place. Listen to the talk.
