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.