Rowyn (rowyn) wrote,

Health Care Reform

Yesterday's Wall Street Journal had an opinion column on health care reform.  The WSJ has had many many way too many columns on health care reform lately, some of which have good ideas and many of which are about how President's Obama's proposals will RUIN US ALL and also KILL BABIES.  No, no, they're not nearly that bad, and I am being grossly unfair.  I'm sorry.  I don't actually like the proposals being tossed around in Congress either, but I still get tired of hearing the same points harped on over and over again.

Anyway, the linked essay does some of that harping, but it also had eight  ideas to offer for health care reform.  The interesting thing about these ideas is that they aren't necessarily incompatible with a government option for covering the uninsured. Five didn't even seem controversial to me, either; I'm quoting those below and adding my thoughts.
Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts (HSAs). The combination of high-deductible health insurance and HSAs is one solution that could solve many of our health-care problems. For example, Whole Foods Market pays 100% of the premiums for all our team members who work 30 hours or more per week (about 89% of all team members) for our high-deductible health-insurance plan. We also provide up to $1,800 per year in additional health-care dollars through deposits into employees' Personal Wellness Accounts to spend as they choose on their own health and wellness.
Money not spent in one year rolls over to the next and grows over time. Our team members therefore spend their own health-care dollars until the annual deductible is covered (about $2,500) and the insurance plan kicks in. This creates incentives to spend the first $2,500 more carefully. Our plan's costs are much lower than typical health insurance, while providing a very high degree of worker satisfaction.

This is one of my favorite options for healthcare reform. I hate the way my insurance company is involved in every single bloody transaction involving a physician.  I don't want to contact my health insurance company every time I need stitches for a cut or a tetanus shot, any more than I want to call my home insurance provider every time I break a window.  It just adds a layer of bureaucracy, expense, and inefficiency to the process.  Current tax policy doesn't subsidize home insurance or home repairs (well, in general), so it doesn't affect my decision to have a high deductible or a low deductible.

But current tax policy does subsidize employer-provided health plans with low deductibles, and makes it a pain in the butt if you want the same subsidy for an HSA/high deductible combo.  So it's trying to corral me down a low-deductible path that I dislike, and I don't see why the government should care whether I pay for my health care by paying $4000 a year for a low-deductible policy, or by paying $1200 for a high deductible one and covering the deductible with cash when I use services.  OK, the former is better for insurance companies, but I didn't think the point of this exercise was to make insurance companies happier.
Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now employer health insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.

This is another thing area of tax law that I don't get.  Why does the government want to subsidize my health care if I get it as a benefit from my employer, but not want to subsidize it if I buy it on my own?  I'm guessing that it's based on an argument that goes something like this: "People are short-sighted, so they won't buy health insurance if left to their own devices.  So we want to encourage employers to provide it for them by subsidizing employers-only.  We can't offer the same subsidy to individuals, because then employers would lose the ability to tout insurance coverage as a better benefit than offering additional salary."

I guess that argument makes some sense.  I don't agree with it, but it's not as nonsensical as "high-deductible policies combined with HSAs should be hard to get compared to low-deductible policies."

Repeal all state laws which prevent insurance companies from competing across state lines. We should all have the legal right to purchase health insurance from any insurance company in any state and we should be able use that insurance wherever we live. Health insurance should be portable.

I'm sure there is some reason to force insurance companies to offer policies in only their own state, but I don't know what it is.  Anyone?
Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

This goes with "I like high-deductible policies so neither I nor my doctor has to deal with insurance companies as much"; insofar as government legislates such policies out of existence, I'm annoyed by it.  But here I can see counter-arguments of "insurance can be insanely complicated if you let companies offer whatever they want, and then people won't understand what they want".  So I'm happy to see government regulation (no, really!) that forces standardization on insurance companies, especially standardizing the way benefits are explained.  I'm not wild about legislating products out of existence, though.  "No, you're not allowed to buy an insurance policy that doesn't cover X, even if you want to." OTOH, some products are especially pernicious (to use a facetious example: insurance that is automatically terminated if you get sick).  Loans charging 100% annual interest were legislated out of existence in the US*, not noticeably to the detriment of either consumers or lending institutions, so I'm not willing to say "no, never ever do that it's always bad".  It isn't always bad.  But I do think it should be done sensibly; if a type of insurance could be purchased by a rational person in a given situation, even if such people only make up a small fraction of the population, it ought to be legal.

* Yes, yes, some payday loans have effective annual interest rates of more than 100% when considering the fees and the short duration of the loans.  You know what I meant.
Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor's visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?

This is another area where some government regulation to standardize forms would probably be for the best.  I mean, it would be ideal if doctors and insurance companies would voluntarily form a board to set standards of how they're going to explain costs and what's covered by insurance and what isn't on any given bill.  For that matter, it'd be nice if insurance companies would set a standard amongst themselves for how medical providers filed claims, because that is a total nightmare for providers of every kind.  But if they're not going to do it on their own, maybe the government needs to threaten to do it to for them.

None of these seem particularly earth-shaking or partisan to me. Any given person might not think they'd help much, but it doesn't seem like anyone would accuse them of KILLING BABIES or RUINING US ALL, or even having the potential of doing much damage to the existing industry.

I also don't expect any of them to happen.  I'm not entirely sure why they won't.  Maybe it's that they're not earth-shaking enough: the people who want a change want a SOLUTION, not an incremental thing that they think will only help a little if at all.  And if you want a solution to all the country's health care problems, maybe an incremental benefit looks like a bad thing, because they fear if the system gets to "good enough" then people will lose their will to get it to "perfect".

Maybe it's that they're too time-consuming to implement. "Repeal laws" is pretty easy, but standardizing thousands of individual bureaucracies is ... um ... daunting.  And expensive. Not only to create a good standard, but also to implement that standard across so many different companies.

Or maybe there are downsides to these ideas that I'm not thinking of.  What do you think?  Are there controversial aspects to these changes that I've missed, beyond the difficulties of political backing and setting standards?
Tags: health care, politics
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