I can see my three-year old in a tri-corner hat pretty vividly actually (though in fairness, this is because she was wearing one this weekend.) Kevin is riffing off this op-ed by Dustin Siggins who writes:
It’s really hard to make predictions about where we will be financially in ten or twenty years, but one thing is certain: if healthcare costs are not contained, we will be in much worse shape than we are today, especially with greater public involvement in the provision of health insurance. As Avik Roy notes:
Unfortunately the healthcare status quo is left virtually untouched by recent reforms. Health insurance is still impossible to purchase across state lines. De facto regional monopolies dominate the marketplace. And consumers have very little or no say as to what insurance they receive. Price transparency is not only opaque, but patients have very little say in how healthcare costs are distributed, leading to higher and higher premiums. And the employer-provided insurance means workers are far too dependent on their jobs, decreasing economic mobility and increasing uncertainty. Entrepreneurs are especially vulnerable. So what can be done?
I would do a few things if I could wave my magic wand:
1) Provide vouchers for universal catastrophic coverage. Alternatively go the Singaporean route and pay over a certain percentage of income while requiring HSA’s for all citizens. Since this is politically not feasible, stick with vouchers. Alternatively, means-test vouchers, though means-testing is tricky and politically difficult.
2) Eliminate the employer tax exclusion. Replace it with national, tax-free HSA’s that employers can pay into for their employees. Sort of a health 401k program, but open to everybody including the self-employed. Or don’t replace it with anything. Getting rid of it is the important thing. HSA’s, however, can be good at curbing costs so long as they don’t keep people from preventative care. Promote preventative care by allowing insurance companies to charge unhealthy patients more, and healthy patients less (using metrics that rate actually preventable things like blood pressure, nicotine use, etc.)
3) Allow insurance to be sold across state lines. Make insurance regulations apply to the state of the purchaser rather than the state of the seller. This avoids the bad pitfalls we’ve seen in the credit card industry.
4) Break up the medical supply-side cartels. Good luck with this one, but it’s going to be necessary to combat costs. Doctors, drug makers, equipment manufacturers, hospitals – all share some responsibility for terribly inflated prices. Actually, the HSA’s (which make people more cognizant of their spending) and the individually purchased insurance (which give people control over their insurance) will help with this. The opacity of the current system is great for the supply side, not so great for consumers. I would also support price-transparency rules.
5) Either voucherize or seriously scale back Medicare benefits or increase the amount seniors pay into Medicare or all three. Means-test Medicare.
6) Repeal the Affordable Care Act and Medicaid and replace them with vouchers for anyone up to 200% of poverty to purchase approved insurance plans. Toss in a public option for this same demographic. Allow states to experiment with their own programs (keeping in mind that all citizens would have vouchers for catastrophic care) to increase access to care. Alternatively, the federal government could keep the ACA and absorb Medicaid patients into the program, though I am very dubious that this will contain costs.
7) Allow low-cost clinics to sprout up in malls, Wal-Marts, and wherever else they choose to provide barefoot preventative care at a low cost. This will increase access to healthcare for many Americans. Low-cost clinics would not need doctors and could be run by nurses and nurse practitioners. These would also serve as gate-keepers to more advanced care, and could refer patients on to primary care physicians, specialists, and so forth.
This is just off the top of my head. For some it will not scale back government spending nearly enough; for others, it will not be as egalitarian as it should be. The fact of the matter is we aren’t going to get government out of healthcare and we’re not going to solve our fiscal forecast unless we make government’s involvement in healthcare more sustainable. The idea is to keep government from meddling too much with the mechanisms of healthcare provision, while still making sure that people aren’t falling through the cracks. Allow markets to work, but keep the worst repercussions and inequities at bay. This is no simple task.
