Tag Archives: health care

A Health Care Coverage Step

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Alexander Acosta, Steven Mnuchin, and Alex Azar, respectively Secretaries of Labor, Treasury, and Health and Human Services, are in the process of offering one.  They’re putting together a rule that would expand HRAs, Health Reimbursement Arrangements.  These are plans that allow employers to reimburse employees for certain qualified health expenses.  Their expansion consists of two parts:

  • permit[ting] employers to offer HRAs to reimburse employees for health insurance purchased in the individual market—allowing employers to provide a contribution as significant as they would have made for the premiums of a traditional employer-sponsored plan.
  • allow[ing] employers that offer a traditional group plan to offer an HRA of up to $1,800 a year to reimburse an employee for certain qualified medical expenses such as stand-alone dental benefits.

Both of these parts would be done on an income tax-free basis for the employee.

Of course, this would compete against Obamacare, and that’s anathema for the Progressive-Democrats in the House and Senate.

Their ire notwithstanding, the rule would be that step toward competition, and competition is one of the ways of making health care and health care coverage less economically onerous to a family.

Free Markets for Health Care

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Here’s an illustration of why one is badly needed.  The Wall Street Journal‘s article is centered on health coverage plans, but the underlying problem is in health care provision and the monopolistic nature of both provision and coverage.

Last year, Cigna Corp and the New York hospital system Northwell Health discussed developing an insurance plan that would offer low-cost coverage by excluding some other health-care providers, according to people with knowledge of the matter. It never happened.
The problem was a separate contract between Cigna and NewYork-Presbyterian, the powerful hospital operator that is a Northwell rival. Cigna couldn’t find a way to work around restrictive language that blocked it from selling any plans that didn’t include NewYork-Presbyterian, according to the people.

And

Dominant hospital systems use an array of secret contract terms to protect their turf and block efforts to curb health-care costs. As part of these deals, hospitals can demand insurers include them in every plan and discourage use of less-expensive rivals. Other terms allow hospitals to mask prices from consumers, limit audits of claims, add extra fees and block efforts to exclude health-care providers based on quality or cost.

We’re on track to commit 20% of our GDP to health care costs, and the industries of health care provision and health care coverage operating outside a free market environment is the major driver of that expense.

The WSJ piece goes on at length in this vein.

If patients and our doctors were able to shop around and force hospitals, clinics, and coverage providers to compete for our business, we’d very quickly see better health care, better (actual) health insurance, and lower costs.  If our doctors had to compete for our business, we’d see just as quickly better care at lower cost.  And our doctors would need have no fear of costs—their fees—going too low: there’s a lot to be said for patient loyalty to a good doctor, both from a quality of care and continuity of that care perspective.

A Next Step

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A step has been taken to mitigate the destructiveness of Obamacare.  A new rule has been promulgated by the Trump administration that will

allow for the proliferation of cheaper, less-comprehensive health plans that have been restricted by the former Obama administration.

Under the rule, actual health insurance plans will be allowed that cover a range of health-related matters that more closely align with a customer’s interests.  These plans also will be good for a year and be renewable for a total of three years, a drastic improvement over Obamacare’s limit of 90 days.  A further improvement of this rule:

The plans don’t have to cover people with pre-existing conditions, and insurers can charge higher premiums based on a consumer’s health status.

This is a good interim step, but more is necessary.  One additional step should be the elimination of the time limit on the duration/renewability of these plans.  What should be available in the health insurance market place should be a market decision—a decision of the buyers and sellers.  Government has nothing legitimate to say in this arena.

Paying for Health Care

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John Cochrane correctly decried the costs of health care in today’s economy, but he has the wrong solution.

Why is paying for health care such a mess in America? Why is it so hard to fix? Cross-subsidies are the original sin.

No, cross-subsidies, “sinful” as they are, are not the original sin.  The original sin is government involvement at all in the form of any sort of subsidy.  Far from the subheadline’s claim that “honest subsidies” (eliding the oxymoronic nature of that label) would encourage competition and innovation, they’d do the opposite, as all subsidies do: they’d suppress competition and innovation by giving the government-favored recipients a government-mandated advantage over their government disfavored competitors, freeing the one from competition’s pressures to innovate and reducing the other’s access to resources needed to innovate—and stifling competition’s engine, the need to innovate to stay ahead of rivals.

AHPs

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Association Health Plans are new plans that, by regulation, allow small businesses to band together across industries and state boundaries to form health insurance buying consortiums.  Using this larger size-generated buying power, they should be able to acquire cheaper, better tailored, more flexible plans for their employees, plans that those employees actually will want.

However.

The left says association plans are junk insurance that will blow up ObamaCare.

Some AHPs likely will be; that’s a fact of life in any market, free or centrally planned. However, a free market is self-regulating and quickly so; junk plans will be few and far between.  Blow up Obamacare?  That’s win-win.