The 2019 Milliman Medical Index, which measures healthcare costs for individuals and families receiving coverage from an employer-sponsored preferred provider plan, found that health care costs have reached $28,386 for a family, an increase of 3.8% from the year prior. Health care costs for the average American adult are at $6,348. Milliman looks at five components of health care costs, including inpatient and outpatient care, pharmacy, professional, and other services.
| A public option is not a moderate, compromise proposal. Its inevitable consequence is the death of affordable private insurance. Government insurance options mainly erode, or “crowd out,” private insurance rather than provide coverage to the uninsured. Jonathan Gruber, the Massachusetts Institute of Technology economist credited with designing ObamaCare, showed in 2007 that when government insurance expands, six people go off private insurance for every 10 people who go on public insurance. And the public option would cause premiums for private insurance to skyrocket because of underpayment by government insurance compared with costs for services. |
Acting on the principle “Why put it off until tomorrow when you can do the wrong thing today?” the House of Representatives last week voted to repeal the Cadillac Tax, the tax of 40% on a portion of the most lavish employer-provided health care plans. The Cadillac tax was proposed not just to help fund Obamacare but also as an incentive for restraining the rapid growth of health care costs. Because the tax break—treating important compensation as untaxable—is unlimited, Alan D. Viard of the American Enterprise Institute says, it encourages employers to provide high-cost plans “that cover routine care and feature low deductibles and copayments. Those plans increase the demand for medical services and drive up costs for other patients.”
Joe Biden’s new health-care plan is supposed to show his moderation, but there was strong pushback from Sen. Bernie Sanders who wants a full single payer system. If you cut through the spin, the only debate Democrats are having is whether to eliminate private health insurance in one blow or on the installment plan. Biden supports a new government insurance plan that would “compete” with private insurance. We use quotation marks since a government insurer with zero cost of capital and political backing starts with an unbeatable advantage. The public option would undercut competitors on price, stiff providers with low reimbursement rates, and crowd out private insurance over time. Voila, single payer!
Millions of Americans in high-deductible health plans associated with HSAs may find it easier to access insulin, inhalers and other treatments for chronic health problems under guidance released last week by the Trump administration. Currently, people in high-deductible plans with pretax health-savings accounts have to pay down their deductible before their insurance covers treatment for chronic diseases such as diabetes or high blood pressure. The rule change will allow insurers to begin providing coverage for those treatments, such as glucose or blood-pressure monitors, before the deductible is paid.
As the administrator of the two largest public health-care programs in the country, Medicare and Medicaid, I can say these programs face major fiscal challenges. Those who seek to expand them do so because of their expected lower price tag on premiums. But there’s a simple explanation that makes the low cost considerably less alluring: Public programs pay health-care providers less than private payers. Low prices imposed on doctors and hospitals can’t stop health-care costs from rising. Someone has to pay the bill—namely, Americans who purchase their coverage directly or through their jobs. In turn, this causes doctors and hospitals to attempt to make up the lost revenue by charging higher prices to private insurers, resulting in higher health insurance premiums for everybody else.
The central unanswered question in the U.S. health system is how to discipline costs. The choice is between reliance on regulatory controls put in place by the federal government or injection of stronger financial incentives for consumers into the markets for medical services and insurance. Currently, the U.S. has a mixed public-private system with pricing controls applied to payments made by public insurance, and markets that function poorly because they are hobbled by misaligned incentives, some of which are caused by government policy. The result is widespread inefficiency. Credible estimates put the amount of wasted spending at about one-third of total costs.
Congress has twice delayed the Cadillac Tax—originally set to take effect in 2018—and weakened it by allowing employers to deduct the levy itself from their profits. But repealing the Cadillac tax is a bad idea. Instead, Congress should modify it to encourage the use of health savings accounts. It would be better to shift the tax advantage toward HSAs and away from third-party payment—especially high-cost employer-sponsored insurance—to encourage consumers to shop around and assess what’s worth the cost. This would give employees greater control over their health spending and reduce the incentive to overconsume care in the mistaken belief that someone else is paying for it.
If there is one thing that tends to unite economists across the political spectrum it’s the view that the government should not give unlimited tax subsidies to employer-provided health insurance. Yet that is what we have been doing. To remedy the problem, in place of the Cadillac Tax, we should offer employers and their employees the option of a dollar-for-dollar tax credit up to the amount of the tax subsidy they have been getting through the tax exclusion. This would solve the problem economists complain about, put health insurance and take-home pay on a level playing field at the margin, and greatly reduce the incentives we all have to over-spend on health care.