Categories
politics State

Health Care Task Force

I’m ready to start focusing on the issue of health care for Utah citizens. The legislature created a task force to study it. The Deseret News addressed the issue in an editorial today. I would like to know who is on the task force. So far I know the following:

All of those listed above are Republicans. According to the bill, at least one senator and two representatives on the committee must be Democrats (unless we have any independent or 3rd party elected officials that I don’t know of).

Citizens are already likely to be shortchanged by the task force when, as Bob Huefner notes from reviewing the bill, “The burden is being put on the patients and the enrollees and the insurance protection is being given to the industry.” That does not bode well. I will be looking at the bill myself and see what else I can glean from it’s text in the next few days.

Categories
politics

Defining “Rights”

I liked this very succinct argument about why health care is not a right.

With one exception, the right to representation in court and a trial by jury, {the rights safeguarded in our Constitution} require nothing of any other citizen but that they recognize your rights and not interfere with them.

Your “right to health care” would require some other person to give up a portion of their life or their property to either treat you or to provide you with drugs or medical implements. The Constitution does not provide for another individual to be indentured to you in this manner.

Therefore, you have no “right” to health care.

What I really like is that this argument provides a plausible framework for distinguishing between fundamental rights and the manufactured “rights” that make for such good campaign promises. Does anyone else have any perspective on this argument (in general or specific to health care)?

Categories
politics State

Rigging Universal Health Coverage

Devising a system of universal health coverage in Utah is a high priority for our governor (I’d say it’s second to expanding our state economy). As usual, Scott is pointing out the glaring flaws in the approach the governor is taking.

I find it more than a little disconcerting that a task force made up of people who make their money on health care are being put in charge of coming up with ideas. It should not be surprising that such a group would encourage a mandate on individuals. If we should have a mandate at all, shouldn’t it be a mandate on those who make their money on health care, perhaps a mandate that insurance companies must offer a broad array of plans, or that health care providers publish their prices (these are very preliminary ideas, just suggesting that a mandate on individuals is misguided).

I also think that the task force should include some people who are not already insured – at the very least they should spend a lot of time talking to people (insured and uninsured) to find out what kind of plans would attract more people to purchase insurance. That should be the basis of any policy decisions and, if necessary, mandates for the insurance companies.

In my experience, one of the reasons that doctors and clinics don’t want to publish their prices, is that they charge different prices depending on your insurance. They accept that when they want to charge someone $100 for a visit the insurance company will return the bill saying that they will only allow them to charge $88 for that visit and that they will pay $73 of that (leaving a $15 copay).

It seems to me that the pricing system is upside-down. Doctors should publish their prices and insurance companies that will accept that doctor will agree to pay that published price (of course allowing for the copay structure). Doctors who charge higher prices would not be accepted by as many insurance companies and insurance companies who would not pay enough to cover the costs to doctors would not be able to offer access to as many doctors. People without insurance would also be able to make informed choices on the services they use. If my experience is any guide, the option of health savings accounts combined with a high deductible policy (sometimes called catastrophic coverage) would look much more desirable to more people.

Categories
National politics

Anti Universal Coverage

This came along before I started reading the Cato blog regularly but I am definitely a member of The Anti-Universal Coverage Club.

  1. Health policy should focus on making health care of ever-increasing quality available to an ever-increasing number of people.
  2. “Universal coverage” could be achieved only by forcing everyone to buy health insurance or by having government provide health insurance to all, neither of which is desirable.
  3. In a free society, people should have the right to refuse health insurance.
  4. If governments must subsidize those who cannot afford medical care, they should be free to experiment with different types of subsidies (cash, vouchers, insurance, public clinics & hospitals, uncompensated care payments, etc.) and tax exemptions, rather than be forced by a policy of “universal coverage” to subsidize people via “insurance.”

That does not mean that I am opposed to everyone having access to health care, but a mandate that every person buy insurance or that the government will pay for insurance (by taxing “the rich” naturally) is contrary to the principles of individual liberty and personal responsibility.

Categories
National politics State

Buyers of Medical Services

Reach Upward nails it again when he talks about Serving Medical Customers.

One of the primary rules of economics is that suppliers do their best to supply what buyers actually demand. Who are the real buyers of medical services? Not you. Unless you pay for everything yourself or have only catastrophic insurance, you are not the buyer. . . The real buyers — the real power entities in purchasing medical services —are the government (via Medicare) and insurance companies.

Since suppliers provide what buyers demand, let’s ask ourselves what the real buyers of medical services demand. Do they demand the best possible medical outcome for each patient? Nope. It’s not possible for them to do that. So they design systems that aspire to that lofty goal. These systems seek to demand proof that proper procedures are being followed and tightly control what procedures will be covered.

Of course, to administer these systems, the government and insurers spawn massive bureaucracies of paper pushers. Medical practitioners actually serve their buyers quite well, supplying the desired paperwork. They report procedures that will bring payment. . .

Electronic Health Records (EHRs) have been touted as a way to improve the medical system. But it turns out that EHRs do not improve actual medical outcomes. This is because they are only a more efficient way of pushing paper around through the bureaucracy.

Every time I read anything about our health care system I come to the same conclusion – the best kind of insurance we could have would be catastrophic insurance that has incentives built in to reward consumers who avail themselves of preventive care. With the current push in Utah to provide universal coverage we cannot emphasize this issue too much. If we want to make the system better we must attack at the actual systemic problems (the shifting of the buyer role from individuals to corporations and government entities) rather than simply trying to massage the current system to assuage some acute and visible symptoms of systemic problems (the cost of health care and insurance).

Categories
culture politics

Conspiracy of Confusion

Diet is about as far from my normal topics as I can imagine. Part of the reason for this is that I generally follow the world’s simplest diet:

“Eat food. Not too much. Mostly plants.” (Michael Pollan January 28, 2007)

I have followed that basic idea for years without knowing anything about Michael Pollan or what he had written. Today I stumbled upon An Omnivore Defends Real Food and could not help but make some connections between the confusion surrounding nutrition (as opposed to the apparent simplicity of the dietary plan above) and the confusion surrounding so many other social, economic, and political issues.

I would not make the argument that everything could be simplified as much as that maxim on diet (or even that everything should be so simple in a perfect world) but the thing that struck me, and the very purpose of my advocacy for liberty, is that we need to be free to our own level of complexity or simplicity in most things. With diet I can choose to ignore all the advertising about the latest health fad, or I can choose to test or follow any given news about the dangers of whole milk or the virtue of Omega3 fatty-acids. On the other hand I am not free to opt out of social security and many politicians are talking about making it illegal for me to choose not to have health insurance.

The argument is that if I don’t get health insurance and something happens to me then I become a financial burden to society as I use government funded health care. The same argument is applied to whether I am allowed to pay in to unemployment taxes – what if I lose my job. The real problem is that government has created a system whereby people can freeload on the system so it does not matter how much someone protests that they won’t. Personal responsibility is a thing of the past because Uncle Sam can/will bail you out. Personal liberty is also reduced because everyone is required to participate (at least on the paying in portion – you can opt out on the receiving benefits side of most programs).

I can’t think of any of the entitlement programs that the government runs that would be a bad thing if they were based on voluntary participation. The universal problems they share are their coercive nature and the complexity that makes themboth inefficient and exploitable.

Categories
politics State

Health Care Assistance

When I wrote about declining enrollment for CHIP in Utah I did some research on the requirements for CHIP. I learned that even though I am fully employed – meaning I make a comfortable living – my kids would be eligible for CHIP if I did not have the option of insurance through my job. More interestingly I learned that there is another program, Utah’s Premium Partnership for Health Insurance (UPP), which my family would qualify for if I chose a traditional insurance plan. (Actually, my company just switched insurance and I could have enrolled in a traditional plan that would have allowed me to have my full premiums paid – partially by my company and the remainder by the state.) This program helps pay the costs of health insurance premiums for working families.

As I looked at the requirements for UPP it shows some interesting biases that are not good for our health care system. The one that makes the least sense is that they explicitly will not cover High Deductible (HD) plans that qualify for Health Savings Accounts. This essentially discourages people from using the best vehicle we currently have for becoming cost conscious and driving down the real costs of health care. If they wanted to encourage people to get the kind of insurance that is better for the whole system they would give the same amount of money – deposited directly into an HSA – for those who have an HD insurance plan as they give for comparable coverage under a traditional insurance policy. Of course the rules would be the same for qualifying plans whether they were HD or traditional.

Categories
politics State

This Should Tell Us Something

The idea that the government should be involved in my health care has always been disconcerting to me. When I read Health care: You can’t give it away I was not sure whether I should laugh or cry. Apparently the state CHIP program is losing more families than they are adding even as they expand their budget to cover more kids. So we’re paying more for a program that is covering fewer kids because people are actively opting out faster than they are opting in. I think that should be a big red flag.

That’s the part that made me want to laugh. The part that made me want to cry was:

Judi Hilman, director of the Utah Health Policy Project, said it’s going to take a “Herculean” effort to combat the stigma that has equated subsidized health care with welfare in Utah. . .

“We need a whole strategic marketing campaign to put these programs in a more positive light,” Hilman said.

If the programs are so good for people why do the people they are designed to help choose not to participate? Secondly, and more importantly, what gives anyone the right to insist that those who are leaving or choosing not to partake should be choosing differently?

Another sentence from Ms. Hilman leads to one more question:

“These programs are absolutely essential if they [low-income families] are going to become permanently self-sufficient.”

The question is – where’s your proof?

I have been uninsured with a family of 5 to take care of and I didn’t use CHIP nor would it have helped me become “permanently self-sufficient.” I don’t mean to say that the program is useless, but I do think her statement is based on a whole range of unfounded assumptions – the kind of assumptions that lead to larger and less efficient government dragging our society towards fiscal slavery.

Categories
National politics

NYT On Health Care

I was impressed with the New York Times editorial The High Cost of Health Care. I don’t really have time to review it here right now (it’s quite long) but it is well worth the read and I would like to come back to it later to review it. They talk about some of the approaches to lowering our health care costs, but they don’t attempt to endorse any particular approach. I hope, and believe, that this was an attempt to paint a broad picture in advance of future articles which will explore the issue in more depth.

Categories
life National pictures

HSA Figures

I’ve already admitted that Health Savings Accounts are not the full solution to our health care system, but they are among the most powerful tools that we have today. The example of Whole Foods grocery really illustrates the point.

Five years ago, the Whole Foods grocery chain switched to a high-deductible plan. If an employee has a sore throat or a sprained ankle, he pays. But if he gets cancer or heart disease, his insurance covers it.

Whole Foods puts around $1,500 a year into an account for each employee. It’s not charity but part of the employee’s compensation. It’s money Whole Foods would have otherwise spent on more-expensive insurance. Here’s the good part for employees: If they don’t spend the money on medical care this year, they keep it, and the company adds more next year.

It’s called a health savings account, or HSA.

CEO John Mackey told me that when he went to the new system, “Our costs went way down.”

Yet today, some workers have $8,000 in their accounts.

The same articles states that:

If people paid their own bills, they would likely buy high-deductible insurance (roughly $1,000 for individuals, $2,100 for families) because on average, the premium is $1,300 cheaper. But people are so conditioned to expect others to pay their medical bills that they hate high deductibles: They feel ripped off if they must pay a thousand dollars before the insurance company starts paying.

From my own experience when people really understand the program they like it. Here are the numbers that our company found as we have been shopping for insurance lately. We chose one high deductible plan and one standard plan that each employee could choose from. The high deductible plan was $2500 a year cheaper in premiums. We calculated that the worst case scenario for the high deductible plans – paying every penny of the deductible without receiving a cent from the insurance company – would cost $884 more than the same medical care under the standard plan (this assumes that much of the deductible is used in preventive care where the standard insurance charges a copay for each visit, if it were some accident that cost the whole deductible for the HD plan the difference is no more than $700). On the other side – the person on the HD plan has to spend a minimum of $3900 (okay it came out to $3899.99) before they have spent as much – including premiums – as the person on the standard plan.

When we started discussing the plans as employees there were 2 of us who were already planning on getting HD plans. By the time we made the decision on what plans to offer 70% of the company had decided to switch to HD plans.