Although there are plenty of negative aspects of our health care
system to report on and analyze, it is important to every so
often emphasize the positive. As of late, there are some very
hopeful developments, ones that move our health care system away
from one that is mismanaged by the government and toward one that
is more market driven. Here are a few of them:
Doctor Coburn: Senator Tom Coburn (R-OK), has
put forward the most market-oriented reform of health care yet.
Under the “Universal Health Care Choice and Access Act,” all
Americans would be eligible for a $2,000 tax rebate, $5,000 for
families. This money would be paid directly to the patient’s
health insurance. This would allow patients to make their own
medical decisions. If the patient uses a cheaper health insurance
company, the excess money will be deposited in a Health Savings
Account (HSA). The HSA is a personal, tax-free savings account
that can be used to help pay future medical bills. The account
would be completely controlled by the individual. Furthermore,
under Coburn’s bill federal laws will be changed to deregulate
insurance companies and allow portable insurance to be offered by
employers. Insurance policies will be compatible nationwide and
increased transparency in the health care system will be
required.
The Show-Me State: When it comes to health care
reform in the states, almost all of the attention has been
focused on states that have expanded government or are poised to
do so, such as Massachusetts and California. That’s unfortunate
because Missouri has passed a reform that expands free markets by
changing the tax treatment of health insurance for those who
purchase an individual policy. Called the “Missouri Health
Insurance Portability and Accountability Act,” it moves the
insurance system in Missouri from one that is employer-based to
one based more on the individual. First, under the new law
employees working in small businesses can purchase their own
individual policies and can pay for the premiums pre-tax by
funneling them through a federal regulation known as “Cafeteria
125.” It also permits small businesses to make pre-tax
contributions to the individual insurance plans purchased by
their employees. This increases health insurance portability —
employees can take their insurance policies with them from job to
job knowing that their premiums will be pre-tax and that their
employers can contribute to them. This is the type of reform that
other states should be considering.
HSAs and Emergency Rooms: On of the big promises
of HSAs is that they would cut down on unnecessary care. An
article from the Journal of the American Medical
Association from March of this year suggests that they are
doing just that. The authors examined emergency room use (the
most expensive type of care) among those with high-deductible
policies and those in a traditional HMO. The results were that
repeat visits to the emergency room dropped significantly among
those with high-deductible plans. There was also a small drop
among referrals from the emergency room to hospitalization. The
article wasn’t fully able to explore how the difference affected
health outcomes. However, the drop in repeat visits occurred
heavily among the “low-severity” group. This suggests that people
cut back on emergency room visits when emergency room visits are
least necessary. Gee, it seems that individuals are pretty good
judges of their own health needs. Who knew?
The Health Care Freedom Coalition: Although it
received little media attention, back in July a group of
conservative, free-market organizations formed the Health Care
Freedom Coalition. It includes Consumers for Health Care
Choices, the Council for
Affordable Health Insurance, Americans for Tax Reform, 60 Plus, FreedomWorks, and the National Taxpayers Unions. (Many
state-level groups have since joined.) Its agenda can be seen
here (PDF), and includes tax fairness and simplification for
health insurance, permitting people to purchase health insurance
across state lines, and opposition to individual mandates and
government price controls. It’s good to see that those on the
right are gearing up for the fight well in advance this time. (To
join the Coalition, contact that Brian McManus at brianfmcmanus@yahoo.com.)
While there are still many big obstacles to establishing a free
market in the American health care system, it’s important to not
get discouraged. There are some positive developments that
conservatives and libertarians can build upon in health-care
battles to come.
David Hogberg is a Washington writer and host of the
website Health Hog.
Jeremy Taglieri is a student at Union College and a former intern
for the National Center for Public Policy Research.
