Thursday, October 15, 2009

Reform, Costs and Premiums

The government mandates certain features on your automobile; seat belts, for instance, air bags, crush panels in the doors, mileage standards, roll bars in the roofs, fuel vapor recycling, and quite a lot of other things most of which are related to consumer safety.

For the government to require health insurance companies to provide certain features, then, is by no means out of line; things like covering pre-existing illnesses, setting caps on copays and deductibles, not placing caps on payments, etc. These, too, after all, are matters relating to consumers.

What the government did not do with the auto industry was mandate all of these features while requiring that manufacturers sell cars at lower prices and, in fact, all of these mandates have increased the price of cars by quite a lot; several thousand dollars per car. But with “health care reform” the government wants to require additional features from health insurance companies while making those companies sell their product at lower prices. When health insurance company representatives point out that these new requirements will raise the price of insurance, just as new safety features raised the price of cars, loud cries of outrage erupt.

An editorial in today’s New York Times addresses the “deep dishonesty” of the insurance industry report, beginning by admitting that the “individual mandate should probably be stronger.” With that little treasure they validated about half of the report. They begin their criticism with,

First, under the legislation, anyone who currently has a policy that turns out to be cheaper than those sold on the exchanges will be allowed to keep it.

What that has to do with the insurance company claim that premiums will rise under the current “reform” proposals is completely beyond me, and nothing that follows makes it any more clear. Further down they declaim,

In a particularly glaring omission, the industry report made no effort to factor in the effect of proposed subsidies that would help millions of people to buy their own insurance on those exchanges.

Again with the exchanges, but the fact that the government is offering subsidies does not refute the claim that premiums will increase; offsetting those premiums with subsidies does not eliminate the increase in the premium. It does eliminate the effect of that increase for those who receive the subsidy, but it doesn’t make a whole lot of sense to take government action to drive up premiums and then use government money to offset that increase, which was caused by government action.

The editorial than describes the proposed tax on high priced policies, never mentioning the President’s promise that “if you like the policy you have, nothing will change.” Or maybe you don’t consider a 40% increase in the price of your health insurance to be a change.

As much as Americans hate the idea of taxes, there is a strong logic to this approach. It is designed to encourage employers and their workers to buy less-expensive plans — and make a more rational calculation of what services they need versus what is “free” because it is covered — and encourage employers to shift compensation more toward higher wages.

So health care reform is now designed to discourage policies that provide outstanding coverage for those who can or want to pay for them, and drive them to more average policies that provide less elaborate care. Employers, paying less for those more moderate plans, will raise your wages instead. Of course they will; and I have some land in Florida that I would like to talk to you about.

Finally, the report makes no mention of the legislation’s efforts to find ways to rein in the relentless spiral of health care delivery costs — the main culprit in today’s spiraling premium costs. In the long run, those reforms should reduce the cost of insurance for everyone.

This is absolutely the first time in the debate that I have seen anyone suggest that the prices charged by doctors, hospitals, clinics, labs and drug companies and paid by insurance companies might have something to do with the high cost of health care, or that the "reform" proposals might be addressing those costs. Obama cut deals with hospitals and drug companies specifically not to address their pricing, so I strongly suspect that this paragraph is disingenuous.

Even if it is not, if these costs are “the main culprit in today’s spiraling premium costs” then why all of the religious fervor regarding the “public option,” which would be paying those same costs? How is this magical “public option” going to “keep the insurance companies honest” and drive down the cost of insurance if it is paying the same prices for the same services that insurance companies are?

To repeat what I have said before, I am not opposed to reform; I strongly favor reform and the more fundamental the reform the better. I know we are not going to get a good bill; Congress has not passed a good bill on anything in many years, and is steadily becoming less and less capable of passing a good bill on this matter or on anything else. We are going to get a bill that is butchered up by the desires of special interests.

But even with that in mind, this is nonsense.

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