Dr. Andy

Reflections on medicine and biology among other things

Thursday, December 01, 2005

Market based health care reform

is the proposal of this article (which only those who subscribe or have institutional access can actually read). It is compelling about how the government makes things worse:
Unfortunately, a handful of U.S. public policies prevent markets for health services from accomplishing this objective. In two areas—tax policy and health insurance regulation—government policy has actively hindered the operation of markets. In three other areas—the provision of health care information, the enforcement of antitrust laws, and medical malpractice rules—government policy has failed to adequately promote the proper functioning of markets. In doing so, it has contributed to the spread of wasteful (inefficient) medical practice, rising health care costs, and rising rates of uninsurance. Although makingmarkets work is not a silver bullet, it is a necessary first step.
They point out that making employer sponsored health insurance but not other forms of spending on health tax-deductible has led to an overreliance on insurance as opposed to out of pocket spending. Solution: make out of pocket spending and individually purchased insurance tax-deductible as well, and give tax credits for the poor to buy insurance. Health savings accounts would also be expanded.

They go on to talk about how over-regulation has made the insurance market non-competitive. For example:
One particular form of state insurance regulation—benefit mandates—has expanded dramatically over the past forty years. In 1965 there were fewer than a dozen such mandates throughout the fifty states and the District of Columbia; by 2003 the number had risen to more than 1,800. Benefit mandates now require coverage of off-label drug use (thirty-seven states), acupuncture (eleven states), and chiropractic (forty-seven states). According to the Congressional Budget Office (CBO), states’ benefit mandates have raised the cost of a typical insurance plan 5–15 percent. According to one study, about one-quarter of those who lack coverage are uninsured because of the cost of state mandates alone.
So insurers in 47 states are forbidden from offering policies that exclude chiropractic. I wish I had the choice to save money by forgoing this form of health care. They propose a federal (versus the current state) market for insurance to make things simpler and cut back on this kind of wasteful regulation (although I'm skeptical that Congress would do any better).

If you can get access, read the article. Whatever one thinks about universal health care, I think proposals for a single payer are not realistic in the current political environment, so this kind of incremental reform is what we need.


At 4:13 AM, Anonymous Blue Cross of California said...

It is unfortunate to see health care costs rising so quickly. I hope the health care system is improved and many can receive health insurance.

At 11:34 AM, Anonymous sherlock said...

Unfortunately i think the UK may have to go the same way as the US. The NHS waiting lists are so long now that people are having to wait too long for treatment.

At 10:26 AM, Anonymous clearsite said...

i agree sherlock; people are waiting months and months for operations and they're often cancelled at the last minute. yet if you pay to have treatment privately you'll be seen in a matter of days! the NHS also takes far too much money to maintain, it's a complete sinkhole of funds. far too many treatments are available and i think the original aim, of basic healthcare for all, has been lost.

a lot of people are opting out and getting their own health insurance, but even so we still have to pay our (rising) taxes to fund the NHS! it's lose-lose for the ordinary worker!

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At 10:16 AM, Anonymous nursesforchange said...

I think there is room for regulation in the market, but it needs to be the right regulation. Part of reducing health care costs is reducing the number of uninsured people. To do this, there needs to be some regulation of how the insurance companies drop and exclude people from coverage on the basis of pre-existing conditions or lack of previous group coverage. Tax credits and shifting to out of pocket cost payments and away from employer-based plans will not help make health care accessible to the uninsured and underinsured UNLESS the costs of health care go down. There is a chicken and egg problem here; some people cannot start to bear more cost burden until costs go down and costs will not go down for the insured until more people access the system with coverage.

At 12:55 PM, Blogger Mary said...


This is the assistant editor for Hospital.com which is a medical publication offering hospital news, information and reviews. We also cover a wide variety of medical topics, some of these articles being relevant to Health Care reform as you will see from the homepage of our site. We are in the process of updating our health care news section with dozens of articles on the reform and other relevant issues. If possible I would like Hospital.com to be included within your blog roll, offering our information as a resource to your readers and essentially building a relationship between our sites. Please let me know if this addition can be made, Thanks!

Please email me back with your URL in subject line to take a step ahead and to avoid spam.

Thank you
Mary Miller,

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