And this is exactly right. Government intervention has also caused most of the problems with health care expenses.
Policy design is critical. It's true that insurance that provides "free" services and low deductibles and copays makes us into poor consumers, especially if our employers have paid most of the premium costs. One of the better changes made by the ACA - and one of the most universally reviled, by both employers and unions - is the Cadillac tax, that would tax employers who maintain the most generous health plans. Those sorts of plans are what allow doctors and hospitals to charge so much - patients don't care because those costs are being paid for with other peoples' money.
For this reason I've supported tax-favored medical savings accounts coupled with high-deductible insurance coverage. It gives patients real skin in the game and discourages profligate use of health care services. But what individuals really need are better choices and better information. If the AHCA reforms can restore a robust and competitive individual insurance market, I'd like to see employers incentivized to replace their traditional plans with tax-favored contributions to medical reimbursement accounts, that could be used by employees to purchase insurance - the insurance they want - in the individual marketplace.
Much of the revenue needed to support health insurance for the poor could be obtained by eliminating the employer's deduction for health coverage provided over a certain dollar amount, say $7,000 for individuals and $12,000 for families. Maybe increase the deduction to $8,000 and $13,000 if the employer declines to sponsor a group health plan and instead contributes that dollar amount to a health reimbursement account that the employee could use to either purchase insurance in the individual market or use to self-insure his or her medical expenses. Millions of employees would, with such a change, bring their healthy lives into the individual marketplace, expanding the pool, increasing competition and lowering premium costs.
I have no ideological aversion to government involvement in health care financing. What I care about is good policy vs. bad policy. Good policy makes the difference. The ACA is bad policy in most respects. The ACHA is a step in the right direction, but the real hurdle will be to change fundamentally the current employer-based system.
