Saturday, January 28, 2006

Ouch

It's nice to be reminded that I'm generally against the Democrats when they're in power, albeit nowhere near as vehemently as I am against today's governing cabal. But a fresh reminder comes from Josh Marshall's Talking Points Memo blog, of which I am generally a fan, but which today is circling the wagons against Bush's reported HSA proposal, and the general conservative position, by saying:

"[T]he core premise of the policies the president is about to lay out is that Americans are over-insured when it comes to health insurance. Over-insured. Got too much insurance."

Josh's point, of course, is that millions of Americans lack any health insurance. But the conservative position concerns something else. Its point is that the Americans who have health insurance have too much, or more specifically too much low-end, health insurance. As in coverage for routine expenditures that reduce cost-consciousness among consumers. I make you pay for treatment that I value at less than its cost, and you do the same for me. We both end up paying for each other (and everyone else who is doing the same thing) through our insurance premiums.

It's not really helpful to miss, be it ignorantly or willfully, the correct point behind the conservative analysis of healthcare. How important the over-insurance problem is compared to the lack of coverage for poorer Americans one can reasonably debate. (Although the two might be linked, in terms of misallocation of resources.) How much correctly oriented cost-consciousness we can really expect in a market as flawed as that for healthcare is another open question. As per my earlier post, I don't think HSAs are a constructive answer to the sector's unsustainable growth and its fiscal consequences. Put me down instead for the Tax Reform Panel's proposal to cap the exclusion for employer-provided health insurance. (Not to say that the reforms and rethinking should stop there.) Another fair point is that it borders on insane, in the current budgetary setting, to address the over-insurance (for the insured) problem by adding more tax benefits rather than by paring them back. But let's not fail to see a genuine problem concerning misaligned incentives that affects not just consumers but the entire healthcare industry. (E.g., why should drug companies chase cost-saving treatments rather than expensive new ones when their market isn't cost-conscious.)

I've wanted to return to being a good-humored plague-on-both-their-houses type, as I was until recently. But the Republicans haven't been willing to help me on this - I can'f warm up to the idea of living in a corrupt dictatorship run by incompetent scoundrels - so I wish that the left & Democrats would hold off for now on doing their part.

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