Thursday, May 29, 2008

New Ideas for Health Insurance?

Finally it looks like governments are trying to have an answer to the health care affordability issue.



From the Wall Street Journal


The Florida Revelation . . .

Republicans in Congress may be out of gas, but that doesn't mean conservative ideas aren't percolating elsewhere, and even on the supposedly Democratic stronghold of health care. Take the news from Florida, where GOP Governor Charlie Crist succeeded last week in moving an innovative reform through the state legislature.

The Sunshine State has about 3.8 million people without insurance, or about 21% of the population, the fourth-highest rate in the country. The "Cover Florida" plan hopes to improve those numbers by offering access to more affordable policies. As even Barack Obama says, the main reason people are uninsured isn't because they don't want to be; it's because coverage is too expensive.


But the Florida reform, which both houses of the legislature approved unanimously, renounces Mr. Obama's favored remedy: It nudges the government out of the health-care marketplace. Insurance companies will be permitted to sell stripped-down, no-frills policies exempted from the more than 50 mandates that Florida otherwise imposes, including for acupuncture and chiropractics. The new plans will be designed to cost as little as $150 a month, or less.

Mr. Crist observed that state regulations increase the cost of health coverage, and thus rightly decided to do away with at least some of them. It's hard to believe, but this qualifies as a revelation in the policy world of health insurance. The new benefit packages will be introduced sometime next year and include minimum coverage for primary care and catastrophic expenses for major illness.

Critics are already saying that, without mandates, the plan won't guarantee quality of care. That's purportedly why the states have imposed more than 1,900 specific-coverage obligations. But invariably mandates are the product of special-interest lobbying. Health-care providers – not consumers – are always asking for tighter regulation, because they profit from making everyone subsidize generous plans that cover, say, podiatry or infertility treatment. Given the choice, consumers might choose policies that cover some services but not others.

These government rules are imposed without regard for how much they will cost and who will bear the burden. In practice, the costs are disproportionately carried by lower- and middle-income workers, who already on average have more limited insurance coverage as part of their compensation, or none at all. When prices rise because of mandates, the less affluent are often forced to make an all-or-nothing choice between "Cadillac coverage," which involves just about everything, or going uninsured. In other words, they're prohibited from buying the lower-cost options that might be better suited to their needs.

Governor Crist is to be credited for removing this artificial, regressive floor on plans. It's a simple matter of equity. And though the plan will only enroll those who have gone without coverage for six months, it also creates a clearinghouse that will let small businesses that can't afford coverage offer their employees a variety of similar policies.

Despite his often populist brand of politics (such as on hurricane insurance), Mr. Crist also avoided the typical liberal health-care response of expanding public programs. Mitt Romney should have taken this route in Massachusetts, but fell instead for the siren song of "universal coverage," even if provided by the government. Florida is already having a tough fiscal year, but such state-level expansions are often pushed anyway.

Some 13 states currently offer bare-bones policies on a full or trial-run basis. While not a cure-all, they're movement in the right direction – especially as the states can't do anything about the continuing tax bias for employer-provided health insurance. That kind of much-needed change can only come from Washington, as John McCain is proposing.

The Florida success also shows the political benefits when Republicans talk seriously about health care. Mr. Crist has made increasing consumer choice a signature issue. When Mr. McCain talked up his health-care reforms earlier this spring, he did so in Tampa. He chose the right state.

The Flip Side

And Escape From New Jersey

New Jersey is about the last place one might think to look for free-market policy reform. But this week Jay Webber, a Republican Assemblyman in Trenton, will introduce legislation to let Garden State residents buy low-cost health insurance from any registered policy in any of the 50 states.

Mr. Webber's proposal is a state version of Arizona Congressman John Shadegg's federal legislation to let individuals buy insurance across state lines, and John McCain has also endorsed the idea. But New Jersey would be a perfect test case, because its multiple mandates have made insurance too expensive for hundreds of thousands of families.

The average national cost for a family health plan is $5,799, according to America's Health Insurance Plans, but in New Jersey that same plan costs $10,398 on average. The state's politicians have driven up these costs by forcing insurers to provide gold-plated coverage – even for such voluntary medical services as in vitro fertilization. New Jersey also follows New York and Massachusetts – two other high-cost states – in requiring so-called "guaranteed issue." That allows New Jersey residents to avoid buying health insurance until they get sick, which means they can avoid paying premiums until they need someone to pick up the bill.

This one-policy-fits-all system tends to cause the young and healthy to drop insurance, which only raises the cost of insurance for the sick, which in turn makes coverage unaffordable for ever more families. It's no accident that about 1.2 million people – one of every eight residents – is uninsured in the state.

Under Mr. Webber's choice proposal, New Jersey residents could buy policies chartered in more enlightened states. For example, a healthy 25-year-old male could buy a basic health plan in Kentucky that now sells for $960 a year, about one-sixth of the $5,880 it would cost him in New Jersey. Residents of Pennsylvania pay health premiums that are one-half to one-third as high as do Garden State policy-holders. A new study by the National Center for Policy Analysis estimates that the availability of lower cost plans would reduce by 25% the number of uninsured.

Opponents of interstate insurance say families would be pushed into bare-bones health plans. Not so. Families could still buy the more extensive coverage, but those with modest incomes would have options other than going uninsured. The goal of public policy shouldn't be to cover every medical procedure or doctor's visit, but to prevent families from catastrophic expenses due to a health problem that is no fault of their own.

New Jersey is turning into a microcosm of the national debate on health care. Democrats in Trenton are rallying behind a plan to require that every uninsured individual in New Jersey purchase health insurance from a new state-administered program. So a state that is already so broke that its politicians are contemplating mortgaging its highways might now add a $1.7 billion health subsidy.

The Webber proposal offers lower costs and more choices for consumers, while the Democratic plan mandates public coverage and no choice, while putting a new burden on taxpayers. This is the kind of debate the country should have this election year.



It goes to the old saying Government needs to a part of the solution and not part of the problem.

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