January 8, 2003

January 8, 2003 | Commentary on Health Care

ed010803: A healthy debate

OK, so maybe the words aren't that easy to grasp.

Maybe trying to wrap the mind around terms such as "assignable tax credits" or "Medicare reimbursement rates" or "medical savings accounts" is what makes the average American's eyes glaze over and brain go into neutral when politicians and bureaucrats bring up health-insurance issues. The fog of nomenclature so shrouds the debate over how to help the 42 million Americans without health insurance that it's hard to see that answers even exist.

But it's time we learn what the terms means so we can focus on the problems and help those who are suffering.

It's time the average taxpayer got a little relief, too. In Southern California, ground zero for America's property-tax revolt in the late 1970s, citizens recently voted themselves a hefty property-tax increase to cover shortfalls created by the uninsured in the health-care system. In Massachusetts, the speaker of the state House of Representatives, Thomas Finnernan, has warned that Medicaid costs could soon "bankrupt" the state.

In Michigan, clinics and hospitals that serve the poor limit hours and services to make ends meet, and Jennifer Granholm, the newly elected governor, already has ordered a summit to address health-care funding woes. State governments from coast to coast find themselves in dire financial straits over the Medicaid problem. In 2001, 37 states overspent their Medicaid budgets. By mid-2002, 23 had busted their budgets again.

"We are certainly seeing real crises that have to be dealt with," Richard Cauchi, a health-care analyst for the National Conference of State Legislatures told the Washington Post recently.

Yet, Congress seems unable to restrain itself from throwing money at the crisis and unwilling to look past the tried-and-failed solutions of the past. For many on Capitol Hill, the solution is to funnel the uninsured into Medicaid. Never mind that doctors are abandoning the program in record numbers or that hospitals and other providers have threatened to stop accepting Medicaid patients because it takes so long to receive reimbursement.

The good news is that some doable, affordable and productive solutions already exist. My colleague, Dr. Robert Moffit, director of domestic policy studies at the Heritage Foundation, has been researching and talking about them for two decades.

For starters, Moffit says, the goal should be to contract, rather than expand, Medicaid. To do this, he suggests the federal government offer health-care tax credits to individuals and families to allow them to purchase the coverage they need. Make the credits advanceable - available now, so struggling families don't have to put up the money, then wait months for reimbursement; and/or assignable - have the credit go straight to the insurance company the person chooses.

This approach - modeled on the plan by which federal employees, including members of Congress, get their insurance - goes to the heart of the problem, which is that most Americans are forced to get their health coverage from their employers. Through its tax policy - those who buy insurance through their employers get to do so with pre-tax income, a break so significant it all but wipes out competition from those who sell directly to consumers - the government practically insists we buy our insurance at work.

At all except the largest employers, that means little if any consumer choice. It means employees must change plans or lose coverage every time they switch jobs - an expensive and exasperating problem in a nation where the average 32-year-old is on his ninth job. It's the biggest reason why most of the households containing our 42 million uninsured are headed by people with full-time jobs.

It is a complicated system, but one thing is clear: Medicaid doesn't work. Having employers function as the sole providers of health insurance hurts competition, drives up costs and leaves people powerless over their own health-care coverage.

Providing tax credits - $1,000 per individual, $3,000 per family - would cover as much as 90 percent of average health-insurance costs for recipients and move most of those 42 million people off the rolls of the uninsured and into a system where efficiency is rewarded, savings are applauded and some level of permanency is established.

Critics say affordable policies still wouldn't be available, but prices already have come down some and doubtless would come down more if a large coterie of customers - armed with their tax credits - materialized. Supply and demand - that's one market force all of us understand.

Rebecca Hagelin is Vice President for Communications and Marketing at The Heritage Foundation.

About the Author

Rebecca Hagelin Senior Communications Fellow

Related Issues: Health Care

Reprinted with permission of the Internet newspaper WorldNetDaily.com.