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Friday, February 02, 2007

One Step Forward, Two Steps Backward?

This is from Andrew Samwick:

Jon Gruber on Health Insurance Reform, Vox Baby: Via the Economic Research Initiative on the Uninsured (ERIU), here is an interview with Professor Jon Gruber of MIT, who played a key role in the recent Massachusetts health insurance reform. Here's his assessment of the recent proposal by the Administration...:

Bush's proposal is a step forward and two steps backward. He's rightly drawn attention to the largest hidden expenditure on health care, the $200 billion a year that we spend on subsidizing ... employer-provided health insurance. Basically, people who get paid wages get taxed on those wages, but individuals who are paid in the form of health insurance don't get taxed on that compensation. And if they were, we would raise about $200 billion more a year in tax revenue. This is a very inefficient ... for several reasons. First, it's very regressive; the richer you are, the bigger tax break you get. Secondly, it's what we call a marginal subsidy; every dollar an employer spends on health care is cheaper than that spent on wages, leading to excessively generous, even gold-plated, health insurance. The third problem is that it props up the system of insurance being tied to employers, extending a number of inefficiencies and distortions in how the labor market works.

However, what the president has done is say 'let's blow up the existing system by taking away the entire employer exclusion and rededicating it to an individual tax break where every person, as long as they were insured, would get an individual tax break of $7,500 or $15,000 per family.' The reason that is two steps backward is that it doesn't address the two things you need to address to get rid of this employer exclusion: 1) he doesn't acknowledge that this system is devoting most of the money to the rich. Under his proposal, the system becomes even a little more regressive than the existing one; and, 2) even more importantly, if you're going to blow up the employer-based system you need someplace else where people can go. Bush doesn't do that, and that's the fundamental flaw. Overall, he has raised an important issue, but he chose to do it in a dangerous context.

I remain convinced that the first reform is to remove the tax exclusion for health insurance premiums. Phase it in over time if you like, but sunset it in any case. Use the money saved--$200 billion a year according to Gruber--to start fixing the gaps in coverage.

Here's a bit more from the interview:

So you believe a universal coverage approach is preferable, along with tax code changes and pooling mechanisms. What else?

GRUBER: We need universal coverage, and to get to universal coverage, there are three things you have to address. You have to address pooling, where people can come together in large groups independent of health, like employers, for example. If you don't use employers, you need an alternative mechanism. Secondly, you have to deal with affordability, which the Bush plan doesn't do. In Massachusetts, the average family policy is about $12,000 a year, and that's not affordable for families earning one, two, three, even four times the poverty line. Giving them 25% off, which is what Bush is trying to do, is not going to solve the problem. The final issue is mandates. If you have a voluntary approach, you won't get to universal coverage. Many people today are offered heavily subsidized insurance and they choose not to take it. So if you want universal coverage, you have to mandate that people take it. Those are the three pieces of the puzzle you have to solve for this to work.

    Posted by on Friday, February 2, 2007 at 01:39 PM in Economics, Health Care | Permalink  TrackBack (0)  Comments (13)


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