As the presidential candidates discuss their plans for the American health care system, they point their fingers of blame in several directions – toward insurers, toward employers, and even toward over-eaters and non-exercisers. But none of the leading candidates are pointing toward the main culprit – the government.
The federal and state governments have driven up the cost of health insurance and health care with Byzantine regulations, outdated tax policies, and price-setting that distorts the marketplace.
States have piled on health insurance mandates, artificially increasing the cost of insurance and skewing the concept of risk. Texas ranks among the top five most heavily mandated states with 52, requiring insurers to cover everything from alcoholism to in-vitro fertilization, acupuncturists, and marriage therapists. Lower cost coverage sold in another state-perhaps one without all the mandates-is not an option since only policies approved by Texas regulators are available here.
The federal tax code tethers insurance to employers giving favor to employers providing insurance and to individuals with employer-sponsored coverage. The results include needless periods of uninsurance coinciding with unemployment, limited insurance options that reflect the choices of employers instead of employees, and individuals who buy their insurance only after Uncle Sam takes the first bite from their paychecks. Texas even gives employers credit for providing insurance coverage in calculating their tax burden, but individual taxpayers paying for their own care see no such benefit.
Prices for health care services are often based on Medicare rates, which are set by Washington. State and federal governments insulate public beneficiaries from the cost of their care, instead asking taxpayers to pay the full freight even as they work to provide for their own family. Federal laws create perverse incentives allowing people to receive treatment without paying, which stick the tab to federal, state, and local governments; along with those who have insurance.
If health insurance and health care are out of reach for people, it is due to government meddling in the marketplace and stifling competition.
Government regulations have given us this mess, so it is unlikely that government can lead us out. The stories of foreign heads of state coming to the United States for health care services, Canadians waiting in long lines for would-be life saving treatment, and Britain’s willingness to ration care according to age, seemingly fall on deaf ears.
But it is hard to imagine that a government that addresses customer service complaints about long lines at the post office by taking the clocks off the walls, can ever handle the complex and deeply personal health care decisions of more than 300 million people.
The differences between Republican and Democrat presidential candidates’ are not as “sharp” as most people believe. Candidates of both parties may differ on the specifics of their plans, but most envision an increasingly active role for government in regulating health insurance and paying for health care.
Despite historically loud objections to establishing a single payer health care system in the United States, decades of quiet and incremental government expansion have resulted in record levels of government involvement in health care-everything from regulating what providers can do and what they are paid, to actually writing the checks to pay for care.
Today, people are awake to the significant problems in health care, yet most have been duped into believing that the radical departure from the status quo is more government.
Indeed, that may be the real granddaddy of health care myths.
A new direction in health policy would follow the path of competition with the goal of delivering Texans a great deal of choice in insurance and care, with both increasing quality and decreasing cost.
Mary Katherine Stout is Vice President for Policy and Director of the Center for Health Care Policy at the Texas Public Policy Foundation, a non-profit, free-market research institute based in Austin.