The Cost of the Health Care "Fix": 
Now They Tell Us...

Charles N. Steele
 
Issue CCXLVI - April 27, 2010
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The lead story on today's Yahoo Finance is an interesting little piece from Associated Press on the health care "fix."  It turns out that the "fix" not only does nothing about rising costs of health care, it's also expected to increase insurance premiums more than they'd have increased otherwise.
 
Neither point is at all surprising.  Among the things that are most responsible for rising health care prices are increased technological sophistication and the lack of incentive for consumers and providers to take costs of an additional procedure into account.  Increased technological sophistication is largely a good thing; we are able to successfully treat many conditions that were largely untreatable in the recent past.  Studies by health care economists have clearly shown that technological advance has, overall, generated net benefits in terms of longer and healthier lives.
 
However, our system of third-party payments makes the cost of one more procedure effectively zero to an insured patient (and to many uninsured ones), and health care providers respond accordingly.  And there's also defensive medicine; again, since the marginal cost to the patient is effectively zero, why shouldn't the provider order additional tests and procedures?
 
This helps explain why health care prices and spending are expected to continue rising, but why the acceleration in insurance price increases?  This one is simple: the "fix" increases the insurance pool, and forbids rating based on individuals' actual health status ("pre-existing conditions").  Reinforcing this effect is the apparent fact that fines for not buying mandatory insurance are considerably less than the price of insurance, so healthy uninsured people will have an incentive to remain uninsured, and then purchase insurance if they become unhealthy.  It doesn't take a degree in actuarial science to understand that this increases the riskiness of insurance pools, and hence rates.
 
These points are quite apart from concerns that the health care "fix" is fiscally unsound (e.g., my previous post).  These are simply consequences of the facts that people respond to incentives -- including prices -- and that there's no free lunch.  Unfortunately, our leaders are more interested in their own political power than in actually fixing problems, and hence have promoted this "fix" with demagoguery rather than logic and facts.  But as time goes on, more and more unpleasant facts will come to light.

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