My back and forth with Matthew Holt on HSAs continues…
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Health Care
Unnecessary Restrictions Are Holding HSAs Back
Federal law requires consumers to have a “qualified high-deductible health plan” before they can open a tax-free health savings account (HSA). Today, Sarah Rubenstein of the Wall Street Journal reports that those rules make HSA-compatible coverage more expensive than necessary.
In a recent paper, I argued that Congress actually requires HSA holders to have a “high-but-not-too-high-deductible health plan,” and that Congress should let consumers choose their own health insurance.
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No, Really — You Have a Point
Matthew Holt of TheHealthCareBlog.com devotes a lengthy post to criticizing my (much lengthier) paper, “Health Savings Accounts: Do the Critics Have a Point?”
Holt — who has an HSA himself, as I understand it — is not entirely critical. For example, he calls Cato “the sensible libertarian’s think-tank.” As for the uncomplimentary parts, I found them odd.
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Spending Your Tax Dollars to Advocate for Even Higher Taxes
In 2003, Congress created a “Citizens’ Health Care Working Group” to gather from the citizenry ideas on how to fix America’s health care sector. This past Friday, the group released interim recommendations worthy of the Clinton Health Care Task Force:
It should be public policy that all Americans have affordable health care
This and other of the recommendations contained here call for actions that will require new revenues… We recommend adopting financing strategies…such as enrollee contributions, income taxes or surcharges, “sin taxes”, business or payroll taxes, or value-added taxes that are targeted at supporting these new health care initiatives.
One need not be an advocate of socialized medicine to see that America wastes gobs and gobs of money on health care, which is one of the reasons that health care is so unaffordable. And these people think we should spend more? The group does recite the usual incantations about how the government should use electronic medical records, evidence-based medicine, et cetera to improve efficiency. But it does not pretend that such efforts would obviate the need for new taxes to achieve its goals. Nor does it consider that such a tax burden would hamper the economy’s ability to deliver on the group’s promises. Nor does the group seem to have any comprehension of the enormity of the task of making “affordable health care” actually happen. (For more on that point, see the introduction to Healthy Competition.) The public can read the group’s interim recommendations here and comment on them until August 31.
Kudos to the Left. They seem to have successfully hijacked this panel — despite the group having a chairman from the business community and one member who is a cabinet official in the Bush Administration.
Go figure.
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The FDA and Your Dinner Plate
Two years ago, Time asked me to write one half of a short point-counterpoint on the obesity debate for a special issue of the magazine entirely devoted to how government should intervene to prevent the fattening of America.
My job was to defend the notion of personal responsibility (my meager 350 words were the only such defense the entire issue). I remember squabbling with one of the magazine’s editors over one contention I made in the article — that it was only a matter of time before public health activists and the federal government would attempt to regulate the portion sizes of food served in restaurants. Seemed like a logical prediction of where things were headed. The editor accused me of hyperbole, and nixed the prediction from the piece.
Last week, this story hit the wires:
Those heaping portions at restaurants — and doggie bags for the leftovers — may be a thing of the past, if health officials get their way.
The government is trying to enlist the nation’s eateries in the fight against obesity.
The report, funded by the Food and Drug Administration, lays out ways to help people manage their intake of calories from the growing number of meals prepared away from home, including at the nation’s nearly 900,000 restaurants and other establishments that serve food. One of the first things on the list: cutting portion sizes.
“We must take a serious look at the impact these foods are having on our waistlines,” said Penelope Royall, director of the health promotion office at the Department of Health and Human Services.
The recommendations are voluntary.
For now.
Canadians Are Healthier
I wish that I had the knack for making a media splash the way some people can. For instance, when Harvard’s Karen Lasser and some fellow health care researchers recently released a goofball telephone survey of health care, the media werere all over it.
Here’s a closer look at the gap between the United States and Canada on various health conditions:
- Obesity: 20.7 percent of U.S. respondents; 15.3 percent of Canadian respondents.
- Sedentary lifestyle: 13.6 percent of U.S. respondents; 6.5 percent of Canadian respondents.
- Diabetes: 6.7 percent of U.S. respondents; 4.7 percent of Canadian respondents.
- High blood pressure: 18.3 percent of U.S. respondents; 13.9 percent of Canadian respondents.
- Arthritis: 17.9 percent of U.S. respondents; 16 percent of Canadian respondents.
- Chronic obstructive pulmonary disease (COPD): 1.9 percent of U.S. respondents; 1 percent of Canadian respondents
Wow, that Canadian health care system is amazing! Look at the big difference in “sedentary lifestyle.” That’s obviously due to the fact that they have socialized medicine and we don’t—or so the reasoning goes:
“Compared with Canadians, U.S. residents are one-third less likely to have a regular medical doctor, one-fourth more likely to have unmet health care needs, and are more than twice as likely to forgo needed medicines,” write Lasser and colleagues.
They add that “problems accessing medical care are particularly dire for the U.S. uninsured,” and that while both countries had racial gaps in health, those gaps were wider in the U.S.
But why did Lasser et al. conduct their own telephone survey of Americans? The Medical Expenditure Panel Survey, a larger and more reliable study of U.S. health care consumers, would have been a perfectly reasonable source to use. The “gaps” may be a little harder to find, though. The average health care spending of people below the poverty line was slightly above that of people above the poverty line—and far above that of people in Canada.
In deference to supporters of government-run health care, we ought to try a single-payer system at a state level in the United States. Then we could see whether having a single-payer system magically improves everyone’s lifestyle, access to doctors, and so forth. Until then, we have this “grass is greener” outlook on Canadian health care in the media, and any attempt at a reality check is fruitless.
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A Return-Quibble
Two days ago, I blogged that Americans spend too much for health care as a result of the bizarre health care financing system that has been fostered by government regulation and tax provisions. Michael Tanner subsequently responded that my claim makes little sense in a free society–Americans, who are wealthy, consume more health care because they simply prefer more health care and they have the money to buy it.
Permit me a response to Michael’s response. I offer a lengthy counter on my own blog; here is an excerpt of my reply:
I think of the American health care system not as a free-market system, but as a government-designed contraption constructed to vacuum money out of the pockets of consumers and into the pockets of health-care providers. A lot of this contraption is built into state regulations of health insurance and provider licensing. The Federal government adds an important layer by encouraging “employer-provided health insurance” (i.e., vacuuming wages into prepaid health plans).
[…]
Our difference is tactical. Tanner wants to put libertarians on the side of saying, “The American health care system is the finest in the world. Don’t mess it up with a socialized system like everyone else’s.”
I think that tactic is vulnerable to charges that people in other countries are healthier, charges which very well may be true. I would rather be in the position of attacking our vacuum contraption than defending it.
The debate continues…