Commentary on the economy, the markets, and business

So would the McCain health plan cost more or less than what we've got now?

For those of you who don't stop by Swampland first on the way to this blog, here's McCain's adviser Doug Holtz-Eakin splainin' something about his boss's health insurance plan:

For the typical ESI [employer-sponsored insurance] recipient -- $12,000 policy — nothing changes. The tax liability on the policy ($12,000 x .35) when insurance is taxed as compensation is $4,200; this will be immediately offset by the credit of $5,000. In short, if they want to stay with the current plan, it just means a lot of computer entries on the pay stub.

If that's the case, the McCain plan would decrease the tax subsidy only for those with more-generous-than-average corporate health plans, while increasing it for those with plans that are average and worse, plus all the people out there who currently have no health insurance at all. Which means that, at least initially, the McCain plan would substantially increase the tax subsidy for health care, but distribute it more fairly and evenly than it is now. Over time, though, the subsidy is likely to shrink, as James Kvall of the Center for American Progress explains in yet another of Karen T's posts:

This would work by holding down the growth in the credit to the inflation rate (about 2% a year), unlike the current benefit which rises with health care premiums (about 6%). Surprisingly quickly, the tax cut turns into a tax increase, even for typical workers with ordinary health care plans.

Now if you believe that the tax subsidy for health care is a major part of what drives health care costs up, as many conservative economists do, this is a good thing. If you don't, everything's messier. The McCain plan would still be fairer than the current system, in which the people with the swankiest employer-paid health plans get the biggest tax break. But it might well mean a decline in the quality of health-care available to most people now covered by corporate plans.

And that's still leaving aside all those questions about adverse selection, the value of expert decision-making, etc. I don't think this McCain plan is some kind of scam. It just shows clear signs of having been designed by free-market-oriented economists who don't know all that much about the health-care system. As a mostly free-market-oriented non-economist who doesn't know all that much about the health-care system, I'm naturally sympathetic to it. But I'm also extremely dubious of how well it would work in practice.

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  • 1

    Justin, isn't the very idea of how things might work in practice kind of an elitist question? Maybe if you spent a little less time buying arugula at Fairway and a little more doing shots of Jamo at the Dublin House, you'd get this.

  • 2

    Efficient markets (note I said efficient, not the stockmarket) depend on all players having reasonable access to information. Medicine isn't like that. In addition to not having any medical expertise, even if you did, you have very little way of truly evaluating your true illness risk, especially years down the road, so it is difficult for you do buy appropriate coverage. Best you can do is get lucky...Buying auto/house insurance is already complicated for invidivuals, and there are far fewer variables involved.

    Or let's take it another way. Ms. Kiviat goes out and buy what she thinks is an appropriate healthcare policy, that covers the NYC area well, and has some vague countrywide/int'l coverage, since she knows she'll be doing at least some travelling for the job.

    While she's out in omaha listening to the sage speak, she catches a nasty illness from one of the other attendees and falls unconscious mid-speech. She is rushed to local hospital and spends a fair amount of time in intensive care until cured.

    However, her policy considers that hospital out of network, as the ambulance didnt take her to the one that is in-network, and she was unconscious at the time. It only pays token amounts for treatment.

    Her hospital bills mount up and she has to declare bankruptcy, all because the EMT saved her life. Is this the system you would like to sign up for?

    This is just an issue with individual based healthcare that single-payer solutions avoid. the issues that usually befoul the comparison with US healthcare is many single payer systems are also single provider systems and thats where the issues tend to crop up.

  • 3

    @TomT: What most people don't realize is that if you buy several pounds of arugula and smash it up into a ball you can

    (a) go bowling with it, and

    (b) after a few weeks have passed, distill it into a nasty high-proof alcoholic beverage

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