Tag Archives: Tax Reform

In One Image, Everything You Need to Know about Health Insurance, Community Rating, and Pre-Existing Conditions

When discussing government involvement in the health sector, I usually focus on the budgetary implications. Which makes sense since I’m a fiscal wonk and programs such as Medicare, Medicaid, and Obamacare are diverting ever-larger amounts of money from the economy’s productive sector.

I also look at the tax side of the fiscal equation and complain about how the healthcare exclusion mucks up the tax code.

Though it’s important to understand that government involvement doesn’t just cause fiscal damage. All these programs and policies contribute to the “third-party payer” problem, which exists when people make purchases with other people’s money. Such a system is a recipe for inefficiency and rising prices since consumers generally don’t care about cost and providers have no incentive to be efficient. And since government figures show that nearly 90 percent of health care expenditures are financed by someone other than the consumer, this is a major problem. One that I’ve written about many, many times.

But there’s another economic problem caused by government – price controls on insurance – that is very important. Indeed, the fights over “community rating” and “pre-existing conditions are actually fights about whether politicians or competition should determine prices.

Simply stated, politicians want insurance companies to ignore risk when selling insurance. They want artificially low premiums for old people, so they restrict differences in premiums based on age (i.e., a community rating mandate), even though older people are statistically far more likely to incur health-related expenses. They also want artificially low premiums for sick people, so the crowd in Washington requires that they pay the same or similar premiums as healthy people (i.e., a pre-existing conditions mandate), even though they are statistically far more likely to incur health-related expenses.

Set aside that the entire purpose of insurance is to guard against risk. Instead, let’s focus on what happens when these types of price controls are imposed. For all intents and purposes, insurance companies are in a position where they have to over-charge young and healthy people in order to subsidize the premiums of old and sick people. That’s sounds great if you’re old and sick, but young and healthy people respond by choosing not to purchase insurance. And as fewer and fewer young and healthy people are in the system, that forces premiums ever higher. This is what is meant by a “death spiral.”

The pro-intervention crowd has a supposed solution to this problem. Just impose a mandate that requires the young and healthy people to buy insurance. Which is part of Obamacare, so there is a method to that bit of madness. But since the penalties are not sufficiently punitive (and also because the government simply isn’t very competent), the system hasn’t worked. And to make matters worse, Obamacare exacerbated the third-party payer problem, thus leading to higher costs, which ultimately leads to higher premiums, which further discourages people from buying health insurance.

So how do we solve this problem?

One of my colleagues at the Cato Institute, Michael Cannon, is a leading expert on these issues. And he’s also a leading pessimist. Here’s some of what he wrote a week ago as part of a column on the Senate bill to modify Obamacare.

ObamaCare’s “community rating” price controls are causing premiums to rise, coverage to get worse for the sick and insurance markets to collapse across the country. The Senate bill would modify those government price controls somewhat, allowing insurers to charge 64-year-olds five times what they charge 18-year-olds (as opposed to three times, under current law). But these price controls would continue to make a mess of markets and cause insurers to flee.

But he wasn’t enamored with the House proposal, either. Here are some excerpts from his analysis earlier this year of that proposal.

The House leadership bill retains the very ObamaCare regulations that are threatening to destroy health insurance markets and leave millions with no coverage at all. ObamaCare’s community-rating price controls literally penalize insurers who offer quality coverage to patients with expensive conditions, creating a race to the bottom in insurance quality. Even worse, they have sparked a death spiral that has caused insurers to flee ObamaCare’s Exchanges nationwide… The leadership bill would modify ObamaCare’s community-rating price controls by expanding the age-rating bands (from 3:1 to 5:1) and allowing insurers to charge enrollees who wait until they are sick to purchase coverage an extra 30 percent (but only for one year). It is because the House leadership would retain the community-rating price controls that they also end up retaining many other features of the law.

Though existing law also is terrible, largely because of Obamacare. Here are passages from Michael’s column in the Hill.

ObamaCare’s core provisions are the “community rating” price controls and other regulations that (supposedly) end discrimination against patients with preexisting conditions. How badly do these government price controls fail at that task? Community rating is the reason former president Bill Clinton called ObamaCare “the craziest thing in the world” where Americans “wind up with their premiums doubled and their coverage cut in half.” Community rating is why women age 55 to 64 have seen the highest premium increases under ObamaCare. It is the principal reason ObamaCare has caused overall premiums to double in just four years. …Why? Because community rating forces insurance companies to cover the sick below cost, which simply isn’t sustainable. The only solution ObamaCare supporters offer is to keep throwing more money at the problem — which also isn’t sustainable.

Anyone who wants to really understand this issue should read all of Michael’s work on health care issues.

But if you don’t have the time or energy for that, here’s an image that I found on Reddit‘s libertarian page. Using not-so-subtle sarcasm, it tells you everything you need to know about why price controls ultimately will kill health insurance.

P.S. None of this suggests we should feel sorry for health insurance companies. They got in bed with the previous administration and endorsed Obamacare, presumably because they figured a mandate (especially with all the subsidies) would create captive customers. Now that it’s clear that the mandate isn’t working very well and that increased Medicaid dependency accounts for almost all of the additional “insurance coverage,” they’re left with an increasingly dysfunctional system. As far as I’m concerned, they deserve to lose money. And I definitely don’t want them to get bailout money.

P.P.S. Republicans aren’t doing a very good job of unwinding the Obamacare price controls, but they deserve a bit of credit for being bolder about trying to undo the fiscal damage.

Addendum: A comment from Seb reminds me that I was so fixated on criticizing price controls that I never bothered to explain how to deal with people who have pre-existing conditions and therefore cannot get health insurance. I’m guessing the answer is “high-risk pools” where the focus of policy is directly subsidizing the relatively small slice of the population that has a problem (as opposed to price controls and other interventions that distort the market for everyone). But the main goal, from my perspective, is to have states handle the issue rather than Washington. A federalist approach, after all, is more likely to give us the innovation, diversity, and competition that produces the best approaches. States may discover, after all, that insurance doesn’t make sense and choose to directly subsidize the provision of health care for affected people. In the long run, part of the solution is to get rid of the health care exclusion in the internal revenue code as part of fundamental tax reform. If that happened, it’s less likely that health insurance would be tied to employment (and losing a job is one of the main ways people wind up without insurance).

Reposted from International Liberty

Are We About To Throw The Baby Out With The Bath Water?

Tom Kite is PGA Tour player whose low Major total belies his resume as a player….He only led the Tour in earnings twice, but he was the second Tour player to crack $1 million in a season (1989, a year after Curtis Strange did it), he finished in the Top 20 in money 17 times, and he was the first player to accumulate $6 million, $7 million, $8 million, and $9 million in career earnings.1 Tom, although an excellent player was not Greg Norman, Ben Crenshaw, Arnold Palmer or Jack Nicklaus; names one might expect to head that list. How? He did it by having a considerably higher finishing average than other players and naturally earned more prize money as a result.

In 1960, the New York Yankees lost to the Pittsburgh Pirates, 3 games to 4. Amongst the Yankees’ roster were future Hall of Fame Players Berra, Maris and Mantle. Still the Yankees lost despite having scored a total of 55 runs to the Pirates’ 27 runs.

These stories seem relevant to today’s political campaign rhetoric. We are told our system is corrupt. It may be; but wouldn’t it be a good thing to look at where and how? In light of the twisted language of our politically correct consciousness, which makes honest substantive discussions on issues difficult at best, it would likely be prudent to ensure my words here are clear.

Ever since our nation’s founding, we, the average citizen, have had a say in our national elections and discourse. But, aside from our votes, it has never been direct. Our votes, other than on state and local initiatives, nearly always involve our selection of someone to represent us. We delegate our political desires to someone who, hopefully, will reflect our views when they cast their votes on specific legislation.

We are not, as a political structure, a pure democracy. Never have been, although it could be argued that we have moved more in that direction. Our founders did not trust a pure democracy: structurally, we are a representative republic.

“what is government itself, but the greatest of all reflections on human nature? If men were angels, no government would be necessary. If angels were to govern men, neither external nor internal controls on government would be necessary. In framing a government which is to be administered by men over men, the great difficulty lies in this: you must first enable the government to control the governed; and in the next place oblige it to control itself. A dependence on the people is, no doubt, the primary control on the government; but experience has taught mankind the necessity of auxiliary precautions.”

– Federalist No. 51, James Madison

As Franklin, replying to a woman who asked as he left the Constitutional Convention, “Well Doctor what have we got, a republic or a monarchy?,” stated, “A republic . . . if you can keep it.”

Note Madison states the obvious: government is necessary due to the flaws of humanity generally. Not that people are evil per se (though some most certainly are – Hitler & Stalin come to mind), but that self interest is a universal human characteristic. Yet, government, established to prevent individual self interest from becoming anarchy or rule of the jungle, is an organization run by people. So how do you prevent the very self interest government is set up to protect against from becoming a tool of those who work in government?

A republic. A pure democracy is essentially mob rule: 50%, plus one negates the 50% less 1 in all matters. That is law of the jungle, lynch mob governance. A republic on the other hand is a layered form of democracy that attempts to mitigate the aggregation of political power. This form is still imperfect because people are still people.

I’ve recounted all of this because we’re being told nearly every day how corrupt the delegate system is. When, in truth, if any one cared to go beyond the railings and look into the process, it is actually a full demonstration of the principles of our founders’ efforts to keep us from being our own worst enemy. How?

First, the delegate selection is NOT controlled, at least in one political party’s structure1, by one centralized entity or small group of elites. Each state has it own rules, means and methods. This means that no one person or small group can control the outcome. A successful candidate must be able to navigate many different process rules, from state to state. It is much the same as a business in one state seeking to expand its offices to another state – they have to look at how the laws, taxes, etc., impact how they conduct business in order to successfully operate there.

This multi-faceted, variable process is accidentally brilliant. Accidentally because the states themselves and the state party structures were set up independently, over a period of decades, and through their own localized self interest developed whatever delegate process they thought would serve their own constituents best. Each of these statewide party representatives are individuals who got involved in the process because they wanted to influence the outcome however they could.

Perfect? Not at all. But it does keep political power less concentrated and more diverse. And that benefits us all.

Confusing? Yes. Corrupt? Not likely; it is just too diversified, too disconnected for full centralized control. Those who argue for pure democracy would do well to recognize the dangers of mob rule. Is that what you really want? How long would our society survive if that were how we decided things?

Don’t like the outcomes? Get involved. But regurgitating easy and disingenuous slogans which tend only to stoke emotional fervor is destructive. It is the very thing that lead to the rise of some of history’s most wretched atrocities. One only need look to 1789 France to appreciate the horror of the mob. Our elected officials, particularly in the last three election cycles, have not been as representative as many had hoped they would be as to the direction of the country, the size, scale and scope of government’s influence in our daily lives. But to allow that disappointment and frustration to literally blow up the layered system meant to protect us from ourselves is precisely what some advocate for – an utter collapse of the system allowing for who knows what.

It should be noted that what makes government necessary is at the same time the very thing that requires government be restrained and limited in size, scale and scope. Otherwise, we cease being even the imperfect representative republic.  The Constitution acknowledges the imperfections of humanity and attempts to allow each of us to enjoy individual liberty to pursue life as we envision it. It seeks to protect our God-given, unalienable rights by preventing each of us from using political power to our own advantage over one another. And while, we’ve done considerable damage to that bulwark, it is not yet fully lost.

But, if the tone and language, accompanied by blind, emotional outrage and verbal assaults are any indication, we could inadvertently usher in that which disassembles the very thing that ensures each and everyone of us are able to continue being a free people, to enjoy life as we would pursue it.

“Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety.”

– Benjamin Franklin

  1.  PGA Tour Career Money Leaders History
  2. The Democratic Party delegate process has what are known as “super delegates”. These delegates are solely controlled and assigned by the DNC directly to the candidate the Party decides, not the voters. CNN interview DNC Chair Debbie Wasserman Schultz explaining this: https://youtu.be/w5llLIKM9Yc

Lex Rex
April 20, 2016