Thursday, 16 February 2012

In which I risk seeming in agreement with Rick Santorum

It seems to me that if one’s goal is to reduce the escalating costs of health care (or at least reduce the rate of escalation of those costs), it would be rather counterproductive to increase people’s consumption of health care resources. Yet a number of policies, all implemented or encouraged by the present administration, have done so:

  • Obamacare proper required all health care plans to get rid of co-pays for many routine office visits to physicians.
  • The DEA‘s War on Meth and People with Colds has pushed two states (Mississippi and Oregon) to the point of requiring a prescription for dispensing any effective cold medicine containing pseudoephedrine, and many other states require it to be controlled behind the counter. Already one idiotic prosecutor has gone after someone trying to evade this silly requirement. Ten years from now, if not sooner, I have good money that says the feds will be going after “meth doctors” who are “overprescribing” pseudoephedrine, à la Oxycontin, and pharmacies who are “oversupplying” it.
  • Now, we have the administration requiring health care plans to provide women with birth control without a co-pay. Never mind the evidence that women on the pill have worse taste in men.

I get that these things are politically popular and/or support politicians’ desires to Look Tough On Drugs. I also get that women who cannot afford birth control probably should have that expense covered in full. What I don’t get is why these mandated “no-co-pay” coverages aren’t means-tested in some way to at least try to keep costs under control for the large share of the population who can reasonably afford some out-of-pocket health care expenses—indeed, our entire federal income tax system is structured, in part, around the idea that 7.5% of your AGI is expected to be dedicated to health care and thus cannot be deducted, even if you itemize deductions.

Finally, I conclude with the following two necessary caveats: (a) I have no particular truck with the moral positions of the Catholic Church or other churches with similar positions on birth control, and think if they want to employ people they can either provide health care coverage or pay the fines/taxes for not providing it, and (b) employer-based health care in general is a stupid way to accomplish universal coverage, and given that we seem to have decided that universal health care coverage is desirable it follows that some form of single-payer or government-subsidized system is preferable, particularly if you’re going to have a nominally private system that is totally loaded down with mandated coverages (aka unfunded mandates), must-issue rules, and uniform premiums. Hence I think some sort of subsistence level universal government-paid system, with rationing-by-queueing and ward-type inpatient service, is inevitable (if not desirable), and as long as individuals are free to pay (or buy supplemental insurance) to upgrade their place in line and to the Beyoncé Birthing Suite, I can’t say I have any particular problem with it.