Brad DeLong’s Health Care Proposal
I left this comment over at the League of Ordinary Gentlemen regarding Brad DeLong’s health care proposal, some of which is interesting, and some of which is rather silly. Matt Yglesias distills the idea into the following seven action items:
— 1. Taxes on public health hazards (booze, sweeteners, etc.)
— 2. An army of publicly employed doctors and nurses working in clinics and vans and such roaming the country dispensing preventive care and lifestyle advice to all and sundry.
— 3. 15 percent of your income is automatically plunked into a Health Savings Account.
— 4. When you want health care services that aren’t covered by the clinics, you pay out of your HSA.
— 5. If there’s money left in your HSA at the end of the year, it gets plunked into your IRA unless you specifically fill in an opt-out form.
— 6. If you run out of money in your HSA and need more health care, the government pays for it.
— 7. On top of the 15 percent HSA deduction, there’s a 5 percent tax to pay for 6.
Points three through five, regarding the Health Savings Account, are interesting. The rest of the points, of course, are going to be dismissed out of hand by conservatives. It seems the HSA idea could comport quite easily with conservative thinking, so I frankly don’t understand why it’s bundled up with other ideas that are so anathema to conservatives.
But the HSA idea might have enough of a “pay for your own self” spirit without too much paternalism in forcing folks to pay into it. But oy!—what’s this bottomless pit lurking around in there at number 6? I think I can find catastrophic insurance for less than 5% of my income. I understand that folks have this over-enlarged “social justice” center in the brain that spurs them to sliding measures like this into the conversation, but many of us do not. Over here in California, we pay through the ear for social programs. If health care is the social program du jour, then implement some pay-go spirit, and shift the cost from welfare into health care. All of it seems silly to me, this feeling worse for people than they feel for themselves. But shift around those silly program dollars to less silly programs, if you like, and you’re not likely to hear folks like me pipe up about it.
Without the HSA idea, the rest of the points are rubbish. I’m on board with fighting costs by some federal preemption on health care regulation and lifting the shroud of mystery over the costs of procedures. (And re pharma, is anyone talking about any ways of kicking the euro-free-riders off the innovations we pick up the tab for?) But let’s do those things before shoving out with this funny sounding mobile government doctor army idea. And “taxes on public health hazards” at number one on the list is going to halt the eyeballs’ downward momentum straight off.