How to Fix the
Health-Care 'Wedge'
There is an alternative to ObamaCare.
By ARTHUR B. LAFFER
President Barack Obama is correct when
he says that "soaring health-care costs make our
current course unsustainable." Many Americans agree:
55% of respondents to a recent CNN poll think the
U.S. health-care system needs a great deal of
reform. Yet 70% of Americans are satisfied with
their current health-care arrangements, and for good
reason-they work.
Consumers are receiving quality medical
care at little direct cost to themselves. This
creates runaway costs that have to be addressed. But
ill-advised reforms can make things much worse.
An effective cure begins with an
accurate diagnosis, which is sorely lacking in most
policy circles. The proposals currently on offer
fail to address the fundamental driver of
health-care costs: the health-care wedge.
The health-care wedge is an economic
term that reflects the difference between what
health-care costs the specific provider and what the
patient actually pays. When health care is
subsidized, no one should be surprised that people
demand more of it and that the costs to produce it
increase. Mr. Obama's health-care plan does nothing
to address the gap between the price paid and the
price received. Instead, it's like a negative tax:
Costs rise and people demand more than they need.
To pay for the subsidy that the
administration and Congress propose, revenues have
to come from somewhere. The Obama team has come to
the conclusion that we should tax small businesses,
large employers and the rich. That won't work
because the health-care recipients will lose their
jobs as businesses can no longer afford their
employees and the wealthy flee.
The bottom line is that when the
government spends money on health care, the patient
does not. The patient is then separated from the
transaction in the sense that costs are no longer
his concern. And when the patient doesn't care about
costs, only those who want higher costs-like doctors
and drug companies-care.
Thus, health-care reform should be
based on policies that diminish the health-care
wedge rather than increase it. Mr. Obama's reform
principles-a public health-insurance option,
mandated minimum coverage, mandated coverage of
pre-existing conditions, and required purchase of
health insurance-only increase the size of the wedge
and thus health-care costs.
According to research I performed for
the Texas Public Policy Foundation, a $1 trillion
increase in federal government health subsidies will
accelerate health-care inflation, lead to continued
growth in health-care expenditures, and diminish our
economic growth even further. Despite these costs,
some 30 million people will remain uninsured.
Implementing Mr. Obama's reforms would
literally be worse than doing nothing.
The president's camp is quick to claim
that his critics have not offered a viable
alternative and would prefer to do nothing. But that
argument couldn't be further from the truth.
Rather than expanding the role of
government in the health-care market, Congress
should implement a patient-centered approach to
health-care reform. A patient-centered approach
focuses on the patient-doctor relationship and
empowers the patient and the doctor to make
effective and economical choices.
A patient-centered health-care reform
begins with individual ownership of insurance
policies and leverages Health Savings Accounts, a
low-premium, high-deductible alternative to
traditional insurance that includes a tax-advantaged
savings account. It allows people to purchase
insurance policies across state lines and reduces
the number of mandated benefits insurers are
required to cover. It reallocates the majority of
Medicaid spending into a simple voucher for
low-income individuals to purchase their own
insurance. And it reduces the cost of medical
procedures by reforming tort liability laws.
By empowering patients and doctors to
manage health-care decisions, a patient-centered
health-care reform will control costs, improve
health outcomes, and improve the overall efficiency
of the health-care system.
Congress needs to focus on reform that
promotes what Americans want most: immediate,
measurable ways to make health care more accessible
and affordable without jeopardizing quality,
individual choice, or personalized care.
Because Mr. Obama has incorrectly
diagnosed the problems with our health-care system,
any reform based on his priorities would worsen the
current inefficiencies. Americans would pay even
more for lower quality and less access to care. This
doesn't sound like reform we can believe in.
Mr. Laffer is the chairman of Laffer
Associates and co-author of "The End of Prosperity:
How Higher Taxes Will Doom the Economy-If We Let It
Happen" (Threshold, 2008). His research on health
care can be viewed at
www.lafferhealthcarereport.org.