Why Oh Why Are We Ruled by These Dorks? (Health Care Edition)

Dan Froomkin http://www.washingtonpost.com/wp-dyn/content/blog/2006/01/25/BL2006012501071_pf.html directs us to some real analysis of the forthcoming Bush health proposals:

On NiemanWatchdog.org, Harvard Medical School professor emeritus Rashi Fein writes:

"One of the strengths of large employer-provided health insurance (and of Medicare) is the sharing of risk across large numbers of individuals. If the pool is fragmented and each of us has his or her individual insurance and savings account, premiums will increase for those who are sicker or older as they fall for those who are healthier or younger. This cannot be justified as a matter of social policy. For instance, it would exacerbate the present situation in which almost 20 percent of African Americans and one-third of Hispanics are uninsured.

"Furthermore, the tax-free characteristics of the savings account provide an incentive to postpone preventive care services and early diagnoses -- if I wait perhaps it will go away and I get to keep the money in the savings account. Yet in some cases such postponements lead to bad health outcomes and even higher long run costs. Thus the savings account approach is not only bad social policy, but -- because it negates the current emphasis on health promotion and disease prevention -- it represents bad medical policy."

Columbia University researchers Sherry Glied and Dahlia Remler recently found that HSAs are not likely to be an important contributor to expanding coverage among uninsured people because most of them do not face high-enough marginal tax rates to benefit substantially from the tax deductibility of HSA contributions. Leonard E. Burman and Linda J. Blumberg of the Urban Institute call HSAs a "tax cut for rich people." Ezra Klein writes in the American Prospect that "what HSA's really do is separate the young from the old, the well from the sick. Currently, insurance operates off of the concept of risk pooling. Since health costs tend to be unpredictable and illness isn't thought a moral failing, we all pay a bit more than we expect to use in order to subsidize those who end up needing much more than they ever thought possible. The well subsidize the sick, the young subsidize the old, and we all accept the arrangement because one day we will be old, and one day we will be sick, and no one wants to shoulder that alone.

"But HSA's slice right through this intergenerational, redistributionist arrangement: they're a great deal for young, healthy folks because they don't force subsidization. Just don't get sick."...

As I've said before, I believe the reason that Bush is pushing HSAs is that they are a tax cut, his only rule of domestic policy is to cut taxes, and that this is the only tax cut he thinks he can sell.

Impeach George W. Bush. Impeach Richard Cheney. Do it now.