• Cost is still an issue

    From the Commonweath Fund today:

    Using data from The Commonwealth Biennial Health Insurance Survey of 2010 and prior  years, this report examines the effect of the recession on the health insurance coverage of adults  between the ages of 19 and 64 and the implications for both their finances and their access to  health care. The survey of 3,033 adults [was] conducted by Princeton Survey Research Associates  International from July 2010 to November 2010

    I encourage you to go read the whole thing, but here are some highlights:

    • 43 million adults are in families with a job loss in the last two years. Of those, almost half lost their insurance because of the job loss, and almost 60% of those (or 9 million) became uninsured.
    • Of adults age 19-64 who tried to buy individual coverage,19 million of them had serious issues or couldn’t find affordable coverage at all. More than 80% of those people had health problems.
    • Over 120 million adults age 19-64 were uninsured, went without health care because of cost, or paid large shares (more than 10%) of their income on medical costs.

    While the PPACA has significant problems, it does a lot of work to correct these issues. I’d appreciate anyone who supports repeal specifically addressing how their preferred method of reform does the same.

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    • On the first point, as long as health insurance is tied to employment, people who lose their jobs will lose their insurance. This is true even under PPACA– the individual mandate has a grace period of 90 days. If you want to fix this problem, you have to decouple insurance from employment. The method for that is simple– change the tax code so that income spent on health care through your employer is treated the same as income spent on health care independently. It’s a simple change, that could be accomplished with a one-page bill, but no Democrat will touch it with a ten-foot pole.

      On the second and third points, the real issue is health care costs. (You’ll never have affordable insurance when the health care itself is unaffordable for insurance companies!) My preferred reform for health care costs is to increase price awareness, and the best way to do that seems to be through some kind of health savings account system. It doesn’t require high deductibles, and you can preserve whatever subsidies for the poor, elderly, etc. that you want. (Just deposit more money into the HSAs of people you think need it.)

      The major drawback to both of these reforms is that they rely on market pressures. Of course, I believe that’s a huge bonus. But if you don’t trust the unwashed masses to make intelligent decisions with their own money/HSA, then you need to resort to some kind of government-run system.

    • ” It’s a simple change, that could be accomplished with a one-page bill, but no Democrat will touch it with a ten-foot pole.”

      IIRC, it was a central piece of Wyden-Bennett. Klein, among others, has advocated for this. If you read this blog regularly, it is often talked about. The ACA partially finances through this mechanism.

      “and the best way to do that seems to be through some kind of health savings account system”

      AFAICT, all of the studies on HSAs suffer from significant selection bias. There is no strong evidence I am aware of that HSAs save money.

      Steve