Let’s take a magical journey into Hypothetical Land (cue wind chime sound…):
Massachusetts Governor ToMittDev PatReilHealNey announced a proposal that would increase health care costs by 41% by the year 2009. In addition, he/she proposed that fewer employers would offer coverage; that co-pays and deductibles would rise sharply; the numbers of uninsured will grow by about 25%.
"Well, you can always declare bankruptcy — oops, guess that’s off the table, too," laughed PatReilHealNey. "The people of Massachusetts are getting a strong message: We’re prepared to sacrifice human lives and your pocketbook to keep your taxes low."
At the hearing for the Health Access and Affordability Act (HA3), it was clear that lawmakers are concerned about the cost of such an expansion of access. That is a reasonable concern. However, let’s be clear about this subject: We’re paying for it now, with huge increases every year, and we’re not getting a proportionally better product or greater access for all the extra cash that is flowing out of our pockets — or just never showing up in our take-home pay.
HA3 would help to lower premiums by essentially making the state a "co-payer" for catastrophic cases. This has worked fairly well in New York State so far — premiums dropped after adopting what they call a cost-sharing "corridor" — that is, the state picks up an increasing percentage of insurer’s costs above a certain amount. That makes the insurers happy, since it limits their risk; and it makes consumers happy, since it allows insurers to lower their premiums.
So there’s a chance to actually keep more money in your pocket by allowing the state to administer such a program. But it’s an investment — we’ve got to put a little money on the table to enable this money-saving device. HA3 pays for it through a 50 cent tax increase on cigarettes, and there may be some other "revenue enhancements" necessary. But let’s be clear: if your premium drops $2 and your taxes go up $1, then you’re ahead. That’s more money in your pocket. Let’s not let the pols be spooked by tax hike hysteria: let’s do a real cost-benefit analysis. I don’t care if I have to pay the state, or an insurer: I just want to keep more of my money and have better health. Sounds pretty normal to me.
(I wrote more on the "Return on Investment" in public health here.)
