The Affordable Care Act (ACA) is the wrong prescription for an improperly diagnosed problem. Consequently, whatever benefits it may provide will be greatly outweighed by its adverse side effects. They will worsen a serious cost problem and degrade senior citizens’ access to care.
What ails US health care is too much third-party payment.
Imagine how the cost of food, another basic need, would skyrocket if Americans were told that government or private payers would subsidize 89 cents of every dollar spent. Instead of addressing these perverse incentives, the ACA will make them worse by expanding the amount of subsidized care and imposing federal control on decisions that most other markets leave in the hands of individuals.
Policies that provide the right incentives would better serve Americans – and significantly reduce the number of uninsured.
In Medicare we can achieve this by switching from offering open-ended packages of defined benefits to giving beneficiaries a fixed amount of funds, which they can use to choose among a broad array of health plans. Officials have already used the same idea for more than a half decade to allow seniors to select their Medicare drug benefits; the fierce competition among plans has helped reduce such drug expenses by 30 percent over time, and by nearly 40 percent in 2011.
Medicaid can follow a similar path if Congress gives states a set dollar amount and allows them to decide how best to manage their programs – a move that would expand consumer choice, increase competition among providers, and lower costs.
Converting the tax exemption for employer-sponsored health insurance to a fixed-dollar tax credit for individuals that varies by income and health status would likewise avert many problems of the current system – and harness the unparalleled shopping ability of Americans to find good value for their money.
Christopher J. Conover is a research scholar at Duke University’s Center for Health Policy and Inequalities Research, an adjunct scholar at the American Enterprise Institute, and author of “American Health Economy Illustrated.”
