links for 2008-08-25
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Morning Coffee: Why McCain's Health Reform Plans Frighten Me (August 25, 2008)

The biggest economic bad news is that health care costs keep rising. The total bill charged by insurers for employer and employee averages $12,100 for a family of four--twice the level of seven years ago, and comfortably more than the full-time earnings of a minimum-wage worker. On top of this come the taxes for government health care programs. The American health care bill is over $7,600 per person per year.

This matters for American businesses. Businesses pay for health insurance coverage for 165 million non-elderly Americans, for the high-wage jobs that make use of the educations, skills, and high potential productivity of American workers come with benefits. This creates a direct link between rising health care costs and slower economic growth. When health costs rise, the costs of employing workers in high-wage high-benefit jobs rise as well. Businesses find that they cannot afford to expand employment as rapidly as they would otherwise: higher health care costs make maintaining their old workforce and expanding it via new hires very expensive. They economize. They hire fewer workers. They offer lower wages. Workers resist. The result is slow employment growth and higher unemployment until workers recognize that the scarcity of good jobs and the higher risk of unemployment teaches them they have little bargaining power--a process that takes years. Meanwhile workers who ought to be in high-skill high-wage high-productivity jobs with benefits find themselves in low-skill low-wage low-productivity jobs without benefits instead. This is a waste. Workers who could hold down high-productivity jobs don't, and so don't get the wages that they deserve. Firms who could employ high-skill workers don't, and so don't get the profits that they deserve.

Successful economic growth requires a more efficient, lower cost health care sector. John McCain and Barack Obama propose diametrically-opposed plans for trying to get the health care system to where we all want it to be.

John McCain proposes a root-canal surgery approach. The problem, he and his health-care advisors believe, is that good jobs are linked to health-care benefits. Break that link--remove the expectation that good high-productivity jobs come with benefits--and the health care sector will no longer be a major drag on the American economy as it goes its own way, whatever that way might be. Hence John McCain proposes, relative to the current system, to penalize employers that offer high-value employer-sponsored coverage and subsidize individuals who get health insurance outside the employment relationship.

We see two problems with McCain's approach: the journey and the destination. The journey: The McCain plan works in the long-run by making employer-sponsored coverage more expensive in the short- and the medium-run. It thus attempts a cure by giving American business a worse case of the rapidly-rising health-cost disease from which it currently suffers. Rapidly rising health costs are a drag on high-wage high-profit high-productivity employment now, and they will be a much worse drag on high-wage high-profit high-productivity employment under the McCain plan--at least until we come out the other side and enter a world in which it is no longer expected that high-productivity jobs come with benefits.

The destination: The biggest problem in health care today is that insurers are rewarded not for keeping their customers healthy but for figuring out which customers are likely to get sick first--and then dumping them onto other insurers or onto the government. At present, this problem is restrained by the institution of employer-sponsored insurance: bid for an employer's contract and ERISA requires that you take any of their workers who want to purchase your plan. The destination of McCain's plan is a place where insurers have much more freedom to spend money, administrators' time, and computer power separating the healthy sheep from the costly and sick goats--but the profits to doing this for one insurer are not savings for the system because the sick and uncovered do show up at the emergency room eventually and are more expensive to treat when they get there. We believe that when the McCain plan does move us to a world in which the expectational link between high-productivity jobs and benefits is broken we will then have a system that works even less well than our current one.

Barack Obama, by contrast, offers a much more conservative approach to the problem of health care reform. Instead of using tax penalties and incentives to break the existing system and create a whole new set of untried health care financing institutions, Barack Obama proposes to build on those components of our current system that do work--and to make them work better.

But I've talked for More than Long Enough