Health Affairs

There are two ways people can insure for medical expenses: third party insurance and individual self-insurance. Under the former, a third party (insurance company, employer or government) pays the expenses. Under the latter, people must save and pay the expenses directly, from their own resources. This division of insurance responsibility is a normal aspect of... Read the rest of this entry »

Of all the issues bandied about in the recent debate over the debt ceiling, none generated more contention, more TV ads and more unseemly rhetoric than potential changes to Medicare. Health economists generally believe that Medicare is on an unsustainable course and is desperately in need of reform. Yet public opinion polls show that most... Read the rest of this entry »

Cass Sunstein, President Obama’s regulatory czar, announced last week that the administration intends to repeal cost-increasing, unnecessary regulations from 30 different agencies. If the administration is serious in this effort, a good place to start is with a web of regulations that are preventing life saving drugs from reaching the patients who need them. Doctors... Read the rest of this entry »

Editor’s Note: In addition to John Goodman (photo and bio above), this post was coauthored by Gerald Musgrave and Devon Herrick. In our third-party-payer health insurance system the price for care is typically set by entities external to the doctor-patient relationship.  As a result, providers rarely compete for patients based on money prices. Potentially they... Read the rest of this entry »

Editor’s Note: In addition to John Goodman (photo and bio above), this post was coauthored by Gerald Musgrave and Devon Herrick. Go to the web site of the Detroit Medical Center (DMC) and you will learn that DMC facilities rank among the “nation’s best hospitals” by U.S. News & World Report and that they have... Read the rest of this entry »

Over the next decade I believe we are going to see a major transformation of American medicine. It won’t be the kind of transformation that is normally discussed at health care conferences and at inside-the-Beltway briefings. Nor will it be the kind of change anticipated by the people who gave us the Affordable Care Act... Read the rest of this entry »

If you don’t keep up with the latest twists and turns in healthy policy, you probably don’t know what value-based health insurance benefits are. A Health Affairs article takes a focused look at it. Here is my layman’s summary: If you are like most people, you are not a very good consumer of health care.... Read the rest of this entry »

The House Republican “Pledge to America” calls for opening up the health insurance marketplace by allowing people to purchase insurance across state lines. Families USA director Ron Pollack objects that this would cause a “race to the bottom,” with consumers buying insurance in states with the fewest consumer protections (read: regulations) and, therefore, the lowest... Read the rest of this entry »

In the national debate leading up to the passage of the Patient Protection and Affordable Care Act (PPACA), President Obama said on several occasions that he would veto any bill that did not lower the growth rate of health care spending. So now that the Act is law, you would expect to find a lot... Read the rest of this entry »

One of the most oft-repeated arguments for health reform is that uninsured patients make costly and delayed trips to the ER when they do not have a health plan that pays for care at physicians’ offices. Insure the uninsured, it is said, and they will decrease their reliance on the ER and get prompter, less... Read the rest of this entry »

Cost sharing in a fee-for-service health care system is almost universally recommended by health economists. The reason: When patients pay some part of the costs of their care, they are likely to be more conservative, prudent shoppers in the medical marketplace. Under the recently enacted health reform, for example, the out-of-pocket exposure can be as... Read the rest of this entry »

Should everyone be required to have health insurance? The short answer is no. There is nothing that can be achieved with a mandate to buy health insurance that cannot be better achieved by a carefully designed system of tax subsidies. Beyond that, a requirement that everyone obtain insurance (as the new health reform law dictates)... Read the rest of this entry »

Critics of consumer-directed health care often argue that patients are not knowledgeable enough and the market is not transparent enough for consumerism to work in health care. But a study by The Commonwealth Fund says there is an international trend toward self-directed care (SDC) and it is focused on a most unlikely group of patients:... Read the rest of this entry »

The most significant and most radical change to the health care system that President Obama is proposing is to virtually eliminate the market for individual insurance and replace it with a highly-regulated health insurance exchange. But why would anyone want to do that? One reason is the persistent myth that the market for individual insurance... Read the rest of this entry »

I live in Texas. Right now, the only health insurance I can buy is insurance regulated under Texas law. But if bills before Congress (most notably, one sponsored by Arizona Republican Congressman John Shadegg), are enacted, I would be able to buy insurance regulated, say, by the laws of Virginia, or the laws of Delaware,... Read the rest of this entry »

Most proposals for dealing with the problems of pre-existing conditions would completely divorce health insurance premiums from expected health care costs. Yet a policy of trying to force health plans to take enrollees they do not want risks jeopardizing the quality of care they receive. Instead of suppressing the price system, I propose ten ways... Read the rest of this entry »

Truth is not only the first casualty of war, it is also the first casualty of serious public policy debate. Last year, a report by Families USA made the astounding claim that 6 people die every day in Florida because they are uninsured. Seven die every day in Texas, 8 in California, and 25 in... Read the rest of this entry »

Here is a paper with as many as 100 references that you almost never see cited in Health Affairs, or in the Journal of the American Medical Association (JAMA), or in the New England Journal of Medicine (at least not in their public policy articles). In fact, if you are a regular reader of these publications,... Read the rest of this entry »

For a long time, I have believed the greatest potential for Health Savings Accounts (HSAs) is in the treatment of chronic illness. I even wrote some fictional vignettes in a “vision” chapter in the National Center for Policy Analysis’ Handbook On State Health Care Reform, describing how HSAs might work for diabetics and other patients.... Read the rest of this entry »

What are the prospects for health reform? That depends on how flexible the new president turns out to be. Although Barack Obama was highly critical of John McCain’s health plan during the election, he actually needs key elements of the McCain plan. He also needs key elements of Mitt Romney’s health reform enacted in Massachusetts,... Read the rest of this entry »