January 12, 2017


Republican Health-Care Plan: Rand Paul Makes a Good Start (Michael Tanner, 1/11/17, National Review)

Paul's proposal draws liberally from the best ideas in other Republican plans, while avoiding many of the pitfalls that make some of those plans unworkable. He would, for example, dramatically expand health savings accounts (HSAs). HSAs shift control of health-care spending from employers to employees. Paul's expansion would allow much larger tax-free contributions to these accounts, and would allow them to be used for a wider variety of health-related expenses, including insurance premiums. That would mean that you -- not your boss -- would be able to choose your insurance plan. Expanded HSAs would also mean increased portability for health insurance. Because you could use your HSA to pay your premium, you wouldn't be as likely to lose your insurance if you changed or lost your job.

This would replace many of the subsidies in Obamacare without the dangers of government-designated insurance inherent in some of the tax-credit proposals that some Republicans have backed. (If the government offers a credit for insurance, it has to define what insurance qualifies for the credit.) [...]

Paul would eliminate the pre-existing-condition regulations altogether (after a transition period), while his other reforms would significantly reduce the number of people who genuinely cannot buy health insurance because of a pre-existing condition. For those who still need help, Paul envisions responsibility for covering them being shifted to the states, possibly in conjunction with proposals to block-grant Medicaid.

This would give states the freedom to experiment with ways to cover people who are unable to buy their own insurance for whatever reason, whether pre-existing conditions or low income. Importantly, it prevents a small number of high-cost cases from distorting the rest of the insurance pool. It wouldn't try to insure the uninsurable, but would provide their health care more directly. After all, it is health care that counts, not health insurance.

Once you make the HSAs universal and fund them you've got the future.

Posted by at January 12, 2017 7:19 AM