Friday, January 4, 2008

Hyde on Individual Mandates

The December 29, 2007 Rocky Mountain News has printed the following OpEd by Steve Hyde on the problems with the individual mandates advocated by the 208 Commission. Here are some excerpts:
An Unhealthy Cure

Health-care reform proposal won't solve underlying issue of escalating costs

The Colorado Blue Ribbon Commission for Health Care Reform, after soliciting and reviewing health-care reform proposals from numerous organizations, recently approved recommendations that were reported to closely mirror its own "fifth proposal." While this proposal has a number of beneficial features, its major recommendations would do little, if anything, to contain rising health-care costs, while significantly increasing both taxes and the regulatory burden on employers, health-care providers, insurers and consumers.

A big mistake

Some people believe this proposal has a chance of winning approval. But based on my many years working in the health-care field, I think that would be a mistake. A big mistake.

The commission recommends that all legal residents of Colorado be required to have health insurance, with basic plan coverage. But that's like requiring that we all have auto insurance that pays for oil changes and dent repair, but not for a totaled car. The basic benefit plan, with its emphasis on low-cost primary care, anemic hospital coverage ($25,000 maximum) and low maximum total benefits ($50,000), is not so much an insurance product as a prepaid primary care product.

Real insurance is intended for people to pay relatively small amounts into large risk pools to fund major, unpredictable and otherwise unaffordable events. But with acute medical conditions often far exceeding $25,000, the basic plan is anything but catastrophic insurance. People needing it most will be left high and dry, with huge bills to pay.

True high-deductible, catastrophic insurance would be no more expensive than this basic plan, but offer far better, real insurance coverage for the currently uninsured. As a bonus, those so insured would be eligible for significant federal tax benefits via health savings accounts...

Continuing a flawed system

Setting minimum benefits merely continues and further complicates the current, deeply flawed defined-benefit system of health benefits.

Such approaches have utterly failed to provide consistently high quality health-care at affordable prices to all our citizens. Getting the state out of the benefit-setting business and properly enabling a more market-based solution will allow the use of a more rational defined-contribution approach. That will allow the state to apply its subsidies in a much more precise and targeted manner to aid those most in need of assistance, while relying on market solutions to make health care increasingly affordable.

No matter how low one sets the level of basic benefits, even the most inexpensive plan will eventually become unaffordable if health costs and premiums continue to rise by two to seven times the rate of wage growth. We need reform that will truly contain costs, not just pump more money into the current, dysfunctional system.

There is nothing in the Blue Ribbon Commission's plan that will result in cost containment and much that will exacerbate the problem.

Steve Hyde is the president of Hyde Rx Services Corp., and former CEO of Peak Health Care. He is the author of the book, Prescription Drugs for Half Price or Less, and the forthcoming How I Destroyed American Health Care, And Why We Need To Do It Again. Reach him online at