Monday, October 27, 2008

Health Care Shouldn't Be Linked To Employment

The October 19, 2008 Boston Globe has a piece by Jeff Jacoby explaining how the US ended up with the bizarre system of health insurance as part of one's job benefits. At root, the problem was government interference with the free market:
Healthcare shouldn't be linked to employment

...[W]hat's unnatural is the link between healthcare and employment. After all, we don't rely on employers for auto, homeowners, or life insurance. Those policies we buy in an open market, where numerous insurers and agents compete for our business. Health insurance is different only because of an idiosyncrasy in the tax code dating back 60 years - a good example, to quote Milton Friedman, of how one bad government policy leads to another.

During World War II, federal wage controls barred employers from raising their workers' salaries, but said nothing about fringe benefits. So firms competing for employees at government-restricted wages began offering medical insurance to sweeten employment offers. Even sweeter was that employers could deduct those benefits as business expenses, yet employees didn't have to report them as taxable income. For a while the IRS resisted that interpretation, but Congress eventually enshrined the tax-exempt status of employer-based medical insurance in law.

Result: a radical shift in the way Americans paid for medical care. With health benefits tax-free if they were employer-supplied, tens of millions of Americans were soon signing up for medical insurance through work. As tax rates rose, so did the incentive to keep expanding health benefits. No longer was medical insurance reserved for major expenditures like surgery or hospitalization. Americans who would never think of using auto insurance to cover tune-ups and oil changes grew accustomed to having their medical insurer pay for yearly physicals, prescriptions, and other routine expenses.
As Jacoby concludes, "De-linking medical insurance from employment is the key to reforming healthcare in the United States." I agree -- this is one of the most critical free market reforms to implement.

(Via Mark Hillman.)