The blog of Freedom and Individual Rights in Medicine (FIRM)
The real news is that New York ruined its individual insurance market two decades ago by imposing the same regulations that ObamaCare is about to impose on every other state. If the Empire State's premiums do now fall, it will be because the Affordable Care Act partially deregulates New York insurance.Incentives matter. (Via Dr. Richard Amerling.)
Here is the ultimate justification for the Bloomberg soft-drink ban, not to mention his smoking ban, his transfat ban, and his unsuccessful efforts to enact a soda tax and prohibit buying high-calorie drinks with food stamps: The taxpayer is picking up the bill.
Call it the growing chattelization of the beneficiary class under government health-care programs. Bloombergism is a secular trend. Los Angeles has sought to ban new fast-food shops in neighborhoods disproportionately populated by Medicaid recipients, Utah to increase Medicaid copays for smokers, Arizona to impose a special tax on Medicaid recipients who smoke or are overweight. New York itself, with private money, some of it from Mr. Bloomberg's own pocket, has also tried the carrot approach, dangling direct payments to encourage beneficiary families to adopt healthier habits.
So perhaps the famous "broccoli" hypothetical during the Supreme Court ObamaCare debate was not so fanciful after all. It flows naturally from the state's fiscal responsibility for your health that it will try to regulate your behavior, even mandating vegetable consumption.(Read the full text of "The 5th Avenue to Serfdom".)
If Michael Moore has a toothache, it is not my responsibility to pay for his dentistry. If it were, then I would have the right to tell him not to eat sweets. I don’t want that kind of government-paid medical policy. Do you?
While the causes of the perceived obesity crisis are too complex to delve into in a blog post, it is pretty obvious that this super-sized soda ban will do nothing. First of all, there’s nothing in this proposal to prevent customers from purchasing multiple bottles of 16 ounce drinks. Furthermore, sweetened drinks in bottles greater than 16 ounces will still be available in grocery and convenience stores.
So why is he doing this? Perhaps Mr. Bloomberg is really stretched for a way to spend the $15.5 million in stimulus money? As the Heritage Foundation reported last October, the Centers for Disease Control (CDC) provided $230 million for 25 communities’ obesity campaigns. And here I thought stimulus money was meant to help struggling communities and to decrease unemployment — turns out it was really meant to make commercial that portray American companies (aka employers) as selling carbonated fat-in-a-can.
Perhaps this is just an attempt to look like a do-something-mayor in the lead up to the City’s 2013 election. Or perhaps he really wants to reduce the rate of obesity. Whatever his reasons, this type of overreach demonstrates that he either has a lack of understanding of how public policy can affect public health, a disregard for individual choice, and/or zero knowledge or complete disregard for how economies function...(Read the full text of "New York City Mayor Michael 'Nanny' Bloomberg Wants To Ban Super-Sized Soda".)
Starting next year, New York will become the first state to require lawyers to perform unpaid work before being licensed to practice, the state’s chief judge announced on Tuesday, describing the rule as a way to help the growing number of people who cannot afford legal services.
The approximately 10,000 lawyers who apply to the New York State Bar each year will have to demonstrate that they have performed 50 hours of pro bono work to be admitted, Chief Judge Jonathan Lippman said. He said the move was intended to provide about a half-million hours of badly needed legal services to those with urgent problems, like foreclosure and domestic violence.The Freakonomics Blog asks a very natural question: "What would happen if newly minted doctors were similarly seconded into pro-bono work?"
New York's insurance system has been a working laboratory for the core provision of the new federal health care law -- insurance even for those who are already sick and facing huge medical bills -- and an expensive lesson in unplanned consequences. Premiums for individual and small group policies have risen so high that state officials and patients' advocates say that New York's extensive insurance safety net for people like Ms. Welles is falling apart.The spiral of controls causing problems leading to calls for more controls is clear:
In 1993, motivated by stories of suffering AIDS patients, the state became one of the first to require insurers to extend individual or small group coverage to anyone with pre-existing illnesses.ObamaCare seeks to avoid this problem by the individual mandate, requiring people to purchase insurance (as in Massachusetts). The result:
New York also became one of the few states that require insurers within each region of the state to charge the same rates for the same benefits, regardless of whether people are old or young, male or female, smokers or nonsmokers, high risk or low risk.
Healthy people, in effect, began to subsidize people who needed more health care. The healthier customers soon discovered that the high premiums were not worth it and dropped out of the plans.
But analysts say that provision could prove meaningless if the government does not vigorously enforce the penalties, as insurance companies fear, or if too many people decide it is cheaper to pay the penalty and opt out.Unfortunately, the insurance industry lobby has argued for stricter penalites rather than free market reforms -- i.e., further infringements on individual freedoms. Unless they take a principled stand for freedom, they'll just be aiding in their own eventual destruction through this increasing spiral of regulations -- and taking the rest of us down with them.
New York enacted a health reform package with these two mandates - known as guaranteed issue and community rating - in 1993, making it unique among the states (only five others have both mandates but none has requirements as strict as New York's). Back when the state instituted the reforms about 752,000 residents were buying health insurance directly from insurance companies in the individual market. But premiums immediately started to soar, and as residents realized they could purchase insurance at any time, even after they got sick, New York's individual health insurance market disappeared, shrinking by 95 percent all the way down to a mere 34,000 individuals. Meanwhile, the ranks of the uninsured spiked to 20 percent by 1997.(Read the full text of "Health Care Reform: Welcome to NY, America".)
New York's response to its vast increase in uninsured residents was to offer more state-subsidized insurance. When the price tag on these plans began to weigh down the state budget, New York slapped new taxes on residents and businesses to pay for them, including a new $275 million assessment against insurance companies on top of some $3 billion in assessments they already pay in the state. All of this so that the state's uninsured rolls would soar as costs spiraled upward and then declined again as government stepped in with subsidized coverage.
...In a study of New York, the Manhattan Institute estimated that the Empire State's mandates increased the cost of health premiums by a whopping 42 percent to the highest in the nation (this was before RomneyCare spiked Massachusetts' premiums even higher). The study estimated that up to 37 percent of those who were uninsured in the state could afford coverage if the state junked its expensive mandates, especially the guaranteed issue and community rating mandates...
In 1993, New York adopted two of the most popular parts of the health care reform bill that recently passed the Senate: "guaranteed issue," or a rule that insurers must sell to anyone, regardless of pre-existing conditions; and "community rating," which prevents insurers from setting premiums based on characteristics like age and sex. (New York's reform is more radical than proposed federal reforms, as it allows no variance at all on age; the Senate bill would cap the amount of age-based difference).(Read the full text of "A 'Scaled Back' Health Bill Won't Work".)
New York did not require anybody to buy health insurance, nor did it give out subsidies to help people pay for it (though it did expand government-provided insurance at vast taxpayer expense.)
These reforms were supposed to make it possible for more people to get insurance coverage. Instead, what they did was drive premiums through the roof. Now, the cheapest insurance plan for a family in New York City costs $26,040, compared to a national average of around $13,000.
Unsurprisingly, few New Yorkers find these prices affordable, and the share of New Yorkers with individually-purchased coverage has fallen by 96%, to about 2 in 1000. Functionally, New York barely even has an individual insurance market anymore. As a result, New York's rate of uninsurance is in the middle of the pack nationally, even though the state ranks 4th in the share of residents on Medicaid.
New York experienced what is known as an "insurance death-spiral." Under community rating and guaranteed issue, healthy people found insurance premiums to be a bad deal and they dropped out. This increased the average risk among insureds, so premiums rose once more, again driving the healthier and poorer participants to drop. The process repeated itself until almost nobody found it worthwhile to buy their own insurance.
Why is private health insurance so expensive? Blame Albany. First, state lawmakers have mandated that all health plans cover a host of procedures and "alternative-medicine" services, far more than companies in most states offer. Even the most stripped-down plan must include coverage of off-label drugs, surgical second opinions, and midwife and podiatrist services. Each mandated benefit makes the policy more expensive. Two state insurance regulations -- "guaranteed issue," which forces insurers to sell to any applicant, and "community rating," which requires them to offer the same price to everyone, regardless of age and health -- inflate prices further. Finally, the state has added billions of dollars in taxes and fees to private insurance policies, making them even pricier.(Read the full text of "The Medicaid Monster".)
The perverse result: the young, healthy, and self-employed -- facing higher premiums for insurance that they seldom use, and realizing that they can always wait until they become ill to buy insurance -- tend to drop their coverage. (If New York regulated home insurance like this, you could buy a policy after your house had caught fire.) What's left is an insurance pool of older, sicker people, which drives private premiums higher still. Worse, the large number of uninsured people -- a consequence of Albany's bad policies—then becomes a justification for expanding the Medicaid rolls.
...[T]he trade group for the nation's insurers, America's Health Insurance Plans, estimated that the average premium for family coverage in the individual market nationally was $5,800. But the study found wide disparities in costs, ranging from average premiums north of $12,000 in New York and Massachusetts to premiums costing on average only $3,000 to $5,000 in more than a dozen states. Some states have even allowed insurers to introduce low-cost, high-deductible policies that can cost under $1,000 a year.(Read the full text of "To Cut Your Health Insurance Costs, Move".)
It's fair to say that the costs imposed by some states based on how they regulate health insurance are now a bigger burden on individuals and small and mid-sized firms than state and local taxes.
...There's no evidence that states garner any benefit from such regulation and mandates. States with numerous mandates don't have healthier populations, for instance. Indeed, many state mandates are enacted for political reasons that have little to do with health care outcomes. Several years ago New York's then-Governor Pataki signed into law the state's hefty in vitro fertilization mandate as a payoff to conservative religious groups whose members favor big families and lobbied heavily for the law. It's a rather classic example of how, when you vest such power in lawmakers, some will eventually abuse it.
New York - FAILSuderman concludes:
Massachusetts - FAIL
Maine - FAIL
Tennessee - FAIL
Despite these state-level failures, President Barack Obama and congressional Democrats are pushing forward a slate of similar reforms. Unlike most high-school science fair participants, they seem unaware that the point of doing experiments is to identify what actually works. Instead, they've identified what doesn't -- and decided to do it again.(Read the full text of "The Lesson of State Health-Care Reforms".)