Jane Galt’s health plan

by on March 26, 2006 at 10:54 pm in Medicine | Permalink

Have the government pay for all health care expenditures above 15% of
adjusted gross income, and cover 100% of health care expenditures by
people living under 200% of the poverty line.

This preserves the market in most health care services–happy HSA
advocates! It is progressive, and provides universal coverage–happy
single-payer advocates! It directs coverage to those who really need
it–the very sick–without a middle class subsidy–happy Jane! And it
preserves market prices for almost everything from hospital beds to
surgical procedures, since a significant fraction of the market will be
paying their own way. That keeps the government from having to set
prices, which as Soviet Russia showed us, is generally a bad idea. Most
importantly (from my perspective) it preserves the market for
innovations in drugs and medical equipment.

Here is the full post.  My guess is that this needs to be defined across wealth rather than
income, if only to a) cover the retired elderly, and b) prevent people
from tanking their incomes when family members get sick.  It could
therefore resemble extreme means-testing for Medicare, one of my
favorite ideas.  Except it would treat young and old on the same plane.

One worry I’ve had about means-testing is the implicit tax hike on wealth creation.  How
steeply would this implicit tax rise, as health care consumes a growing percentage of gdp?  And when suppliers are charging the often-identifiable eligibles (what percent of the population lies below 200% of the poverty line, and how do they dress?), what kind of controls must we impose on the contracts?  Would any doctor or hospital down here in Cajun country have free prices?  If the government set prices too low, would these noble crawfish-boilers end up with greater access to care?

Addendum: Read her post on why HSAs and single-payer plans are unlikely to lower health care costs.  Second addendum: Read Arnold Kling as well.

1 Sarah March 27, 2006 at 12:01 am

Where in New Orleans are you?! Are you giving any lectures??

-A huge fan at Tulane university

2 Slocum March 27, 2006 at 8:25 am

My guess is that this needs to be defined across wealth rather than income

Both wealth and income, I’d say. A reasonable analogy would be financial aid for college students (which takes both factors into account).

3 Dan K March 27, 2006 at 9:41 am

Uhm, Christopher, are you familiar with the concept of insurance?

4 Slocum March 27, 2006 at 11:56 am

“I’m with DeLong on this one. This is Kerry’s plan.”

In Delong’s comments Jane explains why this is not Kerry’s plan.

5 Kyle N March 27, 2006 at 6:06 pm

Although I agree with you COSMO, I would say some sort of universal health insurance is an inevitability. I would just like to see it retain some of the competition of the free market.
It also has to take into account illegal immigration. Two large hospitals in My state are filing bankruptcy due to the costs brought by illegals whom they have to treat.

6 Don March 28, 2006 at 7:45 am

“Why are we giving them free health care? It’s to preserve some semblance of society. No one wants sick people on the streets, and it benefits us all (at a modest cost, sometimes) to provide it.”

No one wants poor kids to be forced to go barefoot, either. We need a massive transfer program ensure that everyone has a decent pair of shoes! It benefits us all, and good grief, the richest country on earth can certainly afford it! It’s to preserve some semblance of society, which of course makes further cost and benefit estimates moot.

(removing tongue from cheek)

7 dsquared March 29, 2006 at 12:35 pm

would not the same result be achieved, without the known problems of means-testing and withdrawal rates (sucks to earn that extra dollar that takes you over 200% of the poverty line!) by simply providing a really second-rate system for free to anyone who wants it, and letting the highest quality of health care be bought on an open market? This is what we do in the UK and France and it seems to work OK.

8 linda October 9, 2006 at 7:23 am
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15 Roger Mill June 4, 2007 at 3:45 am

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