Arnold’s Folly
California’s disastrous new health-care plan is another step toward a single-payer system.
By: Sally C. Pipes
1.22.2007
National Review Online, January 22, 2007
“Everyone in California must have health insurance," declared Gov. Arnold Schwarzenegger as he rolled out a Massachusetts-style scheme to blanket the state in health insurance. The politician who came to power attacking an employer-health-insurance mandate, and vetoed a single-payer bill once in office, is now proposing a health-care plan that relies on the former and will almost certainly result in the latter. Arnold’s health-care program, designed with the loving care of the folks at the New America Foundation, requires everyone to purchase at least a $5,000 deductible health-care policy. It boosts Medicaid roles, opening the taxpayer-supported program to illegal immigrants, children in families earning up to three times the official poverty level, and any adult whose income falls below the poverty line. It raises Medicaid reimbursement rates, a net gain to providers who specialize in low-income communities, and then taxes doctors and hospitals at 2 percent and 4 percent respectively — a total tax increase of $3.5 billion—to pay the increased tab. Employers with more than ten employees will either offer health care or pay a four-percent tribute, an estimated $1 billion, to the state. Insurers will have to offer policies on a guaranteed-issue basis, meaning that they will no longer be able to select and charge based on health status. This approach increased premiums by 500 percent in New Jersey. California’s insurance companies are also mandated to limit administrated expenses to 15 percent of revenue. This heap of contradictions, mandates, and taxes is justified by soft notions that access to health care is dependent on insurance status, that people without insurance are less healthy because they lack insurance, that the uninsured shift costs to the insured through uncompensated care, and that the uninsured are, in part, free riding on the rest of us. None of the problems justifies the proposed tax, spend, and regulate rampage that Arnold and others propose. But let’s examine the most compelling argument, at least for Republicans and former free-market advocates like Arnold who heed the left-of-center sirens: What about the problem of the uninsured transferring costs to the insured? This is not untrue, as we do not deny care to people who can’t pay. Although it can’t be precisely quantified how much extra private payers pay for charity care, it can be roughly estimated. . The New America Foundation quantified the number at $1,186 per insured California family. Nationally, about 2.5 percent of health-care spending is accounted for as unreimbursed, roughly what a store loses to shoplifting. Yet what Arnold and company fail to mention is that the biggest shifters of costs, shirkers of duties, and reduced-fare riders aren’t the totally uninsured. It’s the government payers, Medicaid and Medicare, which pay roughly $.92 and $.95 for a dollar of care. This adds up to 22 percent to the insurance tab of the privately insured, according to an article in Health Affairs that is cited by the New America Foundation’s study. This is double the study’s generous estimates for the uninsured but somehow not a problem, injustice, or outrage. More to the point is that Arnold’s plan, like that of Massachusetts, relies on passing the buck to other taxpayers: It sends the bill for California’s new program to the taxpayers of other states. Nearly half of the tab of Arnold’s $12 billion expansion — $5.5 billion — will be extracted from Washington to match his Medicaid spending spree. When this is considered, it’s hard to see why these plans get national applause, unless one considers that the applauding aren’t taxpayers in Iowa but liberal editors and writers in New York and D.C. In essence, Arnold is putting illegal immigrants and lower-middle-class families on the government roles and sending the $5 billion tab to D.C., which, in turns, passes the collection plate through the fruited plains. As economist John Goodman has noted, in an era of emerging pay-go legislation, Arnold proposes increasing federal spending by $50 billion over a decade without a single member of Congress casting a vote. Two states can get away with this, provided the feds acquiesce, but it’s hardly a national solution for health care, unless that solution is to be based on increased general taxation supporting government-financed care. There is no possible way this ends anyway but badly. Poor people will drop care, enroll on the taxpayer’s dollar, and drive up costs. Employers will face new taxes, and therefore limit the size of firms, stunting economic growth while depressing cash wages. The high-deductible plans will appear to be raw deals to many, especially if it comes at a guaranteed-issue premium. People will refuse to sign up and dodge the tax. The politicians will not have the will to enforce the individual mandate — individuals, after all, vote, write letters to the editor, and appear on sob stories on the news. Instead, they will load up the mandated coverage with extra benefits, lower deductibles and co-pays, and demonize the insurance industry when it charges market prices. The result: Employers will be paying higher taxes, employees earning lower wages, Medicaid will be subsidizing more people, and 10 to 20 percent of Californians will still be officially counted as uninsured. Next stop: single-payer health care for America. Sally C. Pipes is president and CEO of the Pacific Research Institute, a health policy think tank. She can be reached at spipes@pacificresearch.org. She is author of Miracle Cure: How to Solve America’s Health Care Crisis and Why Canada Isn’t the Answer.
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