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Justin Fox on Health Care


The Time online columnist continues his discussion with me on the subject. (I wrote an article, he commented, and I responded.)

He notes that answers to poll questions on health care are sensitive to their wording and that some poll questions yield results that favor Democratic over Republican policies. He is absolutely correct on both points. But his initial comment was that “hardly anybody in the U.S.” wants the free-market health policies I wrote about, and even the poll findings that he mentions do not bear out that strong claim. Free-market policy advocates have an opening to make their case.

He also points out that few people in the federal employee health plan have chosen the type of high-deductible coverage that conservative reformers think would be a larger presence in a free-market system. I have two qualms about Fox’s point here. First: To have an apples-and-apples comparison, we’d have to know whether the cash value of the high-deductible plan was the same as the cash value of the alternatives. Otherwise we have a test only of whether employees like high-deductible plans coupled with pay cuts.

Before getting to my second qualm, let me try to clear something up:

As I understand it, though, the “Republican” plan that Ponnuru embraces involves wresting this whole enterprise out of the hands of employers and leaving people to fund their own health savings accounts, albeit with tax incentives for doing so. That may be a great deal for some people who don’t have insurance now, but it’s clearly going to be a tough sell for the rest of the populace.

Well, no, not exactly. The tax break for employer-provided coverage would stay on the books, although it would be flattened so as not to encourage gold-plating. It’s just that the playing field between employer-provided and individually-purchased insurance would be leveled. I suspect that over time we would have a much larger individual market, but it would be a gradual shift. The Republican plan is radical in some respects, but it’s not quite as radical as Fox makes it sound.

And this leads to my second qualm. If you don’t want a high-deductible plan, an employer-run system could leave you stuck with one against your will. A more robust individual market might not give you what you consider the perfect option, but you would at least be able to choose among the options yourself, based on your preferences rather than those of your employer.

I haven’t answered all of Fox’s points, but I have probably taxed the patience of my fellow Cornerites enough. If Fox is a true glutton for punishment and wants to know my views in greater detail, I’d encourage him to check out my article in the Sept. 24 issue of NR.


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