When No News Is Good News

P resident Biden’s proposed budget for 2023 lacks specifics about how to cut drug prices, cover the uninsured, and lower premiums — and that’s probably a good thing.

Don’t get me wrong: Health care has gotten unbearably expensive and making it more affordable should be a priority. But there are no quick fixes to our health-care woes. The various laws proposed in the past year — such as allowing Medicare to negotiate drug prices and lowering the age of Medicare eligibility from 65 to 60 — would be financially devastating for patients. There’s no reason to lament their absence in the budget.

This is, of course, a familiar story. The federal government has a tendency to make problems worse, even with the best of intentions.

For the past several decades, the federal government has busied itself with enacting laws aimed at cutting costs and covering the uninsured. Take Obamacare, for instance. As its official name indicates — the Patient Protection and Affordable Care Act (ACA) — the law was designed to make coverage more generous and cut costs. Yet twelve years later, 31 million Americans are still uninsured, and health-care spending per capita grew from $9,326 in 2008 to $12,531 in constant 2020 dollars.

Nevertheless, Obamacare is still popular among Democratic voters and President Biden promised to build on it. And even though the pandemic threw a wrench into his plans, he did just that. The American Rescue Plan Act (ARPA) — the stimulus bill of 2021 — was chock full of generous subsidies for people to buy ACA health plans and provisions to expand Medicaid.

Just last month, the Centers for Medicare and Medicaid Services announced that ARPA’s “investments” were saving Americans money. In reality, the opposite is happening: The federal government’s spending spree makes health insurance cheaper for some in the short run but in the end will drive up health-care prices across the board.

Those “investments” are tax credits and subsidies doled out to low-income people so they can purchase health insurance. Free money worked its magic. Enrollment jumped 21 percent, with now 14.5 million Americans on those plans.

Sure, those subsidies may have cost taxpayers dearly, but at least they helped some get access to care. Didn’t they? Not really. The ACA plans with the cheapest monthly premiums have an average annual deductible of $7,051. What good is insurance if you have to shell out over $7,000 before insurance kicks in? So much for affordability.

Perhaps the government could chip in and cover those out-of-pocket costs, too. Why not? Why isn’t all health care free and covered by the government, as some would have it? Because in the end, taxpayers always foot the bill.

And that’s the real problem with placing our hopes for affordable care in legislators. They tend to hide the high costs through subsidies and tax credits so that we believe that insurance is affordable. In turn, having insurance encourages us to seek more care without counting the cost, and providers, to overtreat us. Health plans respond by raising premiums and deductibles.

We go confidently to the hospital because we have insurance. We believe that it will cover it all. In reality, when patients check into the hospital, they also check their  agency at the door. They receive services and are on the hook for whatever insurance happens not to cover.

It’s no wonder, then, that one in three Americans has medical debt. Medical debt is so ubiquitous and problematic that credit-score companies just decided to remove paid-off medical debts from people’s credit-score records. Ironically, people on “cheap” insurance plans find themselves spending more out-of-pocket than they perhaps would without insurance, as the high cost of uninsured medical services would have kept them from going to the doctor in the first place.

What is there to be done? Congress can start by attempting to reverse some of the laws that have gotten us to where we are today.

Consider, for example, that employers currently get a tax break for the dollars they spend on employees’ health insurance. This forces employees to choose among a small number of plans that may not work well for them and often unnecessarily reduces their take-home pay. What’s more, it may make it difficult for them to change jobs.

Ideally, people should be able to enjoy the tax benefits individually — not via their employer — and pocket the savings when they make smart health-care choices by shopping around. They shouldn’t be compelled to buy coverage they don’t need, let alone be lured into buying it only to realize they can’t afford the deductibles.

Policies that put patients in the driver’s seat are the key to affordable health care. Top-down solutions won’t cut it. So, today, we can celebrate their absence in the budget.