Over at Signal Health Tom Hilliard has been having an entertaining time with Mark Pauly and the boys from Cato. Go over there and take a look at the latest round of back and forth. Suffice it to say that if Mark Pauly had to buy his insurance in the individual market rather than receiving from the Ivy League Ivory Tower he sits in, I suspect that he would be rather more concerned about the way the individual market works, particularly the 20% he acknowledges doesn’t work well.
Meanwhile, Eric Novack and I are both reading Cato’s Michaels Cannon and Tanner’s latest work which is out today. (I had planned on a pre-publication review but then again…) We’ll be discussing it in another podcast sooner or later, but you’ll get the basic idea from the SignalHealth discussion.
Meanwhile, Health Affairs has some numbers out about the rise of the HDHP and the HSA. You can see the full article here. But here’s the abstract pull:
Almost 4 percent of employers that offer health benefits offer one of these arrangements in 2005, covering about 2.4 million workers. Deductibles, as expected, are relatively high, averaging $1,870 for single coverage and $3,686 for family coverage in high-deductible health plans with an HRA and $1,901 for single coverage and $4,070 for family coverage in HSA-qualified high-deductible health plans. One in three employers offering a high-deductible health plan that is HSA-qualified do not contribute to HSAs established by their workers.
The last line is by far the most significant (hence my bolding it). Even though the HSA is supposed to be the employees benefit, in fact in a third of the cases setting up a HDHP is straight cost-shifting to the employee. You were getting something and now you’re getting nothing to deal with the first chunk of medical expenses. So at least those employers have figured out how not to screw over their own risk pools (assuming that they keep some of that money that would have ended up in the HSAs in reserve to cover the expensive cases). You know that the rest of them will go down that path too — in fact a survey that was covered in this THCB article confirmed it a while back. Oh, the joys of a "jobless recovery".
And of course employers are getting out of the game of providing insurance anyway. Another Kaiser Foundation survey this morning confirms that the percentage of employers offering insurance has gone from 69% in 2000 to 60% in 2005. In effect the HDHP over time offers the employer a way to get out of the game without having to bear the shame of leaving the field completely.
This of course continues to boil the frog….
Finally, it does make me chuckle that in the comments to this post about Medicare Part D, Eric Novack is apparently appalled that a combination of lobbying from drug companies, PBMs, health plans and providers mixed in with the endemic scratch my back corruption of the current Administration and its leaders in Congress ended up with a welfare plan for them all called Medicare Drug Coverage. But it’s a little weird that he thinks that the water-carriers for the Administration over at Heritage are actually surprised. The guys from Cato might be forgiven for being true believers, but Heritage, AEI and the rest sold their souls long ago, and know exactly how they’re dealing with.
CODA: I hate to link to Tech Central Station given how dishonest it is in its lack of transparency, but if the funny Cato boys will insist on writing there, then this one from Randy Balko is worth a chuckle.