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POLICY: Has the dog’s sore not completely healed?

The NY Times has been getting much better in its reporting on health care policy. After all David Leonhardt had Shannon Brownlee’s book as economics book of the  year! And they’ve been getting Jack Wennberg in frequently.

But every now and again something crops up that worries me about it’s desire to go straight adn reminds me of that dog with the licking problem. Today it’s the idea that concerns about health care costs are global, which I guess is true, and that the rest of the world–where employers often don’t pay for health care–is becoming more like the  US where employers do. The short piece is called Going Global With Concerns on Health Costs and the casual reader might think that systems are converging around the idea that employers should pay for health care because governments can’t afford to.

Leaving aside the basic point that the route by which money is raised to pay for health care is not very relevant compared to how it’s spent and the system by which people get coverage, the article makes two tiny confusions.

First, as it says, it’s supplemental health care costs that employers are paying for in most countries–and in many countries like the UK they’ve done that for decades. Here employers pay for everything. that’s a massive difference.

Second, the increase in percentage paid by employers is only big enough to grow really fast in 4 countries. Those are India, China, Venezuela and Russia. Not exactly health care systems that compare to the US. Our health care system is bigger than those economies!

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  1. > Here employers pay for everything.
    > that’s a massive difference.
    For now. Seems to me a Big Story&tm; is the success Detroit have had in turning over responsibility for retiree healthcare benefits to the UAW. I think what it means in practical terms is something like this: if healthcare spending growth exceeds the growth of the economy generaly, the UAW will have to cut benefits to retirees. They don’t want to do that, so there will be pressure for utilization containment and cost containment coming from “workers” not from “corporations”. I cannot imagine it will stop with retirees. If I were an employer, I’d greatly prefer a defined contribution to a defined benefit. And so I expect this to spread. Pattern bargaining, you know.
    Its not bad at all though — from my perspective it gives unions (and professional associations) a greater scope of activity and at least the potential to act in the members’ best interest. I sometimes rant a rant about this. The abbreviated version: I see “professionals” who expect their employers to pay their professional association dues. Then the same “professionals” are astonished that the professional association wants more to serve “the industry” (i.e. their employers) than it wants to serve its putative members (i.e. them). They shouldn’t be.
    This needn’t stop with unions and professional associations: benevolent societies like the Woodmen and the Knights of Columbus already do life insurance. My bet is the main reason they don’t do health insurance is the overwhelming prevalance of the employer model and the adverse selection they’d likely suffer if they offered the product in today’s environment. At the very least they could be a “group” and buy the actual insurance product(s) from a commercial insurer. I’m sure a good many of them could operate under an ASO arrangement and self-insure if their members had a way to direct their “benefits dollars” to them. I can dream, can’t I?
    t

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