How Do We Fund What We Are Committed To?
There are many dramatic failures in our current health-care system and the most striking is the inexorable rise in the number of uninsured in our nation. Further, we know that this group is complex and, to some extent (meaning that some individuals -- and we can quibble with exactly who and how many they are), must receive some subsidy to afford health insurance. How do we pay for this? We can continue to transfer our liability to our children and grandchildren or we can pay for it as we go.
Since I refuse to continue to transfer our generation's obligations to future taxpayers, I am forced to believe we should pay for it now. I would hope the cost of this program can be held to the minimum possible. I believe, strongly, that there are enormous savings that can be reaped from true reform. But, to the extent that we can not get to these savings immediately, we need to be fiscally prudent and generate appropriate revenue to pay our bills.
How then to generate revenue in a manner that does not stifle our economy? Perhaps the most appealing (but apparently politically-challenging) proposal is to "tax" employer-purchased health benefits that exceed a certain level. We have no obligation to federally-subsidize expensive health benefits when we do not provide any direct subsidy to the uninsured. I do not see this as taxing the rich, but rather merely reducing their federal subsidy. And I include myself in this group: my employer (Yale University) provides me with access to a generous health benefit and flexible spending account. Combined, I am receiving a federal subsidy that exceeds $3000 per year.
As a side-effect to reducing this generous federal subsidy, we might even find our workforce becoming more sensitive to insurance costs and medical decision making. This would not be a bad thing. Together with provider payment reform and better information to assist medical decision making, we might even be on track to achieving better health, rather than merely more health care!
July 17, 2009; 10:41 AM ET
Health Care Reform
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