Battles for Freedom

While fierce battles were raging in Baghdad, 70 health policy experts gathered in a beautifully pastoral setting at the University of North Carolina early this week to ponder “Health Insurance in America: Challenges and Prospects.”

Half a world away in Iraq, the battles were about the most basic of human freedoms. In Chapel Hill, the conflict was over how much freedom Americans will have to lose to get to universal health coverage.

Discussions centered around three choices: 1) Imposing an employer-mandate on the largely employment-based health insurance system in place today; 2) An individually-based system with tax credits for individuals to purchase private coverage, with an eventual individual mandate; or 3) a government-run system.

Option 1 was most popular, although many acknowledged that their hearts really were with option 3.

Does it go without saying that I was in the minority here?

With options 1 or 2, the discussion centered around how to reach outliers who don’t have a job or the money to buy insurance. Even with this group of policy experts, which overwhelmingly favored centralization, much of the discussion focused on tax credits and how to get coverage to those outside the reach of the job-based system. That clearly is where the debate is today.

But legislative mandates are the wrong way to go – either for employers or individuals. Any mandate would come with miles of red tape, choking off flexibility for people to choose the coverage that best suits their needs and stifling innovation in health insurance arrangements.

We may have reached the limit of what employers can provide, and a new set of incentives and subsidies is essential for individuals to purchase private coverage. New arrangements will be created to allow people to affiliate through pools outside the place of employment to gain economies of scale and better negotiating power.

If those eligible for subsidies don’t purchase coverage, then their allocation can by default purchase at least basic catastrophic coverage so that they and society are protected against the risk of major medical expenses.

While I can’t give you quotes because participants’ statements are off the record, I can tell you that Heritage’s Stuart Butler gave an eloquent conclusion based upon points he has been making for years – and with which I agree:

There is no way that the American people will accept sweeping legislative changes to their health care system. The only way to evolve toward change is by building new systems on the ones we have: Use the employment-based system as a vehicle to provide more individual choice; offer tax credits to individuals to buy into new pooling arrangements; and give people with public coverage more options.

The conference was sponsored by the School of Public Health at UNC and ably organized, hosted, and moderated by former Centers for Disease Control Director Dr. Bill Roper, dean of the school.

On the other side of the country, Galen’s Greg Scandlen spoke this week at the Consumer Directed Health Care Conference and Expo in Las Vegas where he reports: “Refreshingly, there was very little politicking going on. Members of Congress were hardly ever mentioned, legislation was of little concern?Consumer driven health care is based solidly in the market, and that in itself is encouraging.”

Indeed.

Grace-Marie Turner




Grace-Marie Turner is president of the Galen Institute, a not-for-profit research organization focusing on ideas to promote free-market health reform. She can be reached at P.O. Box 19080, Alexandria, VA, 22320.

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While fierce battles were raging in Baghdad, 70 health policy experts gathered in a beautifully pastoral setting at the University of North Carolina early this week to ponder “Health Insurance in America: Challenges and Prospects.”

Half a world away in Iraq, the battles were about the most basic of human freedoms. In Chapel Hill, the conflict was over how much freedom Americans will have to lose to get to universal health coverage.

Discussions centered around three choices: 1) Imposing an employer-mandate on the largely employment-based health insurance system in place today; 2) An individually-based system with tax credits for individuals to purchase private coverage, with an eventual individual mandate; or 3) a government-run system.

Option 1 was most popular, although many acknowledged that their hearts really were with option 3.

Does it go without saying that I was in the minority here?

With options 1 or 2, the discussion centered around how to reach outliers who don’t have a job or the money to buy insurance. Even with this group of policy experts, which overwhelmingly favored centralization, much of the discussion focused on tax credits and how to get coverage to those outside the reach of the job-based system. That clearly is where the debate is today.

But legislative mandates are the wrong way to go – either for employers or individuals. Any mandate would come with miles of red tape, choking off flexibility for people to choose the coverage that best suits their needs and stifling innovation in health insurance arrangements.

We may have reached the limit of what employers can provide, and a new set of incentives and subsidies is essential for individuals to purchase private coverage. New arrangements will be created to allow people to affiliate through pools outside the place of employment to gain economies of scale and better negotiating power.

If those eligible for subsidies don’t purchase coverage, then their allocation can by default purchase at least basic catastrophic coverage so that they and society are protected against the risk of major medical expenses.

While I can’t give you quotes because participants’ statements are off the record, I can tell you that Heritage’s Stuart Butler gave an eloquent conclusion based upon points he has been making for years – and with which I agree:

There is no way that the American people will accept sweeping legislative changes to their health care system. The only way to evolve toward change is by building new systems on the ones we have: Use the employment-based system as a vehicle to provide more individual choice; offer tax credits to individuals to buy into new pooling arrangements; and give people with public coverage more options.

The conference was sponsored by the School of Public Health at UNC and ably organized, hosted, and moderated by former Centers for Disease Control Director Dr. Bill Roper, dean of the school.

On the other side of the country, Galen’s Greg Scandlen spoke this week at the Consumer Directed Health Care Conference and Expo in Las Vegas where he reports: “Refreshingly, there was very little politicking going on. Members of Congress were hardly ever mentioned, legislation was of little concern?Consumer driven health care is based solidly in the market, and that in itself is encouraging.”

Indeed.

Grace-Marie Turner




Grace-Marie Turner is president of the Galen Institute, a not-for-profit research organization focusing on ideas to promote free-market health reform. She can be reached at P.O. Box 19080, Alexandria, VA, 22320.

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About the author