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The tax break for employer-provided health insurance
Remember when I wrote?
...how can a simple relative price, whether a distortion or not, corrupt the cost control practices of an entire industry? And if government provision of health care is ineffective and costly, isn't there a positive externality from the purchase of private health insurance?
The tax break for employer-provided insurance is, more or less, thirty percent. Therefore the cost burdens of employer-supplied health care should not exceed that same thirty percent. Have you noticed that current problems come in the form of cost escalation at high ongoing rates, and not just from a one-time cost bump upwards?
If you think the tax break is behind the spiral of rising costs, you need only wait. Once the sum total of those unnecessary costs exceeds thirty percent, the tax subsidy won't be worth it, we'll move to a more rational system, and all will be well, more or less.
That hardly seems believable.
Consider an analogy with food. Say my restaurant expenditures were subsidized by thirty percent (remember the tax deductible business lunch?). They might put too much on my plate, and they'll start overcharging me. Maybe. But once the initial adjustment occurs, it won't lead to 5-10 percent cost escalation for meals each year. And if it did, in a few years' time I would simply switch to the unsubsidized meal sector, thus checking how bad the problem could get.
Addendum: See also Becker and Posner today.
Posted by Tyler Cowen on April 16, 2007 at 08:37 AM in Medicine | Permalink
Comments
My restaurant... may put too much on my plate and start overcharging me..."
And this is different from what restaurants do today - how?
Pat, in search of a decent meal in the portion size I was reared to, back when a computer's input device has lead at one end and an eraser on the other, and a quarter pounder was a big burger.
Posted by: Pat Mathews at Apr 16, 2007 9:44:46 AM
My suspicion is that the rising rates have little to do with the tax benefit. The increasing regulation of the private health insurance industry plays a much larger role. Insurance companies have very little control over what level of coverage they decide to offer, there are 51 jurisdictions that spell this out in terrifying detail, and they are constantly adding mandatory coverage. I wonder if this opens the opportunity for an offshore health insurance company to offer coverage in the US that provides a lower level of coverage that the mandatory state limits at a lower rate?
Posted by: C L at Apr 16, 2007 9:45:41 AM
I'm not sure why Glenn Hubbard's argument is so hard for you to credit. Okay, sure, in a rational world people would negotiate higher salaries in exchange for forgoing employer-provided insurance once the excessive costs outweighed the tax subsidies. But people aren't rational. They think they are getting health insurance "for free", despite the transparent idiocy of such a concept.
Costs that you don't understand you bear produce the same behavior as costs that someone else bears. Call it externality-by-stupidity.
Posted by: eddie at Apr 16, 2007 9:52:38 AM
if 30% is the tax deductibilty then the employer related costs shoudl rise by upto 100/.7=142. a 42% increase in employer costs before it starts to hurt for employees and employers. this % would be a little more(less) for firms with older(younger) forces and other reasons. this 42% multiplied by the amrket share of employer provided h'care shoudl give an approxiamte number for ballooning from this factor alone using this one can put a rough ceiling on the eventual cost of emplyer provided h'care. maybe this is the holy grail, make medicare expenses tax deductible for the children of those who use it.
Posted by: sa at Apr 16, 2007 10:46:55 AM
Isn't this a sort-of prisoner's dilemma? It only takes a little tax incentive to get people into the healthcare commons. But once we're in the game, where the costs of individual healthcare purchases are severed from individual benefits, prices skyrocket, and the costs of unilaterally opting out become huge -- much larger than 30 percent.
Posted by: Dwight Schrute at Apr 16, 2007 11:04:35 AM
But there is another important factor in the provision of health insurance through employers. This creates a large pool that an insurance company can insure with confidence that they can accurately estimate the cost of providing this pool health care.
If you shift to individuals purchasing their own insurance how do you create this pooling that is so important to the operation of insurance markets.
Unless you find some way to pool risks wouldn't individual health insurance be inheritently more expensive then employer based insurance even if you ignore the tax advantage?
Do you create a system like auto insurance where such factors as age and residence strongly influence individual cost?
this is the problem with your food analogy, the seller of food knows the cost ahead of time but the seller of insurance does not know their cost until long after the purchase is completed. This is where pooling enters the picture.
Posted by: spencer at Apr 16, 2007 12:23:17 PM
They think they are getting health insurance "for free", despite the transparent idiocy of such a concept.
The employer's share of Medicare, Social Security, and health insurance should all appear on an employee's pay stub.
Posted by: Matt at Apr 16, 2007 1:24:51 PM
I didn't know that anyone had claimed that the current tax treatment of employer-sponsored insurance was responsible for the rate of increase of health care spending. Clearly, it isn't. But that doesn't mean it's a good thing.
1. Obviously, it does hold health care spending at a constant factor above socially optimal levels. That factor might be 30%, which is a pretty significant chunk of change in a country that spends 15-20% of GDP on health care.
2. Obviously, it's unfair to those outside the system who buy their own insurance or pay for medical care out-of-pocket.
3. Less obviously, it fosters the illusions of people like spenser, who think that the point of insurance is to socialize costs. The point of insurance is to reduce uncertainty; if I have a pre-existing condition that will cost a lot of money to treat, there is no uncertainly to reduce: my expected future costs are large and I should expect to pay a lot to cover them. If you want to have a government transfer program to help out such people, that's a fine idea and we can disucss how much to spend on it, but we need to implement it in such a way that it doesn't interfere with the workings of the markets in medical treatments and insurance. The current system interferes massively in this market, doing its best to hide from all agents the cost-benefit trade-offs that must be made.
Posted by: David Wright at Apr 16, 2007 3:56:58 PM
It isn't so much the tax break that matters, as the laws that have grown up pre-supposing that people will have employer-based healthcare. As a result, the cost disadvantage to freelance healthcare, is probably much more than the tax disadvantage.
Posted by: Chris at Apr 16, 2007 4:40:41 PM
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