Warning: Medicaid is hazardous to your health

So says the headline of my article in the Boulder Daily Camera today. A scan of the print version is here. The first half of the article is pretty much the same as the one that appeared in the Denver Post a few weeks ago. The second half goes into more detail on how Medicaid could work on the food stamps model:

Medicaid should not compete with insurance companies. After all, the government doesn’t try to emulate Soviet Russia by operating its own grocery stores. Instead, it taxes us to provide food stamps. Similarly, Medicaid could provide vouchers for private insurance, which some states are already considering.

This would be an improvement over the current system, but it’s still a coercive charity. To remedy that, I propose a tax credit for those who donate money to Colorado charities that compete with Medicaid. Of course, this isn’t “perfect,” either, as surely the government would have a role in determining who qualifies as such a charity, and hence exert influence on how they run. This argument comes up with school vouchers, too. But it’s a good way to get people to start thinking about Medicaid as competing with both insurance companies and charities.

I also have a better definition of consumer-driven health care. I’d made the error of identifying it as a Health Savings Account with a high-deductible insurance plan. But this is only an example. Most generally, it results from not having a tax code that neither (a) favors employer-provided insurance over buying it on your own, and (b) favors paying for medical expenses with insurance vs. directly with one’s own money.
So regardless of what kind of insurance you have, you should be able to have an HSA. That way, if you have a choice between spending an extra dollar on an (employer-provided) insurance policy, or insuring yourself by saving that dollar, it’s a true dollar-per-dollar decision. As it is, if you choose not to spend the extra dollar on the insurance, then you are taxed on it, and have much less to spend on out-of-pocket medical expenses.


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