A Health Plan for America

Arming people with tax breaks and free choice, we could have health-care benefits that are competitively priced and are portable from job to job

By , Stuart M. Butler is director of domestic policy studies at the Heritage Foundation in Washington and co-author (with Edmund Haislmaier) of the Heritage Consumer Choice Health Plan, "A National Health System for America."

IN January the Resolution Trust Corp. (RTC), the agency that handles failed savings and loans, closed Perpetual Savings Bank in the Washington, D.C., area. The RTC previously had taken over or closed nearly 100 other thrift institutions, employing more than 14,000 people; another 77 S&Ls, with more than 20,000 employees, remain on the RTC's critical list.

One of the biggest problems facing these newly unemployed workers is the loss of health coverage. They find themselves in the market for an expensive product, health insurance, designed for large company buyers, not individuals. And while company-provided benefits are tax free, these workers are unlikely to get any tax breaks if they buy insurance on their own.

It is a national problem. Last December, the 25,000 former employees of Pan Am saw their company-provided health benefits run out. The same fate awaits 20,000 IBM employees scheduled to lose their jobs, 10,000 being let go by TRW, and thousands being let go by General Motors.

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The link between health-care benefits and the place of work is one of the great anomalies of modern life. Unlike auto, homeowners, and most life insurance policies, only health benefits are tied to the job.

In a booming economy, nobody really notices the problems this creates. With consumers buying, rising health-care costs can be padded into the price of goods an services. But when the economy goes soft, the problems become apparent:

First, workers who lose their jobs also lose all of their health benefits. Second, many smaller companies can't afford the high cost of medical benefits, making it difficult for them to attract highly skilled workers. Most of the estimated 35 million uninsured people in America have jobs, or are dependents of people with jobs - they just work for firms without health plans. Finally, rising health-care costs handicap United States businesses in the global marketplace.

The reform plan outlined by President Bush in February moves in the right direction, providing vouchers (similar to food stamps) and tax deductions so low- and middle-income families without insurance could purchase their own coverage. But it would leave the rest of the system largely intact, doing little to relieve the crushing economic burden health care has placed on the economy - now consuming more than 13 percent of GNP.

The Heritage Foundation's Consumer Choice Health Plan would carry the president's proposal to its logical conclusion: We would eliminate the tax break for employer-provided health plans (whose value is not taxed as income) and replace it with individual tax credits so families could choose their own health plan.

By shifting the focus from the workplace to individuals and families, the Heritage plan would:

1. Develop a market for creative new health-benefits programs. These group plans would be offered not only by traditional insurers, such as Blue Cross and Blue Shield, and by managed-care and health-maintenance organizations (HMOs), but by a variety of other organizations: unions, farm bureaus, health charities, even religious organizations.

2. Make consumers conscious of costs. When individuals start paying for insurance out of their own pockets, they'll start shopping around for good value, as they do today for virtually everything else they purchase. This will help slow health-care inflation.

3. Break the link between the job and medical care. According to a recent survey by a presidential advisory council, 28 percent of all Americans said that they or a member of their family had been unable to change jobs because they feared losing their medical coverage.

4. Improve US competitiveness. Last year, the average US employer reportedly spent more than $3,500 per employee on health care. General Motors, for example, spent a reported $3.2 billion on employee health care in 1990 - adding more than $770 to the cost of every car and truck made in the US.

In theory, the Heritage Consumer Choice Plan would solve all of America's health-financing problems, without adding a dollar to the budget deficit. But how would the plan work in practice?

We need only ask the nearly 10 million Americans who already enjoy a consumer-choice health-benefits system similar to the one we have proposed. Since 1959, the Federal Employee Health Benefits Program has covered all US government and Postal Service employees, from a rural let-ter carrier in Montana to Senate Labor and Human Resources Committee chairman Edward Kennedy (D) of Massachusetts.

And this market-based program has been a success. Federal employees now have some 400 health plans to choose from nationwide. As a result of aggressive competition among "providers," cost increases have been well below those in the rest of the health-care economy.

As the emperors in Washington fiddle with various health-reform plans, US workers remain trapped in a system that restricts their mobility while pushing many of their employers toward insolvency. Washington should take its cue from the market - and its own federal health-benefits program - and rebuild the entire system on the twin pillars of capitalism: choice and competition.

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