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Tag Archives: Affordable Health Care Act of 2010

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Looking forward to your daily Double Chocolaty Chip Frappuccino, you see that the calorie count sign says 500 calories. Change your mind? Most studies indicate that knowing a calorie count has little if any impact on purchasing decisions.

Then, you stroll to your local Whole Foods to pick up some fruit juice flavored carbonated drink. Defined by legislators as sugary, the beverage’s price includes a 7% “soda” tax.  The 7% extra does not dissuade you from making your purchase. Researchers have concluded that the threshold is a penny an ounce tax. Any less and people still buy.

Next stop, the doctor’s office where you happily notice that those thick folders of paper records are gone. The practice has fully digitized and now will save all of us money by following the cost saving precepts of the Affordable Health Care Act. Yes? Maybe not. One study from Harvard says that physicians who have fully digitized tend to order more medical tests, thereby increasing costs.

Mandating calorie count information, taxing sugary drinks and digitizing health records… each is supposed to pull down health care spending. But they might not work.

The Economic Lesson

Stanford University health policy expert Victor Fuchs says we need massive policy change to depress health care spending that averages $8000 a person, double Europe’s average. Why so high?

  • Too many specialists.
  • Equipment with excessive “standby capacity.”
  • Inadequate support for the poor who are chronically ill.
  • Drug prices.
  • Physician income.

 

A NY Times bubble interactive for President Obama’s 2013 budget shows perfectly where health care spending is going. Look at the 8.4% increase Medicare and Medicaid.

An Economic Question: Would you support Dr. Fuchs’s solution of a dedicated value added tax that funds universal coverage?

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One of the first parts of the new health care plan to be implemented, the Pre-Existing Condition Insurance Plan (PCIP) surprised its administrators. 

North Carolina was ready for a “stampede” but initially only 674 people joined. Nationally, 375,000 people were expected but by April 30, the total was 21,454.

According to this Washington Post blog, logistics might be one problem. To increase enrollees in another federal/state implemented program, the Children’s Health Insurance Program (CHIP), certain states reduced red tape. The key was to eliminate personal interviews, implement a mail-in renewal form, and even partially fill in forms that were sent.

That takes us to the entire health care program. How will federal and state officials enroll more than 30 million people?

The Economic Lesson

Red tape represents a transaction cost. Defined economically, cost means sacrifice. Standing in line, filling out forms, listening to voice mail instructions, we are sacrificing what we otherwise might have been doing. Sometimes, the transaction costs of signing up for a health care insurance program are so daunting that they outweigh the long term benefit.

With lines reflecting the dysfunction of the former Soviet Union, the huge transaction costs helped to speed its demise.

An Economic Question: Which transaction costs did you experience today?

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Inventions that Fuel Economic Growth

Health care and steamboats are related. The link is the Commerce Clause of the Constitution.

Hoping to promote a single national economy, the framers of the Constitution said that the Congress has the power to, “regulate Commerce with foreign nations and among the several states, and with the Indian Tribes.”

But, what is “commerce?” In 1824, the Supreme Court had to provide an answer. And now, in Cincinnati, a federal court asked the same question.

In 1824, the Supreme Court was asked to decide if New York State could give a monopoly to a steamboat operator. In his decision, Chief Justice John Marshall rejected the narrow “buying and selling” definition of commerce. Instead, he said that commerce included all economic intercourse. Consequently, New York could not confer an exclusive right to travel on interstate waterways because Congress had the power to regulate interstate transport.

Fast forward to 2011. Obama health care legislation is being challenged in federal courts. The law’s opponents are saying that the Congress cannot require the uninsured to purchase medical coverage because of the Commerce Clause. Supporters of the mandate say Congress can require insurance purchases because of the Commerce Clause. The key again? A broad or narrow definition of commerce.

Supreme Court Justice William O. Douglas (1898-1980) said that the Commerce Clause was the “fount and origin of vast power.” (p. 48) Used to strike down New Deal legislation and to support Civil Rights law, its history since 1824 has actually been varied. Now, with federal courts in different states disagreeing, again the Supreme Court will probably tell us what commerce means.

The Economic Lesson

The United States could have been like Europe before the euro zone was created. Remember the French franc, the German mark, the Italian lira? Send some French wine to Germany and foreign exchange is involved. Travel across Europe and you needed multiple currencies. The result? None of Adam Smith’s (1723-1790) economies of scale could be enjoyed. Economic growth and development were constrained.

Not in the United States. After the powerlessness created by the Articles of Confederation (1781-1789), our founding fathers knew that Congress needed more power. One source would be the Commerce Clause. The Congress could stop one state from obstructing free movement of goods. A national market could evolve with specialization that would fuel economic growth.

An Economic Question: Knowing that a broad definition of commerce gives more power to the Congress while a narrow definition tends to favor state power, explain which one you support.

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