To justify repeal of the deduction, the Administration is introducing us to economists who argue that the deduction favors employees of companies that pay for health care, and that the deduction encourages payment of premiums for health care insurance covering expenses for routine care rather than only catastrophic problems. The chair of the White House Council of Economic Advisors refers to "standard economic theory," "textbook economic theory" and "scholarly literature in economics" when advocating this and other changes.
People who know me know what I think of theory: it is useful as an incentive to creativity, so that people are encouraged to try things. If it works, fine. If it doesn't, hopefully no one has been killed or maimed. The difficulty is that some theories, such as those affecting tax and the economy, are a wee bit trickier to test than is, for example, the theory that traffic circles are safer than four-way-stop-sign intersections. The latter can be tested by fooling with one intersection. Tax law doesn't permit disallowing the deduction for a few random companies, and the closest one comes to a tax laboratory is the experience of a state with a comparable tax system that tries out someone's idea.
Let's think about the theoretical arguments raised in favor of repealing the employer deduction for providing health insurance to employees. Does it favor employees of companies that pay health insurance premiums? Yes, it does. The deduction reduces the net cost to the employer of the health insurance premium. To offset this advantage, however, the tax law contains deductions for individuals who are not covered by employer health care insurance. One question thus becomes one of determining, through empirical analysis, whether the savings achieved by the employer who pays for health insurance premiums passes those along to the employees in the form of higher salaries or other benefits. Another question requires empirical analysis of salary and other benefits earned by employees of companies paying for health insurance and employees of companies not paying for health insurance. Has any such study been conducted? Are its results being publicized to support the claims made by the advocates of repeal and the advocates of retention?
Does the deduction encourage the payment of higher premiums? It depends on what sort of theory one applies. The theory that is advanced answers in the affirmative. But another theory says that employers seek to reduce costs. That theory, by the way, has been proven. A deduction saves an employer a fraction of the cost. Thus, if the premium is $100, the employer continues to seek identical coverage for $90. Why? Because even with a deduction, the net cost of the $90 premium is less than the net cost of the $100 premium. The "employers spend more because of the deduction" theory makes sense if the government were fully reimbursing the employer, directly or through an unlimited and refundable tax credit, because then, and only then, would the employer (at least in theory) conclude that price is no object because someone else is paying.
The theory advanced in support of repeal suggests that deductions for the cost of routine medical care are somehow less beneficial to the economy than deductions for the cost of catastrophic illness. The Economic Report of the President states:
If automobile insurance were structured like the typical health policy, it would cover annual maintenance, tire replacement, and possibly even car washes....health insurance markets can be improved . . . [to] focus on large expenditures that are truly the result of unforeseen circumstance [and] to provide a more standardized tax treatment of all health care markets.What nonsense.
Automobile insurance covers theft and collision. If automobile insurance were structured like health insurance it would pay for the cost of the annual safety inspection, medical examinations for drivers similar to those given to airline pilots, and anti-theft devices. Well, guess what? Although automobile insurance companies don't pay for the annual safety inspection (perhaps because the cost is so low it can be considered comparable to a co-pay or deductible), automobile insurance companies invest in the development of safe vehicles, road improvements and hazard removal, anti-theft device research and development, and a wide array of programs designed to reduce the frequency and severity of automobile accidents. Of course they don't pay for car washes, and health insurance companies don't pay for nail clippers. Likewise, automobile insurance companies don't pay for auto maintenance, such as changing engine oil and transmission fluid, because automobile insurance companies don't pay for the replacement of engines or transmissions that fail because of lack of care. In other words, the comparison made by these theoreticians sounds nice and makes a nice sound bite but it is so flawed that I wonder where they learned to develop analogies. Surely not in one of my law courses, where the ability to make good analogies enhances teaching and learning and bad analogies do so much damage that one quickly learns the difference and avoids the latter.
From the perspective of doing what is best for the economy and for people, the ideal approach is to minimize the need for, and the cost of, medical care. The best way of doing this is to consider that "an ounce of prevention is worth a pound of cure" and to understand that the dollars expended on annual physicals are cheaper dollars than those spent on surgery. If health insurance pays for some or all of the cost of preventive care, people are more likely to get that care than they are if they must pay the entire cost. This isn't theory, it's been empirically demonstrated. Of course there are people who don't get preventive care even when it is covered by insurance, but their reasons for avoiding the doctor visit aren't economic and require some other incentive.
Any argument or theory that considers payment for preventive care to be less deserving of subsidy than payment for catastrophic injury is an argument or theory destined to saddle the economy with even more health care costs. Discouraging preventive care will increase health care costs because health problems will be discovered at later stages, when cures are more expensive, care is more expensive, and adverse impact on life is more expensive.
This, too, is empirically clear. Repeal of the deduction would cause employers operating on the margin to terminate health care coverage for employees, unless the subject of collective bargaining. And in that case, the next round of negotiations would be even more combative than they've become recently as employers try to balance health care cost allocation.
Perhaps the theoreticians believe that people will seek preventive care simply because it makes sense to do so no matter who is paying. That's true. People will seek preventive care but some won't get it because they won't have the economic resources. Unlike those who would simply dip into the "leftover" income that otherwise would be invested, these folks would need to cut back on something. Perhaps they would cut back on the dollars spent for DVDs and X-box cartridges for the children. Perhaps they would cut back on food for the children.
Critics of the crtics claim that the critics tend to dismiss the intellectual merit of the Administration economic policies, and that the criticism ignores how well the economy is doing. The health care segment of the economy is not doing well, and anyone who sees intellectual merit in the horrendously flawed analogy between health care insurance and automobile insurance is....well, I'll let readers of this blog finish the sentence.