Obamacare Repeal

The Health-Care Conspiracy of Silence

By Clark Havighurst,
from The Wall Street Journal,

If Bezos, Buffett and Dimon want to reduce costs, they should focus on the tax exclusion.

Amazon, Berkshire Hathaway and J.P. Morgan have announced a nonprofit initiative to address excessive spending on health care, starting with their own million or so employees. They can expect many suggestions. Here’s one: The three CEOs— Jeff Bezos, Warren Buffett and Jamie Dimon, whom I’ll call “BB&D”—could do a huge service by describing the depth and nature of the cost problem, something politicians have long failed to do. American health-care markets have many problems. The worst are those that cause consumers to act in ignorance of, and thus against, their own economic interest, making health care inexcusably expensive. International comparisons suggest that questionable health-care spending in the U.S. exceeds 6% of the economy, roughly $1 trillion in 2017. BB&D should tell their employees, plus the more than 150 million other Americans with employer-sponsored health coverage, the unvarnished truth about the heavy costs that insured workers personally—though mostly indirectly—bear. Although politicians deplore high health-care costs, they rarely speak of the staggering, unfair and unnecessary burden on working people, preferring instead to talk earnestly about the need to slow cost increases. Focusing on costs only at the margin, however, reinforces the industry’s deceptive narrative that health care is almost infinitely valuable, is always improving, and costs what it costs.

Politicians have never felt pressed to take the cost problem seriously for the remarkable reason that the health-care industry picks consumers’ pockets mostly without the victims realizing it. Because employees don’t pay taxes on employer-paid insurance premiums, most workers assume that—and behave as if—their health-care costs are borne by employers.

Employers and labor unions have mostly opposed any changes in the tax treatment for employee coverage. They apparently find it advantageous to cultivate workers’ goodwill by conferring increasingly generous health benefits paid for largely and unwittingly by the workers themselves.

Because so many interest groups and most insured consumers are happy with the current arrangement, both political parties have generally left what they see as well enough alone. To be sure, progressive Democrats hope that international cost comparisons will lead Congress to adopt a national single-payer plan. Republicans seem glad to feel no pressure from voters for radical reforms needed to fix health care’s many market failures.

It would greatly benefit American workers if BB&D—as employers and opinion leaders—kicked off their companies’ joint venture by publicly stating that working-class Americans may be paying $1 trillion a year too much for health care and could benefit from major changes in the way they purchase it. Such a statement could counteract Democratic and Republican complicity with special interests in keeping voters ignorant about their stake in health policy.

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