A Healthy
Initiative
Tax the rich to help others buy health insurance?
That's what Mr. Bush proposes.
Tuesday, January 23, 2007; A16
THIS TIME last year, President Bush's main health policy proposal was to
expand tax-sheltered health savings accounts. In the days leading up to
tonight's State of the Union address, he has signaled a welcome shift in policy. Expanded tax shelters for
health savings accounts would have drained billions of dollars from the budget,
and the shelters would have mainly benefited the affluent. Their legitimate
goals -- to correct the tax bias against people who don't work for big companies
and to discipline health costs -- would be far better advanced by Mr. Bush's new
initiative, which is budget-neutral and progressive.
At present, people who get health insurance from employers pay no tax on the
value of the benefit. Someone with a marginal tax rate of 35 percent and a
generous insurance policy worth $20,000 a year gets a $7,000 tax break. But
people who buy insurance on the individual market must usually do so with
post-tax dollars, so their tax break is normally zero. The administration
proposes to eliminate that unfairness by giving salaried workers and freelancers
the same tax deduction.
The reform would also remove the tax incentive to buy excessive insurance.
Currently, the more generous your health plan, the more tax subsidies you
capture; the person in the example above would get a tax break worth only $3,500
if he chose a more restricted insurance plan worth $10,000 annually. Generous
insurance plans, which impose few restrictions on visits to specialists or on
possibly redundant tests, inflate demand for medical services and push up prices
for everyone; they help explain why the United States spends almost twice as
large a share of its economy on health care as do most rich economies. By giving
all insurance buyers a standard deduction, irrespective of the type of health
coverage they choose, Mr. Bush would restrain medical costs and promote
fairness. Because richer people tend to have more expensive insurance, the
reform would slightly increase tax rates for people in the top fifth of the
income distribution while slightly reducing tax rates for others, according to
the White House.
There are weaknesses in the president's proposal. Rather than embracing tax
deductions, which are most valuable to people in high tax brackets, Mr. Bush
could have made his proposal even more progressive by recommending a refundable
tax credit that would be worth the same to everyone. Moreover, there's a danger
that ending the tax privilege for employer-provided insurance will cause
companies to discontinue coverage, driving more buyers into the individual
market, where it's hard to buy insurance at a reasonable price, especially if
you already have a medical problem. The administration promises to support state
efforts to redeploy federal Medicaid dollars in ways that would make the
individual insurance market work better. But success here will depend on the
states, and the details are sketchy.
Despite these caveats, the president is right to go after the existing system
of tax subsidies for health care. Like the deductions for mortgage interest,
these subsidies are regressive and have perverse consequences. Mr. Bush has
kicked off a needed discussion.