Opinion: A mixed healthcare mandate

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Roger A. Forsyth, who served on the board of directors of Kaiser Permanente from 1986 to 1994, replies to The Times’ column, ‘ Going Solo.” If you would like to respond to a recent Times article, editorial or Op-Ed in our Blowback forum, here are our FAQs and submission policy.

The objections raised by Ronald Brownstein in his column, ‘ Going Solo,” against individually purchased coverage are invalid.

Employers would face a rebellion if they tried to simply drop their involvement under an individual system. They would still be expected to administer payments on employee policies. On the other hand, having the employee take the tax deduction rather than the company provides an incentive for individuals to manage their healthcare dollars and not run up costs ‘because the insurance is paying for it.’ The employer’s economies of scale that Brownstein mentions would be less significant under a more rational system. (That no other country uses ours is an indication that it is not indispensable.)

For the government, the sine qua non with respect to healthcare is protection from infectious disease and protection of the most vulnerable -- pregnant women, infants and the elderly. The government should be expected to enact laws that facilitate spreading non-routine financial risk across society at the least possible cost. It should also find a better way to finance routine healthcare, which engenders the most cost for the least benefit.

Therefore, rational reform should consist of two parts: mandatory universal coverage for obstetrical care, neonatal care, vaccinations and catastrophic costs; plus flexible health savings account for routine care. The universal policy should be offered at the same price to groups and individuals. It should be fully tax deductible and relatively cheap. There would be details to work out, but they would not be insurmountable.

The health savings accounts should be tax deductible up to a limit. Each pay period, employers would deposit a given amount that the employee could use to pay for routine healthcare -- and only for healthcare. Under such a plan, instead of a one-size-fits-all mandate on coverage, individuals would decide how to best utilize their healthcare dollars, resulting in significant savings.

The key to adopting an effective system would be to start low and go slow. Those who advocate far-reaching ‘reforms’ are inviting disaster. Already, the cost of healthcare is adversely affecting the competitiveness of our products overseas. Our stagnant wages are not really stagnant -- the money is going into healthcare benefits. The higher our costs go, the more people go uninsured. Neither party has it entirely right.