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To put it mildly, the current Medicare debate is not the
conservative movement's finest hour. Not only are a Republican president and
Congress doing everything they can to create an explosive new entitlement,
but key conservative groups are attacking one of few genuine free-market reforms
before the House-Senate conference committee. These conservatives have managed
a trifecta: a policy, tactical, and political blunder — all before the relevant
negotiations have begun.
The great object of health-care reform is to reduce government influence over
consumers' choices. In private health-insurance markets, this means evening
out the tax treatment of untaxed employer-provided health benefits and other
types of health-care financing.
Until this year, the most conservatives had argued for was to enhance and
expand eligibility for Archer Medical Savings Accounts (MSAs), which extend
tax-preferred status to savings accounts dedicated for medical expenses (self-insurance)
so long as they are coupled with high-deductible third-party insurance. While
expanded MSAs would improve upon current law, the government still would play
a paternalistic role, dictating that consumers must purchase a particular type
of insurance in order to receive equitable tax treatment for self-insurance.
In June, House Ways & Means Committee Chairman Bill Thomas (R., Calif.)
moved the ball forward. To attract conservative votes for an unsavory Medicare
bill, he attached to it a measure that would expand MSAs but also would create
a new type of tax-preferred health account. Health Savings Security Accounts
(HSSAs) would further reduce government paternalism, notably by allowing more
health-insurance choices. Even those who do not want or cannot find health
insurance would qualify. (Eligibility would be restricted by income, a provision
that should be removed.)
A number of MSA supporters have attacked HSSAs. As it happens, some of them represent
companies that sell the insurance HSSA holders would not have to buy. Though
their attacks are
as easily answered as
the Left's well-worn criticisms of MSAs, they are crippling future efforts to
reduce government paternalism beyond what the pending MSA expansion would achieve.
That is, if we can achieve an MSA expansion. The merits of HSSAs aside, attacking
them now makes an MSA expansion less likely.
Were conservatives united behind the Thomas bill, House Republicans would
enter the negotiations with more political capital. Yet conservative attacks
on HSSAs diminish HSSAs' value as a bargaining chip and increase the likelihood
that the MSA expansion itself will be traded away.
"Don't negotiate with yourself." "Ask for a whole loaf, get half
a loaf." Whatever your preferred adage, the upshot is the more these groups
attack HSSAs, the more likely we all are to walk away from the Medicare negotiations
without an MSA expansion.
And it could come back to haunt them. Picking the pocket of a Ways & Means
Committee chairman during a high-stakes negotiation is not the height of political
savvy. Particularly when he is trying to help you. To be fair, some MSA supporters
are still smarting from the Thomas bill's haphazard evolution. To be blunt,
they should get over it. Rep. Thomas more than made up for any mistakes by
advancing a health care bill better than anyone expected.
MSA supporters are on the vanguard of health-care reform. Unfortunately, some
of them are endangering their signature issue and crippling the next step in
health-care reform by attacking a good idea that happens not to be their own. |