In yesterday’s Washington Post, Health and Human Services Secretary Kathleen Sebelius makes an impassioned plea for skeptics to reconsider the Affordable Care Act. Secretary Sebelius argues that the Act will bring down health care costs by, among other things, assisting those who cannot afford health insurance coverage. Although expanding health insurance coverage is a worthy goal, bringing more folks into the health care system could result in higher prices for health care services. The housing market provides a nice example: although subsidized mortgage rates allowed more people to own homes, more buyers eventually meant higher home prices.
Secretary Sebelius reminds us of the broth of new regulations designed to constrain the worst impulses of insurance providers, including requiring providers to justify premium increases above 10 percent in an online forum; to spend at least 80 percent of premium dollars on health care as opposed to salary or advertising; to accept applicants with preexisting conditions; and to charge zero copays for so-called preventative services. This level of micro-management seems excessive, even by regulated-industry standards.
Given the raging debate over the constitutionality of the Act’s requirement that everyone buy health insurance, the other provisions of the Act have received relatively little attention. To an economist who believes in the efficacy of prices to allocate scarce resources in an economy, the zero-copay rule is perhaps the most offensive provision of the Act. Even for preventative services, a positive copay ensures that users do not abuse their privileges. For any doubters (who live or work in major cities), look out the window during rush hour to see what happens when an activity (using a road) is priced at zero. It is not clear that the increase in demand for preventative services will be offset by the promised decrease in demand for treatment of chronic ailments. Moreover, providers are likely to react to a zero-copay rule by raising deductibles; these terms are highly interrelated. Finally, there is no limit to what constitutes preventative medicine; some men do get breast cancer, but not enough to justify free mammograms for all men.
This is not the first time the Administration has imposed a zero-price rule. The chairman of the Federal Communications Commission, who was carefully screened by President Obama on the issue of net neutrality, adopted the Open Internet Order, which banned an Internet service provider (such as AT&T) from charging a price to an Internet content provider (like Sony) in exchange for speedier delivery. Under the Commission’s rationale, if some websites could not afford the surcharge for higher quality of service, then no one should.
It seems that prices for “critical” services such as preventative medicine and Internet access are evil because they exclude certain segments of the economy. To be fair, under certain conditions such as information asymmetries, externalities, and adverse selection (common in health insurance markets) market-based prices may result in too little or too much consumption relative to the socially optimal level. But the attacks on the price mechanism by these two pieces of regulation do not seem to be grounded in those traditional market-failure arguments. Without a limiting principle, one could oppose prices for just about any good or service, as there will always be someone who cannot afford it. Better to leave prices in place (and subsidize those who cannot afford the “critical” service) than to ban pricing altogether. In contrast to a zero-price rule, the cost of the subsidy is transparent to taxpayers.