Alan Reynolds

The Senate wants to pile a costly prescription drug subsidy on top of the tumbling Medicare edifice. This is called a benefit rather than a tax, but there is no such thing as a benefit without a cost.

The plan is to tax and spend some $400 billion over 10 years to subsidize even the wealthiest old folks at the expense of even the poorest young workers. The cost could easily end up two or three times that large, because health-care subsidies make it easier for providers to hike prices. That is why the health industry lobbies so generously to get everyone over-insured and therefore desensitized to prices.

President Bush recently expressed concern that nearly a third of seniors have no insurance for prescription drugs (closer to a fourth, actually). To the extent that this particular consumer choice is a problem, it was mainly caused by the government. To the extent that it was not caused by the government, it reflects free choice and is therefore none of the government's business. Absence of one particular type of insurance certainly does not prove poverty, because the poor are covered by Medicaid.

My sister, a well-known writer in Marin County, decided to skip any sort of Medigap insurance when she went on Medicare. She is one of those healthy seniors without drug insurance who annoy those who insist everyone must be insured for every troublesome hangnail. Yet she is doing just fine without subsidies, thank you very much.

Why do so many seniors decide not to buy their own insurance for prescription drugs? They buy their own home insurance, car insurance and life insurance. Yet many pass when it comes to drug insurance. Why is that? Perhaps it is because it is illegal for seniors to buy any separate policy for drug insurance.

About 25 years ago, the federal government began imposing minimum standards on private Medigap insurance, requiring such policies to cover co-payments for hospitals and doctors (although without co-payments nobody cares how much they are overcharged).

Suppose the government mandated that you could buy a homeowner policy to cover losses from fire only if you also purchased a zero-deductible policy for theft. Such a package deal would be unnecessarily expensive and unsuitable for those who wanted only part of the package. Many would simply choose to do without.

Drug insurance for seniors is no different. Harvard economist Amy Finkelstein found that initial imposition of minimum standards during the '80s resulted in a 25 percent drop in Medigap use. She also found that policies in 1977 did cover prescription drugs, ironically. Such policies were banned because they did not meet the feds' new standards.


Alan Reynolds

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