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By: Gov. Mitch Daniels
8/27/2012 06:15 AM
The central contention of a book I recently wrote is that our liberty
depends on the personal responsibility and accountability of individual
citizens. Unfortunately, many, especially those setting national policy
today believe that Americans are too intimidated, gullible or dim-witted to
make wise, informed decisions about the important issues affecting their
lives, and need their benevolent betters in government to do it for them.
My experience in public life leads me to the opposite conclusion. I have
seen that our citizens, properly informed of the facts, are fully capable of
governing themselves.
There is no better example of this than healthcare. In this area of policy
Indiana has pursued a path that respects the right of all our people to make
their own healthcare choices, and trusts their ability to do so. In the
process, we have restored the true concept of insurance and returned to it a
measure of consumerism that presses for quality and cost control in every
other economic sector.
Shortly after taking office I added Health Savings Accounts, personal
accounts from which to pay medical expenses, to our state’s menu of
healthcare plans, which featured the usual fee-for-service plans. HSAs
challenge purchasers to think more carefully about services, which are no
longer “free,” incentivizing citizens to look at heath care with a
consumerist eye.
Despite resistance from the defenders of the third-party payment system and
the proponents of a government-run, single-payer healthcare system, the HSAs
have been an unqualified success. In 2006, the first year of availability
for Indiana state employees, they were selected by only four percent of us.
But over the next few years, this option grew in popularity: by 2012, more
than 90 percent of state workers had signed up.
Real consumerism kicked in
Along the way real consumerism kicked in. Patients began avoiding emergency
rooms for non-emergencies, and using generic drugs and preventative care at
higher rates than their counterparts in traditional plans. Ultimately, the
HSAs saved both the state and the employees money. Outside analysis showed
double-digit reductions in the state’s costs compared to traditional health
coverage. Meanwhile, employee premiums were much lower and HSA holders had
accumulated savings in the amount of $54 million.
In addition to lowering costs for taxpayers and state employees, HSAs have
also helped us bring the peace of mind that comes with health insurance to
many low-income Hoosiers. The Healthy Indiana Plan (HIP), which we enacted
in 2007, created personal accounts managed by participants and funded
through a combination of modest premiums and state contributions. The
accounts, which total $1100 per person per year, offer “healthcare you can
control, at a price you can afford,” and have presented our state with a
partial solution to the problem of the chronically uninsured.
Today nearly 50,000 Hoosiers are enrolled in the plan. When surveyed, over
99 percent indicated that they would re-enroll in the HIP. Members have
lower non-emergency ER use versus the traditional Medicaid population, and
higher generic drug use than a comparable commercial population.
Unfortunately, despite this success, HIP’s continued federal authorization
is in doubt, a consequence of the current administration’s preference for
the traditional Medicaid program.
The crisis in American healthcare is the result of a system built for
overconsumption and overspending. Most Americans are, in essence, using
someone else’s credit card to cover medical expenses. But when it’s your
money and not someone else’s, you will always be more judicious about
spending it. As Indiana’s two programs show, by encouraging citizens to be
more thoughtful about healthcare decisions, HSAs can bring skyrocketing
healthcare costs back toward earth and provide affordable coverage for those
lacking insurance.
Unfortunately, these virtues were ignored during President Obama’s recent
healthcare overhaul. The idea of a form of insurance controlled by
individual citizens, rather than a panel of experts, is anathema to the “
reformers.” In fact, ObamaCare, with its avalanche of hastily written (and
not yet written) regulations, not only limits the use of HSAs, but also
purposely discourages insurance companies from offering them.
This is all too typical of our national policy, which refuses to trust
Americans with decision making power over not only healthcare, but a range
of other important issues ranging from education to consumer finances. As I
wrote in “Keeping the Republic: Saving America by Trusting Americans,”
this is the fundamental question facing our country. What type of people
will we be? Objects of therapy, or creatures of dignity? Wards of the state,
or a free people born to liberty?
Influenced by my experiences in Indiana, I’m betting on the latter. |
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