Pie's never free ... Planet Money talks breast pumps and the ACA

I could honestly recommend virtually every Planet Money podcast ever produced as "must listen" material -- their crew does a great job of looking at both very complex and regular everyday issues and making them approachable and informative.  If you have an interest in economics or business at all, I highly recommend adding their podcasts to your brain consumption.

Their most recent episode talks about the impact of federal legislation (specifically the ACA, aka "Obamacare") on the breast pump market, and poses some good questions in the mind of the listener in terms of when it is really appropriate to legislate private market activity and when it isn't.

If I was King (or a noble dictator), I'd reform our healthcare system in a way that de-links health insurance from employment, which would allow for more career mobility in our country and, frankly, make it a lot easier for businesses to do business (instead of devoting so many resources to being healthcare insurance providers).  The tradition of health insurance being a part of an employment package is a somewhat artificial construct dating back to the days of wage controls in WWII.  In other words, it arose as a workaround to existing government regulation that were distorting the job market.  Similarly, today, one could assume that if employers got out of the business of providing healthcare insurance, salaries may well rise by roughly the amount that employers were previously spending on health insurance (as many/most people today are making their job decisions factoring in the value of the health insurance perks).

I'm also definitely in favor of some basic level of universal healthcare insurance.  We already have universal access to healthcare -- it just happens to be incredibly inefficient and creates terrible incentives both on a cost and care basis.  Federal law requires that anyone showing up to a healthcare facility with urgent healthcare needs must be given treatment.  Without that law, a possiblity exists that people would be left to die simply because they couldn't pay for the healthcare services they needed.  As a society, we've deemed that scenario to be one we can't morally or ethically stomach, so we've put a mandate in place to prevent that from happening.

So why do we need univeral healthcare insurance?  Absent a person having healthcare insurance (or such large sums of money available to them that they are essentially self-insured), we run into two problems: 

1. The very real situations where people simply can't afford healthcare insurance (and don't have the ability to pay for needed treatments out-of-pocket), and they end up utilizing more expensive versions of healthcare (waiting until it's really bad and then hitting the ER, etc.) rather than being proactive and utilizing cheaper forms of healthcare; and
2. The same general scenario, except from people who can afford health insurance, but simply gamble that they won't need it, knowing that they can just freeload in the event that they ever do need it. 

As in the case of breast pumps above, nothing is ever "free," so those higher costs in both scenarios are borne indirectly by the rest of society, driving up healthcare costs for everybody who does pay their own healthcare costs.

My "back of the envelope" solution to our healthcare reform needs would be to have a base level of health care insurance that would be either [Plan A] mandated to be purchased by the individual, with support for those who can't afford it; or [Plan B] a system where everyone gets vouchers that would pay for a minimal amount of private healthcare insurance (essentially a voucher that would purchase enough insurance to cover basic needs to keep people healthy and to prevent them from losing everything in the event that they get sick/injured, but nothing extravagent).  I'd leave it up to a vote of the people (I would be a King/Dictator of the people, of course) to collectively decide which option they preferred, depending on how much they were willing to pay in taxes. 

For Plan B, people could pay for more generous insurance coverage over the voucher amount out of pocket.   

I wouldn't have any mandates in terms of what specifically was covered.  If people didn't want, say, breast pumps covered by their insurance, they could buy a policy that didn't cover that sort of thing.  Same with contraception, etc.  One can make the argument that subsidizing breast pumps is good for society, and it may be on some level, but at the end of the day, I'm not generally in favor of subsidizing people's life decisions (including their decisions to have kids) unless the benefit to society is very clear and so compelling that the benefit to society far outweighs the cost to society.  In this particular instance, I don't think the math favors the mandatory breast pump coverage.  As the economist in the podcast argues, if a strong benefit to society argument can be made for the use of breast pumps/breast feeding, it seems like a better approach would be to provide subsidies only for those women/families who can't otherwise afford their own breast pumps as opposed to making it a benefit available to everyone. 

I'd also borrow a lot of ideas from the ACA, such as creating the Health Insurance Exchanges, so people could competitively shop for insurance plans in an easy-to-understand online marketplace.  I'd also implement a lot of electronic records and other tech-laden ideas to increase the efficiency of our entire healthcare system.  The HMO we currently use seems to do a really good job of both providing quality healthcare service and keeping costs down, so to the degree that my crown could encourage the geographic expansion of their HMO model, especially into rural areas, I'd have my minions strongly consider such a plan.

This is really just an incredibly rough draft that popped into my head while listening to that podcast, so I'm sure much of it is complete garbage when examined by people who know a lot more about these topics than I do, so I welcome that input to tell me where I'm wrong, or where more thought/info is needed, or even if I got something right.

After I fixed all of our nation's healthcare woes, I would immediately resign as King/Dictator, as I truly can't stand either monarchies or dictatorships, and I'd hate to be that emotionally conflicted for too long.