Republican presidential candidate Dr. Ben Carson is doing well in the polls despite the fact that he frequently comes up with half-thought-out policy proposals. The latest example is his health care reform plan.
Carson really likes Health Savings Accounts (HSAs), which are combined with high-deductible health insurance. He wants them to be the cornerstone for how we pay for health care so that everyone has a tax-free HSA. (Here’s more on HSAs.)
Conservatives—including me—have supported the same thing for two decades. So far so good.
But as Politico reported last week, Carson’s plan also had the government depositing $2,000 a year into every American’s HSA. He said his plan would cost about $630 billion a year—i.e., 315 million Americans x $2,000 a person.
Here are the two major problems with that approach:
More than half of Americans already receive some form of subsidy or assistance from the government, and Carson’s plan would make that 100 percent. So every citizen, cradle to grave, would be on the federal dole. Does that sound like a conservative plan to you?
Everyone would have to use some of that money—Carson suggests about one third—to buy a high-deductible health insurance policy. Isn’t that the same mandate to have coverage that conservatives have fought so hard against?
Plus, the U.S. spent about $2.9 trillion on health care in 2013. That works out to $9,255 per person. And while most health policy experts, including free-market advocates, believe that we would spend much less if the right policies (such as HSAs) were adopted, virtually no one believes we could cut spending by nearly 80 percent. Carson seems to think we could.
But apparently you can forget most of that now. When Carson appeared on Fox News with Chris Wallace on Sunday, he tried to explain that he’d scrapped most of that plan, including the part that raised lots of eyebrows: ending Medicare and Medicaid in favor of providing seniors and the poor with HSAs and $2,000.
According to Carson: “No, that—that’s the old plan. That’s been gone for several months now. The plan now for funding health savings accounts is using the same dollars that we use for traditional health care.”
As you can see from the transcript, Wallace was more than a little confused by the switch. And understandably so: Carson’s YouTube video explaining the old plan is still up.
And while the switch from the government handing out $630 billion to every American to using the money currently being spent buying health insurance is the right approach, Carson provides no explanation of how that will happen.
Individuals and employers spend about $850 billion purchasing private health insurance. And many already have an HSA option with a high-deductible policy, though Carson’s plan would likely allow a much higher deductible than Obamacare.
The Employment Benefits Research Institute (EBRI) estimates there are about 17 million policyholders and their dependents with HSAs, with about $24.2 billion in the accounts. They are popular and their number is growing fast, especially because the high cost of Obamacare is driving people to HSA-eligible deductible policies.
But would Carson take the very un-conservative approach of forcing everyone into an HSA and high-deductible policy? If not, how is his plan much different than the HSA options that most employers and individuals have today?
Carson now says Medicare and Medicaid beneficiaries could choose his $2,000 HSA option, rather than being forced into the plan. But would any senior choose that option when $2,000 wouldn’t come close to buying a high-deductible policy for someone age 65 or older?
In short, Carson’s health care plan appears to be on the right track, but it is impossible to figure out how it would work or why it’s much different than what people can access now. Since we could conclude the same thing about most of frontrunner Donald Trump’s proposals, maybe voters are, at least for the present, more concerned with vision than details.