Assessing Health Care's Costs

Robert J. Samuelson's otherwise excellent Jan. 31 column, "Hiding Health Care's Costs," misfired on a few points.

The employee share of workers' health premiums for "family" coverage was indeed 27 percent in both 1999 and 2006, but the employee share of premiums for "single" coverage was 14 percent from 1999 through 2001 and 17 percent from 2002 through 2006.

The individual mandate for adults in Massachusetts to purchase "affordable" insurance applies to people at all income levels, not only those with incomes above three times the federal poverty line. However, a sliding scale of state subsidies is aimed at making insurance policies offered within a new "connector" purchasing pool more affordable for those with lower incomes. Thus, the political tensions in Massachusetts also involve the difficulty in either offering policies with more affordable premiums or subsidizing them even more heavily with state taxpayer dollars.

Also, a recent study by the journal Health Affairs concluded that "reducing emergency department use defies simple solutions such as expanding insurance coverage or restricting access for undocumented immigrants." The high use of emergency care in Medicaid probably is the result, in part, of little or no cost-sharing for the use of health services, and perhaps lack of access to office-based physicians because of low physician reimbursement rates. In 2004, only half of emergency room visits involved patient conditions that were emergent or urgent, and only 15 percent of patients arrived by ambulance. Or, as Yogi Berra might say regarding a typical emergency room, "Nobody goes there anymore; it's too crowded."

TOM MILLER

Resident Fellow

American Enterprise Institute

Washington