More from Ponnuru's piece:
The tax code, as noted above, has shaped the private health-care market. Restrictions on who can perform medical services also keep their prices higher than they otherwise would be. And states have imposed an ever-larger number of mandates on insurers. Arkansas is one of thirteen states, for example, that require health insurance to cover in vitro fertilization. Add up such mandates, and the effect can be to price a lot of people out of the market. Duke University professor Christopher Conover estimates that the number of uninsured Americans would drop by a quarter if these mandates disappeared.
This idea that states force insurers to offer overly-comprehensive coverage is a common one. Sebastian Mallaby put it slightly differently when he snarked that Minnesota covers wigs and massage therapy, and what sort of health care system was that? So let's take a look at what these mandates are.
The Council for Affordable Health Insurance -- an industry front group -- puts out a yearly report on the mandates, and repeats this figure that one-quarter of the uninsured are uninsured because the mandates are so onerous. I picked a state at random -- Arizona, who's not too red nor blue, and who has an average number of mandates -- and collected all the conditions and treatments the state is forcing them to cover. Tell me which ones you'd want insurers to drop: Alcoholism, ambulatory surgery, breast reconstruction, colorectal cancer screening, contraceptives, diabetes care and supplies, emergency services, home health care, mammograms, maternity stays, maternity health parity, off-label drug use, infant formula, chiropodists, chiropractors, nurse anesthetists, nurse practitioners, nurse midwives, optometrists, occupational therapists, podiatrists, psychologists, and speech and hearing specialists. Additionally, they mandate that insurers offer coverage for adopted children, dependents, handicapped dependents, and newborns.
Certainly, you can pick a couple things to carve off. Maybe you'll take off chiropractors, though that may actually cost you money as patients opt for covered (and ineffective) lumbar surgeries over manual readjustments. You could take out midwives, but they're saving you money, too. And this stuff just doesn't cost that much: The benefit mandates (your wigs and in-viutro fertilizations and diabetes care), according to Conover, cost only $13 billion. The money comes in access mandates ($81.4 billion), which force insurers to cover the disabled, pregnant women, and let you go to psychologists, chiropractors, etc. And the calculated benefits of those mandates come to a bit over $70 billion. So here's my question for Ponnuru and others: Which of these services shouldn't be protected? And how will its absence improve the cost-effectivieness -- to be distinguished from the mere cost -- of medical care?
