Diana Ernst
Diana Ernst is a public policy fellow in health care studies at the Pacific Research Institute. She contributes opinion editorials to print media, and routinely writes the monthly PRI Health Policy Prescriptions. Prior to joining PRI, Ms. Ernst was an intern at the Heritage Foundation in Washington D.C. in the American Studies and Judicial Studies departments. She was also a Publius Fellow with the Claremont Institute in Claremont, California. Ms. Ernst is a graduate of Claremont McKenna College with a B.A. in Government and Philosophy.
Monday, January 14, 20082008: A Good Year for Health Savings AccountsBy Diana ErnstCategories: HSAs, etc.HSAs are still young, but they are part of a burgeoning reform movement called consumer-driven health care (CDHC), which is proving to lower costs and encourage responsible behavior among Americans seeking to save more money for health care. Our previous briefing on consumer choice insurance anticipated that 2008 would be a special year for HSAs.Indeed, reliable reports indicate that HSAs are becoming increasingly popular. HSAs are a fundamental part of the effort to give Americans greater ownership of health care. The taxfree accounts provide a new incentive to save money for health-care expenses, and they restore choice and control of our health services to us. Americans with low-premium, high-deductible policies can open HSAs, which are offered through financial institutions. Employers, employees, and individuals can deposit pretax dollars into their accounts, and all health expenses drawn from HSAs are absolutely tax free. To read more, see the Pacific Research Institute (PDF).
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Friday, December 28, 2007Grinchy California Health CareBy Diana Ernst
After months of exhausting irresolution, Governor Arnold Schwarzenegger and Assembly Speaker Fabian Nuñez crafted the Schwarzenegger/Nuñez health-care bill, ABX1 1, which sounds like it requires batteries and a remote control. As it turns out, ABX1 1 requires $14 billion that California doesn’t have. For more, please go to the following link at Pacific Research: http://liberty.pacificresearch.org/publications/id.3550/pub_detail.asp
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Friday, November 16, 2007Medical Travel is a RealityBy Diana ErnstInternational travel for medical care is an increasingly important phenomenon. Medicine is perhaps the least expected of American industries to face global competition, but as businesses become globalized, national boundaries weaken against competitive forces and economic necessity. Today, doctors can work remotely from patients, and patients can choose remote health care. Medical tourism is growing, and that makes it more important for American public policy to streamline health care and allow domestic providers to compete internationally. Patients worldwide are saving time and money traveling to high quality hospitals for non-cosmetic surgeries in developing countries like India and Thailand. Medical malpractice costs, employer mandates, and underpaying federal programs threaten to stifle ourability to compete globally in health care.As long as U.S. laws hinder cost-effective and patient centered reforms that emphasize individual choice and ownership, American patients will increasingly choose health care outside our borders. Please find "The Globalization of Health Care, Round Two" (PDF) at the Pacific Research Institute Website for more.
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Friday, October 19, 2007Out of Control SCHIPBy Diana ErnstCategories: SCHIPYesterday, the House failed to override President Bush's veto of their legislation to expand SCHIP, the State Children’s Health Insurance Program. The program has more than six million enrollees, including 600,000 adults, a detail seldom mentioned in the news. Meanwhile, S-CHIP has failed to enroll almost two million qualified children. The president wants to require the program to deliver on its promise — providing insurance to poor children, and specifically children in families with incomes below 200-percent of the federal poverty level. Interestingly enough, the Congressional Budget Office recently reported that the President's reauthorization proposal would actually cover many more American children in the next 10 years than Congress' vetoed legislation. In reaching a new compromise on SCHIP, Congress should craft a solution for Americans using tax incentives and credits, so they can continue to own their own health care, rather than rely on a government bureaucracy. http://article.nationalreview.com/?q=NTQyODA0NGNhZjVlNTQ1ZmRjNjBiNmZlOWVlYzFlOGY=
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Wednesday, August 15, 2007Small is BeautifulLarge, government-run systems disappoint By Diana ErnstMore than a year from the presidential election, health care pushes ahead as an important domestic priority. Americans must decipher what is right for health care reform, but some pundits appeal more to the heart than the mind. This year alone, one film and three books take on this important topic, with mixed results. Michael Moore’s latest film Sicko introduces the American victims of unreformed insurance, bad incentives, and soaring costs, but after a skillful pulling of heartstrings, his movie lurches into a series of bewildering solutions to our problems. For example, Sicko portrays golden, government-run health care in other countries, but two years ago, the Canadian Supreme Court found that government monopoly health care violates basic human rights. The plaintiff in this case was prohibited from paying privately for a hip operation. He didn’t want to wait for years in the public line, so he went to court, and he won. Cuba’s health care system, another recommendation from Moore, treats Cuban party officials and a group of American patients in the film pretty well. Some 11 million Cuban civilians, however, use dirty facilities, receive dated prescription drugs, and are even required to bring their own sheets, food, and soap to the hospital. The textual equivalent of Moore’s shockumentary is Sick, by Jonathan Cohn, a senior editor at The New Republic. Like Moore, Cohn focuses on our worst health care failings, and blames the disorder of our modern health care system on “corporate debauchery and free market hysteria.” Cohn’s best evidence for government-run health care success are monopoly health systems abroad, and our very own Medicare system. In The Diagnosis & Treatment of Medicare, Dr. Thomas Saving of Texas A&M University and Andrew J. Rettenmaier, senior fellow at the National Center for Policy Analysis (NCPA) examine the true impact of our imminent Medicare costs.They estimate thatMedicare will consume almost a quarter of all federal income taxes by 2020, three-eighths of all federal income taxes by 2030, and 11 percent of the GDP by 2080. We cannot expect to place the price of benefits on the shoulders of younger generations forever, but we can anticipate a more equal distribution of health care payments, and we must foster personal savings for future sustainability to make it happen. Saving and Rettenmaier offer a new approach– prepayment for retiree health benefits and a structural reform of Medicare insurance coverage. Harvard Business School professor Regina Herzlinger paints a picture of the U.S. health care system as a “battle ground" in her book, Who Killed Health Care? She notes the philosophical difference between the “villains” and the “heroes” in American health care: those who believe “big [government] is beautiful” will promote government cost controls and health care rationing. Fundamentally different is the “small [government] is beautiful” crowd that entrusts the choice to individual Americans to utilize a free market, and to shop for even complex products. Herzlinger argues that consumers need more information, and here she welcomes a role for government, to standardize and report health care information for consumers to use at their own discretion. This still means abandoning the “big government” ideal, and it means a total modification of the existing health care villains. And so we compare two representatives of each camp, “big is beautiful” and “small is beautiful.” The makers of Sicko and Sick believe that the federal government will provide everything for everybody: technology, choice, and a free, efficient economy. Authors Savings, Rettenmaier, and Herzlinger recognize that we cannot scrap growth and innovation as we repair our health care system, or more lives will be lost in the end. The better solution is competitive reform, not big-government bureaucracy. Read the full review at the Pacific Research Institute web site.
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Monday, May 7, 2007Health Care ConnectorsBy Diana ErnstThe health-care connector model originated with the Massachusetts health plan last year. It expands section 125 cafeteria plans to provide portable, tax deductible health insurance for employees and individuals. We have yet to see its outcome in Massachusetts, but it already faces regulatory challenges in other states. By itself, a connector may be a good idea, but state governors seeking universal health care are facing the challenge of state health-care mandates and federal law, which inhibit a connector from serving as a truly cost-effective and competitive model for health insurance. We must deregulate health care first, to provide diverse and cost effective health plans in every state for every American, and we must do that before we try to patch up and further complicate health care with new law. For the full text of this paper, please visit: http://www.pacificresearch.org/pub/hpp/2007/hpp_04-07.html
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Thursday, March 15, 2007Consumerism is in Our FutureBy Diana ErnstThree laissez faire-loving authors offer three books with a positive forecast for the future of health care in America: less government control and more individual autonomy.The Business of Health: The Role of Competition, Markets, and Regulation, Robert J. Ohsfeldt and John E. Schneider, (AEI Press 2006) The Cure: How Capitalism can Save American Health Care, David Gratzer, (Encounter Books 2006) The New Health Insurance Solution: How to Get Cheaper, Better Coverage Without a Traditional Employer Plan, Paul Zane Pilzer, (John and Wiley Sons Inc. 2005) In The Business of Health, authors Robert J. Ohsfeldt and John E. Schneider of the American Enterprise Institute and the University of Iowa College of Public Health provide technical analysis on the benefits of profit-seeking in health care. The authors begin by noting the complexity of cited reports about U.S. health care performance on an international scale, and find that broad, population-health metrics may overlook differences in health-systems across countries. Such measurements may also capture population characteristics that have nothing to do with health systems. For example, injury and homicide cause a significantly higher mortality rate in the U.S., but you hear less often that the U.S. ranks very high in patient survival rates due to early detection of disease and post-diagnosis management. Ohsfeldt and Schneider write that many comparisons of the U.S. health-care system to those of other countries are founded on misunderstood international standards; their misuse by supporters of a centralized government system threatens to stifle innovation and research in the U.S. The authors conclude that health policies intended to lessen the adverse effects of competition should be measured against the loss resulting from restrictions on competition. Those looking for a lighter read will find The Cure full of facts, entertaining anecdotal references, history, and even a little philosophy. Author David Gratzer, senior fellow at the Manhattan Institute, is also a physician who has practiced in both Canada and the United States. Gratzer remarks on America’s exceptional capacity to innovate in the medical arena, but our antiquated method of delivery. Citing Milton Friedman, he writes that health care should be cheaper as it evolves and more Americans use it, like other sectors of the economy that have achieved economies of scale. Our health-care delivery system, Gratzer explains, has sprouted from a few bad seeds: for example, employer-sponsored care, which began in the 1940s, has distorted the true cost of health care by giving beneficiaries excessive benefits, tax free. Employees pay increasingly less out-of-pocket for their own health care as a result. The average out-of-pocket expense for health care in 1962 was 46 cents of every dollar; today it is around 14 cents. Gratzer supports President Bush’s recent health care tax reform and Health Savings Accounts (HSAs), essential steps to break America from dependency on employer-provided health care. Finally, Paul Zane Pilzer, economist, entrepreneur, and professor, wrote The New Health Insurance Solution, which amounts to health insurance 101; how to find and keep portable health insurance, and how to save money doing it Pilzer writes that Americans are wasting their money enrolling in employer-sponsored plans. Especially if you’re healthy, he says, you should choose individual or family high-deductible insurance with an HSA. Employer-sponsored health care only means we may have less choice of providers, no protection if we lose our jobs, and financial risk even when we keep our jobs. Pilzer also provides an appendix with a state-by-state guide to individual and family health insurance premiums. He helps readers understand the currently convoluted system, including employer plans, Medicaid, health insurance laws and loopholes, and a series of FAQs: What if you think you can’t afford health insurance? What if you just transferred jobs? What if you own a small business? All authors ultimately provide substantive evidence supporting the rising trend of consumer directed health care (CDHC). All agree that pro-consumer policy recommendations would allow patients to grow into savvy clients and savers, that consumers should be able to buy insurance plans across state lines, and benefit from tax deductible health-insurance premiums. Those bothered by the current debate can take heart. More choice, cost effectiveness, and quality are in our future with consumer-directed health care.
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