If we want to radically improve insurance and health care in our country to ensure that every American receives the care they need, we have to be bold. And that begins with divorcing insurance from where we work.

Not only would that improve the choices of consumers, but it would also help lower costs and provide more options for people who aren’t covered in the current system. That would empower individuals to choose their health plans according to their needs.

As of March 2019, the U.S. Census estimates that 91% of the population had health insurance. Nearly one third receive coverage from government health insurance, whether Medicare, Medicaid or state employees. Left out are approximately 29.9 million Americans without health insurance — public, private or otherwise.

The number of uninsured is an important metric because it is the target group for most substantial health insurance reforms of the past decade, including Obamacare at the federal level and the expansion of Medicaid eligibility at the state level, both problematic in their own right.

According to a Kaiser Family Foundation survey, 45% of the uninsured say the cost is too high, while 31% of the uninsured lost their coverage because they made too much money for Medicaid or they changed employers.

The single largest category of the insured in our country is those who receive insurance through their jobs, approximately 54%. Why is that?

Since 1973, the federal government provided incentives to employers who set up Health Maintenance Organizations for their employees. Since then, our health insurance market has pivoted to match having a job with health insurance. Incentives to employers to cover health care for their employees is good policy on its face, but it has led to unforeseen economic consequences.

Employee health plans, managed by state-based health insurers (another worthy reform to consider), often become a headache for workers and firms alike.

These plans aim to define benefits and coverage according to a firm’s needs and often have to hire several people to oversee them. Then, bureaucracy balloons, administrative costs creep up, and whatever advantage these plans initially offered is now buried in red tape.

Added to that, if you leave your job for another one or find yourself unemployed, you are now one of the 9% without health insurance, which puts you at risk.

There has to be a better way.

The alternative to this system would be a free and open marketplace in which individuals would be empowered to choose their health care insurance plan according to their needs, just like car insurance. Employers could offer cash subsidies in line with current federal incentives, but the choice of plan would remain that of the workers.

Such a plan would then empower people to try new innovative health care delivery models, such as direct primary care, concierge medicine and medical startups.

We take out insurance to cover the costs and the risks we don’t foresee, not to cover each routine transaction we make with a provider. It’s the same reason we don’t insure windshield wipers or tires on our cars.

If someone wants more comprehensive insurance, they should be free to take it. And the costs should be reflective of that option.

If employees could be encouraged to build their plans, that would remove administrative and bureaucratic hurdles from existing insurance arrangements or mandates. It would also encourage more competition and lower prices from health insurers, helping bring down costs for employers and employees alike.

But doing so will require a huge shift in the way we think as Americans. We can no longer marry our health insurance to our jobs.

Separation of job and insurance should be a mantra as much as separation of church and state. And federal policy should encourage Americans who take control of their own private health insurance plan.

Yaël Ossowski is a writer and deputy director at the Consumer Choice Center, a consumer advocacy group based in Washington, D.C.

Originally published here.

Scrapping Public Health England, a body with the ambition of nannying every Brit, is a significant step towards enhancing personal responsibility and allowing greater freedom. But there’s much further to go.

The UK government should drastically change its approach to healthcare and lifestyle regulations to create an enduring change. With 320,000 confirmed cases of Covid-19 across the country and close to 41,000 dead, there is an urgent need to find a scapegoat. PHE is problematic for many reasons, but it is hardly the root of the UK’s failed Covid response. Enormous centralisation and bureaucracy, on the other hand, are what the UK government needs to do away with. The response to the pandemic gives us clear examples.

It took the UK over six weeks to catch up with other developed countries’ testing capabilities. Germany’s decentralised and private laboratory network had already tested over two per cent of its population while the UK had tested a meagre 0.7 per cent. Britain’s centralised testing system, and its failure to scale up Covid-19 tests, might help explain part of the mortality gap between the two countries.

Testing, as we have learned, should be decentralised, which makes it more easily accessible to all groups of the population. The US government failed to stop the pandemic early on for a similar reason. The Food and Drug Administration (FDA)’s initial regulations prevented state and private labs from developing their own coronavirus diagnostic tests.

During the crucial weeks of February and March, it was only possible to get tested for Covid-19 in the US at the Centre for Disease and Control (CDC). The consequences were devastating. As a result of a massive shortage of tests, many undetected cases speeded up the spread of Covid. On 29 February, the US government allowed private labs to begin developing their own tests.

On 16 March, the procedure was decentralised further, making it possible for commercial manufacturers to distribute and labs to use new commercially developed before obtaining an FDA’s Emergency Use Authorisation (EUA). Not long after the red tape had been cut, private labs went on developing tests that were notably more effective, allowing many more people to get tested.

The centralisation at the NHS has also contributed to its vulnerability towards external shocks such as Covid-19. Decentralised hospital systems that promote private competition and patient choice have proven to be much more resilient, as Germany’s system demonstrates.

With that in mind, introducing more market mechanisms in the NHS would not mean that patients would be denied care – you can have universal healthcare in a social insurance model too. Having more private hospitals does not necessarily lead to fewer hospital beds, but a better allocation of skills and resources. Indeed, it allowed Germany to scale up its ICU capacity, as well as keeping services such as cancer treatments and screenings open in different locations.

Another reason not to get overjoyed about the season finale of the Public Health England’s reign is that it would continue to deal with the agency’s other non-Covid public health work, such as obesity policy, until the spring. Boris has set out to introduce radical anti-obesity measures, and there is every reason to expect the PHE will contribute its most poisonous ideas to that debate. One last time.

While free-marketers like me have been cheering the fall of the PHE with sugary milkshakes and burgers, health secretary Matt Hancock announced that nannying will be “embedded right across government… and in the work of every single local authority. We will use this moment to consult widely on how we can embed health improvement more deeply across the board.”

Even without PHE, we need to look at health issues, such as obesity, through the prism of innovation, education and personal responsibility. PHE’s better health marketing campaign to promote a healthy lifestyle is just one part of Boris’ anti-obesity approach, which tells us that even without institutions such as PHE, nannying will likely continue to flourish. That’s where we need a fundamental mindset change, not just an institutional one.

Abolishing old agencies and setting up new ones often gives the impression that such actions will have a positive lasting impact on our lives. Unfortunately, that is not always the case. While it is tempting to think that merely putting an end to the PHE will help make the UK better prepared for health crises, it is naive, to say the least. Neither will it move the needle away from paternalism. But it’s a great start!

Originally published here.

The Consumer Choice Center is the consumer advocacy group supporting lifestyle freedom, innovation, privacy, science, and consumer choice. The main policy areas we focus on are digital, mobility, lifestyle & consumer goods, and health & science.

The CCC represents consumers in over 100 countries across the globe. We closely monitor regulatory trends in Ottawa, Washington, Brussels, Geneva and other hotspots of regulation and inform and activate consumers to fight for #ConsumerChoice. Learn more at consumerchoicecenter.org