Mike Mitternight, a small-business owner, writes (The Advocate, March 15) that he is deeply concerned the rising health-care costs. Mitternight is conscientious in providing health insurance for his employees. He is worried about paying a “health insurance tax” that he believes is part of the Affordable Care Act, or Obamacare.

Rising health-care costs are a big problem. But there is no such thing as “health insurance tax” in the Affordable Care Act.

What is happening is that the Affordable Care Act taxes certain industries, including the health insurance industry and medical device makers. Understandably, these industries are lobbying Congress to get these taxes removed.

Mitternight would be right to worry insurers and device makers will attempt to pass the cost of these taxes onto their customers. In order to prevent this, the cost-control regulations in the Affordable Care Act need to be maintained and should be strengthened.

The insurance industry, in particular, needs cost-control regulations. Insurers have not been able to control medical cost increases, insurers’ own inefficiencies have added to health-care inflation. In the past, competition among insurers has meant pursuing healthy customers and denying care to unhealthy people. No one wants that anymore. But health insurers, as well as device makers, will get millions of new customers as a result of the Affordable Care Act. So we should not worry that these companies are treated unfairly by the law.

For businesses trying to cover their employees, Medicaid expansion would ease the burden for some businesses by helping with coverage of low-wage employees. Beyond that, Medicaid expansion would help rectify the inefficiency and inequality of a system in which some people do not get the care they need, while at the same time there is overuse and over-testing elsewhere. But businesses would benefit, too.

Finally, because Mitternight’s competitors will now be obliged to provide health insurance to their employees, he need not fear that his competitors will gain an advantage by not being as conscientious as he is.

Health-care costs are a big problem for U.S. society. In practice the U.S. health-care system is more market-oriented than other wealthy countries, but we spend twice as much per person as other wealthy countries, and get worse results.

The Affordable Care Act is not ideal. It works within the U.S. market-oriented system, which is a complicated way to get near-universal coverage, and it does only part what is needed to address the problem of health-care costs.

In the end, the solution to the health-care cost problem depends on all of us to choose effective treatments, which often are not the most expensive, and to create a health-care system that works for everyone.

Aaron Lercher


Baton Rouge