That sets up one of the recurring problems in health-care policy, which is that the more you do to control costs, the more people will hate you. Insurers found this out in the 1990s, when HMOs managed to save a lot of money without doing any measurable harm to care, but the American people loathed them for it. Various provisions in the Affordable Care Act ”” or any serious cost-control effort ”” will end up proving it again.
This will present a useful test for seeing who’s serious about controlling health-care costs. Conservative economists, for instance, almost universally hate the fact that employer-provided health benefits aren’t taxed, and that public-sector workers have bargained so aggressively for generous benefits. John McCain’s 2008 health plan relied on ending the employer deduction entirely and converting it to a capped deduction for individuals ”” which is a much more violent version of this kind of change.