HISTORY'S LESSONS FOR HEALTH CARE COSTS Keeping a lid on prices through legislation sounds easy -- until you try it.
(FORTUNE Magazine) – POLITICIANS have tried to stop prices from rising since the 18th century B.C., when Babylonia's King Hammurabi decreed how many gur of corn a farmer could pay for a cow. Never mind that most such efforts end badly, or that economists, in a rare state of agreement, condemn them. Price controls are seductive, and anyone who has muttered ''there oughtta be a law'' while writing out a check can understand why. Bill and Hillary Clinton are the latest to succumb. The President told the nation that his health care plan avoids using ''price control'' and ''the heavy hand of government.'' But his main mechanism for forcing health care costs down -- premium caps on the insurance policies that all citizens would be commanded to buy and all businesses required to offer -- is a classic example of price controls. Every year on March 1, the National Health Board would compute the ''regional alliance inflation factor'' that would limit insurance premium increases. Congress could override the caps, just as it periodically raises the ceiling on the national debt. But would politicians want to take the blame for pinching voters' pocketbooks? Not likely. If the controls stick, history suggests they will produce fewer health care services, lower quality, and rationing. While the Clinton plan largely avoids setting prices for specific goods and services beyond insurance, it contains ominous portents. An Advisory Council on Breakthrough Drugs would ''make a determination on the reasonableness of launch prices.'' The law would ''establish a program to monitor prices and expenditures in the health care system,'' with power to compel ''providers and third party payers to disclose'' information. In the past, controls have tended to breed more controls. The results of Hammurabi's initiative are lost in history, and the fate of President Clinton's lies with Congress. But there are cautionary tales galore in the 38-century history of price controls. Here are a few of the more notable. THE EMPIRE STRIKES OUT THE Roman EmperOR Diocletian (A.D. 245?-316), who is remembered as the last great persecutor of the Christians, also directed the first well-documented attempt to control prices. President Clinton could learn a thing or two about enforcement from his experience. Diocletian and his fiscally irresponsible predecessors reduced the silver content of Roman coins, creating what we would recognize as consumer price inflation. But Diocletian blamed the ''avarice'' of merchants and speculators, and promulgated the Edict of 301, which set maximum prices for more than 1,000 goods and services. The penalty for evading the controls was death, but even that didn't make them work. One reason, according to a contemporary account, was that ''the people brought provisions no more to market, since they could not get a reasonable price for them.'' The edict was revoked after much bloodshed and suffering. Diocletian abdicated in 305. AIDING THE ENEMY THE SIEGE of Antwerp is a stark lesson in the law of unintended consequences. In 1584 the port city (then part of the Hapsburg empire, now part of Belgium) was besieged by Spanish forces led by the Duke of Parma. He slowly cut off access by land and blockaded the city by sea. Food prices rose sharply to reflect the dangers of supplying the city. Antwerp's outraged rulers enacted strict price controls. The result: Supplies ceased and the hapless inhabitants, facing starvation, were forced to surrender. WORLD WAR II: THE REAL THING AMERICA'S most extensive experience with price controls demonstrates how they tend to cascade and how much government muscle they require to enforce. The U.S. began by merely urging producers to hold down prices of selected goods as their patriotic duty. Soon formal price schedules appeared, and across-the- board wage and price controls followed in 1942. The Office of Price Administration eventually employed more than 64,000 people, kept another 100,000 busy as volunteer ''price watchers'' around the country, and filed 259,966 lawsuits to enforce the controls. At the same time, the government rationed all sorts of goods. Official inflation figures remained subdued, although a vibrant black market arose for everything from underwear to automobiles, and evasions were common. Consumer Reports magazine documented a famous case in 1943, when it tested candy bars and discovered that 19 of 20 had shrunk in size since 1939, effectively increasing their unit price. A burst of inflation drove prices up 21% after the controls came off in 1946. PRICE CEILINGS, LEAKY ROOFS ONE WORLD WAR II emergency measure -- rent control -- took on a life of its own in New York City. Direct descendants of the wartime measures are still in force today, and for 50 years rents on many New York apartments have been held below market levels -- often far below. While this created windfalls, with well-to-do renters paying only a few hundred dollars a month for palatial apartments in chic neighborhoods, it also reduced the quality and quantity of rental housing. Investors were less willing to finance construction of new apartment buildings. Landlords failed to maintain buildings in some neighborhoods and abandoned them in others, helping to produce the vistas of urban desolation that have become one of the enduring images of New York City. THE BEST CASE FOR CONTROLS INFLATION surged when the United States entered the Korean war, mainly because consumers and businesses feared a return of World War II conditions. But the panic dissipated after President Truman imposed a wage and price freeze in 1951. At the same time, the Federal Reserve adopted a new, anti-inflationary monetary policy. Prices stopped zooming and barely budged when President Eisenhower repealed the controls in 1953. The lesson? Price controls that work best control least, and are accompanied by substantive policy changes. THE VOLUNTARY APPROACH THE KENNEDY Administration devised voluntary wage and price ''guideposts'' in 1961 to keep order in the economy. Steelworkers limited their wage increases that year, and President Kennedy fumed when big steel companies upped their prices anyway in 1962. The industry backed down after a presidential tongue- lashing, but wage increases resumed and prices eventually rose. Verdict? Talk is cheap. HARBINGER OF HEALTH CARE? % RICHARD NIXON presided over America's most slapdash attempt at price controls. First came Phase I -- a purported 90-day freeze of wages and prices in 1971. That turned into Phase II, and then Phase III and Phase IV -- the last of which ended in 1974 in roaring inflation. While the controls didn't hold back prices, they did produce distortions and bottlenecks throughout the economy. Indeed, this episode provided a consummate example of how price controls create shortages. When OPEC quadrupled oil prices in 1973 in the midst of the control effort, the government held the retail price of gasoline steady. The result was round-the-block lines -- precisely what critics say will happen in hospitals and doctors' offices under the Clinton health care plan. |
|