The Role of Tax Policy in the
Current Health Policy Debate
Robert B. Helms
American Enterprise Institute
Those who have participated in this series for several years must have learned by now that economists do not view the world as others do. And those who have participated so far this year must have learned that this is especially true of those economists who specialize in health economics. Given that most of my career has been spent in Washington, it is my observation that economists play a very small role in the national health policy debate. While there is a grain of truth in the well-worn jokes about economists not being able to reach a conclusion, the reality is that health policy debates have been dominated throughout the twentieth century by strong groups of providers who have a direct stake in the outcome of legislation. In the last few years these groups have been joined by other groups claiming to represent “consumers” or specific groups of patients. All of these participants in the health policy debate provide ample employment to a new army of pollsters and political analysts willing to tell the politicians and the public what kind of health policies they think we want. In the midst of all this noise, the hard-working academic or government health economist, trained to ask fundamental questions and seek answers based on factual information, and having earned a reputation for producing overly technical and dull reports, has a difficult time being heard. The result is a political environment that has a higher probability of producing legislation based on emotion and wishful thinking than on the economist’s usual standard of economic efficiency.
Nowhere is this danger for bad policy more prevalent than in the current health policy debate. Politicians are striving to legislate im-