Personally I think these are great ideas to make America better, but I think our country is honestly too comfortable, unambitious, and driven by the whims of political rhetoric to do so. The 'Buy American' provisions of the BIF/BIIA are driving up our infrastructure costs even more right when we make a good investment into it. And Biden is doing great stuff on welfare program efficiency and state capacity stuff, and no one cares! Left doesn't care because hes not cancelling student loan debt or whatever, and Right doesn't care cause hes no on the right lmao its kinda disheartening...But I mean we gotta continue the slow boring!
May be missing something, but I always thought the reason for talking up the job creating aspects of the Green New Deal wasn’t to address current unemployment, but to address the unemployment that would be created through rapid decarbonisation? Coal miners become solar installers etc.
Does anyone have a recommendation for how EU-style VAT and payroll taxes constrain consumption as Matt asserts in this piece?I believe it, and it makes sense intuitively, but I live in Italy, home of high taxes and 22% VAT and it just seems like there's A LOT of personal consumption everywhere I look. I suspect part of that has to do with much lower housing costs so people have money to buy fancy shoes, handbags, sporting equipment, etc. But I'd like to see the bigger picture.
Something I surmised in visits to Sweden was that Stockholm was so much more economically successful than much of the rest of the country that it wasn't uncommon to see highly-taxed and very expensive Volvo XC-90s (full of $8/gal gas) all over the city whereas much of the rest of the country was rolling in excellent trains or economy cars.
Every dollar you spend on healthcare is a dollar you can't spend somewhere else.
So if dollars (a LOT of dollars) are being wasted in healthcare that's a big deal. Especially given how large a percent of GDP healthcare is.
Of course there are different ways to achieve those savings. Single payer nations achieve those via a healthcare budget (ie rationing).
I think it should be achieved through competition. Mandate that all prices are posted online. Don't allow providers to very prices depending on who's paying.
Then focus on increasing healthcare supply faster than demand, and let competition work.
Yes, competition works in healthcare, see plastic surgery etc. But it requires price transparency
In the infrastructure bill what is the system of governance to prevent another California High Speed Rail, which has created a lot of jobs but is still a very long way from offering an attractive alternative to Greyhound, let alone Southwest Airlines?
I think the main system of governance answer here is that Mayor Pete doesn't want too much ammunition for attack ads during his next presidential run saying he wasted government money on roads to nowhere when he was Transportation Secretary, so he has a huge amount of control over the money and will try to minimize waste. I'm not saying that is a good system, but I think that's the main system for this bill.
Given Pete’s rationalization of extra tax credits for union made electric cars (self-immolating Chevy Bolt, anyone?), I don’t expect much scrutinizing of infrastructure spending.
My concern about this tack is that I think the economy remains under-stimulated and inflation is still too low.
While this sounds like an insane take, my reasoning is simple: there’s way less automation in our economy than there could be even with existing out-of-the-box solutions. When the $15 minimum wage was a big talking point, conservatives liked to joke about losing fast food jobs to kiosks. But the kiosk wasn’t going to eliminate a worker, it was going to move them to a productive food prep role because that’s what the restaurant needs but doesn’t have the space/administration to have unless it can eliminate another workspace/role. We need wages to rise until companies are forced to invest in this kind of technology, shifting more of our labor out of tasks that are amenable to automation.
When a person who is capable of producing $10 per hour in value is granted a statutory $15 minimum wage, that person’s wage becomes $0, or they work off the books at $10 or less. That is a fact of life.
I would not go quite so far. Productivity in group tasks is difficult to measure, and so some people (within reason, of course) can be overpaid so long as others are underpaid relative to their productivity.
"Productivity in group tasks is difficult to measure..."
You know what institution is really good at measuring group productivity and its causes? The US Army. And they won't take anyone with an IQ less than 80 because they are untrainable for even the most basic of soldierly duties.
"Jobs" has always been the wrong metric. If I have an employee making $40,000 and I fire him or her and hire two people at $20,000 each as replacements, I have doubled the number of jobs but the world is not a better place for it. Gene Sperling, in his book Economic Dignity, wrote that a worker should be able to put food on the table and be at the table with his or her family. That's about right.
"An America where a larger share of the population is working in the care economy is probably one where a smaller share is working in the foodservice economy."
There are a substantial number of people for whom getting served by a server who meets your every demand and has to give you exactly what you want... or no tip... is "care" to them. Care for their ego, care for their sense of "it feels good and makes me feel important to have people cater to my whims".
When that got taken away for a few weeks at the start of lockdowns, boy howdy did you see the Applebees Karen crowd get pissed. With the labor shortage in hospitality, this is only going to get worse, because as it turns out, serving Angry Karens doesn't just pay poorly - it is also really effing demoralizing.
MY's pretty clear point in this post is that increasing taxes on the rich has diminishing benefits because we are (pace higher immigration) labor-constrained. I get the analysis but it leaves me with disquiet on ethical and moral grounds: the rich have made out like bandits in part because they're undertaxed. If so, what should we do with higher taxes from the rich? Reduce the deficit and national debt? Cut the payroll tax in half? What else?
Matt has stated in the past that a wealth tax is a fine idea but we should be clear that it is punitive/intended to alter wealth distribution rather than something that can fund social programs in a real way.
Why would giving money to poor people be inflationary? If it was done with a work requirement, I would expect it to drive wages down by depressing wages (as people more people would be willing to take lower wage jobs).
I believe that its inflationary impact would depend both on the amount (of money) and on the method of distribution.
I see a lot of talk about health care pricing and the lack of the free market. A patient seeing a doctor right now, if they have insurance, personally pays less for their time than if a plumber had come to their house. There's no free market that will ever allow those costs to come down from where they are subsidized by insurance.
One problem is that health “insurance” is increasingly defined as covering everyday routine care as opposed to opposed to a major unexpected expense like a broken leg or a heart attack.
How is that a problem? Insurance companies have discovered that getting you in for "everyday routine care" early and often saves money in the long term. They are not being forced to remove copays on 'preventive care.' That's a business decision.
If everyone gets a "free" check-up, then everyone's premium has to be high enough to cover the cost of the check-up. But for most people the full cost of premiums are hidden - part of your compensation that you never see (when your boss decides how much he can afford to pay you better believe he takes into account the cost of the health plan)
No, "if everyone gets a 'free' checkup, then everyone's premium [must adapt,]" _or_ the checkup must _in fact_ be free. And the insurance companies have, in fact, discovered that on average, not only are checkups free, they actually have a negative cost. Getting a checkup, on average, reduces the cost of your overall care more than the cost of a checkup.
Matt's heel turn to being a full on Thatcherite is uhh certainly interesting.
Choke the economy into recession with rate hikes because of inflation, bring in third world helots to crush any gains in labor power, and now end federal spending to create positions is certainly a *set* of policy preferences. A set that would make the Iron Lady blush.
This is a really bizarre way of characterizing supporting the Fed trying to do a soft landing as inflation has lowered real wages for most people, as well as asking that government funds actually get used productively.
I think the Nordic model is unpopular in the US for good reasons. If people wanted more of those services provided under that model, they could buy them privately in the US. Yes there are reasons they can be under bought in a private market, but you should have to do a lot of work to demonstrate that's what people would really prefer and I'm almost certain it's not true in the US.
The main issue the US has at the moment, social spending-wise, is that we collectively pay way too much for healthcare. Not that we are clearly preferring to purchase more of it, but that its price has gone up dramatically in part because we’ve placed low caps on the number of new doctors and so on.
The US would be a lot better off if we could reduce this cost and people could shift their money elsewhere.
In the late 1980s I lived in France for 6 months as an exchange student. I remember the mayor of Paris shelving every street sweeper (which takes on operator) and replacing it with five guys with brooms. The goal: increase employment.
Of course, the broom crews were slower with even 5x the manpower, did a worse job, and cost much more.
"In a story beloved by economists it’s said that Milton Friedman was once visiting China when he was shocked to see that, instead of modern tractors and earth movers, thousands of workers were toiling away building a canal with shovels. He asked his host, a government bureaucrat, why more machines weren’t being used. The bureaucrat replied, “You don’t understand. This is a jobs program.” To which Milton responded, “Oh, I thought you were trying to build a canal. If it’s jobs you want, you should give these workers spoons, not shovels!”
I like that they hide the "edit" feature under a "..." so that we don't do it frivolously. (Or maybe it's the opposite of like, but it's some sort of response that I have to this placement.)
The vast preponderance of the evidence says that does no good and in some cases it’s actively damaging. Child care is important. Trying to force kids to learn things before they are cognitively ready is not.
A key to reducing cost is having less costly forms of care actually cost less to the end consumer. But with insurance copays you often pay the same price to see a doctor as to see a nurse practitioner so care ends up being rationed by how long you are willing to wait rather than how much you are willing to pay. And if I want to see someone today, often the only person available is a physician's assistant. Same out-of-pocket cost in $, but not in wait time. Unfortunately, as a provider you can't cash people's wait times to pay to increase supply.
Copays, coinsurance, and deductibles are one of the worst ideas in healthcare - nothing but a stealth premium hike. If a treatment is unpredictable and expensive enough that it needs to be covered by insurance, it should be covered by insurance, period. It does nobody any good to gratuitously ding patients with a small fraction of a large bill that's mostly paid by the insurer for a necessary treatment, whether it's a drug or a hospital visit, whose rate has been directly negotiated between the insurer and the provider without any patient input, and where the insurer has independently satisfied itself that the treatment is medically necessary.
There might be some small category of predictable, low dollar healthcare purchases where it makes sense to give patients a prefilled account, funded out of their total premium, and makes them responsible for covering those items out of that account.
Yes for sure. Insurance is a component of health plans, but health plans are also used as a mechanism for consumers to buy routine care at a fixed, predictable price. That doesn't mean copays, coinsurance and deductibles are a good idea, though, especially on non-discretionary, nonmarginal items.
I dunno. For the last three years I was on a high-deductible plan and maxed out my HSA contributions. The math worked out so that if I needed to spend all of the HSA contribution on medical care I would have come out really close to even on what I saved on premium contributions. I think that's a good system.
Except deductibles are paid on the margin for consuming a service or good, so unlike a premium hike they reduce consumption of things that people value less than the deductible. If someone does not want something for even a fraction of the actual price making it free to them at point of use increases everyone's costs on the plan for little value to them. In the context of car insurance, this is obvious and uncontroversial. In the context of healthcare we obviously care more about people having access to a minimum standard of care, but you're not talking about a minimum standard of care for poor people, you're talking about everyone paying nothing on the margin.
I don't believe that this is true, because I haven't heard of any plan with a deductible in Europe, and our healthcare costs less per capita. (We do have copays for some things though, but I think it's mainly to convince people to choose the generic drug over the original.) If a service has little value, my provider doesn't offer it in the first place.
Of course people provide services of little value if they get paid a lot of money to do so. For example, pediatricians in a hospital get paid extra for performing a circumcision because it's a surgical procedure.
In Europe care is rationed by making people wait. You can fix a price, but if demand outstrips supply you still must ration care. Fixing a low price can decrease costs, but it also decreases supply.
That isn't true though. A coronary bypass is not marginal, insulin is not marginal, cancer drugs aren't marginal, etc, etc. All cost more than most patients afford out of pocket, hence the reason they are primarily paid for by insurance as a way to share risk between unlucky/unhealthy people and lucky/healthy people. Yet even though patients paid a premium that can and should be actuarially set to cover exactly those sorts of nonmarginal, non-discretionary costs, they are subject to copays, coinsurance, and deductibles. It doesn't make sense, except as a stealth premium increase.
You just named a bunch of things where most people would happily pay the deductible to get the good or service as they can be life saving. What you're leaving out are the things that are more elective. Even within the categories you highlighted though, different drugs can have vastly different prices and deductibles incentivize people for example to decide whether they really care about the difference between the brand name drug and a very similar but much less costly generic. Finally, deductibles are not a stealth premium increase. Deductibles are included in the insurance terms and are priced into the plan. Plans with a higher deductible actually have lower premiums because (a) healthier people pick them and (b) they control costs as I describe.
Personally I think these are great ideas to make America better, but I think our country is honestly too comfortable, unambitious, and driven by the whims of political rhetoric to do so. The 'Buy American' provisions of the BIF/BIIA are driving up our infrastructure costs even more right when we make a good investment into it. And Biden is doing great stuff on welfare program efficiency and state capacity stuff, and no one cares! Left doesn't care because hes not cancelling student loan debt or whatever, and Right doesn't care cause hes no on the right lmao its kinda disheartening...But I mean we gotta continue the slow boring!
May be missing something, but I always thought the reason for talking up the job creating aspects of the Green New Deal wasn’t to address current unemployment, but to address the unemployment that would be created through rapid decarbonisation? Coal miners become solar installers etc.
Does anyone have a recommendation for how EU-style VAT and payroll taxes constrain consumption as Matt asserts in this piece?I believe it, and it makes sense intuitively, but I live in Italy, home of high taxes and 22% VAT and it just seems like there's A LOT of personal consumption everywhere I look. I suspect part of that has to do with much lower housing costs so people have money to buy fancy shoes, handbags, sporting equipment, etc. But I'd like to see the bigger picture.
Something I surmised in visits to Sweden was that Stockholm was so much more economically successful than much of the rest of the country that it wasn't uncommon to see highly-taxed and very expensive Volvo XC-90s (full of $8/gal gas) all over the city whereas much of the rest of the country was rolling in excellent trains or economy cars.
Every dollar you spend on healthcare is a dollar you can't spend somewhere else.
So if dollars (a LOT of dollars) are being wasted in healthcare that's a big deal. Especially given how large a percent of GDP healthcare is.
Of course there are different ways to achieve those savings. Single payer nations achieve those via a healthcare budget (ie rationing).
I think it should be achieved through competition. Mandate that all prices are posted online. Don't allow providers to very prices depending on who's paying.
Then focus on increasing healthcare supply faster than demand, and let competition work.
Yes, competition works in healthcare, see plastic surgery etc. But it requires price transparency
In the infrastructure bill what is the system of governance to prevent another California High Speed Rail, which has created a lot of jobs but is still a very long way from offering an attractive alternative to Greyhound, let alone Southwest Airlines?
I think the main system of governance answer here is that Mayor Pete doesn't want too much ammunition for attack ads during his next presidential run saying he wasted government money on roads to nowhere when he was Transportation Secretary, so he has a huge amount of control over the money and will try to minimize waste. I'm not saying that is a good system, but I think that's the main system for this bill.
Given Pete’s rationalization of extra tax credits for union made electric cars (self-immolating Chevy Bolt, anyone?), I don’t expect much scrutinizing of infrastructure spending.
My concern about this tack is that I think the economy remains under-stimulated and inflation is still too low.
While this sounds like an insane take, my reasoning is simple: there’s way less automation in our economy than there could be even with existing out-of-the-box solutions. When the $15 minimum wage was a big talking point, conservatives liked to joke about losing fast food jobs to kiosks. But the kiosk wasn’t going to eliminate a worker, it was going to move them to a productive food prep role because that’s what the restaurant needs but doesn’t have the space/administration to have unless it can eliminate another workspace/role. We need wages to rise until companies are forced to invest in this kind of technology, shifting more of our labor out of tasks that are amenable to automation.
When a person who is capable of producing $10 per hour in value is granted a statutory $15 minimum wage, that person’s wage becomes $0, or they work off the books at $10 or less. That is a fact of life.
LOLOLOLOL... Feel free to back up your claim if you disagree.
You are unaware that there are a number of really low intelligence people in the world? And a number of really poorly behaved people?
You are aware that these "really low intelligence people" do not make up 100% of the people employed for $10 per hour?
Of course not. There are also ignorant people. And immature people.
I would not go quite so far. Productivity in group tasks is difficult to measure, and so some people (within reason, of course) can be overpaid so long as others are underpaid relative to their productivity.
"Productivity in group tasks is difficult to measure..."
You know what institution is really good at measuring group productivity and its causes? The US Army. And they won't take anyone with an IQ less than 80 because they are untrainable for even the most basic of soldierly duties.
80 is, like, the 9th percentile.
Yes.
I’m not sure how much I care about the unsubsidized job prospects of the 9th percentile and lower.
That’s a really strong assumption about productivity!
"Jobs" has always been the wrong metric. If I have an employee making $40,000 and I fire him or her and hire two people at $20,000 each as replacements, I have doubled the number of jobs but the world is not a better place for it. Gene Sperling, in his book Economic Dignity, wrote that a worker should be able to put food on the table and be at the table with his or her family. That's about right.
"An America where a larger share of the population is working in the care economy is probably one where a smaller share is working in the foodservice economy."
There are a substantial number of people for whom getting served by a server who meets your every demand and has to give you exactly what you want... or no tip... is "care" to them. Care for their ego, care for their sense of "it feels good and makes me feel important to have people cater to my whims".
When that got taken away for a few weeks at the start of lockdowns, boy howdy did you see the Applebees Karen crowd get pissed. With the labor shortage in hospitality, this is only going to get worse, because as it turns out, serving Angry Karens doesn't just pay poorly - it is also really effing demoralizing.
Wigan may be fat, but it is hardly fair to describe him as "a substantial number of people." Let's not have any of that around here, okay? \s
I'm actually unusually, it might even be fair to say comically, skinny.
lol, this is the Festivus Spirit I crave
How do you define substantial?
MY's pretty clear point in this post is that increasing taxes on the rich has diminishing benefits because we are (pace higher immigration) labor-constrained. I get the analysis but it leaves me with disquiet on ethical and moral grounds: the rich have made out like bandits in part because they're undertaxed. If so, what should we do with higher taxes from the rich? Reduce the deficit and national debt? Cut the payroll tax in half? What else?
Matt has stated in the past that a wealth tax is a fine idea but we should be clear that it is punitive/intended to alter wealth distribution rather than something that can fund social programs in a real way.
But what do you do with the money? "Alter wealth distribution" how?
You just take it and give it to poor people, but you have to recognize this will be inflationary.
Why would giving money to poor people be inflationary? If it was done with a work requirement, I would expect it to drive wages down by depressing wages (as people more people would be willing to take lower wage jobs).
I believe that its inflationary impact would depend both on the amount (of money) and on the method of distribution.
I see a lot of talk about health care pricing and the lack of the free market. A patient seeing a doctor right now, if they have insurance, personally pays less for their time than if a plumber had come to their house. There's no free market that will ever allow those costs to come down from where they are subsidized by insurance.
One problem is that health “insurance” is increasingly defined as covering everyday routine care as opposed to opposed to a major unexpected expense like a broken leg or a heart attack.
How is that a problem? Insurance companies have discovered that getting you in for "everyday routine care" early and often saves money in the long term. They are not being forced to remove copays on 'preventive care.' That's a business decision.
If everyone gets a "free" check-up, then everyone's premium has to be high enough to cover the cost of the check-up. But for most people the full cost of premiums are hidden - part of your compensation that you never see (when your boss decides how much he can afford to pay you better believe he takes into account the cost of the health plan)
No, "if everyone gets a 'free' checkup, then everyone's premium [must adapt,]" _or_ the checkup must _in fact_ be free. And the insurance companies have, in fact, discovered that on average, not only are checkups free, they actually have a negative cost. Getting a checkup, on average, reduces the cost of your overall care more than the cost of a checkup.
Matt's heel turn to being a full on Thatcherite is uhh certainly interesting.
Choke the economy into recession with rate hikes because of inflation, bring in third world helots to crush any gains in labor power, and now end federal spending to create positions is certainly a *set* of policy preferences. A set that would make the Iron Lady blush.
This is a really bizarre way of characterizing supporting the Fed trying to do a soft landing as inflation has lowered real wages for most people, as well as asking that government funds actually get used productively.
I think the Nordic model is unpopular in the US for good reasons. If people wanted more of those services provided under that model, they could buy them privately in the US. Yes there are reasons they can be under bought in a private market, but you should have to do a lot of work to demonstrate that's what people would really prefer and I'm almost certain it's not true in the US.
Yeah, I think this is accurate.
The main issue the US has at the moment, social spending-wise, is that we collectively pay way too much for healthcare. Not that we are clearly preferring to purchase more of it, but that its price has gone up dramatically in part because we’ve placed low caps on the number of new doctors and so on.
The US would be a lot better off if we could reduce this cost and people could shift their money elsewhere.
In the late 1980s I lived in France for 6 months as an exchange student. I remember the mayor of Paris shelving every street sweeper (which takes on operator) and replacing it with five guys with brooms. The goal: increase employment.
Of course, the broom crews were slower with even 5x the manpower, did a worse job, and cost much more.
"In a story beloved by economists it’s said that Milton Friedman was once visiting China when he was shocked to see that, instead of modern tractors and earth movers, thousands of workers were toiling away building a canal with shovels. He asked his host, a government bureaucrat, why more machines weren’t being used. The bureaucrat replied, “You don’t understand. This is a jobs program.” To which Milton responded, “Oh, I thought you were trying to build a canal. If it’s jobs you want, you should give these workers spoons, not shovels!”
OMG guys we can edit comments now.
Edit our own or, more usefully, other people’s?
I like that they hide the "edit" feature under a "..." so that we don't do it frivolously. (Or maybe it's the opposite of like, but it's some sort of response that I have to this placement.)
“ availability of early childhood education”
The vast preponderance of the evidence says that does no good and in some cases it’s actively damaging. Child care is important. Trying to force kids to learn things before they are cognitively ready is not.
A key to reducing cost is having less costly forms of care actually cost less to the end consumer. But with insurance copays you often pay the same price to see a doctor as to see a nurse practitioner so care ends up being rationed by how long you are willing to wait rather than how much you are willing to pay. And if I want to see someone today, often the only person available is a physician's assistant. Same out-of-pocket cost in $, but not in wait time. Unfortunately, as a provider you can't cash people's wait times to pay to increase supply.
Copays, coinsurance, and deductibles are one of the worst ideas in healthcare - nothing but a stealth premium hike. If a treatment is unpredictable and expensive enough that it needs to be covered by insurance, it should be covered by insurance, period. It does nobody any good to gratuitously ding patients with a small fraction of a large bill that's mostly paid by the insurer for a necessary treatment, whether it's a drug or a hospital visit, whose rate has been directly negotiated between the insurer and the provider without any patient input, and where the insurer has independently satisfied itself that the treatment is medically necessary.
There might be some small category of predictable, low dollar healthcare purchases where it makes sense to give patients a prefilled account, funded out of their total premium, and makes them responsible for covering those items out of that account.
“If a treatment is unpredictable and expensive enough that it needs to be covered by insurance, it should be covered by insurance, period.”
We don’t have health insurance, we have health care plans. Insurance would not cover preexisting conditions.
Yes for sure. Insurance is a component of health plans, but health plans are also used as a mechanism for consumers to buy routine care at a fixed, predictable price. That doesn't mean copays, coinsurance and deductibles are a good idea, though, especially on non-discretionary, nonmarginal items.
I dunno. For the last three years I was on a high-deductible plan and maxed out my HSA contributions. The math worked out so that if I needed to spend all of the HSA contribution on medical care I would have come out really close to even on what I saved on premium contributions. I think that's a good system.
Except deductibles are paid on the margin for consuming a service or good, so unlike a premium hike they reduce consumption of things that people value less than the deductible. If someone does not want something for even a fraction of the actual price making it free to them at point of use increases everyone's costs on the plan for little value to them. In the context of car insurance, this is obvious and uncontroversial. In the context of healthcare we obviously care more about people having access to a minimum standard of care, but you're not talking about a minimum standard of care for poor people, you're talking about everyone paying nothing on the margin.
I don't believe that this is true, because I haven't heard of any plan with a deductible in Europe, and our healthcare costs less per capita. (We do have copays for some things though, but I think it's mainly to convince people to choose the generic drug over the original.) If a service has little value, my provider doesn't offer it in the first place.
Of course people provide services of little value if they get paid a lot of money to do so. For example, pediatricians in a hospital get paid extra for performing a circumcision because it's a surgical procedure.
In Europe care is rationed by making people wait. You can fix a price, but if demand outstrips supply you still must ration care. Fixing a low price can decrease costs, but it also decreases supply.
That isn't true though. A coronary bypass is not marginal, insulin is not marginal, cancer drugs aren't marginal, etc, etc. All cost more than most patients afford out of pocket, hence the reason they are primarily paid for by insurance as a way to share risk between unlucky/unhealthy people and lucky/healthy people. Yet even though patients paid a premium that can and should be actuarially set to cover exactly those sorts of nonmarginal, non-discretionary costs, they are subject to copays, coinsurance, and deductibles. It doesn't make sense, except as a stealth premium increase.
You just named a bunch of things where most people would happily pay the deductible to get the good or service as they can be life saving. What you're leaving out are the things that are more elective. Even within the categories you highlighted though, different drugs can have vastly different prices and deductibles incentivize people for example to decide whether they really care about the difference between the brand name drug and a very similar but much less costly generic. Finally, deductibles are not a stealth premium increase. Deductibles are included in the insurance terms and are priced into the plan. Plans with a higher deductible actually have lower premiums because (a) healthier people pick them and (b) they control costs as I describe.
It's mostly gatekeeping.