It’s back! “It” is the zombie-libertarian project of shifting more of the costs of health care from insurance to individuals, through high-deductible health plans combined with health savings accounts.  As Politico reported last week, Republicans and a few Democrats “want Americans to embrace more risk when it comes to their health care…. The [high-deductible] plans … require patients to pay more toward their care before benefits kick in.”

“The chief beneficiaries will be affluent individuals.”

Proponents justify shifting health costs from insurance to individuals as a way to empower consumers, while using market competition to lower prices. But the libertarian panacea for high health-care costs in the United States will only discourage many Americans from seeking necessary care, while the chief beneficiaries will be affluent individuals who use health savings accounts as a tax shelter.

For starters, why does the United States have the highest health-care costs among advanced industrial democracies? One theory, promoted by the physicians lobby, is that the cost of medical-malpractice insurance drives up the cost of American health care. But this is a myth. The combined costs of medical liability add up to a minuscule fraction of all health spending: $50 billion to $150 billion, relative to more than $4_ trillion_ in overall expenditures.