Barack Obama

A Bipartisan Solution to ObamaCare

Why Republicans should call their own summit


President Obama's televised health care summit has put Republicans in a tough spot. They can't accept any part of his latest trillion-dollar, Big Government overhaul, but if they reject it as a whole, they risk coming across as partisan naysayers.

The way out for Republicans is to use the occasion to do some deft political jujitsu by extending to President Obama—on camera—an invitation for a follow-up summit of their own.

The stunning thing about the proposal President Obama released Monday—which was supposed to serve as the blueprint for his summit—is just how willfully deaf it is to the American people. At a time when the public is worried sick about federal spending and deficits, the price tag for the proposal is $75 billion more than that of the Senate bill. Americans are overwhelmingly opposed to a mandate requiring them to carry coverage on the threat of fines or jail. More than 30 states are working on so-called Health Care Freedom laws to protect their citizens from Uncle Sam's mandate.

So what does President Obama propose? Increase the amount of income that the uninsured would be forced to cough up in fines. In addition, he wants to create a national board to keep insurance premiums in check, ignoring that one of the root causes of rising insurance costs is government mandates. Obama's answer to worries about government spending, regulations, and fines, then, is more government spending, regulations, and fines. This is not compromise—this is a royal snub to the American people.

A Republican conference could call the bluff on the president's phony bipartisanship. Its sole objective should be to identify patient-powered, market-based alternatives to Big Government approaches that are consistent with both parties' core principles and concerns. Here are five Republican and five Democratic measures that reasonable people on both sides could use as a launching pad:

Democratic list:

Abandon the mandate: The one thing that simply cannot be reconciled with a patient-centered approach is the individual mandate. What self-respecting Democrats ought to understand is that they can't consistently threaten to slap insurance companies with anti-trust laws to curb their monopolistic practices–as they have been talking about doing–while at the same time using the government's muscle to deliver these companies a captive clientele.

Loosen the chokehold of provider cartels: Another measure that should appeal to the little guy, pro-consumer instincts of Democrats is breaking up all the provider cartels. A big driver of health care costs in this country is the artificial scarcity of doctors, nurses and other providers that medical cartels such as the American Medical Association have created. The AMA, for example, has put in place onerous licensure laws to diminish the supply of doctors from within the country–while getting Congress to impose a tight annual cap on the foreign doctors allowed in from abroad. The upshot is that American doctors make twice as much as their overseas peers, something that bumps up health care spending in this country by $58 billion annually.

Reduce the role of insurance in the medical marketplace to lower administrative costs: The left supports eliminating private coverage and replacing it with government-run insurance to save on administrative costs. That's because, you know, government insurance will run by itself without a massive bureaucracy or copious red tape! But there is a more realistic way to cut administrative costs that doesn't rely on magic or fairy tales.

It is true that America's reliance on third-party coverage imposes an extra cost on the system. Providers and hospitals incur processing costs when they submit their bills to insurers. And then insurers incur processing costs when they pay these bills. The best way to reduce these costs is by giving patients who use cash to pay for their medical services the same tax deduction that patients who use insurance get.

Extend refundable tax-credits for uninsured working families: The main reason why there are 47 million uninsured people in this country is the inherently regressive nature of the tax code. So one would have thought that Democrats would jump on President George W. Bush and Sen. John McCain's proposal to hand refundable tax credits worth $5,000 to low income uninsured families. However, they have resisted this in the hope of getting comprehensive, government coverage for all. It is silly for Democrats to allow the best to be the enemy of the good.

Create an insurance exchange: Republicans have opposed a national insurance exchange that would serve as a one-stop shop for patients shopping for health coverage. But that wouldn't be such a bad idea if it served purely as a shopping venue and didn't involve giving government draconian powers to regulate participating insurance companies. There are already private exchanges such as that offer such services, but they are stymied by federal and state anti-trust laws—a problem that Uncle Sam wouldn't have.

Republican list:

Abandon Tort Reform: Tort reform has become something of a holy grail for Republicans who have bought the line that defensive medicine is among the biggest driver of health care costs in the country. Even if this were true, the best cure wouldn't be federalizing tort law—which has always been a state issue. It would be to make patients in charge of their own medical dollars so they have an incentive to ask questions and compare prices before submitting to endless procedures and diagnostic testing.

Allow individuals to purchase coverage across state line: Many states don't allow their residents to purchase health coverage across state lines, thanks to successful lobbying by Big Insurance to limit competition. This means that unlike car or life insurance, individuals can't shop nation-wide for the best medical coverage, something that greatly limits their choices and raises insurance costs. After a great deal of hemming and hawing, President Obama is relenting on the idea of including in his reform bill a national law that would pre-empt these anti-competition state laws. Republicans should make this the top topic of conversation.

Voucherize Medicare: Absolutely no one disputes that this government-funded health care program for seniors will put the country on the road to fiscal ruin if nothing is done to contain its runaway spending. It currently consumes over $500 billion. And if current trends persist, by the end of 2082 Medicare will be devouring 19 percent of gross domestic product—or $3 trillion, almost the entire U.S. budget right now. It will take a heartburn-inducing 135 percent increase in payroll taxes to bring it into actuarial balance.

The best way of capping the government's liabilities without compromising care is by giving seniors an option: They can take a lump sum to use toward comprehensive coverage or they can stick with the traditional fee-for-service program that offers only limited benefits.

Reform Health Savings Accounts: Creditably, over the last decade Congress has expanded the scope of these accounts, under which individuals are allowed to set aside a fixed amount of money tax free to purchase high-deductible coverage and pay for their daily medical needs. Any leftover funds at the end of the year are rolled over into the next year, allowing people to build a nice nest egg.

But here is the problem: Employers who set up these accounts for their workers can get a tax deduction for their insurance premiums. However, individuals—unless they are self-employed—can't. Moreover, employees don't have to pay payroll taxes on the money in the account, but unemployed individuals do. These extra taxes severely limit the appeal of HSAs for unemployed uninsured folks–the very people who most need them. There is absolutely no reason for such lop-sided tax treatment of the most vulnerable.

Amend the tax code to extend to individuals the same treatment large employers get: This is the mother of all reforms that would cure a number of problems with the U.S. health care system. It would of course make it easier for people whose employers don't provide coverage to buy it. But if individuals own their coverage, they will be able to keep it even when they lose their job or find a new one. This would go a long way toward shrinking the rolls of the uninsured while giving Americans more health care portability and security.

It is unlikely that President Obama will entertain these ideas in good faith—or at all—since he has already given Republicans an ultimatum: They either sign on the dotted line or he will use reconciliation to ram his bill through Congress over their objections—not to mention those of Blue Dogs Democrats.

Which is why Republicans need their own conference post-haste that offers a voice to all those whom President

Obama's summit is trying to silence. Regardless of what ideas they end up mixing and matching from the two sides, it is a safe bet that they will end up with a far more bipartisan and less disruptive compromise than ObamaCare. And it won't cost the country $1 trillion either.

Shikha Dalmia is a senior analyst at Reason Foundation and a biweekly columnist at Forbes. This column originally appeared at Forbes.

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  1. The first and foremost thing to remember is that health care policy should be handled by the states.

    1. Most state Governments are just as inept as the Federal Government. That is why there would be significant savings if people were allowed to buy insurance across state lines.

      1. People who advocate buying insurance across stateline as a solution is either uninformed or dishonest. It’s like advocating buying movie tickets across stateline. You still go to a local theater to watch the movie. It offers more choice of buying tickets for the same old theater. It takes only minimal effort for a company to file papers to sell insurance in a state by certify compliance to state laws. A company does not do business in a state mostly because inability to get discount from providers.

        1. That’s a specious argument. Insurance by nature is entirely portable. Even your movie tickets analogy is flawed as exemplified by national ticketing outfits like ticketmaster. I can buy flowers delivered to a door through a national network. I can buy practically anything delivered to my door from anywhere in the country if the price is lower.

          A company does not do business in a state mostly because inability to get discount from providers.

          If that’s true then interstate portability couldn’t possibly hurt anything.

  2. why?

  3. “ignoring that one of the root causes of rising insurance costs is government mandates.” Is that not a product of state control?

  4. “A Republican conference could call the bluff on the president’s phony bipartisanship. Its sole objective should be to identify patient-powered, market-based alternatives to Big Government” I call bluff on that statement. They already know all the existing solutions and yet they did noting when they were in power.

  5. NOTHING?! Do you not remember the medicare prescription drug “fix”???

    1. Which included a tiny bit of nice things on HSAs, but in return there was a giant new entitlement.

      Not incidentally, that’s the best one could hope for from this healthcare reform, a tiny amount of real reform, bundled with a giant new entitlement.

  6. This means that unlike car or life insurance, individuals can’t shop nation-wide for the best medical coverage…

    Actually this isn’t exactly true.

    All states that regulate insurance (all of them, pretty much) require insurance carriers in all lines to be licensed with the state, even to the point of forming separate state affiliated companies.

    There are only a tiny set of circumstances which allow you to buy any kind of insurance across state lines.

    I do recall interviewing with a PA based engineering firm doing business in Florida that bragged that their Health Plan was from BC/BS of PA which was totally superior to BC/BS of FL. Don’t know exactly how they did that, but they did.

    However, as to the larger point, I do support the general principle of having a nationwide insurance market, rather than fifty separate state ones. But that, I suspect, would lead to Federal, rather than state, regulation of insurance which I’m not entirely convinced would be an improvement. Also expect state insurance commissioners to discover new fidelity to constitutional principles when they face the disappearance of their sinecures.

  7. Yeah, people are really, really worried about federal spending. It Just Eclipses Every Other Concern.

    When their family members go bankrupt from medical bills due to dropped coverage, the first thing people think is “but what about the national debt?”

    When home medical equipment providers hit post-surgery patients with thousands in surprise bills because the insurance company punted on paying, people lay there and fret: “my God, I hope the Chinese don’t buy any more T-bills.”

    When a guy skips on getting coverage and visits the emergency room for his health care the first 20 years of his adulthood, getting care in the absolutely least efficient and most expensive way possible, he’s doing it out of nothing less than national fiscal responsibility.

    And you know who’s most worried about national debt? Those flabby defecit hawks who draw Hitler mustaches on faces for their signs. Sure, they were nowhere to be found during the past eight years, two wars and massive explosion in gubmint privatization, but they’re here, they’re dressed like Paul Revere, get used to them.

    Shame on Reason for cheerleading this demented circus.

    1. Most of those problems you refer to have to do with personal debt coupled with no savings safety net, which is the root cause of our borrow all we want, pay later mentality on a national level. If your family member is going to go bankrupt due to medical bills, if you’ve saved a pile of money you might actually be in a position to help them. If you’re post-op and have a pile of money, you can pay the medical equipment company.

      And if your medical insurance has a co-pay and deductible, you need to have the money to cover those costs. It’s not a question of if you’ll get sick. It’s when. It’s not rocket science.

      As for the young guy getting care in an ER, if he can pay for it, why are you upset? It’s his choice, not yours.

      1. Well, Werner von Braun, the rocket science you seem incapable of performing is noticing that the industry’s greatest victims are their own customers, who pay premiums and then get huge bills for services anyway. That is called “recission” – an industry favorite feature of the free market for coverage. Making recission illegal – as it is in every other industrialized democracy – is central to the regulatory effort.

        Personal savings levels have nothing to do with consumer rape, except in that they are wiped out when the insurance company is legally allowed to skip on its obligations.

        And going to the emergency room is NOT paid for in the main by patients. That Is The Point. It Is An Emergency Room and utilization for routine care represents enormous waste of resources that never are recouped in full by any individual’s payment.

        1. “Consumer rape”- epic fail. To think such a heinous crime even compares makes you a prick of the highest order.

          It demonstrates you are also a shit headed troll, but that is a secondary offense.

          1. You’re right. It’s not like rape.

            It’s actually worse. It’s more like rape inside of one’s own family. You sit down, sign a deal, send in the money month after month, then when you get sick, it happens to be legal to be left with the enormous bills and lose your house.

            At least with generalized rape, all one was doing was minding one’s own business instead of operating under the assumption of safety. You’re right – the health insurance industry is doing something even more insidious than that. Thanks for the help.

            1. Take them to court.
              If you think the health insurance company has unfairly breached the contract by not paying for legitimate expenses, sue them.

              1. Wow! What a great idea! Maybe the bankruptcy attorney can recommend a tort lawyer while I’m over at his office! In fact, I should have the bankruptcy guy arrange to pay my tort guy with the proceeds from the house I had to liquidate to pay the hospital! Hazel, you are really on to something here!

                Wait, wait, even better – why don’t I securitize my medical bankruptcy debt? Wall Street can make a buck selling anything: why not my medical bankruptcy? I can see it now: Recission Bonds. We can sell that shit to Iceland, they’ll buy anything.

                Surely you’d underwrite my scheme – you don’t want to turn your back on the Free Market, Hazel. Send $250K to start to

                1. Get a grip. Do you realize how many ambulance chasing lawyers there are out there? If they are making money on medical malpractice suits, you can damn well bet that they will take clients for lawsuits against insurance companies.

                  You’re a fucking retard if you think lawyers en masse are going to turn down clients that are suing their insurance companies for non-payment of insurance claims.

                  And it only takes a few cases to establish precedent. Insurance companies don’t enjoy getting sued up the wazooo any more than doctors do. There is such a thing as settling out of court.

                  1. No, I like my idea better. I’m INNOVATING. See, with your idea, all I’m doing is making the problem worse and more expensive by involving attorneys. After all, you can’t possibly expect the health insurance company to not fuck me, so we have to do something.

                    In fact, my idea presents far less moral hazard than yours does: why in the world should I attempt to use the courts/the state to hold the company to terms they no doubt already made sure they didn’t quite have to legally meet. That’s coercive!

                    What exactly do you have against the free market, anyway? Hazel, how long have you been a Communist?

                    1. Oh, I understand now. You’re an elaborate spoofer.

                      Of course insurance companies never uphold their contracts! I mean, in a free market NOBODY adheres to the terms of ANY contract EVER! It’s not liek we have some kind of system for enforcing them. What kind of ‘tard are you?

                    2. Well, all I can say is: the Somalia-like state of affairs you just referred to? It’s just in your head. Nowhere else around here. Nowhere.

                      I guess that means I shouldn’t check my PayPal account.

                    3. No, it just means you’re an idiot. An uninformed idiot. An idiot who cites no sources or anything approaching fact whatsoever to support his arguments. Nowhere in anything you typed was there any evidence to show this practice you speak of is a significant problem. Give me some numbers. Show me why this is crucial to the health care debate. Why is nobody else talking about this event which from the tone of your posts is happening on every street corner.

                      And again, you apparently also can’t read, as I stated quite clearly that the young man in my scenario could pay for his services. I am a physician and I have experience working in emergency medicine so I am quite familiar with who pays for medical care. Many of our patients do pay out of pocket and believe me they cover the cost of their care when they do (and other people’s care too). Those who are covered by private insurance do also. You know who doesn’t always cover the costs of treating them? Oh, wait for it….those insured by the government! Medicare just pays whatever the hell it feels like, regardless of whether that correlates with how much it costs. That’s if you can get through the billing process.

                    4. Doctor, it hurts when I do this:


                      And this:


                      [I had seven more links, but Reason kicks out comments with more than two.]

                      Feel free to answer each of these exposures of widespread, systematized, free-market abuse by the health insurance industry, doctor. Any time you’re ready, I look forward to your comment on the photocopied evidence of bonuses being paid by insurance companies to their employees for recissions, doctor.

                      And after you do, please explain, doctor, why you are shilling for that industry on

                  2. Hazel, are you a lawyer? Your solution to every problem seems for be for everyone to sue everybody else over everything.

                    And what fantasy world do you live in where that wouldn’t be a thousand times more burdensome than regulation?

                    1. The above conversation demonstrates perfectly why there is no such thing as bipartisanship. I would say that people should stick to facts rather than resort to personal insults to supplement an argument, but that might be asking too much.

        2. Hmm…this seems to happen in Germany now. The bureaucracies are so slow in approving new medicines from America that the patients have to pay out of pocket. This is not even mentioning all of the people who die in Europe from the lack of technology lost via taxation and regulation and who die while waiting on the infamous wait lists here.

          It is quite comical that no one understands the simple fact that they are not entitled to insurance. The insurance companies, no matter how evil they seem, offer goods and services and take their own risks. In short, they put a product on the market to meet a demand. Without their labor, it would not exist. If you find such a thing objectionable, then enter the insurance industry and offer the type of service you find fairer. There is nothing barring entry to the market . . . yet. Forcing other people to labor and provide a product against their will is immoral. Or perhaps slavery was okay?

          And, yes, I do fear national spending, as any rational person should. The real delusion is believing somehow that we can tweak the old program that didn’t work, which was put into place to tweak the older program that never worked. Hoping against all historical evidence and logic is delusional.

          The problem that most on the left have is they only blame one side of the equation, perhaps as a result of their hatred for free markets. They always forget the second component of crony capitalism, government. The writer of the article showed how prices rise not just as a result of greed or some other emotive concept, but from a gov’t/business relationship, which restricts access to the markets, thus driving up costs. The same government that is spending us into oblivion is causing prices to rise without end. Of course, nationalizing an industry doesn’t lower costs. It increases them. See Soviet Union.

          1. How many medical bankruptcies are there in Germany?

            1. Sure there are “0” bankruptcies in Germany now, but look no further than Greece for a massive bankruptcy built on shoresighted emotion-driven savings destroying policies you support. Give it another 15 years, and Germany could be in the same boat.

              Moreover, they are “smarter” in Greece than we are. What makes you think this nation full of morons “schooled” by the state will fare any better then then our socially elightened Grecian superiors? Maybe when our collective IQ stops wallowing in the halls of your public schools will health care “reform” have a snowball’s chance in the 9th circle of hell of not failing within 25 years.

              1. You are aware that the only similarity between Germany and Greece is that the names begin with the letter “G”, right? You are also aware that you are issuing this dire, unsupported warning to the largest economy in Europe by using Greece, a comparative basket case of US and IMF intervention located thousands of KM away geographically and culturally from Germany?

                I mean, no shit bad government exists. So What? Government that allows people to lose their homes because they got sick is also bad government – in fact, pretty goddamn detestable government. Most people who use democracy to arrange their nations and societies have figured this out. What is your excuse?

                1. Positive rights…great…enter the housing industry and offer housing to these people…I’ve lived in Russia, live in Germany now…it’s all stagnation and limited freedom…live in these places first before you advocate what you do…the people here don’t even like it…it’s always the same with these types of arguments…someone else should use their labor to produce things for society…Europe is a stagnating hell-hole waiting to happen…just move here and see for yourself…you have an open invitation

                  1. Then by all means, please do what people in your position have done for 240 years: come to the US. The taxes are very low, you can have a gun, and you are very free.

                    Except you’re not all that free to call things what they are. We have fire departments and roads just like over there, but nobody dares call it socialism – mainly because we’ve been conditioned from birth to avidly fellate and celebrate big business.

                    We have waiting lists for medical care just like over there, but we call it “the best health care in the world”.

                    We have medical bankruptcies just like you have over there, but…oh, wait. You don’t have those. Well, at least here you’re free to go broke if you get sick, and dammit, that’s what matters.

                    1. I am American…I’ve just left the borders and experienced the socialist paradise, which is a nightmare, especially when you speak and understand the damage it does to their great cultures.

                2. My prediction is that Greece will go bankrupt, followed by France, then the rest of the dominoes. Ultimately, most of the world’s superpowers will fail economically from the weight of overbearing entitlements. And yes, Germany will be right there. Do you deny that these large entitlement states are over extended? Look no further than Socialist California, NJ and NY. They will be next. The only answer will be for the world to write off its debt. What is gold at right now?

                  1. There are no superpowers, plural. There is only one superpower: the US.

                    Yet oddly, the sole superpower spends FAR MORE on arms than it did when there was an actual other superpower – twenty years ago.

                    Even more oddly, people look at this fact, look at the future and conclude that it’s entitlements to PEOPLE that will drag the country to ruin. Defense contractors/privatization/corporate welfare and tax breaks – that’s all fine, nothing to see here, move along.

                    But to keep someone from losing their house as a result of legalized health insurance fraud – whoa – we can’t be doing that! That’s dangerous!

                    The saddest part is none or very few of you are being paid to provide this exquisite cover to big business. Billions and billions go every year into marketing and lobbying to protect and extend corporate dominance over the society.

                    But you get none of that money.

                    Because you blurt the company line for free. As ideologues.

                    You call yourselves libertarians and refer to your position away from the political mainstream, claiming marginalization.

                    Yet every tenet of your economic outlook is not only favored by big business, it has become government policy over the past thirty years. Huge tax cuts. Massive privatization of government services. Massive injections of private capital into public elections. Deregulation. Denial of the existence of a public, let alone a public interest. An explosion of corporate lobbying. Fierce struggles against campaign finance reform. Systematic corruption of democracy. And all opposition to this trend branded as communism.

                    You people aren’t marginalized. Your simplistic economics are actually the centerpiece of the neoliberal state – and have been for thirty years.

                    It’s really too bad you aren’t invited onto the yacht. For your service, you deserve it.

                    1. I hope this is a joke, because it is absurd. You’re confusing libertarians with your perception of what they are. How you can say that anything over the last even 100 years is a neoliberal state is beyond nonsense. We have outrageous growth in all sectors. We have a welfare state, socialism for the rich, increasing bureaucratization, confiscatory taxation, overmilitarizaiton (and of the police force), and the list goes on and on.

                      Libertarians also think defense spending is outrageous, which is why we reject Republicans’ form of big government, too. You see George Bush as the ultimate capitalist probably. We see him as a Christian socialist/statist who grew government out of control, only to be followed by Obama’s idiotic expansions. Yet, you think that we support him. Why? Because you can’t imagine the world otherwise. If libertarians oppose Obama, then, voila, they must’ve supported Bush. This is where we get the whole “where were you guys for the last 8 years?” But the funny thing about that is that you’re not saying the criticism is wrong. You’re actually admitting it isn’t. Your only criticism is that you didn’t hear libertarians’ criticism of Bush’s expanded state. You can criticize conservatives for this hypocrisy, but not libertarians.

                      Perhaps, our theories are simplistic because they don’t violate Ockham’s razor. The simplest explanation is normally the best one. I mean Newton’s ideas were considered too simple at one time. Gallileo’s too. When you need endless amounts of explanations to make your theory work and it still doesn’t and there is in existence a simpler explanation, then you have most likely violated Ockham’s razor. Your conceited criticism of “simplicity” is actually one of the best compliments you could give us and worst criticisms you could give yourself. Thank you!

            2. Medical bankruptcies? No idea, but they have something called a stagnating economy from oppressive taxation and overly bureaucratic regulation. So, maybe it’s better if everyone goes bankrupt.

              You have no right to make others labor for you. Until you address that, you are just taking an unprincipled, illogical position. If you care so much, enter the market. You won’t, I know, because your value system is based on greed. You prefer others labor for you to provide you with the products of their labor.

        3. the industry’s greatest victims are their own customers, who pay premiums and then get huge bills for services anyway. That is called “recission” – an industry favorite feature of the free market for coverage.

          I’m sure you hear this a lot but you don’t know what you are talking about. Rescission is the cancellation of a policy as if it was never in force. Your premiums are returned. It happens when there are material inaccuracies on an application and it is a breach of contract issue having nothing to do with health care.

          1. Fuck that nonsense.


            1. If consumers were paying for their own insurance, instead of getting their employer to pay for it, they couuld choose to buy from companies that don’t do such things. Another reason to allow inter-state insurance sales.

              Secondly, if the customer really is honest, then he’s got an airtight case against the insurance company. Sue them. With punitive damages.

              It’s *already* illegal to breach a contract you signed with a customer after the fact. Unless the insurance company can prove that you withheld relevant medical information they have no case.

              This is why we have courts. This is why the free market relies upon fair contract enforcement.

            2. Fuck that nonsense.

              Is there supposed to be a point in that whiny nonsense? Do you have a problem with an insurer’s refusal to cover you with a policy that never would have been issued had the truth been told in the first place? If you lie on an insurance form and sign it you are committing fraud; if an insurance company rescinds in bad faith then sue them for breach of contract. Otherwise feel free to mind your own business.

            3. The troll is citing the unbiased “consumer watchdog” and Huffpo. Please go back to the dailykos and leave us normal people alone.

              1. Refute the journalism. I dare you.

                Here, try these several dozen newspaper reports containing smoking-gun documents, illustrating the recent consumer abuses of the health insurance industry.


                Those corporate douchebags you live to defend are waiting.

        4. “Well, Werner von Braun, the rocket science you seem incapable of performing is noticing that the industry’s greatest victims are their own customers, who pay premiums and then get huge bills for services anyway. That is called “recission” – an industry favorite feature of the free market for coverage. Making recission illegal – as it is in every other industrialized democracy – is central to the regulatory effort.”

          Actually, rescission is the setting aside of a contract. Nothing more, nothing less. If you use services that weren’t covered under your insurance plan, for instance, it would not be “rescission”. I’ve seen it first hand: many people who complain about insurers were unaware of what their plans covered. That doesn’t diminish the tragedy when something goes wrong, but you can’t fault the insurer in these cases.

          A few broader points on rescission:

          1. The statistics I’ve seen indicate that rescission is a relatively rare event, affecting a fraction of 1% of those who carry health insurance.

          2. Even if we accept that some insurers have rescinded policies in a questionable fashion, it doesn’t mean that *all* rescissions are unjustified. Individuals are just as capable of lying on health insurance applications as insurance companies are capable of being “evil”.

          3. There is no way to fully “ban” rescission without upending contract law. As I mentioned, some rescissions may be perfectly legitimate (i.e. in cases of fraud). Because of this, adjudicating disputes over rescissions via the court system will always be the most viable solution.

          4. You do not need a 2,700 page bill that fundamentally changes the healthcare system to address the issue of rescission. If lawmakers believe this is a serious problem, they can simply pass a law that deals with this in a targeted fashion.

          5. Finally, a freer market for healthcare would lead to greater competition, and this would do far more to keep insurers honest. After all, with greater competition, any insurance company that gains a reputation for being sneaky will have a hard time selling its product.

          1. Not only can I, and everybody else not afflicted with free-market fundamentalist delusions fault the insurer, we notice there is NOBODY ELSE TO FAULT. NOBODY ELSE is shoving a surprise bill up people’s asses. NOBODY ELSE is mass marketing to the tune of many billion per year, NOBODY ELSE is selling peace of mind but delivering economic terror, and NOBODY ELSE is writing the contracts.

            1. Dude I hope you are a joke. I have had enough Reason for today. That is all.

            2. Sounds like taxes…wait, you’re talking about crony-socialist insurance companies…you had me going for a second!

            3. You can fault the insurer all you want. But since you failed to address my points with anything substantive, I’ll take it that you don’t really have anything substantive to say.

              Health insurance is not a right, and it isn’t an obligation (at least not yet). If you don’t like insurance companies, you can opt to pay directly for the services you use. Of course, you have no more right to a doctor’s labor than he does to yours, so when dealing with expensive services…

              Ironically, the healthcare bill you seem to so strongly support would *force* American consumers to do business with the very insurance companies you say can’t be trusted. That is delusional.

              1. If health care is a “right” then who determines adequate care?

                If shelter is a “right” then who determines adequate shelter?

                If food is a “right” then who determines adequate food?

                You get my point. If we surrender any liberty, we will not get it back. The troll has not figured that out yet. He also does not understand that he has no ownership rights to the toil of others.

                1. If voting is a “right”, who determines who gets to vote?

                  If free speech is a “right” who determines what its limits are?

                  If private property is a “right” who determines at what point those rights end?

                  The obvious answer in a democracy is: we do.

                  The answer on Planet Libertaria is “I am terrified of the people I live among and express that terror in the flimsiest terms of liberty to mask my crippling self-absorption.”

          2. Thank you very much for making these points. Wish I had scrolled further before replying.

          3. 3. There is no way to fully “ban” rescission without upending contract law. As I mentioned, some rescissions may be perfectly legitimate (i.e. in cases of fraud). Because of this, adjudicating disputes over rescissions via the court system will always be the most viable solution.

            Oh, there is a VERY easy way.

            Universal coverage.

            1. Universal coverage with what precisely?
              I always wondered, if everyone is supposed to be covered with healthcare, why you need a middleman of an insurance company& Make it a sservice-on-demand, anyone can walk in a hospital, get serviced and then the hospital will settle a bill with the budget on its own?

              1. I agree. There is no real reason to keep zombie insurance companies around. Medicare for All.

                1. Medicare for All.

                  Force Americans to buy insurance they don’t want.

                  Force doctors to accept insurance they don’t want.

                  Let Freedom Ring!

                  1. Okay, maybe we’ll have to legally mandate freedom to ring, but still…

    2. People *are* worried about federal spending because they know that when the federal government spends money it doesn’t have, *they* are the ones who are really paying.

      Whether in the form of increased taxes or a lower standard of living because of a debased currency, a growing number of people recognize that they pay far more for the federal government’s spending than they do for just about anything else, including healthcare.

      1. I’m sorry, this is delusional. People do not care about federal spending when they are facing bankruptcy due to no fault of their own – or even some fault of their own. You’re completely wrong. Nobody, not one single person who has been socked with a six figure bill for surgery that their insurance company skipped on, has ever, in the history of the world, reacted by saying “This wouldn’t happen if we didn’t use fiat currency.” Nobody. Ever. Anywhere.

        1. you are wrong sir. I have been in just that situation and when I was handed the bill I thought if we had a flat income tax I could pay for this. so I paid my medical bill and not my tax now the IRS is on my case because I’m not allowed to right it off because I’m self employed.

          1. Indeed. If you work for someone else, your health care is tax-deductible. If you work for yourself or pay for it yourself, it’s not.

          2. Well Ron you did not pay tribute to the state which is far worse you see.

          3. Holy crap. You were forced to choose between tax and medical bills by your insurance company who didn’t, you know, insure you. And from this, you determine that the problem is you pay too much tax.


            1. Yes, actually taking personal responsibility and owning up to your obligations is a foreign concept to you, isn’t it?

              1. It is certainly less foreign to me than it is to the insurance company who created the situation in the first place.

        2. If it wasn’t for the egregious amount of taxes ripped from my weathered hands, I could probably save up enough over a lifetime to handle most unforseen healthcare expenses and still have something to provide to the charities your ilk have systematically dismantled through legislation. Moreover, if more people just had catastrophic insurance, we would not be paying for regular bullshit like checkups and irregular bullshit like AIDS medication through increased premiums.

          1. Yes, it’s gay people with AIDS driving up taxes that are the problem. Not an industry that has six lobbyists for every Congressman running DC. Right.

            1. Way to completely distort the original point and turn it into some anti-gay rant. Note that the original post said nothing about gays. Most AIDS patients are not gay. You should be ashamed of yourself.

              1. It is hardly distorting the point to repeat it, genius. Paying for the “irregular bullshit” care of AIDS patients are not why taxes are “high”. Not on this planet.

        3. I think people should remember what the gulag looked like

    3. Orel Hazard – “When their family members go bankrupt from medical bills due to dropped coverage, the first thing people think is “but what about the national debt?”

      Fuck Yeah

      But why stop at med insurance?

      My old boss was an dickhead so I told him to FUCK OFF. The assholes at the UE office said I couldn’t get any checks cause i quit “voluntarily”. So I’ve had to live off my credit cards for the last 8 months. Now there all run up and cancelled and what the fuck am i supposed to do?
      Get a job? WTF

      In a country as rich as the US its a crime that me or anyone else should go BK because food or rent or a car or cable of a quick getaway to Fiji.

    4. Orel Hazard – “When their family members go bankrupt from medical bills due to dropped coverage, the first thing people think is “but what about the national debt?”

      Fuck Yeah

      But why stop at med insurance?

      My old boss was an dh so I told him to F— OFF. The assholes at the UE office said I couldn’t get any checks cause i quit “voluntarily”. So I’ve had to live off my credit cards for the last 8 months. Now there all run up and cancelled and what the fuck am i supposed to do?
      Get a job? WTF

      In a country as rich as the US its a crime that me or anyone else should go BK because food or rent or a car or cable of a quick getaway to Fiji.

    5. Most people are responsible enough to make sure they don’t go bankrupt from getting sick. Those people are indeed concerned about federal spending.

      Some day there may be more people that are irresponsible and happy to take from other people to pay for their irresponsibility, at which case of course no one will bother to be responsible at all.

      But that day is not today.

  8. Yep, now did that hurt or help pharma? Neither side will go against the insurance and pharma industry.

  9. As a purely tactical matter, Shikha’s advice is terrible.

    The Dems are absolutely destroying themselves on healthcare. They have welded themselves to the hated and reviled Senate bill.

    Why on earth would the Republicans want to do anything to help them?

    The best outcome, since we will never see any kind of free market reform from the current political class, is for the Democrats to be so horribly mauled by voters in November for pushing crypto-socialized medicine that they wait another generation before trying again. The best way to achieve this is for the Republicans to stand aside and let the Dems auger in.

  10. Rc, so you prefer the fight over any sincere effort to represent people?

    1. Which one is representing people? I can’t see much in either proposal that wouldn’t continue to screw my patients.

      1. Speaking of screwing patients, why don’t you talk about billing codes, deals/bonuses with insurance companies to treat less?

        1. What exactly am I supposed to be talking about? I do not get paid any differently regardless of what tests/treatments I order. That being said, study after study has found that we way over-order tests, procedures, and medications. If two physicians get exactly the same outcomes, but one spends 5000 dollars and the other spends 20000, are you okay with the first guy getting a bonus for keeping costs down?

          1. Note that there is no system like that of which I am aware, but there is a tremendous variance between how much money is spent for the same outcomes.

    2. I prefer that any effort to socialize healthcare meet a horrible bloody end, and so traumatize the politicians that support it that whoever among them survives the electoral holocaust will never, ever, vote for such an abomination again.


    3. Speaking of screwing patients, why don’t you talk about billing codes, deals/bonuses with insurance companies to treat less?

      If you knew anything at all about healthcare billing and law, you would know that such deals/bonuses are illegal, and the laws against them are enforced pretty strictly.

      1. If you knew anything at all about healthcare billing and law, you would know that such deals/bonuses are illegal, and the laws against them are enforced pretty strictly.

        Insurers and providers are adversaries and that is a good thing. Claims payers spend a lot on software specifically to address upcoding, bundling and all of the other games that providers choose to play because of Medicare, indigent care and general government interference.

        1. Yeah no kidding…I’m required to document essentially a full physical exam so that we can get paid the appropriate amount for treating your earache.

        2. Is it legal for a man who is hungry to go into a grocery store and steal a loaf of bread? Well it is legal for him to come to my ER and steal from me. How fucked up is that? And the uninsured and/or medicaid are 10 X more likely to sue me. If anyone wants my job, come and get it. Its 3AM and I am seeing a litany of people who don’t need to be here. Most are on medicaid or uninsured. Most have cell phones and nice clothes and they are either drunk, drugged and use tobacco. So to Orel above, go to fucking hell. Most assholes can afford health care. Just get the GD government out of the way and use the real free market.

          1. Steal from YOU? Wow. So you’re on the hospital board then? That’s a little odd for an ER doc. So did you personally negotiate the latest tax break from the local community? And when I say “negotiate a tax break” I mean of course “threaten to close”?

            Wait, you’re not on the board? So how exactly are you a “victim” of “theft”, again?

            I realize it’s all about you, doctor, and that the ER is the #1 top choice of evening destinations for people. Everybody loves the ER, can’t get enough of it.

            I just wonder how in the world you manage to soldier on treating people who have the gall to use a cellphone. Truly, the world weeps in joy at your selflessness.

            1. They steal from me by not paying their bill. I work for myself Sir. My intellectual and technical skills have a price. You really have no idea how the world works.

              1. You bill the patients as well as deliver services? My god, you’re a powerhouse. Typically, the billing in health care is so convoluted and filled with fraud ($1,000 toothbrushes, $140 asprin – ) that there is an entire industry employing millions called Medical Billing devoted to it. But you do it yourself, you say. Huh.

                That sounds very efficient. But I have my suspicions that you’re coercively appropriating the revenues of the Medical Billing industry, and that is a sin around here. Does libertarianism not teach us that you Must Never Interfere In The Free Market (For $1,000 Toothbrushes)?

                1. You’re a very confused hamster. What is free about the health care market?

                  Can you point to a market that is not more meddled in, regulated, subsidized, taxed, price controlled, supply restricted, service mandated, litigated, and generally cut up and parceled out to government favored groups than any market in the history of the United States than health care?

                  Health care makes the mortgage market look laissez faire by comparison.

                  Your $1k toothbrushes are due to market intervention. They don’t cost that much at the local market.

  11. I swear if this discombobulation of a bill passes, its time for a peacful coup. the citizens should march to DC, tar and feather every politician there from the pres to the first term house members and run them out of town, and start over at square 1 by throwingout all laws regts etc. and making a new republic founded back on the correct principles of life liberty and the pursuit of happiness. Its our duty in the Const. to overthrow this type of crap. note to the cia fbi ss i mean secret service etc. I am making a point not a threat, so dont read it that way!

    1. Yes. God forbid we begin to frown on making a buck off of cancer and let ourselves slide into a state resembling the totalitarian hellholes of France, Norway, Canada, Brazil, Japan, The Netherlands, Germany, Israel, Ireland, Italy, Australia, New Zealand, Spain, Denmark, the UK, Thailand, Hong Kong, South Korea, the UK, etc.

      Oh, and let’s also make sure that we fail to distinguish between consumer protection and Hitler. Brilliant.

      1. Is that Hazard as in Hasard County?

      2. You’re the only one mentioning Hitler here. You’re also the only troll. (So far).

      3. If you like those other countries way of doing things so much, don’t let the door hit you in the ass on the way out on your one way trip to one of them.

        Over here I would prefer a system refrains from stealing my money to give free handouts to leeches such as yourself.

        After all, it’s not like I owe any of you anything – seeing as how there isn’t so much as one single thing that you of you have ever done in your entire lives that has ever had anything whatsoever to do with me having anything that I’ve got.

        1. Yes, that’s right. Pointing out the rest of the industrialized Western democracies don’t have medical bankruptcies and that we shouldn’t either is the exact same thing as wanting to live there. Truly, that is genius.

          1. Oh the horror of cheating death, and then HAVING BILLS. I mean, death would be preferable to bankruptcy, right?

            Nobody should be forced to PAY MONEY, to, you know, survivive a live-threatening disease. We should all live forever, without paying a dime for it, because we’re entitled to.

            1. Great point! The moral hazard of costless immortality surely awaits us who dare brave the slippery slope of eliminating medical bankruptcy. Bravo!

              1. Because bankruptcy is so rare and horrific. Nobody should EVER have to go through it. Least of all, in preference to being dead.

              2. Because bankruptcy is so rare and horrific. Nobody should EVER have to go through it. Least of all, in preference to being dead.

              3. Prove to me that your welfare is my responsiblity.

                1. Prove to me that you have a moral claim to material assets.

                  1. I have a claim to any assets that I own – it’s called 5th Amendment private property rights.

                    Private property rights are unconditional, absolute and forever.

                    1. Except when the government wants your property and takes it through imminent domain. Then your property rights are not your rights, they are the government’s.

      4. Are you incapable of logic, or are you just hoping that your mix of begging the question, offering false dichotomies and handing out failed equivalences will fly?

      5. Holding up the French, British and Canadians systems as what we should emulate. Brilliant.

      6. Yes. God forbid we begin to frown on making a buck off of cancer and let ourselves slide into a state resembling the totalitarian hellholes of France, Norway, Canada, Brazil, Japan, The Netherlands, Germany, Israel, Ireland, Italy, Australia, New Zealand, Spain, Denmark, the UK, Thailand, Hong Kong, South Korea, the UK, etc.

        In other words, the countries that are mostly going broke even faster than we are.

        In a perfect world, money would fall out of the sky and brain and heart surgeons would all work for free and all of our wants and needs would be taken care of with a snap of the fingers.

        Sadly, in the real world we can’t afford it, and neither can the other countries you listed. You really ought to pay attention to the news once in a while, get a clue about what’s going on, and fill up the empty space between your ears.

        1. You’re right. Those democracies are just not in the real world. Their crazy experiments have only lasted many, many decades. And nobody there can buy private health care, either! Their far better care and lack of bankruptcies are mere illusions, soon to be snatched back by the almighty free market. At some point. This decade? Next decade? Next century? Who can really say?

          In such an uncertain world, the one thing we do know with absolute certainty is this: we must never, ever interrupt the fellatio we administer to US big business.

          1. You mean those countries who entire existence is predicated on getting free military protection welfare from the United States – which they have been doing ever since the end of World War 2.

            Not only would not a single one of them be capable of affording ANY of their social welfare programs if they hadn’t been getting that military protection welfare, not a single one of them would even be in existence as an independent nation state today without it.

            1. Indeed. We seriously need to tell the rest of the world to cover it’s own ass.

            2. Protection? From what?

              They wouldn’t be in existence? Why?

              Why do each of them want very much for Yankee to go the fuck home already?

              What planet do you live on and what color is the sky there?

              See, on this planet, we have a military-corporate complex that calls the shots. It’s the same economic engine that overdetermines policy in every nook and cranny of this society. It’s the same one that gets everything it wants, here and abroad. And it’s the same one you’re busily fellating by denying the effectiveness of socialized medecine.

              While you’re down there, don’t forget to breathe.

              1. No on this planet, the Soviet Bloc would have taken over all the rest of Europe withing about two or three years after the end of World War 2 if it hadn’t been for the counterbalance of US military power.

                But someone who thinks anyone on the planet has ever been the least bit capable of proving that socialized medicine has ever been “effective” is likely to far to stupid to grasp that fact or much of anything else.

                1. Right. The Red Menace would have simply steamrolled around the world, as they proved so well when they came up against illiterate Afghans armed with Allah, rocket launchers and small arms…and then COLLAPSED AS A RESULT OF TOTAL DEFEAT.

                  Delusion: it’s what’s for dinner.

                  1. You really are a moron.

                    Do you think the Afghans manufactured those Stinger missles they used to beat the Soviets on their own?

                    Do you think the Soviets wouldn’t have hesitated to use nuclear weapons to defeat other nations if there were no offsetting American power to hold them in check?

                    You aren’t even a third rate troll.

                    1. Do you work for Raytheon? I think that by now, it’s safe to quit overstating the threat of the USSR, seeing as it’s been 19 years since it TOTALLY COLLAPSED.

                      You gotta get with it: the new enemy is “Islamofascism” and “terror”. You may begin justifying a $700B-plus military budget beginning…now.

                    2. Are there zero nuclear weapons in Russia, Orel?

                      How about China?

                      You are a fucking lunatic.

                    3. Oh, I see. It’s not about the USSR at all, it’s really about nuclear weapons. Well, great! The DOE budget for nukes, where the maintenance for those are hidden, is estimated to be $30B/yr. Leave in $200B/yr for conventional forces worldwide – which still outspends the Chinese and Russians by a wide margin.

                      Now: begin justifying the remaining half trillion a year when we are the sole superpower on the planet, busy fighting bronze age douchebags living in caves. Annnnd: GO!

                    4. And by the way don’t think I didn’t notice you punting on attempting to defend you absurd claim that Afghanistan “defeated” the Soviet Military all on their own.

                    5. Punt? I didn’t punt – that touchdown was scored a long time ago. You just weren’t reading about it:


                      “Major General Oleg Sarin and Colonel Lev Dvoretsky argue that the
                      Soviet intervention to support the crumbling Communist administration in Afghanistan in
                      1979 had a major impact in the events in the USSR. According to authors, financially,
                      ‘the Afghan war laid a heavy burden on the Soviet economy’ and that more broadly the
                      war shook the morale and faith of the armed forces and the masses in the Party leadership
                      and Marxist-Leninist ideology.18 This is collaborated by William Watson’s analysis of
                      the USSR implosion, who argues that ‘as a consequence of the Afghan war, the morale of
                      the Soviet armed forces was the lowest in the history of the USSR.’19 Moreover, a
                      similar collapse in ideological faith and certainty was experienced among the lower
                      echelons of the KGB as a consequence of the Afghan war20, thus suggesting that the core
                      of the Soviet system, the coercive forces of state violence underwent a crisis of
                      confidence during the Eighties. If the Soviet Union cannot depend upon the secret police,
                      who can it depend upon? From a financial perspective, the Afghan war exasperated the
                      already strained fiscal situation, where the balance-of-trade had turned against the Soviet
                      Union and the end of high oil prices were a crucial factor in pushing the USSR into
                      extreme fiscal crisis.”



                      Of course I have many more examples of scholarship agreeing with me, but Reason won’t let me post more than two links.

                      Don’t thank me. It’s only out of my sense of duty to the public that I make sure ridiculous bullshit is countered.

              2. You’re oddly fascinated by fellatio of objects…

                So you want to take this government that has fostered this military-corporate complex and… give it more power?

                Big business is only the enemy because it’s in bed with big government.

          2. How is waiting in pain on a waiting list “far better care”?

            Personally, I would consider (especially when it comes to medical care) a speedy response to be a VERY high factor in considering overall quality.

            1. Yep I will take speedy care and living with bankrupcy to waiting and dying with my savings that I can’t use when I’m dead.

              Bankruptcy sucks but you do live through it. You can do like Ron above and not pay your taxes too, but I doubt that story will make the DNC cut of sob stories I hear on NPR on my drive to work.

          3. Do you know anything about these countries?




            1. First of all, three of the four sources you posted are pro-corporate rags that can be counted on to give maxium cover to big business.

              Second of all, whining about waiting lists is retarded when we have waiting lists right here. Weeks to see a GP, weeks to see a specialist. Right here.

              Thing is, here, we wait AND we risk our homes doing it. They don’t risk that. Their system is therefore better. You’re welcome.

              1. I’m still waiting for a reason as to why your welfare should be any of my concern.

                There is absolutely nothing you have ever done in your entire life that has ever had anything whatsoever to do with me having anything that I’ve got – so you don’t have any sort of moral claim on any of my property.

              2. Point taken, BTW The Nation is not a credible source either.

              3. …three of the four sources you posted are pro-corporate rags…

                Do you actually have any evidence that the stories they report are untrue?

              4. You’re right. There’s a vast conspiracy devoted solely to enriching “big business”, the military-industrial complex, etc. etc. Who was the guy on the grassy knoll while we’re at it?

                Seriously, dude, if it’s that bad there is no hope for any sort of reform and all of your whining and bitching won’t get anywhere. In fact, since you know the truth, you’ll probably disappear into an unmarked white van. Nice talking to you, and say hello to the Illuminati when you get there.

              5. Oh my! You have to wait weeks! What shall you ever do? Of course, people in other countries wait months, or even years.

                But since you so easily dismiss facts about waiting times and survival rates, when does your flight to London or Paris leave?

                1. Uh huh.


                  “Business Week, no great fan of a national healthcare system, reported in late June that “as several surveys and numerous anecdotes show, waiting times in the U.S. are often as bad or worse as those in other industrialized nations — despite the fact that the U.S. spends considerably more per capita on health care than any other country.”

                  Huh. Business Week is a business publication. Business publications give the maximum cover to businesses and constantly demonize the government, yet, have an obligation to the executives reading to not parrot the same crap coming out of Fox News and AM hate radio and the fucking Cato Institute.

                  I guess that means that Actually…you’re kind of full of shit.

                  1. Fuck Businessweek, that pro-corporate rag.

                    See how easy this is?

                    1. Well by all means, let me know why ANY business/trade magazine would report that US health care wait times are as good or worse than in countries where health care has medical bankruptcy protection if there wasn’t a big, honkin’ pile of evidence that it was true.

                      Please, go ahead. I can’t wait for the answer.

          4. We have the best health care on the planet. We have the best educated physicians, nurses, and are responsible for the vast majority of new treatments, new drugs, and new medical technology. Those paradises you list have been able to sustain their systems precisely because you can actually make a profit here. Your claims are based purely on fantasy. Those statistics you cite, when actually adjusted for factors that have nothing to do with quality of health care, like violent death, automobile accidents, drug/alcohol related illness and injury, and obesity, demonstrate our superiority quite clearly. It’s not even close. Get a clue.

            1. Citations, please.

              I find it interesting that you assume that our high obesity rates (and drug/alcohol abuse) are not at least in part *caused* by our absurd health care system.

              You also seem to be unaware how quickly the medical technology industries in the US have been outsourcing. We are still #1, but losing ground very quickly. Frankly, what keeps us on top nowadays is NIH.

              1. It’s funny that we are so rich that our poor’s main problem is obesity.

          5. “In such an uncertain world, the one thing we do know with absolute certainty is this: we must never, ever interrupt the fellatio we administer to US big business.” Orel, you do write with un je ne sais quoi qui me pla?t.

          6. In your socialistic utopias of western Europe, the very large middle class lives at home until age 28, buys a 200 year old flat, rarely uses air conditioning, most often does not own a car, hands their laundry out, and rarely ascends into financial freedom. The euros have created serfs whose only hope is to land a government job. Taxes are crippling. You can have that life of mediocrity. I will believe in America and liberty.

            1. The US is a great place but your ideas of Western Europe are just silly. None of my adult nieces and nephews continued to live at home. In fact, they are much more independent than their American peers. They tend to travel earlier and not for a semester abroad but for work and adventure. They don’t use air conditioning because they don’t need it or have it. (this is the case in Canada too). The “hands their laundry out” sounds like a positive to me but that as not been my experience. I think you are confusing financial freedom with life choices. It is difficult to explain the difference between live to work and work to live but both are valid lifestyles. What you see as mediocrity,they may see as living life.

      7. If nobody makes a buck off of treating cancer, there’s no incentive to treat cancer.

        1. He doesn’t understand how incentives work.

          1. You’re an ER doc who complains about how well off your patients are as part of your fight against getting those people out of the ER.

            I know enough about incentives to know that someone with your scumbag attitude wouldn’t be practicing medicine were it not for the paycheck. Hippocrates thinks you’re a self-absorbed asshole.

            1. Stop demanding more money from us. That’s selfish.

              1. Excellent sentiment! Now, head over to CIGNA and make sure they heard you.

            2. You don’t even know me. Sorry someone made you pay for your health care. I am also sorry that we don’t live in Utopia where everyone works for the greater good. I actually love my job. I work my arse off. Why is it wrong for a doc to want a paycheck? Do you get one? Do you go to work for altruistic reasons?

              1. You bet I get a paycheck, from my own LLC that does its own billing. Yet somehow you don’t find me complaining, as you did, about how “well dressed” the people I work with are. And if I worked with hurt people, I would be even less inclined to complain about their cellphones.

                I’m going to bet that has something to do with how I’m not a self-absorbed chump who is clearly in the wrong job, standing in defense of an unregulated free-market system that prices people away from insurance and preventative medicine and into medical bankruptcy and the wrong facilities for care, such as your ER.

                1. What happens to prices with more competition?

  12. Most of this advice sounds pretty good to me. I can’t see abandoning tort reform though, and I really can’t see deregulating the medical field so that anybody who wants can be a physician.

    As a physician, I can tell you that defensive medicine is very, very real and it costs a ton of money. Doctors are scared to death of lawsuits, we have very little in the way of protection, and you see a commercial for a lawyer every five minutes on daytime television. I realize that tort reform is a state issue, but all that federal money strongarming that goes on with every other pet project could really be used here.

    As for allowing anyone who wants to come through to be a physician, it’s difficult to argue that having more physicians around would lower costs. Instead, it would likely drive good applicants away from medicine. Our salaries in constant dollars have already been declining for years, while the cost of medical education has been skyrocketing. Why on earth would I want to come into a field where it’ll be difficult for me to make enough to pay off the cost of becoming a doctor? That’s already a big reason why few go into primary care. We didn’t spend seven to ten years getting medical training to make low salaries. Sorry if that’s not altruistic and all the crap that people want to put on us (but not on their field of endeavor), but that’s the truth.

    1. The real issue, as I’ve read it, is that insurers pay more for tests than they do for care.

      So random technical specialist gets paid a ton for every extra test ordered, as does the hospital, but primary care physician who might have caught the problem before it was serious doesn’t get jack.

      That is the one benefit I see in the socialized systems – they have managed to retain a much higher ratio of primary care physicians to patients.

      That said… I don’t know if we need more full-fledged doctors, but there’s a lot of work that you don’t need a full-fledged doctor to do, and something moving towards highly trained nurses to handle shots, basic examinations, etc and referring the worst cases to doctors makes a lot of sense to me, and the AMA has been fighting any movement in that direction tooth and nail.

    2. I’m a physician as well, and I agree with a lot of what you’ve said. The only thing I’d disagree with (and I’m probably alone on this one) is tort reform. Call me crazy, but I don’t like a federal mandate capping amounts on pain and suffering. For one, if some SOB messed me up and I couldn’t work for the rest of my life, I sure as hell would want more than 250K. Additionally, I don’t think the 250K is going to drive down the healthcare costs that much, if at all. I agree with you wholeheartedly – I’m guilty as charged. I’ve ordered MRI’s on folks that I know are crazy, simply because I believe “what if I miss something?” But guess what – that wouldn’t change if malpractice were reduced. The threat of losing a lawsuit isn’t any less real just because the lawsuit is for less money. It’s the rise in your malpractice insurance in the end that would really hit you hard.

      As far as med mal goes, I’d like to see a “loser pays” system, and I’d also like to have all cases reviewed by a panel of docs and lawyers BEFORE they go to trial. Some of these lawsuits are absurd and have no business being allowed to continue.

      1. “Additionally, I don’t think the 250K is going to drive down the healthcare costs that much, if at all.” It has not helped the consumer in Texas but it has definitely lowered insurances rates for physicians.

  13. “Doctors are scared to death of lawsuits, we have very little in the way of protection, and you see a commercial for a lawyer every five minutes on daytime television.”

    No shit. I keep seeing this Lawyers for victims of Mesothelioma ad where this lady says her now dead husband wouked in apowere plant where the asbestos fell like rain. As someone working in the utility industry (electric / natural gas) I find that claim highly suspect.

    1. The mesothelioma crowd bankrupted Dow chemical and many other chemical companies. It probably led to 100K workers loosing their jobs. Thanks trial attorneys!

      1. “bankrupted Dow chemical”


        Last trade (extended hours) 02/26/2010 4:38 PM ET

        Dow Chemical Co (DOW)

        $28.31 / share

        Doctor, I think you’ve been raiding the drug cabinet.

  14. So because the President is talking about something, that automatically makes it important?

    The Republicans should talk about whatever they want. If they don’t want to talk about health care, that’s fine.

  15. SPOILER ALERT: The following contain spoliers about (Denmark’s) Susanne Bier’s After the Wedding and (Spain’s) Pedro Almodovar’s Volver. Do not read on if you plan on seeing them.

    Both are mid 00’s European movies, and one interesting thing they share is having a character who has terminal cancer. In both movies, the idea of possibly beating it – by going to the United States – comes up. Considering all the crap about what shitty healthcare we have, and how much better the euros do it, blah blah, I found it amusing that apparently a few Europeans have a different take.

    1. SPOILER ALERT? BP, the only foreign film that is seen by these guys comes in a brown paper wrap. 🙂

  16. My favorite part of the whole summit was when one Dem noted that over the last 20 so years, all reform has been incremental, and we’ve seen a tremendous rise in costs.

    His argument was that it was time to end the incremental fixes.

    My question was: If government has gotten more and more involved over the last 20 years and we’ve seen an explosion in costs over that time, doesn’t that tell you something?

  17. they risk coming across as partisan naysayers

    That ship sailed on Jan. 21, 2009.
    Not that there’s anything wrong with that.

  18. Oh, and this tidbit from the summit: Canadian ministers come to the US for care.

    Of course the Dems cried that this isn’t about the rich, but those who can’t afford insurance.

    But again: Do we want a system modeled after a system where no one wants the coverage.

    As someone at the summit said: We want good health care, not good health insurance.

    1. Having friends from Canada, i can tell you that they ALL like the healthcare in the US much better than in thier homeland. one exapmle is my buddies son broke his arm, he was put in a sling and told to take asprin for the pain, and come back on monday, it was a sat night not the evil opiates, lol but reg ole almost worthless asprine for bone pain! yeah thats healthcare

    2. Try to follow along. The bill as it stands resembles Netherlands / Switzerland – private providers, higher regulation as with public utilities. Canada or single-payer does not enter into it – and as we have seen from the Max Baucuses of the Hill doing AHIP’s bidding, it never will.

  19. I can tell you for a fact the mesothelioma claim is legit. The exposure occured 30, 40 or 50 years ago, but its legit.

    They refer to it as “asbestos snow storms.”

  20. These are all good ideas, but I’d be surprised if the Republicans actually adopted any of them.

    Thus far, they havn’t had the balls to advocate interstate insurance sales.

    The vourchers for Medicare thing is the boldest idea so far, but most of the gOP seems scared of it. Probably conflicts with their demagogery on medicare cuts.

    1. Both the Repubs and Dems are corporatists. Don’t expect either camp to champion liberty.

  21. How about Republicans go fuck themselves? Isn’t there another country they can completely screw up?

    1. Gee, Tony, that’s the most intelligent comment I’ve ever seen from you.
      I’ll bet your kindergarten class mates think you’re a real howl.

  22. I would call anything that keeps the Democrats talking about healthcare a good thing. I had thought this summit was going to be an attempt to leave it all behind with the press blaming everything on Republicans. But I am now convinced the Democrats are stupid enough to go sixty more days then try their ill concieved, ill fated reconcilation push. I’d almost think Republicans are running the Democratic party.

  23. Abandon the mandate
    The mandate is a necessary tool for combating adverse selection, which is the critical market failure for which the “free market” has no viable solution. Any law that did not have a mandate but does require insuring those with pre-existing conditions would only worsen the adverse selection problem. While unpopular, so is any part of any bill that requires anybody to do anything other than collect a check or a free service.
    Loosen the chokehold of provider cartel:
    We largely agree on this one. The AMA needs to be forced into allowing the creation of more medical professionals, or have their ability to govern it removed entirely. I do not feel that the licensing procedure for doctors is particularly onerous?the problem is the restrictions on how many schools can train doctors, and the number they are allowed to train each year.

    Reduce the role of insurance in the medical marketplace to lower administrative costs
    I don’t understand where you think you are saving any paperwork. As long as I have any insurance at all, everything has to be tracked, even if I am currently below my annual deductable. Paying with cash and then fighting with my insurance company for reimbursement would be a far bigger paperwork burden than my doctor’s staff doing it for me. Now, there is a magnificent way to streamline the process?only have one insurer. Just about everyone else has figured this out.
    Extend refundable tax-credits for uninsured working families: The main reason why there are 47 million uninsured people in this country is the inherently regressive nature of the tax code.
    Wait! I thought half the population didn’t pay any income taxes? How is that regressive? And why play the chicken-shit game of calling welfare a “refundable tax credit”? Please have the courage of your convictions for once.

    Allow individuals to purchase coverage across state lines
    Yes, because I have this overwhelming desire for my only options for health insurance to be companies operating out of a post-office box in South Dakota (or whichever state lowers the bar even further in an attempt to snag a few jobs). What part of “race to the bottom” don’t you understand?
    Voucherize Medicare
    Imagine my grandma. She is 86, half blind and a quarter senile. Now, imagine her “shopping” for health insurance and haggling over the bills with whomever she (or someone on her behalf) chooses. Now, imagine her only insurance options are crappy, unregulated companies from a post-office box in South Dakota. Enough said.
    Reform Health Savings Accounts
    Ahh, nothing would foster economic growth and efficiency like most Americans having thousands of dollars of their capital locked up in a no-growth account where they have very limited access, and have to document everything if they want to touch it. How about we just get rid of the accounts and lower taxes?

    1. There you go again with that “market failure” shit.

      There has never been any such thing as market failure.

      Markets are not required to achieve socialist outcomes you happen to like.

      The best idea for healthcare is to get the government completely out of it altogether and let it be what it is supposed to be – just another commodity available for those willing and able to pay for it.

      Paying for your healthcare is no benefit to me – or any other taxpayer.

      It is far cheaper to simply let you die in the street from lack of treatment and simply pay the public works guy to haul your mangy carcass off to the rendering plant and turned into soap to help defray his salary than it is to pay for your medical treatment.

      1. Market failures don’t exist? lol.

        Talk about sticking your head in the sand. Why on earth should anyone take you seriously when you deny basic facts about the world? Not only do they exist, it is actually rare when they DON’T exist.

        1. Really Chad?

          Let’s see some absolute definitive proof that free markets are “required” to achieve ANY outcome other than the maintainence of freedom of contract in order to function.

          1. Insurance, particularly health (adverse selection)

            Environment (externalities)

            Collusion (game theory)

            CEO pay (agency)

            Why don’t you ask me a hard question?

          2. Remember, in Chad’s mind Market Failure = any outcome that Chad doesn’t like.

            1. No, it means any time that the assumptions of free market theory do not apply. It isn’t my opinion, it is textbook economics. I know it pains you that your vaunted theory doesn’t make it past Chapter 2 of Econ 101, but you are just going to have to deal with it.

    2. “Ahh, nothing would foster economic growth and efficiency like most Americans having thousands of dollars of their capital locked up in a no-growth account where they have very limited access, and have to document everything if they want to touch it. How about we just get rid of the accounts and lower taxes?”

      No we would rather lock up our money in social security with its great 0.1% rate of return. How about get rid off SS, medicare, medicaid, dept of Ag, Energy, Education for starters……

      1. Justify your .1% figure. Don’t make crap up. I want a good citation, either peer-reviewed or from relevant federal organization or non-partisan group.

        Actually, your rate of return on SS is highly variable, depending on how much money you earn over your career. If you are generally poor most of your life, the ROI is enormous. If you are regularly contributing on incomes in the upper end of the ~$100,000 range that is taxed, you actually have a negative rate of return. I am sure you know how benefits are calculated and understand all the bend points, right?

  24. This is the best article I have read on Health Care reform in a long time. The far-left wants to create a false choice between the status quo and “government in charge” reform. Republicans are very much on board with free market health care reform. They even tried during the Bush years but democrats shut it down using the filibuster.

    Why are liberals so tone-deaf? Why do they beleive all their opponents are like cartoon characters? Because many live extremely ideologically insular lives. As a libertarian I would love to live a more insular life but that cant happen if you go to school, work, watch TV and movies, or just have ears.

    1. CA has a lightly regulated market and lots of competitors. Costs are spiraling out of control do to adverse selection, the market failure that dooms “free market” health insurance. Why anyone would chose to get “on board” a sinking ship is beyond me.

      1. It is the whole system that is broken. Government already pays half of all healthcare dollars directly (from taxes). Medicare and Medicaid pay below cost in most cases so those costs as well as the unfunded mandates of emergency care from the government are all passed onto whatever fool with a job and insurance walks into a hospital. They are going to re-coup all those other costs from you.

        Even if Health insurance companies became non-profit it would only reduce health-care costs theoretically 3.6%.

        If you pay taxes and have insurance and go into the hospital and their are 7 of you in their you likely are paying directly and indirectly for the other 6. This is why health-care costs are exploding is because of hospitals recouping costs.

        Our current system is the worst of both worlds from socialism and capitalism.…..86-by.html

        1. (Sorry about the “there”)
          FYI this is all coming from a practicing CPC.

        2. Health care costs are out of control because we overpay for everything, focus on expensive technical solutions to simple problems (because someone makes more $$$), because we are grossly unhealthy to begin with because of our lack of a comprehensive wellness system, and because our insurance system is loaded with all sorts of overhead that other nations do not burden themselves with.

          Medicare for All solves most of this.

  25. Republicans should establish a modest system that will guarantee that no one will be denied basic health care. This will permanently block the Democrats from continually trying to socialize medicine in America.

    1. Guaranteed catastrophic coverage is very cheap. Once HC costs are at perhaps 20% of income, it kicks in. Problem fixed.

  26. Another measure that should appeal to the little guy, pro-consumer instincts of Democrats is breaking up all the provider cartels.

    Yes. If the Democrats are known for anything, it’s their zeal in union-busting.

  27. Why not just offer Nixon’s health care reform plan from the 1970s? Dust if off, update it, and we have a Republican option.

  28. Oh please…the article claims we have a regressive tax code as if that’s part of the problem.

    To the writer of this: Check the numbers: the “rich” pay the lions share of the tax burden and the percentages due increase as people move up the income ladder. Yes, there are loopholes, but over 90% of government revenue comes from the top 10%. Decent article otherwise.

  29. Actions speak louder than words. Let the Republicans accomplish something concrete — actually taking on the lawyers to effect significant tort reform would be nice — and I might rethink things a bit. Until then, they’re going to have to prime their own pump as far as I’m concerned. They’ve already spent all the credit I might have given them. I use to think the opposite but your this article and this article…..nship.aspx has changed my views…

  30. Liberalism exposed and the real problem with them:…../#comments

    1. Liberals don’t believe in God and are responsible for Jersey Shore. Got it.

  31. Does anyone know if it is correct that the HSA accounts actually fold into the next year and can build up? My HR dept. tells me if I don’t use it I lose it. This may vary from state to state.

  32. Baumol Cost Disease/Healthcare Reform:

    What afflicts the American health care system (and those of other industrialized nations) is called Baumol’s cost disease. It is named for William J. Baumol, an economist at New York University, who turns 88 next month. And it explains why health care costs will almost certainly continue to rise faster than general inflation, and why Democrats might not want to set expectations too high when it comes to their health care bill.…..sease.html


  33. Who can tax you? Who can ? The Government can!

    Ray Stevens and Obamacare:

    Breaking News! Just in:

    The United States Constitution has just been found in a dumpster behind the White House:

    1. Okay, I give up.

      Before this, it was true that the most self-absorbed, society-denying, pro-corporate twerps Reason has to offer were doing very poorly in this thread, but that’s all over now.

      Even I stand mute before the colossus of rhetorical genius that is Ray Stevens.

      You win. Let’s just fork over a % of GDP to Humana tomorrow.

  34. I laugh that anyone still worries that Republicans can “risk coming across as partisan naysayers.” They’ve already proven that’s exactly what they are on this issue. If they had any intention whatsoever of seriously addressing this issue they could have done so between 2000-06 when they essentially ran washington. They have no credibility on this issue at all.

  35. It is interesting and informative article. Thank you.

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