Obamacare

Crass Market

How ObamaCare's exchanges undermine quality health care.

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When Barack Obama pitched his health care overhaul last year, he declared, "My guiding principle is…that consumers do better when there is choice and competition." But judging by the legislation he signed into law, his idea of a competitive marketplace is one that's run by the government.

ObamaCare calls for each and every state to set up a "health exchange," a highly regulated, government-run marketplace where individuals can shop for health insurance, by 2014. Each state is required to either show progress on building an exchange by 2013 or make way for the federal government to build and manage one directly.

These exchanges are the chief method by which the federal government will exert control over the insurance marketplace. Despite being operated at the state level (provided they choose to set up the exchange), state governments won't entirely be in charge. The Department of Health and Human Services will have the authority to determine minimum health insurance requirements for most medical services and providers as well as cost-sharing details for plans offered through the exchanges. By the end of the decade, the Congressional Budget Office estimates that 24 million individuals will be served by these exchanges.

In theory, they will expose health insurance customers to greater competition while protecting them through regulation. Insurers participating in the exchanges, for example, will face strict limits on how they can price their premiums according to individual risk factors. In practice, they will likely prove difficult to design and implement, and may ultimately undermine the country's quality of care. No matter what, there is little doubt that the exchanges will fundamentally alter the health insurance landscape across the states.

Already, some state insurance regulators—including the head of the National Association of Insurance Commissioners' exchange task force—are openly advocating banning insurance companies from selling individual policies outside the exchanges, leaving the state-run exchanges as the sole market for individual health insurance.

Others simply propose applying exchange regulations to all health insurers, even if they operate outside the exchanges. The effect of both policies would be the same: to get rid of individual insurance sales outside the purview of the exchanges and their rules.

States tasked with building the exchanges can expect the process to be tricky at best. Because the exchanges will be the vehicle through which individuals receive ObamaCare's new health insurance subsidies, they will be expected to quickly and accurately determine an individual's eligibility. That will require the exchanges to rapidly verify such variables as family size, location, smoking status, and income.

Income verification will be the biggest challenge of all, as eligibility is based on family income—a major problem for dual income homes. Will states ask employed women to provide their husband's tax returns? What if she's separated but not divorced?

Meanwhile, there's evidence that the sort of government-managed competition fostered by exchanges does little to prevent adverse selection. Indeed, because insurers will be limited in terms of how they can charge based on health risk factors, the new rules may encourage plan providers to avoid investing in resources that help the sick.  

For example, a 1997 New England Journal of Medicine study looked at billing records for elderly Americans participating in Medicare HMOs in Florida. The study found that, despite exchange-like regulations guaranteeing access to any HMO plan and prohibiting insurer cherry picking (or "medlining," as it's sometimes called), insurance companies managed to lure in the healthiest—and cheapest—patients, while leaving the sickest, most expensive patients on publicly funded Medicare.

Individuals enrolled in the HMOs used two-thirds less care than those on traditional Medicare. And those who eventually rejoined the publicly funded Medicare rolls went on to use 180 percent once back on the public program. In other words, despite rules that were designed to ensure equality, private insurers had still managed to attract the healthiest, cheapest patients while pushing the sickest, most expensive patients away.

But how do they do this? As John Goodman, president of the National Center for Policy Analysis, explained in his book Lives at Risk, plan providers in managed care environments offer benefits likely to attract healthy people, like sports club memberships, but avoid or dump services that will attract sick and expensive individuals.

In 1998, for example, the Kaiser Family Foundation released a study suggesting that Medicare HMOs tailored their advertising to "target physically and socially active seniors, rather than beneficiaries in poor health." That same year The Washington Post reported on one health plan in Minnesota that offered easy access to obstetricians, but quickly dropped the service after it lost millions by attracting too many pregnant women. Another health plan in California quit dealing with a university hospital that had developed a reputation for pursuing complex, expensive treatments.

Or look at the case of Shelby Rogers, as noted by the Cato Institute's director of health policy studies, Michael Cannon. In 2008, The Washington Post reported on the story of the 13-year-old with muscular atrophy whose private duty nurse was initially paid for by her family's federally-provided insurance. Eventually, though, the insurer tried to back out. Why? According to a representative, the reason was because coverage for private duty nurses made the plan too likely to attract patients with similar maladies as Shelby's.

ObamaCare's defenders will likely argue that such practices merely prove the need to get tough with insurers. The ominous warnings against insurers from Health and Human Services Secretary Sebelius surely count. But in ObamaCare's exchanges, which force insurers to take all comers and charge similar prices regardless of health history, pressure to avoid the sick by any means will be fierce. Squeezed by federally-required regulations, insurers will certainly compete—but only to avoid the sick.

Peter Suderman is an associate editor at Reason magazine and a 2010 Robert Novak Journalism Fellow.

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  1. “My guiding principle is … that consumers do better when there is choice and competition.”

    … = that the government should engineer a single-payer system, despite the fact

    Continuing to study Obamaese …

    1. It’s double-plus good!

    2. I saw a picture in the intranet about Obama and Hillary and George Lopez, and Hillary and George Lopez had their hands over the hearts, but Obama never thought to do that! I’m voting for Hillary and gorge Lopez!


  2. No matter what, there is little doubt that the exchanges will fundamentally alter the health insurance landscape across the states.

    Insurance adds no value. Anytime there is a Third Party Payor (even the government programs) the patient can care less of the cost and the DOctors charge whatever they can get away with it.

    In the free market, the customer (or patient in this case) controls prices a provider charges. If they can’t pay, the prices come DOWN.

    Get RID of Insurance. Make EVERYONE pay to see the Doctor or go to Hospitals. PERIOD.

    As for the Poor and the Eldery and the Disabled, setup Government runned MAYO Clinics that ONLY the poor, elderly, and disabled can go to.

    I hope this does happen.

    1. Who are you to tell me what contraction I should or shouldn’t enter into?

      If you don’t want to buy insurance, then—and pay attention here, ’cause this is the hard part—don’t buy insurance.

      Well…at least as long as our every so benign lords and masters allow that.

      1. You know, I said nothing about your Contraction.

        However, If i were Barak, I’d do my best to OUTLAW Heath Insurance and make people pay the provider out of their own pocket. This would drive cost down.

        1. You’re completely right! We should outlaw auto, home, life and all other types of insurance too. Why would anyone need protection against low-probability, high-cost events?

        2. You know, I said nothing about your Contraction.

          Insurance is a contract, Alice. Outlawing that contract is exactly telling me that I can not contract for this service.

          So I ask you again: who are you to say this thing? Do you Alice believe that I am a sovereign person or that I am a slave? And consider–if you answer that I am a slave–what moral force them should bind me to care for the integrity of your person when you care not for the integrity of mine?

          The same question applies, BTW, to those who support a mandate. Who are they to say I must make such a contract, and why should I not treat them like any other slaver?

        3. My Gawd, what a fool.

    2. Get RID of Insurance. Make EVERYONE pay to see the Doctor or go to Hospitals. PERIOD.

      So someone in a burn unit, a newborn in neonatal intensive care unit, an individual with a spinal chord injury, they should all pay all of their expenses out-of-pocket? Each of those conditions can hit a policy’s lifetime maximum without much difficulty.

      1. The ONLY reason those services cost so much is because of THIRD PARTY PAYOR. If the providers (regardless of the level of service) has to deal with the FREE market and the ability of people paying, the cost would be much less. This affect would happen AS SOON as we outlaw health insurance, medicare, and medicaid.

        1. The ONLY reason those services cost so much is because of THIRD PARTY PAYOR.

          That is not even remotely a response to my point. In the first place third party payors bring negotiated discounts and options you could not get as an individual. And even if you (falsely) believe that 90% of the cost of healthcare is because of third-party overhead, fraudulent malpractice claims and graft, there are still plenty of injuries that are outside the affordability of most people. That is the purpose of insurance, mitigating risk. Feel free not to buy any. Whoops, that will no longer be an option.

          1. Feel free not to buy any. Whoops, that will no longer be an option.

            Exactly! This stooge did nothing about helping the problem. He (Obama) himself is nothing more than a stooge of the Insurance company.

            Why not the Free Market?

            Why not let people pay and have providers charge what they are capable for charging?

            Do you not believe that the Free Market would actually work for Healthcare?

            I know I’m being a facist by saying that we should OUTLAW insurance and take away peoples options from buying. I know this. However, I see that the THIRD PARTY THING (including Obama’s stupid single payor solution) cause a Price inflation that is not seen anywhere in the Free Market.

            1. Do you not believe that the Free Market would actually work for Healthcare?

              Medical insurance is a free market solution. Would you also ban automobile insurance? It is quite possible for me to do more damage with my car than I could ever repay, just as it is quite possible for me to incur medical expenses that are more than I could afford.

              It should go without saying that libertarians loathe government intervention in the marketplace in general, and in the healthcare arena specifically. But attacking insurance is missing the forest for the trees.

        2. Alice, are you off your medications? Or, on some new ones?

          Neonatal care costs a lot of money because there are a lot of things going on that are expensive.

          24 hour nursing at a ratio of 1 nurse for every 1 or 2 patients means that the nurse who is paid $50K/year+benefits is being billed into 1 or 2 patients. There will be three nurses per day. The babies stay in incubators that cost 10,000 dollars a piece, have 100 dollars a day in electricity/consumable supplies. They will stay in this unit for about as long as they would have stayed in their mom had they not be premature. A baby born at 30 weeks can expect to spend 10 weeks in the unit. That means the three nurses for the 10 weeks which comes to $10,000, the incubator’s fractional cost of $400 (5 year life expectancy means cost of $2000/yr/1/5 of a year) and will have $7000 in consumable supplies. Add the ventilator, the doctor’s salary, the labs, and any other consultants, and the inevitable need for a social worker to deal with the social issues, and you get an idea why they are so expensive.

          Get a clue.

        3. The presence of a 3rd-party payer is not the only cause of the high cost of modern health care. You must take into account the costs of the technology, the expertise of those whose skills are required to render the care & all the resources that are involved. It takes hardly any level of care to ratchet up to prices few people can afford to pay, even over time. Libs are shooting for a gov’t-sponsored, single-payer system that, if implemented, will wreck the quality of health care as we have come to know it in the US. Pray, dear Alice, that the health care insurance industry can survive the boneheaded health care overhaul called Obamacare.

    3. For something that adds no value, people are sure clamoring to buy it.

      It does add value insofar as it allows people to hedge risk.

      1. The consequence of hedging this risk is the outlandish costs of medical services.

        You can get Open-Hearth Surgery in India for under $10k.

        1. Is that the one where they splay you out over a fire and eat your heart?

          1. No, not THAT one…the one you refer to actually costs extra.

        2. I tend to agree, and it’s only there because it’s propped up through government intervention in the form of tax-free employer policies.

          1. It is not the hedging of risk which is doing it, it’s the tax code driven dominance of employer-provided group-health, which gives us the trifecta of

            * transferring of expected costs into an “insurance” plan
            * one-size fits all plans for N people with little in common
            * the requirement that you buy coverage you might not want

            Lets take them one at a time:

            First, paying for expected costs through a third party is dumb and no one would do it it it weren’t for the tax laws. Consider that if you go to the doctor for a physical and pay out of your own pocket, you pay with taxed dollars[*], but if your “insurance” plan covers it you pay with pre-tax dollars. That situation encourages putting expected costs into the “insurance” plan and allows the insurance company to take a little overhead off the top for each visit. The individual is trapped between paying Uncle Sam or paying Blue Logo. And Blue Logo promises convenience to boot.

            Second, employer does the negotiating. They’re presumably responsive to the employee base in a broad way because they want to hire and retain people, but the plan they negotiate can only represent some nominal median employee’s desires, which is to say that it almost certainly doesn’t match any given employees needs. But the tax break thing gives it an edge versus going out onto the market, none the less. Big employers can offer a choice of several plans, which mitigates the situation, but does not make it go away.

            Finally, with employer provided plans dominating the field, special medical interest groups have every incentive to push their state insurance boards to require coverage for their treatment-de-jour. Forcing everyone using these plans to hedge against a wide spectrum of low incidence, but expensive and often not life threatening diseases. I have to buy a hedge against wanting infertility treatments in order to get some protection against be bankrupted by a bad accident or sudden illness. Yeah, it’d be nice to know that I could afford IVF if that became an issue, but I might prefer to spend that money some other way.

            [*] Unless you’re sick enough to accumulate sufficient health care cost to qualify for the deduction, and they 1) do lots of paper work to get your tax break and 2) pay now (and if you haven’t judged your withholding just right Uncle Sam collects interest on your money in the mean time), and see the difference next year.

            1. All you’ve said is true, IMHO. The health care we get in this country is exmplary, the best available. LEAVE IT ALONE. What we need to do, very desperately, is reform the health insurance industry. I would like to see it modeled after the auto insurance industry, more or less. My employer does a pretty good job of providing coverage for Most of its employees. Due to my personal situation, it a lousy plan. There does need to be a way to make it more affordable for more people. Not everyone needs to buy a Cadillac plan, economy car plans should be available, too.

    4. Re: Alice Bowie,

      Insurance adds no value.

      No, it does add value. Not that you’re not on to something – I just wanted to clear that matter up.

      Insurance against catastrophic events ensure an unforeseen illness or accident does not wipe you out. So, such insurance does have the added value of hedging risk, just like fire or theft or life insurance.

      Anytime there is a Third Party Payor (even the government programs) the patient can[‘t] care less of the cost and the D[o]ctors charge whatever they can get away with it.

      This s true, but only in the case of insurance that purports to pay for every minor medical issues including the sniffles. The true costs of health services are indeed hidden from the eyes of the patients through this cumbersome arrangement.

      In the free market, the customer (or patient in this case) controls prices a provider charges. If they can’t pay, the prices come DOWN.

      Yes, it’s called the “Market Clearing Price.”

      Get RID of Insurance.

      No, wrong approach. Just enough not “mandating” it through tax loopholes or regulation or labor laws. The main reason companies are compelled to offer health care insurance to employees is because it costs less in payroll-related taxation to offer that as part of your “salary” than giving you money straight. Take out every single payroll-related tax, and the problem of health coverage by your employer disappears, as insurance companies would then have to offer cheaper products directly to the customer (that is, YOU), having to enter a more cutthroat market than they would prefer.

      As for the Poor and the Eldery and the Disabled, setup Government runned MAYO Clinics that ONLY the poor, elderly, and disabled can go to.

      There’s no REAL need to set up government-run hospitals. Once you let people keep more of their money, charity-driven hospitals for the elderly and poor will become more robust and numerous.

      1. Absolutely!

    5. “Insurance adds no value.”

      It allows you access to the security of a collective pool of savings without having to actually remain at risk until you can build up the equivalent pool yourself (that is, you’re protected as soon as you get a policy), and it lets you endure a fixed, small burden rather than a risk an unlikely but huge one.

      It’s also good for society since it reduces the number of cases where a person is financially devastated by an incident and has to declare bankruptcy, thus adding random hardships to their creditors and possibly triggering a chain of bankruptcies.

      Finally, it encourages the existence of professional actuaries, which produce invaluable statistical knowledge regarding various types of risk — accurately assessing the harm in unlikely but catastrophic events being a weakness of the untrained human mind.

  3. “When Barack Obama pitched his health care overhaul last year, he declared, “My guiding principle is?that consumers do better when there is choice and competition.”

    His guiding principle is to lie through his teeth about what he believes and what he’s doing to make people think he’s actually doing something less radical.

    1. But “choice” and “competition” poll well, so that’s what he calls it. Never mind that it’s anything but…

      1. That kind of crap is Obama’s MO on everything issue – not just the healthcare bill.

        He has been doing it for years. He makes speeches tailored to make people think he is some kind of pragmatist who only wants to do “what works” instead of the socialist twit he actually is.

        1. Google “George Lakoff” and you’ll see where this is coming from.

  4. [A] government-run marketplace[.]

    An Oxymoron – government cannot run a marketplace anymore than a mafia don is running a protection “market.”

  5. We don’t need to get rid of health insurance. Because, for the most part, we don’t really have health insurance.

    Insurance has to do with high-cost, low-probability events.

    Due to endless state interventions in the health insurance markets, very little health “insurance” actually works that way, and shortly it will be illegal to offer such a policy.

    Good old-fashioned high-deductible catastrophic insurance puts the market forces back at work in health care, but we’ll never see it again in our lifetimes.

    1. Right on, RC!

      What most people call ‘insurance’ is really a contract to provide overall health care.

      Rather than protection against high-cost low-probability events, people want to get ‘health care’ for less than what it actually costs. Additionally, use of a third-party payer system encourages both overuse of and overpayment of services.

      The PPACA edifies these ridiculous concepts into law. It is inevitable that such a system will increase, rather than decrease, expenses. Furthermore, it obligates further regulation of medical care by the government in order to attempt to control these rising costs.

      A few years ago, the government delayed payment of medicaid to providers until the fiscal year ended and a new budget made more money available. As the other party in that transaction, I would be fined (and face jail) if I tried to do the same.

      As both a physician and a private citizen, I dread the consequences of a medical system further destroyed by the PPACA.

    2. That’s what HSA plans hoped to address, and that’s precisely why Obamacare killed any support for that concept immediately. Insurance is supposed to help you pay when the sh*t hits the fan, not for your day-by-day incidentals. Does anyone here think that if car insurance covered all maintenance & upkeep costs ? like health insurance currently does – its consumers also wouldn’t be facing skyrocketing prices and reduced quality of services? We don’t have health insurance anymore: we have government mandated and regulated complete healthcare coverage masquerading as such.

      Let’s quit kidding. For the last 40 years these collectivists have pushed government regulations on insurance with the end game always being to break the system and get people to then demand government take it over. Once you control your serf’s healthcare access, you as government wield some awesome power.

  6. The reason the regulation exists is due the abuse insurance companies were committing. They didn’t exist before insurance existed.

    I agree with Dean, insurance has to do with high-cost, low-probability events. And not everyday doctor visits.

    1. Bing!

      If we could get regular care to be cash on the barrel head, you would see a lot of the behavioral stuff in adult medicine get a lot better fairly quickly because the positive consequences of a luscious Tbone steak will be immediately balanced by the negative consequence of having to go to the doctor to get told to eat less and get exercise.

      The downside of this model is that there are people who can’t afford medical care and don’t qualify for medicaid. They basically either don’t work (and become full-time leaches on society), or they don’t get care. We saw this in pediatrics where we saw kids not vaccinated or kids with preventable complications of chronic illnesses that weren’t caught because they weren’t seen.

    2. Across state line shopping for high-cost, low-probability events; not everyday doctor visits.

  7. Insurance companies will compete to dump the sick?!? How is that different at all from the current situation? Obama care only continues the current ‘cash in from the healthy, deny care to the sick’ ie let em die. the weak sicko’s. They shoulda took better care of themselves. When will America stop letting above market income=life. Below market income=death.

  8. The silver bullet to all of the US health care problems is…..
    MAKE ALL INSURANCE COMPANIES NOT FOR PROFIT!!!
    Its elagant in its simplicity.
    Since the primary goal of a corporation, to make profit is denied to it; the secondary mission comes to the for. That is how do you be number 1? Market share. How do you gain market share in a non profit situation? By offering the best services at the least amount of price!!
    Corporations will actively do the ‘wallmart thing’ and squeeze their suppliers to reduce prices so that they can offer a better deal.
    The market can work by removing the profit incentive!

    1. Do you work for no pay?

      1. Do you work for no pay?

        All ‘non-profit’ means is that any profit (surplus funds over operating expenses) are not distributed to owners or shareholders. They are instead used to improve the business, which can include lowering prices. Do you consider your pay to be surplus funds?

  9. “…released a study suggesting that Medicare HMOs tailored their advertising to “target physically and socially active seniors, rather than beneficiaries in poor health.” That same year The Washington Post reported on one health plan in Minnesota that offered easy access to obstetricians, but quickly dropped the service after it lost millions by attracting too many pregnant women.”

    Wow. They really must be “socially active” senior women?

    — Cape Cod retiree

  10. During Obama’s backyard rally the base get together two days ago a female supporter told him that her healtcare premiums were going up 20 percent and she is worried about keeping her job.

    Obama said, don’t worry, under my plan you have noting to worry about – you can keep your doctor and costs are going down.

    1. I’ve noticed he’s taken to saying “in the long term, however” a lot lately.

  11. Regarding Medicare usage (aka demand): what about the reality that people tend to use more of the things they don’t pay for. “The Insurance” is paying is a pretty common outlook and clouds the issue of which services are really medically indicated. Perhaps this is a result which is hard to measure, but seems to be in play in all medical arenas, Medicare most obviously. Add in the (anecdotally observed) phenomenon that older people may like the social aspects of hanging out in doctors’ offices and talking to the pretty nurses and doctors, how about introducing the novel concept of people paying for health care and reverting to the true definition of insurance: sharing economic risk instead of prepaid health care.

  12. Interesting that you can tell any health blogger’s inherent bias by use of the term “ObamaCare.” If you want to have any semblance of fairness and legitimacy, you can start by calling the legislation by its name, PPACA.

    1. The name itself is biased in favor of the legislation. So, to have a semblance of fairness, you need to use a term selected by the proponents that is inherently biased.

      1. It’s a name of a thing. It’s proper to refer to things by their name.

  13. I see how there is a problem of adverse selection. I understand how the exchanges endeavor to make it better.
    I don’t see how they make it worse than leaving it all up to an unregulated private market.

    1. I don’t see how they make it worse than leaving it all up to an unregulated private market.

      *Yawn* Straw man.

      1. Um… what straw man? Do you know what that means? The drift of the article is that somehow PPACA will make things worse. But it doesn’t manage it. It just claims that it won’t solve the problem of adverse selection even though it has several measures to that end.
        I think the burden of proof is on the author to state how PPACA is likely to make things worse.

  14. Repeal to save lives.

  15. Any society that activly trys to not help the helpless sick is a sick society that will soon perish of its own hand. Such is our lot and all of this is moot anyway. But while we are all dying in a polluted world we can be happy that we are so FREE YEHHHHHHHH

  16. Indeed it is terrible thing for insurance companies not being able to deny coverage while still gouging the consumer. What kind of America are we living in where a corporation does not have the freedom to screw the general public with impunity? Forcing corporations to be honest and fair is socialism – we should depend on the markets to do this job.

  17. So why aren’t we having this debate concerning car insurance?

  18. Most certainly Obamacare will degrade healthcare in this country. Just as in our retirement system, benefits will be cut as costs rise. Social Security was always supposed to start at age 65. Now for some (me), it’s 66, for others it’s 67. And I’ve heard of plans to raise the age to 68 for still more, younger workers.

    Obamacare will increase the number of clients, and try to hold down costs. The only way that can happen is to cut back on services. Just like SS has done already.

  19. You are an idiot. There is not a single sentence in this article that says how health care is undermined by reform. Why is evidence of past failures by ‘similar’ plans evidence of future failures. More people will get fair access under this plan and you can cry all you like about it but that makes us a stronger contry.

    1. It’s a near certainty and economic reality that you cannot cover more people for less money with out cutting back somewhere.

      Stronger?!? If by stronger you mean less free then you are spot on. The key complaint with this boondoggle is the fact that, regardless of its relative effectiveness, it is government further limiting personal choice and freedom.

  20. The whole debate about insurance has been off the mark from the very beginning. What we should be concerned about is the quality and availability of health care, period. If the democrats had even the slightest interest in that goal they would have proposed ways to encourage training more doctors, opening more clinics and developing more cures. The health care “reform” they pushed through does none of these things. Instead it is likely to do the very opposite, while introducing unconstitutional mandates and raising costs to the breaking point.

    For the cost issue it has been clear from day one that the only way to lower costs without substantially cutting the quality of care is to leave decisions in the hands of patients and doctors. The only purpose of insurance is to limit liability and risk in the case of catastrophic disease or injury. Insurance companies or any other third parties, least of all the federal government, need to be involved in a routine check-up, allergy medications, medical tests or elective surgery. If no one had insurance for these things and both doctors and patients knew their true value, and were paying with their own money, their costs would plummet.

    That would leave the well-to-do the option of buying private insurance as they might wish to protect themselves or loved ones from catastrophic financial loss, and the less well-to-do to rely upon a combination of non-profit private charities and local government supported clinics and hospitals. There is broad consensus in the society that no one should be turned away from emergency care for lack of money, and Americans will step up as they always have to support local health facilities by voluntary tax deductible contributions, and local and state taxes if necessary.

    Before any of this can habit, or we can even have a rational debate on the subject, the insane and harmful health care “reform” act of 2010 must be reformed by repealing it before it does permanent damage to health care for millions in this country.

  21. There is broad consensus in the society that no one should be turned away from emergency care for lack of money, and Americans will step up as they always have to support local health facilities by voluntary tax deductible contributions, and local and state taxes if necessary.

  22. There is broad consensus in the society that no one should be turned away from emergency care for lack of money, and Americans will step up as they always have to support local health facilities by voluntary tax deductible contributions, and local and state taxes if necessary.

  23. What kind of America are we living in where a corporation does not have the freedom to screw the general public with impunity? Forcing corporations to be honest and fair is socialism – we should depend on the markets to do this job.

  24. In other words, despite rules that were designed to ensure equality, private insurers had still managed to attract the healthiest, cheapest patients while pushing the sickest, most expensive patients away.

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  26. You are an idiot. There is not a single sentence in this article that says how health care is undermined by reform. Why is evidence of past failures by ‘similar’ plans evidence of future failures. More people will get fair access under this plan and you can cry all you like about it but that makes us a stronger contry.

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  29. There is not a single sentence in this article that says how health care is undermined by reform. Why is evidence of past failures by ‘similar’ plans evidence of future failures. More people will get fair access under this plan and you can cry all you like about it but that makes us a stronger contry.

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