Shikha Dalmia in the Wash Exam on Turning Obamacare Into a Free Market System

Now that Sen. Ted Cruz's daft/noble (take your pick depending on which side of the Angry Bird/Wacko Bird split you are on) effort to defund ObamaCare is behind us, maybe it is time for the GOP to face reality. And the reality is that so long as a Democrat occupies the Oval office -- which, as per current schedule, is till 2016 -- the chances of repealing the law are less than zero. So what should the GOP do?

The law is riddled with internal contradictions that are likely to lead to its steady unraveling. At that point, Reason Foundation Senior Analyst Shikha Dalmia in her morning Washington Examiner column, notes:

Liberals will blame greedy insurers for their mess and say, "Markets have failed to provide affordable coverage. We need to give government direct control to cover people and pay providers."

This is not mere speculation. Senate Majority Leader Harry Reid last month openly admitted that Obamacare was "absolutely" a step toward creating a single-payer system.

However, if Republicans play smart, they can use the moment of Obamacare's reckoning to erect the market-based, patient-centered system that they've long advocated.

Go here to read how.

Comments

[Alice Bowie]

Where the hell was Ted Cruz when GWB started spending $11b/month on that stupid war.

At least healthcare is going to treat sick people and not kill healthy people.

I wish Affordable Care Act was able to keep two key components:

- Medicare eligibility for those over 50
- The Public Option

After they removed these two features, ObamaCare is Crap.
I would have preferred a Public Clinic than a Public Option.

A free market can definitely work for regular visits, elective surgery, and non-catastrophic illnesses and injuries and is perfect for middle-to-upper income people.

Nonetheless, there should be a safety net for all people so that people don't have to go bankrupt. And, I'm OK with taxpayer-funded PUBLIC Clinics EXCLUSIVELY for those on Medicare, the poor, and all that require really expensive treatment.

[DesigNate]

He wasn't even in office yet you fucking imbecile.

And you DO NOT HAVE A RIGHT TO MEDICAL CARE.

[Alice Bowie]

What I ment was, where were people the like of Ted Cruz.

We will, at some point, HAVE A RIGHT to MEDICAL CARE. Right now, the poor are treated and it is almost a defacto right. The neo-liberal opinion that people have NO RIGHT to Medical Care only works for healthy people and those who don't have loved ones being screwed by the system and the insurance industry.

[Jordan]

Fuck off, slaver.

[Mike M.]

Go suck Nick Gillespie's cock.

[Alice Bowie]

where did that come from?

[Lady Bertrum]

Alice - the rude comments are just their way of disapproving of the premise of your argument which is very un-libertarian.

[Alice Bowie]

Does it have to be rude.

I agree with many libertarian views such as a free market for healthcare. But I also agree with the liberal view of government healthcare (but not for all).

[Lady Bertrum]

What you've said here is basically a contradiction. There's no such thing as a "free market" that's partly controlled by government.

[Alice Bowie]

That's the difference between a reasonable Libertarian and a WACKO.

[James Anderson Merritt]

No, that's the difference between people who really know how markets work and and people who don't (and don't trust them to work, either).

Refer back to the California energy debacle. The legislature overwhelmingly (unanimously, iirc) created a market-like energy exchange. The key phrase here is "market-like." In reality, it was a government-sponsored and controlled game, which was supposed to harness the power of the free market to produce an abundance of electricity at the lowest possible cost to the consumer. Its rules had been slanted to favor certain well-connected players (Enron and their cronies, e.g.), while doing nothing to stop and everything to cause "market failure" and shortages that resulted in the infamous "rolling blackouts" that those of us who were living in the State then remember only too well. The free-market was blamed for the catastrophe, electricity regressed back into a tightly-regulated utility industry, and proposals to de-regulate electricity anew since then have rightly been met with cold skepticism.

Had we gone for a true free market in energy back then, we might now enjoy that abundance of affordable energy. If we went for a true free market in healthcare, we could soon enjoy an abundance of effective, affordable health care. But if we embrace Obamacare, I suspect we'll have a similar experience in medicine as California had in energy. Let's watch.

[DesigNate]

Let me break it down for you since you are half as retarded as Tony.

Medical care cannot ever be a right. You do not and cannot have a right that requires the use of someone else's time, talent, or body. For you, or any of your brain dead liberal friends, to think otherwise proves you to be slavers of the worst kind.

And I'm sure there was at least one person standing up against Bush's retarded wars (Hint: His last name starts with a P).

[Lady Bertrum]

DesigNate - I agree with the substance of your point but your style is awful. Do you want more or fewer people sympathetic to libertarian ideas? Persuasion - flies and honey.

[DesigNate]

I will admit that I could definitely work on my delivery. It just cheeses me to no end when someone talks so nonchalantly about basically enslaving a group of people because feelings.

[robc]

I dont think slavers should be treated politely.

[Alice Bowie]

As long as people can vote and the number of HAVES significantly out numbers the HAVE NOTS, we'll see a change in such policies regardless of the opinions from the RIGHT and the neo-liberals.

[wareagle]

as long as people believe they can vote themselves other peoples' money, then we will continue down the road to clusterhood.

[Lord Humungus]

Where the hell was Ted Cruz when GWB started spending $11b/month on that stupid war.

Considering Cruz started being a Senator in 2012, he was in Texas being a Solicitor General.

[Bardas Phocas]

Where was Ted Cruz when Hitler was slaughtering the Jews.
He sickens me.

[some guy]

Nonetheless, there should be a safety net for all people so that people don't have to go bankrupt.

The only ones who "have to go bankrupt" are the ones who get seriously ill or injured as children, and that's a very small number of people. Everyone who makes it to adulthood healthy has an opportunity to buy insurance. If they choose not to, that should be their problem, not society's. I could get behind universal coverage for children in exchange for a true free market for adults.

[Alice Bowie]

Insurance doesn't work if the company is not Mutual owned by policy holders and is Publicy traded or Privately owned.

That's why the effort was put into the ACA. Insurance companies just try to weasal out of paying high-cost claims as a matter of business.

[The Last American Hero]

That's nonsense. The profit margins of health insurance companies are amongst the lowest of large public companies - typically about 3-4% of revenue. And that "corporate greed" is also why corporate insurers have a fraudulent paid claims rate of 1-2%. For Medicare, the fraud rate is 10%-12. For perspective, Medicare alone (not including Medicaid) paid out 3 times more in fraudulent claims than the top 10 private insurance companies made in profits in 2009.

Incentives - how do those work again?

[Alice Bowie]

It's not just 3-5%. The SERVICE COST they claim has LOTs of PROFIT in there, and thats about 25%.

[robc]

So?

Buy your insurance from a mutual company then.

[Lady Bertrum]

If we introduced real competition into the health insurance market the big companies would slash each others throats squeezing out the excess margin much like any other service industry. But, because we don't have anything like a free market - even prior to Obamacare - the insurers have "safe" markets due to the state crony-regulations. Insurers specialize and operate in regions because they have ipso facto cartels.

[robc]

The easiest federal fix would be to allow people to buy insurance across state lines.

An actual proper use of the ICC.

Immediately watch the prices drop in the states with heavy restrictions on plans.

But, no, that wasnt considered.

[robc]

They buy your insurance from a mutual company.

Stop giving a fuck about other people, you slaving nanny.

[DesigNate]

You do realize that the ACA was written with the help of the insurance companies right? I mean the mandatory purchase rule is a freaking giveaway to them.

[Alice Bowie]

That's what I HATE about it and I HATE Obama for it.

I would prefer straight up OUTLAWING health Insurance, Medicare, Medicaid, and all THIRD PARTY PAYERS. Have a 100% free market for health care. And offer FREE clinics paid by TAX Payer where ONLY the Retired/Disabled/Poor/Highly expensive Treatment.

[James Anderson Merritt]

"Insurance" is the wrong model. We adopted the employer-provided health (insurance) plan to avoid WWII-era wage and price controls, and get a tax break. Those are the wrong reasons to intervene so massively in such a crucial economic sector.

Our goal should not be to get everyone insurance. Rather, it should be to restore the ability that Americans once had (even up to the early 1970s, as I recall): to pay for all but the most catastrophic health problems out-of-pocket, or from reasonable savings or financing (as, for instance, one might finance a car).

In the system we had -- which we abandoned NOT because it didn't work, but because FDR/HST-era politicians deliberately BROKE it, and then LBJ-era politicians broke it again in 1966 with Medicare -- there were many charity hospitals or charity wings of private hospitals. The poor and indigent were not routinely denied care, as some today would have us believe. Ironically, with the growth of insurance-based health plans, Medicare, the HMO Acts and other government interventions, the charity system in the US withered into a shadow of its former self. We need to resurrect this network of facilities. If we go in THIS direction, I am confident that US health care will once again lead the world. If Uncle Sam merely says, "me too," and adopts socialized or semi-socialized medicine, as found in so much of the rest of the world, US health care will continue, and probably accelerate, down the road to ruin.

[some guy]

However, if Republicans play smart, they can use the moment of Obamacare's reckoning to erect the market-based, patient-centered system that they've long advocated.

So long as the GOP supports Medicare, any amount of Medicaid, and health care related tax deductions they are not advocating for a market-based, patient-centered system.

[Alice Bowie]

To tell you the truth, the problem is third-party payer. It would be nice if we could just get rid of ALL third party payers and have public clinics EXCLUSIVELY for the Poor, retired, disabled and have a free market for the REST.

However, doctors won't be able to charge $5,500 for six stiches. So, the AMA won't let it happen.

[some guy]

Under a free market you wouldn't even need public clinics. Plenty of charities would set up clinics of their own, especially if you throw in reasonable tort reform.

[Alice Bowie]

I don't believe the charity thing. Neo-liberal and the Ann Ryan Types don't prescribe to this. Look at how stingy they are about taxing hall to help the few.

I'm telling you, you can have a 100% free market for all except the retired/disabled/poor. Have them go to government funded clinics. And, if they don't like it and can afford, they can come to free market.

[DesigNate]

The fact that you don't believe in charity (even though it exist right now) but do believe daddy government can somehow make sure all 330Million of us get medical care without bankrupting the country really says a lot about you.

[Alice Bowie]

I believe in CHarity. I just don't believe that the mean-hearted people that are pushing the elimination of safetlynets are not particularly charitable.

[robc]

The two have nothing to do with each other.

Lots of people oppose government funded safety nets BECAUSE its the charities' responsibility.

There is a reason that the majority of hospitals in my city have a religious name on them, even if that is more historical.

[John]

One of the craziest aspects of America's health care system is that while employers get limitless tax deductions when they purchase coverage for employees, employees paying out of pocket get no breaks, which unfairly boosts their costs.

Is Dalmai just really stupid and not understand how accounting works or is she just lying here? Employers get "limitless" tax deductions for any money they spend on benefits to their employees. They are called "costs" you fucking half wit. There is nothing special about insurance costs. Regular salary costs are just as "deductable". You don't have to pay taxes on the cost of running your business, just on the money left over. You know, income.

[UnCivilServant]

That always bugged me, why am I taxed on the grosses with only a few exceptions when companies are taxed on the net? I have operational costs to exist, why aren't they deductable?

I'd rather see the government stripped of its taxing power anyway.

[John]

Then you would rather just not have a government. That is one position.

[robc]

You have deductions. Including one that isnt connected to any spending at all.

The taxation system is stupid and gameable, but your complaint isnt one of the problems.

[Skomoroh]

The limit would be at the point where you owe no taxes, i.e. your net profit is zero or less. However, even above this you are only saving the tax rate. For instance I think the tax rate on the first $10,000 dollars of profits is 15% so for every dollar spent on insurance deductions you would be saving 15 cents on taxes. Companies don't think like this. Companies offer insurance in order to compete for the employees they want.

I would much rather drop our company insurance and offer our employees a raise to offset but it is difficult for many people to quantify the benefits of insurance and laws do not allow me to treat each person individually so I have found this not to be an effective strategy.

[John]

Companies don't think like this. Companies offer insurance in order to compete for the employees they want.

Yes people are risk adverse and want insurance. I am sure you would love to drop insurance. Hell, I am sure you would love to pay your employees half of what you currently pay them. But the labor market and the preferences and other available options of employees restrict that. Your employees like their insurance, so providing insurance is a cost of doing business.

[Adam330]

His employees would look at the issue very differently if the tax law were different. For instance, if the value of the health plan was taxed as income just like wages, I think most of his employees would take higher wages over the insurance.

[DesigNate]

I bet his employees would like their insurance even more if it wasn't tied to their job, they could get paid more, and if they could deduct their private plan from their taxes.

[James Anderson Merritt]

Without generous, favorable tax treatment, employers would probably not try to compete for employees using a health benefits package. This approach was adopted in the WWII era because of FDR's wartime wage and price controls, which forbade companies from raising employee salaries and wages, or luring employees from other companies by offering wage/salary increases to job-hoppers. (IIRC, even job-hopping was banned, in order to keep production stable for the war effort.) Employers still had to compete for the best employees (whose numbers were diminished by enlistment and conscription during the war). So they worked hand-in-hand with the government to make health benefits a legal tax-free basis for competition. This should have been a temporary wartime measure at worst. But, like the withholding tax -- also an alleged "temporary" wartime measure that has long outlived the war that introduced it -- favorably taxed, employee-provided health benefits have survived into the modern day, but have also been very important to making a mess of US health care.

[The Late P Brooks]

It would be nice if a hot seventeen year old girl would come to my house and give me a long, slow blowjob. And then make my bed and wash my windows before leaving.

Blowjobs are my right as an American!

[Adam330]

Dalmia seems to be under the mistaken impression that Republicans are interested in making the healthcare system better, rather than demagoguery and political power.

[Leigh]

Unlike our democrat friends?

[Adam330]

No, they are just as bad, if not worse.