Did RomneyCare Save Lives?


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Does health insurance save lives, or make people healthier? The answer to this question might seem obvious: Of course people who are insured are healthier and likely to live longer. But the evidence has not all been so straightforward. A 2005 study published by the National Bureau of Economic Research found that, in the decade following the introduction of Medicare in 1965, the establishment of a universal health insurance program for the elderly had "no discernable impact on their overall mortality." A large observational study of more than 600,000 respondents conducted from 1986 through 2000 found that, after adjusting for demographics, health, and behavior "the risk of subsequent mortality is no different for uninsured respondents than for those covered by employer-sponsored group insurance." Last year, a rigorous, randomly controlled experiment by a team of top-flight health researchers working in Oregon found that there was no statistically significant difference in measured physical health outcomes between people awarded Medicaid coverage in a lottery and a control group of people who were not. Initial findings from the same study also reported no mortality effect.

In other words, it's not at all obvious whether health insurance makes people healthier or increases longevity. Which is why the result of a new study on RomneyCare, published in the Annals of Internal Medicine, is practically counterintuitive. The study looks at Massachusetts' experience in establishing the state-based, near-universal health insurance program in 2006. A trio of researchers from Harvard and the Urban Institute compared Massachusetts counties in 2007-2010 with similar control counties in other states, and found a corresponding 2.9 percent decrease in mortality. More specifically, they found a 4.5 reduction in "mortality amenable to health care"—basically, deaths that we know how to prevent using medical services—following the introduction of the Bay State's health reform. No similar mortality reduction was found in the control counties.

This is a big study with a really large sample size, which means we ought to give it more weight. It also looks at a somewhat longer time than the Oregon experiment—four years, rather than Oregon's two. In other words, it's a good solid study that you should not dismiss.

So does this mean that RomneyCare saved lives? Well…maybe. It's entirely possible, and plausible. But the study can't quite answer that question one way or another. It's not randomly controlled, like the Oregon experiment was, which means it's subject to problems with confounding variables and selection effects. It's a study that does a pretty good job of proving correlation, but doesn't quite get us to causation.

To which a frustrated liberal health wonk might demand to know: Well, what else could have caused the same effect? There's a measurable drop in mortality in the four years following the implementation of a state-wide, near-universal health insurance scheme, and that's just a coincidence?

It may not be a complete coincidence; indeed, I suspect, though I cannot prove, that if we could determine causality with anything approaching real certainty, we'd find out that it's not. But there may be other, additional factors at play as well.

Massachusetts is a wealthy, highly educated state that already had one of the highest insured rates in the nation. It's home to a slew of elite hospitals and health care systems. Judging by the unemployment rate, which topped out at 8.7 percent, the state weathered the recession a good bit better than the United States as a whole. The authors control for the difference in unemployment rates, of course, but wealth, employment, and health are correlated in all sorts of complex ways that we don't fully understand; the recession's lighter toll may be expressing itself in other, subtler ways.

Massachusetts is different from other places in ways that are obvious and ways that are not so obvious. The implementation environment in Massachusetts, for example, was radically different than the one Obamacare faces nationally: broad public approval, bipartisan political support, a booming economy. Which means that even if you assume that RomneyCare's increase in coverage was the sole cause of the drop in mortality, enacting a similar program nationwide wouldn't necessarily produce the same results. Government-run health care pilot programs are notoriously difficult to scale up. Just because something works in one place, even if it works really well, does not mean it will work as well or at all in another.

But let's assume, for a moment, that it does. The result of a nationwide 3 percent drop in mortality would be about 17,000 fewer deaths per year. But as with anything, there's a cost. To put it another way, the study suggests that in order to save one life each year, about 830 people would need to enroll in health coverage. That's an expensive proposition. As Michael Cannon, director of health policy at the Cato Institute, estimates in a post at Forbes, "If we assume the per-person cost of covering those 830 adults is roughly the per-person premium for employer-sponsored coverage in Massachusetts in 2010 (about $5,000), then a back-of-the-envelope calculation suggests that RomneyCare spent $4 million or more per life saved," perhaps more when the law's other costs are included. It's not enough to simply ask whether a policy has any effect at all. It's also necessary to ask whether there are different, more effective sets of policies that could be achieved for a similar price tag. 

And as Cannon points out, his estimated cost for RomneyCare probably doesn't pass a basic cost-effectiveness test:

The World Health Organization considers a medical intervention to be "not cost-effective" if it costs more than three times a nation's per-capita GDP per year of life saved. This in turn suggests that RomneyCare would have to give every person it saves an average of nearly 30 additional years of life to meet the World Health Organization's criteria for cost-effectiveness. Given that the mortality gains were concentrated in the 35-64 group, that seems like a stretch.

On the same note, it's worth remembering that for the past several years, the price tag in Massachusetts has looked unaffordably expensive. In a 2011 review of the state's health reform published in Health Affairs, a team of researchers looked at the results of the program over the same time frame measured by the new study. What they found was more coverage, more utilization of care—and costs that could not be supported over time. Not in Massachusetts. Not anywhere. "The pre-2010 status quo is not a sustainable option for Massachusetts or the nation," the report said. Around the same time, state health officials were also describing the program's costs as unsustainable, warning that, if left unchecked, they will crowd out everything else the government needs to do. Some reforms have been put in place by then, but even still, cost-containment is a challenge—in part because more coverage has led to greater use of care.

The new Massachusetts study sheds some genuinely useful, though not perfectly conclusive, light on the question of how health insurance effects health. But it offers less help with the public policy questions that come next: What should we do, and how much will we have to pay for it? Health insurance programs like RomneyCare won't help anyone if their costs turn out to be unsustainable.  

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    Tony is Mitt Romney.

  2. In my mind, the key question I haven’t seen answered is the health care access question. Did people who changed insurance go to the doctor more? Did more people change insurance than would have? Did diagnostic guidelines change in response to some particular part of the law? They are using health insurance as a proxy for so many behaviors that might not be tightly bound to insurance.

  3. It’s a sign of how goddamned stupid our times are when we have to actually pose a hypothetical question about whether a financial instrument saves lives.

    Insurance is a financial instrument, not a health instrument. It provides a mechanism for payment of health care costs, but does not by itself provide health care. Sure, easing the burden of catastrophic costs provides some greater measure of affordability. However, the monstrosity that is the ACA requirements dictates that insurance cover portions or a whole of a wide variety of things that are relatively affordable and should be costs bourn by the consumer. The net result is that deductibles are higher and a wide range of unforeseeable and potentially costly health services will be less covered than under the previous regime allowing for a more concentrated catastrophic care.

    1. SLD, the implementation of this by fiat and force is not something I agree with. But the “AC” in PPACA is the “Accountable Care” feature which, as originally formulated, gives financial incentive to care providers (docs and hospitals) to prove that they have improved outcomes over time. The problem is that it was originally formulated by a Public Health specialist and it is a going around the ass to find the elbow approach to addressing the disaggregation between the payer and recipient created by the “insurance for everything” model of health care created by government policies. So they have correctly addressed the problem: The provider has less incentive to provide the best care for the cheapest price than they would if they person being treated had to pay for most care.

      1. It’s the Patient Protection and Affordable Care Act; not “Accountable”. It’s pretty sad when you need to make shit up to advance your argument.

        1. Sorry, you’re right about the title. But it actually does specify that Medicare and Medicaid providers transition to Accountable Care Organizations, which I have been involved with professionally writing software. So take a deep breath about my “making shit up”. I didn’t say that it would work (it won’t) and you must have seriously misread the standalone post. Also the big SLD up front.

          1. I didn’t say that it would work (it won’t) and you must have seriously misread the standalone post.

            You’re right, upon re-reading I realize I did misconstrue your point. Apologies.

  4. Does health insurance save lives, or make people healthier? The answer to this question might seem obvious: Of course people who are insured are healthier and likely to live longer.


  5. Seems that there is correlation but not necessarily causation, especially since health is mostly a matter of genetics and life choices. And when people without health insurance do get sick or injured, they still generally get taken care of one way or another. (Quality of life is a whole ‘nother argument.)

    Sort of like having auto insurance correlates to being a better driver. It’s not magic, it’s just part of not being a fuck up.

  6. 1. What Sudden said.

    2. Lets say MassCare saved lives. But let me propose a hypothetical:

    A. Previously uninsured mortality decreased! Yeah!
    B. Previously insured mortality increased.

    Even if the net is positive, that is fucking evil. By making insurance overall less good, they have stolen life from group B in order to extend the life of group A.

    I think my hypothetical has a damn good chance of being true.

    1. Absolutely. It’s not like they added a ton of providers since that would add a ton of cost, so there’s only so much to go around.

      I’ve asked this question of people who support single-payer: every single good or service produced is rationed somehow, so what is your solution for rationing health care services?

      If it’s not price signaling due to supply/demand, then it must be first come first served, or a lottery, or some panel of TOP MEN deciding what care is provided to whom.

      1. There answer will be the elimination of profit will allow for more care. Every dollar that currently goes into profit will go into care instead.

        Of course, this only works if they have solved the economic calculation problem, which they havent.

        1. Flye,

          I am skeptical. You claim that when you talk to fools, they accept your posit: “every single good or service is somehow rationed.”

          Sorry to be a d!ck, but I suspect, in the majority of real conversations, fools would deny said posit, & they would therefore not be stumped/ confounded by your incisive follow-up question.

          1. Nope, you are correct. It was all part of the question. And I’ve had this very real conversation a number of times.

            The typical answer is the BOOOOSH-like attempt to turn the tables, “well you just want rich people to get health care?”

            Second most popular is, “well we just need more doctors.”

      2. Most of these people have an egalitarian impulse, and imagine rich and poor all lining up together to see a randomly selected doctor.

        They do not understand that a market system rationing by price is replicated EXACTLY in nationalized systems, mainly through national budgets or boards.

        So instead of a poor person saying “I can’t afford that super expensive cancer med!” you get the budget office saying “the country can afford that super expensive cancer med!”

        Which is not a better result if you think about it.

        And of course what happens in real life is a second tier of medicine appears in nationalized systems, where indeed, the rich can buy that modern cancer med, or see the top notch specialists, whereas poor people just don’t get that med or doc. Or the connected get moved up that hidden waiting list that does not exist at the VA.

        There are only a few instances where I think that a panel of experts making national decisions might help:

        1) End of life care. By moving that decision to far off technocrats, the doctor and patient’s family can rationalize doing less to save the dying person. (I think education could easily solve this problem though.)

        2) The same with saving very expensive births.

        1. can’t! The country can’t afford.

    2. “Even if the net is positive, that is fucking evil.”

      Try another hypothetical: Would locking everyone in their homes (with food provided) save lives?
      Why, of course! But so what? It’s not my job to provide food to people and not the government’s job to lock them away.

  7. Did RomneyCare Saves Lives?

    Nothing can saves grammar anymore.

  8. I guess, Peter, that you are about to drop your health insurance for both yourself and your family because there just is not any discernible effect on outcomes, and its just not OBVIOUS that it makes anyone healthier. Yeah, right.

    1. You might want to make the government = mafia comparison less obvious.

      You break people’s legs, then fault them for taking the crutches?

      1. Government is forcing people to make less healthy choices? Government keeps them from exercising? Government makes them diet on Twinkies?

        And lastly, Peter’s health insurance is from the government?

        1. Peter’s insurance is manipulated by the government. He may be paying for coverage he would never buy himself.

          Ive got coverage for pregnancy now. If I get pregnant, I have bigger health problems that insurance aint gonna help with.

          1. Yeah, but you’d be making a fortune on public appearances, book sales, and movie rights.

            1. Jackand Ace|5.6.14 @ 1:44PM|#
              “Yeah, but you’d be making a fortune on public appearances, book sales, and movie rights.”

              See? Jackand Ace has the answer! To a question no one asked.
              Hey, asshole, want to ay my added costs?

            2. Sorry, Rob, sevo missed your joke.

              1. What joke?

                I was dead serious.

        2. Government is forcing people to make less healthy choices?

          Well, I didn’t mean to bring the FDA, USDA, DEA, etc. into the discussion, but if you really want to…

          And lastly, Peter’s health insurance is from the government?

          Peter, like all of us, is mandated by the government to buy health insurance. That is a key element of the PPACA, or have you been asleep for the past 5 years?

          1. Actually, I would like to know how you figure that the government makes one unhealthy first. Last I looked, its always been my choice to eat right and exercise, and it was my parents who gave me whatever genetics I have, not the government.

            Regardless, if you believed that health insurance does not provide any positive impact, you would pay the relatively small fine to ignore insurance…it certainly would cost less than buying it.

            Lastly, I would be willing to bet Peter had health insurance BEFORE the ACA…before the government said you had to have insurance or face a fine. Which means, he has always believed that health insurance has had a positive impact…contrary to what he wrote and suggested to everyone else.

            1. The USDA exerts great influence over agricultural policy and prices, which in turn affects what you are able to afford to eat.

              The FDA outright bans certain foods and medicines, the consumption of which may improve your health.

              The DEA shoots people and throws them in prison for the things they consume, outcomes which are not conducive to health.

              Never mind the nanny laws and liability suits which have drastically curtailed the forms of physical activity people may engage in.

              Regardless, if you believed that health insurance does not provide any positive impact

              Health insurance isn’t magic. I don’t buy it because it makes me healthy, I buy it because I can’t afford to pay a $50,000 hospital bill on the spot if I get seriously hurt.

              Of course, the only reason the hospital is so expensive is because of the previous attempts by the government to “fix” healthcare, like HIPAA, EMTALA, and HMO. The PPACA is but the cherry on top of the sundae that is government fuckups of the healthcare industry.

              you would pay the relatively small fine to ignore insurance…it certainly would cost less than buying it.

              And paying the mafioso to “protect” me is cheaper than getting beaten up, but that doesn’t make it right.

            2. Lastly, I would be willing to bet Peter had health insurance BEFORE the ACA…before the government said you had to have insurance or face a fine. Which means, he has always believed that health insurance has had a positive impact…contrary to what he wrote and suggested to everyone else.

              Believe it or not, there was a government before 2009, and it was composed of the same sort of fools and knaves that currently run it.

            3. Jack,

              The fine may be small for you. For me, it would be more than 200/ month. Of course health insurance costs me even more than 200 per month. So, if some straw man is claiming that there’s no benefit what-so-ever to buying health insurance, he might be willing to pay 200 per month rather than pay 225 or whatever for health insurance. But the benefit is puny; less than 600/ year. insurance comapnies are EVIL. When i get shot in the face or contract [enter horrible disease] i have complete confidence the insurer will just deny the claim, as the insurance folks did to the poor people in The Rainmaker. I’m furious that Obama forces me to enrich these corporate-jet flying, champagne-sipping greedheads.

              1. I have no idea about Peter, but I had no health insurance until the mandate deadline.

    2. Actually, for the last 20 years, I paid for insurance and got exactly zero benefit from it (eyes excepted).

      I went from 1994 to 2014 without visiting a doctor or hospital or etc.

      I paid out of pocket for dental for the entire stretch and for eye for most of it. Even when I did have eye insurance, I chose to pay for methods that insurance didnt cover (the machine where they take the picture of your retinas instead of dilating your eyes and just looking at them).

      It isnt a given that health insurance is a positive.

      1. I’m not all that different, until recently. Paid for insurance my whole life, had random visits to the doctor, and never entered a hospital. Until 2 years ago, had to go to the ER, and spent one week in the hospital. Total bill, over $40,000. So I was glad for the insurance then.

        However, if Peter was a man of his convictions, or at least a man of his suggestions, he would be dropping his health insurance. Unless of course, he’s not buying all that he wrote in the article.

        1. First off, you’re now legally required to purchase health insurance or face a fine. Secondly, assuming that health insurance has no effect on health outcomes, it could still make sense to purchase it from a financial POV, especially for a risk-averse person.

          1. Peter’s entire point to THIS article is simply whether or not health insurance provides any positive impact on one’s health. And he cites 3 different studies that seem to indicate that it does not have any positive effect.

            Peter COULD have cited studies that say insurance does have a positive impact on health. Here is one.


            The fact that he chose only to present one side should seem to indicate his own belief. I’m only suggesting he does not believe what he wrote. Being risk adverse has nothing to do with it…being risk adverse just means you DO believe that health insurance IS providing positive impact on health. And I think Peter believes that, contrary to what he wrote.

            1. being risk adverse just means you DO believe that health insurance IS providing positive impact on health

              You are playing a correlation vs causation game here.

              Health insurance doesn’t provide health, it provides a diffuse way of paying for healthcare services.

              If you don’t employ those services, then it doesn’t benefit you to have health insurance.

              1. You would be wrong, particularly in regard to the ACA. Because under the ACA, preventative care became part of health insurance. Things done preventatively, like cancer screenings and physicals, do not have a co-pay, and are covered. The whole point being taking insurance away from simply a paying mechanism, as you say, toward one that improves individuals lives in health.

                Unless of course you don’t think preventative care would do that. I would then just disagree with you.

                So I take it you believe that preventative care

                1. Access to “preventative care” for people who wanted it was not a problem pre-ACA. MRIs, blood tests, etc. were commonplace and fairly inexpensive.

            2. There is also the benifit of insurance managing financial risk. It may not effect your health much, but it means you don’t get stuck with a $50k bill you are paying off for years if you do need to have a large treatment.

              That is what insurance is – a financial product to manage risk. As many have discussed here previously it’s why I wish my employer had a high deductable – low premium plan. I’ll gladdly pay for normal health costs. I just don’t want to risk getting hit with a huge bill.

        2. The two dont follow.

          And I dont think you read what Peter wrote. He actually says he thinks it probably did save lives.

          However, I will argue the opposite, with math to back me up, and still keep my insurance.

          Insurance, of any type, by definition, is a net loss to the consumers. You pay $10 in NPV to receive $9 in NPV benefits (or $8 or whatever, I dont know the exact margin. Somewhere between $8 and $9, I bet). That is why it is always better to self insure whenever possible. And why extended warranties are such a bad idea (ignoring their 80-90% margins). The reason you insure is for those incidents that are too large to self insure for. Like, say, your 40k hospital visit. Although someone like Romney could handle that.

          The extension of health insurance to small things that shouldnt be insured against is a huge drain on the consumers. I dont think there is any way that MassCare can be a net positive. But Im not talking about just mortality here.

          I already explained up above why event he mortality change would be evil if true.

          1. Peter is questioning the whole concept of whether or not health insurance has a positive impact on one’s health.

            “So does this mean that RomneyCare saved lives? Well?maybe.” Which also means, maybe not.

            Its clear what he is doing. He is questioning the whole concept of getting everyone insured will actually improve all of those people’s lives. And I am saying that judging Peter by his own actions (and yes, I am assuming he has health insurance), he really is not questioning that fact.

            And if you keep your health insurance, you don’t question it either. You believe health insurance does have a positive impact.

            The details of what is in the health insurance is not important on this particular article written by Peter.

            1. “Peter is questioning the whole concept of whether or not health insurance has a positive impact on one’s health.”

              Insurance is a financial mitigation strategy and risk grouping mechanism. Your own damn example answers the question.

              “Until 2 years ago, had to go to the ER, and spent one week in the hospital. Total bill, over $40,000. So I was glad for the insurance then.”

              In other words, health insurance didn’t provide health care, that’s what the hospital provided.

              Health insurance allowed you to smooth out your payment flows over a long period of time. Ergo, health insurance doesn’t positively effect health care, beyond the benefits of financial mitigation.

        3. How long is your “whole life” ?

          If you had put your health insurance premiums into a reasonably safe investment vehicle for the same time period would you have had $40K or more ?

          1. ACA pays out 85% of money taken in (minimum) – that is premiums to payouts.

            You better believe that the biggies get better rates with hospitals, docs and drug makers than you can.

            Add those two things together and the result is that you would be worse off saving the investing the money (which is ridiculous anyway because no one would ever do it anyway).

      2. robc, actually – as any honest actuary will tell you – the odds are in favor you will never need insurance.

        1. Not true at all when it comes to health insurance. That’s the exception rather than the rule. RomneyCare, which I have, covers a physical every year. I am relatively healthy, but they still want to check for colon cancer at 50, do blood tests for various levels, etc.

          Maybe what you are trying to say is that insurance companies take in more than they pay out? True – and up until the ACA, they had no limit on how badly they could screw us. Now they must pay out 85% of what they take in.

          Better, right?

          Debating whether health insurance is “good” is similar to debating whether my house or car insurance is. The question isn’t whether I take more than I give – it’s just a pool which allows modern society to function. Simple, really.

    3. I don’t see anyone arguing health insurance is useless. Pretty much everyone agrees its valuable as a financial tool to protect against the risk of catastrophic medical costs. So the fact that Peter doesn’t want to drop his insurance says pretty much nothing about his (presumad) belief it has no discernible effect on outcomes.

      1. I’m beginning to wonder if J&A is trolling, or if he really can’t intellectually grasp that fundamental mechanism?

  9. Hasn’t RomneyCare basically been scrapped by Obamacare? Whatever good it might or might not have done seems a moot point, now that our betters in DC have decided how states are permitted to do such things.

    Anyway, government programs are virtually guaranteed not scale well. Which is why we have states in the first place. And why the federal government was never given the authority to do such things.

  10. The thing that annoys me with this whole debate is that progressives argue both sides of this argument depending on context. Ask a progressive does the US spend frivilously on healthcare? The answer will be YES!!!!! we need government to rein in the spending there is an enormous amounts of waste (IPAB). Ask does insurance make a difference or medicaid or any other spending, and the answer is YES!!!! it saves lives. So in the end we will have more wasted government spending. Ultimately I think this is their true goal.

    1. Their goal is free health care for everyone, because that’s the utopian future they imagine. Their problem is reality: how do you get people to provide services without paying them, then who is going to pay them, then how do you then ration those services, then how do you make people responsible for their own health if care is free, etc., etc.

      Obama is their perfect leader, disappointed in the world for not bending to his will.

      1. Nothing – yawns – comes for free.

        It’s the one misconception of our existence during the welfare period that has corroded people’s minds.

        It’s the one axiom in life that’s tried and tested: Nothing. Free.

        Subsidies and taxes are…PAYMENTS. It’s just that we’ve offloaded our financial freedom to a third party.

  11. If it did, it was only for a while.

  12. ObamaCare is Health Insurance. Health Insurance is not Health Care. Health Care is not Health.

    Insurance is a financial transaction. It has nothing at all to do with health.

    Most of us are born in good health. With care, caution, common sense, and a bit of luck, most of us could maintain that status for most of our lives. All we would need is accident, disabling disease, and terminal condition insurance coverage.

    What we now call “Health Insurance” is like Home Owner’s Insurance that covers painting the eaves and mowing the lawn, or Auto Insurance that pays for car washes and oil changes. You could probably buy Home and Auto coverage like I described, but they would be prohibitively expensive.

    Tuh Dah!

  13. I am morally superior to all of you children, because I am willing to demand that the government take as much money as it needs from The Rich in order to pay the “unsustainable” costs of the Mass. healthcare reform.

    We all know that every Evil Rich Person in America keeps their ill-gotten lucre in the form of gold coins, stored in a swimming pool so that their nephews can swim around in them when they visit, and thus not invested in the economy. This money needs to be taken from the so-called Job Creators and divvied up among the poors, who will spend it on health insurance, thus making the economy grow and grow!

  14. Does health insurance save lives? Yes. But it can not prolong a life. Drivel! No matter, are you insured, or not… you can not live over 200 years old.

  15. People die for all sorts of reasons. The drop in “mortality” in general doesn’t tell us much.

    The study says there was around a 4% decrease in mortality among patients with treatable diseases. But that’s only significant if there was high number of patients who died because hospitals won’t accept uninsured individuals. Which seems unlikely.

    If you visit a hospital every time something’s wrong with you, or use every available resource available to you just because it’s available to you, you’ll obviously improve your chances of survival. But that’s not sustainable. Hospitals in LA (less whiter than healthier than Mass) won’t survive if half of their population visited the hospital for annual checkups and insisted on every preventative treatment. Your doctor might insist the cyst looking thing on the X-ray is probably benign or nonexistent, but why take the chance when insurance can pay for it?

  16. Hah, I love it!

    The author states that part of the problem is the lack of “broad approval”, when that metric was/is bought and paid for by the Koch Brothers and other aligned interests…who own this site, etc.

    You couldn’t make that up if you were writing fiction!

    In other words “Since the billions we have spent on propaganda and lies worked so well, we can’t expect teh ACA to actually help people anywhere except Liberal Land”…

    I won’t even start with the “new math” the author works out about lives saved. Silly stuff. It doesn’t take into account that, whether insured or not, we end up paying all the hospital and medical bills – often higher ones, because of the lack of preventative care. 2 + 2 =4 also.

    Why complicate a simple subject. Preventative care works. Systems work better when people have skin in the game (pay something). Large businesses as well as those who do biz with local, state and federal Gubment (utilities, etc.) are often regulated in what they can charge…which is a good thing.

    Universal health coverage (or insurance, whatever you want to call it) doesn’t cost any more than the old system – in fact, over time it will cost less. The main improvement, though, is in the health and happiness and general welfare of the people…you know, you have to be fairly healthy to enjoy the blessings of liberty.

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