Obamacare

Supply Side Health Care Reform

|

House.gov

Could the Netflix model work in health care? A doctor's office in Rochester, New York is aiming to find out. Good MD, a primary care office set up this year, charges patients a single, flat monthly fee for unlimited visits. Monthly charges are based on age, and extra services—whether stitches or strep throat tests—are provided for an additional fee, posted online and in the office. The practice doesn't accept private insurance at all. The result is a system that benefits not third-party payers, but doctors and patients, Good MD founder Dr. Thuc Huynh, told local TV station WROC. "Insurance isn't who reimburses me or dictates what we do together in terms of our treatment. So, it's a direct financial relationship."

This is what the future of health care reform could look like: It's provider-driven. It's consumer-focused, with an emphasis on both price and service. And while Good MD isn't the only doctor's office to try variations on this model, it's happening at the margins—at individual practices across the country. 

As Obamacare's has settled into place, the Republican party's promises to repeal and replace the law have stagnated. The law is still unpopular, but the coverage expansion has made the already difficult prospect of repeal harder than ever, and despite years of promises, no obvious replacement plan has emerged. Obamacare's critics in Congress are still opposed to the law, but increasingly seem unsure about what to do instead.

Provider-driven experiments like what's happening at Good MD could help point to a different way of thinking about the problem.

"[Obamacare] repeal is at least not immediately practical," says Robert Graboyes, a Senior Research Fellow with the Mercatus Center focused on health policy. "And to replace you need something to replace it with." That's a problem too, he says, because in order to craft a large-scale replacement bill that enough people could agree on, it would likely be necessary to jettison or weaken many important provisions.

Instead, Graboyes suggests that health care reformers look to supply-side reforms—small-scale fixes that make way for innovators to improve the system. 

It's a way of thinking about health care reform that emphasizes distributed improvements over centralized solutions, and that works from the assumption that lots of minor improvements can sometimes work better than one big overhaul. 

He describes the approach as a "World War II Pacific theater island hopping strategy—where you've got ten-thousand islands, you go after a few of them now, and you keep folks surprised as to which ones you're after." The work would be done piece-by-piece, and it would be focused on small victories rather than grand plans, with the understanding that just as markets make change at the margins, so should policy reformers.

Last year, Graboyes published a short paper outlining his principles for reform. Those principles include rewards for innovators, autonomy for providers, choices for consumers, and meaningful, transparent prices throughout the system. The essential idea though, is this: Find ways to transform the health system into a market, and then let the real reforms happen from the outside in.

At full scale, some of those reforms would be politically difficult—perhaps even more so than repealing Obamacare. But that's where the island-hopping strategy comes into play.

In the paper, for instance, Graboyes urges a move toward "a seamless market," without the fragmentation that results from the U.S. health care system's layered design, with Medicare, Medicaid, employer-sponsored coverage, and now Obamacare exchange plans all working through different silos.

That's an impossibly big job. And Obamacare, which builds on top of the existing layers, "severely limits the extent" to which this can be done, Graboyes says. Indeed, it makes the problem worse by organizing exchange-based insurance into overly standardized, government-defined tiers of insurance. This creates additional "gulfs of separation" between different types of insurance. And yet with a willing administration, he argues, this could be addressed administratively, through regulatory changes, by allowing greater flexibility for health plans.

Graboyes also points to the massive problems with Medicare's pricing formula, which distorts the practice of medicine (doctors do what they are paid to do) and drives up costs. The pathologies created by this system, he writes, "comprise the single greatest challenge to America's fiscal stability and the single greatest obstacle to health care innovation."

Yet there's clearly no way to fix its problems all at once. "That task would be so huge, and so overwhelming and so hard to encapsulate in a few words that the conversation dies," Graboyes says. Reformers should therefore attack the biggest and most obvious problems first, with the goal of slowly untangling the mess left by decades of price controls.

There are other islands to be taken as well. Various laws and regulations that inhibit specialty hospitals would have to be dealt with. "A lot of the really important reforms are going to have to happen at the state level," Graboyes says. These include overtly anti-competitive policies such as professional licensing requirements and Certificate of Need rules that require providers to obtain permission from local officials, who in many cases are simply acting on behalf of incumbent competitors. In many cases, state-level reforms have the advantage of being an easier lift politically than changes to federal law.

And while it is in some ways a different task, reforms at the Food and Drug Administration could help too. "We have built an information structure [at the FDA] that forces everything through narrow strictures," he says. That might have made sense decades ago when information was hard to acquire, but now we have the opposite problem: an excess of information. The old approach, which relies on centralized chokepoints, is out of date.  

Ultimately, it's the profusion of chokepoints that have taken hold of the health system that Graboyes wants to get rid of. The hope is that doing so, bit-by-bit, over time, will free up providers and consumers for even more experiments, many of which we can't even conceive of now, above and beyond Good MD's direct-care model. "There are so many small pieces we could begin doing now," he says. The first step is to start doing them.

NEXT: The Ever-Evolving Story of the White House Fence Jumper

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. Excellent idea attacked for being anti-poor in 5, 4, 3, 2…

    1. This excellent idea is anti-poor.

    2. It is a fine idea, but it isn’t a solution. It is part of a solution because it is a process. And no one is attacking it for being anti-poor. The problem is that health care does not exist, and never has in the modern sense of the term, within a simple market. Health care is not toothpaste or cellphones that is a simple supply and demand of goods and services. It also is not national defense or fire protection which most people agree (even hyper-libertarians) are a bit beyond normal market forces. Health care is somewhere between the two and no amount of free-market chants can change that basic aspect of health care. By the way, I don’t particularly like Obamacare – but it might have actually helped for the far right to actually honestly engage in health care reform rather than abandon its responsibility to lead. It is lazy to blame without a solution.

      1. The problem with “Healthcare Reform”, like the problem with “Campaign Finance Reform”, as well was a great many other reform issues, is that the sensible way to go about it would be to remove, all at once, all the Government Meddling in the market, and then take a short time to see where that leaves us.

        The Healthcare situation has, for decades now, been a matter of whomping up a new “Reform” package to deal with the dislocations caused (at least in part) by the last “Reform” package. So we keep slapping on band-aid on top of another without examining the actual wound. The same is true for Campaign Finance. We are never going to straighten these ongoing clusterf*cks out until we dismantle the pile of failed regulations they stagger under.

        But admitting that the Government has been making things worse for decades would make the status quo seriously seasick. So the Political Class isn’t eager to do it.

  2. We can wage war all over the globe, killing millions of people over time, and physically and mentally maiming people for life, but when it comes to talk about healthcare, the subject is treated almost as if it were “evil”. Apparently war must be “good” and healthcare “bad”. Anyway, when the Republicans gain control of the country again (probably as a conservative dictatorship posing as a democracy), they will get rid of healthcare reform, and probably a host of other things.

    1. It’s pretty obvious by your comment that you never read (or maybe didn’t comprehend) the article. It’s inconceivable that anyone with two spare brain cells could defend the bloated dysfunctional system we have.

      1. I like defending bloated dysfunctional systems.

        1. Oh, I see. The person spoofing your handle at 10:44 just dropped the period off.

      2. the article was about people who
        have money, goober

        1. Don’t waste your time responding to me unless it’s something pertinent. I don’t waste my time responding to obvious trolls.
          That is all.

    2. On The Road to Mandalay:

      We can wage war all over the globe, killing millions of people over time, and physically and mentally maiming people for life, but when it comes to talk about healthcare, the subject is treated almost as if it were “evil”. Apparently war must be “good” and healthcare “bad”. Anyway, when the Republicans gain control of the country again (probably as a conservative dictatorship posing as a democracy), they will get rid of healthcare reform, and probably a host of other things.

      Yeah, that’s my read on the USA: America is screwed up, and by screwed up, I mean republicans.

      I feel sorry for people who don’t grow up enough past middle to school to see past the two-party system.

      1. if your talking libertarians, they are a bunch of wackadoo’s whose ideas
        have no basis in reality, that’s why they
        are part of the lunatic fringe

      2. War is about breaking things; that’s fairly simple. Health Care is about fixing people; that’s relatively complex.

      3. Right on, man. It’s better voting for self-righteous third parties who get 1% of the vote. They don’t have to bother pandering for votes so they can appeal to right-wing cult group members like you.

        even better is to tell people I don’t vote at all. Some might call me a smug asshole, but fuck them, because I know I’m right and they’re just a bunch of no-nothing duopolists

  3. The problem is always going to be the outliers. Sure any of us who have a job can afford catastrophic insurance to cover big unexpected healthcare crisis and pay as we go for check ups and maintenance medication. It will make healthcare more profitable to physicians and cheaper to clients, but the people with rare diseases and true disabilities like cerebral palsy, will always be used as the excuse for universal healthcare and laws requiring hospitals to give care away for free. The obvious answer is charity but good luck getting people to have faith that it will all workout for the most vulnerable. The people want assurances and that is what politicians offer. They may not be able to back it up, but they will make the promises. That is why I’m not too optimistic about a free market in healthcare.

    1. if only we were smart enough to realize what outliers are. instead, we crafted the system based around the worst case scenario. it’s like we crafted the system on the assumption the entire country is going to get cancer at the same time.

      1. The people I feel bad for is those born with a disease that makes them unable to be productive. No insurance company is going to cover someone with a lifetime debilitating illness. I would expect an organization of charitable hospitals would get enough donations to operate but I can’t be sure. I know the American people donated tons of money to the Red Cross to help Thailand, I am skeptical that that they would be less willing to help fellow Americans.

        1. St Judes only gets about 10% from government grants based on my research.

          Local hospitals should have charity drives and/or local and state governments should take care of their own as well.

          1. in other words, your fine, screw the poor

          2. Yeah and doctors should be paid with chicken and root crops ? time to leave the 13th century my friend. The beginning of large heath care systems in the West began when Charlemagne helped set up hospitals that were funded and managed by the Catholic Church. That was NOT by donations because tithing back then was the same as taxation now. Charities never have supported urban hospitals anymore than they supported fire departments or road construction. St Judes only exists with that model because it is a small part of a fringe segment of a much, much larger health care market. Guess what would happen to St Judes if it had to compete with EVERY hospital in the country?!

        2. Avik Roy suggests richly subsidized high-risk pools for these people.

          Supporting Americans who are born with a debilitating disease is something I’m willing to pay some tax dollars for, as long as those people get a stipend or voucher for efficiently administered quality care and supervision as needed.

          1. If you could direct taxes, I would mind paying them. But what politicians do is skim tax dollars and underfund popular items. That way they can always call for more taxes to fund what is popular.

          2. Supporting Americans who are born with a debilitating disease is something I’m willing to pay some tax dollars for, as long as those people get a stipend or voucher for efficiently administered quality care and supervision as needed.

            This is one of the most inane lines of argumentation, and yet so many people use it.

            Taxes are coerced. If you want to pay for something, then just fucking pay for it. You don’t need somebody forcing you to do things you already find worthwhile to do.

            1. “If you want to pay for something, then just fucking pay for it. You don’t need somebody forcing you to do things you already find worthwhile to do.”

              Hmm, I think you just topped the list of inane arguments right there.

              1. Reading comprehension isn’t your strong suit, is it?

    2. I believe (and follow) the catastrophic health insurance approach, my policy has a $10,000 deductible. The ACA will probably force that policy to be canceled.

      As to the outliers, it’s not just the people with “rare diseases and true disabilities” that had trouble getting health insurance prior to the ACA — even catastrophic plans. I speak from personal experience as somebody turned down for coverage, as was my spouse, and as a licensed insurance agent since 1983.

  4. Right. Go ahead and propose that to the American people…a new system that will replace the one they have. And in this new system, you STILL would be dealing with third party payers, because you still would need at a minimum catastrophic insurance, because you really don’t want to be paying for that transplant out of pocket, do you?

    And in some of these concierge systems, doctors are charging as much as $2500 to even $15,000 per year. By the way, note below that its physicians using it to boost their income…not to provide more cost effective service.

    http://www.physicianspractice……ice-income

    Tell me, Peter, if this is the face of a new health care system, such as you say it is, are you willing to take your family off of the health insurance you currently have in order to take part in it? At least if you said yes, it means you are willing to do what you suggest others should eventually do. Somehow, I doubt it.

    1. The only solution is to turn all of healthcare into the model of efficiency and efficacy that the VA represents.

    2. I would certainly be willing to if it was still legal to purchase catastrophic insurance. But since it’s not, I have to maintain the bloated, unnecessary policy that I currently have.

      Regardless, though, your point is a non-sequitur, since there’s room in a true market for all kinds of policies. One can buy service plans for cars that cover routine maintenance if they wish to. Most people choose not to for some mysterious reason.

      1. I don’t disagree…let them create those practices. No problem. But if you think that system will replace what we currently have, I would disagree.

        1. But if you think that system will replace what we currently have, I would disagree.

          The current system does have the competitive advantage of being compulsory, so you’re probably right, you’re just incredibly fucking stupid.

          1. when it comes to stupid your no slouch
            without the current system (obamacare)
            you’d have single payer, airhead

            1. “You’re” is a contraction of “You Are.” “Your” indicates possession. I’ll give a pair of examples: You’re stupid. That is your stupidity.

    3. The third party point is a good one. It could be handled with catastrophic coverage policies and direct reimbursement to the customer, who would then pay the other parties, allowing the market to work efficiently.
      I would leave the current system, pay for services out of pocket and pay for catastrophic coverage. Oh, wait. That’s exactly what I’ve been doing for years. Obama promised I could keep my plan. That’s a huge relief.
      I had to have MOHS surgery a few years back and the physician could barely answer a simple question about the cost involved. Somehow I doubt the same doctor would permit me to install a wood floor for him without having some idea of the cost beforehand.

      1. I had MOHS myself. I wonder it that would be considered “catastrophic” under most plans, since it took about just an hour. Maybe, because its cancer. But there are plenty of other medical procedures that cost plenty and are not catastrophic. Just paying for them out of pocket would put a severe crimp in anyone’s budget.

        1. I wonder it that would be considered “catastrophic” under most plans, since it took about just an hour.

          What does or does not constitute “catastrophic” would normally have absolutely nothing to do with the length of the procedure. But that aside, there’s really no need to wonder: you could always read your policy.

        2. But there are plenty of other medical procedures that cost plenty and are not catastrophic.

          Largely attributable to the fact that both consumers and providers are completely disconnected from the price in our current system.

        3. Just paying for them out of pocket would put a severe crimp in anyone’s budget.

          If saving your own life is not worth a little crimp in your budget, then I guess you don’t really value your life that much.

          And if the procedure isn’t life-saving, then it’s a luxury not a necessity and there’s no reason for other people to subsidize it.

          1. kbolino|9.30.14 @ 1:29PM|#
            “If saving your own life is not worth a little crimp in your budget, then I guess you don’t really value your life that much.”

            Yep.
            I love the nitwits who bemoan that ‘people go bankrupt paying for life-saving medical care!’.
            I guess bankruptcy is far more appropriate when you overpaid for the 60″ flat-screen.

      2. To be fair your doctor doesn’t know because depending on who pays the bill the price changes. If it was cash for service then it would always be the same price. Some outpatient surgery centers are listing cost for service and not taking insurance as a real world example.

        1. My MOHS scenario happened at a local Dermatology PA. I explained that I had a catastrophic, high deductible plan and inquired what my costs would be. It was quite clear that the doctor was not prepared for the question but he did manage to muddle through something well enough for me to decide. Instead of going to the hospital, the practice could do it at their other facility, within a mile of my home, for less than my deductible level.
          I thoroughly welcome the scenario you mention. It works for my dentist.

    4. Tell me, Peter, if this is the face of a new health care system, such as you say it is, are you willing to take your family off of the health insurance you currently have in order to take part in it?

      This is the same horseshit argument people use in school choice debates. “Hurrr durrrrr, you’re a hypocrite for participating in a system you’re compelled to support by force”. I’m actually really impressed you were able to regurgitate it in multiple contexts though.

      1. Thanks.

      2. I really like the “did you got to public school when you were a child? Yes. Then you owe taxes until you are dead.”

        Never mind I never asked to be born, had no choice in where I grew up and my parents are forced by law to send me to school. But hey who ever expected an honest debate by a statist.

        1. I disagree…Peter is not a statist. But your point about him being unfair, since he would not opt out of his insurance for this new plan, is a good one.

          1. Like he has a choice about giving up his plan. People with guns have forced him into his plan.

            1. Wow, you are why most people don’t trust libertarians.

          2. I was referring to the social contract you sign by being born argument, not to any particular person.

          3. So is it unfair that Barry takes a charitable deduction on his taxes when he thinks the rich should pay more? Yeah, thought so.

  5. Some doctor(s?) in New York tried that Netflix version of basic health care a couple of years ago and were forced by someone — city, state, can’t remember — to raise their prices. I read it in the Wall Street Journal, can’t remember any other details.

    Anyway, good luck to anyone wanting to provide basic healthcare at a reasonable price.

  6. That’s been around for over 30 years. It’s an HMO, but with only one doctor.

    Fixed monthly cost for unlimited treatment, no third-party insurance.

    1. “That’s been around for over 30 years. It’s an HMO, but with only one doctor.

      Fixed monthly cost for unlimited treatment, no third-party insurance.”

      THIS!

      Funny when Libertarians finally get it….this is the way it is now, and they act as if it’s a new proposal. It proves that Libertarians are low-info audiences.

      As I have said from the start, what the GOP (one and the same with the Koch’s form of Libertarian) doesn’t like about Obamacare most is the name. Call it RandCare and they’ll suck it up.

      1. If it’s been around for 30 years, then why is there a new law about it?

        1. ktolino,

          If it’s been around for 30 years, then why is there a new law about it?

          There isn’t.

          It was 30 years ago — I’ll give you the date if necessary — when HMOs became a mandated option for covered employees.

      2. Funny when Libertarians finally get it….this is the way it is now,

        Unnm, nope.

        1. your right, they don’t get it

          1. joshrendell,
            Do you REALLY believe the current healthcare system is HMOs? No more fee for service? REALLY? Wow, Dude.

            Have you graduated yet?

            (You STILL don’t know how to reply to the comment you intend to.)

  7. Looks like someone (since yesterday) has assumed my posting identity, thus having me as posting things which I did NOT post, and do not originate with me.

    Well, you got your wish. Have to hand it to you. You are clever. You are getting rid of someone only because you don’t like their opinions.

    Looks like you win, and I really will have to QUIT this site. Have fun kissing each others’ libertarian assholes.

    1. On The Road To Mandalay|9.30.14 @ 12:34PM|#
      …”You are getting rid of someone only because you don’t like their opinions.”…

      No, it’s your abysmal ignorance.

      1. Sevp,
        No, it’s your abysmal ignorance.

        Did your parents raise you to be so shamefully intolerant? Are they proud of what you’ve become? Are you a social conservative?

        1. “Did your parents raise you to be so shamefully intolerant?”
          Were you born such an ignorant twit, or did it take years of training?

          It’s not my job to educate you; go search for road-guy’s stupidity. It comes by the bushel.

          1. (laughing) So … ARE your parents proud of what you’ve become?

    2. Is this your last post ? Again ?

  8. Since when does everyone buy into this “replace” nonsense? Do you really want to replace AIDS with cancer? Because that’s essentially what these douchebags are talking about with this “repeal and replace” talk. Radical idea: a market-driven health care system.

    1. “Radical idea: a market-driven health care system”

      They must still pass a law to make it happen. I like to call it “repeal and replace.

      I’m still waiting for somebody — anybody — to propose one. A REAL one, not Medicare vouchers with “market-driven” bullshit and soundbites.

      1. I’m still waiting for somebody — anybody — to propose one. A REAL one, not Medicare vouchers with “market-driven” bullshit and soundbites.

        Then step up to the plate, asshole.

        1. Then step up to the plate, asshole.

          (laughing) Okay, dumbfuck I’ll go slowly for ya,

          Medicare vouchers seek to control healthcare costs through competition. See Paul Ryan, Cato and others who are clueless on free markets. No different from Obamacare, which controls EXPENSES but does NOTHING for the the underlying COSTS, Do you know the difference?

          Ummm, Can we control auto repair costs with more competition between Allstate and GEICO? Yes, precisely that stupid.

          We already have competition in Medicare, since the beginning. Seniors shop for their providers. That’s what competition IS!!!

          Ever hear of “skin in the game?” Seniors have none. Give them the tools and pay them a percentage of what they save by shopping around.

          THAT would be a market-based solution. We libertarians have been talking about “skin in the game” for only 40 years now. Who teaches Paul Ryan and Cato?

          And you?

          1. So in other words, you have created artificial requirements and complain about the costs of meeting them.

            There is no “replace”. There is only “repeal”. Start with the PPACA and don’t stop until the word “health” does not appear once in the United States code.

            1. So in other words, you have created artificial requirements and complain about the costs of meeting them.

              (laughing) Are you REALLY so totally illiterate?

              There is no “replace”. There is only “repeal”. Start with the PPACA and don’t stop until the word “health” does not appear once in the United States code.

              One more time, that does require passing legislation. Sorry, but your brand of fascism is unconstitutional. We need a majority to pass that legislation. And they must be elected by a majority of voters. (gasp)

              So you can swing through the trees like Tarzan, beating your chest and screaming “REPEAL” forever. Or try pissing up a rope.

              But libertarianism is NOT a cult.

    2. “Radical idea: a market-driven health care system.”

      Can we spring Bernie Madoff to run the thing?

      1. craiginmass|9.30.14 @ 4:52PM|#
        “Can we spring Bernie Madoff to run the thing?”

        “Since 1991, Madoff and his wife have contributed about $240,000 to federal candidates, parties and committees, including $25,000 a year from 2005 through 2008 to the Democratic Senatorial Campaign Committee.”
        http://en.wikipedia.org/wiki/Bernard_Madoff

        Yeah, we need more D’s handling the money.

        1. Umm, let’s finish the rest of your dishonest quote, shall we? (emphasis added)

          Since 1991, Madoff and his wife have contributed about $240,000 to federal candidates, parties and committees, including $25,000 a year from 2005 through 2008 to the Democratic Senatorial Campaign Committee. The Committee returned $100,000 of the Madoffs’ contributions to Irving Picard, the bankruptcy trustee who oversees all claims. Senator Charles E. Schumer returned almost $30,000 received from Madoff and his relatives to the trustee, and Senator Christopher J. Dodd donated $1,500 to the Elie Wiesel Foundation for Humanity, a Madoff victim.[46]

          Hmmm

          Yeah, we need more D’s handling the money.

          You are a piece of work.

    3. Radical idea: a market-driven health care system
      hey, goober, that’s what got us into this mess in the first place…DUH

      1. joshrendell,
        hey, goober, that’s what got us into this mess in the first place…DUH

        (lol) You’re drooling all over your shirt.

  9. Wait!

    That sounds exactly like an HMO or most private insurance!

    They pay per month per patient.

    Now you’ll have to make up why it isn’t the same……sure, insurance companies have to do admin (15% cost under ACA), but I suspect that this is a cost which is hard to avoid – billing will cost someone money.

    Good One!

    1. (laughing) Suderman is (often) clueless.

      Seattle’s Group Health is a Co-Op HMO. (GHC) Doctors are salaried employees of their patients. They own their own pharmacy and run their own hospitals. So, umm, NO reimbursements costs. Not a penny (unless you’re out of plan, like on vacation)

      It was originally considered in Obamacare, INSTEAD of a government. It was even endorsed on the far-left Daily Kos instead of government. To most fiscal liberals, GHC is socialized medicine, just not government run. Members who vote actually have more control than voters who vote.

      Problem is, the GHC model would destroy BOTH government AND third-party insurance, so which party would support it? It’s a modern version of how we did healthcare before FDR created the mess we have now.

      1. Nixon coming from California thought HMOs were the solution. In 1970, HMOs were given a big boost with Federal grants for starting them, and any employer offering Federal tax qualified health benefits had to include any HMO available to employees.

        Lots of HMOs were started in the 70s and by the 80s they were the fastest growing way of providing health care.

        Then conservatives joined with the for-profit insurers to destroy HMOs and also the not-for-profit Blues – both of which paid no income taxes because they were “charities” even though they were now billion dollar operations.

        To provide “fairness” Reagan signed laws that created imaginary profits to be taxes as corporate profits for the “insurance” sold by the Blues and the HMOs. That is when both the Blues and HMOs were flipping back and forth from deficit to surplus and government regulators and legislatures were holding hearings about whether they were going to go completely bankrupt.

        1. (laughing) Are you on drugs?

          1. Michael Hihn|9.30.14 @ 4:41PM|#
            “(laughing) Are you on drugs?”

            (laughing) How did you become such an asshole?

            1. Sevo,
              Are your parents proud of how you turned out? Did they raise you to be like that?

              Do you REALLY believe an “asshole” is anyone who disagrees with you .. on anything? Anything at all?

              Are you a social conservative?

              1. A copy pasta shitpost from shit for brains.

          2. When did the quality of trolls here go down so significantly?

      2. “It’s a modern version of how we did healthcare before FDR created the mess we have now.”

        You mean before we created the Polio Vaccine, decent antibiotics, etc?

        When the average American didn’t live to 60?

        No thanks.

        1. HIHN:”It’s a modern version of how we did healthcare before FDR created the mess we have now.”

          CRAIGINMASS: You mean before we created the Polio Vaccine, decent antibiotics, etc?

          1) (laughing) So we should KEEP our current healthcare?
          2) If you think health insurance has ANYTHING to do with vaccines and antibiotics … you’re an Obama supporter,right?

          1. well you better be an obamacare supporter
            unless you like single payer that would
            replace obamacare

            1. joshrendell,
              Do you not know how to reply to the message you intend to? 🙂

          2. “1) (laughing) So we should KEEP our current healthcare?
            2) If you think health insurance has ANYTHING to do with vaccines and antibiotics … you’re an Obama supporter,right?”

            I had insurance under Carter, Bush, Clinton, GW and now Obama. I’ve had insurance for many years.

            Does that make me a supporter of one Prez or another?

            You are a silly man. The only thing I can say about our MA (RomneyCare – so ask me if I love Mittens?) is that we get a lot of the basics included – that is, physicals and other such stuff have to be included. Also, we can’t get turned down or thrown out of a plan, etc.

            I think those are important benefits if we want to cover everyone.

            As far as what vaccines and life expectancy have to do with health care or insurance, might I point you to the automobile industry. You could say car safety advancements have nothing to do with insurance coverage – but you would be wrong!

            I’m coming to the conclusion that many “libertarians” are really closet luddites – that is, they fail to grasp the complexity of our modern lives, so they disassociate themselves and just throw their hands up in the air and shout “You love Obama, you statist” – and then walk away contented.

            1. craiginnmass, STILL dishonest.

              I had insurance under Carter, Bush, Clinton, GW and now Obama. I’ve had insurance for many years. Does that make me a supporter of one Prez or another?

              Shame on you. What Is said was, “If you think health insurance has ANYTHING to do with vaccines and antibiotics … you’re an Obama supporter,right?”

              Put up or shut up. Do you REALLY believe health insurance has ANYTHING to do with vaccines and antibiotics? Yes or no. (laugh)

              Now you get downright retarded!!

              As far as what vaccines and life expectancy have to do with health care or insurance, might I point you to the automobile industry. You could say car safety advancements have nothing to do with insurance coverage – but you would be wrong!

              (laughing) Most safety measures were legislated. You’re under 25, right?

              ANSWER THE QUESTION.

              I’m coming to the conclusion that many “libertarians” are really closet luddites – that is, they fail to grasp the complexity of our modern lives, so they disassociate themselves and just throw their hands up in the air and shout “You love Obama, you statist” – and then walk away contented.

              Umm, no. I assume you’re an Obama supporter because you believe health insurance has ANYTHING to do with vaccines and antibiotics … which you REFUSE to answer. (sigh)

        2. FDR invented the Polio Vaccine ?

          Who knew ?

    2. craiginmass,
      That sounds exactly like an HMO or most private insurance! They pay per month per patient.

      Wrong again. “Most private insurance” does no such thing.

  10. I’ve looked at some of docotor’s offices that have Netflix style care. They were all far more expensive than any other doctor I’d ever seen. They charged as much for one month as many other doctors charge for a single visit…probably due to moral hazard. They will not the future. Pay-per-service will probably be the cheaper alternative.

    1. Bingo, that’s the REAL reason we need to get “consumers” sharing the cash savings, which can be 50-75% … especially doctors who refuse any more insurance (or Medicare) paperwork.

  11. Ok, so he’s reinventing the HMO, …

    …the system destroyed by changes in tax code in the US during the Reagan years to make it possible for for-profit insurers to compete with not-for-profit Blues which were doctor and hospital coops that did what Good MD is doing as a group of doctors owning a prepaid service payer, and not-for-profit HMO that had the doctors and facilities getting prepaid for caring for patients directly.

    In health care, nothing is new, just the same old things rewarmed and delivered as innovations a decade or two after the same conservative groups attacked them and progressively destroyed them.

  12. Good luck. The Left would fight even the smallest market-based change from the current pathological system. It would have to be shoved down their throats.

    A lot more likely scenario is that the system will continue to be made worse and worse, with more meddling from insurance companies, politicians, etc.

    1. Healthcare reform circa 1965; “We tried the free market and it didn’t work! The remnants of New Deal era wage and labor policies represent a market failure that requires state intervention to fix.”

      Healthcare reform circa 2010; “We tried the free market and it didn’t work! The grossly inflated prices brought on by the AMA price controls and the Medicaid/Medicare bureaucracy represents a market failure that requires state intervention to fix.”

      Healthcare reform circa 2064; “We tried the free market and it didn’t work! Obamacare represents a market failure that requires state intervention to fix.”

      Healthcare reform circa 2084; “We tried the free market and it didn’t work! The reform of 2064 represents a market failure that requires state intervention to fix.”

      Healthcare reform 2100; “The humans had their chance at civilization and it didn’t work! Now those who remain must kneel before their new robot overlords! All hail President 01010101010101!!!”

    2. “A lot more likely scenario is that the system will continue to be made worse and worse, with more meddling from insurance companies, politicians, etc.”

      Yeah, with any luck we can go back to the GW days when premiums advanced double digit each year and you got turned down or thrown out because you were born with a wayward gene!

      That would be heaven on earth! Soon we could get to 25% of GDP, then 30%. Imagine all the jobs!

      1. craiginmass|9.30.14 @ 4:54PM|#
        …”Yeah, with any luck we can go back to the GW days when premiums advanced double digit each year and you got turned down or thrown out because you were born with a wayward gene!”…

        Yep, asshole. Your fave lying bastard got us right there with even higher premiums and a whole new federal bureaucracy to boot.
        I’m sure assholes like you are just thrilled.

        1. Again — are your parents proud of the potty mouth you’ve become? Or did they INTEND to raise you that way?

          1. Copypasta

            Even anonbot mixes it up more.

  13. Misuse of the term supply side, this is “marketplace” healthcare.

    The problem with marketplace healthcare is it doesn’t address the real need for insurance, which is serious injury which leads to crippling financial debt. Most American’s don’t require insurance for basic medical needs, but overtime the insurers have co-opted the system for profit.

    I’m good with this, but it doesn’t address the following:
    1) Serious injury that leads to financial bankruptcy or close
    2) cover those who don’t earn enough to afford basic medical because they are to young to work, or because there wages are so low they don’t visit the doctor and many times only go to the emergency room, which we all pay for in the long run.
    3) Such private companies have the right to refuse and therefore those with disabilities or pre-existing conditions will soon be relegated to the sidelines so companies can enhance profit growth.
    4) Not sure what is covered and as anyone who has dealt with both providers and insurers can tell you, because of the complexity of Health Care it’s difficult for the consumer to actually understand what they are buying and what’s excluded. In situations such as this, putting some government standards and regulations always trumps the free market because consumers are at a disadvantage in knowledge for services that are complex, costly, and infrequently used.

    1. The problem with marketplace healthcare is it doesn’t address the real need for insurance, which is serious injury which leads to crippling financial debt. Most American’s don’t require insurance for basic medical needs, but overtime the insurers have co-opted the system for profit.

      It’s only financially crippling because of healthcare restricting policy. Ask yourself why it is that in every other industry in existence, innovation lowers costs and increases access to goods and services. But in healthcare this is the opposite. So either there is some sort of system-wide unnatural distortion taking place in this industry or the healthcare industry is magically exempt from the laws and principles of economics.

      2) which we all pay for in the long run.

      Yes taxation to cover private debts does unnecessarily increase costs.

      . In situations such as this, putting some government standards and regulations always trumps the free market because consumers are at a disadvantage in knowledge for services that are complex, costly, and infrequently used.

      It’s complex because of that regulation! Free markets incentivize entrepreneurs to make their products more salable. Regulatory bureaucracy incentivizes entrepreneurs to use the coercive hand of the state to build and keep market-share. The only trumping of the free market that the government is capable of is kind where a man with a gun trumps a man without a gun.

      1. Ask yourself why it is that in every other industry in existence, innovation lowers costs and increases access to goods and services. But in healthcare this is the opposite. So either there is some sort of system-wide unnatural distortion taking place in this industry …

        Simple! How many of today’s advanced procedures were available 5 years ago? 10? 15?

        Does the auto industry gross a lot more than 10 years ago? 15?

        What if the auto industry had expanded into space capsules, missiles, computers?

        More stuff = more dollars.

        1. More stuff = more dollars

          WTF kind of moron are you?

          1. kbolino,
            WTF kind of moron are you?

            (lol) More stuff DOES equal more dollars. Why wouldn’t it?
            One more time for the mentally challenged: How many of today’s advanced (medical) procedures were available 5 years ago? 10? 15?
            Or did not even exist yet?

            1. I only have one (or two) of each major organ. No matter how many services doctors are willing to provide, there is only so much I am able to consume, even with an unlimited supply of money.

              Furthermore, the increase in price of existing services is not explained by the availability of new services (ceteris paribus). Just because you bought the newfangled “machine that goes bing!” doesn’t mean my appendectomy should cost more than it would have before.

              1. You’re in denial. (laughing)
                He’s not talking about individual procedures, Sluggo.

                Umm, here’s his statement AGAIN (emphasis added)

                Ask yourself why it is that in every other industry in existence, innovation lowers costs and increases access to goods and services.

                One MORE time for the mentally challenged: How many of today’s advanced (medical) procedures (aka “goods and services”) were available 5 years ago? 10? 15? Or did not even exist yet?

              2. No shit. My grandfather was a factory worker for Ford in the ’30’s. He managed to pay for 2 kids to be born with no insurance, no problem. Recently there was an MD on The Independents moaning about what a hardship it was to pay for childbirth as a resident with no insurance. There are countless examples like this where routine procedures are orders of magnitude more expensive than they were 50, 60, 100 years ago. This is not because of the “free market” but because of decades of government interference in the market.

    2. So you are arguing that a system largely fucked up by government since Roosevelt requires more government to fix it….BRILLIANT/progderp

  14. What do you do if you’re out of town and need medical care?

    1. …the system destroyed by changes in tax code in the US during the Reagan years to make it possible for for-profit insurers to compete with not-for-profit Blues which were doctor and hospital coops

      Since you’re a conspiracy theorist, are you also a Birther?

      You’re also tragically misinformed on healthcare co-ops. By then co-ops were down to a half dozen or so in the entire country.

    2. larryseltzer|9.30.14 @ 4:25PM|#
      “What do you do if you’re out of town and need medical care?”

      Umm, you get the care you need. It’s called “out of plan” coverage. It is required, to pay for (say) rushing to the closest emergency room in your home town instead of the ER in your plan, being out of town, etc.

  15. There’s a viable solution just sitting there waiting:

    1) Allow cross-state purchases of insurance, as regulated by State Insurance Departments.
    2) Indiana is very advanced in Catastrophic/Health Savings Accounts products
    3) Cat/HSA was added to the menu for Indiana’s State Employees in 2005. That year 4% chose them.
    4) Cat/HSA was chosen by 92% last year. They have over $40 million of THEIR OWN money in their accounts, and the State has saved tens of millions because HSA’s FIX INCENTIVES.
    5) Watch the shift over, the Death Spiral of Obamacare and PPO/POS products, and drink a toast….

    Should add Cat/HSA’s to Medicare as well, to fix that program. Indiana put Cat/HSA into Medicaid and it’s working out well for them there as well….

    1. Just abolish the FDR era tax incentives for employer provided healthcare, abolish the Medicaid/Medicare bureaucracy and eliminate the AMA’s authority to price fix procedures and accredit medical schools. Basically every single problem is traceable to these policies.

      1. “Basically every single problem is traceable to these policies.”

        Actually, most problems are traceable to hot dogs, breakfast cereal and milk since it’s well known that all who have partaken in them created this mess!

      2. Not really. Our cost problem is almost entirely caused by our “near-the-end-of-life” care. We’re the only country that can and will pay $250,000 for less than a year of life:

        Thus
        1) In round numbers, 5% of our population accounts for 50% of all our healthcare spending.
        2) 20% accounts for 80% of our total spending.
        3) The United States spends more money on GOVERNMENT insurance, for 31% of our population than many social welfare states pay for 100% of their population. Both per capita.

        Even Obama — when he was still partially honest — described his grandmother getting a costly hip replacement, AFTER she was terminal cancer, then dying a few months later.

        If we banned all private health insurance AND kept their current customers uninsured, we’d STILL have the world’s highest healthcare costs.

        The Medicare/Medicaid bureaucracy is a tiny part of the problem, compared with near-end-of-life care.

        1. The Medicare/Medicaid bureaucracy is a tiny part of the problem, compared with near-end-of-life care.

          Again, WTF kind of moron are you?

          You are not as smart as you think you are, and when your mommy tells you otherwise, she’s lying.

          1. He is absolutely right that a massive portion of health spending in this country occurs in the last years of life. It is a simple fact.
            If you disagree you should refute his argument with facts, because your insults paint you as the very thing you call others.

            1. He bemoaned the distribution of health care spending with respect to age not five seconds after discarding the influence of an institution specifically established to distort the distribution of health care spending with respect to age.

              Lots of money is spent on treating old folks, because there exists an agency whose purpose is to spend lots of money on the treatment of old folks.

              NEWS AT FUCKING ELEVEN

              1. He bemoaned the distribution of health care spending with respect to age not five seconds after discarding the influence of an institution specifically established to distort the distribution of health care spending with respect to age.

                You really are a totally pathetic liar. I never said a word about age. Shame on you.

                I also “discarded” NOTHING.

                Lots of money is spent on treating old folks, because there exists an agency whose purpose is to spend lots of money on the treatment of old folks.

                (laughing)

                You got called out (again) on your total ignorance, and THIS is the best you can do? TRULY pathetic.

          2. Again, WTF kind of moron are you?

            (laughing) Once more for the mentally challenged

            Our cost problem is almost entirely caused by our “near-the-end-of-life” care. We’re the only country that can and will pay $250,000 for less than a year of life:

            1) In round numbers, 5% of our population accounts for 50% of all our healthcare spending.
            2) 20% accounts for 80% of our total spending.
            3) The United States spends more money on GOVERNMENT insurance, for 31% of our population than many social welfare states pay for 100% of their population. Both per capita.

            (laughing harder) If bureaucracy costs MORE than 80% then you’re up to 160% — PLUS every bit of medicine for 90% of the people under 65.

            Again, WTF kind of moron are you?

            (snicker) 160%+

        2. “The United States spends more money on GOVERNMENT insurance”

          Are you including military in there?

          People are starting to get it – cost aside. They don’t want as many interventions – don’t want to get chemo when they are 89 years old, etc. etc….

          Lots of reasons why it swung so far the other way – among them:
          1. Americans have great fear of death – our culture generally does not expose us to it as a natural part of life.
          2. Madison Avenue – medical profiteers – it goes without saying that it’s profitable for many to extend life. TV and other commercials seem to promise us that we can be healthy and happy at any age…as long as we……
          3. Lack of “skin in the game” – people will jump up and down to make sure granny has a 1 million dollar operation – but try suggesting that they take the $$ out of their inheritance or that they sign a note for it – you’ll see a big change!
          4. Right Wing Ideology – yes, shouts of “Government Death Panels” and all the associated BS means that we better all keep paying for million dollar operations for poor old people lest the GOP accuse us of having Gas Chambers for old folks.

          I know among my baby boomer cohorts the end of life care is likely to be less of an expense…..there is a more wholesome approach to the subject.

          Take away the profit motive and ask for some skin in the game from those who have built up assets. Inform patients of real life – life expectancies, quality of life, etc.

          1. Are you including military in there?

            Yes. If you’re a wonk on this, here’s the source. Commonwealth Fund is a top independent research group.

            http://bit.ly/1i0Yq9c

            People are starting to get it – cost aside. They don’t want as many interventions – don’t want to get chemo when they are 89 years old, etc. etc….

            Many now sign living wills. A bigger issue, recently debated, is that people want to die at home, not in a hospital, which is also cheaper but Medicare is not setup to pay home care.

            My own plan provides cash for the patient’s estate if they forego the costly treatmemt many don’t want anyway (that’s for Medicare) Like your “skin in the game” but a give instead of a takeaway.

            2. Madison Avenue – medical profiteers – it goes without saying that it’s profitable for many to extend life ..

            I’m 72 and track that closely. There MUST be massive fraud there, but probably impossible to prove. That’s why I like patient-centered decisions like Living Wills. It’s also more proper.

            1. “I’m 72 and track that closely. There MUST be massive fraud there, but probably impossible to prove.”

              Oh, they can prove it – beyond any doubt. But our gubment is not big enough to do anything much about it.

              Florida, for example, is permeated with nursing home fraud. The perps are closely tied in with the GOP legislators and Rick Scott….in fact, one top guy is a former priest! He lobbied the gubment there to allow for “for profit” nursing homes (formerly was all non-profit) and then built out a vast corporation which now abuses the system.

              They did some metrics on his operation and came up with something like this. Medicare pays two different sums per day depending on the condition of a patient (normal…I guess, or ambulatory). One pay $200 a day and the other $500. Over the entire USA, something like 10-15% of nursing patients get the $500 per day – but this guy has over 50% of his patients collecting the big bucks – which all go to him, of course!

              Type in nursing home fraud in Florida and you will find a lot of good reading. Rick Scott probably loves this stuff….

    2. your number one is hilarious
      did you even bother to read what you wrote?

      1. I am loathe to give credence to this troll, but I must agree that the first point (“Allow cross-state purchases of insurance, as regulated by State Insurance Departments”) is kind of self-defeating. State departments of insurance can regulate providers within the state, but my commerce with providers in other states is not subject to their jurisdiction.

        1. but my commerce with providers in other states is not subject to their jurisdiction.

          Wrong again. There are no “out-of-state” providers. There are regional and national providers who may or may not choose to do business in any given state.

    3. 1) Allow cross-state purchases of insurance, as regulated by State Insurance Departments.

      Hello? It’s the different regulations in different states which CREATES all the difference. We’d just be reshuffling deck chairs on the Titanic.

      In my 2000 General Election Campaign for WA Insurance Commissioner, I learned that the state had gone from over 30 health insurers down to 2 (only one statewide), in only 7 years.

      Guess what the legislature had done 8 years earlier!

      1. In other words, most in-state insurers only existed because people were forced to consume in-state insurance. When cheaper out-of-state insurers were accessible, the dollars left the state, forcing a consolidation of the remaining in-state insurers.

        1. The difference in prices between in-state and out-of-state insurers being a product of the state regulators.

          1. kbolino

            The difference in prices between in-state and out-of-state insurers being a product of the state regulators.

            And availability. Out-of-state is not now a choice … for anyone.

        2. (laughing) The absolute dumbest comment on the page!

          In other words, most in-state insurers only existed because people were forced to consume in-state insurance. When cheaper out-of-state insurers were accessible, the dollars left the state,

          Out-of-state insurance is illegal, chump, as in NEVER accessible.

  16. That system is what we have here in Mexico. I have govt. insurance for $29/month which covers everything, but of course is bureaucratic and slow.

    So we often go to private doctors and clinics which charge as little as $2 to see a real doctor. Specialists charge from $14 to about $40 for a visit.
    All lab-work and most medicine is available WITHOUT prescriptions. Drug prices are highly competitive.
    Come on down and try it! Back in the 80’s we flew from the USA to Mexico for surgeries etc. and a nice vacation because we had no insurance.

  17. This experiment is fine and may even be some benefit to people as it will encourage them to visit the doctor for wellcare. It could prevent some large expenses down the road.
    It is no solution to health care for our country though. What happens when you visit the doctor and he discovers a serious problem. Almost no person in the US can afford to pay for any serious, prolonged disease out of pocket.
    That is what insurance is for. We can all have opinions on what form insurance should take but it is absolutely necessary.
    Those that tout “charity” as an answer are delusional.
    Libertarians have a lot to add to a political discussion because self interest is a powerful motivator. Some of those ideas may actually be incorporated if they would stop pretending self interest and the profit motive were the only considerations.

    1. Those that tout “charity” as an answer are delusional.

      Or a lot smarter on healthcare history than you! Prior to FDR we had a 100% private healthcare system, no health insurers and everyone was treated — either paid or charity.

      Before FDR we still had a 100% private system, but now including health insurers required by the New Deal. The uninsured were treated in charity hospitals. We had 100% treatment. Healthcare was 7.8% of GDP.

      Now, government is 31% of the population, less than 25% from for-profit insurers, 50 million uninsured. Healthcare is 17% of GDP.

      And the uninsured rate among Medicaid eligibles is 18.8% (before Oamacare expansion). vs only 16.3% in the private market. Both pre-65.

      if they would stop pretending self interest and the profit motive were the only considerations.

      Umm, you had just mentioned charity, which is mostly advocated by libertarians. How does self-interest and the profit-motive affect private and/or church-run charities?

      … delusional …

      Is that as bad as suffering severe denial?

    2. We can all have opinions on what form insurance should take but it is absolutely necessary.

      So we can all have opinions in the narrow box you provide. How generous of you!

      Those that tout “charity” as an answer are delusional.

      Well yes, after you systematically destroy the viability of charity hospitals and clinics, it is unsurprising that so few of them remain.

      At the end of the day, though, if you can’t do it for yourself and you can’t convince somebody to do it for you, then you don’t deserve it. Anything else is theft.

      Some of those ideas may actually be incorporated if they would stop pretending self interest and the profit motive were the only considerations.

      Self-interest is the only consideration in a human being’s mind. The politicians you elect? Self-interested. The people you appoint as tax collectors? Self-interested. The doctors who will treat you? Self-interested.

      The foolishness you have is thinking that there is some other motive. That you can somehow find perfect or at least perfectible people through sufficient application of good intentions. They don’t exist; never have, never will.

      1. One quibble. Insurance is a legitimate part of a free market in health care. Of course I am referring to catastrophic or emergency insurance.

  18. I am a doctor who just left the field, partly because of bureaucratic BS and declining pay for the same services over my 28 years of practice. This practice’s “experiment” is illegal almost everywhere in the US, as it constitutes the unlicensed provision of insurance. I wonder who these docs had to blow to get those regulations waived?

    1. “his practice’s “experiment” is illegal almost everywhere in the US,”

      And so is direct to consumer drug advertising and a lot of other stuff.

      Here it’s all about skewering everyone – docs included. That’s the “free market”. If some fat cat behind a desk somewhere is smarter than you, has more capital and political connections and is more ruthless and predatory, all your “caring doctor” stuff goes out the window to the altar of profitability.

  19. As someone approaching 70 who has lived a life never making enough money to be vested in SS or Medicare , I welcome the blooming of a retail health market , essentially just ignoring as far as possible the elephantine bureaucracy governmental interference in the medical market has created . I look forward to online shopping for the best service at the best price I can find around the CO Front Range .

    I think there must be many others , eg , immigrants and visitors , who also would welcome more retail competition .

    I saw when last in NYC that some drug stores now have a doctor in residence . That seems a damned useful vertical integration given the horrendous burdens placed on just getting appropriate medicines for clear-cut symptoms thru the USA prescription proscriptions .

    1. “As someone approaching 70 who has lived a life never making enough money to be vested in SS or Medicare ”

      Really?
      !0 years of working with you and your spouse?

      That’s not much of a barrier.

      At the same time, I like the idea of all these retail health services for most common needs. It’s underway already – got my shingles vaccine at the rite aid.

  20. Obamacare is impossible to repeal because something has to replace it. That really says it all.

    The entire debate has been framed by the statists/leftists. Reform is essential! The government must involve itself MORE! Right from the get go, the entire debate ignores the question of whether rolling back regulation instead of adding to it was thrown aside. The Democrats argued that reform was essential, the media towed the line, and the Republicans caved on that point. Now, we are stuck in a situation where they must present an alternative to something that wasn’t necessary to begin with. Dems addressed a problem created by decades of government bungling with more government bungling.

    Libertarians are a fringe. Libertarian ideas aren’t even considered worthy of debate. Meanwhile, progressive ideas which have mostly failed everywhere implemented are front and center. This is how the pendulum in this country increasingly swings to the left, and why the right somehow gets viewed as having become unreasonable while the Dems have moved further on their platform.

    There is an alternative from the right/libertarians – it just involves the government doing less, which is inconceivable to most Americans.

    1. “This is how the pendulum in this country increasingly swings to the left, and why the right somehow gets viewed as having become unreasonable while the Dems have moved further on their platform.”

      BULLSHIT.

      Heck, Nixon suggested employer paid health care (forced) and we on the left have been shooting for universal health care for decades – if not longer.

      And what did we get? The Newt Gingrich/Heritage Foundation plan. Weak, but arguably better than nothing because we are adding real health-based reforms to it (preventative care, health education, science-based approaches, limits in profiteering, clamping down on fraud).

      Framing that as “the left got it’s way” is unReasonable….

      I will agree that Libertarians are a fringe….currently one that would not exist without both funding from a few billionaires as well as some GOP’er who can’t admit they are part of that scheme any longer. Everyone needs to belong to a club it seems.

      1. You’ve been brainwashed craiginmass. several times. The Heritage plan has almost no connection with Obamacare.

        Do you know Canada’s healthcare was ruled an unconstitutional threat to human life, citing all the Canadians who die or suffer on waiting lists of a year or more?

        Are you aware of the major scandal in England, earlier this year? Cost-cutting led to a severe shortage of nurses (among others). Patients were abandoned in hospital rooms. Many were found dead in their own feces.

        Political healthcare will ALWAYS fail, because we have to trust politicians — facing a choice of cutting benefits or increasing taxes … umm … they ain’t gpnna increase our taxes are they, as we’ve seen for the past six years in both parties?

        1. “Are you aware of the major scandal in England, earlier this year? Cost-cutting led to a severe shortage of nurses (among others). .”

          I am aware of life spans, infant mortality and other well accepted indicators of value and life in those countries and areas.

          The real question here is are you?

          Or do stories, tales and anecdotes make up your metrics? We could go on for a couple years right here about the patients left behind in the USA – those denied insurance or procedures (before ACA), etc. –

          As to the Heritage Plan, semantics aside….politifact says:
          “Qualls said the Affordable Care Act “was the Republican plan in the ’90s.” The bill she had in mind did have a strong roster of Republicans behind it, and it did share many major features with the Affordable Care Act. There were some significant differences but in a side-by-side comparison, the similarities dominate.”

          No need to split hairs in web discussions. Republicans were for it before they were against it. That’s quite hypocritical, don’t you think?

          I will agree with you in this much – Republicans wish to do the least possible to help anyone other than perhaps the top 1% and will change their tune to do so. They kept cheering that “we have the best in the world” even as we fell behind CUBA in effectiveness (they spend $250 per year per person, we spend $8000). In short, they believe in profiteering and predatory health care – a model which will never work, despite your ideology. It can’t work.

      2. So, libertarians wouldn’t exist without the GOP and are just pawns…

        Funny, because I have never voted for a Republican, and outside a small consideration to vote for Rand Paul if by some miracle he made it through the primaries, I won’t be voting for any Republicans.

        And yes, the left has gotten its way over the last century. We have shifted farther to the goals of progressives (aka pseudo socialists).

        As for the supposed benefits you just mentioned, I can only laugh. Never has fraud been reduced by more government involvement.

        1. “Never has fraud been reduced by more government involvement.”

          Maybe not – but it certainly has been increased by lack of it! Read about Madoff and the sad GW Bush excuse for an SEC at the time. THe Gubment said “hands off” and we got a Great Depression II and the largest frauds in history.

          Heck, you guys elected Medical Fraudster in Chief Rick Scott as Gov – and are about to return him to office!

    2. Republicans caved on that point. Now, we are stuck in a situation where they must present an alternative to something that wasn’t necessary to begin with.

      Something is VERY necessary, especially on Medicare. Thanks to Bush and the GOP. Medicare is now subsidized with $250 billion from INCOME TAXES, That’s roughly 25% of the entire personal income tax, and will continue taking more and more..

      1. What is necessary is slashing or rolling back the government regulation. Yet, as stated above, that’s not even an option that would be considered. So, I agree – something should be done. It’s just something that is unthinkable to the majority of Americans and not part of the debate.

        The discussion has been framed from one angle – how can the state do MORE to fix the problems (with no acknowledgement of the role the state played in their creation).

        1. To add to that/put it more succinctly – doing less wouldn’t be considered a plan according to most Americans. So, if you were to suggest it, most of them would lump you into the category with Republicans who don’t have an alternative.

  21. I expect between licensing and lobbying, this won’t last if it actually works.

    It’s much easier to understand why the ACA is so screwed up once you realize that it is basically a law that guarantees doctors, pharmaceutical companies, health insurers, and hospitals high incomes. The fact that it fails to reduce costs isn’t an accident, that’s its whole purpose.

  22. Umm, the effect of ACA on both doctors and hospitals is precisely the opposite of your claim. You ever hear about Docfix?

  23. How To Opt Out Of Obamacare. Know your options and become savvy self-pay patients. Join a health care sharing ministry. These are voluntary, charitable membership organizations that agree to share medical bills among the membership. They function similar to insurance, and are probably the best alternative to conventional health insurance. There are four of them, at least that I know of. Three are open only to practicing Christians (Samaritan Ministries, Christian Healthcare Ministries, and Christian Care Ministry) while a fourth, Liberty HealthShare, is open to anyone who agrees with their ethical commitment to religious liberty. They operate entirely outside of Obamacare’s regulations, and typically offer benefits for about half the cost of similar health insurance. Members are also exempt from having to pay the tax for being uninsured. From the article by Sean Parnell
    http://thefederalist.com/2013/…..iM_o.email

  24. Will Obamacare be repealed or won’t it? Will Congress fund it or won’t it? Will the web site be fixed or won’t it? Blah, blah, blah. We the people just need to do what we need to do and Congress be damned. Resist. Refuse. Revolt. EXEMPT OURSELVES! We did not comply with Prohibition and we simply should not comply with Obamacare. For religious reasons. For privacy reasons. For the cause of liberty and freedom and in protest of the idea that the federal government (under one party rule, no less), can force private citizens to purchase anything with our own money. Are we citizens or subjects? Mice or (wo)men? Just say NO to socialism and to the corrupt, unionized, far left IRS, the gestapo of America’s political class. After all, the federal government ignores millions of illegals who are breaking U.S. immigration law every day. Our Founders pledged their lives, their fortunes and their sacred honor. All we have to do is just say no to a scheme we all know is un-American and a violation of our most basic founding fundamentals of privacy, self reliance, limited government and individual freedom.

    1. I wish you knew what you are talking about. 🙂

  25. right on, Devan! Govt, leave us alone!

  26. Watching headinass, and Micheal Hinh debate is like watching to giant, unflushable turds fight over who is king turd in their little turd stained toilet bowl.

  27. I think one of the first things you need to do is make it illegal to have different prices depending on who pays.

    IE the cash price, insurance price, and government price should all have to be the same. And they should all have to be posted.

  28. Get government out of the health care business as much as possible. Limit them to limited regulations and financial support to those who need it.

    Obamacare, Medicaid, Medicare and VA hospitals should be abolished.
    People under these programs and those who are financially below the poverty level should be given a yearly amount that they could use to purchase health insurance.
    Keep the Federal regulation stating that insurance companies have to cover pre-existing conditions as long as the person had previous insurance.
    Allow people to purchase insurance from any state.
    Deregulate state health insurance markets.
    Unhinge medical insurance from employers in the tax code.

    Getting government out and increasing competition in this way will lower health care costs. It cuts the bureaucracy costs, cuts the fraud costs and improves competition and quality of care.

Please to post comments

Comments are closed.