Obamacare

The GOP's New Health Care Plan Shows That Republicans Have Become Trapped By Obamacare

New Republican replacement plan is barely a plan at all.

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(Official White House Photo by Pete Souza)

House Republicans have been promising to propose an Obamacare replacement since at least 2010. Last week they finally delivered on that promise. It wasn't worth the wait.

The plan is less of a fully realized proposal and more of a quick sketch of the sort of health care policy Republicans might pursue if given the chance.

As it turns out, the health care policy that Republicans might pursue looks, well, a lot like Obamacare—except, possibly, worse.

Although the plan starts by repealing the health care law in its entirety, it ends up replacing many of its central components with similar provisions: preexisting coverage rules, subsidies for the purchase of insurance, and even an (implicit) mandate.

Cato Institute Health Policy Director Michael Cannon, writing at Forbes, identifies a number of striking similarities between the House GOP plan and Obamacare, including the use of tax credits to help subsidize insurance coverage, regulations requiring insurers to sell to all comers regardless of health status, the millennial mandate to cover dependents up to age 26, and the sort of political definition of what constitutes qualifying coverage that is inevitable with any plan that doles out subsidies to some plans but not others.

The GOP plan would also create a kind of an insurance mandate. While there's no rule requiring people to maintain coverage or pay a fine, the existence of tax credits ends up pulling everyone into the system anyway, by essentially declaring that everyone who does not maintain qualifying coverage has to pay more in taxes.

The plan also retains a modified version of an Obamacare rule known as community rating, which, in very general terms, requires insurers to judge risk based on the properties of a group rather than on an individual. Essentially, it's a form of price controls. And as Cannon argues, the price controls in the Republican plan, combined with the loosening of some other regulations, might actually make the insurance that is offered in the individual market worse than it is under Obamacare, trapping people in a cycle of ever-worsening coverage.

Granted, not all of the ideas are bad.

In particular, the expansion of Health Savings Accounts (HSAs) is a useful idea that if anything could benefit from further expansion. The proposal might help weaken the link between health insurance and employment. 

But what this plan, as with the plans released by GOP presidential candidates last summer, demonstrates most is an inability to move substantially beyond the framework established by the Affordable Care Act.

The Republican plan to repeal and replace Obamacare, then, is to repeal the law and replace it with something that isn't an exact Obamacare clone, but works from many of the same principles, modified to Republican preferences. Maybe that's not too surprising, given that Obamacare was, after all, based on a Republican idea

In any case, it's clear that Republicans have become trapped by Obamacare, their policy imaginations and political inclinations limited by the president's health law and the world it has created. 

Even that, however, may give it too much credit: This thin sketch of a plan lacks a number of crucial details, like the size of the credit it would offer, saying only that it would be big enough to cover the cost of a typical pre-Obamacare plan. Without that number, it is impossible to produce any serious cost or coverage estimates, which means it is impossible to even make an educated guess about what its real world effects on either individual health coverage or the federal budget would be. It is like listening to a real estate developer describe a building, but finding out that no measurements exist, and thus you cannot even see a render of what the final product might look like. 

The Republican plan to replace Obamacare is here, in other words, and it is not a plan at all.

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  1. While there’s no rule requiring people to maintain coverage or pay a fine, the existence of tax credits ends up pulling everyone into the system anyway, by essentially declaring that everyone who does not maintain qualifying coverage has to pay more in taxes.

    Wouldn’t that be paying the same as before in taxes? It doesn’t seem as bad as a mandate to me.

    1. Don’t interrupt the narrative with your questioning.

    2. Either way failure to comply/report results in a higher tax burden. The only difference is the slender possibility that you could end up in jail under ObamaCare.

      1. Meet the new boss, same as the old boss…

    3. They’d bow to “revenue neutral” and take care of that real pronto.

  2. “In any case, it’s clear that Republicans have become trapped by Obamacare, their policy imaginations and political inclinations limited by the president’s health law and the world it has created. ”

    That was widely stated as a likely outcome of the 2012 election. That if Obama won, he’d cement the law in place, if Romney won, he’d significantly reduce the scope of the law if not repeal it. Obama won.

    “As it turns out, the health care policy that Republicans might pursue looks, well, a lot like Obamacare?except, possibly, worse.

    Your article fails to substantiate this point. I think the comment is mere mood affiliation. You don’t like the GOP, so if you can’t find something to outright disagree with you leave some vague disagreeing comment.

    1. This proposed law appears to be PPACA but without any mandates. That is possibly worse because that’s how you get “death spirals”. Don’t get me wrong, I think the mandates and PPACA, in general, are unconstitutional and horrible policy, but at least the Dems realized you had to force people into the system for it to have a chance at looking like it was working.

      1. Death spirals are a feature, not a bug.

        1. If you want to institute a crappy single-payer system, then yes they are.

          1. Not really. I expect there will be a bifurcation of the market where people who are continuously insured will be able to find affordable insurance, but people who lapse will be totally fcked.

        2. Good. Let the medical and insurance* rackets burn. We’ll rebuild from the ashes.

          *”health insurance”. Oh, sure, if neither involves either health or insurance, the phrase totally works.

      2. That is possibly worse because that’s how you get “death spirals”.

        Sure looks like we’re in the early stages of one right now, as predicted.

        The only way to prevent it is massive subsidies for the companies offering health insurance exchange products. The Dems favor it, of course. The Repubs will wet their pants in their eagerness to give your money to insurance companies.

        1. Won’t prevent it at all. Just delay it a year or two.

        2. Insurance was just the result of wage ceilings anyway, so is trusting the same government that caused insurance to come into existence who you want to trust to manage the entire industry?

      3. but at least the Dems realized you had to force people into the system

        No no no.

        The point of all Democratic policy is rule by force.
        They didn’t “have to” force people, they *wanted* to force people.

  3. Would I still have to pay for maternity coverage despite my conspicuous lack of a uterus?

    1. But what if you change your mind and decide you want a uterus at some point in the future? See, this is why you need to leave the thinking to the TOP MEN.

      1. We all support Hugh’s… I mean Loretta’s right to have a uterus !

        1. Hate crime! Hate crime!

          hahahahahaha

    2. Conspicuous?

    3. You don’t expect just the people who need such coverage to pay for it all themselves, do you? I mean, what kind of a monster are you?

      1. /head_scratch

        Um, that’s kind of how insurance pools work. Like, explicitly. People pooling together their risk to amortize the cost among everyone, including covering (for other people in the pool) sevices that you won’t use just as they cover services that you will use but they won’t.

        I suppose with modern computers, it wouldn’t be too challenging to split people up into infinitely small demographics to share the costs with (ah, 30-something male non-smoker of caucasian heritage who drinks once or twice a month? You go into pool- oh, you drive a motorcycle? Let me adjust this real quick…), but if you slice it too finely then you’re largely defeating the point of having an insurance pool at all, and might as well go for full coverage under a HSA or something similar.

        Which, IIRC, is something you can do. It’s been a while I admit, but when I looked into it back in 2010 I thought there was a provision that if you could establish that you had enough cash-on-hand to cover whatever your ill-health threw at you, that you didn’t have to get insurance.

    4. I’d hardly call it conspic…

      Ok, Tonio, well played.

    5. Even for people with a uterus it’s annoying. When my wife and I were just married, we got our health insurance on the individual market. We were able to cut our costs for her insurance in half by denying the maternity coverage (using several types of bc at the time). We wouldn’t have been able to afford it if we’d been forced to pay for the maternity coverage.

      1. My wife and I had our first kid with no insurance.

        We went to a teaching college in Memphis where all of her prenatal stuff was done by student nurses.

        It would have actually been cheaper than having paid for insurance if my wife hadn’t ended up needing a c-section.

        Even so, we got a payment plan and had the balance paid off fairly soon.

        1. Oh my goodness!

          No insurance?!

          Don’t you get it? Health Insurance = Healthcare!!

  4. The Stupid Party outdid itself this time. After 6+ years of big talk about how they were going to “repeal and replace” PPACA, the best they could come up with is a clone of PPACA. I mean, I know the average voter has the attention span of a coked-out ferret, but does the GOP really expect to get any traction with this?

    1. Peter Ferrara says otherwise.

    2. The average voter responds well to promises of free stuff. The GOP apparently still realizes this, even though we all know that the average voter will end up like that Venezuelan woman who was quoted as saying “I’m a Chavista” while describing how she and her family are starving.

  5. Why fucking replace it with anything? The Stupid Party has stupidly bought into the narrative that Obamacare provides something that is necessary and must be replaced with SOMETHING. Here’s a clue, assholes, when you cut out a cancer you don’t need to replace it with something else!

    1. Because, as demonstrated by AmSoc below, the public has stupidly bought in to the narrative that healthcare is a “basic human right.”

      1. Health care is a service provided by other people. Something that must be provided by the labor of others can not be a right. Unless you believe that involuntary servitude is a right.

        1. Unless you believe that involuntary servitude is a right.

          I think you’re on to something.

          1. Yeah, pretty sure Democrats are actually the living embodiment of that ideal while the Republicans simply strive for it.

          2. Unless you believe that involuntary servitude is a right.

            Now you’re catching on, tax cattle.

        2. Anything can be made a right by guns, including slavery & Mexican ass sex. Rights are whatever you can force others to honor.

    2. That’s why you can never get rid of free shit. If it’s repealed then all the people getting goodies will be on national TV. “Look this baby will die cuz republicanz.”

      It’s politically impossible to get rid of. Sliding it back is the only possibility.

    3. Because it’s inevitable. I’ve seen it that way for a good long while?that all that can be done is delay it as long as possible, then keep it as stingy as possible as long as possible. Guaranteed health care is so popular worldwide that it doesn’t matter how bad a deal it is; people will sacrifice all other ends to it, & sacrifice you until you let them have it. I think we can make progress vs. all sorts of other welfare rights, but not medicine. If we can get rich enough in the meantime by reasonable success w most other things, we an afford this $ pit.

      1. Universal catastrophic care coverage actually makes some sense.

        Combine with health savings accounts.

        The real advance isn’t in providing services, but giving us some *freedom* to have access to medicine and tests without getting a permission slip from a doctor. Probably not gonna happen. Freedom is always the one unthinkable policy. You can’t do that!

  6. As long as it allows right-wingers to tut-tut about the personal responsibility of a poor person who gets cancer I’m on board. Fuuuuccckkk Obama.

    1. Welcome to Retardation: A Celebration. Now, hopefully, I’m gonna dispel a few myths, a few rumors. First off, the retarded don’t rule the night. They don’t rule it. Nobody does. And they don’t run in packs. And while they may not be as strong as apes, don’t lock eyes with ’em, don’t do it. Puts ’em on edge. They might go into berzerker mode; come at you like a whirling dervish, all fists and elbows. You might be screaming “No, no, no” and all they hear is “Who wants cake?” Let me tell you something: They all do. They all want cake.

    2. Even poor people could afford insurance before PPACA was passed. You just had to not be stupid with your time and money. I know because I knew a number of poor people back then who had insurance specifically because they worked and lived within their means. (By “poor” I’m assuming you mean someone who didn’t used to qualify for Medicaid or Medicare.)

    3. The sad reality is that except for a select number of cancers, people tend to die from them whether or not they get treatment.

      1. The sad reality is that except for a select number of cancers, people tend to die from them whether or not they get treatment

        But what about their health in the meantime?

        1. What, you mean burning up as much of other people’s money as possible to extend their lives by a few months or years?

          Nearly all the total lifetime healthcare costs incurred by a randomly-selected person are within the last year of their life.

    4. So right. It’s obviously the personal responsibility of a rich person to pay for that poor persons cancer. Justice!

      1. That’s the problem when you try to confront feelz-based “arguments” like AmSoc’s with actual logical arguments – the feelz win out. Every single time.

        You provided one of the best comebacks I’ve ever heard, but I wouldn’t go there with “rich” and “poor” as we know where that always leads.

    5. Because it’s better that everybody die of cancer clutching worthless insurance cards than some people getting better treatment than others.

      In other news, bread lines are a good thing.

      1. +1,000,000

    6. What’s a socialist without a care-rationing health insurance scheme?

    7. I take it you ran out of cake.

      Quick, someone tell AmSoc’s mom to bring him some more cake! It’ll keep him busy for a little while.

    8. Huh, had no idea that an insurance card equals care. You should probably mention that to the VA Doctors, it seems like every Military member has this magic card yet, somehow, they aren’t getting what they need even while being managed at their very tip top levels by a Socialist that’s also ‘running’ for POTUS. Perhaps he’s…just the wrong Top Man? Some other Socialist? Who else could we ask? I’ve heard Mao and Stalin had some idea’s, could you ask them for me?

      And sorry 250,000 Doctors seeing 300,000,000 people was never, ever, in a googolplex years going to work. Ever. You’d have been better off creating incentives to become a Doctor other than assuming that some people are geniuses that are also altruistic utopians without the need for sleep.

      It’s sad that it never occurred to you that if people were actually like this, if humanity had these characteristics in the amount you seem to think they do, that something like socialism would be the default mode for humanity?

      But no, since humanity does not conform those who don’t must be expunged.

      Ah, Socialism. You never change.

  7. OT: I got an email from the Johnson campaign. Their social media hash tag is #TeamGov. It’s supposed to be for Team Governors (because they are both former governors), but come one guys! No one stopped and said “Is isn’t it sort of weird for the Libertarians to use #TeamGov?”

    They really need to bring me on as a campaign consultant.

    1. Being libertarians, they’re not really good at this stuff.

      1. Politics? Winning? Interacting with other human beings?

        1. They have no money. Will you work for free as their political consultant?

          1. See below. Costs nothing to elicit free hashtags.

          2. Doesn’t his friends have some left over from the last campaign?

          3. Actually, yeah. I can’t devote myself to it full time but I’d be happy for them to bounce some ideas off of me. Or maybe help with their debate prep.

          4. Perhaps they just decided to surround themselves with other ex-GOPers.

            Hence the poor performance on CNN, poor hashtag choices; the list goes on and on.

        2. All of the above. Final answer.

    2. That really does read as “Team Government”. Who is their campaign manager, Jonah Ryan?

      1. No, it’s some guy named Jon H. Ryan.

    3. #TeamCumOne

      1. #TeamFuckOffSlavers

      2. Too exclusive. We are libertarians after all.

        #TeamCumAll

      3. I still think they should’ve gone with #GottaGetGary.

      4. #VoteWithYourJohnson

        1. #VoteJohnsonIn!

      5. #TeamWoodchipper

    4. Another good laugh for the day.

      It’s like they’re doing a spoof of Libertarians running for President.

      #TeamGov

      Who knows? Maybe it’s genius! Maybe they’ve been consulting with Scott Adams, and he decided it was the perfect mind fuck to get statists to vote Libertarian.

      I’m voting #TeamGov! I love government! These Libertarians aren’t so nutty after all!

  8. I guess you were expecting that Republicans would come up with a plan. Peter Suderman, you pathetic, na?ve fool.

    1. Heaven forbid a reporter report on a thing happening even if he expected it to happen!

  9. I can’t find the section in the Constitution that authorises the Federal government to be involved with healthcare. Am I looking in the wrong place? Oh wait, there it is, under the FYTW clause.

    1. I love the part where the FEDS are mandating insurance that is provided only at the STATE level.

    2. The magical Commerce Clause, because it’s been magically found to negate pretty much the entire rest of the constitution regarding limits on federal power.

      1. The magical Commerce Clause, because it’s been magically found to negate pretty much the entire rest of the constitution regarding limits on federal power.

        Next up = progs want to tax and regulate farts.

    3. Necessary and proper. Duh.

  10. If Team Red wanted to propose a real alternative to ObamaCare, they would start by phasing out the mandates and taxes that require/incentivize employers to offer health coverage as part of their compensation. Once people had to shop for health insurance like do any other insurance, premiums and treatment would both have to respond to competitive pressures.

    1. And get rid of all the government mandates in coverage, which artificially drives up costs by loading up policies with things many people neither want nor need.

    2. Once people had to shop for health insurance like do any other insurance, premiums and treatment would both have to respond to competitive pressures.

      And the health insurance market would look just like the term life insurance market. It would be cheap and easy to get as long as you were young, healthy, and didn’t have much use for it. As you got older and your risks went up, the price would rise and at some point no one would sell it to you. Try buying a term life insurance policy when you are 80 sometime. Good luck.

      There has to be some way to pool your risk or you end up with a system where the only people who can afford insurance are the ones who don’t really need it. Before the government got involved there were mutual aid societies that did this. The first health insurance companies were mutual aid societies. That is where “Mutual of Omaha” and such companies came from. Basically, they allowed you to buy in at a higher price when you were young and then in return agreed to cover you when you got old.

      The problem we have pretty fucked that old system out of existence. And rebuilding it will take time and screw pretty much everyone over the age of 40 right now.

      1. When private, well thought behaviors are replaced by broadcast Force, someone eventually gets it in the ass. The more direct forms of socialism fuck people clearly and presently, other – more subtle forms – do it later on. Whether the time delay is there or not, be sure that the unleashing of Force has victims.

      2. I think the obvious lesson is that it doesn’t make sense for an 80 year old to have term life insurance, or for an 80 year old to get expensive medical care. Unless that is how they choose to spend the money they could otherwise leave to their kids.

        Isn’t that how prices work? Allocate resources?

        1. I think the obvious lesson is that it doesn’t make sense for an 80 year old to have term life insurance, or for an 80 year old to get expensive medical care

          Said by someone who is not 80 years old. It doesn’t make sense to give healthcare to a lot of people. Why are we spending money giving healthcare to prison inmates doing life? Why are we spending on people who are handicapped and have no future income potential?

          I really don’t think you want to go down this road.

          1. It doesn’t make sense to give healthcare to a lot of people.

            ^^^^THIS^^^^

            When resources are limited and costly, it is ludicrous to think the answer to the problem of life being unfair is to pretend that costly and limited resource should be retermed a basic human right and something that should be mandated (not two guys on a date).

            1. Like. You took up the challenge.

              I’d add that people are *already* not being given effective care. We can’t keep everyone alive and healthy. All you can do is spend the money you’re spending effectively.

              So much of the politics of health care is maintaining the illusion of comforting lies.

          2. I absolutely agree John.

            Frankly the only thing they seem to be talking about at this point is how that resource is going to be rationed because it’s impossible that it won’t be rationed somehow by it’s very nature.

            Before, it was rationed by the individual. Now, well, it still is it’s just twice the cost.

            The ultimate goal, of course, is having it 100% regulated by the government. They’ll get there eventually, they just need to keep hammering on us it.

            This is why the left can’t do anything except lie; the truth is naturally abhorrent. So they obfuscate, they lie, they bend the truth because it can be no other way. They want to decide who lives, and who dies. Call it what you will, by any name you want, a rose by any other name…

        2. No, it doesn’t make sense for an 80 YO to buy life insurance, but it does make sense for them to get expensive medical care, because sick is sick.

          1. Life-years.

      3. By age 80 you will have saved enough from buying cheap insurance to self insure.

        Or, you know, get a term policy that lasts past then. Buy a 100 year term policy at age 20.

      4. People confuse healthcare with health insurance. We should have a catastrophic health insurance plan that covers all, and let individuals go out and buy whatever healthcare coverage they want based on what they can get grouped into. Once you have an incentive to pool for coverage of the basics and non critical stuff, you will pay for that, and then when the shit really hits the fan and the bills look like they are goign to hurt, you can turn to insurance for help there.

        This system should cost less and provide better coverage, but it has fewer opportunities for political graft and pandering, so we will never see it.

        1. We shouldn’t have lunch “insurance”.

      5. John,

        No system works for 100% of the population in 100% of the cases. There is no perfect healthcare system.

        The question is which system is as close to ideal as possible. Only a market-based system can drive the cost down (in both healthcare and for insurance) while driving innovation up.

        In a market-based healthcare (not necessarily health insurance) system, cost goes down. The healthcare cost (and insurance premium) for an 80 year-old will also go down.

        Now for an 80-year old, the cost may still be too high. So let’s figure out ways to help either publicly (if we choose) or privately. That is no reason to enforce a government-based system on 100% of the population today.

        1. +1000

    3. It would also help if health insurance was actually insurance, like any other insurance. You need maintenance, you go to the doctor and pay for it. You get injured, you get cancer, that’s when the insurance kicks in.

      1. That is nonsense. Health insurance can cover anything the customer is willing to pay for. When the government says “you must cover this” that is a problem. But, there is nothing wrong with a health insurance company and its customers deciding that the insurance should cover whatever the hell they want it to cover.

        It might be that the insurance company concludes that it is cheaper to pay for something like a yearly physical than it is to not and risk their insured having undiagnosed conditions that end up costing more later. I don’t know but that is up to them not me. Why Libertarians have this strange idea that insurance can only cover catastrophic risk is something I have never quite understood.

        1. But, there is nothing wrong with a health insurance company and its customers deciding that the insurance should cover whatever the hell they want it to cover.

          First dollar coverage only came about because of tax arbitrage.

          Get rid of that, and let the market sort itself out.

          1. It might in some cases but not all. People are risk adverse. They are always going to be predisposed to buy more coverage than the strict economic math says they should.

            1. Before Obamacare, the cost of a catasrophic plan and the deductible were literally less expensive than a first dollar coverage plan. People like health insurance because they think it’s free money – a comp. Given the choice of spending $14,000 a yr for it or saving the money and paying out of pocket, most people will choose the latter every time.

              There’s also a weird idea floating around out there that insurance is a system that gives everyone more back than they put into it. Which is obviously impossible, without even considering the deadweight loss of it.

              1. No people like health insurance because they are risk adverse and hate taking even the smallest risk of not being able to afford medical care or facing financial ruin to do so.

              2. A couple years ago, the high deductible plans were the cheapest option under just about any scenario I could figure.

                Now, at least for my employer plans, the low deductible choice is the most economical. The real switch was when copays started counting toward the out of pocket max. I don’t think pricing has caught up to that.

              3. “The state is that great fiction by which everyone tries to live at the expense of everyone else.”
                ? Fr?d?ric Bastiat

            2. Does ANYONE have first dollar car insurance?

              Does anyone have home insurance to pay for their lawn or insect treatment? Or even to replace the roof due to natural aging?

              1. Does ANYONE have first dollar car insurance?

                Yes. You can get that in collector car insurance.

        2. The answer to your problem of “only the young and healthy can afford it” is “health insurance can cover anything the customer is willing to pay for”. If true catastrophic insurance was legal, it would be offered and it would be cheap(er).

          The problem (as insurance companies know) with covering “preventive” care is that it only pays off in the long run, when you don’t know if the beneficiary will still be on your books. In a free market for insurance, there might be a fix for that. But in our massively regulated system, there isn’t.

          1. The answer to your problem of “only the young and healthy can afford it” is “health insurance can cover anything the customer is willing to pay for”. If true catastrophic insurance was legal, it would be offered and it would be cheap(er).

            It would be cheaper than now but it would still not be cheap for someone who is a bad risk. Unless you have some way to pool your risk with other people, you are stuck paying according to your individual risk. And that is fine at first. But the problem is everyone becomes a bad risk at some point if they live long enough or get sick enough. All “catastrophic plans” do is delay the inevitable.

            1. We should just honestly cover those people via welfare.

              1. We should just honestly cover these people with tar and feathers. Or concrete.

              2. This is true. Even though people will strategically impoverish themselves, it still would pay for gov’t health insurance policy to be explicitly redistributive rather than implicitly & opaquely so. Medicaid should be all it takes.

            2. Mutual benefit associations existed over a century ago.

              To pool risk. Its not hard.

              1. Mutual benefit associations existed over a century ago.

                They existed until Nixon ended the gold standard.

            3. The mechanics of the insurance industry pretty much require that risk be pooled, John. Insurance companies are very adept at constructing risk pools, even for high-risk people, that spread enough risk to lower premiums, and offer enough benefits (including limits on premium increases or future medical underwriting) to get people to sign up.

              Your argument seems to lead to the conclusion that it is impossible to run an insurance program without government mandates and control. I don’t think that’s the case.

              1. That is not my argument at all. Yes, risks must be pooled. And insurance companies used to do that. Sadly, thanks to the government they don’t do that anymore. So if the government walks away tomorrow, you have all of these people who had the government never been there would have been paying into mutual aid societies but haven’t, who are going to be screwed. That is the problem.

                Also, employer provided health insurance was a wonderful pooling mechanism. Since you got your insurance through your employer, you were automatically pooled with the other employees. That was a very good thing and a good way to pool risk. Why Libertarians decided that was evil and wrong is frankly bizarre.

                1. you have all of these people who had the government never been there would have been paying into mutual aid societies but haven’t, who are going to be screwed.

                  The whole fucking racket is BASED on deciding who gets screwed and who doesn’t. For a change it would be nice for the stupid and unproductive to get screwed.

                2. The size of the pool is ALWAYS every policy sold by the same company.

                  Sometimes larger, if they buy reinsurance.

                3. The size of the pool is ALWAYS every policy sold by the same company.

                  Sometimes larger, if they buy reinsurance.

          2. It turns out that for the things they’ve studied, preventive care doesn’t save $. It does in some cases lead to better quality of life.

      2. But if it isn’t mandated to cover the pill, then you are against women’s health, or something.

      3. It would also help if health insurance was actually insurance, like any other insurance.

        Yep, and let be honest that isn’t going to happen in one fell swoop.

        My plan is to eliminate pre-paid health insurance altogether and replace it with catastrophic coverage via welfare.
        So people would pay out of pocket for coverage up to some threshold – say 100% of their previous years income, at which point medicaid plus or the like would cover them. The person would of course be free to purchase their own health insurance to cover the gap or top off what the government pays.

        That plan may be anathema to conservatives and libertarians but it, or something like it, is the only realistic way to get consumer control, competition and price signals back into the system. It also would not be much more expense than current government healthcare spending after the subsidies, medicaid, medicare, tri-care and insurance for government employees is factored in.

        1. Your plan screws with the market every bit as much as Obamacare. Let people buy the insurance they want. Don’t tell them anything about what it must be or can’t be.

          1. Healthcare insurance wouldn’t exist except for the decades old tax distortion and there is no way to eliminate that because employers would pocket most of the difference.

            Under my plan you are still free to buy your own health insurance if you want – but most people would not need to do so.

            1. Healthcare insurance wouldn’t exist except for the decades old tax distortion and there is no way to eliminate that because employers would pocket most of the difference.

              That is just not true. Health insurance had to exist once medical technology became available, effective and expensive. You have to buy health insurance because you can’t plan for the costs. My health insurance costs could be anything from zero to in the millions. I could die of a heart attack right now and incur no costs or I could get some chronic disease and incur millions in costs. There is no way for me to tell for sure where on that spectrum my costs are going to land. The only way I can plan and account for my healthcare costs is to pool my risk with other people in a similar situation and buy insurance.

              Health insurance exists because of the uncertainty of health costs. it is an absolute result of market forces.

              1. Do you have lifetime housing insurance because you have no way of knowing what your housing situation will be in 20 years?

                Should automobile insurance cover the procurement of automobiles? After all they run to the many tens of thousands of dollars each and the average person probably buys half a dozen to ten new ones over the course of their life.

                1. Do you have lifetime housing insurance because you have no way of knowing what your housing situation will be in 20 years?

                  No. But I know what my housing costs are right now. And I know it is not going to change tomorrow. So I can budget for it. And I absolutely make efforts to control that cost or at least get some certainty by signing a lease or a mortgage.

                  I can’t do anything with like that with my health costs. They could in a moment go from zero to astronomical without any warning. There is just no way to plan for it. All health insurance does is allow me to pay money up front in return for my costs being certain thus allowing me to properly budget and plan around them.

                  Should automobile insurance cover the procurement of automobiles?

                  If someone wants to purchase that coverage, sure. You can buy insurance for anything. All it takes is a risk that can be accurately assessed and priced.

              2. Health insurance had to exist once medical technology became available, effective and expensive.

                And it is expensive because nobody is price sensitive. There is no incentive in the healthcare industry to develop cheaper alternatives of care.

                Look at computers: you can buy a decent processor for $100 or the bleeding edge 20% more effective for $250. That 20% costs over twice as much. If everyone was on a payment plan “CPU Insurance” then everyone would expect that their insurance gets them the top of the line CPU. There would be no incentive to create the cheaper processor.

                As others have noted- “expensive” medical procedures that are subject to price sensitivity, such as plastic surgery and LASIK are some of the only areas of health care where the cost has consistently gone down. Yes, the market forces has created this situation.

                1. And it is expensive because nobody is price sensitive

                  That is true to some degree but not enough to eliminate the need altogether. Some things are just expensive. It takes a smart person years of training to be a doctor. You are not going to get a good doctor for minimum wage. Demand and competition can only reduce the price so much.

                  The other thing is that medical care is pretty price inelastic. If you really need it, you are going to beg borrow and steal to pay for it. Sure, the demand for truly elective things like laser eye surgery is going to be elastic. You can always wear glasses. But the demand for getting your broken leg set or getting life saving surgery is not going to be very elastic.

                  Big modern health care is just expensive. And frankly, that is not a bad thing. Sometimes you get what you pay for.

                2. One thing I have a problem with is co-payments. I can go to a doctor who would charge $100 cash and pay $40 co-payment. I can go to a specialist who charges $400 cash and still pay $40, so I have no incentive to consider the cost. This kind of think adds up. It’s not just the big ticket items. It seems to me the insured should pay a percentage.

              3. Many health risks are low probability, high cost.

                Perfect for the pooling of risk – insurance.

            2. Why do you think employers would pocket the difference?

              Your healthcare is part of the salary that the company pays to keep you working for them. They pay it because a dollar spent on health insurance goes more or less totally to your insurance, but if they paid you a dollar, some percentage is taxed away. They are doing it, not because it is cheaper for them, but because it is a more cost effective way for them to attract talent.

              If you take away their tax savings, the incentives change. They could pay you the dollar THAT THEY WOULD HAVE SPENT ANYWAYS or they could pay it to their insurance plan. They have already acted on their preference when they paid for the insurance. Why wouldn’t they just turn around and pay that dollar to you? it was a cost they were paying and if they don’t pay it, someone competing for your labor will do it and steal you away.

              1. Why do you think employers would pocket the difference?

                Because I know how businesses operate in the real world.

                End it all of a sudden and I guarantee you that employers would not pass the full cost down to their employees.

                1. End it all of a sudden and I guarantee you that employers would not pass the full cost down to their employees.

                  Then they will lose out to other companies that do pass it down. Again, they were already paying this cost- that the check went to an insurance company, not you directly doesn’t matter to them.

                  The whole reason companies previously paid for insurance (prior to the mandate) was that they wanted to attract new employees. If they were interested in pocketing the change, they wouldn’t have offered health insurance in the first place. And yet they did. They took out their wallets to pay for insurance because it was a cost they were willing to bare in order to get your labor.

                2. Depends on the employee. An employee in demand would search for a better employer. The employer would have to compete to retain good people. Sure, this doesn’t happen over night, but that employment landscape would change in less than 7 years.

    4. Health insurance as an employee benefit is purely a result of tax and wage control policies. It also perverts the labor market and the employee/employer relationship.

      I’m all for ending that practice.

      1. It is all that. But it likely saved us from single payer. The reason why single payer never took root in this country but did in pretty much every other industrialized country is because people got their insurance from their jobs and didn’t worry about losing it if they got sick. Of course, they did worry about losing it when they got old and we ended up with medicare which is nothing but single payer for old people.

        1. President Truman kept the tax advantage for health insurance after the end of WWII explicitly because he saw it as a stepping stone to socialized healthcare, which it in fact was / is.

          1. He may have thought that, but I think he was wrong. The economics of everyone being on the individual market are what made single payer appealing.

            1. Employer provided healthcare is socialized medicine just at a smaller scale and at the employer level instead of the general society level. It has all of the problems that come from a 3rd party payer scheme that other socialized healthcare systems have.

      2. It was that at 1st. I’m not sure it wouldn’t’ve come about anyway 20 yrs. later.

    5. You mean like they did in the actual plan that suderman was too thick or lazy to read?

      http://www.forbes.com/sites/jo…..392d9f6e37

  11. Alt Text:

    “…Paul, this is the PPACA text. You just scribbled my name out and wrote “GOP” beside it… in crayon.”

  12. Alaska is down to one Obamacare provider. Mmm… markets….

    1. Don’t worry. The FTC will just force that monopoly provider to break up into smaller entities. Problem solved!

  13. This isn’t that hard to fix. Get rid of the individual mandate, the pre-existing condition mandate, the various coverage mandates, and end the subsidies along with the various taxes and you undo most of the damage this monstrosity did.

    1. IOW, repeal everything but the Medicare expansion.

      1. That would be a start. So much of the law is so idiotic and obviously stupid, you really can’t help but improve things by just repealing as much of it as possible.

      2. You mean the Medicaid expansion, don’t you?

    2. The pre-existing condition mandate isn’t going away, because kids with cancer.

      I wouldn’t want to be the politician on the target end of THAT inevitable ad campaign.

      1. No private insurance for kids with cancer. Instead, free government care, courtesy of the VA (why, these children could one day be soldiers, so it’s a readiness campaign). If it’s good enough for The Troops, it’s damn well good enough for kids with poor and/or stupid parents.

        1. Catastrophic care provided by government. There’s no way around it.

  14. And can I just take a moment to say, well done on the Reason crew for all this econ talk.

    Seriously. Well done, y’all.

    1. MOAR TRUMP

        1. On your date, like usual?

    2. And can I just take a moment to say, well done on the Reason crew for all this econ talk.

      Not to belittle their efforts but; Holy shit! I just thought of another reason why I want a country to leave the EU every week for the next 2+ years.

  15. Before Obamacare, poor people didn’t have insurance and didn’t want it. What the hell did they care? Hospitals had to treat them if they were sick and there are plenty of charity hospitals who would treat them if they got really ill. And they have no assets. So the prospect of running up a bunch of bills didn’t matter.

    Meanwhile, most middleclass people had healthcare and health insurance they were satisfied with. All Obamacare did was totally fuck the middle class to provide health insurance to the poor who didn’t even the insurance in the first place.

    1. It did a lot more than that as it gave the government another vector for controlling healthcare.

    2. Wrong.

      They provided health care to the poor to rationalize totally fucking everyone else.

      The goal is always control of the mass, not the rationalizations for the control of the mass.

  16. We would all save a lot of money if we would just toughen up and refuse any kind of medical care.

  17. Ah crap… “Explosion and gunfire heard at Istanbul’s Ataturk airport, Turkish media report”

    1. In other words, Tuesday

    2. It is probably some damned right wing Christian repressed homosexual. I hate those guys.

  18. On a more positive note, this video is pretty funny. And my God is the “Lilly” chick from the AT&T commercials adorable.

    https://pjmedia.com/instapundit/237413/#respond

    1. And my God is the “Lilly” chick from the AT&T commercials adorable

      both of ’em

    2. Kanye West has Resting Bitch Face.

    3. mad.casual approves!

    4. Yeah, I expect someone is going to snap her up for actual TV or movies soonish.

    5. They got the phrase wrong though – it’s Resting Bitch Face, not Bitchy Resting Face.

      And yes, adorable.

  19. http://www.bloomberg.com/view/…..cebook.com

    It looks like the California choo choo won’t even be a train to nowhere. It will just be a project that sucks money and never builds anything.

    1. You know, if the money is gonna get sucked in and shat out (and it is), I prefer that it’s completely virtual, so there’s not additional cost of removing half-finished useless things twenty years later.

    2. Gee, who could’ve predicted that?

      At least the old boondoggles produced tangible results.

    3. California’s high-speed rail project increasingly looks like an expensive social science experiment to test just how long interest groups can keep money flowing to a doomed endeavor before elected officials finally decide to cancel it. What combination of sweet-sounding scenarios, streamlined mockups, ever-changing and mind-numbing technical detail, and audacious spin will keep the dream alive?

      […]

      But the assurances were at best wishful thinking, at worst an elaborate con.

      […]

      The total construction cost estimate has now more than doubled to $68 billion from the original $33 billion, despite trims in the routes planned.

      Huh, pretty stinging rebuke of California politics. I’m pleasantly surprised.

    4. They’ve been buying land up though. It would be informative to see who the sellers were. And since the authority can also sell/swap land, those real estate transactions are deserving of a lot of scrutiny.

    5. By the fucking by… WHERE IS THE ATTORNEY GENERAL TO PROSECUTE THE FALSEHOODS SPREAD BY THE CALIFORNIA RAIL AUTHORITY? HMMMMMMMMMMMMMMMMMMMMMMMMM?

    6. It will just be a project that sucks money and never builds anything.

      Congratulations to California! They have perfected Progressive Government.

  20. The funny thing about all of this is President Hillary is going to have to come up with a New Plan because Obamacare has proven itself to be utterly unsustainable in an even shorter time than its fiercest critics predicted.

    1. Oh, yeah, that’s what I’ve been hearing. What’s Hillary gonna do about the ACA?

      Wouldn’t it be abso-fucking-lutely awesome if she gets plowed under on emails and Benghazi so that Teams Stupid and Evil can patch up the ACA without looking like racists?

  21. This is because Republicans don’t understand the concept of leverage. You don’t walk onto a used car lot and announce your budget to the car dealer and you don’t open a new session of congress by announcing that nothing proposed by the opposition will go unfunded. Republican leadership is simply too lazy to make the case or they just aren’t really that into limited government.

    1. or they just aren’t really that into limited government.

  22. Take the Democratic Party from two decades before, add a couple of ill-advised ground wars and some vague rhetoric about free markets and the glory of the military and you have the quisling GOP.

    I hope Trump sweeps the whole lot of them out the door and rebuilds the party from the ground up with populists & tea partiers.

    1. I think the bow ties have all left the building.

  23. I knew the minute Obamacare passed it would become a “mend it, don’t end it” target for the GOP – and now the fuckers will own it. If the Dems proposed we all jump off a 500-foot cliff this afternoon the Reps would come back with a plan where we all jump off a 400-foot cliff tomorrow. It’s why I truly hope Trump destroys the party – let the Dem-lites get their own party and the Jesus freaks get their own and let us small government types fight it out with them.

    The government is a systemic failure at problem-solving, it’s primary purpose is to funnel money and power to insiders and cronies and lobbyists and rent-seekers and you can’t get a goddam thing done when the leeches mean you gotta pay double for half the results for every single thing you try to get done. When will people get it through their thick skulls that no matter how simple a problem is and no matter how easy a solution is, looking for government to handle it means you gotta filter it through the government system first and everybody and their brother has a tollbooth they’ve put up just for the express purpose of making sure they get a little piece of the action. Their whole purpose is to make damn sure no simple problem gets solved easily and cheaply.

    1. I am frankly surprised they even want to mend it. Why should they? Since the Democrats were retarded enough to pass it without a single Republican vote, it allows the Republicans to blame the Democrats for every thing that is wrong in the health care system. Trying to mend it will just get the Democrats off the hook. I swear that is half the reason they secretly want Hillary to win in November. It will allow them to have four or eight more years of sticking it to the Democrats over Obamacare.

      These people are scum. All of them.

  24. The Republican plan to replace Obamacare is here, in other words, and it is not a plan at all.

    That sounds like a ringing endorsement in my book. If only it were true.

    What gives anyone the notion that we have to have a central plan for health insurance? Do we have one for clothing? For our food?

    Christ, I never thought I’d live to see the day where libertarian magazines criticize a proposal for insufficient government planning.

    1. I am not sure if Reason is actually criticizing the lack of sufficient government planning.

      1. I don’t think actual libertarians moonlight for Vox. So.

  25. IT WAS SET UP THAT WAY IN THE BEGINNING……….

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  28. My guess is that nothing in the plan gives me any more freedom from the medical mafia.

    Am I right? What do I win?

  29. Anyone else see that first page and think that it looked like the effort of some PTA mom who had never used a computer before?

    I’m not an expert at producing quality media, but I just winced when I saw the bottom half of the page. I’m not even sure exactly why.
    But, ugh.

  30. A. Repeal Obamacare.
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    C. Go to the bar for a beer ….. WELL DONE!

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  36. This article is emblematic of how we got Obamacare in the first place and how, if the author’s opinion held way, we will likely get a single payer system in the near future. It is also how we got Donald Trump. The truth is, Republicans woke up only after Obamacare was enacted. It took them 6 years but they finally produced a plan that, while not perfect, is a hundred times better than Obamacare. For starters, there is no individual mandate – thus, no coercion. Instead, there is an insurance guarantee for being continuously covered – a huge incentive to get insurance without forcing anyone to buy under penalty.. The number of essential benefits is far less than in Obamacare. Tax credits to buy health insurance are perfectly legitimate way to advance a policy goal – they are no better and no worse that any other tax credits we have. This could be the first step of liberalizing the health industry and using the marketplace (rather than government) to push cost control on the cartel of providers and pharmaceutical companies. We do not live in a perfect world and this reform is as close as we get to the “good” not being the enemy of the “perfect”.

  37. Either way failure to comply/report results in a higher tax burden. The only difference is the slender possibility that you could end up in jail under ObamaCare.

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