Obamacare

Trump Picks Tom Price For HHS Secretary. Does This Really Mean He Wants to Repeal Obamacare?

Ultimately, legislation to repeal and replace the health care law will have to be driven by Congress.

|

KEVIN DIETSCH/UPI/Newscom

President-elect Donald Trump has picked Georgia doctor and House Representative Tom Price as his Secretary of Health and Human Services (HHS). Price is an ardent critic of Obamacare, and also the author of one of the most detailed plans to replace the health care law. Since winning the election, Trump has appeared to waver on his promise to completely repeal the health care law, saying he might consider retaining certain provisions.

His choice of Price to oversee the sprawling federal health care apparatus is the strongest signal yet that the incoming president is firmly committed to opposing Obamacare—but it does not by itself guarantee that Republicans, who have long been wary of uniting around legislative specifics, will repeal or replace the health care law. And, along with a second pick to manage Medicare and Medicaid, it raises the possibility that Republicans will simply use the federal health bureaucracy to reward favored constituencies.

Aside from his consistent opposition to Obamacare, the most notable thing about Price is his own health care alternative. Unlike a lot of Obamacare critics in Congress, Price understands that on health policy, the details matter. When I interviewed him in 2013 about Republicans and health policy, he lamented the GOP habit of simply saying that Obamacare is bad law and declining to offer solutions of their own, and seemed frustrated by the lack of attention to particulars.

"Health care is complex," he told me at the time. "Most individuals kind of have their topline talking points. But if they're asked any questions beneath that veneer about the practicality or logistics of providing care and the consequences of whatever system you're recommending, it becomes very difficult to answer any of those questions in a normal talking-points kind of language…Once you drill down a bit, people become a bit uncomfortable."

Price, in contrast, has actually drilled down, a sign of his seriousness about tackling the challenges of U.S. health care policy. Many of the Republican replacement plans take the form of statements of principle or white papers. Price's plan, on the other hand, already exists in legislative form, as a 250-page bill known as the Empowering Patients First Act. The plan offers a level of detail that allows you to better imagine how it might work, and what sort of trade-offs it might entail.

The plan has a number of virtues, including its specificity, its emphasis on eliminating mandates, and its potential for massive reductions in federal spending. But it also comes with some risks and concerns, and, because Congress controls the legislative process, it may not prove the best guide as how Republicans end up treating health care in the Trump era.

Price's plan is focused on getting rid of a lot of the rules and regulations that make coverage under Obamacare expensive. It would eliminate the health law's essential health benefits rules—the list of mandates that require insurers to include a government-determined list of features, whether or not they're wanted. This would free up insurers to offer a wider array of types of coverage, and could help make coverage cheaper for many people, especially those who are in relatively good health and don't want or need comprehensive coverage. It would also allow for the purchase of health insurance across state lines to an even greater extent than already allowed under Obamacare.

Price's plan offers two mechanisms for sicker individuals who might be sicker and more expensive to cover: a provision that does not allow insurers to charge more for health conditions so long as someone maintains continuous coverage, and $3 billion in funding, over a three year period, for high risk pools. The continuous coverage provision is designed to encourage people to find insurance when they are young and then stick with it in hopes of creating a sustainable, long-term insurance pool—something that Obamacare, which has struggled to attract young people, has had trouble with so far. The $3 billion in funding for high risk pools—which comes to $1 billion a year—would help cover some of the hard cases, but may end up being too little for the job: Obamacare's high risk pools, which bridged the gap between when the law was signed and when its coverage provisions kicked in, ended up drawing a far more expensive patient pool than expected. And other Republican plans that rely on high risk pools estimate the cost at more like $2.5 billion a year.

Price's plan would result in a huge net savings to the federal government—about $2.3 trillion over a decade, according to a 2013 analysis by former Congressional Budget Office Director Douglas Holtz Eakin. So even with a significant increase in high risk pool funding, the plan would still represent a significant trimming of the country's budget.

There are, however, some real risks and worries to Price's plan as well. For one thing, it attempts to cut defensive medicine costs by offering legal protection to doctors who engage in best medical practices—which end up having to be determined by the federal government, or by some federally empowered board of medical providers. The potential for both bureaucratic sprawl and insider dealing with a system like that is high.

Price's plan also relies on the creation of voluntary purchasing associations designed to give bulk purchasing power to small businesses and individuals—basically by allowing them to band together to act as large organizations that can get the discounted coverage and preferential treatment enjoyed by large corporations. But the voluntary association model has been tried in several big states already, including Texas, California, and North Carolina, and it didn't work out. Those associations broke down as small businesses with healthier employees left the group to get even cheaper rates, leaving a pool of companies with sicker and more expensive workers.

Obamacare, of course, isn't just the private insurance market. A big chunk of its coverage gains comes from the expansion of Medicaid, the jointly run federal-state program for the poor and disabled. Price's plan would eliminate the Medicaid expansion entirely, with no replacement. That may have less impact than previously expected, however. As Brian Blase of the Mercatus Center noted yesterday, new research indicates that about two thirds of Obamacare's Medicaid enrollees were previously eligible—meaning they would have been able to get coverage without Obamacare, and would not be affected by repeal. Other Republican alternatives, like the Better Way plan championed by House Speaker Paul Ryan, would allow states to maintain the law's Medicaid expansion, but with somewhat reduced federal funding.

But today's personnel announcements may hold another clue as to how a Trump administration might treat Medicaid. In addition to Price, Trump also picked health care consultant Seema Verma to run the Centers for Medicare and Medicaid Services (CMS), which manages the two major health entitlements. Verma helped design and implement a Medicaid-expansion plan in Indiana under Gov. Mike Pence, who is now Trump's Vice President elect. That plan, touted as a market-based reform to Medicaid, was little more than a lobbyist driven deal to direct federal Obamacare money to the state's hospitals, even as Pence implausibly insisted that it wasn't really an expansion of the president's health law.

Indeed, the selection of Verma for the top slot at CMS may be more revealing than the selection of Price, because CMS is heavily and directly involved in negotiations over how states operate their Medicaid programs. Verma was involved in both the Pence plan and a previous Medicaid overhaul in Indiana under Gov. Mitch Daniels, a more defensible plan to integrate consumer-driven incentives into Medicaid. But especially with Pence in the White House, it at least raises a question about whether we can expect more lobbyist-driven, health care industry friendly deals in the future. And it suggests the possibility that we can expect the Trump administration to frame these deals as firm rejections of Obama's policies, even if they are not.

Because for all the details of Tom Price's Obamacare replacement plan, the Trump administration won't be crafting repeal or replace legislation. Instead, that process will be driven by Republicans in Congress, who have consistently failed to unite around a replacement plan, and have already begun to express some uncertainty about how much of the health care law they want to eliminate, and how long it will take to do so. Sen. Lamar Alexander, who as Chair of the Senate Health, Education, Labor and Pensions Committee is likely to be a key player in any GOP replacement effort, recently said that it might take six years to draw up a replacement plan—not mentioning that Republicans have been promising to deliver a replacement plan for about that long already, but have failed to unify around a plan.

A Trump administration could take some significant actions on its own, speeding up the decay of the health law's exchanges by stopping some of the legally dubious payments that the Obama administration has been making to insurers. But even a complete disintegration of the marketplaces would still leave Obamacare on the books, without any replacement.

The administration, for all its power, can't drive the repeal and replace process entirely on its own. So Price's nomination is a signal and a symbol, arguably a rather important one, of the Trump administration's opposition to the health care law. But as Price himself knows, symbolic statements of opposition aren't enough. Fully repealing and replacing the law will require actual legislative action, which means debating and agreeing on the details—and so far that's something that many Republicans in Congress have not been willing to do.

Advertisement

NEXT: On Flag Burning, Trump Differs With Scalia but Agrees With Clinton

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. Suderman’s alive.

    1. Tears have a cleansing effect.

    2. God dammit! I was honestly starting to think he had either killed himself or moved to Canadia and we were rid of him.

    3. I was going to question if this was the real Suderman, or a simulacrum, but nobody else does this sort of insouciant wonkery: “…but it does not by itself guarantee that Republicans, who have long been wary of uniting around legislative specifics…”

      Indeed, why not unite around legislative specifics when the presence of Obama guarantees that they would never become law, and would only serve as lightening rods for opposition and criticisms from the likes of Mr. and Mrs. McArdle?

      Or is Peter really this ignorant of how the game is played?

  2. Obamacare is a three-legged stool between the individual mandate, the pre-existing conditions mandate, and the community rating mandate. All three are necessary for the survival of any one, otherwise the whole thing falls apart. And we’re seeing it fall apart already because the individual mandate is too weak to sustain the other two. So this talk of retaining the ban on discriminatory pricing means we can’t return to a tenable insurance model.

    1. It’s not that the mandate is too weak. I think it’s weakness is why prices aren’t spiraling upward even faster. If the mandate were stronger you’d see a higher demand pressure pushing prices up even faster than they’re rising now. Right now the death spiral is going very slowly. If nothing is changed it’ll take another 5-7 years or so to reach levels of unsustainability instead of 3-4.

      1. The mandate isn’t compelling enough young people to buy in, and the enrollment periods are not enforced strictly enough to keep people on their plans before needing them. Demand for care is curtailed by fewer doctors offering services for exchange enrollees. This is the bottleneck that Democrats, stupidly, tried to fuck with and only managed to sprain their dicks. Insurance is not a substitute for care and the plans they mandated is not proper insurance. I agree that if it worked as intended prices would be rocketing upward even faster, but the administration didn’t have the confidence of its convictions to enforce the act stringently and all at once.

        1. While visiting a liberal 60-year-old friend in NY state, the topic of ObamaCare came up. He said it was “Great!” and cost just $500/month for him and his wife before subsidies. I found this rather shocking because it runs almost triple that in Texas for me and my wife before subsidies.

          Then I looked it up on the Kaiser ObamaCare calculator. It turns out that NY state premiums aren’t age rated; a 60-year-old pays the same premium as a 25-year-old.

          Is it any wonder that such a scheme would fail to attract young people?

          1. No wonder at all. It’s a wonder Democrats thought it would work.

            1. “It’s a wonder Democrats thought it would work.”

              The voters keep hoping for something for nothing and the politicos keep hoping for the New Soviet Man.

          2. A 25 year old would have to be very stupid to spend $500/month on health insurance.

            Thing is that a lot of ObamaCare supporters have an intense obtuseness about probability theory.
            As far as they are concerned as long as there is a non-zero chance of getting cancer, you should buy insurance, regardless of the price. Any time someone points out that the likelihood of a 25 year getting cancer is so low that the average cost should be around $50/month instead of $500, they scream “But there’s still a chance !” As if all random distributions are uniform or unknowable.

            A good response to this is to ask them if they play the lottery.

            1. I have not seen that argument for Obamacare…

              Forcing young people to buy insurance isn’t about making sure they have coverage (even if they don’t want it), it’s about making stable insurance pools that actually function for the profit-driven companies that sell them. It’s not some nanny-state, I know better than you; it’s dollars and cents.

              Under Prices’ plan, young people will be able to buy cheap-o bare-bones plans, and coverage costs for them will absolutely go down. I’m sure the young and/or healthy are going to love it. However, plans WILL be more expensive for the older and sicker to make up for the lost revenue. Again, that’s just dollars and cents. If the subsidies for these people are indeed far short of what they should be, as many even Republicans are saying, there will be people left out in the cold.

              Now, I’m not saying this like it’s some kind of silver bullet, ACA > Empowering Patients kind of way. But those are the trade-offs.

              1. “…It’s not some nanny-state, I know better than you;…”

                I know better than you; it’s nanny state.

              2. Anytime the government tells you that you HAVE to do something, it sure as shit IS nanny-state, I know better than you bullshit.

                1. As my earlier comment suggests, I strongly disagree with you. I think you are willfully ignoring the evidence in front of you in favor a narrative you like. That narrative being the government is always playing a paternalistic/predatory roll and isn’t just operating to the best of its ability within the confines of political will.

                  I mean, you do know how insurance companies work, right? Why it needs a large body of customers who don’t use the service? Why you can’t just buy fire insurance once your house in on fire?

                  1. Yes, I am aware how insurance works. If there is a problem creating a big enough risk pool, the solution is not to force everyone into it at an inflated rate and under penalty of jail or penaltax. (Of course this completely elides the fact that there were 284 million people insured in 2014, so it is beyond asinine to pretend that the insurance companies didn’t have a large enough risk pool to begin with. )

                    It seems that you are the one ignoring the evidence before you: If I tell you that you have to buy my miracle tonic that cures all ailments and will lengthen your life (objectively good for you), and if you don’t my friends over there are going to rough you up and take your property, how is that not being predatory and saying that I know better than you what you need?

                    But please, condescend to me more.

                    1. Sorry. I generally like to keep a civil and polite tone, but I don’t always succeed.

                      I see the penalty as being a bad but necessary part of a cobbled together system. I support it to the degree that it’s a needed part of a market-driven approach to healthcare.

                      1) I’m against people being turned away from health coverage because of preexisting conditions

                      2) Insurance companies must be guaranteed a healthy pool of people if they can’t turn away the very expensive cases.

                      3) There must be a mechanism to force people to buy insurance.

                      One step leads to the next. My preferable option would be for single-payer, but since that’s not politically possible, we’re left with the ACA or something that looks a lot like it.

                    2. 2) Insurance companies must be guaranteed a healthy pool of people if they can’t turn away the very expensive cases.

                      False. They can simply charge incredible amounts, in proportion to the expected costs.

                      If there’s some overriding need to help these people, it would be much more reasonable to treat it as an actual social safety net expense, (and subsidize their premiums directly) than to build complicated rules which only achieve 3 things:

                      – Hide the expense off the government’s books, and shift it directly onto each resident of the country.
                      – Discourage healthy people from getting health coverage for accidents (which is normally a thing responsible people would do, but now makes no sense, penalty or not).
                      – Break the functioning of the health insurance market in hard to predict ways, leading to further issues down the road.

                      I’m a libertarian, so neither approach would satisfy me, but at least the direct, honest approach makes it easier to calculate the real costs, and doesn’t fuck things up even further.

                  2. Insurance companies can work as long as $Premiums > E($AnnualPayouts) + $Margin

                    Theoretically they can do this profitably even with just one customer, as long as they estimate well and have enough money to cover the possible bad luck (it’s called Ruin Theory, the most appropriately called branch of statistics ever).

                    Getting the expected value of annual payouts for a customer is a reasonably solved problem, both in health and other types of insurance. Auto insurance demonstrates how widely premiums can vary when the system is allowed to function correctly.

                    We know how insurance works, we just don’t buy the premise that forcing people to buy insurance at inflated prices (compared to the actual value received) is “operating to the best of its ability”.

                    1. Re: They can simply charge incredible amounts.

                      Well, yeah, but that doesn’t exactly do what we want, does it?

                      The point of healthcare insurance is to make healthcare affordable and available. Sticking to some principle of the market as healthcare becomes unavailable is silly; it defeats the whole purpose.

                      I explained this concept in another post below, but I think a core question that is missing from this debate is “What do we want healthcare to mean, and why?” Next, we calculate the best method to reach that goal. Sticking to a particular methodology, like free markets, that doesn’t meet some standards of what healthcare should be about, is self-defeating.

                    2. “The point of healthcare insurance is to make healthcare affordable and available.”
                      No it is not. Insurance is intended to cover unexpected costs. It has nothing to do with making the market for a good cheap.

                      “Sticking to some principle of the market as healthcare becomes unavailable is silly; it defeats the whole purpose.”
                      Given you don’t understand the purpose of insurance, you still fail here; O-care has accelerated the cost increase in the market.

                    3. RE: Insurance is intended to cover unexpected costs. It has nothing to do with making the market for a good cheap

                      I disagree. Along with “unexpected” cost is “unmanageable.” Otherwise no one would buy insurance and instead they would just save the money in a savings account or whatever until they need to pay for something unexpected. A rainy day fund does not take the place of insurance, not when the cost of a car accident, house fire, surgery, civil lawsuit, etc., can be multiple times higher than many people’s yearly salary. Insurance makes it possible for an average person to pay, through their insurance company, for extremely expensive things. Thus, it is made affordable.

                    4. Which is a very long ways from this:
                      “The point of healthcare insurance is to make healthcare affordable and available.”

                      Yes, it is to cover unexpected *large* costs or there is no need for it.
                      Which still leaves you arguing for something which has done nothing of the kind.

                    5. I’m arguing for the ACA insofar as it’s better than what we had a few years ago. This does not mean that there aren’t more preferable options, or that it can’t be improved upon. More than anything though, I’m arguing for an honest assessment of healthcare in general, and rejecting the multitude of “healthcare is easy, all we have to do is X!!”

                    6. What you’re doing is privileging the law merely for being the law. Since PPACA is in place, we must fix or improve it, rolling it back is out of the question.

                      Most people here will point out that this has been the dominant trend over the last 60+ years (ever since wage controls + beneficial tax treatment caused people to get insurance from work instead of buying it themselves).

                      Instead of asking “what did we do wrong that we can undo?” every government merely piles on new fixes that further worsen the situation.

                      There is a free-market fix for the purported problem of “people won’t be able to get insurance anymore”.

                      Instead we have layers of problems. CON laws, supply-control of medical professionals, regulated treatment costs, etc.

                    7. I would agree that rolling back the ACA would be the right thing to do if it’d make healthcare better, but we know what healthcare looks like sans ACA – it sucked, and was getting worse.

                      If your proposal is even more rollbacks of various laws, regulations, etc., along with some new pieces like health-status insurance; cool. But that’s not the same thing as just hitting the reset button on the ACA and calling healthcare “fixed.”

                    8. “I would agree that rolling back the ACA would be the right thing to do if it’d make healthcare better, but we know what healthcare looks like sans ACA – it sucked, and was getting worse.”

                      Not nearly as bad as O-care made it. Please quit lying; it does not help your already lame case.
                      ————————————–
                      “If your proposal is even more rollbacks of various laws, regulations, etc., along with some new pieces like health-status insurance; cool”

                      You seem to think your lefty opinion of what constitutes improvement matters. It doesn’t.

                    9. It would be disingenuous of me to say I don’t favor “lefty” options; my top pick for healthcare is single payer. But I also realize that not everyone agrees, and that it’s not the only option we have.

                      In this instance, what I’m more after is the admission that healthcare prior to the ACA was bad and getting worse, and that something had to be done. Also, while there’s plenty to criticize in the ACA, I think it gets unfairly bashed – there’s a logical progression to the whole law, and I suspect it was close to the best that could be made under the circumstances.

                    10. “I’m arguing for the ACA insofar as it’s better than what we had a few years ago.”
                      Claiming facts not in evidence. We have the medical care we had before, while the taxpayers are paying people to buy insurance they don’t want.

                      “I’m arguing for an honest assessment of healthcare in general, and rejecting the multitude of “healthcare is easy, all we have to do is X!!”
                      Actually, it isn’t difficult: Get the government out of the medical care market and it will self-correct in a hurry.

                    11. “Insurance companies can work as long as $Premiums > E($AnnualPayouts) + $Margin”

                      It’s even better than that:
                      $Ps + $from investments + $M (greater than) $Es.
                      Most insurance companies make money on the investments rather than the premiums; See, oh, Warren Buffett.

  3. …it does not by itself guarantee that Republicans, who have long been wary of uniting around legislative specifics, will repeal or replace the health care law.

    Considering the Democrats got completely destroyed in the mid-terms following Obamacare’s “passing”, one can see how congressional GOP’ers would shy away from taking their turn at fucking up the nation’s health insurance and in turn its healthcare systems. You don’t win elections by putting your name on any bill not named for the latest tragedy. But the Republicans will only be able to eat their lunch based on Obamacare for maybe one more election cycle. They better get cracking.

    1. You don’t win elections by putting your name on any bill not named for the latest tragedy.

      “The Obamacare Clusterfuck Reversal Act”.

      1. Finally, calling a bill what it really means.

  4. This will get batted around and the press will propagandize against all who try to repeal it.

    The bottom line is that there will be no unrestricted competition across state lines nor will there be more choice as a consequence. I hope for better but really, what are the chances that an industry that is riddled with special interests will be able to be fixed by actually allowing open competition, which is always the best solution for the consumer?

    1. And again, people keep focusing on the insurance part of health care when it’s the actual care part that needs the major overhaul with respect to increasing competition and bringing down prices.

      1. Isn’t it frustrating trying to explain this to friends or family? Have you had that displeasure? It’s like the financial crisis, there are so many moving and overlapping parts that explaining it briefly and comprehensively are mutually exclusive undertakings. And the competing narrative, “banksters/insurers are just greedy,” as dumb and flat as it is, is hugely compelling for people who are rationally ignorant on the subject.

      2. Most definitely it does, but the insurance companies really mask pricing indicators. The question right now is does my insurance cover it? Yup, okay get it.

        The insurance companies are too big and slow to move with the market on individual medications or treatments or even doctors. Opening up cross state insurance would most definitely help alleviate this aspect of the market.

        Now that is not to say that they’re just screwing us all over. They’re not, their profit margins suck. The money is going into the healthcare industry, not the insurance companies, so I get what you’re saying, but lack of competition due to red tape in the insurance market means that insurance companies need not or can not put pressure on bringing prices down.

        1. I would like to add that the biggest culprit in healthcare costs is the FDA. A truly evil organization that has caused the death and suffering of millions by jacking up costs and pushing back medications and devices years that could have saved people in the mean time.

          1. What, do you want children to die of horrible side effects because those greedy pharmaceutical companies couldn’t be bothered to test their products before injecting them into kids?!?!!!

  5. “Ultimately, legislation to repeal and replace the health care law will have to be driven by Congress.”

    In the meantime, though, Obama has set the precedent that just about every word in the PPACA can be waived by the executive branch, including “and” and “the”, and the Supreme Court has ruled that just about every word in the PPACA can be interpreted in precisely the way the executive branch wants to interpret it, especially “penalty” and “tax”.

    1. Nice.

      I may have mentioned this before to all those who were squalling about the possibility of Obama’s edicts being descended – Ok, you wanted a king to make edicts? You got one. You get a new king, you get new edicts. Isnt it amazing they cant understand the simple concept that having unchecked power means it will eventually fall into the wrong hands?

      RC Dean – Me today, you tomorrow.

      My Wife – When you are considering how much power government should have imagine that power in the hands of the most depraved person imaginable because it is going to eventually fall into the hands of the most depraved person imaginable.

      1. Your wife is a smart cookie. I may have to steal that.

  6. This time of year I do my year-end tax planning. I’m self-employed so I have quite a few options. I’m a geezer, so ObamaCare with a $12,600 deductible costs around $15000/year for my wife and me. I make over 400% of poverty line so, if I don’t take some action, I won’t get the $9500 ObamaCare subsidy. However, there are a three things I can do to get the subsidy. First, a $30000 contribution to an individual 401k. Second, a $7000 contribution to an HSA account. Third, I’m going to buy a new computer and accessories for around $3000. After subtracting the $40,000 from gross income, I can get AGI below 400% of poverty line and qualify for the subsidy.

    Of course, that means I need $40,000 in ready cash. Fortunately, I’m a lifelong saver and fairly affluent. Because I’m rich, I can get the subsidy. If I didn’t have the means to scratch together $40,000, I wouldn’t get the subsidy. This is the sort of “fairness” that Democrat legislation achieves. Kind of like the “fairness” that encourages dimwits to go college and become burdened with student loans and the “fairness” that encourages uncreditworthy people to buy houses they can’t afford.

    1. ObamaCare is even more obscene than permitting rich people to get subsidies while depriving less affluent people of a subsidy if they have AGI over 400% of poverty line. ObamaCare also deprives people of a subsidy if they have AGI less than 100% of poverty line. (The geniuses that designed ObamaCare relied on the stupidity of the American voter, and assumed that all states would expand Medicaid. They may have been right about the stupidity of voters, but not the stupidity of state legislatures which would have to pay for it.)

      1. Of course, that means I need $40,000 in ready cash.

        “May The Force be with you.”

    2. Third, I’m going to buy a new computer and accessories for around $3000.

      If you wait another month…

      PC master race or GTFO.

      1. I really wish I had enough free time and money to justify an $800 graphics card purchase.

          1. Are the curved diplays really worth the cost? I’m going to need a new TV within the next 2 years and I’ve no experience with them.

            I’d like to try chaining monitors for gaming purposes, but it’s probably 15 years before I have the free time to treat video games as anything more than a relaxing bit of downtime. I’m sure something better and cheaper will come along by then.

            1. Tbh the curve thing seems gimmicky. I assume there’s some benefit to having all that widescreen real estate closer to your eyes, but it’s such a slight angle I can’t imagine that alone would make it worth the pricetag. I could be wrong.

              But it’s just icing on the high refresh rate IPS screen at 1440p.

              1. I always assumed the curve was to curb reflections off your monitor.

                Makes sense to me at least.

            2. the acer one is. do not got ultra wide at 1080.

    3. If only Carribean vacations were tax deductible …. 8sigh*

    4. This is the sort of “fairness” that Democrat legislation achieves.

      Just like it’s totally fair that I pay $2100 in rent so my wealthier, older neighbors can pay $500. Affordable housing in action!

    5. “…If I didn’t have the means to scratch together $40,000, I wouldn’t get the subsidy….”

      It costs a lot of money to remain in poverty.

    6. Kind of like the “fairness” that encourages dimwits to go college and become burdened with student loans and the “fairness” that encourages uncreditworthy people to buy houses they can’t afford.

      I just heard something on NPR where a wealthy family was shown that their kid was getting welfare for college, and they didn’t even know it. The Mother justified it, couched her argument in fairness and talked about the benefits of sending her kid to college. This was immediately after admitting they sent their son to the much more expensive college because they preferred the “intimate feel” of the campus.

      1. What welfare is there for college? Is this “welfare” actually some kind of income tax deduction or credit?

        1. No. It’s a long but interesting story.

          Welfare reform in the 90s allowed localities to shift welfare funds into things that fell into four major categories. One of those categories was mitigating out-of-wedlock pregnancies.

          The states can earmark welfare funds into those categories by simply checking a box on the flimsiest of evidence.

          Somewhere, a study shows that kids who go to college are less likely have unwanted pregnancies. Therefore, welfare money is funneled into college grants– given a different name- and anyone– regardless of income can qualify for these grants.

          So essentially, the rich kid is going to the more expensive college, you’re footing the bill, and the State’s Interest is minimizing unwanted pregnancies.

    7. You should put this example in front of every zealot who claims, “..Obamacare premiums are very affordable…after the subsidies”
      Just like rent control, there are always to game the system.

  7. Alright. Where is Peter Suderman and what have you done with him?

    1. His head exploded on November 8th and this is Ron Bailey’s cloning experiment in progress.

    2. Perhaps Mrs. McCardle is covering for her husband while he convalesces.

    3. The jacket made him write a piece that was not anti-Trump after the election. He had to take some time off to psyche himself up for it.Now he is so ashamed that he drowning himself in whiskey, cuddling with an 8×10 frame of Obama, listening to Kate McKinnon’s rendition of “Hallelujah” on repeat.

  8. 1. Break the state line barriers to insurance pools
    2. Stop penalizing High Deductible plans
    3. Expose prices to the consumers
    4. Tax incentives for HSA’s
    5. Provide HSA based vouchers for people who cannot afford health care insurance
    6. Problem solved.

    1. See. The left was right all along. Republicans and Libertarians criticize Obamacare but they don’t offer any ideas of their own.

    2. Repeal ObamaCare.

      Deregulate health care. Not 100%, of course, but about 90%. Keep the 10% that makes fraud difficult.

      Deregulate health insurance. Not 100%, of course, but about 90%. Keep the 10% that makes fraud difficult.

    3. “1. Break the state line barriers to insurance pools”

      You’re running up against a system that has been set up to account for the state lines that administer Medicaid. Providers get a tiny fraction from the government for providing care to Medicaid patients; they have to effectively gouge other private pay patients to make up for those losses. Each state has different payer groups, different ways of administering their programs, etc. that have a serious impact on the providers in their state–and how they reimburse themselves for Medicaid patient losses by gouging private pay patients. You have to restrict the market distortions you cause with your Medicaid rules to the providers who are set up in those state to deal with those distortions. Otherwise you’ll end up like California did with electricity deregulation. (See Gray Davis).

      Ultimately, Medicaid is the biggest source of the problem, and eliminating it is the solution to that problem. Medicare is also a source of the problem, but Medicare intermediaries cover a broader geographical area and their reimbursement rates are higher (although they still reimburse providers for less than the cost of care).

    4. The best solution short of eliminating Medicaid is to stop requiring hospitals to serve Medicaid patients. Have government run clinics. Have government owned and operated emergency rooms in areas with large concentrations of Medicaid patients. Let private hospitals send Medicaid patients from the ER to a government hospital once they’re stabilized.

      Making private industry give away healthcare below cost and leaving them to gouge private pay patients for the difference is the problem. The government needs to either pay the full cost of care (instead of a small fraction of it) or they need to provide the care themselves–like they do at the VA, only more so.

      1. Medicare/Medicaid is not the lowest payer, they are the highest payer. The days of Medicare/Medicaid being the lowest payers are long gone. Now, they essentially set the bar and the private market goes under it. ”

        Otherwise, interesting points.

        1. “Medicare/Medicaid is not the lowest payer, they are the highest payer”

          Uh,
          “Wonder why some doctors grumble when a Medicare patient walks in the door? It’s likely because the government program typically pays only 80% of what private insurers do.”
          http://money.cnn.com/2014/04/2…..index.html

          1. Yeah, the doctors who serve high concentration areas of Medicaid patients typically make it up in volume.

            Those are the doctors you go to and whether you have a heart condition or the flu, they give you five minutes.

            The only people who want to go to those doctors are people who’ve never known anything better.

            Why would you want to go to a doctor that treats you like a widget on a conveyor belt?

            We can do better than this for the poor, even.

        2. It’s true that doctors get paid by Medicare and Medicaid . . . okay. They get paid more than the cost of care.

          But that isn’t true of hospitals.

          Here’s an article that brings a few figures to bear.

          Average Cost for Heart Attack with Four Stents and Major Complications.

          $166,174

          Amount reimbursed by Medicaid:

          $27,397

          Average Cost of Intestinal Procedures with Major Complications:

          $248,105

          Amount reimbursed by Medicaid:

          $44,794

          Permanent Pacemaker Implant:

          $127,038

          Amount reimbursed by Medicaid:

          $20,836

          How do the providers make up for all the money they lose on Medicaid patients?

          “In an effort to survive the healthcare system, hospitals determine how much it costs them to treat a patient with insurance. They then multiply that cost by a factor of two, three or whatever number they think will help bring in enough money to help cover the costs of treating patients who don’t have any insurance.

          Hospitals attempt to make more money on patients who have insurance in an effort to treat the uninsured, which is why you don’t see people dying in the streets. And this explains why a hospital charges more than what you’d expect for services ? because they’re essentially raising the money from patients with insurance to cover the costs, or cost-shifting, to patients with no form of payment.”

          http://www.multibriefs.com/bri…..D3PfVyI44M

          1. They have to price gouge to make up for all the merchandise they lose to the government’s shoplifting.

            I used to work for a hospital with a large number of Medicaid patients in the area. They tried to play that game for along time, but ultimately, there just weren’t enough privately insured patients in that part of town. Their solution was to close. Now that neighborhood has to go to the emergency room across town. It’s unconscionable.

            1. My knowledge of this comes from working in health care; my employer is a durable medical equipment provider (prosthetics, in case you were interested). The top payers are 1) worker’s comp, a government-subsidized program, 2) Medicare. Medicaid is about 20% less than Medicare, as are private insurers. This is true across health care – except hospitals, apparently.

              Interesting bit of history: Medicare paying more than private insurance is technically illegal under the original law. 20 years ago, Medicare was the low bar. But now, private insurers negotiate for 20-30% lower than Medicare; it has become the high bar.

              Many health care providers are able to get by only because of the margin between Medicare and private insurers. Essentially, public health payments are subsidizing private insurers.

              1. I think DME (durable medical equipment) is viewed differently than cognitive E and M (Evaluation and Management) services. DME reimbursements seem to be very high–Medicare pays an exorbitant amount for wheelchairs and walkers which can be purchased at the nearest Goodwill for $10-20.

                E&M and particularly procedures are not reimbursed well under Medicare. Anesthesia in particular describes Medicare payments as multiples (i.e. several hundred percent) less.

              2. My experience with this comes from working reimbursement in a private hospital in Los Angeles for seven years and then working as the quality control analyst for a company that did the reimbursement software, groupers, etc. for some of the biggest hospitals and hospital chains in the country.

                Some codes pay better than others for various reasons. Ventilators for poor crippled children and prosthetic limbs moms may pay higher than other things simply for political reasons. We’re talking about general averages. When you take all the hospital codes and average them out, Medicaid pays a fraction of the dollar billed–12.5 cents last I checked. Medicare pays about 25 cents. And Aetna pays somewhere around 80 cents.

                Your particular products may take advantage of well reimbursed codes, but that does not speak to how hospitals are reimbursed for codes across the board.

                1. I’m not nearly as familiar with the inner finances of hospitals, so I’ll take your word for it.

                  Up until the ACA, the prosthetic and orthotic field was basically free-range. Providers could bill for virtually anything, and payers, public or private, wouldn’t look twice. It was ripe for abuse, and abuse happened. The ACA is a huge bill, and some of it’s lessor-known parts are meant to address this type of stuff. Not just in P and O either – do you remember the stories about doctors who billed Medicare/Medicaid outrageously higher amounts than other doctors in the same field? That’s what the ACA is trying to clean up. It’s a painful process for the people in the field(s), and a lot of providers are closing up shop, but it’s necessary.

                  Not really responding to your post specifically, I just find it interesting.

              3. “My knowledge of this comes from working in health care;”

                You’re “knowledge” has been shown to be buillshit.

          2. P.S. The reason insurers only want you to go to providers who are in their network is to protect them from gouging. They have contracts with providers in their network that limit the cost of care. If you end up in another facility with which they have no contract, they’re paying through the nose.

            They’re just hoping and praying that you don’t get into an accident or have a heart attack at work–and get admitted through the ER of a provider they don’t have a contract with. ’cause then they’re up shit creek.

    5. 1) Eliminate about 3/4 of the reporting requirements that are driving doctors to scale up practices to get services at an affordable scale
      2) Offer a dollar for dollar tax credit for every pro bono service performed at their going rate to private insurances for every procedure performed or hospital stay.
      3) Let doctors write off non-payment as a tax deduction after two years to encourage pro bono procedures. That is, if you send someone a bill and they can’t pay it, you can write off the bad debt after you carry it for two years, but it counts as a deduction from your adjusted gross, not a credit towards the tax burden that you would get if you never billed in the first place.

      1. You need to renumber those 7, 8, 9.

  9. “It does not by itself guarantee that Republicans, who have long been wary of uniting around legislative specifics, will repeal or replace the health care law.”

    Reform can’t be ignored much longer. Insurers abandoning the exchanges and taking huge losses on ObamaCare patients are one reason. The medicaid expansion cost overruns are another reason.

    If they could get away with doing nothing, I could see inaction, but they won’t be able to avoid it for long. Might as well do it quickly and blame it all on Trump if things go wrong.

    “Price’s plan would result in a huge net savings to the federal government?about $2.3 trillion over a decade”

    I might have said those savings would go to the taxpayers, but whatever.

  10. Of course any attempt at reform will have to run a media gauntlet of talking heads screaming that without Obamacare exactly as His Majesty established it nobody will be able to see a doctor and we’ll all be dying in the streets.

    1. I’m not fan of scare tactics, but legitimate points should get legitimate coverage. Price’s plan will almost certainly result in people, sick people, not being able to get coverage. People will probably die.

      I’m going to be super clear here in that a massive “death panel” style scare campaign is not a good thing. But just ignoring the drawbacks of Prices plan is also a bad thing.

      1. People die now. What’s your point? When an insurance company tells a mother that she isn’t cleared for the expensive treatment, but is for palliative care, isn’t that just a death panel? That happened in 2016. Whatever you think Obamacare fixed, it did not fix the problem that medical care places competing demands on finite resources that can be allocated to multiple uses. You know what makes the most efficient allocation of competing demands on finite resources that can be allocated to multiple uses? A free market. Everything else will give suboptimal results. What you’re arguing for is how rich you have to be to avoid those results.

        1. “What you’re arguing for is how rich you have to be to avoid those results.”

          Or how politically connected.

        2. So much this, Brett L.

        3. I agree with you, I though that was clear from my post. My point is that each plan has drawback and advantages, and talking honestly about what those things are is the goal.

      2. “I’m not fan of scare tactics, but legitimate points should get legitimate coverage. Price’s plan will almost certainly result in people, sick people, not being able to get coverage. People will probably die.”

        You show up on about every socialized medicine thread trying to convince the rest of us here that we just haven’t thought it through like you have and then backing that up with the same propaganda we get from the other lefty trolls.
        Socialism DOES NOT WORK, period, and the medical market is a market like any other. Diddle with it, and it will get screwed up, as is has since Truman was too stupid to let wages float.

        1. Pleasant dreams, but a real free market in medical care is not going to happen. A monstrous chimera of market and government elements designed to benefit financial institutions and other cronies works far worse than a single-payer system. We have to choose between the real possibilities.

          1. Yes, Benjamin Rush was right.

            “Unless we put medical freedom into the Constitution, the time will come when medicine will organize into an undercover dictatorship to restrict the art of healing to one class of Men and deny equal privileges to others; the Constitution of the Republic should make a Special privilege for medical freedoms as well as religious freedom.”

            And it is not coincidental that religious freedoms have suffered directly from the current regime either.

            None of which is a reason not to attempt some release of the ratchet.

  11. “Price’s plan would eliminate the Medicaid expansion entirely, with no replacement. That may have less impact than previously expected, however. As Brian Blase of the Mercatus Center noted yesterday, new research indicates that about two thirds of Obamacare’s Medicaid enrollees were previously eligible?meaning they would have been able to get coverage without Obamacare, and would not be affected by repeal.”

    To dream the impossible dream
    To fight the unbeatable foe
    To bear with unbearable sorrow
    To run where the brave dare not go

    To right the unrightable wrong
    To love pure and chaste from afar
    To try when your arms are too weary
    To reach the unreachable star

    This is my quest
    To follow that star
    No matter how hopeless
    No matter how far

    To fight for the right
    Without question or pause
    To be willing to march into Hell
    For a heavenly cause

    And I know if I’ll only be true
    To this glorious quest
    That my heart will lie peaceful and calm
    When I’m laid to my rest

    And the world will be better for this
    That one man, scorned and covered with scars
    Still strove with his last ounce of courage
    To reach the unreachable star

    https://www.youtube.com/watch?v=bHrqrlZYsDA

    And it doesn’t mean anything without Gomer Pyle

    Anyway, the problems with our healthcare system will be resolved to the extent that Medicaid and Medicare are eliminated from the system.

  12. They had better fucking repeal it, given that they control both houses and the presidency. if the D’s could ram it through reconcilliation, so can they.

    And that includes the pre-existing conditions mandate and the community ratings parts. However, Mr. Populist has already signaled he doesn’t want to get rid of the “popular” parts so good luck with that.

    1. “However, Mr. Populist has already signaled he doesn’t want to get rid of the “popular” parts so good luck with that.”

      I think what he signaled is that the voter market won’t put up with that. You can only sell what the market will buy.

      Like I said, “Impossible Dream”.

      It’s one thing to take healthcare away from people who might get sick in the future. Quite another to pull the rug out from under people who already have life threatening conditions, are maintaining themselves with medication, dialysis, etc.

      Again, I’m not saying that’s the way it should be; I’m saying that’s the way I think he’s reading the voter market. Here’s what they’ll put with; here’s what they won’t put up with.

      1. And what about morality? Are you, personally, comfortable with pulling the rugs out from under people who need coverage and access to drugs, care, etc.? I’m all for a brutally honest look at what can feasibly be done from a financial perspective, and I’m aware it might mean some people – many people, even – getting less than optimal coverage. But I think it poor form to just dismiss those concerns in the name of free markets or something.

        1. “And what about morality? Are you, personally, comfortable with pulling the rugs out from under people who need coverage and access to drugs, care, etc.?”

          Yeah, what about that?
          “Down’s patients denied medical care”
          […]
          “In some cases parents of Down’s syndrome children have been invited to withhold life-saving treatment for a condition that is perfectly treatable.”
          http://news.bbc.co.uk/2/hi/health/291355.stm

        2. From a morality perspective, no one should be relegated to Medicaid. People only cling to it because they have no other option.

          A freer market would offer poorer people more and better options than Medicaid, and as I outlined above, people would have more and better options if it weren’t for Medicaid.

          Medicaid is the source of the problem. That the richest, large scale country in the world is artificially inflating costs so badly that our poor are relegated to something as bad as Medicaid is morally unconscionable.

          When I look at the hospitals that get into trouble in Los Angeles, it’s the ones with high Medicaid populations: King Drew, Harbor UCLA, etc.

          Like I said, I think there should be a transition period, but first things first, you have to exit Medicaid patients from the private system.

          Currently, Medicaid pays about an average of twelve and a half cents on the dollar billed–not a true barometer of cost, for sure, but telling. Show me a hospital with financial problems, and I’ll show you a hospital in a neighborhood with a high percentage of Medicaid patients.

          If they’re going to be on the government program, the government needs to pay 100% of their costs. Maybe that means the cost of Medicaid goes up 300% to the taxpayers–but the providers in those areas will be able to offer care for what the care costs rather than making sick people and their insurers pay both for themselves and everyone on the Medicaid program.

          1. The solution where uninsured people who stay in a hospital bed for a few days and get a bill for $12,000 dollars when it should be $1,000–just because they didn’t qualify for Medicaid–is also morally unconscionable. Meanwhile, if the cost of Medicaid went up some hypothetical 300%, the government would get busy figuring out how to wean people off of the program.

            The solution to keeping spending down on the Medicaid program is not to refuse to pay hospitals for the full cost of treating patients.

        3. Are you going to merely stand there and watch it happen?

          Or are you, like others, going to stand there seeking political advantage while watching it happen.

          Because other people will at least try to assist them. People like the Little Sisters of the Poor.

          And maybe they’ll have more resources to do so now that they aren’t having to fight government attempts to force them into immoral acts.

          Funny how that morality thing works, isn’t it?

          1. I’m not a Catholic, but forcing nuns to underwrite the fornication of their employees if they want to provide people with healthcare . . . that’s definitely also unconscionable.

            1. Sorry, I don’t buy that argument. Healthcare is healthcare is healthcare, and that includes contraception.

              1. Shorter Mortiscrum: “My Morality is the Only Morality.”

                Yeah, I kinda new that already.

              2. Well it isn’t your religious beliefs that are under siege either.

                Why should your opinion of other people’s religious convictions matter?

                You think our rights are only valid if you like them?

                1. You miss the point.

                  It’s not what I (or you, or anyone else) think of other people’s religious convictions (or even their non-religious based concept of morality) it is the absolute certainty that ‘healthcare’ trumps any and all of them.

                  Even – arguendo – if we accept that contraception is healthcare what he is saying is that that must compel us to provide it either willingly, or by government coercion, lest we be deemed immoral.

                  My argument is that government coercion essentially renders all of it amoral if not necessarily (although quite possibly) immoral.

                  1. Also, if you do not notice the confluence between “what is most moral” and “what government must provide/control” then you are not paying attention.

                  2. Let me fully explain my position: ideally, employers aren’t the main vehicle of insurance coverage. This change would solve this entire issue, as religious organizations would no longer be in the position they are now. I’m not entirely dismissive of their morals; I balk at employees, or patients, being forced to comply with those morals.

                    I don’t think employers should be compelled to provide healthcare – but if they to do it, I don’t think healthcare should be a vehicle for an employer to enforce their morals on their employees (or even worse, patients).

                    1. The employer mandate, viewed specifically, is a side issue at best. I only alluded to it to note that issues of morality cut both ways.

                      Your answer, while reasonable to the specific issue, still does not address the premise inherent in your question.

                      “And what about morality? Are you, personally, comfortable with pulling the rugs out from under people who need coverage and access to drugs, care, etc.?”

                      Just because someone’s morality may assign them a moral duty to assist those in need does nothing to establish a mandate that government be the one to enforce that obligation.

                      You need to square that circle.

                2. No, but I do think your rights end where someone else’s nose begins.

                  Religiously affiliated hospitals are often the only health provider in a given area. I think there’s a compelling public interest in saying that hospital must provide care according to best medical practices, not religious doctrine.

                  1. mortiscrum|11.29.16 @ 3:59PM|#
                    “Religiously affiliated hospitals are often the only health provider in a given area. I think there’s a compelling public interest in saying that hospital must provide care according to best medical practices, not religious doctrine.”
                    Move. No one guarantees you health care ‘in a given area’
                    Put another way, fuck off, slaver.

                  2. ” I think there’s a compelling public interest in saying that hospital must provide care according to best medical practices, not religious doctrine.”

                    You think there is a compelling public interest that the dictates of a profession trump the moral teachings of a religion?

                    And just what is the moral foundation of this profession that it can claim such authority?

                    (You really haven’t thought this through, have you? )

                    1. Just because someone’s morality may assign them a moral duty to assist those in need does nothing to establish a mandate that government be the one to enforce that obligation.

                      Let’s take this one step further.

                      Even if I believe that:
                      1. It is my obligation to care for the needy, and
                      2. agreeing to have the government provide that fulfills my obligation

                      What does it say about my morality that I am willing to have the government will compel other people who do not agree with me?

                    2. In a word, yes, I do believe that. If a religious doctor knows that their beliefs will prevent them from best medical practices, they should not swear the Hippocrate Oath.

                      If a person is against gay marriage, they don’t also get to keep their job that requires then to sign marriage licenses when gay marriage is legal.

                    3. You are still dodging the question of just who decides what ‘best medical practices’ are and why those people warrant such authority.

                      Or do you think they are delivered from on high?

                    4. No, I think they are developed by the best and brightest scientists, doctors, and medical ethicists, and shouldn’t be constrained by the vagaries of religious belief. Am I really being that unclear or unreasonable?

                    5. mortiscrum|11.29.16 @ 5:08PM|#
                      “No, I think they are developed by the best and brightest scientists, doctors, and medical ethicists, and shouldn’t be constrained by the vagaries of religious belief. Am I really being that unclear or unreasonable?”

                      You are very clear in your wish to dictate to others. We, fortunately, just celebrated the death of another dictator.

                    6. mortiscrum|11.29.16 @ 4:28PM|#
                      “In a word, yes, I do believe that. If a religious doctor knows that their beliefs will prevent them from best medical practices, they should not swear the Hippocrate Oath.

                      If a person is against gay marriage, they don’t also get to keep their job that requires then to sign marriage licenses when gay marriage is legal.”

                      One of these is not like the other, and I’m assuming you’re not bright enough to know why.
                      Nor am I going to waste time educating a lefty twit.

                    7. It’s also pretty rich coming from a guy who is trying to argue against any elimination of government healthcare on a moral level.

                      Insisting that healthcare be dictated by ‘best medical practices’ yet never noting how many times government healthcare dictates just what a medical professional will and will not be paid to provide.

                      He’s either severely dense or arguing in bad faith.

                    8. Or, like, fifteen.

                    9. “He’s either severely dense or arguing in bad faith.”

                      S/he’s been here for nearly every O-care thread for, oh, several months. S/he presumes we are opposed to O-care since we just haven’t thought it through like ‘scrum; we’re just not blessed with the higher level of knowledge and morality.
                      IOWs, s/he’s like every other lefty troll who shows up to tell us how s/he just found the one fatal problem in libertarianism and we (who have spent years examining the issue) have missed it.
                      Let’s start with this: s/he simply does not accept that socialism is immoral on principle and offers suboptimal results on utility.
                      No, it’s just that we don’t have the proper tweaks to the system.
                      I repeat; fuck off, slaver. You don’t own me.

                    10. I’m surprised you included he and she pronouns. That’s almost politically correct!

                    11. Yeah, my guess is he’s primarily intellectual dishonesty. In the sense that he is fundamentally unwilling to lay his own ideological cards on the table.

                      He’s only secondarily dense in that he thinks we can’t see through to them.

                    12. “Yeah, my guess is he’s primarily intellectual dishonesty. In the sense that he is fundamentally unwilling to lay his own ideological cards on the table.
                      He’s only secondarily dense in that he thinks we can’t see through to them.”

                      I’ll add that there’s a degree of hubris in the assumption that s/he’s obviously correct while we just simply refuse to bow to ‘top men’.

                    13. Nope, I’m arguing in good faith – though perhaps with a touch of devil’s advocate.

                      When I brought up the moral implications of ending a program like Medicaid, I think it imperative that we do that with good reason and full awareness of the trade-offs. I’m not saying it shouldn’t be done, necessarily, but I do think their should be a damn good reason for it.

                      Often times, I feel that healthcare debates circle around private vs public in a theoretical sense – like, the people who argue for privately run healthcare markets do so because they believe in the power of private markets, while proponents of public options do so because they believe in the power of government. I think a more direct question though is “What do we want our health care system to do, and why? And what is the best way to meet those goals?”

                    14. Horse Shit.

                      From start to finish you are still dissembling.

                      “What do we want our health care system to do, and why? And what is the best way to meet those goals?”

                      As if the only possible answer is a collective one.

                      That’s called begging the question.

                    15. “I think a more direct question though is “What do we want our health care system to do, and why? And what is the best way to meet those goals?””

                      “OUR healthcare system”? Is that a turd in your pocket?
                      Personally, I want to be able to afford the best medical care I can; screw your “system” and your pathetic efforts to direct it, comrade.

                    16. Actually, they’re the same in the way I was using: In both cases, a person takes a job knowing full-well they will be constrained in their ability to do the job by their personal beliefs.

                      More explicit example: If I applied to be a garbage man, but then refused to go near garbage because I have a weak stomach, I would be rightly fired – I’m not doing my job! If someone says becomes a doctor, they better be prepared to fulfill their duties as laid out in the Hippocratic Oath – having a personal belief system that doesn’t let them do that is not doing their job.

                    17. Stop talking about this mythical “person” and explain where authority over this person’s actions are derived from.

                      You’ve been presented multiple opportunities to explain yourself, yet you refuse to do so.

                      It’s obvious.

                      And drop the ‘Hippocractic Oath’ nonsense. It marks you as a simpleton.

                      Better yet, try reading the damn thing and see if it mentions contraception… Then explain to me why it needed to be revised into a modern version and just exactly who authorized those changes.

                    18. Alrighty, I’ll try to present my position on a number of points and make this as crystal-clear as I can. In no particular order –

                      1) I would like to there to be more dialogue around what we as a society want healthcare to be in this country. How available is it? How comprehensive? How much are we willing to pay? These are all factors and to a degree conflicting variables. Once that is determined, a method of how best to reach those goals can be determined. As it stands, there’s a lot of ideological grandstanding about healthcare rights, free markets, etc. It kind of skips over the question of “What are we even trying to do with healthcare?”

                      1) a) Yes, it’s “our” healthcare system. We all live here, in the grand US of A. It’s our government, our roads, our healthcare, our society, our laws, etc.

                      2) If someone chooses a certain profession, and is recognized as such by society, they are morally and in some cases legally compelled to fulfill the obligations of that profession OVER their own personal beliefs. In fact, many professions have oaths of service they must swear to exactly this effect (policeman, doctors, soldiers, financial planners). I don’t see how a doctor’s, and by extension a hospital’s, personal beliefs about contraception or abortion trump this oath of service. If a person is unable to set aside their personal beliefs enough to do that job, they should not be doing that job at all.

                    19. First, it’s not “healthcare”; it’s up to you to keep yourself “healthy”. It’s medical care.

                      “1) I would like to there to be more dialogue around what we as a society want healthcare to be in this country. How available is it? How comprehensive?”

                      Fine. First we agree that medical care is an economic good like any other. That way, we can start logically rather than emotionally.
                      ———————————————–
                      “1) a) Yes, it’s “our” healthcare system. We all live here, in the grand US of A. It’s our government, our roads, our healthcare, our society, our laws, etc.

                      And you’ve already blown it.
                      Is it “our legal professional system”? “Our real-estate sales system”? No. It’s you hire a lawyer or an RE professional if you need one.
                      ——————————————–
                      “2) If someone chooses a certain profession, and is recognized as such by society, they are morally and in some cases legally compelled to fulfill the obligations of that profession OVER their own personal beliefs.”

                      Fuck off, slaver

                    20. I’m happy to talk with you if you can abide by some rules of civility – in fact, that’s why I’m here – but if you’re just going to reject my position out of hand and tell me to fuck off, than I’ll be forced to bid you adieu.

                      RE: 1) a) Please elaborate. How is this not the case? I assume you live in the US. Do you not feel that the country is “yours?” Do you not have a interest in the country’s operations?

                      RE: 2) Please elaborate. Codes of professional conduct is the foundation of how it’s even possible to “hire a professional if you need one.” When I need lawyer, I can find one and be reasonable certain they are going to act in a certain way BECAUSE of oversight from BAR associations and the like.

                      Are you saying these codes of conduct shouldn’t exist, and there should be no oversight over any profession?

                      A free market, do a shitty job and don’t get hired any more solution is also possible, I suppose, but I struggle to see how that would be preferable.

                    21. “I’m happy to talk with you if you can abide by some rules of civility – in fact, that’s why I’m here”
                      You are here in the hopes you can ‘talk some sense’ into those who have called your brand of BS for years, which in large measure results in the lack of civility. How often do you think I and others here have been over this ground? It is plowed 10′ deep.

                      “RE: 1) a) Please elaborate. How is this not the case? I assume you live in the US. Do you not feel that the country is “yours?” Do you not have a interest in the country’s operations?”
                      A country is not a goods market; we do not have a “grocery system”, we have grocery stores offering a variety of goods, quality and prices.
                      Your presumption of a ‘system’ includes the presumption of direction for that system, and centralized planning, in case you’ve missed it, suffers from the ‘knowledge problem’. Neither you nor the best imaginable management team can match the most basic ‘price = knowledge’ process of a market. None.
                      Any time a ‘disinterested’ party sticks its nose in a free transaction between two moral agents, one (or both) of those agents loses, as does mankind in general. This is true of ANY market, including the market for medical care.
                      cont’d.

                    22. cont’d.

                      “RE: 2) Please elaborate. Codes of professional conduct is the foundation of how it’s even possible to “hire a professional if you need one.” When I need lawyer, I can find one and be reasonable certain they are going to act in a certain way BECAUSE of oversight from BAR associations and the like.”
                      Which says nothing about “a system”.

                      “Are you saying these codes of conduct shouldn’t exist, and there should be no oversight over any profession?”
                      Which says nothing about “a system”.

                      “A free market, do a shitty job and don’t get hired any more solution is also possible, I suppose, but I struggle to see how that would be preferable.”
                      Which says nothing about “a system”, and see above; Do a shitty job in a government agency and get promoted.

                    23. What do you mean by “which says nothing about a system”?

                      To me, a “system” is whatever has been put in to place, intentionally or haphazardly, to achieve a goal. In this way, a collection of unrelated stores selling food becomes the “food delivery system.” We all have to eat, and most of us don’t want to farm and hunt. So we buy it. So we need stores. Just because it wasn’t planned out from the get-go doesn’t mean it’s not a system.

                    24. mortiscrum|11.29.16 @ 11:21PM|#
                      “Just because it wasn’t planned out from the get-go doesn’t mean it’s not a system.”

                      If you keep changing subjects and definitions, why, you could be a really good salesman. If you had really dumb customers. Cut it out; that sort of happy horseshit doesn’t fly here.
                      We do not have a “grocery system”, we have individual grocery stores offering their goods to individual buyers who may shop there or somewhere else. So, yes, it means it is not a “system”.
                      Your pitch for a ‘healthcare system” has nothing to do with that arrangement.
                      And I’ll point out that your claim of ‘civility’ is being tested in that you seem to be either not bright enough to understand or understanding and being ‘clever’ in claiming otherwise. Insulting the intelligence of those from whom you might learn something is not a good idea.

                    25. I was not trying to redefine definitions, I was merely clarifying how I define the word “system.” You have a much more narrow sense of the word, apparently.

                    26. “I was not trying to redefine definitions, I was merely clarifying how I define the word “system.” You have a much more narrow sense of the word, apparently.”

                      Quit bullshitting. You were defining it to include anything at all in the hopes it advanced your argument.
                      You were busted and your argument is crap besides.

                    27. mortiscrum|11.29.16 @ 5:20PM|#
                      “Actually, they’re the same in the way I was using: In both cases, a person takes a job knowing full-well they will be constrained in their ability to do the job by their personal beliefs.”

                      As I said, you aren’t bright enough to understand..

                  3. It’s a good thing healthcare isn’t a right then.

              3. mortiscrum|11.29.16 @ 2:28PM|#
                “Sorry, I don’t buy that argument.”

                Sorry, I don’t buy your line of bullshit.

  13. Does This Mean Trump Really Wants to Repeal Obamacare?

    No. Next question.

  14. Ultimately, legislation to repeal and replace the health care law will have to be driven by Congress.

    Obama disagrees.

  15. Trump can just declare that the individual mandate is not a tax, and Obamacare is not justified under the Commerce Clause, and he cannot enforce laws that are inconsistent with the constitution. Simple!

    1. I don’t think repelling it outright is the problem. It’s what happens after that.

      1. “I don’t think repelling it outright is the problem. It’s what happens after that.”

        You’re a lefty propagandist, so your opinion really isn’t worth much.

        1. Left-centrist, actually. Statist, maybe. Propagandist? Not so much.

          1. mortiscrum|11.29.16 @ 11:13PM|#
            “Left-centrist, actually. Statist, maybe. Propagandist? Not so much.”

            Your choice:
            “Propagandist” or “useful idiot”. Knave or fool.
            Either one is fine by me.

  16. A single-payer, socialized system is coming. It’s inevitable. No private, deregulated regime that would actually be better is politically feasible. It’s time to give up this fight and start working on a single-payer system. As Quintus said in Gladiator, “people should know when they’re conquered.”

    1. So who’s our Gladiator to prove that wrong?

      1. You mean, who’s our Alaric to prove that wrong.

    2. It’s inevitable.

      No, it’s not. The most likely outcome is just a greater clusterfuck than what we have.

      1. In the near term, maybe. Eventually, the cluster will get so fucked that popular demand for single-payer will be irresistible.

        1. Oh, you mean the clusterfuck that is the VA health care system. Because that is what government run single payer will turn into. Up above “morticscum” mentioned people may die if we repeal Obabacre. Well, in the VA health care system people are dying from lack of proper medical care. That is what single payer will turn into.

          And then they can’t get rid of the bad managers. They just shuffle them around to different hospitals and facilities.

          1. VA is even worse than single payer, because the government also operates the VA hospitals, on top of paying for them.

            Mind you single payer turns into single provider pretty fast, because when healthcare is “free”, the only way to control spiralling costs is to introduce wait times, and you can’t do that while there are competing providers willing to take customers on.

            1. I was merely pointing out that people dying for lack of medical care was all too common pre-ACA, and that it had been reduced (not eliminated) with the introduction of the ACA. If you want to argue that the costs are not worth the benefits, fine, but less people dying for lack of coverage IS a benefit of the ACA.

              I have another question though: if single payer is so bad, how are so many other countries doing pretty well with it? I’m talking pure outcomes here; other countries with single payer healthcare beat us in many healthcare related stats, like child morality, life expectancy, obesity, death during child birth, etc. Oh, and satisfaction with their healthcare.

              1. mortiscrum|11.29.16 @ 11:11PM|#
                “I was merely pointing out that people dying for lack of medical care was all too common pre-ACA,”

                Bull
                .
                .
                .
                .
                .
                shit.
                Fucking liar.

                “I have another question though: if single payer is so bad, how are so many other countries doing pretty well with it?”
                Bull.
                .
                .
                .
                .
                shit.
                Fucking liar.

  17. RE: Trump Picks Tom Price For HHS Secretary. Does This Really Mean He Wants to Repeal Obamacare?
    Ultimately, legislation to repeal and replace the health care law will have to be driven by Congress.

    What?
    Repeal Obamacare?
    But…but how will The State control all the little people if The State doesn’t control health care?
    What would Lenin say?

    1. The fear of brutal and capricious law enforcement seems to be working well.

  18. Want prices to go down?

    1) Create a publicly available database of what’s actually being paid by the insurance companies for every single procedure, doctor, hospital, drug, et al. – you can’t shop for a cheaper price unless you know what’s being charged.

    2) Nobody gets away without a co-pay – skin in the game makes great shoppers.

  19. Facebook gives you a great opportunity to earn 98652$ at your home.If you are some intelligent you makemany more Dollars.I am also earning many more, my relatives wondered to see how i settle my Life in few days thank GOD to you for this…You can also make cash i never tell alie you should check this I am sure you shocked to see this amazing offer…I’m Loving it!!!!
    =====================> http://www.homejobs7.com

Please to post comments

Comments are closed.