Democrats Defect from Obamacare

Meanwhile, the GOP learns to stop worrying and love Obama's signature legislative victory.


For practically all of the Obama administration, the partisan battle lines over the Affordable Care Act were clear. Democrats love it. Republicans want to kill it. End of story, right?

But at the end of 2016, as President Barack Obama prepared to leave office and the health care law entered another open enrollment period, something unexpected happened: Democrats stopped defending Obamacare. It wasn't despair over the law's fate in the hands of President Trump. The trend began when Hillary Clinton was still the presumptive winner.

In October, Minnesota's Democratic governor, Mark Dayton, complained publicly that although the health law had "many good features," it was "no longer affordable to increasing numbers of people." Around the same time, Democratic House Minority Leader Nancy Pelosi, whose determination to pass health care legislation helped push the bill over the congressional finish line in 2010, was asked on Meet the Press about the high price of health insurance premiums under the law. "Let's see how it works, and let's improve it," was her response. She also noted, as she has before, that what she would really "love" is a single-payer system. Just three years before, as the law's coverage expansion kicked in, she had touted it as a path to "more affordability, more accessibility, better-quality care, prevention, wellness, a healthier nation honoring the vows of our founders of life, a healthier life."

Also in October came complaints from former President Bill Clinton about a provision of the law that provides financial assistance to individuals at between 100 and 400 percent of the poverty line. "The people that are getting killed in this deal are small business people and individuals who make just a little too much to get any of these subsidies," he said at a rally in Michigan. He called the subsidy scheme "crazy" and declared that "it doesn't make sense. The insurance model doesn't work here."

Clinton was stumping for his wife. And Hillary, who just a few years earlier had blasted Republicans as a "noisy minority" engaged in "bad politics" for their opposition to the law, wasn't doing much to defend Obamacare either. In the month prior to Bill's remarks, she had only mentioned the Affordable Care Act once in campaign trail speeches—somewhat unusual given the law's prominence—and then only when Obama was in the room.

After Bill's comments made news, Hillary issued a begrudging follow-up statement. "I've been saying we've got to fix what's broken and keep what works," she said, "and that's exactly what we're going to do."

This was the Democratic presidential nominee's defense of her predecessor's signature achievement, the most expansive and expensive piece of social welfare legislation signed in a quarter century: Keep the parts that work, and fix what isn't working. It was an acknowledgement, as if anyone needed it, that the law was broken and was no longer desirable in its current form.

To be sure, no Democrat would be signing on to any GOP repeal vote in the near future. The Democratic opposition is subtle. But it is real.

More and more, Democrats have stopped defending the actual legislation as it exists on the books and in the real world. Instead, they have started arguing in favor of what might be described as a hypothetical "good parts" version of the law. They defend the idea of Obamacare, of a government-granted guarantee of affordable universal coverage, rather than the whole legislation itself.

Donald Trump's inconsistent and often incoherent opposition to the law—he promised to repeal and replace it with some unspecified alternative—meant that Democrats did not have to respond to detailed Republican attacks on the system. Instead, pressure came from the legislation's real-world failures. From spiking premiums to dwindling plan choice to blatantly illegal payouts, 2016 was the year that Obamacare finally became indefensible.

To understand why Obamacare went so wrong in 2016, you have to understand its history and design. Obamacare was always politically contentious. When debate over the legislation that would become the Affordable Care Act began in 2009, Republicans were unified in their opposition to the law. The public, too, was always wary: For essentially all of the health law's life, more of the public has opposed it than supported it. Committed Democrats were its only basis of support.

The law was challenged repeatedly at the Supreme Court, and though it survived, it did not remain unchanged. In particular, the Court altered Obamacare's expansion of Medicaid, the health program for the poor and disabled jointly funded by the states and the federal government, which was one of the two main ways that the law expanded insurance coverage. After a 2012 Supreme Court challenge, states gained the option to decline to expand Medicaid under the law without risking federal matching funds.

The law's other major mechanism for expanding coverage was a system of subsidies for middle- and lower-middle-class Americans to buy health insurance. That kicked in at the beginning of 2014, but it struggled out of the gate. Most of the online health insurance exchanges—some run by individual states, some managed by the federal government—were essentially unusable for months after they went online in October 2013. Even after they became usable, back-end systems remained incomplete for years, causing headaches for insurers, who had to manually compile and submit information about what subsidies they were owed by the government.

At the same time, it became clear that Obama's repeated promise that anyone who liked their current health care plans and doctors would be able to keep them was false, and that millions of individuals would be forced to drop their coverage and providers. Through an executive action of dubious legality, the Obama administration issued a fix allowing some people to remain on non-compliant plans. But that only raised questions about whether health plan sign-ups in the exchanges would actually hit government projections.

Beyond the questions about total enrollment numbers, there were also questions about the demographic mix of people who would enroll under the law. Obamacare's insurance scheme was reliant on a sufficient percentage of relatively young and healthy adults signing up for coverage. Because these people use less medical treatment, and are thus less expensive to cover, their premiums would balance out the sicker and more expensive enrollees. If the young and healthy didn't sign up, premiums would rise, meaning that at the margins, fewer people would choose to purchase coverage, leading to more premium hikes, even fewer sign-ups, and so on, eventually resulting in what was widely described as a "death spiral."

All of this turmoil set the stage for 2016, a year in which Obamacare seemed to be, if not fully descended into a death spiral, standing on the precipice of one.

As it turned out, enrollments in the exchanges have come in far below initial projections. The Congressional Budget Office (CBO) initially predicted that about 21 million people would be signed up for coverage through the law's exchanges in 2016. In January, the nonpartisan budget office slashed the estimate to about 13 million. In March, it fell to 12 million. That same month, the Centers for Medicare and Medicaid Services (CMS), the federal agency that oversees the law, announced that it expected an "effectuated enrollment"—that is, people who have not only signed up for coverage but are up to date on their payments—of just 10 million for the year.

So it was little surprise when health insurers, who had entered the Obamacare business in hopes of finding a large new customer base, eventually began looking for the exits.

At the end of 2015, UnitedHealth, one of the nation's largest health insurance companies, said on an earnings call that it was likely to scale back its presence in the exchanges the following year. The decision, an executive explained, was driven by about $425 million in expected losses on individual exchange products. Part of the reason for the losses was that the people who had signed up were far sicker, and more expensive to cover, than expected. And while the administration had repeatedly promised that those numbers would improve over time, UnitedHealth saw no indication that the trends were changing.

In April, the company made its decision official, announcing that it would cease selling Obamacare plans in most states. Loss projections, the company said, had grown to about $650 million. Nearly 800,000 people covered by the company's Obamacare insurance would be left to find new plans.

The law's defenders downplayed the move, noting that UnitedHealth had entered the exchanges late and was not ultimately a major player. "We have full confidence—based on data—that the marketplaces will continue to thrive for years ahead," a spokesperson for the Department of Health and Human Services said at the time.

But UnitedHealth's exit was just the beginning. In July, citing losses of $1 billion, Humana said that it would scale back from selling plans in 1,351 counties across 19 states to offering Obamacare coverage in just 156 counties in 11 states. In August, another major U.S. insurer, Aetna, announced that it too would scale back its participation, ceasing to sell in 11 of the 15 states where it had operated.

Around the same time, several of the co-ops—a series of smaller, state-based nonprofit insurers set up using government-backed loans under the law—announced that they would be closing up shop at the end of 2016. Most of the co-ops had struggled from the outset; by the fall of 2016, just seven of the 23 created under the law remained open for business. They too cited operating losses and a sicker-than-expected population.

As insurers bolted from the market, plan choice dwindled—and premiums skyrocketed. The law's problems were particularly acute in Tennessee. In September, BlueCross BlueShield of Tennessee (BCBST) said that it would leave the state's largest markets, Nashville, Knoxville, and Memphis, leaving 130,000 customers to find new plans. BCBST had already requested and won permission for an average 62 percent rate hike in the state; the company expected a $500 million loss in 2017. Two other insurers operating there, Cigna and Humana, had requested rate hikes of 23 and 29 percent, respectively, but had been allowed to refile at even higher rates—46 and 44 percent. The state's insurance commissioner allowed the move out of fear of a mass exit of insurers, warning that the state's Obamacare exchange was "very near collapse."

As it was, BCBST's partial exit left many without much choice of plans. According to The Tennessean, 72 of the state's 95 counties will be served by just one carrier in 2017.

Nationally, the number of insurance plans available in the exchanges was also dropping dramatically. About a third of the country's counties would be served by just one insurer in 2017, according to an estimate by Avalere, a health policy consultancy. In Arizona, one county very nearly ended up with no insurer providing exchange coverage at all. Only after receiving approval on a 51 percent premium hike did Blue Cross Blue Shield of Arizona agree to sell Obamacare plans in the county. The company agreed to sell there even while facing substantial losses in its overall Obamacare business, and urging policy makers to stabilize the market—making it clear that it couldn't sustain such losses for long.

As it turned out, exchange enrollments have come in far below initial projections. Obamacare in 2016 seemed to be, if not fully descended into a death spiral, standing on the precipice of one.

This is the fundamental problem for insurers, and for the law: Not enough people are signed up. More specifically, not enough healthy people are signed up. Virtually every insurer that has pulled back from the law has cited losses stemming from a sicker and more expensive than expected exchange population. That means insurers have to raise premiums to cover costs.

More than a year after UnitedHealth's earnings call, there is little reason to believe that the situation will improve. In October, the financial analysis firm S&P Global forecast that overall Obamacare enrollment was likely to stagnate in 2017. And more insurers look ready to ditch their Obamacare business. In November, as the exchanges opened for business, Anthem—which sells Blue Cross Blue Shield plans in 14 states—said that "overall the financial performance in individual ACA compliant products has been disappointing." The company hinted that it might follow its competitors and pull back next year. "If we do not see clear evidence of an improving environment and a path towards sustainability in the marketplace, we will likely modify our strategy in 2018," Anthem Chief Executive Officer Joseph Swedish said on an earnings call. If Anthem does back away, it would mean that all of the major national health insurers had substantially scaled back their business.

Obamacare was sold as a market-driven system in which private insurers would compete for business. But the business—regulated, managed, and designed by the federal government—was never as good as promised. The customers didn't show up, and now the insurers are on their way out too.

President Obama's signature on the health insurance reform bill at the White House, March 23, 2010. Photo by Chuck Kennedy

The slow meltdown of the exchanges happened against a backdrop of other problems. An August CMS report found that the cost of the Medicaid expansion was about 50 percent higher than expected on a per-capita basis, coming in at just over $6,300 per person—meaning that the Medicaid portion of the law is much more expensive for the federal government, which pays the full cost of the Medicaid expansion up front and 90 percent in later years.

Legal challenges remained too. In September the Government Accountability Office issued a report finding that the Obama administration had been wrongfully making payments to health insurers via its reinsurance program, which Republicans in Congress had been investigating. In a separate case, a federal judge ruled in May that the Obama administration had been illegally reimbursing health insurers under the law's cost-sharing program, which provides additional subsidies to individuals between 100 percent and 250 percent of the poverty line. The administration, in other words, was still trying to prop up Obamacare illicitly.

In its final days, the Obama administration was pushed into admitting some of the law's struggles. In October, newly released data forced the White House to admit that premiums for "benchmark" health insurance plans in the exchanges—a kind of typical plan on which the law's subsidies are based—would go up about 25 percent on average.

Administration officials attempted to downplay the news, arguing that about three quarters of customers would be insulated from the hikes because the subsidies would increase along with the cost of the premiums. But that means the overall cost of the law to the public will be higher. The administration also justified the increases by noting that premiums, which had initially come in somewhat lower than CBO projections, were merely rising to be closer to what was initially projected. But that's hardly a comfort to the individuals affected by the hikes, most of whom were probably not basing their expectations on CBO projections. And it ignores the limited choice and skimpy quality of the plans on offer. As Mercatus Center health policy scholar Brian Blase noted in October, Obamacare exchanges tend to have "extremely high deductible policies with very narrow provider networks," which means they "are generally lower quality than CBO expected when the law passed."

One administration official simply shrugged off the increases by saying that the initial rates had been too low. "The reality is, I think in many markets the rate increases are just needed," acting CMS administrator Andy Slavitt told the Association of Health Care Journalists in October. In a September op-ed published as many of the premium hikes were starting to become public, Health and Human Services Secretary Sylvia Matthews Burwell euphemistically described 2017 as a "transition year" for the law, suggesting, with more hope than evidence, that this would be a one-time shift.

Even Obama seemed to treat Obamacare more as a policy foundation than as something complete and functional unto itself. Its successes were real, he insisted, but "that doesn't mean that it's perfect. No law is."

As the election neared, it was left to Obama himself to mount a full-throated defense of the law that bears his name. On the eve of the election, he delivered an extended speech praising it for providing millions of people with health insurance coverage, for reducing health care cost inflation to its lowest level in years, and for making health coverage available to those with pre-existing conditions.

"Because of this law," he said, "because of Obamacare, another 20 million Americans now know the financial security of health insurance…Never in American history has the uninsured rate been lower than it is today. Never."

But even Obama seemed to treat Obamacare more as a policy foundation than as something complete and functional unto itself. Its successes were real, he insisted, but "that doesn't mean that it's perfect. No law is." He tempered his praise by framing the end of his speech as a question about how to address the system's "growing pains."

That, in itself, represented a failure for both the president and the law. Speaking about universal health care in 2009, as the Affordable Care Act struggled to make its way through Congress, Obama declared, "I am not the first president to take up this cause, but I am determined to be the last." The election of Donald Trump all but ensured that he would not be.

As Obamacare continued to show signs of strain, the public remained firmly divided over the system's merits, which was itself a problem. Democrats had enacted the law without clear public support and over the strenuous objections of the opposing party, and the political dynamic had changed little in the ensuing years. Frustration over the law's failures, which Donald Trump bashed repeatedly on the campaign trail, almost certainly contributed to the surprise GOP sweep in November's election. Its ultimate fate would be left up to a political party that opposes it.

In the weeks after the election, Republicans declared that they would tackle the health law immediately after Trump assumed the White House in 2017. Vice President–elect Mike Pence said in November that Trump "wants to focus out of the gate on repealing Obamacare and beginning the process of replacing Obamacare with the kind of free market solutions that he campaigned on." Speaker of the House Paul Ryan suggested that Republicans might go even further by overhauling Medicare as well. And Trump named Georgia Republican Tom Price, a staunch critic of Obamacare and the author of one of the most detailed legislative plans to repeal and replace the law, to head the Department of Health and Human Services, signaling the administration's strong opposition to the law.

But just as quickly, it became clear that repealing Obamacare would be difficult, as both a political matter and a legislative process—and replacing it might be even tougher. Republicans lacked the 60 votes in the Senate necessary to defeat a filibuster, meaning that the law could not be repealed in its entirety. (Ending the filibuster remained a possibility, but several GOP senators expressed wariness about doing so.) Instead, Republicans would be left using a complex legislative process known as reconciliation, which can only be used on measures that affect the federal budget. This maneuver would allow them to strip out many of the law's core components, including its subsidies for private insurance, but might leave some of its coverage regulations in place, depending on judgment calls by the Senate parliamentarian (although some critics of the law argue that reconciliation could be used to repeal those regulations too).

Nor was it clear that Republicans truly had the appetite to repeal the entire law. Several GOP legislators said that a provision allowing dependents up to age 26 to stay on their parents' plans would almost certainly be kept. In anonymous interviews, GOP aides suggested that the Medicaid expansion, responsible for much of the law's coverage gains, might also stay in place. And any major rollback that did occur would almost certainly be delayed for a year or two while Republicans tried to put a replacement plan together.

Down-and-out Democrats find themselves sticking up for Obamacare in name only. At the same time, Republicans rail against the law while quietly considering the merits of maintaining many of its core components.

Even with more time to figure things out, a Republican replacement might not be forthcoming. GOP legislators spent most of the Obama presidency promising that a comprehensive replacement plan was imminent, but they didn't manage to release even an incomplete framework—principles, not policy—until 2016. Sen. Lamar Alexander (R–Tenn.), the chair of the Senate Health, Education, Labor, and Pensions Committee, which would be critical to the development of any real plan, suggested that crafting a detailed alternative would take around six years. Although various Republicans have sketched out some paths forward, the party has failed for years to unite around any one of them. Repeal and delay, then, threatens to turn into delay without repeal.

A Trump administration could act without Congress, hastening the insurance-market meltdown by refusing to fund the illegal payments to insurance companies. But Republicans seemed anxious about taking that approach as well: Days before Thanksgiving, House Republicans filed a motion to delay the lawsuit challenging the legality of the Obama administration's payments.

Trump himself, meanwhile, seemed to waver on his opposition to the law. Although he frequently lambasted Obamacare on the campaign trail, it was never clear that he understood what it did or how it worked, and he never offered a coherent alternative. Nor, despite his running mate's suggestion to the contrary, did the preferences he stated consistently rely on free market principles. On multiple occasions, Trump offered praise for single payer systems; at other points, he seemed to describe provisions that would look a lot like Obamacare.

And so D.C. is trapped in a kind of bipartisan Freaky Friday scenario. Down-and-out Democrats find themselves sticking up for Obamacare in name only, while gesturing vaguely at an ill-defined glorious future. Meanwhile, newly empowered Republicans rail against the law while quietly considering the merits of maintaining many of its core components.

As always, the possibility remains that Trump will change his mind. Just days after he won the election, he met with President Obama, who urged the incoming president to keep significant parts of the health care law in place. After that meeting, Trump said that he would consider doing so.

NEXT: Brickbat: Difficult Labor

Obamacare Death Spiral Republican Party Repeal and Replace Democratic Party

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162 responses to “Democrats Defect from Obamacare

  1. Trump’s a businessman and I suspect he’ll jettison the provisions that don’t appear to be working and maintain the provisions that do, whether under the remnants of the ACA proper or as part of a new health act (that will most likely provide for purchasing insurance across state lines). Not ideal but probably a better deal from both a health care delivery perspective and a libertarian perspective. The Republican congresscritters, on the other hand, are showing themselves to be as inept as they seem to be on damn near everything here as well.

    1. They are going to keep the popular aspects of the law which also happen to be the things that do the most to prevent it from ‘working.’ Allowing coverage for preexisting conditions defeats most of the purpose behind having health insurance.

      1. Coverage for preexisting conditions is not insurance, it’s welfare. Which is why it is popular.

        1. It’s not so popular with me; my health care premium has gone up more that 400% since the ACA was signed, plus I make too much for the subsidies, which also means that I pay a higher tax rate. If Bill Clinton can admit to the lunacy of this, one would hope that perhaps Congress will see it.

        2. Insurance companies (before the ACA) didn’t just decline applications for people that would immediately prove to be unprofitable – the insurance companies also made judgments as to the probabilities of an applicant ever costing them too much money in the future. It didn’t take much in somebody’s medical history to be deemed unacceptable by insurance companies. I speak from experience as somebody who used to sell health insurance (from 1981 to 1997) and as somebody who has experienced first hand the difficulty of obtaining an individual policy due to past (not current) health issues.

          1. Assuming that’s true–and I’ve got no particular reason not to believe you–it’s still not the responsibility of a private health insurance company to provide insurance to anyone and everyone who applies, profitable or not. There’s definitely a problem with health care costs in this country, but addressing the cost of health care by forcing insurance companies to cover people they normally wouldn’t while forcing people who don’t want insurance to buy plans they don’t need is throwing gasoline on the fire.

            1. Exactly. High health insurance costs is a symptom of a deeper disease – a politicogenic increase in the price of healthCARE.

              This article does an excellent job of explaining the long history of government intervention in healthcare markets; they are absolutely not “unregulated” as Obamacare supporters claimed.

              1. Given the relative powers of the various stakeholders, the ACA is exactly what the US political system could be expected to produce: a system to coerce people to deal with private parties (the insurance companies) at a disadvantage in order to enlarge the companies’ receipts, with some payoffs to the proles to get them to sign on. As one Welfarist said to me, ‘It’s bad, but it’s the best we’ (meaning the proles) ‘could get.’ Thus the ambivalence of the Democrats about it.

                However, the goodness or badness of the ACA is not their present interest. That is the opportunity to torture the Republicans with it. Either the Republicans will have to go to a great deal of trouble to rewrite the ACA into something that will do just about the same things, or they will have to abolish many of its Welfaristic aspects and enrage its beneficiaries (many of whom voted for Trump and other Republicans), or they will default. (I’m betting on the last.) The more leftish Democrats will also use the defects of the ACA to push Single Payer. Sometimes losing is a winning strategy.

      2. AFAIK, insurance companies were allowed to cover pre-existing conditions before O-care; it’s just that nobody chose to do so, for understandable reasons. O-care doesn’t merely allow plans to cover pre-existing conditions, it requires that they do so.

        1. “hi, my house is on fire. figured it’s a good time to buy home-owner’s insurance.”

          “no problem at all sir, we have to cover you!”

          1. “That will be $50,000, please. From each of your neighbors as well.”

          2. “Hi, I had a fire in my house – in one room – several years ago. The damage was all repaired and we had the house completely re-wired because we learned that the old wiring caused the problem.”

            Before the ACA, the insurance company would likely say “tough shit – you had a fire and we think you will again, so we don’t want you as a customer.”

            1. “Hey, I need you to walk my dog. He’s bitten several dog walkers in the past, but the $20 I’ll pay you will offset the $500 you’ll have to pay if he happens to bite you. But don’t worry, he hasn’t done it in a really long time.”

            2. The health insurance industry would refuse to cover a healthy individual who had completely recovered from a non pre existing disease?

              If you do all your stunts like Jackie Chan or have 20 years of obesity problem, the insurance company would avoid you.

              1. Those are questions we really, really don’t need to have a national conversation about.

        2. I think the solution for the pre-existing condition as well as the exceeded maximum allowance dilemmas should have been handled by Medicaid. The difference being is that as long as the beneficiaries have the ability to pay, they should pay. So once you except Medicaid reimbursements for one of those situations, you start having to make monthly payments into the Medicaid system plus a penal tax if you were under insured to begin with by your own fault in the case of exceeding the maximum. For preexisting condition coverage you would have to prove that you could not get private insurance coverage within your ability to pay for it . You would not be allowed to stop paying for the Medicaid reimbursements until you’ve paid back the full amount plus the penaltax if any. Not perfect but better than Obamacare and addresses the two biggest issues the media was harping on.

          1. The hospital’s get paid and the beneficiaries have to absorb as much of the cost as they can afford. Are we still getting screwed as taxpayers, sure, most of those amounts will never be fully reimbursed but we’re going to get screwed one way or another so we should at least recoop what we can. I think the key is that you make having insurance much cheaper than not having it through the penalties. Maybe you do 25% interest on the balace due or something. The payments should also greatly exceed what your premiums would have been if you just choose to not have insurance or adequet coverage even if you could have afforded it.

            1. At least our insurance premiums would have not gone through the roof.

          2. Nah, best to not cover pre-existing conditions at all. Healthcare is not a right.

            The living will have a better life.

            1. Feel free to start up an insurance company that will follow prog feelz as a business model. Good luck even drawing any initial investors, much less staying in business…

            2. In practice, no system provides adequate healthcare to everyone. Some ration with queues (and in many cases, healthcare delayed is healthcare denied), some force people into debt, some offer to pay for healthcare but at rates which ensure few doctors will actually provide services, some just skip on costs and provide shitty healthcare to all. Some restrict it to those who can pay, and some mitigate that with insurance.

          3. Don’t forget about the dominance of employer-provided health insurance (with its tax code quirks). The pre-existing condition problems were primarily part of the individual insurance marketplace, not employer-provided plans. It’s worth noting that plenty of people (especially workers over age 50-55) were “safe” regarding health insurance as long as they kept their jobs that provided coverage – but (prior to the ACA) would have had trouble obtaining individual policies.

            I have no doubt that the ACA exchange business has been unprofitable for some (many?) insurance companies because of “sicker” applicants, but I also know that prior to the ACA that plenty of people who merely used to be sick were turned down for coverage. The free market falls short when it comes to health insurance.

            1. And where do employers get their healthcare? The businesses that cover their employees obviously want to retain their talent or attract new ones. That’s the market in action.

              The individual market place had incentive to deny or modify coverage to patients with pre exising conditions to prevent massive price hikes on everyone else in the insurance pool. Most people who favor single payer system would instantly balk at the idea if the price of gas went up to 5,6 dollars tomorrow – but that was the standard in Europe no that long ago.

              Keep in mind that insurance companies have to cover costs that are entirely fixed. No politician will reduce Doctors and nurses salary and administrative fees that drives up healthcare cost. Big drug companies can make their deals with hospitals and providers and push out smaller competitors.

              Claims denial rate wasn’t that high to begin with. It was 3 to 11% depending on the sources, and many eventually found coverage elsewhere or won on appeal. Some people were denied due to paperwork errors.

              1. Employer-provided health insurance mutes many market forces when it comes to health care and heath insurance consumption. Employer-provided health care is a relic from the post WWII wage and price freeze. Employers competed for workers offering insurance since they couldn’t offer high wages. The employers got a tax deduction, the employees had zero tax liability for that part of their compensation – and that flaw continues today. Employees have no say in what type of health insurance they receive, they are shielded from the cost of insurance (at least in part) and their incentives to shop for health care have been reduced by decades of low deductible and low co-pay plans. Of course, costs continue to increase, so deductibles are increasing.

                1. I would add that employer-provided health insurance also means that if I leave an employer for some form of self-employment or unemployment, or for a company that for whatever reason cannot provide health insurance, I’m up a creek without a paddle, because, short of COBRA (which has its own problems) I can’t take insurance I like with me.

                  Sure, I can sometimes get a life insurance policy from my employer…but I have since had other employers since purchasing my own policy, and keeping life insurance has never been a hassle. That’s the glory of self-provided insurance. It’s a pity that our tax and regulation system is stacked against purchasing our own insurance!

        3. also, some companies had waiting periods of varying lengths before actually covering whatever condition might have been involved. But yeah, no one was eager to accept the previously uninsured person now facing a major expense.

        4. Yep. My old boss couldn’t change insurance companies because his wife had ongoing issues related to having polio as a child. The rate savings for the rest of us wouldn’t quite make up for the rate increase for her, and the insurance company wanted “all or none” of our business.

      3. So… guess you shouldn’t have developed that lymphoma before your insurance company dropped the plan you were on?

    2. “that will most likely provide for purchasing insurance across state lines”

      Because the insurance commissioner of Oklahoma will want policy dictated by the one from Maine. Assuming that he does, this has been tried: http://www.rwjf.org/content/da…..rwjf401409

      But try it again, because this time it’ll work because it will be done by the “best people, smart people”

      1. No it’s not about dictating policy, it’s about allowing consumer choice.

      2. The real problem is that places like OK and ME will be at the mercy of the populous states, particularly CA.

        1. This is one of the places where the Commerce Clause could actually *help*. Preventing CA officials from interfering in commerce between CA businesses (for example) and OK or ME customers.

      3. You’re right, that’s a totally insurmountable problem. It’s not like every single other insurance policy I carry is located outside the state of my residence…

  2. Donald Trump’s inconsistent and often incoherent opposition to the law?he promised to repeal and replace it with some unspecified alternative

    I fail to see how promising to repeal it and replace it with a plan to be specified later is “inconsistent and often incoherent”. In fact, the current (rumored) plan to pass a law immediately repealing effective in a couple of years strikes me as a politically very smart – get the repeal done without getting tangled up in the details of “replacing” it, and then have the replacement done under the hard deadline of the effective date of repeal.

    1. I don’t see that either. It is almost like Suderman has a tick that causes him to never admit Trump has a point no matter how obvious it is.

  3. The people Obamacare helped were going to vote Democrat for the foreseeable future, but the ones it burdened suddenly realized they had been abandoned by the party. A few congressional Democrats started to realize that, as well, when Trump started striking a chord with voters in working class blue areas.

    1. 2018 will be a bloodbath for Team Blue if they don’t play ball. Their best bet is to let the Republicans fuck up like we all know they’re going to so that future foul ups are on them.

      1. Past Democratic social programs have primarily benefited the middle class. Social Security and medicare are more or less middle class entitlements. That is why they are popular. They are also popular with young and old because even though young people don’t get checks themselves, their parents do and they don’t want the burden of taking care of their parents.

        Obamacare is something entirely different. It does not benefit the middle class. It totally fucked the middle class. Lost in all of the “our system is broken and millions don’t have insurance” bullshit that was put out before its passage, was the fact that something like 75% of the public both had health insurance and was satisfied with it. Obamacare reduced the quality of healthcare available and raised its price for most people in the country all to benefit a fairly small group of people, most of whom were Democratic voters anyway. It was never going to be popular and anyone who gave the issue any thought should have seen as much.

        As much as I loath the people who passed this, the idiots on the right like Rob Dreher and David Frum and Sudderman who were sure its passage would lead to an endless Democratic majority are just as stupid.

      2. Will the blood be blue or red?

    2. That’s why only *real* taxpayers and land owners should be allowed to vote, else we have those who don’t support the government voting themselves a piece of the pie of those that do.

      1. I don’t think tying suffrage to land ownership makes as much sense these days as it may have in centuries past. A lot of people rent. There are plenty of productive people who rent for a variety of reasons…

        – They just moved to a new town and haven’t settled on a house yet
        – They choose to rent because they foresee moving in a few years
        – They’d rather live in a high-rise apartment close to their job than a far-away suburban house

        I do think that taxes should have some bearing on whether or not you’re allowed to vote, however. Those who are living off of others should not get a say in how much cash gets funneled their way. Don’t like it? Get out of poverty (or solicit voluntary aid from friends, family, and private charities) and you can vote along with everyone else.

  4. affordable universal coverage

    You can have one or the other, you can’t have both.

    The first lesson of economics is scarcity: There is never enough of anything to satisfy all those who want it. The first lesson of politics is to disregard the first lesson of economics.
    -Thomas Sowell.

    1. But America spends 16% of its GDP on healthcare! Most in the world! And we get the WORST RESULTS! It’s known.

      One thing I’d be very curious about is just how many hidden costs go along with the ‘universal’ systems elsewhere. Parts of paying for the system that bean counters put under some other column.

      1. A lot of it just comes down to rationing, which is why universal healthcare tends to be shitty healthcare.

        1. That is part of it. But the part that interests me most is the bullshit about ‘administrative’ costs. A category that not only isn’t the same in every country, but which governments have all different sorts of ways of manipulating and hiding costs. Even here, Medicare’s ‘administrative’ costs are severely under reported because a number of other agencies are involved besides HHS. Biggest and most obvious example being the IRS.

        2. Yes – all systems ration care. Ours does too, just with a somewhat different approach.

      2. Well over half of that money was already being spent by government on one level or another and most of the rest was controlled by government in one way or the other. We got the worst of both combined.

        I don’t know about other states, but here the insurance commission mandates what has to be covered plus sets the maximum prices even for ostensibly private insurance.

        I can’t fathom how anyone could believe that you could provide more services and add additional layers of bureaucracy and still think you can come up with lower costs.

        It’s all unicorns.

      3. “One thing I’d be very curious about is just how many hidden costs go along with the ‘universal’ systems elsewhere. “

        These systems are appearing “work” (mostly in Scandinavia) because there are very different conditions in those countries.

        – Scandinavian countries are incredibly wealthy with robust capitalist economies. If you look up economic freedom rankings from the World Bank and International Monetary Fund, you’ll see that Scandinavian countries often outrank the US in economic freedom (despite the perception that they’re “basically socialist”). Yes, they have a lot of welfare spending, but they generally have less burdensome regulation than the US.

        – Scandinavian culture is different. There’s a strong work ethic along with a belief that one should contribute to the community as a whole. The result is that the disincentive presented by high taxes for social welfare spending is not as strong as it would be in other countries. There is also a stigma against being a welfare “leech”.

        – The US is far outpacing the rest of the world in medical and pharmaceutical innovation. In other words, other countries are spending little to nothing on R & D while new drugs and devices are periodically made available to them. This is because in the US – as overregulated as the industry may be – companies still stand the best chance of making a profit on these innovations.

    2. “The first lesson of economics is scarcity: There is never enough of anything to satisfy all those who want it. The first lesson of politics is to disregard the first lesson of economics.
      -Thomas Sowell.”

      That sounds pretty racist! This Thomas Sowell guy must be some hardcare white nationalist to spew right-wing tripe like that.


  5. You know what I’m not seeing?

    Any evidence that there are better outcomes from our health care system since OCare went into effect. There’s lots of (cooked) numbers on the increase in coverage (protip: its almost all Medicaid expansion), but coverage is just a means to the end of getting better healthcare. So, can anyone point to whether we have actually accomplished the real goal of delivering better healthcare? If not, what’s the point of all this?

    1. Averaged lifespans for not-so-rich white people decreased for first time in a long time last year, so there’s that.

    2. By the time the rubes realize that they aren’t really covered for anything, or that Medicare sucks, they’ll probably be dead before the next election, anyway. The point of all this is to allow your political party to take credit for things. The left is obsessed with the notion of everyone being ‘covered.’ And they don’t particularly care about/for honest discussions over the quality of said coverage.

    3. “…There’s lots of (cooked) numbers on the increase in coverage (protip: its almost all Medicaid expansion), but coverage is just a means to the end of getting better healthcare.”

      Which is the reason you won’t see better outcomes.
      Increased demand on already limited supply is bound to reduce the quality of the services delivered; it can’t be otherwise.
      And increasing demand by making it free to the user means the increase will be wasted in trivial matters.

    4. You are not seeing evidence because none exists. Life expectancy has actually gone down. The only “positive” results from this are cargo cult numbers like “number of insured” and I am not even sure about that.

      1. A large part of the “number of insured” consists of people who had to sign up because they had their previous plans cancelled, thanks to Obamacare.

        1. Around 5mm people lost coverage when OCare went into effect. So, the first 5mm who signed up after it went into effect are catch-up, but the vast majority of “coverage” increases are Medicaid expansion. The rest, the expansion in private commercial plans, are what you would expect from a slow economic recovery.

          Its entirely possible that OCare has not led to any increase in coverage outside of Medicaid. And, it has made coverage worse in economic terms.

          It will be interesting to see what the exchange enrollment looks like this year.

          1. “Around 5mm people lost coverage…”

            So Obamacare also screws really, really short people? At least they weren’t overlooked.

    5. Well, our vaunted health care system kills – by accident or preventable error – up to forty times more people than are murdered with firearms. So it’s not, and never was, a “healthcare” bill; it’s only a “who’s gonna pay the bill” bill, by shifting the burden up the tax brackets a bit (although the intent was for the young and healthy to foot a large part of the costs. Didn ‘t work.)
      Funny, when HMOs first arrived (“Health Maintenance Organization”) I was thrilled, because I mistakenly believe that perhaps the reality would match the name – those enrolled would be tasked with participating in nurturing their own health. Naw, it was just a way to force people to use the cheap doctors.

    6. If not, what’s the point of all this?


    7. There was an almost accidental opportunity for doing a gold standard study of the difference in outcomes between medicaid and going uninsured several years ago in Oregon. They had some “extra” money and could expand Medicaid enrollment. Who got it was picked by lottery.

      When they tracked those groups of people over time they found that the Medicaid people had no better (and in some ways worse) outcomes than the uninsured.

  6. Did you know that there’s no word in Italian for “fiasco”?

  7. Democrats are right to walk away from Obamacare.

    If we’re really concerned about the rate of increase in insurance rates and that these companies offer shitty coverage with high deductibles, why don’t we just put them out of business? In the end, what do insurance companies do besides provide a large pool of capital? You know who else’s in modern society who has a lot of money? And that institution that I’m hinting at allows for one to throw out the head insurance officer every 4 years if he doesn’t provide for my Cialis at a reasonable cost.

    1. Fuck off, slaver.

      1. Do not feed.

    2. american socialist|1.3.17 @ 10:14AM|#
      “Democrats are right to walk away from Obamacare.”

      It’s a shame there weren’t free abortions when your mom was pregnant. She could have easily made the world a better place.

      1. There were when your mom was, and it did not do much good, did it?

        1. Defending the Stalin lover? Noted.

          1. Is MarconiDarwin a new sock? I don’t recognize it and it says stupid things.

            1. Everyone here is Tulpa until proven otherwise. And even then they might still be Tulpa. Or Hitler. Like that Hitler commenter. Don’t trust him.

        2. There were free abortions in 1938?

    3. If we’re really concerned about the rate of increase in insurance rates and that these companies offer shitty coverage with high deductibles, why don’t we just put them out of business?

      Sure comrade. And while we’re at it, why not apply this line of reasoning to food and housing? After all, the government knows exactly how much things ought to cost, unlike those capitalist fat cats and their faux concerns with imaginary concepts like supply and demand.

      1. This is what I always ask “progressives” who deny being outright communists; the ones who say they want a “free market society with just a few common-sense regulations and social programs”.

        If the government is capable of providing free healthcare – an extremely complex service – to every citizen, while doing no injury to the supply or quality, then why not have them provide every product and service? If they can manage and finance the care for heart attacks and cancer, surely they can coordinate the manufacture of things like cars, houses, food, computers, and everything else we buy. I mean, with profits out of the way, these things would be in great supply and of even better quality, right?

    4. And that institution that I’m hinting at allows for one to throw out the head insurance officer every 4 years if he doesn’t provide for my Cialis at a reasonable cost.

      You need Cialis? TMI bro.

      1. Is it any surprise the socialist is a limp dick?

        1. It requires Cialis to treat a critical medical need. How else would it and its ilk be able to keep screwing everyone?

          Now, lay back and enjoy it, you ungrateful prole. Big Brother love you long time.

    5. You mean like the VA? Great model!

      1. Yep, at the VA, we save money by withholding expensive treatment, until that treatment is no longer necessary! Because expiration of the patient!

    6. And that institution that I’m hinting at allows for one to throw out the head insurance officer every 4 years if he doesn’t provide for my Cialis at a reasonable cost.

      Nope. Your vote is statistically meaningless. And even if your preferred candidate wins, you still have to abide by every regulation and law on the books. If I don’t like my insurance plan, I can walk away.

      Meanwhile, employees who put people on fake waiting lists not only can’t be fired, they can’t even have their bonuses taken away.

    7. “In the end, what do insurance companies do besides provide a large pool of capital?”

      That’s pretty much how you and your ilk sees all of us isn’t it? In your mind, we exist to provide capital for your utopian fantasies. I’ve had conversations with socialists about “the rich” and they can’t even fathom that people who have money might not think giving it to the government is the best use for it. In their mind, everybody owes their money to the government because the government made it possible for them to earn it.

      Oh, and as far as providing your Cialis at a reasonable cost, price controls don’t work. There’s not a single economist who thinks they do and it’s easy to see why they cause massive problems in a market. Every time they’ve ever been tried, they result in decreased supply. Every single time. Currently, you’re seeing those effects as insurance companies are fleeing Obamacare, leaving people with little or no choices. The fact that you think the government can decide how much something should reasonably cost illustrates in stark terms how much twaddle your opinions are.

      1. One correction: price controls only decrease the supply when the forced price is lower than what it should be, based on current demand. When the price is forced higher, we get more than what we need, because people are going to want to buy the thing in question.

        In any case, price controls never produce an optimal outcome. It only produces a waste of resources (such as the 39 lbs of cheese for every man, woman and child in the United States, stored by the government because of the subsidies provided to dairy farmers…)

    8. Yep. We know you lying shit-heels always had single-payer as your endgame. Fortunately, you and your media pals weren’t able to drag HRC’s political corpse over the finish line in a race against, of all people, Donald Fucking Trump, and Obama has systematically gutted your party from the neck down. Thank God. As screwed as we are right now, you guys would’ve made things much worse.

      Fuck off.

    9. You know who else’s in modern society who has a lot of money?

      Umm, I don’t know. Bill Gates? Apple Computer?

      And that institution that I’m hinting at allows for one to throw out the head insurance officer every 4 years if he doesn’t provide for my Cialis at a reasonable cost.

      Oh, I get it. You were referring to the Federal Government. Of course you got it wrong. The Federal Government has ~no~ money. That’s why it has to steal a bunch from us every April 15th and borrow even more.

  8. This is not a complicated issue. Blow all of the smoke away and face it head on. Call it what it is; the current system is a boondoggle.

    Solution: Mandate by law that every single individual in the country is subject to the same healthcare system, government employees and elected officials and their families included.

    Watch how fast this clusterfuck would get untangled. It will make your head spin.

    1. the same healthcare system, government employees and elected officials and their families included

      It’s not a separate healthcare system with it’s own hospitals and doctors (as the VA is a system separate from the rest of US healthcare); it’s simply a series of insurance plans. The main difference between federal health insurance, and that available in the private sector, is that the federal plans were required to provide coverage for pre-existing conditions, just like O-care does. Of course the premiums for federal employees and their dependents is heavily subsidized.

      Not all federal plans are available in all locations. Some like Blue Cross (whatever they are calling themselves now) are universally available.

    2. This right here.

      I’ve said before that if we began hiring illegal alien college professors, who will profess for less, then open immigration would no longer be taught to be a good thing.

  9. Speaking of OCare:

    The rule, which went into effect Jan. 1, says that doctors can’t refuse to provide medically necessary health services within their scope of practice because of a patient’s gender identity. For instead, a gynecologist couldn’t refuse to perform a cervical Pap test for a transgender man. . . .

    A Texas judge halted the rule over the weekend.


    Seems like an issue that libertarians might be interested in. For example, does OCare’s antidiscrimination rule apply to “sex” discrimination or “gender identity” discrimination? Are we still chill with expanding restrictions on contract and association rights in favor of certain identity groups, because fairness?

    1. For instead, a gynecologist couldn’t refuse to perform a cervical Pap test for a transgender man. . .

      Isn’t a transgender man a woman who transitioned into being a man and not the other way around? Or I am reading this wrong in that a woman who is transitioning into being a man will still require female medical services from a gyno?

      1. I think in this context it means a man who wants to be a woman. But, who the fuck knows.

        1. Why wouldn’t a gynecologist want to provide that service? It’s a license to bill for nothing! “OK, I looked, and you’ve nothing to worry about?you don’t have one.”

      2. A transgender man is female-to-male, and they usually don’t have genital surgery, just a mastectomy.

      3. Pro-tip: The word after “trans” refers to what the individual currently identifies as, so transMAN is F2M, transWOMAN is M2F.

        So, in the case of the transgender man (F2) he probably still has a vagina since phalloplasty (plastic surgery to rebuild or construct a penis) doesn’t yield good results.

        1. he probably still has a vagina

          And thus, the English language dies of a thousand cuts.

          1. A few millennia from now a technoarchaeologist is going to be sifting through files and find reference to “his cervical cancer” and assume the guy must have been an oncologist or cellular microbiologist.

          2. Yes. When I was young “gender” was essentially a language construct, and “sex” was determined from the configuration of your nether bits.

    2. A pap smear is not a medically necessary test under a reasonable definition. It is an elective test that is recommended to screen for malignancy, like a mammogram or a colonoscopy. Of course, CMS decided that medical necessity is almost anything at all a physician might order to prevent, evaluate, diagnose, or treat an illness, injury, or disease. In other words, anything and everything is necessary as long as you can find any physician who might think it’s appropriate. It’s the most tortured definition of necessity I’ve ever seen.

      The consequence of this rule is that a doctor might have to perform a service that he or she might think poses a substantial risk of harm to the patient because some other doctor thinks the patient should get the service. You would have to prove you aren’t refusing because your patient is transgender. It’s the path to madness. Of course the AMA is all for it, illustrating why I and most of my colleagues do not belong to the AMA.

      1. There is a pervasive myth that preventive care leads to better outcomes. Without any evidence that yearly mammograms save lives women were told that they should irradiate their breast tissue annually and so they blindly comply with the recommendation to get expensive and risky imaging performed that in no way prevents poor health and the cumulative effects of radiation are a known cancer risk. Healthy asymptomatic adults without substantial risk factors don’t benefit from yearly “checkup” and bloodwork.

        We are poor stewards of healthcare spending because we are removed from the costs. We should not have insurance for plans that cover minor illnesses. Insurance should be reserved for catastrophic events.

        I am a nurse and there are so many levels of dysfunction I have no idea how to fix it but I do know the policies mandated by the Centers for Medicare and Medicaid and the racket Joint Commission who has to implement new requirements that add no value to patient care but extensive burden on the providers. The amount of meaningless redundant documentation requirements and mandated screening tools are staggering and yet there is no money to add additional nurses so patients receive less care while we spend 60% of our shift filling out form and clicking boxes instead of caring for patients.

  10. Part of the Democrats’ tacit approval for reform must surely be driven by the expiration of the risk corridor and reinsurance programs after 2016.

    In order to keep their good parts of the program, the Democrats will need to reauthorize what amounts to bailouts for the insurance companies, so they better start talking about reform.

    I mean, if, one way or the other, they’ll either need to accept gutting the program or supporting corporate welfare, then they better start talking about how delicious crow is–since it’s definitely on the menu.

    1. Setting up a system where people could wait until they were sick to buy insurance has made selling insurance unprofitable. Who could have seen that coming?

      I am constantly amazed at how many middle of the road non partisan people or even Republicans I meet who can’t grasp that concept.

      1. Not merely unprofitable but instead reliably ruinous.

    2. Part of the Democrats’ tacit approval for reform must surely be driven by the expiration of the risk corridor and reinsurance programs after 2016.

      A huge shit-hits-fan part of the bill is timed to hit first year Lightworker is gone? Complete coincidence.

      1. I really think they thought it would make them popular and give them huge majorities in Congress allowing them to implement single payer. After it destroyed their majorities, they have just been playing for time trying to avoid the inevitable disaster.

    3. Ken, just to be clear, when someone busts you on your bullshit, it’s the mark of an ass to call them names.

      1. Are you still looking for proof that the Allies didn’t capitulate to Stalin on eastern Europe, that the the Tehran and Yalta conferences happened and meant something, that we held back to let the Russians catch up in the race to Berlin because of those agreements, etc?

        Are you still waiting for proof that the iron curtain being where it was ultimately derived from mistakes made by the Allies at the end of World War II–and we could have done things differently?

        Your insistence on proof of these things makes you willfully obtuse–just like in Shrike’s post above . That may be calling you a name, but it’s also speaking the honest truth.

        1. “Your insistence on proof of these things makes you willfully obtuse–just like in Shrike’s post above . That may be calling you a name, but it’s also speaking the honest truth.”

          Your bullshitting proves you don’t have a clue as to what you’re posting about.
          Put up or STFU, asshole.

  11. Dec 21, 2016

    Federal health officials Wednesday touted a record 6.4 million customer sign-ups on the federal Obamacare marketplace HealthCare.gov so far this open enrollment season ? topping last year’s pace during the same time period by 400,000 customers.



    1. Can’t read, turd?
      “R C Dean|1.3.17 @ 10:04AM|#
      You know what I’m not seeing?
      Any evidence that there are better outcomes from our health care system since OCare went into effect. There’s lots of (cooked) numbers on the increase in coverage (protip: its almost all Medicaid expansion), but coverage is just a means to the end of getting better healthcare.”

      Pick them cherrys, Mr. 8%!! It’s all you can do.

    2. I recall something about the CBO outlining how many people, and what demographics, needed to sign-up to make this all work. Numbers which were not hit in the first or second year. And which have not been hit. But here’s your dumbass to tell us what a success it all is because they signed up more people compared to their previous underperforming high in a three year sample.

      Brilliant stuff.

    3. That’s like people rushing in to buy AR-15s in the wake of a mass shooting. People who wouldn’t sign up for ObamaCare before are suddenly afraid they won’t be able to game the system in 2017 now that Trump is going to be President.

      I understand there’s been a big surge in illegal alien crossings in anticipation of it being harder to get across the border once Trump becomes President, as well. No, that doesn’t mean illegal alien crossings will be at a sustainable crisis level for the foreseeable future. It’s panic buying.

      There’s a hurricane coming, so now everybody’s decided to stock up on generators and bottled water and ObamaCare. This isn’t an indication of a new normal, but if you think it is, that is an indication that you’re an ignoramus.

    4. And the chocolate ration has been raised to twenty grams a week!

    5. a record 6.4 million customer sign-ups on the federal Obamacare marketplace HealthCare.gov so far this open enrollment season

      That’s nice. From last March:

      Indeed, based on the CBO’s own numbers, it seems possible that Obamacare has actually reduced the number of people with private health insurance. In 2013, the CBO projected that, without Obamacare, 186 million people would be covered by private health insurance in 2016?160 million on employer-based plans, 26 million on individually purchased plans. The CBO now says that, with Obamacare, 177 million people will be covered by private health insurance in 2016?155 million on employer-based plans, 12 million on plans bought through Obamacare’s government-run exchanges, and 9 million on other individually purchased plans (plus a rounding error of 1 million).


      And, of course, the administration has lowered its targets for HIE enrollment every year since the law passed.

    6. Buttplug you should ask for a recount after the first 2 or 3 payments have come due.

    7. Hmm, yes… I am one of those people. Couldn’t afford to both eat and pay for my Obamacare premiums(my disability income is from a private insurer, not taxable, meaning my AGI is zero and it has to be AT LEAST $14,000 to get a subsidy), so they sent me nnotice after notice that my coverage would lapse 12/31/16 unless I re-enrolled. Then, when I did nothing, they started sending me bills for my January premium ($2,300 for a $12,000 deductible plan? No thanks!).

  12. It is a testament to how broken our existing government is that replacing this stupid ass law is so difficult.

    1) Remove the tax exemption on employer-provided health care.
    2) Give everyone Health Savings Accounts where they can deposit a certain amount (and even match from employers) tax free each year.
    3) Allow people to buy whatever catastrophic health care/insurance they want out of the account. They can supplement the coverage with post-tax dollars.
    4) Mandate that insurance companies must cover all pre-existing conditions starting 1 year after the customer began carrying coverage from any approved insurer.
    5) Decide how much money you want to pay out to the unfortunate and deposit it right into their Health Savings Account.

    Is it Libertarian? No. But it gets people caring about the cost of their healthcare once again- they must shop for services, decide whether they want catastrophic or the all-you-can-eat buffet. It deals with pre-existing conditions in a way that still incentivizes getting coverage, and provides the safety net that the vast majority of the country expects for the poor.

    The best thing is that it could fit into a short piece of legislation that isn’t 6500 pages long.

    1. 6) Liberalize role distinctions in healthcare provisioning. Allow nurses to render services traditionally provided by physicians. Allow more low-cost, limited service practices for non-emergency care. Hospitals should be like mechanic’s shops and clinics should be like lube shops.

      1. Why, instead, let’s just do the opposite:

        “How California limits affordable care options for pregnant women”
        “Her situation is mirrored by countless other women in a state with a severe shortage of obstetricians and gynecologists. Eight California counties, mostly in the far north and east, lack even one licensed obstetrician/gynecologist, and 11 other counties have only a handful, according to the state Health and Human Services Department.
        Certified nurse-midwives, who help ease the load, argue that they could do more. But they are restrained by the fact that California is one of just six states requiring them to work only under a physician’s supervision. A bill that would have expanded their reach by permitting nurse-midwives to work independently almost cleared the Legislature, but failed in the waning hours of the session amid opposition from the doctors lobby.”

        1. I reiterate what I said yesterday: Calizuela. These idiots could fuck up a corndog.

      2. Make most common and non dangerous drugs over the counter.

        A person can OD on asprin easier than hydrocodone yet which one is easier to legally buy ?

      3. That has started to become a reality, with the “nurse practitioner” entity in many states.

    2. Ultimately, the problem is Medicare and Medicaid and the fact that those services are provided at a loss to providers.

      ObamaCare was ultimately a Medicaid expansion, with the subsidies, individual mandate, etc. meant to make up for the losses providers would rack up due to the Medicaid expansion.

      There are things we can do to make our stay in prison more enjoyable, but until we see Medicaid patients being separated out from the private system, we’ll know that the real cause of the problem isn’t being addressed.

      Ultimately, there needs to be a private option.

      1. “Ultimately, the problem is Medicare and Medicaid and the fact that those services are provided at a loss to providers.”

        This has to be the best-kept secret in healthcare. Yet, doctors have to deal with cranky oldsters who are sure we are “ripping off” Medicare by charging less than our cost to see a patient!

  13. Mark Dayton, complained publicly that although the health law had “many good features,” it was “no longer affordable to increasing numbers of people.”

    Gee, Mark, could throwing a grab-bag of wish-fulfillment provisions into the law have anything to do with costs spiraling out of control?

  14. Democrats stopped defending Obamacare.

    headline stories from last week =

    Democrats extol health care law in bid to derail GOP repeal

    Minority Whip Steny Hoyer, the No. 2 Democrat in the House, said he believes that many people who voted for President-elect Donald Trump want the health care law preserved even though Trump made repeal of the statute a central part of his campaign.

    “I think a lot of people are going to be looking at this and saying, ‘Gee, I really didn’t mean that,'” Hoyer said … Rep. Frank Pallone of New Jersey, the top Democrat on the House Energy and Commerce Committee, said Republicans are “blind to the success” of the health care law. Repealing the law is rooted in politics, he said, and will hurt middle class Americans.

    “Repealing the Affordable Care Act is not logical; it’s simply ideological,” Pallone said.

    President Obama Wants to Help Democrats Save Obamacare From Donald Trump


    the only person i can find who is saying “go ahead and repeal it! Is Joe Biden

  15. I just don’t get the whole point of Obamacare.

    If the stated purpose was to offer coverage to uncovered people – preexisting conditions, choice etc. – why not just have a government agency set up where people could apply and see if they get accepted?

    Why rework the entire medical/insurance industry? It was foolish as it was overly-ambitious.

    No law is perfect he says. Nice cop out. Like he has to deal with the consequences.

    1. “I just don’t get the whole point of Obamacare.”

      The point, which some Democrats will actually admit if pressed, was to implement the first stage of a bait and switch plan to bring the entire healthcare sector of the economy under direct control of the federal government, thereby making everyone, at some level, a ward of the state.

      It was, and still is, about control. Healthcare was just a means to that end.

    2. > I just don’t get the whole point of Obamacare.

      Wishlist, litmus test, profits for the insurance industry?

      The Democrats got their wishlist of items to force insurance companies to offer to everyone, they got a litmus test to find unsavory businesses, and the insurance industry got a projected 1T USD in new revenues.

  16. We’re doomed no matter who’s in power as long as even the supporters of repeal believe that a replacement is necessary.

    Probably the cleanest break/most libertarian solution that wouldn’t lead to actual rioting would be a progressive refundable tax credit and grandfathering in all current preexisting condition patients. And that would be bad. Whatever the Republicans craft will be far worse.

    1. What to do with people that have preexisting conditions is a serious question. Even in Libertopia, our options would be limited by the Overton window. Pulling the insurance rug out from under people with life threatening conditions wouldn’t be acceptable to a lot of people in Libertopia either.

      Sometimes the stupidity of our politicians saves us from having to answer tough questions.

      There are questions I have about what we’d do with all the useless government employees if we ever laid them all off. They know they’re mostly unemployable outside of government–and that’s why they cling to their government jobs. Would we stand by and do nothing while these people eventually starved to death for being unemployable?

      I guess the answer is that a crisis brings things to a head–like the implosion of ObamaCare. Politicians won’t make tough choices until they have no other choice–like they won’t cut spending until they’ve exhausted every other option including stimulus spending. The reason we’re even talking about this now is because ObamaCare is unsustainable in its present form. If it isn’t changed, it won’t last long–and that justifies making changes that people wouldn’t accept otherwise.

      1. Can’t tell if serious re gov’t employees. In my experience, gov’t employees are just like everyone else?in particular, just as employable. Teachers, firemen, soldiers, sailors, assistants, clerks, cops, doctors, investigators, garbage men, researchers…all just regular folks you couldn’t tell as a group from any other folks.

    2. Incidentally, the argument for cutting spending is like that, too. Eventually, interest rates will rise and the credit markets will cut us off. Fiscal conservatism is about avoiding that situation in the first place, so we can make rational choices about cutting spending so it suits our preferences, now, rather than have cuts imposed on us by hard, cold, economic reality like in Greece.

      The argument about ObamaCare was always like that, too. A great reason to oppose it was to avoid the situation we’re in now. Thank goodness for awful politicians saving us from having to stand behind our beliefs, I guess?

    3. I really don’t want tax credits or tax deductions offered as a solution for anything. We’re trying to simplify the tax code, not add yet another volume to the humongous encyclopedia that it is now.

      1. “We”? I just want to cut taxes any way possible, and I think that in many cases the easiest way to achieve that would be to complicate them. Keep adding loopholes until all the loopholes merge into a single big 0.

  17. The problem is that the left is still controlling the terms of the debate as long as we’re all talking about how the government should fix the healthcare delivery system. Obamacare isn’t working very well the same way a dead dog doesn’t work very well as an airplane. So discussing how we’re going to fix the problem and arguing that this, that, or the other proposal isn’t going to work is simply a red herring – the left has proposed smacking you in the face with a baseball bat and now we’re sitting here arguing that, since obviously getting smacked in the face with a baseball bat is a no go, what sort of bat would be the best bat to use for face=smacking purposes.

  18. It is dishonest to refer to what we have come to call “health insurance” by that name. Insurance, properly understood, is a hedge against calamities. What we are really discussing here is a health maintenance cost-shifting scheme wherein the taxpayers (buffered by the magical Keynesian credit card, of course) are ultimately left holding the bag. It makes no more sense for “health insurance” to cover non-catastrophic expenses than it does for auto insurance to cover oil changes.

    Until we begin to call a spade a spade in this debate, this rolling disaster will continue. And does anyone here really believe that the GOP–much less the Democrats who initiated this massive fuck up way back under FDR–will at this point be inclined to man up and stop this cycle of pandering? what the Democrats have so royally fucked up?

    1. EDIT: That last dangling clause should’ve been deleted. As many others have said, an Edit button would sure be nice.

    2. “It makes no more sense for “health insurance” to cover non-catastrophic expenses than it does for auto insurance to cover oil changes.”

      We can probably blame the insurance industry for that one. I’m guessing they started throwing in office visit copays as an extra “perk” for their policies. I myself would rather pay a reasonable rate for a doctor visit in a copay-free environment than be forced to pay a super-high rate because I’m stuck with a copay-free policy while others get to only shell out $10-20 for their visit.

      1. As a part of FDR’s wage control regime to mobilize the economy during World War II, employers began to offer “health insurance” as a non-wage benefit in order to get around wage restrictions and be competitive in the labor market. This created the initial disconnect between consumer and provider, which has distorted the healthcare market ever since. In defense of the insurance companies, of course they went along; it was an offer they couldn’t refuse. And now, as a result of the inflationary pressure inherent in this ever expanding market distortion, routine healthcare costs have far exceeded what many people are able or willing to pay out of pocket.

        The only way to restore rationality to the healthcare market–and all other markets–is to get government out of the business of mandating what private entities must buy and sell. Government’s greasy thumb on the scale, regardless of good intentions, invariably has unforeseen negative consequences (if you view things charitably). There is no such thing as a free lunch.

        1. Repealing prescription laws would be a good start towards medical freedom. Of course the AMA would be totally against it because ever since the AMA was formed back in 1846, it’s primary objective has been to increase the income of physicians through using the power of government to restrict “competition”. Same basic principle as that of any labor union with the objective of creating a “closed shop” where only union members could be employed. Restriction of “supply” has always been the best way to raise prices (income for those who are members of the organization). Think of how much your computer would cost is every part of it had to be constructed by organized American labor? What your cell phone would cost if produced by a legal monopoly? Your TV set? Professional monopolies likely raise our own living costs by thousands of dollars per person…

      2. Part of the reason why non-catastrophic expenses are covered is that the insurance industry knows that a significant portion of the non-catastrophic expenses are preventive care that reduce the frequency and cost of the catastrophic expense. They want you to go see your doctor once a year so that when you’re pre-diabetic, the doctor can notice it early on and put you on a program to keep your blood sugar stable, so they don’t have to pay for your legs to get amputated and other such things later.

        If auto insurance was set up to pay to fix your car when it broke down, no matter what caused the breakdown, you can be sure that they’d be paying for oil changes.

        1. All of which is just fine as long as it exists within a truly free market in which the government mandates neither what (and who) must be covered nor the costs of the insurance. If supply and demand meet such that this is sustainable absent government subsidies, let the insurance companies sell what policies they wish to those customers willing to buy them. In practice, this would allow for a wide variety of different policies with varying levels of coverage.

          As for the care of the indigent, that is a separate issue. But calling taxpayer subsidized care of any kind “insurance” while foolishly siphoning private sector funds from a genuine health insurance marketplace to pay for it muddies the water and defers both clear thinking about the issue and accountability for the politicians who dispense this largesse.

        2. That is just not true. There no evidence to support the theory that there is value in “preventative Care” and is a major contributing factor the failing system and out of control costs.

        3. That is just not true. There no evidence to support the theory that there is value in “preventative Care” and is a major contributing factor the failing system and out of control costs.

        4. That is just not true. There no evidence to support the theory that there is value in “preventative Care” and is a major contributing factor the failing system and out of control costs.

        5. That is just not true. There no evidence to support the theory that there is value in “preventative Care” and is a major contributing factor the failing system and out of control costs.

        6. That is just not true. There no evidence to support the theory that there is value in “preventative Care” and is a major contributing factor the failing system and out of control costs.

  19. Yes just trust the government, we’ll make it all better. And we would never lie to you.

  20. Like every other Government program (interference), this one’s a vampire. Shoot it dead on logical grounds, it arises. Kill it on economic terms, it comes back. Suck out it’s life’s blood by following it’s provisions, it get propped up in the corner with subsidies.

    The only solution is a stake to the heart and then burial at the bottom of the ocean. Come, villagers we must arise!

  21. You’re right Obama not every law is perfect, but conversely not every law is complete and utter shit either…

  22. RE: Democrats Defect from Obamacare
    Meanwhile, the GOP learns to stop worrying and love Obama’s signature legislative victory.

    Rats leaving the ship when its sinking?
    Who would’ve thought?

    1. Goddamned parasites, all.

  23. Gosh, government schemes to expand the supply of free and subsized lunches don’t work?

    Whodda thunk it?

  24. Just because worthless republicans did little or nothing to repeal obama care does not mean that they could not have done much more nor that they dare muddle around with Trump in office. Fiddling around at the edges could get them primary challengers and no defense for their neglect of duty.

    1. Given the slimmest crack of wiggle room, they’ll find some way to fuck up this opportunity, too. In this, if nothing else, the Republicans are consistent.

  25. There is an easy way to reduce health care costs that costs absolutely “nothing”. Simply repeal prescription laws. Suddenly people have the legal right to control their own health care to a far greater degree than what is possible today. Prior to 1938, Americans did have the legal right to buy medical drugs (with the exception of narcotics) without have to obtain a prescription from a doctor. Instead, if you needed help in deciding what medicine to buy, the druggist could generally assist you in making the decision at no extra charge.

    Of course the AMA hated this state of affairs. It should be understood that “all” professional organizations effectively fill the same purposes as do labor unions. That is, raising the incomes of the members at the expense of everyone else.

  26. It is over. Look at the size of Sander’s support. The contingent of people who think nearly everything should be free is large and growing.
    The U.S. will break under it’s own welfare state, just like Venezuela.
    And for as long as they get to keep the trappings of their position, the politicians will continue to give it.
    Classic vote buying.

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  28. Repeal of the Affordable Health Care Act legislation wording:

    1. All provisions of the Affordable Health Care Act are nullified and voided in their entirety upon passage of this Act;

    2. Upon passage of this Act, it will be a capital crime punishable by death for any Senator or Congressman to propose or seek to re-enact any provisions of the repealed Affordable Health Care Act at any time while the planet Earth remains in orbit around the Sun;

    3. Any person who buries, entombs, or attempts to bury and / or entomb within the United States and its territories any Senator or Congressman executed after conviction of violation of section 2 of this Act shall be indicted with improper disposal of hazardous waste.


    Was that so hard?

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