Obamacare

How to Replace Obamacare

Republicans have a lot of ideas about how to replace Obamacare.

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You can't swing a dead cat these days without hitting someone who has made fun of congressional Republicans for not having a plan to replace Obamacare. And the critics are right: Republicans don't have a plan. They have a whole bunch of plans. House Speaker Paul Ryan has one. Texas Sen. Ted Cruz has another. HHS nominee Tom Price not only has a plan, he has a bill: The Empowering Patients First Act. The trouble is that Republicans haven't collated all those plans into one single, omnibus proposal.

To some degree, that's their own fault. The GOP has painted itself into a corner. Republicans had a whale of a good time mocking President Obama's claims that under the Affordable Care Act, if you liked your doctor or health plan you would be able to keep them. That turned out to be untrue for millions of people, a fact that Republicans took great delight in repeating.

But repealing Obamacare also would cause millions of people to lose coverage—many more, in fact, than lost it through Obamacare's passage. The GOP might find this awkward. On the other hand, Democrats can make too much of the point. Many Americans bought insurance under duress, and might not be brokenhearted at no longer having to pay for something they didn't want in the first place.

Still, even many conservative Trump supporters might be unhappy if they lost coverage due to ACA repeal. Indeed, as the Washington Post's Catherine Rampell recently pointed out, "there's an entire subgenre of journalism" devoted to seeking out and interviewing Trump supporters who could lose their health insurance if Obamacare is repealed. (Somebody's gotta teach those rubes a lesson, apparently.)

Polls do show widespread public support for several provisions of the ACA, because—let's be fair—the law does try to address things about health care in the U.S. that Americans don't like, such as not being able to afford insurance or getting turned down because of an existing medical condition. The trouble is that Obamacare tries to solve those problems with a gargantuan law that tries to regulate the entire health-care system through central planning. Many Americans don't like that, either.

Nor should they. People need food as much as they need medical care—and yet somehow the U.S. manages to feed everybody without employer-sponsored food plans and state-run food-purchase collectives and a federal Ministry of Eating and a Center for Breakfast and Lunch Services and so forth.

The government helps the very poorest by giving them food vouchers, but Washington doesn't micromanage every grocery store and farmer's market. It's almost as if there were some kind of "invisible hand" at work.

When Republicans do get around to collating their proposals, what should they include?

The first order of business should be to fix what has been called the original sin of U.S. health care: WWII-era decisions, driven by wage and price controls, that exempted fringe benefits such as health coverage from those controls, then treated employer-provided health insurance as wage income for the purpose of collective bargaining—but not for the purpose of taxation.

This led to several harmful results: It created an incentive to expand health insurance more than necessary. It reduced the incentive for patients to price-shop for medical care. It left the self-employed at a disadvantage. And it stunted the growth of wages. (It's no coincidence that wages have stagnated as the costs of employer-provided health care have soared.) It also led to the loss of "portability": If you change jobs, you can't take your coverage with you.

To begin addressing those issues, Congress should eliminate the tax preference for employer-provided insurance and replace it with a standard income-tax deduction for health insurance from any source. To help the poor, couple it with a refundable tax credit—i.e., a subsidy.

Obamacare tries to solve the problem of pre-existing conditions the Rube Goldberg way: Make insurers cover individuals no matter what, then guard against people buying coverage only once they get sick by forcing everybody to purchase a policy through the individual mandate—an unprecedented expansion of government power.

Congress should replace that approach with a more direct one: Offer Medicaid or Medicare coverage to anybody turned down by private insurance. Or simply create a high-risk insurance pool similar to the ones that states create for problem drivers. This would protect insurance companies against the sick-customer "death spiral" and protect patients against premature death.

Another option, which would help address the portability issue, entails allowing organizations to create multi-state insurance pools. Instead of having to choose between a tax-advantaged policy offered by your employer or a tax-disadvantaged individual policy, you could choose from plans offered on a level playing field by your church, or Kiwanis, or the ACLU, or the NRA or a host of other groups.

Any change from the status quo will leave some people better off and some people worse off. That's the nature of change. But moving the U.S. away from Obamacare toward a more rational, market-oriented system would be a huge improvement. The three steps outlined above would make a good place to start.

NEXT: My wife makes me so miserable, it's unconstitutional!

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  1. But repealing Obamacare also would cause millions of people to lose coverage?many more, in fact, than lost it through Obamacare’s passage.

    Yes, but the former aren’t GOP voters, so they can rest easy.

    1. But repealing Obamacare also would cause millions of people to lose coverage?many more, in fact, than lost it through Obamacare’s passage.

      As ever, the devil is in the details:

      (1) The vast majority of increased “health insurance coverage” through OCare is Medicaid expansion. If that separate title isn’t part of the repeal (and I don’t know if it is), then many fewer people will lose “coverage”. That piece of OCare is at risk anyway, because the 100% federal subsidy for it ran out on December 31, and is at a 90% level for several more years (the regular subsidy level is around 65%). Medicaid is typically the biggest single chunk of many state’s budgets. When the subsidy drops, states will start cutting back Medicaid coverage anyway.

      (2) Nobody paying full price for a policy now will “lose” it. People getting subsidies for their policies may drop them because they can’t afford them. Getting rid of OCare mandates that crank the premiums will help with this.

      1. All the women on my facederp are 100% certain this means that birth control will no longer be covered, pregnancy will go back to being a pre-existing condition, and insurance companies are going to drop you the second they find out that you’re sick.

        1. Is there a woman on the planet who’s gainfully employed, even part time that couldn’t afford birth control?

          1. At insurance-driven prices, certainly.

            1. You’d be amazed at the reductions in cost when prescription laws didn’t exist any more. Especially if people regain the legal right to purchase their medications from any supplier they wish to use.

              We need to get rid of the idea that we need the government regulating everything we do.

        2. All the women on my facederp are 100% certain this means that birth control will no longer be covered,

          If there is enough demand, the insurers will offer policies that cover birth control.

          pregnancy will go back to being a pre-existing condition,

          Well, it is. And, again, if there is enough demand and you are willing to pay, insurers will let you sign up for a policy even if you are pregnant.

          Guess what? HIPAA (which stands for Health Insurance Portability and Accountability Act) already said that if you get pregnant while you are insured, its effectively not a pre-existing condition when you change/renew policies.

          and insurance companies are going to drop you the second they find out that you’re sick.

          As noted, HIPAA already made that illegal, and of course the states (which have primary responsibility for regulating insurance) can always pile on.

          1. I didn’t know that about HIPAA, that will be quite useful if I ever decide to actually talk to them about their politics and not just inane things like teh kittehs.

            1. Privacy, which is the only thing anyone thinks HIPAA did these days, was pretty much a footnote in the statute.

              Then, of course, CMS seized the opportunity to grossly exceed their statutory authority to nationalize privacy law.

          2. In most cases, pregnancy is a condition voluntarily entered into. Insurance is for events you have no control over.

    2. But repealing Obamacare also would cause millions of people to lose coverage?many more, in fact, than lost it through Obamacare’s passage.

      Um, no. People like me who were forced off their plans lost insurance. So, 30-45 million at least. Most turned around and purchased crappy expensive new policies, but we had lost coverage.

      Stop repeating the lie.

      1. ….30-45 million at least…. Stop repeating the lie.

        You go first …

      2. Insurance companies want to sell insurance. They can create “affordable” plans as long as you understand what the levels of the plan are. How many people buy “no limits” insurance for cars, houses, or anything else? This was the big failure of Obamacare. To offer “no limits” coverage and avoid creating astronomically expensive plans, it was necessary to cut coverage to the bone on the front end along with massive deductibles. Do it the other way like people do with cars and houses, and while the “not limits” disappears, you get much better coverage at lower cost on the “front end”. The only reason for “no limits” was to appease the wishes of hospitals and doctors who often ended up having “write off” most of the bill after the individual died or went bankrupt. Note that medical services are often priced at double or more of the actual cost. I’ve seen a $5000 bill that my insurance paid about $1000 to “settle”. In health care, the true cost of service is a tiny fraction of what they will charge if they can…

        1. How many people buy “no limits” insurance for cars, houses, or anything else?

          The limit is the replacement cost. Nobody would sell a $1 million homeowner policy on a $100,000 house.

          “No limit” health insurance has been the norm from the very beginning.

          The only reason for “no limits” was to appease the wishes of hospitals and doctors who often ended up having “write off” most of the bill after the individual died or went bankrupt

          That’s not true either. If I die after a hip transplant, the insurance still pays the bill. Personal bankruptcy does not absolve an insurance company from their liability. And neither of those has anything to do with lifetime limits anyhow.

      3. actually if we keep obamacare millions of union members with so-called “Cadillac plans”, which Obama pulled waivers out of his posterior to keep from being cancelled, will finally lose them and be forced into the garbage exchanges. remember, if you like your plan you can keep your plan, because Obama cares about you like that.

  2. The core issue is the nitwit idea that the government should be in the business of controlingnhealth care and/or health insurance at all. Unfortunately, like so many government idiocies, getting the government to flat out stop,the meddling it has been doing for almost a century would put a lot of the economy into freefall.

    My pont? A powerful argument against getting the government involved in ANYTHING is “How hard is it going to back out if it turns out that you (meaning the pro government faction) don’t know what the hell you’re talking about after all?”

    1. the nitwit idea that the government should be in the business of controlingnhealth care and/or health insurance at all

      BUT PEOPLE ARE SICK

      1. Sarcasm (I hope) noted.

        Nevertheless;

        The weakness of most Statists is that they imagine the government to be (metaphorically) a vast tool box with tools for every occasion. In fact, government is closer to being amlarge spiked mace. Is there an outbreak of genocidal conquest in Europe? Send for the government. But don’t try using it on anything that you don’t want to see reduced to rubble.

        So, people are sick. Now, ask yourself, how is a huge government bureaucracy, promulgating rules and covering its butt as fast as ever it can, going to help?

        1. How does pissing and moaning address the problem?

        2. cuba and north korea governments seem to take care of their people very well. Michael moore says so.

    2. Government intervention in health care is why it costs so much. Strip off prescription laws, medical licensing, protection given to the drug companies against competition, everything that we’ve legislated since say 1950 when the local hospital’s room rate was $10 a day and I expect the cost of US health care would drop to something much closer with what the rest of the developed world is now paying for health care. Its “Uncle Sam, the monopoly man” that is the problem. It is the use of government supplied “force” by the vested interests that drives prices so high. See my blog at “muskegonlibertarian.wordpress.com” for how we are forced to pay far higher prices than anyone else just because certain groups have been able to “buy” themselves “protection” from the competition of the free market.

      1. You’re in the wrong market. Insurance is not healthcare,

        1. I’ll give him a pass, even if I point it out. – the Left & MSM have been deliberately obfuscating those terms for a long time.

  3. Any change from the status quo will leave some people better off and some people worse off.

    The key is to engineer it so that your voter base is better off and the other side’s is who cares.

    1. He also suggested the plan will allow people and small businesses to create their own markets.

      “There’s no reason why (a business owner) with four employees shouldn’t be able to join with hundreds and hundreds of other businesses that are small to become a large entity to get leverage to bring your prices down,” Paul said.

      This is key. Allow people to form their own ‘groups’ to purchase health insurance. This gives the Ins companies large enough samples to use statistics-that’s why large co policies are cheaper.

      1. “There’s no reason why (a business owner) with four employees shouldn’t be able to join with hundreds and hundreds of other businesses that are small to become a large entity to get leverage to bring your prices down,” Paul said.

        This is key.

        It’s typical ignorant bullshit.
        Small businesses have been doing that for over 50 years (except in a few states). And it can be a self-employed individual with no employees at all. I formed one myself for a local small-business otrganization I founded in Cleveland. The National Federation of Independent Business has long offered a variety of group plans for businesses as few as one.

        The REAL scandal is how the entire fiscal right is essentially ignorant on health insurance.

        This gives the Ins companies large enough samples to use statistics-that’s why large co policies are cheaper.

        Proves my point!! The SIZE of the group is 1000% irrelevant, A million employee group with an average age of 45 will pay MUCH higher premiums that the smallest possible group of 20-30 year olds.

        1. Of course you have to compare apples to apples, such as age – but the point is that OCare doesn’t allow these types of groups unless they’re grandfathered in, and then has incentives for those to be eventually run out of business.

          1. Of course you have to compare apples to apples, such as age

            You seem to have missed the point entirely:

            “This gives the Ins companies large enough samples to use statistics-that’s why large co policies are cheaper”

            Size of the group has nothing to do with the premiums — simply because size has nothing to do with risk. It’s not like selling goods. There are no volume discounts for insurance.
            .

            1. I’m agreeing with the point you reiterated, then additionally pointing out that the ACA did away with other types of group coverage. If people don’t want them they’ll go away. No need for the govt to ban it.

  4. Yes. Because when you remove a cancerous tumor you must replace it with something.

    1. Yes. Because when you remove a cancerous tumor you must replace it with something.Unless it’s in a dictatorship. But we still vote in this country

  5. The article proves one theory right: that once govt gets involved in something, the argument that it should not be involved at all gets lost. Now we’re left with squabbles over the level of involvement.

    1. So on a fundamental level, Obama care is a success.

      1. Most Americans already felt this way before, though. I think that ship has sailed.

  6. “Offer Medicaid or Medicare coverage to anybody turned down by private insurance.”

    How does this work in practice?

    1. Badly. Kind of like Medicare and Medicaid currently work. If Medicare is so wonderful, why does almost every senior pay for a supplemental policy?

      1. Ok, but that’s not what I mean.

        How do you make the determination that somebody is not covered by private insurance and grant them Medicaid? How expensive would be this be?

        1. Utterly unworkable. You would need to require that someone be rejected by every insurance company to get free government-funded coverage. One rejection means nothing.

          1. You would need to require that someone be rejected by every insurance company to get free government-funded coverage. One rejection means nothing

            Umm, he suggested that only for pre-existing conditions, which are quite easy to confirm, as a possible alternative to the GOP spending tens of millions of dollars on seed funding to re-establish the high-risk pools that Obamacare destroyed — an expense that would be saved.

            States have known how to qualify high risks for several decades.

        2. RC, in practice there will only need to be one rejection. In the 00’s I lost my health insurance due to a fuck up by my former employer. Having a preexisting condition, I was rejected when I tried to re-apply for my policy. When I called a different insurance agent, they said I was blacklisted, and behind the scenes all the insurance companies would know of the one rejection, and also reject me. So no point in applying for other policies.

          A real problem with giving people with Medicaid is that insurance companies could be extra picky and dump people with *slight* risks into Medicaid so they won’t have to insure them. I’m not sure how that could be prevented.

          1. In the 00’s I lost my health insurance due to a fuck up by my former employer. Having a preexisting condition, I was rejected when I tried to re-apply for my policy. When I called a different insurance agent, they said I was blacklisted, and behind the scenes all the insurance companies would know of the one rejection, and also reject me. So no point in applying for other policies.

            Were you also unemployed? You seem to comparing individual coverage, paid by yourself, with group coverage paid by an employer,

            “Portability” from one employer to another employer has been the law since 1996 … even with a pre-existing condition.

      2. Almost everyone pays for supplemental care because Medicare doesn’t cover some things. Nor should it.

      3. Medicaid should provide coverage for people too sick to take care of themselves. Expanding it to people who aren’t taking care of themselves just widens the welfare trap.

        1. Medicaid is for people too poor to buy insurance, and is therefore already a welfare trap.

          1. Medicaid is for people too poor to buy insurance, and is therefore already a welfare trap.

            Do you know why? Do you even know what the welfare trap is?

        2. Medicaid should provide coverage for people too sick to take care of themselves. Expanding it to people who aren’t taking care of themselves just widens the welfare trap.

          They should just die? And you’ve got it totally backwards. It’s always included low-income people, and NEVER covered pre-existing conditions outside the income limits.

          And that was the only good idea in this piece. Pre-existing people have always been in high-risk pools subsidized by state taxpayers. He suggested Medicaid as a possible alternative to state high-risk pools — where the insured do pay subsidized premiums. If they went to Medicaid instead, that’s where the premiums would be be paid.

          Since high-risk pools were destroyed by Obamacare, GOP proposals includes tens of millions in subsidies to states for creating new pools from scratch. Why?

      4. If Medicare is so wonderful, why does almost every senior pay for a supplemental policy?

        Umm, to get coverage for things Medicare doesn’t cover, or smaller deductibles and co-pays..

    2. And wouldnt this dramatically increase spending? Medicare is funded by people who arent on medicare. If they are suddenly on medicare then thats more taking out than putting in.

    3. The data I’ve seen indicates that Medicaid on the average costs $6,800 a year.or a bit under $600 a month. Much of this is spent on seniors in nursing homes. So the cost of individual coverage for everyone else must be less. Medicaid and the VA both have the authority to bargain drug prices. Medicare doesn’t because the drug companies “bought” themselves a “deal”.

      In a libertarian society, most likely low cost medical services would be provided by nurse practitioners. Who would be quite adequate to handle the common level of medical problems that people now see MD’s about. Having been the subject of a number of “medical mistakes”, I do not have a high opinion of most MD’s.

      1. Medicare doesn’t because the drug companies “bought” themselves a “deal”.

        It’s called Patent Law

  7. The latest is that they do have a plan–they simply aren’t airing it out before they repeal ObamaCare, which is precisely the right thing to do.

    Like Cortez scuttling his ships so that there was no way back, the politicians and interests won’t give up what they have until they know they’re getting something better. Why should they give up the individual mandate when they’ve already got one now?

    But maybe giving the interests at play something better than what they have isn’t in the best interests of the voters or the consumers.

    This commercial is being run by an PAC that’s closely tied to the Republican House leadership. It says they DO have a plan–and I like the sound of that plan.

    https://www.youtube.com/watch?v=EZQQde857zQ

    What’s not to like about that plan?

    If you go to the website the commercial directs you to, you’ll see the details of the plan.

    https://abetterhealthcareplan.com/

    Or, in other words, there are no details of the new plan whatsoever–and that’s exactly how it should be.

    You want to know what’s in the new plan?

    You have to repeal ObamaCare to find out what is in it.

    This is exactly the way it needs to be. If the repeal of ObamaCare were predicated on various interests squabbling over the details of the new plan, then ObamaCare would probably never be repealed.

    FU Repeal ObamaCare.

    1. This is exactly the way it needs to be. If the repeal of ObamaCare were predicated on various interests squabbling over the details of the new plan, then ObamaCare would probably never be repealed.

      That’s my take. And if the replacement never happens because of squabbling, I won’t shed a tear.

  8. Typical ACA argument =

    “It hurts 100s of millions of people”
    “but it helps 10 million people! why are you such an asshole?”

    1. *if it continues

      “but 2/3 of those 10m were already eligible for Medicaid. The “new” parts don’t even apply to them”
      “your hatred of the poor is disgusting”

    2. ObamaCare was intended to force the middle class to sacrifice the quality and affordability of care for the benefit of the poor through an expansion of Medicaid.

      It would be easier to defend to my mind if they argued for it like that, but they don’t because the middle class determines the votes–and they don’t want to make sacrifices of the quality and affordability of their healthcare for the benefit of poor.

      1. I’ve always said the same thing. It’s an overall quality for coverage trade off. Had they marketed it like this instead of being deliberately deceitful I would’ve had a bit more respect.

        1. . Had they marketed it like this instead of being deliberately deceitful I would’ve had a bit more respect.

          Hahaha!! You think Gruber, Pelosi, and Schumer want your respect??

          1. Everyone wants my respect.

      2. sacrifice the quality and affordability of care for the benefit of the poor through an expansion of Medicaid.

        This might be plausible if there were any mechanic by which

        “marginal declines in quality, increases in cost for all”
        produced
        “wildly successful results in delivering actual care to the currently-underinsured”

        Instead, what you get is =

        “huge declines in quality/affordability” for most people in America”
        in exchange for
        “marginal expansion of ‘coverage’ but not ‘access to care’ for the poor”

        the side that argues that these trade-offs are worth it does so by pretending that there isn’t any trade-off at all. because if they did acknowledge it, they’d be forced to measure it and demonstrate that the ‘exchange’ is a cost-beneficial one.

        1. “the side that argues that these trade-offs are worth it does so by pretending that there isn’t any trade-off at all. because if they did acknowledge it, they’d be forced to measure it and demonstrate that the ‘exchange’ is a cost-beneficial one.

          They don’t acknowledge the trade offs because their power depends on the support of the middle class.

          They don’t want the middle class thinking that they’ve been forced to sacrifice anything.

          When you look at the original bill, there were things in it like a tax on spending money on improved medical devices and machines. They put a “Cadillac” tax on plans that were too generous to employees. That was all about forcing a sacrifice of quality.

          On the other hand, the system was meant to favor expanding the number of hospital beds available.

          Forcing middle class healthy kids to buy insurance they didn’t need, keeping kids on their parents’ plans well into their 20s, all of this stuff was meant to keep middle class people paying more into the system–to help accommodate the losses providers (and ultimately insures) suffer because of Medicaid and the Medicaid expansion.

          The entire system was intended to make the middle class pay more and sacrifice the quality of their care so that more people could get care for free by way of Medicaid.

      3. But Medicaid patients have gotten the shaft as well. Quoting my (chronically-ill, disabled) wife’s GP: “It costs me more to provide your care than Medicaid reimburses, but so long as each doctor takes on a few the system can work.” This was before the ACA doubled the number of Medicaid recipients.

        1. Ultimately, they get the shaft. I didn’t say there weren’t any unintended consequences.

          Regardless, the intention was to expand Medicaid and make private pay patients cover the costs of that expansion.

        2. To be more truthful, the doctor is well aware that he or she could earn more per hour if he or she didn’t take Medicaid. Back in the 1960’s, I could see a doctor for $8. Reason was that doctors back then only had an “office nurse”. The half dozen “staff” people you see in today’s medical office is one of the reasons (along with malpractice insurance and government requirements regarding record keeping) why the figure today is usually in the $100 range at the minimum. Is the care better today? Or are we just paying more for it?

  9. You can’t swing a dead cat these days without hitting someone who has made fun of congressional Republicans for not having a plan to replace Obamacare.

    Suderman better steer clear of dead cats, or wear a hardhat.

  10. All I know is, before Obamacare my mother died of a heart attack despite paying a lot of money for health insurance and after Obamacare she didn’t spend a nickel on insurance and didn’t die of a heart attack. Your move, GOP.

    1. Did the free birth control also prevent her corpse from getting preggers?

      1. She aborted Jerryskids for free, obviously.

  11. “Instead of having to choose between a tax-advantaged policy offered by your employer or a tax-disadvantaged individual policy, you could choose from plans offered on a level playing field by your church, or Kiwanis, or the ACLU, or the NRA or a host of other groups.”

    Just as an aside, I think it would be funny as shit if Republicans legalized this kind of thing and the NRA subsequently became the biggest provider of health insurance and made a profit in the process. I’m already overstocked with gallon jugs of “progressive” tears from Trump’s election; I’d have to build a new warehouse if this happened.

    1. The group policy only works if it is all or nothing.

      A self selection among various groups doesn’t get you anywhere.

      The group of employers works as an extension of the current system. But if everyone can pick and choose among five groups, then adverse selection will follow.

  12. “Facebook will filter ‘fake news’ in Germany”
    http://www.sfgate.com/technolo…..858918.php

    CNN, CBS, ABC hardest hit.

    1. NBC has a sad.

  13. Ugh. The point should not be health insurance, the point should be health care. There are dozens of things that could be done to make care cheaper:

    – Rein in the FDA and the AMA.
    – Ban certificate of need laws.
    – Require transparent pricing.
    – Allow nurses and pharmacists to do more.

    Regarding insurance, eliminate mandated coverage of various things.

    1. I’d guess that something like 90% of the population hasn’t a clue what a certificate of need is. Basing that on the fact that exactly zero of the educated, professionals I’ve mentioned this to knew what I was talking about.

      1. A number of factors spurred states to require CONs in the health care industry. Chief among these was the concern that the construction of excess hospital capacity would cause competitors in an over-saturated field to cover the costs of a diluted patient pool by over-charging, or by convincing patients to accept hospitalization unnecessarily.[2]

        “excess capacity” resulting in “over-charging”?
        “unecessary hospitalization”?

        i can *sort of* see the latter case (practitioners convincing patients they’re worse off than they are, and exaggerating risk). Its what happens in markets with high-degree of information imbalances… like say, the way auto-repair shops deal with the average female customer.

        (you’ve never seen a smile quite like that of the auto mechanic who is told by some middle aged woman that her car is “Making a Noise”)

        but the excess capacity leading to ‘over-charging’ makes zero fucking sense to me. unless they also have the ability to hide costs from patients until they’ve got them in the beds and prisoner to their care. which is only something they’d have if they had some other legislative scam going.

        1. CONs are relics of an era when hospitals were basically regulated like utilities – they would submit their charges to the state for approval, etc. Its typical of utility regulation that both capital investment and prices are regulated by the state, in order to ensure that the utlity/quasi monopoly not overcharge, and not underinvest.

        2. GILMORE, never heard of the law of supply and more supply?

      2. I would say that 99.99% of the population would give you a blank look if you mentioned the phrase, “certificate of need”.

    2. Allow nurses and pharmacists to do more

      Extend this to roles such as nurse practitioners, physician assistants, midwives, etc.

    3. On the payment side:

      – Let full HSA balance carry over year-to-year
      – Make HSAs portable or better yet detached entirely from insurance
      – Greatly expand what is eligible for purchase/reimbursement from HSA
      – Increase HSA contribution caps
      – Allow HSAs to accrue interest

      People can plan for things, if you let them.

      1. I think you’re confusing HSAs with Flexible Benefits Plans. HSA balances already carry over, have pretty high contribution caps (relative to Flex; something like $6000 per family compared to $500 or so), can be invested in different vehicles (including stock market), and can purchase just about anything related to healthcare except insurance itself but must be associated with an HDHP plan.

        Flex plans have the problems you list.

        1. Fair enough. I’m more familiar with FSA/HRA because that’s what’s been made available to me. I don’t have access to what the government calls an HSA. That’s a problem unto itself. Also, you can’t use the funds on OTC medications.

  14. “To some degree, that’s their own fault.”

    To some journalists, it doesn’t seem to matter how well the Republicans are doing–they’re always failing.

    The Republicans can take the White House, but they’re still failing.

    The Republicans can control both houses of Congress, but they’re still failing.

    The Republicans can have total control of more state legislatures than at any time in history, but they’re still failing.

    The Democrats are losing control of Michigan and Wisconsin, but it’s the Republicans who are failing.

    Anybody else remember Elaine Garzarelli? She was doomsday, contrarian fund manager, who went around prophesying doom. Everywhere she went, she made the same predictions for years. One day, back when FNN/CNBC was new, she was on making the same predictions she’d always made–and it just so happened to be the morning of the big selloff in 1987. Were her same old tired predictions somehow suddenly ingenious?

    I don’t think so.

    Someday, the Republicans will fail. But if what they’re doing right now is failing, then I’d rather be “failing” like the Republicans than winning like the Democrats.

  15. My Replacement for ObamaCare

    1. Get rid of tax breaks for employer-based health insurance
    2. Get rid of the mandate.
    3. Government gives a tax credit for up to something like 50% of the cost of a HDHP plan. If you still cannot afford a HDHP plan after this, then congratulations you’re on Medicaid.
    4. Government gives matching funds for annual contributions to an HSA, up to some amount (maybe like $1000 or something). But it only goes to people with an HDHP plan.
    5. Begin to unwind Medicare such that when working people today have a fully paid up HSA by time they get to retirement age, Medicare should be gone by that point.

    No one is FORCED to get health insurance. But if you don’t have health insurance, you don’t get the matching funds for the HSA.

    1. Mine:

      Let me trade with whoever I please for whatever service I want to contract for and leave me the fuck alone

      1. As an deal, yes. However the State has been buggering up the health care market for so long that the correction involved in bringing about your ideal would look catastrophic to too many voters, who would loudly demand that Somebody Do Something.

        And here we go again, only this time we’d get a National Health Service.

        *shudder*

        1. Purism vs pragmatism? In MY Reason comments? Say it ain’t so!

    2. Why not just offer everyone Medicaid with a $10k deductible?

      Then people can insure the gap.

  16. But repealing Obamacare also would cause millions of people to lose coverage?many more, in fact, than lost it through Obamacare’s passage.

    This captures the absurdity of it all. Pass Obamacare and people lose coverage. Repeal Obamacare and people lose coverage. I’m starting to think that I’m getting iied to.

  17. I’m not terribly optimistic the average American health care consumer can learn how to price shop for treatment. We’ve had two generations of patients being told what procedures they’re getting, either by their insurance or by their doctor.

  18. Taxdollars invested in Obamacare, is as brilliant and successful as taxdollars invested in Solyndra!

  19. “But repealing Obamacare also would cause millions of people to lose coverage”

    That isn’t necessarily so.

    Repealing ObamaCare would cause millions of people to lose coverage–if the replacement doesn’t address that.

    Just based on popularity, I expect some form of the protection for people with preexisting conditions to remain. I suspect they will keep a subsidy for those people in place–so long as they have maintained continuous coverage. No skipping payments for six months, and then suddenly jumping back on when your symptoms flare up again.

    It should also be said that no one in America can be refused life saving care at an emergency room just because of an inability to pay. It doesn’t matter if you’re an illegal alien. It doesn’t matter if you’re unemployed. It doesn’t matter if you don’t have a penny to your name. Show up to an emergency room with a serious condition, and you will get care free of charge.

    If ObamaCare were repealed and the Republicans replaced it with nothing, it would still be the case that anybody could walk into an ER anywhere in the country and received care regardless of their ability to pay.

    1. To dig a bit deeper, what wold those people actually lose? For many, it is health insurance in a nominal sense; glorified catastrophic care basically with a ridiculous deductible and ever-rising premiums. I’m old enough to recall my folks having major medical but the out of pocket things like physicals or routine visits were affordable and no one talked about co-pays and the like.

      1. “Show up to an emergency room with a serious condition, and you will get care free of charge.”

        I should add that the way I said it the second time was better.

        Show up to an emergency room with a serious condition, and you will be get care.

        “For many, it is health insurance in a nominal sense; glorified catastrophic care basically with a ridiculous deductible and ever-rising premiums.”

        There are still deals out there for people getting subsidies.

        I was helping someone navigate the exchange myself recently. She got a silver plan through UnitedHealth, no deductible except on prescriptions, and she was paying about $70 a month.

        She qualifies for subsidies a la the working poor. Makes a little too much to qualify for Medicaid. UnitedHealth is getting somewhere north of $300 a month from the government in addition to her $70.

        For her, losing that subsidy would mean a loss of care. She wouldn’t even be considering health insurance if it weren’t subsidized. It would cost too much.

        So, when premiums rise 30% from $370 to $481 a month, that doesn’t mean much to her. That means now UnitedHealth is getting $390 from the government per month, but her payment has only gone up from $70 to $91 per month.

        If you’re talking about people who don’t qualify for the subsidies, yeah, they’re all getting screwed.

        1. My family qualifies for the subsidy. Fat lot of good that does when the premium shoots from 1000 to 1300 (before subsidy). (And a nice little trick that they did was that you’re not supposed to use that subsidy to buy a plan that actually covers anything. You’re supposed to use it to buy the second highest bronze plan or something)

          We have been completely fucked by this law and our asshole “friends” want to talk about how that’s horrible for us but look, that lady is able to get insurance for only $91 where she wasn’t able to get it at all before. And then bitch about the Republicans working towards repeal.

          1. Yeah, she was just buying for herself.

            I don’t see how this helps a working family of four.

            If you’re not a doctor or an engineer, I think you were supposed to join the UAW or something.

            Or be unemployed and poor enough to qualify for Medicaid.

            It’s a middle finger to regular people–sold as if it were supposed to help them.

            It’s really about screwing regular people to help the very poor.

    2. This.

      Obamacare didn’t invent protection for pre-existing conditions. That already existed under HIPAA where an individual could demonstrate that they maintained continuous coverage. If you don’t have insurance and then try to buy it after getting sick, that’s basically the same as trying to buy auto insurance after you’ve wrecked your car. At that point, your policy would no longer be insurance against potential issues, but would be more of a discount club for receiving medical services at a cheaper cost.

      Insurance is a gamble. You pay too much for healthcare when you are healthy to ensure (insure) that you don’t have to face the full cost when you get sick. When people only use the second part of that process, it breaks the system by forcing others to pay even more when they’re healthy. If blackjack tables had to change their rules and let you buy “insurance” at any point (even after all of the dealers cards are shown), casinos would go broke. It’s not a small swing to the odds (profitability); it’s huge.

  20. Hmmm… just thinking pragmatically, not libertarianishly, the government could establish a clearinghouse of mostly anonymized but itemized medical debt from HSAs in the red (IOW, you could see that the family of 5-year-old patient X owed $80,000 for cancer treatments, or that 37-year-old patient Y owed $10,000 for breast implants, or whatever), and let anyone make donations to cover those debts. It could treat any payments made by taxpayers against those debts both tax-deductible, with some percentage available as a non-refundable tax credit. Basically, give people some incentive to pay off each other’s medical debt, but not enough to be foolish about it or be motivated by money over charity. Depending on how much information was provided, it could use the wisdom of crowds to identify possibly fraudulent charges.

    1. It’s a good thing I don’t let people’s retarded politics influence the movies/art/books/music/etc. I consume, otherwise I’d probably have to sit quietly everyday. Fuck that is disappointing though.

      1. Seriously, I have been really disappointed the last several months that authors that I really like as people (as well as enjoying their books) have become so abrasively political. He is one that I admired very much for many years, and now his feed is nothing but parroting all the other progressives in the industry and making people of any other political stripe feel increasingly unwelcome. I don’t know how they expect that to help, it’s just going to deepen the divide.

  21. The guys at the Surgery Center of Oklahoma, mentioned by reason a couple of years ago, have struck again! https://reason.com/reasontv/201…..doctors-fi

    Like an idiot, I gave myself a hernia moving something I shouldn’t have. Because they fixed a similar problem back in ’07 I called them up. The total price, including the initial doctors visit, was listed online. I don’t have insurance because I can’t really afford it and I don’t do government “subsidies”. I paid with a credit card.

    This makes 3X I have used the Surgery Center of Oklahoma. My daughter broke her arm a few years ago. The hospital said it would cost a minimum of $2500 to set her arm and they wanted her to show up at 6:00 am. (A friend in the health care industry claimed that the final bill would have been much higher) The SCoO quoted me a price of $1750 and the final bill was…I swear to Science, less than their estimate.

    If you give a shit about poor people, making care less expensive should be your priority. Providing birth control for middle class women should never even enter the question.

    1. One good thing about living in OKC you can’t swing a dead cat without hitting a hospital.

  22. moving the U.S. away from Obamacare

    Yes, technically they might do that.

    toward a more rational, market-oriented system

    No, they won’t do that.

  23. Also: this bold small press is taking a brave and heroic stance against tyranny, since no one else except EVERY SINGLE OTHER author, editor, literary agent, and small press on Twitter will.

    Because “we believe in our #constitutionalrights,” as long as it’s an icky Republican who’s threatening them. And as long as they’re not that gross and outdated second amendment.

    1. If I had twitter, I’d ask them where they were when President Obama ordered the murderdroning of a 16 y/o American citizen without due process.

  24. eliminate the tax preference for employer-provided insurance and replace it with a standard income-tax deduction for health insurance from any source.

    This is mostly just more tax games BS if you think its a ‘solution’. Makes it more impossible to reform the tax system. Taxes are for revenue not economic macromanagement. And the biggest needed change for employers is to get rid of the ‘annual enrollment’ so that people can begin to think about lifetime medical which is the only solution for Medicare.

    simply create a high-risk insurance pool

    Even worse BS. If there is gonna be an insurance pool, it has to be universal (including all employers and Medicare and everything else) and the role of the federal govt is reinsurance (like Lloyds). And yeah it would be mandatory – FOR INSURERS. No one else would even know what it is. So politically it doesn’t get votes so pols don’t like it.

    entails allowing organizations to create multi-state insurance pools.

    “Don Quixote is libertarian” solution for those who don’t understand the diff between ‘provider networks’ and ‘insurance pools’. Offer East Coast hospital coverage to West Coast residents. Real cheap. Real useless.

    1. If there is gonna be an insurance pool, it has to be universal (including all employers and Medicare and everything else) and the role of the federal govt is reinsurance (like Lloyds). And yeah it would be mandatory – FOR INSURERS.

      Oh, great. A Federal Reserve System for health insurance. Yes, let us incorporate more private-sector risk into the federal government. What could possibly go wrong?

      1. Reality is that the elderly, veterans, govt employees, and the poor are already in the pool. Actuarially, the main problem with insurable medical risk is the outliers – annually, two out of 1000 people will incur $300,000+ (preemies, hemophilia, head trauma from auto, end-stage renal, etc). 1% of patients incur 25% of total medical expenses. This is WAY beyond dicking around with copays and deductibles. This is reinsurance and case management and SERIOUS legal exposure to life/death decisions (which is ALWAYS going to involve govt in one way or the other). All the ‘high-risk pool’ does is force the govt to pay that in full anyway while everyone else passes the potato and jacks up the bill and manages nothing until it falls to govt. For example, an employee gives birth to a hemophilic child – so the employer finds a convenient reason to can them – so it all goes to court or bankruptcy or Medicaid. We should stop playing these fucking games.

        1. Reality is that the elderly, veterans, govt employees, and the poor are already in the pool

          And the government’s just done such a wonderful job managing that risk, eh?

          We should stop playing these fucking games.

          What are taxes and spending if not games played with other people’s money?

          The government is not a doctor. It is not an insurer. It is quite literally competent at nothing except the use of force. Collecting taxes doesn’t save a child’s life; a doctor does.

          Tying insurance coverage to employment was a mistake but one that was necessitated by the punitive taxation of WW2. You would solve one mistake of government with another?

          1. Collecting taxes doesn’t save a child’s life; a doctor does

            Whether you like it or not, the govt is involved in these big expensive life/death cases – here and everywhere. These are, basically, execution decisions. Whether it is via courts or lawsuits or bankruptcy – or directly because virtually everyone is profoundly uncomfortable with the idea that third-party self-interest alone should decide whether someone is rich enough to live another day or should be killed. And the health infrastructure for this stuff is heavily fixed-cost not variable-cost so individual pricing decisions are always a bit political/arbitrary anyway (no matter who makes it).

            The reason our system here sucks is because everything about those decisions here is ad hoc and defensive and incapable of dealing with this on either a human individual level or a systematic level. So the spending/etc decisions are profoundly distorted and remarkably ineffective (medically).

            Anarcho theory is just that. Theory that doesn’t give a shit about empirical reality – which is why no advocates can EVER name a SINGLE example of even a tiny country (hell – a big city would be an OK example) where the free market actually has free rein over these big expensive life-death decisions. I won’t hold my breath waiting. I much prefer looking at things that actually work and there are plenty of those.

          2. Tying insurance coverage to employment was a mistake but one that was necessitated by the punitive taxation of WW2. You would solve one mistake of government with another?

            Understand the fatal impact of that. Up to WW2 the number of hospitals/beds was increasing (absolutely and per capita). Most hospitals were religious founded and still religious-run at that point. That meant those big life-death decisions involved deep shared understandings of what life/death means.

            Once insurance/financing became employment-based, coverage itself became sporadic with no shared life/death understanding. Religions got out of hospital biz as ‘insurance’ became secular. Some hospitals were taken over by municipalities with some absolute growth (per-capita stability).

            Once elderly got coverage, the system changed again. Specialists (transaction-oriented) exploded – GP’s (relationship-oriented) declined. Hospitals/beds declined 50% in absolute terms – but are now massively capital-intense. It is now a specialist-driven-lawyer-intermediary system. There is NO common understanding of life-death anymore – at even a shallow level – but a serious entitlement mindset.

            This can’t simply ‘be reversed’. What is now – is. And what we do from here has to deal with what is now.

        2. Moreover, the idea that veterans should have every medical treatment paid by the government is already preposterous. If you have left the service, and the injury or treatment has nothing to do with your service, then you should be on your own.

          As for government employees, well there should be a lot fewer of them, anyway.

  25. People need food as much as they need medical care?and yet somehow the U.S. manages to feed everybody without employer-sponsored food plans and state-run food-purchase collectives and a federal Ministry of Eating and a Center for Breakfast and Lunch Services and so forth.

    You shouldn’t give them ideas.

    1. Actually, I thought this pretty well described more than half of the Department of Agriculture’s activities (counting “surpus” commodity purchases as food-purchase collectives).

    2. What about shoes? The last time I went to a beach in Florida, virtually everyone was barefoot! Government needs to take over Big Footwear and provide shoes for all.

  26. if the free market system worked we wouldnt have needed aca…so now you have 2 and only 2 choices…health care for all..or health care for some..for all its easy,take profit out of health care,,,for some easy yet again,,revoke the hippocratic oath and the mandate that hospitals must treat you regardless if you can pay..so if you show up to the ER with your femur protruding from your skin and no insurance you get turned away…if you wish everyone to have health insurance make it a birth right like every other industrial country on this planet…how???

    1. There is no such thing as “taking profit out of health care”. Doctors and nurses don’t work for free. Medication and equipment doesn’t manufacture itself.

      We already had “healthcare for all” before the ACA. It was called Medicaid.

    2. I spend about 50k a year on things that I have no insurance for. The free market works for apparently every single product but this single one.

  27. The government helps the very poorest by giving them food vouchers, but Washington doesn’t micromanage every grocery store and farmer’s market.

    Give us time.

    sin/
    Congresslime.

  28. Instead of the ACA mandate and penalties, instead of the coverage for everything under the sun…

    Define a true meaningful minimum catastrophic insurance plan. Heart attack, broken arm, yes; birth control, breast enlargement, viagra no.

    Structure the above as an HSA with high-deductible plan.

    Allow insurers to penalize pre-existing conditions and non-coverage. Pre-existing conditions excluded for perhaps 2 years after initially signing up, but like HIPPA rules today, cannot be excluded if converting coverage from one company or plan to another. If you go more than 2 years without coverage, you may be denied entirely.

    At some age, maybe 18 or 21 or 25, young people must convert from their parents plan to one of their own, to establish their own continuous coverage baseline. If they do not do so, they will face pre-existing conditions exclusions and higher premiums later. By converting at a young age, they have time to build up their HSA.

    Redo taxation/deductability to remove employer-provided plans from the equation and to encourage individual plans for increased continuity and eliminating the 4th party (employer) from health-care decisions.

    1. I got screwed on this. As of 2013 insurance companies could not deny my daughter based on preexisting conditions but they could charge the fck out us.

      We had been continuously insured. I stuck with COBRA until I landed another job.

  29. No love for health-status insurance?

    It still seems to me like the best fix: separate the cost-of-treatment and change-in-future-cost-of-treatment components, allowing people to forego health insurance when healthy while retaining protection against becoming suddenly sick in a lasting way.

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    Read more on this site
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    1. This spammer gets it. Earn 75 an hour and pay for your own damn care.

      1. Better yet, upload your consciousness onto the internet, become a spambot, and make money while not requiring health care at all!

  31. “Congress should replace that approach with a more direct one: Offer Medicaid or Medicare coverage to anybody turned down by private insurance. Or simply create a high-risk insurance pool similar to the ones that states create for problem drivers. This would protect insurance companies against the sick-customer “death spiral” and protect patients against premature death.”

    When did Reason get bought out by Slate?

    Is this piece a joke?

    1. When did Reason get bought out by Slate?
      Is this piece a joke?

      The joke is your own ignorance. And Hinkle’s. States have run high-risk pools for several decades. Americans are more than willing to pay for them …. mostly because even libertarians (these days) have no credible alternative when, somewhat obviously, we had a vastly superior way before the gummint. But screeching anti-gummint slogans has KNOWING how to replace it.

  32. We need more doctors and hospitals. Almost three quarters of qualified medical school applicants are turned down during the application process because the supply of doctors is controlled by the guild-like AMA. The total number of hospitals is reduced and the remaining hospitals are consolidated into single entities in order to reduce competition in the name of ensuring adequate quality.

    Read more about the economics of government intervention in the healthcare industry in this excellent piece on Mises.org: https://goo.gl/SflVm8

  33. ” employer-sponsored food plans and state-run food-purchase collectives and a federal Ministry of Eating and a Center for Breakfast and Lunch Services and so forth.”

    I second Hinkle’s call for a government provided food security blanket. No nation can call it self great without a governmental guarantee of essential food!

    1. I second Hinkle’s call for a government provided food security blanket

      So you lied through your teeth on what he actually said so you could post … drivel.

      Emphasis added

      somehow the U.S. manages to feed everybody without employer-sponsored food plans and state-run food-purchase collectives and a federal Ministry of Eating and a Center for Breakfast and Lunch Services and so forth.

      A typically dumb argument. “Employer provided food” is called … wages!

  34. If we’re serious about providing decent health care for all, it’s time to get the insurance companies out of whatever is determined to be “baseline care”. In other words, if we’re going to provide healthcare to everyone including those who can’t afford to pay for it, it makes no sense to allow insurance companies to profit from what is provided through government largess. Let the insurance companies compete for supplemental plans that allow those with the appropriate finances to pick their doctors, hospitals and treatments. France has a similar model and it seems to be working quite well for them. Their overall healthcare costs are significantly less than in the US.

    1. Their overall healthcare costs are significantly less than in the US.

      1. Do you get a bill for your share of “overall healthcare costs” or do you get a bill for services rendered?
      2. Governments lower “overall healthcare costs” by rationing care and lowering standards.

      France does do some things better than the U.S., like allowing pharmacists to prescribe common medications. But prices are not costs and lower aggregate spending is, in any other sector of the economy, a bad sign not a good one. The biggest barrier to cheaper care in the United States is not the insurance companies but the state and Federal governments. If you want to get insurance companies out the picture, start by getting the government out of the picture. That’s where this mess started.

  35. Our healthcare is the highest in the world because we’re the only place where one can spend $150,000 or more for only a few months more of life. When Obama was honest — pre-election — he described his grandmother getting a costly hip replacement when she was terminal cancer, then dying a few months later,

    Plus, we do much more diagnostic testing than anywhere else, per OECD data.

    start by getting the government out of the picture. That’s where this mess started.

    That requires a transition plan, which even libertarians haven’t had since the 80s. Ant-gummint screeching is now the rule from so-called fiscal conservatives.

  36. I am making $89/hour working from home. I never thought that it was legitimate but my best friend is earning $10 thousand a month by working online, that was really surprising for me, she recommended me to try it. just try it out on the following website.
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  37. *Just* put our medical system back on a cash-for-actual-costs-only basis. Insurance adds a layer of fat that will always make any program unsustainable. Cash for actual costs, we as a nation can afford and should be willing to pay.

  38. so A Barton Hinkle does not wish to repeal millions of words of police state marism!!

  39. Regionalism: How ObamaCare is Merely a Tool..Repeal and Replace is still Socialism..

    https://www.youtube.com/watch?v=QoWh48dfKZo

  40. The media and politicians are not talking repealing and replacing all of this marxist law..

    20,000 Pages of Federal Regulations Create Obamacare Tower (Photo) | The Gateway Pundit
    http://www.thegatewaypundit.co…..wer-photo/

  41. Bureaucracies in the Obama Administration have thus far published approximately 11,588,500 words of final Obamacare regulations, while there are only 381,517 words in the Obamacare law itself.

    http://www.cnsnews.com/news/ar…..x-long-law

  42. Repeal, But Don’t Replace ObamaCare..
    Last year, a man at my local meat market stopped taking his blood pressure medication because he could no longer afford it when his employer switched to a cheaper insurance plan. Obamacare literally priced him out of his life. He died two months later.

    http://www.newswithviews.com/N…..igh382.htm

  43. Trumpcare is No Solution For Obamacare….
    So all the talking heads and millions of others that are screaming that the government takeover of the health care system is a very bad idea are right. But even if it was a good idea, it would be a criminal scheme all the same, because the Constitution provides no authority for the federal government to involve itself in “health care” or in “health care financing” or in “insurance” of any kind. Furthermore, to replace the current system of health care with a “better idea” will still remain unconstitutional; therefore, illegal and criminal.
    The operative clauses to look up here are Article One, Section Eight, of the Constitution, as well as the Tenth Amendment. It will only take you about six minutes to read and understand that Obamacare, or any variation of it, is more than just a bad idea for the health care of Americans. It is a dangerous and tyrannical trespass into American homes and lives.
    All the smoke and mirrors about what “Obamacare” costs, or newly appointed head of the Department of Health and Human Services Tom Price’s plan to fix the current problems we see with the Affordable Care Act, are irrelevant.
    Simply put, there is no right way to do a wrong thing. To repeal Obamacare is the correct Constitutional solution, but to replace it means we will still have a unconstitutional Federal Healthcare system. Trumpcare is no solution for Obamacare..
    http://www.newswithviews.com/MacAulay/jake187.htm

  44. 2013 – Replace Obamacare With Nothing..
    The bottom line besides being unconstitutional, Obamacare is a financial nightmare. Don’t let the incompetent Republicans ram another Band Aid down our throats. Get the U.S. government out of health care and see how things get turned around for everyone regardless of political party or any other “identifier”. The ones who hate that idea are the insurance companies who will make out like bandits under Obamacare.

    http://www.newswithviews.com/Devvy/kidd608.htm

  45. I wonder “why” no one considers suggestions for reduce the cost of American health care to something closer to what the rest of the developed world pays? What is so “sacred” about paying the world’s highest prices for health care? No doubt our three trillion dollar health care industry is able to “buy” Congress for a billion or so. With the exception of Bernie Sanders, no one has ventured the idea that perhaps we pay too much for the level of care we receive. Right now health care is one of the highest costs that many Americans pay. Health insurance premiums now often exceed the cost of paying a mortgage. They certainly exceed car payments or what we spend to eat. Probably the majority of Americans pay more for health insurance than they pay in taxes for all three levels of government.

    Discussing how we are going to pay for it seems to be the only answer anyone seems to have. It is almost today considered to be a “fixed cost” that nothing can be done about. That we have to pay whatever prices the industry wishes to charge. That while insurance companies might be able to bargain prices down a bit, that is really all that can be expected. Nothing more can be done… This may be the case for Democrats and Republicans, but it is really also the case for libertarians?

    This is the question we need to ask.

    1. This is the question we need to ask.

      Asked and answered, decades ago. A combination of factors. #1 the biggest.

      1) We’re the only country that can pay $150,000 or more for 6 more months of life ? so we do it. Back when Obama was honest about health care, he described his grandmother, already terminal with cancer when she got a costly hip replacement — then died a few months later,

      2) We do a LOT more diagnostic testing, which is costly My dad was cured of colon cancer in the 1950s. As of 2003, Canada was STILL not providing colonoscopies. It’s hereditary, so I get one every 10 years. VERY costly, but very infrequent. The equipment costs are massive, starting frorn scratch now. Mammograms compare similarly.

      Wait for it ..

      3) And we spend more per capita on government insurance ALONE– for less about 40% of our people — than Sweden, the U.K., Australia, New Zealand, and Japan spend for their ENTIRE population. Page 3 at this link http://bit.ly/1i0Yq9c

      Do the math. if our private health insurance disappeared tomorrow, and all those people remained uninsured, we’d have the exact same same people and costs for gummint insurance as today ,,,, and STILL spend more than those five countries!

  46. 1) the bill passed in 2010 (or whatever it was) is void
    2) Any payment made by an employer to an insurance provide will be taxed as income
    3) Every person may set aside up to $5,000 per family member per year pretax, and interest accrued will also be tax exempt and may be passed on to ones children for their heath care needs.
    4) Outlaw prohibition of purchase of health insurance across state lines (cite Amendment IX)
    5) President Reagan’s “Emergency Medical Treatment and Active Labor Act” is void, AND 100% of donations to hospitals will be counted as taxes paid.

    1. Insurance is not health care. You’re in the wrong market.
      $5,000 is WAY too small to offset the loss of exemption on employer healthcare, and is a fixed amount versus the widely varying tax increase. If I’m paying 25% average and my neighbor pays an 8% average then my taxes increase 3x as much as his — which means soaking the rich to subsidize median incomes.

      Marx would love it.

  47. “Obamacare tries to solve the problem of pre-existing conditions the Rube Goldberg way: Make insurers cover individuals no matter what, then guard against people buying coverage only once they get sick by forcing everybody to purchase a policy through the individual mandate?an unprecedented expansion of government power.

    Congress should replace that approach with a more direct one: Offer Medicaid or Medicare coverage to anybody turned down by private insurance.”

    So after frothing yourself into a fury about how government is the problem in healthcare, you propose dealing with the most challenging part – how to deal with the very sick or potentially very sick – by moving them into socialized medicine?

    Your right, that’s the only way they’ll be able to get affordable coverage. But why aren’t you questioning the rest of your dogma?

    1. Any change which can be a transition step back to Charity Hospitals who never denied anyone.
      Back when we had 100% treatment. Pre-LBJ.

  48. It is UN-Constitutional for the federal government to be meddling in the health-care industry. Completely repeal the ACA and leave safety nets to the state.

    1. Just as Unconstitutional for the states. Ninth amendment.
      But where is it denied?

      1. 10th amendment specifically says “all remaining powers reserved to the states” [after enumerated powers in art 1 sec 8]. the 9th simply reiterates that the individual liberties in the bill of rights shall not be infringed. 9th doesn’t say states can’t offer healthcare services (unless they infringe on the bill or rights). congress is explicitly limited to art 1 sec 8 and “reserved to the states” is common sense plain English. what is reserved to me is not what I get after you have taken everything else. what is reserved to me is mine. what is reserved to the states is all remaining powers after those enumerated to congress. the problem is the supreme court is reinterpreting plain English common sense wording like “regulate commerce among the several states” to empower congress to regulate non-commerce and commerce that is not conducted among multiple states (intrastate), and in the obamacare supreme court case literally considering that enumerated power to regulate you sitting on your couch doing nothing in order to force you to buy something you don’t want to buy. sooner or later, we are going to have to clean out these activist judges who don’t give a damn what the constitution says, and who even have contempt for it.

  49. most healthcare (products and services addressing injury/illness) is delivered through clinics on an outpatient level. markets of scale cut costs and increases quality in every other product/service. the vast majority of retail economic activity in this country is conducted through national and regional chains. look what walmart and CVS did to the cost of prescription meds, for example. for some reason government has singled out healthcare and blocked the market from operating as it does with every other product or service. remove all these barriers to national chains offering products and services DIRECTLY to the market, nationally or regionally, and eliminate almost all insurance. insurance is supposed to cover the things you can’t plan to pay for on your own, like your home insurance. national catastrophic plans with high deductibles could cover you affordably against the big things you could never afford on your own, and national chains could offer affordable plans that could easily take care of all your normal needs (or just pay the walk in clinic fee without a plan). chains could even release apps that show wait times are nearby locations to increase efficiency and access. the pre-existing condition issue is a relatively small number of people that we could be dealt with at the state level.

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  51. “The U.S. manages to feed everybody without employer-sponsored food plans and state-run food-purchase collectives and a federal Ministry of Eating and a Center for Breakfast and Lunch Services and so forth.”

    Um, yeah, no.

    From https://en.wikipedia.org/wiki/Agricultural_subsidy

    “The United States currently pays around $20 billion per year to farmers in direct subsidies as “farm income stabilization” via farm bills. ”

    The food market is vastly regulated and subsidized by the Federal Govt.

  52. “The U.S. manages to feed everybody without employer-sponsored food plans and state-run food-purchase collectives and a federal Ministry of Eating and a Center for Breakfast and Lunch Services and so forth.”

    Um, yeah, no.

    From https://en.wikipedia.org/wiki/Agricultural_subsidy

    “The United States currently pays around $20 billion per year to farmers in direct subsidies as “farm income stabilization” via farm bills. ”

    The food market is vastly regulated and subsidized by the Federal Govt.

  53. I Leave my office job and now I am getting paid 96 Dollars hourly. How? I work-over internet! My old work was making me miserable, so I was to try-something different. 2 years after…I can say my life is changed completely for the better! Check it out what i do…

    ================> http://homejobs7.com

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