Obamacare

The One Number That Shows Why Any Health Care Reform Effort Will Fail

People don't really want insurance.

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A doctor
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Congressional Republicans are finally inching forward with a plan to repeal and replace the Affordable Care Act (ACA), a.k.a. Obamacare. About time, right? After all, displeasure with the 44th president's health care overhaul is what sparked the Tea Party movement in 2009–10 and swept the GOP to a majority in the U.S. House. President Obama was dinged with "lie of the year" in 2013 by the otherwise left-leaning website PolitiFact for his claim that "if you like your health care plan, you can keep your health care plan." Donald Trump vowed during the campaign to repeal the law and replace it with something where "everybody's going to be taken care of much better than they're taken care of now." And since Obamacare went into effect in 2013, there has never been a time when the polling giant Gallup has found more people approving than disapproving of it.

But the attempt to do away with it completely was never going to be as easy as it looked. Although the public has remained, on the whole, more sour than positive toward the ACA, there were always aspects of it people liked. Now that the Republicans have regained control of both houses of Congress and the White House, they're realizing that getting rid of those provisions in particular is going to be tough to accomplish politically.

That reality is highlighted by a new poll, out this morning, from CNN and ORC. Support for the law is still outstripped by opposition to it (46 percent vs. 49 percent). At the same time, though, a whopping 87 percent of Americans favor "maintaining the protections offered to people with pre-existing conditions under Obamacare."

That is, to put it mildly, a problem.

We've collectively lost sight of what insurance actually is: a way to protect yourself against a possible future outcome. Some of the people who buy the insurance will eventually be affected by that outcome. Others never will be. But since none of us can know beforehand which camp we're in, we're willing to pay a little bit now for the peace of mind of knowing we're covered, just in case.

But if insurers can't turn anyone away, there is a strong incentive on the individual level to treat the system as something else entirely—and to not buy in unless you know you're going to need a lot of expensive care in the near future. If you're young and mostly healthy, why would you pay premiums every month, potentially for years, while drawing little value out, if you can just wait until you have an imminent use for a lot of coverage and join a plan then?

Traditional insurance markets don't have that problem, because a company isn't obligated to sell its coverage to someone who's already hurt or sick, and it's definitely not going to sell coverage at roughly the same price it would charge to a healthy customer. Obamacare took that freedom away, but tried to compensate for the bad incentive it was creating by taxing those who chose to go without coverage. The new GOP plan eliminates the individual mandate—the requirement to either sign up for a plan or pay a penalty—but does not appear to do away with the mandate that companies cover people with pre-existing conditions (and not charge them many times more than they charge everyone else). That dramatically increases the chances that we could fall into a so-called death spiral where only sick people buy coverage, and insurance companies have to jack prices way up for everyone just to stay in business.

Keeping protections in place for people with pre-existing conditions seems to many Americans like the compassionate thing to do. In a previous life I conducted focus groups with voters for a living. Over and over again, no matter which city I was in, I heard the same things when it came to health care policy: People didn't like the ACA; they saw it as big, complicated, and confusing. They believed it would cause disruptions in their lives and worried it would end up costing their families more than they were paying at the time. But they did very much support ensuring people couldn't get locked out of the insurance market just because they were already sick.

The poll from CNN/ORC I cited earlier proves that hasn't changed. It also suggests that any attempt by Republicans to fix the problems with Obamacare will likely fail the affordability test. Politicians are rarely willing to go against the people who employ them. Unfortunately, the people who employ them want the unattainable in this case: access to unlimited health care with minimal waiting at low prices that doesn't "discriminate" against people who already know they're going to use a lot of care. That's not insurance. It's a pipe dream.

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  1. And since Obamacare went into effect in 2013, there has never been a time when the polling giant Gallup has found more people approving than disapproving of it.

    What were Gallup polls showing on the election results of 2016?

    1. I could be wrong, I’m no polling or statistics expert by any means. But I feel like the trends should be somewhat meaningful even if the raw numbers are off.

      Sometimes I feel like the man who runs the universe from Hitchhiker’s Guide to the Galaxy.

      1. You mean the guy who runs The Restaraunt at the End of the Universe?

        1. No, the man who runs the universe is the guy with a cat who lives in a shack in some obscure backwater and doesn’t assume that he can know anything beyond what his senses tell him. Perhaps the reference was a bit too oblique.

          The point being that if I am to believe that I can know anything beyond what I directly experience, I have to believe to some degree in what other people tell me and in statistical extrapolations like opinion polls.

          1. You make solipsism sound like a bad thing.

            1. More useless than bad.

          2. “No, the man who runs the universe is the guy with a cat who lives in a shack in some obscure backwater and doesn’t assume that he can know anything beyond what his senses tell him.”

            Sounds a lot like the commenters on this site.

      2. “In the beginning was the Creation of the Universe. This has made a lot of people angry, and has been widely regarded as a bad move.” – Hitchhiker’s Guide to the Galaxy

    2. There were no polls conducted by Gallup for the POTUS elections of 2016.

      But that might have interrupted your narrative. Go on..

    3. “everybody’s going to be taken care of much better than they’re taken care of now.”

      V: Well, the President is leavin’ for Florida and when he’s gone, he wants me to take care of everyone.
      J: Take *care* of everyone?
      V: Not that! Take them out. Show them a good time.

  2. “We’ve collectively lost sight of what insurance actually is: a way to protect yourself against a possible future outcome.’

    Thank you.

    1. I love the media and politicians who say that Obamacare must be changed, but we must keep the elements that the public loves the most: guaranteed issue and community rating. The two things that make it cost so much and not actually be insurance.

    2. I recall Obama specifically endorsing that misconception. At some point during the fight to pass the ACA, he was asked (I believe not by a reporter, but a citizen during a radio call-in or some kind of photo-op) why healthcare reform efforts weren’t limited to basic catastrophic coverage, and he responded that “That’s not insurance!”

      Well, it obviously is. It’s just not an HMO — which really more closely resembles prepayment for services than it does simple insurance.

      My two strong suspicions regarding healthcare are that: 1) Some sort of nationally mandated catastrophic expense insurance would cost a small fraction of what’s currently being required, and 2) That federally subsidizing the increased cost of insurance for people with pre-existing conditions would cost a small fraction of what the current subsidies cost. The single biggest mistake in going down the road we have was in accepting the idea that its somehow unfair to have to pay for healthcare at all, ’cause it’s not your fault you’re sick. Leaving aside things like contributory unhealthy habits, the idea that the government is obliged to pay for your misfortunes is a pretty major step down the Socialist path.

      1. Excellent post Schill.

        Plans now are more pre-payment for services rather than insurance in the classical sense of meaning of the word, “insurance”. Currently though many have a nationally mandated plan that turns into catastrophic only. For example, Obamacare created the “$6000” deductible plan–did anybody have that type of deductible in 2005? Moreover, such plans now cost $18,000/year. A turd sandwich by any measure.

        The very sick and those with pre-existing conditions must go into a special pool–much like Medicare handles dialysis patients. Providers delivering care to the indigent should be allowed to directly write off the cost of that care against their bottom lines–that will solve the problem of getting care for the 15-20% without access. Getting rid of certificates of need and so many other common sense reforms would be a start to fixing the mess. Unfortunately, the clods in DC will likely do none of it. The GOP is setting itself up for a big disaster.

    3. Which is kind of irrelevant to what the ACTUAL problem is here:

      How to structure ACTUAL health care in this country so it CAN work.

      As long as 94% of the problem (Medicare, Medicaid, employer-based with annual enrolls, no generalist doctors and way too many specialists, etcetcetc) is being ignored then it is beyond insane to believe that the only problem here is the remaining 6% (individual ‘insurance’) or that putting the burden on that 6% is going to fix the remaining 94%

      1. And just to give one part of what Medicare/Medicaid itself needs to do if they are to provide a way for ‘the market’ to fix something:

        They need to completely stomp on all specialists. Cut reimbursements by 50% on day 1. Force all referrals to specialists to go through a primarycare generalist first and have the generalists serve as the medical case-managers for their patients through the specialist system.

        If specialists want to then ‘opt-out’ of Medicare, then they can charge whatever the hell they can get people to pay via ‘insurance’ – and they lose their base of taxpayer-funded patients. Specialists earn a bit under $500,000 on average. It is about time they create a tiered price system and it will only happen when they are forced to stop sucking at the public teat for their accounts receivable function.

        1. good points

  3. We’ve collectively lost sight of what insurance actually is: a way to protect yourself against a possible future outcome.

    The good news for republicans is that we had lost sight of that long before Obamacare went into effect. The task for Republicans will be to craft a plan that allows people to keep that misconception while fixing the most glaring problems of Obamacare. No, I don’t have the answers, but this ‘losing sight of what insurance means’ is not a new problem.

    1. Insurance is healthcare, and therefore a right, so craft your new law around that fact.

      1. Seems like people having a right to purchase insurance would be an easy sell. Especially for a master of the dark art of twitter.

        1. Anyone has the right to buy insurance … at a price those who sell it are willing to sell it for.

    2. We lost sight when insurances started offering copays for doctor visits and prescriptions. Then health care insurance plans pretty much became frequent-shopper-reward-card-style programs, where if you’re a member, you got to save more on services (instead of products). And if you weren’t a member, you got screwed over having to pay full price.

      Ideally I’d like for everything to go back to no copays for doctor visits, with the doctors charging considerably less for services in reciprocation. Have insurance be for catastrophic or incurable disease/disorder care only, with reasonable deductibles. Allow out-of-state policy purchasing, reform tort laws, and make sure there’s at least a few companies that don’t turn away those with preexisting conditions.

      1. Oh yeah, and full transparency from everyone on what everything costs.

  4. This One Weird Trick Shows Why Any Health Care Reform Effort Will Fail

    As somebody who never seriously expected otherwise, I’m not exactly surprised by what happened next.

    1. Funny how Obama’s reform effort succeeded… in passing that is.

      1. In the most shady way possible, and with bipartisan OPPOSITION and unipartisan support. Yeah, funny how that happened.

  5. I’m glad I have insurance. Instead of paying cash for my doctor’s visits during the year, and for my prescriptions, which would probably amount to $200, I get to pay more than that every month to “insure” against having to pay that once a year.

    It’s a relief. Having a lot of money in the bank really sucks and insurance has prevented that.

    1. Well, I think you’re just being sarcastic.

    2. I try to make a similar point as often as possible. If I had all the money that my employers and I have spent on health insurance for me over the past 20 years, I could easily have money in the bank to pay for a major injury or operation.
      But it has to be this way because people are bad at saving, or something.

      1. It’s because what we did during WWII wage and price controls worked then, and so employer-provided health coverage should still work now. What are you, unpatriotic? You a commie?

      2. True. But if you had gotten, say, leukemia 20 years ago, what would you have done then?

        1. I personally probably would still have purchased a catastrophic insurance plan in case of major calamities like that.

          1. That is the simplest and only solution to the entire problem. Imagine what would happen if people actually cared what the full price for a doctor’s office visit was. Perhaps some prices would fall due to competition, just like Lasik and breast augmentation.

            1. Doctor office fees were low when only a few people had health insurance. Back in the 1960’s an office was $8. There was a hospital connected clinic that charged a bit less. I believe doctors could write “never expires” prescriptions back then too. I had a couple of minor surgeries done. One was $80. The other, my own choice to have it done, was $150. The doctor did both of these in his back room after hours with just has office nurse in attendance. Hospital room rates were $45 a day.

              1. Effectively, we now have “never expires” prescriptions again, because anyone can order prescription drugs from pharmacies in India and other countries where they don’t care if your prescription is expired.

              2. According to the CPI Inflation counter, something that cost $8 in 1965 would cost $61 today. That’s what the government and the Federal Reserve system have done to our money.

                https://data.bls.gov/cgi-bin/cpicalc.pl

            2. This is not even remotely the ‘solution’ to the problem. ‘Doctors office visits’ are virtually nothing as a % of medical spending.

              1% of patients incur 20% of total spending – avg $200,000 each
              5% of patients incur 50% of total spending – avg $100,000 each

              This is not ‘price shopping’ (those patients may well be comatose) for 99+% of the population. Nor is it ‘well let’s just dump that stuff on govt and pretend to solve the rest via ‘insurance”. That is the big elephant in the room and until someone has both a)the guts to address this issue without b)the gutlessness of just saying ‘poor/old – just fucking die already’.

              This is really not an insurance problem at all. It is a medical case management and a cultural ‘when is it time to die’ problem and the problem is that the US is unique in totally failing to figure out how to solve it. And its pretty obvious to me that the US is still not really willing to even talk about the problem yet. Maybe we need to hit 30% of GDP and $40 trillion in public debt before we hit that wall.

              1. So, death panels are the ‘final solution’?
                Makes sense, death is cheaper than medicine.
                You first.

                1. Like it or not, healthcare spending occurs over an entire lifetime. Most of that is spent in the last 2 years – with death the outcome. The only market solution is gonna be something that allows for people to prepare for that for all the years before that happens. It won’t and can’t happen if no one has the guts to mention it.

                  And yeah – there is a serious question about ‘death panel’ of some sort. The reason the topic is so fucking taboo here in the US is only partially cultural (we are forever young and therefore cannot die yet). It is also because we refuse to acknowledge that ‘dealing with death’ and ‘getting older’ and ‘what actually works v what is just waste’ is what general practitioners – and geriatricians in particular – are trained in. The number of geriatricians in the US is going down – from pathetic levels (we have 2x the number in Denmark which has 6 million people). It’s just a different conversation when people actually HAVE a geriatrician so the conversation doesn’t have to be politicized among strangers.

            3. We already have that data. Before government-mandates on medical care, before Medicare and Medicaid, before HIPAA, doctors made house calls and you could pay in spare livestock.

          2. if you had a catastrophic plan 20 years and ago and gotten leukemia, the plan would have covered your costs through the end of the policy year. Then you would have been cancelled and wouldn’t be able to get another policy.

          3. I did not find statistics from 20 years ago but what I did find points to being ‘cured’ of leukemia to a coin toss. Also I am not real familiar with catastrophic insurance from 20 years ago but you probably would be dead without financial assistance from family or government. Think several rounds of radiation and chemo. Add in the possible cost of a bone marrow transplant, prescription costs, possible unemployment if living in a right to work state, in home assistance when to sick to take care of yourself, housekeeping costs, transportation costs, and possibly even homelessness.

      3. No, it has to be this way, because when people who are bad at saving get hurt, we cannot decide to look the other way, and stand our ground.

        1. Well, yes, we can. The question is, do we want to? We can decide to give people something they don’t have a right to demand just because it’s a good idea.

  6. I work in health care and see sick people with and without insurance every day.

    I would say about 75% of those who benefit from ACA have what is called expanded Medicaid, the State run health insurance programs for persons with limited resources and incomes.

    The rest of persons who qualify for subsidized health insurance, and pay around $50-$80 a month for their coverage with the government [tax funded, naturally] picking up the rest [around $400 for an individual].

    For anyone else, ACA is too costly and does far too little; this is why there has largely been enrollment by persons of limited means or person who are sick [aka adverse selection] because no one in their right mind would buy this stuff at full cost on the open market. Unless you are desperate, or poor [and taxpayers pick up the tab].

    But of course now that everyone has access regardless of pre-existing conditions and can put a young adult child under the age of 26 on their employee group health plan, we do not want that “taken away” from us.

    When you mix government largess with market forces [as with rationing or price controls], you get shit. Every time.

    We are going to have to decide do we want everyone to have a Medicare equivalent, or a free market, Until that decision is made [and everyone will have problems with either choice] we are going to be faced with half-assed solutions.

    1. Of course. Besides giving a bunch of sick, poor people free medical care, the plan still needs to turn a profit for Insurance companies.

      It’s impossible for anybody else to get a “good deal” from this scam.

      1. Health insurance companies generally work on a basis of 80-20. They expect to pay out $.80 in benefits for every $1.00 in premiums. US hospitals have as many paper shufflers as patients. They also use expensive RN’s to do takes that used to be done by nurses’ aids or LPN’s. So we’re paying a college educated nurse to empty bed pans. Spending three to four times as much to do a task that anyone can do. The US private health insurance system has extremely high administrative overheads. My wife used to work in insurance verification. Dozens of insurance companies. Every company with half a dozen different plans they sold to the general public. Then there are the plans created for employers that can vary all over the place. Doctor’s offices have the same problem to a lesser degree. This is why the cost is so high. It is estimated that these costs may be close to a trillion dollars a year.

        1. Regardless of other inefficiencies, you identified a problem with insurance;

          $1paid in results in $0.80 paid out. That is a losing deal.

          Further, carrying a bunch of freebies has to be paid by someone.

          Spread across the aggregate, Insurance is a losing deal.

          It should not be the means by which people pay all their medical bills. It should be a hedge against catastrophe. The “losing deal” for most people is offset by the benefit in a catastrophic situation.

    2. People refusing to pay for your stuff means “you’re losing access”.

    3. We are going to have to decide do we want everyone to have a Medicare equivalent, or a free market

      Actually I think the choice is – do we want a patient-centered healthcare system or a disease-centered diseasecare system.

      Right now we have the latter and both Medicare and the private system tilt everything towards that. And that sort of system isn’t amenable to a pure market-based system either. Everyone else in the world has the former and it is why they can spend less – and they could actually become more market-oriented if they want to.

    4. When you mention mixing government largess with market forces and getting sh*t. This is true but is almost always better than any alternative. pure market forces will most certainly lead to chaos. Look at the great depression without government largess. Government largess without balancing market forces also leads to chaos. The best example that comes to mind is the Soviet Union. So mixing the two as we have today may be sh*t but at least we are not drowning in the cesspool.

  7. And this shows how the nationalization of medicine will be accomplished. The only way forward is to put the medical insurance business pretty much back to the way it was before ACA, and have the government directly pay for the care of those uninsurable due to poor health and pre-existing conditions. That program will expand as people naturally age and sicken. Eventually we will go to full single-payer system that includes everyone.

    1. Yes. I think it will come to single payer eventually, at least for catastrophic payments. I envision creating thousands of “pools” based on some factor like the last 4 or 5 digits of the SS#. This would help prevent one pool from getting overly represented with the sick. Then each pool would have some “agent” who would be in charge of finding decent insurance. This would be a private entity, though licensed by the government. This would use competition.to help keep things affordable. Insurance would be completely divorced from the employer. The insurance in question would be catastrophic insurance, perhaps a $20K deductible.

      1. That sounds better than any actual proposal coming from congress.

      2. But catastrophic health insurance doesn’t cover contraception. Women can’t afford to pay for that. Are you a sexist pig?

        1. A rubber costs 50 cents.

        2. I believe in this age and time, getting pregnant is a voluntary act. Making contraceptives OTC would help.

          1. Yes, but they would have to be sold in an embarrassing way, because you know, sex.

      3. You know who else put agents in charge of stuff?

        1. J. Edgar Hoover?

        2. My computer?

    2. It’s possible we’ll have two separate systems. A very low cost system using nurse practitioners prescribing generic drugs. Pretty much a system that puts prevention first to keep costs low. Income based co-pays. Those want more and can pay for would be able to buy private insurance similar to the way Medicare Advantage works today. Various sorts of “package plan”. This system does work fairly well.

      Of course there would be a lot of “discussion” as to what the “Basic” system would pay for. And each state could decide this for themselves. As for the “Medicare for All” idea (Bernie Sanders), Medicare Part A has a pretty hefty deductible before it starts paying anything for hospitalization. Then it only covers a percentage of the cost leaving the rest for the patient to pay. Medicare Part B pays 80% of the “allowed amount”. The other 20% is up to the patient. Medicare Part D pays for drugs. There is a deductible and co-pays to consider. Along with the infamous “Donut Hole”. The joke here is that Medicare does “NOT” meet the lifetime benefits requirement of Obamacare!

    3. No, no, no. There is another way. Make it so that everyone with pre-existing conditions gets grandfathered in, but that if someone decides not to buy insurance, they will have to pay the actuarially fair rate at the time they decide to buy. That eliminates the gaming the system. Then let insurance companies sell the cheap catastrophic insurance policies with no regulations on the conditions. Then you solve the problem of all the people who decide not to buy insurance. I would add making all employer provided insurance taxable income and put everyone in one pool. That would increase the pool enough to take advantage of the law of large numbers.

      But the Republicans are too cowardly to do that. So Americans will get a Canadian system soon enough. Someone should mention that the Canadian system only works because people with money can escape the queues by going to the States.

  8. Unfortunately, the people who employ them want the unattainable in this case: access to unlimited health care with minimal waiting at low prices that doesn’t “discriminate” against people who already know they’re going to use a lot of care.

    Fine, give the people what they want. They deserve it.

    1. Yeah, but *I* don’t!

    2. It’s possible to reduce US health care costs considerably. The repeal of prescription laws is the first step towards doing that. Second step is repeal of the laws forbidding import of medical drugs outside the US. The combination together goes a long ways to allowing people to take care of their own health. Yes, you have to study, but it is doable.

      1. Prescription drugs account for less than 10% of healthcare spending. Hospital direct (not labs or doctors) spending is 32%.

        A much bigger indicator of the overall spending problem is poverty level correlation with ER admissions:

        1. Prescription drugs account for less than 10% of healthcare spending.

          Bet that doesn’t include the Doctor’s visit to get the prescription.

          My meds cost a pittance. Doctor shakedowns to get my permission slips cost a good deal more. What costs the most is simply my lack of freedom to treat myself based on rational cost/benefit/risk analysis.

          Most health care plans are basically HMOs now. Once you’re locked into a system, doctors insist on you seeing “specialists” for every pill.

          You need medicine. They need a new Benz. They’ll demand as many appointments as they feel like shaking you down for. Oh, they’ll be convinced they’re doing “what’s best for you”. Just a happy coincidence that bloats the HMO profits.

        2. poverty level correlation with ER admissions

          Open Borders Uber Alles!

        3. Here’s the poverty correlation with ER admissions and doctors visits:

          The poor visit the doctors office half as often as the rich. They have lower prescription use too.

          13% of poverty-level poor visit the ER twice per year.
          6% of 2x-4x poverty level visit the ER twice per year.
          4% of 4x-poverty level visit ER twice per year.

          Granted the sick are more likely to be poor simply because they’re sick and can’t work. But the real problem here is that the US sucks at providing generalists, family doctors, clinics, and other routine care. So the poor themselves have to ration their doctors – until they end up having to go to the ER instead.

  9. There was never a pre-existing disclaimer for Medicare beneficiaries. Working people resent paying for Medicare for others while also paying their own insurance costs.

    Medicare is the #1 problem – followed closely by Medicaid.

  10. Tom Price is on the TV now saying the problem with Medicaid is that some docs won’t take it.

    1. He’s a walking/talking cliche’ machine.

    2. Because Medicaid reimburses squat and you can’t balance bill. Until the government forces doctors to accept those patients, why should doctors take a loss treating Medicaid patients.

      1. The Medicaid compensation reimbursement is actually higher than what doctors get in a lot of other countries. Of course in these countries the doctor’s only “staff” is likely an office nurse. US doctor’s office fee has to cover the wages and benefits of all the people employed by the doctor. Plus malpractice insurance which for most purposes is uniquely American. It is possible to file malpractice lawsuits in the rest of the developed world, but it is rare.

      2. The govt should be forcing specialists out of the Medicaid/Medicare system by reducing their reimbursement to them. And using most of the savings to reimburse PCP’s for longer patient visits. Tilt the field back towards generalists rather than toward specialists.

        A specialist can always start charging more for their wealthier patients – how much is this heart bypass surgery worth to you Bill Gates – and how many poor people do you want me to practice on pro bono before I cut into you? That sort of differential pricing is the only way the market can control specialist spending.

        Someone who earns less than a generalist (prob 98% of the population) can only ration ‘doctors’ – and realistically they need a generalist doctor to even do that.

  11. Is Medical Insurance going the way of Public Education?

    Everybody deserves to get it “free”. It sucks. Rich people pay for it and then pay for their superior private coverage too.

    1. Everybody deserves to get it “free”. It sucks. Rich people pay for it and then pay for their superior private coverage too.

      United Kingdom’s NHS system explained.

    2. As I understand it, in Canada, it is illegal for rich people to buy private coverage outside their health care system (unless they buy it in another country).

  12. Jesus, this is what Trump tweeted today:

    “Our wonderful new Healthcare Bill is now out for review and negotiation.”

    Negotiation?!?! So the best deal maker in the world has just announced that Obamacare Lite is the GOP’s low ball offer — and that he expects us to meet somewhere in the middle. God help us.

    1. I don’t take most of what Trump says seriously. Whatever he says is not going to have much relationship to the final result.

  13. After all, displeasure with the 44th president’s health care overhaul is what sparked the Tea Party movement in 2009?10

    Oh for fuck’s sake, not this shit again! Goddamnnit, Reason, of all the outlets it shouldn’t repeat this blatant lie. The Tea Party Movement as we know it began with Ron Paul’s Money Bomb on November 5th, 2007 and really kicked off with the Tea Party Money Bomb on December 16, 2007. Obama wasn’t even the nominee yet. The Tea Party was a rejection of the Republican Big Government Party as epitomized by George W. Bush.

    https://youtu.be/DKZmIzEMUN8

    1. W’s billion dollar TARP started the fire. O’s Billion dollar stimulas (ie union kickback) threw in the dynamite.

    2. The Ron Paul stuff was small. It gave the name ‘Tea Party’ – but it didn’t stick. I was personally an elector here in CO for the ‘Boston Tea Party’ (one of those silly LP purist spinoffs that got on the ballot in CO cuz everything can get on the ballot here) and we received 600 votes here in Nov2008.

      Personally I think the real impetus was the TARP bailout in Oct2008. A few million people wrote/emailed/etc their critters in opposition. They were ignored – and then the bailout expanded to included autos – and then those email folks started realizing how many of their social contacts had done the same. Yeah – it was a initially a rejection of the GOP establishment – but it didn’t take long for them to be coopted by the GOP establishment and turn into their partisan poodle.

  14. Insurance companies shouldn’t be forced to cover people with pre-existing conditions. If you want to create a welfare benefit for them let them utilize Medicare or Medicaid with the caveat that they have to make payments into the system based on ability to pay. If you don’t sign up for it and and then go to doctor, guess what, you’re now on the payment plan to pay the system back with punitive interest. Your free to still enroll for future doctor visits paying what you can afford for that entitlement.

  15. Medicaid is already forced “charity” wealth redistribution. Just put everyone with “preexisting conditions” on that, but have it cover ONLY THOSE conditions (and the offshooting ones) for each person. Then they should have no problem finding insurance that will cover other shit like a broken leg.

    Kind of like how the VA should cover only shit that happened in the military.

    Or have insurance companies permenantly cover all conditions that happen while the person was enrolled in that plan until the person dies or the company goes out of business.

    None of this is libertarian, but still better than Obamacare.

    1. LOL. More national debt (just wait for the tab) with fewer people covered and poorer coverage is better than Obamacare. Is this how libertarians buy things? Without looking at the tab?

      On the other hand, you can get health care for the cost of an iPhone, so there’s that.

      1. Fuck off slaver.

      2. On the other hand, you can get health care for the cost of an iPhone, so there’s that.

        If the actual cost of the insurance was spread out through your monthly bills for the contract period, sure.

      3. Yeah, but the Apple Store lets you look at the tab in the first place. Most hospitals don’t put out price lists.

    2. but have it cover ONLY THOSE conditions (and the offshooting ones) for each person.

      An interesting thought.

  16. I work as the administrator of a private practice, & my job is basically to keep our practice compliant with the bullshit requirements of insurance companies. There are many insurance companies, & they each have their own bullshit. On my tired days, I sometimes think that we should just switch to single payor & get it over with. There would still be bullshit, but I would only have to keep track of one organization’s bullshit rather than dozens.

    1. your job needs to be eliminated. Sorry, free markets say no single payer.

      1. I do dream about a free market healthcare system where I could spend my time doing not what insurance companies say I need to do to make us a “good” practice, but on things that would actually make us a good practice (continuing education, innovative treatment, developing a patient-centered approach as opposed to the insurance-centered approach we’re forced to have now, etc). But given our current political & healthcare climate, which is scenario is more likely?

      2. There is no free market in health care except for plastic surgery and lasik eye treatments. Neither of which are covered under insurance. Or by Medicare or Medicaid for that matter. Don’t know about the VA,

  17. I’m still waiting for somebody to propose a solution that doesn’t use insurance as a modality for delivering healthcare.

    Perhaps something like backing away from insurance altogether and going to a system where anybody can put as much in an HSA as they like, and medical care migrates to an entirely pay as you go system. Reforms can be centered on price transparency so people can more easily shop services.

    There will need to be some nanny statism, so for financially destitute people needing necessary care there can simply be low interest state or federally backed financing for people. Put cash in their hands and send them shopping. At least the market is still fighting for their dollars in a competitive manner.

  18. That reality is highlighted by a new poll, out this morning, from CNN and ORC. Support for the law is still outstripped by opposition to it (46 percent vs. 49 percent). At the same time, though, a whopping 87 percent of Americans favor “maintaining the protections offered to people with pre-existing conditions under Obamacare.”

    That is, to put it mildly, a problem.

    The problem being that people like Obamacare, just not its name.

    Good job, Republicans.

    I like the libertarian solution much better: eliminate all government regulations and hooks into healthcare and let hospitals, drug manufacturers, and doctors deal with anybody who wants health care privately. Barter with chickens if you care.

    All we have to do is get a few libertarians elected to Congress.

    Hint: Rand Paul and Justin Amash are Republicans.

  19. Being individually responsible, is the answer. Live it and teach it. You and I can not save the world from its self.

  20. The best answer is to repeal all the rules and regulations that make health care so expensive. This means repeal of prescription laws, drug laws in general, and legal importation of medical drugs for a person’s own use. This would be a good first start towards bring the cost of US health care down to more “reasonable” levels. For those computer literate, you could do a great deal of preserving your health if US health care was totally “deregulated” and you were free to buy what you needed without getting “permission” from anyone. High blood pressure, high cholesterol, arthritis, high blood sugar? All treatable for about $160 a year buying the medication from Walmart. Some more study, you will able to do even more. Of course there are “limits” to what you can do, but probably half or more of the people in a doctor’s waiting room don’t really need to be there.

    1. Trump’s healthcare policy proposals during the election were surprisingly reasonable from a libertarian perspective (the best arguments people seemed to come up with against them were, quite literally, “he’ll never get the Republicans to agree to that!”), which is why he completely forgot about them after he took the chair.

    2. For those computer literate, you could do a great deal of preserving your health if US health care was totally “deregulated” and you were free to buy what you needed without getting “permission” from anyone.

      Death to the Medical Mafia and their government enabled pound of flesh.

      *You* don’t need to be computer literate. Google/Microsoft would have handled most routine care but for regulations. We’d be Big Data mining a hundred million people with 23andme data, and routinely doing microfluidics bloodwork at a kiosk at the local supermarket pharmacy.

  21. Further proof that the vast majority of voters are economically illiterate.
    Thanks, Ed-system.

  22. It’s not the pre-existing conditions that kill these plans. It’s the belief that “insurance” should cover everything, including birth control pills that cost $10 a month. This isn’t insurance it’s madness.

    Solution: sliding high deductibles, up to certain limits, which are offset by health savings accounts based on income. Not paying for the first $500, $1000, $5,000, or $10,000 depending on income would probably cut premiums in half. Second eliminate waste and wasteful regulations, reduce licensing requirements for certain procedures (like massage).

  23. we still continue to avoid the real issue. We need to lower costs throughout the whole system. There are two ways to do that.

    One government single payer where the government rations care. IE a government bureaucrat decides who gets what care.

    The second is a free market system with real competition. In this system if you increase supply faster than demand then competition will over time bring down costs. To do this you need to force providers to make everyone pay the same price, and post those prices online

    1. Your first one will not lower costs.
      For free markets to work, employer provided insurance must be eliminated. Choosing yes or no is not free market shopping. Good luck with that.

  24. People don’t want other people dying in the streets, or bankrupted.

    Best case, government covers costs over some dollar amount. Tax free payroll deductions for HSAs. Subsidies to HSAs for the truly needy. Expansion of *freedom* to treat yourself without giving the Medical Mafia their government enabled rent seeking pound of flesh. Expansion of *freedom* to offer services.

    Basically, government insures against large costs, mandates savings to pay your own bills, and limits government enabled rent seeking.

    1. Yup. Subsidized HSA for routine care. Totally separate insurace for catastrophic.

  25. Problem is that since US health care is the world’s most expensive, trying to pay for it by buying private health insurance (which in itself has relatively high overheads) you run into the problem that the insurance premiums are so high that they exceed house and car payments. This is what happens when the US spends 18% of GDP on health care. That’s $3.2 trillion dollars a year or about $10,000 per capita. There is no way you can make that “affordable”.

    The solution is to reduce health care costs so that it becomes “affordable”. This is doable, but will result in loss of income to those now working in the field in one way or another. Including the employees of health insurance companies. Reducing the dependence of people on the heath care system through deregulation will bring down prices. It will of course also mean lower incomes for those involved in health care. You can’t have one without the other. Remember here that the reason work in health care pays so much is because it is effectively a government enforced and protected monopoly which gives those working in health care the means to be able to charge far more for their services than what would be possible without this “protective monopoly” Uncle Sam is providing. In a true free market incomes would be considerably less because people would be able to a far greater degree take care of the more simple and basic health issues they may be subject to. Something I’m sure the profession would like to avoid.

    1. You sound like a union buster.

  26. Excellent piece, Stephanie. Good job. I totally agree.

  27. Before Obamacare I couldn’t get any coverage because of my preexisting conditions. How do we create a free market based healthcare system that won’t exclude me?

    1. Family. Friends. Private Charities.

      1. In other words, get rid of any dignity you have and go begging for money. Uh… no.

        I would rather answer: allow the purchasing of insurance across state lines, or have the private charities contribute to high-risk pools.

  28. “displeasure with the 44th president’s health care overhaul is what sparked the Tea Party movement in 2009?10”

    ummm… no. Tea Party like gatherings were happening in small pockets before Obama even got elected. I went to a couple in 2008. The ones I went to were about taxes, debt (Bush’s) and the Patriot Act. I hadn’t even heard of
    the Tea Party. Just caught wind of some peaceful rallies with speakers talking about those subjects. Good people. They may have later become members of the “Tea Party”, but I don’t know. My schedule got in the way of attending many more.

  29. just before I saw the receipt that said $7527 , I accept that my mom in-law wiz like actually making money in there spare time from there pretty old laptop. . there aunt had bean doing this for less than twenty months and at present cleared the dept on there apartment and bout a great new Citroen CV . look here…..
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  30. just before I saw the receipt that said $7527 , I accept that my mom in-law wiz like actually making money in there spare time from there pretty old laptop. . there aunt had bean doing this for less than twenty months and at present cleared the dept on there apartment and bout a great new Citroen CV . look here…..
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  31. just before I saw the receipt that said $7527 , I accept that my mom in-law wiz like actually making money in there spare time from there pretty old laptop. . there aunt had bean doing this for less than twenty months and at present cleared the dept on there apartment and bout a great new Citroen CV . look here…..
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  32. What’s up with this nonsensical subtitle, “People don’t really want insurance.”?

    Everyone wants ‘insurance’….the issue is how its defined. Its the socialized medicine proponents that actively propagandize differing definitions, equating doctors visits with “insurance”.

    And guaranteed insurance for pre-existing conditions is easy to achieve. What insurance covers is the problem, with the absurd current expectation that it cover everything.
    Socialized healthcare is easily affordable provided that it covers only the bare-bones, basic expectations of a modern society.
    Everyone covered for the basics as defined by the gubment. (pre-existing is fine, since everyone is covered from birth)
    Add-on coverage available on the private market and various pricing tiers for the level of insurance policy. (pre-existing or not dictated by the private policy agreement)

    Break your arm, need basic surgery, etc, etc, defined in the basic governmental support and your covered. (pretty much what every other modern country already has)
    Need chemo, transplants, reconstruction, end of life treatments, etc, etc, then you better have the private add-on, or you are outta luck.

  33. My Uncle Nolan recently got Infiniti G Sedan by working part-time from a macbook… go to
    the website…………. https://tinyurl.com/5days-job

  34. “The new GOP plan eliminates the individual mandate.”

    Wrong. Rinocare absolutely keeps the individual mandate.

  35. What I see and read way to much of is how to make insurance affordable. Or, we have to cover prexisitng conditions. Yet no one, even here gets back to first principles. Lets take insurance off the table, we can always bring it back later, because healthcare is not insurance. This is supposedly a Libertarian website.

    How do you go about paying for everyday medical expenses? If your ceiling leaks, you call the landlord or roofer, depending. Either way you end up in some way taking out your wallet to pay for it. So you plan for it. Someone in your house is going to get the flue, break a leg, need glasses. You save for it. You’re car is gonna die and you will need another one You save for it. But with your roof or your car you can look around and see what it will cost to fix or replace.Not so with Doctors, medicine or hospitals…you don’t know till you go. Would you go to a restaurant like that? The advantage of Government strikes again.

    So how to we do two major things. Make it’s costs available in advance to the user and make it financially reasonable for most uses. A third might be, how do we drive down the cost or the occurrence of the very expensive parts of medicine? I’m not sure but I suspect a lot of people have ideas.

    Your phone could guide a rocket to the moon for say $600 vs a few billion when they actually did it. There are many comparisons for this. Why is medical care so different?

    1. … (continued)
      We are lost if we depend on Government or Insurance companies or ever growing Hospital corporations(non-profit hint hint, nudge nudge) to provide health care. And yet all the discussion is to have one of these “helpers” fix things. These all distort the market. Why the GOP has amnesia about it I am not sure. I think they are cowards.

      Back up. Start at the beginning. Start with a world without Insurance. It used to exist. Without tax exempt insurance by employers where are we? Stripped to the bone what does medical look like. Not Insurance. How do you find a Doctor? How does he charge you? What training does a medical person need to tell you its a cold? To order a blood test? To analyze that test? Is it programmable? Turn things over to your betters and no one asks those questions.

      Someday we may have to agree to a Federal Catastrophic Insurance plan with a 20,000 deductible for all or some such. But let’s look at what really broken first.

      For me, Repeal First…. It can’t be much worse than it is now. Markets are better than bureaucrats everytime

  36. A pipe dream, except for all the countries not as wealthy as ours that manage to have health care systems that the vast majority are satisfied with, all of them at lower cost, too. So, who is the dreamer here?

    1. Lower cost,…. to whom? If you paid over 5 bucks for a gallon of gas and de facto healthcare tax regardless of your income level, yeah you better get MRIs for 40 bucks. It’s not like in America, whose giant economy and the ability to print endless amount of money can support millions of people who pay little into the system.

      If you lived in Korea right now, you’d probably live in some cramped apartment that doesn’t come with heat and you would work 11 hours a day. These countries fund everything by squeezing money out of people. The healthcare in Asia is legendarily crappy. Doctors can’t make money there so they recommend all kinds of surgeries you might not even need.

  37. It’s a pipe dream for the GOP to repeal the preexisting condition mandate. The dems would have all the emotional outcry on their side. On the other hand, if premiums and other costs continue to mount, the law’s defender won’t be able to rationalize it as a “way to pay for the patients with pre-existing conditions.” And once the individual mandate is killed, the insurance pool will take a gigantic hit.

    People don’t buy insurance thinking that it’ll help OTHER people. They buy insurance for themselves. Even if you recognize how insurance actually works, once it starts to inconvenience YOU, you might try to bail out. “Oh those poor people who I won’t be able to support with my own money” – few will think like this.

    So we already won this fight, like just about every other aspect of the law. The dems will churlishly insist on the GOP to come up with a replacement and gain a momentary advantage because party leadership isn’t especially bright. But you can’t beat the GOP, the insurance companies AND the public opinion. The death spiral is pretty much here and insurers will bug out more if they can’t find ways to pay for healthcare.

    So please – just kill the individual mandate. Work from there.

  38. The real issue at stake here is whether or not we’re going to make sure everyone has access to decent healthcare or not. The polls I have seen state that most people think no one should be turned away for the inability to pay or, of course, for a preexisting condition. If that’s the case, then it is insanity to continue to include insurance companies in a national healthcare program. Insurance companies add no value to healthcare. They are quite simply parasites. What they do is add twenty percent or more to the overall cost of US healthcare. The United States spends more per capita on healthcare than any other nation yet we have mediocre outcomes. What we need is a government guaranteed system that provides a baseline level of care for everyone. If you have the means and want better choices then you should be able to do so. This is roughly what exists in France and several other countries. They spend less than us and have better outcomes. I don’t like the idea of expanding government, but our healthcare system is an embarrassment. We can do better.

    1. One of the reasons that we are more expensive is that US companies are doing about half of all the drug development in the world. You can argue whether it’s 1/3 or 3/5 or whatever, but the bottom line is, the US is doing the lion’s share of the heavy lifting.

  39. “The Moon is a Harsh Mistress” should be required reading in middle school “social studies”, and the single question exam at the end should be: “What does ‘TANSTAAFL’ mean?”.

  40. Excellent job on this article Stephanie.

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