Billy Wayne Shiflett was reading the newspaper the other day when I stopped in to pick up the chain saw he had sharpened for me. That's one of Billy Wayne's many admirable qualities: He still takes the news in paper form.
"Course I do," he said once when I remarked on the fact. "You ever try to sop up a spill with an iPad?"
Hard to argue with that.
Billy Wayne pushed the paper aside when I came in.
"Morons," he muttered.
"Oh, them. No argument here. What'd they do this time?"
"It's what they ain't done. Can't get their act together on Obamacare repeal. Taken 'em seven years just to knock together a rough outline."
"Well, it's complicated," I said.
"No it ain't."
This floored me.
"Nope. Just pass a law says the old law ain't in effect no more."
"I don't think it's that easy," I said. "There are a lot of angles to consider."
"Such as what?"
"Well, a lot of people can't afford to buy health insurance."
"So help 'em out. Give 'em a tax break. Folks who work at big companies get their health insurance tax-free. Let everybody get it that way an' even things out."
"All right," I conceded. "But not everybody pays enough in taxes. Some people don't pay any income tax at all."
Billy Wayne nodded. "S'pose not. So if they're poor just give 'em the difference."
"You mean a refundable tax credit?"
"That what they call it?"
"I believe so," I said.
"Well there you go."
"I think that's their plan," I said. "And it's fine for people who can get insurance. But sometimes insurance companies turn down people who have a pre-existing condition."
"Waitress over t'the IHOP. Sweet gal. Got this big ol' thing on the side of her neck, pains her awful. Had it for years."
"I was thinking more like heart disease or cancer, but yes. Like that."
"Easy fix," Billy Wayne said. "You take all those folks like Becky an' you put 'em together in one big group an' you write special policies just for them."
"A high-risk pool, you mean?"
Billy Wayne shrugged. He took an oil-stained rag from his back pocket, blew his nose loudly, carefully studied the results, then tucked it back into his pocket. I was glad we hadn't shook hands when I came in.
"That sounds good in theory," I said smugly. "But it will never work in practice."
I made ready to bowl Billy Wayne over with the irresistible force of my argument.
"High-risk pools have been tried," I said. "Many times. They never end well."
"They don't, eh?"
"No sir, they do not."
"Well, for one thing, they're based on a flawed premise," I said. "Insurance works by spreading risk around, which spreads the cost around. High-risk pools concentrate the risk, so they concentrate the cost."
"Meaning they're really expensive. The one that Minnesota ran required more than $173 million in subsidies in one year."
Billy Wayne pinned me with a gimlet eye. "How's that different from Obamacare?"
"I saw one a' them 'fact-checker' things you media types love so much a while back. Said Obamacare run up $1 trillion in taxes in 10 years. One trillion dollars just to help people get health insurance. Sure sounds like a 'subsidy' to me."
"Well, yes, but The Commonwealth Fund says the Affordable Care Act spreads, and I quote, 'risk across a broad population to decrease per capita costs and allow for more affordable and comprehensive coverage for all.'"
Billy Wayne laughed. "Ain't no dang different," he said. "Healthy people still payin' for sick ones to see the sawbones. Money's still comin' outta our pockets in the end. My daughter, she pays more'n twice what she used to for health insurance, thanks to Obamacare. She's young and healthy, see? So her insurance never cost much. Now it does."
"But according to a piece I read in The Washington Post," I retorted, "high-risk pools are characterized by high premiums, waiting lists, lifetime caps on coverage, and temporary exclusions for pre-existing conditions."
"Don't have to be," Billy Wayne said. "All depends on how you write the law."
"That could get very expensive."
"You figure that out all by yourself, genius? Look…" Billy Wayne leaned over the counter and pointed a stubby finger at me. "Some people get really sick and it costs a hell of a lot o'money to get 'em right. More than they'll ever make. So somebody else has gotta pay for it, or either we let 'em die. Not too many folks like that second choice. Now we can all pay for it by forcin' everybody to buy insurance and tellin' insurance comp'nies how to write they policies an' all. Or we can all pay for it with taxes. Seems to me Obamacare does a lotta both, an' none of it very well.
"Either way, we're all gonna pay for it, one way or another, until people can't stand to pay no more. Eventually we're gonna spend so much on health care, ain't gonna be no money left for nothin' else. An' then somebody's gonna hafta put his foot down an' say we're just not gonna pay for some things no matter how sick you are. Ain't a country in the world don't have limits on how much doctorin' people get. We're no different. .. Least not until we figure out how to make doctors work for free."
"Like you, you mean?"
"Hell I do," Billy Wayne said as he reached for my chainsaw. "That'll be eight seventy-five, plus a little something for the governor."
This column originally appeared at the Richmond Times-Dispatch.