Republicans Are Trying to Embrace Obamacare's Ideas Without Embracing Obamacare. It Won't Work.

The continuous coverage provision is just one of the ways the House health care plan recycles the health law's policy scheme.


Tom Williams/CQ Roll Call/Newscom

If you want to understand how awkwardly constructed the House Republican health care bill is, and how unlikely its policy scheme is to work, look no further than its continuous coverage requirement. It's just one of the many ways that Republicans are trying to embrace Obamacare's ideas without technically embracing Obamacare.

The rule requires insurers to tack a 30 percent, one-year "premium surcharge" onto the bill for anyone who has gone more than 63 days without coverage. The requirement is designed to create an incentive for people to avoid going without coverage, in hopes of maintaining an insurance pool that is healthy enough to be viable and affordable. If too many people wait until they are sick to buy coverage, then insurance premiums rise, more people drop out of the system, and the whole thing collapses.

Basically, the continuous coverage provision is a replacement for the individual mandate—with a crucial difference: It is likely to be even less effective. Its chief virtue is that it allows Republicans to say that the GOP health care bill repeals Obamacare's individual mandate.

Because the continuous coverage requirement is a mandatory charge levied by insurers rather than a penalty on individuals who fail to buy a product, it doesn't raise the same sort of constitutional concerns that plagued Obamacare's mandate.

But as a policy mechanism, it's virtually certain to be worse than a failure. Instead of giving people an incentive to stay covered, it would give healthy people an incentive to avoid coverage until they needed it.

That's because the main thing it really does is give people who don't have coverage an incentive to avoid buying insurance. But someone who lacks coverage and then gets sick with some expensive malady suddenly has a fairly significant incentive to pay the surcharge, which only lasts a year and in many cases is unlikely to be greater than the cost of treatment, while someone who is still healthy has an incentive to stay uninsured.

Here's how Robert Laszewski, a consultant for the health insurance industry, recently explained it:

The Republicans now want to create a scheme that doesn't require anyone to sign up. But when they get sick enough that they need insurance, they will be able to quickly do so by paying a paltry 12-month 30% premium surcharge.

For example, a person paying $5,000 for health insurance would pay a one-time total $1,500 penalty! A family paying $10,000 in annual premium would pay only a $3,000 penalty for any late enrollment!

Obamacare is so poorly constructed it is literally an anti-selection machine. The Republican proposal is worse.

Health policy experts have found evidence that Obamacare's mandate penalties are not particularly powerful motivators. The GOP's provision isn't just weak. It encourages the opposite behavior of what is intended.

The reason that Republicans included the provision is because the House health care bill leaves Obamacare's key insurance regulations in place. Like Obama's health law, the American Health Care Act requires insurers to sell to everyone, and restricts carriers from charging more based on an individual's health history. Those regulations are what made the mandate a crucial part of Obamacare's policy scheme. When states tried to implement the insurance market regulations without the mandate, their individual insurance markets melted down.

Reports this week suggest that House Republicans may soon ditch the provision. That merely leaves the original problem in place: How to make insurance markets viable with preexisting conditions rules in place? Obamacare's attempt at a solution was the mandate. Republicans do not appear to have a solution at all.

The core problem for Republicans, and for the House health care bill, is that they are trying to replicate Obamacare's basic structure in a form that is somehow not Obamacare. It is not the same exact plan, but like Obamacare it relies on a system of insurance market subsidies and regulations, along with financial penalties for those who don't stay covered.

Obamacare was already a politically compromised piece of legislation with serious flaws and real uncertainty about its long-term stability. Republicans have decided to use an unstable version of its already-kludgy policy scheme for the individual market as a foundation for their own plan, buying into its essential ideas even as they claim to reject them.

NEXT: That Time They Tried to Film Finnegans Wake

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. You don’t get it, Suderman. Obamacare was done by Obama; Trumpcare will have been done by Trump. Thus, they’re COMPLETELY DIFFERENT.

  2. I kinda feel bad for Paul Ryan. He seems like a nice enough guy, but he owns this turd. Even if it doesn’t sink his career, the smell will never come off.

    1. He’s certainly proving himself to be a spineless politician. Not that I ever saw him as principled, but I thought he was a bit smarter and more ‘serious’ than this.

    2. Nice enough guy? Unlike the Kenyan Muslin who was in the WH before?

      If he was nice enough, he’d have worked to fix he promised to repeal, will not repeal, and will tinker with it to make it worse.

      No, he bought the BS that he is a policy wonk.

      He is a fucking idiot

  3. Speaking of Republicans, the Glibs have a new logo. It’s a top hat and monocle.
    I am not making this up.

    1. you think they’re republicans?

      1. Duh, they love Trump over there, just like people here love Trump.


        1. True story: Derp-O was the dumbest, whiniest, most annoying henchman in Skeletor’s evil horde. Never made the show though.

      2. you think they’re republicans?

        Let’s see: they stormed off because they felt Reason was picking on Trump (a Republican), that Reason wasn’t “balancing” its Trump-bashing with an equal amount of Hillary-bashing; they’re obsessed with left-wing “proggies” but not with right-wing conservatives; many are Christian anti-abortionists; they don’t tolerate any dissent from a leftward point of view…yeah, they’re either Republicans or the world’s worst libertarians.

        1. Uhh…I take it you haven’t read any of the numerous articles bashing Sessions then? Just because Reason isn’t as liberal as you might be, it doesn’t automatically make them Republicans either.

          1. Dude, it’s Weigel. He’s just upset that everyone started ignoring his habitual shit-posting and lies about the cause of the exodus(Sloopy) so he once again changed his handle.

            The obsession with Glib is equal parts hilarious and pathetic.

        2. they’re either Republicans or the world’s worst libertarians.

          While the two are not mutually exclusive, it is the former. Mostly.

  4. It’s designed to fail. Republicans are trying to drive us to single-payer. You think I’m joking.

    1. Well, when given the option between government being smart and evil and being stupid and evil, I’ll go with stupid evil every time.

      They actually think this is a “good” idea, whatever they might mean by that. That it won’t work isn’t surprising, it just means they’re economically illiterate. If they weren’t they almost certainly wouldn’t be in Washington DC.

    2. If they want it to fail, they could just leave it alone.

      But yeah, you’re probably right. The GOP is the party of Medicare and Social Security, after all.

  5. I wonder if the incentive would work if the alternative to having health insurance was either 1)die or 2)go bankrupt?

    1. Exactly.

      And the flip side is that if you price insurance at market rates, all of a sudden, people will be having those conversations about BMI and HIV risk with their doctors and insurance carriers, because coverage for the resulting conditions would be expensive.

  6. Set up the US govt as the catastrophic health care insurer of last resort (everyone gets a US Catastrophic Health Insurance ID at birth, but are free to choose other catastrophic insurance if they want) for the nation, force all health care providers to be completely transparent as to pricing and results (pricing is today considered proprietary knowledge of the insurance companies, which is terrible), allow people to pay non-catastrophic health care bills OOP or via tax-exempt health savings accounts, and eliminate restrictions on the practice of medicine (free market in the provision of medical services). This is all you need. Within a few years, it’d be just like servicing cars: you pay for your oil changes, but if the car is totalled, the insurer comes in to cover the loss.

    This cannot work without the proviso that health care providers be forced (by law) to divulge their prices and results.

    1. Yea i think this is the way it should go ultimately

    2. I would consolidate tax deferrals.

      401k, 529 and HSA should all be the same pot of money. It is too hard for me to anticipate where I am going to allocate my spending 20 years from now when I am retired, sick and have kids in college.

      1. That’s a great idea.

    3. Set up the US govt as the catastrophic health care insurer of last resort

      A large part of the problem with US health care spending is that that’s what the US government is for the elderly. That is, doctors, hospitals, and pharmaceutical companies go to the US government and declare that in their professional opinion, it is necessary to spend a few hundred thousand dollars on the last few weeks of life, and the US government pays.

      “Catastrophic” just isn’t a well-defined concept. An HIV infection isn’t “catastrophic” anymore, it simply amounts to a $25000/year medical bill. Heart failure may be “catastrophic”, but that doesn’t mean it is sensible to give people free heart transplants.

      In fact, much, if not most, “catastrophic” medical problems are the result of lifestyle choices: poor nutrition, unsafe sex, lack of exercise, and the only way to reduce those problems is to give people a price signal. That is: “we’ll cover you for HIV, but that means an extra $300/month” or “we’ll cover you for a heart transplant, but that means an extra $100/month or reducing your BMI to the normal range”.

      The failure of the US health care system, like most of the rest of progressive social policy screwups, is the result of trying to shield people from price signals.

      1. At least it becomes a political decision made out in the open, like the annual Social Security payment adjustments. We can, in principle, discuss it as a people: do we, as a people, want to cover the $1M spent to prolong our miserable lives as we lay dying in the last few days of our lives, or do we prefer to spent $100 on effective opioids?

        1. What are you going to do when a lot of people choose to fall back on this “last resort” insurance, and there’s not enough money to pay for it?

          What are you going to do when they starts saying that we will save money if the insurance covers “free preventive care”?

          What do you do when they start saying it’s cheaper to provide mental health care ad rehab than to deal with suicides and overdoses in the emergency room?

        2. We shouldn’t discuss these things as a people. If you want HIV drug insurance, you ought to pay for it or of your own pocket.

          1. What’s covered as a general rule is what we discuss. The rest, you take upon yourself.

            1. Nothing should be covered “as a general rule” (i.e., by law); any government rules or regulations sooner or later will lead to problems.

              You need to pay for the insurance you want and need, that’s the only rule that works.

      2. With that idea then *everyone* will be paying (no one is completely innocent) and we’d be back to unaffordable costs. Even “healthy” life style choices can lead to medical problems. Some even cause more injuries. Then you get into why people make these lifestyle choices. Is he overweight because he works two sedentary jobs to take care of his sick parents? Does he deserve to be punished like the guy who ate 50 hamburgers? Who gets to make that judgement and how is that ANY different? What gets approved of and disproved? Is it by approved choices? Does the jogger who has increased risk of daily injury (a common problem) and later joint issues exempt from paying extra because he was practicing “healthy” choices from the approved list? And what happens if you do everything “right’ and you still need care that is usually for the “unhealthy” people? How do you prove that every day you WERE doing the right thing?

        And how is it NOT already more expensive when your lifestyle choices lead to the need for increased care? Transparent pricing doesn’t mean that everyone gets free oxygen. If I hardly ever go to the doctor because I do something “right”, and my cousin is going all the time and must buy extra things (oxygen) because they did “wrong” things…aren’t they already getting hit in the pocket book? Increased doctor visits, increased need for medication, oxygen, etc.

        1. I’m not sure what you mean by that idea. All I’m saying is that insurance companies should be able to charge whatever they need to in order to cover certain conditions the result would simply be, that for many preventable conditions, you would either not be covered, or you would probably have to pay a steep surcharge. In any case, we can’t cover these conditions the way we are because treatments are very expensive there is no price signal

          1. What is it you don’t understand?

            The price signal is increased need for treatment leads to higher costs. It’s actually fairly easy. If I drive my car like shit and abuse the hell out of it, I need to take it to the mechanic more often and buy more parts. That’s the price signal. If I treat it well and take good care of it, then I spend less.

            My mechanic does NOT ask me if I always drive the speed limit, if I use my signal properly, if I put gas in it at x point, etc etc etc. Abusing the car = more care needed = increased costs.

            If we accept the arguement that insurance companies need to exist at all in their current form, they do not need to decide WHY you are need further care. It’s not useful. Even if they did need to ask WHY, it still wouldn’t explain details present in the human body that are not present in my car. It’s a judgement call that is unnecessary. Either way, they already pay increased costs simply because of their need for increased care.

            And what is that judgment call based on? One person’s approved list of “healthy” lifestyle choices, some of which lead to their own increases costs? Is it “science” and is it the science that says we NEED meat or is it the science that says we should never eat meat? In what way is that judgement call made that is both fair and right? Especially given that we do not actually know the cause of things like heart disease, cancer, high blood pressure, etc? (Increased risk of does not equal cause)

            1. You have a good point here about the trade offs for healthy choices. Don’t forget the problems from making this year’s ‘healthy’ choice that turns out to be the exact opposite. Remember when low-fat, high carb diets were the key to longevity?

              1. Exactly!

            2. My mechanic does NOT ask me if I always drive the speed limit

              Your mechanic doesn’t provide your auto insurance; insurance companies do that. And they do, indeed, ask you how you drive and charge you accordingly.

              Abusing the car = more care needed = increased costs.

              Increased costs for you, and increased income for your mechanic. Which is why your mechanic has no problem with you abusing your car. It’s also why you don’t buy “car maintenance insurance”.

              And what is that judgment call based on? One person’s approved list of “healthy” lifestyle choices, some of which lead to their own increases costs? […] In what way is that judgement call made that is both fair and right?

              The judgment call may be neither fair nor right, but it is a judgment call that the insurer ought to make. That is, the insurer creates an insurance product with certain conditions (“we only insure vegetarians, and we verify with regular blood tests”, “if you catch an STD, we drop you”, etc.), and you as a customer decide whether that’s the contract you want to take.

      3. The failure of the US health care system, like most of the rest of progressive social policy screwups, is the result of trying to shield people from price signals.

        I really disagree. This sounds like a mere bumpersticker. We FORCE price signals – do I go to the doctor or put food on the table this week – in this country on every part of medical care – from really basic to catastrophic. And the consequence is that we have destroyed the basic cheap fixed cost element of medical care that can control the expensive inflationary stuff.

        France – 618 people per GP – 595 people per specialist – kind of a weird system but it works well for them
        UK – 1243 people per GP – 525 people per specialist – state (mostly) controls specialist utilization
        Netherlands – 1385 people per GP – 459 people per specialist – generalists control specialist utilization
        Switzerland – 1665 people per GP – 313 people per specialist – generalists control specialist utilization
        US – 3390 people per GP – 477 people per specialist – patient controls specialist utilization

        We have killed the GP – the relationship-oriented doctor v the transaction-oriented specialist. We pay more as a result. It is just kinda nonsense to argue that we are somehow uniquely ‘progressive’ and ‘statist’ compared to these other places. The ‘public side’ of our system is just spending its money on the wrong freaking things and we aren’t asking the right questions.

        1. I don’t really like the gp gatekeeper method. Not every GP is really all that interested in sending you to someone else when needed. I like the ability to chase down my own specialist. My ENT is much less likely to experiment with my ear infections, because we know what the problem is.

          Did we kill the GP or did the GP kill itself by making so many of us wait far longer than we should have for a specialist?

          1. GP as gatekeeper may not be wanted – for the 5% of time when GP plays that role. But it does control costs and its only decentralized way to control costs. It takes medical knowledge to self-diagnose how to utilize specialists. Specialists themselves don’t take on risk – no diagnosis/surgery on contingency.

            There is real value in making sure that GP is available for 95% of time/need so that they exist for the 5% gatekeeper role – and geographically distributed as well. It’s basic fixed cost infrastructure of a health system. If Medicaid/care covered ONLY GP’s at best-in-world density and nominal fee usage (universal coverage), it would reduce their spending by about 90% – a trillion per year.

            A private system can build on that – esp with a trillion extra dollars in pocket. Don’t like GP’s and want to manage your own specialists? Well that will cost a lot in ‘insurance’ or out-of-pocket. If GP’s are ok – but you also want catastrophic/hospitalization protection, then you can get that as insurance too. Bunch of different biz models that can work.

            Yeah we killed GP’s. Insurance by definition is about how to manage payments/risk/transactions re specialist stuff. For GP’s – ‘insurance’ is installment payments not risk transfer – and that’s what taxes are too. the more ‘insurance’ is the focus of politicized discussion, the more it kills off the GP – not just here either.

          2. Oh and re did GP kill itself by being too much of a gatekeeper

            No. In countries with a lot of GP’s, you can always have enough to shop around (while generally healthy) for a GP that you can trust (if you become sick in future). That’s the relationship-part that a transaction-based system punishes. And it also drives down even GP costs a tiny bit because of competition. When there aren’t many GP’s, then you don’t have that choice and realistically it then becomes hard simply to SEE a GP because they don’t want to accept new patients.

        2. And the consequence is that we have destroyed the basic cheap fixed cost element of medical care that can control the expensive inflationary stuff. […] We have killed the GP – the relationship-oriented doctor v the transaction-oriented specialist. We pay more as a result.

          Your GP can’t fix the fact that you’re obese, that you don’t exercise, that you smoke, that you engage in risky sex, or that you want to cling on to life for another week when you’re effectively already dead. You need to fix those things by working on yourself, and since the cost of treating the consequences of these poor choices is extremely high, naturally, insurance rates need to rise proportionately. Think insurance rates that rise severalfold, to the point that many people can’t afford it. Once that happens, not only does the insurance system start working all of a sudden, people will also start living more healthy lives.

          1. Your GP can’t fix the fact that you’re obese, that you don’t exercise, that you smoke, that you engage in risky sex,

            No they can’t ‘fix’ that. But that is what GP’s discuss at checkups/visits and that’s their focus – general patient health. Across countries, peeps/GP and general health habits of the adult population is highly correlated. Within the US, those habits are correlated with income (high income can access GP and GP is often who helped while they were still healthy). Why are these behaviors that should only be punished in those who can’t afford to see a basic doctor?

            or that you want to cling on to life for another week when you’re effectively already dead.

            This is also what family doctors used to do – and that geriatricians nowadays are specially trained to deal with eventually. But discussing aging/death with a patient/family requires relationship/trust – with a knowledge of that patient/family/religion/beliefs about death, even that patient’s bucket list. No specialist CAN do this.

            If you think this is gonna be dealt with via a transactional/insurance approach (x$ per office visit, copays, deductibles), you’re wrong. And yeah – our system is killing off geriatricians too. 75 graduated last year (fewer than the number who retired) – 2.5 million people turned 65 last year.

    4. RE: eliminate restrictions on the practice of medicine (free market in the provision of medical services).

      I see the logic of the rest of your ideas, but this one makes my hair stand up. Sticking with the car theme, I can’t be the only one here who doesn’t trust a car mechanic as far as they can be thrown. Do you legitimately think it’s a good idea to remove all licensing and quality of care regulations (if that’s indeed what you’re talking about), freeing every snake oil salesman and con-man lose on the population?

      Reduce paperwork requirements, let nurses and dental hygienists do more; that makes sense to me. Letting anyone set up a shop with a sign that says “Chirurgeon” is not a good idea.

      1. I got this idea from Milton Friedman. In theory it should work, and we libertarians like our theories. Seriously, you may need to get there in increments. I’m okay with that.

        1. BTW, true fact: I actually shook Milton Friedman’s hand at the Cato 25th Anniversary Dinner. One of the most awesome moments of my life.

        2. Hmm, this hits on why I struggle with libertarianism. There’s a frustrating lack of examples of libertarian theory actually being shown to work. Often times, it feels like a libertarian is free to argue entirely from theory, while a statist is stuck defending a state that displays various level of flaw. The curse of the person with evidence, if you will.

          I’m all for increments though. All-or-nothing is the realm of the True Believers, and they’re assholes. Cynical Opportunists (or Principled Transactionists, if Cynical Opportunism makes you uncomfortable) is how stuff actually gets done.

          1. Same here. I’ve worked for the government and there’s nothing better to make one cynical about statist solutions than seeing how things work from inside the beast, but there’s a decided lack of evidence for alternatives. Incremental changes are generally better for anything, because they allow people to adjust to the new system with a minimum of pain. I strongly support allowing nurses, PA’s, and dental hygienists to do a lot more, but unregulated surgeons is just a bit too far for my taste.

      2. given your own analogy about mechanics, why is licensing a panacea when it comes to doctors? All those specialists who now exist owe more to govt regulation than to the market. Sure, “do no harm” regulations are fine until we start debating their extent. How many of those regulations are touted by politicians because they mean power, and how much support do they get from some medicos who see the rules of protectionism?

        1. It’s not a panecea, but it’s a hell of a lot better than nothing. I personally take a great deal of comfort in knowing the person I’m consulting about my health at least went to school for years, passed some very difficult exams, and is held by law to a code of ethics.

          Like I said, I’m up for tweaking the margins. Tactically addressing certain requirements to encourage more small, locally-focused type medical practices would be a good thing (I actually have some first hand experience with this).

          Historically, the medical field has always been ripe for cons. In medicine, the conman finds almost by definition a desperate person who might be looking for a miracle. This is not the industry to open the flood gates on.

          1. Who said anything about eliminating the school requirement? That’s a big fat straw man you just invented. Going to med school and finishing is a huge leap from licensing, especially licensing from a group that has every incentive to limit the pool of practitioners in the marketplace.

            1. Would you believe me if I said I’m not intentionally misconstruing the idea? When someone says “eliminate the restrictions on the practice of medicine,” I don’t think it unreasonable for me to not be entirely clear on how far that goes. Currently, school is a requirement to practice medicine.

      3. Those models all come from last millennium, man. Seriously, we have the internet to aggregate information about patients’ experiences. I would have, if anything, more faith in a few hundred positive reviews than in a govt permission slip

    5. This makes entirely too much sense. No one will ever believe it.

    6. “Set up the US govt as the catastrophic health care insurer of last resort”

      Isn’t that basically what Medicaid is/was? If you truly can’t afford to buy insurance, govt will provide it for you. This incidentally (along with Medicare) is a big reason why the prices have gone up. I don’t see how govt as insurer of last resort (or expanding Medicaid essentially) isn’t just a step closer to single payer?

      Everything else you mentioned makes sense.

      1. Voters tend to react badly to people suffering or dying for lack of medical care. No matter how far a free market system could realistically lower prices, there’s going to be poor people who can’t afford it. Having the government backstop the whole thing and set a floor of medical care below which people can’t really go is as much a way to sell the whole thing as anything.

        Ideas like Draco’s are a political non-starter anyways, but without some option for the poor and old, it’s a super-duper-non-starter.

          1. Get back to me when your idea includes a flat fee charged to every citizen to support this. Otherwise you have just moved the entire country onto medicaid.

            1. What’s wrong with a less expansive, less expensive, more narrowly focused version of Medicaid for all?

            2. People really need to understand the “veil of ignorance” argument of Rawls. It’s really applicable here. If we all got together before we were born, not knowing whether we’d be rich or poor, healthy or sickly, one thing we could easily agree on is cutting our risk by agreeing to purchase some basic insurance where everyone kicks in enough to cover the worst cases. My proposal of a US Health ID is basically conceding that point: as an infant, you get catastrophic coverage. And yes, you’d have to pay your share for it (or your parents would). Yes, I understand the devil is in the details of defining what’s covered. But you have to start somewhere. No one should ever be turned away for medical treatment, and anyway in America he won’t be: may as well accept this about our culture up front, and build a reasonable system around it.

              1. Actually that isn’t really where the Rawls argument would lead. The ‘veil of ignorance’ argument is – regardless of your circumstance (rich/poor/healthy/sick/ignorant/educated), you will NEVER have the medical knowledge to diagnose yourself and decide on the best course of action. That does require someone else – who is going to be paid more than most people because they do have that sort of knowledge – and a Rawlsian system would view providing that person and their entire role (healthcare, case management, and in the end how to face death) as a societal obligation not something that is merely available to the wealthy.

                The ‘catastrophic’ obligation assumes that the sole purpose of the medical system is death prevention rather than healthcare. And AFAIK – everyone will die. That death prevention system will always fail in the end. But the wealthy WILL finance that ‘heroicness’ – and they will do so via differential pricing. Bill Gates WILL pay more for his own open-heart surgery – because he will want to make sure that the doctor doing it has ‘developed experience’ on others and he will be paying for that proven demonstration of skills. A catastrophic obligation just needs to make sure that differential pricing can happen.

        1. Well, there are options, just no one wants to let those in.

          My biggest problem is pain. I don’t want to hurt. What’s wrong with providing a nice calm drug that will let me feel no pain? If I have every chance to affect my chosen result, do everything in my power, and I can’t get the care I need why should I hurt at the end? My grandmother is so tired…..so tired. She’s ready to go. I don’t like it, but it’s her life. No matter how much I adore her it’s not my choice to make. What’s wrong with her having a nice calm drug?

          And there are fairly cheap nice calm drugs out there that anyone could afford. Three $8 pills aren’t that much all told.

          And yes, some people might make the choice that they will spare their family the financial issue, but if that’s what’s important to them (I’d probably do that) then why not let them? It’s their priorities, who are we to say “you need different priorities”?

          1. Preaching to the choir, friend. There’s a very unhealthy obsession with avoiding death in American culture, and it leads to us spending the majority of our lifetime healthcare dollars in the last 6 months of life. More palliative care, more freedom to choose to die; I’m on board.

            The problem with this is you’re purposing a cultural shift as the remedy to our tangled healthcare system. “We’re spending too much money so you should let yourself die” is not exactly a winning campaign slogan.

            1. Yeah, that’s that whole “expecting people to be smarter than they are” thing.

              Actually MY actual proposal to remedy is the elimination of insurance, extreme penalties to fraudulent billing and overages and transparent pricing. I can’t afford the affordable care and honestly, my ER bills (I’ve had a few with several kids) are pretty reasonable once you eliminate the bs. $4k of “oops” charges should NOT exist on a $8k bill, nor should forcing people to use services that are not necessary for what they actually need. ($2k of that particular bill was for using the ER. We weren’t supposed to use the ER. Our doctor made an appointment for a quick test that was pretty vital. They FORCED us to go through the ER)

            2. You’d be interested in avoiding death, too, if you take half seriously the predictions of Kurzweil that if you live until the year 2029, you will effectively become immortal. (This is based on his correct insight that tech progress is exponential not linear, even though we are evolved to think linearly, so we consistently underestimate the pace of technological progress.)

              1. I can’t fucking WAIT for the tech singularity. I would love to abandon my physical body and exist as a few billion lines of code on a server.

              2. No, actually I wouldn’t be interested in avoiding death. I recognize that not everyone is meant to live forever. Some people wake up every day and the world is new and THOSE people should probably live forever. People like me that know that the world is shit and people are stupid would go insane after the first 100 years.

                And as I recall, after the year 2000 we were all supposed to be “with Jesus”…the world was supposed to end in general…we were supposed to have flying cars. Immortality isn’t everything.

    7. The problem is this sets up a free rider problem and progressives will try to expand it to become more and more comprehensive, which will make the free rider problem worse, which will drive us toward single-payer.

      1. Yes.

      2. Yes, the devil is in the details Hazel. But we have to start somewhere. Everyone will have to pay into it – no free riders. Unless you can’t pay, in which case, well, what we usually do: the rest of us pick up the tab. But he who pays makes the rules. Or at least it should be that way.


    9. The only way it can work is if the govt stops trying to be the front-end of any part of the health care system. It does IMO have a role in providing the basic infrastructure of it. But that means asking different questions and doing different things.

      We have fewer generalists per capita now than before WW2. The only doctor that 95% of the population needs for 95% of their lives and that needs to be geographically distributed. That is infrastructure.

      Geriatricians are a post-WW2 generalist – but Medicare punishes the only generalist who deals with old people and senescence (main cause of death now) as the major health issue. The number of geriatricians in the US is pathetic and dropping – while the number of elderly is rising. Let’s just pay bigger medical bills instead. Nuts.

      We have fewer hospitals and hospital beds now than in 1960 (and not much different than 1940) – now geographically concentrated and overly capital-intense. There is less ‘cheaper’ infrastructure available (eg ‘clinics’) and thus also less competition to drive prices down. Without the infrastructure in place and an overhaul of govt role, the market will NOT provide it.

      Feds shouldn’t be involved in individual usage AT ALL. It should merely use landrents to make sure that the infrastructure is there (via fed/state cooperation since that is a state level tax) – and only if necessary using debt to charge future generations for making sure it can get built (for them and us to benefit from).

      1. Basically – ‘insurance’ is the wrong damn question. Defining ‘what is basic medical infrastructure’ is the role where govt is useful (ignoring anarcho nonsense).

  7. I don’t get it.

    Don’t require insurance.

    Don’t require coverage of pre existing conditions unless continuously covered.

    Set a time limit on the pre existing condition. But it needs to be 12-18 months.

    1. Set a time limit on the pre existing condition. But it needs to be 12-18 months.

      Some conditions are lifelong and costly.

      I think the only way of dealing with this is to do what Medicaid often does already: if you don’t have insurance, you need to spend down your savings and property and then go onto Medicaid.

      No doubt it’s painful, but you can only discourage people from doing very stupid and risky things (like not getting insurance) by making sure that the consequences are proportional. And the proportional consequence for not getting health insurance is that you end up poor if you require expensive treatments.

      1. Medicaid pays pennies on the dollars. That “benefit” you thinks is extended to person A is later paid for by person B and his/her private insurance.

      2. And why are they such expensive treatments in the first place? Other countries don’t seem to have that problem.

        1. You’ll end up poor even if you DO have health insurance if you require expensive treatments that are getting more and more expensive every year.

          1. I don’t really get the people who bitch and moan about healthcare being expensive in a free market (and we don’t know how expensive it would be). Yeah, you might be poor, but that medical technology that didn’t exist ten or twenty years ago that saved your life means that you’re now poor and alive versus rich and dead. Or, you’re dead just like you would have been 10 or 20 years ago.

            If someone put a gun to your head and was going to pull the trigger unless you gave them your life savings, would you give it to them? That’s the question here. And no, the industry isn’t holding the gun. Nature itself is. If you have a problem with that, blame either God or the uncaring Multiverse.

            This is the reason why people have friends, family, and charities but apparently the only answer is in Washington.

            If there was a health procedure that could save your life, but it required zero gravity, is NASA sending you into space for a trillion dollars a right? Somewhat serious question. At what point do you draw the line on who deserves care, and who is going to die? Centralized healthcare revolves around this concept.

            I can’t wait until the national policy debate over if people who have genetic conditions should be allowed to reproduce because of their collective drain on the national healthcare coffers. Just wait, it’s coming.

            1. Or, to put it another way, there is no price that someone wouldn’t pay to stay alive. The resource that has a chance at keeping them alive is a limited and rare resource. Instead of attempting to increase the supply of said resource, which would definitely work, we’re attempting to give everyone access to that same limited supply of resource while simultaneous reducing the incentive for that supply to expand.

              This is quite literally the worst of all available options, and everyone is acting like it’s a brilliant idea because it sounds ‘fair’. Yeah.

  8. Pretending that coverage for pre-exiting conditions is “insurance” is just ridiculous. If the federal government wants to provide coverage for pre-existing conditions, the only way to do it is via federal spending. But, generally speaking, the only sound policy is to deny coverage to people who didn’t pay for it, beyond some minimal standard of care, like what the WHO considers essential (90% of US health coverage is not essential by world standards).

    The real problem with ACA is that it is a massive transfer of money from middle income earners to low income earners, and from young and healthy individuals to the old, and mostly to pay for what can only be called luxurious and excessive medical coverage. Most of the complexity of the ACA is simply designed to obscure this fact.

    1. Whereas Republicans are barely concealing the fact that their plan is a massive transfer of wealth from the poor to the rich. Of course, that’s been their lone policy idea for about 40 years now.

      1. All of SS is a transfer of wealth from the poor to the rich. Pretty much all government spending does that. So it’s almost like both parties do that nonsense.

        1. All of SS is a transfer of wealth from the poor to the rich.

          Sorry, but that’s not true. Social Security is a good deal for low-income earners, it’s a lousy deal for high income earners.

          1. Considering that it isn’t an investment (see the Supreme Court ruling on the subject), it’s taking from the “poor” (currently working) to the “rich” (the retired”. Of course, “poor” is relative in the US, but it takes from those who are in debt and gives to those who have stored up a bunch of wealth.

            1. it takes from those who are in debt and gives to those who have stored up a bunch of wealth.

              it takes from everyone. It also gives to everyone which is its biggest problem. Then again, eligibility age was older than life expectancy when this thing was created. No one wants to means test the program or do anything to change the Ponzi nature of it.

              1. Yes, it takes from all who work, though the majority of those who work are in debt, which was my point.

                1. Plus the majority of those 65 and older are not poor and don’t really need it. And of course they’ll say they paid in. But it’s essentially a welfare program that those with higher incomes don’t need. And in all fairness to high earners, they were obliged to pay into it, when they could have taken the same money and invested in a retirement program like government employees have.

              2. Yeah, but the EITC gives it right back to 30% of everyone, and then some.

                After EITC and other credits, 46.5 million filers (out of 144 million “tax units”, i.e., households filing a return) have Zero or Negative Sum of Income and Payroll Taxes. Those are households which are *not* contributing to SS (it is not clear how many of those are elderly and already on the other side of the equation).

                It’s already a ponzi-structured welfare program. If it didn’t pay out to everyone, it’d lose the last shred of the transparent covering that lets it pretend that it isn’t.

          2. Social Security is a good deal for low-income earners

            No it isn’t. Life expectancy at age-50 for a lowest quintile income man is 76 years (and that sort of person often can’t stop working at age-65). Life expectancy at age-50 for a highest quintile income man is 88 years. And within the poorest quintile, there are pretty big differences in subgroups – length of low-income time, race, etc. A flat% tax that stops at about the highest quintile is actually highly regressive compared to what actuarial-based ‘insurance’ would cost.

            SS is a middle class entitlement program. Not a poor welfare program.

            1. Comparing those different life expectancies to entire countries.

              Our lowest quintile income (less than 22k/year with an average of 14k) has the same life expectancy at age-50 as – Jordan ($11k average income), Tunisia (12k average income), Thailand (17k).

              Which is interesting re our healthcare system as well. Our system for those people delivers nothing more than the self-financed system of countries with the same average income. IOW – there is NO effective transfer from rich/middle to poor in the US. Whatever things like Medicaid and such deliver is merely just enough to offset the increase in medical prices that higher incomes drive into the system.

      2. Whereas Republicans are barely concealing the fact that their plan is a massive transfer of wealth from the poor to the rich.

        How is simply not paying (as much) for health coverage for the poor a “transfer” from the poor to the rich?

        1. The money being used for healthcare subsidies would be turned into a tax cut for rich people.

          I know, it’s “their money” or whatever circular bullshit you say that enables you to justify all manner of kleptocracy. But we can at least acknowledge that the most pressing problem this country is facing right now is not that the rich aren’t rich enough.

          If you endorse prioritizing addressing that “problem” before all others, as Republicans apparently do, then I get to call it out as the moral abomination it is.

          1. the most pressing problem this country is facing right now is not that the rich aren’t rich enough

            Then why don’t you want to kill SS off? It’s much worse than this program is…

            1. Because he is a mendacious asshole who basically never debates in good faith?

          2. Look, slave, just shut the fuck up and support me or whatever circular bullshit you say that enables you to justify all manner of kleptocracy.

            Not taking is giving. Not giving is taking…

          3. “Their money” can be dismissed as “circular bullshit” if you just FEEL that it is.

      3. how does wealth get transferred from the poor who, by definition, have no wealth?

        1. They have health coverage for the moment.

          1. who’s paying for that care the poor get? Oh, that’s right; not the poor. And a monstrous deductible combined with premiums someone else is funding is ‘care’ if you totally bastardize the definition of the term. All of which ignores Medicaid, specifically targeted at the poor. By the way, does anyone who is a Medicaid recipient ever come off of it? Sort of like how some kid getting free lunch in first grade is also getting it 12 years later.

      4. Again, excellent satire Tony. I’m glad to see you’re fighting the good fight and illustrating to everyone that there is essentially no major difference between the ACA and RINOcare.

        Your commitment to the Libertarian cause through appearing to be the biggest retard on the comments section is duly noted. Well done. You’re picking up where AmSoc left off.

      5. The poor don’t have any wealth to transfer, so this is impossible.

  9. Resurrecting cemeteries of notions isn’t possible even with trillions of dollars aiming for wizardry and millions of plastic smiles concealing faux dote.

    Clunky, lurching, stealing, bemoaning, and infinitely collectivized and, ultimately, typically mismanaged will be the end-all to federalized American health care.

    The Rand Paul’s of the political scene are valiantly attempting to shrink the leviathan but this will be suppressed in favor of pulling the conservative polka-dotted bloomers down and spreading mottled hams for giddy anal penetration by absurdly-narrow communism-envying cocks and red dildos driven feverishly into gaping holes shockingly fetid from years of scarfing down cattle fat pinned beneath bleached flour.

    The chortling livid Leftist spitters through cum and grease will gaze into an afterglow of ideological triumph because the last remaining hope for freedom and individual rights paused, wilted, and finally staggered under the immense vacuum of its own convictions.

    Exist politically without a conceptual core and your movement withers on the violent vines of history under the brutal burning lasers of murderous dogma.

    1. Don’t quit your day job. Shakespeare you ein’t.

      1. Letters on a screen… just letters on a screen.

        1. Not you, Agile. Mortiscrum-Tulpa or whoever.

        2. I liked it.

          1. Tell us more about the red dildoes

        3. Sorry, didn’t mean to offend.

      2. Who the fuck are you? Tulpa?

        1. OK what is “tulpa”?

          1. Tulpa is an imaginary being who assumes the identity of anyone here who is not otherwise well known.

            1. No, Tulpa used to be a poster here. I’m here rather sporadically and I remember Tulpa.

              As far as I can tell, he just wanted to come here and see if he could make that vein in everyone’s forehead pulse.

  10. a lot of folks thought the “replace” part of the equation was wrong-headed. Few of them apparently are in Congress. The sad reality is that the argument over govt being involved in health care at all has been ceded, including it would seem by Reason.

  11. Heaven forbid the Republicans try to expound on why the preexisting condition provision IS the problem with Obamacare. All the other crap around it is really just designed to make the preexisting condition mandate palatable for the insurance companies. If the Republicans could just explain this in a rational manner, surely Joe Public would get it. Hell, through in a few truths about the Dems being in bed with insurance companies and take a page out of their playbook for once.

    If you could just convince everyone that the preexisting condition thing IS the problem, I think you can just repeal Obamacare in a phased manner and move on with life. IE passing tax cuts, or other healthcare bills that aren’t tied to this stupid preexisting condition thing.

    1. Here’s the thing – the effort deficit required for that debate is unsustainable.

      You could write 20,000 words on the economic and social science problems with requiring “insurance” to cover predictable or pre-existing conditions, but all it takes is “here’s a cute orphan whose mom died of a pre-existing condition!” to completely override that explanation in the mind of the median voter.

  12. ^throw not through

    I will now publicly shame myself due to the lack of an edit button.

  13. Obamacare or: How I Learned to Stop Worrying and Love the Trumpcare

  14. “Compassionate Conservatism” – being generous with OPM, just not quite as much as the Dems.

  15. NPR thawed Pelosi out the other day so they could have her on the air, in an interview during which she claimed that Paul Ryan is a small-government fanatic and ideologue. I know Nancy is retarded, but she isn’t that stupid. NPR lets her on to preach to her dumb-as-shit base, who ARE dumb enough to believe that Paul Ryan is a small-government fanatic, even though he is in favor of small-government the way I am in favor of going to see the Rolling Stones.

    “Sure, it sounds like a good idea, but when you really think about it, it’s kind of icky,” he would say. “It makes me uncomfortable. It’s like confronting my own mortality.”

    Anyway, fuck NPR, and fuck this turd of an attempt to fix O-care. You can’t polish a turd, Congress. Not even lion shit, or bear shit, or whatever shit the Mythbusters polished. Even if you successfully polish a turd, you just end up with shiny shit.

  16. I can’t wait until, after years of wrangling with this, the US finally goes single payer and the smug argument for it is “Look what the free market has wrought! Government is needed to fix this mess!”

    1. Hell, just watch the news coverage since 2007 or so. It’s what they’ve been saying all along despite a century of government interference in the healthcare sector. On that note, watch news coverage since before the invention of television. That’s how long they’ve been at it.

  17. 1. Build a wall between the USA and Canada

    2. Throw people that are too expensive to treat over the wall.

    3. Claim that the wall is stimulus spending

    Life is so simple when the green beer is flowing

  18. I am using it now & it’s awesome! I’ve signed up for my account and have been bringing in fat paychecks. For real, my first week I made ?350 and the 2nd week I doubled it & then it kinda snowballed to ?150 a day! just folllow the course.. they will help you out

    ================> http://MaxNet80.com

  19. If the continuous coverage requirement had a premium surcharge AND allowed exclusions for pre-existing conditions for 3-5 years it might work better.

    If you’ve gone without insurance for a few years, get a diabetes diagnosis, then decide to sign up for insurance you should not expect them the start paying for insulin, etc. But if you break your arm in a car wreck, that should certainly be covered.

    OTOH, if you don’t have insurance and break your arm in a car wreck, too bad for you. The ER will bill you into bankruptcy, and should be allowed to– you had a chance to buy insurance and decided not to.

    1. Really? Can you defend any reason why insurance companies should exist in their current form? Because it seems to me they are only really useful for hiding the obscene overages and fraudulent billing practiced in ERs with the full support of those with insurance.

      Or we could just not allow those kinds of unethical and illegal practices and make it cheaper for everyone….

  20. Odd how requiring pre-existing conditions hasn’t been a problem with HIPAA and group plans.
    I don’t think ACA is financially a problem (freedom issues not included). Fact is the mandatory/subsidized insurance plan does work in other countries.

  21. I would consolidate tax deferrals.

    401k, 529 and HSA should all be the same pot of money. It is too hard for me to anticipate where I am going to allocate my spending 20 years from now when I am retired, sick and have kids in college.

    I love this idea. If you need a $20k surgery, why shouldn’t you be able to use your 401k to pay for it? Especially if you’re not going to make it to retirement without the surgery.

  22. I am fairly sure his attempts will fail. He has very little ability to threaten the freedom caucus, and neither does Trump. They are mostly from areas where the voters voted anti Hillary, not pro Trump.

Please to post comments

Comments are closed.