Health care reform

Why Trump Can't Fix Health Care

People want it all, but they can't have it.

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ACA protest
Ronen Tivony/ZUMA Press/Newscom

Bill Clinton tried to fix America's health care problems and was shot down by Congress. Barack Obama got his solution enacted only to find most people didn't like it. Republicans who voted repeatedly to repeal Obamacare and replace it with something far better have found it fiendishly hard to agree on how.

It could be that our health care problems don't get solved because of partisanship, incompetence, corruption or dishonesty among our elected officials. Or it could be because those problems are not soluble.

Oh, some of them can be solved, for sure. But not all at once, and not within the constraints of our political environment. We have trouble accepting that. So we muddle along with a system that is riddled with flaws and causes a lot of dissatisfaction.

The changing perceptions of the Affordable Care Act are a marvel to behold. It was so controversial that it barely got through Congress in 2010. Long before it was fully implemented, it was unpopular, and it mostly remained so.

Republicans ran against it with great success in the congressional elections in 2010 and 2014, and Donald Trump won last year after calling it a "disaster" that he would repeal and replace with something "much better and much less expensive." As one of Ernest Hemingway's characters said, "Isn't it pretty to think so?"

But something shocking happened on the path to the repeal of Obamacare: It began to look better. In the latest poll by the Kaiser Family Foundation, 49 percent of Americans said they liked it, the highest figure since 2010, and just 44 percent didn't, down from 53 percent in 2014.

What accounts for the shift in sentiment? One factor is that when it comes to their health care, Americans nurse a deep distrust of change. They may not be satisfied with what they have, but they assume anything different will be worse.

Another is that a lot of them really didn't know what the ACA did but disliked it because they associated it with a president they opposed. Given that Obama's approval rating hovered around 50 percent for most of his second term, it's not surprising that his signature initiative evoked widespread disdain, particularly among Republicans.

Stubborn ignorance also plays a role. An NPR/Ipsos poll in January found that more than half of Americans didn't realize that the number of people with health insurance rose under Obamacare. One in three mistakenly thought it put restrictions on end-of-life care—remember the "death panels"?

The ACA also clashed with intractable preferences. It forced individuals to purchase insurance. It meant more government interference in private markets. It expanded a major entitlement, Medicaid. It required new taxes. It didn't reduce total health care expenses for most people. All of these features grated.

And Americans are not slaves to logic or consistency. Opposition to this massive federal program has been particularly high among seniors—most of whom are covered by that massive federal program known as Medicare. The implicit attitude: Big government for me, but not for thee.

Only lately has it occurred to many detractors that ACA also has elements that they would rather not surrender—such as allowing young adults to stay on their parents' policies until age 26, barring exclusions for pre-existing conditions, mandating free preventive care, giving subsidies to moderate- and low-income people and expanding eligibility for Medicaid.

Trump has led voters to believe they can have all the stuff they want and none of the stuff they resent. But neither he nor anyone else has found a plausible way to accomplish that.

The mournful realities are inescapable. If you remove the individual mandate, you allow younger and healthier people to opt out, which would mean higher premiums for older and sicker ones. If you cut the cost of Medicaid, you leave a lot of poorer Americans without coverage, forced to rely on expensive emergency room care. If you eliminate the taxes, you raise the federal deficit.

You can't have it all. Our aversion to this simple truism has yielded a dubious achievement: Compared with other Western nations, we have more people without insurance, spend far more of our national income on health care and are less happy with our system. That's what you get when you resist fundamental tradeoffs.

Americans who want a solution that has no downside don't really want a solution. Not to worry: They won't get one.

© Copyright 2017 by Creators Syndicate Inc.

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  1. Uhh, Steve. You need to learn how a free market worked, when we were allowed to have one. Then you need to learn how to transition back to that. Yes, we had an unregulated insurance market. Technically, until FDR, we had no “insurance” at all. We did have coverage, provided mostly by fraternal organizations since the 1400s, joined by ethnic lodges which were widespread a century ago. And there was more.

    Americans evolved a PRIVATE social safety net, including health care provided my multiple religious owned charity hospitals in larger cities, and at least one in every city. Shame on modern libertarians who know nothing of free market OUTCOMES. and no clue how to restore them.

    So progressive will continue kicking our butt on health care. They don’t know how to restore universal treatment. and never could (through government). But they at least CLAIM to be trying, in this, the most humanitarian society in human history. So sad.

    1. This. This. This. This. This.

      Why is it that THIS is not what pro-religion, pro-establishment group, republicans are pushing?

      There has never been a time in US history where people died in the streets.

      Why can’t we sell the concept of freemarket care to the masses? Why don’t the pro-market folks even try?

      1. One only sees what they’re looking for. Their focus is “limited government” so all they see is a government to be dismantled. The moral dead end of anti-government libertarianism. Pro-liberty libertarianism looks to restore and rebuild individual liberty. So they look for TRANSITIONS to get back there. The anti-gubs see only government power. They never see, nor can they grasp. PEOPLE power. So they miss it all. It’s not about government vs no government. It’s whether we empower government or empower people.

        The consequences have been deadly. A little over 10 years ago, Cato commissioned a Brand Preference survey. First, they surveyed the “product” – libertarianism, and 59% of Americans would self-define as fiscally conservative and socially liberal. Those same people were asked how they would “brand” themselves. Only 9% of people with libertarian beliefs would call themselves libertarian.

        So, the libertarian political ideology was rejected by 91% of … libertarians. In marketing, that’s called “toxic” which means the brand name is damaging the product. We HAD a libertarian moment, last November 8th, And blew it. NOT Johnson/Weld. Imagine two experienced and successful governors, running a campaign with NO policy platform — not a single solution. That’s the libertarian establishment, not them.

      2. Because if somebody is making a profit off of it, it can’t be as cheap as it could be. And “the masses” understand that.

        1. If only government ran all industries everything would be much cheaper.

        2. LOL…oh, you were serious?

        3. I’m a political moderate who think government absolutely has a role to play in healthcare, and even I think this is absolutely preposterous.

          What you’re describing is payment being equal to the cost of doing service, which implies you think the inherent goodness of humans is enough to run the economy. No one needs a material incentive or personal gain; pure altruism is enough to not only provide goods and services, but also to drive innovation. Sorry, that experiment has been tried before.

          Humans are more petty, greedy, and self-interested than we like to admit. It’s better to base a system on the recognition of that fact, and build guidelines to “aim” these qualities to positive ends than it is to pretend these qualities don’t exist.

          1. Humans are more petty, greedy, and self-interested than we like to admit.

            Your bitterness is so sad. And history proved you wrong.

            Greed and self-interest dominate ONLY if government makes things available by a vote, or some policy. So then we get various factions competing for the unearned — including much off the middle class, which sucks heavily on the teats of the rich. Without the power, the greed dies of starvation.

            1. I’m talking about greed and self-interest in the more “benign” sense: a small business owner doesn’t get out of bed every morning, work for 10+ hours, and deliver a good product out of the goodness of their heart, they do it to make money, provide for themselves and/or family, and hopefully improve their life. That’s not greed in the 7 Deadly Sins sense of the word, but it’s its close cousin.

              1. : a small business owner doesn’t get out of bed every morning, work for 10+ hours, and deliver a good product out of the goodness of their heart, they do it to make money

                Same reason the worker punches a time clock. That’s not greed.

                That’s not greed in the 7 Deadly Sins sense of the word, but it’s its close cousin.

                Then your original claim was an outrageous lie??? Do you now disown this:

                Humans are more petty, greedy, and self-interested than we like to admit. It’s better to base a system on the recognition of that fact,

                You need to recognize that you’ve been called out … so you reverse your argument .. which then destroys your own position. But Bernie will still give you a cookie!
                And a pat on the head.

              2. : a small business owner doesn’t get out of bed every morning, work for 10+ hours, and deliver a good product out of the goodness of their heart, they do it to make money

                Same reason the worker punches a time clock. That’s not greed.

                That’s not greed in the 7 Deadly Sins sense of the word, but it’s its close cousin.

                Then your original claim was an outrageous lie??? Do you now disown this:

                Humans are more petty, greedy, and self-interested than we like to admit. It’s better to base a system on the recognition of that fact,

                You need to recognize that you’ve been called out … so you reverse your argument .. which then destroys your own position. But Bernie will still give you a cookie!
                And a pat on the head.

                1. Nonsense. I was merely clarifying my position. My exact quote is “humans are MORE greedy, etc., than we like to admit” (emphasis added). That is, we’re not driven entirely by greed, clearly, but we are motivated by self-interest.

                  I can’t believe I’m making an argument in favor of the basis for capitalism in one comment thread, but arguing against free markets in another with the same person…

                  1. Nonsense. I was merely clarifying my position.

                    With a TOTAL revision. And now a MASSIVE lie>

                    My exact quote is “humans are MORE greedy, etc., than we like to admit” (emphasis added).

                    Liar. I replied to this link and quoted from it (connect the space.

                    https://reason.com/archives/2017/03/27/ why-trump-cant-fix-health-care#comment_6806528
                    That’s not greed in the 7 Deadly Sins sense of the word, but it’s its close cousin.

                    THIS false claim was stated here:
                    https://reason.com/archives/201…..nt_6806075

                    I can’t believe I’m making an argument in favor of the basis for capitalism in one comment thread, but arguing against free markets in another with the same person.

                    I can’t believe you’d take BOTH sides of a single issue! And get them BOTH wrong.
                    Plus, your snotty (and also dishonest) comment regarding 1984.

                    1. Dishonest comment regarding 1984?!?! All I said was I read it when I was 14, a long time ago!! The implication is that I don’t remember it very well.

                      You see what you want to see. I know what I think, and I’m confident what I wrote reflects it. If you insist on calling your own misunderstanding me switching my story, there’s not a lot I can do about that.

                      It was fun while it lasted.

                    2. (laughing in ridicule) NO COMMENT on your lie PROVEN in what you responded to.

                      NOW A NEW LIE!

                      Dishonest comment regarding 1984?!?! All I said was I read it when I was 14, a long time ago!! The implication is that I don’t remember it very well.

                      You lied because my comment was about Newspeak … after PROVING you had used it..

                      AGAIN proof that you lied.

                      https://reason.com/archives/201…..nt_6806868

                    3. (laughing in ridicule) NO COMMENT on you lie PROVEN in what you responded to.

                      NOW A NEW LIE!

                      Dishonest comment regarding 1984?!?! All I said was I read it when I was 14, a long time ago!! The implication is that I don’t remember it very well.

                      You lied because my comment was about Newspeak … after PROVING you had used it..

                      AGAIN proof that you lied.

                      https://reason.com/archives/201…..nt_6806868

    2. Well that doesnt make him wrong. Prexisting conditions will still be a problem there. Thats the whole point, we wont get free market which is arguably better, because we then have to deal with the fact that cancer bob still cant get coverage.

      1. Going along with this, I’m also extremely leery of comparisons that equalize healthcare (and how to pay for that healthcare) from 100 years ago to today. I strongly suspect that healthcare and health technology has grown in complexity more in that time than in the span of human history before it. It’s alarmingly hand-wavy to say “well we covered all the health expenses through private organizations 100 years ago, so it’ll work just as well now!”

        Specialists, MRI’s, screenings, lab tests, etc., have all become routine care. The costs are substantial and look nothing like what healthcare looked like in 1910.

        1. This is a really good point. There were only a couple of antibiotics in 1910, so that during WWI medics used honey-soaked bandages for wound care. Read diet advice books from the period for a really good scare. Even by the 30’s there had been few significant new medical inventions and we had just finished a massive war with hundreds of thousands of casualties to be used as guinea pigs. The treatment available for, say, head trauma or gunshot wounds available today makes the 90’s look like the days of barber-surgeons. All that stuff is expensive.

          1. The treatment available for, say, head trauma or gunshot wounds available today makes the 90’s look like the days of barber-surgeons. All that stuff is expensive.

            Just as the 90s were infinitelt mire expensive compared to when humanitarian aid for health care began. In the late 1400s.

            This thread is depressing. It looks like Daily Kos. So many argue that a free market is no longer possible. That America

            1. “So many argue that a free market is no longer possible. ” The “free market” has only ever been free for those who have power.

              1. The obvious answer is to make everyone powerless.

                To enforce that we will have to give some people power.

              2. The “free market” has only ever been free for those who have power.

                100% bass ackwards. When we had a free market in healthcare we had universal treatment. Low incomes and other needy were treated in charity hospitals, several in each larger city, at least one in smaller cities, funded by a complex web of private charities and foundations..

                Then LBJ destroyed it all. Healthcare is now a “guaranteed right” for all low incomes … but … the uninsured rate for THEM has skyrocketed to over 20% — which is HIGHER than in the private market. In other words. Medicaid eligibles are the MOST likely to die uninsured.

                You may have a point on income taxes. where the rich now subsidize over 50% of the entire share of taxes for the core middle class ($40k-100k). So enjoy sucking at Bill Gates’ teat, instead of a free market.

              3. The “free market” has only ever been free for those who have power.

                100% bass ackwards. When we had a free market in healthcare we had universal treatment. Low incomes and other needy were treated in charity hospitals, several in each larger city, at least one in smaller cities, funded by a complex web of private charities and foundations..

                Then LBJ destroyed it all. Healthcare is now a “guaranteed right” for all low incomes … but … the uninsured rate for THEM has skyrocketed to over 20% — which is HIGHER than in the private market. In other words. Medicaid eligibles are the MOST likely to die uninsured.

                You may have a point on income taxes. where the rich now subsidize over 50% of the entire share of taxes for the core middle class ($40k-100k). So enjoy sucking at Bill Gates’ teat, instead of a free market.

                1. RE: When we had a free market in healthcare we had universal treatment. Low incomes and other needy were treated in charity hospitals, several in each larger city, at least one in smaller cities, funded by a complex web of private charities and foundations

                  I know a lot less about the history of healthcare than I do of our current system, but this seems terribly implausible to me. As in, I highly doubt the system was as robust and healthy as you make it sound. Health insurance was invented in the early 1900’s because healthcare costs were ALREADY climbing to untenable levels for the average person.

                  I know it’s practically an axiom among some that government can only break what’s not broken or ignore what needs attention, but I also find it highly unlikely that Medicare and Medicaid would’ve been started at all had the existing system been so great.

                  1. . Low incomes and other needy were treated in charity hospitals,

                    Health insurance was invented in the early 1900’s because healthcare costs were ALREADY climbing to untenable levels for the average person.

                    When I said low income, I meant what we now call uninsured, And before FDR it was not insurance as we know it now, There were virtually no insurance companies. It was mostly through ethnic and fraternal lodges.

                    but I also find it highly unlikely that Medicare and Medicaid would’ve been started at all had the existing system been so great.

                    Then you weren’t there! Progressives had wanted government health care for decades. It was not a guaranteed right — even though humanitarian aid had existed since the late 1400s. Now Medicaid is a guaranteed right, but the uninsured rate for Medicaid is now over 20%. It’s fairly well known that Medicare underpays physicians. Medicaid pays even less. In many inner cities areas there are no doctors at all. Except Planned Parenthood, because abortions pay the fixed overehead.

                    1. RE: Progressives had wanted government health care for decades

                      This is what I’m focusing on: why do progressives want government healthcare? It’s flatly insane to say “because they’re a bunch of evil statist who want to make life worse for everyone.” A few notable, corrupt examples notwithstanding, people don’t get in to politics to make life worse for people, they go in to politics to fix social problems.

                      Every post-industrial country in the world has embraced some form of government-sponsored healthcare. Slowly, in a piecemeal fashion, so is America. Clearly, the private sector is not up to the task otherwise there wouldn’t be such a world-wide, consistent, trend towards public healthcare.

                    2. why do progressives want government healthcare?

                      Umm, because they believe government is more fair than — the blindly assume private healthcare is for-profit insurance. And they believe majority rule should govern.

                      It’s flatly insane to say “because they’re a bunch of evil statist who want to make life worse for everyone

                      Yes it is. What’s your point?

                      A few notable, corrupt examples notwithstanding, people don’t get in to politics to make life worse for people, they go in to politics to fix social problems.

                      Yep. I’ve been elected to public office twice. It’s the leaderships who manipulate them into — let’s say partisan solutions which place the tribe above “the people” (both left and right)

                      . Clearly, the private sector is not up to the task otherwise there wouldn’t be such a world-wide, consistent, trend towards public healthcare.

                      The AMERICAN system was 100% voluntary, with universal treatment — destroyed by FDR and LBJ. And your tribe must not have told you about all the atrocities in political healthcare. 🙂

                    3. why do progressives want government healthcare?

                      Umm, because they believe government is more fair than — the blindly assume privatre healthcare is for-profit insurance. And they believe majority rule should govern.

                      It’s flatly insane to say “because they’re a bunch of evil statist who want to make life worse for everyone

                      Yes it is. What’s your point?

                      A few notable, corrupt examples notwithstanding, people don’t get in to politics to make life worse for people, they go in to politics to fix social problems.

                      Yep. I’ve been elected to public office twice. It’s the leaderships who manipulate them into — let’s say partisan solutions which place the tribe above “the people” (both left and right)

                      . Clearly, the private sector is not up to the task otherwise there wouldn’t be such a world-wide, consistent, trend towards public healthcare.

                      The AMERICAN system was 100% voluntary, with universal treatment — destroyed by FDR and LBJ. And your tribe must not have told you about all the atrocities in political healthcare.:-)

                    4. RE: And they believe majority rule should govern

                      How is this unique to progressives? Isn’t this the basis of democracy, or even representative rule?

                      RE: Yes it is. What’s your point?

                      My point is that a critical mass of people were unsatisfied with privately supplied healthcare, and they elected politicians to do something about it. None of these programs were sly, clandestine pieces of legislation slipped passed the American people in the dead of night for nefarious ends, they were passed by legitimately elected officials who represent the will of the people. This, de facto, says that the people saw a problem with the existing system and wanted it changed.

                      RE: And your tribe must not have told you about all the atrocities in political healthcare

                      I’m not claiming fully socialized healthcare is free of problems – that’d be an absurd claim. Heck I’m not even claiming it’s a GOOD option. But, I remain strongly convinced that it is the least bad option.

                    5. And they believe majority rule should govern

                      How is this unique to progressives? Isn’t this the basis of democracy, or even representative rule?

                      I should have said “rule.” And I described how they destroyed our system. How many die uninsured this year, because of them, do you not care?

                      It’s flatly insane to say “because they’re a bunch of evil statist who want to make life worse for everyone

                      Yes it is. What’s your point? JG

                      None of these programs were sly, clandestine pieces of legislation slipped passed the American people in the dead of night for nefarious ends, they were passed by legitimately elected officials who represent the will of the people. This, de facto, says that the people saw a problem with the existing system and wanted it changed.

                      Yes, what’s your point?

                      And your tribe must not have told you about all the atrocities in political healthcare

                      IHeck I’m not even claiming it’s a GOOD option. But, I remain strongly convinced that it is the least bad option.

                      And your mind is made up, don’t confuse you with the facts. Sorry, I gamed you. You didn’t ask what the atrocities are … never asked about the Medicaid eligibles who will die this year …. which says you don’t give a damn about people only about government . “GIVE ME GUMMINT HEALTH CARE!”

                      Do you know what “Newspeak” was in Orwell’s 1984?

                    6. I read 1984 when I was about 14, so it’s been awhile. Anyways, I seem to have failed (??) your hidden morality test. Does that mean you’re done talking with me?

                    7. I should be done, since you get so snotty. It was hardly a morality test, Closer to an IQ test.
                      And I just got finished exposing your massive lie here

                      https://reason.com/archives/201…..nt_6806986

                      Perhaps comments sections are not your strongest suit?

        2. Meanwhile, prices for procedures where there is some market competition, such as lasik eye surgery go down.

          1. Aah the eternal diversion to cosmetic surgery. That ain’t covered by socialized systems – or private insurance – anywhere. And boobjobs, tummytucks, and Lasik are usually cheaper in Europe than they are in the US.

            1. Well then. The more procedures that are not covered the cheaper medical care will get.

            2. Aah the eternal diversion to cosmetic surgery

              Which part of competition is so confusing? We see the same effect with the growing number of physicians who give discounts as high as 50% for cash. Price competition because Medicare pays the same regardless, So do insurance companies, in effect, except PPOs.

              1. Difference is I don’t have the luxury of saying no and waiting for the price to come down. If I say no to $30K meds I end up with $200K surgery or death and still need the $30K meds. Someone claimed people don’t die in the streets, well they sure would your way.

                1. MANY more “die in the streets” since Medicaid, because the charities are gone and Medicaid/CHIP eligibles have the HIGHEST uninsured rate in America.

        3. Going along with this, I’m also extremely leery of comparisons that equalize healthcare (and how to pay for that healthcare) from 100 years ago to today.

          It was 50 years ago. I suspect we are far more wealthy these days. And so sad that you believe a free market can no longer work.

      2. If Americans want to give Cancer Bob, who never paid insurance premiums commensurate with his risk and now demands $500k in treatments, treatments, that needs to be paid for out of tax dollars; trying to piggy-back his coverage onto the premiums of freelance workers who try to buy insurance in the private market is absurd, and that’s what the ACA does.

        1. Im not disagreeing with you, just pointing out that this is the point of the article and still stands in the face of 19th century free market health care.

          Someone is going to be unhappy, and have to live on the ledge no matter what the situation. I say its Cancer Bob and not what we have now which is everyone lives on the ledge except cancer bob (at least as long as he gets rid of his cancer before the bottom falls out.

          This is not a problem unique to healthcare. Everyone likes pretending that all problems have clean solutions when, in everything, theres a dark side with various levels of visibility and stomachability to every solution.

        2. This is exactly why people don’t like free market healthcare: blunt and open healthcare rationing via who can pay is politically intolerable. There’s a reason why the preexisting condition clause of the ACA is so popular: it feels awfully callous for a country as generally wealthy as ours to tell someone “born with or develop a chronic health problem? I hope you have lots of money, otherwise it’s tough shit.”

          Some form of health rationing is always going to exist, that’s the unspoken ugly truth of the world. However, making the rationing tied to money REALLY rubs most people the wrong way.

          1. This is exactly why people don’t like free market healthcare:

            Because they’ve been brainwashed and manipulated by authoritarians: progressives and many anti-government libertarians.

            blunt and open healthcare rationing via who can pay is politically intolerable.

            That never happened — not for over 400 years — until government got involved. We know about the moral atrocities in Canada and England. How many will we never know, without the forceful actions that revealed them?

            There’s a reason why the preexisting condition clause of the ACA is so popular:

            It’s a stupid way to fix a problem created by government ? which fiscal conservatives are too ignorant (or brainwashed) to accept.

            “born with or develop a chronic health problem? I hope you have lots of money, otherwise it’s tough shit.”

            Thank you for that Democrats.

            Some form of health rationing is always going to exist, that’s the unspoken ugly truth of the world.

            Why did it never exist for over 400 years before the Great (sic) Society?

          2. I applaud you for actually thinking outside this “free market cures all ills.” Fine to lean towards it but to think that all of society’s issues can be solved with a one line philosophy is foolish. It’s precisely why people look towards libertarians as weirdos with too dogmatic views.

          3. That’s exactly it. Odds are if you’re chronic you’re not rich. Too much time in the healthcare system being sick. Too much money paying for it.
            Even non-chronic Cancer Bob’s bills will break most Americans.
            I’ve wondered if those saying everyone pays their own way or dies aren’t trolling. They sure made the case for completely socialized medicine once Trump got in and they started dreaming out loud.

            Basically what they’re calling for is a slightly different eugenics program than the progressives had. And if they’re “conservative” throw in not allowing abortion, they’ll kill you when you get off your parent’s insurance at 18.

            1. I’ve wondered if those saying everyone pays their own way or dies aren’t trolling.

              They’re quite sincere in their delusions. The context is two factions within libertarianism, pro-liberty vs anti-government, liberty lovers and government haters.

              They sure made the case for completely socialized medicine once Trump got in and they started dreaming out loud.

              Yes, they are that stucking fupid, which is how they destroyed the libertarian movement. They’re actually authoritarian — or they’d have a plan to transition back to a free market, which … (laughing) …. would make Medicaid probably over 90% obsolete.

              Basically what they’re calling for is a slightly different eugenics program than the progressives had.

              Now you’re just being snippy — eugenics. More accurate to say they and the progressives are fighting tor the best deck chairs. On the Titanic.

              And if they’re “conservative” throw in not allowing abortion,

              Even crazier, they defy the will of God in the name of God!! And shit on the Constitution they claim to revere. JUST as brainwashed as the “proggies” they ridicule..

          4. This is exactly why people don’t like free market healthcare: blunt and open healthcare rationing via who can pay is politically intolerable. There’s a reason why the preexisting condition clause of the ACA is so popular: it feels awfully callous for a country as generally wealthy as ours to tell someone “born with or develop a chronic health problem? I hope you have lots of money, otherwise it’s tough shit.”

            That’s not how free market healthcare works. In actual free market health care, kids are covered by their parents’ policy.

            Free market health care also doesn’t mean that we let people die in the streets. What it does mean that if people choose not to get insurance, they need to spend all their personal assets (savings, home, retirement) before they get covered by government programs that provide a minimal medically necessary coverage. That’s no different from how we treat reckless people who choose to drive without a license or choose not to have personal liability insurance.

            1. Free market health care also doesn’t mean that we let people die in the streets. What it does mean that if people choose not to get insurance, they need to spend all their personal assets (savings, home, retirement) before they get covered by government programs that provide a minimal medically necessary coverage.

              (shudder)It’s GUMMINT healthcare which does that. You proggies crack me up!

              In the free market we had, they’d be treated at a charity hospital. PEOPLE don’t let people suffer; only government does that. I’m a non-believer, but I know a church-owned hospital would NEVER ask WHY you were uninsured. They’d just treat you. And there’d be no stigma. You were in the same room as the insured and staff never knew which was which, because they had no need to.

              They didn’t babble about free riders. And we spent less than 6% of GDP.

      3. Well that doesnt make him wrong.

        Merely uninformed.

        because we then have to deal with the fact that cancer bob still cant get coverage.

        American Cancer Society.

    3. Then you need to learn how to transition back to that.

      We aren’t going to transition back to that from where we are (a gawdawful mess of Medicare, Medicaid, employer, individual, ‘nothing at all’).

      And I’m convinced that the most difficult part of the current mess (Medicare reform and ending the entitlement mindset that it has created – which is unique among ‘public’ health systems) can’t be addressed until everyone is covered by that. It is probably easier to introduce free market health reforms in Europe now than it is in the US.

      1. RE: Medicare reform and ending the entitlement mindset that it has created – which is unique among ‘public’ health systems

        I’m super curious about this. Can you explain further? Why does Medicare create a unique level of entitlement, even compared to other socialist-style healthcare system?

        1. Medicare is the only system that encourages a notion among its beneficiaries that if they live and pay taxes for a few decades, they are entitled to its benefits. The corollary of that is that the beneficiaries themselves assert that most current people need to pay their dues first (like we did). That same mindset infects the entire ‘insurance’ debate. And its the reason Medicare is ‘off-budget’ and can’t even be discussed.

          Every other system is overtly pay-as-you-go welfare. This is the pot this year. This is how we will ration the spending in that pot this year. If we ration, everyone is rationed. If we spend more, everyone pays more. Still very very difficult to reduce spending – but at least everyone is in the same pot.

          1. It’s not that it’s off budget, it’s that it has a trust fund. Medicare and Social Security are the only entitlements with one.

            That’s also why the notion that people should “pay their dues” — because they are the only entitlements that last until death. Likewise private pensions only pay out if one has paid in, not to imply that SS and Medicare are financed that way, only that it’s a rational assumption. 40% of Medicare is now subsidized by income taxes, thanks to the crooked deal that Republicans cut under Dubya (Prescriptions)

            Fiscal conservatives have whined for years that the trust fund does not exist (it does), but that’s not very relevant to some woman in her 80s, when they (in effect) tell her to get a job. — as they tell low-income Medicaid and ACA exchange recipients,

            1. The trust fund does not exist in any real sense. It is composed solely of govt debt – which is a liability of govt not an asset of a govt trust fund. It is identical to shifting money from one pocket to another and is, legally, a pay-as-you-go system and the US govt has admitted as much in front of the Supreme Court.

              A lot of countries have gone down this fraud road re social retirement plans because it makes it easy to market and impossible to ever reform and thus serves as induced demand for govt debt. But we are the only ones who do that for healthcare.

              1. The trust fund does not exist in any real sense.

                You don’t know what a trust fund is. So it doesn’t exist, for you.

                It is composed solely of govt debt – which is a liability of govt not an asset of a govt trust fund. It is identical to shifting money from one pocket to another and is, legally, a pay-as-you-go system and the US govt has admitted as much in front of the Supreme Court.

                Memorized slogans don’t cut it, not do falsehoods.
                When I transfer money to my pension fund …. guess what? … I transfer it from one pocket to another!!

                But we are the only ones who do that for healthcare.

                SOLELY because we don’t have single-payer. As Wyatt explained to you.
                Ours is the only one limited to retirees. See the difference?

      2. Then you need to learn how to transition back to that.

        We aren’t going to transition back to that from where we are (a gawdawful mess of Medicare, Medicaid, employer, individual, ‘nothing at all’).

        You donl’t know how to, so it’s impossible.

        And I’m convinced that the most difficult part of the current mess (Medicare reform and ending the entitlement mindset that it has created – which is unique among ‘public’ health systems)It’s only unique because we don’t do rationing.

      3. Then you need to learn how to transition back to that.

        We aren’t going to transition back to that from where we are (a gawdawful mess of Medicare, Medicaid, employer, individual, ‘nothing at all’).

        You donl’t know how to, so it’s impossible.

        And I’m convinced that the most difficult part of the current mess (Medicare reform and ending the entitlement mindset that it has created – which is unique among ‘public’ health systems)It’s only unique because we don’t do rationing.

    4. Uhh, John. If “free market’s” worked why do they need to be defended? ‘Twould be. Naturally. The whole “competition of ideas” thing.

      Besides. It’ll never happen.

      1. Twould be. Naturally. The whole “competition of ideas” thing.

        It has nothing to do with competition — healthcare for the needy. You may be underestimating the innate humanitarian nature of human beings.

        Besides. It’ll never happen.

        If you mean restore a voluntary system that worked better, not by conservatives or libertarians. They have the wrong agenda

  2. Why Trump Can’t Fix Health Care

    The GOP is addicted to losing.

    They have the votes. They have the leadership. They can ram through changes using the reconciliation process. But too many would rather “nobly” enshrine Obamacare for eternity than put their votes behind something *better*, but not quite the sparkling unicorn pony in their wet dreams.

    Muh principles.

    On the brighter side, maybe they learn. What did it take, 9 months for Obamacare to pass? The Repubs still have the tactical advantage. Whenever they get their heads out of their asses they can use that advantage to make progress.

    1. They have the votes.

      They did not,

      They have the leadership. They can ram through changes using the reconciliation process

      They tried that. And failed. They have no idea what a free market in healthcare did. So they’re playing to their goobers, just like the Dems.

      Left – Right = Zero

  3. The debate is not about health care, it is about insurance.

    1. No, the debate is not about insurance because the ACA isn’t about insurance, it’s about an entitlement that has little to do with insurance.

      1. Republicans think it’s about insurance, because they don’t know how, or don’t care, to allow the private charity market to rebuild — which would eliminate Medicaid entirely.

  4. One in three mistakenly thought it put restrictions on end-of-life care?remember the “death panels”?

    A very large portion of US health care spending is on useless end-of-life care. You can’t rein in spending without denying coverage for people who are invariably going to die within a few weeks. So, the assumption that ACA encompasses “death panels”, i.e. government panels that restrict care for hopeless cases, is rational because it’s the only way the ACA could work. It’s the way other public health care systems run, it’s inevitable.

    And Americans are not slaves to logic or consistency. Opposition to this massive federal program has been particularly high among seniors?most of whom are covered by that massive federal program known as Medicare. The implicit attitude: Big government for me, but not for thee.

    ACA adds millions of people to government health care programs, programs that are already under financial strain. It is entirely rational for current beneficiaries to oppose that.

    1. The opposition to reform among Medicare beneficiaries is far more intractable than any other program. Medicaid and the poor ALREADY ration care – and there is no one among the poor who asserts – I spent my entire life trying to be poor so I deserve what I get from the system now. Medicare beneficiaries are the only ones who are asserting generational Ponzi rationales for their entitlements.

  5. Chapman has a gift. He can take a perfectly valid point and manage to screwed up the argument for it with misrepresentation and flawed logic.

    If he had stopped at, basically, “Healthcare is hard to fix because a large portion of the population wants to have its cake and eat it too,” I could have agreed with him.

    But he then takes a lot of completely reasonable objections to the ACA and acts as if they are unreasonable, acts as if IPAB was never part of the ACA, and as if ACA’s ballyhooed increase in the number of insured was due to the whole act, not just the Medicaid expansion, which we could have done without?the rest of the act — and I have heard that 75% of the people added to Medicaid would have qualified before the expansion. Like all ACA apologists, he equates health insurance with health care, despite research showing that people on Medicaid don’t have better healthcare outcomes than the uninsured.

  6. Slightly OT: NPR, without an iota of self-awareness, has taken to calling every piece of legislation or executive action taken under the previous administration, “Obama’s Signature [action]”;

    Obama’s Signature Healthcare Law
    Obama’s Signature Environmental Legislation
    Obama’s Signature Immigration Reform

    I kinda wish we’d gotten steaks, wine, and vodka instead.

  7. …t ACA also has elements that they would rather not surrender?such as allowing young adults to stay on their parents’ policies until age 26, barring exclusions for pre-existing conditions, mandating free preventive care, giving subsidies to moderate- and low-income people and expanding eligibility for Medicaid. i.e. Free Stuff that some fat-cat someplace else pays for.

    The American population has a lousy grasp of economics and no interest in personal responsibility / freedom.

    1. Including the libertarian establishment.

  8. Why is this a federal issue? Wouldn’t differentiation among the states give us a much better set of healthcare systems and allow for a much easier repeal of the poor performers?

    1. False choice. Note how “everyone”thinks this is about which level of government. (Don’t mean you personally,
      When we were allowed a free market, EVERYTHING was voluntary — including universal treatment

    2. False choice. Note how “everyone”thinks this is about which level of government. (Don’t mean you personally),
      When we were allowed a free market, EVERYTHING was voluntary — including universal treatment

  9. TANSTAAFL!

  10. This appears to be one of the few areas where you and John Green are in complete agreement: https://youtu.be/09RvU9_m30Q

  11. It’s not an easy task fixing healt care after 8 years of Obamacare, i think it would take even more than one presedential term! I used to make reviews of essay-writing platforms for Resumes.expert reviews and I have read many works about healtcare systems of different countries. I think US need to take a closer look on EU’s develompent in this field.

  12. The medical care system is fixable if people are willing to go back to what worked–putting it on a cash basis, with health care providers required to do a certain amount of “pro bono” work to maintain certification. Nothing based on the insurance gambling racket is or can ever be fixable, because the insurance gambling racket is not designed to benefit either the sick, the healthy, or the health care providers, but only the insurance companie.

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