Medicaid

The Illusory Savings From Cutting Medicaid

Congressional Republicans promise to achieve greater frugality in Medicaid without inflicting more hardship. It's not gonna happen.

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Trump talking health care during the annual Congressional Picnic at the White House
SHAWN THEW/EPA/Newscom

When economists talk in their sleep, they say, "There is no such thing as a free lunch." This axiom is drilled into them from day one of their undergraduate education and never leaves their minds. Any economist who tried to deny it would find herself suddenly choking in pain and unable to speak.

What it means is that if the government does something that costs money, some human somewhere will bear the expense. "Free" public schools, "free" parks, and "free" roads all have to be paid for by the citizenry. Collectively, we can't get something for nothing.

This useful insight has long been offered as an objection to costly government programs. But it applies as well to measures that extract savings from costly government programs.

In their replacement of Obamacare, congressional Republicans promise to achieve greater frugality in Medicaid, which helps low-income Americans, without inflicting more hardship. The melancholy truth: Not gonna happen.

Last year, total spending for Medicaid amounted to $533 billion. Nearly two-thirds of the funds come from the federal government, and the rest comes from the states. Some 69 million people are covered by it, up from 54 million in 2012.

The expansion was intentional. Under the Affordable Care Act (ACA), Washington signed on to cover 100 percent of the cost of expanded coverage at the outset, with its share falling to 90 percent from 2020 on.

The health care plan offered by Senate Republicans, like the one passed by the House, would reverse the trend by giving states a certain amount per Medicaid recipient or a block grant for a fixed amount. Either way, the federal contribution would steadily shrink compared with what it would do under the ACA.

Under the House plan, the federal savings would amount to $880 billion over a decade. The Senate bill is supposed to wring out even more. Supporters say Medicaid enrollees would be better off because states would be free to redesign their programs to make them more efficient and responsive to beneficiaries.

But remember that fundamental economic proposition. Just as you can't get something for nothing, you generally can't get more for less.

The House changes, according to the nonpartisan Congressional Budget Office, would reduce the number of people on Medicaid by 14 million by 2026. Many people who now have coverage would lose it, and many who would have become eligible would be turned away.

States could always protect the vulnerable by boosting their contribution to make up for the lost federal funds. But that would mean requiring their taxpayers to foot the bill.

Republicans say the changes would be positive because Medicaid coverage is often useless. House Speaker Paul Ryan claims that "more and more doctors just won't take Medicaid."

In fact, 69 percent of physicians currently accept new Medicaid patients, and the percentage has been stable for decades. It's lower than for privately insured patients, because Medicaid provides doctors with lower reimbursements, but budget cuts would probably exacerbate that malady.

Some recipients would get cut off under the GOP plans, and some would get less coverage. That—surprise!—would leave them worse off, because comprehensive health insurance is a good thing to have. Medicaid coverage, reports the Kaiser Family Foundation, is proven to ensure "earlier detection of health and developmental problems in children, earlier diagnosis of cancer, diabetes, and other chronic conditions in adults, and earlier detection of mental illness in people of all ages."

Cutting back Medicaid coverage would save taxpayers some cash, but only by taking it from others. The reduction would raise costs for low-income people and most likely degrade their health.

It would also increase the financial load on hospitals, which treat a lot of people who have no coverage. A study by scholars at Northwestern University and Columbia University figured that each new uninsured person costs nearby hospitals an average of $900 a year.

Less Medicaid coverage would strain the finances of struggling hospitals, particularly small ones in rural areas, and put some out of business—to the detriment of all patients, not just those on Medicaid. When one closes, the uninsured migrate to other hospitals, putting more stresses on them.

Economists know there's no such thing as a free lunch, a free medicine, or a free X-ray. There is, however, such a thing as a false economy.

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186 responses to “The Illusory Savings From Cutting Medicaid

  1. That argument was so economically stupid, it had to be a Chapman. And it was.

    1. It would be nice if they would just do the sensible thing and get rid of him so I can justify a donation. I don’t come here to get a poorly xeroxed copy of a junior high newspaper trying to be mother jones. It is kind of disgusting reason would print this.

      1. Dude, respectfully, have you been living in a cave for the last nine or ten years? Chapman completely speaks on behalf of Welch, Gillespie, and the entire cabal of fakers who hijacked Reason.

        1. Dude, have you been living in a cave for the last 50 years? You speak for the entire cabal of anti-gubmint Gomers who destroyed our movement. The libertarian label is now rejected by even 91% of libertarians (per Cato)

          You reject free-market results … or have no clue what they were. Pre-Medicaid, the uninsured had whatever treatment they sought, regardless of income. — since the 1500s ? paid by voluntary funding of (lately) charity hospitals and clinics. Who are you to defy the freely expressed will of the people?
          Until Gomers took charge, led by Rothbard, Rockwell and Ron Paul, the REAL liberty movement debated the best transition back to the private care infrastructure.

          Gomers snarl and whine (like Ron Paul), “git gubmint OUT.” Do they not give a shit about market outcomes? Or are they dumb enough to think a complex private care infrastructure will spring from the earth on its own ? Liberty lovers, know that market alternatives come first, which then replaces government.
          Gomers have it exactly backwards, which is why progressives kick our ass on every major issue.

          Americans support universal treatment and are willing to pay for it. If we can’t SHOW a better way to do it ? more than memorized slogans and soundbite, then progressives will kick our ass again ? by providing the only alternative.

          Why is this rocket science? Because Gomers.

          1. What the fuck are you talking about you stupid bitch? You want more government AND more markets? Not possible. The one displaces the other. Nobody wants to prop up charity care with their private dollars when they’re already getting mugged by “gubmint” to pay for it. Do you get that you fucking pathetic asshole?

            1. (boldface in defense o1 THIRTEEN aggressions by a psycho stalker)

              Boldface for the integrity challenged

              ME ?Pre-Medicaid, the uninsured had whatever treatment they sought, regardless of income. ? charity hospitals and clinics. Who are you to defy the freely expressed will of the people?
              Gomers snarl and whine ? “git gubmint OUT.” Do they not give a shit about market outcomes? Or are they dumb enough to think a complex private care infrastructure will spring from the earth on its own ? Liberty lovers, know that market alternatives come first, which THEN replaces government.

              You want more government AND more markets? The one displaces the other

              THAT’S WHAT *I* SAY, YOU SAY KEEP MEDICAID!

              hello.|6.25.17 @ 10:28PM
              Chapman should have told Rhode Island that it was impossible for them to spend less money and get better patient outcomes. Because they fucking did.

              YOUR LINK, chump.

              In your FIRST assault
              I said “shrink the government” and you LIED that I’d said “the same size”
              I said we need to “transition back” to a free market … and you SLOBBERED that I would “keep all current regulations. Bend over as I jam this link up your ass. AGAIN
              https://reason.com/archives/201…..nt_6884068

              1. I agree with him. You’re a stupid bitch.

    2. Not merely stupid, but dishonest.

      “… without inflicting more hardship….”

      1. WHY, Sluggo?
        Can you act adult, just this once? Instead of committing aggression on a libertarian website — which is neither smart nor honest?

  2. This article’s logic and “facts” are even more twisted than what it tries to describe.
    First, there is no free lunch. But, God never told anyone to be stupid. I can buy Ritz crackers at Walmart for $2.50 while the City Market across the street charges $4.99 for the exact same box of Ritz. In this example the City Market is the current Medicaid price, while Walmart is the lowest available price for the EXACT same product. Is going to Walmart a “free lunch”? No one in their right mind (maybe left mind) would say so. The difference in price is due to better management, better negotiations of price and volume. The same can be obtained by a well run medical care program. Currently there is little incentive for the any Government to run anything well or least expensive. Too many hogs at the trough, too many special interests, too many Steve Chapmans crying crocodile tears for the “children” or other free crap special interests.No one is crying for me the taxpayer who must foot the bill for all the waste and corruption. Not to mentions that Health Care is NOT a right I am forced to pay for everyone. Unfortunately, Chapman is right about one thing. The Repub plan is at least as bad as the Dumo plan, just not for the reasons he pointed out. Both parites are going to bankrupt the republic, it’s just a matter of time.
    There were so many other straw men in this article I am beginning to think Chapman wrote it on April 1.
    Grumpy

    1. Where, in this misanthropic jabber, have you advocated a free market in medicine?

    2. No one is crying for me the taxpayer who must foot the bill for all the waste and corruption.

      Bullshit.

      REAL libertarians work to transition and restore what the free market achieved – while you recite useless slogans and sound bites. YOU are the greater threat to liberty. By not giving a shit for the sick and dying “children” you ridicule, you are a PERFECT recruiting poster for progressives … by proving everything they say.

      There’s a REASON that private charity works better. It’s because the vast majority of people DO care about others, and have shown it for centuries. That leaves you all alone, twisting in the wind — shaking your fist at the sky,

      And it makes you and your ilk a threat to MY liberty.

      1. REAL libertarians work to transition and restore what the free market achieved – while you recite useless slogans and sound bites.

        Says the stupid fucking piece of shit copying and pasting the same slogan over and over again while advocating for MORE government in health care that will somehow lead to a free market? Do you even read this shit before you post it? Jesus fucking Christ you are stupid.

        1. (boldface in self defense from aggression … and to TWIST my ridicule of so massive a fuckup)

          REAL libertarians work to transition and restore what the free market achieved – while you recite useless slogans and sound bites.

          gain while advocating for MORE government in health care that will somehow lead to a free market?

          Trashmouth says that “restoring the free market” means “advocating MORE government” .,.. then shits into both his hands and smears it all over his own puss!

          Do you even read this shit before you post it?

          (smirk)

          Christ you are stupid

          Did any of that shitsmear go up your nose?

  3. Medicaid ***COULD*** get cost-cut w/o hurting anyone, by deregulating… Taking most or all meds off of the “needs a prescription list”, allowing people to see un-licensed doctors (or veterinarians) for their health care, if they want to, etc. Slashing the living snot out of the FDA budget would help, too!

    Well, when I say ” w/o hurting anyone”, though, I didn’t include licensed doctors, the AMA, FDA parasites, regulators, and other hangers-on & rent-seekers. THEY are the reason why we never discuss cutting costs by cutting Government Almighty and its minions!

    1. +1,000

    2. That was fucking useless babbling — memorized slogans and soundbites.
      How do we transition back to — and restore — the private charities and infrastructure that provided universal TREATMENT for 450 years — until 50 years ago. That alone trumps every slogan you listed. But it requires actual policies and the strategies and tactics to implement them.

      1. That was fucking useless babbling — memorized slogans and soundbites.

        He said before pasting the EXACT SAME THING for the third time. Are you actually this stupid or do you have some kind of mental disorder?

        1. Boldface in self-defense of a aggression by a trashmouth bully. Again. (sigh)

          He said before pasting the EXACT SAME THING for the third time.

          You’re full of shit again. And there were three fuckups to correct (not counting all of yours). And …

          Are you actually this stupid or do you have some kind of mental disorder?

          (sneer) THIS fuckup is not as fucking stupid your other one:

          https://reason.com/archives/201…..nt_6884062

          Are your parents proud of how you turned out???
          Do you publicly humiliate yourself elsewhere? How many times, Slick?

          1. Meet The Hihnister One, who never met a Government Almighty program or pogrom that He did NOT like… With exceptions made ONLY for Government Almighty programs that actually CUT the size and power of Government Almighty!!!

            1. (Boldface in self-defense of aggression by an illiterate dumbfuck

              I say: How do we transition back to — and restore — the private charities and infrastructure that provided universal TREATMENT for 450 years — until 50 years ago. That alone trumps every slogan you listed. But it requires actual policies and the strategies and tactics to implement them.

              Squirrel drools: Meet The Hihnister One, who never met a Government Almighty program or pogrom that He did NOT like… With exceptions made ONLY for Government Almighty programs that actually CUT the size and power of Government Almighty!!

              Somehow chooses to smash a pie in to the face of …. himself! (sneer)

              1. How do we get from point B back to point A if we insist that we must be perfectly situated at point A before we can move away from point B?

                How do we get the parasites (AMA, FDA, licensed doctors, etc.) to back away from the coerced milk, and buy the Libertarian cow, when they are getting their “free” milk, via coercion!?!

                Cut them off, name them and shame them! I have ***NOT*** seen you spelling out a better solution! All you do is call the non-Hihnister ones evil and stupid! Back at ya, buddy! It takes one to know one! I am rubber, you are glue?

                1. (posted is defense of ANOTHER aggression by punk)

                  How do we get from point B back to point A if we insist that we must be perfectly situated at point A before we can move away from point B?

                  NOW cyber-bully says “transition” means “being perfectly situated” BEFORE YOU MOVE!

                  Cut them off, name them and shame them!

                  You ARE shameful. Stupid or a fucking liar, or both.

                  I have ***NOT*** seen you spelling out a better solution! That excuses your STUPIDITY of what transition means?

                  (how to get them?. buy the Libertarian cow, when they are getting their “free” milk, via coercion!?!

                  You ADMIT ignorance!! (sneer)

                  Repeat:

                  How do we transition back to — and restore — the private charities and infrastructure that provided universal TREATMENT for 450 years — until 50 years ago. ? it requires actual policies and the strategies and tactics to implement them.

                  HAS NO CLUE … ATTACKS ME FOR ASKING.

                  PRO-LIBERTY libertarians ? instead of “git gubmint out” goobers … have proposed FOR 40 YEAR ? one being a 100% tax credit for donations to life support charities … for ENTIRE SAFETY NET … shifts money from government to the private sector, at the EXACT time and pace required to rebuild the private infrastructure.

                  all you do is call the non-Hihnister ones evil and stupid!

                  I just proved it, chump. Make my day.

  4. “There’s no such thing as a free lunch”? I call BS on that one! OK, I acknowledge that the saying is trying to transmit a useful idea, but, let’s recalibrate?

    ‘1) The free market is a “free lunch” compared to socialism? Just compare North Korea v/s Singapore.

    ‘2) Peace is a “free lunch” compared to war. Compare living in NAZI Germany in 1944 v/s living in Switzerland.

    ‘3) Voluntary, un-coerced association in general, is a “free lunch” compared to having endless armies of do-gooders backed up by endless armies of armed thugs. See point #1.

    NOW can we talk about improving medical care WITHOUT growing Government Almighty? Maybe even by SHRINKING Government Almighty? The Rethuglicans and Demoblicans sure aren’t filling this niche; Maybe Libertarians could!

    1. ‘4) Technological advancements are a “free lunch” compared to the lack of it. Yet, in the face of medicines (or tools or types of surgeries) used overseas, safely and effectively, for decades, the FDA ***STILL*** says we must spend $millions here, to prove them safe and effective HERE, before we can be allowed to use them here! Do the laws of physics, biology, and chemistry change, when we cross national boundaries? Or are we looking at greedy FDA parasitism, plain and simple?

      1. But….THALIDOMIDE!

    2. Maybe even by SHRINKING Government Almighty?

      Totally fucking backwards rant.
      Shrinking gubmint does not rebuilt and restore the entire private care infrastructure that provided universal treatment.
      Put individual liberty ahead of hating government. transition back to what wr had. and government will shrink.
      You’re trying to do it bass ackwards. STOP.

      1. What’s your proposal then that leaves the government the same size, leaves all the existing regulations in place, and leads to a free market? Oh right, you don’t have one, because it’s not possible and you’re babbling incoherently like a fucking retarded asshole.

        The government displaced those old institutions you stupid fucking piece of dog shit, DO YOU GET THAT? Do you get that operating a charity clinic like you would have found 80 years ago in this country is completely and totally fucking ILLEGAL today?

        No, of course you don’t. Just continue pasting the same stupid shit and telling every one else that they’re ranting and spewing talking points.

        1. (Boldface in defense of multiple aggressions by a stalker/bully)

          ME: transition back to what we had. and government will shrink.

          What’s your proposal then that leaves the government the same size, leaves all the existing regulations in place,

          OMFG!
          Says “shrink” means ” the same size.”
          Can he get wackier? YES!

          The government displaced those old institutions you stupid fucking piece of dog shit, DO YOU GET THAT? Do you get that operating a charity clinic like you would have found 80 years ago in this country is completely and totally fucking ILLEGAL today

          1) Don’t know what “transition back” means EITHER?
          2) SHITS in the OUTCOMES of a free market … which was 50 years ago, not 80, until Medicaid. (sneer)

          telling every one else that they’re ranting and spewing talking points.

          In your case, it’s a lot crazier than a mere rant. Even crazier than this:

          https://reason.com/archives/201…..nt_6884062

          Three total meltdowns (so far). How many more on his raging hissy fit?

          1. Michael, he’s frustrated.

            And he’s frustrated because you appear to be speaking against the gradual removal of the funding of the current system–said gradual removal of funding an integral part of transitioning to a true market solution.

            You need to explain how not gradually defunding the massive government program that undermined what the free market achieved is a net plus for transitioning back to the earlier , more free market solution that you’re describing.

            Because as it stands now, you appear to be agreeing with Chapman, who seems to be speaking against getting rid of Medicaid–and I know that cannot be your intention.

            1. Removal is not transition. Anti-gubmint gobbers are self-deluded. And drool a lot.
              Restoring the private charity infrastructure requires more than snarling “git gubmint out.”

              Since the 70s, pro-liberty libertarians have proposed several ways to do that. My own favorite is a direct tax credit for contributions to life support charities. This provides the cash … at the same amount and pace required … by the rebuilding .,.. taken from government. Any questions?

              Assholes like Ron and Rand Paul have disgraced our movement, and likely destroyed it.
              Cato reports that 91% of libertarians REFUSE to call themselves libertarians.
              So we have over 60% of the electorate .. Americans are eager for even radical change … but we have NOTHING … not even a better way to provide what people already want … and our very name has been slandered and disgraced by fake libertarians.

              HOW the Gomers attack Chapman is part of that disgrace.

  5. When economists talk in their sleep, they say, “There is no such thing as a free lunch.” This axiom is drilled into them from day one of their undergraduate education and never leaves their minds. Any economist who tried to deny it would find herself suddenly choking in pain and unable to speak.

    Wait, is Krugman still an economist or is he not?

    1. Krugman is an economist the same way that an arsonist is a fireman!

    2. Krugman clearly has transcended beyond economics.

      1. He has no intelligent competition. Wins by default.

        1. *spit take*

          1. Thanks for proving my point!

            Krugman says the postwar boom proves that 91% tax rates do not damage economic growth,
            Nick Gillespie says the postwar boom proves that HUGE spending cuts (even roughly 50%) can STIMULATE, not depress, the economy,

            The 91% tax rates and huge spending cuts are both true. So … wait for it ….
            Krugman says, in effect, that we had a major boom after huge spending cuts.
            Gillespie says, in effect, that we had a major boom despite 91% tax rates.

            Point being that “spit takes” are no match for being informed and intelligent.
            And how do you explain the obvious disparity. Can they each be both be right and wrong from a single statement?

            1. Could be that you’re a fucking retarded piece of shit who doesn’t understand the arguments of either Krugman or the free market economists who oppose him. Which, by the way, Nick Gillespie is not.

              But then you defending a Keynesian democratic socialist isn’t that surprising since you somehow think that more government in health care will lead to a free market.

              You are possibly the single most moronic fuck head I’ve seen on here, and that’s saying a LOT.

              1. (boldface in self-defense of multiple aggression by raging bully.)

                ANOTHER massive fuckup by my stalker!

                The correct answer is the ONLY obvious one ,,, waif for it (smirk) ,…
                THERE WAS NO POSTWAR BOOM, Sparky.

                We had five back-to-back recessions 1945-1961, UNTIL KENNEDY REPEALED THE 91% TAX RATE! These are the official dates for our business cycle, http://bit.ly/14sQeMy

                Recessions start when the last expansion peaks. Under the PEAK column: Feb/1945 … Nov/1948 … Jul/1953 … Aug/1957 … Apr/1960

                But then you defending a Keynesian democratic socialist

                WHERE, chump? I just proved that he’s full of shit. Sorry.

                isn’t that surprising since you somehow think that more government in health care will lead to a free market.

                That was your first of five (so far) MASSIVE fuckups .,.. where you SCREAMED that “:shrink the government” means “the same size” and “transition back” to a free market means keeping all current regulation!

                https://reason.com/archives/201…..nt_6884068

                Chill, dude. It could be your uncontrollable rage has caused severe mental damage,

  6. If the Republicans offered even a hint of free market medical reform the pain might be mitigated. But the GOP has no more affinity for economic liberty than do the Democrats, so our choices are among various sorts of socialism (or fascism, if you prefer). You don’t hear many libertarians demanding the end of medical licensure and prescription drug laws, either.

    1. “You don’t hear many libertarians demanding the end of medical licensure and prescription drug laws, either.”

      Count me among these exotic beasts!!! Step number one is to make it optional… Just lemme “opt out” of the coercive system!

      1. I have nothing against medical licensure, any more than I oppose plumber licensure.

        What I object to is being restricted to obtaining goods and services from those so licensed.

    2. Walmart might be able to brag convincingly that “you get two boxes of Ritz for the price of one at our competitors” but who would ever believe a pitch, especially from the GOP, that they can cover double the number of medical visits, etc. for what the Dems’ medicare plan does?

      1. but who would ever believe a pitch, especially from the GOP, that they can cover double the number of medical visits, etc. for what the Dems’ medicare plan does?

        No, but I certainly believe the pitch that if people have to pay for the healthcare they consume out of their own pocket instead of “socializing” the cost, they’ll try to be healthier and spend a lot less.

        1. I certainly believe the pitch that if people have to pay for the healthcare they consume out of their own pocket instead of “socializing” the cost, they’ll try to be healthier and spend a lot less.

          Hardly anybody else believes such total bullshit. Thanks for proving Bernie Correct about us.

          “Those damn libertarians say we don’t need insurance! They’d save a FORTUNE rebuilding a burnt-down home with cash.. Cancer? Just save up longer before you need treatment!! Simple enough?”

          How do I try to avoid cancer? (Other than lung)

          1. What the fuck are you talking about you hopeless piece of shit? Seriously, you are fucking deranged. Nothing you said had anything to do even remotely with the post you are responding to.

            1. (Boldface in defense of multiple aggressions, by a serial stalker .. now seven … starting with THIS meltdown
              https://reason.com/archives/201…..nt_6884068)

              What the fuck are you talking about you hopeless piece of shit? Seriously, you are fucking deranged. Nothing you said had anything to do even remotely with the post you are responding to

              Pay attention. He said we shouldn’t buy insurance (lol)

              I certainly believe the pitch that if people have to pay for the healthcare they consume out of their own pocket instead of “socializing” the cost, they’ll try to be healthier and spend a lot less

              REPLY: “Cancer? Just save up longer before you need treatment!! Simple enough?”
              How do I try to avoid cancer? (Other than lung)

              .So YOU say we don’t need insurance either!!!

      2. but who would ever believe a pitch, especially from the GOP, that they can cover double the number of medical visits, etc. for what the Dems’ medicare plan does

        YES!
        Only a total dumbass would believe such a thing.

        “Take ME on faith alone, instead of the other tribe on faith alone. Because liberty, and because I’m better. Just because.,”

        1. “Take ME on faith alone, instead of the other tribe on faith alone. Because liberty, and because I’m better. Just because.,”

          That’s your own argument you’ve just summarized. Holy shit are you fucking stupid.

          1. (boldface in self-defense of ANOTHER aggression. Okay, also ridicule. Walk a mile in MY shoes)

            That’s your own argument you’ve just summarized. Holy shit are you fucking stupid

            Fuckup NUMBER EIGHT from my stalker. Does he even have the mentality to grasp my argument? See for yourself here, attack #1.
            https://reason.com/archives/201…..nt_6884068

            In his first assault, I said “shrink the government” and he ATTACKED ME that I’d said “the same size”
            Equally crazy, I said we need to “transition back” to a free market … and our resident genius slobbered that I would “keep all current regulations.

            I know, I know, you cannot believe ANYONE could be THAT stupid. Check the link.
            Because, raging cyber-bully.

    3. You don’t hear many libertarians demanding the end of medical licensure and prescription drug laws, either.

      Excuse me, but I advocate for oxycodone vending machines in front of Target.

      1. “Excuse me, but I advocate for oxycodone vending machines in front of Target.”

        Yeah Dude, I agree!

        This idea that, because a few of us abuse the stuff and cause driving accidents (and deaths and overdoses and sadness for loved ones), the rest of us should live in pain and deprivation, is WAAAY bogus!

        My favorite comparison is, “Most mammals don’t control their bowels, and they shit in public, anywhere they please, spreading disease and filth! Therefor, from now on, ALL mammals (including YOU!!!), MUST wear diapers when out in public!” … Excuse me, I an NOT like some other mammals, and I am NOT like irresponsible over-dosers!!!

      2. Except they would not be available to those boycotting Target.

    4. “You don’t hear many libertarians demanding the end of medical licensure and prescription drug laws, either.”

      This is only a true statement if you are either

      A. Deaf
      B. Never within earshot of a libertarian.

      It would be difficult to find someone who declares themselves a libertarian who doesn’t demand those things.

      1. Ooops.
        Beat me to it.

      2. It’s more like, we’re so sick of saying it & nobody responding that we hardly ever do any more. We can just say we’re libertarians, & everyone else thereby knows we have that opinion about licensure of goods & services, & therefore pays no att’n.

        1. So instead we promote things like letting some differently-licensed professionals practice each other’s art (resulting for example in that nurse-midwives are now allowed to deliver babies instead of their having to be MDs, even if lay midwives aren’t allowed) in the hope that people who don’t know us will take what we promote seriously, & hope they don’t think, “This person’s just saying that because s/he’s a libertarian,” & dismiss it. So, for another example, allow pharmacists to fill prescriptions written by a broader class of professionals; not as good as allowing nonsprescription dispensing of those drugs, but it’s still an increase in freedom that has a chance of being adopted, & therefore can serve as a real-life model for further deregul’n.

    5. “You don’t hear many libertarians demanding the end of medical licensure and prescription drug laws, either.”

      Either you are new here or can’t read.

    6. “If the Republicans offered even a hint of free market medical reform the pain might be mitigated. But the GOP has no more affinity for economic liberty than do the Democrats, so our choices are among various sorts of socialism (or fascism, if you prefer).”

      I don’t understand why someone would write this in a thread about how the Republicans are trying to cut Medicaid.

      “Under the House plan, the federal savings would amount to $880 billion over a decade. The Senate bill is supposed to wring out even more . . . . The House changes, according to the nonpartisan Congressional Budget Office, would reduce the number of people on Medicaid by 14 million by 2026.

      I’d understand your sentiments if we were talking about some other topic. This article is about the Republicans cutting eligibility for Medicaid. Do you oppose them doing this because the Republicans aren’t really about . . . whatever?

      Cutting eligibility for a socialist program should be applauded. We shouldn’t criticize the Republicans for fighting to cut the eligibility of a socialist program. I wish they’d do other things, too–in addition to this. I’m not against doing good things because doing them doesn’t also include doing other good things.

      1. “If the Republicans offered even a hint of free market medical reform the pain might be mitigated. But the GOP has no more affinity for economic liberty than do the Democrats, so our choices are among various sorts of socialism (or fascism, if you prefer).”

        I don’t understand why someone would write this in a thread about how the Republicans are trying to cut Medicaid.

        Umm, because we had universal treatment for the uninsured — regardless of income — when we still had a free market in that area. So you also “don’t understand” 450 years of private charity, until only 50 years ago.

        Cutting eligibility for a socialist program should be applauded.

        Only by people who are totally clueless about private charity ,… who MIGHT get 15% of the vote, On their best day.
        Your authoritarian compulsions aren’t very popular in “the land of the free.”

        1. Wow. Just wow.

          Cutting Medicaid undermines private charity and is authoritarian? How the fuck do you remember to breathe from one moment to the next with a mental deficiency that severe?

          1. AGGRESION #9 by my stalker! (boldface in defense of aggression)

            ME: Umm, because we had universal treatment for the uninsured — regardless of income — when we still had a free market in that area.

            GOOBER: Cutting eligibility for a socialist program should be applauded.

            ME: Only by people who are totally clueless about private charity ,… who MIGHT get 15% of the vote, On their best day. Your authoritarian compulsions aren’t very popular in “the land of the free.”

            STALKER: Cutting Medicaid undermines private charity and is authoritarian?

            I’l TRY dumbing down to your level.

            1) The free market provided universal treatment to the uninsured.
            2) The LIBERTARIAN solution would be a transition back to that.
            3) He is AUTHORITARIAN, because … wait for it, Skippy … he REJECTS THE OUTCOMES OF A FREE MARKET! While posturing as a libertarian. A fraud like YOU

            How the fuck do you remember to breathe from one moment to the next with a mental deficiency that severe?

            Cyber-bullies be vicious AND dumb!
            You BEGAN stalking me down the page with
            I said “shrink the government.” You SCREECHED that I said “the same size:.
            I said “transition back” to a free market. You drooled that I said keep “current regulations.”

            Yes, folks, the drive-by aggressor is PRECISELY that wacky.
            https://reason.com/archives/201…..nt_6884068

            1. Michael, you need to explain why you think cutting funding to a socialist program and transitioning people from a socialist program and back to a market solution is wrong.

              People keep thinking that you want to keep ‘current regulations’ because you appear so adamantly opposed to gradually defunding Medicaid–the only way we can transition back to a market economy in healthcare–by getting the government to stop interfering.

              1. Michael, you need to explain why you think cutting funding to a socialist program and transitioning people from a socialist program and back to a market solution is wrong.

                OMG. I’m the ONLY one defending that!

                ME: I said “shrink the government.” You SCREECHED that I said “the same size:.
                I said “transition back” to a free market. You drooled that I said keep “current regulations.”

                YOU: People keep thinking that you want to keep ‘current regulations’ because you appear so adamantly opposed to gradually defunding Medicaid–the only way we can transition back to a market economy in healthcare

                1) BULLSHIT.

                2) ONLY THE ONES WHO CAN’T FUCKING READ. LIKE YOU.

                YOU: by getting the government to stop interfering.transitioning people from a socialist program and back to a market solution is wrong.

                HOW TO DO THAT REQUIRES MORE THAN DROOLING, “Git gubmint out.”

    7. You don’t hear many libertarians demanding the end of medical licensure and prescription drug laws, either.

      You might think that…

      …if you never actually read a single article @ Reason

      the opposite is true; its a constant theme.

      the standard-critiques were recently rehashed last December, when reviewing possible FDA picks =

      “We should reform [the] FDA so there is approving drugs after their sponsors have demonstrated safety?and let people start using them, at their own risk,” O’Neill said in a 2014 speech…. “Let’s prove efficacy after they’ve been legalized.”

      Those “insane” ideas that relate to the FDA may seem familiar to readers of Reason as they have been defended at length and intelligently here by our science correspondent Ronald Bailey, at most detail in this 2012 article.

      Here’s a good, lengthy piece (“How Govt Killed the Medical Profession“) from a physician on the standard libertarian complaints about both doctor-licensing and FDA pharma barriers.

      and shikha dalmia (not a much-liked writer, but still) wrote a decent piece on libertarian objections to the AMA here

    8. Maybe YOU don’t hear them, but I do, and say so myself. Coercive government may not be the root of all evil, but it sure is the enabler of a lot of it.

    9. “You don’t hear many libertarians demanding the end of medical licensure and prescription drug laws, either.”

      Yes you do.

      Government medical licenses reduce the entry of doctors and nurses by increasing the cost to become one. Eliminate medical licenses and the allow private companies to offer the same for those that need the security. You’ll get cheaper, better, and more doctors.

      Prescription drug laws have the same affect. It increases the cost of drugs by requiring a doctors visit when it’s often unnecessary.

      Both should be eliminated for better medical care.

    10. I guess you never read one of my many comments on this subject.

  7. I am actually shocked at how low the average monthly cost is… $644. Keep in mind that Medicaid ends up with some of the sickest, most expensive, people. Pre ACA I was paying just over $400/mo in the north east for a (relatively) shitty hmo plan through a corporate shell. I’m sure there is fraud that should be dealt with and it can probably be made more efficient, but it doesn’t seem to be all that far off from the current private market either.

    1. “I am actually shocked at how low the average monthly cost is… $644.”

      If you look at some of my other comments in this thread, you’ll see that Medicaid doesn’t actually cover costs.

      That’s how much Medicaid reimburses providers for treating Medicaid patients.

      Medicaid only reimburses providers for a fraction of the cost–leaving providers to gouge private insurance companies for approximately 150% of actual costs (circa 2015).

      $644 might be what the government is paying. $800 might be the actual costs. $1,200 might be what they get from an insurance company.

      P.S. In addition, yeah, Medicaid is paying for more costs–for instance the fertility rate among Medicaid patients is higher than the general population. Having babies is expensive, and moral hazard is a real thing.

      1. Having babies is a young people’s game, and young people tend to be poorer.

        1. It’s also a poor people’s game.

          One of the two main reasons women start to have fewer children (cross culturally and throughout history) is when they have opportunities to contribute to household income by working outside the home.

          Medicaid is an entitlement for poor people–a disproportionate number of whom are women who do not work outside the home.

          Women who do not work outside the home simply tend to have more children than those who do, and, again, that isn’t just in the United States. Over the course of a few generations, the fertility rate in places like Ireland and Italy (where people avoid birth control for religious reasons) dropped from more than six per female to less than two per female today–after women started entering the workforce in the ’60s and ’70s.

          Show me a place where women don’t work outside the home, and I’ll show you a place with a relatively high fertility rate. Protecting poor women from the medical expenses of child bearing certainly doesn’t discourage having children any.

    2. I am actually shocked at how low the average monthly cost is… $644.

      I’m not sure where you get that number from. Medicare/Medicaid spends an average of upwards of $1000/covered member.

      Maybe you’re just looking at the federal portion of the spending.

  8. “Cutting back Medicaid coverage would save taxpayers some cash, but only by taking it from others.”

    And statements like this is why this place is now a ghost town.

    1. Indeed.

      ‘Some recipients would get cut off under the GOP plans, and some would get less coverage. That?surprise!?would leave them worse off, because comprehensive health insurance is a good thing to have.’

      Yes, comprehensive health insurance IS a good thing to have.

      However, when it comes at the expense of putting a gun to another person’s head in order to pay for the premise, any and all pretense of advocating on its behalf in the name of compassion rings a bit hollow.

      ‘In their replacement of Obamacare, congressional Republicans promise to achieve greater frugality in Medicaid, which helps low-income Americans, without inflicting more hardship. The melancholy truth: Not gonna happen.’

      That’s so far removed from the point(from a libertarian perspective), that one wonders what the fuck business Chapman has even being here.

      Oh, Reason. Once again, you display your tepid, lukewarm commitment to individual rights by publishing another article by an unapologetic statist.

      While I agree that the Republicans’ plan is deeply flawed, and if I was in Congress I wouldn’t vote for it even if you offered up Jessica Alba’s oiled up ass as reward, Chapman never touches upon how flawed and unsustainable the program is in regards to long term federal budgeting.

      But hey, to Hell with your grandchildren. There’s shortsighted social signalling to be done.

      For fuck’s sake, Reason. STATE HARDER!!!

      1. Well said,

      2. However, when it comes at the expense of putting a gun to another person’s head in order to pay for the premise, any and all pretense of advocating on its behalf in the name of compassion rings a bit hollow

        Luckily there are several alternatives, all better than your (non)”solution” here,

        Oh, Reason. Once again, you display your tepid, lukewarm commitment to individual rights by publishing another article by an unapologetic statist

        Not nearly as bad as your own tepid, lukewarm commitment to the outcomes of a free market.

        When we still had one for the uninsured, we provided universal treatment — regardless of income — through a complex network of charity hospitals and clinics, financed by various types of charities, churches and other nonprofits — like fraternals (Rotary and others)

        So, unless you support a transition back to the OUTCOMES of a free market, then you have not a trace of commitment to individual liberty. That’s why a raging hatred of gubmint is no match for even the mildest love of liberty. Think about it, eh?

      3. “Oh, Reason. Once again, you display your tepid, lukewarm commitment to individual rights by publishing another article by an unapologetic statist.”

        That statement gets my vote for the updated Reason masthead.

        1. ThomasD,
          You’re drooling, Gomer. As explained just above your wacky rant.

  9. “The House changes, according to the nonpartisan Congressional Budget Office, would reduce the number of people on Medicaid by 14 million by 2026.”

    The AHCA moves these people to private insurance by way of subsidies, and moving people from Medicaid to private insurance through subsidies is exactly like moving students from public schools to private schools with vouchers.

    Seeing someone defend Medicaid on a libertarian website is absurd. It’s a socialist program financed with coercion to the extreme detriment of market solutions for healthcare. Medicaid is indefensible from a libertarian standpoint, and cutting eligibility–something I don’t believe has ever happened before–will be an historic victory for libertarianism

    Maybe best of all, the AHCA shows us the way to get rid of Medicaid entirely.

    I repeat: Moving people from Medicaid to private insurance through subsidies is exactly like moving children from public schools to private schools with vouchers. The more we do this, the better the healthcare market will function, and as all real libertarians know, market solutions are the only real solutions–not socialist programs like Medicaid.

    1. But the trouble is all you’ll hear about is “The mean Republicans will be killing people because 14 million people will lose Medicaid coverage,” just like “the GOP puts in a Secretary of Labor who wants to let your kids go uneducated.”
      He who controls the narrative wins the battle. The “Tea Party,” who might provide a contrasting image in town halls and in front of congress critter’s offices seems to have disappeared, and the Libertarian Party sure hasn’t taken up any of the slack.

      1. Education,not Labor/

      2. “He who controls the narrative wins the battle”

        The battle is right before us.

        It’s over one or two votes in the Senate.

        We’ve already won half the battle–since cutting Medicaid already passed in the House.

        That’s the battle. You win the battle by scoring runs. The AHCA isn’t a home run, but it’s a lead off double.

        Nobody ever lost a game or a battle because of a lead off double.

        1. You’ve never watched a Phillies game?

          1. You can’t lose because of a lead off double.

            It can’t happen.

            The government will never be so flush with cash that it decides to cut spending, and a baseball team can’t lose because of a lead off double.

      3. But the trouble is all you’ll hear about is “The mean Republicans will be killing people because 14 million people will lose Medicaid coverage,”

        Because it’s TRUE!!!!

        Every one of them had treatment. regardless of income, when we still had voluntary, free-market charitable care.
        If you don’t support a transition back to that, then you’re no friend of individual liberty. But a threat to it, in effect co-conspiring with progressives by making their case for them.

        Hating government does nothing to expand individual liberty and free markets, Especially if one knows nothing about free markets, and with little or no commitment to individual liberty..

        1. Do you think Medicaid is a private charity or something you fucking retarded asshole? What the FUCK do you think everyone here is arguing for? Stop having Medicaid provide the safety net and let other people do it.

          1. (boldface in defense of the 1oth AGGRESSION by a serial stalker)

            Boldface for the mentally retarded

            ME: Every one of them had treatment. regardless of income, when we still had voluntary, free-market charitable care.
            If you don’t support a transition back to that, then you’re no friend of individual liberty. But a threat to it, in effect co-conspiring with progressives by making their case for them.

            STALKER: Do you think Medicaid is a private charity or something you fucking retarded asshole?

            (sneer) I said we should transition back to private charity. You’ve made the same fuckup TEN TIMES now, so who’s the retarded asshole!!

            https://reason.com/archives/201…..nt_6884068

            I said “shrink the government” and you ATTACKED ME that I’d said “the same size”
            I said we need to “transition back” to a free market … and you slobbered that I would “keep all current regulations.

            What the FUCK do you think everyone here is arguing for

            REPEALING MEDICAID!

            Stop having Medicaid provide the safety net and let other people do it.

            (snicker) Like … oh …..transition back to private charity? … which you’ve fucked up reading TEN TIMES … as a trash-talking PUNK!
            (flush)

    2. Seeing someone defend Medicaid on a libertarian website is absurd.

      Yet you defend Medicare.

      If the GOP had balls they would get rid of both.

      1. I’ve never defended Medicare, you lying sack of shit.

        1. You defend whatever spittle comes out of Trump’s weird little mouth, don’t you?

          1. Don’t you have anything to say in defense of Medicaid?

            P.S. Shrike was lying.

            1. P.S. Shrike was lying.

              Agreed. You’re each full of shit, one by lying and the other by ignorance of free markets and individual liberty.

              https://reason.com/archives/201…..nt_6884041

              1. The only person here ignorant of free markets and individual liberty is the retarded asshole arguing that reducing Medicaid will somehow prevent private charities from helping the sick. And hey, that’s you!

                1. (boldface in defense of ELEVENTH assault by the stalking cyber-bully)

                  The only person here ignorant of free markets and individual liberty is the retarded asshole arguing that reducing Medicaid will somehow prevent private charities from helping the sick. And hey, that’s you!

                  Pathetic fucking liar.
                  You dumbass goobers believe that the entire private charity infrastructure will magically spring from the ground. “Just repeal Medicaid” they screech.

                  This is your ELEVENTH pile of bullshit on what I’ve said.

                  In the first assault, I said “shrink the government” and you FUCKING LIED that I’d said “the same size”
                  I said we need to “transition back” to a free market … and you FUCKING SLOBBERED that I would “keep all current regulations. I now jam this link up your sorry ass. Again.

                  https://reason.com/archives/201…..nt_6884068

                  (Can he REALLY be that big a bully, Check the link. Because, raging cyber-bully)

  10. The question is about who pays for the lunch.

    If the cost of medicaid is borne primarily by the federal government, it means that taxpayers in the populous states like New York, California, and Texas pay for the medical care for people in the less populous states.

    If the cost of medicaid is borne primarily by the state governments, it means the less populous states have to cover their own costs.

    Which option is best depends entirely on one’s point-of-view. There are valid arguments for and against both strategies.

    1. Only if your priors are kind of screwed up.

      To have a ‘valid argument for’ either of those you would

      a) Have to believe the state covers costs – they don’t. Taxpayers do.

      b) That its OK to coerce people to cover those costs

      c) That either that coercion is fine if it encompasses the whole country or its fine if its limited on a state by state basis.

      d) If you choose the former you’re still stuck with explaining why people living in LA are on the hook for medical costs of people in Alabama – but not in Liberia.

      e) And you assume that when someone buys something for a second party using funds taken from a third party that that someone will ever bother to try to contain costs or give a shit about quality.

  11. “But remember that fundamental economic proposition. Just as you can’t get something for nothing, you generally can’t get more for less.”

    We actually do get more from less government, and that’s what we’re talking about. There are a number of reasons why we get more from less Medicaid.

    “Last year, total spending for Medicaid amounted to $533 billion. Nearly two-thirds of the funds come from the federal government, and the rest comes from the states.”

    One of the reasons we get more from less government is because that $533 billion every year doesn’t come from the federal government or the states. It comes out of taxpayers’ pockets, their future paychecks, and the profits of the companies they work for.

    Was Reason.com bought out by Salon last night?

    “Under the House plan, the federal savings would amount to $880 billion over a decade.”

    Oh, noes! What will people do with all that consumer discretionary income? What will businesses do with all those profits?

    1. It’s not like they’ll pay less taxes. The federal government will just spend $880 billion on something else.

      1. I shouldn’t support the government spending $880 billion less because they’ll just spend it on something else anyway?

        There will be less pressure to keep taxes where they are or raise them in the future if we spend $880 billion less than expected over the next 10 years.

        We’ve had tax cuts before. We’ll have tax cuts again. Tax cuts are the solution to spending, and the point of not spending money is so that the government will stop taking it away through taxes.

        This really will make the government smaller than it would be. Meanwhile, if and when they try to spend that money on something else, I can oppose that, too.

  12. Anyone else remember when Reason was a libertarian website? #FireChapman

    1. Yeah, but it’s getter to be such a long time now it’s becoming harder and harder to remember.

  13. “Cutting back Medicaid coverage would save taxpayers some cash, but only by taking it from others. The reduction would raise costs for low-income people and most likely degrade their health.”

    Another interesting idea completely destroyed by facts.

    Exhibit A: 16 hospitals in New York City have been forced to close in recent years because Medicaid only pays for a fraction of the cost of care.

    “For . . . patients in financially strapped neighborhoods, the biggest problem with the hospital closures has been the lack of access both to an emergency room and to primary and specialist care. Because Medicaid does not fully reimburse for specialty care, those doctors who are specialists tend to congregate in Downtown Brooklyn and wealthier neighborhoods, and are reluctant to take on Medicaid patients. As more and more patients have lost access to specialists, their underlying health problems have gone from serious to life threatening, putting greater strains on the remaining hospitals to care for them.

    http://tinyurl.com/medhjus

    Crib Notes:

    —Medicaid only reimburses providers for a fraction of the cost of care.

    —Providers make up for the shortfall by gouging private pay patients and insurers.

    —Providers that serve poor populations in poor neighborhoods that don’t feature enough private pay patients to gouge simply disappear.

  14. The fundamental problem Chapman doesn’t even begin to understand is

    A) Medicaid only reimburses providers for a fraction of the cost of care.

    B) Providers make up for the shortfall by gouging private pay patients and insurers.

    C) Rolling back Medicaid eligibility lowers the amount of providers need to gouge insurance companies to make up the shortfall.

    But don’t take my word for it!

    “Mayo reported a sharp increase in the amount of unreimbursed costs related to Medicaid patients, from $321 million in 2012 to $548 million in 2016. The figures include its campuses in Arizona and Florida. Mayo nonetheless remained profitable in 2016, with income of $475 million.”

    “Mayo to give preference to privately insured patients over Medicaid patients”

    http://tinyurl.com/kekwamp

    Notice what they’re saying. They lost $548 million treating Medicaid patients in 2016, but they made up for it by gouging privately insured patients–just like all the other hospitals do.

    1. The difference between the Mayo Clinic and a typical community hospital is that the Mayo Clinic attracts wealthy cash paying patients from all over the country and all over the world–so the Mayo Clinic can charge customers a huge premium to make up for the losses they suffer treating Medicaid patients.

      . . . or at least they could before ObamaCare came into effect in 2014. If you read the linked article, it’s all about how not even the Mayo Clinic–not even the Mayo Clinic!–can afford to take those losses on Medicaid anymore. . . . not since ObamaCare expanded Medicaid eligibility and increased their Medicaid patients population to unsustainable levels.

  15. . . . without inflicting more hardship.

    One thing the article does not explain – how is reducing Medicaid *inflicting* hardship? Its simply reducing a welfare payout. The hardship already exists (someone is poor), the existence of Medicaid (state *charity*) reduces the ‘felt’ magnitude of that hardship but removing it does not increase its actual magnitude.

    And Chapman – are you taking into account the hardships imposed on the people who are having their money forcibly taken to fund this (and other) programs? Maybe reducing Medicaid is a *net reduction* in hardship for society as a whole (since you seem to be taking a collectivist – vice individual liberty – stance here).

  16. Finally, take a look at this chart–especially you, Mr. Chapman!

    http://www.aha.org/research/re…..art4-6.pdf

    The reason private insurance costs so much is because providers gouge insurers to cover the losses they suffer treating Medicaid and Medicare patients.

    Per the chart, private insurers have been gouged close to 150% of the cost of treating insured patients in recent years to make up for the losses those providers suffer treating Medicare and Medicaid patients. But it should be noted that those are averages!

    If an average hospital has 60% Medicare and Medicaid patients, then they have to gouge private insurance for 150% of cost–but Medicaid patients and the poor aren’t evenly distributed around your city much less the country. In community hospitals in poor part of downtown Detroit, South Central Los Angeles, Newark, and Atlanta, they don’t have the national average percentage of Medicaid patients. Medicaid patients may make up 70% or more of their patient population–so the amount they have to gouge private pay patients to break even is much, much higher.

    And I’ve show in other comments, if they can’t find enough private pay patients to gouge–in those poor neighborhoods–they simply disappear.

  17. But it applies as well to measures that extract savings from costly government programs.

    Here you’re basically saying that once an entitlement program is in place we can never remove it because ‘there ain’t no such thing as a free lunch’ and it will impose costs ‘on society’?

    1. The idea that less government necessarily means bad things for taxpayers is patently absurd.

  18. States could always protect the vulnerable by boosting their contribution to make up for the lost federal funds. But that would mean requiring their taxpayers to foot the bill.

    That’s what its *always meant*. That’s how taxes work. Remember, there ain’t any such thing as a free lunch? The only thing that’s changed is who is footing the bill for who now.

    The difference is at least now the people within that state would be paying for each other rather than the people from some states paying for the people in other states.

  19. Cutting back Medicaid coverage would save taxpayers some cash, but only by taking it from others.

    You sure this article wasn’t meant for Salon? Because that’s just an idiotic statement.

    You’re saying that not taking (ie, taxing) from you is the equivalent of giving to you. In fact you’ve gone further and are saying that not taking from you is the same thing as taking from someone else.

    This whole article is collectivist garbage. Its not libertarian, its not even neo-liberal. Its straight up socialist.

  20. . . . and put some out of business

    What are we told? That if you can’t afford to pay a living wage you don’t deserve to be in business?

    Well, there you go.

  21. “…Medicaid coverage, reports the Kaiser Family Foundation, is proven to ensure “earlier detection of health and developmental problems in children, earlier diagnosis of cancer, diabetes, and other chronic conditions in adults, and earlier detection of mental illness in people of all ages.”…”

    Notice we have ‘detection’, not treatment or outcomes
    Of course when you go to see a doctor because you have an “owie” and it’s free, you might be found to have what they might call ‘developmental issues’. What this means as regards the economics of medical care is (hint, hint, nudge, nudge) left to your imagination.
    Anyone using this as part of an argument for additional government involvement in medical care is a disingenuous piece of shit.

    1. Incidentally, that Medicaid even pays for diagnostics like that is only because they were embarrassed into doing so by the HMOs.

      Breast cancer is an excellent example. Back in the ’80s the number crunchers at the HMOs realized that giving away free mammograms more than paid for itself because detecting breast cancer early is the key to avoiding costly treatments later.

      In Medicaid, at the time, you couldn’t run a diagnostic test unless there were specific reasons justifying that test. They wouldn’t pay for a test to screen for something simply because you wanted to test for it.

      The survival rates for things like breast cancer were so much higher at HMOs because of this that it embarrassed Medicaid into reform. At the time, they started saying that Medicaid was racist because it disproportionately served minorities, and breast cancer patients at HMOs had survival rates that were so much higher than Medicaid patients, it was ridiculous.

      That would have been a great time to cut Medicaid eligibility and transfer those patients to HMOs with subsidies like moving public school kids to private schools with vouchers, but noooOOOoooo. They had to make Medicaid more like HMOs.

  22. my state didn’t participate and did we get a thank you from the states that are free riding? nope, just whining for more.

    1. Some ACA Medicaid expansion highlights below:

      http://www.dhcs.ca.gov/dataand…..Afinal.pdf

      “In June 2014, nearly 2 million Medi-Cal eligibles were classified as non-citizens. Individuals classified as non-
      citizens represented 17.4% of Medi-Cal’s total enrollment. Between June 2013 and July 2014, Medi
      -Cal’s non-citizen population increased by over 31%, which mirrored Medi-Cal’s citizen population growth of 35% during
      this time frame. This dramatic increase in enrollment was initiated by the implementation of the Patient Protection and Affordable Care Act on January 1, 2014.”

  23. I can’t help but think, Reason, that if you had actually listened to your base and terminated non-libertarian hacks like Chapman’s contracts you wouldn’t be seeing your clicks and views in freefall.

    1. I’ve explained here how Chapman served a purpose on Cato’s “Byline” (Fairness Doctrine), but here & now he’s useless. We can get this sort of stuff anywhere if we want it, so putting his material here amounts to trolling by the hosts.

      1. What is he wrong about? He lacks a solution, but so does the entire libertarian establishment.
        But he’s correct on the stupidity he called out. Tell me what you disagree with. Specifically.

        Then explain why Americans have ALWAYS been willing to provide — and pay for — health care for the uninsured, regardless of income … through a complex web of charity hospital and diverse charitable funding that evolved since the 1500s.

        So … if libertarians are too fucking stupid to transition back to private charity — “git gubmint out” ain’t gonna do it .. then the people will choose the ONLY ones who CLAIM they can do it. While assholes like Cato and the Pauls say “Let them eat cake.”

        How MASSIVE a failure. that we cannot desribe a better way to provide .,.. what the vast majority of humanity has wanted … and paid for … for 450 years. We REJECT free-market OUTCOMES, by pandering to goobers who are less than 5% of THE PEOPLE. Umm, consent of the governed????

  24. ‘Any economist who tried to deny it would find herself suddenly choking in pain and unable to speak.’ – I’m sorry, to whom is ‘herself’ referring? The turd in Chapman’s pants?

    1. The shit oozing out of your ears — overflowing.

  25. Fiscal prudence has been out of vogue with both parties for decades. We are on a slow boat to financial ruin and there is little either party can do to fix it. Claiming savings as a reason for cutting Medicaid is just nonsense and it would seem that most everybody knows it.

  26. Well, this may not apply to Medicaid, but the article overlooks (as my libertarian friends so often do) that some government spending saves more than it costs, prevents more expenses than it costs. Vaccination, abortion, safety-regulations and inspections of potentially hazard industries like nuclear power and meat-packing.

    1. I don’t remember the Gov’t paying for my vaccinations. I think it was mom and dad.

      And if a thousand people die in Phoenix waiting in line for VA care, we can just ignore it.

      Top administrators got 18 months of paid vacation- and nothing else happened.

      Now we got Los Angeles VA, where another hundred died.

      hazard industries like nuclear power and meat-packing.

      Perhaps they should regulate “organic” vegetables that lead to most e. coli illness.

      Tell me when will Gov’t get it right…

      1. Tell me when will Gov’t get it right…

        When will you?

    2. Intelligent Mr Toad|6.25.17 @ 1:00PM|#
      “Well, this may not apply to Medicaid, but the article overlooks (as my libertarian friends so often do) that some government spending saves more than it costs, prevents more expenses than it costs. Vaccination, abortion, safety-regulations and inspections of potentially hazard industries like nuclear power and meat-packing.”

      First, a statist like you probably has no libertarian “friends”. Secondly, very few of those things are both provided by the government and actually save more than they cost.
      So, let’s just admit you pulled that pile out of your ass and note that you are a lefty liar, shall we?

      1. First, a statist like you probably has no libertarian “friends”.

        How woulld you know what a libertarian is?

        Secondly, very few of those things are both provided by the government and actually save more than they cost.

        That’s not what he said. (snort)

        So, let’s just admit you pulled that pile out of your ass and note that you are a lefty liar, shall we?

        All you EVER have is name-calling … and abject stupidity. … and an authoritarian mentality.

        The uninsured have had an absolute legal right to all the free care they need … in Emergency Rooms … but only since the 1950s. How does the cost of prevention compare with the cost of curing a severe illness?

        Why have Americans ALWAYS been willing to provide free health care to the uninsured, regardless of income.
        Why are you such a disgrace to individual liberty, by denying the OUTCOMES of a free market in health care … or are you too fuckinng stupid to knew what they were .. plus yout authoritarian compulsions. Sad,

    3. “that some government spending saves more than it costs”

      This is undoubtedly true in some areas.

      But if the spending saves more than it costs, then why does it have to be mandated by government? Wouldn’t private actors rationally choose to spend the money as an ounce of prevention, no coercion needed?

      1. Wouldn’t private actors rationally choose to spend the money as an ounce of prevention, no coercion needed?

        They did for centuries, But “git gubmint out” is a fucking stupid way to restore and rebuild the private charity infrastructure.

        Repeal Medicaid tomorrow .. and what replaces it? You may not care, but you’ll NEVER get elected without an answer .. and progressives will keep winning. By default.

    4. Well, the government doesn’t pay for vaccinations or abortions and the meat packing ‘inspections’ are paper drills, not, you know, actual *inspections*.

      And in my experience, every safety regulation that is worth a damn is accompanied by 2 or more that aren’t and just force you to waste money and time.

      In the end though, if this spending ‘saves more than it costs’, then the government can make that case – and provide actual evidence – instead of relying on people saying that maybe, in some cases, sometimes, it does and so we should give them the benefit of the doubt *here*.

  27. All economic forecasts about government spending are inaccurate.
    The issue with the proposed legislation is that it does not repeal the nationalization of both the healthcare industry, and the healthcare insurance industry. Thus the fascists retain control of 18% of the USA economy.
    The second biggest non-considered, ad non-reported as a problem is employee paid health insurance. I would love to see reporting on the number of employees who would more productive in the economy in a different job, but cannot leave due to the insurance handcuffs.
    1. Repeal Obamacare and all of its rules and regulations
    2. Outlaw employer paid health insurance. If they insist,they can contribute to HSAs, but after tax.
    3. Require healthcare providers to charge everyone the same price, and to post those prices by September;
    which have to remain constant for the next calendar year. (yes, this means no discriminatory ‘networks’)
    4. Require health insurance companies to post their policy coverage and prices by November, and charge everyone the same for the same policy. These prices also must remain the same for the next calendar year.
    Now individuals can select the combination of providers and coverage that suit them, not the government or their employer. Men do not have to buy maternity coverage, women do not have to buy prostate coverage.
    After a few years to transition from the fascist system, the requirements on pricing by the year can be reduced, then eliminated.

    1. Require healthcare providers to charge everyone the same price.

      If they offer a $3 million max policy, should a 23 yr old and 56 yr old pay the same price?

      1. Healthcare providers aren’t insurance companies. They don’t sell ‘policies’.

        That’s why there are two sections–

        3. Require healthcare providers

        and

        4. Require health insurance companies

    2. Longtobefree (sic) wants to impose his will by authoritarian means. because he sneers at the notion of electing anybody to change it, thereby shitting on the known outcomes of a free market,

      SEIG HEIL!

  28. Of course, people don’t stop going to the ER because they lack money or insurance, so the cost is socialized no matter how you organize the payments.

    The sick thing is libertarians imagine a “utopia” in which those who can’t afford healthcare simply lie down and die, as supply and demand would have it.

    1. Repeal EMTALA…

      Maybe we will finally have “bodies in the streets”,,,

      Cleaning up dead animals-That’s the job of our “County Engineers” in my state- I’m sure they could go from raccoons and deer to the occaisional humans that drop dead…

    2. “Of course, people don’t stop going to the ER because they lack money or insurance, so the cost is socialized no matter how you organize the payments.”

      Sounds like mission accomplished, yet, the bitching continues. Weird: we have socialized medicine, yet it’s not the most efficient system ever invented. How expected and predictable.

      I just think people should have as much of a personal stake in their own medical care and costs as possible, which rules single payer right out. I know it’s not as popular as Oprah-level thinking.

      That’s probably why I don’t get invited to all the bestest A-lister parties to be had in Tulsa, like all the other chattering democrats who live there.

    3. “Of course, people don’t stop going to the ER because they lack money or insurance, so the cost is socialized no matter how you organize the payments.”

      There are the stats of what percentage of hospital admissions are never recovered for failure to pay by people who can’t do so (“uncompensated care” in the chart linked below)

      1980: 5.1%

      2000: 6.0%

      2014: 5.3%

      http://www.aha.org/research/re…..art4-5.pdf

      2014 was the year ObamaCare opened the floodgates and let all those new people onto Medicaid. Uncompensated care is pretty much the same as it always was–even when Medicaid eligibility was much lower.

      In fact, the percent of national hospital costs born by Medicaid has almost double since 1980–but the percentage of unpaid hospital bills has actually grown by two-tenths of one percent over that time period.

      Again, Tony’s ideas are completely unhinged from anything like real world observations or facts.

      1. Ken, ever the dumbfuck, does not know that the uninsured rates for Medicaid eligibles were higher than for private eligibles — 18.8%-16.3% because Medicaid pays so little and so many doctors refuse it.

        That was BEFORE Obamacare significantly increased the eligibles …. but no increase in doctors.

        Again, Tony’s ideas are completely unhinged from anything like real world observations or facts.

        Among the things you don’t know, blowhard, is the Obamacare hustle. Enrollment is Medicaid is automatic, for ANYONE who gets free ER treatment within Medicaid eligibility limits … which means THEY STILL HAVE NO DOCTOR! So you’ve been snookered again by bullshit.

        It’s a challenge to me, who is the most eager to be brainwashed by their own ignorance. You or Tony.

    4. The uncompensated medical care rationale for socialized medicine is pretty weak. An unpaid hospital bill is just like any other unpaid bill. Does having an unpaid electricity bill mandate socialized electricity generation? Does having an unpaid car payment mandate socialized auto production? No and no.

      Of course one could argue that one may choose to go without a car, or even electricity, and still function reasonably well, and thus forego those costs, but one cannot forego medical care and its associated costs. Well, one cannot forego the cost of food either. Does that mean food production should be socialized? Of course not.

      The unpaid hospital bill is a pretty weak argument in favor of socialized health care, when you get right down to it.

      1. Nobody actually makes that argument.
        If you didn’t have a car, would you die?

        The vast majority of Americans don’t give a fuck what you think, since they’ve always been willing to pay for universal treatment — voluntarily, right up until Medicaid. Who are you to ignore the outcomes of a free market … and will of the people .., and consent of the governed?

        1. Sorry, who was *voluntarily* paying for universal healthcare in the US up until Medicaid?

    5. Yeah, or private charities could pay for it as they have throughout history.

      That utopia you described sounds pretty cool. Will there be a popcorn stand?

      The sickest thing about liberals is that you can’t see how seethingly cynical you all are.

  29. “Cutting back Medicaid coverage would save taxpayers some cash, but only by taking it from others. The reduction would raise costs for low-income people and most likely degrade their health.”
    Huh? Taxpayers save cash by taking it back from someone who took it from them? And I’m supposed to be alarmed?There is no shame in being poor. I’ve been there and done that. But what Mr. Chapman and his fellow welfare statists always ignore, is that human beings react to economic incentives. Poverty is not a life sentence unless you find it preferable to busting your ass to enter the middle class or beyond. If you get free food, housing and healthcare the tradeoff is obviously worth it to a significant portion of the population to remain poor.

    1. I’ve been a Reason reader for decades going back to when there was no online magazine or online at at all. I’d await my glossy magazine, put it on the toilet tank, and be done by the next month’s edition. I’d have to scratch my head at Virginia’s promises that technology would make everyone on the planet rich and work would be an anachronism in the near future, but I always found the publication an interesting alternative to whatever paper I might pick up. This article is straightforward statist crap. Do the editors not read this shit? What exactly is the criteria for publication in Reason? Free markets and free minds? Chapman fails both tests.

      1. What exactly is the criteria for publication in Reason? Free markets and free minds?

        Why do you shit on the OUTCOME of “free markets and free minds” — which provided free treatment to the uninsured, regardless of income? And who are you to defy the freely expressed will of the people, when we were allowed to do so, right up until Medicaid?

  30. The ones who are doing the taking are the people who take the subsidies, not the other way around.

  31. Well, I am trying to be fair-minded with this article.

    I think Chapman is saying that if the Medicaid cuts actually go through, it doesn’t mean that the total cost of health care would *necessarily* go down – all else being equal – it’s just that other people would end up picking up the tab. Which I think is a fairly unconventional conclusion. But it should be noted that those people who would end up picking up the tab would be doing so from a more voluntary premise. Probably not 100% voluntary, because there would still be laws like EMTALA and the like, but more so. But the general idea, that the costs borne by individuals are those that are voluntarily accepted rather than coercively extorted, is to be celebrated, not condemned.

    I also don’t fault people like Chapman for being concerned with what happens to the health care of those at the margins in society, if Medicaid does get cut. Personally I have never thought that libertarianism means cold-hearted disregard for the welfare of others. But the solution is to promote private, voluntary associations that provide health care, not to continue a redistributionist government program because it is the status quo. It is easy to raise one’s fist in anger at the coercive government, but it is much harder to seek out and do the heavy lifting for those voluntary associations that would inevitably take the place of the coercive government program.

    1. I think this is one thing that could separate libertarians from both the left and the right.

      The left generally believes that everyone deserves health care, and that the government via force and coercion ought to be the institution to provide it. Their premise is right, but their proposed solution is wrong.

      The right generally believes – well I don’t know what they honestly believe anymore when it comes to health care. I USED to think that the right also generally accepted that everyone deserves health care, just that it should be provided by markets not the government, much like libertarians believe, but I don’t think that is true anymore. Look at the current bills under consideration after all. I think perhaps a better way to frame the right’s current beliefs is that only “deserving” people should get health care as an entitlement provided by the state, and that everyone else – the “moochers” – should be left to fend for themselves. So they agree with the left that the government ought to provide health care, just that they don’t want to provide it to everyone. So they are wrong both in their premise and in their solution.

      Libertarians can be the ones to offer the non-coercive alternative – everyone deserves health care, but that deservedness does not come with an expectation of coercion by the state. Voluntarism works every time over coercion even with health care.

      1. everyone deserves health care

        I “deserve” a Lamborghini- tell me my delivery date.

        1. But “deserving health care” doesn’t necessarily imply “health care should be coercively supplied to you”. That is the difference.

          1. What DOES it imply?

            And if it implies nothing that has any obvious public policy implications, what’s the point of claiming it?

            1. In the big picture, I think it implies a moral duty to help other people.

              Even Ayn Rand believed in charity, as long as people didn’t fool themselves into labeling it some altruistic act – it’s ultimately a selfish act.

              It is more about how we frame the message rather than the particular public policy involved. When we talk about tearing down the edifice of statism, we should also talk about what would replace it. Talking about tearing down Medicaid is great. We are all on board with that (well, everyone maybe except Chapman). Talking about a post-Medicaid future is tougher but we should do that as well. If we don’t do the latter, then a lot of people who believe the government’s spin that “Medicaid is the only thing saving poor people from certain death” won’t be convinced with getting rid of it, even if they don’t particularly like how Medicaid is run. Take the DMV as an example – virtually no one actually likes the DMV, but if you told people that the only alternative to the DMV is “LAWLESS CHAOS IN THE STREETS” then they would probably begrudgingly vote to continue the DMV. It’s the same deal here.

              Personally I would love to see more discussion about how HSA’s could be used as a vehicle for near-universal health insurance coverage in one form or another, because I tend to really like the HSA concept.

              1. It is more about how we frame the message rather than the particular public policy involved.

                You haven’t actually specified any message at all. If you want to preach about other people’s moral duty, go to church.

                If you can’t articulate any particular policy out of your claimed moral obligation, its just empty rhetoric.

                1. Of course morality transcends religion.

                  I do not think a moral obligation to help people should necessarily lead to a coercive public policy of forcing others to help people. I do think that we should frame our message in a way that says replacing the coercive welfare state with voluntary associations and solutions that help people is fully compatible with a broader moral duty to help people, with the added benefit that it doesn’t involve sticking a gun in anyone’s face and robbing them. But just talking about getting rid of the welfare state, that doesn’t send the same type of message.

              2. ” I think it implies a moral duty to help other people.”

                Then, as a libertarian, you should act to meet that duty. If you don’t you are not being moral.

                Compelling others, either personally or governmentally, does nothing to help you meet your moral obligation to ‘help other people.’ That you might also be forcing people to do something against their own wishes does not reflect well on you libertarianism either.

                1. Then, as a libertarian, you should act to meet that duty. If you don’t you are not being moral.

                  Umm, what does being libertarian have to do with that????

                  Compelling others, either personally or governmentally, does nothing to help you meet your moral obligation to ‘help other people.’ That you might also be forcing people to do something against their own wishes does not reflect well on you libertarianism either.

                  The moral means chosen — which shows your ignorance of core libertarian principle. And getting all preachy on something he explicitly disavowed says “self-righteous”

              3. Personally I would love to see more discussion about how HSA’s could be used as a vehicle for near-universal health insurance coverage in one form or another, because I tend to really like the HSA concept.

                It’s fascist, mandating something that so ,many people refuse ti choose where they have an option. That’s for employee coverage, which is the only replace it could even apply. And it retains the mandate for employer-provided coverage.

                It’s even crazier, when ant-gubmint goobers propose it to replace the government safety net. I mean, how fucking stupid is it to tell a vedy poor person, “Sorry to hear you have cancer. Simply pay for the firts $6,000 of treatment and the rest will be covered.” (That’s also why so few choose it as an employer option)

      2. “Their premise is right…”

        No. Their premise is (at best) faulty. Or worse it is ignorant, even worse it is shamefully dishonest.

        de?serve
        [d??z?rv]
        VERB
        do something or have or show qualities worthy of (reward or punishment):
        “the referee deserves a pat on the back for his bravery” ?

        Health care does not exist absent the effort of others. Nobody deserves anything they have not in some manner earned.

        1. Health care does not exist absent the effort of others. Nobody deserves anything they have not in some manner earned.

          (yawn) Slogans and soundbites, totally devoid of common sense.
          450 years of private charity proves you wrong. There’s a difference between deserving and being entitled.
          This is why progressives keep kicking our ass,

      3. The left generally believes that everyone deserves health care

        Hey, Sparky, that’s true for the vast majority of Americans … who paid for it voluntarily, when they were still allowed to. Also true for most of humanity, since the 1500s.

        Voluntarism works every time over coercion even with health care.

        So why does the entire libertarian establishment have NO CLUE how to restore that? A flock of goobers, all chanting in unison, “git gummint out” ain’t never gonna elect a majority in Congress … or the Presidency.

        Do you understand our Constitution?

    2. Personally I have never thought that libertarianism means cold-hearted disregard for the welfare of others.

      How much did you donate last year? I’ll bet you just let the Gov’t take care of it.

      1. I actually do donate to various causes of my choice. How much did you? But these types of ad hominem arguments are generally preposterous anyway.

        1. But these types of ad hominem arguments are generally preposterous anyway.

          His ilk now dominates the libertarian movement — anti-government replacing pro-liberty. In Eric Hoffer’s seminal book, “The True Believers,” he shows how all “mass movements” are eventually dominated by zealots and fanatics. The militant self-righteous.

          Mass movements do not need a god, but they do need a devil. Hatred unifies the True Believers.”
          -Eric Hoffer, “The True Believers” (1951)

          Throughout human history, the worst moral atrocities have been committed by those manipulated to BELIEVE they are defending some “greater good” — the Collective, the State, the Master Race, the Party or a God. Zealots and fanatics. The militant self-righteous.
          -Mike Hihn (1994)

          Over 60% of the electorate self-describe as holding libertarian values, fiscally conservative and socially liberal … by a staggering 91% of them REJECT the libertarian label, per Cato.

          That means libertarian values hate the current libertarian ideology (which is valueless) The goobers have destroyed our movement, also per Cato.

      2. How much did you donate last year? I’ll bet you just let the Gov’t take care of it.

        How much would he donate if he controlled the dollars taken from him government?
        You might want to learn about libertarianism. Versus just being smug and making wacky assumptions.

  32. I can’t believe Chapman just made the preposterous claim’ there’s no free lunch’ is some kind of made up axiom.

    Makes me wonder why his articles are published at what’s supposed to be a libertarian (classical liberal) publication. He’s closer in line with progressives with this illogical nonsense.

    “Nearly two-thirds of the funds come from the federal government, and the rest comes from the states.”

    That’s a fancy way of saying 100% from taxpayers.

    1. I can’t believe Chapman just made the preposterous claim’ there’s no free lunch’ is some kind of made up axiom.>

      I can’t believe you said that. In public.

  33. I realize that libertarianism isn’t a lock step ideology but there is not a single libertarian idea in this article. Why is Reason publishing this?

    1. I’m hoping that someone like Soros gave them a big bag of money because I’d hate to think they publish stuff like this for no reason at all.

    2. Chapman’s ass’n w libertarian outlets goes back 40 yrs. to when he was among rotating “Byline” (“liberal, conservative, & libertarian” but with an overall libertarian slant) radio commentors for Cato. But that was when:

      (1) The Fairness Doctrine was still in effect, & they needed balance so the program wasn’t conspicuously ideologic overall.
      (2) Cato was trying to sneak libertarianism in in disguise via Inquiry magazine.
      (3) They weren’t running all his columns, but picking for commentary bits where libertarians could agree on the narrow issue.
      (4) It was a time when even the libertarian-ish was hard to come by in the media. “Conservative” voices were relatively common, but there was a desire to distance the libertarian brand from that sector.

      Of course that was when Reason & Cato were competitors, but people went back & forth. Exactly how that resulted in Chapman’s columns getting into HyR now I don’t know, but I can only suspect someone made a hasty decision to fill out content here with a familiar-somehow originator they really had no memory or knowledge of. Chapman doesn’t seem even mildly more libertarian than the avg. person now.

      1. That’s name-calling. What is he wrong about? And why would you defy the overwhelming majority of Americans … as expressed by them when we had a free market in healthcare? And most of humanity for only the past 450 years?

  34. For starters, taking my own advice, here is an article on HSA’s as a vehicle for universal health insurance coverage.

    http://dailycaller.com/2017/02…..ax-credit/

    1. FUCKING STUPID. Mandates HSA’s for everyone, goddamn statists.
      Suckers the goobers by saying the same high-deductibles for people WITHOUT employer coverage (or employer cash DUH).

      We look like total assholes — and are — when we tell people, “I’m sorry you were diagnosed with cancer. Your insurance kicks in after you spend the first $6,000.”

  35. Chapman should have told Rhode Island that it was impossible for them to spend less money and get better patient outcomes. Because they fucking did. Stupid fucking asshole.

    1. Stupid fucking asshole.

      Stupid fucking statist wants to KEEP MEDICAID!!!

      Attacks me TWELVE TIMES saying it’s ME who wants to save Medicaid … every time a fucking lie … repeating the same fuckup. Starting here

      https://reason.com/archives/201…..nt_6884068

      I said “shrink the government” and he FUCKING LIED that I’d said “the same size”
      I said we need to “transition back” to a free market … and he FUCKING SLOBBERED that I would “keep all current regulations.”:

      For total raving lunacy, the psycho said EVERYONE wants to restore private charity .., except ME! Here:
      https://reason.com/archives/201…..nt_6884063

      Now he says MANAGE MEDICAID BETTER! WTF

      Check the link. Because cyber-bullies B attack dogs.

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  37. Cutting back Medicaid coverage would save taxpayers some cash, but only by taking it from others.

    It’s pretty gross to see Reason run this.

    Reason editors, I await your apology.

    1. Pull your head out of your ass, goober.

  38. HIIIIIIIIIIIIIHHHHHHHHNNNNNNNNNNFECTION

  39. Had to check to make sure I was on reason.com just now. What the fuck is this horse shit? Do you guys want my money or not? Have you been infiltrated? Blink twice if you need help.

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