Forget Trump. The 2018 Midterm Election Is a Fight About Obamacare's Pre-Existing Conditions Rules

Turns out voters like the Democratic health law...when it's run by Republicans.


Ralf Hirschberger/dpa/picture-alliance/Newscom

On the surface, the run-up to the 2018 midterms looks a lot like a circus, with Donald Trump as the ringmaster.

From the furors over Michael Avenatti and Stormy Daniels, to bizarre controversies over dehumanizing internet memes, to silly debates about Elizabeth Warren's DNA, to the tiffs between Melania Trump and rapper T.I. or Ben Sasse and Sean Hannity, to the latest round of foreign policy horrors, to most every word uttered or tweeted by Trump himself, the news, for those who keep up, often resembles a particularly anarchic variety show, in which every performer looks determined to make a fool of himself. Viewed this way, politics in 2018 resembles most everything else in 2018: weird, bad, and Extremely Online.

But outside of Twitter and cable news chyrons, the midterm itself looks a lot more conventional, a contest about classic kitchen table issues, especially health care, and protections for pre-existing conditions in particular. And in this fight, you can see the shape of health policy debates for years to come.

Although Democrats have been running health care-focused ads all year, the pre-existing conditions argument came to the fore with the nomination of Brett Kavanaugh to the Supreme Court. Prior to the sexual assault allegations against him, one of the most frequent attacks against Kavanaugh was that he would provide a fifth vote to overturn Obamacare's pre-existing conditions rules, should a lawsuit by conservative state attorneys general reach the High Court.

This was an implausible argument for a variety of reasons—the case is weak, Kavanaugh authored an opinion that offered a legal rationale for upholding the regulations, and even if he did vote against the health law, there would probably still be five votes to keep it in place. But it offered an early preview of the Democrats' midterm election strategy, which is focused on making the case that Republicans wouldn't maintain legal protections for people who are or have been sick.

You can see that argument play out, among other places, in Arizona, where Republican Senate candidate Martha McSally has fended off attacks from her Democratic opponent, Kyrsten Sinema, that she doesn't support protections for people with pre-existing conditions. "That's a lie," she told a questioner at a campaign event recently. Instead, McSally has argued that she favors keeping those rules in place.

"I voted to protect people with pre-existing conditions," McSally said during a debate this week. "We cannot go back to where we were before Obamacare, where people were one diagnosis away from going bankrupt, because they could not get access to health care." Republicans in a number of races have begun to run ads insisting that they favor pre-existing conditions rules; in Texas, GOP Sen. Ted Cruz closed out a debate with Beto O'Rourke by saying that he wants to preserve those rules.

Liberal pundits have argued that Republicans health care promises are misleading, if not outright lies. I wouldn't go quite that far, but it's fair to say that much of what Republicans have said about pre-existing conditions this year is designed to obscure rather than illuminate.

McSally did, for example, vote to preserve some of Obamacare's pre-existing conditions rules, but only as part of a bill that would have repealed and rewritten the health law (hence the argument that the replacement plan was Obamacare-lite), provided less funding for coverage, and allowed insurers to charge sick people more than under existing law. Other Republicans have pointed to their support for legislation that would have required insurers to cover people with pre-existing conditions—but would allow insurers to decline to cover care related to the conditions themselves.

One can perhaps justify these positions on the merits, as attempts to strike a balance between protections for the sick and the actuarial realities of offering similarly priced coverage to everyone, regardless of health status. And it would certainly be possible to make an explicit case that the health law's pre-existing conditions rules are among the primary drivers of health insurance costs.

But that is not, for the most part, what Republicans are doing. Instead, they are pretending to support Obamacare's regulations as they exist under Obamacare. They are saying that Obamacare got it right.

You can understand why Republicans might choose to obfuscate.
Voters trust Democrats more on health care, Obamacare has become more popular since Republicans tried and failed to repeal it last year, and the pre-existing conditions regulations almost always poll well. The presence of Obamacare has altered the politics around pre-existing conditions rules.

But even here the story is more complex: Yes, surveys that ask about standalone support for pre-existing conditions show that they are popular, but polls that ask respondents to consider the costs of those rules show the opposite. Yes, Obamacare has become more popular under Trump (moreso than the GOP tax law), but the rise in popularity has occurred as Republicans have made a series of changes to the program that Democrats charged amounted to a policy of coordinated sabotage—cutting promotional funding, allowing for cheaper insurance subject to fewer regulations, ending a line of insurance subsidies a court had ruled illegal, and zeroing out the individual mandate penalty.

Yet the charge of "sabotage" has become harder to sustain as the results of GOP changes have become clear. Under Trump, enrollment in Obamacare's insurance exchanges has fallen only slightly, the overall uninsured rate has stayed basically the same, and after years of steady hikes, health care premiums have leveled off or even fallen in some states, while insurers who fled the exchanges are returning. Yes, it's early, and all of this could change. But what this offers right now is a potential explanation for why the health law's popularity has increased.

What the polling suggests, then, is that the public prefers the version of Obamacare we have now, with stable rates and insurer participation, along with access to a wider variety of plans. The popular version of Obamacare is the one remodeled, but not repealed, by Republicans.

But that, of course, is an argument that neither party is willing to make, at least at the moment. So instead we are witnessing a strange sort of argument, in which Democrats pretend that Republicans have undermined Obamacare, even as the results suggest that little if any serious damage has been done so far, while Republicans pretend they support the law's pre-existing conditions regulations as they exist today, even as the policies they favor would change them.

The odd shape of this debate is a result of both Obamacare's flaws, which were visible throughout the Obama administration, as well as its relative stability, in which it has stubbornly refused to collapse under its own weight. It is also a product of the natural dynamic between the two parties when it comes to health policy, in which activist Democrats press for greater government involvement, while Republicans, despite some reformist gestures, back roughly the status quo. And it points toward the equilibrium that is likely to come, in which Republicans end up defending something like Obamacare, while Democrats end up pressing for something like single-payer.

This would be a notable shift from the health policy arguments that have defined the last decade, but it would also mark yet another way in which, even amidst the freakshow weirdness of the Trump era, American politics has retained a core of conventionality: For anyone who prefers an alternative that would reduce and restructure government involvement in health care, it leaves much to be desired.

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  1. Amazing! Turns out people like free shit. Who’da thunk it? Buying insurance for pre-existing conditions isn’t insurance, it’s getting somebody else to pay your medical bills. And who doesn’t like somebody else paying their bills?

    1. You know who else was somebody else?

      1. Herbert “I Led Three Lives” Philbrick?

    2. “Preexisting conditions” was used as business fraud. You pay for a service. You need the service. They kick you off the service so you can come back with that condition excluded.
      It is BS anyone who claims to be a libertarian supports that kind of scam. That is not freedom, that is a corporatocracy, but many who claim to be libertarian do confuse the two.

      1. ^^Upvote

      2. What “service?” It’s health insurance, originally used to mitigate a catastrophic health event. Before Obamacare, The phrase “pre-existing condition” developed because people lied about their health history so that their insurance rates would be cheaper – thereby undercutting the ability of insurers to assess their risk in covering people’s health expenses.

        Under Obamacare, now you can’t even exclude conditions that you will NEVER have.

  2. This law is an abomination and that everyone was right about, the republicans about how terrible it would be and the democrats who realized once they passed it it wouldn’t ever go away no matter what was in it.

    1. …and what was not yet in it. Recall that Obama himself postponed major unattractive components in order to child Democrats from accountability until after elections, and some after he left office. In effect, it never became Obamacare as written. Only a half-ass bill.

  3. Elect Rufus and his gas lighter.

    My role here is to settle this issue like Newman did with the bike for Elaine and Kramer.

    I promise once elected I will find that damn book that had to be passed in order to see what’s in it (and it sounds like nobody still knows because who’s gonna read 2400 pages of bureaucratize, amirite?) and burn it.

    Then I will resign and leave office because I’m Canadian. But it sounds like it will take a Canadian to put an end to such a stupid and odious law that does nothing but divide people and aliens alike.

    1. I think they made copies.

      1. That’s a lot of….money at .09 cents a copy.

        1. You are gonna need a permit for that bonfire.

          1. And the carbon release will give Sullum a sad.

    2. Rufus, you can’t burn it, you’re *Canadian*. You’ll melt if you get too warm.

  4. Voters trust Democrats more on health care,

    hence the victory of Hillary Clinton in 2016.

    1. They didn’t like her health care back in 1992.

    2. She won by 3 million votes, despite a biased media, the Comey letter, and Russian hacking helping Drumpf.


      1. Well if she won she’s dressing weird because she looks just like Donald Trump.

      2. Sounds like she should be President of California, lol

        1. The Empress Hag.

      3. She did not ‘win’ by 3 million votes, as the total vote count has no bearing whatsoever on who wins the presidential election.


      4. She didn’t win anything, the media was biased IN HER FAVOR, Comey let her off for obvious violations of multiple laws and her campaign was the one that colluded with the Russians to have 0blama spy on Trump to try to defeat him.
        Epic fail!


  5. Guaranteed issue and community rating are going to bankrupt the nation.

    But the people want it, and they’re massively innumerate, so they’ll get it, good and hard.

    1. Those two things transform insurance into an expensive finance plan for future payments, gee I wonder why those things make healthcare more expensive? Derp!

    2. There are many other developed nations that have guaranteed issue and they spend less per capita on health care than the USA – and cover all their citizens. Not all of those countries have “socialized” medicine. Switzerland is a good example. I’m not suggesting we can wave a magic wand and adopt Switzerland’s approach (which happens to be highly regulated, but is more free market that our fucked up system). I just don’t buy the argument that we cannot afford to cover everybody. The recent criticism about Bernie’s plan cost $33 trillion over the next decade is silly. Our current spending is already on track to spend that much in the next decade – it will just be spread around employer-provided health insurance, Medicare, Medicaid, and the individual health insurance markets.

  6. How surprising that many voters like the idea in isolation that they can force the insurance companies to make wagers with them that the voters have already “won”, but they don’t like what the economic consequences of such a policy actually are. There is some difficulty conceptualizing that eating the cake means not having it.

  7. There is no way to feasibly maintain a requirement that insurers cover pre-existing conditions at no additional cost and have insurers remain viable without a universal mandate. Anybody arguing otherwise is ignorant about economics. The biggest failure of Democrats during the Obamacare debate was their refusal to be honest with the American people and say, “OK, you want to require a pre-existing conditions rule for insurers, then we need a universal mandate, which means that those of you without such conditions will have to chip in to pay the health care costs of those who do have these conditions.” This was exacerbated by their lack of political courage to; (1) put real teeth into the penalty; (2) not have the penalty take effect for several years after the law took effect; and (3) failure to enforce the penalty once the penalty kicked in. I don’t fault the Republicans for repealing the penalty because of the Democrats dishonesty on the subject, but the repeal was not conducive to the long term viability of the program. For those of you who say we should have a universal, state run healthcare system like they do in Europe (i.e. Democrats), then you have to be willing to tax like Europe, but again, I don’t think the Democrats are willing to propose the enormous middle, and even lower, class tax hike that would be required to sustain this system. Without the willingness to do any of the above, put the dream of universal health care out of your minds.

    1. There is also the problem of the federal government having legitimate authority to coerce the entire citizenry into buying health insurance. As well, as trying to get around the issue of due process in enforcing that requirement, which was why the punishment could be a fine or a tax, depending on how you looked at it.

      1. Well yeah, of course there’s that too.

      2. Do you think the Obama administration knew ahead of time that Roberts would feel obligated to find an alternate and constitutionally acceptable argument before striking down the law? Had they felt the need to make it explicit in oral arguments or specifically label the penalty as a “tax” in the statute itself, it would have been easier for Republicans to attack in the court of public opinion as the law was being debated, because they could rightly claim that Obama and congressional democrats were passing an extremely regressive tax. Or perhaps Roberts’ reasoning was pure dumb luck on their part.

        If there’s one thing from that ruling that I’m thankful for, it’s that SCOTUS finally actually found limits on Commerce Clause power claims, even if it wasn’t in the act of striking down a statute.

        1. That argument that the penalty was a tax was floated by the Democrats, though it was not used in the court cases. Making the IRS responsible for administering the penalty was to avoid due process considerations for imposing a regular fine.

        2. Harry Reid changed the mandate from an explicit excise tax to a penalty om November, 2009, just before introducing it in the Senate. I assume his reasons was exactly the one you describe, and it almost bit him in the ass.

    2. “”I don’t think the Democrats are willing to propose the enormous middle, and even lower, class tax hike that would be required to sustain this system. Without the willingness to do any of the above, put the dream of universal health care out of your minds.””

      Yeah. That does become the problem. NYS passes universal health care in the lower house. It’s been DOA ever since because they can’t come up with a way to pay for it, and get re-elected.

    3. Not to mention all the exemptions.

    4. I think a lot of it was anger at the stories of the insurance companies dropping people for “pre-existing conditions” when they found out they had cancer or had a heart attack or something. Being honest, only the most aspy of us wouldn’t be ticked off reading some of those stories.

      But that’s a totally different problem from someone with diabetes or high blood pressure having to pay more in premiums because they have a chronic condition that requires treatment and observation.

      1. Most of the stories you mention ended up being someone lying about their health on applications

    5. “OK, you want to require a pre-existing conditions rule for insurers, then we need a universal mandate, which means that those of you without such conditions will have to chip in to pay the health care costs of those who do have these conditions.”

      From Obamacare’s winners and losers in Bay Area

      “Of course, I want people to have health care,” Vinson said. “I just didn’t realize I would be the one who was going to pay for it personally.”

    6. The only way out of the pre existing condition issue is to make it easier for charitable organizations to provide some amount of subsidy. But at the end of the day, people with pre existing conditions will have to pay more.

  8. This is an interesting article by Suderman. Better than his usual writing. It’s not remotely Libertarian, of course. But it’s as close as he ever comes to a Libertarian point of view I guess.

  9. Under our current system, there is no way to have rule forcing insurers to cover pre-existing conditions without a real and effective universal mandate. Anyone who believes otherwise is economically ignorant.

    1. Ditto. Forced to cover pre-existing conditions, insurers will go bankrupt unless everyone – at birth – is forced to buy their insurance. Imagine if home insurance or car insurance had to be issued after the fire or accident.

      1. that’s the idea. prove that the market can’t handle health care. pave the way for single payer

        1. Yeah, but they’ll never be able to pass the middle and lower income tax increases to support that, and the leftists will never understand that.

          1. You say that like it could even work, when the historical data regarding revenue as a percentage of GDP says otherwise.

            Increase the tax rates too much and all you’ll do is shrink the economy. There is simply no way to generate the revenue necessary to cover that sort of expense. Never mind that we cannot ever hope to generate the revenue necessary to cover our existing entitlement programs.

            The Europeans ‘succeed’ at what they do because their success leaves the vast majority there substantially poorer than us.

            1. The historical data is based on the simple fact that we have always relied on a very narrow tax base and an extremely progressive system of taxation. If we broadened the tax base (leftists freak out when you tell them what “broaden the tax base” really means) we could increase revenues substantially, but it would never sell politically. Leftists really don’t realize how much poorer Europeans are than Americans.

        2. Yeah, but they’ll never be able to pass the middle and lower income tax increases to support that, and the leftists will never understand that.

      2. Or we can lay for it by organ harvesting large numbers of progtards. Preferably the ones with pre-existing conditions.

      3. I agree with your statement but I think we can all agree that auto and home insurance is a little different than someone’s health. Government has their hand to deep in the cookie jar at this point and will take a machete to fix it outright. We need to be a little sympathetic to those Americans with sever health problems that are beyond their control because guess what, one day anyone of us could be in their shoes. Just an honest opinion!

        1. Sympathy is only for private charitable organizations that someone else donates to.

          1. “Sympathy is only for private charitable organizations that someone else donates to.”


            Government cannot sympathize with anyone or anything. Encouraging government to act as if it had sympathy and you invite government involvement in all sorts of other personal interests and lifestyle choices.

            Foreseeable consequences are not unintended consequences.

  10. This isn’t really news. We’ve known for close to a decade now that when you talk to voters (regardless of political alignment) about the actual content of the ACA, that they like it.

    And that’s why they didn’t ever repeal it, because the only thing that was consistently unpopular was the name they’d given it (“Obamacare”). It’s almost like the whole thing was just a political stunt that they strung out for close to a decade or something.

    1. Please, escher, tell us more about the content. Don’t leave anything out.

    2. The individual mandate was exceptionally unpopular, but good talking point

    3. The individual mandate was exceptionally unpopular, but good talking point

    4. The individual mandate was exceptionally unpopular, but good talking point

      1. Aw, nuts

        1. impressive

        2. I had the same problem with this thread. See above.

    5. “”about the actual content of the ACA, that they like it.”‘

      I don’t think many know. The mandate wasn’t popular when you tell them the IRS could end up keeping that tax return check you’ve been counting on.

    6. When you ask people about the benefits but not address the cost, they like it. It’s like asking someone if they want a new car and then implying we should now buy everyone a new car. Any questionnaire that addressed costs dropped the numbers a ton.

  11. Turns out voters like socialized medicine as much as Suderman (a lot)

  12. Few people understand what insurers mean by “pre-existing condition.” It is absolutely not buying a policy to cover cancer treatments the day after the doc shows you the bad test results. Before Obamacare, insurers routinely denied coverage even after collecting premiums for years when someone got sick, claiming that the illness was the result of some other condition which they said the insured failed to disclose. My doctor had a patient who’s insurer denied coverage for her chemotherapy for breast cancer based on the fact that she once had a C-section. One of the Obamacare witnesses in the Congressional hearings was denied coverage for cancer treatment because she failed to disclose that she had acne as a teenager. Without this provision, insurers will collect premiums for years only to cancel the policy at the moment of the first claim.

    1. Clearly more regulation should solve the problem

      1. Sure.

        Regulate “health insurance” into a grave, sent up HSA (or equivalent) for every American, and require all doctors to give a bounded estimate before all services.

        The single biggest reason healthcare costs are exploding like they have been for decades is because our system is full of so much obfuscation and misdirection that the Free Market (which works best with fully informed consumers) cannot function.

        For obvious reasons, this is not what anyone is going to go for. But it would probably work.

        1. It’s crazy that you think we have had a free market in healthcare at any time in the last sixty years.

          1. “Man the free market totes sucks. Just look at how high prices have gotten at colleges. Damn free market or something”

            – “Suderman libertarians”

          2. To quote myself:

            [?] the [healthcare] Free Market cannot function.

            1. How do you know it can’t function when the ‘market’ is mostly non-transparent government distortion? It never recovered from government wage caps.

            2. “To quote myself:\
              [?] the [healthcare] Free Market cannot function.”

              Bullshit assertions are no arguments.

            3. Except for it works great for many industries like dental and optometry.

              1. Fairly true. Although I think this is a place where responsible state legislators should seek to hold the line, and establish some sanity in the mind of the public.

                I have no problem with organizations that sell dental or optometric ‘plans.’ Just don’t call them insurance. Because they are not insurance (not in the actuarial sense.) They are – at best – negotiated group rates and deferred payment plans.

                Which is fine insofar as they give people a mechanism for controlling costs and saving for expected expenses.

                States need to come down like a ton of bricks on anyone who tries to sell these plans as ‘insurance.’ Because that’s largely a fraud.

    2. No Karen, it’s both.

    3. Your post is what is known in common circles as “Bullshit”. As in, 100% false.
      Your anecdotes are false. Even if they were true, the patients could have (successfully) sued their insurance companies with only the most trivial effort. It wouldn’t even require the patient to spend their own money; just reporting to the state government would have resulted in action because the behavior you say supposedly occurred would be ILLEGAL, even before the PPACA.

      The “Pre-existing conditions” part of the PPACA is exactly what you claim it isn’t: The ability of insurers to adjust rates or deny coverage based on medical conditions that the patient is known to have when applying for coverage.

      And pre-existing conditions themselves are just a known cost increase to an insurer. If you are known to need $1000 a month in medicine, then the insurer MUST charge you at least $1,000 per month in premiums. Charging less isn’t insurance anymore; it’s just charity.
      If the known increase cost is greater than any practical increased premium could be – such as the patient in Iowa that costs more than $1 million per month – then the insurer denies coverage. If it cannot deny coverage… it shuts down. Just like in Iowa.

  13. Next month marks the most important midterm election of my lifetime. We currently have a white nationalist, mentally unstable Russian intelligence asset (possibly dating back to 1987) in the White House. He has already been able to rush through two Supreme Court picks, when he hasn’t been busy ruining the prosperous economy he inherited from Obama. His immigration policies are so draconian they literally involve ripping children out of their parents’ arms. And he’s attempting to turn this country into The Handmaid’s Tale by restricting access to abortion care.

    Obamacare is great, but this election is about so much more. Libertarians need to vote Democrat so the #BlueTsunami will put Congress back in Democratic hands, where it belongs. Then in 2019 when Mueller submits his final report, Orange Hitler can be impeached and removed from office.


    1. Hey, you worked “The Handmaid’s Tale” into this one!

      Good job.

      1. OBL listens to good advice.

    2. “Obamacare is great” you are a f’n nut if you think it is great. It is a piece of shit. I know, it was the first step to “Universal health care” and you love that. Yep, I want my health care like the VA, yea, that is the ticket.

      What the hell is “abortion care”? Really, what is it?

    3. “Next month marks the most important midterm election of my lifetime. We currently have a white nationalist, mentally unstable Russian intelligence asset (possibly dating back to 1987) in the White House”

      But Hillary lost the election. You’re confused.

    4. Orange Hitler has indeed had a rough start.
      We’re just 2-4 after 6 weeks, while OBJ, Jordan Howard, and Larry Fitzgerald have been very disappointing, while Derrick Henry has finally been cut.
      Thankfully, our division leader is only 3-3 and all 12 teams are between 2-4 and 4-2. Hopefully the long awaited addition of Mark Ingram to the lineup will give us the boost we need to dominate the remaining 8 weeks.

      Handmaid Tails lost this week, but is faring much better. We’re 4-2, good for 4th place, and 3rd in overall points scored. Gurley gives us a great foundation, and if Le’Veon Bell plays this season we should be nigh unbeatable.

      Keep up the good work, OBL, and lead us to a strong 2nd half!

    5. I was going to refute this, point by point, but then I wonder if this is maybe sarcasm? I often cannot tell, honestly. Either sarcasm or pure derangement. Hopefully sarcasm.

      1. Without a doubt, pure derangement.

    6. And the LINO progressive speaks!!! Stop pretending you are a Libertarian because we all know you are a progressive troll.

      1. No, he’s actually trolling leftists. They’re just too dumb to realize it.

  14. Obamacare has refused to collapse under it’s own weight?

    Obamacare is not carrying it’s own weight. It is being propped up by federal taxpayers.

    Most of the people buying insurance on the exchanges are insulated from the absurdly expensive premiums via tax subsides.
    That doesn’t lower the actual cost of anything. It just sticks the taxpayers with the bill.

    1. “It just sticks the taxpayers with the bill.”
      As can be said for every wealth redistribution scheme the proggies have come up with, which even the architects of 0blamacare admit it is.

  15. Oh Jesus, Suderman, Election 2018 is going to be about American not wanting crazy Lefty Democrats in office anymore.

    Don’t worry, I will be here to tell you that I told you so.

  16. Why is there a picture of Stormy Daniels in this article? And it’s the same picture that is in another article. Is this the only one you could find where she is clothed?

    1. The disrobed pictures might work better. Show pics so we can compare

    2. Ghonnorhea sp? Is pre existing.

  17. Obamacare was a God send.
    How else can you control the masses if you don’t give them government healthcare?
    How else are you going to make life and death decisions over them if not through healthcare?
    How else are you going to control them by with holding their medications if they are not politically correct?
    How else are you going to cull this over-populated country if you don’t deny them life-saving surgery?
    Controlling the unenlightened masses is a must in any socialist slave state, and the healthcare is one of the best, if not the best, way to do it as Lenin said…and Lenin was never wrong.

  18. Once upon a time, Reason would publish articles on the pros and cons of covering pre-existing conditions, and how one might minimize the moral hazard and adverse selection.

    Now we get opinion pieces on the political optics.

    1. This is actually a very funny comment to me. I used to be a centrist Democrat. I’m gay so that means I have to be right? But then all the sudden I was surviving only by my white privilege. Then I was a full blown racist. Then all the sudden I was a mysogonist. Thank God I’m not old enough to be a baby boomer.

      Reason was the website that really opened up my eyes. Different viewpoints, intelligent articles, insightful comments. It really shocked me how horribly biased most news was. I always considered CNN balanced. Let that sink in.

      Now I am not so sure anymore. Half the articles are crap and I have to rely on the comments section just to get a different perspective.

      I guess I have nowhere else to go but it makes me sad

      1. I only occasionally read the articles here. I come for the comments, which are very good despite some.
        You might consider checking out ZeroHedge. Good array of articles from very varied sources, a bit of an anarcho-capitalist perspective. Be careful wading into the comments, though. They’re not quite WaPo level animals… but they are savages and largely anti-semitic.
        The Federalist has Harsanyi, who’s a good writer and wrote one of the two decent/libertarian articles I’ve read here over the last month or two.

    2. Bubba, I hear ya. This really used to be a place for very intelligent, thoughtful, balanced articles, full of Libertarian education and wisdom, devoid of traditional partisan rhetoric, and that were, above all else, thought provoking. And then supplemented with the (mostly) very intelligent comments from the readers. One could learn and expand one’s horizons on a daily basis. What happened?

      1. “What happened?”


      2. What happened?
        The writers realized that you have to toe the progressive line to get those awards they hand out to each other.

      3. The new editor is a progressive masquerading a Libertarian A leftist version of a RINO. Guess you would call them LINOs Lmao!!!!

  19. >>>”We cannot go back to where we were before Obamacare, where people were one diagnosis away from going bankrupt, because they could not get access to health care.”

    elect McSally, your next (D) senator from Arizona!

    1. Sinema is much worse.

  20. How is a “libertarian” site backing Obamacare? This is just like 1984. When Obamacare was making its way through to be a law every article on Reason was against it. Now all of a sudden they like it.

    1. OBL captures the spirit of Reason magazine pretty accurately

    2. This has not been a Libertarian website for over a year now. It is just a little less to the left than Politico

  21. to silly debates about Elizabeth Warren’s DNA

    By the way, there is no debate about Warren’s DNA. Warren put that debate to bed herself by bringing it up and waving it in front of the press.

  22. Yeah people with pre-existing conditions should just fuck off.

    1. Nobody has said that you disingenuous twat.

      Insurance, by definition, cannot cover something that has already happened. That is more like a maintenance plan.

      1. It is more like a different bet by the insurance company. They do stratify by age. For a given cohort they do not know which 40 year old has diabetes and which does not. So it does result in higher premiums.

        If they already know your medical history is like a poker game where they see all your cards and then choose who to bet on.

        Eliminating the provision will do nothing about the major problem which is overall cost. Someone will end up paying for the diabetics one way or the other. Healthy younger people will benefit from lower premiums but will end up paying more in other ways.

        Here is an idea. Just put a Vicodin vending machine in the ER waiting room. That would cut out a lot of visits.

  23. Guaranteed issue and community rating are a sure fire way to fuck up healthcare. This must explain their popularity then, right? Or is this just the final proof of wide-spread idiocy?

    1. Pre ACA… The worst state run individual markets had the most regulation and lowesr community ratings. Obama: “let’s do tgat everywhere.”

  24. Perhaps I have my facts wrong, as I do not follow these things as closely as I might, given the constraints of living my rich and full life and enjoying the goodness this wonderful country has to offer. But I seem to recall the Republicans campaigning for the better part of 7 years on “repeal and replace” Obamacare, or something to that effect. And that they ‘passed’ many bills (with only Republican support) during this time frame. Then, they find themselves in the position to do exactly what they promised. And . . . nothing. So, what makes anyone think they will do it now? They had their chance, and they showed that their arguments were disingenuous. The law is here to stay, and everyone knows it. Whether I like it or hate it, it is now etched in stone. The fact that the Democrats are still trying to scare people with this is . . . well, scare tactics are all that they have, really. So, when I say ‘wonderful country’, I guess I must exclude Rs and Ds in Washington.

    1. Well, their replacement was pretty meh… But it literally only got shot down because of a few cuck, sell out, RINO senators didn’t vote for it.

      Again, not that it was a great improvement… But they did take a stab at it.

    2. It was nothing due to RINOs like those who were the “undecided votes” on Kavanagh and McCain. There were enough to kill the bill and keeping the promise.

  25. The best real world way to fix health care in the USA is probably something like:

    Deregulate the hell out of every healthcare related thing possible.

    Encourage HSAs +catastrophic, because they tend to reduce spending 30%+ just because people are spending THEIR OWN MONEY on regular course of business visits. If almost everybody went to these alone, it would basically fix the healthcare problem spending wise.

    Probably leave in the pre-existing conditions provision, but allow them to charge more for such cases. This would be a good gimme for the bleeding hearts to keep them at bay… And honestly it was kind of messed up that people could end up in a position where they couldn’t get coverage at any cost. If you allow them to charge more, and possibly exclude the pre-existing condition from coverage, this would mitigate if not eliminate the costs being spread to others.

    That’s about it. With the deregulation lowering costs, HSAs lowering costs, and leaving in basically the only even semi-valid complaint about the pre OC system, there wouldn’t be much left to bitch about. If Medicare/caid still exist for the poor and infirm ONLY even shit libs wouldn’t have much to bitch about.

    1. Repeal EMTALA.
      If you show up for treatment, with no insurance, have the government pay and then get the IRS to collect as they would from any other delinquent taxpayer. No discharge through bankruptcy.
      The mandatory coverage was because those, who did this, got their care paid for by everyone, who was insured. If you are going to be irresponsible enough to not have insurance, then suffer the consequences.
      Those below the poverty line get Medicaid, so the excuse that you can’t afford it is invalid.

      1. Having the IRS go after people is an evil, but practical, idea. LOL

        The truth is there is no “perfect” system, because it’s the real world. And the world is not a perfect place. But we could improve it all so dramatically with the above that we wouldn’t mind the problems that are impossible to eliminate.

    2. I’ll do you one better, enough of the overseas military spending and pointless war campaigns that price out in the billions if not trillions, enough with this endless war on drugs costing in the billions each year and enough with the mass incarceration problem government has created. I’m sure with that and your plan included it could work.

      1. Well sure! There are plenty of useless spending things we need to get rid of. The more the merrier! But the stuff I say above would do well enough to get HC on a far better track. We can deal with other budget issues later!

  26. single payer healthcare NAO

  27. 1- Replace the FDA with for profit private competing certification agencies

    2- Replace the ACA mandated insurance with private routine medical care subscription services

    3- Replace the ACA mandated insurance with true catastrophic insurance

    4- Push HSA’s.

    Point 1 will allow medical technology to follow the same cost curve as all other minimally regulated technologies.

    Point 2 gets rid of the idiocy of pretending their is some sort of risk pooling going on with routine medical care.

    3 and 4 don’t need explaining.

    Problem solved, and the USA ends up having the best health care system by every metric.

  28. When we talk about coverage for pre-existing conditions we need to be more clear. What we are actually talking about is the inability for insurance companies to cancel coverage when you experience a major health crisis. In the past if you developed cancer or some other catastophic illness, companies would immediately cancel coverage or refuse to renew it when it expired to avoid paying for care. Once you didnt have insurance, no one would cover your “pre-existing condition” which was a scam created by and only benefitting the insurance companies. Changing this practice was not a bad thing but it is unique among insurance coverage. You cannot burn down your house, buy a policy and they demand to be paid for it.

  29. The one thing that would dramatically lower costs is selling policies across state lines Problem is states like California and NY do not want lower costs. Those states are run by progressives who want single payer HC so the government controls the people. Control who lives and who dies and you control the people.

  30. Why would anyone with a brain want to vote to get the same quality of healthcare given to Vets? What the VA provides veterens is a crime and only idiot Democrata would advocate the same substandard care for everyone. The reason is simple. Control who lives and dies and no one will oppose you changing the government and abolishing the Constitutitil

  31. One of the Obamacare witnesses in the Congressional hearings was denied coverage for cancer treatment because she failed to disclose that she had acne as a teenager.

  32. Everyone (or lots of people, anyway) kept saying that the Republicans needed to offer an alternative or replacement for Obamacare if it was going to be repealed.
    The problem with this is that only a government plan or policy can “replace” another government plan.
    For anyone who truly favors liberty, the Duopoly tactics are just a horse and pony show to give the impression that honest political debate is occurring. But neither party has any real interest in cutting back costly and intrusive government.

  33. Per the usual, my mornings are a little… uncalibrated. But today was fun, as between my under-caffeinated state along with the absence of my reading glasses, I looked up to misread:
    Forrest. Forrest Trump.
    And that is what I will call him if he signs off on big government republicanism where house and senate continued their kabuki dance to preserve the ACA in place as a means to destroy what’s left of our insurance system. Dems will offer a deal in the coming congress, and it’s just another cup of hemlock.

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