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Free Minds & Free Markets

The Failures of the American Health Care Act

Here are the problems with the House plan to repeal and replace Obamacare.

From the time it was enacted, most Americans disliked the Patient Protection and Affordable Care Act, also known as Obamacare. Republicans, promising to "repeal and replace" Obamacare, rode the wave of public dissatisfaction to repeated election victories. The GOP took the House of Representatives in 2010, the Senate in 2014, and the White House in 2016, largely capitalizing on the skyrocketing premiums, rising deductibles, and disappearing choices that characterize Obamacare.

C-SPANC-SPANNow, as Republicans control both Congress and the White House, they finally have the chance to deliver on their promise. And not a minute too soon. Because the mandates that Obamacare places on health insurance have sent our health insurance system into a death spiral. Premiums continue to soar as insurance companies are pulling out of the market, leaving consumers with fewer and fewer affordable choices. In over a third of the nation's counties, individuals have just one insurance plan as a choice. Soon, many counties will have no plans available. Repealing and replacing Obamacare is no longer an option. It's essential.

Answering the alarm, on March 6 the House leadership unveiled the American Health Care Act, their attempt at "repeal and replace." To advocates of health care freedom there is little reason to be pleased. The American Health Care Act does little to stop the death spiral underway. It may even accelerate it. Here's why.

A major force behind the death spiral is the series of mandates that Obamacare places on all health insurance sold in the U.S. Companies that offer insurance that is not "ACA-compliant" suffer penalties, as do any individuals that buy such a policy.

For example, there are 10 essential benefits, including maternity care, mental health care, chemical dependency rehab, and vision and dental care for children under 18—which all insurance must provide, regardless of the needs or desires of the health plan customer. This makes insurance much more expensive than it would otherwise be for people who don't want or need those benefits.

But the mandate that contributes in the greatest way to making premiums unaffordable is called "guaranteed issue/community rating." This is the requirement that insurance providers accept people who are currently sick or have preexisting conditions, yet providers are not allowed to charge such people any differently than those who are not sick and don't have preexisting conditions. In order to have enough money in the risk pool to pay out claims, this feature makes insurance companies thus charge younger and healthier people much more, while charging sicker and older people much less. Even worse, it creates an incentive for people to put off buying health insurance until they get a health problem, when the insurance company must sell it to them and cannot charge them any differently than if they were healthy. Imagine if auto insurance worked this way. There would be no reason to buy it until you got in an accident. But imagine how much that auto insurance would cost.

To deal with this problem, Obamacare has the infamous "individual mandate," which penalizes people with a tax if they put off buying health insurance. But the penalty isn't stiff enough because more and more young and healthy people are choosing to take the penalty rather than pay for expensive health insurance they don't need.

The American Health Care Act effectively leaves all of the Obamacare mandates in place. It does remove the individual mandate, but in its place is the threat of a 30 percent premium surcharge for one full year for anyone who goes without continuous coverage for more than 63 days (which sounds a lot like a Republican version of an individual mandate). Obamacare makes the individual mandate penalty payable to the Internal Revenue Service. The American Health Care Act makes it payable to insurance companies.

Therefore, nothing in the American Health Care Act addresses the cause of rising health care premiums, rising deductibles, and insurance companies leaving the market. Proponents say the proposal increases consumer choice. But as long as the government is designing insurance policies with one-size-fits-all mandates, there never really will be choice.

To be fair, the GOP leadership argues that arcane Senate rules left no choice but to leave the mandates in place. In order to avoid a filibuster by the Democrats, the Republicans are forced to use a procedure called "budget reconciliation." Otherwise, they reason, nothing at all will clear Congress and head to the president's desk for his signature. And the budget reconciliation process does not allow them to address the mandates.

However, some serious analysts argue that, based upon information provided by the non-partisan Congressional Budget Office, mandate reform can indeed be included as part of this budget reconciliation package. The cautious House and Senate leadership seem unconvinced by such arguments.

The architects of the American Health Care Act reassure critics that Secretary of Health and Human Services Tom Price can address the mandate problem in what they call "Phase 2" of Obamacare repeal/replace, once the act ("Phase 1") is passed. They point out that the Affordable Care Act delegated extensive administrative authority to the HHS secretary. They refuse to specify, however, just how the secretary will do the fix administratively. Moreover, constitutional law professor Josh Blackman argues that the powers of the secretary are severely limited when it comes to the matters of the essential benefits and guaranteed issue/community rating.

To help people deal with the exorbitant insurance premiums resulting from the mandates, Obamacare provided means-tested subsidies to many people. These subsidies were paid directly to the insurance company in order to reduce the premium price to the consumer. The American Health Care Act ends these subsidies. In their place it offers an age-adjusted, means-tested, refundable tax credit (meaning the credit is given to people even if they pay no net income tax) that, again, is paid directly to the insurance company to lower the premium. This amounts to nothing more than renaming the subsidy as a "tax credit" to make it sound more Republican. The entitlement created by the Obamacare subsidy still remains but in a slightly different form.

To be sure, there are some good things in the American Health Care Act. It removes most (but not all) of the taxes in Obamacare that have been a drag on economic growth, investment, and job creation. The act also removes the mandate that employers of 50 or more full-time workers (defined as 30 or more hours per week) provide ACA-compliant health insurance. This has stifled full-time job growth while increasing the number of part-time workers.

The expansion of Health Savings Accounts is also a very laudable feature. This empowers patients to use their own money to make their health care decisions.

A major step in the right direction is the act's block granting of Medicaid funding to the states while also allowing states to innovate and design programs free of Washington micromanagement. Fiscal conservatives have issues with the way in which this is structured. For example, it allows for Medicaid to be extended to working, healthy adults (not the original mission of Medicaid) until 2020. Nonetheless block granting constitutes a major entitlement reform.

GOP leaders promise to make even more improvements with separate legislation ("Phase 3") to allow for the sale of insurance across state lines. This will result in more competition and consumer choice, and help drive down insurance premiums. Again, Senate rules preclude this matter from being included in any budget reconciliation bill.

These things are nice, but they really don't matter: Unless and until the House and Senate leadership find a way to repeal the Obamacare mandates, none of the positive features of the American Health Care Act will be able to stop the individual insurance death spiral that is already well underway. And, in fact, it could be argued that removing the hated "individual mandate" while leaving the Obamacare mandates on health insurance in place will make things even worse. Either way, when it all comes crashing down, the Republicans will have only succeeded in wresting ownership of this disaster from the Democrats.

Perhaps it is time for the GOP leadership to exercise some of the same raw legislative gamesmanship their Democratic predecessors used to ram the Affordable Care Act through in 2010. For example, it is within the Senate majority's power to declare that repealing the Obamacare mandates is germane to budget reconciliation. Senate Republicans even override the Senate parliamentarian if he disagrees.

If the Republicans are not up to the task, then, as cynical as it seems, it might be politically safer to just do nothing, avoid the blame for the crash, and then try to rebuild from the ashes.

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  • Ken Shultz||

    "Therefore, nothing in the American Health Care Act addresses the cause of rising health care premiums, rising deductibles, and insurance companies leaving the market."

    Ultimately, the cause of the problem we have with our healthcare system derive from Medicare and Medicaid only paying for a fraction of the cost of care.

    This chart gives a glimpse of that:

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

    Providers gouge private insurers to make up for the money they lose on Medicare and Medicaid patients. There are other sources of problems, of course, but Medicaid and Medicare are the ultimate source of the problem.

    The ACA did a number of things to make the problem worse, but the thing it did that exacerbated the problem the worst was the Medicaid expansion. There is no effective solution to our healthcare problems that doesn't include cutting Medicaid--and the Ryan plan revokes the ACA Medicaid expansion.

    In that way, the Ryan plan--uniquely, far as I can tell--actually addresses the ultimate cause of our healthcare problems by revoking the Medicaid expansion.

    I suppose an alternative solution might be for the government to fund the total costs of Medicare and Medicaid, but taking money out of taxpayers' paychecks to save consumers by way of their insurance premiums is just a shell game. Unless people are being shifted off of Medicaid--as the Ryan plan does--then we know the ultimate cause of the problem isn't being addressed.

  • Michael Hihn||

    There is no effective solution to our healthcare problems that doesn't include cutting Medicaid--and the Ryan plan revokes the ACA Medicaid expansion.

    But he FAILS to replace it, pandering to all the goobers.

    When we had a free market, supply and demand were balanced, EVERYONE that sought treatment received it.
    The uninsured -- both poor and elderly -- were treated in religious-based, charity hospitals. The humanitarian works of fraternal organizations, like Kiwanis and Rotary, then included health care.

    THAT is what the free market provided. THAT is what Americans WANT and have ALWAYS paid for.
    THAT is what we must transition back to. And THAT is what PHONY free-marketers REJECT.
    So the progressives will keep kicking their ass.
    And capitalism is slandered by selfish pigs -- in THE most humanitarian nation that ever existed.
    How shameful.

  • Scarecrow Repair & Chippering||

    Prices and money and markets are, in my mind, the supreme invention of all time, although "invention" is a bit over the top -- they all exist even in the animal kingdom, in an economic sense, as in when a cheetah chases a gazelle, they both expend resources for gain, and have limits on how much they are willing to spend, and thus supply meets demand. But humans have defined them in terms of actual numbers, which makes them much handier for much bigger things. Unfortunately, that also means governments have interfered with them in every way possible.

    More than almost anything else, I wish government would just get out of markets and leave them to the experts -- the individuals who supply and demand goods which others demand and supply. Prices are an incredibly handy way of regulating supply and demand, and it almost makes me cry to see how governments distort them for such petty political reasons.

  • Michael Hihn||

    I love your animal analogy..

    You're struggling with "invention" so why not try evolution -- as in a spontaneous order.
    I don't think formal economics gives enough weight to trial and error. Like survival of the fittest -- of ideas -- which then flows easily to creative destruction. To me anyhow.

  • ThadM||

    And yet, the insurance companies aren't hurting. UnitedHealth announced it expected another record year of revenue at $197-$199 Billion. In 2016 they had $185B in revenue and $13B in profit. The problem with the current setup is that it does not force competition for insurance. Insurance companies are able to pick and choose where they sell, creating defacto monopolies or near-monopolies.

  • jerbigge||

    The amount that Medicaid pays is about what doctors in the rest of the developed world get paid. Part of the problem is today American doctors have big office staffs which the doctor has to pay from the he receives from patients. In the past a doctor had an "office nurse" and that was that. The cost of a visit was about $8 in 1960. I had a doctor in the early 1960 do minor surgery for $80. He did it himself with just his office nurse in attendance. The US actually did have "affordable" health care back then. My mother in 1948 was in the hospital for a couple weeks and the entire bill was $300.

    The creation of health insurance meant that since the insurance company was paying the claim, less and less people were concerned over the cost of what was done to them. Most of the cost was coming out of their employer's pocket. (actually out of theirs through lower wages). This is really what has driven our health care costs so high today...

  • Fist of Etiquette||

    Normally Washington has no problem choosing winners and losers, but in the health insurance debate, attempts to refuse the fact that some will benefit and some will not in whatever course they take is making things worse. Democrats lost control of Congress because they decided to make that choice and all but a select few benefited (and even that is proving to be short lived). Congress needs to understand that not everyone can benefit equally and all they're meddling in the healthcare market can do, at best, is manage how bad things get overall.

  • Michael Hihn||

    attempts to refuse the fact that some will benefit and some will not in whatever course they take is making things worse

    That is not a fact and never has been.

    When we had a free market in health care, EVERYONE got treated, through a wide variety of options that evolved freely. The uninsured were treated at no cost -- paid by a variety of voluntary means -- by people who OBVIOUSLY got what they wanted. Ummm, everybody wins in a free market,

    Today's sorry excuse for free-marketers and libertarians are NOT seeking win-win. And that's why they're getting their asses kicked.

  • Scarecrow Repair & Chippering||

    What an ignorant statement -- "EVERYONE got treated" -- no, they didn't. Economic and reality scarcity by definition mean some didn't get what they wanted, just as no matter what the price of almonds or necklaces, not everyone will get what they want. Government attempts to set the price to zero will also not eliminate scarcity.

    How many poor people died who could have been saved by a heart transplant? Or by expensive chemo treatments? No sir, not everybody got treated, even if by "treatment" you mean someone checked their pulse and said "You're not doing so well" and moved on to somebody with more cash.

  • Scarecrow Repair & Chippering||

    As an addendum, this is probably the biggest problem with trying to keep the government out of healthcare markets. It's all too easy for politicians to pretend they can eliminate scarcity (see their response to the first rule of economics) in healthcare. If they promised everyone could drive a Rolls-Royce or Ferrari, or live in a 50 room mansion, people would laugh instinctively at their nonsense. But health care for the poor hits a nerve that even houses for the homeless doesn't.

    People have a visceral reaction to some poor schnub not getting health care, no matter how preposterous any case might be. They think it is wrong to reserve transplants for those who can afford them, and one of the side affects is the elimination of markets for organs. The doctors and staff who remove an organ and put it in somebody else, the staff who transplant it, they all get paid quite well, but those who actually provide the organs which make so much money for everybody else are forbidden by law from any remuneration. In its place is the usual government simulation, but with corruptible bureaucrats in the place of money. It's still rationing, but by means which no one except a few politically-connected elites have. And politicians are among those elites, so they have a positive interest in daemonizing money as the rationing agent.

  • Michael Hihn||

    I CAUGHT ONE!

    What an ignorant statement -- "EVERYONE got treated"

    His reason is even crazier. And proves my point!

    -- no, they didn't. Economic and reality scarcity by definition mean some didn't get what they wanted,

    THEORY TRUMPS REALITY!
    More babbling soundbites from the goobers.

    just as no matter what the price of almonds or necklaces, not everyone will get what they want.

    Cold-hearted bastard. America is the most humanitarian society that ever existed. In that free society, we erected a massive support network -- mostly church-owned Charity Hospitals. (Only Catholic ones had Charity in their name) Anyone who walked in - or called an ambulance -- was treated. Free, or what they could pay. Fraternal organizations had been providing humanitarian help since the 15th century, as they do today. Then, it included healthcare.

    Government attempts to set the price to zero will also not eliminate scarcity.

    "Also" is the dumb word., Gummint is different,

    How many poor people died who could have been saved by a heart transplant?

    IN THE NINETEEN-TWENTIES? ... GUESS.

    "You're not doing so well" and moved on to somebody with more cash.

    IN A CHURCH HOSPITAL .. THAT WOULD HAVE BEEN A SIN (I'm an atheist)

  • Michael Hihn||

    I GET MORE!!!

    As an addendum,

    You should have quit while you were merely wrong.

    this is probably the biggest problem with trying to keep the government out of healthcare markets.

    The ignorance of how free markets actually worked .,.. among anti-gummiint goobers ... which is why they get trashed by progressives.

    People have a visceral reaction to some poor schnub not getting health care, no matter how preposterous any case might be.

    Which is WHY Americans never allowed it to happen.

    Americans have ALWAYS wanted to care for everyone .. and willing to pay for it,.
    Pro-liberty libertarians work to transition back to that free market OUTCOME,

    Anti-gummint libertarians have NO love for liberty, only a consuming HATRED for government.
    They DEFY the will of the people ... for their own AUTHORITARIANISM.
    Repeal Obamacare. FUCK the poor. Not in THIS country.

    How can we transition back to a free market, without depriving the care Americans want.
    How can liberty do better what government does now. Just that simple.
    The gummint haters have no clue ... and don't even care.

  • Longtobefree||

    I don't know about everybody, but those who came into my fathers office got treated. If they could pay, they paid (or their union, or their insurance). If they could not pay in full, they paid what they could over time. If they could not pay at all, they were assisted in contacting charities for assistance. If they could not find a charity, the bill was written off. But they were all treated, and treated the same.
    As a side note, when medicare came along, (yes, this was a long time ago) he would often treat for free rather than be bothered with the paperwork and restrictions. "No bureaucrat is going to tell me how to be a Doctor" was often heard at the dinner table. After so many were on medicare he could not afford not to file the paperwork, he paid a company to come around once a week and go through the files to send in the paperwork. By the time he retired, there were 5 clerks doing paperwork, and 2 Doctors and 3 nurses providing care. And politicians were still wondering why "healthcare" costs were rising.

  • Michael Hihn||

    Here's how a Libertarian handled it about 20 years ago. I was a marketing professional and first paid director of a state LP, WA,managing many campaigns. A physician, in a very rural area, was running for US Senate. My first visit was a memory that lives forever,

    He and his wife were the DEEPLY religious types, so very humble and soft-spoken. I say that to put a picture in your mind. His town, on the north shore, was heavily Medicare. He had a paid clerk process paperwork, leaving much undone. His wife, imagine Mother Theresa sobbing hopelessly, wracked with tears, barely able to talk. Got it? On many weeks, she had to process paperwork .... on "the Sabbath" She said "Sabbath." I'm an atheist, but I knew her agony.

    He told me that a recent movement had united doctors to promote steep discounts for cash. I was still a freelance op-ed writer, and interviewed the head of the Seattle chapter. He was far from libertarian, but he knew that PAPERWORK was a major problem, At the time, general practitioners offered an average of 25% of for cash. Some specialists as much as 50%

  • Stormy Dragon||

    GOP leaders promise to make even more improvements with separate legislation ("Phase 3") to allow for the sale of insurance across state lines. This will result in more competition and consumer choice, and help drive down insurance premiums.

    The GOP keeps saying this, but it is it actually true? One of the reasons that many counties have only one insurance is the increasing prevalence of health care networks where nearly all the doctors and hospitals in an area are owned by a particular insurer. For one particularly prominent example I'd mention the way UPMC (University of Pittsburgh Medical Center) is increasingly using it's control of hospitals in the Pittsburgh area to drive its main competitor Highmark out of the western parts of Pennsylvania.

    What good would letting insurers from other states come in, when even in-state insurers are getting locked out of the market? It doesn't matter how cheap insurance elsewhere if the local hospitals refuse to accept it. Are you going to propose banning insurers from owning hospitals and doctors practices? That hardly seems libertarian.

  • Jerryskids||

    I'd propose banning restraint-of-trade laws that grant monopolies to the local hospitals. Let Walmart and CVS and Johnson open a few hospitals and offer whatever services they want and let's see what happens. Selling insurance across state lines is bullshit if the government still dictates the specifics of the policy - how competitive would automobile pricing be if the government mandated that all automobiles must be Ford Explorers?

  • Jerryskids||

    *Johnson ampersand Johnson you stupid squirrels. What the hell does Reason have against ampersands?

  • Scarecrow Repair & Chippering||

    It's not Reason, its HTML/XML. Try this -- ...ampersand... "amp;" and see what happens. I will try it right here: (&)

  • Scarecrow Repair & Chippering||

    There you go -- look at source, search for "ampersand".

    The other two are greater than (>) and less than (

  • Scarecrow Repair & Chippering||

    Well hell, they are tricky sons a bitches. 1(

  • american socialist||

    I think the gop just doesnt let this go thru and then the aca keeps falling apart making reform easier politically (though continue govt intervention keeps causing problems)

  • Vaelyn||

    Probably right, but of course the GOP will be blamed for the crash of Obamacare anyway, even if they do nothing. "Why, Trump gutted the law with his executive order! Republicans never funded it properly! They've been undermining it since it passed! They never tried to fix the law! Blah Blah Blah! Reasons reasons reasons!"

  • Michael Hihn||

    Probably right, but of course the GOP will be blamed for the crash of Obamacare anyway,

    It was the GOP that fucked it up, pandering to Obama-hatred.

    The original plan included REAL co-ops, not the co-op INSURANCE that dumbfuck Republicans forced.

    Patterned on Seattle's Group Health Co-Op -- a Co-op HMO -- as a REPLACEMENT FOR A PUBLIC OPTION. Obama, like Kennedy's tax cuts, went for more GOP votes -- and broader appeal -- by ignoring his own far-left.

    An HMO co-op is the 21st century version of the membership lodges that provided most coverage pre-FDR, Doctors are salaried employees of their patients. They run their own pharmacies and hospital rooms, so CONSUMERS have direct control of the ENTIRE healthcare structure. And competition. GHC has a lower-cost competitor in Seattle.

    It was even endorsed on the ultra-left Daily Kos ... INSTEAD OF a public option. To the left, a patient-controlled non-profit is "socialized medicine." (which makes them smarter than fiscal conservatives)

    Senator Hatch led the attack saying it was "socialism." Yeah, like that fucking communist Kiwanis.
    Republicans sold us out to the insurance industry, when they could have killed singe-payer forever.
    HMOs have no claims processor costs. And member control offsets HMO faults.
    The GOP forced Obama to deal with his far-left.

  • bartzman86||

    You should talk to my old friend, seroquel. Because I can taste your rage bro, and drugs seem like a good idea at this point.

  • Michael Hihn||

    bartzman
    You should talk to my old friend, seroquel. Because I can taste your rage bro, and drugs seem like a good idea at this point.

    Instead of the childish insults of a 12-year-old-bully, tell me what you challenge ,.. SO I CAN JAM IT UP YOUR ASS ...With extreme delight (sneer)

    (Tone and boldface to punish aggression by a cyber-bully, in self-defense)

  • bartzman86||

    No challenge, I don't really care about your thoughts/ramblings. Just a practical solution based on my observations of your very odd behavior. I'm here to help!

  • Michael Hihn||

    Be a man. Why do you defend the GOP fuckup instead of them killing single-payer forever when it was offered???

    No challenge,

    Liar As you so witlessly demonstrate here!!

    I don't really care about your thoughts/ramblings.

    Why are they "ramblings?"
    And if you don't care .. why bother? Lose control?
    Now the fucking lie

    my observations of your very odd behavior.

    One more time for the integrity impaired:

    TELL US WHAT *YOU* SAY IS "ODD" ... SO I CAN JAM IT UP YOUR ASS.

    ..... Actually, I just did!

    (This is self-defense from serial aggression by a cyber-bully now-stalker)

  • Another Phil||

    I'd recommend Zyprexa.

  • Michael Hihn||

    One more cyber-bully, committing aggression. Sad.
    (they run in a pack here, like wild dogs -- and DAMN anyone who DARES defend against aggression by their fellow thugs. You know who else punished Thought Crimes?)

    The militant self-righteous -- now infesting both the left and right,

  • Michael Hihn||

    but in its place is the threat of a 30 percent premium surcharge for one full year for anyone who goes without continuous coverage for more than 63 days (which sounds a lot like a Republican version of an individual mandate).

    Uhhh, no, Continuous coverage is a common-sense solution to pre-existing conditions, tracing to 1996. Health insurance was then made portable when changing jobs, even with pre-existing conditions.

    Despite equal hysteria by progressives and Cato's Michael Tanner you do NOT lose coverage when changing jobs (not for that). Crazy assumption. If you've always had coverage, then you're not waiting to get sick I had the same requirement when I entered Medicare because I worked to age 69. I had to prove I had the employer-paid coverage .. or pay a surcharge. Makes sense to me. What confuses you? 30% is too low and it's NOT for a year, because deadbeats will simply cancel. Insurance is paid monthly.

    If you think it's a mandate to pay insurance companies ... instead of FORCING the insurers to accept a MUCH lower premium than a free market would command ... you've just continued the total ignorance that we see in Reason's Suderman on the same issue, and all of fiscal conservatism.

    There's more, but characters are limited here .... Kinda frustrating that the anti-gummint goobers have NO free-market alternative ,... nor understand how it worked when we had one.

  • jelabarre||

    but in its place is the threat of a 30 percent premium surcharge for one full year for anyone who goes without continuous coverage for more than 63 days (which sounds a lot like a Republican version of an individual mandate).

    Despite equal hysteria by progressives and Cato's Michael Tanner you do NOT lose coverage when changing jobs (not for that).

    You don't effectively lose coverage, but if you think medical is outrageously expensive when you're working, you should try paying Cobra coverage while on unemployment. You get the choice of paying for medical, or eating and paying rent. Never both. That 63-day requirement is going to be very bad when you work in a field where companies like to take on contract staff and then dump them on a couple-hours notice when they need to flog the quarterly numbers. Takes way more than 63 days to find a new job.

  • Michael Hihn||

    I've done Cobra, but had some cash for the gap. I was defending one statement about the GOP plan, which SUCKS overall. I was a healthcare researcher/writer pre-retirement. You look to be in s segment that Obamacare helped, one of very few, and, yes, the GOP wants to throws you under a bus. Many or most of the goobers here are cheering that.

    With both parties in terminal collapse, we're all in jeopardy -- which doesn't say much for your situation .... except.....

    I see very little hope of passing the current bill. But if they do, they'll get thrown out on their asses next year --- just as they did after Dubya. They didn't deserve punishment for a crisis created by Democrats, but they will this one. The braying jackasses ... err, elephants ... suffer the same arrogance that brought them to power. That may buy you some time, if it comes to that, Just bein' honest. We're all in trouble, each facing different threats.

    Best to you.

  • XM||

    "If the Republicans are not up to the task, then, as cynical as it seems, it might be politically safer to just do nothing, avoid the blame for the crash, and then try to rebuild from the ashes."

    I never thought Reason would write something like this. Was Gillespie among the "staff" that wrote this?

    But yeah, doing nothing and allowing the law to crumble is a viable as a last ditch strategy, especially since the democrats' solution is basically not change anything about the law.

    I didn't know they replaced the individual mandate with something else. Now I'm not so hot on this proposal. Just kill the employer AND the individual mandate.

  • Michael Hihn||

    Yeah, let people die. Because NOBODY proposes a return to the free market we had before FDR.
    Well, only pro-liberty libertarians. But hating government is stringer these days than a love for liberty and markets,

    Sorry, Lady Liberty, but nobody really cares to heal your pain.

  • Paloma||

    People's sympathies go more to poor people not getting medical care because it's quite different from other commodities. One never knows when or if he'll get sick and actually require it. Thus insurance companies. And to say "leave it to charities" sounds to many people like leave it to the good will of others, or even leave it up to fate. People want to be sure because they fear "Could I be next"?

  • Michael Hihn||

    And to say "leave it to charities" sounds to many people like leave it to the good will of others, or even leave it up to fate. People want to be sure because they fear "Could I be next"?

    Yep, that's what created the Medcaid/Medicare mess. EVERYONE was being treated -- at less than 6% of GDP But it wasn't a "right."

    Now it's a "right" and Medicaid eligibles have a HIGHER uninsured rate than the private market (everyone else under 65). I don't think anyone felt the fear you mention -- until the political hype. The Charity Hospitals were not ENTIRELY charity. There was no external stigma because a welfare recipient could be in a bed ... right next to a union steelworker ,,, but in a ward. The beds were just as far apart, so same personal privacy. Medical staff didn't know who was a charity case, because they had no need to. It was a different CULTURE. There was a sense that PEOPLE. your community, would be there for you. As it had been for centuries. That's what we've lost, part of what made us America.

    BTW, I know you were saying what people think, not necessarily what you believe!

  • Praveen R.||

    I think preventive care has to be Single Payer just to streamline volume based discounts, have people not put off preventive care. But private insurance that is portable, fully free market , not dependent on employment should be for everything else. Because I really care about choice when I need to see a doctor for something other than a simple lab exam or first aid or something simple.

    But we also need to increase the supply of doctors and more importantly Physician Assistants. Also, nurses need to be paid better to attract more nurses even if it means a doc has to take a measly 20K paycut and he or she will still get paid handomsley. Also getting more docs means quality will not necessarily go down because what we have is already idiots who slip through the system and part of a doctor being bad is laziness or unstable behavior after he or she finishes medical school. With the advent of medical informatics which make it so easy to remember drug interactions, symptom matching, etc, the old method of crazy hours during residency is ridiculously inflexible driving away qualified candidates for medicine.

    But what really is needed as a first step is to make costs more transparent to the users. And yes, for that we will need some kind of regulation to actually facilitate the capitalistic part of the system. A patient should have the right to know if everything in a treatment chain of care is in network when they get admitted to a hospital.

  • Praveen R.||

    But what to do about preexisting conditions? is it fair for the insurer at the time of the inception of the disease be responsible lifelong since that is when it occurred under their watch? Is it fair for the insurer that comes into play when the treatment is at its most expensive despite the inception happening under anothre insurer's watch? In theory, what is wrong about a private company not wanting to cover a preexisting condition?

    Or should the state be the defacto insurer for stuff like cancer, diabetes where the state is making a statement that if you are born a citizen of the country, we provide basic protection for stuff that is too big for private individuals to bear reasonably and not shift the dilemma of who covers such people to the vagaries of which insurance company is in coverage at inception of that disease and who takes over during a serious part of the treatment needed. and let insurance companies insure everything else including full coverage for most conditions, and supplemental coverage in terms of enhacning care for those preexisting conditions covered by the state?

  • SomeGuy||

    Why is anyone entitled to cutting edge medicine and life extension shit that is super expensive? Why is it everyone else's problem to spend 3 million dollars making you live an extra 3 years?

    If you don't have 3 million dollars than go fucking die!

    I see no issue with being able to buy insurance that does not provide expensive life saving bullshits...er life extending bullshit....because we all are going to die anyways.

    I am for one will let a disease kill me than drain society of millions of dollars for a few days or years.

    I hate medicare and medicaid. Why the fuck am I paying for some old hag to live another 5 fucking years on a death bed? If she or her family doesn't have the money let that bitch die. It is part of life fuck.

  • SomeGuy||

    I would much rather a free market exists that allows insurance to sell many packages.
    I would buy basic care and catastrophic. Basically injury base coverage with minimal coverage for cancer. This would be super cheap.

    If someone wants insurance that pays for all sorts of weird shit and will spend 3 million to help you beat cancer thats fine. Have fun with 2,000 a month premiums.

    I'll gladly have my insurance with 100 dollars a month premiums.

  • SomeGuy||

    Right now i pay 330 a month for a PPO that has 40% coinsurance and a 14K deductible.

    Jesus is it completely useless if i didn't have TRICARE as a secondary to pick up the massive amount of uncovered shit.

  • SomeGuy||

    If i could buy insurance without all this unneeded bullshit my premiums would be like 50 bucks a month! and not have a 14K deductible. But all these woman shit, cancer shit, mental health bullshit, and other fringe shit makes it ridiculously expensive.

  • Michael Hihn||

    What's your alternative? Who gives a royal fuck what YOU do?
    When we had a totally free market in healthcare, NOBODY was denied treatment, regardless of income. Nobody. THAT is the will of the people. This is free society, right?

    So ... how do we TRANSITION back to what people WANT?
    Can YOU describe how to do that ... in a way that can get people elected to ACHIEVE it?

    "Let people die .." ain't gonna cut it .. in THE most humanitarian culture on earth HOW DARE YOU defy the will of the people -- as clearly expressed in a free market?

    When goobers like you defend RATIONING -- as does the libertarian establishment, THAT is why progressives have been kicking our ass on this for over a half century.

  • SomeGuy||

    jesus your stupid. You didn't even read what i said.

    I made no statement about rationing you stupid fuck.

  • Michael Hihn||

    jesus your stupid. You didn't even read what i said.

    My name's not Jesus -- not in this carnation.

    I made no statement about rationing you stupid fuck.

    I am deepy sorry. Apparently somebody else typed all that crazy shit under your name,

    Why is anyone entitled to cutting edge medicine and life extension shit that is super expensive? ... If you don't have 3 million dollars than go fucking die!

    Why the fuck am I paying for some old hag to live another 5 fucking years on a death bed? If she or her family doesn't have the money let that bitch die. It is part of life fuck.

    So ... how do we TRANSITION back to what people WANT?
    Can YOU describe how to do that ... in a way that can get people elected to ACHIEVE it?
  • SomeGuy||

    Yea your reading comprehension is shit.

    I said no one is *entitled* to cutting edge medical treatment on other peoples money you statist shit. If you can't afford it that is your problem dumbass. Is this too hard to comprehend?

    That has nothing to do with rationing.

    If you can't afford the medical bills that means natural process of life takes over and you die.

  • SomeGuy||

    you seriously are a statist/socialist POS so Fuck off slaver. my money is my money and not anyone else's. They are not entitled to my money to pay for their bills.

    As someone pointed on here most medical bills are from a small group of the population. Why is it my problem to pay for those people if they can't afford it? How are they entitled to my money and other people's money?

    They aren't unless you are hihn who likes to believe in socialistic statist bullshit.

  • Michael Hihn||

    I hate medicare and medicaid. Why the fuck am I paying for some old hag to live another 5 fucking years on a death bed

    What is VERY scary is that you feel sage spouting such dumbfuck comments here. Scary, but not unusual.

    Would you run for Congress on that?

  • SomeGuy||

    How is it dumb? I don't see anything right or justice about having my money taken without a choice to give someone an extra 3 years on their death bed. If they can't afford the medical bills or have someone willing donate for such bills let them die. It is how life works you statist fuck.

    Fuck off slaver

  • Michael Hihn||

    How is it dumb?

    YOU must be ashamed of it, because you called me a "fuck" for saying you did, Now you defend it??

    It is how life works you statist fuck.

    Check the web archive of my published writing -- especially my "statist" taxes and healthcare. You'll see why I'm not the only one .,.. amused ... by your ... outburst.

    Fuck off slaver

    Again:

    "So ... how do we TRANSITION back to what people WANT? Can YOU describe how to do that ... in a way that can get people elected to ACHIEVE it?"

    This is a public comment page. If you comment here, people may respond. If you need a "safe space" perhaps you should go elsewhere -- where snow-flakes are protected.

  • SomeGuy||

    pretty sure your the person who can't read or comprehend my basic language....totqally lost of your snowflake part but keep distracting if that makes you feel better.

    why do you need a transition. Simple remove all the government mandates that should have never existed. You don't need a transition.

    But again your still a statist shit for being cool with stealing peoples money and saying people are entitled to others money and health care they can't afford. So again fuck off slaver and your socialist entitlement bullshit.

  • Praveen R.||

    i never said we should provide cutting edge medicine for free for anyone. Covering preexisting conditions by the state was just a brainstorming idea as a form of self insurance pool. But I dont know offhandhow much is fair to provide as coverage for such dire afflictions. I would rather have some consensus to set limits and people will have to pony up for some private insurance for cadillac care.
    As far as you hating Medicare as a concept, i hope you share the same consistency for defense. There are some people out there self armed who feel they don't need a military to defend them from external threats. They dont care who is in power, and they woudl rather not pay taxes to fund a national military. But you know what? You can't get everything you want. If you benefit from a community, you have to pay up or you are free to move to another country with a system that pleases you more.

  • Longtobefree||

    1. Outlaw employer provided insurance. They do not pick individual policies that best meet each employees needs. So employees have to pay part of premiums for policies they would not choose in a free market. Allow employers/unions to assist in funding health care saving accounts, or allow them to just increase wages.
    2. Allow insurance companies to sell whatever policies they wish. Require them to publish the premiums. This allows consumers to shop, comparing the benefits to the costs of their chosen provider.
    3. Require healthcare providers to set a single price for each service they provide, and to publish that price. This lets consumers shop comparing the costs to their chosen insurance. It eliminates the mess of networks.
    This leaves 2 problems caused by the existing interference of the feds; the mandate, and low income assistance.
    Eliminate the mandate, but allow policies to have reduced benefits in the first x number of years, like guaranteed issue life insurance. This will provide a carrot to buy and keep insurance, rather than a stick of "tax". The stick is provided by eliminating the slave mandate of treating with getting paid. Anyone choosing to self insure (not buy insurance) will have to rely on charity to get treated. Harsh, but fair.
    Provide help to low income citizens in a manner similar to food stamps. Overall cheaper than the current mess, and to the replacement mess. And a lot more transparent in showing the taxpayer costs.
    (Oh yes, I would also like a pony)

  • Michael Hihn||

    Closer! Better than anything from the libertarian establishment.

    rely on charity to get treated. Harsh, but fair.

    Not harsh. EXACTLY how we treated everyone in a free market. regardless of income, before LBJ.

    publish that price

    Better yet, I only recently learned that Medicare does LOCAL competitive bidding for medical equipment. (I needed a walker). Anti-gummint goobers scream. Should we ban bidding for ANYTHING government buys.

    "Negotiating" lower prescription prices, on patented drugs, is total fascism.

    But .... there are IMMENSE local price differences in many costly but fairly frequent procedures. THAT is where local competitive bidding could save gazillions for Medicare ... and likely impact the private market.

    Thanks for posting that,

  • jelabarre||

    Allow employers/unions to assist in funding health care saving accounts, or allow them to just increase wages.

    The whole process of healthcare savings accounts is just set up wrong. The whole "use it or lose it" mentality prevents you from putting a little extra in it during good years in order to give you a buffer for off years. You should be able to roll-over savings, especially as you get older and may need more coverage. I suspect the only reason some pols wanted HSA's was so they could confiscate more ill-gotten gains.

  • SomeGuy||

    yea the whole use it or loose it seems super shady and a giant con by the government.

  • Michael Hihn||

    yea the whole use it or loose it seems super shady and a giant con by the government.

    There is no such thing for HSAs. Never was. Rollovers are fiine, There is no rollover for FSA's (Flexible Savings Accounts) This link shows the RESULTS of a Google search on HSA rollover details. Pick your own source.

  • SomeGuy||

    ah yea FSAs thats what i had. I almost never used it because its shaddy as fuck.

    I used it once when ex wife was guaranteed to get an eye surgery other wise i never touch it.

  • Michael Hihn||

    I didn't read it, but I did double-check the HSA rollover. Just the first sentence was phrased that FSAs had a very narrow objective.

  • Michael Hihn||

    You should be able to roll-over savings, especially as you get older and may need more coverage

    The original "savings accounts" -- under Reagan -- allowed the rollovers. They also had something Yvanka might like! There was a partisan balance. One could also have a tax-free account for childcare. The rollover was repealed a few years later.

    Problem is, the libertarian establishment (Cato/Mercatus/Reason) has too many windbags in policy positions, who know little about policy and even less about markets. Hey. they can raise a HUGE amount of money on slogans and soundbites alone.

  • gary47290||

    Prove that ACA premiums are the problem. The new reports I just googled suggest that medical inflation is similar for ACA versus employer provided health insurance. The real ACA problem is that it is exposing the inflation of medical care cost that has been hidden behind employer insurance and Medicare / Medicaid. The death spiral is the entire system, not whichever detail in ACA that you object to.

  • Michael Hihn||

    The new reports I just googled suggest that medical inflation is similar for ACA versus employer provided health insurance

    Prove it.
    Many of the same mandates apply
    And OVERALL medical inflation is known to have been a factor in Obama's shittiest-ever recovery. Do you know how to adjust for that?

  • SomeGuy||

    mandates are the reason it costs so much. The total lack of choice is the issue.

  • Michael Hihn||

    Mandates REDUCE/offset the risk of guaranteed issue (pre-existing conditions) -- thus lowering rates (for guaranteed issue)

    Health insurers offered that as a deal - just after Obama's election. A mandate in exchange for guaranteed issue. It failed (as a deal) because the penalty is too low -- exactly how Obama campaigned AGAINST the mandate in 2008.--until Republicans forced him to cut the final backroom deal with his far-left wing, Rockefeller Democrats.

    If voters knew what Republicans were offered --- and refused (to hurt Obama) -- voters would hang them from lampposts -- with piano wire instead of rope.

  • SomeGuy||

    mandates raise rates...you fail basic understanding of how insurance works.

    I can get cheap car insurance if i have limited insurance coverage. The rates go up as i added more protections.

    I would never buy an insurance that covered expensive mental health, and other pointless shit I would never use even if i needed it because i think they are a waste.

    That would drastically lower insurance risk and my premium. I don't care if i am 60 years old and my risk of cancer was high. I still wouldn't want coverage for it because it is expensive and something i am okay with if i die.

    Just like I wouldn't buy term life insurance at 70 years old. It isn't worth the premiums for the benefit. I do buy term life insurance in my 20s because its cheap and if i do die my family is set.

    I am not required to buy life insurance and i am not required to buy certain riders that raise my rates that i dont want.

    mandates lower the cost for people who benefit from those mandates and screw people over like me. So take your socialistic statist trash and shove it up your ass.

  • rkoffler||

    Insurance premiums increase because healthcare costs increase. This is obvious to most, but somehow the conversation continues around premiums as if commanding-and-controlling them will solve the underlying problem.


    The key statistics are: 5% of the population consume 50% of the national healthcare spend, and 15% consume 85%. Why? Because patients scream that "money is not an object" when it isn't their money. Single-payer won't solve the problem, just stick future generations with a many-trillion-dollar liability.


    Unfortunately, there is zero political courage to undo decades of laws and regulations that created this mess. I am pessimistic that we'll see the problem solved. It will go single-payer and after a few years no one will remember how it was before, thus adapting to the new normal.

  • SomeGuy||

    exactly, lack of competition and too many regs/mandates. Epipens are a prime example!

  • Michael Hihn||

    The key statistics are: 5% of the population consume 50% of the national healthcare spend, and 15% consume 85%. Why? Because patients scream that "money is not an object" when it isn't their money. Single-payer won't solve the problem, just stick future generations with a many-trillion-dollar liability.

    Wrong conclusion. Those usage patterns have nothing to do with "money no object."

    They explain WHY we have the world's highest healthcare costs. That 50% is life-extending procedures, Mitch Daniels is the only politician to say it. We're the only place that will spend $250,000 or more for as little as six month of life. That confuses the goobers. Nobody KNOWINGLY does that for as little as a few months. Much of it adds many years.

    In 2008, Obama beat Hillary running as a centrist on healthcare -- which is why Bernie lost. Obama described, as a problem, his own grandmother. She got a costly hip transplant when she was terminal cancer, then died a few months later.

    The numbers have changed, but this has been a known problem for over 20 years. I first saw it when I was covering HillaryCare.

    Many goobers say "let her die" which is what the single payer countries do. We call it rationing.

  • SomeGuy||

    or maybe in a free market people die because they don't have the money. That is how life works you statist shit. Rationing only exists when the government or someone else controls health care.

    In a free market you buy what you want and if you cant afford it life does what life does and you die.

    Your the one who supports theft and entitlements like a bernie sanders supporter.

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