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Trump’s Misleading Statement On Obamacare Is a Sign That Republicans Have No Idea How to Talk About Health Policy

Instead of justifying the GOP position on pre-existing conditions, Trump and other Republicans are trying to confuse people.

With the midterm elections approaching, Obamacare's pre-existing conditions regulations have become the focus of numerous House and Senate races, and this morning President Trump weighed in, tweeting that "Republicans will totally protect people with Pre-Existing Conditions, Democrats will not! Vote Republican." It is a statement that is designed to mislead, from a politician and a party that no longer knows how to discuss health care any other way.

Trump has made statements along these lines on multiple occasions. He follows other Republicans who have made similar claims, with some even going so far as to run campaign ads insisting that they support plans to regulate how insurers must treat individuals who have been sick.

Polaris/SIPA/NewscomPolaris/SIPA/NewscomComing from most Republicans, this is a kind of obfuscation, intended to create the perception that they support the health law's suite of insurance regulations as they are.

This is typically not the case: While many Republicans voted last year for bills that would preserve Obamacare's requirements that insurers sell to everyone and not exclude pre-existing conditions, those were Obamacare repeal bills that typically would have let insurers charge more or imposed waiting periods. Other Republicans have pointed to their support for legislation that would require insurers to sell to everyone, but would allow them to exclude coverage for pre-existing conditions.

It may be possible to justify any of these positions in full or in part, since Obamacare's pre-existing conditions rules impose real costs on insurance coverage, and are responsible for a significant portion of the individual market premium hikes we have seen in recent years. The problem, as I wrote last week, is that's not what Republicans are doing. Instead, in response to allegations that they want to weaken the health law's regulations, they are implying that they support the pre-existing requirements more or less as they exist now, under Obamacare. Although there is a veneer of truth to their statements, the intention is to allow for politically convenient confusion about what Republicans actually support.

Coming from Trump, however, it is more like a lie. Earlier this year, the White House made the unusual decision not to defend Obamacare's pre-existing conditions rules in court, arguing instead that they should be severed from the rest of the law. The administration's decision, which came in response to a long shot lawsuit from a group of red state attorneys general challenging the entire law, is legally dubious, with some legal experts who have sided against Obamacare in previous court battles calling the White House position unsound. But sound or not, the Trump administration's official position in the courts is that Obamacare's pre-existing conditions rules should be struck down.

It's true that Trump is not technically saying that he supports guaranteed issue and community rating—the two major pre-existing conditions rules under the Affordable Care Act—only that Republicans support protecting people with pre-existing conditions. But Trump's policy knowledge can be described, at very best, as cursory; rarely, if ever, is he so precise as to name particular regulations. And the GOP's recent defensiveness came in direct response to criticism from Democrats arguing that Republicans don't support the rules as they exist under Obamacare. Trump's statement, like similar statements from other Republicans, is an implicit response to the charge that Republicans don't support the pre-existing conditions rules that exist under current law.

Trump and other Republicans could, of course, make a clear case against those rules, arguing that they distort insurance markets and raise costs for everyone. They could argue that Republican changes to the health law that have been branded sabotage have resulted in lower insurance premiums, more plan choice, and no significant change to the overall uninsured rate. Instead, they have adopted rhetoric that is designed to confuse people about their position regarding health insurance regulations.

On health policy, this sort of deliberate muddling of the issue has become par for the course for Republicans. One of the most striking things about last year's repeal-and-replace effort was how little effort the party devoted to explaining or defending the plan. Even more remarkable (if not exactly surprising) was how little President Trump seemed to know about what was in the plan—his first major policy initiative as president—or how it worked. At this point, it would be notable if Republicans made a concerted effort to describe and defend their health care ideas accurately.

Doing that, however, would require both rank-and-file Republicans and Trump to know and understand just what sort of health policy regime they actually support, and there is little evidence—and plenty of counterevidence—that this is a party goal.

Thus, the consistently evasive statements on health policy by GOP politicians serve a dual purpose—allowing them not only to mislead ordinary voters, but themselves as well.

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  • chemjeff radical individualist||

    Well, Republicans made it this far lying their asses off to their own voters on how sincerely they were going to repeal ObamaCare. They never did have any semblance of a realistic plan. It was only "cut money from Medicaid, in the future - maybe - but we promise to follow through with it this time, unlike all the other times that we reneged on our promises to cut spending, but don't worry, we will keep all of the 'good parts' of ObamaCare so you can't call us mean and heartless, and for that, we deserve to be recognized for keeping our promise of 'repealing ObamaCare'".

    So I guess they are just keeping the same tactic going. No real plan, no vision about what they think health care ought to be like, other than "Democrat-lite level of a social welfare state", but they will promise to keep the goodies that they think their voters care about.

  • Nardz||

    Democrat lite is still better than going full democrat

  • chemjeff radical individualist||

    I vote for none of the above.

  • Just Say'n||

    I don't think anyone believes that any more than if John had said the same

  • BYODB||

    I think it's pretty obvious that Jeff probably isn't old enough to vote anyway, and if he is he's firmly in the age demographic that doesn't.

  • chemjeff radical individualist||

    Well most around here are Republicans, sure, so *they* don't believe in voting for none of the above.

  • Just Say'n||

    You're right. John doesn't pretend like he's not a Republican, yet you continue to pretend as if you're not a progressive. Which is laughable

  • BYODB||

    I think most people around here just seem like Republicans because you're just that far to the left, Jeffery.

  • chemjeff radical individualist||

    So how exactly am I "that far to the left"? Which specifically leftist positions have I advocated for?

  • BYODB||

    Open borders just off the top of my head.

  • chemjeff radical individualist||

    That's a libertarian position.

  • loveconstitution1789||

    Open borders is not a Libertarian position.

    Americans choosing to have relaxed immigration IS a Libertarian position.

  • BYODB||

    It's also the position of the far left, coincidence?

  • chemjeff radical individualist||

    So is that your only standard by which to judge someone as "far left" or not? Open borders? Out of all the million issues out there, that is the single solitary one by which one is judged to be "far left" or not?

    Well it is just as I figured, the epithet of "leftist" or "progressive" has become a general-purpose slur that just means "doody-head", much like the accusations of "racist" or "fascist" have become coming from the left.

  • BYODB||

    No, you asked for one position and I gave it to you. Your 'defense' consisting of it also being part of libertarianism, which is of questionable 'right / left' leaning and a position that is notably impossible in any realistic scenario regardless of who espouses it.

    Frankly, I don't keep a notebook of all the stupid things you've said. If you want a liturgical recitation go read your own posts.

  • chemjeff radical individualist||

    No, I asked for positions. You gave one and that's it. And just be honest, that is the only one that matters in your mind. I could be the biggest opponent of the welfare/warfare state and you would still declare me to be "far left" because I also favor the free migration of people. I'm not on the far left and I'm not on the far right, when judged by any fair standard. You however don't mind throwing out "far left" as some insult against an erstwhile ally just because I disagree with you on this one issue. What exactly are you doing here at Reason again?

  • vek||

    Your real problem, Jeff, is that you have the "virtue signalling disease." You can't help but act all bleeding heart about a bunch of dumb social crap that the left has a major hard on for. With some of the issues it's not even your actual position, but HOW you go about defending it, how you emote versus reason, etc.

    I don't mind The Gays buttsekksing themselves, but the way I would defend that position is radically different from yours.

    Don't worry though, the Reason staff does it just like you! They don't actually defend libertarian principles most of the time anymore either, they just frame everything as some emotional appeal to peoples morality... Just like the left!

    Sometimes it's not what ya do, but the way that you do it. And THAT is why I would say you're an emotional thinker, hence proggy tainted, in your views.

  • Mcgoo95||

    Jeff is actually the only one in this thread using logical arguments. Now run along all you little Real Libratarians, you don't want to be late for 6th period! Come back to Reason when you can articulate objectively.

  • Vince Smith||

    Open borders with a welfare state is absurd.

  • Weigel's Cock Ring||

    "Republicans" didn't lie. John McCain, an even bigger sorry ass piece of crap than you are, lied.

    I just wish there was actually a hell so that McCain could be suffering miserably there.

  • JFree||

    Be careful what you wish for. What makes you think you won't be joining him to spend eternity with him there?

  • Ordinary Person||

    Because God is a psychopath.

  • loveconstitution1789||

    There is no God.

  • BYODB||

    Let us of course ignore that Republicans didn't win big enough to actually repeal without some Democrats. Recall that it was passed with a supermajority without a single Republican vote? Well, guess what Republicans would need to repeal it.

    It's a thin excuse, all it really means is that most people want to destroy the health sector even if they have no idea that's what will happen with their preferred policies. I thought the 14th amendment prohibited state takeover of healthcare, but it seems it's not as much of an impediment as previously thought.

  • chemjeff radical individualist||

    I know I know. They deserve credit for trying, right?

  • loveconstitution1789||

    Stopping the media lies about GOP not wanting to repeal ObamaCare when they cannot because they need Democrats, would be a good start.

  • BYODB||

    Maybe they do, maybe they don't, but I'm curious why you're pissed at the party that had nothing to do with the debacle in the first place. What, you're mad at them for not repealing legislation they are incapable of repealing due to procedural hurdles? Ok.

  • chemjeff radical individualist||

    What, you're mad at them for not repealing legislation they are incapable of repealing due to procedural hurdles? Ok.

    They had a majority, you know.

  • TuIpa||

    And?

  • BYODB||

    So here we have an explicitly admission that you have absolutely no idea how government works. So, yes, a high school student or just started college.

    For your edification, I suggest you take a class on government and actually pay attention when they talk about supermajorities.

  • chemjeff radical individualist||

    You're right, BYODB. Those Republicans were absolutely powerless to get rid of the filibuster so that they could get rid of ObamaCare. Those wascally Democrats thwarted them again!

    And even if they did blow up the filibuster to do what they campaigned on doing for EIGHT FUCKING YEARS, what they claimed over and over again was a socialist government takeover of health care, the bills they would have passed wouldn't have actually repealed ObamaCare in the end. Those damn Democrats, forcing Republicans to write bills that didn't do what they claimed to want to do for eight years!

  • TuIpa||

    So... you're bitching about Republicans because they didn't blow up one of the checks on their power.

    Sounds about right.

  • BYODB||

    I'd suggest, once again, that you read a book on government Jeff. You're digging yourself to China.

    Republicans literally did not have the votes to repeal the ACA. I don't care how you try and spin that, it's the truth. Attacking the only party who will even give it a try is retarded, since the Democrats are pivoting to single payer and a government takeover of the healthcare industry.

    Put that in your pipe and smoke it.

  • Vince Smith||

    There was a vote on Obamacare in which there was no filibuster allowed; it was part of reconciliation. McCain, Collins, and Murkowski voted "no" and ruined everything. So blame them. Don't blame everyone else who voted "yes."

  • Moo Cow||

    What procedural hurdle?

  • Just Say'n||

    Radical collectivist, why are you so concerned with pre-existing conditions? Is there some make believe totally libertarian, and definitely not just progressive, rationale for complaining that one party is not being honest in their lack of support for pre-existing condition mandates?

  • BYODB||


    Radical collectivist, why are you so concerned with pre-existing conditions?

    Great nickname for drugged Jeff, and also a good point regarding pre-existing conditions. What I'd like to know is why people think that insurance should cover known and continuing costs. Usually, we'd call that a finance plan.

    You can not insure against a certainty. That isn't insurance, so what this reveals is a gross misunderstanding of what insurance actually is as a base concept. It's pathetic that this is such a widespread misunderstanding, too, given that almost everyone has an insurance plan.

  • Just Say'n||

    True. Suderman should really not have this beat. He's performed disgracefully on the topic. He's to the left of Will Wilkinson on this topic, which basically puts him somewhere closer to Bernie Sanders than even Barbara Boxer

  • BYODB||

    Agreed. Guaranteed issue and community rating are cyanide to a health system but people act as if that is the base requirement for the system. That doesn't end well for anyone, but I guess at least the upper middle class and the upper class can both simply leave the country for their healthcare needs after they crash the American system into a ditch.

  • magellannh||

    Obamacare's preexisting condition rule affects 9 million people while an identical ERISA rule, which bars employers from charging people with preexisting conditions more for their insurance, affects 140 million people.

    If conservatives truly wanted to get the government out of healthcare, wouldn't it make more sense to fight for a repeal of the rule that affects 141 million people rather than the one affecting 9 million people?

    The fact that I haven't heard a single conservative call for the repeal of this ERISA rule makes me think their position is driven more by hatred of Obama than principle.

  • BYODB||

    The fact is that most 'conservatives' don't understand insurance or healthcare any more than 'liberals' do. That's because most people only talk about liberal and conservative in relation to their social views, rather than it having much to do with fiscal issues.

  • Microaggressor||

    Health insurance has been transformed into finance plans at this point. Of course people want to use their insurance for known costs. It's a tax evasion scheme and nothing more. As long as we have these tax carvouts you're going to keep seeing this behavior.

  • magellannh||

    I hear this repeated a lot, but it's dead wrong.

    I'm self employed and my Obamacare policy has a $5k deductible and costs me around $8k per year. I don't have any preexisting conditions and don't get any subsidies.

    What makes you think this isn't insurance and instead is some kind of finance plan?

  • Jerryskids||

    It may not be *your* finance plan, but you're financing *somebody's* healthcare.

  • D-Pizzle||

    ^This^

    What most people don't understand about Obamacare is that those without preexisting conditions are paying for the preexisting conditions of others. This is the foundation upon which Obamacare was built.

  • magellannh||

    Isn't that exactly how insurance usually works?

    I'm healthy now, but if I get sick, my insurance will pay out. Since so far this year I've been healthy, my premiums went to paying for other peoples' care.

    I understand some people have preexisting conditions and they do get a better deal than me, but there actually aren't very many preexisting conditions that cost more than $5k per year. So even those people will usually end up paying a lot in premiums and not getting anything in coverage (since they don't hit their deductibles).

    Most preexisting conditions like high blood pressure, diabetes, heart disease cost just a few thousand dollars a year to control. Now sure, these people get a much better deal on insurance than me, but it's still usually insurance, even for them.

    In most years, they'll spend $8k in premiums and pay a few grand out of pocket for medical care since they don't hit their deductible.

  • BYODB||


    Isn't that exactly how insurance usually works?

    No, but it does reveal that you're another person that doesn't understand how insurance works. You can't insurance against certainties. Otherwise, you'd be able to get cheap tornado insurance in Kansas without government subsidy.

  • Stephen Lathrop||

    BYODB, on a policy basis—taking the entire population into account—there aren't any certainties. The only sound public basis for health insurance policy is to start before birth, not knowing what conditions may ensue. On that basis, few if any pre-existing conditions are certainties—maybe a very few genetic diseases. It's perfectly sound national insurance policy to treat every "pre-existing condition" as an unexpected occurrence, because in almost every case, each of them was in fact unexpected before it occurred.

    As more insight into genetic contributions to disease accumulates, that "unexpectedness," may diminish somewhat. Doesn't matter. That just becomes an argument to socialize the costs of those obviously-unavoidable occurrences. There could then be some ethical and moral questions to confront, regarding compelling private choices for the sake of general fiscal advantage.

    I suggest you may understand one aspect of the insurance business (underwriting), better than you understand how insurance works in a more general context.

  • Nardz||

    "but there actually aren't very many preexisting conditions that cost more than $5k per year"

    You serious?
    Ever here of dialysis?
    How about cancer?

  • magellannh||

    I have a friend who had cancer and we've talked about this. The year they were treated, it cost over $100k ($30k for surgery, $30k for radiation, and $40k for chemo). However, that year they could get insurance without preexisting conditions. So that $100k is off the table.

    Now they have follow up appointments with an Oncologist twice a year costing about $500. In addition, they get blood work and imaging done once a year for another couple of grand.

    So unless the cancer comes back, which I think is about a 10% chance, they'll never hit their deductible.

    I have another friend that needed a heart stent in his 50s. Again, he was an avid cyclist in excellent condition before the heart attack. The surgery and testing that first year cost almost $200k I think. But now he just spends a few thousand a year on meds and a single visit to his cardiologist every year.

    Now sure, you'll be able to find cases where people have tens of thousands of known preexisting expenses every year. IMO, that's really the exception, not the rule.

  • BYODB||

    It might be dead wrong for you, but look at what many are clamoring for insurance to cover. Things like birth control are known and continuing costs, yet people want their health insurance to cover it. That isn't at all what is typically known as 'insurance'. That's just one simple example, but things like routine M.D. visits (I.E. preventative care) are also covered which is, of course, more or less the same thing as the birth control argument.

  • magellannh||

    Point taken, but as I understand it, all the preventative stuff and birth control just add a few percent to premiums. Now sure, I'd like to be able to keep that money, but it really isn't very much in the grand scheme of things.

    Even with the mandated coverage stuff, the only thing I'd jettison if I could is the mental health benefit. That too is relatively small potatoes. Again, I'd like that money in my pocket, but it's not huge compared to the $8k I'm paying in premiums.

    I think on average we spend $8k per year on medical care for Americans between the ages of 18 and 65. So it's not a surprise that my premiums are where they are.

    Reasonable people can disagree about the Obamacare mandates, but it seems important to keep things in context and realize that all this outrage is over 5-10% of premiums.

  • loveconstitution1789||

    Cash for minor medical stuff and catastrophic health insurance for major stuff.

    Your premiums are what they are because of lack of market pricing for medical services, insurance does not always act in your best interests, and government socialized medical insurance schemes.

  • BYODB||


    Point taken, but as I understand it, all the preventative stuff and birth control just add a few percent to premiums.


    Perhaps if those were the only parts of insurance that cover known continuing costs, but those are the tip of the iceberg of problems. Mandated minimum coverage and a plethora of other regulation work in tandem to inflate costs. Even the people who put the ACA together knew that the program could only serve to inflate costs. That isn't even a question, but what is a question is why they would frame the ACA as a method to control costs.

  • magellannh||

    I agree that the cost control provisions were just window dressing. That said, I'm basically fine with that because I'm not a big fan of government price controls.

    The thing is, public opinion is now very strongly moving toward some sort of medicare for all plan. That would be a huge mistake and would pale in comparison to the evils of Obamacare.

    Obamacare's individual market rules affect just 9 million people or around 5% of the US population. People fighting to repeal Obamacare are going to end up getting us saddled with a medicare for all plan that'll mess with everyone's medical care.

    Personally, I think the general framework of Obamacare is workable and can easily be tuned to handle the tiny 5% of people in the individual market. The Republican approach should be to leave the basic Obamacare framework in place, negotiate some reasonable tweaks to the coverage mandates and regs with the dems, and declare the US health care problem solved.

    That's the best and lowest risk strategy for Republicans going forward.

  • loveconstitution1789||

    No. Media propaganda is strongly moving toward some sort of Medicare for all plan.

    Big difference.

  • BYODB||


    I agree that the cost control provisions were just window dressing. That said, I'm basically fine with that because I'm not a big fan of government price controls.

    Then it's sort of bizarre that you'd be in favor of a program that creates government price inflation, no offense. Especially when cost control was the reason it was supported by most at the time.

  • Vince Smith||

    Government price controls are bad. Government interference creating inflated prices is also bad.

  • Stephen Lathrop||

    BYODB, your arguments against coverage for birth control and preventive visits must confront counter-arguments that both coverages reduce insurance claims overall, by more than the cost of the premiums. If true, that would make requiring those coverages sound public policy. It will take more than mere assertion to dispose of that.

  • UnrepentantCurmudgeon||

    OK, but birth control is not a "preexisting condition", nor is it particularly expensive. So that's not an issue. And many conditions can be treated relatively inexpensively; I take meds for diabetes, high blood pressure, hypertension and bipolar II disorder. My diabetes is under control and I have had no incidents of the other conditions in several years. So treatment for my "preexisting conditions" is a negligible cost even though it took a waiting period before my insurance would cover it (that was a drag).

    There are expensive preexisting conditions, for example, a diabetes patient undergoing dialysis. That sort of thing is the rub. And it is correct to say that covering such a thing is not insurance but something closer to compensation, and it is (or can be) a huge expense. So the question is: are we willing to spread the cost over a population or do we insist that the cost be borne by the person suffering the condition? Most individuals cannot afford the cost, so I tend to lean toward the former though I understand the opposition.

    I would also say that this should not be an issue to be resolved along party lines inasmuch as it is a society-wide issue in that sooner or later it will affect people on all sides. Surely there are enough grownups in the Executive and Congress who can work together toward a resolution.

  • CLM1227||

    I think the lack of transparency in health costs to the public make it more difficult to plan for. Though pre-existing conditions should come with some predictability in cost due to repeated exposure, paying a different company to negotiate "60% of medical costs" seems somewhat reasonable.

    I like the new concierge option some doctors have created - pay a monthly membership fee for discounts on care in their offices. Seems like a better method than insurance at this point.

  • JFree||

    Well - the best insurance coverage in the world won't actually do a damn thing to deliver medical care or positive medical outcomes.

    This whole argument about 'pre-existing conditions' is about how/whether sick people have access to doctors/nurses. Or should be. I'm not sure how stupid one has to be (one both sides) to pretend that the argument is really about whether sick people have access to insurance salesmen.

  • Stephen Lathrop||

    JFree, as a patient with no access to an insurance salesman, the customary market practice in the hospital business is to charge you multiples of what an insured patient would pay for the same procedure. It doesn't seem stupid to want to avoid that.

  • Weigel's Cock Ring||

    Status quo collectivist is far better and more fitting for him than radical collectivist. He's one of the biggest apologists for the status quo we have around here.

  • chemjeff radical individualist||

    Radical collectivist, why are you so concerned with pre-existing conditions?

    Where did I say that I was?

    Is there some make believe totally libertarian, and definitely not just progressive, rationale for complaining that one party is not being honest in their lack of support for pre-existing condition mandates?

    Yes yes I know, circle the wagons around Team Red because they're not as bad as Team Blue, amirite? Sheesh this type of crap gets old around here.

    Why won't you bring yourself to criticize Team Red's abysmal behavior when it came to their completely disingenuous behavior with regards to ObamaCare? They campaign for 8 FUCKING YEARS on wanting to repeal it, and then when they get the chance, the best they can do is "uh uh let's not dismantle anything let's just send it all to the states to deal with, but only if you re-elect us to make sure the Democrats don't undo our fake repeal, oh and by the way, we're not really repealing most of the core regulations of ObamaCare, you know, the ones that we yelled for years and years was tantamount to 'socialism' and 'government takeover of health care', we're gonna keep most of that 'socialism' in place while we wrap ourselves in the flag and pretend that we are the pro-free-market party". I mean, does any of this get any criticism from you? Any at all?

    They LIED THEIR FUCKING ASSES OFF. They have no clue on what to do.

  • TuIpa||

    "I mean, does any of this get any criticism from you? Any at all?"

    It might, but your incessant continuous bitching about them and only them kind of obviates the need for it.

  • Just Say'n||

    "It was only "cut money from Medicaid, in the future - maybe - but we promise to follow through with it this time, unlike all the other times that we reneged on our promises to cut spending, but don't worry, we will keep all of the 'good parts' of ObamaCare so you can't call us mean and heartless, and for that, we deserve to be recognized for keeping our promise of 'repealing ObamaCare'".

    This is also hilariously untrue. Their package would have made Medicaid a block grant program, much like what was done with welfare. Is it totes libertarian, and definitely not just progressivism, to oppose welfare reform now too? Are the cost savings from TANF also made-up?

  • chemjeff radical individualist||

    It would have made Medicaid a block grant program, maybe, sometime in the future, if they get re-elected.

    I'm not opposed to welfare reform. I'm opposed to giving people credit for fake welfare reform proposals.

  • Just Say'n||

    I believe the program was to take effect around 2020. It would have happened even if they weren't re-elected. Only if Democrats were to repeal the program would it have not been implemented. And that never happened with TANF, so I think it's safe to say that the odds of it happening with Medicaid reform would have been low as well

  • ||

    lol.

    The entire law is based on a LIE.

    Hello.

  • Vince Smith||

    Why can't Republicans campaign on "We're going to take away your free stuff. Free stuff means government had to steal from others. You're selfish for wanting free stuff. Now grow up and learn to take care of yourself."?

  • Vince Smith||

    Sorry for basically posting the same thing twice. I didn't see my comment appear, so I thought that the website didn't post it. Can I delete comments here?

  • Vince Smith||

    Why can't Republicans campaign on "We're going to take away your free stuff. Getting free stuff means the government had to steal from other people. You're selfish for wanting free stuff. Now grow up and learn to take care of yourself or ask family, friends, and charity for help."? The honesty would be refreshing.

  • Idle Hands||

    Why do they need a plan the ACA overhauled the industry and fixed all our problems.

  • Idle Hands||

    In all honesty the best thing these fuctards can do is nothing, anything they do will exasperate the problems and has an 80% chance of fucking sucking.

  • VinniUSMC||

    What would we do without the mind readers at Reason?

  • Just Say'n||

    Can anyone explain to me why an ostensibly *libertarian* commentator is so obsessed with keeping pre-existing conditions in healthcare reform?

  • loveconstitution1789||

    Easy... Suderman aint Libertarian.

  • Ken Shultz||

    The Republicans in the Senate had a bill under consideration that cut pretty much everything out of ObamaCare except the preexisting condition exclusion, and, even better, it cut $1.022 trillion in direct spending--$770 billion of it from Medicaid.

    https://www.cbo.gov/publication/52849

    The Republicans in the House had already passed a bill that cut even more spending.

    Suderman opposed that bill because of what it didn't do and because if congress cut spending, future congresses might reinstate it.

    It was fucking retarded, and I haven't forgotten.

    Paul Ryan's and Mitch McConnell's commitments to cutting spending and getting rid of as much of ObamaCare as possible make Peter Suderman look like a fraud.

  • Just Say'n||

    Pretty much. It's amazing how fast "bleeding heart libertarians" quickly morphed to "liberaltarians" to now just basically progressives. And yet we are suppose to pretend as if that is not the case.

    Suderman provided no cogent argument for what was wrong with every single repeal bill that he opposed, beyond the fact that he takes a progressive position on healthcare.

    This guise of pushing progressive policy while pretending as if perhaps, at some time, maybe we may consider, perhaps cutting some aspect of the welfare system is getting really tiresome. But, that's how conservatives like Suderman think.

  • vek||

    The divide between libertarians is the same as for typical left/right folks... It's the difference between people who FEEL things versus people who THINK things.

    Reason has been taken over by people who FEEL things should be a certain way, because of XYZ reasons they cook up to support their case. This is why they usually don't even bother to use underlying principles to defend anything even when there is such a case to be made... Rather they appeal to morals, or emotion.

    I can't stand people who emote versus reason. ESPECIALLY not when they're writing for a publication called REASON FFS!

  • loveconstitution1789||

    That is the new Lefty trick. Oppose a budget cutting bill because "it does not cut enough'" or because some future Congress will reinstate the spending.

  • loveconstitution1789||

    And when I say "trick", I mean what whores do for money.

  • chemjeff radical individualist||

    Paul Ryan's and Mitch McConnell's commitments to cutting spending and getting rid of as much of ObamaCare as possible

    BWAHAHAHAHAHAAHAH

    You actually could type that with a straight face? You *sure* you're not just a shill for Team Red at this point?

    Their repeal bills did virtually nothing to repeal the regulations for ObamaCare. All they did was almost pass a bill to pretend to cut spending some time in the future, but only if you re-elect them.

    It was not a "repeal ObamaCare" bill. It was a "pretend to repeal ObamaCare but really try to get Republicans elected by claiming to have repealed it and then scaring voters to the polls in 2018 and 2020 that if they don't vote for Republicans, the Democrats will undo their fake repeal".

    If ANY DEMOCRAT had tried to pull such a trick, you would be mercilessly criticizing them for their lies and duplicity. But yet if a Republican does it, they deserve credit for trying, amirite?

    THEY LIED TO YOU. They never wanted to repeal ObamaCare. They lied to all of us for 8 fucking years. It was all just a con to drive voters to the polls. "Vote for us and we will repeal the socialist government takeover of health care!" Then when they actually got the votes, they were caught like deer in the headlights with no plan on what to do, other than to just try to continue the con a little bit longer.

  • Just Say'n||

    They lied and yet they had four bills (which Suderman denounced every single one) that couldn't pass due to two representatives.

    Drop the act, already. We get it. You're a progressive.

  • chemjeff radical individualist||

    NONE of their four bills did what they campaigned on. NONE of them actually repealed ObamaCare.

    I'M a progressive for criticizing Republicans for not following through on what they claimed to do? Wouldn't the progressive position be, instead, to be GRATEFUL that Republicans never meant what they said?

    Stop shilling for Team Red and stop defending them whey they lie to your face.

  • BYODB||


    NONE of their four bills did what they campaigned on. NONE of them actually repealed ObamaCare.


    That's because Republicans did not, and still don't, have the numbers to actually do that. Seriously, you need to read a book on government because when you say things like this it really makes it obvious how little you know about literally any subject.

  • chemjeff radical individualist||

    That's because Republicans did not, and still don't, have the numbers to actually do that.

    So Democrats forced Republicans to write bills that didn't do what they campaigned to do for eight fucking years. Good Lord stop making excuses for them.

  • efreet||

    "So Democrats forced Republicans to write bills that didn't do what they campaigned to do for eight fucking years. "

    I don't understand how you think this makes sense. You do the best you can, and if that is what they had the votes for, it is what they had the votes for. It doesn't seem to be excuse making, just accepting reality.

  • BYODB||

    I didn't say that, try reading instead of emoting. It's not an excuse, it's the actual honest to god reason. It's sad you can't tell the difference.

  • chemjeff radical individualist||

    With voters like you, no wonder Republicans are so successful. You'll swallow almost any excuse from them on how the Democrats thwarted them yet again.

  • BYODB||

    It must blow your mind to know I've never voted for a Republican outside their primaries.

  • BYODB||

    And for the record, Republicans don't need Democrats to thwart them they manage to thwart themselves all on their own.

  • chemjeff radical individualist||

    Yeah right.

  • chemjeff radical individualist||

    And if you don't believe me, here is a summary of what Congress was considering in 2017:

    http://www.healthaffairs.org/d.....1127/full/

    What you'll see is:

    - Tax cuts now
    - Spending cuts later, maybe
    - A few token regulations removed
    - No changes to the major regulations of ObamaCare

  • loveconstitution1789||

    Hopefully the USA will work our way back to paying cash for all minor medical stuff and have catastrophic health insurance for major medical stuff.

    Cheaper for individuals and businesses and mostly gets the government out of health care.

  • magellannh||

    This is exactly what Obamacare is for most people on it.

    I'm self employed and pay $8k per year for a plan with a $5k deductible. I don't get any subsidies and don't have any preexisting conditions.

    I pay for most everything myself until I exceed $5k in medical expenses. If they dropped the rules about first dollar preventative coverage, I'd probably save $30 a month, so basically nothing.

    How is this not a catastrophic plan?

  • Just Say'n||

    And you think that not having enough government is the problem here?

  • magellannh||

    The only area I'd call for more government is that people should have to pay an initiation fee to buy into the system if they let their insurance coverage lapse.

    That would kill the free rider problem and makes more sense to me than a mandate, which punishes everyone and doesn't allow people to choose to opt out.

  • BYODB||

    Most people can't 'opt out' in either scenario.

  • Nardz||

    So you're paying $8k/year on top of paying your own medical bills?

    Seems expensive

  • magellannh||

    In America, the average person aged 18-65 consumes around $8k worth of health care.

    In my case, it seems that my premium plus my deductible is pretty close to the average expected cost of healthcare for someone my age.

  • loveconstitution1789||

    You would need to cite that because CMS cites women at $7500 per year and men at $5700 in 2012. In 2016 they list average at $10,348 per person.

    CMS stats medical spending

    I still say that these numbers are heavily skewed since this yearly average is based on more expensive insurance medical bills rather than patients paying cash and what their yearly average would be.

    I also think that super sick people with pre-existing conditions are driving those numbers very high.

    I have never spent over $1000 per year on medical expenses.

  • Stephen Lathrop||

    I have never spent over $1000 per year on medical expenses.

    Wait a while. You will still be you when you start to bust the bank.

  • loveconstitution1789||

    You pay a monthly fee for medical care that you dont need.

    It would be far cheaper to pay $60 a month for catastrophic medical insurance and less than $1000 cash per year in doctor visits, lab work, etc.

    If you have a heart attack or cancer, your catastrophic health insurance would cover most of that tab.

    Medical insurance covering routine doctors visits and birth control would be cheaper if you paid cash.

  • magellannh||

    Again, the average cost of medical care for an American between the age of 18 and 65 is $8k. For someone my age it's well over $10k.

    It's completely unrealistic to think an insurance policy with comprehensive coverage could cost $60 a month. I've been buying my own individual insurance for over 15 years and I used to spend a lot of time shopping for insurance before Obamacare. The $60 a month policies were always sham insurance for idiots who couldn't read. I've looked at the fine print for every one of them I could find looking for a deal. There was always a catch. The most common catches were things like a $20k cap on total benefits, exclusion of drug coverage including cancer drugs, exclusions on outpatient treatments of any kind.

    Basically, the $60 a month policies were more like prepayment plans. They paid for a couple of stupid visits to the doctor a year for a flu and that's about it. If something serious ever went wrong, you'd be high and dry.

  • loveconstitution1789||

    I have great catastrophic health insurance. I pay cash for all minor stuff. I dont worry about my plan not covering over $200k in expenses because I will either pay cash or check out. There is not way in hell that I am having $500k spent on me to maybe live. Fuck that. If I get cancer, I do the cheap plan and then if that doesnt work, take my dirt nap. Everyone is so scared to just die already.

    Some of those catastrophic plans were utterly gutted because of ObamaCare.

    You can always overlap catastrophic plans, ya know? Each plans has exclusions, so fit the best combo of plans.

    As for how much the average is for Americans, that number is clearly skewed since that is not what their actually medical costs would be with free market costs. The Socialized medical market being what it is, people still spend medical insurance money like drunken sailors because they need to get their money's worth.

  • vek||

    HSA my friend!

    Pre-tax money, tax free gains on investments, and you can get a wide variety of catastrophic plans to suit your tastes. Depending on your age etc, I bet a solid one would be in the $100-150 a month bracket.

    For anybody who ain't gettin' it for free from their employer, HSAs are THE ONLY way to fly.

    The thing about that average, is that it's bullshit. Almost NOBODY spends that in any given year. Almost all health spending is for people in the last few years of their life, or for a single expensive event or two spread over decades.

    The thing is, lots of people simply DIE when that one big expense finally comes along. So if you just invest that cash, which is yours, in that HSA, you will likely never need to spend it, or it will turn into a giant nest egg and you'll blow it all at the end. Either way you're saving on your monthly payouts the whole friggin' time. If you happen to just die, at least your heirs get a pile of cash to keep.

    So it's basically got no downsides, and potential upside if you never get sick, or don't get sick until the very end.

  • Dillinger||

    >>>It is a statement that is designed to mislead, from a politician

    forgets lies OCare pitched on, or lives under rock?

  • MikeP2||

    Obamacare created a new political third rail, establishing 'entitlements' that voters won't give up. Hence the messaging issues from the GOP. It's next to impossible to take away entitlements once they are expected.

    Perhaps more articles on the unbelievable travesty that is 'Obamacare' and the havoc it has wrought upon our healthcare system would be in line with what a 'libertarian'-minded site should be expected to focus on. There are almost zero libertarian ideals in Obamacare and everyone here should be wishing for it to end.

  • vek||

    Why would Reason publish articles about "the unbelievable travesty that is 'Obamacare' and the havoc it has wrought upon our healthcare system"?

    Ooooh, you thought Reason was "a 'libertarian'-minded site." Yeah, no. Not anymore. So don't be expecting anything railing on the overall idea of Obamacare anytime soon. They might publish some articles about why the GOP is dumb for supporting pre-existing conditions, or heartless for NOT supporting pre-existing conditions. But don't expect them to tackle the big issue....

  • ||

    This article ignores the fact that everyone is lying.

    Insurance has been around a long time and is a well understood market driven device to create a risk-sharing pool of funds. There is no risk in covering pre-existing conditions where it is known there is going to be cost. The mandate is a cost-sharing device, an entitlement to the already sick.

    It's an entitlement you stupid bastards, quit lying about it. Democrats delight in the perverse incentives that entitlements create, and Republicans love to set up entitlements and then bash the seekers with a hammer.

    We are all well and truly fucked.

  • Stephen Lathrop||

    There is risk in covering pre-existing conditions, if you are talking about health insurance policy for everyone, starting before birth. On that basis, no one knows what to expect, and each condition is unpredictable at its onset.

    There is, likewise, enormous moral hazard in excluding preexisting conditions once they have been identified. Doing that just reverses the generally recognized hazard that if you let the already-sick sign up for insurance, you end up with an unworkable insurance pool. It's the same hazard the other way around. For some reason, many folks who don't want sick people gaming the system are fine when corporations game the system in exactly the same way, and just as much for their own benefit.

    The solution to both moral hazard problems is the same. Choose a system based on community rating, and universal insurance.

  • Rockabilly||

    Hey man, author. You want confusion. Try reading the IRS instructions for the beloved ObmamaCaresSoMuch.

    My hunch is that it increased paperwork for most everyone

    Lost time that could have been spent on something else, like harvesting my marijuana crop.

    https://tinyurl.com/y87e6a95

  • ||

    Republicans are dishonest talking about a law whose entire existence is based on faulty premises.

    Got it.

  • damikesc||

    Again, Dems arent expected to have answers to immigration. But the GOP is demanded to fix Obamacare.

  • fabian||

    Let's face it, if the pre condition clause stays, Obamacare stays at least in all its core principles. When the pre condition clause is included, you must make health insurance mandatory. Otherwise people will sign up only when necessary. If health insurance is mandatory, there must be a penalty or a cost for those who don't subscribe. Otherwise nobody will subscribe. Et voila, you've Obamacare redux. That's the problem the Republicans face because if they work to get rid of the pre condition clause they will certainly put themselves in a corner politically. For once, the left will have a real argument; they let people die in the richest country in the world!

  • loveconstitution1789||

    If you dont sign up for catastrophic health insurance early in life just in case you get super sick, then that is on YOU.

  • Echospinner||

    Charge is around $80 for a Tylenol in ED.

    Cost is on you.

    You are the target market.

  • loveconstitution1789||

    I assume ED is the emergency department?

    A single tylenol does not cost $80.

    Ask what things costs before approving the charges.

    Hospitals act inconveienced by asking what things cost but they kiss your ass once you say that you are paying in cash. They know that they are getting paid that day.

  • markm23||

    If a nurse gives you a Tylenol in the emergency room, it is quite likely to cost $80. You are paying for the doctor, the nurse, and the room - and for all the people whom the ER had to treat even though they were never going to pay for their treatment, and for the difference between Medicaid/Medicare rates and the normal rates for all the people who went to the ER under a government medical plan.

    I'm not advocating denying care while the hospital figures out if you can pay. I am advocating a quite different approach to poor people who misuse the ER for "free" care (with much higher costs for someone else than getting the same treatment in a doctor's appointment): instead of ripping off their paying customers, allow the hospitals to sell their uncollectable debt to the IRS as a collection agency. For the genuinely poor, limit what the IRS can do to collect, - no taking the housing voucher, e.g.- but allow tactics that discourage ever getting into that position again. Like they can drain the foodstamp account and bring the family a box of groceries, selectected to give the nutritional requirements at minimum cost.

  • Lester224||

    Wasn't a lot of the drive behind covering for pre-existing conditions based on scams? E.g. you would pay for expensive insurance which theoretically would cover a condition, like cancer. Then you got sick. When renewal time came around they wouldn't re-enroll because you had a pre-existing condition.

  • loveconstitution1789||

    Then dont sign up for insurance that does that.

    Start a co-op or charity for insurance.

    Free market means that YOU are responsible for making sure that your interests are covered.

  • vek||

    I believe that did in fact happen like a couple times, from a few companies... But it was never a major thing, just a leftist scare tactic. It was more a theoretical problem than an actual one.

    What was real was people waiting to sign up for insurance, and being denied because they were already sick... Or sometimes people who had to change insurance for whatever reason, changing jobs, becoming self employed etc, and then not being able to get a new policy, or the new policy being super expensive.

  • bernard11||

    "Misleading statement?"

    No. Call it what it is - a barefaced lie, and one that is being repeated by Republican candidates all around the country.

  • BioBehavioral_View||

    "An error lurking in the roots of a system of thought does not become truth simply by being evolved." -John Frederick Peifer

    The current, failing system of American medical delivery (misnamed "healthcare") cannot and will not improve through evolution. We must replace it with an entirely new system based upon Biobehavioral Science not politics, personal opinion, or abstract ideology.

    Excerpt from the recently released novel, Retribution Fever:
    G. Benefits for All
    Consider the benefits of a scientifically-based, scientifically-driven, detailed plan for delivery of universal, competitive medical care by the private sector characterized by the following attributes:
    1) Simple;
    2) Straightforward;
    3) Free of special taxes;
    4) Minimal regulations;
    5) Minimal bureaucracy;
    6) Free of fraud at taxpayers' expense; and
    7) Acceptable to insurance companies.*

    Achieving those attributes demands properly managed contingencies. Put into play, a well-designed, comprehensive plan for delivery of medical care can manage those contingent consequences properly — consequences governing the behavior of the four participating parties; namely, government, intermediary, physician or hospital, and patient. It can do so while benefitting each of the parties concerned via positive control.

    *The plan initially appeared in Healthcare Reform D.O.A. (1994; out of print). Unsolicited, it was nominated for two national awards by the academic arm of the American insurance industry.

  • AD-RtR/OS!||

    What is not confusing about the various plans dealing with "health care"?

  • Vince Smith||

    This is why I wish Rand Paul was president. He actually knows about the issues, especially this one. He is also articulate enough to explain libertarianism and free markets to the common man and get him to agree with them. Trump is just an idiot. What does he actually support on the healthcare issue?

    If Republicans keep control of the House and gain at least one seat in the Senate, they have the opportunity to once again repeal the ACA. Let's hope they do it if that happens.

  • cynicalretiree||

    Anyone who has intentions to help low wage earners with chronic or catastrophic illnesses,would create a better plan before repealing the existing plan. This president is maximum ignorant vs blatantly cruel.

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