March 14, 2017

"The implicit standard in analysis of the health insurance system is that every consumer must have government-selected coverage. But why?"

"This chosen paradigm doesn't take into consideration the most forceful motivation of human behavior, namely, whether a large expenditure of limited resources is in one's economic interest. This standard of 'universal coverage' is as artificial as the government's bloated health care costs. A young person with minimal health expenses is well served not to purchase one of these government-created insurance policies: their yearly medical expenses do not exceed the cost of their premiums and deductibles. With the rate Obamacare costs are skyrocketing, that pool isn't just confined to young people anymore. If an individual or family has to fork out tens of thousands of dollars before seeing health care benefits, what's the point? Why not save that money and when services are needed, pay directly to the care providers?"

Good questions asked by Liz Sheld at PJ Media.

I don't know what the answers are, but I'm suspicious of mainstream media for obscuring these questions, which were also obscured when Obamacare was passed. Healthy young people who'd been choosing not to buy insurance were needed in the pool, paying premiums, to make it possible for companies to be forced to take in and keep customers with pre-existing conditions. The pro-Obamacare propaganda continually presented insurance coverage as an end in itself, as if the individual is better off with insurance. But really the idea was more that the entire system of financing health care with private insurance companies is better off if more people participate — especially more people who don't have high current expenses — that is, the kind of people who, left to their own devices, are most likely to prefer to use their money to buy something other than insurance they don't think they're going to use.

It's a difficult scheme, and to pull it off, it seems that people need to be fooled. The key to the fooling — I think — is to speak in terms of how many people are "covered," not in terms of how many people are better off. Right now, it seems that many of the people who have coverage pay a lot of money for something they can't use. If they are not better off in that position, why are we supposed to feel bad if they get a reprieve from needing to pay a lot of money for something that has no value to them? I think the secret answer is: Because insurance companies need that money to keep paying the bills for the customers who do have expensive conditions, the people who are happy to get to pay premiums because they get back more than they put in.

I wish we could speak clearly and honestly about the real problems. I find the complexity — confused by partisan propaganda — horrible. And I am not dealing with a struggle to pay premiums or any serious health problems. I do not see how most people can be expected to engage with these issues other than to gravitate toward the propaganda of one side or the other and be scared.

178 comments:

tola'at sfarim said...

Bigger q is why Paul ryan,who surely knows all this and has already been accused of pushing grampa off a cliff, would be pushing so hard for ocare lite?

rhhardin said...

Catastrophic health expenses is a scare condition. it doesn't really come up much.

The scenario is that you get really really sick but don't die, which I suppose is possible but the insurance company is going to limit their own risks in that situation and may not cover more than you could have covered yourself anyway.

The remedy to fright is to look at all the ordinary risks of death in everyday life that you're quite comfortable to take, and just add this scare situation as another one.

If you're really poor, there's a tradition of pro bono that will cover a lot of stuff if it comes up.

Henry said...

The fundamental problem is that the government already has two programs to provide health insurance to the old and poor. They are financial disasters that cannot be fixed and no politician dares touch them. The ACA was an attempt to meet a need that already had programs to meet it while pretending that those programs didn't exist.

sojerofgod said...

"Occam's razor is never dull" -R.A. Heinlein.
I think if you follow the money, it will be the shortest path to the truth.
My opinion is that the money is all on the side of the
insurance companies, the hospital systems and Pharma. From what we have seen produced by Mr. Ryan it is clear he got the word which can be summed up as, If the gravy train stops at the station we are all getting off.
Thinking this through, you see about 6 or 7 large companies who have 90% of the health insurance market. Obamacare guaranteed them millions of new captive "customers" who were supposed to make good on the costs to cover bad risks. Now if the rules are changed where, as Trump publicly stated, the goodies of Obama care will not be withdrawn but the money to pay them will be, why not just walk away? I can imagine these CEO's meeting with Ryan et al, over lunch and telling him exactly that. Thus was the birth of Rynocare, an abomination slouching toward law.
No one is addressing the real problem, and they never have which is that Medicaid is about to be broke, along with Medicare and SS, because politicians have over promised (and spent) for decades while the birth rate for native-born citizens has plummeted so there is no one to pick up the check. Anyone who thinks unbridled immigration is about getting your lawn mowed is an imbecile.

rhhardin said...

Variable doctors' fees used to be an economics textbook example where market-clearing prices didn't apply.

The condition is that the service is non-transferable.

So you can charge the wealthy more than the poor and nothing bad happens.

traditionalguy said...

Socialism ought to be free. All that Obama's health insurance does is demand tax money up front and then eliminates itself with a $10,000 annual deductible. That is three card monte.

Private market insurance does much better...but it's not FREE.

The Obama Globalists just want to wreck the USA. Not a single one will ever vote for a successful outcome, because they want Trump to fail more than they want life itself.

Quayle said...

“I wish we could speak clearly and honestly about the real problems. I find the complexity — confused by partisan propaganda — horrible.”

The complexity is by design. It is a fog, crafted to hide the truth, which is really pretty simple:

The baby boomers, having throughout their entire lives insisted on receiving government services beyond their willingness to pay, and having therefore run up every form of credit to the max, of course leaving the tab for their children and grandchildren – these same boomers now want to wring out those last few drops of blood from their children and grandchildren, by forcing them to pay for the boomers' healthcare throughout the boomer’s peak healthcare consumption years.

Is there any other way to see it?

rhhardin said...

Derbyshire, who is certainly on the political right, thinks health care ought to be socialized in any case.

I guess this would limit the quality and quantity of care but how good does it have to be.

traditionalguy said...

What we need right now is a new Speaker of the House of Representatives. Ryan is a totally sold to special interests man.

Robin H said...

There is a huge financial illiteracy in this country. When people spend thousands of dollars a year to cover appliances they should be able to pay cash for, why are we surprised they think they need to have insurance to cover medical bills? Even with 2 small kids we only ever had catastrophic coverage. It was cheap and the money we didn't pay in premiums went to pay the doctors.

Someone said that the increase in healthcare costs was due to the involvement of insurance companies. Just look at the increase in vet charges now that there are pet insurance policies. I'm beginning to believe we need to get back to paying doctors directly. Remember the days when you could pay with a chicken?

Rusty said...

Why, because, Ms Shield, you way does not allow room for graft. Which is the sole purpose of any government care. Despite what the bleeding heart know it all reasonable usual suspects would have you believe.

AprilApple said...

The MSM is an arm to the democrat party. They never ask honest or real questions. It's all scripted BS.

The MSM is a Potemkin village.

Unknown said...

For those who have chosen to purchase insurance, they clearly are worse off if the price increases substantially, especially if insurance no longer is affordable. That's the simple economics of "revealed preference". I don't know many people are in this group, but clearly its in the (tens of) millions.

Sebastian said...

"This chosen paradigm doesn't take into consideration the most forceful motivation of human behavior, namely, whether a large expenditure of limited resources is in one's economic interest." This chosen paradigm of homo economicus doesn't take into consideration the most forceful motivation of homo politicus Americanus, namely, whether a large expenditure of coerced government resources is in the economic interest of officials, crony companies, and voting-bloc interest groups. That individuals should use their own resources to make their own decisions about their own health as they see fit, given their own risk preferences, is heresy.

Derek Simmons said...

Well said, Sojerofgod

roesch/voltaire said...

I have not had an auto accident in over fifty years of driving, but I have paid for that insurance just in case, but because I was young and healthy I skipped health insurance for myself until a running accident at age 38 tore my meniscus and then I had to pay thousands. The high costs of health care are numerous and complex starting with the cost of a doctor's education, pharmacy costs, million dollar bonus for insurance CEOs etc. Still I believe the general health of a nation is important enough to have me chip into a pool of resources to be used by all. I saw just how well this works when a student of mine broke a leg in Toulouse, France during a study abroad summer. He received excellent care at no charge! What a contrast to my knee injury.

Anthony said...

I don't understand why people don't feel a moral obligation to be insured, sick or healthy. You cannot predict when you will need care outside of your regular, preventative or incremental care. And unplanned care is the most expensive care; it is the care that you will need if you want to live, and it is the care that, without insurance, no one except the extraordinarily wealthy can afford. And, generally speaking, you will be provided that lifesaving care regardless of your insurance or ability to pay. As a very healthy person who only uses my health care (right now) for my annual physical, I'm not bothered that my prelimiums subsidize care for those who are sick and have insurance. I'm bothered by subsidizing the care of those who are suddenly sick, felt no need or desire to have insurance, but now expect that their lifesaving care will be provided to them, without regard for those who bear the cost of that care, including their own family.

Bill Harshaw said...

As a society, we're all better off if our members are educated, so even those without children or whose children are grown have to pay school taxes. The debate on healthcare is whether the same principle applies to health care. I believe it does.

Another part of the debate is whether the individual knows what's best for herself. We don't let children decide whether or not to go to school. We don't let drivers decide whether or not to carry auto insurance. By the same token I think we're right to require people to carry a certain level of health insurance, and provide subsidies to help on the cost.

AprilApple said...

Sojjer

Thinking this through, you see about 6 or 7 large companies who have 90% of the health insurance market.

I have been pointing this out from the get-go.

The top 8 mega insurance corporations crawled into bed with O-care, and Obama gave them secured taxpayer bailouts (oh yes he did) and the rest of us are paying for it.
One way to lower costs would be to break up the mega-corporations and allow for smaller mom and pop insurance companies to spring up to sell products across state lines, then break it from employer based and allow individuals to carry insurance with them, as needed. also allow people to shop for insurance... Just like we do everything else.

Can't to that! - no room for government meddling, lobbying and graft.

bagoh20 said...

It really is a basic problem with socialism that it punishes the many to help a few. The proponents of Obamacare often remind us of how terrible the risk is of having a very expensive healthcare need without insurance, but Obamacare has become a guaranteed expensive health need that even the luck of good health can't save you from. It's a gamble you only win if you get extremely and expensively sick, and even then the win will cost you a huge deductible anyway.

My answer is to give the system to Amazon or any other competitor that wants in. You go on line and pick cafeteria style what you want covered and build your own plan. Pay for it with a couple clicks from among nation wide providers including doctor groups and individual hospitals or clinics. You get a card that has loaded on it whatever you bought, and you take it to your provider or whoever will honor it. You can even go around the insurance companies if a particular provider wants to honor it personally. Currently there are too many middlemen, too many hands in the pie, and too little choice or competition. Competition is the only thing that can lower costs while maintaining or improving quality. A lot of people are making a living in health care who provide zero health services. There would be no room for that waste in a competitive system.

CWJ said...

I saw the implied emphasis on coverage in last night's ABC news shows both national and local. The story in both cases took three steps. First state the nonpartisan CBO had released an analisis of the plan. Then mention the millions who would lose their coverage now and over time. Third, spend the remainder of the report on partisan reaction to that claim. So the story consisted not of the report itself, who was predicted to lose coverage and why, but entirely of freefloating predictable reaction to the report's claim.

It's as if you picked up a newspaper, looked at the headlines, but when you read the stores there was no news there but only people's reactions to each headline. It really is fake news.

AprilApple said...

An honest press wold have dug deep into Gruber's statements. The Architect of the original O-care legislation should be asked a few questions.

Matt Lauer: "Mr. Gruber - what did you mean when you said people are stupid and need to be fooled and lied to for O-care to pass?"

MikeR said...

"I don't understand why people don't feel a moral obligation to be insured, sick or healthy. You cannot predict when you will need care outside of your regular, preventative or incremental care. And unplanned care is the most expensive care; it is the care that you will need if you want to live, and it is the care that, without insurance, no one except the extraordinarily wealthy can afford."
Indeed - but that is _not_ the kind of insurance we can buy today. That is called catastrophic insurance, and ACA forbade it.
Instead, young people are forced to buy insurance that covers their annual checkup. Except that there's a high deductible, so it doesn't really cover their annual checkup unless they get eight of them or something. It's kind of like insuring gas for your car.
As Megan McArdle has said many times, the simple way to take care of your case with a safety net would be for the government to take responsibility for catastrophic medical expenses that are putting you into bankruptcy. For instance, if they exceed a quarter of your income. That way you don't need to regulate and twist the rest of health care, and people still have skin in the game; the remaining expenses are still heavy and they should insure against them if they can.
That's if you want the government to do this, which apparently lots of people do.

MikeR said...

Avik Roy has repeatedly said that being insured is not the same as having medical care, that health care practitioners avoid Medicaid in particular, and we know of people with Medicaid who suffered and died because they could not get care.

GWash said...

another question being asked today is 'name a nation where a free market insurance system actually works not only for the business but for the purchasers of insurance'... there is none and never will be... one must not only worry about the costs of a catastrophic health issue for one's self and spouse but also their children... we are all an event away from bankruptcy... this is a real loser for the 'republicans'... can we all agree that ryan is as dumb at gingrich... both are bankrupt in ideas and philosophy... an ideology is only as good as it works in our 'common' reality... never thought i would have to use that phrase but now a days alternate reality seems to reign...

Henry said...

I was listening to a back-and-forth on NPR last night about the Republican plan to replace the ACA. One guest was an Obamacare architect. The other guest was from the Hoover institute. The Hoover guy was not a huge fan of the Republican plan, but he pointed out that by cutting taxes and fees on insurance companies (and medical device makers), the Republican plan would help insurers lower costs on their premiums.

The Obamacare guy's response was to accuse the Republicans of giving tax breaks to the rich.

I don't believe this is economic illiteracy. It is, rather, clear deception. For Obamacare to function, health care must be expensive. You have to create the illusion that costs start at a certain high plateau. This then justifies government intervention, subsidies, the individual mandate for young healthy people, the works.

robother said...

Health "insurance" through the employer is the main driver of the USA's health cost inflation. If it were really insurance, it would cover only catastrophic, unplanned for events. But with state and now federal mandated coverages of ordinary health maintenance, the disconnect between consumer and payor has predictably exploded demand and cost.

Young people might buy low cost true insurance against catastrophic events that took their own health into account, but paying thousands a year for plans with thousands of copay before the insurance kicks in is obviously stupid.

sojerofgod said...

April Apple said;
no room for government meddling, lobbying and graft.

Now there's the crux of the biscuit, as Frank Zappa once said.

I have business and family dealings with the health care industry. Since the inception of Obamacare I have watched as private practice physicians were squeezed out by large hospital corporations. It started before the Ink was dry, and they obviously knew perfectly well what was coming down the pike while the doctors had to "wait until it was passed to see what's in it." So today your doctor is far more likely to be an employee of a large corporation, and instead of you getting the care he personally thinks you need, you get the care the corporation gets the maximized income from. This includes tests done as "defensive medicine" which are supposed to protect the doctor from lawsuits. At some level that is true, but who gets to run these tests and profit from them? Does anyone see large hospitals lobbying congress to enact tort reform that would limit wildly extravagant lawsuits, and would reduce the need for all these expensive tests?
uh huh.

Bob Ellison said...

The comparison between, as robother rightly puts it, health "insurance" and car insurance can teach.

When your car needs an oil change, you don't expect the nearby garage to bill Geico for you.

But when you go to the doctor for a pap smear or an anal fingering, you expect Obamacare to foot the bill?

Henry said...
This comment has been removed by the author.
Henry said...

Obamacare's locking-in of high cost healthcare is not JUST a way to petrify the markets against Republican reform. It is also a corporatist defense against the idea of universal healthcare promoted by the left.

By equating health care with health insurance and mandating taxes and policies that force insurance to be very expensive, Obamacare proponents can silence the left by telling them their ideas are too expensive.

The obvious approach to providing care to the poor and those with expensive long-term conditions was to expand and reform Medicare and Medicaid. But to do this meant that the government had to be honest about costs. The corporate-left simultaneously wants to push the costs of healthcare onto scapegoatable proxies (insurers and employers) and avoid actual reforms that might lower costs.

Sebastian said...

"He received excellent care at no charge! What a contrast to my knee injury." Other people paid for his care! I paid for my own! What a contrast!

AprilApple said...

Sojerofgod -

Since the inception of Obamacare I have watched as private practice physicians were squeezed out by large hospital corporations. ... So today your doctor is far more likely to be an employee of a large corporation, and instead of you getting the care he personally thinks you need, you get the care the corporation gets the maximized income from.

The sick part is listening to leftists whine, in unison, that Healthcare CEO's make too much money. LOL - well, leftists, go ask your precious leftwing progressive democrat god Obama why he made that so.

tim in vermont said...

It has to be cheaper for a large health insurer to have a department, for instance responsible for Vermont, than Vermont having their own companies, from CEO down.

tim in vermont said...

The ACA has become a loyalty test for Democrats to Obama.

Freeman Hunt said...

If we're going to live in a society that does not countenance the idea of refusing medical care to those who can't pay, likely a mark of a good society, it makes sense to require everyone to pay in. Otherwise you end up with lots and lots of people paying nothing in and getting care all the same.

sojerofgod said...

Gee Bob Ellison you make that sound kinda dirty.
But you are right, the Car insurance analogy breaks down when you add routine maintenance and preventive care to the mix. Insurance is supposed to make you whole after you have a loss. Extended warranties can pay for repairs after something breaks down. There is a series of commercials on air in my neck lately that joke about homeowner's insurance not fixing a busted water heater but paying for a Zombie apocalypse. It is an apt comparison with our situation, in that we should be paying for insurance to prevent the disaster -zombification- and paying separately for routine health maintenance.
This will never happen though. Generations have been raised to believe that they are entitled to government money for damn near every life event they don't like, and neither you or I will ever disabuse them of the notion.

AprilApple said...

Unlike greedy leftists, I am happy to pay for routine care out of pocket.
Right now, under O-care, my premiums have skyrocketed, my deductibles are stupidly high, and I pay out of pocket anyway. It's lose /lose .. Just the way the economic bully progressives like it.


tim in vermont said...

Canada does it with sales taxes, taxes on the poor. There are not enough rich people to pay for it. The left thinks that the tax the rich talking point is worth more than universal coverage.

I also wonder what relieving hospitals of the cost of caring for illegal aliens working for cash and no benefits would do.

sojerofgod said...

RE April Apple said;

The sick part is listening to leftists whine, in unison, that Healthcare CEO's make too much money. LOL - well, leftists, go ask your precious leftwing progressive democrat god Obama why he made that so.

A waste of time. 99% of leftists believe whatever they are told. the 1% who actually run things and set policy don't believe in anything except their own power.

This goes for both sides by the way.

Not that I am saying that you are all SHEEP! NOTHING BUT f'ING SHEEP!!!
or anything...

AprilApple said...

We already subsidize lower income health care needs. That's where Gruber's lies came into play. It wasn't enough. Government(D) had to lie and tell us the sky was falling, painting a false crisis. Never let a false crisis go to waste.

dda6ga dda6ga said...

The CBO report issued recently is mentioned and quoted frequently as a standard to use in measuring the cost. BUT this morning the following is on the wires: "The CBO Made A 24 Million Person Mistake When It Scored Obamacare.

http://dailycaller.com/2017/03/13/the-cbo-made-a-24-million-person-mistake-when-it-scored-obamacare"

AprilApple said...

soferofgod -

Yeah - I think Paul Ryan is a coward, too. ;-)

traditionalguy said...

The pre-ObamaCare world included private Group Insurance paying out 100K for your 10 day hospital stay, and the uninsured ridng for free. The Conservatives pretend they want that back. That is stupid. They too just want to see DJT fail for fun and profit.

My money is on the new HHS secretary to do what works no matter how many lies are being told. He has the brains to do this right.

sojerofgod said...

Just kidding of course...

But truth is, if you are a 'normal' person who was not born to power, or have that unquenchable thirst for it, you really have very limited options. Sure we can all bitch about it and call our congressman, but my vote stands starkly small when stood next to a corporate magnate who's petty cash account is the size of the entire annual salaries of all 535 congressbeasts, plus the Pres, and who knows what all else.

AprilApple said...

Hands - who thinks the CBO is crap?

The Cracker Emcee said...


"Someone said that the increase in healthcare costs was due to the involvement of insurance companies."

Layer upon layer of government regulations might, just might, be a factor too. That $10 aspirin isn't due to the involvement of insurance companies. When some 25 year old unskilled liberal bureaucrat insists that the 32-inch doorway in your outpatient clinic must be 34 inches, guess who's actually paying for that?

Unknown said...

"The implicit standard in analysis of the health insurance system is that every consumer must have government-selected coverage. But why?"

Maybe because that is the legal status quo? You know, the law that was passed now nearly 7 years ago, which were litigated extensively multiple times in the court of law? If you know what the most contentious items were before and after the law's passage, as well as during the litigation you cannot possibly ask the above question without being obtuse. You want to be taken seriously, you should speak and act like an adult.

Bob Ellison said...

sojerofgod, your 99% v. 1% comment is powerful.

It reminds me of an essay (or maybe a book) by David Mayhew, wherein he said that we should analyze politicians as "single-minded seekers of re-election". His main thing was to suggest that this basic calculus could be a useful way of figuring out why they do what they do.

I think Mayhew is correct. Those 1% in power may be nice people and may have fuzzy puppies in their bedrooms, but who gives a crap? They behave the way they do because they want two things: power and money.

That's pretty much the Trump Lesson.

C.U.N.T. said...

Your awkward disclaimer says it all, especially this part: "And I am not dealing with a struggle to pay premiums or any serious health problems."

M Jordan said...

One of the biggest problems in health care today is price. Nobody knows what anything costs. Don't believe me? Call your local hospital and ask them what anything costs and you'll get smoke and mirrors. Even with pharmaceuticals, price has been obscured by NeedyMeds and other outsiders.

Price is the resounding signal of where supply and demand meet in a free market. It gives buyers and sellers the info they need to make decisions. But thanks to government meddling and insurance company backdoor deals, this signal is lost. That's what I would seek to restore in this healthcare process ... as a start.

bagoh20 said...

I was around in the pre-Obamacare days, I know I look too young, but I really was there. It had problems then, but I heard a lot less complaints then. The insurance was much cheaper with no deductibles in our plans. I also saw people with no insurance get great care then. I had great care myself, and my employees had affordable Cadillac insurance with no deductibles. With OCare, I lost my doctor, I can never get into see the new one, they spend no time on you now, and the plan that I and my employees have now cost 50% more with huge dedcutables, and they suck. That's just the way it is on the ground out here. I'm not sure what the answer is, but from the experience of myself and all the employees of one small business, It got much worse in every way.

Johnathan Birks said...

The question policymakers should be asking is "why is health care so expensive?" The honest answer is that generations have been conditioned to believe someone else pays for it. Doctors and hospitals charge a grand for procedures that objectively shouldn't cost more than a couple hundred because they can. Even if they wanted to comparison-shop, consumers face a market that is overregulated and actively discourages competition, even across state lines.

This is why Obama had to lie, and lie, and lie some more to con Americans into accepting Obamacare. It's also why Dem senators like Nelson and Landrieu had to be bribed and blackmailed into voting for it. And why young, healthy people had to be taxed on a product they neither need nor can afford.

Mark said...

The why is the same reason they intentionally conflate a Ponzi finance system with the provision of health care treatment.

To be in control of people's lives, to obtain their money, and to enrich themselves and their crony corporate friends, all under the pretense of helping people to gain credit that will increase their electoral prospects.

Static Ping said...

Part of the problem is there are really two issues here: medical insurance and medical care. Politicians being politicians, they regularly conflate the two, switching from one definition to another and back again as suits their interests. This is complicated by the voters who want high quality medical care when they need it but do not actually want to pay for it, which is further exacerbated by a media that loves sob stories, even self-inflicted ones.

M Jordan said...

Ryan and Trump should respond to the CBO report with this: "Well, if 24 million people don't want government-mandated health care, then 24 million people are free to take that path. God bless them."

Freeman Hunt said...

Rh, sometimes I think I might be coming around to Derbyshire's way of thinking. Baseline care socialized. (And yeah, how good does it really need to be? In Japan a relative was told to bring his own pillow, cup, and utensils. Okay.) Private supplemental insurance for people who want something fancier.

CR said...

Health care is like many issues today in its bewildering complexity. All issues are so complex that we must depend on experts to explain them and what to do about them, and we cannot verify if the experts are trustworthy or not, nor can we predict the future result of taking a particular course of action. So all our public policy positions come down to a kind of blind faith, really.

AprilApple said...

Bagoh - To progressives - you and your company just don't count. Because, law and stuff. Because "we had to do something". The left had to create a false crisis and then rescue that false crisis with a big lie and an unfeeling money-sucking bureaucracy. We had to destroy 90% to save the 10% that didn't need saving.

Mrs Whatsit said...

Bill Harshaw said, "We don't let drivers decide whether or not to carry auto insurance." Oh, yes, we do! This construct pretends that "auto insurance" is one monolithic thing. It's not. What we require drivers to buy is LIABILITY coverage, which protects other people from any mistake on the driver's part that causes a crash. State (not federal) governments require liability insurance and specify how much we have to buy because it's not obviously in a driver's self-interest to pay money to protect other people. If it's not required, some people won't buy it and then injured people won't have any recours e.

But coverage for the car itself - Bill Harshaw's "auto insurance" is not required by any government. The decision whether to pay for collision coverage that will reimburse the driver for damage to his own car is left up to the driver and the bank that holds the car loan, if there is one. If the car is new and expensive, the driver's self-interest (or the bank's requirements) will provide the motivation to pay for coverage. If the car is old and not worth much, many people will decide not to pay for coverage that costs more than the car is worth, and just take the risk that they may have to pay to fix or replace the car with their own funds if there's a crash.

Health insurance is, of course, more like collision coverage than like liability coverage, since each person's self-interest affects their calculation of how much risk they want - and can afford - to avoid. But that's another truth that needs to be hidden in a fog of self-righteous evasion, as it doesn't lead inexorably to more government controld of personal decision-making. So, we pretend that there's such a thing as "auto insurance" and that governments require it.

Freeman Hunt said...

Medical insurance and medical care overlap if you get an extremely expensive lifelong condition.

Bob Ellison said...

bagoh20, I've been paying for private insurance for about fifteen years.

Blue Cross was happy to insure me before Obamacare. Good plan. No problems. Several years on the same plan.

After Obamacare, they cancel my insurance EVERY YEAR. And the premiums go up. I degrade my insurance in order to afford it.

And my doctors drop off the plan.

For people like me, with private insurance, Obamacare is a mugging.

AprilApple said...

Johnathan Birks @ 8:55.

Well said.



Pookie Number 2 said...

Freeman: If we're going to live in a society that does not countenance the idea of refusing medical care to those who can't pay, likely a mark of a good society, it makes sense to require everyone to pay in. Otherwise you end up with lots and lots of people paying nothing in and getting care all the same.

I hesitate to argue with someone as thoughtful as Freeman, but two thoughts come to mind.

1) The essence of liberty is that other people can't force you to do things just because those other people think you should do them.

2) Even moral imperatives have economic implications. Requiring everyone to pay in also has the normal impacts of raising costs and creating opportunities for graft, and those considerations also need to be factored in.

M Jordan said...

I grew up in an era where me and most of my friends were in health care insurance-free families. I went to the doctoe once in my first 18 years of life. My four siblings probably didn't go that much. Hospital visits by my family? None except to be born. The medicine cabinet in our house had in it aspirin, burn salve, and Tums.

My dad lived to 91. My mother is 92 and going strong. She hasn't been to a doctor in decades.

When did we all become such health care pussies?

Bob Ellison said...

And this seems weird: my kids' doctors are unaware of this problem. Your plan was canceled? OMG!

rehajm said...
This comment has been removed by the author.
Peter said...

"Catastrophic health expenses is a scare condition. it doesn't really come up much."

We've become so used to health "insurance" that pays for practically everything that we've lost sight of what insurance (in other contexts) is: in most cases, it's protection against unlikely yet very costly events.

Since the cost of insurance must cover not only the actuarial risk but also overhead and a risk premium for the insurer, buying insurance for predictable expenses (instead of just paying these directly) makes sense only if the actuaries have underestimated your risk.

In any case, a basic problem remains that if you get expensively sick and can't pay, you'll get at least some sort of healthcare anyway and, so long as that's true, if you have few assets then why should you spend your own money to buy catastrophic coverage? After all, the catastrophic event is not only unlikely, but even if it happens others will be forced to pay for it.


Freeman Hunt said...

"Health insurance is, of course, more like collision coverage than like liability coverage,"

Not in a society that will not refuse care.

bagoh20 said...

As staunchly libertarian as I am, I too like the idea of single payer, as I do national defense, courts and roads paid by all, but I know that any service the government does for me is always substandard to the point of being insulting while always having out-of-control costs that never get reigned in due to unfirable overcompensated employees and politicians using the system as a item of ransom to get reelected. Public education is a great example. Bad results despite exploding costs, and it has become essentially a Democrat-owned political organization,that holds the public hostage, and did I mention, bad results?

AReasonableMan said...

Although both this post by Althouse and the AHCA are ostensibly about health insurance in reality they are both primarily about Ryan's career. Althouse, as you remember, voted against Trump in the primary in the hope that Ryan might win a brokered convention.

The AHCA is designed to keep Ryan in power as House Speaker. He will do whatever it takes to pass this turkey in the House and then hope that it fails in the Senate. He can then claim to have fulfilled his promise to repeal Obamacare without having RyanCare enter the real world, which would kill his political career. A few Red team senators will take the blame, this won't hurt them in moderate states and the upcoming Senate elections are very favorable to the Red team so the Red team will most likely retain power in the Senate even if a few Senators go down.

It's a nice little scheme.

rehajm said...

AprilApple said...
Hands - who thinks the CBO is crap?


Me! Me! Pick me!!!!


What I find disturbing about CBO is they are required to estimate every change in our behavior when the rules and requirements of the healthcare policy are changed but they must ignore any and all possible changes in our behavior when we make changes to our tax policy. It is suspiciously and disturbingly inconsistent as both rules favor larger government.

Freeman Hunt said...

"The essence of liberty is that other people can't force you to do things just because those other people think you should do them."

Right. But our society has already decided that refusing people medical care is unacceptable. If that's the reality, everybody has to pay in.

AprilApple said...

I've purchased health insurance my entire adult life. Even when I was younger, and thought it was a stupid waste of money, I would get a phone call from my father and a stern lecture from him on why I must always have health insurance. I capitulated.

Over the years I have paid a lot of freaking money to "be covered." I am happy to buy insurance and be a part of the big system. I do not need a corrupt man like Gruber who admits to lying, to write that legislation. Obama-Pelosi-Gruber-SCare is corrupt garbage and it needs to be tossed in the trash.

We should all demand a free market system that eliminates as much of the big government corruption and bureaucracy as possible.

Fernandinande said...

AprilApple said...
The MSM is a Potemkin village.


Here's an example:
Drug [Daraprim] Goes From $13.50 a Tablet to $750, Overnight
“What is it that they are doing differently that has led to this dramatic increase?” said Dr. Judith Aberg, the chief of the division of infectious diseases at the Icahn School of Medicine at Mount Sinai. She said the price increase could force hospitals to use “alternative therapies that may not have the same efficacy.”

Awww. Why is Dr. Judith Aberg, the chief of the division of infectious diseases at the Icahn School of Medicine at Mount Sinai, either clueless and/or dishonest? Why doesn't she or the article mention the fact that the drug is easy to make and freely available for next to nothing?

https://en.wikipedia.org/wiki/Pyrimethamine#Availability_and_price
In India ... US$0.04 to US$0.10 each.
In the UK ... US$0.66 each.
In Australia ... US$0.18 each.
In Brazil ...US$0.02.

AJ Lynch said...

I did a back of the envelope calculation of Medicare outlays per retiree. It came out to about $11,200 per year per retiree. So it seems to me that should be the ceiling for an annual insurance premium and for those younger people, the outlay should be much much less.

Yet we hear of these utterly expensive annual premiums for families and couples who are years away from retirement. Why?

sunsong said...

Healthcare is a right. The pubbies, clearly, are loath to help people. They appear to prefer people dying to helping people. Their overlords, the oligarchs, don't want money spent helping people. They want that money for themselves. The pubbies always vote the way their overlords tell them to...

AprilApple said...

ARM - still waiting for an explanation from you on Gruber's comments.

sojerofgod said...

Obamacare was always about 2 things:
1. bailing out Medicaid/care without admitting what a sorry disaster the whole thing was, and,
2. accruing power to the federal government the way they have in Europe. American pols and power brokers have for many years been jealous of how the EU nations can push their subjects around, and they want it here desperately. its a hunger. A thirst. a desperate gnawing that supplants sex, sleep, even oxygen.
The will to power passeth all understanding, save for those who rightly fear it.

Ron Winkleheimer said...

It's a difficult scheme, and to pull it off, it seems that people need to be fooled.

It's back-door socializing the medical industry and that's all there is to it. It isn't complicated at all.

They young and healthy subsidize the old and sick.

The argument the pro-socializing forces could make, if they could be honest, is that it is in the long term interest of the young to pay in now, so that they can be covered when they are old and sick. However, that would require them to admit that what they are engaged in is socialism. And young people are only in favor of socialism when it benefits them.

I don't think the young would be so enamored with socialism if it was ever implemented in the US. You know, real socialism where, instead of subsidizing young idiots studying why women having less upper body strength than men is a social construct, they told them to get to their assigned jobs at the factory or be imprisoned for malingering. Comrade.

Freeman Hunt said...

Outlaw unions in the public sector. That would solve a lot of waste problems. There's no justification for them anyway.

AprilApple said...

Sunsong - you are ridiculous, wrong, greedy and you pedal lies and nonsense. Do you get your brain washed at the Colbert school of idiocracy?

AJ Lynch said...

An honest CBO would issue a report with several ranges of outcomes if AHCA is enacted ala yesterday's weather forecast of 12-18 inches of snow for Philly. We have maybe 4 inches so far.

Angel-Dyne said...

tola'at sfarim: Bigger q is why Paul ryan,who surely knows all this and has already been accused of pushing grampa off a cliff, would be pushing so hard for ocare lite?

I think that has been adequately addressed by other commenters above. There can be no real reform because the players who benefit from our gigantic clusterfuck of a health care system are too powerful and too entrenched, and they are the true constituents of "our" elected representatives. The only "solutions" will consist of adding more epicycles to the existing structure, which will allow the continued gouging of businesses and the shrinking middle-class. Meaningful reform will require some pretty radical changes, and I can't see that happening.

Mrs Whatsit said...

A true analogy between Obamacare and car insurance would be if the federal government required everyone to buy comprehensive collision coverage for their vehicles, no matter whether the car was new and expensive or an old beater worth a few hundred bucks. Not only that, but the government also requires the policy to cover every single repair or maintenance cost of driving the thing - not just unlikely but expensive repairs like fixing a transmission problem or blown head gaskets , but also predictable, regular costs like annual inspections, replacing worn-out brake shoes, rotating the tires and replacing the windshield washer fluid. It's obvious that if the government did this, collision coverage would immediately have to become so expensive that it would make no sense for most people to buy it, and would get more and more expensive as the costs of all of those repairs went up now that there are no competitive market forces holding them down. Nobody would argue that this would be a good move for anybody other than the insurance companies who'd profit from it. But that is exactly what we did with health insurance under Obamacare - and then we named it the "Affordable Care Act"!

Dust Bunny Queen said...

Because insurance companies need that money to keep paying the bills for the customers who do have expensive conditions,

Ah...but....the reason they need to have everyone pay in is because of the insane idea that insurance should cover all people, even those who are already sick and that they can't charge people with higher risk a higher premium. This is no longer insurance!.

If the government would get out of micro managing insurance. Let people choose the coverage they want. Let the insurance companies decide what is worth covering and the people decide what is worth paying for. Let the insurance companies manage the risk pools by charging the risky people more then the system would work again.

For those who are UN insurable, whose houses have already burnt down and they didn't buy insurance first, then the government might be able to consider some sort of assistance out of a sense of humanity. Better yet. Let there be charitable organizations who take care of those who didn't care enough about their own welfare and who now expect all of US to care and pay for their foolishness.

bagoh20 said...

Before Obamacare uninsured people were still getting necessary medical care. It was just that if they refused to insure themselves, they had to fight to avoid paying out later. The cost was often negotiated down, and also often paid out in installments over years. I knew many people who went that route. It wasn't all that bad. They got what they needed, and they paid what they could. They avoided using the system unless they really needed it. In other words, it kind of had a market pricing mechanism.

sojerofgod said...

I always thought the whole Gruber thing was just BS and smoke. As most of you should remember, the bill passed by legislative tricks and sleight of hand; not a single Republican voted for it. So, who exactly was Gruber lying to? His own Democrat friends? They would have been on board if he had shoved the entire 2000 pages right up their wazoo...
That whole thing was just a media ploy by him to make himself look like one of the smart kids.

"Sound and fury, signifying nothing..."

Mark said...

A thing is what it is. And providers of health care, like providers of education and providers of public housing, have become leeches. They are going to continue to feed and feed off of whatever wealthy entity they are attached to, rather than lowering costs as in an authentic market. And now that government is all too willing to provide subsidies, the insurance industry is happy to be a leech too.

Meanwhile, the consumer has bought into this simultaneous helplessness and entitlement mentality where they insist that they cannot pay themselves and thus should not be responsible for their own health care costs, but that someone else has an obligation to pay for them.

HoodlumDoodlum said...

Ann Althouse said...It's a difficult scheme, and to pull it off, it seems that people need to be fooled. The key to the fooling — I think — is to speak in terms of how many people are "covered," not in terms of how many people are better off. Right now, it seems that many of the people who have coverage pay a lot of money for something they can't use.

That's half of the problem, Professor; the other half is that the "coverage" in reality does very little for most people. That is, if their deductible is $8k or $10k, as many are, and the people in question have maybe $1k in savings...in what sense are they insured? You insure for unexpected large payments you couldn't otherwise cover. Well, these people still can't cover their deductibles--and for that plan they're still paying hundreds per month.

The "number of people covered" is the least meaningful metric. It's the last one pro-Obamacare people have--they first cited increased competition, lower actual insurance costs, lower procedure/actual health care costs ("bending the cost curve down"), less ER utilization, etc. None of that happened, so the one thing they cite is "more people covered." Putting aside the fact that the majority of those people are covered due to Medicare expansion, it's close to a meaningless metric.

If I make it illegal (at the price of a tax penalty) to not own something and then come back a few years later and note that a more people own that thing, have I accomplished much of anything? The metric ought to be whether people themselves--the people forced to buy the thing--are better off. Those people seem to think they aren't. But hey, what do they know, right?

Pookie Number 2 said...

The pubbies, clearly, are loath to help people.

The essence of Democrats like Sunsong is believing obvious falsities to justify their hatred for others. It used to be African Americans that Democrats loathed because of their biases, now it's Republicans, but the motivation is identical.

Mark said...

Guy goes to a car dealership and is all too willing to purchase a $30,000 vehicle.

Guy goes to the doctor and bitches that he cannot afford a $5,000 medical bill, even if it will save his life, and demands that someone else pay the bill.

Its a case of misplaced priorities and responsibilities.

All too many people are happy to be and want to be dependents, especially government dependents, effectively reducing them to little children.

Hagar said...

If you want to establish a National Health Service, then prepare a National Health Service bill with an attendant tax plan to pay for it and sell that to the voters and Congress.

In the current phrase: don't pee on my leg and tell me it's raining!

Insurance companies are financial institutions, they do not do health care. Doctors and hospitals do. You want to control health care, you have to control the medical profession and its attendant institutions.

If you set up a system whereby the medical industries have to provide unlimited services which the insurance industry has to pay for by law and be reimbursed by citizen paid premiums mandated by law and promised to be sufficient to guarantee the insurance companies a profit, you have set up a terrible merry-go-round with no one at the controls.

As the saying goes in Las Vegas: if you look around the table and can't tell who the mark is, you are the mark.

And - the wealth of the insurance companies backing the system is largely invested in the stock market. When the next financial crisis comes and the DOW takes a bellyflop from 21,000 or higher - what then?

Big Mike said...

I wish we could speak clearly and honestly about the real problems. I find the complexity — confused by partisan propaganda — horrible.

So do a lot of us. I don't even believe Megan McArdle anymore -- I used to trust her analyses, but lately I'm not so sure.

AprilApple said...

rehajm - 9:10

"What I find disturbing about CBO is they are required to estimate every change in our behavior when the rules and requirements of the healthcare policy are changed but they must ignore any and all possible changes in our behavior when we make changes to our tax policy. It is suspiciously and disturbingly inconsistent as both rules favor larger government."


It is disturbing. But we are supposed to worship the CBO as the ultimate authority.

Left Bank of the Charles said...

"The people who are happy to get to pay premiums" - no one wants to pay premiums, that's an imaginary group of people. If that's the basis of one's thinking about how health care should be payed for, it's not very sound.

The difference between health insurance and fire insurance is that we know all the health houses are eventually going to burn down (some burndowns being more expensive than others, to be sure). One might imagine a system where parents have to put down a deposit on their child's health costs at conception or better still before they engage in procreative sex. That would not be very sound either.

Both ObamaCare and TrumpCare involve subsidies. What's different is how those subsidies are delivered. That's a really boring conversation. These imaginary conversations are so much more interesting.

Hagar said...

If you set up such a system, the insurance companies will no longer be insurance companies, but tax farmers as in Louis XIV's time.

Ron Winkleheimer said...

Roesch/Voltaire tells another obvious lie.

"Contrary to widespread belief, health care is not free in France and you will be presented with a bill at the end of your treatment, which you’ll be expected to pay before you leave. (French residents get reimbursed by the system for a variable percentage of the fees.) If you come from the United States, the payment will likely be much less than you’d pay back in the states."

http://www.davidlebovitz.com/health-care-tips-for-travelers-t/

Mark said...

When did we all become such health care pussies?

Rational economic behavior. When you are paying $$$$ into the system, you expect to get something in return. Only an idiot would pay all that money in and not get something out. So they go to the doctor for the sniffles and for this and for that and demand that this and that routine things like aspirin be paid for.

Hagar said...

As for today's headlines: 24 million people will loose coverage!!!

How can relief from something I don't want be called a loss?

AprilApple said...

Why Gruber is a 'big f*ing deal' is that it proves that the left do not mind being lied to by one of their own.

Ron Winkleheimer said...

So do a lot of us. I don't even believe Megan McArdle anymore -- I used to trust her analyses, but lately I'm not so sure.

Yeah, I ran into that too after reading an analysis of why the stock market is doing well under Trump. She cannot conceive of a successful economic model that doesn't involve capital exploiting cheap labor. Her analysis amounted to stating that Wall Street must think Trump is lying about bringing jobs back to the states and enforcing the immigration laws.

HoodlumDoodlum said...

Here, compare these two sets of empirical data:

Obamacare avg premiums & deductibles 2017

How Much Americans Have in their Savings Accounts

Bronze plans have premiums of $311/mo (for a 30 year old) and a yearly deductible of $6,100.
How many 30 year olds have $6k in savings? In what sense are those people "covered" by insurance if they can't even pay their deductible for a single year??

Silver plans cost that same 30 year old $364/mo and have a deductible of $3,600. That's more reasonable...but look at the second chart on the savings website--only about 1/3 of 30 year olds will have more than $1k in savings. The other 2/3s are still unable to meet a $3.6k deductible.

The gold plan gets the deductible down to $1,200--that's reachable! The gold plan, though, costs $464/mo, or $5,600/year...but at least you get "free" birth control with that, I guess. I used the cheapest age and only individual plans, so obviously it's worse for older people and families.


"Number of people covered" is a useless measure here because it includes some very large number of people who cannot possibly pay their full deductible for even one year if they incur a large unexpected cost. Just trying to meet their deductible would financially ruin large numbers of people on those plans, so saying "they're covered" by insurance doesn't make much sense.

sunsong said...

I did not write this but I agree with most of it:
This is where I stand. The 45th President, his power hungry cronies taking positions of authority in his Cabinet and administration, and the majority of Republicans in Congress are a real and active threat to me, my way of life, and all or most of the people I love.
Some people are saying that we should give Trump a chance, that we should "work together" with him because he won the election and he is "everyone's president." This is my response:
•I will not forget how badly he and so many others treated former President Barack Obama for 8 years...Lies about his legitimacy and hatred for his principles and his attempts to work within the system.
•I will not "work together" to privatize Medicare, cut Social Security and Medicaid.
•I will not "work together" to build a wall.
•I will not "work together" to persecute Muslims.
•I will not "work together" to shut out refugees from other countries.
•I will not "work together" to lower taxes on the 1% and increase taxes on the middle class and poor.
•I will not "work together" to help Trump use the Presidency to line his pockets and those of his family and cronies.
•I will not "work together" to weaken and demolish environmental protection.
•I will not "work together" to sell American lands, especially National Parks, to companies which then despoil those lands.
•I will not "work together" to enable the killing of whole species of animals just because they are predators, or inconvenient for a few, or because some people want to get their thrills killing them.
•I will not "work together" to remove civil rights from anyone.
•I will not "work together" to alienate countries that have been our allies for as long as I have been alive.
•I will not "work together" to slash funding for education.
•I will not "work together" to take basic assistance from people who are at the bottom of the socioeconomic ladder.
•I will not "work together" to get rid of common sense regulations on guns.
•I will not "work together" to eliminate the minimum wage.
•I will not "work together" to suppress scientific research, be it on climate change, fracking, or any other issue where a majority of scientists agree that Trump and his supporters are wrong on the facts.
•I will not "work together" to criminalize abortion or restrict health care for women.
•I will not "work together" to increase the number of nations that have nuclear weapons.
•I will not "work together" to put even more "big money" into politics.
•I will not "work together" to violate the Geneva Convention.
•I will not "work together" to deny health care to people who need it.
•I will not "work together" to deny medical coverage to people on the basis of a "pre-existing condition."
•I will not "work together" to increase voter suppression.
I will not “work together” to eliminate or reduce ethical oversight at any level of government.
•I will not support anyone that thinks it's OK to put a pipeline to transport oil on Sacred Ground for Native Americans. And, it would run under the Missouri River, which provides drinking water for millions of people. An accident waiting to happen.
I will not "work together" to legitimize racism, sexism, and authoritarianism.
This is my line, and I am drawing it.
•I WILL stand for honesty, love, respect for all living beings, and for the beating heart that is the center of Life itself.
•I WILL use my voice and my hands, to reach out to the uninformed, and to anyone who will LISTEN:
That "winning", "being great again", "rich" or even "beautiful" is nothing... When others are sacrificed to glorify its existence"

AReasonableMan said...

Megan McArdle said ...
Republicans are going to stand accused of taking insurance away from a lot of needy people in order to cut nearly a trillion dollars worth of taxes. And in fairness, that is kind of what this bill does.

a near-senior ... making 175 percent of the federal poverty line, around $20,000, will see their premiums rise from $1,700 to $14,600 -- an amount that would be pretty much mathematically impossible for them to pay. Indeed, as you get nearer to the poverty line, it is theoretically possible for a 64-year-old to face premiums that actually exceed their income.

many of the folks who will see their insurance options shrink are those older white voters in rural districts who helped put Trump over the top. The merely middle aged won’t get hurt too badly, though they, too, will see their premiums go up. But the older, not-poor-but-sure-not-rich folks? They get creamed.

That’s going to be … a hard sell. The AARP will not like it, nay, they will not like it at all. And things the AARP does not like tend to have a hard time getting made into law.


From Ryan's point of view this last observation is a feature, not a bug.

Ron Winkleheimer said...

@Bill Harshaw makes the honest argument.

As a society, we're all better off if our members are educated, so even those without children or whose children are grown have to pay school taxes. The debate on healthcare is whether the same principle applies to health care. I believe it does.

Another part of the debate is whether the individual knows what's best for herself. We don't let children decide whether or not to go to school. We don't let drivers decide whether or not to carry auto insurance. By the same token I think we're right to require people to carry a certain level of health insurance, and provide subsidies to help on the cost.


But that is not the argument we are having. Because the steps to do that would be relatively simple. Providing subsidizes for the poor and allowing insurance companies to compete across state lines would be a start.

Not enough scope for graft.

Michael said...

Sunsong

Well, bless your heart. But really nobody asked you to work together.

Pookie Number 2 said...

Sunsong: I did not write this but I agree with most of it:

Of course you do. If this is what your superiors tell you to think, then you're happy to do so, because thinking is hard.

But thanks for sharing!

Truthavenger said...

Finally someone is asking the fundamental question that should have been asked a long time ago--what right does the government have to force you to buy something?

Maybe this will be a seminal turning point on this issue, like the gun control debate a couple decades ago, when the debate finally shifted to the gun rights side.

It's called the "leave us along" philosophy. To bad we have to use it issue by issue.

Mrs Whatsit said...

When I said "Health insurance is, of course, more like collision coverage than like liability coverage," Freeman said, "Not in a society that will not refuse care."

Yes, I agree, once we made that decision, some kind of hugely expensive mandated operation was inevitable. And we obviously aren't going to turn willingly into a society that locks the hospital doors against sick people who can't pay - so I'm beginning to think, as you do, that we might be better off with some kind of basic socialized public system, presumably with private supplementation for those who can afford it. (I agree about getting rid of public sector unions, too!)

I don't think the care that such a system would provide would be as good as what those who can afford to pay have gotten used to in our current system, but even mediocre care might be better than this ridiculously complicated edifice of lies that hurts most of the people it was supposed to help.

David Carlson said...

questions are a burden for others. answers are a prison for oneself

AJ Lynch said...

Angel-Dyne is right. Real reform would be a huge shock to the populace and the establishment won't risk that.

Trump's best move right now may be to calculate the annual cost of the Medicaid expansion and agree to freeze it at that rate forever. Then he should cut other fed spending to offset the Medicaid costs. Dems shouldn't oppose that [but they will] and then Trump can move on to other fixes.

Angel-Dyne said...

Ron Winkleheimer: Roesch/Voltaire tells another obvious lie.

"Contrary to widespread belief, health care is not free in France and you will be presented with a bill at the end of your treatment, which you’ll be expected to pay before you leave. (French residents get reimbursed by the system for a variable percentage of the fees.) If you come from the United States, the payment will likely be much less than you’d pay back in the states."


No kidding. And what kind of study-abroad program at an American college doesn't require participants to purchase travel/health insurance for that very reason?

And even if it was "free of charge" to the student (which I doubt), somebody was paying for it. "Free of charge", lol.

The stuff about his adventures among the scary liberal-hating militias of Appalachia didn't pass the smell test, either.

CWJ said...

The Cracker Emcee wrote -

"Layer upon layer of government regulations might, just might, be a factor too. That $10 aspirin isn't due to the involvement of insurance companies. When some 25 year old unskilled liberal bureaucrat insists that the 32-inch doorway in your outpatient clinic must be 34 inches, guess who's actually paying for that?"

My own personal example. My monthly BC/BS bill is now several pages long thanks to a helpful notice that "Discrimination is against the law" translated into fourteen(!) languages. This is every month lest someone forget it. The bill itself is still in english. Racists

AprilApple said...

Sunsong provides the official strawman list.

'daddy - I hate you, hands off my uterus - but you must pay for my abortion! and celebrate it too!'

No mention that most Americans would prefer a 20 week ban on abortion and a ban on late term abortions. No mention that right now there is no national legislation to ban abortion on the table. But - be scared and stuff!

**Telling Planned Parenthood to pay for their own abortions without the help of tax payers is not a ban on abortion. Let PP fund it thru leftwing charity or Soros, for example. NOT the tax payer.

glenn said...

Quayle is right.

Having said that my opinion is that if you really want universal health care it has to be universal. Everybody goes in the same pool. Everybody. With one basic plan that covers catastrophic events. And a fixed budget at a percentage of GDP. And supplements purchased by consumers to cover their specific needs. Writ large. Rationing.

AprilApple said...

Trump promised bold moves. Paul Ryan is a coward.

The best voice on the subject is Rand Paul.

sunsong said...

"A 64-year-old making $26,500 a year would pay $1,700 in premiums for insurance under Obamacare. Under the Republican bill, he would pay $14,600 — more than half his annual income."

Unknown said...

Excellent comments, Ann.

Bill Peschel said...

glenn inadvertently hits on the problem: Rationing

Or "Death panels," as Sarah Palin accurately put it.

You can have two kinds of health care: rationed or unlimited.

People want rationed when it's someone else's kid; unlimited when it's their own.

Freeman Hunt said...

"I don't think the care that such a system would provide would be as good as what those who can afford to pay have gotten used to in our current system, but even mediocre care might be better than this ridiculously complicated edifice of lies that hurts most of the people it was supposed to help."

That's what I'm thinking too. Normally I don't like sales taxes because they're so regressive. However, in this case, I think sales tax is the way to go. All people, including illegal immigrants, pay in.

sunsong said...

1) The essence of liberty is that other people can't force you to do things just because those other people think you should do them.

LOL - abortion is a more real example of liberty. It is a woman's choice. Period.

Livermoron said...

Jeezus sunsong....you have read the recent study that showed people who proclaim their virtue as much as you do are really just trying to distract from the fact that they are really awful people?

Don't worry, you haven't fooled us. We know who you are.

Mark said...

"The more real example of liberty is killing innocent human beings with impunity."

That really does speak for itself, doesn't it? And yet, in our pathological culture, some really do believe and applaud such things.

AReasonableMan said...

There seems to be broad agreement for once, an unserious proposal by an unserious man.

Livermoron said...

Wait until the whole health industry causes our economy to collapse, then see how cheap medical care becomes.

sunsong said:
1) The essence of liberty is that other people can't force you to do things just because those other people think you should do them.


Seems like one person forcing another person to die is granting liberty to only one of the participants.

sunsong said...

“Never before have so few with so much promised to take away so much from so many and then laugh their asses off as the so many with so little vote for the so few with so much.”

~ Jim Pence

Unknown said...

President Donald Trump: "We're gonna come up with a new plan that's going to be better health care for more people at a lesser cost."
ABC News, 1/25/17

Trumpcare: Well, well, well.

Told ya' Trumpies, your man is a con-man.


Unknown said...

Trump promises:
- Insurance for everybody
- Lower cost
- Won't touch Medicaid

TrumpCare:
- Millions lose insurance
- Deep Medicaid cuts

Trumpies: Told ya'. Trump is the ultimate con-man.

Pookie Number 2 said...

LOL - abortion is a more real example of liberty. It is a woman's choice. Period.

Absolutely. Just like wife-beating and honor killings are men's choices. Period.

Kevin said...

The government will "give you" health insurance, and if you're not good to those in power it might be "taken away".

Starting to make sense yet?

Livermoron said...

sunsong (SS for short) proves once again she is incapable of an original thought

Mary E. Glynn said...

Freeman Hunt said...
"The essence of liberty is that other people can't force you to do things just because those other people think you should do them."

Right. But our society has already decided that refusing people medical care is unacceptable. If that's the reality, everybody has to pay in.
-----------------------
Spoken by somebody who uses more than she pays in...
Not everyone carries Liability auto insurance. That's why some states require Uninsured/Underinsured insurance. So those of you who access the system are not stuck paying for someone without.

The people who don't access the system should not pay for those who do, and who choose to subsidize the non-insured (ie/illegal immigrants, people without insurance who have health needs.)

The independent with no outstanding health needs (who can afford to pay for what they use) can steer clear. Thanks Trump!

Rusty said...

I see the usual suspects have chimed in and have not advanced the conversation at all.
Tear it all down and then, once the market has stabilized, decide how we can advance to a solution.
The utterly fascist, tyrannical current abortion is unworkable and so is the establishment republican solution.

AReasonableMan said...

Donald Trump said ...

"We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

"Obamacare has to go. We can't afford it. It's no good. You're going to end up with great healthcare for a fraction of the price. And that's going to take place immediately after we go in. Okay? Immediately. Fast Quick."

"Everybody's got to be covered. This is an un-Republican thing for me to say because a lot of times they say, "No, no, the lower 25 percent that can't afford private. But-- ... I am going to take care of everybody. I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now."

"We're gonna come up with a new plan that's going to be better health care for more people at a lesser cost."

"There are people who say everybody should have a great, wonderful, private plan, and if you can't afford that, and there is a percentage, a fairly large percentage that can't afford it, then those people don't get taken care of. That's wrong. We're going to take care of that through the Medicaid system. We’re going to take care of those people. We have no choice."

"The new plan is good. It's going to be inexpensive. It's going to be much better for the people at the bottom, people that don't have any money. We're going to take care of them through maybe concepts of Medicare. Now, some people would say, "that's not a very Republican thing to say." That's not single payer, by the way. That's called heart. We gotta take care of people that can't take care of themselves."

"I’m not going to cut Medicare or Medicaid."


h/t TPM

sunsong said...

Absolutely. Just like wife-beating and honor killings are men's choices. Period.

I am NOT surprised that that is what you stand for...

AprilApple said...

Sunsong - Pay for your own damn abortions. Liberty means I should never have to pay for your choices.
Got that?

sunsong said...

Liberty means I should never have to pay for your choices.

You are wrong. Think!

AprilApple said...

I must pay for your abortions? Really? You might want to think about how absurd and backward that is.

you want government out of your uterus? Pay for your own abortions.

Pookie Number 2 said...

I am NOT surprised that that is what you stand for...

That would actually mean something, if you hadn't already expressed your affinity for murdering the inconvenient.

But because you're quite a stupid person, I'm happy to take the time to clarify that I endorse none of murdering babies, beating wives, or killing female relatives that "dishonor" the family.

Of course, as a Democrat, you will continue to believe false things about the people you feel compelled to hate. That's not really something I can help with.

cubanbob said...

sunsong said...
1) The essence of liberty is that other people can't force you to do things just because those other people think you should do them.

LOL - abortion is a more real example of liberty. It is a woman's choice. Period."

What brand of stupid pills do you take in the morning? But hey,to play along, let's make child support optional unless the man consents in writing in advance of conception that he agrees to pay support. Hows that for real liberty?

sunsong said...

But because you're quite a stupid person

How stupid is it to say things you don't mean because you, I assume, think you are making a fantastic point? LOL

Pookie Number 2 said...

How stupid is it to say things you don't mean because you, I assume, think you are making a fantastic point? LOL

Not stupid at all. If I was dealing with someone halfway intelligent, she would have realized that there's no moral merit to simply declaring that some people have no rights, so you can abuse or kill them.

I acknowledge overlooking the fact that you're not smart enough to understand an analogy without it being spelled out in painful detail. In doing so, I erroneously gave you more credit than you deserve, and I sincerely apologize.

rehajm said...

In February 2013, CBO predicted that ObamaCare enrollment in the individual market would be 13 million in 2015, 24 million in 2016 and 26 million in 2017. The actual enrollment for those years were, respectively, 11 million, 12 million and 10 million. As recently as March 2016, CBO was projecting an enrollment boom of 15 million for this year.

-source (behind the paywall?).

rehajm said...

CBO was also badly wrong about the 2003 Medicare prescription drug benefit, which unlike ObamaCare used incentives, markets and private competition to control public costs. The drug benefit cost about 40% less over its first decade than CBO projected.

Nostradamus, they are not.

sunsong said...


The Congressional Budget Office (CB0) has come out with its report on the Republican replacement for the Affordable Care Act (Obamacare). No surprise – 24,000,000 people will lose health care.

24,000,000 - people – humans - men and women and children.

I know Republicans are accused of not caring much about people, but do they really want to start killing them? I guess it reduces taxes on the wealthy? So that makes it OK?

I sincerely doubt that the Republican House will vote for this bill, and if it does I think it has almost no chance to pass the Senate. But, still, is this what my conservative friends voted for when they voted for a Republican President, Republican Senate, and Republican House?

This administration is such a mess.



do republicans really want to start killing people>

Pookie Number 2 said...

I know Republicans are accused of not caring much about people

You "know" a lot of things that are untrue.

rehajm said...

The actual enrollment for those years were, respectively, 11 million, 12 million and 10 million

Key point here: Millions of people being forced out of the system under ObamaCare.

sunsong said...

How stupid is it to deny that "republicans are accused of not caring about people?"

Honestly Pookie Number 2 - you are just NOT demonstrating much smarts - lol

bagoh20 said...

I will not work together.
I will not work alone.
I will not work,
But, I do appreciate that others do, so I can be so principled on their dime.

Pookie Number 2 said...

Honestly Pookie Number 2 - you are just NOT demonstrating much smarts - lol

That too would mean something if you had ever demonstrated the ability to recognize intelligence. But, alas, you've proven beyond a doubt that you're a brainless, thoughtless drone, and that really limits the sting of your feeble insults.

bagoh20 said...

"The Congressional Budget Office (CB0) has come out with its report on the Republican replacement for the Affordable Care Act (Obamacare). No surprise – 24,000,000 people will lose health care. "

It also explains the reason for that is that they will CHOOSE to not pay for coverage without the mandate forcing them. A minor detail. Why do Democrats hate choice?

AReasonableMan said...

TPM said ...
A report by the Commonwealth Fund comparing the CBO's 2010 predictions to how the ACA played out over the next five years found the agency was "reasonably accurate," with estimates "closer to realized experience than those of many other prominent forecasters."

“While the CBO was off on where people would get their coverage, they did pretty well on how many people would gain coverage overall," he explained to TPM. "They expected the uninsured rate to fall roughly by half, in the long run, from where it was in 2010. If you look at the actual data we have today, the uninsured rate has fallen by about 43 percent. It's a fairly modest error, and there's probably more room to make progress if the law is left in place."

"CBO was right that insurance coverage would rise sharply under the ACA, which a number of prominent people disagreed with at the time," he told TPM. "CBO was right that employers would not stop offering health insurance in large numbers. The CBO was right, roughly, about the level of insurance premiums today."


Most of the errors relate to the Supreme court ruling on the expansion of Medicaid, which the CBO could not, for obvious reasons, include in their predictions.

sunsong said...

Pookie Number 2

WOW! I gave you a number of chances to come clean and be an honest person. So now I know more about you. You seem like Trump - wanting to win at all costs - even if you have to lie your ass off. What you don't realize is that you still lose. Dishonest people are losers...

sunsong said...

"You've got audiences cheering at the prospect of somebody dying because they don't have health care and booing a service member in Iraq because they're gay. That's not reflective of who we are."
~ Barack Obama

Amy said...

Has anyone participating in this academic/theoretical exercise actually HAD a major health crisis? Well I have. Eight years ago at age 51, in the best physical shape of my life, I was diagnosed with an aggressive form of breast cancer. In the space of a year, I had surgery, 6 chemos, a year of Herceptin (a very new drug that most likely saved my life) and 35 radiation sessions. Plus installation and removal of a port, countless blood tests, heart scans, onc and surgeon appts. I estimate the total cost to be somewhere around $250K. I had insurance which covered everything after the deductible.
But at one point, due to an insurance glitch, they cancelled my chemo and I had to scramble. To be sick and in treatment and unsure if you can find a work-around when the clock is ticking down, was one of the more terrifying few days of my life.
To face the entire ordeal uninsured would be unthinkable.

I don't have any firm opinions about how healthcare should work. I am not in favor of single payer. But I do know that to compare it to auto collision coverage is not appropriate. A normally strong, independent and decisive woman, I was vulnerable during that period like none other before or since. It's not like being without a car for a while, if you wreck yours and repairs aren't covered. The fall-back of 'everybody gets medical care that needs it' is not something you want to experience at a time of true need. I wouldn't, anyway.
And the 28 year old who was diagnosed last month with Hodgkins Lymphoma and is just starting chemo now is very glad she has coverage as well.

The system is rotten, it rewards insiders, no doubt. But I won't take my chances, not having seen what I've seen.

AprilApple said...

Obama is a lying creep. That's not who we are.

Pookie Number 2 said...

So now I know more about you.

[I'm typing this really slowly so people as stupid as Sunsong can follow along.]

It's not news that ignorant, biased people like you think they "know" things, and it's not news that what you "know" is generally untrue. It's also not news that you cannot understand or process this.

But if we need someone to murder a baby or model a pussy hat for us, it's good to know you're available and up to the challenge.

sunsong said...

Stupid is calling a fetus a baby. A "baby" by definition, is born...

But then, dishonest people have trouble with facts.

sunsong said...

Obama is a lying creep. That's not who we are.

LOL - so you support a congenital liar - Trump

Obama lied a number of times - really big whoppers. Trump lies about 70% of the time (according to fact checkers). Congratulations for picking the real liar :-)

AReasonableMan said...

Amy said...
To face the entire ordeal uninsured would be unthinkable.


And you would have received parsimonious or 'rationed' care.

Thank you for your story and I sincerely hope that your future does not involve any recurrence of your disease. Cancer treatment remains a medieval endeavor that future generations will look back on as we look back on surgery without anesthetics.

rehajm said...

But the CBO's latest report on ObamaCare simply defies reality. It says, for example, that ObamaCare will cost $104 billion less over the next 10 years than it thought just two months ago. That drop rests almost entirely on the CBO's belief that premiums will remain virtually flat next year, which then lowers the insurance subsidy costs. But the CBO somehow missed the fact that the industry is already warning of double-digit rate increases across the country next year. Right now, in fact, it's pushing for changes to minimize the rate shock. A sharp spike in premiums will drive ObamaCare's costs up far beyond the CBO's current estimate.

.

jimbino said...

Health care in America costs the average person a fortune. Health insurance to cover that costs a fortune plus a 25% premium. That's the mathematics behind Obamacare's 80% "loss ratio."

Not only does Obamacare make health care 25% more expensive on average, it transfers income and wealth from young, healthy, single, childfree males to old, sick, married breeding females.

There's no way that a liberty-loving person can participate.

Walmart, on the other hand, publishes its prices and treats every customer the same. Can you imagine a Walmart, Home Depot, Lowes or Amazon that greets you with questions about your sex, age, or health status to determine what to charge you?

William Chadwick said...

Why? Because the more the serfs have to depend on Big Brother, the more "liberal" State-fellators like it.

Yancey Ward said...

I wrote about this a couple of weeks ago, but my own experience highlights the problem with the ACA.

I was in the individual insurance market for three years before the ACA opened for business at the end of 2014. In two of those years, I bought a catastrophic insurance policy that paid zero dollars for anything until I spent at least $7500 in a calender year, and the second policy didn't pay for anything until I had spent at least $10,000. It paid for nothing until I had met those limits. It was the only thing I needed- I wasn't going to spend even a fraction of that outside a car accident or a medical emergency like a heart attack or getting cancer, and I could easily pay the limits if necessary.

Of course, after the ACA went into effect, such policies became, technically illegal since they didn't provide mandated coverage for a lot of routine predictable medical expenses, many of which it is literally impossible for me to have to need. Because of the way I had structured my finances, I qualified to the highest subsidy possible under the ACA (most of my income is in tax sheltered retirement accounts), and the cheapest policy I could buy in Tennessee was almost three times the cost out of pocket than what I was paying unsubsidized the year before. Having not enough taxable income, I didn't even have the incentive of buying due to the penalty.

Freeman Hunt said...

Spoken by somebody who uses more than she pays in...

Actually, no. Not that that's relevant.

Yancey Ward said...

The weakness of the ACA was that it was attempting to hide the costs without resort to explicit tax funding. It was always going to run aground on the reef of premium inflation because the policies were stunningly bad deals for anyone under the age 50, even with the government carrying part of the premium costs.

Given the structure, the only solutions were even more extensive subsidies and/or significantly higher and more strictly enforced penalties for non-coverage. Absence those, the collapse of the exchanges is a dead certainty.

Freeman Hunt said...

If you, and your family, use insurance regularly, (and for multiple childbirths, and childhood checkups/innoculations -- you do) the premiums you pay likely are not enough to cover your costs.

That's why you need insurance, right?


I've always purchased health insurance. I buy it in case someone in the family gets cancer or some other astronomically expensive thing. Your beliefs about likely are irrelevant. I know what's been paid in and what's been paid out. At this point, the paid in side is more. Again, not that that's relevant.

And no, the premiums are not set so that with regular use you will get out more than you pay in. You pay extra for each family member. In fact, you will not get out more than you pay in even with fairly heavy use. Something major has to happen.

sunsong said...

From the Onion :-)

"WASHINGTON—In an effort to address concerns about the affordability of coverage, Republican congressional officials advised Americans Monday to set aside the income from one of their jobs to pay for healthcare costs under the newly introduced American Health Care Act. “Under this bill, you would simply set up a separate savings account for the total earnings from one of your jobs, which will ensure that you can comfortably cover your healthcare expenses each month,” said House Speaker Paul Ryan, adding that the GOP’s proposed Affordable Care Act replacement would keep healthcare costs for the average American from exceeding the entire salary of one full-time job. “If you budget things correctly, you’ll have plenty of money left over from your other job or jobs to spend on food, rent, and any other personal expenses. In some cases, healthcare will even be low-priced enough to afford using only the income from a part-time side job on the weekends. The important thing here is that this legislation will allow Americans—not the federal government—to decide for themselves what kind of healthcare they want and how many jobs they choose to have in order to pay for it.” Ryan also recommended that in order to be prepared for the added costs of a sudden medical emergency, Americans should create a dedicated savings fund using the money from at least two of the mortgages on their homes."


GOP Recommends Americans Set Aside Income From One Of Their Jobs To Pay For Healthcare Under New Bill

Freeman Hunt said...

"Other people would make different choices in that situation than you did. Maybe your result will pay off, maybe it will be costly in the end."

That's the problem. The vast majority of people who "make different choices" suddenly want care when something major happens and they can't afford treatment. Our society will not tolerate refusing care to such a person. Therein lies the problem in need of a solution.

Original Mike said...

What I would really like is to be able to do is pay cash for most of my healthcare needs from whomever offers the best deal, and to shop around nationally for an inexpensive catastrophic plan to cover major medical expenses — you know, actual insurance.

CWJ said...

rehajm,

If I recall, nearly half of that first year's enrollment were those whose existing coverage was made illegal by Obamacare.

Martin said...

Ann and the PJ Media person ask the right question. Where has it been commanded that everybody must have government-approved medical coverage, regardless of cost to them or to others, and regardless of whether they see benefit?

As long as we all go along with that framing (on almost everything, not only health insurance), there is no hope for any of us, the government will just grow and grow and strangle us all.

Mrs Whatsit said...

"If you, and your family, use insurance regularly, (and for multiple childbirths, and childhood checkups/innoculations -- you do) the premiums you pay likely are not enough to cover your costs. That's why you need insurance, right?"

Wrong. In fact, exactly backwards. In a healthy market, most people will pay MORE in premiums than they use in coverage, including families like Freeman's that are using a normal amount of preventive and routine care with no out-of-the-ordinary expenses. Most people have to pay for more than they use, so that there will be enough money left over to cover the costs of the smaller group of people who get catastrophically expensive conditions and have to use much more care than they've paid for. The actuaries who calculate the premiums use risk calculations spread over the population to figure out how much each healthy person has to pay in order to make sure there's enough extra to cover the higher needs of the sick few.

And no, we don't buy health insurance to "cover our costs" - or at least, we didn't before Obamacare. We bought health insurance to protect against the risk that we might be among the unfortunate minority who incur large health-care costs that they can't afford to pay for from their own funds. The "insurance" imagined by the original poster, in which everyone freeloads by paying less in premiums than they take out in benefits, will necessarily go broke in a hurry - as, in fact, our current system is doing right now.

Oso Negro said...

State-mandated charity is immoral. If the Sunsongs of the world want poor people to have health care, they should be free to pay it out of their own pockets or establish charity hospitals that do the same. Not to force others to suscribe to their modern sense of what is ethical.

rehajm said...

CWJ said...
rehajm,

If I recall, nearly half of that first year's enrollment were those whose existing coverage was made illegal by Obamacare.


Yes, the Obama administration was more than happy to report those people as newly insured. Alternative facts wise...

...they also gamed the system by double counting people between the end of the enrollment period and a few months later when insurers reported their updated insured rolls, to the tune of 2-3 million.

EsoxLucius said...

Your beloved Bonzo signed the Emergency Medical Treatment and Active Labor Act in 1986 that requires hospitals to treat anyone who walks in the door. That insured all people health care; all we've been arguing about since is who's going to pay. Trumpcare is just desserts for the poor rural voter who is going to lose in the system. It's funny because it isn't going to pass, but the Republican congress is marching off a cliff anyway, and "policy wonk" Paul Ryan, representing no one in his district but Diane Hendricks leading the way.

Rusty said...

Blogger CWJ said...
rehajm,

"If I recall, nearly half of that first year's enrollment were those whose existing coverage was made illegal by Obamacare."

Reason enogh to start over.