There is no free market in health care

Republicans are enduring an entirely predictable backlash to the Frankenstein’s monster they’ve proposed to replace the ACA. In a new post over at Forbes I describe the persistent logical flaw that blocks Republicans from proposing effective legislation on issues that matter – unrestrained markets cannot solve every problem.

There is no free market for health care. You cannot craft a free market for health care. Conditions under which people need health care inherently destroy the prerequisites for a market. It is impossible to build a system that will deliver effective health care without recognizing the limitations of unregulated markets.

In medical matters we expose one of the central problems with Republican ideology: less government does not always equal more freedom.

150 Comments

  1. I don’t usually like David Brooks-he was tepid when the Tea Pot was boiling. He said something though, which just seems so obvious.

    “The core of the new era is this: If you want to preserve the market, you have to have a strong state that enables people to thrive in it. If you are pro-market, you have to be pro-state. You can come up with innovative ways to deliver state services, like affordable health care, but you can’t just leave people on their own. The social fabric, the safety net and the human capital sources just aren’t strong enough.”

    And I looked over to the left side of the screen regarding more ‘Why Clinton lost’ obits.

    She didn’t lose, we are still paying the several centuries price of our inability to grasp that the existence of individual freedom depends on the equality of opportunity. Manufacturing jobs will not come back-neither will unions. RIP.

    Move on, rewrite all the bloody rules, the constitutions, the regulations forever and ever, amen.

    It took our revered forefathers twice to get it working in one document for their world and they still f___d it up because they screwed up the equality part-which is why Mr. Trump is President.

    1. Also, this.
      https://www.yahoo.com/news/paul-ryan-says-fatal-conceit-175427920.html

      “The fatal conceit of Obamacare is that healthy people are subsidizing the sick”

      The fatal conceit of auto insurance is that people who don’t get in accidents pay for people who do.
      The fatal conceit of home insurance is that people whose houses don’t burn down pay for people whose houses burn down.
      The fatal conceit of Paul Ryan is that he thinks he knows what he’s talking about.
      The fatal conceit

  2. As I’m sure some of you have heard, evidently Trump has told several Republicans on Capitol Hill that if Republicans’ healthcare ‘reform’ falls through, he’s content to simply let the ACA deteriorate on its own and blame Democrats. This, I suppose, is supposed to work in such a way that the GOP gains a supermajority in the Senate in ’18 so they can pass whatever they want then without fear of the filibuster.

    Assuming that this is true, it’s hard to overstate just how incredibly stupid this would be. Trumpistas will always stick by their man of course, but if Republicans just sit back and let the insurance market collapse, what do they think EVERYONE ELSE is going to do? Just sit out the election, shrug their shoulders and be all “meh” about it?

    And what about Republicans wanting to do tax cuts, deregulation, and all the rest? Just how much bad blood will GOP leaders and Trump incur if they look like they’re giving up halfway through and letting their much desired Obamacare repeal go the way of the Dodo? Does anyone think the Freedom Caucus is just going to take that lying down?

    1. I find it highly unlikely that the ACA is going to fail, explode, or fall under some cataclysmic malady that will kill off most of America as the GOP is always eager to proclaim from atop their soapbox.

      Markets like stability and predictability. They adapt to whatever environment is present, and don’t like it when the boat gets rocked. If the ACA is going to bring about the ApocalypicAids and wipe out humanity, it’ll be the result of GOP sabotage. They’re already trying, by prioritizing the removal of the individual mandate that underpins the principle of ‘insurance’ in the first place: The healthy people are needed to help fund the sick ones. That’s how it works!

      ACA was a big change to the ecosystem, so there’s an adjustment period complicated with a heavy and largely factless partisan propaganda campaign, starting with giving it a name to rally their conspiracy-vulnerable and highly uneducated base. That’s not to say the ACA was passed under ideal circumstances or that it’s perfect legislation, but it was a much needed break from a stagnating status-quo that was failing to meet the healthcare needs of a country.

      Right now, congressional GOP will pass anything to save themselves from the profligate lie they initiated and invested almost a decade on. They’re the dog that caught the car, and they’re desperate to not get their skull crushed, and in doing so, they’ve sacrificed nearly all their vertebrae.

      That’s on top of the vertebrae they already lost to Trump, the monster that grew from their right-wing conspiracy theory echo-chamber fringe that they cultivated to deny Democrats persuadable voters.

      1. Here’s what will happen if AHCA isn’t passed into law. The GOP has so truncated the funding and support structure for the ACA, that vital operations will not be able to function properly. Insurance companies will continue to bail out and people will have fewer choices. This is what potus was threatening. They (GOP) know they have denuded the ACA to the point that even if the AHCA doesn’t pass, the ACA will be badly crippled.

        I do not share your optimism for its functional survival. I wish I had more confidence in the American people to send those who are playing games with people’s lives back to the private sector where they can live under the remnants of the health care system they have destroyed.

    2. “As I’m sure some of you have heard, evidently Trump has told several Republicans on Capitol Hill that if Republicans’ healthcare ‘reform’ falls through, he’s content to simply let the ACA deteriorate on its own and blame Democrats”

      Look at how many whoppers he’s told and the dearth of any real consequences so far; I’m not shocked that he thinks he could do that.

  3. To counteract the iphone comment, this guy, author of “A People’s History of Poverty in America” and the forthcoming “Ghettos, Tramps, and Welfare Queens: Down and Out on the Silver Screen” restated the real reasons people become poor.

    He also says, “a year’s worth of health care would equal 23 iPhone 7 Pluses in price.”

    https://www.washingtonpost.com/posteverything/wp/2017/03/08/laziness-isnt-why-people-are-poor-and-iphones-arent-why-they-lack-health-care/

    1. Tone deaf is tone deaf, even when you’re arguing for expanding health care insurance.

      Chaffetz is in the let-them-eat-cake zone:

      If Chaffetz were self-aware, he might remember that as a member of Congress, he has a very nice healthcare plan that is subsidized in part by the federal government–paid for, in other words, by taxpayers like you and me and the low income people he patronized this morning. Also, from photos of the congressman at work, it’s clear that Chaffetz himself is an iPhone user–and considering that congressional employees get government-issued phones to use at work, it’s possible that Chaffetz’s shiny new iPhone is paid for by taxpayers, too.

      http://www.spin.com/2017/03/jason-chaffetz-iphone-healthcare/

      Leech.

      1. Ryan, according to Merriam Webster an immigrant is “a person who comes to a country to take up permanent residence.” A voluntary or involuntary component is not mentioned.

        The intention of both men was not to minimize the horror of slavery. They both said that the immigrants came in the bottom of slave ships.

        Immigrants have come to this country in a variety of ways. I think the intent here was to weave the experience of African-Americans into the fabric of our history and not in any way say that the passage of slaves into this country was good and acceptable.

      2. With all due respect, whether that was their intention or not means less than nothing to me. What’s important is the meaning that their words conveyed, and what I hear is verbal sugarcoating that seems to minimize the horrors of slavery.

        That being said, the dictionary can say whatever it wants. A slave is a slave and an immigrant is an immigrant.

    1. If you can’t see the difference between those two speeches, well, that’s really sad but not surprising.

      As for your comment that you aren’t sure if the AHCA is “much of an improvement” – I suggest you read the plan. NO ONE here has asserted that there are not problems within the ACA just as SS and Medicare had and required changes over the years. The problem you will not admit, is that Republicans would NEVER help fix the problems because all they wanted to do was attack the plan. I have studied the replacement proposal. When the focus places highest priority always on cost vs comprehensive coverage, full and affordable access, it is guaranteed to leave millions of people uninsured or underinsured. Before you make a vague statement comparing the two plans, please make an effort to know what is proposed.

      1. Mime, I am still in the process of reviewing the new health care bill.

        As I commented in a previous post, no plan will work successfully unless there is a way to lower costs. That goes for the Republican bill as well.

        Obamacare was a disaster because medical costs have risen to the point many people can’t afford to go to the doctor even if they have insurance. The deductibles and out of pocket costs are too high, so they will put off going to a physician even if they have an Obamacare policy.

        I realize that you are older and insulated in some ways by Medicare coverage. You have no idea the straits some people are in.

        Even regular insurance deductibles and out of pocket costs have become ridiculous. My family’s deductible has risen to $6,000 and our out of pocket is $12,000. Many in the middle class simply have put off seeing their doctors or having diagnostic tests done simply because they do not have the funds available.

        It’s true that Medicaid expansion has helped many people like my sister-in-law and my brother-in-law. However, it has hurt other people, like my sister, who are just slightly more prosperous. It makes sense to make less and just stay on Medicaid. They do not have the money for an unexpected medical emergency.

        It’s true that Republicans have not helped fix any problems. It is also true that they were shut out of the process when Obamacare was thrust on them. Is it any wonder that Democrats have lost over 1000 elected positions? People ARE unhappy with their health care. Unfortunately, there is no way to fix Obamacare. Changing bits here and there is just like putting lipstick on a pig.

      2. I’m somewhat “insulated”? Really? Because we are on medicare, supplemental and a separate prescription plan? If you add up the cost of our supplemental insurance at 490/month, which does (at this time) cover the deductibles for Parts A/B, we’re pretty much in the same deductible cost situation (500×12=$6K appx).

        Many seniors are relatively healthy, just aging. We are not so fortunate. Your $12K out of pocket? Last year ours was $35K. This year it is $45K. That’s a $10K increase year over year – not a good trend – and I have professional caregivers 20 hr/week which means I do all the rest. I do not complain, it is what it is and I wish I could do more to help my husband. Be careful when you are making assumptions about other people’s situations.

        As for Republicans not having the opportunity to have input into the ACA? That is BS. They took over a year of non-stop committee hearings to develop the bill that became the law. What you may not realize is how much of the ACA was built upon Republican legislation. I submit that nothing would be acceptable to the GOP if it offered subsidies for those needing them, nor if it imposed taxes (especially on incomes over $250K) on people and medical devices.

        You and I have a fundamental disagreement about health care. I deeply believe health care in the United States should be universal to all, and that it should be affordable, comprehensive and accessible. The latter three we agree upon but I believe that health care is a right, not a privilege and that our country as an economic, industrialized nation should follow ALL peer nations in the world in making health care a reality not a privilege. It is fact that in the USA, medical costs are the leading cause of personal bankruptcy. This is unheard of in the UK, CAnada, Spain, France, Italy, Switzerland, Sweden, Japan, Germany….to name the most well known. I don’t care what healthcare is called in America, I just want people to not have to worry about having it.

        You might find this legislative explanation interesting to illustrate what the sources were for the construction of the ACA. I didn’t do a deep search but it gets my point across. I’m not reading anything that isn’t readily available to anyone about the differences between the ACA and the AHCA. It is up to each of us to inform ourselves so that our opinions are based upon solid information.

        http://addictinginfo.org/2013/11/10/obamacare-study-republican-contribution/

      3. Mime, out of curiosity, how is what Obama said and what Carson said different?

        They both referred to slaves as immigrants. They both mentioned that they came in the bottom of a slave ship – signifying that it was involuntary. Both said that slaves had hopes and dreams of their offspring having a better life.

      4. Begin with the fact that Obama stated those who came from Africa did so involuntarily. Then he elaborated about what they had to endure. He segueyed to their hopes but he clearly differentiated from the Immigrants that came over in the hold of the ship. Nowhere did Carson acknowledge that these people were slaves.

      5. Mary, I’m sure most people understand that when Cason said the people came over in the bottom of slave ships, he was not indicating that they came voluntarily! Please listen again. 🙂

      6. “Unfortunately, there is no way to fix Obamacare. Changing bits here and there is just like putting lipstick on a pig.”

        Crazy thing here, I’m starting to agree with you. It would be painful to go back to where we were pre Obamacare but it would do wonders for us as a country, in the long run. Imagining the shrieks from trump supporters and the turmoil in the political landscape is not difficult.

        We may even get to what you and I want, universal, low cost healthcare.

        You socialist you.

      7. I ran across this piece on health care in the Brookings Institute series, “Unpacked”. What is important is that the author, Stuart M. Butler, makes the case that basic guidelines must be agreed upon before designing a plan to replace the ACA . After significant reading on this subject, I totally agree with Mr. Butler. This is where reform should begin – not focusing on what is politically desirable, not cost-effective , but in developing concensus on what fundmental tenets underscore a quality health reform effort. Get these right and deal with the money and politics after- both of which are important but not first.

        Set a goal: health care in America should be affordable, accessible, and comprehensive. Then, develop guiding principles before attempting to craft a plan. At present, the process is reversed, and the likelihood of finding agreement, difficult. Decide: Is health care a right or a privilege? Start there. Agree upon guidelines, then make a plan that gets you to the moon.

        https://www.brookings.edu/blog/unpacked/2017/03/08/replacing-the-affordable-care-act/?

      8. @objv: >] “It’s true that Republicans have not helped fix any problems. It is also true that they were shut out of the process when Obamacare was thrust on them. Is it any wonder that Democrats have lost over 1000 elected positions? People ARE unhappy with their health care. Unfortunately, there is no way to fix Obamacare. Changing bits here and there is just like putting lipstick on a pig.

        Republicans were “shut out” of the process? What a complete load of crap. Democrats had a strong majority in the House and a supermajority in the Senate. Republicans couldn’t filibuster the ACA and so they put on the pretext of bipartisanship to drag out the process as long as they could in the hopes of killing it. Sen. Grassley himself was intimately involved in those discussions. By all means, go back and look for yourself.

        That said, one of the primary reasons the ACA is floundering is because the individual mandate has failed. Not enough young and healthy people have enrolled to stabilize the marketplace and so we see premiums rising out of control. Insurers are, of course, starting to leave, putting us on course towards a death spiral.

        Enacting a public option would go a long ways towards trying to alleviate this problem. Government-run health insurance could compete in every district across this country, enabling competition to lower premiums and helping with costs. To be clear, I’m not saying it would be a perfect solution, but the idea that there’s nothing we can do is simply false.

  4. Between this atrocity of a health bill, cuts to HUD, and cuts to the EPA, the administration is really sticking it to the poor. And by extension, their children.

    Just imagine if the energy of all those Right-to-Lifers was harnessed to care about actual living, breathing children. What a difference that could make!

    But they’re too busy worrying about closing down clinics that provide health care to women, and ensuring that fetuses get buried with full funeral rites. What a shame.

    1. Honestly, MassDem, I’m worried about my sister’s lack of health insurance right now.

      Saying that Right-to-Lifers don’t care about children does no good. Many people are not going to their doctors and getting treatment because of unaffordable health insurance or high deductibles.

      Obamacare is not working for a large swath of the population. I don’t know if the Republican plan is much of an improvement. The only thing that is clear is that Democrats and Republicans have to work together on healthcare for the good of the country.

      I have hope … but not much.

      1. “I don’t know if the Republican plan is much of an improvement. ”

        Seriously! Read what they have put out there, it is not a plan it is a disaster. According to the GOP your sisters lack of health insurance is her problem. Does she own a cell phone? Sell that shit and get some health insurance. Does the family have a boat, more than one car, a refrigerator , etc. ? Sell that shit and get some health insurance. You know, boots straps and all. Your sisters lack of health insurance is not my fucking problem (says every conservative in elected office).

        Single payer is the only responsible, compassionate ( if you call yourself a Christian ) thing to do.

        https://www.forbes.com/sites/theapothecary/2015/01/27/conservative-think-tank-10-countries-with-universal-health-care-are-economically-freer-than-the-u-s/#9ee3124137e6

        What the hell is wrong with people.

      2. Texan, okay, I won’t call you pro-abortion. Can I say you are pro-Planned Parenthood?

        I don’t agree with the GOP on every issue. Apparently health care is one issue where I differ from both parties.

      3. Texan, I like the Forbes article. I will study it in more detail later. Got company coming tonight and still need to head out to do some grocery shopping. We’ll be going dairy, gluten, and pork free. Wish me luck!

      1. Well, two major committee hurdles surmounted and the AHCA moves on to the Budget Committee where we will FINALLY see some $$ assigned to plan provisions. How responsible is it to pass a major piece of legislation like this without knowing what the cost is going to be? The CBO is working as fast as they can with the information they have while the plan components change daily. The rush, of course, is to meet a March 31 deadline to put a bill onpotus’ deskl for signing. TRUMPCARE. This event will not be the end of this. Anything this rushed, leaving out as many people as it will, and opposed by as many players other than those needing coverage, are going to persist.

        So what does our deep thinking POTUS say about the potential for it not hitting his desk? “Trump however told conservative groups critical of the legislation at the White House on Wednesday that if the full court press to pass the bill fell short, he would let Obamacare fail and blamed Democrats, sources said.”

        Always vengeful. Small. Shallow. Always.

  5. In case there was any doubt, Jeff Sessions is one mean son of a gun. Forget compassion in the justice system. BLM is going to have its work cut out for them as are the SPLC and ACLU. What a mean-spirited bunch of people. The little progress that was made under Obama in reforming the justice sytem is going to be destroyed. More private prisons, less flexibility for the prosecutors and courts in sentencing, more police power with even greater authority…

    http://www.politico.com/blogs/under-the-radar/2017/03/sessions-drug-charges-235853

    1. Old KS Governor Brownback has suffered another defeat from his failed attempt at “trickle-down” funding for state government. Of course what is unfortunate is that he personally suffers nothing more than a legal rebuke while teachers, kids, administrators and families have been struggling to work with significant cuts in funding for education. This man doubtless has his fans – despots always do – but they hurt so many innocent people in the process. Of course, as Fly noted long ago, the voters put him back in office even knowing how he was crippling state operation.

      https://www.theatlantic.com/education/archive/2017/03/can-a-court-decision-help-close-the-achievement-gap/518859/?utm_source=nl-atlantic-daily-030817

    1. What sticks out is this provision that if you’re sick and you don’t have insurance, you can rejoin an insurance pool, but insurance companies can charge you an additional 30% premium for a specified amount of time (I don’t remember the exact language).

      How, exactly, does this not result in a death spiral? If I didn’t know better, it almost seems like it’s tailored to cause exactly that. We don’t have enough healthy people in the markets anyway, which is why premiums are rising for so many, and this is only going to exacerbate that problem profoundly.

      Seriously, what in the hell were Republicans thinking putting this out there? This is a political statement and a giveaway to insurance companies, not a serious proposal, one which, of course, disproportionately slams the poor.

      1. This provision is ALL about the insurance companies. It gets worse. If you’re 50+, your tax credit maxes out at $4K but there is no limit (as is currently in ACA)to how much the insurers can hike your premiums. As one who deals with health and health costs/care daily, people with chronic or serious illnesses have significant out of pocket expenses even “with” insurance. So, your subsidy is reduced (significantly), your tax credit capped per age, and your premiums have no ceiling. All the other medical expenses one has that insurance doesn’t cover? OUT.OF.POCKET.

        At present, middle-aged folks are going to take a big hit as are Medicaid recipients. Good article about the per capita allocation built into the new AHCA for Medicaid in which it notes: “the core problem with aggregate limits, whether across the board or per capita, is that they’re impervious to the factors that drive health care spending.” IOW, chronic illnesses, epidemics, etc….This is why Republican governors met a week ago to form recommendations and a block within the GOP to address the certain shortfalls they will experience in trying to cover the costs that exceed the per capital allocation…

        https://www.nytimes.com/interactive/2017/03/07/us/politics/medicaid-reform-impact-on-states.html?WT.nav=top-news&action=click&clickSource=story-

    2. This article explains what I am witnessing in my little corner of the world, affirmed by stories I’m reading. Grassroots democracy! The article notes that it has energized people across party lines which will set up an interesting situation for the mid-terms but it will be a victory for Democracy if more people vote who not only are passionate about the right and responsiblity to vote, but understand the issues.

      https://www.theatlantic.com/politics/archive/2017/03/how-donald-trump-is-reviving-our-democracy/518928/?utm_source=nl-atlantic-daily-030817

    1. Speaking of gerrymandering, Georgia Republicans have just done something extraordinary, ramming through a new gerrymandering bill even before the next census rolls around. These new lines are specifically tailored to redraw lines around the Atlanta suburbs that host Republican incumbents that have been gradually losing the their margins of victory in recent years.

      To be clear, Republicans have an overwhelming advantage in the Georgia state House already, so one could look at this as their way of trying to bolster their chances of a veto-proof majority even if Democrats are fortunate enough to succeed Gov. Deal in ’18 so as to keep their hold on state government.

      http://www.dailykos.com/stories/2017/3/6/1640743/-Spooked-Georgia-GOP-re-gerrymanders-Atlanta-suburbs-revealing-worries-over-House-special-election

      Disgusting though this tactic though, there is opportunity here. Because it’s so blatantly partisan, Democrats and civil rights groups will, of course, file suits faster than you can blink. If a favorable ruling makes it all the way to the Supreme Court, it provides another opportunity to set a nationwide standard for what constitutes an unlawful gerrymander. We’re getting closer.

      1. You may recall that former GOP Congressman Tom Delay did the same thing in TX a number of years ago, and though it was a different era, the changes “stayed put”. He usurped the census year and his gerrymandering was instrumental in flipping a lot of critical seats in TX.

        Delay – now there’s a MoC I don’t miss. I’m sure you’re right about the lawsuits. BTW, did you notice the decision in VA was unanimous?

      2. Yeah, and you’re right when you say that Delay’s tactic was in a different era. Arguments have evolved and there’s a much more concerted effort to fight against gerrymandering now.

        Again, the Supreme Court is going to have to rule on this sooner or later. Whether it comes via the Wisconsin decision or whatever else, it’ll have national reverberations.

  6. Chris, thank you for the article. I paid my way through college working in a public hospital as a radiology tech in the ER. I have always professed that my 5 years in Emergency Rooms was more educational than all my time at school.

    One aspect of health care rarely discussed is geography. Specifically, do you live in a community with a comprehensive emergency room and trauma unit? Do you live near a public hospital? These are becoming rare in many parts of the country further complicating the notion of “free market”. You may purchase excellent comprehensive insurance but once “under the bus unconscious”…you will be taken to the nearest ER. The difference in quality of care and services offered vary dramatically by community. Folks assume every ER is like Chicago Hope or Grey’s Anatomy.

  7. No – for the reasons Chris mentioned, and more, healthcare is not a free market. Of course, there are those who believe (free market) = (bad), but we’ll ignore them.

    It is not practical for *all* things to be traded within a free market paradigm. Law enforcement, military forces, and large infrastructure programs are examples. But we can for the moment place the complexities of the alternatives aside, and focus on the gorilla in the room: cost.

    Remember the hew and cry when gas was expensive, and how greedy the oil companies were? Well, take a look at the EBITDA of the healthcare industry at large over the last 20 years. Where are the protests? Healthcare has been effectively nationalized here, (and by this I mean over 50% of revenues coming from the government in the form of Medicare and Medicaid), for a couple of decades. Yet, quite unlike a regulated monopoly, it has been completely free to behave as though it were operating in a classical “marketplace”. Want to charge an uninsured customer 10X what you charge an insurance company for the same service? Fine! That’s free enterprise. Want to make an asinine margin on a proprietary drug? Go for it. (Oh, and BTW be sure your lobbyists make sure that your largest customer can’t negotiate.) This list goes on. Speaking as a Classical Liberal, this crap is not “free enterprise”.

    By now we should all be aware that as a nation we spend at least 2X per capita on healthcare as our brethren in the developed world. And, while we do many things better than they do, outcomes in healthcare are not among them.

    Without control on costs in the form of enforced transparency in pricing, oversight on price gouging, enforcement of a level playing field, *external* enforcement of professional ethics regarding ownership of healthcare facilities and services, control of the $50B+ medical tort morass, Spreading the word that your 90 year old Aunt Mildred can’t have a new hip, and drunk Uncle Louie can’t have a new liver, expectations that end-of-life care does not mean another day or two of life at *any* cost, an understanding that running your kid to the emergency room every time they have a runny nose is not free, (nor has it ever been), abandoning the notion that there is a pill for everything, and that the newest and most expensive ones work best, and …

    None of this will happen unless and until we collectively recognize the message of the parent post – that healthcare is not a marketplace. And until we do these things, the clock is ticking – ticking to financial ruin for all but a very, very few.

      1. Went to my primary doctor for a growth on my ear and he sent me to an ENT. Before the guy even looked at me his nurse was planting the seed. She said he will probably want to put you under anesthesia , not completely out, but groggy enough that I needed a driver after the procedure. Sure enough, he took one minute to look at my ear and repeated the same thing the nurse said. It would be done in the operating room so there is the cost of the operating room, the pre-op, etc. I left knowing that was all bullshit, they were just trying to sell services so the hospital would make more money. Went to a dermatologist the next day, he looked at it and said they could do it in the office with a local.

        Buyer beware. Got me thinking about the people taking a doctor at his word and not being educated enough about there own healthcare. Reminds me of that old joke about the guy in the doctors office and the doctor says I have good news and bad news. The bad news is you need an operation that is going to be very expensive. The guy asks, “What is the good news?”, the doctor says, ” now I can buy a new boat”.

      2. OK. So nobody wants to argue, so following Tex”s lead, here”s a doctor joke:

        A naked man runs into his psychiatrist’s office and says, “Doctor, doctor, am I crazy?”

        The doctor replies, ” Well, I don’t know about crazy, but I can clearly see your nuts.”

      3. Very few people who are property owners can relate to the fact that they are paying for indigent care one way or another. I wish it were a line item in the taxes in clear terms instead of a euphemistic “Hospital Tax”….

        In addition, we pay through days lost due to illness of the worker or someone in their family. All these losses aggregate into less spending power which reduces tax revenues which means you have to make it up somewhere else. Such a vicious cycle and so wrong, in addition to the abject ignorance that we’ll pay one way or another.

      4. Well, I dunno, mime. I may not be the sharpest knife in the drawer, but I sure recognize what the line item “Harris County Hospital District Tax” means. It’s no euphemism to me.

        As to the other things you mentioned, Chris summed it up above; “[We] are paying for them in the first place.” And yes, the sooner that is recognized, the better.

      5. Hey – didn’t you invent some satellite thingy up there? I cannot tell you how many people I have discussed this with (mostly seniors) who haven’t a clue….they think it’s for the building or whatever…

    1. Fifty — You know I support universal health care. Not only because I believe it’s the right way for a nation to care for its people, but also because research supports the fact that better outcomes for less cost are achieved in countries that offer universal care. I have stated many times that I believe it should be paid for by a VAT because that way everyone who benefits will have contributed. I know about sales taxes being regressive but health care is expensive. Without question, procedures should have transparency in costs and abusers should be punished.
      I don’t know if I will see some iteration of universal care in my lifetime but it has to come.

      1. A VAT is a Pandora’s Box of virtually bottomless government revenue that we should not open. What’s the logical connection with health care?

        And yes, it is regressive, (at least without myriad additional layers of complexity), is pretty easily traversed, (mostly by outsourcing), and is a bureaucrat’s dream. Bad, bad idea.

      2. EJ

        I’m not an economist, but it’s my understanding that sales taxes may not be the best way to handle it. For one, they’re regressive (they disproportionately strike poor people) which seems a strange thing to combine with a universal single-payer system. For another thing, they act to reduce aggregate demand, which may have unpleasant consequences in the current economic climate.

        This is not to say that sales taxes don’t have their place as part of an overall mix of forms of taxation, but (like other forms of taxation) they have bigger effects than simply “it feels right.”

      3. One of the frequent, loud complaints by conservatives regarding health care is that there are too many people partaking without contributing. I understand the regressive argument but am trying to find a contributory funding vehicle to which all could contribute . My goal in health care is universal coversage vs the smoke and mirrors “universal access” that is driving the current GOP legislation. Sadly, many people think they are the same.

        Appreciate you viewpoint and that of Fifty’s….How do other countries who provide universal health care fund their plans so that all contribute?

      1. Answer: Yes, and yes. It’s a line item on our property tax bill. W2? Where did that come from? Unarmed – please google it and get back to us before mime rests her case so far she can’t awaken.

      2. Ok, I googled it. I’ve never seen a separate tax for hospital care. In Pennsylvania we sometimes get a separate school tax bill on property. Sometimes other specific income taxes for specific districts. In Allegheny county (Pittsburgh) we pay an extra 1 percent sales tax also.

        So here, I guess indigent care is handled by raising everybody’s bill and therefore everybody’s insurance premium. I’m guessing.

        But Mime, I know that somehow, someway, it gets paid for. Paid by me and the rest of society.

      3. I know that. I’m just razzin’ you, Fifty! But what I told you is the absolute, unthinkable truth – about people not realizing their line item “hospital district” represents indigent care….try it out with some of your neighbors…you might be surprised.

    1. This bill won’t please anybody. It keeps the basic structure of Obamacare (community rating+mandate+subsidies) so the wingnuts will hate it, but the subsidies are cut back so much for people who actually need it that most of the healthy exchange customers will leave. So insurers will hate it. It keeps the Medicaid expansion for a while – so the wingnuts hate it again – but chops its head off later, so the Republican governors will hate it. It takes four years off the lifespan of the Medicare trust fund, so seniors will hate it. It lets insurance companies waste more money and gives them tax break for further overpaying their CEOs. And it will probably increase the deficit in spite of all this.

      This isn’t a hot mess; it’s a hot radioactive nuclear waste mess.

  8. I like simplistic jargon, so I will keep this simplistic and gloss over how complicated many of these issues are but, this is what the people running the WH, Congress, and Senate think:

    1. If you are poor, you should just go away and die.
    2. If you are sick and old, you should just go away and die.
    3. If you are non-white, you should just go away and die.
    4. If you don’t believe in a christian theocracy where women are chattel, you should just go away and die.
    5. If you don’t believe in the supremacy of rich white american citizens over the rest of the planet, you should just go away and die.

  9. From Forbes.com: “As I LAY unconscious under a bus, I am in no position . . . ”
    ***************
    Grammatical correction: It should be LIE — “As I LIE unconscious . . . ”

    Here on the blog it’s very informal, but on Forbes.com you need to be beyond reproach. Sorry. 🙂

      1. First paragraph:

        they refuse to wrestle honestly with the hard-cases; the situations
        ***************
        I see no reason for a hyphen between hard and cases. Also the semi-colon after cases should be a colon.

      2. Fifth paragraph:

        Insurance companies have certain needs and interests that will never line up squarely with their customers.
        *************
        I would add an apostrophe to the end of customers — as in customers’

        Implying needs and interests that will never line up squarely with their customers’ needs and interests.

        Your choice.

      3. Also in the fifth paragraph:

        I am at the mercy of an entity with interests at conflict with my own.
        *************
        AT conflict with my own? Sounds awkward. IN conflict with my own?

        To avoid splitting hairs over those options, I would just say “which conflict with my own.”

      4. Seventh paragraph:

        What if the insurer TRIED to intervene in my care to their own benefit instead of mine?
        ***********************
        To be consistent, I would use TRIES, since all the other What if scenarios in that paragraph are in the present tense.

      5. Ninth paragraph:

        Modern health care with all its fancy instruments, amazing methods, and success in extending life and happiness only exists
        ***************
        I would add a comma after Modern health care, and a comma after happiness.

        That’s it.

      6. Tutt, You might!

        I’ve enjoyed my Be a Mexican-American day. Today, I am celebrating International Women’s Day by not doing any work in solidarity with my liberal sisters. (So far my husband has not noticed.)

        I don’t know about you, but I am disappointed that the new health care bill doesn’t seem to go far enough to control medical costs.

        Well, I need to get back to my strict schedule of not getting anything done. (So far my husband has not noticed.)

        Catch up with you mañana.

      7. Yes, lucky you! I grew up in a community of tyrannical Hausfrauen.

        It is important to iron everything : handkerchiefs, tablecloths, bed sheets, and it goes without saying, clothes must be totally wrinkle free. Wear an apron to protect your clothes. It must also be ironed. 🙂

        I haven’t ironed anything in years. Some day I may have to pay for my rebellious ways. 🙁

    1. Sure, the easy joke would be to send Chaffetz to remedial math to learn how $600 for like two three years < $17500 a year (average health insurance cost), but what I really hope some town hall member shouts in his ear is that iPhone purchases are nearly always subsidized.

  10. I have never seen written how health insurance companies can exist not discriminating against pre-existing conditions unless there is a health insurance mandate. (Or, i guess, charge outlandish premiums! That could work:-)!)
    The mandate is the cornerstone to making this all work. The mandate was originally a Republican idea, out of the Heritage Institute if I am not mistaken. An idea almost all Republicans endorsed and Gov Romney actually put into practice!
    But once that insidious black guy of a different political party latched on to it, it was tantamount to treason!

    Add to that, how does one pay for all this? Well, if you tax the wealthy, who have been the recipients of tons of tax breaks since G W took office, that would work! But you can not tax the wealthy and still be a Republican!

    No Republican plan will work until they get past the above. And i doubt i will live to see that day!

    1. I just spoke to a 60 year old male retiree. Under the AHCA, at his age, his tax credit will be $4K. That isn’t near what the ACA subsidy is he is currently receiving. Having a heart condition, he’s vulnerable to the flim flam way the AHCA pre-existing coverage works. He’s hoping he will not have a major event before he qualifies for Medicare and that their savings won’t be ravaged by premiums they will have to pay to avoid having a gap in coverage and having to go through medical underwriting.

  11. Interestingly, the term “Health Care” is generally used as a surrogate for “Health Care Insurance.” It is absolutely true that there is no free market for either one of them, even though they are totally different things.

    A free market for health care would mean an opportunity for health care consumers to shop around for their health care. That’s fine when it means selecting a GP for the normal checkups and the ongoing treatment of chronic conditions. Unfortunately, that’s only a part of the picture of health care needs. When your mother has a stroke, or your wife is diagnosed with lung cancer, there’s little opportunity to shop around.

    With health care insurance, the problem is the opposite. There’s plenty of opportunity (i.e., lead time) to shop around, but the “stores” selling it are very few, and the prices are set by an oligopoly that doesn’t negotiate in good faith.

    For many idealists, “free market” means “unfettered market.” To economists, that’s not a good definition. The market information and leverage should be symmetric to create a free market.

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