Like most Republicans, I’m unhappy with the GOP Obamacare replacement proposal known as the American Health Care Act.  Partly because, if passed, it would not kill widows and orphans sufficiently quickly enough for the impulses of my Republican blood lust but also because it would fail in its intended purpose: reducing insurance premiums.

Now, I don’t want to come across as defeatist here but I already know where this is going.  The GOP Majority is going to fuck us again.  It’s just the way they are.  Either they want those overindulged insurance company executives to keep the donations coming or the town hall protests really did scare them into pretending to be compassionate; but they have already failed to do the one thing that they were elected to do in 2010, 2012, 2014, and 2016.

Repeal the Affordable Care Act.  You had one job.

We, your GOP voters, gave you the House.  We gave you the Senate.  Improbably, we even elected Donald Trump with the understanding that you needed both houses of Congress and the White House to get rid of Obamacare.  You have had sufficient time to do it and so nobody on our side should have any doubt that you are going to betray us.

The key thing to recognize is that any version of comprehensive health care reform which allows for everybody with preexisting conditions to purchase health insurance is never going to work at accomplishing much unless ever-increasing premiums and reduced insurance coverage for the not-sick are the goal.

I think everybody understands by now that when we refer to “health insurance” in the United States we are using the term almost oxymoronically.  It isn’t insurance if you don’t actually have to insure against anything.  I mean, insurance was always understood to work a certain way for a few hundred years or whatever.

The understanding was, “Something bad might happen to you and you might need certain costs paid for with money you don’t have right on hand.  If you will pay our insurance company money on a regular basis, then we will cover the expenses under an agreed-upon set of conditions and for a set amount of costs found in this policy.”

What we have with health insurance is, “If something bad happens to you, give us money.  We’ll pay off some portion of your costs, but you can end your policy and stop giving us money as soon as you are done incurring more costs.  We’ll simply get the money it cost us to fix your problem from other people, like the morons who are dumb enough to have insurance policies when they aren’t sick.”

It’s as if someone built their home next to an active volcano.  Would you demand that State Farm sell them homeowner’s insurance?  No, I don’t think so, but if you apply our understanding of health insurance to that example, then that homeowner can recoup his losses from State Farm simply by signing up for a policy the day after his beautiful hardwood floors are scorched away by a stream of liquid hot magma and then dump his policy the day after the house is rebuilt.  Who pays for it?  No idea.

I mean, we all agree that health insurance isn’t really “insurance” anymore, don’t we?  This has all been discussed before by smarter people thousands of times since Obamacare passed.  You absolutely cannot require an insurance company to cover a risk event that has already occurred and call it insurance.

If you want any sort of “free market” alternative to government-run health care, then you must acknowledge that the politically-popular provision of the ACA which requires the insurance companies to provide coverage for preexisting conditions must be eliminated.  As long as that is there, the government will be forced to help the insurance companies cover their inevitable losses, one way or another.  The GOP Congress clearly seems to recognize that this is a granted entitlement that they are fearful to attempt to take away.

“But, Thrill, are you saying that you want to dump all of these sick and dying people off of their insurance plans?”

No.  Congress could certainly include a provision within the bill that forbids the insurance companies from dumping any person with preexisting conditions who would otherwise not have been covered prior to the bill becoming law.

Alternately, they could go with Mark Cuban’s inventive idea and just keep taking care of those people forever:

It amounted to single payer coverage for chronic physical and mental illnesses and life-threatening injuries, and standard insurance for all other healthcare. 

But this post isn’t really about how bad Obamacare was, how greedy the insurance companies are, or how much fat people without medical insurance who smoke and drink and then wait to buy coverage only when their self-destructive behaviors finally get them sick deserve to die.  It’s about how nutless the GOP Congress is and what I think of the looming suspicion that they are now preparing to champion Obamacare under a new name after pretending to hate it for all those years.

If the GOP will not (and it is “will not” and not “cannot”) repeal Obamacare and fully embrace a free market solution –whatever that really means–then we may as well stop kidding ourselves and admit that it’s time for the Republican Party to just go ahead and take the lead over the Democrats in establishing universal, single-payer health care.

I’m not going to make the argument for single-payer.  I do not believe it will work for us, or that we can afford it, or that we can accept the inevitable rationing of care and increased wait times.  It’s not what I want.

The GOP has two choices it seems to have locked itself into.  Either they can  stop the further descent into socialized health care now by abolishing the ACA and deregulating the hell out of the health insurance industry (which is what the conservative base that elected them wants them to do) or they can wait until the Democrats eventually quit being babies and remember how to win national elections again and pass universal, single-payer health care once and for all (which is clearly what they want to do based on their own retarded instincts).

There isn’t a middle ground.  If the GOP decides to keep Obamacare-In-All-But-Name-With-A-Tweak-On-The-Mandate, premiums will continue to rise, the uninsured will multiply like zombies in a gun-free zone, and they will ultimately taste the wrath of voters for it.

I propose that if the GOP Congress has really decided that it can safely ignore its base and not do the one thing it is expected to do, then it might as well just figure out how much its going to cost to run a national single-payer program, raise the taxes, have Bernie Sanders write the bill, and then pass it.  Then profit, I guess.

You might think I’m kidding, but I’m not.  I say that if this is destiny, then it might as well be the Republicans who pass it and Trump who signs it since they have made it clear that they want what is best for their own careers and legacy, not what those of us who believe in limited government and the free market want for the good of America.

Let’s just admit that it’s better for the GOP to be the better socialist party if they’ve given up on being the conservative one and have it done with.  I’m tired of the pretenses.  Maybe I really am just being prematurely defeatist, but only full repeal would put my doubts at rest.

 

22 comments

  1. Universal healthcare is on its way in one shape or another. Unfortunately the insurance industry is a perfect example of why not everything in life has a free market solution. Prescription drugs are a fully subsidized industry inside of a crony capitalist insurance industry, as one example.

    Getting rid of the aca will hasten the republican party’s death by a decade. They could try to craft a competitive bill, as they have, but it seems to be the compulsion of republicans these days to turn just about anything in this nation as a tax break for the wealthy, which is all this bill is.

    The only functional place the republicans have in modern politics is as a leverage to punish democrats. The American people only vote for republicans when they’re angry at democrats and republicans know this. So, as a party, this is what they’re reduced to; sitting in congress quietly defunding little stuff to give the appearance they’re doing something and avoiding doing anything substantial.

    And, to dispel that the idea of republicans are the smaller government guys, I raise you the 2017 budget. No real trimming of money spent, it’s more reallocating any of the remaining government money that’s not allocated to the military goes now into the most bloated and beauracratic money pits the United States has, to date. There’s already so much money in contracting defense industry that they don’t even know how to spend it all.

    I think it’s just time to face that it’s a dead party that dug it’s own grave by expanding the wage gap until their only real constituents are america’s wealthiest, hiding behind citizens united to give the party dark money. The Republican Party as we’ve come to know it won’t be around in 20 years if it survives at all.

  2. turn just about anything in this nation as a tax break for the wealthy

    While I do agree that the current bill does little to actually fix the problem…

    This is such a disingenuous statement that I’m sick of seeing in the media. If you give a tax break – any tax break, to the tax payers, and the “rich” pay a higher percentage of the taxes in this country, who gets the benefit of such a tax break? Anyone who uses this statement must want a tax break for those who don’t pay taxes?

  3. Sorry – going to have to get my Insurance PR hat on for this one….

    “Something bad might happen to you and you might need certain costs paid for with money you don’t have right on hand. If you will pay our insurance company money on a regular basis, then we will cover the expenses under an agreed-upon set of conditions and for a set amount of costs found in this policy.”

    Actually no – that’s not it, and it’s a common misconception that insurance is like an individual savings account for when the bad times happen.

    Insurance is collectivism. Sorry, it is. Insurance is about distributing risk across a collection of entities so that everyone can be more productive. It is not an individual agreement between a company and a person. The insurance company makes a gamble that the amount collected from the entire pool will be more than the amount they pay out in claims – they then deal with the reinsurers to turn a profit from their investors.

    You can’t do that on an individual basis, because the risk is so high. If I insure Thrill against troll attacks, let’s say that there’s a 20% chance I have to pay out more than I take from you. No investor is going to touch that. But if I insure all 50,000 people who read this blog, the probability decreases because the risk is spread. So that’s a much better bet for my investors.

    So it’s in the insurance company’s interest to get as many items into that pool as possible, because it further spreads the risk. Even high risk items (such as your volcano example) are useful to bring into the pool because it spreads the risk further – the actuarial wonks just need to use their fancy tables to work out at what level of income makes that risk worth it. You’re not pricing the insurance on the probability that the risk occurs. You’re pricing the overall pool on the probability that the risk will occur to a certain percentage of them.

    So to your volcano example – while we shouldn’t demand that State Farm cover them – but it is in their interest to expand the pool. In a purely free market model, this would be priced accordingly, and if Pompeii citizens can’t afford it, they’d have to wear the risk themselves.

    The lefty way of looking at this, is that if the free market is left to itself, and citizens of Pompeii are priced out of the market, then the entire city of Pompeii becomes uninhabitable, and therefore less productive to society as a whole. Less economic output, (Volcanic soil is very fertile, and is prime farming ground – we don’t want that to go to waste). Also, won’t someone think of the children?

    So the lefts idea is to have some sort of regulation that ‘encourages’ insurance companies to take on risks that they might not ordinarily look at – possibly by covering part of the risk out of the Government pot (spreading the risk even more). Yes the entire country pays a little more to ensure Pompeii can function, but overall it’s a net win because of those sweet sweet volcanic bottled water sales.

    I’m not a health insurance guy – and it is very different (complicated, who knew?) but the basic philosophy of what insurance is needs to be accurate – else the system will be designed badly.

  4. But is there really any “risk” if you can simply get coverage when the event occurs? Yes, I get the idea of cost sharing and all that, but there’s no other type of insurance in which you can suffer a loss from a risk and THEN get insured and have the past risk event covered.

    Nobody assumes the risk themselves. There isn’t actually any risk at all.

  5. Not sure I follow – are you saying that I can get hit by a bus (or whatever) and then get health insurance the next day and get my medical bills paid for?
    (Not a Health insurance Guy)

  6. Yes, I get the idea of cost sharing and all that, but there’s no other type of insurance in which you can suffer a loss from a risk and THEN get insured and have the past risk event covered.

    That’s not entirely true. I’m aware of one exception. When a homeowner allows their insurance to lapse, the mortgage company will cause a forced placed insurance policy to go into effect. These lender based policies will cover back to the date of the lapse, even if the house has burned down in the meantime. The other side of that coin is that the policies are much more expensive than normal homeowners insurance to compensate for the added risk.

  7. No, not exactly. You wouldn’t be able to sign up for insurance and have the emergency room bill paid. You wouldn’t be able to pay retroactive costs.

    But if you needed to sign up for insurance to cover physical therapy and treat conditions that resulted from the accident, yes, the insurance company would be obligated to sell you insurance to cover those costs.

    It’s why Obamacare could never work. The insurance companies are responsible for the costs of people who aren’t even in the risk pool or paying into it. They can just pop up and say, “Hey, I haven’t been paying into your pool for the past several years, but you have to cover my expenses anyway. Once you’ve paid off my costs, I’m going to cancel my policy and leave your pool with the loss.”

    Because of this, the insurance companies have to raise premiums on their existing insured customers. If those customers are healthy, they will eventually drop their policies because they’re too expensive. Besides, they can just wait until they’re sick to get insurance again. Once the pool is completely filled up with sick and old people and no healthy people, the insurance company hemorrhages money. That’s the “death spiral”.

    Our only choice at that point is to bail out the insurance companies or repeal the pre-existing condition mandate.

    It’s really not insurance at all.

  8. Ahhhh, I think the force-placed insurance case you’re making here is more applicable to the “individual mandate” than the “pre-existing requirement” issue.

  9. It’s worked this way for years for employer-provided plans. At worst, some plans had a 12 month time out if you interrupted coverage. Under the ACA there is no time out. No one is complaining that employer plans are hemorrhaging money and they cover the vast majority of Americans. How come?
    The idea behind the mandate/tax penalty was to have *everyone* in the pool, not just the sick people. If you get a big enough pool, the risk spreads out.
    Your volcano example sounds a lot like flood insurance for people living in the hurricane areas. They have to have insurance and the the taxpayers keep bailing them out. I wonder what the difference is between people with no health insurance and people with oceanfront property that makes one set worthy of bailing out and the other not so much? Hm

  10. In this case the tax breaks go to the wealthy not as a percentage of the overall, but by design.
    The ACA had a 0.9% Medicare tax only on high-income earners (over $200/$250k individual/family)
    There was also a tax on net investment income which disproportionately hit people who get most of their income from investments.
    The new bill makes those taxes go away.
    In total, this gives back $35k or so to the top 1% v. $180 to an average family.

  11. I know, right? Somehow, people are able to make the connection that the insurers are the ones who benefit from a health insurance bailout, but not a property insurance bailout. There’s definitely a disconnect there.

    If property insurers don’t want to charge enough for premiums when people build in flood zones, then they deserve to go under. These losses are almost entirely foreseeable.

  12. And I just had a huge moment of self doubt that caused me to look up the definition of “pedant” to make sure I didn’t accidentally refer to myself as one of the terrible words that start with the same letters.

  13. No, it’s a good one. I applaud you for the attempt. However, I’m just going to say “It’s different because reasons” and you’ll somehow have to deal with it.

  14. I guess in the general insurance market, what you’re generally buying is ‘repair and replace’. With health, you’re never ‘as good as new’ because…. ageing.

    There’s another difference with the general insurance market, and that’s around liability – i.e. you’re only covered for things that aren’t your fault.

    If I drive drunk and smash into a lamp post, then my car insurer won’t cover it because it was my fault. However, my medical bills would be covered even though it was my fault.

  15. Unfortunately the insurance industry is a perfect example of why not everything in life has a free market solution.

    You mean it doesn’t have a free market solution so long as government regulation completely strangles it to death, right? The system has been anything but “free market” for at least as long as I’ve been alive.

  16. In this case the tax breaks go to the wealthy not as a percentage of the overall, but by design.

    I’d agree with that. The GOP bill as first presented was a complete shit sandwich. I have no idea what those idiots were thinking other than trying to appease everyone, and in so doing appeased no one. Obamacare must be repealed, not just modified. And yes, some people will probably lose coverage, and yes, that is going to get screamed by every talking head everywhere.

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