Why replacing Obamacare is so hard: It’s fundamentally conservative - Craig Garthwaite, Washington Post

[Jazzhead]

You really do not know what the term "insurance" means, do you?  Where do you read one must insure 'pre-existing'?

You're the one revealing your ignorance.   The whole point of an individual mandate is to encourage everyone to be part of the insurance pool.   Then you've got true insurance - folks part of the risk pool before their health problems start.   

Resentment of the individual mandate among conservatives is puzzling to me.   Folks resent the imposition on their liberty - their liberty to be free riders, to develop health problems in the absence of insurance and then dump those costs on others - on hospitals, on their neighbors who've purchased insurance, and on the government.

If you oppose the individual mandate (or something like it that punishes free riders),  then what you must advocate instead is the government stepping in and providing welfare to folks who cannot get insurance in a private marketplace, or to their providers.  That is, of course, the premise of single payer - fund health care as a right regardless of individual condition.

But if you believe in private markets, if you believe in private insurance, then you need to address how the insurance pool is created.   If you can put off buying insurance until you need it,  that will collapse the market - because THAT is not insurance.   But the individual mandate is the essence of insurance -  healthy folks can no longer shirk their responsibility to insure themselves against future events and force the rest of us to pay for their selfishness.     

[Sanguine]

You're the one revealing your ignorance.   The whole point of an individual mandate is to encourage everyone to be part of the insurance pool.   Then you've got true insurance - folks part of the risk pool before their health problems start.   

Resentment of the individual mandate among conservatives is puzzling to me.   Folks resent the imposition on their liberty - their liberty to be free riders, to develop health problems in the absence of insurance and then dump those costs on others - on hospitals, on their neighbors who've purchased insurance, and on the government.

If you oppose the individual mandate (or something like it that punishes free riders),  then what you must advocate instead is the government stepping in and providing welfare to folks who cannot get insurance in a private marketplace, or to their providers.  That is, of course, the premise of single payer - fund health care as a right regardless of individual condition.

But if you believe in private markets, if you believe in private insurance, then you need to address how the insurance pool is created.   If you can put off buying insurance until you need it,  that will collapse the market - because THAT is not insurance.   But the individual mandate is the essence of insurance -  healthy folks can no longer shirk their responsibility to insure themselves against future events and force the rest of us to pay for their selfishness.   

Your continued and obstinate refusal or inability to understand that says it all.

[Jazzhead]

Your continued and obstinate refusal or inability to understand that says it all.

At this point I accept it, Sanguine.  I support the GOP reform bills that will jettison the individual mandate in favor of different forms of incentives against free-ridership.   I prefer the House version, where the insurer must accept the free rider, but can charge a substantially higher premium.   (In the Senate version, the free rider can be denied insurance altogether for six months.)

But from the standpoint of efficiency and fairness,  I think an individual mandate is better,  provided that the mandate is enforced with respect to an insurance marketplace that is affordable and provides choices that people want.  Under ObamaCare, the choice was between paying the mandate tax and paying for completely unaffordable insurance - especially for younger Americans,  for whom rates are set arbitrarily high to support lower premiums for older folks.  It is perfectly rational for a millennial  to pay the tax and go without insurance coverage - and that has led to the huge premium spikes as the insurance companies face ruin because the younger, healthier lives that were supposed to be in the pool aren't there.   

[INVAR]

The American Middle class has two things the French did not. Numbers, and arms.

I believe we are resilient enough to even endure enough of the economic strictures that we will survive in numbers which will require forcible elimination, if they dare to try.

The Numbers are being diminished via government redistribution and the consequences of Socialism's debt.  By design - crushing the middle class via redistributive economics, it shoves the greater bulk of the Bourgeoisie into government dependence of one sort or another.   Elimination in total will be as easy as shutting off the free shit subsidies and denying health care.   I got that from a horse's mouth (or ass) operative of the DNC some time ago.

They are very aware of the Second Amendment 'problem' and they really believe that causing economic desperation, instigating class and race warfare to go hot while the State grows and redistributes wealth and limits liberty in the name of fairness - is going to thin the bulk of the people they want to eliminate.

Look at the growing meme and zeitgeist among their followers that are suggesting eliminating Whites, punishing the wealthy by confiscating and redistributing what they have to government-approved constituencies.

Indoctrinating the country to accept Marxism as better than or more fair has been going on for decades and they think enough of the population having accepted it incrementally will embrace, rather than take up arms against their fundamental transformation.  As the pain begins to be felt, they will turn to the state for provision and those angry at the state for causing the problems will be told they are an enemy to fairness while growing government.

That plan is working.

Look how many imbecilic morons who claim to be Conservative are supporting and promoting government-mandated and run healthcare.

Then there are the truly deceitful ones among the leftovers of the Conservative herds trying to convince them that Communism has always been at it's root - a Conservative position.

[Smokin Joe]

ObamaCare isn't conservative.   It wreaks too much havoc with private markets and consumer choice for that.   In many places,  it's devolved so there's only one insurer in the market.    That's not competition,  that's not conservative.

It's roots are conservative, in the sense that it addresses the free rider issue by taxing those who do not participate in the insurance marketplace,  thereby expanding the risk pool sufficiently to (theoretically) make community rating coverage affordable.   There are fewer folks with "pre-existing" conditions since more people are part of the pool in the first place.   The costliest folks' expenses are spread among a wider group.  Remember, of course,  that the idea of individual mandates to achieve affordable community rating coverage has always been proposed in the context of the alternative of single payer.  The conservative rationale of the individual mandate has always been to preserve private markets and avoid single payer.   

But the ACA goes about it all wrong - principally, in my view,  by forcing the young to subsidize the old (effectively driving those healthier lives out of the pool),  and by eliminating competition with respect to the scope of coverage.   The only policies in the marketplace are gold-plated, with competition coming in the form of deductibles/copays and the skinny-ness of provider networks.

Yes,  the ACA can be reformed in a more conservative direction, as both the House and Senate bills attempt to do.   But the ship has sailed with respect to scrapping it altogether, and returning to the bad old days when folks with preexisting conditions had no access to coverage,  and imposed their costs on hospitals.   Some have proposed the alternative of high risk pools for the most expensive lives,  or slicing off that population and simply providing them with Medicare.  Such approaches also have merit,  so long as those outside the pools have access to affordable coverage that fits their needs, and effective penalties exist for the free riders.

Screw the penalties. That amounts to a tax on the healthy for breathing. NO!

If you aren't on the train (not requiring medical care) you aren't riding, so you can not be a "free rider". That would be someone who uses the service and doesn't pay.

If you want that look for illegals. Look for the welfare crowd who go to the ER for skinned knees and sniffles.
Get off the working man's back with the rules and penalties that not only don't improve his health care, just add another burden to pay for those who are getting better than he can afford for himself. And just because folks don't have insurance doesn't mean they don't pay their bills. I can write a check quicker than the insurance company can process the bill.

[INVAR]

Screw the penalties. That amounts to a tax on the healthy for breathing. NO!

If you aren't on the train (not requiring medical care) you aren't riding, so you can not be a "free rider". That would be someone who uses the service and doesn't pay.

If you want that look for illegals. Look for the welfare crowd who go to the ER for skinned knees and sniffles.
Get off the working man's back with the rules and penalties that not only don't improve his health care, just add another burden to pay for those who are getting better than he can afford for himself. And just because folks don't have insurance doesn't mean they don't pay their bills. I can write a check quicker than the insurance company can process the bill.

It is a waste of time to attempt to argue the egregious faults and wrongness of Communism with a Communist.  Logic is not going to affect their thinking, because they are ideologues first and foremost.

Which necessitates an equal resistance.

The fact is, government EFFS up or creates chaos and imposes tyranny upon anything it touches.  Those are matters of undeniable fact to anyone who is honest and understands what was intended for us versus someone who will argue fundamental transformation into slavish despotism.  That is government's nature.  Like fire, unless constrained and controlled in it's very limited and beneficial use, it will grow to consume everything and burn it to ash.  People pushing for more government statism see what is as yet unburnt and will demand the fire be accelerated and given more resources to consume.

This is why we are in debt to the tune of trillions upon trillions without any mathematical ability to pay those debts back.

Still, the fire of government is sought to consume what is as yet still standing.

People pushing Communism and arguing it's benefits and citing them to be 'fundamentally Conservative' will indeed argue the 'fairness' and 'need' to tax the air you breath and tax each beat of your heart. 

Stopping your heart from beating and eliminating your breath is exactly what those who make these arguments for Communism will do to those who refuse to comply with their demands.

Because all life, wealth, and power is but a grant of government to those who have embraced Collectivism - whether by the hand of a dictator, or by the hands of millions in a mobocracy .

[rodamala]

Hmmmmm. Do you dress well, eat decent food go to the dentist out of pocket, keep those disposable contacts coming, or do you pay for insurance and be broke at every turn? You take your chances.

It isn't obstinacy, it's a good gamble, even if some don't come out winners.

@Smokin Joe

Protip: Insurance is a bad bet



(P.S.  Always split 8s.  Never split 5s or 10s)

You're welcome.

[IsailedawayfromFR]

You're the one revealing your ignorance.   The whole point of an individual mandate is to encourage everyone to be part of the insurance pool.   Then you've got true insurance - folks part of the risk pool before their health problems start. 

Please reread the definition.   Insurance is to mitigate future events, not past events.

Just like you like to redefine what a conservative is, you try to redefine insurance.

It doesn't work and you are called out on both.

[INVAR]

You're the one revealing your ignorance...what you must advocate instead is the government stepping in and providing welfare to ...fund health care as a right regardless of individual condition.

Please reread the definition.   Insurance is to mitigate future events, not past events.

Just like you like to redefine what a conservative is, you try to redefine insurance.

It doesn't work and you are called out on both.

I'm glad I'm not the only member here who knows what this person really is, despite his insistences to the contrary.

He provides a great service to us, in helping us combat Socialism and Communism disguised as Conservatism.

[Smokin Joe]

@Smokin Joe

Protip: Insurance is a bad bet



(P.S.  Always split 8s.  Never split 5s or 10s)

You're welcome.

A lot depends on how the cards are running. Dealer has a face/ten up changes things from 4-5-6, too.
Best I have ever done on a Blackjack table was as the Dealer, though.

[Jazzhead]

If you aren't on the train (not requiring medical care) you aren't riding, so you can not be a "free rider". That would be someone who uses the service and doesn't pay.

Pray you stay healthy.  Pray you stay wealthy.   It could all change in an instant. 

Free riders will usher in socialism in this country.  Once the costs of selfishness and greed become intolerable,  socialism will demanded by the community.   Liberty is not a right.  It must be earned, and exercised with responsibility. 

Pray you stay healthy.  Pray you stay wealthy.   It could all change in an instant.     
 

[Jazzhead]

I'm glad I'm not the only member here who knows what this person really is, despite his insistences to the contrary.

He provides a great service to us, in helping us combat Socialism and Communism disguised as Conservatism.

Jazzhead - exposing batshit craziness on a daily basis.   

[Smokin Joe]

Pray you stay healthy.  Pray you stay wealthy.   It could all change in an instant. 

Free riders will usher in socialism in this country.  Once the costs of selfishness and greed become intolerable,  socialism will demanded by the community.   Liberty is not a right.  It must be earned, and exercised with responsibility. 

Pray you stay healthy.  Pray you stay wealthy.   It could all change in an instant.   

"Free riders" won't usher in anything.

It's the gibsmedats and others who won't take responsibility for what they do who are ushering in socialism.

And, again I heartily object to the term 'free riders' for people who aren't riding at all or are paying cash for their ticket.

I know one thing for sure, If I had paid Obamacare rates for insurance the last two years we would have starved to death. How's that for "healthy"? All our bills are paid, instead--including medical bills.

Kill Obamacare now.

[Free Vulcan]

ObamaCare isn't conservative.   It wreaks too much havoc with private markets and consumer choice for that.   In many places,  it's devolved so there's only one insurer in the market.    That's not competition,  that's not conservative.

It's roots are conservative, in the sense that it addresses the free rider issue by taxing those who do not participate in the insurance marketplace,  thereby expanding the risk pool sufficiently to (theoretically) make community rating coverage affordable.   There are fewer folks with "pre-existing" conditions since more people are part of the pool in the first place.   The costliest folks' expenses are spread among a wider group.  Remember, of course,  that the idea of individual mandates to achieve affordable community rating coverage has always been proposed in the context of the alternative of single payer.  The conservative rationale of the individual mandate has always been to preserve private markets and avoid single payer.   

But the ACA goes about it all wrong - principally, in my view,  by forcing the young to subsidize the old (effectively driving those healthier lives out of the pool),  and by eliminating competition with respect to the scope of coverage.   The only policies in the marketplace are gold-plated, with competition coming in the form of deductibles/copays and the skinny-ness of provider networks.

Yes,  the ACA can be reformed in a more conservative direction, as both the House and Senate bills attempt to do.   But the ship has sailed with respect to scrapping it altogether, and returning to the bad old days when folks with preexisting conditions had no access to coverage,  and imposed their costs on hospitals.   Some have proposed the alternative of high risk pools for the most expensive lives,  or slicing off that population and simply providing them with Medicare.  Such approaches also have merit,  so long as those outside the pools have access to affordable coverage that fits their needs, and effective penalties exist for the free riders.

The young subsidizing the old essence of insurance, as the young tend to be healthy. As compensation they tend to pay lower premiums. Thing is whether you force them in the pool or not, they're still subsidizing the old. I'd rather deal with 'free riders' by at least giving them the choice of buying insurance or being taxed for Medicare or something.

I would also allow companies the choice of taking high risks and pre-existings, with some incentive like tax credits for subsidizing their premiums. There is a big difference between a guy with an old football injury to the knee and needs a massage twice a month, and state 4 cancer. We could do this with national policies fairly easily.

I don't know how else to deal with high risk/pre-existings and 'free riders' other than to have a dual system that allows for some choice and doesn't mix two different types of health care needs and force square pegs into round holes.

[Bigun]

Obamacare is hard to repeal because the big money boys over on K street don't want it repealed and for no other reason!

[Smokin Joe]

The young subsidizing the old essence of insurance, as the young tend to be healthy. As compensation they tend to pay lower premiums. Thing is whether you force them in the pool or not, they're still subsidizing the old. I'd rather deal with 'free riders' by at least giving them the choice of buying insurance or being taxed for Medicare or something.

I would also allow companies the choice of taking high risks and pre-existings, with some incentive like tax credits for subsidizing their premiums. There is a big difference between a guy with an old football injury to the knee and needs a massage twice a month, and state 4 cancer. We could do this with national policies fairly easily.

I don't know how else to deal with high risk/pre-existings and 'free riders' other than to have a dual system that allows for some choice and doesn't mix two different types of health care needs and force square pegs into round holes.

You're only looking at part of the picture. The old tend to tone down their lifestyle a little. At this age, I wouldn't live through half the stuff I did when I was younger. Older drivers (to a point) tend to be better, too.

What does shift is the type of medical expense and the cause of the expense. I still look around in amazement at all the 'healthy' folks half my age who have had shoulder or knee surgery, etc. mostly sports injuries.

Bottom line is that an honest assessment of risk would lead to some level of coverage for an individual, and the catastrophic care plans covered the worst-case scenarios. That, thanks to Obamacare, is no longer an option, but would have balanced personal perception of risk versus cost. If a person is healthy, that would cover most of the major stuff, and leave them the resources they need to eat well and do the rest of that "healthy" stuff to avoid larger problems later.

Demanding that people be divested of resources forcibly without letting them assess their needs, real and potential, and allocate those resources as they see fit is totalitarian, and has absolutely no flexibility for individual situations. But forcing them to spend money on insurance that might have put new tires on the car will at least have them covered when they hydroplane into a bridge abutment, right?

All my young life I was told to "Grow up, be responsible!". I did. Now that I am there, I have some pencil necked pinhead two thousand miles away that hasn't been within a thousand miles of where live at ground level telling me to do things which go contrary to common sense, with the force of law behind them.

No wonder we're becoming a nation of snowflakes. Too damned much cognitive dissonance out there.

Under the current "health care" system post-menopausal nuns are required to carry coverage for contraceptives. That isn't covering people who might need some service, it is just a ludicrous abuse of power.

[Free Vulcan]

You're only looking at part of the picture. The old tend to tone down their lifestyle a little. At this age, I wouldn't live through half the stuff I did when I was younger. Older drivers (to a point) tend to be better, too.

What does shift is the type of medical expense and the cause of the expense. I still look around in amazement at all the 'healthy' folks half my age who have had shoulder or knee surgery, etc. mostly sports injuries.

Bottom line is that an honest assessment of risk would lead to some level of coverage for an individual, and the catastrophic care plans covered the worst-case scenarios. That, thanks to Obamacare, is no longer an option, but would have balanced personal perception of risk versus cost. If a person is healthy, that would cover most of the major stuff, and leave them the resources they need to eat well and do the rest of that "healthy" stuff to avoid larger problems later.

Demanding that people be divested of resources forcibly without letting them assess their needs, real and potential, and allocate those resources as they see fit is totalitarian, and has absolutely no flexibility for individual situations. But forcing them to spend money on insurance that might have put new tires on the car will at least have them covered when they hydroplane into a bridge abutment, right?

All my young life I was told to "Grow up, be responsible!". I did. Now that I am there, I have some pencil necked pinhead two thousand miles away that hasn't been within a thousand miles of where live at ground level telling me to do things which go contrary to common sense, with the force of law behind them.

No wonder we're becoming a nation of snowflakes. Too damned much cognitive dissonance out there.

Under the current "health care" system post-menopausal nuns are required to carry coverage for contraceptives. That isn't covering people who might need some service, it is just a ludicrous abuse of power.

Even if we'd strip out all the mandated coverages, we still have a cost that's going to exist to make insurance more expensive - the uninsured. We have created the mess of forcing hospitals to care for the uninsured by law, so there is always this existing pool of people that run up the tab.  The cost is not going away, and the American people politically will not let it be ignored.

So how do we deal with it? I don't know how to dig ourselves out of the hole other than by some sort of dual system, for now. I think we could get that pretty low by doing the right things to make insurance more affordable, first.

[jmyrlefuller]

Well, he was 33 when he died and had never married, so it's not really that far fetched. 

Watch it...

(yes, I know that was sarcasm and I'm just playing along)

[Jazzhead]

Good post, all around.

The young subsidizing the old essence of insurance, as the young tend to be healthy. As compensation they tend to pay lower premiums.

Yes, exactly.  But insurance companies left to their own actuarial devices would price policies for younger workers about five times less than polices for over 60-types, but the ACA requires they be charged only three times less.   The young are unfairly subsidizing the old,  IMO - and in the eyes of a lot of rational millennials, who are paying the tax and refusing a bad deal. 

Thing is whether you force them in the pool or not, they're still subsidizing the old. I'd rather deal with 'free riders' by at least giving them the choice of buying insurance or being taxed for Medicare or something. 

Interesting idea.  Let 'em enroll in Medicare and impute taxable income equal to the value of the subsidized benefit provided.   Some folks could be subsidized more than others.     

I would also allow companies the choice of taking high risks and pre-existings, with some incentive like tax credits for subsidizing their premiums. There is a big difference between a guy with an old football injury to the knee and needs a massage twice a month, and state 4 cancer. We could do this with national policies fairly easily.

The lack of policy flexibility and consumer choice is ObamaCare's fatal flaw.   If Medicare were to be an option alongside private insurance,  no reason why this couldn't work.   

  don't know how else to deal with high risk/pre-existings and 'free riders' other than to have a dual system that allows for some choice and doesn't mix two different types of health care needs and force square pegs into round holes.

   I keep thinking about the idea of national stop loss insurance.  Let government take care of the catastrophic stuff for everybody on a simple stop loss basis, and let a private insurance market flourish for everything else.   

[Jazzhead]

Bottom line is that an honest assessment of risk would lead to some level of coverage for an individual, and the catastrophic care plans covered the worst-case scenarios. That, thanks to Obamacare, is no longer an option, but would have balanced personal perception of risk versus cost. If a person is healthy, that would cover most of the major stuff, and leave them the resources they need to eat well and do the rest of that "healthy" stuff to avoid larger problems later.

Demanding that people be divested of resources forcibly without letting them assess their needs, real and potential, and allocate those resources as they see fit is totalitarian, and has absolutely no flexibility for individual situations. But forcing them to spend money on insurance that might have put new tires on the car will at least have them covered when they hydroplane into a bridge abutment, right? 

[/quote]

I agree.  IMO, the problem with ObamaCare isn't the mandate tax per se, but the reality that, in the individual market, the plans you have to get to avoid the tax are just ridiculously over-comprehensive and expensive for a lot of folks.

As this point the mandate tax has been discredited, and I think other ways can be found to more specifically target free riders.    But choice in the marketplace will alleviate a lot of the problem. 

[Smokin Joe]

I agree.  IMO, the problem with ObamaCare isn't the mandate tax per se, but the reality that, in the individual market, the plans you have to get to avoid the tax are just ridiculously over-comprehensive and expensive for a lot of folks.

As this point the mandate tax has been discredited, and I think other ways can be found to more specifically target free riders.    But choice in the marketplace will alleviate a lot of the problem.

If you don't need the service why should you insure for it?

I still strenuously object to the terminology "free riders".

It isn't medical care that is so expensive, it is the doctors paying up to half their income for malpractice insurance, the government mandating insurance for services people may never or definitely never need.

There is a word that keeps coming up there. Armies of people are engaged in this process and making very good livings at it who have nothing to do with diagnosing or treating disease.

They are in one end or the other of the insurance business.

Aside from tort reform, find ways for people to more directly pay their providers and eliminate the paperwork that makes the whole process so costly. This started with HIPAA and just got progressively worse.

[Jazzhead]

If you don't need the service why should you insure for it?

How do you know you won't need medical services?  The essence of a free rider is someone who doesn't purchase health insurance when he's healthy,  and then forces others to pay when he eventually and inevitably gets sick.   As many have pointed out,  if you can hold off purchasing insurance until when you get sick, that's not insurance.  It's welfare.   And I resent having to provide welfare to free riders who coasted all those years when I was paying premiums to stay insured like a responsible adult.   

[IsailedawayfromFR]

How do you know you won't need medical services?  The essence of a free rider is someone who doesn't purchase health insurance when he's healthy,  and then forces others to pay when he eventually and inevitably gets sick.   As many have pointed out,  if you can hold off purchasing insurance until when you get sick, that's not insurance.  It's welfare.   And I resent having to provide welfare to free riders who coasted all those years when I was paying premiums to stay insured like a responsible adult.

That is a clear, outright distortion of what insurance is.

Insurance is only what you get prior to a sickness, not afterwards.

Keep it up with the distortions, it will not help your case and you expose yourself for the liberal you are.

[Jazzhead]

That is a clear, outright distortion of what insurance is.

Insurance is only what you get prior to a sickness, not afterwards.

Keep it up with the distortions, it will not help your case and you expose yourself for the liberal you are.

Get a grip sir.  I was agreeing with you.  Read what I wrote.  Read it twice if you need to: 

As many have pointed out,  if you can hold off purchasing insurance until when you get sick, that's not insurance.  It's welfare.

[Hondo69]

I don't know what's so Conservative about Socialism.