The Congressional Republicans continue to reveal their political hamhandedness in their approach to dealing with the Affordable Care Act. Some time after their 25th vote to repeal the ACA during President Obama’s term of office they should have realized that they wouldn’t be able to just repeal the law. At that point they should have just tried to reduce expectations as the ACA collapsed of its own weight and blamed it on Obama and the Democrats.
As it is they’re caught on the horns of the dilemma of needing to repeal the ACA lest they face a political backlash from their own voters and the impossible complexity of enacting a replacement that appeases all of the Republican senators.
Sometimes a do-nothing Congress is the best case scenario.
As Will Rogers put it the difference between death and taxes is that death doesn’t get worse when Congress is in session.
“At that point they should have just tried to reduce expectations as the ACA collapsed of its own weight and blamed it on Obama and the Democrats.”
That’s certainly the political angle. One would have hoped that after all those years they would have had a good policy solution rather than the debacle of Obamacare.
I saw an interview with Rand Paul (that included separate commentary from some guy who was an architect of Obamacare – not Gruber) and although there is much to debate the intractable issue remained the one I don’t know how to resolve either: pre-existing conditions vs free riding.
How do you tell someone they can wait until the house is on fire, have paid no premiums into the risk pool, but as the flames reach the sky say “come on over, your neighbors will take care of this for you.” It’s not insurance. It’s not responsible behavior by either claimant or payer. It’s bizarre. The architect, a real asshole, went right for the political moneyline: people with cancer (of course, cancer, of course) need this insurance for what has befallen them no fault of their own. No fault, you see you heartless bastard.
No one seems to have the stomach, or the political skill, to make the case to the voters that one can’t shirk the responsibility to insure oneself at reasonable economics and/or subsidy, and with some sort of bridging for the current population. We’ve seen how the current system doesn’t work.
And that’s just the insurance side of the coin…….
I don’t think the Republicans expected to win the presidency.
The word “insurance” as used by the federal government has become so debased as to be meaningless. If premiums are unrelated to risk, it’s not insurance by definition. Whatever you call its tail a horse has four legs. What people want but can’t afford is a prepaid maintenance plan. As long as health care costs rise faster than incomes or revenues in sectors of the economy other than health care, the country can’t afford it. Again, that’s not politics. It’s arithmetic.
The difference between health care and maintaining furnaces is that there’s a cap on the risk represented by a broken furnace: the cost of replacement.
No one seems to have the stomach, or the political skill, to make the case to the voters that one can’t shirk the responsibility to insure oneself at reasonable economics and/or subsidy, and with some sort of bridging for the current population.
You have basically described Obamacare.
That depends on what you mean, Modulo. The penalty for free riding was set so low, and the premium cost shifting of mandated unnecessary or unwanted benefits set so broadly, that a purely economically driven consumer would choose to ride if possible. And others would shoulder the burden. The model was a sham, designed to fail. And it did. It was not about a genuine attempt to resolve a social problem, but a cynical ploy to drive another massive entitlement with all the attendant benefits of power, control and fundraising for politicians…………..who would be exempted.
As Dave points out, and as all my insurance needs are priced, there is or should be a linkage. Fancy sports car? High premium. Hurricane risk? High premium. Etc. what we acknowledge in food, clothing and shelter, we don’t in health care insurance. If you throw yourself upon the mercy of society, you might get assistance, but it probably is going to be a Chevy and not a Porsche.
I completely agree on not expecting to win. And now they have been exposed. RINO is, I believe the term.
Just as viewing sport, I think it will be interesting to see how Trump deals with them.
I disagree. As I wrote at the time and since I think it was purely political and not pragmatic. Democrats believed they’d pick up seats in the House and Senate rather than losing them.
I know you do. But I can’t square Grubers commentary and the obvious adverse economics with thinking this would be well received. I think politicians are generally dull, but they do have sharp advisors. This was predictable and predicted.
And I’m cynical enough about politicians to think that creating a “they’ll eventually just throw up their hands and take single payer” as Gruber suggested was the plan all along.
Cynical. Websters. See IL legislature……
Qualities that seem to be universal among politicians are optimism and thin skins.
When you add to the optimism the echo chamber of localized one party rule I think it explains how party leaders can make enormous miscalculations.
The GoP is making all the same mistakes the Democrats made when passing the ACA except they are both less competent and more venal.
The fundamental political problem with the ACA is that it was a de facto partisan bill which meant it would always be vulnerable to actions by the GoP once they came to power. The Democratic leadership created the most liberal bill they could get passed by appealing to the minimum number of moderate Democrats.
The GoP is making the same mistake – They are trying to make the most “conservative” bill as possible and only changing it to get enough moderate Republicans to vote for it (working with Democrats is verboten and the GoP isn’t even trying to make a show of bipartisanship). So even if they get something passed (I’m skeptical), it will engender a similar response in Democrats as the ACA did in Republicans – so it will only last until the Democrats come back to power.
It’s really a total shit-show.
I do not want “health insurance”. I want health care. For my wife, I am paying through the nose for a platinum policy, and it is mostly worthless. I have to jump through hoops to get anything.
For me, I am with the VA, and I get health care. Some people might think it is substandard, but whatever. I go to a VA facility, and I get care. Period. The VA is my network, but since the new New Orleans VA hospital is not fully functional, I can go to any hospital.
F*ck “single-payer”. I want “no payer and no paperwork”.
Also, “buying across state lines” means no state control of health insurance.
Furthermore, why do we have a public education system. It is not a right, but it is socialized schooling. I do not see the usual suspects clamoring to end public education. Give me my public health care system, and call it socialization if you like.
@Guarneri
The model was a sham, designed to fail.
It could be, or it could be for some. I think a lot of the problem is the human tendency to disregard the downside risk. The dotcom and housing bubbles are two examples.
RINO is, I believe the term.
If every Republican refuses to “repeal and replace”, it was obviously a sham.
… freeriders …
It is really simple. If you drop coverage, your pre-existing condition is not covered for a year. It could be made more complicated by taking the length of the lapse into consideration – no coverage for pre-existing conditions for the period of lapse.
Flood insurance takes 30-days to kick-in to keep people from getting it just before a hurricane hits. When my wife got a job with health insurance, she had to wait a year for any pre-existing conditions. (She is not working there any longer.)
Help me on this free-rider concept. I have a platinum plan because my wife needs one $500/mo medication, and he doctor wants to prescribe an additional $700/mo medication. This is all due to a California teenager refusing to look both ways before pulling out into traffic.
I had to get a lawyer to sue the hell out of his (parent’s) insurance company, and we got the existing medical bills paid. Now, the teenager, his parents, and the insurance company are no longer responsible for my wife’s ongoing health needs. I am stuck with the consequences of their actions.
Are they free-riders? If my policy lapses for a nanosecond, I am a free-rider.
“What a Wonderful World”
Actually, up to a certain grade level it is a right. However, I see no evidence that despite an effective single-payer educational system we are achieving significant economies. We pay much more per student in real terms than any other OECD country and real spending on education has tripled over the last 25 years.
I continue to think that counting the number of payers is a red herring and that we should start thinking about delivery models in mass markets for education and health care.
I disagree about education as a right, but I do not want to hijack the thread.
If I send my child to public school (K-12), I do not have to worry about costs, and for those in need, there are programs to help with the extra costs. If I do not want my child to go to public school, I can opt into a private/parochial school.
There are problems with the public education system, but I suspect that if you exempt higher education, it is not as bad economically. I also think that US students are a lot smarter than they are portrayed. Give them a reason to do something, and they will excel.
(If the “Roaring Twenties” had lasted, “The Greatest Generation” would have been no greater than today’s Millennials.)
The US health system is a mess because it is “insurance” based. If we had “education insurance”, the public school system would be the same as the health care system.
What would be the effect with “single payer” or “single provider” on businesses. They would suddenly have a lot of extra money. If that money were invested in producing more goods and services, the country might be a little better off.
There is no reason why a country as fabulously wealthy as the US cannot provide basic health care. If this is too much of a burden for anybody, move to somewhere else – Somalia, Nigeria, Syria. There is no socialism in those wonderful places, and don’t let the door hit you in the ass on your way out.
I agree. No one in the United States seems to want “basic health care”. It’s certainly not what the ACA covers.
@Dave Schuler
[…] No one in the United States seems to want “basic health careâ€. […]
That is as concise and accurate an assessment as I have ever seen.
Sad, but true.
Despite the danger of “highjacking the thread”, let’s go back to the issue of education.
Yes, all kids in the U. S. have a right to a free public education. Although the Supreme Court has held that it’s not a fundamental right the U. S. is a signatory to international conventions which obligate the U. S. to provide a free public education up to a certain level. That could be overridden by the Congress but not by the states. IIRC there are also federal laws to that effect.
I’m not sure that Will Rogers’ adage holds true now that the federal government is involved in regulating healthcare.
“If premiums are unrelated to risk, it’s not insurance by definition.”
Google insurance definitions and few if any encapsulate the idea that premiums are related to risk. Insurance is just a way to transfer risk to someone else. How much you pay is between you and the insurance entity. In the case of the ACA payment were higher for older people than younger at, IIRC, a 3:1 ratio. Older people are sicker so you do partially, if not completely, relate premiums to risk. If their must be a strict, direct relationship between costs and premiums, then I don’t think health insurance by that definition exists anywhere. Certainly not with employer based insurance.
Drew’s conundrum is a good one. There is also the one where we know a large segment of the population cannot afford quality care.
Steve
I don’t care what Google says. I’ve been a consultant to the insurance industry off and on for the last thirty years. I know how insurance works. Take my word for it on this.
That’s right. It’s a euphemism and it’s passed its sell-by date.
BTW what you described is not insurance. It’s the way derivatives work under the false belief that if you pool things with a high risk with things that bear a low risk it lowers the overall risk. Insurance pools things with comparable risks together. Therefore you pay more for auto insurance if you have high coverage, low deductibles, and have a history of getting into accidents, as do the other people who have high coverage, low deductibles, and a history of getting into accidents.
My question is what happens next. It seems answer involve answer the following three questions.
Are the exchanges collapsing? What are the possible fixes?
For Medicaid expansion, can the Federal Government support the added costs?
Dave- Is there some rule that says all insurance products need to behave the same way? I am unaware of such, but I guess this is just semantics. Since there is no health insurance that behaves like your definition of insurance then it is probably not worth battling over.
Steve
I guess the first question is one of definitions. In the absence of anything else being done I suspect that within the next five or so years about 10% of the counties in the country will have no carriers on the exchanges and another 30% will be down to one carrier. Premiums and deductibles will continue to rise and more people will take their chances and drop out. Death spiral? Hard to say. Maybe.
The states will have increasing problems paying their Medicaid tabs. Medicare will remain solvent. That’s what “doing nothing” looks like.
The federal government could shovel more money at the insurance companies to avoid that, of course. That’s another option.
The reason that it matters is that pooling risk among people at fairly equal risk on events with fairly low likelihood is moral but transferring risk from someone who is already experiencing the event to someone who otherwise would bear little risk is immoral. It may be expedient but it’s immoral. At some point government expedience renders government illegitimate.
Yes, it’s unfair that some people get sick but others don’t. You can’t remedy unfairness by immoral means. Inaction may indicate an absence of virtue but wrong action is vice.