The idea of "shopping" for health care is ludicrous. It's akin to shopping for police protection while you're being mugged. Keep your innovation and give me the health plan of any other civilized country.
92
Health care, education and other "people" professions do not get better through competition. That is because a huge number of people in these professions go into them with goals other than a paycheck.
Those "other goals" - in short, improving people's lives, cause us to do things that the competitive businesses don't do. This is because collaboration and sometimes working for "free" often allow us to help people better, even though it may not increase our personal wealth. So, teachers put lesson plans on line for free and buy supplies out of their own pockets. Nurses and doctors can stay past their shift because doing so may help a patient. And while we of course want money, we tend to prefer perks such as security or benefits so we can focus on those helping goals without constantly worrying about the need to stay competitive.
This doesn't mean that business people are not altruistic, good people who may wish for quality work on principle. But their way of doing things is not our way. And our "clients" don't choose our products- they need them.
Those "other goals" - in short, improving people's lives, cause us to do things that the competitive businesses don't do. This is because collaboration and sometimes working for "free" often allow us to help people better, even though it may not increase our personal wealth. So, teachers put lesson plans on line for free and buy supplies out of their own pockets. Nurses and doctors can stay past their shift because doing so may help a patient. And while we of course want money, we tend to prefer perks such as security or benefits so we can focus on those helping goals without constantly worrying about the need to stay competitive.
This doesn't mean that business people are not altruistic, good people who may wish for quality work on principle. But their way of doing things is not our way. And our "clients" don't choose our products- they need them.
16
The problem with any conservative approach to health care is that it asks half the population without insurance or with inadequate insurance to further subsidize the health care costs of the fortunate half of the adequately insured population. Convenience store clerks, fast food workers, door greeters -- all of these people in our "new" economy would be asked to forgo health insurance in order that the consumers of their services (the convenience of buying gas quickly at a convenience store, getting your happy meal quickly without having to wait at a sit-down restaurant, enjoying the pleasant experience of a stroll through a Walmart by having a greeter remind you that you're being watched, etc.) now take for granted.
This is just as grossly unfair and inhumane as it was to have people of a certain color pick our cotton for us. As for economic efficiency, it would be an efficient only for those who were benefiting from it.
We only ask the poor who can least afford it to pay cash out of pocket for their health care needs. Most of the wealthy are fortunate enough to have insurance, which most of them get through their employers. It's time to recognize health care insurance not as a luxury that only those who are well-employed ought to be able to rely on, but a macroeconomic necessity that helps everyone together.
This is just as grossly unfair and inhumane as it was to have people of a certain color pick our cotton for us. As for economic efficiency, it would be an efficient only for those who were benefiting from it.
We only ask the poor who can least afford it to pay cash out of pocket for their health care needs. Most of the wealthy are fortunate enough to have insurance, which most of them get through their employers. It's time to recognize health care insurance not as a luxury that only those who are well-employed ought to be able to rely on, but a macroeconomic necessity that helps everyone together.
14
Trump promised that he would repeal Obamacare. Period. And he didn't promise that everyone would be covered under his new plan - he promised that everyone would be BEAUTIFULLY covered. So let's not let him off the hook too lightly. Having said that, I hope Trump takes a Federalist approach on healthcare and other domestic policies because I live in Massachusetts. Trump voters need to get what they voted for and maybe learn something from the experience...Not that anybody seemed to notice the disastrous Republican policy experiment in Kansas. It is astounding to me that Kansas (and Michigan!?!) voted GOP.
16
What seems to be missing in all these debates is the simple fact that "health insurance" in the U.S. doesn't mean protection against catastrophe in the same way that car insurance covers a policyholder in case of an accident. It means access to doctors, medical procedures, and medication - basic benefits that all Americans should be entitled to regardless of age or condition or employment. By leaving it up to the states to decide to opt in or out of an ACA-type plan, the health of our citizens becomes more and more dependent on where they live. It also supports the continued growth of 50 separatist entities, where access to healthcare, jobs, education, and opportunity varies greatly and the common good of America as a whole is lost.
21
Love the disingenuous pretzels conservatives fold themselves into to avoid the only real answer to decent health care--Single Payer!
39
Republicans care only about the unborn . The living especially the downtrodden can go to the devil. That's republican Christianity in a nutshell. Godfather wishes it so.
33
I think we know what health care looks like when people around or below the median household income (about $50K) looks like when they don't have low-cost insurance with low deductibles.
It's painkiller addiction. Cheap, and it takes the edge off of the worst symptoms of ill health.
It's painkiller addiction. Cheap, and it takes the edge off of the worst symptoms of ill health.
15
I continue to scream at my screen: "It (almost) doesn't matter how you pay for it as long as you get hospital costs down! (to Western European levels, i.e. to about one third (e.g. France) or half (e.g. Switzerland))", which are about 75 to 80% of the healthcare expenditures. Obviously, the Pre-Obama market was unable to contain costs. That is, Mr. Douthat, because health care isn't a well working marketplace and that, in turn is because the demand is INELASTIC! So you can use Friedman, Cassidy-Collins, Kruegmann and your capitalist edition of the Bible together: it will never work to contain costs. As long as a baby in NYC costs 26000$ to deliver (vaginal, no-problem, Columbia@ 168th) whereas it's roughly 8000$ at the University Hospital in Zurich (who also have private insurance with mandate and whose doctors and nurses make more money), it is an idiotic distortion of priorities to discuss how to pay for it. We urgently need an overhaul of the hospital system. And if somebody could ram that through, it's the Orange One. Please, one good thing out of this administration.
14
I propose that any replacement offered by the Republicans be tested by them before being foisted on the American public. If they think their plan is great they should be happy to try to survive on it themselves. Cancel the insurance they have now just like they want to do to millions of Americans and let them stay up at night wondering how they will pay for their child's chemotherapy.
31
Millions will die prematurely from manageable, curable conditions because people like you consider human life a commodity to gamble with.
I have a hereditary condition - that I've done nothing to deserve. If I can't afford medication for it, I will eventually die from progression of the disease. My daughter has it too.
So, Mr. Douthat, know that you support my premature death. You, sir, are a death panel judge, and you want me and my beautiful 25 yo daughter to die sooner than later. You are nothing like a Christian. Your desire for my death makes you exactly the opposite.
I have a hereditary condition - that I've done nothing to deserve. If I can't afford medication for it, I will eventually die from progression of the disease. My daughter has it too.
So, Mr. Douthat, know that you support my premature death. You, sir, are a death panel judge, and you want me and my beautiful 25 yo daughter to die sooner than later. You are nothing like a Christian. Your desire for my death makes you exactly the opposite.
43
"Markets and competition can deliver lower costs and better care"? Really? Wouldn't this would require that ALL health care providers publically issue a list of services and medications with their associated costs? If it's not something that requires immediate care I should be able to compare costs before deciding where to get the care. And shouldn't I also be able to look and consumer reviews of the various providers, along with statistics evaluating the providers' success rates for various types of care? Insurance says I pay a percentage, so I need to know the actual cost to figure out my share. And in an emergency I don't have a choice - I'd be taken to the nearest hospital. Where is the free market and competition in all of this?
21
"Liberal Health Economics"?
Come on. A system based on Romneycare, which was based on Hatch's alternative to Hillarycare with no public option is not in any sense "Liberal Heath Economics". It was a compromise that the left made under the delusion that the right actually had any principled support behind their own proposals... rather than just a goad to shift the center to the right.
Come on. A system based on Romneycare, which was based on Hatch's alternative to Hillarycare with no public option is not in any sense "Liberal Heath Economics". It was a compromise that the left made under the delusion that the right actually had any principled support behind their own proposals... rather than just a goad to shift the center to the right.
18
We have another comparator for health care just to our North. Without going into all the ways that Canadian health care is clearly superior (universal, affordable, etc.), one of the common criticisms is that Canadian health care is slow and non-innovative. It is a silly criticism based on experiences, but, in any case, which U.S. hospital just performed the first procedure of this type in the world in an amazingly fast response. This one.
https://www.theguardian.com/world/2017/jan/25/canada-doctors-remove-lung...
https://www.theguardian.com/world/2017/jan/25/canada-doctors-remove-lung...
10
The principal benefit that Obamacare provided for low-income people (in states that adopted it) was to create a federal standard for Medicaid eligibility. In many states, single people were never eligible. In others, the amount of income qualifying for Medicaid differed significantly. The Obama administration was giving states some flexibility in determining how Medicaid benefits would be provided. This allowed a state to choose a private health insurer to do so. That kind of flexibility should be expanded. But to deny the poor any healthcare benefit is contrary to our values.
10
Providing "compelling evidence that markets in health care can do more to lower costs and prices" does not consist of linking your column to one by David Brooks. Brooks's column also provides very little such evidence. At least not what economists or physicians consider evidence. I guess the bar is lower for Republican ideologues. More of what you might call "alternative" evidence.
15
There is no free-market in health care. There are no price-lists. It is guild-regulated. Cost for one day in the hospital has increased 8 to 10 times over adjusted median per capita income in the last 50 years. Want to trim individual provider costs? Return to the high nominal tax rates of the Eisenhower Administration on ordinary income. Never happen in this republic.
8
One other thing that needs to be mentioned, Ross, is that the "less spending" you end up with when people "pay for more of their health care in cash" (e.g., when they pay for it out of their own pockets) is that what they are often doing is deferring costs until they are old enough to be covered by Medicare.
So we can either have lower deductible, lower out-of-pocket care over a lifetime, which may actually help people live healthier, longer and more productive lives. Or we can use high deductible, high out-of-pocket plans that encourage people to ignore sickness, defer treatment and not take relatively inexpensive medications to keep easily treated chronic conditions at bay, with the result that when they retire they are sicker and costlier for everyone in society to treat anyway.
Personally, I'd rather bleed those costs in over a lifetime than simply be inflating a balloon of deferred costs that gets popped at 65 (or whatever age Medicare eligibility ends up being raised to). Again, if we focus on the goal -- providing care, not insurance, we'll all end up healthier and probably wealthier in the end, in part by treating minor conditions before they become major problems.
So we can either have lower deductible, lower out-of-pocket care over a lifetime, which may actually help people live healthier, longer and more productive lives. Or we can use high deductible, high out-of-pocket plans that encourage people to ignore sickness, defer treatment and not take relatively inexpensive medications to keep easily treated chronic conditions at bay, with the result that when they retire they are sicker and costlier for everyone in society to treat anyway.
Personally, I'd rather bleed those costs in over a lifetime than simply be inflating a balloon of deferred costs that gets popped at 65 (or whatever age Medicare eligibility ends up being raised to). Again, if we focus on the goal -- providing care, not insurance, we'll all end up healthier and probably wealthier in the end, in part by treating minor conditions before they become major problems.
14
Ironic? Will this mean a migration to states that provide better coverage?
Will the most anti-Obamacare states, the states with the highest rates of poverty, take the funds yet try to deny as much assistance to their citizens as possible? On principle?
What will happen if the citizens of a state bordering theirs have a different approach. More comprehensive coverage.
If you get sick, is it going to be too late for you to move to California?
Will the most anti-Obamacare states, the states with the highest rates of poverty, take the funds yet try to deny as much assistance to their citizens as possible? On principle?
What will happen if the citizens of a state bordering theirs have a different approach. More comprehensive coverage.
If you get sick, is it going to be too late for you to move to California?
7
You could be charged out-of-state medical expenses for one year similar to the way out-of-state residents now have to pay college tuition.
2
Are you kidding me! Burke, Friedmam? Conservative health theory? This is insurance governed by actuarial statistics, period. In a society with equal income or wealth distribution, there would be no discussion. This is way over thought.
Health care could be a commodity like gasoline, but the "Free Market System" has made it a profitable enterprise more like the fashion industry. The costs have gone up too much and it has started to steal commerce from other enterprises. We are paying more than the real utility. that is the Friedman free market effect. People don't have choices, they have to listen to their Doctors, who end up partnering with the profit centers. Burke?
I am sorry I don't get Conservatism. In this instance, you are advocating a government with no allegiance to its citizens, but to an abstract theory!
Health care could be a commodity like gasoline, but the "Free Market System" has made it a profitable enterprise more like the fashion industry. The costs have gone up too much and it has started to steal commerce from other enterprises. We are paying more than the real utility. that is the Friedman free market effect. People don't have choices, they have to listen to their Doctors, who end up partnering with the profit centers. Burke?
I am sorry I don't get Conservatism. In this instance, you are advocating a government with no allegiance to its citizens, but to an abstract theory!
8
We already have the Republican health care plan; it was conceived of by the Heritage Foundation; it was implemented successfully in Massachusetts and called Romney Care. So we already have Romney Care and a close to national scale. Just change the name ot Trump Care and we're already home.
Interesting Ross did not mention that Aetna pulled out of Obama Care markets in which it was profitable so that it could play gamesmanship with the Justice Department to permit its mega competition busting merger.
Ross -- time for some honesty.
Interesting Ross did not mention that Aetna pulled out of Obama Care markets in which it was profitable so that it could play gamesmanship with the Justice Department to permit its mega competition busting merger.
Ross -- time for some honesty.
15
Here's how "competition" would work in a health insurance market: companies would compete to provide broad coverage and low rates to people who have no need for health care services. Anyone who actually needed health care services would be placed in some sort of "residual market" mechanism for which they would pay high premiums and get little coverage.
Sound familiar? It should -- it's how auto liability insurance markets work in most states. Teenage drivers, too many accidents, etc. -- into the state pool you go, and you're lucky to get a minimum limits policy. Great driving record, high deductible, etc -- you get lots of choices and cheap rates. Why would anyone imagine it would be different with health insurance?
And that's the issue: the goal should not be "making sure more people have health insurance." The goal is ensuring that every American has access to affordable, high quality health care.
If we continue to define the goal incorrectly, we'll keep coming up with bad solutions. We don't need to redefine the wheel here. There are plenty of countries with good, single payer systems -- some public, some private -- which work better than ours does now.
As long as we remember that the goal is providing CARE not providing INSURANCE, we'll eventually get where we need to be.
Sound familiar? It should -- it's how auto liability insurance markets work in most states. Teenage drivers, too many accidents, etc. -- into the state pool you go, and you're lucky to get a minimum limits policy. Great driving record, high deductible, etc -- you get lots of choices and cheap rates. Why would anyone imagine it would be different with health insurance?
And that's the issue: the goal should not be "making sure more people have health insurance." The goal is ensuring that every American has access to affordable, high quality health care.
If we continue to define the goal incorrectly, we'll keep coming up with bad solutions. We don't need to redefine the wheel here. There are plenty of countries with good, single payer systems -- some public, some private -- which work better than ours does now.
As long as we remember that the goal is providing CARE not providing INSURANCE, we'll eventually get where we need to be.
14
"The promise is that by having people pay for more of their health care in cash and by giving them more freedom in what plans they’re allowed to buy, you would end up with less spending, lower prices and less cost inflation."
But should we worry that asking people to pay for more of their health care in cash may mean they'll postpone medical treatment until they require much more expensive intervention? Or perhaps die.
You may "end up with less spending, lower prices and less cost inflation" all right. But at what cost??
But should we worry that asking people to pay for more of their health care in cash may mean they'll postpone medical treatment until they require much more expensive intervention? Or perhaps die.
You may "end up with less spending, lower prices and less cost inflation" all right. But at what cost??
12
Generally speaking, preventative care is much less expensive that catastrophic care. For example, if you see your doctor with a cold/cough and get an antibiotic, it's pretty cheap. If you skip the doctor to save a few bucks then end up in the hospital for a week with full-blown pneumonia, that's expensive.
7
Glad to go along with the Republican experiment with one addition: Paul Ryan puts "real skin in the game" by promising to perform seppuku live on Facebook on November 8, 2020 if his replacement for the ACA hasn't provided higher quality care for less money to more people by then.
6
Ross, a reasonable argument reasonably presented. Two problems; first competition in health care is not real, in particular the docs and big pharma work very hard to eliminate competition; second, the radical extremists in control of congress will never accept the Cassidy-Collins plan. Mr. Cassidy and Ms. collins are to be commended for actually trying to come up with a viable plan, the Repub bosses will never accept it. For the record, I probably would accept it, and therein lies the problem.
2
So Douthat's point comes down to "No one's built a competitive health system so it can't be done."
Capitalism and healthcare are inherently opposite.
8
Has Douthat ever negotiated the price of a procedure with his doctor? I doubt it. The uninsured don't either. They just don't pay the bills and suffer the bill collectors, garnished wages, and bankruptcy. The courts then determine what the doc will be paid. I daresay this is a more expensive process when multiplied by millions than underwriting national healthcare.
Where do ideas like this lead: To on even bigger brain drain to blue states.
Where do ideas like this lead: To on even bigger brain drain to blue states.
7
...which will make it easier for the next knucklehead Republican to win the presidency without winning the popular vote.
3
Health Care is one context in which the profit maximization model is not the best model. Think now. Suppose access to clean water were a matter of income. The Rich would drink pure clean water and the Not-So Rich would drink mud and muck. The result -- wide spread illness and a society that does not produce.
By analogy, think of health care as a utility. It is a necessary product and service to keep the society functioning and productive. Managing health care might best be done using the regulated utility model.
This does not mean free plastic surgery or breast enhancement to the poor. It means basic health maintenance and control of diseases, the absence of which could cause the collapse of the society. Think of what happened in Europe during the time of the bubonic plague. Should control of contagious disease only be for the well off? I think not.
Without getting into the quasi-religious capitalism v socialism debate, I would argue that the utility approach would best serve our society and create the best conditions for health a prosperity.
Thus endeth the sermon.
By analogy, think of health care as a utility. It is a necessary product and service to keep the society functioning and productive. Managing health care might best be done using the regulated utility model.
This does not mean free plastic surgery or breast enhancement to the poor. It means basic health maintenance and control of diseases, the absence of which could cause the collapse of the society. Think of what happened in Europe during the time of the bubonic plague. Should control of contagious disease only be for the well off? I think not.
Without getting into the quasi-religious capitalism v socialism debate, I would argue that the utility approach would best serve our society and create the best conditions for health a prosperity.
Thus endeth the sermon.
8
Wow, aside from a few snarky and gratuitous uses of the work 'liberal', which he seems incapable of not doing, I thought this was pretty interesting and informative (and somewhat fair). I really don't think the ACA is really a failure, other than making conservatives look outrageously alarmist it's done a reasonable job and I think with a reasonable congress it would get a reasonable tweak to work even better. I like Susan Collins, but the Confederate health care plan and Union health care plans facing off is probably going to result in an even more unhealthy Confederacy. Given the history of stubbornness and willingness to live with ridiculous governments in order to avoid admitting they are wrong I don't think there will be voter revolution if the red state "plan" doesn't work out. Has there ever been a voter revolution in the south that wasn't about race? I haven't seen one...
3
For years I've been hearing about conservative "ideas". When they're not simply being contrarian for the sake of being so, their "ideas" aren't ideas at all but just an agenda: create a situation where they or their friends or their friend's friends can make money off something the government used to do better and cheaper.
11
The notion that health care systems should be left to the states reminds me of the civil-rights days. Back then many states made Blacks sit in the back of the bus because of the color of their skin. Analogously, some of these same states, as well as others, would make the less than well-to-do sit in the back of the healthcare bus. All under the banner of states' rights.
Sorry, we've heard that one before.
Sorry, we've heard that one before.
10
The problem with having people become more frugal with their healthcare spending is that most people are unable to make the ounce of prevention leap. Untreated medical issues lead to crises and even death. if you think healthcare is expensive, you should try living without a wage earner.
2
So can we also apply these concepts to the nation's defense? Can we create a system where folks can opt out of paying to support it? Can we set up state-by-state armies and defense budgets? Massachusetts gets F-15 fighters and Alabama squeaks by with biplanes with propellers? California gets nukes and Mississippi gets peashooters? Why not? What about it is sacrosanct to protect it from the conservative ire towards socialized anything? Why does it get a pass? Is it because it's just so essential and critical and important to all of us? Wouldn't applying that standard to what is nationalized and government-run instantly put healthcare into the same bucket? It's a matter of life and death, after all.
7
While I in general like the idea of each state keeping their version of Obamacare, I think a better fully implemented solution would be:
1) Completely take the states out of healthcare. Right now healthcare is like bankning in that it is regulated at the state level. Each state has different requirements and different regulations. Functionally for the insurance agencies this amounts to anti-freemarket protectionism. It forces insurance companies to be regional, and limits competition. If heathcare regulations were federal, then economies of scale could allow for national low cost insurance companies. Things like the Amazon.com of insurance or the Geico of health insurance. This is different from the proposed mega Aetna/Humana merger, which leaves the aggregate regulations in place. Ideally we don't want these companies to combine, we want them to compete against each other driving the smaller companies out of business, but allowing the rise of nimble competitors.
2). Price lists. Every place that offers medical services need to have an easy to access list of prices. More of this fixing a broken leg costs $1000 in one hospital and $50,000 in another 10 minutes away. Hospitals in a freemarket should compete.
3) economies of scale. Hospitals, pharmacies and maybe even insurance companies should be able to say "I will need x drugs this year, give me your best price. And consumers should be given a list of generics also bought in bulk"
1) Completely take the states out of healthcare. Right now healthcare is like bankning in that it is regulated at the state level. Each state has different requirements and different regulations. Functionally for the insurance agencies this amounts to anti-freemarket protectionism. It forces insurance companies to be regional, and limits competition. If heathcare regulations were federal, then economies of scale could allow for national low cost insurance companies. Things like the Amazon.com of insurance or the Geico of health insurance. This is different from the proposed mega Aetna/Humana merger, which leaves the aggregate regulations in place. Ideally we don't want these companies to combine, we want them to compete against each other driving the smaller companies out of business, but allowing the rise of nimble competitors.
2). Price lists. Every place that offers medical services need to have an easy to access list of prices. More of this fixing a broken leg costs $1000 in one hospital and $50,000 in another 10 minutes away. Hospitals in a freemarket should compete.
3) economies of scale. Hospitals, pharmacies and maybe even insurance companies should be able to say "I will need x drugs this year, give me your best price. And consumers should be given a list of generics also bought in bulk"
Douthat, why don't you and the conservatives admit that you want to return to pre-Obamacare: if you can't afford medical insurance or just want minimal coverage, that's ok with you. Oh, yes. Just let the uninsured and minimally insured die. That's ok with conservatives as long as they have the best insurance possible!
4
A free market solution to healthcare is just as asinine as privatizing the police and fire departments. Imagine if the fire department would only stop your house from burning down if you already paid into a plan with them? Or if you could not be granted "police insurance" because you have been mugged too many times in the past and are too high risk. What all of these things have in common is that they prevent things that are arguably and in most cases out of your control. How about instead of trying to reinvent the wheel, we simply look at the health care systems in every other developed country as a model. We have been experimenting with a free market health care systems for decades and it does not work no matter what you name it.
17
This is all just so foul. Millions of people are going to become uninsured again. People will have unnecessary pain and illness, some will die prematurely.
What a sad day this is because Mary Tyler Moore died. What of love and hope and optimism? Why does Trump (and his lousy enablers) want to drag us back into more misery? What's wrong with those people? Haters!
What a sad day this is because Mary Tyler Moore died. What of love and hope and optimism? Why does Trump (and his lousy enablers) want to drag us back into more misery? What's wrong with those people? Haters!
8
Mr. Douthat writes: "The peril is that there would be too wide a gap between what the money in your health savings account covers and what you need before your catastrophic coverage kicks in. In which case many people with consistent health care costs for chronic problems would rack up impossible medical bills in short order."
This is the fatal flaw in the proposal. Far too many people, at-risk people in particular, suffer from chronic health problems, and this is independent of their political philosophy. Access to health care is a personal issue, not a party-vs-party issue, which is why proposing a "conservative experiment" is not fair to the people it would affect.
This is the fatal flaw in the proposal. Far too many people, at-risk people in particular, suffer from chronic health problems, and this is independent of their political philosophy. Access to health care is a personal issue, not a party-vs-party issue, which is why proposing a "conservative experiment" is not fair to the people it would affect.
7
I have never understood why my health or anyone else's should be considered a "commodity".
11
The best thing that could happen is to ask each person who is part of Obama care to elect if they want to stay. If they elect not to, they cannot take advantage of any aspect for 10 years regardless of changed circumstances. That would allow for a stable market. Each year persons who are coming off of parents or company plans make election an it remains for 10 years. Pre- existing conditions remain with you. It would also mean that people who are eligible during the 10 year period whose income drops would not be eligible for an expanded Medicaid even if their state has it. Also do not allow bankruptcy for more that the deductible for the cheapest plan for persons who opt out; Elections have consequences.
3
The only path to proper universal health care follows the path of medicare, a single-payer system embraced by all other progressive countries.
The "market-based" approach will not work because those who are young and fit will not buy policies. That inflates the policy costs. Temporally, policies will get progressively more expensive over time as the more healthy opt-out, leaving only those in immediate need of health car willing to purchase insurance.
In the end, no one who is not supported by a company health plan will buy insurance. This concept was proven quite elegantly by George Akerlof ("The Market for Lemons". Google it.)
The "market-based" approach will not work because those who are young and fit will not buy policies. That inflates the policy costs. Temporally, policies will get progressively more expensive over time as the more healthy opt-out, leaving only those in immediate need of health car willing to purchase insurance.
In the end, no one who is not supported by a company health plan will buy insurance. This concept was proven quite elegantly by George Akerlof ("The Market for Lemons". Google it.)
7
Tens of thousands of Americans will die, and many more will suffer and go bankrupt when Paul Ryan kills ACA. But that is in keeping with Paul Ryan's guru Ayn Rand and her Objectivist philosophy where little people are riff raff, flotsam that should be eliminated from society.
11
We humans are a funny bunch. When ever we're presented with a problem ( take Ross's column, today) the first step is to have one side ( because that respects our penchant for a division, typically along political lines: if there's an us, then there has to be a them). The explain the problem ( as they see it), and delineate the possible solutions, granulating how one option "may" prove better then another, and finally, describe why the other side's plan will fall short, or is at best problematical, and, thus, likely to fail.
The point? What is it about an American health-care industrial complex business model designed to feed itself what it requires (money) to sustain its annual growth demand that people like Ross feel compelled to explain ( to whomever ) ad nauseum?
The model no longer works. But y'all keep talking as though dreaming up New and different ways to keep feeding the beast is a way to go. Tell me how that solves our problem, Ross?
The point? What is it about an American health-care industrial complex business model designed to feed itself what it requires (money) to sustain its annual growth demand that people like Ross feel compelled to explain ( to whomever ) ad nauseum?
The model no longer works. But y'all keep talking as though dreaming up New and different ways to keep feeding the beast is a way to go. Tell me how that solves our problem, Ross?
4
Let me get this straight: the party that vociferously opposed the individual mandate -- with claims of a heavy handed Washington overreach -- now proposes to "auto enroll" everyone in the coverage for catastrophic illness (with a right to opt out). The hypocrisy is unbelievable. Can we imagine what the Republicans would have said if Obamacare had adopted an "auto enrollment" feature?
18
Hahaha. Douthat asserts: "There is compelling evidence that markets in health care can do more to lower costs and prices than liberals allow, and good reasons to think that free-market competition produces more medical innovation than more socialized systems." But then admits there is no real-world model to back this up. Isn't that just like a conservative? Works great IN THEORY!
8
Obamacare was not a liberal proposal It was born in the Heritage Foundation in 1988. It was a conservative alternative to the feared 'socialized medicine. It does not provide universal health care, it provides more or less universal insurance. That it had flaws was not a surprise to anyone. That the flaws were not corrected in a bipartisan manner is a tragedy. The idea Trumpcare is an oxymoron.
12
Thinking Republicans won't support the Collins/Cassidy experiment because the blame risk is too high. They recognize that there is likely a very good reason that no other developed economy has deployed this proposed system. It's not viable enough to ensure not paying a political cost. And the blame opportunity for failure is not clear enough.
Never mind the human cost.
Never mind the human cost.
3
I'll use my advancing age as an excuse, for not recalling, "Burke vs. Friedman," as it applies to economic policy. Other than that? I believe Mr. Douthat’s argument couldn’t be clearer--
"...Congress, as well as our fifty State Legislators, ought to give serious consideration to what Senators Cassidy and Collins are saying..." [my caption]
--
And if I might throw in my own two cents?
...Perhaps it's true, that the Democrats were indeed guilty, of applying undue force, in "giving us,” Obamacare...
But it looks like the Republicans are about to repeat the same mistake, by replacing it with a highly politicized version of, “Something Better.”
--
In which case? I second Mr. Douthat’s motion-- "Let Federalism work its magic!" [my caption]
...By letting the fifty States participate fully, in the Ongoing Saga of Health Reform, according to the spirit of the Cassidy-Collins Proposal...
—
Thank you Mr. Douthat, for illustrating again, how wise our Founding Fathers were, in giving their descendants the Essential Tools, for building, “...a More Perfect Union..."
"...Congress, as well as our fifty State Legislators, ought to give serious consideration to what Senators Cassidy and Collins are saying..." [my caption]
--
And if I might throw in my own two cents?
...Perhaps it's true, that the Democrats were indeed guilty, of applying undue force, in "giving us,” Obamacare...
But it looks like the Republicans are about to repeat the same mistake, by replacing it with a highly politicized version of, “Something Better.”
--
In which case? I second Mr. Douthat’s motion-- "Let Federalism work its magic!" [my caption]
...By letting the fifty States participate fully, in the Ongoing Saga of Health Reform, according to the spirit of the Cassidy-Collins Proposal...
—
Thank you Mr. Douthat, for illustrating again, how wise our Founding Fathers were, in giving their descendants the Essential Tools, for building, “...a More Perfect Union..."
Missing entirely from this article is the most important part of ObamaCare from a longterm improvement perspective: How we move away from fee-for-service to outcome-based medicine.
A market approach is rooted in the past -- in the old fee-for-service mindset.
Ultimately, we won't succeed in reining in healthcare costs -- or making Americans healthier -- without changing the incentive structure.
A market approach is rooted in the past -- in the old fee-for-service mindset.
Ultimately, we won't succeed in reining in healthcare costs -- or making Americans healthier -- without changing the incentive structure.
2
It seems that conservative healthcare wonks like Paul Ryan and Tom Price get pleasure from the suffering of those who would get the short end of the stick from their healthcare proposals.
Ryan and price enjoy political contributions from businesses/businessmen in the healthcare industry who would rape and pillage fellow Americans and the very wealthy who would be spared the ACA surcharge tax.
Ryan and price enjoy political contributions from businesses/businessmen in the healthcare industry who would rape and pillage fellow Americans and the very wealthy who would be spared the ACA surcharge tax.
6
Sure, let's have states choose to individually keep the ACA in place. But, also include a 2+ year permanent residency requirement for any individual health coverage in a state. Otherwise, someone living in a Red state that has no health coverage would immediately move to a Blue state maintaining that coverage when they received an expensive diagnosis, such as cancer. That will greatly disadvantage those that live in the state that has maintained the ACA.
5
Douthat (and Republicans, generally) implies that Obamacare is one big government sponsored, run, and managed system when in fact it relies heavily on the private sector and free market.
One can argue about minor details - such as deductible levels and benefits coverage - but giving more power to states could easily create more problems than it solves. Having a consistent program keeps people from gaming the system by moving to (and thus, penalizing) states with the best benefits. And repealing the mandate would be disastrous, as people - particularly those with limited income - would purchase only when they need care. . . This is a no-brainer, and I haven't seen any Republican plan to constructively get around this issue.
One can argue about minor details - such as deductible levels and benefits coverage - but giving more power to states could easily create more problems than it solves. Having a consistent program keeps people from gaming the system by moving to (and thus, penalizing) states with the best benefits. And repealing the mandate would be disastrous, as people - particularly those with limited income - would purchase only when they need care. . . This is a no-brainer, and I haven't seen any Republican plan to constructively get around this issue.
2
The GOP would never select this system because it gives ObamaCare an opportunity to show that it works better than the GOP alternative in the non-ObamaCare states. They would never allow this to be demonstrated!
5
Trump says he want's to have low-cost insurance for everyone and that no one will lose their coverage. I think he described single payer.
7
The whole premise of this column, that competition will somehow improve medical care is ludicrous on it's face. As an example, let's compare the use of colonoscopy in Europe (socialized medicine, no competition) with the current state in the United States. In the USA, basically every hospital in every major city has at least one, usually more, colonoscopes; the hospital feels it needs to have a full service, fully equipped gastroenterology department in order to compete with all the other hospitals in the area. As a result of this expense, repeated colonoscopy is recommended to everyone over the age of 50. Besides being very uncomfortable, this is a dangerous procedure; if you doubt that, then why does each hospital and DR insist that the patient waive all rights to compensation should anything go wrong. In Europe, the number of colonoscopes in a region is controlled by regulation, as a result, there is no need to have as many people undergo the procedure. And there is one other very important fact to consider: European medicine has better result with regard to detecting and dealing with colon tumors.
3
I'm a late arrival on the Left Coast. So my thoughts while I'm reading the article have been addressed by the commenters posting hours ago. I don't read them all, normally I start from the top of the Readers' Picks and proceed to the NYT Picks if I still think there are things left unsaid. Apologies to the later posters like myself, but I don't have the time or inclination to read, at 12:25 pm PST, 372 comments.
This column is a complete joke. It could be fodder for a standup routine or a Twilight Zone episode. Except that it's not funny, and peoples' lives are at stake. As many have noted, we have a working model that works perfectly fine in almost every other Westernized democracy. Health care isn't a comparable free market like shopping for a stereo or suit to wear to a wedding. And it certainly shouldn't be "for profit" with entities more concerned with their quarterly Wall Street numbers than anything else.
I propose a poll- that Ross Douthat be deemed unqualified to pen any more nonsensical articles about health care in these pages. We've seen his comedy routine. His material is lousy and the delivery is dreadful. Anyone got any rotten tomatoes?
This column is a complete joke. It could be fodder for a standup routine or a Twilight Zone episode. Except that it's not funny, and peoples' lives are at stake. As many have noted, we have a working model that works perfectly fine in almost every other Westernized democracy. Health care isn't a comparable free market like shopping for a stereo or suit to wear to a wedding. And it certainly shouldn't be "for profit" with entities more concerned with their quarterly Wall Street numbers than anything else.
I propose a poll- that Ross Douthat be deemed unqualified to pen any more nonsensical articles about health care in these pages. We've seen his comedy routine. His material is lousy and the delivery is dreadful. Anyone got any rotten tomatoes?
6
I'll use my advancing age as an excuse, for not recalling, "Burke vs. Friedman," as it applies to economic policy. Other than that? I think that Mr. Douthat’s argument couldn’t be clearer--
"...Congress, as well as our fifty State Legislators, ought to give serious consideration to what Senators Cassidy and Collins are saying..." [my caption]
--
And if I might add my own two cents?
...Perhaps it's true, that the old Democratic Majority was indeed guilty, of applying undue force, "in giving us,” Obamacare...
But it looks like the new Republican Majority is about to repeat the same mistake, by replacing it with a highly politicized version of, “Something Better.”
--
In which case? I second Mr. Douthat’s motion-- "Let Federalism work its magic!" [my caption]
...By letting the fifty States to participate fully, in the Ongoing Saga of Health Reform, according to the spirit of the Cassidy-Collins Proposal...
—
Thank you Mr. Douthat, for illustrating again, how wise our Founding Fathers were, in giving their descendants the Essential Tools, for building, “...a More Perfect Union..."
"...Congress, as well as our fifty State Legislators, ought to give serious consideration to what Senators Cassidy and Collins are saying..." [my caption]
--
And if I might add my own two cents?
...Perhaps it's true, that the old Democratic Majority was indeed guilty, of applying undue force, "in giving us,” Obamacare...
But it looks like the new Republican Majority is about to repeat the same mistake, by replacing it with a highly politicized version of, “Something Better.”
--
In which case? I second Mr. Douthat’s motion-- "Let Federalism work its magic!" [my caption]
...By letting the fifty States to participate fully, in the Ongoing Saga of Health Reform, according to the spirit of the Cassidy-Collins Proposal...
—
Thank you Mr. Douthat, for illustrating again, how wise our Founding Fathers were, in giving their descendants the Essential Tools, for building, “...a More Perfect Union..."
No mandate + Pre-existing condition coverage = no healthy people in the market = no insurers that will offer plans
The math doesn't work. If you can opt out then people will until they get sick and then they will buy insurance after they need it. Sorry, but if you are a rational it makes no sense to carry insurance if you are healthy and you can buy insurance right after you get sick. It is like allowing people to buy retroactive flood insurance when the water is up to the first floor ceiling. They will pay the premium until they get the claim check and they drop the insurance.
The math doesn't work. If you can opt out then people will until they get sick and then they will buy insurance after they need it. Sorry, but if you are a rational it makes no sense to carry insurance if you are healthy and you can buy insurance right after you get sick. It is like allowing people to buy retroactive flood insurance when the water is up to the first floor ceiling. They will pay the premium until they get the claim check and they drop the insurance.
6
Dear Dr. Douthat:
The prescription you just wrote to replace the Affordable Care Act is a placebo, sometimes called a "sugar pill".
Sorry, Doctor. I'm afraid it will be impossible for you and your Republican cronies to sugar coat the mess that the Republican Party is about to make of healthcare in the United States.
The prescription you just wrote to replace the Affordable Care Act is a placebo, sometimes called a "sugar pill".
Sorry, Doctor. I'm afraid it will be impossible for you and your Republican cronies to sugar coat the mess that the Republican Party is about to make of healthcare in the United States.
8
I think it's interesting that the idea for Obamacare had it's origin in the plan that the Heritage Foundation came up with years ago...And a vital stipulation of the HF plan was the Individual Mandate that ALL Americans would be required to buy health insurance..So in this plan put forward....All would be "auto enrolled" ...Call it what you want... they like the message, but not the messenger...Seems that the most efficient and cost effective plan would be to have Everyone enrolled in Medicare..Medicare for All...
I'm a big fan. Those red states will turn blue in two to four years.
6
It is remarkable that these two statements exist in the same document, apparently without irony.
The dominant systems in the developed world, whether government-run or single-payer or Obamacare-esque, are generally statist to degrees that conservatives deplore.
Which is not to say that the conservative health policy vision lacks empirical grounding.
In other words, there is no system in the world that demonstrates conservative concepts of health care, all of which, according to the statistics that I am aware of offer, by every measure, are less costly and offer more effective care and yet Mr Douthat posits that there is empirical evidence that disproves the perspective that conservative health systems offer better and less costly care.
I love the way conservatives can twist themselves into knots. They simply do not understand logic and rationality.
The dominant systems in the developed world, whether government-run or single-payer or Obamacare-esque, are generally statist to degrees that conservatives deplore.
Which is not to say that the conservative health policy vision lacks empirical grounding.
In other words, there is no system in the world that demonstrates conservative concepts of health care, all of which, according to the statistics that I am aware of offer, by every measure, are less costly and offer more effective care and yet Mr Douthat posits that there is empirical evidence that disproves the perspective that conservative health systems offer better and less costly care.
I love the way conservatives can twist themselves into knots. They simply do not understand logic and rationality.
7
" good reasons to think that free-market competition produces more medical innovation than more socialized systems."
Right, if you have plenty of money, you will get good health care. The other 99%, well not so much.
The Paul Ryan-Tom Price "plan" could be characterized as the Dickens Model, loosely based on Dicken's London. In short it's "Every Man, Woman and Child for themselves." If you don't have the money to afford healthcare, well that's just too bad. Work harder!
Right, if you have plenty of money, you will get good health care. The other 99%, well not so much.
The Paul Ryan-Tom Price "plan" could be characterized as the Dickens Model, loosely based on Dicken's London. In short it's "Every Man, Woman and Child for themselves." If you don't have the money to afford healthcare, well that's just too bad. Work harder!
6
Sadly, you like other pundits and government wonks, fail to take in consideration Americans inability for self-restraint when it comes to what they put in their bodies - which in my opinion vastly comprimises everyone's health insurance premuims. Tell me, how are Coca-Cola's sales doing, or any of the myriad amounts of fast food joints that spew their poison out there? Business is booming! Health care costs should be based on the indivuals history of consumption, and more specifically what they consume. As a healthy 60 year old male it's gets me peeved to see folks making poor food choicing that drives up not only their own health insurance premiums but also who actually take care of themselves and watch what they consume. But, hey, it's a free market society and what people shove down their gullets is their business. You reap what you sow.
The origin of the problem with health care is that Americans consume too much of it, and the services cost more than they ought to. Thus we blow 18% of the GDP on health care while other countries spend about 1/2 of this.
Any system that reduces the cost of health care so that it is in line with other developed countries will therefore have to cut half the cost of health care out. This will result in either people in the health care industry losing their jobs, or in having to accept less pay. Either way, the political blowback will be severe.
So, rather than implement one of the many health care systems that work just fine in Europe, Japan, Taiwan, etc, the Republicans (who keep giving us the failed trickle down economic nonsense) will probably try a grand experiment with a market based solution like Ross describes here, hoping that ideology will trump empirical evidence of what works.
Its the same thing Winston Churchill said "Americans always do the right thing, after they have first exhausted all the other options."
Any system that reduces the cost of health care so that it is in line with other developed countries will therefore have to cut half the cost of health care out. This will result in either people in the health care industry losing their jobs, or in having to accept less pay. Either way, the political blowback will be severe.
So, rather than implement one of the many health care systems that work just fine in Europe, Japan, Taiwan, etc, the Republicans (who keep giving us the failed trickle down economic nonsense) will probably try a grand experiment with a market based solution like Ross describes here, hoping that ideology will trump empirical evidence of what works.
Its the same thing Winston Churchill said "Americans always do the right thing, after they have first exhausted all the other options."
5
Sounds like a catastrophic plan to me and. This idiotic plan is proposed only to save face because the Freedom party scuppered any cooperation over the ACA with the Democrats.
What a waste of money and time. All that is happening with each Trump announcement from healthcare, to the Wall, to cancelling TPP, to environmental deregulation and investment reduction is an extravagant toilet flush of money down the drain because of Trump's belief that Obama was not a legitimate president and the Democratic party are full of chumps he can bully.
Trump cares nothing for the federal budget because like all his deals, he never puts up any money.
What a waste of money and time. All that is happening with each Trump announcement from healthcare, to the Wall, to cancelling TPP, to environmental deregulation and investment reduction is an extravagant toilet flush of money down the drain because of Trump's belief that Obama was not a legitimate president and the Democratic party are full of chumps he can bully.
Trump cares nothing for the federal budget because like all his deals, he never puts up any money.
5
If the right is wrong, we won't just learn a lesson about the economics of healthcare; people will die.
4
And what happens to the folks who go bankrupt or who die because of the "experiment"? Oh well. At least the billionaires and right wing Cobressmen and their families will be ok.
9
Douthat states: "There is compelling evidence that markets in health care can do more to lower costs and prices than liberals allow, and good reasons to think that free-market competition produces more medical innovation than more socialized systems. "Where does he get this compelling evidence? From a non-partisan organization offering a comprehensive study refuting every other study conducted proving that single payer systems offer far superior care at less than half the cost of Douthat's purported "free market" model? No, it isn’t. No such study exists. What Douthat gives us instead isn't even an investigative article but rather a thoroughly debunked Op Ed piece by a fellow conservative commentator. Why not top it off with other "facts" on medical coverage like the opinions of Sean Hannity and Rush Limbaugh? Ross, you construct your entire argument on the misrepresentations of Republicans instead of facts. This is the new reality, just another form of fake news. A Republican says something which is blatantly untrue, but if enough Republicans repeat it and treat it as an actual source, it magically transforms into fact. Ross, your proposals are a total dodge. You pretend you're offering a viable alternative to the ACA when you are only trying to reanimate the long dead and rotted lies Republicans have been pushing forever. It makes you yet another snake oil salesmen. We already have a raft of con-men and liars, they're called Republicans, and the greatest of all is Trump.
11
When will the pundits understand that for profit healthcare will never favor the people - we had that - and Obama changed it. A federal judge (nice to learn that someone at upper levels has some intelligence) determined that Aetna pulled out of even the profitable states to try to fool legislators to rule positively on its merger with Humana - the timing was suspicious and I expect a Republican hand in there somewhere.
6
Whenever Republicans start bandying the word "Freedom" around- get nervous - the idea they are about to offer is probably the exact opposite.
Republican ideas about healthcare are freedom all right- freedom to die in the streets without healthcare, or go bankrupt when you get sick.
Republican ideas about healthcare are freedom all right- freedom to die in the streets without healthcare, or go bankrupt when you get sick.
7
Lets just be real here. The right and far right Republicans (there are no more moderates in that party) had voted 60 plus times to destroy Obama's plan without one of their own. Seven years later they still don't have one. Lead by Mr. P. Ryan we will revert to years passed. Insurance companies denying coverage for a "hangnail", High risk state run insurance pools for those with "costly illness" with a waiting line to get in the pool. All these were present years ago and Republicans had no problem with them or people dying because either they couldn't insurance or were locked out. There is a very easy answer to the problem. Everybody has a Social Security number.
Put Everybody in the USA with that number on MEDICARE and stop all this.
Put Everybody in the USA with that number on MEDICARE and stop all this.
5
Human health is not something that is consumed, though it may be promoted. Insurance competition leads insurance companies to reduce risk to increase profits. Just do not see how market and insurance models transfer from say houses to humans. A house is not going to fall off a bike, get an acute illness, or have a chronic disease. A house may be poorly maintained, fall in value, and require less insurance, or may be in a flood zone and require more, say to cover damage and replacement. How do you monetize a human life to make similar adjustments?
No one desires to be a consumer of health care. Choice is either A. Betting that fate grants good health, so reduced coverage. B. Can't afford plans covering preventive care, so reduced coverage. C. Can't afford any coverage, so no coverage. D. Job benefits guarantee low co-pays and full coverage, everyones choice if the option was affordable. E. Affluence makes health care cost no object, everyone is wealthy, nirvana.
Perhaps the only way the "experiment" works is if hospitals and healthcare systems are the insurers. Then affordable or free preventive care of consumers would reduce costs, improve outcomes, and increase profits. But again, a few emergency room visits by the uninsured would greatly impact the bottom line of a system operating at high efficiency.
Sorry, universal single payer, proven to work else where, seems to make the most sense. Or provide no care to protect profits of a narrow margin, efficient system.
No one desires to be a consumer of health care. Choice is either A. Betting that fate grants good health, so reduced coverage. B. Can't afford plans covering preventive care, so reduced coverage. C. Can't afford any coverage, so no coverage. D. Job benefits guarantee low co-pays and full coverage, everyones choice if the option was affordable. E. Affluence makes health care cost no object, everyone is wealthy, nirvana.
Perhaps the only way the "experiment" works is if hospitals and healthcare systems are the insurers. Then affordable or free preventive care of consumers would reduce costs, improve outcomes, and increase profits. But again, a few emergency room visits by the uninsured would greatly impact the bottom line of a system operating at high efficiency.
Sorry, universal single payer, proven to work else where, seems to make the most sense. Or provide no care to protect profits of a narrow margin, efficient system.
2
So DonTCare will be just like ObamaCare, except less organized. Sounds great.
4
Why experiment when single payer has a successful track record in other countries? Well, it's 'statist'!!! No matter than it delivers good health care at a lower price that any model in the US, so far tested.
Why not work hard to amend, improve and build upon ACA (based on a GOP model)? Well, Obama did it! Can't do that.
Let's have health savings accounts! Let the states experiment with ACA type plans, on and on. That's reasonable, you say. On what basis? Why, for the chance to get those conservative ideas tested, once and for all!
But giving the states a chance to experiment is still just too much "gummit" for conservatives.
The real conservative health care idea is Darwinian, which amounts to a ruthless culling of Americans who in the worldview of the GOP, just don't cut it. To conservatives, the quiet, intellectually honest ones, the preferable health care program is no program at all. It would, to quote Dickens: "decrease the surplus population." No amount of dissembling, artful argumentation or clever 'columnizing' can hide what the GOP is, and what the conservative movement is really all about.
Why not work hard to amend, improve and build upon ACA (based on a GOP model)? Well, Obama did it! Can't do that.
Let's have health savings accounts! Let the states experiment with ACA type plans, on and on. That's reasonable, you say. On what basis? Why, for the chance to get those conservative ideas tested, once and for all!
But giving the states a chance to experiment is still just too much "gummit" for conservatives.
The real conservative health care idea is Darwinian, which amounts to a ruthless culling of Americans who in the worldview of the GOP, just don't cut it. To conservatives, the quiet, intellectually honest ones, the preferable health care program is no program at all. It would, to quote Dickens: "decrease the surplus population." No amount of dissembling, artful argumentation or clever 'columnizing' can hide what the GOP is, and what the conservative movement is really all about.
5
A question and a comment: You say that people would be "auto-enrolled in a catastrophic plan," but how does that work in practice? What if they simply refuse to pay for it? Then we're back to free rider problem when the uninsured go to the emergency room. Comment: Most of the people we are trying to get insured can't afford a health savings account, or if they can, not in any meaningful amount. The HSA idea is a red herring.
4
A physician and health researcher at Harvard gets his family on a high deductible plan, and finds he avoids getting care even when it could be critical. Yup, that's a major reason these plans 'save healthcare money', i.e., people spend less, but that's not always good.
""Simply calling the patient a consumer doesn’t make buying health care anything like buying cars and computers," said Chandra.
In fact, Chandra’s research shows that even higher-income earners with more economic flexibility do not really shop for health care efficiently, even when they're given a state-of-the-art computer program to compare prices. People on these plans tend to forgo all sorts of care, regardless of their own need and health status."
http://www.marketplace.org/2017/01/18/health-care/cost-vs-care
""Simply calling the patient a consumer doesn’t make buying health care anything like buying cars and computers," said Chandra.
In fact, Chandra’s research shows that even higher-income earners with more economic flexibility do not really shop for health care efficiently, even when they're given a state-of-the-art computer program to compare prices. People on these plans tend to forgo all sorts of care, regardless of their own need and health status."
http://www.marketplace.org/2017/01/18/health-care/cost-vs-care
3
For the millionth time, so much of ACA is exactly what conservatives were calling for before their arch-nemesis Barack Obama suggested that those ideas actually be implemented. If they hadn't worked endlessly to sabotage ACA, we would know by now whether conservative free-market principles could be used in an industry with essentially static demand. They remain vindictive while the former President takes a well-earned vacation.
I suspect it is too much too hope that Republicans might actually look at the benefits of ACA, and perhaps recognize that if they hadn't pulled funding for the exchanges and other coverage options our premiums would likely be lower. Then maybe correct course and build upon the successes, rather than throw us to the wolves and pretend that the old days were better. They weren't.
I suspect they could do that, and wordsmith their way out of admitting that there was much in ACA to like. I don't think most of us would care who got credit if it actually improved the situation.
I suspect it is too much too hope that Republicans might actually look at the benefits of ACA, and perhaps recognize that if they hadn't pulled funding for the exchanges and other coverage options our premiums would likely be lower. Then maybe correct course and build upon the successes, rather than throw us to the wolves and pretend that the old days were better. They weren't.
I suspect they could do that, and wordsmith their way out of admitting that there was much in ACA to like. I don't think most of us would care who got credit if it actually improved the situation.
5
And what burns me is the Republicans want to propose a whole new government healthcare insurance system after the taxpayers paid a big bill for setting up the ACA.
Trump loves to spend other people's money, the one common cause he has with the Rep party. He certainly won't be contributing his own dollar to the Federal budget.
Trump loves to spend other people's money, the one common cause he has with the Rep party. He certainly won't be contributing his own dollar to the Federal budget.
1
Everytime government has put conservative ideals to the test, they've failed; Kansas, Wisconsin, Louisiana, Michigan, etc. have all put their states close to default while failing to provide adequate government programs. In fact, the ACA has had problems because the health care system is now in the hands of big, for-profit healthcare providers.
Instead of running an experiment that will probably lead to millions of people losing their healthcare, we know what works; a single-payer system for all. It turns out this is the most efficient way to guarantee healthcare while restraining costs.
Instead of running an experiment that will probably lead to millions of people losing their healthcare, we know what works; a single-payer system for all. It turns out this is the most efficient way to guarantee healthcare while restraining costs.
5
With all this talk about what kind of health care coverage we will get, why isn't anyone talking about the most obvious problem.
Why does our healthcare cost twice or more than most industrialized nations?
Why does our healthcare cost twice or more than most industrialized nations?
1
Self-proclaimed Conservatives love handwaving pseudo-intellectual games. They value their "principles" over the lives of human beings. Healthcare is not at all like markets for optional goods and services because everyone needs healthcare, and sometimes in an emergency. Moreover, there can be no free markets in areas with only one hospital within 40 miles. And Americans don't want to be used as guinea pigs to test Conservatives' fantastical theories.
If the Obamacare exchange system doesn't survive, it will be because Republicans intentionally killed it.
If the Obamacare exchange system doesn't survive, it will be because Republicans intentionally killed it.
10
And at the same time killed tens of thousands of. Americans and condemned many more to suffering and bankruptcy.
3
A major problem with high deductible is not just running up medical costs for people who can't afford them; people will not go to the doctor to get preventative care and will not get timely medical care when it is needed to prevent more costly treatments later.
Conservative governors have always had the power to eliminate insurance regulation in their state to create a national market. They don't because they know it won't work. And Texas has essentially done away with malpractice law suits (but not malpractice), but it hasn't helped reduce consumer costs.
"Conservative" ideology, however, trumps facts.
Conservative governors have always had the power to eliminate insurance regulation in their state to create a national market. They don't because they know it won't work. And Texas has essentially done away with malpractice law suits (but not malpractice), but it hasn't helped reduce consumer costs.
"Conservative" ideology, however, trumps facts.
8
I love how Douthat's memory works on the Obamacare approach and it being a liberal plan. It was the conservative plan in the 90s and Romney (a Republican) instituted it as the 1st state-wide insurance plan to create full coverage. The liberal plan is universal health insurance not Obamacare. The Republicans don't know what to do with themselves b/c the Dems took the R's plan and implemented it and now they can't find a conservative alternative b/c that is the conservative option.
Douthat is now creating a myth that we haven't actually tried the conservative alternative out. IT'S BEEN TRIED AND IMPLEMENTED. Now Douthat and conservatives are just looking for something even farther to the right than what we have now, which is ultimately what we had before. It will mean going back to when insurance was unaffordable and virtually inaccessible to older individuals, the self-employed or those with preexisting conditions. Admit it Douthat, conservatives want the old unregulated market place back so they can decrease taxes on the wealthy and let insurance companies determine if people live or die. If Rs wanted a real solution they would have supported Obamacare (their own original plan) and would be interesting in making the needed adjustments to the system.
Douthat is now creating a myth that we haven't actually tried the conservative alternative out. IT'S BEEN TRIED AND IMPLEMENTED. Now Douthat and conservatives are just looking for something even farther to the right than what we have now, which is ultimately what we had before. It will mean going back to when insurance was unaffordable and virtually inaccessible to older individuals, the self-employed or those with preexisting conditions. Admit it Douthat, conservatives want the old unregulated market place back so they can decrease taxes on the wealthy and let insurance companies determine if people live or die. If Rs wanted a real solution they would have supported Obamacare (their own original plan) and would be interesting in making the needed adjustments to the system.
8
We already tried a conservative plan - it's called Obamacare, which is Romneycare 2.0 (I have yet to hear any conservative who complains about Obamacare tell me whey they are mute about Romneycare), and along with many earlier bills sponsored/authored by conservatives, and 3 articles from Heritage Foundation 'scholars' (Stuart Butler (2), Robert Moffitt (1)), also has the hated universal insurance mandate (socialist as of late 2009 when Obama embraced it), a conservative idea to get at the free rider problem.
http://healthcarereform.procon.org/view.resource.php?resourceID=004182
More broadly, a 'free market' in any good presumes symmetric and even full knowledge about the product by the seller and the buyer. That is not the case in the healthcare market where there are huge asymmetries of information between doctor and patient on diagnosis and treatment; the potentially dire consequences of health events also makes this market very different from buying soap; patients also mostly don't shop around for prices and prices are not easily available - transparent - with or without insurance. Throw the insurance in and it is even a more abnormal market.
It is precisely because of the market distortions, including life and death aspect of the market, that government regulations are necessary. There may be some aspects of the market that are well-served by competition, but to pretend that the market overall should be treated like one providing ordinary consumer products is idiotic.
http://healthcarereform.procon.org/view.resource.php?resourceID=004182
More broadly, a 'free market' in any good presumes symmetric and even full knowledge about the product by the seller and the buyer. That is not the case in the healthcare market where there are huge asymmetries of information between doctor and patient on diagnosis and treatment; the potentially dire consequences of health events also makes this market very different from buying soap; patients also mostly don't shop around for prices and prices are not easily available - transparent - with or without insurance. Throw the insurance in and it is even a more abnormal market.
It is precisely because of the market distortions, including life and death aspect of the market, that government regulations are necessary. There may be some aspects of the market that are well-served by competition, but to pretend that the market overall should be treated like one providing ordinary consumer products is idiotic.
4
SOUNDS reasonable Ross but will get VERY messy! Adverse selection (sicker people signing up) between states will kill states who provide programs vs those who don't.
If you are really sick and live in NH for example and they don't provide coverage then just establish residence 20 miles away in MA and have your cancer treatments covered and premiums subsidized. The greater and more expensive the medical issue per individual, the more motivated people will be to move.
Think it won't happen? Take a look at current ACA stats. The cost is going up mostly because......many more sick people signed up then healthy people. Hence the adverse selection. Or people traveling to Europe for hip replacements.
The difference here is that a single state will be paying for it and they could easily be swamped with costs they can't afford and will shut down that state's program.
Whatever system is established the fact is, short of having nothing (which many in congress really want but are afraid to say) it will only work if everyone is in the pool. Half measures (the current ACA) just don't work! If it's too expensive or people think it is "un American" to force people in, then so be it. Be honest and shut it down. But pretending any system that doesn't include all Americans will work is just a waste of time and a shame.
Congress should fess up and just kill it with no "replacement" or reform what is there as opposed to lying to us about "access".
If you are really sick and live in NH for example and they don't provide coverage then just establish residence 20 miles away in MA and have your cancer treatments covered and premiums subsidized. The greater and more expensive the medical issue per individual, the more motivated people will be to move.
Think it won't happen? Take a look at current ACA stats. The cost is going up mostly because......many more sick people signed up then healthy people. Hence the adverse selection. Or people traveling to Europe for hip replacements.
The difference here is that a single state will be paying for it and they could easily be swamped with costs they can't afford and will shut down that state's program.
Whatever system is established the fact is, short of having nothing (which many in congress really want but are afraid to say) it will only work if everyone is in the pool. Half measures (the current ACA) just don't work! If it's too expensive or people think it is "un American" to force people in, then so be it. Be honest and shut it down. But pretending any system that doesn't include all Americans will work is just a waste of time and a shame.
Congress should fess up and just kill it with no "replacement" or reform what is there as opposed to lying to us about "access".
5
ACA does work, just improve it.
Better yet, universal healthcare such as,Medicare for all.
Better yet, universal healthcare such as,Medicare for all.
4
"That is, the right’s best health care minds believe that markets and competition can deliver lower costs and better care,".....This is correct up to a point. It works, but it only works when you correctly define the customer. Over and over Republicans want to define the patient as the customer. But when it come to healthcare this is very clearly not the case. The patient is very often under duress and does not have the knowledge to make an informed decision. The patient is not capable of deciding who provides the best service or even what service at the most reasonable cost. The doctor is primarily interested in outcome; the insurance company is driven by cost. The reason government run single payer works best is they have both an outcome and cost incentive, and in addition because of their size they are in the best position to drive competition among the market suppliers to provide the best outcome at the lowest cost. Serious conservatives who think that a market driven solution is always best need to think harder about exactly how that can best be accomplished...duh, government run single payer.
5
It really goads me when conservatives point out that the exchanges are heading for a death spiral but fail to mention that Republicans ensured that when they repealed the risk corridors that would have allowed insurance companies that initially underpriced insurance in the exchanges to get covered for the first couple of years.
4
Great so the experiment is going to be a High Deductible Plans with an HSA attached to it.....exactly the type of plan that the exchange now offers that will have better benefits for less cost... sounds like "alternative facts". How about experimenting that every insurer who provides coverage to large employer groups also participate in the individual market ......that way we spread the risk and all companies will be able to share the high claimant exposure.....let's be innovative not destructive.
1
Funny that a plan created by Mitt Romney becomes liberal when adopted by Obama.
7
Dude,
"And if the right (experiment) is wrong, if its model doesn’t match reality, if people are simply miserable as health care consumers...the country and conservatism will be better off if we learn that via a voter rebellion in 10 right-leaning states, rather than through a much more widespread backlash against a nationwide health-insurance failure."
This is not a college experiment in Social Science!! You're talking about actual human beings. What aspect of Social Justice Catholicism does your plan grown from?
NONE! Because you're taking the Ebeneezer Scrooge approach:
Let's kick 18 to 20 million people off the ACA because it now has flaws and start something new.
WHY! Because the Republicans refused to come up with any alternative/fixing ideas over 7 years during it's initial rollout and growth, hoping it would crash and burn, denying people protection.
The rabble should be glad they can await the new wonderful, huge, best-in-the-world TrumpianCare.
Bottomline, You want to not only throw the baby out with the bathwater, but also the pan they were both in. SAD!
"And if the right (experiment) is wrong, if its model doesn’t match reality, if people are simply miserable as health care consumers...the country and conservatism will be better off if we learn that via a voter rebellion in 10 right-leaning states, rather than through a much more widespread backlash against a nationwide health-insurance failure."
This is not a college experiment in Social Science!! You're talking about actual human beings. What aspect of Social Justice Catholicism does your plan grown from?
NONE! Because you're taking the Ebeneezer Scrooge approach:
Let's kick 18 to 20 million people off the ACA because it now has flaws and start something new.
WHY! Because the Republicans refused to come up with any alternative/fixing ideas over 7 years during it's initial rollout and growth, hoping it would crash and burn, denying people protection.
The rabble should be glad they can await the new wonderful, huge, best-in-the-world TrumpianCare.
Bottomline, You want to not only throw the baby out with the bathwater, but also the pan they were both in. SAD!
3
We tried markets. They failed spectacularly--if the standard is actually delivering health care to people. But corporatists don't care about health results. They care about profits.
3
Burke and Friedman, but not Marx. This piece is written in the author's conservative ideological silo. As such it does not address the overwhelming evidence that the European single payer systems produce a greater good for a greater number, for that would necessitate abandoning a non-rational attachment to the totems of Friedman and Burke. No one abandons an erotic attachment easily.
2
Weren't we essentially living with a failing market-based health insurance system before Obamacare? It was a system that would not cover pre-existing conditions, had limited life-time coverage, ever-increasing premiums for those who had insurance, and constant battles with insurance company bureaucrats. Obamacare - which was inspired by the conservative Heritage Foundation and the system Romney helped put in place in Massachusetts - solved some of the problems and did provide insurance to 20 million who had not previously had coverage, but it is not perfect. Efforts should have been made to improve it and we should have added a public option - Medicare for all. Mr. Douthat -- who I assume has health insurance and doesn't have to worry about the ACA repeal --can engage in his philosophical musings about marketing-based solutions, but lives are at stake. We don't have market-based solutions for police and fire protection services. Why should healthcare - in the richest nation on earth - not be guaranteed? Prior to ACA, we were all paying for those who were without health insurance as they sought expensive emergency room treatments and had no preventive care. These ER visits impacted taxes and insurance premiums. I am through with experimenting with the market to see if those seeking profit can lower costs. We already have a proven health insurance system that works - Medicare. I am done debating healthcare with those who have no worries about health coverage being available.
3
Might as well codify what has been a running trend in the US for years, the growing disparity of outcomes in blue vs red states. Its ironic that "states rights" would be an argument to move in this direction, but increasingly citizens in the states under GOP leadership are getting shafted, from healthcare, to reproductive rights, to environmental poisoning, out of control drug epidemics and growing inequality. As a New Yorker, Im not too worried about whats going to happen in my state, but it does sadden me that the hopeless and apparently mindless citizens who keep supporting the GOP in state and national elections continue to get what they deserve, but without the recognition of the source of their troubles. This is just more of the same...
3
Face it? Obama help the poor and middle class obtain healthcare. The GOP's plans are a CON on Americans. They include tax hikes, no out of pocket limits or control of treatment cost and the Tax Credits is another tax cuts for the rich. The poor and many middle class are loaded with debt and can not save for healthcare.
1
The marketplace has had years to formulate at least even a good healthcare system and failed miserably. You are an apologist for conservatives, which means facts have nothing whatsoever to do with your arguments. You're at this paper just to irritate and obfuscate. I don't know why I bother to read what you have to say.
Yes, under the Collins/Cassady proposal states can now be a great laboratory. Let's hope they are better at this than Kansas has been in trying to prove dramatic tax cuts can spur business investment. Seriously though, the market based approach won't succeed unless there is transparency on pricing and quality. I see no efforts on the part of providers to make their pricing known to the public. As for quality, yes there are some practice standards but also vast swaths of medicine where one has no clue about what quality care is.
Obamacare is hardly socialaized medicine, but our previous system of anti-social medicine disproves a key premise of this article. While, having worked in corporate research, I agree that free market forces may drive faster innovation, the claim that "There is compelling evidence that markets in health care can do more to lower costs and prices than liberals allow," overlooks equally compelling contrary evidence. From epi pens to orphan drug profiteering to billions for ED drugs, money gets meds while needs like Ebola, malaria, or other tropical diseases require governmental support. There is no corporate quarterly shareholder pressure to improve the lot of those who cannot pay.
This was an experiment we ran for 220 years, and while it had successes in medicines and technologies, it failed the challenges of public health. The underserved are potential breeders in epidemics, have more absences from work, do more desperate things to self-treat, are sicker, and die sooner. Not just the poor, but veterans, children, elders, any citizen who cannot obtain proper care is a victim of public health failure.
Stop hiding the victories of public health, the FDA, city hygiene, vaccinations from smallpox to polio, better food, and quarantines. Public health works for all citizens from Denmark to Cuba. But not here. We do not have a free market. we have corporate control of most medicine.
This was an experiment we ran for 220 years, and while it had successes in medicines and technologies, it failed the challenges of public health. The underserved are potential breeders in epidemics, have more absences from work, do more desperate things to self-treat, are sicker, and die sooner. Not just the poor, but veterans, children, elders, any citizen who cannot obtain proper care is a victim of public health failure.
Stop hiding the victories of public health, the FDA, city hygiene, vaccinations from smallpox to polio, better food, and quarantines. Public health works for all citizens from Denmark to Cuba. But not here. We do not have a free market. we have corporate control of most medicine.
1
My concern with "trying out" a market driven approach that appeals to conservatives is whether conservatives will be willing to accept the failure of the market driven alternative if it does not deliver lower costs and broader coverage. Or, will conservatives (a) offer "alternative facts" when analyzing the results, or (b) argue that if only it had been a truly free market, then the desired results would have been delivered. Try the market approach, if you must (and perhaps to the damage of people who need but cannot get coverage) - but conservatives have to accept the results, even if they contradict their ideology.
The problem that Mr. Douthat hasn't seemed to grasp is that the modern Republican Party doesn't care about helping ordinary Americans--they care about helping rich people, especially the exceptionally rich people who happen to donate to their campaigns.
The second problem is the idea that spending on healthcare can be controlled through the consumer market. But it can't, and the reason should be self-evident: whereas I can choose to buy a pair of shoes or not, or a couch, or a car, or whatever, I can't choose to not go to a doctor if I have a broken leg or I'm sick--or at least I shouldn't.
And there's the other danger. Much of our healthcare costs aren't technically consumer driven--they're driven by inefficiencies in insurance delivery, hospitals overcharging for stuff like Advil, administrative costs, expensive pharmaceutical drugs, etc.
Single payer is the way to go. It's much cheaper, more efficient, more effective, and there are multiple examples we could look at to base our system off of--and it's universal.
The second problem is the idea that spending on healthcare can be controlled through the consumer market. But it can't, and the reason should be self-evident: whereas I can choose to buy a pair of shoes or not, or a couch, or a car, or whatever, I can't choose to not go to a doctor if I have a broken leg or I'm sick--or at least I shouldn't.
And there's the other danger. Much of our healthcare costs aren't technically consumer driven--they're driven by inefficiencies in insurance delivery, hospitals overcharging for stuff like Advil, administrative costs, expensive pharmaceutical drugs, etc.
Single payer is the way to go. It's much cheaper, more efficient, more effective, and there are multiple examples we could look at to base our system off of--and it's universal.
1
This would be so much more reassuring if the GOP had noticed how the big experiment in Kansas of lowering taxes and spending had gone and modified their thinking based on that. It isn't clear that factual outcomes have any impact on many policy setters in Congress.
9
Do you really believe that Trump has any interest in a compromise approach? Approaching him , or the Tea Party conservatives with a reasonable proposal will instantly fail. They have no interest in being reasonable, they have no interest in the value of experimentation. Witnesss Trumps investigation into "voter fraud" that doesn't exist. He is only interested in his own ego and repeating lies often enough that people forget thaat truth ever existed. I'm sure the "alternative" health care system will equal the value of "alternative facts."
3
For the love of God, let's just have Medicare for all.
9
Mr Douthat chooses to ignore the most significant inherent failing of the American medical industry. Insurance companies, like all corporations, exist solely and exclusively to maximize the wealth of their executives and shareholders. That obligates them to offer coverage only to those who don't need health care, until they do need it.
Even insurance executives recognized that a system which MUST exclude so many people is unacceptable. That's why they allowed the ACA. Even though the ACA was the Heritage Foundation's conservative solution to this failing, it's apparently not conservative enough for Republicans.
Previous tests of conservative solutions prove they do an excellent job of helping the wealthiest among us acquire more wealth, at everyone else's expense. Thus, health savings accounts will clearly benefit insurance companies by giving them free money to invest, along with revenue from inevitable fees. But the benefit to people who don't have thousands of dollars to give insurers interest-free loans is much less clear.
Allowing states to opt for Obamacare or a "conservative solution" may be the least-bad approach from Republicans, whose zeal to repeal is motivated entirely by partisan vindictiveness. This test will surely demonstrate why every other advanced country long ago rejected conservative solutions to health care. But not before it inflicts needless suffering on millions of Americans. (And conservatives will ignore the results anyway.)
Even insurance executives recognized that a system which MUST exclude so many people is unacceptable. That's why they allowed the ACA. Even though the ACA was the Heritage Foundation's conservative solution to this failing, it's apparently not conservative enough for Republicans.
Previous tests of conservative solutions prove they do an excellent job of helping the wealthiest among us acquire more wealth, at everyone else's expense. Thus, health savings accounts will clearly benefit insurance companies by giving them free money to invest, along with revenue from inevitable fees. But the benefit to people who don't have thousands of dollars to give insurers interest-free loans is much less clear.
Allowing states to opt for Obamacare or a "conservative solution" may be the least-bad approach from Republicans, whose zeal to repeal is motivated entirely by partisan vindictiveness. This test will surely demonstrate why every other advanced country long ago rejected conservative solutions to health care. But not before it inflicts needless suffering on millions of Americans. (And conservatives will ignore the results anyway.)
2
I'd welcome such competition if it were fairly structured and there is the likely rub.
You want a valid comparison of competing economic ideologies? I'll spot your Kansas with a California or Minnesota and I'd win hands down.
I keep hearing the GOP wailing about free market economies, but everything they espouse is exactly the opposite.
Free Market? Who voted to block Medicare from requiring drug companies to competitive bid for sales of their products?
Free Market? How many cable companies do you get to choose from and how easy is it for you to get the channels you want and not the ones you don't?
Free market? Free market forces killed the coal industry, but our new leader is going to fight tooth and nail to revive it in the face of those same forces.
Free market? The evidence on global warming is incontrovertible. It is becoming clear that the new administration plans to oppose this idea by effectively hiding the evidence.
Free market? It now appears Aetna insurance withdrew from health care exchanges in Florida and PA not because they were LOSING money but in fact even as they were MAKING money.....and they did so because they wanted to retaliate against an Obama Justice Dept. effort to block their merger with Humana as an anti-trust violation. Le's see how quickly Mr. Trump and Mr. Sessions reverse that.
You want a valid comparison of competing economic ideologies? I'll spot your Kansas with a California or Minnesota and I'd win hands down.
I keep hearing the GOP wailing about free market economies, but everything they espouse is exactly the opposite.
Free Market? Who voted to block Medicare from requiring drug companies to competitive bid for sales of their products?
Free Market? How many cable companies do you get to choose from and how easy is it for you to get the channels you want and not the ones you don't?
Free market? Free market forces killed the coal industry, but our new leader is going to fight tooth and nail to revive it in the face of those same forces.
Free market? The evidence on global warming is incontrovertible. It is becoming clear that the new administration plans to oppose this idea by effectively hiding the evidence.
Free market? It now appears Aetna insurance withdrew from health care exchanges in Florida and PA not because they were LOSING money but in fact even as they were MAKING money.....and they did so because they wanted to retaliate against an Obama Justice Dept. effort to block their merger with Humana as an anti-trust violation. Le's see how quickly Mr. Trump and Mr. Sessions reverse that.
5
As a supporter of Obamacare, I appreciate Douthat's thoughtful analysis. I would add a third option for the states: Allow them to use a single provider option. Then let the "grand experiment" test the waters. My only hope is that along the way, the people who need insurance are not left in the dust. And I applaud Obama for starting this conversation. Without Obamacare, we would be experiencing the chaotic, inadequate and costly (both to taxpayers and individuals) free-market insurance scam that existed before enactment of the ACA. Finally I agree with Dan that there must be an independent way to measure the outcome of this experiment, perhaps through a knowledgeable, independent group like the Kaiser Family Foundation.
24
So if I understand Mr. Douthat correctly he is proposing that we should use the consumers in 10 red states as lab rats in a great social experiment to determine whether the unproven conservative model for healthcare is viable or not...and if it's not, rely on a voter rebellion to effect change.
You are kidding me....right?
You are kidding me....right?
1
I will remind Ross that for the past thirty years the No. 1 cause of bankruptcies in the United States has been citizens who lost their life savings trying, and failing, to keep up with their outlandish medical bills.
Ross writes as if the America First (read Capitalist First, Citizen Last) health care proposals were an untested innovation, and by gosh! we should give it a chance!
But they have been the status quo every day for the past 240 years of this republic's existence.
The purpose of privately held insurance companies is to make the stockholders wealthy, not to address the medical needs of subscribers. Great for them, but a disaster for tens of millions of citizens.
Ross writes as if the America First (read Capitalist First, Citizen Last) health care proposals were an untested innovation, and by gosh! we should give it a chance!
But they have been the status quo every day for the past 240 years of this republic's existence.
The purpose of privately held insurance companies is to make the stockholders wealthy, not to address the medical needs of subscribers. Great for them, but a disaster for tens of millions of citizens.
3
Health Savings Account
My friend, 42,single, no children, works for a franchised but national fast food chain. She makes $7.45 /hr before taxes. She works 36 hr/week. Her employer does not offer health insurance and she has not seen a doctor or dentist for more than 10 years.
Exactly how could she save into a HSA? Perhaps eating one meal every other day.
HSA really only works for those who have at least some disposable income.
For folks like her, it's a FRAUD!
My friend, 42,single, no children, works for a franchised but national fast food chain. She makes $7.45 /hr before taxes. She works 36 hr/week. Her employer does not offer health insurance and she has not seen a doctor or dentist for more than 10 years.
Exactly how could she save into a HSA? Perhaps eating one meal every other day.
HSA really only works for those who have at least some disposable income.
For folks like her, it's a FRAUD!
6
¨ The promise is that by having people pay for more of their health care in cash and by giving them more freedom in what plans they’re allowed to buy, you would end up with less spending, lower prices and less cost inflation.¨
My husband´s employer generously pays two-thirds of our insurance premium, leaving us with $6100 to pay for 2016. After that, there were co-pays and deductibles for us to pay - about another $2000. And then we could add in what we spent for medicare. I´m really tired of flippant comments about people needing to have more financial skin the game to meaningfully bring down prices. For most families, shelling out over $700 per month is real money. We buy insurance because the hope is to avoid bankruptcy if one of us has a serious accident or illness. Unfortunately, there is no guarantee this will be true.
My husband´s employer generously pays two-thirds of our insurance premium, leaving us with $6100 to pay for 2016. After that, there were co-pays and deductibles for us to pay - about another $2000. And then we could add in what we spent for medicare. I´m really tired of flippant comments about people needing to have more financial skin the game to meaningfully bring down prices. For most families, shelling out over $700 per month is real money. We buy insurance because the hope is to avoid bankruptcy if one of us has a serious accident or illness. Unfortunately, there is no guarantee this will be true.
3
It's funny because the exchanges, which have conservatives so up-in-arms, were created directly from a conservative blueprint.
But I agree that this could be a sensible solution. If liberals can free themselves from the healthcare/no healthcare dichotomy (or Trump would deign to allay those obviously widespread fears), then experimenting with new models would be a good thing.
I'm just afraid the red-staters all feel they have been left out of the country's prosperity because they have been victims of red-legislator stinginess. Part of blue-state prosperity has always been enforcing worker protections and compelling employers to offer benefits that make life worth living and a job worth sticking to for the long haul. Everyone wins.
If the red states are given free rein to further limit healthcare options, then they will continue to blame the blue states for their problems.
But I agree that this could be a sensible solution. If liberals can free themselves from the healthcare/no healthcare dichotomy (or Trump would deign to allay those obviously widespread fears), then experimenting with new models would be a good thing.
I'm just afraid the red-staters all feel they have been left out of the country's prosperity because they have been victims of red-legislator stinginess. Part of blue-state prosperity has always been enforcing worker protections and compelling employers to offer benefits that make life worth living and a job worth sticking to for the long haul. Everyone wins.
If the red states are given free rein to further limit healthcare options, then they will continue to blame the blue states for their problems.
Prior to the ACA states had their own rules for health insurance. I worked in health care in a state that allowed for catastrophic health insurance policies, pre-existing conditions clauses and dollar caps for the amount the insurance company is expected to pay for an individuals health care per year. I worked with children who were impacted by these rules. Children born with a heart defect that required surgery had to wait until their third year to have the surgery that was required as soon as possible after birth. Many of the procedures weren't fully covered due to cost. One young family divorced solely to qualify for Medicaid. The main success of the ACA was the unification of rules and regulations. It put the consumer and safety first rather than the needs of insurance companies. It allowed for basic preventive care rather than only covering dire medical conditions We shouldn't return to that type of situation. Have a heart.
2
Do we need to repeat, yet again, that the ACA actually IS the conservative plan for healthcare insurance?
4
By "less comprehensive" you mean "illusory," don't you, Ross?
1
It seems like a plantation mentality to put employers in charge of connecting us to our healthcare. Aside from making employees overly dependent on employers and averse to risks in changing employment, it also puts in a burden on the employer and stifles entrepreneurship. If it weren't for healthcare, I could leave my current employment and start my own agency with a few employees. But I would have to give up my healthcare and incur the cost of providing for somebody else's, which I could not do easily as my large employer does. Here I am stuck working for a large employer, and less able to breakaway and actually offer some innovative solutions to my local marketplace. In doing a cost-benefit analysis, does my employer prefer to cover my healthcare because it increases my dependency and limits my ability to compete with them? Maybe. But the trade-off is at the expense of my freedom and the potential for greater economic dynamism that the so called champions of the entrepreneurial class should support.
4
"Instead, it’s a federalist compromise. It lets individual state governments decide whether they want to stick with Obamacare or not."
How would this work in states that keep flipping between Republican and Democratic administrations? Could people's healthcare be pulled out from under them every four years?
How would this work in states that keep flipping between Republican and Democratic administrations? Could people's healthcare be pulled out from under them every four years?
2
The Cassidy-Collins plan is this:
Allow blue states that want Obamacare to keep Obamacare, but cut out the details that make the ACA work, such as the individual mandate and the low-income subsidies. Allow red states that don't want Obamacare to ditch it and give the insurance companies and corporate health care providers everything they want, which will look a lot like the system that was in place during the Bush43 administration with some popular Obamacare provisions tacked on. And then see which one works best.
And I think this will prove that neither of these options work very good. After 3-4 years of Cassidy-Collins, Americans will be begging for a single-payer system. Begging for it.
Allow blue states that want Obamacare to keep Obamacare, but cut out the details that make the ACA work, such as the individual mandate and the low-income subsidies. Allow red states that don't want Obamacare to ditch it and give the insurance companies and corporate health care providers everything they want, which will look a lot like the system that was in place during the Bush43 administration with some popular Obamacare provisions tacked on. And then see which one works best.
And I think this will prove that neither of these options work very good. After 3-4 years of Cassidy-Collins, Americans will be begging for a single-payer system. Begging for it.
2
I agree. Maybe we should just let it happen. Single payer is the direction we need to go in, anyway.
The real motive driving the Republican proposals is not some lofty theory as Ross postulates-- it's greed. The pockets of lawmakers are lined with sumptuous "campaign contributions" from Big Pharm and Big Health which derive ridiculous profits from the "market driven" system. It would not take socialization of health care to solve this. Those of us fortunate enough to have a decent health insurance plan-- such as those available to government employees-- get excellent coverage for a rather moderate premium. Something like this could be opened to anyone desiring it-- providing universal access-- without forcing the issue on anyone. (Pre-existing conditions are covered for the feds.) In terms of the medically indigent, some form of support would be needed. But it is unconscionable that anyone should lack health care access in our nation.
2
Part of the ACA is a health insurance plan, part is a health care plan. What Ross and most conservatives look at is only the insurance side. Ross, M.Friedman acolites, and most conservatives need to stick with what they know. This topic is not one of them.
As one who has dealt with health insurance and care issues at every level, there simply is no private insurance plan that provides good care without an overriding single payer, government based system. The "market" is not for everything. We cannot have private roads or defense or any number of government functions run solely on the basis of free enterprise, even with strict regulation.
State run systems leave people to the mercy of red states where people will suffer w/ substandard care either provided by the state or allowed by the state. Sick people will move across state lines to get affordable care in blue state, swamping the system. If you don't think it can happen, it already does. Who would not move to get treatment for their child w/ cancer?
What on earth is the definition of "catastrophic" that is to be covered. For most a catastrophe is not being able to afford the meds for your child's asthma.
Lastly, Dr. Price nominated for HHS gave the most cynical and dishonest testimony I have ever heard from a physician. This self serving man should be nowhere near the levers of policy. Not even counting his unethical stock trades.
As one who has dealt with health insurance and care issues at every level, there simply is no private insurance plan that provides good care without an overriding single payer, government based system. The "market" is not for everything. We cannot have private roads or defense or any number of government functions run solely on the basis of free enterprise, even with strict regulation.
State run systems leave people to the mercy of red states where people will suffer w/ substandard care either provided by the state or allowed by the state. Sick people will move across state lines to get affordable care in blue state, swamping the system. If you don't think it can happen, it already does. Who would not move to get treatment for their child w/ cancer?
What on earth is the definition of "catastrophic" that is to be covered. For most a catastrophe is not being able to afford the meds for your child's asthma.
Lastly, Dr. Price nominated for HHS gave the most cynical and dishonest testimony I have ever heard from a physician. This self serving man should be nowhere near the levers of policy. Not even counting his unethical stock trades.
3
Perhaps if members of congress had to live wit the same health plan as the rest of us, they would come up with a good one. Instead they reserves the best for themselves, while we pay for it.
1
An interesting approach. Sounds a lot like Medicare (Part A is major medical/hospitalization and is FREE. Part B is public/private and carries premiums. Part D is optional and also has premiums with it. Lots of choice. Hmmm ... Sounds a lot like Medicare for all! Maybe that's the answer. The irony of it all is that most private healthcare plans carry a $1,000 deductible per person. It's been reported that 70% of American families cannot put together $1,000 cash on short notice. Two characteristics of insurance which make it work. (1) You never insure the first dollar. (2) healthy people have to pay premiums that they will never need in order to cover the costs incurred by the sick. Unless you take out the profit motive, insurance companies will always "take their cut" of those premiums as profit for stockholders. Making such a system work requires 100% buy-in. We need health insurance far less than we need access to affordable healthcare. We need continued medical research which cannot be funded without continued government subsidies.
As someone who actually cares for patients, I am completely behind a single payor, Medicare for all type system. My staff would not spend hours on the phone determining who needs a prior authorization and when, the pharmacy wouldn't be calling us every January to tell us about all the patients who need med changes because the insurance has changed formulary (again), wasting time on the phone if a diagnosis or billing code isn't exactly right so taht an insurer will pay for a patient's care, etc etc etc. We could instead focus on caring for patients. Healthcare is a "product" that we will all eventually need and so, it is an illusion that there is a choice to participate in a healthcare "market." I wish we could just "get on with it" so to speak, and join the rest of the developed world in caring for its citizens health needs equally. Humans have inherent worth just by being, and they deserve at least basic healthcare.
3
Ross, thanks for a well-written article free from most of the dogma that surrounds this topic. I'm not a fan of federalism as a solution to all problems, but it may be the only viable political path forward.
"...if the right is wrong, if its model doesn’t match reality, if people are simply miserable as health care consumers...both the country and conservatism will be better off if we learn that via a voter rebellion in 10 right-leaning states, rather than through a much more widespread backlash against a nationwide health-insurance failure."
Of course! Forget the good of the people. Any healthcare system must be voter proof. Something that won't rankle red states or the tea bag folk and run the GOP out of office.
Douthat claims without evidence {the new way of things in the GOP alt facts world] that markets in healthcare can do more to lower costs and prices than liberals allow.
Sure, like the GOP not allowing Medicare to bargain drug prices, making costs twice that of systems who do bargain. That kind of free market stuff?
Douthat thinks free-market competition produces more medical innovation than socialized systems. But we don't need innovation; we need health care. Leave it to the publicly funded. university-subsidized research companies to innovate devices and drugs. The medical community shares freely innovative techniques and practices throughout the world.
The GOP hates universal healthcare, wants it to remain a profit-making business reaping from people's misery profits for expensive CEO's and lobbyists for insurance and drug companies. The GOP cares nothing for the health or job freedom of the people, despite whatever silly moniker it sticks on to its proposal.
Of course! Forget the good of the people. Any healthcare system must be voter proof. Something that won't rankle red states or the tea bag folk and run the GOP out of office.
Douthat claims without evidence {the new way of things in the GOP alt facts world] that markets in healthcare can do more to lower costs and prices than liberals allow.
Sure, like the GOP not allowing Medicare to bargain drug prices, making costs twice that of systems who do bargain. That kind of free market stuff?
Douthat thinks free-market competition produces more medical innovation than socialized systems. But we don't need innovation; we need health care. Leave it to the publicly funded. university-subsidized research companies to innovate devices and drugs. The medical community shares freely innovative techniques and practices throughout the world.
The GOP hates universal healthcare, wants it to remain a profit-making business reaping from people's misery profits for expensive CEO's and lobbyists for insurance and drug companies. The GOP cares nothing for the health or job freedom of the people, despite whatever silly moniker it sticks on to its proposal.
3
You obviously have no direct experience with situations where you, or a loved one, faces a critical health problem and is unable to purchase coverage at any cost; or if coverage is available the "free market" cost is so outrageous that even a NY Times columnist cannot afford it. There is no free market where health care is concerned. Physicians, hospitals, big-pharma and insurance companies are cooperating monopolies with authority to price goods and services for maximum profit. The consumer must pay as much as can be scrounged together or watch a loved one suffer without help. Meanwhile the med-pharm-insurance cabal smiles all the way to the bank. A suggestion: Get a real job, one without health insurance coverage, develop a chronic disease and pay your own way in the "free market" and then let us know how that works for you.
4
The media has been complicit in the excoriation of a workable national healthcare system by permitting it to be called Obamacare rather than The Affordable Care Act.
1
When will conservatives learn that the Invisible Hand is a golden idol that demands as a sacrifice the blood of the poor and the sick.
3
I hope that the hospitals are considered and are released from the unfunded mandate. Mr. Douhat does not mention the effect of any Republican plans
on hospitals. Our hospitals, no matter how they are structured, are forced to accept all patients without any reimbursement provided. This threatens their very existence.
on hospitals. Our hospitals, no matter how they are structured, are forced to accept all patients without any reimbursement provided. This threatens their very existence.
1
No one should have insurance through their place of employment even if the work for the federal or state government. Pull yourself up by your bootstraps! Do what the self employed have to do. Buy insurance on the free market. You would have the masses screaming on top of their lungs for our government to do something. The free market cost to us for a half way decent policy ? Well for a couple in my state a few years back when we were in our mid fifties was $1800- a month! Go ahead let freedom ring and see what happens! Change would come about very quickly indeed.
Any discussion on healthcare access or coverage needs to recognize cost has become too high for most middle class family. Catastrophic coverage deductible often is more than ten thousands, very few middle class families can afford that.
Conservatives like skin in the game, which basically means people not seeking treatment until problems become much more serious, or catastrophic. "Lower healthcare cost" essentially come from self deprived care.
Moreover, what was healthcare market like before ACA? Besides Medicare and Medicaid, IT WAS FREE MARKET! The cost of both healthcare and insurance coverage kept going up with bigger deductible and less benefits, with frequent stories of people with insurance being denied coverage, and pre-existing conditions precluding coverage all together. We seem to forgotten all that.
"Cost" has to be paid, somehow, unless as a society we feel comfortable in letting sick people who cannot afford care die or suffer in perpetuity.
We need to question why cost is so high in this richest country of the world.
Why for profit hospitals, medical device companies, pharmaceutical companies and insurance companies reap all that profit. We need to question why we have money for billion dollar war plane but no money to take care of our families, friends, neighbors, co-workers, or fellow human beings. Since conservatives love capitalism and market place, then should we not ask what is our greatest capitalist resources and assets, but our citizenry?
Conservatives like skin in the game, which basically means people not seeking treatment until problems become much more serious, or catastrophic. "Lower healthcare cost" essentially come from self deprived care.
Moreover, what was healthcare market like before ACA? Besides Medicare and Medicaid, IT WAS FREE MARKET! The cost of both healthcare and insurance coverage kept going up with bigger deductible and less benefits, with frequent stories of people with insurance being denied coverage, and pre-existing conditions precluding coverage all together. We seem to forgotten all that.
"Cost" has to be paid, somehow, unless as a society we feel comfortable in letting sick people who cannot afford care die or suffer in perpetuity.
We need to question why cost is so high in this richest country of the world.
Why for profit hospitals, medical device companies, pharmaceutical companies and insurance companies reap all that profit. We need to question why we have money for billion dollar war plane but no money to take care of our families, friends, neighbors, co-workers, or fellow human beings. Since conservatives love capitalism and market place, then should we not ask what is our greatest capitalist resources and assets, but our citizenry?
1
We can all quibble about the details of various coverage scenarios, but as long as the insurance industry and big pharma lobbyists are in Washington or state capitals, we will not get a solution that really gives most of us what we need. They care about their shareholders and quarterly profits. Even nonprofits have for-profit subsidiaries and care more about their profits than us.
3
If if I were to get cancer I wouldn't give a fig about free choice markets! I know people who depend on the ACA and they don't care either.
5
Republicans have had 7 years to come up with a replacement plan. What makes you think they can realistically all of a sudden come up with a plan that insures as many people, provides the same or higher level of care at the same or lower cost. If it doesn't do the latter then it is simply a repeal & cut plan.
5
I would think healthcare would start to be viewed the same way we look at utilities. They have a monopoly to deliver electricity. Society then regulates that monopoly by reviewing their price structure. They are allowed to make a reasonable profit.
Can this model not be considered for healthcare? That seems to be the medicare approach.
Can this model not be considered for healthcare? That seems to be the medicare approach.
2
There
s compelling evidence that markets work in HC? More like there's compelling evidence that market failure has been the hallmark of efforts to use market-dominant approaches in health care. Indeed, the conditions that give rise to market failure are found in abundance in HC.
Collins-Cassidy is the best idea, by far, yet offered up by anyone in the GOP, but will fail to cover all adequately, and would leave us a nation where HC haves and have nots are determined in part by the states they reside in.
s compelling evidence that markets work in HC? More like there's compelling evidence that market failure has been the hallmark of efforts to use market-dominant approaches in health care. Indeed, the conditions that give rise to market failure are found in abundance in HC.
Collins-Cassidy is the best idea, by far, yet offered up by anyone in the GOP, but will fail to cover all adequately, and would leave us a nation where HC haves and have nots are determined in part by the states they reside in.
6
I think liberals would be the first to admit that one reason the ACA is such a hash is that it tried to build on the existing system. Conservatives are now in the same position of having to build on the currently existing system—the “preexisting condition” of all legislative reforms. The impulse behind their plan seems to be to let red and blue states proceed as each sees fit until broader, nationwide agreement develops.
2
Actually, the reason the ACA is a hash was the need to compromise with recalcitrant Republicans. We need a single payer "option" -- a national plan that ensures everyone can get coverage, with the option to buy your own plan if you want "in the market". That would make the insurers work a little harder to design better plans, that aren't so full of gotchas, that cost less.
1
There is nothing "conservative" about our current delivery model. I'm all for competition and markets when it creates efficiency. But why do we think that most health care decisions are shopped?
What if we delivered police protection and criminal just the same way? Instead of taxes that covered everyone, we'd each need to buy police protection plans. You get assaulted and robbed while on vacation in Montana? Can you find a police force that's in your protection network? Or a private court that will recover your goods and punish the perpetrator?
We tried offering fire protection the same way in colonial times, and those whose buildings didn't have a medallion showing they paid would just be let to burn. At some point, as a society, we found this unacceptable, and fire protection became "socialist".
The best documentation I've seen on why our system is broken is this one: http://fixithealthcare.com/watch-the-movie
What if we delivered police protection and criminal just the same way? Instead of taxes that covered everyone, we'd each need to buy police protection plans. You get assaulted and robbed while on vacation in Montana? Can you find a police force that's in your protection network? Or a private court that will recover your goods and punish the perpetrator?
We tried offering fire protection the same way in colonial times, and those whose buildings didn't have a medallion showing they paid would just be let to burn. At some point, as a society, we found this unacceptable, and fire protection became "socialist".
The best documentation I've seen on why our system is broken is this one: http://fixithealthcare.com/watch-the-movie
6
Come on how ignorant can you be. If free market system of care worked and implemented many people would be making lots of money and the health care would be of great quality. We would not be having theses stupid conversations it does not and will never work. That is why most industrialized countries have a healthcare system that require some government intervention. please when you link to an article make sure 1 it is not an opinion piece 2 and the "compelling evidence" is for an elective more cosmetic procedure. When your life matters it is time to go shopping is a free market approach. A scientist you are not.
1
People can't afford for-profit health care any more than they can afford an NBA team. The entire notion is absurd. The AMA has been fighting cost controls for the last 100 years.
The GOP idea is for people to pay $5000 or $10,000 of routine health costs and then buy insurance for catastrophic coverage.
That's all Donald promised: Insurance for everybody.
The GOP idea is for people to pay $5000 or $10,000 of routine health costs and then buy insurance for catastrophic coverage.
That's all Donald promised: Insurance for everybody.
3
Obamacare should stay in the states that voted democrat and the repealed or replaced version of "free Market" in those states that voted red or loved free markets then those people will know what the forces or free market can do for them which is not necessarily lower their premiums or bringing more participants into the market.
I think it is a fair to do so.
Then those "reds states" realize their error and the fact that those manufacturing jobs are not coming then they will realize their mistake and pay of it.
We all do not have to pay for the elections of an uneducated minority.
I think it is a fair to do so.
Then those "reds states" realize their error and the fact that those manufacturing jobs are not coming then they will realize their mistake and pay of it.
We all do not have to pay for the elections of an uneducated minority.
1
Normally I would agree with you Ross, but in this case there is no wisdom of tradition and no wisdom of markets as we've had chronically millions of uninsured and the most expensive health care system with poorer results than other industrialized countries. Never mind that Obamacare and Romneycare in Mass. were conservative ideas.
Since you believe in free markets why haven't they solved that problem for so long?
Since you believe in free markets why haven't they solved that problem for so long?
4
Why do conservatives ignore the market driven health care system the U.S. had before the Affordable Care Act? Much higher costs, much worse outcomes and double digit inflation for health care. Conservatives hate the ACA because it taxes the rich, period. They could care less about most Americans.
4
The conservative objection to Obamacare is that it wasn't called Romneycare. Plain and simple, it was a conservative plan - implemented by a Democrat, and thus they feared its success and seek it's abolition because they would get no political credit for it.
Yes - it costs more for business and the well off. Insurance providers dropped out for a variety of reasons - and the jury is out (even as written in these pages) on whether those dropping out did so for fiscal or other reasons - like failure to approve a desired merger.
The American health care issue is an interesting dual of the issue of women's choice. At the end of the day, you either agree or object on its morality, or the cost of the care. In this case, liberals take the opposite views the conservatives have on choice. They see health care as a key moral issue - and health care cost secondary.
And you can suggest that free market competition will make health care available to all, but at the end of the day, the indigent can't afford even a cheap plan and if you're going to take care of all Americans, someone has to pony up the dough.
The morality point here that we can argue for the next six generation is that some of us think entrepreneurial profiteering on health care is both a boon - in generating new solutions to terrible health problems - and a bust - the sick needing to make wealthy the people who cure the awful diseases none of them chose to contract.
Yes - it costs more for business and the well off. Insurance providers dropped out for a variety of reasons - and the jury is out (even as written in these pages) on whether those dropping out did so for fiscal or other reasons - like failure to approve a desired merger.
The American health care issue is an interesting dual of the issue of women's choice. At the end of the day, you either agree or object on its morality, or the cost of the care. In this case, liberals take the opposite views the conservatives have on choice. They see health care as a key moral issue - and health care cost secondary.
And you can suggest that free market competition will make health care available to all, but at the end of the day, the indigent can't afford even a cheap plan and if you're going to take care of all Americans, someone has to pony up the dough.
The morality point here that we can argue for the next six generation is that some of us think entrepreneurial profiteering on health care is both a boon - in generating new solutions to terrible health problems - and a bust - the sick needing to make wealthy the people who cure the awful diseases none of them chose to contract.
The Cassidy-Collins proposal will never be passed, for two main reasons: (1) The GOP cannot stomach the idea of any Obama-era programs remaining in place and they want to dismantle the ACA throughout every square mile of the U.S. (2) They are very worried that if some states were allowed to keep the ACA, their health statistics would look better than those in states which turn away from the ACA. Actually, those statistics are already available. Look at increasing maternal mortality in Texas (which rejected Medicaid expansion) compared to falling maternal mortality in states which embraced the ACA.
Of course, the GOP can always suppress data, which is already starting to happen as government agencies are being ordered to quit releasing facts to the public. We can already expect that under the GOP, all facts produced by the government will be alternative facts. "Mortality rates are dropping. Terrifically!" "Everyone has health care. Beautiful!"
Of course, the GOP can always suppress data, which is already starting to happen as government agencies are being ordered to quit releasing facts to the public. We can already expect that under the GOP, all facts produced by the government will be alternative facts. "Mortality rates are dropping. Terrifically!" "Everyone has health care. Beautiful!"
3
OK, Ross, and I assume you'll be the first to sign up for one of these Republican health care plans.
Or, maybe Ross, you and the rest of those who refuse to see see your fellow citizens as ... well, fellow citizens will eventually come to open your heart and realize that those fellow citizens should be guaranteed the same quality of coverage as you know enjoy.
Oh no, wait, it's much more important that you be able to afford that second Mercedes or that trip to Aruba of another din-din at Jean Georges.
Your greed and selfishness, in the most over-indulged country this planet has ever experienced, appalls me.
Or, maybe Ross, you and the rest of those who refuse to see see your fellow citizens as ... well, fellow citizens will eventually come to open your heart and realize that those fellow citizens should be guaranteed the same quality of coverage as you know enjoy.
Oh no, wait, it's much more important that you be able to afford that second Mercedes or that trip to Aruba of another din-din at Jean Georges.
Your greed and selfishness, in the most over-indulged country this planet has ever experienced, appalls me.
3
How do you write an entire column on health care policy without reference to people's actual health? It's all about dollars and systems and ideology. Please acknowledge unnecessary human illness and death under these cold ideological experiments.
2
It's just getting more and more complicated to get health care in America. It would be more reasonable to keep Obamacare while slowly expanding Medicare to cover everyone. We've had socialized medicine for a long time (Medicare, for the Republicans who just fainted). Stop fighting, forget party politics and look after the people you work for. The US should be ashamed that it is the only advanced country without universal medical care.
3
Mr. Douthat: I am not surprised that the Cassidy-Collins approach has little support. Why would the Republican radicals support anything that has the possibility (in my opinion, the likelihood) of demonstrating that their approach is less effective than the ACA?
I also am not surprised by the popularity of the "repeal and delay" strategy. This strategy allows Republicans to: (1) fulfill the promise to their base of "repeal," (2) while not immediately depriving maybe 20 million people of coverage, and (3) destabilizing the private insurance market, thus likely exacerbating the problems of the ACA (cost for those without subsidies, high deductibles, changing networks, lack of competition), and, finally (4) allowing the Republicans to say, "See, we told you Obamacare was a disaster that would implode."
I also am not surprised by the popularity of the "repeal and delay" strategy. This strategy allows Republicans to: (1) fulfill the promise to their base of "repeal," (2) while not immediately depriving maybe 20 million people of coverage, and (3) destabilizing the private insurance market, thus likely exacerbating the problems of the ACA (cost for those without subsidies, high deductibles, changing networks, lack of competition), and, finally (4) allowing the Republicans to say, "See, we told you Obamacare was a disaster that would implode."
2
The "market" does not belong in health care. We should not subject our health and our very lives to a profit motive. Period.
Mr. Douhat's opinion is worthless. All his caveats after explaining why the Republicans, even though that is not his intent, cannot show their plans as acceptable anywhere in the world. Yet here we are still debating our horrendous health care system.
It was know, and should have been communicated, that once all that pent up need for health care was allowed to get covered, there would be a "death spiral" and premium increases very soon after the system went into effect.
This plan outlined would have even more of a death spiral if only certain states continued with the exchanges. It's a poison pill by the Republicans floated to see if the Democrats are stupid enough to swallow it. By the way, they probably are.
The "inefficient" government can run a plan at 3% for administraive costs. The private market requires 15 (need funds for shareholder profit and executive pay) yet the private market promises to save money. The only way to save money, while increasing administrative costs is to deny claims and stop those who will need the coverage the most from getting coverage. This has always been true and it will continue to be true. Don't buy into the lie that private insurance will be more effective. If each aspect of the system has a profit motive built in, they the cost will ALWAYS by much higher for private plans that public ones.
Mr. Douhat's opinion is worthless. All his caveats after explaining why the Republicans, even though that is not his intent, cannot show their plans as acceptable anywhere in the world. Yet here we are still debating our horrendous health care system.
It was know, and should have been communicated, that once all that pent up need for health care was allowed to get covered, there would be a "death spiral" and premium increases very soon after the system went into effect.
This plan outlined would have even more of a death spiral if only certain states continued with the exchanges. It's a poison pill by the Republicans floated to see if the Democrats are stupid enough to swallow it. By the way, they probably are.
The "inefficient" government can run a plan at 3% for administraive costs. The private market requires 15 (need funds for shareholder profit and executive pay) yet the private market promises to save money. The only way to save money, while increasing administrative costs is to deny claims and stop those who will need the coverage the most from getting coverage. This has always been true and it will continue to be true. Don't buy into the lie that private insurance will be more effective. If each aspect of the system has a profit motive built in, they the cost will ALWAYS by much higher for private plans that public ones.
3
I like this idea since it will shine a greater light on the problem of healthcare in general and also make clear the differences. It would be wise to point out however that some experimenting is already in place by states that have/have not expanded Medicare. Like states that recklessly cut taxes (KS, OK) the results of these "experiments" are already coming back. They are not good.
It appears that Mr. Douthat is more concerned with free market principles than in whether people receive health care. Thus, he views other countries' health care systems through the prism of how they compare with his conservative principles - not on their effectiveness. How many people receive health care? What is the quality of the health care? What is the cost - to the individuals utilizing the services and to the country? Rather than asking questions like this, Douthat starts at the other end - how do these systems measure up in terms of free markets/competition? This is a major problem with conservatives - they are unable to pragmatically consider how best to approach a problem since they start out with the answer in hand. So actual people are hardly even considered.
1
Ross, your intelligent discussion here is going nowhere. Trump, Price, and Bannon are intent on teaching that black boy ( excuse my language but the point has to be made ) a lesson he will never forget. If Republicans do come up with a decent replacement, that means Barack Obama still gets credit for pushing the country into a direction that reformed health care. Trumpists will not stand for it!
In my anxiety over losing ACA, I have read other alternatives that are generally conservative that I could support. But in this atmosphere none of them have a chance. Republicans should listen to you and consider these other proposals. But they will not do it. Anger and revenge will rule the day. As a result we will have single payer health insurance in apprroximately 10 to 16 years.
In my anxiety over losing ACA, I have read other alternatives that are generally conservative that I could support. But in this atmosphere none of them have a chance. Republicans should listen to you and consider these other proposals. But they will not do it. Anger and revenge will rule the day. As a result we will have single payer health insurance in apprroximately 10 to 16 years.
1
Why do solutions that involve the state scare the pants off conservatives so much? It is because our national govt. has the power to tax and because, in the post WWII world, that power expanded to include massive expenditures for all but endless programs to benefit people other than the rich. It is the power of taxation that the right hates. So, hey, let's bend ourselves into pretzel shapes trying to keep health coverage for Americans, in some form, and still fight taxation.
This is one of the true legacies of the Obama years: the fixed idea that everyone in America should have access to health care and not just when they are about to die and are rushed to an ER. You can pound Obamacare into a million tiny pieces but this idea will not go away. It's out there, sports fans.
It might be possible to craft a health care system that doesn't involve massive federal intervention. (Go ahead, try it.) The problem for the right generally is that this is not a concern of theirs. A corrupt, under the table way of paying for health care existed and it was billions of dollars shipped to hospitals for treating the indigent and they were just fine with that. Why? It was under the table. They didn't have to admit they were violating "principles".
At base, they don't care if millions go without health care as long as the "tax threat" is not over their heads. Now, they are caught in a dilemma of their own making because they refused to address the issue earlier or cut a deal with Obama.
2
Ah Ross you buried the lede. The peril is indeed "that there would be too wide a gap between what the money in your health savings account covers and what you need before your catastrophic coverage kicks in." MOST people with health problems need ( good ) chronic care and this will only increase as the population ages.
I am reminded of the past movement of chronically mentally ill people out of the horrible large institutions they were kept in. Promises to "save money" by having the money from the institutions go to local communities never materialized. The knowledge of good care represented by the experienced professionals was dispersed, the mentally ill moved on the the streets and now our prisons are our largest mental health facilities.
The reader is referred to books and articles by Atul Gawande most recently "Tell Me Where It Hurts" in the Jan 23 New Yorker which explains much more eloquently than I could why current plans are a poor way to make America healthy again.
I am reminded of the past movement of chronically mentally ill people out of the horrible large institutions they were kept in. Promises to "save money" by having the money from the institutions go to local communities never materialized. The knowledge of good care represented by the experienced professionals was dispersed, the mentally ill moved on the the streets and now our prisons are our largest mental health facilities.
The reader is referred to books and articles by Atul Gawande most recently "Tell Me Where It Hurts" in the Jan 23 New Yorker which explains much more eloquently than I could why current plans are a poor way to make America healthy again.
This column starts with an oxymoron in its first two words- "Modern conservatism". There is nothing "modern" nor innovative about today's conservatism. It is in fact oligarchy.
No one, not even the Congress and Senate whose golden healthcare is paid for by taxpayers, can argue that any proposal by conservatives would benefit the middle-class's health needs. The ACA is only the first step towards a goal of coverage for all. Now we take two steps back thanks to "modern conservatism".
No one, not even the Congress and Senate whose golden healthcare is paid for by taxpayers, can argue that any proposal by conservatives would benefit the middle-class's health needs. The ACA is only the first step towards a goal of coverage for all. Now we take two steps back thanks to "modern conservatism".
We should not forget that the Supreme Court (with Scalia) ruled that Obamacare is not authorized by the Commerce Clause. This abandonment of 80 years of Constitutional jurisprudence bodes ill for any federal effort to regulate health care that cannot be shoe-horned into Congress' taxing authority - even Republican proposals.
The obvious answer is Medicare for all with supplemental policies available for purchase by those who believe that Medicare is not to their liking. Of course, Republicans don't like this approach since Medicare is a Federal program that demonstrates the the Federal government programs can work to the benefit of Americans (where private insurance had failed for older and sicker Americans) and most importantly the extension of Medicare to all would require an increase in taxes.
There are 2 reasons why Republicans don't like the ACA: 1) it has a provision in it that taxes the wealthy to help fund the Act, and making that disappear is the real reason behind the Repeal Obamacare diatribe; and 2) it came from Obama, and Republicans believe that it breeds Democrats.
There are much better options to replace the ACA than this hybrid, competitive approach. The first is a single-payer system, which is far more cost-efficient than a market structure, and would provide a much more comprehensive set of coverages across the country. And, second, it is no secret that the ACA has some issues which need fixing. So, fix them in place. Keep the ACA as is, but work together to fix the problems without killing the Act, which would be catastrophically disruptive. Maybe that could even include a reduction in the taxes on the high end. It shouldn't, but it could.
In fact, rename the ACA. Change the branding. Call it something completely different so that Republican voters can be fooled into thinking it was repealed AND replaced. Call it "The Healthcare Efficiency Recovery Opportunity Act". The HERO Act. Sure, it's just word salad, but the right would love that and would never know that it was actually the ACA under the covers. Everyone would be happy, including the insurance lobby.
But there should not be any way that 28 million people would be tossed off their insurance plans, just to cut taxes for the wealthy. That's plain... unAmerican.
There are much better options to replace the ACA than this hybrid, competitive approach. The first is a single-payer system, which is far more cost-efficient than a market structure, and would provide a much more comprehensive set of coverages across the country. And, second, it is no secret that the ACA has some issues which need fixing. So, fix them in place. Keep the ACA as is, but work together to fix the problems without killing the Act, which would be catastrophically disruptive. Maybe that could even include a reduction in the taxes on the high end. It shouldn't, but it could.
In fact, rename the ACA. Change the branding. Call it something completely different so that Republican voters can be fooled into thinking it was repealed AND replaced. Call it "The Healthcare Efficiency Recovery Opportunity Act". The HERO Act. Sure, it's just word salad, but the right would love that and would never know that it was actually the ACA under the covers. Everyone would be happy, including the insurance lobby.
But there should not be any way that 28 million people would be tossed off their insurance plans, just to cut taxes for the wealthy. That's plain... unAmerican.
1
Why should the people in this country be subjected to drastically different health care regimes depending on what state they live in? Few people can jump up and leave state A because state B has better healthcare. And how many people can predict their health care needs, and make informed decisions in selectively choosing between treatments, or rejecting the advice of a medical professional because their healthcare savings account balance is running low.
The notion that people trapped in a miserable state, in terms of healthcare coverage, can simply correct the problem in the voting booth is putting lipstick on a skeleton. I think what most people want is a care system that they can turn to when they or a family member need medical care, and can get it without devastating economic consequences, aka universal health care.
To me universal health care should be viewed as a necessity whether you live in a blue state or a red state. If conservatives don't want everyone to have affordable health care, just come out an say it. No need to reach back to antiquity to find a rationale.
The notion that people trapped in a miserable state, in terms of healthcare coverage, can simply correct the problem in the voting booth is putting lipstick on a skeleton. I think what most people want is a care system that they can turn to when they or a family member need medical care, and can get it without devastating economic consequences, aka universal health care.
To me universal health care should be viewed as a necessity whether you live in a blue state or a red state. If conservatives don't want everyone to have affordable health care, just come out an say it. No need to reach back to antiquity to find a rationale.
1
Q: Why is it so difficult for Ross Douthat and other so-called conservatives to understand how the delivery and management of health care is completely different from buying laundry detergent?
3
If the "market" will produce better health care, why have things gotten better under the ACA. friedman was way overboard on his love for the free market. We are heading for dangerous times with right wing nuts actually running the country.
1
I agree with many other commentators that the conservative healthcare proposals likely won't work. They will benefit corporations, not patients. They will leave more people without coverage, increase out of pocket costs for patients, and will increase the overall cost of healthcare (not decrease it). They are also likely to be very unpopular, less popular than the ACA. But the GOP has promised to repeal and replace the ACA, which puts them in quite a bind.
So at least the Cassidy-Collins compromise would limit the damage. It would also allow for comparisons between states, and the harm when the conservative plans fail would fall on Republican-controlled states where the voters (presumably) asked for this. I hope there will be more discussion of this plan over the weeks and months ahead.
So at least the Cassidy-Collins compromise would limit the damage. It would also allow for comparisons between states, and the harm when the conservative plans fail would fall on Republican-controlled states where the voters (presumably) asked for this. I hope there will be more discussion of this plan over the weeks and months ahead.
Why not start the reform of healthcare by mandating that ALL healthcare providers are required to post a price list for services? No more secret deals between insurers and providers. Everybody pays the same price.
OK, Obamacare has flaws. Some of these flaws could be fixed. Some require tighter regulation of insurance companies and hospitals (who currently resemble the Mafia in many ways).
But meanwhile the country and the legislature are spending countless hours and millions of dollars debating a system that health policy analysts say is as good as it gets, without extending Medicare. The vast majority of Americans would be thrilled to get Medicare but the insurance lobby is holding us back.
So we're spinning wheels, spending time and energy, on an exercise to stroke the ego of the new president, who won with the help of the Russians and who's probably got mental health issues of his own. We're also pleasing the conservatives who want to reduce the role of government in everything but women's reproductive rights and the private, intimate relationships between individual couples.
We're back to a medieval model of thought and governance.
But meanwhile the country and the legislature are spending countless hours and millions of dollars debating a system that health policy analysts say is as good as it gets, without extending Medicare. The vast majority of Americans would be thrilled to get Medicare but the insurance lobby is holding us back.
So we're spinning wheels, spending time and energy, on an exercise to stroke the ego of the new president, who won with the help of the Russians and who's probably got mental health issues of his own. We're also pleasing the conservatives who want to reduce the role of government in everything but women's reproductive rights and the private, intimate relationships between individual couples.
We're back to a medieval model of thought and governance.
1
i'm struck by how focused on ideology and economic this is - where's the effect on the millions of people subjected to experimentation in order to prove or disprove an ideological point?
1
Ross Douthat's column presupposes that: a) Republicans sincerely want to deliver affordable healthcare, and b) they're capable of objectively evaluating alternative methods of doing so. So far I have yet to see evidence of either.
1
As long as your surveying health care models, Mr. Douthat, how about mentioning the ones world-wide that are working optimally?
1
For what should be the last time, Obamacare IS the conservative option. Yet the blind partisans in Congress and their apologists, such as Mr. Douthat, can't acknowledge that because it would be acknowledging that government can actually help people.
People are going to die because of Trump and Ryan. Die, as in dead.
People are going to die because of Trump and Ryan. Die, as in dead.
Conservatives love to blather on about the free market when it fits their agenda, but the minute free market forces negatively impact Republican proposals/priorities it's suddenly the fault of Democratic policymakers. How can a homeless human being afford to put money into a health savings account for primary care? That model works for folks w/ money. How does universal, catastrophic healthcare coverage address the healthcare needs of patients w/ chronic diseases like diabetes or hypertension? What a shame that our Representatives always think money first and patients second. They should go spend a night on the streets. It would impact their decisions profoundly.
1
Red states will do what they have always done - underserve and mistreat their poor (thought to be black) citizens until they leave for greener pastures (as they did in the 40 year great migration to find jobs and escape lynchings). Then these same red state politicians (think Newt here) will point to the failure of the "liberal states" in handling the problem they created and benefitted from (free labor for several hundred years). As to the "opt out" crowd from the so called "catastrophic plan" - do we deny them hospital access and let them die on the street when they show up sick or injured? After all, they wanted their liberty. Are we ready to give it to them?
What a nightly newscast we could have - millions of illegals being rounded up door to door and put on trains to who knows where, while the non mandate "liberty states" would have dead bodies piling up on the sidewalk because their citizens opted out of coverage, along wth a modern "trail of tears" of poor people leaving these same red states for blue states that will actually offer them medicaid insurance. Now there is a snappy visual that will enhance our moral leadership in the world.
Lets hope the President's proposed military parades and flyovers during championship games can all make up feel proud and patriotic, while we avert our eyes.
What a nightly newscast we could have - millions of illegals being rounded up door to door and put on trains to who knows where, while the non mandate "liberty states" would have dead bodies piling up on the sidewalk because their citizens opted out of coverage, along wth a modern "trail of tears" of poor people leaving these same red states for blue states that will actually offer them medicaid insurance. Now there is a snappy visual that will enhance our moral leadership in the world.
Lets hope the President's proposed military parades and flyovers during championship games can all make up feel proud and patriotic, while we avert our eyes.
2
So called "free market" economics should be nowhere near our healthcare system. As author points out, there is no industrialized country with a free-market conservative approach to healthcare. Time and time again, it is shown that Medicare is a very efficient system. The root problem with Obamacare is that it relies on the private sector insurance companies. We need a Medicare For All plan and I hope that Senators Sanders and Warren will speak up and fight for it!
2
Whether you are on the right or left, one thing that cannot be disputed is that Obamacare changed the debate on healthcare.
I have always wondered why conservatives and deficit hawks dis universal healthcare or "socialized medicine" because they seem to produce better outcomes and much less cost.
Another thing to consider: most of the countries that have universal healthcare are democracies. In other words, they could get rid of it any time they want. When was the last time there was a widespread call in any of those countries to do away with their healthcare system?
The opponents of universal healthcare in America are the obvious stakeholders like the health insurance companies, the pharmaceutical companies and the rest of the health industry that did very well before Obamacare and would like to see it repealed.
One constituency that is not talked about, but that I believe is very important: the wealthy. They don't care if the poor has inadequate healthcare or that healthcare here cost twice as much as it does in Canada. They, like the wealthy foreigners who come here for treatment can afford it. What they don't want is to have to stand in line like everybody else.
I have always wondered why conservatives and deficit hawks dis universal healthcare or "socialized medicine" because they seem to produce better outcomes and much less cost.
Another thing to consider: most of the countries that have universal healthcare are democracies. In other words, they could get rid of it any time they want. When was the last time there was a widespread call in any of those countries to do away with their healthcare system?
The opponents of universal healthcare in America are the obvious stakeholders like the health insurance companies, the pharmaceutical companies and the rest of the health industry that did very well before Obamacare and would like to see it repealed.
One constituency that is not talked about, but that I believe is very important: the wealthy. They don't care if the poor has inadequate healthcare or that healthcare here cost twice as much as it does in Canada. They, like the wealthy foreigners who come here for treatment can afford it. What they don't want is to have to stand in line like everybody else.
70
Actually, I think there are many wealthy liberals out there who have stood up for the ACA. I live in MA, and we passed RomneyCare (which ACA is modeled on) in 2006 -- it wasn't a vote along economic lines, and our health system in MA has worked well to ensure everyone. But you are probably right about the wealthy conservatives, who tend to vote their pocketbooks.
So, in a nutshell, conservatives are desperately looking for a system that works like Obamacare but not called Obamacare, just to satisfy their and their constituents vengeful natures.
2
"plus a directly funded health savings account to cover primary care." That's the rub, right there, and you speak to it below. With a minimum wage of $7, say, that's $14,000 per year. $10 is $20,000 and $15 is $30,000 - approximately. That health savings account isn't going to have much in it for everyone that falls into that group - and, really, even $40,000 for a family? No way. Health savings accounts are more a small tax savings for the well-to-do. Destroying what's just been built at a high cost to tax payers - before it had time to work and be improved to work better - is a colossal waste of everyone's money. And let's be honest, Obamacare is Romneycare in a slightly different shade. They're against it because Obama's name is on it.
2
Douthat argues that Obamacare is "failing less than imagined," or in others words, "Obamacare is a success, but perhaps not the runaway sensation that the most optimistic proponents hoped for." 22mnewly insured in less than 24 months is a monumental achievement by the standards of any government benefit program. You may be opposed to health care as a benefit to be provided no matter what, but that is not the argument. Even the Republicans have largely given up arguing that the poor, sick and needy should be left to rot in the gutter - the argument advanced by both Presidents Bush, most famously by GHW's mother who once said, "Why people would choose to be poor is beyond me."
1
The problem with using market driven solutions to cost issues in healthcare is that the objective decision based upon cost isn't applicable here. First making a comparison of price and quality is very difficult to do because of difficulty in getting good information. And there are so many other factors; many are emotional; so making decisions regarding healthcare is much more complex and often with little or no time to make such a decision.
People with chronic health issues present all kinds of problems to the rationality of such decisions. The only way of dealing wiht them is to get rid of them from the system which is why we have mandatory inclusion of all in the pool to be insured. THen you won't take them in ERs either. They mess up your nice rational system.
People with chronic health issues present all kinds of problems to the rationality of such decisions. The only way of dealing wiht them is to get rid of them from the system which is why we have mandatory inclusion of all in the pool to be insured. THen you won't take them in ERs either. They mess up your nice rational system.
I'm always surprised that columnists spend so much time and space talking about healthcare without, you know, talking about actual health and what it takes to get and keep people healthy, how chronic conditions and emergency conditions differ, why primary & preventative care might be a better investment than ongoing heroic end of life care, why we might want to invest in more palliative care --- why healthcare is different than most other expenditures and why market solutions, though they might have a place, are imperfect for the question of health.
1
This is the best idea I've heard from Congress for a few years. People seem to take ideological sides on this issue, but the fact is that nobody really knows what is the right answer quite yet. A federalist compromise would allow more experiments, which would produce more data, which could eventually push us all toward an optimal solution.
2
Contained within Mr. Douthat's brief analysis is the obvious reason the Republicans will never get on board with the Collins/Cassidy plan. They would allow states to keep the ACA as is if they want. The blue states would likely do so and the red states would not. It would become clear within a short time that there is no superior "replacement" that covers as many people at a similar cost. Since single payer isn't gonna' happen, the ACA is about as good as it gets!
1
"That system may not survive, and its condition has a lot to teach us about the problems with liberal health economics."
The ACA was NOT Liberal health economics. It was a 100% Conservative idea that was adopted in an effort to get Republican & insurance company support (and 1 out of 2 didn't cut it).
Liberal health economics is Medicare for all. We know it would work, because it works in every other Western nation on the planet. Even Cuba has a better health care system than the US, and their economy was wrecked by US sanctions.
If/when the US finally does test Medicare for all, THEN you can call it a success or failure of Liberal policy. Until then, the Conservatives own this mess.
The ACA was NOT Liberal health economics. It was a 100% Conservative idea that was adopted in an effort to get Republican & insurance company support (and 1 out of 2 didn't cut it).
Liberal health economics is Medicare for all. We know it would work, because it works in every other Western nation on the planet. Even Cuba has a better health care system than the US, and their economy was wrecked by US sanctions.
If/when the US finally does test Medicare for all, THEN you can call it a success or failure of Liberal policy. Until then, the Conservatives own this mess.
6
The `freedom’ to choose a health care plan the covers practically nothing is not exactly the answer to our challenge to look after the health of our people. Young healthy people buying plans that cover only catastrophic events does not get them to embrace preventive care, nor does it do anything to spread the costs through the total population to make the system more efficient and affordable for all our citizens. Republicans offer a series or mirages of coverage and affordability with their “free market” ideology which stubbornly they continue to insist will lower the cost of healthcare through “competition” the way that competition lowers the price of big screen televisions. That the health care sector does not, is not, and never has been, a sector of the economy which functions according to free market principles never deters these ideologues from trying it yet again. The result this time will be no different than going back to the employer based health care plans that were in place prior to the ACA. Millions of people not employed by large corporations will lose their health insurance. It’s all smoke and mirrors for these guys. Instead I encourage everyone to read the following, scholarly and well researched article which makes a business case for universal health care: http://digitalcommons.wcl.american.edu/cgi/viewcontent.cgi?article=1132&...
Look at this real answer to the problem instead of the phony repub stuff.
Look at this real answer to the problem instead of the phony repub stuff.
2
Cassidy-Collins scenario: many of the unhealthy and poor will move into trailers (if they don't live in them now) and move from state to state to gain a state's more appealing health coverage.
2
Gov. Kasich of Ohio was one of the first conservatives to pragmatically embrace Obamacare since it saved the state millions while supporting tens of thousands of healthcare jobs and shoring up clinics in less densely populated area.
Ironically, Kentucky also embraced Medicaid expansion under the name "Kinect" even though its best known Senator, Mitch McConnell was one of Obamacare's harshest critics. The red states like Georgia that opposed and resisted the healthcare expansion have seen hospitals and clinics in low populated counties fold while healthcare workers have gone unemployed.
It is hard to understand Republican ideology that defies logic in order to resist providing coverage to its most needy citizens.
Ironically, Kentucky also embraced Medicaid expansion under the name "Kinect" even though its best known Senator, Mitch McConnell was one of Obamacare's harshest critics. The red states like Georgia that opposed and resisted the healthcare expansion have seen hospitals and clinics in low populated counties fold while healthcare workers have gone unemployed.
It is hard to understand Republican ideology that defies logic in order to resist providing coverage to its most needy citizens.
3
Republican ideology is based on alternative facts so in that sense, it doesn't defy their logic.
If we say that our free market healthcare plan will be wonderful, it will be!
If we say that our free market healthcare plan will be wonderful, it will be!
2
Sounds like a plan to get Republicans re-elected first and then if someone actually wants a health plan that works it would be left up to luck. Typical behavior from a party that obsesses about getting elected but backtracks on actually running things well. Too much work and all the good ideas have been taken by the other party. Thanks for nothing.
2
The Cassidy-Collins comprise is a constructive step forward. The only thing I would add is the public option for those States that choose to retain the Affordable Care Act (ACA). This would provide a way to deal with those whose particular situation places them at a disadvantage with the many others who now benefit from the current ACA. This would provide an opportunity to fix what may need fixing with respect to the current ACA and not perpetuate some of its flaws. Perhaps in time, those States who did not elect to choose the ACA may decide to do so, based on the experience of other States that selected the resultant "improved" ACA. The option to change certainly should be available to all States.
13
As a retired physician, I have been watching health care policy evolve for nearly 50 years. Trying for universal access has been a long, hard slog. I am not an expert in health care systems, but neither are you or most of the people commenting here.
The decent people trotted out by partisans complaining of the harms or touting the benefits of the ACA magnify the problems of too much focus on personal testimonial in setting national health care policy.
Mr. Douthat, a "yuge" problem is so much focus on the promise to "repeal." That focuses too much on negative testimonial. It ignores benefits of the ACA. Trying to move away from slogans is difficult. I watched Senators Collins and Cassidy comment on their proposal. They know it is just a starting point, but it could lead to compromise that ultimately amends the ACA in sorely needed ways.
I wish so much emphasis was not heaped on the back of slogans, on engineered testimonials using citizens to push unilateral agendas. It is not likely to stop. But there is reason to hope the idea of "repeal" can be gradually replaced by notions of incremental system improvements. It will not--as we all know--be a smooth ride.
The decent people trotted out by partisans complaining of the harms or touting the benefits of the ACA magnify the problems of too much focus on personal testimonial in setting national health care policy.
Mr. Douthat, a "yuge" problem is so much focus on the promise to "repeal." That focuses too much on negative testimonial. It ignores benefits of the ACA. Trying to move away from slogans is difficult. I watched Senators Collins and Cassidy comment on their proposal. They know it is just a starting point, but it could lead to compromise that ultimately amends the ACA in sorely needed ways.
I wish so much emphasis was not heaped on the back of slogans, on engineered testimonials using citizens to push unilateral agendas. It is not likely to stop. But there is reason to hope the idea of "repeal" can be gradually replaced by notions of incremental system improvements. It will not--as we all know--be a smooth ride.
26
You make a couple of interesting points, but what you don't tell us -- and that's the most important piece, I think -- is what you think is wrong with ACA.
What would you do to the current law to perfect it?
What would you do to the current law to perfect it?
Melissa,
There are plenty of independent analysts that do a better job than what we see on these boards. The notion that solutions arise here is unrealistic. Deductibles are too high, regulations are too onerous, overall participation is too low, prices of pharmaceuticals and equipment are too high, and a few other things--all well known to experts who've been analyzing this for a very long time. I know, we don't like experts these days: they are essential here.
It will take compromise to work this out, not a series of brief assertions or slogans. There are ways to do this, but the public has to be willing to take part: younger, healthier people cannot withdraw to the sidelines. A fifty state solution will make matters worse. There is not enough space here.
It is a virtual impossibility to handle all this in full public view--people start complaining before any broad based solution can be crafted. The expectation of making everyone happy is a non-starter.
I do not think there is any single "most important piece," other than the ability for partisan actors to move away from deceptively phrased grudge-matches and try to build something sustainable, improving on what is already there.
There are plenty of independent analysts that do a better job than what we see on these boards. The notion that solutions arise here is unrealistic. Deductibles are too high, regulations are too onerous, overall participation is too low, prices of pharmaceuticals and equipment are too high, and a few other things--all well known to experts who've been analyzing this for a very long time. I know, we don't like experts these days: they are essential here.
It will take compromise to work this out, not a series of brief assertions or slogans. There are ways to do this, but the public has to be willing to take part: younger, healthier people cannot withdraw to the sidelines. A fifty state solution will make matters worse. There is not enough space here.
It is a virtual impossibility to handle all this in full public view--people start complaining before any broad based solution can be crafted. The expectation of making everyone happy is a non-starter.
I do not think there is any single "most important piece," other than the ability for partisan actors to move away from deceptively phrased grudge-matches and try to build something sustainable, improving on what is already there.
Too late. The avalanche is already rolling downhill.
Citing David Brooks as evidence for efficacy of market-based health care is a fail. Brooks is not an expert and whatever sources Brooks may be relying upon Douthat has the duty to reference directly after vetting.
When we get down to the nitty gritty of the difference between liberals and conservatives it seems that conservatives are far more likely to bobble head.
When we get down to the nitty gritty of the difference between liberals and conservatives it seems that conservatives are far more likely to bobble head.
1
I believe it is time to let the Conservatives ideas on health care be tested. What better way to determine which is best than by allowing both Trumpcare and Obamacare to operate side by side.Then the Red state voters can use the Ballot to show there dislike to the Republican alternative or use their feet to move to a Blue state. The Blue state voters will have the option to get rid of Obamacare or move to a Red State.
It is always laughable to here Conservative commentators extolling how GOP health care will cover catastrophic healthcare costs without even giving thought to the fact that the word "catastrophic" is determined by the level of a person's or family's economic means. For some an unexpected health care bill of $100.00 could be the difference between paying the rent or buying food. I know, I have been there.
This Cassidy-Collins plan is DOA on the House floor. Republicans are to afraid that Obamacare would work better.
It is always laughable to here Conservative commentators extolling how GOP health care will cover catastrophic healthcare costs without even giving thought to the fact that the word "catastrophic" is determined by the level of a person's or family's economic means. For some an unexpected health care bill of $100.00 could be the difference between paying the rent or buying food. I know, I have been there.
This Cassidy-Collins plan is DOA on the House floor. Republicans are to afraid that Obamacare would work better.
45
The only silver lining may be that when the right wingers get their way, the fallacy of "free market" in health care might just become clear. If that failure leads eventually to a single payer national health system then loss of the ACA will have been worth it. The ACA was a give away to the insurance and pharmaceutical lobbies intended to draw Republican support, which did not happen anyway because of the color of President Obama's skin.
5
Those who think Medicaid will not eventually become a tool of the state voucher system: I have lovely beachfront property in Kansas for sale.
2
"and the wisdom of free markets ..."
There is no wisdom of "free" markets. There is a little wisdom in FAIR markets, but only a little, and only under very special circumstance outlined under very strict conditions in ideal situations in introductory (and mostly wrong-headed) mainstream economics texts. This is of course, far, far beyond the intelligence of all of today's GOP universe.
There is NO "compelling evidence" that "markets" have anything whatsoever to do with "efficiency" in health care. Extraordinary assertions require extraordinary evidence.
There is no compelling evidence that markets have anything to do with solving problems of a collective nature. Hmmmmm... AGW? Just what short-term private interest without government coercion into solutions is going to solve that? Declaring the problem a "hoax?"
Anybody with half a brain -- which apparently doesn't include Ross Douthat -- knows all of this is Republican dogwhistle for unfettered, unfair, crony, corrupt "markets" and nothing but sophistry meant to allow more coercion of unfairness in the totally broken American health care system.
There is only one fair, decent, civilized, efficient way: single payer. The public coming together to solve a public/collective problem.
Period.
There is no wisdom of "free" markets. There is a little wisdom in FAIR markets, but only a little, and only under very special circumstance outlined under very strict conditions in ideal situations in introductory (and mostly wrong-headed) mainstream economics texts. This is of course, far, far beyond the intelligence of all of today's GOP universe.
There is NO "compelling evidence" that "markets" have anything whatsoever to do with "efficiency" in health care. Extraordinary assertions require extraordinary evidence.
There is no compelling evidence that markets have anything to do with solving problems of a collective nature. Hmmmmm... AGW? Just what short-term private interest without government coercion into solutions is going to solve that? Declaring the problem a "hoax?"
Anybody with half a brain -- which apparently doesn't include Ross Douthat -- knows all of this is Republican dogwhistle for unfettered, unfair, crony, corrupt "markets" and nothing but sophistry meant to allow more coercion of unfairness in the totally broken American health care system.
There is only one fair, decent, civilized, efficient way: single payer. The public coming together to solve a public/collective problem.
Period.
4
I am struck again by how little Russ Douthat understands his own party. It is not a Burkean party and has not been since the days of the Contract on America.
2
Americans always do the right thing after they have exhausted all other options. Finally there will be single payer or a regulated healthcare system. The alternative is factually no HC for all but a few.
Why is that so hard to grasp?
Why is that so hard to grasp?
2
The very notion that free market works in healthcare is wrong. When the market consists of "sick people" who does not have the freedom to choose to buy or not buy the product and when the products (hospitals, doctors, etc.) are physically in limited location, how can the concept of free market exist?
Why can't this government be sensible and expand medicare for all in cheaper form to cover basic cares by raising taxes and then have people who can afford to buy extra private insurance to cover more expensive care? Life is never equal for everyone. Repeal Affordable care and replace it with something that could be worse just because Republican Congress promised to do so? Do we really need to pay these incompetent people in Congress to spend our time and money and hold us hostage? They had 7 years to think about replacing Obama care and they just proved that they are utterly incompetent and spent 7 years collecting tax payer's money while sitting idle and only gave us lip services.
Why can't this government be sensible and expand medicare for all in cheaper form to cover basic cares by raising taxes and then have people who can afford to buy extra private insurance to cover more expensive care? Life is never equal for everyone. Repeal Affordable care and replace it with something that could be worse just because Republican Congress promised to do so? Do we really need to pay these incompetent people in Congress to spend our time and money and hold us hostage? They had 7 years to think about replacing Obama care and they just proved that they are utterly incompetent and spent 7 years collecting tax payer's money while sitting idle and only gave us lip services.
3
"..markets and competition delivering lower costs.." ??That's pretty amusing.
It was Obamacare that forced the major health insurance companies to lower their administrative costs to 15%, or pay significant penalties. This allowed increased payouts for actual medical care. Compare this to 4% for Medicare historically. That adds up when you're talking average yearly premium income in the billions for these companies.
It was Obamacare that forced the major health insurance companies to lower their administrative costs to 15%, or pay significant penalties. This allowed increased payouts for actual medical care. Compare this to 4% for Medicare historically. That adds up when you're talking average yearly premium income in the billions for these companies.
4
Mr. Douthat,
There is are several key notions you need to be disabused of, and clearly your ignorance rises from the fact that you have never been without a decent health insurance policy.
Catastrophic coverage is not health insurance. With a catastrophic plan, you cannot afford to go to the doctor, much less get tested for any serious illness lurking in your body. Catastrophic coverage is just that: after your health has declined to a point that you can no longer ignore it, your desire to keep living forces you to the hospital where you may find the care too late to help you. This is why the CBO suggests that 43,000 people will die if the Affordable Care Act is repealed.
Further, the majority of governorships are in Republican hands, and many of those refused to allow health exchanges in their states. The Collins bill, devised by the Maine a senator whose state has a governor who would rather see the people of his state die than accept expanded Medicare funds or set up s health exchange so that they can have health coverage, would be an option for the states that Republican governors would still reject.
The solution offered is smoke and mirrors.
There is are several key notions you need to be disabused of, and clearly your ignorance rises from the fact that you have never been without a decent health insurance policy.
Catastrophic coverage is not health insurance. With a catastrophic plan, you cannot afford to go to the doctor, much less get tested for any serious illness lurking in your body. Catastrophic coverage is just that: after your health has declined to a point that you can no longer ignore it, your desire to keep living forces you to the hospital where you may find the care too late to help you. This is why the CBO suggests that 43,000 people will die if the Affordable Care Act is repealed.
Further, the majority of governorships are in Republican hands, and many of those refused to allow health exchanges in their states. The Collins bill, devised by the Maine a senator whose state has a governor who would rather see the people of his state die than accept expanded Medicare funds or set up s health exchange so that they can have health coverage, would be an option for the states that Republican governors would still reject.
The solution offered is smoke and mirrors.
4
Let's give it a try. I wonder who will provide better health care five years down the line, Massachusetts or Alabama?
2
Friedman and Burke are polar opposites. Friedman stands for unbridled change and Burke for order and stability. This basic contradiction makes today's American conservatism logically and practically impossible.
The ACA is the conservative alternative to what liberals want-- single payer. the ACA was proposed by the conservative heritage foundation.
5
"Of course this would mean that Obamacare’s existing problems would persist in the states where it continues. But those problems — the rise in premiums, the fleeing insurers, the risk of a death spiral downstream — are not equally problematic in every state, and they are not fiscally dangerous, as yet, on the scale that many conservatives initially feared."
Allow the states that retain the Affordable Care Act to add Medicare to their exchanges as a "public option" and these problems disappear. Medicare does not need to make a profit; there are no wall Street investors to satisfy every fiscal quarter; there are no corporate executives making tens of millions of dollars a year for serving as middle men. Why if f private insurers do flee the exchanges, it will be a feature rather than a flaw as it will effectively bring us another step closer to a single payer Medicare for All system. Single payer remains the only system that is both humane and makes fiscal sense (regardless of the delusions of conservative theorists).
Allow the states that retain the Affordable Care Act to add Medicare to their exchanges as a "public option" and these problems disappear. Medicare does not need to make a profit; there are no wall Street investors to satisfy every fiscal quarter; there are no corporate executives making tens of millions of dollars a year for serving as middle men. Why if f private insurers do flee the exchanges, it will be a feature rather than a flaw as it will effectively bring us another step closer to a single payer Medicare for All system. Single payer remains the only system that is both humane and makes fiscal sense (regardless of the delusions of conservative theorists).
5
What, exactly, is the evidence that "socialized" medical insurance systems result in less innovation? To claim that it does is to make the very arrogant and surely false assertion that basically all medical innovation from the last half century has come from the USA and the rest of the developed world has contributed nothing. What utter nonsense.
By the way, medical innovation usually comes from medical research scientists and universities, so this notion of free market health insurance fostering medical innovation is simply wrong. This would be like claiming that our free market car insurance system provides an environment for the innovation of new car technology. That sounds pretty stupid, now doesn't it?
By the way, medical innovation usually comes from medical research scientists and universities, so this notion of free market health insurance fostering medical innovation is simply wrong. This would be like claiming that our free market car insurance system provides an environment for the innovation of new car technology. That sounds pretty stupid, now doesn't it?
7
What makes you think the people will be heard if the red state solution fails? Who was listening before Obama and the Affordable Care Act to the many thousands of citizens buying individual insurance (non-subsidized employer insurance) at great expense to cover them and their families for catastrophic events, paying upcharges for as little as having seasonal allergies or being denied insurance because they once had a biopsy for a benign cyst in the breast?
No one was listening and no one is listening now. Washington does not "get it." Health care is a human right in a civilized country, not something to be insured against. Conclusion: we are not a civilized country.
No one was listening and no one is listening now. Washington does not "get it." Health care is a human right in a civilized country, not something to be insured against. Conclusion: we are not a civilized country.
3
Good Health Care..the kind Trump enherited by way of his father's wealth, should be a right for all and not regarded as some communist plot. A nations good health is in everyone's best interest, just as education is. These are the two main backbones of any succesful modern society, the darwinian approach is unneccessary, counterintuitive and outright cruel. So let's leave ideology out of it for once and do the right thing. If Donald or anyone else wants to have their hair frozen in place or skin died orange that's on their dime, but basic preventative health care benefits all.
2
It worked for banking: competition has given us a highly responsive, strong, innovative, fair, transparent banking system. If we introduce competition and deregulation into healthcare just think – it will be as strong, trustworthy and healthy as the financial sector!
2
Excellent idea. We can allow the states to experiment with healthcare the same way we have state economic plans and education plans. Across the board, the answer is clear: Democratically controlled states pummel Republican states in both of these areas.
With economic plans, Massachusetts and California are booming. With some of the lowest unemployment numbers and advances in the industries of the future, they are doing quite well. Meanwhile the free-market low taxes paradise of Kansas is drowning in ink redder than the GOP who controls every lever of power in the state.
With education, it doesn't take a genius to see that blue states are performing vastly better than the old Confederacy of dunces in Alabama, Mississippi, and Louisiana.
Let's finally agree that blue state policies lead to better outcomes for the greatest number of people. The only people who "suffer" are the wealthiest of the wealthy who can't buy a second yacht.
With economic plans, Massachusetts and California are booming. With some of the lowest unemployment numbers and advances in the industries of the future, they are doing quite well. Meanwhile the free-market low taxes paradise of Kansas is drowning in ink redder than the GOP who controls every lever of power in the state.
With education, it doesn't take a genius to see that blue states are performing vastly better than the old Confederacy of dunces in Alabama, Mississippi, and Louisiana.
Let's finally agree that blue state policies lead to better outcomes for the greatest number of people. The only people who "suffer" are the wealthiest of the wealthy who can't buy a second yacht.
2
The only way to have an free market in healthcare is to get the insurance companies out of the picture. They muddle healthcare delivery costs so much that there is no transparency to the consumer. Not that I believe that this is a really viable approach, but if they really believe in free markets, then they need to get the insurance companies to take their thumbs off the scales. Otherwise
we should go to single payer.
we should go to single payer.
1
Of course Conservative lawmakers want to try an untested, theoretical, free market health care access system. It's not them or their children or their parents who will die while system works out the kinks or falls flat. And make no mistake, people will die.
Health care is not, and will never, work as a free market system until we find a way for people to decide when and where they will need to access the system. People surely could be more responsible and plan their auto accidents, their cancers, their strokes, or their broken bones, right? Then we could talk market based approaches.
Oh, how I wish I or my children had gone into the mortuary business! Surely, that will soon be a growth profession.
Health care is not, and will never, work as a free market system until we find a way for people to decide when and where they will need to access the system. People surely could be more responsible and plan their auto accidents, their cancers, their strokes, or their broken bones, right? Then we could talk market based approaches.
Oh, how I wish I or my children had gone into the mortuary business! Surely, that will soon be a growth profession.
2
"The promise outweighs the risk-and this is, again, a reasonable belief"
Reasonable to whom? The VERY few moderate GOP bright enough to realize they are dealing with farce? Go ahead, "Repeal and Replace ".
You break it, you Own it. Unfortunately, all of us will suffer from this lunacy.
Also, Sir, you may soon need a chiropractor from all the twisting, turning and tying yourself into knots.
Reasonable to whom? The VERY few moderate GOP bright enough to realize they are dealing with farce? Go ahead, "Repeal and Replace ".
You break it, you Own it. Unfortunately, all of us will suffer from this lunacy.
Also, Sir, you may soon need a chiropractor from all the twisting, turning and tying yourself into knots.
2
Do you want to know one reason why Obamacare is unpopular?
Today I got an Email -- in large type, as if they think I'm stupid -- saying "Last Chance to Get 2017 Health Coverage. URGENT! Only 1 Week Left."
I bought my Obamacare policy a month ago.
Today I got an Email -- in large type, as if they think I'm stupid -- saying "Last Chance to Get 2017 Health Coverage. URGENT! Only 1 Week Left."
I bought my Obamacare policy a month ago.
You cite DAVID BROOKS' COLUMN as your "compelling evidence" that markets work for health care??? His column was pretty lacking in actual evidence--his only example was Lasik!!
1
",,, there is no existing system on a national scale that looks like the health care system that Paul Ryan or Tom Price would design,.."
Exactly the point I've preached for years. Numerous discussions on this matter continuously demonstrate that there is no example, past or present, of free markets delivering universal health care. Indeed, all evidence is to the contrary.
In devising a health care system, one must first decide if it is to be universal, a matter about which Republicans have over the years shown much indifference or even hostility (you can have "access" to all you can afford). But, if it is to be universal, then there are many examples to draw from, all of which are routinely ignored by our free marketeers (e.g. Price, Ryan). Rather, the latter apparently are guided much less by a desire to provide universal health care than by an unthinking free-market and government-is-bad ideology. That's the main impediment to an effective system.
Electorates everywhere support universal health care. History and current conduct show that Republicans, nearly alone, think otherwise.
Exactly the point I've preached for years. Numerous discussions on this matter continuously demonstrate that there is no example, past or present, of free markets delivering universal health care. Indeed, all evidence is to the contrary.
In devising a health care system, one must first decide if it is to be universal, a matter about which Republicans have over the years shown much indifference or even hostility (you can have "access" to all you can afford). But, if it is to be universal, then there are many examples to draw from, all of which are routinely ignored by our free marketeers (e.g. Price, Ryan). Rather, the latter apparently are guided much less by a desire to provide universal health care than by an unthinking free-market and government-is-bad ideology. That's the main impediment to an effective system.
Electorates everywhere support universal health care. History and current conduct show that Republicans, nearly alone, think otherwise.
5
We had a catastrophic policy.
Back in 2000 my husband had a brief episode, losing half of the visual field of one eye, while reading the Sunday Times (I kid you not!).
He went to the Eye Institute, where they determined it wasn't his eye, but a small stroke. He needed an ultrasound. But only after we paid FULL PRICE! Which we did. That led to a bunch more doctor visits and other tests. But only after we paid FULL PRICE for each test. One by one, I "authorized" each test and paid thousands of dollars. Finally, it was determined he needed open heart surgery to fix the congenital hole in his heart, found by the first ultrasound.
With trepidation, he had the heart surgery. But only after an MRI and a heart cath. For which we paid FULL PRICE.
Then.... the surgery. Which, despite my concerns they would dispute the bills, was paid for. Plus, we began to receive refunds - because once we had paid 100% of the first $5000 and 20% of the next $5000, we qualified for the reduced prices insurance companies negotiate.
But THINK! Suppose we had not been able to pay for all the tests and doctor visits and blood-thinner visits (this process went on during a total of 3 months).
Right there is the problem!
The heartless GOP would condemn the poor and the working poor to huge charges and possibly an early death. (My husband was 60 at the time.)
We need Universal Healthcare. Where ACCESS is provided to ALL. Access, not an invitation to debt.
Humanity First!
Back in 2000 my husband had a brief episode, losing half of the visual field of one eye, while reading the Sunday Times (I kid you not!).
He went to the Eye Institute, where they determined it wasn't his eye, but a small stroke. He needed an ultrasound. But only after we paid FULL PRICE! Which we did. That led to a bunch more doctor visits and other tests. But only after we paid FULL PRICE for each test. One by one, I "authorized" each test and paid thousands of dollars. Finally, it was determined he needed open heart surgery to fix the congenital hole in his heart, found by the first ultrasound.
With trepidation, he had the heart surgery. But only after an MRI and a heart cath. For which we paid FULL PRICE.
Then.... the surgery. Which, despite my concerns they would dispute the bills, was paid for. Plus, we began to receive refunds - because once we had paid 100% of the first $5000 and 20% of the next $5000, we qualified for the reduced prices insurance companies negotiate.
But THINK! Suppose we had not been able to pay for all the tests and doctor visits and blood-thinner visits (this process went on during a total of 3 months).
Right there is the problem!
The heartless GOP would condemn the poor and the working poor to huge charges and possibly an early death. (My husband was 60 at the time.)
We need Universal Healthcare. Where ACCESS is provided to ALL. Access, not an invitation to debt.
Humanity First!
7
The ACA was never intended to be the final, cast-in-concrete, form of universally available health care insurance for Americans. Its supporters realized from the get-go that it needed tweaks - maybe even big ones. Those tweaks were supposed to happen somewhere (soon) down the road. Unfortunately, no fixes emerged, only the polarized options of repeal it all or keep it all. What you call the Cassidy-Collins compromise. . . when is the last time congress compromised on a major issue? Are you suggesting they may be about to start? I'm all for cooperation and mature problem solving, but will believe it when I see it.
7
As long as insurance companies, doctors and hospitals "control" costs they will continue to rise. Even with Obamacare, we have a market-oriented health care system that is the most expensive and least effective in the world. A single-payer Medicare-for-all is the only way to cover everyone, rich and poor, while reducing costs and improving quality.
6
Why would we want a geographic disparity in basic health coverage? So the unfortunates in Red states can act as human guinea pigs in a right wing experiment? You'll only accelerate existing trends. The young, educated, and mobile will flock to Blue urban centers and everyone else will get left behind. You've just given one more incentive to abandon rural America.
Obviously, the people staying are going to be the ones most likely to vote Republican and least likely to contribute to a health savings account. Thus, you'll create massive risk pools in certain parts of the country without the ability for states repeal the experiment. That's part of the reason some states rejected medicaid expansion in the first place. How does that iincentivize health care providers to compete in these areas? Why would they want to operate in risky areas at all?
I'm not saying the over-the-cliff proposal is desirable but Republicans need to try a little harder. Please.
Obviously, the people staying are going to be the ones most likely to vote Republican and least likely to contribute to a health savings account. Thus, you'll create massive risk pools in certain parts of the country without the ability for states repeal the experiment. That's part of the reason some states rejected medicaid expansion in the first place. How does that iincentivize health care providers to compete in these areas? Why would they want to operate in risky areas at all?
I'm not saying the over-the-cliff proposal is desirable but Republicans need to try a little harder. Please.
3
Very sensible column, but I thought it odd that "Friedman" is used as a short-cut reference to "the wisdom of markets" rather than "Hayek/von Mises". Friedman wrote much about monetarist macroeconomic control, plus at least one diatribe against socialism without much reference to why, exactly, markets were wiser. The real insights about markets belong to Hayek and von Mises.
1
It's so obvious that Medicare for all is the solution.
The enemies of health reform always complain about the cost, but that's a red herring.
The cost of pointless wars, endless tax cuts for prosperous businesses and the 1%, and the annual blank check to the Pentagon are never questioned.
The enemies of health reform always complain about the cost, but that's a red herring.
The cost of pointless wars, endless tax cuts for prosperous businesses and the 1%, and the annual blank check to the Pentagon are never questioned.
8
There is NO convincing evidence that market forces work in health care. The David Brooks article you reference could only point to economies in laser eye surgery, by definition a luxury health care item. Parents want their child's broken arm cared for without making the family homeless. Please hear me: your thesis is founded on an incorrect conviction. Market forces are so theoretically attractive they blind conservatives to the life and death stresses they cause for average citizens. We do not want market forces to tell us which water supply is safest, or which elevator or bridge or auto is least likely to kill. We want government regulations.
7
Ross, you keep thinking that the Republicans want to replace ACC---they don't. Most of them, including the President don't know who Burke or Friedman are, but they do know who Ebenezer Scrooge is. Should add that I do appreciate your analysis and attempts a bringing some rationality to an administration who thrives on chaos.
12
The ACA was a republican plan from the Heritage foundation. Even that didnt satisfy republicans because it came about during Obama's administration and they hate everything that helps non-rich people. The debacle of repealing the ACA will haunt us for generations. Get used to it people. Republicans own the country and it is their right to mess it up for all and they intend to. Just look at all the changes and executive orders he has done so far. Who do they help? (hint: rich) Who do they hurt? (hint: poor).
10
Mr Douthat, You and most sensible conservatives know perfectly well that the ACA is a pretty darn right-wing plan. Go any further to the right and many people will lose coverage, those with chronic conditions will be dropped and premiums will rise for the remainder. The current Congress will never consent to a state-by -state-system, because that sort of laboratory experiment, (ordinarily a conservative rallying cry) will give poorer voters in conservative states a clear reason to stop voting against their own interests. The disastrous Kansas "experiment" has not woken up the nation partly because it's a single state and partly because the broad spectrum of an economy, it can be argued, has many variables. A red state- blue state comparison on health care would be the end of any pretense that the Republican Party has the interests of any but the rich in mind.
10
Market-driven healthcare is not possible.
Because illness and healthcare needs do not follow identifiable patterns, each market-driven model I have seen could not be successful at lowering costs or providing a more broad scope of coverage.
As long as a few people can, under the current public/private insurance models, receive quality care and not have to pay for all of it, any replacement system will be adamantly resisted and probably fail.
Because illness and healthcare needs do not follow identifiable patterns, each market-driven model I have seen could not be successful at lowering costs or providing a more broad scope of coverage.
As long as a few people can, under the current public/private insurance models, receive quality care and not have to pay for all of it, any replacement system will be adamantly resisted and probably fail.
36
Ross, writing for the New York Times as you do, I imagine you don't live in a Red State where you advocate this experimentation should take place.
3
The affordable care act works. It is flawed but it works. It should just be fixed. If people just stopped calling it Obamacare most people wouldn't know the difference. Actually in surveys most people think Obamacare is something different than the ACA. Republicans started calling it Obamacare as a derogatory name (in their eyes) thinking it would collapse before it got off the ground and Obama would be associated with a failed program. It didn't work out that way and now they have to cobble something together using many features of the ACA. If there was no ACA Republicans would not even be entertaining the idea of health care. The real irony in the whole debate over the ACA is it is a Republican plan to begin with.
6
No matter how many Edmund Burke and Milton Friedman "wisdom bombs" you drop, you will never, ever, persuade me that the ACA is a liberal's idea of good policy, that the right's opposition to the ACA (then or now) is "principled," or that the Republicans are acting in good faith (then or now).
The very seriousness and earnestness of these columns on the Republican health care plans would be entertaining if it weren't absurd. For eight years it's been crickets. And now, all of a sudden, they are spinning up "compelling evidence" out of nothing and talking policy like they know something the rest of us don't. But then you look and — whoosh! — there's nothing there.
Notwithstanding the fact that your "Compelling evidence" is a link to David Brooks column, you actually assert that "no existing system on a national scale looks like the health care system that Paul Ryan or Tom Price would design" and admit that there is "no wisdom of developed-economy experience that proves that such a system would actually keep overall costs low and prevent too many people from being shut out of insurance markets."
So you are proposing to overhaul the nation's health care system on nothing more than ideology, and your proposed solutions are in no way based on any existing model, and you have no idea if it will keep overall costs low or prevent people from being shut out.
That's rich.
The very seriousness and earnestness of these columns on the Republican health care plans would be entertaining if it weren't absurd. For eight years it's been crickets. And now, all of a sudden, they are spinning up "compelling evidence" out of nothing and talking policy like they know something the rest of us don't. But then you look and — whoosh! — there's nothing there.
Notwithstanding the fact that your "Compelling evidence" is a link to David Brooks column, you actually assert that "no existing system on a national scale looks like the health care system that Paul Ryan or Tom Price would design" and admit that there is "no wisdom of developed-economy experience that proves that such a system would actually keep overall costs low and prevent too many people from being shut out of insurance markets."
So you are proposing to overhaul the nation's health care system on nothing more than ideology, and your proposed solutions are in no way based on any existing model, and you have no idea if it will keep overall costs low or prevent people from being shut out.
That's rich.
8
Funny how driven the right is by their own profoundly distorted egos. They railed against a healthcare system devised by one of their own, leaving the left stymied as to how to proceed in the face of an indomitable opposition driven more by hatred than wisdom. Now, the right is faced with the responsibility of dealing with facts as they are. Too bad the country can't simply sit back and pass the popcorn as this epic tale unfolds. But too many lives are at stake...too many lives that depend on a broken system the right hasn't the humility to honestly appraise.
4
The first national health care system in modern times (some Greek city states had public physicians) was put into place by Bismarck in 1883, who was anything but a bleeding heart liberal. Bismarck understood that industrialization had made the lives of workers miserable and that he needed to provide them with a social safety net or risk Communist revolution.
The system works to this day and provides better care with a fraction of the costs run up by American insurers. Maybe now is the time to reconsider the wisdom of an arch-conservative politician, who was honored by the good people of Nebraska by naming their state capital after him.
If Republicans were wise, they would accept this evidence and put pragmatism over ideology. But the Republican Party has been the party of Trump for twenty years, and empiricism and reason have been their arch-enemies enemies since you graduated high school.
The system works to this day and provides better care with a fraction of the costs run up by American insurers. Maybe now is the time to reconsider the wisdom of an arch-conservative politician, who was honored by the good people of Nebraska by naming their state capital after him.
If Republicans were wise, they would accept this evidence and put pragmatism over ideology. But the Republican Party has been the party of Trump for twenty years, and empiricism and reason have been their arch-enemies enemies since you graduated high school.
4
I have been in the insurance business for decades, the last 2 as an underwriter. There is no evidence that competition works to lower prices. And if Ross had studied economics, he would know just why. The purchaser cannot judge the goods he is buying.
Think of this anecdotal example: I have bought many cars over my life and driven many more. But I have only have 2 echocardiograms. What can I as a consumer bring to bear when a doctor suggests that I need one.
Nothing!
There is no working free market with health care. Stop the nonsense.
Think of this anecdotal example: I have bought many cars over my life and driven many more. But I have only have 2 echocardiograms. What can I as a consumer bring to bear when a doctor suggests that I need one.
Nothing!
There is no working free market with health care. Stop the nonsense.
26
"This system could be layered on top of the existing Medicaid expansion, replacing only the Obamacare subsidies and exchanges, or it could replace the Medicaid expansion as well, offering the poor and near poor the same “catastrophic insurance plus a subsidy” as everyone else in the individual market."
The problem with this magical thinking is that almost every state with a Republican governor already rejected Medicaid expansion, and Paul Ryan would like nothing more than relegating Medicaid to block grants, further diminishining its effectiveness. And there is no evidence, zero, that "catastrophic insurance plus a subsidy" would be even remotely sufficient to cover those with chronic health conditions, i.e. obesity, diabetes, kidney failure, HIV, hepatitis, etc.
The market, as usual, provides nothing but the back of its hand to the poor. So, Ross, does the Times' most fervent Catholic prefer the Edmund Burke/Milton Friedman teaching about treating the poor, or that of Jesus?
The problem with this magical thinking is that almost every state with a Republican governor already rejected Medicaid expansion, and Paul Ryan would like nothing more than relegating Medicaid to block grants, further diminishining its effectiveness. And there is no evidence, zero, that "catastrophic insurance plus a subsidy" would be even remotely sufficient to cover those with chronic health conditions, i.e. obesity, diabetes, kidney failure, HIV, hepatitis, etc.
The market, as usual, provides nothing but the back of its hand to the poor. So, Ross, does the Times' most fervent Catholic prefer the Edmund Burke/Milton Friedman teaching about treating the poor, or that of Jesus?
7
The idea of 'experimenting' with health care that leaves people with chronic long-term and expensive health care needs and costs in physical or financial trouble is astonishingly callous. What is wrong with Douthat and his fellow conservatives?
7
This cold-blooded approach to an issue so vital to the well-being of the population sends chills down my spine. Douthat weighs different healthcare proposals in terms of their political viability, arguing, for example, that an experiment in some states with catastrophic care policies might determine their acceptability to the voters. He concedes that costs for people with modest incomes might mount so quickly that they would face bankruptcy long before the insurance benefits kicked in. But, hey, not to worry! They can always vote out the legislators who approved this plan.
Unfortunately, the people harmed by it might have died or suffered permanent disabilities before the political process could correct the error. Perhaps Douthat has never encountered the fundamental principle that one does not conduct lab experiments with human beings as guinea pigs. For that is exactly what the Cassidy-Collins proposal entails, an experiment in which the metric used to measure success focuses on the number of lives lost or wrecked by a reliance on catastrophic insurance.
The extent to which Obamacare resembles a catastrophic insurance plan measures the kind of reforms required to improve it. But the Republicans, in thrall to an ideology that confuses governmental neglect of human needs with freedom, dismiss such improvement as an unacceptable expansion of state authority. Some Trump supporters may have signed their own death warrants when they elected this man.
Unfortunately, the people harmed by it might have died or suffered permanent disabilities before the political process could correct the error. Perhaps Douthat has never encountered the fundamental principle that one does not conduct lab experiments with human beings as guinea pigs. For that is exactly what the Cassidy-Collins proposal entails, an experiment in which the metric used to measure success focuses on the number of lives lost or wrecked by a reliance on catastrophic insurance.
The extent to which Obamacare resembles a catastrophic insurance plan measures the kind of reforms required to improve it. But the Republicans, in thrall to an ideology that confuses governmental neglect of human needs with freedom, dismiss such improvement as an unacceptable expansion of state authority. Some Trump supporters may have signed their own death warrants when they elected this man.
6
We get our electricity through regulated monopolies.
It has worked well for 100 years.
I never heard Republicans or Milton Friedman complaining about that.
It has worked well for 100 years.
I never heard Republicans or Milton Friedman complaining about that.
6
Nope. You can set up a healthcare system ripe for continual politicization. Would a GOP Congress threaten subsidy funding for those states that keep Obamacare? Would states themselves switch from the exchanges to opting out to back into the exchanges as state leadership changes parties?
Democrats need to hold the line and make the Republicans come up with one comprehensive system - and force them to live or die by that system politically.
That easiest thing by far is making the relatively minor fixes to the exchanges: address the burdens of the deductibles (through another risk sharing device or HSAs); address rising costs of drugs; and tweak how the costs of high-use people are spread out better to reduce premiums for younger, healthier.
Democrats need to hold the line and make the Republicans come up with one comprehensive system - and force them to live or die by that system politically.
That easiest thing by far is making the relatively minor fixes to the exchanges: address the burdens of the deductibles (through another risk sharing device or HSAs); address rising costs of drugs; and tweak how the costs of high-use people are spread out better to reduce premiums for younger, healthier.
1
Conservatives continually demonstrate they know nothing about healthcare and care less about people. They only way to replace the ACA is to recreate it and call it Trumpcare or a singlepayer system. At least, if you want to cover everyone and to have the features Americans like.
1
Douthat has started drinking from the trump fountain. He is saying things about privatizing healthcare that are proven wrong. These people really don't give a damn about others. They all think that facts are filtered through ideology and become alternate facts! Care for others only means you give people crumbs while the system starves them. Douthat is a disgrace!
2
Modern free-market conservatives believe all manner of things for which there is no clear example of a real-world system that successfully operates along the lines they desire. They have become the least "conservative" and the most "utopian" human beings imaginable, understanding no more than Marx did about human nature and the human reaction to out-of-control risk. They would have horrified Burke, just as they horrify many of the rest of us.
5
Let me try to get this straight.
The Cassidy-Collins bill advocated by Douthat would grant each state the authority to experiment with its own public health insurance plan. This fascinating real-life test would enable liberals and conservatives to observe and gauge what works. Of course in the Red states, people with chronic diseases would soon discover that their healthcare "savings accounts" are insufficient and quickly emptied. These unfortunates (the little people) are now facing both ill health and bankruptcy.
But that's ok. They're just part of an experiment.
Mr. Douthat, you often write about your Christian faith and Catholicism. How do those teachings lead and guide you in this case?
(PS. Your sources of information asserting the failures of the Affordable Care Act, and the advantages of national health care provided and insured by enterprising competitors, are slanted, chosen to reconfirm your perspective. Not surprising, but please talk to Paul Krugman. He'll have additional studies.)
The Cassidy-Collins bill advocated by Douthat would grant each state the authority to experiment with its own public health insurance plan. This fascinating real-life test would enable liberals and conservatives to observe and gauge what works. Of course in the Red states, people with chronic diseases would soon discover that their healthcare "savings accounts" are insufficient and quickly emptied. These unfortunates (the little people) are now facing both ill health and bankruptcy.
But that's ok. They're just part of an experiment.
Mr. Douthat, you often write about your Christian faith and Catholicism. How do those teachings lead and guide you in this case?
(PS. Your sources of information asserting the failures of the Affordable Care Act, and the advantages of national health care provided and insured by enterprising competitors, are slanted, chosen to reconfirm your perspective. Not surprising, but please talk to Paul Krugman. He'll have additional studies.)
7
Countries like Denmark, Germany, and Netherlands pay half what we pay for health care GDP / capita.
And they have universal health care.
On the other hand, infant mortality rates for the poor in the US are the same as Botswana.
What are we getting for our money?
And anything people are talking about so far, will just slow the rate of heath care inflation.
It will not address that we pay twice as much.
And they have universal health care.
On the other hand, infant mortality rates for the poor in the US are the same as Botswana.
What are we getting for our money?
And anything people are talking about so far, will just slow the rate of heath care inflation.
It will not address that we pay twice as much.
5
The push among major employers (like Ford) to retain employer-based insurance coverage in the immediate post-war years, rather than shift to a single-payer system as was being debated, will go down as one of the saddest policy moments in US history. Companies wanted to use their insurance as part of the compensation package to attract and retain good employees. Fine. But see now where it leads, at least in part. The worst health outcomes in the industrialized world, the highest costs, and surely the nastiest politicization of the problem. Things are especially bad, of course, for those who don't obtain insurance through their employer.
We don't have test cases for the experiment Republicans are cooking up for post-Obamacare. But we do have test cases for the reverse. See Taiwan. It had a market-based system and people went bankrupt all the time when someone got cancer or some other illness. Mostly, people just suffered and died earlier than they otherwise would have. Following the implementation of a single-payer system, things improved greatly along the usual metrics. But people also earned a sense of security. And - alert, Republicans! - it freed people to take entrepreneurial risks, knowing that their health coverage wasn't tied an employer and was always guaranteed. No, the system's not perfect. But in a society that could hardly be described as socialist in any way, a single-payer system made a huge, positive difference to satisfy some big egos.
We don't have test cases for the experiment Republicans are cooking up for post-Obamacare. But we do have test cases for the reverse. See Taiwan. It had a market-based system and people went bankrupt all the time when someone got cancer or some other illness. Mostly, people just suffered and died earlier than they otherwise would have. Following the implementation of a single-payer system, things improved greatly along the usual metrics. But people also earned a sense of security. And - alert, Republicans! - it freed people to take entrepreneurial risks, knowing that their health coverage wasn't tied an employer and was always guaranteed. No, the system's not perfect. But in a society that could hardly be described as socialist in any way, a single-payer system made a huge, positive difference to satisfy some big egos.
9
It is correct to ask when "primary"coverage ends and "catastrophic" begins, and also what the difference between "auto-enroll" and the "individual mandate" is. What I see conservatives doing is harking back to the good old days before the ACA, where the mis-mash of byzantine policies favored big pharma and insurance companies. And we know how well that was going...or do they even remember? We will hear two conservative tropes. First that the states are better at this, so block grants will be given to states for high risk pools. Secondly, individuals will be given a "defined contribution" (here is your stipend, now go find what you can in the market, and god bless). Then as always these block grants and/or individual stipends will be cut, and cut and cut again because we just can't afford them, tax cuts must come first, and would you look at the deficits!
3
I clicked on the link to the article that supposedly shows that America's superiority in biomedical research is linked to the high per capita cost of its health care system, and I wasn't at all convinced. It's all linked to the money spent on research, yes, but even that link points out that university-conducted research in the US dwarfs that in Europe and the rest of the world. It's all about the money, and direct government spending on health care research is better than private industry spending. Public research isn't directed only at "profitable" treatments; it can be directed towards the greatest need. And there is no need for the "market" to tell us what is "needed;" we all know what diseases exist, and what shortcomings there are in existing treatments. Cut out "Big Pharma." Give plenty of money to university professors to run their labs and fund their graduate students, and the Nobel Prizes will continue to pile up.
1
No one mention here of pre-existing conditions. People like me-- a cancer survivor will likely be out of luck, I suppose. I'll just have to wait for the cancer to return and then, just get ready to die? And what about mental health? By having coverage through the ACA, for the first time in my adult life, I've had the mental health services I need to keep me healthy, functioning, and productive. Well, I guess those of living in 'Red' states and who are working poor should be thrilled that we'll have 'catastrophic' coverage. For me, the loss of my health insurance through Obamacare IS a catastrophe.
118
Ross-What choice do I really have to buy health care that fits my needs? I get called from insurers every day. Here's what I ask. I can afford good health insurance, I want a policy that gives me access to the best facilities in the country if I get sick. They don't even know how to respond.
Insurance companies have created a maze of complicated networks both in and out. Nobody the insured, the insurer or the health providers know what a particular event is going to cost. That was true before the ACA, after the ACA and after the right wing reduces payments and people with coverage. There is no such thing as competition in health care.
I can buy reasonably priced fire insurance because my town has a public fire department and they have a pretty good idea of replacement cost and risk. That doesn't exist in the Health care marketplace unless you get everyone in. What we really need is more health care to drive supply. We have a shortage of primary care physicians because they aren't paid enough.
Insurance companies have created a maze of complicated networks both in and out. Nobody the insured, the insurer or the health providers know what a particular event is going to cost. That was true before the ACA, after the ACA and after the right wing reduces payments and people with coverage. There is no such thing as competition in health care.
I can buy reasonably priced fire insurance because my town has a public fire department and they have a pretty good idea of replacement cost and risk. That doesn't exist in the Health care marketplace unless you get everyone in. What we really need is more health care to drive supply. We have a shortage of primary care physicians because they aren't paid enough.
81
"I want a policy that gives me access to the best facilities in the country if I get sick."
So, in other words, you want Medicare.
So, in other words, you want Medicare.
1
What about going back to ice floes?
6
If only "conservatives" had paid attention in econ class when Efficient Markets were being discussed...
To have an efficient market you need at least 4 and ideally at least 8 competitors, none of which have more than a 50% market share.
The market for doughnuts is highly efficient, it has many competitors.
The market for medical insurance will never be efficient. It should be highly regulated as should be any monopoly or oligopoly.
(Thank you Walter Adams for Econ 444)
To have an efficient market you need at least 4 and ideally at least 8 competitors, none of which have more than a 50% market share.
The market for doughnuts is highly efficient, it has many competitors.
The market for medical insurance will never be efficient. It should be highly regulated as should be any monopoly or oligopoly.
(Thank you Walter Adams for Econ 444)
6
What frightens me most about this article is the laissez-faire approach Mr. Douthat takes in promoting an untested experiment. He made no comment throughout the entire article about the thousands of people whose lives will be at stake when their health care is upended. No, let's ignore what is working well in many other countries, he says; trust me! Why am I not surprised?
I'll take part in this health care experiment, if all of the Congressmen and Senators give up their tax payer funded, high end, compressive health insurance and experiment with the health of their family too.
8
> which would mean that the law would remain intact
> in most blue states for the time being, while redder
> states would have the opportunity to turn roughly
> the same amount of money (95 percent) to a different end.
Sounds great! Just so long as the Blue states get to deny coverage to anyone who moves there from a Red state when they get sick or old or some such... (While we're at it, should we really be recognizing high school diplomas that get issues in Texas?)
> in most blue states for the time being, while redder
> states would have the opportunity to turn roughly
> the same amount of money (95 percent) to a different end.
Sounds great! Just so long as the Blue states get to deny coverage to anyone who moves there from a Red state when they get sick or old or some such... (While we're at it, should we really be recognizing high school diplomas that get issues in Texas?)
8
It's really simpler than all your "conservative versus statist" gyrations over health care systems, Mr. Douthat. As long as we continue to favor health care for profit (useless health insurance companies getting margins far beyond what is needed for admin and doctors billing by the service rather than living on healthy salaries) we Americans will continue to languish behind the rest of the civilized world. Stop looking for a "conservative" health plan and start looking for a humane health plan.
149
It's striking how many commenters feel they have the answer (Medicare for all, single payer etc.) yet reject the Cassidy-Collins approach of letting states choose -- which of course is the only way single payer will ever get a chance to prove itself in the US.
Subsidiarity is the principle that in a multi-level system the lowest level of government possible should deliver services. It allows government programs to be tailored to best fit local needs and desires. The US could use a lot more of it.
Subsidiarity is the principle that in a multi-level system the lowest level of government possible should deliver services. It allows government programs to be tailored to best fit local needs and desires. The US could use a lot more of it.
QUOTE: "Fewer people are being insured on the exchanges than liberals hoped, fewer employers are dumping high-cost employees onto the exchanges than conservatives feared."
One is the mirror-image of the other: fewer people in exchanges BECAUSE fewer employers dumped workers there. PERIOD.
Forget the deceiving editorializing of "hope" and "fear": this is fodder for the dumb that even in front of self-evident facts, quench their thirst for rage at the guv'mint.
This is the contorted kind of arguments that ideologues like Douthat feed to themselves and the safety net of Know-Nothing thinkers like themselves who shut their ears to the sounds of reality so as not to hear the poor that drown.
One is the mirror-image of the other: fewer people in exchanges BECAUSE fewer employers dumped workers there. PERIOD.
Forget the deceiving editorializing of "hope" and "fear": this is fodder for the dumb that even in front of self-evident facts, quench their thirst for rage at the guv'mint.
This is the contorted kind of arguments that ideologues like Douthat feed to themselves and the safety net of Know-Nothing thinkers like themselves who shut their ears to the sounds of reality so as not to hear the poor that drown.
1
So, with successful systems to examine world-wide, we should experiment while people suffer and die?
7
I honestly believe that Democratic Senators and Congressmen should work with Cassidy and Collins to make this happen. I am a liberal and a supporter of Obamacare, but elections have consequences.
The elections that should be more important to the health care debate are the Congressional Elections. Voters kept power in the hands of the Republican Party while shrinking their majorities. This should encourage Congress to compromise. It is promising that Republican's in the Senate seem eager to do just that. By working with these Senators, the Democrats are only one vote shy of averting a potential health care disaster for millions. This might be the best they can do. They can of course opt to do what Republican Senators and Congressmen have been doing for six years, but that would only hurt people.
If the Republican's are hell bent on repealing the ACA the Collins/Cassidy plan may allow them to save face, while saving lives.
The elections that should be more important to the health care debate are the Congressional Elections. Voters kept power in the hands of the Republican Party while shrinking their majorities. This should encourage Congress to compromise. It is promising that Republican's in the Senate seem eager to do just that. By working with these Senators, the Democrats are only one vote shy of averting a potential health care disaster for millions. This might be the best they can do. They can of course opt to do what Republican Senators and Congressmen have been doing for six years, but that would only hurt people.
If the Republican's are hell bent on repealing the ACA the Collins/Cassidy plan may allow them to save face, while saving lives.
I applaud Susan Collins for trying to put dress up the deck chairs on the Titanic, but making it okay for some to reach the life rafts while leaving the rest of us behind to drown is not a solution.
"Repeal this! Replace that! Let the states decide!" What's missing all of this rhetoric? An actual focus on of human beings. Patients. People. Their affordable access to quality care. Not one politician is offering a solution that will make things better for Americans. They keep blathering on about what's best for "America", whatever that means.
"Let's do Block Grants instead of Medicaid!" should be called "Cut 'em off at the knees and then wait until the money runs out!" (Block grants are finite, and don't account for recessions are the next epidemic or bad state decisions including patient exclusion).
"Let's let the states decide participation in the ACA because that worked so well last time around when we gave them a way to out of Medicaid expansion!" (I live in Texas, need I say more?) People suffered and thousands died because of the red vs. blue politics when the ACA was enacted and states chose along political lines not to expand medicaid to people who were in desperate need of it, including children.
If politicians want one less individually insured American on the books, just mention the phrase "whats best for Americans and their families" just once and mean it. That alone would probably give me a heart attack.
"Repeal this! Replace that! Let the states decide!" What's missing all of this rhetoric? An actual focus on of human beings. Patients. People. Their affordable access to quality care. Not one politician is offering a solution that will make things better for Americans. They keep blathering on about what's best for "America", whatever that means.
"Let's do Block Grants instead of Medicaid!" should be called "Cut 'em off at the knees and then wait until the money runs out!" (Block grants are finite, and don't account for recessions are the next epidemic or bad state decisions including patient exclusion).
"Let's let the states decide participation in the ACA because that worked so well last time around when we gave them a way to out of Medicaid expansion!" (I live in Texas, need I say more?) People suffered and thousands died because of the red vs. blue politics when the ACA was enacted and states chose along political lines not to expand medicaid to people who were in desperate need of it, including children.
If politicians want one less individually insured American on the books, just mention the phrase "whats best for Americans and their families" just once and mean it. That alone would probably give me a heart attack.
93
How many thousands died? You're clearly on top of the situation. Once I have that info, I'll email my congressman. Thanks so much.
Here's the silver lining in the plan: people might actually move out of red states to get better access to medical care. This transfers voting power to the blue states, who will ultimately help us elect a sane president and Congress, at which point we can put a proper health care system.
Right now, since people without health insurance know they cannot be turned away by a hospital Emergency Room, damn if that isn't where they go for their medical care. On 60 Minutes, Mitt Romney said as much: "Well, we do provide care for people who don't have insurance. If someone has a heart attack, they don't sit in their apartment and -- and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care."
Whether one follows Friedman or Burke, by Republican logic, the next step is to repeal laws requiring emergency rooms accept anyone who shows up at the door.
Make no mistake, that's the end game of Republican free market policy.
Whether one follows Friedman or Burke, by Republican logic, the next step is to repeal laws requiring emergency rooms accept anyone who shows up at the door.
Make no mistake, that's the end game of Republican free market policy.
3
One problem with this plan: many Republican governors given a block grant would be inclined to use it to do what Conservatives like to do the most: cut taxes on the highest wage earners!
3
Good god, Obamacare is a CONSERVATIVE program, invented by Republicans initially. It only turned "liberal" when it was enacted during a Democratic presidency.
And why do we keep imagining that health care costs are the result of people spending other peoples' money? Most people I know pay a ton for health care, even with "good" insurance. We pay thousands in premiums - no choice there - and then still pay thousands if we actually need care, like minor surgery. Making health care even more expensive is unlikely to have good results for anyone.
And why do we keep imagining that health care costs are the result of people spending other peoples' money? Most people I know pay a ton for health care, even with "good" insurance. We pay thousands in premiums - no choice there - and then still pay thousands if we actually need care, like minor surgery. Making health care even more expensive is unlikely to have good results for anyone.
3
We've learned from the system that was in place before Obamacare that with competition, sick people always los. (Unless your dad is Bill Gates. ) even if you were not chronically ill, a bad year could drive you to bankruptcy. A car accident or a fall or a bad infection could leave you many thousands in debt. This was a barbaric system, and not "free market" at all, since you were pretty much locked into your plan with that pre-existing condition clause.
People whose large employers provide their insurance are insulated from this.
Republicans need to fix, not repeal ACA. It's not perfect but it's the only real healthcare reform we have.
People whose large employers provide their insurance are insulated from this.
Republicans need to fix, not repeal ACA. It's not perfect but it's the only real healthcare reform we have.
2
Yeah, let's make the administrative costs of healthcare double by making every state have to recreate the wheel. That's the ticket.
8
The "moderate Republican" plan will, if passed, result in little more than an experiment in managing health care costs that has the populations of the Red States as their guinea pigs.
Medicare for all is a much better solution, where the administrative costs are very low and the health care consumer has some "skin in the game" with a 20% contribution to costs. Along with nationwide negotiations on prescription costs and what Medicare will pay hospitals and doctors, including the limiting expensive care in some cases, is a reasonable outcome for the most-expensive health care system in the developed world.
Medicare for all is a much better solution, where the administrative costs are very low and the health care consumer has some "skin in the game" with a 20% contribution to costs. Along with nationwide negotiations on prescription costs and what Medicare will pay hospitals and doctors, including the limiting expensive care in some cases, is a reasonable outcome for the most-expensive health care system in the developed world.
1
Experimenting with this conservative alternative in 10 red states and waiting until "people are simply miserable as health care consumers because the system has too much of Friedman and not enough of Burke — well, in that case both the country and conservatism will be better off if we learn that via a voter rebellion in 10 right-leaning states." Human beings who rely on a health care system that is experimenting with them (with itself, really, using them as subjects, as if they were lab rats) have to become "simply miserable." "Simply miserable" translates into "simply" trapped in whatever illness assails them, trapped until some of them die for lack of adequate health care. This is an immoral proposition.
2
"The dominant systems in the developed world, whether government-run or single-payer or Obamacare-esque, are generally statist to degrees that conservatives deplore."
I don't care about the pride of conservative wonks. The rest of the world has multiple systems which _have_ driven down costs, and deliver _better_ health care results. You're telling me the reason that Americans are supposed to be subjected to experimental health care is that the poor conservative leaders are unhappy with using a working system which does everything their system _might_ do. Get them a tissue and send them to their room. And find me some adults to talk to.
I don't care about the pride of conservative wonks. The rest of the world has multiple systems which _have_ driven down costs, and deliver _better_ health care results. You're telling me the reason that Americans are supposed to be subjected to experimental health care is that the poor conservative leaders are unhappy with using a working system which does everything their system _might_ do. Get them a tissue and send them to their room. And find me some adults to talk to.
4
Ross, when you need a medical procedure done and choose the most affordable surgeon instead of the best surgeon you can find, then talk to me. Of course, you would not opt for Walmart heart surgery, would you. That is why the conservative wide open "free market" will not work.
As to enrolling anyone in a high deductible plan, they would only use it in life threatening cases while small problems that escalate into big ones would fester until they became life threatening because of the hight deductible.
Oh, and the savings accounts. Probably as effective as 401 K's have been for the average American.
The wealthy would work that system to perfection because they would not have to make short term choices between the needs of food, housing, transportation, and raising children and the hundreds of dollars worth of medical tests involved in simply undergoing an annual physical.
As to enrolling anyone in a high deductible plan, they would only use it in life threatening cases while small problems that escalate into big ones would fester until they became life threatening because of the hight deductible.
Oh, and the savings accounts. Probably as effective as 401 K's have been for the average American.
The wealthy would work that system to perfection because they would not have to make short term choices between the needs of food, housing, transportation, and raising children and the hundreds of dollars worth of medical tests involved in simply undergoing an annual physical.
1
A more accurate view of "conservative" healthcare policy is "repeal and run," which seems to be Congressman Price's choice.
It's not conservative; it's genocide.
It's not conservative; it's genocide.
2
Hatred of everything Obama is the basis for repealing the ACA not concern about the American people. The sooner we all realize that we are just pawns in the Republican revenge game the sooner we will all see this process for what it is=a destruction of health care for the American people based on hatred. It is obscene to play with people's lives in order to get your revenge.
7
REPEAL OBAMACARE The what? Wait for the Trumpster Dumpster Trickle Down Healthcare plan? Guess what folks--since 1980 when Ronnie Ray Gun came into town talking about the miracles of trickle down, somehow the reverse happened. Most of the new profits in the US go to the 1% leaving the 99% with the poopy end of the stick. So now there's a proposal to pull the same sort of stunt with the Affordable Care Act. Rig the system again so that most of the profits from a restructured health care plan will result in most of the new profits going to the 1% while most of the increased costs will be borne by the 99%. Looks like a lousy deal to me. Just the kind that the Trumpenstein Monster has favored in his own businesses, where he is reputed to have screwed employees, suppliers and builders out of negotiated wages and costs for services. Except that will put the Quackenstein in Chief in the position of being the Death Panel of one for Grandma. And all the rest of the family. Duck Donald! Duck!
"Conservatives" are trying to put lipstick on a pig. That pig is genocide through malign neglect by pulling away health coverage from 18-30 million fellow Americans. Many have chronic conditions that can be managed before they become life-threatening, but without care it's a death sentence without any sort of guilt through a crackpot ideology.
Trump's inauguration day, January 20, 2017, marked the 75th anniversary of the Wannsee Conference, called by Heinrich Himmler to set up the protocol for exterminating six million plus people. A "day of patriotic service"? That is 1/3--or less--the number of fellow Americans the Repubs want to snuff.
Trump's inauguration day, January 20, 2017, marked the 75th anniversary of the Wannsee Conference, called by Heinrich Himmler to set up the protocol for exterminating six million plus people. A "day of patriotic service"? That is 1/3--or less--the number of fellow Americans the Repubs want to snuff.
This ignores the fact that the patient has no way to shop around for better bargains. The prices are hidden, the need is usually immediate, the service quality varies widely, and the patient doesn't even know what he needs until after he makes his choice. How can anybody make an informed choice? And whatever plan the Republicans choose, none will force the hospitals, drug companies, and doctors to reveal their prices ahead of time.
1
Competition works great for commodities - like refrigerators or cars - but health care for real people is not a commodity. There are a number of reasons for this but the most important reason health care is not a commodity is that it is really one of our "unalienable rights" - "Life" is pretty dependent on health care.
Thus when someone arrives sick in the emergency room, no hospital would refuse them care (and can't by law), even if that care is going to be hundreds of thousands of dollars of high tech care.
It is amazing to me that Republicans will fight so hard for the "right" to bear arms and not for healthcare as an "unalienable" right. I suspect it is all a matter of following where their money comes from.
Thus when someone arrives sick in the emergency room, no hospital would refuse them care (and can't by law), even if that care is going to be hundreds of thousands of dollars of high tech care.
It is amazing to me that Republicans will fight so hard for the "right" to bear arms and not for healthcare as an "unalienable" right. I suspect it is all a matter of following where their money comes from.
1
I'm mystified at this opinion. Catastrophic coverage will not work for most people. They will suffer a thousand cuts (payments) before they reach their kick in of catastrophic coverage.
Mr. Douthat does not understand that someone in the bottom 1/3 of income most likely cannot take tax deductions and worst is his comment "too wide a gap between what the money in your health savings account covers and what you need before your catastrophic coverage kicks in" How many people earning 7.50 per house have heath savings account. He has got to be kidding.
Maybe Mr. Douthat should start by talking to people in the bottom third of income to see what their real concerns are. They live paycheck to paycheck with most having nothing extra for health issues
Mr. Douthat does not understand that someone in the bottom 1/3 of income most likely cannot take tax deductions and worst is his comment "too wide a gap between what the money in your health savings account covers and what you need before your catastrophic coverage kicks in" How many people earning 7.50 per house have heath savings account. He has got to be kidding.
Maybe Mr. Douthat should start by talking to people in the bottom third of income to see what their real concerns are. They live paycheck to paycheck with most having nothing extra for health issues
2
The insurance lobby is not going to allow for meaningful competition. Period. That is why market based solutions cannot work. You will get another series of smoke screens at the end of which you pay more for less and, if you really get sick, go bankrupt.
Supply and demand and making rational choices do not apply to Medicine.
In the 60s the supply of physicians was increased to ease total health care costs. The costs went up.
No system whether single state payer or the system we have can afford all the health care the population thinks they need.
If you, your children or a loved one face extinction from an illness rationality is the first thing to go.
Right now the easiest choice is Medicare for all, allow the government to negotiate drug and care costs, and most importantly allow science and not Congress to determine what treatments are cost effective.
In the 60s the supply of physicians was increased to ease total health care costs. The costs went up.
No system whether single state payer or the system we have can afford all the health care the population thinks they need.
If you, your children or a loved one face extinction from an illness rationality is the first thing to go.
Right now the easiest choice is Medicare for all, allow the government to negotiate drug and care costs, and most importantly allow science and not Congress to determine what treatments are cost effective.
2
Saying a system shouldn't have "too many uninsured" is essentially calculating how many poor people can be allowed to die because of bad or nonexistent health care before voters will demand a change in the system. That's not how a first-world country should be thinking. While it's possible to view principled Conservatism as a marriage of Burke and Friedman, the guiding principle of Republican health care policy is simpler and less principled: no system should be allowed that doesn't further enrich the wealthy owners of corporate health care providers, who tend overwhelmingly to vote for and fund the Republican party. No advanced and democratic country cares less about the welfare of its citizens than we do.
1
"That end would look like one of the more plausible conservative alternatives to Obamacare: a subsidy to cover the cost of a catastrophic health insurance plan, plus a directly funded health savings account to cover primary care." If that's your plan, those catastrophic plans had better be pretty hefty, because HSA's as "insurance" plans stink. People do not like to pay out of pocket for primary and/or preventative care. It's human nature- nobody likes to pay for healthcare if they're feeling fine and they discount the likelihood of preventing something worse later, by paying for something now. Therefore, there'll be plenty of catastrophic care to pay for- or not pay for and then plenty of medical bankruptcies once again. Another nonsensical factor is the idea of "competition" in the healthcare arena. Most areas of healthcare are not really competitive in the traditional sense of the word. Much of your truly expensive care, especially the catastrophic, is not something anyone will be shopping for on a cost basis. Having your husband treated for cancer is not the same as buying a car - you can't and shouldn't have to shop around. I am baffled by how an advanced, rich society sees healthcare as anything but an inalienable right. A more perfect union doesn't let it's citizens die because they are poor.
2
Access to quality affordable health care is a fundamental human right that rests on the divine natural equal certain unalienable rights of life, liberty and the pursuit of happiness. The inhumane cruel selfish notion that health care is for the privileged few as allocated by socioeconomic political values and interests is a diabolical delusional denial of the values inherent in human nature and nurture.
Obamacare originated as the conservative Republican Heritage Foundation's free market capitalist alternative to the Clinton Administration's failed Hillary led health care reform effort. Faced with their human mortality human beings are not going to be engaged in any rational cost benefit analysis regarding their medical health care options. Private bureaucrats standing between you and your doctor and hospital bed and treatment is an abomination.
Single payer today. Single payer tomorrow. Single payer forever.
Obamacare originated as the conservative Republican Heritage Foundation's free market capitalist alternative to the Clinton Administration's failed Hillary led health care reform effort. Faced with their human mortality human beings are not going to be engaged in any rational cost benefit analysis regarding their medical health care options. Private bureaucrats standing between you and your doctor and hospital bed and treatment is an abomination.
Single payer today. Single payer tomorrow. Single payer forever.
1
Obamacare (the mandate to buy health insurance) is a conservative idea! It is a market driven approach. When Dick Cheney proposed it in the 90's and Mitt Romney implemented it in Massachusetts, it was considered a conservative approach to universal healthcare. When Obama implemented it, it was deemed a socialist policy.
1
The concept of health insurance is the catastrophe we face. Everyone needs to plan to spend on health care just as we spend on food and housing. Before you were conceived you benefited from the health care your mother received. During your pregnancy and after your birth you received enormously important health care and immunizations. In adulthood you need to be checked regularly for the development of health issues that, left unaddressed will lead to suffering and premature death. This money must be spent, it is one of the most important investments you will make.
Insurance, however, implies that you may not need to spend any money, anymore than you may need to rebuild your home after a fire. It implies that if you are a good "Driver" in life you will avoid health issues and need not have to spend money on your health. Good luck with that idea.
What insurance does do is eliminate the marketplace. Prices are fixed, with a high degree of collusion, for everything from doctor visits to hospital stays to the cost of tests and drugs. The prices Americans pay for these items are outrageous by world standards. It is as though your basic family sedan was suddenly $100,000 or a loaf of bread $10.00. Some of that high cost is for the insurance company themselves, some of it is to support the ridiculous level of litigation and much of it is to support a bloated and inefficient hospital system.
To paraphrase Ronald Regan, insurance is the problem.
Insurance, however, implies that you may not need to spend any money, anymore than you may need to rebuild your home after a fire. It implies that if you are a good "Driver" in life you will avoid health issues and need not have to spend money on your health. Good luck with that idea.
What insurance does do is eliminate the marketplace. Prices are fixed, with a high degree of collusion, for everything from doctor visits to hospital stays to the cost of tests and drugs. The prices Americans pay for these items are outrageous by world standards. It is as though your basic family sedan was suddenly $100,000 or a loaf of bread $10.00. Some of that high cost is for the insurance company themselves, some of it is to support the ridiculous level of litigation and much of it is to support a bloated and inefficient hospital system.
To paraphrase Ronald Regan, insurance is the problem.
1
Living in a prosperous blue state as I do, I'm glad we will be able to keep Obamacare ( as even on the tiny coastal elite bubble where I live) it has helped a lot of people I know. I do feel sorry for the guinea pigs in the Pole red states, who will be experimenting with their health. Hope being "miserable" doesn't lead to too many deaths. Kafkaesque and draconian are the adjectives I would use. Not Burkean or Friedman like.
4
Most industrialized nations, with the exception of England and Canada, utilize market based Exchanges where buyers have options among competing plans. Everyone is covered. Health care insurers compete for buyers on the Exchanges driving down costs. It is called "managed competition." Insurers have colluded in dropping off the state exchanges. TrumpCare: The insured will pay for the uninsured." fp
"Conservative health care". Now there's an oxymoron for us all.
Mr. Douthat can't seem to acknowledge that the Republican Party of today is no longer conservative, but reactionary and nihilistic. That it is not conservative was clearly demonstrated by its backing of Donald Trump, who is not conservative either, and that it is reactionary is demonstrated by its rabid opposition to anything Obama, including holding hearings on Merrick Garland as it was required to do under the Constitution.
I challenge Mr. Douthat to put forth one - just one - conservative principal that the GOP has gone to the wall for over the last eight years. Oh, opposition to all things Democratic is not really a conservative principal. It's just the leg on which the modern GOP has chosen to stand.
This lack of governing principles is why the GOP will lose the Senate in 2018 and the rest of the show in 2020. The Democrats, meanwhile, will have to rediscover their own principles. They seem to have gone missing as well, thrown out of the house by the likes of Debbie Wasserman Schultz and Donna Brazile.
Mr. Douthat can't seem to acknowledge that the Republican Party of today is no longer conservative, but reactionary and nihilistic. That it is not conservative was clearly demonstrated by its backing of Donald Trump, who is not conservative either, and that it is reactionary is demonstrated by its rabid opposition to anything Obama, including holding hearings on Merrick Garland as it was required to do under the Constitution.
I challenge Mr. Douthat to put forth one - just one - conservative principal that the GOP has gone to the wall for over the last eight years. Oh, opposition to all things Democratic is not really a conservative principal. It's just the leg on which the modern GOP has chosen to stand.
This lack of governing principles is why the GOP will lose the Senate in 2018 and the rest of the show in 2020. The Democrats, meanwhile, will have to rediscover their own principles. They seem to have gone missing as well, thrown out of the house by the likes of Debbie Wasserman Schultz and Donna Brazile.
1
" So embracing even the smartest conservative Obamacare alternative"
Obamacare IS the smartest conservative alternative to single payer, at least according to the Heritage Foundation where it came from.
Obamacare IS the smartest conservative alternative to single payer, at least according to the Heritage Foundation where it came from.
3
The magical market as a solution to providing health care to Americans was the failing, flailing model before the ACA. The real substance of the Conservative answer is encapsulated in one sentence, " though its benefits would be less comprehensive than Obamacare’s." Exactly Mr. Douthat, and how is that different than rationing? What death panel will determine what constitutes catastrophic and who will turn away those seeking expensive care with inadequate coverage? Your billionaire President and his millionaire secretary of HHS can pay their own way. No Mr. Douthat, the burden of your inadequate fantasy will fall on me and my 15 employees. You'll have to better than this, much, much better to come close to replacing even the deeply
flawed ACA.
flawed ACA.
I like it. Red Staters ? You hate Obamacare so much? Great, then live with something your leaders on the Right will cook up. Meanwhile the residents of blue states will stick with the ACA (and Romneycare) and see how that goes.
States rights. 50 laboratories of democracy and all that. Yeah, but don't count on Republicans letting us have that side-by-side comparison.
States rights. 50 laboratories of democracy and all that. Yeah, but don't count on Republicans letting us have that side-by-side comparison.
4
RE: "the right’s best health care minds believe that markets and competition can deliver lower costs and better care"
Well, yes, that's true in regards to insurance. IF you are young, healthy, and wealthy. Otherwise you won't be invited to participate - thus keeping costs down and being able to give better care to the well(off).
Well, yes, that's true in regards to insurance. IF you are young, healthy, and wealthy. Otherwise you won't be invited to participate - thus keeping costs down and being able to give better care to the well(off).
The crisis in health care is fundamentally about cost and accessibility (which really are the definers of a market). Costs are driven by, lifestyles, an aging population, the expectation (perceived as the right) for highest technological solutions to treat illness even in the final days, and the litigious culture in which we inhabit. Costs INCREASES are lower not costs themselves. Accessibility is limited by income and location. While the GOP "experiments" what do we say to those who are impacted by the gaps and the costs? "Sorry, the market just didn't warrant your care?"
I suggest we simply remove federal funding for everything in the Red States, since they like to squawk about Washington so much.
If it is true that "Modern conservatism ... delivered a kind of bottom-up democratic wisdom", then why are Republicans so frightened of democracy that they routinely use voter suppression tactics and laws?
It seems the author believes that only "conservative" approaches, promoted by people who are already dead and have no need for health care, are the only ones worthy of consideration, even if they have never been field tested anywhere. So lets go test them on the poor. How christian of you Russ. I have a different idea - why don't you try out any or all of these proposals on your own family, Russ? Then get back to us and let us all know how it turns out. After all, that would be the "conservative" thing to do.
Mention Milton Friedman and I start to choke.
Milton Friedman’s economics has become for many a religion, or at least like a religion. But is it? Religious feeling always originates from inner experience. As this experience unfolds, it becomes the source of conviction on matters relating to the “Ultimate.” It is always expressed in some form to an attachment to the ultimate. It is variously described in terms of awe, wonder, presence of God, an oceanic feeling. One feels connected to "all that there is." A sense of attachment to an "energy" field beyond the individual takes hold. This awe experience can be so profound as to totally encompass and overpower all rational thought.
New age Friedman economists view their new “religion” as fitting all of these requirements. Descriptions of the Friedman-ian experience by his devotees includes words like compassion, ecstatic, and life/society transforming. Many reckon that the prosperous good life embraced by his economics with its fervent belief in unfettered capital markets as a means to attain a life fulfilled.
This is a delusion.
www.InquiryAbraham.com
Milton Friedman’s economics has become for many a religion, or at least like a religion. But is it? Religious feeling always originates from inner experience. As this experience unfolds, it becomes the source of conviction on matters relating to the “Ultimate.” It is always expressed in some form to an attachment to the ultimate. It is variously described in terms of awe, wonder, presence of God, an oceanic feeling. One feels connected to "all that there is." A sense of attachment to an "energy" field beyond the individual takes hold. This awe experience can be so profound as to totally encompass and overpower all rational thought.
New age Friedman economists view their new “religion” as fitting all of these requirements. Descriptions of the Friedman-ian experience by his devotees includes words like compassion, ecstatic, and life/society transforming. Many reckon that the prosperous good life embraced by his economics with its fervent belief in unfettered capital markets as a means to attain a life fulfilled.
This is a delusion.
www.InquiryAbraham.com
1
I have a lot of respect for Sen Collins and her attempts at reasonable Republicanism. However, I worry that the guinea pigs - the potential losers - in the experiments run by the states will not be Paul Ryan or Mitch McConnell or even "the government" but individuals who in those states where it is tried, and they may loose bigly in terms of either financial or physical health.
I understand the Trump does not like to read, but perhaps he can watch the 2008 PBS Frontline program based on T.R. Reid's "Healing of America". Reid surveyed the health insurance/care systems in a number of countries. From a description of the program:
"Three of the countries in the movie --Germany, Switzerland, and Japan -- providee health care for everybody at reasonable cost using private doctors, private hospitals, and private insurance."
Maybe viewing the film might prompt effective change, but maybe I am dreaming.
"Three of the countries in the movie --Germany, Switzerland, and Japan -- providee health care for everybody at reasonable cost using private doctors, private hospitals, and private insurance."
Maybe viewing the film might prompt effective change, but maybe I am dreaming.
Excuse me, Ross, but the American people are not an experiment. Some of them may not live to make it to the revolt.
3
The ACA is republican market driven approach that they cannot escape because there are no good alternatives other than the progressive single payer system. Access is without the means to actually get care is a cruel hoax. Republicans don't are about the ACA , they just used it to hate on Obama, and now they have no idea how to run country after taking the last 8 off from governing.
Of course, let's try that good old Conservative approach and get to that Republican utopia just as quickly as we can. It is working so well in Kansas, after all.
27
Sure Ross, let the states decide if it's most vulnerable should receive health car. While we're at it, let's allow the states to decide if blacks can sit at the same lunch counter as whites, if getting an abortion is a capital offense, and if gay guys and gals should be able to marry their loved ones. State's rights.
24
Note to readers: one fleeing insurance provider that Mr Douthat omits, Aetna, vacated markets as leverage over the government on a proposed merger with Humana. This is true conservative greed in action: Bow down to the blackmail of an insurance executive or he will destroy the healthcare coverage for millions.
18
In your summary of Cassidy-Collins proposal, you leave out any discussion about pre existing conditions; a vital requirement of Obamacare.
Also, you make it sound like republicans wanted health care but have been frustrated by mandates in Obamacare. During the past eight years, please name one republican in Congress, including Susan Collins, who was passionately arguing on behalf of American citizens without health care to become insured.
It was all about defeating President Obama and not allowing him a legislative victory. This latent discussion about 'replace' by the GOP is a ruse to nowhere when it comes to providing coverage for American citizens.
Also, you make it sound like republicans wanted health care but have been frustrated by mandates in Obamacare. During the past eight years, please name one republican in Congress, including Susan Collins, who was passionately arguing on behalf of American citizens without health care to become insured.
It was all about defeating President Obama and not allowing him a legislative victory. This latent discussion about 'replace' by the GOP is a ruse to nowhere when it comes to providing coverage for American citizens.
19
A thoughtful article. Both sides need to remove their ideological blinders and look at the results on the ground. This approach seems like a way to encourage that behavior.
1
Congressional Republicans are just scheming to push their unpopular positions on healthcare out to the governors. They are afraid to put their ideas on the line. Having Donald sign executive orders and governors get block grants takes the heat off their necks, or so they believe. This is not about the courage of their convictions. Quite the contrary. This belies their complete cowardice and inability to defend their indefensible position on this life and death issue. They disgust me.
14
I'll take part in this experiment, but only if all of the Senators and Congressmen join me and give up their high end, compressive, government health insurance plan. We can all experiment together. So, if their children get sick, they too, can try to manage through the programs (or lack of) and experiments they inflict on others.
17
The logic is frightening. For-profit corporations are created only to make money. To rely on them to lower healthcare costs is an oxymoron. Eliminate administrative costs and perhaps the system will make some sense. Congress will not eliminate administrative costs.
11
The basis for ACA was actually based on an idea out of a conservative think tank as a compromise for a single payer system. Two big issues not mentioned with catastrophic plans tied to health savings accounts without individual mandates are 1) either people with preexisting conditions will not be guaranteed coverage or the rates will be intolerably high since there would be little incentive to buy/keep insurance until you are ill and 2) there is little incentive for preventive care and screening which actually keeps people healthier and keeps long term costs down. The biggest killers in the US are heart disease (related to high blood pressure, diabetes, etc) and cancer.
8
Americans should get the same health care that Cassidy and Collins are entitled to.
17
Thanks for injecting meaning into the news again. This is an important topic and you selected two good thinkers to show us how to get a handle on health care programs. I still feel health care needs government intervention to preserve pure foods and drugs and to hold Big Pharma accountable for pricing policies. Freedom to stay sick is not a freedom most of us would appreciate.
So Blue states can keep the ACA... How about they keep the Federal tax dollars their citizens send to Washington DC too? And then we can make vouchers the means of funding DC. Each state can pay a fee to DC and they have to live within those means. Then each Blue state would be able to provide for their citizens and the Red states could fend for themselves.
15
Its been my understanding that the only reason that health insurers were able to offer plans in many rural areas (where people are generally less healthy) was because there was a mandate that required healthier people to get into those pool too, or be fined an amount that helps pay into the system.
Remove the mandate and those plans collapse, and a big part of the funding disappears. The plans that insurers will offer in it's place will be outrageously expensive and people will opt out and abuse the ER.
Remove the mandate and those plans collapse, and a big part of the funding disappears. The plans that insurers will offer in it's place will be outrageously expensive and people will opt out and abuse the ER.
10
The horsefly in the ointment is the nature of health care. It is not soap. People do not think rationally when they are in pain or in threat to their lives. When not in distress, they mostly view going to the doctor as a negative experience instead of as an opportunity to improve their current and future health. They engage in magical thinking--if I go to the doctor and don't tell him about my cough and he finds nothing, it must be nothing. Within a torrent of advertising, few people wish to be reminded of limitations such as a prudent diet or the need for exercise. They believe they can have it all. No one has cirrhosis in a beer commercial.
In short, few health consumers see value in supporting a primary care infrastructure to maintain health and place their bets on Behemoth General, that big hospital that can save them in any catastrophe without regard to cost. Very few people will be ready for a $5000 annual deductible in a catastrophic coverage plan. Everyone wants the advertised new pill and no one wants the unadvertised running or walking shoes.
In short, few health consumers see value in supporting a primary care infrastructure to maintain health and place their bets on Behemoth General, that big hospital that can save them in any catastrophe without regard to cost. Very few people will be ready for a $5000 annual deductible in a catastrophic coverage plan. Everyone wants the advertised new pill and no one wants the unadvertised running or walking shoes.
5
"why Republicans should give serious consideration to the proposal that Senator Bill Cassidy of Louisiana and Senator Susan Collins of Maine have just put forward as a possible health care reform alternative."
RD loves the idea that GOP governors, especially in the south, can control a health slush fund to dole out according to whim. What joy!
RD loves the idea that GOP governors, especially in the south, can control a health slush fund to dole out according to whim. What joy!
10
the examples cited are specious! Drug costs and laser eye surgery?
Laser eye surgery is largely discretionary. Medicaid drugs are usually renewing and ongoing prescriptions for seniors and thus a steady predictable product.
These examples actually prove why health care is NOT the real market the conservatives want to claim
Laser eye surgery is largely discretionary. Medicaid drugs are usually renewing and ongoing prescriptions for seniors and thus a steady predictable product.
These examples actually prove why health care is NOT the real market the conservatives want to claim
5
There are at least 3 questions that advocates for the wisdom of free markets need to answer in health care.
First, if free markets are the answer in healthcare, why does our healthcare system cost so much more than every other healthcare system in the world?
Second, why are internal medicine physicians paid about 1/10th of cardiologists? And yet, there is a huge need for internists? I would argue that internists deal with complex patients and that the difficulty of the medical issues they manage are equally complex.
And, finally, when you are riding in the ambulance having a heart attack how do free market forces work? In this situation, you are about to make the largest healthcare purchase of your life. You are not going to be weighing the options for care at this moment and making a rational market-based decision because you are vulnerable (you might be undergoing CPR for example). Instead, it is a moment where decisions are made in a paternalistic way for you, and very much out of your control.
During these vulnerable moments I strongly question the ability of the market to regulate supply and demand in the way we would hope. When you have a heart attack, cancer or a broken bone, rational economic decisions regarding price are out the window. People advocating for free market solutions need to address these concerns before advancing free market "solutions."
First, if free markets are the answer in healthcare, why does our healthcare system cost so much more than every other healthcare system in the world?
Second, why are internal medicine physicians paid about 1/10th of cardiologists? And yet, there is a huge need for internists? I would argue that internists deal with complex patients and that the difficulty of the medical issues they manage are equally complex.
And, finally, when you are riding in the ambulance having a heart attack how do free market forces work? In this situation, you are about to make the largest healthcare purchase of your life. You are not going to be weighing the options for care at this moment and making a rational market-based decision because you are vulnerable (you might be undergoing CPR for example). Instead, it is a moment where decisions are made in a paternalistic way for you, and very much out of your control.
During these vulnerable moments I strongly question the ability of the market to regulate supply and demand in the way we would hope. When you have a heart attack, cancer or a broken bone, rational economic decisions regarding price are out the window. People advocating for free market solutions need to address these concerns before advancing free market "solutions."
362
Excellent example of how markets with inelastic demand work.
If you really want to disrupt health care insurance in a good way, eliminate the employer deductions for employee healthcare and make everyone buy their nationwide insurance on a open National / Federal / state market and have major league consequences for not having insurance, like death or bankruptcy.
This may sound harsh but as the GOP says you gotta take responsibility for your own stuff. There should also be subsidies for those who cannot afford a basic plan ...say equivalent to a current bronze plan. Neither the Federal government nor any employer can actually determine the best healthcare plan for each individual only the individual can do that. This will drive insurers to provide plans that meet a minimum health care requirement and offer a wide variety of plans to meet individual needs.
Several popular features of ACA should remain such as keeping kids on the Ps plan until they're 26, No lifetime/ annual caps, wellness programs, free preventive care etc.
Fully fund an independent healthcare organization with 1% off the top of each insurance policy; provides price comparisons on healthcare providers for standard procedures; has performance scorecard on healthcare providers; provides a drug price comparison website; patient advocates to mediate billing and level of care disputes; and doctor information such as malpractice rates, additional income from drug companies, etc.
Increase drug pricing transparency and prohibit deals to keep generics off the market
This may sound harsh but as the GOP says you gotta take responsibility for your own stuff. There should also be subsidies for those who cannot afford a basic plan ...say equivalent to a current bronze plan. Neither the Federal government nor any employer can actually determine the best healthcare plan for each individual only the individual can do that. This will drive insurers to provide plans that meet a minimum health care requirement and offer a wide variety of plans to meet individual needs.
Several popular features of ACA should remain such as keeping kids on the Ps plan until they're 26, No lifetime/ annual caps, wellness programs, free preventive care etc.
Fully fund an independent healthcare organization with 1% off the top of each insurance policy; provides price comparisons on healthcare providers for standard procedures; has performance scorecard on healthcare providers; provides a drug price comparison website; patient advocates to mediate billing and level of care disputes; and doctor information such as malpractice rates, additional income from drug companies, etc.
Increase drug pricing transparency and prohibit deals to keep generics off the market
5
Mr. Douthat points to the fundamental incoherence of pre-Trump "modern conservatism" in his first sentence. The "wisdom of tradition" and the "wisdom of markets" are often in conflict with each other. One moves slowly, the other often moves quiet quickly. One abhors disruption, the other often thrives on it. Conservatives like both for their claims of unassailable transcendence. But their slimy actions consistently belie their vaunted values. A free and open market for pharmaceuticals? Hearings for Obama's SCOTUS nominee Merrick Garland as dictated by the Constitution? So-called conservatives have been cherry-picking their priorities for decades.
3
Great idea, only if the states that want to keep Obamacare get the same amount of money and no more than the other states.
1
More free market gibberish and another shameless apology for reactionary Republican policies designed to bankrupt Americans and enrich billionaires and insurence companies. This from another GOP shill whose disingenuous punditry and unceasing opposition to Obama paved the way for Trump. He is YOUR president Ross and you and YOUR party will pay dearly for foisting this sociopath on our nation.
7
Next time your kid needs surgery, tell her to suck it up so you can save a few bucks on "discretionary" health spending. How dare those damn poor people waste taxpayer money seeing the doctor when they feel sick!
12
You forgot to mention that the Collins-Cassidy plan includes REPEALING the federal mandate that large employers (like the NY Times) provide insurance to their employees. Let's see, that's millions of Americans who would suddenly have to hope and pray their employer didn't just ditch health care coverage.
And the biggest issue? Health care users are NOT consumers. Can conservatism acknowledge people's health should not be subject to the vagaries of the free market? It works for other countries.
And the biggest issue? Health care users are NOT consumers. Can conservatism acknowledge people's health should not be subject to the vagaries of the free market? It works for other countries.
8
Let's make this simple.
Under Donald Trump, how much is my next pacemaker going to cost me?
How about my neighbor's kidney dialysis?
How about the premature babies that will be born?
And more......
Under Donald Trump, how much is my next pacemaker going to cost me?
How about my neighbor's kidney dialysis?
How about the premature babies that will be born?
And more......
4
This column sounds as if it were written from a galaxy far far away...it seems to take as given that 1) I engage in recreational health care, that I go to my family practice or the ER for fun, as an option, because, after all, I'm not paying for it. I don't know anyone who does that. It's Tuesday. Did you decide to treat yourself to a facelift and a Viagra scrip on whim, Mr Douthat? 2) When I do need to go to the doctor, or, God forbid, the ER, my first order of business will be to call every provider within 100 miles and dicker about prices. So, when you have a heart attack, again, God forbid, Mr. Douthat, do be sure to instruct the EMTs to wait while you call around.
9
I am a retired nurse.... I was working when in the early 80's
Elite business schools ... Harvard , Yale, Princeton ... to name a few
Put forth the profits inducing premise ... that all health care is a privilege , NOT, a right!
The Bill Of RIGHTs supports health care as a Right inferred.
Life , liberty and the pursuit of happiness cannot be achieved unless we have a healthy physical ability and mental status.
Today's generations from the 80's forward cannot imagine a health care facility or caregiver not charging them for services. Gone are the local docs and their nurse wives opening up an office in their house and taking barter for payment.
So we have " business model healthcare standards instead of moral ethics and our caregivers running the show.
Elite business schools ... Harvard , Yale, Princeton ... to name a few
Put forth the profits inducing premise ... that all health care is a privilege , NOT, a right!
The Bill Of RIGHTs supports health care as a Right inferred.
Life , liberty and the pursuit of happiness cannot be achieved unless we have a healthy physical ability and mental status.
Today's generations from the 80's forward cannot imagine a health care facility or caregiver not charging them for services. Gone are the local docs and their nurse wives opening up an office in their house and taking barter for payment.
So we have " business model healthcare standards instead of moral ethics and our caregivers running the show.
2
"Free market" health care has been put to the test everywhere and everywhere it has failed. Essentially all other advanced countries have gone to centralized systems, mostly single-payer, and this delivers universal care at a fraction of the cost in the US. The ACA is actually a conservative plan, originating from the Heritage Foundation. It has extended coverage but not reduced costs (slowing the growth rate is not reduction).
It is long past time for "tests" of "free-market" systems.
It is long past time for "tests" of "free-market" systems.
17
"Romneycare" in Massachusetts was the model for the ACA. It's been a clear success and it will undoubtedly continue to be. If the ACA is repealed, every Democratic governor (and every sentient Republican administration) should simply repeat the Massachusetts experiment. They don't need The Donald's permission to do so.
39
MassHealth (aka Romneycare) really isn't a clear success. If everyone in the state were on MassHealth, no private medical practice would be able to stay open. It is economically unsustainable.
1
Included in the ACA was a tax on incomes over $200,000 to help finance the subsidies, the expansion of Medicaid and to close the donut hole for prescription drugs in Medicare. Congressional Republicans hate that tax and their first order of business concerning the ACA is to repeal it.
Their main objection to the ACA is not lack of competition or high deductibles but, as usual, to lower taxes on upper income individuals.
The driving force behind the Republican Party is to rob the federal government of the funding it requires to provide for the common good and to reward upper income citizens with a lower tax burden. Congressional Republicans hate the TAXES the ACA generated to help fund it. It's always about taking care of those who don't need it and punishing those who do. Follow the money.
Their main objection to the ACA is not lack of competition or high deductibles but, as usual, to lower taxes on upper income individuals.
The driving force behind the Republican Party is to rob the federal government of the funding it requires to provide for the common good and to reward upper income citizens with a lower tax burden. Congressional Republicans hate the TAXES the ACA generated to help fund it. It's always about taking care of those who don't need it and punishing those who do. Follow the money.
49
This is the problem with insuring expensive chronic conditions with high risk pools.
They work for auto insurance as liability limits are set by the state, and the asset covered has a certain market value. Above that, the car is simply considered "totaled out" and there are no further payments, not for a replacement cost, not for the utility value of a car that was very old and basic but was the sole transport to employment.
At what value, are we to total out a human being and citizen of our nation?
They work for auto insurance as liability limits are set by the state, and the asset covered has a certain market value. Above that, the car is simply considered "totaled out" and there are no further payments, not for a replacement cost, not for the utility value of a car that was very old and basic but was the sole transport to employment.
At what value, are we to total out a human being and citizen of our nation?
13
Mr. Douthat,
The most telling thing is that Republicans have had years to come up with an alternative, but have shown the American public nothing.
It's remarkable that Republicans still pretend that people should shop around for coverage. It's remarkable that Republicans think that it's a choice whether you should have health insurance or not. It's remarkable that Republicans pretend that the ACA is different from Romneycare. But then again with the new president, at least now they are being led by the perfect Liar-in-Chief who matches their pathology.
Medicare for all.
Pay for it by having people like Trump pay taxes, people like Romney and hedge fund guys not pay a lower tax rate than others through the carried interest tax rate loop and corporations not paying their fair share, because when America was great, those people paid their taxes for the good of all of us.
The most telling thing is that Republicans have had years to come up with an alternative, but have shown the American public nothing.
It's remarkable that Republicans still pretend that people should shop around for coverage. It's remarkable that Republicans think that it's a choice whether you should have health insurance or not. It's remarkable that Republicans pretend that the ACA is different from Romneycare. But then again with the new president, at least now they are being led by the perfect Liar-in-Chief who matches their pathology.
Medicare for all.
Pay for it by having people like Trump pay taxes, people like Romney and hedge fund guys not pay a lower tax rate than others through the carried interest tax rate loop and corporations not paying their fair share, because when America was great, those people paid their taxes for the good of all of us.
46
It is remarkable also that children are never mentioned in Republican plans event though they are perfectly innocent of any blame for the health care mess.
These are the same people who would get in the lifeboats first instead of children.
How can representatives and senators accept free healthcare when there is even one child without care?
These are the same people who would get in the lifeboats first instead of children.
How can representatives and senators accept free healthcare when there is even one child without care?
1
And yet other countries have a true health CARE system that serves every person. No one dies from lack of access to the care they need. No one has to worry about going bankrupt from needing medical care. Only in America do we see a lack of interest in what the patient needs. Only in America are patients told they are consumers, to shop around, to get the best deal, to expect their choices to be unreasonably limited in terms of specialists, hospitals, and the level of care. Only in America do patients skip out on care they need because, even with insurance, they know that a simple test can lead to a hassle with the insurance company. Or, even with insurance, they can wind up with costs that are more than they can afford due to co-pays, deductibles, coinsurance costs, out of network costs, and premiums.
We need to fix the ACA, not repeal it. We ought to have a universal access, single payor health CARE system instead of the wealth care fee for service system we're currently suffering under. If it can't be fixed, let's remove Congress' access to their system. Betcha they'd fix things for all of us then.
We need to fix the ACA, not repeal it. We ought to have a universal access, single payor health CARE system instead of the wealth care fee for service system we're currently suffering under. If it can't be fixed, let's remove Congress' access to their system. Betcha they'd fix things for all of us then.
47
Conservatives give lip service to free market principles but consistently favor monopoly enterprises, big business over labor, tax breaks for the wealthy, and huge Federal subsidies and handouts to private contractors. The symbol of the GOP should not be an elephant, it should be a pig at the trough.
45
And the withdrawal of insurance companies from many markets under the ACA had nothing to do with insurance losses but to monopoly practices:
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-aetna-obamacare-20...
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-aetna-obamacare-20...
2
Mr Douthat's glaring and probably intentional error: Much of what he's talking about is part of existing law. The ACA, for example, has market competition as a fundamental hallmark of the policy, as evidenced by the fact that healthcare.gov is a marketplace, not a signup portal for government-run health care. Also, it's perfectly legal under current law to get a catastrophic health insurance policy ("Bronze Plan") and combine that with a health savings account. This isn't surprising, since the ACA's birthplace was the conservative Heritage Foundation.
So, what does he mention that is actually different?
1. He wants the states to be allowed to do almost anything they want with the money they currently get for implementing the ACA. Including gut the Medicaid expansion.
2. He wants to include auto-enrollment. This sounds like a recipe for a lot of back-scratching to figure out which company gets to be the one everybody is auto-enrolled in.
Neither of them sound like a good idea to me.
So, what does he mention that is actually different?
1. He wants the states to be allowed to do almost anything they want with the money they currently get for implementing the ACA. Including gut the Medicaid expansion.
2. He wants to include auto-enrollment. This sounds like a recipe for a lot of back-scratching to figure out which company gets to be the one everybody is auto-enrolled in.
Neither of them sound like a good idea to me.
23
In devising a system, it is necessary to start from the bottom. Do we want to provide insurance for everyone or nearly everyone? If that is so, what are the economic conditions of the bottom 20, 30, 40% of the people to be covered.
What is the minimum coverage to be offered and what amounts these individuals who have little or no resources, need to make possible their coverage. Because the fundamental problem is this. People in the top 30% will have their insurance from their work or their own resources. The next third
may need some help, the bottom third will need much more. However, the system cannot be controlled fully by the market with its desire to derive more and more profits, unless the state (states) is willing to cover the inevitable increases, otherwise the bottom third will soon be priced out of the market. Free market works on the basis of choice, you can buy or not, the health market is an absolute, you must buy or die. The power of the consumer is limited or null, the power of the provider is absolute. That's something that cannot be escaped.
What is the minimum coverage to be offered and what amounts these individuals who have little or no resources, need to make possible their coverage. Because the fundamental problem is this. People in the top 30% will have their insurance from their work or their own resources. The next third
may need some help, the bottom third will need much more. However, the system cannot be controlled fully by the market with its desire to derive more and more profits, unless the state (states) is willing to cover the inevitable increases, otherwise the bottom third will soon be priced out of the market. Free market works on the basis of choice, you can buy or not, the health market is an absolute, you must buy or die. The power of the consumer is limited or null, the power of the provider is absolute. That's something that cannot be escaped.
47
Compelling evidence that markets in healthcare lower costs? The US as just about the most open and profit oriented healthcare system in the world and it's the most expensive in the world. Either Douhat is telling porkies or ignorant.
162
And least cost-effective
I'd rather see the Collins-Cassidy bill than other Republican proposals, but only because smart states that retain a mandate and stay on the marketplace could avoid the meltdown that's coming for everyone else. I agree that it's the more Burkean approach. It's also a nice wedge issue for Republicans, since the Republican proposal since Romney has been that healthcare should be left for states.
But you can't cite an op-ed by Tyler Cowen--one not purporting to be a serious academic study by any means--or a piece by David Brooks cherry-picking one or two studies (one of which appears to be theoretical, not empirical) and then suggest that the conservative view on healthcare is well-grounded empirically. There are numerous studies challenging the effectiveness of market-based pricing in healthcare. Most of the healthcare economists who think that markets price healthcare well would favor a system that's much more "statist" than anything Republicans are considering--indeed, more statist than Obamacare.
But you can't cite an op-ed by Tyler Cowen--one not purporting to be a serious academic study by any means--or a piece by David Brooks cherry-picking one or two studies (one of which appears to be theoretical, not empirical) and then suggest that the conservative view on healthcare is well-grounded empirically. There are numerous studies challenging the effectiveness of market-based pricing in healthcare. Most of the healthcare economists who think that markets price healthcare well would favor a system that's much more "statist" than anything Republicans are considering--indeed, more statist than Obamacare.
30
"while an alternative system gets set up in red states"
Oh, really? I can't wait to see what Texas cooks up.
Oh, really? I can't wait to see what Texas cooks up.
45
Single payer is the only answer. Medicare for all.
243
Single payer with a private option, every other industrial country provides higher quality healthcare than ours for 1/2 or more less. We spend twice as much and more.
More so it could help reduce worker's comp costs, eliminate most of the Medicaid programs, which are duplicating the Medicare program, eliminate the Public Health System.
Lets be neither liberal nor conservative but instead pragmatic as we can do much better for a lot less.
And by the way, if you give tax credits to a person making $20,000 per year to purchase insurance which costs $8000 - $12000 per year how does that help a person who would only pay about $4000 in taxes. Tom Price says poor people would have access but not having enough money is not really access.
More so it could help reduce worker's comp costs, eliminate most of the Medicaid programs, which are duplicating the Medicare program, eliminate the Public Health System.
Lets be neither liberal nor conservative but instead pragmatic as we can do much better for a lot less.
And by the way, if you give tax credits to a person making $20,000 per year to purchase insurance which costs $8000 - $12000 per year how does that help a person who would only pay about $4000 in taxes. Tom Price says poor people would have access but not having enough money is not really access.
"Which is not to say that the conservative health policy vision lacks empirical grounding...'
Please, that's exactly what it lacks, Mr. Orwell.
I suppose it's futile to remind you and Edmund Burke that real lives are at stake.
Please, that's exactly what it lacks, Mr. Orwell.
I suppose it's futile to remind you and Edmund Burke that real lives are at stake.
24
Right. Catastrophic care, and "skin in the game" for everything else. Translation: only the well-off will have solid preventive and wellness care; and the rest will be too stupid to notice (Will you take a look at that beautiful wall!?!) while they die off. I really can't imagine what it must feel like to be one of you people.
36
Correction. Only the well-off without pre-existing conditions.
Medicare for everyone. Negotiate drug prices.
39
But why should we experiment with a system based on lightly regulated private insurance that far from being untried, has been tried by most other developed countries? None of these countries could get it to work. ALL of them have moved to a system of universal government run health care and achieved much better results. The data are overwhelming. Here are some:
All other industrialized countries have some form of universal government run health care, mostly single payor. They get better care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person. If our system were as efficient, we would save over $1.5 TRILLION each year.
www.pnhp.org & www.oecd.org, especially
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
Here are the per capita figures for health care costs in 2013 in PPP dollars (which take cost of living into consideration) from the OECD:
OECD average - 3463
US - 8713
UK - 3235
France - 4124
Australia (similar obesity) - 3966
Germany - 4919
Denmark - 4553
The Netherlands (partially like Switzerland) - 5131
Canada - 4361
Israel - 2128
Switzerland (Highly regulated private insurance) - 6325
Let;s compare some bottom line statistics between the US and the UK which has real socialized medicine.
Life expectancy at birth:
UK - 81.1
US - 78.8
Infant Mortality (Deaths per 1,000):
UK - 3.8
US - 6.0
Maternal Mortality (WHO):
UK - 9
US - 14
All other industrialized countries have some form of universal government run health care, mostly single payor. They get better care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person. If our system were as efficient, we would save over $1.5 TRILLION each year.
www.pnhp.org & www.oecd.org, especially
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
Here are the per capita figures for health care costs in 2013 in PPP dollars (which take cost of living into consideration) from the OECD:
OECD average - 3463
US - 8713
UK - 3235
France - 4124
Australia (similar obesity) - 3966
Germany - 4919
Denmark - 4553
The Netherlands (partially like Switzerland) - 5131
Canada - 4361
Israel - 2128
Switzerland (Highly regulated private insurance) - 6325
Let;s compare some bottom line statistics between the US and the UK which has real socialized medicine.
Life expectancy at birth:
UK - 81.1
US - 78.8
Infant Mortality (Deaths per 1,000):
UK - 3.8
US - 6.0
Maternal Mortality (WHO):
UK - 9
US - 14
94
With all the statistics cited on the cost and outcomes of healthcare, the true benchmarks should be how much money is spent on actual care versus overhead,and what is the profit margin ? That will tell you a lot about where the money is going. The Republicans mantra is profit,profit, profit. If they were concerned,really concerned about quality and cost, they would have chosen a family doctor,not an orthopedic surgeon to head HHS.
Writers should really look closely at the Canadian system, which is single payer and run by the Provinces and where the federal Gov't has a largely supervisory role.
"Obamacare is failing less than we thought" is just right-speak for "it's succeeding, darn it"
50
Like Marxists, the right wing is convinced of the rectitude of Adam Smith's market under all circumstances even though Smith himself wasn't. For the GOP this means that if there is a problem it will only be solved with more market...in this case with health care that is easily shown to not be a market commodity.
The upside for them is that this dovetails nicely with the 1%er plutocrats who would love nothing more than to dump the whole thing on the working class under the banner of "freedom".
And the beat goes on...
The upside for them is that this dovetails nicely with the 1%er plutocrats who would love nothing more than to dump the whole thing on the working class under the banner of "freedom".
And the beat goes on...
30
Remember that Adam Smith also said that when two "producers" met in a pub in private, the first thing they did was talk about colluding to control prices and workers wages and cornering the market to maximize profits!
When all you have is a hammer, everything looks like a nail.
This is ridiculous and most of all your assumptions are untrue. Innovation in the private sector with complex systems like healthcare is inefficient and costly. That's why the government had to do chip-fab labs under Reagan and NASA. The private sector is capable of hording money but incapable of serious research because of the need for surplus as motivation. You are the Ford equivalent of auto care where it's only fixed when it breaks while the Japanese/Deming program of regular upkeep is less expensive and makes the car drive longer. This ridiculous pedantry must stop. I don't know why they let you write in this newspaper filled with thoughtfulness. It took a Donald Trump to drive the NYTimes out of it's complacency. Now your only purpose is to show us how bankrupt so called "tradition" really is when it is actually just the old fashioned Tories that were kicked in the Revolutionary War back for a second try. REH
44
Once again, with feeling: Capitalism's definition of "efficiency" is the best allocation of a scarce resource based on the ability to pay for it. Therefore Lamborghinis go to the rich, buses to the poor. Filet mignon with truffle oil to the rich, rice and beans to the poor.
Healthcare to the rich..... And, well, sickness, disability, slow death, insecurity, stress and grief to the poor.
With a state based approach, we make the right to survive a matter of good luck in employment and the location of your house. Y'know, you have the personal responsibility to not choose to get sick if you can't afford it. And don't have sick kid, either.
Healthcare reform's best hope WAS the ACA, since our political reality makes nationalizing health insurance investments unlikely. We could have tried to fix it, expand it, get rid of regulations that don't work. But instead we have decided that whole bunch of people are simply disposable. And Sarah Palin complained of death panels. Amazing.
Healthcare to the rich..... And, well, sickness, disability, slow death, insecurity, stress and grief to the poor.
With a state based approach, we make the right to survive a matter of good luck in employment and the location of your house. Y'know, you have the personal responsibility to not choose to get sick if you can't afford it. And don't have sick kid, either.
Healthcare reform's best hope WAS the ACA, since our political reality makes nationalizing health insurance investments unlikely. We could have tried to fix it, expand it, get rid of regulations that don't work. But instead we have decided that whole bunch of people are simply disposable. And Sarah Palin complained of death panels. Amazing.
109
I thought modern conservatism wanted to ban a marriage between Edmund Burke and Milton Friedman?
54
What tripe. There is no such thing as Conservatism. The Republican Party consists of radicals and shills for the rich conning the ignorant to get what they want.
281
Free market healthcare is an illusion. When a person walks into an ER and has to be treated no matter their ability to pay (or if they have insurance or not), that is not free market. Someone else will pay for that very expensive care. And because you CAN buy insurance doesn't mean you WILL buy it. Catastrophic insurance does nothing to help to make people get healthier, thus lowering costs. All it's intended to do is prevent bankruptcy. It doesn't provide any regular healthcare. So where will all those people who have no insurance or can only afford catastrophic insurance go for regular healthcare? The ER. The most expensive place to get healthcare. All the Republicans are aiming to do is have a plan to provide regular healthcare for those able to afford it and let everyone else rely on very limited healthcare, based on their ability to pay. Make no mistake: the Republican "plan" is to "take care" of those who can pay. Those who cant, well altruism is not an American value anymore. The reason the Republicans don't have a plan yet is they are trying to put the facade on it so the public doesn't figure out what it is and who to blame. Enjoy your wait in the ER.
142
As said many times before: Republican health plan: Don't get sick.
There is a reason that the system you describe does not exist Ross, it does not work. Do you suppose the rest of the developed work deluded, mistaken, or just ignorant, no they understand that healthcare is not subject to the same rules that apply to other markets. The US is now led by people for whom "markets" are not just the answer, it is the only answer. That is not policy it is ideology.
169
Conservatives just can't seem to get their heads around three essential facts:
1. Without a mandate, only the sick or at risk of sickness opt-in and the per person cost of the system spirals out of affordability and viability. So Ross' point that coverage would be universal is a conservative fantasy...
2. Essential healthcare is a good with no substitutes. When Antonin Scalia wondered whether we should be compelled to eat brocolli as a comparison to being compelled to purchase healthcare the correct answer was "no because you could eat other goods to get the same nutrients and you can flourish without it". There is nothing you can substitute healthcare for except ill health and death.
3. Catastrophic healthcare assumes that the only thing that people need is support with sudden life threatening illness. Bit that assumes that there is no such thing as chronic conditions that may start off with non catastrophic symptoms that worsen without treatment.
When oh when will we let go of idelogy and let the best system possible deal with the problem at hand. If that is free markets, fine. If it is socialised medicine, fine, and if it a combination then that too should be fine. But markets fail and healthcare is not an iphone or a car and competition and innovation are not the most important considerations.
1. Without a mandate, only the sick or at risk of sickness opt-in and the per person cost of the system spirals out of affordability and viability. So Ross' point that coverage would be universal is a conservative fantasy...
2. Essential healthcare is a good with no substitutes. When Antonin Scalia wondered whether we should be compelled to eat brocolli as a comparison to being compelled to purchase healthcare the correct answer was "no because you could eat other goods to get the same nutrients and you can flourish without it". There is nothing you can substitute healthcare for except ill health and death.
3. Catastrophic healthcare assumes that the only thing that people need is support with sudden life threatening illness. Bit that assumes that there is no such thing as chronic conditions that may start off with non catastrophic symptoms that worsen without treatment.
When oh when will we let go of idelogy and let the best system possible deal with the problem at hand. If that is free markets, fine. If it is socialised medicine, fine, and if it a combination then that too should be fine. But markets fail and healthcare is not an iphone or a car and competition and innovation are not the most important considerations.
171
Didn't take much for Federalist Society Scalia to concoct an argument and then have the neocons fawning over his "wisdom" of original intent
The Founders had a concept of "the general welfare" but 240 years ago it was not an articulated concept. There was no modern medicine and even economics ie Adam Smith was not invented.
So talking about some cockamamie philosopher who was a "conservative" at a time when the English conservatives were writing to protect a rigid class structure with no social mobility.
They were hanging people for stealing a loaf of bread.
Remember when they paid the head of United Health Care $128 million?
Yay Markets!!!
The Founders had a concept of "the general welfare" but 240 years ago it was not an articulated concept. There was no modern medicine and even economics ie Adam Smith was not invented.
So talking about some cockamamie philosopher who was a "conservative" at a time when the English conservatives were writing to protect a rigid class structure with no social mobility.
They were hanging people for stealing a loaf of bread.
Remember when they paid the head of United Health Care $128 million?
Yay Markets!!!
But you could cut out screenings and so called "preventative care." Big dip in the cost and a surprisingly small impact. Public health experts, such as Dr. Gilbert Welch of Dartmouth, have been saying this for years. Recently Christiane Northrup, a board-certified OB-GYN and author, wrote Goddesses Never Age; she emphasizes that screenings are not health care and risk reduction comes from lifestyle, not meds. In particular, many older people are on meds they don't need. I''m meeting more and more educated people who are turning down screenings and tests.
Well said, To risk healthcare system as we risk investments in Iphones or any other commodity is a false concept. It would be interesting to read a health care essay that is not steeped in conservative obsessions or liberal obsessions. Notice that this uses a "conservative" thinker and there is that usual barb thrown at Blue States. Free market in health care is an illusion, and now these two are playing with fire. Why don't Congress members give up their platinum plans and enter a pool themselves. Health care is a national and world wide issue, it is not restricted to the borders surrounding states. People move back and forth all of the time...It would be a nightmare for all Americans, as people try to figure out what would be a good state to move to in search of the right health plan. To base a long term commitment on health care on this stupid election is short sighted and restrictive. A catastrophic umbrella presumes that poor people on have life threatening problems and does nothing for preventive medicine. As far as health care is concerned in the US. to paraphrase Obama's first convention speech..."there are no blue states and there are no red states" we are all Americans and we all deserve solid health care for all, not only for those who can afford it. Stop resisting the obvious that health care is something that needs to be provided for all.
Catastrophic coverage brings to mind the old line about owing money to banks: if you owe the hospital $5000 and can't pay, you're in big trouble. If you owe the hospital $500,000 and can't pay, the hospital is in big trouble.
It is as much or more for the benefit of the hospitals as it is for the people.
It is as much or more for the benefit of the hospitals as it is for the people.
64
Yes, smaller rural hospitals are very concerned. Ironic, most of their community members, who utilize their hospital and clinic services, are Republicans!
Um...Ross? Did you miss the memo about the right wing health wonks at Heritage who, while the GOP. was avoiding addressing the problem came up with a market based approach? Gingrich himself endorsed it. And how about the Republican governor who tried it out successfully? And that the ACA is based on this? And all it really needed was for the GOP to get behind it to make reasonable accommodations and improvements for it to work nationally? But of course they turned their back and called it Obamacare to try to sandbag it. Shame. If Romney had been elected in 08 the GOP would have welcomed it with open arms, taken credit, worked out the bugs and it would be fine today. Pox on the lot of them.
1102
Douthat fails, once again, to report that ACA is the GOP plan, from Nixon through Romneycare. For decades, conservatives favored a market based approach to health care insurance: the mandate, choice of provider, buying insurance on an exchange or marketplace. When Republicans promise to “repeal and replace” because they have a more workable market plan, they’re promising something that does not exist.
The mandate does not initiate a new transaction: people only buy insurance to pay for care. It is nothing more than a requirement to pay for a service that everyone is already using – in the only way most can – with insurance, since most cannot afford to self-insure.
Health care is not voluntary in the same way as eating broccoli. Health care is chosen under duress. Many people lead fine lives without eating broccoli, but life is brutal without health care or the means to pay for it. The mandate was opposed only by libertarians who were OK if millions had no access to insurance.
We have insurance because most cannot afford to self-insure. Insurance is when everyone pays in to cover the times when each person has an expense. Permitting inadequate coverage (very high deductibles, high risk pools, paying with vouchers) is about the same as permitting non-coverage, which is the opposite of insurance.
The main GOP case against ACA is presented in Josh Blackman’s book “Unprecedented”. See the point by point reply in my review on Amazon site > all reviews > top critical review.
The mandate does not initiate a new transaction: people only buy insurance to pay for care. It is nothing more than a requirement to pay for a service that everyone is already using – in the only way most can – with insurance, since most cannot afford to self-insure.
Health care is not voluntary in the same way as eating broccoli. Health care is chosen under duress. Many people lead fine lives without eating broccoli, but life is brutal without health care or the means to pay for it. The mandate was opposed only by libertarians who were OK if millions had no access to insurance.
We have insurance because most cannot afford to self-insure. Insurance is when everyone pays in to cover the times when each person has an expense. Permitting inadequate coverage (very high deductibles, high risk pools, paying with vouchers) is about the same as permitting non-coverage, which is the opposite of insurance.
The main GOP case against ACA is presented in Josh Blackman’s book “Unprecedented”. See the point by point reply in my review on Amazon site > all reviews > top critical review.
3
Exactly. And the Democrats would have been working with them to work out the bugs. And they'd have been giving credit where credit was due. And that would actually have been good politics for them, because their base is comprised of people with heart, and that's the difference. Trump's a symptom; even the Pence/Ryan cabal (who'll actually be high-fiving when Babyhands implodes) is only a symptom. The real issue, and what we never talk about, is conservatism at its core, and what's at the core of those who gravitate to it. To wit: every word of this column.
1
Obama, himself, called the ACA, "Obamacare," a huge mistake, and a big contributor to it's ultimate undoing. If Obama wanted to get rid of anything in the federal government he should prefix the name with his.
The Republicans relentless twenty four seven attack on anything "Obama" was predictable, and thanks to Fox, totally effective. They used a relatively benign healthcare assistance for the poor, and turned it into a "wedge issue."
I have spoken to many people totally against the ACA, and they don't know anything about it. People don't even know what the name, "ACA," even means. They all say, it's cheaper for people to just go to the ER for emergency care.
"Alternative truths," the mainstay of Republican cognative dissonance, ignorance, and job security!
The Republicans relentless twenty four seven attack on anything "Obama" was predictable, and thanks to Fox, totally effective. They used a relatively benign healthcare assistance for the poor, and turned it into a "wedge issue."
I have spoken to many people totally against the ACA, and they don't know anything about it. People don't even know what the name, "ACA," even means. They all say, it's cheaper for people to just go to the ER for emergency care.
"Alternative truths," the mainstay of Republican cognative dissonance, ignorance, and job security!
1
Ross, I appreciate the fresh perspective that you bring to this column, but the knot that none of these "market" approaches can reliably address is how to provide decent health care for people with long-term chronic conditions. As you note, with only "catastrophic" coverage or other limited protections, these people "would rack up impossible medical bills in short order".
The problem that should concern us all is that ANY of us can become chronically ill at any point of our lives. Life is a game of chance. If your child suddenly develops cancer, if you are hit by a bus and become paralyzed, or if you have an unexpected stroke, you are rapidly going to become bankrupt even if you've been a good citizen, taxpayer, and family provider all of your life. You may be the healthiest person on the planet, but accidents happen. There is nothing unfair--or wrong--with healthy individuals having to pay a slight premium (a mandate) to ensure that any of us are not forced to sleep on the streets or die on the hospital steps if we find ourselves in that predicament.
For tomorrow, that hypothetical person with the long-term, chronic, and expensive disability could be me.
Or you. Then what?
The problem that should concern us all is that ANY of us can become chronically ill at any point of our lives. Life is a game of chance. If your child suddenly develops cancer, if you are hit by a bus and become paralyzed, or if you have an unexpected stroke, you are rapidly going to become bankrupt even if you've been a good citizen, taxpayer, and family provider all of your life. You may be the healthiest person on the planet, but accidents happen. There is nothing unfair--or wrong--with healthy individuals having to pay a slight premium (a mandate) to ensure that any of us are not forced to sleep on the streets or die on the hospital steps if we find ourselves in that predicament.
For tomorrow, that hypothetical person with the long-term, chronic, and expensive disability could be me.
Or you. Then what?
620
Allow me to provide myself as an example. As a young man, I was extremely healthy. I was athletic, playing in full-court basketball leagues into my early thirties. I never smoked or used drugs. I ate healthy foods and was never over weight. From the time I completed college at the age of twenty-two, I had health insurance through my employers. My insurance companies loved me. My employers and I paid premiums and I never collected a dime in benefits because I was so healthy. Then, when I was thirty-four years old, I was diagnosed with multiple sclerosis. The new medications to treat MS cost upwards of $80,000 a year. You know what? My private health insurance company did not love me anymore. The hoops they made me jump through to obtain treatment were shocking and burdensome. I lived with the terrifying knowledge that if I lost my health insurance no other company would cover me because I had a chronic pre-existing condition that was very expensive to treat. Today, even though I struggle with paralysis and other complications of MS, I know that I can continue to get health insurance due to the Affordable Care Act. It is good for all Americans to know that Disabled Americans is the one minority group that anyone can become a member of at any minute of the day.
243
We have to decide whether chronic illness is an individual misfortune to be borne by the individual, his or her family, insurance (according to the terms of the policy), and volunteers (charity), or whether society will make chronic illness a common burden to be borne by us all. In the first case, chronic illness is something to be dreaded for economic reasons as well as because health is better than illness. In the second case, the economic burden is lifted and the chronically ill person is left with the burden of getting better or managing the condition. The distraction of economic conditions and the perverse effects of economics on treatment decisions are gone.
For some reason, Americans have chosen the first, Russian roulette approach. Every time we drive we put the pistol of unaffordable medical bills to our heads and pull the trigger. We usually survive.
For some reason, Americans have chosen the first, Russian roulette approach. Every time we drive we put the pistol of unaffordable medical bills to our heads and pull the trigger. We usually survive.
3
I'm sorry about your circumstances. But if you aren't a billionaire, no one in the Republican Party cares what happens to you (after you vote for Trump, of course).
7
"...That is, the right’s best health care minds believe that markets and competition can deliver lower costs and better care, ..."
The free market doesn't work in health care because it's not a free market. It's not a free market because you don't get to choose illnesses that fit in your budget like you can when buying a career a computer, and you can't decide to do without because you can't decide not to be ill.
Then there's the canard about "choice". But what choice? "Choosing less than a plan that offers full coverage is not a choice but an economic necessity unless one is so rich and healthy, he can choose no or little insurance and still afford to pay for the care he will eventually need. All others have no such choice.
And finally, Conservatives, modern or traditional, aren't moved by the plight of the poor who can't afford the health care they need. Conservatives feel they should rely on charity. In other words, "Let them beg!"
Modern conservatism isn't about tradition it's about greed and not wasting their "hard earned" money on the less fortunate who are that way because they are lazy or otherwise takers and moochers.
The free market doesn't work in health care because it's not a free market. It's not a free market because you don't get to choose illnesses that fit in your budget like you can when buying a career a computer, and you can't decide to do without because you can't decide not to be ill.
Then there's the canard about "choice". But what choice? "Choosing less than a plan that offers full coverage is not a choice but an economic necessity unless one is so rich and healthy, he can choose no or little insurance and still afford to pay for the care he will eventually need. All others have no such choice.
And finally, Conservatives, modern or traditional, aren't moved by the plight of the poor who can't afford the health care they need. Conservatives feel they should rely on charity. In other words, "Let them beg!"
Modern conservatism isn't about tradition it's about greed and not wasting their "hard earned" money on the less fortunate who are that way because they are lazy or otherwise takers and moochers.
987
William Dufort, thank you for your logical comment. No, we don't usually get choices in what illnesses we get, inherit, or wind up with due to exposure through other people. We can make choices to eat healthy foods, exercise, finish school, etc. But life has a way of throwing us curve balls, wicked ones that can really derail any plans we've made. Lose a job, have an accident, have a child, whatever. Life happens and we have to accommodate it.
2
@William Dufort: The free market also doesn't work in healthcare because hospitals are required to provide some of their most expensive services--trauma and emergency care--regardless of patients' ability to pay.
2
That should have read: buying a car or a computer...
1
The right fails to appreciate that there is no "market" that is not already skewed because of lobbyists, government welfare for big business, and the fact that being affordable is not the goal of insurance - because they are FOR profit, it's all about the he short term profit. Until we have a single payer system, we are doomed to spin our wheels on health care while people are deprived of the care they need and the ability to treat issues without going bankrupt.
4
Yes, the major problem with the ACA is the rising out of pocket cost, its really just catastrophic insurance with no help for the day to day doctors visits. When I look at the GOP's replacements to fix this what I see is what we had before the ACA with the provision that insurance company's can not discriminate. Those days were not cheap and the company's could cherry pick customers, what makes people believe they will now offer cheap, great coverage to everyone regardless of age or health, especially when only sick people need apply. I believe some things need a mandate to work. A example is having car insurance, social security and medicare. When the people who do not want health insurance have a problem and get a large bill they just file for medical bankruptcy, all that does is drive the cost up for us all.
3
'But still — there is no existing system on a national scale that looks like the health care system that Paul Ryan or Tom Price would design...'
That's because good Christians Price and Ryan would design a system that was basically 'Don't get sick and if you do, please die quickly'. Few people seem to hate the poor for being poor as much as Ryan -- maybe he missed those particular teachings of Jesus (let alone the current Pope). It's odd that he seems so hellbent on creating as many of them as he can -- he is practically salivating at the possibility of destroying Social Security and Medicare.
As for Cassidy-Collins Care, well, at least someone in the GOP has, AFTER SIX YEARS, floated an actual idea. (Obama, er, trumped them by proposing the only Republican plan previously floated and getting it passed with all Democratic votes.)
The ACA could be improved with a few tweaks -- a public option (including the possibility of buying into Medicare at a lower age), requiring big pharm to negotiate in better faith over drug prices, the GOP Holy Grail of 'portability' (which is mostly meaningless, but worth trying), stricter penalties and better subsidies for the mandate and targeted help for smaller businesses would all be good starts.
Heck Obama probably wouldn't (publicly) object if they re-named it 'Trumpcare'. (Anything passed post-repeal should definitely be called that so the Narcissist-in-Chief can take full credit if it doesn't work.)
That's because good Christians Price and Ryan would design a system that was basically 'Don't get sick and if you do, please die quickly'. Few people seem to hate the poor for being poor as much as Ryan -- maybe he missed those particular teachings of Jesus (let alone the current Pope). It's odd that he seems so hellbent on creating as many of them as he can -- he is practically salivating at the possibility of destroying Social Security and Medicare.
As for Cassidy-Collins Care, well, at least someone in the GOP has, AFTER SIX YEARS, floated an actual idea. (Obama, er, trumped them by proposing the only Republican plan previously floated and getting it passed with all Democratic votes.)
The ACA could be improved with a few tweaks -- a public option (including the possibility of buying into Medicare at a lower age), requiring big pharm to negotiate in better faith over drug prices, the GOP Holy Grail of 'portability' (which is mostly meaningless, but worth trying), stricter penalties and better subsidies for the mandate and targeted help for smaller businesses would all be good starts.
Heck Obama probably wouldn't (publicly) object if they re-named it 'Trumpcare'. (Anything passed post-repeal should definitely be called that so the Narcissist-in-Chief can take full credit if it doesn't work.)
5
I often wonder if Conservatives and Republicans have any older relatives or family members who are chronically ill or know anyone who lives in the rural "health deserts".
This heartless plan eliminates the employer mandates and promotes health savings account (HSA) plans.
Rural areas and many red states have older, more sickly populations and limited healthcare infrastructure. (Rural health disparities is a yuuuuge problem.) Those people will be dropped like hot potatoes from their employer plans because they are more expensive to cover.
If Americans can not even save enough money for retirement (average 401k is about 100,000-110,000), then how will they accumulate an additional $200,000 for a serious illness in the HSAs? $200,000 is barely enough money for ONE chronic, common illness like cancer or kidney failure. (Alzheimer's disease, the next pending US epidemic, costs significantly more.) Most Americans as they age develop co-morbid (multiple) conditions.
Catastrophic health insurance (aptly named) is associated with high premium deductibles. A major illness would lead to financial catastrophe for the policy holder.
It seems that GOP voters were intent on cutting off their noses to spite their faces when the voted in a Republican controlled government.
Too bad they won't be able to afford the medical bills to re-attach their noses after the GOP guts the ACA...................
This heartless plan eliminates the employer mandates and promotes health savings account (HSA) plans.
Rural areas and many red states have older, more sickly populations and limited healthcare infrastructure. (Rural health disparities is a yuuuuge problem.) Those people will be dropped like hot potatoes from their employer plans because they are more expensive to cover.
If Americans can not even save enough money for retirement (average 401k is about 100,000-110,000), then how will they accumulate an additional $200,000 for a serious illness in the HSAs? $200,000 is barely enough money for ONE chronic, common illness like cancer or kidney failure. (Alzheimer's disease, the next pending US epidemic, costs significantly more.) Most Americans as they age develop co-morbid (multiple) conditions.
Catastrophic health insurance (aptly named) is associated with high premium deductibles. A major illness would lead to financial catastrophe for the policy holder.
It seems that GOP voters were intent on cutting off their noses to spite their faces when the voted in a Republican controlled government.
Too bad they won't be able to afford the medical bills to re-attach their noses after the GOP guts the ACA...................
6
Douthat is unreadable these days. Old conservative tropes about everything. They don't work!!! Kansas was a massive failed experiment of just that. Single payer system for all!! The only losers would be health care execs, congress and all the .01 cronies.
10
Wait a minute.
Ross Douthat admits the empirical data are now and always have been stacked against the ideological fantasies of the right.
And Kenneth Arrow, 54 years ago, gave the wonky economic explanation for why health care will never be better off in the hands of the so-called free market.
http://web.stanford.edu/~jay/health_class/Readings/Lecture01/arrow.pdf
Read it and hide your heads in abject shame all ye who would try to suggest that healthcare economics is not irredeemably biased in the direction of a social welfare -- not "statist," Ross -- approach.
To Douthat's suggestion that free market systems are given more to innovation?
Economists have shown that the size of the US market, the gusher of money that the government has poured into basic research, and, conveniently forgotten in the paeans to free market innovation in health care, the funds unleashed into the system through Medicare and Medicaid, upon which the modern hospital explosion has been founded, account for the innovation advantage the US has, without any help from Friedmanism or Burkeanism.
So now Douthat and similar "best and the brightest" of failed conservativism think it's just dandy to start "experimenting" with inherently flawed economic models, using the lives of 330 million Americans as guinea pigs.
Amateur hour, Mr. Douthat, amateur hour.
Let Donald, Ivanka, Ivana, Jared, and your family try it out first, and come back to the rest of us when you've got the kinks out.
See ya'.
Ross Douthat admits the empirical data are now and always have been stacked against the ideological fantasies of the right.
And Kenneth Arrow, 54 years ago, gave the wonky economic explanation for why health care will never be better off in the hands of the so-called free market.
http://web.stanford.edu/~jay/health_class/Readings/Lecture01/arrow.pdf
Read it and hide your heads in abject shame all ye who would try to suggest that healthcare economics is not irredeemably biased in the direction of a social welfare -- not "statist," Ross -- approach.
To Douthat's suggestion that free market systems are given more to innovation?
Economists have shown that the size of the US market, the gusher of money that the government has poured into basic research, and, conveniently forgotten in the paeans to free market innovation in health care, the funds unleashed into the system through Medicare and Medicaid, upon which the modern hospital explosion has been founded, account for the innovation advantage the US has, without any help from Friedmanism or Burkeanism.
So now Douthat and similar "best and the brightest" of failed conservativism think it's just dandy to start "experimenting" with inherently flawed economic models, using the lives of 330 million Americans as guinea pigs.
Amateur hour, Mr. Douthat, amateur hour.
Let Donald, Ivanka, Ivana, Jared, and your family try it out first, and come back to the rest of us when you've got the kinks out.
See ya'.
10
"There is **compelling evidence** that markets in health care can do more to lower costs and prices than liberals allow, and **good reasons to think** that free-market competition produces more medical innovation than more socialized systems "
I don't think your links, delineated with **, really support your case. The "compelling evidence" is yesterday's David Brooks opinion piece, neither the text nor the author "compelling evidence" on health care. The "good reasons to think" has a 2006 date. Times change, health care changes. Something that old is not really a "good reason" for health care today.
I don't think your links, delineated with **, really support your case. The "compelling evidence" is yesterday's David Brooks opinion piece, neither the text nor the author "compelling evidence" on health care. The "good reasons to think" has a 2006 date. Times change, health care changes. Something that old is not really a "good reason" for health care today.
6
I think we need more clarification of the "auto enroll" aspect?
Health Insurance--and all insurance--relies on a broad pool of subscribers who do not utilize coverage providing funds for those who submit claims.
When the young healthy enrollees decide to forgo their premiums--in favor of a new mountain bike--are they "auto un-enrolled"
Then what?
Health Insurance--and all insurance--relies on a broad pool of subscribers who do not utilize coverage providing funds for those who submit claims.
When the young healthy enrollees decide to forgo their premiums--in favor of a new mountain bike--are they "auto un-enrolled"
Then what?
7
Nobody who has ever looked a medical bill can consider such a proposal without a horselaugh. Fall down and break your finger and require a pinned fifth metatarsal and removal of the pin? It will bankrupt you (many personal bankruptcies are based on medical bills). If you don't have the money (sneeringly referred to as "savings") the providers eat the cost, and raise the costs to compensate. Often the injury or disease simply goes untreated, to the great detriment of workforce health and public health generally, throwing the patient onto public assistance. We had this conversation years ago. The sheer bland unctuousness of your language suggests the old saw is true: A Republican is someone who can't enjoy his breakfast unless he knows someone else is starving.
22
The Evil Empire (R) is back. Republican health care rations, restricts, delays and denies. The Republican masters of deceit are the masters of death panels by any other name.
12
ACA was a reform that hit the entire country. this one is closer to a test of ideas. let the test begin. put big bucks into evaluation and see which things work, which do not.
just because there are no model elsewhere does not mean impossible, just hasn't been fully tried.
just because there are no model elsewhere does not mean impossible, just hasn't been fully tried.
1
My fellow progressives-
We're in a bad spot right now and it's time for some nimble thinking!
We should turn 180* and adopt state's rights as our favored method of governance. And BOLDLY challenge the Movement Conservative types to a good old-fashioned competition.
Millions of us and our neighbors would be spared the pain and anguish of losing our medical care. And the rest of the nation can catch-up at will.
The same holds for Creationism in public schools. If they really want it, let them have it. The citizens of those states will just have to learn to control the wackos in their midst. It's not my problem!
Gun control.
Helmet laws.
Even abortion. Progressives can be SEEN doing the right thing by setting up and funding an underground railroad to help the women of those states that choose to outlaw it. In the mean time WE could be living in states with a more reasonable attitude.
LBGT rights.
Equal pay/gender equality issues.
The list goes on and on...
If anyone has a better idea NOW is a good time to speak up!
We're in a bad spot right now and it's time for some nimble thinking!
We should turn 180* and adopt state's rights as our favored method of governance. And BOLDLY challenge the Movement Conservative types to a good old-fashioned competition.
Millions of us and our neighbors would be spared the pain and anguish of losing our medical care. And the rest of the nation can catch-up at will.
The same holds for Creationism in public schools. If they really want it, let them have it. The citizens of those states will just have to learn to control the wackos in their midst. It's not my problem!
Gun control.
Helmet laws.
Even abortion. Progressives can be SEEN doing the right thing by setting up and funding an underground railroad to help the women of those states that choose to outlaw it. In the mean time WE could be living in states with a more reasonable attitude.
LBGT rights.
Equal pay/gender equality issues.
The list goes on and on...
If anyone has a better idea NOW is a good time to speak up!
3
Mr. Douthat has just provided what is needed most at this moment in time and its not his thoughts about healthcare reform. Whether from a conservative/Republican or liberal/Democrat, opinions on any subject, stated in an evenhanded, non opponent view demonization are the most effective method of focusing a thought on the message, rather than the messenger.
5
This still fails to address the issue of those who will "opt-out". Absent the young and healthy enrolled, the premiums ( cost somebody will pay) subsidy or not will go up for those who are sicker and/or older. I think that the ER's of hospitals would be swamped again. Many more would simply close.
Republicans want something else entirely. They want to starve Medicaid out. Their "health care" plan is strikingly simple: "If you get sick, die quickly."
Republicans want something else entirely. They want to starve Medicaid out. Their "health care" plan is strikingly simple: "If you get sick, die quickly."
7
Douthat writes about policy when the reality of this Republican congress has little interest in serving the public. If it did it would have been willing to fix Obamacare's problems. The issue is not cost, as we will see appropriations for a "wall" at the Mexican border. Mr. Douthat should be more concerned about the dismantling in progress of our democratic institutions as the press and his opinions are in danger.
6
"But still — there is no existing system on a national scale that looks like the health care system that Paul Ryan or Tom Price would design, no wisdom of developed-economy experience that proves that such a system would actually keep overall costs low and prevent too many people from being shut out of insurance markets."
One American without health insurance is "too many people from being shut out of insurance markets."
One American without health insurance is "too many people from being shut out of insurance markets."
7
"There is compelling evidence that markets in health care can do more to lower costs and prices than liberals allow,"
And when one clicks on 'compelling evidence' one is sent to an opinion piece by David Brooks! Proof only the blind will continue to lead the blind.
And when one clicks on 'compelling evidence' one is sent to an opinion piece by David Brooks! Proof only the blind will continue to lead the blind.
13
I have always liked the approach that enshrines Brandeis' "50 laboratories of democracy" metaphor. The healthcare needs and priorities of urban NJ are likely very different than rural WY, and even states like NY and PA that have big populations but big urban/rural divides can tailor plans to their unique demographics. Such a plan still can have broad minimum principles as requirements to receive the block grants. I do not think this approach would be cheaper in the near term - because it would be more fragmented. However, it would be more locally tailored, which would help its acceptance. It also is more likely in the "laboratories" to produce, in a few states, a best-in-class system that other states would eventually emulate. Perfect? No. Will some states underperform? Sure, but that happens all the time in plenty of other policy areas. More likely to last and evolve to a better place naturally and in a quiet, more boring (boring = good) way over time? Probably.
1
Let's be perfectly clear. This election was not a mandate to return to the previous, seriously flawed, free-market system of delivering health care. It didn't work then, and there is no reason why it should work now. In my own situation, from 1998-2013 premiums rose over 400%, 20% per year compounded, and the range of services covered was very limited. Since the ACA my premiums are down 40% and services are much broader.
Please, do not make the mistake of thinking that a consumer can make complex choices about which plan covers hospitalization better, or lab testing worse, or certain procedures more fully, or others less completely. It is a virtually impossible comparison for the average consumer to make. The idea that I will "choose" the best plan that "serves my needs" is a wholly unworkable one. We don't know which disease we will get when we become ill, in the vast majority of cases, so we cannot therefore pick the best plan in advance. It is utterly naive to assume otherwise.
No: the "swamp" (as in "drain the swamp") that Trump talks about was what we previously had in health care. It is not about competition and never was.
Please, do not make the mistake of thinking that a consumer can make complex choices about which plan covers hospitalization better, or lab testing worse, or certain procedures more fully, or others less completely. It is a virtually impossible comparison for the average consumer to make. The idea that I will "choose" the best plan that "serves my needs" is a wholly unworkable one. We don't know which disease we will get when we become ill, in the vast majority of cases, so we cannot therefore pick the best plan in advance. It is utterly naive to assume otherwise.
No: the "swamp" (as in "drain the swamp") that Trump talks about was what we previously had in health care. It is not about competition and never was.
46
@Srose... Thank you, thank you! The republicans are not dealing with the reality of what health insurance costs were like before the ACA. If we go back to that, the poor and middle class are doomed.
Collins and Cassidy are to be commended at least for their effort to field the frayed flag of pragmatic Republicanism. It may be the last time we see it. This 2017 version of the "great compromise" is a recognition that Republicans had nothing of value to offer during the past 10 years and an admission of their bitter closed-minded hatred of the ACA and its champion. It also conveniently forgets that the ACA essentially was proved under a Republican governor as a state program. Policy wonks are notoriously detached from reality. The health care "promise" described by Douthat is akin to the promise of trickle-down economics. The peril, as usual, is a misleading and simplistic economic calculation and grossly understates its likely real result: inhumane forced choices, crippling bankruptcy, unnecessary death and a host of attendant societal effects. We shouldn't have to deal with this situation. There is more than enough wealth to provide good affordable health care to our citizens. The questions are who makes money and at what rates of return, and what degree of regulation is appropriate or required to strike the optimum balance? Conservative ideologues believe an unregulated health care market can accomplish this on its own. Their theoretical approach is as dangerous as their strikingly ignorant and simplistic adherence to Rand's teachings.
27
Ross,
The whole idea of eliminating O-care is not to offer better healthcare, but to stop the subsidy that appears on Form 1040, which mandates that people who earn a nice income pay more for someone else's health insurance than what their own insurance costs them.
The whole idea of eliminating O-care is not to offer better healthcare, but to stop the subsidy that appears on Form 1040, which mandates that people who earn a nice income pay more for someone else's health insurance than what their own insurance costs them.
19
With all of this ideology, does anyone care about actual people?
10
Why should conservatives look at the facts about how well the other 22 industrialized nations' single-payer healthcare works? After all, American Exceptionalism is always right.
That the other 22 have lower costs and better outcomes, and insure everyone, is just an "alternate fact". Conservatives are married to capitalist market-competition as the answer to everything. It works on buying washing machines, why not oncologists?
That the other 22 have lower costs and better outcomes, and insure everyone, is just an "alternate fact". Conservatives are married to capitalist market-competition as the answer to everything. It works on buying washing machines, why not oncologists?
710
You're absolutely right, Grey -- the biggest flaw in Douthat's argument is that he is actually looking at evidence. Anyone who has observed the GOP should know that is a non-starter.
1
Ross Douthat so wants us to believe "the Right" is chock full of serious people with furrowed brows deep in thought about how best to develop and promote legitimate public policy. What a fantasy. His column includes two words that make all this a non-starter for Republicans -- compromise and Medicaid. They won't consider anything that smacks of a compromise to fully repealing the ACA, and they won't miss their opportunity to turn Medicaid into a state voucher system. "Repeal and compete?" C'mon. "Destroy and lay waste" is a more accurate description of Republican intent.
474
As Sen. Kaine pointed out, it's not so easy for people to move to states where both coverage and access to healthcare might be provided. There are a lot of miserable people in states where the ruling party made the decision to refuse federal funding for an expansion of Medicaid.
There has been an intense and expensive public relations campaign against ACA. Now, there are promises to keep what people like and get rid of what they don't like. Those promises will be hard to keep.
Talk about access is cheap. It gets expensive to actually provide access.
The hatred of "statism" is hard to understand when you are talking about the welfare of all the people of the United States. The federal government has funded research. It has given millions security in retirement. It has tried to ameliorate the impact of recessions on people who lost jobs. But the PR funded by people like the Koch brothers is hard to overcome. I'm hoping the resistance to Donald Trump will inspire an uprising of involved citizens who will challenge conservative orthodoxy.
There has been an intense and expensive public relations campaign against ACA. Now, there are promises to keep what people like and get rid of what they don't like. Those promises will be hard to keep.
Talk about access is cheap. It gets expensive to actually provide access.
The hatred of "statism" is hard to understand when you are talking about the welfare of all the people of the United States. The federal government has funded research. It has given millions security in retirement. It has tried to ameliorate the impact of recessions on people who lost jobs. But the PR funded by people like the Koch brothers is hard to overcome. I'm hoping the resistance to Donald Trump will inspire an uprising of involved citizens who will challenge conservative orthodoxy.
2
You keep talking about catastrophic care. Isn't that the most expensive care and that which we all hope to avoid by consistent care through life?
Of all the health care plans that have been tried and found wanting - the private health care plan is the most known.
Private Health Insurance Companies 101:
We are here, we exist to make money. We have chosen to do so in the health care industry. Every body gets sick and everybody gets old and dies. Dr's and hospitals and tests and medicines cost a lot. Its a money maker.
We deliver no health care services.
We sell insurance policies to people who hope they don't get sick, and we will sell policies to the people who are most likely right. The less likely they are, the more we will charge. If they are very likely to get sick, we will not insure them.
If they are already sick - are you kidding? Does a Homeowners Company insure a house that's burning?
The more kinds of coverage they want, like maternity, the more we charge, so all women pay more.
If anyone has parents that had heart disease or cancer - no deal.
Do they smoke? Nope.
Kid just born? Heart surgery already? Exclude the kid or raise the rates so much they can't pay it. If they can pay, cancel the policy.
Diagnosed with leukemia? Well, it's not going to cost us more than than the life tome cap, and when we say no to all the procedures we can say no to, they probably won't live that long.
Of all the health care plans that have been tried and found wanting - the private health care plan is the most known.
Private Health Insurance Companies 101:
We are here, we exist to make money. We have chosen to do so in the health care industry. Every body gets sick and everybody gets old and dies. Dr's and hospitals and tests and medicines cost a lot. Its a money maker.
We deliver no health care services.
We sell insurance policies to people who hope they don't get sick, and we will sell policies to the people who are most likely right. The less likely they are, the more we will charge. If they are very likely to get sick, we will not insure them.
If they are already sick - are you kidding? Does a Homeowners Company insure a house that's burning?
The more kinds of coverage they want, like maternity, the more we charge, so all women pay more.
If anyone has parents that had heart disease or cancer - no deal.
Do they smoke? Nope.
Kid just born? Heart surgery already? Exclude the kid or raise the rates so much they can't pay it. If they can pay, cancel the policy.
Diagnosed with leukemia? Well, it's not going to cost us more than than the life tome cap, and when we say no to all the procedures we can say no to, they probably won't live that long.
3
You lost my attention when you proclaimed it is reasonable to insist that the risk that even one person in the red state model suffering the consequences of not having enough money in a savings account to cover their medical necessities for dealing with a chronic condition is outweighed by the benefits of such a plan. The risk that this person would have to discontinue treatment or become a pauper to survive on charity is worth it so that other people might be able to save a little bit of money in taxes or health care premiums each year...until they also become the one with a chronic condition!?! Shifting the burden from the wealthy to those on the edge of poverty to provide "health care" for all makes no sense. It should be like Medicare or Social Security, everyone a me to (basically anyone who earns wages) chips in over the span of their working years and reals the benefits when they need them.
3
A free market does only exist in very special circumstances. Hence free market policies do not work in most segments of society. You ever heard that pharmacies have a buy 2 get 1 free prescriptions? Did you ever run across an ad where physical examinations were sold as 3 for 100 Dollars? Was there ever a study who looked into the how patients with a heart attack shop around for the best price to save their lives? As more vital the market as more regulated it is: police, fire departments, military...In the case of health care the opposite is true when it comes to low price and high quality markers: the most regulated modern health care system in the world is the British NHS is also the one that beats every other national western system in the world in these categories. Anyone who talks about a health care market is either ignorant, sloppy or ideological.
3
In the spirit of the Trump Conspiracy Theories (patent pending), I would like to offer:
This health plan will be great. Only the best states will sign up for scorched Earth health care, and some of those that do have already demonstrated how effectively drunk freshman know-it-all economics adapts to the real world.
One enthusiastic enrollee would be Sam Brownback's Kansas, a laboratory where GOP True Believers have tested those policies that make Paul Ryan salivate. They set out to Make the Prairies Great Again by reducing taxes on those with excess capital and ended up impoverishing the State treasury because that old saw about reducing taxes will always increase revenues (!) was an echo chamber canard.
“It’s demonstrably proven that tax cuts increase revenues” – Rush Limbaugh
Let's not pretend that the policy of the GOP big lie began with Trump.
So, states with red legislatures, those grown-up children who apparently sided with the Giant in Jack in the Beanstalk, will adopt this one-size-fits-all subsidy that will exile sensible people to blue states. Now, I don't know if Elbridge Gerry ever imagined this form of his-mandering, but think about how firmly in the red column John Kasich could tuck Ohio if everyone with a brain moved to Pittsburgh or Ann Arbor.
It will be great. Tweak the 2020 census (you know that Le Grand Orange will have an opinion on the veracity of that survey), preserve relative levels of state representation, and voila! What demographic shifts?
This health plan will be great. Only the best states will sign up for scorched Earth health care, and some of those that do have already demonstrated how effectively drunk freshman know-it-all economics adapts to the real world.
One enthusiastic enrollee would be Sam Brownback's Kansas, a laboratory where GOP True Believers have tested those policies that make Paul Ryan salivate. They set out to Make the Prairies Great Again by reducing taxes on those with excess capital and ended up impoverishing the State treasury because that old saw about reducing taxes will always increase revenues (!) was an echo chamber canard.
“It’s demonstrably proven that tax cuts increase revenues” – Rush Limbaugh
Let's not pretend that the policy of the GOP big lie began with Trump.
So, states with red legislatures, those grown-up children who apparently sided with the Giant in Jack in the Beanstalk, will adopt this one-size-fits-all subsidy that will exile sensible people to blue states. Now, I don't know if Elbridge Gerry ever imagined this form of his-mandering, but think about how firmly in the red column John Kasich could tuck Ohio if everyone with a brain moved to Pittsburgh or Ann Arbor.
It will be great. Tweak the 2020 census (you know that Le Grand Orange will have an opinion on the veracity of that survey), preserve relative levels of state representation, and voila! What demographic shifts?
3
There is compelling evidence that markets in health care can do more to lower costs and prices than liberals allow, and good reasons to think that free-market competition produces more medical innovation than more socialized systems.
It is pretty weak that you provide a link to another OPED piece as your "evidence" that markets in health care lower costs. How about some real evidence. By the way, free market competition will produce lower costs and innovation at the Health Care Provider part of the system, but that does not prevent a true Mutual insurance system with the maximum of risk sharing. You and your conservative buddies don't seem to understand the difference between Health Care delivery and insurance.
It is pretty weak that you provide a link to another OPED piece as your "evidence" that markets in health care lower costs. How about some real evidence. By the way, free market competition will produce lower costs and innovation at the Health Care Provider part of the system, but that does not prevent a true Mutual insurance system with the maximum of risk sharing. You and your conservative buddies don't seem to understand the difference between Health Care delivery and insurance.
4
Dear Ross,
Republicans should adopt the Collins proposal for a political reason. The blue states would most likely keep the ACA and perhaps even enhance it with their own adaptations and thereby provide excellent coverage for their residents. Red states reject it and replace it withe the minimalist Price-Ryan type plans. The results is a mass exodus of poor and unemployed to the blue states. This polarizes the country more and ensures Republican political dominance in the short term through their gerry mandered control of the house, the 2 Senators per state and the electoral college. In the long term the blue states economy goes down due to the overburden and they win again. Nice try, but we need a National Health Care policy not a political stunt to make it seem like something has been done.
Republicans should adopt the Collins proposal for a political reason. The blue states would most likely keep the ACA and perhaps even enhance it with their own adaptations and thereby provide excellent coverage for their residents. Red states reject it and replace it withe the minimalist Price-Ryan type plans. The results is a mass exodus of poor and unemployed to the blue states. This polarizes the country more and ensures Republican political dominance in the short term through their gerry mandered control of the house, the 2 Senators per state and the electoral college. In the long term the blue states economy goes down due to the overburden and they win again. Nice try, but we need a National Health Care policy not a political stunt to make it seem like something has been done.
2
The Heliocentric Theory of Health Care Reform
Before Copernicus and Kepler, people generally believed the sun and the planets revolved around the earth, but as we got more data it became increasing hard to reconcile this basic idea with the observed facts. People thought up the Ptolemaic system in which the heavenly bodies didn't just revolve around the earth, but they revolved in small circles called epicycles as they went around the earth. That eventually turned out not to be sufficient, so they hypothesized epicycles within the epicycles. The last iteration of the Ptolemaic system was an incredible complicated mess that was almost beautiful in it's complexity.
That's what we are doing today with health care reform. We wanted a "uniquely American solution." We wanted to keep the private insurance industry. We wanted the sun to go around the earth.
So we talk about mandates, exchanges, reference pricing, death spirals, etc. The problem of adverse selection is an example. We need some more epicycles. We wound up with a bill with thousands of pages whose result is unknown. HR676 (improved Medicare for All) had 70 pages.
If Kepler were alive, I am sure he would say, "If you simply give everyone Medicare, you wouldn't need all this complication, and I'll bet it would be cheaper, too."
Before Copernicus and Kepler, people generally believed the sun and the planets revolved around the earth, but as we got more data it became increasing hard to reconcile this basic idea with the observed facts. People thought up the Ptolemaic system in which the heavenly bodies didn't just revolve around the earth, but they revolved in small circles called epicycles as they went around the earth. That eventually turned out not to be sufficient, so they hypothesized epicycles within the epicycles. The last iteration of the Ptolemaic system was an incredible complicated mess that was almost beautiful in it's complexity.
That's what we are doing today with health care reform. We wanted a "uniquely American solution." We wanted to keep the private insurance industry. We wanted the sun to go around the earth.
So we talk about mandates, exchanges, reference pricing, death spirals, etc. The problem of adverse selection is an example. We need some more epicycles. We wound up with a bill with thousands of pages whose result is unknown. HR676 (improved Medicare for All) had 70 pages.
If Kepler were alive, I am sure he would say, "If you simply give everyone Medicare, you wouldn't need all this complication, and I'll bet it would be cheaper, too."
4
Fiscal conservatism would indicate that the best health care system is a national one (gigantic risk pool there) because costs per user are lowered. Example: France, where the system allows for private doctors and small co-pays for doctor visits except in the case of chronic conditions (diabetes, emphysema, etc).Insurance through the private market is available for private hospital rooms and ambulance transport in certain cases. This system costs 1/3 less per capita than our present mix, and is always rated highly by the WHO. We could learn much from studying the health insurance models of other countries. They vary in many ways but they all have one thing in common:they deliver health care to all their citizens for less cost than the roughly 18% GDP that we spend each year. Modern conservatism is wrong about the effectiveness of the free market health care system, unless the "effectiveness"is measured in insurance company profits .
5
It is quaint that writers such as Douthat continue to pretend that Republicans have a political philosophy. It has been clear for decades that the modern GOP cares only about gaining and keeping power through any means necessary. It absorbs large bribes from nefarious donors such as the Koch brothers in exchange for class warfare against the poor, cheats on lower house elections through gerrymandering, openly supports destructive propaganda tactics to demonize the opposition, lies and employs fear mongering to leverage low-information voters, and even violates constitutional oaths to illegally block a rightfully-appointed Supreme Court justice.
Personally, I have given up hope that any part of the GOP is salvageable from the depths of depravity to which it has sunk, but I wish that writers such as this would stop insulting my intelligence with this nonsense about political philosophy. Anyone who was paying attention knows that the ACA grew out of conservative circles as a feeble alternative to single-payer. That it came under attack from the very same group when it was adopted by Democrats tells you all you need to know about "modern conservatism."
Personally, I have given up hope that any part of the GOP is salvageable from the depths of depravity to which it has sunk, but I wish that writers such as this would stop insulting my intelligence with this nonsense about political philosophy. Anyone who was paying attention knows that the ACA grew out of conservative circles as a feeble alternative to single-payer. That it came under attack from the very same group when it was adopted by Democrats tells you all you need to know about "modern conservatism."
10
I knew the free market article was coming.
For profit health insurance is a disaster. Simply compare OECD numbers for America against any European country, Canada, etc.
The largest drag on the US economy is the for profit health insurance, US spends more on this than the military. Overall healthcare is 17% of GDP. I refer *only* to the 5% of GDP that is the insurance component, *not* the 12% GDP actual goes to providing health care component.
There are no 'free market' forces operating, no 'downward pressure', 'competition, etc. In fact metaphors from physics applied to free market ideology create an illusion of concreteness where none exists. Bureacracies are populated with self-serving agents and heavily impacted by special interests. If there was *any* validy to using a free market model for private insurance, the US would *already* have the most slick, efficient, cheapest, easiest, smooth running bureacracy on the face of the earth. That it is the most bloated, inefficient, blood sucking bureacracy that has ever existed any where should be obvious to the most simple minded person.
Besides, for profit medicine is immoral. When are the CHINO's (christian in name only) going realize this? Yes, it is mostly the CHINO's and Joe six-packs that vote republicans and mis-labeled 'conservatives' into office (Eisenhower was a conservative, a type that no longer populates the republican party).
For profit health insurance is a disaster. Simply compare OECD numbers for America against any European country, Canada, etc.
The largest drag on the US economy is the for profit health insurance, US spends more on this than the military. Overall healthcare is 17% of GDP. I refer *only* to the 5% of GDP that is the insurance component, *not* the 12% GDP actual goes to providing health care component.
There are no 'free market' forces operating, no 'downward pressure', 'competition, etc. In fact metaphors from physics applied to free market ideology create an illusion of concreteness where none exists. Bureacracies are populated with self-serving agents and heavily impacted by special interests. If there was *any* validy to using a free market model for private insurance, the US would *already* have the most slick, efficient, cheapest, easiest, smooth running bureacracy on the face of the earth. That it is the most bloated, inefficient, blood sucking bureacracy that has ever existed any where should be obvious to the most simple minded person.
Besides, for profit medicine is immoral. When are the CHINO's (christian in name only) going realize this? Yes, it is mostly the CHINO's and Joe six-packs that vote republicans and mis-labeled 'conservatives' into office (Eisenhower was a conservative, a type that no longer populates the republican party).
3
Let's begin with the obvious: There are no "free"-markets. There are markets with rules and regulations. There will always be rules and regulations. Without them, there is anarchy.
Whatever the GOP decides will be the replacement, (if they can get a replacement agreed to.) it will have rules. Policies and plans will have to be vetted, buyers will require clear information with which to make choices, doctors and medical facilities will have to be rated, so too treatment options.
In other words, informed decision-making requires fact-based information and clear, enforced rules. Someone has to vet and supply that. And someone has to decide what works and what doesn't.
Conservatives talk and write in utopian terms of magic, free-market solutions that diminish government involvement. Thus far, they have no concrete plans based in fact and vetted for both the benefit and harm they bring. They won't even guarantee not to make things worse. They offer instead lavish praise of market-based solutions, entirely free of evidence or example. They offer fact-free assumptions and push reality aside.
Well, 20 million more people are insured. Fact.
Those with pre-existing conditions can get coverage. Fact.
Lifetime caps are gone. Fact.
And conservatives argue about philosophy in mythical free-markets as if people won't live, go bankrupt, or simply die as they impose their vision on the American people. Fact.
Whatever the GOP decides will be the replacement, (if they can get a replacement agreed to.) it will have rules. Policies and plans will have to be vetted, buyers will require clear information with which to make choices, doctors and medical facilities will have to be rated, so too treatment options.
In other words, informed decision-making requires fact-based information and clear, enforced rules. Someone has to vet and supply that. And someone has to decide what works and what doesn't.
Conservatives talk and write in utopian terms of magic, free-market solutions that diminish government involvement. Thus far, they have no concrete plans based in fact and vetted for both the benefit and harm they bring. They won't even guarantee not to make things worse. They offer instead lavish praise of market-based solutions, entirely free of evidence or example. They offer fact-free assumptions and push reality aside.
Well, 20 million more people are insured. Fact.
Those with pre-existing conditions can get coverage. Fact.
Lifetime caps are gone. Fact.
And conservatives argue about philosophy in mythical free-markets as if people won't live, go bankrupt, or simply die as they impose their vision on the American people. Fact.
3
Republican members of Congress have insisted that if Obamacare was really a good idea, their Democratic colleagues would have required it for themselves rather than continuing in their private Congressional plan. I trust they will have the courage of their convictions if and when they ever come up with a replacement.
1
Go to any country with a single payer healthcare system and ask the residents how they feel about their healthcare. In the vast majority of cases, people love it. One of these days the US is going to have to pull the bandage off (get rid of insurance companies) and develop a single payer system. It is cheaper for everyone, it is more efficient, and it is more compassionate. It doesn't take an economic genius to figure out that costs would come down if everyone paid into one source, a bunch of middleman were cut out of the loop, and corporations weren't trying to make a profit by betting on the state of your health. The GOP is taking us backward by getting rid of Obamacare. The government can't start functioning properly until the people in power start caring more about its citizens than about putting money in the pockets of big business. It would be great if the GOP allowed the Blue states to set up their own systems. It would allow for a type of comparative research, but it would inevitably show that competitive healthcare is not the best solution and they would never risk that.
6
Mr. Douthat, while extolling the ideology of conservatives, laments that there is no empirical evidence on a nation level that show it works. That, in a nutshell, is the problem with conservatives - their thinking is tied to ideology and facts don't seem to sway them.
First we need to define what success in health care really means. Most of us think that means healthier outcomes, not increased profits for insurers or hospitals.
Next, we have existing models from nations providing ample empirical evidence. World Health Organization show us that the major developed world with either a government backed system or single payer system delivers health care for about half the cost of the US (measured by percent of GDP) and provide better (healthier) outcomes across the board. Our current single payer system (Medicare) provides health care at much lower administrative cost than private insurers.
Why won't conservatives use facts?
First we need to define what success in health care really means. Most of us think that means healthier outcomes, not increased profits for insurers or hospitals.
Next, we have existing models from nations providing ample empirical evidence. World Health Organization show us that the major developed world with either a government backed system or single payer system delivers health care for about half the cost of the US (measured by percent of GDP) and provide better (healthier) outcomes across the board. Our current single payer system (Medicare) provides health care at much lower administrative cost than private insurers.
Why won't conservatives use facts?
2
Because they have alternative facts.
I favor using the states as laboratories but history has shown states will adhere to policies long after they have been shown to be bankrupt - segregation in the south and family welfare in the north come to mind. At some point the Federal government should intervene when some citizens (often minorities) are suffering unnecessarily. Unfortunately this very intervention is an anathema to conservatives.
2
"Repeal and compete" doesn't work because of the adverse selection in the health market. We have a State-by State experiment already in the present ACA initiated by the Supreme Court, when in its wisdom it allowed each State to decide whether to accept Federally-funded expansion of the Medicaid benefit. States who did not accept expanded Medicaid are exiling their sick poor to other States with better benefits. As a physician I meet them in the hospital and care for them. I know that this situation can only be remedied by truly National healthcare. Senators Cassidy and Collins should know that too.
11
Douthat has really outdone himself this time.
His "compelling evidence" is an opinion piece by David Brooks that uses a single McKinsey report which, in turn, shows mixed results of health care competition including the quote "sometimes market forces lead to worse outcomes". The article further lauds well-run competitive systems without actually proving that they exist. Yes, a well-run system produces good results - by definition - whether market based or not.
His "good reasons" refer to an article that shows the US as the leader in medical scientific results - especially those that have led to Nobel Prices. We all know that the US is a scientific power house - even in Medicine. But science is not medical care.
Overwhelming evidence from the rest of the world is that single-payer or government run systems produce the best results at the lowest costs. The rest of the industrialized world pays about half of what we do in the US for results that include lower infant mortality rates, lower obesity rates, lower trauma rates, etc.
Ross is entitled to his own opinion, but when he supports it with ephemeral "facts" while ignoring a world of evidence, he demeans himself as well as his readers.
The problem with health care is that unlike a bottle of shampoo we don't have competition, we don't know its price, and we rarely have a choice whether to buy or not. We need to get over the idea that market driven systems are the right solutions for all problems.
His "compelling evidence" is an opinion piece by David Brooks that uses a single McKinsey report which, in turn, shows mixed results of health care competition including the quote "sometimes market forces lead to worse outcomes". The article further lauds well-run competitive systems without actually proving that they exist. Yes, a well-run system produces good results - by definition - whether market based or not.
His "good reasons" refer to an article that shows the US as the leader in medical scientific results - especially those that have led to Nobel Prices. We all know that the US is a scientific power house - even in Medicine. But science is not medical care.
Overwhelming evidence from the rest of the world is that single-payer or government run systems produce the best results at the lowest costs. The rest of the industrialized world pays about half of what we do in the US for results that include lower infant mortality rates, lower obesity rates, lower trauma rates, etc.
Ross is entitled to his own opinion, but when he supports it with ephemeral "facts" while ignoring a world of evidence, he demeans himself as well as his readers.
The problem with health care is that unlike a bottle of shampoo we don't have competition, we don't know its price, and we rarely have a choice whether to buy or not. We need to get over the idea that market driven systems are the right solutions for all problems.
5
President Obama was right to recognize that so many Americans are one catastrophic illness or accident away from losing everything. ACA helped that a lot, especially with so-called pre-existing conditions.
While it is clear that most "conservatives" go into anaphalactic shock at just the thought of government-run healthcare, they should really look at it from a different perspective: Job creation.
If the government, say, could open up the marketplace OPM has for federal workers (except congress and their staffs—ouch) and let people use the bargaining power of the federal government instead of having to twist in the wind, looking for extremely expensive single plans, the chances are good that even if those people didn't get the subsidies that federal workers do, they would still find significantly more affordable insurance.
But consider the power of a single payer system with respect to job creation: Without the necessity to provide employees with health insurance, you have just lowered the barrier to entry for small business creation, which is touted as the biggest source of new jobs. A lot of small business people i know hated ACA because it raised their costs—and in many cases forced them to make artificial decisions on hiring and staff sizes. A lot of that was about greed.
But what if I wanted to start a small business tomorrow and didn't have to worry about how big it got because I knew my employees had healthcare?
While it is clear that most "conservatives" go into anaphalactic shock at just the thought of government-run healthcare, they should really look at it from a different perspective: Job creation.
If the government, say, could open up the marketplace OPM has for federal workers (except congress and their staffs—ouch) and let people use the bargaining power of the federal government instead of having to twist in the wind, looking for extremely expensive single plans, the chances are good that even if those people didn't get the subsidies that federal workers do, they would still find significantly more affordable insurance.
But consider the power of a single payer system with respect to job creation: Without the necessity to provide employees with health insurance, you have just lowered the barrier to entry for small business creation, which is touted as the biggest source of new jobs. A lot of small business people i know hated ACA because it raised their costs—and in many cases forced them to make artificial decisions on hiring and staff sizes. A lot of that was about greed.
But what if I wanted to start a small business tomorrow and didn't have to worry about how big it got because I knew my employees had healthcare?
7
I get it, that the intention motivating the implementation of the ACA, "ObamaCare", was laudable, health insurance coverage for all.
However, what's stupid about the ACA is that you should be able to shop around and buy health insurance coverage from any insurer in any state regardless of where you reside and you should be able to see the medical provider of your choice regardless of any so-called network or state requirements. Let the carriers compete. If there are no carriers who want to go into this business then the government will need to set up an insurance company, or set up a system like the Assigned Risk Pool where uninsureds can enroll and the government assigns the customer to a rotating list of carriers whether the carriers like it or not. Carriers who object can get out of the business.
I am in New York. My car insurance comes from an insurance company in Illinois and when I need to repair my car for an insured incident I can take it to anyone I please. That's the way it should be with health insurance.
However, what's stupid about the ACA is that you should be able to shop around and buy health insurance coverage from any insurer in any state regardless of where you reside and you should be able to see the medical provider of your choice regardless of any so-called network or state requirements. Let the carriers compete. If there are no carriers who want to go into this business then the government will need to set up an insurance company, or set up a system like the Assigned Risk Pool where uninsureds can enroll and the government assigns the customer to a rotating list of carriers whether the carriers like it or not. Carriers who object can get out of the business.
I am in New York. My car insurance comes from an insurance company in Illinois and when I need to repair my car for an insured incident I can take it to anyone I please. That's the way it should be with health insurance.
3
Mike, you misunderstand the situation. Yeah, your car insurance company is in IL, but it is still subject to regulation by the state of NY. In fact, they offer different plans for different states. What the Republicans propose is to take away state regulation, To see what would happen, you can look at credit cards.
A number of years ago, a large bank (I think it was CitiBank) went to the Republican governor of SD and said that if you would relax your credit card regulations, we will move our credit card operation to SD and thus provide a lot of jobs for your state. He said, "Sure!". So they did and then so did every other major credit card company. The result is outrageous interest charges and lots of fine point "gotchas". It was a race to the bottom.
A number of years ago, a large bank (I think it was CitiBank) went to the Republican governor of SD and said that if you would relax your credit card regulations, we will move our credit card operation to SD and thus provide a lot of jobs for your state. He said, "Sure!". So they did and then so did every other major credit card company. The result is outrageous interest charges and lots of fine point "gotchas". It was a race to the bottom.
3
The real problems with Obamacare are 1) the name and 2) the constraints of reality. The GOP can certainly come up with a system with a new name, but they can't get away from the constraints on the system, which will make their system pretty similar to the ACA or just cover far less, leaving more people unable to pay their bills.
What will improve the situation is more regulation. Get rid of fake prices, windfall profits, surprise bills and advertising, for a start.
What will improve the situation is more regulation. Get rid of fake prices, windfall profits, surprise bills and advertising, for a start.
3
You know how the government pays to provide us with universal necessities like cops, education, fire departments, roads, snow removal, defense, garbage removal and the like? That's what we need to make sure that everyone in the country is covered for medical care. Just like with the other services it should be paid for by the government using the taxes which we pay.
The ACA is deficient in that not everyone is covered because people are permitted to opt out by paying a fine. What sense does that make?
The ACA is deficient in that not everyone is covered because people are permitted to opt out by paying a fine. What sense does that make?
7
Don't don't we already know that market forces in health care don't bring costs down? More medical facilities generally mean more procedures. When there is a more limited customer base, health care providers and insurance companies raise rather than lower prices. The market incentive is to get as much as possible out of the paying customers rather than expand the customer base. Health care costs went up faster before the ACA than after even though fewer people were insured. The one thing keeping prices from going even higher were regulations - the combination of federal caps on reimbursements for programs like Medicare and caps negotiated by insurance companies with health care providers. There are a lot of reasons for the negative market dynamic in health care, but no rational argument that competition will fix it.
4
There is a top end to which anyone will pay for a Rolls Royce. There is a top end to which anyone will pay for a mansion. There is atop end to which anyone will pay for a bottle of wine. There is no top end to which someone will pay to live. That is the problem with curbing health care costs. Medicine can demand any payment and someone will pay it.
229
There is a top end to what some people will pay to live. Some feel it is more important to leave resources to educate grandchildren, protect the environment, reduce the suffering of poverty than it is to pursue hundreds of thousands or millions of dollars for treatment that will prolong or intensify suffering, and cannot guarantee the ability to live a life with purpose.
There are many greater goods than maximizing the length of one's life.
Personally, I feel that the government's responsibility should include an optimized public health infrastructure, coverage for most acute health conditions and a priori defined limited coverage for chronic conditions. As we live our lives we need to recognize we will die and do the work and reflection necessary to come to grips with reality. We as a society cannot afford to fund healthcare benefits without limits just because someone is afraid to die. Rationing is a dirty word, but the adults in the room need to have these discussions.
There are many greater goods than maximizing the length of one's life.
Personally, I feel that the government's responsibility should include an optimized public health infrastructure, coverage for most acute health conditions and a priori defined limited coverage for chronic conditions. As we live our lives we need to recognize we will die and do the work and reflection necessary to come to grips with reality. We as a society cannot afford to fund healthcare benefits without limits just because someone is afraid to die. Rationing is a dirty word, but the adults in the room need to have these discussions.
1
Yes. Thank you. I say that, rather than a free market economy, health care is a "pay or die" economy. This "blackmail" effect is why health care can never be fully free market.
Richard's argument is well taken, and it's only one of the reasons why free market economics doesn't work well for healthcare. Countries that have adopted "statist" systems knew what they were doing.
1
Americans should receive the same healthcare that our congressional representatives receive. After all, we taxpayers are paying for it, though I'm not sure why. We should also receive the same bribes and graft from the healthcare industry that our representatives receive. Maybe then we'd understand why health insurance leeches are allowed to add so many layers of expense to our health care system without making it any better. It is shameful that America is the only modern country in the world that does not care about the health of its citizens. Folks who work and pay taxes their whole lives get sick and die too soon, leaving their families deep in debt, under the current system. Profit over people: is that what makes America exceptional?
527
As a therapist who gets paid by Medicaid Medicare Blue Cross Tricare I am in a unique position to compare. I had one client who worked for Feds and was retired. Her insurance, BC/BS, was the best of any client I had before or since. High payments, no coinsurance and no deductible. I was frankly, pretty astounded. How can our legislators understand what its like for people who can't even imagine a health savings account as they can barely pay their rent. I have a client who became homeless when she got breast cancer and had to have a mastectomy. Is this the America I was taught by my grandparents, immigrants themselves, to love? Health care including mental health care, which does seriously impact physical health (see ACES study on CDC website) should be free for the poor which now includes 99% of us.
Or, open up the same plan that federal workers are eligible for (in the federal exchanges) to anyone who wants to sign up, with the same federal subsidies, choices, etc. I believe people will be suprised to see the myriad of options available to federal workers and these exchanges are already there. Of course, like Mr. Douthat, this is likely not actuarially possible at the stated insurance premiums, but I can engage in fantasy too! Check it out for your zip code:
https://www.opm.gov/healthcare-insurance/healthcare/plan-information/com...
https://www.opm.gov/healthcare-insurance/healthcare/plan-information/com...
Ughh. Again, to be clear, members of congress must purchase care on the federal exchanges under law. Ipso Facto, they are receiving the same healthcare options as anyone on the exchanges. I marvel at the lack of facts sometimes (PS - I support universal healthcare).
1
"Conservatives who want this model to replace Obamacare nationwide believe that the promise outweighs the risk — and this is, again, a reasonable belief. But it’s also a belief that hasn’t been tested on any kind of sweeping, economywide scale."
Good God, Ross, sure it has! What do you think people had BEFORE the ACA? A fragmentation of healthcare delivery and access: people who had employer-funded health plans got care, and the rest of the nation either had nothing, or was poor enough for Medicaid.
Before the ACA, those who lost jobs could buy expensive COBRA coverage or try to find something else on the private market. As a freelancer toward the end of my career, I learned quickly there was pretty much nothing except extremely high cost care. At least I had the good sense to remain covered by ANYTHING--so preexisting conditions stayed covered.
No, Ross, we don't need a grand experiment of state choice in retaining ACA and red state free markets with catastrophic coverage. Anyone who needs a catastrophic policy only, or a health savings account has to be pretty rich to get by on that.
Do not denigrate statist solutions for healthcare. Private markets and capitalistic solutions for quickly cost-accelerating healthcare services have already failed the test before the ACA. Time to move on to what every other country's citizens enjoy: universal health coverage.
Good God, Ross, sure it has! What do you think people had BEFORE the ACA? A fragmentation of healthcare delivery and access: people who had employer-funded health plans got care, and the rest of the nation either had nothing, or was poor enough for Medicaid.
Before the ACA, those who lost jobs could buy expensive COBRA coverage or try to find something else on the private market. As a freelancer toward the end of my career, I learned quickly there was pretty much nothing except extremely high cost care. At least I had the good sense to remain covered by ANYTHING--so preexisting conditions stayed covered.
No, Ross, we don't need a grand experiment of state choice in retaining ACA and red state free markets with catastrophic coverage. Anyone who needs a catastrophic policy only, or a health savings account has to be pretty rich to get by on that.
Do not denigrate statist solutions for healthcare. Private markets and capitalistic solutions for quickly cost-accelerating healthcare services have already failed the test before the ACA. Time to move on to what every other country's citizens enjoy: universal health coverage.
51
Oh brother Ross. You have become much to high and delusional. Please. A reactionary health care plan based on Health Savings Accounts & tax credits along side a viscous competitive market based system designed to weed out unsuccessful patients based on dollars.
Please. Tell us which pot shop you buy from. And don't read either Burke or Friedman but listen to Sen. Sanders.
Please. Tell us which pot shop you buy from. And don't read either Burke or Friedman but listen to Sen. Sanders.
10
We have had in the past a mostly market oriented "system" that is/was no system. It has not worked for at least the last 40 years since the demographics of our population changed to a much hiher percentage of middle aged and older people. For those of us who are older we have had a "socialized system" for decades that has gradually increased its coverage. And most importantly is a system and it works.
Why shouldn't the rest of the population have this benefit?
Why shouldn't the rest of the population have this benefit?
7
The Collins plan will never pass because it doesn't cut the ACA taxes and the big subtext to killing the ACA is actually to sink/death-spiral the entire individual and small business insurance markets. Big companies hate that people are self-employed and run small businesses. They don't like the competition for workers or the competition for business. The quickest way to improve their bottom line is to get the Republicans to indirectly crash these insurance markets, blame Obama or the Democrats, and profit when employees flee to job-lock-in corporate jobs, in order to get any health insurance.
6
Reality check. Trump said he would repeal and replace the ACA with something BETTER and MORE AFFORDABLE. Health savings accounts and catastrophic insurance isn't either of those things. It guarantees healthcare for only the wealthy and bankruptcy for the middle class or lower who develop a chronic or serious disease. He said citizens wouldn't DIE ON THE STREET under his healthcare-,block granting Medicaid to red states with no strings attached would create literally thousands of death spirals. All of us need to loudly and clearly remind him of these repeated campaign promises. He promised to protect us from the corporate, greedy titans and their stockholders. If he doesn't, get out the pitchforks
6
So the sickest population, the population with pre-existing conditions, with chronic conditions, would migrate to the states with the most generous health insurance benefits, quickly overwhelming those states and requiring them to repeal the generous benefits. All states would become Mississippi in a race to the bottom. Now that's a health plan only Douthat and his extremist comrades could love.
10
The problem in a nutshell is the difference between healthcare and health insurance. With single payer government healthcare for all US citizens, the heath insurance industry is no longer necessary and summarily out of business. I believe that to be a real problem for any politician who has ever accepted money from the health insurance industry and that is why we are witnessing any number of "solutions" that all attempt to continue to include this industry and maintain their current and future profitability. These so called refactored solutions to the ACA are not healthcare.
6
I just picked up Jonathan Chait's new book and he has something interesting to say about these matters. He writes that Yuval Levin has been consistently wrong about ACA beginning early on with Levin's statement that the "catastrophe is a very function of the law's design." Levin stated in 2010, according to Chait, that ACA would "likely to begin wreaking havoc with the health care sector - - raising insurance premiums, health care costs, and public anxieties." Chait noted with obvious relish that "Instead, the opposite happened. As the law's cost reforms took effect, hare care inflation began falling." And you cite David Brooks for offering "compelling evidence that markets in health care can do more to lower costs and prices than liberals allow. . . ." Brooks wrote in 2009 that "this legislation was supposed to end that asphyxiating growth [in health care costs]. It will not." But of course, it has. At this point, I would say that it is Conservatives who are suffering a very large credibility problem, not only because the policy-wonks (Levin and Brooks) you rely on has been wrong so often, but also because of Conservative rapacity and cynicism. They really don't seem to care what happens to the rest of us, do they? And now with Trump as President? No more Mr. Nice Guy?
8
Our experience in Maine is that you cannot depend on the 'States' for something as critical as insurance for health care.
Governor La Page has refused to even consider expanding Medicare despite the fact that the Federal Government would pay nearly all of the costs.
I seriously doubt that many states would opt for Obamacare, and the lack of a large universal base of people enrolled in the program would soon doom it.
Governor La Page has refused to even consider expanding Medicare despite the fact that the Federal Government would pay nearly all of the costs.
I seriously doubt that many states would opt for Obamacare, and the lack of a large universal base of people enrolled in the program would soon doom it.
5
It's Medicaid that Governor LePage has refused to consider expanding, not Medicare. Governors have no control over Medicare.
This health care issue has been discussed and debated ad-nauseum since the 90’s with little success. ACA was the only positive and it has its own problems.
The problem cannot be solved until our dysfunctional Congress becomes functional again. And that is not going to happen anytime soon I'm afraid.
The problem cannot be solved until our dysfunctional Congress becomes functional again. And that is not going to happen anytime soon I'm afraid.
4
The Collins-Cassidy Plan is the very similar in construction to Medicare Part D Plan in that it is a High Deductible Doughnut Hole Plan. Provide some measure of first dollar coverage, say $5000 per family, then a very large deductible say $15 - $20,000 must be met before the policy kicks in again and provides catastrophic coverage. Also, if a family does not use all of their $5,000 in a given year they can carry it forward indefinitely in a Health Savings Account with interest accruing. If healthy, a very large health savings account accrues over time. Also, there is some talk that the health savings money accrued could be used for non medical expenses like college tuition, down payment on a house, etc.. This type of coverage works extremely well for healthy Americans than does Obamacare. The problem is that for the minority of families that have chronic expensive conditions the Collins-Cassidy Plan is a disaster. If every year chronic medical expense families have to pay the entire doughnut hole (plus the premium remember) many families will end up in bankruptcy. On the one hand High Deductible Doughnut Hole Plans reward the 85% of Americans who are fortunate enough to have good health through genetics and/or lifestyle choices, but does so at the expensive of the 15% who incur about 80% of the medical expenses. Conservatives want cheap insurance for healthy people, and have unhealthy people unsubsidized by the healthy. The very antithesis of insurance.
7
@shend: At least one-third of Americans have chronic illnesses requiring continual treatment. Some estimates put the number as high as 50 percent.
Douthat: "This containment means that conservatives have room and time to be more patient, cautious and experimental than were the Obama Democrats before them." Conservatives have had many, many years to be "patient, curious and experimental" in designing a healthcare system. After all, Democrats have been trying to get a universal healthcare plan since Franklin Roosevelt considered it in the 1930s. Only one Republican president, Richard Nixon, proposed universal healthcare over these many years. I think it fair to say that Republicans have really never been very concerned about healthcare for all our citizens until Democrats finally put one in place. Now Republicans (especially this group of Republicans) consider it their duty to oppose what Democrats (i.e., Obama) accomplished. Whatever approach is finally in place, subsidies in some form will be necessary for many middle- and lower-income people. That puts government in the picture. The free market can never accomplish that alone.
2
The main problem with the private model, Ross, is that the number one fiduciary responsibility of a corporation is to return a profit to its investors and, to do that, costs must of course be kept down. For medical insurance companies, this builds in the incentive to resist paying claims "by whatever means necessary" since their labor costs are not as onerous as in other industries. (Watch the film "Sicko," if you haven't.) I am not suggesting that insurance companies do not pay claims - they pay millions of dollars in claims. It's just that the incentive to reduce or avoid claims payments is "built in" to the private model, and that's a uniquely bad "bedfellow" for patients in the health care system. Do I oversimplify? Sure. But just talk to someone who found themselves in the blind alley of claim denial in the pre-Obamacare system. They knew all too well why that was happening to them.
4
I have a friend whose career was in the insurance industry. He refers to Social Security as a "Ponzi scheme." Social Security is actually a social insurance program. You pay in to it and receive benefits when you turn either 62 or 65 or older, whatever your choice. He replied that no, it can't be insurance because insurance companies get to pick who they cover. My reply was that you have to work and have a paycheck to receive non disability benefits.
Health insurance companies want to pick who they cover, and not cover people with pre-existing conditions unless these same people pay exorbitant premiums. It's time for Medicare for all.
Health insurance companies want to pick who they cover, and not cover people with pre-existing conditions unless these same people pay exorbitant premiums. It's time for Medicare for all.
In Massachusetts, 96% of the population has health insurance. Romney care works. if you want it to.
21
Healthcare resembles the fire department more than it resembles Microsoft. It's difficult to shop around when you are in extremis. The knowledge differential between supplier and consumer is insurmountable. Healthcare insurance should be a right of all citizens- not just those over the age of 65.
5
I'm always struck by the "free market will bring down healthcare costs" line. Is not a "free market" what we had before? Did that not lead to many folks unable to get insurance or unable to afford care or having their main chronic conditions blocked from their coverage?
Some argue that the panacea is allowing insurance companies to sell insurance across state lines. Well, banks used to be chartered by the states and only allowed to operate in that state. That changed, as did the laws which limited the business which banks could do (e.g., savings banks could not sell investment instruments to the public). All of banking was opened up; big banks swallowed small ones; banks became 'too big to fail' and we had ourselves a whopper of a financial crisis. So, sure, let's do the same thing for the insurance industry...
Some argue that the panacea is allowing insurance companies to sell insurance across state lines. Well, banks used to be chartered by the states and only allowed to operate in that state. That changed, as did the laws which limited the business which banks could do (e.g., savings banks could not sell investment instruments to the public). All of banking was opened up; big banks swallowed small ones; banks became 'too big to fail' and we had ourselves a whopper of a financial crisis. So, sure, let's do the same thing for the insurance industry...
11
We don't need to wait for some new Republican plan to prove that their Free Market principles are an abject failure. We have our entire history of Free Market madness compared with the rest of the industrialized world which pays half as much, get better outcomes, and covers more of their population to prove its failure. We also have Medicare vs. Medicare Advantage which has decades of a head to head comparison of Free Market vs. government designed which proved insurance companies couldn't do better.
The way to control health care costs is to control health care costs. Duh.
The way to control health care costs is to control health care costs. Duh.
5
A few notes and questions:
1. Are there policy-literate Republicans?
2. If so, do any of them know that our market based health insurance system is vastly more expensive than any of the government run, single payer, or Obamacare-like systems every other industrial nation enjoys?
3. And by "vastly more expensive", I mean this: We spend approximately 18% of our GDP per year on health care: https://www.cms.gov/research-statistics-data-and-systems/statistics-tren...
4. Meanwhile, the government run, single payer or Obamacare-like systems hover around the 8% to 11% range: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
5. The really shocking thing about that is that those systems all have universal coverage, whereas our market based system has never come close to it. We do good to cover 90%.
6. Despite our vastly more expensive market based system, we do not excell in results, with middling results in life expectancy, infant mortality and other such metrics.
7. In our system, the elderly and disabled have to be covered by the government run programs, which are far more efficient than private health insurance companies
So the real question is, why, with all this evidence available, are we still questioning what is the best way to run a health care system? And the answer is, politics doesn't adhere to evidence in the United States.
Not anymore.
1. Are there policy-literate Republicans?
2. If so, do any of them know that our market based health insurance system is vastly more expensive than any of the government run, single payer, or Obamacare-like systems every other industrial nation enjoys?
3. And by "vastly more expensive", I mean this: We spend approximately 18% of our GDP per year on health care: https://www.cms.gov/research-statistics-data-and-systems/statistics-tren...
4. Meanwhile, the government run, single payer or Obamacare-like systems hover around the 8% to 11% range: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS
5. The really shocking thing about that is that those systems all have universal coverage, whereas our market based system has never come close to it. We do good to cover 90%.
6. Despite our vastly more expensive market based system, we do not excell in results, with middling results in life expectancy, infant mortality and other such metrics.
7. In our system, the elderly and disabled have to be covered by the government run programs, which are far more efficient than private health insurance companies
So the real question is, why, with all this evidence available, are we still questioning what is the best way to run a health care system? And the answer is, politics doesn't adhere to evidence in the United States.
Not anymore.
43
The only good thing about this column is that it reveals the lack of intellectual heft on the right regarding health care in the United States. The Republican party has had five or six years to come up with a "replacement" for ACA but all it's managed is a proposed disaster of a plan that would effectively deny some 32-million Americans access to affordable and meaningful coverage (according to the CBO), send the cost skyrocketing and result in the deaths of untold millions who could no longer afford to see a doctor.
Mr. Douthat writes, "There is compelling evidence that markets in health care can do more to lower costs and prices than liberals allow." The "evidence" cited has been discredited for a long time, and America continues to spend more on health care with poorer results than every other developed nation on earth.
Today's column represents another example of how ideology continues to - pardon the expression - trump reality in the Republican Party and the entire conservative spectrum of thought.
Mr. Douthat writes, "There is compelling evidence that markets in health care can do more to lower costs and prices than liberals allow." The "evidence" cited has been discredited for a long time, and America continues to spend more on health care with poorer results than every other developed nation on earth.
Today's column represents another example of how ideology continues to - pardon the expression - trump reality in the Republican Party and the entire conservative spectrum of thought.
14
The most dispiriting thing about America's attempts to solve any of our pressing problems is that we are divided into two teams, Conservatives and Liberals. The game metaphor is apt in our football mad country, but the problem with this competitive tribalism is that it forces each side onto the playing field, each playing a different game.
Neither side can admit to the failings of their particular game theory and so they push back and forth across some central line shouting slogans, sometimes getting closer to one goal or another, but since the ground rules clash, there's no way of winning an actual game.
Let's start with one glaring example that questions the doctrinal rules of play: to start with, health care is a market like no other, even if it's even a market. We don't chose to get sick and die. When we are sick, we don't make rational free market choices. We have no choice but to seek help. On the other hand, a single payer system like Medicare, in our entitlement culture, doesn't know when to say no. We overpay at life's end and make the dying miserable with unending interventions.
How does Douthat's writing solve these glaring problems? How does it address the different ways that an insurance-based system or a socialized system spreads the risk among us mere mortals. Tragically, when your magical health savings account is empty or your catastrophic policy too skimpy, where do you turn?
Out, out brief candle? Compete thy way to dusty death?
Neither side can admit to the failings of their particular game theory and so they push back and forth across some central line shouting slogans, sometimes getting closer to one goal or another, but since the ground rules clash, there's no way of winning an actual game.
Let's start with one glaring example that questions the doctrinal rules of play: to start with, health care is a market like no other, even if it's even a market. We don't chose to get sick and die. When we are sick, we don't make rational free market choices. We have no choice but to seek help. On the other hand, a single payer system like Medicare, in our entitlement culture, doesn't know when to say no. We overpay at life's end and make the dying miserable with unending interventions.
How does Douthat's writing solve these glaring problems? How does it address the different ways that an insurance-based system or a socialized system spreads the risk among us mere mortals. Tragically, when your magical health savings account is empty or your catastrophic policy too skimpy, where do you turn?
Out, out brief candle? Compete thy way to dusty death?
4
Republicans don't believe that health is a human right. For them people are worth their wealth so if you are poor and sick you deserve to die.
6
"[T]he right’s best health care minds believe that markets and competition can deliver lower costs and better care, and they believe it even though there is no clear example of a modern health care system built along the lines that they desire."
In other words, Ross, like the rest of the Right, the "right's best health care minds believe" in fairy tales and myriad other things that don't exist or that are untrue, such as "supply side economics."
There is no "free market" in healthcare: there is no transparency and people don't have enough knowledge and they are not in a position to choose much about healthcare. My mother is in the hospital as I type, and she is in no condition to get up out of her bed, drive to a different facility, ask them to treat her for her nausea, then drive back to her original treatment, only then to drive to a different facility because they charge less for blood work.
It's a fantasy, Ross: think it through. I recently had blood work done - I had no choice of whom to go to (there are only 2 providers in the country, essentially) and the list price for said blood work was $1,500. The negotiated price was $55. Next time you go buy a car, when they quote you a price of $1,500,000, see if you can negotiate them down to $55,000, because it's the same percentage markup.
Right-wing healthcare, supply side economics: they are policies based on ideologies with no empirical support, based entirely on the fantasy that markets are always efficient.
In other words, Ross, like the rest of the Right, the "right's best health care minds believe" in fairy tales and myriad other things that don't exist or that are untrue, such as "supply side economics."
There is no "free market" in healthcare: there is no transparency and people don't have enough knowledge and they are not in a position to choose much about healthcare. My mother is in the hospital as I type, and she is in no condition to get up out of her bed, drive to a different facility, ask them to treat her for her nausea, then drive back to her original treatment, only then to drive to a different facility because they charge less for blood work.
It's a fantasy, Ross: think it through. I recently had blood work done - I had no choice of whom to go to (there are only 2 providers in the country, essentially) and the list price for said blood work was $1,500. The negotiated price was $55. Next time you go buy a car, when they quote you a price of $1,500,000, see if you can negotiate them down to $55,000, because it's the same percentage markup.
Right-wing healthcare, supply side economics: they are policies based on ideologies with no empirical support, based entirely on the fantasy that markets are always efficient.
4
Excellent points made here. A consumer in health care loses all negotiation strength the minute they are diagnosed. At that precise moment, their care is a life saving necessity, and they enter a system with (1) few insurance companies, none of whom are subject to antitrust laws, giving the patient almost no leverage (2) a hospital industry consolidating at an ever increasing rate, giving the patient almost no leverage, (3) with a supply of physicians intentionally limited by government policy, giving the patient almost no leverage, and (4) with no sophistication to price shop and no clear menu with which to choose from.
Every other industrialized country in the world figured out these basics of economics in health care long ago (especially its inherent inelasticity and unequal bargaining positions) and acted accordingly. But in the United States, we still cannot overcome the Republican Party.
Every other industrialized country in the world figured out these basics of economics in health care long ago (especially its inherent inelasticity and unequal bargaining positions) and acted accordingly. But in the United States, we still cannot overcome the Republican Party.
2
"...well in that case both the country and conservatism will better off if we learn..."
This is propaganda in action.
First, conservatism is the only one that has not learned, dragging the whole country in is a propaganda ploy. Second, where does the "voter rebellion" in this scenario come from? Answer: The widespread unnecessary suffering and death of sick people who are now covered by Obamacare.
What an experiment! - just to help conservatives who can't do math learn.
This is propaganda in action.
First, conservatism is the only one that has not learned, dragging the whole country in is a propaganda ploy. Second, where does the "voter rebellion" in this scenario come from? Answer: The widespread unnecessary suffering and death of sick people who are now covered by Obamacare.
What an experiment! - just to help conservatives who can't do math learn.
6
Conservatives believe "the promise outweighs the risk." Sure, what risk? If you're a legislator you have the gold standard of health care. Not for you the fear that if you are unlucky you will exhaust your familiy's savings and be left bancrupt. No other modern industrialized country has a model like that? All others involve some government safety net? Could it be compassion for citizens who suffer from bad health, accidents or birth defects are viewed iwith compassion in all those other countries? Could it be they view health care as a right and not a commodity? Could it be the free market survival-of-the-fittest health care model is too brutal for all the other industrialized nations?
The ACA was, originally and for many years, the plan of Republican think tanks, the compromise set against the single payer plan democrats prefer. Killing the ACA was originally fueled by the petulance of a congress that wanted to see president Obama fail. Now Trump's voters are waiting for the big, beautiful better health care Trump promised. I've got a hint for you, Ross. It's not health savings accounts, bankruptcies, and huge systemic cracks to fall through. I'd like to think those voters will hold republicans feet to the fire, but I fear, by the time they catch onto the truth, it'll be far, far too late.
The ACA was, originally and for many years, the plan of Republican think tanks, the compromise set against the single payer plan democrats prefer. Killing the ACA was originally fueled by the petulance of a congress that wanted to see president Obama fail. Now Trump's voters are waiting for the big, beautiful better health care Trump promised. I've got a hint for you, Ross. It's not health savings accounts, bankruptcies, and huge systemic cracks to fall through. I'd like to think those voters will hold republicans feet to the fire, but I fear, by the time they catch onto the truth, it'll be far, far too late.
12
Douthat tends to evaluate Republican plans differently than than Obamacare. He touts 'out of pocket' health care expenses as a driver of reduced consumption, but under Obamacare, out of pocket expenses were a main reason for Republican cries to repeal. But that hypocrisy aside, there would seem to be a few unappealing aspects masked over.
Catastrophic coverage with a guaranteed minimum subsidy for all would necessarily increase financial distress for those unlucky enough to make this choice and have medical issues. But more importantly, this option would result in the young and healthy not buying expanded coverage in droves, which would raise premiums for those who remain, who would be older and sicker.
It looks like a deflection, rather than a solution of the critical support provided by a mandate. You'll be better off if you stick with catastrophic coverage and don't get sick. Otherwise, you're quite likely to be worse off. The fact that you would have a choice has strong appeal, but should not be used to mask the significant effect on 'winners' and 'losers'.
Catastrophic coverage with a guaranteed minimum subsidy for all would necessarily increase financial distress for those unlucky enough to make this choice and have medical issues. But more importantly, this option would result in the young and healthy not buying expanded coverage in droves, which would raise premiums for those who remain, who would be older and sicker.
It looks like a deflection, rather than a solution of the critical support provided by a mandate. You'll be better off if you stick with catastrophic coverage and don't get sick. Otherwise, you're quite likely to be worse off. The fact that you would have a choice has strong appeal, but should not be used to mask the significant effect on 'winners' and 'losers'.
139
In many areas of the country there is no competitive market for health care. Without someone watching out for the people health outcomes will continue to be among the worst among advanced economies. Before Obamacare we had high costs, limited participation, and poor outcomes. Since then there have been improvements, but not for a certain group of self-employed people. While we need to fix Obamacare, the Republican alternatives are going to push us back to where we were with more sick people, policies that are not affordable for the poor, and increased bankruptcy rates as people are unable to pay their medical bills. Hopefully, someone will look at why we have Obamacare rather than trying to conjure up ways that deny coverage to poor people.
2
I, for once, agree with mr. Douthat. A small scale experiment may shut down many wrong ideas in a system that, basically, depends on sympathy from the healthy towards the unhealthy in order to keep any healthcare program balanced. However, a piece of information is missing here: Obamacare worked in those states where the program was implemented as expected, meaning, a combination of market exchanges and expansion of Medicare. If shy on one side, it had problems. My hope is that Collins plans may be seriously considered and, if adapted, those states w Obamacare may also improve and, side by side, the public may be able to compare which is the most successful.
“Either way the individual mandate would disappear”
That statement says it all. I have for all of my adult life (40 years now, I’ll retire and go on Medicare in a few months) been covered by employer plans. Employer plans like Obamacare are not allowed to deny coverage for pre-existing conditions. We frequently see women who have just become pregnant start work just to get the medical coverage. A better example of pre-existing condition doesn’t exist.
The particular employer I’m at now is self-insured, How can their health coverage survive the costs of covering pre-existing conditions? It’s simple, because all employees are required to enter the employer plan(s). No one is allowed to opt out, thinking they’re young and health, they’ll take their chances.
That’s why Obamacare has the individual mandate. If the Republican plan is to allow states to continue with Obamacare but without the individual mandate, then no, it’s not a fair fight or contest which is better. Rather it would be like tying one hand of the blue states behind their back.
Not surprising that a conservative would support this idea.
That statement says it all. I have for all of my adult life (40 years now, I’ll retire and go on Medicare in a few months) been covered by employer plans. Employer plans like Obamacare are not allowed to deny coverage for pre-existing conditions. We frequently see women who have just become pregnant start work just to get the medical coverage. A better example of pre-existing condition doesn’t exist.
The particular employer I’m at now is self-insured, How can their health coverage survive the costs of covering pre-existing conditions? It’s simple, because all employees are required to enter the employer plan(s). No one is allowed to opt out, thinking they’re young and health, they’ll take their chances.
That’s why Obamacare has the individual mandate. If the Republican plan is to allow states to continue with Obamacare but without the individual mandate, then no, it’s not a fair fight or contest which is better. Rather it would be like tying one hand of the blue states behind their back.
Not surprising that a conservative would support this idea.
3
The new republican plan is to enroll everyone in catastrophic coverage and then provide subsidies into health savings accounts which will be difficult to regulate as they are credit cards and can be used anywhere.
What will stop folks from using them to pay for say..their cell phone bill or groceries? Who will audit that?
The republican plan is just a way to put money directly into the hands of red state citizens at the expense of blue state tax payers
Real access to healthcare wont be accomplished until there is a public option based on medicare rates that sets the standard and negotiated rices for drugs.
What will stop folks from using them to pay for say..their cell phone bill or groceries? Who will audit that?
The republican plan is just a way to put money directly into the hands of red state citizens at the expense of blue state tax payers
Real access to healthcare wont be accomplished until there is a public option based on medicare rates that sets the standard and negotiated rices for drugs.
2
These battling conservative principles went out the window a long time ago. Now it's starve the beast and let the people die in emergency rooms. A modern health care system already exists in many other countries where better outcomes and less expense has been proven not to be a product of a free market. Today's hypocritical conservative or Republican politicians and pundits are only interested in distracting us with these philosophical arguments while a kleptocrat administration takes our rights and our money away along with our health. Tom Price is your exemplar, isn't he? All about using the health care system to win big at the stock market. Says it all, Ross. Why not zero in on what's really going on for a change?
5
Democrats should not replace ACA! They should not work with republicans at all. Just dig in your heals until you regain control as the GOP did! I hope it is repealed and NOT replaced! We don't need a republican "fake" victory. Democrats need their own tea-party up-rising!
3
How about allowing the States to try a third alternative, "Medicare for All"
The States could have a great competition to demonstrate which system works best for all the people.
Just think how it might enrich moving companies!
The States could have a great competition to demonstrate which system works best for all the people.
Just think how it might enrich moving companies!
3
If it's about competition, how about a public option too. The key word is "option." Let people buy into medicare in the same way people have a choice between the post office, UPS, FedEx, etc.
4
Of course, the reason that a market-driven example of health care does not exist is that the health care 'market' violates every assumption of a free market. That was apparent to me decades ago in Economics 101. Square peg in round hole anyone?
5
The idea that the struggling lower middle class will be able to put aside enough money to deal with the absurdity of medical cost is a dishonest fantasy. Most American families absent the members of the wealthy class have no available savings to deal with large deductibles. The healthcare industry is monopolistic and adversarial to the healthcare consumer. Without significant controls the lower middle class will rapidly be priced out of healthcare. This would not concern those conservatives whose underlying puritanical philosophies beleive that the poorer among us are morally deficient, but should be a concern of a just society.
3
Written by a guy who comes from a family of wealth who would never have to worry about whether or not he has enough extra cash to sock away in a health savings account.
The conservative plans all insist on moving to HSAs as a way of making people have some responsibility for their health care and offer tax breaks to use them. Let's see, you make $10 an hour in a rust belt state and while you're waiting for the factories to re-open and give you a job where you make $60 an hour, you're supposed to sock away 5-10k in your HSA. So when you have health care needs you can pay for them until your catastrophic plan kicks in when you reach 15k in health care expenditures. But your catastrophic plan only covers catastrophes not things like prostate cancer screenings or any testing for catastrophic illnesses.
And how about this idea of automatic enrollment in plans aka the non-mandate mandate. How to find everyone? Are we all going to be required to register somewhere? And if you don't register so the government can automatically enroll you will there be a penalty? And who pays to enroll everyone?
When you have family money and a good job at The NY Times, it's easy to think HSAs are a good idea. But for those people who voted for Trump because they hate the ACA they're really going to hate HSAs. Fortunately conservatives can just blame Obama for their new plan because the ACA was so bad it will take generations to recover from it's impact.
The conservative plans all insist on moving to HSAs as a way of making people have some responsibility for their health care and offer tax breaks to use them. Let's see, you make $10 an hour in a rust belt state and while you're waiting for the factories to re-open and give you a job where you make $60 an hour, you're supposed to sock away 5-10k in your HSA. So when you have health care needs you can pay for them until your catastrophic plan kicks in when you reach 15k in health care expenditures. But your catastrophic plan only covers catastrophes not things like prostate cancer screenings or any testing for catastrophic illnesses.
And how about this idea of automatic enrollment in plans aka the non-mandate mandate. How to find everyone? Are we all going to be required to register somewhere? And if you don't register so the government can automatically enroll you will there be a penalty? And who pays to enroll everyone?
When you have family money and a good job at The NY Times, it's easy to think HSAs are a good idea. But for those people who voted for Trump because they hate the ACA they're really going to hate HSAs. Fortunately conservatives can just blame Obama for their new plan because the ACA was so bad it will take generations to recover from it's impact.
3
Republicans need to put their hatred of Obama aside and do what's right for the people.
2
Douthat: "The individual mandate would disappear, but people would be auto-enrolled in a catastrophic plan (with the option to opt out)."
With no mandate means all the young, healthy people will opt out...until of course they get sick. They key feature of EVERY other healthcare market in EVERY other developed country is that EVERYONE is opted in. Without a mandate insurance will be more costly and nowhere near universal.
With no mandate means all the young, healthy people will opt out...until of course they get sick. They key feature of EVERY other healthcare market in EVERY other developed country is that EVERYONE is opted in. Without a mandate insurance will be more costly and nowhere near universal.
3
There is no "best hope" for conservative health care models. Costs will continue to increase and people will continue to be saddled with huge bills as long as we allow health care delivery to be profit-driven at every level. Also, where does this ridiculous myth come from that single payer systems are "innovation-squaring"?There is still plenty of money to be made from new devices and drugs in these systems, just not such exorbitant profits as companies currently enjoy.
1
Ross: At least you recognize that other developed countries have various healthcare systems that do not include free market based healthcare. The reason that all countries that have universal healthcare at much lower cost is because of government regulations, including regulation of healthcare costs. Every other country has figured out that so-called free market based healthcare is much more expensive and it does not lead to universal healthcare for all people. Most Americans know that, but the government is the problem right-wingers will never see it. And that's why having them in charge of our healthcare system is so dangerous.
4
No. This is the wrong way to go.
To be sure, market forces can work to help lower costs. But the devil is in the details, as usual. “Market forces” does not simply mean the profit motive, which is rather disgusting when related to health care in any case. It means transparency in pricing and choice in buying medical services. We need not belabor the lack of both in the present and even potentially in this state-experiment plan. Then there is the problem with the “compelling evidence” cited – actually an article by David Brooks referring to vague studies of some reduced costs due to market forces. Nobody is denying that more providers competing for business could lower costs. And our health system has been and continues to be primarily a market based one -- and not very cost-efficient. It’s the monopolistic features of medical patents and the power of large providers (EpiPen) that counter this simplistic hope. And we know that preventive care is the way to improve health care in the long run – which is not supported by high up-front costs required by high deductible plans. AND many red states are very poor states – so you are experimenting on the poor, leaving them to possibly die if your experiment does not work as you hope. AND since we are all citizens on the same country, will these poor red-state folk simply move to blue states to get health care, overloading that better system? If this is modern Conservatism then modern Conservatism is doomed.
To be sure, market forces can work to help lower costs. But the devil is in the details, as usual. “Market forces” does not simply mean the profit motive, which is rather disgusting when related to health care in any case. It means transparency in pricing and choice in buying medical services. We need not belabor the lack of both in the present and even potentially in this state-experiment plan. Then there is the problem with the “compelling evidence” cited – actually an article by David Brooks referring to vague studies of some reduced costs due to market forces. Nobody is denying that more providers competing for business could lower costs. And our health system has been and continues to be primarily a market based one -- and not very cost-efficient. It’s the monopolistic features of medical patents and the power of large providers (EpiPen) that counter this simplistic hope. And we know that preventive care is the way to improve health care in the long run – which is not supported by high up-front costs required by high deductible plans. AND many red states are very poor states – so you are experimenting on the poor, leaving them to possibly die if your experiment does not work as you hope. AND since we are all citizens on the same country, will these poor red-state folk simply move to blue states to get health care, overloading that better system? If this is modern Conservatism then modern Conservatism is doomed.
1
The reason there are no examples of free market health insurance systems in advanced countries, as any economist will tell you, is that free markets are likely to break down in the insurance industry, because insurance is a product that is particularly affected by asymmetric information.
Friedmanesque arguments about the efficiency of free markets are, in general, based on an assumption that both buyers and sellers of a product have the same information about that product. That assumption is especially unlikely to be valid in insurance markets, because customers have much more information about their own health than insurance companies do.
Instead of efficiently providing everyone with the benefits of insurance, a free insurance market is likely to feature a "death spiral", in which people who believe they are especially healthy choose not to buy insurance, so that insurance companies price their policies under the assumption that most buyers are likely to be sick. Ultimately "insurance" can only be sold to those in need of immediate acute care (reflecting the price of that care) which is essentially the same as having no insurance market at all.
That said, I strongly support the Cassidy-Collins proposal. Let the states that want public insurance have it. Let the states that think there is an alternative try to provide one. Federalism is one of the greatest strengths of the USA.
Friedmanesque arguments about the efficiency of free markets are, in general, based on an assumption that both buyers and sellers of a product have the same information about that product. That assumption is especially unlikely to be valid in insurance markets, because customers have much more information about their own health than insurance companies do.
Instead of efficiently providing everyone with the benefits of insurance, a free insurance market is likely to feature a "death spiral", in which people who believe they are especially healthy choose not to buy insurance, so that insurance companies price their policies under the assumption that most buyers are likely to be sick. Ultimately "insurance" can only be sold to those in need of immediate acute care (reflecting the price of that care) which is essentially the same as having no insurance market at all.
That said, I strongly support the Cassidy-Collins proposal. Let the states that want public insurance have it. Let the states that think there is an alternative try to provide one. Federalism is one of the greatest strengths of the USA.
The unmentionables in health care must address not only the cost of delivering health care but also the costs that are curbed by placing restrictions on the "rights" of patients. This means less patient choice, more "judgment" in the setting of premiums and the determination of what emanates from controllable behavior, and a more control over access to specialized services to ensure they are not pursued casually.
All of these things step on the toes of both Left and Right. Ultimately, if we want health care we can afford, we need to take a benchmark (say, 1990 level of care) in an era where Liberals want everything science can uncover and Conservatives want a market mechanism to magically allocate a scarce and expensive resource. But we want the miracle cure, the new procedure (transition surgery), and the endless discoveries hoping to ensure eternal life.
Democracy is showing signs that a culture built on rights over responsibilities writes checks it cannot cover.
All of these things step on the toes of both Left and Right. Ultimately, if we want health care we can afford, we need to take a benchmark (say, 1990 level of care) in an era where Liberals want everything science can uncover and Conservatives want a market mechanism to magically allocate a scarce and expensive resource. But we want the miracle cure, the new procedure (transition surgery), and the endless discoveries hoping to ensure eternal life.
Democracy is showing signs that a culture built on rights over responsibilities writes checks it cannot cover.
1
The wisdom of tradition? Not all tradition, Ross--such as slavery and women's suffrage. The freedom of markets? Not totally free, Ross--our baser instincts need to be regulated. So another Ross Douthat essay comes to a self-inflicte grinding halt practically before it even starts. Democrats understand this. Republicans never will.
1
The assertion that there is "compelling evidence" that markets in health care lower costs is unfounded. Studies overwhelming show that the aggregate supply curve for medical care in the US is inverse. This means that increasing hospitals, doctors and specialists increases costs. Increasing competition increases costs. Health care is not a commodity like wheat, so it should not be a surprise that an increase in supply (aka an increase in competition) has a profoundly different effect on cost. If you lower prices, say for example MRI scans, but increase utilization, total cost will increase. Price and cost should not be conflated.
Heavy regulation of "public" hospitals is required in Singapore with "limited hospital beds", a system of rationing. The city state is geographically bifurcated into two health governance systems, so its hard to see this as true competition. The system is paid for through significant individual mandatory savings (up to 26%) of income. How this system is used to support Republican health policy is unclear to me. That a conservative recognizes the advantages of mandatory individual savings is impressive indeed--bravo!
The health outcomes of the Singapore system manifest the public health policies, lifestyle and genetics of the population just as the US outcomes do.
Friedman never commented on health care, but if he had studied it, then he would not deny the inverse aggregate supply curve nor would he advocate for more "competition" in health care.
Heavy regulation of "public" hospitals is required in Singapore with "limited hospital beds", a system of rationing. The city state is geographically bifurcated into two health governance systems, so its hard to see this as true competition. The system is paid for through significant individual mandatory savings (up to 26%) of income. How this system is used to support Republican health policy is unclear to me. That a conservative recognizes the advantages of mandatory individual savings is impressive indeed--bravo!
The health outcomes of the Singapore system manifest the public health policies, lifestyle and genetics of the population just as the US outcomes do.
Friedman never commented on health care, but if he had studied it, then he would not deny the inverse aggregate supply curve nor would he advocate for more "competition" in health care.
2
Ross,
So from the same folks who brought us the conservative theory of economics, supply side trickle down, we should have faith in their grand, unproven experiment in health insurance? Relying on free market dynamics is an inelegant solution for solving our health insurance challenges. Just like financial regulation conservatives blindly adhere to foggy, free market ideology until it spectacularly fails and then come begging for federal bailout. Let's not repeat that with health insurance. I'm tired of paying to clean up their spilled ideologies.
So from the same folks who brought us the conservative theory of economics, supply side trickle down, we should have faith in their grand, unproven experiment in health insurance? Relying on free market dynamics is an inelegant solution for solving our health insurance challenges. Just like financial regulation conservatives blindly adhere to foggy, free market ideology until it spectacularly fails and then come begging for federal bailout. Let's not repeat that with health insurance. I'm tired of paying to clean up their spilled ideologies.
6
Well, how much money goes into my Health Savings Account? Let's start with that fact. Without knowing that, what's there to say?
3
Great idea: Risk the health care of 18-30 million people in order to experiment with the "promise and peril of conservative health care policy" and cater to Donald Trump's thin skin.
11
Obama are experimented with the health of 300 million Americans. Where were you then?
1
Run for the hills when you get 2 pols like Collins and Cassidy pushing this "bipartisan" garbage.
In many ways, this is WORSE that Obamacare. The states can still use Obamacare? So if my state, for example, says "no", but my neighboring state says "yes", I still have to pay for my neighboring state.
No. Just repeal the damn law and let freedom ring.
In many ways, this is WORSE that Obamacare. The states can still use Obamacare? So if my state, for example, says "no", but my neighboring state says "yes", I still have to pay for my neighboring state.
No. Just repeal the damn law and let freedom ring.
1
Spoken like a true employer provided health care recipient.
1
Universal catastrophic coverage is interesting. We need to stop pretending that free market principles apply when life and limb are at stake. Try to draw a supply and demand curve for a kidney transplant. Demand price = anything you want. But market-based solutions can still apply to other types of care. Universal catostrophic coverage is also pro-life.
There are there are no free market solutions to universal healthcare.
Healthcare is a right for each citizen.
The rest of the world has proven Medicare for all is the only answer. Stop wasting our time by trying to fit a square peg in a round hole.
Healthcare is a right for each citizen.
The rest of the world has proven Medicare for all is the only answer. Stop wasting our time by trying to fit a square peg in a round hole.
7
The problem with both the ACA and the vague alternatives is the same. It assumes there will be competition and there is some nebulous free market in health care. I have homes in two states. At the start of the ACA, one state had three insurers in our area and one dominates the market with over 85% of the plans both before and since the ACA. In the other state, it had 4 insurers and now has 2. In each state, the premium difference was minimal. That is not competition, that is oligopoly. This conundrum was aided and abetted by the respective state insurance commissioners who have allowed a limited number of entries. Unless and until we have real competition by insurers, the system will not work.
2
I continue to be amazed that despite all the evidence from other industrialized countries that the US will not pursue a single payer system. Even more perplexing, using the concept of profit driven insurance for the most basic of health care.
You can always count on Americans to do the right thing after they have tried everything else.-Winston Churchill
You can always count on Americans to do the right thing after they have tried everything else.-Winston Churchill
9
Desden, we have a little boulevard here in Washington D.C. that defends our system of profiting on healthcare; it's called K Street.
Everyone is amazed that our lawmakers ignore the facts about universal healthcare success elsewhere. They go deaf, dumb and blind when anyone brings it up to them. They have conjured up a system here where the minority rules, and just the other day, disclosed their primary strategy of alternative facts.
This and the monetary support of the lobbyists on K Street makes it easy for them to look the other way.
Everyone is amazed that our lawmakers ignore the facts about universal healthcare success elsewhere. They go deaf, dumb and blind when anyone brings it up to them. They have conjured up a system here where the minority rules, and just the other day, disclosed their primary strategy of alternative facts.
This and the monetary support of the lobbyists on K Street makes it easy for them to look the other way.
2
Senator Collins has put forward a thoughtful and tempered vision for that would likely be 85-90% palatable for every single American. It's not going to appease the right, nor will it settle the left, but it is a model for compromise that almost everybody can live with, and one I hope will win the day.
Trump and the Republicans are fixated on cost, not healthcare. None of the replacement proposals are comparable to the ACA because they don't provide the same level of benefits. A thin catastrophic policy with a Health Savings Account would mean avoiding healthcare until small problems become big problems. This is what people without health insurance did before the ACA. It's a back-end, hero centered way of addressing healthcare needs.
If you have any experience with serious health problems, you know up-front, preventive measures are vastly superior to waiting till it's too late. Diabetes and colon cancer are just two obvious examples. Prevention and early intervention are effective, low cost ways to use healthcare providers. Desperate attempts to undue serious illness and disease after it has taken hold are ineffective high cost ways, and often do more harm than good by spreading infection and causing bleeding.
The way to purchase anything is to identify what's needed first and find a good price for it second. If you reverse the process, you end up paying almost as much for something that isn't needed or doesn't solve the problem. If Republicans want to improve healthcare, they will fix the ACA. It's main problems are the uncertainty and avoidance caused by Republican attempts to kill it, and their blocking of promised risk-sharing payments to insurers. There is a lot that's good about the ACA, real conservatives would start there and fix what's wrong.
If you have any experience with serious health problems, you know up-front, preventive measures are vastly superior to waiting till it's too late. Diabetes and colon cancer are just two obvious examples. Prevention and early intervention are effective, low cost ways to use healthcare providers. Desperate attempts to undue serious illness and disease after it has taken hold are ineffective high cost ways, and often do more harm than good by spreading infection and causing bleeding.
The way to purchase anything is to identify what's needed first and find a good price for it second. If you reverse the process, you end up paying almost as much for something that isn't needed or doesn't solve the problem. If Republicans want to improve healthcare, they will fix the ACA. It's main problems are the uncertainty and avoidance caused by Republican attempts to kill it, and their blocking of promised risk-sharing payments to insurers. There is a lot that's good about the ACA, real conservatives would start there and fix what's wrong.
4
I like the idea, but only if the Blue States and Red States have separate federal governments so each group of states can fully control their health care plan. What we don't want is the federal government allowing the Blue States to keep the ACA but preventing them from making any necessary adjustments to the law, so the Blue States get stuck with a plan that can't evolve as it needs to evolve to be truly successful.
But really isn't this just an argument for dividing the country in two? On a host of issues the Blue States and the Red States have completely different visions. Let's just divide into two and have the Blue States run their country and the Red States run theirs. It won't take long to find out which system works best.
But really isn't this just an argument for dividing the country in two? On a host of issues the Blue States and the Red States have completely different visions. Let's just divide into two and have the Blue States run their country and the Red States run theirs. It won't take long to find out which system works best.
6
Obamacare WAS a conservative idea. But because it was not so affectionately given the name of our prior (and very much missed) President by conservatives and Republicans, it's now a terrible idea. Here's an idea: do what's right by the American public. Obamacare is not perfect, but it's working. Make it better. But do not act like a toddler with this "repeal and replace" whine. We are all tired of it. Just take care of the health of all Americans. If we can build a useless giant wall, we should be able to do this.
6
Single-payer systems do not squash innovation. That has already been proven. What they do squash are some of the immoral profits made by capitalists at the expense of patients.
5
This idea is just repeal with a fig leaf of catastrophic coverage which will not help to get people preventive care which can help avoid serious illness
2
Conservative Edmund Burke lived when citizens didn’t have voting rights. They had to depend on the beneficence of aristocrats. And he was terrified at the extremist violence of the French revolution. Don’t apply his ideas to America today, please.
Did the idea ever enter your head to wonder just why dozens of other capitalistic democracies do not have health care based on a free market, max profit model? Why ever not? Don’t they respect our greatest minds? Why don’t they use the Gop type plans if they’re so great for choice and ‘Freedom from big govt’?
A few countries use single payer, and other use insurance co’s, but it’s normal to negotiate price with corporations on behalf of the citizen majority who elects their govt. See, that’s what voting is for. That’s democracy that has evolved to our time, but which our Gop rw is trashing. After all health is a life and death issue. Conservative Burke might approve of health care for all.
This whole column is over complicated—as is ACA, and any gop plan to replace it. The US system uses our tax money, not to pay for our medical care, but to prop up corporate profits. Why not, they’re some of the biggest donors to our elections? This shows our democracy has developed, and then gone backward. Not sure which era it belongs to now.
America's politicians cannot face that health care since the 20th C has been a basic right of citizenship for multi millions in dozens of nations.
Did the idea ever enter your head to wonder just why dozens of other capitalistic democracies do not have health care based on a free market, max profit model? Why ever not? Don’t they respect our greatest minds? Why don’t they use the Gop type plans if they’re so great for choice and ‘Freedom from big govt’?
A few countries use single payer, and other use insurance co’s, but it’s normal to negotiate price with corporations on behalf of the citizen majority who elects their govt. See, that’s what voting is for. That’s democracy that has evolved to our time, but which our Gop rw is trashing. After all health is a life and death issue. Conservative Burke might approve of health care for all.
This whole column is over complicated—as is ACA, and any gop plan to replace it. The US system uses our tax money, not to pay for our medical care, but to prop up corporate profits. Why not, they’re some of the biggest donors to our elections? This shows our democracy has developed, and then gone backward. Not sure which era it belongs to now.
America's politicians cannot face that health care since the 20th C has been a basic right of citizenship for multi millions in dozens of nations.
7
So in other words people that had health care protection who had the unfortunate luck to live in a red leaning state will automatically be enrolled in a catastrophic health insurance policy because of that states elimination of Obamacare. Then when the insurance they did not want can not cover their bills until they meet the deductible, they don't go to doctors, don't get their medicine and get really sick and in some cases die.
So what do they do? They check themselves into the emergency room where they must be admitted by law. If this is universal access it's a sham. This is Trumpcare, Making America Sick Again.
So what do they do? They check themselves into the emergency room where they must be admitted by law. If this is universal access it's a sham. This is Trumpcare, Making America Sick Again.
758
The solution is to repeal the law that says emergency rooms must provide service to the uninsured. That way it would force the poor to either get a better job or die. Problem solved. The truth seems to be that medical industry can charge whatever they want including more than the market can bear. This is because the sword of Damocles hangs over every man when it comes to matters of mortality. Diagnostics is a huge racket where hospitals can charge 3,000.00 dollars and hr. to rent a MRI machine. And bill you a thousand dollars to read it. This means the lower wage people are effectively shut out of preventative diagnostic care if they do not have insurance. There is no law that says one must be provided with insurance it you are fully employed. Conservatives love to drag out some old dead guy philosopher to rationalize their greed. The rights of man are only gained by struggle, immersed in the baptismal blood of the martyrs who struggle against those who would oppress.
Health care is a human right that the GOP has turned into another beautiful cash cow that grazes on the miseries of illness.
Health care is a human right that the GOP has turned into another beautiful cash cow that grazes on the miseries of illness.
2
That assumes that the law providing emergency room access stays in place. I wouldn't bet on it.
1
People don't live in a "red leaning state" through "unfortunate luck." They and their fellow citizens, either through overt action or failure to take enough oppositional action, have earned what they are dealing with.
No sympathy here.
No sympathy here.
1
If the right is wrong, people will be more than "simply miserable." Some will be what we call "dead". A pair of Harvard researchers has estimated that there could be upwards of 40,000 deaths due to the repeal of the ACA.
6
If you want to see how much support any of these "alternatives" to Obamacare have just require the legislators and their families to give up their gold-plated government health care and live with what they want the rest of us to have.
Obamacare is not perfect, or even close to perfect (single payer is the fairest for all), but "health savings accounts" are useless if you can't afford to fund one!
Obamacare is not perfect, or even close to perfect (single payer is the fairest for all), but "health savings accounts" are useless if you can't afford to fund one!
6
I shudder to think what Mississippi or Alabama would come up with not to mention my totally red state government here in Florida. I see very high out-of-pockets; stingy HSAs; narrow networks; lots of procedures not covered ( think women's health, preventive); underfunded high risk pools (Florida had all of 200 enrolled in its last attempt); work requirements; annual caps; and probably a return to pre-ex.
And then, what do you do if you move? Do you get first day coverage? What if you live close to a state line? Will your Kansas Care pay for a provider in Kansas City, MO? Why should someone in poor Mississippi not get the same quality care as one would get in a rich, more generous state like Massachusetts? What about the incentives for the very sick to relocate to states with better systems? This 50-different flavors approach just adds yet more complexity to an already Byzantine system.
I say single payer. Medicare for all. Simpler. Lower total costs. Equitable.
And then, what do you do if you move? Do you get first day coverage? What if you live close to a state line? Will your Kansas Care pay for a provider in Kansas City, MO? Why should someone in poor Mississippi not get the same quality care as one would get in a rich, more generous state like Massachusetts? What about the incentives for the very sick to relocate to states with better systems? This 50-different flavors approach just adds yet more complexity to an already Byzantine system.
I say single payer. Medicare for all. Simpler. Lower total costs. Equitable.
24
It's all very simple. Republicans, unlike the rest of the civilized world, believe that health care is a privilege not a right.
If you can't pay for it you die....
It's that simple. Nice Christians eh ?
If you can't pay for it you die....
It's that simple. Nice Christians eh ?
19
Ross, didn't the Republicans have a health care plan back in the '90's? What was it called; oh yes, the Affordable Care Act. I think there was a Republican governor who implemented it in his state - I think it was Romney.
Why don't they just go with that?
Why don't they just go with that?
20
Once again, when one is making $50k or less per year they will not have the disposable income to fund a medical savings account of any value. What the "conservatives" (what ever that really means) fail to grasp at the start of their very weak argument is the concept of market failure. To contend with the spillover effects insurers exclude those with either pre existing conditions or no money. They land at emergency rooms and run up bills that can never be paid off. So the external costs are forced upon the citizens at public hospitals or them closing due to excessive requirements to treat those who show up. It is not just blue states which jumped on the program, Kentucky seems to be a model of efficiency on ACA. Also, if you allow the opt out provisions, who takes care of the individual when the catastrophe hits? Same thing they throw themselves on the mercy of the state, which is us. But there is one truth, only red states refused the money from the feds.(the 95% he mentions) And of course in doing so, they threw their citizens at the mercy of the state, shirking their responsibility of their citizens, all to attempt to(and fail) to prove a point. Make no mistake, not one governor was without paid up health insurance by a state.
2
Are you seriously proposing running an experiment on tens of millions of American, without the consent of a majority of them, with side effects of your treatment that range from bankruptcy to death by health care neglect? If you tried to test a new drug that had these side effects, the FDA would not approve the testing protocol. And the comment that says let's wait for the Red State voters to render an opinion on the health care insurances changes is both unethical and impractical. As any person taking care of a special needs child or a frail and failing relative knows, there is no time, energy or money to play politics. And using these suffering families as economic guinea pigs is beyond unethical, it's cruel.
16
"Market solutions" will never lower the cost of health care. Health care is not and never can be a free market. It is an extortionist market. Pay or die.
9
While Douthat wants to see health care as a political model choosing between, or combining, Friedman or Burke; many of us think it is health care--making access to medical care available to all Americans. Douthat and Republicans seem to want this to be a political experiment, like Kansas' tax circus. Lives are a bit too valuable to take that kind of risk with. We have seen, and continue to see, that Republicans continue to believe that risk needs to be transferred to the lowest level and least able to tolerate it. Somehow that is supposed to be instructive to them and the society at large. They also seem to believe that it is tolerable to allow our worst states like Alabama and Mississippi to give rein to their worst impulses and call it good policy. We know what will happen. People in the poorer states will get worse care; one could say that people in the Red states will get poorer care. And people in Blue states will do better. In the long run that likely means the Blue states will continue to get economically and politically stronger. The whole calculation seems back end to and a perfect illustration of the current Trumpian thinking that people who have less deserve to be hurt and those with more deserve to be helped. This is crazy thinking.
3
The Cassidy-Collins compromise proposal would allow states to decide the fate of Obamacare. It "would remain intact in most blue states for the time being, while redder states would have the opportunity to turn roughly the same amount of money (95 percent) to a different end."
I do not like this compromise, but given our current state of affairs and the Republican majority, this may be a good and viable option. And let us suppose it plays out and becomes the law of the land. We'll see how the blue states thrive on healthcare indices indices whereas the red states will have far more deleterious conditions.
We've seen how this plays out already in case of state taxes. Governor Brownback cut taxes in Kansas with the stated intention of spurring economic growth; we all saw the state spiral downwards rather than upwards. Expect the same in case of the differential healthcare systems if left to the states.
I do not like this compromise, but given our current state of affairs and the Republican majority, this may be a good and viable option. And let us suppose it plays out and becomes the law of the land. We'll see how the blue states thrive on healthcare indices indices whereas the red states will have far more deleterious conditions.
We've seen how this plays out already in case of state taxes. Governor Brownback cut taxes in Kansas with the stated intention of spurring economic growth; we all saw the state spiral downwards rather than upwards. Expect the same in case of the differential healthcare systems if left to the states.
8
Ya and he was reelected!!
The Collins compromise is, like most GOP proposals, a disaster. At best it will set up a multi tiered system in which people who live in states like New York, California and Massachusetts have access to affordable health insurance and care while people who live in states like Texas, Mississippi or Alabama will have access to emergency rooms and not much else (unless they are rich).
The ACA was the Republican alternative to single payer universal care. Now that the GOP has declared it a disaster because of their hate for Obama, they have nothing to offer. And it shows.
The ACA was the Republican alternative to single payer universal care. Now that the GOP has declared it a disaster because of their hate for Obama, they have nothing to offer. And it shows.
5
Talking about 'conservative' healthcare policy is absurd. I have yet to hear even one, single Republican state that their goal is absolute, universal coverage. We hear talk of lowering costs and (sometimes) expanding coverage, but never do they state unequivocally that healthcare should be a right for all citizens and residents.
Let's be clear: conservatives have a purely ideological opposition to healthcare. If they were genuinely empirical they would look at systems around the world, and use them as the basis for designing a working American healthcare system. They wouldn't worry if the system is 'socialist' or not, because efficiency and outcomes would be all that would matter. Does this sort of clear-eyed analysis and objectivity sound like any American conservative you know? Hardly....
At the core of Republican opposition to healthcare is the wealthy owners of the party who don't want to pay more in taxes. They are indignant if you bring up the idea that they might pay a small bit more (so little they almost certainly wouldn't even notice it), so that we can extend genuine healthcare to the 100 or more million Americans whose healthcare is lacking in some way (including putting them at risk of bankruptcy). Republicans believe in greed and power, and giving healthcare to poor people feeds neither of these desires.
Let's be clear: conservatives have a purely ideological opposition to healthcare. If they were genuinely empirical they would look at systems around the world, and use them as the basis for designing a working American healthcare system. They wouldn't worry if the system is 'socialist' or not, because efficiency and outcomes would be all that would matter. Does this sort of clear-eyed analysis and objectivity sound like any American conservative you know? Hardly....
At the core of Republican opposition to healthcare is the wealthy owners of the party who don't want to pay more in taxes. They are indignant if you bring up the idea that they might pay a small bit more (so little they almost certainly wouldn't even notice it), so that we can extend genuine healthcare to the 100 or more million Americans whose healthcare is lacking in some way (including putting them at risk of bankruptcy). Republicans believe in greed and power, and giving healthcare to poor people feeds neither of these desires.
6
How are the "failures" of the ACA exchanges, which lie primarily in the high deductibles of the basic "Bronze" plans, to be addressed by "basic catastrophic coverage"? The ACA Bronze plans are already, in fact, basic catastrophic coverage, but with important exceptions designed to encourage preventive care and protect consumers from insurance company abuses -- denial of coverage for preexisting conditions, pricing women and the elderly out of insurance, and annual and lifetime caps. Health savings accounts address only the needs of those with sufficient resources to put savings in them, by definition none of those currently receiving ACA subsidies. Even for the relatively affluent, savings accounts fall woefully short.
The "less spending" envisioned as a benefit of "market based solutions" is precisely people foregoing preventative care they cannot afford, which only leads to greater health crisis spending that might have been avoided. Penny wise, pound foolish.
The proposal to move "experimentation" with this obvious recipe for chaos and catastrophe to the states is neither more nor less than a vicious proposal to experiment with other people's lives. No matter. It won't be with Mr Douthat's life or the lives of anyone he knows. Just the lives of people unfortunate enough to live in "Red States" run by ideologically rabid Republicans, namely the ones already denying their poor the life-saving Medicaid expansion. I live in California, but I'm not cynical enough to cheer.
The "less spending" envisioned as a benefit of "market based solutions" is precisely people foregoing preventative care they cannot afford, which only leads to greater health crisis spending that might have been avoided. Penny wise, pound foolish.
The proposal to move "experimentation" with this obvious recipe for chaos and catastrophe to the states is neither more nor less than a vicious proposal to experiment with other people's lives. No matter. It won't be with Mr Douthat's life or the lives of anyone he knows. Just the lives of people unfortunate enough to live in "Red States" run by ideologically rabid Republicans, namely the ones already denying their poor the life-saving Medicaid expansion. I live in California, but I'm not cynical enough to cheer.
534
Bravo.
In the discussion lately, I've noticed this both-sides-of-mouth set of statements from opponents of the ACA:
1. Obamacare exchanges "don't even feel like health care" because of the high deductibles, and that families find that they can't pay the total costs because of the high deductibles.
2. Forward-looking innovative GOP health care will include high deductibles to incent policy holders to shop in the health care marketplace and that will through the magic of the marketplace bend the cost curve down.
A note on experimentation in the states - my being in New York, your being in California, it strikes me that since health insurance markets have been on the state level anyway, this affords an opportunity for *state* legislatures to enact stabilizing mechanisms (risk corridors, facilitating reinsurance) and to adjust parts of the law that aren't working, without being subject to a political Congress blockade of anything a Democratic President does.
As to my sister and kin in Wyoming, in that tiny market, well, they made their beds. Maybe they can purchase those Mississippi minimed plans that would become ubiquitous in an unregulated national market.
In the discussion lately, I've noticed this both-sides-of-mouth set of statements from opponents of the ACA:
1. Obamacare exchanges "don't even feel like health care" because of the high deductibles, and that families find that they can't pay the total costs because of the high deductibles.
2. Forward-looking innovative GOP health care will include high deductibles to incent policy holders to shop in the health care marketplace and that will through the magic of the marketplace bend the cost curve down.
A note on experimentation in the states - my being in New York, your being in California, it strikes me that since health insurance markets have been on the state level anyway, this affords an opportunity for *state* legislatures to enact stabilizing mechanisms (risk corridors, facilitating reinsurance) and to adjust parts of the law that aren't working, without being subject to a political Congress blockade of anything a Democratic President does.
As to my sister and kin in Wyoming, in that tiny market, well, they made their beds. Maybe they can purchase those Mississippi minimed plans that would become ubiquitous in an unregulated national market.
4
Thank you for finally saying it! Before the ACA there was a lot of talk about catastrophic coverage! Well, they got it, but don't seem to recognize it when they see it.
The results of this experimentation are already known. Poor people's lives are shorter, especially in red states. Conservatives think this is natural and acceptable and gives people another reason to fight their way out of poverty.
1
The President and many in his cabinet are rich, accomplished people with a wealth of business experience. None of them, if given the opportunity to fix a troubled company, would quickly shut down that company and immediately start a new one that did exactly what the original one did. So it's completely clear that "repeal and replace" is a 100% political move that makes no sense in reality. As the column notes, the proposals we've heard about so far are fraught with risks. It's mystifying that after carping about Obamacare for all these years the Republicans didn't have an off-the-shelf risk-proof solution to plug in and play.
If the new solution isn't successful the nation will have gone through approximately 10 years of health care crisis and we'll be no better off than where we were when Bush 43 left office.
If the new solution isn't successful the nation will have gone through approximately 10 years of health care crisis and we'll be no better off than where we were when Bush 43 left office.
2
Firstly, the GOP healthcare plan is obfuscation and takeaway healthcare entirely because they are heartless. They might build a new aircraft carrier instead of funding a program. Their gambit is to destabilize the market and make the exchange system fail and forgetaboutit.
2
Blue states already pay for Red states' failures. This isn't Federalism. It is just more Federalist Welfare, protecting Red states' right to follow failed conservative policies and have the successful liberal Blue states subsidize them.
28
The subsidies the liberal states provide to "conservative" states is one of the biggest public policy problems we have. Republicans don't realize the true cost of the government services they enjoy. Meanwhile, in California, New York, Illinois, Massachusetts and Connecticut (and a few others), the citizens face either higher state taxes or reduced government services specifically because they have to subsidize the government services in Mississippi, Louisiana, Alabama, etc.
This needs to end.
This needs to end.
14
As Mr. Douthat admits the different ideas floated by Republicans as health care plans have never been tested, they may or may not work. On the other hand, Obamacare has been working for the past 5 years albeit it has serious flaws, the biggest one being the lack of a public option. Furthermore, numerous versions of single payer systems have been working fine in many developed countries, providing better health outcomes for MUCH lower cost than our system, whether before or after Obamacare. It is incredible that anyone claiming to be a capitalist, including Mr. Douthat, would not support such a system, given that it is tested, works, significantly cheaper and yields better outcomes. A clear example of ideology trumping reason and rational thinking.
9
Sure. Let's change the name to Trumpcare and keep the system in place, only this time working in a bipartisan way to fix and enhance if as needed. I could live with that. Only why is it that Republicans are insane during Democratic administrations and rational only in Republican ones?
10
"The dominant systems in the developed world, whether government-run or single-payer or Obamacare-esque, are generally statist..." Maybe they are. But they work! They deliver quality care to all of their citizens at far lower cost than then the US. Of course there are challenges in an industry that has high demand, ever increasing technological and pharmaceutical innovations, aging populations and so on, but at least the decisions about the level of spending is made by politicians who are accountable as opposed to corporate bean counters who aren't. The biggest problem with Obamacare, as I see it, was that it didn't include a public option which left the corporate health industry free to sabotage it at will, which it did.
19
The "conservative" health care solution already exists. It is the system designed by the Heritage Foundation, tried successfully in Massachusetts by Governor Mitt Romney and passed by the Congress as Obamacare. Replacements to Obamacare reduce insurance coverage-less care is paid for by insurance- and the pool of insured persons is less than complete, violating the cardinal rule of insurance which requires everyone to be in the pool. Less care and inadequate insurance doesn't sound like a workable plan. Why would any responsible public official support such a plan? Because the conservative agenda is driven by the 1% who refuse to pay their fair share into the country's coffers. It's as simple as that. Small government principles don't seem to apply to oil drilling subsidies, tax reductions for business developments or imaginary depreciation of commercial buildings which reduce real estate developers taxes. It's what we choose to value and from whom we take the money in taxes to pay for what we value that tells the tale. Keeping money means more to the GOP than keeping our health. There are only two things without which our lives are doomed- health and freedom. Nothing else counts as much. Without health or freedom, money doesn't matter. We have a system which provides the most freedom of any society that ever existed in the world. Now we need health to be guaranteed. The GOP doesn't care about health, only money.
22
You state “The right’s best health care minds believe that markets and competition can deliver lower costs and better care.” But that was precisely the system we had before Obamacare. The results: rapidly rising costs of health care and health insurance, and nearly 50 million uninsured. Obamacare has produced huge benefits since its inaction and can be made even better. Replacing it makes no sense. The democrats could still prevent its repeal by acknowledging its current deficiencies and showing that they can be readily corrected, as proposed below. This message should be urgently conveyed to the public, preferably by Barack Obama.
As it stands now, Obamacare’s goals cannot be fully met. There has been a sharp rise in premiums making participation difficult for insurers because the pool of persons seeking insurance in the exchanges is smaller and less healthy than anticipated. These deficiencies, currently exploited by G.O.P. in its efforts to repeal it, can be eliminated by removing their root cause: failure of the individual mandate to encourage younger and healthier Americans obey the law and buy insurance. The mandate could become a powerful incentive either by drastically increasing the penalty for not subscribing or by making participation in the program mandatory. The latter is the case with Social Security. Persons working in employment covered by Social Security are subject to the FICA payroll tax. Like all taxes, its payment is compulsory.
As it stands now, Obamacare’s goals cannot be fully met. There has been a sharp rise in premiums making participation difficult for insurers because the pool of persons seeking insurance in the exchanges is smaller and less healthy than anticipated. These deficiencies, currently exploited by G.O.P. in its efforts to repeal it, can be eliminated by removing their root cause: failure of the individual mandate to encourage younger and healthier Americans obey the law and buy insurance. The mandate could become a powerful incentive either by drastically increasing the penalty for not subscribing or by making participation in the program mandatory. The latter is the case with Social Security. Persons working in employment covered by Social Security are subject to the FICA payroll tax. Like all taxes, its payment is compulsory.
16
Remember most Republicans in charge of our country do not actually PAY taxes, they just steal from the citizenry, who voted for them to keep up the kleptocracy, because you know, Hillary's emails.
5
Perhaps Mr. Trump will turn out to be a great uniter after all (but not quite in the way he envisioned).
I can honestly say this is the very first of Mr. Douthat's columns that I agree with. Instead of staking everything on "repeal and replace," let individual states decide and see what happens.
My main concern with this approach is that it presupposes that there will be some objective way to measure the relative success or failure of Obamacare relative to the Republican alternatives. From his conduct over the past several days, it appears that Mr. Trump is likely to reject any empirical evidence favoring Obamacare in favor of "alternative facts" of his own fabrication.
I can honestly say this is the very first of Mr. Douthat's columns that I agree with. Instead of staking everything on "repeal and replace," let individual states decide and see what happens.
My main concern with this approach is that it presupposes that there will be some objective way to measure the relative success or failure of Obamacare relative to the Republican alternatives. From his conduct over the past several days, it appears that Mr. Trump is likely to reject any empirical evidence favoring Obamacare in favor of "alternative facts" of his own fabrication.
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Health care (actually sickness care) is a business. The business can be profitable in one of two ways. The first is to pay for each service. In that system the more "service" provided the greater the profit. Unfortunately more service does not equate with better outcome - often the reverse is the result.
The second way of increasing profit is by providing health insurance. In that system, carefully restricting service leads to more profit. Any patient or physician dealing with the private insurance system already appreciates other negative factors.
As long as people believe that the "free market" will provide the best results they will be disappointed.
Having been both a provider and a recipient of the Canadian system of single payer I would not trade our system for that just a few miles to the south.
The second way of increasing profit is by providing health insurance. In that system, carefully restricting service leads to more profit. Any patient or physician dealing with the private insurance system already appreciates other negative factors.
As long as people believe that the "free market" will provide the best results they will be disappointed.
Having been both a provider and a recipient of the Canadian system of single payer I would not trade our system for that just a few miles to the south.
3
Good luck to people living in the Deep South. Look how many decades it took for black Americans to vote without harassment because of States Rights.
And if someone moves from a generous state like Massachusetts, they'll be penalized because of another state's indifference?
And if someone moves from a generous state like Massachusetts, they'll be penalized because of another state's indifference?
1
Healthy today, but not healthy tomorrow, through no fault of your own.
Nice if you can predict if/when cancer strikes, or a heart condition, or multiple sclerosis, or whatever.
This will be based on pre-existing conditions no matter what. Insurances want to make money. And Republicans want to help them to do.
Cassidy-Collins might sound helpful, but read between the lines.
Insurances will now have the upper hand again and too bad. Shameful.
Nice if you can predict if/when cancer strikes, or a heart condition, or multiple sclerosis, or whatever.
This will be based on pre-existing conditions no matter what. Insurances want to make money. And Republicans want to help them to do.
Cassidy-Collins might sound helpful, but read between the lines.
Insurances will now have the upper hand again and too bad. Shameful.
7
Actually we do have a real-world example of health care subordinated to the needs of the market, an ideal example, in fact. In the US prior to the ACA, everyone not on Medicare or Medicaid was in that position, and everyone not in a (usually) employer-negotiated group was on their on in the market. The results were millions of uninsured, sky-rocketing costs, personal bankruptcies, homelessness, and unnecessary deaths. Individual insurance was unaffordable in states like NY that didn't let insurers exclude the sick by one means or another, and unavailable or useless in states that did not.
I see no evidence that Republicans want to "balance" Burke and Freidman, even if such a thing were possible. Burke is simply their marketing mascot. These are people who want to sacrifice all human values and insitutions, as well as our lives, on the altar of their fanatatical & incoherent free-market ideology. They make Soviet communists look pragmatic.
I see no evidence that Republicans want to "balance" Burke and Freidman, even if such a thing were possible. Burke is simply their marketing mascot. These are people who want to sacrifice all human values and insitutions, as well as our lives, on the altar of their fanatatical & incoherent free-market ideology. They make Soviet communists look pragmatic.
32
Health care policy should not be a test, a crucible, where you try something based on ideological principles, step back and wait and see how things turn out. That's the Joseph Mengele approach to health care. What's missing from the right's heady conservatism is any value on compassion and kindness. Without a doubt, these basely inadequate plans will cause massive amounts of suffering for millions of Americans who run into health problems.
9
Like Obamacare, far too much detail. Figuring out how to pay for doctors' visits and hospitalizations need not be as complicated as filling out an income tax return. Attack the problem at the cost end, rather than at payer end. Put the burden on the bean counters, not on the patients. If the reason medical costs are in the stratosphere is medical equipment, let the government subsidize *that*, not individual insurance premiums.
The goal of government where red tape is involved should always be to ensure that the citizen has as little of it as humanly possible. Clinton couldn't imagine that, and neither could Obama, and neither can the Republicans. Obviously, we need a Health Care Party.
The goal of government where red tape is involved should always be to ensure that the citizen has as little of it as humanly possible. Clinton couldn't imagine that, and neither could Obama, and neither can the Republicans. Obviously, we need a Health Care Party.
6
I applaud David Brooks for being willing to admit that the kind of 'plans' that Republicans are talking about have never been successful anywhere else. But he -- and everyone else who talks about catastrophic plans -- misses something extremely important: the best and cheapest way to treat catastrophic illnesses is to catch them very early, and catastrophic plans do not provide for catching them early. So catastrophic plans will lead to much worse outcomes and cost much more than real insurance coverage.
7
I propose the following "conservative" health care plan;
Take one "conservative", put his income at the national median, get him seriously ill, and ask him what approach he would then suggest.
Take one "conservative", put his income at the national median, get him seriously ill, and ask him what approach he would then suggest.
19
The answer to health care insurance is to be found in the federal system. All American citizens should be eligible for the same health insurance that is available to federal employees at the same prices. There is a veritable plethora of plans to choose from at varying cost with the majority of the cost being paid by the government.If it's good enough for the feds it should be good for all America.
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A brilliant idea Ross, experiment with a "red state/blue state" solution and let the games begin--- further divide America along the ignorant and educated gap. Change the "pledge of allegiance " to "...two nations under God or maybe not"-- face it--stop straining your brain-- Obamacare's 1.0 of the Heritage Foundation's version of health care is the only cobbled together and workable solution for the "conservative thinkers"-- especially if the Republicans simply support Obamacare in ALL STATES (red ones, too)--- here's an idea, call it Trumpcare, and declare it "new and improved" -- the reality-show president will claim it, and half of America won't notice the scam.
38
Self-managing an HSA account requires every citizen to develop actuarial skills as well as a advanced medical knowledge, which is not a reasonable expectation. It leaves the population exposed to quacks and hucksters who will drain every dollar. Did we not learn anything from deregulating banks and their predatory HELOC's? As for red state experiments in conservatism, what about Kansas? This red state failure in No Taxes continues to roll on, and yet it will soon be expanded to the federal level.
Letting the blue states keep the ACA is a blatant attempt to divide and conquer. Eventually we'll all end up bailing out the red state the plans, just like we had to do with TARP. Also Remember, these are human lives you are 'experimenting' with.
Letting the blue states keep the ACA is a blatant attempt to divide and conquer. Eventually we'll all end up bailing out the red state the plans, just like we had to do with TARP. Also Remember, these are human lives you are 'experimenting' with.
25
Creating an ACA / Obamacare alternative of a "block grant system" so that GOP controlled states could opt-out would be a dismal policy.
Pretty soon, that money gets swept into state coffers and the health care goal vanishes. Is there any serious belief that the GOP would have an interest in enforcing the goal of funding health care? Dream on ... and not in a good way.
Pretty soon, that money gets swept into state coffers and the health care goal vanishes. Is there any serious belief that the GOP would have an interest in enforcing the goal of funding health care? Dream on ... and not in a good way.
11
"...peril of a too wide gap between what the money in your health savings account covers and what you need before your catastrophic coverage kicks in. In which case many people with consistent health care costs for chronic problems would rack up impossible medical bills in short order."
Mr. Douthat, no conservative healthcare plan is without the silly HSA--health savings accounts--that Paul Ryan and his Ayn Rand adherents want to visit upon the working poor. How, with depressed wages, are they to accumulate anything like a healthy savings balance for "catastrophic coverage?"
The problem, as it always is with the Right, is "how can we get the lesser people in *our* country to accept even less than they have now?" Mr. Douthat, sorry, but single payer is the only sensible option. What's more important, "innovation-squashing price controls" or a healthier and more productive labor force? Conservatives (such as yourself) want it both ways: high premiums=greater profits for the insurance and drug industries while the people paying for it see their wages tanked because they have to stay alive by ponying up for expensive diagnosis, treatment and medication.
This goes to the heart of red-staters, Trumpistas and clueless constituents voting against their own interests. People get sick; always have, always will. Why not make the inevitable something they can live with instead of the eternal need for privatization and profits?
What about people? In this wise, ObamaCare failed?
Mr. Douthat, no conservative healthcare plan is without the silly HSA--health savings accounts--that Paul Ryan and his Ayn Rand adherents want to visit upon the working poor. How, with depressed wages, are they to accumulate anything like a healthy savings balance for "catastrophic coverage?"
The problem, as it always is with the Right, is "how can we get the lesser people in *our* country to accept even less than they have now?" Mr. Douthat, sorry, but single payer is the only sensible option. What's more important, "innovation-squashing price controls" or a healthier and more productive labor force? Conservatives (such as yourself) want it both ways: high premiums=greater profits for the insurance and drug industries while the people paying for it see their wages tanked because they have to stay alive by ponying up for expensive diagnosis, treatment and medication.
This goes to the heart of red-staters, Trumpistas and clueless constituents voting against their own interests. People get sick; always have, always will. Why not make the inevitable something they can live with instead of the eternal need for privatization and profits?
What about people? In this wise, ObamaCare failed?
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Whatever GOP-Trump plan is proposed it should be laid out in full and complete detail so the American people can see everything FIRST before anymore repeals of the Affordable Health Care Act continue. Hold hearings. Transparency. Sunshine. Full Disclosure.
In my view, in the end I think the best deal for Americans would look similar to what every other democratic country has been doing with their health care systems. In US it would be Medicare for all.
In my view, in the end I think the best deal for Americans would look similar to what every other democratic country has been doing with their health care systems. In US it would be Medicare for all.
54
Never happening. Look at all of the damage done in one week - it's going to get very ugly, quickly.
6
It is not possible to be a smart consumer when it comes to healthcare. You can't choose insurance policies that provide what you want and leave out what you don't. Policies are packaged deals approved by insurance commissions mostly run by Republicans. You can get yelp rating on doctors but it's mostly about whether the doctor's staff was nice. As for meds, your Rx depends on which attractive blonde drug rep dropped the most new sample drugs off in the office. Even the FDA does not study the efficacy of meds. And then there's the problem of not having enough doctors in rural areas so no competition and the staggering cost of a medical education which prices out people who would work in rural areas. Competition in health care is malarkey. It's really a crap shoot,
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To your comments I would add the whole business of in-network vs out of network in emergencies.
5
It is also not possible to be a "smart consumer" of health care when you are ignorant of science, unconscious, in pain, or dying.
4
While I basically share much of your sentiment, your point about the FDA and drug efficacy is odd. While the FDA itself does not conduct or sponsor drug efficacy studies, a drug will not be approved by the FDA without studies (sponsored by the drug manufacturer) demonstrating that it is adequately efficacious.
1
Douthat is correct in that market mechanisms reduce spending on health care.
But market mechanisms do NOT yield better health care.
Many people who should undergo screening will not do so because of cost.
Cancerous lumps, diabetes, high blood pressure / cholesterol will not be discovered in time and people will die unnecessarily.
But medical costs will decrease because of decreased utilization.
And conservatives find this increase in unnecessary death acceptable.
For the conservative argument see
https://www.washingtonpost.com/opinions/end-obamacare-and-people-could-d...
Milton Friedman was an idiot. He would not require doctors to be licensed.
Let the free market determine if a doctor is competent. If a certain doctor’s patient do not get well then patients will not go to that doctor.
What happens to those patients who croak before it is discovered that the doctor is incompetent. Often this takes a long long time.
Friedman does not care just like he didn’t care about those people who were “disappeared” by Pinochet in Chile.
But market mechanisms do NOT yield better health care.
Many people who should undergo screening will not do so because of cost.
Cancerous lumps, diabetes, high blood pressure / cholesterol will not be discovered in time and people will die unnecessarily.
But medical costs will decrease because of decreased utilization.
And conservatives find this increase in unnecessary death acceptable.
For the conservative argument see
https://www.washingtonpost.com/opinions/end-obamacare-and-people-could-d...
Milton Friedman was an idiot. He would not require doctors to be licensed.
Let the free market determine if a doctor is competent. If a certain doctor’s patient do not get well then patients will not go to that doctor.
What happens to those patients who croak before it is discovered that the doctor is incompetent. Often this takes a long long time.
Friedman does not care just like he didn’t care about those people who were “disappeared” by Pinochet in Chile.
270
But medical costs will decrease because of decreased utilization."
But then why have medical costs continued to go up and up? The US has operated on the market-based system always, and proved it doesn't work.
It rations health care to those who can pay.
This "medical free market" is a monopoly. Why can't conservatives get this through their thick skulls? Because the believers all can afford health care, don't really shop for it (they get what their employers provide), and most importantly: they don't care who dies. In fact, dying helps lower costs as dead people don't need health care.
But then why have medical costs continued to go up and up? The US has operated on the market-based system always, and proved it doesn't work.
It rations health care to those who can pay.
This "medical free market" is a monopoly. Why can't conservatives get this through their thick skulls? Because the believers all can afford health care, don't really shop for it (they get what their employers provide), and most importantly: they don't care who dies. In fact, dying helps lower costs as dead people don't need health care.
11
Milton Friedman was an idiot. He would not require doctors to be licensed.
Let the free market determine if a doctor is competent....
Friedman does not care just like he didn’t care about those people who were “disappeared” by Pinochet in Chile.
If only economists were licensed, too. Douthat wouldn't be able to qualify.
Another commenter above, sDavidc9 also nails some of the economic arguments why healthcare doesn't respond to market forces.
Here'a another one: in a free-agent market a buyer can determine that the cost is too high *and choose not to buy.* So, say that flat screen you fancy is too much, you can choose not to buy hoping and knowing that the price will come down over time. This is an essential part of the market working as it should.
How many cancer diagnosed patients are going to use their free market savvy and wait for the price of cancer care to fall? They can't. Because it might not. In fact, they can almost be sure it'll go up! Thus a key free-market component is missing in the health care area.
Put that in your pipe and smoke it, Milton Friedman and Mr. Douthat.
Let the free market determine if a doctor is competent....
Friedman does not care just like he didn’t care about those people who were “disappeared” by Pinochet in Chile.
If only economists were licensed, too. Douthat wouldn't be able to qualify.
Another commenter above, sDavidc9 also nails some of the economic arguments why healthcare doesn't respond to market forces.
Here'a another one: in a free-agent market a buyer can determine that the cost is too high *and choose not to buy.* So, say that flat screen you fancy is too much, you can choose not to buy hoping and knowing that the price will come down over time. This is an essential part of the market working as it should.
How many cancer diagnosed patients are going to use their free market savvy and wait for the price of cancer care to fall? They can't. Because it might not. In fact, they can almost be sure it'll go up! Thus a key free-market component is missing in the health care area.
Put that in your pipe and smoke it, Milton Friedman and Mr. Douthat.
9
Republican encounter a problem and instead of thinking "how can we solve this problem," they think "how can some people profit from this problem, whether by solving it or exacerbating it."
5
The kind of blue-red state experiments that Ross suggests tend to favor discovering alternative ways of generating new jobs, which could be broadly adopted once proven effective locally; but probably won’t sell or even work with healthcare. For example, reducing regulation or even relaxing start-up loan requirements in areas expected to benefit from infrastructure stimulus could be a boon to filling the hole we have in the number of available welders nationally; but just about everywhere, when someone needs a kidney … s(he) needs a kidney.
So-called “conservative” healthcare policy depends on the assumption that people are entitled to nothing from their government; and it’s as invalid and ultimately unsalable as the liberal conviction that people are entitled to a guarantee of basic sufficiency in ALL matters, including healthcare, while making no efforts to earn that sufficiency themselves. NEITHER extreme view works, and yet another failure in healthcare in America could destroy Republicans just as it so manifestly (at least temporarily) destroyed Democrats electorally.
No, it’s not going to be so easy as temporizing on healthcare by saying what conservatives are implying on abortion: “let’s let abortion be decided on a state-by-state level and see how it goes – let’s let STATES compete for how many or few dead mothers each can generate”. Republicans will need to offer real leadership on a NATIONAL scale on healthcare, and they need to do it BEFORE they kill the ACA.
So-called “conservative” healthcare policy depends on the assumption that people are entitled to nothing from their government; and it’s as invalid and ultimately unsalable as the liberal conviction that people are entitled to a guarantee of basic sufficiency in ALL matters, including healthcare, while making no efforts to earn that sufficiency themselves. NEITHER extreme view works, and yet another failure in healthcare in America could destroy Republicans just as it so manifestly (at least temporarily) destroyed Democrats electorally.
No, it’s not going to be so easy as temporizing on healthcare by saying what conservatives are implying on abortion: “let’s let abortion be decided on a state-by-state level and see how it goes – let’s let STATES compete for how many or few dead mothers each can generate”. Republicans will need to offer real leadership on a NATIONAL scale on healthcare, and they need to do it BEFORE they kill the ACA.
56
Good luck with that Richard. All we're seeing these days are optics not real leadership. Let's make sure only one party controls the government so they can be re-elected endlessly. And while we're at it, let's strangle government in a bathtub and then the country will be great. Again and again and again and again.
7
Your idea of what liberalism requires of people is dead wrong.
13
Wow, he was almost rational today.
8
An "alternative" view: Modern conservatism (and its historic antecedent) emerged from parliament's debates over law and slavery--how far property rights extended, how buying and selling persons could be justified, under two competing theories of law--Burke was irrelevant except for the practical application of his ideas--slavery was no "experiment,"--the trade financed the industrial revolution. To shroud history in intellectual discourse is a tactic, not a truth; it also denies a choice--slavery had no competition. This deplorable veil is why conservatism leads to fascism and authoritarian regimes.
Speaking of healthcare as a "statist" ideological expression stands Occam's razor on its head--the broader truth is form follows function: healthcare, by its very nature, can not succeed in its goals of saving and preserving the maximum of lives in a society in the form of market practices--it is the one vital aspect of life that doesn't fit/contradicts market goals: profit. The balance sheet is inherently at odds with saving lives. Death is not a government recall by repeal.
In the end, Occam rises: the "leap of faith" shows "the right is wrong" (It's model doesn't match reality!): layering human health into categories of events/income (catastrophic/poor), using a calculus of "hope" to deny facts (Obamacare insured 20 million, repeal will kill 36,000 (more than terrorism!)), slipping in inflation is modern conservatism's balance sheet--still making money selling human lives.
Speaking of healthcare as a "statist" ideological expression stands Occam's razor on its head--the broader truth is form follows function: healthcare, by its very nature, can not succeed in its goals of saving and preserving the maximum of lives in a society in the form of market practices--it is the one vital aspect of life that doesn't fit/contradicts market goals: profit. The balance sheet is inherently at odds with saving lives. Death is not a government recall by repeal.
In the end, Occam rises: the "leap of faith" shows "the right is wrong" (It's model doesn't match reality!): layering human health into categories of events/income (catastrophic/poor), using a calculus of "hope" to deny facts (Obamacare insured 20 million, repeal will kill 36,000 (more than terrorism!)), slipping in inflation is modern conservatism's balance sheet--still making money selling human lives.
127
A state report in South Carolina (a red statist government!) estimates 30,000 jobs (in SC) will be lost if the ACA is repealed and 3 billion dollars will be lost. That's bad for the vaunted balance sheet conservatives love to present as the holy grail. (They hide these facts!)
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Free-market competition does produce more innovation than more socialized systems, but the innovation is not mainly in medicine or medical care but rather in how to make money within the existing system and change it so as to make more. Finding a more effective drug is to a great extent a matter of chance. Finding a more effective way to promote and market that drug is something much more under a manager's control, and something that can and should be done whether the pipeline of new products is full or empty. So most of the innovations in the medical industry have little to do with healing people compared with healing profitability. And in this area they are outstanding.
Markets and competition may deliver lower costs and better care, but they are trying to make money, which means higher costs and more expensive care. The competitors are managing competition so that it does not become a price war that would deliver better care at a lower cost.
Businesses compete against each other and against their customers. They compete against each other by giving their customers bargains. They compete against their customers by working together so the way they compete does not give customers the advantage.
Markets and competition may deliver lower costs and better care, but they are trying to make money, which means higher costs and more expensive care. The competitors are managing competition so that it does not become a price war that would deliver better care at a lower cost.
Businesses compete against each other and against their customers. They compete against each other by giving their customers bargains. They compete against their customers by working together so the way they compete does not give customers the advantage.
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C-3p0:
I'm afraid I don't buy your premise, so I have a problem buying your conclusions.
Certainly, the INCENTIVE that drives innovation, in medical matters as well as anything else, isn't merely or even primarily Kumbaya but making money. It has ever been thus, since long before the dawn of the Industrial Revolution and the evangelization of Adam Smith. But the OUTCOMES to society of successful incentives to innovate aren't merely money for the innovators.
Many demonize Trump because in pursuit of money he built and participated in the building of so much. Yet, at the end of the day, we still have the buildings. As an illustration relevant to THIS topic, consider the explosion in medical diagnostic aids that we've seen over the past dozen or so years, and consider the predictions of so much more to come soon. All the new software, databases and hardware tools are immensely facilitating diagnosis -- a VERY high percentage of what doctors now do that costs so much and if it can reliably be automated will cost so little.
Your perception of how markets work in a matter that in truth VASTLY benefits society as a whole is ... inaccurate. Our governance should be doing EVERYTHING it can to incentivize innovation, through rational tax and regulatory policy. Some will simply have to accept the evil inherent in some making money at it, even when society so clearly and yugely benefits.
We'll still have the buildings.
I'm afraid I don't buy your premise, so I have a problem buying your conclusions.
Certainly, the INCENTIVE that drives innovation, in medical matters as well as anything else, isn't merely or even primarily Kumbaya but making money. It has ever been thus, since long before the dawn of the Industrial Revolution and the evangelization of Adam Smith. But the OUTCOMES to society of successful incentives to innovate aren't merely money for the innovators.
Many demonize Trump because in pursuit of money he built and participated in the building of so much. Yet, at the end of the day, we still have the buildings. As an illustration relevant to THIS topic, consider the explosion in medical diagnostic aids that we've seen over the past dozen or so years, and consider the predictions of so much more to come soon. All the new software, databases and hardware tools are immensely facilitating diagnosis -- a VERY high percentage of what doctors now do that costs so much and if it can reliably be automated will cost so little.
Your perception of how markets work in a matter that in truth VASTLY benefits society as a whole is ... inaccurate. Our governance should be doing EVERYTHING it can to incentivize innovation, through rational tax and regulatory policy. Some will simply have to accept the evil inherent in some making money at it, even when society so clearly and yugely benefits.
We'll still have the buildings.
2
Your paragraph on incentives actually does make sense. The rest of your comment is like Trumps where he rolls from the topic at hand to some meaningless topic that only makes him look small.
4
Businesses compete to make a profit. ..period.
1