Patterico's Pontifications

3/27/2017

What Should Be the Next Step on Repealing ObamaCare? Ted Cruz Has the Answer

Filed under: General — Patterico @ 2:00 am

So. What comes next on repealing ObamaCare?

The TrumpCare bill (AHCA) was a disaster. It was not a vote to repeal ObamaCare, but rather a vote to keep it, and tweak it. That’s not what Republicans promised to do, and it’s not good enough. We should not mourn its passing, but celebrate it. The defeat of the bill was glorious, and the members of the Freedom Caucus who opposed it are heroes.

The reason fans of the free market are angry is not because TrumpCare failed — but because of the statements by Paul Ryan and Donald Trump that they are done with trying to repeal ObamaCare. Those statements are wrong and dangerous. As Ted Cruz once said:

First principle: Honor our promise. When you spend six years promising, “If only we get elected, we’ll repeal Obamacare,” you cannot renege on that promise. Failure is not an option. Breaking our word would be catastrophe. The voters would, quite rightly, never again trust Republicans to deliver on anything.

Amen.

The response to the defeat of TrumpCare is not to pick up the ball and go home. It must be to draft a bill that actually does what Republicans promised, and drives down costs through market-based mechanisms.

What should such a bill look like? As it turns out, Ted Cruz had a proposal that outlined an answer to that question. I blogged that op-ed before, but with the defeat of the AHCA, Cruz’s op-ed has renewed relevance, as a blueprint that could bring Republicans together and actually repeal ObamaCare. I think it’s worth giving his proposal another detailed look.

First, Cruz suggests something I have been pushing throughout this process: starting with the 2015 repeal bill.

First, begin with the 2015 repeal language. . . . Virtually every Republican in Congress voted for that language, and the parliamentarian has already ruled it as permissible. We should begin with that previously approved repeal language as the baseline.

Bingo. The recent debate over AHCA has shown that the previous votes to repeal ObamaCare may have been fraudulent show votes. But here’s the thing: if you’re a moderate, it’s easier to justify a vote against AHCA than it would be to justify changing your vote on the exact same language you voted for before.

A duplicate of the 2015 bill, we learned yesterday from Andrea Ruth, exists — today, in this Congress. It is languishing in committee. It needs to be pushed to the floor and voted on.

But the 2015 bill is not enough. So Cruz next focuses on areas that should provide broad consensus for Republicans. They include excellent ideas like “allow[ing] consumers to purchase insurance across state lines,” ensuring the ability to buy “low-cost catastrophic insurance on a nationwide market,” and the use of health savings accounts. These would all have the effect of increasing competition and lowering costs. But it’s what Cruz says next that I consider critical:

Third, we should change the tax laws to make health insurance portable, so that if you lose you[r] job you don’t lose your health insurance. You don’t lose your car insurance or life insurance or house insurance if you lose your job; you shouldn’t lose your health insurance either. And that would go a long way to[wards] addressing the problem of pre-existing conditions, since much of that problem stems from people losing their jobs and then not being able to get new coverage on the individual market.

Fourth, we should protect continuous coverage. If you have coverage, and you get sick or injured, your health insurance company shouldn’t be able to cancel your policy or jack up your premiums. That’s the whole point of health insurance.

These suggestions by Cruz are very important, and I want to discuss them at some length. Here’s where it gets tough, because there’s a bitter pill that, in my view, Americans have to swallow: we have to get rid of the ObamaCare provision that requires companies to insure pre-existing conditions. Now I can already hear a bunch of people yelling: hold up there hoss, that’s never going to work and people don’t want that. Do me a favor: hear me out. There’s a way to address the concerns people have about insurance companies’ refusal to insure against pre-existing conditions without this mandate. The answer lies in Cruz’s suggestions in his op-ed, which contains terms that may seem abstract to some people, such as “guaranteed renewal” and “equal tax treatment for individual plans” and “portability.” But if you stick with me for a moment, I’ll explain the reality behind these abstract terms, and how they can help solve the problem.

First, let me say that I understand why people wanted the provision requiring coverage for pre-existing conditions. Very simply: the situation before ObamaCare was untenable for a lot of people, and the recession made it worse. Here’s the scenario: you’ve been carrying health insurance for years through your job — but then the recession hits and you are laid off. You’ve been responsible all these years, but in the meantime you’ve developed a serious health condition. Because insurance is tied to work, you’re now thrown into the individual market, which is entirely dysfunctional and which may well reject you because of your “pre-existing” condition.

This is an entirely unacceptable state of affairs. It’s unfair, and Americans should not have to stand for it. And it seems to many people as though the easy answer is to tell insurance companies: hey, you have to cover these conditions! But here’s the problem: that leads you inextricably down the ObamaCare path, because if you mandate coverage for pre-existing conditions, most people just won’t buy health insurance until they develop those conditions. That’s clearly an unworkable situation for insurance companies, because they can’t make money by selling only policies that are going to lose them a lot of money. And that’s what led us to this Rube Goldberg contraption of ObamaCare, where the government decided to pad the insurance companies’ bottom line by forcing healthy people to buy insurance, and even forcing them to buy coverage for things they didn’t want and would never want (like maternity care for a single male).

So the pre-existing conditions requirement is not some perk that we can keep while ditching the rest of ObamaCare.

So what else can be done? Well, there’s always single-payer. If you liked socialism and think it worked well for the Soviet Union, North Korea, and Venezuela, you’ll love socialism in health care! The rosy Big Media descriptions of socialized health care in Canada, the UK, and elsewhere often leave out the plight of people who die waiting for their operations, and are simply neglected by a system that has no real incentive to improve their health. There’s also a corrosive effect of nationalized health care on your ability to criticize the government. If you think politicians making decisions about your life is a good thing now, just wait until they have power over whether you live or die. Dissent is going to be a little more difficult then, isn’t it?

Luckily, the free market has another way. It’s called guaranteed renewability — the same concept as the “continuous coverage” described by Cruz in his op-ed. Guaranteed renewability is described in this excellent paper from the Mercatus Center:

[G]uaranteed-renewable insurance permits consumers to renew their coverage at the same premium, regardless of whether they have developed any new chronic health conditions since obtaining the insurance.

If you really want to go deep into the policy analysis, I recommend reading that paper. But the essence of the idea is that, like term life insurance, annual premiums are lower if you buy in when you’re young and healthy. This way, the money that insurance companies need to cover people who have developed serious health conditions is provided voluntarily by younger people who want to buy into guaranteed renewal coverage early, rather than by a government-ordered mandate enforced by penalties (or if you prefer, Justice Roberts, by “taxes”) imposed on people who don’t comply.

Why didn’t this happen pre-ObamaCare? Actually, it did — but it was unworkable for a lot of people who lost their jobs, because insurance was not truly portable. The Mercatus Center paper says that “most individual market plans were indeed sold with this guaranteed-renewable provision” — but if you lost your job, you’d end up having to convert from a health plan sponsored by the employer to an individual health plan. This would subject you to rejection for a pre-existing condition — the very same unacceptable racket described above. The HIPAA law in 1996 attempted to address the issue of portability, but did not really fix the problem.

A large part of the reason health insurance is not fully portable is the differential tax treatment between employer-sponsored and individual plans. Insurance premiums paid by employers are not taxed, while premiums paid by individuals are.

How could we even out the tax treatment of employer-sponsored and individual plans? We could follow the lead of most economists and rescind the tax exemption for employer-sponsored plans, but that would be very unpopular. The Mercatus Center instead suggests “modification of the tax code to extend the tax break for health insurance beyond the employment-based market into the individual market.” In other words, give the tax exemption to everyone. This would still amount to a subsidy by the federal government — but employees already enjoy this subsidy, and the unequal treatment of individual plans is not equitable and distorts the market. The key is treating both types of plans equally under the tax code.

Of course, we can’t just snap our fingers and achieve all this overnight. As the Mercatus Center paper acknowledges, “a transition to this market-oriented arrangement would likely have to be coupled with high-risk-pool coverage for those who already have pre-existing conditions, but the need for these high-risk pools would decline over time.” You can’t just yank the rug out from people who have no choice but to depend on the ObamaCare system in the near term. But moving towards a market-based system will lower costs and premiums.

We also have to move away from the situation where a third party pays for everyday costs. Basic health care should not be covered by insurance. Your car insurance does not cover oil changes, and health insurance should not be used for basic care like checkups and treatment of everyday illnesses. When people have to make their own choices about how much to spend, prices will fall — and so will insurance premiums.

What about the people who can’t afford insurance (or who are simply irresponsible and do not buy insurance)? Well, first of all, with the above reforms, there would be far fewer people in that situation than there were in 2008, before ObamaCare was passed. But in the end, this is a separate question from the basic policy of how to repeal ObamaCare. There will always be the less fortunate in society who can’t afford some of the basics of life: housing, food, health care, and the like. And there will always be people who are irresponsible and don’t plan for their future, whether it’s in the area of health insurance, life insurance, retirement, their kids’ education . . . the list goes on.

For these groups of people, there will always be a tension between people like me, who recommend that such issues be taken care of by charity and the private sector when the problems to be addressed are serious or life-threatening, and leftists who want the government to take care of everybody. Either way, the reality of the world is that resources are scarce, and not every need can be met. This will always be true under any system. Government cannot simply decree that everyone will receive the best possible care for every illness. Any system, whether public or private, will result in some people not being able to access scarce resources. No government health care system is a panacea, and anyone who keeps their eyes open and watches for stories of people being mistreated under socialized health care will find them. The VA is just the tip of the iceberg.

But the solution is not to give ideal care to people who could have bought insurance but chose not to. Imagine doing that with any other type of insurance: Gallant buys a fire insurance policy and Goofus does not — but Goofus knows that government will buy him a new house if his house burns down. Goofus is not going to buy insurance in that scenario — and Gallant won’t either. The concept of insurance is destroyed by such an arrangement. Some Goofuses are going to suffer in the free market — but again, no resources in this world are unlimited, and Goofus will never have all his needs met without contributing to society.

Finally, let me briefly revisit a topic I covered before — because the reigning assumption appears to be that repealing ObamaCare would leave millions uninsured and worse off. This is completely bogus, and the fallacy of that argument must be central to any discussion of what to do next. For the full argument, I commend to you my post from March 8. Here’s the summary: to the extent that health care coverage has increased, that increase has resulted from two factors: a) gains in employer-sponsored insurance, and b) an expansion of Medicaid.

The former (increased employer-sponsored insurance) is not due to ObamaCare but rather is due to the (tepid) recovery and millions going back to work. Indeed, private coverage has been harmed by ObamaCare, since ObamaCare has hampered the recovery and hurt employers’ ability to hire more people. Since the passage of ObamaCare, believe it or not, “the share of Americans with private insurance has declined.” Yes: declined. So ObamaCare does not get credit for expanding private health insurance.

The latter factor (expansion of Medicaid) is not a net gain for Americans because outcomes under Medicaid are worse than outcomes of the uninsured. Under ObamaCare, age-adjusted death rates increased in 2015 after declining for decades — and life expectancy fell for the first time since 1993.

Repeal will not cost lives. If anything, full repeal with no replacement will save lives.

We can’t give up. Republicans promised repeal. The time to deliver is now. Republicans need to stop buying into the false premise that ObamaCare has helped people. Republicans need to enact real market-based reforms.

The principles articulated by Ted Cruz would be an excellent place to start.

[Cross-posted at RedState and The Jury Talks Back.]

186 Responses to “What Should Be the Next Step on Repealing ObamaCare? Ted Cruz Has the Answer”

  1. The freedom caucus and all republicans can kiss my old hip.

    mg (31009b)

  2. Well said, counselor. If only the Beltway R’s would support this strategy we could get somewhere.

    crazy (d3b449)

  3. Your position on health care is lucid and logical.

    Your position on what the Republicans promised isn’t.

    Trump promised cheap universal healthcare and the people who voted for him each took their preferred view of what that looks like and includes.

    Voting in Conservative justices is relatively non-controversial and from that angle Trump was a good vehicle to keep the Democrats out and push their agenda.

    On economic policy (from healthcare to trade) voting in a populist demagogue may prove to have been worse than principled opposition for the medium term conservative agenda. Steve Bannon is closer to Hugo Chavez than he is to any orthodox Republican.

    Bob (e21732)

  4. It was not a vote to repeal ObamaCare, but rather a vote to keep it, and tweak it.

    pervy Mitt Romney’s slicked-up little sex poodle Paul Ryan

    he was too cowardly to let anyone do anything so bold as to cast a vote

    happyfeet (28a91b)

  5. Yes.

    It may also be necessary to give away some free stuff to make the transition from Obamacare more palatable. For example: for a time, subsidizing premiums for people with preexisting conditions. Obamacare has already done tremendous damage and we might have to pay for some of that to make the switch happen.

    We should be promoting catastrophic plans, rather than gold-plated “insurance pays for everything” plans. If you want glasses, pay for it yourself, etc. That would make it a heck of a lot more affordable for people. (But: not outlawing gold-plated plans, we would let the market operate.) In general, spending on health should be tax deductible whether it’s insurance, or self-insurance, spending on medical devices, medicine, etc. outside of an insurance plan, and that should be true whether you are spending on yourself or others.

    One idea I had is: when you get health insurance through your employer, you ought to fund more than 100% of it. In other words, if you work for your employer for a year, instead of paying for 1 year of premiums, you would pay for 2 years. If you work there for 10 years, you would pay for 20. So if you got laid off, you would have more time to find new work before you had to kick in premiums. That would happen until your insurance was paid up for year 65. After that, you would probably be looking to fund some sort of medicare supplemental plan. I haven’t worked out whether this should be purely optional or what. Also, I don’t necessarily think a mandate is bad if it’s to buy catastrophic insurance (much less expensive) and it’s limited to some people with jobs (who can afford it). Basically it would be like paying for unemployment insurance, you are insuring yourself against future job loss.

    Daryl Herbert (7be116)

  6. the freedom filth caucus doesn’t negotiate in good faith

    they’re as neutered as Mitt Romney’s baby-boy sex poodle now

    happyfeet (28a91b)

  7. the freedom filth caucus doesn’t negotiate in good faith

    they’re as neutered as Mitt Romney’s baby-boy sex poodle now

    happyfeet (28a91b) — 3/27/2017 @ 5:02 am

    You might have a point if anyone actually tried to negotiate:

    “Guys, look. This is not a discussion. This is not a debate. You have no choice but to vote for this bill,” Bannon reportedly said.

    But please, continue with your tired schtick.

    Sean (41ed1e)

  8. Pat,

    Portability is a problem because employers group premiums are modified by experience (claims). It would be risky for high turnover companies to have non employee claims affecting there current costs.

    Until some insurance industry solution to managing and modifying these experience (claims) risk adjustment, then Obama care or Cruz care no matter how principled or conservative is a non starter

    EPWJ (5022ab)

  9. the freedom filth caucus negotiated with Mitt’s slicked up sex poodle, not with the WH

    the won many concessions, but ultimately decided their constituents were better off sticking with obamacare and oodles of delicious planned parenthood abortions

    happyfeet (28a91b)

  10. *they* won many concession i mean

    happyfeet (28a91b)

  11. ugh *concessions* i mean

    happyfeet (28a91b)

  12. You can’t force healthy people to pay high health insurance prices to subsidize the ongoing self-abusive misbehavior of drug addicts, drunks, and smokers.

    Unless and until our elected leaders face up to the cold hard wisdom contained in the phrase “you reep what you sow” efforts to pass real healthcare reform will continue to suffer defeat from misguided nostrums and idiot fantasies in spite of the growing need for a rational health insurance system.

    Politicians dependent on mass voter approval will prove incapable of desigining a multiteared system which rewards healthy lifestyles and appropriately charges the self-indulgent for the consequences of a wasted life.

    ropelight (734d75)

  13. It’s a great plan. Combined with Cruz’s unparalleled ability to work with other lawmakers, in both chambers and from both parties, to pass legislation, not to mention his world-renowned personal charm and leadership skills, it should be on Trump’s desk for signature by noon tomorrow.

    nk (dbc370)

  14. didn’t harvardtrash ted run this whole campaign or whatever where he could have made the case for these reforms?

    i mean

    in lieu of shrieking about bathroom trannies and canoodling with carly pupperoni

    happyfeet (28a91b)

  15. Anyone who think fidgeting with insurance regulations will drive down Cost of Health Care is an idiot.

    To keep repeating this is a big lie and a bad one for Republicans to regurgitate.

    Only way to reduce costs in any meaningful way is to reduce the consumption of actual health care.

    That requires making people pay for it (which lowers quantity demanded).

    Insurance should be exclusively for those thing you can’t foresee and are serious.

    This is why catastrophic policies covering inpatient care and some outpatient surgery is the way forward.

    The days of forcing insurers to issue policies that cover every stinking visit to the doctor and pharmacy is bad. Drives up costs and drives up deductibles.

    They days of forcing insurers to cover drug treatment and other self-made conditions is also bad. Drives up costs and drives up deductibles.

    The finer the risk pool the better for the consumer in terms of costs.

    The worst kind of insurance is the one you can consume and consume and consume while passing costs off on others. Because then everyone wants to get over.

    Blah (44eaa0)

  16. #15 and change standards of care along with med mal … but this is moreso a supply side effect.

    Blah (44eaa0)

  17. Ropelight, smokers are bad for commercial insurers but great for the country over all.

    Living 10 years less means 10 years less of Social Security and Medicare.

    And the final 18 months of life just happen earlier so spare me the costs of the cancer treatment argument because if it aint cancer at 65, it is cancer or dementia at 92.

    So I am pro smokers though not pro smoking.

    Blah (44eaa0)

  18. Portability is a problem because employers group premiums are modified by experience (claims). It would be risky for high turnover companies to have non employee claims affecting there current costs.

    I don’t think that’s an issue. When an employee leaves, his policy would become an individual policy, and not a group one. His former employer’s group policy wouldn’t be affected.

    Chuck Bartowski (bc1c71)

  19. Not to mention that smokers don’t get Parkinson’s Disease, an expensive chronic disease of the elderly and of some young people too.

    But you’re all missing the forest for the trees. Why do we have mandatory car insurance? So safe drivers will pay for the misbehavior of bad drivers. It’s all about insurance companies maintaining their profit margin and their suits’ multi-million dollar salaries by forcing, through their flunkies in government, people to buy a product they will likely never use, at prices dictated by said insurance companies.

    You want to bring down the cost of health insurance? Get rid of health insurance companies.

    nk (dbc370)

  20. This just in… Chinese escalator disaster! Film at eleven…

    Colonel Haiku (470cbb)

  21. [G]uaranteed-renewable insurance permits consumers to renew their coverage at the same premium, regardless of whether they have developed any new chronic health conditions since obtaining the insurance.

    …the essence of the idea is that, like term life insurance, annual premiums are lower if you buy in when you’re young and healthy.

    Wrong, wrong, wrong!

    Term life insurance is cheaper precisely because it does NOT HAVE guaranteed renewability.

    What guaranteed-renewabality is, is Whole life insurance.

    There is a special form of term insurance known as renewable term, but the premium in such cses will be re-evaluated and is not fixed at the time of the ourchase of the original policy..

    http://www.protective.com/learning-center/life-insurance/term-life-insurance/what-is-renewable-term-life-insurance

    It’s important to note that even though the life insurance company has guaranteed you the right to renew your term policy, your premiums for the same amount of coverage will be based on your current health. For example, let’s say you purchased a $100,000 20-year term policy at age 30 as a non-smoker. Now, at age 50, you smoke and have gained an extra 50-pounds. Based on your current age and health, you may be looking at double the amount of premium for the same $100,000 worth of coverage.

    WHat this amounts to, I assume is that there is cap on the amount of the increase. But even so, it is going to cost more than just plain term insurance.

    People advocate term life because the idea is that life insurance is important while someone has dependents still, or more years of dependency to provide for, or has a mortgage maybe, and insufficient savings or pension benefits. Life insurance is for the survivors. Less insurance is often needed later in life.

    Sammy Finkelman (0d0ca8)

  22. #19 … Clearly if no insurance costs would go down. Minute someone isn’t on the hook for your outcomes, your outcomes change drastically.

    But I would consider this a bridge tooooo far for many.

    Convincing the Public we are over insured and should terminate coverage for routine medicine is much easier than to tell them no insurance at all even for tragic events.

    Blah (44eaa0)

  23. Renewable term has to cost more than just plain term. Otherwise there’d be no reason to offer them both.

    What I see here is attempts to do the impossible. People think they have a solution, but we know it doesn’t work because it is mathematically impossible. It’s like a proof for squaring the circle. You know it won’t work.

    All that can be done is cost and income shifting, with some people (or the government, maybe state governments) losing out, maybe badly. This cost shifting may be hidden from the eye, or not too obvious, but it’s there. It must be there.

    Even if competition drives down prices, which is not easy to achieve, that costs jobs and income and may result in bankruptcies. It would improve the total productivity of the econoomy because the people who lose jobs should get other ones, although maybe not as well-paying. That may be the way to go. (It’s not noted enough that in single payer countries, doctors get paid less than here, although that wouldn’t happen in the United States.)

    .

    Sammy Finkelman (0d0ca8)

  24. Your confusing car insurance with people insurance, Nk like the previous Nobel laureate.

    narciso (d1f714)

  25. Insurance is insurance. The low risk insureds make it possible for insurance companies to stay in business. The high risk are an undesired but unavoidable cost — useful to the insurance companies as object lessons to scare people.

    nk (dbc370)

  26. A lot of people can’t afford, or are afraid to spend, the first dollar.

    The solution is give everybody a refundable tax credit of fixed dollar value, probably the same for everyone, possibly funded by a consumption tax, maybe a partial carbon tax, which some liberals might like. (nobody should be fooleed into thinking its doing anything virtuous)

    I would tweak it further by having some money expire after a year and the rest after two years, [so that that it really does cost a person nothing, but at the same time there is price resistance] with several ways to salvage it however, including medical gift cards (issuance of which would be limited or insured) or by donating it to cover somebody else’s bills.

    This first tax credit could only be used any medical expenses, except insurance premiums. This could be kept track of by credit card billing codes, which are established (there might need to special rules to prevent to many other things from migrating under that) and, in places like drug stores, by paying for things now tax exempt in states that exempt medical expenses from sales tax, policed by bar codes. Computers are now well established enough to do this.

    I might have a second tax credit, which could enable anybody to buy catastrophic care. The sam premoum for everyone regardless of pre-existing conditions, but not the same deductible. To make buying and price comparison easier at least 10 (maybe each one in 2 or 3 versions) standard medical insurance policies would be established and listed on an exchange, although they wouldn’t have to be bought through it, and people could buy non-standard ones too. But the majority would, if this works well, be these standard policies that books and web sites could be written about.

    While I’m doing this, I would abolish Medicaid, except maybe to have some governmental entity pay for (that is, fill) the doughnut whole. I would abolish applications and have that all done done automatically entirely based on whether or not someone owed income tax or, if you want, had bank deposits over a certain amount – but all this may not be necessary, as Social security can handle it just like with people slightly over the current Medicaid limit. Since people on Medicaid may eventually work, and this whole change is designed to eliminate the disincentive to work, or to train anyone to work, or find them a job, a portion of their future Social Security benefits can still be used as collateral.

    The next level above the fixed amount everyone gets is the doughnut hole. This could be filled by savings, including savings in an HSA, contributions from others, regular credit card debt, special low interest medical credit cards, borrowing from the IRS (up to let’s say $3,000 a year) and cashing out or borrowing from Social Security. The cash out or borrowoing should not affect any current payments coming from Social Security (making this most actuarialy sound for people below age 60 or 62) and the government should expect to lose some money on the last. Some people may never work again.

    The next level is what is after the standard deductible. An insurance company may raise the deductible because of pre-existing conditions, but it may not raise the premium or co-pays or anything. There needs to be some incentive to set it right. The goal is to insure the unknown, and pay for the known by means other than “insurance.”

    An insurance company would be either obliged or allowed to reinsure it the high risk (the level between the standard deductible and the high deductible till you reach the evel at which catastrophic kicks in.)

    The premium for the re-insurance is paid for by the government, except that the original insurance company pays the full amount of the premium plus 5% or whatever figure works best, minus whatever claims it does not have to pay that do not reach the standard dedictible.

    In other words let’s say the deductible is $6,000, creating a doughnut hole between $1,500 and $7,500, but the standard deductible for that policy is lets say $1,500 and expenses come in at $2,500, of which the insurance company pays $1,000 – the insurance company gets back the $500 although it still loses the premium plus 5%.

    The re-insurance is packaged in tranches, and the the re-insurance company gets the right to attempt to negotiate lower prices, but the patient must agree to anything. This needs a little work.

    The level after that is catastrophic. There needs to be complete freedom to choose doctros, combined with it mattering, at least psychologically, what the bill is, plus avoidance fo surporise billing and freedom to transfer medical records so that no provider traps anyone, plus uninsured peoplle get charged clos to the least amount not the highest, except maybe for foreign visitors who specially came for treatment.

    No family policies are needed – everyone is covered individually.

    As for people currenly insured by an employer, or where an employer charges an arbitrary price, they get the out of pocket tax credit, and the second tax credit minus whatever value their insurance is assessed at. This needs work. Somebody needs to evaluate the value. Also everyone gets to deduct the first dollar of medical expenses above the tax credit from income, provided that the money is first deposited in an HSA, [after which the money is locked in and can’t be spent for anything but medical expenses] and if someone paid cash, they can adjust that within 90 days. Since all medical expenses are deductible for income, there is no need to worry about inequality in taxation between those getting their coverage paif for by an employer and those who are not.

    Sammy Finkelman (0d0ca8)

  27. Daryl Herbert (7be116) — 3/27/2017 @ 4:56 am

    If you want glasses, pay for it yourself, etc.

    There already is alittle competition, but people don’t know it.

    What you really need to do is make it non-prescription. This is alresdy the case for reading glasses (for far sightedness) which can be bought for 99 cents each at times in places, plus sales tax. If you are less careful, you can pay $14.99.

    Now the argument for prescriptions is basically paternalisic – people should get their eyes examined for other reasons, so they are only good for a year or two.

    For other prescriptions, you can get glasses made with the frames, which you pick, (for noncomplicated prescriptions, and minimum standards and not bificals or trifocals) for $40 I think at Factory Eyeglass Outlet. Turnaround time is about a week or two.

    And you can get them for $35 or $50 or so plus the frames, (again simple prescription) which if you don’t bring your own (and frames with glasses you can discard are available for 99 cents maybe) may cost you as low as $25, at Minzer Optical, at 907 48 St, near Maimonides Hospital in Brooklyn.

    It is open Sunday through Thursday except Jewish holidays and the day before – and by holidays that also means all of Passover and Succos – check your calendars, and don’t forget about Shavuos – and you can get the whole thing done within an hour if it is not close to closing. If somebody is in New York, they can get it done there. It’s not too far from the Ft Hamilton stop of the D train, and the B11 bus is near, as well as the B790, and maybe they’ll run a bus along that portion of Ft Hamilton Avenue nearest Maiminides one day. The cheapest you probably heard of is $99.

    This is because in fact a lot of people do pay for this out of pocket.

    That would make it a heck of a lot more affordable for people. (But: not outlawing gold-plated plans, we would let the market operate.) In general, spending on health should be tax deductible whether it’s insurance, or self-insurance, spending on medical devices, medicine, etc. outside of an insurance plan, and that should be true whether you are spending on yourself or others.

    One idea I had is: when you get health insurance through your employer, you ought to fund more than 100% of it. In other words, if you work for your employer for a year, instead of paying for 1 year of premiums, you would pay for 2 years. If you work there for 10 years, you would pay for 20. So if you got laid off, you would have more time to find new work before you had to kick in premiums. That would happen until your insurance was paid up for year 65. After that, you would probably be looking to fund some sort of medicare supplemental plan. I haven’t worked out whether this should be purely optional or what. Also, I don’t necessarily think a mandate is bad if it’s to buy catastrophic insurance (much less expensive) and it’s limited to some people with jobs (who can afford it). Basically it would be like paying for unemployment insurance, you are insuring yourself against future job loss.

    Sammy Finkelman (0d0ca8)

  28. Q.What does Ted Cruz mean by the word “mandate?”

    It doesn’t sound like it’s the Obamacare mandate (to buy insurance) but it’s the mandate on the insurance company to sell it at the same price to all comers.

    Sammy Finkelman (0d0ca8)

  29. I think I have posted this here before, but I should never go without saying again. We need to stop having arguments over “who pays?”, and start having arguments over “why so much?”

    If insurance costs $50 a month there would be no uninsured. Lack of insurance is a function of cost. So why does insurance cost so much? because medical care costs so much. Why has the cost of medical care exceeded that of inflation for so many decades? Why are the costs for other things decreasing, while medical costs increase?

    Try this experiment some time – ask you doctor how much a procedure or visit would cost if you paid cash, right now, on the spot. Ask how much it would cost if his liability insurance was halved.

    We have done everything possible to build the most expensive possible care into the system. This has occurred largely because costs have been shifted from the consumer to someone else.

    If I were the Republicans I would put a bill together designed to increase completion, increase supply, and reduce costs.

    Create a truly national market for health insurance (like we have for everything else). Increase the supply of doctors and nurses in the marketplace (endow medical schools so that people choosing these professions would come out of college debt free). Reform the medical liability system. Look at every part of the system and say how can we increase efficiency and reduce costs.

    Make our goal for health insurance to make it cheaper, much cheaper.

    Tenn (131b65)

  30. Props to Ted.

    My second choice after Walker but both proved tone-deaf on presenting themselves to the USA.

    harkin (517285)

  31. I will bet you $100 against a jelly donut that President Trump will veto a straight repeal. Although I think the Senate will vote it down even if it passes the House, which it won’t.

    Kevin M (25bbee)

  32. My second choice after Walker but both proved tone-deaf on presenting themselves to the USA.

    Hard to hold a reasoned debate against Yosemite Sam.

    Kevin M (25bbee)

  33. Paul Ryan, like him or not, is a policy wonk. The health care industry is one he knows well. Trump delegated responsibility for revamping Obamacare to Ryan, because the Speaker explained to Trump the political and economic realities of health care reform, as he sees them. Trump believed him and deferred to the Speaker’s appearance of good judgment. Your comments here in this post, suggesting ways in which health care law could be reformed, would not be news to Ryan. They have been part of the discussion for a very long time – Bradley Herring, the author of the Mercatus piece, dates the discussion back 20 years. With Ryan, a lack of expertise has never been the problem.

    The problem with Paul Ryan is that the Speaker and most of his backers in the lower house are beholden to the health insurance industry – who, exactly, do you think wrote the AHCA? Steve Bannon has figured this out and commented publicly about it. We all should figure it out. It has been painfully obvious for a very long time that the GOPe is bought and paid for by corporate interests. The health insurance industry is one of those interests. At some point, we knew this. The GOPe remains what it has always been, the enemy of conservative, small government. Has our dislike for Trump caused us to forget?

    As long as a large swath of the Republican congressional conference is a wholly-owned subsidiary of the health insurance industry, true reform will remain a pipe dream. Senator Cruz is a clever boots, but cleverness is not enough. It will never be enough.

    I share your relief at the failure of AHCA. It was a bad bill. In addition, the bill’s failure is yet another reminder of the corruption and fecklessness of Paul Ryan and his wing of the Republican Party. President Trump was simply wrong to permit Ryan to take the lead. I am reminded of Otter’s comment to Flounder: “You f**ked up. You trusted us.” Hopefully, our new President will not trust Paul Ryan again.

    ThOR (c9324e)

  34. it would still be nice to get the filthy lying republican congresstrash on record with respect to a straight repeal Mr. M

    happyfeet (28a91b)

  35. The first stumbling-block is that bit about “Republicans” promised repeal – only some of them were singing that tune. And I’m pretty sure a good portion of them were lip-synching the lyrics. If somebody promises to give you a brand-new Mercedes and then shows up with an old Pinto, are you going to feel like you won something if you can negotiate with them for a two-year old Chevy? For some people, making a deal is the end of negotiations; for others, making a deal is where the negotiations to make them keep their end of the bargain starts.

    Jerryskids (3308c1)

  36. Off topic. Look on this in awe.

    A carrier flight deck is about 50 feet above the water line. Much higher and you can’t escape it.

    A B-52 is 185 feet, wing tip to wing tip. Do you have any idea how precise you have to fly?

    Not only did this pilot trust his skills but so did his crew. And the crew of the USS Midway. Who gave him permission for a second fly by.

    Look on this with awe.

    Steve57 (0b1dac)

  37. any landing you can walk away from is a pretty good one

    but pervy Mitt Romney’s special little speaker-boy couldn’t land his pseudo-repeal health care bill to save his life

    he disgusts me

    happyfeet (28a91b)

  38. “So. What comes next on repealing ObamaCare?”

    I would suggest an examination of the complete lack of political skill exhibited by the President coupled with an accurate assessment of his manifest incompetence, intellectual defects and the total absence of positive character traits leads to the conclusion that he should be encouraged to spend all his time playing golf at Mar-A-Lago. The next step towards repealing ACA is refusal to increase funding to cover the defects which will lead to its collapse. The Democrats’ stinking albatross isn’t done rotting yet, why remove it?

    Rick Ballard (782882)

  39. For most politicians the press conference is the important thing.

    Kevin M (25bbee)

  40. 29. Tenn (131b65) — 3/27/2017 @ 9:26 am

    I think I have posted this here before, but I should never go without saying again. We need to stop having arguments over “who pays?”, and start having arguments over “why so much?”

    If insurance costs $50 a month there would be no uninsured. Lack of insurance is a function of cost. So why does insurance cost so much? because medical care costs so much. Why has the cost of medical care exceeded that of inflation for so many decades? Why are the costs for other things decreasing, while medical costs increase?

    Insurance, and other forms of third party payment.

    Sammy Finkelman (0d0ca8)

  41. The principles articulated by Ted Cruz would be an excellent place to start.

    And instantly stop.

    As the electorate– and his own family– have seen, Tedtoo has no principles.

    With apologies to Tom Lehrer:

    “Gather round while I sing you of Canadian Cruz,
    A man whose allegiance is ruled by expedience;
    Call him unprincipled for changing his views,
    “Principles, schminzables” coos Canadian Cruz.

    Don’t say that he’s hypocritical,
    Say rather that he’s quite political;
    “‘Bout Trump what I said, I’ll be changing my views!
    Memories are short,” coos Canadian Cruz.

    Some have harsh words for this bait-and-switch ruse,
    But some say their attitude should be one of gratitude;
    Like the wife and the father; their honor abused,
    So easily betrayed by Canadian Cruz.

    To become a conservative hero;
    Just show Texans you’ll stand up for zero;
    “In Calgary ‘oder’ Houston, I have proved I can lose,
    And I’ll prove it again,” coos Canadian Cruz.”

    DCSCA (797bc0)

  42. Wow–Republicans are in huge trouble.

    I doubt if you gave even five of us–here–three months–that those five could agree on a plan.

    I also think ObamaCare created a point of no return. IOW–we cannot go back simply to how our healthcare was before because ObamaCare permanently changed the landscape, for example–once businesses dropped coverage of spouses– because of costs–they are not going to bring that benefit back so easily, once people qualify for Medicaid–they want to retain that. I’m sure there is more.

    Also doctors have simply quit or gone to early retirement during ObamaCare so that reduces supply–while demand has increased because a significant portion of the population thought ObamaCare meant–Free!–healthcare and jammed the emergency rooms.

    Anyways–if I had to pick five people from here that could agree on a plan in three months–who would they be?

    Who are five guys here that could agree?

    You could call it Five Guys HealthCare Plan!

    But now we need how many in the House and Senate–plus the President to agree?

    Guys who have made a living and show of being–difficult. Guys who have fed off of the hysteria and drama of talk show radio.

    America is Pelosied.

    Rae Sremmurd (2fd998)

  43. Haskell’s retried dog food is almost not worth noting, it came from The acme workshop.

    narciso (d1f714)

  44. I dunno–pessimism isn’t helpful.

    One rational idea I saw somewhere on twitter–can’t remember who said it–but–pass one fix at a time that most can agree on–instead of trying to pass a comprehensive plan.

    Maybe something like that could at least be a start.

    Rae Sremmurd (2fd998)

  45. Amen, you had me lock stock nd barell two paragraphs in. Do ths snd adopt a multi layered immigration [rotcol, ok, forrhe flippin kids, level 1:, fr those who were brought here before their (pick an age) -th birthday a path to citizenship: Have finished blank gradr(I’d say at leat 9th, vcn apass a cprehensive english comprehensio exam and US histoy exam, have no criminal hstory, ok-, level 2: gfor the ose arriving s yping men and womebn before teir 16th b-dy, same educational, engish exam and US history exam requirewments, snd again, no crminal hitoy, can aply gor and pay fine to receive Green card, service in US military helps, Level 3, arrival after 18th b-day, 10th grade education, sam engish and histoy exam requrements, can apply for guest worker visa and pay fee to reveive it. All have US citizen sponsors and have verifiable address wt risk of penalty to sponsor, register address every six months. none qualify for bringing in chain of family members (ending chain migration).

    neoCon_1 (4d97ca)

  46. I share your relief at the failure of AHCA. It was a bad bill. In addition, the bill’s failure is yet another reminder of the corruption and fecklessness of Paul Ryan and his wing of the Republican Party. President Trump was simply wrong to permit Ryan to take the lead. I am reminded of Otter’s comment to Flounder: “You f**ked up. You trusted us.” Hopefully, our new President will not trust Paul Ryan again.
    ThOR (c9324e) — 3/27/2017 @ 10:17 am

    *****************

    Stop this.

    It’s an insult to most people’s intelligence to pin this on Ryan.

    You–have–got.to.be.kidding.

    Trump went to Tennessee to campaign for the bill.

    Trump and Bannon THREATENED (holy gawd this pisses me off) to PRIMARY the Freedom Caucus members that would not vote for the bill, this is after THREATENING to primary RINOS.

    Add to all of that–you want us to believe that Trump wasted his most valuable political capital going first on a bill–that he didn’t want.

    Then–Paul Ryan is “the stupid” but he outsmarted and conned THE GOD EMPEROR–Trump.

    Jeezuz–it’s the logic of liberals fumed by hate.

    Go sell crazy to the Dems–maybe they are buying.

    Rae Sremmurd (2fd998)

  47. Yes, in insurance the low risk pay for the high risk but for insurance to work you can’t know which bucket you are in before paying for it.

    This is why the smartest money in this fight is to take routine medicine OUT of insurance and only cover “tragic care.”

    Everyone will abuse “routine medicine” if the insurance company pays for it. No one wants to “cash in ” on tragic care coverage.

    Sorry but 99% of folks really argue in circles on this — especially those who think that somehow “competition” in Insurance is going to “ring out” significant costs for consumers. LOL.

    Again, insurance is about figuring out how to cut a pie most efficiently.

    The goal is not that though it is a nice to have.

    The goal is to shrink the pie and that requires reducing consumption levels in a way that match true need/willingness to pay.

    Blah (44eaa0)

  48. @36 That’s a picture you pray nobody sees until you’re well into retirement.

    There are old pilots. There are old pilots, but there are no old, bold pilots!

    crazy (d3b449)

  49. If you don’t think the Ryan is to mostly blame for this, then you have missed the last 60 votes on repeal from the House.

    Blah (44eaa0)

  50. It’s an insult to most people’s intelligence to pin this on Ryan.

    Wise up.

    “You let a whole column get stalled and strafed because of a couple of jackasses? What the hell’s the matter with you?” – Gen. Patton [ George C. Scott] ‘Patton’ 1970

    DCSCA (797bc0)

  51. “A B-52 is 185 feet, wing tip to wing tip. Do you have any idea how precise you have to fly?”

    Back in the mid-80s, we were cruising the Black Rock Playa (northern NV and now site of the annual Burning Man nonsense) when a B-52 flew by about 50′ off the deck and throwing up the biggest dust rooster tail I’ve ever seen.

    harkin (517285)

  52. Ryan wasn’t beaten on the details. He just walked into the same Trump-era froth that derailed Trump’s primary opponents. The details don’t matter. The policy almost doesn’t. What matters is how much naive cynicism you can muster and how loudly you do it.

    This is why Brutus never had a chance against Marc Antony, appealing to the wisdom of the crowd,rather than their base instincts.

    Kevin M (25bbee)

  53. yeah this ugly baby belongs 100% to lying sleazebag Paul Ryan who promised to repeal obamacare but was lying and he’s a complete joke anymore

    happyfeet (28a91b)

  54. Nobody knew that health care could be so complicated.

    Davethulhu (fab944)

  55. Why are the costs for other things decreasing, while medical costs increase?

    It’s not that simple. The number of things people expect of medicine constantly increase. My wife was cured of cancer two years ago, using techniques that are anything but cheap, such as focused beams of X-rays that mostly don’t harm surrounding tissue. Thirty years ago, they would have not been able to do much for her, now the cure rate is over 90%.

    Similarly for heart attacks, trauma (“death” is somewhat recoverable now), drugs, therapies, etc. We expect an AWFUL lot from medicine. I know for a fact that asthma treatment has progressed a LOT over the last 60 years.

    Other factors, too, are involved that have nothing to do with insurance. That $23 aspirin tablet has been taken from a certified bottle, the lot has been recorded, the whereabouts of that bottle are know to the beginning of time, every hand that has touched that bottle or the aspirin is known, the patient’s condition when s/he ingested the aspirin is recorded, along with the follow-up observation methods to make sure there was no bad reaction. Why? Lawyers will crucify you in court if they ask about this and you say “I don’t know”.

    It’s not just the 3rd party payments. Even if everyone was on a catastrophic policy and paid directly for their day to day, they’d still want quite a bit of medicine.

    Kevin M (25bbee)

  56. Ryan isn’t going to stop being speaker. He’s doing a job nobody else wants.

    Davethulhu (fab944)

  57. “Nobody knew that health care could be so complicated.”

    and made even more so due to the Obamacare wrecking ball taken to the healthcare industry and infrastructure on the dirty road to “single payer”.

    Colonel Haiku (470cbb)

  58. Rae, the strategy republican leadership chose to push this bill through as a Team R vs Team D is where it failed. The bill grew out of the Speaker’s election year effort called A Better Way. Six areas of effort (Poverty, National Security, The Economy, The Constitution, HealthCare, Tax Reform). The Speaker’s leadership team tackled each producing detailed reports such as HealthCare Policy Paper that committee chairs turned into legislation. There’s a lot of detail under each area there to review and help in anticipating what Ryan’s team has planned.

    It’s not hard to see that it was written for the expected winner of Bush v Clinton not Trump. If the strategy had been to move straight repeal by Team R sunsetting Obamacare down the road a year of two Team D, the Tuesday group, the HFC and others would have had plenty of incentive to debate, ammend, compromise and pass something like this or better.

    Instead Team R did the same thing they’ve been doing since the Bush years. Put together compromise legislation and turn it into a test of loyalty while Team D sits on the sidelines enjoying the show. Dumb move.

    Whatever happens next, straight repeal needs to start it or the only other thing we’ll get is what Team D wants to give republican leadership. Another dumb move. It all depends on whether the Team R leadership hates the rebel factions or Team D more. That’s why I pray Team R dials the blame game down. Let’s hope they regroup and move deliberately through regular order after sunsetting Obamacare a couple of years down the road to allow insurers, employers, providers, states and individuals to adjust.

    crazy (d3b449)

  59. Ted Cruz, I think, is selling snake oil. And I don’t think people have to look into it too much till they realize it is snake oil.

    If they so desire, consumers should be able to purchase low-cost catastrophic insurance on a nationwide market.

    The whole point is that catastrophic insurance is no longer low cost! What deductible does Ted Cruz think catastrophic means? What does Ted Cruz think “low cost” means? I think things have inflated to the point where this does nmot make sense, except for thse with assets to protect. Input some numbers, even with exclusions, and you’ll see that this is snake oil.

    In 2014, it was estimated a 20-something could pay little over $100 a month ($1200 a year) for catastrophc that kicks in at a little something over $6,000 for an individual. This is well above the cost of a healthy birth, the most likely high expense. If someone doesn’t have over $12,000 in savings or assets, does this make sense? Just declare bankruptcy!

    Sammy Finkelman (0d0ca8)

  60. Fourth, we should protect continuous coverage. If you have coverage, and you get sick or injured, your health insurance company shouldn’t be able to cancel your policy or jack up your premiums. That’s the whole point of health insurance.

    More to the point, if you want to change companies for any reason you should be able to do so. Maybe the company dropped the doctor or hospital you rely on. Maybe they are just sticky about paying for things and/or hit you with a ridiculous amount of bureaucratic make-work, hoping you’ll give up. Maybe they’re dropping their policies and leaving the state. Whatever.

    So long as you are covered continuously (allowing the new insurance company to subrogate), you should be able to go to any other company with the same risk rating you had at the first one, no matter how ill you got in the interim. Sure this may be a hit on them, but the churn should balance out. If noone is allowed to cherry-pick, everyone should have the same percentage of cherries.

    But here we start getting into regulation, which raises red flags. To me, government regulation of a privately-run system is difference from Obamacare, which is private implementation of a government-run system.

    Kevin M (25bbee)

  61. Remember when an actual doctor was the Senate majority leader?

    Pepperidge Farms remembers.

    Paul Ryan comes out looking like Bernie Mac in Mr 3000.

    Pinandpuller (a5cd30)

  62. Kevin M (25bbee) — 3/27/2017 @ 12:13 pm

    The number of things people expect of medicine constantly increase. My wife was cured of cancer two years ago, using techniques that are anything but cheap,

    Why are they not cheap?

    You see, you don’t see the problem. We live in it, we don’t see that it is something abnormal anymore.

    Federal regulations on any kind of new develoment, except new types of surgery, are a large part of the problem, but it is also because the prices wll be absorbed.

    such as focused beams of X-rays that mostly don’t harm surrounding tissue.

    This needs to cost an arm and a leg?

    It’s not the cost of manufacturing these devices that raises the cost so much. How much does a huge flat screen TV cost?

    I know for a fact that asthma treatment has progressed a LOT over the last 60 years.

    but the price you pay for each new development has gone up astronomically.

    Other factors, too, are involved that have nothing to do with insurance. That $23 aspirin tablet has been taken from a certified bottle, the lot has been recorded, the whereabouts of that bottle are know to the beginning of time, every hand that has touched that bottle or the aspirin is known, the patient’s condition when s/he ingested the aspirin is recorded, along with the follow-up observation methods to make sure there was no bad reaction. Why? Lawyers will crucify you in court if they ask about this and you say “I don’t know”.

    Not just lawyers. Or the lawyers involved aren’t just the ones suing.

    Sammy Finkelman (0d0ca8)

  63. Is COBRA just a really bad Sylvester Stalone movie or am I out of my mind?

    Pinandpuller (a5cd30)

  64. The real problem that everyone hits with “continuous coverage” and “preexisting conditions” is that we don’t start fresh. Particularly since the old system locked people out of the insurance market. It’s not that (some) didn’t want insurance, it’s that they were not offered any due to an existing condition.

    There’s a young woman I know whose family has a history of bipolar disorder. She has a touch of it, easily controlled with some fairly innocuous medication. Other relatives have a LOT of it. She had real trouble getting private insurance in the old system, even at the age of 20, so she did without for a time.

    Obamacare solved this, of course, although the solution, uh, wasn’t satisfactory. The Ryan plan ALSO solved this with an entry fee. The question comes up, however, to what degree ARE insurance companies to price risk. There are good arguments that they ought not do so, other than by age and, perhaps, behavior. It simplifies a lot if they don’t, and in a big enough pool there’s no real savings to be had. Anyone can get sick.

    Since I trust insurance companies to game any form of discrimination they’re allowed, to no one’s benefit but themselves, I’d give them as few and hard-to-aim as possible.

    Kevin M (25bbee)

  65. How much does a huge flat screen TV cost?

    Bwahahahaha. You have no idea.

    Kevin M (25bbee)

  66. It’s not just the 3rd party payments. Even if everyone was on a catastrophic policy and paid directly for their day to day, they’d still want quite a bit of medicine.

    But if people had to pay, if they were given a budget to pay – and it’s complicated how this would have to work out because some people need to spend more money, ir do more things so they need a bigger budget or they need not to have too much fear of spending money – if peole had to pay, the price of whatever it is that they got would start declining.

    Just take drugs. When a drug goes from prescription to nonprescription, the price immediately drops in half. Drug manufacturers actually like it for many drugs to remain prescription only, and one way of gaming the system, is to make it non prescription only for lower doses.

    There’s so much irrationality. Take doctor’s visits. Most are done just to update records, check on progess, or renew some prescriptions. Or fif say, physical therapy is needed, a lot of other thigs are done. Many of these visits are unnecessary. A lot could be done more economically by visiting nurses, and telephone conversations, and when someone did see a doctor, the doctor would have more time to spend.

    Sammy Finkelman (0d0ca8)

  67. This needs to cost an arm and a leg?

    Five days a week for 12 weeks adds up. Then there’s the chemo.

    Kevin M (25bbee)

  68. SF: How much does a huge flat screen TV cost?

    Kevin M (25bbee) — 3/27/2017 @ 12:45 pm

    Bwahahahaha. You have no idea/

    But suppose you could charge a fee for every half hour it was used, and it was used 8 hours a day five days a week, 30 weeks a year, how much would you have to charge to make back the cost in a year and a half?

    That X-ray machine costs far more than it needs to. Of course patents (and a limited market) are part of the reason, but the patent system and then the FDA approval for medical devices system just adds costs and costs, each little bit of which is paid for over and over.

    Sammy Finkelman (0d0ca8)

  69. You’ve got machines selling for $1 million let’s say, that should cost no more, tops, than $30,000.

    Sammy Finkelman (0d0ca8)

  70. Trump has promised to get US drug prices down to international drug prices, and to get the FDA to approve generics more quickly.

    Currently, the most effective drug for chronic asthma is Advair. It costs $500/month. Insurers hate it and would rather not have any asthma patients as customers. The last patent expired in August, but the FDA isn’t likely to approve a generic until 2018. Meanwhile generics approved in other countries are available for $25/month.

    Kevin M (25bbee)

  71. How much an airplane cost? And how much does a ticket cost? And how much more does it cost the airline to carry one passenger? The same thing with an X-ray machine. The marginal cost is very low, really the cost of the salaries of the people involved.

    Cosider this: Even when an airplane costs millions, the airlines (some of them) still make money.
    OK, people don’t buy 60 tickets, but even the inflated cost is less than an airplane, and my whole point is the cost of this machine is inflated.

    Sammy Finkelman (0d0ca8)

  72. You’ve got machines selling for $1 million let’s say, that should cost no more, tops, than $30,000.

    Leaving aside your truly silly estimate of the cost to focus multiple widely separated x-ray beams on interior tissue so that they combine (using interferometry) only at a particular cubic centimeter…

    If that $30,000 X-ray machine goes on the fritz with a patient on the table, and it burns out their eyeballs, you may find it was rather expensive after all.

    Kevin M (25bbee)

  73. I’ve decided to start identifying as dog-kin so I can get treated at my local veterinarian clinic. I mean, in Prison Break a vet sewed T-Bag’s hand back on so they’re pretty good, right? And affordable.

    Excuse me, I think I hear the UPS guy.

    Pinandpuller (a5cd30)

  74. 85% of a person’s health is determined by what and how much they eat and how they move their bodies.

    Cancer, Type 2 diabetes, stroke, heart disease, Alzheimer’s, etc., etc. are all shown to have clear links to an individual’s BEHAVIOR!!!!!

    You so-called Conservatives and Libertarians on this site are completely missing the core message of our ideology: PERSONAL RESPONSIBILITY. Focus on the basics!

    If you insist on some grand federal program to transform the health and well-being of Americans within 5 years, there is an easy way to do it. Create a voluntary program where all persons over the age of 23 can have the following measurements taken on an annual basis: age, body-fat percentage, blood-pressure, presence of nicotine and other health-impairing chemicals. Create a ranking system so that a 57 year old male with 11% body fat, and a 110 over 60 blood pressure reading would receive a $1,500 check. A 30-year old female with 45% body fat and a 180 over 120 blood pressure reading would get $0. If you don’t participate in the program, then you also receive $0. Create a reward structure in between these 2 extremes.

    I guarantee that you will see a YUUUUGE reduction of America’s waistline and an even bigger reduction in medical expenditures. This program would expose the huge socialist lie that we need doctors, hospitals, and other experts on the public dole to ensure our health.

    Once you have sewage treatment, safe water delivery, innoculations, refrigeration and safe food handling practices, shelter, and clothing, you’ve already received 95% of the benefits that civilization can offer to improve and extend your lifespan. Doctors and hospitals come into the picture only when we are personally irresponsible with our own bodies or random events strike.

    If someone cannot afford medical care, then there’s a welfare program for that. State, county, or municipal level program. Definitely, no need for a federal law. It’s ridiculous to pawn off this welfare problem on to insurance companies. Why is it a problem for people to understand that it is stupid to out-source the alleviation of poverty to insurance companies?

    If Trump got up and gave this speech, then Americans would get it. It would be innovative. It would also make sense, and most important — it would work.

    El Gipper (f1f816)

  75. Paul Ryan has a reputation as a policy wonk like Madonna has a reputation as a good lay. One of them is also known as a good marketer so YMMV.

    Pinandpuller (a5cd30)

  76. 73. Kevin M (25bbee) — 3/27/2017 @ 12:54 pm

    Trump has promised to get US drug prices down to international drug prices, and to get the FDA to approve generics more quickly.

    That’s a very general promise, and unless he, or someone else, knows what he’s doing, and he doesn’t show great signs of that, it isn’t likely to make much of a change.

    I don’t think lawyers caused this thing, at least not plaintiff’s lawyers. Lawyers would want harmful drugs to be around, so they would have what to sue over.. Taking things off the market is an unwelcome by product of lawsuits. Taking the wrong things off the market, maybe not so. Just as many people will be sick, and they can find another target.

    My solution is to appoint a panel of 60 doctors, and if let’s say 30 of them say it is worth trying, let it be manufactured, with a warning label. If the FDA wanted the warning label to have some credibility, adnd be taken more seriously than California’s hazard warnings, they would approve things faster.

    I would call it ERDA – the End Run Drug Agency.

    Sammy Finkelman (0d0ca8)

  77. Currently, the most effective drug for chronic asthma is Advair. It costs $500/month. Insurers hate it and would rather not have any asthma patients as customers. The last patent expired in August, but the FDA isn’t likely to approve a generic until 2018. Meanwhile generics approved in other countries are available for $25/month.

    By the way, I read encironementalists got rid of very good inhalers. They got rid of the ones containing CFCs, which even if you think CFCs are a big problem, asthmas inhalers are an important enough use to justify using them.

    The FDA pretended the new one was just as good, and here, they didn’t go through their usual long and rigorous process. They also did it sneakily, and this was during the Bush II Administration, and asthma sufferers were taken by surprise in 2009.

    Sammy Finkelman (0d0ca8)

  78. I’ve had bosses who stand behind me when my work is in question and I’ve had those who cut and run. I imagine most of us have had similar experiences. A good boss doesn’t cut and run. Donald Trump didn’t cut and run.

    After delegating health care reform to Ryan, Trump followed up by doing the standup thing: he fought for Ryan’s bill. He negotiated with conservative critics – something that Ryan should have done but didn’t – he cajoled, and he rallied popular support. He did everything he could to get the revamped health care program passed into law. There are many things Trump can be faulted for, but to fault him for standing behind Ryan is not one of them.

    There is a reluctance among many NeverTrumpers to give President Trump credit where credit is due. Like the AHCA or hate it, Trump deserves credit for standing behind Ryan and Ryan’s bill. Give the man a fair shake. To do otherwise makes you look small.

    ThOR (c9324e)

  79. “Nobody knew that health care could be so complicated.”

    Davethulhu

    LOL

    ThOR (c9324e)

  80. 77. El Gipper (f1f816) — 3/27/2017 @ 1:01 pm

    85% of a person’s health is determined by what and how much they eat and how they move their bodies.

    I don’t know if that’s the case, and then maybe you could say 85% of a person’s health is determined by his age.

    Create a voluntary program where all persons over the age of 23 can have the following measurements taken on an annual basis: age, body-fat percentage, blood-pressure, presence of nicotine and other health-impairing chemicals. Create a ranking system so that a 57 year old male with 11% body fat, and a 110 over 60 blood pressure reading would receive a $1,500 check. A 30-year old female with 45% body fat and a 180 over 120 blood pressure reading would get $0. If you don’t participate in the program, then you also receive $0. Create a reward structure in between these 2 extremes.

    First of all, a lot of it is not a person’s fault. This amount of money, by the way, is probably not enough to get many people to make changes. And tehn people don’t actually know what to do – although maybe if here was money in it, people might work heir way toward what is effective.

    Once you have sewage treatment, safe water delivery, innoculations, refrigeration and safe food handling practices, shelter, and clothing, you’ve already received 95% of the benefits that civilization can offer to improve and extend your lifespan.

    I think something like that’s been argued, I don’t know about the numbers, to explain the increase in life expectancy from about 1860 to 1930, or to explain the decline in tuberculosis.

    Sammy Finkelman (0d0ca8)

  81. ThOR (c9324e) — 3/27/2017 @ 1:18 pm

    There are many things Trump can be faulted for, but to fault him for standing behind Ryan is not one of them.

    yes, you can, if it;s ehe wrong thing.

    Now some people read into a tweet he sent Satirday morning

    Donald J. Trump @realDonaldTrump

    Watch @JudgeJeanine on @FoxNews tonight at 9:00 P.M.

    7:41 AM – 25 Mar 2017

    into a criticism of Paul Ryan, because she opened up the show by saying that Paul Ryan should resign. His aides had to argue no, Donald Trump didn’t mean that. I suppose she maybe didn’t tell him she would start it that way or include that little bit.

    Sammy Finkelman (0d0ca8)

  82. For some reason I decided to listen to Sam Harris interview David Frum. At one point DF said it was a mistake for the Republicans to have no input or votes for the ACA.

    Where we are now, seven years or so later, are the dems and Obama really catching any hell over it? Obama’s gone. Reid’s gone. Republicans rule Democrats drool. Or do they?

    That’s a priceless Steinway!

    Not anymore.

    Pinandpuller (a5cd30)

  83. Kevin M (25bbee) — 3/27/2017 @ 12:59 pm

    If that $30,000 X-ray machine goes on the fritz with a patient on the table, and it burns out their eyeballs, you may find it was rather expensive after all.

    Don’t we have to worry about that with lasers some more. And what you have to worry about there is the doctor not communicating effectively with the patents – thinking somebody hears clearly when they don’t, for instance.

    When X-Rays were first invented, well, maybe they weren’t good, they discoveed slowly what it did, but if things worked then like they work now they never would have been used.

    Sammy Finkelman (0d0ca8)

  84. Fourth, we should protect continuous coverage. If you have coverage, and you get sick or injured, your health insurance company shouldn’t be able to cancel your policy or jack up your premiums. That’s the whole point of health insurance.

    That would be an incentive for having it. Obamacare tried to impose a tax (far too low to have an effect) Ryan’s bill tried to do that by saying anybody uncovered would pay 30% more for 2 years (also not enough)

    Continuous coverage is a form of adverse selection, and will raise insurance premiums, as compared to not having it. Portability is a form of adverse selection. The healthy people will drop coverage, and the sick people, or people with sick dependents, will not.

    It may be a good idea in spite of the problems it causes.

    Portability is actually the same thing as continuous coverage. Guaranteed renewal exists now, as far as I know, with the exception of when people leave, or have to leave, groups.

    Sammy Finkelman (0d0ca8)

  85. Let’s go back:

    First says Ted Cruz, let insurance be sold across state lines. What this means is: Let health insurance be regulated and bound by the laws of any state they choose, like credit cards.

    Now there are two kinds of problems with this proposal:

    If the Obamacare coverage mandates remain, nothing much will happen. It is already legal in a few places; few insurance companies compete. One reason is that insurance companies typically lower costs by negotiating with selected hospitals and creating preferred or exclusive provider networks -the out-of-state insurance company will not have done that.

    The other way insurance companies can lower premiums is by excluding customers.

    Now if one state demands community rating, and the law now says, let insurance that excludes pre-existing conditions be sold there anyway by an insurance company based in another state, what will happen is that the death spiral in some states will be made even worse, and render local individual health insurance non-existent. Health insurance companies will mostly be based in five to ten states after a few years.

    And then you may have heard of another thing: The problem of insurance companies selectively nullifying policies – they get a big claim – they investigate to see if the person concealed something not necessarily at all connected with the condition that they got, and then they say, they’ll refund all the money and not pay the claims. This might be legal in a state or two. It might start to become standard.

    It could also be legal to sell insurance that fools people – that just pays for hospitalization, for instance – the per day cost – but not for anything that takes place within the hospital. It can take a few years till people find all that out.

    Maybe it’s even illegal and lawyers will win a few class action suits. Or maybe they won’t be allowed in that state. But maybe a federal court will allow the suit to be brought.

    Sammy Finkelman (0d0ca8)

  86. What’s his next big thing? Health savings accounts.

    Fine, a good idea, and maybe this can give everyone else the same tax deduction that those who have insurance paid for by employers have. But that’s only a tiny piece of a solution.

    A good element yes, and it will add to the deficit, unless paid for, or does Ted Cruz think it will not??

    Sammy Finkelman (0d0ca8)

  87. That’s why I pray Team R dials the blame game down. Let’s hope they regroup and move deliberately through regular order after sunsetting Obamacare a couple of years down the road to allow insurers, employers, providers, states and individuals to adjust.
    crazy (d3b449) — 3/27/2017 @ 12:24 pm

    *********************

    Yep. Donald Trump himself said that he was with Ryan on this and disappointed that Dems did not cross the aisle to vote for the bill.

    I do not understand surrogates for Trump going after Ryan because that only reinforces the idea that you cannot trust what comes out of Trump’s own mouth, and what he said right after the bill is pulled.

    In effect they are doubling down on the idea that you cannot trust what Trump says and also the idea that Trump is really not in charge. That it some other actor like Bannon who thinks he is still in campaign mode and can simply “thug out” to intimidate people into coming on board.

    If I was a representative in Congress who saw Bannon threatening the RINOS and the Freedom Caucus with Trump primary-ing them, my trust in Trump for Phase One and then Phase Two would diminish greatly and I would jump off the ship because it could very well be me next.

    This attack by Trump surrogates undermines Trump in two ways; it says–do not trust what Trump says–he is lying when he says “X”–and Trump isn’t really in control– it is Bannon who is really behind everything.

    That is not good when you are a President without a resume or track record, who didn’t articulate very well whatever the Trump Healthcare Plan might be–and on top of all that you are asking people to just trust you about Phase Two and Phase Three.

    Bannon or whoever is working in the background to point people to Judge Jeanine’s opera try out in competition with Judge Napolitano’s effort to compete for Trump’s Supreme Court “Short” List–needs to be fired because they are undermining the President’s effectiveness and trustworthiness in one fell swoop simply because they cannot complete the transition from campaign mode to governing mode.

    Rae Sremmurd (2fd998)

  88. Small business pools: Wait a second: Any element of joining just for the purposes of health insurance that you add leads to adverse selection, with the pool getting sicker with time.

    (As the risk of the pool grows, the insurance premium will rise, fewer businesses will join that particular pool, and more will drop out, and they’ll join a fresh pool with younger and healthier people in it.)

    Of course the whole thing is messed up anyway, and this will allow people to maneuver their way through the mess a little better, while making the system a little worse.

    I like this idea but don’t think this is any kind of solution.

    Sammy Finkelman (0d0ca8)

  89. And we should allow states to create high-risk pools or pursue other innovative solutions to insure that the most vulnerable among us have access to affordable health care.

    Hand waving.. Snake oil.

    With high risk pools, Everything depends upon how much money you allocate. It’s s not cheap. Where does the notion that this would be both affordable and adequate come from?

    Sammy Finkelman (0d0ca8)

  90. Medicaid block grant: The problem is, wasteful and stupid as New York State may be in spending Medicaid money, cutting down the amount money won’t change things.

    It won’t keep people out of nursing homes, for instance. It won’t stop dentists from running an assembly line operation. The problem is baked into the cake, has worked itself into the DNA, so to speak.

    Only creating incentives at the individual not to waste money can do anything about this.

    Studies did show that people on Medicaid did have worse outcomes, and visited both the emergency room and doctors more without a statustical improvement in health outcmes.

    I can think of two reasons: First, people were getting most necessary treatments anyway, but secondly people on Medicaid were sicker – because people wound up on Medicaid when they went to hospitals and hospitals put them on Medicaid because they wanted to get paid. (Medicaid is the only form of “insurance” that is retroactive.)

    Second, some medical care makes people worse off, so when you incrrease he amount of health care comsumed, you don’t make people better off.

    Sammy Finkelman (0d0ca8)

  91. Ted Cruz:

    Those six ideas enjoy virtual unanimity among Republicans who now control both Congress and the White House. They bring all of us together.

    But they don’t amount to a replacement for Obamacare!! Also, I think it’s not true that most Republicans want to repeal the requirement not to charge more for pre-existing conditions, and that’s part of what Ted Cruz proposes. Selling insurance across state lines doesn’t make any sense without that.

    Sammy Finkelman (0d0ca8)

  92. this looks like it might could be a thing

    “The community’s got to be nervous about this, and rightfully so, because you have a right to be in your own home without being intimidated,” Villegas said. “I’m conflicted because I haven’t got all the details [of the incident] yet, but from the way this has started to play out, it looks like an overstep by an overzealous ICE agent who’s just trying to follow Trump’s orders.”

    the article’s poorly-written so it’s hard to say for sure what this adds up to

    happyfeet (28a91b)

  93. I’ve had bosses who stand behind me when my work is in question and I’ve had those who cut and run. I imagine most of us have had similar experiences. A good boss doesn’t cut and run. Donald Trump didn’t cut and run.
    After delegating health care reform to Ryan, Trump followed up by doing the standup thing: he fought for Ryan’s bill. He negotiated with conservative critics – something that Ryan should have done but didn’t – he cajoled, and he rallied popular support. He did everything he could to get the revamped health care program passed into law. There are many things Trump can be faulted for, but to fault him for standing behind Ryan is not one of them.
    There is a reluctance among many NeverTrumpers to give President Trump credit where credit is due. Like the AHCA or hate it, Trump deserves credit for standing behind Ryan and Ryan’s bill. Give the man a fair shake. To do otherwise makes you look small.
    ThOR (c9324e) — 3/27/2017 @ 1:18 pm

    *****************************

    Well then why in the heck are you making your earlier comment?

    Trump was duped by Paul Ryan into making his first and biggest move and spending his most valuable political capital on a bill that Trump knew nothing about?

    You think that Paul Ryan would not coordinate with the new leader of the GOP and the President to make sure he approved of the bill?

    How ludicrous would it have looked to go with a bill first that Trump did not approve of–and would simply veto?

    Trump campaigned for the bill at a rally in Tennessee at great expense to the taxpayer for Secret Service, crowd security and Air Force One costs–and he did all of that without knowing what was in the bill?

    They also had Bannon threaten to use Trump to primary the Freedom Caucus–because–they didn’t know what was in the bill?

    Well then–what is the conclusion? Trump is naïve and dupable or the whole Trump posse is inept as hell. That’s the road you are going down with this damn scapegoating of Paul Ryan because some damn radio host knows it is simpler to feed you your rage of the day hit rather than bust your bubble of Trump as God Emperor– who should never be questioned.

    Rae Sremmurd (2fd998)

  94. Ted Cruz:
    Those six ideas enjoy virtual unanimity among Republicans who now control both Congress and the White House. They bring all of us together.
    But they don’t amount to a replacement for Obamacare!! Also, I think it’s not true that most Republicans want to repeal the requirement not to charge more for pre-existing conditions, and that’s part of what Ted Cruz proposes. Selling insurance across state lines doesn’t make any sense without that.

    Sammy Finkelman (0d0ca8) — 3/27/2017 @ 1:54 pm

    Only those that took Trump seriously when he talked about Obamacare are worried about replacing it. Most of us voted for these representatives over the last 7 years because they promised to repeal the law, not repeal and replace.

    Sean (1d5074)

  95. Can Trump at least make Mexico pay for anchor babies and Mexican national’s ER bills?

    Pinandpuller (a5cd30)

  96. So let me get this straight–The current Trump supporter argument is that Trump did not know what was in Phase One–and you want everyone to buy this argument while Trump is trying to pitch the sale–that America should not worry about ObamaCare and just trust him–Phase Two and Phase Three will be great!

    See how that is going at cross purposes?

    Rae Sremmurd (2fd998)

  97. Can Trump at least make Mexico pay for anchor babies and Mexican national’s ER bills?
    Pinandpuller (a5cd30) — 3/27/2017 @ 2:04 pm

    ********

    No, because Bannon pissed away Trump’s credibility in order to turn America’s attention to the real power–Judge Jeanine! (–most likely because Bannon wants to get in her granny panties and whispered sweet nothings in her ear about how she could be on Trump’s Supremes Short List if she “performed” well enough.

    Rae Sremmurd (2fd998)

  98. President Trump did so good for to try to get the ball rolling on repealing the obamacares.

    But wiscotrash sex-gimp Paul Ryan, he failed to put together a bill that could pass.

    Then the freedom filth kept moving the goalposts.

    I deserve so much better than this.

    happyfeet (28a91b)

  99. They used to put xray machines in shoe stores.

    Pinandpuller (a5cd30)

  100. Happyfeet

    The shoe store xray was called the “Pedoscope” lol.

    Pinandpuller (a5cd30)

  101. i already asked the googles

    Shoe shops and their customers loved the Pedoscope, which was in use from the 1920s onwards for four decades. Ten thousand machines were installed in the US, about 3,000 in Britain and 1,500 in Switzerland, the home of Bally, once the world’s largest shoe manufacturer.

    the future used to be so fancy

    happyfeet (28a91b)

  102. Sammy

    Radiologist groups these days are almost set up like call centers. An MD sits in a dark room reading xrays from potentially anywhere. They can work a shift or take call.

    Pinandpuller (a5cd30)

  103. I’m not sure Rich galen, referring to CBC is talking about the same policy but we are now at the stage where deductibles are averaging $12,393 for families enrolled in a bronze plan, according to CNBC), and premiums are at $4,200 per year.

    This seems to be the article: (I don’t see the $4,200 figure)

    http://www.cnbc.com/2016/10/26/obamacare-deductibles-are-on-the-rise-for-2017-along-with-monthly-premiums.html

    Sammy Finkelman (6f9f42)

  104. Yes, Rae, if you like your ObamaCare you can keep your ObamaCare…

    Colonel Haiku (6b7575)

  105. I think what you had in shoe stores was not quite an X-RAY. This was still going on in the 1960s, maybe a bit later, so it couldn’t have been a real X-Ray.

    Sammy Finkelman (6f9f42)

  106. Rae

    The trouble with Jeanine in person is no mute button.

    I must say I agree with those who are sick of calling people by the last title they held in government.

    How does “Fox News Slut” sound?

    Pinandpuller (a5cd30)

  107. Sammy

    For accuracy it was a fluoroscope. Basically that’s a live action xray and the other is still shots.

    They use fluoroscopes in OR’s during surgery.

    Pinandpuller (a5cd30)

  108. people forget President Trump just wants America to do prosper and thrive

    happyfeet (28a91b)

  109. Rae
    The trouble with Jeanine in person is no mute button.
    I must say I agree with those who are sick of calling people by the last title they held in government.
    How does “Fox News Slut” sound?
    Pinandpuller (a5cd30) — 3/27/2017 @ 2:36 pm

    ***********

    I dunno–her voice is deeper than Caitlyn Jenner’s.

    Perhaps–Fox News “Talent”.

    Rae Sremmurd (2fd998)

  110. Yes, Rae, if you like your ObamaCare you can keep your ObamaCare…
    Colonel Haiku (6b7575) — 3/27/2017 @ 2:34 pm

    *****************

    Ya–you wish I was a Democrat. I’m a Republican and I’ve been fighting Democrats longer than Trump and Bannon–combined.

    Haiku THAT!

    Rae Sremmurd (2fd998)

  111. “Anyone opposed to policies providing incentives to change diet and exercise for improving health is a mean-spirited shill for the Profits of Sickness: Health Insurers, Big Pharma, Hospitals, Doctors.”

    Wouldn’t it fee great to hurl that demagoguery at your favorite SJW, Bernie Sanders, or some other smarmy Universal Payer advocate who thinks Denmark is better than the good ‘ole US of A? Well you could feel that feeling if you change the way you think about healthcare policy.

    Why not create a bold new vision of healthcare policy that doesn’t play inside the policy sandbox created by the Left? Let’s focus on Personal Responsibility for Health.

    Anytime I argue with a leftist or a squishy-moderate like Finkelstein, I crush them with the arguments, based on science, that personal health is largely determined by your choices in your nutrition and exercise. Government-subsidized healthcare will make people sicker because it removes responsibility for taking responsibility for your own health.

    So we build a new sandbox to play in that the Left won’t understand what to do. When we trot out all the research showing the links between diet and exercise versus cancer, Type 2 diabetes, strokes, heart disease, Alzheimers, and more, then we can ridicule the Left for sounding like Deniers of Climate Change.

    Yes, the implications of all this scientific research is that Federal dollars are best spent on creating incentives for people to change their behavior, and not lining the pockets of Insurers and Pharma. If you insist on having a government-funded program to improve health (and as a pragmatic Libertarian, I get that I may have to make concessions to ideological purity), then turn everyone’s attention to the SCIENCE!!!!

    I welcome all the apologists coming out of the woodwork saying that all those 5′ 6″ 300 pound Lane Bryant shoppers have some kind of “hormone imbalance” and they couldn’t possibly be held responsible for their grotesque bodies. Let them rail against the SCIENCE!!!! The science linking diet, exercise, and morbidity is settled, my friends.

    I’m not opposed to HSAs, interstate insurance sales, abolishing community ratings, and all that other jazz. It’s all fine and dandy. But you are playing inside the Left’s sandbox when you just talk about this stuff. The real action is focusing upon Personal Responsibility and changing how Americans eat and exercise.

    El Gipper (f1f816)

  112. Ted has it right, per usual. It’ll never be allowed to happen, per usual.

    Of course basic office visits should not be covered. Guess what? That is what DEDUCTIBLES are for! If all a given policyholder has in a given year is a basic visit or two, there is no cost to the insurer. So, any new requirements that such healthcare not be subsidized offer no genuine basis for opposition. But…deductibles would have to be pared waaaaay down or eliminated.

    A third rail in all of this, but an incredibly costly component, are torts. The degree of testing and over-cautious diagnostics is beyond immense. Sensible tort reform would save billions each year.

    The solutions are out there. The willingness of the polity to accept increased self-responsibility and cost is not.

    Ed from SFV (3400a5)

  113. Rae, you do know all Trump can do is get congress to put a bill on his desk to sign or veto, don’t you? As president he can encourage, cajole, threaten, shout and bait, but it’s the job of congress to write the bill and present it. Short of that, any failure to present a bill is on congress. Blaming Trump for this 6 y.o. clusterflick is like blaming your publisher because you couldn’t finish writing your book.

    thOr is right, you just make yourself look small.

    Leon (168f33)

  114. Until Conservatives and Libertarians make the case that healthcare costs are related to your individual choices, then how can you expect anyone to buy the argument that individuals should accept personal financial responsibility for their healthcare costs?

    Increasing the supply of doctors, interstate commerce in insurance sales, transparent pricing, HSAs, and all the other myriad proposals on the table pale in significance to this simple truth. The only way to improve health and reduce healthcare expenditures is for more people to make smarter choices about how they take care of their own bodies.

    It’s time to stop believing that health and sickness are random acts of God, and that we’re all helpless victims who need Big Government to take care of us.

    Anyone who supports Obamacare or Universal Healthcare wants to see more people get sicker, fatter, and die sooner.

    The best policies are ones that gives individuals the compelling incentives to make better choices for nutrition and exercise.

    El Gipper (f1f816)

  115. No, I don’t wish you were a Democrat.

    he fought teh Dems but
    teh Dems won he fought teh Dems
    but teh teh Dems won

    Colonel Haiku (6b7575)

  116. I remember those X-ray machines in shoe stores. You could see the bones in your feet and how they fit within the outline of the shoe. There were viewing ports for the salesman, the client, and a parent or spouse.

    However, the machines lacked proper shielding and the repeated exposure of salesmen to raw X-rays necessitated their prompt and unceremonious removal. Last time I saw one was in a museum display of quack equipment back in the early ’70s.

    ropelight (734d75)

  117. And what you have to worry about there is the doctor not communicating effectively with the patents – thinking somebody hears clearly when they don’t, for instance.

    They don’t say “hold still”, they lock you down on the table with a custom-built head/face restraint so you CAN’T move.

    Kevin M (25bbee)

  118. No, I don’t wish you were a Democrat.
    he fought teh Dems but
    teh Dems won he fought teh Dems
    but teh teh Dems won
    Colonel Haiku (6b7575) — 3/27/2017 @ 3:54 pm

    ************

    I suck at haiku

    But if we blame Dems

    Let’s focus on that–or something. ( off to google fu–the rule for haiku)

    Rae Sremmurd (2fd998)

  119. El Gipper, personal responsibility isn’t the only factor in a person’s health. I’ve known smokers that lived to 90 and fitness fanatics that had a heart attack at 35. Young kids get cancer.

    Experts decide perfectly responsible things are unhealthy all the time. Like having a gun. Eating red meat. Neglecting to put on sunscreen whenever you are outside.

    Then you have perfectly fit people doing dangerous stuff I would never do on a bet, like rock climbing, skydiving, or surfing.

    I get what you are saying, but it seems a risky path you are selling, rife with authoritarian abuses and subject to control freaks out to protect you from life.

    Are you sure that’s the road you want to go down?

    Leon (168f33)

  120. Mr. Trump is doing so many good things

    whereas Mitt Romney can’t find Paul Ryan’s ass with both hands

    advantage: President Trump

    happyfeet (28a91b)

  121. ok just kidding about Mitt that part was hyperbole

    happyfeet (28a91b)

  122. We’re doing Grant not Patton… After a reasonable cooling down period this could still work.

    crazy (d3b449)

  123. A blast from the pre-Obamacare days. The Impossible Healthcare Solution: Go Back to Cash

    crazy (d3b449)

  124. @50, I disagree.

    @36 That’s a picture you pray nobody sees until you’re well into retirement.

    There are old pilots. There are old pilots, but there are no old, bold pilots!
    crazy (d3b449) — 3/27/2017 @ 11:54 am

    You are talking pilots in general. Who can afford to fly an 8 engined bomber? It takes money to acquire the skills this man acquired and make no mistake, he acquired them. Courtesy of your tax dollars. He acquired them because this country told him to fly under the radar.

    Sorry if the gent supplying your village in the DC-3 hasn’t acquired the same skill set as this national asset. If it wasn’t dangerous, we wouldn’t teach it. If it couldn’t be controlled, we wouldn’t let the USAF do a second fly-by.

    Steve57 (0b1dac)

  125. Trump and teh Congress
    better get act together
    start walking teh walk

    Colonel Haiku (2601c0)

  126. It’s only a risk if you don’t know what you are doing.

    Steve57 (0b1dac)

  127. we need Democrats
    exactly like EU needs
    a Greek accountant

    Colonel Haiku (2601c0)

  128. A B-52 driver gave us Navy types a good laugh when he described his “pop up” technique.

    We all respected what he did. Controlling that much airplane is a lot.

    Steve57 (0b1dac)

  129. in my perfect world
    Schumer would get one thousand
    colonoscopies

    Just on general principles

    Colonel Haiku (2601c0)

  130. if I had a dog
    he would look just like the dog
    that Obama ate

    Colonel Haiku (2601c0)

  131. …I must say I agree with those who are sick of calling people by the last title they held in government.

    Call me Steve.

    Steve57 (0b1dac)

  132. Controlling that much airplane means, not controlling that much airplane.

    Steve57 (0b1dac)

  133. then there’s ted koppel
    whose very annoying voice
    launched ten million snores

    Colonel Haiku (2601c0)

  134. Coronello, preliminary results are you are s**t if you banking on the A1 Skyradered.

    https://www.youtube.com/watch?time_continue=5&v=CJBeqVYwuZs

    The ground pounders used to wonder how the aviators closed their legs.

    Steve57 (0b1dac)

  135. ted koppel’s rocking that crypt-keeper vibe

    happyfeet (28a91b)

  136. Its certainly pining for the fjords
    http://www.powerlineblog.com/archives/2017/03/is-time-dead.php

    narciso (d1f714)

  137. if I had a dog
    he would look just like the dog
    that Obama ate

    Hahahahaha that’s funny.

    Patterico (115b1f)

  138. That’s awesome Steve!

    Colonel Haiku (2601c0)

  139. “Effective as of Dec. 31, 2017, the Patient Protection and Affordable Care Act is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted.”

    — Rep. Mo Brooks (R-Huntsville)

    Colonel Haiku (2601c0)

  140. 140… yeah, you’re right. That sucked. That killed on twitter a few years ago, though.

    You hasta know your audience.

    Colonel Haiku (2601c0)

  141. I like it. Maybe someone’s listening to me! Here’s me five days ago:

    Patterico (115b1f)

  142. Also this (in response to Michael Cannon’s tweet saying Ryan was threatening to pull the bill and blame the Freedom Caucus for leaving ObamaCare in place):

    Patterico (115b1f)

  143. Yes it should be that simple, but there are too many remorse that profit from the system
    acecomments.mu.nu/?post=369040

    narciso (d1f714)

  144. If I had a child, she probably wouldn’t be in a paid flight status*.

    Same as me.

    But she’d go though SERE just so her Ops O would know.

    *Ask me later.

    Steve57 (0b1dac)

  145. The first half of #137 came out wrong. I won’t even try to correct it. I meant no offense, coronello.

    Steve57 (0b1dac)

  146. and smokers…

    ropelight (734d75) — 3/27/2017 @ 7:05 am

    I always thought smokers were good for your health.

    https://www.youtube.com/watch?v=14vcRftzS_A

    NAVY BOXING (SMOKERS) MWR

    I gather you weren’t thinking of three, three minute rounds.

    Which I guarantee will solve all your problems. Or at least focus the mind.

    Steve57 (0b1dac)

  147. 120.And what you have to worry about there is the doctor not communicating effectively with the patents – thinking somebody hears clearly when they don’t, for instance.

    120. Kevin M (25bbee) — 3/27/2017 @ 4:23 pm

    They don’t say “hold still”, they lock you down on the table with a custom-built head/face restraint so you CAN’T move.

    They also tell you how to position your eyes so that the wrong part doesn’t get hit by the laser..

    Sammy Finkelman (8a31dc)

  148. I can also guarantee that there is someone reading this who, in my prime,
    could have kicked my #$$.

    Steve57 (0b1dac)

  149. 120. Kevin M (25bbee) — 3/27/2017 @ 4:23 pm

    They don’t say “hold still”, they lock you down on the table with a custom-built head/face restraint so you CAN’T move.

    They also tell you how to position your eyes so that the wrong part doesn’t get hit by the laser..
    Sammy Finkelman (8a31dc) — 3/27/2017 @ 8:17 pm

    Or, the NORKs can pound your face in using that high tech weapon known as
    the fist, so all your teeth are broken, then blow you apart with a 40mm cannon.

    “I want you to die, Mr. Bond.”

    It’s all so terribly complicated.

    Steve57 (0b1dac)

  150. @127 I was trying to gently point out the AF would ground that BUFF crew for flying 150′ below minimum training altitude and that close to the carrier especially when they repeated it. Bomber guys work their way down in training to operate at lower and lower altitudes without supervision but they don’t operate legally in peacetime below 200′ AGL. It was a great AF-unapproved show but the they really frown on that stuff. I know it happens, but that’s why I said you hope nobody sees the pictures until you’re long gone.

    crazy (d3b449)

  151. They are syrpriding old school about stuff like that, none of this scorpio sting then antivenom, rinse and repeat.

    narciso (d1f714)

  152. What’s the altitude at which radar doesn’t track you.

    narciso (d1f714)

  153. It depends on range, frequency, power, reflectivity, ground clutter, etc, etc. The training mins are a balance between realistic training and safety. You start operating below the wing span of you aircraft and you don’t have much maneuverability or many options. Newbies at exercises like Red Flag all want to hid in the dirt until they discover the Bandits saw the dusty rooster tail before they saw the aircraft. War time – you do what you have to do.

    crazy (d3b449)

  154. @154, the were on a training mission. They were training as they were supposed to fight. The Midway crew didn’t even see them until they passed by. Say what you like about the crew of the Midway, like they didn’t know their job (I never would) but that’s how effective they were. If you’re advocating grounding the flight crew for that, then ground the whole force as it’s worthless.

    Also, please note, I don’t do jargon very well any more. I retired in 2008, and after I returned from Operation Noble Eagle/Operation Iraqi Freedom and served in the IRR I largely didn’t give a rip. So my sense of precision is, shall we say, lacking.

    Steve57 (0b1dac)

  155. Have another drink mate. They did it. Everybody loved it. As far as I know their unit commander didn’t know and didn’t bust them. Lucky them. Sounds OK to me.

    crazy (d3b449)

  156. Crazy @157, I think it needs to be said. Nobody has repeated this since 1989. I think this speaks to what you are saying. This is the kind of stunt that ruins your career.

    Unless it’s not a stunt.

    Steve57 (0b1dac)

  157. Agreed. Many got a little crazy back in the “Top Gun” days. Even the BUFF guys wanted to be Maverick.

    crazy (d3b449)

  158. Obamacare wasn’t about health care. It was about creating another of these entitlements that would wedge issue the hell out of the GOP. Now the GOP’s actions will be twisted (or presented honestly) to scare people who think they are dependent on another program, and their inaction will be seen as weakness and akin to driving us over a fiscal cliff.

    This is the true reason they rammed this through several years ago. It ensures just these sorts of chaotic problems.

    It’s critical, strategically, that the GOP kill this thing as quickly as possible. Now is pretty close to as quickly as possible. It will be painful politically, but only more painful next year, and more painful the year after. Eventually it becomes a third rail like Social Security. Even just getting on board with Obamacare would maintain the wedge issue. There is only one winning move, and that is repeal. I do not think a replacement bill is a good idea. Leave that to the lowest level of government to enact these intrusive programs (or not). Texas’s tort reform is a great example of a health care reform. Massachusetts had a different direction. Let us all do our own things. That should be the GOP’s philosophy, even about issues they care dearly about.

    If Ryan can rise to the occasion despite the constant back stabbing from his supposed Republican allies, I’ll regain some respect for him.

    Dustin (ba94b2)

  159. 159. Have another drink mate. They did it. Everybody loved it. As far as I know their unit commander didn’t know and didn’t bust them. Lucky them. Sounds OK to me.

    What are you saying? A few thousand sailors, several dozen O-6s and a few flag officers were in on this illicit activity? Not once, but twice? The entire ****ing Battle Group?

    Steve57 (0b1dac)

  160. This is hilarious.

    I’ve never really understood why Trump hated Obama so much. He historically was very warm, close friends really, with the Clintons. He’s friends with a lot of democrat politicians. But he has always hated Obama, almost as much as he hates George W Bush. I wonder if we’ll ever learn what the deal was.

    Dustin (ba94b2)

  161. Every comment I made was about the USAF B-52 and crew. Period. Over and Out

    crazy (d3b449)

  162. I don’t want to speak out of school. But when I was in the Air Force types would brief us Navy Neanderthals on what antics we could expect to see. H3ll, the JASDF guys would brief us. Something about the little courtesy of not shooting at each other.

    Steve57 (0b1dac)

  163. 165. Every comment I made was about the USAF B-52 and crew. Period. Over and Out
    crazy (d3b449) — 3/27/2017 @ 9:37 pm

    Received and understood.

    It hardly clears anything up.

    Steve57 (0b1dac)

  164. No he slobbered all over Obama in 2008-09, precisely because of his contempt for w, you absorb it by osmosis in New York, perhaps the same way it happens in austin

    narciso (954a48)

  165. http://www.al.com/news/huntsville/index.ssf/2017/03/rep_mo_brooks_files_bill_to_re.html

    one-sentence repeal is a real thing

    I would have put the date out further than December 2017, but I very much like the idea. If that bill passes, it will be all hands on deck for Congress to start building a replacement for Obamacare.

    If Ryancare passed, we could not count on Congress to pass additional laws to fix the death spiral. I don’t even know that Ryancare could be fixed. It’s only slightly less broken than Obamacare.

    But if this Bill passes, we can count on Congress to start coming up with new fixes and additions, etc.

    Daryl Herbert (7be116)

  166. @167. Steve the AF point of view from those days was that a realistic low-level training mission turns into a stunt when the pilot ignores the standards and starts showing off ala Maverick buzzing the tower in “Top Gun.” The same BUFF flyby 100ft higher is almost as memorable but not nearly as reckless or career threatening for the BUFF crew. Maverick caught hell from his command and the BUFF guys easily could have too if the video beat them back to the base. That’s all.

    crazy (d3b449)

  167. Steve. Aircrews tagged the B-52 with the BUFF nickname (Big Ugly Fat F*****) back in the early days.

    crazy (d3b449)

  168. Great post.

    So Ted Cruz can intelligently discuss the nuances of health care reform, and articulate the path to a market-oriented solution that lowers costs.

    Wouldn’t it be nice to have someone like that in the White House, calling the shots against Obamacare?

    Instead, we have a president so clueless that he’s forced to change the subject when someone wants to negotiate the specifics of his bill.

    Maybe he should have skipped a round or two of golf to read some background information and attend a briefing…

    Dave (711345)

  169. Yeah, I m aware of the origin of BUFF. I’m so old I know that Rhino is a nickname for the F-4 Phantom, A triumph of thrust over gravity. With enough thrust, a brick can fly.

    I’m so old I served with the remnants of the F-8 Crusader Mafia.

    Now that I’ve hopefully established how old I am…

    https://www.youtube.com/watch?v=DUT5rEU6pqM

    “Shakira – Hips Don’t Lie ft. Wyclef Jean”

    …trust me. Or don’t. Hips don’t lie.

    But I can only speak for the period when I served. 1987 until 2008. This picture was taken in 1989.

    Yes, they’ve put thirty years of wear and tear on them. If I were an aviator, I doubt I
    d fly them like I did thirty years ago.

    As for now, I’ll just glory in the fact my DI told me, “[Steve57], you’ll make a good intel officer.”

    Steve57 (0b1dac)

  170. crazy, has it ever occurred to you that someone set that photo up?

    There was a freaking helo standing off that ship, with a guy, with a camera.

    To do what? According to you, document the evidence for someone’s court martial. And this would have required the destroyer squadron commander’s, the air group’s commander’s, the effing Marine Det’s commander’s, I’ve only just begun how many COs who would have had to sign off on this, is what you’re saying? Then it gets up to the battle group. Is this your final word?
    br

    Steve57 (0b1dac)

  171. Now it gets weird.

    Steve57 (0b1dac)

  172. Twice.

    Steve57 (0b1dac)

  173. I’m not trying to be a jerk about this, but.

    https://tse1.mm.bing.net/th?id=OIP.dSGYsIh3LPyxG1biQ0tv6gEsCV&pid=15.1

    This picture didn’t just happen.

    Steve57 (0b1dac)

  174. 38. any landing you can walk away from is a pretty good one…

    happyfeet (28a91b) — 3/27/2017 @ 10:59 am

    And if they can use the plane again, that’s like double bonus points.

    Steve57 (0b1dac)

  175. Steve. I’m not trying to deconstruct anything or prosecute anybody. I tried to take you inside the cockpit of the B-52 where the crew likely high-fived one another after the flyby and then got their stories straight on the long flight home in case they had to explain it. Their job was to stress the carrier’s defenses. They did it. The group’s job was to find them and target them before they could threaten the carrier. It looks to me like Mission Accomplished.

    crazy (d3b449)

  176. Can you block happyfeet? It’s hard to read through his pile of garbage to get to the folks who actually want to discuss.

    Ryan (60001b)

  177. 97. Sean (1d5074) — 3/27/2017 @ 1:57 pm

    Only those that took Trump seriously when he talked about Obamacare are worried about replacing it. Most of us voted for these representatives over the last 7 years because they promised to repeal the law, not repeal and replace.

    it was many more people than Trump who said “Repeal AND replace. Probably the majority of Republican memebers of Congress. That slogan did not originate with Donald Trump.

    Here’s the Huffington Post on December 6, 2013 01:15 pm ET (Updated Feb 05, 2014)

    http://www.huffingtonpost.com/bob-semro/repeal-and-replace-affordable-care-act_b_4393913.html

    Opponents of the Affordable Care Act have said many times that the law needs to be “repealed and replaced.” The natural follow-up is: “OK, replace it with what?”

    Supporters of the ACA say that the opposition does not have an alternative plan..

    Then it list 4 and describes bills, all of which look to me very incomplete)

    Now there may be some Republican members of Congress who didn’t say thst.

    Sammy Finkelman (8a31dc)

  178. El Gipper (f1f816) — 3/27/2017 @ 3:32 pm

    Yes, the implications of all this scientific research is that Federal dollars are best spent on creating incentives for people to change their behavior,

    This actually was Obamas idea, except he thought peple neeeded monetary incentives (like no cost) to see doctors.

    Obamacare has no co-pays for “wellness visits” with the idea that bad health would be prevented by what the doctors told the people they saw. This is not really true, or, for whatever is saved in costs, more is spent.

    Most “preventative” treatment costs more money than it saves.

    Sammy Finkelman (8a31dc)

  179. 183.El Gipper:

    I welcome all the apologists coming out of the woodwork saying that all those 5′ 6″ 300 pound Lane Bryant shoppers have some kind of “hormone imbalance”

    They really do, although the right kind of diet, can affect the hormones. Exercise doesn’t work, because a person simply eats more; and eating less doesn’t work, because the basal metabolism rate goes down and the body burns up less energy per day; but increasing muscle mass, which does not require a lot of exercise, but only heavy exercise * does work, (because it increases the basal metabolism rate) as does long gaps between meals. Low fat diets do not work but low carbohydrate ones do.

    ————
    * Go to a stationary bicycle, peddle as hard as you can for 20 seconds, peddle slowly and moderately for two [2] minutes, peddle again as hard as you can for 20 seconds, peddle slowly and moderately for two [2] minutes, and then peddle again as hard as you can for 20 seconds.

    Total time elapsed: 5 minutes.

    Do this 3 times a week – that’s all the exercise you need to do.

    https://www.nytimes.com/2017/02/01/well/move/how-to-do-the-shortest-workout-possible.html

    This kind of thing is more valuable in older people. Of course, I think somebody could be really out of shape, so maybe in certain case this could be dangerous, so if somebody feels a problem, of course, stop or slow down.

    Sammy Finkelman (8a31dc)

  180. This is a GREAT post. I don’t even want to venture a guess at how long you worked on it.

    shipwreckedcrew (56b591)

  181. Dustin (ba94b2) — 3/27/2017 @ 9:34 pm

    I’ve never really understood why Trump hated Obama so much. He historically was very warm, close friends really, with the Clintons. He’s friends with a lot of democrat politicians. But he has always hated Obama, almost as much as he hates George W Bush. I wonder if we’ll ever learn what the deal was.

    By the time Obama cae along, and also George W. Bush, Donald Trump was seriously contemplating running for president.

    So he registered as a Democrat in 2001 and criticized Bush, and then re-registered as a Republican in 2009 and criticized Obama.

    (In 2011/2 he temporarily registerred as no party, then re-registered as a Republican and decided to cast his lot with the Republicans because he practically stopped making political contributions to Democrats around that time.)

    friends with a lot of democrat politicians. But he has always hated Obama, almost as much as he hates George W Bush. I wonder if we’ll ever learn what the deal was.

    Sammy Finkelman (8a31dc)


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