Patterico's Pontifications

7/31/2017

The Cruz Solution to the Pre-Existing Condition Problem: Individual Responsibility

Filed under: General — Patterico @ 8:30 am

Everything about ObamaCare flows from one principle: that companies can’t deny coverage to people with pre-existing conditions. It’s an overwhelmingly popular concept. But is ObamaCare’s way of addressing the problem the best way? The answer is clearly no. There is a better way: one consistent with individual responsibility. I call it the Cruz solution.

Before we get to the Cruz solution, let’s talk about what we have instead: the ObamaCare solution. The ObamaCare solution is to tell insurers they must cover people with pre-existing conditions. Period. The message that the ordinary person hears is: “Go ahead and wait until you are sick to buy health insurance.”

This concept has been a disaster that has caused premiums to skyrocket, wreaking havoc all over the country. The media ignores the human cost of this ongoing disaster, of course . . . but you can read about it elsewhere.

For example, The Federalist recently had a piece that told the all-too-typical story of a man named Joe Cato, whose insurance won’t pay for back surgery, but will pay for opioids. Joe used to pay $36 a month to Aetna for insurance that “paid for CT scans, an MRI, nine spinal injections, visits to the emergency room, physical therapy, chiropractic care, and massage specialists.” But the costs resulting from ObamaCare drove Aetna out of the individual market, and Joe was left with one choice: a $120 per month Blue Cross plan that won’t pay for the surgery Joe was about to have with his Aetna plan. John Daniel Davidson, the author of the piece, explains that this is all a result of ObamaCare’s way of handling the pre-existing conditions problem:

Joe’s story illustrates in a microcosm what’s been happening all over the country. Obamacare sought to transform the individual health insurance market by making two major changes: 1) forcing everyone to purchase coverage—the individual mandate provision—and 2) forcing insurance companies to cover everyone, even those with preexisting conditions. The idea was that the young and healthy would sign up, and their premiums would pay for the cost of older and sicker people, whose premiums wouldn’t actually cover the cost of their care.

It hasn’t worked out that way. Young people didn’t sign up for coverage on the exchanges in sufficient numbers, opting instead to pay the penalty. Insurers were forced either to raise premiums, which have skyrocketed in recent years, or simply exit the market in the face of huge financial losses.

This year, insurers fleeing the market left 21 percent of all Obamacare exchange customers with only one insurer in their area—including Joe Cato in North Carolina. Next year it might be even worse, with as many as 1,200 counties projected to have only one insurer and 47 counties with no Obamacare insurers at all.

That matters because of people like Joe, who are left with no choices and inferior coverage that won’t pay for necessary procedures—but will pay for opioids. That’s especially callous, given the ongoing opioid crisis.

The ObamaCare solution is what caused Joe Cato’s premiums to skyrocket, while his options for care dwindled to nothing. It’s the solution that says: don’t worry. You’ll be covered whether you bother to buy health insurance or not. We may give you a little penalty. We’ll send our grinning fool of a President out on the talk show circuit to persuade you to buy health insurance. But in the end, thanks to him, you don’t really need it. We’ll make sure you’re taken care of, whether you act responsibly or not.

There is another solution, which I call the “Cruz solution”: lawmakers could craft proposals that ensure that people who are responsible and obtain insurance should not have it taken away because they develop a serious health condition. I call it the “Cruz solution” because Ted Cruz explained it in his March 2017 piece The Right Way to Repeal ObamaCare:

[W]e 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.

The Cruz solution is a logical approach. The Cruz solution says: if you want coverage when you get sick, you have to buy insurance when you’re not. That way, you have it when you need it — and we won’t let insurance companies play tricks on you and snatch it away from you even though you kept your end of the bargain. If you get hit hard by circumstances, we’ll work with you. There will always be charity care, mandatory treatment in an emergency, and Medicaid under current law. But this may not be ideal. If you want proper treatment, ultimately, it’s your responsibility. You need health insurance when you’re not sick — because we’re not going to suddenly let you buy it for the first time when you are.

In the end, we do have to have some solution to the pre-existing condition issue. Most people I know, including me and the members of my conservative family, agree that the state of affairs before ObamaCare was unacceptable. The individual market has been broken for as long as I can remember. And health insurance through one’s job carried the ever-present threat that you could lose your job — meaning you would lose your policy, and another insurer could come along and deny you health insurance if you had developed a health condition in the meantime.

But if you don’t want government completely running health care through single-payer — a totalitarian state of affairs that leads to Charlie Gard situations where the overwhelming power of the state trumps family when it comes to health care decisions — then the solution to this problem requires insurance companies to stay afloat. This means enough people must buy insurance for insurers to stay in business. There ain’t no such thing as a free lunch. Insurers have to be paid or insurance will disappear.

The question is: will the solution to this problem be one tied to individual responsibility, or one that puts the responsibility on government?

The ObamaCare solution isn’t working. Just ask Joe Cato.

Why not give the Cruz solution a try?

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

123 Responses to “The Cruz Solution to the Pre-Existing Condition Problem: Individual Responsibility”

  1. The individual market has been broken for as long as I can remember. And health insurance through one’s job carried the ever-present threat that you could lose your job — meaning you would lose your policy, and another insurer could come along and deny you health insurance if you had developed a health condition in the meantime.

    To sell Cruz’s idea, you will need something concrete to explain how someone in that position–no health insurance but a chronic illness or a new severe illness–will get help, given that charity care, mandatory treatment in an emergency, and Medicaid under current law tend to yield only the skimpiest, cheapest available, most bureaucratically degrading result.

    a totalitarian state of affairs that leads to Charlie Gard situations where the overwhelming power of the state trumps family when it comes to health care decisions

    Try to find a different example, because with all the focus on the British health system stomping on the rights of Charlie’s parents the other truly pertinent facet of the case seems to have gotten lost, and that facet is actually much more pertinent to the debate right now: had Charlie’s parents been allowed to treat Charlie the way they wished, they still would not have been able to, because of the cost. They ran a crowdfunding campaign to raise the money, but on their own, they didn’t have nearly enough to pay for it (and as an experimental procedure, it’s doubtful any insurance company would have paid for it). And the crowdfunding succeeded in large part simply because of the furor over the case. Without that furor, Charlie’s parents may well have been been able to afford the procedure. So (I repeat a question I asked last week) do you really want to live in a world where the ability of a patient to get needed medical care is directly tied to how well their family can run a crowdfunding campaign?

    kishnevi (bb03e6)

  2. I agree with the Cruz solution. Try explaining it to most Americans, though, what with the Dems, MSM and CBO laying in the weeds, ready to pounce at anything that doesn’t look and smell like socialized health care. Millions will die, I tell ya!!!

    I believe it’s impossible to implement a palatable solution without cutting the insurance companies and hospitals out of the loop whilst crafting legislation. Of course, this would require legislators to understand free markets and be willing to piss off their donors. That is too high a hurdle for them to clear. And so I’m pessimistic.

    Lenny (5ea732)

  3. heroic hero John McCain says obamacare is just fine the way it is, that it is so good, and that Ted Cruz is a wacko bird

    end of discussion

    happyfeet (28a91b)

  4. without cutting the insurance companies and hospitals out of the loop

    Insurance companies, yes. Hospitals, no. If an insurance company can’t survive in whatever new health care environment arises, we lose–an insurance company. If a hospital can’t survive, then we lose a major provider of health care for a community.

    I am tempted to add legislators to your lists of people to be cut out of the loop. Perhaps I am too cynical.

    kishnevi (bb03e6)

  5. So (I repeat a question I asked last week) do you really want to live in a world where the ability of a patient to get needed medical care is directly tied to how well their family can run a crowdfunding campaign?

    You’re applying the exceptional to the typical. In the typical case, families don’t have to run a crowdfunding campaign. So, we aren’t living in such a world. If truly exceptional cases cause people to take extraordinary means to fund, I can live with that; in fact, I’d donate to their cause.

    Chuck Bartowski (bc1c71)

  6. 4/kishnevi

    I disagree —- the hospitals are in cahoots with the insurance companies. That is how they can charge $45 for an aspirin and the insurance company pays – or, really WE pay. They’ll survive by acting like any other responsible corporation. Or maybe that’s too much to ask.

    Lenny (5ea732)

  7. Just ask Joe Cato.

    Yeah, there’s a couple of questions one might want to ask. He was paying $36 per month under the Aetna plan, which skyrocketed to $120/mo. under Blue Cross at the start of 2017? Well, Joe was getting exceptional good value for money in 2016 – certainly only because of Obamacare – and indeed the $120 monthly premium for Joe and his wife (and, one assumes, his four (4) kids) was indubitably far below market value/price, and available only because of Obamacare and its subsidies. Any knowledgeable/thinking person must know that absent Obamacare in the first instance, Joe’s premiums for insurance comparable to what he had/has in 2016 & 2017 would have been vastly more (assuming that pre-existing condition rules unburdened by Obamacare rovisions would have presented him with any potential insurers in 2017.)

    And the only plan available to Joe on the exchange in 2017 was the Blue Cross “Blue Value”? Bullshit. My brother also lives in Waxhaw, and in 2017 bought under the exchange, the Blue Silver option. And I have virtually no doubt but that there were several (if not many) other Blue Cross options available on the Union County exchange at the start of 2017. And, of course, for all those “free-marketeers” out there, so far as I know there still are Aetna health insurance products available in Union County – just not ones “on the exchange.” See, e.g. http://www.aetna.com/individuals-families/document-library/rates/2017/CB/Rates_2017_NC.pdf; https://www.aetna.com/plan-info/individual/health-plans/2017/north-carolina.html

    What a piss-poor piece of writing, and what a dishonest exposition of the issues and the options. Pathetic.

    Q! (267694)

  8. [W]e 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.

    This is only part of the solution. Insurance companies can go bust, insurance companies can stop doing business in your state, you can leave your job and lose your company-provided plan (PARTICULARLY if you are sick), etc.

    There needs to be a system where “preexisting conditions” are not a barrier, or even an upcharge, so long as one HAS maintained coverage. There also needs to be a “disability due to medical condition” rider that extends policy coverage in the absence of a premium.

    Yes, there are were HIPAA plans that covered people who were laid off, if they could afford the full unsubsidized cost of their former company plan (with now taxable dollars). And, yes, there are were HIPAA extensions where you could, under a set of difficult conditions, get even longer coverage. However , none of these applied if you left work “voluntarily”, such as because you had a stroke.

    Kevin M (752a26)

  9. R.I.P. Sam Shepard

    Icy (0ffc83)

  10. In the typical case, families don’t have to run a crowdfunding campaign.
    Yes, because either insurance covers it, or public funding through public hospitals, or… they can’t afford it. Charlie’s case was not so exceptional as you think. It was exceptional merely because of the boot on your throat intervention of the government.

    That is how they can charge $45 for an aspirin

    And the insurance companies never pay that much, and you’ll never know because the lack of pricing transparency works in favor of both insurance company and hospital. But (especially in the public hospitals) a lot of that overcharge simply covers the cost of paying for the care of patients who don’t have insurance and not can’t self fund.

    Have you ever investigated the financials of your local public hospitals? You might be surprises at the amount of “profit”.

    kishnevi (bb03e6)

  11. Even in the old system, one could get coverage with any disease, so long as one could get a job at a company that offered insurance. For at least the last 20 years, and much longer in many states, group plans could not discriminate against those with preexisting conditions. At worst, one would have a 6 month waiting period if there was no previous insurance (for subrogation).

    This worked because employers COULD discriminate against people who were too sick to work, and people who GOT too sick to work would leave the job and coverage would drop (absent some additional disability plan, which may or may not have been offered). So, a worker with late-stage disease could find themselves without insurance when they needed it most, even though they had been as responsible as one could be.

    I’m really not sure what the answer to this is, and to what extent employers (or the insurance companies, or the state) are responsible for ongoing care. But we live in a society that generally rejects the “let them die on the sidewalk” position, so it’s a question that needs resolving.

    Kevin M (752a26)

  12. But it was the hmo bill and erisa in concert that enabled this circumstance, one might surmise it was about bending the cost curve down.

    narciso (d1f714)

  13. Heh. Can anything good come out of Reddit?

    ..my car insurance is $120 PER YEAR, liability only, and I am covered to $20,000,000. Because you car insurance is really expensive because its really medical insurance for who you hit.”
    https://www.reddit.com/r/AskReddit/comments/6qdfd9/seriousnonamerican_redditors_what_is_it_really/dkx0hqj/

    Has anyone else ever seen this point being raised? With the HUGE potential savings on auto insurance, and the not-all-that-much-higher taxes that many Europeans pay, it seems like this could be an important factor in persuading people about the benefits of single-payer health care.

    The whole thread (Non-American Redditors: What is it really like having a single payer/universal type healthcare system) is interesting:
    https://www.reddit.com/r/AskReddit/comments/6qdfd9/seriousnonamerican_redditors_what_is_it_really/

    (Spoiler alert: They love it, and can’t imagine life any other way, although admittedly several people criticize the mental health component of national health care.)

    P.S. I’ve tried to fix the huge white space below that first quote… sorry, I don’t know what I did wrong.
    5

    Ben burn (4f4dda)

  14. Insurance companies want insureds, whether, it’s patients or drivers, that they will never have to pay out for. More than want. Need.

    That’s why they got the state legislatures to pass mandatory car insurance — lots and lots of good drivers paying for a few bad drivers; and they got Congress to enact the Obamacare mandate — lots and lots of healthy people paying for a few sick people.

    Two government “solutions” to the problem of keeping insurance companies profitable.

    nk (dbc370)

  15. Looks like Rand saw it coming. Hoodathunk ACA would give relief?

    https://www.moneytips.com/impact-of-obamacare-on-car-insurance/252

    Ben burn (4f4dda)

  16. Nk: I used to work in corporate manuf. Wholesalers were paid to keep the supply pipeline healthy and flowing. They should have done what we asked for free but I never heard a complaint from either their Board of Directors who represent stakeholders.

    Ben burn (4f4dda)

  17. Flash from the front: beachhead secure; cutting through hedgerow country.

    On to Paris.
    ___________

    Today’s Beldar the Bitter ‘Watergate, Watergate, Watergate’ Words of Wonder:

    “I don’t give a damn about the publicity. We could, we could rock that through, if we had to let the whole thing hang out. It would be a lousy story for a month. But I can take it. But the point is, I don’t want any criminal liability.” – President Nixon discussing how to avoid culpability if Watergate cover-up is exposed with John Dean and H.R. Haldeman, secret White House Oval Office tapes, March 21, 1973

    DCSCA (797bc0)

  18. Libertarians and Conservatives will NEVER win the healthcare debate until they refute the myth that we rely on doctors and pharma companies to keep us healthy. As long as people believe that sickness is a random menace that only afflicts the unlucky, then, of course, socialized medicine is THE solution. Let me demonstrate:

    Practically no conservative or Libertarian would oppose government-funded ambulance and emergency room services for car accidents, shootings, or other injuries that are mostly random events, where there is almost no individual responsibility that could have avoided the incident.

    However, heart disease, Type 2 diabetes, stroke, dementia, Alzheimer’s, and most cancers are related to nutrition and exercise decisions made by people. Individual behavior can affect the costs of care in these circumstances.

    Our current health compared to 150 years ago is 95% a factor of: public sanitation, purified water, housing, clothing, vaccinations, plentiful food, and a strong system of law and order deterring violence. Hospitals and Pharma are primarily employed to undo the illnesses we create by our own terrible lifestyle choices.

    Socialized medicine will only relieve Americans from assuming individual responsibility for changing their own health outcomes. Socialized medicine is a system that will kill more Americans.

    Shout that from the rooftops. Single-payer, socialized medicine will kill more people than today’s system.

    El Gipper (f1f816)

  19. El crapola..

    Disease and deformity are 99% genetic, not behavior based. You can aggravate inflammation with poor personal care, but how far do you want to take hampering the ‘freebies’of genetic traits and pre-conditions based on your morality play about judgement and body shaming others less fortunate.

    Ben burn (4f4dda)

  20. related to nutrition and exercise decisions made by people.

    To some degree, but far from totally. Genetic dispositions also have an important part to play. And the factors which induce or impede those conditions you name, and similar ones, are not necessarily clear. We have a pretty good idea of what causes strokes and heart attacks. Alzheimer’s,not so much. And some cancers, especially those that seem to come from toxins in the environment, either have no clear linkage or begin from things the individual usually has no idea where in the environment, or had no way of knowing to be carcinogenic. And some can take decades to become apparent (again, Alzheimer’s is a good example. The process starts years before any symptoms appear.)

    kishnevi (bb03e6)

  21. Remember, the Obamacare champions are same people who told us the UK’s National Health was a model for what the US could have:

    “Patients are having to plead with the NHS for hip replacements, cataract surgery and other routine treatments that were once provided without question, an investigation has found.

    There has been a surge in the number of special requests made by doctors on patients’ behalf for procedures to be funded.

    In total, some 73,900 requests were made in 2016/17. Out of these, half were rejected as they were not deemed cost effective or beneficial.

    The total number of requests has increased by 20 per cent in the past year and by almost 50 per cent compared to four years ago. Many were for treatments that were previously routinely available on the NHS, such as hip and knee replacements, cataract surgery, and procedures to repair damaged nerves or varicose veins.

    Those patients whose requests are turned down must decide whether to put up with their pain or pay up to £10,000 to go private.”

    http://www.dailymail.co.uk/health/article-4666028/Patients-forced-beg-NHS-fund-cataract-hip-surgery.html

    harkin (97d6f1)

  22. Ben Burn and Kishnevi are members of the science-denying, non-empirical, empathy-based healthcare policy camp.

    95% of what makes Americans of 2017 healthier than Americans of 1867 has nothing to do with hospitals and medicines. The dollar-weighted cases where medical science makes a difference is not primarily devoted to life- saving surgeries after a car accident, or fixing a birth defect. It is primarily devoted to dealing with morbidity.

    Heart disease, strokes, and type 2 diabetes are definitely related to behavior, not just genetics. When the Soviet Union stopped subsidies to Cuba after 1991, Cubans had to use their bicycles more and curtail their consumption of meat and sugar. The rates of these diseases plummeted. Q.E.D.

    El Gipper (f1f816)

  23. When we can observe that hunter-gatherer tribe members, who have not had contact with “civilization,” do not have diabetes, cancer, heart disease, strokes, Alzheimers, dementia, or tooth decay, then we can reasonably conclude that most of these ailments are caused by our nutritional and exercise choices. Environmental toxins play some small part, too.

    Just be logical folks! Stop believing all the crap these medical-pharma-advocates are pushing on all of us.

    Assume individual responsibility for your health outcomes.

    El Gipper (f1f816)

  24. Disease and deformity are 99% genetic, not behavior based.

    Why bother telling people not to smoke or overeat? Do intravenous drugs or engage in promiscuous sex with multiple partners? That’s ok as long as you have the right genes……

    And the anti-fat shaming people are a hoot. They are actually arguing that obesity is OK, contrary to all evidence.

    harkin (97d6f1)

  25. It was Tory dithering that created the same imbalanced morbidity groups in insurance pools having IEDs like concierge plans like First Class vs Coach cattle. The UK was cuck-slapped as a warning to the rest of the West

    Ben burn (4f4dda)

  26. Medical researches are discovering that excess consumption of short-chain carbohydrate foods (bread, cereal, pasta, sugar, fructose-sweetened foods) over a lifetime create molecules that accumulate in the brain to create conditions leading to dementia and Alzheimers.

    You can define “sugar” as a toxin. Its properties are very similar to alcohol. Both sugar and alcohol must be digested in the liver, not by the stomach, because of their toxic properties. But let’s face it, both are consumed in large quantities by Americans and bad-health apologists like Ben Burn and Kishnevi who are freaked out by the possibility that most Americans don’t need some health-expert bureaucrat writing laws to promote greater health among the population.

    You can tell how correct my propositions are by the inverse relationship of the fear-mongering they will create about my analysis.

    El Gipper (f1f816)

  27. Actually, I belong to the camp that takes its morality from the Bible, and therefore consider it a positive evil that someone might be left to “die on the streets” as Kevin phrased.

    Mind you, a major reason hunter-gatherer populations don’t have many of those diseases is that they tend to die long before they reach the age those diseases usually appear. So you seem to suggest the best model is to be healthy until you die at what we now consider an early age. Or are you just denying science yourself?

    kishnevi (bb03e6)

  28. Inflammation is a leading cause of disease EXACERBATED..not caused by bad behaviors, harkin.

    Ben burn (4f4dda)

  29. This Ted Cruz guy seems smart, understands health care issues, and communicates in complete sentences. He really should have run for president.

    It seems to me that the single biggest problem for those who would deal with Obamacare is the individual mandate. It is wildly unpopular, in isolation, but getting rid of it inevitably leads to CBO projections of “X million fewer people insured”, followed by “millions will die!” rhetoric from the Democrats and low-information voter backlash against moderate Republicans.

    An engaged and credible president could push back and explain that the X million are uninsured because they choose to be, but we don’t have that option. Also recall that Donald Trump ran on universal health coverage (“everybody’s gotta be covered”), and promised that he would negotiate with “existing hospitals” to cover everyone and save untold sums in the process. That, of course, was another lie.

    Unless and until the GOP finds a way to frame the freedom for people who don’t want insurance to decline buying it as a feature, and not a bug, it’s hard to see how repeal of the individual mandate will ever be politically viable.

    Dave (445e97)

  30. You can tell how correct my propositions are by the inverse relationship of the fear-mongering they will create about my analysis.

    Actually I am just pointing out your claims are mostly bovine fecal matter.

    “Healthy lifestyle” is something that science still knows relatively little about,and what we do know makes your claims way overbroad and not supported by the actual evidence. There’s not enough clear evidence, and much too much remains unknown to make any general claim such as you make. Similar to the situation with “climate change”.

    kishnevi (bb03e6)

  31. Explosion of toxins destroys immune system, systemically by killing beneficial microbes in the gut. It seems 95 percent of health is gut related.

    Ben burn (4f4dda)

  32. By toxins I mean those pervasive in air food and water. I don’t think a list is necessary.

    Ben burn (4f4dda)

  33. There is no “be fruitful and multiply and replenish the Earth” a/k/a propagation of the species reason for people to live past forty. But that’s not all we live for. And “bad habits” are part of the quality of life that we want as human beings.

    nk (dbc370)

  34. Our first world health care systems with their insistence on covering “preexisting conditions” together with the welfare state are an interesting breeding experiment, an attempt at reverse eugenics.

    It will end like all attempts to defy nature end – badly.

    Fred Z (05d938)

  35. 26 are you saying Trump is irresponsible in his eating habits but that’s his problem? He can afford to abuse himself so, no problem? He has no responsibility to serve his full term?

    Ben burn (4f4dda)

  36. Fred z. We should thin the Herd to avoid the genetic cul-de-sac in Idiocracy?

    Ben burn (4f4dda)

  37. Ben Burn,

    Seems like alcohol and sugar “toxins” are far more pervasive and likely to affect the gut than whatever is in the air and food. 99.9% of Americans don’t have “toxins” in their water to be worried about.

    There is plenty of actual evidence about the relationship between lifestyle and illness. Post-1991 Cuba is just one example. There are many others. But your theological dogma is held too tightly and is impervious to empirical challenges. Maybe because you are over-weight, or family members have some of these diseases, and it would be too painful to accept this truth.

    I understand.

    NK,

    That sounds wonderful! Bad habits as a part of your quality of life….just pay for your own ailments when they arise. Don’t ask others to pick up the tab for your indulgences.

    El Gipper (f1f816)

  38. The UK Tory bund made their healthcare based on Orwells Animal Farm cuz some animals are more equal than others.

    Ben burn (4f4dda)

  39. .just pay for your own ailments when they arise. Don’t ask others to pick up the tab for your indulgences.

    El Gipper

    Well said. If someone really likes cake, and makes the choice to live their shorter life with the happiness they get from that cake, that seems like freedom. Until they expect society to pay for their increased medical bills. One of the many reasons I do not support these schemes of healthcare from both parties is that it inevitably impacts free choices instead of responsibility.

    Dustin (ba94b2)

  40. So a middle-aged man goes to see his doctor for a physical. After the usual checklist he asks, “Doctor, what are my chances of living to 80?”

    “Well”, says the doctor, “a lot of it has to do with your lifestyle. Tell me, do you smoke?”

    “No”, says the man?

    “Drink?”

    “No”.

    “Do you enjoy lavish meals?”

    “Not particularly”, says the man. “Just simple healthy fare when I’m hungry?”

    “Lot of women, maybe. Sex every day?”

    “Nope.”

    “Hmm. Do you engage in risky activities like motorcycle riding, surfing, mountain climbing, water skiing, skydiving, that kind of stuff?”

    “No, doctor”, says the man. “Nothing like that.”

    “Well”, says the doctor, “what the hell do you want to live to 80 for?”

    nk (dbc370)

  41. I’m not sure what your definitions of toxins are gipper,but there are purposeful chemicals in city water that kill beneficial bacteria in the gut. Yes, sugar fat and salt are all that’s needed in food that is processed. It tastes good!

    Ben burn (4f4dda)

  42. It is an interesting idea that just like the annual review of traffic violations and mileage affects your car insurance premium, an annual weigh-in could raise or lower peoples’ health insurance premiums…

    Dave (445e97)

  43. CNN reporting that Anthony Scaramucci is out as White House Communications Director…

    Dave (445e97)

  44. https://www.globalhealingcenter.com/natural-health/12-toxins-in-your-drinking-water/

    Of course fluoride was laughingly conspiratorial when General Jack Ripper discovered it’s love for our vital bodily fluids, but in fact it is a serious toxin found in nearly every toothpaste.

    Ben burn (4f4dda)

  45. New York Times:

    The decision to remove Mr. Scaramucci, who had boasted about reporting directly to the president not the chief of staff, John F. Kelly, came at Mr. Kelly’s request, the people said. Mr. Kelly made clear to members of the White House staff at a meeting Monday morning that he is in charge.

    Dave (445e97)

  46. 45 – best news on the White House this week.

    Mooch was a horrible choice.

    harkin (97d6f1)

  47. Greetings:

    Me, I’m thinking that this “individual responsibility” sounds like the oppressive white male patriarchy has come up with a brand new brand.

    11B40 (6abb5c)

  48. Mirror-image Scaramouch?

    Harkin: how can you say that when Scary is just a little more loudmouthed than his noss?

    Ben burn (4f4dda)

  49. CNN reporting that Anthony Scaramucci is out as White House Communications Director…

    Dave (445e97) — 7/31/2017 @ 11:52 am

    Wow. That was an expensive weekend for the administration.

    Dustin (ba94b2)

  50. “Of course fluoride was laughingly conspiratorial when General Jack Ripper discovered it’s love for our vital bodily fluids, but in fact it is a serious toxin found in nearly every toothpaste.”

    Sounds like bad science, Portland-style.

    “Without a study to stand on, the main opposition to water fluoridation seems to be political. It is almost understandable that Portland could stand up to health experts and refuse fluoride. Part of the American experiment was letting states decide for themselves what’s best for them and giving citizens the freedom to criticize government action. But the opponents of water fluoridation are boxing with a ghost. There are no known victims of water fluoridation. There are no cities receiving a toxic concentration of the ion. Water fluoridation isn’t just the addition of fluoride; it’s the regulation of fluoride in the water supply. The ion occurs naturally in ground water in varying levels, some that are in fact too high. When this is the case fluoride is actually removed from the water to get the greatest benefit. Arguing against having a regulated supply of fluoride in your water is like an anemic refusing to take iron supplements. The doctor isn’t trying to add enough iron to your blood so that Magneto could pull it out; she is trying make sure the levels in your blood are right for health.”

    https://blogs.scientificamerican.com/but-not-simpler/why-portland-is-wrong-about-water-fluoridation/

    harkin (97d6f1)

  51. 49 – I can say that about Mooch and not The Don (pun intended) because removing one is no big deal and removing the other would mean a constitutional crisis.

    Kelly’s already having a positive effect. Hope it continues.

    harkin (97d6f1)

  52. On the other hand, Scaramucci was saying that members of the Trump administration would be executed years ago for their leaking. It’s kinda hard to work for a boss who wants to kill you.

    That’s one of the many amazing things about Trump. He demands a lot of loyalty, but he has no sense of loyalty to anyone who isn’t related to him. He’s a weak leader, and that’s why there’s so much more chaos and turnover in the Trump administration than in any other modern administration.

    I’ll agree that if Kelly made this request it was a reasonable one, but firing someone you just hired also proves that the administration is making very poor decisions. I don’t want these same guys deciding whether or not to nuke North Korea. You can’t take back every drunken Friday decision the coming sober Monday.

    Dustin (ba94b2)

  53. Sean Spicer issues a statement on the Scaramucci firing…

    Dave (445e97)

  54. The message that the ordinary person hears is: “Go ahead and wait until you are sick to buy health insurance.”

    technically what they hear is they have to pay a penalty if they don’t.

    Also there is a limited open enrollment period.

    Now if you think it is agood idea for people to buy health insurance who have a low risk, that is wrong, at least with a low deductible. They will use up more medical resouirces that way or be used.

    If the aim is that everybody should get care and doctors and hospitals should get paid, using the insurance system is only away to waste money with unnecessary care, and averyregressive method of payment. There can’t be anything more regressive than charging everyone the same flat fee regardless of income or resources.

    This concept has been a disaster that has caused premiums to skyrocket, wreaking havoc all over the country.

    No, taht;s not why premiums have skyrocketed. If medical care cost less most people would buy insurance even if is a losing proposition acturally. Premiums have skyrocketed because costs have skyrocketed because nobody cares about costs – there is no great price resistance. Medical centers advertise but they never advertise about price, just maybe that they take all insurance. There won’t be price competition until nobody has to go looking for lower costs – lower costs go looking for them, at least to some degree. (the cheapest places rely on word of mouth and proximity to a medical center, and won’t advertise, and quality is extremely important too)

    By the way, Medicaid is a form of insurance that is retroactive

    Obamacare won’t work because medical prices are just too high. There’s no point in asking people to pay for it. If you tru, more people will go without insurance, and bills will handled partly by people selling, doctros and hospitals aoffering settlement agreements, and also not getting paid. the worst problem is people postponing checking into things because they have no insurance or because the deductible is too high. By the way I consider is completely backward to give no co-ays for routine wellness exams but co-pays for emergecnies or unscheduled appointments. It should be the other way around. If that means people cut down on doctor visits to update records or renew prescriptions: Good!

    Sammy Finkelman (02a146)

  55. Maybe an idea would be that no annual deductible can be higher than 5% of the annual premium (and even then can be paid out over a 2-3 year period)

    OR

    No premium can be more than 5% of the deductible.

    But both cannot be high.

    There is very very much wrong with medical billing.

    Sammy Finkelman (02a146)

  56. The Cruz solution sounds like COBRA forever. It would help some people. It would also raaise premiums for the others, of course.

    Sammy Finkelman (02a146)

  57. 13. Ben burn (4f4dda) — 7/31/2017 @ 9:53 am

    With the HUGE potential savings on auto insurance, and the not-all-that-much-higher taxes that many Europeans pay, it seems like this could be an important factor in persuading people about the benefits of single-payer health care.

    The United States wouldn’t have single payer. It would have Medicare for all. Medicare does not pay for things that other insurance covers. Auto insurance would continue to pay for people hit by cars. All projections of costs for single payer probably assume so.

    Also this wouldn’t save too much as a lot of the payment is for “pain and suffering” and economic damage (loss of wages and income)

    Sammy Finkelman (02a146)

  58. “There are no known victims of water fluoridation. ”

    The semantics of the word ‘TOXIC’ are in play here. They establish ‘safe’ levels of tolerance for neurotoxin based on averages within the population. We know certain haplogroups are more sensitive to say mercury poisoning, as an extreme example of neurotoxicity. But I hope you aren’t saying neurotoxin can be called safe.

    Ben burn (4f4dda)

  59. Breaking news–The Mooch has screwed the pooch; Kelly fired Scaramucci ‘escorted’ off WH grounds.

    “I gotta biggggg mouth!” – Ralph Kramden [Jackie Gleason] ‘The Honeymooners’

    DCSCA (797bc0)

  60. 14. nk (dbc370) — 7/31/2017 @ 10:03 am

    That’s why they got the state legislatures to pass mandatory car insurance — lots and lots of good drivers paying for a few bad drivers; and they got Congress to enact the Obamacare mandate — lots and lots of healthy people paying for a few sick people.

    Two government “solutions” to the problem of keeping insurance companies profitable.

    Not really insurance companies.

    It’s to assure that liabilities can be paid. The nebeficiaries are not insurance companies. They are trial lawyers and hospitals.

    Car insurance ensures that settlements won by lawyers can be collected; medical insurance ensures that dooctors and especially hospitals will be paid. Medical ethics and sometimes law precludes not treating people.

    Sammy Finkelman (02a146)

  61. Sammy: see link @ 15

    Ben burn (4f4dda)

  62. I wonder if Kelly already mad as Hell after Comey was fired, told Trump in no uncertain terms that only the General will be in charge in the WH so “STFU! MR PRESIDENT!”

    Ben burn (4f4dda)

  63. 11 days.

    WH sez Scaramucci wanted to give Kelly the chance to “build his own team.”

    ROFLMAOPIP.

    Somebody should quote Scaramucci back to himself on that shovelful.

    “Expletes deleted” – insertion for profanity, Nixon WH tape transcripts.

    DCSCA (797bc0)

  64. Sean? Sean!? SEAN!?

    “Shane! Shane! Come back, Shane!” – ‘Shane’ 1953

    DCSCA (797bc0)

  65. 63. I see there’s an argument that people won’t cost shift some medical costs to car insurance, but the effect won’t be all that great.

    The link says:

    Health insurance does not substitute for auto insurance; the auto companies pay first before health insurance kicks in – at least that is the current practice.

    That can be expected to stay the same unless somebody deliberately changes it.

    Sammy Finkelman (02a146)

  66. 60 – “But I hope you aren’t saying neurotoxin can be called safe.”

    I didn’t see where the Scientific American article I linked made that claim at all.

    If you read the next five or six sentences after the one you quoted, you may begin to understand exactly what they are saying.

    harkin (97d6f1)

  67. The Cruz plan sounds great but given the state of play in the Senate there’s little hope for passage. Repeal’s done. Repeal and replace with market reform is done. Like it or not the real problem is there is a bipartisan majority that wants to fix it and make it work which is just a vote away from Medicare for all ages and disabilities when the complexities of fixing it fail to lower cost or price.

    It took decades for the left to gradually nationalize medical care for seniors, chronically disabled, veterans and the indigent. They finally captured the rest with Obamacare with the complete support of the insurance companies who either write the policies or process claims for these programs and they’re just not gonna let go. So let’s just pry their grip open a bit.

    Rather than fight over taking the safety net away it’s time to chip away at these programs and infect each of them with market-based alternatives for those who want more freedom of choice. Obama escaped accountability for the Obamacare problems by waiving, delaying or ignoring the requirements of PPACA. It’s time to enforce them. How else can you bring the bipartisan supporters, insurance companies and medical providers to the table to give up their lifelong dream of total control?

    crazy (11d38b)

  68. Dustin

    If you don’t sell that fat gay guy his cake there’s going to be hell to pay.

    Pinandpuller (ea25a3)

  69. It’s estimated at 2 percent but it could be more if the secondary insurer when two spouses employed in different companies waive co-pay or percentage, but cooperate to keep costs down.

    Making healthcare fail is not a worthy objective if one’s objection is colored by past thinking. It’s time to work to make it work. Openness to new ideas helps.

    Ben burn (4f4dda)

  70. What is estimated at 2%?

    Sammy Finkelman (02a146)

  71. I’d like to know what you..are saying. Is fluoride toxic?

    Ben burn (4f4dda)

  72. You said it might not save much…I said 2%…. forget the rest except this one thing….try to think of ways to make SP (single payer) work..its coming.

    Ben burn (4f4dda)

  73. For a free market solution how about we stop subsidizing commodities based on 1930’s logic? Sugar, corn, milk….

    Pinandpuller (ea25a3)

  74. Seven years to prepare a repeal and replace plan; last minute meetings w/o including women and the final skinny inked on a napkin at lunch.

    Conservatives said no to Social Security.
    Conservatives said no to Medicare.
    Conservatives said no Obamacare.
    Conservatives have no solution but no.

    The solution is to say no to conservatives.

    DCSCA (797bc0)

  75. Healthcare is the ideal public need that is best addressed by centralization.

    Unless you stipulate each state have it’s own Pentagon.

    Ben burn (4f4dda)

  76. How about we stop funneling kids whose parents can afford it into crummy school cafeteria food like Temple Grandin?

    Pinandpuller (ea25a3)

  77. I’ll give the Trump admin this much: they did clearly make a mistake with Scaramucci. They could have saved face by putting him under a bunch of restrictions, but this would have failed. The best thing they could do today is just peel the bandaid off fast, and that’s what they did. Good response to a bad decision, at least.

    Also, it will take attention away from whatever else is going on. I assume that was part of the intention if they did this on a Monday.

    Dustin (ba94b2)

  78. How about we stop funneling kids whose parents can afford it into crummy school cafeteria food like Temple Grandin?

    Pinandpuller (ea25a3) — 7/31/2017 @ 1:14 pm

    No kidding. I understand the idea that it’s better to scale out the food to save money, but it doesn’t ever really work this way. Truth is that mom or dad making a sack lunch is a valuable part of parenting and childhood. It’s a valuable part of learning personal responsibility and about dieting. Some leftovers from last night? Cool.

    Instead we put them on an assembly line where they get mediocre food, but with the government seal of approval.

    Mom and dad don’t want to put a sack together for you? Well that’s a shame, but you might as well pick up the slack, son, because that’s the hand you’ve been dealt. Fair? More fair than hiding reality from you until it’s too late. Folks too poor? Ok, we’ll buy you a couple of meals, but something tells me a lot of this is the same damn roll of dependency we’ve been on with Obamaphones and food stamps.

    Dustin (ba94b2)

  79. Laugh all you want about Michelle Obamas health dictatorship…she moved the Army into believing.

    Sweets, fatty foods are verboten @ Boot. Drill Sergeants enforce with alacrity not just because of regulations, but because they’ve seen a vast improvement in their results. HUZZZAAAAAHHHH!

    Ben burn (4f4dda)

  80. What’ve you got against Temple Grandin? Outstanding citizen…

    Ben burn (4f4dda)

  81. Green Stamps revisited. Every 10 cases of Bud Lite gets you a free paracentesis.

    Pinandpuller (ea25a3)

  82. Unless you stipulate each state have it’s own Pentagon.

    Considering that was the original idea….
    aka militia under command of the state governor.
    Yet one more idea that died in 1861 (although it was already dying by the time of the Mexican War).

    kishnevi (e93d54)

  83. I don’t remember the last time anyone mentioned Green Stamps!
    P&P, was your mother like mine, making you paste on the newest bunch of stamps after every grocery trip?

    kishnevi (e93d54)

  84. Ben, what are you talking about? You think it was Michelle Obama who figured out that sweets are bad for you? I was in the military decades before her and I can assure you my drill sergeants did not hear about this from her.

    Dustin (ba94b2)

  85. What branch dustin?

    Ben burn (4f4dda)

  86. You comment then ‘book’?

    Ben burn (4f4dda)

  87. I do agree that we cannot let people buy insurance the afternoon after they lay down their motorcycle on the 110. All the medical and insurance people in my family say that hospitals and doctors spend a huge amount of money on a very small number of patients, so they negotiate with carriers all the time for patients like that.

    A friend of mine didn’t want to by insurance because only $50,000 would be covered for cancer care, but my BIL in group health said, do it, any reputable hospital will take that rather than nothing.

    So maybe every should have to buy major medical, but how could we do that in a way that is not coercive?

    Patricia (5fc097)

  88. Ben Burn: No we do not thin the herd, we let the herd thin itself. Or maybe not, because there is also the argument that we evolve as a herd and possibly looking after apparently weak and useless people helps the herd survive.

    I dunno, but I see politicians fooling around with incentives affecting survival and breeding and fear the result. Who wouldn’t? Politicians are too often malevolent, low IQ, sociopaths.

    Fred Z (05d938)

  89. @92. “He was joking.” – WH Press Secretary Sarah Huckleberry Hound, 7/31/17

    DCSCA (797bc0)

  90. Of course fluoride is toxic!
    .
    .
    .
    In heavy concentration — just like many other chemicals.

    Icy (0ffc83)

  91. fluoride is good for your teeth it helps keep them strong for so you can eat lots of candy

    iced tea has gobs of it – naturally!

    and that is the story about fluoride

    happyfeet (28a91b)

  92. OK. Regs are different for each branch of Mils. Marines/Navy have separate mess for enlisted versus officers, and charge for quarters as opposed to Army. The fat/sugar reduction is new an Marines were still bulking recruits on that gare in 2007. Don’t know for sure at present.

    Ben burn (4f4dda)

  93. “Politicians are too often malevolent, low IQ, sociopaths..”

    Are they the best we Americans have to offer or is there disincentives for more qualified people?

    Ben burn (4f4dda)

  94. @81 Ben Burn

    Michelle O’s message would have been received better had she swallowed her French fries first.

    Pinandpuller (ea25a3)

  95. Apparently when you join the Trump WH staff you’re issued credentials, a building pass and a light saber.

    DCSCA (797bc0)

  96. The Mooch…the Mooch…the Mooch has been fired…

    WE DON’T NEED NO WATER.

    Demosthenes (09f714)

  97. @82 Ben Burn

    Temple Grandin proposed calmly marching feed lot cows to slaughter. Thus the comparison to government school cafeterias.

    Pinandpuller (ea25a3)

  98. @85 kishnevi

    More of a grandma thing.

    I am old enough to remember a real Kmart blue light special where they rolled out the cart

    Pinandpuller (ea25a3)

  99. Pin: Quite the contrary.

    Grandin, in autistic high function, focused on the fundamentals.

    She saw animals grown for food (“If we didn’t eat them, they would only exist in zoos”)

    She saw cruelty and eco nomic inefficiency in cattle pens. She designed, sold and convinced hardened cattle to listen to a woman in matters strictly masculine.

    Revolutionized the beef processing industry.

    The other motivation..?…”We raise them for food and our continued survival…the least we can do is respect their sacrifice and end their lives with compassion ” or words to that effect.

    Ben burn (4f4dda)

  100. Sheesh..’convinced hardened cattlemen..’

    FU captcha.

    Ben burn (4f4dda)

  101. Whoops Bartman

    harkin (97d6f1)

  102. WaPO breaking news: President Trump personally dictated misleading statement on son Don Jr’s, ‘Russia’ meeting.

    https://twitter.com/washingtonpost/statuses/892170318529404931

    DCSCA (797bc0)

  103. Further, Scary seems to have brought his designated hitter role to a conclusion..

    I thought Trump was jeeneous people pusher who is best when he says FIRED!.

    But the guy can’t handle Priebus? What is he good for?

    Ben burn (4f4dda)

  104. Teh Bench is getting thin.

    Ben burn (4f4dda)

  105. Teh Bench is getting thin.

    Are they saving Hannity for the start of impeachment hearings?

    Dave (445e97)

  106. mooch has a new book coming out titled “In a N.Y. minute”

    mg (31009b)

  107. Dave: I look forward to seeing Jerry Mahoney on Trumps knee.

    I expect to see his lips move..

    Donalds, that is.

    Ben burn (4f4dda)

  108. Breaking: “John Miller” rumored as next White House Communication Director

    Dave (445e97)

  109. Dennis Miller would be my choice

    mg (31009b)

  110. Burnie and ASPCA really do think there’s such a thing as a free lunch. They just think free means the rest of you saps pay till you’re bankrupt.

    NJRob (8efab2)

  111. @115 – Well, aren’t you quite the wit, Dave! Good one!

    Q! (267694)

  112. Way up top of the comment thread someone mentioned that car insurance is there to pay for the medical of the person you hit.

    Not so much.

    My daughter got broadsided by a lady who ran a red light. Had a witness and the lady got a ticket and even went to court where the court said, sorry lady, you ran the light the ticket stays on your record (it was not her first and points on her license were at issue). My daughter’s car was totaled, every air bag deployed. Her two children were in the back seat properly belted in but sustained some injuries. The lady who hit her got in the ambulance and departed before the cops got on the scene for the hospital (she was not injured it turned out). We drove my daughter and grandchildren to the hospital. Many hours later they departed with a $83,000 medical bill. There have been no extended treatments or other bills, just the emergency room and treatment for the night of the accident. (no claiming whiplash 10 months later etc) And nobody will pay it. The lady’s insurance paid for the car replacement but said no to the medical. Why? They just don’t want to pay it. My daughter’s insurance says no, it’s the other companies issue and you talked to them so we aren’t handling the case (um, they TOLD my daughter to talk to them… lesson learned, never talk to the other company yourself). Health insurance says nope, it was due to a car accident and it isn’t our issue. So now 18 months later she’s working through a lawyer to try and get it settled. All she wanted was her bills paid and they’ve made it a miserable experience. They came back with an offer of $17,000. Really, with $83K in bills you think she will take $17K? So now she’s in collections and getting tons of mean calls. The lawyer is working on it but says they’ve never hit such a brick wall. And this is a major national company that says you’re in good hands. Right…. I don’t think so.

    I’m of the opinion insurance is one huge scam. It’s really based on fear.

    As far as health insurance… I have issues with people who think that insurance should pay for everything. Years ago insurance was for catastrophic illness, not for regular check-ups but I have to admit that today with the collusion (it’s really the Russians doing this you know) between insurance, drug companies and providers the cost is so high nobody can do the regular stuff without insurance. Even a common cold can become catastrophic in costs.

    Marci (e5bb26)

  113. @46 Ben burn (4f4dda) — 7/31/2017 @ 11:55 am

    The article you linked cites an article published in the Lancet as its basis for the claim. The Lancet article says exactly and only this concerning fluoride:

    A meta-analysis of 27 cross-sectional studies of children exposed to fluoride in drinking water, mainly from China, suggests an average IQ decrement of about seven points in children exposed to raised fluoride concentrations.44 Confounding from other substances seemed unlikely in most of these studies. Further characterisation of the dose–response association would be desirable.

    The cited article in the Lancet article is a Harvard study published in Environmental Health Perspectives.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/

    I’m not a huge fan of Snopes, but they give a good analysis of the Harvard study (and your claims) here:

    http://www.snopes.com/water-fluoridation-reduces-iq/

    Always closely examine claims based on meta-analysis.

    And, toxicity is meaningless unless qualified by dose.

    JoeH (f94276)

  114. I managed to foul up the nih.gov link above. Here is the correct link.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/

    JoeH (f94276)

  115. That is how they can charge $45 for an aspirin

    They charge a lot for “an aspirin” because they have to do a lot of things that an individual would not normally do. They have to:

    Record which bottle, from which lot, the aspirin was retrieved, and when and by whom.
    Record who gave the patient the aspirin, and when.
    Sign off that they checked all relevant patient history.
    Show that they checked on the patient afterwards (who/when) in case of adverse reaction.
    Get all this information into a database.

    Why do they do all this? Because if the patient croaks after getting the aspirin, and a lawyer asks about ANY of this, “I dunno” isn’t a good answer.

    This kind of documentation costs money.

    Kevin M (752a26)


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