Patterico's Pontifications

5/8/2017

Justin Amash on the AHCA

Filed under: General — Patterico @ 7:32 am



The bottom line: it’s better than ObamaCare, but only marginally so — and does not end the tinkering with the free market that is ObamaCare’s Achilles heel.

This is not the bill we promised the American people. For the past seven years, Republicans have run for Congress on a commitment to repeal Obamacare. But it is increasingly clear that a bill to repeal Obamacare will not come to the floor in this Congress or in the foreseeable future.

When Republican leaders first unveiled the American Health Care Act, a Democratic friend and colleague joked to me that the bill wasn’t a new health care proposal; it was plagiarism. He was right.

The AHCA repeals fewer than 10 percent of the provisions in the Affordable Care Act. It is an amendment to the ACA that deliberately maintains Obamacare’s framework. It reformulates but keeps tax credits to subsidize premiums. Instead of an individual mandate to purchase insurance, it mandates a premium surcharge of 30 percent for one year following a lapse of coverage. And the bill continues to preserve coverage for dependents up to age 26 and people with pre-existing conditions.

I want to emphasize that last point. The bill does not change the ACA’s federal requirements on guaranteed issue (prohibition on policy denial), essential health benefits (minimum coverage), or community rating (prohibition on pricing based on health status). In short, Obamacare’s pre-existing conditions provisions are retained.

The latest version of the AHCA does allow any state to seek a waiver from certain insurance mandates, but such waivers are limited in scope. Guaranteed issue cannot be waived. Nobody can be treated differently based on gender. And any person who has continuous coverage—no lapse for more than 62 days—cannot be charged more regardless of health status.

Consider what this means: Even in a state that waives as much as possible, a person with a pre-existing condition cannot be prevented from purchasing insurance at the same rate as a healthy person. The only requirement is that the person with the pre-existing condition get coverage—any insurer, any plan—within 62 days of losing any prior coverage.

If a person chooses not to get coverage within 62 days, then that person can be charged more (or less) based on health status for up to one year, but only (1) in lieu of the 30 percent penalty (see above), (2) if the person lives in a state that has established a program to assist individuals with pre-existing conditions, and (3) if that state has sought and obtained the relevant waiver. Here in Michigan, our Republican governor has already stated he won’t seek such a waiver, according to reports.

So why are both parties exaggerating the effects of this bill? For President Trump and congressional Republicans, the reason is obvious: They have long vowed to repeal (and replace) Obamacare, and their base expects them to get it done. For congressional Democrats, it’s an opportunity to scare and energize their base in anticipation of 2018. Neither side wants to present the AHCA for what it is—a more limited proposal to rework and reframe parts of the ACA, for better or for worse.

In March, when this bill was originally scheduled to come to the floor, it was certainly “for worse.” The previous version provided few clear advantages over the ACA, yet it haphazardly added provisions to modify essential health benefits without modifying community rating—placing the sickest and most vulnerable at greater risk.

Over the last month, several small but important changes were made to the bill. The current version abandons that fatally flawed approach to essential health benefits (though the new approach includes new flaws), incorporates an invisible risk sharing program, and permits limited state waivers. These changes may slightly bring down (or at least slow down the increase in) premiums for people who have seen rates go up. Even so, the AHCA becomes only marginally better than the ACA.

Many have questioned the process that led up to the vote on May 4. I have publicly expressed my disgust with it. The House again operated in top-down fashion rather than as a deliberative body that respects the diversity of its membership. But it’s important to acknowledge that the bulk of this bill (123 pages) was released on March 6. Only about 15 pages were added after late March. Members of Congress were given sufficient time to read and understand the entire bill.

While an earlier version of the AHCA included a CBO score, the types of changes made to the AHCA in more recent stages render an updated score highly speculative and practically meaningless. For that score to be useful, the Congressional Budget Office would have to effectively predict which states will seek waivers, which waivers they will seek, and when they will seek them. This complex analysis of the political processes and choices of every state is beyond anyone’s capability. I weighed the lack of an updated score accordingly.

When deciding whether to support a bill, I ask myself whether the bill improves upon existing law, not whether I would advocate for the policy or program if I were starting with a blank slate. In other words, the proper analysis is not whether it makes the law good but rather whether it makes the law better. In this case, I felt comfortable advancing the bill to the Senate as a marginal improvement to the ACA. The House has voted more than 30 times to amend (not just repeal) Obamacare since I’ve been in Congress, and I have supported much of that legislation, too, on the principle of incrementalism. If it advances liberty even a little (on net), then I’m a yes.

Nonetheless, the ACA will continue to drive up the cost of health insurance—while bolstering the largest insurance companies—and the modifications contained in the AHCA cannot save it. Many of the AHCA’s provisions are poorly conceived or improperly implemented. At best, it will make Obamacare less bad.

The Framers of the Constitution understood that federalism—the division of powers between the national and state governments—would maximize the happiness of Americans. As long as Washington dictates health insurance policy to the entire country, there will be massive tension and displeasure with the system. I’ve always said, and I will continue to say, we need to start over: Fully repeal Obamacare, let the people of each state choose their own approach, and work together in a nonpartisan manner.

Yup. That would be the sane policy. But in a country where people write pieces titled A conservative case for single-payer health care (coming next: “A conservative case for socialism”), the prospects for sane policy are poor indeed.

[Cross-posted at The Jury Talks Back.]

79 Responses to “Justin Amash on the AHCA”

  1. Posting from me will continue to be light for a while. For the next several weeks, probably. Thanks to the guest posters as always for keeping the place alive.

    Patterico (115b1f)

  2. Republicans lied about wanting to repeal obamacare.

    This is who they are.

    happyfeet (28a91b)

  3. Not only is this not the bill that they promised the American people, it is a bill that they promised members of Congress would never become law.

    I say, if that is so, and it is, Paul Ryan should have brought to the floor a bill where that was even more obvious. They should have included numerous contradictpry provisions, or something lik a massive tax increase, and thrown every idea that been tossed around into the bill, and every funding mechanism, so it would be available in conference.

    This bill was drafted so it would fit under the reconciliation rules of the Senate, and I suppose the intent is to write the real bill in the conference committee. What I don’t know is, if bills written in conference are exempt from a filibuster in the Senate. Probably not, but I suppose Mitch McConnell can change the rules again.

    Sammy Finkelman (5818f3)

  4. If “essential” health benefits as mandated by the federal government are absolutely necessary to avoid cataclysmic mass dealth, how did we survive pre-2010?

    Colonel Haiku (92ce59)

  5. Guaranteed issue at the same price can be waived. Does Amash really want people to be denied insurance under any terms whatsoever? Not even a million dollar a year deductible or premium?

    Some states do not allow discrimination in terms because of pre-existing condirions. New York State does not even allow discrimination by age. (which is, after all, a pre-existing condition0

    Sammy Finkelman (5818f3)

  6. From Americans For Tax Reform…

    The American Health Care Act (HR 1628) passed by the House today reduces taxes on the American people by over $1 trillion. The bill abolishes the following taxes imposed by Obama and the Democrat party in 2010 as part of Obamacare:
    -Abolishes the Obamacare Individual Mandate Tax which hits 8 million Americans each year.
    -Abolishes the Obamacare Employer Mandate Tax. Together with repeal of the Individual Mandate Tax repeal this is a $270 billion tax cut.
    -Abolishes Obamacare’s Medicine Cabinet Tax which hits 20 million Americans with Health Savings Accounts and 30 million Americans with Flexible Spending Accounts. This is a $6 billion tax cut.
    -Abolishes Obamacare’s Flexible Spending Account tax on 30 million Americans. This is a $20 billion tax cut.
    -Abolishes Obamacare’s Chronic Care Tax on 10 million Americans with high out of pocket medical expenses. This is a $126 billion tax cut.
    -Abolishes Obamacare’s HSA withdrawal tax. This is a $100 million tax cut.
    -Abolishes Obamacare’s 10% excise tax on small businesses with indoor tanning services. This is a $600 million tax cut.
    -Abolishes the Obamacare health insurance tax. This is a $145 billion tax cut.
    -Abolishes the Obamacare 3.8% surtax on investment income. This is a $172 billion tax cut.
    -Abolishes the Obamacare medical device tax. This is a $20 billion tax cut.
    -Abolishes the Obamacare tax on prescription medicine. This is a $28 billion tax cut.
    -Abolishes the Obamacare tax on retiree prescription drug coverage. This is a $2 billion tax cut.
    As a presidential candidate in 2008, Barack Obama had promised repeatedly that he would not raise any tax on any American earning less than $250,000 per year. He broke the promise when he signed Obamacare. With the passage of the House GOP bill, tens of millions of middle income Americans will get tax relief from Obamacare’s long list of tax hikes.

    Read more: http://www.atr.org/list-obamacare-taxes-repealed#ixzz4gV13i2G2
    Follow us: @taxreformer on Twitter

    Colonel Haiku (92ce59)

  7. Greetings:

    Back in my Public Administration studying daze, this was referred to as “Incrementalism versus Fundamentalism”. It’s nice to see someone kept his old textbooks.

    11B40 (6abb5c)

  8. Sigh. Give a lollypop to a toddler and then try to take it back. Just try it. I dare you. I double dare you.

    nk (dbc370)

  9. Fedcare in any form suffers from the same demographic destiny facing Medicare and Social Security. There simply aren’t enough “other people” to keep each person’s share low enough for them to join voluntarily. We all know what should be done. The problem is how to get the swamprats to do it. Without a straight repeal of the ACA as of a couple years down the road there is no incentive for the bipartisan wrangling keeping the republican infighting front and center on the road to nowhere.

    crazy (d3b449)

  10. Does Amash really want people to be denied insurance under any terms whatsoever?

    “Insurance” for those with pre-existing conditions that would make them uninsurable in a free market system, is not insurance.

    Serious pre-existing conditions should be dealt with in a separate system. The French cover the condition separately, but the patient uses the normal system for other diagnoses. Personally, I would suggest Medicaid,perhaps with some augmentation.

    The two options that I think are most reasonable are one; Catastrophic insurance plus HSAs. Pay cash for routine care.

    The other option, and more realistic politically, would be a variation of the French system which I favor, in which everybody gets a basic reimbursement for medical care AFTER paying the bill, but they are allowed to pay more than the fixed fee schedule that determines reimbursement.

    That would restore a semi-free market but those who could not, or did not want to pay market prices, would have an option like Medicaid.

    It worked pretty well in France until the French economy has gotten so bad that payroll deduction cannot pay the whole cost, They have had to dip into tax revenue more and more. In our economy, payroll deduction could probably pay the whole bill.

    The problem, as Instapundit always says, may be that there is not enough graft available.

    Mike K (f469ea)

  11. Mike K’s proposals make too much sense for Congress to act on just as The Bill to Permanently Fix Healthcare for All and its implementation timeline is far too simple and far too graft-free for Congress to consider. But we can dream…

    crazy (d3b449)

  12. Thank you, Patterico, for your post.

    And thank you, Dr. K., for actually using your knowledge to respond to this, instead of sloganeering.

    Simon Jester (c8876d)

  13. These rich people out there stumping for single payer should cull their resources for the pre-existing, let the rest of us have the free market.

    JH (1fc204)

  14. There’s a good argument that medical insurance is too big a business to be regulated state-by-state.

    * Drugs, an obvious case of interstate commerce.
    * Major medical expenses (i.e. actual insurance claims), where people may travel for the best care.
    * People travel much more and may need medical attention while away.
    * Those tiny east coast states where people live and work in different states.

    It really hasn’t worked all that well anyway, state-by-state.

    Kevin M (25bbee)

  15. Well let’s try it anyways, we’ve been under mccarren/ferguson for 70 years.

    narciso (916136)

  16. #6:

    It also abolishes the welfare trap on the tax credits by phasing the credit out rather than cutting it off abruptly. The rapid rise in premiums under Obamacare made it so many older Americans had an effective income cap, where making one dollar more cost them as much as $10,000 in tax credits.

    Tax policy should never influence actions to that extent.

    Kevin M (25bbee)

  17. I sure would like people to identify whether they’ve ever BEEN in the individual policy market, which is massively different than a group plan. Frankly, people who haven’t don’t know jack. Every discussion I’ve ever had on Obamacare makes this incredibly clear.

    Kevin M (25bbee)

  18. Well let’s try it anyways, we’ve been under mccarren/ferguson for 70 years.

    McCarren-Ferguson PUT the regulation at the state level.

    Kevin M (25bbee)

  19. This can only get worse.

    mg (31009b)

  20. I was on private insurance, on and off for ten years, between getting out of law school and getting married. I was paying a $1,000 a year with a $1,000 deductible. Hospitalization insurance. No doctor’s visits, no reconstructive surgery, no dental. I can’t tell you if I had maternity coverage, the subject never came up. 😉

    nk (dbc370)

  21. The real story about the ACA is, as happy pointed out, the serial lying by those Republican Congressmen who previously voted for repeal. Given their unreliable history, I guess it should have come as no surprise that the obstacle to repeal, and a conservative agenda more generally, are Republicans in Congress. The best news to come out of the repeal/ replace process is that when RyanCare failed, President Trump turned to Mark Meadows and the Freedom Caucus for help. That reflex should please us all.

    To think, I, among others, thought it was going to be Trump who would sell out Republican voters. Live and learn.

    Today’s good news – I try to focus on the good news – is that Trump is about to nominate a slate of principled conservative jurists to the federal courts. Conservative jurists are the gift that keeps on giving.

    ThOR (c9324e)

  22. I had paid individual market for my daughter after i became Medicare eligible. I think her premiums were about $66 a month until suddenly they had to include maternity, maybe when she turned 18 or something. Then it was about $166 a month. After she graduated she got a job with full benefits. She quit that and moved to South Carolina and probably did not get insurance because of Obamacare. I’m not sure about now.

    What really depressed me was back in 1995, after the GOP took Congress, I was just finishing a Masters in health policy at Dartmouth and I got interested in trying to do something with the new majority. The Dartmouth people had been involved with Hillarycare and, like most academics, were lefties. I had retired from practice after back surgery and had been interested in health policy for years. I got some help from Senator Gregg and went to DC to talk to the people involved. I was willing to spend a year working for nothing just to help.

    I was told no thanks. Any health policy legislation would be written by tax lawyers. They were not interested in medical input. The present bill is written the same way. It is all about tax policy. Look at comment #6 above.

    Mike K (f469ea)

  23. {{{{{TORT REFORM}}}}}

    mg (31009b)

  24. We miss you, Pat!

    ThOR (c9324e)

  25. While an earlier version of the AHCA included a CBO score, the types of changes made to the AHCA in more recent stages render an updated score highly speculative and practically meaningless. For that score to be useful, the Congressional Budget Office would have to effectively predict which states will seek waivers, which waivers they will seek, and when they will seek them. This complex analysis of the political processes and choices of every state is beyond anyone’s capability. I weighed the lack of an updated score accordingly.

    disingenuous.

    happyfeet (28a91b)

  26. Here’s a better plan.

    David Aitken (e0d788)

  27. Some states do not allow discrimination in terms because of pre-existing condirions. New York State does not even allow discrimination by age. (which is, after all, a pre-existing condition0
    Sammy Finkelman

    Pre-existing conditions and age are not “discrimination” in insurance parlance, Sammy. They are risk assessments. Only leftist lawyers ignore this. And they do it to deliberately harm the insurance industry and thus to harm the Freedoms Americans have. Again, insurance does not cover existing claims, a patron does.

    Rev.Hoagie® (630eca)

  28. I looked at that “better plan.”

    All surgical providers of any sort must publish de-identified procedure counts and account for all complications and outcomes, updated no less often than monthly. Consumers must be able to shop not only on price, but also on outcomes. Because outcome odds do vary with the seriousness of the presented case providers may classify severity as well provided it can be done in an objective way.

    I went to Dartmouth specifically to study how to measure quality in medical care, especially surgery, I think I learned how to do it but no one was interested, least of all insurance companies or the government.

    Trying to enforce some sort of punishment based on outcomes is VERY problematic. It is an excellent way to stop a lot of doctors, especially surgeons, from taking on tough cases.

    In my research on this complicated topic I ran across a rather amusing example.

    Two hospitals in Philadelphia did heart surgery. One hospital had inferior results. The hospital dismissed the team of heart surgeons they had been using and hired another group from a hospital with better results. The other hospital hired the group fired by the first hospital. Thus, the two hospitals switched heart surgery groups.

    Both hospitals saw their results improve.

    Explain that one.

    One possible explanation was published in the study I read.

    One hospital had better surgeons but poor pre and postop support. The other hospital had excellent pre and postop support but the surgeons were weak.

    The weak surgeons got better results with the better pre and postop care.

    The weak hospital got better results with better surgeons.

    When I was at Dartmouth, the Dartmouth hospital got dinged by Medicare for less than optimal results in heart surgery.

    One of the guys there, Gerry O’Conner started a study group to try to improve results and they found that, by cooperative analysis of their procedures, not just the surgery, they improved outcomes significantly.

    It’s a very complicated process. I went there to learn how to do it and found, when I finished, that no one was interested outside of a few academic centers. They all assumed better quality would cost more. I tried at UC, Irvine to do a study proving better quality was not more expensive but was thwarted, not by the docs who were enthusiastic, by by administrators.

    If anyone is interested, one of the proposals can be read here.

    Mike K (f469ea)

  29. I should add that the study linked above preceded Medicare Part D, which provided pharmacy benefits,

    Mike K (f469ea)

  30. The Framers of the Constitution understood that federalism—the division of powers between the national and state governments—would maximize the happiness of Americans. As long as Washington dictates health insurance policy to the entire country, there will be massive tension and displeasure with the system. I’ve always said, and I will continue to say, we need to start over: Fully repeal Obamacare, let the people of each state choose their own approach, and work together in a nonpartisan manner.

    The ‘framers’ used leeches. https://18thcenturyminds.wikispaces.com/Medical+Procedures+and+Medicationswere

    Yup. That would be the sane policy.

    Nope. A sane policy for modern, vibrant countries in the 21st century is a single payer universal healthcare system. May 4, 2017, President Trump tells Australian PM Turnbull– and the world, on camera:

    “You [Australians] have better healthcare than we do.”

    Australia, of course, has universal single-payer healthcare coverage.

    Thank you, Mister President.

    DCSCA (797bc0)

  31. https://18thcenturyminds.wikispaces.com/Medical+Procedures+and+Medications

    Referncing 18th century ‘Framers’ in discussions of a 21st century health care system is counterproductive.

    DCSCA (797bc0)

  32. The Framers platform for Freedom remains the same today. Whether it’s about health insurance, speech, slavery or driver licenses. The division of and therefore the decentralization of power over the individual by oppressive government agencies, bureaucrats and politicians are even more acute now than then. They have more murderous weapons and far greater technologies to enslave and plunder us with. I’s sad you don’t understand that DCSCA. Sad, but not surprised.

    Rev.Hoagie® (630eca)

  33. I wasn’t aware the Ideals behind the Declaration of Independence and the Constitution had expiration dates, DCSCA. I must have missed reading the small print disclaimers on the back.

    Rev.Hoagie® (630eca)

  34. “You [Australians] have better healthcare than we do.”

    Donald Trump, who never says he is wrong, doubled down on that.

    Well, he could. He just had to say Obamacare is the worst kind of thing you could have.

    @realDonaldTrump · May 5

    Of course the Australians have better healthcare than we do –everybody does. ObamaCare is dead! But our healthcare will soon be great.

    Sammy Finkelman (6f9f42)

  35. And they do it to deliberately harm the insurance industry and thus to harm the Freedoms Americans have.
    Hoagie, you do realize that the insurance industry is part of the problem?

    Thank you, Dr K., for providing all that insight. It should be sobering to realize large segments of the health care industry don’t think that improving health care is important​.

    In response to Kevin M’s question: Except for two periods of unemployment, both in my twenties, I have had employer provided insurance my entire adult life. I just took early retirement from JCPenney, and until I find a replacement job, will be on COBRA. So no individual insurance from me.

    kishnevi (9dfc8c)

  36. 26. This is not good enough, for practical reasons.

    One good point is it repeals and replaces Medicaid. You can’t repeal EMTALA. And the idea of restrictuing this to U.S. citizens and permanent residents? Medical ethics will not permit leavbing people untreated so what you have is hospitals absorbing the cost. Now maybe you can have other counties pay for this.

    The tax lien is actually not much worse than the current Medicaid law, but you realize most of this money will never be collected. You could also have people permanentl;y in debt. You wiuld take zway Social Security diability and up to 25% of Social Security retirement and any windfall amounts in cash or property that cumulatively exceed $10,000 in a rolling 12 month period from any source (e.g. inheritances, lottery winnings, gifts, etc. So they won’t get them. Lawyers will figure out ways to establish trusts no matter what you do.

    You;d also stop people with medical debt froim marrying because if they ddi teh responsibility for paying it would fall on the spouse.

    And get rid of this too:

    government billing shall not be available for any condition, drug, device or treatment for which a lifestyle modification that the consumer refuses to make will alleviate any or all of said expense and need for medical goods or services.

    Sammy Finkelman (6f9f42)

  37. in australia people die all the time from spider bites and crocodile attacks and these fish you step on and also snakes and killer stingrays god knows what else

    the whole entire island’s basically an abattoir where people are prey and life expectancy is an oxymoron

    ivanka should check it out i hear they have shiny poles there

    happyfeet (28a91b)

  38. kishnevi, yes I do realize the health insurance industry is part of the problem. Do you realize the health insurance industry is not the health care industry and they are both part of the problem? Do you realize that trying to put together a plan that will cover 330 million Americans plus who knows how many illegals and “refugees” is a Utopian dream and that too is part of the problem? The only way to permit people to select what they want is the free market. For some reason folks have been fed the idea that because some people aren’t covered the system is bad. It’s a con. And oddly enough they are being convinced the same folks that administer the VA should be in charge of the rest of us too.

    You know, if it was such a good idea they wouldn’t have to force us to do it.

    Rev.Hoagie® (630eca)

  39. BTW, the population of Australia is about 24 million. Blue Cross of Jersey covers more than that.

    Rev.Hoagie® (630eca)

  40. I don’t need all you fact checkers to jump in, I was being flip.

    Rev.Hoagie® (630eca)

  41. My wife and I are in the individual market. We pay over $1600 a month. Every year it seems our package dropped from Platinum to Gold to Silver to Bronze and the price and deductible rises.
    We used to be in an industry group that did not survive Obamacare.

    Blue Shield used to attach a pie chart showing where my premiums go. Less than 1/2 goes to health issues a male of my age might encounter. The chart showed I was required to buy coverage for pre natal care, women’s reproductive health, pediatric dental. Haven’t seen the chart in the packet lately

    steveg (114097)

  42. AmashL

    ….For that score to be useful, the Congressional Budget Office would have to effectively predict which states will seek waivers, which waivers they will seek, and when they will seek them. This complex analysis of the political processes and choices of every state is beyond anyone’s capability. I weighed the lack of an updated score accordingly. ..

    haooyfeet @25:

    disingenuous.

    Well, that’s true, because the first score was also pretty worthless. Amash is arguing that nobody knows how many states would take advantage of the waivers. But the bill does provide fixed amounts of money.

    This does bring out a good point:

    Any really good reform will probably be impossible to score.

    Sammy Finkelman (7b1b59)

  43. “haooyfeet”… Sammeh for teh win…

    Colonel Haiku (2601c0)

  44. What if someone wrote “A Conservative Case For Political Assassination”?
    After all, The Left already has “Mein Kampf”, and “Das Kapital”.

    askeptic (8d10f9)

  45. quick question

    why does the US Army keep promoting and pooping out shady trash like Colin Powell, Mike Flynn and David Petraeus?

    happyfeet (28a91b)

  46. tell me tell me

    i can too handle the truth

    happyfeet (28a91b)

  47. I’ll tell you, if you’ll admit that Brigitte Macron is a hottie even at age 64. (Not to mention that she is a French First Lady who is actually married to the French President.)

    nk (dbc370)

  48. Too swarthy and long in the tooth for my tastes.

    Colonel Haiku (2601c0)

  49. Let’s see if this link works.

    nk (dbc370)

  50. oh my goodness the hills have never been so alive with the sound of music…

    and love!

    she’s gonna make it after all

    happyfeet (28a91b)

  51. We were this close to having Theresa Heinz-Kerry as first lady.
    How many days before Marcon’s mistress moves into the guest suite

    steveg (114097)

  52. Very telling passage…

    “Yet Mrs Macron has herself shown she can laugh about their age difference. She is quoted in one book as having said: “He needs to go for it in 2017 because by 2022, his problem will be my face.” Heavy use of a depilatory for longer than five years is strongly discouraged.

    Colonel Haiku (2601c0)

  53. “EUROPE’S PROBLEM — CHILDLESS LEADERS? “[Now that] he is elected, the leaders of France, Germany, and the U.K. will have zero biological children among them. . . . President Trump, by contrast, has 5 children.”

    From the comments: “Seems very appropriate for Europe which has chosen demographic suicide.”

    https://pjmedia.com/instapundit/264364/

    Colonel Haiku (2601c0)

  54. Brigitte’s insides were a rocky place where my seed could not find purchase.

    Europe’s Problem — Childless Leaders.

    papertiger (c8116c)

  55. beat me there.

    But I stuck a solid movie quote in for added value.

    papertiger (c8116c)

  56. Mike K @ 10. “Insurance” for those with pre-existing conditions that would make them uninsurable in a free market system, is not insurance

    Nobody is uninsurable. There should be a certain premium or deductible at which point someone is insurable. There is still some uncertainty, and at a high enough premium or deductible you hit it.

    But you are right, what is certain, or extremely probable, is not insurance. It would be more honest (and maybe more logical) to take care of pre-existing conditions another way.

    I would simply re-insure high risks by auctioning them off in tranches, with the riginally insurance company paying the premium plus, say, 5% 10% and the federal government paying the rest.

    Sammy Finkelman (7b1b59)

  57. Bob Owens shot and killed himself.

    I used to chat with him regularly in ’07 and ’08. We talked about a lot of stories.

    Patterico (115b1f)

  58. Col, re your #48 did you land a Jaliensce or a novela star?

    #54, those are the ravages of forceps and vacuums.

    urbanleftbehind (a88e42)

  59. Nobody is uninsurable.

    I don’t think you know what the word “insurance” means. Insurance indemnifies against a risk. If the risk is already a claim it cannot be insured. Insurance companies don’t buy claims, they buy risk. If a person has a preexisting condition there is no insurable risk. But, if the insurance company were able to exclude the preexisting condition it could insure the person for any other risks not already incurred if it was allowed by law.

    Rev.Hoagie® (630eca)

  60. Are you sure? He just retweeted yesterday.

    papertiger (c8116c)

  61. How did you find out?

    narciso (d43435)

  62. You know that foul mouth wishing death on all of us, I’m not claiming any expertise and correct me if I’m wrong, but epileptic fits is the diagnosis you get after the docs have exhausted their limited ability to fix what’s wrong.

    It’s basically MD’s throwing up their hands saying, “I surrender. Learn to live with your condition.”

    The only Eisenberg would need is to cover the cost of a shrink to to treat his psychosis.

    papertiger (c8116c)

  63. Rev.Hoagie® (630eca) — 5/8/2017 @ 8:55 pm

    Insurance indemnifies against a risk. If the risk is already a claim it cannot be insured. Insurance companies don’t buy claims, they buy risk. If a person has a preexisting condition there is no insurable risk.

    What do you mean? Of course there is. Do you know if someone is going to have medical expenses of $500,000 or $1 million or $5 million the next year? The extra risk of a pre-existing condition is not insurance, or the same kind of insurance, but there is some range of probable expenses that you can say there is only a 5% chance of it being outside that range.

    Now the person can’t be charged the same premium and have the same deductible, but there is some element of uncertainty.

    But, if the insurance company were able to exclude the preexisting condition it could insure the person for any other risks not already incurred if it was allowed by law. </blockquote. I don't know if you can totally separate them so they would still charge ahigher premium or have a higher deductible.

    Anyway the thing is to cover the higher risk some other way than trying to include it in the insurance.

    Sammy Finkelman (7b1b59)

  64. *insurance

    papertiger (c8116c)

  65. 60. His last tweet is dated 7:17 PM – 7 May 2017

    There aee bi retrns (yet) on Google about him doing anything to himself. NOt on the web and not in Google News.

    Sammy Finkelman (7b1b59)

  66. Everyone and everything is insurable at the right price.

    The last comment should have had a line starting: There are no returns (yet)

    Sammy Finkelman (7b1b59)

  67. Thanks for the link, Kishnevi.

    Lots of people get these thoughts and hopefully have someone around who notices and helps them, but sometimes that doesn’t happen.

    I suspect a lot of troubled folks wind up spending a great deal of time online.

    Dustin (ba94b2)

  68. My thoughts are with his family.

    Patterico (1b4610)

  69. Amen, Patterico. He may not have been a close friend to you, but you did know him. My condolences.

    Simon Jester (80f908)

  70. Sad.

    mg (31009b)

  71. Kevin M – I’ve been in the individual insurance market. 2007-2014. (My timing sucked.) Actually had a good plan, made a deal with my new employer (2012) to keep individual plan until they grew.

    By 2014 the company was forced into Obamacare (yay – growth!). My insurer withdrew from Ohio. So I jumped into my California employers Obamacare compliant plan. My premiums doubled in 2015, and doubled again as of Jan 1, 2017. I now pay more for healthcare ($1960/month) than my Ohio mortgage.

    Steven Malynn (d29fc3)

  72. I’ve been robbed. Had the tools of my trade stolen from the trunk of my car. Twice. Some stranger or at least unknown sneak = in the dark of night creeping up to take away your livelihood.

    As bad as that was how much more so it must be to have an insurance company effectively do the same out in the open, with the government in league, smiling to your face knowing you have no recourse.
    And you have to stand there knowing they’re going to do it, the promise of more of the same next month.

    papertiger (c8116c)

  73. Not to be margin the android

    https://pjmedia.com/news-and-p
    olitics/2017/05/09/gop-senator-determined-healthcare-bill-will-pass-jimmy-kimmel-test/

    narciso (58ede9)

  74. Blame Huey Long (the legacy of a widespread state hospital network) for that one, Narciso.

    urbanleftbehind (5eecdb)

  75. http://www.nationalreview.com/article/447454/health-care-reform-preexisting-conditions-myths-exaggerations-mar-debate

    He says that if you have a pre-existing condition, you are not being insured in any real sense.

    And there are four different ways to pay for that.

    1. You could say people cover the cost themselves, either by paying an actuarially fair premium (like I said there is a premium at which just about everyone can be insured) or paying out of pocket. For some people or conditions the increase would be small, and there’s chairty care and federal law mandates hospitals provide emergency care but a lot of people wouldn’t get care or would be bankrupted or maybe forced into taking a vow of poverty. Virtually no one favors this option (I don’t know about Justin Amash)

    2. Other people in the insurance market could pay the costs. this is the approach of the ACA and also, since 1996, of employer proivided insurance.

    3. The costs of insurance subsidies could be spread across the entire population. This is the approach of highh risk pools. It preserves the illusion that people with pre-existing conditions are being “insured” This makes people there look equal to other people, and not charity cases, but at the cost of doing something unsound. A pool can be underfunded and not well designed.

    4.Pay for it up front. This sounds like the same thing as # 3 except we’re not pretending it is insurance. Medicaid is like that (except that Obama and company called Medicaid “insurance”) Rand Paul, he says, favors this approach.

    Noen of these approaches involves the use of money tree. Who should pay is natural to argue about. But tooo much of teh discourse about pre-existing conditions pretends it is cost free.

    Sammy Finkelman (6f9f42)

  76. Report about Bob Owens:

    http://bnonews.com/news/index.php/news/id5882

    Sammy Finkelman (7b1b59)


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