Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
Why Can’t We Have Market Solutions in Health Care?
Some time back, I asked “What Are We Going to Do When Republicans Don’t Repeal Obamacare?” And I got a fair amount of grief for doubting the sincerity of the Republican leadership that voted 30+ times to repeal Obamacare, but only when they knew the repeal would be vetoed. The House “repeal” bill barely repealed Obamacare at all (it offered the states some waivers over parts of the law), and now the Republican Senate Bill is even weaker.
Although Senate Republicans had initially indicated that they would scrap the House bill and start from scratch, the Senate plan looks more than a little like its House counterpart, which kept much of Obamacare’s structure in place. But even more tellingly, the Senate plan looks even closer to the health care law that is already on the books.
In other words, it is exactly what critics predicted: a bill that, at least in the near term, retains weakened versions of nearly all of Obamacare’s core features while fixing few if any of the problems that Republicans say they want to fix. It is Obamacare lite, the health law that Republicans claim to oppose, but less of it. It represents a total failure of Republican policy imagination.
Here’s what I don’t understand. To set this up, I don’t think the government has any business regulating health insurance beyond protecting people from fraud. People should be able to work out any contractual arrangement with an insurance company they want. The government’s only role should be to enforce that arrangement should either party try to renege; which would be done through the judiciary, not the legislature.
That’s what I believe, but apparently, I’m in the minority. All right, fine. So, the majority believes that the government should be able to tell insurance companies what kinds of policies they have to sell.
OK, if that’s the parameters for this discussion … why would it be so bad, even in that scheme… for the government to set a Minimum Coverage Baseline that was just Catastrophic Coverage plus one check-up per year? People would be covered if they got cancer or had a heart attack or were attacked by a bear … big expensive stuff. And they could get an exam from a doctor once a year if they want. That wouldn’t cost much, and the minimum that anyone needs. And if you have a minor medical issue, you assume the risk of paying for it out of pocket. From that baseline, you could modularize coverage, paying more for prescription coverage, and more for mental health treatments, depending on what you think you might need in the future.
You may not personally like that choice … but why doesn’t the government even allow that choice?
I kind of suspect that its the insurance companies that want the Government to force middle-aged gay men to pay for insurance that covers obstetrics and gynecology, and tee-totaling Mormons to buy coverage for alcohol and drug addictions. And forcing normal people to pay for sex reassignments for those with body dysphoria. Having the government force people to buy stuff they’re never going to use is sort of Crony Capitalism 101.
Published in Healthcare
Cruz did ok debating Sanders regarding healthcare. However, I wish they would have narrowed the debate to two points specifically:
So frustrated you doubled down on the post?
You mean that you should be able to get coverage for what you want as long as you are willing to pay for it? Forfend!
Market based solutions would make much of government superfluous. Can’t have that-no matter how much you want it.
I don’t think your views are in the minority. Of those who actually pay attention and are not left wing, most would understand a sensible position on market reforms. It’s that even our people are afraid to speak the truth. If they had the courage to speak the truth they would win the argument with normal people. On the other hand if they don’t address the issue with clarity, they leave a vacuum the Democrats fill. Thus they are cowed by their own cowardice. Cruz did better than most of them, but he backed away from pre existing conditions. If we want to pay medical costs for uninsured people with pre existing conditions tax payers must pay for them. Why is that so difficult? But to do so our guys have to break some things out of the market approach and get their talking points down so they can wax compassionate but not destroy the medical care market by trying to appear compassionate.
risk aversion
Catastrophic care policy and the option for a Health Savings account.
That is what I want.
We have partly socialized medicine and want more because we are like alcoholics and it is like alcohol. The more socialism the society drinks, the greater the failures, and the more they believe that what they need to ease the pain is more socialism.
The people’s normal personality is being replaced by a new, socialist personality, as a drunk loses his personality and acquires an alcoholic personality.
The judgement is shriveling; and more and more the nation mistakenly sees the disease as the cure.
Because every approach we take is based on nonsense- basically the idea that health care costs are driven by insurers, not doctors, hospitals, pharmaceutical suppliers, and ambulance chasers.
The problem will be fixed when the factors that limit supply and competition (e.g., restrictions on technology, and licensing/other provider entry limiters) are removed or radically changed.
None of it matters. We go socialized (of sorts) within 9 years. Either Trump or the democrat after him. Promise.
BTW Someone tried to get a 3 cent tube of Acyclovir cream today. The cost was about 1000$. It used to be about 20 bucks a few years back. One little tube of a generic cream. Rebranded through the epipen insider laws. Big Pharma , and Big Insurance execs need to be boiled like lobsters. I’d buy tickets.
I’m with you, V the K. Sincerity gets you nowhere; courage is what’s called for. The Republicans have caved to some unidentified constituency that won’t be happy with anything they do. The government should not be running health care. Let Obamacare crash and then if absolutely necessary, offer the bare minimum that you suggest. Then let’s move on.
This.
Avik Roy writes:
I agree with Avik Roy.
I also support Ted Cruz’s amendment which would essentially eliminate the Obamacare regulations on insurance, including the ones for preexisting conditions (community rating).
But Ted Cruz’s amendment will likely be ruled out of order by the Senate parliamentarian for not conforming to budget reconciliation procedures.
Regardless of whether Cruz’s amendment passes or not,, conservatives should vote for it.
We can thank the FDA for some of this problem. That can be blamed on Rumsfeld and Regan with a Democratic congress.
By far the biggest most long term devastating mistake Regan made as President. Although some might argue that was amnesty but at lest massive amounts of people did not die from unintended consequences of that law.
However in my mind the one good part of Obamacare is that companies are required to disclose how much they spend on healthcare on your paycheck. Granted when they self insurance there is not a reconciliation process to insure the amount reported matches the paycheck amount. However it appears to cover themselves they tend to overestimate not under. Then again COBRA was a lot higher than when I add my out of pocket premium with what was reported on my paycheck. However I think that is COBRA laws allow one to jack up your rates to be a lot higher than they need to be.
The solution should be expansion of health savings accounts so it is not use it or loss it at year end. The ability to increase or decrease deposit once or twice in the middle of the year on them. The ability to take your companies reported contribution to your insurance and get that deposited into your health savings account in lue of them providing healthcare. Along with a complete deregulation of selling insurance across state lines (you can thank Regan for that restriction also). That in addition to there not being a single line left in law as part of the ACA. If Republicans thinks there is good things in that law then they need to vote on it as it own separate clean bill.
Curtailing the FDA role to almost nothing would be a huge step into lowing drug cost and stopping science from reducing suffering and extending peoples lives.
Avik knows more about the sausage making than just about anyone. What he misses is that the sausage factory will be appropriated by the state in due course. The dynamic between suppliers and products for health care is responsible for unsustainable growth of costs. It does not get fixed. It falls apart despite whatever the GOP passes. Then it implodes.
The American people have spoken, they demand unicorns be delivered on gilded unobtanium plates, at no cost to them.
Any party which does not promise the unicorns will be crushed. Any party which promises and does not deliver unicorns will be crushed. Reality will be damned.
Explain? URL?
Well put. We can rail at those yellow-bellied, lily-livered Republicans and wonder why they aren’t as conservative as we are. The answer is that we are outliers. The average voter even in very Republican districts and states still thinks there is plenty of room for government intervention if that means that someone else can be compelled to pay for things the voter wants.
DocJay – I feel there’s a dystopian best seller in there somewhere. I’d buy it.
For everyone’s information, Forbes has wholeheartedly endorsed the Senate healthcare plan. Here.
You can read the whole thing, and it does say it doesn’t fully repeal Obamacare, but it does attack the worst elements. It concludes with this to conservatives:
I can’t say I’ve made up my mind on it yet, but the Forbes analysis gave me a good push in support of it.
People want “the best health care someone else’s money can buy”.
FIFY
Here is an explanation in parallel case, perhaps: the cost of asthma inhalers skyrocketed when the EPA (or whoever) decided that the propellant was ruining the atmosphere. Big Pharma had to devise new inhalers. So, currently, all inhaled asthma drugs are proprietary, again, because they have been patented anew. ..
One commentator who is not a conservative described McConnell’s bill as “a cheaper version of Obamacare.”
Conservatives might be tempted to think of that as a reason to oppose McConnell’s bill.
But given a choice between an enormously expensive government boondoggle and a significantly less expensive (but still costly) government boondoggle, cheaper is better.
So, conservatives should support McConnell’s legislation.
I bet it’s a bit like the AC guy was telling me about the freon ban. The real reason it’s banned is because DuPont’s patent expired.
Oh. Wow.
Stuffing anything (basically) other than catastrophic risk into premiums is stupid. Employment based group rates are stupid. Medicare and Medicaid just messes up price discovery and is an actuarial theft scam. The VA is stupid. Mandatory care laws (from the 80’s) are stupid without forcing everyone to cover risk.
If you want to socialize something, do it honestly, progressively, and transparently out of the U.S. Treasury.
The Swiss system is O.K. Kevin Williamson just covered it.
The Swiss system is similar to Obamacare, isn’t it?
anonymous
Boil Scott Gottlieb, if he doesn’t do anything. But the solution here is actually more government, rather than less- have you tried to buy tetracycline lately? The pharmas have empty pipelines because their business model (15 years NCE FDA/USPTO exclusivity for broad population application of the drug for $1b/year sales) was built on something that for the most part does not exist any longer. Thus, they have all bought generic drug manufacturers, eliminated production of anything that doesn’t fit the high margin investment profile, and raised the prices of everything else; FDA helps by shutting down competitors for alleged GMP violations.
The obvious solution? FDA or NIH put out RFPs for large quantities of generic drugs, everything on the WHO essentials list, and sell into the market. After the squawking is done, sell each product line to pharmas on a competitive basis, with strict pricing rules or they lose the rights to produce. Market failure caused by regulatory issues and market uniqueness requires blunt instruments to address.