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Old 12-27-2013, 12:25 PM  
HonestChieffan HonestChieffan is online now
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Replacing ObamaCare . The next big step for Washington

The number of people who still hold on to the hope that the ACA will survive is growing terribly small. Even progressive pundits are distancing themselves from the disaster called ObamaCare. Before long only Alan Combs will be left selling this .


The future holds some great opportunity to replace ACA with something that actually does improve HC in the US is huge. Doing the right thing will be a two stage effort. Eliminate all memory of ObamaCare and replace with something that works.

Interesting take from WSJ:


By JOHN H. COCHRANE

The unraveling of the Affordable Care Act presents a historic opportunity for change. Its proponents call it "settled law," but as Prohibition taught us, not even a constitutional amendment is settled law—if it is dysfunctional enough, and if Americans can see a clear alternative.

This fall's website fiasco and policy cancellations are only the beginning. Next spring the individual mandate is likely to unravel when we see how sick the people are who signed up on exchanges, and if our government really is going to penalize voters for not buying health insurance. The employer mandate and "accountable care organizations" will take their turns in the news. There will be scandals. There will be fraud. This will go on for years.


Yet opponents should not sit back and revel in dysfunction. The Affordable Care Act was enacted in response to genuine problems. Without a clear alternative, we will simply patch more, subsidize more, and ignore frauds and scandals, as we do in Medicare and other programs.

There is an alternative. A much freer market in health care and health insurance can work, can deliver high quality, technically innovative care at much lower cost, and solve the pathologies of the pre-existing system.

The U.S. health-care market is dysfunctional. Obscure prices and $500 Band-Aids are legendary. The reason is simple: Health care and health insurance are strongly protected from competition. There are explicit barriers to entry, for example the laws in many states that require a "certificate of need" before one can build a new hospital. Regulatory compliance costs, approvals, nonprofit status, restrictions on foreign doctors and nurses, limits on medical residencies, and many more barriers keep prices up and competitors out. Hospitals whose main clients are uncompetitive insurers and the government cannot innovate and provide efficient cash service.

We need to permit the Southwest Airlines, Wal-Mart, Amazon.com and Apples of the world to bring to health care the same dramatic improvements in price, quality, variety, technology and efficiency that they brought to air travel, retail and electronics. We'll know we are there when prices are on hospital websites, cash customers get discounts, and new hospitals and insurers swamp your inbox with attractive offers and great service.

The Affordable Care Act bets instead that more regulation, price controls, effectiveness panels, and "accountable care" organizations will force efficiency, innovation, quality and service from the top down. Has this ever worked? Did we get smartphones by government pressure on the 1960s AT&T phone monopoly? Did effectiveness panels force United Airlines and American Airlines to cut costs, and push TWA and Pan Am out of business? Did the post office invent FedEx, UPS and email? How about public schools or the last 20 or more health-care "cost control" ideas?

Only deregulation can unleash competition. And only disruptive competition, where new businesses drive out old ones, will bring efficiency, lower costs and innovation.
Health insurance should be individual, portable across jobs, states and providers; lifelong and guaranteed-renewable, meaning you have the right to continue with no unexpected increase in premiums if you get sick. Insurance should protect wealth against large, unforeseen, necessary expenses, rather than be a wildly inefficient payment plan for routine expenses.
People want to buy this insurance, and companies want to sell it. It would be far cheaper, and would solve the pre-existing conditions problem. We do not have such health insurance only because it was regulated out of existence. Businesses cannot establish or contribute to portable individual policies, or employees would have to pay taxes. So businesses only offer group plans. Knowing they will abandon individual insurance when they get a job, and without cross-state portability, there is little reason for young people to invest in lifelong, portable health insurance. Mandated coverage, pressure against full risk rating, and a dysfunctional cash market did the rest.

Rather than a mandate for employer-based groups, we should transition to fully individual-based health insurance. Allow national individual insurance offered and sold to anyone, anywhere, without the tangled mess of state mandates and regulations. Allow employers to contribute to individual insurance at least on an even basis with group plans. Current group plans can convert to individual plans, at once or as people leave. Since all members in a group convert, there is no adverse selection of sicker people.

ObamaCare defenders say we must suffer the dysfunction and patch the law, because there is no alternative. They are wrong. On Nov. 2, for example, New York Times columnist Nicholas Kristof wrote movingly about his friend who lost employer-based insurance and died of colon cancer. Mr. Kristof concluded, "This is why we need Obamacare." No, this is why we need individual, portable, guaranteed-renewable, inexpensive, catastrophic-coverage insurance.
On Nov. 15, MIT's Jonathan Gruber, an ObamaCare architect, argued on Realclearpolitics that "we currently have a highly discriminatory system where if you're sick, if you've been sick or you're going to get sick, you cannot get health insurance." We do. He concluded that the Affordable Care Act is "the only way to end that discriminatory system." It is not.
On Dec. 3, President Obama himself said that "the only alternative that Obamacare's critics have, is, well, let's just go back to the status quo." Not so.

What about the homeless guy who has a heart attack? Yes, there must be private and government-provided charity care for the very poor. What if people don't get enough checkups? Send them vouchers. To solve these problems we do not need a federal takeover of health care and insurance for you, me, and every American.

No other country has a free health market, you may object. The rest of the world is closer to single payer, and spends less.

Sure. We can have a single government-run airline too. We can ban FedEx and UPS, and have a single-payer post office. We can have government-run telephones and TV. Thirty years ago every other country had all of these, and worthies said that markets couldn't work for travel, package delivery, the "natural monopoly" of telephones and TV. Until we tried it. That the rest of the world spends less just shows how dysfunctional our current system is, not how a free market would work.

While economically straightforward, liberalization is always politically hard. Innovation and cost reduction require new businesses to displace familiar, well-connected incumbents. Protected businesses spawn "good jobs" for protected workers, dues for their unions, easy lives for their managers, political support for their regulators and politicians, and cushy jobs for health-policy wonks. Protection from competition allows private insurance to cross-subsidize Medicare, Medicaid, and emergency rooms.

But it can happen. The first step is, the American public must understand that there is an alternative. Stand up and demand it.

Mr. Cochrane is a professor of finance at the University of Chicago Booth School of Business, a senior fellow of the Hoover institution, and an adjunct scholar of the Cato institute.
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Old 12-31-2013, 05:25 AM   #31
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it's a ****ing 10000% scam to begin with. The big banks/insurance companies wrote the ****ing bill that would in return, would line their pockets with billions. That was the bill's primary goal...not to produce free or affordable health care like all of the moronic liberal Obamanoids were sold.

Obama cares about 2 things....that's please the people he works for at any cost and piss on the American middle class. That's exactly what this bill's intentions are.
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Old 12-31-2013, 07:54 AM   #32
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Originally Posted by CoMoChief View Post
it's a ****ing 10000% scam to begin with. The big banks/insurance companies wrote the ****ing bill that would in return, would line their pockets with billions. That was the bill's primary goal...not to produce free or affordable health care like all of the moronic liberal Obamanoids were sold.

Obama cares about 2 things....that's please the people he works for at any cost and piss on the American middle class. That's exactly what this bill's intentions are.
Obama doesn't mind doing their bidding if it results in the destruction of the Middle Class. That's the goal of commies. That keeps the politically connected not only wealthier but powerful. Then we have a two-tiered class system instead.
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Old 12-31-2013, 09:14 AM   #33
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All we really need to do is reduce costs. That's why the public says it should be replaced with a nebulous "something".

The primary cost driver is government interference, such as the woeful underfunding of all programs where government is the payor. If they had fully funded these programs instead of trying a government takeover the whole system, we'd have gone a long way toward fixing these issues.

Some common-sense regulatory measures like enabling insurance to be sold across state lines would be good, but all we really need the government to do is to stop passing the check for the promises they have already made and already weren't paying for off to people who pay for their own coverage.
As a working member of the insurance industry, I'm tired of seeing this argument. Its usually thrown against the wall by Republicans who are pressed to explain what they are going to replace the ACA with.

"Enabling insurance to be sold across state lines" would not do a damned thing. It is not hard for an insurance company to do business in a state. I think people are imagining that if only they would do away with state regulation of insurance, which has worked for over a century, then someone in California who is paying a ton might finally be able to buy that cheap Nebraska policy they've been eyeballing.

Well, no. There is a reason why insurance rates vary not just from state to state, but often from zip code to zip code. Medical procedures cost more in one state than it does in another state, and you can't make that go away by replacing a state regulator with a federal regulator. People understand that home insurance costs more in Florida than in Wyoming, and they sort of understand that car insurance may cost more in heavily urban areas, but they have a hard time understanding that health care costs can vary significantly by geography too.
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Old 12-31-2013, 03:39 PM   #34
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Personally, wouldn't have a problem with a lot of this. At the minimum it acknowledges that there is a problem and offers a solution (don't know a lot about the feasibility of it) rather than just throwing poo on the wall and screaming for an appeal.
I don't know what this means, but almost everyone acknowledges that there was a problem.
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Old 12-31-2013, 03:50 PM   #35
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Yep, we need single payer, that will fix it, but then, that was the objective all along. Obama in his wildest dreams never thought it would come to pass so quickly. You see left wingers, he HAS been successful. You middle of the roaders, I forgive you, but puhlease, WAKE THE F** UP!!!

All too easy, everything is proceeding according to his plan.
Maybe I'm misunderstanding your post, but that article isn't advocating single payer.
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Old 12-31-2013, 03:58 PM   #36
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Let's face it, there are two distinct, but greatly intertwined issues: healthcare costs and heath insurance costs.

Most other insurance costs are actuarially based. Home, auto, and life insurance premium costs are easily obtained from a company produced chart. Health insurance has been pretty much an employer-based with cost based mainly upon the employee base. That is, all other things equal, an employer with 40,000 employee will have lower premiums than one with 400 employees. Bigger pool to spread the individual risk. One reason why many employer-based associations grew, was to make available lower health insurance costs to it's members. Health insurance companies can't really rate individual polices as they have no experience in doing so.

Hospital costs are based upon the "chargemaster." Steven Brill discussed this in his Time article "Bitter Pill." Why do aspirins cost $5.00 - chargemaster says so. Never mind that no one can definitely say where the numbers come from. Chances are that some costs are duplicated, if not tripled or quadrupled. No one can be sure. Although, even with the steep discounts given to insurance plans, hospitals still make money. Hospitals and other medical facilities are probably one of the few industries that really don't know what are their true costs for a given procedure.

As to the ACA - it was destined to be a big flop. If anyone wanted to help the uninsured, Medicare is up and running and works to a large extent. All congress had to do was to, say, double the monthly premiums for the uninsured to $208/month and move on. But politics got in the way.

And let's face it, there will always those who don't want health insurance. Just like there are those who drive without auto insurance and those who prefer to live on the street or in the woods than in a shelter.
Let's be clear though, "chargemaster" is not a cause of high prices any more than the menu at your local restaurant is a cause of the prices for your meal. The cause, at least in part, is that 3rd parties pay the bill instead of the patients who consume the services and in the heavily regulated healthcare/healthcare insurance fields, there isn't a functioning market to regulate prices.
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Old 12-31-2013, 04:01 PM   #37
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Is it constitutional? I don't think it should be, but Roberts flipped.
Would you have believed it was unconstitutional even if Congress had explicitly declared the mandate a tax penalty or is your position based on a belief that the authority claimed by Congress (i.e. the Commerce Clause) should have been the authority evaluated by the SCOTUS?

BTW, the rest of that post was excellent IMO.
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Old 12-31-2013, 04:01 PM   #38
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As a working member of the insurance industry, I'm tired of seeing this argument. Its usually thrown against the wall by Republicans who are pressed to explain what they are going to replace the ACA with.

"Enabling insurance to be sold across state lines" would not do a damned thing. It is not hard for an insurance company to do business in a state. I think people are imagining that if only they would do away with state regulation of insurance, which has worked for over a century, then someone in California who is paying a ton might finally be able to buy that cheap Nebraska policy they've been eyeballing.

Well, no. There is a reason why insurance rates vary not just from state to state, but often from zip code to zip code. Medical procedures cost more in one state than it does in another state, and you can't make that go away by replacing a state regulator with a federal regulator. People understand that home insurance costs more in Florida than in Wyoming, and they sort of understand that car insurance may cost more in heavily urban areas, but they have a hard time understanding that health care costs can vary significantly by geography too.
Forgive me, but you say it "wouldn't do a damn thing (as in not lowering prices)" and then seem to imply that it would if it would be allowed, no?
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Old 12-31-2013, 08:26 PM   #39
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Originally Posted by patteeu View Post
Would you have believed it was unconstitutional even if Congress had explicitly declared the mandate a tax penalty or is your position based on a belief that the authority claimed by Congress (i.e. the Commerce Clause) should have been the authority evaluated by the SCOTUS?

BTW, the rest of that post was excellent IMO.
Calling it a tax penalty when its fundamental nature isn't a tax is a bit facetious.

I think that's too much deference to Congress. At its core, its a massive expansion of the commerce clause. We talk about "free markets" as a fundamental characteristic of capitalism. How can a compelled entrance to a market be at all "free"?
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Old 01-01-2014, 12:00 AM   #40
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Calling it a tax penalty when its fundamental nature isn't a tax is a bit facetious.

I think that's too much deference to Congress. At its core, its a massive expansion of the commerce clause. We talk about "free markets" as a fundamental characteristic of capitalism. How can a compelled entrance to a market be at all "free"?
The same way that growing one's own food for only one's self and family can be deemed 'commerce' and that penumbras can be discovered in the Constitution: The Supremes make shit up.
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Old 01-01-2014, 12:38 PM   #41
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Let's be clear though, "chargemaster" is not a cause of high prices any more than the menu at your local restaurant is a cause of the prices for your meal. The cause, at least in part, is that 3rd parties pay the bill instead of the patients who consume the services and in the heavily regulated healthcare/healthcare insurance fields, there isn't a functioning market to regulate prices.
As to your first statement - I'll respectfully disagree. The restaurant owner knows pretty much why he/she charges a certain price for a meal. Hospital CEO's haven't a clue on their chargemaster source.

I will agree that those who don't have to pay for any particular service, will use that service more than perhaps they should. Medical prices seem to be somewhat regulated by what insurance companies will pay for a particular procedure. And, consumers do pay, albeit a greatly reduced amount, for their use of the medical system through deductibles, copays, and whatever % of the bill that their insurance doesn't cover.
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Old 01-01-2014, 01:03 PM   #42
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As to your first statement - I'll respectfully disagree. The restaurant owner knows pretty much why he/she charges a certain price for a meal. Hospital CEO's haven't a clue on their chargemaster source.
What's your disagreement based on? Whether or not CEOs or restaurant owners understand their pricing isn't really related to what I said. The chargemaster doesn't cause high prices.
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Old 01-01-2014, 01:08 PM   #43
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As a working member of the insurance industry, I'm tired of seeing this argument. Its usually thrown against the wall by Republicans who are pressed to explain what they are going to replace the ACA with.

"Enabling insurance to be sold across state lines" would not do a damned thing. It is not hard for an insurance company to do business in a state. I think people are imagining that if only they would do away with state regulation of insurance, which has worked for over a century, then someone in California who is paying a ton might finally be able to buy that cheap Nebraska policy they've been eyeballing.

Well, no. There is a reason why insurance rates vary not just from state to state, but often from zip code to zip code. Medical procedures cost more in one state than it does in another state, and you can't make that go away by replacing a state regulator with a federal regulator. People understand that home insurance costs more in Florida than in Wyoming, and they sort of understand that car insurance may cost more in heavily urban areas, but they have a hard time understanding that health care costs can vary significantly by geography too.
More competition would lower prices and bring more value to the consumer. Right now, each state can regulate what companies are able to offer health insurance. This leads to just a few companies in each state. Less competition. Being allowed to sell across state lines opens up much more competition as many companies would be able to compete in every market.

Did you get better value, service, and price when the USPS was the only organization that was able to deliver packages to you? Or did the USPS competing with Fedex, UPS, and now DHL bring more value, a better price, and more options?
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Old 01-01-2014, 05:02 PM   #44
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More competition would lower prices and bring more value to the consumer. Right now, each state can regulate what companies are able to offer health insurance. This leads to just a few companies in each state. Less competition. Being allowed to sell across state lines opens up much more competition as many companies would be able to compete in every market.

Did you get better value, service, and price when the USPS was the only organization that was able to deliver packages to you? Or did the USPS competing with Fedex, UPS, and now DHL bring more value, a better price, and more options?
I would imagine that the amount of red tape around insurance restrictions creates massive increases in the cost of doing business. Between compliance, lawyers, cash reserves as a result of preparing for risk of lawsuit, building tech systems that have to talk to each other despite very different rules, and then having to re-engineer systems when the rules keep changing.
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