CBO Numbers Depend on What You Believe Health Insurance Should Be

Let’s stop calling it health insurance, shall we? Insurance is coverage you buy to guard against the possibility of an adverse outcome. Like damage to your car. Or your house. Or your 1972 Telecaster Thinline autographed by Waylon Jennings himself, being stolen from your weekend band’s van, outside Domino’s, in the parking lot on the way back home. Did I say it was snowing?

What countless articles and endless summaries in dozens and dozens and dozens of media sites/platforms/folded-pieces-of-paper-with-print-on-them, have been arguing about is really health entitlements. Or call it health benefits as many do nowadays.

Obamacare is a huge entitlement program that uses a welter of rules, regulations, taxes, and penalties to ensure consumers in a government-run safety net. Because it of its complexity, the trade-offs that underly any choice one makes in forging a health policy - specifically the ACA - are hidden under all the rules and regulations. But the one clear theme that the many opponents of the AHCA or RyanCare or TrumpCare agree on, is that voters are entitled to health care.

Even libertarian-leaning Rand Paul does not come out and directly say, you do not have an absolute right to health care. It costs a lot of money and some people spend far more on health care than others, and if they are subsidized - as most high-spending older patients are - then the government has to pay for it. Sorry, you have to pay for it through higher taxes or the certainty of higher taxes for your children and grandchildren.

It's been close to 25 years since the Clinton's - especially First Lady Hillary Clinton - came up with the Health Security Act (nice that HSA nowadays means Health Savings Accounts). And it's been close to 25 years since Republicans and conservatives in general rallied public support against that complex bill by reminding the public of the simple fact that they would have to pay for the plan through higher taxes. William Kristol helped lead that battle, of course.

What's changed?

Obamacare passed. Barely, without a single GOP vote. But it became law. And as Charles Krauthammer and others have famously stated: no entitlement has ever been taken back once it has been handed out to the American public through some government program. Like Medicare, Medicaid, Social Security etc.

So when the Congressional Budget Office released estimates of the AHCA's effect on the number of people in America with health entitlements - sorry health insurance - the reaction to those numbers is clearly a function of how you see health insurance/benefits. If you see health insurance as something that should be just that, insurance, then the fact that less people witll choose the product when there are less mandates and penalties is merely a logical consequence of price and quality on demand. Although by offering high-deductible/low-premium plans that can be at least partially offset.

If, however, you're feeling rather Swedish or Canadian when it comes to health care, then ANY tweak to ANY health policy that results in ANY greater number of people abandoning their health plans is a national disgrace. And it doesn't matter how accurate the CBO numbers may or may not be. It's the principle of socialized medicine that's at stake, in your mind.

Because the reactions to the AHCA divide along a widening gap between conservatives who want health plans to be true insurance - like cars and houses and telecasters - and progressives who want a single-payer system but haven't quite said so yet. Not withstanding a few million or so Bernie supporters. And a large percentage of Millennials. Two groups which tend to overlap.

Is there, therefore, any real possibility of compromise between those two camps? Re-doing the AHCA so that Senator Lee and Senator Paul can vote yes, means that Senator Collins and Senator Cassidy vote no. And vice versa. And Collins and Cassidy are merely GOP moderates. But their positions are driven by progressive voters in their states. So, can any plan that passes the House be approved by the Senate? Not with the posturing - and it's more than just posturing - we've seen over the last week.

Posted by Keeley at March 14, 2017 5:37 PM
Comments
Comment #414379

“It’s the principle of socialized medicine that’s at stake, in your mind.”

For many, that’s true Keeley.

Some claim that health care is a “right”. Really, where is that written in our founding documents?

More people need food, clothing, and shelter than need health care. Are there “rights” to those also?

Keeley is correct, using the word “insurance” to describe Obamacare is a sham. True insurance is based upon assessing risk, and charging an appropriate premium for indemnifying against that risk.

Posted by: Royal Flush at March 14, 2017 6:14 PM
Comment #414380

I was wondering how long it would take for conservatives to write about health care. Paul Ryan’s bill became public a full week ago and nary a peep has been heard from anyone here. Apparently, the prospect of repealing Obamacare must not seem as thrilling today as it was before.

Anyway, Keeley has the correct diagnosis. Americans will not accept any replacement for Obamacare that covers fewer people. Americans believe their fellow citizen ought to receive medical treatments regardless of his or her ability to foot the bill.

If Republicans actually pull the plug on Obamacare without guaranteeing health benefits to Americans, they will pay for it dearly in the polls in November. My hunch is that Paul Ryan and the rest already see the writing on the wall. The AHCA is designed to fail in the Senate, thereby enabling Ryan and company to play the blame game with dissenting Senators.

Posted by: Warren Porter at March 14, 2017 7:16 PM
Comment #414381

Frankly Warren, I hope the Republicans do nothing to repeal or change Obamacare and let this foul, stinking, obnoxious legislation collapse all on its own. I want the Dems in congress to beg Republicans to help them out of their misery.

Posted by: Royal Flush at March 14, 2017 7:23 PM
Comment #414383

Tough luck with that. Citizens in blue states such as New York and California have a wide array of affordable health plans to choose from. From every perspective, ACA has been successful in these places. Eventually, Americans in the heartland are going to wise up and realize that they could be benefiting too if it weren’t for Republican control of their state government gumming things up. Soon enough, they’ll toss out their Republican state governments that have completely undermined the ACA in their respective states. Already, we hear rumblings that the Medicaid expansion may be adopted in the near future in Florida and Maine.

Posted by: Warren Porter at March 14, 2017 7:55 PM
Comment #414384

Why can’t Congress face facts? I was just watching an advertisement from Colorado Rep Hoffman telling us how good the bill in the HoR is and how it will get us away from the job killing mandatory requirement and so on with all the BS conservatives can muster. Yeah I guess the better question is why can’t the American people see thru this crap and throw these disgraceful fraudsters out.

With all the examples from all the different countries out there, Mexico, Cuba, Canada, Australia, Britain, any of the European countries, to copy, to draw from, to learn from, the repubs cannot after 7 years come up with anything but lies and fraud.

It is time to recognize employer based health insurance for the job killing, economy wrecking crap it is. It is time to recognize the health insurance industry has been a problem for 30 years (can you think of a year, since Reagan left office, double digit increases in premiums didn’t happen) , Hillary was right on this back then, and won’t fix itself. The free market approach doesn’t work when it comes to health care IMHO. Hedge funds own hospitals. never get cheaper despite becoming more efficient. Drug companies spend millions to discover a cure for dry eyes and giving old guys Viagra, I would venture a bet Fleming is turning over in his grave considering what he did for the world without becoming a billionaire.

Posted by: j2t2 at March 14, 2017 8:42 PM
Comment #414388

Here we are in 2017 and we can’t get an estimate of charges for delivering a child! I wonder if the rest of the world suffers the conservative ideologies as we do.

http://www.vox.com/2016/5/5/11591592/birth-cost-hospital-bills

Posted by: j2t2 at March 15, 2017 3:49 AM
Comment #414389
Some claim that health care is a “right”. Really, where is that written in our founding documents?

More people need food, clothing, and shelter than need health care. Are there “rights” to those also?

Royal let me introduce you to Article 25 of the United Nations Declaration of Human Rights…


http://www.un.org/en/universal-declaration-human-rights/index.html

Posted by: j2t2 at March 15, 2017 3:57 AM
Comment #414390

Once the ACA was passed, the chances of it ever being repealed were miniscule. Krauthammer was correct in his assessment. IMO the tax break on employer-provided health insurance should be repealed, and the resulting tax money used to subsidize those with pre-existing conditions or whom can’t afford health insurance in Medicaid. The stigma (if people actually feel it anymore) of being on welfare should remain, to minimize the moral hazard.

There is no reason to upset the apple cart of the entire health care system to serve the few.

Posted by: Mike in Tampa at March 15, 2017 8:00 AM
Comment #414392

I wonder if this is true and if Trump will listen. Hard to believe a conservative suggested this to Trump, any thoughts on whether Bannon will allow Trump to try this?


http://www.vox.com/policy-and-politics/2017/3/14/14923784/christopher-ruddy-medicaid?yptr=yahoo

Posted by: j2t2 at March 15, 2017 9:58 AM
Comment #414400
There is no reason to upset the apple cart of the entire health care system to serve the few.

I also favor repealing the tax break for employer-subsidized insurance and I’m not opposed to using that money to subsidize health care for the poor. However, I am not naive to believe that this wouldn’t upset the apple cart for the vast majority of Americans who receive employer health benefits.

Posted by: Warren Porter at March 15, 2017 11:49 AM
Comment #414402

Warren writes; “Citizens in blue states such as New York and California have a wide array of affordable health plans to choose from.”

Really? Most likely Warren is still on his parents health care coverage. For my other Lefty Pals, a few simple questions.

Are you on Obamacare?

How much is your deductible and co-pay annual out of pocket cost?

How much is your out-of-pocket annual premium cost?

Posted by: Royal Flush at March 15, 2017 4:34 PM
Comment #414403
Some claim that health care is a “right”. Really, where is that written in our founding documents?

Well…

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, — That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.

Healthcare is central to life and the pursuit of happiness, and our enjoyment of our liberties is seriously impaired if our health and wellbeing is not ensured.

We are more than just worker ants to be pumped through a system, we are human beings. It has been the claimed ideal of many cultures that the sick are taken care of, the weak strengthened, the old and infirm supported, and that those who suffer injury should be aided. When Jesus tells the parable of the Good Samaritan, the moral isn’t just that the Samaritan did right, it’s that the Priest and the Levite were so concerned with avoiding ritual pollution, that they left the beaten, stripped man on the side of the road, crossing to the other side to avoid his blood.

So it is with the modern day priests and Levites of the GOP and the conservative movement. So concerned are they about defeating even the barest hint of socialism, that they neglect a basic truth about today’s healthcare system: that it is too expensive for people to afford it out of pocket. As the famous syllogism begins, all men are mortal, and few among us possess any unique resistance to disease and injury.

You guys operate on the assumption that government can’t do it, shouldn’t do it, and you don’t see that it’s inevitable that when you have people and techniques with the ability to save people from a given fate, attempts to draw too much money off of it inevitably run up against, ancient, dare I say it, truly conservative social principles! Take advantage of people in dire circumstances enough, and people will rebel against what’s being done.

Posted by: Stephen Daugherty at March 15, 2017 4:41 PM
Comment #414404

j2t2 writes; “Here we are in 2017 and we can’t get an estimate of charges for delivering a child!”

He then blames Conservatives. I wonder if our Lefty Pal could explain?

According to j2t2, UN proclamations now supersede our Constitution. OH, MY. What other UN demands should be adopt?

Article 25 that j2t2 believes binds us here in the United states is a very wonderful statement. The question I have for my Pal is; define exactly what is meant by each provision and exactly how these right are to be enforced and who gets to pay for them?

Posted by: Royal Flush at March 15, 2017 4:47 PM
Comment #414405

Stephen writes; “Healthcare is central to life and the pursuit of happiness, and our enjoyment of our liberties is seriously impaired if our health and wellbeing is not ensured.”

I knew for certain that Stephen would resort to the “welfare” clause despite not knowing what it actually means. I will simply ignore him for now and perhaps he will do some research to further his education.

Posted by: Royal Flush at March 15, 2017 4:52 PM
Comment #414406

Stephen also writes; “…a basic truth about today’s healthcare system: that it is too expensive for people to afford it out of pocket…”

Do you ever read and review what you write Stephen?

If healthcare is too expensive for people to afford it out of pocket we should institute the idea of “insurance”.

OH, WAIT! That’s been done. The concept of insurance began ages ago Stephen and is nothing new.

Posted by: Royal Flush at March 15, 2017 5:03 PM
Comment #414413

James Madison: With respect to the two words general welfare, I have always regarded them as qualified by the detail of powers connected with them. To take them in a literal and unlimited sense would be a metamorphosis of the Constitution into a character which there is a host of proofs was not contemplated by its creators.

Alexander Hamilton: This specification of particulars [the 18 enumerated powers of Article I, Section 8] evidently excludes all pretension to a general legislative authority, because an affirmative grant of special powers would be absurd as well as useless if a general authority was intended.

Posted by: Royal Flush at March 15, 2017 6:39 PM
Comment #414414
Most likely Warren is still on his parents health care coverage.

Nope. I turned 26 in 2015 and I am on my own. I get my health insurance through Obamacare and I am satisfied with the results. Granted, I have not had any reason to see a doctor during these two years because I am young and in good health, but for a minimal payment I have the peace of mind that I am covered if the unthinkable were to happen.

Posted by: Warren Porter at March 15, 2017 7:12 PM
Comment #414415

Thanks for your honest response Warren and congrats on reaching age 26.

Can you answer these questions also?

How much is your deductible and co-pay annual out of pocket limit?

How much is your out-of-pocket annual premium cost?

Posted by: Royal Flush at March 15, 2017 7:15 PM
Comment #414418

WP
A member in the family of one of my friends died this weekend
He was 11 years old
So are you so arrogant to say I am invincible and death or a serious health situation will not visit me.
That is not faith. That is ignorance.

Posted by: tom humes at March 15, 2017 7:41 PM
Comment #414420
He then blames Conservatives. I wonder if our Lefty Pal could explain?

Sure Royal, you guys support the “free market” health care system in particular and big business in general. This system is corrupt and doesn’t need to tell consumers what services costs. Conservatives in Congress won’t do anything to change it because they will be left off the crony capitalist list come reelection time.

According to j2t2, UN proclamations now supersede our Constitution. OH, MY. What other UN demands should be adopt?

No one said that a UN proclamation supersedes our Constitution but seeings as we are a founding member of the UN Royal,why wouldn’t we work towards this “wonderful statement”? Why do conservatives hate the thought that all people are created equal. You seem to sour when universal human rights are at issue. Limiting yourself to a Constitution that declared some of us 3/5ths a person seems rather evil IMHO. Fortunately as times passes and we get more enlightened as a whole we tend to fight for many of these rights, suffrage is but one as is the right of all people to participate in their government by…. oh wait you conservatives prefer to suppress the vote of minorities and oppress religious groups to this day. No wonder the US Constitution was the end all and be all for you guys.

The question I have for my Pal is; define exactly what is meant by each provision and exactly how these right are to be enforced and who gets to pay for them?

Define them yourself Royal. Our systems of government should reflect the attitude of the declaration of universal human rights and strive to meet these…Never mind read this quote from the document it serves as a good definition ” Now, Therefore THE GENERAL ASSEMBLY proclaims THIS UNIVERSAL DECLARATION OF HUMAN RIGHTS as a common standard of achievement for all peoples and all nations, to the end that every individual and every organ of society, keeping this Declaration constantly in mind, shall strive by teaching and education to promote respect for these rights and freedoms and by progressive measures, national and international, to secure their universal and effective recognition and observance, both among the peoples of Member States themselves and among the peoples of territories under their jurisdiction.”

Posted by: j2t2 at March 16, 2017 1:45 AM
Comment #414423

Royal Flush-
First of all, as I understand it, “general welfare” type programs are still constitutional, so your objection is merely philosophical in nature. It’d be a sorry and short-lived government that could not meet the needs of its people.

You can’t go around insisting that people subscribe to your opinion, or else be ill-informed. If nothing else, Healthcare is an interstate market, and regulation of interstate markets is a delegated power right out of section eight. And if any market needed it, God help us, that was one.

Yes, we invented insurance! And you ignore that necessity when you push the idea that somehow access alone is sufficient to satisfy the needs of the American people.

You assume an ethical market. That’s your mistake. You assume that Insurance companies wouldn’t cheat the system by seeking as many healthy people as possible and tossing all the sick people. They did. You assume that hospitals wouldn’t reap the profits by going more for repeat business than successful resolution of illness and injury. They did.

It’s one thing to give the benefit of the doubt to an industry that is starting fresh, having done nothing, having not misbehaved. It’s another to give it to those who have done much to deserve a jaundiced eye towards their actions. That seems to be the SOP for Republicans. People can seriously abuse the public’s trust, screw consumers, even injure and kill them, and still the Republicans say, let us behave as if they can be trusted.

That’s what law is for: when people can’t help themselves, when simple human decency isn’t enough, and social stigma doesn’t convince people to do better, we need rules and punishment for breaking those rules.

I’ve seen it happen a million times. I live on the gulf coast in famously petroleum-centric Houston, so I often got news reports about one refinery or another blowing up, or springing a leak. I’d like to report that Cigarette companies, Asbestos Companies, and other various corporations, when confronted with evidence that their products were addictive, killing people, causing cancer, etc, would decide to take them off the market. I’d like to report that meat companies, when confronted with evidence that their beef, chicken, or pork were contaminated, would spontaneously and autonomously issue recalls and clean up their plants and processes.

I’d love to believe that people who make ****loads of money on Wall Street, when faced with evidence that their banks were becoming too big to fail, or with the sheer, catastrophic terror of capitalism’s potential fall, would reform and set themselves right.

Unfortunately, I don’t tend to see that. Not in the real world. What I see is people cutting corners. What I see are bad behaviors caught after the fact, rather than prevented before it. What I see is that when a bad behavior is near-term profitable, people will engage in it, and others might be drawn into what they know is risky behavior by the need to compete with those who dive into it.

The Republicans are a corrupted party. They are not dealing with the voters in good faith. They are giving the justifications for a short-term profit oriented set of industries, and scapegoating their opponents for the bad things that happen. The trouble is, that is not a consistent basis for governing a nation. That’s a good way to screw things up every time you get into office. That’s a good way for there not to be a consistent conservative philosophy, just a bunch of bought and paid-for positions that don’t mesh when put into practice.

Posted by: Stephen Daugherty at March 16, 2017 12:20 PM
Comment #414424

SD
And Democrats are not corrupt?
Is that gulf air you inhale getting to ya?
Are you trying out for SNL?
Of course you would not BS us would ya?
Did you learn that kind of stuff at Baylor?
These questions are for your fellow southpaws. I know the answers already.

Posted by: tom humes at March 16, 2017 1:37 PM
Comment #414425

tom humes-
You always “know” the answers. That’s your problem. Yes, Democratic Politicians can be corrupt. Difference is, we’re a lot more willing to dropkick their asses, rather than keep the vipers embraced to our bosoms. Republicans, anxious about defeating us at all costs, are more than willing to let their politicians get away with stuff. The Right Wing media also helps them get away with it, too.

Democrats, at the very least, are reachable. They can be shamed into doing the right thing.

Posted by: Stephen Daugherty at March 16, 2017 3:32 PM
Comment #414426

Stephen wrote; “First of all, as I understand it, “general welfare” type programs are still constitutional, so your objection is merely philosophical in nature.”

Well Pal, if the written understanding of the “welfare clause” I provided by Madison and Hamilton is not sufficient for you, I give up on your civic education. Please try not to influence anyone with your non-factual historical rewrite.

Here’s a real gem by my Pal Stephen; “That’s what law is for: when people can’t help themselves, when simple human decency isn’t enough, and social stigma doesn’t convince people to do better, we need rules and punishment for breaking those rules.”

So, we need laws to force people to help themselves, to be decent, and to do better. Is this crap in your novel?

Considering Stephen’s jaundiced view of capitalism as noted above, if enacted, would put humanity back in the Stone Age.

Will no one who has signed up for Obamacare share the answer to a few questions? Are you all ashamed.

How much is your co-pay, deductible and premium in annual out of pocket cost?

Posted by: Royal Flush at March 16, 2017 4:22 PM
Comment #414436

sd
you have so much to learn and some day you will reconcile you thoughts to reality

Posted by: tom humes at March 17, 2017 12:58 AM
Comment #414437

sd
you have so much to learn and some day you will reconcile your thoughts to reality

Posted by: tom humes at March 17, 2017 12:59 AM
Comment #414438

sd
you have so much to learn and some day you will reconcile your thoughts to reality

Posted by: tom humes at March 17, 2017 1:00 AM
Comment #414439

sd
you have so much to learn and some day you will reconcile your thoughts to reality

Posted by: tom humes at March 17, 2017 1:01 AM
Comment #414440

sd
you have so much to learn and some day you will reconcile your thoughts to reality

Posted by: tom humes at March 17, 2017 1:06 AM
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