What I don’t understand about the insurance and state lines thing

Obamacare set up health insurance marketplaces. It didn’t take over health insurance like some would make you believe, but one thing it did was establish a website, not much different from expedia, where people can compare available insurance plans. Of course, it made some rules about the plans that can be sold on this platform, and each state has its own set of plans, so somebody from NY, for example, only gets to shop for plans in NY. Republicans latched onto this, and said that it hurt competition, because insurance companies should be able to sell across state lines. I’m not an expert in health insurance, so I’m sure I’m missing something (maybe something big), but the whole thing always seemed silly to me. I’m the first to warn against anecdote, and I should probably use my own advice here, but every now and then we all ignore the rules (even our own), so here goes.

Continue reading “What I don’t understand about the insurance and state lines thing”

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A graphic to save for later (how to distribute welfare)

There are some things that I tend to say over and over. One of them is about the options, as I see them, when it comes to offering social services to a society. There is always going to be a group of people who we can agree are deserving of these services, and a group of people who take advantage of the services and get something they don’t deserve. In an ideal world, we will only give coverage to those who deserve it, and not one undeserving person will get benefits. This will reduce the costs to the lowest possible, because there is no waste in the system. Because the ideal never seems to be possible in an imperfect world, we have to pick which way we want to err. Do we want a system that covers the most people, or the fewest. The system that covers the most costs more, but makes sure that all the “deserving” get what they need, while unfortunately letting some of the “undeserving” take advantage of the system. The system that covers the fewest saves money, by making sure that no “undeserving” get help they need, but leaves some “deserving” without help they need. Of course we can also debate who is “deserving” and who isn’t, but that’s a separate issue (not unimportant, just separate). Nevertheless, the whole purpose of this post is to have a place for a graphic that I created to illustrate this. It’s rough, and I spent less than 10 minutes creating it, but here it is. Sharing is welcome, but it would be nice if a link to this post came with it.

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Sometimes when you win, you lose. Sometimes when you lose, you win. And sometimes when you win or lose you really tie.

 

 

The House of Representatives has voted, once again, to repeal the Affordable Care Act. This is not the first time they have done so, and it likely won’t be the last. They passed several bills and amendments since 2011 that repeal or limit Obamacare, and few of these became law. My guess is that this bill will die like the others have, but this time it will be killed by a more pensive (and smart?) Senate. Senate republicans are already saying that they can’t pass the current bill, and it’s not clear that they even have enough support for a vote. It’s hard to see how the House and President see this as a win, but they do, and they had a party at the White House about it. Vice President Pence rallied the crowd (of middle-aged to old white men) with a line, “Welcome to the beginning of the end of Obamacare.” Silly line. Doesn’t that assume that Obamacare will end? Doesn’t it assume that the previous votes weren’t the beginning of anything? Silliness all around.

Continue reading “Sometimes when you win, you lose. Sometimes when you lose, you win. And sometimes when you win or lose you really tie.”

Abortion, abortion, abortion…

[Somewhat rushed piece…overwhelmed with work, but trying to stay in the habit of writing, and it’s been a long time. I’m sure it’s full of typos and other problems, but at this point, it will have to do]

I’ve spent a bit of time talking about abortion and abortion rights since Hitting Bregma started (notably here and here). I’m fascinated by it as a topic because it’s so meaningful to so many people, that I honestly see it as the number one guiding issue in our politics today. I don’t have any scientific evidence for this at all, and I would enjoy being shown that it’s not true, but I think the abortion question actually drives many people in one direction or another, and then the other partisan issues take hold. It’s easy for me to imagine somebody being appalled by abortion, leaning toward a particular political identity because of that, and then slowing assimilating with all the other beliefs of that political party. It seems like a key reason, for instance, why a deeply religious Christian would so predictably care about small government, about maintaining strong borders, about a super powerful national defense, about implementing the death penalty, about low taxes (especially for the wealthy). On the flip side, it’s puzzling to me that advocacy of abortion rights does such a good job at predicting where somebody stands on raising taxes on the wealthy, on being against the death penalty, about working hard for minority rights and environmentalism, and about government services for the poor. Of course, there are plenty of folks out there who don’t fall into those more predictable positions. I know plenty who are deeply religious, and guided by this to be sickened by abortion, but put this aside to otherwise favor liberal politicians who are anti-death penalty, pro-helping the poor, pro-helping immigrants, and willing to tax people to make that possible. It would be a silly straw man fallacy to say that I’m implying that this applies to everybody equally, but I find it interesting to see how many people seem to find their political identity by following the pro-choice or anti-abortion trail to the rest of the stuff.

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Do our priorities expose moral flaws?

The GOP is busy trying to repeal and replace Obamacare. They’ve proposed the American Health Care Act as a means to that end. To be honest, I can’t seem to find the bill online anywhere, but the CBO has released its estimates of the impact (the CBO says it combines legislation, but it doesn’t say what legislation it combines). As an aside, in my search for the bill on congress.gov turned up H.R.277 (American Health Care Reform Act) that has collected 29 cosponsors), but also turned up H.R.1275, which has a much better name: “World’s Greatest Healthcare Plan.” I’m quite sure it’s not, but it’s still a great name.

I am not going to get into details about the CBO score, but the summary is that the plan will save Americans $337 billion over 10 years, at the cost of increasing the number of uninsured by 24 million. The CBO says that 14 million people will become uninsured by 2018, mostly because they will opt out of coverage after the mandate is repealed. People speaking in support of the plan have said that it will maintain coverage for pre-existing conditions for people who maintain continuous coverage, so it looks like these 14 million will lose that benefit of the ACA. By the end of the ten year estimate, the CBO says a total of 24 million more Americans will be without insurance, bringing the total uninsured to 52 million Americans. The impact of this could be devastating to those Americans, and we will watch them suffer, all to save some money. I think that’s a moral failure.

Continue reading “Do our priorities expose moral flaws?”

Repeal, and replace with what?

Folks on the right often complain about government handouts, and accuse liberals of wanting something for nothing. It often, however, seems to be exactly the opposite, especially when it comes to discussions about Obamacare. And so much of the hatred about Obamacare concerns things that were just as bad, if not worse, before it.
Drew Altman, in a Times Op-Ed looks at sentiment in Trump voters about Obamacare repeal.
“If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs. It would also address consumer issues many had complained about loudly, including eliminating surprise medical bills for out-of-network care, assuring the adequacy of provider networks and making their insurance much more understandable.”
So, basically, they want it to do MORE than it does, not less? Isn’t that what democrats were pushing for, but scaled back as an attempt to compromise with republicans? Isn’t the republican philosophy to let the free market take care of it, not to mandate lower prices, regulate out-of-network care?
I’m continually baffled by how people make their decisions, and how comfortable people seem to be with their strong opinions, when there’s a clear lack of understanding serving as a basis of those opinions.
An old friend who I’ve kept in touch with almost entirely through FaceBook voted for Trump (or at least supported him in discussions on FaceBook before the election). In the run-up to the election, he said that all he wanted was lower taxes and affordable health care. This pained me. I don’t know his annual income, but I know his job and what he does, and I suspect that he doesn’t have income in any of the tax brackets that are targeted for reduction in any of the tax plans put forward by Trump or any of the republicans. But, more to the point here, what does he expect from a repeal of Obamacare? Maybe he expects to be able to buy a cheap plan again, without any requirements for minimum standards of coverage, like those that came with the ACA. Maybe he’s OK with a plan that won’t actually cover him if he gets sick, but makes him feel covered because it has low co-pays for routine stuff, and low premiums. Maybe he wants that, but of course that leaves the rest of us covering his bill if he gets sick and needs help that his insurance won’t provide, or leaves him broke and sick.
Of course there are things wrong with the ACA, and of course I’d like to see them fixed, but much like what I wrote earlier about government failures, the answer doesn’t seem to do less, it seems like the fix involves doing more. That means not repealing, but strengthening. Of course, that’s not what any of the GOP plans look like, but we’ll have to wait and see what we get.
The GOP needs to be very careful here, or they might end up shooting themselves in the foot, without a good insurance plan to cover the treatment.