What should we replace Obamacare with? Perhaps we should try freedom:The biggest problems with Obamacare are, from my perspective, these:
1. The freedom to choose inexpensive insurance free of government dictates.
2. The freedom to save unlimited amounts in a health savings account.
3. The freedom to buy insurance across state lines.
4. The freedom for all individuals to join together in voluntary associations to gain the leverage of being part of a large insurance pool.
1) It makes my health everyone else's business, which means that everyone else in theory has an interest in telling me how to live.
2) It distorts the market towards worse kinds of jobs, especially at the lower end. The result is to increase poverty and the hardship of life for working Americans.
3) The mandate is unconstitutional, SCOTUS notwithstanding.
It's unclear from the details in the wild whether Rand Paul's plan fixes those three things, although it sounds like he probably is gunning for the mandate.
According to Paul's Twitter account, which I suppose is how we do governance now, Trump is 100% on board with the plan.
Removing the mandate to buy insurance while leaving in place the dictate that people can wait to buy insurance until after they are ill will only accentuate the bankrupting of the insurance industry.
ReplyDeleteThis statement, from Paul's article at the first link, demonstrates a misconception that's widespread and that nearly fatally contaminates any serious discussion of repealing Obamacare and any replacement.
What we have today, and have had since Obamacare was passed, is not health insurance; there is no health insurance industry extant today. What we do have is federally mandated, private/public funded health coverage welfare.
Insurance, including health insurance, is a transfer of risk in return for a fee agreed between the risk transferer and transferee, a fee based on the risk being transferred. That doesn't exist today.
Even an extreme like preexisting conditions could be insured, were government not involved and a free market allowed to handle the thing.
Whether we should have health coverage welfare programs is certainly a legitimate debate, but that debate can't occur, either, with this misconception governing the parameters of the discussion.
Eric Hines
I have no problem with Twitter communication. It beats press conferences and media filters. How is it different from announcing things on a pol's blog?
ReplyDeleteOccasionally you'll see things here that could be on Twitter, but also many things that couldn't be. Twitter doesn't really give itself over to clarity or extended argument, or careful debate either (though it's fantastic for snark, which has its place).
ReplyDeleteAs a form, it is limited. As a forum, it doesn't tend to inspire the best. And, of course, it has a persistent leftward bias in its corporate management, which makes it an ironic choice at best for Trump or Paul to prefer.
[I]t has a persistent leftward bias in its corporate management, which makes it an ironic choice at best for Trump or Paul to prefer.
ReplyDeleteOr that's part of the dig at the Twitter culture.
Twitter also can serve as the executive summary of the executive summary.
Or as a test market trial. Trump, after all, has run his entire campaign and his post-election policy promotion as a typical evolving marketing campaign. His fellow Republicans and the Progressive-Democrats, being pure, dyed in the wool politicians, never understood that.
Eric Hines
Even an extreme like preexisting conditions could be insured, were government not involved and a free market allowed to handle the thing.
ReplyDeleteOr if you do want to subsidize people in this situation, you can pay for the rider to cover the preëxisting condition, and let them pay for the base policy they want. It's still a subsidy, but it's direct (instead of hidden in everyone else's premiums) and it leaves some choice and market power with the person.
No need for taxpayers to pay for someone else's rider.
ReplyDeleteFirst, government needs to get out of the way of what a preexisting condition is. Childhood asthma is considered one for adults, yet, in most cases it's not, medically.
Government also needs to get out of the way of the market. Even a legitimate preexisting condition can be insured at a risk-based premium market rate, because even a preexisting condition isn't a realized certainty. Take heart conditions as preexisting, for example. Everyone isn't going to have a heart attack at the same time, and a significant fraction won't have a subsequent attack. That risk can be amortized across time, if a free market were allowed to operate.
Sure, it's a higher risk, and insurance coverage of the condition would come with a higher premium. Some people will need help with that premium. Even here, though, Government must be a last resort, not the default.
Eric Hines