June 14, 2009

Let's Beat Something with Something Better! - UPDATED

Hatched by Dafydd

Even though everybody says it, it's still true: You can't beat something with nothing.

So how do Republicans and moderate Democrats beat back Barack H. Obama's plan for the federal government to seize control of all health care -- essentially extending Medicare to the entire country by force of law? By not simply attacking that Socialist Ponzi scheme, but by also offering something better in its place.

What can we possibly offer to solve the health-insurance "crisis?" There are an estimated 45.7 million uninsured. There's nothing, nothing we can do other than hand it all over to the same people who run the TARP bailout program (and the State Department -- they have such a good record of success).

But wait; let's think a second time about this vital issue.

The only driving force behind President Obama's scheme to "reform" (nationalize) American health insurance -- switching to a government-run system à la Great Britain and Canada -- is the problem of the "uninsured." After all, the vast majority of Americans who do have health insurance are fairly satisfied with it and certainly don't want a revolutionary reboot of the entire system.

But by large margins, Americans believe that we have a "crisis" of uninsured. (I believe it's but a minor problem; but in politics, perception is king.)

So what can we do about that Census Bureau number of 45.7 million uninsured in 2007? First of all, we should realize that number includes a very large number of people whose income is far above the poverty line. Appendix B of the linked Census document (p. 53 of the pdf) defines "poverty" based upon total number in the household and the number of children; for a family of 4 including two kids, the poverty line in 2007 was $21,027 per year; you must be a pretty large family (at least five with no more than two kids) for the poverty line to exceed $25,000.

Yet according to Table 6 (pdf page 30) of the same Census document, of the 45.7 million uninsured in the United States in 2007, only 13.5 million (30% of the total uninsured) had less than $25,000 annual income. Amazingly, 17.6 million had more than $50,000 per year -- 38.6% of the total uninsured. In other words, significantly more uninsured have upper-middle incomes or better than live in poverty.

So why the heck don't they have insurance? The "crisis" of the uninsured is not primarily driven by poverty. In most cases, they can afford to buy insurance; they simply choose not to.

With this in mind, the lizards have a modest proposal; we urge the GOP to offer a bill very like this one in place of ObamaCare, forcing the Democrats to brutally suppress it, in full view of the whole country:

  • First, let's start with an indirect federal mandate that every person have medical insurance of some kind.

UPDATE June 14th: Commenter Snochasr makes the point that there is no enumerated power allowing the feds to directly mandate insurance; therefore, I've changed this point from a direct federal mandate to a federalist version: The federal government should make various health-related revenues to the states contingent upon them enacting some form of insurance mandate that meets certain minumum standards.

In the GOP plan, those standards absolutely should not include a laundry list of coverage... that can sink such a mandate quickly. Rather, the federal standard should be very light, allowing each state to create its own plan. That way, some states will do better than others; and the states with overly determined plans will have to face voters eventually. Conservatives can run against those bad plans by pointing to the much less determined -- and more successful -- plans in neighboring states.

Even for a libertarian, which I still consider myself, this isn't too odious a change; a patient who doesn't have insurance at all forces the State (i.e., some other taxpayer) to pay for his medical care anyway... since we're not the kind of society to let people die in the streets from easily treatable injuries, diseases, or conditions. Forcing me to pay for somebody else's stupidity is patently unfair.

(It's especially unfair when the patient with no insurance is also an illegal alien; but that is a subject for another post. We already pay for the health care of illegals, and in the most expensive possible way -- all medical care delivered through trauma centers. We must stop doing so; but again, the American people will not stand for allowing them to bleed to death or die of the flu. It's a complicated enough issue that it deserves its own series of posts on immigration reform in general.)

  • So the feds will bully the states into requiring every resident to have some form of insurance. But what kind? I think the Republican answer should be -- whatever kind each resident wants, from whatever company he wants, so long as it's a qualified, licensed insurance provider that won't just take the money and run. But at bare minimum, a catastrophic health-care policy coupled with a fully tax deductable medical savings account (MSA).

(Again, the feds should not overly determine these state plans; but by setting a very light federal standard, catastrophic plus an MSA, we encourage the states to do the same.)

Therein lies our plan: catastrophic care plus an MSA. Such plans are very, very cheap; but what about people so impoverished, they cannot afford even that? Here's the only major government expenditure in the lizardian policy proposal:

  • For patients who live in poverty as defined by the Office of Management and Budget’s (OMB) Statistical Policy Directive 14, the government pays a significant part, but not 100%, of health-insurance costs, including premiums and/or keeping MSAs "topped off." The requirement that even the poor pay something gives them a greater stake in society.

Note that the government would not offer insurance itself -- no "public option." It would simply pay welfare to the poor, a defined contribution to mostly (not totally) cover the insurance each individual chooses to buy. I believe this would actually result in reduced spending, since with health insurance, the poor could get less expensive treatment than going to the emergency room for every problem.

So the plan comprises an indirect federal mandate; insuring the impoverished by working through the market, not by trying to dynamite it; and the use of catastrophic care and MSAs to insure the uninsured (and the uninsurable).

And that's it. That is all that the feds pay; the rest is mandated by state law, but up to each individual to pay for himself.

So how much would this run? We assume that about 14 million of the 46 million uninsured live in poverty. It's hard to figure an "average" premium cost for catastrophic care, because quotes depend upon each individual. But I have read that catastrophic care in 2004 averaged around $3,000 per year per household (compared to $9,000 for regular insurance). Assuming this is still the same, then in 2008 dollars, that would be $3392.78, according to the Inflation Calculator. So let's make calculation easier by saying $3,500 per year per household.

If we again pick a four-person household as the average, that works out to approximately $875 per (uninsured, impoverished) person per year.

Thus the total premium value would be $875 times 14 million, or about $12.25 billion per year. That's a hefty chunk of change, but it's less than an eighth of the $1 trillion over ten years ($100 billion per year) that Obama estimates his own government-run health care would cost.

(And about Obama's estimates, well, um, I don't exactly trust them. I strongly suspect, as does everybody else -- including ObamaCare supporters -- that such a program would cost considerably more than $100 billion each year.)

But wait, there's more: Somebody must also fill up those MSAs and keep them topped off. If you want, say, $10,000 per household in them, that would be an additional $35 billion; but that's a one-time cost, and you can amortize that over, say, ten years, for an additional $3.5 billion per year.

Then you must keep the MSAs filled. Assuming a continuing cost of perhaps 20% ($500) per year per uninsured, that would be $7 billion per year. The grand total works out to $12.25 plus $3.5 plus $7, or in round figures, a little less than $25 billion per year.

But wait, there's less! Part of the plan is that the feds only pay "a significant part (but not 100%) of health-insurance costs." Even those with incomes less than $25,000 should expect to pay some of the cost themselves; if it's even 15% average, that would reduce the total annual payout to about $20 billion... a tiny fraction of the cost of ObamaCare, even using Obama's own figures.

And the best part is -- the federales would not have to take over America's health care.

Obviously my figures are just estimates, guesstimates even; but they're not out of line. The Republicans can easily rope in some actual insurance experts to find out what premiums insurance companies would charge for such a massive buy (any government purchase should be distributed evenly among all carriers, like "assigned risk" in auto insurance, to avoid even the appearance of corruption).

Then GOP representatives and senators could craft a plan with a completely realistic and accurate price tag that is certainly dramatically lower than socialized medicine. And when combined with allowing all of the insured, above and below the poverty line, to maintain individual control of their insurance and medical care, the plan would be a huge winner with the American voter.

We could sweeten the pot by adding a number of free-market features designed to appeal to the great majority of us who do have health insurance:

  • Making insurance policies portable when we change jobs or move;
  • Creating incentives for insurance carriers and consumers to switch to low-premium, high-deductable insurance coupled with expanded MSAs for anyone who wants that option. Medical savings accounts lower costs, because patients pay for their own minor medical charges out of their MSA, which they must then replentish: When the patient himself is the primary payer, he tends to be a more careful shopper.
  • Creating a national query-friendly database registry of insurance carriers, coupled with software to allow consumers to quickly and easily find their best insurance deal over the web;
  • Allowing Medicare and Medicaid recipients the same range of plans that ordinary insurance consumers have -- "the GOP is pro-choice on health insurance!"

If we did this, then instead of simply being "the party of NO," we'd be the party of options, choices, freedom, and Capitalism. I believe that nearly every single Republican, from a Jim DeMint (R-SC, 100%) conservative to a Rep. Peter King (R-NY, 50%) moderate, would get behind such a proposal.

In fact, the lizardian proposal is so clean and inexpensive (compared to the Obamic alternative), we would probably pick up a number of blue dogs. Imagine the fun of more than half the Senate lining up behind the GOP bill, forcing the humiliated Democrats to filibuster their own Congress. Oh, the humanity!

In any event, we would no longer be trying to beat something wicked with a fistful of nays. Instead, we could go head to head with the Democrats, substance for substance. It is from exactly such principled but unifying proposals that we can build the nucleus of another Contract with America.

Hatched by Dafydd on this day, June 14, 2009, at the time of 2:38 AM

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Comments

The following hissed in response by: snochasr

A couple of things:
First, your universal mandate sounds a lot like Mitt Romney's plan in Massachusetts, which has foundered on the rocks of excess government regulation-- insurance mandates-- driving up the cost to where more people cannot afford it, and thus costing the taxpayers more than necessary.

As for portability, the best approach is the McCain plan of taxing employer-paid benefits, and then giving out a corresponding tax credit to everybody to buy their own insurance. There's probably enough "excess" revenue in doing this that the tax credit could be made refundable, thus paying for the "poor" and NOT paying for the rich. It's even simpler than what you suggest.

I'm not totally convinced that we need to really offer a positive alternative. This is such a bad idea that "no" is the natural response of the voters already. If Republicans can cast this bill as "Hillarycare II" or "nationalized health care," the battle is probably one. Offering a positive alternative is just nailing the coffin, and a matter of good governance. Which is something we haven't had in a long time.

The above hissed in response by: snochasr [TypeKey Profile Page] at June 14, 2009 7:15 AM

The following hissed in response by: snochasr

One more nice thing about the McCain plan is that it avoids the prospect of having the federal government telling every citizen what to do with a big chunk of their own money. There is a tax on your income (as the benefit you receive from your employer), just like other income taxes. There is a tax deduction/credit for you if you do what the government wants, to buy health insurance, just like so many other deductions and credits. But, it is strictly voluntary, as it should be. I see no place in the Constitution where the government is allowed to tell you what to buy, or that you must buy. It's a bad precedent. Next thing they'll be telling you that you have to buy a GM "green" car.

The above hissed in response by: snochasr [TypeKey Profile Page] at June 14, 2009 7:22 AM

The following hissed in response by: Dafydd ab Hugh

Snochasr:

You make a good point about the unconstitutionality of a direct federal mandate. It's better to do it via federalism by making various health-related federal revenues to the states contingent upon them enacting state mandates... as the states do have such general police powers. (If a state chooses to forgo those revenues and not enact mandates, that is its legislature's choice.)

However, on the other point, I don't see how requiring people to have some form of insurance would necessarily "driv[e] up the cost to where more people cannot afford it," unless the government -- the state government, in this case now -- got too specific as to exactly what such insurance should cover.

Sure, any good plan can be turned into a bad plan by monkeying with the details; but that is no reason not to have a plan. If we're using federalism here, then let each state decide for itself how to mandate insurance coverage; some states will have better plans than others, and that leaves room for the unsuccessful states to have to face the electoral music.

(Conservatives in those states can run against the overly determined plan, pointing to the successes of neighboring states with less odious regulations.)

As to the idea that we can assuredly defeat this bill without having a positive alternative -- the problem is that even if we defeat this particular version, the existence of the perceived "crisis" is a perpetual invitation to the Democrats to come back again and again and again with new plans, each more devious than the last, each more subtle in trying to achieve their ultimate goal of government-run health care.

Even now we see this: Rather the the crudity of HillaryCare, with its "health-care alliances" that flat-out forbade citizens from seeking out private health care even could they afford it out of pocket, we now have the "public option"... which in the end will have that same effect (driving out all health care but the government's), but which requires much explanation to convince the voters of that fact.

The next one may well be more subtle yet; and eventually, if we leave the door open by doing nothing about the perceived "crisis," one of them will sneak through. Remember, in politics, perception trumps reality: You must not only govern but be seen to govern.

But I'll change the post to reflect your excellent point about the lack of an enumerated power for the feds to require the insurance directly.

Dafydd

The above hissed in response by: Dafydd ab Hugh [TypeKey Profile Page] at June 14, 2009 11:45 AM

The following hissed in response by: Bart Johnson

When you encounter some wonderfully grand project that will save all of Mankind, help us loose weight,
bring peace to the Middle east, etc., etc., etc.,
but which is not Constitutionally supported,
the proper response is NOT to find a way around it.
The proper way is to say,
"Tsk, tsk. Such a pity."

Then get private enterprise to make money off of it.

Correction, that should have read,

Then let private enterprise to make money off if it.

The above hissed in response by: Bart Johnson [TypeKey Profile Page] at June 14, 2009 12:39 PM

The following hissed in response by: Dafydd ab Hugh

Bart Johnson:

In an ideal world, that would indeed be the proper response.

But we live in a political world with socialist enemies of Americanism running our government. I'm not as sanguine as you that if we just firmly stand by our principles, and announce that none of these perceived crises is really the responsibility of the federal government, that the voters will come to their senses, rise up, and throw out Obama and the Pelosi/Reid Congress.

In real life, there is no John Galt.

Dafydd

The above hissed in response by: Dafydd ab Hugh [TypeKey Profile Page] at June 14, 2009 12:52 PM

The following hissed in response by: Bart Johnson

When I was a boy, very few people had health insurance. They also paid about 5% in federal taxes.
We are in the current mess because people played fast and furious with their morals,
"For the Children."

Why do we complain that a politician doesn't keep his word when we demand that sort of behavior.

It's harder when The One, The AntiGalt is in charge.

The above hissed in response by: Bart Johnson [TypeKey Profile Page] at June 14, 2009 3:06 PM

The following hissed in response by: BarbaraS

Dafydd

You don't have provision for the 6.4 million who have lost their jobs and their insurance at the same time along with future loss of jobs. With no money coming in except unemployment for a limited time these people will not be able to afford insurance of any kind. They will too busy trying to save their homes and buy groceries. But on the other hand, with the loss of revenue (taxes) of this group hoq does Obama think the government can pay for his vote buying inniative. Only by putting the country into hock with the Chinese or by printing some more money.

The above hissed in response by: BarbaraS [TypeKey Profile Page] at June 14, 2009 4:31 PM

The following hissed in response by: snochasr

Yes, a federal mandate that we all buy insurance runs afoul of the Constitution, thank you for recognizing that. But your solution, of denying federal dollars to states that do not create an equivalent mandate runs afoul of the Constitution's 10th amendment, and is even now the subject of a few lawsuits by the States. Besides, there should be a RIGHT, under the Constitution, to NOT having insurance, even were it free, and certainly a right not to have to pay for something I do not want. Am I supposed to buy insurance instead of food? What kind of freedom is that?

The reason costs would rise out of control is one reason why costs are already out of control, because of individual State mandates on what insurance must cover. Here is where the federal government could actually use its Constitutional authority to do good things, by mandating that the "interstate commerce" of insurance may not be obstructed by state regulation, permitting Illinois insurance companies, for example, to sell low-cost, no-frills policies in Ohio or Texas.

Your point about the need to drive a stake through the heart of this terrible idea is a good one, but we first need to get this incarnation of the monster on the ground. There is no way the Republican/conservative/common sense/Constitutional alternative can be passed in the current Democratic Socialist Congress. Defeat it, and use the defeat to elect people that will "sell" and implement the alternative.

The above hissed in response by: snochasr [TypeKey Profile Page] at June 15, 2009 5:42 AM

The following hissed in response by: Geoman

All plans will fail that do not address the drivers for increased costs. Your plan is brilliant. Yet, $20 billion per year will continue to grow and grow, uncontrollably.

What causes health care costs to grow faster than inflation? Simple. Your life and health is worth all the money in the world...to you. Once your life and health is backed by large corporation, the state, or the federal government, costs will inevitably escalate uncontrollably.

The only solution to control costs has been draconian government rationing of care. Other nations practice this.

One possible solution would be direct medical endowments. Each year the federal government would endow various hospitals to provide free care to the uninsured. The money would be invested like any endowment, and 5% of the total value each year would be used to pay for care.

Now, each year you spend money, your are permanently investing in health care for people, and removing their costs from the system.

Obviously there would be an initial rush of people into the free hospitals, demanding free care. Fine. Those hospitals would have to ration the care, just like the government would have to. BUT over time, as more and more money as poured into the endowments, the crises would ease.

Added benefit - eventually (20 years? 50 years?)the endowment would be large enough to provide everyone in the U.S. free health care, cradle to grave, in perpetuity. Added benefit - lots of money being invested into the U.S. economy.

There are probably a bunch of holes in a plan like this, but I can't see any fundamental problems that would keep it from working.

The above hissed in response by: Geoman [TypeKey Profile Page] at June 15, 2009 10:56 AM

The following hissed in response by: Freetime

In the late 19th century, insurance companies were numerous and activity was extreme with players entering the market at an ever increasing rate until competition became cutthroat. Many states saw this as a tax windfall and used those powers unmercifully and, at the same time, imposed large numbers of regulations that were highly variable between the states. State supervision was in many cases ignorant and corrupt as well. The companies were trapped between extremely high competition and equally high government-imposed costs and petitioned Congress for relief through a national regulation scheme with basic standards that they could all work under. This was stymied by a Scotus decision (Paul vs, Virginia, 1868) which essentially ruled that insurance was a contract as opposed to commerce and, hence couldn’t be controlled by the national government. The Gordian Knot of state control continued. (This information is from The Triumph of Conservatism by Gabriel Kolko. My apologies to him if I have misunderstood his points).

I don't know if this has been resolved since the mid-19th century. It would seem, though, that it is still the case and in order to sell insurance in each state the companies have to offer an ever-increasing set of insurables to be able to continue operating across the state lines. The contract/commerce argument seems specious at best to me and it seems that it is past time for the fed to step in. Not at the specific, mandate, single-payer level, but at the overall nation-wide set of standards level. One would think that alone would have a beneficial effect on costs (and costs are the root problem here).

The above hissed in response by: Freetime [TypeKey Profile Page] at June 15, 2009 10:58 AM

The following hissed in response by: BD

Any mandate that everyone have health insurance "of some kind" will inevitably become a mandate for "gold plated insurance" - health care providers who wind up outside the mandate will go to work immediately lobbying legislators to compel their inclusion (we all know elected officials are legislative nymphomaniacs).

Giving people some sort of tax credit for health insurance premiums would give them less opportunity for mischief.

The above hissed in response by: BD [TypeKey Profile Page] at June 15, 2009 1:13 PM

The following hissed in response by: Dafydd ab Hugh

Snochasr:

Yes, a federal mandate that we all buy insurance runs afoul of the Constitution, thank you for recognizing that. But your solution, of denying federal dollars to states that do not create an equivalent mandate runs afoul of the Constitution's 10th amendment, and is even now the subject of a few lawsuits by the States.

Those lawsuits will go nowhere. The principle is well established that the federal government can choose who it will send money to, so long as they don't decide on forbidden grounds (e.g., race -- and even there, the Court has approved obviously racist "affirmative action" distributions). The states have no "right," not even under the Tenth Amendment, to federal largess.

Besides, there should be a RIGHT, under the Constitution, to NOT having insurance, even were it free, and certainly a right not to have to pay for something I do not want.

Perhaps there "should be," but there isn't. States and local governments often compel people to pay for things they don't want. In an ideal world...

The reason costs would rise out of control is one reason why costs are already out of control, because of individual State mandates on what insurance must cover.

Exactly; and that is an independent question from general state mandates for insurance coverage. But see my comment below.

BD:

Any mandate that everyone have health insurance "of some kind" will inevitably become a mandate for "gold plated insurance"

That's certainly a distinct possibility in some states -- e.g., New Jersey, New York, Massachusetts, my state of California, and so forth.

But one benefit of the new proposal is that other states would probably not require such "gold-plated insurance;" as with Capitalism itself, the former states would have terrible econonmic consequences -- in contrast to the latter.

The contrast would be so marked that it would be difficult for any but the most diehard supporter of such golden hospital beds to fail to recognize that the specific insurance mandates were out of control in his state.

And that opens the door as wide as Joe Biden's mouth for Republicans, and even Democrats who believe in a free market and libertarian economics, to run against Democratic (or Republican!) statists.

Finally, I honestly do not expect this GOP plan to pass, not in this Congress. Rather, its purpose is to show that there are much better, much cheaper, much more responsible, and much less socialist ways to resolve the problem of the uninsured than Obama's stunning attempt to put all of America's health care in the hands of the federal bureaucracy, instead of in the hands of doctors, patients, and even insurance companies.

I expect it to fail. But its existence will also, I am convinced, stop ObamaCare from passing.

Likely nothing will be done in this Congress; and the very fact that the Democrats shoot down, probably by fillibuster, a widely popular health-insurance reform plan -- which this would be, supported by nearly all Republicans and quite a few Democrats -- will make the Democrats suddenly vulnerable on a signature issue that until recently, they have positively pwned.

(Yes, there is a very Machiavellian component to my proposal; we live in a political world, and every policy has political implications, good or bad.)

This is precisely what happened to HillaryCare in 1993; and I am likewise persuaded that its failure led in large part to the Republican sweep in the 1994 Congressional elections.

Dafydd

The above hissed in response by: Dafydd ab Hugh [TypeKey Profile Page] at June 15, 2009 1:41 PM

The following hissed in response by: Dick E

Dafydd-

Actually, I think the cost to society of mandating universal health coverage would be less than you estimate. Assuming the accuracy of your $875 annual premium per uninsured, impoverished person, the actual cost to the rest of us would really be less than that. The $875 includes actual medical expenses plus the insurance company’s administrative costs and profit. We (society) are already paying the medical expenses -- you specified that the coverage would be catastrophic -- so the only new cost to the rest of us would be the insurance company’s piece.

Similar logic applies to the not-so-poor uninsured. They too can have catastrophic medical expenses that they find themselves unable to pay. Maybe they negotiate a discount, maybe they declare bankruptcy, but somehow the rest of us end up paying their medical bills. If everyone were forced to buy medical coverage, society’s cost would be lower to the extent we would otherwise be paying those bills.

By the way, I’m glad to see you’ve come around on mandated universal health care. That’s quite a change from your previous position. (“I absolutely, utterly oppose any mandate for anyone to have health insurance.” Your response of 9/1/06 at 12:33PM) Was it my impeccable argument? (My response of 9/2/06 at 12:07AM) Or was it the threat of Obamacare? Yeah, I thought so.

The above hissed in response by: Dick E [TypeKey Profile Page] at June 15, 2009 7:19 PM

The following hissed in response by: Dafydd ab Hugh

Dick E:

It's the latter, as you surmised; but actually, I've mellowed in my opposition to mandates: I just can't get around the "free rider" problem of people who refuse to buy health insurance, get sick or injured, and expect to be treated anyway, even if they cannot pay.

What to do, what to do? We can't refuse to treat people who don't have insurance; if it's a disease, that puts the rest of us at risk; and if it's an injury, especially to the wife or child of some man who refused to buy insurance, can we really, as a society, allow the victim to bleed to death in plain sight of a doctor?

Nor can we even require the hospital and doctor to hold off treatment until they can determine whether the patient has insurance. What if it takes hours?

No doctor worth his degree would do so. Unless it's a triage situation, they'll treat the patient, no matter what. So the problem always resolves as the rest of us paying for that one guy and his family.

Too, my main concern three years ago was that if the government can mandate insurance, it can mandate specific coverage -- you have to get insurance that specifically covers mental illness, pregnancy, abortion, drug addiction treatment, obesity, AIDS and other STDs, marital counseling, leg dislocation due to bungee jumping, and everything else in the world.

But you may know very well that you, a young, single guy, don't need coverage for most of those things... so why must you pay for it?

This is still a huge concern of mine; it's clearly something we all agree jacks up the price of insurance something fierce... and remember, I live in a state that is very prone to add on such frivolities to a general mandate to have insurance.

But I see the freight train a-comin', it's rollin' down the track. We'd better find a way to derail it with a smaller, lighter, cheaper, and less aggressively statist train; because if we just stand on the tracks and shout "STOP!"... well, it won't be pretty.

We're in the same conundrum as with the prescription drug benefit for Medicare or Medicaid, whichever it was (or both): Some form of benefit was going to be added -- the only question was whether we could mitigate the damage... which I think we did. (The Democratic plan was much, much worse.)

In the case of the uninsured, the argument for a mandate is actually better; there really is no other way to prevent them from mooching off the rest of us than to make them buy insurance (or post an equivalent bond). But we can at least try to prevent the ghastly scourge of ObamaCare (just as bad as HillaryCare, but more devious) from being inflicted upon us by the One That International Socialism Has Been Waiting For.

But good catch, Dick E.: Clearly I'm not as adamant against mandated insurance now as back in 2006. I've been, in a sense, mugged by reality. Or at least by the bread and circumcisions of democracy.

Dafydd

The above hissed in response by: Dafydd ab Hugh [TypeKey Profile Page] at June 15, 2009 9:56 PM

The following hissed in response by: snochasr

The problem with a "less aggressively statist train" is that it is still statist, and it still moves us in the wrong direction. The problem with our health care system today is strictly one of cost, and 50% of the cost in the current system is caused by one form or another of government meddling. MORE government meddling is simply a way to guarantee higher costs, and not a properly conservative approach. Yes, whatever you propose needs to be "sellable" and make such simple common sense that it will be readily obvious to a large majority that it makes sense and will be better than what THEY have now.

You have made a great analysis and proposal, of using federally-funded MSAs for the poor and currently uninsured, but that should not translate into a mandate on the 85% of us who ARE insured. Why should it? Better to leave us alone, for the time being, thus gaining you most of the 85% as instant allies. But when somebody shows up at the clinic without insurance, they get treated and they are mandated to sign up for some PRIVATE insurance, and the government foots the bill until government can recoup the cost from the patient, or maybe not. This to me was the most odious provision of Hillarycare, that you had your choice of doctor until you actually needed one, and then they told you which one you could have, and what you would pay. It was objectionable because it applied to everybody, not just the poor and irresponsible. If the problem is the uninsured, then do something better for the uninsured and leave the rest of us be. For now.

If the problem is it costs too much, for all of us, then you have to get government out of the business of health care, not let it further in. Lift the federal limit on MSA accounts. Make insurance portable and directly involve the consumer by moving the federal tax benefit of employer-paid plans to the employee. Talk about reforming Medicare and Medicaid because they are BROKE and stand as irrefutable proof that government doesn't know how to run a health care program. Make the point that health insurance is NOT health care, so that just giving (or mandating) insurance doesn't mean you have a doctor willing or able to see you, let alone treat you. Say that the only way government can control costs is by rationing, one way or another, and that Obamacare is just Hillarycare's corpse warmed over. It's a pie-in-the-sky fantasy that they're trying to rush through without anybody noticing.

A positive alternative is good, even necessary, as you point out, but it doesn't have to be any more clear and realistic than the current muddy pig in the gold sequined gown that Obama and Kennedy are trying to peddle, until we can get somebody into Congress willing to consider such alternatives.

The above hissed in response by: snochasr [TypeKey Profile Page] at June 16, 2009 2:38 AM

The following hissed in response by: Dafydd ab Hugh

Snochasr:

I don't understand this point of yours:

You have made a great analysis and proposal, of using federally-funded MSAs for the poor and currently uninsured, but that should not translate into a mandate on the 85% of us who ARE insured. Why should it? Better to leave us alone, for the time being, thus gaining you most of the 85% as instant allies.

The mandate is only that each person have some form of insurance. If you "ARE insured," then you meet the mandate by definition -- no change is necessary.

(The only exception would be if someone claimed that he was "insured" by his unemployed cousin in Juarez, and he has a handwritten note from his cousin to prove it. Obviously, the "insurance" must be real, not imaginary!)

That is part of the plan above: Because there is no federal government option, that means private insurance need not be affected... but that is up to the individual states. (We can't have it both ways: If a mandate can only be enacted by a state, not by the feds, then it's hard to see how the feds could prevent the state from mandating a bunch of gold-plated coverage.)

So at the very least, the statism is pushed down to a lower governmental level than with ObamaCare; and this itself is a tremendous improvement. If a state, rather than the federal government, mandates an odious level of coverage, it's easier to change -- and much easier to depart their jurisdiction, if necessary.

And once again, the contrast between states that overdetermine their required coverage and those that do not will be so obvious that antistatist candidates for office can surely use that contrast to oust the statists from office. So it serves a dual use (like Saddam Hussein's "trailers for making weather balloons").

Dafydd

The above hissed in response by: Dafydd ab Hugh [TypeKey Profile Page] at June 16, 2009 12:23 PM

The following hissed in response by: Dick E

Dafydd-

The mandate is only that each person have some form of insurance. If you "ARE insured," then you meet the mandate by definition -- no change is necessary.

The problem is, if the government mandates that everyone have some form of health coverage, they will also decide which policies qualify and which don’t.

They’ll decide which companies can offer plans. Minimum capitalization is a criterion that immediately springs to mind.

They’ll also decide what must be covered. It’s highly unlikely, for example, that they would consider a plan qualified if it excluded coverage for “leg dislocation due to bungee jumping,” the example you (facetiously) gave above. Once the camel’s nose is under this skirt, the door is wide open for further specific coverage mandates.

And how likely is it that our leaders will require nothing more than the “catastrophic” coverage you specify?

These are obviously not “selling points” for conservatives to convince them to back mandated health coverage. Just things to keep in mind while selling.

(I resist calling these plans “insurance” because of the kinds of things typically covered: Pregnancy, immunizations, preventive care, etc. Those are not the catastrophes that true insurance is designed to indemnify. It is, however, appropriate to call your catastrophic plan insurance.)

The above hissed in response by: Dick E [TypeKey Profile Page] at June 16, 2009 4:49 PM

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