Still trying to kill Obamacare

The ongoing efforts by the Trump administration and many Republicans to destroy Obamacare is outrageous. This is especially true because nothing has been proposed as a viable alternative.

Conservative “solutions” relying on health savings accounts, direct pay primary care, competition, etc. are bunk. And, they fail to comprehend how individuals view health care and paying for it.

This is not to say the progressive extreme is viable either, but we need to start with a single premise; every American must be covered with comparable assistance with medical bills.

A public option is no solution. All it will do is create growing adverse selection and slowly but painfully destroy all private insurance. That’s no way to get to something better.

True, Obamacare has not accomplished it’s promised goals for coverage or affordability, but it has helped millions of Americans. We do need something better.

Not assuring coverage for every American simply means that the cost of care for the uninsured is buried in the costs for insured individuals.

And please, don’t use the word “free.” A health care system must include reasonable cost sharing by all Americans. That means taxes, premiums and some out-of-pocket costs.

The Trump ad­min­is­tra­tion urged the Supreme Court to in­val­i­date the Af­ford­able Care Act in a le­gal brief filed Thurs­day, putting health care at cen­ter stage in an elec­tion year al­ready fo-cused on the coro­n­avirus pan­dem­ic’s im­pact.

The Jus­tice De­part­ment said the 2010 health law, a sig­na­ture achieve­ment of the Obama ad­min­is­tra­tion, is in­valid be­cause Con­gress in 2017 ended the fi­nan­cial penalty for not hav­ing health in­sur­ance, though it didn’t take ef­fect un­til 2019.

Source: Trump Administration Asks Supreme Court to Invalidate Affordable Care Act, Wall Street Journal June 26, 2020

5 comments

  1. Viable alternatives have been proposed. Those alternatives, however, would require people to actually pay for their health care coverage – not smoke and mirrors have someone else pay. That is, people want the best health care YOUR money will buy!

    Viable alternatives were proposed in 2008, but, once the D’s had a super majority in the House and Senate, they pushed through something that clearly wouldn’t “allow you to keep your plan”, “allow you to keep your doctor”, “will lower annual costs per family by $2,000+”, and “won’t add one dime to the deficit”.

    As sold, the Patient Protection and Affordable Care Act of 2010 was never viable, and never will be – if we are to measure its performance based on the representations made in 2009 and 2010.

    And, seriously, no one wants a viable alternative now. They want someone else to pay. I say who do they think will pay the cost if we ourselves are not willing to pay the cost of the services we receive. The French? Perhaps Mr. Trump can get the Mexicans to pay for the wall and health coverage.

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      1. You are correct. There is no perfect solution for everyone. That is, some Americans believe this is a right, an entitlement, that society should provide – without, at the same time, acknowledging that they, as members of Society, are themselves responsible to provide for the coverage. We have lots of idiot Senators and Representatives who nurture this idea as a means to buy votes. These are folks who want the best coverage YOUR money will buy!

        In 2008, there were perhaps five different proposals that had some support. In various discussions with policy-makers in DC, we went over the five alternatives. I think Dick was in on some of them.

        Everyone was sure their proposal was best. We had a variant of health reform (loosely based on Massachusetts health reform), single payer, managed care, and some stupid stuff left over from health “reforms” in Washington State, New York State, New Jersey and others – where the local state insurance officials had wrecked the individual insurance systems.

        What was obvious, and laughable, was that no one changed their mind after the discussion – they continued to favor their own proposal. And, when asked their preference for #2, every last one of them preferred maintaining the status quo over the other proposals.

        That was even true for the states who had wrecked individual health insurance markets. You ask, what do you mean by “wrecked”? Well, keep in mind that after PPACA added the individual marketplace/exchanges in 2014, the premiums for individuals in states like NY and NJ went down – despite the more generous coverage. For most other states, for most other individuals in the individual marketplace, premiums went up – but net, net, declined for those who enrolled because of taxpayer subsidies. That is 90+% of folks in the individual marketplace after 2014 were those who got taxpayer subsidies. In 2019, the average premium before application of the tax credit was $612/month. The average tax credit covered about 86 percent of the total premium in 2019, and the average net premium paid by enrollees was $87 in 2019. Obviously, this significantly increased taxes others had to pay.

        Despite that modest cost, 8% of Americans, 26+MM Americans (as well as most of the 20+MM individuals here illegally/undocumented) remain uninsured. Keep in mind that 26+MM is more than 50% of Americans who don’t otherwise have access to employer-sponsored coverage, Medicare, Medicaid or VA coverage!

        Health Reform is a Failure:

        it is a failure, especially if we measure it against the promises mentioned above – everyone covered, lower cost, keep plan, keep doctor, avoid increasing the deficit, national debt.

        I once described health reform in an October 2010 presentation as: “Federal Health Care Reform – Reducing the Number of Uninsured at Any Cost; All past, similar attempts have had varying levels of success at reducing the number of uninsured; but all were unsustainable – generating significant increases in cost and reducing access to service providers.”

        Here’s an excerpt from my October 12, 2010 Cleveland Ohio presentation:

        My prediction is based on analysis of what Health Care Reform meant for something similar, but not exactly the same … the 2006 Massachusetts (MA) changes. Like our new federal law, MA added:
        1. An individual mandate,
        2. An employer mandate, and
        3. Set minimum coverage levels, etc. – all based on the belief that “getting everyone covered would reduce the cost of coverage to all”.

        Unlike the new federal law, the MA changes:
        1. Were not resisted by litigation, or state legislation/constitutional amendments,
        2. Only imposed minimal penalties on employers who did not offer coverage, and
        3. Initially served to encourage individuals to ignore the individual mandate until they needed coverage.

        Who pays, how much?

        Health care spending is 18% of GDP. GDP is measured many ways, but if we do it on the income approach, it is: GDP = Total national income + Sales taxes + Depreciation + Net foreign factor income Where: Total national income is equal to the sum of all wages plus rents plus interest and profits.

        Personal income was about 18.6 Trillion in 2019, GDP about $21.4 Trillion. So, health care was about 20.7% of personal income in 2019. Does every American have a deduction on each paycheck that is 20% of their gross wages? No, of course not. There would be significant resistance. So, we are attempting to do something as a society that most of us are unwilling to do as individuals. Because the cost of health care coverage is not a function of wages, but a per capita amount (multiplied by the number covered in the family), the cost would result in a percentage of 30% – 90% of wages for individuals who earn less than the median.

        My Concept – Nothing New, A Variant of Past Proposals

        So, the variant of health reform I believe would successfully attract the support of the majority of Americans splits the cost of health coverage into three parts:
        (1) Coverage for acute care expenses above a specific stop loss level, what I call society’s responsibility, to be funded by general revenue taxes. That includes over 50% of all health care costs typically incurred by less than 5% of America’s population, where 90% of that 5% are typically individuals covered under Medicare or Medicaid today, I am thinking of a stop loss level of $25,000/year/person.
        (2) Coverage for acute care expenses below the specific stop loss level, where individuals would be responsible for coverage costs:
        (a) Can be employer-sponsored coverage,
        (b) Can be coverage under Medicaid, Medicare, VA (to the extent Congress decides to retain/revamp those programs given changes #1, above and #3, below, or
        (c) Can be coverage through an exchange.
        (3) Coverage for preventive services.

        Every individual who is “lawfully present” in America is covered under (1) and (3) – no premium or contribution required. That is, those services are societal in nature, where the exposure to society justifies the investment/coverage. Under items (1) and (3), charges are limited to those that would apply under Medicaid – no balance billing.

        Every other person in America, “lawfully present” or not, is covered under (2) in one of two ways:
        (1) They can voluntarily enroll in employer-sponsored coverage, Medicare, Medicaid or through the exchange, or
        (2) They can elect to be self-insured (and liable for the $25,000 in potential expense).

        Enrollment in the public exchange (where premiums are added to withholding taxes) shall be the default, where individuals can opt out only by demonstrating that they have coverage under an employer-sponsored plan or that they have maintained accumulated, cash-equivalent assets equal to their potential liability throughout the calendar year. This will become part of the income tax filing process. Outstanding debts will accumulate, and will no longer be discharged in bankruptcy. Parents will be liable to cover children under age 18.

        Those who are not lawfully present in America are self-insured for all costs – or where they have coverage under a foreign insurer or foreign state system, the provider is free to accept payment from that coverage. Again, costs are no longer discharged in bankruptcy. American taxpayers should not be called upon to pay the costs to cover individuals who are not American taxpayers, not part of American society.

        History/Rationale of This Concept:

        This is a variant of a concept once supported by Senator Ted Kennedy (D-MA), Senator John Kerry (D-MA), Senator Jack Reid (D-RI), Bill Frist (R-TN) https://www.nytimes.com/2004/10/23/business/momentum-builds-for-us-role-in-paying-highest-health-costs.html The variation is that it covers every lawfully present American – whether you are covered under Medicare, Medicaid, employer-sponsored coverage, the exchange or self-insured. It reflects what I call Society’s responsibility – in that no one person, no individual insurance policy, and most employers’ cannot afford to finance health coverage that has no maximum benefit, if that is society’s goal, then it is society’s burden, not one that should be allocated to only a few. And, consistent with that goal, the reimbursement rates should be determined by Society as well.

        Lot’s more detail, but it is a 100% coverage solution that attempts to allocate the financial burdens of health care coverage to society, where appropriate, and to individuals (or to their employers who voluntarily offer coverage as part of total rewards programs).

        I believe this would gain support from a majority of Americans, those who understand that Congressional promises don’t include monies from some outside source – that they are pledges to tax some to provide benefits to others. I believe a majority of “lawfully present” Americans will support embrace of Society’s role. And, importantly, most Americans (and their employers) will see their nominal cost of coverage decline (their taxes may modestly increase) where half of all medical expenses are now subject to arbitrary, lower reimbursement rates under Medicaid. Providers get the certainty of payment, not the opportunity to achieve significant profits. That’s also true for the health insurance companies because over half of medical costs are now financed by taxpayers through stop loss/reinsurance.

        However, no one who asserts that they are entitled to the best coverage YOUR money will buy will support this concept. No one who believes health care is an entitlement will support this concept. No one who believes America is a “rich country that can afford to provide coverage for all” will support this concept.

        My apologies for the length of this post. However, we are talking about 1/5th of the entire US economy!

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  2. Speaking of health care…why are some politicians opposed to tax dollars being used at religious schools while our Medicaid/Medicare tax dollars are currently being spent at religious hospitals…just asking the question?

    Liked by 1 person

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