Hey Chris- you said that “House Republicans have voted to repeal and replace the ACA at least 100 times. Some of the plans were good; some less so; but many were real comprehensive reform bills.” Were they reforms along the lines that you have already stated before in your piece? Which of those plans do you consider the top reforms- the best the GOP has viably put forward?
One of the reasons I found the article you were responding to so compelling was that it seemed clear after 15 years of holding my breath for a GOP alternative that none has arisen. Now you seem to indicate there might have actually been such a thing- and the only difficulty was getting it through the senate. But doesn't the fact that none of these plans could get through the senate undermine the sense that the GOP had an actual viable alternative? Shouldn't any such plan meet the standard of “passable” to be a good plan?
The reason none of those reforms ever became law is they were politically toxic and couldn’t garner majority support. Filibuster is just cope and allows the majority to blame the minority party when in reality the majority party just wanted an excuse not to do something unpopular or they think is a bad idea.
I understand the need to have something in place for people who currently have a pre-existing condition. But what incentive will there be for people to get insured under Republican proposals? Simplest, of course, would be to say that going forward insurers *will* be allowed to charge higher prices to people with pre-existing conditions.
Also:
-- Wouldn't it be a great step forward if employed people could get the tax break for *any* health care plan, not just ones offered by their employer?
-- Wouldn't it be helpful to set up a system where an insurer with a costly customer can allow that customer to switch insurer while paying the new insurer a lump sum payment. Otherwise, switching is hard.
“Specifically, Congress should allow individuals to obtain lower-cost, unsubsidized insurance, priced in proportion to their medical risks, if they sign up before they get sick.”
But healthy people aren’t what drive costs; it’s paying for medical care for sick people. I have a friend who got throat cancer. His medical bills were a shade over a million dollars in a single year. Because of chemo, his long-term memory is now shot. Allowing a 30-year-old with no preexisting conditions to buy a cheaper plan says nothing about how my friend’s medical costs get paid for.
Paying for health insurance for people who aren’t going to use it is easy. The hard question in healthcare is always: who pays for the sick, and for what? When it comes to the government’s fiscal situation and taxes, that is the only question that matters.
Here’s a modest proposal: we fully repeal Obamacare. All regulations and subsidies are eliminated. New rules are enacted that allow insurance to be priced based on someone’s health risks. Finally, one change is made to Medicare: if insurance companies will not sell someone a policy, if the policy costs more than 10% of their AGI, or if no policy will cover the necessary medical treatments, then that person is allowed to join traditional Medicare.
Of course, if you did that, large numbers of people would stampede into Medicare, and many others would be apoplectic about how much insurance costs because they have diabetes or happen to be women of childbearing age.
Most GOP reform plans are as follows:
1) Hi-risk pools
2) Med mal reform
3) Sell insurance across interstate lines
4) HSAs with High deductible health plans
5) short term health plans
6) Risk adjusted premiums
Each is an idea. Together they are not a system.
Hey Chris- you said that “House Republicans have voted to repeal and replace the ACA at least 100 times. Some of the plans were good; some less so; but many were real comprehensive reform bills.” Were they reforms along the lines that you have already stated before in your piece? Which of those plans do you consider the top reforms- the best the GOP has viably put forward?
One of the reasons I found the article you were responding to so compelling was that it seemed clear after 15 years of holding my breath for a GOP alternative that none has arisen. Now you seem to indicate there might have actually been such a thing- and the only difficulty was getting it through the senate. But doesn't the fact that none of these plans could get through the senate undermine the sense that the GOP had an actual viable alternative? Shouldn't any such plan meet the standard of “passable” to be a good plan?
The reason none of those reforms ever became law is they were politically toxic and couldn’t garner majority support. Filibuster is just cope and allows the majority to blame the minority party when in reality the majority party just wanted an excuse not to do something unpopular or they think is a bad idea.
But doesn't the fact that none of these plans could get through the senate undermine the sense that the GOP had an actual viable alternative?
No, this doesnt logically follow
When it comes to political solutions or policy proposala, aren't they only viable if they can - you know- become legislation?
A policy can be viable if implemented while being politically unpalatable at any given moment
this is very interesting but have you heard of adverse selection
I understand the need to have something in place for people who currently have a pre-existing condition. But what incentive will there be for people to get insured under Republican proposals? Simplest, of course, would be to say that going forward insurers *will* be allowed to charge higher prices to people with pre-existing conditions.
Also:
-- Wouldn't it be a great step forward if employed people could get the tax break for *any* health care plan, not just ones offered by their employer?
-- Wouldn't it be helpful to set up a system where an insurer with a costly customer can allow that customer to switch insurer while paying the new insurer a lump sum payment. Otherwise, switching is hard.
“Specifically, Congress should allow individuals to obtain lower-cost, unsubsidized insurance, priced in proportion to their medical risks, if they sign up before they get sick.”
But healthy people aren’t what drive costs; it’s paying for medical care for sick people. I have a friend who got throat cancer. His medical bills were a shade over a million dollars in a single year. Because of chemo, his long-term memory is now shot. Allowing a 30-year-old with no preexisting conditions to buy a cheaper plan says nothing about how my friend’s medical costs get paid for.
Paying for health insurance for people who aren’t going to use it is easy. The hard question in healthcare is always: who pays for the sick, and for what? When it comes to the government’s fiscal situation and taxes, that is the only question that matters.
Here’s a modest proposal: we fully repeal Obamacare. All regulations and subsidies are eliminated. New rules are enacted that allow insurance to be priced based on someone’s health risks. Finally, one change is made to Medicare: if insurance companies will not sell someone a policy, if the policy costs more than 10% of their AGI, or if no policy will cover the necessary medical treatments, then that person is allowed to join traditional Medicare.
Of course, if you did that, large numbers of people would stampede into Medicare, and many others would be apoplectic about how much insurance costs because they have diabetes or happen to be women of childbearing age.