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GOP Health Care: Backwards We Go

Category: Health Care
Posted: 03/08/17 00:42

by Dave Mindeman

It seems like some of us do not remember health care prior to the ACA.

The driving force behind the push for Obama's ACA was finding a way to cover everybody. Make it affordable. And make that coverage comprehensive.

The country had a lot of uninsured people. Pre-existing conditions was a method used by insurance carriers to dump sick expensive people off the roles. Businesses were locked into a health insurance inflation spiral....

September 16, 2009. Today, the average cost of a family health insurance offered by an employer is $13,375. That's up 131% over the last decade--a period in which inflation rose only 28%. And one estimate says that if costs continue on their current trajectory, premiums will go up another 166% in the decade ahead.

That was the motivation. Health care needed to be fixed. We needed to get more people covered with lower premiums and stem the tide of rising costs.

The ACA was a comprehensive plan with a number of moving parts. And all of them were meant to fit together to keep other parts in check. The individual mandate meant to offset the mandatory coverage of pre-existing conditions. The exchanges were meant to increase insurance competition. The risk pool funding was meant to ease the transition into the ACA and cover insurance overages. Prevention coverage was mandatory in hopes of making people healthier in the future. There were taxes on the very wealthy and on some of the medical manufacturers to help offset costs and make sure that the ACA did not contribute to the national debt. And there were mandates for businesses to cover their employees.

The ACA has accomplished a lot of the things it was meant to do. It has cut the number of insured in this country by over half. The premium increases were slowed down, although in the individual market, they have begun to move up again. Prevention coverages are improving outcomes. And the ACA has not contributed to the debt and has given Medicare a longer forward projection.

But there have been some glitches. The technical software issues have been a drag on effectiveness. The exchanges had a lot of dysfunction because of that - and have been slow to recover. And premiums are still fluctuating substantially.

In addition, the ongoing resistance from the Republican Party has intentionally sabotaged some of the mechanisms needed for the ACA to succeed. Republicans fought the Medicaid expansion in the courts and each state was then given this expansion as an option...and a number of states chose not to take it...even though it was paid by the Federal government. The risk pool funding was wiped out by Republican legislation and insurance companies had no recourse when some of their plans increased in cost beyond their own projections. And many companies dropped out of the exchanges as a result. A number of Congressional representatives attacked the tax revenue which supported the comprehensive program. Erik Paulsen has undermined the cost structure by removing the medical device tax; even though the industry benefited from the ACA with more demand for their product.

Despite all of those issues, the ACA insured more people with better coverage and saved many rural hospitals from closing down. The days of emergency rooms being besieged by uninsured patients began to taper off and helped stabilize financial structures for many providers.

But the longstanding opposition of the Republican Party finally took its full effect and they now control Congress with a Republican President. And after 6 years of distortions and sloganeering, they now can repeal this program from existence....and replace it? With what?

The Paul Ryan plan released this week will take large numbers of people off the health care roles. It wipes out the taxes that made the ACA work in a comprehensive way and replace it with a piecemeal plan that will bring back a system that is dictated by insurance carriers. Wipes out prevention coverage. Will raise the costs for sicker people by giving healthy people an option to opt out of any insurance. And again, put hospitals in jeopardy with uninsured emergency room visits. And affordability will be a huge question mark.

The GOP plan drops the intricate network of cost structures for another haphazard band aid of ideas that put us back to the path we were on prior to the ACA.

The GOP hopes to delay any voter backlash by stripping the revenue while keeping the program intact temporarily. Which, of course, will simply add more debt and deficits in the short run - but allow them to minimize the effects on patients until after the next election.

This is barbaric health care. It is short sighted. It is heartless. And it will be a bigger failure than the ACA ever was in their imagination.

Republicans cannot set aside politics. They cannot govern.
comments (6) permalink
03/09/17 23:26
Agreed. Kill the bill. We need to get it right. This is a political fix by hacks. Wonks need to step up and fix this.
03/09/17 22:42
I think Dave sums it up pretty well. It is fine that Ford has purchased a plan and method that works for him. Unfortunately most struggle to understand the principles of insurance and related health care benefits. The ACA did a good job of mandating a baseline of specifications to assure policies weren't total junk. Unfortunately, we are going backward where fine print policies will provide inadequate health care and UnitedHealth Group and others will reap in big profits. Can't wait to see the CBO scoring which will expose the Ryan-Trumpcare for the fraudulent piece of cow dung it is.

03/09/17 14:50
I agree, no need for a King. We have the Donald...

You need to get your head around where we are and the half-way point the GOP has reached across the aisle.

The extreme right wants NO entitlement. You want it to be a pure entitlement. Free is not free. The market is not a free market. It has been SUBSTANTIALLY tampered with and cannot function. So you have death panels picking winners and losers.

There is a reason the Doctors and Hospitals are against it. For the very same reason the media is against getting the money out of politics. Because they are the current winners. the people lose.

If we eliminated the ability of Doctors and providers the right to simply send a bill to your insurance company, they would have to explain it to you, explain why you need a procedure, and how much it was going to cost your resources. Your insurance company would be forced to explain to you why it is covered and why it is not. Awkward yes. But absolutely crucial to getting costs contained.

It is the reason you can get a full body MRI in california for $700 and shop it around. It is also why the same process costs upwards of $6K in MN. it is the very same reason you can get a full set of dental implants in Mexico for $10K when you pay $30K in MN for the same procedure.

My daughter always got an allowance based on need--her needs. Some months it included $100 for new blue jeans for school. Amazingly enough, when she got to the store, she could buy 1 pair of special brand jeans, or 3 store brand jeans, or 5 pairs of generics. all with the same $100. Sit back and watch what happened. You could bring it to the bank. Make it her responsibility to choose, and she picked 3 pairs because that is what she needed. We would have been fine with her buying 3 generics and 2 video games because it filled her needs and satisfied her desire to select "Price, Quality, or Service... pick any two." She always chose 3 store brand because of her desire for quality. But it was her choice.

Yes, many are unable to navigate the price, quality, or service, landscape when it comes to health care. Which is why people need to educate themselves on their unique conditions, opportunities, and costs. That is where your care provider's reputation and your loyalty to it needs to be formed, embraced, and celebrated. The federal and state government needs to end the nanny state and make people step up and take some responsibility for their choices.
03/09/17 12:05
Gee Ford, your plan is great if (1) people had extra money to put into HSAs...(2) if people understood health care procedures enough to manage them...(3) if allowing people to pick and choose benefits wouldn't make them unaffordable for the people who actually do need them.. Thank heavens you are not king.
03/09/17 11:46
Make me King for a day and my list of features would include:

Disconnect insurance from the employer and give it to the employee to select and manage. The deductible feature can be retained as a perk. Why we allow employers to handle this is a historical artifact.

Allow the insured to group their needs into risk pools. At our age, maternity care is no feature. For our daughter, it is a different equation.

Make copious use of massively large Health Savings Account options. An HSA is effective way for families to manage dental, eye care, rehab, prosthesis, birth control, and a multitude of health care needs that currently a continual debate. The government needs to stay the hell out of my decisions.

Build a health care system that works well for the 80%. Then deal with creating a safety net for the 20%.

Encourage the use of 'faith based newsletters.' If you don't know what that is, try here:


There are dozens of these and many secular similar.

The federal government needs to establish a system of saving that bypasses banking. The banksters have ruined our ability to save for needs--retirement, health care, elder care. Establish a debt category that is open to individual Americans to provide a reasonable rate of return--say 5% or 6%--and make it 100% backed by the federal government.

End the Social Security Ponzi scam. If your electric utility came to you saying they need to raise your electric bill today, because at the current rate they will go broke in 20 years, there would be an outrage like none we've ever seen. Dave your October 2035 electric bill needs to be paid today! You would scream bloody murder. Yet that is EXACTLY what we do with social security and medicare. These federal vultures are taxing it and moving it to the general fund to be pissed away by General Hayden types that want to spy on everybody everywhere. If we made more effort on how to end premature deaths on our highways, or falls in our bathtubs, we would be money ahead. How many die falling in their tubs versus by car bombs in America? Yet we piss away TRILLIONS on ending the car bombs. We are fools.

Figure this out for the 80% and then build a safety net for the rest.

03/08/17 14:13
The 80% / 20% rule most certainly applies here. 20% consume 80% of the claims against policies.

I disagree with your demand for insurance for all. What people need is healthcare, not insurance. Get it straight and maybe there is hope of getting it right.

The tribal demands for features needs to end. What we need is a workable healthcare system that works for everybody. End the arguments and push for reforms that create a system that works. What we had was not working. The ACA is a mess. Single-payer destroys one of the last remaining occupations that has hope of providing a decent living for working Americans.

Your analysis ignores the beneficial effects of self-insurance. If people were wealthy, they wouldn't need insurance. The 80%/20% rule applies. Virtually everybody eventually ends up in need of significant resources. Setting up another Ponzi scheme to fund our needs is unwise.

The HSA approach can and does work for most people in this country. When they are healthy, they need to fund that account for that rainy day when there are significant needs--like maxing out deductibles, needing memory care, and elder care in general. No plan you promote deals with any of this. Just more of the same for Dave? Fix it damn it! Let's fix it!

The idea of the HSA is that an account set aside to self-insure a high deductible plan serves to lower premiums. Company plans that offer it actually take the savings the employer enjoys in the form of lower premiums and donates that amount to the account. The $2000/$4000 tax credit should be applied to that account and not a tax credit, but maybe that is something the democrats can offer as an improvement?

In my adult life, and I include my married life, we have met our deductible only 3 years. Most years we expend about $4000 on average covering prescription drugs, dental, eye care, chiro care, etc. So when we purchase a silver HSA from Blue cross, the $7200 family deductible results in a premium reduction of about 85% of that. $7200 less the $1000 deductible is $6200x85% is $5270, which we use to fund our HSA. We fully fund and carry over the balance and let that fund accumulate.

The method provides 100% deduction for the funding of the deductible without limits on the itemized deduction method. And it can be used for items that are very clearly medical in nature but not even allowed as consideration in an insurance claim--dental, eyecare, etc. This current proposal expands it to >$14000. If the 80% enjoy normal consumption in their lifetime, they will be carrying over up to $10K/year and be able to build a war chest to fund financial catastrophe like memory care or elder care, which costs $6K to $10K per MONTH!

Do we need a safety net for the conversion from a Ponzi scheme to self-insurance? absolutely! So let's talk about THAT instead of using this as some token to promote tribal arguments, which clearly only serve to confound and confuse our real need, which is real reform the 80% and the 20% can live with.


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