Greedy Goblin

Monday, December 5, 2016

Full repeal Obamacare!

This post is not about health care itself (how doctors and treatments are selected) but about health care financing: how we pay for whatever health care we have.

Republicans are in trouble that after years of barking at Obamacare, now they clearly have an option to get rid of it. Their problem is that only 26% of the people are behind full repeal. Below I'd like to explain why Obamacare is a disaster and must be repealed and the demands of the people met different ways.

Obamacare is a welfare mixed into health insurance. Insurances spread risks of a person over time. They make an evaluation on your risks (this case health risks), look at the statistics and see that someone with your demographics has X costs on an average year and make you pay X + operating costs + profit for your insurance. Your advantage is that for an individual there is no average year. You can't get 0.2% heart attack. You either don't have it (this case you lost your insurance money) or you have it and then the insurer pays 500X for your expensive treatment.

Now the problem is that X can be too high for poor people and for people with high risk of medical treatment, typically those with pre-existing medical conditions. These people will go uninsured and when they have medical costs, they go bankrupt or untreated. Obamacare "fixes" this by forcing insurance companies to take these customers for less-than-X payment, mandating them to operate at loss. Of course they would go bankrupt if they'd operate at loss, so Obamacare also mandate people with low risks to buy insurance at a higher price than market. So Obamacare is a simple welfare taxing healthy people to donate to sick ones.

No, I don't go into goblin here and say that this is wrong and the sick are not our problem. I'm saying that it's not insurance problem but welfare. It's a political decision to give taxed money to uninsurable poor and sick people. But mixing this welfare into the insurance just make it overly complicated and ineffective as no one is allowed to make good business decisions.

The solution is simple: full repeal, don't replace with anything, let the poor and sick go uninsured and if there is political will, give them Medicaide or taxed vouchers to buy insurance on the market or whatever welfare you want to give them.


Anonymous said...

The problem is that health has become a commodity in the USA. Because of what the insurance industry has been able to get away with, the cost of a procedure is not r fledged in what insurance ends up paying. thousands for a procedure that only costs hundreds.

Thats why obamacare fails to work - it's playing in the same toxic cesspool the rest of the private health is.

The answer is socialised medicine, available to anyone who wants it. Private health doesn't go away but instead has to adjust its prices to be more inline with reality.

Smokeman said...

"It's a political decision to give taxed money to uninsurable poor and sick people."

This is inaccurate, and this is the entire problem: It's a political decision to give taxed money to HEALTH CARE PROVIDERS. These same health Care providers (And their support industries.) wrote the ACA, and provide jobs and other paying positions to politicians that supported them when their political careers end.

I know (Or I think I know...) that you mean essentially that, but it's important to specify.

Rest assured, people in politics and the leaders of the health industry don't give a crap about uninsurable poor and sick people... they're just tools to an end.

There are no partial measures that will fix this. Only the complete dismantling of the current system and the return to fully local, pay for care doctors and clinics will do it. Then a more fair system of insurance that covers "catastrophic care" can emerge.

But I'm not holding my breath, here. We're all too convinced (In the US, anyway.) that we're special and deserve unlimited care for no cost to ourselves.

Azuriel said...

The problem is that Republicans would never do Medicare for all, e.g. "socialist medicine," and no amount of vouchers would get insurance companies to cover people with chronic/pre-existing conditions. Healthcare is an area with a total market failure; nothing other than single-payer or "die in the streets" really works well. Obamacare doesn't work well either, but it uses the insurance infrastructure already in place.

Halycon said...

The repeal # flips all over the place depending on the day, the month, and how it's phrased. There's a gallop pole from earlier this year that says 58% of the population wants single-payer. Meanwhile there's an AP pole that says most American’s don't even know what single-payer means.

Hell, most American's don't even know what the ACA does or how. There is so much misinformation about it to even try to figure it out is near impossible. I'm pretty certain part of how you described it is wrong because it skips over a multi-billion dollar provision for Medicare & Medicaid expansion; which some state legislatures downvoted taking part in meaning the whole thing is different from state to state. Some people still think the infamous "Death Panels" sound bite is still true.

Meanwhile, insurance companies do not want it gone. They want it changed, not gone. To them requiring every single American to have health insurance is the biggest financial windfall in the history of the business to them. So long as the numbers can be spun correctly.

To try and have an intelligent conversation about health care in the country is pretty much impossible, it's complex, and more than a few bad actors on the congressional level have outright lied to the American public about it on the evening news. Multiple times, from both sides. And I don't mean little fibs, great big huge fibs.

I know doctors who have personally come into contact with the thing who believe conflicting things about it, the only thing they agree on in regards to the ACA is giving insurance companies any sort of stakeholder status is akin to giving the fox the keys to the hen house.

99smite said...

the way health insurances assess the individual risks leads to unaffordable insurances. These insurances are in almost EVERY case badly managed (at least in germany) where WAYtoo much is spent on administration costs...

the system in Germany prohibits competition and ind instead of taking private health insurance companies as example, plans are to get rid of them...

Anonymous said...

Anyone who wants to talk about repealing obamacare usually has to avoid one simple truth: There's not an alternative to it in our country.

The united states is caught between a rock and hard place right now. On the one hand, productive citizens are dying because they can't afford healthcare. On the other hand, you have two of the most powerful industries in the country who wants to protect their bottom line: Medical Providers and Insurance Companies.

If you lived in the united states, you've probably noticed that big pharmaceutical companies have pretty much taken over television advertising in the past several years. You can't go through a commercial break without seeing at least two advertisements for some drug. The main street of my hometown, which had been quite empty the last 20 years suddenly has a variety of medical practices, rehabilitation centers and doctors offices pop up. The largest hospital near me is currently going through a half billion dollar expansion. Long story short, the Medical industry is booming.

Medicine is a big business right now and they have the capital to make sure nothing is going to interfere with that. That's why Martin Shkreli can just laugh in the face of congressmen before an oversight committee and the CEO of Mylan(the makers of Epipen) can straight up lie about how much it takes to make an auto injector. They know that congress can't touch them.

The fact of the matter is, These companies love Obamacare and they want to expand the benefits they get from our government, not get rid of them. The republican party itself isn't concerned with getting rid of Obamacare, the target they have in the cross hairs is actually medicare. They want to reduce the expenses covered by medicare and expand the need for private health insurances over the course of the next four years. Paul Ryan, the Speaker of the House, actually wants to entirely privatize medicare. It's been part of the budget reform package he's put forward for the last six years.

Let's just call this what it is: Crony Capitalism. You can pass blame around for it but the problem right now is the new administration, with it's full majority in congress, control of the white house, and the majority on the supreme court, is gearing up to continue with it not combat it. If there is a swamp around here that really needs to be drained, its medical and insurance lobbying.

Anonymous said...

Republicans cannot introduce a socialist healthcare program. That is why the Democrats had to dress it up Obama-care as a free-market insurance policy. It was the only way it could get anywhere close to politically acceptable.
The US-healthcare industry is a tragic example of a market failure brought about by a failure of the free-market to function efficient. With insurance companies acting as buyers, challenging costs is more expensive than accepting the charges and passing the cost (with premium), to the end client. Unfortunately there is no acceptable fix.

Yaggle said...

The problem is supply and demand. Everybody must buy insurance under Obamacare, so it does nothing to force health insurers and physicians to lower costs. Either government must take over health care and force costs lower, or find a way to lower demand. Obamacare was supposed to bring costs down by putting more people into the health insurance system. But it raised demand so why should anybody keep prices low?

Eaten by a Grue said...

Obamacare is not perfect, but there is an old saying - "don't let perfect be the enemy of the good."

In theory a better, simpler system is surely possible, but the government moves very slowly. Biggest issue if Affordable Care Act is repealed is that people with pre-existing conditions will get dropped and may not be able to get any kind of insurance to help them. And whatever solution is proposed to remedy this may take years to get agreed on.

Gevlon said...

@Grue: people with preexisting conditions should NOT get insurance. They can get welfare if there is political will. Giving them insurance is like giving home insurance to a guy whose home is already on fire.