The most sensible solution was to fix what was already in place until the inevitable day, coming soon, when we become a dual health-care system: Single-payer for the majority of Americans and concierge health care for the wealthy. It’s just a matter of time.
Health Care Is a Business, Not a Right
“The health of Americans should not be a profit center. Health care is a right. Full stop.”
.. Almost everyone feels that there is something fundamentally wrong about making money off of someone else’s illness.
.. No, don’t sputter and tell me that it’s obvious, that people need health care. People need a lot of things. You’ll die without food long before you’ll die without health care, and yet few people say we need to “take the profit motive out of farming”.
.. We are evolved, he suggested, to provide costly forms of care to members of our community when they get sick, not just in the interests of making them better, but to demonstrate loyalty.
there are two different economic systems
market exchange:
Market exchange is impersonal, explicit, and limited: I know exactly what I’m getting, and once we walk away, we have no further obligations to each other. Market exchange is what modern societies use for most of their economies, but what foragers use for dealing with strangers.
The second form of exchange is “reciprocal altruism,” and you’re also familiar with it, though you may never have given it a name. It is a system of mutual obligation: I do a favor for you now, and you do a favor for me at some unspecified point in the future.
.. Hanson is suggesting that we have a strong intuitive preference for altruistic health care — for an enormous, practically unlimited amount of altruistic health care — because health care is a way to demonstrate loyalty and caring to people you love.
.. Bringing money into an altruistic exchange taints it (as you’ll quickly find if you try offering your spouse cash to get romantic when they say they’re not in the mood).
.. The issue, in other words, is not necessarily profit — health insurers are not particularly profitable as industries go, and hospitals and other care organizations are often nonprofit. The issue is making decisions based on money.
.. If it costs too much per year — at the time, they were leery of treatments that were above the 20,000 pound to 30,000 pound range — then NICE will generally not recommend it.
.. Britain had achieved cost-effective treatment for everyone, at the cost of some people missing very expensive treatments that might help them.
.. I had not called NICE a death panel, or said that it was bad; I had simply described what NICE does, which is keep the NHS from blowing its budget on very expensive treatments that deliver relatively little value per pound spent.
.. people don’t want to think their health care system might let them die because it’s too expensive to keep them alive.
.. Before the internet, most people had no way of knowing whether there were other treatments than the ones their doctors recommended, so as long as doctors only prescribed treatments that were approved, the government could maintain the fiction that there was no calculation going on.
.. because most doctors take a lot of different kind of insurance, and they don’t know what will be covered until after they’ve discussed treatment options
.. Americans could hear about a treatment, find out it wasn’t covered, get outraged, and call their congressman. This may be one reason that our system is so expensive.
.. Health care cannot be a right, full stop; it has to stop before we run out of wallet. Which means that no matter how much it horrifies, we have to stop hoping for a system that will make those hard decisions and unhappy trade-offs go away.
Byron York: 14 lessons from the GOP Obamacare debacle
1) Don’t over-promise
2) Jobs, jobs, jobs: Trump won the presidency on a pledge to create more and better-paying jobs. Taking up Obamacare as the first legislative project of his presidency was not consistent with that pledge
3) Find more votes.
4) Start with giveaways .. an infrastructure bill first, the story from Capitol Hill would have been a president and Congress giving things to the American people
5) ‘The Art of the Deal’ doesn’t work with ideologically-driven politicians
If the president wants to succeed in Washington, he’ll have to learn how to deal with people who aren’t in it just for the money.
6) Trump made a “rookie’s error” in bringing the Obamacare measure to a finale too quickly.
7) Trump and the House Republicans have different priorities and agendas.
8) John Boehner was right about the House Freedom Caucus. In an appearance last month, the former Speaker laughed at the notion that Republicans could agree on an Obamacare replacement.
9) Keep it simple. : It all got way too complicated to benefit from Trump’s talents as a simplifier and a salesman.
10) For years, House Republicans were able to pass bills like repealing Obamacare with the assurance that they didn’t really mean anything .. “We were a 10-year opposition party where being against things was the easy thing to do,” the Speaker said.
11) On big-ticket items, the president leads Congress, not the other way around.
12) while there is still intense opposition to the healthcare law inside the GOP, it has not stayed at that 2009-2010 level. In retrospect, Republicans were maddest at Obamacare before it actually went into effect
13) CBO estimates matter.
“In a community-rated environment, giving more choice to healthy individuals means worse coverage for those who are sicker,” said Michael Cannon, an Obamacare opponent from the libertarian Cato Institute, who is sympathetic to the House Freedom Caucus position on regulations. “This proposal shows bad faith,” he said. “The President is being misled by incompetent advisors who will cause the GOP to lose both chambers of Congress if this bill passes.”
The problem comes because the bill would then still leave in place not only the requirement that insurers cover those with pre-existing conditions, but also the restriction against charging more based on health status, a regulation known as community rating.
In such a market, healthy people would have every incentive to purchase the cheapest plans possible, knowing that they could always upgrade to more comprehensive plans if they get sicker.. “In a community-rated environment, giving more choice to healthy individuals means worse coverage for those who are sicker,” said Michael Cannon, an Obamacare opponent from the libertarian Cato Institute, who is sympathetic to the House Freedom Caucus position on regulations.“This proposal shows bad faith,” he said. “The President is being misled by incompetent advisors who will cause the GOP to lose both chambers of Congress if this bill passes.”