It appears to be ObamaCare Lite:
At a fundamental level, the Senate plan accepts Obamacare’s premises about the nature of health insurance and the individual market. It works from the assumption that the only way to make expensive health insurance cheaper is to subsidize it through the federal government. It is a plan that subsidizes, and therefore disguises, unaffordability, rather than attempting to bring down costs directly.
Republicans are useless.
[Update a few minutes later]
Bob Zubrin has a more radical plan:
…the problem that we face is not that there are too many people who lack health insurance, but that there are too many people who have it. If we want to get health-care costs under control, we need a system where the majority of medical expenses are paid for by informed individuals who shop for value and are free to choose what they want to buy accordingly.
So what should Congress do? The most effective action the government could take would be to simply ban health insurance and enact transparency laws forcing medical providers to clearly advertise their prices for services rendered. This would crash health-care costs overnight.
Unfortunately, things are not so simple. Health-care costs differ from grocery costs in one key respect: They are unpredictable, which means that for most people catastrophic health insurance would still be warranted. What’s more, there would still be indigent Americans unable to pay for health care even at the greatly reduced rates such a system would provide. Such people, however, could be given medical stamps, analogous to food stamps, to help cover all or part of their medical bills.
The recently failed Trump-Ryan health-care bill was useless, because it simply perpetuated the current nonsensical system in slightly altered form. To truly fix health care, we would need to build a new system from scratch with two cornerstones: the free market and a safety net — the former to drive down costs, and the latter to protect the most vulnerable.
Yup. The whole system is a disaster, and has been for decades, ever since employee-insurance and union demands completely warped the very concept of health insurance.
[Mid-morning update]
Well, here’s a different opinion:
Finished reading the Senate HC bill. Put simply: If it passes, it’ll be the greatest policy achievement by a GOP Congress in my lifetime.
— Avik Roy (@Avik) June 22, 2017
Republicans are useless AND part of the swamp that needs to be drained.
Dr. Zubin & fellow colonists will be able to ban health insurance on Mars One. Sometimes, you just really have to start over….
It looks like the republicans are just as guilty for putting average citizens tens of thousands in debt as Jim and the democrats were.
I recommend everybody file for medical bankruptcy, that might get their attention.
“the free market and a safety net ” Megan McArdle has been saying for a long time that the simplest solution is some kind of federal help that kicks in if people’s uncovered medical expenses exceed a certain fraction of their income. If you’re worried about medical bankruptcy, that’s a direct response.
There is no reason and no excuse that for something like that the government has to regulate my personal health care.
Government should not be in the business of health care/health insurance other than to deal with things like tort reform, cross-state insurance availability and coming down hard on anyone who violates the insurance contract.
if you can not afford the deductible or is too high, you have no insurance
This simple fact puts the LIE to democrat arguments against repealing zero-care.
This^^^
My deductible is so high, that I pay out of pocket for everything. At best I get some kind of discount, to make me feel like I got a deal, off an inflated price, to make them lots of money.
And what about major medical expenses? Well, insurance should help after I cough up $10k. Insurance basically does nothing for me. Just sucks all the money out of my pocket that I could be spending on treating my medical conditions, which currently get ignored.
Solutions exist. Putting idiots in charge is not the solution. We don’t get to start over because the idiots find their way to anyplace ya go.
While it’s nice to propose solutions, even if great, that isn’t the problem.
The problem is we are over run with idiots.
We are a republic for a reason. Its supposed to be an idiot filter. We will always have idiots, but we’re not supposed to put them in charge.
Bill Burr, George Carlin and others have talked about thinning the herd, which isn’t funny but may be right.
If we limited voting to those who demonstrated having their act together to the extent of not needing government support, I expect far fewer idiots would find their way into top levels of goobernment.
Limit voting to men over 30 and problem solved.
This stinks.
In support of Zubrin, look at the part of health care that isn’t covered by insurance: bariatric, cosmetic and Lasik. There is cutthroat competition on price and every other aspect. Moreover, the prices quoted are all inclusive and fixed before the procedure, including unforeseen complications and post treatment.
Try finding out the cost as they are wheeling you into the cath-lab or even six months later. Without insurance, you are writing blank check by calling an ambulance, the insurance companies really don’t want the individual market and will charge a hefty premium for their trouble.
The rational solution is some sort of catastrophic insurance with a large deductible. How many people can write a check for $10K? The hospitals know that they would be left on the hook for the deductible.
Health care saving accounts are an obvious answer, but mine comes with a debit card and instructions on how to use it for all sorts of minor costs rather than leaving it for actual need.
The main problem is that we have allowed the tax code to completely distort the whole health care system. No one Bill is going to fix it and I don’t see any evidence that more than a very few politicians of any party are interested in improving it rather that shifting money in their own direction. Of course, finding any part of the economy that isn’t distorted by the tax code is probably impossible, it’s how politicians get paid.
Forcing healthcare providers to make their prices public would be a start yes. Another would be to increase the amount of doctors somehow so prices would come down even more.
Read an article about price transparency a while back. It was about an insurer that said it didn’t work. They posted all of the prices for medicines from their network of providers. They said no one used the system.
The first problem, is that you have to jump through a bunch of hoops before you can shop around. The second problem, is that posting the prices from your walled garden doesn’t matter.
Ah yes, insurance. Find out what the average claim is and set the deductible at or just below it. Collude with the suppliers of the services you are insuring against to charge the uninsured 10 x the real price. The suppliers get the real price which just happens to be on average at the level of the deductible. They split the difference. Nice work if you can get it.
Avik Roy has an article which expands upon his tweet above:
https://www.forbes.com/sites/theapothecary/2017/06/23/the-new-senate-republican-bill-will-transform-american-health-care/#31e926424318
I don’t know anything about Roy.
“But Paul Ryan’s bill contained a fatal flaw. Its flat tax credits, which provided identical assistance to the poor and the wealthy, would price millions of near-elderly low-income workers out of the insurance market and trap millions more in poverty.
Fortunately, buried in the House bill was a way out of the morass. Section 202 of the bill contains a transitional schedule of tax credits that was meant to serve as a bridge between the old Obamacare system, ending in 2017, and the new Paul Ryan system, beginning in 2020.
It turns out that if you simply kept that bridge in force, and tossed overboard the Paul Ryan flat tax credit, you’d solve all of these problems with the House bill. By making that change, the near-elderly working poor would be able to afford coverage, and the poverty trap would be eliminated.
And that’s precisely what the Senate bill did! Section 102 of the Senate bill—the Better Care Reconciliation Act of 2017—closely mirrors Section 202 of the House bill, with age- and means-tested tax credits up to 350 percent of the Federal Poverty Level.
Making this change not only solves the problems I described above. It also makes it easier to reform the Medicaid program.
Real Medicaid reforms
The Senate bill includes and refines the best part of the House bill: its reforms of Medicaid, the dysfunctional government-run health care program for the poor that whose enrollees have no better health outcomes than the uninsured.
Because the Senate bill’s tax credits are robustly means-tested and available to those below the poverty line, the bill is able to repeal Obamacare’s Medicaid expansion while offering higher-quality coverage to individuals who signed up for Medicaid under the expansion.
The reason that Medicaid’s health outcomes are so poor is because the outdated 1965 Medicaid law places a laundry list of constraints on states’ ability to manage their Medicaid programs. As a result, the main tool states have to keep Medicaid costs under control is to pay doctors and hospitals less and less each year for the same care. Hence, many doctors don’t take Medicaid, and Medicaid enrollees struggle to gain access to care.
The Better Care Reconciliation Act of 2017 addresses these problems in several ways.
First, the bill repeals Obamacare’s Medicaid expansion, and replaces it with tax credits so that low-income Americans can buy the coverage of their choice at an affordable price.
Second, the bill gives states a new set of tools to make their Medicaid programs. For example, under Obamacare, states are only allowed to check if someone is eligible for Medicaid once a year, even if that enrollees has moved to a different state, or become no longer eligible, or is no longer alive. Jonathan Ingram of the Foundation for Government Accountability, in a recent report, recommended allowing states to redetermine eligibility more frequently and thereby culling their rolls of ineligible individuals.
Third, the bill puts the legacy Medicaid program on a long-term per-capita cap tied to medical inflation through 2025, and conventional inflation (CPI-U) thereafter. This change is important, because Medicaid per-enrollee spending is growing at a slightly slower rate than Medical inflation; hence, making the program sustainable requires the use of CPI-U. The fiscal sustainability of Medicaid is essential to making sure that those who depend on the program can know it will be there for them in the future.
Innovation at the state level
A third area where the Senate bill does extremely well is in giving states the latitude to come up with new ways to serve their needy populations with better results and lower costs.
We’ve talked already about the new flexibility that states will have with their Medicaid programs. They’ll have even more flexibility to open up their private insurance markets to innovation and competition, through a new set of “Section 1332” waivers in which the validity of the waiver applications will be assumed by the federal government so long as the plan doesn’t increase federal spending.
Furthermore, the bill offers states around $100 billion in stability and innovation grants that states can use to shore up their insurance markets, by providing extra assistance to the needy or the sick.
The Senate must fix its individual mandate replacement
There’s one key flaw in the Senate bill. It had been originally reported that the bill would contain a six-month waiting period for those who did not sign up during open enrollment each winter. Such a waiting period is important to ensure that people don’t jump in and out of the insurance pool when their sick or healthy, respectively.
But no such waiting period was included in the bill, reportedly because the Senate is still trying to work out how such a waiting period would work within Senate parliamentary rules. That will worsen the bill’s score from the Congressional Budget Office, which is already likely to claim that the bill will cover at least 18 million fewer Americans, due to the CBO’s belief that repealing the individual mandate will alone have that effect.
Addressing right-wing complaints
Some on the right are complaining that the Better Care Reconciliation Act doesn’t do enough to repeal Obamacare, echoing those on the left in 2010 who complained that Obamacare wasn’t a single-payer bill.
Full repeal was never going to be possible in a Senate where Republicans did not control 60 votes. And furthermore, we have learned that moderate Republicans in both the House and the Senate have no appetite to fully deregulate Obamacare at the federal level.
But any Republican conservative in the Senate who is thinking of voting “no” on this bill: how many times in your life will you have the opportunity to vote for a bill that fundamentally transforms two entitlement programs? How often will you get to vote for a bill that cuts spending by hundreds of billions of dollars? How often will you get a chance to make a difference for millions of your constituents who are struggling under the weight of rising premiums and exploding deductibles?
As Sen. John Cornyn (R., Tex.) put it on Thursday, “it’s time to put up or shut up.”
I can understand Zubrin’s wish to set up a single-payer ultimate safety net as necessary to get the whole thing passed. The problem is, of course, that once that single-payer system is in place, it will be slowly expanded to become the monster that most readers on this site want to avoid.
I mean, just look what they did with the income tax over the course of a few decades.