Saturday, March 11, 2017

Ryancare in trouble?

RyanCare is being strongly dissed by many Republicans and all Democrats will vote against it.  Opponents say it cannot pass in the House, let alone in the Senate.

Breitbart News
Rep. Dave Brat: RyanCare a Perverse Economic System
Neil W. McCabe

Rush Limbaugh on Obamacare 2.0: ‘Why Do the Republicans Want to Hurt Trump’s Base?’

Exclusive — Sarah Palin on Paul Ryan’s ‘RINO-Care’: ‘Socialized Medicine’; President Trump Will ‘Step In and Fix It’
Matthew Boyle

Breitbart News Daily: Rand Paul on Ryancare


Matt Franko said...

Last time I drove thru Brat's district I kid you not there was a 25' minimum stars and bars flying high on a 100' galvanized steel pole above 8 lanes of I-95 right off the Chancellorsville exit...

lastgreek said...

I think you posted in the wrong thread, Matt.

I remember, when vacationing in Florida and other states, how freakin' big those US flags were. Why so big? All you Americans nearsighted or something? ;)

Dan Lynch said...

NOBODY likes Ryan-Care, except for the rich who are looking forward to seeing their taxes cut.

Note that Trump sees health care reform as a 3 stage process:
1) repeal and replace with Ryan-Care
2) roll back regulations issued by the Obama administration.
3) new legislation to allow selling insurance across state lines and to allow Uncle Sam to negotiate drug prices.

The state lines thing is a Trump fantasy that simply is not workable.

I gave a speech to 750 health insurance brokers and consultants in DC last week.

When selling health insurance across state lines, something Trump and a number of other Republican presidential candidates have been pushing, was mentioned the audience literally laughed. That's what health insurance professionals who spend their days in the market think of it!
This is about as dumb an insurance "reform" idea as has ever been proposed.

In summary, Republicans have no clue how to fix health care, other than Trump's proposal to negotiate drug prices (which will be tough to pass because Congress takes bribes from drug companies). Perhaps Republicans really believe their own bullshit about how rolling back regulations will reduce cost and increase competition?

At any rate, whatever happens, Republicans will own it and will have to face the consequences in 2020.

Matt Franko said...

Greek the 'stars and bars" is the Confederate flag....

US flag is the "stars and stripes"...

Ryan Harris said...

Selling across state lines is a political problem not a functional problem. The pretense that state lines somehow prevent insurers from selecting is ridiculous. I understand why people operating in the system view state regulators as essential in maintaining the system they operate in, but we are talking about destroying the entire system they work in because it IS unworkable and replacing it with the type of system used in other places that does work. The fact the the entire industry thinks it couldn't work is why it will work. It breaks down the barriers the cockroaches hide behind so they don't compete and can avoid addressing the perverse incentives in the medical system.

Dan Lynch said...

Ryan, the price of insurance is based on 1) the health of the insured pool and 2) the prices doctors and hospitals charge.

The health of the insured pool varies from area to area. People in the Mississippi Delta are not as healthy as people in San Francisco.

The prices charged by providers varies from area to area. Doctors in New York charge more than doctors in Alabama.

So it makes no sense to sell across state lines. In fact insurance districts are broken up within states.

The Federal government has no legal right to override state insurance regulations. Refer to the 10th amendment.

lastgreek said...

Greek the 'stars and bars" is the Confederate flag....

Thanks, Matt. I wondered why you wrote "bars," guess it didn't click on me. Very embarrassing for me because I pretty much know most of the Confederate songs by heart -- the result of attending, and parents having no choice in the decision, a protestant elementary school (Protestant School Board of Greater Montreal). Had no idea what they meant as a kid, but easy songs and lyrics to memorize ;)

Oh, I wish I was in the land of cotton,
old times there are not forgotten
look away, look away, look away Dixie land!

Noah Way said...

The purpose of selling across state lines is to further increase the profitability of megacorps, who could even more easily obfuscate delivery of benefits. Imagine an insured in Tennessee trying to collect from an insurer in New York. Exactly what legal protections would they have?

Ryan Harris said...

The prices charged by medical providers are different across state lines, across county lines, across the street, and even one provider will charge different rates to members of a household. Insurers themselves have driven the opaque pricing and multiple price lists in a race to the bottom with other insurers that has hurt the public as a whole. Government has the regulatory ability to correct this, I assure you. If the interstate commerce clause can be used to regulate corn sales within Iowa, trading, and settlement surely an insurer from Cincinnati paying for health in Texas in a Florida owned hospital using a bank in New York on a patient from Oregon using meds from California and surgical instruments from Illinois qualifies as interstate commerce and by-passes the 10th amendment restrictions.

Spreading risk is what insurers do. For centuries actuaries have been able to spread cost across time, geography, populations, even countries etc. State lines are trivial. The same arguments were used when interstate banking was opposed by finance. Small communities were going to lose their banks and loans wouldn't be available. The opposite happened and more Americans used more credit, for better or worse, while the number of branches and ATM machines have multiplied.

Matt Franko said...

Insurers also help the firms achieve larger scale with the providers but indirectly... as the insurers represent numerous firms...

With Trumpcare for it to work best imo the providers are going to have to eliminate the insurance company middlemen... and start selling their own policies for comprehensive care.... it remains to be seen if the providers (academics) can think this way (as businessmen)...

Tom Hickey said...

The way it works now the actual providers of medical and healthcare services do not know what a procedure or service costs. They just circle a billing code.

The fact is that there is no set price. Different clients are charge differently for the same service (billing code) depending on the type of payer they are. Medicaid is paid on one schedule, Medicare on other, different insurers differently depending on their volume, and uninsured are billed the retail price, which knowledgeable ones negotiate.

This is the antithesis of market competition. It is impossible to introduce perfect market competition, which is what Austrians/Libertarians want to see, in the health care market in a developed society with all the existing asymmetries. It's utopian thinking.

The way to fix it is single payer and single price set regionally based on differences in cost of living. Providers would receive more for the same service in high-income areas than low-income areas, since they have to live there and need to be compensated to scale. This is consistent with income and costs overall in rural, suburban and urban areas.

Ryan Harris said...
This comment has been removed by the author.