Category Archives: Healthcare

ACA Open Enrollment 2.0

healthcare.gov

The ACA open enrollment period for 2015 coverage ended on February 15.

Before the ACA, consumers could purchase health insurance 12 months out of the year. Now consumers are limited to an “open enrollment period.”

This is meant to increase access. Or something.

In any case, the federal exchange website continues to be pathetically bad.

It would not accept the login information I had recorded in my passbook. I tried the “forgot my password” options successfully implemented on thousands (millions?) of websites around the world. After hours of frustration over successive days of effort (it rejected all my answers to questions about my pet’s name, best childhood friend, favorite kind of food, etc.), I gave up and created a new account.

This did not end my problems. Every time I entered my Social Security Number, the system kicked me out. It knew, you see, that a person with that SSN already had an account (it just disagreed with me about that person’s favorite pet and best childhood friend). I was only able to create the new account when I skipped the first field asking for my SSN.

I then entered a mystifying cycle of being asked for my state, clicking the button to start the process, being delivered to a new screen where I was asked for my state, clicking the button to start the process, being delivered to a new screen asking for my state, etc. This went on, to the tune of “I Got You Babe,” until I made a snow sculpture with Bill Murray and started clicking random buttons to break the cycle.

After that, I answered a series of questions and viewed some options. Eventually, I was told that I had to enter a Social Security Number if I wanted to buy coverage. This seemed counter to what I know of the law, but I was simply grateful that I was able to enter the number at that point without getting kicked out for impersonating that other Sarah Baker with the same Social Security Number but a lesser predilection for Mexican food.

I successfully purchased (I think!) a health plan for 2015.

All in all, it took hours of effort over a series of months to complete this process. This is in sorry comparison to what could be accomplished on a website like ehealthinsurance.com before the federal government decided to “make things easier.”

I was not alone in experiencing continued glitches with this ridiculous website. Peter Suderman gets a money quote from a federal government employee who emailed him with frustrations over the process:

“Today’s some sort of deadline, they’re e-mailing me like mad,” he wrote. “I signed in to try and fix that and tell them that my [relative] already got insurance. I was able to log in, but that’s about all, there were buttons, I clicked them and nothing works. This is a solved problem, Amazon, Google, Facebook, hell every bank and probably 50% of small businesses have a more functional website than this.”

Anyway, now that we all have health insurance (except for the tens of millions who still don’t) let us not forget that having health insurance is not the same thing as getting health care. Being forced to buy the former in no way ensures the latter.

Premiums spent on high-deductible policies sap funds available to pay for actual care. Having insurance at all results in higher charges per visit, even when the patient is paying out-of-pocket for the deductible.[1] Narrow networks sometimes mean people cannot see the doctors they want or need unless they come up with the money on their own. Compounding the problem, providers are increasingly opting out of the lower reimbursement rates and higher headache rates associated with the plans.

The doctor shortage is not just an abstract problem. It is a real-world problem with real-life consequences for patients like Julie Moreno, who needed cataract surgery:

For three months after her November 2013 diagnosis, the 49-year-old Mountain View resident said, she tried to get an appointment, but each time she called, no slots were available. Desperate and worried, she finally borrowed $14,000 from her boyfriend’s mother to have the procedure done elsewhere last February.

When Noam Friedlander needed back surgery, she found that the surgeons who were covered by her insurance operated out of hospitals that were not—or vice versa:

Unable to match a hospital and a surgeon that were both covered, Friedlander started haggling between doctors for a cash price for the surgery. She chose a surgeon who wasn’t covered by her insurance but who operated in a hospital that was covered. … In the end, she had to take out two credit cards so she could pay $16,000 out of pocket.

The ACA’s defenders will argue that however flawed it may be, the system is an improvement over what came before. No one disputes that reform was needed. But the ACA fails to address the root cause of outpaced inflation at the point of service. It fails to address the medical school cartel and doctor shortages that push prices higher. It fails to repeal expensive employer mandates that drive health insurance (and health care) costs higher and incomes lower. It fails to deliver better tax treatment for out-of-pocket expenses or equal tax treatment for individual and employer plans.

In many cases it instead exacerbates these problems.

In short, it fails to take advantage of the myriad free market alternatives that might remediate the root causes of high health care costs and result in a truly better—and not just different—system.

_________________________

[1] I discovered this strange phenomenon in 2014. For the nine years prior to that, I had the same plan, which I had purchased myself in the individual market. It was cancelled at the end of 2013 due to the passage of the ACA. For several reasons (the unworkable website and my rebellious nature among them), in 2014, for the first time in my adult life, I went without heath insurance. I was pleasantly surprised to discover that office visits were $50-$60 lower once I had no insurance, and more expensive procedures, such as mammograms, were hundreds of dollars lower.

Sarah Baker is a libertarian, attorney and writer. She lives in Montana with her daughter and a house full of pets.

Rand Paul Sees Anti-Vax Fire, Adds Gasoline

needle

Does Doctor Rand Paul believe vaccines cause autism? Well, let’s see exactly what he said on the topic (video after the fold):

I’ve heard of many tragic cases of walking, talking, normal children who wound up with profound mental disorders after vaccines.

Really, Rand? You’ve heard of cases. Seems like you and my wife have something in common. As I like to say, I believe in evidence-based medicine, while she believes in anecdote-based medicine.

Of course, it’s not all that dangerous that my wife has this blind spot. She’s neither a doctor NOR a US Senator. You, however, should think before you open that hole on the front of your face and let words fall out. The world holds you to higher standard.

90% of your interview was extolling the virtues of vaccines. You make a great point about freedom. Vaccines ARE voluntary, which seemed to be a surprise to the anchor. We as parents must carefully weigh evidence and do what we believe is right for our children. I’ve argued as such here on this blog.

But this one sentence is going to be used as evidence that vaccines cause autism. Your position as a Senator and as a doctor are going to be used to give this idea credibility. Oh, and if you now come out and publicly try to distance yourself from this, the conspiracy-minded anti-vaxxers out there will view that as only damning you further.

And you base this on what? Anecdotes? Anecdotes from parents who are reeling from the emotional sting of realizing their perfect little child is facing a neurological disorder and the terror of what that will mean? Parents who wonder “why” life is unfair–and who is to blame? These parents are vulnerable, and some of the subcultures in the autism community will have them quickly believing that vaccines, antibiotics, and frankly anything sold by a pharmaceutical company is evil, and delivering them into the hands of pseudoscience hucksters selling hyperbaric oxygen treatments, chelation, and homeopathy as the solution. As the father of a child with autism, I’ve watched it happen. I don’t tend towards hyperbole in this area, but the behavior of many of these groups is remarkably cultlike.

I’m not sure what Sen. Paul truly believes as it relates to vaccines and autism. But he’s now entered the debate, and on the wrong side. He did so without evidence; merely anecdote.

I lost some respect for Rand Paul today.
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Rand Paul Caters To The Insane Anti-Vaxxer Crowd

rand

On Monday, Senator Rand Paul (R-KY), a prospect for the 2016 Presidential Election, put forth his opinion on vaccinating children. It wasn’t Dr. Paul’s finest moment.

In light of the recent measles outbreak in California, Dr. Paul was asked about the disease, and the ant-vaccination movement, on Laura Ingraham’s radio show. He stated that while he felt vaccinations were a “good idea”, he felt that parents should have the option to decline them:

“I’m not arguing vaccines are a bad idea. I think they’re a good thing, but I think the parents should have some input,” he added. “The state doesn’t own your children. Parents own the children and it is an issue of freedom.”

Dr. Paul noted to Ms. Ingraham in his interview that he believed vaccinations should be optional. In the same show, Ms. Ingraham stated that she didn’t believe measles was “that big of a deal“.

Later in the day, in a CNBC interview, Dr. Paul used anecdotal evidence to state that parents were justified in their skepticism:

“I’ve heard of many tragic cases of walking, talking normal children who wound up with profound mental disorders after vaccines,” Paul, R-Ky., said in an interview with CNBC anchor Kelly Evans.

This coincides with fellow GOP hopeful Chris Christie, who explained that while he vaccinates his children and believes they are a good thing, believes parents deserve more input:

He said that he and his wife had vaccinated their children, describing that decision as “the best expression I can give you of my opinion.” He said they believe doing so is an “important part of making sure we protect their health and the public health.”

“But,” Christie added, “I also understand that parents need to have some measure of choice in things as well. So that’s the balance that the government has to decide.”

Mr. Christie made greater input into vaccinations for parents part of his campaign for Governor of New Jersey in 2009.

Some of these public statements of support for anti-vaccination proponents can be explained as a matter of timing: earlier in the morning, an interview the Today Show did with President Obama made clear his thoughts on the matter: there are no reasons not to vaccinate:

“I understand that there are families that in some cases are concerned about the effect of vaccinations. The science is, you know, pretty indisputable. We’ve looked at this again and again. There is every reason to get vaccinated, but there aren’t reasons to not,” the president explained.

Anti-vaccination proponents – often called “anti-vaxxers” – believe that vaccinations for many diseases once viewed as eradicated can cause mental defects, with autism being the most commonly referenced, due to the amount of mercury in the vaccinations. More fringe elements of the anti-vaxxer movement believe that the government intentionally puts mercury in vaccinations as a passive form of population control.

However, most anti-vaxxers, if I’m putting this bluntly, are not very smart. They read a few articles on Infowars, see Jenny McCarthy speak for twelve seconds, put on their finest tin-foil hats, and let loose their ridiculous, half baked ideas, just before their diatribe about chemtrails. These people are clearly cuckoo for Cocoa Puffs. But what’s truly harmful is to have people like Senator Paul – a DOCTOR, for heaven’s sake! – and Governor Christie (a successful lawyer) giving oxygen to these people by enabling their nonsense.

The argument being made is that parents should have the liberty to do whatever they want with their children. However, that argument ends at my child’s body. This isn’t something like school choice, or even a voucher program that would use tax dollars in religious schools against the wishes of secular parents. Not vaccinating a child against measles puts that child’s life in danger before they even know what measles are. They also put other children at risk, particularly other children who either are not vaccinated or can’t be vaccinated due to other health concerns.

It’s one thing to argue that a parent – or even a mature minor has the right to put a child at risk if they believe the treatment is worse than the disease; I’m sympathetic to that argument to an extent. But a measles epidemic has been cut loose for the first time since “Leave It To Beaver” was being taped, and it’s affected a lot of people. Parents affected who willingly did not vaccinate their children should be held liable for the damage they have personally caused.

It’s easy to call the anti-vaxxer issue a bipartisan one – thank the “Whole Foods crowd” for that – but this is a problem that is disproportionate among hardcore, anti-government right wingers, who have been raised into a froth into believing that anything involving the government, or Barack Obama, is a bad thing. Such constant pandering – particularly by grifters like Sarah Palin and others – replaces education with nonsense because to them, these “facts” are education. Due to this, they distrust anything that goes against their worldview. “The CDC!? Liberal media fascists!” If President Obama said the sky was blue in a speech, that would be the tinder that starts a purple sky movement.

We expect “I’ve heard it causes brain damage!” to come from the wingnuts. But coming from Doctor Paul, a very intelligent man, calls into question his sincerity, his respect for the American primary voter – part of me thinks “he can’t believe that shit, can he?” – and his qualification to hold the highest office in the country.1

1 – I’m not holding Governor Christie to so strong a flame because I feel his statements, and clarifications, exhibit more nuance than those of Dr. Paul, who is no stranger to some real whoppers in his time.

Christopher Bowen covered the video games industry for eight years before moving onto politics and general interest. He is the Editor in Chief of Gaming Bus, and has worked for Diehard GameFan, Daily Games News, TalkingAboutGames.com and has freelanced elsewhere. He is a “liberaltarian” – a liberal libertarian. A network engineer by trade, he lives in Derby CT.

Connecticut Supreme Court: Tying a 17 Year Old To a Bed And Injecting “Poison” Into Her Body Against Her Will Is A-OK

Image credit: Hartford Courant

Image credit: Hartford Courant

In a stunning, tyrannical ruling, the Supreme Court of Connecticut has ruled that the Department of Children and Families has acted correctly in ruling that a 17 year old girl from Windsor Locks, identified in court documents as “Cassandra C”, was right in taking her from her home and forcing her to undergo chemotherapy for Hodgkin’s Lymphoma:

A 17-year-old Connecticut girl with a highly curable cancer is not mentally competent to make her own medical decisions and will continue to receive the chemotherapy treatments she’s battled to halt, the Connecticut Supreme Court ordered Thursday.

Chief Justice Chase T. Rogers ruled that the teen — listed only as Cassandra C. in legal records — is not mature by any standard.

That means Cassandra will remain at a Hartford hospital, in the temporary custody of child-welfare workers, and will receive her full course of chemotherapy to treat Hodgkin lymphoma. Doctors have said her odds at recovery are 80 to 85 percent with chemo, but that she will die without it.

(…)

In an interview Wednesday with NBC News, (Mother Jackie) Fortin denied pressuring her daughter into her decision to forgo chemo.

“I am not coercing her at all and that is what this is about, what they think I am doing,” Fortin said.

Cassandra simply does not want to be infused with “toxic” chemicals, Fortin added.

“My daughter does not want poison in her body. This is her constitutional right as a human being,” Fortin told NBC News. “She is almost 18. [Her birthday is nine months away]. If she was 18, I don’t think this would be an issue. She is not 10. She is over 17. She is very bright, very smart.”

In a Hartford Courant editorial, Cassandra told her own side of the story. Her description of what she went through when DCF got involved is surreal and gut-wrenching:

In December, a decision was made to hospitalize me. I didn’t know what was going to happen, but I did know I wasn’t going down without a fight.

I was admitted to the same room I’m in now, with someone sitting by my door 24/7. I could walk down the hallway as long as security was with me, but otherwise I couldn’t leave my room. I felt trapped.

After a week, they decided to force chemotherapy on me. I should have had the right to say no, but I didn’t. I was strapped to a bed by my wrists and ankles and sedated. I woke up in the recovery room with a port surgically placed in my chest. I was outraged and felt completely violated. My phone was taken away, the hospital phone was removed from my room and even the scissors I used for art were taken.

I have been locked in this hospital for a month, missing time from work, not being able to pay my bills. I couldn’t celebrate Christmas and New Year’s with my friends and family. I miss my cat and I miss fresh air. Having visitors is complicated, seeing my mom is limited, and I’ve not been able to see all of the people I’d like to. My friends are a major support; I need them. Finally, I was given an iPad. I can message my friends on Facebook, but it is nowhere near like calling a friend at night when I can’t sleep or hearing someone’s voice to cheer me up.

This experience has been a continuous nightmare. I want the right to make my medical decisions. It’s disgusting that I’m fighting for a right that I and anyone in my situation should already have. This is my life and my body, not DCF’s and not the state’s. I am a human — I should be able to decide if I do or don’t want chemotherapy. Whether I live 17 years or 100 years should not be anyone’s choice but mine.

Hodgkin’s Lymphoma is 80-85% curable with chemotherapy, but likely fatal without it.

I need to put forth some of my own perspective on Connecticut’s Department of Children and Families. Growing up poor in Connecticut, DCF was never, EVER the “good” guy. Even in cases where intervention to protect a child was warranted, DCF was viewed by everyone I knew as nothing short of terrorists. They were often called in by people who did not have a child’s best interests in mind – often by a former boyfriend/girlfriend of a single parent to “get back” at their ex – and were known to forcefully remove children from their houses and homes, putting them in a foster care environment that is comparable to prison, with all of the social issues (read: constant larceny, constant beatings, and constant sexual abuse by both peers and superiors) that entailed. The threat of DCF coming into my life was a constant for the child of a single mother that worked full time, and led to other consequences in my life that I will tell publicly at a later time. To put it bluntly: DCF was basically the Ministry of Love in our eyes, and rightly so.

Their actions in this case justify that mindset. They took a 17 year old girl out of her house – someone who can legally enlist to fight in a war – and blew away any idea of a mature minor1, judging her too immature – in a state where the sexual age of consent is sixteen – to reject medication that they are forcing her to take by strapping her wrists and ankles to a bed, drugging her, and sticking a pipe in her chest to inject, while removing any form of communication with her family and friends. You know, for her own good. Just One Child™, and all that.

So she can enlist to get shot at in our (illegal) wars, she can have sex with whoever she wants, and she can work. But she can’t say that she doesn’t want something she’s called “poison” to be forcefully injected into her body by a state that is keeping her prisoner and abusing her Constitutional rights.

The mindset of the state – assuming anyone has any good intentions beyond simply exerting their authority – is likely that she will thank them in twenty to thirty years. This assumes that her fears of not being able to give birth, or that her fears of other side effects, do not come true. The quality of Cassandra’s medical care has been atrocious. Now, she would be right to distrust the state for any reason. She was terrorized by people who ostensibly have her best interests in mind, and has been routinely degraded in demeaned in the one way no one should be: by losing total bodily autonomy. She has had her dignity permanently destroyed, and I would not blame her, or her mother, for leaving the state of Connecticut forever, if they haven’t been put on some No Fly List for daring to cross a few bureaucrats.

This is pure fascism. Hateful, evil fascism. There is no other way to put it. And I am ashamed to say I live here right now.

1 – From a legal perspective, Cassandra, her mother, and her lawyers did not assert the mature minor doctrine, which asserts that minors as young as 15 can make their own medical choices without authorization or knowledge of their parents, though the American Civil Liberties Union of Connecticut mentioned it in their amicus brief (PDF). Connecticut is not one of the states that has codified a mature minor doctrine into law. DISCLOSURE: I am a member of the Connecticut ACLU.

Christopher Bowen covered the video games industry for eight years before moving onto politics and general interest. He is the Editor in Chief of Gaming Bus, and has worked for Diehard GameFan, Daily Games News, TalkingAboutGames.com and has freelanced elsewhere. He is a “liberaltarian” – a liberal libertarian. A network engineer by trade, he lives in Derby CT.

Community Conservatism: Healthcare Under Fire

The "A"CA - Good for Elites, Bad for the Middle Class

The “A”CA – Good for Elites, Bad for the Middle Class

Contain the Cost of Healthcare and Preserve Options for the Middle Class

This is an issue that requires a bit of an introduction. We believe it is very important to recognize that our healthcare system is both incredible in its productivity and humanity…and very much broken. The middle and lower class see healthcare is a pressing concern because the cost to maintain insurance is getting high enough that it is forcing some serious and uncomfortable decisions onto struggling families who have to balance their budgets. The CBO estimates that, by the year 2045, the average American family will spend nearly 20% of its take-home pay on health insurance (about what they currently spend on their mortgage!). At the same time, unfunded liabilities to cover the cost of government-backed health programs like Medicare and Medicaid will soon account for 100% of all estimated tax revenue taken by the government. This is obviously an enormous problem. One that threatens to destroy our economy, cripple our access to quality care, and generally make us miserable in the not so distant future.

There are many theories for how we might go about solving this problem, but few of them have been fleshed out enough to back with the force of legislation. Prior to the bastardized half-breed of state-driven insurance mandates and taxes that is now commonly known as the Affordable Care Act, there were two competing visions for the future of healthcare in American. On the left, you had advocates for a single-payer state-run healthcare system as is common throughout the European Union and in Canada, among other places. On the right, you had advocates for transparency in healthcare service charges, tort reform, and interstate insurance commerce. The left’s concept would immediately be recognized by the American public as a massive tax hike. The right’s concept is a series of piecemeal, small-scale ideas that don’t sound like they can really fix the problem of out-of-control healthcare costs on their own.
The healthcare system has costs far beyond the basic ones associated with providing care directly. There are costs associated with:

• Medical Research and Development (and government regulation thereof)
o The research has basic costs
o The government heavily regulates how this research must proceed to get drugs and equipment to market
o The government research institutions try to assist in a wide variety of areas and this unfocused mandate yields inefficiencies
• Malpractice Insurance
o Private practice doctors report that something like half of their profits go straight to malpractice coverage because malpractice lawsuits now routinely go for huge payouts and the insurer must cover the cost
• Hospital Administration
o Here again, there are basic administration costs for running any healthcare business
o And then there are bloated government regulations that require record-keeping that rarely makes sense and is exceedingly expensive, while forcing administrators to retain fleets of expensive lawyers
• The Actual Medical Care
o Even here, there are basic costs…and then there are costs associated with doctors padding their bills to bilk the insurance companies (or at least to force them to pay out as much as they possibly can)
o And further, there is the cost of unpaid medical care given to people who are not insured and cannot pay
o And, ironically, there is the added cost of the government’s drive to get us to see our doctors more regularly (preventive care), which has yet to show any evidence of reducing expensive and undesirable health outcomes
• Insurance Company Administration
o And then we have the insurers – who are, themselves, heavily regulated by the government, and are also guilty of padding their bottom lines, and perhaps of paying out more than they should when doctors are overbilling
• American Status as Cost Sponge
o What I mean here – the US is doing most of the work to lead the way on new medical breakthroughs because countries running on single-payer systems or depending on US financial assistance to function cannot afford to do high end medical research – the result is that all of the world comes here to advance medical science (at great cost to our government research institutions), but we in the U.S. pay higher prices for all of the beneficial new drugs and technology they produce, because other places around the world can’t pay enough for big pharma and big med-tech to break even without us being charged far more

The ACA does, to its credit, recognize many of the places where profiteering, waste and excessive spending are occurring, but the liberal answer to each spending sore spot is the heavy hand of more regulation. Rather than just propose a series of bills the way we’ve done elsewhere in this series, we will explain what the ACA does about each sore spot and the risks that method poses vs. what the conservative counter should be. We’ll use the same bullets from above to organize our plan.

A) Medical R&D Costs

The ACA doesn’t specifically address medical research in a major way, other than to levy a medical device tax and make matters worse for research, but the common answer on the left is to move the cost out of the private sector and into increased government spending on the issue. This way, private sector companies can charge less for the drugs and technology they produce and the actual cost of the work can be spread among the taxpayers less obviously. The conservative approach would include carefully relaxing certain regulations on big pharma and big med-tech regarding the cumbersome and lengthy process to get from experimental drug to approved market-ready drug or experimental medical device to sales and reduce the scope and cost of the FDA. It would also include a restructuring of the NIH, CDC and other government health researchers to significantly narrow their focuses and cut the sugar out of their research diets. And finally, the GOP approach should include a repeal of the medical device tax in the ACA.

B) Medical Malpractice

The ACA doesn’t even tackle the cost of malpractice insurance for private practitioners or legal counsel for hospitals – one of its most disappointing failures, but one that is understandable, considering that the Federal Legislature can’t really regulate state civil courts). The left has, traditionally, completely ignored the increasing need for tort reform. Unfortunately, so has the right. Every once in a while, you’ll hear a Republican talk about the need for it, but they tend to be economists, rather than politicians with any clout. The GOP must act now to enact stiff limits on settlement amounts in medical malpractice cases in the states. We recognize that medical mistakes are always extremely damaging and life-altering (or ending) for their victims. We also recognize that the legal system shouldn’t be a lotto-draw for someone looking to get even with a doctor or make a quick killing after a mistake. The GOP should also enact “loser pays” laws for all civil matters, including medical malpractice. Unfortunately, these are generally matters reserved for the states, and the GOP must spearhead the effort at the state level to address them.

C) Hospital Administration and Record-Keeping

The ACA likely made these costs much worse, I’m afraid, by changing medical billing codes to a ludicrous, byzantine array of unrecognizable codes and further regulating how this information is to be collected. The GOP should move to vastly simplify medical insurance/incident/billing codes, and take a more holistic approach to auditing hospital financial and medical records.

D) Medical Fees and Insurance Models

As we know, the ACA attempts to decrease the number of people who are uninsured and thus to lower the liabilities for hospitals who must treat all patients, whether or not they are insured, by requiring that everyone get health insurance and taxing you if you do not. On top of this, the ACA requires all businesses of a certain size (more than 50 full time employees) to offer health insurance or pay massive fees. The ACA requires that children under the age of 26 be allowed to remain covered by their parents. And it requires that insurance companies never reject someone who has a pre-existing condition. And finally, the ACA requires that those plans cover a huge range of medical services in an attempt to capture all of the potential costs. The theory was that young, healthy people were going uninsured to avoid paying for it when they felt invincible at rates high enough to balance out all of the people who’d been rejected for preexisting conditions. The mandate-driven approach has proved to be a spectacular failure. Many are choosing to pay the tax – especially the healthy – many more are finding that their plans are far too expensive and have huge deductibles as insurance companies look for ways to shield themselves from the increased cost of covering high risk people. And, of course, if the government is forcing the insurers to cover everyone, many insurers will drop out of the marketplace, and that is exactly what is happening.

Having said all of that, we do not think that every idea in the ACA is bad and we do not think it is necessarily the best approach to wholesale repeal it at this point. We believe that there should be a national program to provide everyone with catastrophic insurance (to protect hospitals for huge unpaid bills, and patients from bills that ruin them financially). We also believe “guaranteed issue” and the clause extending coverage to children under the age of 26 are popular because they are necessary. We even believe the idea of a national health insurance marketplace is a very good one (we wouldn’t have the government running it, we’d set up a cooperation between the various health insurance providers and let a private company maintain the marketplace). Here is what a conservative plan would look like:

• Repeal the individual and employer mandates
• Require all Americans to buy catastrophic coverage plans the same way we require them to buy at least minimal collision insurance if they drive
• Nationalize the healthcare market (no more state insurance networks; this is not simply “selling across state lines”, this is true nationalization) and allow insurers to offer a la carte supplemental coverage – if you need coverage for prenatal care, you buy it; if you need coverage for prescription drugs, you buy it, etc.
• Require healthcare providers (private doctors and hospitals and clinics) to publicly announce their price points on a government-managed website for all of their procedures to allow consumers to price compare instead of being blind to the cost – market awareness frequently leads to market efficiency
• Require insurers to similarly announce what they’ll pay out for given procedures (in an attempt to prevent the sort of “doctor charges way too much to max out what the insurer will pay out” games we previously mentioned)
• Give tax credits to people who buy preventive care packages and repeal the Cadillac tax
• Enact the Ryan/Wyden plan for Medicare

E) Insurance Company Administration

The ACA includes a bunch of downright frightening top-down controls in an attempt to reign in insurance payouts for Medicare (because retired people are expensive, health wise, and paid for on the government dime), including but not limited to yet another in a long line of ill-advised price-fixing schemes promulgated by the left. They keep trying to fix the market to their liking and it keeps going spectacularly wrong and cause misery every time. This time, I’m referring to the Independent Payment Advisory Board. While I would stop short of calling it a ‘death panel’, there is excellent reason to fear this entity and its impact on the end of life process. IPAB will basically regulate insurance company payouts to Medicare by fiat, which will cause doctors and hospitals to begin to refuse to perform certain procedures, leading to a downward spiral in the quality of care for the elderly. We saw a glimpse of this with the VA – where aging WWII and Korean War veterans were being denied access to treatments and redirected to hospice care in some cases. The left sees the IPAB as a way to end insurance company inefficiency and doesn’t understand why this process should lead inexorably to premature death in some cases, but we have many examples – starting with the British National Health Service. The conservative answer to insurance company bloat and overpayment is, as noted above, to improve price transparency and let the customers straighten out the market. We would also add that government could play a role here with some far less heavy-handed regulations on payouts based on the going market rate for the service, once the service itself is priced publicly. Data is power – market data leads to a powerful market. Either way, the IPAB must be dismantled as soon as possible.

We’ve laid out many proposals here that attempt to make healthcare decisions less costly and stressful for the middle class, but rest assured, we’ve barely scratched the surface. We are hoping that this will start a dialogue among conservatives as to what sort of healthcare platform GOP Congressmen should build heading into 2016.

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