Politics. So I don’t understand why the Democratic Party hasn’t explained this in the clearest, strongest, most forceful terms.
It’s not a difficult argument. Until it is made, insurance mandates sound unnecessarily onerous and intrusive.
Please share widely!
We could eliminate pre-existing condition limitations, drive the insurance companies out of business, and replace them with Medicare for all. I doubt anyone except their employees would miss them.
I know politicians treat criticizing Medicare as one of the third rails of politics, but Medicare is a train wreck heading for the cliff. There isn’t a single study which doesn’t point to a disaster looming ahead and yet I keep hearing people say things like… “let’s put everyone over 50 on Medicare…”
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p>Does it make sense to increase an enormously expensive entitlement which we know is killing our budget and the future deficit and we have no political will to control?
… outlooks. Even more so the healthier the risk pool gets. Medicare for all would be largest risk pool full of the most healthy people and would improve the fiscal outlook immensely. Try to guarantee that your own pool is full of nothing but healthy people and your insurance will be dirt cheap. Guarantee that your pool is full of old people and your insurance will be high. Guarantee that your pool is a high-risk pool and insurance without (outrageous) subsidies will be impossible. Want to cover everyone? Get the biggest pool you can. Single payer works well this way because the mandate creates a huge pool and the costs are collected through taxes – instant mandate into an efficient pool. Tack on on comparitive effectiveness studies and fast track adoption of MedPAC provisions and you’re even gaining efficiency in utilization of the pool.
In other words, force healthy people to pay more for something they won’t use.
I’m not sure why this is an objection.
Even unhealthy people don’t like to be forced to buy insurance, they just want health care. Which is the same thing supposedly healthy people find they want, when they twist their knee, or discover a lump in their testicles or something.
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p>But maybe if we got rid of the idea of “forcing people to buy insurance” and focused on providing health care, we’d overcome the objection of healthy people like Seascraper.
and focused on providing services, we’d overcome the objection of people who don’t like to pay taxes like Seascraper.
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p>We’d also go bankrupt damn quickly.
The mandates are there as a tax on the healthy, an admission that the system needs more money to actually pay for all the healthcare we have promised to the sick and old.
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p>I am not against people getting healthcare or insurance, and it’s a pretty popular idea.
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p>I think mandates would make it through easily if you coupled it with a tax policy which created the extra money through productivity improvements at the private level.
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p>In other words, the money has to come from somewhere. Right now Obama is proposing to take the money from healthy productive people, as well as cut medical reimbursements (take the money from doctors/hospitals). Obama is making promises we know he can’t keep, and which we know will come out of our hides as higher taxes.
for our military, and make those who have no children pay for school systems. More to the point, just as we make workers pay for Social Security. Like those workers, your healthy people eventually will use the programs they are paying for. For every older person who’s “never been sick a day in their life,” there are thousands who have needed health care. A society that allows people to only pay for things they actually use is pretty useless for anyone who isn’t rich.
Why should someone who makes conscious choices to avoid risk pay the same brain injury insurance as a bicyclist or bungee jumper? Why should I pay for Paul Pierce’s knee surgery (I probably don’t pay for his knee surgery, but I probably do pay for it for thousands of backyard basketball players. But being allowed to play basketball without risking your children’s college chance’s or a bigger kitchen is why people purchase insurance. Having insurance acts as a motivator to make the most of it. Maybe what we need is a system of taxes on the risky activities themselves, like a tax on soccer balls and kayaks and hiking shoes, a bdsm license fee (the subs would love paying this), a vehicle passenger toll, oh, and how about fines and penalties, like a smoking too near a busstop fine, a fornication fine, a jaywalking fine, etc.
… still need to be considered. Your point on behavior is one. Another is that there needs to be an incentive not to over-consume health care. In general, the incentives not to over-consume can be incentives on behavior that would cause you to over consume. Within that kind of a framework, what one usually finds is that because the spread risk is so efficient, worrying about the kids who play more contact sports verses not tends not to be the kind of thing that saves you much money for the level of effort needed to institutionalize the cost differences of such behavior. In the end it tends not to be worth the worry (assuming the incentives in place against over-consumption are working).
Are you talking about $25 co-pays? Having to pay 30% of your bills? Having to deal with annoying bills? Do people with gold-plated health plans never over-consume? Or are you really talking about the potential of homeless alkies over-consuming with weekly emergency room visits, who might also be discovered to need not only to need their stomach pumped every week, but also need knee replacements, chemotherapy, brain scans, eye exams, viagra, anti-psychotic medication, blood pressure medication, marijuana prescriptions, etc. If the doctor and hospital and drug company get paid for everything they prescribe, it’s not really the bums that need an incentive not to go to the hospital, it’s the hospital that needs an incentive not to treat them for everything they have that needs treating.
… mechanism to curb from over-consumption. Other methods include fund pooling for visits rather than a la cart pricing on testing.
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p>You’re right of course that the consumer-side is only part of what can be driving over-consumption.
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p>In any hypothetical system of ‘free’ universal health care, there needs to be mechanisms in place to curb over-consumption.
Who do you think has higher medical bills lifetime — the physically active or the physically inactive?
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p>Cyclists may tend to get more treatment for abrasions and broken bones than the general population, but I’d bet they get far less treatment for heart disease, respiratory problems, and any other number of extremely expensive medical conditions. I’d bet the same goes for just about any other sport. Instead of guessing, I’m sure that there are actuaries and public health experts who know the answer. You know, make public health decisions based on fact, not on FUD.
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p>
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p>No, no it isn’t. People aren’t worried about tearing a ligament playing basketball. They’re worried about the disease that will bankrupt them. People understand that big medical costs, while correlated with lifestyle, have lots of randomness and unpredictibility, and they want to make sure that if the worst happens, that health care is available and that the family doesn’t suffer severe financial consequences too.
I asked my surgeon. Have I worn myself out? Did all that running and exercise contribute to my foraminal stenosis? Would it have been better had I just sat on the couch all these years?
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p>His reply, “NO…ABSOLUTELY NOT…it is the inactivity of the sedentary which causes the MOST severe health problems…get back out there as soon as you can and STAY HEALTHY”
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p>After 3 months recuperating I did my first few miles this afternoon, I was reborn.
You’re comparing the population that regularly play sports with the population that never even walks anywhere. I’m thinking more about the guy who drives everywhere, but who also goes out and tries to play sports on the weekends, he’s probably more susceptible to injury while no better off on the heart disease front, either. If people walked half an hour a day, and ate real food, they’d get the benefits of exercise and avoid the main contributor to diseases, poor nutrition food habits, caused by eating too much processed foods on the go instead of preparing meals at home.
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p>I seems we agree though that, in answer to Bob’s promotion comment “Health insurance companies: what exactly is their purpose?”, that the purpose is to guard the nest egg, to keep the family from suffering severe financial consequences. I guess it also applies to the individual without a family, they just want to guard their savings for a nice retirement, or a nicer house, etc. In other words, health insurance is not health insurance, it’s wealth insurance, and that is why even BMGer’s seem to be balking at providing health insurance to poor people without jobs or wealth, they have no wealth to protect so giving them insurance is going to make them act like wealthy people and go see the doctor all the time.
I do question the basis of all this talk about “overusing health care.” Putting aside for the moment the arguments about abortion, cosmetic surgery, and sex-change operations, just what would this overuse consist of? Are we talking about hypochondria, or what? Also, why is this not a major issue in those countries with single payer? They have poor people and hypochondriacs, too (and unwanted pregnancies, and ugly people, and those unhappy with their gender). If those countries are able to deal with it, why can we not?
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p>This continuing obeisance to American Exceptionalism is really stupid.
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p>Waiting for an illness to go from bronchitis to pneumonia to near-death before going to the emergency room for treatment is misuse of the system: underuse of the first line of defense and overuse of the last line of defense.
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p>
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p>Because they have moved the ‘must have’ line: in our system the “must have” begins at the emergency room, in their system the “must have” line is at the doctors office.
is stuff like doing tests and procedures when best practice is to wait and see or to make behavioral changes.
With respect to the guy you’re thinking of…
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p>again, why are you speculating? Why wouldn’t you first try to discover if actuaries and/or public health experts have data? You’re simply guessing and, frankly, your guess is worth the paper it’s printed on — and part of the frustrating part of this debate. Folks with no expertise are making wide claims based on nothing but their own ignorance. It’s simply unhelpful when it comes to many things, including public health.
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p>With respect to health insurance vs. wealth insurance: it’s only strictly wealth insurance if (1) you could have afforded to pay for the medical care out of pocket otherwise, and (2) you would have paid for it out of pocket.
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p>For folks who can’t pay for their treatment, it insures their health because they’ll get the care. For folks who could pay for it but would then have to choose between treating their chronic condition or providing food/clothes/shelter for their family, it insures their health because they might not have gotten treatment given that particular Sophie’s choice.
I was healthy until I got appendicitis at 27. No amount of exercise, diet or hand-washing could have prevented it. 10% of people get appendicitis, and it’s not predictable.
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p>Then I was healthy until I got a herniated disc at 30. I needed lots of healthcare for that, too.
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p>So Seascraper, I suppose you should not have to pay for the fire department because your house has never burned?
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p>And Seascraper, I suppose you should not have to pay for police because you have never been robbed or stabbed or shot?
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p>And Seascraper, you should not have to pay into Social Security because you have never been old nor blind?
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p>Some things we do better together, like fire & police departments, like Social Security, and we need to do healthcare together because together we will do it better.
…is that we pay for the other services through our taxes, and they are then provided for “free” from a psycological standpoint by the government. SS is a little different in that is calculated separately and I wouldn’t necessarily mind doing health care that way especially since that is how Medicare is done and we could just eliminate the age restriction on that. It may be a distinction without a difference to some, but I would prefer my taxes go up a bit and have the service provided, rather than be told I have to purchase something from a private entity.
And though there is a difference between the Senate Bill and Medicare For All, for Seascraper to reject a mandate because of “healthy people” not needing to pay is bad logic.
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p>The problem of too many government services being done by private middlemen is worth reforming, Christopher. Hopefully we can make progress on that front by reforming student loans, now, then health insurance later.
And though there is a difference between the Senate Bill and Medicare For All, for Seascraper to reject a mandate because of “healthy people” not needing to pay is bad logic.
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p>The problem of too many government services being done by private middlemen is worth reforming, Christopher. Hopefully we can make progress on that front by reforming student loans, now, then health insurance later.
That’s what I do with auto insurance.
And the police force (people don’t usually try to mug someone my size).
And firefighters (I’ve never had a fire).
Etc., etc.
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p>If you don’t want to suffer paying for others’ need, move to Somalia where everyone’s on their own.
“Generally speaking, if you arrive in Québec from outside Canada, even if you are a Canadian citizen, you will be eligible for the Québec Health Insurance Plan after a waiting period of up to three months following your registration.”
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p>http://www.ramq.gouv.qc.ca/en/…
but it is onerous in that the legislative bills presented don’t reduce much the cost of healthcare as it is currently priced today.
It does protect against future excessive hikes, which is important, and it creates the protections needed for all to be covered, but I think many people cannot even imagine how they are going to pull those funds from their current houselhold budgets. It’s frightening for people who are already on the edge thinking that some time soon they are going to have to find hundreds more dollars every week in their already stretched budgets.
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p>For that reason I will continue to say that there should be no mandate if there is no affordable public option. Mandates for the purchase of private sector overpriced insurance policies is onerous and intrusive. It’s not a perception, it’s a fact.
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p>I agree with Bob. It’s time to get rid of private sector insurance companies. They have no business making a profit off of the health/or not of the American people.
it ain’t gonna happen so why bother discussing it? Plus, if we got rid of every insurance company and had the government handle the claims… how much money would it save… $10B, $20B, $60B… how much and would that amount make a huge difference?
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p>PS When do we get rid of the private oil companies, car companies and the private farmers?
We’re probably stuck with the private market of health insurance and all the inefficiencies that that comes with. I always thought we’d wind up transitioning to a German model, where the private system is retained, but the inefficiencies are spread across the private providers with a fiscal mechanism that grants subsidies from firms with healthy pools to firms that have unhealthy ones. This makes them compete not on the basis of adverse selection but service. Of course, this would mandate a special tax or fee to every insurance company that was ‘doing well’.
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p>The comparison to oil, car, and farms is inapt because insurance is about risk pooling, not product production. When you point out that people are not denied care in this country, that is only true to the extent that everyone else pays for the poor and uninsured when they do get treated. That means, in effect, we’re really all dealing with risk pooling as is, just doing it very badly and not gaining any efficiencies from it. It’s a public interest that such pooling be done well and efficiently…. perhaps as much in our interest to handle it as a public good and not a private market.
A better statement might have been when is the government taking over car insurance, life insurance and other forms of insurance.
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p>I pointed out the “fact” that people are not denied service because I have often heard the hyperbole from the Democrats which makes it sound as if people are being turned away at hospitals with limbs hanging off. I was at a Doctors office yesterday and there was a big sign saying “immunizations will not be denied due to ability to pay”. We provide uber amounts of care for people who do not have the needs.
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p>As for spreading the risk among all the population, I think it has merit. Another piece of demagoguery I keep hearing is that 4x million people don’t have healthcare insurance and I’d like a bigger point to be made that xx million of those people DON’T WANT INSURANCE! They are young healthy working people who feel like taking the risk. I understand that we all pay for their risk taking but let’s not engage in hyperbole with the sad faced remarks about 4X million people going to bed at night nervous about their healthcare, it’s not true! I’m not saying there aren’t 2x million who do need it, but lets be more accurate.
majority of MA residents are not included in this large number of uninsured.
People who live in Massachusetts want to stay here forever. No one wants to move?
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p>Since people can easily move across state lines, a single state with mandates for everyone and subsidies for the poor will not work out in the long run. Young healthy people will move to escape premiums that they don’t think they need to be paying, and poor people will move here to get a better deal than they can get elsewhere.
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p>I don’t think that this is happening quickly, because the difference between here and another state for the poor only affects the range of people who are working, but in a lower-wage job, and it’s not that easy to move states if you’re in that situation, and I don’t think there are tons of younger people who adamantly don’t want to buy insurance, but still, this is a trend to watch, and that is why a national plan would be good for our state.
…. and getting away with not having it is counter productive toward creating an efficient risk pool. In other words, it makes everything more expensive.
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p>As for your assertion that “it’s not true!” that “4X million people [are] going to bed at night nervous about their healthcare”, last I checked the number of uninsured was in the 30+millions. To assert that not even 10% of them are worried is more than likely wrong.
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p>To assert so enthusiastically is stupid.
…that not wanting insurance is usually about cost. It’s not like all the young people who don’t take insurance are Christian Scientists or something. It doesn’t make sense to have a significant portion of one’s paycheck deducted for something you’re not likely to need when you’re living paycheck to paycheck to begin with. I may have misheard him, but I could have sworn I heard Howard Dean the other night claim that in VT when he was Governor they actually did figure out how to prohibit pre-existing discrimination without mandating purchase of coverage.
Again, I’m sure many of the uninsured cannot afford it. I’m sure another portion of those people CAN afford it but have to make decisions on insurance or basic “wants”. But there is a bunch of other people who CAN afford it but chose not to because they like other things in their life. I know some of them! IF insurance costs you $500/month and you’re young and healthy, no kids and saving for your first home… it might be a worthwhile risk. About 12 years ago I was playing hockey and guy got cut over his right eye. He was a computer programmer and had NO INSURANCE. He borrowed a guy’s insurance card and got stiches. He said he could use the money for other things and knew he could go to any emergency room for serious problems.
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p>If car insurance wasn’t “mandated”, do you think it would only be people who couldn’t afford it not getting it? People do a risk/reward analysis and decide.
That would take away the affordability decision and risk entirely so that regardless of how healthy people are, when the time comes they do need care they can just get it without having to have thought about it ahead of time.
THese theories need to be tested before we go “all out”. The risk is too high for failure or even a relatively small miscalculation or error.
Europe?
Eskimos eat whale blubber… French people eat wine and cheese… Asians… well you get the drift. We are very different people with very different life styles and cultures. I’ve said in the past we can’t just cookie-cutter replace our “x” system with their “X” system.
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p>When do we go on the Euro? When will the UK drive on the right side of the road? When do we lose some Constitutional rights which some European countries don’t have… we are not the same.
I mean, how can you possibly compare two groups of people?
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p>Oh, right, statistical analysis. It’s that evil MATH again.
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p>You know where math comes from don’t you? EDUCATION?!
And where does education come from? TEACHERS!
And what are are teachers? SATANICAL SOCIALISTS!
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p>RUN!
… wondering if there were a place single payer could be tested, ignorant (possibly willfully) that the principals of single payer have been well tested in other countries. I hardly think that the particulars of a RI single payer system will be very much more informative about single payer than the vast amounts of actual historical data that already exists. Just because the data are from Europe that is no reason to fear them.
But I still believe you cannot talk about complicated systems like healthcare with all of the intricacies and cultural/societal subtleties and expect to be able to equate them into our country. Learn from them yes, but not equate.
That’s also true of Rhode Island.
There is a big difference between a person from Finland who grew up there and has a certain philosophy and ideology ingrained in them compared to someone from Boston. And while the person from Boston has a different accent that from Providence, they have much more in common on how they think and act.
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p>I don’t want to beat a dead horse on this, I just think the idea of taking a system from another country in Europe and plunking it down here and trying to plug it in may not be as simple as it sounds. We can differ here.
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p>
Monthly
Consumption per Capita
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p>
BEVERAGE
USA
EUROPE
Carbonated Soda Pop (12 oz.)
48
10
Coffee (6 oz.)
35
28
Tap Water (12 oz.)
20
82
Beer (12 oz.)
20
12
Milk (12 oz.)
17
15
Fruit & Vegetable Juices (8 oz.)
12
10
Bottled Water (12 oz.)
10
10
Hot or Iced Tea (8 oz.)
9
21
Liquor (2 oz.)
7
8
Powdered or “Sports” Drinks (12 oz.)
6
less than
1
Wine (4 oz.)
5
16
Agreed, the U.S. has a much larger public health issue associated with our over-consumption of too much sweet liquid and the consequent rise in obesity, diabetes, heart disease, and cancer.
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p>I think you have to make the case, though, that that is unfavorable to a single-payer system or a regulated private Swiss/German system like on the one before Congress. On its face, the reverse would seem to be true.
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p>There used to be a lot of talk about insurance companies lacking an incentive to keep people healthy long-term. The medical system has become detached from public health. With a more regulated system, we get more levers not fewer to try to reduce the quantity of carbonated soda pop consumed.
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p>(Another problem here is regulatory capture. Americans eat too much meat, but neither the FDA nor the USDA is going to go out and tell you that — and it’s not because the science is unclear.)
Well, if you made intelligent comments, it would.
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p>Promise!
throughout almost every industrialized nation in the world beginning with Japan in the 1920’s. It has brought amazing results bringing down health care costs, (Japan is almost a quarter of the US), while improving care, (none have results as poor as the US).
At this point its similar to debating the propeller plane vs the jet engine. The health insurance lobby has kept us locked in some weird time warp since WW!!, while the rest of the world has marched forward.
Given that Christopher is one of only two remaining commenters who respond to you seriously, you might think twice about using dismissive language like “bullshit”.
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p>If Christopher takes the time to put up with respond to you, then you might consider being more courteous in your responses.
I’ve heard Obama say 30+ million, 40 million, 42 million, 45 million and recently heard someone say 52 milion. Hence my 4X (FORTY-SOMETHING) million it a guess!
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p>I never said anything about NONE of them were going to bed nervous about their healthcare insurance. I said…
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p>Meaning not ALL FORTY-“X” million…
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p>I’m sure it is far more than 10%.
In the time you spend defending your inanities, you could actually do a little research…
What did you “check”?
That means your statement that “about 4X million people going to bed at night nervous about their healthcare” is an assertion bout at least 10% of uninsured.
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p>I didn’t say it. You did.
Most of the readers understand what I meant. Those who disagree with me will complain and whine (se above). I got my message across to whom I wanted to.
We could imagine that you are reporting some very different things: off-the-cuff remarks of politicians, one number of under-insured and another of actually insured, different methodologies of counting, etc.
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p>There could be nothing at all “scandalous” about these different numbers.
I usually assume that “4X million” meant “somewhere between 40 million and 49 million” not “4 Million”
I need to start refreshing before I respond! sorry!
Over ten thousand needless deaths every year. Emergency rooms provide only emergency treatment. So, you can get your limbs sewn back on, but not cancer treatment or treatment for any other condition or disease until your condition reaches a crisis.
… know that waiting for crises is the most cost efficient way to manage disease. Oh wait.
Here’s a CDC guide to getting help paying for cancer treatment.
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p>And here’s the grim reality:
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I do not want any citizen of the US to go without treatment for cancer or any other serious medical malady. Never did and never will.
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p>My Aunt and her kids lived in the projects in South Boston and had little to no income. I know for a fact they never went without medical care and to this day my aunt goes to Doctors and hospitals all the time. If I truly believed that Americans could not get care for a serious ailment like cancer then I would support a program which provided it.
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p>I read the article you linked and it was informative but it not convince me that people without insurance do not get treatment for cancer. It did say that the uninsured are less likely to get screened and thus may alow cancer to progress before being discovered thus reducing their chances for survival. But this could be linked to other factors since many of the “uninsured” in this country may share other “problems” which make regular DR visits less of a priority.
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p>I also didn’t understand this tidbit…
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p>Since 15% of the country (45.7 million Americans) don’t have medical insurance, and these people don’t do well becuase of the lack of screening… why wouldn’t this number be above 4% and at least 15%?
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p>There’s also the fact that we don’t really “know” if there is a link, same article …
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p>Maybe I just have a biased view because of living in MA but even before we instituted “our” universal healthcare, I do not believe a person with cancer (or heart problems…) would be turned away from treatment. Maybe if I lived in Texas or AK I would have a different view or opinion.
No emergency room is going to deny someone treatment. Likewise, there are free clinics and doctors that do community work for free. There are even occasional free screening programs. All of which aren’t really free. Costs get passed on to the rest of us, one way or another.
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p>That’s still not the same as regular checkups or preventive medicine. And none of them pay for life threatening illnesses like cancer. And yes, people do get turned away. Even more likely, they just won’t be able to afford treatment. It will be their choice…
it amazes me how quickly the renewed shout-out for the public option was sent back to it’s grave.
on either the policy or political side.
We have the best government that money can buy.
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p>Our government represents the wealthy interests that allow them to be elected.
The Democrats who are blocking real reform should be challenged in primaries. I have stopped giving to DSCC and DCCC because I am sick of the bait and switch.
Ben Nelson and Blanche Lincoln will never get a penny from me.
and the general elections. Relative nobodies (Scott who?) will be giving incumbents the fight of their lives. With any luck, the 112th Congress will look far different from the 111th (including Dems replaced by other Dems). Should be a fun election year.
…without rock solid price controls like bulk buying by the government, drug re-importation, a public option, the removal of the insurance companies anti-trust exception, and more is a corporate give-away of the highest order. This is what we have in MA (primary thanks to the designs of Mitt Romney and Sal Dimasi) and seems to be the shape of the latest incarnations of national plans. If this is instituted nationally, without firm control, the insurance companies will be so flush with cash that the will be able to buy whatever the want from the political system and real reform will never be possible.
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p>Making it illegal to not have health insurance is a fake way to get everyone covered…just like making it illegal to skip a meal would be a fake way to end hunger.
Massachusetts, before our insurance reform (and after) is one of only a handful of states that bans discrimination against preexisting conditions. Even before we passed our reform bill, we had ~92% coverage. Now, we’re at ~96%. Unless only 4-8% of this state were healthy and had no major preexisting conditions, then you’re just wrong on this one, Kbusch. While I’m sure the mandate gets some healthy people to buy into the pool, it’s clearly not the biggest factor. Affodability, quality and availability are probably far larger factors in determining whether people buy insurance, or not.
… doesn’t disprove anything. It just shows that MA, as a pool in and of itself, is large enough to handle avoiding an insurance death spiral. This isn’t that surprising really, when you consider that MA’s population is actually larger than Denmark, which doesn’t have a problem paying for everyone. The risk, of course, in allowing such a mandate in a private market system is that you’re trusting that when private actors act, in congregate the risks will even out. The real problem is that you can only really trust this in an environment where no one insurance company tries to be ‘better’ than any other – a situation that would create private action on behalf of customers that would undo such evening out.
This is about the mandate and so-called necessity to have it if there’s going to be a ban on preexisting conditions. KBusch says to not have the mandate, but have the ban on preexisting conditions, would create a sitution where people without those conditions would simply choose not to have insurance at all. My point did disprove that. KBusch’s theory can only exist in a reality in which people aren’t worried about the inevitable accident or disease they’re likely to acquire sooner or later, or the effects those potential diseases and accidents would have on those around them sans insurance — and all of the above, doubly so, when it comes to spouses or children.
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p>For many years in Massachusetts, we banned discrimination against preexisting conditions without a mandate. According to Kbusch’s logic, that should have led to a precipitously low rate of people being insured. Instead, 92% of the population was insured before our own HCR, a rate which would still be amongst the highest in the country today. Why? The vast majority of people want to have health insurance, including people with no preexisting conditions. Whether or not those people get that insurance, whether they’re healthy or not, has to do with affordability, quality and access. Period.
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p>If they can’t afford it, they’re not going to get it. If they don’t have access to it, they almost certainly can’t afford it on their own. And if it costs a lot, but the product is lousy, they’re not going to want it even if they could somehow fit it in their budget. It is under these guidelines in which we should create policy to increase the pool if we aren’t going to allow a government option.
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p>If there’s going to be a mandate, there needs to be an option. Otherwise, you’re only going to be mandating coverage that’s a lousy product, which many people can’t afford and doing so explicitly to make the industry new-found billions in profits. Furthermore, a bigger pool does little good in that case when the industry is legally allowed to collude with each other to keep consumers from sharing in the savings or system efficiencies.
The point is that a ban on pre-existing conditions increases the incentives that lead to adverse selection. The Californian market, without such a ban, is now experiencing it.
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p>P.S. This is not KBusch’s theory. It’s the “theory” of almost everyone who writes about healthcare policy.
I repeat: Massachusetts had a ban on preexisting conditions and had amongst the highest rate of insurance in the country — all before our health care reform. “Everyone else” is as wrong as KBusch on this one. There’s, what, 2 states in the country that have a ban on preexisting conditions? Where the heck was their statistical basis for such a bizarre theory — especially when at least one of the two had one of the highest rates in the country and the mandate that’s come since then has only had a very, very small proportional effect on the number of additional people insured since then (4%).
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p>Sounds like a bunch of sociologist quacks going on gut feelings, rather than sound, statistical evidence, to me — and I have no interest in what they have to say until they explain just why Massachusetts worked about as well as it does now without the mandate.
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p>Banning discrimination against preexisting conditions expands the number of people who can get insurance, it doesn’t diminish it. People want insurance, and as I’ve said over and over again, if they have access to it, can afford it and the product is good, there’s no reason on earth why they won’t buy it. The mandate only provides cover to an industry to skimp out on those three principals in forcing people to buy the product they would have bought anyway, if they could have reasonably afforded the opportunity to do so in the first place. We don’t need the mandate, we need affordability, access and quality. The only mandate that should be created is if we decide to allow government to get involved in providing at least an option to compete with private insurers.
… pre-existing conditions pre-MA-HCR and 92%?
Linked to on FDL, most likely. I don’t have the link anymore, however, from a quick google search, there’s this:
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p>
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p>100-9.6%= 91.4%. That satisfy you?
,… now we need a cite for the ban on adverse selection.
I’m not 100% sure I’m getting you here. I suppose you could say Massachusetts has a ‘ban’ on adverse selection today via the mandate and would be the only state to do so. We’re the only state to have a near-universal mandate. 96% of us are insured today.
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p>One of the only (and best) states to compare it to is Massachusetts pre HCR, for a state supposedly with “adverse selection” by banning discrimination, but not mandating coverage. As said before, the rate of insurance was 92%. So the difference is 4%, the small difference mostly accounted for by increased access and subsidies, not “adverse selection.”
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p>Yes, the much-acclaimed “Massachusetts Universal Health Care Reform” only managed to insure half the populace when we already had 92% coverage. This is definitely the plan we want to emulate across America. Whee!!! /sarcasm off
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p>I’m sorry to Mr. Lynne, KBusch and “everyone else” (Ezra Klein?) but this dog just ain’t hunting. With very few examples for statistical analysis, one of the only ones flies in the very face of the entire theory. A line’s being crossed in the sand and the “reality-based community” is squarely on this side.
“For many years in Massachusetts, we banned discrimination against preexisting conditions without a mandate”
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p>Since the mandate is post MA-HCR, I assume this ban you’re talking about is pre-MA-HCR. I just want a cite that says (or better – explains) about there being a ban against discriminating based on preexisting conditions prior to MA-HCR.
My classmate came to live in Massachusetts before we enacted HCR, I had a class with her in 2005 — and that wasn’t her first semester here — explicitly because we banned discrimination based on preexisting conditions. She said it was only one of two states to do so.
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p>Bearing in mind that the provisions guaranteeing benefits quite possibly came before the advent of the internet (or, at least as we know it), I’m having some difficulty finding the exact provision in whichever statute the policy was enacted. But I at the very least have personal testimony that it was there 😉
… (and wasn’t) an outright ban on discrimination. See KBusch below.
Adverse selection is a well-established phenomenon.
conditions, or at least it didn’t when one of my old college classmates specifically moved to Massachusetts from California because she developed major back issues and, therefore, couldn’t find coverage in California anymore, nor just about anywhere else.
and a friend who has been individually insured. Three things about Massachusetts pre-reform bill:
So Massachusetts’ old system was designed to have a mild adverse selection effect — sicker people would always renew their insurance, healthier people might take a risk. The high prices seem like evidence that that was, in fact, what we were seeing.,
I’m reminded of the kind of arguments Kant first made about perception. If we witness something that defies the law of causality or of gravity, for example, we are inclined not to ‘believe our eyes’.
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p>Likewise, the idea that people would act contrary to the incentives and an effect like adverse selection would not occur seems gravity defying. It should make one look for other explanations.
… bullet was what I was remembering. Not a ban on discrimination, but a ban on discriminating while coverage was continuous.
that after 6 months, or 12, depending on the kind of employer-base coverage, your insurance had to again cover you.
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p>So, for the first 6-12 months you’re right, then I am. http://healthinsuranceinfo.net…
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p>I was oversimplifying it, but that’s only because there are ways for you to keep your coverage before you shifted under most circumstances.
Anything from pre-MA-HCR? These limitations are exactly the kind of thing I’d expect to see by design with a mandate.
I only provided that link to show how the policy works. It was there before the ’06 bill.
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p>Here, try this, since I’m the only one who’s provided a single link about pretty much ANYTHING in this thread, you show me where it is in the 06 bill. Good luck with that, cuz it ain’t there.
… about the conditions pre-MA-HCR. I’m just looking for what the law regarding pre-existing conditions was pre-MA-HCR so I can have context to examine your assertion. Your link to 2007 policy doesn’t help toward that end.
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p>I’m not making the assertion about what the law said back then, you are.
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p>Sure you are… just a few posts ago, to boot.
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p>
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p>Here’s what a person I know (personally) from FDL said, who’s had experience with this:
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p>As I’ve said elsewhere, I’ve oversimplified things here, but we have had protections for preexisting conditions for a long time now.
… more slowly.
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p>What I asserted:
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p>This is clearly not an assertion of what the law said or did. It’s an characterization of the likelyhood of what might be or have been. It’s a ‘hunch’, not an assertion of fact. You should know better.
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p>I’d also note that your example cancer survivor differs from your earlier assertion and the 2007 quote above (no mandate discrimination, no conditional discrimination within 18 or 12 months of being uncovered, no conditional discrimination within 2 months of being uncovered). I’m still waiting to find out what it actually was. You gave an anecdote. Your example commenter gave an anecdote, and so fare nobody has been able to point to anything definitive.
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p>I just want to know what the law actually said.
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p>At some point I’ll probably delve more deeply into the 92% figure for pre-MA-HCR in order to better understand the market performance for coverage, because there are details in there that will provide context.
I’m sorry I can’t provide every single detail of it. The internet is pretty much as far as my research abilities go these days, because I don’t have access to research journals, etc. like I did a few years ago. So, pretty much anything before the year 2000 is just not going to show up adequately on the internet, especially something as arcane and difficult to comprehend as health care statutes, which could be half a century old for all we know.
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p>
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p>Including you. I honestly can’t handle much more of this thread, it’s making me go insane. When a person moves to a state for its protections for people with preexisting conditions, I believe that person that they exist. Do I know or understand all the fine print? No. I’ve tried to provide some small analysis on those details in two capacities, but I don’t know the actual policy, I just know that we offered at least some protections that went above and beyond the vast majority of other states in this country. Unless you’re willing to find the exact details of that law (I’m not), I think we’re done here.
… to ‘provide every single detail of it.’ I just want the details that you specifically assert. For my way of thinking, if I were to come up on the data you describe, I’d want to look into the details to see if I can make an assertion before I actually made one. You’ll note that I haven’t yet called you wrong, for the same reason: I want to see the details before I make an assertion. You point out that I haven’t been able to “point to anything definitive.” either. The difference here is that I haven’t really made an assertion. I’ve been trying to gather information first. Logically, the best place to start was the information behind the data that you assert ‘proves’ something. You’re acting like I’m just arguing the opposite point from you. Far from it. I’m trying to examine your claim.
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p>Now I have some guesses as to what I might want to examine in your data to see if it really points to what you say it points to. I have plenty of suspicions why I think your data might not necessarily indicate the pre-MA-HCR mechanisms (preexisting condition ban without a mandate works fine) that you conclude. To start with, I wonder about the 92% figure. To make an assertion about the effectiveness of the private market in these conditions (no mandate and no discrimination) at coverage, I should extract the coverage percentage that can be said the market can be said to be responsible for. That means excluding those covered by Medicare, Medicaid, and the VA. Of those remaining, it stands to reason that the number will be less than 92% Whatever the resulting number is, the delta between where we were and where we are (97% before ‘cleaving’ the non-market elements) will similarly be greater. I don’t know what that number is yet, so I haven’t made assertions. But this is an example of why I might want to know the details before making an assertion. Looking at the other half of the equation (no discrimination), I wanted to see the specifics. When first made your assertion (without the qualifiers that were brought in later in the conversation about it only being a ban when you haven’t dropped coverage), I remembered that it wasn’t an outright ban on discrimination but that there was more to it. Still, I didn’t assert anything because I couldn’t remember the details. Of course, this ban on discrimination is a major pillar of your argument so I figured I should ask you for them, which is why I asked. In further consideration, one aspect of this ‘don’t drop your insurance because then they can discriminate against you’ rule in MA is that it sort of functions as a mandate… its a very strong mechanism to incentivize being (staying) insured. It’s inefficient as a mandate because the sick have a much stronger incentive than the healthy and its the healthy that make a risk pool better. But again, this is a suspicion where I’d need to actually see the details to sure and make a decent estimate of how strong a ‘mandate effect’ this is. (It’d be a stronger mandate effect if the ‘window’ of allowable coverage lapse is smaller. Your cancer patient said 2 months for pre-HCR and your cite from 2007 said 12 or 18 depending. (Maybe that’s a number that changed as a result of HCR.) So again the details would matter.)
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p>So my initial problem here is that I’m not sure what your data say in large part because I don’t have the details to confirm or contradict what you say the data assert (which again – if you read my comments – I haven’t). Knowing how well your gambling information is researched frankly I’m surprised that you might not have considered delving into the details before making your assertions.
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p>If you want to capitulate that you haven’t actually looked into the details (unlike your research on gambling) and that your assertion is more like a hunch or hypothesis than a proof, that’d be something altogether different than what you’ve been doing on this thread. But I suspect it’d be a more accurate description of where we are considering what details we (don’t) have (yet?).
In wondering about the percentage of coverage before and after I was also piqued by Paul Simmons’ Comment that official estimates of coverage are inflated. That assertion is with regard to 2008 rates, but it makes me wonder why he thought the estimate was inflated and if these reasons might also apply to estimates before 2006. I just hadn’t gotten around to asking him yet.
Another comment back out on the left margin
I’ve been paying attention to the casino issue for years. KBusch posted about this a few days ago. No doubt if I wrote about this topic for a year or more, I’d have a lot more details, but I doubt my mind would change much. In the end, the policy here pales in comparison to the politics — we need a decent health care bill and the mandate is a poison pill.
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p>Even if adverse selection led to the total destruction of the private market — who cares? Why on earth should we be trying so hard to protect the profit margin of Aetna, when we all admit a single-payer system would be infinitely more efficient and better. I say we insert our own poison pills for the industry and let it fail for once — we’ll have a public option (or more) and real reform that way before the roosters crow. As you yourself love to point out, America’s only good at fixing things when they’re totally broken. Well, the private market’s gotten itself to the top of the hill, the bottom of which lies the cliff. No reason not to give ’em a little push.
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p>Whatever, I think I’m too preocupied by the dangers of lurking werewolves this weekend to worry anymore about this. It’ll be passed in whatever fashion it’ll be passed and the rest of the country will then make its decisions. I’d advise every member of Congress to stop with the assumption that President Obama cares a shred about whatever happens to them. He only cares about his reelection, and the means to that (so long as Rahm is around, anyway) may very well run counter to the means of Congressional democrats’ reelection campaigns.
… to be said and that has been said about the politics and social justice issues behind this. The thing is here is that KBusch wasn’t really delving into those thing. What he was pointing out was a feature of mechanics, not politics or social justice. Obama himself recognized the poison pill of the mandate during his campaign. Then when it came to actually making something work, he concluded that the necessary mechanics to make it work needed a mandate,… at least with regard to what seems possible at this point. Personally I’d do away with private insurance. But I also know that isn’t going to happen this round. Knowing the history of how bad Medicare and Social Security were when they started out, this doesn’t look so bad. It’s not like there isn’t a mandate in a non-private system. All the systems that work well have some kind of mandate – weather through taxes or what not. I still think that we, as Americans, tend not to fix things until after they’ve gone wrong. I think that is what is happening now because people who pay attention to budgets see what has gone horribly wrong with the current system. The fact that there is resistance to what would be better solutions just means we’re still in America.
“A bunch of sociologist quacks”? What a name for economists! You can hunt for material on adverse selection and on asymmetric information. This is not as central as evolution is to biologists but it’s a central concept to analyzing a number of economic phenomena and not just health care.
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p>Uwe Reinhardt, one of the most prominent economists in the country on healthcare: The Case for Mandating Health Insurance. Note his quoting of the New Jersey experience.
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p>Krugman from 2005: Health Economics 101 and also more recently.
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p>Krugman has been consistent on this issue. Critiqued from the right by David Henderson who writes:
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p>WellPoint sited adverse selection in its rate hike.
I remember when, in a 8th grade science class, my science teacher asked, “What is glass?” I was the only one who raised my hand for “liquid.” Everyone else picked “solid” and got it wrong… It happens sometimes.
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p>KBusch, I’m sorry, but academia, while a great thing for society in general, is not always right. Sometimes they miss the forest for the trees. While Krugman and a whole host of other people may be debating the merits of a mandate, fearing adverse selection, in the real world, even the healthy are afraid of catching cancer or breaking a leg.
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p>I don’t want to hear any rubbish about adverse selection when the only case study we have today suggests its importance in whether people choose to get insurance, or not, is marginal, at best. There are clearly other, more important factors. Accessibility, quality and affordability will get people to buy it with or without a mandate.
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p>I’m fine with a mandate AFTER those things are instituted, but not before it. The mandate is fine only when the insurance is good, affordable and available. So, either we have to institute a competitive public option that’s available to everyone, or we need to come up with some other scheme and strict regulations to keep the health insurance industry honest. The Senate bill fails utterly at doing that… the House bill, with their watered-down option, doesn’t fare much better (and almost certainly isn’t even going to be a part of HCR anyway, given the side-car route).
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p>Furthermore, you still haven’t explained how bigger pools will help health insurance policy holders given that it’s perfectly legal for health insurance companies to collude and conspire together, given their exemption from anti-trust laws. Creating a mandate will certainly increase pools — and may even prevent the perceived threat of adverse selection — but none of that suggests it will actually benefit patients and costumers, just the pockets of CEOs and shareholders.
who got it wrong (assuming the teacher was asking about cool glass).
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p>As for economists, this New Yorker article about Paul Krugman claims (as he does) that economists tend to embrace theories that are easily modeled mathematically, even if they do not account for real-world behaviors. Like supply-side models, for instance. I am not eager to let economists define the debate about health care.
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p>We should adopt one of the systems that already works in the real world. This wheel does not need reinventing.
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p>Emphasis mine (obviously).
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p>I’m not saying adverse selection wouldn’t factor in at all, but clearly people are more worried about access, quality and affordability. Most relatively healthy people like me, who have no preexisting conditions, know that they could get in an accident, catch cancer, or any number of other random, terrible things, any day of the year. Clearly, Krugman’s model in this case is just too simple and can’t explain what happened in Massachusetts, before our health care reform.
You are going to run contrary to the thinking of economists based on a single example that you understand poorly and dimly.
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p>It might have worked in 8th grade.
Really, KBusch, I expect more from you.
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p>I think you should at least admit that there are other factors which people use to decide whether or not to get health insurance that may factor in as more important than adverse selection. Most people aren’t so stupid as to think that because they’re healthy now, they’ll be healthy ten days from now.
Most people who are healthy now are healthy ten days from now.
Because my point was that most of those people know it’s within the realm of possibilities that they won’t be, which is kind of the point of insurance.
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p>You don’t know when you’ll be diagnosed with something terrible, or when an accident will strike. My brother was runner up for league MVP his junior year playing football — only losing by one vote (his head coach, my father, who abstained from voting). He was being recruited by Notre Dame and a whole host of other Division 1-A bowl-league teams in 1991. Then he started feeling sick and lost his appetite in the summer before his senior year and, a few months later, just after his last football season in his senior year, he was diagnosed with strep in his heart valve, requiring a heart-valve transplant. He was in the hospital for over 6 months, a few months after he thought he’d follow in my father’s footsteps, playing for a big time college program and getting into the NFL. Perfectly healthy one day, deathly sick the next.
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p>This was precisely why my father always had the best health insurance available to him as a teacher who was a member of his town’s teacher union, because he — like most people — understood that a health crisis can happen at anytime. You just don’t know. That’s the whole, entire point of health insurance — and people know that, which helps explain why the difference between having a mandate and not having one in this state is only 4% of the population being covered. People who are healthy get insurance because they know they may not be healthy and can’t predict when that would happen — the only don’t get health insurance if they can’t afford it, don’t have access to it or think the quality sucks so bad that it just wouldn’t be worth it.
Look you wrote:
In fact, it would be stupid to think that because they’re healthy now that they won’t be ten days from now. Most healthy people make plans two weeks in advance assuming that they will be healthy in two weeks. You might know a few such people.
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p>The whole point of the adverse selection mechanism is that we live in a world of risk and we measure that risk. All rational actors decide which risks to take. As stomv pointed out in an exchange above, running does expose one to risks, but not exercising exposes one to larger risks. You can’t avoid risk entirely.
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p>Your obviously wrong attribution of stupidity seemed to indicate a blindness to the sort of risk appraisal we all do.
If I may supply some counter-tutting, I really think that, given your understanding of the Massachusetts statistics, you have recklessly overstated your case and possibly a more modest statement of it would sit better. As I answered above, the prices regulation regime, and the continuous coverage incentive would all act as brakes on adverse selection. The higher premiums indicate that some adverse selection was in effect.
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p>A number of economists point out that you rarely see a pure example of adverse selection in the wild. The reason is that it destroys the markets that it affects. When such markets disappear, so does the evidence. As a result, you do find institutions that rein it in and that often is the best evidence of it.
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p>But you read all, didn’t you, before unmasking the economics profession.
You’re really grasping at straws here. 10 days was an example. You’re turning it into a red herring — something I’d expect better from you more than anyone else in this community. Oh, well. People know they’ll get sick or injured eventually, but not when, which is why healthy people tend to buy insurance. I’m sure adverse selection fits in somewhere, but maybe it’s you (and the Krugmans of the world) who have overstated their case, because access, affordability and quality are always going to be way more important.
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p>In the end, though, it matters little, because this is so politically toxic it could cost us Congress and end up with the bill, as passed, being repealed, or government grinding to a halt for the next 2-ad infinitum years. Go ahead, keep rooting for the party to jump through the curtain into the abyss, I’m sure it’ll make you feel all morally superior or something pushing for a rather small policy detail that may or may not be the right thing to do on the merits, but only makes sense in a complete vacuum. Keep cheering about the “national mandate” which will still lead to 15-30 million Americans without insurance, a policy that’s really just about corporate welfare and not about making the health care system work for Americans.
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p>A year of Obama and Harry Reid has taught me we are not ready to be the party in power, and yet the only alternative is the Tea Bagger brigade. We’re all screwed.
… can become corporate welfare, but it’s not about corporate welfare. That is, having a system of mandates combined with a system of private insurance doesn’t have to necessarily be a giveaway (look at Germany). Mandates in general, however, seem to be a necessary component to any system that’s going to work. Even in a system where you get everyone to join because of super-affordability, you’ve more than likely created such a system with a mandate. How? The only way you make it affordable is to draw in cash from somewhere – probably taxes – and some of that cash will be from people who wouldn’t pay for the true cost of insurance without the mandate of payment through taxes – weather the affordability is channeled through public or private systems. You can argue politics, of course, but mechanically some sort of mandate seems necessary and desirable to make the system work and that’s all KBusch has argued here. I think you’re under the mistaken impression that KBusch is ‘cheering’ anything here. He’s just saying that it can be shown that mandates are necessary and that this probably needs to be part of the framing of the discussion on the part of Democrats. I think one point of confusion here is what a mandate actually is. Mechanically, a mandate is a cost mandate. The particulars of how you apply it can be progressive or regressive, but it’s still just a cost mandate. Getting a cost risk pool to act efficiently means getting low risk people who may think they don’t need to share risk into it. That means a cost mandate of some sort. The easiest way would be through taxes – since then the progressive vs. regressive target can be achieved through your tax policy – where you’re already tweaking progressive vs. regressive anyway, and if I thought we could get that to pass I’d be pissed off that we’re not doing it.
We’re looking at a situation in which at least 15-20 million people won’t be mandated, or covered, in this mandate. More may choose against coverage, opting for the fiscal penalty, if the options are lousy or too expensive.
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p>Make no mistake, I’m not opposed to a mandate. I’m only opposed to a mandate for a bad product.
… a better mandate would be preferable, here in MA as well as for national HCR.
in the hospital were healthy 10 days ago?
and none of them think they can do without health insurance.
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p>I’d also remind you that despite your assumptions, Ryepower12 is not always right. It is OK to admit you’re incorrect, as in much of this back-in-forth with KBusch.
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p>Honestly, you are a lot more convincing when not insulting people in the course of your arguments. Just a helpful piece of advice.
at least insofar as I’ve given an example that flies in the face of the theorem.
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p>In science, you’re supposed to be skeptical. So far I’ve just seen a bunch of people take this as some bizarre holy grail, one that — if found — is toxic to politics and quite possibly policy, at least so long as we don’t force insurers to provide good quality, affordability and accessibility (and the Senate bill fails utterly in all three regards). No thanks.
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p>BTW, Hoyapaul, if you’re going to complain about “insulting people,” it’s best not to be an annoying prat about it. I’m friendly with KBusch and like him a great deal, I just don’t think he’s right about this and he’s yet to suitably back up his position. Note the fact that his diary itself didn’t include a single, solitary link to back it up.
As far as KBusch’s argument goes, I think he has a pretty good point about the way in which the Massachusetts “pre-existing conditions” piece worked before the mandate. Whether he’s backed up his position “suitably” I suppose is up for debate, but he certainly has backed up his position with facts.
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p>And as I said before, I’m not trying to be an “annoying prat”; I’m trying to be helpful. I doubt I’m the only one here who thinks that your tone consistently and seriously undermines your substantive arguments.
Any examination of any specific case is going to have a lot of different factors to weigh. I’m surprised to see you jump from an imperfect understanding of the pre health reform situation in Massachusetts to a full blown declaration that people who’ve studied this stuff for their day jobs are wrong.
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p>Weak methodology aside, this is a dangerous game. People really want to believe you can eliminate the Department of Waste and lower taxes. Or that by lowering taxes you can increase state revenues. Or that global warming isn’t.
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p>These are all remarkably convenient things to believe. They mean policy can be nicer, taxer lower, and regulation lighter. But if you’re going to advocate a particular kind of healthcare Lafflerism, you’d better be damned sure you’re right. And as I’ve written, one dimly understood example is a huge distance from “damned sure”.
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p>Maybe you’ve made a case for doubt or for examination, but you haven’t made a case that you, Ryepower12, have exploded a myth that has blinded Uwe Reinhardt
… “Laffer” (no second “l”).
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p>More interesting tidbits here.
I always make that mistake, too, but I usually catch it.
Until the Eighties, public and family health systems (particularly for children through school nurses, family clinics, etc.) were integral parts of the system. Being on the preventive end, they worked to hold down costs.
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p>This is another one of those topics that would require a monograph to even touch the surface, so I’ll get Socratic on y’all, with the proviso that folks consider the hyperinflation of real-cost college and medical school tuitions in their models:
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p>Why (relative to technology) did Boston have a better and (in constant dollars) less expensive public health system during the Great Depression than it does now?
Evidenced by the fact that your argument, verbatim, has been repeated over and over again for a year, seemingly without effect. “Mandates” always sound scary, no matter how they’re justified. That said, I share your frustration.
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p>I wonder if there’s something else we could call it? “Risk-sharing?” “Enrollment?” “Opt-out?” There’s got to be a better frame for the mandate, in addition to justifying the policy.
… but in the context of a private insurance market this doesn’t have the ring of a public good that it should
It sounds bad, but it’s just the way the discourse works in this country, and this is why Republicans don’t use clear explanations.
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p>Attacks move votes. Explanations don’t.
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p>You can’t expect to win in politics with explanations.
Emotional appeals and catchy phrases do have to represent some underlying truth.
Policy and politics of “adverse selections” and insurance mandates are succinctly laid out in this must-read diary by Dr. Steve B, on Daily Kos, Feb 25 2010
“Obama’s come-to-Jesus moment with Mandates”
http://www.dailykos.com/story/…
The Myth of Adverse Selection
Comment #5:
(Emphasis in original.)
Also it might not be so informative to look at the gross enrollment figures in the state, because, in fact, there isn’t a single health insurance market. Individuals, insured employees, and medicare recipients all occupy very different parts of it.
… that medicare recipients can be said to be part of a market at all. (Ooops, I forgot publicly subsidized and new found GOP favorite Medicare Advantage – where private insurers beged to compete for Medicare customers asserting that the private market will be more cost efficient and then asking for (and getting) subsidies to stay in business when the experience proves them wrong.)