The Worstall Obamacare reform plan

Make Obamacare plans catastrophic insurance only.

Y’know, the actual insurance part of health care?

Allow sales across State lines.

Drop tax exemptions for employer provided health care.

Insurance expands (for more people will buy plans with the vastly lower price) and the insurance itself becomes hugely less expensive as national systems replace the state hodgepodge. Plus tax revenue rises.

It’ll also piss off absolutely everyone which may or may not be a benefit.

25 comments on “The Worstall Obamacare reform plan

  1. Sounds a bit like Britain before the NHS – national insurance covered A&E. Or so I’m told. If it had been expanded to include communicable diseases ( something with a -ve externality ) then the job of government would be done.

  2. 1. Don’t need that. Insurance companies were offering catastrophic only plans before Obamacare put them out of business.

    1a. *Maybe* (and I’m not really on board with this idea) turn Medicare into an insurer of last resort that only provides catastrophic coverage (but universal). You got over a hundred thousand in medical bills this year then Medicare will cover the part that’s over a hundred thousand. The actual number can be quibbled over. I’m not really onboard with this idea because IMO inevitably politicians will try to push that number lower and lower to buy votes. But people will freak out ‘if we leave people to die in the streets’.

    2. Definitely – and across national lines as well.

    3. Drop exemptions on the employer side, offer tax credits/debits to the insured directly. No more job-anchored health insurance, get your own portable plan that you keep as you move from job to job while keeping the tax benefits that already exist.

  3. Not so fast, Timmer.

    States have insurance pools to protect against people losing coverage if an insurance company goes broke. Selling across state lines removes consumer protection. And don’t tell me nationalizing coverage is a good idea; that’s one of the things wrong with Obamacare.

    The idea of making insurance insurance again is a good idea. High deductible mandatory. Withdrawing incentives for employers to provide “insurance” is a good idea, too. Go to the doctor; pay for the visit.

    More Gamecock fixes:

    – Require the Federal government to reimburse the cost of providing mandated health care (in line with Takings Clause). I had a friend who was the CFO of a hospital. He said 16% of their cost was care for the indigent. If the Feds mandate care, then they should pay for it.

    – Eliminate punitive damages in lawsuits. Limit damages to 133% of actual damages. Cover damages, and throw in some for the fine lawyers. Mega awards today just drive up cost for everyone else.

  4. More or less what Agammamon says but add:

    – of course insurance companies can provide ‘ordinary’ health insurance of any coverage they choose. But they may only do it on group terms, which means in essence that pre-existing conditions cannot be considered; and that an individual cannot have premiums raised (the group rates can rise and fall) or insurance cancelled. Make it simple to form Groups – the larger they are, the cheaper the rates (roughly). The responsibility of a Group is solely to exist and keep track of its members. It can charge what it likes (including $0). Insurance companies can form or sponsor groups. Organisations like AARP, IEEE, etc can all form Groups. Yes, groups of size 1 are allowed, but the insurance companies are free to apply their statistics and so it probably won’t be an attractive option financially.

  5. The other supposed benefit of high deductibles is that patients will shop around more carefully, since they’re spending their own money. But wil that really happen? Or will people just purchase additional insurance to avoid the hassle of finding the best price for every little scan and every little blood test?

  6. Reduce bureaucracy required for claiming insurance.
    Increase supply of doctors by expanding medical education.

  7. “States have insurance pools to protect against people losing coverage if an insurance company goes broke. Selling across state lines removes consumer protection.”

    Make that the insurance industry’s problem, something like ABTA.

    Remove all Certificate of Need legislation.

  8. “Drop tax exemptions for employer provided health care.”

    No, no, no, make all health care insurance premiums a deductible expense by whoever pays them.

  9. BiND,

    It isn’t just the pools, good point Gamecock, that cause problems with selling across state lines. Each state has it’s own set of laws about insurance. This requires an insurer to have separate plans for each state as the same plan can not simply transfer. Selling across state lines will do nothing unless we get the state governments out of the way.

    In this area you have to think of the differences between PA and SC more like the differences between the UK and France.

  10. LY,

    This sounds to me like a boot leggers and baptists problem.

    Anyway, why don’t interstate commerce laws cover this?

  11. Interstate commerce laws don’t matter when you have the best government money can buy.

    Our problem isn’t actually insurance. It is rents. Good luck finding a politician willing to take on the AMA. 2.5 doctor per capita simply isn’t enough to met demand. Unless we fix this type of issue no amount of insurance reform will do anything.

  12. “States have insurance pools to protect against people losing coverage if an insurance company goes broke. Selling across state lines removes consumer protection. And don’t tell me nationalizing coverage is a good idea; that’s one of the things wrong with Obamacare.”

    None of that is even close to being true.

    If my insurance company in Arizona goes broke, I am in the exact same boat as I would be if I had bought one from a broker in NY.

    All the state’s regulator needs to do is the same thing they do for in-state companies – check for the same stuff before certifying that insurer to offer policies in that state.

    Secondly, ‘national competition’ is the exact opposite of ‘nationalization’. Obamacare did the latter, Worstall suggests we do the former.

  13. “Andrew M
    January 22, 2017 at 6:58 pm

    The other supposed benefit of high deductibles is that patients will shop around more carefully, since they’re spending their own money. But wil that really happen? Or will people just purchase additional insurance to avoid the hassle of finding the best price for every little scan and every little blood test?”

    The beauty of that is that the people receiving the care are the ones that get to decide how much their time is worth. So, some will spend more to cover incidental but expected expenses, some will spend time to look for cost-effective services.

    We get a whole spectrum of services and prices catering to the whole spectrum of consumer desires – unlike the current one-size-fits-none model.

  14. “Liberal Yank
    January 23, 2017 at 12:05 am

    Interstate commerce laws don’t matter when you have the best government money can buy.

    Our problem isn’t actually insurance. It is rents. Good luck finding a politician willing to take on the AMA. 2.5 doctor per capita simply isn’t enough to met demand. Unless we fix this type of issue no amount of insurance reform will do anything.”

    The problem buddy is that its your fellow liberals that are insisting that its not ‘safe’ to create a class of para-professionals in between nurses and full-on doctors.

    All the AMA could do is lessen pressure limiting the number of doctors – but then we get people complaining that their doctor might not ‘be the best-of-the-best’.

    So, no equivalent to muffler, brake, and oil change shops for the medical profession.

  15. ‘The other supposed benefit of high deductibles is that patients will shop around more carefully, since they’re spending their own money. But wil that really happen?’

    I don’t care if they do or not. At that point, it’s their money, not mine.

    ‘None of that is even close to being true.’

    It was true when I got my license. Idiot.

  16. The problem buddy is that its your fellow liberals that are insisting that its not ‘safe’ to create a class of para-professionals in between nurses and full-on doctors.

    We have things like physician’s assistants in between. We have to because there aren’t enough doctors to serve the demand.

    All the AMA could do is lessen pressure limiting the number of doctors – but then we get people complaining that their doctor might not ‘be the best-of-the-best’.

    As if the current doctors are really all that good. Normally I have to tell the doctor what is wrong and what treatment I need. Despite what they try to tell you disodium 6-hydroxy-5-((2-methoxy-5-methyl-4-sulfophenyl)azo)-2-naphthalenesulfonate, to name one common food additive, is not actually safe to ingest for some people. Even worse is that eating more fiber only exasperates the problem.

    So, no equivalent to muffler, brake, and oil change shops for the medical profession.

    Then we might as well go with socialized medicine since, according to you, there is no such thing as a functional healthcare market.

    To be clear I think that we could have a functional market as long as the trade guilds are broken. I pick on the AMA because they are such an easy target and I am one of the millions taking the hit from their greed.

    I could easily pick on big pharma as well though. My gf’s sister works for one and the bumpkins making your drugs most definitely aren’t good chemists. I can at least say that trying to retrain coal miners to do chemistry is not the best solution for jobs in WV. They do enjoy the much higher pay though, even if they end up working with methyl azides any, relatively sane, trained chemist wouldn’t be caught less than 10 miles(roughly 16 km) downwind of.

    I could also pick on insurance. During a stretch on unemployment(Long story short RBS subsidiary was doing something shady. I know it’s a shocker) I took a, supposedly up to 90 day temp position(to not lose my benefits) at an insurance company.. Differences in state law between various states(I used PA, where I live, and SC, where Gamecock is but we had accounts in a couple dozen states) are what makes selling insurance across state lines impossible. Account management representatives(paying not much more than government cheese and less once the cost of working is accounted for) were only allowed to deal with one state as the differences were easily confused. If it helps it was the ‘privatized’ administration of welfare benefits.

    We also have limited numbers of provider networks. I am lucky to live in an area where we have two. Unfortunately the second is always close to bankruptcy and therefore has limited services. The major one isn’t actually good but they have the money to tell people they should believe the highly profitable company(despite it’s non-profit status) is good and voters allow politicians to increase their near monopoly.

    What I want is to be able to shop around and find a doctor who actually understands what they are talking about. Restricting the numbers only make me wait, sometimes months, only to find out that the physician is a quack. Take your socialism and shove it. I want to see 3.5-4 doctors, drug options, … per capita given the demographics in the US. Based on the medical treatments I’ve been subjected to I’ll still visit a lot of quacks but at least they will be affordable and accessible.

    Anyway I’m off to drink away the pain of my beloved Stillers losing to the socialist system that is the NFL yet again. I’d much rather go for a long run but I really need a backiotomy yet the US medical system has failed me. I’d partake in the one painkiller that actually helps, marijuana, but the state says I am a criminal for wanting to function in the world.

  17. “Allow sales across State lines.”

    Yeah, right, I’ve heard this for years. But what does it mean? Not what it says, I think. In fact I doubt it has any practical meaning.

    I’m not obliged to, but I can if I wish, travel across state lines from Connecticut to Alabama, to buy pretty much any product I want – lumber, shoes, fertilizer, you name it. It’s true I can’t travel across the same state lines to Alabama, to buy individual medical insurance. Well, so what?

    Why would I want to buy my insurance from an Alabama insurance company anyway? The company may not have a physician or hospital network in Connecticut. My Alabama policy may require me to choose a doctor in an Alabama network. My Alabama policy may pay me less because I have an “out of network” doctor in Connecticut. Why would I ever choose that? What’s driving the repetitive calls to let me buy insurance “across state lines”? What’s in it for me? The idea expressed in the phrase “across state lines” is baffling.

    Try this instead – I think it makes much better sense:

    “Any policy that is approved for sale in any state, shall be available for sale in every state.”

    Advantages:

    1. I could buy insurance in Connecticut that is no longer held hostage to the coverage “mandates” legislated by Connecticut. These mandates drive up the cost of insurance. I could choose a policy approved in Alabama that costs me less in Connecticut because it contains fewer mandates than Connecticut imposes today.

    2. I wouldn’t have to travel across any state lines.

    3. I might have more choices. Lots more choices. More choice is good – because it usually means more competition among suppliers and better deals for me.

  18. LY: “I’d partake in the one painkiller that actually helps, marijuana, but the state says I am a criminal for wanting to function in the world.”

    Your state might. But you could always move to one that doesn’t…

  19. On the matter of self-medicating with cannabis…

    Your state might. But you could always move to one that doesn’t…

    I’ve always wondered how this fits in with random drug testing regimes undertaken by some companies? Do they suddenly become illegal in that state or do you just turn up Monday morning after a weekend on the wacky backy and find you have no job anymore?

    As for US healthcare mandates, If I can buy travel insurance in the UK which gives me global medical insurance for a year, I can’t believe it is without the wit of man not to have an equivalent level of coverage for the United States.

    As many have said, the problem here is interference by both state and federal governments.

    As for the state-by-state funds in the event of failure, surely any insurer that sells insurance in that state should contribute to the fund. If a company doesn’t want to contribute, then it can’t sell in that state.

  20. Your state might. But you could always move to one that doesn’t…

    You are assuming that drug prohibition is only a state law. We are discussing a drug that is a criminal offense at the federal level.

    On the bright side I didn’t end up chasing pink elephants after back surgery. One Oxy was enough to know I shouldn’t use opium, even in its legal form.

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