Why Ryancare will not work

Ryancare, like Obamacare, involves cross subsidies. Some people wind up subsidizing other people. The resulting landslide of rules and regulations will shut down competition, with the result that everyone plus the government winds up paying unreasonable prices.

Ryancare requires that insurance cover people with pre-existing conditions. That is not insurance, that is a handout. If the government is going to give people handouts, should be done openly through government funded hospitals and the like. If you rope private enterprise into giving handouts, you will find that this turns out to be a stupendously expensive way of providing handouts, not a cheap way.

You order private enterprise to give handouts, you wind up giving them monopolies so that they can fund these handouts, and they wind up abusing these monopolies. Further, people receiving handouts tend to be problem people. Some of them are unlucky, but most of them are no good. You don’t want no good people showing up to hospital in front of the good people who are actually paying for the hospital, or you get the Canadian situation, where no Canadian who can avoid it goes to a Canadian hospital but rather nips across the nearby border to an American hospital, because the Canadian hospital is full of homeless and drug addicts. And when I say full, I mean very full indeed, with beds in the corridors and urine soaked sheets, and not a normal middle class person in sight.

If the government is going to give handouts to people with pre-existing conditions, or handouts to anyone, it needs to keep the insurance companies and private sector hospitals out of it. Handouts need to be done openly and need to appear on the books as handouts. Hidden handouts inadvertently shut down the free market system, resulting in at best socialist levels of service, at worst socialist levels of service with staggeringly high costs.

Ryancare is the continuing ratchet leftwards, Ryancare is Republicans doing their jobs as tax collectors for the welfare state, where Democrats create unfunded entitlements, and Republicans proceed to make white middle class males pay for them.

Ryancare means that Republicans get to take the blame for Obamacare. If you are not going to repeal Obamacare, at least hang it on the Democrats.

28 Responses to “Why Ryancare will not work”

  1. John Morris says:

    Ryan has an unsolvable problem. Trump ran on a platform of keeping the pre-existing condition , children until age 26 and “nobody left to die in the street” parts of Obamacare. Well that IS Obamacare, everything else is implementation detail.

    Combine with most of his caucus are “Conservatives” who must now conserve the new status quo of Obamacare and there isn’t a solution. Everybody knew that years ago, everybody said once the freebies flowed there would be no turning them off. History does not record a freebie EVER being stopped.

    • Cavalier says:

      “History does not record a freebie EVER being stopped.”

      I know the head of a mid-tier city hospital, and he said that nearly word for word.

      Fortunately, we’ve reached the end of history.

      • John Morris says:

        If you mean the cycle breaks with the Kaboom! then we are in agreement. But anything less and it ain’t ever being taken away. After the Kaboom!, when we are rebuilding we need to add in a mirror to “No Taxation Without Representation” to cover the equally important idea of “No Representation Without Taxation” to stop the plebs from voting themselves largess from the Treasury.

        • Samuel Skinner says:

          Do that and you have oligarchy where the rich will import immigrants to drive down the wages of the poor. That is why “No Representation- Period” is stable over the long run.

    • c23 says:

      How about the ampora (free grain subsidy) in ancient Rome?

      I have not been able to find any record of what happened to it, but presumably when Rome crashed it burned, it did too, around the same time Rome became a village of a few tens of thousands of people.

      Freebies being stopped without disaster, I’m not so sure about.

  2. jim says:

    Not necessarily. A system where uninsured people with pre-existing conditions got special charity treatment, went in to rather fewer hospitals by a different door to the door insured people go, would cover Trump’s promise.

    The problem is that you need to keep a good separation between the people paying for handouts and the people receiving handouts. If they go through the same door to the same hospital and they are covered by the same payment system, you get the Canadian system, which is totally overrun by no-good people receiving handouts, so much so as to crowd out the people paying for it, because having jobs and families, they are too busy to compete with the bums in ever lengthening queues.

  3. Alrenous says:

    Can’t do Singapore in America. It’s inegalitarian. Classism and all that.

    Just made medicine legal again.
    http://freenation.org/a/f12l3.html

    We understand why Trump can’t do that, right?

  4. Mister Grumpus says:

    Some people net-pay and some people net-take. Fine. White males like me wouldn’t actually mind net-paying, to SOME degree (warning-warning), if we were just recognized and respected for it. But if not then fuck these people.

  5. Alistair Hermann says:

    “because the Canadian hospital is full of homeless and drug addicts. And when I say full, I mean very full indeed, with beds in the corridors and urine soaked sheets, and not a normal middle class person in sight”

    Now why is it that Australian hospitals are not like this? Or at least not in my experience, in Sydney and in Tasmania.

    Is it that there is no border for the middle class to cross?

    Is it that there is a fairly consistent mandate that if you don’t have some sort of serious condition, you are going to sit in the waiting room until tomorrow?

    Is it simply that we have a better class of bogan?

    • Alistair Hermann says:

      Slight flag – ‘Sydney’ being in this instance the outer reaches of white exburbia.

    • Space Ghost says:

      Do you have fat Bogans? Obesity is 20% of US health care costs, and disproportionately concentrated in our lower class, so for that class I’d bet obesity accounts for 40 or more percent of their health care costs.

    • jim says:

      If you go to an Australian hospital, they will ask if you have health insurance. And if you have health insurance, they will ask you to enroll as a private patient. Now theoretically the private and public patients get the same treatment, and they do, eventually. But yes, the public patient is apt to sit in the waiting room till tomorrow and then get an aspirin. Among the horror stories I have encountered: Public patient with retinal detachment, where hours make the difference between being blind and not being blind. Public patient went blind. Public patient with brain cancer. Six month wait for operation. So generally, good idea to have health insurance.

  6. I have a heretical idea here. You know, I always wonder why over here ever even our Le Pen type “far” right does not oppose stuff like government healthcare, while in the US even liberals are often sort of lukewarm about these things.

    I mean, I do get libertarianism, I really do, but apparently it is not popular, so why do all the non-libertarians seem to still oppose government invention into healthcare?

    Perhaps because in the US government interventions in these matters are often worsely done, too much bureaucracy and too few results?

    So here is how a truly European style healthcare would look in the US:

    – The government offers to pay for the education of some doctors (in cheaper colleges) who then graduate without debt

    – In return they must work for the government 10 hours a week, working the rest in the private market

    – That part time working for the government means spending those hours in a public clinic, which would be organized much like a public school, they get paid a middle class, but below market rate for this

    – The public clinic simply accepts a social security number as an insurance, or maybe not even that, no questions asked only referral from the family doctor, GP necessary

    – Decent middle class people will typically avoid public clinics

    That’s it. It establishes the two-tier system Jim wanted, so that decent people don’t compete for beds with drug addicts. It forces the private market to compete with “free” which makes them efficient. It does not distort the private market in bad ways. It does not really waste money, the taxpayer money is spent on educating doctors and running clinics which is not a bad way to spend it.

    So why not try something like this?

    • I mean, one thing I noticed is that the US gov likes to regulate the private market, Europe more likes to leave the private market relatively alone, tax it hard, and finance it offer parallel fully government ran services: government housing, university, hospital, all modeled mostly after the public high school.

      Taxes suck, that part sucks, but aside from that it is a better idea, because when the government provides X for “free” and does not regulate much the private company who also offer X, it pushes them to improve their efficiency in order to be able to compete with “free” ?

      If you look up the Nordic Model it is almost explicitly this. It is not only socialism, it is not that simple. It is high taxes and lots of government services, but often balanced by low regulations. The job market in Denmark is almost deregulated, nobody is protected from getting fired, it is at-will employment. But the taxes are high. The idea is that as long as you work, you work in an almost deregulate, efficient free market. When you drop out of work, then the state steps in.

      I am not a huge fan of that either – I too have too libertarian instincts for it – but I would rather choose a tax-and-service based system over a regulation based system. Regulations can grow and grow into infinity. Taxes are painful, so there is always a resistance to them, they cannot grow forever, and people can better compare what services they get. While most people cannot really follow the insane complexity of the federal code of regulations.

    • jim says:

      Yes, if you are going to spend money on healthcare for poor people, that is by far the least damaging, and least expensive, way to do it. And it allows middle class people to buy middle class healthcare.

    • peppermint says:

      Why do doctors go to college? Why can’t there be more specialized apprenticeship and multiple accreditation agencies or just let the HMOs handle accreditation?

  7. Mandos says:

    This. So much this. As a professional from the field I am baffled to see that this simple truth seems to elude the decision-makers. My single biggest disappointment with Trump is when I heard him gleefully confirm that he likes the principle of covering pre-existing conditions and wants to keep it in his version of the law, basically rendering the repeal inoperant since it’s all ever been about that, and that only, in the first place.

    This ignorance from the insurance field is going to bear enormous political costs for Trump, not to mention the economic ones. Someone redpill him on the issue for the love of Gnon, pronto.

    But what used to baffle me even more was why insurance companies themselves would not, through their executives, voice their concerns, point the elephant in the room and seize this unique opportunity to lead the new boss back to the greeny pastures of sound medical underwriting and get rid of all these bad risks in their books. I can somehow figure why non-specialists would be baited into believing this just gotta cover pre-existing conditions bullshit but that professionals wouldn’t unanimously revolt against the overturn of what has always been the very nature of their business – claims eligibility management – was beyond me.

    Then it hit me: of course they won’t. All we are talking about, as far as lawmaking is concerned, is just pozzed corporate executives who have never been in front of another client than their n+1 peers in the banks and consulting firms they come from, and for whom “possible” is mandatory vocabulary, especially when DC status and corporate image are at stake and you are being soothed all day long with fairy tales on how premium income will follow and how well you will be rewarded for it.

    These fuckers are signing blank checks to the government to reward bad behaviors, punish good ones and get a truckload of money in the process while never being accountable to anybody else than their blind shareholders, while betraying their clients and their frontliners like yours truly like French generals during a world war. I swear, making the public genuinely believe affordable insurance that covers pre-existing conditions is possible is borderline treason – a treason well in line with the whole cultmarx proposition, I’ll give you that.

    But I digress. Let’s talk numbers. The average annual healthcare expenditure in America is north of USD 10’000 as we speak. Per head.
    Let that sink in for a second. The aggregate of what the average(!) American costs in medical expenses/insurance/medically-related subsidies is above 10 grand.

    It means that if all these costs were to be ultimately supported by the insurance company, which is pretty much the path we’re on minus Medicare/Medicaid, the average annual premium they need to charge to a family of four to only break even is USD 40,000.

    All of it with a an annual medical costs inflation navigating in the high single digits. The good years.

    I spare you the demographics components of these trends. How do you think this will end?

    Trump needs to be brought to his senses urgently on this. And as a matter of fact, the very people whose mission would be to do it won’t. Because they are pozzed fucks who don’t like him anyway and think it’s gonna be ok as long as they have the law enforcement behind them to ensure premium collection, but also because now that so many bad risks have been enrolled under medical plans according to Obamacare provisions, discontinuing their coverage threatens the firms with concrete PR risks.

    Now, those risks could be offset by openly working hand in hand with the government to ensure a smooth transition of the risks to a newly funded public system and helping it establishing sound cost containment strategies. Trump would harvest the fruits of shifting the healthcare costs for the most vulnerable members of society to the responsibility of the government, which on top of being a better idea will make his popularity skyrocket while driving the libs absolutely nuts, and the disintermediation costs alone will save billions. Avoiding the Canadian system trap can be accomplished by different levels of access to hospitals indeed, and investing in additional public medical facilities.

    But the most important part of it all might be that making the bill public would allow Trump and his administration to use the very real financial consequences of unhealthy behaviors as a political weapon. I suspect the main reason why Obama didn’t go all the way to a publicly funded health system, although he had the political capital to do it, didn’t owe as much to muh private sector opposition as it did to the opportunity to keep the costs of bad behaviors somehow hidden – as casting them in broad daylight would contradict the Dogma – while still cashing in the status points. Trump could take advantage of this and turn a situation with massive unpopularity potential on both sides of the spectrum into a major success.

    • peppermint says:

      Preexisting conditions – mandate = dead insurance companies. Good riddance.

      The next step will be to legalize medicine without a licence which means multiple accreditation agencies and employer based healthcare comes back through the back door.

  8. Oliver Cromwell says:

    The best solution at this point would be to ban healthcare while exercising some tolerance for the black market.

  9. Trollercoaster says:

    The enslavement of the American male is due to the erection of toll booths around life’s necessities: housing and healthcare. Worthless people get them for free, decent people must expend their life’s labor to keep them.

  10. Inquiring Mind says:

    So tell me. How is it that a person getting prepaid healthcare through their employment with a preexisting condition is OK (or partially paid — ever increasing co-pays and deductibles are pretty much standard for all “health insurance” these days), but a person on their own wanting a prepaid health plan is not?

    There are all manners of conditions affecting your health status, not all of them being below the poverty line and consuming enormous amounts of Mountain Dew?

    So you have a preexisting condition, you cannot get a prepaid health plan, so you pay your medical care out-of-pocket. Have you seen “the spread” between healthcare provider reimbursement from the prepaid health plans and the full-retail price of out-of-pocket pay? Kto kogo? Who is subsidizing whom?

    And then you spend all of your money and then money you don’t have and have a medical bankruptcy, so you then qualify for Medicaid? Is that how this works? The government is then paying for your health care after all?

    So isn’t, hasn’t Medicaid been the health plan of last resort, and Medicaid expansion has been the lion’s share of Obamacare covering more people? And isn’t Medicaid the modern version of the public charity hospital or the clinic with different doors? Or at least I am told you have a much more limited choice of providers?

    And finally, why is our generous Internet host Jim and others going full Libertarian on Mr. Trump? Wasn’t the deal, the bargain, the “thing” we were getting with Mr. Trump that Libertarian sentiments were for the misguided Conservatives who just “didn’t get it”, that the real issues were Open Borders, destruction of the non-minority Middle Class, the subordination of men?

    Seriously, I am not trying to troll or be difficult. An Inquiring Mind just needs to know.

    • jim says:

      I am not going libertarian on Trump. Going libertarian would be “no handouts”. Going libertarian would be “Throw the improvident and the feckless on the street”, which of course Trump has promised not to do. I just say that people getting handouts need to go to hospital through a different door, or be explicitly classified as a different category of patient in hospital, so that the middle class people who are paying for all this don’t find fifty drug addicts looking for free drugs and fifty vagrants looking for free room and board in front of them.

      Someone asked how come Australian hospitals are OK, even though they are for the most part free like Canadian hospitals? They are OK because middle class people going to hospital are generally sent there by their doctor, to whom they paid a small fee right out of their pocket, rather than showing up at the waiting room for the triage nurse, and generally have private insurance, so the hospital formally classifies them as private patient, meaning “patient that we want, because we get substantially more money for them than those @#$%$^% public patients”. So the middle class enters the hospital by a different door in the sense that they bypass the triage nurse, often literally by a different door, and has a formally distinct patient classification.

      Australia allows people to sign up for health care even with a pre-existing condition, but you are not covered for the pre-existing condition for a waiting period, normally twelve months, and you permanently have to pay a higher penalty insurance rate.

      In Australia what happens if someone without insurance gets a detached retina is that he goes to the hospital, where he waits sixteen hours for the triage nurse, who then puts him into hospital as a public patient, where he waits another twenty four hours for the doctor, who gives him an aspirin for his detached retina, because a detached retina needs to be treated within a few hours, not much point in treating it two days late.

      Australian solution for pre-existing conditions: 12 month waiting period and “free” treatment – free after you wait and wait to see the triage nurse.

      In Canada, if a middle class person tries to go to hospital, there are fifty drug addicts in front of him, because hospitals are free. In Australia, hospitals are theoretically free, but the triage nurse keeps the drug addicts down, and the middle class person gets to skip the triage nurse.

    • jim says:

      The Australian health care system is very far from being libertopia or Ayn Rand’s hard core capitalism, but they have a twelve month waiting period and permanent financial penalties for pre-existing conditions.

      If Trump implemented the Australian system, or better still, the Singaporean system, he would be keeping all his promises. Those that cannot or will not pay are taken care of, they are just taken care of in a somewhat second class way, and have to get past a rather unsympathetic triage nurse.

      • Inquiring Mind says:

        Thank you! I appreciate you taking my remarks seriously.

        It seems to me that Medicaid is as close to the charity hospital or the Australian Triage nurse as you are going to get in the U.S. under political, social, and cultural conditions. I am told that most of the coverage of the previously uninsured claimed for Obamacare is under Medicaid.

        This is according to “respectable opinion” that dares dirty itself by considering why anyone at all voted for Mr. Trump, of course holding their nose, covering their mouth and wearing the latex-free gloves over their hands. While signaling that personally, they still loath Mr. Trump, they claim his ardent supporters to be the “man and his wife owning the gas station, who are overwhelmed by regulations, who cannot get a permit to build a new gasoline storage tank and dare not stir the hornet’s nest of the environmental remediation of their old storage tank.”

        The man and his wife with the gas station used to get their health insurance much more cheaply if they had no preexisting conditions whereas if they had such conditions, which can be broadly defined because as you get older, there is always something “wrong” with your health, they simply hoped that didn’t get expensively ill. Now their health insurance (properly their government-mandated only partially prepaid health plan) is horribly expensive but they don’t have to worry as much (maybe) about getting sick? These are Mr. Trump’s constituents, these are our constituents, these are ourselves, and I am pleased we are on the same page regarding the need to support Mr. Trump.

        As to Mr. Ryan, whose GOPe “provenance” is more suspect, he is a smart, incredibly hard-working guy who is willing to take the heat of being depicted by an actor dumping Grandma out of a wheelchair over the precipice of a cliff. He is telling us, “Trust me — this bill is only Phase 1 and there is a long legislative process with the slim majorities in Congress.” Mr. Trump is telling us “Trust Mr. Ryan.”

        We could take Moldbug’s “don’t even vote” detachment from the political process until the current trajectory reaches its endpoint and Charles II gets back on the throne. But if we are politically engaged, and some point one has to trust what someone claiming to represent our interests — Trump — is saying.

        • jim says:

          The man and his wife with the gas station used to get their health insurance much more cheaply if they had no preexisting conditions whereas if they had such conditions, which can be broadly defined because as you get older, there is always something “wrong” with your health, they simply hoped that didn’t get expensively ill.

          The Australian rule is that you are supposed to maintain continuous coverage. If you have large unexplained interruptions in your health insurance, the insurance company suspects you are taking out insurance because you know or suspect you are about to become sick, and charges you accordingly.

          I am not complaining about giving people handouts. Trump promised that, and we all voted for him enthusiastically anyway. I am saying that those receiving handouts need to go in by a different door to those paying for the handouts, need to be a different class of patient in hospital, or middle class people will get no healthcare because there are fifty vagrants looking for free room and board, and fifty drug addicts looking for free drugs in front of them.

          Not everyone who gets a handout is a drug addict and vagrant, some of them are your aging man and his wife with a gas station, but when you start giving out handouts, you get so many druggies and vagrants, that is hard to find the man with the gas station.

          • Oliver Cromwell says:

            Many people in the system are there to help alcohol vagrants, and would turn their noses up at the gas station guy.

            In the modern world high IQ conscientious people are employed in high status jobs as nannies and servants of low IQ useless people.

  11. eikey says:

    I’m SO disappointed in Trump right now. Not even a glimmer of moving in the right direction.

    His plan is only slightly less bad than the added regulations and bureaucracy that Hillary would have ordered.

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