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10 March 2017 @ 05:44 am
Accurately representing millions of voters  
For years we heard that Paul Ryan was one of the smart Republicans. He would present some complex economic plan, and the Very Serious People would praise it, except for a few spoilsports like Paul Krugman who would actually read it and demonstrate that it made no sense.

Now, as Charles Pierce and many others have pointed out, Ryan has proclaimed that insurance cannot work if healthy people have to pay more to subsidize the sick, which is the way insurance always works.

He is nowhere near alone. Many, many people who get one vote each used it to rid themselves of the scourge of Obamacare only to discover to their shock that doing so would coincidentally remove the ACA that is keeping them alive. (It’s international: “Let’s vote ourselves out of the European Union. OK, now let’s find out what the European Union is.”)

I really don’t want them to lose their health care. Nature punishes stupidity, but the purpose of society is to be less unforgiving than nature. In fact, I’d like all of us to have a real national health system like the first world does, and the worst that would befall the Trump trusters is the galling realization that the colored and the queers have it too.
 
 
 
The Mystery of the Supranational Rabbit: Finnish hare stampporsupah on March 10th, 2017 05:07 pm (UTC)
Perfectly put. At least it does sound as if there are indeed some Republicans now realising that they actually have to provide some kind of alternative - but, the devil's in the details, and indeed, if the insurers can possibly shed themselves of "pre-existing conditions", you know they'll snap that bill up in an instant. A friend, for instance, has an immunodeficiency disorder - if insurance doesn't cover the medication keeping him alive, it'd be on the order of $3-5K/mo. (Their "plan B" is emigration; not easy, but better than the alternative)

(I trust you noticed the actual title of the proposed legislation? O.o;)
eub on March 11th, 2017 09:12 am (UTC)
My sense is that the discussion around the ACA did raise public awareness of just what could happen to people once they had preexisting conditions, raised awareness of horrible practices like digging up reasons to rescind a policy once somebody gets sick, etc. The slice of the population who remembers that is going to take some selling on anything that goes back to the bad old days. So I have some hope the Republicans could pay for screwing people over.

Unfortunately I suspect the Republicans can patch together something that has the right top-line description for enough people to let it pass, even when it gives them their tolerable coverage by taking it away from the poorer and more powerless.
Sharon Kahndreamshark on March 11th, 2017 12:10 am (UTC)
Ryan has proclaimed that insurance cannot work if healthy people have to pay more to subsidize the sick, which is the way insurance always works.

It seems that most Americans (including, but not limited to, Republican legislators) have lost track of what "insurance" actually means and are now conflating it with "prepaid health plan." The point of insurance is to protect you from the unexpected. This can be combined with prepaid health services, but it is not the same thing.

The catch phrase that is beginning to drive me crazy is "Young, healthy people will just wait until they get sick and then buy insurance." Just because you were healthy when you woke up in the morning doesn't mean you will have the same status by the end of the day. After you wake up in the hospital with a head injury or a bullet wound is not the time you want to be shopping for insurance, kids. And the demographic with the highest death rate in the 1918 flu epidemic was "healthy young adults." Er, make that, "previously healthy young adults."

Edited at 2017-03-11 12:12 am (UTC)
Arlie Stephens: pic#6301806ertla on March 11th, 2017 06:21 am (UTC)
This confusion is not remotely new. Lots and lots of so called "insurance" plans have limitations on the total they will ever pay. On the other hand, they proudly cover routine expenses. That's the exact opposite of insurance.

American health insurance combines
- a large powerful group negotiating what providers will be paid. So you get a lower price even when still meeting your deductible.
- rationing/death panels, aka bureaucrats interfering with treatment choices and disallowing those they deem too expensive
- a kind of enforced savings plan for medical expenses.
- some aspects of actual insurance, in some plans
- a way of assigning different treatment based on class/socioeconomic status, Different insurance plans result in sending people with the same crisis to different ERs, with different availability of the better treatments, And of course no insurance means "stabilize but don't attempt to fix it"

The whole things is seen most clearly in the context of health insurance for pets, except that the socioeconomic class aspects don't apply there.


Edited at 2017-03-11 06:21 am (UTC)
eub on March 11th, 2017 09:04 am (UTC)
When it appears that somebody makes no sense whatsoever, look for the reading that makes them make sense to themselves.

I don't believe Ryan is actually saying the wacko "insurance should not pool risk between individuals". He's saying that coherent-if-immoral "everyone should pay premiums for their own statistical risk."

When he talks about paying for "sick people" he doesn't mean "previously healthy people who got hit by a bus", he means "sickies who can be expected to be sick" (subtext: because they're fat or do something wrong probably). He wants. He wants to turn the actuaries loose on whatever data they can mine to say that a person has a higher estimated future payout for the insurance company. Like an Objectivist would do.
Arlie Stephens: pic#6301806ertla on March 11th, 2017 10:25 pm (UTC)
You are probably right, if he has an actual brain and remembers how to use it.

The morality there is at least arguable.

I remember when a Canadian politician going door to door encountered an over 25 year old woman, and tried to convince her to support him, because he favoured not considering statistical risk for automobile insurance. In particular, he wanted to forbid charging single males under 25 years old more than other demographics. (This was standard practice for all insurers in that place and time.) The lady in question had no driving age sons, and was in fact too young to be reasonably expected to have children 16 or older, and was unable to understand how this could possibly seem, to the male canvasser, like the right argument to use with her, so filed him under "dumb as a brick; would not be competent once in office" even though she had a history of supporting the political party which had nominated him.

Of course car insurance is an entirely different thing than health care, particularly in a first world country with effective public transit, so that the ability to drive isn't a necessity for most jobs. (In the US, where public transit is rarely adequate, and often absent, the cases look more similar.)



Edited at 2017-03-11 10:26 pm (UTC)
Johnjohnpalmer on March 13th, 2017 03:55 pm (UTC)
The "insurance" meaning is a bit of a red herring, and not accurate, either. It's true, most insurance is "protection against unexpected big losses" but that's not the whole of it. Getting regular medical care at a discount-to-you is a perfectly legitimate use of the word - it just means that you're controlling outlays/losses far earlier than many other insurance products. Thing is, the wealthy would love it if they could save up $5k per year in health savings accounts (deposits and earnings tax free if used for medical purposes) and buy an insurance policy that kicks in after $20,000 in expenses. Such a policy is cheap! And the tax breaks are valuable.

Elenbarathi: Abandon hopeelenbarathi on March 11th, 2017 01:32 am (UTC)
Ultimately, single payer/enhanced Medicaid for all is the only option that makes any sense. However, the Republicans will never agree to that. The blue states will institute state versions; the red states won't; the worst that will befall the Trump trusters will be more of what's already befalling them: unaffordable care, unpayable bills, bankruptcy, homelessness, premature death from neglect.

They'd rather have all that, than let the coloreds, the queers, and most of all the women have equal rights in our society. If it were just 'stupidity', we might find it morally obligatory to be forgiving, but it isn't; it's the intention to benefit from the suffering of others. Whether or not we apply the E-word to that intention and the behavior it engenders, the purposes of society are not served by condoning it.

I have zero sympathy for the GOP voters who will suffer from the policies of the GOP reps they elected, and not much more sympathy for the voters who weren't arsed to vote. They've thrown the whole planet under the bus, and whatever logical consequences come back on them for that are no more than their just desserts.

The people I'm sorry for are the innocent: those who had no say, and those who tried but failed to stand against the tide of folly.

Edited at 2017-03-11 01:33 am (UTC)
Johnjohnpalmer on March 13th, 2017 04:00 pm (UTC)
Honestly, the ACA is a sensible approach - single payer is a great option, too, but the ACA's method could yield benefits. Insurance companies would have incentives to find better ways to track care, and better methods to provide optimal care. Single payer might do the same thing, but with multiple insurance companies trying different things, it's *possible* that something better will be found.

I don't worry about single payer because it won't happen - and the ACA is possible, at least.