Health Services – Capitulating Out The Gate

In the news today is that “The Republicans Have A Health Care Plan!”.

The problem is that it capitulates right out the gate. It is rightly, as Rand Paul calls it, “Obamacare Lite”.

The essential structure of Obamacare is kept, along with mandates and penalties, but gets tinkered around the edges with the dropping of some specific rules and having the penalty from the mandate be paid to the insurance companies rather than the government.

OK, “the question not asked”: Why in heck is the provision of Health Services (it isn’t “care”… it is a service provided by people paid wages) a U.S. Federal responsibility? Where is that in the Constitution?

IMHO, the only correct thing for the Federal government to do is to declare that Health Insurance Companies can sell in any State, doing business as they wish, and with each State having whatever the State government wants in terms of regulations, State provision, Subsidy, etc.

Wash the Federal Government hands of it and walk away.

The Federal Government does not provide my lawn mowing services, my car washing services, my car repair services, my home insurance, my auto insurance, my food services. It just is not their job to be a national service provider.

The Peculiar Problems Of Health Services

There are a few particular and peculiar aspects of Health Services that causes much of the “problem” in providing them. These issues lead to unequal distribution of outcomes and needs along with unequal access to services. They do need some kind of fix, but that “fix” is at core a welfare program. Money must be taken from one person (or company) and given to another for services that the Money-Bags does not get.

Most of the fight is over who is the Money-Bags and who gets the money.

The largest consumers of Health Services are those who are old, nearing the End Of Life (EOL), those with chronic (pre-existing) conditions, and those who suffer unexpected and catastrophic injury or illness (think car wreck or onset of ALS.

Of those three classes, two are very predictable. Old Age and Existing conditions. Insurance is NOT about paying for what is predictable, it is about paying for what is an individual surprise (but predictable on a statistical basis for a population). What is not insurance, is welfare. Transfer payments from the Money-Bags to the Money-Sinks.

To ignore that is to get the kind of crap that is Obamacare.

One example: I’ve been in an Ambulance once. My Mother-In-Law had not been in one at all by my age, that I know of. When she reached about 75, the Ambulance rides started. At least a dozen. Each followed by one or more days in the hospital. Sometimes intensive care, always the Emergency Room. That is a fairly typical Health Services consumption profile. Very little for the first 90% of life, a huge amount as EOL approaches.

Similarly, folks with Diabetes have a fairly clear health serviced consumption profile. “Prognosis” if you will. Ditto Cancer patients.

So what Obamacare does is force the young and healthy to buy incredibly expensive “insurance” that they do not need in order to fleece them for the money to provide welfare health services to those with EOL and Preexisting Conditions high expenditures. That isn’t insurance, that is welfare. It then layers on all sorts of stupid penalties, fees, whatever if you don’t “voluntarily” submit. Governments are not for the purpose of coercion of the voter, IMHO.

IF you want a Medical Services Welfare Program, go ahead and set it up and use general fund taxes to pay for it. Much of anything else is just a lie. Lies don’t work well in the long run.

Additional problems:

There is no limit on how much a person will spend for medical procedures when they are paid for by someone else. It can cost tens of thousands of dollars to add a day or two to an ending life. Few folks will voluntarily say no to more life. Similarly, the technology of “fixing things” pushes forward faster than the ability to pay for those fixes. We can now replace almost all the bones of the body. Synthetic organs are being developed. Total cost to repair someone as they wear out can exceed their lifetime ability to create. When that happens on a population basis, the nation goes bankrupt.

Letting the AMA practice Occupational Birth Control on the number of medical doctors is just a monopoly by a trade union. Build as many medical schools as can be filled with students and the cost of medical care WILL drop. There are many times more bright and gifted students who would make great doctors than there are medical school slots for them.

Letting malpractice lawyers game the system as an ersatz form of welfare / wealth redistribution is just crazy. It makes for many rich lawyers, some compensation for actual injuries, and astounding increases in medical costs. At one point I knew an anesthesiologist who had malpractice insurance costs equal to about 1/2 his annual pay. He was good at his job. But some folks DO die or have failures under anesthesia. The simple fact is that medicine is NOT a perfect technology. Instead of recognizing this and having each person accept their risks like adults, we have set up a system to “compensate” them in some kind of “social justice” way, while making lawyers rich in the process. Get that out of the system and costs will drop by about 1/2. IF you want such an injury compensation system, set one up but without the lawyers cut. Set standard payments for typical known bad outcomes and cut the checks. It would save all the legal costs AND eliminate the randomness of Lawyer Roulette for the injured parties.

Over the years, the billing practices at hospitals has evolved to “3rd Party” the costs from those who did not have enough money to those with private health insurance. This was another kind of back door welfare program, and it is why a “small tray” for the ER that ought to cost about $10 runs closer to $100 last I looked. (some minor bandages, scissors and tape and such). I worked in Patient Accounting for a couple of years, so got to see it up close. Medicare doesn’t pay enough? They pay $50 for “FOO” and you charge the private health insurance $150 to “make up the difference”. Simple fix: Mandate that ALL parties pay the same price for a service. A billing code has ONE price at any one facility. Private insurance costs will plummet and the true cost of welfare will be visible, and can be planned for properly.

Insurance companies try to dump anyone who costs too much (as do employers, BTW, so if you have a spouse with high medical costs and that raises the insurance rates, the employer knows and will try to remove that cost…) Now you have a choice. Let them not cover preexisting conditions and have lower insurance costs, or require that they take all applicants regardless of medical status and have higher insurance costs. Doing it 1/2 way like in Obamacare Lite is just silly. Force coverage for preexisting most of the time, but have a penalty if the insurance lapses? Punishes people who are ill, does NOT reduce costs (since they still get treatment and most folks will stay covered), adds red tape. Sigh. Either admit you are going to provide a welfare transfer payment to those folks, or leave them exposed to lack of treatment and / or high expenses.

The alternative is what is called “Adverse Selection”. Almost everyone with lots of expensive service demands will sign up for the “reduce my costs” welfare “insurance”, while those who don’t need it will buy none, paying out of pocket being cheaper, or go to a different provider if available (even if insurance companies are forbidden from offering lower cost plans to the healthy, Doctors can make pre-paid medical service contracts and select for the healthier clients). This eventually loads up the “insurance” with lots of excess costs and the company goes out of business (or leaves that market). To avoid Adverse Selection, you must either have some kind of preexisting condition exclusion or a clear Welfare provision. Trying to dodge that issue is what causes most of the mess in the present systems.

It is all about who pays and who gets treatment. The “Single Payer” approach says anyone in the tax rake pays and everyone gets treatment. The Free Market says everyone pays their own way for what they can afford. Real insurance says everyone pays according to their average statistical risk, and gets what is the usual payment for that expected risk if it hits them; everything else is excluded. Welfare says “soak somebody to pay the unfortunate”. Trying to mix those into one “system” is what creates chaos.

In Conclusion

I’ve lived under each of the major systems for some part of my life. The first few decades were “pay as you go” with no Medicare / Medicaid and few folks buying private health insurance. The local doctors had an office in the first floor of their home and lived upstairs. It worked reasonably well. “Indigents” got “free” medical care at the County Hospital. Some folks just did without medical services. Some folks paid for lots of stuff they didn’t need but wanted (rather like now…).

The major issue was folks at EOL running out of money and going bankrupt due to their unwillingness to say “I’m going to die in a year anyway, just let me go”. So we’ve instituted Medicare. The idea being to unburden the EOL folks from that worry.

Then we instituted Medicaid for the same reason for folks with chronic / surprise medical problems beyond their means.

That just left the folks who were a little moneyed, but not moneyed enough, hitting the wall (and paying the bills). As Medicare and Medicaid cut back how much they would pay for procedures (and the odd failure to pay) more of the costs got “3rd Partied” onto those with Private Insurance. I was working in Patient Accounting watching that happen. Private insurance costs began to rocket up.

Now we have Obamacare. The purpose of it was to force more healthy folks to pay into the Welfare System of Services while making it easier for those who wanted services to get them without paying (much). It also tried some ill advised Social Manipulation via things like mandating nuns get birth control coverage and pay for abortions. It is now in freefall due to the massive increase in costs to the system from all those folks with preexisting conditions and whatever getting welfare payments (as bill payments) and all the rest of us unable to actually use our “insurance” as the deductibles are incredible.

Essentially, it became “catastrophic coverage” for me. I had “Blue something”… Shield? Whatever… and the deductible went to $5000 per year plus some other things. I just don’t use $5000 a year of medical care. And that was AFTER paying about $8000? a year in premiums. Sorry, but I sure don’t need $1000 / month of medical services. Cheaper to just say no. Many folks did that math, and a whole lot of adverse selection set in.

So now we have a very complicated and very broken Medical Welfare System masquerading as “insurance”, festooned with a phonebook worth of rules, regulations, fees, mandates, PITA “savings accounts” (mixing the IRS and Income Taxes with Medical care? You think that’s a good idea?), whatever.

All because folks will not admit to the truth. It is a WELFARE system and a WELFARE problem, not a Medical Care problem. And certainly not insurance.

So the Republicans are continuing this lie with Obamacare Lite. It stinks.

IF you really want a national Medical Welfare System, admit it, and built a simple clean one.

IF you really do not want a national Medical Welfare System, don’t keep 1/2 of one around. Kill and bury it.

But be honest about what you are doing and stop calling welfare insurance.

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About E.M.Smith

A technical managerial sort interested in things from Stonehenge to computer science. My present "hot buttons' are the mythology of Climate Change and ancient metrology; but things change...
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26 Responses to Health Services – Capitulating Out The Gate

  1. cdquarles says:

    I agree. I saw this coming with Certificate of Need Boards (captured) and Diagnostic Related Groups. That was followed by EMTALA. More of same, piled higher and deeper. That said, I cannot see many people wanting to sign up for the slavery of delivering medical care. I know that I told my children to steer clear of it, if they desired freedom. I guess it is time to see what the numbers are these days. Medical school enrollments were increased by enlarging class sizes and opening new ones 30 years ago, to relieve perceived ‘doctor shortages’ and they created ‘physician extenders’, too.

  2. philjourdan says:

    Damn! You covered all the bases. At this juncture, I can only say AMEN. You could have left SOME of the thoughts to us plebeians!

    I will add a side note. I found it especially amusing that Pelousi was so quick out of the box to condemn it. I know she has not read it. She did not read her own damn bill! And of course her objections were cookie cutter democrat playbook villianizations.

    If anyone wants to quote her, be my guest. But that immediately brands them as ignorant and stupid. Just like her.

  3. Having grown up with the NHS in England, I see the benefits (and at least some of the problems) of having “free” medical care.

    The benefits are that some accident or serious illness will not leave you or your family bankrupt, and that a healthier population will be more productive.

    The downside is that going to the doctor is the first resort, when most small illnesses will get better at just about the same rate whether you go to the doctor or not. The pills just make you feel more comfortable while you recover. There’s also no cost if you miss an appointment, so doctors’ time is often wasted waiting

  4. Richard Ilfeld says:

    These thoughts are not permitted. Common sense is the enemy of progressive governance.
    Please report to the appropriate reeducation camp.
    If I could only drill one thought into the minds, and more importantly language, of these idiot savants (political skill & no other evidence of intelligence) it would be that insurance is a financing issue, health care is a doctor/hospital/other provisions issue. Health care is a commodity that must be provided by a practicioner, whose numbers and compensation make up a marketplace, whether we like it or not.. Health insurance, and Obamacare or Ocare lite are a financing mechanism for this marketplace.

  5. andrewsjp says:

    Forwarding this to my Congressman and to my two Senators. However, I am sure they already know all this. Sigh!

  6. Sorry, hit enter accidentally….

    Here in France you pay a proportion of the bill (30% for me) and a missed appointment is charged at full rate. People don’t miss appointments.

    One thing that would really help the USA situation is to stop people suing doctors. Medicine is not an exact science, and if you don’t think the risk is worth it then don’t go to the doctor. You need a medical court that can strike doctors off for malpractice, and of course some support for the people who fell the wrong side of the statistics, but no massive compensation deals. Life is a lottery anyway, and falling ill is one of the chances. Expecting everything to be put right again is not reasonable.

    EOL care is very expensive, and when it’s Alzheimer’s or ALS, or something else that needs long-term 24-hour care, then at around $130 per day at minimum it will soon remove any life-savings (and that’s about the cheapest available). There goes the house, too. It costs money to hire enough people to do the job, even if it’s often a minimum-wage job for the majority of the employees.

    Though Obamacare-lite is obviously far from ideal, without a major shake-up it was always going to be a patchwork. The compact between government and the people is that if the people pay into a common fund, then by the time they get to need to take out of it that fund will still be there, and looking at history will make most people somewhat wary of that promise.

    Becoming a doctor is a long and expensive task. The stress of dealing with life or death decisions all the time means it’s also pretty draining. The proportion of life spent learning to the time spent doing the job is also somewhat high, so doctors will need to earn more than average in order to be attracted into the job (you’ll make a lot more money as a banker). Still, overall it comes down to what percentage of your working population needs to do the job and what the ratio of pay needs to be. Also how much money your country is prepared to spend on health. I really need to look up those figures for various countries, but IIRC a doctor (GP) in the UK will generally have somewhere 200-500 patients on the books. In India it’s several thousand. For the UK, therefore, the cost of GPs would be somewhere less than 1% of GDP, with somewhat less than that number working in hospitals, say another 1% of GDP if you include support staff. Somehow, that makes the overall spend of around 7% of GDP suddenly sound somewhat expensive and you wonder who’s profiting. Of course, the drugs companies charge quite a bit, too, and some of the modern drugs are eye-wateringly expensive.

    Despite all the problems, some sort of cheap universal medical care still seems to be a good thing to have. If you need more than patching-up after an accident, then it’s not unreasonable to have to pay for it. Getting the costs reasonable, though, does seem to be an urgent priority and doesn’t seem to have been addressed. Too many people seem to be making a profit by shuffling money around.

  7. cdquarles says:

    Um, in case you weren’t aware of it, being a “no-show” costs you. No-show rates are around $50 locally.

  8. cdquarles says:

    Simon, that chart is meaningless. For one thing, it does not consider that the USA often is the only place where cutting edge research is done that is privately funded. It also does not take into consideration legal system differences.Some one has to pay for the multi-billions it takes to run the FDA gauntlet for pharmaceuticals that survive, where the copying costs, at the margin, are far smaller.

  9. CDQ – In the UK, currently a no-show is not charged. In France, it is.

    The chart is most likely somewhat misleading in some ways, since it’s from the wiki. The legal system in the US is however one of the things I pointed at needing a change to reduce the medical costs (together with a realisation that medical intervention is not risk-free). I’ve no idea how the costs of developing a new drug could be reduced, since ultimately it will be tested on people. Inevitably this will have failures, since everybody’s DNA is different.

    Taking the chart as reasonably close to what is actually spent per person, though, that’s still showing around twice the cost in the USA as other Western countries. Unless the average earnings are also twice as great, that’s a lot more than seems reasonable. How much of that money spent goes to the actual medicine and how much to the insurance company and lawyer profits? I haven’t found that data.

  10. R. de Haan says:

    Mmmm, the current trend in the West is to merge Government social health care programs with private insurance companies. Apart from the fact that this “cooperation” is 100% pure corporatism, it kills the free market and with it the right of the consumer to choose for or organize tailor made health care. It´s a totally insane system with CORRUPTION and WASTE written all over it.

    And there is another aspect that I really dislike. Health Insurance Premium has been coupled with your fiscal income. The more you earn, the higher the premium/penalty.
    This could cost you up to 40% of your income and that is simply groce.

    In the USA there is a huge liability problem.

    I found out about this when a friend of mine thought it could be a good idea to start a dental clinique in the US. I did some due dilligence and found out that 50% of the overhead of such a practice had to be paid for liability insurance, same for a basic GP practice.

    The insane claim culture in the USA has lead to a country that is ruled by lawyers whose primary interests lies with generating red tape and fleecing people and businesses.

    Still hope Trump will make the right decissions in regard to health care in the end.

    The USA looks more attractive by the day now the Liberal Scorge that undermined the country for so long is subceding.

  11. Graeme No.3 says:

    R. de Haan:
    “ruled by lawyers whose primary interests lies with generating red tape and fleecing people and businesses” You left out public ‘servants’. Here in Australia we have a ‘universal’ scheme.
    Medicare gives Australian residents access to health care. It is partly funded by taxpayers who pay a Medicare levy of 2% of their taxable income.
    Your Medicare levy is reduced if your taxable income is below a certain threshold. In some cases you may not have to pay the levy at all.
    If you don’t have private hospital health insurance, you may have to pay the Medicare levy surcharge (MLS) in addition to the Medicare levy. This depends on your income for MLS purposes.
    If you do have an appropriate level of private hospital health insurance, you won’t have to pay the MLS, and depending on your income you may be eligible for the private health insurance rebate. (i.e. you get a deduction from your income tax of a fraction of the health insurance premium). This rebate is an amount the government contributes towards the cost of your private hospital health insurance premiums. The Medicare levy and MLS and any reductions are calculated from information provided in your tax return.

    All this brought in by the Federal Government Health Dept. employing ~3500 (as at June 2014!) when the Constitution specifically makes the States responsible for Health Care. The other problem is the gross financial inefficiency of public hospitals, so much so that there are multiple restrictions on private hospitals but they are still booming. A friend of mine (a specialist and part owner of a private hospital) told me that their running costs were 60% of what they had to charge because they weren’t allowed to undercut public hospitals. That was in 1989 and things haven’t got any better.
    It is a bit like Federal funding for education (another supposedly State responsibility) where there seems to be a direct relationship between funding and performance i.e. more funding, worse student results.

  12. EMS,
    If you don’t start paying health insurance at an early age insurance companies would never be able to make a profit. As you point out, it is an EOL problem.
    Young Americans will not pay for insurance unless forced to do so. It maybe that with the current job market they simply can’t afford to. What do you suggest? That people should be allowed to die if they can’t pay for basic treatment?

    Two things.
    First, health care can never be a free market as you can’t search around for the best price while having a stroke or heart attack. Even if you could, I defy you to find out the probabey hospital costs because they are not published and vary according to the payer.
    Second, The basic problem is the COST in America. It is two to eight times as expensive as other advanced countries.
    It is not just malpractice insurance costs. Remember that the latest figure is ~200,000 killed in hospitals each year by mistakes. Some people should be held accountable. The other side of the coin is that doctors prescribe a laundry list of procedures that are probably not required in order to avoid being sued.

    Some version of a single payer system is best. Have a look at how Singapore does it. Oh. And other systems work better that America for many things from infant mortality to curing treatable diseases including cancer (See Consumer Reports). The super advanced health care you can’t get anywhere else is for a handful only.

  13. John Robertson says:

    Want less of a service at uncontrolled costs?
    Just let Government Provide.
    As a Canadian I can tell you, the “single payer” system works great, for our Kleptocrats.
    For we who pay, long waits,long lines and service so delayed to be the same as service denied.
    As for the competency of the servers??
    They are government servants , working to the same “standards” we expect from all our “helpers”.

    The best irony is for the taxpayer to be subject to a “service” which the people who regulate this “public good and those paid to provide this same are all exempt .
    Politicians and public servants having wonderful “healthcare plans” compared to what they provide the taxpayer.

    No 18 month waits for these types.

    Contrasting the real time service between my dentist and my doctor, is enlightening.
    If I ever get badly injured I think I will consult my vet.
    Our pets are surviving better than our friends.

  14. p.g.sharrow says:

    The best example of Government single payer health care in the U.S. is provided by the Veterans Administration. Do I need to continue?…pg

  15. Steven Fraser says:

    @Chief: Fine article. I loved your functional decomposition of the problem.

  16. E.M.Smith says:

    @Steven Fraser:

    Thanks! “It’s just what I do”…

    Functional decomposition, flow, process identify and map. Root cause and optimization failure analysis. Summary write up. It’s a habit now, and I just do it constantly. At a store today I was doing a process flow map of their checkout process in my brain while waiting for the clerk… and identifying a couple of areas for improvement …

    I really do think they would have an easier time of it and make a better product if they just divided the problem into “Make a clean real insurance system” and “Make a clean simple Medical Welfare system” as separate products.

  17. Gail Combs says:

    “I really do think they would have an easier time of it and make a better product if they just divided the problem into “Make a clean real insurance system” and “Make a clean simple Medical Welfare system” as separate products.”

    Add getting rid of the Ambulance Chasers and cap the doctor’s insurance costs. This is a good idea otherwise you end up with the UK plan; pay the hospitals to kill off the expensive ‘useless eaters’ the unhealthy babies and kids and the elderly.

    Top doctor’s chilling claim: The NHS kills off 130,000 elderly patients every year
    * Professor says doctors use ‘death pathway’ to euthenasia of the elderly
    * Around 29 per cent of patients that die in hospital are on controversial ‘care pathway’

    Children placed on controversial ‘death pathway’

    Now sick babies go on death pathway doctors haunting testimony reveals how children are put on end of life plan

    Doctor admits starving and dehydrating ten babies to death in neonatal unit.
    Until now, end of life regime, the Liverpool Care Pathway was thought to have involved only elderly and terminally-ill adults.

    A good round-up Abuse of Liverpool Pathway extends to dehydrating newborns with disabilities

    The medical profession’s lethal arrogance over the Liverpool Care Pathway

    Hospitals ‘paid millions to put patients on death pathway’
    Hospitals are being paid millions of pounds to reach targets for the number of patients put on a controversial pathway for the withdrawal of life-saving treatment, according to data based on Freedom of Information requests.

    This all makes sense if you understand the Fabian perspective.
    How eugenics poisoned the welfare state:
    A century ago many leading leftists subscribed to the vile pseudo-science of eugenics

    …Most accounts of the origin of Britain’s welfare state begin with the Minority Report of the Royal Commission on the Poor Laws, drafted by Sidney and Beatrice Webb during the first decade of the 20th century. Beneath their seemingly compassionate rhetoric, the founders of the Fabian Society were snobbish, elitist and harboured a savage contempt for the poorest of the poor. Both husband and wife were enthusiastic supporters of the eugenics movement, which held that most of the behavioural traits that led to poverty were inherited. In short, that the poor were genetically inferior to the educated middle class….

    It came over to the USA where North Carolina was still sterilizing Blacks in the 1970s.

    Loudmouth Fabian Co-founder George Bernard Shaw gives the best insight:

    KILLING THOSE “UNFIT TO LIVE”
    “The moment we face it frankly we are driven to the conclusion that the community has a right to put a price on the right to live in it … If people are fit to live, let them live under decent human conditions. If they are not fit to live, kill them in a decent human way. Is it any wonder that some of us are driven to prescribe the lethal chamber as the solution for the hard cases which are at present made the excuse for dragging all the other cases down to their level, and the only solution that will create a sense of full social responsibility in modern populations?”

    Source: George Bernard Shaw, Prefaces (London: Constable and Co., 1934), p. 296.

    “Under Socialism, you would not be allowed to be poor. You would be forcibly fed, clothed, lodged, taught, and employed whether you liked it or not. If it were discovered that you had not character and industry enough to be worth all this trouble, you might possibly be executed in a kindly manner; but whilst you were permitted to live, you would have to live well.”

    George Bernard Shaw: The Intelligent Woman’s Guide to Socialism and Capitalism, 1928, pg. 470

    Sure sounds like the way a farmer treats his livestock.
    I do not give medical care to the very old or for animals with an economically low cost replacement value like my sheep and goats. They get their shots, worming and whatever care I can provide at home since I can replace a sheep or goat for the same cost as a trip to the vet. For my ponies the upper limit is ~$1,000 unless the animal is VERY VERY special.

    My last trip was $200 for the vet to look at my Haflinger and tell me she was dying and he could do nothing for her.

  18. philjourdan says:

    @Simon

    One thing that would really help the USA situation is to stop people suing doctors.

    Yep! The true “replace” for Obamacare from conservatives had but 2 provisions.
    #1 – remove Interstate restrictions on Insurance (that is actually one of the few things the Federal government is tasked to do in the Constitution).
    #2 – Reform tort law to make it harder to sue, and put a cap on it.

    The rest is just more power grabbing by the feds.

  19. philjourdan says:

    @Simon and CD

    Simon, that chart is meaningless.

    I would not go that far. However it is deceptive. The USA cost includes elective surgery (face lifts, boob jobs, etc.) whereas those costs are not factored into most of the Western European numbers. So the top of the bars is meaningless.

    However, the bottom half of the bars is more telling. In the US, the government does not pay for elective surgery (well mostly not – there is chelsea manning), so that is closer to the truth than the over all numbers. And it does show the US is wasting a lot of money (that is what government’s do).

    Before Obama, the bottom of the bars would be the closer comparison to other countries. However with the addition of “snowflake” surgeries being listed as “needed” instead of “wanted”, that is no longer the case

  20. Gail Combs says:

    ” However with the addition of “snowflake” surgeries being listed as “needed” instead of “wanted”, that is no longer the case…”

    They make up for it by telling those over 70 that that test/procedure is no longer available for older people. Hubby got that from his doctor.

  21. Gail Combs says:

    ” The true “replace” for Obamacare from conservatives had but 2 provisions.
    #1 – remove Interstate restrictions on Insurance (that is actually one of the few things the Federal government is tasked to do in the Constitution).
    #2 – Reform tort law to make it harder to sue, and put a cap on it.”

    Those are the EXACT suggestions made by Trump in his books. One of the reasons I supported him so early.

  22. Gail Combs says:

    Sundance at the Conservative Tree House does a good job of explaining what is actually going on and why:

    Why ObamaCare Cannot Simply Be Repealed…

    … If you do not understand how legislation is created; if you do not understand the difference between the Senate and House; if you do not understand the way ObamaCare was created, you really need to read this first:
    https://theconservativetreehouse.com/2017/03/07/repealing-and-replacing-obamacare-much-confusion-is-in-the-process/

  23. R. de Haan says:

    Who do you trust…?
    I don’t trust Ryan… Period.

  24. R. de Haan says:

    Trump gives thumb up for Rand Paul’s views aimed at a “clean repeal” of the entire ObamaCare Train Wreck: https://www.infowars.com/trump-tweets-support-for-rand-paul-healthcare-bill-following-infowars-appearance/

  25. Pingback: Dear Congress: How to Repeal & Replace Obamacare | Musings from the Chiefio

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