Two weeks ago, the Supreme Court heard arguments on the constitutionality of the administration’s health law, aka ObamaCare. Opponents are giddy with the possibility that the law might be struck down.

But what then? Millions of uninsured, both those who choose not to purchase coverage and those who can’t due to pre-existing conditions, will still be with us. The rising costs and inefficient delivery of health care will still be with us.

The country can have a vibrant market for individual health insurance. Insurance proper is what pays for unplanned large expenses, not for regular, predictable expenses. Insurance policies should be “guaranteed renewable”: The policy should include a right to purchase insurance in the future, no matter if you get sick. And insurance should follow you from job to job, and if you move across state lines.

Why don’t we have such markets? Because the government has regulated them out of existence.

Most pathologies in the current system are creatures of previous laws and regulations. Solicitor General Donald Verrilli explained as much in his opening statement to the Supreme Court: “The individual market does not provide affordable health insurance,” he noted, “because the multibillion dollar subsidies that are available” for the “employer market are not available in the individual market.”

Start with the tax deduction employers can take for their contributions to group health-insurance policies—but which they cannot take for making contributions to employees for individual, portable insurance policies. This is why you have insurance only so long as you stay with one employer, and why you face pre-existing conditions exclusions if you change jobs.

Continue with the endless mandates (both state and federal) on insurance companies to provide all sorts of benefits people would otherwise not choose to buy. It sounds great to “make insurance companies pay” for acupuncture. But that raises the premiums, and then people choose not to buy the insurance. Instead of these mandates, at least allow people to buy insurance that only covers the big expenses.

What about Medicare and Medicaid? Two words: premium support. The underlying point of premium support is simple. If insurance costs $5,000 and the government gives an individual a $4,500 voucher, that individual will still feel the correct economic signal to shop for cost-efficient health insurance and health care.

The main argument for a mandate before the Supreme Court was that people of modest means can fail to buy insurance, and then rely on charity care in emergency rooms, shifting the cost to the rest of us. But the expenses of emergency room treatment for indigent uninsured people are not health-care’s central cost problem. Costs are rising because people who do have insurance, and their doctors, overuse health services and don’t shop on price, and because regulations have salted insurance with ever more coverage for them to overuse.

If we had a deregulated, competitive market in individual catastrophic insurance, that market would be so much cheaper than what’s offered today that we would likely not even need the mandate.

Meanwhile, staggeringly inefficient markets for health care itself need a thorough, competition-focused deregulation. Americans will know there’s a healthy market when hospitals post prices on their websites, and when new hospital and health-care businesses routinely enter to challenge the old ones. Here too regulations keep competition at bay.

The number of new doctors is still restricted, thanks to Congress and the American Medical Association. Congress caps the number of residencies, the AMA has fought the expansion of medical schools, state tests make it difficult for foreign doctors to work here, and on and on.

There are hundreds of government impediments to competition. New hospitals? In my home state of Illinois, every new hospital, expansion of an existing facility or major equipment purchase must obtain a “certificate of need” from the Illinois Health Facilities Planning Board. The board does a great job of insulating existing hospitals from competition if they are well connected politically. Imagine the joy United Airlines would feel if Southwest had to get a “certificate of need” before moving in to a new city—or the pleasure Sears would have if Wal-Mart had to do so—and all it took was a small contribution to a well-connected official.

The result is a monstrous system in which insurance patients are gouged to subsidize Medicare, and cash patients are gouged most of all. Here’s Mr. Verrilli again: “Insurance has become the predominant means of paying for health care in this country.” Yes, the cash market has been badly damaged. Whose fault is that? Shouldn’t we bring it back?

Group health plans in today’s system may appear reasonable enough—they seem to resemble “buyers’ clubs,” where people pool together to get good deals from providers. But in a real buyer’s club, each buyer still pays his own bill—you don’t go into a Sam’s Club and haul off whatever you can with only a fixed $20 copayment. And real buyer’s clubs don’t depend on where you work. Real buyers’ clubs for health services could be a useful way to get competition going and revive the cash-and-carry market for individuals.

A deregulated health-care and health-insurance market can work. We can at least start by removing the obvious elephants in the room: all the legislation, regulation and interventions that needlessly keep prices up, keep competition and innovation out, shelter people from the economic consequences of their decisions, and prevent the emergence of real insurance that follows you from job to job and from health to illness and back.

Mr. Cochrane is a professor of finance at the University of Chicago Booth School of Business and an adjunct scholar at the Cato Institute. He blogs at The Grumpy Economist. This post first appeared in the Wall Street Journal.

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25 Responses for “What to Do on the Day After ObamaCare”

  1. John Ballard says:

    Whatever you’re smoking must be some really good stuff. It’s been many years, but this makes me want to resume.

  2. Mary says:

    Right on!

  3. BobbyG says:

    Sounds so wonderful.

    Who is gonna write gramps a commercial policy for $5k/yr, “premium supports” or not?

    Seriously?

    You guys and your warm & fuzzy small numbers.

    One CABG is gonna set gramps back $60k. I could go on with the list of geriatric pxs that the AHIPistanis would pass on underwriting “affordably.”

    C’mon, man.

  4. Dr. Mike says:

    I really would like to see a well thought out rebuttal instead of flippant disrespect.
    Why not let the Medicare patient choose between standard medicare +/- secondary (or medadvantage) and a voucher to purchase private insurance?
    Why not allow employers to claim a tax deduction for supporting an employees individual policy?
    Why not remove some of the coverage requirements so that I can find a policy that covers what I want it to cover instead of things I don’t need?
    Why not make health insurance portable?

    • BobbyG says:

      I guess you’re shooting at me. No? Not sure.

      “a voucher to purchase private insurance?”
      __

      Again, who precisely is going to write that affordably for members of the aging, empirically high UTIL demographic? There’s no “market’ for it, actuarially speaking (well, except perhaps for Mitt, Newt, Ron, Rick, and Paul Ryan — the latter of whom has got His on your dime anyway).

      Correct me if I’m wrong?

      Also: See “The Moral Hazard Myth.”

      • Dr. Mike says:

        I don’t see why Medicare part B could not be replaced by a private policy – as long as it was not required to be identical in coverage. I could imagine there might be some willing to pay higher radiology deductibles in exchange for dental coverage, just to give one example. Medicare part A would still be in place for the CABG.

        • BobbyG says:

          Ok, I’ll buy that. Guardedly, but, point taken. You’re verging on Swiss Model there, to a great degree. AHIP won’t have it.

          I’m now 66. Can’t afford Part B (which I would have to pay for on top of my employee coverage, $199/mo premium).

    • John Ballard says:

      @Dr. Mike,
      I’m also guilty of flippant disrespect. I’ll respond to your questions one at a time.

      Why not let the Medicare patient choose between standard medicare +/- secondary (or medadvantage) and a voucher to purchase private insurance?

      I was surprised to learn lately that something like a third or more of Medicare beneficiaries are already using MA. In fact, my wife and I were part of that group the first year we became eligible. Why? Cuz the premium was ZERO, which compared with the monthly premium for one of the old supplemental policies was a no-brainer. Or so we thought. When she had a week in the hospital we took a closer look at what would have happened had her medical problems been far worse. The limitations of the private MA plan would have cost us much more than traditional Medicare. So when that option was ended the following year (no MA offered in our area) we returned to Medicare + a supplemental, but one of the newer ones now offered by private insurance for just that purpose. It’s costing serious money, but we feel much more secure.

      No one ever answered MY question why the first MA premium was (and continues to be in many areas) zero. I have to assume that private insurance is in effect kidnapping Medicare beneficiaries (once there, you may return to Medicare but are then subject to underwriting — potentially even higher premiums — for a supplemental policy) because the Part B deductions from SS checks are a more reliable revenue stream than their costs. Of course I’m guessing here, but if I have learned anything in life is that you don’t get something for nothing. That zero premium business is a real turn-off for me.

      Why not allow employers to claim a tax deduction for supporting an employees individual policy?

      The idea that health care should be coupled with employment is a poisonous notion that started soon after WWII and has become part of the social fabric of the country. At first it was an attractive way for companies to offer “benefits” to employees in a competitive labor environment, unions loved it, and like a virus it has become as American as baseball. But the US version has been from the start also marked with a deal with the Devil that no one in either government or the private insurance sector is allowed to question either physician or hospital charges. (See Paul Starr’s Social Transformation of Health Care in America regarding the fear of price controls following the war, the birth of the Blues, etc.) Until the Sixties all hospitals were non-profit. And by non-profit I don’t mean what is now called “not-for-profit” with executives receiving mammoth compensation packages and their hospitals and/or private insurance operations existing mainly as money-laundering vehicles for the numerous FOR profit companies feeding off them.

      This is a very complicated problem, but the short version for me is that health care should not be treated as a market commodity. A serious part of the challenge is that individual physicians — and I’ve had this conversation til I’m blue in the face and few people seem to get it — either cannot or will not grasp the difference between professional compensation and corporate profits. Thanks to that notion described above that nobody is allowed to question medical bills, the American economy has evolved to the point that twenty percent of the economy (about one in five of every dollar is now for health care) no longer operates on GAAP in any meaningful sense of the terms.

      Why not remove some of the coverage requirements so that I can find a policy that covers what I want it to cover instead of things I don’t need?

      This one’s easy. insurance is shared risk and as good citizens we all share all risks. By that metric women don’t get covered by single men. Anyone born with genetic disorders can be excluded. Anybody can see where this discussion leads.

      Homeowners without children pay school taxes to protect their property values. No one wants to rear children in an area where the schools are no good. And by the same token, when anyone is faced with a medical challenge we all become part of their safety net.

      Why not make health insurance portable?

      Supposedly it is but COBRA is a joke. When the job ends is when a family is at the greatest peril, especially if any medical issues are manifest at the moment of unemployment. Got any good ideas? Nate says to save and prepare ahead for such things but Americans are among the world’s worst savers. Group health insurance if a corporate handcuff — golden or otherwise. Portability remains a dream. See question #2 above.

      • Dr. Mike says:

        Thanks for taking the time to respond. You make some good points but unfortunately sidestep the questions to some extent. I don’t see how the need for “shared risk” has anything to do with what is covered. Shared risk just means that the pot of money is big enough. What is covered only shifts around where money is spent. If I pay $600/mo in premiums and have a $1000 deductible for imaging, $250 for lab, $250 for each ER visit, and no coverage for office visits – how does that suddenly mean that my premium no longer contributes to the risk pool? Whereas a guy with the $1500 deductible across the board and coverage for 6 office visits and a physical per year – his premium is somehow better than mine at contributing to the shared risk?
        Medicare Part B patients might also desire different coverages than is traditionally offered. That doesn’t necessarily mean that their consumption of services will cost more, therefore their premium contributes just as much as the next medicare patient.
        Yes, COBRA is a joke – likely for the same reasons individual policies are so expensive. Why not work to make individual insurance products more attractive by eliminating some of the barriers to doing so?
        Having insurance at all is a compromise – a compromise the PPACA embraced and expanded on. I agree that coupling healthcare with employment is not ideal – but if it is going to be coupled, why not make the changes suggested? I fail to see how having the government take over the role traditionally filled by the employer is an improvement. And coupling insurance with the provision of health care for the poor is also far from the only option, and likely the most expensive one. In otherwords, I fail to see a link between the criticisms of the suggestions in the article and support for programs like PPACA (not that you are making such a link – but others are). If you (the generic you, not you in particular) are criticising one or the other and offering a third option, then game on, we have the start of a real discussion on the best direction for healthcare in America.

        • John Ballard says:

          I suppose we should agree to disagree about a few things, Dr. Mike. You are looking at health care through a commercial insurance lens and I am seeing everyone in society including those without insurance.

          Two challenges stand in the way.

          1. There is no clear understanding of what constitutes basic care and

          2. the word “costs” regarding health care is essentially without meaning.

          In the same way that when you purchase an automobile the dealer starts with what is called a “basic model” and you pay extras for anything more, from fancy wheels to exotic whatever… all of which come at an added cost. But there is no “basic model” for health care. That would take political courage and saying aloud a lot of realities that no one wants to say. I hear all kinds of criticisms of Canadian Medicare and Britain’s BHS, but no one takes into account that both of those systems do have a more or less clear system of defining what will and will not be covered, as well as when to expect it. Canada takes care of the whole population for a pittance — about eleven percent of GDP last I heard — and the UK is a bit more. In the case of Canada private practice may be had (or they may come to the US) but there is no private insurance. Not allowed. In the UK where there is private insurance and a lucrative private system along with the NHS there are many people who never darken the door of a NHS facility or doctor’s office. Why? cuz they can afford better. (But in case of some emergency or trauma, you may want to be taken to a NHS facility. Check out some of Dr. Wachter’s reports about the UK. He’s been there and seen what they do first hand. )
          http://thehealthcareblog.com/blog/2011/10/12/the-acute-model/#more-32863

          Regarding costs, I spent a career in the private sector in management, trying hard to squeeze a nickle or dime out of every revenue dollar. When I went to work for a hospital I was shocked at what appeared to me wholesale waste of both human and material resources. Even worse, nobody seemed to have a clue what anything actually cost. Life was lived according to “The Budget” and everything was discussed in percentages. After five years I never heard a single mention of dollars regarding food, labor or materials used. When I asked details, there was a deer in the headlights look. As far as I can tell billing was essentially “throw a bunch of stuff on the wall and see what sticks.”
          Sorry, but that’s not my idea of running a business. That’s why I said what I did about GAAP. (And I’m not talking about whatever new-fangled variance on Generally Accepted Accounting Principles may be practiced now. I’m talking the old-fashioned way starting with inventories, actual labor charges, depreciation, other overhead, etc — not contracts and agreements that rest more on “offers” and “negotiations.”) Does anybody in health care have any idea what the word “operations” really means?

          I don’t see how the need for “shared risk” has anything to do with what is covered.

          I wrote: “…insurance is shared risk and as good citizens we all share all risks.
          That is my definition of social insurance.
          Lots of people don’t like it, preferring to punish this or that “undeserving” population by denying them even baseline medical care. I am not among them.

          As I said, we can agree to disagree and still remain friends. My visions are no more realistic in today’s political environment than yours. Like Jews and Christians we can wait together for the Messiah, and when he comes we can ask Him together if He’s been here before.

      • civisisus says:

        “When she had a week in the hospital we took a closer look at what would have happened had her medical problems been far worse. The limitations of the private MA plan would have cost us much more than traditional Medicare. ”

        I feel bad about your experience, John, but MA plans DO come in a variety of flavors, so it’s not automatic that anyone with MA coverage would have had the same result – even at the same hospital, for the same care.

        BTW, I share your curiosity about Cochrane’s stash….That the success of his “analysis” depends on the fantasy that “people” (we can only hope he mainly means clinicians, driving demand) are rabidly, eagerly consuming vast quantities of unnecessary care due principally to moral hazard – and worse, that that behavior will instantaneously go up in a puff of smoke with the donning of his magical “premium supporters” – is a fantasy whose outer reaches most can only perceive under the influence of prime “additives”.

  5. John Ballard says:

    Here’s another provocative idea — an economic informed consent for patients and their families.
    Delightful conversation in the comments.

    http://www.kevinmd.com/blog/2012/04/economic-informed-consent.html

    • Nate Ogden says:

      this is actually an angle we are working now. If you read the consumer protection laws in most states the current business model of healthcare would be in violaiton of 3-4 of them.

      When we cut back a claim to a reasonable payment based on cost + or Medicare + we help the employee fight any balance billing. Legally violations of consumer protection law is a great defense.

      Consumer not aware of price at time of contract

      Consumer not in equal position to negiotate price

      Provider never have expectation of full payment

      Charges exceed what the person could get the same or similar service for from other sources.

      The problem is employees don’t want to deal with it. As soon as the provider threatens to hit their credit or whatever they expect insurance to pay the full price no matter how out of line it it.

      Working a bill now.

      Charges for 7 days inpatient were $122,298.36.

      Hospitals cost to deliver care $18,050.02

      Medicare Payable $9,450.14

      Expected Private insurance reimbursement per PPO contract $107,622.20

      They expect private insurance to pay 11 times Medicare.

      We paid them cost plus 12% profit and they are threatening to balance bill. For the $87,000 reduction we took we could and want to fight this with our own attorneys. The issue is hospitals know if they threaten the patient the patient will get scared and run to HR demanding we pay the additional $87,000.

      If the politicians and academics wanted to pull their heads from their arses and actually do something productive for once they would clearly outline healthcare in State consumer protection laws like they do real estate, loans, and other types of business. Saying providers can’t report to credit until a case has been resolved in court would also be a good firest step. They shouldn’t be able to destroy someone’s credit for 3 years until the court rules their charges out of line.

      As a side thought, take a look at what a real everyday problem in healthcare looks like, have you seen any proposal from any politicians or academic from either side that would address this problem? Like just about everything else in life we need to ignore the academics and politicians as they have no idea what they are talking about.

  6. Nate Ogden says:

    “The individual market does not provide affordable health insurance,” he noted, “because the multibillion dollar subsidies that are available” for the “employer market are not available in the individual market.”

    This is missing a lot of gray area. Individual purchased premiums can be deducted pre-tax from payroll.

    And

    Individual employed can write off insurance premiums.

    The only people that can’t write off the cost of individual insurance under current tax law are those not working. A very small subset of the 17 million or so individually insured.

    “Start with the tax deduction employers can take for their contributions to group health-insurance policies—but which they cannot take for making contributions to employees for individual, portable insurance policies.”

    100% factually incorrect.

    http://www.we-r-cdh.com/forms/PDF/F-M07_PRA.pdf

    PRAs have been around for years. Further HRAs which have also been around for years also allow for the reimbursement of individual premiums.

    This is just getting annoying. What is with you professors and being such idiots? Really, do they not teach you in school if you don’t know something don’t go writing about it as if you do?

    ” and why you face pre-existing conditions exclusions if you change jobs.”

    BS, have you really never heard of HIPAA? That problem disappeared over a decade ago. At this point you really need to ask THCB to take down your error riddled post and pretend you never wrote it.

  7. Nate Ogden says:

    http://www.dol.gov/ebsa/faqs/faq_consumer_hipaa.html

    HIPAA is a federal law that:

    Limits the ability of a new employer plan to exclude coverage for preexisting conditions;

    Provides additional opportunities to enroll in a group health plan if you lose other coverage or experience certain life events;

    Prohibits discrimination against employees and their dependent family members based on any health factors they may have, including prior medical conditions, previous claims experience, and genetic information; and

    Guarantees that certain individuals will have access to, and can renew, individual health insurance policies.

  8. Nate Ogden says:

    WHAT IS A PREMIUM REIMBURSEMENT
    ACCOUNT (PRA)?

    A Premium Reimbursement Account, under Internal Revenue Code (IRC) Section 125, allows you to use “taxfree” dollars to pay for individually owned, qualified insurance policies for you, your spouse, and any tax dependents which are not sponsored by an employer.

  9. DeterminedMD says:

    “The result is a monstrous system in which insurance patients are gouged to subsidize Medicare, and cash patients are gouged most of all.”

    Not much of a fan of the post as a whole, but this sentence summed up much of what is concerning from those two groups.

    Again, social darwinist here to give what seems to be my weekly comment just reiterating what it is about: we can’t save or prolong everyone to have sustained quality of life, and yet no one wants to address that gorilla.

    See the M*A*S*H episode, season 2 or 3 I think, where after Hawkeye loses his friend on the operating table, when Colonel Blake comes in and tells him directly: “there are two rules, rule number one, people die, and rule number 2, doctors can’t change rule number one.”

    Society doesn’t like rules though, eh?

  10. Louisdous says:

    John Ballard says:
    “Of course I’m guessing here, but if I have learned anything in life is that you don’t get something for nothing. That zero premium business is a real turn-off for me”
    But, when Obamacare actually promised something (30 million more people covered) for less than zero (a reduction in the deficit) did that give you a tingle up your leg?
    “Insurance is shared risk and as good citizens we all share all risks”
    A risk involves an unknown. Are your maintenance prescriptions and annual physical an unknown? If not, why should “good” citizen share in these non- risks? I believe a “good” citizen is an informed citizen.
    “Homeowners without children pay school taxes to protect their property values”
    No, they pay school taxes because if they do not, their house will be taken from them. You can argue that the relative quality of a local school may affect the surrounding property values (and property taxes), but you may be the only one that rationalizes your payment of them to property value protection.
    “No one ever answered MY question why the first MA premium was (and continues to be in many areas) zero.”
    I’ll attempt. In the early 1980’s (I believe Newt was involved), Medicare costs in certain high cost areas were beginning to average something like $800 per member per month. A pilot program was launched to see if private insurance carriers would offer an option for less. I am familiar with HMOs in Florida at the time that were happy to enroll 65 year olds in their plans for less than $500 per member per month. I seem to remember federal concern that these rates may be underpriced, low ball, too low to be sustainable and put in limitations and requirements on these private carriers. Among them was a requirement that for every Medicare advantage member they enrolled, a non-Medicare private member must be enrolled. Also required were minimum rates of something like 95% of federal per member Medicare costs (sort of like a MLR for the Feds). So, while some private insurers were willing to enroll members at 50% of average federal Medicare costs, they were delighted to enroll as many at 95% as they could based on meeting the Medicare versus private non-Medicare (commercial) ratios imposed. Some were so delighted, they offered plans that were more comprehensive (richer) than “regular” Medicare. These richer plans included no copays for drugs, no donut holes, memberships to gyms, and other bells and whistles to attract deeply entrenched $800 federal Medicare members. It seemed like a no-brainer to a lot of folks, and some even predicted it would be so successful, that regular Medicare might even whither on the vine. Apparently, since some plans continue to be “zero premium” business, I suppose the program has been a success.

    • Nate Ogden says:

      “Among them was a requirement that for every Medicare advantage member they enrolled, a non-Medicare private member must be enrolled.”

      I remember running into this, forget the exact regs but they wouldl lose money on private insurance because they were making so much on Medicare.

      Nothing like losing business subsidized by your own tax dollars. Throw in the requirement that groups had to offer HMOs if one was available in their market and they had a field day.

  11. Peter1 says:

    “and a voucher to purchase private insurance”

    There’s the ugly hand of government again. Dr. Mike, if you truly agree with John Cochrane then wouldn’t you want NO government in healthcare, after all, according to John the wild west of free enterprise will fix this for us – forever?

    Just think, new hospitals emerging then going broke under the weight of competition, the market flooded with doctors each scrambling to lower their fees to attract enough business to pay the rent, insurance companies rising and falling leaving their old clients uninsured, at least until another company eagerly snaps up their pre-existing and health care consumers reaping the benefits of this health bonanza able to purchase health coverage for the same price as a cheese burger.

  12. DeterminedMD says:

    An interesting read I found at another site:

    http://american.com/archive/2012/april/why-obamacare-has-proved-a-hard-sell

    Again, every opinion on this matter does not seem very unobjective nor unbiased, but, when a matter divides the culture/society so evenly, shouldn’t the legislation be pulled and reformatted to try to find a common ground for more approval.

    Not if you are an extremist Democrat. Or, Republican.

    Why is America letting the 20% of either side to this war dictating what the majority 60% really want as moderation? Oh, I forgot, you’re either fully with one of them or against them. Remember the Star Trek episode with the two men who’s faces were half black and half white, but the opposite sides to each man, hence their hatred of the other. Ironic the story line was about left and right? You wonder what the colors of their world was.

    High noon or midnight. Doesn’t anyone appreciate the colors of the sunrise or sunset? Yeah, doesn’t fit that black/white dichotomy!!!

    • John Ballard says:

      We seem to have forgotten, but in the Hillary Clinton vs Barack Obama pre-election contest the issue of health care was barely mentioned, by either party, or by either Democrat. For practical purposes the only difference between Hillary-Care and Obama-care was — guess what?

      The mandate.

      She was for it. He didn’t think it was necessary. (Remember all those “promises” he made about “if you like what you have…” etc.?)

      Post election the issue was tossed to Congress with very little input from the president. He had convened the big players in advance and outlined all the quid pro quos. (Single-payer didn’t even have a seat at the table. But the AMA, Big Pharma, unions and other big players certainly did.)

      Ironically, an individual mandate, exactly what Obama DIDN’T campaign on, the promise of Hillary Clinton, was on every proposal from the start. This is why the insurance industry sat still for all the onerous limitations and reforms — in return for millions of new policy-holders. Whether or not they could afford insurance is no concern of theirs as long as Uncle Sugar picks up the premiums. In that context, the word “affordable” is meaningless.

      To his credit, the president has not once reminded anyone where the mandate came from. He has instead patiently allowed the insurance industry to carry that ball, preferring instead to take the slings and arrows for the whole messy package, warts and all.

      The AEI article was a whimsical but accurate read. I realized as I read that my personal hope for a best-case outcome would be a two-layer system, one governmental, the other private, with both under-girded by private insurance, either MA or supplemental. The government safety net should be Medicare for all with provisions that those with either earned or legacy income pay what they can afford on a sliding scale. And those who can afford more, up to and past the so-called Cadillac policies, will remain free to pay for as much health care as they wish –on their own nickle.

  13. BobbyG says:

    “and a voucher to purchase private insurance”

    There’s the ugly hand of government again.
    ___

    Well, maybe it’ll turn out to be “unconstitutional” for the government to effectively mandate that people buy private commercial insurance via voucher “premium support.”

  14. DeterminedMD says:

    Here’s a theory that I think accounts for what we are stuck between dealing with the DC dichotomy:
    Democrats ruled the House, at least, for what, over 40 years until the Republicans took it over in 1994. At that same time, the ‘Cants had the Executive Branch to themselves for 20 of 24 years with Carter being the 4 year disruption. So, either side was outraged when they lost their branch of power come the 1990′s, first with Clinton’s election and then having Gingrich become Speaker. And like true narcissists and antisocial cretins, they did whatever had to be done to return the branch to their control.

    Boy, did the ‘Cants show us how one party rule could be so crushing and grotesqe (spelling?), and then the ‘Craps showed no problems in lowering to the task come 2008, at least we only allowed them 2 years of that debacle. But, once power is tasted, just like that first cocaine rush, eh?

    Clean house fully, get rid of all incumbents, stop voting for people over 65 years old for at least 3 or 4 election cycles, and by god, people, really look at how we could create a third party! Dumbass and dumbbutt are not choices, just basically deciding whether to jump off the cliff or stand under the boulder. You still crash/crush in the end.

    Live long and prosper, boy have we screwed up that adage!!!

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