How many legs does the ACA have?
The news media keeps harping that the Republican congress has no replacement for the ACA. This is untrue, and they know it, or they should. The problem is not that there is no replacement for the ACA. Congress has already voted on several replacements which were vetoed by President Obama, and there are several more that have been proposed.
The superficial problem, such as there is one, is deciding on which replacement to use and which parts of each replacement.1
The real problem is that Republican have a strong tendency to pre-compromise. Even when they say that insurance works better and produces better medical care without the massive regulatory burden placed on it by the ACA, they still accept the premise: that they are talking about insurance. In fact, none of the people who have signed up on the exchanges or through ACA plans have insurance.2
If you can sign up after you get sick, that is not insurance.
Democrats will argue that this is being mean. This is untrue, and they know it, or they should. It’s simply the truth, it’s what insurance is: insurance is a means of insuring against some future calamity. If a calamity has already happened, it is impossible to insure against it. Anything that pretends to allow you to insure against a calamity that has already happened is not insurance, and cannot be insurance.
Anything that claims to insure past calamities is a scam. The ACA is a huge scam imposed by Democrats on the United States.
Our first Republican president once famously and apocryphally asked, “if you call a tail a leg, how many legs does a dog have?” He could as well have been talking about Obamacare. A tail is not a leg, and if you pretend it is you will experience massive failure.
Some Democrats will argue that ACA plans are health plans, and health plans are good. But they’ll quickly revert to saying Republicans want to take away people’s health insurance, because calling them health plans changes the narrative. It changes the negotiations and the nature of the compromises. There are, after all, other ways to deal with people who can’t afford health care than taking away everyone’s insurance.
This is an important distinction and a discussion the left doesn’t want to have. If you define ACA plans as insurance, you can pretend that the ACA, like Lincoln’s dog, has five legs, because everyone by law3 has ACA plans. But, as Lincoln noted, the ACA doesn’t magically become great at providing health care just because we pretend that a tail is a leg. The ACA does a very poor job of providing health care. The nature of the requirements the ACA makes on ACA plans and ACA providers ensures that deductibles are high, premiums are high, and health care providers are limited.4
As repeal moves forward5, you’ll see more and more news reports on people who will, according to the left and the news media, die because they will lose their insurance if the ACA goes away.
This is completely untrue, and they know it, or they should. And it isn’t just because the ACA is not insurance. The Republicans’ plans all include some means of providing public assistance for people who can’t afford the health care they need6, either because they don’t have the money or because they waited until they were already sick to buy insurance.7
Repealing the ACA will not take away anyone’s health care, nor will it take away anyone’s insurance. All it will change is that those who can’t afford their health care will get that care from public assistance that is called public assistance, rather than public assistance that is called insurance.
There is nothing wrong with having a program to assist people who can’t afford health care, and paying for it through an honest tax, preferably managed at the state level to improve accountability and responsiveness. Barring everyone from buying health insurance is not a good solution. It doesn’t even make sense as a solution.
What the left wants us to do is kill everybody’s insurance, kill everybody’s health care, kill all the innovation that will save lives for less money, so that people on public assistance can pretend that they’re not. What the left is asking us to do, in other words, is kill an infinite, uncounted, unknown number of people so that they can pretend their dog of a law can walk on its tail.
It can’t, and it never will.
In response to Why we must not ration health care: Rationing health care means fewer cures.
I have a strong suspicion that there is big money pushing a quick vote on replacement so that some kind of payoff can be hidden within it without scrutiny. And that the media is part of this attempt.
↑At least not through their ACA plans. Apparently there’s a growing market in insurance plans for people who forgo ACA plans and pay the tax penalty. But the ACA severely limits how these insurance plans work.
↑Everyone who is not exempted in some way, of course.
↑All of which were easily predicted by anyone who read Catastrophic Care: How American Health Care Killed My Father and realized that the ACA did little more than double down on all of the problems Goldhill writes about.
↑Assuming that it does move forward, which, given the way Republicans negotiate (or fail to) is not a given.
↑Some do it with block grants to the states, to pay for it through Medicaid or some other program; some even do it by requiring insurers to cover pre-existing conditions and then reimbursing the insurance companies for covering pre-existing conditions. There are a lot of ACA replacement ideas out there, and so there are probably even more means of handling people who can’t afford insurance in ones I haven’t read.
Note that I’m not saying they’re all good ideas. Handing it off to insurance companies is a very bad idea, not just because it adds another layer of bureaucracy but because insurance companies will quickly realize they can make more money by billing the government than by providing good insurance.
↑You want a great way to improve the number of people who have useful insurance? Make it easier for insurance providers to sell insurance against future health problems to people with pre-existing conditions, without forcing them to pay for the pre-existing conditions.
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- 4 Reasons Obamacare Is Also A Lemon For People With Pre-Existing Conditions: Margot Cleveland at The Federalist
- “Call me crazy, but breaking every promise made to enact the ‘Affordable’ Care Act reeks of spontaneous combustion. There’s a name for a product that goes up in smoke—it’s called a lemon. You don’t fix a lemon, you junk it.”
- Catastrophic Care: How American Health Care Killed My Father
- David Goldhill, inspired by the unnecessary death of his father in a hospital surrounded by great doctors, nurses, and technology, describes in detail why health care today kills people—and then charges for it. In no other industry could a business fail so miserably, and then send a bill for having failed. He also argues persuasively that the ACA took all the bad parts of our health care system—and made them worse.
- The Sanctity of Life: Jerry Seeger at Muddled Ramblings and Half-Baked Ideas
- “I have a friend who might die if the ACA is repealed. I’m not making this shit up to create a straw man, so let me repeat myself. My friend, someone I worked with for several years, needs ongoing care to stay alive and without the ACA he won’t get it. He seriously might die.”
- Suppose You Call a Sheep’s Tail a Leg, How Many Legs Will the Sheep Have? at Quote Investigator
- “There is substantive evidence that Abraham Lincoln did employ this comical riddle by 1862, and detailed citations are given further below. But Lincoln was referring to a conundrum that was already in circulation.”
More health insurance
- Community health acts to improve Obamacare
- Democrats now want to talk about how to improve Obamacare. Here’s how to do it.
- Health insurance reform? What health insurance reform?
- The Truth About Republicans: they don’t want to repeal Obamacare.
More ObamaCare
- Community health acts to improve Obamacare
- Democrats now want to talk about how to improve Obamacare. Here’s how to do it.
- Democrat Chris Murphy: Obamacare is “the end of health care”
- From the mouths of hypocrites, comes wisdom. It’s almost biblical.
- Health insurance reform? What health insurance reform?
- The Truth About Republicans: they don’t want to repeal Obamacare.
- Economies of scale and government-run health care
- Economies of scale only produce lower prices when people are allowed a choice of service providers—including the choice to forego the service. Government-run programs do not benefit from economies of scale—in fact, scaling up will cause increased prices when the industry is run by the government.
- A tale of two negotiators
- If you want to see how Republicans in Congress fail to pass successful reforms, compare the House Obamacare “repeal” with the White House’s budget.
- 16 more pages with the topic ObamaCare, and other related pages
More public assistance
- Starvation, sharing, and charity
- The modern world makes an evil out of sharing, and then complains that too many people go hungry.
- A grumpy basic income
- John Cochrane has useful thoughts on Charles Murray’s universal basic income, after the Swiss rejected a very different version.
- Government cheese goes to school
- Government cheese is government cheese, whether it’s a poor food product, poor housing, or poor education.
- The Family Cow
- If you kill the cow for steak today, you won’t have any milk tomorrow. We are digging deep into our national cash cows—taxpayers—and we’re going to soon run out.
- Everybody gets $7,000 a year
- Charles Murray argues that we can vastly reduce the cost of the welfare system and social security simply by giving everyone $7,000 a year plus a health plan.
- Three more pages with the topic public assistance, and other related pages