Behold: A Republican Health Care Plan

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(Jose Pelaez/ Ap Images)

In their quest to repeal Obamacare, Republicans have faced two political problems. First, while the Affordable Care Act isn’t a popular law, polls show that the idea of simply going back to the way things were is far less popular.

The second is that for the last three years they’ve been promising a replacement for the president’s signature legislation, and their failure to provide one made them look uninterested in — or incapable of –- addressing in a serious way a real problem for American families.

But on Monday, Sens. Richard Burr (R-NC), Tom Coburn (R-OK) and Orrin Hatch (R-UT) — three Republicans who have long worked on health care issues — tried to address these problems by finally unveiling a comprehensive alternative to Obamacare.

In one sense, it’s a sign of progress, an acknowledgement that Obamacare is changing the American health care system in ways that can’t easily be undone and a concrete proposal that can serve as a point of serious debate.

The problem is that it’s grounded in the same old conservative thinking about what ails our health care system. And, as such, a central piece of the lawmakers’ solution is making the vast majority of Americans pay more for their coverage.

As Sam Baker reported for the National Journal, “the plan attempts to lower health care costs by making people shoulder a greater share of those costs—or ‘sensitizing’ consumers to the actual cost of health care, as Senate aides put it in a meeting with reporters on Monday.”

Most people don’t recognize how much their employer contributes to their health care plan and don’t see the costs the insurance company covers. If people are spending more of their own money, many conservatives argue, they’ll be smarter consumers. Overall costs will come down, the argument goes, if consumers have more “skin in the game.”

Currently, the employer-based insurance that covers around four out of five Americans isn’t taxed. The GOP’s plan would limit that exclusion to 65 percent of the cost of an average plan. Those with average plans would pay taxes on 35 percent of their costs, and those with more comprehensive insurance would pay more. As Baker writes, “the idea is to make consumers more aware of how much their health care plan costs (by making them pay part of it), so that employees will go to their bosses and ask for cheaper plans.” The Republican version of magical thinking.

As Sarah Kliff notes in the Washington Post, economists tend to favor reducing or eliminating this tax break because it subsidizes health care for high earners with “Cadillac” insurance plans. But the public hates it because it hits them in the pocketbook.

A bigger problem is that we pay sky-high costs for health care goods and services. Everything from surgery to pharmaceuticals to routine tests cost us more than the citizens of other developed countries, and “more skin in the game” just means getting households to shoulder a larger share of those costs.

The lawmakers’ proposal also would repeal a number of taxes and fees on health care companies that help pay for Obamacare’s subsidies for low- and middle-income workers. It would continue to offer tax credits to help families buy insurance on the individual market, but would reduce the eligibility cutoff for those subsidies from 400 percent of the poverty line under the ACA to 300 percent. The subsidies would also be less generous. And unlike the current law, they would increase with a person’s age, rather than according to income.

Both Obamacare and the Republicans’ alternative encourage healthy people to carry health insurance. The Affordable Care Act does this with an individual mandate, which polls have found to be the only specific provision of Obamacare that doesn’t enjoy majority support. The Republican plan would achieve this through fear. Their alternative would only guarantee coverage for people with pre-existing conditions if they remain continuously insured. Those who lose coverage could face serious costs under this plan – or not be able to buy insurance at all – when they return to the insurance market.

Obamacare expands eligibility for Medicaid (in states that opt in) to everyone making up to 133 percent of the poverty line. The GOP replacement would limit that to a much smaller population – pregnant women and poor children – and encourage lower-income individuals and families to buy private insurance.

Like the ACA, the Republicans’ alternative would allow young people to stay on their parents’ plans until age 26.

It would increase the difference between what insurance companies could charge men and women, and older and younger customers.

It would repeal the law’s limit on annual out-of-pocket costs — which was designed to address medical bankruptcies – and most other regulations, including the ACA’s requirement that insurance companies spend most of their revenues from premiums on health care rather than administration. Insurers would no longer be required to cover a basket of preventive services without co-pays.

Ultimately, it’s clear why Republicans have been so hesitant to offer a concrete plan to replace the ACA. Their plan repeals Obamacare’s cost controls, covers fewer people and would stick most Americans with a bigger bill. At the same time, it maintains many of the basic structures of the Affordable Care Act — a tacit acknowledgement of the law’s legitimacy.

Joshua Holland is a senior digital producer for He’s the author of The Fifteen Biggest Lies About the Economy (and Everything Else the Right Doesn’t Want You to Know about Taxes, Jobs and Corporate America) (Wiley: 2010), and host of Politics and Reality Radio. Follow him on Twitter or drop him an email at hollandj [at] moyersmedia [dot] com.
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  • Anonymous

    It’s interesting that they would tax employer plans to the employee at 35%. Most people I know are operating under the delusion that the ACA will tax their employer plans at 100% and require people making $10K or less to buy “Obamacare” without subsidies. And most people don’t see the simple fact that states are free to “experiment” with single payor beginning in 2017 under the ACA. In other words, we’ll do it the way Canada did it, except in perpetual rightist states like Texas and the rest of the south. The myths out there are legion. Instead of messing everything up, the rightists would do well to get on board.

  • Anonymous

    The Republican plan would take more of the burden off of employers and put more on the shoulders of the the workers. “the idea is to make consumers more aware of how much their health care plan costs (by making them pay part of it), so that employees will go to their bosses and ask for cheaper plans.”

    Of course , what they fail to say is that cheaper plans are cheaper because they cover less. So the cheapest plan would be a “catastrophic health care plan” that only covers you after you’ve forked out $5000 in medical costs per person. It wouldn’t cover doctor visits, medical procedures, drugs , X rays, scans, or anything else UNTIL you have spent $5000 out of pocket. It’s a gold mine for Insurance companies because they know you’ll be more reluctant to seek medical care if you haven’t reached your deductible.
    But it discourages people from seeking medical care when they should.
    And when they don’t seek medical care to save money…small problems can become BIG problems.
    For example, I was self employed so all I could afford was a catastrophic plan from Blue Shield. I paid $500 a month (or $6000 a year) in premiums. My deductible was $5000 per calendar year.
    One time I fell and hit my head hard on the driveway. I went to see my doctor and he recommended a $1200 catscan …..or a less accurate… $200 X ray. The catscan could detect internal bleeding. The X ray could only tell if I had a fracture.
    I had to make a decision…based not on my doctors recommendation…but on cost.
    Since I hadn’t reached my $5000 a year deductible I took a chance and opted for the cheaper option..the X ray. If I had internal bleeding that might have led to a blood clot and the X ray wouldn’t indicate it. I gambled…and made a medical decision..based not on caution…but on cost.
    Fortunately I gambled and won. No blood clot…and no fracture.
    But It could have played out a lot differently.. I had to decide between risking a blood clot and saving $800.

    I don’t think people should have to gamble with their health. If the doctor recommends a procedure…I think the patient shouldn’t have to weigh the difference between the doctors recommendation….and the cost. A doctor’s recommendation should be the only determining factor.
    That’s what I don’t like about the Republican plan. It puts people in the position of having to make medical decisions based on cost…and not the doctor’s recommendation.

    Yes. It would bring down the cost of medical care…but only because people would opt not to see a doctor when maybe they should.
    That’s not good healthcare. That’s gambling.

  • NotARedneck

    “the idea is to make consumers more aware of how much their health care
    plan costs (by making them pay part of it), so that employees will go to
    their bosses and ask for cheaper plans.”

    2/3 of the cost of health care in the US is due almost exclusively to this sort of thinking. It is all about denying everyone but the “deserving rich” adequate health care and ensuring that the “deserving rich” pay as little tax as possible – so they can afford everything that they desire. This system has massive costs built into it that do nothing to deliver needed medical care to anyone.

    How do I get the 2/3. Well there are many advanced countries that deliver high cost health care to ALL their citizens at approximately 1/3 of the GNP that it costs the US.

  • David Lane

    Health care cost are out of hand for one simple reason. We allow health care to be a for profit business.

  • Doug Sanders

    “…Overall costs will come down, the argument goes, if consumers have more “skin in the game.” We were told many years ago that this simple “truth” would send people flocking by the zillions to HRAs and FSAs and other consumer-directed plans … didn’t happen. If the GOP revealed anything in this “plan,” it’s that they understand nothing about the health incurance marketplace and American consumers. It’s only fair to point out that the current administration isn’t a far sight better.

  • Anonymous

    There is something to be said when publicly traded businesses, which rake in exorbitant profits and have some of the highest paid CEO’s in the U.S. are making their money off those held hostage by health care issues. Shameful!

  • Les Weiler

    ….because i’ve not had “skin in the game” of my medical care before?

  • Paula Segnitz

    You are right about that but most folks don’t get that. I’ve got good health care coverage based on what I earned and I didn’t have to worry about previous illnesses I’ve had. thanks you ACA.

  • Anonymous

    Hospitals’ fees vary wildly from region to region – even within the same State! Try to get a ‘cost’ for any procedure or hospital stay and its impossible. Hospitals are fighting any transparency of their costs … yet these republicans believe Healthcare prices have a Marquee in the Lobby of the Health care provider – like a McDonald’s Menu? Their heads must feel terribly compressed in their current location …

  • smooth edward

    Ahhh, the long-awaited Republican alternative to Obamacare is here, and everyone is going to hate it. There’s no mandate, but if you go without insurance for a little while the prohibition about denying coverage for existing illnesses disappears. It also taxes all people on the value of the health insurance benefit after 65% of benefit value. Conservatives want it to cost more, so healthcare consumers have more skin in the game, and will use benefits less often. So, that’s the problem? We pay too little out of pocket for our health insurance coverage? This is a plan only rich, Republicans would like, except the truly rich will find away to reduce their tax liability for their Cadillac plan coverage. Hey, how can I be a job creator if I have to pay more for my cushy healthcare plan, right? This idea will be about welcome as tetnaus.

  • Democratsinceiwasborn

    Well, you mean they have a new plan, I thought the ACA was originally their plan. I’m beginning to think their plans are nothing more than delaying tactics to prevent anything but tax cuts for the 1%.

  • Frankly Terrence

    Is there a proposal where they pay 100% of their own coverage? The CAN afford it.

  • Jack Haesly

    Do you really expect the current bunch of Tea Partiers and Republicans to actually do anything to support the common welfare of citizens? Give me a break. Their actions in the past, have given us a good indication of where their hearts are…and it’s not in their chests. Need a clue? Try their pocket books. Be that as it may, most do like war…any war.

  • Jack Haesly

    Here, here!

  • destroyideas

    The Supreme Court already determined that health care is not a free market. The very nature of medical care is one sided with the consumer having no leverage in the trade. If consumers find the costs of sugar too high, they will buy less sugar. Consumers can’t avoid health care costs.

    This is such a stupid plan for this very reason. It would also mean people will use less health care for prevention and bloat chronic health care costs even more.

  • destroyideas

    This is the crux:

    It would bring down the cost of medical care…but only because people would opt not to see a doctor when maybe they should.
    That’s not good healthcare. That’s gambling.

  • Brenda Duffey

    It’s time someone held individuals accountable for a tremendous number of health care issues that are caused by America’s addiction to a carcinogen, obese way of living. Demand prevention and give those addicted the tools to change their lifestyle instead of giving them insurance policies to treat preventable illnesses.

  • destroyideas

    Invariably conservatives say national health systems work in other countries because they’re smaller populations. The USA has ~300 million, and the EU has ~500 million. The EU requires member states to have universal health care. Each member state has their own way of doing this. But it’s important because the open borders policies would mean a smaller nation could use another nation’s plan to receive health care. This is the same situation we have in this nation, only we have ~200 million fewer citizens. If California has single payer, sick people will move there from Oklahoma to receive care, ideology be damned (because who cares about your libertarian tautologies when you’re dying?). While Obamacare has internal contradictions (like taking the middleman out of student loans but putting a middleman between patient and doctor), the biggest benefit is making sure every state formulate their own plan to cover everyone. I don’t really have a problem with 50 different health systems as long as they’re comprehensive and freely accessible. That’s how new ideas are tried and tested, something conservatives tout – the laboratories of democracy.

  • didoro

    And still no one addresses the problem that so many health care costs are bloated, artificially inflated, and overly expensive, and the fact that smokers and the obese cost us all. (Try stop subsidizing corn— corn syrups costs will rise, and big, fat America will be forced to drink less soda and eat fewer cookies.)

  • Daniel E. Chapman II

    I do have to say this, you almost touch on one of the main drivers of why healthcare costs are ridiculous in the US to begin with.

    Right now, that Doctor gets paid more for doing the cat-scan instead of the x-ray. For him, it’s not about effectiveness or your health, it’s about the more expensive procedure. So he is incentivized to encourage more cat-scans, especially when insurance will pay it without a second thought.

    If our system instead paid doctors according to how well their patients fare, he might not always opt for the more expensive procedure. I mean, he shouldn’t shirk from things that are necessary, but I know from seeing the numbers, when a more expensive procedure is available, the provider will find new reasons to order it up. Their patients won’t necessarily do better, but suddenly the costs will go up.

    None of this contradicts what you’re saying, by the way, I just thought I’d interject with this.

  • Mike Lince

    ‘The lawmakers’ proposal would repeal a number of taxes and fees on health care companies that help pay for Obamacare’s subsidies for low- and middle-income workers.’
    Of course it would, and that may go over well with wealthier earners while it hits lower income earners hardest. Yep, this proposal has all the earmarks of a Republican plan alright.

  • Ned Stotesbury

    I would like to respond in detail but I have to go and get a Big Mac meal…super sized

  • Ned Stotesbury

    Free market? There is no free market

    High cost of sugar…google sugar cane lobby open secrets

    The world of money-in-politics can be sour, but sometimes, its sweet.

    Sugar is the only industry in the entire agribusiness sector that has consistently supported Democrats during the past two decades. Sugar cane is grown in southern states such as Florida, while sugar beets are primarily grown in the upper Midwest and Great Plains and converted into a number of sugar products.

    We have 2 parties that are both bought and paid for. This is what happens

  • Ned Stotesbury

    I know quite a few truly rich. Forbes list rich.

    They don’t have insurance…not on anything. (except min liability on the cars as required by law)
    No house fire insurance
    No health insurance

    When you have 100 million + you don’t need it.
    You self insure.

  • destroyideas

    I’m not sure what your rant has to do with anything discussed here.

  • Ned Stotesbury

    Do you remember the old interview with the CEO of Walmart.
    He said about the same,,it forces our employees to seek value…it’s sams way
    The interview said your pay was 17 that sams way?

  • Ned Stotesbury

    I didn’t think you would but others will

  • destroyideas

    Interesting. I had lunch with a multi-millionaire. He brought along his insurance agent. Of poor people don’t even know our agents’ names.

  • destroyideas

    Other people will take an example of a commodity being a consumer choice and figure out what a rant about sugar cartels and know what it has to do with healthcare?

  • Ned Stotesbury

    Big money and interesting reading how corrupt both side of politics are

    Individuals and political action committees associated with the sugar industry have contributed more than $41.7 million since 1990, with about 58 percent going to Democrats. Over the years, the amount the industry contributes has increased and the industry’s affection for Democrats has waned. During the 2008 campaign cycle, the industry contributed more than $4.2 million, with 65 percent going to Democrats. By the 2012 cycle, the industry accounted for more than $5.3 million in contributions, with the money evenly split 50-50 between Democrats and Republicans

  • destroyideas

    Interesting. But how does this relate to the healthcare issue discussed in this thread?

  • Arm of Keaau

    The health care issue is not as simple as your corn solution. Nor is it totally due to people who are obese or smokers. There are a myriad of environmental and heredity issues in play. I will however agree that there is much built in to the current system for profit of the greedy. (_: FBI

  • Anonymous

    The employee is already paying the full cost of an employer provided plan, when seen from the employer’s point of view. The plan is part of the package, and part of the employee cost to the employer. Employees would also see it this way if they thought about it. A $40K/year employee(salary or wages), costs me about $56K. That’s what the employee is paid.

  • Steve Purnell

    Attention Republicans, WEALTH CARE is not Health Care. Tragedy is not supposed to provide a bonanza for you or anyone. Just thought you might want to consider that.

  • Ned Stotesbury

    You said:If consumers find the costs of sugar too high, they will buy less sugar.

    The price is fixed

  • destroyideas

    It was an example of a consumer choice. The price might be fixed, but the consumer can chose to buy it. It doesn’t have to be sugar, it can be any consumer good. The point being healthcare is not a consumer good. There is no healthcare marketplace.

  • Jane Arney

    Their plan sounds like it was crafted with considerable input from ALEC.

  • JonThomas

    We’ve been getting ‘trickled’ on for years.

  • Frank Grasha Sr

    They like war because the steal taxpayers money funneled thru the military complex ! All the materials used in war benefit the 2% !

  • Anonymous

    Considering my present employer didn’t contribute any to health insurance is why I didn’t have any until January 1st. I seem to recall it was $800 per month for the wife and I. That was about half of my monthly income. Now I’m on Medicaid and for the first time I actually have some kind of coverage for the two of us.

  • Anonymous

    Phasing out or eliminating the tax exclusion for group insurance is good policy. It makes absolutely no sense for your employer to be involved in your purchase of health insurance. This is a policy where our elected representatives should be able to come together and change the system for the better.

  • Anonymous

    Reducing or eliminating the tax exclusion for group insurance is good. The problem with this plan is that it leaves low income people without adequate access to health insurance. Since the requirements on what’s an acceptable insurance policy is eliminated, insurers can offer super cheap “shell” plans which consumers can purchase, then switch to a real plan when they need it.

  • Anonymous

    The ACA actually does address that problem. If you take them at their word, hospitals are marking up services and then spending that additional money to cover care for uninsured people welching on their hospital bills. The ACA should cover most of those uninsured people, thereby eliminating this incentive. It remains to be seen if hospitals will really pass the savings on to their customers, but for what its worth hospital administrators don’t compensate themselves neeeeeeearly as well as insurance execs do. The insurance industry has great profit margins while hospitals have been known to go bankrupt. I’m sure there are a few jerks administrating hospitals too, but its not nearly so systematic.

  • scat

    So if I understand it right, this plan brings down the cost to the insurance companies by making it more expensive for the individual to get good coverage and thus more people have to buy the junk policies which are cheaper and under which the insuror is required to pay out less in benefits. And of course those pesky poor people just won’t be able to get medical care at all and will have a much shorter life span. Or did I miss something?

  • scat

    Insurance policies are only hand designed up to a point. First, you are not the best predictor of what coverage you may potentially need. Take that from one who never thought it possible to have 3 different cancers in a period of 6 years, a heart attack as a side-effect of some very expensive drugs, and a few minor but weird medical issues. Second, a policy that is “off the rack” with coverage designed for the potential of a large segment of the population is ultimately cheaper for all as compared to a designer policy. It’s like the difference between a piece of clothing that you can sell to a large number of people and a piece of clothing designed for one person.

  • scat

    There are additional reasons that costs are so high. We need to get both insurors and employers out of the health care business.

  • Anonymous

    Our country spends about twice as much as comparable countries on health care. Its largely due to profiteering in the insurance industry, not dummies smoking cigarettes and eating bacon cheeseburgers. Our insurance industry has been siphoning off 60 cents of every health care dollar to pay for admin/overhead/executive salaries, and that is THE major cost factor. Every comparable country to ours has one big govt-run health insurance program- they’ve eliminated the private sector bureaucracy required to shuffle papers for thousands of policies from hundreds of companies. They pay their doctors and nurses about the same as us, but they can afford 60% more doctors and nurses. Kicking the cigarettes and hamburgers might save a few bucks, but its not going to eliminate 60% of the costs. Single-payer will do that.

  • Anonymous

    Totally. Skin graft too expensive? You just don’t have enough skin the game

  • Anonymous

    Nope their plan really is “screw you, average americans. we’re delivering insurance execs a return on the investments made in our campaign funding”

  • Yeahright

    I do not believe hospitals care for many people that can’t pay or don’t have insurance. I think that is what they claim to keep their “not for profit” classification. Getting through the front door is not easy without insurance, you need to be dying in the ER and then they might just let you die. It should not be a business……..period.

  • Yeahright

    How about we regulate the food instead of the people? If you can recognize that our food is carcinogenic, why would you put that on the people?

  • Yeahright

    It is totally due to profiteering. There are Big Macs all over the world.

  • Yeahright

    Don’t be stupid……….are you also going to pick which disease you get, how many children you will have? Oh you must not be Catholic. how about how many car wrecks you will be in or how many sports injuries for your kids? You see where I’m going with this? How many of those injuries will you just let your son lay on the basketball court and die with? It is not a foreseeable issue, and we don’t want to pay for you, so get over it and pay the bill.

    You obviously don’t understand the concept of insurance.

  • Anonymous

    As Baker writes, “the idea is to make consumers more aware of how much their health care plan costs (by making them pay part of it), so that employees will go to their bosses and ask for cheaper plans.”

    Dare I ask what Hatch et. al. think about unionization? Does he imagine the lone, overworked Walmart employee walking into the office of upper management and demanding to pay less for their insurance plan? As @naksuthin:disqus points out, at best they’d be given a cheaper plan that did not cover as much.

  • Anonymous

    One of the positive things about Medicare/Medicaid—one of many positive things, I might add—is that Medicare/Medicaid would not pay the $800 it was billed for the Saline bag. Medicare/Medicaid wouldn’t even negotiate the price down—which is what insurance companies do—as it has a fixed pay for an item like saline and won’t pay more.

    Neither would Medicare/Medicaid pay the doctors $1000/per for sticking their heads in the room.

    These and other examples being the reasons why Medicare/Medicaid are the only two entities actually bending the healthcare cost curve downward.

  • Anonymous

    I can’t speak to the issues about “smokers and the obese,” though I am aware that the ACA at least provides preventative care.

    However, it bears mention that the two entities which do address “the problem that so many health care costs are bloated, artificially inflated and overly expensive” are Medicare/Medicaid. They are the only two entities that actually bend the healthcare cost curve downward.

    The ACA is actually designed to do some of this by setting limits on provider payments and rewarding dollar-to-dollar efficiency/outcome. But, because it runs through the private sector, it will never be as effective at lowering costs in the way Medicare/Medicaid are.

  • Anonymous

    If you read Stephen Brill’s research on American healthcare (it was the cover story in TIME’s 3 March 2013 issue), you will find that hospital administrators are, in terms of on-site personnel, actually making a fortune from private/public non-profits. It is unbelievable.

    I’m not saying insurance company officers aren’t doing the same, but they aren’t on-site.

    In fact, in reading Brill’s work, one comes to understand that, in order to incentivize young people to go into medical work, we really have to insure that physicians make a salary commensurate with their contribution to the healthcare system. I can’t believe I am actually saying that doctors are the big losers in the evolution of healthcare in America but, along with patients, they are. The big winners? The bean-counters and the PR-oriented CEO’s.

  • Elphaba Wackadoodle

    “If people are spending more of their own money, many conservatives argue, they’ll be smarter consumers. Overall costs will come down, the argument goes, if consumers have more “skin in the game.” Makes perfect sense to me. If I had to spend more on health care, I’d make it a point not to get sick as often as I do now. And I certainly won’t allow myself to get a catastrophic illness. Those Republicans are smarter then we thought.

  • Sai Das

    In 2016 when Republicans have lost the majority and the Tea Party self-destructs, here is an analogy I hope is played out:

    Democrat legislators with balls (not that there is such a thing of course) to Republican legislators, “We’ll see that and raise you Universal Health Care.” Republicans, “We fold”.

  • Sai Das

    I think their strategy is “pay up…then die.”

  • Anonymous

    We already have the republican solution, remember, Obama simply adopted Mitt Romney’s plan from MA, the one that benefits big insurance companies with forced customers? The democratic plan was single payer with universal coverage.

  • Anthony Endres

    Truly they are a bunch of mere rich ideologic idiots, are they not?

  • Tim Chambers

    Waaaah. The poor doctors can’t bilk us under Medicare/aid. That’s unAmerican, isn’t it?

  • Anonymous

    I personally let a hospital bill go to collections once, which means the hospital sold my debt for pennies on the dollar. I couldn’t afford insurance. When I got injured, I went to the hospital and stiffed them on the bill. Deny it if you want, but my story was repeated millions of times over in hospitals across the country- people who couldn’t or wouldn’t get insured found themselves in need of medical care, so they got the care they needed and stiffed the hospital for the bill. This is a strain on the hospitals. Hospitals have responded by raising prices on those who do pay to cover the costs for those who don’t. Insurance companies can negotiate for a discount by threatening to throw the hospital off their network, but individual consumers paying out of pocket are forced to pay the full sticker price.

  • scat

    But anyone who wants and can afford a real plan must also be able to overcome some of the existing barriers like pre-existing health issues. The Republicans so-called plan has to include many, many pages of information before it can seriously be considered a plan — not unlike the multi-page ACA. I spent a couple of decades in the insurance business and most people who are not in the industry have no idea of what constitutes the writing of an insurance policy and all the variations that need to be addressed. It’s not strictly a contract issue but also has to consider all the thousands of case laws and statututes that are incorporated by reference and all the variations amongst the 50 states as well as issues litigated in the federal system. IT will take years for the Republicans to put together a plan that can be considered worth reviewing.

  • scat

    For good or ill, apparently some employers are opting out of the insurance employement benefit. One step toward more efficiency and single payer system.

  • scat

    There is scarcely an American that doesn’t “cost” us all. What about people who drink to excess? And that creates more than medical costs, including the loss of lives caused by drunk drivers. First, none should be pointing at our neighbors shortcomings or afflictions. And karma has a wicked sense of humor. Second, There is still much to be learned about cause and effect. People die of lung cancer who have never smoked. People live to 100 and swear it’s the liquor and tobacco that kept them living so long. Third, you should not support “ideas” that are thrown out there by big money interests that want us to argue amongst ourselves over such things that distracts us from those who are really trying to gouge us. IT’s not that hard to debunk thier false assertions. One should not be taken in by easy answers and false connections.
    I am currently being treated for my third cancer and all the doctors are puzzled because they have no reasonable idea where any of them came from and disagree mightely on what medicine I should take, and what is good for me and what isn’t . One thinks I should work into doing more exercise, another was so annoyed that I did a little snow shoveling (which I actually like to do at a slow pace since it gets muscles moving) — he offered to come over to my house after work and shovel for me. He does live in my neighborhood, but this throwback to doing “house calls” is a little amazing. I swear it’s true. The nurses got a good giggle from that when they saw it in the notes, but on reflection, they said he is just that kind of guy. Anyway the point is that there is so much disagreement in the medical community on these issues, that it is way to early to turn this into a political issue. These two doctors are going to have a pow-wow in the next few days and I would love to be a fly on the wall for that.

  • Anonymous

    oof thanks for bringing this to my attention. I just took a little stroll through Forbes’ rich list and bumped into some crap I wasn’t expecting to see. Granted, the mere possession of an enormous fortune isn’t a crime, but generally where there’s smoke there’s fire.

  • Tk69

    If you want to fix the health care system, get government at all levels out of it completely. This would not inly reduce cost but increase quality and choices. It is that simple.

  • Xavier

    Most of the woes of healthcare is that the ‘for profit’ of it is outpacing the incomes as well as the insurance coverages of it and I’m not sure Republicans have such interest in not being in the pocket or losing the ‘friendship’ of the making makers. People already have skin in the game, which is as complicated as the worse tax code, and needs specialists to even unravel it for the end user. To which, a lot of people even avoid using the coverage they have for fear of bankrupting or heavily burdening their finances that are already taxed heavily. They’ll fight a minimum wage increase or an opposing healthcare program, but won’t address the costs of living that make it necessary, truly one of their kick the can down the road issues, especially the big money in care and prevention.

  • scat

    I don’t know where your experience has been, but where I live, the hospital and medical care is rated as very high. If anyone was denied emergency assistance, that would be front page news. The system for treating the unisured has been pretty much the same everywhere for many decades and everyone in the system understood how it worked, but it was not something they broadcasted to the public,except when something went wrong. Face it, until the ACA, very few people cared about learning how insurance works.

    Some parts of the country have done a better job than others in handling the uninsured issue. For many years,hospitals have been required to treat whoever comes in the door, they had to have ways of funding the costs when the person was not insured. Insurance companies had to foot some of the costs, since they were the moneymakers in the system. Hospitals also struck deals with the high profit medical suppliers. And doctors were expected to donate some of their services. In two of my short hospital stays, they changed the classification from in-hospital to out-patient because my little policy had better coverage for out-patient treatment. And that was done by the scheduling nurse because she understood the problem and how to fix it. Under the ACA, this sort of roundabout process should be greatly reduced and thus reduce administrative costs.

  • scat

    The ACA is designed to greatly reduce bankruptcies.

  • scat

    Our knowledge of the causes of cancer has a long way to go. IT’s pretty much one step forward and two steps back. I have had three totally different cancers and the doctors are totally stymied. They can’t seem to agree on where it came from or what the best treatment course should be. Everytime the medical community seems to come up with some answers, they get people like me who just do not fit the current ideas. Yes, there are some elements that are considered carcinogens, but that is not the whole answer. HOw much is safe, how do other things in the environment interact with the carcinogen, why do some treatments work well in one group and not in others, what are the side effects of the medicine.

  • scat

    Because some large food processors make a lot of money on using chemicals in our food to give food a longer shelf life.

  • Anonymous

    When people see what the GOP is offering, especially the removal on limits, & no means for negotiating meaningful reductions in drug or equipment costs, etc. I doubt that folks will be impressed.

  • Anonymous

    I’m not sure that the almost stereotypical targeting of doctors is a helpful way to extend the conversation. I only say that because, given the principal reasons for and beneficiaries of the the rise in healthcare costs/profits, doctors occupy a relatively low rung on the ladder.

    In fact, the two primary roadblocks to a single-payer, “Medicare-for-all” type of healthcare system are (1) figuring out how to insure that doctors are commensurately compensated per their actual “place” in the healthcare system in order that young adults be incentivized to look at medicine as a career and (2) devising a plan that insures R&D for the future.

  • whomoi

    go figure, the republicans suggest higher costs for healthcare and health insurance but the right wingers main complaint about the ACA are the high deductibles in the exchange plans.

  • Shawn French

    It’s hilarious to say republicans use fear to push their plan when they use the IRS bagman to enforce their unconstitutional plan.

  • Inattentive Vigilant

    Except that’s the exact opposite of the successful models used by all sane countries on this planet.

    I guess some people aren’t happy with being #37 in healthcare and want to go even lower.

  • Tk69

    There is nothing sane nor successful models in other countries. Until recently the US was the model. And your stats are nothing but propaganda. Why do so many leaders and others come to the US for health care? Maybe they know too that such ratings are nonsense.

    The problem is government. What is needed is a lassie fair health care system. What doe people think happened before state intervention which has actually slowed access to health care.

  • Inattentive Vigilant

    You’re right, the World Health Organization is just propaganda for a communist takeover.

    Oh brother.

  • Tk69

    Yes. And it becomes more evident when you actually look into their stats. If you did you would see that they have changed various definitions and outcomes to suite their own political needs. Again, why do the leaders of the WTO come to the US for serious health care?

  • Inattentive Vigilant

    Well, the WHO and MSF are both also involved in the HOAX of “global warming”.

    Rand Paul 2013!!

  • Anonymous

    Exactly. I have Tricare; my doctor sent them a bill for $178. They disallowed all but about $20 and then covered $12.

    If my doctor is OK with getting $20 for the service, why not just bill that?

    Why do we play this ridiculous shell game?

    It’s like going to a grocery store and getting a quart of milk priced $20, going to the cashier and saying I’m only going to pay you $2 – and the cashier takes it. ??

  • Anonymous

    I could not agree more with you per it being a shell game. Here is the problem, as best I understand it:

    Healthcare—especially when delivered by institutional providers—charges are determined by each institution’s “chargemaster,” which is the true instrument of evil in all of this. Every element of your treatment is recorded in your chart and immediately priced on your running account according to the chargemaster—whose prices, again, are peculiar to each institution.

    Virtually the only people who actually pay the entire bill as it is put together by the chargemaster are very wealthy patients who have come from abroad and are paying in cash—which is why so many of the more elite medical centers actively market their services in foreign countries (particularly oil-rich and mineral-rich countries, where cash wealth abounds).

    Insurance companies and providers routinely negotiate bills downward, though what is left is often obscene. There is also a cottage industry that has developed around this kind of negotiation—you can hire individuals who will actually negotiate FOR YOU with both the insurance company and the provider (they are paid a % of savings they procure and, according to studies I have read, they are actually pretty efficient and well-worth the expense).

    So, we are still left with the WHY? of the chargemaster, given that providers know that neither insurance companies nor patients will typically accept the entire bill. They actually research the percentages of total bills they recover and adjust the chargemaster accordingly, always looking to charge a little bit more so that their percentages will reap a higher profit. I know it sounds crazy, but it is all a high-stakes, big-money game. Worse, it is played by institutions that are classified as private/public NON-PROFITS! The latter explains why, on December 31st of each year, big, big bonuses are paid to hospital execs and administrators and big, big building projects are approved and monies directed toward them—non-profits have to zero out their books prior to January 1st of each new year.

    The best work I’ve ever read on this is Steven Brill’s research, a condensed version of which was published in the 4 March 2013 issue of TIME. You can Google it and read it. But, make sure you’ve got a fifth of stiff Scotch nearby when you read his research—you’re gonna’ need it.

  • Berry Muhl

    “The Republican version of magical thinking.” That “magical thinking” is rooted in truths about the economy, truths that Keynesians have forgotten or never learned.

    Price controls and other factors that limit the functionality of market forces are the main culprit in high prices. Price controls never in fact control prices. Virtually every example of national hyperinflation in the 20th century and onward resulted from price controls. A distorted market cannot self-correct, as we’ve seen with this interminable Obama “recovery.” One simple measure–eliminating restrictions that prevent insurance carriers from competing across state lines–would increase risk pools, improving carriers’ responsiveness to consumers, and allow for the kind of wide-scale competition that truly drives prices down. Meanwhile, the licensing requirements, cost of education and malpractice premiums that result in artificial scarcity among physicians would have to be addressed in different ways, as would the artificial scarcities of treatments caused by FDA regulations.

    But in all cases, the real culprit in the high cost and unavailability of health care remains government involvement in the market. The regulatory burden in health care has massively increased over the past half-century, as it has in all other economic sectors. Throughout that time, prices have increased and availability has fallen.

    There are your two dots. Please connect them.

  • Mike Costello

    Tin foil hat for you

  • Harriet Russell

    Your sacred “Market” is a toxic artificial construct.

  • Berry Muhl

    Your ignorance is charming.

    There are no “artificial constructs” in society. Every feature of civilization evolved from prior features. None of it was willfully created. We cannot arbitrarily order our social environment. We cannot centrally plan an economy. We cannot regulate a complex adaptive system. Any more than we can design and build an ecosystem.

    And what you consider “toxic,” I don’t give a damn about. Competition is natural. Hierarchy is natural. The desire to accumulate territory is natural. The market is composed of natural elements of human behavior. Get used to human nature. It’s going to be with you a long time. If you hate competition, then get used to being outcompeted. If you hate hierarchy, then get used to being on the bottom of the scale. If you hate property, then get used to being poor.

    But don’t you dare inflict your idiocy on others. This is what liberty is, lady: the freedom to NOT live according to YOUR dictates. This country was established to defend LIBERTY, not “social justice” or economic equality or any of the other progressive shibboleths that have led our society so badly astray over the last few decades.

  • nekksys

    Novel idea… Go back to basics and eliminate insurance altogether. There really is no need for this. People seem to want to live forever for some ridiculous reason. We have the longest life spans of any people in history. We’ve gone into full-on population overshoot. Our lands can no longer sustain us through farming. We need to cull the herd.

  • Anonymous

    As is the one you’d have to replace it with.