TrumpCare: 23 Million Uninsured

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The Congressional Office of Management and Budget (OMB) has released their scoring of the Republitrump Health Insurance reform bill, passed recently by the House but not yet taken up by the Senate.

The OMB says the bill will leave 23 million more Americans uninsured by 2026, compared to sticking with Obamacare.

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23 thoughts on “TrumpCare: 23 Million Uninsured

  1. Read the summaries of the scoring, and some responses. No surprises that the general response from the Republicans was denial of the projections, with Ryan saying that this is exactly what is needed.

  2. CBO’s previous projections were way off on how many people would sign up. The majority of this 23 million do not currently have coverage. CBO is assuming that under ObamaCare, they will sign up in the future- the same estimates they got wrong before.

    In 2010, 2012, 2014, the estimates were off by more than ten million.
    http://i2.wp.com/www.powerlineblog.com/ed-assets/2017/05/Screen-Shot-2017-05-25-at-8.51.01-PM.png
    Even the updated 2016 estimate was off by nearly three million for 2017, just one year away.

    They also make assumptions about what states will do with waivers that do not make sense. Before ObamaCare, states didn’t set up their health care that way, so it doesn’t make sense that when given the choice they would jump in that particular direction.

    Plus is it really losing coverage when someone who is only buying because of the individual mandate tax penalty, decides not to buy when the penalty is taken away?

  3. Do you know how to reduce your healthcare insurance costs to zero? Don’t have insurance.

    So demand your employer, instead of giving you “benefits” of “healthcare insurance”, give you cash instead to spend,then don’t spend it. Put it away instead and you can expect to be better off since your scheme has lower running costs than actual insurance and can therefore undercut the competition.

  4. It might be worth just giving up and going for the gusto with healthcare in the USA. NOBODY takes insurance unless they specifically pay for it. No company health plan, since that isn’t decided for the individual, and opting out should not lose you benefits or it’s theft of pay.

    That leaves only the wealthy to pay for all of the health infrastructure that they benefit from in their private health regime. They’ll find out that it’s hard to have high quality healthcare unless there is a large demand for the workers so that the best can be found and retained and paid for. The investors will find that when nearly nobody is buying their products for medicine or health insurance that their business is bankrupt and their investment gone.

    When businesses see that an accident to a known worker (especially a trained one) can no longer be fixed “for free” on healthcare and their output that was how they made revenue from which they extracted both their pay and profits is gone and they must find and risk a new employee, they’ll decide that risking their employees is not a workable strategy.

    Because when health insurance only covers you for when you’re healthy but passes on the costs to you if you’re not, it’s not health insurance, it’s corporate welfare. And by far the cheapest option is to not take the insurance.

    And since the Rs neocon party line is individual choice is good and enforced decisions bad, it should be a free choice of insurance, including none.

    And if Paul Ryan thinks that he’s healthy and therefore can just skip insurance too, he’ll find out that when he’s old and breaking down that there’s no longer any healthcare in the USA since there was no money in it, and he can only get care that is his personal employment of a doctor and the nurses and all the treatments at the rate the suppliers think he can pay for.

    And when his money has been siphoned off in five years and he’s now older and poor, he’ll be crying. But he’s “won” thirty years of not paying for his decision, unlike others who didn’t get the win part, only the pay.

  5. Estimates for coverage were not far off, except for states where Republicans tried to sabotage it.

    In this brief, we take a detailed look at changes in health
    insurance coverage among the nonelderly population from
    2010 to 2015. We find that gains in coverage were large and
    widespread. Nationally, uninsured rates fell substantially for all
    of the groups we examine based on age, gender, race/ethnicity,
    and education status. Uninsured rates fell for all states, but
    coverage gains were larger for states that chose to participate in
    the ACA’s Medicaid expansions.

    https://goo.gl/Yho4FZ

  6. It seems obvious to me that:
    (1) Like any other insurance, health insurance requires that many people who pay for it do not use it or use it minimally in order that those requiring a lot of it can get the care they need.

    (2) The costs in case of major need are beyond the resources of any but multimillionaires..

    (3) Unlike other kinds of insurance, the probability of the need for health insurance increases over time and waiting until you need it is not a viable option because of (1) & (2).

    Given that the GOP has spent a lot of time trashtalking about and fighting against Obamacare which was essentially the system invented by the conservative Heritage Foundation and implemented by Republican governor Mitt Romney, whatever they come up with now is unlikely to be an improvement economically and/or in coverage.

    It should therefore be no surprise that people will be left out and those with coverage will likely get less coverage for more money. Why would anyone expect anything more form the present-day, backward-looking GOP?

  7. “(2) The costs in case of major need are beyond the resources of any but multimillionaires.. ”

    Not really. There aren’t enough of those to support the infrastructure necessary to get that healthcare system in place. How much would it cost to build the FIRST chemotherapy lab?

    There wouldn’t be enough customers for doctors for more than a few scores of them, and there would then be no need for a university to train them. So any millionaire would have to fund one, even if pooling resources. But why would one who thinks that R plans are a good idea fund that if they weren’t already in need of it? Because by the time it all gets going, it will be too late.

    Millionaires would have to hire foreign trained doctors who would charge whatever was possible, the best earning massive wages to be employed full time whether they’re needed that day or not. Doctors would be like NBA stars. Millionaires would not be able to afford them. You’d need billions, or an income millions a year. Or pool resources.

    The only cheaper alternative would be to fly to a doctor or fly them in, but that would require paying insurance to allow you to access a doctor at all, and if you’re ill with something contagious, you may not be allowed in or out.

    What it would do, after much misery, is show to these retards WHY everyone pays in and why everyone should get a chance at getting treated, no matter how much money you have.

    Because without universal access, you lose the money of the poorest, but still have to treat jut about as many people, so you charge more, losing more poorer people, and eventually you have to treat fewer people enough that you can’t support the system at all and it collapses.

    And that’s without the possibility of infection from some poor person who cannot take time off work but can’t afford insurance if it won’t pay out infecting them or someone they employ or just meet.

  8. “and those with coverage will likely get less coverage for more money. ”

    No, it’s worse than that. If they get coverage and don’t use it, it doesn’t make sense to pay the insurance. If they get coverage and DO use it, their costs will rise, meaning the insurance really was just a loan. A very ill designed loan.

  9. #11: “If they get coverage and don’t use it, it doesn’t make sense to pay the insurance.”

    Well, any insurance including health insurance is based on the fact that you don’t know in advance whether you’ll need it or not and how much you’ll need if you do need it. So, not paying for insurance is a bet. Like the Dirty Harry quote: “You just have to ask yourself one question: Do I feel lucky?”

    Also, for many people, even if they do feel lucky, they want to protect their families from staggering debt that a long illness can build up. Someone I know with liver cancer was paying $1300/week for medication alone.

  10. #10: Perhaps you misinterpreted my comment. My statement: “The costs in case of major need are beyond the resources of any but multimillionaires.” was about the costs right now. Anyone with resources less than several millions of dollars who chose to do without medical insurance could easily incur debts that would plunge themselves (if they survived) and/or their families into poverty. They could also be refused care. Since 1986, hospitals can not legally refuse to treat emergency conditions but they are not legally required to treat conditions such cancer without guarantee of payment.

    I thought that I was making an economic case for universal health insurance or close to it instead of whatever cobbled together mess we’ll get from the current crop of Republicans in the government.

  11. #12
    Well, any insurance including health insurance is based on the fact that you don’t know in advance whether you’ll need it or not and how much you’ll need if you do need it. So, not paying for insurance is a bet. Like the Dirty Harry quote: “You just have to ask yourself one question: Do I feel lucky?”

    What a fucking pathetic system the USA has.
    How the fuck can the USA ambassador in Canberra
    not ring up Washington and go ” hey fellas, theres
    a different system out in the world that seem to work alot
    better for everyone. Maybe send a few academics down
    to learn ”
    Well hang on, academics already visit Australia .
    In fact the USA government knows the ins and outs and goods
    and bads of every health system in the world.
    Theres a huge variety of models to pick if they wanna new one.

  12. “Well, any insurance including health insurance is based on the fact that you don’t know in advance whether you’ll need it or not ”

    No, Tyvor, the point is that the insurance will by definition cost more than it pays out. Always must. But if everyone pays an equivalent amount for the same insurance no matter if they use it or have used it or never use it, then you may in the case of a real problem, have paid in less than you would without it.

    But if you pay more if it’s actually used, that will reduce the payments those who never use it therefore got NOTHING out of it, 100% less than what they paid in, the insurance will only pay out less than what you paid in before they either cut your cover or raise your premiums so you STILL pay in more than you get out.

    Therefore there is NO WAY to benefit from buying insurance.

    Your only rational option therefore is to save that money and maybe earn some interest on it and if you need it, the cash saved will be MORE than you pay for the medical bills.

    If the insurance cost the same and didn’t factor in your use of it or cap payout, then your insurance is against the off-chance you get something expensive and deadly, for which no amount of saving would have accrued enough to pay for.

    If insurance can be changed to increase costs for those who use the insurance, there’s no point for the insurance, you are always better off not buying and either hoping nothing happens and spend the cash or saving it to cover the unexpected, which will be able to cover ANY unexpected, not just illness.

    Now, you may make a case where if you are struck with an illness early on and therefore you will not have accrued enough of a cash pot to pay what insurance would have paid. However, in this case, the premiums would then increase so that you will be in a worse state next time, even if you then never use it again.

    It’s cheaper to just buy a replacement vacuum cleaner than pay for five years extended warranty, since the difference between the insurance and a new cleaner is small and the chance you need it slim, and the possibility of a cheaper model being available by then there.

  13. “was about the costs right now.”

    But right now the infrastructure only continues because of the number of customers. How long will a hospital stay open with insufficient bed occupancy? Five years tops. Trained doctors will last longer, but their numbers will reduce on roughly a 20-year scale because of retirements and retraining to a job that pays. Poaching could drain doctors much faster.

  14. Actually, looks like LiD was quoting Tyvor.

    I’ll also ask that you change it to “Do I feel UNlucky”. Remember, the insurance only pays out if you are ill seriously enough and early enough that you cannot cover the cost with your income and whatever you saved by not getting insurance.

    Which is quite unlucky. VERY unlucky. MORE unlucky than it is “lucky” to be covered.

    But that’s where this bill is EVEN WORSE. If you ARE so unlucky as to have something serious, they can just cut your cover after a payout or just increase your premiums while you’re being treated to *just less than your care costs* when you’re a captive audience, then you will never get coverage for that thing again (or your premiums to cover it will be massively increased). So you’re still not actually lucky to be insured, you’re only less unlucky because SOME of your cost is CURRENTLY being paid for, but this will only delay the unluckier part you’d have without insurance.

    Because eventually you won’t be insured for it. Even if you paid for it. So you’d be doubly unlucky in that you paid out and still got the same result as you would if you were not insured.

  15. #15: “No, Tyvor, the point is that the insurance will by definition cost more than it pays out. Always must. But if everyone pays an equivalent amount for the same insurance no matter if they use it or have used it or never use it, then you may in the case of a real problem, have paid in less than you would without it.”

    In my original post (#9) I said “(1) Like any other insurance, health insurance requires that many people who pay for it do not use it or use it minimally in order that those requiring a lot of it can get the care they need.”

    I wrote that statement because I agree that if everyone who buys medical insurance uses a lot of it, then the insurance company will run out of money. Someone buys it because he/she might need it and without it the choice is between not getting care or financial ruin.

    I don’t know where you live or how much money you have but I was not at anywhere near the poverty line but if I had made my highest salary for my entire working life and saved all of it, I would still not have enough money to pay the charges for a really major illness now. Being now retired and on a reduced income this is not an academic point for me.

    Whatever the the exact flaws in the GOP health care law which they will sooner or later pass, it is almost as certain as gravity not be any improvement over Obamacare and might well be worse than what we had before that.

  16. #14: It doesn’t look any better from a vantage point inside the U. S.

    Being busy with a career of sorts in academia and helping raise a family, it took me a long time to notice how stubbornly we as a nation stuck to the idea that we could learn nothing from the rest of the world about almost anything and if someone brought something from elsewhere to our attention we would look at it just long enough to find some flaw or excuse for why it would not work here and discard the whole idea. Now the result of that kind of tunnel vision is apparent everywhere to those that choose to look.

  17. “I wrote that statement because I agree that if everyone who buys medical insurance uses a lot of it, then the insurance company will run out of money”

    You’re agreeing to something else, though.

    The insurance has to get enough in to pay for what they pay out, PLUS everyone’s salary, and they’re all middlemen, not producing themselves any actual heathcare.

    If they go under, then the insurance is lost, and they’ll go insolvent long before the cash they’ve been paid for healthcare has been spent on healthcare.

    There is NO WAY that insurance can pay out for healthcare as much as it gets in to pay for it.

    It’s a far far stronger absolute than you are proposing.

    Moreover, the insurers will happily take any extra as profit. So if they only pay out 70% and the overhead is another 10% of their revenue, then they will pocked the extra 20%. You don’t get refunds for any unused premiums. This isn’t a co-operative.

    The consequences are further reaching, and this is what I don’t think you’re getting here.

    It doesn’t matter how much they have to pay, because if it’s more than they have, and they have already paid wages so far, so that money is lost, they will go insolvent and no more money would be paid.

    It doesn’t matter if the demand was 100%, therefore covered. Because overhead comes out before they run out of cash and pay out.

    So nobody can expect insurance to be anything other than a loss.

    The only reason to take insurance is on the off-chance your case turns out to be expensive.

    If insurance has to cover people without regard to the specific history of that person, then insurers will charge premiums to cover their costs and overheads and a little buffer to cover the unexpected payouts. But everyone still gets the insurance against the extreme need.

    If insurance can change premiums based on the specific history of that person, then as soon as that person starts to cost more than they paid in (less overhead), they will ensure that THAT ONE PERSON will pay more. Then NOBODY gets insured against the extreme need.

    NOBODY.

    So insurance is general: you’re paying for the “anti-lottery” chance and therefore security.
    Insurance is individual: you’re paying more than if you cut out the middle man and in the case you win the “anti-lottery” jackpot is not covered. Therefore no security.

    In this case no sane person would pay for insurance.

    Would you play a casino where the most you could win was 80% of what you’d lost playing? You know, you walk in with 1,000, and if you lose 400 then win a pot worth 3,000, your winnings are capped at 320 for that pot and you’ll be asked to leave the establishment. Would you go there?

    No?

    That is precisely what insurers will be able to do: kick you out as soon as what you paid in runs out, whether you’re cured or still sick. And what you paid for was the treatment PLUS the salaries and profits of the insurer.

  18. “but if I had made my highest salary for my entire working life and saved all of it, I would still not have enough money to pay the charges for a really major illness now”

    And if you have one, you will be kicked off the next year or once you reached the cap payout, You can get insurance again, but that will not cover the existing condition that never got treated, and if you HAVE been cured, your premiums will rise because “you’re more of a risk”.

    So when you have a relapse, you will have to pay even more in insurance to be covered. And if you continue to cost too nearly the amount of your premiums, your insurer will either jack up the price until you’re paying enough to pay them to get you cured, or you can’t afford it any more and you lose your insurance.

    You could only afford that unaffordable major illness if the insurers were not allowed to change your premiums specifically, only for the average of the people who pay in to that scheme.

    And if you never had that major illness,what were you paying for? Nothing.

    You may have bought it in the past for security, but this change will remove that security, you’re now at risk of losing insurance for the crime of needing to use it. And all your earlier premiums were wasted.

  19. With the insurers able to change the deal like this the only thing keeping people paying in is the sunk cost fallacy.

    The young, especially the lower and middle classes, won’t bother because they’re young and healthy. So old or sick people will still be paying in but they are not being “subsidised” by the young and healthy any more, so the insurers will jack up the price to ensure the payments cover all costs plus profits.

    Then some of the old and sick will find themselves unable to pay their premiums and the insurance will stop.

    But no new people will come in.

    Meanwhile the still surviving old and sick are running out of cash and will eventually no longer be able to afford insurance.

    So you will continue to get the treatment for as long as you can afford to pay the insurance, but with only sick and old people still paying, the chances are you’re able to pay those costs directly and cheaper than the insurance costs, so those in that situation leave to just pay directly and pocket what used to go to the insurers’ overheads and they’re better off.

    Those still left are now going to have to be charged more.

    But they were unable to afford the treatment without insurance, so the insurers by definition must be paying out more than they get in.

    So the whole thing collapses.

    Because those who aren’t using it aren’t in, and those still in can’t afford to pay enough to cover the cost of their treatment.

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