Waaaaait a minute.
Patrick Trombly

Mr. Trombly,

“Waaaaait a minute.

There’s a big flaw in this logic.

The law allows states to opt out of “mandatory benefits.””

Yes it does. There are states already working on that. For example in my State of Minnesota the Republican controlled Congress and Senate already have a list of what should not be part of Mandatory Coverage if the AHCA is passed into law.

  • Maternity Benefits
  • In-Patient Care
  • Family Coverage (Covering Child from Birth by addition to Policy)
  • Child Health Services
  • Prenatal Care
  • Outpatient Medical/Surgical Services
  • Services for those that are ventilator dependant
  • Lyme’s Disease (Almost Tick Season!)
  • Diagnostic Procedures for Cancer
  • Cancer Treatment
  • Prostate Cancer Screening
  • Direct access to an OBGYN
  • Anti-Psychotic Drugs
  • Home Care Nursing
  • Emergency Services (Ambulance, ER, etc.)
  • Continuity of Care
  • Specialty Care (Orthopedics, Pulmonology, Cardiology, Etc)
  • Hearing Aids for a person 18 years or younger.

Insurance is a contract. There are different things against which to insure, different levels and types of coverage, etc…

An oversimplification to the point of absurdity. Health Insurance is Insurance, and it is a contract. This ignores that Health Insurance does not, nor can it function exactly like other types of Insurance. The other types of Insurance such as Automotive, Homeowners, and Life Insurance are Actuarially Fair, while Health Insurance is not nor can it be. While it is a Contract, not all contracts are the same either. Marriage is a Contract, purchasing a car from a dealership is a contract, and singing employment paperwork is a contract. All are contracts but they cannot be compared to each other.

The CBO seems to assume that every carrier operating in a state that doesn’t mandate X will opt not to cover X, and that thus, those who end up dealing with X will have to pay for the cost of addressing X.

Before the ACA 43% of people in the Individual Market could not find plans with coverage that fit their needs, or there were no plans available in their Market Area. There are now fewer Insurance Companies offering plans in the Individual Market today. Finding a Plan that offers the coverage needed is going to be a problem. Even if they do find that plan they can live with, before the ACA 60% found it either impossible or near impossible to afford the Plans offered in their area. This is what occurred before the ACA, and it is what some Health Insurers are discussing returning to if the AHCA becomes law. That would make the CBO’s assumption to be much more valid than your protest based upon your own opinion.

That makes no economic sense.

This shows you truly have no idea how Health Insurance works. The Individual Market, without the ACA regulating it returns the Market mostly to the old system. In the old system, only healthy people were be able to get policies, and only those who had good incomes were able to afford the premiums. With the AHCA, they cannot deny a person for a pre existing condition, however, they can price it out of their range, with the intent to deny them coverage. With Health Insurance risks are shared across a pool of people so that each person is protected against unlikely events. 1/5–1/4 of the people drive the cost for the rest due to Health needs. From an economic standpoint it absolutely makes sense for them to restrict coverage as much as possible to those who do not need and will not use it, and contain those who will to plans that will be priced out of most peoples ability to have them. While Medical Care focuses on Patient Outcome, Health Insurance does not.

Some carriers will offer to cover X to attract consumers who want X covered — for whom X is relevant — and those consumers will either pay more or opt for a policy that covers X but not Y, which is not relevant for them.

No Insurance Carrier wants to attract those with Pre Existing or Chronic Health Conditions. Before the ACA they flat out denied those people, and restricted coverage unless the person was lucky enough to live in an area that had a plan that covered more, and the ability to pay for it. With the ACA, which is flawed, they made a deal and tried to get those people as well as those were healthy to balance it out. With the AHCA, they have no reason to do that, and every financial reason to return to avoiding covering those people as much as possible.

Why would it work that way?

Basic Math, Simple Economics.

It used to work that way when States did not put strict limits on the allowable types of insurance and coverage levels.

How it used to work was that 43% of people either could not find a Policy that fit their needs. 60% found it near impossible or outright impossible to find a plan they could afford. 35% were denied coverage at all. Those with Alzheimer’s, Inflammatory Joint disease, Cancer, Cerebral Palsy, Crohn’s disease, Epilepsy, Hemophilia, Lupus, Multiple sclerosis, Muscular dystrophy, Paraplegia, Paralysis, Parkinson’s disease, Premature Birth, Sleep apnea, or had a Stroke were either denied coverage, or had their coverage dropped because of the Illness. Unless they were very lucky, and were able to acquire and unaffordable Policy that would not cover their Pre Existing Condition.

And it works that way for every good and service.

If it worked the same way as every other good and service then Health care would be a refusable or elective service. Since that in many instances would result in being disabled, non-ambulatory or death, it is not very selective. Unless you are a fan of Eugenics, in which the weak, ill and infirm, young and old would be culled from society. Health Care is not a Consumer choice that you so ignorantly are trying to make it into. It is not a simple consumer transaction for your child to receive a life saving surgery, it is not a simple consumer transaction to be treated for cancer. Only a fool would attempt to paint it as one.

A massage at the Chinese place is a dollar per minute.

The lady speaks almost no English, does what she does, at best can be directed to focus on your hamstring versus your calf or back, or soften up rather than knead you like dough. It’s dark, it’s not terribly clean, and afterwards all you get is a cup of water and a piece of Chinese candy. But there’s one in your neighborhood, it’s open late, it’s cheap, you can usually go in without having made an appointment (i.e., if you feel a knot after working out) and as noted above you won’t break the bank over 15 minutes of it.

A massage at Great Jones is performed by a trained sports therapy technician who speaks English and can follow direction, includes time in the water and steam room areas afterward, is cleaner, is more social, is well-lit, but costs more, is open during only certain times, is located in NoHo, and requires an appointment.

What an idiotic analogy. Any person, with any form of Critical Thinking understands that no one requires a Massage to Live. The other issue is that Medical Care and Health Insurance are intrinsically tied unlike other types of Insurance, and your analogy would imply that seeing a shoddy Doctor in a filthy clinic using the same instruments all day long would be justified to save money. Even if you try to claim it solely pertains to Health Insurance it falls flat, since it ignores the Medical Care side of the equation, which is the side that Drives the Financial Side.

You have OPTIONS.

No you don’t. The Cost of Medical Care is not going to go down, and everyone will pay. The only question is how. The ACA pushed for the Insurance Pool to function as it should, and the cost are spread out among everyone. This caused higher premiums for some to balance that out. Before the ACA people paid with their Taxes, as Hospitals were partially reimbursed for their Losses due to the Uninsured. Those who had Insurance also paid through their Premiums. About $85 of each months premium was due to Hospitals and Clinics recovering those losses to continue to operate. If the AHCA passes into Law, then that is expected to rise to $250–400 a month depending on the area.Neither the CBO or Congress has considered that rather big issue. The Money for Medical Care will be paid by all, we just keep shifting around how it is paid.

If Cuomo or DeBlasio, steeped in economic ignorance, were to mandate that all massage places be well-lit and include the water room and steam/sauna area, along with technicians who spoke English as a first language, there would be only one option — Great Jones. It would cost a lot — possibly more than Great Jones does now, since they would not have to compete with the Chinese place. This would not be affordable for many.
Your ignorance of how Medical Care and Health Insurance work is patently obvious. Will there be more affordable insurance? For those in their 20’s and early 30’s that are healthy who acquire a Policy that does not cover anything, then absolutely. For anyone over the age of 40 or who have a pre existing condition then it is going to become much more expensive than it is now, in many of those cases so expensive that they will be unable to afford coverage at all, effectively denying them coverage. You cannot choose to not have Cancer. You cannot choose to not have Asthma. Their is no choice for them, and any attempt to twist and mangle that into some fictitious choice is extremely intellectually dishonest.

Government created this problem by reducing choice. Allowing choice is good. It does not mean no carrier will provide the options that so many people want. It means that different carriers will cover different things — as in any competitive market. You like flame broiled, you go to BK, you like special sauce, you go to McD’s, and neither flame broiled nor special sauce is mandated — amazing.

These problems existed prior to the Government involvement via the ACA. The ACA shifted how the cost were paid which made how it was paid a more spread out and balanced approach making more people shoulder the burden of the cost. This fixed one issue and opened another, which has never been corrected, nor will it with the AHCA. There were more choices in the individual market before the ACA if you only look at the number of carriers and the number of plans available. However, in effect there were less options available due to carriers denying or restricting due to pre-existing conditions, charging higher premiums for people with health risks and young women, placing limits on annual and lifetime benefits, and refusing to renew policies for individuals who became sick. The Individual Market covers more people, much more effectively than it did prior to the ACA. It is not perfect, and it does need modification, but it is better than the previous system.

The proposed AHCA will return us more to the old system, it will save a person money of they are young, healthy, and choose to forgo coverage in their policies. Carriers will charge substantially higher premiums for pre existing conditions, the middle aged, the elderly, and those with health risk in order to discourage them from purchasing a policy. It will also allow lifetime limits on coverage, which was catastrophic for anyone who had a serious medical illness or condition. You have ranted about how Carriers will not lessen what they cover while spouting off about economics. Interestingly enough you ignored how economics applies during your rant. A Carrier is not going to nicely offer coverage that they not only will not profit on, but will take a loss on, just for the fun of it. They will not go out of their way to attract people who will not be profitable to their plans. If the rules from the ACA go away they are going to return to what they did before it, which is the opposite of what you are trying to claim.

It is odd that you bring up McDonald’s and Burger King, two places that our Nation patronizes far too often, and part of our Nation’s complex obesity issue. If a person cannot afford to eat at either they will not die from it, they cannot end up in a wheel chair because of it. They can if they cannot afford or find Health Insurance. You used them to justify your “choices” drivel. The only analogy they would be apt for, is that you are choosing between two crappy garbage meals, neither of which will do you one bit of good. Perhaps you should learn about how the Health Insurance Market worked before, works now, and will work with the AHCA, and how it interacts with the Medical Field before spouting off such offal.

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