You Had Seven Years

Much is being said and written about the failure to launch the Republican's health care plan and yet I just don't think it's been given the truly epic credit it deserves.

You Had Seven Years

Given the GOP premise that the ACA - Obamacare - is bad, sad, terrible, a burden on businesses, too expensive without enough choice and left unchecked would ultimately destroy the US economy and the terrorists would win, should it have been so hard to come up with something better? You had seven years.

Messaging was clearly part of the problem. You never should've added "and Replace" to "Repeal" if you never seriously intended to provide health care to America's poor, old and rural populations. It didn't help that candidate Trump was making vague promises about insuring everyone and having great plans like you've never seen before.

Okay, he got that one right because we still haven't seen those great plans.

I guess it also didn't help that as bad as you were saying Obamacare was, it wasn't. Maybe you realized that and that's why "and Replace" became part of the marketing strategy. Given the anecdotal evidence from dozens of town halls that lives had been saved by the ACA, you really couldn't afford to have a plan that was actually going to cost more and insure fewer Americans.

And still, somehow, you did.

Not Understanding How Insurance Works Didn't Help

Did you know your insurance premiums go up every year? They do! If you have insurance you may have noticed. Your house gets older, your car gets older and you get older and as you and your possessions age, your risk increases. How do insurance companies offset that risk? Increased premiums!

Increased premiums has been one of the knocks on Obamacare but that's pretty much how insurance works. The only way premiums could decrease (really, remaining flat is probably the best we could hope for) is by increasing the risk pool; by increasing participation in the ACA. Younger, healthier people opted out and paid a fine rather than buy insurance.

The lesson here?

Those fines simply weren't big enough!

This ties into another GOP criticism of Obamacare: It's "wealth redistribution." That is, it forces healthy people to pay for sick people's health care. That's right. It does.

That's how insurance works.

You simply cannot have universal health care without an individual mandate.

Good drivers help to pay for bad drivers in their auto insurance premiums. Homeowners who replace their smoke detector batteries every year help to pay for homeowners who don't with their home insurance premiums. Just like young, healthy people help to pay for the poor, aging, at risk people with their health care insurance premiums.

At least Republicans are consistent on this front. They hate Social Security, Medicaid and Medicare for the same reason. Wealth redistribution. Of course, that's how government itself works; government is essentially a group insurance plan where we pay premiums (taxes) to ensure we're covered against foreign aggressors, catastrophic events, and to care for the less fortunate among us. To quote the Preamble to the Constitution (emphasis added)…

"...to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity…"

The Free Market Isn't the Answer to all Questions on the Quiz

Okay, some more notes on how insurance actually works…

Ford Motor Company wants to sell their cars to every person on the planet. They're actively competing with every other car manufacturer for your business and would happily put their competitors out of business (and buy up their assets to increase production) if they could. As a consumer, you know this. You shop for a car based on a number of criteria, with price becoming more and more important as the relative quality of Fords, Chevys, Toyotas, and all the rest becomes less of a differentiator. Maybe gas mileage is a consideration but that's about price, too; your total cost of ownership. That's why car makers want to build cars in Mexico using robots; reducing cost reduces price. But that's another story.

Insurance companies don't work like car makers or manufacturing industries in general. They don't want to put their competitors out of business. Insurance companies need competitors to share the overall risk in the market.

Insurance companies need to have a certain amount of cash in reserve to cover the policies they've written in the event of a series of unfortunate - if unlikely - events. What if all the homes insured by the DJT Insurance Company (not a real insurance company) burned to the ground on the same day? What if the DJT Insurance Company competed on price and sold really amazing policies to every home owner in America. They would need to have the cash reserves to cover the unlikely event all of those homes burned to the ground over the course of a couple of weeks. As one of those homeowners, you'd expect the DJT Insurance Company to honor its promise and you'd probably be happy there are regulatory requirements on insurance companies to make sure that happens.

While this is an extremely unlikely scenario, the cash reserve requirement is a reality for carriers.

Rather than own 100% of the risk in any particular market (and the cash reserve requirement that comes with it), insurance companies prefer to share the risk; they are not interested in pricing their competitors out of the market. They need them. They may want to own 25% of a given market or even 50% of a market that is highly profitable but they will never want 100% of the market.

Insurance companies - like other businesses - do want to be profitable, of course. When you apply for auto insurance they're going to ask if you have any DUIs or if this is a replacement policy because your previous carrier grew tired of paying for the multiple fender-benders you've been involved in, that time you knocked down your neighbor's mailboxes and the incident where "your brakes failed" and you drove into the front entry of your local credit union. Based on your answers when you apply for coverage, the DJT Insurance Company may decide you're a bad risk. They may decline to offer you coverage at all or they may offer you coverage at twice or three times the premium they'd charge a good driver.

Insurance companies do not compete to cover bad drivers, irresponsible homeowners or 55-year old men with a family history of cancer. They compete for profitable business.

55-year old men with a family history of cancer are not profitable risks. 55 may be the new 45 unless, of course, one of your parents died from cancer at 57. 55-year old men with a family history of cancer face three realities: (1) they cannot get coverage at all (2) they're offered coverage but they can't afford it or (3) they can get coverage they can afford but what they can afford will likely not meet their needs. When they make a claim; the bill for diagnostics and treatment for cancer may well be in excess of $100,000 but the policy they could afford will only pay them $20,000.

Okay, maybe our fictional 55-year old man could find a marginal difference in premium if he shops around but there's a hard mathematics to his life that's inescapable. One carrier might charge $2,400 a year for a critical illness policy and another might charge $2,280 a year (a $120 savings!) but that 55-year old man isn't going to find any carrier that will charge him $600 a year, not for the same coverage as another carrier's $2,400 policy. They've all got access to the same actuarial data. Our 55-year old man is going to get cancer. He knows it. The insurance companies know it.

Saying insurance companies will compete to cover that 55-year old man with a family history of cancer and that competition will drive down premiums demonstrates a fundamental misunderstanding of the insurance market.

Or it's a shameless, cynical lie.

Blaming Democrats When You Control the House, the Senate and the White House Makes You Look Like a Whiny Little Bitch

Did Trump and Ryan actually think they would get any Democratic votes?

Were any Democrats involved in writing the American Health Care Act?

Did Trump and Ryan actually think Democrats would vote for something that was practically the exact opposite of Obamacare?

Does President Trump have a parasite in his brain like the one tormenting David Haller in "Legion?" Because that would explain a lot.

Yes, It Is Complicated

Aside from President Trump, I think we all knew that health care was complicated. 1500 words in and I'm just scratching the surface.

It isn't like President Obama was the first to try to make health care for all Americans a reality; he was just the first to make any real, substantial progress. Many tried and failed before him. Forget the details. That on it's own should've been a massive clue to even the most unimaginative of dullards that this wasn't simple or easy.

And yet with seven years to study for the quiz and an answer key (the ACA) in hand, the Republicans failed. They took the F. 0 out of a possible 100. See me after class, Mr. Ryan. Rethink your life goals.

On the one hand it's astounding. On the other, it seems a self-fulfilling prophecy. In the end, all Republicans knew about universal health care is that they were against it and I'm not sure they even know why. Isn't something that saves lives a good thing? Isn't government all about helping people? What would that Jesus guy do?

For the originalists in the GOP, I have to say it seems to me that having our common defense and general welfare make up the bulk of federal expenditures feels like we're actually getting it right. I'm not sure why Republicans are so busy trying to dismantle Social Security, Medicaid and Medicare or why the voted more than 50 times to repeal the ACA. This is the business of government; it's the reason our founding fathers gave us for forming this more perfect union.

We can always do better, of course. So, Paul Ryan, Donald Trump, when you've got something better than the ACA, let me know. I've been waiting seven years. I can wait a little bit longer. But don't take too long. Something tells me you've only got four more years.