This is some answer from Susan Collins on the GOP health bill's Medicaid cutspic.twitter.com/QijjjjuL8l
— Bradd Jaffy (@BraddJaffy) July 16, 2017
I’ve been doing some writing for Slate these days. I wrote a long and profound piece on BCRA and disability here.
Just today, I did a podcast with Jordan Weissmann. I bloviated, but it was fun. I have to raise my podcast game.
The best part was schooling Jordan on BCRA by making analogy to Jay-Z and Rihanna’s relationship woes. Still not sure why he kept laughing when I was trying to make a serious point.
I am shocked, shocked to discover that no less than 155 million Americans are forced by employers to take a substantial part of their pay (or the family breadwinner’s pay) in the form of health insurance. Health insurance they have not chosen, but has been forced on them. Republicans cannot be content with the repeal of ACA and the cutting of Medicaid down to size. As Avik Roy points out, Medicare cannot be ignored for long. Nor should the cancer of employer health insurance. The same sound conservative logic points inexorably to its abolition.
The loss of freedom is on a positively Soviet scale. Consider these well-known facts.
- Employer health insurance covers the healthy and the unhealthy alike, and at the same rates. That’s totally unjust. Why should a 25-year-old trainee who runs a mile every morning, never smokes or drinks, and shops entirely at the farmers’ market, hand over part of her hard-earned pay to subsidise the asthmatic 55-year-old chappie in Accounts who smokes, drinks, never takes any exercise and alternates between McDonalds, KFC and Dominos for his daily injection of cholesterol-, sugar-, and additive-laden food? It’s positively un-American, and removes the vital incentive to make good lifestyle choices.
- Male employees have as much deducted from their pay as women, and the single as much as those who have children. Nothing wrong with children of course, but it’s a personal choice just like preferring a new car to a holiday in Tahiti, and people should assume the consequences of their actions. If a woman has a child without previously arranging for a husband, that is likewise her lookout.
- Employer health insurance is a form of bondage that ties the employee to her employer independently of the mutual benefit of a free labour contract. The costs of losing a job include, as they do not in America’s competitors, the loss of health insurance. Many American workers are trapped in jobs they are not suited for, or have gone sour on, through this fear.
- Employers are also faced with a heavy cost their competitors in other countries do not bear. In a world without employer health insurance, cash wages go up of course. But the employer would still gain on balance: from not keeping on the unhappy workers whose main motive for staying on is assured health cover, and the high administrative costs of running the scheme. Danish businesses don’t employ a team of people in Human Resources to look after employee health, what would be the point?
- The public policy win comes from bringing back that vital “skin in the game” when individuals buy insurance for themselves. In employee health insurance, it’s not so much a principal-agent problem as the absence of an identifiable principal. Firms know little about health insurance. They buy it because it’s expected by new hires and valued long-serving core staff alike, and everybody else does. They will buy “good enough” and then stop looking. Unleashing the power of the free market to lower prices implies real competition in every sale. This means each individual or family unit must be an agent in a vigorously contested market.
Employer health insurance must go, with the massive tax break transferred to individuals. Some of my more radical libertarian friends think that’s far from enough. All insurance is morally flawed, as it removes the “skin in the game” by spreading risk across large pools. Insurance breeds carelessness. Beyond that, the whole concept of employer and employee is suspect. The Marxists are right, they say, in condemning the wage relationship as servile and alienating: you are not selling something you have made to another, but selling him your very will, accepting a temporary but still abject bondage under which your master controls what you do. In a truly free society, the only employees are women and children naturally subject to the authority of the male head of the family. Should slavery be reintroduced, an idea on which I offer no opinion, it would complete the salutary restoration of the Roman paterfamilias.
We must reluctantly postpone these fascinating debates to another day. For now, Republicans must use their possibly short-lived control in Congress to strike off the tentacles of employer health insurance slowly strangling American business and American freedom.
The “American Employee Freedom in Health Care Act” would be very short. It only needs two operative articles, leaving aside the changes to the tax code.
Article 1. With effect from 1 January 2019, it shall be prohibited for employers to provide health insurance to employees, under pain of a fine of $5,000 for each employee and year of service for which such insurance is provided.
Article 2. The date of entry into force laid down in Article 1 shall be brought forward to January 1 2018 where the employer is a media organization, registered lobbyist, think tank, political party, or other organization engaging in political advocacy or policy analysis as its principal activity, and the employee is a journalist, columnist, presenter, analyst, or regular commentator.
…And it’s not alarmist or uncivil to say so.
The effects of insurance on mortality are inherently difficult to precisely forecast.
But we have many strong reasons to believe that uninsuring millions of Americans would cause thousands of them to needlessly die every year.
We can debate the magnitude of this effect and how we might measure it. But the burden of proof does not rest with liberals to defend this sensible proposition, nor to prove that the likely harms associated with BCRA will definitely come to pass. Rather, the burden resides with BCRA supporters to show why we can be confident that snatching coverage from low-income people will not bring serious harm. Bill supporters have not come close to meeting this standard.
Here’s a thought: as soon as we defeat Trumpcare, Democrats in both houses introduce Medicare Part M (for Middle-Aged), covering people ages 50-64.
A. It’s good politics:
1. These are the people who were going to be hit the hardest by Trumpcare premium increases. Offer them a better deal and they’ll support us–and people this age vote!
2. It sounds more moderate than Medicare for All, while also making a solid step closer to single-payer, which the Republicans have managed to make sound like pie-in-the-sky socialism with a side order of end-of-the-world.
B. It’s good policy:
1. These are the sickest people in the Obamacare exchanges–move them out of the pools and premiums go down.
2. BUT they’re healthier than most people now on Medicare: put them into that risk pool and the premiums go down there, too.
DON’T believe Trump when he says Obamacare is collapsing.
DON’T believe pundits who say the Democrats have no platform/positions: this plus increased minimum wage plus let’s get out of Afghanistan is platform a-plenty.
I was in DC on Thursday for some health advocacy, when a topless rather Goth young(er) woman ran up to me and wanted to give a hug. You’ll have to take my word for it that one kindof gets used to this sort of thing as a Twitter celebrity.* Still, I hesitated for a moment, and she said: “Thank you for the work you do,” and she held up her sign (see below fold).
She is a cancer survivor. She is now protesting the Senate health bill, given her preexisting condition and the rest. She’s in remission after punishing chemotherapy and other trials. She was loaded for bear like many people on this list. “It’s a little uncomfortable to see someone like this,” she said. But not as uncomfortable as chemo and surgery.
“You do you,” I said. “And be well.” We went our separate ways.
*Comment meant to be taken seriously not literally.
Prediction: There will be some AHCA mini-drama with a key moderate who hesitates or refuses to sign on. The purpose of the mini-drama is to elevate that person to a key role. That moderate will extract some shiny-object concession such as a showy opioid treatment fund or ornamental consideration for medically-fragile children that don’t address the core difficulties of AHCA.
The strategic function of the mini-drama is threefold: (1) to make AHCA look slightly less hideous–ideally with a maximum of conservative grumbling–without actually fixing its deeper problems, which will remain in the final Senate version; (2) to help McConnell and the moderates quickly coordinate their bargaining, and (3) to provide a dignified political path for moderates to sign onto a bill they publicly criticized when the House passed something very similar barely a month ago.
I mentioned in another post, Kathy Shorr’s beautiful photo book SHOT: 101 Survivors of gun violence in America shows the beautiful human faces of survivors of American gun violence. You should buy a copy to support such humane work.
As I mention over at healthinsurance.org, Shorr’s book provides portraits and brief stories of 101 survivors of gun violence. Her photographs convey the lacerating damage firearms inflict.
I recently met two of the survivors, Mariam Pare and Ondelee Parteet, at a panel on gun violence. There are some nice pictures below the fold.
Both of them required years of costly rehabilitation and costly surgeries. Tens of thousands of Americans every year experience serious gunshot wounds similar to that experienced by Rep. Steve Scalise and the people chronicled in Shorr’s book. If AHCA passes, it will leave millions of Americans uninsured. We should ask what will happen to gunshot survivors with similarly severe wounds who lack insurance coverage. Continue Reading…
Dear American Cancer Society,
Please do not call our home this year asking for a donation. When you subsidize an unworthy figure who is snatching healthcare from millions of people, and weakening protections for cancer patients, I will give my charitable donations elsewhere.
— David Fahrenthold (@Fahrenthold) June 12, 2017