# Trumpcare **URL:** \ **Category:** Politics & Elections\ **Created:** [March 7, 2017, 3:57pm UTC](https://boards.straightdope.com/t/trumpcare/781625 "2017-03-07T15:57:35Z")\ **Posts on this page:** 20\ **Page:** 7
**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\ **Post date:** [March 9, 2017, 8:30pm UTC](https://boards.straightdope.com/t/trumpcare/781625/121 "2017-03-09T20:30:14Z")
> [@Airbeck](#): > > **How then would you prevent every health insurance company from moving its headquarters to the state with the least amount of regulations?** Isn’t this just inviting a race to the bottom, where every insurance plan in the country would be negatively effected and real choice would be eliminated since everyone will have to get insurance from whatever state is most profitable to the insurance companies? How do you prevent that from happening? Or is that actually the point? This is why credit cards can charge 29% interest. Thanks, Delaware. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [March 9, 2017, 8:30pm UTC](https://boards.straightdope.com/t/trumpcare/781625/122 "2017-03-09T20:30:30Z")
> [@Airbeck](#): > > How then would you prevent every health insurance company from moving its headquarters to the state with the least amount of regulations? Isn’t this just inviting a race to the bottom, where every insurance plan in the country would be negatively effected and real choice would be eliminated since everyone will have to get insurance from whatever state is most profitable to the insurance companies? How do you prevent that from happening? Or is that actually the point? The idea is that the federal government sets minimum standards, which it has. If states want higher standards and this policy undercuts them, sure, that’s by design. I’m not sure what’s wrong with people voting with their dollars. Yes, most insurance companies would just incorporate in Delaware or something, but they’d offer widely varying levels of coverage and service, so there’d be plenty of diversity, just like there is with credit card companies. But if we’re negotiating here, how about allowing states to set up public options if they want, which I’m pretty sure is already allowed. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [March 9, 2017, 8:34pm UTC](https://boards.straightdope.com/t/trumpcare/781625/123 "2017-03-09T20:34:06Z")
> [@running\_coach](#): > > This is why credit cards can charge 29% interest. > Thanks, Delaware. That cap is federal. If you want it lowered, all you have to do is call Liz Warren, rather than 50 state legislators. Now this might seem anti-conservative, just having one federal standard, but there are two competing conservative philosophies here. The first, obviously states rights, and no one is advocating outlawing states setting their own standards for credit card or health insurance companies. The second principle though is free interstate trade. The interstate commerce clause does not actually exist to give Congress the ability to regulate whatever it wants. That was a novel interpretation of the New Deal court. The clause actually exists to empower Congress to overrule attempts by states to restrain trade with other states. ---
**Author:** ![Airbeck](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/airbeck/32/6574_2.png) [@Airbeck](https://boards.straightdope.com/u/Airbeck)\ **Post date:** [March 9, 2017, 8:34pm UTC](https://boards.straightdope.com/t/trumpcare/781625/124 "2017-03-09T20:34:49Z")
So race for the lowest regulations is the point then. What “minimum standards” do you see the current legislative and executive branch implementing nation wide? It would neuter the states from being able to set up their own regulations on health care. I thought you guys were all about empowering the states though? This would seem to be counter to that philosophy. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [March 9, 2017, 8:37pm UTC](https://boards.straightdope.com/t/trumpcare/781625/125 "2017-03-09T20:37:42Z")
As I said above(we probably posted at the same time), free interstate trade is a competing conservative principle. I’m also a bit confused about why Democrats would want 50 different standards for an issue that is clearly an interstate issue. Anyway, the idea here is that the coverage mandates increase costs, which makes people who are healthy not want to buy insurance. Insurance companies would still offer generous plans, because many people want generous plans. Consumers would have more choices and overall costs would go down. ---
**Author:** ![running\_coach](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/running_coach/32/15836_2.png) [@running\_coach](https://boards.straightdope.com/u/running_coach)\ **Post date:** [March 9, 2017, 8:41pm UTC](https://boards.straightdope.com/t/trumpcare/781625/126 "2017-03-09T20:41:47Z")
> [@adaher](#): > > That cap is federal. If you want it lowered, all you have to do is call Liz Warren, rather than 50 state legislators. > > Now this might seem anti-conservative, just having one federal standard, but there are two competing conservative philosophies here. The first, obviously states rights, and no one is advocating outlawing states setting their own standards for credit card or health insurance companies. The second principle though is free interstate trade. The interstate commerce clause does not actually exist to give Congress the ability to regulate whatever it wants. That was a novel interpretation of the New Deal court. The clause actually exists to empower Congress to overrule attempts by states to restrain trade with other states. [From here.](http://consumer.findlaw.com/credit-banking-finance/usury-laws.html) > [@](#): > > **Federal law does not mandate interest rate limits for credit cards,** but credit card companies must follow certain federal rules under the Credit Card Accountability, Responsibility, and Disclosure Act of 2009 (Credit CARD Act). Some, but not all, states have “usury” laws that limit the interest a lender may charge on a debt. However, federal court decisions and statutes have virtually exempted credit card companies by allowing them to charge customers, regardless of their state of residence,\*\* the interest rates allowed by the state in which they are incorporated.\*\* ---
**Author:** ![Chefguy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chefguy/32/138_2.png) [@Chefguy](https://boards.straightdope.com/u/Chefguy)\ **Post date:** [March 9, 2017, 8:43pm UTC](https://boards.straightdope.com/t/trumpcare/781625/127 "2017-03-09T20:43:42Z")
I’m wondering why our resident Trump apologists haven’t chimed in on this? This bill is a disaster. It targets those who are the most vulnerable among us. If you think it’s tough to get into the ER now, just wait. ---
**Author:** ![Airbeck](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/airbeck/32/6574_2.png) [@Airbeck](https://boards.straightdope.com/u/Airbeck)\ **Post date:** [March 9, 2017, 8:43pm UTC](https://boards.straightdope.com/t/trumpcare/781625/128 "2017-03-09T20:43:52Z")
Sorry, I just don’t want my Health insurance being controlled by the politicians in Alabama, or whatever state would first rush to eliminate as much regulation as possible. You sound like you’re talking about a fantasy place called conservatopia. We’ve already seen what happens when this kind of thing is allowed. Intelligent people try not to repeat the mistakes of history. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [March 9, 2017, 8:44pm UTC](https://boards.straightdope.com/t/trumpcare/781625/129 "2017-03-09T20:44:33Z")
Okay, so that’s a Delaware law. And nothing prevents the federal government from capping interest rates. I’m not sure what great consumer interest is achieved by forcing people to only buy credit cards in their states. You’d just end up with fewer people with credit lines, which could be fine for credit, but disastrous for health insurance. I think we could all agree that if the upshot of selling insurance across states lines was 100% coverage, even if some of that coverage was poor, that it would be better than what we have now. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [March 9, 2017, 8:47pm UTC](https://boards.straightdope.com/t/trumpcare/781625/130 "2017-03-09T20:47:48Z")
> [@Airbeck](#): > > Sorry, I just don’t want my Health insurance being controlled by the politicians in Alabama, or whatever state would first rush to eliminate as much regulation as possible. You sound like you’re talking about a fantasy place called conservatopia. We’ve already seen what happens when this kind of thing is allowed. Intelligent people try not to repeat the mistakes of history. Why not make all products and services state-based then? Because that would be a disaster. What’s happened with health insurance is the same thing that would happen with any product that can only be sold within state borders: it’s more expensive and there are fewer choices. If we did the same thing with credit cards we’d have monopolies there too. ---
**Author:** ![Airbeck](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/airbeck/32/6574_2.png) [@Airbeck](https://boards.straightdope.com/u/Airbeck)\ **Post date:** [March 9, 2017, 8:48pm UTC](https://boards.straightdope.com/t/trumpcare/781625/131 "2017-03-09T20:48:19Z")
Poor coverage _is_ essentially no coverage. It disappears just when its needed. So no, I don’t think that’s automatically better. Plus soon all plans would be poor since they’d all be based in whatever state follows Delaware’s example. To deny this seems like wishful thinking. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [March 9, 2017, 8:50pm UTC](https://boards.straightdope.com/t/trumpcare/781625/132 "2017-03-09T20:50:39Z")
I am always puzzled by the “sell across state lines” solution. A common criticism of the ACA is narrow networks - which I thought were due to the complexity of insurers negotiating favorable fee structures with a multitude of hospitals, physicians and other providers. So, why would a Delaware insurance company want to negotiate with multiple provider networks in fifty states? Also, when it comes to a premium surcharge to encourage coverage without a mandate - why not use the same stick as Medicare? If you delay Medicare, your premium goes up 1% for each month of missed coverage - AND - that premium surcharge is permanent. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [March 9, 2017, 8:52pm UTC](https://boards.straightdope.com/t/trumpcare/781625/133 "2017-03-09T20:52:46Z")
Not if you have federal standards. ACA already has those standards, and I’ve only called for eliminating the free stuff and allowing companies to charge normal co-pays for them. There would still be no maximums and no dropping of coverage when you get sick. And of course states could set up public options or even single payer if their citizens are willing to pay the taxes for it. ---
**Author:** ![RTFirefly](https://avatars.discourse-cdn.com/v4/letter/r/c77e96/32.png) [@RTFirefly](https://boards.straightdope.com/u/RTFirefly)\ **Post date:** [March 9, 2017, 9:07pm UTC](https://boards.straightdope.com/t/trumpcare/781625/134 "2017-03-09T21:07:31Z")
> [@adaher](#): > > I’m not going to carry water for my party on stupid talking points. Fair enough. 🙂 > [@](#): > > The bill they are trying to pass is garbage. Whether it’s garbage because the combination of ideology and campaign donors made it impossible to write a good bill or it’s garbage because they never really wanted a bill to pass, it’s a total failure of leadership. If it’s a failure of leadership, it’s one that goes back a ways. For all their talk about ‘repeal and replace,’ it’s been seven years since Obama signed the ACA into law, and if they had been taking the notion of an Obamacare replacement seriously, they’d have had plenty of time to investigate and figure out why the only replacements for Obamacare were (a) single-payer, which they are firmly opposed to, (b) nothing at all (i.e. the _status quo ante_), or (c) something that was basically the same idea as Obamacare: community rating (no discrimination against people with pre-existing conditions), some mechanism forcing universal or near-universal participation (e.g. the individual mandate), and subsidies for those who couldn’t afford the insurance. But acknowledging that would have forced them to go down one of two paths: (i) the “Obamacare is OK, just needs tweaking” path, or (ii) the “Obamacare is awful, let’s go back to the way things were before” path. I think you can see the reasons they didn’t want to go down either of those, but they had to basically lie about the realities of health care for the past seven years to avoid that choice. Now they’re stuck in the corner that their lies have backed them into. > [@](#): > > However, ACA actually does have real problems and assuming no changes actually pass, it’s death will come from its poor design. The Democrats wrote a better bill than the Republicans, but that doesn’t mean it was a good bill. The ACA doesn’t have any fundamental flaws. It has aspects that need to be modified or tweaked, for sure - and in the past, that would happen in the natural course of things after a program as significant as the ACA was set up. Once the program itself was in place, nobody would bother fighting over technical adjustments. But during the past seven years, that has not been possible with the ACA due to unyielding GOP opposition. We’re stuck with the ACA as originally written, other than the modifications the Supreme Court has imposed on it. > [@](#): > > According to a recent poll, 51% of Americans want ACA fixed and only 7% want it to stay as it is(the rest want repeal and replace or just repeal). So there’s a huge potential political win in fixing ACA, and there are ways to do that with conservative means. It’s time to find out how smart Paul Ryan actually is, because he should be thinking a move or two ahead. He wants the $600B tax cut that this gutting of the ACA would pay for. Making the ACA work better in the ways that people complain about - deductibles too high, copays too big - can only be fixed with larger subsidies - exactly the _opposite_ direction. Not to mention, the entire right-wing noise machine - GOP politicians, Fox News, talk radio - has spent eight years working the base into a froth over Obamacare, and they expect it _killed_, dammit. What are they going to say now, “Oops, we didn’t mean it, we’re going the ‘mend it, don’t end it’ route”? Most GOP Congresspersons would be primaried next year. But like I said, they’re stuck in the corner that all those years of lies have backed them into. And Paul Ryan hasn’t exactly been a bystander to all that. I guess lying can be smart, as long as you keep getting away with it. _“Has your luck run out?” she laughed at him, “well, I guess you must’ve known it would someday.”_ - Dylan We’ll see if Paul Ryan fares better than the Jack of Hearts. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [March 9, 2017, 9:08pm UTC](https://boards.straightdope.com/t/trumpcare/781625/135 "2017-03-09T21:08:28Z")
> [@adaher](#): > > …I think we could all agree that if the upshot of selling insurance across states lines was 100% coverage, even if some of that coverage was poor, that it would be better than what we have now. I think we could all agree that if the upshot of collecting unicorn droppings was abundantly productive rose bushes, that would be good. What can an insurance company compete with? The math is the math, the risk, the benefit, the premium is the central fact that all must adhere to. There are no miracles, nobody has a bold new innovation that bends those central facts. The person who thinks they have good, cheap health insurance almost certainly does not. That person may feel he has been robbed if his substandard plan is not permitted. He was already being robbed! And the people who sell that ought to be ashamed of themselves. We know its wrong to take somebody’s money by force or fear. Why do we continue to think its OK if you just outsmart them? ---
**Author:** ![filmore](https://avatars.discourse-cdn.com/v4/letter/f/7993a0/32.png) [@filmore](https://boards.straightdope.com/u/filmore)\ **Post date:** [March 9, 2017, 9:15pm UTC](https://boards.straightdope.com/t/trumpcare/781625/136 "2017-03-09T21:15:13Z")
> [@adaher](#): > > 1. The individual mandate part of the bill is half baked, but can be formed into something that can work. Strict enrollment periods and continuous coverage can work better than an individual mandate, especially one as poorly enforced as the current one. > > 2. The coverage requirements can be reduced. Why do certain things need to be free? that just increases the cost of premiums and co-pays for non-free services. That was a Democratic political decision, primarily to woo female voters. Undo it, insurance gets a little cheaper for everyone, luring more healthy people into the markets and giving them more choices. For improving the mandate, I say to do away with penalties and enrollment periods. Instead, pre-existing conditions are not covered for some amount of time proportional to how long you had been without insurance (min 6 months, max 12 months). That would discourage people from signing up only after they are sick since they would have to wait a long time to get care. Switching from one plan to another should still be done with enrollment periods rather than at any time. I also agree coverage requirements should be reduced to make the program more feasible. I personally am fine with the level of coverage, but many people resent it and are electing representatives to fight it. Certain treatments are lightening rods for critics regardless of their cost, so removing them means the program has a better chance of success. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [March 9, 2017, 9:17pm UTC](https://boards.straightdope.com/t/trumpcare/781625/137 "2017-03-09T21:17:19Z")
ACA standards are much, much higher than most people need. No one needs free preventive care or free birth control. If your plan covers all proven technologies and there are no maximum payouts, and your out of pocket maximum isn’t awful, you’ve got pretty decent coverage. That’s all I’m advocating for, not a total gutting of ACA’s regulations. Just let insurance companies charge co-pays for preventive services and birth control, that’s all. They should also have the option of not covering things like mental health or prescriptions, as long as that’s transparent and consumers know what they are buying. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [March 9, 2017, 9:23pm UTC](https://boards.straightdope.com/t/trumpcare/781625/138 "2017-03-09T21:23:45Z")
> [@Bone](#): > > No, it’s not. Not even close and this criticism is an utter failure. The key difference is the mandate - the make everyone buy part. All other insurance **is not** like that, people have a choice whether they want to buy it or not. They don’t necessarily have that choice when there is a public interest involved – for example, I’m pretty sure that auto liability insurance is mandatory in many states and every Canadian province. And the public interest in question is quite similar on at least the level of public liability: if an uninsured motorist is at fault for causing a lot of property damage or personal injury, the affected party may have no protection from huge financial losses, or may have to be compensated from public funds or his own insurance if he’s lucky. Likewise, if some genius who thinks he doesn’t need health insurance suddenly winds up in the ER because he’s been in a serious car accident or just had heart attack, guess who’s stuck with the bill? It’s actually even worse than that because there’s also precedent for laws that just protect people from their own irresponsibility, like seat belt laws and drug laws, but the public liability argument may work best for the strict bean counters. > [@Bone](#): > > And here, I think they have a typo or something. Keeping bad drivers out of car insurance pools would make the insurance cheaper, not more expensive for the people remaining in the pool. It would make it more expensive for those forced out. Yeah, that didn’t make a lot of sense. Maybe they meant to say that “Keeping \*\*good \*\*drivers out of car insurance pools or healthy people out of health insurance”; if people most likely to make claims were the only participants, the insurance business would not be viable. But let me make a more fundamental point here. Yes, insurance is only viable if there is broad participation across the whole spectrum of risk, but health care has a lot more unique issues that simply make the traditional insurance model completely unsuitable. To begin with, no civilized society should (or, one hopes, willingly and knowingly would) deprive someone of necessary health care for lack of ability to pay. One can extend this to say that if everyone is covered, then the system is enormously more efficient if everyone’s rates are the same and simply set for average costs over the entire population. If this is the case, and everyone’s rates and coverages are the same, then there’s no need for bureaucratic meddling between the doctor and his patient. Treatment is then driven entirely by medical need and not by some meddling insurance company bureaucrat whose interference costs time and money while actually impairing medical practice. In what other industry would you pay someone to make things worse? With these greater efficiencies, the cost of health care becomes a lot lower. The underlying point here is that it all dovetails together into a model that practically screams “functional efficient health care does NOT follow a free market model – it’s pretty much the exact opposite”, for the very simple reason that everybody gets sick at some point and everybody needs to be treated accordingly as a matter of basic human rights. It’s really a lot more like an essential public service, like police or fire services. Trying to force-fit health care finance into a free-market model just doesn’t freaking work because the value proposition is all wrong. That’s why any health care system set up by Republicans or with the influence of Republican free-market ideology is like a broken tent with big holes in it that somebody pitched upside down – it’s going to need a hundred tent poles trying to prop it up and it’s still going to be collapsing all over the place – and every one of those useless tent poles is extremely expensive. The present health care system is so expensive, in a nutshell, because the traditional insurance model simply does not work, never did, and never will. ---
**Author:** ![kenobi\_65](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kenobi_65/32/13178_2.png) [@kenobi\_65](https://boards.straightdope.com/u/kenobi_65)\ **Post date:** [March 9, 2017, 9:31pm UTC](https://boards.straightdope.com/t/trumpcare/781625/139 "2017-03-09T21:31:12Z")
> [@adaher](#): > > ACA standards are much, much higher than most people need. No one needs free preventive care or free birth control. If your plan covers all proven technologies and there are no maximum payouts, and your out of pocket maximum isn’t awful, you’ve got pretty decent coverage. That’s all I’m advocating for, not a total gutting of ACA’s regulations. Just let insurance companies charge co-pays for preventive services and birth control, that’s all. They should also have the option of not covering things like mental health or prescriptions, as long as that’s transparent and consumers know what they are buying. Before the ACA, insurers could sell “catastrophic coverage” policies, which were like this. I work in advertising, and at that time (about 10 years ago), I had a big regional health insurance company as a client (I have a different regional insurer as a client today); they sold those catastrophic policies, which we would sometimes refer to as “falling off a mountain” coverage – they didn’t cover everyday medical stuff (like preventative care), but they’d keep you from going bankrupt if you were a 26 year old who, say, liked mountain climbing, and had an accident. But, under the ACA, all individual policies had to cover a broader range of things, as you note, and that largely killed off the catastrophic policies. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [March 9, 2017, 9:32pm UTC](https://boards.straightdope.com/t/trumpcare/781625/140 "2017-03-09T21:32:59Z")
The car insurance argument is interesting, in that better enforcement of traffic laws would reduce rates for everyone as the bad drivers were removed from the pool by losing their licenses and everyone drove more carefully due to the higher risk of getting caught and punished. That obviously doesn’t really tell us much about health insurance, and of course no one is required to buy car insurance as a condition of being a US citizen. I don’t own a car, so I have no car insurance. [Previous page](https://boards.straightdope.com/t/trumpcare/781625.md?page=6) [Next page](https://boards.straightdope.com/t/trumpcare/781625.md?page=8)