# 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:** 8
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [March 9, 2017, 11:29pm UTC](https://boards.straightdope.com/t/trumpcare/781625/141 "2017-03-09T23:29:29Z")
> [@wolfpup](#): > > 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. I’m not well versed in Canadian law so take this with a grain of salt, but the analogy is still poor. The reason it is a poor analogy is that you aren’t required to purchase auto insurance if you don’t drive. The criticism of Ryan in the linked article and from the other sources quoted in that article are hollow. In their attempt at a gotcha they made themselves look foolish. > [@](#): > > 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. I don’t think so. The price would just rise to accommodate for the increased risk. > [@](#): > > 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. I don’t think this is right either. If risk pools are populated by folks with similar risk levels, then pricing would be more even across the pool and one group within the pool wouldn’t be heavily subsidizing any other group. When risk pools have disparate amounts of risk across the participants, if the pricing is similar then to accommodate the higher risk individuals the lower risk people would be paying more. It’s like a junk CDO being rated AAA because 80% of the pool is normal folks and the other 20% are all NINJA loans. That’s the source of the complaint that young people are subsidizing older people. I do agree that healthcare does not always behave like a regular market good. I disagree that the previous model pre-ACA didn’t work. It worked for the vast majority of people. And even with Canadian or other single payer models, there are winners and losers - the choice is just who those winners and losers should be. ---
**Author:** ![F.U.Shakespeare](https://avatars.discourse-cdn.com/v4/letter/f/aca169/32.png) [@F.U.Shakespeare](https://boards.straightdope.com/u/F.U.Shakespeare)\ **Post date:** [March 9, 2017, 11:47pm UTC](https://boards.straightdope.com/t/trumpcare/781625/142 "2017-03-09T23:47:27Z")
Could someone explain to me why it’s necessary to single out lottery winners? I thought Medicaid benefits were already means-tested. If you’re on Medicaid, and make a million dollars by signing with an NBA team, or striking it rich in the stock market, or recording a million-selling record, I assumed your benefits were yanked. Is this not the case? ---
**Author:** ![up\_the\_junction](https://avatars.discourse-cdn.com/v4/letter/u/f1d935/32.png) [@up\_the\_junction](https://boards.straightdope.com/u/up_the_junction)\ **Post date:** [March 10, 2017, 12:02am UTC](https://boards.straightdope.com/t/trumpcare/781625/143 "2017-03-10T00:02:32Z")
It’s almost like there aren’t 30 perfectly viable, mature variations on a successful theme among developed countries that put the lie to Paul Ryan’s rolled up sleeves Powerpoint presentation. As an elected politician drawing a public salary, who is it he represents exactly? ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [March 10, 2017, 12:14am UTC](https://boards.straightdope.com/t/trumpcare/781625/144 "2017-03-10T00:14:36Z")
> [@BobLibDem](#): > > I predict it will pass. They will pressure reluctant GOP Senators to vote for it. They will rush it through. Dolt 45 will sign it. It will fail, people will lose coverage, pay more, and people will die. The really sad thing is that if this is going to screw up health coverage for my family I hope my spouse will die _before_ it takes effect. Because while I am currently confident he’ll get the care he needs _this_ year I am not so sure about down the road. I’d rather he go quickly than linger in agony. He’s had enough of that already. (He has stage IV metastatic bladder cancer - he’s unlikely to make it to 2020 although I’d be happy if he “wins the lottery”. That is the sort of odds we’re looking at.) ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [March 10, 2017, 12:20am UTC](https://boards.straightdope.com/t/trumpcare/781625/145 "2017-03-10T00:20:23Z")
> [@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? > [@jasg](#): > > 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. Some states already allow selling across state lines. The people who don’t want to do it? Insurance companies. “Insurance” is not the product. _The network is the product._ Insurance companies cannot make money unless they have the network. > [@Bone](#): > > I’m not well versed in Canadian law so take this with a grain of salt, but the analogy is still poor. The reason it is a poor analogy is that you aren’t required to purchase auto insurance if you don’t drive. And you aren’t required to purchase health insurance if you don’t have a body. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [March 10, 2017, 12:40am UTC](https://boards.straightdope.com/t/trumpcare/781625/146 "2017-03-10T00:40:53Z")
> [@filmore](#): > > 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. You do realize that in some instances that would pretty much guarantee death? Some diseases and disorders can’t wait months for treatments. If you take the position that life-saving care MUST given by ER’s or hospitals then who is going to pay for it when the patient goes broke? That was bankrupting hospitals before the ACA, want to go back to that? How about birth defects? There was an attempt some years ago by some insurance companies to consider birth defects as “pre-existing conditions” and refuse to cover surgery treatments to make the kid functional or save his/her life. You OK with that or not? > [@adaher](#): > > ACA standards are much, much higher than most people need. No one needs free preventive care or free birth control. You do if your income is low enough. And there are people who have next to no income. If you don’t treat or screen them for treatable disorders (which you then treat) then they are very unlikely to get better and increase their income. Is that where you really want to go? Contrary to the far-right party line, most poor people aren’t poor because they’re lazy - often there are physical or mental problems that could be treated and make the person more functional. Then there are accidents that screw people up for awhile. > [@](#): > > 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. Birth control is a proven technology - why aren’t you willing to cover that? Preventive medication is of benefit not just to the individual but society at large, in other words, that is also a proven technology. Why are you excepting that? The POINT of covering those things is to reduce the costs of unwanted pregnancies (even the more pro-choice person would prefer conception be prevented rather than aborted later) and the costs of treating illnesses in later, more expensive stages. Why are you opposed to investing a little now to save money down the line? How does that make fiscal sense? > [@](#): > > 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. That’s gutting the usefulness of health coverage. How about a policy that covers everything but heart disease? That would save money! Would suck to have a disease that is controllable with medication but not be able to afford it - why are you opposed to prescription coverage, you think all drugs are bad or something? Health coverage that doesn’t cover those things is bullshit and a garbage policy. > [@F.U.Shakespeare](#): > > Could someone explain to me why it’s necessary to single out lottery winners? > > I thought Medicaid benefits were already means-tested. If you’re on Medicaid, and make a million dollars by signing with an NBA team, or striking it rich in the stock market, or recording a million-selling record, I assumed your benefits were yanked. Is this not the case? It is certainly the case in my state - doesn’t matter what your source of income is, if it exceeds a certain amount you’re off Medicaid. Could be wages, investment income, gambling winnings… which is what a lottery payoff is, it’s gambling income. The parts referring to lottery winners are, to my view, pretty much a political sop to someone. I’m not sure who, but it’s ridiculous to include it when access to Medicaid and other government subsidized programs are means-tested. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [March 10, 2017, 12:42am UTC](https://boards.straightdope.com/t/trumpcare/781625/147 "2017-03-10T00:42:01Z")
> [@up\_the\_junction](#): > > It’s almost like there aren’t 30 perfectly viable, mature variations on a successful theme among developed countries that put the lie to Paul Ryan’s rolled up sleeves Powerpoint presentation. > > As an elected politician drawing a public salary, who is it he represents exactly? Ayn Rand? ---
**Author:** ![River\_Hippie](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/river_hippie/32/26_2.png) [@River\_Hippie](https://boards.straightdope.com/u/River_Hippie)\ **Post date:** [March 10, 2017, 12:54am UTC](https://boards.straightdope.com/t/trumpcare/781625/148 "2017-03-10T00:54:36Z")
> [@running\_coach](#): > > Paul Ryan doesn’t understand [how insurance works.](https://mic.com/articles/170748/paul-ryan-s-slideshow-on-gop-health-care-plan-suggests-he-has-no-idea-how-insurance-works) > > When Ryan rolls up his sleeves, a poor person gets fisted. I’m stealing that. ---
**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\ **Post date:** [March 10, 2017, 1:07am UTC](https://boards.straightdope.com/t/trumpcare/781625/149 "2017-03-10T01:07:13Z")
> [@adaher](#): > > 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. What would be the point? You get some disease that can be managed or maybe even cured with a $1000/month prescription, but you didn’t buy prescription coverage and can’t afford the pills, so now you’re left with excellent coverage for all your doctor visits where the doctor can tell you you’d be fine and dandy if only you’d take GreatMedication. You’ve also got good coverage when you show up in the ER because of the symptoms that you wouldn’t have if you’d take the pills, but instead all you’re doing is running up your copays and deductibles and the cost of insurance generally when your insurer has to pay for those doctor and ER visits. Or you end up having to be admitted to the hospital (where your pills are covered by the insurance), instead of having outpatient treatment. Some of the new chemo drugs, for example, are $65,000/month. How much is your cancer treatment going to cost, and what are the chances of success, if the most successful treatment options are not even options for you? ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [March 10, 2017, 1:42am UTC](https://boards.straightdope.com/t/trumpcare/781625/150 "2017-03-10T01:42:54Z")
> [@Airbeck](#): > > How then would you prevent every health insurance company from moving its headquarters to the state with the least amount of regulations? If this is what’s preventing a person in Paterson from buying insurance from a carrier in Manhattan, that’s friggin’ pathetic. Set common minimum regulatory standards, for Christ’s sake. If you’re going to let this theoretical problem prevent Americans from buying insurance from their provider of choice just because it’s in another state, you have legislative myopia of the worst sort. ---
**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\ **Post date:** [March 10, 2017, 3:11am UTC](https://boards.straightdope.com/t/trumpcare/781625/151 "2017-03-10T03:11:49Z")
> [@RickJay](#): > > If this is what’s preventing a person in Paterson from buying insurance from a carrier in Manhattan, that’s friggin’ pathetic. Set common minimum regulatory standards, for Christ’s sake. If you’re going to let this theoretical problem prevent Americans from buying insurance from their provider of choice just because it’s in another state, you have legislative myopia of the worst sort. The problem is that the prime motivation for the insurance company to go to another state is a different (read, weaker) regulatory climate. If I’m an insurance company, it costs me money to enter a new state–I’ve got to establish contracts with the medical providers in that state, obtain a business license and comply with the various regulations surrounding that (e.g., registered agent for service of process), market my plan to that state’s residents, etc. Right now, as an insurer I can open up shop in as many states as I want, as long as I am willing to go through the process to do so. The benefit from “selling across state lines” is having ONE regulatory regime with which I must comply–I can sell insurance in both New Jersey and New York but only have to deal with the regulators in one of those states. I have a strong incentive to pick the regulatory regime that is most profitable for me. This is not a theoretical problem: the example of South Dakota’s credit card industry, e.g., is quite well known. “Minimum regulatory standards” is only part of the issue, because _enforcement_ of those standards is also a function of state regulators. Some states are rather notorious for a cozy relationship between state regulators and the industry they are supposed to be regulating. Even where regulators aren’t overly cozy, there are still perverse incentives. For example, if I am the elected insurance commissioner in Kansas, what’s my motivation to care what happens to customers in New York? They didn’t elect me, and they won’t re-elect me no matter how good a job I do for them. The company that I regulate that provides their coverage, however, is a potential source of campaign contributions for me. ---
**Author:** ![RTFirefly](https://avatars.discourse-cdn.com/v4/letter/r/c77e96/32.png) [@RTFirefly](https://boards.straightdope.com/u/RTFirefly)\ **Post date:** [March 10, 2017, 8:34am UTC](https://boards.straightdope.com/t/trumpcare/781625/152 "2017-03-10T08:34:26Z")
> [@F.U.Shakespeare](#): > > Could someone explain to me why it’s necessary to single out lottery winners? [Apparently it’s something that Fox News has been going on about](https://www.balloon-juice.com/2017/03/09/the-two-kellys/), as just one more thing to throw at Obamacare. Best guess is that it got in the bill because President Dumbshit watches a lot of Fox News. ---
**Author:** ![crucible](https://avatars.discourse-cdn.com/v4/letter/c/5f8ce5/32.png) [@crucible](https://boards.straightdope.com/u/crucible)\ **Post date:** [March 10, 2017, 11:11am UTC](https://boards.straightdope.com/t/trumpcare/781625/153 "2017-03-10T11:11:06Z")
Like much that the R’s do, their plan is a horrible plan, designed to benefit wealthy folks and to stick it to everyone else. They do it because they have been doing it before and it got them elected. Why? Because the American Public, by and large, is a bunch of fools who focus on single issues that seem, at the moment, to be of overriding import to them. The sex of the candidate, the race, the willingness to allow women to choose to have an abortion, the desire to spend tax money of horrible things like education, roads, job training and so forth instead of building walls and more aircraft carriers, 10 for every one anyone else has. We have the only country in the world where conservatives are able to block nationalized health care. Why? Because they are only Christians from 10 until noon every Sunday. Otherwise, they are greedy money-grubbing snakes. ---
**Author:** ![ckalli1998](https://avatars.discourse-cdn.com/v4/letter/c/a3d4f5/32.png) [@ckalli1998](https://boards.straightdope.com/u/ckalli1998)\ **Post date:** [March 10, 2017, 1:46pm UTC](https://boards.straightdope.com/t/trumpcare/781625/154 "2017-03-10T13:46:32Z")
As a conservative Republican, I will admit that I agree that the healthcare plan currently put out by House Republicans and being cheerlead by Republicans is a terrible plan that won’t reduce the cost of insurance and stop premium increases, mainly due to how many taxes it keeps after it being implemented, hell it even keeps the Cadillac tax indefinitely. Sen. Rand Paul’s ObamaCare Repeal & Replace plan is much more better; I just saw it on his website. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [March 10, 2017, 2:07pm UTC](https://boards.straightdope.com/t/trumpcare/781625/155 "2017-03-10T14:07:36Z")
It’s terrible - removing mandates for enrollment will leave it underfunded, which is a sure recipe for disaster. Also, I though Republicans hated deficits? How is that justified? Removal of essential health benefits requirement? How do you justify removing _essential_ benefits? Removal of medical loss ratio requirements? That means it would be legal for a healthcare company to spent 80% of it’s money on salaries and advertising and only 20% on actual care, whereas the current requirement is 80% on actual care with no more than 20% for everything else. How do you justify that reversal? HSA are bullshit for anyone with a chronic condition - they will NEVER be able to acquire any savings! With someone who is afflicted _from birth_ they will never have a chance to get ahead. It also leaves young people who become ill through no fault of their own (which is most ill young people) out in the cold. This ONLY works for people who enjoy BOTH a long period of health in their early adult years AND have the income to put this money aside. The poor and the chronically sick are shit on with HSA’s. (I will note that allowing HSA’s without a high-deductible policy requirement, and allowing their use for things like prescription drugs and paying for premiums could be a very good thing) The problems with selling policies across state lines have already been addressed in this thread. Rand Paul’s proposal have a few good ideas but it still favors the wealthy and shits on the poor and sick. It sucks. It’s more of the same bullshit. ---
**Author:** ![Ann\_Hedonia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ann_hedonia/32/319_2.png) [@Ann\_Hedonia](https://boards.straightdope.com/u/Ann_Hedonia)\ **Post date:** [March 10, 2017, 2:42pm UTC](https://boards.straightdope.com/t/trumpcare/781625/156 "2017-03-10T14:42:28Z")
> [@kenobi\_65](#): > > 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. Something I’ve pointed out before and will continue to point out, even though it is seldom acknowledged. Many of the “plans people loved” weren’t cheap catastrophic plans. Pre-Obamacare, some insurers sold small “bridge policies” to cover the deductible on a real insurance policy. The plans were inexpensive, often well under $100 a month. And they covered a lot of routine services,doctor visits , eyeglasses, prescription drugs… with low or no copays and no deductible. The only catch was the annual maximum benefit which was usually around $2000. Now these plans were not intended as primary insurance. In fact, they had big “This Plan Is Not Insurance” warnings on them. But some people got the bright idea to offer them up to low income employees of companies like McDonalds and Walmart as insurance. And the employees LOVED them and understandably so. Here was this insurance plan that paid for every bit of routine care and it cost under $100 a month. And the large majority of those policy holders, most of them young,never experienced a significant medical event that would expose the fatal flaw of those policies. So Obama wasn’t really as big of a liar as he was made out to be. These plans, along with a lot of “Health Care Savings Club and Discount Card” health plans never met the legal definition of an insurance policy. But telling people they can’t keep their insurance because it wasn’t really insurance sounds weasely, even if it’s 100% true. ---
**Author:** ![Johnny\_L.A](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnny_l.a/32/1084_2.png) [@Johnny\_L.A](https://boards.straightdope.com/u/Johnny_L.A)\ **Post date:** [March 10, 2017, 2:44pm UTC](https://boards.straightdope.com/t/trumpcare/781625/157 "2017-03-10T14:44:28Z")
> [@Rick\_Kitchen](#): > > [Kellyanne says, don’t call it Trumpcare.](https://www.rawstory.com/2017/03/watch-kellyanne-conway-desperately-tries-to-stop-fox-host-from-calling-gop-health-plan-trumpcare/) Too bad. 45 owns it, 45’s Name™ is on it. It is Trumpcare™, and that is that. ---
**Author:** ![ckalli1998](https://avatars.discourse-cdn.com/v4/letter/c/a3d4f5/32.png) [@ckalli1998](https://boards.straightdope.com/u/ckalli1998)\ **Post date:** [March 10, 2017, 2:50pm UTC](https://boards.straightdope.com/t/trumpcare/781625/158 "2017-03-10T14:50:24Z")
> [@Johnny\_L.A](#): > > Too bad. 45 owns it, 45’s Name™ is on it. It is Trumpcare™, and that is that. It’s not “Trumpcare”, it would more accurately be described a “Ryancare”, as the Speaker is the one who came up with the plan. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [March 10, 2017, 2:52pm UTC](https://boards.straightdope.com/t/trumpcare/781625/159 "2017-03-10T14:52:18Z")
> [@Johnny\_L.A](#): > > Too bad. 45 owns it, 45’s Name™ is on it. It is Trumpcare™, and that is that. Actually, I suspect it is Trump doesn’t Care. ---
**Author:** ![Swithin](https://avatars.discourse-cdn.com/v4/letter/s/45deac/32.png) [@Swithin](https://boards.straightdope.com/u/Swithin)\ **Post date:** [March 10, 2017, 2:56pm UTC](https://boards.straightdope.com/t/trumpcare/781625/160 "2017-03-10T14:56:02Z")
> [@ckalli1998](#): > > It’s not “Trumpcare”, it would more accurately be described a “Ryancare”, as the Speaker is the one who came up with the plan. And Obama didn’t personally write the ACA, nor christen it Obamacare. Nevertheless his administration made it a priority, and he put his clout into passing it. There is precedent here, set by republicans. If the bill isn’t good enough for Trump to put his name on it, I’d recommend he stop supporting it so vigorously. [Previous page](https://boards.straightdope.com/t/trumpcare/781625.md?page=7) [Next page](https://boards.straightdope.com/t/trumpcare/781625.md?page=9)