Republicans Whiff on Health Care Again

Congressional Republicans skipped town again for yet another recess without repealing Obamacare, which they insisted they would do on Day One of the Trump administration. These guys work like three weeks a year.

The reason Republicans are having such a hard time coming up with a replacement is that most of them just don't seem to believe in health insurance. At all. They want companies to be able to offer policies that don't cover anything:

According to several members, Mr. Pence had proposed allowing states to obtain waivers from two provisions of the Affordable Care Act. One provision requires insurers to cover a standard minimum package of benefits, including maternity care and emergency services. The other generally requires insurers to charge the same price to people of the same age who live in the same geographic area.

What?! They don't want policies to cover emergencies!? It's like buying car insurance that doesn't cover accidents! What's the point?

They also want to get rid of the pre-existing conditions requirement, allow life-time caps, drug rehab, psychological services, and on and on. Basically, they want to destroy everything that allows an individual health-care marketplace to exist.

They say they want to allow healthy people to buy cheaper polices and save money. But this is nonsense: the policies Republicans want to offer cover nothing, so no one would buy them. Republicans don't seem to get that healthy people don't need health insurance, so they won't pay for it, no matter how cheap the useless policies are.

This brings us to the real question: what is the point of health insurance? Insurance is supposed to spread risk over a large pool and, to use a word Republicans hate, socialize risk to alleviate private misery.

But if policies don't cover emergencies, or the back-breaking costs of cancer treatment, or run-of-the-mill things like prenatal and maternity care, there is no reason to buy health insurance. You might as well just pay for things as they come up, just like in the bad old days, when people who got cancer or had a heart attack just died if they didn't have enough money.

In the 1980s and 1990s health insurance companies justified their existence by saying that they controlled costs. They negotiated with providers to get the lowest cost on the services they covered. However, if they didn't cover a service, they didn't negotiate a lower cost.

You can see how this works when you get a statement from the insurer after visiting the doctor. It typically shows the ridiculously high price the doctor charges guys who walk in off the street, and then it shows how much gets knocked off because the insurer negotiated a lower price with the doctor for that service. If you haven't hit your deductible you pay what's left over. If you've hit the deductible then the insurance company pays the bill.

If, however, you used a service that wasn't covered by the insurer, nothing gets knocked off and you pay full freight.

And that's why the Republican idea of offering policies that don't cover anything is incoherent and worthless: if the health insurance companies don't negotiate lower costs on a service, patients pay the ridiculously high non-negotiated prices that doctors charge.

The one and only job insurance companies have is to lower prices, and if they don't do that then they are providing no useful service and are utterly useless middlemen and parasites. No one will buy their policies. And they will stop selling such policies.

And that seems to be the Republicans' goal. But why?

Do they like seeing families go broke after they lose a battle with cancer? Do they like girls and women getting pregnant because they have no access to birth control? Do they like seeing babies born with birth defects because they didn't receive proper prenatal care? Do they like seeing people with untreated diabetes losing their feet and legs and dying from sepsis caused by ulcers?

I don't know. One thing that seems certain is that they really enjoy making other people suffer.