Rough Book

random musings of just another computer nerd

Tag: healthcare

The Rand Paul Healthcare Bill

The house withdrew the AHCA today. After seven years of screaming about repealing the ACA, it looks like they can wait longer. I had made some criticisms of Ryan’s plan and so a friend asked me what I thought of Rand Paul’s healthcare bill. There are some good ideas in there, but also some bad ones, and some ones that I’m not so convinced would work out, even though they sound good. So here are my thoughts on it in no particular order.

I liked the Charity and Bad Debt deduction for physicians. Basically, physicians can deduct up to 10% of their gross income for amounts they would have otherwise charged for charitable care or for those with bad debt. I think this may help drive down some healthcare costs, while also helping out people who aren’t able to afford healthcare. But I think this whole issue of healthcare costs itself needs to be looked at more (for example, drug costs).

Paul’s plan is pretty bad for poor or unemployed people in general. It brings back the HIPAA protection for pre-existing conditions, but that is tied to the time you were employed. So if you haven’t been able to get a job for a while, you’re screwed. It also takes away the ACA’s essential health-benefits requirements, community rating restrictions, rating reviews, medical-loss ratio, and other mandates. I think these mandates are necessary because otherwise the system is setup so that it is more profitable for companies to deny coverage than provide it. Not only that, without the individual mandate, healthy or younger people don’t really have any incentive to sign up (not that the individual mandate was doing much in that regard). This means that the individual market is not that profitable for insurance companies, and most Americans get their insurance through employers anyway. So I don’t see how market forces will drive prices down, enough to where younger or healthy people don’t feel like it is such a burden to get insurance, or even to where it is affordable for poor people.

One of Paul’s other proposals is to open competition across state lines. I think that may help drives the prices down a bit, but since purchasing individual-coverage is still largely disincentivized, I still don’t see much change happening. This is also not going to happen immediately, so in the meantime, it will be more profitable for insurance companies to deny coverage to risky (in the sense of costs to the insurer) individuals. This will stress out an already expensive market, because these people will inevitably get sick enough to where they need care. They won’t be able to afford it, and will go bankrupt, causing someone to eat the costs, which forces prices to go up even more as they try to offset the difference. He also mentions expanding the Medicaid Waiver program, which lets states change their Medicaid plans without approval by the HHS. This can allow states to experiment with different coverage-rules, but my admittedly-cynical expectation is that they will change rules in an effort to save costs and not expand coverage, which I think will make the problem I mentioned earlier even worse.

He does propose a tax-related benefit; basically you are allowed to deduct your premiums from your taxable income. But I don’t know if that really would be an incentive. Note that you will end up saving more money if you didn’t get insurance and held onto what you would have paid in premiums, than you would by getting insurance, and then claiming the premium as a tax deduction. To encourage participation in the individual market, there’s stuff in there about Individual Health Pools and Association Health Pools, where a bunch of people can get together and pool their money. It sounds like a good idea in theory, but without more details I can’t say whether it would help or not.

There’s a bunch of stuff related to HSAs, but HSAs are only useful for people with steady income, and most definitely not for people making minimum-wage. He does also propose removing limits, but that won’t help someone making minimum wage either. There’s a funny bit where you can use your HSA to pay for insurance premiums I guess, but why not just pay for it directly if you’re going to be putting money into an HSA? I don’t think HSAs in general work; at least not for a healthcare market with the kinds of costs we see today. People don’t have the information to predict what kind of healthcare they would need. Not only that, people have no idea how much such care would even cost. So how does it really help if you’ve been putting away $200 a month for a year, only to get surgery in December that costs $6000? This is not outside the realm of possibility.

Overall, I think Rand Paul’s plan is worse than the ACA, because it will effectively start off by denying coverage to a bunch of people. Some of the ideas sound good in theory, but I am not convinced they will work out. Some of the ones that may work out, will take too long to do so, which means that a lot of people are going to be without coverage in the meantime; it seems unethical to write them off simply because the market needs time to “correct”. However, I think there are some good ideas in there that could be rolled into ACA — some of the tax-related ideas are good, although I would much prefer a refundable tax-credit for premiums compared to a deduction. The tax benefits for physicians that provide charitable care is also good, and I think it would be helpful to expand those to apply to all sorts of healthcare providers.

Glenn Beck is an asshole

…within the span of a few minutes, Beck implied that there are no quality medical schools in India; implied that medical care in India is a shoddy imitation of real health care; implied that the entire nation is an undeveloped backwater without even so much as indoor plumbing; and compared the Ganges River, a holy body of water for one of the world’s oldest and largest religions, to a disease…

I guess the only reason Glenn Beck is popular is because there is apparently a marketable-segment of idiots in America. You know, the morons that watch Fox News and actually believe what they hear. Glenn Beck, you are an asshole. You are an ignorant bigot and a douchebag. There are a few people that I know, that oppose the health reform. But the strange thing is that they have rather valid arguments, and even though I may not agree with them, I find them rather intelligent and well thought-out. I mean, Mr. Beck. I realize that by being an ignorant douchebag it’s beyond you to form coherent arguments but seriously… do you have to stoop to the level of offending an entire nation? Or what about the entire community of Indian-Americans?

Usually when people make arguments or counter-arguments about a topic, they usually know what they’re talking about because they’ve researched the topic thoroughly. Oh wait. That’s only if they have a proper show that actually discusses political topics with valid arguments instead of gleefully bending over for the lunatic far-right and being their sockpuppet. Hell, I probably shouldn’t blame you. You are making money after all, even if you have to sell your soul for it. No, your show is a circus and your arguments are bullshit. Even still, I find it appalling that you would denigrate an entire nation and community. You may not think much about Indian doctors, but they seem to be a successful and well-respected bunch in India, with a large number of satisfied customers. In one fell swoop you’ve insulted the cultural and religious sentiments of Indians, you’ve made light of the sweat, blood, and tears of her doctors that strive to serve their nation (and who have migrated to other nations, including *gasp* the United States and serve Americans), and you’ve implied that India is some backwater country without any sort of facilities. Sure, India is no United States and it has a long way to go, and even though you may have the right to say whatever the hell you want, it’s really, really bad form to make fun of a country and her people. You xenophobic, ignorant, douchebag. I find it surprising that even you would stoop this low for ratings.

You sir, are an asshole.

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