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Posted at 8:55 AM ET, 01/21/2011

ObamaCare for less

By Jennifer Rubin

Matt Miller writes in The Post that he'd advocate repeal of ObamaCare if Republicans could come up with a plan that could cover 30 million uninsured Americans for less. I would suggest that's the wrong question. But in any event, Republicans have come up with such plans, and they no doubt will come up with others.

As for the flaws in the question, the first problem is the size of the "uninsured" population and whether we should be covering every person without insurance. A 20-something who'd rather buy a car than health-care insurance is required to buy health insurance (with the help of government subsidies) or face a fine under ObamaCare. Republicans think that's not how government should be spending taxpayers' money.

Moreover, there is more than a little over-counting in the 30 million uninsured figure. Phil Klein highlighted a couple years ago: "[T]he 2003 BlueCross BlueShield study determined that 8.2 million Americans are actually without coverage for the long haul, because they are too poor to purchase health care but earn too much to qualify for government assistance." Now, Megan McArdle is out with a devasting analysis, observing that there is strong likelihood that "we just passed a massive new health care entitlement in large part based on appeals to the plight of people who do not exist -- at least, not in anything like the numbers that we were told."

The second problem is how ObamaCare defines "insurance." Miller has previously argued that ObamaCare is a "defined contribution" plan. But is that right? ObamaCare defines exactly what type of health-care insurance "counts," and it has loaded up the minimum level of acceptable coverage with many costly items that not every consumer needs or wants. A true defined contribution plan is what Republicans have suggested -- a lump sum that allows individuals to purchase whatever insurance they want.

The third problem is that Miller, like most liberals, shows undue reverence for Congressional Budget Office scoring. James Capretta of the Ethics and Public Policy Center (and formerly an assistant director of the White House Office of Management and Budget) e-mails, "CBO is not at all friendly to market-based reforms." In other words, the sorts of cost-saving measures that Republicans have and will propose are likely to be undervalued or ignored entirely by CBO. Moreover, as Charles Krauthammer argues, CBO's figures on ObamaCare are based on false premises topped off with accounting "flimflammery." So why should CBO be the end-all-and-be-all in health-care plan evaluation?

But now we get to the plans. There are conservative plans that would provide for very large number of Americans to gain coverage at much less cost. Take the plan put out by Sen. John McCain (R-Ariz.) in 2008 that would have covered 27.5 million people at an annual cost of $287 billion. Sen. Jim DeMint's plan would have covered over 22 million people. There was also the Patients' Choice Plan put forth by Rep. Paul Ryan (R-Wisc.), Sen. Tom Coburn (R-Okla.) and others.

However, Miller's point is well taken: Republicans have talked a lot about "repeal." They will have to talk in more detail about the "replace" part. It is good to know that Miller will be in their corner if they do their homework. They need to clearly explain one or more plans that help to keep costs down and extend a reasonable level of coverage to tens of millions of Americans.

By Jennifer Rubin  | January 21, 2011; 8:55 AM ET
Categories:  Obamacare  
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Comments

Under a social contract based on the founding principle of individual liberty, what is the ethical basis for empowering the government to alter the terms of a voluntary arrangement between doctor, patient, and private insurance company?

THIS is the only question that matters to me.

Posted by: kbash33 | January 21, 2011 9:19 AM | Report abuse

Actually, we could have universal coverage for far less (as most civilized nations do) if we simply went to single-payer. Another way of putting that is to allow anyone who wants to buy into Medicare.
I would like one of you rompin' stompin' private-sector boosters to explain to me exactly what for-profit insurance contributes to health care: as far as I can see they take in lots of money, seize 30% off the top (overhead and operating expenses, you know) and give the rest to doctors and hospitals. They are now fighting the Obamacare mandate that they spend at least 85% of their take-in on actual health care--you know, healing the sick and preventing disease. They would prefer, obviously, to keep their 30% and pay CEOs hundreds of millions, while employing actuaries to determine who shouldn't get insurance, and lawyers to fight policy-holders who actually need care. They are an abomination, but they have lots of money to buy Congresspeople and media types.

Posted by: kstack | January 21, 2011 9:37 AM | Report abuse

They are way ahead of you Jennifer, only sadly you don't seem to be aware of it. I suggest you read this article by Bryon York who seems to be following this issue a lot closer than you are.
http://washingtonexaminer.com/politics/2011/01/house-gop-begins-long-slog-dismantle-obamacare

Posted by: cajunkate | January 21, 2011 9:50 AM | Report abuse

A 20-something who'd rather buy a car than health-care insurance is required to buy health insurance (with the help of government subsidies) or face a fine under ObamaCare. Republicans think that's not how government should be spending taxpayers' money.

Good point Jenn,considering how twenty year olds rarely have healthcare needs,like injuries from auto accidents. Oh,and in case your twenty year old son goes beserk and kills a government official and a bunch of other folks,he can take advantage of that state/art mental health care they offer at the penitentary which is at least as good as the care they offered in Bedlam back when.

Posted by: rcaruth | January 21, 2011 10:16 AM | Report abuse

Actually, we could have universal coverage for far less (as most civilized nations do) if we simply went to single-payer. Another way of putting that is to allow anyone who wants to buy into Medicare.
I would like one of you rompin' stompin' private-sector boosters to explain to me exactly what for-profit insurance contributes to health care: as far as I can see they take in lots of money, seize 30% off the top (overhead and operating expenses, you know) and give the rest to doctors and hospitals. They are now fighting the Obamacare mandate that they spend at least 85% of their take-in on actual health care--you know, healing the sick and preventing disease. They would prefer, obviously, to keep their 30% and pay CEOs hundreds of millions, while employing actuaries to determine who shouldn't get insurance, and lawyers to fight policy-holders who actually need care. They are an abomination, but they have lots of money to buy Congresspeople and media types.

Posted by: kstack | January 21, 2011 9:37 AM | Report abuse

-----------------------------------------
Could be that you did not read the data correctly, and that the 30% figure that you cited for all insurance carriers only applied to small insurance carriers. Proper analysis would show that the administrative costs of large carriers is similar to that of the government, 9% or so. The government, supposedly with no overhead, spends about 6% on overhead.

Posted by: PALADIN7E | January 21, 2011 10:50 AM | Report abuse

As is sadly typical of the American left, there is not one rational rebuttal here authored by a liberal. All nastiness and pointlessness. that's what we've come to expect these days. Either one agrees with the liberal agenda or one faces endless childish name calling.

here's a good starting point for today's fight:
==================
I would like one of you rompin' stompin' private-sector boosters to explain to me exactly what for-profit insurance contributes to health care:
========================

No one has to explain diddly squat to you pal. People, of their own free will, buy the products sold by insurance companies. Millions of times a year the market determines, through private transactions, that the insurance companies provide a social good. If they didn't they would have no sales.

It is sad that the author of the above is so blinded by dogma that he (she?) (it?) cannot understand a different point of view. But that's today's liberals.

and what's wrong with profit boy? There is an old saying the healthcare biz: No margin, no mission. Time for you to grow up.

Posted by: skipsailing28 | January 21, 2011 10:54 AM | Report abuse


You know what You guys should stop complaining because, one the health care we have now isnt as good as it was supposed to be. also the law has just been signed so give it some time. so if u want to say u have the right to choose tell that to ur congress men or state official. If you do not have insurance and need one You can find full medical coverage at the lowest price by searching online for "Wise Health Insurance" If you have health insurance and do not care about cost just be happy it and trust me you are not going to loose anything!

Posted by: blythebarne | January 21, 2011 10:54 AM | Report abuse

determines, through private transactions, that the heroin dealers provide a social good. If they didn't they would have no sales.


and what's wrong with profit boy? There is an old saying about the heroin biz: No margin, no mission. Time for you to grow up

I agree,we need more profits in America,I understand that the illegal drug business is bigger than the insurance market. It's time for society to grow up and make some money.

Posted by: rcaruth | January 21, 2011 11:04 AM | Report abuse

What more do we need to know about the Left than that they don't know what insurance is for?

Posted by: adam62 | January 21, 2011 11:08 AM | Report abuse

What more do we need to know about the Left than that they don't know what insurance is for?
Posted by: adam62

Adam,under OCare,the insurance companies are required to offer coverage,but they are not required to pay for care.* So what is insurance for?
*From my viewpoint,this is OCARE's fatal flaw.

Posted by: rcaruth | January 21, 2011 11:17 AM | Report abuse

in response to this:
==============
determines, through private transactions, that the heroin dealers provide a social good. If they didn't they would have no sales.

=======

thanks for proving my point, free people buying heroin are demonstrating that in their minds, the dealer provides a social good. Nice going, thanks for the support.

And yes, American needs more profit. Profit is the engine the employs us and provides for our material well being,.

Again, thanks for the support. You go boy.

Posted by: skipsailing28 | January 21, 2011 11:33 AM | Report abuse

"This does not absolve the Republicans from producing a health-care replacement. They will and should be judged by how well their alternative addresses the needs of the uninsured and the anxieties of the currently insured. But amending an insanely complicated, contradictory, incoherent, and arbitrary 2,000-page bill that will generate tens of thousands of pages of regulations is a complete nonstarter. Everything begins with repeal"
http://www.nationalreview.com/articles/257625/why-everything-starts-repeal-charles-krauthammer

The obvious problem with this opinion is that OCare is unlikely to be repealed*,therfore it is unlikely that the GOP will ever come up with an alternative. The truth is that the GOP's actual position is that the US healthcare system was perfect before OCare,and we shouild just return to that "free-market" perfection.
*The fact that OCare doesn't require the insurance companies to actually pay out anything,has made OCare very attractive to the INS. Companies.

Posted by: rcaruth | January 21, 2011 11:37 AM | Report abuse

thanks for proving my point, free people buying heroin are demonstrating that in their minds, the dealer provides a social good. Nice going, thanks for the support.
And yes, American needs more profit. Profit is the engine the employs us and provides for our material well being,.
Again, thanks for the support. You go boy.
Posted by: skipsailing28

Unfortunately,those with a moral prejudice against legalizing the Drug trade,will prevent that from happening for the forseeable. However,I'm glad that we share the opinion that our national drug policy is insane.

Posted by: rcaruth | January 21, 2011 11:46 AM | Report abuse

"Adam,under OCare,the insurance companies are required to offer coverage,but they are not required to pay for care.* So what is insurance for?
*From my viewpoint,this is OCARE's fatal flaw. "

"The truth is that the GOP's actual position is that the US healthcare system was perfect before OCare,and we shouild just return to that "free-market" perfection.
*The fact that OCare doesn't require the insurance companies to actually pay out anything,has made OCare very attractive to the INS. Companies."

It's hard for me to believe that you think we had a free market in health care or health insurance before Obamacare. Anyway, you provide a very succinct argument against Obamacare--like most liberal attempts at regulation, it establishes crony capitalist relations in which the companies regulated and the parties supporting regulation share the same interest--against the free market.

Posted by: adam62 | January 21, 2011 12:38 PM | Report abuse

It's hard for me to believe that you think we had a free market in health care or health insurance before Obamacare. Anyway, you provide a very succinct argument against Obamacare--like most liberal attempts at regulation, it establishes crony capitalist relations in which the companies regulated and the parties supporting regulation share the same interest--against the free market.
Posted by: adam62

Adam,I don't believe we've ever had a "free"market,in the Misesian,Hayekian,Smithian,Randian model. What I was saying is that in the GOP view,before OCare was the "Free Market",and after OCare is Socialism/not mine,the GOP view,but that view doesn't keep the GOP from voting itself the finest Socialized Medical Insurance program in the nation. 100% coverage,no deductibles.

Posted by: rcaruth | January 21, 2011 12:56 PM | Report abuse

"What I was saying is that in the GOP view,before OCare was the "Free Market",and after OCare is Socialism/not mine,the GOP view"

I haven't seen the GOP set things up in this way--everything that's not a massive government takeover is not thereby the free market, even for Republicans. I think the GOP is terrified to take on entitlements and has been for decades--they know the Democrats and media will pounce on them for the slightest reduction in increase, much less actual decrease, in spending on health, welfare, education, social security, etc. The first move and the headlines will be that the Republicans want to starve/throw out on the street/kill Granny and little Johnny. The Republicans just don't know how to defend themselves against that, so, while in power, they preferred to let things go on as they had; and, of course, it's easy to do so once the campaign contributions from at least some of the favored industries start coming your way. Maybe it won't be any different this time, in which case more radical alternatives will emerge. But, first, the Republican House and, hopefully, after 2012, Senate and President, should be given a chance.

Posted by: adam62 | January 21, 2011 1:49 PM | Report abuse

Adam/after 2012

2016 is after 2012

Posted by: rcaruth | January 21, 2011 1:55 PM | Report abuse

"Adam/after 2012

2016 is after 2012"

Predicting is silly, but I'm hoping for a Republican President in 2012--lacking that, enough Republicans and renegade Democrats to override vetoes.

Posted by: adam62 | January 21, 2011 2:28 PM | Report abuse

"You know what You guys should stop complaining because, one the health care we have now isnt as good as it was supposed to be. also the law has just been signed so give it some time."

blythebarne, I don't want to give it some time, and neither do most R's and conservatives. The problem with giving it time is that once O-care gets it's hooks into our lives, it will be virtually impossible to get those hooks out - even if a majority of the country wishes it. And the insidiousness of a welfare nanny state will then be irrevocably ingrained into America. To liberals that will be just fine as they want it. To conservatives and others who don't want it - well, that's just too bad.

And who decides how much time is appropriate to give? A sympathetic liberal will always say "give it more time" no matter how many years it's been in place. Or, "it can be fixed with a little tinkering here and there." I don't want to "tinker" with it. I want to keep my liberty rather than hand it over to some govt bureaucrat, which means I'd rather have this bill get strangled in the crib.

Posted by: RitchieEmmons | January 21, 2011 4:57 PM | Report abuse

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