Posted on 06/23/2017 4:59:39 PM PDT by 2ndDivisionVet
People accuse me of imagining that everything President Trump does is brilliant (persuasion-wise) no matter what he does. But I expect the next version of the Republican healthcare bill to be a complete failure. That’s because Republicans seem deeply committed to a losing path, thanks to what might be called the Contrast Problem.
Contrast is the driving principle behind all decisions. You have to know how your options differ, and by how much, or else you have no basis for a decision. President Obama solved for the contrast problem by designing Obamacare to cover more people than before. The rest of the details – especially the costs – were hard to predict, so our brains flushed that noise and focused on the greater number of people covered.
Everyone knew Obamacare would need future tuning to get it right. That gave us mental permission to focus on the good parts we understood – the greater coverage – and hope the other details would get worked out later. President Obama nailed the Contrast Problem like the Master Persuader he is.
That was then.
Now, President Trump and the Republicans have the “going second” problem. The public will compare their proposed bill with Obamacare and conclude that the one metric they understand – the number of people covered – does not compare favorably with Obamacare. The contrast is fatal.
We know Paul Ryan will do his wonkish best to tell us about all the amazing advantages of this new bill. And we know the public won’t understand any of it. But they sure will know it doesn’t cover as many people. Done. Bury it.
During the campaign, candidate Trump made some references to taking care of everyone. It sounded like universal coverage, but no one thought he meant it.
He did mean it.
He meant it because he understands the contrast problem. Any Obamacare replacement needs to cover more people than Obamacare, or else it is dead on arrival. Any skilled persuader would see that.
Paul Ryan doesn’t see the Contrast Problem as important, evidently.
I think most trained persuaders would agree that the one-and-only path to a successful replacement of Obamacare should include AT A MINIMUM a plan to reach greater coverage. And the only way to get there is by goosing innovation in the healthcare field. We can’t tax our way to full healthcare coverage. We need to lower the costs. And President Trump also needs to solve the Contrast Problem.
To that end, I suggest creating a special low-cost (or free) plan for low income people who are willing to accept a bit more risk. If the plan is robust enough, it could provide a path to greater patient coverage compared to Obamacare and solve the contrast problem. As a mental exercise only, the plan might have the following elements:
1. Online doctors for 90% of routine cases.
2. Require big pharma to provide free meds for people in this plan as a condition of selling in the United States. The low-income people covered would be the ones who would not otherwise buy these drugs, so the companies would only lose the cost of the materials themselves, which is trivial.
3. Recruit and approve special doctors for this plan who are by law exempt from any malpractice suits so long as they provide reasons for their decisions. This would allow them to avoid some red tape and also use new and inexpensive medical technology before full FDA approval – but only for the new stuff that common sense tells the doctors would not be especially dangerous. I’m not talking about pills and internal medicine. I’m talking about medical devices, mostly. It would be up to the doctor to decide when it was safe to risk using the new methods.
4. Patients agree to wear health monitors – the newest prototypes – and to share their medical information (anonymously) for the greater benefit of society. This would allow early detection and treatment. Perhaps the low-cost insurance could be free to those who walk 10,000 steps a day, or something of that nature.
5. Shine a government light on any medical technology or systems improvements that would lower cost, to guarantee that the good ones are known to doctors and investors. (Then stay out of the way.)
This is just a starter concept for what a special low-cost plan (with slightly higher risks) might look like. The main point is that you could cobble together a low-cost plan if you had some government muscle behind it to clear out the useless regulations and to focus energy in the right places.
If President Trump presents us with a healthcare plan that doesn’t cover as many people as Obamacare, but will cover more people eventually, that’s a winning contrast.
Otherwise, the bill will die on the Contrast hill. And that’s the direction we’re heading.
As I’ve said before, America can’t make a strong claim to greatness if we can’t do healthcare right. So let’s do it right. Or at least have a plan to get there.
> The public will compare their proposed bill with Obamacare and conclude that the one metric they understand – the number of people covered
I don’t believe that for a minute.
The one metric they understand is “what does it cost me?”
The contrast that matters most involves premiums not coverage. At a minimum whatever they do they must get the premium costs down.
It won’t be a complete failure - Øbongo was a complete failure. It will just be mostly a failure.
Small consolation I know...
The 93 million people who lost their insurance want to know that everyone will be covered under new plan? Paid by their taxes.
Uhh,no! Everyone needs to strive to pay for their own healthcare insurance.
Have a plan that offers a $50,000 deductible. That should be pretty cheap/s
He’s right....changes being made don’t help the system...and that’s what’s broken
I think you're both right. Adams was referring to the "one metric" of ObamaCare before it was passed. Nobody considered the personal cost of the ACA because nobody could measure it in advance.
Eight years later, I believe the "what does it cost me?" metric has replaced the "how many people are covered" metric for many Americans. I would point out, though, that the "what does it cost me?" metric applies primarily to a relatively small group of people who buy their own individual medical insurance.
Obamacare allows charging more for a pre-existing condition.
People don’t know that but it’s true.
Allow charging up to an extra 50% for more pre-existing conditions besides just smoking (obesity is one obvious choice) and money is available for more people to get ‘free’ healthcare.
A reasonable menu of pre-exes would only be common sense.
My hope is that NOTHING gets passed at this time. Several Republican Senators can take the heat; what little there will be. Remember, the Democrats don't want this passed. They can't very well attack Republicans for not voting for it.
My hope is that Trump recognizes a losing situation. I think the best outcome is to leave Obamacare intact and let it crash. Let it stay crashed long enough for Democrats to BEG the Republicans to let them vote for some improvements.
Any bill creating health insurance schemes will be a fail.
These are nothing more than an attempt to put bandaides on a gangrenous wound.
The problem is cost. Medical care costs too much for many reasons. It is charging above the market’s ability to bear.
That is what needs to be addressed. The constant inflation of medical costs across the board.
Any attempts at comprehensive medical insurance is going to do nothing more than accelerate that inflation in exactly the same way that student loans have inflated the cost of secondary education.
Karl Denninger at Market-ticker.org has good ideas about the medical thing. Here is one.
https://www.market-ticker.org/akcs-www?post=232164
A One-Sentence Bill To Force The Health-Care Issue
[Comments enabled]
“Here it is:
“Notwithstanding any other provision in state or federal law, a person who presents themselves while uninsured to any provider of a medical good or service shall not be charged a price greater than that which Medicare pays for the same drug, device, service or combination thereof.”
That’s it.”
If nothing else, it would help turn health coverage in the U.S. back into real insurance -- because the insurance industry would actually be able to price their risk in this scenario.
The question is how to provide 10 Jillion dollars worth of benifits on an income of 1 Jillion dollars.
It’s a tough one.
Right. Lots of people want their health insurance for free. I say we should pay out of pocket for routine medical, and carry catastrophic coverage. Premiums should be devised similarly to life insurance premiums. If you smoke, drink more than a few per week, don’t eat vegetables, and/or are a fat gluttonous pig (etc) =====> higher premiums. I would also give a 100% premium surcharge to anyone who believes that the government should pay their medical bills. I would further double the health insurance premiums of anyone who has called for an ambulance because they had a headache or needed a ride to see their doctor.
Rand Paul is proposing limited coverage for $1 a day. Brilliant idea. It will destroy the media narrative that people will “lose” their healthcare coverage.
Where did you get that figure?
Full repeal. End all federal involvement in healthcare.
1. The GOP doesn't have the votes to pass anything remotely effective at fixing the problem.
2. ObamaCare continues to crash and burn at the end of 2017 as more and more people just walk away from their coverage and refuse to renew for 2018, and more and more insurance companies drop out of the business entirely.
3. President Trump announces that he will use his authority under the ACA to grant a blanket exemption for any medical insurance plan that is approved by any state insurance regulatory body, even if the insurance plans don't meet any of the requirements of ObamaCare.
Item #3 will fix the problem by allowing insurance companies to develop plans that actually meet the needs of their clients, and have lower premiums because they eliminate the costly mandates and regulatory requirements that ObamaCare imposed on the industry.
Most of the public will applaud lower rates, assuming the plan achieves that.
The libs / media cabal will focus on # of people covered / not covered. Under obamacare, it was more important to have coverage than it was to have access.
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