Friday, April 28, 2017

Washington Post shoots down "my" reinsurance proposal for health care

The Washington Post writes that “Repeal and Replace Just Got Worse” in an editorial Friday morning, here.

It’s notable to me that the Post seems to reject the idea of reinsurance for excessive claims associated with pre-existing conditions.  Such a program could be left to the states, and some states would not be as generous as others.  Some states might refuse to allow reinsurance to work for “behavior-related” conditions, for example.  That might be bad for a lot of people with HIV, and it wouldn’t cover PrEP – but you don’t have the “right” to make others pay for it.

The Post speculates that federal contributions to such a fund would be inadequate.  Maybe so if most of it is left to states.  But it gives no detail.

This still comes back to “moral hazard”.

But if you value all human life, you have to decide how you will pay for it.  Taxes, or single payer?  The simplest, and most removed (and it comes with rationing and wait lists).  Making everybody pay much higher premiums?  Or goading people with GoFundMe campaigns.  But you have to pick an outcome.  It’s a multiple choice exam.

Politico has suggested a reinsurance system recently, at least according to my Starbucks reading.

Many Republicans favor letting states use their higher risk pools, with premium subsidies for low income policyholders. This way those could afford it would pay for their higher use of medical services.  But imagine the argument extended to Medicare.  You could make people who can afford it pay for more of their share of, say, coronary bypass surgeries.  People do pay for their own custodial care, though.

On the tax code reform – it’s too early to say, but raising the standard deduction could encourage more renting and less home buying, and less charitable contributions.  But it would make taxes take less time, for some of us.

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