Friday, January 13, 2017


This was a dramatic moment:
Speaker Paul Ryan (R-Wis.) faced some tough questions from audience members at a CNN town hall Thursday night, starting with a cancer patient who said ObamaCare saved his life.

Jeff Jeans said he was a lifelong Republican and small-business owner who had worked on the Reagan and Bush campaigns and was originally opposed to the Affordable Care Act.

But he said that at 49 he was diagnosed with cancer and given six weeks to live.

"Thanks to the Affordable Care Act, I’m standing here today alive," he said. "I rely on the Affordable Care Act to be able to purchase my own insurance. Why would you repeal the Affordable Care Act without a replacement?"
It was great TV, although I think Jeans started with the wrong question. (The right question is "Why would you replace Obamacare with something that's going to leave far more people like me without health insurance, according to all reliable reports?") Ryan, of course, insisted that there won't be repeal without a replacement in place -- we don't know whether that's true or whether Republicans are just saying that and hoping we'll forget that they said it when they do the opposite, or won't care -- and he went on to insist that the magic bullet for people like Jeans is government-funded high-risk pools.

At The Washington Post, Paul Waldman explains the problem with that, though not as clearly as he might have:
Ask any health policy expert about high-risk pools, and they’ll tell you that they’re absolutely the worst way to guarantee coverage for people with pre-existing conditions. Before the ACA, many states had them as a backstop for their most vulnerable patients. As this Kaiser Family Foundation report explains, they were characterized by high premiums, waiting lists to get on, lifetime and annual limits, temporary exclusions of the very conditions that made people seek them out (you often couldn’t get coverage for your condition in the first 6 or 12 months you were on the plan), and high deductibles.
Your right-wing uncle would respond to this by saying that's a lot of liberal propaganda. So what else has Waldman got? How about some numbers?
In Paul Ryan’s plan, he suggests funding these high-risk pools with $2.5 billion per year. Tom Price’s plan is even stingier, at $1 billion a year. Those numbers are so low that it almost seems like a joke. This Commonwealth Fund study estimated that a national high-risk pool would require $178 billion a year to fund.
Here's the problem, though: When Price (a Republican congressman who's Donald Trump's choice for Health and Human Services secretary) or Ryan proposes a number like $1 billion or $2.5 billion, it doesn't matter how stingy that actually is -- the average voter out there in the heartland is thinking, A billion dollars? Two and a half billion? Hey, that's a lot of money!

Republicans always take advantage of the fact that any dollar amount over, say, $1,000 (if we're talking about a government grant for an eccentric-sounding research project) can be made to seem like a huge outlay that really picks the pocket of Joe and Jane Lunchpail. Liberals can generate all the infographics and floor-of-Congress easel charts they want demonstrating that these proposals are woefully inadequate, and still much of America will think their cost sounds like a king's ransom.

The numbers in that Commonwealth Fund study aren't all that hard to explain. If a Republican plan were to cover as many of those who were priced out the pre-Obamacare insurance market by pre-existing conditions as Obamacare does, it would be covering 13.7 million people. If those people had an average of $20,000 in annual healthcare costs and paid $7,000 of that per year in premiums, that would leave $13,000 to be covered by this high-risk insurance. Multiply $13,000 by 13.7 million people and you get $178 billion. Ryan proposes to pay for less than 1% of that. Price has proposed to cover even less.

But it's likely that explaining this would make the average voter's eyes glaze over. Maybe it's making yours glaze over. Ryan and Price are proposing outlays that are very stingy but sound like really big numbers. And that will probably be enough to bamboozle America.


Never Ben Better said...

And this is why we can't have nice things.

Victor said...

Another question to ask Paul "Privatiin' & Lyin'" Ryan, is why $7+ million dollar tax breaks to the most already wealthy people, as are more important than providing affordable health care for millions of people.

$7+ million is a lot of moolah, too!

I think that when the rest of us talk about "health care," conservatives hear 'wealth care!' Because that's all they ever seem to support, anyway...

Unknown said...

A lot of Trump's voters will lose their healthcare and blame the Democrats for the pain.

rclz said...

I was wondering last night why they don't just go single payer, medicare for all and then privatize the whole shebang. They keep talking about privatizing Medicare why not give it to everyone and shovel it off to wall street.

Kathy said...

We can hope that at least some Joe and Jane Lunchpails know people who were bankrupted bu health care costs before the advent of the ACA. For the insured, it takes very little time to burn right through a $1 million lifetime limit when one has a serious illness or injury. For the uninsured, it doesn't take anything close to a $1 million bill to bankrupt.

Ken_L said...

The same emotive response to big numbers is apparent in other ways, too.

"$178 billion a year? They must be able to save 10% of that by cutting waste and inefficiency! They'll still have $160 BILLION!!!!"

Trump, as usual, has either learned this or knows it instinctively. That's why labelling the new Air Force One or the F-35 program "too expensive" is a political winner. Most people haven't a clue what they ought to cost. They just know they ought to cost less than lots of billions.

Rand Careaga said...

“In these sentiments, Sir, I agree to this Constitution with all its faults, if they are such; because I think a general Government necessary for us, and there is no form of Government but what may be a blessing to the people if well administered, and believe farther that this is likely to be well administered for a course of years, and can only end in Despotism, as other forms have done before it, when the people shall become so corrupted as to need despotic Government, being incapable of any other.”

—Benjamin Franklin, remarks to the Federal Convention, September 1787

It was a good run, and Jane and Joe have landed about where Franklin said they would. Pity.

Anonymous said...

Ten to the thirteenth, not quite a hundred and a half billion stars in the "known universe". We used to think of such numbers as astronomical. Now, they are merely economic. {sigh}

Ten Bears

Rand Careaga said...

There are more than "a hundred and a half billion stars" in our galaxy alone. The current thinking on stars in the universe pits the figure at closer to a billion trillion, which is a lot.

Anonymous said...

A rhetorical device Rand, a vain attempt to convey the magnitude of such numbers. Don't know why it came out known universe, I was thinking of the "hood".

What's a few billion trillion anyways?