The GOP Healthcare Alternate Universe

Last week, I posted a synopsis of the Republican counterproposal to the PPACA, which was formulated during the 111th Congress. In light of the decision issued this week by Judge Roger Vinson, a Reagan appointee, it’s all the more valuable to examine the expected impact of replacing the PPACA with the Republican proposal.

Let’s start by looking at the elements the proposal would add.

Tort Reform: As we discussed back in the comments section of “Health Insurance Isn’t Really Insurance At All”, malpractice insurance represents only 2% of healthcare costs. This means that a “best case” scenario of eliminating all malpractice insurance (which is not proposed), we’d be looking at a 2% direct reduction in healthcare costs. But only about half of the cost of medical malpractice insurance premiums go toward malpractice claims, so any reduction in claims would be expected to reduce healthcare costs by a maximum of 1%. Naturally, the more realistic outcome is a reduction of far less than 1%.

But wait, what about the defensive medicine practiced because of the malpractice suits? While I agree that there is a lot of defensive medicine practiced in the US (estimates are around 15-20% of total healthcare costs), absence of malpractice suits would be unlikely to appreciably reduce defensive medicine. Since neither the doctor nor the patient directly bears the full cost of the additional testing and treatment, neither of them have sufficient incentive to reduce the costs. Furthermore, they both have incentive to increase the costs, because both want the doctor to do everything possible to eliminate uncertainty and provide the best possible treatment.

In other words, tort reform would be expected to have, at best, a few percent reduction in healthcare costs. That’s not to say that there might not be some benefit, but it’s hardly the panacea that the marketing would lead us to believe it is.

Interstate Insurance: The official impetus here is to increase competition by increasing the number of insurers. However, there is little reason to believe that this would be the long-term outcome. To understand why, I’ll illustrate with an example from the airline industry.

When the airlines were deregulated, they learned that most of their passengers focus on price, to the exclusion of all else. Survival became a function of managing costs, which manifested itself in a steady erosion of customer service. A big contributor here is the combination of relatively infrequent interaction and a significant delay between purchase and use of the service, which creates a mental disconnect between the money paid and the service rendered. This is compounded by a similar delay between the time service is rendered and the next time money is paid. People end up shopping almost entirely based on price. In the end, we have seen a reduction in the number of competing airlines, with airline service reduced to the point that it’s a mere shadow of its former self, albeit with far better airfares than we otherwise might have had.

Health insurance exhibits very similar disconnects between purchase and services rendered, which pushes people to choose based almost exclusively on price. In such a market, profits are based entirely on cost control. By far, the largest cost to a health insurer is payment on claims, so that’s where the bulk of the focus on cost cutting resides. To the extent that the law allows them to deny claims, then, their profits rise.

Now, the states will want the insurance companies to reside within their jurisdictions, because that means jobs, and jobs mean happy constituents and more tax revenues, both of which mean happier governments. In order to get those companies, the states will be competing with each other to set up rules favorable to the insurance companies’ profits. In other words, the states have incentive to make it easier for insurance companies to deny claims. When the states have to compete against each other for the limited number of insurance jobs, that race to the bottom is virtually guaranteed.

Now let’s look at the existing elements the Republican plan would eliminate.

Minimum Standards for Policies: This was put in place in PPACA as a means of protecting against the use of taxpayer dollars to cover costs for the underinsured. It becomes more important in the case of allowing interstate policies, yet it’s being eliminated altogether as part of the plan.

Mandatory Coverage: This, too, was put in place in PPACA as a means of protecting against the use of taxpayer dollars to cover the costs of healthcare. As long as we have agreement as a society to cover, with taxpayer dollars, heroic medicine, regardless of one’s coverage or ability to pay, we are obligated to ensure that we are getting the best results for our money. It is far less expensive to deal with medical issues early, but the system has been set up to push for treatment late. Getting everyone covered reduces the costs. Getting everyone covered with their own money reduces the tax costs still further. Therefore, eliminating this requirement cannot avoid costing more in taxes.

Insurance Subsidies: These are, of course, necessary if there is an insurance mandate, in order to cover those who otherwise cannot afford the minimum coverage. But it’s also of value even if there isn’t a mandate. As I said above, getting people covered reduces the incidence of expensive emergency care, and getting people covered with their own money reduces the tax costs even more. To the extent that the subsidies represent a portion of the premiums, the tax burden is reduced. Naturally, in the case where someone is fully subsidized (e.g., under Medicaid), there is no effective change.

So what do we have in the case of a replacement of PPACA with the GOP plan? Medical costs might be reduced a bit by the tort reform. Insurance premiums would probably be significantly lower over time, at the expense of having worse real coverage, causing substantial unpredictable economic hardship for many Americans at times when they are least able to address it. The upshot would be a long-term greater burden on Medicaid and catastrophic emergency care, though perhaps with a lower short-term tax burden.

But for the time being, over half of Americans are covered by health insurance through their employers. For those people, there would be no appreciable difference between the two plans, provided they aren’t the victims of medical malpractice. They won’t see any appreciable difference in their premiums, and they won’t be in the market for individual insurance. It is only the minority who are in the individual insurance market that will see any difference between the two models. For that minority, the differences are stark.

In a future article, I’ll discuss what I’d like to see as the future of health insurance, and why. Today is about this analysis. Comment away.


About Michael Weiss

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71 Responses to The GOP Healthcare Alternate Universe

  1. GROG says:

    How did Obama and the Democrats think PPACA would ever pass constitutional muster?

    How could the Interstate Commerce clause could cover something that’s not interstate (health insurance cannot be sold over state lines) and isn’t commerce (failure to buy insurance is not commerce)?

    And they were so sure they would win any constitutional challenge that they failed to put in a severability clause.

  2. Bart DePalma says:

    MW: Tort Reform: As we discussed back in the comments section of “Health Insurance Isn’t Really Insurance At All”, malpractice insurance represents only 2% of healthcare costs.

    The proper comparison is with private health insurance costs, not overall healthcare costs. Medicare and Medicaid do not compensate doctors for their medical malpractice insurance or often their time, thus doctors move the costs to their privately insured patients. Ditto the uninsured. Thus, 2% becomes what? 5 or 6%?

    MW: While I agree that there is a lot of defensive medicine practiced in the US (estimates are around 15-20% of total healthcare costs), absence of malpractice suits would be unlikely to appreciably reduce defensive medicine. Since neither the doctor nor the patient directly bears the full cost of the additional testing and treatment, neither of them have sufficient incentive to reduce the costs.

    Eliminate laws against insurance plans which pay doctors flat fees per patient. Doctors will then manage their treatment. Free interstate competition can bypass such local laws.

    Now, the states will want the insurance companies to reside within their jurisdictions, because that means jobs, and jobs mean happy constituents and more tax revenues, both of which mean happier governments. In order to get those companies, the states will be competing with each other to set up rules favorable to the insurance companies’ profits.

    Try rules that allow insurance companies to sell insurance customers want and can afford. Profits are always a byproduct of providing a good or service for which consumers are willing to pay.

    In other words, the states have incentive to make it easier for insurance companies to deny claims.

    The incentive will be to allow consumers to choose what coverage they want (as opposed to that mandated by states and now Obamacare) and the deductions they want to balance risk and cost.

    The purpose of this reform is to bypass state laws mandating unaffordable comprehensive coverage with low deductibles.

    Now let’s look at the existing elements the Republican plan would eliminate. Mandatory Coverage: This, too, was put in place in PPACA as a means of protecting against the use of taxpayer dollars to cover the costs of healthcare.

    We are caught in a very un-virtuous cycle now: Government mandates more coverage at a reduced deductible, insurance premiums rise, more people cease buying insurance, insurance premiums rise, government fines people who do not buy insurance, people pay the fine because insurance is too expensive in comparison, go back to step 1.

    Government should first heed the doctors’ oath – Do no harm. If you reduce the government imposed costs of health insurance, insurance becomes more affordable and there are fewer uninsured.

  3. shortchain says:

    Since the GOP plan would allow insurance companies to sell their sub-standard plans nationally, probably encouraging them, like banks, to move to South Dakota, where their workers would all be required to go to work armed, there is no difference between the GOP and PPACA in making health insurance an “interstate commerce” — except that, in the GOP plan, it would be guaranteed to be.

    One of the reasons people move away from South Dakota is that it is a benighted, backward, Republican-run hellhole, where those with money and influence have all the say in salaries, tax-codes, and health care (SD is the only state where there is no exception in their anti-abortion laws for the health of the woman).

    So I really don’t want their regulations governing my health insurance. I also don’t want Louisiana involved. Been there, done that, paid the bill that the insurance company (based in Louisiana)) refused to pay, even though it had been pre-approved.

  4. Mr. Universe says:

    Ever wonder why your credit card bills are addressed to South Dakota?

    I read about a group the other day that asks why do we need two Dakotas? They want to rename one of them the State of Reagan. I guess that’s in lieu of getting his likeness added to a mountain in South Dakota. Rename South Dakota.

    South Dakota is really a beautiful state; if only they’d ban all those Wall Drug billboards.

  5. Mr. Universe says:

    BTW: the repeal of health care failed in the Senate yesterday as expected. Hopefully, Republicans will get back to doing the nation’s business. Something tells me they won’t.

  6. GROG says:

    Mr. U,

    Getting the Obamacare repealed is the nation’s business.

  7. NotImpressed says:

    Very few people bring malpractice suits. Of those, the great majority are settled before and court gets involved. Of those that go to court, there are vanishingly few large awards. The real problem with medical malpractice insurance is that the insurances companies are ripping off the doctors by charging far more than they need to. Sort of like what they do with healthcare in general.

    Not holding doctors responsible for malpractice means there is less incentive to be more careful. There was a study showing the number of additional deaths we can expect if we have tort reform, I’ll have to find it. (Go ahead and blast me for not linking it yet. I don’t mind.) So in addition to the economic considerations, there are the humanitarian considerations. But we won’t talk about them.

    The idea of letting people buy the insurance they “want” is silly. People “want” good insurance. They want insurance that will cover their medical bills. If they’re in the open market, they’ll buy what they can afford. If all they can afford is crappy insurance, then that’s what they’ll buy. And the Republicans will say they didn’t “want” insurance that actually had coverage.

    The Republican proposals amount to returning to what we had, only making it easier for the insurance companies to screw us. Without doing anything to lower actual costs, other than helping more people to die quicker so we don’t pay as much.

  8. NotImpressed says:

    GROG, no, creating jobs is the nation’s business.

    I’m not thrilled about the individual mandate either. It was a Republican idea, and a bad one. Simply expanding Medicare would have been far better. Universal single-payer, which is what a big majority of the public wanted, is the way to go. If the Supremes kill the mandate, then when the Democrats win back the House in 2012, we’ll push for Medicare for all.

  9. Mule Rider says:

    “One of the reasons people move away from South Dakota is that it is a benighted, backward, Republican-run hellhole…”

    This suggests otherwise…

    http://247wallst.com/2010/10/04/the-best-and-worst-run-states-in-america-a-survey-of-all-fifty/2/

  10. shortchain says:

    MR,

    It’s an odd thing, but people who have never lived in SD seem to think it’s not so bad, based on arbitrary metrics that they’ve made up.

    I’ll believe otherwise when I stop seeing stories like this.

    Which is not unique in SD. Not even close.

  11. Brian says:

    NI,

    We’re not going to get a single payer system without having a public option first. And we won’t get either until filibuster rules are changed, or Democrats have another 60+ Senate. Pushing for it otherwise would be just as futile as trying to repeal the PPACA.

  12. GROG says:

    NotImpressed said: Universal single-payer, which is what a big majority of the public wanted,

    What recent polling do you have that shows a big majority of the public want a single payer system?

    I don’t buy that claim.

  13. dcpetterson says:

    Brian, I agree with you. Which is why the filibuster rules also have to change in 2012. Again, this was presuming SCTOUS strikes down the individual mandate. A reasonable and rational court wouldn’t, of course, but the activist conservatives on the Court don’t care much about precedent or reason, only ideology. So it’s going to be a crap shoot.

    The purpose of the mandate was to add more people into the insurance pool, so there is enough money to pay for those who currently have no coverage. Another approach would be to institute a simple tax to pay for uninsured people, and to credit that tax back to everyone who has insurance. The amount of the tax should be set to whatever is needed to pay the expenses of uninsured people. This is an easy “back door” way to get to single payer.

  14. NotImpressed says:

    GROG, I don’t know of any recent polling on single payer. Which is why I said the individual mandate is what “a big majority of the public wanted” You are free to show us recent polls that indicate they’ve changed their minds.

    There certainly are recent polls that show a plurality (in some polls, a majority) do NOT want to repeal PPACA. Around 20% want it repealed. A similar number want parts of it repealed. The rest want it retained, or improved. Do you need me to find one of these polls, or do you recall when they were discussed here previously?

  15. Mr. Universe says:

    Getting the Obamacare repealed is the nation’s business.

    It is the Republican’s business. The rest of us have better things to do.

  16. NotImpressed says:

    “GROG, I don’t know of any recent polling on single payer. Which is why I said the individual mandate is what “a big majority of the public wanted” ”

    I’m sorry, I meant universal single-payer is what a majority wanted. My bad.

  17. Mule Rider says:

    “It’s an odd thing, but people who have never lived in SD seem to think it’s not so bad, ”

    I seriously doubt that most people who’ve never lived in SD give two thoughts about how good or bad a place it is to live. I think most people who do would come to two general conclusions – it’s mostly rural or sparsely populated, which could be good or bad depending on whether you want more “things to do” or you like peace and quiet. Also, the weather, which again could be good or bad depending on your preference for or against longer winters.

    “…based on arbitrary metrics that they’ve made up.”

    You mean, things like unemployment, crime, business/economic growth, pollution, etc.? Yeah, I mean, they should probably be measuring things like hot dog stands per square mile, the coyote population, and average elevation to get a more accurate picture of how good/bad a place it is to live.

    Seriously, you sound like some of the locals when a report comes out ranking Memphis in the top tier of cities with high violent crime rates….which are built on metrics that are widely accepted as measuring public safety and are applied equally and fairly to all cities….rather than admit there’s a problem and do something about it (admittedly, though, some actually are doing something), they just cry foul about being the victim of an “arbitrary set of numbers” that don’t tell anyhing. C’mon, man, you’re better than that.

    “I’ll believe otherwise when I stop seeing stories like this.”

    So a few major nutcases ruin the entire state’s reputation? C’mon, dude, seriously? There’s a plethora of idiots like that everywhere…

    “Which is not unique in SD. Not even close.”

    …which is what you seem to admit here, which is why it seems curious for you to single them out as a backwards hellhole (plus the partisan swipe).

  18. shiloh says:

    Reagan’s Solicitor General Charles Fried: ‘I Am Quite Sure That The Health Care Mandate Is Constitutional’

    In a Senate Judiciary Committee hearing today on “The Constitutionality of the Affordable Care Act,” President Ronald Reagan’s former Solicitor General — Harvard Law Professor Charles Fried — tore into the reasoning of Judge Roger Vinson’s decision striking down the Affordable Care Act, saying the issue should be a “no brainer”:

    I am quite sure that the health care mandate is constitutional. … My authorities are not recent. They go back to John Marshall, who sat in the Virginia legislature at the time they ratified the Constitution, and who, in 1824, in Gibbons v. Ogden, said, regarding Congress’ Commerce power, “what is this power? It is the power to regulate. That is—to proscribe the rule by which commerce is governed.” To my mind, that is the end of the story of the constitutional basis for the mandate.

    The mandate is a rule—more accurately, “part of a system of rules by which commerce is to be governed,” to quote Chief Justice Marshall. And if that weren’t enough for you—though it is enough for me—you go back to Marshall in 1819, in McCulloch v. Maryland, where he said “the powers given to the government imply the ordinary means of execution. The government which has the right to do an act”—surely, to regulate health insurance—“and has imposed on it the duty of performing that act, must, according to the dictates of reason, be allowed to select the means.” And that is the Necessary and Proper Clause. […]

    I think that one thing about Judge Vinson’s opinion, where he said that if we strike down the mandate everything else goes, shows as well as anything could that the mandate is necessary to the accomplishment of the regulation of health insurance.

    If the right-wing argument against the mandate is accepted, Fried argued “not only is ObamaCare unconstitutional, but then so is RomneyCare in Massachusetts.”

    Fried does explain that he is “not a partisan” for the Affordable Care Act, and that he has some doubts about whether it is good policy. But Fried’s position on the law’s requirement that all people carry insurance reflects exactly how the Constitution is supposed to operate. Elected officials are supposed to make policy decisions, not judges who have to ignore entire constitutional provisions in order to impose their policy preferences on the law.
    ~~~~~

    carry on

  19. NotImpressed says:

    GROG:

    @NI: You are free to show us recent polls that indicate they’ve changed their minds.

    http://www.politifact.com/truth-o-meter/statements/2009/oct/01/michael-moore/michael-moore-claims-majority-favor-single-payer-h/

    The article you linked was from late 2009. I asked for a recent poll. Did you find one?

    The article you linked made the point that the way the question is asked has an affect on the results you get. I suspect we all would agree with that.

    Maybe the meat of the article is this:

    … in an October 2008 Kaiser poll … the public is all over the map. Fifteen percent said they most prefer that “all Americans get their insurance from a single government plan.” A similar percentage said they prefer “requiring employers to either offer health insurance or pay money into a government pool.” And 14 percent each said their top choice was “offering tax breaks to businesses that do offer health insurance” or “requiring all Americans to have health insurance, with tax credits or other aid to help those who can’t afford it.” That’s hardly a consensus for single-payer.

    Single-payer scored extremely well when polls simply ask if people like that. When a range of options are presented, single-payer is one of many that people like. What America doesn’t want is repeal of the PPACA. America also doesn’t want the Republican do-nothing plan. We want something do be done. Notice that none of the ideas that people liked in the poll the article talks about (from October 2008), was the Republican do-nothing idea. Ideas that include various levels of “government intrusion” are wildly popular. Also from the article:

    68 percent in the September poll said they favored a plan to require all Americans to have health insurance, either from their employer or from another source, with financial help for those who can’t afford it

    THIS IS BASICALLY PPACA!!!!

    . … 67 percent said they favored offering tax credits to help people buy private health insurance. The same percentage said they favored a plan to require employers to offer health insurance to their workers or pay money into a government fund that will pay to cover those without insurance.

    THIS IS THE PUBLIC OPTION!!!

    Well, you asked me for a recent poll showing the current popularity of single-payer. I admitted I didn’t have one, and asked you to show a recent poll opposing single-payer. You’ve admitted you don’t have one, but you do have older polls showing the Republican ideas for Health Care Reform to not even be on the map. Thanks.

  20. NotImpressed says:

    GROG,
    Let me also point out, the October 2008 Kaiser poll on which this article was relying, is so old that it is even prior to the 2008 election. Prior to the in-depth discussion of what options are available. This article you linked, from late 2009, had to reach a year earlier to find a poll that ranks single-payer as being no more popular than the other plethora of options that were being discussed in the 2008 campaign.

    Can you find any polls more recent than October 2008? Maybe ones that provide support for your position (I’m not sure the Oct 2008 poll does)?

  21. shortchain says:

    MR,

    Note: “Not unique in” is not the same as “Not unique to“.

  22. Mule Rider says:

    “Note: “Not unique in” is not the same as “Not unique to“.”

    Duly noted. I missed that subtle difference.

    However, I still think you’re overblowing what goes on there. I should send you updates on local events in Memphis and the surrounding area.

  23. Michael Weiss says:

    I’m surprised that nobody has offered a serious rebuttal to the outcomes I outlined. Does this mean everyone here agrees with me on this point?

  24. NotImpressed says:

    GROG asked: “How did Obama and the Democrats think PPACA would ever pass constitutional muster?”

    I missed this before. It’s worth noting that half the Federal judges who have heard arguments agree with the Democrats. This implies the question is not so cut-and-dried as you think, GROG. Apparently there is a good argument to be made for it being entirely Constitutional. 2 of 4 Federal judges think so.

  25. Bart DePalma says:

    shortchain says: Since the GOP plan would allow insurance companies to sell their sub-standard plans nationally, probably encouraging them, like banks, to move to South Dakota, where their workers would all be required to go to work armed…

    Are you referring to the SD with a solvent government, 4.6% unemployment and no sign of recession? Given that SD also has amongst the lowest crime rates, the only reason folks would go to work armed is to meet buddies to go hunting.

    So I really don’t want their regulations governing my health insurance.

    You really don’t get it, do you? If insurers went to SD, it would be because the state did not enact regulation governing your health insurance. It is under Obamacare that you are taxed for buying too much insurance or for not buying government directed insurance at all.

    Mr. Universe says: BTW: the repeal of health care failed in the Senate yesterday as expected. Hopefully, Republicans will get back to doing the nation’s business. Something tells me they won’t.

    The GOP will continue to offer Dems the opportunity to do their voters’ business and repeal Obamacare. The Republicans shouldn’t have to do so given that Judge Vinson’s ruling already found Obamacare illegal. Naturally, that has not stopped this outlaw regime from ignoring the ruling.

    NotImpressed says: GROG, no, creating jobs is the nation’s business.

    Governments do not create private sector jobs. The best government can do is repeal the acts which inhibit job growth. Spiking employee health insurance premiums with Obamacare is a big one of those acts. Even Obama recognizes this as it applies to his allies and campaign contributors as shown by the roughly 750 waiver granted to date.

    I’m not thrilled about the individual mandate either. It was a Republican idea, and a bad one.

    When did Hillary Clinton become a Republican?

    Brian says: We’re not going to get a single payer system without having a public option first. And we won’t get either until filibuster rules are changed, or Democrats have another 60+ Senate. Pushing for it otherwise would be just as futile as trying to repeal the PPACA.

    The Dems did not remove the filibuster because the GOP will almost certainly have a majority in 2013, based largely on the Dem incumbent’s votes for Obamacare. I am all on favor of removing the filibuster, because after Obama loses his job the filibuster will be the only tool the Dems have to preserve Obamacare.

    shiloh says: In a Senate Judiciary Committee hearing today on “The Constitutionality of the Affordable Care Act,” President Ronald Reagan’s former Solicitor General — Harvard Law Professor Charles Fried — tore into the reasoning of Judge Roger Vinson’s decision striking down the Affordable Care Act, saying the issue should be a “no brainer”: I am quite sure that the health care mandate is constitutional. … My authorities are not recent. They go back to John Marshall, who sat in the Virginia legislature at the time they ratified the Constitution, and who, in 1824, in Gibbons v. Ogden, said, regarding Congress’ Commerce power, “what is this power? It is the power to regulate. That is—to proscribe the rule by which commerce is governed.” To my mind, that is the end of the story of the constitutional basis for the mandate.

    No one is saying that Congress may nor regulate commerce. Judge Vinson’s holding was that declining to buy insurance or doing nothing is by definition not commerce.

    If the right-wing argument against the mandate is accepted, Fried argued “not only is ObamaCare unconstitutional, but then so is RomneyCare in Massachusetts.”

    Is Fried being misquoted or quoted out of context? I have a hard time believing that a law professor is this ignorant or dishonest. Article I’s enumerated powers limit the authority of Congress, not any state legislature. Indeed, the Tenth Amendment guarantees that states retain all other powers not delegated to the federal government.

    In sum, the MA legislature may enact anything which does not violate an individual right in the Constitution or the boundaries (if any) of the power granted by the MA constitution. This is why the comparison of the Obamacare individual mandate to state mandates to buy auto insurance are inapt.

  26. shortchain says:

    MR,

    Apparently you missed the part of the story that informed us that he had been a member of the South Dakota state legislature.

    Bart,

    South Dakota has very little crime because there’s almost nothing worth stealing — but also because they simply don’t report a lot of it, especially around the reservations, which occupy much of the state.

    You are obviously ignorant of the conditions in South Dakota. The reason for the low unemployment is the fact that, as a permanently depressed area, and an extremely regressive unemployment insurance, people leave the state rather than becoming long-term unemployed there.

  27. shiloh says:

    Barted ~ shiloh says:

    Actually, to be accurate and “we” always strive to be accurate at 538, it was Ian Millhiser at Think Progress commenting on what Reagan’s Solicitor General Charles Fried said/testified to at a Senate Judiciary Committee hearing re: the constitutionality of ACA.

  28. Mule Rider says:

    “Apparently you missed the part of the story that informed us that he had been a member of the South Dakota state legislature.”

    No, I caught that. Chalk it up as another disgusting animal somehow getting elected….but he ain’t the first and won’t be the last….and it’s not a problem unique to South Dakota.

    Our local politicians (at least the most recent mayor Herenton and his cronies) are notorious scoundrels and criminals, although their infractions were of a completely different sort from fondling underage girls.

  29. Yiddish says:

    Maybe you would get more intelligent conservatives here if you treated them with a minimal amount of respect.

  30. Mule Rider says:

    “South Dakota has very little crime because there’s almost nothing worth stealing”

    Okay, let’s identify this for what it is. An opinion, not a fact.

    “— but also because they simply don’t report a lot of it, especially around the reservations, which occupy much of the state.”

    Misreporting, underreporting, twisting, etc. of crime statisctics isn’t a problem unique to South Dakota.

    “You are obviously ignorant of the conditions in South Dakota. The reason for the low unemployment is the fact that, as a permanently depressed area, and an extremely regressive unemployment insurance, people leave the state rather than becoming long-term unemployed there.”

    And it’s SD’s fault that other states are willing to give them more handouts or let them mooch?

    Maybe they’re simply relocating to fill a labor shortage in another state. Ideally, isn’t that what we want? Instead of people squatting in the same place forever and drawing unemployment or becoming a ward of the state in some other capacity, they actually go find something to be productive elsewhere (in another state). What a novel idea.

  31. shiloh says:

    Maybe you would get more intelligent conservatives here if you treated them with a minimal amount of respect.

    Interesting thought as I would posit intelligent conservatives/liberals, as a rule, probably seek celebrity status and as such flock to CNN, MSNBC, fixednoise etc. to be one of their ad nauseam pundits.

    Human nature dictates cliques ie red state, freeperville, drudge, fixednoise, malkin etc. websites are mostly wingers who shout down the few liberals and kos etc. is progressives who shout down the few winger trolls who have wayyy too much free time on their hands.

    Whereas huffington compost is equal parts wingers/liberals who shout at each other 24/7 to no effect lol.

    >

    Their really is no endgame to political blogging, just occasional entertainment value by default.

    Can you hear me now!

  32. Yiddish,
    I try, but I am just one person. I certainly treated our most recent conservative commenter with a great deal of respect, but he apparently couldn’t deal with a few of the others here.

  33. Bartbuster says:

    Maybe you would get more intelligent conservatives here if you treated them with a minimal amount of respect.

    It looks to me like they’re being treated with the minimal amount of respect, which is probably more than they deserve.

  34. shortchain says:

    MR,

    OK, if your state has low-life yahoos like Klaudt in the state legislature, then I don’t want your state to be the state in which my insurance is based. But hey, I’m a reasonable guy. If you or Bart want people like Klaudt writing the laws governing your health insurance, that’s your lookout. Get your legislature to allow your insurance companies to be located wherever they like.

    Or move to SD. (Write if you find work.)

    Just don’t expect me to go along with it. I’ve seen too much of the result of allowing corporations to locate themselves out of the reach of local laws.

  35. NotImpressed says:

    Bart:
    “If insurers went to SD, it would be because the state did not enact regulation governing your health insurance.”

    You really don’t get it, do you? We NEED regulations governing health insurance because the insurance companies screw us otherwise.

    Or maybe you DO get it. Do you maybe like getting screwed?

  36. Bart DePalma says:

    BD: “If insurers went to SD, it would be because the state did not enact regulation governing your health insurance.”

    NotImpressed says: We NEED regulations governing health insurance because the insurance companies screw us otherwise

    Precisely what regulations in effect now keep insurance companies from screwing us?

    Insurance policies are enforced by contract law and are construed against the insurers who wrote them.

    Regulations which outlaw affordable insurance policies are what screw us.

    Insurers are delighted to sell you as much coverage as you want to buy.

  37. NotImpressed says:

    Mr. DePalama, the PPACA includes a host of regulations that will protect the consumer. That is why America does not want PPACA to be repealed.

  38. GROG says:

    Michael,

    IMHO, you have always treated everyone here with a great deal of respect.

  39. Mule Rider says:

    “IMHO, you have always treated everyone here with a great deal of respect”

    Ditto that. Some of the others are very civil and respectful too (mclever and Realist come to mind), and recent discussions with shortchain, Max, and Number Seven are increasingly pleasant, and while I don’t have much back and forth with them, I’m fine with Jean, Monotreme, and Mr. Universe. Gotta give a shout out to filistro too. She’s been sweet to me, even when I didn’t deserve it. I can tolerate dc/shrinkers, but sometimes he can drive me batty with his blind partisanship and double-standards regarding talking points and baseless assertions.

    Shiloh is just shiloh, which is to say an annoying asshat, but what can you do, right? Just let him cry/laugh it out, I guess.

    Really, the problem I seem to have is with Bartbuster, and even he’s been somewhat more civil in recent days.

  40. That’s why I’m so disappointed that Rob left so quickly. He could have been part of the solution, but instead became part of the problem.

  41. Mule has also demonstrated that even a mule can change his spots, as it were. That’s commendable.

  42. Mr. Universe says:

    @Yiddish

    Maybe you would get more intelligent conservatives here if you treated them with a minimal amount of respect.

    We really try to keep the disrespect reigned in but there’s only so much we can do in a free forum. Plus, some of us have been sparring for years. Mule and I have had our differences in the past but we have managed to form a truce. I’m digging the new improved version of him. I even have to give Bart credit. We’re like matter/anti-matter. If we ever met in person, the universe (the real one, not me) would probably implode but he does manage to keep it civil for the most part.

    As far as political blogs go, I think we’re fairly tame. Although I was a little disappointed in the way parksie was treated recently. Apologies if you’ve been offended by anyone here.

    Oh, and thanks for catching the grammatical error the other day.

  43. shortchain says:

    On the subject of both the healthcare debate and South Dakota, Jack Balkin has something to say.

  44. Mr. Universe says:

    @Yiddish

    The other side of the equation is that there are some pretty smart cookies in here. We make pretty solid arguments. It annoys some folks on the right.

  45. Mr. Universe says:

    From the article Shortchain cited,

    The assault on the health care bill is not a defense of liberty. It is a defense of selfishness.

    Profound

    On the subject of South Dakota, I do like their new Republican rep (and not because she’s easy on the eyes). She has good policy positions. I can see why they elected her even though her opponent had good ideas as well.

  46. mclever says:

    Michael,

    I find very little to disagree with your assessment of the likely results if the Republican plan for Healthcare were to be enacted. You summed it up very well.

    Basically, as I see it:

    – In many ways, I like the idea of insurance being sold across state lines. Given the number of times I’ve moved, I’ve often wished I could have kept my prior health insurance in my new state. With a mobile workforce, there can be some real benefits to such portability. However, if insurance companies are allowed to sell across state lines, but only have to adhere to the minimum regulations of the originating state, then that creates a de facto Federalization of insurance regulation, because the only rules anyone *has* to follow will be whatever the federal rules are. So, hats off to the Republicans for federalizing insurance regulation and increasing portability!

    – But there’s a fly in that ointment. They strip out the existing federal regulations for minimum insurance standards. D’oh! Well, that means there will be no standards, because I’m sure there’ll be at least one state that has no rules (South Dakota has been suggested, but there are plenty of others with poor regulation of health insurance).

    – This creates a race-to-the-bottom for insurance providers, where the “winners” are the ones who can collect the most in fees while paying out the least in claims. Generally not good for the consumer. We have federally mandated consumer protections in other industries (the recently passed credit card rules come to mind), so there is no valid reason why we shouldn’t have some federal minimum standards on health insurance for the sake of protecting the customer from abusive corporate practices. The standards set in PPACA do not seem onerous, and I personally think they don’t yet go far enough.

    – While I’m not fond of the individual mandate, I understand its necessity for purposes of broadening the insured pool and thus lowering the average costs for everyone. I know this is a tough concept for some people, but that’s how it works. If we’re serious about lowering our country’s costs for medical care, then a key element of that must be absolute universal coverage. If you don’t like the mandate, then what is your alternative proposal for ensuring universal insurance coverage?

    – Recognizing the burden that the mandate places on lower-income workers, the subsidies make sense as a means of creating a transition between full Medicare/Medicaid coverage and full premiums paid by the individual. Personally, I would have preferred that they allow people to purchase Medicare coverage on a sliding scale based on income/hardship.

    Any one else with other ideas??

  47. dcpetterson says:

    I’ve also been impressed with the new Mule. Civil conversation beats empty name calling every time.

  48. Mr. Universe says:

    @mclever and others,

    Here’s an example from my field. One of the first abusers of internet downloading was Napster. It was successfully shut down because all of its operations were in the US and fell under the jurisdiction of US copyright law. Afterwards, people got creative and a new company was formed in Australia called Kazaa. The difficulty in going after Kazaa was that different segments of their operations were in different countries. Part of their operations were on the Pacific island of Vanuatu (Survivor filmed a season there). They have almost no copyright laws on Vanuatu. Kazaa’s servers were located in Estonia; another country with weak copyright laws.

    Consequently, downloading laws are now based on the country where the download occurred, not the country of origin.

    I get the impression that something similar is happening with health insurance companies.

  49. mclever says:

    I’ll second dcpetterson’s expressed appreciation of Mule’s recent efforts towards civility. An opinion (whether supported by fact or not) that’s expressed in a civil tone is much more conducive to informative, collaborative debate. While corroborated facts are certainly appreciated, not every opinion requires referenced sources to be a valuable contribution to the discussion. Keep it up Mule!

    🙂

    BTW, I apologize for not being around much this past week… I’d have liked the chance to engage with Rob before he disappeared, but I was serving my civic duty as a Juror…

  50. mclever says:

    Mr. Universe,

    Extending that parallel between Napster and health insurance regulation, what would you see a workable plan for interstate portability looking like? Or do you think it’s unworkable without strong federal regulation?

  51. Bart DePalma says:

    shortchain says: On the subject of both the healthcare debate and South Dakota, Jack Balkin has something to say: “The requirement to join the militia (and purchase arms for the defense of the state) was an aspect of civic republicanism– the political idea that citizens had a duty to work toward the public good and make sacrifices on behalf of their fellow citizens and the republic (the res publica, or public thing)…What is lost in the debate over the individual mandate is that the point of the individual mandate is also civic republican in nature.”

    Article I expressly grants Congress the power “To provide for organizing, arming, and disciplining, the Militia, and for governing such Part of them as may be employed in the Service of the United States, reserving to the States respectively, the Appointment of the Officers, and the Authority of training the Militia according to the discipline prescribed by Congress.”

    The militia clause requires Congress to provide for arming the militia and nowhere grants Congress the power to require citizens to buy their own arms and equipment. Rather than running the issue up through the courts as we do today, the citizenry largely ignored unconstitutional law.

    I suspect Jack Balkin would be among the first to protest if a Republican Congress required him to purchase an M-16, web gear and report for training.

  52. Mr. Universe says:

    @mclever

    what would you see a workable plan for interstate portability looking like?

    Well, I’m with shortchain here. I hated the whole HMO thing that happened in the nineties. And I also experienced a (what’s a polite term….) shafting on a claim that the insurance company had assured me would be covered. Nobody shed any tears that it ruined my credit. I sort of gave up on ever having health care and haven’t since.

    But to address your question, yes. The only way I can see to have universal healthcare is to have federal guidelines regulating the process.

    The car insurance example has been cited previously. I can choose between GIECO or Progressive regardless of where I live. How hard would it be to set that up for health insurance?

    I think the answer to that lays with the insurance companies who have enjoyed gaming the regulation for far too long.

  53. shortchain says:

    I guess Bart thinks the proposed law in SD requiring citizens to buy a weapon is ridiculous.

    I have to guess, because spitting up a hairball of what appears to be legalese is not a sensible response to such idiocy.

    BTW, in the Revolutionary War, the militia were required to purchase their own arms, and we can assume that this was what was implied by the Constitution — so Bart is spouting nonsense, as usual. I wonder if he actually passed military history.

  54. mclever says:

    Mr. Universe,

    Part of what isn’t always obvious to the consumer is that companies like GEICO, Allstate, or Progressive actually setup several smaller companies (for each state where the rules are substantially different) that are then housed under the umbrella organization. For example, there are different Allstate companies for Florida, Texas, and California. Each is fiscally independent, so that if a hurricane hit Florida and bankrupted the Floridian subsidiary, it wouldn’t bankrupt the entire Allstate organization. If you transfer your GEICO insurance from Texas to California, then you actually change “companies” and pay newly re-calculated premiums for a (potentially) totally different coverage basis formulated by California’s rules rather than Texas’s. Same thing with AAA, State Farm, etc…

    Within the health insurance world, Blue Cross already does this, more or less, with it’s multiple subsidiaries. The difference being that (prior to Obamacare) they could ditch you for no apparent reason and/or the sibling subsidiary had no obligation to accept your transferred individual policy. If you move, you basically have to start the application process fresh each time, even though you’re staying within the same insurance network.

  55. mclever says:

    http://news.yahoo.com/s/ap/us_health_care_five_americans

    One says:

    His message for Congress?

    “Don’t take my Obamacare away because I need it.”

  56. mostlyilurk says:

    Even though I mostly lurk, I second (third or fourth maybe) the preference for the new MR. He was kinda scary at the old 538, what with the threats to gut people and all. I actually enjoy reading his posts now, although I don’t often agree with him.

  57. Mr. Universe says:

    @mclever

    So basically, you’re in good hands with Allstate unless you live in New Orleans. Or on the San Andreas fault.

  58. mclever says:

    LOL @ Mr. U

    I have to be careful, because I know far too much about how Allstate does business from a financial risk management perspective. Let’s just say, they’re not my provider for home or auto. And I especially wouldn’t choose them if I lived in Florida or California.

  59. Number Seven says:

    Jon Stewart does it again by calling this what it really is: The No Taxpayer Funding for Abortion Act

    Enjoy

  60. Number Seven says:

    Damned those founding fathers, lol

  61. JC2 says:

    Ok, so I am not too skilled with blogs. Mea culpa. My previous post is not spam and I don’t know how/if I can delete it. The links should be valid and safe to paste into your browser’s address bar. My apologies to all for that premature posting.

    Mr Weiss, I am in general agreement with your evaluation of the impact of the Republican proposals and their possible (probable) impacts as presented in the key article.

    What I was trying to do with my reply was to put up a couple of links to articles about possible legal precedent that might be presented to SCOTUS in favor of PPACA that may also shed light light on what the original constitutional framer’s intent might have been.

    In summary: “in July of 1798, Congress passed “An Act for the Relief of Sick and Disabled Seaman,” this act created government run hospitals and mandatory health insurance paid from privately earned wages. The health care system evolved into “the Public Health Service, a government operated health service that exists to this day under the supervision of the Surgeon General.”

    http://blogs.forbes.com/rickungar/2011/01/17/congress-passes-socialized-medicine-and-mandates-health-insurance-in-1798/

    Also please look at this: http://www.common-place.org/vol-09/no-01/rao/

    And this: http://voices.washingtonpost.com/plum-line/2011/01/founding_fathers_favored_gover.html

    Respects to all.

  62. JC2,
    No worries. Sometimes things get caught in the spam filter. Remember that spammers work hard to make spam indistinguishable from legitimate content. It’s remarkable that the filters work at all.

  63. JC2,
    BTW, your use of disposable email addresses makes it easier for someone to spoof your comments. Any address you supply will be kept in strict confidence, and cannot be found by web crawlers, so feel free to use your real address.

  64. dcpetterson says:

    JC2 Welcome, and thank you for those links! Very informative, applicable, and worthwhile.

  65. Max aka Birdpilot says:

    JC2

    Wow! Thanks for bringing that one to the table.

    Wow!

    Sure makes a BIGASS dent in those arguing original intent, now don’t it!

    Wow!

  66. Mr. Universe says:

    Here’s the achilles heel of the PPACA deal. In getting it passed, the President had to bargain away certain elements that are now being challenged in the courts; specifically, the mandate. But I think the bill was a faulty compromise. We’re either all-in on this thing or we’re not. That means including the single payer or public option. It means regulating health insurance on a national, interstate basis. It probably means the end of employer based health care plans.

    There really is no compromise situation here and the Obama administration is banking on future ‘improvements’ to move us in the direction of…wait for it…socialized health care coverage (Hi, Canada).

    The Republicans are banking on chipping away at the compromise being unworkable. And it is unworkable in its present form. But instead of arguing to improve it, they will use its unworkability to try and tank it.

    The beauty of PPACA is that it set a chock behind the wheel. If we can keep Republicans from removing the chock, then we have something to work with.

    Ironically, Republicans don’t realize the damage they are causing themselves by opposing this. They think they’re doing the country a favour by pushing for its repeal.

    Vice President Biden was right, this is a big fucking deal.

  67. JC2 says:

    @Michael, Thanks for the tips. I might have to go so far as to register but not yet. (can’t think of a good four letter moniker). My erroneous, short post was a case of fumble fingers I felt compelled to explain.

    BTW- I think I gave you a two star vote on this post by accident. Sorry, I meant to hit it hit you with a fiver.- more fumble fingers.

    @DCPetterson, @Max aka Birdpilot

    Thanks for the good words. Been a fly on the wall since a couple of months before Sen. John MCCain selected ‘what’s her name?’ as his running mate. (So sad, there was a time I respected him.) Posted a couple of times on fivethirtyeight.org; Not quick enough to appear original and I just fell through the cracks. You guys and gals are just too sharp and fast for me and that is a good thing.

    The merchant marine insurance information has been around as since least July 22, 2009 but never seems to get much traction:

    http://open.salon.com/blog/paul_j_orourke/2009/07/22/our_founding_fathers_socialist_healthcare_system

    I sometimes wondered why it hasn’t shown up here and wanted to cover it before now but didn’t know where to find source information until I heard it on the Randi Rhodes radio show this week:

    “Meanwhile, those dang founding fathers keep stepping on the GOP talking points” 8:42 PM Feb 1st –

    http://bit.ly/BcmZu

    If you don’t hear much more from me it’s not because I left or anything- more likely that I don’t have anything cogent to add.

  68. Max aka Birdpilot says:

    JC2,

    You just gotta think a couple moves ahead all the time! Keep some ammo back and your powder dry.

    LOL!

  69. Pingback: 538Refugees Twitter Account | 538 Refugees

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