Comment Of The Day: “No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not ‘Discrimination’.”

There have been a lot of lively and articulate debates on Ethics Alarms since it began in late 2009, but I don’t know if any post has generated more thoughtful, informed and enlightening comments than this one. Many of them, and I mean ten or more, are Comment of the Day worthy. I would post them all, but it’s more efficient to just send you to the post. I’m very proud of Ethics Alarms readers on this one. It’s an honor to have followers so astute and diverse.

I chose Spartan‘s comment over the others in part because it was the most overtly about ethics, balancing and altruism. Plus the fact that she gets a lot of flack here, and yet perseveres with provocative comments that are well-reasoned and expressed. She is an excellent representative of all the commenters that add so much to this blog.

Here is Spartan’s Comment of the Day on the post, No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not “Discrimination.”

The biggest problem — single payer is a jobs killer. I’ll admit that. Tens of thousands of people will have to find new jobs. Of course, there’s a flip side to this issue. Is it moral to sustain an industry that only benefits the rich and those who have access to employer-sponsored health care?

If we are going to get anywhere in this political debate, we have to be honest. Single payor is not sunshine and rainbows for all. Many people will have to find new jobs. Not everybody will love the care that they are provided. Medical students might decide to become stockbrokers instead because they will not make as much money. (On the plus side, the risk for med mal will go down so maybe there will not be a mass exodus.)

Another truth: a single payer plan will hurt the upper middle class the most. People like me. Because under single payer, I undoubtedly will have to pay more in taxes (the only way it could work), but I most likely will get a lower standard of care down the road. So, I imagine many people like me will go out and buy private insurance to sit on top of government provided medical care. So now I am even out more money. (Similarly, I don’t like my government provided education, so I pay money out of pocket for my kids’ school.)

While acknowledging all of this, I would still vote for single payer. In my view, it’s not ethical to let people die so other people can have jobs. That’s my position. If it means we can never go on another vacation or eat out again, it is more important to me that everyone have access to basic health care.

71 Comments

Filed under Business & Commercial, Comment of the Day, Ethics Alarms Award Nominee, Government & Politics, Health and Medicine, U.S. Society, Workplace

71 responses to “Comment Of The Day: “No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not ‘Discrimination’.”

  1. My rey is that single payer was tried in Vermont, and failed.

  2. Wayne

    Sorry, I am in the middle class range of income and I absolutely do not want a simple payer system based on the Canadian model with it’s lottery system to see a specialist. I am not particularly bothered by a doctor earning a six figure income: He or she paid big time to complete medical school and their residency. There is not right to healthcare and only compassion compels taxpayers to support Medicaid for low income folks. I do not want any more government interference compelling everybody to enroll in a single payer plan. This is a country founded on freedom of choice rather than social justice.

  3. Junkmailfolder

    Congrats and well deserved, but your last paragraph just screams at me to ask this question: why are you not already donating all your money that you don’t need for your immediate needs to charities that fund needy people’s health care?

    • I know right?

      Progressives feel so much better about themselves by forcing others to pay for their own “compassion” because they think we don’t give out the wazoo to other people already.

      Has anyone seen the latest stats on American charitable giving?

    • Spartan

      Why do i have to defend my charitable donations? Even if I gave every cent that’s left over (that’s not much), it’s not going to pay for everyone’s health care. That’s a ridiculous and ineffective model. We are a two income family in one of the highest cost of living cities in the United States. The current model is broken. My additional donations wouldn’t add up to much.

      For the record though, all of my charitable donations go to medical or the arts.

      • Junkmailfolder

        How is this not just rationalization #49-it wouldn’t matter if I did the right thing anyway?

        Look, I just want to understand your (and others) thought process when you declare something like this. I see this all the time – “I’d be happy to pay more taxes to help poor people ____________.”

        Are you saying you aren’t going to do the right thing until everyone else does? Are you saying you think the government will be more efficient than charities or direct contributions to those in need? That an action isn’t ethical unless the problem is completely solved?

        I’m not donating all my excess money, by the way. But then, I don’t think that the government forcing charity on us results in a more ethical society. Just the opposite, in fact.

        • Spartan

          I’ve already explained my rationale.

        • Chris

          “Are you saying you think the government will be more efficient than charities or direct contributions to those in need?”

          Yes, because it is.

            • Spartan

              Private charities can operate very well, but none can operate on the scale that is needed for this problem. We’re talking about medical care for 300 million people.

              • If the discussion is coverage for people who have a hard time paying for coverage, we’re talking about a number smaller by multiple digits than 300,000,000.

                • Spartan

                  You’re still talking about propping up an entire insurance system designed to do nothing but add costs to health care and premiums. That’s inherently unethical and makes it more expensive for everybody.

                  • How so?

                    would that not mean fire insurance has a similar effect on housing construction costs?

                    Or auto insurance having the same effect on auto repair costs?

                  • 1) Obamacare propped up the insurance system.

                    2) no, actually I’m not. I believe in opening up competition, something the insurance companies don’t truly have to deal with anymore.

                    3) I actually think the insurance companies as a whole, through the Byzantine system of regulations and environment of state stifled competition have slowly metastasized into a pseudo-governmental entity (that is to say as a mass, it’s gained a type of control that looks almost governmental in scope). I’d actually love to see medical insurance be forced into a truly competitive market so dynamic that individuals could even see it make more sense to forgo insurance altogether and pay directly for a lot of services and negotiate directly for the bigger services.

                    • Spartan

                      1. Agreed. What’s your point? I have not defended Obamacare.
                      2-3. It does not make sense to have insurance at all for medical care. None. Because everybody needs it every year of their lives. Your house will probably never burn down, so it makes sense to pay a small amount of money to insure it. Insurance is designed to protect from an accident or an event — e.g., a house burning down or a car being involved in an accident. Most medical care is (or should be) preventative health care visits and tests, so that the event or accident never occurs at all. Insurance does not make sense in that scheme. Plus, no matter which way you cut it — and even if there were no regulations at all — you still have tens of thousands of workers whose job it is to try and deny you coverage. That is: 1) immoral; and 2) drives up the cost of health care for everyone.

                      And in your no insurance-at-all land where there is no single payer coverage, a lot of people will not be able to get health care at all. They are now supposed to negotiate for the cost of their dental visits and pap smears? Do you think doctors want to do this? Doctors are asking for less paperwork, not more, so you want them to waste their time on this?

                      My daughter needs to see an allergy specialist tomorrow. Am I supposed to call up ten different doctors, check their rates, try to beat them down, and then schedule an appointment? This is the most inefficient system imaginable and, in the meantime, my daughter’s access to health care (she’s covered in a rash) is being delayed. I have time to compare services for a luxury purchase (like a new car), but if my daughter needs to see a doctor for an immediate need, I will take the first available appointment.

                      BTW — I was an insurance lawyer at an AM Law 100 for 10 years. This is my specialty.

                    • This begs the question as to why insurance is needed to pay for health care.

                      Auto insurance is not needed to pay for oil changes.

                      Homeowners’ insurance is not needed to pay to paint the house.

                    • charlesgreen

                      OMG, Spartan – you actually have some experience in this area! Another ringer!
                      Seriously, great comments; thanks.

                    • Spartan

                      Michael — you keep using this comparison and it just doesn’t work. Oil change to a car is like food/exercise to a human being.

                      I’m not arguing that food should be covered by insurance.

              • No, we are talking about medical care for at most 40 million.

  4. Too bad we haven’t tried a free market system in almost a 75 years. A system known to increase quality while simultaneously decreasing cost.

    But by all means let’s continue to argue against the Frankenstein systems we have had as though they were free market so we can pretend the only real option is socialized medicine. Government funded systems have historical precedence of increasing cost while decreasing quality. But hey we can at least feel good about everyone getting an equally crappy deal right?

    • charlesgreen

      Texagg, not to pick on only you (I’ll pick on Wayne too), but the claim that “a free market system” and “freedom of choice” is the solution to all that ails us is a mindless mantra that is only occasionally true, but not always.

      It’s important to be clear about when free market solutions are good, and when they are not. It’s not all that hard to sort out. Basically:

      Free market solutions ought to be the presumptive default. Unless there is good reason to the contrary, they ought to be the rule.

      1. Exception Number 1: Natural monopolies. It makes no sense to have competition for municipal water supplies; airports; multiple-gauge railroads; fishing grounds; groundwater; or police departments. The basic reason is the putative economic benefit is either simply not there, or is absurdly overwhelmed by the social confusion engendered by multiple suppliers.
      In these cases, a form of regulated monopoly is desirable. (By the way, the airline industry at a national level is precisely this kind of market; we do not have too little competition there, but too little regulation).

      2. Exception Number 2a: Wallet-driven market power monopolies. It’s strategy 101 in business schools that the way to be successful is to be #1 or #2, and the best way to do that is to get more market share than your competition, so you can drive them out of business. The one guaranteed way to do that is to cut prices so low that no one else can compete. Think Walmart. Think Amazon. Think Japanese in the 60s and 70s in any industry.
      The reason we have anti-monopoly laws is to reset the playing field when a competitor dominates the market too strongly.

      3. Exception Number 2b: Product-driven market power monopolies. Where the product is so obscure, expensive, infinitely variable, and difficult to understand that the producers are de facto in control, because it is too confusing and too dangerous to challenge them.
      Drug prescriptions are an interesting example. The ‘free market solution’ to high drug prices was (partly) to let drug companies advertise, and to loosen up the definition of what constituted a ‘new’ drug. What did we get? New diseases like RLS, new definitions of ‘new’ (moving ‘off label’ to ‘on label’) and even higher drug company profits. Because who’s still going to argue with your doc? Especially when he or she gets side benefits from giving in to the latest DTC ads on network news programs?

      Healthcare falls a bit into all three categories. You really only need so many hospitals in a given area. The AMA limits the number of doctors. The only reason for having a middleman in the business (aka insurance companies) is because people like you insist that a “free market solution” is better. We are the only developed country that believes this, and it’s an incontrovertible fact that we are the highest cost. DOH!

      Single payer is a significant step toward a rational model of an industry that is subject to some natural monopoly limits, and is beyond the reach of the average consumer to be self-educated (those med students aren’t just beer-ponging, medicine is complicated).

      We already regulate the following:
      – drug patent time
      – medical licensing
      – drug efficacy
      – health provider procedures
      – insurance provisions at state and national level

      A single payer system wouldn’t solve all our healthcare problems, but it would be a significant start. A base program of Medicare for all, with an option for concierge level care for those who can afford it, would simplify loads of stuff.

      Both parties don’t like to admit it, but there has to be what the GOP used to derisively call “death panels.” The only question is how to do it, because there’s no way we’re going to pay for everyone to get the most expensive treatment. Every other country has figured this out, we can too.

      The other thing both parties don’t like to admit is that we won’t stand as a society for dumping ill people on the side of the road. We will reimburse emergency rooms for serving everyone. The thing is (and this the GOP should be faulted for not acknowledging) that health-care-by-ER is absurdly expensive, and inefficient.

      Single payer offers solutions to both those issues – “free markets” do no such thing. And those are major issues.

      The medical writer Atul Gawande explored the highest-medical-cost county in the US, and the lowest-medical-cost county in the US. They turned out to be Hidalgo County TX (highest cost), and Grand Junction CO (lowest cost).

      After exploring all other options (demographics, hospitals, income) he figured out the difference.

      –Hidalgo County had doubled down on free markets; every doctor had an ownership stake in a diagnostics lab; they ordered boatloads of studies and tests, because in an unregulated natural monopoly there’s nothing to prevent over-capacity of diagnostic clinics.

      –Grand Junction had agreed to collaborate. They co-located in the same buildings, and used pooled resources for diagnostics (“go upstairs to CatScanCo and get a CatScan, I’ll call them and tell them your’e coming”).

      Basically the high cost solution is your “free markets” idea run wild, without regulation. If you want to call Grand Junction the socialist solution, but if you’ve ever been to Grand Junction you might want to think twice before using those words: they’re a lot more likely to cotton to “sticking together as a community” than “socialism.”

      Free markets are not the automatic knee-jerk solution to everything, and I wish everyone who trots out that old hackneyed phrase without thinking, believing that it actually means something, would give it a rest.

      • Spartan

        This should be COTD, not mine.

      • Wayne

        I do have a problem with some of the things the AMA has done, but the fundamental question is does everyone have a right to healthcare? Nothing about that in the Constitution and the Bill of Rights. Only an individual’s compassion compels one morally to fund low income (or no income!) medical care. Compassion for the truly unfortunate is a good thing: However, I don’t want the damn government to tell me that I must be compassionate by raising my tax burden or forcing me into some single payer system where I get substandard medical care.

        • Chris

          There’s no fundamental right to having protection by the fire department or the police in the Constitution either, and yet both of those are socialized.

          • Because it because rapidly clear that both were core government services. You know the story: private fire departments stood by and watched houses burn because the owner hadn’t paid for the service. There really was no alternative to fire and police being basic government services. It’s not a good analogy.

            • Chris

              I was responding to Wayne’s suggestion that only rights specifically articulated in the Constitution should be publicly funded. I agree that healthcare isn’t perfectly analogous to police or fire departments, but I wasn’t really drawing an analogy; I was explaining that whether healthcare is a fundamental right doesn’t really matter to whether or not it should be subsidized.

            • Still, neither are federalized.

              States have general police powers. Congress only has police powers in limited contexts.

              Article I plainly does not empower Congress to regulate health care throughout the United States.

              • Good point, ME—though Obama-ites talked about federalizing the police, since the current ones are all racists secretly trying to gun down innocent African Americans…

                • I think a better term would be “nationalizing” the police force.

                  And double ugh.

                  The Founders were terrified of a standing army because the standing armies are Europe (and their recent masters in America) also doubled as the police force. An an institution trained to fight *enemies* will inevitably view its own citizens as enemies if expected to fulfill police roles.

                  A nationalized police force would be the very embodiment of what the Founders feared most in a standing army.

          • At what level are they “socialized”, Chris? You see, this is “gotcha” quick-draw that Left-wingers think can really end an argument. It doesn’t. The beauty of being a Federalist, especially a Libertarian Federalist, is that with the nuance of the system, I’m quite content with communitarian solutions to problems — when they are applied at the *appropriate* level and the *higher* they go, the more they need to provide a value, which left to it’s own the devices the market cannot produce the value soon enough to avoid a catastrophic harm to the market. The lower they go the more they can fulfill the various market whims of the locals.

            My wife and I run our *family* as a fairly communist regime, though a bit more free than say, Soviet Russia. We really enjoy our *city* Library system. But for the most part, we really love our State keeping out of our business. I think its great that in places like Chicago and other snow-clad northern wastelands, some communities have mandated that each individual be compelled to ensure his section of city sidewalk is clear of snow – I think its great that some communities don’t.

            When a problem arises which threatens the balance of the market severely enough but the market itself cannot provide a solution quickly enough that it essentially cannot save itself, I would submit that is within the government’s purview.

            The first and easiest example, War (certainly the defensive kind). Should a foreign invader be at the doorstep of a commercial republic, no market anywhere will form, equip, train and deploy a brand new army before the invader crosses the frontier and occupies the land. So, that commercial republic Collectivizes it’s defense into a quickly deployable, already equipped and trained force.

            Another example would be the decision of legal disputes. Despite what the truly hyper-libertarians we call “anarcho-capitalists” say, no there could not be a market solution to arbitrating the breaking of law. Standing courts and enforcement arms already have reason to be a collectivized institution. I don’t think police provide a “core service”, as Jack puts it. They are almost NEVER there to actually stop a crime. At best they provide clean up, pursuit and apprehension after the fact. They’re core role, depending, are as agents of the judiciary or agents of the executive.

            Fire fighting services are a great example. They really don’t exist to save any particular property from a fire as much as they exist to prevent the spread of a fire to the rest of the community and if moral luck is on their side they may save some of the affected property. In a fire-fighter-less community, (with not “bucket brigade” style mandated response), if a fire broke out, the market itself would be much to slow to provide a community-saving response.

            Several considerations go into deciding whether or not a particular risk is high enough for a particular community to collectivize a particular task, this is why you see some communities, typically rural with no fire department or a volunteer department only. This decision is also tempered by the scope of the need, is the area under consideration sufficiently intertwined that Individual A ought foot part of the bill for a collective task that protects against a risk he is likely never to face? This is why we have a National level and Nationally funded military – Everyone, even the most remote citizen is affected by a foreign aggressive take over…but this is also why it makes sense to have divided up fire departments, why should Individual A, living 50 miles from the nearest fire station have to foot the bill for a service he-will-NEVER partake of that only catastrophically threatens the community far away from him. His house may burn down, but no fire engine would reach him anyway.

            Several considerations go into deciding what level of government is appropriate for the various institutions that arise to meet these contingent needs. The primary driving forces in our Republic which decide that proper place are 1) How does it balance the Rights of the Individual vs the Ability of the Government vs the Needs of the Community, 2) At which level can it be held most accountable to the People, 3) At which level is it most economical and responsive.

            So no, this isn’t an argument about providing for fundamental rights, even though fundamental rights (especially to property) is a key consideration here, as the health care debate essentially boils down to the coerced appropriation of property (via taxes) to pay for 1) other people’s bad health decisions and 2) nature’s dealing of undesirable hands to some people. Now, I have yet to see a single substantive argument made for the notion that “health care” is a fundamental right. Feel free to try, but good luck avoiding arguments that boil down to “it’s the right thing to do” or “you’re a heartless bastard”, which is pretty much the emotional appeals that the arguers resort to.

            • Spartan

              “Fire fighting services are a great example. They really don’t exist to save any particular property from a fire as much as they exist to prevent the spread of a fire to the rest of the community and if moral luck is on their side they may save some of the affected property. In a fire-fighter-less community, (with not “bucket brigade” style mandated response), if a fire broke out, the market itself would be much to slow to provide a community-saving response.”

              This doesn’t make sense. If we don’t care as a society if one house burns, why would we care if ten or one hundred houses burn? Property is property. Loss of life is loss of life.

              “Everyone, even the most remote citizen is affected by a foreign aggressive take over…but this is also why it makes sense to have divided up fire departments, why should Individual A, living 50 miles from the nearest fire station have to foot the bill for a service he-will-NEVER partake of that only catastrophically threatens the community far away from him. His house may burn down, but no fire engine would reach him anyway.”

              Most rural areas are closer to fire departments than 50 miles. I grew up in one, and we had tiny fire department stations scattered about that depended on volunteers. We also had patrolling ambulances — one of them was near us when my father had a heart attack. But, the reason your analogy fails is that we know that absolutely everybody requires health care. Whether you live in Alaska or Chicago, you will most likely be born in a hospital and chances are you will die in a hospital. And unless we enter into Gattaca-land, whether or not you will live disease free or be stricken with a rare illness is a role of the dice.

              Farmers/ranchers that live more than 50 miles away from fire services have a fire plan on property. They have to. But, whether or not that rancher’s wife will have a premature baby is not something that can be planned for in advance. This is why single payer makes sense.

              • On your first objection, my comment makes perfect sense and your objection misses the point. A fire broken out is already going to do tremendous damage to the burning property. The arrival of the fire department will not change that. The arrival of the fire department will however prevent the spread of damage across the community. It’s really simple. Of course we care about the private property. Somehow I feel like this was a subtle attempt to make the “you heartless bastard” argument the Left has grown to love.

                On your second objection, I think you miss the point also, as I already alluded to rural communities creating solutions sensible for their situation…even if their solution looks completely different and wouldn’t make sense to the needs of a larger, denser community. The point I made, was that because every little community has its own special circustmances and considerations and priorities compared to other communities across the Greater Community which is why fire departments (a collectivized effort) are best organized and and accountable at this lower community level.

                • Spartan

                  “Somehow I feel like this was a subtle attempt to make the “you heartless bastard” argument the Left has grown to love.”

                  That was all in your mind.

              • “But, whether or not that rancher’s wife will have a premature baby is not something that can be planned for in advance. This is why single payer makes sense.”

                That’s a non-sequitur.

                • Spartan

                  It’s not a non-sequitur. One can plan for fire, flood, or other natural disasters. One cannot plan for what diseases their future offspring might have.

                  Everyone will need access to health care throughout their lives, some more than others. We need a policy that gives everyone access to what they need. And hey, if you end up needing to medical care more than me, I still consider it money well spent Tex, because it could have just as easily been me.

                  • So what part of health care should be socialized? One could argue that only chronic illnesses and acute injuries should be socialized. After all, all of these horror stories that we heard to justify the ACA came from people who either suffered major, life-threatening injuries, or suffered from chronic illnesses.

                    Why then, did President Obama focus so much on covering contraception? No one was going bankrupt over the use of contraception.

            • COTD, and thanks for not making this the COTD X 4.

            • Chris

              At what level are they “socialized”, Chris? You see, this is “gotcha” quick-draw that Left-wingers think can really end an argument.

              That is not how I was using it; I was specifically rebutting the argument that we only socialize things when they protect constitutional rights.

              But your suggestion that healthcare be socialized on a community-wide level, like fire and police, is interesting; expand on that.

  5. Chris marschner

    Actually single payer is not a jobs killer. Single payer will shift a private workforce to a federal one. Every transaction will still require an evaluation of the efficacy of the procedure and the fee billed. It is however a revenue killer as taxable profits will disappear.

    The biggest problem is that insurance decouples the patient from the doctor’s fee. Just like an open bar at a wedding people will consume more when they bear no cost. The more subsidies provided the more decoupled patients become from the actual costs of the resources they are consuming.

    • Spartan

      Chris, yes federal employment will grow dramatically under a single payor program but it is hard for me to imagine that it will be a 1 to 1 job replacement.

    • So why does not auto insurance cause similar problems in decoupling car owners from auto mechanics’ fees?

    • charlesgreen

      Chris, au contraire, single payer is a job killer. It kills bureaucratic jobs. So does any advance in efficiency.
      If you’ve got ten underwriters working at five different companies, and you move to single payer, then you’d end up laying off a lot of underwriters.
      In any other debate, that would be called efficiency. Why isn’t it the same here?
      And it’s not just underwriters: who needs salesmen any more with single payer?
      Ditto for the need for expensive systems interfaces to deal with varying systems: when you get one system, things get a lot easier.
      This is in principle no different than a company moving to install a single computer system across a dozen companies acquired over the years who all had their own systems.

      It is a job killer, and that’s a class problem to have: an important one to be sure, but a class problem.

      • Spartan

        Not to mention the claims handlers and the lawyers.

        • Other Bill

          S, you really think the Trial Lawyers are going to allow Congress to end the medical malpractice gravy train? I bet there will be a federally funded and managed single payer med mal insurance entity that will become a pinata for the trial lawyers, just as government workers’ unions have become a honey pot for organizers and pols.

  6. Steve-O-in-NJ

    I nominate Kurt Eichenwald for Ethics Dunce following his poisoning of this discussion with his vile tweet about how every Republican who voted for this change should see a family member sicken and die.

  7. iRock

    Single payer as a job killer is dubious at best and more likely outright false. Single payer puts your government in charge of your healthcare, Veterans Administration healthcare on steroids with all the lying, excessive wait times, bad care and lack of accountability. Healthcare decisions become political where your treatable cancer care requires the ok of Lois Learner and you’ve been an Obama antagonist; treatment denied and your estate may win the appeal after you die. Meanwhile the cost of single payer will be massive and likely hidden in the government and patronage jobs will be abundant for the undeserving but connected.

    Hate the insurance industry, but capitalism forces efficiency into a market over time. Monopolies are transitory as competition chases profits. The Obamacare bureaucracy of regulation massively distorted the insurance market and the reaction to market distortions is higher costs. The cost of health insurance for young people is low because they seldom get sick and rarely see a doctor. Jack up the cost of health insurance for young people and watch them flee a bad deal, increasing the cost for all despite punitive measures. Restrict insurance company profits and maybe it’s not worth the company’s time chasing fraud because the increase in margin is confiscated. Buy Obamacare plan in January, stop paying in September because the insurance company must keep you on plan for three months even if you don’t pay the premium. Many more distortions were introduced by Obamacare. It is a sweet deal for us suckers, not.

    The best and brightest will seldom consider a medical career when it turns into a mediocre government remunerated job. We will start receiving actual healthcare from the equivalent of a restaurant worker. Hope they wash their hands… with soap.

  8. “Hate the insurance industry, but capitalism forces efficiency into a market over time.”

    Right… in the absence of government interference.

    But don’t delude yourself into thinking that the government will ever fully divest from healthcare. And because the government will always have a thumb on the scale… Whether it’s a regulatory role or an administrative role, it’s rainbows and unicorns to expect the system to ever come to an efficient natural conclusion.

    • iRock

      Fair enough, free market health insurance does not imply the absence of all regulations. Necessary government regulations assure insurers solvency, fair delivery of promised services, non-collusion, etc. but not the stranglehold of Obamacare or single payer or Obamacare Co-Ops. Out of 23 Obamacare Co-Ops only 7 remain, most surviving in precarious financial positions with about $2 billion in uncollectable federal loans. The Obamacare Co-Op “franchises” were won by connected Democrat operatives and be assured that the connected pigs will feed under single payer contracts too. Then there is the cost of Obamacare as-is where Obama made hidden payments to insurance companies to keep them in the game despite congress withholding such spending authority. Starting in 2018, not a single insurer will sell policies in Iowa and maybe more states because the Obamacare stranglehold prevents companies from operating at a profit. Obamacare is not working nevermind the high deductibles and high premiums unless you can get it all “free”. Single payer doesn’t need a profit because it doesn’t need to control cost when the government will simply print, borrow or tax more money. We would be better off setting a date certain for Obamacare to end now before U. S. health insurance is completely ruined.

      • It’s why I think the house should have approved Trump’s first version of the health care reform. Enough with this Kabuki theatre of Democrats opposing everythin the Republicans do and vice verse… The fact is that Obamacare is collapsing. And when it collapses, people will end up losing their plans whether they like them or not.

        Much better to get in on the ground floor now and push for beneficial changes now than when the bottom really falls out and everyone is dripping and gagging for something, anything, to cover them.

        • So why would not Republicans just let Obamacare collapse and blame it on the Democrats?

          • Republicans don’t do good PR. No one likes them. Remember the sequester? That was every bit as much Obama’s failure as it was the Republicans, but the media painted it as GOP obstructionism, and the masses bought it. The Republicans want a deal now because the deal later, despite the added leverage, will be ugly. And more importantly, probably, is that they’re people, not moustache twirling villains, and if the Obamacar exchanges fail without anything to back them up, there’s going to be a lot of people, a lot of voters, in a very, very bad place.

          • Because its a government’s job to prevent harm, not allow it to happen for political advantage. You don’t allow a foreign attack so you can blame it on the weak policies of the previous administration.

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