A few thoughts on the prospects to “repeal and replace” Andy Harris (and Obamacare, too)

The other day I noticed on social media that our Congressman, Andy Harris, had put up a post explaining his vote for Trumpcare 2.0, the “repeal and replace” bill for Obamacare. (Most people refer to it as the American Health Care Act, or AHCA.) At the time I saw this there were 1,043 comments on his post and probably 80 to 90 percent of them were negative. I can guarantee you that 80 to 90 percent of his district doesn’t oppose his vote, but thanks to this so-called “Indivisible” movement we are seeing some of the most seriously squeaky wheels get the grease that comes from taking 30 seconds to write the linguistic equivalent of “you suck!” on his wall. So I took about five to ten minutes to write my response, because there was a little research involved.

1,043 comments, mostly from people who probably didn’t vote for Andy in the first place, vowing he’s going to lose in 2018. Y’all need about 139,000 more folks.

In terms of repealing the disaster known as Obamacare, this was the correct vote, We have a long way to go in the process and it’s way too early to say what will happen in the Senate (except that regardless of what it is, Maryland’s Senators will vote no.)

Oh, and by the way, I just checked out that Allison whats-her-name and if she’s praising NARAL she’s not getting too far in this district. Most of us stand for life.

Also, since you are on the subject of town halls up and down the thread, could you get those aforementioned Senators down here to have one? Interesting how I never hear anyone clamoring for that.

I have to admit I was only being semi-flippant when it came to “Allison whats-her-name” because I had closed my window and honestly didn’t feel like looking it up. Her name is actually Allison Galbraith and she makes her living from, of all things, steering companies to government contracts. I kid you not.

But to begin this piece I want to address the two people who replied directly to my comment, whose names are Gail Jankowski and Bill Schwartz. I’m going to quote their opening sentences here, ladies first.

Gail: We will get MORE than enough votes to replace him because more and more constituents are learning just how negatively this AHCA will affect them!

Bill: Maryland is a Blue State and we need to ensure that the first district is fairly represented.

I’m sure Gail and Bill are nice enough people, and in her case she gets bonus points for (at least presumably, judging by the surname) marrying into a Polish family. (By the same token, I won’t take any points from Bill just because his ancestors insisted on unnecessary consonants.) But they seem to have a slim knowledge of political reality.

What the vast majority of people “know” about the AHCA comes from the talking points being fed to them from the media, which isn’t exactly a set of unbiased observers. But the 2018 campaign won’t begin in earnest for another 15 to 16 months, and what I’ve found out over the years, Gail, is that the issue you may think will drive the electorate this far out isn’t always the one that is front and center by the time people really begin to pay attention, let alone when votes are cast. The big difference between the era of the TEA Party eight years ago in the Obama administration and the Indivisible movement now is, while both are having a discussion about health care as a topic in the off-year before the election – although Obamacare was more dominant in the fall and winter of 2009 – the economy was much, much worse back then. If the economy is in good shape come the fall of 2018, the AHCA will be a minor issue by comparison. People generally vote with their pocketbooks, and the reason the 2010 election was such a wave was the pent-up outrage at an administration that addressed health care before job creation and the economy. (The sticker shock effects of Obamacare were the reason for the 2014 wave election, since it took effect in earnest that year.)

So if the economy remains in decent shape, the AHCA will be so minor of a concern by then that Andy Harris will once again get his 60-65% of the vote and cruise to victory. You see, Bill, Maryland is indeed (and unfortunately) such a blue state that our previous governor and the Democrats got greedy – or at least as greedy as their incumbent Democrat Congressmen would allow them to be. I’ve made this point before, but if the composition of the First Congressional District were the same in 2008 as it became in 2012, Andy Harris would be on his fifth term. By erasing the northern half of Carroll County from the previous configuration of the Sixth Congressional District and adding it to the First, it assured whoever the GOP puts up in the First District will win because the plurality of the state’s Republican voters now reside in the First, and it’s by a factor of almost 50% more than any other district. So based on the electorate of the district the First is fairly represented. (The rest of the state? Well, they are just poorly represented, but I’m working on that.)

So now let me turn to another aspect of social media. My friend Sarah Meyers, who describes herself as a proud moderate Democrat (and is a member of our county’s central committee) was distraught about the passage of the American Health Care Act, claiming, “The Republican House just voted to allow insurance companies to deny me healthcare.”

Now I’ll set aside the false conflation of actually having health care provided and paying for it, since there are other methods of doing so out there, but my response essentially noted that she is in the minority of people who are net beneficiaries of the ACA in terms of paying less. Those who get their insurance through their employer are paying far more, a fact that she chalked up to the “greed” of the insurance companies. But the “greed” is tempered by the fact that group insurers have to pay out 80 to 85 percent of their premium income on medical care, leaving the remainder for “administration, marketing, and profit.” Since neither administration nor marketing are free, one can presume these insurers are not rolling in profit. This “medical loss ratio” is part of the ACA and may be one reason why insurers are dropping out of the business.

One of the next arguments I got was that the ACA “saves lives,” presumably because those who could not afford insurance or were no longer being tossed off for the various reasons of pre-existing conditions, lifetime limits, and so forth were being covered. But the evidence of this is anecdotal at best, and rather dubious in the amount of inference that has to be made. It truly depends on the source, but the best scholarly guess is a net wash. Even some of the partisans concede it’s a bogus argument. And while there’s always the emotional appeal of someone who can come out and claim they are a survivor because they had health insurance through Obamacare, it’s pretty difficult to speak with someone who didn’t because Obamacare made their deductible too expensive.

The most radical solution offered up was the old single-payer bromide, from local leftist Chuck Cook:

Single payer is the only solution, and it has been proven to work in every single industrialized first world nation on the planet… except ours. We are the outlier due to conservative ideology that honors the wealth of billionaires over the health of children.

Uh…..no. Honestly, we’re very close to having a single-payer system in place here given the lack of competition in many places and tight regulations on the health insurance industry in terms of how much they can make, what they must cover, and how they conduct their business. Basically it would be a Medicare/Medicaid for All system and you can just ask a doctor (whose Medicare reimbursement increased a whopping 0.24% this year, with Medicaid reimbursement being a fraction thereof) how they like it or check out study outcomes, as the left-leaning Kaiser Family Foundation did recently, noting…

Multiple studies, though not all, have documented improvements in beneficiaries’ self-reported health, reduced stress and anxiety, and improved quality of life following Medicaid expansions. The Oregon Health Insurance Experiment, which used a research design that is considered the gold standard, compared the experience of adults who gained and adults who did not gain Medicaid coverage through a lottery that allocated a limited number of new Medicaid “slots” for low-income uninsured adults in the state. The study found that Medicaid improved self-reported mental health and reduced clinically observed rates of depression by 30% relative to the uninsured group. The findings related to impacts on physical health were mixed. Medicaid increased the detection of diabetes and use of diabetes medication, but did not have a statistically significant effect on control of diabetes, high blood pressure, or high cholesterol. The researchers note that the study did not have sufficient statistical power to detect changes in these measures, and also that factors including missed diagnosis and inappropriate or ineffective treatments, among others, could mitigate the impact of coverage on clinical outcomes.

…to see if this meets your definition of “proven to work.” For me it’s lacking.

I think both sides agree, though, that the problems with the system are defined simply: access and cost. The government’s solution was twofold: one side was to force everyone into the insurance market whether they wanted to be or not (hence, the “shared responsibility payment”) so that the healthy people would balance out the sick and the other side was to try and make preventative care cost nothing out of pocket, but the problem with that is doctors aren’t going to work for free because they have families to feed, too. And thanks to all of the billing and coding concerns we have with modern government medicine, a good percentage of the staff in any doctor’s office is the overhead required to deal with billing and not there for patient care. (It’s akin to the number of administrators in a school system who don’t educate children.) In other words, “free” is the extra $2,000 on your deductible or $40 a week out of your paycheck.

One analogy often used as a comparison to health insurance is auto insurance, which is also mandatory in most states (New Hampshire is the lone holdout.) However, when you buy auto insurance it does not cover oil changes, new tires, and other mechanical issues. Similarly, the original intent of health insurance was to cover the medical bills in case you were hospitalized, as opposed to supplemental insurance like AFLAC which covers other expenses.

The idea of insurance is that of calculating and sharing risk among as many participants as possible. Let’s say you have a group of 1,000 40-year-olds whose lives are all insured for $100,000 and you know four of them will die on the average in a given year. You then know your premium pool will have to be set to $400,000 plus an amount set aside for the off-chance of a year where more than 4 die, plus administrative expenses, plus a little for shareholders. If you assume those other expenses total $300,000, then each participant would pay $700 a year to be insured for $100,000 if they die, which they may find is a prudent and affordable hedge against that risk as they have families to support. It would be impossible for a group of 2 or 10 to be able to do this, but over a thousand people it’s very attainable.

However, what we now have with health insurance isn’t truly insurance because there is so much mandated coverage and the risks are highly unpredictable. Nor are they being shared among all the participants equally because some are paying themselves through their employer, some are being subsidized for their coverage by the government, and others are completely on the government dime. Because a large amount of the money comes from funds never seen by the buyers (deducted from their checks, or just plain subsidized) they don’t much care what treatment costs, just their premiums and deductibles.

So let me return to the car insurance analogy. You have to have car insurance, and it has to be minimum coverage, but after that the market is relatively free and there are a whole lot of competitors. If you get tired of Allstate because they raised your rates 50% for no good reason, there’s always Progressive. When Flo gets too annoying, Jake from State Farm will be happy to help. If you don’t like them, we have local independent agents. They compete on price, coverage, and service – so why can’t that be the case with true health insurance, too? And what I mean by “true health insurance” is that you select what you want to cover from the options provided by the companies, or you can skip it altogether. (Or, the option for employers to provide group coverage can be left in place as well, as I’ll get to in a moment.)

I can already hear the Sarah Meyerses of the world screaming “but pre-existing conditions!” Yes, there can be high-risk pools created for those at the state level, or even groups of states can create a compact to make the pool even larger and share the cost among more people. If states want to create incentives for employers to provide insurance, that’s fair game as well. I happen to think the Tenth Amendment is the part of the Constitution that’s supposed to be most flexible, allowing states to do a large number of things that should be off-limits to the federal government. I may or may not agree with them, but that is their right to do so. There’s very little need for federal involvement in health care at all – certainly nowhere near the amount we have now.

I’m sorry to break this to Chuck Cook, but the United States isn’t like the rest of the “industrialized first world.” We are a constitutional republic where the federal government is intended to be limited, not maximized and in control of everything. (It’s also worth mentioning that the wealth of our billionaires – and the talent of a lot of other, less well-to-do American people – is quite often freely given to assist in promoting the health of people both here in America and around the world. Here’s a great local example.) So the idea that we don’t have single-payer health care is one of those rare things that’s still a feature of ours and not a bug. That’s not to say it can’t stand some serious improvement, though.

Let’s just see if we can’t make it more in conformance with what our great American experiment in liberty is supposed to be all about, mmmmkay?

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