What might a haberdasher know about insurance that Team Obama did not?

The world is being run by highly-credentialed men and women who have passed
through some of our most exclusive universities. Perhaps it’s time to look at haberdashers, again, to see what they know.
– Elizabeth Scalia, I Don’t Want to be a Hoo-er (Patheos Press, 2013)

As one of my Texas-based friends has said, “I may not know much more about insurance beyond the fact that I’m smart enough to get what I need, but goodgohdamighty, even I could have thought up more sensible ways to get folks covered than these clowns in DC, I’ll tell you whut.”

I love. My Texas friends. I could listen to them talk all day. And in the case of this fella, I’m in full agreement. Even I — goofball that I am — have wondered why the Obama administration went all-in for “unmanageable, disruptive monstrosity that needs Hollywood assistance, constant spin and new lies every day to keep afloat, sort of.”

Not long ago, I had a bit of a tussle on Facebook with a friend — I guess he’s a friend — who wrote two incredibly nasty, ideologically-charged remarks that boiled down to how anyone who disliked Obamacare just hated poor people and was probably racist. Because that dishonest, stale and intellectually lazy narrative hasn’t been bitten through, enough.

Our exchange grew heated, and at one point I was treated to the notion that our hero had been thwarted at every turn by people who “offered no alternative ideas”, because they were too busy pushing poor people in wheelchairs over cliffs and bleaching their robes.

So, I offered alternative ideas that I’ve always thought might have taken care of the problem of 30-to-50 million uninsured without disrupting the lives of 300 million others. The response to my offering was the equivalent of “lalala, I can’t hear you, when are you going to offer an alternative, you hateful, unChristian bigot.”

At that point I walked away from the discussion because if people aren’t going to argue in good faith — if they’re going to pretend you didn’t just do what they asked you to do, and they’re going to fall back on partisan sneering — then really, what’s the point? As I’ve said in the combox, recently, I’m done entertaining (and therefore enabling) our national perpetual adolescences. Matters are too grave for that.

Anyway, like my friend in Texas, I am no gol-dung expert in in-surance matters, but I nevertheless have gathered some mere-and-bare-bones evidence that there really were other ways to think about solving our health insurance “crisis” without upending the country, and I’ve laid them out over at First Things.

They may very well be dumb ideas, by the way, I am making no pretense of expertise; but they’re ideas — and thinking and wondering begets more wondering, and that is where creative, constructive and innovative solutions are born. I can’t help thinking that if the administration had shot for a simpler solution — had they entertained actual debate on alternative ideas — they wouldn’t be in a defensive crouch right now, and people who really were happy with their insurance and their doctors and their hospitals would actually be keeping them, right now. Just like the president said — hundreds of times, before he apparently didn’t — that they could.

It’s time to talk about alternatives to Obamacare right now, and this is why:

As this unpopular policy we call Obamacare begins to crumble from the weight of its own incompetent over-reach and mendacity, the opportunity may soon arise for policy reform, but if other voices do not have alternative plans already designed, thought through and set for discussion when an urgent solution is called for, there will be no option left in the political imagination but a single-payer program—managed by these same incompetents—and a nation full of frightened, uninsured people willing to turn to it.

You can read the rest here, and maybe let’s bring on the haberdashers. Let’s find some people who have actually run companies, even small ones, and built things, and understand that you don’t bring a nuclear missile to a problem that requires a pair of suspenders and a good hat.

UPDATE:
Father Dwight
links with another alternative suggestion. Let’s collect them! What are your ideas? What other ideas have you read about?

Harry S. Truman’s Haberdashery/Source

About Elizabeth Scalia
  • http://ashesfromburntroses.blogspot.com/ Manny

    You are right on this one, and so is your Texas friend. This Obamacare is a monstrosity that can’t possibly work given the numbers of healthy people they need to join up. They won’t do it. And they will have disrupted the entire country’s health plans. From what I remember back in 2009 close to 90% of the people in this country were happy with their health insurance. First rule of anything, don’t create harm. Not only is this going to effect the ten million or so people being dropped because they have individual plans, it will effect everyone else who has health insurance through their employer. The employer mandate was pushed out until next year. This year the personal plans are being disrupted; next year the employer plans are being disrupted. And wait until all the doctors see what they are getting as payment. You’re going to see mass. If you think it’s chaos now, just wait until next year. Obamacare needs to die a sudden death.

  • Fiestamom

    Yeah, I got called a racist in 2009/2010 because I argued with facebookers. One “friend” in particular believed the line about “if you like your health care plan, you can keep it.” I tried explaining how that couldn’t be true, she came right back with the Obama lie that our premiums would go down by $2500. She said that disagreeing with Obama on ACA was “the new racism.” She really said that. I I friended her, then quit FB shortly after. The last time I saw her in the grocery store, I smiled and said hello, but she just glared at me. That was a year ago, I wonder if Obamacare still has any support at all is b/c of people who just don’t want to admit (even to a pollster) they were so so wrong?

    I like your ideas on improving health care. We use an HSA, and would put even more of our own money in it, if more was allowed pretax. But the ruling class doesn’t like us to have too much control over our lives does it?

  • Kathy Hutchins

    Off the top of my head: We need to separate the ‘insurance’ part of health insurance from the ‘help poor people pay for routine care’ part of health insurance. They are very different problems shoehorned into one solution space for no good reason.

    Most people middle class and above could pay for their own routine care out of pocket, if the ‘sticker price’ of medical goods and services were not so grossly out-of-whack thanks to decades of supply restraint, regulation, third-party-payers, and nonsensical tax policy. Get rid of all of it. Quit letting the AMA dictate how many people can go to medical school. Quit subjecting hospitals to more onerous regulation than nuclear power plants. Stop the tax favoring of employer sponsored plans. Get out of the way of medical device innovation instead of taxing it to death. And on and on. Just grab a great big broom and clear it out. Now routine care *is* affordable, and you don’t have to get your insurer’s permission to go see that PCP that isn’t in your network, and you don’t have to pay for things you don’t want or need.

    Catastrophic care insurance could probably be handled just fine with slight reforms like selling insurance across straight lines, but I’d like to suggest a completely different model: an insurance policy that simply pays you a fixed lump sum if you contract a grave illness or suffer a traumatic injury. Automobile and property casualty insurance works that way. If you’re in a massive car accident the insurance company doesn’t pay whatever it costs to fix it; it writes a check and you do whatever you want with it. You probably buy a new car, but you don’t have to. And most people would probably buy the care they need to manage or cure the illness, but they could do so on their own terms, not the terms the insurance company dictated.

    Providing medical care for those who simply cannot afford it, even after we straighten out the prices, is a harder problem. Although I know in principle that it is more efficient to give people cash subsidies than goods, I think it this case it might just be better to set up charity clinics and hospitals where anyone can go to receive basic care. It removes a lot of the need for constant vigilance against billing fraud. It would not have to perform very well at all to be better than Medicaid. There is no evidence that Medicaid enrollees are healthier than people with no medical insurance at all.

  • David

    I have an HSA as well. It works perfectly well. You receive medical treatment “at cost”. Docs like it – no forms to submit, no waiting for reimbursement. The catastrophic insurance covers the big stuff – fortunately which hasn’t been needed. Helps to be married to doc also.

  • Jane

    I can just imagine Obama and his cronies doing the “Dr. Evil” thing saying “Let’s charge them one millllllion dollars” if they don’t comply, and just laughing about it. I agree with you, Elizabeth.

  • http://ashesfromburntroses.blogspot.com/ Manny

    OOps, forgot to type the last words in the third from the end sentence. It should say “You’re going to see mass exudus of doctors.”

  • http://ashesfromburntroses.blogspot.com/ Manny

    Interesting ideas. But how would you know how much of a lump sum it will take to address a “grave illenss or traumatic injury”?

  • http://rosarynovice.stblogs.com/ Augustine

    Government comes in; creates an fiscal system that encourages a third-party payer insurer; since the customer and the payer are not the same person, prices are inflated; insurance premiums are raised in consequence; the uninsured go bankrupt, along with the not insured enough, getting healthcare; government comes in and forces everyone to get enough health insurance. Lather, rinse, repeat.

    Here’s the only actual solution: eliminate the root-cause that made healthcare expensive and inefficient, the government. Health is too an important thing to be left to those running the DMV.

  • Jane the Actuary

    So back when I first started blogging, I put my own pet solution, “VoucherCare” out there — http://janetheactuary.blogspot.com/2013/07/vouchercare.html. Similar “voucher” concepts have been proposed, mostly under the guise of tax credits, but with unserious amounts like $2500 per individual/$5,000 per family, failing to acknowledge that healh insurance expense are not a flat cost per individual or family. Of course, the whole thing has to be paid for with a tax hike — but it should be a fair and straightforward one, rather than dozens of hidden “fees.”

  • Bethany Persons

    I like many of your ideas, especially around getting routine care back to actual market rates.

    Your lump sum idea doesn’t account for chronic illness very well though. As someone who was diagnosed with one as a teenager, I’m looking at expensive medication and regular appointments with a specialist for the rest of my life. The medication may go down after the patent expires, but it still wouldn’t be affordable by most definitions. If I didn’t have that medication, I would probably qualify for disability to some degree.

    Also, we’re already dealing with major market disruptions. Even if your ideas would lead to a better equilibrium, the initial shock would not be any better than what we’re seeing now.

  • Bethany Persons

    I’ve always thought offering insurance through associations is a good way to get in on a group plan if you aren’t at a large company. For example, small businesses going in together through their local Better Business Bureau. The Southern Baptist denomination does this for churches in the convention (and others probably do to, I am only speaking from experience).

    I also thought Tort reform would be beneficial for keeping costs from rising as rapidly, though that is a slightly different topic. I believe part of the reason having a baby is so expensive (which is absurd, is there a more common physical experience in the world?) is that obstetricians face litigation if anything goes wrong with the baby or the birth, and parents are very sensitive to things going wrong.

  • EMS

    The simpliest would have been to extend Medicare to everyone. Almost everyone already pays into it (and I didn’t know that you can get into it even if you didn’t pay into it by paying a monthly premium of roughly $500). The bureaucracy already exists, the laws already exist, no need to add new paperwork, supplemental Medicare plans already exist (and every open season, they view with each other to get seniors to sign with them), the (friendly) website already exists and shows every plan available in every area (including costs and coverage), and it covers everyone who is eligible (no need to worry about preexisting conditions). And everyone already knows what the costs and problems can be, so they can be addressed. Instead, we got a 2000 page bill that nobody really read and a host of new problems. BTW, I live in a senior community (heck I’m one now!), and nobody I know would dream of being without it (I nearly went bankrupt caring for my disabled parents – without Medicare, we would have lost everything.)

  • David

    You’re seeing the signs of the MD exodus already. The Medicaid/Medicare reimbursement rates are quite low, that’s why you seeing more docs refusing to take on new Medicaid/Medicare patients now. Obamacare will just accelerate that pace. Those docs remaining most likely will be in concierge practice or refuse insurance of any kind.

  • David

    Offering insurance through associations is a very good way to get into a group plan. Since I’m self-employed, I have catastrophic coverage through my university alumni association. How long I’ll be able to keep my HSA/catastrophic pairing is unknown, but I suspect I won’t have it much longer.
    Regarding, tort reform, that will go a long way in reeling the costs and how medicine is practiced. My wife’s surgical malpractice insurance is her highest cost.

  • http://ashesfromburntroses.blogspot.com/ Manny

    Yes, that is true.

  • Clare Krishan

    ICYMI being “covered” under PPACA does not prevent you from losing everything – a Bronze plan with $12,000 deductibles means paying up a quarter of your income in out of pocket BEFORE your plan’s coverage pays a cent. And woe betide you face a catastrophe such as cancer or infarct: that same Bronze plan expects you to co-insure yourself for 25cents of every dollar spent healing you (that’d be $300,000 of the $1,200,000 tally for the hi-tech cancer-care of that CA lady in the news, prepare to liquidiate your net worth if you get seriously sick and thank Mr Obama for saving you from ye badde Olde Days of the “Wild West” NOT)

  • Clare Krishan

    What makes you think the politicians feel obliged re: “the whole thing has to be paid for with a tax hike — but it should be a fair and straightforward one” outgoings for Social Security and Medicare will soon no longer be covered by payroll tax income… we are bankrupt, and cannot afford the affordable care act.

  • Clare Krishan

    May I enjoin some humility re: “find some people who have actually run companies, even small ones, and built things” for modern medicine requires a precursor to a company, it requires persons with vocations pursuing first an expensive selective education and secondly equally expensive and selective professional credentialling in the practical sciences of healing therapies as a nurse, physician or various adjunct ancillaries. This is not about money or profit primarily, it is about cura animarum pro bono communis.

  • Dagnabbit_42

    I suspect that the reason leftists are always calling non-leftists “racist” is because:

    1. …they know how deep-seated their own racial prejudices are; in response to that knowledge…,

    2. …they have spent a lifetime attempting (with the best of intentions, in good faith) to avoid racism by signing up to give every disadvantaged group whatever goody-bag of special benefits and protected status they could; and,

    3. …they are projecting their own journey and struggles on to everyone else they meet, thinking “gee, the only way I can imagine holding political views other than those I currently hold is if I hadn’t bothered overcompensating for my own bigotry; therefore, the people who DO hold other views must all be people who’re every bit as bigoted as I am, but who haven’t bothered to resist the temptation.”

    If leftists weren’t so bigoted, they’d give the rest of us some peace. But as it is, leftists figure everyone is just like them.

  • http://thebackporchpundits.wordpress.com/ Christian Ohnimus

    Obama is way ahead of you:

    “They can either abide by the sacred tenets of their faith, pay a penalty of over $14 million, and cripple the companies they have spent a lifetime building, or they become complicit in a grave moral wrong.”

    http://blog.acton.org/archives/61912-federal-court-says-obamacare-mandate-trammels-religious-freedom.html

  • http://thebackporchpundits.wordpress.com/ Christian Ohnimus

    When the only cars allowed on the market are Mercedes Benz then the poor and middle-class get screwed over, especially after they’re forced to pay a fine for the privilege of not owning a car. And yet this is how health insurance works now, courtesy of Obamacare.

    If our strange culture didn’t value “progress” so much we could make a return to how we used to do things, repeal the law, and let people figure things out in the absence of this debacle until a real, tenable alternative is prepared. That, however, would simply be backwards so instead we’ll just get a socialized, government-run system for no better reason than we haven’t personally tried it yet. Progress.


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