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This legislation was a complete mess. Republicans have been warning about the Obamacare "death spiral" for years. For the life of me I can't figure out why no o

This legislation was a complete mess. Republicans have been warning about the Obamacare "death spiral" for years. For the life of me I can't figure out why no one is talking about the much worse, much faster death spiral embedded in this legislation: no one would be forced to buy insurance, but insurers still have to take your preexisting condition, and can only charge 30% more for one year for the extra risk. Hello adverse selection! I'm a pretty free-market guy and can get behind healthcare reform in general, but this bill had holes big enough to drive trucks through from the right and left simultaneously with plenty of room to spare. I could believe it coming from Trump, but I have no idea what Paul Ryan was thinking... the guy is supposed to be a policy wonk.

jplayer01 10y ago
Either Ryan is incompetent when it comes to writing legislation and is only good at pretending he's good at it (wouldn't surprise me), or he just wanted to kill the issue and move on the other things.
ethbro 10y ago
This. As someone who's worked on the insurance side of the equation for a while, it always amazes me when people don't realize the majority of health insurance policy is a zero sum game. If insurance companies aren't solvent and profitable, products won't be offered. And that's exactly what happens when you force unfunded / unbalanced mandates on them. Congress can easily legislate the country into a market where no one wants to offer insurance because there's no way to do so sustainably. That said, one of the best things that ACA did was finally target some of the inefficiency in as conservative of a business as insurance. The provision capping administrative costs did a lot to jolt companies into streamlining their operations and investing in modern, more efficient technologies.
- LyndsySimon 10y ago
  > the majority of health insurance policy is a zero sum game That's what "insurance" is. I also don't get why people don't seem to understand that. IMO, a big part of a solution has to be to stop conflating "health insurance" with "healthcare".
maxerickson 10y ago
Medicaid cap.
Upvoter33 10y ago
"the guy is supposed to be a policy wonk" - only in the media's eyes.
johntb86 10y ago
From https://www.cbo.gov/publication/52486 https://www.cbo.gov/publication/52486 - "Even though the new tax credits would be structured differently from the current subsidies and would generally be less generous for those receiving subsidies under current law, the other changes would, in the agencies’ view, lower average premiums enough to attract a sufficient number of relatively healthy people to stabilize the market." Think of the $3000 subsidy towards health insurance as a $3000 penalty if you don't buy health insurance.

jplayer01 10y ago

Either Ryan is incompetent when it comes to writing legislation and is only good at pretending he's good at it (wouldn't surprise me), or he just wanted to kill the issue and move on the other things.

ethbro 10y ago

This. As someone who's worked on the insurance side of the equation for a while, it always amazes me when people don't realize the majority of health insurance policy is a zero sum game. If insurance companies aren't solvent and profitable, products won't be offered. And that's exactly what happens when you force unfunded / unbalanced mandates on them. Congress can easily legislate the country into a market where no one wants to offer insurance because there's no way to do so sustainably. That said, one of the best things that ACA did was finally target some of the inefficiency in as conservative of a business as insurance. The provision capping administrative costs did a lot to jolt companies into streamlining their operations and investing in modern, more efficient technologies.

LyndsySimon 10y ago
> the majority of health insurance policy is a zero sum game That's what "insurance" is. I also don't get why people don't seem to understand that. IMO, a big part of a solution has to be to stop conflating "health insurance" with "healthcare".

maxerickson 10y ago

Medicaid cap.

Upvoter33 10y ago

"the guy is supposed to be a policy wonk" - only in the media's eyes.

johntb86 10y ago

From https://www.cbo.gov/publication/52486 https://www.cbo.gov/publication/52486 - "Even though the new tax credits would be structured differently from the current subsidies and would generally be less generous for those receiving subsidies under current law, the other changes would, in the agencies’ view, lower average premiums enough to attract a sufficient number of relatively healthy people to stabilize the market." Think of the $3000 subsidy towards health insurance as a $3000 penalty if you don't buy health insurance.