Paul Ryan’s Health Bill: Good, Bad and Ugly

John C. Goodman

Remember how the Democrats did it. They created Obamacare behind closed doors. There was no real pubic vetting. No real attempt to make sure the pieces fit together in a sensible way. And no possibility of a single vote from the other party.

The House Republican Leadership seems enamored of that approach. The latest GOP replacement plan was announced last Monday after weeks of secrecy. The two relevant committees began their markup two days later – with no hearings, no vetting, no CBO score and no amendments.

It does not lower costs. It insures many fewer people. It does not stop the race to the bottom in the exchanges that is so harmful to the chronically ill.

Instead, the GOP plan seems designed to make the individual market work better. That means helping Obamacare work better. For all the apparent differences, the Republicans are just as committed to the managed competition model as the Democrats were.

Source: Paul Ryan’s Health Bill: Good, Bad and Ugly


  1. When Trump says the failure is a good thing I think an overlooked meaning is that now the normal democrats and normal republicans can cobble together something not needing the 40 votes of those idiots called the Freedom Caucus. Being part of health care should be mandatory for everyone just like car insurance. The buffoons of Freedom Caucus say that violates the individual’s right not to participate. Well when the guy with no insurance has that heart attack and needs that $300,000 triple-by pass who will pay for it ? The Freedom Caucus ? There should not be varying plans to choose the “best one” for an individual. There should be one plan with same coverage for everyone.


  2. I feel your frustration. But let’s keep in mind that the individual mandate does not stop cost shifting.

    And most cost-shifting, contrary to progressive dogma, isn’t a result of the uninsured. It is a direct consequence of our insurance billing protocols. The same insurance we are told we can’t live without. Cost shifting goes on every day thousands of times daily with the crazy way hospitals keep books and post meaningless and inflated billed charges; this allows them to show much larger losses than they really have – and receive disproportionate share subsidies from the government for their “losses”.

    Example: average U.S. billed charge for a Cardiac Echo is about $1,400. My local hospital billed price is $2,406. Price on MDSave if paid in advance at a participating facility: $579 which includes interpretation by cardiologist.

    And your by-pass example is emblematic. In India it costs half of what it does in U.S. for same quality and outcomes. In Cayman, probably even less than half. They have more transparent markets.

    And with Automobile Insurance, the mandate to have insurance is to protect us from someone else’s negligence or recklessness, which can cause us direct harm. There is no such equivalent in healthcare. Date is clear that those without coverage mostly AVOID care, not abuse it.

    Now I’m not advocating that they go without coverage; what I’m saying is, there is a better way to obtain access to care than our system allows or that any of the proposals, whether from the Ds or Rs, have put forth. The problem with the current insurance CPT billing system is, even with 100% coverage, the inflated prices would continue. And there is a pretty good body of economic evidence that indicates healthcare inflation would actually accelerate as we insure more and more under the perverse system we have.

    As to one-size-fits-all approach… we tried that with the EHB in PPACA. Combined with no waiting periods and guaranteed issue and community rating, costs in the individual market have skyrocketed in the last 4 years. Premiums have more than doubled in individual market and deductibles up about 300% on average. I don’t want or need to pay for drug/alcohol treatment or maternity or pediatric dentistry, yet it is part of EHB which raises cost for all.

    Take home point: coverage, in today’s healthcare world in the U.S., does NOT equate to care. Often it makes it more out of reach and even pricier. Costs are still rising despite all the regulations and tweaks… because we are not focusing on the real cost drivers.

    Real markets with real prices known in advance for MOST every service = real transparency = deflation of costs = more affordable care = more affordable coverage for high-end treatments.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s