Republican Health Care Plan (Part II: The Senate Version)

[Esper]

I don't get behind the idea of punishing people for lifestyle choices when it comes to healthcare:

• Two people can choose to have the same lifestyle, but genetic and environmental factors could cause them to have dramatically different outcomes regarding their health. (I'm not saying this argument alone is necessarily sufficient - everyone has to adapt to their own circumstances - but governments and healthcare systems should take it into account if they want to be fair and equal to people.)
• Additionally, it's hard to know exactly what the cause of someone's health problems are. If you live where there is a lot of air pollution, you smoke, and you get lung cancer, what is the cause of that cancer? I believe there are often too many variables to be able to definitively say that someone's health concerns are "their fault".
• But then even when you can pinpoint exact causes, it can't possibly be fair to punish people for those without taking their circumstances into account. For instance, what if I choose to eat a lot of bad, junky, processed food and I develop diabetes, but I'm also poor and live in a food desert where my healthy food options are very limited? I can want to eat better and try to, but I have real-world limitations toward achieving that.

Now, if we lived in a world where everyone had free access to healthy food, doctors and nutritionists, pollution-free environments, and so on it would be a different conversation.

 

[twocows]

Gambling does not equal getting a health problem.

It's an analogy.

Any health problem can occur for a number of reasons, and people 90% of the time aren't "knowingly" making decisions that give them a health problem.

Right, and we're talking about the 10% of the time that they are right now. We're not talking about the other 90% of the time. Or at least I wasn't, and you're presently responding to my statements.

What? Are you seriously trying to suggest that people willingly would put their own lives in danger just because they know any injuries/problems that they get from it would be covered?

You really failed to grasp what I was saying there, and I tried to make it as obvious as possible. No, people aren't going to see that risky behavior is covered and immediately go out and fly a motorcycle through a flaming hoop over a cliff. What will happen, though, is that people will unconsciously (and correctly) realize that risk-taking behavior isn't as big of a deal when it's covered by insurance. They'll do riskier things because they wanted to do those things originally but they didn't because they understood the consequences. When you lessen or eliminate the consequences, they end up deciding the other way in a lot of cases. And since people make these kinds of decisions hundreds of times a day and there are 300 million people in the US, even something that creates a relatively small trend can end up putting a great deal more burden on the system. That's what I'm getting at.

But everyone takes from it. There are very few people in this country who don't use the healthcare system at some point in their life. And, again, as I've said several times already, these people aren't just covering "self-inflicted injuries" but all health problems, all the time. That's the point.

People tend to pay into the system as much or more than what they take from it. If they didn't, it wouldn't work. The problem is some people take more than others, and people who live unhealthy or risky lifestyles take disproportionately more from the system as a result of that, since they tend to have all the same issues the rest of us have plus a great deal more due to their lifestyle choices. That's the point I'm making.

Stop. If you literally think someone deserves to die from a treatable injury just because they can't afford to pay for treatment, then that's really bad.

Don't try to put words in my mouth by removing context. I immediately followed that up by saying that the greater evil is for the system to stop working and for more people to die or suffer as a result. That statement was made within that context. No, people don't deserve to suffer or die for self-inflicted issues (I never said that to begin with), what I said was that self-inflicted problems are, by definition, their fault; typically, if you do something dumb, you're going to expect consequences. Our systems aren't perfect and they can't and shouldn't try to save everyone; the system isn't designed to do that and it won't work if it tries to. You typically can't save people from themselves.

How are you agreeing with me and disagreeing with me at the same time?

Because this is a multi-faceted issue and I can agree with one assumption and come to a different conclusion as a result.

But the problem isn't that people are being forced to buy into it

There are a lot of problems with the system. I think that being forced into buying insurance is a problem because I think there are viable alternatives to insurance for many people (like saving money effectively) and I think it's authoritarian to compel someone to buy redundant services.

it's people who think that others don't deserve the same level of healthcare as them because they can't afford it.

I'm not really sure what you mean by the "same level of healthcare." I think a system where everyone can have access to basic coverage for unforseen health issues is good and is the right way to do things. I can't really speak on anything past that without knowing more about what you meant.

Every person is going to need healthcare at some point in their lives, and it's not ethical to pick-and-choose which people are deserving of healthcare based on their income.

Right, which is why I think we shouldn't do that, at least not with respect to basic medical coverage. I don't think self-inflicted problems should be included in the scope of that, though.

Here's some info about what is covered by most health insurances. If you'll notice, the essential services provided here would definitively cover what I believe you would call "self-inflicted injuries."

They shouldn't.

Except... not really. That kind of medical system opens itself up to opportunities for insurance companies to limit their coverage in an effort to save money.

That doesn't make it the wrong way to do things, it just means we need proper oversight and review to ensure the system isn't abused, something which we already need for the system to work.

If I'm involved in a car crash and my leg is broken, and my insurance provider decides not to cover any necessary surgery and rehabilitation I need to fix it because I was involved in a car crash and they deem it as "self-inflicted," I'm going to get royally screwed over with medical bills that I have no choice but to pay because I need my leg.

I wouldn't consider driving a car to be unreasonably risky behavior; almost everyone drives a car. Maybe if it is determined that the driver was unnecessarily risky in the way he was driving, then it should be excluded, but not in the typical case.

If I suddenly developed Type 2 diabetes without realizing that I have until I start passing out, and my insurance decided not to cover my preventative treatments because they believe it was self-inflicted, I'm going to be footing $400 to $500 a month just to pay for insulin to not pass out.

If the condition was a result of poor dietary habits, I think it's reasonable to expect to have to pay out of pocket. The problem in this case is the cost being prohibitively expensive, and that touches on other issues. Insulin shouldn't cost $400-$500 a month, there's no reason for it to cost that much and there are many areas of the world where it doesn't. This is a case of corporate abuse and IMO should be investigated.

You mentioned privilege earlier, this actually ties in here, since I'm pre-diabetic and this has a very high likelihood of affecting me. And if it does, it's my fault; I've had very poor dietary choices for the past few decades and it's part of why I'm trying to improve my diet right now.

A healthcare system that discriminately chooses who gets covered is not a fair healthcare system.

The healthcare system should treat people the same. People who make poor choices shouldn't be covered, regardless of who they are. That's fair.

And as I've said, not every "self-inflicted" problem is from negligence. People can not know things and be undereducated about health problems (it's not like health education in America is that great anyway).

I 100% agree that we need to improve health education here. That should be another one of our priorities. The changes I support shouldn't be made in a vacuum; there should be other things that happen at the same time, and this is one of them.

You have enough privilege to assume that everyone has the ability to save money.

I don't, I know that's impossible for some people because I know people it's impossible for. What I mean is that it is a viable option for a lot of people and that many of those people for which it is an option simply choose not to. This is another thing I think education could improve: proper spending habits and budgeting, personal economics.

For many people, they're simply unable to do that because they're spending so much on their mandatory life expenses that saving money is out of the question.

I completely understand there are people like that because I know people like that. Like I said, I do support basic coverage for everyone. However, if I was in a situation where I was barely making enough to get by, you better believe I would be even more cautious about my life choices than I am right now.

The reason I said it is privileged is because it's people with your attitude that helped create the financial problems that come out of healthcare. People have been protesting paying into the system for the same reason for a long time, and it creates problems for people who actually need to take the healthcare but don't have the resources they need because of bad financial situations that often times are out of their control.

I believe that enough people would pay into the system without the individual mandate for it to still work.

"It's why I don't go doing stupid things and it's why I save up my own money in case something does happen to me rather than spending all of it on crap I don't need." That is a statement loaded with assumptions about the type of people who have to depend on publically-funded healthcare, and that type of attitude is one that stems from the privilege of not knowing the situation of the people you are saying should be perfectly able to pay for their own healthcare.

What I was getting at with that is that people shouldn't be so cavalier with their own health and finance and that if they choose to be, they should expect that bad things may happen as a result. Like I said, I know not everyone can save, but most people are capable of avoiding especially risky behavior, making adequate dietary choices, and at least creating a budget.

I already explained above that even situations like these can be brought on by a million different causes and are usually not the fault of the person who is afflicted with them. Life is unpredictable and people get hurt, but if they can't afford healthcare, we shouldn't be leaving them to suffer. No one deserves to go through ridiculous financial hardships just because some people are stingy with their money.

I get that, and it sucks, but people aren't perfect and there are a lot of factors that play into this. With the state of affairs as they are, we can't save everyone and we need to make certain compromises in order for our systems to function smoothly. It would be wonderful if we could help everyone and that should be something we work toward, but the current reality of the situation makes that impossible.

 

[Kanzler]

It's been getting really difficult to sift through all the posts and line-by-line responses so I'll try to continue the conversation in a different kind of way.

You mentioned privilege earlier, this actually ties in here, since I'm pre-diabetic and this has a very high likelihood of affecting me. And if it does, it's my fault; I've had very poor dietary choices for the past few decades and it's part of why I'm trying to improve my diet right now.

How do you imagine your healthcare would be managed under a system where your "very poor dietary choices" would disqualify you from publically funded medical insurance?

 

[twocows]

How do you imagine your healthcare would be managed under a system where your "very poor dietary choices" would disqualify you from publically funded medical insurance?

I'm not really an expert, so I couldn't say specifically. It's more that I consider the ideas I've stated to be general principles that people who design the system should keep in mind.

That said, off the top of my head, I think it could work like this:

1. Charge your insurance the same way you do now
2. They initially cover the charge and pass the case on to a review board
3. If they find it's not something they cover, they send on a bill for the portion that was covered initially

 

[Kanzler]

I'm not really an expert, so I couldn't say specifically. It's more that I consider the ideas I've stated to be general principles that people who design the system should keep in mind.

That said, off the top of my head, I think it could work like this:

1. Charge your insurance the same way you do now
2. They initially cover the charge and pass the case on to a review board
3. If they find it's not something they cover, they send on a bill for the portion that was covered initially

Well, that's the crux of the matter, isn't it - exactly what kind of scenarios they would and wouldn't charge. Who would provide the review board with the information to qualify or disqualify a case? If it's the doctor, I can see several things happening. 1) The doctor-patient relationship will be gutted as patients realize that the doctor is the gatekeeper of their information to the people who decide whether they pay out of pocket or not, and they will be incentivized to withhold information from their doctor, preventing them from receiving the most appropriate care possible. 2) As I understand it, doctors in the US already have to dance awkwardly with insurance companies as it is, and having another layer of conditions to qualify/disqualify patients will only add more work that ultimately does not provide any healthcare and is a waste of the doctor's time and role in society. 3) Going back to the first point, epidemiological studies that use patient records will be compromised moving forwards because of inaccurate recordkeeping.

Deciding what to cover/not to cover because of lifestyle choices is difficult too. Taking your example of someone who's pre-diabetic, would an annual check-up be covered? Assuming that it is, what if your doctor wants you to follow up more frequently to monitor your blood sugars - would those be covered since they're directly related to your pre-diabetes condition? What if years down the line it develops into diabetes and now your doctor is concerned about kidney function and whether there's damage to your eyes and kidneys such - would the appropriate investigations and referrals be covered? What if you've made drastic changes to your diet since your diagnosis, would that allow this hypothetical single-payer system to cover you again?

The point of all this is to say that 1) I don't think anybody would want the job of deciding whose lifestyle is worthy or not of coverage, 2) I'm not sure how anybody could do that job well, and 3) I'm unsure that the cost savings would justify all the negative consequences on the healthcare system. Also I might add that creating the bureaucracy necessary to review and monitor people's lifestyles is foreseeably a waste of government resources.

 

[twocows]

Well, that's the crux of the matter, isn't it - exactly what kind of scenarios they would and wouldn't charge. Who would provide the review board with the information to qualify or disqualify a case? If it's the doctor, I can see several things happening. 1) The doctor-patient relationship will be gutted as patients realize that the doctor is the gatekeeper of their information to the people who decide whether they pay out of pocket or not, and they will be incentivized to withhold information from their doctor, preventing them from receiving the most appropriate care possible. 2) As I understand it, doctors in the US already have to dance awkwardly with insurance companies as it is, and having another layer of conditions to qualify/disqualify patients will only add more work that ultimately does not provide any healthcare and is a waste of the doctor's time and role in society. 3) Going back to the first point, epidemiological studies that use patient records will be compromised moving forwards because of inaccurate recordkeeping.

Deciding what to cover/not to cover because of lifestyle choices is difficult too. Taking your example of someone who's pre-diabetic, would an annual check-up be covered? Assuming that it is, what if your doctor wants you to follow up more frequently to monitor your blood sugars - would those be covered since they're directly related to your pre-diabetes condition? What if years down the line it develops into diabetes and now your doctor is concerned about kidney function and whether there's damage to your eyes and kidneys such - would the appropriate investigations and referrals be covered? What if you've made drastic changes to your diet since your diagnosis, would that allow this hypothetical single-payer system to cover you again?

The point of all this is to say that 1) I don't think anybody would want the job of deciding whose lifestyle is worthy or not of coverage, 2) I'm not sure how anybody could do that job well, and 3) I'm unsure that the cost savings would justify all the negative consequences on the healthcare system. Also I might add that creating the bureaucracy necessary to review and monitor people's lifestyles is foreseeably a waste of government resources.

These are all good points and I can't think of an adequate response. It's possible that someone with more knowledge of how the system works could come up with a meaningful counter-argument, but I can't. I still believe ideologically that these kinds of things should be excluded, but if there's no way to actually implement those kinds of restrictions, then it's just useless philosophy. It was my understanding in the first place that similar kinds of restrictions already existed, so I expected we could just fall back on the existing system, but it sounds like that isn't the case.

 

[Kanzler]

These are all good points and I can't think of an adequate response. It's possible that someone with more knowledge of how the system works could come up with a meaningful counter-argument, but I can't. I still believe ideologically that these kinds of things should be excluded, but if there's no way to actually implement those kinds of restrictions, then it's just useless philosophy. It was my understanding in the first place that similar kinds of restrictions already existed, so I expected we could just fall back on the existing system, but it sounds like that isn't the case.

Something like whether so and so drive a motorcycle or go skydiving would be easy to objectively monitor. Something like diet and exercise and drinking habits, not so much. Smoking I imagine can be detectable on bronchoscopy, but if a smoker is due to go in for a medically necessary bronchoscopy (looking for bleeds or a tumour, etc) that might take his coverage away, chances are good that he might not go for it. And don't get me started on drug addiction - it's already difficult enough for drug users to seek help without the fear of having their coverage taken away from them. I hope private insurance companies are not able to do that, because that would be senseless.

The requirement that everyone under a government plan live a healthy lifestyle with good nutrition, exercise and without harmful substances seems to be more stringent than what exists in the private sector, where you can buy insurance regardless of your lifestyle choices. In a public system, all taxpayers would be contributing to it, so it's somewhat cruel that someone could have their coverage taken away while they continue to pay taxes for it (unless you give them an unhealthy lifestyle tax rebate - now that would be ironic).

Honestly, the US should move past the individual mandate and move to single-payer. I wouldn't like the idea of being forced to buy insurance from a profit-making private company either. A public option doesn't have to compete with the private sector, but is responsible to the electorate and I think these two factors help keep total costs down.

 

[Corrin]

Moreover, as a matter of principle, healthy people shouldn't be forced into paying for other peoples' medical care. I don't expect other people to pay for me when I'm sick and neither should anyone else.

So poor people who can't afford it should just die right :)

 

[twocows]

So poor people who can't afford it should just die right :)

Poor people who can't afford it should be worked with to come up with a payment plan that works for their situation.

 

[Kanzler]

Poor people who can't afford it should be worked with to come up with a payment plan that works for their situation.

Setting healthcare expenses in relation to what one can afford is already present in both private and public systems. In the US, medicare has a special payroll tax and premiums which I believe are tied to income, and medicaid and insurance subsidies for low-income people. In Canada, medicare funding is all behind the scenes taken from tax revenues.

I guess what you probably mean is what happens to those people who don't have insurance in the US out of choice or affordability despite the incentives made in recent years for people to get insurance. What do you suggest that would be different from the status quo?

 

[Majestic Electric]

As a conservative, I would rather see Obamacare kept until the Republicans can get their crap together. Its obvious there hasn't been much forethought, both in terms of the actual bill and appealing to citizens. They have had 8 years to prepare and have failed on both accounts.

It's likely that, in those 8 years, the Republicans probably didn't even bother to come up with a new plan. ObamaCare has a lot of problems, there's no denying that, but kicking millions off of their insurance and cutting funds to Medicaid, just so the ultra-wealthy can get a tax break, is completely immoral! Sometimes I feel like the Republicans' constituents could do a better job running the government than those they elect to Congress... :p

Moreover, as a matter of principle, healthy people shouldn't be forced into paying for other peoples' medical care. I don't expect other people to pay for me when I'm sick and neither should anyone else.

That's like saying people with pre-existing conditions are unhealthy. Many pre-existing conditions are genetically based or people have them at birth, so should someone be forced to die because, for example, they were born with a heart defect?

Here's another example: My mom was recently diagnosed as being pre-diabetic. She had diabetes when she was pregnant with me, but it went away after I was born. Women who find themselves in this scenario generally are more likely to develop Type 2 diabetes later in their life. Now, hypothetically speaking, if (God forbid) she one day develops full-blown diabetes, and (because the price of treatment is ridiculously expensive) she can't afford treatment, should she be doomed to die? I don't think so!

You are not completely wrong, but to say someone shouldn't be allowed to receive help if they fall ill, through no fault of their own, seems kind of selfish to me.

 

[twocows]

but to say someone shouldn't be allowed to receive help if they fall ill, through no fault of their own, seems kind of selfish to me.

That's the opposite of what I said, though. People should get help, they should just be required to pay for it if they're at fault, at least in principle.

Setting healthcare expenses in relation to what one can afford is already present in both private and public systems. In the US, medicare has a special payroll tax and premiums which I believe are tied to income, and medicaid and insurance subsidies for low-income people. In Canada, medicare funding is all behind the scenes taken from tax revenues.

I guess what you probably mean is what happens to those people who don't have insurance in the US out of choice or affordability despite the incentives made in recent years for people to get insurance. What do you suggest that would be different from the status quo?

I think the status quo is pretty much fine; I'm more against a lot of the proposed changes to it than anything. The main thing that is in it now that I don't like is the individual mandate.

 

[Kanzler]

I think the status quo is pretty much fine; I'm more against a lot of the proposed changes to it than anything. The main thing that is in it now that I don't like is the individual mandate.

I guess you're satisified with the PPACA as it is then? How would you feel about a public option that would alleviate the need for the individual mandate? According to wikipedia:

Japan has a universal health care system that mandates all residents have health insurance, either at work or through a local community-based insurer, but does not impose penalties on individuals for not having insurance.[5] The Japanese health ministry "tightly controls the price of health care down to the smallest detail. Every two years, the doctors and the health ministry negotiate a fixed price for every procedure and every drug. That helps keep premiums to around $280 a month for the average Japanese family."[6] Insurance premiums are set by the government, with guaranteed issue and community rating.[7] Insurers are not allowed to deny claims or coverage, or to make profits (net revenue is carried over to the next year, and if the carryover is large, the premium goes down)

How does that sound?

Didn't want to double post, found this opinion article: https://www.nytimes.com/2017/07/10/...ce-free-market.html?smid=fb-nytimes&smtyp=cur

Don't Leave Health Care to a Free Market

By FARZON A. NAHVI JULY 10, 2017

When it comes to health care coverage, House Speaker Paul Ryan says, "We're going to have a free market, and you buy what you want to buy," and if people don't want it, "then they won't buy it." In this model of health care, the patient is consumer, and he must decide whether the goods and services he wants to protect his life are worth the cost.

But this is often impossible. And what Republicans, and many Democrats, forget to stress, is that in a totally free market health care system, you must be willing to let some patients die.

As an emergency medicine physician in a busy urban hospital, I have patients brought to me unconscious several times a day. Often, they are found down in the street by a good Samaritan who called 911 on their behalf. We are required to care for them, and most of these patients are grateful at my attempts to help them. More than once, however, such patients have regained consciousness furious. It wasn't that they didn't want to live — they were all simply upset at the costs their hospitalization incurred.

Last week I took care of a middle-school teacher who was out jogging on a hot June day. Dehydrated, she lost consciousness when some tourists called an ambulance over to her. A month before that, I cared for a young man who passed out at his desk from a bleeding ulcer in his colon. His co-workers called 911 while he lay in a puddle of his own blood. And about one year ago, I cared for a 56-year-old patient who was found lying in the gutter at 3 a.m. A passer-by called 911 thinking he was drunk. It turns out he had been hit on the head with an iron rod by muggers while on his way home from work as a waiter.

All three of them had ambulances called on their behalf by bystanders. All three of them, unconscious for some or all of their care, had no say in whether they would be treated. All three of them were saddled with gigantic medical bills that they had absolutely no say in.

Most dismaying for me as a physician is that after all of my attempts to apply my compassion and training to save their lives, all three of these patients told me some variant of: "Thanks for what you're doing, but I would rather that you hadn't." Even the man with the brain bleed, who certainly would have died without our immediate intervention, expressed dismay. In the neurology intensive care unit, with a bolt through his skull to measure the pressure around his brain, he told me that while he did not have health insurance, he did have life insurance. He said he would rather have died and his family gotten that money than have lived and burdened them with the several-hundred-thousand-dollar bill, and likely bankruptcy, he was now stuck with.

A believer in free-market medicine, Mr. Ryan has said about health care: "You get it if you want it. That's freedom." Yet being given services without your consent, and then getting saddled with the cost, is nothing like freedom.

Imagine Verizon sending you a bill for hundreds of thousands of dollars (roughly the cost of the medical care of the patient with the brain bleed who required an emergency neurosurgery and prolonged I.C.U. stay) and then telling you, "We called you to offer you some extra services. You didn't answer the phone because you were in a coma, but we guessed that you'd want them, so we went ahead and added them on and charged you for them." Clearly you would be outraged.

So why does this happen with health care? The answer is that we don't truly believe in free-market medicine. We know that in an empathetic and caring society, life is valued above all else, especially when the life in question is in the most helpless condition possible. Deep down inside, we all intuitively know that health care is not a free market, or else society would not allow me to routinely care for people when they are in no position to make decisions for themselves.

Republicans need to be honest with themselves and the public: If they want medicine to be truly free-market, then they have to be willing to let the next man or woman they find lying unconscious in the street remain there and die. In a truly free market, we cannot treat someone — and charge someone — without their consent and against their will. If we believe, however, that those lying there in their most vulnerable moments deserve a shot, then we need to push forward with the idea that health care, at its core, must be designed around a caring system that serves all people fairly.

 

[twocows]

I guess you're satisified with the PPACA as it is then? How would you feel about a public option that would alleviate the need for the individual mandate? According to wikipedia:



How does that sound?

Didn't want to double post, found this opinion article: https://www.nytimes.com/2017/07/10/...ce-free-market.html?smid=fb-nytimes&smtyp=cur

I like the idea of not having an individual mandate but I'm not sure this is the right way to go about it. Honestly, I like the ACA, I just think it needs work. I like that it encourages competition with the marketplaces. That's a good thing. I like that companies are forced to compete with the government plan; I think that's also a good thing and prevents price fixing. I just don't like individual mandate.

 

[Aliencommander1245]

I like that it encourages competition with the marketplaces. That's a good thing. I like that companies are forced to compete with the government plan; I think that's also a good thing and prevents price fixing. I just don't like individual mandate.

Encouraging free market activtiy is a really, really bad thing though? Healthcare shouldn't be seen as a product and it actively, constantly backfires when you deregulate such essential services and let them thrive in a cesspool of "market competition" because "market competition" is inherently about exploiting people here, even if one of the things they're competing against is (relatively bare boned) government healthcare plans

Look at the internet services in the US, do you want a healthcare system that looks like that kind of monopolised system? Because that's the logical conclusion of a system run entirely through trying to get companies compete for a service, a single, or group of larger companies become so big and bloated that they own the market and set the mandatory industry standard, then are free to do what they want

 

[Sir Codin]

Market competition is a myth in a market controlled by oligopolies. Even if it wasn't, services that are vital to people's health and safety shouldn't be operated under the idea of making a profit, especially when automation of jobs and production bring us closer and closer to a post-scarcity environment. I've said this before and I'll say it again: curing people isn't profitable to private health insurance entities. This alone is why healthcare shouldn't operate as a business. Government services aren't designed to make a profit nor should they be expected to; they're designed to provide services that keep society functioning and productive. If we just simply adopted single-payer, many issues would be solved. The idea is that if everyone pays for it, no one pays for it. Sick and unhealthy people are a drain on the economy as they are unable to work and thus can't produce. If we get as many people back on their feet as possible, they can start working again and produce more, which is good for the economy. It'll also take burden off of employers since it'll cut down on their costs to provide health insurance to their employees, since with a single-payer system that won't be necessary as often because most employees will be on state healthcare. This'll save business money in the long run.

People's health and well-being shouldn't be a commodity to be bought and sold. When you think of people's health being in the same category as choosing your cellphone carrier plan, you need to re-examine your values.

 

[twocows]

Competition drives down prices and, with sufficient transparency, drives up quality. The problem with excessive free market capitalism is that eventually a few competitors will acquire enough power or resources to shut out competition and then abuse their position in a very anti-competitive way. There are ways to deal with this, though, and it doesn't change the fact that a truly competitive system ends up being better for everyone.

People's health and well-being shouldn't be a commodity to be bought and sold.

Modern medicine is one of the most valuable services that can possibly be provided to someone but it comes at a high cost, both as far as research and as far as production. It's nice to think what you said, but the system needs to be paid for. No system is perfect, but I think that healthcare marketplaces is a good idea and that with sufficient work can become one of the better possible systems.

I find it kind of strange to be defending the ACA as a moderate libertarian to (presumably) democrats, but healthcare marketplaces are a good idea even if I think there are areas for improvement.