Rand Paul's Full Plan for Repealing and Replacing Obamacare [Videos]

[EBounding]

https://www.conservativereview.com/commentary/2017/02/rand-pauls-full-guide-to-repealing-and-replacing-obamacare?utm_content=bufferacb1d&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

I don't know why they made six different facebook videos, but whatever. Overall it's a good plan that that goes in the right direction. I think it's politically viable too if it's sold correctly.

Rand needs a clear talking point on pre-existing conditions if he wants to sell this to the general public. This is what I understand:

- Those with pre-existing conditions will be covered by insurance for 2 years (this is basically the transition period).
- People with PEC's can obtain new plans if they were previously insured in a group plan since HIPPA protections will be restored.
- Individuals can join large health pools, which are similar to large employer group plans. However membership can't be conditioned on a person's health-status.

He's not really talking about these points when discussing his plan, but PEC's is the #1 problem people have with repealing Obamacare.

[Brian4Liberty]

834841291561324544
https://twitter.com/USAB4L/status/834841291561324544

[phill4paul]

https://www.conservativereview.com/commentary/2017/02/rand-pauls-full-guide-to-repealing-and-replacing-obamacare?utm_content=bufferacb1d&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

I don't know why they made six different facebook videos, but whatever. Overall it's a good plan that that goes in the right direction. I think it's politically viable too if it's sold correctly.

Rand needs a clear talking point on pre-existing conditions if he wants to sell this to the general public. This is what I understand:

- Those with pre-existing conditions will be covered by insurance for 2 years (this is basically the transition period).
- People with PEC's can obtain new plans if they were previously insured in a group plan since HIPPA protections will be restored.
- Individuals can join large health pools, which are similar to large employer group plans. However membership can't be conditioned on a person's health-status.

He's not really talking about these points when discussing his plan, but PEC's is the #1 problem people have with repealing Obamacare.

You are right about this. Anytime there is a discussion this is the #1 issue that get's thrown at me on social media.

[CaptUSA]

You are right about this. Anytime there is a discussion this is the #1 issue that get's thrown at me on social media.

So... how to respond...

When you own your own health savings account, you take it with you regardless of what job you have. You lose your job? You're company goes bankrupt? It doesn't matter because you keep your account. Those with a healthy account will have no problem getting catastrophic insurance in the market regardless of any conditions. And that's the point!

The grace period takes care of people now, and individual planning takes care of the future.

[opal]

so.. I am on the page from the library of congress reading the bill now.
https://www.congress.gov/bill/115th-congress/senate-bill/222/text?q={%22search%22%3A[%22s222%22]}&r=1

It's going to take at least the rest of the day to follow all the links out to their end and actually read and understand the bill

The opening lines "

A BILL

To repeal provisions of the Patient Protection and Affordable Care Act and provide private health insurance reform, and for other purposes."
already makes me get my skeptical face on. Repeal provisions (not all of it.. just provisions) and provide health insurance reform (how.. regulations? throw more money at it?) and for other purposes??? really??? open end much?

I'll be back.. must have coffee

[CaptUSA]

The opening lines "

A BILL
To repeal provisions of the Patient Protection and Affordable Care Act and provide private health insurance reform, and for other purposes."
already makes me get my skeptical face on. Repeal provisions (not all of it.. just provisions) and provide health insurance reform (how.. regulations? throw more money at it?) and for other purposes??? really??? open end much?

Uh, so yeah... "opening lines" are usually "open ended". I haven't read the thing yet, but I certainly wouldn't judge it after the first few lines.

[EBounding]

so.. I am on the page from the library of congress reading the bill now.
https://www.congress.gov/bill/115th-congress/senate-bill/222/text?q={%22search%22%3A[%22s222%22]}&r=1

It's going to take at least the rest of the day to follow all the links out to their end and actually read and understand the bill

The opening lines "

A BILL

To repeal provisions of the Patient Protection and Affordable Care Act and provide private health insurance reform, and for other purposes."
already makes me get my skeptical face on. Repeal provisions (not all of it.. just provisions) and provide health insurance reform (how.. regulations? throw more money at it?) and for other purposes??? really??? open end much?

I'll be back.. must have coffee


I don't think the "25 and younger" provision is repealed for example. I don't know what else would be remaining, but the heart of the ACA is being repealed.

[opal]

Coffee isn't helping
eyes crossing...

The bill wouldn't need to be nearly as long if it just repealed the ACA and all IRS references to it.
There are quite a few good things in here but.. man.. so much could be done away with if Rand actually stood by taxation is theft.

There's a door opening for alternative treatments.. but the rules and regs (and cost) to even put a toe in that market are outrageous.

If you want to get a gym membership.. you're in as long as it "does not offer golf, hunting, sailing, or riding facilities,"
and then you can deduct it from your annual government theft
Need a pedicure? Maybe there's the beginning of an ingrown toenail.. go ahead, claim that too

No state may make any laws superseding the feds.. um.. weed laws anyone? Is this going to undo all the strides forward with medical MJ?

here's a fun excerpt


(c) GAO Ongoing Study and Reports.—(1) STUDY.—The Comptroller General of the United States shall conduct an ongoing study concerning the effect of the amendment made by subsection (a) on—
(A) the number of uninsured and underinsured;

(B) the availability and cost of health insurance policies for individuals with pre-existing medical conditions;
(C) the availability and cost of health insurance policies generally;
(D) the elimination or reduction of different types of benefits under health insurance policies offered in different States; and
(E) cases of fraud or abuse relating to health insurance coverage offered under such amendment and the resolution of such cases.

(2) ANNUAL REPORTS.—The Comptroller General shall submit to Congress an annual report, after the end of each of the 5 years following the effective date of the amendment made by subsection (a), on the ongoing study conducted under paragraph (1).

Who's paying for this (Joe tax payer) and why, if we're trying to get the government out of healthcare do they need to know this stuff???

[seapilot]

https://www.conservativereview.com/commentary/2017/02/rand-pauls-full-guide-to-repealing-and-replacing-obamacare?utm_content=bufferacb1d&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

I don't know why they made six different facebook videos, but whatever. Overall it's a good plan that that goes in the right direction. I think it's politically viable too if it's sold correctly.

Rand needs a clear talking point on pre-existing conditions if he wants to sell this to the general public. This is what I understand:

- Those with pre-existing conditions will be covered by insurance for 2 years (this is basically the transition period).
- People with PEC's can obtain new plans if they were previously insured in a group plan since HIPPA protections will be restored.
- Individuals can join large health pools, which are similar to large employer group plans. However membership can't be conditioned on a person's health-status.

He's not really talking about these points when discussing his plan, but PEC's is the #1 problem people have with repealing Obamacare.

I agree PEC needs to be dealt with in a way that is palatable, but not subsidized by the taxpayer. No private insurance is going to take an individual already with PEC voluntarily as its a lose situation. An association would make the costs come way down and pass the costs onto others in an association. Associations may have to take up to a certain percentage of PECs in their pool to qualify for a group discount?

Why do Hospitals and Health Organizations not sell health insurance? That way locals would buy insurance from local or group hospitals that use funds and profits to improve the facilities. Letting the free market take over eventually will figure out all the details.

[CPUd]

this is purportedly a draft of the House bill:

http://www.politico.com/f/?id=0000015a-70de-d2c6-a7db-78ff707e0000

repeal of individual mandate
repeal of Medicaid provisions
repeal of Medicaid expansions
repeal of cost-sharing subsidy
money for states to create high-risk pools
partial funding for states to cover pre-existing conditions
cut employer tax breaks to pay for it

[Dr.No.]

Health care costs are high because treatment is so high. There is a balance between innovation and price.

I always use the example that the pharma industry has spent about $85 billion on developing a cure for Alzheimer's disease over the past ~25 years, even though to this day, 99.7% of all treatments have failed in clinical testing. Why do they do that? Why do individual companies continue to invest in that treatment area? Because they know that if they discover a treatment, they will be able to make $100+ billion of of it. Our system enables that kind of profit. With patents to protect from generics, orphan drug status, etc. on the regulatory side, and the system of payments (insurance) that spreads the cost/patient on to all of us (a treatment that costs 100K/year would never normally materialize since so few could pay for it; insurance spreads the cost so that everyone is spending pennies/year and it works).

If, through regulation repeal, regulation enactment, or market reorganization, you change some of these factors, price will go down, but innovation will go down. You can increase the supply or nurses and doctors; salaries will come down and fewer of the best people will go into medicine. You can end patent protection and see pharma innovation grind to a halt. Reorganize the insurance system so most people must pay everything out of pocket, and the sky-high treatment options will disappear.

People will point to Europe and other countries breaking the mold; they have lower costs yet access to all new medical innovations. I think that the cost of the innovations come off the backs of Americans. For example, pharma companies will willingly sell drugs in Europe at just above production costs, because they can sell it in the US for 100x production costs. If we had similar rules (or just took away patents), pharma would be unable to add a "research premium", and you'd see fewer drugs/treatment as a result.

[Krugminator2]

Health care costs are high because treatment is so high. There is a balance between innovation and price.

If, through regulation repeal, regulation enactment, or market reorganization, you change some of these factors, price will go down, but innovation will go down. You can increase the supply or nurses and doctors; salaries will come down and fewer of the best people will go into medicine. You can end patent protection and see pharma innovation grind to a halt. Reorganize the insurance system so most people must pay everything out of pocket, and the sky-high treatment options will disappear.

People will point to Europe and other countries breaking the mold; they have lower costs yet access to all new medical innovations. I think that the cost of the innovations come off the backs of Americans. For example, pharma companies will willingly sell drugs in Europe at just above production costs, because they can sell it in the US for 100x production costs. If we had similar rules (or just took away patents), pharma would be unable to add a "research premium", and you'd see fewer drugs/treatment as a result.

All of that is true. The US system is geared more toward innovation. Most of the drugs and medical devices have come from the United States. If we had price controls like Canada the whole world would have less innovation.

The solutions to get costs down are clear. Eliminate the FDA and you will have lower costs with no loss of innovation. Numerous Nobel economists have studied this and come to the conclusion that the FDA does more harm than good. Secondly, eliminate tax credits for employers which will cause people to buy high deductible plans which will put downward pressure on prices. A simple (authoritarian) fix is to force people to buy insurance and save into an HSA like in Singapore and pay for small things out of pocket. You will have substantially lower costs, better quality, you can still cover high risk cases with subsidies, and it will be far more free market than the current system. It is unconstitutional but it works. Singapore spends 80% less per person than the United States.

[EBounding]

A simple (authoritarian) fix is to force people to buy insurance and save into an HSA like in Singapore and pay for small things out of pocket. You will have substantially lower costs, better quality, you can still cover high risk cases with subsidies, and it will be far more free market than the current system. It is unconstitutional but it works. Singapore spends 80% less per person than the United States.

Doesn't Singapore also have some sort of catastrophic universal coverage as well?

[Krugminator2]

Doesn't Singapore also have some sort of catastrophic universal coverage as well?

Yes. And Medisave is their HSA.

https://www.aei.org/publication/the-singapore-model/

"Medishield, the second part of the program, is a national insurance plan that covers the higher cost of especially serious illness or accident, which in Singapore’s system is described as “catastrophic.” Singaporeans can choose Medishield or several private alternatives, some offered by firms listed on the Singaporean stock exchange. Premiums for the insurance plans, including Medishield, can be paid using Medisave accounts."

Freedomworks also thinks Singapore is worth looking at. http://www.freedomworks.org/content/fixing-us-health-care-system-look-singapore

[Dr.No.]

The solutions to get costs down are clear. Eliminate the FDA and you will have lower costs with no loss of innovation. Numerous Nobel economists have studied this and come to the conclusion that the FDA does more harm than good. Secondly, eliminate tax credits for employers which will cause people to buy high deductible plans which will put downward pressure on prices.

I've seen studies that suggest this that were funded by the Pharma industry; for example, that AztraZeneca study that was wildly inaccurate. It really seems like the FDA is a bogeyman for politicians/ideologues to criticize. It isn't like in the absence of the FDA, pharma companies can sell whatever they way. They are still liable to be sued, etc (in fact, you could argue the FDA protects them against this). The FDA does have some standards for clinical trials, and, of course, these increase costs companies money, but these standards are also largely scientific. Again, in the absence of the FDA, the market isn't going to remove the burden of proof from biotech companies. Even the Heritage foundation (in a study that is likely biased, but I have to read it) said the FDA costs the economy $81 billion in 2014, and the vast majority (88%) of that is in the "food" industry, not the healthcare industry.

IIRC, the average cost of a full panel of clinical trials is around $40 million, with about double that amount for any phase 4 studies. The vast majority of drugs fail because they clearly aren't efficacious, not because they *might* be efficacious and the FDA denies approval (either because they doubt the efficaciousness or because of safety concerns). Remember that for preclinical and phase I/II studies, the FDA/government only has rules/regulations regarding animal abuse and patient handling (informed consent, privacy, documentation); they only offer guidelines on good scientific practices. It is only during Phase III and IV where there are mandates regarding study design and post-approval design come into play. 80% of drugs don't even make it to that stage.


A simple (authoritarian) fix is to force people to buy insurance and save into an HSA like in Singapore and pay for small things out of pocket. You will have substantially lower costs, better quality, you can still cover high risk cases with subsidies, and it will be far more free market than the current system. It is unconstitutional but it works. Singapore spends 80% less per person than the United States.

Well, the feds mandated private insurance for sailors in the 1790s, deeming naval trade too important to have it be disturbed by sickness (or something like that).

The HSA idea has been floating around for a long time, and I'll admit, is tempting. The proposal in the US (over a decade ago) was pretty ambitious but only resulted in (obviously theoretical) savings of 30%.

One should also be wary of comparisons to other countries. There are population differences....IIRC Singapore spends less than a 3rd on healthcare compared to the US, but I'm guessing (just anecdotal; no study on this) they probably live healthier lifestyles, don't go to the doctor as much, have a broader healthcare supply, etc.

[Brian4Liberty]

Bump.