Wednesday, March 15, 2017

Initial Observations on the CBO ‘Scoring’ of the AHCA

Under the headline 24M would lose health insurance under Republican Obamacare replacement, Jonathan D. Salant reported:

Republican legislation to repeal and replace the Affordable Care Act would take away health insurance from 24 million Americans within a decade, the Congressional Budget Office said Monday.

I left these comments:

To be generous, this is absolutely false. Neither the American Health Care Act (which I do not support as written) nor the Republican approach generally would “take away” anybody’s health insurance. ObamaCare showed us what it actually means to take away people's health insurance: Thanks to regulations that outlawed many existing policies, millions lost their coverage, forcing many of these people onto ObamaCare. The GOP approach would reduce government subsidies and, through reforms that somewhat liberate the market, expand health insurance by legalizing options currently restricted or banned—including the option of whether or not to buy health insurance.

In Trumpcare is a disaster. Attacks on CBO are desperate, the New Jersey Star-Ledger editorialized:

The CBO is not perfect. It made some big mistakes when it predicted the impact of Obamacare. It expected millions more to obtain coverage, missing the mark in part because the Supreme Court allowed states to reject the Medicaid expansion. And it expected the cost to be much higher than it actually was.

But Obamacare was the most ambitious piece of legislation in a half century, with huge uncertainties baked in. No one got it right, and the CBO was closer than many private experts, and it revised its estimates as new evidence came in.

After acknowledging that “The CBO is not perfect” and “made some big mistakes” in predicting the outcomes of ObamaCare, the Star-Ledger now pretty much asks us to treat the CBO as an infallible and omniscient authority on “TrumpCare.”

Well, if the CBO can be so off-base on ObamaCare, which involves a handful of government central planners dictating Americans’ healthcare choices, how in the world can we take seriously the CBO’s 10-year predictions on the American Health Care Act, which features reforms to create a more properly function market involving a wider range of choices for tens of millions of Americans?

The CBO report on the AHCA makes for great propaganda fodder but is of very little relevance to the debate over the future of government healthcare policy. In my view, the standard for judging health insurance policy should not be the CBO predictions and the like. The standard should be the freedom and individual rights, or lack thereof, of American consumers, patients, and providers to act on and contract according to their own judgement regarding health care, insurance, and charity care. The collective [statistical] outcome in terms of insurance coverage should be left up to the voluntary choices of individual Americans, not their government.

[NOTE: I do not support the AHCA in its current form.]

I answered a couple of replies to my comment under 24M would lose health insurance under Republican Obamacare replacement.

In answer to my reference to “reforms that somewhat liberate the market,” a Correspondent asked: “So was the market liberated before the ACA?”

Absolutely not. But it should have been. Instead of repealing the government tax policies and controls that created the problems ObamaCare was allegedly supposed to “fix,” the Democrats—statists that they are—simply added a whole new layer of controls and taxes and a whole new class of parasites existing on government subsidies. It’s classic vote-buying-with-the-people’s-money corruption. The current outcry from Democrats and their ObamaCare beneficiaries proves that last point. Hell hath no fury like a government dependent whose subsidy is threatened, or a statist politician whose power is threatened.


Quoting another comment reply, a Correspondent wrote: "Those who make poor choices such as opting not to purchase health insurance must be forced to rely solely on voluntary charity should they become ill or suffer an injury.  The insured should not be forced to absorb the expenses incurred by the freeloaders."

But they're not forced to "rely solely on voluntary charity..." because they show up at ERs and get medical care.

So until there is a clause that says the uninsured get no medical care in the ER, they will continue to receive the care and the insured will continue to pay for it.
There are a lot of people who do understand this need. You fail to understand that.

You highlight a fundamental truth: Government controls lead to more government controls in an immoral expanding cycle that steadily empowers government and shrivels freedom and individual rights. In this case, the law mandating “free” ER care led to ObamaCare. However, the solution is not “a clause that says the uninsured get no medical care in the ER.” It should never be illegal for people to pay out-of-pocket, for hospitals to offer voluntary charity care, or for hospital and patient to work out mutually agreeable payment options. The solution to the free rider problem is simply to repeal the law mandating ER charity care.

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