Mary Bryner – 2/17/17

This page was last updated on March 7, 2017.

Repeal of ACA without replacement would be tragic; Mary Bryner (MB); Beaver County Times; February 17, 2017.

The only previous Bryner letter I reviewed was “Don’t cut funding for cancer research.” An editor’s note for that letter asserted, “The writer is a member of the Ambassador Constituent Team for the American Cancer Society’s Cancer Action Network.” In other words, the ACS provides talking points to ACT! members so they can lobby for government policies the ACS wants implemented.

Below is a detailed critique of the subject letter.

“As a cancer survivor, I worried about becoming uninsurable. If I lost my job or wanted to make a life change, I knew that I was jeopardizing my chance of affordable and quality health coverage.”

[RWC] To a large degree, MB can thank FDR’s WWII economic policies.

“Then the Affordable Care Act was enacted and patient protections were put into place, banning pre-existing condition discrimination and arbitrary lifetime or annual caps on coverage -- protections that took away my fear that coverage would be taken away if I got sick again. For the first time, people with cancer, or those at risk of cancer, could rely on being able to access affordable and meaningful coverage options.”

[RWC] Here’s a quick refresher on the concept of insurance. Regardless of the policy type, an insurance policy is a bet. The insurer bets the premium will exceed the benefits paid and the insured bets the premium will be less than the benefits paid.

I know a lot of people disagree, but lifetime and/or annual caps on coverage and not covering pre-existing conditions are a good thing for most of us.

Coverage for a pre-existing condition is not insurance; it’s a handout. It’s like buying a homeowner’s policy AFTER your house burns down and expecting the insurer to pay for a new house.

“Lifetime or annual caps on coverage” are not “arbitrary.” Without them, insurers would have a limitless liability. Insurers have two choices; get out of the medical insurance business or jack up premiums in an attempt to mitigate the increased risk. What would happen if an insurer encountered the “perfect storm” that completely wiped out its reserves to pay anyone’s benefits?

Wrapping up, the subject provisions increase the insurer’s risk and potential payout. As all provisions of an insurance policy, someone pays for them, and ultimately that someone is the insured. What good is coverage of these provisions if you can’t afford the higher premium they demand?

If you’re thinking, “yeah, that’s why we need a government-run, taxpayer-funded healthcare monopoly,” you would be wrong. Someone still needs to pay the bill, and that’s you and I.

“Now, Congress is discussing the repeal and replacement of the health care law. We can’t afford to go back to a time when cancer patients and their families didn’t have reliable access to health insurance. I am grateful there is a bipartisan consensus to maintain these critical patient protections, but if Congress moves to repeal the law without an adequate and immediate replacement, the health care market could collapse, leaving vulnerable people with gaps in coverage.”

[RWC] Why could “the health care market … collapse?” This hyperbole sounds like Delbert Linville’s question, “will we return to the days when millions of Americans in the United States died because they had no coverage?” My response was, “When [did] millions of Americans in the United States die because they had no coverage?”

Citizens cannot be dependent on their government for medical needs and remain free. Let’s say you believe your medical insurance provider, doctor, and so on is doing something illegal. If the provider is in the private sector, you can present your case to our legal system. If the provider is the government, to whom do you go when the wolf is guarding the henhouse? We already have the United States Tax Court. Does anyone want to bet on when we’ll see the United States Healthcare Court?

What will the feds do when the inevitable happens and healthcare premiums and/or healthcare taxes skyrocket? Here are some examples:

- The feds will claim “greedy” healthcare providers (doctors, nurses, hospitals, and so on) are to blame. You probably forgot then-President Barack Obama (BHO) used this tactic against doctors back in 2009 during a White House press conference (July 22, 2009). BHO said, “Right now, doctors, a lot of times, are forced to make decisions based on the fee payment schedule that's out there. So if … your child has a bad sore throat, or has repeated sore throats, the doctor may look at the reimbursement system and say to himself, ‘You know what? I make a lot more money if I take this kid’s tonsils out.’” During a healthcare town hall meeting (August 11, 2009), Mr. Obama opined that in a diabetes case, doctors may favor amputation over treatment because “they might get reimbursed a pittance [for treating diabetes]. But if that same diabetic ends up getting their foot amputated, that’s $30,000, $40,000, $50,000 -- immediately the surgeon is reimbursed.” Ignoring his apparent low opinion of doctors, BHO’s reimbursement figures were pure fabrication. The American College of Surgeons responded “Medicare pays a surgeon between $740 and $1,140 for a leg amputation. This payment also includes the evaluation of the patient on the day of the operation plus patient follow-up care that is provided for 90 days after the operation. Private insurers pay some variation of the Medicare reimbursement for this service.”

- The feds will claim we are to blame because we make poor lifestyle choices. To cut the effects of our bad behavior, the feds could impose taxes on offending foods. For example, in 2016, Philadelphia imposed a 1.5 cent-per-ounce tax on so-called “sugary” drinks because they allegedly cause diabetes, obesity, and so on. In this case, the tax is simply the result of nanny-state “thought.” I should probably mention the tax also applies to sugar-free and/or calorie-free drinks. Yes, you read that right.

According to the story linked to above, “Diet beverages ‘are filled with artificial sweeteners and chemicals. Do we really want people to drink these?’ said nutritionist Mary Story, a professor at Duke University’s Global Health Institute. She did say that researchers had not found any proof of harm caused by the products.”

If your goal is really about reducing diabetes, obesity, and so on, why on Earth would you also target sugar-free and/or calorie-free drinks? Here’s why; follow the money. “Mayor Kenney sold the tax as a revenue-raiser for prekindergarten and badly needed upgrades to recreation centers.” Let’s say the “sugary” drink tax does its job and a large number of people stop consuming “sugary” drinks, opting instead for less-taxed sugar-free and/or calorie-free drinks. Supporters should be exchanging high-fives and/or fist bumps, right? Not exactly.

Here’s what I think happened. At some point, someone figured out the more successful the law, the less tax revenue there would be to spend. That’s why “Diet beverages were included in a last-minute amendment.”

Did you notice what else happened? If you’re a committed pop drinker, there is no punishment for consuming evil “sugary” drinks instead of sugar-free and/or calorie-free drinks. This makes no sense if your concern is really about reducing diabetes, obesity, and so on. This makes perfect sense if your concern is really about generating tax revenue, not the health of Philly citizens.

Then-NY Mayor Michael Bloomberg (MB) imposed taxes on so-called sugary drinks. An NY court put the plan on hold the day before the ban was to take effect and ultimately the NY Supreme Court ruled it violated the NY constitution. Before you do any fist bumps, the ban had nothing to do with the idea government could impose a ban like MB’s. The program was stopped because the court ruled the mayor didn’t have the authority to impose the ban unilaterally. The court ruled the ban was legislation and all legislation for NYC had to be approved by the NYC City Council.

Does anyone remember the 18th Amendment to the U.S. Constitution?

“Sen. Pat Toomey, please don’t repeal the Affordable Care Act without a replacement. We must guarantee uninterrupted and meaningful health insurance coverage for cancer patients -- survivors like me or those at risk of one day developing the disease.”

[RWC] This is probably an insensitive question, but did anyone notice MB didn’t say one word about anyone other than cancer patients?

The only way to “improve” Obamacare is to repeal it and not replace it. Obamacare is bad economic policy and unconstitutional. Here’s my alternative to Obamacare:

- Repeal Obamacare, lock, stock, and barrel, including what anyone calls a “good” Obamacare provision. If we do not, Obamacare will come roaring back even stronger, just like an infection when you stop taking your antibiotic too soon.

- Eliminate special tax treatment for employer-based healthcare insurance. Employer-paid healthcare insurance premiums must be subject to the same taxes – income, Medicare, Socialist Security, et cetera – as wages. This would deal with the portability issue because your insurance wouldn’t have to be tied to your employer.

- Let insurance companies compete across state lines if they cannot do so already. Regulations – whether federal or state - that prohibit consumers from buying medical insurance from insurers in other states reduce competition and drive up prices.

- Get government out of dictating what illnesses, injuries, treatments, et cetera will be covered by medical insurance policies. That is, let consumers and insurers determine what will and won’t be covered by a given policy. For example, if I want to purchase only “major medical” insurance, and an insurer wants to sell it, that should be okay. Forcing consumers to buy more coverage than they need and/or want drives up prices.

The sole purpose of government control of medical care is to provide another way to control us in ways the U.S. Constitution doesn’t allow. For example, the Constitution provides no mechanism to dictate our lifestyle choices. A highly-regulated or a government-run medical care industry, however, could control our lifestyle choices via co-pays, deductibles, premiums, denying care, and so on. What if your body mass index (BMI) is outside the government-determined “acceptable” range? What if you ride a motorcycle? What if you own firearms? In all cases, the “justification” given will be the need to control the government’s cost to provide medical care. Though via a different mechanism, this is how government justifies the ridiculous tobacco taxes. Of the hundreds of billions of dollars collected from tobacco companies and consumers, however, the vast majority goes to state general funds with little spent on tobacco-related programs.

The bottom line is we need to get the feds’ nose out of our medical care. A free market represents the best approach to providing the best combination of healthcare accessibility, choice, price, quality, timeliness of treatment, et cetera. Of course, no approach – either private or public – is perfect and some people won’t be able to afford healthcare or healthcare insurance no matter how inexpensive it is. Do I believe people who need help because of unforeseen circumstances should get it? Of course, but via private charities funded by voluntary contributions.