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Subject: Paul Ryan doesn't seem to understand how insurance works rss

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Professor of Pain
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This is the GOP's intellectual? Their serious policy wonk? By definition, this is exactly what health insurance or any insurance does - people pay into a pool that covers disaster for anyone who has paid into that pool.
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Wendell
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Yeah, I watched part of his little lecture, and as you note he was literally saying why should healthy people have to pay.

Same reason I have auto insurance even though I don't PLAN to have an accident.

And homeowner's insurance even though I don't EXPECT my house to burn down.

Ryan's both stupid and a liar; what I can't figure out is the proportion. 80% stupid/20% lying? 50-50? Not sure.
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Dickie Crickets
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wifwendell wrote:

Ryan's both stupid and a liar; what I can't figure out is the proportion. 80% stupid/20% lying? 50-50? Not sure.


Not to mention callous. The idea that some poor bastard with an complex medical condition should be viewed as a drain on us luckier folk is beyond crass.
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Ken
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I guess I've just gotten used to GOP leadership saying ridiculous things, even when they know better. I'm honestly becoming more surprised when I hear them say something that sounds honest and forthright.

Hell, Rand Paul's made more sense than most of the leadership for a while now.
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Matthew Schoell
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Koldfoot wrote:
wifwendell wrote:
Yeah, I watched part of his little lecture, and as you note he was literally saying why should healthy people have to pay.

Same reason I have auto insurance even though I don't PLAN to have an accident.

And homeowner's insurance even though I don't EXPECT my house to burn down.

Ryan's both stupid and a liar; what I can't figure out is the proportion. 80% stupid/20% lying? 50-50? Not sure.


Auto insurance is a fine example. You are not subsidizing anyone. You pay your insurance and bad drivers pay more. You don't pay more for bad drivers. Rates are vastly different for different classes of drivers.

You want a health insurance pool to have similar rates for everyone. Or even have healthy people pay more than high risk people. That is not insurance. That is socialized medicine.


Are you serious? The money from safe drivers absolutely subsidizes the costs from those who are in accidents or otherwise file claims.
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Khalid Shabazz
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Koldfoot wrote:
Uhhh.

He's 100% right?

The disconnect probably lies on you folks buying the notion that health insurance needs to be socialized. In that case you would be partially correct. Socialized madicine.

Healthy people need to subsidize the sick? No. that is not how insurance should work in the least.

He's only right in the sense that if those with chronic health problems were barred from obtaining health insurance, it would be much cheaper for those who purchase it against future, unforeseen health problems. It lowers the risk pool.

But of course in the context of a discussion on national healthcare, it's a complete non-starter unless you also refuse to treat someone who can't pay. ("Let him die", they cheered during the 2012 Republican primary debate.) So society ends up with the healthcare costs for the uninsured anyway and usually in a worse way, because pre-emptive care is less expensive than emergency care.
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Ken
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Koldfoot wrote:
Uhhh.

He's 100% right?


Except he's not. My premiums get pooled by the insurance company to cover all of the claims activities of everyone insured by the company. That's the way it works whether you're discussing auto, home, life, or health insurance. It's why the economics of the ACA drove premiums up so much - the people added to the pool drew more money out than they put in.

If you don't think that my lack of auto claims hasn't paid for the claims of numerous other people with my insurer over the last 25 years, then I just don't know what to say.
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Daniel Kearns
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If I'm healthy and I pay insurance and you're healthy and you pay insurance and I get sick, your money covers my bills.

But maybe you could have some kind of death panel or something that could help decide who shouldn't be able to participate because they have I dunno a genetic allele, something like that.
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Ken
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Koldfoot wrote:
Bad drivers pay more.


So what? They definitely won't be paying enough to cover the cost of a claim, particularly when liability gets factored in. That's the point of pooling risk. And if they did have to pay enough to cover the actual cost of claims, they wouldn't need the insurance because the cost would be the same.

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You want high risk people to pay the same, and call that insurance.


Wait, what? Who wants that?

You seem to be confusing "subsidize" with "equivalent payment." They aren't the same thing.
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Wendell
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Koldfoot wrote:
Doc Mage wrote:
Koldfoot wrote:
wifwendell wrote:
Yeah, I watched part of his little lecture, and as you note he was literally saying why should healthy people have to pay.

Same reason I have auto insurance even though I don't PLAN to have an accident.

And homeowner's insurance even though I don't EXPECT my house to burn down.

Ryan's both stupid and a liar; what I can't figure out is the proportion. 80% stupid/20% lying? 50-50? Not sure.


Auto insurance is a fine example. You are not subsidizing anyone. You pay your insurance and bad drivers pay more. You don't pay more for bad drivers. Rates are vastly different for different classes of drivers.

You want a health insurance pool to have similar rates for everyone. Or even have healthy people pay more than high risk people. That is not insurance. That is socialized medicine.


Are you serious? The money from safe drivers absolutely subsidizes the costs from those who are in accidents or otherwise file claims.


No it does not.

Bad drivers pay more.

In health insurance your argument does not hold. We are not talking about insurance, although that word is in there.

You want high risk people to pay the same, and call that insurance.

I could probably get hurricane insurance for a very low premium. Someone on the beach in Florida would pay much more. That is insurance. Am I subsidizing their rates? If everyone in North Dakota got hurricane insurance would rates go down for Florida? No it would not. The risk is still the same.


I don't know how it works in Alaska, but in the rest of the world, it absolutely DOES work that good (or lucky) drivers end up subsidizing bad (or unlucky) drivers and their victims.

Sure, bad (or unlucky) drivers end up paying more, once they've had accidents or tickets. But before they were bad drivers, they weren't, and they ended up being in effect cross-subsidized (if you want that word) by good/lucky drivers.

That is literally how insurance works. People pool a little money so that the small proportion of them that need it, can be covered.

I didn't think this was remotely controversial.
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Ken
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Koldfoot wrote:
You Are correct.

It is irrelevant.


If the top statement is true, the bottom statement cannot be true.

Quote:
You want to force Nodaks to buy hurricane insurance to subsidize Floridians, and are calling that the risk pool.


No, I don't and you make your argument much weaker by ascribing motives to people rather than handling the facts.

Further, your analogy fails on a number of other levels. For one thing, if we were to be insane enough to require Alaskans to buy hurricane coverage, premiums for Floridians would definitely go down - the market is a regulated one and there are rules in play for how much the companies can charge. Their individual risk in Florida or for a particular house absolutely hasn't changed, but by backing their potential loss with more premiums, the insurance company requires less from them to cover the risk. For another, companies that were able to secure the Alaskans would be motivated to lower their rates to capture more of the market if they can maintain the same profit margins.

The entire insurance industry is people without claims subsidizing people with claims sufficiently that the insurance company can both pay out the claims and turn a profit at the same time. It's what the companies exist to do. Unless you're talking about something like the way that Lloyd's of London used to operate where the risk was basically sold to an investor (which was so horribly structured they lost a massive lawsuit).
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Koldfoot wrote:
perfalbion wrote:
Koldfoot wrote:
Uhhh.

He's 100% right?


Except he's not. My premiums get pooled by the insurance company to cover all of the claims activities of everyone insured by the company. That's the way it works whether you're discussing auto, home, life, or health insurance. It's why the economics of the ACA drove premiums up so much - the people added to the pool drew more money out than they put in.

If you don't think that my lack of auto claims hasn't paid for the claims of numerous other people with my insurer over the last 25 years, then I just don't know what to say.


You Are correct.

It is irrelevant.

That is how insurance companies mitigate risk and make money.

Ryan's quote in the op is must pay more to subsidize the sick.

You want to force Nodaks to buy hurricane insurance to subsidize Floridians, and are calling that the risk pool. A) you are wrong to do that, it is pure socialism, B)Floridians rates are not going to go down. Their risk is still the same. In the insurance market that risk has a certain value. That value does not change with more people paying premiums.


I'll bet that you have not paid your fair share to live in Alaska. Someone is paying you to live there.
 
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Jorge Montero
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Brian is right in this one: Insurance companies adjust rates based on risk.

The problem of course is that the same model doesn't work well in healthcare, even when we consider starting risk factors. If I am using a car, I can do my best to work towards lowering my insurance costs by becoming a better driver: My accidents in the past will eventually clean up, and having an accident in the past doesn't doom me to having more accidents in the future. In healthcare however, a big percentage of expensive incidents carry forward forever, and nothing you do will make them any better. However, the insurance company won't pay for the treatment of that condition, or any secondary condition forever: Heck, they'd actively drop you if they have the ability to do so, and in a private insurance market, they will.

Another problem is that I can avoid being a bad driver, but I can't avoid being prone to sickness as I age. No insurance company would cover someone in their 70s for anything people can pay, which is why even the US has medicare: Without medicare, life expectancy in the US would drop by multiple years, if not a decade, as people would not be able to afford much. Paul Ryan wouldn't get elected in his own district if he swore he'd get rid of medicare and just lower taxes to corporations instead: It's not a popular thing even among conservatives. The insurance model is just not socially palatable, just like leaving people to die in the emergency room isn't palatable. For good or for ill, the US is no Sparta.

So ultimately we will have socialized medicine, it's just a matter of who is covered by it.

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Erik Henry
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And in Obamacare old people can be charged up to three times more for their health insurance--because they're more likely to need costly care. Again, like any other insurance.
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Ken
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hibikir wrote:
Brian is right in this one: Insurance companies adjust rates based on risk.


Nobody has ever disputed this. And nobody would suggest that drawing comparisons between health insurance and other forms of insurance is a good idea, particularly when you shift to something like hurricane coverage.

Quote:
So ultimately we will have socialized medicine, it's just a matter of who is covered by it.


Being immensely pedantic, we already have socialized medicine. We reserve it for the most expensive/highest risk individuals we could cover (the elderly and veterans), which is arguably the stupidest way we could have it.
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Yeah, I also think Koldfoot is making by a non-vacuous distinction. He and Ryan aren't communicating it perfectly, maybe, but it's perfectly tractable. Whatever the expected value of your health care is, insurance would generally want you to pay that, plus their operating expenses and profit. That's lower for some (healthy) people than others (with pre-existing conditions). Ryan is suggesting that insurance can't work if we inflate this value for the healthy to help pay for the known-sick. That seems false to me, because you can make people buy insurance, but whether it's good policy is another matter. I'm open to the suggestion that the young tend to be most healthy, but also poorest, also that this constitutes an effective regressive tax. If that were true, I'd think it was bad policy (but then I'd also expect Ryan to approve).
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Bojan Ramadanovic
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Koldfoot wrote:
wifwendell wrote:
Yeah, I watched part of his little lecture, and as you note he was literally saying why should healthy people have to pay.

Same reason I have auto insurance even though I don't PLAN to have an accident.

And homeowner's insurance even though I don't EXPECT my house to burn down.

Ryan's both stupid and a liar; what I can't figure out is the proportion. 80% stupid/20% lying? 50-50? Not sure.


Auto insurance is a fine example. You are not subsidizing anyone. You pay your insurance and bad drivers pay more. You don't pay more for bad drivers. Rates are vastly different for different classes of drivers.

You want a health insurance pool to have similar rates for everyone. Or even have healthy people pay more than high risk people. That is not insurance. That is socialized medicine.

Edit: taking this further.

Let us say there is no law requiring drivers to have insurance.

People would still get insurance. Some people couldn't stand to get a ding in their car and are willing to pay for coverage. Banks would require insurance until the car was paid off. Other people would be smart and just get it.

Would there be a clamor for good drivers to pay higher rates to cover bad drivers? That would be laughable.

Yet that makes perfect sense to you folks .


What you say does not make too much sense.

There are two issues conflated - one is risk pooling and other is transfers to poor/sick/unfortunate.

In purest risk pooling you will still have 'healthy subsidizing the sick' in a sense that if five identical people buy insurance and by random chance one of them gets sick and other four remain healthy premiums from the healthy are what enables insurance company to remain solvent and pay for the sick guy's care.

In that sense you can not avoid the healthy paying for the sick. If no healthy person chooses to insure themselves there simply would not be health insurance. If you want it in more stark terms: if no person ends up paying more into insurance premiums then they draw out - there would be no health (or any other) insurance. That is simple mathematics.

The second question - of transfers to poor or needy - only arises for people who either choose to not insure or are for whatever reason (poverty?) unable to insure while they are still healthy.
Among those people - by inevitable force of statistics - some number will fall sick. At that point - if your society, for charitable or any other reasons, decides to actually pay for their healthcare then you have honest to goodness subsidy (in fact you are subsidizing their prior decision to not insure).

Seeing as I agree with you that this sort of subsidy is generally bad policy (it encourages exactly the outcomes it is supposed to prevent by making non-insurance more attractive) you have two choices:

1) Let uninsured sick suffer and die (and possibly endanger public health while they are at it).
2) Force everyone to hold insurance from birth (possibly subsidizing the actually poor who could not otherwise afford it).

Both of these solutions avoid any subsidizing the *decisions* people make. Decision between the two is simply a moral one - do you value individual freedom to risk their lives for monetary reasons, more or less than the substantial suffering that would inevitably happen.


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Bojan Ramadanovic
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Kumitedad wrote:
perfalbion wrote:
hibikir wrote:
Brian is right in this one: Insurance companies adjust rates based on risk.


Nobody has ever disputed this. And nobody would suggest that drawing comparisons between health insurance and other forms of insurance is a good idea, particularly when you shift to something like hurricane coverage.

Quote:
So ultimately we will have socialized medicine, it's just a matter of who is covered by it.


Being immensely pedantic, we already have socialized medicine. We reserve it for the most expensive/highest risk individuals we could cover (the elderly and veterans), which is arguably the stupidest way we could have it.


You are correct. Time then to grasp the nettle firmly and stop with the half measures and embrace some form of single payer. Dancing around the problem like this only prolongs the suffering


I could not agree more.
Anything between single payer (at least single payer for basic medical needs) and letting people fend for themselves is intellectually (and quite possibly economically) untenable.
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Les Marshall
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Koldfoot wrote:

Auto insurance is a fine example. You are not subsidizing anyone. You pay your insurance and bad drivers pay more. You don't pay more for bad drivers. Rates are vastly different for different classes of drivers.


Auto insurance is a terrible example as it is not analogous. First, you only pay auto insurance if you own and operate a vehicle. (Though even this is slightly false as any fares you pay for transportation go in part to insurance). Second, operating a vehicle is a privilege and there are alternatives such as public transportation. Third, if you are careless and cause accidents or infractions, your rates go up and may ultimately cause you to stop driving.

Health Insurance is essentially for your body. Operating your body isn't really a choice and there are no real practical alternatives. Many of the costs of that body in the medical sphere come from incidents or conditions over which you have little control. Moreover, failure to seek medical attention may often result in risks to others.

Bramadan's analysis is spot on. Insurance premiums exist expressly to create common pool from which medical expenses can be paid. If everyone waits to enter that pool until they are sick, injured or elderly, then the premiums will always be high and likely too high for those on fixed incomes. When the young and healthy participate in the pool, then all premiums can be lower. I think most states require that people have auto insurance in order to have a car or risk having their cars impounded and their licenses suspended. Most auto premium dollars are never returned to their policy holders and yet we don't view this as some sort of socialist scheme to transfer money.

The real challenge we face is finding a way to curb runaway medical expenditures. We have one of the most expensive health care systems in the world. Inflation has been rampant for decades (certainly before the ACA) and despite relatively flat inflation in other market sectors.
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Ken
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rinelk wrote:
Ryan is suggesting that insurance can't work if we inflate this value for the healthy to help pay for the known-sick.


No, he's not even doing that. Here, let me make the argument that he should have made to attack the ACA the way that he wanted to.

We think that it's important that people have access to coverage when they need it, yes. But an individual mandate is a bad way to implement that - it's an additional compulsion by the government on an individual's freedom and requires that they buy something they might be happy to live without.

Now, some will argue that you have to have the mandate to get enough healthy people to sign up to offset the number of sick people who now have access to coverage. That's sort of true, because if we don't expand the risk pool with healthy folks, insurance companies will have no choice but to raise premiums. Worse, they'll have a hard time estimating their future costs, which will put them at significant risk of losses and even failures if the balance of new subscribers is off. We could backstop that with government guarantees, but that's an additional cost we really don't want to shoulder with the deficit where it is and it isn't predictable, so we'd also be subject to potentially large losses.

Here's the big problem we have with the ACA - the mandate only works if you get close to 100% coverage. But the penalty for not signing up is dramatically less expensive than the cost of insurance - roughly $700 instead of thousands annually. And because of the way the ACA is structured, an individual can skip coverage until they need it, and then join the system when they do and bring larger costs into the system with them. So there's little risk for a young, healthy person and a lot of reward for skipping out on the mandate.

So there's nothing about the way the ACA's structure that's working as intended. We need to make changes or we'll lose the insurance companies that are willing to enter the exchanges and continue to see premiums rise until the health care costs have stabilized year-on-year. We could up the penalty, but we hate the mandate because we're opposed to such compulsion.

Our plan of credits is structured to...

You get the point, I think. The attack is off, probably because it needs to be off. That's because the best solution available is to do something like drop the age limit from Medicare or go to a full mandate for insurance that covers everyone and eliminating Medicare. This stupid mix of systems simply can't work in the long run, particularly for people who are in the 45-64 age group trying to cover themselves and their kids while paying a mortgage, buying food, etc.

If they'd skip the bullshit, they'd be better off.
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Steve
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When the constitution was written the Founding Fathers could look at 3 to 5,000 years of human experience with civilized societies.
. . This experience led them to socialize certain things and not others. They socialized the Army and to a lessor extent the Navy, they socialized the Post Office, they socialized the Federal part of the criminal justice system [and the states socialized their part too], they socialized the civil court system, they socialized the tax collection system, etc.
. . This experience did not lead them to socialize the health care system. Why do you think that was? I think it was because doctors were pretty much useless back then. In fact it is widely believed by doctors today that Ex-President George Washington was killed by his doctor when he fell off his horse in a light snow storm and was bled instead of being kept warm.
. . Doctors were useless until the 1880s at least. That is when they finally were convinced by Dr. Pasture in France that germs really did cause illness. That all their old theories were so much BS. And then it wasn't until the middle of WWII that doctors got antibiotics and other miracle treatments.

This means that civilization has had just 73 years to learn that health care should also be socialized. Every other advanced nation has figured this out. Only the US has not figured out yet that health care is not like any other "good or service" that the market might provide. The sick or injured person or parent of such will always put a very high value on not dying or not being sick or in pain and unable to work. This puts too much power into the hands of those providing the care or the insurance for the care.

So, now that doctors and hospitals are the opposite of useless it just makes sense to socialize health care like the Army is socialized.

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I never thought I'd agree with Koldfoot on something in RSP but here we are. It's a valid point, and deliberately misinterpreting it as talking about risk pools is a weaselly, bullshit, tribal argument. Price controls applied to a free market do often screw things up.

For example, suppose insurance companies were required to offer the same rates to young and old people wherever they do business, with the result that they tend to lose money on old people and make money on young people. Now you're effectively telling those insurance companies stuff like:

1) Try to make the experience of your old customers miserable so they leave and use another company's insurance.
2) Do business in regions with lots of young people. Avoid regions with lots of old people.
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Steve
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SevenSpirits wrote:
I never thought I'd agree with Koldfoot on something in RSP but here we are. It's a valid point, and deliberately misinterpreting it as talking about risk pools is a weaselly, bullshit, tribal argument. Price controls applied to a free market do often screw things up.

For example, suppose insurance companies were required to offer the same rates to young and old people wherever they do business, with the result that they tend to lose money on old people and make money on young people. Now you're effectively telling those insurance companies stuff like:

1) Try to make the experience of your old customers miserable so they leave and use another company's insurance.
2) Do business in regions with lots of young people. Avoid regions with lots of old people.

Koldfoot's point in not valid for the reasons given and because the ACA does allow young people to be charged 1/3 as much as old people.
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Paul Ryan is sorta right in that the current system (ACA) doesn't work and neither will the new republican system. Health care risk needs to be spread through the largest possible pool: society, that's why we need socialized medicine AKA single payer.
 
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Khalid Shabazz
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SevenSpirits wrote:
I never thought I'd agree with Koldfoot on something in RSP but here we are. It's a valid point, and deliberately misinterpreting it as talking about risk pools is a weaselly, bullshit, tribal argument. Price controls applied to a free market do often screw things up.

I agreed it was a valid point; it doesn't make a lot of sense applying it to healthcare though.

For example, most cancer patients couldn't afford insurance if it was priced according to the care required to treat cancer. So let them die without treatment? That's gonna decrease healthcare costs, sure.

While some health problems can be attributed to personal choices, the majority can not. Ironic that the party that wants to abolish environmental regulations also wants cancer patients to pay more.

Draw a bad ticket in the genetic lottery, or the family lottery and you're assigned to a life of poverty or health problems because you can't afford insurance. It's more ethical than taxation, no? That seems to be the political philosophy of the empathy-deficient in general.
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