When haggling over details, it is easy to forget what the rules are

When you are down in the scrum, butting heads and scrambling for the ball it is easy to forget the rules of the game or even what game you are playing.

Now, if it is wrong for Congress to mandate under pain of tax penalties that everyone buy insurance from privately owned and operated health insurance companies or through state or federally operated exchanges, isn’t it just as wrong for Congress to order those health insurers to charge a 30 percent premium penalty to those who let their insurance lapse?

The Commerce Clause has been stretched beyond any semblance of rationality when a person can be fined for growing grain to feed his own cattle because that disrupts interstate commerce, but health insurance is not commonly available across state lines.

Where does Congress derive the enumerated power to micromanage health insurance — whether via ObamaCare or RyanCare?

And why pray tell can you be given Medicaid — basically government insurance that dictates what allegedly private doctors and hospitals may charge for care no matter what it really costs — if your income is 138 percent of the poverty level, but you are on your own if you earn 139 percent of the poverty level?

Overturn the actuarial tables and whole concept of insurance when Congress dictates that those with pre-existing conditions and “children” to the age of 26 must be covered at the same rate as others. What is the difference between only allowing insurers to charge three times as much for older people than healthier younger people than only allowing them to charge five times as much.

Despite what you may have read in the morning paper, RyanCare does not repeal the tax on so-called Cadillac insurance plans. It merely delays it a couple of years.

When you are up to your arse in alligators it is hard to remember your objective was to drain the swamp.





25 comments on “When haggling over details, it is easy to forget what the rules are

  1. deleted says:

    Medicare does not dictate what a provider can “charge” for the patients they treat. Medicare sets the amount that the government will REIMBURSE a medical provider for treating a Medicare patient.

    And of course, there is NO requirement, that any physician ever treat a Medicare patient; leastways any imposed by the government.

  2. Anonymous says:

    It’s especially hard to remember you were supposed to drain the swamp, if it was never your intention in the first place.

  3. I believe there are limits on “Medicaid” co-pays.

  4. Steve says:

    The contract ( with any insurance provider including Medicaid) a service provider signs sets the amounts that provider will be paid by the insurer and prevents that service provider from charging patients any more than the allowed copay contracted.

    Most certainly, Medicaid limits what service providers may be paid, though they are allowed to try and “charge” whatever they like. Just look at any EOB, the proof is clearly displayed.

  5. I had to look up EOB. Thanks.

  6. deleted says:

    As I said, the government and especially Medicare but also other government health agencies do NOT dictate what a provider can “charge”, but does set the reimbursements that a provider receives for treating Medicare patients (typically through fee schedules based on CPT codes). (Current) Procedural Terminology)

    Nor does Medicare require that a medical provider treat Medicare patients. The individual provider decides that, this isn’t a Russia after all.

  7. Steve says:

    Sure,they can “charge” whatever they wish.
    But they are limited to what the contract with Medicaid (and any other insurer) requires in the agreement.

    Spun all you like Patrick, it changes nothing about reality.
    Service provider fees are contractually limited by Medicaid agreements.


  8. Steve says:

    The EOB tells you what the service provider is contractually allowed to charge for their service.
    In this regard, Medicaid is no different from any other insurer.

    Also, no provider is required to accept any insurance, but try to be a health care provider who does not take insurance and you will be out of work in a short second.

  9. Rincon says:

    I don’t believe the Constitution allows the government to require health care providers to treat anyone who cannot pay for the service. Am I correct on this?

  10. Steve says:

    If health insurance were sold across state lines it would be subject to the interstate commerce clause.
    Really don’t see why liberals complain about that.

  11. deleted says:

    Don’t mind Alan West.

    Last. I heard, he was still lookng for the part of the Constituton allowing him to do this:


    *NOTE. This was the previously “bad” wikileaks release of damning information about a republican administration, not the “new and improved” wikileaks release of orange ball approved information regarding a democratic one.

  12. Steve says:

    When things aren’t going the way your want….dredge up something 7 years old and try to deflect the subject.

    Nice one, Patrick.

  13. noodle35 says:

    I appreciate your posts. Nevada has changed, radically for the worse. It’s not like the State I grew up in.

    Make America Great Again


  14. deleted says:

    Don’t mind Alan West; he’s still trying to figure out how it is that private companies are allowed to persecute Christians by refusing to sell them alcohol.

    *NOTE. Apparently Mr. West went to a local Walmart to buy booze and the line he was in didn’t allow alcohol sales. The clerks name became an issue because it apparently wasn’t “Steve” and Wewt figured it was the beginning of the Sharia Law takeover in America. Turns out, the clerk, whose name wasn’t Steve, was underage and not permitted to sell alcohol to Christians or otherwise. West felt so strongly though, in his stupidity, that he thought he’d pen a column about it.

    Mabe that’s why he can’t find stuff in his Constitution; he’s too drunk with irrational rage over non-existent muslm takeovers and such.


  15. Steve says:

    Must’a hunted around some for that one, Patrick.


    Nice try at changing the subject again, too.

  16. Barbara says:

    Senator Cruz has not made many public pronouncements on the new health care bill, but has met with President Trump where he reportedly outlined his ideas. Here is an article published in Politico that, to me, makes very good sense.


  17. Rincon says:

    “If health insurance were sold across state lines it would be subject to the interstate commerce clause.”

    I was referring to someone uninsured. Unless an ER is straddling state lines, I don’t believe the federal government has jurisdiction. So isn’t the requirement that a medical provider treat someone who is uninsured unconstitutional?

  18. Steve says:

    My comment wasn’t in reply to yours, Rincon.

  19. Rincon says:

    Sorry Steve. It did fit!

  20. Barbara says:

    Any semblance of living in a constitutional republic has been cast aside. The Republicans, with the introduction of Ryan/Trumpcare, can no longer claim to believe in limited government and individual liberty. We have two major political parties that are dedicated to expanding government control and tyranny and give only lip service during election time to the Constitution.

    Here is an alternative penned by Rep. Mark Meadows and Senator Ted Cruz which appeared in the WSJ.


  21. Rincon says:

    Mostly bull cookies, I’m afraid. Specifically:

    “The insurance mandates are a primary driver of these spikes.” He’s saying forcing more mostly young and healthy people to purchase insurance drives up premiums. It will for those who had paid no premiums previously (even though they were covered by the rest of us), but each dollar paid by a new insured should reduce by a dollar the amount paid by those who have quietly been responsibly paying their insurance premiums year after year.

    “To further lower premiums, we should allow families to pay for health insurance from expanded health savings accounts.” This is a shell game. Total health care costs would not change at all, but paying with tax deductible money merely shifts the payment of premiums from the insureds to the taxpayers.

    “We should also include in the reconciliation bill additional reforms that will drive down costs: Consumers should be enabled to purchase insurance plans across state lines to create a true 50-state marketplace.” I couldn’t agree more.

    “Instead, we should implement nonrefundable tax credits, which can be deducted from payroll taxes for lower earners.” Again, a shell game. Tax credits only shift payments from the insureds to the taxpayers. They do not reduce overall costs.

    “Third, ObamaCare’s Medicaid expansion should be immediately frozen and then phased out over time.” Does he think the medical needs of the people to be denied will simply vanish? Instead, the providers will be required to provide “free” care, shifting costs to the other patients.

    I note that legal reform is completely missing. Wasn’t that one of the Republicans’ biggest complaints about Obamacare? They have sold us out!

    Last, but not least, where is the requirement for price transparency? Again, we’re sold out.

  22. Barbara says:

    What they are suggesting is what they think can be passed given the current political climate. Unfortunately, we don’t have enough politicians who believe in a true free market.

    Here is a link to a great discussion between Daniel Horowitz and Professor Cochrane of the Hoover Institution.The portion dealing with pre-existing conditions begins around 13:40.


    Below is a link to 20 ideas to get to a free market. This article covers much of Professor Cochrane’s ideas.


    I especially like the idea of health insurance policies that function like term life insurance. Once purchased they cannot go up in price even if you get sick and they cannot be cancelled. Government regulation would only center around making sure insurance companies were compliant with the policies they issued.

  23. Rincon says:

    Professor Cochrane’s article presents many worthwhile proposals that should be included in the Republican health care bill. There are some that I find doubtful such as his health status insurance, but these proposals by and large would be welcome changes.

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