Ryancare

With great fanfare, Paul Ryan introduced his demolition derby approach to healthcare that will 

1. Invariably increase the number of uninsured people.
2. Reward insurance companies and significant others with tax breaks and
   financial bon bons.
3. Eliminate Obamacare no matter what the human cost may be because ...
4. It's all about the money.

JUST HOURS BEFORE House Speaker Paul Ryan held a press conference to sell his health care overhaul legislation — using a PowerPoint presentation mocked for misrepresenting basic facts  — he was doing something he’s much better at: fundraising.

The two things were related. The Thursday morning breakfast fundraiser he attended was hosted by a lobbying firm working to unwind the Affordable Care Act on behalf of health insurance company Blue Cross Blue Shield, one of the big winners of Ryan’s proposed legislation.

The breakfast, according to an invitation, was sponsored by McGuireWoods PAC, the political action committee for the lobbying firm McGuireWoods. Blue Cross Blue Shield pays McGuireWoods $120,000 a year to lobby on changes to health reform, records show. Attendees of the event paid were asked to pitch in as much as $10,000.

Ryan’s American Health Care Act (AHCA), which rolls back most of the revenue-generating provisions of the ACA, reduces premium subsidies, and imposes deep cuts to Medicaid, has largely been panned by medical professionals, health policy experts, and political advocacy groups from across the ideological spectrum.

It gets better.

As we reported earlier this week, insurance lobbyists are particularly fond of a tax change made by the Republican health bill that removes limitations on deductions for executive compensation. That reversal will reduce the tax bill for health insurance companies while incentivizing higher pay for insurance employees.

The ACHA would also permanently repeal the 2.3 percent excise tax on medical device tax, which was imposed by Obama’s health reform law. AdvaMed, the lobby group representing the largest medical device firms, released a statement commending the Republican-led House Ways and Means Committee for the repeal of the tax.

While some media outlets praised Ryan’s “wonky” style and use of bar graphs to make his case for the bill on Thursday, many reporters noted that the speaker stumbled when asked basic questions about the legislation.

When looking at this ridiculous process of trying to ram through this version of HC as fast as possible with little or no due diligence required for managing something as truly complex as healthcare, no one actually asks the question of why healthcare doesn't work outside of the usual rhetoric of it's too complex, too expensive or too inefficient. 

It doesn't work because billing is separate from services rendered. It's akin to buying a  car. The invoice is the document describing. in very precise terms, what the buyer is buying. Said invoice comes directly from the car dealership selling the car and is part of the package being sold to the customer. In the case of healthcare, the insurance company, in effect, generates the PO payable to the practice or hospital with the gap being covered via the copay by the patient. 

This "invoice" given to the insurance company has no direct connect to the patient record set describing medical treatment like the car invoice has to the car as the invoice, aka the insurance claim, is not only separate and completely different than the patient record from the programming perspective but also is always generated after the service has been rendered, which means the connect of the bill, aka the claim, to services rendered, patient treatment, is tangential at best, thus giving rise to the inability of healthcare to be run like every other business on planet earth to include accurate profit and loss statements keyed to the services provided to each and every patient treated by the practice and/or hospital in question.

To cover costs, the insurance companies make doubly sure patient premiums more than cover healthcare costs as seen by the amazing financial perks given to the ceo's of companies like Aetna, Unitedhealthcare and Blue Cross & Blue Shield. 

When looking at Ryan's inept attempt at "improving" HC, one does NOT SEE this essential analysis of why HC doesn't work. It's all about tax cuts, financial compensation and increased power of the insurance companies to control the process more than ever. Simply unbelievable but, when Ryancare takes effect, the blowback will be intense given what this version of HC does NOT PROVIDE to the citizens of this once great nation.

Addendum: Had to add Krugman's take. A Bill So Bad It's Awesome

Trumpcare — the White House insists that we not call it that, which means that we must — preserves some version of all three elements, but in drastically, probably fatally weakened form.

Insurers are still barred from excluding the sick, but they’re allowed to charge older Americans — who need insurance the most — much higher premiums.

Subsidies are still there, in the form of tax credits, but they’re no longer linked to either income (as long as it’s below $75,000) or the cost of insurance.

And the tax on those who don’t sign up becomes a small surcharge — paid to insurance companies, not the public — on people who sign up after previously letting coverage lapse.

Affluent young people might end up saving some money as a result of these changes. But the effect on those who are older and less affluent would be devastating. AARP has done the math: a 55-year-old making $25,000 a year would end up paying $3,600 a year more for coverage; that rises to $8,400 for a 64-year-old making $15,000 a year. And that’s before the death spiral.

Same as it ever was - Talking Heads