Obamacare and Ryancare

Thursday, March 30, 2017

The map is not the territory.

Alfred Korzybski

If a foreign government had imposed this system of education on the United States, we would rightfully consider it an act of war.

Glenn T. Seaborg, National Commission on Education, 1983


It’s been a tough week. I’ve started my taxes, there are tons of paper to sort through, and all kinds of minor things eat my time or energy or both. I’m coping, but I have neglected this place. I have managed to sort of keep up on Starborn and Godsons, the book Niven and Barnes and I are doing. I keep finding and creating scenes to add, not long, but they turn out to contribute to both characterization and plot. And every now and then Niven adds some more magic. Steve. Bless him, is almost done with the first draft and it’s pretty complete.

And the new version of Word isn’t helping. They seem to have introduced some bugs in the simplest operations, while adding some really good improvements to the capabilities for cooperation at a distance. It’s really possible to have two people work on the same document at the same time, but it gets pretty annoying when you lose the ability to control the layout on your own screen to make room for cooperative effort. My normal practice, learned in typewriter days, of course, is to have the text about 60 characters wide centered in the middle of the screen. I’ve got that on what I’m writing now. But when I open the on-line version of our book, it’s invariably either way over at the left side of the screen, or there’s a fat window there moving my text farther over to the right than I want; but if I close that window, all my text migrates to the left side of the screen and stays there.

I’ve tried the various options in the view and layout “tabs” in the ribbon, and even things like the design tab; some seem to create exactly what I want but when I go back to the text it’s crowded over to the left side again. Maybe cooperative documents have to be this way? Ah well. At least we can both work on the same document at the same time. And eventually someone will be able to communicate with a human on the Word design team at Microsoft. I’m sure there is one.


I wasn’t an enthusiast of Ryancare, and the complex scheme the Speaker had to get three phases of changes to the health care situation through Congress, starting with the arcane rules of using reconciliation to get through the Senate with a simple majority didn’t help. I did fear that some Democrats would be smart enough to vote for it; it would ameliorate some of the disasters of Obamacare, but it would definitely be owned by Ryan and the Republicans; when it didn’t work, Democrats could say, well, we tried, we cooperated, and if you’d just left Obamacare alone all would have been well, but…

As to how I know Ryancare wouldn’t work, come on, I’ve told you all along: this is not health care, It’s a system of entitlements. You can’t insure against events that have already happened, and if you insist that previous conditions don’t matter, that’s exactly what you are doing. Insuring against something that has already happened but hasn’t manifested itself yet isn’t insurance. It’s an entitlement. Ryanvcare was Obamacare light. The problem is that Obamacare is imploding and will cause a national disaster, and it was designed that way: the real crunches come after Obama has left office (and the Democrats have lost both Houses, although that doesn’t seem to have the effect you might have thought it would).

Obamacare is a system of subsidies and entitlements, and Ryancare would be the same thing: a few fewer steps down the road to socialized medicine than Obamacare, but headed in the same direction. If we’re going to have that, we ought to recognize it and do what we can to make it work as well as it does in Britain. For one thing, insist that it covers the working poor, “the deserving poor” better than it does “the undeserving poor.”

Of course the whole notion that we need to tax the productive to pay for the needs of the unproductive is another matter and we don’t have time for it. Obamacare and Ryancare both assume that everyone will get healthcare insurance whether they can afford it or not.

Incidentally, if you think it obvious that the productive have a moral or ethical obligation to pay the health expenses of all those who can afford it, where did they get that? It’s in no State Constitution I know of, and it’s certainly not in the Philadelphia Constitution of 1787. You may plead “plain Christian, or Jewish, or Judeo-Christian duty” and I answer that the courts have already settled that one: there isn’t any. We can’t even display a manger in the public square at Christmas. If you feel an obligation to pay someone else’s medical expenses, please do so. No one will stop you and many will applaud.




health insurance problems

This is in response to your comments about the health insurance problems. The fees the citizens pay for health insurance could be determined, in part, by variable factors such as whether or not a citizen has committed any recent crimes and to what extent he or she maintains a healthy weight, doesn’t smoke, and exercises regularly. Such factors are within a citizen’s control, and if he or she doesn’t make the correct decisions regarding them then the health insurance rate should go up.
Dan Gollub


And whether he is a citizen or not, and does he hold his mouth right in the presence of civil servants, and is he properly deferential to the civil service Nurse, doctors, administrator and ward boys: in other words is he deserving or undeserving poor?

Republican health care bill

Dear Mr. Pournelle,
I think I understand some of the reasons why you’ve opposed the Affordable Health Care Act; but I don’t understand your support of the proposed Republican bill, nor the notion that Democrats should have supported it.
From reports I’ve seen, the Republican bill kept intact the pre-existing conditions provisions, which you’ve described as creating an entitlement. However, the bill seems to have scrapped any incentive to sign up while you’re healthy; which would definitely make it an entitlement rather than insurance. It also cut many of the taxes which were intended to pay for the program. As Peggy Noonan pointed out, this would have been something of a catastrophic victory for Republicans.
As for Democratic support; well, I’ve seen no reports that it was ever sought or asked for. It seems more of a case of “we’ve shouted for years that you Democrats did a terrible thing, now you can watch while we scrap it and do something better.” If the proposal had indeed been better, perhaps some case could have been made for Democratic support (note: not “Democrat” unless you want to be intentionally offensive). But as far as I can see, the bill preserved most of the weaknesses of the ACHA, cut out elements which could make it work, and added expense.
I can’t see any reason why Democrats, unasked, should have supported the bill. Such complaints seem more like a case of “The buck stops elsewhere.”
Allan E. Johnson

I fear I was thinking as a former political strategist. The Democrats should have leaped on the chance to have Ryancare – possibly even Trumpcare – fail instead of experiencing the disaster that will be Obamacare. I also have some concern for my children,

This is not insurance, and all thinking people know it is not insurance. It is an entitlement to have someone else pay your medical bills. There are far better ways of doing that than to mask it as insurance. Simply repeal Obamacare and add a provision that everyone is entitled to $5104.79 in reimbursed medical expenses, after which you are on your own or a charity case might work.



You say that nobody is interested in compromising on the health care fiasco. Here is an example of a liberal blogger who still wants Trump and Ryan to “win”.
His host site needs you to click through political action popups to get to the article, so I’ll past the major portions below. The first post describes a very minor set of tweaks that he thinks will both help Obamacare and will give everyone a “win” before moving on.
* Reduce the income-based subsidies by about a third.
* Add a flat-rate version of Trumpcare’s age-based subsidies: $500 per person across the board.
* Change the age band to 4:1, a compromise between Obamacare and Trumpcare.
* Ensure continued funding of Cost Sharing Reductions.
* Donald Trump gets a big win. Paul Ryan couldn’t get his plan through Congress, but then Trump steps in and pulls off a huge deal. His presidency is back on track.
* Republicans in Congress get an albatross off their backs. Right now, health care is a loser for them, and the Freedom Caucus is riding high. But if they pass a bipartisan plan, it sticks a finger in the eye of the FC ultras. And if they’re worried about their base, they don’t have to be. Trump will sell the hell out of the plan, and his fans will buy it.
* Democrats have to make some concessions, but in return they get stability and permanence—and the possibility of future enhancements—for a social welfare program they’ve been trying to get enacted for decades.
* The health care industry gets some certainty about the future, along with a system that promises to be a moneymaker for them.
The proposal is from Kevin Drum.
Greg Goss.

And when that fails? The problem is we are not answering the fundamental question: just what does being a citizen entitle you to? Of course the courts will soon extend it to legal resident aliens, then undocumented..



Hello, Dr. Pournelle –
My consternation with the entire federal healthcare rigmarole is that the plans are simply unconstitutional on their collective faces.
AHCA is just as unconstitutional as ACA was.
I can see no provision in Article I, Section 8 of the Constitution that gives authority to Congress to come up with any healthcare plans.
General Welfare can’t cover them, because these plans are INDIVIDUAL welfare, not GENERAL. They deal with the healthcare needs of individuals, not the population as a whole. They cut a check to a provider for the healthcare needs of an individual.
It’d be a refreshing change to have politicians actually OBEY the document they swore an oath to defend and uphold.
Running out of hair to pull out in frustration,
Cam Kirmser

You are constitutionally correct, and so what? The courts will not rule that way, and the general public educated in our public schools will not believe it.



Repeal & Replace Fiasco

My take is that President Trump, having spent many, many years in business, probably expected the people he was working with to have some level of honest cooperation in their dealings with him, each other, and their constituents. History shows that just isn’t the way those ‘people’ work. Remember, congress is the opposite of progress. At least this time no one said “If you want to know what’s in it, you’ll have to wait until it is in use.” (a moderate paraphrase)



One Sentence Bill to Repeal ACA

I wonder what the GOP excuse will be this time. They couldn’t craft proper legislation? This seems simple and effective enough; I wonder why they won’t be able to agree to this:


On the same day that the House of Representatives canceled its vote on Ryancare, Alabama Rep. Mo Brooks filed a simple one-line bill to repeal Obama’s signature health care law.

The Huntsville Republican titled the bill ‘Obamacare Repeal Act.” It is short and to the point, AI.com reported.

“Effective as of Dec. 31, 2017, the Patient Protection and Affordable Care Act is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted,”

the bill reads.



Doesn’t get any simpler or easier than that. The bill is H.R. 1718 and has been referred to seven committees with no time table set by the Speaker.

◊ ◊ ◊ ◊ ◊

Most Respectfully,

Joshua Jordan, KSC

Percussa Resurgo

I wouldn’t hold my breath.




Ryan Care

I would be happy to do away with the pre-existing condition mandate once you get your time machine working and repeal the tax deduction for employer provided health insurance.
In an ideal free market for health insurance there would be the health equivalent of whole life available. We didn’t have such a system because health insurance got tied to employment. Maybe back in the Grey Flannel Suit days employer provided was the same as lifetime, but it sure isn’t for my (and Barack Obama’s) generation.
Back when I was young and healthy I chafed at the gouge in my paycheck from the employer provided insurance. I would have preferred the cash. I damn well paid my dues into the system. But as a free agent these days with the loss of invulnerability that comes from passing the half century mark, “free market” insurance would be unaffordable.
If you call for abolishing Medicare, including for seniors already on it, then you have cred for complaining about the pre-existing condition mandate.
Yes, I think full on free market insurance should be legal, complete with exclusions for pre-existing conditions. But such should receive no government subsidy, not even the tax deduction.
A government subsidy is useful for keeping people off Medicaid, and allowing people to be free agents instead of lifetime wage serfs. But the subsidy should primarily be for catastrophic coverage; we want people to pay more out of pocket so we have a pricing mechanism.
The RyanCare model was a decent start. A capped tax credit encourages people to get something without encouraging high salary firms from buying Cadillac plans. I want the well off to shop! The Ryan plan could be made better by increasing the credit substantially, but beginning the phase out at a much lower income: 20,000 instead of 75,000 for an individual.
Low wage day laborers need more than catastrophic coverage. If they cannot afford lower deductible plans, they will end up on Medicaid or clogging the emergency rooms. A couple making $150K can afford to pay more directly out of pocket — and should since we need to restore a cash market in medical services.
There does need to be a few other strings attached to subsidized insurance. It needs to be insurance, not prepaid likely medical, as most dental “insurance” is. This can be easily described:

1. Such insurance must cover everything Medicaid covers.
2. The copay rate must stay the same or go down as expenses go up.
Any other features can be up to the market.



As you say, the notion that health care is provided by employers was an accident of wage and price cojtrols during WWII. It worked because it sorted the deserving from the undeserving poor: those who had someone else pay for their health care had jobs and were willing to  work

The “pre-existing conditions” came from that, too: if you lost your job you lost your insurance, and when you got a new job you got new insurance; a significant number found they had developed pre-existing conditions not detected the first time, and they had been paying – or their employer had been paying – so they should not have had the rate increase.  Also they were older and thus their premiums were higher although they would not have been had they been able to keep the old policy. Like as not, though, the new job came with new insurance, and your previous insurance could not be continued.

That problem could possibly have been solved; COBRA was an early attempt to ameliorate it. And the question of deserving or undeserving did not come up: those working were assumed to be “deserving”, as they generally were, and no one had to decide.

The old system worked better that Obamacare. It was, after all, actually insurance.  And letting employers deduct the insurance costs as a business expense had a beneficial  effect for the company and was not widely thought to be unreasonable.  Simply making health insurance deductible for whomever paid it was in fact reasonable.




Chromosphere Press Announces Book 2 in the Division One Series!

27 MARCH 2017



What if Sir Arthur Conan Doyle was right all along, and Harry Houdini really DID do his illusions, not through sleight of hand, but via noncorporeal means? More, what if he could do this because…he wasn’t human?


Ari Ho’d’ni, Glu’g’ik son of the Special Steward of the Royal House of Va’du’sha’ā, better known to modern humans as an alien Gray from the ninth planet of Zeta Reticuli A, fled his homeworld with the rest of his family during a time of impending global civil war. With them, they brought a unique device which, in its absence, ultimately caused the failure of the uprisings and the collapse of the imperial regime. Consequently Va’du’sha’ā has been at peace for more than a century. What is the F’al, and why has a rebel faction sent a special agent to Earth to retrieve it?

It falls to the premier team in the Pan-Galactic Law Enforcement and Immigration Administration, Division One — the Alpha One team, known to their friends and colleagues as Agents Echo and Omega — to find out…or die trying.

Stephanie Osborn, aka the Interstellar Woman of Mystery, former rocket scientist and author of acclaimed science fiction mysteries, goes back to the urban legend of the unique group of men and women who show up at UFO sightings, alien abductions, etc. and make things…disappear…to craft her vision of the universe we don’t know about. Her new series, Division One, chronicles this universe through the eyes of recruit Megan McAllister, aka Omega, and her experienced partner, Echo.

Award-winning author Osborn is a 20+-year space program veteran, with multiple STEM degrees. She has authored, co-authored, or contributed to more than 30 books. She currently writes the critically-acclaimed Displaced Detective Series, described as “Sherlock Holmes meets The X-Files,” and the Gentleman Aegis Series, whose first book was a Silver Falchion winner. She “pays it forward” through numerous media including radio, podcasting and public speaking, and working with SIGMA, the science-fiction think tank. Osborn’s website is http://www.stephanie-osborn.com.

Division One series Book Two, A Small Medium At Large, will be released in ebook formats on 11 April 2017, and in trade paperback format on 25 April. Book One, Alpha and Omega, was released in January of this year. Additional installments in the ongoing series are anticipated later this year.


978-0-9982888-2-6 (ebook)

978-0-9982888-3-3 (print)

The ebooks are available for preorder at:

Amazon (Kindle/print): http://www.barnesandnoble.com/w/books/1126038430?ean=9780998288833 (Nook format will be available on the release date).

Look for the trade paperback at your favorite bookseller!

~Stephanie Osborn, “The Interstellar Woman of Mystery”


Award-winning author of the Division One, Gentleman Aegis, and Displaced Detective series








Freedom is not free. Free men are not equal. Equal men are not free.



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