Chris Cilizza shows GOP the way on healthcare

[The Velveteen Ocelot]

2. There is no workable *free market* solution to health care.

That's why the GOP can't make it work. They can't think outside their restrictive free-market box, so they just keep moving the pieces around hoping somehow it will all come together - but it never will. Insurance, as originally conceived, is almost pure socialism. One of the earliest forms was invented in the 18th century or thereabouts by shippers who were losing a lot of money as a result of shipping accidents, shipwrecks and piracy. So they created a system whereby everybody would pay some amount of money into a pool, and anyone who lost their ship would be compensated out of the pool. If you never lost a ship you were still paying to compensate those who did. This kind of insurance works pretty well. Most other kinds of hazard insurance (car, homeowners, etc.) works pretty much the same way: lots of people pay premiums but only a relatively small percentage make claims, so the insurer can charge premiums that most people can afford. With life insurance eventually a claim will be made, but because premiums are paid over some period of time the insurer can invest the money and thus make enough to cover the eventual payout (which is why younger people pay lower premiums, determined by actuarial data).

Health insurance is different. Sooner or later everybody gets sick or injured, but it's impossible to predict when or how. Statistically, younger people are less likely to have to make claims, but they do get sick or injured, and they can end up with conditions that will require treatment for many years. And the ability to pay for health care isn't optional: You pay or maybe you die. Because medical treatment is very expensive and the need for it is not very predictable, if you are relying on private insurance a very large premium pool is necessary, which was the reason for the individual mandate. If everybody is paying into the pool, statistically, in any given year, not everybody will make claims and there will be enough to pay for those who do. But if the only people who pay premiums are the people who are more likely to need medical treatment (e.g., older people, the disabled, pregnant women) and need the coverage, there won't be enough money in the pool unless the premiums are extremely high or there are a whole lot of deductibles and exclusions. So the GOP is in an impenetrable box. Every version they come up with can make private health insurance "affordable" only if the coverage sucks. If it actually covers what most people need and doesn't have pre-existing condition exclusions and lifetime caps it's too expensive for many people. So lower income people will opt out entirely because they have no choice (the GOP is big on "choice&quot , and then the pool becomes even smaller and the premiums go up some more.

There is no way to make "free market" private health insurance work. Either it's shit coverage or it's too expensive. There's no way around it, but McConnell, even using his super turtle powers, can't figure that out because his tiny reptile brain can't imagine anything that operates outside the myth of the free market.