Voodoo Cost Savings

If you really want to know about Max Baucus’s bill, head on over to Ezra Klein’s blog, which is all Baucus, all day. If you want to complain about fake cost-saving measures, stay here.

A major selling point of the Baucus bill (can’t really call it the Group of Six bill with zero Republican support; can’t call it the Democratic bill with questionable Democratic support), at least in the media, is its lower cost – $860 billion according to Baucus, $770 billion according to the CBO. This compares to the $1 trillion cost of the House bill. But this is a meaningless number, for two reasons.

The first is that this is just the cost side; it doesn’t take into account how those expenses are financed. The House bill has a net cost of $239 billion, not $1 trillion; why everyone focuses on the $1 trillion number while talking ominously about government deficits makes no sense to me. So if you really want to be selling the Baucus bill, you should be pointing to the $49 billion that the CBO says the bill will save the government over the next ten years.

The second is that the cost number is an accounting fiction. One reason the Baucus bill is “cheaper” than the House bill is that it has lower subsidies. For illustration, let’s assume that the whole $140 billion difference is due to lower subsidies. Relative to the House bill, then, the Baucus bill costs the government $140 billion less; but it costs middle-income people exactly $140 billion more, since they have to buy health insurance. The difference is that in the House bill, the money comes from taxes on the very rich; in the Baucus bill, it comes out of the pockets of the middle-class people who are getting smaller subsidies. Put another way, the Baucus bill is the House bill, plus a $140 billion tax on people making around $40-80,000 per year. That’ s not only stupid policy; it’s stupid politics.

In reality, there are more differences between the bills than just that, and, in its defense, the Baucus bill seems to raise more revenue than the House bill. But this idea that reducing subsidies saves money is just an illusion created by selecting a particular frame of reference. If you start with a different frame of reference, reducing subsidies is just increasing taxes – on the wrong people.

By James Kwak

78 thoughts on “Voodoo Cost Savings

  1. It is well understood that Backus is an errand boy for the health care insurance industry. Trying to sustain the unsustainable is not noble or heroic, it is doomed.

  2. The solution is quite simple. All Democratic voters should tell their Representatives they will refuse to vote in 2010 unless the Party unites behind single payer. There is nothing else these clowns understand.

  3. How about all democratic voters include a $5 bill with their suggestion. That should counter the money from insurance, pharma and device makers.

  4. You can look to the markets response in the healthcare sector for an indication exactly who would benefit from the Baucus Bill. It ain’t poor and middleclass American. Without a public option, said public is going screwed…again. On a side note, it would be helpfull is one the more erudite bloggers would define socialism and explain, how in hell it has been deemed such a grievous evil by the wingnuts in redneck Amerika. These idiot all quick to support socialism when the government forks over trillions of dollars to the shades and shaitans in the finance sector and the predatorclass, (.001% of the population), – but when it comes to government providing some basic healthcare to America’s poor and middleclass, the wingnuts in redneck Amerika go beserk like screechin harpies, whining about socialism, and BIGGOVERNMENT, and all kinds of other pathological lies, and distorted misinformation, or disinformation.

    I’ve been without healthcare for more than 10 years as a result of job losses, and divorce. NO ONE! NO ONE is going to FORCE me to purchase healthcare insurance. I can’t afford it!!!
    These idiots can send me to jail, (where I’ll have both free healthcare, and job training, and easy access to the kind of criminal organizations I need to plot and execute therevolution, which is more than I have now.) Not that I have any desire to go to jail, – nor will I EVER! EVER! be FORCED into feeding the offshore accounts of the predatorclass.

  5. When you think about it $5 is a small cost to pay to avoid bankruptcy liquidating your entire net worth.

  6. James –
    Part of the problem with health care costs is the current system separates demand for the services from their cost. The first step is to make people who use the service see and pay the cost, at least to the extent possible. Having the ‘rich’ pay for health care for others who could afford it simply invites overuse, such as occurrs with driving on public road and with water before it was metered.

  7. Wendell Potter worked inside the insurance industry (at Cigna) for over 20 years. He was not fired, and he was not passed over for advancement. He retired. Then shortly after felt guilty about all those who were going uninsured and decided to speak out about it.

    You can see Wendell Potter’s thoughts, on the link immediately below. He shows clearly how insurance companies spoon-feed Senators bullet points for discussion and basically write lawmakers speeches for them.

  8. I don’t think that’s a viable solution. If you make people see and pay the cost, then poor people die. Using price to control demand works for, say, candy and baseball tickets. I don’t think it works for life-saving procedures.

  9. If you cannot afford healthcare, then you apply for a waiver and you don’t need to purchase healthcare and you aren’t penalized for not having healthcare… at least that’s the process under Mass. Commonwealthcare… see today’s WSJ for examples.

  10. Unfortunately I am having to argue with fellow republicans on why health reform is required. Why does no one talk about what happens if Don’s solution is adopted ? No insurance – Lets repeal the Supreme Court requirement to treat people at the ER. No cash – YOU DIE !

    It works in India very well.

  11. How about mandating that private “health insurers” spend 95 to 99 percent of the premium money on care, similar to how life insurance works? It would change the incentive for the “insurers” to pay for more care, since the only way they can increase profits would be by increasing premiums. Competition might then bring prices down by volume. It might be an improvement over the status quo.

    I still think single payer funded in part by a sales tax is the solution, but I’ll take anything that’ll break the cartels.

  12. In case all you care about is profit…

    Once word gets out that you need to have hundreds of thousands of dollars stashed away to survive any major illness, people will start saving and not spending. Try getting people to buy the useless merchandise that drives our economy, when it means the difference between life and death.

  13. What you say is true for some health care consumption, but if price is not used to ration, then other means will be used, for any free good or service invites outrageous waste, and medical care is no exception. That, I am convinced, is the biggest problem with the current medicare program, and it will have to be addressed sooner or later.

  14. you aren’t penalized for not having healthcare

    That’s very nice of them, not to further penalize the sick people who can’t get health care.

  15. The experience of other countries refutes that.

    Nobody wants more health care than they need.
    Every time you see the doctor you are potentially
    exposing yourself to being killed by him/her.
    That’s incentive enough for most people to dread
    the whole experience.

  16. Ironically, those same rednecks are the ones chest-beating the hardest about their mighty military. You know, the socialist program that protects us all from outside military aggression. Or bleating about their heroic police officers. The socialist program that protects us from the aggressor next door. Or even their heroic fire fighters. Yep, that’s another socialist program too.

    Seriously, why does no one ever explain that those groups the redneck types lump praise on as heroes are shining examples of how great a little socialism can be?

    I’m not saying everything in the country should be socialized, but basic essential services (like military, police, fire, and of course medical) should not be driven 100% by profit motive. We’ve shown exactly where that gets us… which is why this whole debate is happening.

  17. http://en.wikipedia.org/wiki/Hippocratic_Oath

    A good doctor will still treat people and still incur costs. The doctors that are in it just for the money are jerks. The real ones take that oath seriously and are just worried about which solution allows them to save the most people.

    Any doctor saying otherwise is not a doctor I would like to trust my health to.

  18. Don, as someone posted previously. You can’t comparison shop for prices when your wife goes into premature birth. There are real medical needs involving life and death. In such events, you don’t want the cheapest medical care, you want the best.

  19. How come more mention is not made of the cost shifting that occurs for uncompensated care, care that is provided to those w/o insurance via ER.
    According to the Hidden Health Tax study by the Families USA organization, $43 billion in ‘uncompensated care’ were cost shifted into inflated health insurance premiums in 2008.
    The 10 year cost of this cost shifting using a 6% health care inflation rate means over the next 10 years we will have paid over $550 billion for this ‘uncompensated care’ via inflated premiums.
    With a mandate, thus universal insurance, and viable means to recoup that cost shifting (via a public option?) that would mean the true cost of health care reform is $300 to $500 billion based on the bill.
    For that we avert thousands a year from dying due to lack of insurance, hundreds of thousand going bankrupt. No more pre existing condition stipulations or rescissions. And maybe, with a the public option (or Switzerland like regulation) reign in the ever inflated costs of health care.

  20. http://www.npr.org/templates/archives/archive.php?thingId=2

    NPR had a good story yesterday on the possible effects of lower subsidies on the middle class, via a look at the Massachusetts system (“Mandatory Health Insurance May Hit Middle Class”).
    Without a public option and with diluted subsidies, an insurance mandate seems to simply be a tax. I would think that, in most regional markets, a mandate would amount to being forced to pay an inflated premium to a monopolistic local provider, with whatever subsidy received being a transfer from the government to the insurance company with little gained. (I guess one could argue that a given insurance company could charge lower premiums if they had a broader base of members, but without competition to drive premiums down, this doesn’t necessarily seem to be the case.)
    It’s hard to see how the Baucus plan isn’t just a give-away to insurance companies.

  21. I have heard people insist that eliminating fire departments in favor of for-profit fire companies would make fire fighting more efficient, eliminate waste and all the other usual catch phrases.

    case in point

  22. some of the best and most trustworthy doctors I was lucky enough to consult had their budgets under tight control and were quite open about it

    I’d prefer a doctor who has a grip on his finances any time over an idealist who is willing to pauper himself for my well-being

    but maybe that’s something that comes with a “socialist” health care system – that one can openly and in a trust enhancing way talk about money

  23. I can’t help but feel this is another rank betrayal of America’s poor and middleclass by the Obama administration. They pretend to support real healthcare reform on TV with all kinds of spashy speaches, – but when all cards are on the table, – it’s a swindle – again. The oligarchs win AGAIN, and the poor and middleclass are shafted, with no meaningfull reform and even more grievous abuses, and wanton profiteering by the healthcare, (insurance, HMO, pharmacuetical) oligarchs now FORCED on the American people. No doubt those regulating who is amongst is without healthcare will be highly expert at tracking them down, and garnishing their wages. Contrast with the fiends and swindlers and oligarchs on Wall Street, who walk away clean from abuses that pale in comparison. Not only will there be no “public option” or socialized healthcare safetynet provided, and no accountability or remedy for abuse, – but the government is going to FORCE people who cannot afford healthcare now into purchasing some fraudulent insurance policy that will provide neither adequate healthcare, nor any protection from what is CERTAIN to be WANTON abuse from the healthcare providers. It’s moments like these when I do not see anyway out of this horrorshow outside of revolt.

    How much abuse are we expected to tolerate!!??

  24. Over-consumption is not caused by the consumer. It’s caused by distorted incentives. Doctors are paid for performing procedures, not for outcomes. So why not keep grandma on life support even if she’ll never leave the hospital? The meter is running and everyone is making money!

  25. There’s enough medical work to go around, that doctors don’t have to make up medical work to do in order to bill more.

    End of life care for hopeless cases should probably be reformed, but this is not related to incentives on doctors. It does have something to do, however, with people who are dedicated to preservation of life from a few cells onwards (except for criminals, foreigners, animals, and a few other groups).

  26. I wish I could be as sure about end of life care not being unduly prolonged, Yakkis. After all it does provide jobs not only for doctors but for a lot of other services too.

    But from a strictly personal point of view for me the idea to HAVE TO spend time with other people instead of in blessed solitude is pretty horrifying. But then I think of that blessed state I was in while the mini-narcorsis from the colonoscopy was wearing off and then I am not so sure anymore that I could not be persuaded to wish to prolong my life in that blissful angst-free floating around for as long as possible.

  27. Actually read the WSJ story… many of the folks getting waivers are young families, but don’t make enough money to afford a health plan; the root of the problem is that Mass. does not offer a low cost catastrophic plan for the healthy unlikely to get sick soon; or even better, other way the problem could be solved is by raising the income level eligible for gov’t subsidies to 400% of the federal poverty level.
    When the crew looking into how Mass can better deliver services finishes their work… these problems will resolve.

    And I should add here the obligatory… payer and single. I don’t think this cant requires any particular word order.

  28. There may eventually be a public option. It will cover those citizens that the insurance industry has deemed unprofitable.

    So, what do I tell my children? Do I advise them to emigrate to Canada or the UK?

  29. A betrayal of the middle class is what our politics is all about. The rich are protected from plunder by government because they ARE the government, the poor have nothing to offer and everything to gain. The middle are the serfs and slaves that fund the system. Unfortunately, the rich political elite have offered more in entitlements than the middle class can fund.

    If I can’t afford health insurance, and now MUST HAVE health insurance…how much better off am I. I still can’t pay deductibles and out-of-pocket, etc, that I couldn’t afford before… An insurance solution isn’t a solution.

  30. Advise them to go to medical school and join Doctors without borders so that they can be sent to the third world country known as America.

  31. Here is someone who was in the insurance industry, who made a career out of propagandizing for the insurance industry, who flew around on their private jets using gold silverware and eating beluga caviar, who is in some ways responsible for many deaths ADMITTING the insurance industry is actively corrupting politicians, acting in bad faith towards humans, and with reckless disregard of human life.

    How can anyone watch this video and still think that the debate around health care is a serious one?

  32. There is the malpractice incentive. Many procedures
    are performed to fulfill the CYA mandate.

    I had surgery recently. 3 pre-surgery appts, which
    accomplished next-to-nothing. 3 post-surgery appts,
    which did accomplish nothing. The final appt must
    have lasted about 3 minutes, out of the scheduled 15.
    3 superfluous minutes at that. Sure seemed like
    there was some padding going on there.

  33. I’m not sure about billing 15 minutes for 3 minutes of work, but Doctors _must_ check up on patients after surgery, sometimes 3 times just to make sure complications aren’t developing. The same goes for pre-surgery planning.

  34. This is an interesting assertion. I don’t think the subsidy issue should be frame on how much procedure A might cost, but rather on whether it is reasonable of not for for people to be expected to apply available dollars in some kind of reasonable hierarchy of utility. Procedure A is expensive, but if you are paying $900 a year for cable TV, then you should have at least $900 to apply to procedure A. And likewise with a new $24,000 car when $4500 cars with similiar utility are available. If health care is such a critical element to civilized life, then it is entirely reasonable that folks be expected to spend their own money until it hurts. Start with low subsidies and stick with them for 10 years and then reassess as needed.

  35. I don’t mind making people do without cable TV or more expensive cars or any of a number of things that are less important than staying alive.

    The problem now is that many people do sell all of that, and even get to the point of doing without enough food and shelter (relying on food banks and homeless shelters), and still they don’t have enough to treat their illnesses.

    These people might have started from an upper-middle class job, house and car, WITH health insurance. First the co-payments and excluded items had to be paid for. Then, the insurance was cancelled. Then they ran through all their money. Then they sold all their stuff and declared bankruptcy (which is not the most efficient means of protecting yourself from creditors). Then they lost even more. Eventually, they were homeless and starving and sick. Don’t think this can’t happen to you; it’s happening constantly now.

  36. I’d be affected. I do not want single-payer. No one in my wider circle of educated, upscale men OR WOMEN wants single-payer. But, hey, gee…we are not among the current or recent crop of on-campus cheerleaders, AND we’ve actually been on the market for twenty to thirty and more years…we’re what they call taxpayers: real ones.

  37. I’m still for what McGovern wrote in his op-ed. Write a bill with one line that extends Medicare to everyone. Then tell all the providers, drug companies and anyone else involved in healthcare to negotiate to make it work.

  38. Are you the same Russ who wrote on his blog:

    “Single-payer is the only road guaranteed to achieve these, and the only truly moral way to organize this society’s health care.”


    And wrote in here earlier to say:

    Which is part of the reason why private health insurers shouldn’t exist at all. They are existentially “unfair”. That’s the point of the post – it’s a perversion to drag basic human rights into the world of mercenaries and “markets”.
    Russ September 2, 2009 at 2:53 am

  39. Also, do you not want medicare, and the health systems the U.S. has for veterans, government personnel, and native americans?

  40. Also, I’ve heard it mentioned that those stupid 3 minute consultations where you go in are due to the fact that insurance won’t pay the doctor for phone checkups and the time he spends doing that. So while he’s in CYA mode, he’s also jumping through the loops insurance puts out there so he gets paid for honest work.

  41. The above “Russ” comment is not me. I’m the one you quote here, and that’s my only website. I hope that doesn’t confuse anyone.

    Thanks for asking, Yakkis.

    (This isn’t the first time that’s happened. I guess I shouldn’t flatter myself that the other guy used my name intentionally to sow confusion, but still it’s too bad there’s no way short of registration to keep names unique and straight.)

  42. Thanks Russ. I should also thank the other Russ for giving me the chance to correct myself.

    When I said “everyone”, I meant the majority of everyone: the majority of U.S. taxpayers, doctors, nurses, mayors, businesses, unions etc.

    I’m sure there are many fine “upscale” taxpayers in the minority (not the least of whom work in the health insurance industry).

  43. No doubt the Baucus bill is a betrayal of the principles of the Democratic Party. But I’m not sure how it’s Obama’s betrayal, since he hasn’t endorsed it. I’m content to wait and see what he actually signs, before getting out the pitchfork.

  44. Russ, I’m wondering if you will suddenly decide at age 65 that single payer (Medicare)is a good idea.What younger “upscale” men and women don’t understand is that the state of your health changes with age and not surprisingly so does your concept of what’s best for you. I’ve been where you are and I’m now on Medicare and it’s great….and, I’m willing to pay more to help keep it that way.Wait until you get a little older and your insurance company triples your rate or your employer drops your insurance…it happens.”Upscale” people in general-. with their education and vast experience just happen to know what is the best deal for THEM at any given time. It’s time to think about others who are not in the same boat.

  45. This Russ: I have changed my ID so that the confusion will be reduced.

    NOTE: I am 65…exactly. When I was in my 20s and again in my 30s I attempted to pull myself out of the Social Security system: no dice ~ government is insistent on the ridiculous.

    My situation MAY be advantaged: it is not easy to know: but this I do know: to place me in the minority of folks who feel as I do fails to keep pace with the polls over the past month, day by day. The majority does not want single-payer – it’s that simple.

    If you continue to chant for single-payer and you actually realize that result, then you are condemning the young to an even worse draw-down on their incomes than they are already condemned to suffer owing to the greater numbers of the steadily longer-surviving elderly. I do not want that for myself: I do not want my remaining surviving child to suffer that draw-down on bi-weekly income that is likely to be earned in coming years owing to ability, education, and skills, which are formidable.

    Indeed, I would prefer that no one’s child suffered the additional load of single-payer atop Soc. Sec. + FICA.

    Is this so difficult to understand? Not really. [Yet, when factionalism drives reasoning, the answer is quite different, I see.]

  46. draw-down on their incomes than they are already condemned to suffer owing to the greater numbers of the steadily longer-surviving elderly.

    Good point! With medicare, we are condemned to having long-living elderly. With better care, more people will make it to old age.

    This must be stopped!

  47. Please see my post immediately below this one referencing studies showing how single payer SAVES money.

    All other plans SPEND money.

  48. Amazing, since the original fire departments WERE private. People got sick of their houses burning down as the firetruck for a company that they weren’t covered by roared past, and the rest is history. They want that system *back*? Ludicrous.

  49. This entire debate over costs is utter nonsense. This is the richest country in the world, there is plenty of money to pay for health care for everyone ten times over. Getting bogged down in bogus budget estimates just diffuses our energies.

    If Obama and the Dems not want to give us rational health care reform, let’s just say goodbye to him and get someone else in 2012. If the Dems lose again, well, it takes some political parties longer to learn not to screw the people who voted them into office.

    We have waiting around a century for rational health care and a few more years won’t make a difference. If some form of what is being presented as health insurance legislation passes now, it will be another 100 years before it gets changed.

  50. Because no one’s watching it. That video isn’t popping up on the same channel that shows American Idol. It’s on PBS. Nothing “worth watching” is on PBS; there’s no big glamorous stars there!

    In all seriousness, I agree. That really is a great interview that all Americans *need* to see.

  51. The House bill has a net cost of $239 billion, not $1 trillion….this amount is over 20% less than, and a full $61 Billion less than the $300 Billion in CITIBANK (solely, only, exclusively-like not counting any other countless guarantees for other too big too fail idiots)guarantees we have provided.

    Where in the F**K are our priorities? Seriously? Depending on whose numbers you use, and what these include, the too big to fail worldwide financial collapse will cost the US $13.2-$24 Trillion when all the dust settles. And, we are seriously worried about spending $239 BILLION over TEN YEARS to ensure ALL OF OUR CITIZENS? How much money have we spent on Iraq? Afghanistan?

    We have made a choice, and our people have come out at the bottom. We have affirmatively decided that funding and fighting wars is more important than our collective health care. We have decided that the health of the too big to fail financial and insurance oligarchs is far more important by factors in the hundreds than our collective healthcare. We have decided that the profitability and survival of our pharmaceutical oligarchs is more important than our collective health care.

    America doesn’t get it. We can no longer afford to subsidize the world wide profitability of the pharmaceutical companies. US costs are 3-4X accross the board for all pharmaceuticals. No other country affirmatively refuses to negotiate prices in the public health care systems. We can no longer afford to ensure the survival and profitability of a massively broken health insurance indstry that we spend 150-175% more than any other western industialized country on, and get terrible and expensive care for a fraction of our citizens.

    Unfortunately, Americans have no experiential understanding in large part how civilized countries systems work.

    It is a travesty that we don’t have single payer.

  52. “owing to ability, education, and skills, which are formidable.”

    what would you argue, if heaven forbid, your child would become or were disabled in need of extensive care?
    I just met a guy of 30 who via a car accident two years ago became wheel-chair-bound – I feel really good when talking to him KNOWING that cost of medical care is not one of his concerns – I consider that to be a luxury as costly as it may have been over the years to me that is well worth having and the longer I read you talking about it the more I appreciate it and feel rich for having it in a way that no diamond ring could achieve.

    I get always told that America is a Christian nation – if this is how a Christian nation wants to treat its weak members then I prefer our old messy patched-up system*) which is kind and decent and considerate to the patient.

    *) and never forget: invented/created as an ANTI-socialist scheme by Bismarck, the “iron chancellor” in 1881 (EIGHTEEN-eighty-one)

  53. “With better care, more people will make it to old age.

    This must be stopped!”

    Yakkis, stop it, you’ll ruin the last booming portion of our labour market …

  54. So we should have astronomically expensive health care, where if the “middle class” still exists at all, it will have the choice between bankrupting itself for this “care” or dropping dead.

    And this would be better than having much less expensive, much better care for everyone, for which everyone pays, but pays much less.

    I see.

    (I still don’t get what’s the point of having “society” at all under those Social Darwinist circumstances. Since no one answers that question, I’ll assume there is no answer other than “I’ve got mine, now I want the status quo entrenched forever, and the point of society is to entrench that status quo.”)

  55. Russ
    it is quite simple “I’ll go it alone” as long as the going is good and hat-in-hand-humble-me willing to prostrate myself when things go wrong

    the bankers very recently showed examplary how-to-do-it

    you should have heard our Deutsche Bank spokesman’s*) almost uncontrollably trembling voice during the height of the crash with his “we must be all in this together” and his uppity I have warned about the dangers as a highly responsible banker all along after his job was saved

    the only explanation I have is that these people are not only viewing the world as peopled by monads they are also deluding themselves in almost incomprehensible ways.

    *) (Chef-Volkswirt Norbert Walter)

  56. Daryl, single payer SAVES money. Whole percentages of GDP worth.

    That’s money the U.S. would have to bomb other countries! Think of the the cluster bombs!

    From a cost perspective, it’s a no brainer.

  57. Just to start at a summary level – we are currently spending around $7.2K per capital for health care (16% GDP). That is employer, private, individual, fed, state and local government. Around $2.15 trillion every year (give or take a $100 billion or so).

    If everyone (young, old, currently insured, uninsured) in the country had a individual policy that cost $300/month, that would total around $1.2 trillion, leaving about $1 trillion for other associated subsidies. That is annual expense – every year. You don’t need huge percentage savings to make a real positive impact on the economy.

    This is not insignificant – not just in terms of health care, but the entire economy.

    No one in the right mind can say there isn’t enough in current spending to cover everyone and then some – other countries do it for much less as a percentage of GDP.

    This is not a question of resource availability but allocation.

  58. Somehow the title made me imagine the use of voodoo practitioners as alternative medicine. I’m sure that that would save money. And as far as end of life care goes (the last 6 months), that is where a large part of our health care costs lie. With voodoo care, it is hard to see how the outcomes could be worse, and the quality of the life remaining might even be better.

  59. Here is T.R. Reid on Fora-TV talking about his new book The Healing of America. He makes some very good points including the need for leadership on a national conversation on universal coverage as a moral issue.

  60. “Relative to the House bill, then, the Baucus bill costs the government $140 billion less; but it costs middle-income people exactly $140 billion more, since they have to buy health insurance.”

    You mean people would actually have to pay for their own health care? That’s outrageous! I won’t live in a world where able-bodied adults are expected to pull their own weight!

  61. “You mean people would actually have to pay for their own health care?”

    They are already paying for their health care, out of pocket.
    What you would be doing is force people to send 13% of their income to insurance companies. People would continue to pay out of pocket because of the high deductibles.

    “I won’t live in a world where able-bodied adults are expected to pull their own weight!”

    People who do not make a lot of money are just lazy.

  62. People who do not make a lot of money are just lazy.

    Especially the ones working 60+ hours a week at three jobs to make just enough to get by.

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