The Stupid Has Infected Healthcare "Policy"

and they're trying to kill the patient (i.e., all of us)

Author

Joe is Wypoxic
November 19, 2025

This take is… insane (on so many levels it’s hard to know where to start).

Cassidy: "If she goes and gets 2 types of shampoo & one is a dollar cheaper, she'll get the cheaper one & the other lowers their price. Once you give her the power of making the decision, she's gonna shop -- that begins to save her money and squeezes waste out of the healthcare system."

— Aaron Rupar (@atrupar.com)2025-11-19T14:38:46.389Z

I’m a former rural hospital COO. I’ve been in the trenches. This take could not be more idiotic. And it stems from what I’ll call TKESTM (“Trump Knows Everything Syndrome”). So, a doctor and Senator who knows better, and who’s NEVER taken this position before, suddenly thinks somehow “giving” people money so they can have “choice” via a fictional “free market” will solve our healthcare cost dilemma. All because an ignoramus who professes to know more about everything, than, well, anybody else comes up with a really stupid randomly generated “thought”.

Remember, Trump and Republicans have been saying for years that they’ll come up with a better plan for healthcare than the ACA (“Obamacare”), but they never do. Why? Basically - and I wish the media would point this out every f*^king time a Republican says they’ll come up with a better plan - because healthcare policy is complex and Republicans really have no interest or desire to do the hard thinking to figure this out (yes - it’s that simple).

Also, lest we forget what it was like in the ACA before-times, remember that the ACA did the following:

  • Guaranteed everyone could get health insurance at standardized rates (previously, insurers could deny you for having a “pre-existing condition” - asthma, diabetes, pregnancy, past surgery, even acne - and they could also charge sick people much higher premiums).

  • Removed lifetime benefit “caps” on health insurance policies (previously, plans could legally say, “We only cover $300,000 - or $1 million - in your lifetime,” which would wipe people out during serious illness).

  • Removed insurer’s ability to “rescind” policies after the fact. Previously, insurers could comb through policy applications looking for any minor error so they could retroactively “rescind” the policy and not pay medical claims - yes, incredibly, this was legal.

  • Mandated every policy provide defined “Essential Health Benefits” - hospitalization, emergency services, maternity & newborn care, mental health & substance-use treatment, prescription drugs, preventive care, pediatric care, lab services, rehab services, and outpatient/doctor visits (previously plans could omit many of these, rendering them semi-useless to patients needing care).

  • Mandated that preventive care be free. The ACA dictated that plans must cover things like vaccines, colonoscopies, mammograms, and annual checkups without copays or deductibles (previously, most preventive care cost money out of pocket).

  • Critically, mandated the insurers spend a minimum amount of premiums received on medical care instead of on profits/admin costs. This is known ss the Medical Loss Ratio - “MLR” - and the ACA stated that insurers had to spend a minimum of 80-85% of premiums received on medical care, and if they didn’t they had to send rebates back to customers (previously, insurers could do whatever they wanted with premiums received from customers).

  • Banned gender-based premium differences (previously, women were often charged more than men for the same plan coverage).

  • There’s more, but that should be enough for now.

  • One final point - in order to make the ACA work, risk needed to be spread over the biggest possible pool of people (blending different health status, ages, etc.) - THIS IS HOW INSURANCE WORKS - IT SPREADS RISK OVER A LARGE POOL IN ORDER TO BE ABLE TO BE SOLVENT WHILE ALSO HANDLING CLAIMS. This meant 1) expending Medicaid, 2) mandating the otherwise uninsured to be part of the ACA (or else pay a penalty to incentivize the healthy to sign up), and 3) offering subsidies to those who couldn’t normally afford health insurance premiums. SCOTUS said 1 and 3 were unconstitutional (I call BS) and Congress got rid of the penalty provision in 2. Still, the ACA continued to materially reduce the number of uninsured in the country.

Let’s quickly explore why Republicans “know-nothing, death of expertise” view of the world is so harmful and dangerous. I like this analogy from Dean Baker in this article.

Given the difficulties in designing health care policy — which would be known to anyone remotely familiar with the debate — it’s hard not to be reminded of a famous Doonesbury comic strip from a half-century ago. In the strip, Michael Doonesbury, who is a typical college student, is sitting at a desk with his housemate, B.D., the star of the college football team.

B.D. asks Michael about the topic of the paper he’s writing for the biology class they are taking. Michael says he is writing on “juxta bronchial organ secretions in the higher mollusks.” He then asks about B.D.’s paper topic, which is “Our Friend the Beaver.” We are getting a ton of Our Friend the Beaver vibe out of Trump, and indeed much of the Republican Party, when it comes to their alternatives to Obamacare and the system of exchanges it created.

You Can’t Just Give People Money to Buy Health Care

As people who even very casually followed the debate over recent decades know, health care presents problems that cannot be solved just by giving people money to buy their own healthcare or insurance. Most people are healthy and have relatively modest bills, but the problem is that some people do have serious issues and end up with very large bills.

This is the reason for insurance. Putting aside a few thousand dollars a year on your own is not going to cover the cost of heart surgery or cancer treatment. This means that both people who have health issues need insurance, and even healthy people buy insurance in the event they could be in an accident or develop a serious health issue.

Incredibly, Trump and many Republicans seem to think it’s some sort of slam that a large portion of the people on the Obamacare exchanges don’t use their insurance. This is also true with auto insurance and fire insurance. In any given year most of us don’t use these; in fact, many of us may never use them in our lifetime. But we still mostly think it’s a good idea to have them in case we are in a bad car accident or our house burns down.

The big problem with health care insurance, which the “our friend the beaver” crowd misses, is that insurers don’t want to cover people who have major health issues. Unless the government forces them, insurers will either charge people with heart conditions or a history of cancer exorbitant premiums, or refuse to cover them altogether.

That isn’t a conspiracy theory; insurers don’t make a profit paying out large amounts of money in claims. This means that if we want people with serious health problems to be able to get insurance at an affordable price, the government has to regulate the market and limit the ability of insurers to discriminate based on pre-existing conditions.

For the “Our Friend the Beaver” crowd, this means that relatively healthy people will pay more than if we let insurers exclude unhealthy people from their pool. However, if the point is to ensure that people who actually need health care can get it, there is no alternative to government regulation with private insurers.

Finally, hard as it is to say, I agree with Trump on one thing. For-profit insurance companies are “money-suckers” (but NOT because of the ACA, which, again, limits how much these companies can use for profits/admin costs). Given his barely intelligible rantings, I assume The Trumpster is also against these same “money-sucking” companies receiving direct federal support payments in the scam we call the Medicare Advantage program, which is the only way these for-profit companies can make insuring high-risk seniors worthwhile.

If Insurance Companies Are the Problem, There is a Solution

We could go the opposite direction, which would fit some of Trump’s recent anti-insurance comments, and just have a universal health care system provided through the government, as we already do now with Medicare for our older population. A universal Medicare system would eliminate the problem of selective coverage and also get rid of hundreds of billions of dollars of administrative expenses and profits being paid to private insurers.

Along with excessive payments for drugs and doctors, this is one of the main reasons Americans pay so much more for health care than even everyone else. But there is no indication Trump is looking to establish a universal Medicare system.

Instead, we have a confused 79-year-old president leading his loyal followers in the Republican Party on a bizarre path in Never Never Land, where they make bold pronouncements on healthcare that ignore all the issues that have troubled serious analysts for decades. It would be great entertainment except that at the end of the show, millions of people may not get the health care they need.

The healthcare policy debate is, IMHO, the culmination of everything wrong with this perverted version of the Republican Party: relying on TKES (see above), worshipping words like “choice” and “free market” without actually understanding how they relate to the real world or a specific issue, unwilling to acknowledge the complexity of an issue (and the world in general) that requires complex solutions, ignoring - and looking down on - the needs of regular people, and banking on their view that low-information voters (i.e., people who are ignorant on politics/policy) will support their simplistic yet stupid ideas.

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