START OF 2018 OPEN ENROLLMENT PERIOD

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UPDATE: GOP Congressman's vision of healthcare after ACA repeal: "ROBITUSSIN!!"

"You got to have some insurance. They shouldn't even call it insurance. They just should call it ''in case shit.'' l give a company some money in case shit happens.

... That's right, man, you better have some medical insurance, or you gonna die. That's right, everybody. You got to eat right and exercise. No, you don't, you need some coverage. Coverage will save your life. That's right, we all gonna die, but at least if you got some coverage... you will die on a mattress. That's right.

When l was a kid, we didn't have no insurance. We didn't have a damn thing. You had to be damn near dead to see the doctor. You had to be way past Robitussin. That's all we had when l was a kid: Robitussin. No matter what you got, Robitussin better handle it. -''Daddy, l got asthma.'' -''Robitussin.'' -''l got cancer.'' -''Robitussin.'' l broke my leg, Daddy poured Robitussin on it. ''Yeah, boy, let that 'tussin get in there. ''Yeah, boy, let that 'tussin get on down to the bone. ''The 'tussin ought to straighten out the bone. lt's good. ''lf you run out of 'tussin, put some water in the jar, shake it up, more 'tussin. ''More 'tussin!''

--Chris Rock, Bigger & Blacker

In a world where, just this afternoon, Donald Trump has just been formally confirmed as the next President of the United States by the Electoral College, absolutely nothing should surprise me, but here we are: (and from my home state yet. Hooray?)

A Republican congressman outlined the way he would like to see the health care system operate if Obamacare is repealed, as GOP lawmakers are promising. It is a brave new world in which parents would wait and think about it before bringing in their sick or injured kids for costly treatments.

The example Rep. Bill Huizenga (R-MI) gave in an interview with MLive.com was from his own experience when he waited until the morning after to take his youngest son to the doctor with an injured arm, because he did not want to waste money on an expensive emergency room visit. The arm, it turned out, was broken.

"We weren't sure what was going on. It was in the evening, so I splinted it up and we wrapped it up, and the decision was, okay, do we go to the ER? We thought it was a sprain, but weren't sure," Huizenga said, adding that he and his wife "took every precaution and decided to go in the next morning."

Yes, apparently a sitting U.S. Congressman (previously a State Representative) had a child with a broken arm and decided not to take him to the doctor because it might "only" be sprained. Even though, as a U.S. Congressman or a state Representative, he and his family have top-notch, publicly paid for health insurance. Except, of course, it turned out to be broken. I wonder if he poured some Robitussin on it?

Now don't get me wrong. There's a kernel of truth to what Huizenga was apparently trying to get at...it's even one which I've noted myself in the past when it comes to even most "single payer"-type systems such as Medicare still having some basic out of pocket costs to the enrollee:

In addition to all fo this, according to Sanders's plan, there would be no premiums, deductibles or cost sharing of any sort--not even a nominal $5 co-pay or whatever. This strikes even me as a recipe for disaster; while I can see an exception being made for low-income folks, it seems to me that this would result in people going in to see the doctor for every hangnail and paper cut.

However, a broken arm isn't nearly the same thing as a paper cut.

In addition, not only did Huizenga use a terrible example to make a potentially valid point, even if he had used a better example, he still would've really been arguing in favor of the ACA...because one of the main points of the ACA in expanding Medicaid was to try to encourage people to actually make doctor's appointments for less serious ailments instead of going to the emergency room every time they have the snffles. It costs magnitudes more to treat most issues at an emergency room than it does to deal with the same issues via a pre-planned doctor or clinic appointment...and preventative care (covered at no out of pocket charge by design of the ACA) can often help nip potential issues in the bud long before they become serious problems.

Unlike some of those tearing Huizenga in the comments section of his interview, I'm not going to accuse him of child abuse and the like; without knowing more details, it's conceivable that it was a hairline fracture which didn't hurt the child all that much or show any obvious signs of anything more at the time. However, this is a terrible precedent which speaks volumes about the general mindset of the Republican Party when it comes to healthcare coverage: "Walk it off!!"

UPDATE 12/21: Hah! As it happens, the following report was just released:

Under Obamacare, fewer people skipped doctors’ visits because of cost

After the implementation of the Affordable Care Act, people in a majority of states were less likely to skip doctors' visits because of concerns about the cost of care, according to a new report that attempts to paint a snapshot of the effects of the law as its days are numbered.

Census data released this fall revealed that the overall uninsured rate had reached a historic low in 2015. What those broad trends meant about health — or even access to care — was less clear.

The new analysis by the Commonwealth Fund details the decline in the rate of uninsured people in each state between 2013 and 2015, highlighting that those with the biggest declines were states that expanded Medicaid — a provision of the Affordable Care Act, commonly called Obamacare.

It also found that in 38 states and the District of Columbia, the percentage of adults who said they avoided medical care because of its cost declined by at least two points over the three-year period.

And of course the final statement cuts to the chase:

“I think this is a really perplexing point,” Blumenthal said. “There clearly is a disconnect between people benefiting from this particular program and their political perception about which candidates they want to support.”

UPDATE x2: Over at Balloon Juice, Richard Mayhew makes the case that the "savings" from people "walking it off" isntead of going to the emergency room for legitimately frivolous reasons (paper cuts, etc) are pretty nominal anyway:

People who don’t use the ER a lot, who don’t use a lot of services a lot don’t cost the system a lot of money.  Shifting a single in-network medium severity ER visit to a single in-network medium severity Urgent Care visit might lower the contract expenditure by $200 or $300.  If the kid’s arm is broken and it needs surgery, that is 5% of the total episode of care cost.  If there is nothing beyond an “oowie”, the shift might save 75% of the episode cost of care.  The shopping paradigm is that it will change behaviors among people who are not driving most of the healthcare spending.  It will save money but it is limited in what it saves as the people use a lot of medical resources will blow through any out of limit cap very quickly.

And this story only makes sense if there is a significant substitution effect between ER and Urgent Cares.