There really are no words to prepare you for what you’re about to see, except to say that this is the guy—the Republicans’ Great White Wonky Savior, Paul Jesus Christ Ryan—who is supposed to save the American health insurance system from the catastrophic kamikaze death spiral armageddonpocalypse of Obamacare. Just watch:
Ryan: The whole idea of Obamacare is…the people who are healthy pay for the…sick. It's not working, & that's why it's in a death spiral pic.twitter.com/ztTXrn7bpH
— David Mack (@davidmackau) March 9, 2017
This is literally the only way insurance works at any level. This is why anyone who has health insurance has health insurance. It’s called pooling risk—and without healthy people in the pool, there is no reason for anyone to have insurance in the first place. This is like saying about auto insurance, “We can’t make the people who won’t have car accidents pay for the people who will have car accidents!”
This elucidates something Republicans don’t want you to know, namely, that insurance basically is socialism. Insurance is nothing more or less than a way to pool risk so that when someone gets sick or injured, they don’t have to bear the full brunt of the costs. It’s kind of a perverse lottery; your premiums are the price of entry and those who hit the “jackpot” of illness or injury get a payout straight from the pockets of other people who weren’t lucky enough to “win.” That payout comes in the form of paid medical bills.
Every other advanced and marginally advanced and barely advanced civilization on earth has figured this out. They understand that once you’ve signed onto the idea of health insurance as a good thing people should do, there is literally not a single good reason on the face of the earth not to a) put everyone in the same pool and b) stop letting a bunch of fat cats profit from our suffering. It’s not that that’s they’re doing so malevolently, necessarily. It’s just that for-profit health insurance is a casino—and in a casino, the house always wins. The house must win; shareholders must profit, executives must be paid exorbitant sums, the beast must be fed.
In a single-payer system, there are no such requirements. We all just pay the cost to run the lottery. Obviously, there are philosophical debates to be had about how such a system should operate—Should smokers pay more into the pool? Is birth control covered at the same level as Viagra? Does it make sense to spend hundreds of thousands on last-ditch, low efficacy treatment for terminal patients?—and so on. But those are honest debates about how to administer the pool equitably, about how to achieve the best possible health outcomes for the greatest number of people at the lowest cost.
Paul Ryan, the man who wants to repeal and replace Obamacare and “fix” our broken system of paying for healthcare, does not even understand how health insurance works.