"The basic definition of insurance is an agreement to suffer a definite small loss (the premium) in order to avoid the potential of an unknown large loss (a claim). People buy insurance to avoid volatility. Insurance companies accept premiums from a large and diverse group of clients. On some policies, they “win” (the premium exceeds the claims) and others, they “lose” (the claims exceed the premium). The insurance company doesn’t really care who wins and who loses, as long as the winners compensate for the losers.

"A casino provides an environment where people can come and make bets. The casino essentially reallocates the losses of some to the winnings of others (and uses statistics and probability to accurately set pay-outs). It makes an override for creating the environment. The more people placing bets, the better. A casino spends considerable sums attracting people to its environment through marketing, fancy hotels, glamour, etc.

"The insurance industry is not unlike a casino. The industry reallocates money between losers and winners, and charges an override for doing so. It too spends significant sums attracting and retaining customers. The larger the overall insurance industry, the more insurance carriers can make (in an absolute sense). Like a casino, the insurance industry doesn’t actually “create” anything—all funds paid out are just funds paid in by someone else in the system. The insurance industry is essentially a large income redistribution system.

"A group captive is therefore akin to a group of employers creating their own casino. They determine who gets in and the payouts. They keep the override typically charged by the industry. In addition, they often reduce expenses by eliminating the equivalent of the fountain outside the Bellagio."

From the website of Pareto Captive Services (dunno what they do but the quote is spot on)

Dan , Ayn Rand disapproves of your faulty logic. White Jesus also disapproves.

Kind of like how taxes work too.

Those in the blue part (the populated and more liberal cities) pay for those in the red part (the less populated and more conservative rural areas)

I don't know, those sleeves, they look pretty rolled up. I think he means business.

@4: Pssh, wake me up when he spits on his hands and rubs them together.

This is Ryan trying to reframe insurance as a savings account. Rather than thinking of insurance as a risk pool (where we all chip in a little so we have the security of knowing we're covered if the worst happens), he wants Americans to think of insurance as a bank account they're responsible for filling up in order to be covered if something bad happens. If you don't save, well too bad for you, make better choices next time. Very convenient if you're among the 1%, less so if you're anyone else. Taken from the same playbook he uses on Social Security.

Also? Those young healthy people age into old sick people. Especially if they didn't have insurance in their youth. Making things more expensive for the generations following... like. Come the fuck on, assholes.

Somebody should pull the old "do you know how much a gallon of milk costs?" query on Ryan, just, you know, to settle the question of how out of touch he is with the average person once and for all.

@1 Insurance and gambling are exact opposites. One decreases your chances of financial ruin and the other increases it. The risk of lightning strikes and car accidents is never going away, but you never have to even step into a casino, although I'm sure Steve Wynn would't mind a law mandating it.

We need single payer, and we need it now.

If every other "modern, western" country can do it, and see better results for less money, then we are fools to settle for anything else.

President Obama and the Democratic Congress passed the ACA, a plan written by conservatives as an alternative to "Hillary care", under the false pretense that it would somehow be more acceptable to those on the right than single payer would be.
They were wrong.
How many Democrats lost their seats for passing the ACA?
How long did the ACA last?
How many people are going to lose their coverage now?

If the Democrats had done the right thing and passed single payer or single provider health care there is no way the Republicans would be repealing it now because the American people would not stand for it.

The ACA was passed without a single Republican vote. They could have passed single payer.
The Democrats said the consequences would be too great, that they would lose too much.
They still lost everything, and now Trump and the Republicans are going to destroy the incremental progress that was made.

Enough baby steps and half measures.
It's long past time for the United States people to have reliable safe medical care for all people.
It's time for single payer healthcare.

The Republican Party is one big conspiracy. Their object is to get Americans to give up anything and everything that gives them comfort or protection that isn't profitable to the Party's supporters. They will make everything in your life more expensive, more dangerous, or more inconvenient if it will bring them power and make their friends richer.

@11 Medicare has ridiculously low overhead costs, a couple percent. Minimal salaries, no marketing, no CEOs, no shareholder/investors needing dividends. Commercial health insurance companies have huge overheads, which including the 20% profit they're allowed to take, is something over 40%. In other words, of every $10 you pay in premiums, the companies only pay out about $6 for medical bills. It's an industry, a huge one. Medicare-for-all would kill it, and that's one reason the Republicans will never let that happen.

Never too early to get to work on those 2018 Congressional races. Just saying.

@1 Weak analogy. Casino games of chance follow very defined rules of probability, and the payouts are skewed to reflect that. It is impossible for a casino *not* to make money, unless it's extremely badly managed and/or being skimmed.

Insurance actuaries make more or less highly educated guesses on risk. Some are better than others, and it also depends on how available and reliable the data they use so make an assessment. They can make very bad guesses or a sequence of events can occur, such as several years in a row of hurricanes, or an earthquake in a previously unknown fault line. Then the insurance company goes out of business and defaults on the claims.

The quote is from a captive service company, which can be oversimplified to a group of individuals forming their own insurance company. The group pays into a pool, then if there is a claim, then that individual draws from the pool.

Dan's analysis is simply brilliant.
As is the comparison.

But we wonder,
what if 20% of his neighbors' houses burned down every year?
Could he afford $60,000 or more a year in home owners insurance?
Would he bitch at premiums that high?

Obama doubled and tripled the premiums of lower middle class people,
AND raised their deductibles so high that in effect they no longer had insurance.
The Leftist Media focuses on the folks who are getting goodies from ObamaCare
(goodies paid for by those lower middles class folks,
the same ones who voted for Trump...)
but never ask who was/will foot the bill.

Health care in this country is increasingly losing its insurability;
People needing expensive health care are no longer infrequent random occurrences
(like house fires)
more and more people have high health care costs locked in.

The folks on the receiving end of the equation are squealing because a flawed system is being revised, perhaps the media could go talk to the folks who have been and are expected to pay the freight for a different perspective.

@ 15 - Nope. Turns out, widespread health problems like obesity actually have a very minimal impact on our massive overpayment on healthcare.

Go watch this:

https://youtu.be/qSjGouBmo0M

@11:

The reason why single payer is a non-starter in this country is because literally half the population firmly believes it represents one giant leap down the slippery-slope toward Communism, and they absolutely will not even consider it, no matter how much better off they would be by doing so (while at the same time, ironically, they staunchly defend their Medicare entitlements, which is essentially a single payer system, but just for teh Oldz.). They would quite simply rather risk suffering unendurable pain and debilitation instead, rather than take one small step in the direction of socialized medicine.

@17

I'm sorry, but you're wrong.
We manage the pass the ACA, we could have passed Songle Payer Health Care.

The first time any of those people went to the doctor and left without having to pay a bill, they would have been Pro single-payer healthcare for the rest of their life.

Just because a group of people are against it, doesn't mean we shouldn't try it.

@17

Don't forget, the rationale against single-payer was that we would lose Congress. Guess what, we lost Congress and the presidency, so strategy failed.

@18,
Don't you remember the fights the democrats were having among themselves about single payer? There was no way it was going to pass, let alone get seriously proposed. The dems never had enough of a majority for a long enough time to make it filibuster proof, and even when they did, there were some dems that sold their souls and refused to back single payer.

Yeah, if it somehow did happen and people realized how great it was the first time they used it, it'd be invulnerable now. But that's simply a fantasy. Single payer was never going to happen. Period. Too many dems sold out.

I'm sorry everybody, but single pay or did not happen incrementally anywhere that it actually happened.

If every other industrialized Nation managed to do it, including Canada, there is no reason that we could not do it.

You have to understand, the ACA was not a compromise, because no Republicans supported it.
Obama ran and won on single payer.
Anyone that can see what's happening now and still thinks that passing the ACA instead of single-payer was a good idea has no idea what's really going on.

If incremental changes didn't work this time, what makes you think they're going to work next time?

You see, the ACA didn't work, because it's headed for the trash can as we speak.

@18:

Sorry, but it's not wrong. The PPACA as it was only just barely passed in 2009, by a mere 2 votes in the House and by a single vote in the Senate, and then only because Independent Senator Joe Liebermann, who represented the 60th vote needed for cloture, was a vocal opponent of the "public option" that would have been necessary to implement universal coverage. So, it's incorrect to state "we could have passed Single (sic) Payer Health Care" at the time, because Liebermann's opposition (not to mention the 39 House Democrats , mostly from conservative states, who v…), would have made that impossible.

And of course there was also the tremendous backlash in the 2010 midterms against Democrats, when 13 House members lost their seats, in large part because of voter opposition to the ACA.

20/20 hindsight, to be sure, but regardless, it simply points to the fact that some people in this country are against ANY form of socialized medicine, regardless of whether it would benefit them or not. After all, these are people who vote against their own best interests all the time, people (and there are a lot of them) who would rather pay a penalty than pay for health insurance.

Finally, it's a bit disingenuous to suggest nobody "pays a bill" in Single Payer systems, because they DO in fact pay, in the form of taxes, which is simply another reason it's a no-go in the U.S. These people don't want to pay for EITHER type of coverage, public or private, because they're willing to bet (usually wrong) that they'll never need it.

Interesting that Ryan is against the ACA because it costs the healthy to pay for the unhealthy. Why isn't he also against other forms of insurance (e.g., life, car, home owners), too?

@27 - He's only now realized how this one form of insurance has always worked. It will be weeks yet before he realizes that's how ALL insurance works and makes another PowerPoint presentation to share his newfound wisdom with us.

Wait until he realizes that his own federal insurance works in the same way. He'll be apoplectic.

Idiot Republicans are also trying to con America into believing that Social Security is a savings plan with each individual having their own savings account.

Nothing could be further from the truth. Social Security from the very beginning has been an insurance program with the premium deducted from every employees paycheck.
Just like any insurance program, not everyone lives long enough to file a claim (get benefits). It's that money that helps pay benefits to SS recipients.

Why is that people act like buying insurance for poor people would be free, but HSAs would cost money to subsidize? Surely HSA funding would be paid in the same manner as insurance, but the whole amount goes to the recipient instead of sharing it with insurance executives, except for a small premium for catastrophic insurance.

Think about the inefficiency of our current health payment system. What if we gave poor people food insurance? Then they went to a grocery store with no prices and picked stuff out. Then the grocer paid a billing specialist to send the tab to the insurance company with inflated prices. Then the insurance company paid an adjuster to negotiate the prices and paid a reduced rate. Then 6 months later the grocer sent the customer a bill for the $5 they still had to pay. Would that make sense?

So why not have an HSA card for health like we have an EBT card for food stamps. Your employer or government puts money into your HSA. You go to the doctor for care and swipe your HSA debit card and are done. Wouldn't that be easier for all concerned?

Also, what we call health "insurance" is really mostly a pre-payment plan. It's as if your car insurance paid for tires and oil changes, or your homeowners paid for clogged plumbing and new paint. But real insurance, like automobile liability insurance, protects us from our own and other people's bills in a crisis.

@31,
Because health care costs can skyrocket unpredictably, while food prices do not.

Someone is not going to spend $200 a month on food and then suddenly need to spend $50,000 a month for unexpected reasons. That CAN happen with health care. You're healthy one day and the next, you get in a car wreck and become a quadriplegic.

@26

The strategy didn't work.

Since the ACA was passed, we have lost control of both houses of Congress and the White House.

The ACA is about to be lost as well.

There's one thing I can guarantee, if we don't fight for single payer, it won't happen.

No one pays a bill for medical services in countries with single payer systems. Taxes are not medical bills.
With insurance you pay your premium and you still pay medical bills.

One step forward and two steps back.

"and then only because Independent Senator Joe Liebermann, who represented the 60th vote needed for cloture"
How much do you want to bet that the Republicans will get their plan (if you can call it that) passed with a simple majority?

You can say single payer healthcare "will never happen" if you want, but remember this: at this time last year everyone said Donald Dump would never be president.
There is no "impossible" in politics.

@34,

2009 was a year of disappointments for me.

Despite a 60 seat majority, EFCA did not pass. HR 676 died in committee. The Public Option was cut, and some idiot let Max Baucus and How Liebermann write the ACA. Even more painfully, I saw Al Franken, someone I donated so much money to that he had to refund me the balance that fell over the legal limits imposed by McCain-Feingold, co-sponsor SOPA. ENDA did not pass.

When 2010 came, I saw that 60 seats wither away. Despite a receding tide, the Establishment Democrats that had alienated progressives responsible for winning them their seats clung stubbornly to power. Nancy "We're capitalists" Pelosi refuses to step aside. Bernie got shafted by Debbie. And now Tom has bumped Keith to the side.

Despite this, the GOP always gets its way, regardless of how many seats they hold. Even when they were in the minority in both House and Senate, they didn't do the whole infighting thing. They moved in lockstep, supporting each other, and thus always had the votes needed to cut the Democrats down. Democrats, on the other hand, can't get their shit together on anything. Joe Manchin and Heidi Mein Heitkampf (Seig, Heitkamp! Heil, Heitkamp!) and Joe Warner are all willing to vote for Trump nominees. Even Elizabeth Warren voted for Ben Carson.

The RNC knows its there to oppose the DNC. The Democrats, however, have no idea that they're a party- they act like a disorganized bunch of individual actors with zero party discipline and no unified agenda. Wen I look at the candidates for office, I know what that (R) means. I don't need to know anything else about the candidate to know how they're going to vote once I see that (R).

I have no idea what I'm getting when I see that (D). There's no way to tell how they're going to vote or whose interests they will support. The (R) means anti-LGBT, but the (D) does not mean pro-LGBT, as Sam Nunn has shown. The (R) means anti-union, but the (D) does not mean pro-labor.

Frankly, I have no idea what the (D) even means anymore.

Why do I fight for you people?

35
Why indeed.
You can't beat the Arc of Moral Justice.
You can fight it but you will lose.
Surrender now.

@15/The Unbearable Lightness of Being: Much of what you wrote is factually correct. The rest is just nonsense.

@35

I've stuck with the (D) because the (R) Is repugnant.
It is getting harder though, especially when I hear (supposed) allies say things like:
It's impossible because republicans don't want it.

I haven't given up on the Dems yet, because of people like you.
At least some of us are willing to fight for what's right.
Thank you Wandering Stars.
Don't give up hope, and don't stop fighting for what's right.

I got an old man's disease (stage IV colon cancer) when I was a healthy, insanely fit, vegetarian 38 year old woman. Mr. Ryan can go do unkind things to himself. Now.

Ugh! These people!!!!!!