March 9th, 2017

GOPcare is a work in progress

I sometimes am surprised at how impatient a fair number of people on the right can be.

I know, I know. We’ve been disappointed a thousand times. I know. Nor do I (as I’ve often said) think politicians are all just fabulous people trying their best.

But you know what? Some are. Or at least, some are pretty smart and are relatively eager to actually pass some of the things they say they want to pass. I still can get surprised when intelligent people seem to ignore the significant constraints of the Congressional process, and be so lightning-quick to blame Republicans for things they shouldn’t be blamed for (as well as the things they should be blamed for).

Sometimes I’m even one of those people doing the blaming.

So please read this post by John Hinderaker. It may reassure you, as it did me. If not “reassure,” at least it will give you greater insight into what the GOP says is the current plan for health care reform.

Of course, if you think the best plan would be to get the federal government out of the health care business altogether, then you are correct in being very heavily critical of all of the Republican plans. But I think that ship has sailed, although I would like to see less government involvement than these plans envision.

Earlier in this post I suggested you read a piece by John Hinderaker. In his post, he suggests you read the entirety of this article by Peter Nelson, from which he took a series of quotes he used. Here’s one of those Nelson quotes with which I heartily agree. It deals with a theme I’ve been harping on for years (and not just concerning health care, either):

But it’s dangerous if, to foment a public outcry to force changes to the bill, critics instill within the conservative base a sense that full repeal is possible if not for those weak-kneed Republicans elected to Congress. If conservative leaders set unattainable expectations, they will create a perception of failure in Congress that will deflate the conservative base.

That process has been aided and abetted for years by quite a few talk show hosts and/or bloggers on the right, with an assist from an MSM that likes to heighten discord on the right. The talk show hosts and bloggers do it because it’s good for ratings and traffic. The MSM does it because it wants the right to cannibalize itself.

I want to add, though, that one thing I’ve observed over and over is that the GOP is terrible at explaining to its base—at the outset—what it’s doing when it makes some move. The base often doesn’t listen anyway, but it seems to me that the GOP’s explanation often comes quite a while after the fact, when people are already mega-angry.

That’s not smart, and it’s one of many reasons the GOP in Congress is met with charges of “elitist.”

25 Responses to “GOPcare is a work in progress”

  1. Cornhead Says:

    John Hinderaker sometimes subs for Laura Ingraham, but I wish he had a cable TV presence. At least some insiders read his stuff and it gets out to influence them.

    I nearly always agree with John (and neo) and think he usually has a sharp and fresh take,

  2. Montage Says:

    I would say ObamaCare [The ACA] was also a work in progress. It had problems. But those problems could have been ironed out. Maybe to some degree they are being fixed by the GOP? Although they would never admit that. Health care really should not be a partisan issue. I know both sides have a vision for what works best but, for people out there who suffer health issues, politics is the last thing they want to think about.

  3. Artfldgr Says:

    Philip Dru: Administrator: A Story of Tomorrow, 1920-1935 lays out in novel form many of the early goals of Progressivism / When Colonel House first published Philip Dru in 1912, he did so anonymously

    Wilson’s Secretary of the Interior Franklin K. Lane noted the similarities between Wilson’s governing style and the writings contained in the novel: “Colonel House’s Book, Philip Dru, favors it, and all that book has said should be, comes about slowly, even woman suffrage. The President comes to Philip Dru in the end. And yet they say that House has no power…

    Philip Dru’s Policies
    Philip Dru’s policies as the Administrator at the head of all of the bureaucracies are a reflection of the author’s beliefs, in addition to the influence it had upon President Wilson.[29] Here is a summary of many of the major points:

    Income Tax

    Federal Incorporation Act, with government and labor representation on the board of every corporation

    Public service corporations must share their net earnings with government

    Government ownership of all telegraphs

    Government ownership of all telephones

    Government representation in railroad management

    Single term presidency

    Old age pension law reform

    Workmen’s insurance law

    Co-operative marketing and land banks

    Free employment bureaus

    8 hour work day, six days a week

    Labor not to be a commodity

    Government arbitration of industrial disputes

    Government ownership of all healthcare

    they are cathedral builders and the prior law was a copied practices of the famed austrian leaders of last century: Gleichshaltung… where the ratchet is nigh impossible to turn back once its set

    tons more..

  4. Geoffrey Britain Says:

    I think the best plan would be to get the federal government out of the health care business altogether because the alternative is to continue to incrementally stumble ever closer to single payer with unelected beancounters heading the death panels.

    And it’s not just a loss of faith in the patriotism of many Congressional Republicans, it’s a loss of faith in our Constitutional system’s ability to cope with the Left’s March through the Institutions.

  5. Kae Arby Says:

    I have just one question.

    When are the committee hearings, on this bill, scheduled?

    KRB

  6. J.J. Says:

    KRB, see:
    https://waysandmeans.house.gov/american-health-care-act/
    and http://www.nydailynews.com/news/politics/republicans-push-obamacare-repeal-article-1.2991916

  7. CW Says:

    Steve Hayes on Special Report with Brett Baier said it best when he said (paraphrasing) that this Paul Ryan/moderate Republican plan cedes the philosophical argument to the Left and only quibbles over the mechanics. In other words, the GOP would be caving to the Obamacare idea that the FEDERAL government is responsible for ensuring that all Americans are insured. It is no longer the responsibility of the individual. That does not comport to the Constitution or conservative principles.

    I understand that the process of unwinding Obamacare is complicated, but why must that translate to taxpayers having to foot the bill for “advance-able, refundable tax credits” to help ABLE BODIED people pay for health care? It’s as if Republicans have forgotten everything they’ve ever learned about the free market and the importance of personal responsibility.

    If they want to equalize the tax treatment of insurance that’s purchased by the individual on the free market with insurance obtained through employment, that’s fair and fine. Make all health care related expenses tax deductible. But DO NOT force Peter to subsidize Paul up front. That’s welfare, and Republicans are supposed to be for weaning people off welfare.

  8. Xennady Says:

    Nah.

    The GOP is terrible at explaining things to the base because the elitists in the GOP have been shown to have been weaving a wicked web of lies, over and over again.

    The base simply doesn’t believe anything these people say, even if they mean it, but this time for reelz!!

    Show, don’t tell. Succeed, don’t tell me you’ll succeed, if only I trust you, one more time.

  9. AesopFan Says:

    Another common-sense PowerLine blogger:
    http://www.powerlineblog.com/archives/2017/03/one-familys-obamcare-tale-mine.php

  10. J.J. Says:

    CW: “If they want to equalize the tax treatment of insurance that’s purchased by the individual on the free market with insurance obtained through employment, that’s fair and fine.”

    That is exactly what they are trying to accomplish.
    Paul Ryan: “It equalizes the tax treatment of health care. Tax credits for health insurance is something that we as health care conservative reformers have been working on for years. This has been the crown jewel of conservative health care reform, to equalize the tax treatment of health care so we can have a vibrant individual market to have a free market in health care.”

    The Affordable Care Act’s subsidies, which expand as incomes decline, giving the poorer people more help, would be replaced by fixed tax credits to help people purchase insurance policies. The tax credits would increase with a person’s age, and would be tapered down after an income of $75,000 is passed. This is not open ended. It applies at present to only about 11.3 million people who have had to buy Obamacare in the individual market. The vast majority of people get their health insurance outside of Obamacare and that won’t change when Obamacare is gone.

    The big problem is the treatment of the 6 -11.3 million people who got their Medicaid through Obamacare. They are on what is known as expanded Medicare, which 31 states and the District of Columbus signed on for. Expanded Medicaid is slated to expire in 2020 and the states will be responsible for the costs of expanded Medicaid, which Obamacare paid for. The bill plans to retain these people on expanded Medicaid until 2020 and then let the states take over.

    The intent is to transition the 22.6 million people from Obamacare to the new paradigm without too many of them losing coverage. If one person loses coverage you know what the Dems will do don’t you?

  11. huxley Says:

    I assume people have already died on account of Obamacare because they lost their original policies and couldn’t/wouldn’t pay for new ones or the deductibles went up or the coverage got so skimpy it wouldn’t pay for what they needed.

    I have a friend with a fierce set of health issues who hardly sees a doctor anymore because of Obamacare.

    But I rarely run into articles about such people.

  12. Ben David Says:

    uhhhhh….. exactly why is complete repeal impossible?

  13. CW Says:

    @J.J.

    No, the Paul Ryan does not equalize the tax treatment between people who pay out of pocket and people who get insurance through employment. That could be accomplished by simply making all heathcare-related expenses tax deductible. Why must we give people an “advance-able, refundable tax credit” (i.e. cash up front) to accomplish this? I suspect it’s because so many of these people don’t pay enough in taxes to qualify for the deduction, which means this is just another taxpayer wealth transfer courtesy of gov’t representatives.

    >>“The tax credits would increase with a person’s age, and would be tapered down after an income of $75,000 is passed.”

    From each according to his ability; to each according to his need. Is THAT what conservatives stand for now?

    >>“The bill plans to retain these people on expanded Medicaid until 2020 and then let the states take over.”

    Why do conservatives no longer ask how we ended up with so many people on Medicaid? Why do we no longer distinguish between people who can’t afford healthcare because they are disabled or have a crisis outside of their control and those who simply make bad choices in life? Why should we subsidize able-bodied people who won’t get the education or skills they need for a better job that would enable them to pay for their own healthcare? The Paul Ryan plan continues our acceptance of the status quo, and the status quo is wrong.

    The goal of conservatives should be to move us back to a state of personal responsibility, and that is best accomplished by restoring the free market, making healthcare costs transparent BY LAW so we know what we’re paying for, and getting the federal government out of the healthcare business altogether. The states can do what they want.

  14. n.n Says:

    The issue is three-fold: affordability, availability, and corruption. The first is optimized through a functional capitalist market. The second is possible with order and development. The last is mitigated by religious/moral individuals, and by competing interests that prevent others from running amuck.

  15. CW Says:

    @n.n

    Personal responsibility is what makes people care about affordability, so this must come first.

    And then there’s this little issue of the Constitution.

  16. neo-neocon Says:

    Ben David:

    It would need 60 votes, which they don’t have.

    Or they’d have to do away with the filibuster altogether, which has its own dangers.

    They believe that with a combination of reconciliation and executive orders, they can change and improve it dramatically without technically repealing it in full. That probably could work, too, if they could agree on what they wanted to do. The present changes are not the final stage, and a lot of people don’t like them, but that doesn’t mean the method of change is the problem.

  17. J.J. Says:

    CW: “The goal of conservatives should be to move us back to a state of personal responsibility…”

    I agree with all your comments. All good conservative points. However, if the repeal and replace effort does nothing to help those who are on Obamacare now, we can expect to lose at least the Senate and possibly the House in 2018. Politics is the art of the possible. In a country filled with people who know nothing except what the MSM tells them, (and the MSM will trumpet the stories of any who lose coverage) abrupt change is extremely difficult. Obamacare repeal without some kind of transition is fraught with peril for the GOP.

    You cannot dictate personal responsibility. If you could, we wouldn’t have a drug addiction epidemic, or a homelessness problem, or even much crime. Unfortunately, we humans are not perfectible.

    CW: “No, the Paul Ryan does not equalize the tax treatment between people who pay out of pocket and people who get insurance through employment.”

    You’re right, in most cases, it doesn’t. Say an employee between age 30 and 39 gets coverage for which his employer pays an annual premium Of $6,000. If the employee had to pay a tax rate of 25% on that figure they would have to pay the IRS $1500 in taxes.

    If an an individual buyer pays $6000 for his/her policy and is between 30 and 39 years old he/she would get a tax credit of $2000. That is a $500 advantage. The advantage is put there, IMO, to incentivize the 11 million individual policy holders to continue to buy health care insurance under the new paradigm, which includes a wide choice of plans, and eventually, buying across state lines. Ryan believe people respond to financial incentives. So do I.

  18. Frog Says:

    I agree with C.W. (3/9, above) and find his 1st paragraph worth repeating:
    “Steve Hayes on Special Report with Brett Baier said it best when he said (paraphrasing) that this Paul Ryan/moderate Republican plan cedes the philosophical argument to the Left and only quibbles over the mechanics. In other words, the GOP would be caving to the Obamacare idea that the FEDERAL government is responsible for ensuring that all Americans are insured. It is no longer the responsibility of the individual. That does not comport to the Constitution or conservative principles.”

    Some of my comments:
    – what the heck is an advance-able, refundable tax credit?
    -why are we giving money away (tax credits) to people who barely pay taxes? I know, I know, to make their lives better. Sure.
    -why is there a 30% surcharge payable to an insurance company over and above the age-adjusted, health-adjusted premium if health insurance has not been in force for 63(!) or more days? I understand it is intended as a penalty where there should be no penalty, but payable to an insurance company?
    -Why must there be a penalty? To herd us in the “right” direction, to universal coverage. Left, meet Right.
    -why is universal health care coverage a desideratum? Indeed, now a declared right of coverage for all people?
    -The non-profit hospitals will persist as non-profits, paying zero taxes, even though they all make sizeable profits, usually with annual revenues exceeding $1 Billion for hospitals above 250 beds. Why? No free or charitable care is or will be provided by them under Obamacare or GOPcare.

    The GOP has had more than two years to come up with something, and this is their first (best) shot?

    Did you know there are over 10,000 sections in the Obamacare law? No? Neither does Pelosi.

    I think Ryan is a bad man, a dissembler, a cockroach. But I don’t have strong opinions!

  19. Frog Says:

    J.J.:
    85% of the uninsured before Obamacare were enrolled in Medicaid through the exchanges. Eighty-five per cent!
    An equal number, roughly, have become effectively uninsured due to Obamacare with its engendered high premiums and high deductibles.
    The net effect: screw the middle class, boost the “poor”.

  20. Big Maq Says:

    “The MSM does it because it wants the right to cannibalize itself.” – Neo

    Never forget the profit motive.

    The msm don’t move as a monolith, nor can they ignore the economics of their industry to push a political agenda.

    They have an audience for what they produce (which happens to be a broad / sizable swath of our country).

    Infighting on the right is newsworthy to their audience .

  21. CW Says:

    J.J.: “Obamacare repeal without some kind of transition is fraught with peril for the GOP.”

    My response: Obamacare repeal WITH the kind of transition Paul Ryan & Co. are proposing is fraught with peril for the future of all Americans.

    J.J.: “You cannot dictate personal responsibility.”

    My response: Of course you can. You do it by refusing to rescue people from their own failures and poor choices. People do it all the time. Our federal gov’t expects you to take personal responsibility for the taxes you owe, don’t they? They impose a consequence on you for failure to pay, right? The consequence of not getting health insurance is that you risk getting a really big bill which you are required to pay if you get sick or hurt. Problem solved.

  22. J.J. Says:

    CW: “The consequence of not getting health insurance is that you risk getting a really big bill which you are required to pay if you get sick or hurt. Problem solved.”

    The real truth is that everyone in this country gets healthcare. Everyone. It’s not what we would like, but EMTALA, which was passed in 1986, makes it a crime to turn anyone away from an ER regardless of their ability to pay. Illegal immigrants and many poor people know this and get their routine care at ERs. Additionally, most big city ERs have a plethora of drug overdoses, gun shot wounds, stabbings, drunk driving accidents, etc. that will never be paid for because the patients are indigent. All that pro bono work is paid for by people who have insurance. Medicare pays much less than what most insurers pay and that shortage must be made up. Medicaid pays even less than Medicare. More shortages to be made up. That is why health insurance costs keep going up. The big argument that no one is addressing is, who pays? The cost shifting by medical providers is why medical costs are so opaque. They don’t want anyone to know who pays what. I don’t know, but suspect that some hospitals may be making huge profits. I know our local hospital, a regional non-profit, pays its administrative staff very handsomely. CEO makes $500,000.

    I once asked a doctor what a procedure would cost and he looked at me like I was crazy. He said, “You’ve got insurance, don’t worry about it.” Yeah, but my insurance only paid 80% of the bill. I wanted to know what my out of pocket costs were going to be. 20% 0f $50,000 is big money for me.

    CW: “My response: Obamacare repeal WITH the kind of transition Paul Ryan & Co. are proposing is fraught with peril for the future of all Americans.”
    That’s right up there on a par with: “Trump is going to create a fascist state.” Hyperbole a bit?

    Frog: “85% of the uninsured before Obamacare were enrolled in Medicaid through the exchanges. Eighty-five per cent! An equal number, roughly, have become effectively uninsured due to Obamacare with its engendered high premiums and high deductibles.”

    Yes, Obamacare is awful. What I do know is what Obamacare has done to our daughter, a small business woman. Her Obamacare premiums and deductibles have doubled, she had to find a new doctor, and in 2017 she has only one choice of insurers. She makes just a bit too much to get any subsidies, so she pays the full premiums with after tax dollars. She is thrilled by the new plan. Her premiums may not go down, but she will be able to choose from several insurers and find a plan that fits her needs. – as it was for her before Obamacare. That she will get a bit of tax credit also makes her happy. At least that’s what she tells me.

  23. CW Says:

    @J.J.:

    I’m well aware of EMTALA, having written about it myself more than 3 years ago:

    http://commonsensematters-cw.blogspot.com/2013/11/ronald-reagan-emtala-roots-of-obamacare.html

    I disagree with this mandate and think Republicans would be wise to repeal it, which they won’t; but even this homage to failed judgment could be rectified if we just said: “Okay, we’ll treat you if you come to the emergency room without insurance, but we’re STILL going hold YOU responsible for the bill, and not make up the cost of your treatment by raising costs on everyone else.” Don’t you think more people would go ahead and buy insurance rather than take the chance that they end up with a big fat bill for a trip to the emergency room? And if they didn’t, so be it. Put them on a payment plan and let them pay THEIR bill. Why is that so hard and so inconceivable?

    I’m befuddled by you, because you go through the trouble of explaining to me why health insurance costs are soaring, i.e. because the insured essentially absorb more and more of the cost of treating the uninsured and government insured, but apparently you’re okay with the Paul Ryan plan that continues this dynamic. We should be working towards weaning every able-bodied person from their dependence upon strangers.

    And to answer your question, NO it is not hyperbole at all to say that the current GOP plan to replace Obamacare is fraught with peril for the future of all Americans for precisely the dynamic you described above where, instead of reducing costs by restoring the free market and personal responsibility, we simply keep passing the buck to whomever we can to foot the bill. It’s sending us down a very dangerous path as a nation, where government meddling and coddling become the norm and there are fewer and fewer natural market forces to stabilize costs. It cannot last. Just look at what’s happening in Venezuela as a consequence of the socialist mindset and demise of personal responsibility. Yes, that’s a drastic case, but we’re moving in that direction rather than away from it.

    Do a little research and see a chart of what’s happened to the number of people on Medicaid and the cost. Notice how the graph line keeps going up and up. You tell me where it ultimately ends if we don’t say enough is enough.

  24. neo-neocon Says:

    CW:

    “…should repeal but they won’t.”

    Do you think they have 60 votes to do so? Or do you think they should end the filibuster forever to do so? Do you think total repeal vs. the piecemeal replacement is worth making that move?

    Personally, I think that repeal is a red herring. I couldn’t care less if they totally repeal and then replace, or basically replace and accomplish a de facto rather than de jure repeal through a process of legislation, more legislation, and executive action.

  25. Ymarsakar Says:

    The powers that be are husbanding the precious medical resources pulled from dead infants.

    They offer you a bone called THC. Just be happy with that for your ‘health care’ until you get euthanized.

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Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.
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