July 18th, 2017

Back to the drawing board on health insurance reform

The recent GOP efforts have been Shakespearean:

…It is a tale
Told by an idiot, full of sound and fury
Signifying nothing.

Actually, that’s harsher than my own opinion of what’s been going on—although it seems to be a good description of the opinion of what a lot of other people on the right think: that is, that the GOP members of Congress are idiots or even worse.

I happen to think that they are politicians, although rather ineffective ones at the moment, but that’s not quite the same thing as “idiots.” Among them you find varying degrees of honesty and corruption, narcissism and service, pragmatism and principle. In addition, there are some very different political philosophies among members of the GOP that can make it inherently difficult for them to come together on a vote.

As though that’s not enough, in the case of health insurance reform, you have some additional problems. The subject is both complex and deeply emotional, so any “solution” would be a compromise that doesn’t give people what the majority seems to wishfully want: coverage that is cheap and still comprehensive, painless, and kind to all. The more conservative solutions are excoriated as too cruel, and the more liberal solutions as too expensive. And “unfair” is the cry that hangs over everything.

But the GOP is in charge now (be careful what you wish for). And it had better come up with something. Right now that “something” isn’t any of the “replace” bills in House or Senate—it’s a return to a simpler concept, “repeal” and kick the can down the road on the specifics of what might replace it.

You can see a spectrum of coverage here; it’s not a pretty sight.

Paul Mirengoff analyzes the situation and doesn’t think the chances for stand-alone repeal look much better, either:

Majority Leader McConnell might push for a vote on repeal coupled with the House bill (the AHCA) as the default to take effect in two years if no other replacement legislation is agreed upon. Ed Morrissey discusses this option here.

It’s doubtful that this approach could garner 50 Senate votes. GOP Senators rejected the AHCA out-of-hand, instead setting out on the rocky road that has led them nowhere. Susan Collins and some center-right members consider it too draconian. Some conservatives think it doesn’t go far enough. For example, it does not contain the “choice” provision that Ted Cruz demanded.

There’s also the question of whether the House would support such legislation. Sure, it passed once. But as Ed notes, some of the 217 Republicans who barely pushed the AHCA over the finish line did so in the expectation that Senate Republicans would create a better approach to repeal and replacement.

Remember back when Obamacare was first passed, and many pundits declared that the American public would get used to it over time, and that it would be very hard to change it once that had happened? That’s true, I think, and the GOP knows it. The more conservative wing of the GOP doesn’t care; the more liberal wing does.

But although this reflects the results of Obamacare, it’s not just a result. It’s a pre-existing condition, as it were. These conservative/liberal splits within the party have been going on for many decades, long predating Obamacare, and that’s part of the reason that the GOP never was able to come up with a comprehensive health insurance reform bill back in that tiny window of time when it had control of Congress. Instead, it passed Medicare Part D. You can read some of the legislative history of that bill here; suffice to say it only passed by the skin of its teeth, with a lot of arm-twisting. A great many conservatives hated the bill at the time and regarded it as a betrayal. But it represented an effort by the GOP to get some credit for being kinder and gentler—not that they’ve ever gotten that much credit for it at all.

One of the interesting things about Medicare Part D is that the program is widely considered a success (you may disagree, but I’m talking about general perceptions). It’s not that much older than Obamacare (Part D was passed in 2003), and yet I virtually never hear talk of repealing it. If you Google “is Medicare Part D successful?” you will come up with tons of articles that answer “yes.” I’m not going to argue the pros and cons of the program here, though; I just want to say that most people have accepted it and a great many people who like it forget that it was passed by Republicans (some conservatives, of course, are still mad at the GOP because they consider the program too liberal and too expensive).

Back in 2003, Republican leaders Tom DeLay and Dennis Hastert were in charge, and reportedly they (particularly DeLay) were a lot more—-shall we say, forceful—in convincing members to go along. McConnell and Ryan may not be so good at that sort of thing, or perhaps members of the GOP have grown more impervious to the threats and other persuasive devices brought to bear.

It’s easy to observe that Democrats seem to be able to corral their members much more effectively when it’s time to take a controversial vote. That’s the way Obamacare was passed, after all. But I think there is a much smaller percentage of so-called “moderate” Democrats to begin with, and much greater ideological unity on the Democratic side, and therefore the task is easier. And for the Republicans, the “no” votes came from the extremes of both sides, both the conservative and moderate wings of the party.

I can’t predict what will happen next. But I do know that for the moment the Democrats are gloating.

57 Responses to “Back to the drawing board on health insurance reform”

  1. blert Says:

    0-care has floated upon MASSIVE thefts// diversions from Freddie Mac and Fannie Mae.

    &&&

    The PRIMARY issue is COST CONTROL.

    Naturally this is not being addressed by anyone.

    If everyone’s tab collapsed 70%… the issue would go away.

  2. Mr. Frank Says:

    It’s dangerous to feed bears because they get angry when you run out of food.

    The other thing that comes to mind is the story floating on the internet about the elementary school that was having class elections. The last candidate for office was a girl who said elect me and there will be free ice cream. She won.

  3. Geoffrey Britain Says:

    Nice comprehensive article. IMO, neither McConnell nor Ryan are idiots.

    “there are some very different political philosophies among members of the GOP that can make it inherently difficult for them to come together on a vote.”

    Bingo.

    “These conservative/liberal splits within the party have been going on for many decades”

    Yup. Remember the Reagan and Bush primary and Bush’s charge of “voodoo economics”?

    The conservative side doesn’t have the votes to dominate and hasn’t since Goldwater. While the establishment side isn’t philosophically opposed to collectivist solutions, so they incrementally accommodate them to one degree or another.

    I can’t predict what will happen next but we all observe that since FDR the country in fits and starts is gradually drifting ever further toward the collective.

    Democrats understand that a pure democracy will move more quickly in that direction than will a Republic, which is why they continually push for ever more decisions by the mob, such as eliminating the electoral college.

    The Left is far too consistent in their actions not to recognize the truth in Alexander Tytler’s observation that,

    “A democracy cannot exist as a permanent form of government. It can only exist until the voters discover that they can vote themselves largesse from the public treasury. From that moment on, the majority always votes for the candidates promising the most benefits from the public treasury with the result that a democracy always collapses over loose fiscal policy, always followed by a dictatorship.

    The average age of the world’s greatest civilizations has been 200 years. These nations have progressed through this sequence: From bondage to spiritual faith; From spiritual faith to great courage; From courage to liberty; From liberty to abundance; From abundance to selfishness; From selfishness to apathy; From apathy to dependence; From dependence back into bondage.”

    Bondage is what they seek, all for our own good of course.

  4. vanderleun Says:

    Three female turncoat RINOs stand athwart the way. And reinforce my old saying:

    “Republicans, they thirst for death.”

    And they shall have it.

  5. Dobbins Says:

    The Repubs did not hang together………

    Certainly, they will now hang separately in 2018.

    Bet on it.

  6. expat Says:

    What really gets me about all this is that so many are putting the blame on Ryan and McConnell. Why aren’t the blaming the people like Rand Paul? Why aren’t they blaming the voters? Why aren’t they blaming themselves for being unable to deliver a reasonable message to the voters?

  7. Dave Says:

    http://thehill.com/blogs/pundits-blog/healthcare/342520-can-the-gop-stop-shooting-itself-in-foot-on-health-reform

  8. neo-neocon Says:

    vanderleun:

    Why ignore Mike Lee, Rand Paul, and Jerry Moran?

    As far as I know, Susan Collins was the only woman in the GOP who announced she was against, and she of course is a RINO and has always been. No surprise there, and I wouldn’t call her a “turncoat” because she is now what she has always been and there’s never been any “turning.”

    Get up to speed on who the opposition in the GOP was.

  9. Dave Says:

    If I have been maintaining a continuous coverage for 20 years, before ACA, can an insurance company still disregard my 20 years of paying into the system and jacking up my premium ridiculously to force me out of my plan if i have just recently diagnosed of a serious illness? What Rand Paul has been saying was a lie regarding how a person needs to take responsibility of his own healthcare decision by buying insurance before he gets sick, even if you had done just that the unethical insurance companies before Obamacare without oversight can still meticulously force you out by jacking up the premium.

  10. Dave Says:

    A free Market is unworkable without a fair referee, what i hate the most about libertarians like Rand Paul is that his idea of free market is a system that does away with the referee all together.

  11. Oldflyer Says:

    I see that President Trump is saying, “Let it fail”. Too bad that he didn’t use that rhetoric during the campaign. I think it would have been effective to point out that the Democrats own it, but would obstruct any efforts to replace it; so, let it play out, then there will be ample motivation from all parties to fix the problem. It is possible, that even in the face of overwhelming empirical evidence, he underestimated the number of “divas” in the GOP Senate caucus. He may have also overestimated the power of his office when dealing with members of the “American nobility”; as well as his powers of persuasion.

    Persuasion and negotiating go only so far. It is time for Trump to get off of the damn twitter, and get face to face with the mavericks in his own party. I think the political equivalent of a phrase like, “Do I need to send Vinnie and the boys around to call on you?” might be in order.

    He might also remind them that life under Majority Leader Schumer would be hell, and that is the direction in which they are headed. (I know the numbers favor the GOP keeping the Senate in ’18, but they also favored HRC winning the Presidency.)

  12. neo-neocon Says:

    Dave:

    If you have a policy and have kept paying on it, no one can change that policy because you are sick. That was the law BEFORE Obamacare was passed, and I am pretty sure that all the versions of the GOP proposals banned that sort of thing. Of course, I haven’t read them all.

  13. Dave Says:

    Retards like Rand Paul believes we should get rid of all regulations, yeah, lets get rid of all regulations regarding insider trades too, let all these CEOs get even richer by ordering their relatives to buying or selling stocks based on the secret mergers that he knows of from being an executive of one of the companies involved.

  14. Dave Says:

    My understanding of the subject is a bill can be passed with only 50 votes only if it is entirely tax related, and the regulations associated with Obamacare like the pre-existing conditions can only be repealed with 60 votes, am I correct about that?

  15. Bill Says:

    Constitutionally, does a President have the right to just let a law fail? He takes a vow to faithfully execute the laws of the land.

    I realize they have lots and lots of room to move around within that vow. But basically “vowing” to let legislation fail is crossing the line (and I think it’s dumb politics too. He’s going to take the blame rightfully due the Democrats).

  16. Fen Says:

    This is yet another example of what Ace termed “failure theater”. Google it.

    Short version is that the GOP never intended to repeal Obamacare. “Well shucks, we just couldn’t whip the votes. But give us lots of money and send us back next year and we pinkie swears we’ll get it done. Right after we build that border wall. Suckers”

    Mitch McConnell needs to go. Replace him with someone who has spine and leadership.

  17. cshort Says:

    neo-neocon:

    I think vanderleun was focusing on who’s preventing a clean repeal. So far the only ones to declare against it are Capito, Collins and Murkowski. All three have voted for a clean repeal in the past.

  18. parker Says:

    I second Oldflyer’s commit. I will add that politicians and lobbyists created this mess and to them the mess is a feature, not a bug.

  19. Brian E Says:

    Here’s an interesting article why the ACA can’t be fully repealed by reconciliation, how it came to be passed in the first place.

    This is the reason why Trump was calling for the filibuster to be nuked. But even if it were, a repeal is now off the table as four senators won’t vote for anything that rescinds the Medicaid expansion.

    http://theresurgent.com/how-obamacare-was-passed-and-why-it-cant-be-repealed-by-reconciliation/

    I was watching Tucker last night and he had Dr. Tom Price on. Price was talking about the bill before the Senate, as if it was still alive. Tucker asked him if he would support a national catastrophic health option. Price wouldn’t answer the question, reasoning that his focus was on getting the bill passed.

    I was surprised that Tucker raised the question. It looks like we’re going to get some national health insurance plan, and a national high deductible plan be be the best option.

  20. Steve S Says:

    If they are having such insurmountable difficulty in coming together on this bill, then:

    (a) They are so wholly wrong-footed on what they are trying to accomplish that they need a wholesale rethink as a party for what their goals really are, or

    (b) maybe it isn’t theirs to deal with in the first place.

    We have Medicare / Medicaid. That’s as far as the Feds need to go. Anything beyond that should be up to the States. This is what we call ‘Federal overreach’ and we’re all agin’ it – right up until it touches us.

  21. Dave Says:

    Trump did try to save the healthcare collapse, but democrats’ refusal to cooperate prevented him from saving it. If democrats truly care about saving the coverage of the millions affected they should have lend a helping hand to passing the fix, that would have phased out those hard right tea b*ggers who believes people with pre-existing conditions should just die without insurance. Democrats’ refusal to help emboldened the hard liner, giving them more bargain power then they should have.

  22. Brian E Says:

    The reliable radical Karl Denninger, has a novel plan for health care. A one sentence health bill.

    “Notwithstanding any other provision in state or federal law, a person who presents themselves while uninsured to any provider of a medical good or service shall not be charged a price greater than that which Medicare pays for the same drug, device, service or combination thereof.”

    https://market-ticker.org/akcs-www?post=232164

    Now he fleshes out this idea with other novel ideas that are worth a read.

    The remainder of the service is billed to the US treasury against the individuals taxes. After 90 days it would be a tax lien.

    https://market-ticker.org/akcs-www?post=231949

    Someone on another blog suggested there needs to be a website where ideas can be submitted. There are lots of good ideas floating around. Since congress can’t seem to agree, maybe listening to people paying the bills should be their plan C.

  23. Ann Says:

    If Obamacare fails the Democrats will push strongly for a single-payer system. Which should be just fine with Pres. Trump, since he’s on record as having supported single-payer health care over the years, and just recently praised Australia’s single-payer system.

  24. Manju Says:

    Medicare Pt D convinced me that the Republicans were no longer the Bankers Party. They created a expensive program and did not pay for. They didn’t raise taxes, nor did they cut spending. They borrowed money.

    Now, borrowing is fine for temporary programs designed to stimulate the economy when we are below full-employment, imo. I understand many modern-day Republicans (not Trump though) oppose this in principle. But if one thinks Keynesian borrowing and spending is wrong, then Medicare Part D is beyond wrong.

    It was fiscally irresponsible, and had no justification whatsoever.

  25. Cassandra’s Children. | Fuzzy little things that I find interesting. Says:

    […] Back to the drawing board on health insurance reform […]

  26. Ed Bonderenka Says:

    Bill Says:
    July 18th, 2017 at 4:39 pm
    Constitutionally, does a President have the right to just let a law fail? He takes a vow to faithfully execute the laws of the land.
    He can execute the provisions, but not write law to prop it up.
    If it runs out of money, or insurance companies or doctors, it is not on him.

  27. Leveut Says:

    2003 would be the year Tom Delay said the federal budget was nice and tight and he didn’t see anywhere to cut it.

  28. Bittman Says:

    I don’t care if it is the Democrats’ Socialist Obamacare or the Republicans’ Socialist Repeal and Replace. I do not want our government to provide Socialist healthcare and have control of healthcare for me or my family–now or in the future. I’ve read about and talked to people from countries with Socialist healthcare. Just look at Canada — six months to get an appt with an oncologist and another six months to get scheduled for treatment. My aunt’s Canadian friend died of brain cancer because by the time she started getting treated the cancer was too far advanced. A Russian dentist I know was afraid that under Obamacare, he might have to once again treat his patients without novocaine like he had to do in Russia. My grandmother died in a charity ward where she was receiving excellent treatment…I would prefer charity rather than having to depend on our government which is $20 trillion in debt now. We all know politicians couldn’t care less whether Medicaid patients ever receive quality treatment — they’re only concerned about being reelected.

    I can’t imagine why some Americans trusts the government so much with their healthcare. Even before Obamacare, Medicare rejected more treatments than the insurance companies. Obamacare has made healthcare unaffordable to America’s middle class. It is the middle class who is paying the Obamacare bill for the nation…it was the largest tax increase ever imposed on the middle class.

  29. Michael F Adams Says:

    I am not sure who Dave is. I read Neo, ashamed to admit it, more often than I read my Bible, but I don’t remember a lot from him. I can see, however, that he gets his “news”: from some reliable Left-wing source. TEA baggers, including me, do not want people to go away and die. That is a Democrat slogan, as is the epithet “TEAbagger.”

    Believing that there are better and more efficient ways of helping people is not at all the same thing as telling them to go away and die. Short-circuiting the entire discussion of ways and means is merely a way of ending the debate before it starts. It is victory by intimidation, not the discussion and reasoned debate normally characteristic of a bourgeois Republic. Pre-existing conditions have been covered for decades by group policies, usually provided by employers. Once one is covered, the next policy, even bought privately, also covers the p.e.c.

    I well remember stories told during the agitation (Not a debate) over O’care, including one about a woman receiving chemotherapy at MD Anderson in Houston. The woman’s chemo was delayed while her husband went home and second-mortgaged their house to pay for the treatment. MD Anderson has had a means-blind admission policy for many decades, AND Texas banking laws would have prevented that kind of mortgage. It was simply a lie. This is not a debate. This is a bulldozer. I mistrust any policy proposal that needs lies to support it.

  30. Dave Says:

    In a single payer system government merely taking over the insurance companies’ role on negotiating better prices for patients from providers. you know how the cost of same procedure is a lot less when you have insurance comparing to you paying out of pocket. the insurance company has a lot more leverage in knocking down prices and keeping providers honest in their pricing than what the little people can, it’s An even bigger advantage with an even bigger entity like the government fighting on you behave. The government doesn’t tell you which doctor to see, the doctors are still competing against each other in a free market on providing better services than peers. The rest is just catastrophic insurance with the big operations

  31. Dave Says:

    The reason why healthcare is so expensive is because you have two different industries colluding together to artificially jack up prices to benefit both sides in the expense of patients, the healthcare providers and the insurance industry. government taking over the insurance industry completely will lower the cost by eliminating the cost of the middlemen.

  32. Naut Right Says:

    In spite of the Ryan/McConnell leadership dynamic, whatever it is and in spite of ideological differences in the causcus one simple thing festers before the whole country. The promise. The very simple promise made with no discernable rebutal within the Republican party to repeal Obamacare. There’s no wiggle room there.
    When manufacturing was shriveling under the weight of various stresses the party stiffly jeld that these were healthy free market impulses. However, the thought of the free market supplying the market in health care has become heresy except for a minisucule few.

  33. Dave Says:

    The insurance industry to me is a redundant industry which’ existence benefits no one but the CEOs that get paid millions of dollars doing nothing but formulating algorithms to discriminate of high risk people with preexisting conditions.

    By not opposing socialising police, postal service, military or road building means converserives agree that there are certain agencies can be run better by a government than private section, why can’t the health insurance industry be one of it? I just don’t see how competitions in free market helps improve insurance services to patients all that much when it is clearly more a social program than a commercial industry. Let the government completely take health insurance, that will help eliminate redundancy of having two entities handling the same services, keep providers honest while creating a healthy environment with government serving as the referee making a free market of where healthcare givers competing against each other to improve everyone’s service truly possible.

  34. The Other Chuck Says:

    He Dave, if we want to read about the benefits of single payer/socialized medicine we can log in to daily kos, think progress, or huff post. That we choose to read a website devoted to classical conservatism with a libertarian twist means we have already rejected your talking points. I doubt if anyone here will buy what you are selling.

    I was hoping that Dr. Carson’s proposals for expanded health savings accounts would get a hearing. Alas, Trump pigeon holed him at HUD where his expertise is wasted. There are good ideas from a variety of sources that should be considered and included in any health care bill. What the Republican’s lack is principled leadership, both in Congress and at the White House. It’s like watching a mirage in the desert, shimmering hot air with no substance.

  35. Dave Says:

    Your system is failing, it was failing long before obamacare, you are just as indoctrinated in the free market insurance bulls*it as the millennials indoctrined in socialism. The insurance industry in America itself is a mini form of socialism, you take the premiums from everyone and redistribute it from the healthy to the sick. Hey if you are truly honest about free market in healthcare why not repeal Medicare first, complaining about nationalise healthcare in the comfort of Medicare makes you as big a hypocrite as the self proclaimed commies in free America

  36. Dave Says:

    It is well known that tea ba*gers’ end goal is to repeal ACA completely, including all the protections that come with it.

    Healthcare insurance should’ve never been tied to our jobs, I don’t understand how that came about in America, if we don’t get home owner insurance or auto insurance through our jobs why health insurance? Why not group people living in a city together to get an even better group rate instead of our jobs?

    I do not doubt your intention to find a more efficient way to help people, but you still have to recognise the fact that unlike car accidents that can be prevented by practicing safe driving, a person can get sick at any time due to no fault of ones own, why does a person who has been paying into the system for years get penalised by denying coverage for having an existing condition while switching job?

  37. Rob C Says:

    Now here’s what’s really got me confused on the Reconiliation front:

    “My understanding of the subject is a bill can be passed with only 50 votes only if it is entirely tax related, and the regulations associated with Obamacare like the pre-existing conditions can only be repealed with 60 votes, am I correct about that?”

    How can the regulations be put in place under a law passed via reconciliation but not be able to be removed by a law passed under the exact same circumstances?!?!?

  38. Manju Says:

    How can the regulations be put in place under a law passed via reconciliation but not be able to be removed by a law passed under the exact same circumstances?!?!?

    They can’t. The problem for Republicans is that Obamacare was not passed thru reconciliation.

    See here.

    60-39-1 for Passage. Sure looks like they overcame a filibuster.

  39. AesopFan Says:

    Michael F Adams Says:
    July 18th, 2017 at 7:46 pm
    I am not sure who Dave is. I read Neo, ashamed to admit it, more often than I read my Bible, but I don’t remember a lot from him. I can see, however, that he gets his “news”: from some reliable Left-wing source. ..
    Believing that there are better and more efficient ways of helping people is not at all the same thing as telling them to go away and die.. … This is not a debate. This is a bulldozer. I mistrust any policy proposal that needs lies to support it.
    * * *
    The only necessary response to a single-payer proponent’s claim that “the government can do it better” is : Veterans’ Administration.

  40. Dave Says:

    Veterans administration was sabotaged by republicans purposely to perpetuate the ideas that socialised healthcare does not work.

    Singapore and Hong Kong both have government run hospitals to accomplish two things, create competition against private hospitals to drive down overall costs and having an alternative for people who can’t afford private hospitals, they are run way more efficient than you can even imagine

    My uncle in Hong Kong got into a serious accident around new year time and had brain operations , he has been hospitalised since, he may never walk again, he had no insurance at all, how much did the whole treatment cost his family? 24/7 care for seven months? $50 USD, he had two houses so he wasn’t poor at all.

    Have you been to a hospital recently, you know how badly run even commercial hospitals are in America? you have a bunch of people sitting around doing nothing but chitchat with each other whose jobs involve nothing move than pushing beds around. My mom Had a fall a few months ago, I took her to banner, they were ignoring her the whole night even when there weren’t many other patient, took them like 5 hours just to have someone cleaning and stitch up her wounds, another 2 hours just to have someone give her a jaw lock shot. America healthcare overall is simply horrible, it is not a VA only problem.

  41. Dave Says:

    Forgot to mention, my mom’s bill was close to a thousand, yep, she had insurance and that was just a few stitches, a ct scan, and a shot.

  42. Dave Says:

    Funny how America is the only first world country without universal healthcare and coincidentally it’s the only place where its healthcare is close to collapsing while being a huge burden for taxpayers. Let’s waste money on expanding the military for wars that have no purposes but enriching the military complex instead of helping some unlucky people who got sick. Why conservatives hate unions and it’s benefits but okay with healthcare tying to your job which is against free market in every other way and makes it pretty much an union thing? Instead of allowing us to freely choosing our own health insurances, why do conservatives think it’s a good idea that we let our employers make that decision for us? you are a bunch of hypocrites who has no more knowledge about free market and capitalism than millennials.

  43. Fen Says:

    Dave, whatever argument you had imploded when you slimed people as tea baggers. Go fuck yourself.

  44. Irv Says:

    Dave – Just scattershotting unsupported statements doesn’t make them true. Try one statement at a time and you’ll receive proper refutations.

    Every single statement in your previous post is wrong. Your stated facts are wrong and you accuse conservatives of holding positions that they do not now or have ever held.

    Are you familiar with the term ‘TROLL’?

  45. Brian E Says:

    “My understanding of the subject is a bill can be passed with only 50 votes only if it is entirely tax related, and the regulations associated with Obamacare like the pre-existing conditions can only be repealed with 60 votes, am I correct about that?” – Dave
    ________

    Yes, and no.

    The 2015 bill, like the AHCA, begins with the statement that the Affordable Care Act is amended, not repealed.

    A House Republican fact page about HR 3762 also doesn’t make the claim that the bill would have repealed Obamacare in full. The bill summary on the page says, “HR 3762 repeals the health exchange subsidies and the Medicaid expansion included in the Affordable Care Act (ACA), repeals the ‘Obamacare slush fund,’ eliminates federal funding for Planned Parenthood, repeals the individual and employer mandate penalties, and repeals the medical device and ‘Cadillac’ tax, among other provisions.”

    This is from the article I linked to at 4:55 pm.

    This is a moot point because they can’t get to 50 votes to even pass the same bill they passed in 2015. The reasons why are in the article.

    Dave, your slur of the tea party was uncalled for and calls into question your motivations. You come across in other discussions as somewhat libertarian, but your criticism of Rand Paul makes it obvious your not.

    Your characterization of the tea party as “tea b*ggers who believes people with pre-existing conditions should just die without insurance” is a gross mis-characterization of their position and slanderous.

    I’m surprised Neo hasn’t called you for that. This blog has always remained civil, even when the discussions get heated. The tea party members as I understand are interested in reducing the size of the federal government and the huge debt we’re accumulating.

    As to pre-existing conditions, 18 states already had some form of guaranteed issue, well before the ACA was passed, so this issue wasn’t being ignored.

    I went back and reread some of your other comments and wondered if Dave isn’t two persons.

    I read the link you provided to The Hill article and agree that everything we’re talking about, from the ACA to AHCA doesn’t do anything to address the cost of health care.

    I don’t think the health care industry and the insurance company are in collusion, though with third party pay, there is no incentive from the consumer to demand lower prices.

    We should require price transparency in any law passed. It would simply require all medical facilities to make available the price for each medical code in their system.

    Some enterprising business could then aggregate all the codes, and show the comparison between facilities. That probably could be done currently, though getting a facility to give you the thousands of medical codes could be daunting.

  46. Brian E Says:

    “you are a bunch of hypocrites who has no more knowledge about free market and capitalism than millennials.”- Dave

    You must be having a bad day.

  47. Dave Says:

    http://www.breitbart.com/radio/2017/07/18/jenny-beth-martin-death-healthcare-bill-major-step-right-direction-toward-full-repeal/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+breitbart+%28Breitbart+News%29

    I do not know the consensus assessment of credibility on Breitbart among commenters here, but the intention to repeal all of the protections was spell out pretty clearly by this tea party member.

  48. Dave Says:

    in fact it gave me the impression that the extreme portion of the republicans especially the tea party sect sabotaged the reform effort intentionally because they don’t like the protections of ACA included in the new act.

  49. Dave Says:

    There is a big difference between reducing government interventions and abolishing law and order completely by completely eliminate the government’s role in regulating fair commercial activities. The Tea Party is not a party that value Law and Order, they are a bunch of extremists who’s end goal is to abolish the government completely disregarding its vital role in maintaining a fair society where a true free market is possible while returning us back to the era of law of the jungle.

  50. Dave Says:

    I apologize to anyone i might have unintentionally offended by using a derogatory term i didn’t fully understand, sorry. English is not my native language i didn’t know the hidden homophobic allusion associated with the term, sorry.

    Still I do not like Rand Paul at all, this man is the Bernie Sanders of the right, just because he is handsome and more presentable doesn’t make his ideas less loony

  51. Brian E Says:

    OK,
    I’ll accept that most tea party members want full repeal of the PPACA. That would take us back to 2009.

    That’s still a stretch to claim “tea b*ggers who believes people with pre-existing conditions should just die without insurance”

    As I state previously 18 states already have some form of guaranteed issue– covering pre-existing conditions. That would mean liberals should extend their fight to the other 32 states to do the same.

    But even so, your claim is baseless. Public hospitals can’t turn away patients. Even with the passage of the ACA, emergency room use for routine purposes is still way too high.

    The argument against this form of healthcare is the cost– that it’s an expensive way to provide healthcare.

    As to the expansion of Medicaid, analysis shows that the outcomes of Medicaid patients isn’t any better than not having insurance at all.

    For three years, an incredibly nerdy—but consequential—debate has raged among health policy researchers regarding Medicaid, America’s government-run health-care program for the poor. Piles of studies have shown that people on Medicaid have health outcomes that are no better, and often worse, than those with no insurance at all. But supporters of Obamacare were cheered in 2011 when a lone study, out of Oregon, purported to show that Medicaid was better than being uninsured. Yesterday, however, the authors of the Oregon study published their updated, two-year results, finding that Medicaid “generated no significant improvement in measured physical health outcomes.”

    https://www.forbes.com/sites/theapothecary/2013/05/02/oregon-study-medicaid-had-no-significant-effect-on-health-outcomes-vs-being-uninsured/#63903e246043

    Obviously statistics can be manipulated, but this is a study from a group that wanted to find a benefit from Medicaid coverage. If you drill down, I expect that’s true because going to the doctor versus not going to the doctor doesn’t make much difference to the bodies ability to heal itself.

    I don’t want to get sidetracked on this argument, but it does show that we need to get some incentive into the system for people to self-regulate the use of the system. Medicaid doesn’t do that but then neither does most third party pay systems.

    Which is why I’m for increased use of catastrophic insurance (high deductible) policies coupled with HSA.

    But even given the mis-characterization of their position the use of ‘tea bagger’ is scurrilous.

  52. Dave Says:

    taking us back to 2009 and our healthcare would still be collapsing. Obamacare was a mistake but it was a failed attempt to save the already collapsing healthcare system because the system was bankrupting by uninsured people abusing the emergency rooms. You repeal Obamacare completely with no replacement at all the old problems that were causing the system to crumble remain, but I truly doubt the extreme sect of the republican party’s sincerity on coming up a solution.

  53. Brian E Says:

    Here’s Politifact concerning ER use and they’re no fan of the Trump administration. It was like pulling teeth to admit that Dr. Tom Price’s statement that ER usage has gone up not down like was promised by President Obama as an argument to pass the ACA. More importantly it reinforces my assertion that without some financial stake in people’s decisions something that is “free” will be used more, not less.

    Katherine Baicker, a professor of health economics at Harvard University’s T.H. Chan School of Public Health and co-author of the Oregon study, agreed.

    “Expanding health insurance coverage leads to greater use of care across many settings, including the doctor’s office, the pharmacy, the hospital, and the emergency room,” she said. “This is what one might expect from the basic economics: Medicaid took health care that was expensive and made it free, so people used more of it.”

    Our ruling

    Price said the Obama administration said “they were going to be able to drive folks away from one of the most expensive areas for the provision of health care, and that is the emergency rooms. In fact, they did just the opposite.”

    While the data varies a bit from study to study, the findings generally fail to provide any evidence that emergency room use has decreased after the law took effect. Indeed, several studies found increases in emergency room use, though modestly. Price overstated the case slightly, but he’s basically correct. We rate the statement Mostly True.

    http://www.politifact.com/truth-o-meter/statements/2017/mar/10/tom-price/hhs-chief-tom-price-correct-er-use-obamacare/

    By the way, I appreciate your apology. I’m not a member of the Tea Party, though I am a supporter of the effort to reduce the scope of the federal government and the looming debt crisis.

  54. DNW Says:

    “By not opposing socialising police, postal service, military or road building means converserives agree that there are certain agencies can be run better by a government than private section, why can’t the health insurance industry be one of it?”

    No they don’t because the analogy fails as a result of a conceptual transition to a framework of unequal liabilities and non-distributive benefits.

    If the dread Canadians invade the country, we are all at some distributive risk. Military.

    If anthrax is deliberately spread, we are all pretty much at risk. Public Health Service.

    Read, the “general welfare.” distributively.

    We are nor all at equal risk for type two diabetes or AIDS.

    The utilitarian “justification” and informing pretense, is that we all do better when some are required to transfer their labor to others who do not in principle reciprocate. An imputed, not logically distributive benefit.

    Just how we actually benefit from someone getting fake insurance, rather than just granting these persons medical charity is made less clear. Apparently it preserves their “dignity” or something. Meaning that their feelings are preserved by it being made clear to you that you have no choice as to whether to underwrite their needs or not.

    And of course like anything “free”, demand is in potential unlimited. Give away free televisions and sure as the sun rises some sack of will demand enough to build a house out of them. Offer free hospital rooms and some will try to treat them as hotel rooms, as everyone here knows.

    And advertise “All the crab legs you can eat for $18.00” and some 400 lb human pig will sit and eat until he vomits them out, and then demand more.

    Yeah I know … “Where’s your altruism?”

    Because, why gosh darn it, it is just so wonderful to live in a country where we all care so, so much. And if you have to be a kind of slave, well, it is only because we all benefit from caring so, so much.

  55. Dave Says:

    If the way to get the lowest premium for each memebet is taking advantage of group rate principle by creating a group of insurers as big as possible, doesn’t grouping the whole country as one gives you the best rate in theory?

  56. DNW Says:

    Dave Says:
    July 19th, 2017 at 9:56 pm

    If the way to get the lowest premium for each memebet is taking advantage of group rate principle by creating a group of insurers as big as possible, doesn’t grouping the whole country as one gives you the best rate in theory?”

    That was just private marketplace package buying power.

    It worked while actuarial insurance still assessed individual risk and individual rates were based on that.

    Certain people would of course be excluded from the “insurance” paradigm, precisely because there was no insuring them against a possible eventuality when they were already living it. Insurance in that case is a fiction.

    They needed ongoing or imminent medical treatment, not insurance.

    And in the case of the indigent, emergency rooms were forced to give it. And when they were, they collapsed under the weight of the ever increasing demand and the serene indifference of those who began to use them as a public resource; as I think you noted yourself.

    What the hell do you say to a fat guy with diabetes who shoots himself up with a little extra insulin so he can have some donuts.

    Do you think that there is any point in engaging in the charade of distributive risk insurance with such a person?

    But that is where the government has been driving us.

  57. Ymar Sakar Says:

    Dave is the result of Alt Right sucking up the dicks of those in DC, and liking it, while lecturing the rest of us that we are cucks for not backing their power play.

    If he doesn’t sit down and shut up soon, I’ll have to write more.

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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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