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The GOP Healthcare Plan

2017 March 7
by Ian Welsh

This is a good overview.

I’m not going to waste a lot of time on it. Other than the changes to state-based regulations, the removal of the individual mandate and the removal of the tax on good healthcare plans (so-called gold-plated plans), as it stands, this plan is slightly worse than Obamacare in pretty much every way.

It is not an improvement, it is not what Trump promised in his speeches, though it’s not far from what was in his policy documents. It is also not a disaster, but it certainly won’t be a win for Trump or make his followers feel better off and it was one of two ways he could, or can, do so. The other would be to improve their economy.

This matters far more to Trump’s future, and his presidency, than all the noise over immigration or Russia. He should have pushed hard for something simple that was an obvious win; something Democrats would find it hard to oppose.

This is not a win for his supporters, or for him.


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43 Responses
  1. March 7, 2017

    But it remains very difficult to imagine why anyone would have expected differently, unless they thought that policy was somehow more important than the politics

  2. Mallam permalink
    March 7, 2017

    Immigration is not just noise, it was the centerpiece of his campaign. A whole lot of white economic insecurity is going to magically go away as they see Trump’s brutality in how brown people are treated. This is about hierarchy, and feeling in control of “our country”. Policy does not matter as much as you think it does. Moreover, this health care plan is not “slightly” worse. 10-20 million people might lose their employer sponsored health care because of how the incentives work. You think the tax on gold plated employer health plans is bad? This is worse. Also that employer tax has continued to be delayed so it never took effect. Similarly, they took the mandate (an unpopular idea), and made it even worse by forcing a 30% surcharge. So now your penalty goes to the insurance company rather than Uncle Sam. Meanwhile the poor would receive next to nothing compared to what the ACA gives them — which is already inadequate. So the poor will go without. Medicaid would be made worse than pre-ACA. In other words, this bill makes things worse than before the ACA, and significantly worse than post-ACA.

  3. Reality check permalink
    March 7, 2017

    The economic policies he is pushing domestically are going to harm the GOP because they now own them.

  4. March 7, 2017

    The economic policies he is pushing domestically are going to harm the GOP because they now own them.

    This I will only believe when I see — ie, that there is a deterministic connection between economic policy and election prospects of the right.

  5. March 7, 2017

    It is only a disaster if you’re going to die or live miserably from not being able to afford health care, which millions won’t under this plan.

    But they’re just poor people, so who cares? Tough luck, cards you were dealt, didn’t use your own boot straps, nothing we can do, shoulda given up your cell phone, etc.

    I am really curious as to why you have become such a quasi-apologist for Donald Trump and the Republicans. They lie and do what they can for their wealthy pals. If it passes, it is an obvious win for him and the only supporters that count.

  6. Tom permalink
    March 7, 2017

    ACA was worthless to begin with due to the deductibles. This just made the worthlessness open, though this bill still has to be adopted by the senate and pass.

    I suspect it will be a long time for it to clear.

  7. March 7, 2017

    I am really curious as to why you have become such a quasi-apologist for Donald Trump and the Republicans. They lie and do what they can for their wealthy pals. If it passes, it is an obvious win for him and the only supporters that count.

    That one is not hard to answer from everything Ian’s written on the subject. Ian thinks that this is the comeuppance of a progressive elite and/or Democratic leadership class that prevented progressive policy ideas and political methods from being brought to the public in a general election, and has therefore been frozen out of power by a right-wing reality TV celebrity and congressional nutcases. He’s angry that the political establishment refuses to respond to the fact that large geographic swathes of the American public are suffering, and an economic program that benefits everyone can not only (he believes) attract these voters, it can bring everyone into a class-politics tent in which the social and cultural conflicts can more easily be resolved. If only, you know, the American liberal establishment could see what it is that key sections of the American working class have seen in Trump — a promise to shake things up so that they aren’t the way they are before — and offer that themselves too.

    Instead, the liberal establishment has gone on a delegitimization campaign against Trump, and therefore, against the anger into which Trump has tapped, meaning that they aren’t planning on ever running with the policy proposals that Ian thinks would be winners (both electorally and in practical policy application — and I agree entirely with the latter). Rather, they are betting on their ability either to keep the privileges that they have, or, ideally, to reassert the neoliberal political order.

    Unfortunately, Trump is showing the limits of American politics. There is no single-payer health care coming from the right side of the aisle, not even the populist right. The American right defines itself by, as some people memorably put it, “Go die.” That neoliberals tell some people that also is neither here nor there, because they tell that to fewer people.

    That is the lesson of the ACA so far. The ACA represents the limits of American politics in terms of health care. The question remains unanswered (actually not, but you won’t find the answer around these parts) — why was the ACA, as constructed, the stable limit of American health care politics?

  8. EmilianoZ permalink
    March 7, 2017

    As some commenters on Naked Capitalism have said, Trump is the white man’s Obama.

    Trump has surely noticed that Obama got reelected while giving very little to his base. He probably plans to accomplish the same feat.

  9. Willy permalink
    March 7, 2017

    If my sources are correct, at least half of America is now poor (or very close to it). There’s gotta be a way to simply, clearly and concisely present facts and outcomes to them. For example, itemizing the differences between ACA and Trumpcare, line by line with largest differences first, including a column for who wins and who loses, might be good. A bit USA Today, but if one is working two jobs worrying about what tomorrow will bring, that’s about all the discretionary time one has available.

  10. Nancy permalink
    March 7, 2017

    If Trump were smart and wanted to be re-elected in a landslide, he would support universal healthcare coverage. The simplest way to implement universal coverage in the current environment would be to extend Medicare coverage to all Americans. Matters of life or death should not be subject to the profit motives of the greedy bastard insurance and pharmaceutical companies.

    If the rich think they are too good to participate in a universal healthcare system with the great unwashed, then they can set up their own private concierge medical networks. That way they can feel superior and pay whatever they want for the privilege.

    If every other 1st world country can provide universal healthcare for its citizens, why can’t we? Aren’t we supposed to be “the greatest country in the world”? I recommend repeated viewings of Michael Moore’s “Sicko” to counter the anti-Universal Healthcare indoctrination of Americans victimized by years of Republican corporatist and other right-wing propaganda.

  11. The Stephen Miller Band permalink
    March 7, 2017

    I have a brother in law, a Trump supporter, who has been battling one major disease after another since he turned fifty. He’s now in his early sixties. I have estimated that the entirety of his medical expenses for the past decade or more fall somewhere between $1 million and $1.5 million. This is not scalable and/or sustainable. It’s not moral if it’s not available to all, and, come to think of it, what a terrible burden to carry if you’re a conscientious person — the fact that it’s this expensive to keep yourself alive at a greatly diminished capacity and quality of life.

    I have mixed feelings about it, meaning, some days it’s difficult for me to find compassion, because this brother-in-law is such an avid Trump supporter and yet he fails to see that all the medical expenses he has incurred have been paid by other people in an income redistribution scheme we call private health insurance. It’s really socialism under the banner of capitalism except in the case of insurance, any kind of insurance, the shareholders, the wealthy elite, take their skim.

    He never could have afforded to pay these bills out of his own empty pocket, so therefore it necessarily follows that others who pay health insurance premiums to the same insurance company have paid his bills for him with the hope the same will be available to them some day should they need it. But that’s the lie. It can’t be available to all — not that level of healthcare expense and yet so many business models surrounding healthcare make this basic assumption, that it is scalable and can be available to all, especially the companies providing high-tech equipment and the pharmaceutical companies.

    Until we can be truly honest about life, death, quality of life, suffering & dying, it’s only going to get worse until finally, one day, we wake up and realize we’re no better off than India and who needs an extra kidney anyway when selling it can put food on the table for the next few months?

  12. gnokgnoh permalink
    March 7, 2017

    @Mandos

    You make it sound like the “right side of the aisle” and Trump are two different things, because he ran as a populist, and he has now run into “the limits of American politics.” This, from the beginning, is an error in thinking. It’s the same thinking that excused Obama and the shortcomings of the ACA. This is Trump, this is Trumpcare. He is a Republican through and through.

  13. Peter permalink
    March 7, 2017

    Some of the republicans didn’t want anything to replace the ACA just its destruction and some pundits claimed the republicans couldn’t devise any comparable plan to replace it. Trump told his congress to focus and be careful and within a couple months they produce an apparently workable outline for a new plan. The dismantling of the ACA will still be treacherous and the hand-wringer Clintonites will sob about their loss of support from the newly registered democrats in the ACA.

    We’ll have to wait to see what this final product will be and how many people it will help to buy their insurance but we do know what it will stop. There will not be government mandated punishment of those people who reject the program and working class people will not be unfairly taxed for having good insurance.

    We’ve already seen what the ACA was becoming with the massive premium increases which translate into uncontrollable subsidy costs, a black hole many people seem to ignore.

    Trump and the republicans cooking up some costly sloppy program to appease the Clintonites is ludicrous, they are at war and he has set his sights on exposing Obama’s abuse of power as his latest battle plan.

  14. paintedjaguar permalink
    March 7, 2017

    @anonone
    “It is only a disaster if you’re going to die or live miserably from not being able to afford health care, which millions won’t under this plan.”

    As opposed to the tens of millions who already aren’t able to afford health care under Obamacare? Which was always meant to leave 30 or 40 million completely uninsured, plus who knows how many underinsured or unable to use whatever coverage they have. And that’s before we start counting half the states not participating in the Medicaid provisions — the sort of disaster which was completely predictable in kind, if not in detail, due to the Rube Goldberg nature of the ACA.

    Yes, of course the Republicans will strive to make things even worse – that’s what they do. But Obamacare was never worth saving. It’s primary purposes are to act as an institutional roadblock to real reform or cost control and to directly funnel money to the medical/insurance complex. The ACA is a bridge to nowhere, and the individuals who happen to benefit from it are incidental, except in their role as “divide and rule” political support.

    @Nancy
    “If every other 1st world country can provide universal healthcare for its citizens, why can’t we?”

    Mandos Man of Mystery thinks he knows… but he won’t say.

  15. March 7, 2017

    You make it sound like the “right side of the aisle” and Trump are two different things, because he ran as a populist, and he has now run into “the limits of American politics.” This, from the beginning, is an error in thinking. It’s the same thinking that excused Obama and the shortcomings of the ACA. This is Trump, this is Trumpcare. He is a Republican through and through.

    I don’t disagree with you one bit, actually — I was citing Ian’s so far oft-repeated sentiment that what the “right people” (the liberal and/or populist left) won’t and/or can’t do, the “wrong people”, the racist populist right, may succeed at doing. If you are skeptical that the racist populist right had any intention of creating universal health care even for the “in-group”, I tend towards sharing your opinion.

  16. highrpm permalink
    March 7, 2017

    But they’re just poor people, so who cares? Tough luck, cards you were dealt, didn’t use your own boot straps, nothing we can do, shoulda given up your cell phone, etc.

    any collective — the sum of the whole is greater than the parts — worth belonging to requires its members uphold its by-laws, contribute to the whole and pay their own way.

    brick the t.v. manage one’s own health. start by hydrating, eating raw produce and exercising. and educating oneself to understand why.

    and stop putting one’s children at a disadvantage by servicing them at the public education dumps.

  17. March 7, 2017

    I see Peter is still going on about the Great Sekrit Plan Donald “Flash Gordon” Trump has in the cosmic war against the Clintaliens.

    Mandos Man of Mystery thinks he knows… but he won’t say.

    I actually wrote about this extensively during the 2007-2010 period and around these parts too, but it was well before I had guest posting privileges. I guess it’s been long enough that I should write this up again, and as a real post, but it goes on the stack of posts I plan to write…at some point.

    The short answer is: culture, culture, culture.

  18. Hugh permalink
    March 7, 2017

    The Republicans opposed Obamacare because it was a Democratic bill. However, Obamacare was simply the old Republican Romneycare put in a new wrapper. They never expected to be in a position where they actually had to present an alternative. So they could run on the basis of repealing the ACA without worrying about replacing it. But then the unforeseen happened. The popular discontent delivered the Republicans the Presidency and both houses of Congress. These wins have put them in the unusual position of a lose-lose situation on healthcare. Either they go against the popular backlash responsible for their majorities and the Presidency or they go against their ideology and corporate sponsors. What I expect them to do is what they have done. They will deliver to their corporate sponsors and seek to lie to and divide the rubes, –and maybe even hope the Democrats throw them a lifeline. Bottomline though is that any Republican proposal will be worse than Obamacare, and neither Democrats nor Republicans will push, or even mention, the one plan, universal single payer, that would be cheaper, popular with the people, AND give them dependable healthcare. As SomeGuy pointed out a while ago, our country and society are in decline precisely because we can not solve basic problems, even when the solutions to those problems are obvious.

  19. S Brennan permalink
    March 7, 2017

    The Trump supporters I know have been very vocal in their disgust with this plan…and in that way, very different from Obama’s fanboys.

    Team Obama had a protective shield, he and his minions could dismiss any form of policy criticism as being motivated solely by racism. Trump will not have an equivalent, because white Trump supporters aren’t going to buy the reverse logic of: “he’s white; so it’s alright”.

    Thinking out loud, Trump could line item the bill when the elephant finally defecates it and the bill plops onto his desk. That would force House & Senate Republicans, many who conspire with [D]cons, to own it in whole…win or lose.

  20. March 7, 2017

    Well, we’ll see. Maybe this is “good kabuki”, where Trump iteratively coerces the congressional Republicans to turn a crappier version of ACA into something better than ACA. I always leave open the possibility for surprise.

  21. Mallam permalink
    March 7, 2017

    Trump is whipping votes for this piece of shit plan and still people here are in denial. Amazing.

  22. S Brennan permalink
    March 7, 2017

    I may want to reverse my muttering above. I just saw Pence was involved in telling reluctant GOPers to support the bill no matter how bad it appears, or how much Trump voters hate it.

    Since Pence is a Trojan Horse, who’s venal ambition is to undermine Trump and either replace him or to effectively be President as Cheney was, then it would follow that the bill will help show Trump the door….which is what Trump will deserve for allowing the back stabbing scorpion onto his back in the first place

  23. March 7, 2017

    Trump is whipping votes for this piece of shit plan and still people here are in denial. Amazing.

    I know, eh?

    Anyway, if you look at the rhetoric in early 60s Saskatchewan, Canada, which was the birthplace of Canadian single payer, you find something rather absent that I see in American public discourse. The doctors in Saskatchewan were willing to pay lip service to the idea that everyone *ought* to have health care, even if they were wanting to weasel out of Tommy Douglas’ plan (including by striking).

    In US public discourse, things are really quite different: lots of people are willing to admit to the belief that if you were “irresponsible” enough to be poor, your child should die untreated of cancer, basically. That’s a cultural thing, and as long as someone can say something like that and not be drummed immediately out of polite company and public society, you’re not going to have single payer in the USA.

  24. Mallam permalink
    March 7, 2017

    Make no mistake: Trump supporters will mostly align with what Trump says. I know how hip and cool your Facebook friends are in their independent streak, but polling already bears this out with Trump transforming what Republicans believe — this is especially true with “free trade”. If Trump praises this plan, tells his supporters to jump, they’ll ask him “how high?”

    This will similarly have a backlash in polling for issues associated with “left”. People who used to hate free trade will come to love it because people who oppose it support Trump. It’s already happening with young people, the most supportive of free trade and the largest segment of the population. I suspect this is less about trade and more about seeing themselves as less nationalist. Culture matters to selling your policy. I oppose free trade from the left, but I do not support Trump rebuilding the world order with Le Pen and Putin, and I guarantee that’s what’s behind young people supporting free trade.

  25. Spring Texan permalink
    March 7, 2017

    I don’t agree that it is not a disaster. That could perhaps be true of the worsened Obamacare, but the Medicaid changes WOULD be an utter disaster, just a slow-moving one. Keep your eye on the ball, in this case — and the ball is Medicaid.

  26. Spring Texan permalink
    March 7, 2017

    Remember that Medicaid is what helps children with such high medical needs they bankrupt their families, and also what keeps old people who exhaust their funds housed in nursing homes.

  27. ultra permalink
    March 7, 2017

    “It is also not a disaster”

    I don’t agree. The Republican health care plan would pretty much destroy the Medicaid expansion under Obama Care and impose a limit on how much money could be spent on Medicaid on either a per person basis or statewide basis, as dictated by a ‘formula’ (likely, a very miserly one). When Medicaid is restricted on a state-wide basis: this means if a state spends more money on Medicaid than is allotted to it by the Federal government, it would have to pay 100% of the Medicaid costs (many states cannot afford to do that or will refuse to do it). If Medicaid is restricted on a per client basis, that means people will high medical costs will not receive the health care that they need as their health care costs would quickly exceed the average allotment per client. Many of these people are the elderly and the disabled. What the Republicans are really proposing is genocide by default.

  28. S Brennan permalink
    March 7, 2017

    So in a quick look & 2 calls at my Trump voting &/or supporting friends, all oppose this plan. Which says to me that this is poison should Trump seek re-election. The factually unsupported conjecture above by Obama/Hillary fans that Trump supporters are the mirror of Obama/Hillary fans is contradicted by my count.

    But what the hell, Obama/Hillary fans have a great record, they said the Libya bombing campaign was a great idea; regime change in Syria would be a snap; why not have a coup in the Ukraine and let’s not forget Obama/Hillary fans greatest prognostication…Afghanistan was the “right war”. Yes; with all these glaring idiocies in the recent past, not a moment of introspection, not a modicum of humility…just more yapping.

  29. highrpm permalink
    March 7, 2017

    lots of people are willing to admit to the belief that if you were “irresponsible” enough to be poor,
    more accurately, such a state is the luck of the draw. get over it, quit the victim/ entitlement mindset and live your life free of the mental chains that others better off somehow owe you.

    geez, liberals are as bad/ worse with their religious beliefs as the crazy christians they criticize.

  30. gnokgnoh permalink
    March 7, 2017

    @highrpm

    Yeah, those damned, crippled veterans and elderly and poor folks, and young’uns should stop ther whining’. Gumption is what they need, that and hard work. Fer cryin’ out loud!

  31. Peter permalink
    March 7, 2017

    Many people will be satisfied to see Obamacare and its associated rubbish heading for the shredder while the hand wringers will bemoan the imagined suffering they predict will follow.

    This was a bad day for Obama with the ACA replacement and Trump choosing congressional intelligence committees to investigate felony accusations of abuse of power by Obama’s white house. Rogue spying operations by the NSA of Trump’s campaign are being discussed and all that will be needed is for a weak link to break and this High Crime story will spill out.

  32. Lisa permalink
    March 8, 2017

    S Brennan : The points you made are fair enough but had no impact on the infamously ignorant of foreign affairs US public. Rather it has been what 40+ years of constant neo-liberal economic policies.

    The most amazing thing to me about it all has been the willingness of the Dem elites to allow the levels of GOP gerrymandering at State and Federal levels, which means the Republicans have an effective block on just about anything. Common sense states that for the Dems to come back they first have to attack at the State levels to build a solid majority, but there is this unwillingness for them to focus on that.
    Now whether or not they are trying to be clever (because it gives them an excuse not to do things their base wants but the elites don’t) , or are just plain dumb is difficult to work out, personally I think it is a combination in that they are being ‘dumbly clever’.

    But it is an unsustainable position. The book is now in, in that the GOP is just going to run right wing economic actions, neo-liberalism with a slightly different slant while giving the religious right what it wants by hammering the poor, women and of course LGBTI people, while dangerously stirring up racism and gutting the administrative capacity for the Federal Govt, which creaky as it is is still essential for the functioning of society.

    How long until major wheels start to fall off? The US is in poor shape and deteriorating right across the board very quickly, we see this in the death rates and even more astonishingly the maternal and infant death rates. Texas which seems to the be model has the highest maternal death rates in the developed world now.

    So we are seeing Emmanuel Todd’s prediction of the US doing a USSR style collapse, albeit at a slower pace. And no one seems to be able to stop it.

    Both wings of the same political party (as Gore Vidal called it, one party with two wings) are so much more right wing than the electorate and with each election cycle gets ever more right wing, like a ratcheting effect.

    Health is the #1 area where economics and social values meet, developing a half decent healthcare system is a no brainer, just pick one of the many overseas ones and copy. But the US is so dominated by a minority right wing, especially the religious right now, that even this simple consensus is impossible. For once I don’t actually blame the economic elites on this, frankly they probably don’t care all that much (which is dumb of them).
    But conscious and unconscious racism, the astonishing streak of misogyny that runs through the whole society, the desire (very religious) to ‘punish’ others for imagined transgressions*, makes it impossible with the gerrymandered political system to get a sufficient political majority to push it through.

    * That bullying mentality I mentioned before.

    You stand back far enough and you see the US going through a class war, a race war, a gender war and a religious war all at once. The country won’t hold together doing that. If nihilist Bannon gets his way and the federal systems are gutted then there will be even less holding it all together.
    And just wait until the ’Religious Freedom’ laws come out (translated imposition of ‘christian sharia law’ on everyone) then that will blow everything to pieces, what little social consensus exists will disappear under a welterweight of expressed hatred by extremist ‘religious right’ so called ‘christians’, already attacks on mosques and synagogues are at record levels as are murders of trans women (now you might not care about this, but a tip, always watch leading indicators very carefully).

    My advice, if you live in the US and are part of any minority group get out if you can. Because there is no way this is going to end well. At the very least get out of the right wing, ‘religious’ States as they are now hotbeds of ‘christian’ hatred and no one can hate like a so called ‘christian’ can.

    The irony is, the majority of the so right wing so called ‘christian’ States are the ones most dependent on the Federal purse and would go under in days if the money pump stopped.

    Big picture again, the scary thing are the two countries capable of destroying the planet are being ever more captured by ‘religious right extremist christian’ groups, Russia is falling right into the same trap and their ‘christian’ nut jobs gain ever more power and influence as well. Future historians, if there are any, will call that ‘Putin’s biggest mistake’.

  33. V. Arnold permalink
    March 8, 2017

    Lisa
    March 8, 2017

    Big picture again, the scary thing are the two countries capable of destroying the planet are being ever more captured by ‘religious right extremist christian’ groups, Russia is falling right into the same trap and their ‘christian’ nut jobs gain ever more power and influence as well. Future historians, if there are any, will call that ‘Putin’s biggest mistake’.

    Damnit; I’m trying not to post, BUT, I just couldn’t let that slide by.
    Where/what is your evidence re: Russian “extremist Christian groups”.
    I was married in a Ukrainian/Russia Orthodox church ceremony and know a wee bit about their “beliefs”, having attended services. Aside from normal cultural prejudices, there is absolutely no radicalism to be found.
    I think you just spoke above your pay grade.
    Truth be told; you’re somewhat of an evangelical your very own self. Be careful where you cast stones…

  34. Mallam permalink
    March 8, 2017

    Yeah, decriminalizing wife beating isn’t extreme at all, and had absolutely nothing to do with the Orthodox Church’s influence. Lisa, you’re just struck with some “Russophobia”.

  35. March 8, 2017

    @Lisa

    “The irony is, the majority of the so right wing so called ‘christian’ States are the ones most dependent on the Federal purse and would go under in days if the money pump stopped.”

    This is a feature, not a bug. The rich whites in those states aren’t nearly as dependent on the Federal purse as the poor. Cut off the pump, and they can revert to plantation style governance like they’ve wanted since 1863.

  36. BlizzardOfOz permalink
    March 8, 2017

    Obamacare Lite: disappointing, not surprising. In the primary debates, Trump was visibly out to sea on the health-insurance question.

    For people favoring “single payer”: do you seriously DC can produce anything as good as not-awful? DC is a corrupt, self-dealing swamp. The goal should be to extract it from our society, not further enmesh it. Implement single payer at the state level, if you must. I know people here have read the US Constitution. The DC regime has no authority to be doing 1/1000th of what it’s doing. It is laughably illegitimate. Calexit, Texit; as for DC, splinter it into a thousand pieces and scatter it to the winds.

    I was reading Rousseau’s Emile. It’s amazing what you can learn by reading Old Books. So Rousseau, the patron saint of the modern left and the French Revolution, is opposed to doctors. He thought they turn people into weaklings and cowards. How did we get from Rousseau to a left that thinks the state should “care” (as defined in practice, of course, by the lobbyists) for everyone, citizen and non-citizen, from cradle to grave? Today’s mainstream left, nothing to do with classical liberalism, is communist, plain and simple.

    People who clamor for the state to care for them are Aristotle’s “natural slaves”. That’s where we are. We are soft, and nature abhors nothing so much as weakness. We will get what the weak have coming to them, until nature’s school of hard knocks hardens us up.

  37. S Brennan permalink
    March 8, 2017

    This article implies that in order for it to pass it needs [D] help…which it doubts will happen…so it “fails, but we tried” may be what the doctor orders.

    http://nymag.com/daily/intelligencer/2017/03/why-is-mcconnell-rushing-through-a-bill-everybody-hates.html

    Again; my political sense of what was possible back in the Great Recession years [besides leaving the problem for a more prosperous day and focusing on infrastructure build out]:

    1] Expand medicare downward [with a one window buy* in & a loss of employment coverage opt in] to 50-old**

    2] AND mandatory catastrophic* insurance that kicks in at a loss > 20% of yearly income. That leaves out poor [medicaid] and chronically ill.

    The chronically ill issue needs it’s own bill/budget…and no, I don’t have a magic bullet for that. But tying the chronically ill to individual policies while allowing those who receive their policies through high-end employment to be free riders was…idiotic.

    *based on x% of income
    **where; for those that don’t know, individual policies spike upward.

  38. different clue permalink
    March 8, 2017

    @S Brennan,

    Just as Obama has the protective shield of cry-racism to protect against criticism, Clinton has the protective shield of cry-misogyny to protect against criticism. And now that Obama is off-the-field, he has given his racial immunity as best as he can to the Clintonite Forces, to be a sort of Proxybama for his greater glory and their political benefit. . . . they hope.

  39. Lisa permalink
    March 9, 2017

    BlizzardOfOz: You are not understanding the nature of insurance, especially medical or social.

    With a single payer compulsory health system essentially the young and healthy subsidise the older, but do gain personal catastrophe coverage. (which of course can happen at any age) and coverage of their also high cost children (if something goes wrong, extremely high cost) . Naturally as they age they will start to use the medical system more, recouping their original payments in effect.
    Unless you have universal and compulsory payment then the low risk leave the system and it gets ever more expensive, which drives out more in a death spiral.

    So think of this part of it as a social compact between generations.

    Then other advantages accrue, your administration costs are far lower, there are no marketing costs (which are often considerable), economies of scale happen especially with things like purchasing drugs, you can keep doctors (especially specialists) wages under control. You can control and direct treatments, diagnostic tools, etc on a more rational basis than just income maximisation of doctors, providers and hospital management.

    So the end result is a health system that is, on average, two thirds to a half the cost of the US system and with far better health outcomes.

    Similar logic applies to things like unemployment insurance and other social security systems. Pension systems in most places are again compulsory saving schemes, again cheap to administer and guaranteed. Whenever you let the grubby little paws of private industry into them the costs, fees, ripoffs and risks multiply greatly.

    The ones that designed these systems, during and just after WW2, were really smart people, Keynes being one of course.

    So these are rational systems deigned to meet the society’s needs.

    The fact that the US cannot manage to create such a health system is a total condemnation of it at many levels of society*. Someone, I forgot who, said all the US has to do is put up the names of all the countries that have universal systems on a wall, close their eyes and throw a dart …and pick the one you hit…

    * Note the religious right are totally against such a system, in fact they are again ANY health insurance whatsoever, check out their websites. they have no concept of random luck, ‘good god fearing christians’ don’t get heart attacks, if they do they must have done something wrong so it is their fault. Bit bizarre because they almost certainly will have car and house insurance….

  40. Lisa permalink
    March 9, 2017

    Mallam: Yep. I am the last person to be ‘Russophobic, but to be blind to the issues they are facing and the risks they have is just being silly.

    Their Orthodox Church is as bad in every way as the Catholic Church or the evangelicals are here in the west, and breed their own Right Wing Authoritarians as well. In many ways this is even riskier there than in many western nations since the Russian Federation is just so diverse in cultures.

    In fact if I had been asked to come up with a ‘cunning plan’ to tear it to pieces, that’s exactly how I’d do it, encourage their Orthodox religious extremists and the associated right wing groups. People like that are fundamentally divisive in societies and have to be kept under tight control otherwise they will tear them to pieces. They are full of Authoritarians, their (usually) sociopathic leaders and they are universal haters.

    The recent de-facto decriminalisation of domestic violence against women and kids screams ‘Red Alert’ to me that they have some serious issues brewing away there. Now no country pays sufficient attention to domestic wife and child abuse, including child sexual abuse, but they all try at least to pay lip service to the concept. Russia abandoning even that, something the religious right in the US (etc) would love to do, is scary and shows a a major move to the right (especially the religious right) that does not bode well for it as a society.

  41. March 10, 2017

    I think BOO understands it very well, but is rather expressing a sentiment analyzed in great detail in this old blog post:

    http://examinedlife.typepad.com/johnbelle/2003/11/dead_right.html

    I suspect BOO may be annoyed at being compared to David Frum but on healthcare, he is expressing the same thought.

  42. DMC permalink
    March 10, 2017

    @Mandos
    I think you may be a little too generous. I find that if I hum the Horst Wessel-lied to myself while reading Blizzy’s posts it helps keep the right perspective.

  43. Jessica Sager permalink
    March 15, 2017

    “Tom PERMALINK
    March 7, 2017
    ACA was worthless to begin with due to the deductibles. This just made the worthlessness open, though this bill still has to be adopted by the senate and pass.
    I suspect it will be a long time for it to clear.”

    Tom is right about the worth(lessness) of the ACA. Naturally anything the GOP proposes will not be an improvement. Yet, the difference between these two plans is currently presented in the press (the Serious and Objective press) as if the ACA was free healthcare for all while the GOP proposal is the equivalent of free Tylenol for a year. Hyperbolic, of course. My main point is that the ACA did absolutely nothing to lower costs. It provided the insurance companies a pass and built-in excuse to charge more: “there’s so much to administrate to make this work!! As if the guaranteed increase of revenue wouldn’t help close the gap. If those companies haven’t figured out how to admintrate new enrollments without increasing prices, they should be run out of town.

    I’ll admit, I’m bitter over this, and it’s difficult to be objective. My husband works at a small start-up and we have to buy insurance on the exchange. For a family of four, we pay nearly $1,000 a month in premiums, and our family deductible is $9000, $4500 per person. My son was diagnosed with ASD last year, right before he started kindergarten. The evaluation was over $2000, and it all went towards our deductible. Not only do we have the ridiculously high deductible and premium, but there are $25 co-pays AND $50 office visit fees. Which of course are NOT applied toward our deductible. The only thing that has kept us from spending our savings on his therapy is our gold-star school district’s special education department. And I know we are in the minority to have such a great school district, so I’m grateful everyday. And vigilant about maintaining the funding.

    Short of a catastrophic event, the only thing that makes these outlays worth it is our monthly prescription costs. Although that’s another mind-boggling cost: even though we take generics exclusively, the 8 medications we take between us are over $1500 a month.

    I don’t care which side of the proverbial aisle the solution resides, it has to change.

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