Thursday, June 29, 2017


Political Mayhem Thursday: Health Care

There are big stories and little ones. Donald Trump faking a Time cover (at right) is a little one. Health care is a big one.

The Republicans in the Senate are struggling mightily to find a way to undo at least part of the Affordable Care Act without losing three or more of their members. There is a lot of reporting on this, but I want to just lay out three simple facts:

1)  The problem with taking apart the ACA in pieces is that it was carefully constructed to work as a whole; each component relies on the existence of others. Pre-existing conditions are covered, for example, but the costs associated with that (and the uncertainty) are offset with the mandate that everyone buy insurance. That allows the insurers to spread the costs of the sick people. Take away the mandate and keep the requirement to cover pre-existing conditions, and the economic model falls apart. Similarly, expanded Medicare and subsidies for private insurance are paid for with higher taxes. Ditch the taxes but not the expansion and the subsidies, and you blow out the deficit.

2)  Our current health care system is a mishmash of private insurance, no insurance (where costs are shifted to providers), and state and federal programs. The result is inefficient and uneven. Our health outcomes are terrible relative to other countries, too-- we are not getting good outcomes overall.

3)  Changing the health care system back and forth is not good for market stability. The benefits now being reconsidered were only granted a few years ago, after all!  If we are going to remake this system, the answer has to be big, bipartisan, and broad.  That will take time, transparency and civil discussion, which has been the recipe of neither party of late...

John Boehner assessed the situation best, its all just happy talk. A competent GOP administration would have crafted a bill in November and December (or earlier) and had it on the desks of Members of Congress in January. The political momentum from the Fall Election and inauguration of a new President would have helped carry the thing through by May. Its too late now. Even if the Senate does reach some sort of compromise, that Chamber's bill must be reconciled with the House version.

Meanwhile the 2018 elections are getting closer and closer. A lot of Members on the Far Far Right will fear being "primaried" and the ones that aren't in completely safe GOP districts will become more concerned about losing a General election.

Delay is what killed the Democrats in 2010. If the original Obamacare ACA had been passed and signed in 2009, the Democrats would have had a chance to build on the success of ACA and get reelected. Instead, they passed a controversial bill in March 2010 and had to face skeptical voters in November of that year. The dust had not settled.

Contrast that to G W Bush and Reagan. Both came in with audacious agendas of tax cuts (and in the case of Reagan, spending cuts and defense increases). The legislation was written before either man took office. Hearings were held immediately and the big legislative battles were over before the end of Spring.

Worse than Obama or Trump was Bill Clinton. The only legislative accomplishment of his first term was NAFTA, an idea started by his predecessor, GHW Bush. His disorganized and unfocused approach to healthcare reform doomed the effort. Just as it will with Trump and the GOP this time.
I'm not sure how "carefully constructed" the ACA was, but I agree with the premise that its constituent parts were intended to work together. New taxes to support new spending and the insurance mandate to support a larger risk pool. So now the GOP is in a corner not only because of the strategic blunders IPLawguy points out, but also because people decided that they liked the new spending and other ACA benefits.

As a result, McConnell is trying to produce a bill that keeps most of the spending but cuts consumer cost (taxes, fees, mandates, etc.). The math doesn't work, but that's never stopped us before--just look at the ACA itself!
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Some Americans can pay for a portion of their health care. Some can't. When they are very sick very few but the very rich can afford the necessary care without universal and affordable health care insurance

There is only one way to bring good heath to all regardless of their wealth or health is to pool our funding. The bigger the pool the better hearth care for the buck and fair delivery.
A health care system that is universal, nationally regulated and delivered in a just way will not be on the agenda as long as John Boehner is the wisest advocate for a procedure to return us to a truly diabolical expensive healthcare system before the ACA.

The problem is it is not super profitable when we have a proper and efficient health system. Good heath care for all will be opposed by most Republicans and some Democrats as long as money in politics reigns.

Heath care is a moral issue. The immoral new tax schemes in the pipeline shouldn't die because they are mishandled, they should die because they don't do anything but shift wealth.
If a public option for all was available most fixes that all non-ideological Republicans and Democrats want would be achieved. It is the cheapest and cleanest solution.
None of the entities involved seem to understand that in a civilized society health care should be a basic HUMAN RIGHT. Take mental health care in the United States…it is no different than in Malawi or Bangladesh.
I think George Will paints an accurate picture. Attitudes to healthcare in this country have changed dramatically over the past 100 plus years and especially recently. He takes a proper swipe at employer provided healthcare, which I bet most of the people reading this have. For us, this is more of an academic argument. But if healthcare were NOT paid for by employers, the debate over this issue would be a lot more meaningful:

I agree with IPLawGuy...thank you for suggesting George Will's piece! Funny he mentioned asking prices...I did just that that recently when I went for an echocardiogram and asked the clerk who checked me in how much it was. In fast progression, she first looked offended, then she looked at me as if I were some kind of crazy, after which I got the evil eye and an order to go wait. No answer. Found out from my insurance claims page: $4200. The guy to interpret it: another kettle of fish. I guess it's a long way from the $10 degree credentials least people don't die of ingrown toenails anymore!
What is most puzzling in the healthcare debate is the absence of America's business community, especially small businesses. Can you imagine how competitive our business would be if we had single payer and they were relieved of health care costs for current and past employees. It does seem that at least some taxes to cover costs would be predictable.
In the eighties the car companies had about $2000 a car in healthcare costs. The auto companies they were pushing for a national single payer until they made a deal with the healthcare industry for their support for NAFTA. Together they filled the airwaves with dishonest descriptions of the results of what they termed "socialized medicine". They did maybe too good job discrediting what has been proven to be a good system health insurance that provides good health for all for less cost and is now used throughout the industrialized word.
Australia and New Zealand has thrown out their for profit system and now tax everyone as they are able and have had better health results and lowered costs.

The public option should be offered now. It will eventually be used by all except those who can afford private insurance. If you are a senior you know how important it is to have Medicare as your primary provider rather than a private insurer.

The public option would prevent sudden change that would throw a lot of people out of work all at once.It was a good Republican idea before it was a bad idea. Campaign funds from the industry may have something to do with this..

"Campaign funds from the industry may have something to do with this.."

Understatement of the year.
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