ObamaCare: What the GOP could (but probably won’t) do now
[Posted by Karl]
Since ObamaCare’s passage on Sunday night, there has been much talk on the Right about repealing it and replacing it with better ideas. But everyone knows that is at best a medium-term project. John Hawkins floats the idea of starving the funding for ObamaCare’s infrastructure — a worthy idea, but one which again must wait until the Democrats are voted out of the majority in at least one house of Congress.
However, there are a few things the GOP could do even now to start unraveling the Democrats’ takeover of the US healthcare system. These suggestions are based on the fact that — now that it has been signed into law — even establishment media outlets like TIME and the Associated Press can implicitly admit that ObamaCare was a deal largely cobbled together by the very interest groups the Democrats demagogued to the public. The Democrats are now counting on these interest groups to help sell ObamaCare to the public. Republicans ought to teach these groups the risks of trusting your future to the government.
First, the Senate GOP ought to commit to filibustering the so-called “doc fix” that would repeal the current Medicare physician payment formula (which calls for a 20% cut in pay). House Speaker Pelosi and the White House reportedly plan to deliver this $252 billion payoff to the AMA in the next few months. The only compromise that the GOP should offer is support for a paid-for standalone bill that must bear the title, “The Democrats Shamelessly Lied About the Cost of Health Care Reform Act of 2010.” Presumably, the Democrats would reject this, which would leave them with having to pursue a temporary “doc fix” in a budget reconciliation act next year — at which point Democrats may not have the votes to pass it. (I would sympathize with doctors who disagree with the AMA, but if so few are willing to speak up when the president calls them greedy foot-rustlers and tonsil-grabbers, they should expect to become political targets.)
Second, the GOP should join in a bipartisan coalition with pols like Rep. Henry Waxman to stick it to Big Pharma. Waxman does not feel bound by the $80 billion deal the White House struck with PhRMA, so why should Republicans? Why should the GOP allow PhRMA to game the Medicare Part D benefit and avoid drug reimportation problems (as pointless as I might think the latter proposal)?
Third, both the House and Senate GOP will likely have opportunities to attack the individual mandate, and ought to exploit every one of them. The mandate is the straw that stirs the ObamaCare drink, and it is unpopular across the political spectrum. Indeed, the Left would likely join in efforts to weaken the mandate, not only because they see it as a windfall to Big Insurance, but also because they would like to choke off those profits in hopes of moving to a single-payer system. It is more likely that if Big Insurance is made to realize that a mandate-based system is not politically sustainable, these companies will stop backing government control.
Of course, with the possible exception of the mandate, the Beltway GOP probably won’t do these sorts of things. That’s the lesson to be drawn from the messaging idiocy of Sen. John Cornyn. He had a year-long course in what his supposed political opponents can and will do to achieve a key policy goal, and learned nothing from it. Pols like this will think more in terms of collecting donations from these groups later, after the Dems stab them in the back. By then, it may be far more difficult to roll back ObamaCare — but it should be clear now that the Cornyns of the world still have not adjusted to the Democrats’ new way of doing business.
–Karl
I agree with all of this, especially about Cornyn. He’s a nice guy with good values but, like Hutchison, has a bad case of Beltway-itis.
DRJ (daa62a) — 3/24/2010 @ 11:27 amGood, practical points.
Expecting to see this post Green-Room-promoted on Hot Air in 3, 2, …
Mitch (890cbf) — 3/24/2010 @ 11:40 amSo your idea is for the GOP to pick fights with everyone, starting with ‘cutting medicare.’
“the Beltway GOP probably won’t do these sorts of things.”
It’s too bad. Though I think the dems will be more than happy to portray the GOP as doing some of them.
imdw (842182) — 3/24/2010 @ 11:53 amWith Republicans like Cornyn, I often feel that the only difference between them and the abusers called Democrats is that the GOP promises to use lube when they rape us. Democrats…not so much.
iconoclast (ac26cc) — 3/24/2010 @ 11:54 amHold on there. Join with Henry Waxman??? Not no, but hell no. Anyone who gets down in Waxman’s pig pen will carry that stink to the grave.
I understand your point, but working with Waxman is out of the question. There are other ways to stick it to Big Pharma without making common cause with the dark side.
ropelight (859270) — 3/24/2010 @ 12:02 pmActually, one of the few things you can immediately do is strike another blow at the Democrats’ congressional majority.
Wexler’s seat is up for grabs on April 13th. Give this guy some money, call your friends and family in his district.
http://www.electlynch.com/
wt (796386) — 3/24/2010 @ 12:07 pm3, idm-liar, yeah, we know you lie your donkey off to smear the GOP.
PCD (1d8b6d) — 3/24/2010 @ 12:14 pmI like Cornyn. But he keeps trying to change my mind for some reason.
He’s not a firebrand. And he made a great judge because of that. And he’s not at all like John Mccain (they dislike eachother, too).
I think he’s trying to explain that we aren’t going to undo the couple of good ideas in this reform bill. The obvious stuff. But let’s not pretend this reform is a good thing. The aspects that go into effect quickly are obviously more palatable than the crap they are hiding away so they can get reelected.
Now’s not the time to point out, yet again, than of course the GOP has their alternative reform that shares x,y,z with the dem reform. Now’s the time to point out that the bipartisan opposition to this bill is what most Americans want. The cost, the change in the basic relationship between governed and state, the dishonest procedures.
When someone sells you a Chrysler that breaks down every month, you don’t go to the Honda dealer and ask for something with a clock as accurate as a Chrysler. Let’s underline the problems, because the press will take any 3 or 4 words our of context, and follow imdw’s plan to lie and spin.
Dustin (b54cdc) — 3/24/2010 @ 12:37 pmThere is a way to whip up public support for repeal of the bill.
The public supports any policy that is aimed against sex offenders, almost always without regarding the consequences, intended or not. That is because sex offenders are considered nithings. They support registration laws and residency restriction laws, even if it forces sex offenders to live under bridges.
Point out that the law provides benefits to sex offenders, and promise to repeal the law based upon that.
Michael Ejercito (526413) — 3/24/2010 @ 12:45 pmThe Democratic gains in 2006 and 2008 were brought about by a deep, and not misplaced, revulsion with the likes of Cornyn and many other “establishment” Republicans. I have come to the sorrowful conclusion that they are not better than the corrupt Democrats, just more inept.
What the hell have we gotten ourselves into?
GaryS (8351a3) — 3/24/2010 @ 12:51 pm“I think he’s trying to explain that we aren’t going to undo the couple of good ideas in this reform bill. The obvious stuff”
Ponnuru points out the problems with that. To cover pre-existing, you need to expand risk pools — thus a mandate. To have a mandate, you need affordability, thus subsidies. Those 3 all go together.
“Now’s the time to point out that the bipartisan opposition to this bill is what most Americans want.”
The time to point out that this basic structure — pre-existing coverage, mandate, subsidy — is bipartisan? Ask Scott Brown.
imdw (f6a9f8) — 3/24/2010 @ 12:56 pmThe filibuster on the doc fix bill will piss off a lot of doctors who are not AMA members. I think a better idea would be to amend it to require that the ban on balance billing be removed. This will be a long explanation but doctors are not allowed to charge any extra to Medicare patients. What this does is provide a strong pressure to increase Medicare spending, both because the price to beneficiaries is near zero and because Medicare, in theory, must increase fees with inflation.
If doctors were allowed to balance bill, with a requirement that all charges be posted in the office or on the internet or both, this would solve a lot of the problems that are driving doctors out of Medicare and would introduce a market mechanism to allow negotiation. Prices would start to represent a market and not Marx’ labor theory of value.
If Democrats refused to agree, filibuster the bill because the Democrats refused to agree to an immediate cost saving measure. Tell the Medicare beneficiaries that this will stop doctors from dropping out and make it easier to find a primary care doctor. It would be a good reform and would put the Democrats on the spot.
Mike K (2cf494) — 3/24/2010 @ 1:08 pmThough I think the dems will be more than happy to portray the GOP as doing some of them. What a perfect example of the dishonesty that is imdw.
The Democrats brazenly repeated the fraud that is the CBO score that was based in part on the absence of a “docfix”. Now if Democrats are made to live with their own lie, then we’ll see imdw happy to see the GOP labeled as cutting Medicare.
That’s the kind of Democrat troll we’ve seen so much of, lying and blaming others for the consequences of their lies.
SPQR (26be8b) — 3/24/2010 @ 1:14 pmRegarding #12: I wish I’d thought of that myself.
I think Mike K has the right general approach. Bore holes through the bottom of the health care vote by proposing incremental reforms as the price for Republican support of routine measures.
Here’s another such reform: Provide statutory protection for high-deductible catastrophic health care coverage, so that individuals who purchase such plans satisfy the coverage requirements from the bill.
W Krebs (e601a7) — 3/24/2010 @ 1:31 pmTwo things to keep in mind:
1) I’m a staunch opponent of the AMA and its politics
2)I’m a resident physician who is royally pissed at this absurd bill.
The AMA represents a clear minority of physicians. Depending on your source, and total number of practicing physicians, the AMA represents only 15-25% of physicians, with about 1/3 of total membership belonging to students such as my residency classmates and medical students – (who are quite liberal might I add). I agree that as physicians, we are partly to blame for any lack of policial clout because as a whole, we do not bond together well. There are many different professional physician organizations which all look out for their own specific interests. I suspect this will change in MY practice generation if things become bad enough. Think anti-AMA group philosophy. Sadly, physicians are too busy and just do not have the time to devote politically to speak out against alot of the current Washington propaganda and bills. I, for one, do donate my money to whom I feel will best represent my political ideals, as well as volunteering for campaigns when I get the time. The main issue still remains for a majority of practicing physicians – the time to get to your first substantial paycheck is about a decade of training – and we all have families to raise and feed, house mortages to pay, and all the other commmonplace living expenses. At the end of the day, it won’t be single physicians who will impose this change. It WILL have to be a large group who come together to bargain with politicians. My point is this – currently that group is only the AMA, to which a majority of physician do not belong out of political and philosophical differences. It will fall on my generation of physicians to change this – sadly I have not much hope for my current classmates as many are extremely liberal and even more so caught up in the “Obama hype”. Quite amazing when I think about it.
I digress.. my main point is arguing aginst the filibuster tactic proposed here. Anything that reduces the Medicare payments will ultimately affect you, the patient, after the doctor gets hit in the pocketbook. So it would benefit no one to try this tactic.
Filibustering the “doc fix” is useless. First of all, it wasn’t that the AMA acccepted some new bribe to repeal the coming 20% cuts to Medicare for their support for this monstrosity of a bill. The AMA and all physicians, annually, have to fight Congress to get them to “postpone” the upcoming “cuts” to Medicare reimbursement rates. This has been fought by Washington lobby members for quite some time. Each year, the physicians ala AMA “win” by postponing the decision to make Medicare cuts until the next fiscal year. This year was no different – Congress and the President just made more of an issue with the AMA and got them to vocalize their support for the bill first.
If this bill had never been proposed, the same annual fight to prevent Medicare cuts would have occurred and once again, the cuts most likely would have been delayed one more year. The main problem with Medicare is the S.G.R which needs to be entirely repealed.
These are my opinions, feel free to chime in and disagree.
Cornhusker Doc (40040c) — 3/24/2010 @ 1:36 pmimdw,
Note my proposed compromise on the “doc fix” insulates the GOP from the “cutting Medicare” charge. It merely requires that Dems admit they lied to everyone about the cost of their bill.
—
Mike K, Cornhusker Doc:
The parenthetical at the end of that paragraph was included because I was thinking of Mike K. Although the AMA is not representative of all doctors, the fact is that the silent majority of doctors were, well, silent. As such, they find themselves in a system which, if implemented, will ultimately place their salaries in the hands of the gov’t. Better to point it out now than wait. I might be for those alternate reforms, but they will not generate the attention in DC that forcing the Dems’ hand on the “doc fix” will.
Karl (f07e38) — 3/24/2010 @ 2:35 pm“Note my proposed compromise on the “doc fix” insulates the GOP from the “cutting Medicare” charge. It merely requires that Dems admit they lied to everyone about the cost of their bill.”
You think that’s how it would play out?
imdw (054c30) — 3/24/2010 @ 2:49 pmIf you can use Reconciliation to pervert and change any bill for any reason to include whatever you want —– then what is stopping the 50+1 Party from passing some innocuous bill then “Reconciling” whatever the hell they want to do later?
I would pass a bill call “Healthy Start for Seniors” fund it with $1 billion then reconcile away the Dept of Health, Dept of Energy, Dept of Education, Dept of Interior, Dept of Commerce and any law Conservatives don’t like — including reconciling away the EPA and Health Care legislation.
If all that matters is 50+1 ……. the dangers of a democracy.
HeavenSent (a9126d) — 3/24/2010 @ 3:00 pmKarl:
You say the silent majority of doctors were silent – but what are you proposing we would do? The AMA is the only single large group next to the ACP who is advocating for the bill. No other groups exist that can force the AMA’s hand.
My entire point is that most physicians are like you – not able to influence the process even if they want to. Most of the time my schedule along with a majority of other non-resident, currently practicing physicians does not allow them to just “take off” and go to Washington D.C. to fight legislation.
It is a cop out to say “a majority of you were silent” and thus it is fair to filibuster any “doc fix” that comes to legislative light. Physicians are no more to blame for any of this mess than you or a fireman. Anything that the GOP or its supporters do to hamper physician reimbursement via Medicare (re: “doc fix”) will only hurt you. The ENTIRE RISK of this bill is that more people will be thrust into a Medicare-type system since insurance prices will most likely skyrocket. Currently Medicare is broken. Making cuts to existing reimbursement rates will break it more, only upsetting those in the system (all the baby boomers and any additions from the newly passed bill) and making it impossible for care to be had. Physicians will ultimately drop all Medicare patients, which benefits no one. Insurance companies tend to follow suit on Medicare reimbursement rates – usually 110 to 120% of Medicare rates. If Medicare rates are cut next year, rest assured so will insurance rates. This means more and more primary care physicians are going to be screwed and leave entirely – making health care in the US unobtainable in a timely manner.
Filibustering the “doc fix” is something that the level of trying to stick it to the dems I agree with, however it will do nothing positive, and will only do damage. The “doc fix” will go through anyways – it should go through. The ultimately solution is to completely dissolve the Medicare system. Do you see that happening? I don’t.
Sadly, it will take a national payer system before a majority of physicians stand up united as one against the more liberal policies.
Cornhusker Doc (40040c) — 3/24/2010 @ 3:24 pm“You think that’s how it would play out?”
imdw – No, Karl’s probably just saying it for shits and giggles, the same reason you make most of your comments.
daleyrocks (718861) — 3/24/2010 @ 3:25 pmKarl: Cornyn’s more right than wrong, and you’re more wrong than right, on this one. Republicans have to offer something more than “Repeal it!” You should re-think, and even if that doesn’t change your conclusions, you should remember sometimes to engage the clutch between brain and keyboard to moderate your friendly fire, because you’re hurting your own credibility among would-be friends.
Beldar (0f85f3) — 3/24/2010 @ 3:37 pmTom Coburn is a wily old GP who has many ideas to make the Democrats squirm. One of his amendments would ban Viagra for sex offenders. If the Democrats support that, the bill has to go back to the Senate where they don’t have 60 votes anymore. If they don’t, they will see ads saying “Democrats support Viagra for sex offenders!”
I think he has many of those amendments planned. The fact that the bill leaves out the pre-existing condition fix for children, poor drafting plus no hearings, should prompt another embarrassing amendment. They will have to oppose it because they can’t get it through the Senate. Obama has been bragging about the provision that isn’t in it.
I hope the GOP has some smart media folks ready to go this fall.
Mike K (2cf494) — 3/24/2010 @ 3:39 pmWhat they could do (but won’t) is to dig through the thousands of pages of bovine excretement, find the good raisins (the Democrats are bragging about some of them), write them up as single page, single topic bills, and put them in the hopper. Then demand that the BE be repealed, keeping the raisins.
htom (412a17) — 3/24/2010 @ 3:40 pmRyan has the right idea with “repeal and replace,” which puts the current deal in stark contrast with the GOP’s.
Dmac (ca1d8c) — 3/24/2010 @ 3:41 pmI agree on the replace strategy, not repeal. A really smart legislator could amend a lot of these provisions next year to change the incentives.
Balance billing is one.
Another is to change the subsidies and the mandates in the “minimum insurance plans. If you change the required minimum plan to a high deductible tailored for the young to cover catastrophic injury or the rare cancers that affect the young, the cost would go down to a point that the subsidies would not be needed.
You could accelerate the Bernie Sanders’ funding of community clinics and, at the same time, shift them to care for the poor instead of subsidies. Many poor people need more direction than the middle class. They have life style problems and lack education. They would do better in an HMO that emphasizes preventive medicine. Preventive medicine does nothing for the average middle class person and costs more. For the poor, however, it can improve health and cut costs.
I still am angry at how the feds treated the big city hospitals in Medicaid. They were largely excluded. When I was a resident, it was by far the best care for the poor in Loa Angeles. A lot of those people, knew it, too. We would get 40 year old black women coming to GYN clinic. They would tell us their symptoms, which were often fibroids and heavy periods. They would ask us what they should do. Often, we would advise a hysterectomy (Now there is a better alternative). They would say “Well, I trust you boys at the County so that’s what I’ll do. Except that Dr Brown, down at Morningside Hospital, told me the same thing and I can have a semi-private room at Morningside so I’ll have it there. For all I know, Dr Brown was a competent surgeon. Still, they trusted us at County.
A few years later, the black politicians in LA got their own black hospital, Martin Luther King. A few years after that, it became known to the community as “Killer King.”
Had the big city hospitals been rehabilitated with that money, the poor would have had far better care but LBJ was going to make them all middle class with a stroke of his pen. Now, Obama is going to make us all poor with a stroke of his.
Mike K (2cf494) — 3/24/2010 @ 4:07 pmI think it is a great time to brainstorm on possible approaches. And I think the more “polite” among the conservatives need to realize the “gamesmanship” is not a game, and losing has consequences.
That said, I don’t think directly attacking each special interest constituency that got something in this bill is the answer.
The Dems win because they appeal to what “sounds fair” to the basic person who does not think analytically about the issue, including docs.
I think what needs to happen, as mentioned in Powerline, is to put the spotlight on the problems in the bill and in the process that produced it, such as:
…Republicans proposed a series of amendments and made motions that were designed to expose the corruption at the heart of the Democratic Party’s legislation. Thus, John McCain offered an amendment that would strike all “sweetheart deals” from the law:
The amendment repeals the following “sweetheart deals” included in the health care law and the reconciliation bill:
1. Increase in Medicaid disproportionate share hospital (DSH) payments just for Tennessee (Section 1203, page 71 of H.R. 4872);
2. Increase in Medicaid DSH payments just for Hawaii (Section 10201, page 2132 of H.R. 3590);
3. The “Louisiana Purchase” to increase Medicaid funding just for Louisiana (Section 2006, page 428 of H.R. 3590);
4. Increased Medicare reimbursement just for frontier states (Section 10324, page 2237 of H.R. 3590);
5. Medicare coverage just for Libby, Montana residents exposed to environmental hazards (Section 10323, page 2222 of H.R. 3590);
…Senator Judd Gregg offered an amendment that highlights Obama’s double-counting of alleged Medicare savings…
Senator Mike Crapo will offer my favorite motion–to commit the reconciliation bill to the Senate Finance Committee with instructions to ensure that the bill will not result in tax increases for anyone earning under $250,000 a year, as promised by Obama. The Democrats can’t agree to this, of course, since everyone knows Obamacare will increase taxes much more broadly.
The intellectual dishonesty needs to be made painfully obvious and clear as possible so that people who can put 2+2 together will get the figures put in front of them so they can “do the math” (even medical students!).
Rather than stick it to docs en masse, have docs en masse point out how ObamaCare doesn’t address the problems, or makes them worse.
We already saw this in our small town local paper yesterday. A front page article had an interview with the CEO of the local hospital/health system on what to expect with ObamaCare passed. Instead of the probably anticipated good news, he was quick to point out how it would make things worse by increasing their own costs and further threatening the overall economy causing more unemployment ans yet more stress on the medical system.
MD in Philly (59a3ad) — 3/24/2010 @ 4:08 pmI agree but I was talking about next year if the Republicans take Congress.
Mike K (2cf494) — 3/24/2010 @ 4:10 pmBrainstorming the possibilities (#25) is a great idea. But here’s a hint: Any proposal that begins with “the GOP should join in a bipartisan coalition with pols like Rep. Henry Waxman” is almost certainly a very, very bad idea.
Beldar (0f85f3) — 3/24/2010 @ 4:20 pmBeldar, I couldn’t agree more. I keep a list of the most intellectually dishonest public figures that I’m aware of. Waxman is on the list.
The enemy of my enemy may sometimes be a friend, but my enemy is still my enemy and I throw my lot in with him at my peril.
We can either approach this as a game to see who can maneuver to hold power, or we can approach it as if integrity matters.
Speaking of integrity, BTW, did the American Bar Association have anything to say about a judge convicted of bribery serving in the US Congress?
MD in Philly (59a3ad) — 3/24/2010 @ 4:26 pmI agree but I was talking about next year if the Republicans take Congress.
Here is a survey that is coming out tomorrow of 1,000 doctors. It is done by Sermo, the on-line organization that now has more members than the AMA.
* 64% cited the current healthcare climate as somewhat or very detrimental to their delivery of quality care
*
Only 22% are optimistic about the ability of the American physician to practice independently or in small groups
*
59% are of the mind that the quality of medicine in America will decline in next five years; only 18% believe the quality of medicine will improve
*
The majority (54%) strongly disagree/disagree that more active government involvement in healthcare regulation can improve outcomes; less than a quarter feel otherwise
*
A shift from fee-for-service to pay-for-performance gives hope to almost half (49%) who think it will have a very/somewhat positive impact quality of care but;
53 percent believe pay-for-performance will have a negative/very negative impact on the effort required to get paid
The last item is interesting as I think fee-for-service is better for patients. Most doctors are on a salary anyway.
Mike K (2cf494) — 3/24/2010 @ 4:27 pmThe GOP has been saying for the past year that an “incremental” approach to health care reform is best, instead of a comprehensive solution. Thus, the GOP has excused itself from offering solutions to the problems that have ailed the system, and instead has suggested tinkering around the edges. The GOP failed to put forward any comprehensive alternative to Obamacare.
Now that Obamacare is law, the incremental GOP strategy is gone. After all, why would the GOP want to make only incremental changes to the new law? But still there is no comprehensive GOP alternative, or any strategy for developing one.
The GOP does not need “bipartisan” health care summits and commissions and proposals, but rather needs “partisan” health care summits and commissions and proposals. That’s the only way to formulate a real alternative to the stuff that just got enacted.
Andrew (480035) — 3/24/2010 @ 5:02 pm“Now that Obamacare is law, the incremental GOP strategy is gone. After all, why would the GOP want to make only incremental changes to the new law? But still there is no comprehensive GOP alternative, or any strategy for developing one.”
There’s lots of room for incremental change now. It seems like a bit of the opposition to this bill was from people who wanted MORE reform. That’s some more change that can come. But GOP ideas, like Karl’s to cut medicare, can still be considered. In fact, they ought to be touted!
imdw (017d51) — 3/24/2010 @ 5:05 pmKarl,
1st – i dont think the Republicans can use the filibuster in reconciliation
2nd – Karl – quit blaming the republicans, they did everything they could to stop the bill – if the lawmakers did what yu asked the USA would cease to become a functioning country you cannot just stop the country everytime there is a dispute –
To wit:
This is what happens or can happen when one party gets 60 big ones in the Senate
Democrats have had the magic 60 votes 4 times, we got the following:
Federal Income Tax
Federal Withholding
Social Security
Medicare
Medicaid
AFDC
Welfare
Affirmative Action
Socialized Medicine
Republicans have had 60 votes in the Senate 0 times
We got
Elimination of AFDC with 55 votes
The Reduction of Welfare to 8 years lifetime
We failed to with 54 votes
To end Social Security and to make it a private investment fund not a tax
To end Medicare and replace it with a comprehensive prescription drug plan
EricPWJohnson (44912d) — 3/24/2010 @ 5:28 pm“Democrats have had the magic 60 votes 4 times, we got the following:”
The filibuster used to require 67 votes to overcome, not 60. But it also had to be an actual filibuster — the racists who worked against the civil rights act actually had to be there talking.
Interestingly, the civil rights act is one the accomplishments you left out.
imdw (842182) — 3/24/2010 @ 5:36 pmWhy repeal anything? Big Zero and the DemocRATS have promised Utopia and a $2500 per year reduction in my insurance premium. They’ve convinced me that I have a Constitutional right to healthcare and they’d better deliver, God damn it.
GeneralMalaise (20e943) — 3/24/2010 @ 5:36 pm“It seems like a bit of the opposition to this bill was from people who wanted MORE reform.”
imdw – There is always that small kook lefty fringe. Did any House members vote against it for that reason? Can you isolate the % of Democrats in the polling against ObamaCare because it does not go far enough?
daleyrocks (718861) — 3/24/2010 @ 5:40 pm67 votes are required to override a veto
EricPWJohnson (44912d) — 3/24/2010 @ 5:45 pmAndrew & imdw….Now there’s a pair of rocket-scientists to draw to.
AD - RtR/OS! (956a02) — 3/24/2010 @ 5:45 pmFirst the New Deal… then the Square Deal… and now the Big Fuckin’ Deal.
Get ’em all out of there before this country is changed beyond all recognition.
[note: released from moderation. –Stashiu]
GeneralMalaise (20e943) — 3/24/2010 @ 5:46 pmAD – RtR/OS!, what do you mean?
Andrew (480035) — 3/24/2010 @ 5:48 pm“Interestingly, the civil rights act is one the accomplishments you left out.”
Even more interesting – if only sadly so – is that you continue the grand leftist tradition of historical revisionism. Do your homework and learn which party passed the legislation with a higher percentage of positive votes.
GeneralMalaise (20e943) — 3/24/2010 @ 6:04 pm“67 votes are required to override a veto”
That’s true. But we’re talking about filibusters. And up until 1975, 2/3 (67) of the senate was required to override a filibuster. That was changed to 3/5’s (60).
imdw (e6c812) — 3/24/2010 @ 6:24 pmComment by imdw — 3/24/2010 @ 2:49 pm
You do realize that NO REPUBLICAN VOTED FOR A BILL THAT WOULD CUT MEDICARE BY $500
Billion, right? If you supported O-Care, you own its eventual problems, too.
I sense from you that you think the GOP is Forever Stupid when it comes to public positioning and media relations. There is no way you’re going to be able to make the GOP responsible for problems on something they don’t own AT ALL.
Brad S (6d19db) — 3/24/2010 @ 6:58 pmComment by Beldar — 3/24/2010 @ 3:37 pm
Beldar, you’re dead wrong. With no Republican voting for Obamacare, the Party, by definition, doesn’t own a stake in the debate over Obamacare and its problems. As far as “antangonizing” potential “friends” in the struggle, please understand that this isn’t about getting the best deal anymore. It’s about public perception on how Obamacare would work from henceforth, and only that.
Let the Dems explain away any problems with Obamacare. Let the Dems have to explain cuts in Medicare. Let the Dems try to stem outrage over the next increase in health plan fees. All we have to do is yell and point out the problems.
Brad S (6d19db) — 3/24/2010 @ 7:13 pmAD, that’s a different Andrew.
Stashiu3 (44da70) — 3/24/2010 @ 7:23 pmThe GOP has been saying for the past year that an “incremental” approach to health care reform is best, instead of a comprehensive solution. Thus, the GOP has excused itself from offering solutions to the problems that have ailed the system, and instead has suggested tinkering around the edges. The GOP failed to put forward any comprehensive alternative to Obamacare….But still there is no comprehensive GOP alternative, or any strategy for developing one.
Comment by Andrew —
I am assuming that you view a “comprehensive” is to be preferred, and the GOP failed to offer any “real” alternatives to ObamaCare. I will assume that is the position I am now going to address.
This will be lengthy because I do not know how to express the following in a more condensed way.
First, comprehensive solutions and comprehensive take-over are two different things. The bill that was passed is filled with all kinds of special favors, issues about federal funding of college education, and creating 59 new agencies (I think that was what I heard) along with increasing the role of the IRS from just taxes to insurance monitors. I would state the the bill passed is first much more than a bill “regarding health care”, second is quite inadequate as a “comprehensive” plan for healthcare, and third quite misguided as to how to do a “comprehensive” “solution”.
For a moment, let us assume it is the role of the federal government to make sweeping and long lasting plans for the basic economic and social structure of US society, and look how they have fared.
When Social Security was instituted, benefits essentially began at the average age of death. It provided a “safety net” for those who survived past the average age of mortality, which was also assumed to be past the average age of gainful employment.
That situation did not last very long. People started living longer and collected benefits longer; at the same time the program was taking in more money than it spent. The populace was happy receiving “free” money to use as they pleased as they grew older, and the government was happy to have extra funds to spend.
At a fundamental level, the structure of the Social Security system was constructed for one set of circumstances, and when circumstances changed no one would dhange the system because of their short term, self-centered, self-serving goals. What might have been a “stable” system of the able-bodied work force supporting those too old to work turned into a federal government Ponzi scheme- take money from one group to pay off another group, and as long as you can recruit faster than you have to pay out you’ll be fine.
But the problem was it became clear that the pyramid scheme was going to collapse. The time was going to come when the payout commitments would exceed the income. Changes were made in the 80’s to push the day into the future, but politicians used the fear of “taking away Social Security” for their own political power, and the average person was always eager to be told they could keep receiving and not to trust anyone who told them otherwise.
So now we are looking at the approaching collapse of the first “comprehensive over-haul” of American economic system.
On to the medical system example:
Prior to Medicaid often a doctor saw patients of all different classes whether they could pay or not, in the same office. My Dept Chairman took care of major corp. CEO’s and those who couldn’t pay anything, regardless of race, in the same office. Malpractice was low, the availability of medications was very limited. Imaging studies and blood tests were minimal. All simply because of the limited science and technology of the time. People with heart attacks were followed at home or in a regular hospital bed, no such thing as a CCU.
Into that setting the Feds started Medicaid. Medicaid was never intended to reimburse for the cost of care; it was intended to reimburse the doctor for his overhead costs only, so that he/she did not take a loss (other than the volunteered time). It was assumed that the socio-demographics of patients and their doctors would remain unchanged; the typical doctor was expected to see a low number of patients on medicaid at the loss of time only and do fine overall because of “paying” patients (cash or insurance that actually reimbursed the doc for their services).
Again, a system that was designed to work in one context was utterly inadequate to function in a changing context, and no one was smart enough, honest enough, or cared enough to see it and do something about it.
First, the cost of medical care became much more associated with the cost of successful technology than physician fees. One can spend an hour with a doc, billed for say $300.00 for the doc’s time, and $2,000 for labs, another $2,000 for xrays, and $300.00 for medications. Medicaid was originally set up to pay the $25.00 (or so) overhead for the rent, utilities, supplies, and staff (not even the overhead of malpractice today).
As you can see, there was good reason for medicaid costs to soar, far beyond what could rationally be expected to be saved through HMO’s and pharmacy formularies, or as “Doc Obama” says, using the red pill instead of the blue pill, or amputating legs and taking out tonsils unnecessarily.
In addition, one “little” detail often not mentioned, a large part of medicaid spending goes to long term care facilities because as a society and as individuals we typically have little foresight into the care of the aged. You want to cut down on Medicaid expenses?? Cut down on the number of people in nursing homes!! You figure out how you want to do that.
A main reason health care costs have soared is because health care has gotten better. Children no longer die of ALL (a type of leukemia) in less than 6 months at little cost. They live through their leukemia at a tremenous cost, then worry about an increased risk of secondary cancers that need to be treated in their 20’s. When medicaid started the treatment of a heart attack was bed rest for weeks. Now we treat people with heart disease long before the heart attack with angioplasties, etc. etc. Thirty years ago there was no HIV, now it can be controlled for a normal lifespan at over $1,000/month for medications alone.
The number one reason for increased health care costs is improved health care (some would say that is exactly what ObamaCare will take care of); especially in the context of increased illness that is somewhat “voluntary”, or at least a byproduct of choices that later need intervention.
That problem is not addressed in the “comprehensive” health care cure all of ObamaCare.
Are there problems that can be addressed? Yes, but they do not require a comprehensive overhaul of the system, which is a good thing because our track record for getting comprehensive overhauls right is not very good. Barriers to insurability and portability need to be thought about and addressed (more than a magical “you can’t do that anymore”), cost-shifting from one segment to another needs to be dealt with. People ought to know how much it really costs to have a blood test done, not what the cost is if you pay cash vs. insurance A vs. govt. program C. Society needs to know there are no free lunches or magic jackpots. The risk of inappropriate litigation and unreasonable awards is a cost that is paid by someone.
But rather than be honest about hard questions, we get crap about who is compassionate and who doesn’t care and by the promise of an easy way out.
MD in Philly (59a3ad) — 3/24/2010 @ 8:52 pmMD in Philly, thanks for the detailed comment. I did not mean that the GOP needed or needs to develop a plan to comprehensively overhaul the system. What I meant is that the GOP needed and needs to develop a plan to comprehensively address the problems that a majority of Americans are concerned about. As far as I know, the GOP has only suggested partial fixes to some of those problems.
As far as programs like Social Security are concerned, I agree it’s very messed up, and I’d like to see it converted into mandatory private savings accounts that are insured by the federal government, and that cannot be invested in risky ways. But that’s another subject from health care.
Do you think the GOP has developed a consensus about how to comprehensively address the problems facing health care in America?
Andrew (480035) — 3/24/2010 @ 9:07 pmAndrew,
I am confused about what you are asking. You say, “I did not mean that the GOP needed or needs to develop a plan to comprehensively overhaul the system.”, and then “Do you think the GOP has developed a consensus about how to comprehensively address the problems facing health care in America?”
I’ve tried to point out that the idea of “comprehensive reform” is itself a dubious goal, certainly one that we have no reason to believe can be successfully done by the US government on anything.
I’ve tried to point out that the public discussion hasn’t even been helpful on knowing and understanding what the main problems are, let alone address them.
In one way I don’t care if the GOP has any ideas at all, let alone whether I am concerned because they “only” have “partial fixes to some of those problems”.
We were presented with the prospect of a megalomaniac* wanting to push through his idea of how the world should work in the middle of the night, while promising things that were untrue with reasoning that was outrageous and offensive.
I’m feeling a bit like you’re giving me the Obama straw man of “It’s this or nothing”. And even if that was the real choice, I’d choose the nothing.
I know that there are proposals by Republicans/conservatives, but what they are has not been a focus of my attention. I don’t see it as a choice between ObamaCare and the Repubs, I see it as stop the disaster which is ObamaCare and then have a serious discussion.
Mike K. probably could do a much better job of what other proposals are out there and how they would help. I know he has raised some of these points before.
*Megalomaniac- Standing in front of Roman columns, claiming he has the power to determine the shoreline of the oceans and to begin to heal all of those who have been waiting.
MD in Philly (59a3ad) — 3/24/2010 @ 9:54 pmMD, there is a difference between comprehensively overhauling the health care system, and comprehensively addressing the problems in health care. Comprehensively addressing the problems may not require comprehensively overhauling the system.
If the GOP won’t propose a way to solve the problems, and instead only proposes half-measures to partially solve some of the problems, then the mushy middle in Congress and the electorate will be more likely to support Obamacare.
Andrew (480035) — 3/24/2010 @ 9:59 pmI don’t see how you can comprehensively fix health care. It’s like those domino exhibits where touching one thing alters other things, sometimes in foreseeable ways but often in unexpected ways. I suppose it’s human nature, especially these days, to want a perfect fix immediately … but it’s not possible. IMO we’re better off addressing issues separately so we can see what happens when we alter things like tort reform and pre-existing conditions.
DRJ (daa62a) — 3/24/2010 @ 10:15 pmThank you for claryfing things for me.
I usually start out evaluating something on the basis of the intellectual integrity of what I understand. When I realize I am being lied to concerning what I know, then I know not to trust the source on what I don’t know.
I agree with you that it is easier to turn down one choice if one has a better one. I do not know how close to comprehensive the GOP plan is (I’ve been avoiding all of the front page articles on them – 😉 )
I do know that Obama supports a plan that will decrease the quality of health care in the US and will cost more, not less. Both of these things contradict what he says about it. I don’t see why anyone who knows those two facts would want to support it, no matter what else may be in it.
The great majority of Americans are happy with their own health insurance. If they want a change, it is because they perceive something different will be better for everyone else. That is a lie in regards to ObamaCare. If people want to vote for something that will cause them to pay more, have less satisfaction, and help no one else, then there’s not much I’m going to be able to do about it.
MD in Philly (59a3ad) — 3/24/2010 @ 10:20 pmThere are not enough primary care physicians, and that has contributed to high prices. The government could get more active doing loan repayment for med students who go into primary care.
Another thing that contributes to high prices is that many insurance policies cover not just big-ticket items when people get sick or injured, but also routine care that people should be paying out-or-pocket. Instead, people with such insurance policies have a “buffet mentality” that leads them to over-use the routine care, thus driving up prices. So, tax the deluxe health insurance plans that offer too much routine care, and use the proceeds to repay med school loans of primary care physicians.
There are probably tons of other common-sense ideas like this. The GOP ought to gather them altogether and say, “Look, we’ve got a plan too.” Instead, all the GOP talks about is tort reform and buying insurance across state lines.
Andrew (480035) — 3/24/2010 @ 10:27 pmAndrew:
The GOP published its outline for specific health care changes in November 2009. Before that, in May 2009, Coburn, Ryan, and others published a comprehensive health care plan entitled The Patients’ Choice Act that they said would provide universal, affordable health care for all Americans.
DRJ (daa62a) — 3/24/2010 @ 10:36 pmDRJ:
Rep. Shadegg said: “By deciding we were not going to produce our own product, we were deciding we were going to fight on their ground. We gave that ground to them.”
Was Shadegg correct? The Congressional Budget Office found that, by 2019, according to the GOP alternative, the number of nonelderly people without health insurance would be reduced by only 3 million relative to current law. See here. In contrast, the Democratic legislation would get upwards of thirty million people insured. That’s a factor of ten.
Andrew (480035) — 3/24/2010 @ 10:55 pmShadegg’s quote is from December and the Democrats were talking about single-payer and universal health care then. The GOP did have proposals on the table by then, but there was little they could do in the face of the Democratic majorities. The fact that the GOP held them off for over a year and allowed only one major Obama initiative to succeed is not bad.
DRJ (daa62a) — 3/24/2010 @ 11:17 pmI think everyone agrees that a major problem with health care in the U.S. is that so many people could not afford it. I do not like the way Obamacare goes about trying to solve that problem. But I don’t think the GOP ever put a proposal on the table that would solve the problem. Do we agree with the CBO’s assessment of the GOP plan?
Andrew (480035) — 3/24/2010 @ 11:39 pmIncidentally, the Shadegg quote is from an article dated December 25, which is when the Senate approved the bill that the House approved last Sunday.
Andrew (480035) — 3/24/2010 @ 11:42 pmAndrew,
In #51 you get into some of the schizophrenia of the system.
For example:
There are not enough primary care physicians, and that has contributed to high prices.
Back in the 80’s “they” thought medical costs were going up because there were too many doctors, and the total # of doctors led to increased costs, so the feds kept med school admissions low.
I don’t think more primary care docs will decrease costs, at least not directly, but will improve access to care.
There are fewer primary care docs because of the low pay, relatively speaking, and the hassle of dealing with insurance companies and Medicare and medicaid.
many insurance policies cover not just big-ticket items when people get sick or injured, but also routine care that people should be paying out-or-pocket.
Once upon a time routine care wasn’t covered (like in the 1980’s and 90’s). Then HMO’s made their big entrance and they covered routine/preventive care because of marketing and on the argument that better routine care would keep total costs down. I don’t know which was thought to be the more important reason.
So right there you have two ideas which seem straight forward which may or may not work, and both are contrary to what “they” wanted to impliment in the last 20 years… this is why I don’t trust any attempt to through together a bunch of changes and think it will come out the way they want.
As far as fed repay of student loans to work under certain conditions, there are some good programs and some not-so-good, and it has changed over time. In principle it is a good idea. When docs get pushed around as pawns by the admins, not so good.
As far as your discounting tort reform, I am sure there is far more money spent in regards to fear of litigation than because doctors are doing unnecessary surgeries like Doc Obama suggests.
As far as what Shaddegg said, I have no idea. I do have an idea and disagree with the rest of the article that suggests the Dems wanted to work with the Repubs off of the bat last summer but the repubs refused to cooperate. The Dems would have passed a bill last August without even letting the repubs see the thing if they could have. (FWIW, I consider “Politico” to be a liberal-leaning institution that advertises itself as non-partisan. Not as bad as some others, and some at Politico worse than others. I prefer journalists who will up front admit there view but then try to be objective and let us judge how impartial they are in their reporting.)
Good night, way past my bedtime…
MD in Philly (59a3ad) — 3/24/2010 @ 11:47 pmSome of the best practices of Quality Management:
* Small, well designed changes (Plan);
* Test via pilot programs (Do);
* Measure it (Check);
* Expand if good/else fix it, and repeat (Act);
This is efficient and effective. The worst thing to do:
* Major overhaul with poor design changes;
* No testing (pilot or otherwise);
* Projections instead of measurements;
* All encompassing implementation, regardless of quality;
Unfortunately, this second path is what the President choose to do. Even if one totally believes in the Health Care reforms President Obama has promised, this is a textbook demonstration of management incompetence (for a non-believer, this is hardly surprising given the President’s lack of accomplishments, experience or practical knowledge). In short, this is a train wreck.
Pons Asinorum (be2d18) — 3/25/2010 @ 12:34 amSpeaking of Quality management…choose = chose.
Pons Asinorum (be2d18) — 3/25/2010 @ 12:37 amUgh…”m” =”M”
giving up — g’night.
Pons Asinorum (be2d18) — 3/25/2010 @ 12:40 am“I sense from you that you think the GOP is Forever Stupid when it comes to public positioning and media relations. ”
Not forever. I think lately they have faltered but overall they do a good job of messaging.
imdw (3bf1a8) — 3/25/2010 @ 4:51 am