Patterico's Pontifications

3/7/2017

TrumpCare Bill Lays Bare the Schism in the Republican Party

Filed under: General — Patterico @ 10:30 am



There is a schism in the Republican Party. On one side are conservatives, who believe in liberty, the free market, and the Constitution. On the other side is the Donald Trump wing, which has no guiding principles other than blind faith in Donald Trump. The schism has been evident for over a year, but papered over at times by a desire for unity. But the new proposed GOP TrumpCare bill lays bare this division.

Why do I call it TrumpCare? Because this is the bill that Donald Trump wants. Paul Ryan has said the House GOP has been working hand in glove with the Trump administration on this:

“We’re all working off the same piece of paper, the same plan,” Ryan said at a Thursday news conference when asked about conservative opposition. “We are in sync — the House, the Senate and the Trump administration, because this law is collapsing.”

Privately, senior Republican lawmakers and staff are more blunt. They say they have no problem steamrolling conservatives by daring them to vote against an Obamacare repeal that their constituents have demanded for years.

“Conservatives are going to be in a box,” said one senior Republican lawmaker. Trump, the source predicted, eventually will “go out front and … tell the conservatives … they’re either for this or for keeping Obamacare.”

That moment hasn’t arrived yet, though, and conservatives haven’t been shy about voicing their objections to Ryan’s plan — including to administration officials. Several House Freedom Caucus and Republican Study Committee members have joined Senate firebrands Rand Paul, Ted Cruz and Mike Lee in blasting a draft Ryan plan as “Obamacare-lite.”

If there were any doubt about this, Trump has put it to rest this morning, praising the plan as “Our wonderful new Healthcare Bill”:

Meanwhile, Rand Paul has furiously denounced it:

Sen. Paul is right. There are differences between the bill that has been unveiled and the draft Ryan plan, but two central features that make it ObamaCare lite remain.

First, it does not repeal ObamaCare. It amends it. That is a violation of Republicans’ promise to the voter. Republicans promised to repeal ObamaCare. Not tinker with it, mess with it, or delay parts of it. Repeal it.

Second, it retains ObamaCare’s subsidies, calling them “refundable tax credits.” You may have read elsewhere that the subsidies are gone — but really, they have merely been tinkered with. Refundable tax credits are subsidies, plain and simple. They are handouts from the government because you get cash even if the credit is larger than what you owe. In some areas, the subsidies are even more generous than Obama’s.

A few days ago, Ted Cruz laid out a free market vision for repealing ObamaCare. The key ideas included full repeal, combined with regulatory and tax changes that would undo the decades-old bias in favor of employer-based health care and allow greater competition. These key ideas are nowhere to be found in the new bill, which retains the basic regulatory structure of ObamaCare.

Many Republicans won’t know what to think, because they don’t really understand the free market or why it’s important. So they will look to a leader and follow that leader. For many of these, that leader will be Donald Trump. He likes the new bill, and that will be good enough for them. If Hillary Clinton had proposed simply amending ObamaCare, and renaming and tinkering with its subsidies, these same people would have flown off the hand. For them, the brand is all that matters.

Other Republicans will reject this attempt to solidify Democrat interference in the free market under the Republican banner.

It’s a schism, and it isn’t going away. And this bill is bringing the divide into full relief.

[Cross-posted at RedState and The Jury Talks Back.]

127 Responses to “TrumpCare Bill Lays Bare the Schism in the Republican Party”

  1. this is a schism of love

    Mr. Trump’s taking our healthcares back from the authoritarian clutches of the state

    this is the beginning of a beautiful journey to freedom and innovation

    and it’s all cause of Mr. Trump! (not sleazy Romney-lover Paul Ryan)

    the clouds, yes they are beginning to lift my friends

    feel the sunshine on your face

    it’s a new day!

    happyfeet (28a91b)

  2. LMAO — this “schism” existed long before Trump arrived on the scene. There are GOP governors, led by John Kasich, and GOP members in Congress from many different states, who have always been judicious in their “support” of the “free market” conservatives’ demand for repeal of Obamacare.

    In most instances their concerns are driven by the decisions they made for the poorer residents of their own states when Obamacare was passed. They opted to expand their Medicaid roles and took additional federal money to cover the expansion.

    Now they are faced with the loss of that additional federal money which they get through Obamacare’s revenue generating provisions — such as the individual mandate — while at the same time still having expanded the coverage for Medicaid recipients in their states.

    That “schism” was created in 2011 and 2012 when those governors had to choose what path to take in order to comply with Obamacare’s requirement that all Americans, including those too poor to buy health insurance, have health insurance coverage.

    Trump had nothing to do with it.

    shipwreckedcrew (56b591)

  3. That should be “rolls” — not “roles”.

    shipwreckedcrew (56b591)

  4. because they don’t really understand the free market or why it’s important

    *******************

    This is going to be a huge problem in more areas. You have some Trumpians arguing because other countries charge tariffs that this proves that the “free market” doesn’t work. No–all it proves is that the free market isn’t being allowed to work in those cases–it’s being circumnavigated.

    It’s akin to saying the laws of gravity don’t work when I go parabolic in a C-130 or when I dance on the moon. No–those two exceptions don’t disprove the law of gravity.

    Anyways–I think their “model” is Theodore Roosevelt with more class warfare and resentment–because we need that in America right now–on top of all of the racial division and sex wedge issues.

    Rae Sremmurd (2fd998)

  5. I wrote the following before any comments were posted. If it sounds a lot like SWC, I can’t help it:

    For as long as I can remember, there has been a divide in the Republican Party between small-government conservatives and big-government “moderates.” Donald Trump’s arrival on the scene has done nothing to change this schism, which will endure long past the Trump presidency. This bill may have the imprimatur of President Trump, but it is, at its core, a rather typical product of the GOPe side of the divide. I think we all know that.

    The question with Trump has always been: “Will he side with the moderates or with the conservative?” It was a very good question. Trump’s own history clearly suggested he’d govern as a moderate. The biggest surprise of the Trump presidency, at least to me, is how conservative he has been in his appointments and policies. I’ve been very pleased to be able to consistently score Trump’s day-to-day work product on the conservative side of the ledger. He most definitely is not the milquetoast moderate I had feared.

    Unfortunately, this new healthcare bill will be scored on the other side of my ledger, or so it appears at this point. That doesn’t make me or other conservatives like me particularly happy. However, I still see Trump’s as a track record most conservatives will be happy with, on balance, especially after such a long unbroken string of conservative accomplishments.

    One should never become too invested in the behavior of a pol. It is a truism that pols will always, eventually disappoint. In the past, I have commented here about the many disappointments of the Reagan presidency. One can even see this in the unhappiness that Cruz backers like me felt when Cruz decided to forgive Trump for his truly outrageous behavior.

    It is important not to allow a disappointment like this to disproportionately color our view of Trump. Keep a score card. It helps.

    ThOR (c9324e)

  6. Gosh, this shouldn’t be too hard. Use the reconciliation process to repeal, and defund as much of Obamacare as is possible. No worry about Senate filibuster. Return to state of affairs in 2009.

    After that worry about replacing Obamacare. A few highlights:

    Eviscerate the notion that insurance companies should be welfare providers. If you want to subsidize sick people, then that is a responsibility for the taxpayers as a whole to assume instead of assigning it to a private corporation in the business of healthcare.

    Understand that 85% of being healthy is related to the food you eat and the vigorous use of your body on a regular basis. This is the PERFECT conservative message — your health is an individual responsibility. You are not a victim. You control your own destiny. Let’s brutally attack the core message of socialist healthcare proposals. The government doesn’t make you healthy.

    Eliminate income-tax exclusion for employer-provided healthcare plans. Move toward portable individual plans.

    Eliminate barriers to sale of insurance policies across state lines.

    Eliminate restrictions on ability of health insurers ability to exclude coverage for pre-existing conditions, pregnancy, mental health, and other items. Voluntary exchange is a beautiful thing.

    If you do insist on some kind of government involvement, then it should be the following:

    Voluntary participation on an annual basis. You have several biomarkers measured (e.g. body fat percentage, cholesterol levels, blood pressure, presence of nicotine, VO2 Max, etc.) that are highly correlated with your likelihood of contracting cancer, heart disease, stroke, Type 2 diabetes, etc.

    Take measurements each year. Draw up a matrix to rank how healthy you are based on these measurements. So if you are a male, 55 years old, 14% body fat, 110 over 60 blood pressure, with a 180 cholesterol count, then you’d be ranked quite high. If you’re 40 year old female, 45% body fat, 160 over 120 blood pressure with 270 cholesterol count, then you’d be real low.

    Offer cash rewards to participants in the program based on their ranking. The 55-year old male gets $1,500 and the 40-year old female gets $0. You’d completely change the conversation and thinking about healthcare in the USA to get real results.

    Americans are pretty fat and unhealthy compared to most nations around the world.

    El Gipper (f1f816)

  7. To a man like Trump, everything is a negotiation. The question I have is “What did the GOPe give up to get Trump’s help with this bill?”

    ThOR (c9324e)

  8. The much better explanation for the cause of the “schism” should be near and dear to the heart of all free market conservatives — the creation of a national program of health insurance that is a third-party payor system where the consumers of the services being paid by insurers are divorced from and oblivious to the actual cost of the services.

    When you combine the modern reality of the fact that 1) someone else pays health care costs on behalf of the patient, and 2) for 50+ years the patients have been told they have a “right” to health care, you create a market where consumers don’t care about price.

    The only path to a true “market based” health insurance system is to cut the relationship between employment and insurance, and allow huge pools to be created nationwide by eliminating state barriers to providing insurance.

    The execution will be more complicated than that, but until you give consumers a connection to the actual costs (i.e., they write checks for premiums themselves from their income), and allow the insurance companies to actually compete with each other on the basis of cost, coverage, and service, you won’t have a true market based system.

    shipwreckedcrew (56b591)

  9. “What did the GOPe give up to get Trump’s help with this bill?”

    *************

    Trump is the Establishment. How more Establishment can you get than–President of the United States?

    Unless you plan to copy Obama’s template of continuing to run against–“the man”. That might have worked well for Obama because he had the media blocking for him, but it didn’t work out that well for the country and that same tactic will not get Trump re-elected.

    The buck stops on his desk, baby. Republicans still have a fundamental philosophical belief in “responsibility” and trump will be held accountable. Obama Baby Man tactics will n ot work out well for him.

    Rae Sremmurd (2fd998)

  10. yes yes you have to keep a scorecard

    and Mr. Trump, he’s gonna score really high

    cause of he’s doing so good at a lot of different stuff

    and Mr. Surber says this bill has a lot for a fiscal conservative to savor

    so i suggest you start savoring the yummy goodness

    happyfeet (28a91b)

  11. A few days ago, Ted Cruz laid out a free market vision for repealing ObamaCare.

    maybe it woulda helped if he made a big deal out of this during his campaign instead of shrieking about bathroom trannies all the time like a big girl

    just a little constructive criticism there

    happyfeet (28a91b)

  12. this is a schism of love

    Mr. Trump’s taking our healthcares back from the authoritarian clutches of the state

    this is the beginning of a beautiful journey to freedom and innovation

    and it’s all cause of Mr. Trump! (not sleazy Romney-lover Paul Ryan)

    the clouds, yes they are beginning to lift my friends

    feel the sunshine on your face

    it’s a new day!

    happyfeet (28a91b) — 3/7/2017 @ 11:15 am

    I’ve seen people deny the facts before, but this takes it to a whole new level!

    Patrick Henry, the 2nd (e04f50)

  13. I guess I’m not a “principled conservative” since I pretty much like this bill. It’s not because I like Trump, but it’s a far better bill thatn I had hoped for.

    * It eliminates the mandate.

    * It eliminates the tax penalty tax, or whatever Roberts calls it.

    * Instead, it imposes a sign-up penalty on people who have a break in coverage. I would want this penalty to be indexed to the length of the break. Perhaps 1% for each month up to some maximum (now 30%). People often have some difficulty from time to time maintaining payments, such as when they are unemployed.

    * It provides a tax credit to even the playing field for those who don’t have an UNTAXED(!) employer benefit. It FROSTS ME that someone (e.g. Ron Paul) who has an UNTAXED government-paid medical plan better than nearly any private employee would call a tax credit for others unconscionable. That’s just insulting. Federal workers get, for example, $10,000 worth of dental work per year, including implants. Few others do.

    * The idea that these tax subsidies are “handouts” is ludicrous. You could just as fairly call mortgage interest deductions “handouts”. In no case do they refund amounts paid in medical insurance or mortgage interest, so they only defray personal expenses. There is no profit in it. And again, many of the people calling these tax credits “handouts” get free or nearly free medical insurance and pay not a dime of tax on this valuable employer subsidy. Why are these not “handouts” as well?

    Kevin M (25bbee)

  14. If all Republicans were as principled as you, Patterico, President Ted Cruz would have no problem enacting the perfect repeal on day 1 of his administration.

    But if 2% of the Republicans who voted for Trump were as principled as you, Hillary would have won the election.

    The situation is highly imperfect. We can’t afford to wait for the perfect replacement. We can’t expect the goofballs in Washington D.C. to deliver that to us on a silver platter.

    Repealing large parts of Obamacare, by way of reconciliation, without taking away the “popular” parts of Obamacare, is a good first step:

    1 – It’s good political theater–and that is important. It forces Democrats to either vote for the most unpopular parts of Obamacare, or to vote for a bill that the liberal media will hysterically claim is the “repeal” of Obamacare. Either way, they’re screwed. It’s not enough to win once, we have to have momentum. We have to keep winning. If we slip up and let the Dems take back the White House, it’s all over. Trump was right when he said his election was our “last chance” to save America.

    2 – It sets us up to move from “we’re waiting to build one big, perfect bill that does everything we want and gets 50 votes in the Senate + we change the filibuster rules” which results in roughly 52 Senators each grandstanding and threatening to walk away from the bill if it’s not exactly what they want because they know they only get 1 chance to get what they want, to “hey, any Congressperson can submit a bill with a proposed fix, we can have a big, messy, crowded discussion about which fixes to adopt.” That’s where I want to be: Obamacare gutted, Trump wearing its skull like a hat, with everyone talking about “where do we go from here now that Obamacare is finished and Trump is wearing its skull like a hat”

    And if he wants to celebrate his victory at Mar-A-Lago with a well-done steak, a bottle of ketchup, surrounded by people who paid $200,000 to be there, I will have mixed feelings about him, but more positive feelings than negative.

    Do I think after passing this bill that Republicans will deliver free-market reforms? I really don’t know. That depends whether they are more worried about optics (demonstrators calling them mean), their own voters turning out for them, or the economy (a downtick in the economy means people throw the bastards out, and having bad healthcare laws hurts the economy). If they understand that their continued presence in D.C. depends on them not only killing Obamacare, but also passing free-market reforms, things will work out. Steve Bannon probably understands that health care reform affects the economy, and that Republicans own the economy.

    Given the suspicious timing of leaks regarding Trump/Russia, what do you want to bet that Democrats will strategically sabotage the economy leading up to the 2018 midterm elections?

    Daryl Herbert (7be116)

  15. BTW, the idea that government should not distort the medical insurance market died no later than 1966.

    Kevin M (25bbee)

  16. If I had my way, NO ONE who was not stuck in the private insurance market would have a say in this.

    It is REALLY easy to be a high-minded principled stalwart when you are insulated from any effect the decision might have.

    Kevin M (25bbee)

  17. As mentioned above, this schism predated Trump, although I never thought Trump would do anything constructive on the Obamacare issue and am not surprised he has allied with the Democrat-Lite wing of the GOP on this bill.

    I can’t say I’m surprised at this horse manure bill but I am nonetheless angry.

    SPQR (a3a747)

  18. I don’t think it’s time to panic yet.

    ““Our wonderful new Healthcare Bill is now out for review and negotiation,” tweeted the president.
    Read more at http://www.businessinsider.my/trump-tweets-american-health-care-act-obamacare-replacement-2017-3/#M4FvzLsLogG8FSwu.99

    [Bold mine]

    Also; “The president promised future changes to healthcare, including allowing insurers to sell plans across state lines, in what he called “phase 2 & 3″ of his healthcare overhaul.

    “Don’t worry, getting rid of state lines, which will promote competition, will be in phase 2 & 3 of healthcare rollout. @foxandfriends,” tweeted Trump.”

    Obamacare is a monstrous beast with tentacles reaching all through government. “Repeal and replace” is fine rhetoric, but realistically there needs to be a phasing out and phasing in process for a smooth transition that won’t leave a huge part of the population dangling, I would think.

    I advise patience and time to see what the final product is before you all start the circular firing squad.

    Leon (3ad005)

  19. Also, I appreciate that everything with Trump is a negotiation, so if “true conservative super-principled super-patriots” want to demand that the Obamacare repeal bill gets more conservative and more free-markety, I’m in favor of making noise.

    The thing is, when it actually comes time to vote, people need to treat the Obamacare repeal bill as a binary choice. The fact is, if the vote fails, I don’t know that we’ll get a second chance. I don’t know that a do-over bill, that is watered down or changed to get more Senators onboard, will be more likely to pass, or more conservative, than something passed on the first attempt. If anything, Trump is likely to look for broader support, not narrower, if the bill is shot down by hardline conservatives.

    Daryl Herbert (7be116)

  20. Given that plans will be sold across state lines and that the federal- and state-mandated features will be removed, the degree of government control of the insurance market will actually be LESS than existed in 2009.

    All that will be added will be a tax credit and all that will be kept from Obamacare is a prohibition on excluding people from the marketplace, and treating 26-year-olds as children. There are good arguments for both.

    Also, I expect to see tort reform.

    BUT HELL! let’s focus on that one thing that seems iffy — tax credits for buying private insurance! In a country where most health insurance is provided tax-free.

    Kevin M (25bbee)

  21. In this case the devil’s not in the details it’s in the process. The bill as proposed stinks is doesn’t improve on Obamacare in any significant way (just like Boehner said it wouldn’t).

    Looks like the GOP establishment wants a health insurance market about as free and competitive as the cable TV and landline phone markets. Regular order and their willingness to let conservatives win ammendment votes is our only hope, but that’s more than we had before. It’s a first step, I guess.

    crazy (d3b449)

  22. @19- Unfortunately Daryl, that is what conservatives do. Sacrifice the good to the perfect. They virtue signal their vaunted principles and end up worse off than before, every time.

    Traditional Americans are tired of following so called conservative to noble defeat. Trump is taking the first step of the journey in the right direction, and conservatives are predictably crying because 50 years of government meddling in healthcare hasn’t been undone on a month.

    Leon (3ad005)

  23. This is a baby ruth in the pool.

    mg (31009b)

  24. If you don’t have the money to buy insurance to begin with, “the market” is pretty irrelevant. The question is whether it’s a good idea for poorer people to have insurance. Is it a good enough idea to subsidize it, because that is the only way they’ll get it. Are there alternatives?

    If we take the position that everyone does have a “right” to health care and that this implies a right to health insurance, there will have to be some subsidies for those who can’t afford it.

    Darren M. (a4eb00)

  25. Really, Leon, sacrifice the “good” for the perfect. There is no “good” in this horse manure bill. It utterly fails to change the course of the Titanic. You attack conservatives because we are unimpressed that you want applause for your plan to steer for the shinier side of the iceberg.

    SPQR (a3a747)

  26. This isn’t really Trump-care, it’s Ryan care, and it doesn’t attempt reform (which would be, admittedly, a leap into the unknown.

    http://www.washingtonexaminer.com/republican-obamacare-plan-signals-that-liberalism-has-already-won/article/2616636

    left. The argument isn’t over whether the government should require all insurers to cover people with pre-existing conditions. The argument is about whether the government should pay for it by forcing healthy people to purchase insurance under the threat of a penalty, as Obamacare does, or by threatening anybody who doesn’t maintain continuous coverage with a 30 percent late fee, as the GOP prefers.

    The thing about the a late fee is that, unlike Obamacare, it would actually punish people who in many cases could not afford to carry insurance.

    Neither approach is good. Pre-existing conditions should be paid for with a consumption tax, and then universal coverage is not necessary.

    Sammy Finkelman (6f9f42)

  27. It isn’t “my” plan, and I am not looking for applause. Just recognition of reality and the possible.

    Leon (3ad005)

  28. Pre-existing conditions should be paid for with a consumption tax

    Ding Ding and more Ding, but the public is not going to be receptive to that with all the increases in cigarette taxes and new soda and plastic bag taxes levied in the 25 or so years intervening between HillaryCare drafts and today. God help him if he tries to bribe the passage of the border adjustment or plain old border taxes by throwing a bone into health care.

    urbanleftbehind (5eecdb)

  29. Insurance is not healthcare. The more everyone spends on insurance, the more the insurance companies make – not necessarily the more healthcare provided.

    Obamacare is failing, and will ultimately fail.

    I don’t think this solves the underlying disconnect – it just kicks the can farther down the road.

    Steven Malynn (d29fc3)

  30. If we take the position that everyone does have a “right” to health care

    I don’t, so you can stop right there.

    Patterico (52aafa)

  31. plus by-the-ounce beverage taxes

    jesus christ

    happyfeet (28a91b)

  32. what a bunch of numbnuts 7+ years and this is what the tax-payers paid for? off with the heads of these hacks.

    mg (31009b)

  33. It FROSTS ME that someone (e.g. Ron Paul) who has an UNTAXED government-paid medical plan better than nearly any private employee would call a tax credit for others unconscionable. That’s just insulting.

    Calm down. I am calling for the same treatment of employer-based and non-employer-based health insurance. Do you see someone here who fits your description? i don’t.

    Patterico (52aafa)

  34. The primary objective of the American healthcare system is to make money, not provide cost-effective healthcare.

    Once that mind set shifts, the U.S. will adopt a single-payer or two-tiered system similar to Canada, France, the UK, Australia, Japan, Israel etc., and join the 21st century before it ends. It’s inevitable.

    DCSCA (797bc0)

  35. If Donald Trump called for 100% taxation of all income happyfeet would praise it.

    If Donald Trump nuked Greenland happyfeet would praise it.

    I have never seen such a toady in my life. He can’t be for real.

    Patterico (52aafa)

  36. @29. Insurance is not healthcare.

    Precisely. And that’s what these fools are arguing about. Which makes it a genuine a ‘nothingburger.’

    DCSCA (797bc0)

  37. As mentioned above, this schism predated Trump

    There may have been a schism that predated Trump but I maintain I have accurately described the current schism.

    Patterico (52aafa)

  38. The starting point with me is these pathetic politicians should have the sam screwed up healthcare as me period.

    mg (31009b)

  39. same.

    mg (31009b)

  40. Single payer is a better option than this starting point and there’s no way we should want that.

    crazy (d3b449)

  41. Pre-existing conditions should be paid for with a consumption tax

    Pre-existing conditions should be paid for through portable insurance with guaranteed renewal, and charity care for those who willfully did not bother to get insurance or cannot afford it.

    Patterico (52aafa)

  42. The reality is you need a bill that will pass through the Senate as well as the house, a pure repeal might garner Cruz Paul cotton perhaps perdue and sullivan and a few others, but not a majority even a plurality.

    narciso (ed39d4)

  43. They should start all over again from the premise that a tablet of Tylenol on your doctor/hospital bill should be 25 cents and not 18 dollars. Until they introduce competition and reality to medical costs, things will only get worse.

    There’s a reason veterinary and cosmetic medicine have prices which are much more competitive , they aren’t mandated.

    And remember, to the Dems, Obamacare is not a failure despite skyrocketing prices, reduced care quality, government intrusion and expanded bureaucracy as long it’s main aim, to get more people dependent on government (i.e. tax dollars) and/or believing health care is a right, is achieved.

    Harkin (b9f2f5)

  44. They should start all over again from the premise that a tablet of Tylenol on your doctor/hospital bill should be 25 cents and not 18 dollars. Until they introduce competition and reality to medical costs, things will only get worse.

    Ha! Things must be getting better after all! A decade ago when I took my ailing mother in to her doctor the cost on the bill for that same OTC Tylanol administered to her was $22!

    DCSCA (797bc0)

  45. * It eliminates the mandate.
    * It eliminates the tax penalty tax, or whatever Roberts calls it.

    ***********

    That should take a lot of the teeth out of ObamaCare.

    What did they do with the small business requirements?

    Particularly this:

    The health care law does not require employers to provide health insurance for their employees. However, employers with 50 to 99 or more full-time employees that do not offer insurance or offer insurance that is unaffordable will be subject to fees beginning January 1, 2016.  Beginning January 1, 2015, those with 100 or more full time equivalent employees will now face fees if they do not offer coverage to at least 70 percent of their full time workforce. 

    There are more but I consider the above to be pretty significant.

    Without the platforms stated above–ObamaCare essentially–collapses.

    http://www.healthlawguideforbusiness.org/new-requirements

    Rae Sremmurd (2fd998)

  46. happy has re-written the book on trolling. He never ceases to amaze.

    I’m feelin’ the sunshine, hap!

    though it may just be your sunshine happy and not The Donald’s.

    ThOR (c9324e)

  47. The biggest problem Trump will have is–his say anything politics. Machiavellian co-opting of the opposition’s points.

    The problem Machaivellians would always have in a democratic form of government of is one of legitimacy as in garnering “consent of the governed”.

    Obama lied his pants off and took up four different positions on one subject during his first campaign–and the Cult of Personality road looks like it was followed by Trump.

    However Trump –again does not have the same friends in the media and he made enemies out of almost everyone.

    And now it looks like his friends at WikiLeaks have bit him in the ass. A national security nightmare.

    The Donald at Reddit last night was hoping for WikiLeaks to reveal that 9/11 was an inside job–and currently–it is “chock full of nutz”.

    Good going there Team Trumpkin–that cess pool is a damn embarrassment.

    Rae Sremmurd (2fd998)

  48. A tablet of Tylenol costs $18/22 instead of a quarter BECAUSE someone has to pay for that “right” of free healthcare for those who refuse to get it. This new bill is a disaster and the opposite of what every so-called republican ran on in elections since Obamacare was introduced.

    Moviemommy (132e5a)

  49. This new bill is a disaster and the opposite of what every so-called republican ran on in elections since Obamacare was introduced.

    no it’s not you’re just incorrect

    happyfeet (28a91b)

  50. An example –when in the Sam Hell did we debate– during the primaries–spending a trillion on infrastructure?

    Was it during Megyn Kelly’s six questions on abortion–or when Trump was calling everyone his bet names and acting like a two year old?

    Yes–we have the Dems white Democrats in the party now that are reflexively stampeded by hate, but just smart enough to realize the Dem party wasn’t really doing all that much for them–except raiding their pocketbook.

    Rae Sremmurd (2fd998)

  51. I was lying on the grass on sunday morning of last week

    happyfeet (28a91b)

  52. I’ve run out of patience, Patterico. I’ve been a loyal reader of yours for several years, and I agree with you on most policy issues, including this one. Why couldn’t you have made this post about the policy instead of about Trump? I’m just so tired of the obsessive/compulsive bashing of Trump that I just have no more desire to read this site.

    I’m out of here.

    Good look slaying those windmills.

    Doc Rampage (338fac)

  53. @49. No, it’s because of the insurance racket. Malpractice rates for doctors and the rates for plans conservatives want to preserve. Neither do anything to deliver cost-effective healthcare.

    DCSCA (797bc0)

  54. I have never seen such a toady in my life. He can’t be for real.

    it’s all about doing the analysis Mr. P

    a close reading of Mr. Trump’s comments reveals two takeaways to the discerning:

    number one this healthcare plan is “wonderful”

    number two it’s “new”

    now it was just yesterday when all we had to look forward to was nasty obamacare, which is NOT wonderful

    and it’s old and stanky

    advantage: Mr. Trump

    happyfeet (28a91b)

  55. This isn’t ‘Trumpcare.’

    It’s ConservaCare, courtesy of Paul Ryan, from a party more concerned about the a political pledge to placate the insurance lobby than fostering cost-effective healthcare.

    DCSCA (797bc0)

  56. 44-Ha! “Things must be getting better after all! A decade ago when I took my ailing mother in to her doctor the cost on the bill for that same OTC Tylanol administered to her was $22!”

    Not exactly, I was referencing an $18 Tylenol I saw on my hospital bill in 1993.

    They also charged me $125 for a pillow that went under my broken leg.

    harkin (36810b)

  57. By the bye…did you hear DJT offering a deal to Planned Parenthood so it might retain its government finding?

    If any of you think DJT, with the GOPe Congress is not going to ram amnesty down our throats, I would invite such a person to seek intensive mental therapies.

    The only core value DJT has is his self. Everything else is negotiable.

    Ed from SFV (3400a5)

  58. settle down

    just stay calm

    this is all within the normal parameters

    happyfeet (28a91b)

  59. Schism has nothing to do with Trump and everything to do with the establishment, Rockefeller wing of the party. Dumbarse Maine Senator said the “moderates” in the party needed to be given something if they were going to support the bill.

    This bill is garbage. Back to the drawing board.

    NJRob (b2251a)

  60. lobsterpot bimbo has low self-esteem, trades congressional votes for approval and validation

    happyfeet (28a91b)

  61. uh oh Ann Coulter says the bill is crap

    that’s dispositive i fear

    apparently a bunch a low-rent lifeydoodle trash have hijacked the repeal bill for to glorify and magnify trailer park jesus (pbuh)

    this is why we can’t have nice things

    happyfeet (28a91b)

  62. The Bannon-Miller faction might have had second thoughts on PP (presumablybthey could still prescribe birth control under the compromise measure).

    urbanleftbehind (f8e6fa)

  63. Read my lips…

    crazy (d3b449)

  64. @57. Ahhh. So the cost did jump after all. And a $125 pillow. Jaysus. Just unreal. We all have ‘war stories’ but the common thread is the absurd line item costs on the final bill which the insurance firms trade on. That’s the nuts and bolts of the racket these pols are fronting for.

    DCSCA (797bc0)

  65. Happy, that’s what is called a poison pill.

    urbanleftbehind (f8e6fa)

  66. and her vote brought obamacare out of conference
    she could have stopped this whole mess. L7

    mg (31009b)

  67. ugh

    Rs are so

    they’re so how they are

    it’s all about their special little interest groups they don’t care about real people

    happyfeet (28a91b)

  68. Ryan’s press conference today was interesting, and much of the unhappiness in this post is addressed.

    The current bill recognizes the limits of what can be accomplished with 51 votes in the Senate through reconciliation. The current bill does not attempt to make changes that will require 60 votes.

    Remember that the reconciliation process can only be used on matters that have an effect on revenue. The big feature of Obamacare that did not have an effect on revenue was the mandate.

    Ryan said that separate legislation is being worked on by HHS Sec. Price to begin the process of deregulating the health insurance market.

    The third phase will be to improve the post-Obamacare health insurance landscape by tackling issues that require 60 votes in the Senate.

    It simply couldn’t be done all in one package, because the parts requiring 60 votes would have held hostage the parts that could be accomplished with only 51 votes under reconciliation.

    shipwreckedcrew (56b591)

  69. Dumbarse Maine Senator said the “moderates” in the party needed to be given something if they were going to support the bill.

    In other words, “Some of us in the GOP win reelection because we manage to deliver ‘free’ government goodies to our constituents while pretending that we’re fiscally responsible.”

    JVW (6e49ce)

  70. I want these hacks to have the same deathcare as me.

    mg (31009b)

  71. step one we can have lots of fun

    happyfeet (28a91b)

  72. The ‘Ryan presser’ was amusing. Cocksure pol, bragging about his 20 years experience, whistling past the graveyard and brought to mind … Custer.

    DCSCA (797bc0)

  73. Good one, DCSA.
    Frank Burns!

    mg (31009b)

  74. The problem with the current strategy is it allows a threatened filibuster to stop the passage of the right bill. IT NEVER WORKS. What works is what Trump did with the Gorsuch nomination. Pick the right person or in this case policy and the threatened opposition crumbles when they realize they’re fighting the will of the people. Jordan and Lee are sensible guys who get it but are being ignored by the established pols who refuse to step away from Washington knows best gravy train their friends and families feast on.

    The belief that only Washington rules and money can fix healthcare is the problem.

    crazy (d3b449)

  75. Poison Care needs a medic.

    mg (31009b)

  76. Its not reassuring that the company toolbox, was so easily accessed

    narciso (d1f714)

  77. they’re corrupt and incompetent is a big part of the problem

    the cia isn’t the best and brightest it’s just “unremarkable losers what can stand working at a crappy corrupt federal government job with a buncha trannies and other deviants”

    happyfeet (28a91b)

  78. I think its unrealistic to think that 8 Dem Senators would ever vote for a comprehensive rollback of Obamacare.

    Its better politics IMO to take what you can now with 51 votes, propose legislation to deregulate the health insurance industry in order to promote a more robust market, and then campaign in 2018 on improvements to the healthcare system is it then exits. The Dems have so many seats to defend, and the prospect for the far left to “primary” anyone who even smells like a moderate. That improves the chances of the GOP to pick off a few extra seats in the Senate.

    shipwreckedcrew (56b591)

  79. Take Snowden, one of those candidates who washed out and fixed his
    Performance review.

    narciso (d1f714)

  80. Pre-existing conditions are the poison pill in any healthcare plan. So long as very expensive high maintanence needy individuals can access the same insurance plans as the fit and healthy at the same costs, any plan will become unsustainable. That’s how free markets work.

    Widespread health insurance for Americans ultimtely depends on rational expectations and the separation of high risk individuals into appropriately identified and correspondingly priced pools which can serve their needs without unfairly burdening either the young or the healthy.

    Until we face up to the fact that some of us can not expect others to pay endlessly for our misfortunes or for a lifetime of self abuse we will continue to see one ‘comprehnsive’ health insurance plan after another crash and burn on the alter of misguided compassion.

    ropelight (bbf9bc)

  81. SWC. I hope you’re right. You usually are. I’m just trying to remember when this multi-session strategy to slowly rollback an entitlement program actually worked. OTOH I remember big stuff like welfare reform, major tax reductions, that got done because the House and Senate kept pushing it through despite filibuster threats and actual presidential vetoes until it was signed. I like that better.

    crazy (d3b449)

  82. I’ve run out of patience, Patterico. I’ve been a loyal reader of yours for several years, and I agree with you on most policy issues, including this one. Why couldn’t you have made this post about the policy instead of about Trump? I’m just so tired of the obsessive/compulsive bashing of Trump that I just have no more desire to read this site.

    I’m out of here.

    Good look slaying those windmills.

    Loyal reader? Aren’t you the repeat drama queen? Didn’t you try to run off DRJ several years ago? Aren’t you the fella who sent me a series of whiny emails last year complaining that you were upset that I had criticized Vox Day, a white nationalist who had mocked my friend Ken White for discussing his depression?

    Now you want to flounce because it bothers you too much to see Donald Trump criticized?

    Awwwww. You’re his white knight. How sweet!

    You know, I think I’ll be able to muddle on through without you.

    Patterico (52aafa)

  83. Don’t go away mad. Just go away. And this time stay away.

    Patterico (52aafa)

  84. Ryan’s press conference today was interesting, and much of the unhappiness in this post is addressed.

    I have not seen it, but from your description, my concerns do not appear to have been addressed after all.

    Patterico (52aafa)

  85. I do have to say one thing Trump was right about – I’m sick of the winning already.

    Jerryskids (16a4d5)

  86. shipwreckedcrew (56b591) — 3/7/2017 @ 11:50 am

    1) someone else pays health care costs on behalf of the patient, and 2) for 50+ years the patients have been told they have a “right” to health care, you create a market where consumers don’t care about price.

    The only path to a true “market based” health insurance system

    Insurance is still someone else paying And it’s worse. Providers find no need to communicate price, so if someone did want to conserve cash (without diminishing quality) they can’t, and people without insurance get charged the list price – except that thattoo can be negotiated down.

    is to cut the relationship between employment and insurance, and allow huge pools to be created nationwide by eliminating state barriers to providing insurance.

    The execution will be more complicated than that, but until you give consumers a connection to the actual costs (i.e., they write checks for premiums themselves from their income), and allow the insurance companies to actually compete with each other on the basis of cost, coverage, and service, you won’t have a true market based system.

    Sammy Finkelman (be6791)

  87. An example –when in the Sam Hell did we debate– during the primaries–spending a trillion on infrastructure

    It was not debated (I vaguely remember Hillary trying to outbid Donald, but I don’t think that is what you meant by “debate”), but Trump did promise it during the campaign. One thing about Trump: those promises he made which were specific policies or actions, he does seem to be making good on.

    As a person with a long term chronic illness taking expensive drugs and recurring expensive procedures (such as a colonoscopy every other year) even when I am in remission, I probably have too big a stake in this to be objective. But I do believe the mechanisms of the free market don’t really work in health care. (You just had a stroke or other life endangering emergency. Do you have the time to determine the cheapest and most efficient option for ambulances, hospital, and doctors in your area? If you have time to compare, aren’t you going to look for the most effective option, cost be perditioned?)

    kishnevi (57338f)

  88. All the folks who say my description of the schism is wrong: please tell me your version of the schism, including the following:

    1. What are the two groups?
    2. Which group does Trump fall into?
    3. Where do the two groups stand on this ObamaCare bill?

    I’m talking to SWC, ThOP, and NJRob, primarily. Anyone else who wants to weigh in is welcome. SPQR also took issue with me but I think I know how he would answer the questions based on his comment. (Maybe not. Don’t want to be presumptuous.)

    I think my description of the schism as it exists today makes it easy to answer these questions. Other people might have more trouble, but we’ll see.

    Patterico (115b1f)

  89. SWC:

    is to cut the relationship between employment and insurance,

    That connection means the problem of adverse selection is limited. And the problem is not aht employers pays for insurannce, the problem is that insurance pays around 88% of money spent in the medicine.

    The execution will be more complicated than that, but until you give consumers a connection to the actual costs (i.e., they write checks for premiums themselves from their income),

    That is not actual costs. Actual costs is when consumers write checks for lab tests, doctors, hospitals, or a significant number do.

    and allow the insurance companies to actually compete with each other on the basis of cost, coverage, and service, you won’t have a true market based system.

    You don’t want insurance companies competing with each other on the basis of price (which leads to narrow networks, monopolies, and some form of rationaing of care)

    You want providers competing with each otgehr (partially) on the basis of price.

    Prices are not rational. There’s not enough of a market for the remainder of the populatopn, which is around 90%, to piggyback on.

    Sammy Finkelman (be6791)

  90. 88
    Which is why I refuse to join AARP. About the time of Harry and Louise, they became an arm of the Democratic Party. (Maybe before, but that’s when I noticed it.)

    kishnevi (57338f)

  91. There’s more than two groups, not even counting Democrats, who are content to see Republican flounder. They look for losers – in the xcurreent plan, the biggest losers are apparently people in ther early 60s in the just above Medicaid income range.

    By the way. if insurance is too expensive, people won’t buy it, and you’ll get intoa death spiral. And the people drawing up these plans don’t realize at how low an amount of money that hits.

    I don’t know if anyone has come up with a satisfactory solution. Maybe if theer uis a good idea for a system, it’ll gather supporters.

    Sammy Finkelman (be6791)

  92. Patterico, where I would disagree with you is in your discussion of the “wing” pushing this version of the bill. You called it “On the other side is the Donald Trump wing, which has no guiding principles other than blind faith in Donald Trump.”

    However, with respect to this legislation, allied to Trump at the moment are those establishment Democrat-lite Republicans I’ve long despised. Many of them had no fondness for Trump particularly and certainly no blind faith in him. But will make common cause with him to maintain their positions of influence and their cosy sinecures.

    SPQR (a3a747)

  93. All the folks who say my description of the schism is wrong: please tell me your version of the schism, including the following:

    1. What are the two groups?
    2. Which group does Trump fall into?
    3. Where do the two groups stand on this ObamaCare bill?

    I’m talking to SWC, ThOP, and NJRob, primarily. Anyone else who wants to weigh in is welcome. SPQR also took issue with me but I think I know how he would answer the questions based on his comment. (Maybe not. Don’t want to be presumptuous.)

    I think my description of the schism as it exists today makes it easy to answer these questions. Other people might have more trouble, but we’ll see.

    Patterico (115b1f) — 3/7/2017 @ 5:45 pm

    I disagreed with your interpretation because you ignored the literal elephant in the room which I stated in my post that you neglected to mention.

    1) conservatives vs establishment since time immemorial. Broken down further into big government, tax republicans vs limited government, cut taxes conservatives.

    2) He has no discernable political view so some of each. His call of Planned Infanticide’s bluff was conservative. The government catch all to healthcare definitely establishment which is just socialist lite.

    3) In what way? More nuance is needed as this bill has good and bad to it.

    Did you read my post at all? I called the bill garbage.

    NJRob (b2251a)

  94. kishnevi

    but Trump did promise it during the campaign.

    ****************

    True, but I think he primarily did that after winning the nomination.

    One thing about Trump: those promises he made which were specific policies or actions, he does seem to be making good on.

    True again. I’m amazed at everything so far–that I have gotten my way–still we are less than 40 business days into this.

    As a person with a long term chronic illness taking expensive drugs and recurring expensive procedures (such as a colonoscopy every other year) even when I am in remission, I probably have too big a stake in this to be objective. But I do believe the mechanisms of the free market don’t really work in health care. (You just had a stroke or other life endangering emergency. Do you have the time to determine the cheapest and most efficient option for ambulances, hospital, and doctors in your area? If you have time to compare, aren’t you going to look for the most effective option, cost be perditioned?)

    Ugh–sorry to hear this. I only have experience with the military health care system and at the time I was trying to get help for relatively healthy people in my family. While that was happening I consistently said to myself–“I cannot imagine someone having to navigate this bullshit while they are sick!”

    I have been out in the civilian health care economy for a bit now–and holy hell what a mess.

    Ya I have no damn idea what the answers are or should be–but I never really wanted to see civilians folded into the kind of crap government healthcare provides. I also have Canadian relatives who are relatively healthy and their answer was to just go down to “winter” in Destin, Florida–and pay up. So–my opinion of Canada’s answers are that they also–are not doing their “best”. their best were coming down here and using our system.

    Good luck weathering through your healthcare issues. Hang in there.

    Rae Sremmurd (2fd998)

  95. There is this reality, without reconciliation it would take 60 votes to pass a repeal, as it is, this thing has multiple tripwires you lose Collins murkowski and probably Gardner right off the bat.

    narciso (d1f714)

  96. kishnevi

    but Trump did promise it during the campaign.
    ****************
    True, but I think he primarily did that after winning the nomination.

    One thing about Trump: those promises he made which were specific policies or actions, he does seem to be making good on.

    *************
    True again. I’m amazed at everything so far–that I have gotten my way–still we are less than 40 business days into this.

    **********

    As a person with a long term chronic illness taking expensive drugs and recurring expensive procedures (such as a colonoscopy every other year) even when I am in remission, I probably have too big a stake in this to be objective. But I do believe the mechanisms of the free market don’t really work in health care. (You just had a stroke or other life endangering emergency. Do you have the time to determine the cheapest and most efficient option for ambulances, hospital, and doctors in your area? If you have time to compare, aren’t you going to look for the most effective option, cost be perditioned?)

    ***************

    Ugh–sorry to hear this. I only have experience with the military health care system and at the time I was trying to get help for relatively healthy people in my family. While that was happening I consistently said to myself–“I cannot imagine someone having to navigate this bull–merde while they are sick!”
    I have been out in the civilian health care economy for a bit now–and holy hell what a mess.
    Ya I have no damn idea what the answers are or should be–but I never really wanted to see civilians folded into the kind of crap government healthcare provides. I also have Canadian relatives who are relatively healthy and their answer was to just go down to “winter” in Destin, Florida–and pay up. So–my opinion of Canada’s answers are that they also–are not doing their “best”. Their best were coming down here and using our system.

    Good luck weathering through your healthcare issues. Hang in there.

    Rae Sremmurd (2fd998)

  97. No bill was going to come out that didn’t make the medical industry, the pharmaceutical industry, and the insurance industry more money.

    You think Trump had anything to do with this? You’re wrong.

    You think all those Congressclowns who went into politics because they couldn’t hack it as lawyers wrote it? You’re wrong. It was written by lobbyists for the medical industry, the pharmaceutical industry, and the insurance industry.

    Fault Trump only for one thing, if you want to fault him for anything. That he doesn’t have as much muscle as the lobbyists.

    nk (dbc370)

  98. Ah the smithy toves are everywhere:
    http://www.modernhealthcare.com/article/20150504/NEWS/3050599978

    narciso (d1f714)

  99. Mr. Trump is so good

    but he can only do the best he can with the sticky, slicked-up, slightly ripe-smelling, romney-abused congresstrash that he has

    let’s just hope to god phases two and three have some heft

    happyfeet (28a91b)

  100. Patterico, where I would disagree with you is in your discussion of the “wing” pushing this version of the bill. You called it “On the other side is the Donald Trump wing, which has no guiding principles other than blind faith in Donald Trump.”

    However, with respect to this legislation, allied to Trump at the moment are those establishment Democrat-lite Republicans I’ve long despised. Many of them had no fondness for Trump particularly and certainly no blind faith in him. But will make common cause with him to maintain their positions of influence and their cosy sinecures.

    My contention is that, while the GOPe predated Trump, he has begun a process in which Trumpism is swallowing them whole. And in many situations they are being swallowed quite willingly, because their inclinations — a cowardly avoidance of tough decisions — are the same.

    They may not have all been personally fond of Trump, but I always believed they would fall in line, and I believe they are now.

    Patterico (115b1f)

  101. this bill originated in the house

    there is no such thing as trumpism

    pasta is controversial even as a side dish because carbs

    Chicago is crawling with bedbugs

    Saturday is St. Patrick’s Day because river

    Ivanka is hot but stupid

    lol Arnold ain’t got no job

    look at me I’m Larry King

    happyfeet (28a91b)

  102. I think I did describe my idea of the schism. I could elaborate?

    Of all the Republicans in the running for the nomination, Trump showed the greatest contempt for Jeb! I was with Trump on that score: Jeb! is detestable and so is the wing of the party he comes from. I have a very hard time believing Trump is now some sort of GOPe-er, standing in opposition to our hero Ted Cruz and the other conservatives. Very hard.

    To my thinking, the anti-GOPe contingent is divided between Trump and Cruz people. I also think there are some Trump people who are new to the party, including many Bernie supporters I know here in NorCal and quite a few formerly disengaged/non-voters. During the run up to the nomination, I was floored that anti-GOPe types, including a lot of Southern Evangelicals, would embrace Trump. At the time I saw nothing in his resume to suggest he was on our side of the longstanding GOPe-conservative divide. The last month and half have proven me wrong.

    At the moment, I think the Trump side is still emerging, though it is hard to argue that our new President isn’t earning conservative bona fides. Why just today he nominated Noel Francisco to be our new Solicitor General – Francisco clerked for both Luttig and Scalia and is a friend of Ted Cruz – talk about a strong conservative resume. This is just one more example of a string of conservative choices by a man I thought did have it in him.

    One thing I am particularly happy about, in addition to Trump behaving like a conservative over the past weeks, is that Trump is being pushed to the conservative side by his many critics. My guess is that Trump will recoil from the Ryancare roll out and stake out a more conservative position. My guess is that Trump will not be happy with the negative reaction from his base and will blame it on Ryan (and possibly Pence, who I think has his fingerprints all over the bill).

    So far, Trump has been consistently coming down consistently on the conservative side of the longstanding GOPe-conservative divide (just for a moment, imagine what a Jeb! cabinet would look like?). I hope and pray Trump will continue to do so. I see no reason to believe he is a closeted GOPe stooge, as you seem to suggest. Not at all.

    At this point in time, I will freely acknowledge that I know far less about politics than I used to think I knew. This past election season was a real eye-opener.

    I would also like to make a pitch for President Trump. Most pols, to me at least, seem to have no core values. I now think that Trump must have some of the core values that you and I hold dear. He is far too spontaneously narcissistic to be gaming this. Furthermore, he doesn’t behave like he is gaming it. Miller and Bannon may be spoon feeding President Trump, but he seems to be making the beginnings of this term, at least, a conservative one. To Trump the TV personality, the character he is in the process of carving out is a conservative one. Thankfully, it is the roll he has chosen to play. Once established, I don’t see him changing it. And even if Trump goes on to show “moderate” spots, his conservative nominees will still be running our bureaucracy and the conservative road show will roll on.

    ThOR (c9324e)

  103. It was going to be a tough road how man votes to challenge for speakership, that is a proxy,in the senate perhaps heck might have come along but its doubtful Kirk or ayotte would have.

    narciso (d1f714)

  104. Ha, ha, ha! Trump will do the Politburo lets him do. Just like Congress does what the Politburo lets it do. Oh, you don’t think we have a Politburo? That’s because we call it the Fortune 500.

    nk (dbc370)

  105. What would be wrong with the Congress jumping on the Trump bandwagon if Trump continues down the conservative path? That sounds like a good development to me.

    ThOR (c9324e)

  106. I can’t imagine Steve Bannon allowing his septuagenarian political wunderkind to be pulled under by Ryan and McConnell. Can you?

    ThOR (c9324e)

  107. ryan is either muscle-bound between the ears or he wants no part of fixing something his bosses don’t want fixed. (coc)

    mg (31009b)

  108. ThOR (c9324e) — 3/7/2017 @ 6:35 pm

    That’s a very thoughtful post, Thor. Whether we recognize it or not, all of us act on too little information. The intelligent man realizes how little he knows and proceeds accordingly. The older we get, the more we need to come to terms with that. Brashness, pontificating, and bloviating is buffoonery.

    Colonel Haiku (2601c0)

  109. Pre-existing conditions should be paid for through portable insurance with guaranteed renewal

    Patterico,

    I have LONG said that all insurance should be purchased by individuals and families from a SINGLE national marketplace. Companies may subsidize or even pay for their employees policies, but that is taxable income, with income taxes, FICA and etc taken out of the paycheck as normal withholding. They do this now with company life insurance life insurance over a certain level.

    In such a regime, the costs of covering preexisting conditions are minimal (the ACA marketplace is pernicious in this regard as the unsubsidized pool is tiny). If you add some kind of penalty for coverage lapses even this diminishes.

    This was basically the plan that noted conservative John McCain proposed in 2008, although he suggested a mandate rather than coverage lapse charges. WIth that correction, it is remarkably free of government control, other than in policing scams and the like.

    But this will never happen. Too many people have too much invested in making someone else pay for their medical care. The best I see is making that system more fair.

    Kevin M (25bbee)

  110. What makes the GOPe the GOPe is that they are bought and paid for. They are the corporatist wing of the party. It is in their self-interest to follow the money and that’s exactly what they do. When a stiff like Jeb! stake out a particular position, more likely than not it the money talking.

    Trump has plenty of money, but what he lacks is adulation. A narcissist can never get enough. By talking a conservative game, Trump has achieved more adulation that he dreamed possible. He’s not going to give that up because some money men want him to.

    What would be Trumps reason to abandon his acolytes? I don’t see it.

    ThOR (c9324e)

  111. A tablet of Tylenol costs $18/22 instead of a quarter

    Medications of any kind in a hospital costs ridiculous amounts because to the legal regime. That capsule tablet of Tylenol has to be tracked from the dispensary to the patient. There has to be a paper trail covering the chain of custody of that tablet from the individual bottle to the patient’s mouth.

    This way, should anything untoward happen, the hospital can say where the effing pill came from, who handled it, what their qualifications were, and demonstrate due diligence. It’s not good if they have to stand in front of a jury and say “Gosh, we have no idea!”

    Kevin M (25bbee)

  112. I would guess that less than 10% of the people with an opinion on this bill have read any detailed description of what it contains. More likely they know that so-and-so doesn’t like it that that’s good enough for them.

    I am so glad this is a republic and not a democracy.

    Kevin M (25bbee)

  113. everything gonna be all right he’s comin back

    like he said he would

    happyfeet (28a91b)

  114. i got your noted conservative right here

    happyfeet (28a91b)

  115. So long as very expensive high maintanence needy individuals can access the same insurance plans as the fit and healthy at the same costs, any plan will become unsustainable. That’s how free markets work.

    An enlarged prostate was enough to get insurance refused under the old regime for someone I know. No cancer, just an enlarged prostate. High-blood pressure was a no-no with some insurers. No skin off their teeth — the private market was only operated to satisfy state laws, so they cherry-picked.

    The real money is in group plans with their low overhead costs. Ironically there were no exclusions there.

    Kevin M (25bbee)

  116. damn that prostate too damn big

    maybe you try the clinic on Jefferson

    yeah you try down there

    happyfeet (28a91b)

  117. Patterico,

    About that schism… what I have no idea about is what the “Conservative” faction wants here. A return to the status quo ante? There are about 27 votes in the House for that.

    Are Ryan, Trump and McConnell all one faction? And Rand and Gowdy another? How did Trump get into the RINO camp? Aren’t heads going to explode?

    I’m not mocking, I’m just really surprised that anyone can say there are two identifiable sides.

    Kevin M (25bbee)

  118. And I’m more than a little surprised that no one is willing to compromise on something that demands compromise. Unless and until they do, the law is OBAMACARE.

    Kevin M (25bbee)

  119. That’s kind, Haiku, especially after all the bloviating I’ve done in these comment. Thank you.

    ThOR (c9324e)

  120. No, I read it as thinking out loud, Thor. Calm and dispassionate and sans calling the motivation, intelligence, convictions, principles, or ethics of others into question. Good tone.

    Colonel Haiku (2601c0)

  121. Sober and without outright asshattery also come to mind… lol.

    Colonel Haiku (2601c0)

  122. 44. Re: cost of Tylonol. In 2007, $22 iin a doctor’s office – in 2017 estimated at $18.

    When there is no competition, prices vary all over the place. The difference between one provider and another can be a factor of 6.

    But even the lowest is way too high.

    Sammy Finkelman (6f9f42)


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