Patterico's Pontifications

3/8/2017

This Is How You Got TrumpCare: Republicans Don’t Know What They Believe Any More

Filed under: General — Patterico @ 10:00 am

Ross Douthat has a column today titled “Why Republicans Can’t Do Health Care.” with a sentence that is jarring because of its obvious truth:

[T]here was no [health care] bill that could have united all of the right’s disparate factions, because on health care policy, as on a range of issues, the Republican Party as an organism does not know what it believes in anymore.

Republicans ran on a very simple promise: repeal and replace ObamaCare. Now that they’re in office, they remind me of the Joker in the scene from the Dark Knight in which he says: “Do I really look like I have a plan? You know what I am? I’m a dog chasing cars. I wouldn’t know what to do with one if I caught it!”

Imagine a world in which the Democrats managed to enact a policy of communism. Not the inching towards a European socialist state we’ve seen in recent years, but full-on Soviet-style communism, with five-year plans and centralized control of the economy — but with one difference: Americans still had a meaningful vote. Without a market mechanism to allocate resources, there would be suffering, starvation, and death, caused by shortages of basic commodities. The citizens would vote back in Republicans, who would run on an agenda of repealing Communism.

If that happened, what would Republicans actually do when they got into office? Would they really repeal Communism? Or would they worry about the political consequences of government telling voters that the state won’t hand out food any more?

Harry Browne famously said: “Government is good at one thing: It knows how to break your legs, hand you a crutch, and say, ‘See, if it weren’t for the government, you wouldn’t be able to walk.'” But if Republicans were voted into office on a campaign of repealing the Democrats’ leg-breaking program, they would fret about the reaction to taking away people’s crutches.

Friedrich Hayek once said: “The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design.” TrumpCare isn’t the first time people have had the idea that a program run from a central government by a group of experts is the best way to allocate resources. Communism and socialism didn’t happen because nobody believed in such central planning. A lot of people believed in it. So they tried it, and people died by the millions. We have had countless micro-lessons since. The starvation in North Korea and Venezuela stand as a modern and visible testament to the dangers of central planning.

Yet these lessons doesn’t seem to have taken root in the minds of Republicans — the members of the only viable party that might possibly apply these lessons. The free market is the best system ever devised for allocating resources. But if Republicans ever actually believed that, they don’t seem to any more. Now that the details of the House’s TrumpCare bill have been announced, Republicans look for ways to compare its handouts to other handouts they like. They deride those who advocate for the free market as ideologues who don’t understand the real world.

But supporters of the free market understand the real world all too well. We understand that centrally controlled plans aren’t just bad on a theoretical level. They kill people.

Republicans seem to assume ObamaCare is different. We hear about 20 million people with health insurance and think: wow, maybe this time government did something right! Can we really afford to mess with it? What you’re not hearing from Big Media is ObamaCare is not having a positive impact on health, because it’s not having a positive impact on the holding of private insurance.

Anyone who thinks otherwise needs to read a piece in National Review titled No, Obamacare Has Not Saved American Lives by Oren Cass. Cass shows that ObamaCare has not improved health care. If anything, it has made it worse.

Cass notes that the ACA “is primarily an expansion of Medicaid” and that “in recent years, the share of Americans with private insurance has declined.” That’s right: declined. Because health insurance is still a function of employment, there have been gains during the tepid Obama recovery. But if you compare the share of non-elderly Americans who hold private health insurance before the recession and after the recession, the percentage has actually gone down. Even lefty PolitiFact, in one of their “this statement is true but we don’t like it so we’ll rate it Half True” hit pieces on Rand Paul, was forced to concede that “About 20 million people gained coverage and about 14.5 million of those were under Medicaid or CHIP.” The other 5 million or so gained coverage mostly because that’s what happens during an economic recovery.

The fact that the ACA expansion of covered citizens is a function of Medicaid expansion is important, Cass notes, because studies show that outcomes for patients with Medicaid tend to be worse than those of uninsured patients.

What’s the bottom line? ObamaCare is not saving lives:

Age-adjusted death rates in the U.S. have consistently declined for decades, but in 2015 — unlike in 19 of the previous 20 years — they increased. For the first time since 1993, life expectancy fell. Had mortality continued to decline during ACA implementation in 2014 and 2015 at the same rate as during the 2000–13 period, 80,000 fewer Americans would have died in 2015 alone.

But wait: does this correlation mean causation? Not necessarily, but dig deeper and you’ll find that we can compare the states that expanded Medicaid under ObamaCare to those that didn’t — and guess what? Expanded Medicaid is not improving health:

[T]hanks to the roughly half of states that refused the ACA’s Medicaid expansion, a good control group exists. Surely the states that expanded Medicaid should at least perform better in this environment of rising mortality? Nope. Mortality in 2015 rose more than 50 percent faster in the 26 states (and Washington, D.C.) that expanded Medicaid during 2014 than in the 24 states that did not.

If Republicans truly believed in the free market, they would see the relationship between centralized planning and ruinous outcomes as fundamental. They would make that case to the people. They would cite statistics like the ones I just cited.

But Republicans don’t believe in the free market any more. They believe in the same welfare-state principles as the Democrats, just on a slightly smaller scale. And so, to modify a popular saying:

This is how you got TrumpCare.

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

Comments (106)

106 Responses to “This Is How You Got TrumpCare: Republicans Don’t Know What They Believe Any More”

you just wait til phase 2 mister

you just wait
happyfeet (a037ad) — 3/8/2017 @ 10:29 am
Better to be a pagan born than suckled in creed outworn. Communism kills, but only after it’s sucked the humanity out of its imprisoned population, the best and brightest die of starvation the the Gulags exhausted by an official but faceless brutality and the pitiless and unrelenting Siberian winters. Ordinary drones usually quitely succumb to unceasing boordom and advanced alcoholism.

Karl Marx is the bloodiest terrorist who ever walked among us. Compared to him Hitler’s deadly reign was only the noisy but brief tantrum of a mischievous child.
ropelight (bbf9bc) — 3/8/2017 @ 11:03 am
how many Ohioans has John Kasich killed by throwing them onto medicaid like they were worthless subhuman animals
happyfeet (a037ad) — 3/8/2017 @ 11:07 am
Getting government off your back was a fundamental plank in the Trump platform. In many ways, Trump has followed through on this promise in his short tenure.

There was second campaign theme that in many ways seem contradictory, which was a promise to get government to work more efficiently. Trump’s public works program would work better than Obama’s because Trump and his circle know how to get things done, or so we were told. With the submittal date for the new border construction proposals due in just a few short days, Trump is following through on this second promise.

Trump has chosen the latter approach to Obamacare: mend it, don’t end it. Unfortunately, “fixing” healthcare is a much tougher nut that building a fence. What I find particularly wrong-headed about the Douthat treatment is that the problem with Ryancare is that Trump didn’t act like the micro-managing Carter, but instead delegated responsibility for the re-write of Obamacare to the House Republican leadership. BAD IDEA. They’re just old school political hacks. What would they know about making government more efficient? Not one thing. Zero. Zilch. Nada.

This is not some sort of extraordinary political circumstance, as Douthat suggests. It is just more of the same from what we used to call the “Rockerfeller” wing of the Republican Party – that dates it, doesn’t it? I presume Mike Pence convinced Trump that this was best left to the House leadership. Regardless of who convinced Trump that Obamacare must be replaced rather than repealed and that Ryan and company are the ones to entrust with the project, I’m hoping President Trump will learn a lesson from this fiasco. Trump can’t afford to undo all the goodwill he has established with marginal supporters in recent weeks by cramming this awful piece of legislation down our collective throats.
ThOR (c9324e) — 3/8/2017 @ 11:14 am
yes yes paul ryan really screwed the health care pooch

i’m embarrassed for him and his family
happyfeet (a037ad) — 3/8/2017 @ 11:31 am
Trump said he liked the mandate in the South Carolina debate just one year ago.
DRJ (15874d) — 3/8/2017 @ 11:35 am
Very well said Patterico. The best we can hope for are ammendments with the seed corn of real reform that can be nurtured over time until the insurance for all model shrinks into the background of a free-er market. Going forward it’s worth acknowledging that the cost of care Obamacare was supposed to fix went up because the overhead cost of compliance and administration exploded and price rose to reflect it.

No republican alternative can lower the price of care until the added overhead is eliminated but what politician wants to put those people out of work?
crazy (d3b449) — 3/8/2017 @ 11:46 am
Or would they worry about the political consequences of government telling voters that the state won’t hand out food any more?

The Communists did not hand out food. They instituted a policy of people having to work, and anyone who didn’t work was called a “parasite.”

Herbert Hoover handed out food in Belgium during World War I. Lenin refused to let him do it in Russia in 1919, but eventually relented in 1921. And the United States government paid for it, and continued to do so into 1923, while the Communists began to export grain.

http://www.cornellcollege.edu/history/courses/stewart/his260-3-2006/01%20one/befr.htm

https://en.wikipedia.org/wiki/Russian_famine_of_1921%E2%80%9322

Aid from outside Russia was initially rejected. The American Relief Administration (ARA), which Herbert Hoover had formed to help the victims of starvation of World War I, had offered assistance to Lenin in 1919, on condition that they have full say over the Russian railway network and hand out food impartially to all. Lenin refused this as interference in Russian internal affairs.[5]

Lenin was eventually convinced — by this famine, the Kronstadt rebellion, large scale peasant uprisings such as the Tambov Rebellion, and the failure of a German general strike — to reverse his policy at home and abroad. He decreed the New Economic Policy on March 15, 1921. The famine also helped produce an opening to the West: Lenin allowed relief organizations to bring aid, this time. War relief was no longer required in Western Europe, and the ARA had an organization set up in Poland, relieving the Polish famine which had begun in the winter of 1919–20.[11]…

….The main participants in the international relief effort were Hoover’s American Relief Administration,[12] along with other bodies such as the American Friends Service Committee and the International Save the Children Union, which had the British Save the Children Fund as the major contributor.[13] Around ten million people were fed, with the bulk coming from the ARA, funded by the United States Congress; the European agencies co-ordinated by the ICRR fed two million people a day: the International Save the Children Union were feeding 375,000 in its centres at Saratov at the height of the operation.[14] The operation was hazardous — several workers died of cholera — and was not without its critics, including the London Daily Express, which first denied the severity of the famine, and then argued that the money would better be spent on poverty in the United Kingdom.[15]

Throughout 1922 and 1923, as famine was still widespread and the ARA was still providing relief supplies, grain was exported by the Soviet government to raise funds for the revival of industry; this seriously endangered Western support for relief, and was one instance of a long-standing Soviet policy of valuing development above the lives of the peasantry. The new Soviet government insisted that if the AYA suspended relief, the ARA arrange a foreign loan for them of about $10,000,000 1923 dollars; the ARA was unable to do this, and continued to ship in food past the grain being sold abroad.[16][17]

That was after the first collectivisation of agriculture. But Stalin didn’t do what Lenin did and forced people to starve and die. In the country. People in the cities had food, but nobody could move from the country to the city after about 1930.
Sammy Finkelman (4a6ffc) — 3/8/2017 @ 12:19 pm
A politician dependent upon on an electorate dumb enough to reduce the election for President to a binary choice between Godzilla and Mothra for future employment has very good reason examine his belief structure. The premise is exceptionally true after watching the opposing party inflict rather grievous damage upon itself over the very recent past through passage of rainbows and unicorns pap based upon the party’s “strong beliefs”.

Hanging on to the majority long enough to effect a decent restoration ranks much higher with me than fully embracing beliefs of which at least 50% of the electorate is ignorant and another 20% is opposed. Wisconsin continues to provide a good example of the restoration process.
Rick Ballard (a1c54c) — 3/8/2017 @ 12:28 pm
6. DRJ (15874d) — 3/8/2017 @ 11:35 am

Trump said he liked the mandate in the South Carolina debate just one year ago

That was the Town Hall, not the debate (candidates questioned separately, one by one, and Trump apparently was confused, or ignorant, using the word “mandate” to describe the requirement that hospitals treat emergency cases regardless of ability to pay, which had been passed in 1986 and signed by President Reagan. It’s called the Emergency Medical Treatment and Labor Act or EMTALA.

Three days later, Trump sort of clarified what he said (still not using terms otehr people did) to Jake Tapper on CNN..
Sammy Finkelman (4a6ffc) — 3/8/2017 @ 12:31 pm
The federal government was able to require hospitals to treat all comers by making that acondition of belonging to the Medicaid program. I suppose this is the reason hospitals hired Social workers to enroll people in Medicaid or other government assistance.
Sammy Finkelman (4a6ffc) — 3/8/2017 @ 12:37 pm
Pity we didn’t put a Republican in the White House, isn’t it?

Pity we didn’t put someone with conservative principles in the White House, isn’t it?

Pity we didn’t put someone who knows something in the White House, isn’t it?

“You’re going to have such great healthcare at a tiny fraction of the cost, and it is going to be so easy.”
— Ignorant Game-Show Host Con-man
Dave (c7b0f5) — 3/8/2017 @ 12:49 pm
Why are people surprised that when they vote for Hillary’s biggest fan, they get a lot of Hillary policies like government funded healthcare, mandated insurance, and federal control? This is what the Cruz supporters were warning y’all about. You basically elected a democrat who pretends to be a grandiose cartoon Republican, thereby killing the GOP off and creating this new GOP that is an active opponent of conservatism.

There’s really nothing y’all can blame conservatism for that Trump isn’t doing times fifty, and we’re only getting our feet wet in the big government boondoggle presidency to come over the next few years. By the time we vote again, we won’t recognize the GOP at all.

Meanwhile, the nation misses Obama pretty bad. This was an awful long term position for the GOP to take, and for every judicial appointment we get out of it, the democrats will get a dozen in the long term.
Dustin (ba94b2) — 3/8/2017 @ 12:53 pm
Healthcare is an unfathomabley complex issue with no easy answers. There are free market principles that would help, more competition for example, but just chanting free market strikes me as utopian. Lawyer free market would be as practicable, and probably more doable.

Sorry to sound fatalistic, but we can’t just push through a pure free market system for healthcare. It’s a national security issue for one thing, and akin to pushing for the privatization of the military. Possible to do theoretically I suppose, and no doubt some would say a good idea, but it comes with a whole new set of problems, and unrealistic in today’s complex world.

There is way too much government involvement now, Obamacare is a monstrosity, but republicans are starting the process of rolling that back and demanding all or nothing is the same old failed conservative strategy that has failed us over and over.

We didn’t get in this mess in a day, and we aren’t going to perfect everything tomorrow, even if Saint Cruz were president. We have recovered the ball, and now we need to start advancing it down the field. We can’t win by continually attempting field goals from our own 20 yard line.

Let these guys do their thing, cheer them on, build on success. Grow up and quit expecting to score every down. We got a winning season going, cheer the heck up!
Leon (3ad005) — 3/8/2017 @ 1:03 pm
The tough but necessary measures are always phase 2. I’ll start my diet tomorrow.
Patterico (5f0ab0) — 3/8/2017 @ 1:10 pm
Rest In Pieces Lynne Stewart
Colonel Haiku (d17996) — 3/8/2017 @ 1:13 pm
Just mindlessly cheer them on, guys! Surrender your critical thinking! C’mon in! The water is great!
Leviticus (7951f8) — 3/8/2017 @ 1:15 pm
The fundamental misconception of the entire POV that “blames” Trump for the status of the legislative effort to deal with Obamacare is the assumption that his “process” for getting this done should resemble the time-honored fashion in which pols of both parties have always apporached this kind of hallmark effort — stake out a position based on principle, and give ground grudgingly until you reach a point where the opposition finally gives in.

Purists on both sides decry this kind of “compromise” because in their hearts and minds they are convinced only their position is correct, and only their position can be allowed to triumph in the end. Anything short of that is failure.

Now you have Trump, and while his approach is closer to the former than the latter, its different in that he does not approach the issue from a principled starting point. Its just a deal that needs to be made. Obamacare needs to be replaced. What the final product looks like isn’t of that much concern to him, as long as the box is checked. Ryan’s plan is Trump’s opening bid. There will be folks from different ideological persuasions with differing objections to what Ryan’s group has put together.

Trump will negotiate changes to gather support. I don’t think he’s wedded to any particular point, and I don’t think he’ll rule out any particular addition or subtraction from the plan. The only calculus will be whether the addition or subtraction puts more votes in his column for passage of a plan to replace Obamacare.

He doesn’t care what doctrinaire liberals or conservatives think of the plan as announced. He’s not going to negotiate with them in public, but he’ll negotiate for the their votes in private.

So, I’d criticize him for being feckless, and for pursuing this as an agenda item to be accomplished more than making a meaningful makeover of the health care delivery system.

I think the Posts criticism of the GOP is correct, because rather than continuing to pursue health care reform as a meaningful makeover, they’ve simply joined Trump’s effort to fulfill a campaign promise.

But, its not too late for them to do both. But the “bargaining” with respect to the current bill needs to be aggressive.

And, IMO the better opportunity to accomplish what conservatives want to see happen will come after the 2018 midterms

Avoid divisive intra-party fights now, try to win 5-8 more GOP seats in the Senate in 2018, and conservatives will get the health care reform they want in the run-up to the 2020 election cycle.
shipwreckedcrew (56b591) — 3/8/2017 @ 1:23 pm
i had way more faith in pervy mitt romney’s slicked-up boy toy Paul Ryan than it turns out he deserved

why would he even want to be speaker if this is how he’s going to perform
happyfeet (a037ad) — 3/8/2017 @ 1:27 pm
“The diet starts tomorrow”

Diets are hard, and take time; I wanna be skinny today!
Leon (3ad005) — 3/8/2017 @ 1:28 pm
S & P Global was first out of the gate with an initial analysis of Trumpcare. Reducing the Medicaid subsidy by 4-6 million users while instituting a shift to per-capita funding rather than Federal Medical Assistance Percentage is a very good start in regaining control of subsidy growth.
Rick Ballard (a1c54c) — 3/8/2017 @ 1:55 pm
Obamacare reform is easy. Repeal. The market is always better than a 2000 page legislative monstrosity, that requires tens of thousands of pages of regulation to attempt to define.

Then make small, simple laws about specific concrete issues that effect healthcare.

Yes, Patterico is correct. The GOPe has no faith in the market. As a real estate mogul, Trump has faith in the market, but also knowledge that every level of government allows and fosters rent seeking – he is a master at manipulating rent seeking.

I am horrendously appalled at the lackluster first go round at ending O-care.

I pray it gets better.
Steven Malynn (d29fc3) — 3/8/2017 @ 2:06 pm
t’s a national security issue for one thing, and akin to pushing for the privatization of the military.

LOL

Gotta love these big government lefties. If the federal government doesn’t regulate healthcare, ooga booga.
Dustin (ba94b2) — 3/8/2017 @ 2:16 pm
4 senators have already announced opposition to the Plan — because it does TOO MUCH.

They all come from states that expanded their Medicaid eligibility in order to provide coverage to uninsured poor.

They object to the plan because it takes away their increased Medicaid funding to cover the expanded coverage, and would roll back the coverage for persons covered by the expansion beginning in 2020, leaving those persons without coverage. 11 million uninsureds obtained coverage under Obamacare as a result of Medicaid expansion.
shipwreckedcrew (56b591) — 3/8/2017 @ 2:28 pm
Steven — the problem is that only parts of Obama care can be repealed with 51 votes.

The key part that cannot be repealed with 51 votes is the requirement that plans not deny coverage for pre-existing conditions. Payment for that part of Obamacare came largely from the funds generated with the mandate that young healthy people get insurance or pay a tax penalty.

So, when you tell insurers that they are stuck covering preexisting conditions, but no longer have revenue from “mandated” coverage, the price of premiums for people who actually buy health insurance will go through the roof.

It was easy to vote to repeal Obamacare when Obama stood in the doorway with veto pen in hand.

Now that any repeal would be signed, dealing with the fallout from the repeal has to be determined and planned in advance.

Its why being the “Opposition” party is much easier than being the “Ruling” party.
shipwreckedcrew (56b591) — 3/8/2017 @ 2:32 pm
Holy crap this is good—but…
Rae Sremmurd (2fd998) — 3/8/2017 @ 2:40 pm
Patterico — if the “preexisting coverage” mandate cannot be overturned without 60 votes, do you propose repealing Obamacare and leaving that requirement imposed on the marketplace that remains after a repeal?

If you can’t repeal it now, other than have an intellectual exercise about repealing the whole thing, what more can you do other than what is being done?
shipwreckedcrew (56b591) — 3/8/2017 @ 2:49 pm
There’s still some problems.

First–the Republican Party unlike the Demcorat Party–is not an organism. It doesn’t act in unison. An analogy would be the Democrats are kind of like the Catholic Church and the Republicans are like the multi-denominational Protestants.(which answers the schism question–they’re everywhere–and it’s probably philosophically derived.)

Also this is a good thing because it allows for the free market competition of ideas.

Second–people believe that their health is involved–and so they don’t see ObamaCare necessarily as the soul crushing vehicle of capitalism that it might be.

Third–it looks like the Trump Party horse traded in order to bring on rural and rust belt white Democrats–I suspect they are more in favor of the Medicaid expansion. 9In this trade off Heritage and Club for Growth have been left with less leverage.)

Fourth–I see the critique of–“they don’t have a plan!”–“they’ve had eight years!” Well–Trump wasn’t suppose to win. Republicans were predicted to lose the Senate–Johnson, Toomey, Blunt and others were written off.

So–that is just for starters. The problems are kind of illustrated by the fact that we had sixteen candidates for President and the Dems in reality–had only one.
Rae Sremmurd (2fd998) — 3/8/2017 @ 2:50 pm
edit: so they don’t see ObamaCare necessarily as vehicle used in order to crush the soul of capitalism.
Rae Sremmurd (2fd998) — 3/8/2017 @ 2:52 pm
I aver with the notion that the republicans are the joker, the crown prince of nihilism, more like Harvey dent or Bruce Wayne.
narciso (d1f714) — 3/8/2017 @ 3:06 pm
You know what I think? I think there are a bunch of establishment Repubs who don’t want to be in the majority. They are more comfortable sitting on the sidelines sniping.
Bang Gunly (5a4596) — 3/8/2017 @ 3:08 pm
If you really don’t like Trumpcare, wait ’til you see Trumpnesty.
Rick Ballard (a1c54c) — 3/8/2017 @ 3:11 pm
Look, Binary Choice guys!

either we make every illegal alien mass murderer a voter with a guaranteed min income, or we deport those guys but give full citizenship and voting to the rest! Binary Choice! Gotta pick one of these two horrible options, and if you reject that you’re just a nevertrumper bastard.
Dustin (ba94b2) — 3/8/2017 @ 3:26 pm
You’re torching strawmen like Dr. Manhattan.
narciso (d1f714) — 3/8/2017 @ 3:39 pm
You’re right. I don’t think Trump’s fans really rely on the “Binary choice” fallacy ever. I’m sorry for my dishonesty.
Dustin (ba94b2) — 3/8/2017 @ 3:42 pm
Speaking of “Republicans who don’t know what they believe any more” …

http://www.youtube.com/watch?v=Pdy2de3LTe4

Watch the above video of a proven, unprincipled politician who viciously, verbally attacked the now President of the United States a while back and who, tonight, again flushed his ‘principles’ down the toilet and accepted a dinner invitation for himself and his insulted spouse from a person he said repeatedly was unfit for office, for a free dinner, at taxpayer’s expense, in the White House.

The President will have the meatloaf. They will eat crow.
DCSCA (797bc0) — 3/8/2017 @ 3:53 pm
I can’t help but notice that Trump’s biggest fans around here are not calling this bill TrumpCare, but RyanCare — in spite of the fact that the president has made it very clear this bill has his full approval.

I presume this is because they expect the bill to be a massive failure,and don’t want Trump’s name attached to it. That’s not what they’ll say, of course. They’ll say that Trump had nothing to do with writing the bill, so his name shouldn’t be attached. If they thought the bill would be a success, though, my bet is that his lack of authorship wouldn’t stop them from being all about “TrumpCare.”
Demosthenes (09f714) — 3/8/2017 @ 4:00 pm
Patterico, if you could figure out how to put that brilliant (and I really do mean brilliant, cause I’ve read it five times already and saved it) explanation into two or three lines that people can chant in unison at rallies and riots like the radical left does with their slogans we would win every election and pass every free market bill for the next 200 years. Until then, thanks for this eloquent, well thought out and well delivered post which unfortunately will only be seen, read, digested and understood by those of us who agree with you. It’s friggin’ heartbreaking. But once more, thanks.
Rev. Hoagie® (785e38) — 3/8/2017 @ 4:01 pm
@37. It’s ConservaCare.
DCSCA (797bc0) — 3/8/2017 @ 4:05 pm
Wasn’t there some stuff about evolution, survival of the fittest and if you and your tribe didn’t look after your own health you were toast?

I hate to get all red of tooth and claw, but what the fuck obligation do I have to pay for some smoker’s cancer treatment? What the fuck obligation does that smoker have to pay for my motorcycle crash injuries?

Fuck off all of you and look after your own fucking selves.
Fred Z (05d938) — 3/8/2017 @ 4:07 pm
shipwreckedcrew (56b591) — 3/8/2017 @ 2:32 pm

So, when you tell insurers that they are stuck covering preexisting conditions, but no longer have revenue from “mandated” coverage, the price of premiums for people who actually buy health insurance will go through the roof.

That’s what happened in New York State, which had “community rating” and “guaranteed issue” for abou twenty years before Obamacare reduced premiums. Premiums got up to $15,000 a year for an individual policy. (and that’s also what people who turned out to be ineligible for Medicaid were later billed – I stress billed – trying to collect the money is another matter – because Medicaid had become an HMO, and they paid whether anyone saw a doctor or not.)

Here’s a New York Times article from 2014 about this kind of situation. (it turns out The Upshot was running the. I just didn’t notice it, because it wasn’t always on page A3)

https://www.nytimes.com/2014/11/08/upshot/just-because-a-policy-causes-a-death-spiral-doesnt-mean-its-unsustainable.html

Before 2014, New York also had community rating and guaranteed issue. But it didn’t have an individual mandate, premium subsidies or a limited open enrollment period. The result was that insurance was extremely expensive in the individual market, and very few people bought it.

As of 2008, just 2 in 1,000 New York State residents were covered through the individual insurance market. In 2012, when I was a freelancer, I considered buying insurance in the individual market; I found that a plan approximating my prior employer coverage would have cost about $16,000 a year. In the group market, which was not totally dysfunctional, my prior employer was paying less than $6,000 for similar coverage.

This was terrible public policy that led to a lot of people going uninsured. (For my mother’s benefit, I’ll note that I remained on my former employer’s plan through 2012, as permitted for a limited period under the federal law known as Cobra.) But it was not unsustainable policy. New York started guaranteed issue and community rating in the early 1990s, and went through two decades of individual market dysfunction.

It’s not hard to understand why. Repealing community rating (i.e., letting insurance companies charge sick people more) is unpopular. Providing subsidies so healthy people find it affordable and appealing to buy insurance is expensive. So New York stuck with a set of policies in which health insurance was available to everyone at a price that was affordable to almost no one.

There seems to be an idea among some conservatives that a post-King reality would be so messy and untenable that Democrats would have to come back to the table to cut a new deal on health reform. But King could just create a bunch of new New Yorks, where the individual insurance market doesn’t work, and nobody does anything to fix it.

The dysfunction would be especially sustainable since death spirals under King probably wouldn’t be quite as severe as in New York. That’s because the A.C.A. uses a modified version of community rating in which prices can vary based on age, and because the limited period for open enrollment still provides a disincentive to forgo insurance coverage if you are healthy. So, not as many healthy people would flee the market as they did in New York.
Sammy Finkelman (4a6ffc) — 3/8/2017 @ 4:08 pm
37. Obama didn’t actually write Obamacare.
Sammy Finkelman (4a6ffc) — 3/8/2017 @ 4:09 pm
No it was farmed out to the Apollo alliance or Robert creamer, or a collaboration between the two:
http://circa.com/politics/fbi-probe-of-donald-trump-and-russia-during-election-yielded-no-evidence-of-crimes
narciso (d1f714) — 3/8/2017 @ 4:32 pm
i think we should understand right now that when congress rejects sleazy paul ryan’s half-assed and deeply dishonest bill

that this is to be understood as a vote of no confidence in this p.o.s. wiscotrash romney tool
happyfeet (28a91b) — 3/8/2017 @ 4:37 pm
and President Trump needs to stop listening to his stripper daughter and do what he promised

this is just getting nasty
happyfeet (28a91b) — 3/8/2017 @ 4:40 pm
and stupid

nobody wants little boy ryan’s buttsuck healthcare plan

NOBODY

it’s not even a serious plan
happyfeet (28a91b) — 3/8/2017 @ 4:41 pm
and the fact that it slops these puerile lifeydoodles who think the whole goddamn whirl revolves around some goddamn ill-begotten fetus in baltimore

they can go eat a poop i think
happyfeet (28a91b) — 3/8/2017 @ 4:46 pm
And you were weaned by wolves and abandoned to protomolecules
narciso (d1f714) — 3/8/2017 @ 4:52 pm
no i just have very conservative sensibilities when it comes to repealing the obamacares

been like this my whole life
happyfeet (28a91b) — 3/8/2017 @ 4:56 pm
i’M WITH YOU HAP.

Not so much sunshine today.
ThOR (c9324e) — 3/8/2017 @ 5:10 pm
One thing that might help prepare Americans for the required major change is to tell them just what damage Obamacare did to healthcare and to the economy and why it was done. It has to go. Spend some time telling the story – it’s a very compelling one – get it fully socialized with the people and then get real about the numbers. Introduce/roll it out in phases if need be, but have a plan that allows choice, forces people into having skin in the game, get serious like a heart attack about tort reform and all that adds to the cost of healthcare and open things up across state lines.

Stop the sniping and get serious about it.
Colonel Haiku (2601c0) — 3/8/2017 @ 5:11 pm
they’re problematizing something so terribly simple

here’s what would help mollify me

make everyone vote on a straightforward repeal

let mitt romney’s jockstrap sniffer-boy vote

let that self-important lobsterpot bimbo vote

let Meghan’s coward daddy vote

and let Rob “I’ll throw all my constituents straight onto the medicaid like the disgusting ohio losers they are” Portman vote

you know who else should vote is harvardtrashy ben sasse

all of them

we should know where these filthy congress-sluts stand

after that if they wanna vote for the sleazy economy-raping Ryan bill then fine
happyfeet (28a91b) — 3/8/2017 @ 5:19 pm
Well there’s goose graham, fideloflake, that come mind;
http://www.centerforsecuritypolicy.org/2017/03/07/some-quick-thoughts-on-the-leak-of-cia-hacking-documents
narciso (d1f714) — 3/8/2017 @ 5:24 pm
There ain’t no free lunch and I find the thought of the federal government playing Jesus to the American people absolutely appalling.
Colonel Haiku (2601c0) — 3/8/2017 @ 5:26 pm
@ DCSCA, #39:

No, it’s not. Except,perhaps, in the very narrow sense that it will “conserve” many ofthe worst things about the dumpster fire we have now.

@ Sammy Finkleman, #42:

Yes, I know. As far as I’m concerned, this is TrumpCare. As far as Trumpies are concerned, this has to be anything but TrumpCare.
Demosthenes (09f714) — 3/8/2017 @ 5:36 pm
Happy, there’s no escaping these guys, I tell ya…http://gma.yahoo.com/former-utah-gov-jon-huntsman-accepts-nomination-russia-002106247–abc-news-topstories.html
urbanleftbehind (c53904) — 3/8/2017 @ 5:40 pm
Who put it together, largely Ryan and Mcdonnell, who are fair weather friends to this administration, had their been a successful challenge to either, the board would be different,
narciso (d1f714) — 3/8/2017 @ 5:41 pm
that’s nauseating
happyfeet (28a91b) — 3/8/2017 @ 5:42 pm
you guys pushing the “binary outcome” thing don’t get it
if we had all just voted for barry goldwater, then things would be better

it was never a choice between mr donald and nasty hillary
Cruz Supporter (102c9a) — 3/8/2017 @ 5:42 pm
51. That was a job for a about to turn 50 Ronald Reagan, who actually did spots to that effect. Who today could pull that off withouth coming off as a meathead or a partisan?
urbanleftbehind (c53904) — 3/8/2017 @ 5:43 pm
And while we’re at it, eliminate Cadillac healthcare plans for all county, state and federal workers. They are unsustainable and a drain on the taxpayers. And there’s a pension bomb coming to a state capital near you.
Colonel Haiku (2601c0) — 3/8/2017 @ 5:52 pm
The tentacles have long since buried into the infrastructure, the head of the hospital association is a protege of David obey for instance.
narciso (d1f714) — 3/8/2017 @ 5:52 pm
But personnel is policy:
https://www.whitehouse.gov/the-press-office/2017/03/07/president-donald-j-trump-announces-key-administration-posts
narciso (d1f714) — 3/8/2017 @ 6:07 pm
It’s hilarious listening to nevertrumpers run down his supporters. See, we haven’t forgot how you kept telling us Trump was only running to get Hillary elected, there was no difference between the two, Trump couldn’t win, he was going to lose congress for us, and another dozen lies.

Well, Trump won, was the only one that could have beat Hillary, and if she had won we would be bystanders watching her implement single payer, mass amnesty, bringing in hundreds of thousands of Islamic refugees, nominating liberal SCJ’s (Ginsberg would have already announced her retirement), gutting the second amendment, forgiving student loans, and another score of soul crushing moves.

So, just so you know, your mockery is like the lamentations of the women of a beaten foe. Keep it up, it gladness the heart and satisfies the soul.
Leon (3ad005) — 3/8/2017 @ 6:50 pm
They have short memories, Leon. And like liberals, they don’t shame or embarrass easy.
Colonel Haiku (2601c0) — 3/8/2017 @ 7:24 pm
Its like they look at ’24 and say how can we bring this about:

http://www.foxnews.com/us/2017/03/08/lawmakers-probe-claim-doj-aided-iraqi-terror-suspect-days-before-november-election.html
narciso (d1f714) — 3/8/2017 @ 7:51 pm
Oh please.

Are all Trump supporters–the same?

However was Trump unusually nasty? Were his supporters just peaches and cream to all the other candidates?

No.

Could another candidate have wiped the map with Hillary? Quite possibly.

Don’t get cocky in your Trump win–look at the landslide George Bush Sr. had against Dukakis–then what happened?

Also–is it possible that Hillary was even less likeable than Dukakis? Most signs point to yes.

Also while we are at it–most GOP candidates for Senate outperformed Trump even the ones that were slated to lose like Toomey and Johnson.

Also–is it quite possible Trump isn’t all that into a Republican Senate and would love to have an excuse as to why he couldn’t get certain things accomplished–and whoops–he needs to do that single-payer plan he once mentioned in order to save ObamaCare from itself?

You guys have been nasty as hell all over the map.

And if it was any other Republican getting squared up as a “Russian agent” I bet most of you would be just salivating with your long knives out.
Rae Sremmurd (2fd998) — 3/8/2017 @ 9:00 pm
@ Leon, #64:

See, we haven’t forgot how you kept telling us Trump was only running to get Hillary elected, there was no difference between the two, Trump couldn’t win, he was going to lose congress for us, and another dozen lies.

Well, let me see. I never said the first, though I did say I wasn’t prepared to rule out the possibility based on Trump’s past political views. I never said the second — in fact, I admitted there were differences — but also said I didn’t care to parse which would be worse. And I never said the fourth, either. I never would have. I did think Trump might lose the Senate, but I never thought he would lose the House.

The third one? That Trump couldn’t win? Yeah, I said that. I believed it, based on what I thought was solid reasoning supported by evidence. So, apparently, I was wrong. That happens. But if I tell you something wrong that I genuinely believe, you half-witted, thrice-accursed, wretchedly degenerate excuse for a “conservative,” it is not a lie. It is a mistake. You, on the other hand, keeping up the “only Trump could beat Hillary” crapola in direct contravention of every poll that showed him the least likely of the last major candidates to win —

Well, yes, I suppose that doesn’t make you a liar. It just makes you intellectually dishonest. But you support Trump, so big shock there.

@ the Colonel, #65:

What a self-indicting comment. I have yet to see you exhibit any shame or embarrassment, even as you take thinly veiled potshots at our host…and then, when he calls you out (far less often than you deserve, by the way), you simply lie and say “I wasn’t talking about you.” I mean, for heaven’s sake, man, grow a spine. At least when I was taking shots at Ace, I made it plain what I was doing. You, on the other hand, are a coward.

The sad thing is that Patterico seems to believe you, every time…even when the insults couldn’t be plainer. You must have a lot of cachet with him, built up over years, to keep trotting out that same tired ploy. Got news for you, though, buddy. No account has an infinite amount of money. You’ll overdraw yours eventually.
Demosthenes (09f714) — 3/8/2017 @ 9:14 pm
Ah Cochran how could I forget him, the Mississippi merrygoround is for a reason; pat Roberts another collection of cartilage.
narciso (a3f4e8) — 3/8/2017 @ 9:16 pm
https://www.cato.org/blog/supposed-fbi-investigations-refugees-shouldnt-scare-you

Well that’s a relief, till the next unlikely candidate slips throigh
Achilles (a3f4e8) — 3/8/2017 @ 9:36 pm
Patterico’s not a NeverTrump guy, Demosthenes. He’s had a few good things to say when he sees something he believes worthy of it, even though he dislikes the new POTUS. Quite unlike you. You are not of good faith. You are tedious, at best. And your posts read like they’re scribbled by a tired, drunken spinster who’s had a bit too much brandy.

Bugger off.
Colonel Haiku (2601c0) — 3/8/2017 @ 9:57 pm
“It’s hilarious listening to nevertrumpers run down his supporters. See, we haven’t forgot how you kept telling us Trump was only running to get Hillary elected, there was no difference between the two, Trump couldn’t win, he was going to lose congress for us, and another dozen lies.”

I wouldn’t necessarily characterize them as “lies”, but their predictions fell quite short of reality. And there were many made in this vein and they were made for months. And several posters also said they were looking forward to the “I told you so’s”.

And it continues.
Colonel Haiku (2601c0) — 3/8/2017 @ 10:11 pm
1) I complimented the selection of Gorsuch, for a start. If you had good faith, you’d give me a bit of credit there.

2) To extend that point, you saying I’m not of good faith is like Tommy Wiseau saying Chris Columbus is a bad director.

3) It’s port, not brandy. Come on, man, can’t you tell the sound of one from the other?

4) I’ll stay where I please, chico. You don’t run Bartertown.
Demosthenes (09f714) — 3/8/2017 @ 10:13 pm
Oh, you fussy old queen you.
Colonel Haiku (2601c0) — 3/8/2017 @ 10:25 pm
One thing that might help prepare Americans for the required major change is to tell them just what damage Obamacare did to healthcare and to the economy and why it was done. It has to go. Spend some time telling the story – it’s a very compelling one – get it fully socialized with the people and then get real about the numbers. Introduce/roll it out in phases if need be, but have a plan that allows choice, forces people into having skin in the game, get serious like a heart attack about tort reform and all that adds to the cost of healthcare and open things up across state lines.

Stop the sniping and get serious about it.

Totally agree.

Here’s the problem. Trump is pushing against all that. He wants this bill, or a bill very similar to this bill, passed.
Patterico (5f0ab0) — 3/8/2017 @ 11:05 pm
I’m curious to see if President Trump will figure out that he’s been played.
ThOR (c9324e) — 3/8/2017 @ 11:42 pm
“I think the White House, the administration and the president understand that there’s enough conservatives that they can’t pass ObamaCare Lite,” Paul told CNN’s “New Day” on Wednesday.
Colonel Haiku (f0e797) — 3/9/2017 @ 5:26 am
David Yates, seems to have done a good job with the last few installments, his tarzan one was surprisingly good.

Bier seems to prove increasingly dishonest, like the worst in western europe
narciso (d1f714) — 3/9/2017 @ 6:07 am
Republicans ran on a very simple promise: repeal and replace ObamaCare. Now that they’re in office, they remind me of the Joker in the scene from the Dark Knight in which he says: “Do I really look like I have a plan? You know what I am? I’m a dog chasing cars. I wouldn’t know what to do with one if I caught it!”

I thought the gag in this scene was that the Joker was a pretty plan-oriented guy and was manipulating Dent and the wider public. Sort of like Jon Gruber, only with a semblance of moral fibre and the decency to get his own hands dirty.

On the other hand, in the same scene he delivers a rather brutish paraphrase of one of Hayek’s omnipresent themes:

You know, they’re schemers. Schemers trying to control their little worlds. I’m not a schemer. I try to show the schemers how pathetic their attempts to control things really are.
JP (f1742c) — 3/9/2017 @ 6:12 am
https://www.washingtonpost.com/news/volokh-conspiracy/wp/2017/03/08/the-great-anti-semitism-panic-of-2017/?utm_term=.a9d45b79c823
narciso (d1f714) — 3/9/2017 @ 6:19 am
“MARCH 9, 2017
JOHN HINDERAKER: Is GOP Health Care Bill a Disaster? No.

Peter Nelson, my colleague at Center of the American Experiment, is one of the country’s leading experts on health care policy. On the Center’s web site, he urges conservatives to take a deep breath and understand the constraints that Congressional Republicans are working under.

In particular, a full repeal of Obamacare must get through the Senate, which means it must get 60 votes. There are only 52 Republican senators. Therefore, the first bill that has been unveiled is intended to be passed under the reconciliation process, which requires only a bare majority. Only Obamacare provisions that have a budgetary impact can be repealed in the reconciliation bill. Other measures will have to follow afterward.

Read the whole thing, although I’m still not convinced that a bad law with GOP fingerprints on it is an improvement over a worse law with Democrat fingerprints on it. Politically it could be much worse.

There’s an argument to be made that in order to keep up hope, the GOP has to be seen doing something about ObamaCare. But the Reid Option, followed swiftly by a full repeal, would actually accomplish what the Republicans have been promising for seven years and four election cycles now. In other words, doing what their constituents sent them to Washington to do.

The current mess looks more like a “You Had One Job!” meme.”

https://pjmedia.com/instapundit/259355/
Colonel Haiku (f0e797) — 3/9/2017 @ 7:28 am
81 is exactly what I’ve been saying in this thread and the previous one.

There is only so much you can do with 52 votes in the Senate.

The most significant component of Obamacare that can’t be repealed with 51 votes is the requirement to cover pre-existing conditions. That’s a huge expense imposed on insurers. Until you have 60 votes to repeal that you cannot have a “free marketplace” because that requirement will make premiums unaffordable for a huge chunk of the population, and much more expensive for everyone else if the subsidies/tax credits are taken away.

So do what you can with 51 votes, work to elect more GOP Senators in 2018, and if you get 56-58, they there’s a decent shot at flipping the 3-4 Dems that will be needed.
shipwreckedcrew (56b591) — 3/9/2017 @ 7:37 am
Subsidize only catastrophic care for pre-existing conditions.

That is, after a large deductible, cover pre-existing, for those who cannot afford it (means test).
Steven Malynn (d29fc3) — 3/9/2017 @ 7:44 am
the sheer worthlessness of pervy mitt romney’s jock-sniffing speakerboi can’t be overstated

paul ryan’s a useless p.o.s.

something needs to be done
happyfeet (28a91b) — 3/9/2017 @ 8:22 am
They’ll never get a single minority party vote by following this strategy. Ryan promised regular order instead the bill is being rammed through committee in a race to the floor. At least McConnell’s not pretending to return to regular order but he is surrendering to the theat to screw up the Senate calendar but not acquiescing to a vote. The Gorsuch filibuster threat crumbled because of a good pick and a minority realization that they had more to gain by backing off. Do that. Lather, rinse, repeat. Filibusters don’t stop Senate passage, majority surrender does. McConnell knows how to use the rules to get around them he just doesn’t want to.

I don’t underestimate the difficulty in building bipartisan support but there’s never a good time to do the wrong thing. Obamacare is causing bipartisan suffering there is a bipartisan solution out there if the leadership would step away from the power politics of take or leave it. Regular order is the consensus building process everybody wants but nobody enjoys going through.

Cotton’s argument to slow down and do it right makes the most sense to me. Sunset Obamacare far enough down the road for individuals and groups to adapt to the patient-centered care model to replace the big government mega-corp model. Abandon the fierce urgency of now and return to regular order which will defang the no-way, no-how opposition pattern we’re stuck in.

Some will say this is naive or unrealistic. The counter-argument is that it’s naive or unrealistic to believe the republican majority will deliver on years of campaign promises by remaining in the same cycle of must-pass power politics that’s limited by a fear of cloture votes. Fear not.
crazy (d3b449) — 3/9/2017 @ 8:25 am
http://www.businessinsider.com/paul-ryan-powerpoint-presentation-gop-obamacare-replacement-2017-3

Rush Limbaugh says ran some of this (I missed it).

Paul Ryan says, if I understand what Rush Limbaugh said was his point correctly, that Congress created this problem and they can’t just let Obamacare disintegrate. And yes, he knows it is not a market based solution right now.
Sammy Finkelman (4a6ffc) — 3/9/2017 @ 9:36 am
shipwreckedcrew (56b591) — 3/9/2017 @ 7:37 am

There is only so much you can do with 52 votes in the Senate.

Mark Levin said last night on the radio theer’s actuall;y more you can do with reconciliation than they are admitting. He says someone talked to him and told him this:

Donald Trump said he needs the support of the Governors. Most Republican Governors – even Republican Governors – took the expansion of Medicaid. Fpr taht reason Medicaid as it is under the PPACA is extended through 2020. (Cutting it down will blow a hole in their budget, create political problems etc.)

What they really have to do is get rid of Medicaid. If there is a sound replacement for low income people, people on Medicaid can also be put into that system, with maybe some tweak so that if they like ther doctor they can continue to use their doctor.
Sammy Finkelman (4a6ffc) — 3/9/2017 @ 9:55 am
There is a conservative objection that with refundable tax credits people will be getting back more money than they pay in taxes. The Wall Street Journal editotial oage points out that they didn’t bother to object to that when refundable tax credits were included in virtually every Republican health care plan – Tom Price’s Empowering Patients First act, which has been around in some form since 2009, and which Mark Meadows, the chairman of the Freedom Caucus was one of its 84 co-sponsers in the last Congress; the Coburn-Burr-Hatch plan of 2014; the Ryan-Kline-Upton plan of 2014, and the consensus House “Better way” plan of 2015, which was also worked out with Senators. I could mention McCain’s plan of 2008.

I think the obbjection could be mollified if the tax credits were partially funded by a new consumption tax. Everybody who lives in the United States pays, or hopes to pay, a consumption tax.
Also, at the individual level, you can’t get into the position of owing back taxes, as you can with an income tax. The type of consumption tax that might get soem democratic votes is someform of a carbon tax, maybe not covering all items, so it be argues that it can’t be mistaken for a futile attempt to fight global warming.
Sammy Finkelman (4a6ffc) — 3/9/2017 @ 10:08 am
What they really have to do is get rid of Medicaid. If there is a sound replacement for low income people, people on Medicaid can also be put into that system, with maybe some tweak so that if they like ther doctor they can continue to use their doctor.

Sammy Finkelman (4a6ffc) — 3/9/2017 @ 9:55 am

Might be worth looking at. Partial funding provided by a huge Hollywood tax i.e., eliminate all write-offs and opportunities for financial monkeyshines.
Colonel Haiku (f0e797) — 3/9/2017 @ 10:29 am
shipwreckedcrew (56b591) — 3/9/2017 @ 7:37 am

The most significant component of Obamacare that can’t be repealed with 51 votes is the requirement to cover pre-existing conditions.

Nobody wants to repeal at anyway, though, if it means their care won’t be paid for.

Maybe there is an arguuent that changing anything about the finances of medical care can be done. The Parliamentarian may say no, but you can overerule the Parliamentarian.
Sammy Finkelman (4a6ffc) — 3/9/2017 @ 10:31 am
The thing about Medicaid, that people are not warned about, and taht Obama ignored, is if anyone on Medicaid comes into money, people can be required to pay it all back. Not only that, but deadbeat fathers can also be required to pay it all back (which insures they never will try to clear up the back child support amount owed because it only goes to reimburse the government.)

Budget calculations probably assume a lot more will be paid back than actually will.
Sammy Finkelman (4a6ffc) — 3/9/2017 @ 10:36 am
That’s a huge expense imposed on insurers. Until you have 60 votes to repeal that you cannot have a “free marketplace” because that requirement will make premiums unaffordable for a huge chunk of the population, and much more expensive for everyone else if the subsidies/tax credits are taken away.

What you can do to covere pre-existing conditions and avoid both the death spiral and any other attempt to make people buy unpriced health insurance is:

1) Require insurers to charge everyone the same premium for a similar policy, regardless of age or medical condition. There could be a dozen standard policies. All of them charge all comers the same premium.

2) Reflect differences between individuals only in the size of the deductible. Not the premium.

3) Give everybody a tax credit sufficient to cover an average deductible and more, with the money being lost if not spent over two years, but convertible into insured (against going out of business) medical credits issued by providers, or donated to pay somebody else’s bills, with some grace period after the expiration date for that, and other ways to recover from an expiration.

This would not be usable for insurance, though – only full pay, deductibles and co-pays for anything considered a medical expense. Credit card companies have catalogued a lot of that, and many state sales taxes the rest.

4) Give everyone a second tax credit which can be used for insurance.

5) If anyone is charged more than what the credits are there is a cap on what they be held responsible for – maybe $30,000 a year and $100,000 over 30 years. It might have to be that high.

6) The gap can be filled by:

A) Savings

B) Donation

C) HSA savings

D) Regular loan of any kind.

E) Special medical credit card loan.

F) Borrowing from the IRS – up to $3,000 or $6,000.

G) Borrowing from Social Security, with future Social Security benefits as collateral, whether someone reasonably expects to collect benefits or not. The money can be paid back and lost benefits, which cannot exceed three years worth, restored. If not restored, a person could still retire at the same age but would be treated by Social Security as being up to 3 years younger. (3 years worth of benefits is maybe only $50,000, not $100,000, but maybe, because people would be reluctant to do so, take away only half the acturial value of the loan. Maybe do it on alsifing scale. This needs to be worked out.)

Anything above the gap, or doughnut hole, or beyond the personlly liable epenses, paid for the federal government in the following manner: Insurance companies may package policy chunks for reinsurance, with them being auctioned off to the lowest bidder – federal government pays the lowest bidder what was bid. Maybe some ability by bidders to reject a certain percentage of policies, if done via pre-written algorithms – and then they get thrown into an even higher risk pool, and the auction is repeated.

There needs to be soemthing included that prevents surprise billing.

It’s actually better to do this through reconciliation than through regular orderr, because then you are not loimited by budget limitations, and do not have to honor CBO estimates. I think reconcilation cannot add to the deficit, but there are lots of ways to handle that.

So do what you can with 51 votes, work to elect more GOP Senators in 2018, and if you get 56-58, they there’s a decent shot at flipping the 3-4 Dems that will be needed.

It’s already enough if they can see the loss of Senate seats coming. But thee must not be any complicating issues.
Sammy Finkelman (4a6ffc) — 3/9/2017 @ 10:44 am
“I wouldn’t necessarily characterize them as “lies”, but their predictions fell quite short of reality. ”

Well Colonel, the reason I characterized them that way was because they were most often delivered as incontrovertible facts, accompanied by the smug assertion that those in dispute were suckers being conned. Seldom were these “predictions” stated as a difference of opinion. Had that been the case, I would have been more charitable in my choice of words.

” But if I tell you something wrong that I genuinely believe, you half-witted, thrice-accursed, wretchedly degenerate excuse for a “conservative,” it is not a lie. It is a mistake.”

So you genuinely believed a lie. Call me names if it helps, like I said it makes me smile.

Also, I no longer identify as a conservative, just as Patterico no longer identifies as a Republican. Conservatives conserve nothing but their own self-righteousness as far as I’m concerned. #31 was Bang on if he would have said “conservatives” instead of “bunch of establishment Repubs”:

“You know what I think? I think there are a bunch of establishment Repubs who don’t want to be in the majority. They are more comfortable sitting on the sidelines sniping.

Bang Gunly (5a4596) — 3/8/2017 @ 3:08 pm”
Leon (3ad005) — 3/9/2017 @ 12:15 pm
I think the essential problem with the Republican plan,,,is what was wrong with Obamacare. They;re making compormises wth reality.

They are pretending that health insurance is less expensive and more affordable than what it really is – the $3,000 tax credit everyone not on Medicaid and making below $75,000 a year would get – maybe adjusted for age etc. is not enough to prchase health insurance, and people probably then won’t buy it. Or maybe they will buy some catastriophic whose deductible they will have no hope of paying.

They also are pretending adverse selection and a death spiral spiral can be avoide dby charging people who have gaps in inusrance an extra 39%, The problem there is that the 30% won’t pay the costs for thse who sign up late. People who sign up later have an average usage of 30% more ,but that’;s like taking of the average income of people in a room that includes Bill Gates. Theer are asmall minoroty of people whose expenses are enormous. It’s those people who will sign late.
Sammy Finkelman (4a6ffc) — 3/9/2017 @ 5:08 pm
The more I read and hear about this bill, the more I like it. It looks to me like it helps people who work for a living and have kids to raise but don’t make all that much money or have great benefits packages, and “hurts” mainly the food stamp recipients and dopers. And that last part is not for sure, either, until we see how the Medicaid expansion goes.

If the “free market” was under the impression that the new President and Congress was going to restore the virginity that Obama had taken … when was that ever realistic?
nk (dbc370) — 3/9/2017 @ 5:48 pm
damn dopers stoled my big wheel when i was little

classic orange black one (not fancy green black one)

they’re gonna effing pay for that someday
happyfeet (28a91b) — 3/9/2017 @ 5:56 pm
i should take karate
happyfeet (28a91b) — 3/9/2017 @ 5:57 pm
don’t tell lindsey graham i’m taking karate
happyfeet (28a91b) — 3/9/2017 @ 6:01 pm
Karate is macchio and vandamme, krav mega is where its at now.
narciso (d1f714) — 3/9/2017 @ 6:08 pm
This seems interesting

http://emyallpolitics.com/index.php/yp/post/if_at_first_you_dont_succeed_as_rumored_state_sen._mcdaniel_looks_to_primar
narciso (d1f714) — 3/9/2017 @ 7:12 pm
link for Mr. narciso
happyfeet (28a91b) — 3/9/2017 @ 7:46 pm
Thanks now wicker Dorset seem as full of fail as Cochrane, but the clique will pull all the stops
narciso (d1f714) — 3/9/2017 @ 7:55 pm
According to the New York times today, only 3% of the U.S. population both buys health insurance through the Obamacare exchanges, and pays the ful price of that insurance.

The rest of the people wither get insurance through their employer [caveat – they might be paying full price] or gets it through the government (Medicare, Medicaid, Tricare etc) or has the cost of innsurance subsidized, or does not have medical insurance.
Sammy Finkelman (4a6ffc) — 3/10/2017 @ 1:05 pm
nk (dbc370) — 3/9/2017 @ 5:48 pm

It looks to me like it helps people who work for a living and have kids to raise but don’t make all that much money or have great benefits packages,

Actually it doesn’t if their income is low, or their age is getting close to 65, because the tax credit doesn’t come close to fully paying for a policy. One of the problems with Medicaid is if someone made just alittle aboove it they were much worse off in terms of medical insurance – that still remains. That is why the AMA is against this – doctors and hospitals won’t get paid what they charge. If someone is not willing to give up health insurance (theer are grace periods but nobody is educated about the ins and outs of that) they can try to get income. Of course without the mandate maybe a lot of people will forgo insurance.

and “hurts” mainly the food stamp recipients and dopers.

You may want the fopers to have medical insurance soo they can get treatment> Problem: A lot of that treatment could be worthless or overpriced.

Drug addiction treatment probably should just be paid for sparately, probably by Medicare, like kidney dialysis, and treatment for infectious diseases probably should be the same. And it’s only fair to include gunshot wounds. If you don’t do these things people will pushed onto Medicaid – and you know they are not so careful about accuracy when they determine eligibility, but they get more careful for renewals, and tghey certainly don’t help people find employment.

Medicaid is the only form of “insurance” that can be enrolled in retroactively.
Sammy Finkelman (4a6ffc) — 3/10/2017 @ 1:27 pm
Now it was discovered some years ago that people placed on Medicaid actually ad worse outcomes. While that maybe could be because people who visit doctors and hospitals were signed up for Medicaid at a higher frequency, it also could be because some medical reatment makes people worse, and we all know of examples.

Maybe one third of medical treatment helps peolle, a little more than half makes no difference and maybe one eighth harms people. (wild eyed guess)
Sammy Finkelman (4a6ffc) — 3/10/2017 @ 1:28 pm
Theer are so many crazy irrationalities the way things work now. Like audits to make sure people do not keep their divorced spuses on their health insurance. Or people getting jobs just for insurance – maybe even paying an employer to hire them.
Sammy Finkelman (4a6ffc) — 3/10/2017 @ 1:30 pm

3/8/2017

This Is How You Got TrumpCare: Republicans Don’t Know What They Believe Any More

106 Responses to “This Is How You Got TrumpCare: Republicans Don’t Know What They Believe Any More”

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