The GOP's health care dilemma

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Ned Flounders
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The GOP's health care dilemma

Postby Ned Flounders » Tue Mar 14, 2017 7:02 am

Here's what the situation looks like to me, in eight bullet points. I'm trying to be as fair and objective as possible in describing the situation. If you disagree with any of these points, convince me that I'm wrong:

1. Obamacare expanded coverage by taxing the wealthy and using those revenues to subsidize coverage for the poor and working-class. But to keep the ACA close to deficit-neutral, the subsidies were pretty stingy; so the benefits tapered off steeply as you moved up the income ladder. Thus, while ACA was an improvement for most people, some were stuck with too-high premiums or with too-high deductibles. It was a messy attempt to compromise, to expand health coverage without deficit spending or too-high taxes, and like all messy compromises it was easier to oppose than to support.

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Re: The GOP's health care dilemma

Postby Ned Flounders » Tue Mar 14, 2017 7:02 am

2. The GOP opposed ACA because they don't like redistributing wealth downward. However, this was not a popular reason to oppose ACA, so instead they campaigned on two different ideas simultaneously:

  • For the ideologically motivated, they said that ACA was big government run amok and needed to be flat-out repealed.
  • For the rest of the voting public, they said that ACA premiums and deductibles were too high and not enough people were covered. To solve this they would repeal ACA and replace it with something better.

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Re: The GOP's health care dilemma

Postby Ned Flounders » Tue Mar 14, 2017 7:02 am

3. The problem is that the latter promise ("we'll replace it with something better") is incompatible with the GOP's goal of cutting health care spending on the poor and working class. Lowering premiums and deductibles would require more spending, not less. Covering more people would require more spending, not less.

Basically, the GOP campaigned on promises that can't be kept. To some degree, every politician does this, but the GOP's position on Obamacare has been extraordinarily deceptive.

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Re: The GOP's health care dilemma

Postby Ned Flounders » Tue Mar 14, 2017 7:02 am

4. That was fine when the GOP was in opposition, but once they gained control of Congress and the Presidency, the contradictions became obvious. Repealing or scaling down ACA would make all the problems worse, not better -- millions of people would lose coverage; hospitals would be thrown back into the bad old days of having millions of uninsured show up at the ER in desperate need, etc. On the other hand, replacing ACA with something "better" would have meant spending more, not less.

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Re: The GOP's health care dilemma

Postby Ned Flounders » Tue Mar 14, 2017 7:03 am

5. Right up until the end, the Trump administration kept making these impossible promises. They literally promised that no one would be worse off, that no one would lose coverage. Those promises were obviously insane. Everybody with even a modest understanding of the situation knew that those promises could not possibly be kept.

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Re: The GOP's health care dilemma

Postby Ned Flounders » Tue Mar 14, 2017 7:03 am

6. Now the CBO and the White House's own internal studies show that over 20 million people will lose their insurance coverage, to provide hundreds of billions of dollars in tax cuts for the rich. Premiums will soar in the first few years, then drop later because essentially all the older and sicker people will be thrown off the insurance rolls.

This would of course be disastrous for the nation, and particularly for the rural, older, white working class voters who constituted a big part of Trump's voting base. Millions of them would lose insurance, and millions of others would see their premiums skyrocket due to the loss of the ACA's subsidies.

It would lead to over 24,000 additional deaths per year among those who lose coverage -- basically, one additional 9/11 every 4-6 weeks, forever.

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Re: The GOP's health care dilemma

Postby Ned Flounders » Tue Mar 14, 2017 7:03 am

7. The Trump White House knew this, because their own internal studies are even gloomier than the CBO's forecast:

Leaked White House Analysis Says AHCA Would Be Even Worse Than Predicted

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Re: The GOP's health care dilemma

Postby Ned Flounders » Tue Mar 14, 2017 7:05 am

8. Everybody hates the replacement plan. Conservatives in the House are threatening to defect because it doesn't go far enough. Moderates in the Senate are taking the opposite position -- the AHCA is much too severe and will throw millions off of Medicaid in red states. Getting one side on board will require changes to the bill that would further alienate the other side.

The GOP put itself in this dilemma. It wanted to seize every argument possible against ACA, regardless of the internal contradictions. That was fine when it didn't have to govern. Now, though, it has to fish or cut bait. Someone is going to be screwed. Faced with this entirely predictable bad news from the CBO, will they drop plans to repeal ACA, thus enraging their conservative base? Or will they proceed full speed ahead, and throw 24-26 million people off of health coverage, at a terrible cost to the nation and to their own states in particular?

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Re: The GOP's health care dilemma

Postby Ned Flounders » Tue Mar 14, 2017 7:07 am

OK, that's how I see it. Anyone disagree with any of the above?

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Re: The GOP's health care dilemma

Postby Roy » Tue Mar 14, 2017 7:26 am

Ned Flounders wrote:OK, that's how I see it. Anyone disagree with any of the above?

Best explanation I have seen yet, and may throw the Senate to the Dems in 2018.

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Re: The GOP's health care dilemma

Postby PaleoLiberal » Tue Mar 14, 2017 8:07 am

Agree.

I remember Paul Ryan's plan to privatize Social Security back in 2011.

Went down like a lead balloon. The reception may have been what prompted Paul Ryan NOT to run for Senate in 2012. That certainly didn't help among seniors.

So, what did the GOP learn from this?

First, they decide to run Ryan as VP in 2012. We see how well that worked. P*ssing off the seniors didn't help in Florida. Nor did Ryan's addition to the ticket carry Wisconsin.

Now, they really learned their lesson. After electing a presidential candidate Ryan completely hated, they give Ryan the job of overhauling healthcare.

Talk about self-inflicted wounds. This one in YUGE! The biggest and best self-inflicted wound in history! Nobody comes up with better self-inflicted wounds.

And this is just after the Democrats came up with their own self-inflicted wound. The Senate Democrats threatened to shut down the government over issues including a border fence. I'm sure that will get Tammy Baldwin DOZENS of votes in the south side of Milwaukee, but how would it play in the rest of the state. No worries. She can just help block the TrumpCare plan, and have a much easier path to re-election.

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Re: The GOP's health care dilemma

Postby Ned Flounders » Tue Mar 14, 2017 10:04 am

Roy wrote:
Ned Flounders wrote:OK, that's how I see it. Anyone disagree with any of the above?

Best explanation I have seen yet, and may throw the Senate to the Dems in 2018.

Thanks.

I think the Senate geography in 2018 is really, really bad for the Democrats -- so if anything, it seems more likely to throw the House than the Senate.

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Re: The GOP's health care dilemma

Postby Henry Vilas » Tue Mar 14, 2017 10:14 am



Let's see if he keeps his word.

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Re: The GOP's health care dilemma

Postby Ned Flounders » Wed Mar 15, 2017 5:18 am

Republicans Search for Someone to Blame for Trumpcare
http://nymag.com/daily/intelligencer/20 ... pcare.html

This suggests that the current plan may be:

1. Push the AHCA through the House so the GOP can say "Hey, we tried."
2. Let the bill die in the Senate.
3. Blame Democrats.
4. Move on to whatever is next on the GOP agenda.

I don't think conservatives will be very happy about that outcome -- it seems like a big letdown to just give up and move on.

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Re: The GOP's health care dilemma

Postby Ned Flounders » Fri Mar 17, 2017 11:21 am

This has got to give some GOP congresscritters heartburn:

AARP to Alert 38 Million Members How Their Members of Congress Vote on Health Bill
In a letter sent to all 435 members of the House of Representatives, AARP maintained its strong opposition to this harmful bill and urged each Representative to vote 'No' on the proposed legislation. AARP believes this legislation will have a significant negative impact on the health of millions of older Americans ages 50 to 64, as well as other vulnerable groups, including poor seniors and disabled children and adults...

http://www.prnewswire.com/news-releases ... 25482.html

But the Titanic cruises full speed ahead towards the iceberg:

House Republicans aim to vote on Obamacare repeal bill next week, NBC reports

Trump has stopped criticizing the GOP health bill and started cheerleading for it

Should be interesting.


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