I have no reason to be optimistic that a rational plan will be passed either., Iām not going to waste time debate the particularly of this bill because the senate version will be vastly different.
But philosophically there is actually a lot I like about the bill.
Pushing health care out to the states makes a lot of sense to me. States already regulate insurance companies, medical resource varies widely by state. State government is more responsive (especially nowadays) and they are in better position to make fixes to laws. The country is simply too big and diverse to have a one size fits all health insurance, California would be the 6th largest country in Europe and even tiny Hawaii has more population than 10 European countries, and Europe doesnāt have a single health care system.
The biggest problem with American healthcare system is that it is much too expensive for the quality of care in provides. The biggest problems with ACA policies is they are a rip off for young people and healthy people. and especially young healthy people. These type of people arenāt signing up for them which is causing insurers to lose money, and pull out of markets. Obamacare is dying and there is no long-term fix for a fundamentally flawed bill.
We simply have to focus on reducing cost on the system. I wish it was as simple as eliminating profit in the medical system or going to single payer. Letās say we eliminated all health insurance companies and replaced them with Medicare government employee which in theory might lower admin cost by 4 or 5% Even if we eliminated all profits in the system, taxed all pharma, medical device companies, for-profit hospitals at 100% of their profits, capped CEO salaries at say a $1 million, replaced medical lawsuits with arbitration etc. it just does not add up to that much money. Perhaps it would drive average healthcare costs down from over $10K/per person to $9K, but not much more and possibly less.
Many things in AHCA that people are screaming about actually at least steps toward controlling cost. This includes differential pricing for sicker people, eliminating lifetime caps. allowing states/insurance companies to offer policies with fewer benefits, and caps on Medicaid payments, and high-risk pools.
There is no doubt in my mind, that in many cases that the amount of dollars the Republican allocated to a specific program isnāt enough.
It is easy to scream about the heartless Republican killing people, but Obamacare would bankrupt the country or have collapsed in few years.
Nothing in the AHCA law prevents states from maintaining virtually all of the provisions of Obamacare, and if I and the Republicans are wrong then more states will adopt Obamacare, and perhaps in the future, some of the best practices could be made into a federal law.
Thatās interesting, but that might have another reading. Iāve always though charity worked really well in the US (Iām specially impressed by US billionaires philanthropic pushes, which I think are extremely unusual in the world), specially because the lack of government social support makes people consider charity and social organizations as more important for the correct functioning of society in general, since thereās a whole to fill that taxes and government programs are not filling.
That is, the data of how much individuals give to charity or to help others should be contrasted with the data of how much the countryās welfare system does to help the people in need (both in the country and through foreign aid, and as a percentage of GDP). I donāt really know the data, so this might be wrong, but my hunch is that in most welfare states people contribute (or feel that they contribute) with a big chunk of their taxes to the same causes that in states without a comprehensive network need charity of NGOs to prosper. Mind you, I find it telling and uplifting that civil society rises to compensate for the failings of the system.
On the specific subject of healthcare, I found this podcast by Dan Carlin compelling, even if itās just retreading arguments we have all read around here.
How odd, all those Red States are also quite religious. Couldnāt be a coincidence. (IOW giving to a Church while technically charity is also in many cases more RW grift - see the mega churches that proliferate in places like Texas.)
is a tax cut bill, period end of story. The intention is to let the sick, genetically inferior and old die because god dammit paying taxes is immoral.
/s.
The states that mostly canāt pay for what theyāre already dealing with and are generally terrible?
No thanks.
Hereās what Iowaās plan would be:
Nothing. Literally nothing. And weāre not exactly the South.
We canāt pay our teachers. Or anything. Because we gave $120 million in kick backs to Friends of Terry. And the Republicans decided that the people donāt matter and theyāre going to run the state like itās Mississippi in 1953.
Speaking of Iowa (Des Moines Register):
The Iowa Supreme Court issued an emergency order Friday halting the enforcement of a new state law requiring a 72-hour waiting period for women seeking an abortion.
Gov. Terry Branstad signed Senate File 471 at 8:30 a.m. Friday. The stateās highest court responded less two hours later by granting a temporary injunction at the request of Planned Parenthood of the Heartland and the American Civil Liberties Union of Iowa. The order was signed by Justice David Wiggins.
[ā¦]
Nothing suggests the 44 women scheduled to receive abortions from Planned Parenthood on Friday would have faced any harm under the new law other than having to reschedule their appointments, the stateās lawyers said.
But Suzanna de Baca, chief executive officer of Planned Parenthood of the Heartland, said the two-hour period between the time Branstad signed the law and when the temporary injunction was issued wreaked havoc on many patientsā lives.
āOne woman had driven seven hours to her appointment, only to be told she couldnāt have the procedure today; others were angry and upset at the intrusion into their lives,ā de Baca said.
In denying the request for a temporary injunction Thursday, Farrell said Planned Parenthood and ACLU-Iowa faced a high standard in making their case that the three-day waiting period is unconstitutional and creates an undue burden on Iowa women seeking an abortion.
(Oh and it doesnāt include exemptions for rape/incest pregnancies or for pregnancies āin which a genetic anomaly makes life after birth impossibleā.)
More detail on Iowa and healthcare:
We currently pay about 3.5 billion for it. Thatās a 39% share of the cost. And about 20% of our budget.
So weād be at around 50% without the feds. I can tell you what Terry and Friends would do: privatize everything and cut most of it. Because theyāre already doing it and have been for a while. States arenāt any less corrupt than the Feds, which we should have learned back in the Civil Rights era really.
You are right most of the studies Iāve read on charitable giving the attitude among Europeans is that it is the stateās job to help out the less fortunate and they pay high taxes to do so It is considered more of an individual or communities responsibility in the US.
The billionaire moon-shoot philanthropy is a recent phenomenon and seems to very much virtually only American tech entrepreneurs. The majority (62% per wiki) of hospitals in the US are non-profit or not for profit. and of those most are funded by charities, mostly nonreligious charities. Many of the finest hospitals in the country are non-profit and provide free care to the poor.
At the grass roots level charities these organizations are often religious, IIRC ~90% of soup kitchens are religious. When they work they, work very well. It is not often you get a libertarian like Megan McCardle praising Utah for how it handles inequality and progressive magazine praise them for how they deal with homelessness. The LDS church has huge influence on this.
Iowa seems to be doing pretty well in health and poverty measures in the top 1/3 of states in pretty much all measures including life expectancy. Not paying your teachers seems be working well top state for high school graduation and 11th for college.
See, the sort of discussion that Strollen is initiating is the sort of discussion we should be having at the national level, about health care. Agree with its premises or not, his argument is rational, based on reasonable (if of course debatable) assumptions, and has a logical and, theoretically, feasible goal. I could see reasonable people in Washington (assuming, ahem, there are any left) sitting down and hammering out a compromise through a conversation like this. I mean, Iām not nearly as sure that the states are the way to go, nor am I as pessimistic about the federal governmentās ability to deliver on a national health care initiative, but thereās nothing in Strollenās arguments that would preclude us starting a productive conversation.
But, well, so far, from what Iāve seen out of DC, this isnāt the sort of conversation thatās going on. Thereās a lot of grandstanding, a fair amount of Social Darwinism, and, yes, occasionally way too much glossing over of the clear weaknesses of the ACA. I will say, though, that the one thing that I donāt hear from the right is any sentiment that people actually deserve health care, and not as a commodity to be bargained for in the marketplace. To me, thatās the key philosophical difference between the two sides. Even if the ultimate compromise ended up being something both sides could live with, unless the fundamental attitude towards health care as a right as opposed to an option changes, we wonāt make much progress.
Iād agree with this if the states showed any ability to do the job. Many canāt even be relied upon to opt in to programs like expanded Medicaid. Consider also that state-level solutions generally are better for those who can afford to move to the best states, meaning itās another way to improve the lot of the rich at the expense of the poor.
I donāt think anyone disagrees with this, but I really donāt see it being addressed by either side of the debate.
I completely disagree with this. The AHCA is not controlling cost, itās transferring cost. The costs are still there, being paid by the less wealthy, older, and sicker constituents. You might save a little because some of those people just die off, but Iām confident thatās more than offset by the uninsured emergency room bills theyāll rack up before they shuffle off this mortal coil.
This. The AHCA does literally nothing to control costs other than arguably making it easier for insurance companies to make a buck by screwing certain people over. That has nothing to do with the costs of procedures or drugs.
Iowa is clearly declining in education rankings and has been for a while. It is not working well:
https://www.ed.gov/news/speeches/iowas-wake-call
A big reason the ACA was so unpopular was that a disproportionate share of the cost was paid by middle-class voters making just over the subsidy threshholds.
Iām aware. Obviously without addressing costs the ACA had to have a loser somewhere, and thatās where it fell. Which just as obviously sucks for those people, and should be fixed to be more equitable.
ACA prevents human tragedies, doesnāt actually fix the broken cost spiral in USA healthcare. AHCA is a craven attempt to enable those human tragedies again while also transferring a giant pile of money to the wealthy.
So, you know, itās a Republican bill.
Non profit hospitals get most of their revenue from billing people (or medical payors) just like every other hospital. They may get some funding from charities, but that rarely is used to offset bills. It is used for research, construction, and equipment purchase. They may have a couple of endowed beds in the hospital that are free of charge for indigent patients, but those beds are hardly representative of hospital operations. Depending on them is like depending on winning the lottery.
You could likewise point out that most private universities are nonprofit, get charity funding, and have scholarships. True, but tuition is still a significant barrier to access, in many cases insurmountable.
So while every other advanced industrialized nation manages it, we donāt get to have one because weāre too big? Whatās the cutoff, in terms of population? 200 million? 225 million? 231 million?
We already have one size fits all health insurance for old folks; we have one size fits all pensions for the elderly; we have a one size fits all army. But when it comes to health care, suddenly weāre ātoo big.ā
Sucks to be us!
There is one thing I like in the bill, the requirement for continuous coverage. Currently, itās too easy to game the system by waiting until you get sick to buy/ upgrade insurance. I believe you pointed that out years ago. Itās one of many such problems with the current ACA, problems that Congress has never addressed in the hopes that it would force a collapse.
Pushing it out to the states, however, is just a recipe to bankrupt poor people in red states. I understand how you reach that conclusion, because there is a basic disconnect between the GOP and the Democrats as to whether access to decent healthcare should be a right for all citizens (I should say āpart ofā the GOP, though, because a substantial minority of them now agrees with that basic premise), or whether should be treated as any other market commodity.
I view it as part of the basic philosophical difference between the parties: The GOP believes that we all have a duty to help ourselves and our families, but they do not extend that duty toward their fellow citizens. Those citizens must compete in the marketplace like everyone else. You can phrase that positively, by saying it encourages self-reliance and avoids growing a whole class of people dependent on government. Or you can phrase it as, āI got mine, so fuck you and your family.ā Both perspectives have some truth in them.
Itās not an intractable problem, at least if you leave the politics aside. Other countries do better. Theyāre not populated by geniuses, but simply by people who made different policy decisions. If the GOP really wants to ārun government like a business,ā letās consider this business fundamental: Identify best practices, including those in use by your competitors, then analyze and adapt them for your own use.
GOP congressmen have turned their phones off, including NY Rep Congressman John Faso, and theyāre unlikely to hold town halls in the upcoming recess. Dem Congressman Sean Patrick Maloney is now saying that, if Faso wonāt show up at town halls in his district to answer questions, Maloney will go in his stead.
Brief Maddow interview with Maloney: http://www.msnbc.com/rachel-maddow/watch/democrats-on-offense-over-unpopular-republican-health-care-bill-937743939959
I love this strategy, as it highlights not just the flaws of the AHCA, but also the cowardice of GOP reps afraid to face their own voters.
Continuous coverage was part of the problem before with pre-existing conditions. Someone could lose their job, no fault of their own especially saying in 2008-9, find another job in as little as say 2 months, but bam, youāve just had a break in coverage and fell into a six month waiting period on your new employer insurance. Unfortunately your condition doesnāt pause just because you canāt pay for the entire cost and your new insurance wonāt. So you either seek help, which there isnāt a lot of for someone in this situation or, more likely, you skip your medications and treatment for six months which leads to poorer health and potential complications of a manageable condition.
Iāve said it before. All these plans keep focusing on D and barely any if any attention on S. Yes you could game the system and wait until you were sick but only because so many people pushed against a real mandate.