After Obamacare

The long, tortured quest for a conservative health policy.

(Page 4 of 4)

Saved by Obamacare?

The shutdown ended on October 17. But sniping between the two anti-Obamacare camps continued. Norquist gave a series of interviews in which he leveled particularly harsh criticism at Sen. Cruz. "He pushed House Republicans into traffic and wandered away," Norquist told The Washington Post. Cruz responded with several speeches to conservative groups in which he defended the strategy and blamed its failure on the lack of conservative unity and the timidity of establishment Washington.

Meanwhile, Obamacare's exchanges were online. It was hard to imagine that the GOP would be able to start a productive conversation about health policy-what to do about it, and how to talk about it-at a time Obamacare was not only the law of the land but a working policy affecting millions of people's lives. As it turned out, they didn't have to.

Obamacare's glitch-ridden opening day ushered in a disastrous opening month. The federally run exchange system operating in 36 states was practically useless-a catastrophic failure of mismanaged government contracting and technology development. Several of the state-run exchanges experienced serious failures as well.

Suddenly, Republicans had a clear and united path forward: They would intensify their criticism of the law, holding hearings to find out what went wrong while blasting the administration for mismanaging the process. Obamacare's failures had saved Republicans from figuring out what to do about Obamacare.

The exchange mess kept Republicans busy. But the reprieve was almost certainly temporary. The GOP will soon be faced with the same old questions: What does the party stand for when it comes to health care? What, exactly, do Republicans want to do, and what is the method by which they propose to do it?

Some answers to these questions will depend on the outcome of the next several elections. "Given that they don't have majorities to pass legislation, Republicans have to understand the Obamacare fight as a longer-term fight that will require winning elections," Yuval Levin told me in late October. "The fundamental change that has to happen is going to require election victories for people who want to replace this law. And I think that means very different tactics than have been used in the last few weeks."

In the short term, that probably means going small. Big, comprehensive reforms make for big targets and big controversies, so scaled-down ambitions may win the day. "There are smaller pieces that we can break out," Rep. Price says. "We've begun the process of breaking our bill down into smaller pieces of legislation."

In the longer term, it means being patient, and learning to compromise. "Let's get to a free and open market in health care," says Norquist. "How do we get there? Are there baby steps? Maybe. There are some times you have to wait."

To an extent, the Republican Party is hampered by its relative inexperience. With a flood of new members, there has been a concurrent loss of institutional memory as long-time legislators and staffers depart. Republican aides say it's harder than ever to work through major legislative deals simply because so few legislators have a feel for the required compromise. "We don't have a Republican majority that remembers how to govern and understands how to juggle trade­offs," one health policy aide complains.

Substantial reform would mean sustained work over long periods of time, involving legislators, activists, and the policy community. It requires, in other words, a concerted effort much like the one Democrats and their allies made in the years prior to passing Obamacare.

Or, alternatively, like the one that Republicans have already started with Medicare. A decade ago, Republicans passed a deficit-funded expansion of the law-the prescription drug benefit that became Medicare Part D. But there was no consensus plan to restrain the entitlement's unsustainable long-term spending requirements, and limited-government Republicans pointed to Part D as a damning indictment of Bush-era conservatism. But over the years, Republicans slowly coalesced around a broad plan drawn up by Rep. Paul Ryan (R-Wis.)-a plan that many expect to be a centerpiece policy for any future Republican governing coalition.

Ryan's work on Medicare suggests that it's possible to bring Republicans together on meaningful health and entitlement reforms. His work also suggests the sort of steps that will be necessary for a plan to gain broader acceptance. Ryan offered multiple versions of his plan over the years, persisting even as GOP leadership kept its distance. As the plan caught on, Ryan met with virtually all of his Republican colleagues individually to walk them through the details, ensuring that they both understood and could explain what the plan entailed. And he worked across the aisle, signing on to a compromise with Sen. Ron Wyden (D-Ore.) that would leave traditional Medicare in place, even while expanding its menu of private options. The plan eventually helped earned him a slot as Mitt Romney's running mate in the 2012 presidential campaign.

Yet Ryan's struggle to convince his own presidential ticket-mate about the reform plan also suggest the limits of even the most diligent GOP policy entrepreneurship efforts. Ryan's Medicare reforms wormed their way into the congressional consciousness as part of a larger budget blueprint that was amended and reissued multiple times over the years, and eventually helped inform Mitt Romney's Medicare overhaul proposal in 2012. But despite the plan's influence, and Ryan's own slot on the ticket, Romney failed to explicitly endorse the Ryan blueprint for reforming Medicare, deciding a less detailed plan would be more difficult to attack.

That sort of calculated political timidity is why so few Republicans have reached the first step: simply coming up with a plan and then making it known. "There should be different approaches out there," says Levin. "They should be competing, and there should be a sense that Republicans want to solve the problems in the health care system, that they should have different ways of solving it than Obama­care, and right now they're thinking it through. But that's just not happening."

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  • Pro Libertate||

    Massive deregulation of healthcare and of medical services, sharp curtailing or elimination of government subsidies, allowing insurers to cross state lines, etc., etc., etc. Make medicine and insurance competitive, free market activities, and many of our problems will simply go away. If people at the bottom still need help then, at least they can be helped cheaply.

    Of course, the problem with the market solution or, really, any solution is the transition period.

  • Palin's Buttplug||

    Yes, start with Medicare. The elderly are the least productive and have the most means/assets.

    GOP = no balls though.

  • OldMexican||

    Re: Palin's Buttwipe,

    Yes, start with Medicare. The elderly are the least productive and have the most means/assets.


    Those means/assets are their kids' inherintance, so together with their least-productive parents or grandparents, the kids and/or the grandkids will keep voting to keep the program while making the rest of us pay for it.

    There will be no other transition period besides the Great Default. And a painful transition it will be, with millions of elderly people extorting their kids for assitance through hysterical accusations of ungratefulness. It will be fun to watch.

  • On The Road To Mandalay||

    OldMexican,

    How do you figure that "it will be fun to watch"? You must have a warped sense of humor.

    What should bother you and others like you is that none of this is a laughing manner.

    It's interesting how much is "lovingly" spent going to war all over the place, and we can't even take care of our veterans properly.

    What a shame that these political parties can't work together for the good of the American people. Who is it that they think sent them to the Belt Way in the first place?

    Ventura is correct in calling them the Demogrips and the Rebloodlicans. They act like two rival gangs instead of representatives of the People of the United State of American.

  • Redmanfms||

    Shit, you're still around?

  • On The Road To Mandalay||

    Redmanfms,

    I sure am still around. If you don't like it, why don't you complain to a site administrator, and maybe he/she will remove/have me banned from the site.

  • wareagle||

    right, PL. Folks, particularly in the DC bubble, assume that "no GOP (or other) plan" necessarily means no top-down, one-size-fits-most centrally planned approach. Folks act like the system became a cluster absent of govt regulation as opposed to being a result of regulation.

  • robc||

    allowing insurers to cross state lines,

    I would have done just this a few years ago and said "lets wait 5 years and see what happens". I think it alone would have made huge differences, as suddenly everyone is able to get low cost plans without mandated coverage. And networks would have greatly expanded.

  • Brett L||

    No way do the states give up the rackets they have right now. Insurance regulation is one of the huge levers of state government. For instance, when one of the bigs tried to exit the home insurance game in FL after 2006, the state responded by threatening to pull their auto insurance writing privileges. Not promoting this, just pointing out that it was huge for elected and appointed officials to be able to "do something".

  • Pro Libertate||

    So one time interstate commerce could actually apply, it doesn't.

  • Tony||

    And the fact we're fresh out of unicorns.

  • JWatts||

  • CE||

    Get rid of Medicare. If you don't have any savings or insurance by the time you're 70, sign up for Medicaid with the other disadvantaged individuals. Why should young working families subsidize healthcare for wealthy oldsters?

  • Tony||

    Because there aren't actually that many wealthy oldsters, and isn't it better and more efficient having a single standard instead of increasing the bureaucracy in order to means test? Yours is a solution in search of a problem.

  • On The Road To Mandalay||

    "Wealthy oldsters"? Really? Why not some sort of viable health care insurance system for all Americans? Why can't our two political parties work together on this? Why can't our two political parties work together on anything?

  • Michael S. Langston||

    You seem genuinely concerned...it must hurt to feel that much about everyone else... but all your "questions", which I assume are meant to be clever, are juvenile.

    Why not some sort of viable health care insurance system for all Americans?

    This is called "begging the question" - a better questions might be - why is this a legitimate government function?

    Why can't our two political parties work together on this?

    Maybe because some don't believe it's a legitimate government function and they are allowed to vote (until the re-education camps are built)?

    Or maybe because the founding fathers recognized that the most efficient governments in the history of human kind (and not that they knew, but of last century as well) seemed to really excel at mostly one thing - killing and enslaving their citizenry to benefit the connected.

    Understanding that and their goal of designing a government that would preserve freedom for the individual - one can see how they might (and did) specifically setup a system of gridlock (eg check and balances, open public debates, free speech/press, super majorities, etc, etc, etc, et al).

    Why can't our two political parties work together on anything?

    The media right?

    Or maybe you asked the wrong question - as explained above, this is a feature, not a bug.

  • On The Road To Mandalay||

    Michael S. Langston,
    You are an absolute genius. Keep up the good work, and keep on giving stern reprimands to those who ask "juvenile" questions. Nice posting with you ace.

  • R C Dean||

    Its literally unthinkable for the policy wonks and most politicians to do anything other than expand government, via new regs, new spending, and new bureaucracies.

    That's why the Repubs can't come up with a "final answer" to OCare. Because they can't imagine a final answer that doesn't involve more regs, spending, and bureaucrats than the status quo ante. Not necessarily more than OCare, but more than pre-OCare.

    So there's no way they would ever say "Our proposal is the full and complete repeal of OCare, period. Insurance is traditionally a matter for the states, and for good reason. Let the states, who are closer to the people than we are in DC, do what they think best for their residents, while DC gets out of their way."

  • CampingInYourPark||

    On January 19, 2011, in one of their very first actions after retaking majority control of the House of Representatives, Republicans voted to repeal the Patient Protection and Affordable Care Act, a.k.a. Obamacare.

    Looks like a proposal to me

  • John||

    I don't think you are ever going to get some huge sweeping reform. Obamacare has scared the country too much for that to happen again.

    But I do think that Obamacare is so idiotic and damaging that there can be smaller reforms that would while not fixing things at least make things significantly better.

    Lets start with repealing all of the regulations on mandated coverage. Then lets kill off community rating. Then get rid of all of the idiotic provisions of Obamacare like the one that requires charity hospitals to prove to the IRS their community has a need for such.

    Beyond that, Congress needs to think long term. The best way to make health care more affordable long term is to increase the supply of it. So how about instead of spending money to help people buy insurance they don't want, we spend some money to send more people to med school and nursing school and such? And while we are at it, lets see what we can do about allowing nurses and pharmacists to provide services that the AMA has restricted to just doctors.

    Instead of spending our time and efforts paying off insurance companies and fucking with people we don't like, maybe we should spend our time and efforts trying to make it medical care more plentiful. Just a thought.

  • wareagle||

    So how about instead of spending money to help people buy insurance they don't want, we spend some money to send more people to med school and nursing school and such?

    maybe things have changed, but nursing schools have long had a cap on the number of students admitted. A good many health disciplines do that, particularly at the community college level. Maybe that will change.

  • John||

    They do. And that should change as well. It is amazing to me how our "top men" are so concerned about the cost and availability of health care. But it never fucking occurs to them that one way to help with that is to build more medical and nursing schools or do anything else that would increase the supply.

  • wareagle||

    since most community and four-year schools are creatures of the state, seems our top men have actively limited the supply.

  • ||

    Yep.

    I mean seriously. The AMA being able to set caps on student admittance to med school is about as smart as the AIA setting caps on student admittance to architecture school.

    It's. Fucking. Retarded.

  • Don'tTreadOnMe||

    Being a product of and former educational leader in the US medical training system I agree that increasing the numbers of physicians and nurses and other allied healthcare professionals will help improve care and reduce costs. The barriers to accomplishing this are substantial although not insurmountable. That said, healthcare provider compensation is not a substantial portion of the 'excess' cost in our system. We need strategies to reduce drug and implant costs and hospital costs largely by reducing regulations that heap huge costs on the system. Good luck with that one.

  • Carolynp||

    They may have a cap, but they're doing everything except offering gold to get people to sign up. My mil was talking about going back to get a nursing degree and nearby state college offered free tuition, free books, and a nice stipend if she signed a contract to work for five years in the field after graduation. Not bad imho.

  • CE||

    Here's a suggestion:

    Let hospitals and doctors compete for patients by offering better customer service, higher quality and lower prices.

    Let insurance companies compete for customers by offering plans with better or more customizable coverage at lower prices.

    Let consumers decide how to spend their own money.

  • Fist of Etiquette||

    What Republicans don't have is a theory-a broadly shared vision of how health care ought to be delivered in America. Without such a shared understanding, one that can be easily and succinctly described by politicians and activists alike, it's hard to unite around, or even talk about, any particular plan.

    What's the theory underlying Obamacare? The mandate? There really isn't one, beyond empty promises of adding 40 million new people to insurance coverage. The GOP should try selling vague policy promises and then let their lobbyists write their bill for them.

    Of course, insurance coverage isn't healthcare, but they could always try focusing on bringing down costs instead of continuing to subsidize increases.

  • CampingInYourPark||

    What Republicans don't have is a theory-a broadly shared vision of how health care ought to be delivered in America.

    Good. Better even if all the political hacks stop having visions of how things should be done.

  • Palin's Buttplug||

    The theory of Obamacare is a market-based health insurance exchange.

    Where it goes off the rails is the individual mandate and federal subsidies to the indigent. People who want insurance aren't bothered by the former though.

  • CampingInYourPark||

    The theory of Obamacare is a market-based health insurance exchange.

    Except all this other crap that makes it the opposite of market based health insurance.

  • ||

    What in GW Bush's name is "market-based" about Obamacare.

    Because the last time I checked, the market is the cumulative voluntary transactions of people and businesses.

  • CampingInYourPark||

    Welcome to the Forced Free Market!

  • Libertarius||

    "Obama Macht Frei Markets"

  • On The Road To Mandalay||

    Don't even joke about the Nazis.

  • WhatAboutBob||

    The government-run healthcare.gov website says "Welcome to the Marketplace" so it must be market based!!

  • OneOut||

    HaHaHaHa !

    The theory of Obamacare is a market based health insurance exchange !

    HaHaHaHaHa !

    Say it again. That's funny.

  • Sevo||

    Palin's Buttplug|1.10.14 @ 11:00AM|#
    "The theory of Obamacare is a market-based health insurance exchange."

    Go fuck your daddy, you lying shitpile.

  • Carolynp||

    I was going to point out that if it's market based that proves that liberals really have no idea what capitalism actually is, but I think you stated it more succinctly.

  • On The Road To Mandalay||

    SEVO,

    If you said that to someone face to face, what do you think would happen? Insulting someone while hiding behind the cloak of internet cowardice is "delicious" is it not?

  • Sevo||

    On The Road To Mandalay|1.10.14 @ 6:07PM|#
    "SEVO,
    If you said that to someone face to face, what do you think would happen? Insulting someone while hiding behind the cloak of internet cowardice is "delicious" is it not?"

    Self-righteous troll noted.

  • On The Road To Mandalay||

    SEVO,

    As usual, when you can't answer a direct question, you resort to name calling. Troll is getting boring. You need to find some new material.

  • ||

    Lol!

    Coming from the guy whose only contribution to a typical conversation at Reason is telling people to stick their fingers up their anus, using an anonymous username...

  • On The Road To Mandalay||

    PM,

    Thanks for remembering me. It's so nice to be remembered. Too bad you don't know your anus from a hole in the ground. Have a fine day ace.

  • The Other Kevin||

    I have no respect for Republicans on this issue. During the Bush years, when the R's had a majority in both the house and senate, I was self-employed. However, I have a pre-existing condition so I wasn't able to find affordable insurance. At the time I was a member of NFIB and they were pushing simple changes that would have helped me - for instance, allowing purchase of insurance over state lines, and allowing insurance pools to be created by trade organizations. The Republicans could have easily passed these changes but they did absolutely nothing. And they are still proposing nothing.

    My family went 5 years without health insurance, then I decided it was too risky so I closed the business and went back into the work force. So fuck the Republicans. This, incidentally, is a big reason why I am now a libertarian.

  • John||

    The Republicans are in the hip pocket of the insurance companies just like the Democrats are. None of those changes would have made anyone rich. So of course Congress had no time or interest in them.

    Encouraging pooling is something that is not stressed enough. Let people pool in ways other than through their jobs. And further, make the insurance markets more competitive and flexible. It is never going to be great for someone in your position. But there is no reason why you can't be able to pool via a trade organization or something and be able to buy a less generous plan so that you at least have something.

  • robc||

    The AMA killed pooling sometime in the early 20th century.

    It was the norm until then.

  • John||

    Why did the AMA kill it? I am sure it was for some corrupt reason. But I can't see how they benefited.

  • NoVAHockey||

    historically, they fought insurance expansion fearing it would lead to reduced reimbursement.

  • Contrarian P||

    The AMA fought to have what was known as lodge medicine (because it was largely carried on by organizations such as the Moose Lodges and so forth) made illegal because they felt that it cheapened their profession and restricted the fees they could charge. The AMA does not have a great history, particularly when it comes to protectionism, but I think there is a lot of blaming the AMA here for all the ills of medicine which isn't really justified. These days, only about 20-30% of doctors belong to it and the organization is much less powerful politically than trial lawyers groups and other interests. Disclosure: I do not belong to the AMA nor am I interested in joining.

  • Carolynp||

    Mmmm...I think it's really hard to convince people they need change when they're happy and prosperous; which for the most part, people were during the Bush years. The only reason the ACA was passed was because of the market crash of 2009 causing a liberal majority in both houses of congress. Even at that, polls showed that 85 percent of US citizens were happy with their current insurance, so the only way to pass the law was via promising nothing would change for the 85 percent. I think we could end up with several libertarians in office in 2014 and 2016 because all of the sudden those morons woke up and realized that big government does have an impact on them.

  • James Anderson Merritt||

    "I think we could end up with several libertarians in office in 2014 and 2016..."

    Gad, I sure hope so, but I have been bitterly disappointed before. It is encouraging that 1% voted for Gary Johnson in 2012, though. I was beginning to believe I would never see even 1% go to an LP candidate in my lifetime.

  • ||

    What Republicans don't have is a theory-a broadly shared vision of how health care ought to be delivered in America. Without such a shared understanding, one that can be easily and succinctly described by politicians and activists alike, it's hard to unite around, or even talk about, any particular plan.

    So they don't have a TOP MEN plan? You get that that's the problem in the first place, right? That they even think--or anyone else does--that there can be a "shared vision or understanding" of how health care can be delivered? It's the very thought that such a thing can exist that causes the entire fucking problem in the first place. I don't want any fucking scumbag politicians deciding the first fucking thing about healthcare. I want to go find what I'm looking for in a free-ish market (I can't expect more) and figure out what I need with the individuals with whom I choose to do business. That's it.

    Fuck Obamacare, fuck any plan from the GOP, fuck anyone who thinks there can be some centralized or generalized theory other than "fuck off and let individuals interact with individuals".

  • John||

    I agree. I wish Suderman were bright enough to realize that no one should have a "broad vision" of how health care ought to be delivered. These are the times that I really fucking hate Suderman. It is none of Washington's business how my health care is delivered. And even if it was not even a real top man let alone the half wits who inhabit the place would be able to have one vision that is the right one for a country of 300 million people

  • robc||

    The times I hate Suderman are immediately after every one of his articles is posted.

  • wareagle||

    this has to be the bubble mentality. Live inside the Beltway long enough and some of it has to rub off.

  • kinnath||

    I have a broad vision of how health care ought to be delivered:

    "A million individuals making voluntary transactions to buy and sell services without some fucking dweeb in polyester pants sitting at a desk in D.C. writing regulations governing how every transactions must occur"

  • John||

    My broad vision is "however the hell people choose via their money to have it delivered". But I don't think either of our vision is top man enough for Suderman.

  • ||

    Maybe if a Top. Man. said it on TV in a speech like Kennedy's inauguration, then he'd agree.

  • Carolynp||

    ^^^This.

  • OneOut||

    The plan would be to de-regulate the industry now by repealing the market roiling regulations imposed by bribed Congressmen/women ( can't be sexists now can we ) that created the need for an Obamacare like vision in the first place.

    As one poster above said, that ain't gonna make anybody rich though, so there is no support for it.

  • ||

  • On The Road To Mandalay||

    Episiarch,

    I want the same sort of health care insurance plan my Member of Congress has, don't you?

  • RenaD||

    "Fuck Obamacare, fuck any plan from the GOP, fuck anyone who thinks there can be some centralized or generalized theory other than 'fuck off and let individuals interact with individuals.'"

    Exactly.

    The problem is, the Republitards don't have the guts to say so! As long as we keep looking to the government to provide "solutions" for us, we're going to have programs like Obummer Care.

  • On The Road To Mandalay||

    RenaD,

    So what is YOUR solution to all of this? YOU are an individual. Start coming up with a plan.

  • Jefferson's Ghost||

    Post of the day. No plan but real free enterprise will fix the mess.ill gladly take a pay-cut to see it happen.

  • Floridian||

    After Obamacare I'm looking for a new job. The hospital I work at serves a large Medicaid population and that market segment is expanding. They cut my compensation package by 20k/year to offset the decreased payments from Medicaid and increased insurance cost. No hard feelings to the company, they're just trying to survive, but I'm not that charitable. I have an interview on the 24th. With any luck I'll have a new job in 1-2 months. Thanks President Obama, at least you delivered the change and hope. My salary changed for the worst, and I hope I get a new job.

  • kinnath||

    You may have thought you had a job, but it wasn't really a good job. So Ocare will not force you to get a "real" job somewhere else.

  • Floridian||

    The thing that sucks is I like doing trauma. I like helping people that are hurt and scared and just want to know the pain will go away and somebody cares about them. However, I have bills to pay and don't want to spend my entire life at work. That leaves moving to a hospital that does more profitable surgeries. Don't get me wrong, you are still helping someone when you take their gallbladder out but it becomes routine.

  • kinnath||

    The country is now run by people that are shocked, truly shocked, that a vase actually falls to the ground and breaks after you shove it off the desk.

  • Carolynp||

    I feel badly for you, and I've been in your position. It's hard to put a dollar amount on job satisfaction and having someone else do it for you really stinks.

  • kinnath||

    So Ocare will not now force you to get a "real" job somewhere else.

    sort of changes the meaning a wee bit

  • kinnath||

    And I put it in the wrong place. I quit.

  • robc||

    I thought you were switching to Brooks-style postings.

  • kinnath||

    I would like to take credit for that, but that would be dishonest ;-)

  • Smilin' Joe Fission||

    The one place I need help with is what to do with the elderly in a free market. This is always where I trip in explaining how a free market health care system would work.

  • Rich||

    What do you do with an old, say, car in a free market?

  • ||

    Maybe if their children aren't having to spend so much on their own health care, they'll be able to help their parents out?

    Or maybe we should not expect that we will be able to retire at 65 and live another 30 years with no income.

  • Brett L||

    They spend their childrens' inheritance paying long-term care insurance. If you buy LTC insurance at 55, you can buy 30 years worth of coverage for a very reasonable price. Perhaps $1000 per year. Enough old people get hit by buses or drop dead to pay off the million dollar cancer fights.

  • Smilin' Joe Fission||

    This is the sort of stuff I'm looking for. It makes sense. This, for some reason, is the hardest part of the equation for me to really hammer home to people that free market healthcare isn't some inhumane system.

  • Floridian||

    I like though experiments too. One thing I keep coming back to in a free market is that "I" don't have to have the all the answers. With hundreds of millions of people trying to find the solution, the best answers will present themselves given enough time. I think this is why most people gravitate towards statism/religion. They don't care if the answers are correct they just want answers to the big questions in life so they can feel safe. Obviously top men (priest/presidents) have to best chance at picking the right answers.

  • Brett L||

    Hell, my parents bought policies at age 62 after watching my dad's mom go with $500k+ in care expenses for $5000/year for both of them. They also plan to sell their house and buy into one of those reverse mortgage progressive care facilities. The key is to do this planning before you retire. Being healthy enough to work is the key to getting cheap specific life insurance.

    People who are too sick to work before retirement age are probably the hardest case. I don't have that all in my head, but making pro bono services a dollar for dollar tax credit would probably get us most of the way to fixing the problem of poor people getting basic care.

  • Contrarian P||

    The increased costs of medical care as you age could be defrayed through the savings that you should have been able to build while working, but we've created this idea that there's this magical age of 65 or so where you're supposed to stop being productive in the workforce and enjoy retirement, which is treated like some right enshrined in scripture.

    If you've managed to save during your working years, in a free market system you could afford true insurance even at an old age, thanks to the savings that would result from eliminating the endless series of mandates and the resultant bureaucratic cost balloons. For those that haven't been able to save, either because of disaster or low wages, charity could (and has, in American history) provide for their insurance needs. This idea that the only thing separating the elderly from death in the streets is the government is a fantasy with no evidence from history. Old people got health care before Medicare came along.

    Largely, the idea that only government can provide modern health care stems from the concept that people are inherently selfish pricks that don't give a damn if their neighbor lives or dies, but somehow when collectivized as a state become magnanimous and caring. It's quite an amazing thought process to see in operation. Only through the wise guiding hands of angelic political appointees can our base desires and rapaciousness be transformed into the shining light of virtue.

  • Jordan||

    Check out health status insurance.

    HSAs are another option. People should be putting money in them while they are healthy.

  • Christophe||

    Really good stuff. Maybe the repubs need to push this idea out there. It's sane and won't be scary to average voters.

  • Sevo||

    "The long, tortured quest for a conservative health policy."

    There's the problem right there.
    It should be short and sweet: Get the gov't out of the medical care market.
    Anything other than that is an admission that Top Men are going to 'plan' the market and once that happens, you get what we got.

  • Rach||

    The problem is the question, and how it is presented;

    Dems: "here is our big government takeover of your healthcare plan; the republicans don't have one"

    Repubs: "we think breaking down the artificial barriers to interstate commerce on insurance policies is a start and let market competition drive prices down; we see the mandates as a mistake that will cause people to lose coverage, cost jobs, and drive up plan coverage."

    Dems: "That is not a big government plan."

    Press: "Republicans criticize, but fail to come up with big government control plan of their own"

    Slackjaw media fed voters "Ya republicans where is your big government plan."

    you see it is hard to compete when the assumption is there MUST BE a BIG GOVERNMENT PLAN. Especially when you are against the big government plan.

  • Jackand Ace||

    This IS a Republican plan. And that is what is so laughable about the hue and cry coming from them about how bad it is. The basic tenets of it were formulated by Heritage, and then actually put into effect by a Republican Governor. Its a solution through the marketplace, and not single payer.

  • ||

    To be fair, there are republicans who were against it when Heritage dreamed the mandate up. Not to mention the tea party people.

  • Jackand Ace||

    The original Heritage document calling for an individual mandate was dated 1989, when the Tea Party was only a twinkle in their parents eye.

    But you are right, not every Republican liked it.

  • John||

    It is totally a Republican plan. That is why not a single Republican voted for it. Just because some dimwit at Heritage thought the mandate was a a good idea doesn't make this a "Republican Plan" you lying sack of shit.

    Go propagandize for the government elsewhere.

  • Jackand Ace||

    Thanks for the typical mature reply. It was a Republican Governor who tried it first. And the reason not one single Republican voted for it is because Obama and Democrats put it into play. Simple as that.

  • kbolino||

    Is it better to be right for the wrong reasons or wrong for the right reasons?

  • Contrarian P||

    I think the fact that the republicans were completely shut out of the process of crafting the legislation might have had something to do with it.

  • DarrenM||

    But Republicans have no "plan"! I'm confused.

  • OneOut||

    The Repubs didn't enact it on a federal level against the wishes of the majority of citizens.

    That's the difference.

  • Jackand Ace||

    Where do you get "the majority of citizens?" The majority elected a President who said he was going to do it, and then re-elected him over the guy who said he would repeal it.

  • ||

    Appeal to majority is stupid in both instances.

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  • Thomas O.||

    I knew it! Turns out there wasn't much behind a GOP version of health care reform. The priority became "repeal, repeal, repeal!" and when pressed for what the alternative was, it was mostly just a collective "derrrrp".

    This is why I shake my head sadly at the GOP, because they fail Public Opinion 101. Obamacare is deeply flawed, but so was the status quo... and just pushing for a repeal without comprehensive reform got the GOP branded as cancer-kid-killers and grandma-robbers.

  • Libertarius||

    The GOP's problem, in essence, is that they refuse to stand for individual rights (the real, unnamed foundation of the US Constitution) because to stand for individual rights is to reject the moral code of altruism.

    Ayn Rand was right, and that is why she is the target of such desperate and hysterical smear campaigns from the leftoids. Collectivism is the political corollary of the altruist ethics--so if you remove the foundation of altruism, the whole rotten collectivist farce comes crashing down.

    Everybody knows that something is deeply wrong in America, but they always ascribe it to superficial effects; they dare not identify the cause, not so long as they choose to remain irrational in order to embrace the morality of altruism, which *cannot* be defended by reason and logic, but only by appeals to avowed mysticism (religion) and similar claims to "intuitionism" or "just knowing" (the New Atheists).

    The healthcare debate will continue to go in circles (down the drain) until men discover the intellectual courage to challenge the moral precept of altruism.

  • Tony||

    Hahahahahahahaha

  • ||

    This is literally the most cogent analysis Tony has ever produced at this site.

  • Tony||

    That's all "Ayn Rand was right" deserves.

    But since I'm here...

    One (ironic) problem with Rand is that her conclusions do not follow her premises. Altruism doesn't have to play a role at all in these discussions. As Rand herself eventually found out, purely self-interested people can take part in collective action, and purely self-interested people can for very good reason reject laissez-faire economics--even smart, productive, wealthy people.

    Freedom means the freedom to choose to do things collectively when that is the most efficient option. It is anti-freedom to forbid people that choice.

  • SusanM||

    And if that "choice" comes under duress? So what you're saying is that if I'm held up at gunpoint, I still have a choice?

  • Tony||

    Nobody is holding a gun to you. Sometimes your fellow citizens outnumber you when making collective decisions, but as adults we understand that we share the world with other people and we don't always get our way.

  • Ballz||

    hahahahahahahahahahahahaha

  • Ballz||

    "Nobody is holding a gun to you..."
    hahahahahahahaha

    if you get shot, it was your choice!

  • SusanM||

    Maybe you and yours should understand that last bit. I don't think you do, though.

  • SusanM||

    Hang on, so you're saying the ideal state of society is mob rule?

  • sasob||

    Just so long as it's his mob, Susan.

  • On The Road To Mandalay||

    Tony,

    Ayn Rand is dead.

  • Hadley V. Baxendale||

    Why don't the Republicans simply take its health care reform legislation proposed by the Nixon Administration back in the 1970s, modifying it to fit today's inflated costs and technology, and make this its proposal for comprehensive health care reform? Here is what the Republican Party proposed back in 1972 to 1974:

    Early last year, I [President Nixon] directed the Secretary of HEW to prepare a new and improved plan for comprehensive health insurance. That plan has been developed and I am presenting it to the Congress today. I urge its enactment as soon as possible.

    The plan is organized around 7 principles:

    1. it offers every American an opportunity to obtain a balanced, comprehensive range of health insurance benefits;

    2. it will cost no American more than he can afford to pay;

    3. it builds on the strength and diversity of our existing public and private systems of health financing and harmonizes them into an overall system;

    4. it uses public funds only where needed and requires no new Federal taxes;

    5. it would maintain freedom of choice by patients and ensure that doctors work for their patient, not for the Federal Government.

    6. it encourages more effective use of our health care resources;

    7. it is organized so that all parties would have a direct stake in making the system work--consumer, provider, insurer, State governments and the Federal Government.

    Check it out: http://www.kaiserhealthnews.or.....posal.aspx

  • DarrenM||

    ...got the GOP branded as cancer-kid-killers and grandma-robbers.

    Be honest. The GOP would have been branded with this by the MSM no matter what they did.

  • ||

    The "people don't like Obamacare so we will nibble away it at the margins until it no longer exists" plan is just as fucking stupid as anything else out there. Yeah, shitty, obtrusive, unpopular laws never ever stick around to become multi-generational budget bombs. NEVER!

    Whoever challenges Clinton in 2020 will be running on a platform of maintaining the fiction of privately competing insurance plans under Obamacare vs an even more centralized or single-payer solution. It's telling that even the most popular "free market" reforms, as detailed here, center around doling out tax advantages to move people in the direction of the currently-in-vogue behavior and choices they should be making.

    Health care and health insurance is a long-dead-and-buried issue from a libertarian or market conservative perspective. It's fucking done. Learn to enjoy the Schadenfreude or get used to being this generation's equivalent of the cranky old bastard still bitching and moaning about that new fangled income tax in 1935.

    Also, Norquist is rapidly turning into one of the biggest cunts in the D.C. metro area, which is quite an accomplishment, because D.C. has an embarrassment of riches in that regard.

  • blist14ant||

    If you read Murray Rothbard books and the communist manifesto you'll see little disagreements in each book.

  • ||

    Aside from that whole proletarian revolution, state ownership of all property and means of production, and famine-inducing collective farming, why they're practically identical.

  • Tony||

    Republicans are so fucking stupid.

  • ||

    And this is coming from an eminent professional on the subject.

  • On The Road To Mandalay||

    Tony,

    Maybe that's why we need some other political parties in Congress besides the DemoCRAZIES and the RePOOPlicans.

  • Tony||

    I suggest this for an explanation why the "across state lines" "idea" is a very bad one. Don't respond to me unless you bother reading, and please don't bother making playground insults about the author.

  • Jackand Ace||

    Great article. Thanks for posting.

    As for the insults, that's just par for the course for many here.

  • Sevo||

    Jackand Ace|1.10.14 @ 4:53PM|#
    "Great article. Thanks for posting.
    As for the insults, that's just par for the course for many here."

    Nothing you and the asshole tony don't deserve, shitpile.

  • Jackand Ace||

    Bingo!

  • Sevo||

    Glad you agree!

  • ||

    I read it. As I could have guessed, it is far, far better than what we had in December and far, far, far better than what we have today.

    People getting charged their actuarial cost for insurance. What a wild concept!

    If some need subsidy because of poverty or health condition, then subsidize those individuals. Don't screw up the market for the 75% who can quite comfortably get health insurance in the market trying to take care of the 25% who have trouble doing so.

  • XM||

    Apparently Klein's position is "you can't let small conservative states write their own insurance laws!" Which is a non factor for most people. People already buy things from China online.

    If I'm allowed to buy insurance in Alabama that suits my situation, I'll do it. So will other people. If that affords the insurance company and the state government some sort of leverage, then other states will have to adjust.

    But all of this is moot point. ACA says I don't have to buy insurance and points me to medical. Now I'm "covered" by a program none of the good nearby hospitals accept, and I won't have to pay diddily cent into the insurance pool. But thank god I don't have to buy insurance from some podunk red state. Whew!

  • ||

    What actually astonishes me, Tony, is why you think people here would find this idea a very bad one.

    Of course people should be able to buy insurance across state lines. It is the actual point of the Commerce Clause after all. They should even be able to buy insurance across national lines. Why the hell not?

  • Arn0||

    It's a very bad idea because insurance companies (and insurance buyers) could escape state regulations ? That's the point !

  • XM||

    If you were a paid GOP strategist, would you urge the party leaders to go out of their way to suggest a sweeping, full blown libertarian-ish reform? Knowing that the public isn't enthusiastic about voucher programs and privatization efforts, and any such proposal will give ACA battered democrats ammunition for a counterattack?

    Even a semi useful GOP healthcare proposal will also be symbolic. The senate and president won't be for it. Unless public support for market based reform is near TOTAL, nothing they do matters. A piecemeal approach to making ACA more consumer and choice friendly might work, but only if the GOP takes over the senate.

    Let's not misread the discontent over the ACA. It has more to do with increased cost and inconvenience than a true awakening over government takeover of healthcare. If Obama was insane enough to subsidize everyone, it would be pretty popular right now.

  • R C Dean||

    If you were a paid GOP strategist, would you urge the party leaders to go out of their way to suggest a sweeping, full blown libertarian-ish reform?

    Yup.

  • Westmiller||

    Here's the fundamental problem: nobody wants to let anyone die.

    Over 80% of all medical expenditures occur in the last six months of a person's life. Anyone "in control" of those expenditures does not want to take responsibility for declining fruitless medical interventions to postpone mortality.

  • Hadley V. Baxendale||

    Why don't the Republicans simply take its health care reform legislation proposed by the Nixon Administration back in the 1970s, modifying it to fit today's inflated costs and technology, and make this its proposal for comprehensive health care reform? Here is what the Republican Party proposed back in 1972 to 1974:

    Early last year, I [President Nixon] directed the Secretary of HEW to prepare a new and improved plan for comprehensive health insurance. That plan has been developed and I am presenting it to the Congress today. I urge its enactment as soon as possible.

    The plan is organized around 7 principles:

    1. it offers every American an opportunity to obtain a balanced, comprehensive range of health insurance benefits;

    2. it will cost no American more than he can afford to pay;

    3. it builds on the strength and diversity of our existing public and private systems of health financing and harmonizes them into an overall system;

    4. it uses public funds only where needed and requires no new Federal taxes;

    5. it would maintain freedom of choice by patients and ensure that doctors work for their patient, not for the Federal Government.

    6. it encourages more effective use of our health care resources;

    7. it is organized so that all parties would have a direct stake in making the system work--consumer, provider, insurer, State governments and the Federal Government.

    Check it out: http://www.kaiserhealthnews.or.....posal.aspx

  • On The Road To Mandalay||

    Are there any Medical Doctors out there posting on this website? It would be nice to hear from them, plus all the other health care professionals.

  • Sevo||

    ..."It would be nice to hear from them, plus all the other health care professionals."
    Do you ask a cobbler who should pay for shoe repairs?

  • On The Road To Mandalay||

    SEVO,

    Your usual stuff. When you don't like an opinion but can't refute it, you resort to veiled insults.

  • Sevo||

    On The Road To Mandalay|1.10.14 @ 8:25PM|#
    "SEVO,
    Your usual stuff. When you don't like an opinion but can't refute it, you resort to veiled insults."

    Care to explain what part of that was an insult?
    The fact is MDs are no better equipped to direct the finances of medical care than a cobbler is of telling us who should pay for shoe repairs.
    If you're too dumb to understand that, why, buzz off.

  • On The Road To Mandalay||

    Sevo,

    Make me "buzz off". How do you propose to do that? Why don't you complain to the site administrator if you don't like my opinions? Maybe he/she will listen to you and have me banned from the site.

    So you really believe that MDs should not be included in any discussion regarding health care costs, and insurance and related issues? WHY NOT? Because YOU say so? Looks like you will just have to go F yourself.

  • Sevo||

    "So you really believe that MDs should not be included in any discussion regarding health care costs, and insurance and related issues? WHY NOT? Because YOU say so? Looks like you will just have to go F yourself."

    Because it's MY MONEY you stupid shit.
    Go fuck your daddy.

  • On The Road To Mandalay||

    Sevo,

    My daddy is deceased. Quick question. Are you an abortion or afterbirth who lived? Just curious. With that said I guess you will just have to eat some of my stupid shit. Call 1 800 EAT SHIT, and one of my trained operators will instruct you in how to do that. In the meantime you can get ready to hide some of your money by inserting it in your rectum. Can you do all this? Have a nice day Anal Breath.

  • Jefferson's Ghost||

    Yes, ACA is a disaster so bad it doesn't warrant discussion. The semi-socialized monster we had before was terrible financially, but at least was partially self correcting through higher deductibles - HSA plans.

    1. Allow any and all insurance products to be sold anywhere in the U.S., an actual valid use of the CC.

    2. Abolish CMS tomorrow, no one has any clue how much waste is added by these central fools that control the hospital market. It's scandalous and dwarfs physician comp.

    3. Take away ACGME's power to limit residency and or medical school.

    4. Eliminate the FDA

    5. Profit for a better society and better medicine.

    Even if it cost me, I want my children to prosper in a country that has a clue on free enterprise and respects mother liberty.

  • On The Road To Mandalay||

    Millions of Americans could take better care of themselves by not drinking alcohol, not having multiple sexual partners (STD), not smoking, better diet, exercise, and so on. However, when any of this is suggested, a huge stink is raised, indicating that advocating such is violating people's rights, or it's too preachy and so on. Yes I know. This is called an HMO or something along those lines, is it not?

  • Sevo||

    ..."indicating that advocating such is violating people's rights"...

    Wrong.
    No one gripes about advocating such behavior. It's *enforcing* it that causes the ruckus.

  • Sevo||

  • On The Road To Mandalay||

    Sevo,

    Now you are becoming more intelligent with every post. Have a nice day. A pure joy posting with you ace.

  • Sevo||

    "Now you are becoming more intelligent with every post. Have a nice day. A pure joy posting with you ace."

    You, unfortunately, aren't.

  • On The Road To Mandalay||

    Sevo,

    Boo Hoo! I hurt poor Sevo's feelings. Glad my posts piss you off. However, they must be of some importance in your life or you would not waste your time answering them. In any event, knowing that my opinions irritate you gives me a great deal of satisfaction.

    Since you are a f---ing genius, why don't you come up with a health care plan that everyone will just love. Let me see some of your ideas in print instead of your pile of shit rebuttals to me because you don't like my ideas.

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  • Charles Hurst Author||

    Obamacare is just another ideology which will ultimately be the final nail in the coffin to close the corpse that was once the living America. The question I always ask the Progressive, who usually responds with a series of bait and switches or ranting of irrelevant topics, is does Obamacare require that one man pays so another does not? The fact is that is exactly what Obamacare does.

    There was another fiery debate about the same notion of "one man pays so another does not." It was the induction of the progressive income tax--made law in 1913. It had been denied by the Supreme Court twenty years prior. And it should have stayed denied.

    And what do all of these entitlements have in common? The Progressive agenda of one man shall pay so another does not. Because he really isn't a Progressive.

    He is a Marxist.

    If we continue, and it looks as if we are, backed by the now Marxist GOP'rs as well such as Rubio, who is now propagating government subsidies for lesser paying jobs, we will end in one of two ways. And be advised it will have to be one or the other--as history shows. My writing works are based on that exact history. From nations who gave in to the exact mentality we are giving into--today. We will either be ruled by communism a hundred years from now.

    Or we will engage in America's second Civil War.

    Charles Hurst. Author of THE SECOND FALL. An offbeat story of Armageddon. And creator of THE RUNNINGWOLF EZINE

  • MoreFreedom||

    The Tea Party is showing most Republicans are selling out conservatives. In fact most Republicans like Obamacare now, as they believe it will help them get re-elected, even though they've put forth no free market solution. In fact, they don't want a free market solution, as it eliminates government's ability to extract money from the market via threats of legislation/regulation that affect company bottom lines.

    While the GOP was criticized for the shutdown, it might have been different if they left it shut down. The debt ceiling will soon be hit, so we'll see another example of RINOs voting to life the ceiling, so they can spend more of our money, thinking they'll get elected because voters will believe they aren't as bad as Democrats. I'll be voting for a libertarian when the R and D choices are for statists that want more government.

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