On Health Care, Half A Repeal Is No Repeal At All

When Democrats toyed with the idea of scrapping comprehensive health care reform—with its high cost and individual mandate to purchase health insurance—in favor of a smaller bill that banned insurance companies from discriminating against those with preexisting conditions, I called it a terrible idea:  "Insurance reforms without a mandate would, in their own way, be just as bad, and twice as stupid."

Now, with a comprehensive overhaul signed into law, there are signs that the GOP may pursue a legislative strategy that would leave us in much the same place. Here's Sen. John Cornyn talking to the Huffington Post on Tuesday:

"There is non-controversial stuff here like the preexisting conditions exclusion and those sorts of things," the Texas Republican said. "Now we are not interested in repealing that. And that is frankly a distraction."

Politically, there are clear short-term advantages to going after only the mandate: The preexisting conditions exclusion is popular and the mandate is not, so a repeal of just the mandate is far more likely to pick up support. But from a policy perspective, leaving the insurance-market regulations in place but ditching the mandate is a great idea only if you want to virtually guarantee that premiums will spiral out of control. The mandate constitutes the single biggest infringement of individual liberty in the bill, so I understand the appeal, in principle, of repealing it. And in some sense that would be a victory against what is arguably the bill's most egregious provision. But it's not much of a policy reform; indeed, the most likely outcome is that it would just screw up the insurance market in a different way.

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  • ||

    Fuck you Jon Cornyn

  • mark||

    Well I know who I'm not voting for.

  • Slap the Enlightened!||

    Did I really need to tell you that, ultimately, the Republicans will do nothing worthwhile about this at all?

  • ||

    That's exactly why it was important to stop it before it's passed.

    It merely demonstrates why "let the Democrats have a huge unified majority to teach the Republicans a lesson" is a strategy that never works in US politics, because overturning an entitlement expansion is nigh-impossible.

  • ||

    The GOP asked for it because they would not negotiate in good faith.

    Tort reform (29 states have it) and "selling across state lines" (Aetna, UHC, Wellpoint already sell tweaked policies across state lines) were bogus lies from the start.

    The GOP postured politically with disregard for problem solving. They will suffer as a result.

  • ||

    Bullshit. Obama wasn't going to give them anything but token compromises. And if they had voted for this piece of shit, they would have nothing to run on. It would have made the whole thing "bi-partisan" and even more untouchable than it already is.

    Further, there is something to be said for making a stand. Fuck the, oh just surrender and maybe they won't fuck you too bad strategy.

  • ||

    If President Mitt Romney had proposed the same shitty bill (see Romneycare) it would have received 400 votes in the House.

    Its all about who gets credit and who retains power for the GOP these days.

    Medicare Welfare Pharma Part D - thats all you need to be reminded of.

  • ||

    Since there is no President Mitt Romney you are just talking out of your ass. So you hate Medicare Part D so much, fine. You hate Republicans for passing it (which not all of them voted for it)and now you hate them for trying to stop this bill. If they had sold out you would be on here bitching about how they are just the same as Democrats.

    You would bitch no matter what they did.

  • ||

    Medicare Welfare Pharma Part D - thats all you need to be reminded of.

    Which is exactly what you would have gotten if the Republicans had worked with Democrats. The Medicare Part D bill had a few tweaks to expand HSAs, which was the only way to get the HSAs past a filibuster.

    You can't have it both ways. You are the one who is arguing for a Medicare Part D strategy right now.

    The Republicans did produce full, credible alternatives. Those had zero chance of getting a majority in Congress. The only bills that Republicans could have produced to get a majority would have been exactly like Medicare Part D in style and scope.

  • mark||

    It's called the Patients' Choice Act and it was introduced in May of last year.

  • juris imprudent||

    Or as another fellow put it "the evil party passed the bill and the stupid party wants to repeal it".

  • ||

    If the GOP wants popular unrest in its favor, it better keep demonizing the entire bill and beating the drum of wrecking it and every other socialist bullshit move of this government. Otherwise, why the hell should we support them at all?

  • ||

    I guess to delay the inevitable. Margaret Thatcher once said something to the effect of "liberal government expands government until it is replaced by conservative government which slows the expansion only to be replaced by liberal government which starts the process over again". Thanks to people like Cornyn, that is what we have here.

  • West Texas Boy||

    Which is surprising, because Cornyn typically hasn't one of those types of Senators. In the past he has been the guy that McCain cursed at.

    I guess it happens to all of them - they get in, and then they once they get reelected one time, they start thinking like enlightened philosopher-kings for life.

    In fairness to Cornyn, he's thinking like a politician and just let the mask slip a little bit.

    But fuck him. I normally don't get to play the "fuck you and your horse" game with our politicians down here (except when I lived in Sheila Jackson Lee's district) so now Johnny Boy is going to have to earn my vote now. He's got... umm.... 5 more years to do it. Shit.

  • ||

    Which is surprising, because Cornyn typically hasn't one of those types of Senators. In the past he has been the guy that McCain cursed at.

    Well, McCain's still doing that, because McCain's being a lot bolder on repeal than Cornyn is.

  • West Texas Boy||

    [2008] If we have to rely on McCain, we are so fucked. [/2008]

  • ||

    Oh, sure. Though given his incredibly self-righteous personality, he's probably one of the few genuinely upset about the procedural methods used in passing this.

    McCain's an obnoxious self-righteous git with huge blind spots, but his positions are better than most libertarians seem to think. They're turned off by his personality and lack of philosophical coherence, along with his rush to the cameras and focusing on tiny absurd issues. He's very good on free trade, agricultural supports, etc.; things no one really cares about enough to vote on, though.

    Faint praise, perhaps, but few politicians deserve as much or more anyway.

  • West Texas Boy||

    I was probably being a bit too flippant. His utter self-righteousness is definitely an asset here because he believes in the decorum and the dignity of the institution and Harry Reid and his ilk damn sure don't. So that's a good point you make. Back a couple months ago when Franken played the little "time's up!" game with Lieberman, McCain looked like he was going to cry.

    I'll also give McCain credit for the excellent soundbite today with Mary Landrieu crying about how McCain's amendment referred to her piece of the pie as a "Sweetheart Deal" IN THE TEXT OF THE AMENDMENT. I thought that was particularly well done.

    So yeah, props to McCain are indeed due. Point taken.

  • food||

    No, I think McCain's upset because he's not president.

    Either that, or he needs a bottle and his binky.

  • ||

    For example, Damon W. Root has an article up on the site about how bad the Davis-Bacon Act is. Well, guess who repeatedly votes against Davis-Bacon?

    But no one would actually change their vote in favor of Senator McCain because he opposes that terrible law, so it will stay.

  • ||

    But ProL, it's a lot of effort to beat a drum until November, and there are so many cocktail parties to attend.

  • ||

    I share your frustration and your pessimism about how focused they can be for that long. I think we're going to see 1994 redux to some extent, but the GOP younglings had it much more together back then than they do now. Frankly, the intelligence of politicians in general does seem to have declined.

  • ||

    True. But you don't have to be that smart to ride the wave of public sentiment. People talk about Reagan and how we need another Reagan. Reagan was a good guy, but he was no God. He was more than anything just someone in the right place at the right time who rode a wave of popular disenchantment with 70s liberalism.

  • ||

    Reagan was smart. He did, however, bring in a Senate class of real maroons in his 1980 landslide. They just had to be there to ride the wave.

  • ||

    Reagan was smart. I didn't mean to imply otherwise. But liberals and some conservatives act like he was some magical persuader. People were already persuaded and had had enough of 70s liberalism. He didn't have to persuade them. He just had to tell them what they wanted to hear.

  • marlok||

    I tend to think the same way about Obama. People act like he's a genius for winning the election when public sentiment couldn't possibly have favored his party more. His only task was to look plausible. Now the news calls him and pelosi geniuses for passing health care reform when they couldn't have had more advantages. I have heard little mention of the political skill of the minority party that somehow obstructed this for a year.

  • sage||

    Yeah Peter, your whole position in this post has been mentioned here about a thousand times since Sunday.

  • marlok||

    I think he has a post quota to fill, dude. Lay off.

  • ||

    Look Republicans, either you're going to work to repeal the whole fucking thing, or you're dead to me.

  • ||

    So basically you're saying they're dead to you.

  • ||

    Just like you are.

  • adam||

    The design of the subsidies pretty much prevents spiraling premiums from being felt by anyone below 400% FPL- the tax credits will just get bigger when the premiums go up since the are indexed off the cost of the second cheapest silver plan premium and a percentage of income. So exploding premiums will hit the federal budget, not individuals, and will probably result in even more political pressure not to undo the subsidies since no one could afford the premiums without the subsidies.

  • ||

    Progress is progress.

    I don't see any reason to throw poor people and working kids, under the bus just 'cause we can't get rid of the whole thing.

    ...even if they are Obama's idiot base.

    Ger rid of as much as you can.

  • Entitled Slacker||

    it's called thinning the herd.

  • ||

    For the record, when I said "Get rid of as much as you can.", I was talking about getting rid of as much of the damn bill as you can, not the poor and working kids!

    I think this bill will hurt poor people and working kids the most--certainly the part that forces them to buy insurance most of them don't need and don't want to buy.

    And I don't see why they should have to suffer under that part of ObamaCare, that's what I meant by "throwing them under the bus"...

    I think Obama's thrown poor working kids under the bus more than any other group! You know how hard it is to find a cheap car now after cash for clunkers?

    First you make it almost impossible for 'em to find serviceable transportation, now you're gonna force them to buy health insurance they don't want and don't need?!

    Why do you hate working kids so much, President Obama? What did they ever do to you?

    ...except get you elected.

  • MJ||

    The purchasing mandate is an affront to personal liberty while the requirement to accept pre-existing conditions is an affront to economic reality. It takes away the incentives to not to game the system by only purchasing insurance when you need health care. It's the kind of magical thinking that's going to wreck the system. It is the heart of the beast.

  • Gilbert Martin||

    The best strategy would be this:

    First get the individual mandate thrown out as being unconstitional.

    Second take back the House of Representative in November and simply refuse to pass any appropriations bill necessary to fund the program. The bill that was signed into law is merely an authorization bill. With annual funding bills, the program can't be operated. And those funding bills have to originate in the House.

    Third, take back the Senate and the Predisency in 2012 and outright repeal the whole thing.

  • Gilbert Martin||

    Without annual funding bills I meant to say.

  • ||

    Predisency. I like this. In its perfected form, it would read, Predisneycy.

  • adam||

    Isn't most of the spending through the tax credits? They wouldn't need a specific appropriation. You'd need a specific rider to deny funds for paying the credits, and then you'd need to get Obama to sign it or override him.

  • Gilbert Martin||

    The program has to have administrative costs. Just as the IRS will have to have new agents to enfore the insurance mandate tax, there would have to be administrative people to oversee the tax credits - and make sure they are only going to the people who are supposed to get them.

    Cut off the funding to pay the people who run the machinery and the machine grinds to a halt.

  • adam||

    They'd have to go to a shut-down the government momemt a la clinton-gingrich to do this- i doubt it

  • West Texas Boy||

    I was thinking about this today.

    It would be quite the same situation as 1995, but would the public see it the same way? Clinton was fairly popular and the economy was roaring. Gingrich was seen as unnecessarily rocking the boat and picking a fight. I guess what I am saying is, Obama is no Clinton and isn't nearly as popular or sympathetic with the public as a whole.

    Would the public buy the same spin or could they be persuaded that this time it was different? My guess is no, but the background dynamic is at least a little different.

  • ||

    That is a good point. The economy had turned around in 1995. It won't next year. People are going to be very angry.

  • Michael Ejercito||


    That is a good point. The economy had turned around in 1995. It won't next year. People are going to be very angry.


    Would that be an insurmountable barrier for our fifth columnist media?

  • jester||

    I don't ever want to see a Republican president again. He/She will always drag a more sensible Congress down a senseless path. Republicans only behave fiscally responsibly when they have some 'demonic' democrat in the White House.

  • marlok||

    I think demon-crat was what you were looking for.

  • kinnath||

    Given a nice bell curve, the bulk of the population are C-minus students from high school that still can't balance a check book and want some someone to tuck them into bed at night.

    The "lefties" have nightmares about economic boogie men, and the "righties" have nightmare about social demons.

    Otherwise, they are all the same. And they control us with their illogical and uneducated political choices.

  • marlok||

    Beautifully said and unfortunately true.

  • ||

    Can we all secede? I mean, all fifty states at once?

  • ||

    Interesting question. The South was an easy succession problem. They were all in one place. But what is 30 or so states sprinkled around the entire country declared independence? What the hell would the federal government do? Send in the Military? I don't think the military would do it. Not if it were than many states in that many places. Congress would shit their pants. They would be terrified and something would be worked out.

  • ||

    Okay, then. I hereby declare Florida seceded. I can do that, right?

  • ed||

    I'm with you. Who will be designing our uniforms?

  • Curtis||

    These uniforms are lame, man

  • ||

    Let's go one step further than the Founders. They were classicists, right? I mean, a big chunk of where we are is based on the good parts of classical political theory (by way of Polybius and Montesquieu).

    Therefore, let's adopt the toga.

  • ||

    What if Florida did but Georgia didn't but South Carolina did? And they didn't try to run the military off? You could just grant them permission to be in your state. But they kicked out all the federal agents and bureaucrats. Now the reaction would be to decalare an insurection and call out the national guard. And that would work if it was one or two states. But if it was 25 or 30, I think there is a good chance the Guard would refuse to be nationalize or refuse to take the actions necessary. Seriously, you would have to have Guard troops out enforcing martial law and arresting the governor. I don't think they would do it. I think the Congress would back down.

  • ||

    Well, naturally, when Florida secedes, it's keeping everything in Florida. Like the Florida space program, the Florida nuclear subs, the Florida army, the Florida air force, and so on.

  • ||

    We'll give the United States back its bullet train, in the spirit of peaceful coexistence, though.

  • ed||

    Can we give them Orlando? Please?

  • ||

    Our national capital? There's no resisting the Mouse.

  • Trooper Jones||

    We had this discussion before and you didn't like it but, as you no longer seem to be on active duty, let me clue you in. The Army would fight for the federal government against the rebellious states.

  • Slap the Enlightened!||

    If you have 2/3 of the states to ratify it, you can pass an amendment dissolving the federal government.

    At the rate things are going, those 2/3 may not be an insurmountable obstacle.

  • ||

    Have to have the Congress to propose it. the states can only call a constitutional convention. Again, if it ever came to that, Congress would back down.

  • robc||

    And, most importantly, 2/3 of the states have to approve what comes out of the convention.

  • West Texas Boy||

    We have to be careful with a convention for the very reason that there are lots of people out there who could easily be persuaded to buy into a full-on Euro paradise type set of promises. Sure, Obamacare as a whole is unpopular, but the individual I-Want-A-Pony-Too pieces do poll higher and Cornyn was clearly speaking to that dynamic. Gotta be careful what you wish for. None of the good stuff would necessarily be safe in a convention and someone like Obama would LOVE to "fix" some things in there.

    However, we can and should amend the shit out of it, starting with term limits, repealing the 16th, and a balanced budget amendment (with strictly defined exceptions).

  • Reducto||

    Full Brazilian!

  • ||

    There is a window of opportunity to repeal this bill, but it won't be open for very long. As someone else mentioned, it's almost impossible to repeal an entitlement in America, but with this bill a lot of the pain kicks in immediately (higher taxes, etc.), but most of the benefits don't start to flow for several years. So it may be possible to repeal the bill during that period, before there is much of a vested interest in maintaining it. But once the goodies start to flow, it will be impossible to repeal it.

  • Entitled Slacker||

    Why do people keep saying it's impossible to repeal an entitlement? Especially since I'm not feeling all that entitled by theis particular one?

  • George W Bush||

    See my 2005 State of the Union address for how well that idea turns out.

  • ||

    It's not impossible, and I think one thing we need to focus on is killing that meme.

  • The Gobbler||

    Yeah, I know this as nothing to do with this piece, but despite being an enophile, how can I not like these guys:

    "Baboons Gobble Grapes in South Africa Wine Region"

    http://news.yahoo.com/s/ap/201.....ca_baboons

  • ||

    Enophile? You like to fuck goth chicks?

  • ||

    I hear they have treatment programs for that.

  • ||

    No, he likes to fuck Brian Eno, dipshit. "n" is not "m". God I despair for you sometimes.

  • ||

    Let me apologize for Sugar Free for insulting your kind. He meant nothing by it.

  • ||

    That's better.

  • The Gobbler||

    I wouldn't for one second believe you don't know the definition of enophile (shown here in the British spelling:

    http://www.telegraph.co.uk/new.....Bells.html

  • kinnath||

    Sometimes the baboons even get an alcohol kick — by feasting on discarded grape skins that have fermented in the sun. After gobbling up the skins, the animals stumble around before sleeping it off in a shady spot.

    Getting a buzz on is hard-wired into our genetics.

  • The Gobbler||

    Fuck yeah!

  • KyleG||

    I thought they like blueberries?

    Oh shit. That's gorillas.

  • ||

    Unfortunately the Republicans were suckered into supporting the most damaging part of the bill long ago. Maybe there is a way to solve the preexisting condition problem, but forcing insurance companies to accept them is a the most devastating thing that you can do to private insurers. So, even a bipartisan bill is going to get us single payer eventually.

  • ||

    Unfortunately the Republicans were suckered into supporting the most damaging part of the bill long ago.

    Suckered into it by the overwhelming majority for it in the polls, yes, but suckered into it.

  • ||

    I think total economic illiteracy has something to do with that. And a state run media that refuses to tell the truth. It would be nice if someone calmly started explaining to people why as much as pre-existing condition exclusions suck, they are necessary for health insurance to function.

  • Corduroy Rocks||

    Ain't gonna happen. Can you imagine the same people who troll the streets asking passersby "What do you think there ought to be a law about?", actually trying explain why utopia doesn't exist and that you can't have your cake and eat it too?

  • Michael Ejercito||

    Maybe there is a way to solve the preexisting condition problem, but forcing insurance companies to accept them is a the most devastating thing that you can do to private insurers.


    Do auto, fire, life, and disability insurance policies cover pre-existing conditions?

  • ||

    Great SITE for documentaries check it out, knowledge is power

    http://freeviewdocumentaries.com

  • The Gobbler||

    I shit in the mouths of your ancestors. And they love it!

  • Some dude||

    I'm confused. Which bill did Obama sign? Was it the Senate version or did I miss the part where the Senate voted on a "fixed" version?

  • ||

    The Senate version was signed. The "fixed" version hasn't been voted on in the Senate yet. Sen. Tom Coburn is having fun with amendments, because if the fixed version gets amended, it has to go back to the House to repeat the whole thing.

  • robc||

    Personally, I think they need to keep amending the thing and do nothing else until the 1st week in January.

  • ||

    Amen.

  • West Texas Boy||

    What is particularly galling is that now reconciliation abuse is news again and no one is talking about it. Four weeks ago it was outrage at "up and down" and now it's almost a collective shrug.

  • ||

    I'll draft amendments for them if they need help for the next few years. I've got a few ideas.

  • Nancy Pelosi||

    The answer is "yes." That's all you need to know.

  • Steny Hoyer||

    We're under attack! Tea-baggers to the right of me. Tea-baggers to the left of me!

    http://content.usatoday.com/co.....are-vote/1

  • Charles||

    And here I am, stuck in the middle with you.

  • Jeffersonian||

    Leave it to the Stupid Party to pick the peanuts out of the shit sandwich and serve it up as a bipartisan feast.

  • Corduroy Rocks||

    If only they would take out the corn as well....

  • Michael Ejercito||

    There is a way to get the public to support a full repeal.

    The public in general loses all forms of reasoned thought when evaluating laws made to go after sex offenders, such as laws that restrict where sex offenders may live.

    Just point out that the health care reform provides benefits for sex offenders and there will be public support for repeal.

  • MJ||

    Unfortunately, Cornyn is putting the party's electoral success over what is good for the country. The purchasing mandate is the easy sell, few people like being told what to do. The pre-existing conditions requirement is harder, you actually have to spend some effort explaining what the consequences are when ypu give people a license to game the system.

  • Ebeneezer Scrooge||

    Ain't democracy a real pisser?

  • Michael Ejercito||

    Just ask what would happen if life insurance had to cover pre-existing conditions.

  • ||

    You could tweak the pre-existing conditions clause so it only applies to *unknown* preexisting conditions, or doesn't apply in case of insurance fraud, or allows insurance that doesn't cover the condition, or explicitly allows higher premiums.

  • Michael Ejercito||

    You could tweak the pre-existing conditions clause so it only applies to *unknown* preexisting conditions, or doesn't apply in case of insurance fraud, or allows insurance that doesn't cover the condition, or explicitly allows higher premiums.


    That is a very good idea.

    What is the whole deal about pre-existing conditions anyway? Does life insurance cover pre-existing death?

  • ||

    So when it comes to the mandate, it seems some republicans were for it before they were against it.

    ""The truth is this is a Republican idea," said Linda Quick , president of the South Florida Hospital and Health care Association. She said she first heard the concept of the "individual mandate" in a Miami speech in the early 1990s by Sen. John McCain , a conservative Republican from Arizona , to counter the "Hillarycare" the Clintons were proposing."

    http://news.yahoo.com/s/mcclat.....JpbGxpbg--

  • ||

    I'm pretty sure it would be popular if homeowners insurers were required to insure homes as they were burning down.

  • Scott66||

    If Cornyn means you can get sick and then buy insurance, then yeah he is an idiot or an opportunist. However, there are ways this could be structured that would be more free market than we have now.

    Currently, in NC anyway, if you move from one group policy to another group policy pre-existings are covered. The group can be rated but the individual cannot be denied. If the law removed most state mandates, allowed purchase across state lines and allowed individuals to band together to create purchasing power, then the mandate that pre-existings be covered could be workable without premium increases.

  • Ebeneezer Scrooge||

    there are ways this could be structured that would be more free market than we have now.

    It would have saved what's left of the free market, and be a whole lot cheaper for all of us, if the Feds just bought all the uninsured, their own health insurance policies.

    Killing the free market was the whole point.

    I guess you didn't get the memo.

  • Ebeneezer Scrooge||

    The idea of repealing the whole Obamacare is a joke. The Republicans will never have a big enough majority in time, to over ride a certain Obama veto.

    So is it still technically legal for states to succeed from the union? Not that I believe the Fed would allow it. If it was only a few states, they'd get slapped back in line. If it was many, there'd probably be another civil war.

    But I don't believe anybody is getting away with leaving the union peacefully. Even if it was many states.

    --

    Half a repeal would be far better than none. Dump the individual mandate to kill the precedent it sets.

    Meanwhile the Fed goes bankrupt, but they're already going there anyway. And there's no free market in health insurance to kill off in the first place, so if we drive the insurance companies (who bought into Obamacare) broke, what of it? On a relative scale, if I had to trade this off against the individual mandate, I'd break the insurance companies.

    Killing the individual mandate now might help us avoid outright socialist medicine later. It might keep enough sense of independence alive in people that they actually fight it when the time comes.

  • ||

    ""If it was only a few states, they'd get slapped back in line. If it was many, there'd probably be another civil war.""

    Our government likes breakups when it's in another part of the world.

  • Ebeneezer Scrooge||

    yup yup yup.

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