Republicans Are Still Talking About Obamacare Repeal. They Could Be Talking About Obamacare Reform.


In the summer of 2013, Sen. Ted Cruz (R-Tx.) called repeatedly for Republicans to defund Obamacare through the budget process and an upcoming continuing resolution. Cruz insisted that the health law had to be defunded through the continuing resolution because, otherwise, it would be impossible to repeal. All President Obama had to do, Cruz argued, was wait it out; on January 1, 2014, the law's health insurance subsidies would kick in, and the millions of Americans would become dependent on the law for health coverage.

Obama "knows that in modern times, no major entitlement has ever been implemented and then unwound," Cruz told The Daily Caller in August of 2013, later noting that "no Republican has effectively refuted that premise." This was what gave Cruz his urgency: On January 1, 2014, Obamacare would become essentially impossible to repeal.

Cruz's call resulted in an extended budget showdown and a three-week government shutdown. It was politically ill-advised, and, as critics predicted, it did nothing to stop Obamacare (the botched rollout of the exchanges did far more political damage to the law than the shutdown).

But his underlying idea that January 2014 represented a point-of-no-return for the health law, after which it would be largely cemented in place, wasn't crazy. And yet, more than a year later, Cruz is still promising to repeal Obamacare—"every blessed word" of it, as he sometimes says—something he admitted would become all but impossible barely more than a year ago.

Cruz isn't the only Republican legislator who continues to aggressively advocate repeal despite understanding its diminished prospects. Sen. Mitch McConnell (Ky.), the Republican Senate Minority Leader, often says that Obamacare should be repealed "root and branch." But McConnell has also undercut that message by saying that Kentucky residents covered by Medicaid under the health law are unlikely to lose their coverage. In a debate last night, he said that the state could keep its self-administered Obamacare insurance exchange, Kynect, which McConnell has previously described as "unconnected" to the larger issue of Obamacare repeal.

The most charitable way to describe McConnell's remarks is as evasive; at minimum, he is heavily downplaying the ways in which Kentucky's exchange, which, far from being "unconnected," was built using federal grants provided under Obamacare, and which offers subsidized coverage funded federally through the health law, would function differently without Obamacare in place. McConnell surely knows this, which is why his remarks are better characterized as intentionally misleading.

But the inherent contradiction in those statements is telling anyway. What's tripping up McConnell (and, to a lesser degree, several other Republican candidates) is the problem described by Cruz last year: With Obamacare's coverage expansion in place, and so many people relying on it for insurance, it has become nearly impossible to repeal. McConnell seems to want to have it both ways, repealing the law, but not his constituents' access or coverage.

Yet as a report by Politico's David Nather suggests, despite continuing public calls for repeal, many Republicans now acknowledge privately that prospects for repeal are slim. "There is a disconnect between the private dialogue and the public dialogue," on GOP health policy expert tells Politico.

But party politicians are still struggling to settle on a strategy about what to do next. There are several conservative replacement plans on offer, should the party choose to rally behind them, but all assume Obamacare is repealed first, and most focus on tax credit systems that would significantly alter the shape of the American health insurance market. The problem, though, is that the GOP has long criticized Obamacare for being too disruptive; with any of these plans, Republicans would be opening themselves up to a similar charge. 

As it happens, these are exactly the problems that The Manhattan Institute's Avik Roy has attempted to solve with his recently released health care plan, which he pitches as a way of "transcending Obamacare." It's meant to overcome the law's flaws in a way that does not require wholesale repeal. 

"Disruption is extremely important to the average American," Roy said at a private dinner last week. He urges a cautious approach. "What we have to do is be very gradual" in transforming the system. 

Roy's plan is designed to be "maximally plausible," both in its policy reforms and its politics. The basic idea is to keep Obamacare's exchanges, as well as some of its popular insurance reforms, but deregulate those exchanges to allow for greater insurance plan flexibility, end the individual mandate, and—in the plan's boldest move—slowly transition Medicare and Medicaid into the exchanges as well.

In some sense it is a trade: accepting Obamacare, in its broad strokes, but using it as a vehicle to reform the nation's two big health entitlements, which, Roy notes, are responsible for the biggest portion of the nation's long-term fiscal problems.

Roy argues that the plan would mean better coverage for poor Medicaid beneficiaries, who would have access to privately subsidized coverage, as well as more options for seniors, who would no longer be forced to shift to Medicare at 65 or risk losing Social Security benefits. 


In the long term, the transition would produce enormous budgetary savings—an estimated $8 trillion in deficit reduction over 30 years—by transforming Medicare, which now covers seniors regardless of their income, into a means-tested system for the middle class.

With fewer rules governing their products and no mandate forcing people to buy, insurers would have more incentive and more opportunity to compete and innovate. And the nation's overall coverage levels would actually increase by 12.1 million relative to Obamacare, according to estimates produced by University of Minnesota health economist Stephen T. Parente.

The political argument, meanwhile, could give Republicans the advantage. Yes, Democrats might object to shifting seniors onto the exchanges. But that would mean criticizing an updated version of Obamacare, and explaining why exchange-based coverage was great for 64 year-olds but not for 65 or 68 year-olds. Republicans could say that "this is the program that you all"—Democrats—"installed," Roy says. Part of the idea is that it "puts Democrats on the defensive." 

The plan is not without its own potential challenges. Inevitably, there would be fights over exactly how strictly to regulate the exchanges. And even though today's seniors could keep their existing coverage, it might be described as gutting the program, which is quite popular. Roy responds that the same charge was leveled at Mitt Romney and Paul Ryan during the 2012 presidential election, and yet seniors were the one group that voted decisively in favor of the GOP ticket. Some higher-income seniors would see their premiums rise, but Roy says these hikes could be mitigated by a transitional fund. 

More generally, it would require Republicans to level with voters about the likelihood of repeal, and take an affirmative reform position on health care, an issue the party has long been content to ignore. "Who benefits from the status quo? Employed and retired people," Roy says, noting that these are the same people who tend to vote Republican. Thanks to Medicare and the tax break for employer insurance, two massive budget items that subsidize health coverage, "it's actually Republican voters who are on the dole," he says. 

One possible advantage for GOP legislators is that it would help smooth out some of the contradictions from politicians like McConnell. Under Roy's plan, Kentucky could keep its exchange, and residents could keep their coverage. And while the health law would not be repealed root and branch, it would be significantly reformed, which is something that even many Democrats say they want. Like many Democratic candidates this year, McConnell's opponent, Alison Grimes, has promised to fix the law but provided almost no specifics of how she would do so. Keeping the law in place but working to improve it polls well, and Roy's plan could plausibly provide specific fixes. 

Essentially, Roy's plan would take Ted Cruz at his word when the Senator argued last year that unwinding a major entitlement after its benefits kicked in was practically impossible. But rather than continue to call for Obamacare's end, as Cruz has done, Roy would attempt to craft a new beginning, one that, yes, leaves some of Obamacare's words in place, but that on the whole, he says, "expands people's choices rather than takes them away." No, it wouldn't be repeal, but with its overhaul of Medicaid and Medicare, it might be something better: the system-wide, root-and-branch reform we've needed since long before Obamacare became law. 

NEXT: Libertarian Iowa Senate Candidate Doug Butzier Dies in Plane Crash

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159 responses to “Republicans Are Still Talking About Obamacare Repeal. They Could Be Talking About Obamacare Reform.

  1. I knew it. Suderman – and, by extension, reason – loves Obamacare. They loooooooooooooove it. No law is so sacred, so ingrained, that it cannot be undone. Except maybe the 4th Amendment.

    1. No, Suderman recognizes that half a loaf is better than none. In the current environment, it’s not going to be repealed enmass, it has to be chipped away bit by bit.

      Anyone who’s only response to the law is a 67th failed vote for repeal is basically saying they don’t actually care if it stay around forever, they just want to grandstand on an easy soundbite rather than do the hardwork of actually doing something about it.

      1. Chip away? That is one way of looking at it. The problem is that you are likely to only get one shot at doing something about this. The country is in no mood and doesn’t have the attention span to spend the next however many years talking about fixing Obamacare. The Republicans if they are lucky will get one shot to do something about it.

        If they don’t repeal it, what will that shot be? The law is so horrible and so flawed that it is difficult to imagine what a “reform” that would make things meaningfully better would look like. Chances are such a reform would only make things marginally better or repeal a few of the worst parts of Obamacare at the expense of letting the Democrats avoid full responsibility for this disaster.

        No. The better way is repeal or nothing. Since no Republican voted for this thing, the Democrats will forever own the consequences of it. If they think it is so good and don’t want to repeal it, let them filibuster or veto a repeal and live with it.

        1. Then enjoy your big bowl of nothing.

          1. I don’t think so. At some point the Democrats will get tired of losing elections over this thing and not being a viable party outside of the most blue states.

            Once Obama leaves office, the Democrats will have no reason not to support repeal. What does blocking repeal get them? A repeal would let them off of the hook for this disaster and allow them to go back to blaming Republicans for all of the world’s problems. That is what they want and have to have. The only question is what price do the Republicans want to make them pay for getting that. Your idea is to let them have that in return for a bunch of meaningless “reforms”. The better idea is to make them pay for it with repeal. And they will do that. They have no other choice.

            1. The actual solution to this is one that neither party will support, especially as the US health care industry income wise would be loser in any true “reform”. Our health care costs are close to double those of the rest of the developed world. US doctors are by any standard the world’s highest paid. The same is true with the rest of the health care industry. No one involved in the industry wants to see their own income drop.

              Unfortunately to get control over health care costs means that the incomes of those involved in health care have to drop or we simply end up with a system that will eventually bankrupt us all.

              The solution is to remove the government supplied “protection” from the industry, force it to compete in the open market. However, outside of the Libertarian Party, no one is interested in doing this…

              1. Simply not true. The Swiss compensate their providers nicely too. Now it is true that all of the government imposed overhead contributes significantly to the cost as does the fact that we are far more generous in medical care in the final stages of life than the supposedly caring Europeans, not to mention our lovely tort system or the fact that Europeans and Canadians free load off of our drug and medical device cost.

                By all means bring on the free market, but don’t simply assume that provider income is the source of all of the problems.

              2. From reading a few of your posts, you seem to have an issue with doctors and our pay. A few thoughts for you. Most every doctor that has a choice in the matter refuses to see more Medicare and Medicaid patients because this govern “protection” pays below market rates. It is price fixing. We would love to have everyone with HSAs and catastrophic insurance. We can negotiate with insurance carriers. There is no negotiating with what the government pays. Something else, payments to MDs are about 10-12% of Medicare spending. Go ahead and cut what Medicare pays even further to get down to what you think is the appropriate amount, and you are still left with over 500 billion I spending. BTW, of course MDs in the US are are better paid than the rest of the world. I would say that almost every professional in the US is paid better than his or her counterparts in the rest of the world. And as far that prescription complaint, I have no problems with letting you go on web MD and trying to treat yourself, find the appropriate medication and then take it. Good luck, just don’t come running to me or my colleagues when you are pissing blood.

              3. American physicians, myself included, make mid range in terms of % spent on healthcare altogether. Doctors in the us are not overpaid and their salaries are not the driver of cost.

          2. Stormy, there’s nothing but a big bowl of nothing to be had here:

            (1) Repeal won’t pass, so . . . nothing.

            (2) Reform will involve spreading the graft to Repub cronies and adding more layers of rules and bureaucracy, so . . . nothing.

            If I’m going to get nothing, I’d rather get it for doing the right thing than the wrong thing

            1. If you can’t get meaningful reform, do nothing and let the Democrats suffer under its yoke for a while. The worst thing to do is agree to some half assed reform.

              1. Democrats won’t suffer under it, not in the long run anyway. What will happen is what always happens. Democrats will eventually push for single payer and the GOP will champion the status quo (aka the ACA). Like Social Security, they’ll take a leftist program and make it their own. Mark my words; the GOP will eventually become the biggest protectors of the ACA.

          3. A spoonful of wine in a barrelful of sewage is sewage. Enjoy your big bowl of it.

          4. It looks as though by 2016, Obamacare repeal could be a saleable point.

        2. Don’t repeal it. Just replace all the text with something completely different. 🙂

      2. So you honestly think that there is some type of “reform” in the pipeline that could make this program any better?

        For instance, the most popular yet economically disastrous part of the law is the in ability for insurers to refuse to sign up those with pre-existing conditions. The public loves it because “BOOOOO!BIG BAD CORPORATIONS AREN’T GIVING AWAY MONEY!!!BOOOO!!” but the insurers don’t care because they just pass the added cost of insuring pre-existing customers on the their current paying customers in the forjm a gigantic deductibles and increases in premiums, and that’s not even including the insurer bailouts that Obama will inevitably use an executive order for. THIS IS EASILY ONE OF THE WORST PARTS OF THE BILL AND IT WILL NEVER EVER EVER EVER GO AWAY BECAUSE POPULISM.

        There is not a fucking chance that any “reform” will even dent this new behemoth.

        Kill it dead or go home.

        1. Health savings accounts along with repeal of prescription laws would go a long ways towards reducing the cost of health care. Of course the health care profession would have a screaming fit over this. Doctors incomes (like those of all of the licensed professions) are far above true free market levels because of “protection” by the government. Without professional monopoly, the free market determines what people will get paid, not what they would like to get paid which is the case today.

          1. And yet cosmetic surgeons and lasik providers are very well compensated and there very clearly IS a much freer market there. The notion that it’s all greedy providers is bullshit, or perhaps you consider the income levels dictated by government in much of Europe to be “free market.”

        2. You don’t have to kill it dead. The actual plus side of that populism is that the Individual Mandate is the most hated part of it. Repeal that and the whole system collapses anyway.

      3. Hahaha Peter Suderman has become a republican advisor. Now all the so called libertarians can defend him and say he is a real libertarian even after he sold out to make a deal with democrats. Libertarians are a joke.

        1. Hmm, not really seeing any libertarians defending Suderman on this one.

      4. Are you serious? The republicans had no intention of getting rid of obamacare. Like every other unconstitutional move they’ve ever screamed bloody murder about when it was enacted they’re salivating at the thought of using their new power for their own agenda. Don’t be fooled by their public statements which are really just meant to inflame the base, they’re looking forward to being elected on their opposition and will then immediately fall in love with it, and so will their base.

        1. The private health insurance industry is likely the major “winner” in all this since thanks to the individual mandate, everyone is required to purchase a plan which likely costs far more than what a lot of people would be willing to “buy” if they had a choice.

      5. The “half a loaf” argument is trotted out whenever someone has to give up on principle — losing, that is to say — and settle for perhaps less of something they didn’t want in the first place.

        The Federal government should get out of health care, period, with the possible exception of playing referee (not gatekeeper) in areas where practices, goods, and treatments cross State lines. Accepting Obamacare in any substantial form is giving up on that position.

        What about Roy’s proposal will allow, or even enable, a robust private sector health-care system to emerge in parallel with the Obamacare establishment, and someday replace it entirely? I can see that ending the Individual Mandate could be an important step in that direction. But for people who have opposed Obamacare on principle, there needs to be a clear roadmap from the “reformed Obamacare” to the obsolescence of Obamacare and its replacement by a free-market alternative that works. Then, the principled can support the new plan, and go right to work following the roadmap, as soon as “reform” has been achieved.

        1. But absent that clear roadmap, I hasten to add, the principled should NOT accept a “pocket full of mumbles,” as Paul Simon once wrote. It that case, it is wiser to get nothing for the right reasons, as someone above said.

        2. If we were to eliminate state and federal involvement in the health care industry, very quickly there would be new providers providing health care services for much less money. The software industry would produce a “Doctor on a DVD” program that would allow people to make most of their medical decisions without the need for a doctor’s involvement. When people pay for things themselves (instead of insurance) they will decide for themselves what drugs and treatments that they actually are willing to pay for.

          1. “The software industry would produce a ‘Doctor on a DVD’ program that would allow people to make most of their medical decisions without the need for a doctor’s involvement.”

            And the Big 3 killed the engine that runs on water.

            1. “And the Big 3 killed the engine that runs on water.”

              No, that was the big oil companies. The big three bought and buried the design for the 100 mpg carburetor.

          2. “that would allow people to make most of their medical decisions without the need for a doctor’s involvement”

            People should absolutely be allowed to do that, but it would be an exceptionally stupid thing to do. You strike me as someone who really has no understanding of modern medicine if you think a DVD can replace a doc. Next time you have an MI or pancreatitis pop in that DVD and let me know how it turns out.

    2. Suderman and ObamaCare, sitting in a tree! K.I.S.S.I.N.G!!

    3. The premise of this article is fallacious from its beginning so NO the law must be repealed not “fixed”.
      This law establishes so many facist premises that it must be repealed. The biggest one is that the government has the right to hijack an entire industry and impose its will upon it. The second is that the government has the right to force individuals to buy a product that they might not think that they need or want.

      Its like the colonists accepting the rule of King George the third in exchange for some minor economic concessions that could be revoked at any time

      Nope its liberty or its tyranny and we want liberty

  2. Republicans Are Still Talking About Obamacare Repeal. They Could Be Talking About Obamacare Reform.

    Yeah, let’s put some lipstick on that pig!

  3. The only reform that is possible is to burn it down. This malformed abomination is unworkable and has already collapsed under its own weight.

    1. Yeah thats why its working and not even a campaign issue in most places. remember when the republicans were going to make it the major campaign issue of 2014? What happened to that? Oh like the president said, its working, so all the rethuglicans are being very quiet all of a sudden.

      1. Did you hurt your brain shriekiepoo?

        1. i thought this was putin’s buttplug in the world’s worst disguise. Is putin’s buttplug really shriek? How many diseased alter-egos does this pathetic little freak need?

      2. Get back to me once all the delayed mandates start hitting. It will make the previous storm over cancellations look like a gentle summer breeze.

  4. My health insurance is going up $150/month. Fuck.

    1. Not only is my health insurance premium going up, but my GP has decided to “go concierge,” converting his practice to MDVIP. We are asked to pay an additional $1800 annually per patient to keep seeing him, but also retain conventional health insurance, which, in our case, entails a Health Spending Account in tandem with a high deductible (which also went up this year!).

      Is anyone else here in a similar situation? How do you cope?

  5. No. Just No. Kill it with fire or nuke it from orbit. If the Republicans even attempt to touch it they will be blamed for everything, all the stories that were buried by the news will be on the front page. The media and democrats will go door to door looking for anybody remotely effected by anything they pass. What you are asking is political suicide and this article is the wet dream scenario for the dem campaign managers everywhere.

    1. “If the Republicans even attempt to touch it they will be blamed for everything, ”

      Just reference trying to blame Republican’s for Ebola.

    2. Okay. This is how the scenario will no doubt play out.

      First campaign ad: “I’m Joe Gop, elect me and I will work to completely repeal Obamacare.”

      Second campaign ad from his opponent: “Joe Gop wants to go back to the evil old healthcare, with insurance refusing coverage to those with preexisting conditions. Joe Gop wants to bankrupt families with autistic kids, and want cancer patients to lose all their money before being left to die!”

      Election Day: Joe Gop loses by double digits.

      This is why promising to go whole hog on Obamacare repeal will get you nowhere. Get elected on reforming the law – keep pushing YOU’LL SAVE MONEY WITH OUR REFORMS – and THEN once you have the numbers in Congress, dismantle Obamacare.

      There are some situations where ninjas work better than nukes.

      1. Just when in recent history has the US rolled back a behemoth govt program once rolled out? There’s armies of buerocrats feeding on Obamacare right now. Ted Cruz was right to resist its implementation so the GOP wouldn’t get tied to its’ failure. Doubtful of a repeal unless an economic catastrophy strikes, which I wouldn’t count out.

        1. Well, at least they TRIED back in the 90s with “Workfare”. But just as there’s not much of a chance with getting a program rolled back, there’s even LESS of a chance of it being eliminated all at once. And we don’t even have a supermajority in Congress to even try and implement either option, to begin with. You won’t get out the starting gate at all if you can’t elect enough of the right people. And to even get THAT done, you have to present a convincing message to them swing-state voters.

          Again, ninjas vs. nukes.

    3. Like social security and medicare, this was wrong from the beginning, and had to be misrepresented and couched in class warfare terms to get through.

      Kill it.

      Kill it now.

      I’m not kidding.

      This creeping socialism needs to end.

  6. WHAT? No, fucking repeal it. Holy cow. Can we stop treating laws as inviolate–amendable but not repealable? A healthcare reform law, restoring some semblance of a free market in medical services and health insurance might be a good idea, but on its own, without the millions of tons of baggage that that poorly drafted law carries.

    Kill it. Kill it with fire.

    1. Do a full repeal for the simple reason that it would show that yes a Prog “signature accomplishment” domestic program can actually be killed. That alone would make repeal a landmark accomplishment regardless of the actual effects of doing it, which would probably be good and couldn’t be any worse than doing nothing.

  7. What exactly is the Reason position here? There have been any number of articles by Suderman and others talking about how the Republicans are really crap weasels who have no interest in repealing Obamacare and in fact love it and just won’t admit it. Now Suderman is saying the Republicans are really crap weasels because they plan to actually repeal Obamacare.

    Lets just take it for granted that the Republicans are evil and wrong here. Is it too much to ask that Reason give a consistent and coherent reason why that is true?

    1. Its Suderman, of course its idiotic.

      1. All reforming it would do would allow the Democrats to escape blame for its creation. If you reform Obamacare, then Democrats get to blame all of the country’s health care problems on the evil Republican reform of Obamacare while still getting to claim credit for passing it. Just repeal the damned thing.

        1. On this we agree. Times 1000. Just fuckin’ kill it.

        2. And what will flat-out repeal accomplish, without some kind of reformed system, no matter how miniscule, to replace it? Are you wanting to go back to the status quo, the good old way of doing things, by offering nothing to replace Obamacare? Voters do ask those questions, you know.

          Do you really want the media to dredge up a thousand stories of “we’re going bankrupt because my baby can’t get coverage for her (insert lifelong disease or disability here), thanks to the GOP shutting down Obamacare”?

          Running on just killing Obamacare and putting nothing in its place will get you nowhere. And continuing this strategy will ensure a Democratic domination much like the South in the early 20th century. Republicans are gonna get blamed for what happens, no matter what. So it’s better to fight back with our own media blitz, as best as we can.

          1. There are already stories like this about the high deductibles.

    2. “Is it too much to ask that Reason give a consistent and coherent reason…”

      Yes, it is. Reason is not a homogenous hive mind. It is a medium for debate and lots of points of view. Thats why I love this place. No two people agree on much of anything, authors included. It makes for a non-herd mentality and robust debate at times.

      1. I haven’t seen many Reason articles that were skeptical on open borders, gay marriage, or unlimited abortion. So the writers seem pretty homogenous on a few issues that the readers, and commenters are not.

        1. The commentators on this board, the leftist trolls excluded, are as a group smarter, more free thinking and hold more thoughtful and interesting view that the Reason staff. And that is true by a long shot.

          1. I’ve always wondered how one gets a writing job at Reason. It seems like a few of the commentators could do a much better job then some of the writers they currently have.

          2. Well, that’s because we eat spice like sandworms with an addiction problem.

      2. Ya, I don’t mind lack of a company line on issues. It’s OK that Suderman has a different opinion than any other writer.

        We just need to make sure we give him a hard time every time he starts spouting his cosmotarian-surrender bullshit on this subject.

        1. It’s OK thatif Suderman has a different opinion

          Actually I think Matt Welch is also a cosmotarian-surrender monkey on this issue.

          But still. I don’t want top-down enforcement of ideological consistency here.

          1. Anyone who has watched The Independents can see Matt Welch for what he is…cowardly, millennial, liberal

      3. lolz excuses. this so called libertarian is just another neocon in disguise, but now the disguise came off and he is talking about how to improve ACA. how does it feel to support so called socialized medicine, libertarian? haha

        1. Why don’t you do the whole world a favor and eat shit and die?

    3. Maybe I’m wrong, but wasn’t Suderman one of the guys telling us when Cruz was trying to kill it in the budget showdown that it would be better to wait until Republicans had a more realistic chance and then kill it? Now he’s telling us that they shouldn’t kill it?

      Don’t get me wrong. If I were Suderman I might well support keeping Obamacare around, as well. Its fuck-ups provide ample material for great stories. But, that doesn’t strike me as a sound basis for policy.

  8. This article is mindnumbingly stupid even for Suderman. It’s like he has never even followed us politics for the last 200 years.

    1. You haven’t read much Suderman, have you?

    2. AGREED!! and I thought this was a Libertarian website not a clearinghouse for slightly left of center idiots

  9. Oh, bullshit. Obamacare doesn’t need to be reformed. Reformation is irrelevant to its problems, which are systemic. Obamacare needs to be repealed. So does the concatenation of regulations stacked onto the healthcare market since the passage of the social security act. The healthcare market is so distorted by failed government policies that it is impossible to tell what might work as a policy without reverting to pre-regulation and waiting for probably about five years.

    The same is true of far too many other aspects of life in this country, not that any other country is likely to be better.

    We need to repeal some laws just to establish that it can be done without the world coming to an end. For much the same reason, I would live to see us drop a nuclear booms or two on some pesthole like Iran or North Korea. The fact is that the bombings of Hiroshima and Nagasaki didn’t end the world, didn’t kill millions (or even many more than conventional booming raids from that time), and didn’t create huge radioactive fire breathing newts. The knee jerk horror that so many express over the idea of using nuclear weapons seeps over into using nuclear power and has nothing whatever to do with reality.

    1. cntd.

      We assume reflexively that laws and regulations are unrepeatable, so it doesn’t happen. We assume reflexively that atomic bombs leave permanent wastelands in their wake, and people were living in both Hiroshima and Nagasaki by the 1950’s, with so little effect that you have to do careful statistical study to see it.

      1. I like the cut of your jib, but may I suggest neutron bombs instead? Some of that neo-stalinist architecture needs to be kept around as a warning to future generations.

        1. No, they don’t. Each generation creates its own passel of hideous buildings, and neo-stlainist isn’t even close to the worst. Brutalism springs to mind. And, let’s face it, Walter Gropius should have been keelhauled of crimes against humanity.

          1. I happen to like the look of brutalist architecture.

            1. What is brutalist architecture? I’m picturing something built and designed by Orcs, or maybe Russians.

                1. Damn, that is hideous.

                2. Downright Stalinesque, I’d say.

                  Appropriate for the setting.

                  1. Actualy, is doesn’t look Stalinesque. Stalinesque looks like the work od the man who designed the Empire State building, shorn of any remenent of taste and on bad acid. It’s really quite extraordinary. Stalinesque looks like it belongs on the cover of a Hugo Gernsback SF pulp. Brutalist somehow always looks like a municipal sewage treatment plant.

                    1. Huh. You sound like you know the terms. I guess my architecture decoder ring sucks. But, even after you descriptions, still looks stalinesque to me. Although I could definitely accept “stalinesque municipal sewage treatment plant”.

                    2. My mother was an architectural historian by avocation, so I grew up with a lot of it. Since leaving my parents’ house, I’ve taken a casual interest; reading Tom Wolfe’s FROM BAUHAUS TO OUR HOUSE (which is brutal about modern architecture) informs a lot of my opinions.

                      I’m given to understand that Jonathan Meades has done two BBC documentaries on “Dictator Chic” in Architecture; “Jerry Building ? Unholy Relics of the Third Reich” and “Joe Building: The Stalin Memorial Lecture”, but though I’m very fond of Meades’ deadpan humor, I haven’t managed to get hold of either.

                3. Why is that building upside down, and made with tetris blocks?

                4. “Brutalist architecture is a movement in architecture that flourished from the 1950s to the mid-1970s, descended from the modernist architectural movement of the early 20th century. Brutalism became popular with governmental and institutional clients,…”


                  Something described as “brutalist” would be popular with governments. Shocking.

                  1. “Brutalism as an architectural philosophy was often also associated with a socialist utopian ideology, which tended to be supported by its designers, especially Alison and Peter Smithson, near the height of the style. This style had a strong position in the architecture of European socialist countries from 1975 to 1989 (Czechoslovakia, GDR, USSR). In Czechoslovakia brutalism was presented as an attempt to create a “national” but also “modern socialist” architectonic style.”

                    Well, of course.

            2. There’s just no accounting for taste. My parents liked Mondrian, f’Crissakes

  10. King Suthenboy – “The Patient Affordable Care Act is hereby repealed.” That would fix it up just right.

    That would be my first decree. The second would be to undo the oceans of unpossible to comply with bullshit regulations on insurance and medical care.

    Want to compete with all of the insurance companies in the whole country? Knock yourself out.

    Want to sue the doc and hospital for a trillion bucks over the most innocent mistake? Tough shit.

    No more rationing drugs from the FDA. No more withholding drugs over FDA approval.

    I could go on and on. In five years medical care would be about as expensive as car repair. Innovation would take off like a rocket.


    Yesterday I had to go to a three hour seminar on choosing a new insurance plan. There were about a thousand people there and every damn one of them had smoke coming your of their ears. No one could understand the plans or decide which to choose. Everyone’s premiums were going up and deductibles are going up 10x. (300-400 going up to 3000-4000/ max annual payouts from 4000ish to 10,000)

    I am sure Obama’s sniveling little fucktrolls are still trying to polish the Obamacare turd, but everyone else wants heads to roll. It is the equivalent of telling someone ‘It doesn’t hurt, really!’ while you squeeze their balls with a pair of pliers.

    It looks like Mary Landrieu’s head will be one of them. That makes me smile.

    1. I would like to see the rules of suing for damages changed so that jot was possible (or, if its possible now, easier) to sue to get a doctor’s admitting privileges suspended for a period, or to have two burley orderlies hold his arms while I broke his kneecaps. No doctor has ever bungled badly enough to make me want to beggar his insurance company, but a couple have botch care of my Lady to the point that I would like to see them taught a serious lesson about FUCKING PAYING ATTENTION.

      1. I did not mean making it difficult to sue. But those suits would be limited to gross negligence or malice. As it is people sue over the most minute and honest mistakes.

        And yes, having incompetents lose their practice is a good idea.

        1. The Doctor I wanted to see suspended have prescribed a painkiller that my Lady has a potentially lethal reaction to. The reaction was noted clearly on her chart, so he just wasn’t PAYING ATTENTION.

          The one whose knees I want to break put her on too much steroids for far too long, and we have had one hell of a time weaning her down to a maintenance level.

          We went to Johns Hopkins (not for Medicine) and in five years met TWO pre-meds who I would allow to touch me with a stethoscope. TWO!

          Glorified mechanics, most of ’em.

    2. To be fair, I have been attending “three hour seminars” (or longer!) on benefits selection (emphasizing health care plans and retirement accounts) since 1980. They never get any simpler; they never get any better. Then, after all of that, I have to fill out pages and pages of labyrinthine forms that would make an IRS agent proud! WHY? I have always said that, if people wanted to give me a BENEFIT, they should SPARE me that torture! Better yet, just give me the money and let me figure out how to take care of my own needs and those of my dependents. But no! They have to have their multi-day “open enrollment” rituals, they have to make all of our eyes glaze over, they have to keep chanting “The future is now!” and whatever other slogans are in vogue for fleecing the rubes, this year. And they definitely seem to take pleasure in enforcing the deadlines, by which your reams of paperwork must be submitted, or you are penalized or — worse! — must wait to make corrections or changes until next year’s Open Enrollment. What a horrowshow!

      1. “horror show!” Man, that got me so worked up I talked funny in my head and spelled it as it sounded! 😉

  11. I think it is abundantly clear to most of the GOP that they won’t be able to muster the Political Capital necessary to Repeal Obamacare- especially with a Democrat President in office.

    But they are pushing for Repeal because- when they compromise- they will get far more reforms than if they started from the bargaining point of “Let’s reform it”.

    At the end of the day, if they rebranded “Repeal and Replace” as “Open Heart Surgery on Obamacare” they could net the same thing- a vast rewriting of the law to remove all the bullshit mandates, and instead setup a system of private accounts with monetary deposits going to people in need.

    Fuck that new more svelt obamacare could solve all the problems around Employer mandate (let them deposit tax-free money into your private health account) and eliminate scores of the complaints people have.

    1. I don’t see how you can have any meaningful reform that doesn’t effectively repeal it. You tell me the significant part of Obamacare that doesn’t need to go because I don’t see it.

      After Obama leaves office the Democrats are going to be desparate for some kind of fix. Even if there is a Democratic President, that President will have nothing invested in Obamacare and no reason to spend political capital trying to save it. Moreover, that President will have every reason to want to sign onto some kind of bi-partisan “reform” that will allow him to take credit for fixing Obamacare and put the Republicans on the hook for part of the blame.

      But, any significant reform will amount to effectively repealing it. So what will likely happen is the repeal will be called a “reform” to give the Democrats and their media toadies a way to preserve some of their dignity and not have to admit this thing was a total disaster. “It just needed tweeked” will be the spin.

      1. The way I would like to repeal the Individual Mandate would be to repeal the 16th Amendment to the Constitution. Without an unfettered authority to tax income (and then to ladle back people’s own money to them in exchange for behavior modification), the I.M. probably couldn’t have stood judicial muster as a “tax.”

  12. Why not repeal it without saying you’re repealing it (outside of red state base crowds)? Just repeal all the subsidies and mandates and regulations and dismantle the federal exchange, but leave the state exchanges up (without federal funding or oversight) and call those Obamacare.

    1. I like, with one refinement:

      The federal exchanges can be converted to state exchanges within a year or so. If not, shut them down.

      1. That is more than likely what will happen. The only question is how far it goes. That will depend on which party holds the White House.

        1. One further: totally privatize the state exchanges. They become giant markets for individuals to get insurance at group rates.

  13. Yeah, okay, whatever.

    This country is fucked. Even if a politician existed who was willing to offer a principled and coherent refutation of the Total State State, there are only a handful of Americans capable of comprehending.

    Enjoy the all you can eat shit smorgasbord, while it lasts.

  14. I personally don’t think they should be talking about reform. They should work to implement it 100% as written and as soon as possible.

    “The best way to get a bad law repealed is to enforce it strictly.”
    ? Abraham Lincoln

    1. Rethuglicans would never do this tho because if the ACA were to be implemented the way it was supposed to be then people would really like it and the rethugs would be left empty handed.

      1. Yes, that theory perfectly explains why President Obama has delayed various provisions for years. /sarcasm

        1. Um no sorry he had to adjust and tweek various parts because the rethuglicans screwed it up so badly and did everything they could, and made it like an obstacle course for him. now they are pissed that he got through it!

          1. The republicans didn’t force him to hand out goodies to giant corporations (delaying the employer mandate) shreik.

            Seriously, go back to snorting heroin or whatever the fuck you were doing.

          2. ^^^ This troll is droll. ^^^

  15. my co-worker’s ex-wife makes $79 hourly on the laptop . She has been out of work for ten months but last month her paycheck was $12640 just working on the laptop for a few hours. try this site…

    ???? http://www.netjob70.com

    1. Oh, go paint yourself purple and moo.

  16. Reform (or no change) would cement Obama’s legacy as the worst President of my lifetime. Repeal would likely keep him slightly better than LBJ, Nixon, and Bush II (those three are too close to call).

    So, Obama has that as a positive for repeal.

    1. No, your wrong about that. Reform will be branded by every Leftist ever as, Republican’s screwed up Obamacare, that would have been perfect without their interference.

      Repeal on the other hand will result in historian’s trying to come up with some major historical accomplishment to hang on Obama. And the list of possibles is pretty thin.

      1. Considering the political bent of most academics, I have a feeling he’ll be lauded in the history books no matter what.

        Dissenters will, of course, be “racist.”

  17. There are a number of things that could be done to effectively gut it without explicitly repealing it.

    You could gut the individual mandate by creating lots of exceptions and broadening the minimally acceptable plan to include catestrophic and hospital-only plans.

    You could gut the community rating provisions by allowing enough variation in premium rates to account for actual variation in risk factors.

    You could gut the guarenteed issue clause by adding waiting periods for pre-existing conditions, or make it only apply if the person was previously insured when they got the condition.

    1. More bureaucracy, more complexity.

      Not what OCare really needs, thanks.

      1. Indeed. Any repeal effort needs to make the law simpler, all of those make a hideously complex law, even more complex.

  18. Many “libertarian” journalists are talking about tweaking the edges of big shitty government. They could be talking about actually making it smaller.

  19. I’d love to see ACA repealed. But I really cannot see how it would happen. By what mechanism would it occur? What historical evidence do we have to think it’s possible?
    Wouldn’t returning HSAs and catastrophic plans be significant improvements?
    It seems like a lot of the anti reform crowd doesn’t want to legitimize the ACA by trying to fix it. But I think that ship has sailed. Yes, prices will go up, quality will go down. But how can you have faith that the US public will learn the right lesson? History leads me to think the conclusion the US will come to is more intervention.

    1. By what mechanism would it occur?

      Passage by House and Senate, signed by the President (or veto overridden), would be my guess.

      1. That is the theory. But I meant to ask for a mechanism that had a chance of happening.
        Even if elephants retake Senate and presidency, I have trouble thinking they could get the numbers for repeal, when the donkeys and their MSM apologists would be apoplectic at the notion, and ready to fight to the death.

        1. That only matters if Obamacare has some significant public support.

          Obamacare has a 43% approval rate and a 53% disapproval rate. It’s underwater. If the numbers don’t change, maybe Democrats could successfully defend it, but it would be difficult.

          If the disapproval hits 60 and the approval drops below 40, for an extended period, there would be no hope of defending it.

  20. So is Suderman calling for the Republicans to be the phony small government types that libertarians hate them for being?

    1. Yes. Yes he is.

  21. More generally, it would require Republicans to level with voters about the likelihood of repeal, and take an affirmative reform position on health care,

    Do I detect the whiff of Total State here? What counts as “affirmative reform”? Since repealing existing laws apparently doesn’t count, I have to assume that “affirmative reform” involves a proposal for government involvement, no? So that nothing counts as “reform” unless it creates a new government program and more buildings full of bureaucrats?

  22. The problem, though, is that the GOP has long criticized Obamacare for being too disruptive; with any of these plans, Republicans would be opening themselves up to a similar charge.

    Any libertarian plan would be pretty disruptive too you know.

    1. That is a good catch. Since when is “disrupting” an admittedly unfree and horrible system some kind of a downside?

  23. The cover picture of Nancy Pelosi smiling at fearless leader with her look of adoration is just to much to take and I am totally despondent, and I can now imagine a Tony run re-education camp in my future.

  24. How’s this for reform?

    1 Get all the pages of the ACA.

    2. re-form them into a pine tree.

    3. Shove that tree up Obamas ass.

    Also, I’m no fan of Cruz, but damn if I wasn’t rooting for him during the “shutdown”.

    1. I’m sure some will remind you that you forgot a step:

      4. Then light it.

  25. Good to see some are beginning to act like mature adults (that would be Roy, not Cruz). As long as the GOP, and Libertarians, keep acting like petulant school children who did not get their way, well, then they won’t get anything. They (and you) keep acting like there is not a majority of people who want the law to stay in place, and only want it fixed. Check out any Pew poll, and that is what the majority of Americans say…keep it and fix it. At least Roy got the message.

    1. Take your racism eslewher. Obamacare was the biggest domestic achievement since Johnson. And now you are on here saying that it needs reform. You wouldn’t be saying that if Obama was white. No one said that about LBJ’s accomplishments or FDR’s. When a black President accomplishes something big, and don’t tell me its not everyone admitted as much at the time, people like you immediately want to fold to the Republicans and “reform it” so some white President can take credit for Obama’s program.

      Any liberal who wants to reform Obamacare is just a racist who can’t handle a black President getting credit for something.

      1. That is a pretty bulletproof parody there. The leftists could not argue with you using any of their standard gibberish. I’m sure you put JA into quite a huff.

        1. Its all true. As recently as October of 2013, people like Ace were calling Republicans terrorists for tying to stop Obamacare. Here we are a year later and things are a little hard and they fleeing from Obama and his signature achievement like rats from the Titanic.

          They didn’t act that way when Republicans have wanted to repeal the Great Society. They didn’t abandon Carter or Clinton the way they are now abandoning Obama when things got tough. The only difference I can see is that Obama is black and the other Democratic Presidents were not.

          The one thing you could always say about the Democrats is that unlike the Republicans they stand by their achievements and they stand by their Presidents. That is until they had a black President. Then everything was somehow different. Black Presidents only get Jackland’s support when it is popular to give it.

          1. Lots of things he doesn’t get my support for…try keeping up if you want to guess at what I stand for.

            1. Its not supporting a black President that is for sure.

      2. Avik Roy wants to fix it, and oh guess what, sounds like Peter finally got the message.

        1. It is a shame people can’t stand a black President having a success that some white man doesn’t later take credit for “fixing”.

          1. Your a racist John the most racist people in America are Blacks and white Liberals None of you will be happy until America burns Piece of shit

  26. They (and you) keep acting like there is not a majority of people who want the law to stay in place, and only want it fixed. Check out any Pew poll, and that is what the majority of Americans say…keep it and fix it

    Convince me those people have read and understand the legislation. Most of the people “in favor” of Obamacare apparently still believe it represents Free Unlimited Health Care For Everybody.

    1. They just want the parts of the law that are making things worse fixed. What they don’t understand is that is the entire law. People feel like they should like the law because its racist not to but they also hate everything they know about it. So they say “just reform it” hoping to have it both ways.

      1. The law is only making things worst when the rethugs did there best to break it. In the house and in the state governments they did everything they could to make sure it didnt work, and oh look guess what, it got a rocky start. but now its working and no one is complaining and even faux news is being quiet about it because they know there lies are exposed.

        1. The law is working great. You only say it isn’t because you are too racist to defend a black President when things get tough.

        2. LOL, what a crock of unadulterated shit.

          Unadulterated by any resemblance of reality, that is.

          Not one Republican voted for Obozokare. They stood on the sidelines and told the country it was going to be a fucking disaster. It’s a fucking disaster, and now you–you childish, mindless partisan asswipe–have the mindless gall to blame your failures on others?

          Oh wait, you’re a leftoid, that act pretty much sums up the totality of your psychological universe.

          Everyone who works for a living and receives healthcare through their employer, or who buys it on their own, has seen drastic increases in their withholding and payments, and astronomical increases in their deductibles.

          Obozokare is another free lunch charade of the left, which only the most stupid and pathetic of losers in the country are still supporting. Anyone with any real intelligence (and honesty) realizes that the left sells you a free lunch that they drain your life and future to pay for.

    2. You don’t understand the legislation.

    3. No they don’t.

  27. The best reform is repeal.

    1. Ain’t ever going to happen…that ship left long ago.

  28. 1. Allow HSA, catastrophic plans, and other cheaper insurance to be sold in the marketplace.

    2. Continue to weaken the mandate by increasing exemptions. This is inevitable and the next best thing to an outright repeal.

    3. States that didn’t expand medicaid should be allowed to run their own equivalent and set their own rules (I’m not sure if they can do that now)

    I’m predicting that people will game the system somehow to apply for medicaid (in states that expanded it) even if they’re not eligible. The insurance companies won’t be happy.

    You can’t give free coverage to one group of people and have another pay more for theirs and not have some sort of conflict. If you’re paying the insurance company 500 bucks a month, you have to share resources with medicaid crowd who might not pay a thing in to the system?

  29. There is no way to reform a program designed to bankrupt this nation!

  30. Unless all of the clauses in the law deferring authority to the Secretary of HHS are replaced with actual legislative details that are voted on by Congress, and for which they – as the People’s Representatives – can be held accountable, the whole thing needs to be repealed in its entirety. Anything else will just more permanently cement into place the oligarchy that was established when the federal government usurped sole authority over the limits of the federal government’s authority (i.e., via “judicial review” and, later, via the 14A and “incorporation doctrine”)

    This isn’t a question of political feasibility or other nebulous, “nuanced” nonsense; it’s recognition of the fact that PPACA – as written – is nothing less than Congress giving the Executive carte blanche to legislate health care and insurance regulations from the White House.

  31. The only way Obamacare will be repealed is if they keep raising the rates on the poorest purchasers who are having to purchase the bronze plans. Those plans amount to bankruptcy whether the injured/sick poor person has insurance or not. Therefore they see no benefit for the amount they are paying out.

    The question is what will Obamacare be replaced with? The most likely (given our current political/economic climate) will be full government healthcare.

    I think the most likely reform would be to make the bronze plans free for the poor. This will, of course, make the economics even worse, but it will make the poor happy.

    People are stupid and (when it comes to government handouts) actually think that free is free.

  32. To actually reduce health care costs requires that the medical profession be stripped of their monopoly power over access to medical drugs. Once that has been accomplished, the cost of health care drops as people start taking care of their own health, especially as the medical drugs they need are now available upon an “adult signature required” basis.

    Let me give an example of how this would work. Say a diabetic needs insulin. The price of the various insulins varies quite a bit. The lowest cost is available for about $25 a vial. The most expensive is about ten times that. However the doctor, not the patient, is the one who decides which to use. In effect human medicine isn’t that much different from what your cat or dog experiences in that the “decision” is made by others, not by the one effected.

    In a free society the one who decides is the one effected, and their decision is much more likely to be “sensitive” to cost than it is today when the doctor (who isn’t paying for the medicine) is the one making the decisions.

    1. In Tx, insulin is available over the counter. Neither the doc nor the pharmacist will tell you this. My father, who is diabetic, discovered it be accident. I wonder how many other ‘prescription’ drugs are like that.

    2. You seriously think doctors set drug prices? Did you get that from your “Doctor on DVD?” No, that would be the free market provided by the Pharma companies. Now if you want to bitch about a woman having to pay for an office visit to get birth control, you have a point, but that’s not what you’re arguing. And you expect the average low information voter to be able to properly dose complex medications? The same people who buy tylenol instead of generic acetaminophen (paracetomol in Europe)? Yeah, right.

      Now at this point you think I support the FDA and required prescriptions. I don’t. You want to self-medicate testosterone because your balls ache? Knock yourself out. What WON’T happen in that world is any significant reduction in health care costs. You get the rough concept of freeing the market as part of the solution, but you completely misunderstand what that means.

  33. Repeal is the only option because too many people will never understand that it cannot work. If you ask leftist why the premiums and deductibles are high they will tell you it’s because of corporations, or the 1%, or rethuglican obstructionism. Many simply cannot comprehend that you can’t cover pre-existing conditions and fund free healthcare without either raising cost or lowering quality. And that is because blue collar working people who make healthcare products and services do not work for free.

    Reform will remain focused on hiding the increasing costs into taxes so that most people don’t realize what they’re paying.

  34. If we could wind the clock back to pre-Obamacare, a three point plan for healthcare reform:

    1. End tax exemption of employer health benefits (offset with tax cuts). Employers will replace benefits with higher pay and we can shop for insurance that meets our individual needs (with visible costs) and stays with us even if we change jobs.(as you know, employer-based health care is not a creature of markets but a relic of WWII wage/price controls)

    2. Insurance companies must cover not pre-existing, but POST-existing conditions. That is, even after coverage is cancelled, an insurer must pay for illnesses that originated when the policy was in force. Protects responsible people from falling into the pre-existing trap without rewarding those who want to wait until they get sick to buy insurance.

    3. Income-based assistance to purchase private insurance. Get three quotes and submit along with your 1040 to determine the amount. Structured so that even those receiving assistance will behave as cost conscious consumers.

    Unfortunately, GOP & conservatives botched the health care debate, playing defense instead of offense, defending a status quo that was far from a free market. Maybe we could get back on track by burrowing into O-care and fixing it from within.

    1. Why wouldn’t everyone just cancel their policy and be covered for life?

  35. We wouldn’t have Obamacare of the GOP had done its’ job in the decades before. So as bad as centrally planned healthcare is and becoming worst, what can the GOP do if they repeal it?

  36. The argument is disingenuous, Obamacare was designed to fail from the beginning to allow for a single-payer system i.e. Socialized Medicine, it was shoved down our throats with Parliamentary tricks and back room deals like the Cornhusker kickbacks and Insurance company bailouts… this abortion of an unconstitutional power grab penalizes the maximum amount of people while helping the fewest.
    Nothing this mess would have ever addressed in theory, could have been accomplish far easier in-fact, by expanding Medicaid. Notice the feverish pitch Washington is trying to dismantle Medicaid? Don’t pee on my leg and tell me it’s raining.

  37. People should take a second look at Avik Roy’s proposal, because its essentially a trojan horse.

    ACA uses markets called exchanges. He’s saying use those – keep those, but make them better markets.

    Then roll two entitlement programs into those markets and voucherize them.

    Meanwhile, you’re keeping enough of a shell of the ACA to give Dems cover.

    The Dems wanted Single Payer but instead used this market style solution of exchanges, but tried to seed as much socialism into them as possible.

    Roy’s saying to remove the poisonous stuff (mostly) and keep the markets.

    I might even keep the mandate. The SCOTUS already broke the plane on that, and it prevents media sob stories. Yes, I hate it but again, the court already wrecked the principle.

    In reality, the GOP should attempt the following:

    Repeal with something to replace.

    But if that fails, then come up with this “compromise” which is better than nothing.

    Again, repeal would be awesome, but the public may start to love their horrible system like the Brits love the NHS, thus, the next step is to gut it from within.

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