Obamacare

Peter Suderman on Why the GOP Can't Win on Health Care

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In anticipation of the Supreme Court's big health care ruling in King v. Burwell, I've got a piece in Politico Magazine today looking at the GOP's history of being about to have an Obamacare replacement plan already…but never quite having one ready. Here's a bit from the middle of the piece that goes all the way back to the 1990s: 

The GOP's failure to engage proactively with health policy has become more apparent in the Obama era, as the Affordable Care Act has taken hold, but it goes back long before that. Its modern incarnation arguably starts with the collapse of the Clinton health care plan in the early 90s.

What Republicans learned from the defeat of the Clinton plan was that they could win health care debates by refusing to provide an alternative. An enormously influential 1993 memo from Bill Kristol cautioned Republicans to avoid the temptation to "[help] the president 'do something'" on health care, which would only lend credence to the Democratic idea that the system was broken. Instead, Kristol advised Republicans to question reforms that would upset a system with which a majority of the middle class was already satisfied, and to concentrate on tweaking the system as it already existed.

The result was that many Republicans in Congress walked away under the impression that the American health care system was largely fine, and that doing something to significantly redirect it would only serve the other party's interests. And so in the decade and a half after the collapse of the Clinton plan, Republicans, on the whole, were largely content to ignore health policy.

Democrats, in contrast, used the time between the demise of the Clinton plan and the election of Barack Obama to regroup and rebuild, with a focus on overcoming the specific challenges that doomed the 1993 effort. The Congressional Budget Office (CBO) scored the Clinton plan as an increase in the near-term deficit, with health premiums counted as government spending, so Democrats, starting with Sen. Ron Wyden, worked with the CBO to craft legislation that the CBO could score as deficit neutral, and premiums kept off the government tabs. The Clinton plan was widely criticized for causing people to lose their doctors and health care plans, so Democrats worked out legislation that President Obama could plausibly—if not, it turns out, accurately—promise would allow anyone who wanted to keep their current plan to do so. The Clinton plan was assailed by a mountain of industry funded ads opposing the proposal, so one of the first orders of business in crafting Obamacare was to negotiate support from doctors, hospitals and health insurers.

Planning for what would eventually become the Affordable Care Act begun not only prior to President Obama taking office but before he even won the nomination. As John McDonough, an influential health policy adviser to former Democratic Sen. Edward Kennedy, notes in his 2011 book Inside National Health Reform, the effort began in earnest in April, 2008, when a group of forty-some veteran health wonks, most of whom had worked on the Clinton health plan in the early 1990s, met in Saint Paul, Minnesota to discuss the prospects for overhauling the health care system. Not everyone was sure that it would succeed, but, importantly, all three Democratic presidential candidates had "produced similar reform plans." The party had settled on a unified vision, and had even managed a general agreement about the particulars.

Obamacare, in other words, was ClintonCare's second act—the culmination of more than 15 years of work and consensus building. To put it another way: Republicans never started working on health policy; Democrats never stopped.

Whole thing here

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  1. I’ve got a piece in Politico Magazine

    Of course you do.

  2. “Republicans never started working on health policy; Democrats never stopped.”

    I still prefer the Republican plan.

    1. Something must be done!

    2. You must not be sucking up to the Beltway “technocratic elite” in Politico.

    3. not working on things that aren’t supposed to be worked on… now that’s at least SOMETHING the GOP has gotten right.

    4. No, because the Republican plan has been to basically coast along with the status quo. Almost no one was/is happy with the status quo.

      Opening healthcare to market forces would still be “working on health policy”.

      1. Almost no one was satisfied by the status quo, but almost everyone was somewhat happy w it.

  3. “What should we replace Obamacare with?” is entirely equivalent to a cancer patient asking the surgeon “what will you replace the tumor with?”
    As long as the ‘discussion’ is phrased in those terms, the slavers have an inherent advantage and will win the argument.

    1. Except that ObamaCare does have to be replaced with something, even if that something is nothing. If it is nothing, then Team Red has to make a convincing case that it should be scrapped and the healthcare sector should be left to market forces.

      But they won’t do that, of course. Not only because it would be political suicide to suggest that people be responsible for their own healthcare, but also because nobody on Team Red is really a principled believer in that idea. It would be too disruptive of the grotesque daisy chain of payoffs and favor trading between the government, insurers, and healthcare providers.

      1. I’ve already solved this fucking problem. Coops that directly employ doctors on salary and share the employment costs of specialists. Get docs right out of school and pay them $250k per year, or pay down their debts, etc., and you’re good. All you need to worry about then is drugs.

        DONE. Voluntary coops that can, if they choose, subsidize the needs of the poor with the higher spending of their rich members. This can happen tomorrow. However, nobody wants it because they don’t want healthcare- they want to make sure someone else pays.

        1. There used to be such a thing as mutual aid societies, where resources were pooled to get services like medical care. Of course, the government is a jealous god, so such options have been largely denied to us.

          1. The mutual aid societies were also done in by AMA and other trade organizations jealousies. They were furious that young doctors would hire on to mutual aid societies and not charge the exorbitant rates a professional should charge. They lobbied legislatures to requires occupational licensing which was, surprise surprise, controlled by the AMA, they banned mutual aid doctors from the AMA, they did everything in their lobbying power to disrupt mutual aid doctors.

            It’s a sordid history of corruption and patronage and fear mongering.

    2. This is like how I argue w those who want to use the size of the Federal Register as a measure of rate of growth of fedgov. The Federal Register is filled w changes & proposed changes requiring administrative action. The existence of a change doesn’t tell you whether it increases or decreases gov’t activity, the proposal of a change doesn’t tell you whether it will be adopted, & the changes adopted don’t tell you about all the changes that don’t require admin. action.

      The Republicans have just as much of a problem as the Democrats do in formulating a compromise that will win & be workable. It’s an inherent problem in democracy, esp. with the broad & numerous interests in health issues. What Mr. Suderman didn’t point out is that Hillarycare too did try to get a winning coalition of interests seats at the table, & get out a compromise that they would fight for.

  4. Just because the GOP health care plan is vaporware now, in other words, doesn’t mean it has to stay that way forever.

    Now, *that* is a dramatic conclusion!

  5. What “plan” do they need other than repeal Obamacare? Not to suggest that we didn’t need deregulation and reform before the stupid law was rushed through, but that’s a relatively easy step.

  6. So the statists won a round, so the ostensible party of limited government needs to counter with their own “plan”….

    WTF, Mr. Suderman?

    1. yes. the people who believe nothing should be done must do something!

    2. He’s gotta consider his domestic tranquility here.

      1. No, he’s just as full of shit as his wife is.

        1. So are you some kind of Team Red flak or do you just have a weird boner for Suderman?

          1. Frankly, I’m tired of these douchebag Beltway lefties pretending that they’re libertarians for a paycheck out of one side of their mouth while they tirelessly advocate for more big government out of the other side of their mouth at Politico and Time Magazine.

            This worthless motherfucker should be at Bloomberg full time with his wife and his shitheel buddy Weigel.

            1. So it should be pretty easy for you to quote/link to an article where Suderman calls for expanded government power or net increase in spending.

    3. Again, a plan to open healthcare to market forces is still a plan.

      Doing nothing is fine if you’re starting from a point of limited government. We obviously are not starting from that point, so proactive steps need to be taken to reduce government interference.

  7. What should we replace Obamacare with?

    Voluntarism in the healthcare marketplace? Nah, that’s crazy talk.

  8. Sorry, I call Bullshit.

    I don’t like everything that the GOP has done, but they have been working on Health Care Policy since the Bush administration.

    Does anyone remember the Medicare Drug Expansion? Was that not a piece of healthcare policy?

    While I despise the free shit mentality of the Medicare Drug Expansion, one of the greatest pieces of health care legislation came with that bill- the establishment of HRAs and HSAs. Health Savings Accounts and “Consumer Driven Health Care” are one of the most important innovations introduced into the health care system as they begin to bring consumer price sensitivity back into health care.

    Suderman seems to play by a double standard here, by saying the Dems were “working” on plans for years after the Clinton plan failed while condemning the GOP for not actually producing a full plan. Well, with Obamacare, Dems didn’t offer a real plan until the night before it passed. Both sides of the aisle offered healthcare reforms in the 2000, 2004, and 2008 presidential elections. McCain, contrary to what Suderman indicates above, actually suggested getting rid of the tax breaks on Employer Sponsored Healthcare (and was hammered in the debates for it).

    6 years ago, making HSAs the centerpiece of healthcare reform was untenable since so few people used it. However today over a third of companies offer HSAs or HRAs to their employees.

    1. McCain got hammered on it because he didn’t understand the plan he was proposing.

      1. McCain got hammered on it because he didn’t understand the plan he was proposing.

        No he got hammered on it because he offered to move the Tax Deduction from the employer to the Employee. This allowed Obama to complain that McCain’s plan raised taxes on Corporations.

        1. This allowed Obama to complain that McCain’s plan raised taxes on Corporations.

          This is like O. Henry and Alanis Morissette had a baby and named it this exact situation.

        2. No he was hammered by Obama for wanting to tax people’s health insurance and was too feeble to rebut that it would be deductible at the individual level and that people’s pay would increase by the amount that companies were spending for their health insurance.

          1. It actually wasn’t deductible– he offered a credit that would have been better for the poor and lower middle class than the current deduction, but worse for the upper middle class.

            1. Refundable tax credit for all Americans replacing the deduction that would have been larger than the value of the average deduction for the poor and lower middle class (since deductions are worth more the higher your tax rate).

              1. And he explained this quite well in the debates. What then happened is Obama turned around and said “He is paying for these credits by raising taxes on corporations.” Of course, the accounting is much more complex than that- Corporations would lose the deductibility of their health insurance dollars, but that expense would also go away, since individuals would be responsible for the cost of insurance.

                Despite the irony of Obama suddenly being concerned about corporations, it was an effective attack as he was able to paint this as wealth redistribution and/or gimmickry.

      2. McCain got hammer on it because he was a Republican. Obama has show, on multiple occasions since its passage, that HE didn’t understand work one of Obamacare. Does the Progressive Shill Media care? Oh, my, no.

    2. My point above is that Suderman, true to his form, would rather blame the GOP for the Democrat’s messes. If anyone is to blame, it is the American public. They are concerned for people who don’t have coverage, but want to keep the bloated Employer Sponsored system that insulates a strong majority of them from having to consider cost in their healthcare decisions. This has made ending that distorting system difficult.

      ACA didn’t pass because the GOP lacked a strong alternative (indeed, the GOP offered up NUMEROUS alternative plans in congress during the run up to ACA passing). ACA passed because media outlets helped Obama lie about the impact of the plan. Every promise made to assuage the public’s concerns that they would lose doctors, see higher premiums or increase the deficit was based on lies and accounting gimmicks. That isn’t the GOP’s fault. No alternative based on addressing real problems in our healthcare system will ever stand up to the fantasies that Dem politicians doled out prior to ACA becoming law.

      1. Suderman is blaming the GOP for claiming they want to repeal Obamacare without actually having any real replacement legislation in the works, not just speeches and vapor. This has nothing to do with McCain’s campaign, which was just vaporware of its own.

        If you want to change the subject, do so with your own article. But don’t blame Suderman for not writing your article for you.

        1. Suderman is blaming the GOP for claiming they want to repeal Obamacare without actually having any real replacement legislation in the works, not just speeches and vapor.

          Except as others have shown in this thread, there are several alternatives already working on the floor.

          But don’t blame Suderman for not writing your article for you.

          Perhaps you should read Suderman’s article then. He specifically blames the GOP for not being concerned with healthcare policy after the ClintonCare plan collapsed. This is demonstrably not true. The GOP considered and passed numerous Healthcare bills (Medicare drug expansion, HSA/HRA Reform, etc) after the collapse of ClintonCare and continued to offer alternatives through the presidential race when McCain offered his own healthcare proposals, through the run up to ACA when numerous competing plans were offered by minority house GOP and up until today when there are several GOP alternatives sitting in the wings.

          I don’t know why Suderman always writes these types of articles where he has to ensure that people hate GOP more than Democrats, but in this case, his article is wildly off base. It ignores vast swaths of reality.

          1. In this case he added to his usual dissing of the GOP some shortchanging of the Dems by making it as if the groundwork that resulted in Obamacare was new to them. They’d laid a lot of political groundwork for Hillarycare for years too; it just wasn’t quite enough. Politics is like that.

            Lowering the cost of medicine is something that can be done even in a socialized system; it’s just that the incentives to do so are less?& even less in a system where the costs fall as they do in Obamacare than they would in most countries’ systems.

    3. I have complained about every single article Peter has written on healthcare that he never even brings up HSAs to dismiss them.

      There are more people with HSA/HDHPs now (17.4 million) than people who have healthcare through the PPACA exchanges. So it’s at least significant.

      1. Certainly many people with HSA/HDHPs had health care before HSAs existed, but probably more expensive. That also describes the exchanges, more or less.

  9. But the GOP does have a plan. AHCRA is fairly complete. Yes, it’s a political play but the foundation is there. Read my 2-parter on it.

    http://www.sgberman.com/2015/0…..re-part-1/
    http://www.sgberman.com/2015/0…..re-part-2/

    1. A suggestion, hopefully you will take it as constructive criticism: way too many words, too many quotes which only repeat what you just wrote yourself.

      It reads like any other commercial story meant to fill out pages.

      If you actually want to convey information as clearly and concisely as possible, drop the quotes and just say what AHCRA proposes. Drop the damned quotes from politicians! Drop the history lesson on how Obamacare passed, drop the history lessons and get to the meat of the matter.

      1. Drop everything, and follow me!

  10. I think that a big part of the “Health Care” problem is that the Government, on various levels, has been mucking about with it for half a century. I know that in theory each successive layer of “fix” erased what came before, but I am sufficiently dubious of the “efficiency” of government to seriously doubt that that is the case. I fear that we have, so to speak, a patient covered in layer upon layer of bandages, and nobody has any idea, anymore, what is under the bottom layer.

    What is needed is not a “proactive” health care “plan”; the majority of what is wrong with modern American can be traced to government planning. What is needed is a broad repeal of existing health care regulations, down to some kind of minimum (I don’t want to, for example, legalize goat-testicle therapy), followed by a cooling off period before we even begging to THINK about erecting a new regulatory edifice.

    And if that works we could try it on, say, Drug laws.

    1. No goat gland transplants? Fuckin Off, Slaver!

    2. This. There’s no way to provide this tooth fairy fantasy that more and more people in our dumbed-down nation have of a world class health care system that costs nothing, and no politician is obligated to try and pretend orherwise.

      The entire premise of this piece is utter horseshit.

      1. Everything I feel I need to know about a National Health system is summed up by the following;

        The British National Health was established in 1948.

        Carl Giles, cartoonist and British institution, drew single panel cartoons that were a combination of humor, social commentary, and political cartoons from the Second World War until his death in 1994. Giles was a Socialist, an actual Party member (I believe) in the 1930’s, and I don’t think he repudiated it later. Yet, by the mid-1950’s, less then a decade after the creation of the British National Health system, he was drawing cartoons about its dinginess and inadequacy. Less than ten years after it was born a Socialist, who might be expected to defend it as part of the core Socialist vision, despised the thing.

        The British, the people most like us on Earth, have tried it in three of their territories; The British Isles, Canada, and Australia. All three are widely acknowledged to be total clusterf*cks.

        It. Doesn’t. Work.

        1. I got to experience the NHS up close and personal when I lived in Wales. It is literally the medical version of the DMV or the Post Office.

  11. Peter Suderman on Why the GOP Can’t Win on Health Care

    Oh, silly, silly Suderman. Do you really think the Grand Old “We Never Met A Big Government We Didn’t Like” Party has ANY intention of replacing Obamacare with something entirely different or market-based?

  12. Provide every citizen, upon birth, a health care account with, say, a million dollars to start. The citizen (or its custodian) may spend that on anything. When the account reaches zero, the citizen is on its own with regard to health care.

    1. Or upon naturalization.

    2. It’s just as easy to offer people health expense accounts, like HSAs that are blended with Health Reimbursement Accounts (where money deposited by a third party can be used for Health Care expenses, but is not “owned” by the account holder.) For the truly needy (income below X% of the poverty line), HRA funds can be made available by the government which will help them pay for deductibles and premiums.

      By pairing HRAs with High Deductible Plans, even the poor will have to consider the cost of their healthcare before spending the money. All these commercials for personal mobility devices and insulin products “that our insurance experts will charge directly to Medicare or Medicaid” will be impacted as people have to consider whether getting a new scooter is worth depleting their reimbursement account.

    3. Silly boy. The first person to empty their account and be at the mercy of charity will provide an excuse for the politicians to jump in and fill the void with government assistance. It’s the same trap for every government assistance program: it’s evil for a rich society like ours to let anyone fall through the cracks. Welfare, unemployment, health care, you name it, statists want to expand it.

      The ONLY cure is to get government out of the handout process entirely.

      1. The ONLY cure is to get government out of the handout process entirely.

        Yeah that would be preferable.

        However, the reality is that people want a safety net for the needy. If there is going to be a safety net, putting the dollars as close to the individual as possible is the best way to ensure that it isn’t wasted on giant bureaucracies and market-distorting regulations.

        The point of moving to HSAs is that as long as you keep the welfare component limited to a small portion of the economy (i.e. don’t offer subsidies to the middle class) the pressures of price sensitivity will help push the cost of healthcare down.

  13. Before I RTFA, let me guess: because free shit?

  14. Well,if they went to a free market approach and they treated insurane as medical care when needed instead of ‘health care’.That would help.But that’s not doing something,it’s doing less.

  15. I don’t disagree with anything you wrote. But it’s years late. About 5 years ago David Frum chastised fellow Republicans for their “take my ball and go home” childish approach to governance, most particularly in regard to Obamacre specifically and healthcare in general.

    http://www.frumforum.com/waterloo/

    And he wrote that because he understood what Americans are asking for, and they most certainly are not asking for government out of health care. Try to run on dissolution of Medicare if you think they are.

    But this is typical of the GOP. They are doing the same on climate change…ignoring it. So when all the solutions only come from the left, they will only have themselves to blame.

    1. Re: Jackass Ass,

      And he wrote that because he understood what Americans are asking for, and they most certainly are not asking for government out of health care.

      If the people want to make 2 plus 2 equal 5, by Gawd they should get 2 plus 2 equal 5!

      There is no denying that when politicians are beholden to voter preferences, reality and principles are thrown out the window.

      Try to run on dissolution of Medicare if you think they are.

      Indeed. No politician will run on such a policy. Either the government dissolves Medicare surreptitiously or Economic Law will do it for them.

    2. Telling people that there’s no free lunch and you can’t get something for nothing forever is “childish”?

      Fuck off, you worthless piece of crap.

    3. David Frum’s a gadfly, a troll, a professional critic. You can’t follow him anywhere except in circles.

  16. Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s.

    It’s hard to exaggerate the magnitude of the disaster. Conservatives may cheer themselves that they’ll compensate for today’s expected vote with a big win in the November 2010 elections. But:

    (1) It’s a good bet that conservatives are over-optimistic about November ? by then the economy will have improved and the immediate goodies in the healthcare bill will be reaching key voting blocs.

    Ace prognosticator David Frum, everybody. Nobody knows the beating heart of America quite like this guy.

    Obamacare is the Wagner Act of healthcare. The GOP will repeal Obamacare piecemeal when they regain control of the Presidency and have Congressional majorities, but the Act will technically stay in effect in perpetuity purely to satisfy the Democratic party’s pride. It matters not how much harm it causes, it’s the culmination of two generations’ worth of effort.

  17. The reasons why the GOP can’t win on healthcare:

    (1) They have fallen for the same bad idea that Suderman has: if its not a big, centralized bureaucratic fix, its not real. So they are playing their usual role of Dem Lite. If that’s their play, they don’t deserve to win.

    (2) The DemOp media will make damn sure they take all the blame of everything bad that happens anywhere. Even in states and cities where the Repubs haven’t had power for a generation or more, its always their fault.

    Notice how the utter failure of legislation that got zero Republican votes and has been overseen by zero Republican appointees is the Republican’s fault? Yeah, that’s what I mean.

    Forget it, Peter. Its DemOp town. Even when you don’t think you agree with them, you propagate their memes and assumptions.

    1. Notice how the utter failure of legislation that got zero Republican votes and has been overseen by zero Republican appointees is the Republican’s fault? Yeah, that’s what I mean.

      Right. This is exactly Suderman’s point, and a point I have seen echoed by people like Jack and Ace and other liberals on my facebook feed. “See, if the GOP hadn’t been so intransigent and actually WORKED with the Dems on their plan, it would have been much better. Er go, any failures with the new plan are actually Republicans’ fault.”

      Nevermind the fact that the GOP minority congress offered numerous amendments to ACA that were rejected by the Dem majorities. Never mind that the GOP has been offering health policy proposals for the past 20 years.

      In general I agree with point 1. It took a massively harmful Medicare Drug Plan to get HSAs through congress. Even when something good comes out of GOP legislation, there is tons more graft and red tape accompanying it.

      1. To quote Sam, you must remember this:

        That is Frum I quoted above…a Republican. I’m not one, and I take it you aren’t either. But who knows, there are plenty around here masquerading in libertarian clothes.

        He was criticizing his own. The fact is, the GOP did next to nothing to address the growing number of uninsured in this country. Don’t agree? Take it up with Peter that was the point of his article. They have ceded the playing field of solutions to the Dems.

        By the way, same with libertarians. Look at all the comments encouraging nothing to be done, other than government getting out of health care completely. If that is the proposed solution here, have at it. Even Peter knows that is a recipe for disaster.

        1. I did take it up with Suderman. You and he are talking bullshit.

          The GOP did nothing except offer multiple counter proposals, provide numerous plans for consumer driven healthcare, even pass important legislation that today puts healthcare spending control in the hands of those consumers (HSAs).

          They did a lot, and you, Frum (concern troll masquerading as conservative), and Suderman denying it doesn’t change that fact. You think that your attempt to shift from the actual problem (ACA is a bloated piece of shit) to arguing over process (“Well the GOP should have engaged more, or this would have never happened”) is somehow relevant. It is not.

          1. They didn’t. They had control of both houses and the Oval Office for most of the Bush years, and only enhanced Medicare….but just barely.

            At least Frum understands how governance works. When the ACA was passed, Dems controlled both houses and the oval office. You and the GOP talk like you think you never had to bargain with anybody, that everything should just go your way. At least Frum knew that is fantasy.

          2. Frum (concern troll masquerading as conservative pundit)

            He does think & research a lot, but his object seems to be to promote himself as a better thinker than…everyone else…, rather than to benefit society, the GOP, or anyone AFAICT.

  18. This will be the down fall to the greatest country on the planet. too many leaches think they are entitled to other peoples earnings. ????? http://www.Workweb40.com

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