Obamacare

Donald Trump Is Amazed to Discover That Health Policy Is Complicated

That's why the GOP's Obamacare repeal effort is flailing.

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Gage Skidmore

Donald Trump has finally discovered that health policy isn't easy. Speaking to reporters yesterday, he shared his revelation. "It's an unbelievably complex subject. Nobody knew that health care could be so complicated."

Nobody knew! Nobody, except, perhaps, President Obama, congressional legislators, health insurance executives, hospital administrators, doctors who manage practices, individual humans trying to navigate the system, or literally-in-the-Joe-Biden-sense anyone who has ever interacted with American health care in any way whatsoever. The complexity of both the health care delivery and policy is the defining aspect of the system.

On the one hand, Trump's statement is yet another reminder of both his deep aversion to specific policy knowledge, and his habit of describing any new piece of knowledge or understanding he gains as a unique personal revelation.

At the same time, it also reveals the very real problem that Republicans are encountering as they attempt to repeal, replace, and reform Obamacare. The policy issues are complex, and the politics are, if anything, even more complicated, and the interaction between the two creates an additional layer of complexity that Republicans have yet to really solve.

Just to take one example: One of the biggest parts of Obamacare was an expansion of Medicaid. A 2012 Supreme Court decision gave states a choice about whether to expand the program, which provides coverage for the poor and disabled, and 31 states said yes. A full repeal, or even a repeal of all the spending in the law, would roll back that expansion.

But Trump himself has repeatedly promised not to touch Medicaid, one of the nation's biggest entitlements. And just this weekend, Trump's Treasury Secretary, Steve Mnuchin, also said that the administration's budget plan won't touch entitlements. And as Trump found out at a meeting with state governors over the weekend, lots of governors, including some Republicans, are wary about rolling back or Medicaid as well. Hospitals, which get a lot of money from the Medicaid expansion, have also pushed for caution when it comes to repeal. And that's just the inside-Washington forces.

In any case, if Trump agreed to a full repeal of Obamacare, he would be going back on his promise to not cut entitlements, and if he agreed to leave some version of the Medicaid expansion in place, he would be reneging on his promise to repeal Obamacare. Trump has stayed away from embracing any specific plan so far, allowing him to maintain this contradiction. But at some point, he'll have to make a decision.

Of course, a full repeal isn't really what's on the table. That's because Republicans are planning to use the reconciliation process to repeal the law, and that process only allows them to touch provisions with a non-trivial budgetary impact. That means that the subsidy spending and the mandate can go, but the rules prohibiting insurers from discriminating against people with preexisting conditions stay on the books.

Now, there are some reasonably strong arguments that the GOP could repeal the law's insurance regulations through the reconciliation process if they wanted to. As the Mercatus Center's Charles Blahaus recently pointed out, the Congressional Budget Office has said in the past that those provisions have a clear budgetary impact. In theory, Republicans could use this as evidence when making the case for including the repeal of those rules. At the very least, they could try. But so far they haven't.

One problem is that those regulations are among the most popular parts of the law. Another related problem is that Trump said after the election that he wants to preserve Obamacare's preexisting conditions protections. Even some Congressional Republicans are on board. GOP Sen. Chuck Grassley recently told a townhall questioner that, "There are a lot of consensus in Washington that the one issue that you brought up — pre-existing conditions — should not be changed."

Trump and his top advisers have also said that he wants to preserve coverage for everyone who currently has it under Obamacare, but the GOP plans currently being drafted wouldn't do that. And even if they eventually led to a system with roughly equivalent coverage numbers, there would be a huge amount of short-term disruption.

These sorts of difficulties are why the repeal effort has bogged down, and why Republican leadership is, according to a Wall Street Journal report, now intent on holding a vote on the reconciliation bill, and essentially daring their fellow Republicans to oppose it. That's a high-risk strategy, because there isn't much margin for error: The GOP can sustain just two defections in the Senate, and 22 in the House, so any sizeable opposition could derail the plan. In fact, it may already have been derailed: Last night, Rep. Mark Meadows, who heads the House Freedom Caucus, has said his faction cannot support the current legislative draft. Presuming no support from Democrats, the bill won't survive without them.

The interlocking complexity of the system is one of the reasons that Obamacare is such a frustrating law: It built on top of an already-labyrinthine system that had been created and modified over years, and it was crafted and influenced by an array of factions with competing interests.

It's also why, with Trump's big address to the joint Congress looming, some Republicans are now looking to Trump to guide them out of this mess. "The president can play a major role in endorsing a plan he wants to sign into law, and I think it's absolutely essential that he takes a lead role," Rep. Chris Collins told Politico. Given Trump's near total lack of engagement with the various policy mechanisms and trade-offs involved, I wouldn't raise expectations too high. Even if he does endorse some specifics in his speech, it's always possible he'll reverse himself.

In any case, though, Trump's essential point is right: Health care is indeed complicated. And not only is it complicated, Trump's inconsistent and uninformed statements on the matter have made it even more so.

NEXT: The Paranoid Presidency

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  1. Healthcare? Anyone? Bueller? Bueller?

    1. If you have a piece of paper that says you can get care, you have care. Even if it’s too expensive to use, doesn’t cover anything worthwhile, no local doctor takes it, etc.

      If you have a piece of paper that says you can get care, you have care. Coverage = care.

  2. Nobody, except, perhaps, President Obama, congressional legislators…

    To be fair, they only found out when they read what the lobbyists writing PPACA had cooked up.

    1. There Peter goes again with his famous comedy routine.

      Medical care and health insurance for the government is not complicated because they should not be in that business.

  3. Every market is complex. The part that makes Repeal complex is the desire to control every means of production, consumption and payment at a hyperdetailed level- to squeeze every ounce of “efficiency” and “good incentives” at each layer.

    With the logic used in this article, the same argument could be made about welfare reform. Every single program was setup to manage incentives and payouts at specific layers of the production chain- from health care to housing to food- and untangling it is either very complex (we need to preserve all these incentives and outcomes) or very simple (Let’s just cut a check to who we deem “needy” and let them manage their own personal complexity.

    And yet Reason editors have no problem calling for the mass deregulation and consolidation of welfare, but seem to want the more managed “Top Men” approach to health care policy. If we just gave everyone an HSA with deposits for the truly needy, and a basic mechanism for pre-existing conditions (you need to have continuous coverage for 9 months before covering preexisting claims) and you have market solutions to most problems.

    1. Yea top down solutions to achieve efficiency and good results achieves anything but

    2. also allow open markets to all insurers in all states and allow everyone to buy their own just like auto insurance at anytime they see fit not just in November that would force pricing down real quick.

      1. Why does ‘all-states’ solve anything? Yeah – I’m sure a ‘CA hospital/doctor network’ can be offered cheap to residents of NC. But what the hell good is it? And technically, insurers could offer that now – contract with doctors/hospitals in India and peddle a plan that covers things only within network. Dirt cheap.

        1. The problem with allowing consumers to purchase plans across state lines is basically the exact same problem the state exchanges are having–a lack of regulated competition.

          Currently insurers are pulling out of the state exchanges, giving both the burden of care and market dominance to fewer and fewer companies. This was supposed to be solved by the individual mandate, so state exchanges (which only exist as a compromise for Republicans) would be self-sustaining micromarkets.

          However, allowing customers to shop across state lines will cause insurers to flee to states with the least amounts of consumer protections/the lowest legal standards of care and insurance companies won’t be able to offer comparably priced plans unless they do the same. And by dropping the individual mandate and allowing almost 20 million people to drop their coverage completely will further destabilize the market. And without price-fixing or regulation, it’s anyone’s guess how high prices will go from there–because insurance prices only ever increase.

    3. I didn’t see an endorsement of a top down approach on healthcare, I’m seeing an acknowledgement of the political realities. Disruptions are going to be unpopular, and facing that reality it’s hard for republicans to come up with something meaningful, effective, and politically viable.

    4. Every market is complex…If we just gave everyone an HSA with deposits for the truly needy, and a basic mechanism for pre-existing conditions (you need to have continuous coverage for 9 months before covering preexisting claims) and you have market solutions to most problems.

      This is the biggest failure of free market advocates – the assumption that everything is equally complex so there’s no need to think much about anything. Basically your solution is – if you don’t have insurance, then die. So no it won’t work – cuz death is not an acceptable outcome for most non-ideologues.

      1. Basically your solution is – if you don’t have insurance, then die.

        Oh, bullshit. Don’t accuse libertarians of simplistic thinking and then serve up a whopper like that one.

        Do you proglydytes even know what insurance actually is? It’s not a “pool of free money” that anyone can dip into, it’s a hedge against catastrophe. People don’t buy auto insurance to get tire and oil changes, and people shouldn’t buy insurance to get annual PHAs done–but that’s been the model in the industry since the end of WWII. And then people wonder why healthcare got so fucking expensive, especially after the government got into the insurance business and started trying to figure out ways to mitigate costs which, in hindsight, weren’t nearly as bad back then as they are now.

        1. Don’t forget that the reason why employer based health insurance only exists in the first place because of Government created wage controls. Socialists and progressives have distorted this market for a century, then they turn around and want to talk about market failure. Woodchippers for the lot of them.

          Repeal and replace with nothing except deregulation. The big secret is that the ACA incentivized hospital systems to conglomerate, and now they’re exercising their market control to keep these types of programs in place. It’s anti-competition all the way down. Unsurprisingly to anyone with a few brain cells to rub together, this will never result in affordability. Ever. Top down regulations and control will only result in more shortages, higher prices, and more death. Period.

          Anyone who says otherwise is either a useful idiot or lying to you.

        2. Don’t accuse libertarians of simplistic thinking and then serve up a whopper like that one

          What else is – you have to have nine months of coverage before existing conditions are covered? Does cancer stop growing at will?

          Pre-existing conditions is a SERIOUS complexity which cannot be dealt with at individual coverage level. Likewise the large $ cases – which are majority of total costs. Likewise, you can’t shuffle off the elderly/poor to govt/taxpayers and then separate the rest into a ‘market-solution’ that ‘works’ because they use the same hospitals/etc so cost-shifting is inevitable.

          1. What else is – you have to have nine months of coverage before existing conditions are covered? Does cancer stop growing at will?

            None of which addresses the actual issue of the cost of healthcare overall.

        3. people wonder why healthcare got so fucking expensive

          Do you actually think healthcare is so expensive in the US cuz there’s too much routine coverage? Buy a clue. The US has expensive medical care because we have a shit-ton of specialists (transaction-oriented and really expensive) – and patients (who know nothing) control their own access to them. It doesn’t matter whether coverage is private or public. Neither controls those transactions because people go ballistic when they try. So instead they squeeze the routine/generalist doctor (relationship-oriented and only relatively expensive) stuff. Every other country on Earth understands that ‘medical’ is not about transaction financing/insurance but about LIFETIME health. Which means a relationship with a family doctor – who can then be your medical expert to control specialists when the time comes and life/death fears cloud personal decision-making. Totally upside-down from the way we approach the issue. And unlike us – both rational (necessary for a market to work) and cheap.

          There are a lot of ways for markets to make this work. But no easy way to turn the whole system upside down after 50 years of creating a system that sucks money and entrenches cronies. And R’s who refuse to think beyond platitudes are worse than useless

          1. Do you actually think healthcare is so expensive in the US cuz there’s too much routine coverage? Buy a clue.

            Buy one yourself, shitlib. I just had my healthcare provider charge $500 for an annual physical. You really think that cost is ratcheted up by specialists? How fucking stupid can you be?

            1. You really think that cost is ratcheted up by specialists?

              Yes it is. Hospitals/labs/etc have to cost-shift almost solely because of specialist stuff. They shift those prices to whatever will pay more and apparently you qualify. Walk-in clinics and stuff that has no specialist service at all – a physical probably costs $200 or less. And it could probably be even cheaper if we actually had more clinics and GP’s and such.

              1. Yes it is. Hospitals/labs/etc have to cost-shift almost solely because of specialist stuff.

                Source?

                They shift those prices to whatever will pay more and apparently you qualify.

                Except the insurance company disallowed about half that charge. So apparently the “price” is entirely flexible and not at all dependent on cost-shifting.

                And as I’ve pointed out before, the cost for a normal live birth and two days in a private hospital room is about $25K now. For our youngest, the insurance company paid about 3/5 of that and disallowed the rest, except for about $250 for the 24-hour bloodwork that we paid out of pocket. So what was the real cost–what the provider charged or what the insurance company paid? That’s why your contention that specialists are driving up prices doesn’t wash–if that was the case, they wouldn’t be willing to eat whatever difference in payment they’re getting from these insurance companies, which also varies depending on the insurance.

                1. Except the insurance company disallowed about half that charge. So apparently the “price” is entirely flexible and not at all dependent on cost-shifting.

                  This is precisely cost-shifting. If your insurance disallowed it, that only shows the specific attempt didn’t stick. They will now charge someone else more instead – and historically that has been the uninsured who get outrageous bills that follow them into bankruptcy. They will NOT write off anything or use the ‘price paid’ as an indicator that their prices are too high.

                  normal live birth and two days in a private hospital room

                  Hospital charges are completely specialist driven. Not just the variable costs – all the capital equipment that is used by specialists and purchased cuz of specialists but is included as overhead for everyone who enters hospital and for every other thing they can charge for (including cafeteria food). In your specific case – the charge almost certainly included full ‘just in case’ overhead for the preemie specialist/ward/stuff as well as ‘whatever they can get away with’ overhead for all the other specialist wards (much of which is now considered a ‘minimum medsurg requirement for a hospital’). They are ONE hospital. Pricing is as flexible as a retailer who does ‘loss-leaders’ who recovers those elsewhere. The difference is that specialist services are not a mere marketing decision; they are overhead. And cost accounting is not arbitrary like pricing.

          2. Every other country on Earth understands that ‘medical’ is not about transaction financing/insurance but about LIFETIME health.

            Which wasn’t a goddamn issue here until people started using insurance for every damn thing and then demanding that the government get involved in the insurance business.

            In New Mexico, 70%–that’s right–70 fucking percent–of births are paid for with Medicaid. Medicare and Medicaid now cost over $1 trillion a year in taxes. In what universe is this sustainable?

      2. If you have an issue where healthcare can prevent you from dieing then they typically perform work before asking how it will be paid for.

        1. Yes they do. And then if the bill can’t be paid, their accounts receivable dept passes the costs on to others via higher prices (roughly 6% of medical spending is this ‘cost shifting’ from uninsured). But remember the reason govt mandated EMTALA was because hospitals DID dump people off at city hospitals – and before that during Jim Crow days it was worse. So this ain’t just a theory problem.

      3. Basically your solution is – if you don’t have insurance, then die.

        Did you miss the part you quoted where I said “with deposits for the truly needy”? We can argue about why you think lacking insurance is somehow a death sentence, but my specific point was that if we are going to subsidize health insurance for the needy, then give them an HSA and grant some amount of money depending on their level of need. It supports people who need the money to buy the coverage they need, without re-routing the money through a bunch of absurd programs and grants to people who aren’t, ya know, the actual consumer of the service.

        The biggest problem with our healthcare market is that the people consuming the products and services are not price sensitive. So there is no incentive to appeal to people with more cost effective treatments. Thus health care costs keep going up up up.

        1. the people consuming the products and services are not price sensitive.

          It’s not just that. People everywhere in the world are a bit irrational and price insensitive when it comes to ‘Will I die or not if I buy or not’. People who are sick/unconscious/bleeding aren’t exactly the sort of ‘rational consumers’ that normal markets are built around. If they were, they’d be at the mall not the hospital. And patients don’t know shit about diagnostic medicine – so they can’t even define what they actually want as a consumer – much less be price-sensitive about different things.

          NONE of this is unique to the US. So it isn’t the cause of uniquely high medical spending in the US. What is unique to the US is the ratio of general doctors (family, internal, pediat/geronto/gyne) to specialists (cardio/neuro/onco/etc) and how specialist transactions/equipment are controlled. That isn’t really a mere insurance issue.

          1. Just as one example of how different the US is:

            The US has roughly 45 generalist doctors per 100,000. We have roughly 65 specialist doctors per 100,000. Patients themselves decide how to utilize specialists (often don’t even have/want a ‘primary care’ because in the US that is an assembly line not a ‘relationship’) and expect insurance to just pay whatever. US spends 17% of GDP on healthcare – $950 out of pocket, $3500 indirect insurance (individual), the rest via taxes.

            NL has roughly 150 generalist doctors per 100,000. They have roughly 50 specialist doctors per 100,000. Everyone can see a generalist easily with no assembly line. They have the time to build trust with patients – and patients have enough choices to find someone they can trust. Generalists then ‘manage’ specialists (and yes I’m sure via ‘rationing’ of some sort). Generalists in NL earn about the same as here – specialists earn less. NL spends 11% of GDP on healthcare – 700 euros directly by patients, 1200 for ‘insurance’ (individual), the rest via taxes.

            And no I’m not advocating the Dutch system. Just pointing out how structurally different it is.

          2. Another area where the US is blind. Medicare is obviously universal and public and a big part of total healthcare spending and ain’t going anyway anytime soon. The number of elderly is going up. The number of geriatricians (who are only going to practice in a Medicare environment) is not only going down – it is going down from levels that were almost non-existent to begin with. Only 14 med schools in the US even HAVE a geriatrics department – and only 3% of med school students take ANY geriatrics curriculum beyond a single intro. Roughly 2.5 million Americans turned 65 last year. 75 geriatricians graduated. 1 for every 33,333 new elderly.

            We don’t even make an attempt to look at anything from the patient’s entire health perspective or anticipate what was perfectly predictable 65 years ago. Even when it is entirely on the public dollar. They are simply diseases walking around and they have to diagnose themselves and select the right specialist (cardio/etc) and figure out how drugs work differently on aging bodies and how multiple chronic conditions affect each new ache/pain. God forbid they then get Alzheimer’s and can’t even make decisions anymore. The 97% of specialists who don’t take any serious geriatrics coursework sure as hell don’t have this knowledge either. Something as simple as poorly maintained feet in the elderly can cause problems walking/standing. Neurologists/orthopedists/etc won’t even look for that.

  4. They are failing to repeal obamacare because people got goodies and it is bad politics to take them away. repeal isnt really hard because it is complicated (i agree healthcare is complicated and coming up with plan….not the actual repeal part)

    The preferred solution is just to get out completely of the aca and lessen govt involvement overall but that would mean i am thrown out of office quick

    1. Regulate prices for medical care across the board. Guarantee access to healthcare, refine prices based on the data coming in. If you leave it to the corporations, totally free market, they will fuck us all. I’ve watched you comment for a long time, and you are a fucking moron. A moron. I would bet that you don’t have analytic math or science or formal logic in your background. You can prove me wrong by replying what the two basic areas of study in calculus are. Without looking it up.

      1. Regulate prices for medical care across the board. Guarantee access to healthcare,

        All of these things are guaranteed to increase prices and limit access to healthcare.

        If you leave it to the corporations, totally free market, they will fuck us all.

        Because it behooves companies to fuck-over their customers…You DO realize that in the private, competitive market, companies have to actually give customers what they want in order to succeed, right?

      2. Regulate prices for medical care across the board.
        What would happen if this occurred in any other industry? Let’s start with the one that butters your bread.

        Guarantee access to healthcare
        Same question as before, and once more, let’s start with your industry to see how it works.

        If you leave it to the corporations, totally free market, they will fuck us all.
        That totally explains why the marketplace is littered with options for EVERY good and service that a person might want or need. But we’re all duly impressed with your knowledge of math; one more individual educated far beyond his actual level of intelligence.

        1. Yep. How come they never want the govt to impose price controls on colleges?

          1. Who is they?
            When is never?

            1. Leftists. Jeezus. Really?

      3. So, being able to name two areas of academic study in Calculus make you an expert in economics? Awesome! I can name two areas of study in physics – they do math pretty well, mind you – soclearly I’m now qualified to work on Wall Street. Because those fields overlap so much.

        More than that, you’re missing a very glaring point: regulation is what got us to the point that (way way too many) people – even those who can name two areas of study in Calculus, apparently – thought more regulations were the answer.

        Trust me. My freedomto live without the government deciding what everything should cost is more valuable to me than your need to signal your virtue to those you want me to who you believe deserve.

        1. The Stone Age called. They want their dumbasses back. I told them to ask around here.

          Government isn’t going away. We should alter or abolish the parts of it that don’t serve the People. I personally would like every part of it to be totally voluntary, except the parts that affect everyone, like healthcare/transpo/education/air/water. Most of you fucktards don’t realize that there HAS to be some form of communalism or socialism to have nice things in common (roads, parks, schools, museums, et al).

          Fuck the plutarchs & fascists that the morons and submorons worship (mostly tight wing theocrat Republipukes, but I hate the DNC, too).

          It would be cool if there was a ‘Coventry’ option (al? Heinlein) where all the hardcore Kaczinskis, Libertardians and sociopaths could fuck off to. Let them live in total anarchy. No compulsion to do anything whatsoever.

          1. You forgot to tell us all to move to Somalia.

            Epic Troll Fail.

          2. Tronald_Dump|2.28.17 @ 12:30PM|#
            “The Stone Age called. They want their dumbasses back.”

            But you’re here instead!

          3. Save your ranting for the campus coffeehouse or the homeless shelter where it belongs.

          4. Medical costs in this country started seriously going up after the introduction of medicare (medicaid too but that was initially small and restricted). What did medicare do? Exactly ehat you want. It created the first ICD and standardized and regulated the cost of virtually every aspect of care. So integrate that, dumbass.

          5. Obviously it makes sense to have certain things shared. It’s how they’re shared that matters.

      4. Guarantee access to healthcare

        EMTALA’s been around for 30 years. You might want to look it up, since you’re clearly executing the standard proglydyte trope of conflating healthcare and health insurance.

        If you leave it to the corporations, totally free market, they will fuck us all

        Before Medicare, Medicaid, HMOs, and Obamacare, a normal live birth and two days in a private hospital room cost about $1000 inflation-adjusted. Now the average “charge” is about $25K and the insurance companies negotiate it down to about 1/2-2/3 of that.

        That’s the consequence of getting the government involved in the healthcare industry to the scale that it is today, and it’s just one of many examples.

        I would bet that you don’t have analytic math or science or formal logic in your background.

        By the same token, I bet you don’t have a fucking clue what the feds spent on Medicare and Medicaid services last year, nor the percentage of total federal spending they took up. Hint: it’s yuuuuuuge.

      5. The basic areas of study in bodily calculus are tooth, urinary, & biliary.

      6. Integrals and derivatives. And both are a major problem in health care. The problems arise as a derivative of the attempt to integrate all parts of health care into one humongous government dictated structure.

  5. Durr hurr durr hurr huur durr hurr EMAILS hurr duurr OBAMACARE hurr hurr durr durr WALL hurr durr CROOKED hurr durr durr durr HURR EMAILS!

    1. You have the eloquence of a 2 year old. One who went to public daycare.

      1. You just got trolled, beeee-yotchhhh!

    2. I’ve just stopped giving you the benefit of the doubt that you’re intelligent enough to have passed any math class beyond counting marbles.

      1. Dude, I bet you couldn’t solve a quadratic equation to save your pimp’s life.

        1. Dude, I bet you couldn’t solve a quadratic equation to save your pimp’s life

          Will that graph out the exponential cost from the negative rates the women in your family charge to suck dick?

        2. By factoring, the quadratic equation, or completing the square? Maybe it’s just square to believe that you can’t bring all the factors of health care into one massive government equation and have it work.

  6. How much longer before we see “The Libertarian Case for Single Payer Healthcare”? Not too much longer, I would guess

    1. Perhaps the writers here have heard of a naturalism fallacy, and thus are aware that a description of the current state of the political process doesn’t constitute advocacy of that state.

    2. Eh…

      The problem with this topic, when it comes to libertarians/Libertarians, is that the “pure libertarian” answer isn’t very palatable to most people. If you repealed all government regulation, including Emergency Medical Treatment and Active Labor Act (1986), then you would literally have people dying in the streets. Get rid of medicare, medicaid, and so-on? Poor and old people with serious on-going health conditions simply die for lack of treatment.

      Sure, there might be some utopian future where cost of care balances out with the huge gap left behind when the government exits, but quite simply care will *never* be cheap enough for people that are living paycheck to paycheck as-is.

      In-short, trying to apply a pure libertarian solution to healthcare exposes all the things people (as a group) fear/hate about the philosophy.

      Now, a libertarian-ish solution, like catastrophic coverage with government-subsidized HSAs? That might be something you could swing past people. But going whole-hog? It’s DOA.

      So if libertarians/Libertarians want input in what healthcare in America ends up looking like, they need to decide what they’re willing to compromise on. Because a steadfast position just opts them out of a seat at the table.

      1. If you repealed all government regulation, including Emergency Medical Treatment and Active Labor Act (1986), then you would literally have people dying in the streets.
        Because charity care and indigent care never existed before the govt mandating either.

        Get rid of medicare, medicaid, and so-on? Poor and old people with serious on-going health conditions simply die for lack of treatment.
        That totally explains how old people lived to be old before Medicare.

        A libertarian solution would be what health care largely used to be: a fee-for-service industry for physicals and routine matters with perhaps major medical insurance coverage for big things. But then came the mindset that you exhibit: that things can only happen if 1) govt is involved and 2) if some third party pays for an increasing number of things out a magical honey pot.

        1. That totally explains how old people lived to be old before Medicare.

          A lot more of them who had serious health conditions probably died and fewer people lived to those ages before Medicare. Of course that has at least as much to do with lifestyle and the available treatments at the time.

          1. Of course that has at least as much to do with lifestyle and the available treatments at the time.
            I’m going with this. Life expectancy did not grow because of govt intervention. But the poster’s contention that “people will die if not for govt” is just moronic.

            1. I don’t know, I think it’s probably true that some people will die who wouldn’t have if Medicare were just eliminated.

              Everything has it’s tradeoffs and it’s silly to pretend that big policy changed won’t have negative effects for some people. It’s really a big part of why it’s so difficult to convince people on libertarian thinking. The immediate downsides are a lot easier to see than the big picture benefits and people have a strong emotional reaction to the downsides, even if they are likely to be temporary.

        2. Because charity care and indigent care never existed before the govt mandating either.

          If charity were sufficient to cover the need, mandatory welfare programs wouldn’t have come into being to begin with, because they’re have been insufficient public demand for them.

          I’m reminded of Kent Snyder. He was a political aide for Ron Paul for 20 years who ended up dying from viral pneumonia after racking up $400,000 in medical bills. The campaign held a fundraiser for him. It raised $34,870.53.

          You really expect me to believe that people who can’t raise enough money to treat one guy who they’ve had a close personal relationship with for two decades are going to make more than a token contribution to treatment for millions of people they’ve never even heard of?

          Charity is just a dodge so libertarians can pretend the consequences of their proposals don’t exist. If you think those proposals are worth the cost, then fine. But don’t lie about the costs.

          1. the hospital in a city where I used to live wrote millions upon millions in indigent care every year, and this was before universal health care had gained traction. The notion that if govt does not do it, no one will and/or no one should is perhaps the most dishonest argument that people make.

            We’ve seen the consequence of collectivist ideas, even within controlled populations like the VA. They don’t work. Wonder why.

          2. Charity is private and not a right. If you want to give your money to everyone, have at it. It’s your money. It’s when you determine that it’s illegal for me to not contribute to those that you feel deserve my money, unearned, that we disagree.

            Go on. Convince me that they deserve it.

            1. I didn’t say they deserve forced contributions to public welfare. I’m objecting to wareagle’s “everything will be unicorns and rainbows” prediction of what the results of eliminating those forced contributions would be.

              1. ‘m objecting to wareagle’s “everything will be unicorns and rainbows” prediction of what the results of eliminating those forced contributions would be.
                you’re going to have to show where there was mention of unicorns and rainbows since I never used anything remotely near that sort of nonsensical language. Even your example of Kent Snyder didn’t die for lack of care; he died from a condition that could not be arrested.

                Further, I would suggest that the fundraiser for his bills fell short more of a belief of “fuck it, someone else can pay for it” than from any other reason. Curiously, the “someone else can pay for it” mentality is pervasive across health insurance and care, to the point that no one knows what any service or med actually costs anymore.

              2. I don’t believe wareagle came within 5 zip codes of calling what was in place before ACA was ideal. Only that, even when already over-regulated, it was better.

              3. Did it ever occur to you that medical care might be cheaper if the government wasn’t involved and, therefore, everything would be ‘unicorns and rainbows’? Or are you one of those people who wonders why college tuition began to increase faster than the rate of inflation when the government got into the business of guaranteeing loans?

                1. “Did it ever occur to you that medical care might be cheaper if the government wasn’t involved […]”
                  Sure.

                  But that doesn’t mean “Unicorns and Rainbows”, it means that some people who can’t currently afford healthcare would be able to afford it, that all people currently able to afford healthcare would save some money, and that some people currently unable to afford healthcare would be without the safety net that they currently have.

                  Quite simply, there’s a sliding price-per-person scale where lowering the price-per-person increases number of customers but reduces profit-per-customer, and raising the price-per-person decreases the number of customers but increases profit-per-customer. And on these scales, there’s always a tipping point where continuing to reduce the price no longer increases customers enough to increase overall profit.

                  There is zero reason to believe that medical care is exempt from that and would continue to see prices decrease until everyone can afford it. And based on historical and modern evidence, there is zero reason to believe that “charity” would fill the gap.

                  And to be clear (because apparently this confuses people), I’m saying this without judgement. But for people advocating policies that lead to this, it’s something you need to address head-on. Blindly denying it, as some here seem to be inclined towards, does no favors for anyone.

        3. “That totally explains how old people lived to be old before Medicare.”
          It does, actually. Prior to modern medicine, the only way to live to see old age was to get lucky (as we still see happen today where someone with horribly unhealthy habits beats the odds and lives to 100). But starting in the 1800s you start to see a divergence in life expectancy based on wealthy, with most of the gains to life expectancy being concentrated among the wealthy.

          This trend continues to today, with middle and upper class American men living decades longer then men in poverty. That said, the life expectancy of poor men has ticked up since the 30s (Social Security) and 60s (medicare).

          1. Life expectancy has far more to do with lifestyle choices and habits than it does with govt intrusion into health care. Sure, a rich guy can afford to paper over his excesses by affording care a less wealthy person cannot pay for, but the less wealthy guy is not a walking heart attack.

            Poverty is the sum total of a person’s choices and decisions. Period. Full stop. But at least you’re open about your statist bent.

            1. wareeagle, you are dead wrong about poverty. You couldn’t be more wrong.

            2. “But at least you’re open about your statist bent.”
              I’ve never claimed to be a libertarian, which ’round here pretty much makes a slaver statist Tulpa by default, so sure, why not?

              That said, I was describing history, not giving value judgement. If you want non-libertarians to accept libertarian policies, then you have to be able to justify the consequences. Blindly denying them isn’t helpful to anyone, least of all you.

            3. Poverty is the sum total of a person’s choices and decisions. Period. Full stop.

              Yes, that’s right, every single person in poverty is there solely and completely because they have not made the right decisions to not be. Nothing at all can be attributed to a person’s starting point in life. Therefore, if you are in poverty, it is your fault. You should be ashamed of yourself.

          2. The wealthy always live longer and had better lives than those less so. So that I and those that with whom I choose to share my wealth longer and better.

            That’s exactly why I don’t want to give my money to your virtue-signally hashtag-activism cause.

            1. Uh, where does he say that you should be forced to share your wealth?

              He makes an observation about the world. If it’s false, you should try to refute it. Stating facts that are inconvenient to arguments for libertarianism is not evidence of statist tendencies.

              1. Maybe I should direct you to a law passed in the last few years. Some people call it Obamacare.

                1. And EscherEnigma had something to do with that law passing?

                  You seem to be missing the point. No one here is saying that Obamacare is great. They are describing real reasons why it is difficult and likely unpopular to repeal it (or certain parts of it, at least). If you think they are wrong, dispute what they are saying, don’t make completely unsupported assumptions about their motivations.

        4. That totally explains how old people lived to be old before Medicare.

          A lot of those people lived to be old in part because they were living at home with their families at that time. Now you can certainly make moral arguments for eliminating Medicare, but if eliminating Medicare causes several hundred thousand or more elderly people to have to move in with their children, grandchildren, etc., because they can no longer afford both rent and medical care, politicians with any sense of self-preservation are not going to vote for eliminating Medicare.

      2. The problem with this topic, when it comes to libertarians/Libertarians, is that the “pure libertarian” answer isn’t very palatable to most people. If you repealed all government regulation, including Emergency Medical Treatment and Active Labor Act (1986), then you would literally have people dying in the streets. Get rid of medicare, medicaid, and so-on? Poor and old people with serious on-going health conditions simply die for lack of treatment.

        Uh if “most people” don’t want to allow others to die in the streets, why the fuck would anyone still be dying in the streets?

        1. Most people are also really good at ignoring problems that don’t directly affect them.

          1. And yet they care so much they demand their govt do something about it. You can’t have it both ways. The public was misled, lied to, and outright forced into the system we have by authoritarian slimebags. Obamacare is only the latest example. Look at the freaking Orwellian name it has, not to mention the polls at the time they forced it through.

            The real issue is that this misguided series of bad ideas has created a dependency situation that makes the problem worse, especially in any kind of transition back to sanity. Along with the usual retarded thinking that the current system comes with zero hidden costs.

            1. And yet they care so much they demand their govt do something about it. You can’t have it both ways.

              Sure I can. Where is the contradiction?

              1. No you can’t. The contradiction would be people ignoring things whereas making demands about things is by definition not ignoring those things. This conversation is moving slowly.

                1. “Someone ELSE ought to do something about that” is pretty much the epitome of ignoring a problem.

                2. You are right, it is. Let me try one more time.

                  The great majority aren’t demanding that government do anything in any way except in how they vote (if they vote). That’s a pretty minimal effort.
                  To fund charitable efforts to pay for medical care for those who can’t afford it would require a lot more people to be a lot more actively engaged. I’m not sure that would happen.

                  If you think I’m wrong there, make an argument against that. Some logical “gotcha” mostly having to do with my choice of words doesn’t refute what I’m saying. Show me I’m wrong. I hope I am wrong.

                  1. Excuse me but my alternatives are either snark or repeating common knowledge, and snark is more fun.

                    If only few people need healthcare and can’t afford it, charity can cover them. There’s over a thousand free clinics in the US who treat millions of people a year. The catholic church has run many thousands of free hospitals for centuries. And this is with the crowding out (not to mention outrageous regulations and outright prohibiting) of charity by govt programs in the last several decades.

                    On the other hand, if many people have a need for something and can’t afford the products on the market, the market will provide them a cheaper product. The govt drives up prices and literally prohibits solutions to the cost problem.

                    1. The catholic church has run many thousands of free hospitals for centuries.

                      More than half of the Catholic Charities’s revenue comes from public grants. Without forced welfare, most of those Catholic hospitals would disappear.

                    2. A. roughly half. So discount half of that unknown number that I didn’t actually give…

                      B. “for centuries”.

          2. Make it clear why it’s a problem

        2. People might die in the streets because of the implications of shared costs, proximity and communications. I might be willing to pay a few bucks a month for care for the indigent when everyone else is paying the same, but not willing to pay $400,000 to save one person if I’m the only one around or the only one aware of the need at the time care is necessary. And people who aren’t around or aware may well be willing to pay for the care but there may not be systems in place to communicate the need. I’m not saying I’m a fan of universal care. Or even that people will die on the streets without it. But it’s certainly possibly, and not a logical fallacy.

    3. Actually all the responses to my comments prove my point. It’s just a matter of time now. Once ‘libertarianism’ has been whittled down to meaning nothing and the only people who identify with that movement are just watered down progressives you get “The Libertarian Case for Single Payer Healthcare”.

      1. If it makes you feel better, I no longer identify as libertarian.

        13 years of commenting here have basically convinced me that there’s no such thing as an actual libertarian.

        I describe myself as politically alienated now.

        1. there’s no such thing as an actual libertarian.

          Sure there is. Someone who agrees with me about everything.

          (joke, in case it’s not obvious)

    4. I’m not the only libertarian who thought single payer would be better than Hillarycare. Fortunately we never got Hillarycare.

  7. Remember Pelosi’s words “we have to enact it to know whats in it” so I guess Trump isn’t alone in not understanding the complexity of health care and I would include all politicians in that. That said the best way to control people is through unneeded complex buracracy

  8. I don’t know, Peter. The Dems sure made it sound like it was easy. After all, every other civilized nation was doing it, then Nancy said it would free people from the common workplace so they could pursue their dreams, and Obama told us how most people’s lives would go unchanged.

    Instead of taking a cheap shot at Trump, it would make more sense to suggest he said out loud what a lot of folks – most of whom were ignored – said when this was being cobbled together and rammed through.

    1. It was debated and worked on for close to a year and a half. If your take-away from that was “those Dems make it look easy”, that sounds like a personal failing.

      1. I didn’t say “made it look” easy; I said “made it sound” easy, which is what they did with the constant drumbeat of you can keep docs/plans, you’ll save X, etc etc. That Dems were bribing their own into compliance told a different story. But that’s okay; play the man, not the topic. Always sound strategy.

      2. “Debated” is a funny way to describe “dropping a thousand-page document on legislators’ desks 3 hours before the vote.”

        If it had been debated then an intelligent, engaged, and well-meaning public servant like Nancy Pelosi would not likely have suggested that passing the bill was the way she would find out what was in it.

        History is a bitch when it doesn’t fit your narrative.

        1. I remember at the time Obama wanting to rush the ACA bill through, and commenting that he was happy taking more time to decide what kind of dog to get the kids than he was willing to have the nation spend discussing ACA.

    2. Well, it’s easy when all you have to do is vote for some legislation that other people wrote and you haven’t read and then have a million bureaucrats interpret and implement it.

      1. and it gets easier when you pretend that bureaucrats like Jon Gruber didn’t say what they said. But, hey; something has to be Trump’s fault.

  9. Nobody knew! Nobody, except, perhaps, President Obama, congressional legislators, health insurance executives, hospital administrators, doctors who manage practices, individual humans trying to navigate the system, or literally anyone who has ever interacted with American health care in any way whatsoever.

    Obo and the D’s that passed the PPACA are healthcare savants that understood the complicated system so well that they made it way more complicated, you guys.

  10. I like these stories where you take Trump’s sentence fragments and them as bookends for some disconnected rambling about policy, concluding they are significant of something. Do more of these.

    1. There are many reasons to dislike the contemporary version of the Republican Party, but by far the least significant is their tolerance for incoherent rambling. Lincoln’s speeches are still taught in literature classes, Reagan could make almost anything sound appealing and inspiring. Trump repeats his five favorite adjectives over and over.

      It says a lot of bad things about me that my favorite reason for rejecting Republican candidates is their inability to at least try to sound like they finished elementary school. I can produce word salad on my own, thankyouverymuch.

  11. lol. everyone already knew you love this piece of shit law suderman. repeal horrifies you. this must be how Denny Green felt after playing the Bears.

    1. “It was what we thought it was!!!”

  12. “But Trump himself has repeatedly promised not to touch Medicaid, one of the nation’s biggest entitlements.”

    Entitlement? I hate that term. When the government promises something to someone who has not paid for it… its not an entitlement, it’s charity. Forced charity at that, since the government can only give what it takes from someone else.

    Call it what it is.

    1. I think there’s an even better word for “forced charity”.

    2. It is an entitlement if the government puts a gun to your forehead and takes the money for that promise from you. I mean, you’ve got a gun to your head, you gonna argue about terminology?

    3. No, I think charity is when people give to others because it’s what they want to do, not because they are forced to.

      I think “entitlement” is appropriate. There is a legal document that says people are entitled to certain benefits from the government. What else does “entitlement” mean?

      Since people seem to be having a real hard time with this on this thread, I will add that nothing I write above should be interpreted to mean that I support and government entitlement programs or policies.

    4. Medicare is an entitlement; workers paid into the system via taxes for years. The other entitlement is Social Security.
      Medicaid is not an entitlement. It is forced public charity.
      You can fully abolish Medicaid without touching entitlements.

      1. Yes, good point. I still don’t like calling it “charity” of any kind because charity has to do with the motivations of the giver.

        It’s a welfare program.

      2. If Medicare and Social Security were fully funded and if your benefits were strongly tied to what you contributed I’d agree. But neither of those conditions exist. Medicare is the worst example of the two. Anyone of a certain age gets Medicare, even if they contributed zero.

  13. Yeah I saw that Healthcare quote from Trump made into a massive stupid story on other sites, and was thinking it was nice that Reason seemed to be above the stupidity in this case at least. oh well.

    1. “Woke Minds and Intersectional Solidarity”

    2. It’s not just that Trump said something stupid, it’s that the stupid thing he said was indicative of a deeper ignorance. “Building a functional perpetual-motion machine is harder than it looks – who knew it would be this difficult?” It doesn’t matter how hard you study the problem or how many experts you have studying it or how much legislation you pass or how carefully crafted it is – the net net is that everybody wants free stuff and they all want somebody else to pay for it. And it’s not just healthcare, it’s just about every government program you care to name. They all cost more than they’re worth because they’re all promising to output more than what is input and thermodynamics and math and the universe just don’t work that way.

      1. As for “deeper” anything, I just see projection. You can’t measure someone’s IQ with quotes. The only depth is that which you add to it in your own imagination. I grew tired of this kind of mindreading three presidents ago.

        CNN had a response from Bernie Sanders (making the same basic snarky attack as Suderman). A socialist who never held a real job. I suspect his version of how-this-proves-Trump-is-stupid is completely different from yours.

  14. Donald Trump Is Amazed to Discover That Health Policy Is Complicated

    To be fair, so were the Democrats and that super-sharp intellect, Barack Obama. Bill Clinton was gobsmacked a bit by it as was his wife who(m) he put in charge of the whole thing back in the 90s.

  15. Blah blah blah Trump blah. Just shut up already Peter.

    Obama’s administration pushed the ACA through, knowing they were lying about details to the public, and then allowed the program to flounder when reality started showing all the flaws and issues with it. They then did nothing….absolutely nothing….to try to fix, or improve the system, for his entire second term.

    Even though healthcare is a massively impactful area that desperately needs improvement, Trump has opening declared he is willing to aggressively address it. Yeh its complicated. Do you really think he didn’t know that FFS?

    We can all wait to criticize the specific actions. But ffs, let them develop a proposal before you start whining like a prog.

    1. He said: “”It’s an unbelievably complex subject. Nobody knew that health care could be so complicated.”

      So what’s your position here? We should completely ignore everything he says and not comment at all on anything to do with Trump until actual laws are passed or policies implemented?

      1. maybe we could pretend that Trump or what he says is not always the story. The left pretended as if a solution was easy and that things would be wonderful. The reality said otherwise, which is why the whole thing was built on a foundation of lies.

        A better case could be made that O-care was designed to fail so that single-payer would be easier to implement since by the time talk of repeal came around – and keep in mind, Dems thought they would have a generational majority after Obama’s election – the system would be entrenched enough that repeal would be political suicide. It’s already being painted as a form of suicide and O-care is barely in place.

      2. Oh FFS, he didn’t say that in a policy declaration. He made an off-hand comment in a speech. Big friggin deal. As if no one ever says things (57 states) in speeches (‘Fool me once, shame on…shame on you. Fool me ? you can’t get fooled again) that aren’t the epitome of genius.

        Trump was not elected for his oratory skill. He was elected because he promised to fix the shit that was broken.
        It’s 5 weeks into his term and Suderman is declaring that the ACA is too complicated for Trump to do anything about before we even hear a proposal.

        1. I’m not saying everything Suderman says is great. But Trump is the goddamn president. You expect political writers not to comment on the things he says publicly? It’s kind of what they do.

          1. I expect political writers to write about real things, instead of their fevered interpretation of an offhand POTUS comment in an informal talk to reporters that Suderman links to the Twitter count of an NBC flack of all places.

            FFS, this isn’t political writing. This is a teenager girls diary.

            1. I guess I’m not really understanding the whole “Leave Trump alone!” sentiment. If Obama had said half the stupid shit that Trump had said, I think the commentariat would have (rightfully) skewered him. If anyone said – “Hey guys, let’s lay off what Obama said until we see what legislation he passes and how it works out,” I have little doubt that he’d be greeted with scorn and derision for treating the Messiah with kid gloves. But now, for some reason, we’re supposed to give Trump the benefit of the doubt lest we suffer from TDS?

              Fuck that. Being libertarian is about calling the government out and calling our stupid leaders stupid when they say stupid shit. Principles before principals, and I don’t care who’s fucking team the president is on, or whom he pisses off: if he says stupid shit, I shall call him a moran and mock him.

              1. whose, not who’s. Fuck.

              2. There are a multitude of intelligent things Reason could write about, ripping our government from left to right.
                Instead, Suderman pens a mindless article about common knowledge that he thinks is a relevation in Trump’s cluelessness based on a tweet of an NBC flack of an informal press meeting in which Trump said something.

                That isn’t “leave Trump alone!”. that is “grow the fuck up”

  16. I notice the subtle shift in wording here; health care .vs health policy.
    Health care is not at all complicated. You pick a provider, get the service you want/need, and pay the provider. Nothing to it.
    What is complicated is federal intervention into 18% of the national economy; health care AND health insurance. (as a side note, that is the classic economic definition of fascism) It was deliberately made more complicated by combining the two. No one has health insurance any more, it is illegal. You must, by (current) federal law purchase a combination of pre-paid health care and health insurance. That is how you get the “free” stuff. The payment is divorced from the receipt of service.

  17. Just throw grandma, cancer patients, the poor, and the sick into America’s emergency rooms. They have to treat them there. I don’t understand why all these people are showing up at their congressperson’S door and screaming at them. Oh, besides all the Soros’ dollars and Jew money being thrown to them. That might be the reason.

    1. GLEEMORE?|2.28.17 @ 12:38PM|#
      “Just throw grandma, cancer patients, the poor, and the sick into America’s emergency rooms.”

      Or, you can proved a NHS and let ’em die in the queue!
      Fuck off.

    2. Those poor souls already go to the emergency room under Obamacare. Which was supposed to happen less….. right?

      I don’t understand why weasels like you insist on lying after getting your asses spanked by the republicans in two midterms and Trump in the last election. You’re probably getting insurance from your work (which how most Americans get their private insurance, NOT the exchange) meaning things are hunky dory for YOU. I’m on medicaid and I’m only “covered” if I can find places that accept it. And even if I do, they still make me pay things out of pocket.

      47% of Americans liking ACA is now some indication that the law is super popular now. But that means 53% of the overs either don’t like it or “have no opinion” of it. And that’s with the law at the death’s doorstep. If Trump does nothing but repeal the individual mandate, the nation will be behind it.

  18. Speaking of complicated and health care: I downloaded TurboTax and started income taxes last weekend. I’m self-employed and enrolled in an ObamaCare policy. During 2016, I reduced my adjusted gross income (AGI) — mostly with retirement plan and HSA contributions but also by turning down work — such that I did qualify for an ObamaCare premium tax credit.

    I discovered yet another screw-up in ObamaCare. Before ObamaCare, a self-employed person could deduct health insurance premiums — with a limit set by net self-employment earnings — to determine AGI. With ObamaCare, a self-employed person can only deduct health insurance premiums to the extent that they exceed the ObamaCare premium tax credit. That’s fair enough. However, you need to know AGI to calculate the premium tax credit, and you need to know the difference between premiums paid and the premium tax credit to calculate AGI.

    The way I discovered this is that I plugged in an additional $100 of business expense into TurboTax (i.e., a reduction of $100 in total income and AGI), and discovered that it REDUCED my tax refund by $240 (i.e., an increase in taxes.) In other words: TurboTax says that it is possible to pay less in taxes by earning a little bit more money.

    1. I did some research, and discovered that this anomaly is not an error in TurboTax. In fact, TT has strictly conformed to methods for calculation that are outlined in CFR 601.105 Rev. Proc. 2014-41 in its calculation of the premium tax credit and the deduction.

      If you’re self-employed and eligible for OCare premium tax credits, it’s worth checking whether the sum of the tax credit and the deduction equals the premium paid.

  19. Poor Dear Leader. People expect his jaw movements to actually mean something. He’s just there for show– doesn’t everyone get that? He’s just there to flap his mouth open and shut all day and let Paul Ryan– genius– do the heavy lifting.

    1. Ironic coming from an advocate of socialism

      Love you boo

  20. “Nobody knew! Nobody, except, perhaps, President Obama, congressional legislators, health insurance executives, hospital administrators, doctors who . . .”

    If all these geniuses knew it was so complicated, why did they feel so confident in taking it apart and attempting to put it back together? Whoops. Darn! Where does this little gear go? And how about that spring? Does it wind clockwise or counterclockwise?

  21. “This healthcare policy is really easy to understand”

    Trump doesn’t know what he’s talking about.

    “This healthcare policy is unbelievably complex”

    Trump doesn’t know what he’s talking about.

    Lots of people KNEW the law was complex. The law’s supporters treated it as if it wasn’t. Remember when Obama dismissed the glitchy rollout and headaches resulting from mishandling info as some early pains typical for any startup business?

  22. It’s really not that complicated.

    Eliminate all health care and health insurance regulations. See? Not so hard.

    1. That was exactly my reaction to this article. Just because the current law is complex doesn’t mean that health care policy is fundamentally difficult.

      I don’t know the context of the quote, but it was framed as if he was asked about how to implement a health care policy, to which the only proper response would be of the form, “What policy?”

  23. 57 states

  24. President Obama knew that healthcare was complicated??? Only after he watched his program’s failures over and over again, no doubt. When the ACA website kept crashing for months after rollout, sure, maybe he eventually figured it was complicated.

    Not until then.

    At least Trump has just a little more foresight going for him.

  25. Tear it ALL down and start again:

    1) No federal involvement in health care, nor tax deductions therefore; healthcare premiums paid by one’s employer on one’s behalf are fully taxable.

    2) Reduce the income tax accordingly

    3) Allow purchase across state lines of insurance.

    4) All prices for medical care to be available in printed form to all parties.

    5) No federal involvement in health care

    6) No federal involvement in health care

    7) No federal involvement in health care

  26. That was a awful lot of meaningless no direction President Trump bashing. What you did not understand is this:

    He will simplify the complicated process, this is the hidden message, get on board and stop letting your mind block dictate frazzled and pitiful responses.

  27. If only they’d listen to the Libertarians, this would be solved tout de suite!

  28. It is only complicated if you believe the government and the private insurance industry should be in control of it. There is of course the problem that reducing the cost of health care means medical providers won’t earn as much. The drug companies won’t be able to create “new drugs” by modification of existing drugs. First step is to repeal the prescription laws passed during the FDR administration. Give people back their legal right to purchase medical drugs for their own use. Of course the AMA will have a screaming fit. The AMA has been supporting “monopoly medicine” since its founding 170 years ago. Lets be honest about this: Professional organizations are exactly the same as labor unions. Would you want the UAW to decide what kind of car you can buy? Any organization that seeks the power of the state to carry out its objectives is a group using “force” to get its way!

    1. Fair point on giving purchasers access to drugs, but the other side of the monopoly is the IP protection afforded to drug developers on the backs of publicly-funded research. The hybrid public/private model of drug development is incredibly costly and doesn’t make a whole lot of sense.

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  30. These sorts of difficulties are why the repeal effort has bogged down, and why Republican leadership is, according to a Wall Street Journal report, now intent on holding a vote on the reconciliation bill, and essentially daring their fellow Republicans to oppose it. That’s a high-risk strategy, ???? ?????? ?? ?? ??????
    ???? ?????? ?? ??
    because there isn’t much margin for error: The GOP can sustain just two defections in the Senate, and 22 in the House, so any sizeable opposition could derail the plan. In fact, it may already have been derailed: Last night, Rep. Mark Meadows, who heads the House Freedom Caucus, has said his faction cannot support the current legislative draft. Presuming no support from Democrats, the bill won’t survive without them.

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