Trump Aide Attacks Amash, but This Libertarian Rep. Is Ready for a Fight

Republicans have tried taking him out in the primaries before and failed.

ReasonTV

President Donald Trump didn't take his first big policy defeat—the failure to pass the American Health Care Act—terribly well, heading to Twitter to complain and blame, particularly the members of the Republican House Freedom Caucus who refused to get behind the legislation.

Matt Welch already blogged last week the president declaring war on the Freedom Caucus, noting the president's vague threat that they need to be "fought" (as in, primaried) in 2018, and also the generalized stupidity of Trump behaving in such a way that jeopardizes the ability of the GOP to pass anything at all (cutting out the Freedom Caucus eliminates most of the Republican advantage in the House). Trump's goal, obviously, is to try to shove those Republicans out in favor of those who are more likely to give his agenda a thumb's up.

Over the weekend, the attacks became a bit more specific when Dan Scavino Jr., Trump's director of social media, went after caucus member and libertarian fave Rep. Justin Amash of Michigan. Scavino's tweet got national media attention as it specifically called for Amash's defeat in the primary:

.@realDonaldTrump is bringing auto plants & jobs back to Michigan. @justinamash is a big liability.#TrumpTrain, defeat him in primary.

— Dan Scavino Jr. (@DanScavino) April 1, 2017

Amash was not remotely intimidated and responded with a "bring it on" tweet (I mean, it actually used the words "Bring it On") and is now openly fundraising off an attack by what he's calling the #Trumpstablishment:

Trump admin & Establishment have merged into #Trumpstablishment. Same old agenda: Attack conservatives, libertarians & independent thinkers. https://t.co/ALcV59iHXx

— Justin Amash (@justinamash) April 1, 2017

There's a whole debate now over whether Scavino violated the Hatch Act (which restricts government employees' direct involvement in political activities) and should be fired. Without dismissing the idea that there's a problem when executive branch employees start openly trying to affect congressional elections, Trump and his administration are themselves arguing on a daily basis that the Democrats are openly trying to take them down, not just oppose their agenda. Scavino's response was to essentially push even harder on Twitter, dismissing political ethical critics as an example of those trying to harm Trump.

It's really more of an example of the Trump administration now openly engaging in behavior that political party establishments used to politely keep behind the scenes in order to at least keep the intraparty fireworks at street level.

After all, if Amash does face a strong, well-funded primary challenge from within the Republican Party, it won't be the first time. There's a reason and a tactic behind lumping Trump in as part of the establishment. Back in 2014, Amash faced a well-funded primary neocon antagonist who went after him for opposing mass federal surveillance, going so far as to call him "al Qaeda's best friend in Congress."

It didn't work, and Amash won handily in the primary. Looks like he's prepping for the possibility of another "establishment"-funded fight.

On the other hand, Trump went golfing with Sen. Rand Paul (R-Kentucky), a major Amash ally, over the weekend, and they talked about health care. It's possible the tweets are just frustrated rants from an administration that has no message discipline and doesn't think it needs any. We will see next year.

Below, watch a ReasonTV interview with Amash:

Comments

[Fist of Etiquette]

It's really more of an example of the Trump administration now openly engaging in behavior that political party establishments used to politely keep behind the scenes in order to at least keep the intraparty fireworks at street level.

At long last, a transparent administration.

[Just the Tip]

Do you know who had a similar agenda early in their political career?

[Memory Hole]

Robespierre?

[Chipper Morning Wood]

You leave Robby out of this.

[Redcard]

Aqua Buddha?

[Aloysious]

Joe "Plugs" Biden?

[JFree]

Shirley Temple

[loveconstitution1789]

Thomas Jefferson?

And in 1802, President Thomas Jefferson wrote to his treasury secretary, "We might hope to see the finances of the union as clear and intelligible as a merchant's books, so that every member of Congress and every man of any mind in the Union should be able to comprehend them, to investigate abuses, and consequently to control them."

[Chipper Morning Wood]

Chad Thundercock?

[Crusty Juggler aka "Chad"]

Yes?

[Vince aut Morire]

Julius Caesar?

[Uncle Jay]

Johnny Fuckerfaster?

[Johnimo]

Please! Let's get the names correct. That's "Little Johnny Fuckerfaster."

[Citizen X - #6]

It's possible the tweets are just frustrated rants from an administration that has no message discipline

Whoa, whoa, whoa. Just because there's smoke and flames and emergency crews rushing in with hoses and whatnot doesn't mean there's a fire, come on.

[mad.casual]

I dunno about you, but I really do miss the good ole days twitter message discipline, where we got #bringbackourgirls to distract us from something having something to do with Benghazi (I think).

/sarc

[$park? leftist poser]

The problem with one-upmanship is that eventually you're stuck having to one-up yourself.

[Chipper Morning Wood]

Isn't that what life is all about?

[Gaear Grimsrud]

" you're stuck having to one-up yourself"
These masturbation euphemisms are getting a little too explicit for family hour.

[Just the Tip]

Without having the faintest idea of what Michigan's third district demographics look like, and basing this solely on conjecture from time spent in Detroit and Ann Arbor, I assume we will see Amash reelected or a democrat in his place if he's primaried. There seems to be a strong union sentiment and focus on social issues in Michigan. If Amash gets primaried it will be by a protectionist RINO, and whoever that is will have a hard time promising more union love or SJW focus than the D opposition.

[JFree]

It is one of the safer R seats in Michigan

[Detroit Linguist]

Michigan districts are radically gerrymandered--one of my colleagues made it to the front page of the Detroit Free Press today talking about my district (the 14th) that includes the Grosse Pointes on the east side and and some of the richer north-east suburbs. It really does look like a snake.
Amash's district is very conservative and includes Grand Rapids and Battle Creek. It's the home district for Betsy De Vos too. It is most certainly not pro-union--in fact that area was responsible for making Michigan 'right-to-work'. NTTAWWT.
I've met Amash at local libertarian events, and he seems genuine. I actually sent him money for the last campaign even though he's not in my liberal democrat district.

[KBeckman]

Correction:
South-east Michigan is heavily Gerrymandered.
Not so bad outside of that.

[John C. Randolph]

I don't think a protectionist RINO can beat Justin. M 3 has gotten used to electing a man with integrity.

-jcr

[Ken Shultz]

My understanding is that, historically, when the President calls out specific members of Congress, it's generally good for the person being called out.

Average people don't pay much attention to politics, but it seems like they figure that if the President is calling their representative out, then he must be doing something right.

At least he isn't doing nothing.

Meanwhile, the Freedom Caucus pulling the rug out from under a bill that both killed the individual mandate and got rid of the ObamaCare Medicaid expansion is pathetic. We may never see a bill to crimp Medicaid eligibility go up before a President who will sign it again in our lifetimes.

Calling the Freedom Caucus a charade is giving them the benefit of the doubt. I'd hate to think they were standing on principle to keep both the Medicaid expansion and the individual mandate. If killing the Ryan plan is what the Freedom Caucus is about, then as far as healthcare is concerned, they might as well be on the same side as Elizabeth Warren and Nancy Pelosi.

[wareagle]

Meanwhile, the Freedom Caucus pulling the rug out from under a bill that both killed the individual mandate and got rid of the ObamaCare Medicaid expansion is pathetic.

Maybe, but when your party mantra for years has included "repeal" and the who won your party's nomination harped on the word, too, then it's not unrealistic to expect a clean up/down repeal measure, is it?

[Ken Shultz]

We could be making the same complaint right now--except without the Medicaid expansion or the individual mandate.

[Robert]

Exactly. Where did the idea come from that once an issue's been addressed, it'll never be addressed again? Did they think they could hold repeals of the individual mandate & Medicaid expansion hostage for a better offer? Hell, repealing the individual mandate alone would soon enough lead to a situation in which further measures had to be undertaken.

Still, I'm confident that eventually some good reform will come thru. But that was in the offing anyway.

[HazelMeade]

Where did the idea come from that once an issue's been addressed, it'll never be addressed again?

Because once the part of the Republican party that doesn't give a shit is satisfied there will never be enough votes to ever get a bill to a vote again. Duh. How are you going to get the people who are just fine and dandy with the "new and improved" ACA on board, if you don't have anything to negotiate with? Once you settle for less, they will never have to give you more. This is like the first rule of negotiation.

[Johnimo]

Right you are, HazelMeade! The individual mandate was eliminated in name only in Ryan's bill. If I'm not mistaken, it was replaced with a heavy fine levied by the insurance companies. The Medicaid expansion was to be shunted to the States in a yet-to-be-determined form such as a block grant. So, it's too clever by half to say both were eliminated.

Furthermore, and just as important, the Democrats are now -- as they were before -- fully responsible for Obamacare in its unaltered form. So, unless we're going to get something much better, we are all better off letting the Obamacare ship go down slowly, like the leaking boat it is, with the Union Jackass flying proudly from its mast.

[Robert]

But we're on that boat. I'm 63 & not in great health heart-wise.

[loveconstitution1789]

Get catastrophic health insurance and pay cash for minor medical stuff. It's way cheaper than any government health plans.

[Bob Meyer]

It's not legal to buy what used to be called "major medical". If you buy insurance you get covered for everything including prostate cancer for women, pregnancy for men and addiction treatment for teetotalers.

The coverage mandates are the ones that have to go. Combined with third party payments the mandates drive the cost of insurance through the ceiling since there is no incentive to cut costs.

[Bubba Jones]

I agree in part with your criticism of the freedom caucus,but I honestly think it is better to do nothing and then let obamacare collapse.

The parts of the reform you (and I) liked would not have saved Obamacare but it would have shifted the blame to the GOP.

[mad.casual]

The parts of the reform you (and I) liked would not have saved Obamacare but it would have shifted the blame to the GOP.

And also initiated the whole iterative tweaking process.

[Johnimo]

Amen!

[Redcard]

Why not simply repeal it like they successfully did in December 2015? This president will then sign it into law.

[MarkLastname]

I don't think they have enough votes. There are a few republicans in the senate (4 I think) who vowed not to vote for a substantive repeal, which effectively means, in this issue, the Dems have a slight majority in the senate.

[loveconstitution1789]

They are not Republicans but RINOs and everyone knows it.

[Just the Tip]

I may be missing something in terms of how congressional procedure works (maybe they don't have the votes for a clean repeal?), but why is killing this plan bad? What the Freedom Caucus stands for, and I think most of us here agree with, is why do we need a repeal AND replace bill? Just kill the damn thing altogether. If you want to have government involved in healthcare, put measures up for a vote after getting rid of the abomination known as the ACA. Ryan and company were pushing for a new take on essentially the same thing - while I agree with you that it was better than the ACA, it was still a hot mess.

Repeal the ACA and introduce legislation to encourage more competition in healthcare: open pricing, nationwide market-places, less restrictive licensing for non-emergency services ... the list goes on.

[Ken Shultz]

Killing the plan is bad because the two worst parts of the ACA were the Medicaid expansion and the individual mandate--and the Ryan plan killed both of them.

The real reason the Freedom Caucus opposed the Ryan plan was because they didn't like the timing. The Ryan plan didn't kill the Medicaid expansion until 2020--after the midterms. They're afraid that the Democrats might win more seats in the midterms, that Ryan will compromise with the Democrats after they do, and that those two groups will prevent the Medicaid expansion from really going away.

It's an incredibly stupid objection. There will always be the danger of future congresses undoing what's being done. That's no reason to reject the Ryan plan. That's like never cashing in a winning lottery ticket for fear that someone will just steal all the money anyway.

[Ken Shultz]

In short, they don't trust Ryan not to save the Medicaid expansion in an Congressional election year.

Again, if you've got the winning lottery ticket, you go cash it in.

[Just the Tip]

There's so much more to the ACA that is horrible. How about setting the requirements on what coverages insurance policies must include? Coverage for pre-existing conditions? And yes, it would do away with the Medicaid expansion, but would do so by creating a new handout in the form of tax credits. If the bill had passed, keeping all the goodies from the ACA in place, and changing some from Medicaid to tax credits, all while removing the funding mechanism, you end up on the same trajectory where the whole thing implodes. Only now the R's are responsible and the next wave of congressional elections swing the other direction, and we're on the path to single-payer. It was a train wreck in the making.

I believe the FC members fundamentally want government out of healthcare altogether (a pipe dream, I know), but barring that, at least want legislation that can be easily understood, and puts us on a positive trajectory. Maybe I'm naive, but that's my take.

[Johnimo]

You've explained it very well; much better than I could've. If necessary, we'll need to give young people a completely free enterprise (catastrophic only) healthcare system, while we pay off the old entitlements. This we must do if we can't scrap the system all at once. At least it would be headed in the right direction.

End interstate restrictions. Allow drug re-importation. Get rid of certificates of need for all healthcare facilities, and recognize (without further licensing) all healthcare degrees from anywhere throughout the world. Make all prescription drugs "over the counter" and allow the combining of IRAs with HSAs, and allow both to be inherited (fully funded) without any tax penalty. This latter will incentivize healthy living. Can the pols bring themselves to act this radically? Probably not, but we need to at least get the radical conversation started.

[Robert]

But that takes a combination of state & federal legisl'n.

[HazelMeade]

The two worst parts of the ACA were/are guarenteed issue and community rating. Which Ryan's plan left untouched. And the Ryan plan didn't even kill the individual mandate, it just replaced it with that ridiculous surcharge.

The real reason the Freedom Caucus opposed the plan is because the plan was/is total bullshit. They want a real repeal, because they actually care about principles and not just appearances.

[junyo]

No, the worse part of the ACA was it created a whimsically funded perpetual entitlement program would have further hollowed out the remaining shell of the Federal budget. The Republican bill tweaked the funding slightly, to say they did something, but in a way that actually increased the spend. Honest to God, straight up repeal would have been cheaper. And thinking/hoping that Ryan was setting up for some tax reform down the road is exactly what got us the ACA; Democrats passed a bad bill and assumed that someone, at some future time, somehow, would help them put out the dumpster fire. And in passing Dumpter Fire 2:The Trumpening, Republicans finger prints would then have been all over that entitlement program, making substantive change nearly impossible. So no, killing the plan was least bad option if straight up repeal wasn't on the table.

[KBeckman]

The gambling metaphor is nice, but it's more like Ryan handed them a scratch ticket that they'd have to wait until 2020 to see if they won.

[Juice]

That's easy. You didn't win.

[creech]

Three of the moderate GOP congressmen in the Phila. suburbs would have voted "no" too, because the bill went too far. I wonder if it could have passed if the Freedom Caucus had been on board? And is there some rule in Congress that a bill withdrawn cannot be brought up again, even in a different form, during the same session? If not, then the media's gloating over the defeat of the GOP reform bill is just wishful thinking.

[Hail Rataxes]

And is there some rule in Congress that a bill withdrawn cannot be brought up again, even in a different form, during the same session? If not, then the media's gloating over the defeat of the GOP reform bill is just wishful thinking.

Trump is the one who doesn't want to work on it anymore. The White House told the Freedom Caucus they weren't going to get another chance at this, because the WH said so.

[Jgalt1975]

A bill can always be reintroduced, but conventional wisdom is that if a bill didn't pass the first time, it's not going to pass the second time unless there are material changes to it.

[Redcard]

And then there is the bill which repealed Obamacare in December 2015, and it did pass Congress.

Reason they are not just reintroducing that? Because that was done just to spite the black president.

[MarkLastname]

Yeah, people who disapprove of obama's healthcare policies are just doing it because they're racist.

I knew it was too much to hope for your brand of retardation to disappear.

[Zeb]

Well, I think it's great that they sunk the bill. Someone needs to have some balls.

If you always just go with the "you're with us or against us" thinking, you never get any real change and no one is allowed to have any principles.

[Ken Shultz]

It doesn't take balls to preserve an expansion of Medicaid in perpetuity.

It takes balls to cut medicaid eligibility.

The Freedom Caucus showed that they don't have any balls.

[HazelMeade]

You're retarded. The Freedom Caucus did not oppose the bill because of Medicaid. They opposed it because it didn't go far enough in repealing the ACA. It's Ryan who has no balls, not the Freedom Caucus. The Ryan plan was an absolutely capitulation on the central ideas behind the ACA. It was an absulute capitulation on guarenteed issue. It was an absolute captiulation on community rating. It was an absolute capitulation on the idea that health care costs should be socialized across all of society.

[Ken Shultz]

The bill got rid of Medicaid and the individual mandate.

Now we have nothing.

If you thinks that's some kind of principled improvement, then you're retarded.

"The Ryan plan was an absolutely capitulation on the central ideas behind the ACA.".

The ACA was primarily a means to expand Medicaid and subsidize the insurance companies to help them cover the loses they suffer when providers gouge them to recover all the money they lose treating more Medicaid patients.

If you think it was anything else, then you are misinformed.

Here, this piece could have been written just for you.

http://tinyurl.com/n5ulftk

Read and learn.

[HazelMeade]

The idea that cost-shifting from Medicaid is a large part of the problem with the cost of private insurance is nonsense.
Providers aren't under an obligation to accept Medicaid patients. They do not want to drive away their private paying customers by charging them more in order to charge Medicaid less. If they can't turn a profit from Medicaid payments they simply turn away Medicaid patients. Private insurance companies have their own negotiated rates that have nothing to do with what Medicaid gets paid.

You are simply off in a la-la land of your own invention on this. It seems to me you are confabulating excuses to carry water for the Republican party, for some reason. You're trying to rationalize continuing to support a Republican party that has just completely repudiated it's libertarian principles.

[Ken Shultz]

What you're calling "cost shifting" is the heart of all the problems, and the Ryan plan directly addressed that but killing the ACA medicaid expansion.

If I hadn't spent so many years working codes and reimbursement for a hospital and years more making coding and grouping software for all the largest hospital chains in the country, I might take your aspersions seriously.

You're an ignoramus. And all my former coworkers in the industry--almost entirely of the left variety--would agree that you have no idea what you're talking about.

I suppose the more disturbing observation is that your can't be persuaded with facts. The fact is that the purpose of the individual mandate was to force young healthy kids to buy health insurance they didn't need and wouldn't use in order to help the insurance companies survive the medicaid expansion. The primary reason why private insurance costs so much is because providers lose so much money on Medicare and Medicaid patients.

The Ran plan got rid of both the individual mandate and the medicaid expansion--but you opposed it because you're an ignoramus.

[HazelMeade]

The puspose of the individual mandate was to force young healthy kids to buy health insurance they didn't need and wouldn't use in order to help insurance companies survive the guarenteed issue and community rating mandates. Medicad doesn't have fuck all to do with it. Medicaid is a government program that is financed with government funds that has nothing to do with private insurance.

The primary reason why private insurance costs so much, is because most people buy it through their employers where it is effectively community rated (due to being group insurance) and they hence have no reason to care about costs. Also some states (i.e. New York) have community rating mandates in the individual market. When your insurance premiums don't have anything to do with your consumption, you lack effective price signals, consumption goes up and drives up costs for everyone in the plan.

The Ryan plan did nothing about either community rating, guarenteed issue, OR employer-based plans. They didn't even have the balls to make it tax neutral to buy your own individual insurance policy.

Medicaid is NOT THE PROBLEM. Medicaid doesn't have anything to do with what's wrong with the private insurance market.

[Ken Shultz]

"Medicaid is a government program that is financed with government funds that has nothing to do with private insurance."

Medicaid and Medicare only pay for a fraction of the cost of care, leaving providers to gouge patients for a nationwide average of 150% of the cost of care.

Whatever you do about the healthcare system, if it doesn't add some $300 billion a year to reimburse providers through medicare and medicaid or get rid of the medicaid expansion, then it isn't actually addressing the ultimate cause of the problem.

You don't know this because you're a willfully obtuse ignoramus, who can't grasp facts even when they're smeared all over your face. You're such a partisan hack in your hatred of Trump and the rednecks you think supported him, that you're impervious to not only reason but facts.

The Ryan bill got rid of the individual mandate and the Medicaid expansion--actually addressing the ultimate causes of our healthcare woes. And your hatred of rednecks and Trump has nothing to do with it.

[Ken Shultz]

Here's an article that says two things:

1) It says a lot about 16 hospitals in New York City that have had to close in recent years because Medicaid only pays for a fraction of the cost of care. In poor neighborhoods, it's especially bad because they don't have many private insurance patients to gouge to make up for the losses.

2) It says that Hazel is an ignoramus.

http://tinyurl.com/medhjus

[Ken Shultz]

"The Ryan plan did nothing about either community rating, guarenteed issue, OR employer-based plans."

What would changing any of those things do to address the fact that providers are charging insurers for 150% of the cost of care?

Duh!

The correct answer is "nothing".

If only private insurance was centered on individuals, providers wouldn't charge 150% of cost to make up for the money they lose treating medicaid and medicare patients?

Where'd ya git yer learnin'?

[Ken Shultz]

"If they can't turn a profit from Medicaid payments they simply turn away Medicaid patients."

This is so uniformed, it's hard to know where to start.

Do you see the chart?

Do you see that providers lose money on every Medicare and Medicaid patient?

Did you graduate from a public high school?

[JFree]

Cost-shifting is a problem - but Medicaid (the expansion part) is almost irrelevant to that cost-shifting. Medicare is much worse.

Medicare - $12,744 spending per beneficiary - probably about $2000 more in cost-shifting
Medicaid (elderly nursing homes - not expanded) - $17,500 spending per bene - prob $3000 more in shifting
Medicaid (disabled - not expanded) - $18,500 spending per bene - prob $3000 more in shifting
Medicaid (children - not expanded) - $2,500 spending per bene - prob 0 in shifting ex FL/WI/MI
Medicaid (under-65 adults - expanded) - $4100 spending per bene

Of that last group, the average spending in states that expanded is LOWER than in the states that didn't. IOW - they chose not to expand because they suck at controlling the costs of the existing bene population. There is no cost-shifting - merely incompetence that may even have the reverse effect of shifting costs TO Medicaid. The only exceptions are FL, WI, UT, ME and maybe OK. There is certainly some incompetence in the expansion group as well but with the possible exceptions of CA/NV/IA and maybe IL there is negligible cost-shifting to the private sector.

[Ken Shultz]

Medicaid is much more of a problem because 1) the reimbursement rates are less and 2) it bankrupts hospitals because the poor aren't evenly distributed around town--much less the country.

When the chart shows that the average hospital is gouging private pay patients for 150% of costs to make up for their losses on Medicare and Medicaid, those are averages.

If an average community has 10% Medicaid patients, that doesn't mean it's the same thing in the nastiest part of Chicago or Detroit. In those hospitals, if 50% of the patients are Medicaid, then that 150% number is going way, way up.

In the nasty part of Los Angeles, it typically took us one private pay patient to cover the losses on eight Medi/Medi patients. I used to run that report every morning. That was the first indication of whether we were losing money.

[JFree]

Reimbursement rates per se do not indicate cost-shifting. Much of the medical system in the US is fixed cost not really variable cost. The only cost-shifting would be - yes - in local areas where the Medi/medi utilization of capacity is large enough to force incremental fixed cost investment without fully reimbursing it. Otherwise, it is simply filling unused capacity.

And yes - CA is one state where there may be some cost-shifting from that expansion group as I said. But even there I'm gonna guess that much of their lower spending on Medicaid is due to the a)state availability of primary care physicians (unlike many states) and b)their utilization of them via 'managed care' (HMO's) instead of fee-for-service. MediCal spends $2850 per non-disabled under-65 adult and that is probably not far from what medical spending for that group SHOULD BE in the US IF we actually had more managed/integrated care in the US.

Now maybe they are squeezing the non-HMO PCP's (idk) - but if they are that is a consequence of a crappy structured healthcare system in this country (which is mostly driven by Medicare's fee-for-service model)

[JFree]

As an aside - and correct me if I'm wrong - but it sounds to me as if you actually think the US healthcare system was actually working well before Obamacare. That that broke what wasn't broken already before. And that therefore 18% of GDP is a perfectly reasonable number to spend on healthcare.

If that's what you think - then sorry but you are actually part of the problem not the solution. Not that govt programs are part of the solution either - hell they are part of the problem here. But the underlying problem with the medical system in the US is that it is bankrupting the country. Ignore the 'who is paying for what'. 18% of GDP is a massive rent-seeking parasite on the rest of the US and it must diminish. HOW is the main relevant question.

[HazelMeade]

The squirrels keep eating my link to this study ....

https://tinyurl.com/lwmyuy4

*sigh*

[JFree]

That's a useful study. The 'cost shifting' argument always revolves around hospital/labs (the big fixed cost elements in our system) utilization. The same argument was made in 1939 - when 'employer insurance' first became tax-exempt and deductible for employers. At that time, hospitals were still being built in large numbers - charity/nonprofit because those were big tax deductions for high-income folks; municipal (for the first time) because of new deal stuff re muni bonds. Munis were required to take all patients - and their capacity utilization was 90%. Charities/nonprofits weren't required to take all patients but they did take many who couldn't pay - and their capacity utilization was 50% - and they were arguing that munis were 'stealing their patients and forcing their own prices higher'.

IOW - at that time in pure economic terms there was already an overcapacity of private charity hospitals and still a shortage of muni hospitals. The wealthy still wanted a tax deduction with income tax rates of up to 70% - but the hospital infrastructure they could fund was glutted. So they pushed for employee insurance (where they could still get a partial deduction via company ownership) as a way to goose utilization in charity hospitals that had their name attached to it.

It's one reason I don't think much of abstract 'free market' arguments. Because the big stuff has always been about tax code games not a real free market.

[Ken Shultz]

"That's a useful study. The 'cost shifting' argument always revolves around hospital/labs (the big fixed cost elements in our system) utilization."

16 hospitals closed just in New York City, in recent years, because Medicaid payment rates are too low to cover their costs.

That's isn't an argument. That isn't a theory.

It's a fact.

[JFree]

16 hospitals closed just in New York City, in recent years, because Medicaid payment rates are too low to cover their costs.

What costs? NY has the 2nd highest Medicaid spending per beneficiary. You're arguing that it is too LOW?

NYC real estate is in a bubble. If rents are too high now for hospitals or workers who earn less than 100k or anything other than corp HQ or Wall St; that isn't a problem caused by Medicaid.

[Ken Shultz]

"NY has the 2nd highest Medicaid spending per beneficiary."

And hospitals with large Medicaid populations still can't stay open because the they don't cover costs--why is this so hard to understand?

16 hospitals in NYC alone closed because of it.

Are facts that don't conform to your preexisting biases not facts?

IF IF IF New York spends more to supplement Medicaid than other states--and it still isn't enough to cover costs--do you imagine hospitals in low income areas can make it up in volume? If there isn't a local private insurance population large enough to gouge for the difference, the hospitals just close.

Show me a community hospital that's closed recently in the USA, and I'll show you a hospital in a low income area with a large local medicaid population.

[MarkLastname]

I find it difficult to believe cost shifting from Medicare would be negligible, but if it's true that providers aren't shifting costs for Medicare or Medicaid, it means one of two things:

1) they are rationing care to Medicare and Medicaid patients, and that's how they're avoiding 'selling' care at below market prices, as the ACA requires them to do. Or

2) they're actually capable of taking below-market compensation for Medicare/Medicaid because their prices are already so far above what would be the competitive market prices if there were more competition. In which case it's things like CoNs that prevent competition that warrant more blame.

[JFree]

In which case it's things like CoNs that prevent competition that warrant more blame.

That federal mandate ended 30 years ago. 16 states (mostly Plains/Mountain) don't have them. It's a state level issue. Whether it has had an impact on actual hospital construction - or hospital day rates - prob not a lot. For-profits generally haven't (and won't compete with themselves). Private non-profits depend on big charity donors to build - and that depends on high tax rates (not 'free market') for the deduction. And munis depend on taxes to build.

[Ken Shultz]

That the effect isn't enough to bankrupt the entire system for the affluent and people on private insurance isn't surprising.

When I wrote that the effect of medicaid isn't evenly distributed, do you understand what that means?

Am I supposed to ignore 16 hospitals in poor areas of New York City being closed because medicaid reimbursement rates are so low--because your study shows that the system isn't bankrupting nationally (circa 2011)?

That's asinine.

When I'm talking about the problems of the healthcare system, I'm talking about the cost of private care being artificially inflated beyond the reach of the working poor and an incredible cost to the middle class.

What are you talking about?

Yeah, go out to Irvine, where they have very few Medicaid patients, and there's not much of a problem. The hospitals that are in danger of closing aren't in Irvine. They're King Drew Medical Center, County USC, and Harbor UCLA.

In short, national averages aren't typical of inner city Detroit, Philadelphia, New York, or Chicago. Why would they be?

[Ken Shultz]

The next time a hospital is forced to close in a major metropolitan area because Medicaid reimbursement rates are so low and there aren't enough private pay patients in the community to make up for the difference, maybe you should email them your study.

Then they'll know not to believe their own lying eyes.

LOL

[Ken Shultz]

Incidentally, here's a story about the Mayo Clinic accidentally going public with its plans to prioritize privately insured patients over Medicaid patients.

This bit stood out.

"Mayo reported a sharp increase in the amount of unreimbursed costs related to Medicaid patients, from $321 million in 2012 to $548 million in 2016. The figures include its campuses in Arizona and Florida. Mayo nonetheless remained profitable in 2016, with income of $475 million.

---Star Tribune

http://tinyurl.com/kekwamp

Their losing twice as much money in 2016 as they were in 2012 providing for Medicaid patients, but they made up for those losses by gouging private pay patients--they're still making money.

I mean, those are the facts, but I guess we shouldn't believe our own lying eyes--because Hazel has a study that tells us the truth--regardless of the facts.

Too bad the rest of the country can't gouge private pay patients from all over the world like the Mayo clinic. They've moved into really nice areas with high private insurance populations in Arizona and Florida. Inner city hospitals can't do that. They just circle the drain and beg for mercy.

[JFree]

When I'm talking about the problems of the healthcare system, I'm talking about the cost of private care being artificially inflated beyond the reach of the working poor and an incredible cost to the middle class. What are you talking about?

I'm talking about the 18% of GDP we spend in total. That is 50% higher than anyone else and because we charge fixed$ (rather than % of income as most countries do), the effect on lower income is that they pay 200% more of their income than elsewhere. THAT is what squeezes the low end.

'Cost shifting' is only arguing about how that 18% is split. It ASSUMES that the 18% is itself - OK. The real problem is that the 18% is way too effin high - ESP if we are going to charge a fixed$ to people. And yes, Medicare - not Medicaid - is the main source of the problem because of their fee-for-service structure which distorts the way our entire system is structured. It goes way beyond mere 'cost-shifting'.

[Ken Shultz]

The amount of money we spend on any particular thing doesn't matter--unless you're a central planner. Do you care how much of our GDP we spend on vacations and new shoes?

"Cost shifting' is only arguing about how that 18% is split."

Again, you're living in a centrally planned dream world.

If entrepreneurs can't compete on price effectively because their prices reflect them being charged 150% of cost, then the resulting distortions are about much more than how some arbitrary portion of GDP is split. And we haven't even started talking about the moral hazard aspect of people on Medicaid seeking more care than they would otherwise because they aren't the ones paying for it. Can't afford the medical bills for having another baby? People on Medicaid don't have that problem.

[KBeckman]

"Am I supposed to ignore 16 hospitals in poor areas of New York City being closed because medicaid reimbursement rates are so low--because your study shows that the system isn't bankrupting nationally (circa 2011)?

That's asinine."

Statistically it's an outlier.
You are talking about one of the most expensive cities to live in.
In a state with asinine healthcare laws and regulations that make it difficult to open up cheaper alternatives like direct primary care.

There's no question medicaid played a primary role in the closures, but there are a number of factors that also played key roles.

[Zeb]

I'm quite aware of what you think on the subject. I disagree. Ryan's bill would have left us with a healthcare system just as shitty as the current one in almost every way.

What I think takes balls is sticking to your guns on actually reducing spending, the proper role of government and the constitutional powers of the federal government.

[Crusty Juggler aka "Chad"]

If you always just go with the "you're with us or against us" thinking, you never get any real change and no one is allowed to have any principles.

If that shitty bill passed the Repubs would have alienated their base like whoa.

[Ken Shultz]

Why?

Because it got rid of the individual mandate?

Wait 'til you see what happens after they're compelled to fund ObamaCare all over again--as a major expansion, even, to keep the insurance industry solvent.

[Redcard]

Getting rid of the individual mandate did what specifically? Other than take away some revenue, it did jack squat to help healthcare.

[Ken Shultz]

The individual mandate is about the most anti-libertarian thing that's happened in recent years. Quantification isn't the deal with that one.

Using the government to force people to buy broccoli against their will is anti-libertarian. Siccing the IRS on people because you don't approve of their personal choices is anti-libertarian.

I wouldn't accept an ACA revision that didn't get rid of that evil. Meanwhile, any revision that didn't roll back the medicaid expansion doesn't really address the ultimate cause of the problem.

[Hugh Akston]

Not to mention they would have owned the train wreck that followed, which would have made any kind of meaningful reform impossible. It's just a shame that they didn't have enough time to come up with a more comprehensive bill.

[Crusty Juggler aka "Chad"]

It's just a shame that they didn't have enough time to come up with a more comprehensive bill.

Which is pathetic, and could harm them in the next election unless something like Rand's proposal gets passed, which is a massive improvement.

[chemjeff]

Which is exactly where NHS is in Britain, politically. All parties have vested interest in keeping it going, and so the most that will ever happen is minor tweaking. If RyanCare had passed, it would have meant the same thing here. No one would have standing ever again to repeal ObamaCare.

[Redcard]

Yes, seven years were never enough.

The fucking Constitution was crafted in four months. Obamacare took about a year.

And in seven, Policy Wanker Ryan got a worse form of Obamacare.

[MarkLastname]

Pretty sure he was being sarcastic.

[$park? leftist poser]

There is no such thing as flexible principles.

[Ken Shultz]

Cutting medicaid and getting rid of the individual mandate isn't betraying any principle.

Refusing to cut medicaid or get rid of the individual mandate unless you get also get x, y, and z is betraying principle.

[$park? leftist poser]

If you're principles say government has no business managing health insurance, then only removing a couple items from government managed health insurance is not following your principles.

[GILMORE?]

If you're principles say

Never trust people who misuse apostrophes

[EscherEnigma]

How does the prayer go?

God, give me the serenity to accept the things I cannot change,
the strength to change the things I can
and the grace to know the difference

Sometimes you can get everything you want. Sometimes you can only get a partial victory. Refusing to do what you can because you can't do what you want is just an excuse to do nothing while sitting on a pedestal.

[MarkLastname]

And arguing that something is inevitable even though it isn't is a common cowardly way of avoiding having to consider alternatives.

[Chipper Morning Wood]

Come on, Ken. The GOP bill was shit and you are defending shit. Sometimes it is better to do nothing than to do a half measure.

[GILMORE?]

Sometimes it is better to do nothing than to do a half measure.

explain how this is one of those cases, please

[Chipper Morning Wood]

Because many in Congress would consider the issue done and nothing further would probably be attempted. This way, there is reason to mount another attempt. On the other hand, if nothing further is done, and there is a collapse if the system in place, the blame will go to Obama rather than the GOP "fix."

[GILMORE?]

if nothing further is done, and there is a collapse if the system in place, the blame will go to Obama rather than the GOP "fix."

[as gen mattis says]

... and then what?

[Crusty Juggler aka "Chad"]

... and then what?

And then a new plan that sucks tremendously less will take its place, or no plan will take its place, and Congress will let the free market figure everything out.*

*LOLOLLOLOLOLOLOLOLOLOLOL

[chemjeff]

At this point, it looks like both the Democrat and Republican base wants government-provided health care. So the Freedom Caucus will be primaried out of existence and both parties will sing kumbaya as they jointly enact single-payer together. Which is what was going to be the net result ANYWAY under RyanCare, only with this sickly veneer of "free-market health care" which was a total lie.

[HazelMeade]

At this point, it looks like both the Democrat and Republican base wants government-provided health care. So the Freedom Caucus will be primaried out of existence and both parties will sing kumbaya as they jointly enact single-payer together.

Pretty much this. The Republican party of Trump is not going to be friendly to libertarians. Anyone who thought it would be is a complete idiot. Thanks a lot, you fuckers.

National socialists vs. international socialists.

[chemjeff]

RyanCare wasn't even half a measure. It was more like "repeal 10% of ObamaCare and then declare victory".

If RyanCare had passed, there would be no chance at all for repeal of ObamaCare. Because then both sides would have been fully vested in the idea of a health care entitlement for the middle class.

[GILMORE?]

then both sides would have been fully vested in the idea of a health care entitlement for the middle class.

this is modestly better than CMW's just-so political prognostication.

but then this presumes that they aren't already. and i'd suggest that of course they are

both parties are completely invested in the idea of middle-class entitlements, as is the public. its just that no one wants to pay huge out-of-pocket costs for them in the process of getting lower benefits.

I don't think the bill put forward was very good. i thought the freedom caucus criticisms were mostly legit. but i don't think most of them want to put their name on a bill that will have visible impact before the mid-term elections. better to do something (probably the same sort of thing) next year.

i think that pretending that this was a singularly awful bill and that it would be the end of the process is wrong tho. as are claims that anything less than 100% stripping every element of the ACA simultaneously in one single-bill is a compromise of principles. anyone who handwaves about "principes" in the context of politics understands neither. Politics is the art of compromise, and it is defined by endlessly sacrificing the perfect for marginal good.

[Crusty Juggler aka "Chad"]

this is modestly better than CMW's just-so political prognostication.

Alright everyone, let's put our heads together to come up with an argument that receives the Gilmore stamp of approval.

[GILMORE?]

I think anything other than "durr Obama will get all the blame" is at least 'less-stupid'.

[Crusty Juggler aka "Chad"]

I think anything other than "durr Obama will get all the blame" is at least 'less-stupid'.

Eh. I don't know...

[GILMORE?]

Eh. I don't know...

- if the ACA implodes, and millions of people experience loss of coverage/skyrocketing of premiums in a short time-frame, the net value of "I told you so" will last about 30 seconds before the current administration is blamed for failing to prevent foreseeable problems,

- if the ACA doesn't implode in any obvious way, and instead you simply get continued degradation of the marketplace that we've seen over the last year or 2, they'll simply be blamed for dragging their feet

while i'm not generally a fan of "doing something for the sake of being seen to be doing something".... i think the 'half-assed' measure of the ryan bill would have at least demonstrated a political willingness to address the problem, and provided incentive for continued measures (possibly even getting some red-state dems on board) if people can be seen as 'trying to solve a problem' rather than just playing politics.

this isn't really an argument on the merits of the bill so much as a case that the political process needed to truly "fix" the ACA may have to come in fits and spurts, opportunistically, and that this was a missed opportunity to create some inertia.

[Crusty Juggler aka "Chad"]

while i'm not generally a fan of "doing something for the sake of being seen to be doing something

which accurately sums up the bill.

i think the 'half-assed' measure of the ryan bill would have at least demonstrated a political willingness to address the problem

This is the best they could come up with after six years, so I don't think Ryan has a willingness to actually address the problem.

if people can be seen as 'trying to solve a problem' rather than just playing politics.

Rand Paul and the Freedom Caucus are trying to solve the problem, while Trump and Ryan are clearly playing a political game.

[GILMORE?]

Rand Paul and the Freedom Caucus are trying to solve the problem

not really. they're demanding specific elements be included simply for the sake of appeasing their own red-meat-eating constituents.

you seem to forget that the freedom caucus isn't primarily libertarian; its mainly SoCon, and one of their sticking points is "Defunding Planned Parenthood".

you can try explaining to me how defunding PP is part of "Solving the Problem" of the wider health insurance marketplace if you want.

[GILMORE?]

**and yes, i know Trump has played rhetorical games, suggesting that their objections to this bill are simply delaying his own methods for achieving the same goal of ending PP.

my point is that its simply wrong to pretend that the main objections of the more-conservative Freedom Caucus are purely motivated by some practical concerns about what's the best path forward for health care market reform. they're just trying to score their own points.

also - re: ""which accurately sums up the bill.""

did you not actually understand the point i was making about 'political inertia'? yes, i don't think the ryan bill was particularly good. you seem to think this is some major concession when it was actually my starting point.

as i said above, the case i am making is that there needs to be some political progress merely on "process". contra CMW's derpy-assertion above, i don't think simply 'waiting for the ACA to fail' has any practical benefits for anyone.

[MarkLastname]

A big part of the problem is that the Ryan bill doesn't do enough to have noticeable positive effects; it may show political will, but it's like a bad kind of goldilocks bill: it changes just enough of that status quo to force the GOP to take ownership of the status quo, but not enough to actually mitigate skyrocketing costs; it minimizes positive impact while maximizing blame for a catastrophe that could only be averted by more significant measures.

If Ryancare passed, as likely as not it would simply mean it's inevitable failure to seriously address rising costs would allow the Dems to pronounce the right wing free market ideas it never really tested a failure and use it as a springboard to jump toward a single payer once they reclaim power.

[Citizen X - #6]

Ooh. If we gonna try to qualify for the GSoA, we're gonna need to be MUCH better dressed. Crusty, i'm afraid it's time for you to put on pants.

[Crusty Juggler aka "Chad"]

i'm afraid it's time for you to put on pants.

I have, and their double-pleated polyester.

[Crusty Juggler aka "Chad"]

Oh no! They're! NO! NO!

[Citizen X - #6]

Hoist with you're own retard!

[Chipper Morning Wood]

Perfect.

[Robert]

Am I doing the math wrong? The midterm elections are next yr. When will we ever be farther away from coming Congress elections? Some lame duck session?

[Citizen X - #6]

Well, if the Perfect is the enemy of the Good, and the Perfect is also the enemy of the Remarkably Shitty, then the Good and the Remarkably Shitty must be on the same side, and this remarkably shitty bill was therefore good. Q.E.D., mothafackos!

[Crusty Juggler aka "Chad"]

Why didn't Ken just write that?

[HazelMeade]

This is pretty much Ken's position in a nutshell.

[Ken Shultz]

How does saying that we should have settled for an imperfect bill that actually got rid of the two worst parts of the ACA amount to any of that?

We should settle for ObamaCare because getting rid the individual mandate and Medicaid isn't good enough?

Are you people this stupid at work?

Do you all work for the government?

[Just the Tip]

Ken, no one here is arguing to keep the ACA. The argument is to not trade a steaming pile of shit for a room temperature turd. The point of opposing the latest bill is to force everyone back to the table to negotiate something better. The solution doesn't have to be perfect but it needs to reduce government involvement in healthcare and not put healthcare on a trajectory to implode (this leads to D gains and pushes us ever closer to single payer).

[Ken Shultz]

We still have both the individual mandate and the Medicaid expansion.

We could have had neither.

If Elizabeth Warren had used black magic to possess the bodies of the Freedom Caucus, she'd have had them do the same thing.

[chemjeff]

Oh good, we're back to binary thinking mode, just like in the election.

"If you don't vote for Trump, you're supporting Hillary!!!!"

"If you don't vote for RyanCare, you're supporting Elizabeth Warren!!!!"

[MarkLastname]

If Elizabeth Warren could possess the GOP to pass market oriented reforms in healthcare she would do that too, because she genuinely believes they would fail miserably and vindicate socialism. Should we oppose thosr too then?

[Just the Tip]

As a follow up: I get what you're saying WRT Medicaid and its impact on insurance prices, but that's a separate battle. One part of the ACA was to expand Medicaid, and the house measure would have rolled this back. That's great and all, but there are other large, underlying issues with the ACA. If you're going to put a bill forward to fix the problem, then fix the damn problem. Don't nibble around the margins, keep some things that are inherently awful (but maybe good for short-term prospects (i.e., reelection), and pretend that it's a good solution.

[Ken Shultz]

"One part of the ACA was to expand Medicaid, and the house measure would have rolled this back. That's great and all, but there are other large, underlying issues with the ACA."

You are vastly underestimating the size of that problem.

Rolling back the ACA medicaid expansion wouldn't solve all of it, but it's a necessary step before we can roll back the rest of medicaid.

And we may never see a bill go to a general vote that rolls back medicaid eligibility again in our lifetimes--not when there's a president that's willing to sign it.

That kind of historic opportunity doesn't happen every day. We'll be luck if it happens again this century.

[HazelMeade]

What's the fucking point of rolling back medicaid, which only covers the poor, while simultaneously entrenching the ACA, which EVERYONE is forced to participate in?

This is like celebrating the repeal of food stamps with a bill that institutes national food insurance.
Chicken in every pot! Thank got we got rid of that welfare!

[loveconstitution1789]

We're not forced to use Obamacare. Thanks to Trump, I ignored the IRS question about healthcare.

[Ken Shultz]

"We're not forced to use Obamacare. Thanks to Trump, I ignored the IRS question about healthcare."

What are you going to do when the next Democrat is elected to be President?

If Elizabeth Warren becomes President in 2020, what are you going to do?

EOs are only as good as the Presidents who perpetuate them.

[Robert]

I bet it'll happen again within a year.

[Robert]

But what makes you think not voting on this one "forces" everyone back to the table? Wouldn't passing or at least voting on it have encouraged them back to the table? You know, a small victory that'd tell them, we can win this?

[Citizen X - #6]

Kenneth, Kenneth, Kenneth. Who here is saying anybody should settle for Obamacare?

[chemjeff]

Meanwhile, the Freedom Caucus prevented 90% of ObamaCare from being permanently entrenched into the federal government's responsibilities, and exposed Ryan and Trump as being complete phonies for ever claiming to be genuinely in favor of repealing ObamaCare.

[Zeb]

If they actually meant what they said about repeal, they could have passed a bill that says "Obamacare is hereby repealed".

You can't do repeal and replace without the repeal part.

[Robert]

There's no such thing as permanently.

[Not a True MJG]

We may never see a bill to crimp Medicaid eligibility go up before a President who will sign it again in our lifetimes.

"again"? It didn't go up at all. It never even got to the Senate.

If the Freedom Caucus puts together a bill, one that is 'better' from a libertarian and fiscal conservative perspective, and some GOP Reps don't vote, is the Freedom Caucus still at fault? If that bill does go to Trump's desk and he refuses to sign it, will it still be their screw-up?

[DarrenM]

It's too bad that's the only bill Republicans will ever bring up again.

[wareagle]

no message discipline

Really? Tweeting has been part of the message, or at least the messaging strategy, from the start.

[Zeb]

That doesn't make it disciplined, necessarily.

[Citizen X - #6]

For some value of the word "strategy."

[Chipper Morning Wood]

Massage Discipline was the name of my side business in college.

[Redcard]

Libertarian? No, he is a registered Republican. At least until he runs as an independent, he is a conservative Republican.

A libertarian would not be afraid to put forth his free market ideas; Amash can never win except as a Republican.

[Robert]

Tempest in a teapot. Eventually they'll do something about health legisl'n, & Trump'll be satisfied.

[A Cynic's Guide to Zen]

What's this? The commentariat seems healthier than normal...

Are we pulling through?

[Crusty Juggler aka "Chad"]

It's really more of an example of the Trump administration now openly engaging in behavior that political party establishments used to politely keep behind the scenes in order to at least keep the intraparty fireworks at street level.

I am all for putting the sleaze on display.

[Citizen X - #6]

WE KNOW.

[AlmightyJB]

So are the Russians

[Jerryskids]

Once upon a time, Trump was in favor of putting the sleaze on display. Wasn't that half the reason he was elected - because the RINO GOP Establishment never kept their promises and obviously were riding the conservative train just for the gravy? But you should have gotten a clue from Trump when, right after attacking the GOP establishment, he turned right around and attacked Ted Cruz with the line about how nobody in Washington likes him. I thought the insiders in DC were the enemy - shouldn't the fact that they all hate Ted Cruz be an endorsement of Cruz? Trump can talk all he wants about draining the swamp, he ain't interested in draining the swamp except insofar as he gets the contract for doing the draining. Trump ain't a plumber and he don't know shit about drainage. All he knows is the water's nice and warm, the mud packs are great for his skin and the methane bubbling up's kinda like a Jacuzzi. Damn, this swamp sure is soothing and relaxing now that he thinks about it, like a spa treatment at a world-class super-elegant Trump resort.

[Crusty Juggler aka "Chad"]

Theory: Justin Amash is not a true libertarian because he seems to dress well. This is how a true libertarian dresses.

[Hugh Akston]

Amash is just another Washington Suit. If you want a well-dressed politician you have to go to Kentucky

[Crusty Juggler aka "Chad"]

He is rocking the "professor with a secret" look.

[Chipper Morning Wood]

It is not how a libertarian dresses that matters, Crusty, but how he undresses.

[Citizen X - #6]

In Crusty's case, that would be "frequently and without regard for audience."

[AlmightyJB]

You would have thought the Chuck E Cheese restraining order would have slowed him down a smidge.

[Memory Hole]

Trust Paul and protect your soles. Fashion will choke you out and leave you crippled.

[Uncle Jay]

RE: Trump Aide Attacks Amash, but This Libertarian Rep. Is Ready for a Fight
Republicans have tried taking him out in the primaries before and failed.

Just another example of why there is no real difference between the two parties.
Amash show the republicans they are as big a fascists as the democrats are totalitarian socialists.
No deviation from the party line will be tolerated. (Isn't that something Stalin started?)
No questioning Dear Leader Trump.
No debate on any subject.
Just do as you're told, when you're told.
That's what both dominant political parties in this country demand.

[Rhywun]

there is no real difference between the two parties

Well, the Democrats are a lot better at keeping everyone in line. It's how they got so powerful in the first place.

[Uncle Jay]

"Well, the Democrats are a lot better at keeping everyone in line."
Somewhere, Stalin and Hitler are smiling.

[chemjeff]

It still amazes me that there are still so many people here who are upset at the defeat of RyanCare.

At this point it isn't even a question that RyanCare wasn't libertarian enough. RyanCare wasn't even *Republican* enough, based on what the Republican Party has been saying for the past 8 years about how evil and awful ObamaCare was.

The Freedom Caucus exposed both Ryan and Trump as being total frauds when they ever claimed to be in favor of repealing ObamaCare. And yet we are supposed to be supportive of their fraud?

Just checking, but libertarians aren't supposed to be just a branch of the Republican Party, right? When the Republicans are wrong, it is okay for libertarians to say that they are wrong. And here, they were very wrong.

[Not a True MJG]

One isn't many.

[Zeb]

Ken just seems like more people. Someone has to keep the word count up.

[HazelMeade]

it's your duty to support the Trumpetarian alliance, which basically involves libertarians capitulating on everything so that we can keep out immigrants. because we need a wall to protect our freedom!

[Jerryskids]

Libertarians are in favor of capitulating anything you're drunk enough to load into the bucket. Like if you want to re-enact the Holy Grail scene where the Frenchmen capitulated a cow onto King Arthur and his men, that's at least 3 bottles of schnapps or a pint of embalming fluid.

[Uncle Jay]

"that's at least 3 bottles of schnapps or a pint of embalming fluid."

Aren't they the same thing?

[Robert]

I'm not upset, but am disappointed. Ryan's bill was much less than seemed achievable, but that doesn't mean it should've been scuttled. But I'm not upset, because surely they'll get around to the elephant in the room sooner or later.

[Redcard]

"Federal Gubmint should stay out of marriage"

Classic cop-out from Republican libertarians.

No one champions to get federal government out of marriage, occasionally some libertarian farts that sentiment, gets hailed for "libertarianism" and then nothing.

Basically, all such "small government" advocates seem to think

1. Wrong for federal govt., but presumably OK for state govts. No idea why gubmint gets different treatment
2. By doing nothing more than lip service to get federal govt. out of marriage, they are basically advocating status quo. Which is the perfect cover, right? Don't push for gay marriage, because "marriage is not the federal govt.'s business" and the law (until, thanks Olsen, Boies) only recognized straight marriage, so by default hold on to it.

The intellectually honest position would be to demand abolition of federal laws for marriage, and until that happens, support gay marriage.

"Pro life" ... yup, libertarian. LOL

That said, if compromises are to be made, there is not a better one than Amash.

[Chipper Morning Wood]

Yes, I agree with you on gay marriage. Jacob Levy wrote a whole book on the interplay between individuals, the government, and what he called "intermediate groups." State governments are an example of an intermediate group, but so are churches. The difference between true libertarians and conservatives/yokeltarians is that former go down to the level of the individual and the latter care more about intermediate groups. Sometimes the federal government protects individuals from intermediate groups, and this is where the conflicts arise.

[MarkLastname]

The federal government shouldn't have anything to do with marriage. That's not a cop out, that's a fact.

State governments should either, but two wrongs don't make a right.

Governments should not be in the marriage business anymore than the baptism or bar mitzvah business. If you think that's a right wing position, then your mom drank way too much when she was pregnant with you.

[Robert]

What happens when someone takes a case to court, & it's material to the case whether someone is married? Not allowed to take the case, because that would be "in the marriage business"?

[Redcard]

Your mom must have been sucking your dick while you wrote that. Nothing else would explain why you could not concentrate long enough to read past two sentences.

In your defense, she can be very distracting that way.

[DenverJ]

When I was a kid, I read a book where medicine had been outlawed. Can't remember the reason, but it sure would move us further away from single payer.

[Homple]

Libertarian moment! Amash for President on LP ticket! As long as he keeps his clothes on at the convention, anyway.

[Citizen X - #6]

President? No. But he can be Kmele's running mate.

[Chipper Morning Wood]

Do we have a slogan for Kmele yet?

[Not a True MJG]

And I thought the 2016 ticket was too white!

[Mauser]

Amash 2024

[karan98]

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[AuntiE]

I know it has zero to do with Rep. Amash's politics however, someone needs to help him with tie selection.