Obamacare

On Obamacare, Republicans Achieved Nothing

Years of failure to establish a shared health policy vision led to last night's debacle.

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ddp USA/Newscom

In the end, on Obamacare, Republicans accomplished nothing.

Not repeal. Not replace. Not even "skinny repeal"—the hastily constructed package eliminating a handful of discrete provisions from Obamacare that the Senate drafted, debated, and voted on last night. After seven years of promises to repeal and replace, the last-ditch measure failed by a single vote, thanks to a trio of GOP senators, including John McCain, who were worried that if it passed it might actually become law, an outcome that few if any Republicans desired. The health care law will live on, for now.

Last night's legislative denouement mostly served to demonstrate how desperate and confused Republicans are when it comes to health care: Senate Republicans could not come up with any health care legislation that they wanted to pass, so their final push revolved around a plan to vote for legislation that they very much did not want to pass.

Let that sink in for a moment: The final Republican health care plan was to pass legislation that they did not want to become law.

The goal, instead, was to use the skinny repeal bill as a vehicle to move on a conference negotiation with the House, in hopes that some sort of common ground could be found between the two chambers. How exactly this was supposed to succeed where previous efforts failed was never clear. Senate Republicans couldn't come up with a bill on their own; why would adding the House, which is divided by factionalism and internal disagreement, make the process any easier?

It's not just that Republicans didn't have a plan. They didn't even have a plan to come up with a plan.

Part of the problem was a lack of policy leadership. President Trump does not appear to grasp the most basic elements of health care policy, or care about the details of the legislation he signs. He wanted a political win, not policy progress.

And Senate Majority Leader Mitch McConnell wanted to give it to him. McConnell is an effective congressional tactician who understands the legislative process and the pressure points it creates. But he is not a policy visionary, and the evolution of the Senate plans—from repeal and replace to clean repeal to skinny repeal—shows the limits of tactics without strategy.

For the last decade or so, Paul Ryan has served as the party's most prominent policy entrepreneur. But the further he has risen in the party's official ranks, the less effective he has become. Now, as speaker of the House, his main job is to corral the party's many confused and warring factions rather than to make the case for the bigger picture and legislation to support it. The tumult of the Trump presidency has only made this job more difficult.

So even the more detailed legislative plans that the House passed and the Senate published were little more than plans to scale back Obamacare but continue working within its essential framework.

The outcome, splayed out in the news for all to see over the last several months, was that when the party gained power and it finally came time to legislate, debate, and vote, Republicans had no shared vision, and thus no workable plans to achieve it.

The result, in other words, was total failure: to live up to the party's most persistent political promise, to advance the nation's health care policy in meaningful ways, or even to achieve a narrow "win" and move on to something else.

The push to repeal Obamacare may—may—now be over. But health care policy is not going away. Half of the nation's health care spending, give or take, flows through the federal government. The exchanges set up under the health care law are still struggling, and premiums are still rising. Many doctors still reject or limit access for Medicaid beneficiaries, and Medicare is the single largest driver of the nation's long-term budget problems. The good news, which is also the bad news, is that there will be plenty of time and opportunities to address the nation's health care problems in the future.

What Republicans—and Democrats and independents and anyone else interested in a health care system that is more fair, more effective, and less expensive—need to do, then, is what they have largely failed to do for so many years: Start from the ground up, think comprehensively about the health system as a whole, develop a vision, and then debate and defend plans and policies that would bring us closer to it.

Earlier this month in The New York Times, I outlined what such a vision might look like: encouraging supply-side innovations, emphasizing cost reductions instead of subsidies, seeding the idea that insurance is financial protection rather than health care, emphasizing aid to the poor and needy rather than comprehensive universal coverage, focusing on eliminating fragmentation and favoritism in a system that for decades has been defined by it.

This is the health policy long game that Republicans have never bothered to play—and that Democrats who support a larger role for government already are. Single payer, price controls, and more expansive government systems of all kinds are already in the works, especially at the state level. Republicans and others who want to limit the role of government in health care have a lot of catching up to do.

As I wrote in that piece, it won't be quick or easy. But as Republicans have now discovered in such a public and embarrassing fashion, it never is.

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  1. Last night’s legislative denouement mostly served to demonstrate how desperate and confused Republicans are when it comes to health care…

    The Democrats were, as well, but yet somehow they managed to get their lobbyists to cobble together the massive ticking bomb that is Obamacare. And they did it in, what, a year? The GOP couldn’t even manage something in six years.

    1. Democrats took the ideas of conservatives turned into law under the leadership of conservative Gov Mitt Romney and then spent a year on hearings working with Republicans and including 99 Republican amendments into the Senate bill, including insurance plans that have high deductibles to force patients “to have skin in the game” so they aren’t recklessly spending other people’s money.

      And most important, the government does not provide the insurance because for profit private sector insurers will do the job cheaper than government by bargaining with doctors and hospitals and drug companies and restricting payments to only effective treatment.

      Except for the working poor with no employer benefits for which control over health care delivery is turned over to the States because States can come up with innovations like rationing care, death panels, government run hospitals, setting price controls, by way of Medicaid where conservative State elected officials decide how to spend money from Washington.

      What was not done by Democrats is to expand Medicare to everyone in a total government takeover from Washington! Nope, Democrats compromised with Republicans and turned all the health care policy over to either the insurance companies, or to the States, and to individuals.

      1. “…conservative Gov Mitt Romney…”
        When you start with bullshit premises, you’re going to get bullshit results.

    2. And about individual responsibility. Republicans argue individuals must be held responsible. Except, neither individuals nor government has the right to take sacred life to save money. Thus, those who refuse to buy insurance or save but instead party hardy recklessly and end up in a hospital can not be killed by the hospital like Charlie Gard, not can someone who is sick but denied insurance by an insurer save his family money by telling doctors to put him to sleep like a sick pet. But no one can force doctors and hospitals to provide free health care. But government should not pay for health care for reckless irresponsible people who partied away their money.

      So, Republicans and conservatives say individuals must not be required to be responsible, (no mandates), nor held responsible, (no death panels and creative destruction), and no taxes, and no enslavement of doctors.

      As Obama said, starting from scratch, Democratso would simply tax everyone to pay for health care for everyone. But starting from Romneycare which is a Republican implementation of conservative policy, Democrats included every Republican idea that was logically consistent.

      TANSTAAFL

      1. “But starting from Romneycare which is a Republican implementation of conservative policy, Democrats included every Republican idea that was logically consistent.”

        Interesting comments. Is it not true, or very likely that Romney’s and Obama’s laws were written by the same people? I mean people working for the Insurance Lobby among others.

      2. “Except, neither individuals nor government has the right to take sacred life to save money”
        That is what’s known as an assertion masquerading as an argument.
        IOWs, bullshit.

      3. But starting from Romneycare which is a Republican implementation of conservative policy,

        Right, never mind that the Democrat legislature in MA overrode all of Romney’s vetoes on Romneycare, it was all totally the overwhelming number of Republican legislators in MA ramming conservative laws over Democrat objections… right…

  2. Half of the nation’s health care spending, give or take, flows through the federal government.

    And most of the remaining is driven by tax distortions. Won’t go over well on this site – but I think the best next step is give up the pretense that we can nickel-and-dime our way into a ‘free market’ system.

    Let govt take over the whole damn thing. Let it fail where it will and succeed where it will. At least then an alternative to that can be proposed that starts from the comprehensive basis of ‘what do we want health care in the US to look like’

    1. Worked for the VA. Oh wait…

      1. That is just yet more nickel-and-diming and pigeonholing of the system. There is no possibility of a fix when veterans, retirees, disabled, indigent, self-employed, fully-employed, sporadically-employed, children and their mothers while pregnant, etc are all treated as their own separate universe in need of a particular politicized (and my original point was that the ENTIRE system is now totally politicized) solution. At best that is whack-a-mole (since we will spend money on one thing without paying for it).

    2. “Let govt take over the whole damn thing. Let it fail where it will and succeed where it will.”

      In the meantime, I’ll be needing to go to the doctor once in a while.

    3. But that’s the thing – I don’t think there should be any libertarian solution that starts from a grand systemic health care premise. If people don’t want health insurance, they shouldn’t be forced to buy it. If people want to spend enormous amounts on stupid and pointless health insurance they should be allowed to do so. If people want to spend small amounts of money on rather pitiful health insurance they should be free to do so. But all of these solutions will make someone on the left or right mad and upset. I say, fuck ’em all.

      1. I don’t think there should be any libertarian solution that starts from a grand systemic health care premise.

        But the reality is that we are NOT starting from scratch. We HAVE created some ‘public rights to healthcare’ – but are deliberately avoiding paying for them directly. You can’t get rid of or even reform those entitlements without the entire thang being reformed. Stop deluding ourselves that that is possible unless ‘libertarians’ start winning elections on a platform of:
        1. Let people die in the streets
        2. Let the poor go to veterinarians or butchers instead of doctors – or self-medicate with alcohol
        3. Let the over-65’s take care of themselves

        1. We do you mean ‘We’? I have nothing to do with this because there is no right to healthcare. But if you think there is, walk into a doctor’s office and demand to be treated for free, because it’s like a right man…

          You are free to donate your time and serves to others. Have you heard the term ‘private charities?’ No? Look it up. They run more efficiently than gumbermit and their 5 year plan….

          have a nice day, now I’m going to smoke some home grown untaxed and un regulated marijuana — this buds fro you DEA big government thugs ; )

          1. there is no right to healthcare

            You’re wrong. We created all sorts of rights to healthcare. When you turn 65. If you are dying on the street. If you are a child of poor parents. They may be poorly defined and ill-thought-out and aren’t coherent and are unpaid for and all sorts of other problems. But they DO exist unless and until you have the balls to win elections based on your specific promise to REVOKE those rights and revert to something else. Or hey just smoke dope and pretend that wishes are fishes.

            Oh and btw – libertarian ideas actually have a chance of gaining some traction if those who advocate ‘private charity’ as a libertarian solution actually participate in private charitable work. My guess is – you don’t. You’re just an asshole. Which means that everytime you open your mouth and associate yourself as ‘libertarian’, everyone else just hears ‘oh – another one of those assholes’.

            1. JFree|7.28.17 @ 7:22PM|#
              “…We created all sorts of rights to healthcare…”

              We did nothing of the sort; we legislated a entitlement.

              1. That’s what a right is – an entitlement to something.

                1. JFree|7.30.17 @ 12:05PM|#
                  “That’s what a right is – an entitlement to something.”

                  Bullshit.

      2. Fine, if you want a libertarian solution, you must start with repealing EMTALA. Good luck with that!

    4. “”Let govt take over the whole damn thing.””

      Yeah, putting people like Trump and appointees at the HHS in charge of our health care is a brilliant idea.

      1. Well Dems want that outcome – and Reps deserve that outcome – and everyone else long ago expected that outcome and doesn’t care.

        It doesn’t matter if it is a good idea or a bad idea.

    5. In Africa they have no Medicare, no Medicaid, no FDA, no insurance regulators, no HHS, no CMS, no tax advantaged employer health benefits, no VA.

      In Africa, you pay cash, or wait in line for charity care. Mostly charity care from mostly American Christian charities or US rich liberals, or the US and European government and taxpayers.

      So, if the US adopted the free market health care system of Africa, which countries would come to the US to provide free charity medical care?

      1. “So, if the US adopted the free market health care system of Africa, which countries would come to the US to provide free charity medical care?”

        Did you carry that strawman all the way from home or find it on the way?
        You and bullshit are very closely acquainted.

    6. “Let govt take over the whole damn thing.”

      You mean by nationalizing the health insurance system, a al Canadien? Won’t this be quite a challenge given that under the present system, this industry, in private hands, is doing just fine, thank you very much.

      1. Canada is only one model. I am quite specifically NOT advocating a particular model. I am saying that we do at this point need to have SOME imposed model that is at least coherent. Because our current imposed system is an absolute mess of subgroup entitlements and subsidies and impositions and prohibitions. There is no way a true free market in anything can work within that framework. And that mess of subgroups also makes it impossible to even figure out or discuss ‘what is an actual reasonable expectation about healthcare that a human in America can rely on?’. We have the worst of all worlds. Problems that are blamed on a ‘free market’ even though no such thing exists. A divide et impera mindset that only serves partisan politics and cronyism not healthcare. And out-of-control costs that are strangling the economy.

  3. Fuck Dave Weigel, and fuck you too, you fake libertarian turd that should be flushed down a toilet.

    1. I was just about to say that I was wondering if Suderman included the Weigel tweet just to trigger Mike M.

      1. Sadly, it’s never assholes like Suderman who get Seth Rich’ed like they deserve.

        1. If a person disagrees with Simple Mikey, they deserve to be murdered. Good to know.

          1. But remember – the guy wishing murder upon political writers he dislikes is totally the realest, #1 libertarian out there.

            1. He’ll also threaten to beat people up via a mostly-anonymous forum when he knows he’ll never see them in real life, which everyone knows is the hallmark of a brave, intelligent, potent man.

              1. Are you suggesting you’d like to tell us where we can come find you cause I’ll get In on that.

                No games, no posturing.

                You.

                Where and when.

                1. Here’s another one. Sad!

                  1. Right.

                    That’s what I thought.

                    1. “Thought” is not the right word for what you did there.

                    2. Right.

                      That’s what I thought.

                      His point – I think you missed it. Rather glaringly.

                      But indeed you might in fact be able to beat him up, if you met him personally.

                      Which is the important thing, of course, from a libertarian perspective.

                2. Whoa, that escalated quickly.

                  Also, “where we can come find you”? Have the voices in Mikey’s head manifested themselves as another account?

                  1. Mikey is pretty sure everyone else in the comments is either Weigel or me, so i wouldn’t put it past him to start sockin’ up as some form of “self defense.”

                3. All I know for sure is that that Block Yomomma faggot lives in or very close to D.C. And he probably works for the media, probably the Post in all likelihood.

                  And it goes without saying that he couldn’t beat an egg.

    2. Someone needs a nappy change.

    3. If only we had a healthcare system that could provide Mikey the care he needs for his glue-huffing addiction. Alas…

  4. I confess, I am surprised by the utter shamelessness of Republicans over the last 7+ years. They spent enormous amounts of time, money and energy denouncing ObamaCare. And now when they finally arrive at a position where they can make substantive changes to it, they completely whiff.

    1. You mean like the libertarian commitment to lower spending? After all there’s no point in reforming medicaid because that doesn’t fix medicare.

      1. Are you saying your doctor should have his pay cut? What is the maximum pay for doctors and nurses? $10 an hour? $5?

    2. And now when they finally arrive at a position where they can make substantive changes to it, they completely whiff.

      That’s because they never actually understood what was wrong with it. Don’t forget that the two parties were completely reversed in their positions when “Romneycare” was on the table.

      All they know is people are unhappy about Obamacare and expect the Republicans to “do something” about it. That people might just want the government out of healthcare would never in a million years occur to them.

      1. That people might just want the government out of healthcare would never in a million years occur to them.

        That seems to quite demonstrably not what the people want, at least not the bases of the two major parties. The Democratic base wants a fully nationalized, “European-style” system. It’s not clear how many of them know exactly what that means in practice, but it’s what all the right celebrities seem to want, so it must be amazing.

        The Republican base hates Europeans, socialists, and Democrats, but revealed preferences indicate they basically want the exact same thing as the Democrats, just called something else and tailored to exclude transgender individuals and women who want abortions from participating.

        1. I think “most people” aren’t particularly rational – especially political partisans.

          My experience with card-carrying Democrats is that they don’t really know what they want other than they don’t want to pay for their own healthcare, and they want the quality of healthcare that currently exists in this country today.

          They don’t want government mandating what kind of care they can get, or enacting policies that restrict markets and raise prices.

          Thus, they want the benefits of a capitalist system without the costs.

          Republicans seem to want the same things. But mostly partisan Republicans and Democrats want very badly to believe that they disagree with each other absolutely and fundamentally.

          Thus, while people want all the benefits of free market healthcare and all the benefits of government giving them healthcare “for free,” people will get neither one of those things and will blame the Other Party for taking it away from them.

          What I should have said was “that the only way to give people what they want is to get government out of healthcare would never in a million years occur to either Party or their partisan supporters.”

        2. ^This. I think a national health care system is inevitable at this point.

          To be honest, we are pretty much already there, and it’s not just about the ACA. Over a third of the population gets health insurance directly from the government. Many more through direct and indirect subsidies. And there’s a whole bunch of regulation (and not just on insurance) on top of that. The US government spends more per capita and as a % of GDP on health care than any other government in the world. Even adjusting for national health care spending, our government covers about 65% of health care spending – in Canada, a country with full-blown single-payer, that number is about 70% – a mindblowing statistic. Our system may not give everyone insurance, but I don’t think that means it isn’t a national health care system.

          At this point, I just hope that whatever the next evolution is, that it isn’t single-payer. Most European countries actually don’t have single-payer. While I’m not saying these systems are perfect, I’d much prefer something along the lines of Singapore, Switzerland, or the Netherlands than the UK or Canada.

          1. Even adjusting for national health care spending, our government covers about 65% of health care spending – in Canada, a country with full-blown single-payer, that number is about 70% – a mindblowing statistic

            This is what I’m sort of trying to get at above.

            Since both parties are essentially just acting on their own internal agendas, which are actually very similar to one another, what we end up getting in the tug of war between “government funded” and “capitalism” is the government spending just as much as it would with a nationalized system, but without the actual nationalization.

            We wind up with the worst effects of both capitalism and socialism with the benefits of neither.

            1. Agree with your points here and above, thanks for the clarification.

        3. You want the free market health care system of Africa?

          They spend only a few hundred per year per person for health care in Africa. In some places, you must shop for all the supplies needed by surgeons to operate on your child, letting you find the lowest price instead of being charged $100 for two aspirin.

          And no wasted money on fancy hospitals! The shade of a tree is all that’s needed to see patients.

          1. mulp|7.29.17 @ 4:07PM|#
            “You want the free market health care system of Africa?”

            Even MORE bullshit.
            What a fucking asshole.

      2. “That’s because they never actually understood what was wrong with it. Don’t forget that the two parties were completely reversed in their positions when “Romneycare” was on the table.”

        Don’t you need to add the word ‘public’ to the your phrase ‘their positions?’ I’m assuming their private positions remain unchanged.

  5. “This is the health policy long game that Republicans have never bothered to play?and that Democrats who support are larger role for government already are.”

    At this point, I honestly don’t know what a long game for “government isn’t going to pay for all of your stuff” looks like, if that’s even a goal for the Rs.

    While Obamacare continues to gobble up an ever increasing amount of my paycheck, I’ll at least still be able to swing by Facebook and read a heartwarming story from a high school friend who was able to stay home and realize the dream of learning to play guitar because of Obamacare subsidies.

    1. Lol at you idiots thinking the “market” will fix healthcare. Name me a single country. ONE.

      Idiots.

      1. Well, this was certainly a comment.

      2. Let me know when we have price transparency and I’ll let you know when we have an actual market for healthcare.

  6. At this point, I honestly don’t know what a long game for “government isn’t going to pay for all of your stuff” looks like, if that’s even a goal for the Rs.

    It isn’t. The long game appears to be, “Government will pay for all your stuff, provided that you are the ‘right’ kind of person”.

  7. The reason I quit the Republican party was their support for Trump. But shit like this contributed. The party has no interest in governing, to them government is just some grand glorious community theater. There is no sense of an ideology behind the party, just dozens of contradictory coalitions unified only in their hatred of Hillary.

    Not that they Democrats are any better. Their only advantage is that they have the mainstream and offstream media in their corner. And not that the Libertarians are any better. They have an ideology, but would rather engage in purity pogroms than in getting votes. Any candidate without a lower case (i) after their name is a chucklehead not worthy of my attention.

    1. “Well, hello there!” – Bernard Sanders, (I)-Vt.

      1. That’s an upper case (I).

        1. You know that and i know that, but Bernie Sanders isn’t a very smart or observant guy.

        2. Actually and uppercase D

    2. The real problem is that none of them are willing to lose their seats. When Dems rammed Obamacare down everyone’s throats some of them knew they were on a defacto suicide mission. But they treated it like D-Day: they sacrificed for the greater good (of their party) in order to claim territory that ensured a long term victory. They understood, as did Ted Cruz, that it’s nearly impossible to claw back public freebies once they’ve started. “Medicare for all” is less than five years away.

      If any republicans had the same dedication they would have voted to kill Obamacare in its entirety, with no replacement, and let the media go apeshit.

      1. Yep, in 2009, Arlen Specter got in his time machine and became a Democrat swept into Congress on Reagan’s coattails!

        And the Mitt Romney who became a big government liberal was actually an android manufactured by Bill Gates while he held Mitt Romney captive from 2002 to 2006.

  8. Anyone who expected the Republicans to repeal something they promised to repeal while campaigning was clearly not paying attention to all of the other times the Republicans promised to repeal something and then promptly stabbed the chumps who voted for them in the back.

    1. But fairness, it had been like 6-7 years since the last time that happened, and when you’re feeling freshly betrayed by Democrats, where are you going to turn?

      1. But Obamacare was written by Republicans like the skinny bill as a bill they expected Democrats to never pass because it was based on private insurers and conservative State government rationing Medicaid to the poor.

        Democrats instead passed the bill Republicans created with 99 amendments in an evil plan to eliminate every Republican talking point.

        Conservatives say “individual responsibility” and that means a mandate to buy insurance.

        Conservatives say “skin in the game” and “only catastrophic insurance” and you get $5000 deductible policies.

        Conservatives say “give control to the States” and you have Federal funding for State government single payer in Medicaid, and State insurance regulators defining the private insurance policy prices and running the State health insurance marketplaces that are subsidized by the Federal taxpayer.

        If conservatives and Republicans want no government in health care, start shouting “we want African free market health care”.

        1. Is it possible for you to post without lying?

  9. Anyone who expected a politician to repeal something they promised while campaigning was clearly not paying attention to all of the other times politicians promised to repeal something.

    I’ve said for years. If you want to know what a politician won’t do, listen to what they say they will do on the campaign trail.

  10. Omg, I just realized we haven’t heard anything from Ken Schultz today. Has anyone checked to make sure he didn’t hang himself in his room when he heard the news?

    1. He started typing a comment in the Morning Links and he hasn’t finished yet.

    2. He’s trying to figure out how many more dimensions need to be added to the chess board to explain how this is a brilliant, carefully calculated move by the Trump administration.

  11. charlatans.

  12. This is a case of “nothing is better than something”. At least “nothing” leaves open the demand to keep trying, while “something” would allow R’s to pretend they repealed it, and then proceed to do nothing further.
    This ensures that everyone knows that ObamaCare is still law and still needs to be repealed. It leaves the political impetus to repeal it unsatisfied. Which means there will likely be another attempt before year’s end.

    1. This ensures that everyone knows that ObamaCare is still law and still needs to be repealed.

      ^ This.

      Given the direction the Republicans have been taking on this, I hope and pray every day that they continue to fail. Team Blue partisans have already started bitching about what a clusterfuck healthcare is now and are having to be constantly reminded that we haven’t actually touched Obamacare in any way yet

  13. Now I see the democratic strategy use Medicaid for single payer health care. It appears that approach will work given Republicans will not fight this.

    1. I don’t think single payer is going anywhere. It’s been voted down by the people in CA, CO, and VT.

      1. Yeah, but they have to pretend to pay for it. The feds can just write a check and be done.

    2. Now I see the democratic strategy use Medicaid for single payer health care.

      A perfectly fine strategy… if we cut costs to European levels.

  14. This seems like an opportunity for the Libertarian party. The Republicans campaigned on repealing Obamacare for years, and gained a lot of seats doing it. Then, when they finally got the votes, they blew it. Libertarians could benefit by picking up the torch.

    1. Why should voters believe they would do it? Why wouldn’t it go just as it did with the Republicans?

    2. “They” didn’t blow it, McCain was simply being a prick again, the same as always. Neither Trump nor the other Republicans should be blamed for that.

      1. McCain has been a prick for a long time and I’d say the cancer diagnosis explains a lot.
        His stands on various issues have been erratic at best. I thought it was simply a result of dementia; perhaps not.

        1. I’d say the cancer diagnosis explains a lot.

          Unfortunate, glioblastoma can’t explain (or excuse) his past erratic behavior, dishonesty, or disruptiveness.

  15. 1. Trump is not a Republican; he just won on the Republican ballot. Trump is Trump.
    2. We are living in history. We just watched the Republican party die.
    3. When the people who used to be republicans stay home next year, the democrats will take back the legislature, and that may well be the last election ever.

    1. “Longtobefree, saying three serious things and then a joke”

    2. You’re so out of touch with reality, it’s kind of funny.

  16. We wouldn’t be having this discussion if people who voted for clean repeal a few years ago voted once again to repeal it. These people would have changed their tune even if a more conventional republican became president (like Romney).

    I have no idea why some republicans were against repealing the individual and employer mandate. They’re the most unpopular aspects of the law. You can escape the rising premiums (insulated by subsidies anyways) by simply choosing to be uninsured. The CBO estimates that 14-15 million people would drop coverage once the individual mandate goes kaput.

    Repeal the mandates, allow cheaper plans, go with medicaid block grants – that’s 70-80% Obamacare repeal right there.

    1. Simply repealing it doesn’t address the core issue, which is the out-of-control rise in actual costs for healthcare.

      Until we break the AMA’s licensing monopoly, get rid of the various state permitting systems for hospital construction, and make FDA compliance voluntary, repealing Obamacare will simply look like a disaster caused by the Republicans.

  17. I’m in favor of Congress never achieving anything, so maybe this is a good first step.

  18. The mistake was to try to combine repeal and replacement into one bill. That was never going to be possible, not just politically, but because there is no replacement that can work. It is little wonder that members of Congress can’t agree on one. It does not exist, at least not something that can get by the ACA stakeholders, the insurance companies and the medical providers.

    The ACA was never to provide care to the ill. It was to funnel money to the stakeholders. Now we will see the debacle of the insurance companies dropping out and the medical providers going bankrupt.

    One of the reforms needed is to repeal the Emergency Medical Treatment and Labor Act (EMTALA). Hospitals need to be able to turn away patients who can pay for treatment. That seems harsh, but it is necessary.

    1. Not remove the EMTALA, reform it.
      Have the hospital ER treat and then have FEDGOV pay for the entire process – not have the hospital “eat” the cost.
      Then make it a debt to the patient that they can never rid themselves of, especially through bankruptcy and have the IRS collect as if it was unpaid taxes.
      That should provide incentive to the deadbeats, who are relying on free care if the worst should happen, to get and keep catastrophic insurance.
      It’s not everything, but it’s a start.

      1. No, replace EMTALA with a death panel law!

        If a patient is brought to the ER without money or insurance, then the hospital uses creative destruction, just like tow truck and mechanics do? Can’t pay for the work on your car, your care is killed and chopped up and the parts sold to people with money. Lots of wealthy people are waiting for organ transplants, so if a young “”party hardy instead of buy insurance” needs an operation to survive an accident, the hospital should put him “to sleep like an injured pet” and his organs sold for transplants.

        Free market creative destruction of sick and injured people just like for wrecked cars, or for cars with blown engines after 60,000 miles. (New cars come with maintenance insurance – if the engine turns out to be defective, ie, experiences a health problem, then the warranty insurance pays to repair it.)

        1. “the hospital should put him “to sleep like an injured pet” and his organs sold for transplants.”

          Great plan, but I see one flaw. You want doctors to put the deadbeat to sleep? Haven’t they got better things to do, as in saving lives? I say transfer him to the local prison and have the guards do it.

        2. mulp|7.29.17 @ 4:40PM|#
          How is someone so stupid capable of breathing?

        3. then the hospital uses creative destruction, just like tow truck and mechanics do? Can’t pay for the work on your car, your care is killed and chopped up and the parts sold to people with money.

          Uh, this doesn’t actually happen anymore, and it’s precisely because price transparency was enforced in the repair business. The mechanic gives you an estimate and you decide whether they will do the work. Many of them even have price lists displayed for basic services.

          Where is this in the healthcare industry?

    2. Not repeal EMTALA, reform it.
      Have the hospital ER treat the patient and then FEDGOV picks up the entire tab, instead of having the hospital get everyone else to pay.
      Then give the patient a bill that is owed to FEDGOV, that, like a student loan, cannot be discharged in bankruptcy.
      Make the IRS the debt-collector as though this was a bill for unpaid taxes.
      That should give the deadbeats incentive to get catastrophic insurance.

      1. “Have the hospital ER treat the patient and then FEDGOV picks up the entire tab, instead of having the hospital get everyone else to pay.”

        I’d rather the hospital distribute the cost as best it guesses it can.
        Pretty sure that’s ten times better than letting, oh, Pelosi get a chance to effect the result.
        As a civilized society, we do not want kids and grandma dying on the street. The EMTALA let the local parties make the choice where to recover the costs absent the ‘Secretary of Recovering Emergency Room Costs’ and the attendant bureaucracy.

  19. On the contrary. The GOP Estblishment proved that they are politically and morally bankrupt, and do not care at all about the GOP grassroots, who voted their presidential candidates down in almostst every primary and caucus last year by at least a three-to-one margin.

    Next year, it will be time for the GOP grassrootss to demonstrate that it does not care about them.

    Everyone who is eligible to vote in a GOP primary or caucus in 2018, do everything you can to vote out RINOs and vote in Constitutionalist, and then vote out Democrats and vote in Republicans in November.

    I mean YOU, dear reader. What can YOU do? Well, do it. This matters.

  20. This is a great comeuppance for the GOP, because ObamaRomneyHeritageCare *is* their plan. The beauty of all this is that whenever someone complains about the problems with ORHC, the Democrats can simply say that Medicare-For-All will apply a permanent fix to the problem.

    1. Bullshit. Scumbag Romney’s commie crap was confined to Massachusetts — which, in case you haven’t been paying attention, is basically a communist state.

      1. But Mitt Romney ran for governor and did health care reform in order to run in 2008 for president on the platform he can deliver a bipartisan health care reform for the entire nation that was in crisis from exploding health insurance costs and employers being forced to change insurers and pay premiums twice of three times as high just because one worker got cancer or an employee had a premature child that cost a million dollars before leaving the hospital.

        The crisis while Bush was president was employers were seeing health care costs explode and small businesses were having their insurance cancelled all the time because one employee or their family had big medical bills.

        That has been largely fixed by Obamacare because just as Romneycare did, employers were freed from doctors and hospitals jacking up bills to pay for uninsured individuals without employer or government insurers paying their bills.

        1. Fuck off. We have plenty of stupid here already.

    2. the Democrats can simply say that Medicare-For-All will apply a permanent fix to the problem

      It’s a great permanent fix… as soon as we lower our per-patient Medicare spending to that of other single payer systems. Cutting Medicare by 50-70% should do the trick.

      I’m all for it, since doing so would require no new taxes and it would require doing nothing to the existing private insurance system.

      What we can’t do, and what no other nation does, is pay US private insurance rates to providers as part of a single payer public insurance system. That’s the corrupt crony capitalist system Democrats are pushing for, and it simply can’t work.

  21. Nobody knew healthcare could be so complicated.

    1. Health care isn’t complicated. The temper tantrums of Democrats, special interests, and big donors over taking away their government handouts are complicated.

  22. It may ultimately be physicians and other providers who simply refuse to be made de factor government employees.

    But don’t hold your breath. Today’s residents barely understand the issue. Physician is still a prestigious career, and the title “doctor” still carries some weight. They can still specialize enough to recoup the massive expenditure of their education, which is coupled with the forfeiture of the 20s (into the mid-30s, depending on specialty) as earning years.

    But if physicians fail to prevent the total takeover of their trade by the state- and I believe they will ultimately fail- that will no longer be the case. When that happens- when you tell somebody to go through undergrad, med school, a five year surgical residency, and a fellowship- so that they can make a government salary, you will no longer want to have surgery in the States.

    There will be rationing. You WILL wait two years to have your gallbladder taken out by a 4th year supervised by grumpy attending who regards you as a waste of his time. You WILL be told that you don’t really need that elective procedure/treatment/QOL-enhancer.

    It will happen if we go down this road. If OCare fails, do we really think people are going to demand free-market solutions and reform? No, they will demand that government DO SOMETHING, and our Mitch McConnells will gladly oblige.

    Fuck.

    1. That’s funny, I don’t remember petroleum’s having been nationalized in the USA after the oil crises. Instead, they repealed controls.

    2. So, you believe doctors want to try to collect medical bills from patients with no health insurance and no income or money?

      In your theory, Africa with no government health care insurance nor promotion of employer health benefits has five times the number of doctors per 100,000 as the US does because more doctors are free to collect money from Africans to get rich like in the few doctors in the US get rich from the government restricting the supply of government.

      1. In your theory, Africa with no government health care insurance

        Funny how healthcare started becoming more expensive here after the government implemented Medicare and Medicaid.

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  24. These gutless Republican turds make me want to puke.

    Those spineless maggots should man up, throw out this Senate 60-vote bullshit (the demoscum would have done it by now), kill OFascistCare, then boldly pass simple free-market health care legislation that BEGINS WITH selling insurance across state lines and MANDATING that insurance companies, hospitals, doctors, testing laboratories and drug makers PUBLISH rate schedules of ALL their charges.

    This fascist nanny government forces restaurants and food processors to label (read that PUBLISH) calorie counts and other nonsense, so why shouldn’t it force those concerns to publish their prices?

    How do you kill OFascistCare? Easy… You do it by passing a bill containing a single sentence: “The Affordable Care Act is hereby repealed.”

    You’re too gutless to repeal the socialist/commie idiocy? Okay, let it stand but shut off all its sugar-tit funding, pass legislation creating all the above and let OFascistCare compete with it.

    The former communist mongrel-in-chief’s idiocy will be history in less than six months.

    Could any of that happen? No. Because politicians are gutless scum of the earth.

  25. Part of the problem was a lack of policy leadership. President Trump does not appear to grasp the most basic elements of health care policy, or care about the details of the legislation he signs.

    So, just like Obama, Hillary, Bush, and all the other presidents and presidential hopefuls, then?

    He wanted a political win, not policy progress.

    Good! As a libertarian I also don’t want “policy progress”, I want “policy reduction”.

    In fact, a big advantage of Trump is that he isn’t passing a lot of legislation: he didn’t set out to do so, and the few things he wanted to passed are tied up in Congress, as predicted.

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  27. What they were supposed to do is what they promised. Repeal the massive pile of shit. And the reason they didn’t is not because of Republicans, it’s because of that lying piece of shit Democrat, John McCain.

    1. Just like “Democrat” Republican Sen Arlen Specter?

  28. Yes the Republicans did achieve something: they’ve exposed themselves to more conservative voters, as a bunch of RINOs that say they’re for free markets and repealing Obamacare but don’t vote that way.

    Face it, they say conservative things to get elected. But then vote for government control of markets because they want the campaign cash it generates from the rich looking for government favors. Politicians that support free markets, like the Freedom Caucus (only 31 of the 240 GOP House members) don’t get money from the rich who want to buy government favors. And the rich look carefully at how these RINOs vote.

    You can’t cover people with expensive pre-existing conditions and keep premiums low. Universal care will just create a two-tier system as Dr. Jeffrey Singer has written in Reason. But worse, it will stop innovation because innovators will need to payoff politicians to displace the existing providers who get the money now. That makes investing in medical innovation politically risky, rather than just a risky economic investment.

    1. So, you believe in medical creative destruction, treating patients just like cars. When no one can or will pay for fixing the car, or the patient, the mechanic or doctor kills the car, or patient, and then the body parts are sold to people who need replacement body parts?

      After all, no young healthy people become old and sick because the young and healthy put a bullet in their brain at a age 26 so they never get old and remain forever young.

      1. mulp|7.29.17 @ 5:15PM|#
        “So, you believe in medical creative destruction, treating patients just like cars”

        No.
        Just those whose death would improve the average IQ of humanity.
        Like you, you imbecile.

      2. When no one can or will pay for fixing the car, or the patient, the mechanic or doctor kills the car, or patient, and then the body parts are sold to people who need replacement body parts?

        Shitthatdoesnthappen.txt

        1. Red Rocks, you might have missed this near the top:

          mulp|7.29.17 @ 3:52PM|#
          “…Except, neither individuals nor government has the right to take sacred life to save money….”

          Note that by this assertion, which the nitwit presumes is an argument, a single terminally ill person has claim to the entire wealth of the world.
          We are dealing with the newest lefty twit dumb enough to believe his brand of bullshit or hoping we’re dumb enough to accept it as valid.
          I see the belt doesn’t go through the loop on the right….

    2. You can’t cover people with expensive pre-existing conditions and keep premiums low.

      Well since pre-existing conditions also tend to lead to people not being able to work because of disability – and ensure that they have no bargaining power individually either; then there is no possibility that they can be expected to cover the costs on their own. Either because their income will be erratic or because they will get screwed by the more powerful market player.

      So the only solution is to a)tell them to eff off and ultimately die or b)pay for their care via taxes rather than ‘insurance’. I have yet to meet anyone other than an asshole who accepts the former. And Americans simply refuse to accept the latter even for those whose care is paid for by govt. We have this fixation about ‘insurance’ as a way of paying for healthcare. When it would be much easier to pay via taxes – and in so doing also create a different way of paying for and rationing actual care and thus reducing costs.

  29. Why does no one every mention the health care system in Canada? Canada is the not only our nearest neighbor geographically but the most similar culturally. (as a Californian I feel more in common with Canadians in Alberta than Americans Mississippi!). Every single one of the dozens of my Canadian friends and acquaintances love their single payer system. I personally know of Americans who live near the border who use Canada for cheaper better, health services not to mention drugs. Despite the name Reason many readers here are apparently like Trump immune to objective facts but here perhaps foolishly are some anyway:
    Life expectancy Canada: 82.14 years, USA: 78.74
    Infant mortality Canada 4.6, USA: 5.8

    1. Why does no one every mention the health care system in Canada?

      Because we’ve had plenty of Canadian commenters here who’ve told us about the wait times.

    2. “Canada is the not only our nearest neighbor geographically but the most similar culturally. (as a Californian I feel more in common with Canadians in Alberta than Americans Mississippi!).”
      I live in CA and I’d guess I feel more in common with those who live in Mississippi than urban CA socialists.

      “Every single one of the dozens of my Canadian friends and acquaintances love their single payer system. I personally know of Americans who live near the border who use Canada for cheaper better, health services not to mention drugs.”
      Every single one of my Canadian friends sings the glories of the health plan, but can’t seem to find their way to the airport to go back there. And our Canadian MD friend admits you’d better get in line the minute you nick your finger, or you are not going to get care.

      Funny, that:
      “The average life expectancy in Canada overall is 80.7 years old. For women it is 82,9 years old, while it is 78,3 for men.”
      http://www.answers.com/Q/What_is_the_….._in_canada
      Which is irrelevant besides; how did the deaths occur?
      I’m calling bullshit on a typical CA lefty.

    3. rfb99|7.29.17 @ 8:32PM|#
      “…I personally know of Americans who live near the border who use Canada for cheaper better, health services…”

      Uh, Rufus?
      I was given to understand you had to be registered in the province to get medical care under CDN law, excepting emergencies for travelers.

      1. As someone who lives in Alberta (and was educated in California), I can comment on this.
        1. To get non-emergency treatment in Alberta, you need to show your Alberta Health Card. This is the first question asked when you go for treatment. So it is false that you can go get treatment in Canada.

        2. Waiting times are very long. I spent more than a year waiting to get a corrective surgery for a urological issue several years ago. In early July, I went to see my GP about a torn ligament in my ring finger of my right hand. The GP was able to see me in two days from my call. But the specialist will see me on Sept. 26. That is more than a two month wait. According to the Fraser Institute: “The median wait time in Canada in 2016 was 20 weeks?the longest ever recorded?and more than double the 9.3 weeks Canadians waited in 1993, when the Fraser Institute began tracking wait times for medically necessary elective treatments.” (see “Waiting your Turn” at https://www.fraserinstitute.org)

        3. I have a colleague at work who had hip problems. His wait time was similar to my own. So he went to Phoenix to get the hip replacement done for $20,000 US. This is not an uncommon experience.

        4. “Tony” who like “mulp” infects this site with his drivel called me a liar about my wait time when I posted about it a few weeks ago. Tony: my appointment is at Banff Hospital at 8am on the 26th of September. You are welcome to come and verify.

        1. So it looks like a pretty sure bet that the entire post is either cherry-picked (life expectancy), or flat out bullshit.
          Well, imagine a lefty bullshitting!

    4. Canada and UK are actually pretty good (others like France and Australia are better though) for the majority of people who are healthy. Because they ration and thus overall costs are relatively low. By the same token, they are not very good for people who are sick – because they ration.

      So the question is – do we want a health system that is better for the people who are healthy and paying for everything – or a system that is better for the sick and spending. Its not actually an easy question. And the US is clearly designed for the sick and spending – and screw the healthy.

      Personally I would like to see a rebalance towards the healthy and cost-control – but that means honesty whenever ‘death panels’, ‘dying in the waiting room’, etc rear their heads in the discussion. And Americans are the least publicly honest people in the world.

      1. That whole post and it’s logic completely ignores what no one is actually trying…free market health care. Are you really resigned to the idea that government should have control and it’s just a matter of which way it swings? The problem with rationing and the healthy people that pay getting all the benefits is in those countries, most everyone becomes a ward of the state at some point and healthy tend to get sick as they age.

        It’s more like the rationing systems are built for the young and healthy. Enjoy it while you’ve got it and resign yourself to an old age or pain and misery as the government denies care you’ve been paying for your whole life. Good times!

        There’s one problem with health care. It’s the government thinking they can manage it. They can’t and any attempt always winds up in rationing, higher costs or poor care…or all of the above.

  30. What the republicans achieved is to prove to the world that they are completely and totally incapable of governing.
    Which defines 2017 as the official beginning of the collapse of the United States of America.

    1. implying that the progressive dems are capable? that’s cute.

  31. The fund-raised for seven years, and gained control of all aspects of government.

    That is all they got, which is a LOT

    1. You lost, loser.
      Fuck off.

  32. At this point, I honestly don’t know what a long game for “government isn’t going to pay for all of your stuff” looks like, if that’s even a goal for the Rs.

    It isn’t. The long game appears to be, “Government will pay for all your stuff, provided that you are the ‘right’ kind of person”.

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  35. At least Dems have the guts to shove something down the nation’s throat. The GOP is so busy stumbling over themselves in some vain attempt to please everyone, especially special interests and the media, I’m not surprised they couldn’t muster the votes to pass anything. They talked a good game when they has absolute certainty POTUS would veto anything they passed but now when they have the numbers on their side, they’re all running for cover.

  36. simple question – where were all the 20M ‘people dying in the streets’ before Obamacare? Answer: they weren’t. Government need to get the fuck out of the healthcare system and let market forces work as intended. Don’t tell me that’s what we had before because we didn’t. The gov’t set payment schedules through Medicare and tort laws forced doctors to run endless unnecessary tests to cya. The market never had a chance to prove itself. We can devise a simple system to cover the poor so long as we don’t define poor in too broad of terms so everyone qualifies for it.

    Some of the 20M left to die – which is a fallacy on the face of it – don’t want insurance in the first place.

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