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Obamacare Repeal, R.I.P.

The short, sad life of a Republican health care bill

Jeff Malet Photography/NewscomJeff Malet Photography/NewscomAfter a protracted battle with politics, Obamacare repeal died swiftly last night due to a policy complication stemming from an issue related to insurance market design. Although supporters had high hopes for the bill, in reality it may never have had a chance. In its life and in its death, it was a testament to Republican incoherence about health care.

The repeal plan, which close associates knew was never really full repeal, began life as a Republican campaign mantra—repeal and replace—which was uttered and promised by nearly every GOP politician for seven years, since the passage of Obamacare in 2010.

It was always more of a slogan than an actual plan: As early as 2011, Republicans promised that a replacement could be expected in short order, but a real candidate never arrived. It wasn't that Republicans and conservative health policy scholars never developed any alternatives. There were op-eds and white papers and even a full-fledged draft of legislation or two. But there was never any consensus on any of these options.

And, more importantly, the party could never settle on any clear systemic goals for health policy. It wasn't like not being able to pick a design for a house. It was more like not knowing whether you want to build a house or a boat or a tractor. The most basic elements of a health care plan were always up in the air.

So when Republicans won control of both chambers of Congress and the White House last year, they were caught unprepared. They admitted as much. "I didn't expect Donald Trump to win, I think most of my colleagues didn't, so we didn't expect to be in this situation," Sen. Pat Toomey said earlier this month, when asked why the health care bill had stalled.

The first version of the bill, the American Health Care Act (AHCA), faced significant reluctance from Republican lawmakers. In March, Speaker of the House Paul Ryan, who had enthusiastically backed the bill, pulled from a floor vote in dramatic fashion, and many assumed that was it was dead. Conservatives, in particular, worried that it was too like Obamacare—a repeal that was really more of a rewrite, perhaps in ways that exacerbated the problems they saw with the existing law. In May, a revised version passed on the slimmest of margins, after much arm-twisting from President Trump.

But even Trump, whose grasp of the health legislation has always been limited, didn't seem too enamored with the bill he urged wary Republicans to pass. Later, he called the bill "mean."

So it was left to the Senate to draw up a plan. The upper chamber initially promised to start fresh, but after weeks of secret meetings the legislation that was released looked a lot like the House bill—except even more like Obamacare. Conservatives senators like Rand Paul and Mike Lee weren't happy with the bill's resemblance to the law it was supposed to replace. Moderates, meanwhile, had concerns of their own, mostly about the rollback of Obamacare's Medicaid expansion. The public wasn't thrilled either; one analysis found that the bill, with 28 percent support, was the most unpopular major legislation in 30 years.

Senate Majority Leader Mitch McConnell tried to address all of these concerns. He revised the bill further to leave some of Obamacare's major taxes in place. He started whispering to moderates that they shouldn't worry about the Medicaid rollback, because it was delayed and would never happen. And, crucially, he included a provision backed by Texas Sen. Ted Cruz that would allow insurers to sell plans that did not comply with Obamacare's regulations, provided they also sold compliant plans. This would have segmented the market, creating cheap plans for healthy people and subsidized and regulated plans for the sick—turning Obamacare into a de facto high risk pool.

But McConnell, under pressure from moderates, altered the Cruz amendment in an obscure and unexpectedly important way: He included a provision required both the Obamacare plans and the non-compliant plans to be in a single risk pool. In other words, it would require an actuarial link between the expensive, regulated plans and the cheap, less comprehensive plans.

After the plan was released, no one was really sure how, or if, the idea would work. Insurance companies said that it simply wouldn't. Actuaries warned that it would destabilize the market. Conservative and libertarian wonks warned that it would raise prices for everyone. Some raised concerns that linking the two types of plans would cause both markets to crash together.

The confusion over the single risk pool was the Republican confusion over health care in distilled form: Conservatives proposed an idea intended to loosen the grip of insurance regulations, but that might have ended up more expensive in the long run. Leadership used that idea, but modified it in a way intended to appease moderates. That modification would have made the provision work at cross-purposes to its original intent, or maybe not at all. It was a compromise that ended up providing nothing for anyone.

And in the end, it was what killed the bill. "The new version still forces insurance companies to follow Obamacare's 'single pool' regulation," Sen. Mike Lee, who had said that the previous iteration was the price of his support, wrote last night, noting that the altered version would cause premiums to rise.

The disagreement over the single pools regulation may seem wonky or obscure, but it represents the whole of GOP disagreement over health care in miniature. Moderates want one thing; conservatives want another; leadership just wants to pass something and doesn't care much what it is—and the result is legislation that doesn't make any sense, as policy or as politics.

Even in defeat, that appears to be the GOP strategy: McConnell has said he plans to resurrect a 2015 bill that garnered a majority of Senate Republicans under President Obama. That bill is being described as a clean repeal, with no replace, but it is almost the exact opposite of a compromise: As a result of Senate procedural requirements, it leaves in place the Obamacare insurance regulations that conservative Republicans oppose, while rolling back the Medicaid expansion that moderates want to preserve even faster than the original Senate bill. (Months ago, Republicans passed on using the 2015 bill as a vehicle because, as one aide said, "We're not dumb.") It is possible though unlikely that this bill will pass. But in any case, it is, as always, a compromise that isn't a compromise.

The GOP health care plan passed from this world on a technicality, but it was afflicted by something deeper—a fundamental lack of vision. It was never more than a hollow campaign promise that many Republicans never really had a plan to execute, and in the end it died as it lived, in confusion and poor repute. R.I.P.

Update: The plan to vote on the 2015 repeal bill now faces three no votes, making it effectively dead. All of the firm objections so far come from moderate Republicans: Susan Collins, Shelley Moore Capito, and Lisa Murkowski.

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  • UnrepentantCurmudgeon||

    So it is now official: the GOP does not know what or who it is as a party, much less what it "thinks" in its majority. In this they are not really different from the Dems, but given the Dems' locked-in populist base it matters far less to them than it does (or should) to the GOP. Here we are with the GOP controlling Congress and the White House and not able to do a damn thing of importance with either.

    I gave up on party politics many years ago. In a way it's refreshing to have my antipathy for the Republicrats proven valid again and again

  • Red Twilight||

    Now it is official?

    You mean you learnt nothing from the trickle down reign of Reagan, the spend like it is fashionable reign of W, and the great repeat of Kansas?

    You are a fucking moron, who will vote straight Republican again.

  • Last of the Shitlords||

    With that analysis I wouldn't be throwing stones.

  • DesigNate||

    You do understand that the problem with Kansas was that they increased spending while cutting taxes, right?

  • Bubba Jones||

    "not able to do a damn thing of importance"

    Why wouldn't I vote for that?

  • Dizzle||

    Lol, you didn't realize this when trump kicked all their candidates asses in the primaries? I think the dismay over trump winning and the shock over their platform falling flat on voters outlined this pretty well 9 months ago.

    Where you been?

  • Hank Phillips||

    The Dems are locked in by CPUSA and Econazi spoiler votes, and have been since the Y2k election. The GOP has been locked in by the Prohibition party since 1928. So... what else is new?
    Party politics works like an acceleration force vector if you vote for a small third party. Our four million libertarian votes times 21 (the clout multiplier based on how the Populist, Socialist and Prohibition parties changed many laws with few votes) yields a number larger than the vote count of either half of the looter kleptocracy. And the LP has changed many laws starting with Roe v. Wade. It takes a mighty poor grasp of arithmetic to throw away votes on lying looters.

  • Tom Bombadil||

    Congress: A confederacy of pussies and cunts.
    I've said it before: 99% of elected politicians are 99% guided by re-election concerns.

  • Tony||

    As long as you end up blaming both parties for the never-ending supply of screwups by Republicans, Republicans count that as a win.

  • Tony||

    Tom is blaming "Congress" for something Republicans alone did. I find it quite relevant to the discussion, because Republicans have long been able to fall back on this strategy. "Government can't do anything right. See, we just proved it! Vote Republican 2018!"

  • BYODB||

    I suppose this makes sense if you start from the assumption that the ACA itself was immaculately conceived.

  • Dillinger||

    the virgin harry.

  • mortiscrum||

    Of course it wasn't. Ironically though, opponents of the bill seem to be holding it to a standard appropriate for a bill that IS immaculately conceived. The bill is massive and attempts to change an incredibly complex, hodge-podge of a healthcare system. To what should have been a surprise to no one, it didn't work perfectly from day 1. That's far from a damning indictment of the bill overall.

  • The Last American Hero||

    And what part of it did work?

    It didn't contain, costs, they continue to rise at a blistering pace, bending the cost curve in the wrong direction.

    It didn't make people healthier, lifespans actually declined under the bill.

    It didn't create markets, many areas are now served only by one insurer.

    It didn't insure the uninsured, there are still 20 plus million of them roaming around.

    It didn't ensure a Team Blue Hegemony for a generation, they've lost at every level except in hard core blue enclaves.

    Oh, and there's millions of people that didn't get to "keep their doctor".

  • Dillinger||

    here's a damning indictment of the bill overall.

  • Tony||

    So my post is the irrelevant one even though it's the only one addressing the topic of the article?

  • Last of the Shitlords||

    No, he doesn't. Nor is he intellectually honest with that tiny little nugget of cognition he possesses.

  • Tom Bombadil||

    " Tom is blaming "Congress" for something Republicans alone did."

    I made a general statement about Congress and politicians. It applies to all the tremendous failures I've witnessed in my lifetime including the one under discussion.

    For example, Obamacare is a massive failure that fits the bill that I wouldn't blame on the Republicans.

  • Citizen X - #6||

    Childish partisan non sequiturs are all Tony's got, man.

  • Tom Bombadil||

    " the never-ending supply of screwups by Republicans"

    I've heard stories of the Democrats being dragged kicking and screaming into the welfare state.

  • Tony||

    It is a screwup on their own terms. What are we talking about? Most of the time I'm glad when Republicans screw up.

  • Last of the Shitlords||

    Of course you are Tony. Because you are a communist piece of shit.

  • BYODB||

    Do you know what irony is, Tony?

  • Incomprehensible Bitching||

    I'd blame democrats, but, where are they?

    Winning, that's where!

  • Hank Phillips||

    Remember George Waffen Bush? Son of Holy War Bush? His Richard Nixon and Herbert Hoover imitations wrecked the economy completely, and HANDED two elections to the Dems running a Kenyan! Only their pseudoscientific efforts to ban energy for Gaian Planetary Eugenics provided the suicide vest they wore to defeat in 2016. FDR had way fewer nazi infiltrators to deal with!

  • Mickey Rat||

    The GOP is failing to deal with the awful policy the Democrats imposed on this country through questionably legal parliamentary shenanigans. The GOP is not covering themselves in glory here, but they would not have to if the Dems had not been reckless authoritarian scumbags.

  • Crusty Juggler :)||

    They were elected to fix the Dem mistake, but they are too scared of being called evil, white, murderers, etc, by the Dems and the media, so now they are bungling, incompetent, evil, white, murderers.

  • Red Twilight||

    Yes, both sides do it. 70/99 legislatures are Republican.

  • DesigNate||

    Obamacare is Democrat's screw up.

    I can't believe you continue to defend this blatant handout to Big Insurance. What would Marx think Tony? For shame.

  • Hank Phillips||

    A huge majority of Americans despise the entire Congress. A referendum initiative to unseat or deport the lot of them would be a thing of beauty to watch unfold.

  • Robert||

    Yeah, but they'd replace them with people who'd do the same thing.

  • Robert||

    99% of elected politicians are 99% guided by re-election concerns.


    That's how it's supposed to be. What sense would there be to representative democracy otherwise?

  • Ken Shultz||

    "Moderates want one thing; conservatives want another; leadership just wants to pass something and doesn't care much what it is—and the result is legislation that doesn't make any sense, as policy or as politics."

    Wow, if you weren't paying attention, you might think the AHCA didn't kill the individual mandate, didn't kill the employer mandate, didn't roll back Medicaid eligibility, and didn't (according to the CBO) cut $880 billion in spending over the course of ten years.

    You also might think that the AHCA never passed the House.

    That they're now introducing a resolution to simply repeal the ACA is pure theater, too. If they didn't have the moderate votes necessary to pass the AHCA without getting rid of the ACA's stance on preexisting conditions, why would they have the moderate votes necessary to repeal the ACA, which would get rid of the ACA's popular stance on preexisting conditions?

    One thing I'm sure of after this--Rand Paul is not presidential material. He may be great running opposition to whatever in the Senate, but being president requires something different. If we can't roll back Medicaid eligibility or cut $880 billion from the budget over the course of ten years because of Rand Paul's principles, then he might as well be a progressive on those issues.

  • NotAnotherSkippy||

    Well that would better align him with Pete's progressive tendencies.

    Can't reason afford mccardle? We can let pete get back to his games.

  • Calidissident||

    If you read the article, the "clean repeal" proposed in 2015 didn't actually repeal the regulations, due to Senate procedural requirements.

  • Tom Bombadil||

    Then "clean repeal" is a misnomer.

  • Calidissident||

    True, hence the quotes.

  • Ken Shultz||

    I don't understand what this has to do with killing the AHCA or the bill in the Senate.

  • Tom Bombadil||

    It's just an interesting tangent. These things happen.

  • Calidissident||

    Is it not possible to comment on one part of a post without addressing everything in it? You've made the same arguments about the AHCA 1000 times over the past few months, I have no interest in rehashing that.

  • timbo||

    Why did trump not just say; "pass a bill or go back to the repeals that were passed by the GOP congress and vetoed under Obama"??? that would then put the dems on the hook for the repeal without replace. Also, would call out the swamp dwellers that were just trumpeting at the time.

    If it is going to fail anyway, why volunteer to hang the albatross upon your neck. pols are fucking stupid.

    They are likely dumber than the constituents that believe the government can and should pay for healthcare.

  • The Last American Hero||

    They can't flat out repeal. Team Blue has the votes to hang any repeal. They didn't need to use those tools when Obama was in the White House because they could count on a veto.

    The only thing they can do is use the same Team Blue parlor trick of reconciliation, which limits their options.

  • Last of the Shitlords||

    I would use what authority I did have to make the dems writhe in agony every second, until I could peal enough of them off to fully repeal the thing. But McConnell is completely lacking the balls to go that direction.

  • Robert||

    Team Blue has the votes to hang any repeal.


    Not if the Reds (!) simply change the rules, which they can do with simple majorities. They can simply change the rules to apply just this 1 time if they think that looks better. Is not this issue more important than their rules?

  • BYODB||


    ...in reality it may never have had a chance. In its life and in its death, it was a testament to Republican incoherence about health care.


    No shit. Everyone knew it wasn't going to happen, for one reason or another.


    That being said, I'll still take incoherence over coherent central planning any day of the week.

  • BYODB||


    began life as a Republican campaign mantra—repeal and replace—which was uttered and promised by nearly every GOP politician for seven years, since the passage of Obamacare in 2010.


    I gotta ask, which Republicans have been saying 'Repeal and replace' for 7 years? I didn't hear this until perhaps 2016. If they had been saying that for 7 years, I think we could have expected them not to get a majority.

  • BYODB||

    Nevermind, Suderman did have at least one GOP member saying the word 'replace' in 2011 in the linked article. That's one guy, but it's something. I suspect that was always their 'backroom' opinion on the matter, but until much more recently they seemed to only want to say the word 'repeal'.

    They are snakes, it's true.

  • sarcasmic||

    Got to replace it, dude. I mean, when you remove cancer you've got to replace it with something!

  • mortiscrum||

    yeah, 'cause American healthcare was working so well before the ACA came along.

  • The Last American Hero||

    I would call substantially lower premiums, longer lifespans, and more choice in insurance working better than the current cluster fuck.

  • Citizen X - #6||

    Healthcare was fine. It still mostly is.

    Health insurance has been getting steadily more fucked since 1945, and the ACA aimed to unfuck somehow it by increasing the speed and the depth of the fuckin'.

  • BYODB||

    So you recognize that Government interference in Healthcare for almost the totality of the last century didn't produce good results, and your takeaway from that lesson is 'double down'.

    It is as expected. You are precisely the sort of person who will usher in single-payer, and are a good example of the type of thinking that is leading us to our inevitable end. On one hand, I should thank you because the end can certainly be hastened along and that will probably produce less suffering. On the other, I wonder how someone can be so dense.

  • mortiscrum||

    RE: So you recognize that Government interference in Healthcare for almost the totality of the last century didn't produce good results, and your takeaway from that lesson is 'double down'.

    We all see what we want to see - you look at the unfocused, patchwork development of American healthcare over the last 100 years and conclude that government can't possibly do a decent thing about improving health outcomes. Meanwhile, the entire rest of the world is giving us lots of different examples and techniques, all of it built around "government interference." Not all government interference is built equally.

    In fairness, specifically the AMERICAN government shouldn't be giving anyone a ton of hope on getting this right, considering the history....but 1,000 monkeys on 1,000 typewriters will work out for us eventually.

  • Last of the Shitlords||

    American healthcare worked fine before. It was really just a matter of getting government away from shit so costs would stop rising so fast. In fact, overall, American healthcare capabilities at least were the greatest in the world.

    If you're referring to healthcare INSURANCE COVERAGE, that's a different story. It was still way better than now.

  • Lester224||

    A lot of people had problems getting insurance (especially non-bankrupting insurance) coverage due to "pre-existing conditions" before ACA. That's why the AHCA/Trumpcare had to leave that language in there regardless of whether they really meant it.

  • BYODB||

    The obvious problem, of course, is that a 'pre-existing' condition is impossible to insure because it is a certainty. Insurance is not, never was, and should never be the vehicle for them to do anything. It's a non-sequitur that 'insurance' was ever the method that Democrats thought would be appropriate, especially given that such a requirement for insurance has caused it to fail each and every time it has ever been tried.

    Frankly, there isn't a way for those people to get what people want them to get that doesn't involve their own bank account or charity. They are a certain expenditure that is only going to increase the longer they live. There is no way around reality, but that doesn't stop legislators from trying.

    If everyone who is in favor of giving those people money for their conditions did so directly, it would be a far simpler proposition than trying to create some labyrinth of sticks and carrots that no one will ever understand and will never work well, efficiently, or at all to the effect that it's proponents want it to.

  • mortiscrum||

    RE: The obvious problem, of course, is that a 'pre-existing' condition is impossible to insure because it is a certainty

    If this is the case, I think it begs the question "what's the point of insurance at all?" Is insurance really only suitable for people who are healthy, and will remain so for the foreseeable future? And if THAT is the case, why are we even fucking around with private health insurance at all? It's fundamentally a system built for people who don't need it.

    You're kind of dancing around the issue, but are you advocating for social Darwinism? There is a kind of elegant simplicity in saying "if you're rich, good for you, if you're not, tough titties," but surprisingly, it hasn't really caught on.

  • BYODB||

    It is the way it is, essentially, because of wage control policy during WW2. That's overly simplistic, but it boils down to the free market was abandoned 'because war' and never returned.

    From Wikipedia, because I'm Lazy:


    Employer-sponsored health insurance plans dramatically expanded as a direct result of wage controls imposed by the federal government during World War II. The labor market was tight because of the increased demand for goods and decreased supply of workers during the war. Federally imposed wage and price controls prohibited manufacturers and other employers from raising wages enough to attract workers. When the War Labor Board declared that fringe benefits, such as sick leave and health insurance, did not count as wages for the purpose of wage controls, employers responded with significantly increased offers of fringe benefits, especially health care coverage, to attract workers

    But I'm sure in your view the government will get it right this time, after failing all other times. /sarc

  • BYODB||

    And the reason why you can't insure against certainty is so obvious that it's clear you're an idiot.

    If you are certain to need a thing, it is no longer uncertain and thus it is no longer insurance against a possibility but rather a payment plan in advance of a thing that will happen.

    There is a massive difference in price and cost, but being a fool of course you won't see it.

  • mortiscrum||

    RE: And the reason why you can't insure against certainty is so obvious that it's clear you're an idiot.

    C'mon man, why do you have to assume the worst of me? What you're saying about insurance is not lost on me - heck, I entirely agree with it. But the conclusion I draw after that is that the private market is ill-suited to provide healthcare, absent a framework of government. At the very least, the government needs to provide care/coverage/whateveryouwanttocallit to the proverbial hopeless cases that an insurance framework is a very poor match for.

  • DesigNate||

    Yes, it actually was mortiscum. You'd know that if you weren't a slimy piece of shit like Tony.

  • mortiscrum||

    RE: Yes, it actually was

    A whole lotta people with pre-existing and/or chronic conditions say "no, it wasn't."

  • DesigNate||

    Those people are full of shit. They have the same access to medical care they had before Obamacare (if you can't afford a $6000 deductible, you're just as screwed as you were when you paid for it out of pocket).

    Actually, strike that, they don't because a shit ton of doctors don't take marketplace plans (Blue Advantage HMO, etc.), stopped seeing medicare/medicaid patients altogether, or just retired. And since the AMA helped write the damn bill, there was no reform to the supply of Doctors, or to loosen what RN's are allowed to do with patients.

    Oh, and if you have a pre-existing or chronic illness, what you're looking for is essentially a maintenance plan. Not insurance.

  • mortiscrum||

    RE: Oh, and if you have a pre-existing or chronic illness, what you're looking for is essentially a maintenance plan. Not insurance.

    Read my response to BYODB. When you say this, all I see is a big, fat reason to not rely on the private market for societal healthcare.

  • DesigNate||

    Even if the government controls all of healthcare (socialized medicine) or is the final payer (VA, Medicare), that doesn't change the fact that what you and people with pre-existing or chronic illness are asking for is not insurance.

    And just because someone lacks the imagination of what the market would come up with, doesn't mean it has failed. (Especially when the government has been fucking with the industry for nearly 100 years.)

  • KennethJohnKelly||

    RE: They have the same access to medical care they had before Obamacare (if you can't afford a $6000 deductible, you're just as screwed as you were when you paid for it out of pocket).

    That's nonsense. ACA plans are heavily subsidized by the tax-payer (to the tune of about $40B in 2016). You might object to that on principle, but it's still a good idea to get your facts straight. The ACA added an average of about 7M extra people to the individual market in any given month. Most of those people are in households earning between 100% and 200% of the Federal Poverty Level, and consequently have plans with deductibles in $0 to $500 range, due to the cost-sharing reduction subsidies that Trump is threatening to end. The remainder are generally higher income people with pre-existing conditions and/or high-risk factors (recent cancer survivors for example) who were either locked out or priced out of the pre-ACA market. It's idiotic to pretend that a cancer survivor has no use for health insurance to cover unrelated surgery, or that a type I diabetic has no use for a plan that covers cancer treatment, even if they have to cover the first $6K of expenses themselves.

  • Crusty Juggler :)||

    Everyone knew it wasn't going to happen

    No.

    I'll still take incoherence over coherent central planning any day of the week.

    We will still have "coherent" central planning, and the end game is probably even more central planning.

  • BYODB||

    The Republicans never had the votes, one way or the other. They just don't. Sure, they have a majority, but the 'Republican' party has it's own in-factions that don't really like each other. The writing was on the wall from the start.

    I agree that it appears they're still 'for' central planning, as near as I can tell, just slightly 'less' of it. Not a great choice, obviously.

    I'd rather leave it alone and watch the whole thing burn down. It's the only chance, not guarantee just a chance, that the American people will realize that maybe their government doesn't have all the answers. People are going to die, it's true, but maybe that will be the incentive needed to get the government out of healthcare.

    If the people want to double down on retarded after a lot of people die and care gets significantly worse, well, there isn't anything we can do about that either. As noted many times before, Democracy tends to last up until the point where the populace realizes it can vote itself largesse via the central government. Well, we're there, so...

  • Crusty Juggler :)||

    that will be the incentive needed to get the government out of healthcare.

    And into single payer, because that's what going to happen.

  • Calidissident||

    Yeah, I sadly agree with that. I think it's much more likely people will view any failure as justification for even more government involvement than the opposite.

  • Tony||

    Rejiggering 17% of the American economy is "government involvement" no matter how it's done.

  • MarkLastname||

    Getting the government less involved in 17% of the economy is the idea.

  • DesigNate||

    Tony's so fucking stupid he doesn't understand that nearly half of that 17% is already government involvement. (Which, incidentally puts us in line with government spending in other civilized countries that have universal/state healthcare.)

  • Crusty Juggler :)||

    "We tried and failed so now it's up to you to make your own decisions in a free market" < "let's take even more control and make it fair for everyone."

  • BYODB||


    And into single payer, because that's what going to happen.

    I would feel much worse about that if I wasn't already certain that single payer is an inevitability.

    It's the obvious end-game, unless you pretend that medical legislation isn't increasing every year. Eventually, you regulate it into single payer. It's just the logical progression of what's going on here, and is even the stated end goal of some of the more honest Progressives.

    There is essentially zero talk in Washington of going to any kind of free market system or deregulating. It's all about how they're going to force you to do something. That's the only argument they're having, no matter how much people like Ken want to see some silver lining.

    This battle was lost when 'deregulation' became a code-word for killing people. The rhetoric writes itself, and it's clear 'We the People' are swallowing it hook, line, and sinker.

    Fortunately for us, it seems probable that nothing can or will save Medicaid, Medicare, or Social Security. The implosion is just around the corner now.

  • sarcasmic||

    The implosion has been just around the corner for decades. Just like artificial intelligence and a practical electric car.

  • BYODB||

    When I say 'just around the corner' I actually do mean decades, but there are always options to put it off even longer. All the ways I can think of off-hand have terrible consequences, but that hasn't stopped them from taking those routes before.

  • Last of the Shitlords||

    It needs to be a concentrated effort to ostracize all big government politicians and their supporters. Just like we used to have the Red Scare in the old days. People need to feel a knee jerk cultural revulsion to that shit. Or their won't be enough pressure to force the right kind of change.

  • Red Twilight||

    Well, it is not a choice. Incoherent is what you are

  • Ken Shultz||

    "Everyone knew it wasn't going to happen, for one reason or another."

    There is not force separate from the politicians who wouldn't vote for the bill. Are you suggesting that even if they had voted to repeal and replace ObamaCare, it wouldn't have been repealed and replaced?

    The bill died because Rand Paul and other senators wouldn't vote for it. If they had voted for it, the bill wouldn't have died and ObamaCare would have been repealed and replaced.

  • BYODB||

    Ken, what have I been telling you for months? That it was a doomed endeavor.

    Then you post here and act like it wasn't doomed, and that somehow it's the fault of people who we all knew were not going to vote for the plan. They even literally told the leadership what the plan had to have for them to buy in. Leadership thought they called a bluff, but it turns out it wasn't a bluff at all. Maybe Paul will be ousted, I don't have a crystal ball, but if he is I'll guarantee you that you'll see a lot fewer of those 'good things' you liked in this plan the next go around. It'll probably pass, too, but so what?

    Frankly, every change the Republicans make to the ACA hastens the inevitable move to single payer. I think you must at least recognize that. The Democrats want it, and the so-called 'moderate' Republicans want it. The only people who do not appear to want that are the one's who just killed the bill.

    Notably, those are the people who appear to have a problem with. Interesting.

  • Ken Shultz||

    "Then you post here and act like it wasn't doomed, and that somehow it's the fault of people who we all knew were not going to vote for the plan.

    They came up a couple of Senators short.

    You seem to be describing some supernatural force beyond the senators who refused to vote for it as the main culprit.

    We did not know it was going to come up two Senators short, and since it did, there is no invisible force to blame this on. You blame the senators, like Rand Paul, who refused to vote for it--that's why it wasn't passed.

  • BYODB||

    You didn't know it was going to come up two senators short, when those senators explicitly said what was required for their support and the thing that was required was something the so-called 'moderates' would never agree to in a million years?

    What planet do you live on Ken, and is the weather nice there?

  • Crusty Juggler :)||

    Suderman refuses to mention the important issue, which is that the media lies and is stupid.

  • Tom Bombadil||

    If that is true, then Suderman cannot mention it because he is the media, thus a liar (and stupid).

  • Crusty Juggler :)||

    Exactly.

  • Red Twilight||

    Yes, it is the media's fault that the Republicans cannot get Moran in Kansas to vote for this

  • Last of the Shitlords||

    It's a shitty bill to start with. They need to go with Rand's proposal. If they can't get the votes for that, then those who oppose it are really just Marxist lite when you get down to it.

  • Brandybuck||

    You've got the house, the senate, and the presidency... and you can't fix/repeal a law you campaigned on fixing/repealing? Even when the overwhelming majority of voters wants you do?

    This is why I quit the Republicans. A bunch of jokers.

  • Last of the Shitlords||

    Fix it with the current Senate bill? That thing is more commie bullshit. Get a real bill that isn't GOP ACA and then excoriate anyone who isn't behind it in lockstep as an anti American subversive.

  • Dillinger||

    Idiotas.

  • sarcasmic||

    My first thought was "Damn, my health care costs have eaten up all my raises over the last eight years. Be nice to see some of that on my paycheck."

    Then I reminded myself that these fuckers could screw up a wet dream. Probably would have made it even more expensive.

  • Incomprehensible Bitching||

    I look forward to single payer healthcare.

    Because socialized medicine never acts like an HMO.

  • Red Twilight||

    A public option would be sufficient

  • Incomprehensible Bitching||

    Hear hear! Health Post Office!

  • Last of the Shitlords||

    If they pass that kind of shit I hope to see a second American revolution and watch every one of you fuckers that support that communist shit burn for it.

    That's what it comes down to. If you support communism, or are willing to accept it to avoid actually having to stand up and fight for the republic and the constitution, then you're a worthless traitor, or at least a sympathizer. I would rather die fighting to preserve our constitutional principles than see a totalitarian state run by people like Tony.

  • sarcasmic||

    You won't. The descendants of wild and free people who created this nation are fully domesticated. The blip of liberty that was the American Experiment will be forgotten. And humanity will go back to its default state of slavery.

  • The Last American Hero||

    Death panels for the win!

    Walter Reed for all!!

  • EscherEnigma||

    Go look at the data on what portion of medicare patients eat up what portion of medicare costs.

    Fact is, medicare and Medicaid don't have "death panels", and that contributes to their high costs.

    Private plans do have "death panels", and that's part of what keeps their costs down.

  • BYODB||

    Be specific, what area of a private plan constitutes a 'death panel' to you?

  • EscherEnigma||

    For current plans, I doubt I can be specific enough to satisfy you. They've had to get more subtle after Obamacare.

    But plans before Obamacare? One very specific way was "lifetime benefit caps".

    Face it, any insurer that wants to be profitable needs a mechanism to cut off people that are too costly. It's basic math.

  • lap83||

    That bill is being described as a clean repeal, with no replace, but it is almost the exact opposite of a compromise: As a result of Senate procedural requirements, it leaves in place the Obamacare insurance regulations that conservative Republicans oppose, while rolling back the Medicaid expansion that moderates want to preserve even faster than the original Senate bill.

    So it leaves them all unhappy. That actually sounds exactly like a compromise.

  • Red Rocks Baiting n Inciting||

    The repeal plan, which close associates knew was never really full repeal, began life as a Republican campaign mantra—repeal and replace—which was uttered and promised by nearly every GOP politician for seven years, since the passage of Obamacare in 2010.

    This is where the GOP really showed how mendacious they are--replace it with what, exactly? None of them could ever provide a coherent explanation, and when it came time to craft their own plan, they showed no ability to spin bullshit into gold because they still haven't grasped the fact that the media hates their guts and won't spin their make-believe the way they would for the Democrats.

    The fact that they never even proposed something ridiculously simple like price transparency, which would probably do more than anything else to increase competition for services, showed they were never very serious about actually enabling measures that would lower the cost of healthcare.

  • sarcasmic||

    Yeah. I can't think of anything else that I purchase where I don't have any fucking clue in the world how much it is going to cost, and no one can give me an answer because they don't know themselves.

    Though I have every incentive to, now that I'm stuck with a catastrophic plan that costs as much as a plan that actually paid for shit. And it's not for lack of trying. Nobody fucking knows.

  • BYODB||

    'Price Transparency' can't exist within the framework that currently exists, so there is that...

  • Red Rocks Baiting n Inciting||

    Sure it can. I hear this excuse from progs all the time, but they can't seem to explain why, in this day and age, a medical practice can't set up a website that lists the services they provide and the cost for it. Shit, if the Oklahoma Surgery Center can do it, why can't every other medical provider?

    the biggest reason "it can't be done" under what we have is because of the very monopolistic behavior that the providers practice. Making sure they operate under a system where they have to set a standard price on their services would go a long way towards eliminating the opaque, exponential pricing system that's in place now.

  • BYODB||


    ...but they can't seem to explain why, in this day and age, a medical practice can't set up a website that lists the services they provide and the cost for it

    Because there is no 'base price', it's a sliding scale based on insurance and a host of other factors that can't be known when looking at a price sheet. So even if you provided such a sheet, it would be grossly inaccurate, which is also why no one generally provides those. People will throw a fit and/or litigate every time you send a bill, and that costs money.

    Now, if your practice straight up doesn't take insurance you can offer such a price sheet and expect it to be reasonably accurate but you'll also not do as much business because everyone wants to use that insurance plan that they are generally, by force of law, forced to carry through their employer.

    Now, if you successfully manage to get very lucky and penetrate about two layers of bureaucrats you might find someone who could actually give you the theoretical 'base' price of a given procedure but I would dare anyone to get that lucky. Even then, that sheet will change. Often. So unsurprisingly even the people who are 'supposed' to know the 'true' price usually don't.

    If you look at a graph that indicates health expenditures, you'll see that things like 'compliance' and other regulatory measures are where hospitals have spent most of those increases. That is where costs are exploding.

  • EscherEnigma||

    "Because there is no 'base price', it's a sliding scale based on insurance and a host of other factors that can't be known when looking at a price sheet."
    That's why you don't give a flat number, you go all statistical and give min, mean max and standard deviation. Graph it as a box-and-whisker plot and folks will understand it easy enough.

    Tack on "this is historical data and is not an estimate or quote" and people can't sue you for not billing them close to the mean.

    As far as lawsuits go? Sorry, but hospitals already are involved in lawsuits when they bill unreasonable amounts. Normally as the plaintiff as they go after folks that can't pay their bills. At least if hospitals were upfront with how much people have historically paid, people that can't afford the bills will know to look elsewhere.

    Face it, the only thing stopping hospitals from doing this sort of thing is themselves. They certainly don't need you playing apologist for them.

  • Ken Shultz||

    The AHCA and Senate bills both repealed the individual mandate, repealed the employer mandate, and cut some 11 million people off of Medicaid and gave them subsidies to buy insurance on the open market instead--much like school vouchers move kids from public schools to private schools.

    If you get your news from Suderman, you may not have seen what this was about--but why limit yourself to that? Because Suderman denigrated the GOP plan doesn't mean there wasn't a plan.

    P.S. Cutting 11 million people off of Medicaid, repealing the individual mandate, repealing the employer mandate, and cutting $880 billion in spending over the course of ten years (according to the CBO) is not ObamaCare rebranded–no matter what Suderman says either.

  • BYODB||

    Except that the Republican plan had absolutely no idea how to handle the fact that guaranteed issue will by necessity kill any insurance market you care to point at, but by focusing on three good things you do manage to slightly deflect from the structural instability of any such plan.

    It also fails to address the very fact that the things that will cause these 'plans' to self-destruct are by far the most popular parts of them. That should give you a momentous amount of pause before endorsing any government plan at all, because they are de facto a ticking time bomb if they at all conform to what people want.

    This is literally each of the major things warned of by critics of democracy coming together into a head. We'll see what happens, but if people really super want a Unicorn it seems that we have admitted that we should at least try to give them a Unicorn. Doesn't matter if they exist.

  • Robert||

    the Republican plan had absolutely no idea how to handle the fact that guaranteed issue will by necessity kill any insurance market you care to point at,


    But so does the status quo, so how are any of the Republican plans any worse? And as the insurance markets die, that gives Congress even more incentive to legislate, which can only be good when momentum is on the deregulatory side.

  • Red Rocks Baiting n Inciting||

    Calling out the GOP for not explaining what "repeal and replace" meant is hardly out of bounds. And their actions on this bill show that they aren't willing to confront the structural problems with the healthcare industry's exponential price growth over the last 35 years or so head-on.

  • BYODB||

    And, more to the point, they don't have enough of a majority to confront any of those problems realistically and no Democrats are willing to help fix those glaring problems. So, in other words, nothing will be passed. This is somehow a surprise to people.

    This isn't meant to imply that if Republicans did have such a majority that they would confront those problems. They would not. They would, however, have just passed this bill. Hell, they probably would have passed the first one. It would allow them to ignore the 'conservative' and/or 'libertarian' part of their party. Nothing more, and probably nothing less.

    It would appear that plenty of people think that is the most desirable outcome here; ignoring the few sane members of the Senate and Congress who might remain.

  • Lester224||

    Enabling measures that would lower the cost of healthcare would offend the lobbyists and contributors they need to stay in office.

  • Maven Houlihan||

    "an issue related to insurance market design"

    How about not trying to design the market and let it do it's thing.

  • Red Twilight||

    Yeah, like let Tesla sell cars in Tejas.

    And the market is really doing its (or it's) thing in Kansas.

  • The Last American Hero||

    The objections of libertarians to Tesla have nothing to do with car dealerships and everything to do with Musk feeding at the public trough.

    And yes, the market is doing its thing in Kansas, as elsewhere. People are making choices about trade offs.

  • Tom Bombadil||

    A bare minimum to be taken seriously here is being able to choose "its" where appropriate.

  • ||

    Obama gets the last laugh. Good job you cucks.

    The Democrats pushed this monstrosity without a single GOP vote and despite all the tough talk they're just a bunch of 'Fredos.

  • Red Twilight||

    Yes, because now people will know that Obamacare was created by Obama and he totally owns it. Up until now, this was not clear.

    LOL at you morons!

  • The Last American Hero||

    If they fail to do anything about it in the next 12 months, they own it in the eyes of the public.

  • Tom Bombadil||

    Obamacare is entirely a Democrat shitshow.

    Only by passing Obamacare 2.0 do the Repubs get painted with it.

    Aside from repealing it, the best outcome for the Repubs is to not try to tweek it at all.

  • ||

    That pos Gruber is actually claiming premiums have gone up under the....GOP.

    Get ready for the left spinning the shitshow as if it's all the fault of the GOP.

    Slimy losers.

  • Robespierre Josef Stalin||

    Winning.

    Jesus Christ, was there anything that the Republicans campaigned on that wasn't complete horseshit?

  • Bubba Jones||

    Gorsuch

  • ||

    The mere fact he turned the left into unhinged morons is more than enough for me.

    Not only that, we also discovered Reason isn't all that into libertarianism anymore.

  • Last of the Shitlords||

    Punch and pie at their receptions.

  • Red Twilight||

    Any policy can be improved. When the wingnuts recognize this and improve the ACA, you will have better healthcare.

    This is not a pile of legos, where you do not like what you see, you tear it all down and rebuild something else.

    The ACA did not do that, and it used other models. The next thing after ACA should take the same approach. Like one would in a business. After all conservatives are all too fond of running government like a business. Fix incrementally, and you'll get something better. You only start from scratch abandoning everything when you are in a startup.

  • MarkLastname||

    IOW, if I season a turd enough you'll eat it?

  • DesigNate||

    Just an FYI, since you obviously don't know: Obamacare didn't do a goddamn thing to improve medical care. It did however, expand Medicaid and the possibility that people could get insurance (you know, if you can afford the premiums and your house payment).

    But please, keep pretending that it did anything but fuck a huge chunk of middle class people.

  • Dillinger||

    These people are not qualified to regulate insurance markets.

  • The Last American Hero||

    I would argue nobody is.

  • Dillinger||

    Word.

  • blondrealist||

    Meanwhile, the USA continues to spend far more per capita on health care than the rest of the developed world.

    Let's see - we could change the system and have one risk pool, where pretty much every citizen pays. It's called single-payer.

    People with employer provided health insurance mostly don't want to give up their tax subsidized benefit - and they certainly don't want a true free market in health insurance or health care.

    Seniors age 65 and older are generally pleased with Medicare - which is a single-payer hybrid.

    I know - Libertarians want the freedom to not buy insurance. A lot of Libertarians would probably chose - if it were possible - not to have any of their tax dollars go to the defense budget or public schools or public infrastructure (like roads) either - but hey, that's not a choice - and for the benefit of our overall living standards and security - we all do chip in for that stuff.

    I love the idea of a much smaller federal government. it's just that when it comes to health insurance - the free market falls short. As I've said several times on these comment sections - we have not had a free market for health insurance or health care since WWII.

  • Lester224||

    May I mention that lots of diabetics aren't fat? Some just have bad genetics.

  • Tom Bombadil||

    You're still Leslie to me.

  • blondrealist||

    Yeah, I understand not wanting to pay for health insurance for people that make bad lifestyle choices - like those fat diabetics - especially the fat diabetics that smoke!

    Let's assume that Medicare went away tomorrow and seniors age 65 and older were on their own. Wonder what the insurance industry would come up with for them......I can't even guess what the "risk pool' premium would come to for that population. $50,000 a year? More?

    Insurance companies have no interest in signing up unprofitable customers. If you're fortunate enough to become "old" one day - remember that the odds of you being a bad risk for insurers are pretty much a sure thing.

    Single-payer would free much of our population from job lock. We all know people who keep jobs they hate because they don't want to lose the insurance - and this was especially true before the ACA due to pre-existing condtions -which the individual insurance market wanted to avoid (and not just for the chronically ill).

  • Bubba Jones||

    We probably spend more on iTunes per capita than the rest of the developed world, so I'm not sure that's the right metric.

  • NotAnotherSkippy||

    VA for all! What could go wrong?

  • blondrealist||

    I put the VA in the "socialized medicine" category - where the doctors and hospital staff are government employees. I would prefer that doctors remain in private practice and that hospitals compete -as they do now. Single-payer replaces the insurance companies - and let's us all pick, choose, and fire our doctors if we want. Yes - single payer means price controls We have that now - even with employer provide health plans. Those doctors in the approved networks all negotiate with the insurance companies and agree to the fee schedules. Medicare obviously relies on price controls. I live in Florida - which if jammed with Medicare patients. The doctors and hospitals seem to be doing okay.

  • Brian||

    blonderealist:
    "...but hey, that's not a choice..."

    You'll have a great point, just as soon as you show me that whatever system we have is dictated by what you choose.

    Go.

  • Red Rocks Baiting n Inciting||

    I know - Libertarians want the freedom to not buy insurance.

    I'd like the freedom to not buy an insurance plan that covers birth control I don't need.

    As I've said several times on these comment sections - we have not had a free market for health insurance or health care since WWII.

    Yes, but Medicare and Medicaid have made the problem worse. Just because oldsters love Medicare doesn't mean it's a sustainable program. The feds have been spending over $1 trillion a year on Medicare and Medicaid services for several years now, and it's not going down. That's a structural problem in the entire industry, not a shortage of government-subsidized payments.

  • DesigNate||

    It's pretty hard for the market to do anything,b> if it hasn't been free in almost 100 years.

  • DesigNate||

    Stupid tags.

    Also, it would have been awesome if Obamacare hadn't said that my wife's plan from her part time job didn't qualify anymore. Too bad the company had to drop it and said "Fuck me, these mandated plans are hella expensive! Sorry part time employees, no insurance for you anymore."

    But please, keep telling me how I think.

  • blondrealist||

    Meanwhile, the USA continues to spend far more per capita on health care than the rest of the developed world.

    Let's see - we could change the system and have one risk pool, where pretty much every citizen pays. It's called single-payer.

    People with employer provided health insurance mostly don't want to give up their tax subsidized benefit - and they certainly don't want a true free market in health insurance or health care.

    Seniors age 65 and older are generally pleased with Medicare - which is a single-payer hybrid.

    I know - Libertarians want the freedom to not buy insurance. A lot of Libertarians would probably chose - if it were possible - not to have any of their tax dollars go to the defense budget or public schools or public infrastructure (like roads) either - but hey, that's not a choice - and for the benefit of our overall living standards and security - we all do chip in for that stuff.

    I love the idea of a much smaller federal government. it's just that when it comes to health insurance - the free market falls short. As I've said several times on these comment sections - we have not had a free market for health insurance or health care since WWII.

  • blondrealist||

    Meanwhile, the USA continues to spend far more per capita on health care than the rest of the developed world.

    Let's see - we could change the system and have one risk pool, where pretty much every citizen pays. It's called single-payer.

    People with employer provided health insurance mostly don't want to give up their tax subsidized benefit - and they certainly don't want a true free market in health insurance or health care.

    Seniors age 65 and older are generally pleased with Medicare - which is a single-payer hybrid.

    I know - Libertarians want the freedom to not buy insurance. A lot of Libertarians would probably chose - if it were possible - not to have any of their tax dollars go to the defense budget or public schools or public infrastructure (like roads) either - but hey, that's not a choice - and for the benefit of our overall living standards and security - we all do chip in for that stuff.

    I love the idea of a much smaller federal government. it's just that when it comes to health insurance - the free market falls short. As I've said several times on these comment sections - we have not had a free market for health insurance or health care since WWII.

  • Loss of Reason||

    Well Blond, you must love your point since you posted it 3 times.

    As for the free market falls short in healthcare - no. You haven't shown a single bit of info. You are right, we spend more per capita than the rest of the developed world. We also have the shortest weight times, the most available medicine and the most doctors. Did I miss what tax benefit I get for employer provided health insurance? I still have 1500 ded and can't write it off on taxes.

    I can give you a person example for Russia. They have public health care and private. My girlfriend's mother just got sick. They took her to the public health care. I asked her what was wrong with that. She said that most of the time they don't have meds, they don't have IVs, and they don't do anything because they are under staffed. She wanted to pay to go to a private hospital (Yes, this was an emergency).

    In Canada, simple operations are delayed 6 or more months. You do realize most health care in Europe is rationalized right? Let's bring that here!

    Yes, health care is expensive, but it's expensive because the government is in the way and because it's so easy to sue (Malpractice insurance are insane).

  • Tom Bombadil||

    I have a Canadian friend whose hip was fucked. He needed a hip replacement. The national health services said "we'll call you". They finally called him after a 2 year wait. Put a price on that.

  • Bubba Jones||

    Coworker's mom is on an 8 month waiting list in Canada.

    Well, that's what they say at the beginning of the wait...

  • blondrealist||

    Sorry for the duplicates. We don't have the shortest wait times for many services - but we do for major surgery - if the patient has insurance. We don't have the most practicing physicians per capita - Denmark, Switzerland, France, Germany, Israel, Italy, Norway, Sweden all have more (by a good margin) per 1,000 of population than the USA. Cherry picking sad stories of wait times in Canada, etc. does not hold much water for me. Our system has plenty of sad stories too.

    As great as our system can be- we don't rank very high in overall outcomes. Some of that is cultural, related to diet, etc. How about mortality amenable to health care (deaths per 100,000 of population)? We don't win that comparison - we're behind the UK, Sweden, Norway, Germany, France....you get the idea.

    You are missing the tax benefit you get from employer provided insurance. The employer writes off the cost of your premium -but you have no tax liability for that part of your compensation. The portion of the premium you pay, including the dependent coverage (if applicable) is deducted pre-tax.

  • Azathoth!!||

    The US has the highest life expectancy and lowest infant mortality--when controlled for non-medical factors and disparate definitions of 'live birth'.

    We have much better medical outcomes--most of our elevated 'mortality rates' stem from having more auto accidents, higher crime rates and other factors that do not show when speaking of general medical care. Our cancer survival rate is the highest in the world. Our transplant survival rate is the highest in the world. Our extreme premature birth survival rate is the highest in the world--which leads to our infant mortality rate. Ours appears higher because we have a much more expansive idea of 'viability'. Nearly all of our 'high' infant mortality rate is comprised of infants that would be considered simple miscarriages in the rest of the world--and thereby not counted in with the infant mortality rate.

    We also have the shortest wait times overall.

  • Sevo||

    "Meanwhile, the USA continues to spend far more per capita on health care than the rest of the developed world."

    Pretty sure our housing costs are among the highest also.

  • Ron||

    Republican as stupid as democrats or they are all just theater. thats the two choices they get and neither bods well for them

  • Azathoth!!||

    Why is this so hard?

    Repeal Obamacare.

    Remove the artificial limitations on how many doctors we graduate every year.

    Pass tort reform--loser pays.

    Restructure health insurance along the same lines as auto insurance.

    Retain Medicaid and Medicare as supplements.

    Done.

  • BYODB||


    Remove the artificial limitations on how many doctors we graduate every year.

    Congrats, you're one of the only people I've seen around here mention the supply side of health care and how it's been fucked for years.

  • Hank Phillips||

    True dat; socialized prohibitionist medicine is the kleptocracy choice. And it's another reason christianofascists fueled by Big Pharma want enemy status for communist Cuba. Cuba trains lots of doctors and always has. Excluding them by coercion meant more medical corpsmen to patch up communist fighters in Angola and Latin America. Prohibitionism, with the gunfights it makes inevitable, provides a ready underground market for physicians eager to help the injured. What sort of doctor would you rather have slicing into your own body? a cartel-forming lard-ass opposed to competition, or a non-hypocritical Hippocratic oath-taker?

  • DesigNate||

    To be fair, a lot of us take it as a given that it goes without saying. You'll usually see someone throw it in Tony or mtrueman's face every once in a while.

  • Azathoth!!||

    If you've ever worked in the field you know that this is the real problem.

    Talk about barriers to entrance.

    There are quotas on how many pre-med slots there are, quotas on med school slots, an extremely long period of study--with not as much actual training as one would think*, quotas on graduates, artificially limited internship slots--it just goes on and on.

    *Training--consider that a doctor deals with a single species of patient and then compare their time training to a veterinarian--who deals with multiple species of patient--including moving from mammal to bird, to reptile, to fish, to, in some cases, insect.

  • Stormy Dragon||

    PS - Shelley Moore (R-WV), Susan Collins (R-ME), and Lisa Murkowski (R-AK) have all issued statements today that they won't vote for repeal only, so that's dead now too.

  • ||

    Then to the woodchippers with them.

  • john_nantz||

    I have to say, I'm getting tired of Peter Suderman's health insurance commentary. Does he even have a libertarian perspective on these issues? If so, he seems to be great at hiding it.

    Yes, politics is messy. That's not an interesting point requiring years of articles. Social Security was messy (does Peter know the history of Social Security or how incoherent that bill was?) as was the Great Society legislation. That's politics. So to say that this bill is particularly messy or not ideal or fails free-market perfection etc. is simply to state a political truism.

    If the GOP does not pass a bill, then we are left with the ACA. Does Peter support that or not? If so, why; if not, why not? Does this bill represent progress given Reason's values or no?

    I have no idea because Peter so rarely comments on hard issues. Instead, we are left with a sort of "this is messy ... they don't know what they're doing ... the GOP is dumb" ... schtick which gets Peter great coverage on left-leaning media (hmmm ... wonder why? "Hey look, here's my libertarian friend who also doesn't want Obamacare repealed because it's so bad ... and doesn't seem to think through whether leaving Obamacare as-is would be better or worse ... let's get him on Charlie Rose!") but gives Reason's readers no insight into the messy options available to the country and our political class. The GOP is wrestling with the messiness of actual reform; the fact that Peter so rarely does is not impressive.

  • marshaul||

    "The GOP is wrestling with the messiness of actual reform"

    The brave heroes!

    But seriously, from your post one might conclude that any good news story, in your view, must do one of two things: 1. Tell you how to think, or 2. Be GOP apologia.

  • DesigNate||

    In his defense, he's not wrong about Suderman.

  • Longtail||

    A free market healthcare would involve competitive pricing which you will never see in America. You will never be told what a health service costs until you get the bill. That hasn't changed in 100 years. trying to inject capitalism into people's health is just going to result in more deaths and more profits.

  • Sevo||

    "...trying to inject capitalism into people's health is just going to result in more deaths and more profits."

    New lefty imbecile on site!

  • Flinch||

    The 'never Trump' crowd hiding within the establishment GOP aside, there is one thing that should be perfectly clear: congress is unqualified (at any speed) to shape, run, or design out nations health care without respect to party - both bands of buffoons have tried and failed to deliver anything better than dog squeeze wrapped in gold foil.
    We need straight up repeal, and beyond that congress can shove off.

  • marshaul||

    Really, we should just repeal congress. And never replace it.

  • David B.||

    See my other comment. They are actually the real libertarian party. They can't do it because it would ruin our country.... fucking ignorant assholes get to vote too

  • Hank Phillips||

    Further proof that the Republican and Democratic parties are the same damn thing. Both want cops to shoot your dog and daughter over plants; both want men with guns to forfeiture-confiscate homes and bank accounts until the economy again collapses, and both see in the political state a fountain of paychecks for cronies and a hand in the till for themselves. The ONLY difference is that the Dems in their platform seek to ban electricity and fuel, and God's Own Prohibitionists want to keep energy safe and legal in theirs. That single issue elected the real estate developer and defeated the female candidate.

  • David B.||

    Republicans won't just repeal it because that would mean they have to do some impossible work.... it's infinitely more difficult to defend free markets than promise free shit like the socialist party. If the Republicans get slaughtered in an election then this country will be a socialist utopia and likely a war zone

  • ||

    Dr. Jerry Pournelle recently went on a righteous rant against these cowards. They don't want to be the majority party because now the fucksticks have to work. They really are a batch of spineless pussies.

  • TGoodchild||

    How do you like your politicians? Evil, corrupt, idiotic, incompetent, or all of the above?

  • ||

    The Republicans are the Banana Splits. I am guessing they are fighting who gets to be the leader Fleegle.

  • Robert||

    I liked each of the Republican bills. I also knew anything that would be seriously considered by the Republicans in Congress would be better than the status quo. It still would be. Pass something, dammit! And get momentum back on your side by doing so.

  • Robert||

    What are they trying to do, get people like me to put on so much pressure that they could bundle their bill w extermination camps & we'd still be for it? At some point we'd no longer entertain their efforts.

  • Robert||

    What's the worst case scenario here? That the health insurance biz ceases to exist. But doctors won't go out of biz. We'll get taken care of somehow.

  • Douglas Proudfoot||

    The way to go was the original Cruz Amendment. People need an escape path from Obamacare. The Cruz Amendment allowed any company who sold Obamacare compliant policies to sell non compliant policies as well. It was a way to give people more choices. The moderates chickened out because the Congressional Budget Office estimate 18 million people would lose coverage.

    The CBO estimated Obamacare would be a net plus to the US Treasury.Their prediction was not directionally accurate. Obamacare was a huge net expense.This time liberals are saying the CBO estimate of 18 million people losing their health insurance is rock solid? Judging by last time, 18 million people may gain coverage. CBO estimates are LOL inaccurate every time. It would be idiotic to believe any CBO estimates.

    The CBO assumes that the free market does not react to tax and regulation changes. We know it does. The original Cruz Amendment would have allowed any insurance company that sold Obamacare policies to sell health care policies that do not conform to the Obamacare rules. If the Cruz Amendment was passed, lots of people would buy non conforming health insurance because these policies could be offered at half the cost of Obamacare policies.This would at least make the lost coverage numbers far less than the CBO estimates. It could arguably increase coverage if enough people aren't buying policies because they can wait until they get sick to buy a policy under the "must cover pre existing conditions rule."

  • loveconstitution1789||

    Repealing ObamaCare is the only good solution.

  • tlapp||

    Well now those that want freedom to choose on healthcare should know better than to elect democrats or any of the republican establishment. Politicians from both sides that believe in individual freedom are a very rare species.

  • Stanllow||

    Repealing ObamaCare will hurt millions of Americans. However, the president has his constitutional rights.

  • pedz||

    Remember when Obamacare was being introduced? The claim was that millions would lose their health care.

    I find it funny odd that that argument is never mentioned in the process of repealing Obamacare. Funny odd because it isn't a scare tactic. It seems like hysterical scare tactics statistics are the only things ever mentioned today.

  • SEO Consultant||

    We can only wait to see what happens in the days to come. Trump is bent on repealing Obamacare

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