Capitol Hill Blue Forums Political Issues Politics In General GOP at war with itself on health care

I believe that Trump just wanted to get rid of Obamacare because it was a major accomplishment of that black guy. Trump was not involved in drafting the promised "improvement" of the healthcare plan and it met none of his campaign promises. He handed it off to Sphincter Speaker of the House, Paul Ryan, who created it in his own draconian image. The far right hated it because it wasn't draconian enough. Moderates and Democrats hated it because it would have cost people more and insure fewer people. Those brave enough to have town-hall meetings realized it could cost them their jobs if they voted for it. Trump did not even know what was in it and did not work to help get it passed. He did NOT leave it all on the field as his fawning sycophants claim.

I think he left just enough out to step on it.

I have always been of the opinion, that the main motivation of most of the teaparty rabble was anti-Obama racism with just enough "fiscal conservatism" thrown in to poorly hide the racist intent and appear "patriotic". We are now able to see that hypothesis tested, by removing the black president variable. Suddenly much of the middle class working class is supportive of Obamacare with self interest trumping the residual racism associated with the name Obamacare.

I think that the teaparty, now Freedumb party in the house are misreading their current voting population, either intentionally or by mistake. We know they are avoiding town meetings like the plague. I think many of those house right wingnuts may be true believers in small gubment, and also basically racist, but I think that they have a dwindling constituency. The midterms may tell, particularly if purrceptive "moderate" GOPs start to "primary" them. Sauce for the goose seems appropriate. I hope they enjoy the basting.. How are those poor teaparty types going to mobilize the "one issue" racist voters now?
Stay tuned experiment in progress.
Tat

The rather stunning thing is how little Trump seems to care exactly what got passed. Not a thing in the bill agreed with his campaign or even later promises. I know he wouldn't read the whole bill, but couldn't he have somebody read him a one page synopsis? What's his daughter doing in that office? Can't she look out for him so he doesn't completely ignore the people who voted for him?

The health care insurance system he promised was very popular. Why couldn't he see that this was not that? Facts matter. Is he going to do the same thing on the next big issue? Most Presidents have a staff that guides everything coming out of the White House (including from the President) to a consistent platform first outlined in campaign positions. I think this President needs that more than most.

I disagree. The shortest path to impeachment/resignation is to continue the course he has set for himself. In his campaign he endorsed what sounded like single payer, everyone is insured for lower rates and better coverage. The clumsily assembled Ryancare plan he later backed was nothing short of a massive tax break for the wealthy with nothing in it really addressing health care.

PIA:: here is my spitballing on multiple approaches to HC.

First the decision has to be whether we want everyone (true universal coverage) or optimal coverage. The reason is someone has to pay for it. Of course we could just raise taxes but that obfuscates the underlying problem of what services do we want government to provide and who is going to pay for it. Absolutely no one wants to pay for hiways, what do you think they want to do with HC?

Optimalization is my choice because I believe costs can be managed and as in all things government there will be some losers. We can always work on the small subset to try and bring them onboard.

The equation is maximize coverage with acceptable costs and most importantly from a government perspective, bend the curve of rising HC cost drivers. I suspect the solution to this equation requires a single pool, not multiple pools of varying risks. Insurance is always a hedge against the worst outcomes. Not everyone views this gamble the same, but if it is to work, the pool has to be large and inclusive.

maybe you have a counter argument?

Mr. Porter...The ACA did raise taxes but they did it in a minimally invasive way. Optimization would simply be to adjust those taxes and to tweak the existing program.
What we have seen is that people like to be insured. Even Republicans. Once they get used to having coverage they don't like to give it up. One of the eventual tweaks to the system would be to eventually allow younger healthier people an opportunity to buy into the Medicare system, hopefully phasing more and more into it until it became a nationwide single payer system. Medicaid would also be phased into Medicare with state and federal funds used to finance those who simply can't afford coverage.

Larger pools, lower costs.

There are solutions out there, and they are not that complicated. I'm a big believer in a "public option". It would be especially effective in rural markets - where Republican voters live. Opposition to a public option is not fiscal, it's philosophical. During the development of the ACA, the public option was in the bill to the end. The Origins And Demise Of The Public Option. The CBO scored it as saving up to $110 billion over 10 years.

How to fix Medicare the right way.

A bigger problem, in the long run, is the shortage of primary care providers. This issue, again, is particularly acute in rural America. What the Primary Care Physician Shortage Means for Health Plans. As that article notes, this is not an issue of lack of insurance, but lack of providers.

There are many ideas and lots of information and data in the cited articles. I'd encourage the reading. Also, How Do We Get More Doctors Interested in Becoming Primary Care Physicians?

Greger:: yeah I meant raising direct taxes i.e. x% increase in tax bracket 3. While even moderately intelligent folks will realize an increase is an increase no matter where it comes from, a well disguised tax is optically more palatable.

The concept of pools is interesting as it appears to me what conservatives wanted to do was segregate groups to disguise an idiots legerdemain. With healthy groups premiums would be lower, so it appears the rates have gone down, while in the other hand the high risk pool is paying astronomical rates but they are a minority so all is well. They also argued the actual rates would be lower for the high risk pool because .... well because ... and thus the cost outlay would be smaller. I don;t think that would be the case because .... basic arithmetic. If premium costs are X because HC costs are Y, it does not matter how X is subdivided, the cost will remain the same and in fact may even be higher i.e. the cost of high end care may outstrip the low end premium cost reductions of the low risk pool.

Bottom line, I think the single pool is a better spread.

NWP:: I just listened to Rep Yoho and I have to snicker. This guy has never said anything I thought remotely resembled something intelligent and today is no different but he was far more dense.

He said the HFC could work with Democrats and get stuff done. Now, he looked sober, but that sounded as if he was smoking the wacky weed and had a kumbaya epiphany. It is as you and many others have said, there is a fundamental philosophical difference between the extreme conservatives and everyone else and never the twain shall meet.

But this points out a more revealing reality. No Republican can work with Democrats because of basic conservative theology (get government out). Notice I didn't say it the other way, as I believe Democrats could work with a solution which achieved the desired goal even if a free market solution. The underlying problem is someone has to tell the free market which direction to go.

At some point in time I think a simplification should be introduced to remove employer paid insurance.

Personally, if I was health care czar, I would end every health care program including military and VA, put everybody (including illegals and refugees) into one big pool, and go Canadian-style National Health. I think we have a much bigger pool and way more resources so it would work well. I would also nationalize all the drug companies and medical device manufacturers and make all their employees civil servants.

I would also nationalize all the medical and nursing schools or at least support them with federal dollars so medical training was free but with a service requirement upon graduation. There is no reason we can't train enough students to have adequate numbers of rural GPs. Maybe those will be doing their service requirement, maybe they will be the folks who entered medical school with just an A average instead of A+, maybe they will be mostly PAs.