Friday, March 24, 2017

Healthcare Plan Pulled

CNN Healthcare Plan Pulled

Here is what our new friend had to add.
"...and the bill goes down in flames.
It's amusing to watch people who hate government fail at governing."
Anonymoose
At G2A Healthcare Bill Fate Uncertain, I proposed that  the GOP has a much bigger challenge since they don't believe in robbing Peter to pay Paul...  Where as the Dems have no moral concern with mauling Paul and taking his money...

Thoughts?

51 comments:

Anonymous said...

Since Trumpcare would have taken health insurance away from 24 million Americans in order to fund tax cuts for wealthy Republican donors, it's really a question of robbing Paul to pay Peter.

Republicans have never been able to grasp the idea of insurance which is in it's essence of form of wealth redistribution. As Paul Ryan famously observed, "Why should healthy people pay for sick people?"

--Hiram

jerrye92002 said...

I do have to find major fault with the GOP on this one. They are hiding cowardice behind complexity, when the solution is simple.

You pass full repeal in the House, it goes to the Senate and passes by reconciliation because it was passed as a "comprehensive" bill-- it did not even contain the usual "severability clause" allowing the remainder to stand if one part was overruled by the courts-- and as a whole it has "budgetary impact." Done.

But there would be two additional provisions added. The first is that those with Obamacare policies can keep them; "if you like your (Obamacare) plan you can keep your plan." NOBODY loses their insurance so that isn't an argument against. The second is that Congress MUST-- by overriding Obama's Executive Order to the contrary-- no longer be exempt from the mandate to be covered by Obamacare. Their staffs cannot afford it, and thus Democrats AND Republicans have a tremendous incentive to pass a "replacement" plan that lets them, and everybody else, choose insurance plans they like. Done right, people will abandon Obamacare in droves and it will die a natural death without anybody "losing coverage."

Done. Simple.

John said...

Hiram,
You would be correct if Paul had done anything to earn that money/service. But he did not.

If you disagree, what do you think the Paul's have done to earn that money/service?

Jerry,
Unfortunately keeping ACA involves keeping the tax increases and subsidies they pay for, and the GOP folks really want to undo those.

As I keep saying... This is not a healthcare policy issue, it is a "how do low income people afford to pay for health insurance"?

G2A Healthcare Right or Privilege?

Anonymous said...

What I haven't been able to figure out is why people are surprised that an anti government is unable to govern.

--Hiram

Anonymous said...

This is not a healthcare policy issue,

When I am asked why the Republican Party, which after all is the party of business, governs so atrociously, one of my responses is that it's because they don't see any connection between policy and how to pay for it. With respect to health care policy, they really, and truly and very genuinely, see no connection between health care, and health insurance.

--Hiram

Anonymous said...

John, people deserve health care because they are people. It's really quite simple.

Anonymoose

John said...

Anonymoose,
That is an excellent opinion.

- Now what level of care do people living on American soil deserve just for living here?

- Who is obligated to pay for this care?

- Should the level of care vary depending factors?

- Should the maximum allowed expenditure vary depending on factors?

- If so, what factors?

Anonymous said...

- Now what level of care do people living on American soil deserve just for living here?

Good care.

- Who is obligated to pay for this care?

People living in America

- Should the level of care vary depending factors

No.

--Hiram

Laurie said...

John's questions actually make sense to me. I support single payer medicare for all, but it would not cover every possible procedure for everyone no matter how old or how close to death. People who care nothing about cost and want this type of policy could buy a supplemental policy.
My govt provided policy would have some limits to keep costs down. I am not knowledgeable to say exactly what they would be. My cost limiting proposal would necessarily be complex.

Laurie said...

Under my proposal the rich, with their supplemental policy, might have access to more care and more choices and more costly care than someone who does not buy a supplemental policy.

John said...

Along those lines...

The Atlantic: German vs US Plans

John said...

Interesting thought. The best systems are in much smaller countries. Maybe we can shrink the US, make it much more homogeneous and reduce our large population of illegal residents???


BI 16 Best Systems

John said...

Hiram, Please be more specific...

"Who is obligated to pay for this care? People living in America"

How does this work in your plan?

Remember that this seems to be the real sticking point...

jerrye92002 said...

"how do low income people afford to pay for health insurance"?

You do realize that about 90% of the "newly insured" under Obamacare simply signed up for Medicaid? And that many were already eligible, without the expansion?

John said...

ACA Facts

"10.8 million more enrolled in Medicaid or CHIP since Oct 2013 (estimated at 11.7 million as of May 2015). Not all who enrolled were ineligible before the ACA but instead enrolled due to the woodworking effect (increased awareness under the ACA leading to more sign-ups). Uninsured rates dropped lower in states that expanded Medicaid."

The reality is that the subsidies gave a nice gradual way to wean off of Medicaid. When an individual no longer qualified for medicaid they still got some assistance. And as they become more successful the assistance went away.

It is too bad that the moderate Dems and GOP won't work together to fix ACA...

jerrye92002 said...

The ACA was never intended to "work" and there is no "fix." It wasn't possible for it to work because nobody in the world, not even 535 geniuses in Congress, can craft a health care system that did all of the things promised, for all 300 million of us. For example, of the 45 million /supposedly/ uninsured, only about 1/4 of them now have insurance. Most of those were those who took Medicaid or lost the plan they liked and wanted to keep and got "dumped" on Obamacare. And there doesn't seem to be any "weaning" off of Obamacare other than the fact that the premiums and deductibles are going up so fast it is basically UNaffordable. And "uninsured" was never the issue anyway. The issue was health CARE, and the ACA didn't do a thing to increase the amount available or the efficiency of it. In fact the ACA made both things worse.

John said...

I think Hiram left this comment for you...

"When I am asked why the Republican Party, which after all is the party of business, governs so atrociously, one of my responses is that it's because they don't see any connection between policy and how to pay for it. With respect to health care policy, they really, and truly and very genuinely, see no connection between health care, and health insurance."

--Hiram

John said...

From me...

Apparently many people are growing to appreciate ACA now that they have seen one possible alternative... :-)

Isn't that timely, ironic and amusing.

John said...

And even Kansas is now thinking about expanding Medicaid.

Anonymous said...

Obamacare was always popular when individual elements of it were polled, or as long as it wasn't called "Obamacare". Even now, Republicans want to retain the most popular, and most expensive features of the ACA. There focus is on eliminating the means by which we pay for them.

--Hiram

jerrye92002 said...

I think we should have free automobile insurance for everybody. Whaddya think?

John said...

Or from your view we should let everyone decide if they want to carry auto insurance, how much and what type??? And let people drive without a license???

I think I would avoid the auto insurance arguments...

Anonymous said...

I think we should have free automobile insurance for everybody.

We shouldn't have to provide auto insurance for people without autos, should as I very strongly believe that we shouldn't provide health insurance for people without health.

--Hiram

Anonymous said...

"When I am asked why the Republican Party, which after all is the party of business, governs so atrociously, one of my responses is that it's because they don't see any connection between policy and how to pay for it. With respect to health care policy, they really, and truly and very genuinely, see no connection between health care, and health insurance."

It is very strange to me. Republicans really don't see a connection between policy and how to pay for it. Republicans are just as strongly supportive of insuring pre-existing conditions as they are opposed to establishing any means for paying for it. This disconnect between policy and cost is why Republicans so often go broke, e.g. Donald Trump.

--Hiram

jerrye92002 said...

Explain to me why the government should mandate that I carry auto insurance, what that will consist of and what it will cost? Why should I not be given the choice of choosing insurance that I want, need and can afford? Should the government tell me I should have collision, comprehensive, $500,000 liability, major medical, road service? Should I pay the same whether my teenage son drives the car or I have caused multiple accidents? Can I wait to buy it until after the crash? Should the taxpayers subsidize my car insurance?

Sean said...

Broadly speaking, this is what happens when you have a President who doesn't understand policy. President Trump didn't particularly care what was included in his health care bill, other than it could pass and be marketed as "repeal and replace". As such, he gave up all of his leverage to negotiate because he had no firm principle on which to stand other than he wanted a bill to sign in some form. House Republicans, on the other hand, had real policy concerns that had to be weighed against one another.

Anonymous said...

Explain to me why the government should mandate that I carry auto insurance, what that will consist of and what it will cost

It's because you engage in risky behavior so the policy is, you should assume the costs of that risky behavior.

--Hiram

Anonymous said...

It's sort of like when Republicans complain that Democrats didn't read the Affordable Care Act. Say what you will, reading or not reading a bill doesn't make it either better or worse. I assume all Republicans everywhere read President Trump's health care bill and yet it was still a lousy bill.

Republicans couldn't repeal and replace Obamacare, because Obamacare is essentially a Republican approach to health care issues. The main, if maybe not the only alternative, is a Democratic bill. Ironically, Mr. Trump is now blaming Democrats for the failure of his health care bill. In some ways, this makes a certain amount of sense. We are the party of government, and anyone who wants government to work, has to come to us. And, of course, since we want government to work, we are open to deals, and dealmaking is Trump's strength. But the problem is basic to dealmaking theory. Trump doesn't have the power to make a deal with Democrats. He knows, as we know, that any deal he makes with us will be rejected by his own party and his own party has the votes to reject any deal. So there just isn't any point to negotiating with Trump, more's the pity.

--Hiram

jerrye92002 said...

"you should assume the costs of that risky behavior" EXACTLY. If I only drive six blocks to church on Sundays, why should government mandate that I buy auto insurance the same as some drunken teenage hotrodder?

jerrye92002 said...

I still think it all comes down to policy. Republicans SHOULD have drafted the best possible "repeal and reform" bill they could, and made it simple enough anybody could understand it, and then DARE the Democrats to vote against it. If it's defeated they can pin the failure on Democrats, and if it succeeds Republicans get the credit. That should be the extent of the political posturing. Unfortunately the bill was "compromised" with political considerations and wasn't good policy. Hopefully somebody will come along with something more straightforward, simple and effective before O'care collapses of its own dead weight.

Anonymous said...

why should government mandate that I buy auto insurance the same as some drunken teenage hotrodder?

Because you choose to drive.

Those who choose not to live, like non-drivers, don't have to buy insurance.

--Hiram

Anonymous said...

I still think it all comes down to policy. Republicans SHOULD have drafted the best possible "repeal and reform" bill they could, and made it simple enough anybody could understand it, and then DARE the Democrats to vote against it.

One of my favorite things to say, is that things don't get simpler, because simplicity doesn't have a constituency. It's people who want to make things more complicated that hire lobbyists.

Health insurance could be a lot simpler, but the simpler alternatives are deep into the Democratic zone of policy. Single payer would be simpler. But that doesn't happen because too many powerful constituencies would be hurt.

Trump and the Republicans could really put Democrats on the spot, but that simply is out of the question given their internal politics. Republicans really were in the power position when Obamacare was enacted which is why it looks so much like a Republican plan, with it's 50 state markets and what not. And the problems Obamacare has are Republican problems which basically have to do with the fact that sometimes markets just don't work very well.

--Hiram

Anonymous said...

People want simplicity, but they are reluctant to pay for it. This time of year, I like to talk about the complexity of tax returns. Taxes are too complicated, right? But I propose a thought experiment. Measure the time you are doing the things that cost you tax dollars and then measure the time you do things that save you tax dollars. What you will find, I think is the first, fastest and most expensive thing you do, is put down your income. Just about everything you do after that are the complications, but they just about all reduce your tax bill. So when people say, less make taxes less complicated, that can only mean giving up complications and complications reduce your taxes.

It really comes down to this. Would you prefer a simpler tax form, if it means, as it does, you would pay more in taxes?

--Hiram

Anonymous said...

why should government mandate that I buy auto insurance the same as some drunken teenage hotrodder?

Of course, bad drivers often find themselves paying more in car insurance. Should that be the case with bad livers? Or people who have bad livers? That's a political question, at least in part. My answer is for the most part, no, because things work better with a no answer. By dividing up the insurance pool, we are raising costs, and creating political division. The fact is, the most expensive thing we do in the health area is grow older, and unlike driving drunk, growing older isn't a choice. There is, for example, no incentive we can offer to people it to stay young.

What I think is ridiculous is a lot of old people complain about this. Why should 60 year old ugly guy be paying for maternity benefits he will never use? What that guy fails to understand is that he is getting the better of the deal, because his medical expenses even without maternity benefits are going to be much higher than the young guy's. Bear in mind that under TrumpCare, it was the older pre Medicare individuals which would have suffered the huge increase in insurance costs, savings that would have gone to fund someone else's tax cuts.

--Hiram

jerrye92002 said...

"So when people say, less[sic] make taxes less complicated, that can only mean giving up complications and complications reduce your taxes."

That is the common perception, that everybody gets these "deductions" that reduce their taxes, but that everybody else is using "loopholes" and not "paying their fair share. The solution for this is simplicity.

My preferred tax reform is the FAIR tax, the result of which would be that NOBODY would file a tax return, and everybody would pay the exact same rate on retail purchases from disposable income. Perfectly fair, simple, everybody can understand it and it shows up at the checkout stand.

It is the same thing with healthcare. We simply allow insurance companies to sell any sort of insurance plan they like, at whatever price they like, so long as there is full disclosure of the coverages (and preferably comparison to other plans-- an "exchange" of the kind that already exists for Medicare supplemental policies). Government subsidies should be limited to block grants to the states to subsidize their own individual Medicaid programs. From the government standpoint, nothing could be simpler, and everybody could understand that if they wanted health insurance, they could buy it, either privately or from government, what it would cost and what it would cover, and they could simply choose what suited them, rather than what suited some far-off bureaucrat.



jerrye92002 said...

"By dividing up the insurance pool, we are raising costs,…"

I hear that sort of logic all the time, but where it does not make sense is that all a larger pool does is to spread the risk. So as a result, the young and healthy pay more so that the old and sick can pay less. But why should they? The risk exists where the risk exists and the cost of covering that risk should be borne by those people. That way, everyone receives "good value" from the money they spend on insurance. The "pool" for the old and sick still spreads the risk, but the average risk is higher and therefore the premiums are higher. We have not raised the total cost of all premiums, we have simply allocated that to those sub- pools where the risk is highest and lowered it for everybody else.

John said...

Jerry,
The answers to your questions are very simple.

We should force people to carry the appropriate insurance to protect others and the state from financial loss. Auto liability insurance protects the other drivers and the public from a driver doing more damage than they can afford to pay for.

That little old lady who drives a short distance can turn in front of another car just as easily driving 1 mile as driving 100...

Since we have agreed to not let people die... Citizens who choose to not purchase adequate health insurance are a huge potential liability to the tax payers.

So like with driving, people should be forced to maintain an appropriate health insurance policy. And yes the state needs to set base policy reqts because people almost always underestimate their risk and the potential costs.

As Hiram noted maternity coverage cost is nothing compared to open heart surgery, cancer treatments, low term care due to stroke and the dozens of other things that can happen to old men and/or women.

Anonymous said...

We should force people to carry the appropriate insurance to protect others and the state from financial loss.

How does that apply to health insurance. Given that we are not the sort of society that allows people to die in the streets for lack of health care, how do we protect ourselves from losses generated by people who are uninsured?

--Hiram

John said...

Let me repeat...

"So like with driving, people should be forced to maintain an appropriate health insurance policy. And yes the state needs to set base policy reqts because people almost always underestimate their risk and the potential costs."

jerrye92002 said...

When we discuss welfare, John, you are always concerned about people being "irresponsible." Now, when it comes to health insurance or auto insurance, you demand that the Almighty State dictate that they be forced to pick what the Almighty State determines is an "appropriate" insurance policy. Yes, the State does command that everyone carry liability insurance, to "protect others." But you also carry "uninsured motorist" coverage, do you not? The State does NOT command you to carry collision, comprehensive, road service, etc. because those are things you should be allowed to decide if you want, need, can afford, right? So why should the State dictate that the old bachelor farmer need maternity coverage, or the Adventist preacher pay for drug treatment?

The problem with your false choice scenario-- Obamacare or "let people die"-- is that Obamacare does absolutely nothing to affect the availability or quality of health CARE, except to, in the real world, make it LESS available and LESS effective. Just like in the case of driving, where we would be better off educating the public on avoiding driving risks and letting them make their own decisions on how to pay for it.

jerrye92002 said...

"Citizens who choose to not purchase adequate health insurance are a huge potential liability to the tax payers."

Why? Does a millionaire create a liability to taxpayers because she does not have health insurance? And why does it fall on the taxpayers at all? Do you not always want people to take responsibility?

jerrye92002 said...

" I support single payer medicare for all, but it would not cover every possible procedure for everyone no matter how old or how close to death."

Laurie, thoughtful as usual, but I fear I must take exception. We already have single payer Medicare for all seniors. It is mandatory, it costs the taxpayers (who see no benefit) a boatload, it has price controls and limits coverage by arbitrary rules. Anybody that can afford a supplemental policy buys one (driving up their total costs) to cope with all the limitations otherwise. Most doctors don't like to serve Medicare-only patients because it costs them money, the reimbursements are so low and the paperwork burden so high. They either accept the loss, cut down on quality of care to fit within the payment schedule, or pad the bill with marginally useful services to get the total bill up to something reasonable. And contrary to Obama's promise for Obamacare, Medicare does have an upper limit, to contain costs. It would be a terrible system to expand to everybody, and we would be wise to start getting rid of it as it currently exists.

Anonymous said...

Does a millionaire create a liability to taxpayers because she does not have health insurance?

That's a question we need more information to answer. Does the millionaire self insure? Lots of millionaires are in fact broke. Donald Trump has gone bankrupt numerous times. If he had a serious illness during one of his bankruptcies, who would have paid his medical bills?

--Hiram

Anonymous said...

why does it fall on the taxpayers at all?

Because we are not evil. Remember back in the day when we wanted to create death panels which would be empowered to determine who would receive health care, and who would not? Who was it who led the charge against that? It was conservatives and Republicans who said, "NO", in the strongest terms, and you know, they were right. I came away from that battle so convinced, and became a convert to the conservative cause. We should not deny health care from those who need it, and don't take my word for it, send an email to Sarah Palin.

Do you not always want people to take responsibility?

We do, and I am big on that. Too often, politicians try to delegate power on the theory that they are also delegating responsibility, and that should never be allowed. Block grants are like that. Some politicians want to send money to states and allow them how to spend it. That's ok as far as it goes, but it must be clear to those politicians that they are responsible for the decisions made on the state level, even when they have no power to make them. They must not ever be allowed to delegate responsibility.

--Hiram

jerrye92002 said...

We are not evil? Who is this "we"? It sounds like you are trying to say that those who refuse to give up the resources they earn to care for their own families, so that government can give it to some stranger, are somehow evil. I do not accept that. I would rather say those who take from my family to inefficiently help someone else are the evil ones.

The problem with politicians "delegating power" is that maybe they should not have the power in the first place. It is also true that the closer to the problem, the better and more responsive the solution, so having the federal government delegate responsibility and the accompanying resources to the states is not only wise, but closer to the way it should always have been done.

John said...

"When we discuss welfare, John, you are always concerned about people being "irresponsible." Now, when it comes to health insurance or auto insurance, you demand that the Almighty State dictate that they be forced to pick what the Almighty State determines is an "appropriate" insurance policy."

These seem aligned to me what am I missing. I think:
- Baby Mamas / Daddys who are receiving tax dollars should be mandated to perform as Parents, or face consequences.
- every citizen should be forced to carry good health insurance that will pay their bills if they get sick and/or injured.

The exception to mandatory insurance would possibly be for the upper 1% who can be self insured.

John said...

As for the content of the policy, yes the policies should very similar.

But maybe the actuaries can give the old farmer a break on premiums because it unlikely we will have a baby. However his premiums will likely be much higher as his risk of heart issues, stroke, etc increase.

jerrye92002 said...

Maybe I'm confused. You seem to want to force baby mamas to take responsibility for the kids, and indeed you would "force them" to do so. Oh, never mind, I see it now. You would also FORCE drivers to carry cadillac insurance on their Toyota, and force everybody to carry cadillac health insurance on themselves. You don't want people to be responsible, except for following your wishes.

Anonymous said...

We are not evil?

The people who passed laws who said that emergency rooms are not allowed to let folks die untreated on their doorsteps. But yes, I am aware that there are evil people in the world, people who would let those people die.

This really isn't an issue we dispute much. The whole point of Trumpcare is to shift the cost of medical care to low and middle income tax payers in ways that are hard to track. None of it's designed to result in the denial of care.

--Hiram

Anonymous said...

People are asking why Trumpcare was moved to the top of the political agenda, ahead of things like tax cuts. The reason basically, is that for the tax cut plans to go forward, they wanted the trillion dollar savings to the federal budget that Trumpcare would have generated. Now whatever the merits of that proposal in terms of highly technical budget considerations, it should be noted that that trillion dollars in spending doesn't go away, it just goes on someone else's set of books.

As I have said many times before, when Republicans talk about running government like a business, the business they have in mind is Enron. Enron succeeded for as long as it did because they were able to develop an accounting strategy that shifted and concealed liabilities. That's what Republicans want to do with government very consistently across the board. They want to shift responsibility for that trillion dollar shortfall to someone else, state governments perhaps, or charities, a choice that might be popular around here. Now to some extent, the GOP is ready to ameliorate this choice by appropriating some money to pay for the transfer. But bear in mind, this comes up to another essential principle of Republican accounting, that it's ok to forecast increases in revenue, but not increases in expenditures. What this does, of course, is systemize deficit spending in a way that avoid accountability.

--Hiram

John said...

Jerry,
No Cadillac plans or efforts required... The baselines are pretty basic.

- Parents should be held accountable for ensuring their kids are fed, have good hygiene, they are prepared for Kindergarten, get to school, do their homework, etc. Seems pretty basic.

- Citizens should be held accountable to have normal health insurance... And we have thousands of companies who know what this means... It is what is offered to hundreds of millions of employees across the country.

People may think they can scrimp on their plans, but the statistics prove differently.