House repeals ACA

[TheLeviathan]

 

A conservative case for single-payer health care

 

Let's hope this kind of rhetoric actually takes hold with conservative circles.

 

I think it is.  I think frustration over costs is getting people to abandon ideology in search of solutions.

 

That's always a good thing IMO.

[Craig Arko]

 

Not at all. I'm saying that comment did not make me feel good about going to work. 

 

But I am also saying that saying insurance companies are why costs are escalating nearly completely misses the mark on the actual underlying causes.

 

These are, of course, my opinion, and in no way reflect the stance of my employer.

So do you think it's (over)-regulation? I remember when I was in the medical device industry it was commonplace to conduct trials in Europe a couple of years prior to the US because of the stringent FDA requirements.

[Mike Sixel]

 

So do you think it's (over)-regulation? I remember when I was in the medical device industry it was commonplace to conduct trials in Europe a couple of years prior to the US because of the stringent FDA requirements.

 

that's a pittance.

 

Costs are driven by:

 

An aging population that needs more expensive care.

More drugs w/o price controls in the US.

More cool devices to detect / treat issues (no judgement if they are good idea, but those MRI or other machines cost a lot of money)

 

Really, cost increases are driven by demand of an aging population that lives longer thru more disease, and rising costs from providers.

 

Do insurance companies skim off a percent? Yes, yes they do.

 

As for single payer.....companies like UHC will probably do the processing and other work, no chance government could do that. They'll still be there making money.

 

Again, my thoughts, not the thoughts of my employer.

[Craig Arko]

 

that's a pittance.

 

Costs are driven by:

 

An aging population that needs more expensive care.

More drugs w/o price controls in the US.

More cool devices to detect / treat issues (no judgement if they are good idea, but those MRI or other machines cost a lot of money)

 

Really, cost increases are driven by demand of an aging population that lives longer thru more disease, and rising costs from providers.

 

Do insurance companies skim off a percent? Yes, yes they do.

 

As for single payer.....companies like UHC will probably do the processing and other work, no chance government could do that. They'll still be there making money.

 

Again, my thoughts, not the thoughts of my employer.

And other countries (I'm thinking Europe and Japan, here) don't face similar issues of an aging population?

[Mike Sixel]

 

And other countries (I'm thinking Europe and Japan, here) don't face similar issues of an aging population?

 

they have price controls. 

 

And, they live healthier than we do.

 

But mostly price controls.

[Badsmerf]

thanks, I really feel better about being at work now.

 

If only you knew what was really driving up costs...

Now I feel like a Dick.

 

The items you listed are also problems. Insurance companies will not just curl up and die if single payer happens. However, they will be forced to change. Hospital ceos also wouldn't join the middle class. There will still be plenty of money in health care, even if these people become state employees.

 

I just wish insurance companies acted more like union leaders than corporate cronies. Unless you are a board member, my distaste in directed at you.

[Craig Arko]

Now I feel like a Dick.

The items you listed are also problems. Insurance companies will not just curl up and die if single payer happens. However, they will be forced to change. Hospital ceos also wouldn't join the middle class. There will still be plenty of money in health care, even if these people become state employees.

I just wish insurance companies acted more like union leaders than corporate cronies. Unless you are a board member, my distaste in directed at you.

I've met plenty of union leaders who were not much better than corporate cronies, or any other kind of entrenched bureaucrat.

[TheLeviathan]

 

Now I feel like a Dick.

The items you listed are also problems. Insurance companies will not just curl up and die if single payer happens. However, they will be forced to change. Hospital ceos also wouldn't join the middle class. There will still be plenty of money in health care, even if these people become state employees.

I just wish insurance companies acted more like union leaders than corporate cronies. Unless you are a board member, my distaste in directed at you.

 

Unions are really little more than mini-corporations these days.  Not sure that's the solution.

[Mike Sixel]

I

Now I feel like a Dick.

The items you listed are also problems. Insurance companies will not just curl up and die if single payer happens. However, they will be forced to change. Hospital ceos also wouldn't join the middle class. There will still be plenty of money in health care, even if these people become state employees.

I just wish insurance companies acted more like union leaders than corporate cronies. Unless you are a board member, my distaste in directed at you.

Ha.

 

No need to feel bad. I know who I work for, and I know the good and bad of it. It's my choice, and I work what tiny influence I have to help. Frankly, I want single payer.

[glunn]

 

My worst case scenario:  IIRC, reconciliation in the Senate will only require 50 votes.  So the GOP game plan may very well be: pass some reasonable version in the Senate with 60 votes, goes back to the House and they add all their lunacy, comes back to Senate for reconciliation and they'll only need 50 votes, and we end up with much of the House lunacy.   

 

Dems can't play ball at all; they must support no version of any bill in the Senate. 

I believe that you are correct about needing only 50 votes in the Senate, so long as this qualifies as a budget reconciliation bill, which I believe that it is.

 

I respectfully disagree about the Democrats supporting no version of this. I think that the Democrats should offer a compromise in the interests of the people who will suffer and die if this is left to the Republicans.

 

Yes, the Democrats may gain politically when tens of thousands of people start dying because of the final bill. Yes, many of those deaths will include Trump voters and also people who did not vote at all. Yes, there is karma in that.  But I think that the Democrats need to rise above politics and make a fair effort to at least offer a compromise, because that's the right thing to do as human beings.

[ashbury]

 

I respectfully disagree about the Democrats supporting no version of this. I think that the Democrats should offer a compromise in the interests of the people who will suffer and die if this is left to the Republicans.

C'mon. Nobody Dies Because They Don’t Have Access To Health Care^TM.

[stringer bell]

 

I believe that you are correct about needing only 50 votes in the Senate, so long as this qualifies as a budget reconciliation bill, which I believe that it is.

 

I respectfully disagree about the Democrats supporting no version of this. I think that the Democrats should offer a compromise in the interests of the people who will suffer and die if this is left to the Republicans.

 

Yes, the Democrats may gain politically when tens of thousands of people start dying because of the final bill. Yes, many of those deaths will include Trump voters and also people who did not vote at all. Yes, there is karma in that.  But I think that the Democrats need to rise above politics and make a fair effort to at least offer a compromise, because that's the right thing to do as human beings.

I liked your comment, but I disagree that Democrats should or will offer a compromise that Republicans will accept. If the topic or bill is fixing the ACA, there is room to improve the existing legislation, but if the question in front of Senate Democrats is to repeal the ACA for the current proposal, I can't see what can be offered to fix health care using the GOP bill as the basis for that change. The Republican bill was altered from the form that failed to placate the conservatives, not to reach out to moderates. The bill that passed is even worse than its predecessor.   

 

I don't think McConnell can find 50 votes for the House bill and I would much prefer it fail than adopting the House version which essentially gives more to the richest in America and does nothing good for 90% of the population.

[kab21]

So far the repeal and replace bills have been drafted in secret and they aren't even including the GOP congressman for input. And they are just trying to ram this through congress with only 'campaign promise' as the selling point. 

 

The democrats could draft whatever they wanted but it isn't even going to get read by a single GOP congressman. There is no way that they can 'rise above politics and offer some sort of compromise' imo.

[Mike Sixel]

 

So far the repeal and replace bills have been drafted in secret and they aren't even including the GOP congressman for input. And they are just trying to ram this through congress with only 'campaign promise' as the selling point. 

 

The democrats could draft whatever they wanted but it isn't even going to get read by a single GOP congressman. There is no way that they can 'rise above politics and offer some sort of compromise' imo.

 

They also aren't including women or minorities. Just old white men....

[PseudoSABR]

 

I believe that you are correct about needing only 50 votes in the Senate, so long as this qualifies as a budget reconciliation bill, which I believe that it is.

 

I respectfully disagree about the Democrats supporting no version of this. I think that the Democrats should offer a compromise in the interests of the people who will suffer and die if this is left to the Republicans.

 

Yes, the Democrats may gain politically when tens of thousands of people start dying because of the final bill. Yes, many of those deaths will include Trump voters and also people who did not vote at all. Yes, there is karma in that.  But I think that the Democrats need to rise above politics and make a fair effort to at least offer a compromise, because that's the right thing to do as human beings.

I think in order to get to the reconciliation, the Senate would have to first pass a bill that would survive a legislative veto; thus, Republicans would need Democrat votes to even get to that step.  I may be incorrect on this, but if that's the case, the Democrats should not support any version, because if they do, it will allow for reconciliation to take place, after the House has altered whatever protections Democrats demanded. 

 

Of course if the choice is to have bill that lets people die and one that doesn't, the Democrats should get involved, but I don't think that will be the choice.  To be clear, my recommendation wasn't motivated by political optics for Democrats, rather to prevent the bill from going into reconciliation, and thus retaining Obamacare. 

[TheLeviathan]

If the Democrats want to actually be brave, maybe they should embrace single payer.  I honestly think if they have the courage to do that, it might not be initially beneficial to them, but in the long run could swing them a lot of permanent votes.

 

If their honest attempts to help this bill are rebuffed, pivot that into single payer and sell the ever loving hell out of it.  It's risky, but they're at the point where risks like this should be taken.

[glunn]

 

So far the repeal and replace bills have been drafted in secret and they aren't even including the GOP congressman for input. And they are just trying to ram this through congress with only 'campaign promise' as the selling point. 

 

The democrats could draft whatever they wanted but it isn't even going to get read by a single GOP congressman. There is no way that they can 'rise above politics and offer some sort of compromise' imo.

What if they at least developed and proposed a plan that the public could consider?

[glunn]

 

If the Democrats want to actually be brave, maybe they should embrace single payer.  I honestly think if they have the courage to do that, it might not be initially beneficial to them, but in the long run could swing them a lot of permanent votes.

 

If their honest attempts to help this bill are rebuffed, pivot that into single payer and sell the ever loving hell out of it.  It's risky, but they're at the point where risks like this should be taken.

It seems to me that Trump embraced single payer when he told the Australian Prime Minister that the Australian system is better. For fun, maybe the Democrats could propose the Australian system.

 

I personally like the system in Israel, because it has some competition.

[TheLeviathan]

 

It seems to me that Trump embraced single payer when he told the Australian Prime Minister that the Australian system is better. For fun, maybe the Democrats could propose the Australian system.

 

I personally like the system in Israel, because it has some competition.

 

I think many of his voters just want a fix.  I wonder how many true "free market" health people there really are other than the powerful talking heads on the right.

[kab21]

 

What if they at least developed and proposed a plan that the public could consider?

They already have their proposed plan. It is the ACA.

 

Any actual improvements to it that they would like to do would be making it more liberal and less of what the GOP wants. Any 'improvements' that you think they can propose to satisfy the GOP will be a list of concessions that further weakens the ACA and is not something that the democrats should consider.

[kab21]

 

If the Democrats want to actually be brave, maybe they should embrace single payer.  I honestly think if they have the courage to do that, it might not be initially beneficial to them, but in the long run could swing them a lot of permanent votes.

 

If their honest attempts to help this bill are rebuffed, pivot that into single payer and sell the ever loving hell out of it.  It's risky, but they're at the point where risks like this should be taken.

Single payer is a very, very hard concept to sell to the conservative and moderate middle class. The ACA was only passed on repeated campaign promises that if you like your health insurance and health care then you can keep it and the GOP's continual alternative facts have convinced many that the ACA is awful and was the wrong thing to do. It was likely one of the principal issues that caused many swing voters to back Trump even though they hated him personally.

With that being said the GOP has not started out their president, senate and House trifecta with popular legislation and could get brutally beaten in the next two elections. It might be possible to sell single payer in the next election cycle to an increasingly liberal voting block though. It would almost certainly hurt their election numbers overall even if it could help them in the long run. The help would be a fairly successful health care system that covers everyone.

[TheLeviathan]

 

Single payer is a very, very hard concept to sell to the conservative and moderate middle class. The ACA was only passed on repeated campaign promises that if you like your health insurance and health care then you can keep it and the GOP's continual alternative facts have convinced many that the ACA is awful and was the wrong thing to do. It was likely one of the principal issues that caused many swing voters to back Trump even though they hated him personally.

 

I don't disagree and I fully admit I'm speculating, but I think the sands are shifting on this.  I think people care less about who their doctor is and more about whether they can see one and not give up their life savings for it.

 

Promise them much cheaper prescription drugs and nothing out of their pockets every month and you could swing a lot of those people.  (Depends, largely, on how you sell it)

[drjim]

Probably will end up campaigning for single payer and legislating a public option.

[glunn]

 

They already have their proposed plan. It is the ACA.

 

Any actual improvements to it that they would like to do would be making it more liberal and less of what the GOP wants. Any 'improvements' that you think they can propose to satisfy the GOP will be a list of concessions that further weakens the ACA and is not something that the democrats should consider.

What about allowing insurers to sell across state lines?  

[drjim]

What about allowing insurers to sell across state lines?

Basically already happens. Large insurance companies already have a presence in mulitple states. Have to be separate entities because each state has unique requirements.

 

I suppose an argument could be made to make all requirements universal.

[kab21]

 

What about allowing insurers to sell across state lines?  

This is not going to sway the repeal and replace agenda. 

 

Basically already happens. Large insurance companies already have a presence in mulitple states. Have to be separate entities because each state has unique requirements.

I suppose an argument could be made to make all requirements universal.

And making all requirements universal is directly in conflict with the GOP agenda of letting states make requirements that are as exclusion riddled as possible if they want.

The democrats have been given a 'sit down and shut up' card due to the GOP holding congress and the presidency.

 

I think the democrats should have been making their list of improvements to the ACA more clear during the election. I can't honestly remember one thing they proposed other than repeatedly saying that the ACA was working and would continue to be in place.

[TheLeviathan]

 

I think the democrats should have been making their list of improvements to the ACA more clear during the election. I can't honestly remember one thing they proposed other than repeatedly saying that the ACA was working and would continue to be in place.

 

Honestly?  I don't think they wanted to give the Republicans any ideas.  I think they read the tea leaves that the  Republicans had squat.

[PseudoSABR]

In any case, insurance companies aren't going to compete on cost, they will compete on service (or lack thereof).  Competition won't lower health care costs, but it could lower why insurance plans provide. (As Mike points out there's a nominal profit that all insurance companies need to make in order to stay operational; that's not to let them off the hook, but rather to point out how market conditions won't solve the cost problem).

[kab21]

 

Honestly?  I don't think they wanted to give the Republicans any ideas.  I think they read the tea leaves that the  Republicans had squat.

Except that the democrat improvements are not compatible with the GOP improvements.There is very little common ground between the two and that is why I don't fault the democrats at all in this current debacle.

[TheLeviathan]

 

Except that the democrat improvements are not compatible with the GOP improvements.There is very little common ground between the two and that is why I don't fault the democrats at all in this current debacle.

 

Right, but laying out policy might have allowed the GOP to look less foolish now.  It probably wasn't in their best interest during the campaign.

 

Plus, Obamacare wasn't a particularly strong issue to run on.  The less most Dems talked about it the better off they were.