Governing is different from knee-jerk opposition.

[kallend 1,618]

House Majority Leader Kevin McCarthy's press briefing yesterday (from WaPo):


For six years, Republicans have talked of replacing [Obamacare], and dozens of times they voted to repeal it. But now they’re in no hurry. At Tuesday’s session, McCarthy said repeatedly that Republicans hadn’t yet decided what to do about Obamacare. “We’re being sworn in today,” he pleaded.

What are some possible alternatives?

“No decision has been made yet. There’s nothing right out there.”

Would the GOP alternative cover as many as Obamacare?

“There’s a lot of areas that you want to look at.”

When will repeal happen?

“I only do week by week.”

How would they avoid upsetting insurance markets?

“Nothing has been decided yet.”

McCarthy was equally unprepared to talk about another longtime GOP priority: the repeal of regulations. “We’re just being sworn in,” he demurred, again, when asked.

...

The only sure way to survive a canopy collision is not to have one.

[mirage62 0]

John and others here will rejoice at any failure of the current admin I have to say that if the Republicans don't get some of the low hanging fruit out of the way.... FAST ......many of their believers will fall away.

I do believe that Obama care needs changing but it won't be easy or fast.

Kevin Keenan is my hero, a double FUP, he does so much with so little

[kallend 1,618]

mirage62

John and others here will rejoice at any failure of the current admin I have to say that if the Republicans don't get some of the low hanging fruit out of the way.... FAST ......many of their believers will fall away.

I do believe that Obama care needs changing but it won't be easy or fast.

4 years of disfunctional government benefits nobody.

...

The only sure way to survive a canopy collision is not to have one.

[Transmitter 0]

mirage62

John and others here will rejoice at any failure of the current admin I have to say that if the Republicans don't get some of the low hanging fruit out of the way.... FAST ......many of their believers will fall away.

I really really doubt that the republicans will loose any support whatever they do. If we approach this from a rational perspective they should have lost all support when they essentially blocked the goverment for the last four years or started spilling lies.

[billvon 2,379]

Quote

John and others here will rejoice at any failure of the current admin I have to say that if the Republicans don't get some of the low hanging fruit out of the way.... FAST ......many of their believers will fall away.

I don't think that's true. Trump is already pre-emptively blaming Democrats for any failures of Trumpcare. Trump's believers will buy that, and continue to blame the Democrats for any failures of government.

[rehmwa 2]

mirage62

I do believe that Obama care needs changing but it won't be easy or fast.

it'll be easy and fast -

1 - Everyone is agreeing that you can't just delete it and leave a void in its place. --- Everyone..... any argument based on that is a ridiculous strawman. So revising/replace/adjust/fix is the right way to approach or talk about it.

2 - The fix will be somewhere between two positions (I'm really narrowing it down ):
----a. It'll be put back on the private market with very popular revisions to insurance company rules (like existing conditions, kids on parents' policies to a later age, cross state sales, etc)
----b. No substantial change - just a cosmetic name change.

3 - Regardless of the results:
----a. Dems will proclaim the Reps FAILED to repeal the ACA. Though more important to claim Rep failure, some will also claim Dem success at 'improving the ACA' even more. The media will support and advertise that spin. Half the people here will also do so with great smugness.
----b. Reps will proclaim the Dems FAILED to keep the ACA. Though more important to claim Dem Failure, some will also claim Rep success at coming up with an improved plan. The media will mock and ridicule that spin (except for Fox). another half of the people here will also agree with the Rep spin and do so with great smugness.
----c. Politicians from both sides will try to cash in on their spin every other years for nearly the next decade.
----d. Speaker's Corner on the subject will involve childish insults and people completely talking past each other

4 - In reality, it'll be a little better, but still suck and cost more than when we started the original. And even those tiny gains will take a long time.

5 - Trump will tweet something or the other and manage to piss off both reps and dems. Comedians and talk show hosts of all kinds will flourish.

6 - Anyone in Congress won't understand because during the entire cycle of the last decade THEIR plan didn't change at all.

...
Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[rehmwa 2]

billvon

I don't think that's true. Trump is already pre-emptively blaming Democrats for any failures of Trumpcare. Trump's believers will buy that, and continue to blame the Democrats for any failures of government.

he's learning quick from his predecessor. Dems in Congress already pre-blaming the Reps too. And Obama already advising them to stand back and let the Reps own the messy cleanup - just for the very reason is so they can also point fingers at the other guys.

See? politics at that level is very easy and predictable.

nothing gets done other than a couple hundred people on each side pointing at each other.

an eye could get poked out

which, I believe, is mandated to be covered, still

...
Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[JerryBaumchen 1,046]

Hi rehmwa,

Quote

Anyone in Congress won't understand

I agree; and this applies to almost everything that they do.

Clearly this one did not: http://www.nbcnews.com/politics/politics-news/republican-congresswoman-marsha-blackburn-s-obamacare-twitter-poll-backfires-n703271

Jerry Baumchen

[rehmwa 2]

JerryBaumchen

Hi rehmwa,

Quote

Anyone in Congress won't understand

I agree; and this applies to almost everything that they do

Thanks, but I don't want to oversimplify......someone might wet themself

...
Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[gowlerk 1,901]

I'm already enjoying driving down the road and listening to interviews with R politicians trying to say they are going to repeal, but keep the rule against refusing to insure sick people.

None have been able to say anything about how they will pay for the cake. The one they eat nor the one they keep.

Always remember the brave children who died defending your right to bear arms. Freedom is not free.

[billvon 2,379]

>I'm already enjoying driving down the road and listening to interviews with R
>politicians trying to say they are going to repeal, but keep the rule against refusing
>to insure sick people.

Yep. Apparently they're also keeping the tax on people with no insurance, but still repealing Obamacare. "Great news! Now you'll be paying that tax AND you'll have no healthcare!"

[kallend 1,618]

billvon

>I'm already enjoying driving down the road and listening to interviews with R
>politicians trying to say they are going to repeal, but keep the rule against refusing
>to insure sick people.

Yep. Apparently they're also keeping the tax on people with no insurance, but still repealing Obamacare. "Great news! Now you'll be paying that tax AND you'll have no healthcare!"

Not only paying more than other developed countries, but having worse outcomes than those with socialized medicine:

www.washingtonpost.com/news/wonk/wp/2014/09/29/our-infant-mortality-rate-is-a-national-embarrassment/?utm_term=.2daca7502228

www.infoplease.com/world/statistics/life-expectancy-country.html

...

The only sure way to survive a canopy collision is not to have one.

[billvon 2,379]

>Not only paying more than other developed countries, but having worse outcomes than those
>with socialized medicine:

Heeere we go!

======================
Conservatives ready to support $1 trillion hole in the budget

By Kelsey Snell and David Weigel
January 5 at 6:35 PM
WaPo

Some of the most conservative members of Congress say they are ready to vote for a budget that would — at least on paper — balloon the deficit to more than $1 trillion by the end of the decade, all for the sake of eventually repealing the Affordable Care Act.

In a dramatic reversal, many members of the hard-line House Freedom Caucus said Thursday they are prepared later this month to support a budget measure that would explode the deficit and increase the public debt to more than $29.1 trillion by 2026, figures contained in the budget resolution itself.

As they left a meeting with Sen. Rand Paul (R-Ky.) on Thursday, some of the conservatives said that spending targets contained in the budget for fiscal 2017 are symbolic. The real goal of the budget legislation, they argued, is to establish an opportunity to finally make good on GOP promises to repeal President Obama’s signature domestic achievement.

“I just came to understand all the different ideas about where we go next,” said Rep. David Schweikert (R-Ariz.), a member of the House Freedom Caucus that typically opposes massive spending increases. Schweikert now says he will probably vote for the budget resolution.

The growing conservative consensus comes nearly one year after the approximately 40-member group announced it would rather torpedo the entire budget process than vote for a fiscal blueprint that increased spending without balancing the budget.
======================

So get ready to get saddled with thousands of dollars in debt per person just to make sure that poor people don't have health care! It's a win-win for rich people who don't pay taxes.

[rehmwa 2]

billvon

Some of the most conservative members of Congress say they are ready to vote for a budget that would — at least on paper — balloon the deficit to more than $1 trillion by the end of the decade, all for the sake of eventually repealing the Affordable Care Act.

'all for the sake of' ????

They already have the votes. What, exactly, are they negotiating (i.e., they allow more spending in trade for anti-ACA votes).

this doesn't sound like a tit for tat - this sounds like two separate things

1 - going after the ACA (either cosmetic or significant), we knew that was in place

2 - dramatic increase in spending - we knew that was happening. Trump's campaign was about out of control spending. Maybe not on the scale of Bernie, but still....And any time both houses get the same party = SPENDING.

I don't see how one leads to the other. Both should be expected independent of the other.

Any politician that says 2 is necessary to achieve 1 really does think pretty poorly of the general voter's intellect.

nothing good will come of this. we can just hope for Congress to get split up again in 2 years.

...
Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[GeorgiaDon 340]

Quote

'all for the sake of' ????

They already have the votes. What, exactly, are they negotiating

Republicans have promised a replacement for the ACA that keeps the (expensive) things people say they like, such as coverage for pre-existing conditions, while eliminating all the provisions intended to help pay for that (such as the individual mandate). Basically they have promised a system where people can skip paying for health insurance until they actually get sick. They also promised that no-one would lose their insurance as a result of them repealing the ACA. The only way both promises can be kept is to vastly increase federal subsidies. Otherwise premiums will have to skyrocket in order to cover pre-existing conditions without a large pool of not-yet-sick people paying premiums, and skyrocketing premiums without subsidies will force millions of people to lose their insurance.

Personally I expect that two years from now we will see exploding federal spending on health care to cover 20-30 million fewer people than today, while Kelly-Ann Conway looks us straight in the eye and tells us that 20 million fewer somehow means more people are covered (in Trump University math I suppose).

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[rehmwa 2]

Got it - So the increase in spending is something the current ACA already causes, it would just push the expense downriver.

I don't see anything substantial between:
1 - we all pay out of the butt for our own health care
2 - we all pay out of the butt to have the government broker our health care

other than who takes a cut for the effort

...
Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[kallend 1,618]

rehmwa

Got it - So the increase in spending is something the current ACA already causes, it would just push the expense downriver.

I don't see anything substantial between:
1 - we all pay out of the butt for our own health care
2 - we all pay out of the butt to have the government broker our health care

other than who takes a cut for the effort

CEO salaries:

www.google.com/imgres?imgurl=http://medcitynews.com/wp-content/uploads/2015/06/Screen-Shot-2015-06-24-at-9.58.14-AM.png&imgrefurl=http://medcitynews.com/2015/06/what-were-the-top-healthcare-ceo-salaries-last-year/&h=976&w=1006&tbnid=ikpfL5kmp1TqFM:&vet=1&tbnh=160&tbnw=165&docid=Sjbv5ECY0Bk0UM&usg=__jtoKVhI_NCtxVuPRWZZrGdRpFBY=&sa=X&ved=0ahUKEwi78sGvtrXRAhXoz4MKHTm6B6MQ9QEIHjAA


And just for insurance companies:

academeblog.files.wordpress.com/2016/09/ceo-salaries-in-health-insurance-industry.jpg

...

The only sure way to survive a canopy collision is not to have one.

[rehmwa 2]

That's enlightening.

So the ENTIRE HEALTH CARE PROBLEM is execs taking too big a cut. got it.

it's not fair, policians want their share too

...
Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[billvon 2,379]

Quote

Personally I expect that two years from now we will see exploding federal spending on health care to cover 20-30 million fewer people than today, while Kelly-Ann Conway looks us straight in the eye and tells us that 20 million fewer somehow means more people are covered (in Trump University math I suppose).

Matt Groening was right.

[GeorgiaDon 340]

rehmwa

Got it - So the increase in spending is something the current ACA already causes, it would just push the expense downriver.

I don't see anything substantial between:
1 - we all pay out of the butt for our own health care
2 - we all pay out of the butt to have the government broker our health care

other than who takes a cut for the effort

If you want to reduce everything to $$ you might have a point, though even there one could still discuss which system results in your butt being butt-hurt for the fewest dollars.

We all know of skydivers who (before ACA at least) decided to spend money on jumps instead of health insurance. When they broke themselves they got treated, and although they may (or may not) have paid something towards their treatment most of the bill was absorbed by the rest of us, in some combination of higher insurance premiums (hospitals charging the insured more to cover the costs of caring for the uninsured) and taxes (to pay for medicaid or medicare disability payments).

Even if you have insurance, for most people that is through your employment. Get too sick/injured to work, you lose your job and your insurance. For all but the most well off, you were (before ACA) always one serious illness away from bankruptcy. If you recovered from that illness, you likely could never get insurance coverage again. If your cancer relapsed you're on your own. After you've lost your house, savings, retirement accounts then the government would again step in and pay the bill.

If the only thing that matters to you is how much your butt will get hurt, perhaps the optimal system is that when people get sick/injured the government never steps in, so once you've run out of butt your treatment stops and you live (or not) with whatever level of benefit you have been able to buy to that point.

It seems to me there is a fundamental choice that has to be considered:
Choice A. Everyone is completely on their own. If you do not have insurance, or you bought poor insurance, if you don't have personal resources you don't get treatment, whatever the consequences. If you are a student, a kid with parents who don't have resources, a young person just starting out in life and don't have a few hundred thousand in savings, too bad so sad. Your value as a human being is exactly equivalent to how much you can pay.
Choice B. As a society we choose not to let people die or suffer life-long disabilities because they don't have the resources to pay for enormously expensive medical procedures.

Choice A may or may not be more efficient in $$. If fewer people can afford medical care, that care will become more expensive for those who can pay, just to keep the hospital doors open and staff on hand. Also there will be a lot of people who actually do get unhooked from their chemotherapy drugs or dialysis or whatever and get wheeled out to the parking lot. I'd like to think most people would have a problem with that.
If choice B is preferred, there are ways to offset the cost. One is to reduce freeloading by requiring everyone who can pay at least something for insurance to do so. That brings us to the individual mandate Republicans and Libertarians so hate.

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[kallend 1,618]

[STRAWMAN ALERT:]

rehmwa

That's enlightening.

So the ENTIRE HEALTH CARE PROBLEM is execs taking too big a cut. got it.

it's not fair, policians want their share too

[/strawman alert]

No-one said it was the "ENTIRE" problem. It is, however, indicative.

...

The only sure way to survive a canopy collision is not to have one.

[billvon 2,379]

Quote

Choice A. Everyone is completely on their own. If you do not have insurance, or you bought poor insurance, if you don't have personal resources you don't get treatment, whatever the consequences. If you are a student, a kid with parents who don't have resources, a young person just starting out in life and don't have a few hundred thousand in savings, too bad so sad. Your value as a human being is exactly equivalent to how much you can pay.

The problem is that most conservatives want this but not to that extreme. Their rallying cry is "why should I pay for XXX when it's not me who is in the hospital?" However, that does not extend to "so just let them die." If you asked most conservatives if they wanted to repeal EMTALA (that's the law that says ER's can't deny care) they'd say no* - because they don't really want to "just let them die."

So that leads to strange decisions about care. $10 in prenatal vitamins per woman would save over $1000 per person over the life of that child, averaged over the US population - but giving away "free stuff to lowlifes" is just not on the list for many conservatives. So instead of just making sure that all pregnant women have access to prenatal vitamins, we pay when the kid with spina bifida comes in to the ER with a life-threatening infection, and needs $130,000 worth of care for severe meningitis.

Obamacare (or any guaranteed-coverage system) ameliorates this to some degree, of course, because prenatal care becomes a lot more commonly available. But it's still not ideal.

So the problem is that we're living in this gray area between the two extremes - we don't want to pay for care for all those lazy dirtbags, but we're uncomfortable just letting people die because they can't pay. And that leads to the worst of both worlds; a world where we avoid spending small amounts of money for preventative care, and try to avoid spending medium amounts of money for care for illness - but then spend huge amounts of money to stave off death when the first two are neglected.

(* - EMTALA came about under Clinton, so a more likely reply would be "well, I'd want to repeal any Clinton law of course, but I still don't want people dying in ER's if they can be helped.")

[rehmwa 2]

billvon

Matt Groening was right.

Matt Groening is always right

...
Driving is a one dimensional activity - a monkey can do it - being proud of your driving abilities is like being proud of being able to put on pants

[GeorgiaDon 340]

Quote

So that leads to strange decisions about care.

I recently heard about an insane example of this. Medicare will pay for a kidney transplant (about $100,000), but by law they can cover the anti-rejection drugs needed to keep the kidney viable for only three years. After that the patient has to come up with as much as $950/month for the co-pay for anti-rejection drugs. Medicare pays about $15,000/year for the anti-rejection drugs. Medicare also pays the full cost for dialysis (about $90,000/year) with no limit on the duration of treatment. Dialysis requires 3 sessions of 3-4 hours each/week, making it difficult for patients to hold down a regular job. So patients with failed kidneys get dialysis ($90,000/year) until a kidney becomes available at which time they receive a transplant ($100,000) and drugs for three years ($15,000/yr x 3 = $45,000). At the end of three years many patients cannot afford the anti-rejection drugs, even if they have insurance, as the co-pay is so high. So they skip doses to make the drugs go farther, which doesn't work and trhe kidney is rejected, or they just stop taking the drugs altogether and let the kidney fail. Then they go back on dialysis ($90,000/yr) until a new transplant is available and start the process all over again. In other words, to prevent so-called "freeloaders" from getting their anti-rejection drugs for "free" (costing taxpayers $15,000/yr) the government would prefer to pay $90,000/yr for dialysis and perhaps another $100,000 for another transplant. Also you can factor in that people on dialysis generally can't work because they have to spend so much time getting dialysis treatment, so they are not paying taxes and are often also collecting disability payments. On the other hand after a successful transplant people don't need dialysis and so they can work and pay taxes. Cutting people off from the drugs they need to keep their transplant viable is beyond stupid, it is insane!

Don

_____________________________________
Tolerance is the cost we must pay for our adventure in liberty. (Dworkin, 1996)
“Education is not filling a bucket, but lighting a fire.” (Yeats)

[winsor 185]

GeorgiaDon

Quote

So that leads to strange decisions about care.

I recently heard about an insane example of this. Medicare will pay for a kidney transplant (about $100,000), but by law they can cover the anti-rejection drugs needed to keep the kidney viable for only three years. After that the patient has to come up with as much as $950/month for the co-pay for anti-rejection drugs. Medicare pays about $15,000/year for the anti-rejection drugs. Medicare also pays the full cost for dialysis (about $90,000/year) with no limit on the duration of treatment. Dialysis requires 3 sessions of 3-4 hours each/week, making it difficult for patients to hold down a regular job. So patients with failed kidneys get dialysis ($90,000/year) until a kidney becomes available at which time they receive a transplant ($100,000) and drugs for three years ($15,000/yr x 3 = $45,000). At the end of three years many patients cannot afford the anti-rejection drugs, even if they have insurance, as the co-pay is so high. So they skip doses to make the drugs go farther, which doesn't work and trhe kidney is rejected, or they just stop taking the drugs altogether and let the kidney fail. Then they go back on dialysis ($90,000/yr) until a new transplant is available and start the process all over again. In other words, to prevent so-called "freeloaders" from getting their anti-rejection drugs for "free" (costing taxpayers $15,000/yr) the government would prefer to pay $90,000/yr for dialysis and perhaps another $100,000 for another transplant. Also you can factor in that people on dialysis generally can't work because they have to spend so much time getting dialysis treatment, so they are not paying taxes and are often also collecting disability payments. On the other hand after a successful transplant people don't need dialysis and so they can work and pay taxes. Cutting people off from the drugs they need to keep their transplant viable is beyond stupid, it is insane!

Don

Public health care is to health care what public housing is to housing.