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The GOP Sellout Of Working People

So, the health care bill. It appears that the House GOP is poised to eliminate Obamacare’s rule that would protect people with pre-existing conditions from being denied insurance. They might say no, they aren’t, but that’s not really true [1]; the protection may remain in name only.

Whatever you thought of Obamacare, that part of it was fair and necessary. Why on earth would this supposedly newly populist party want to do something that stands to hurt the most vulnerable? What kind of ideologues would do this? What kind of populist president would support it?

David Brooks tells us that this is a catastrophic failure of Republican elites. [2] Excerpts:

I opposed Obamacare. I like health savings accounts, tax credits and competitive health care markets to drive down costs. But these free-market reforms have to be funded in a way to serve the least among us, not the most. This House Republican plan would increase suffering, morbidity and death among the middle class and poor in order to provide tax cuts to the rich.

It would cut Medicaid benefits by $880 billion between now and 2026. It would boost the after-tax income for those making more than $1 million a year by 14 percent, according to the Tax Policy Center. This bill takes the most vicious progressive stereotypes about conservatives and validates them.

It’s no wonder that according to the latest Quinnipiac poll this bill has just a 17 percent approval rating. It’s no wonder that this bill is already massively more unpopular that Hillarycare and Obamacare, two bills that ended up gutting congressional majorities.

More:

If we’re going to have the rough edges of a populist revolt, you’d think that at least somebody would be interested in listening to the people. But with this bill the Republican leadership sets an all-time new land speed record for forgetting where you came from.

The core Republican problem is this: The Republicans can’t run policy-making from the White House because they have a marketing guy in charge of the factory. But they can’t run policy from Capitol Hill because it’s visionless and internally divided. So the Republicans have the politics driving the substance, not the other way around. The new elite is worse than the old elite — and certainly more vapid.

A study released this week found that mortality rates among the white working class shot up 60 percent [3] — 60 percent! — in fewer than twenty years. It’s complicated why this is happening, but the last thing these people need is to give insurance companies an opportunity to deny them coverage. These are Trump’s people, and as Brooks indicates, he’s selling them out for the sake of a political win. I completely understand the need to reform Obamacare and make it better, but it looks like the Congressional Republicans never had a plan for this, and went into this process hacking willy-nilly, and have no idea what they’re doing.

This is not an abstraction! This is the health care of the American people. People, not integers.

These Republicans can’t govern, can they? Again, let me mention a conversation I had last week in Washington with a conservative, pro-Trump friend. He said that policymaking is such a disaster — in large part because the president himself is disinterested and disengaged — that when the wheels come off, the Democrats are going to come roaring back, and it’s going to be hell to pay for conservatives. Feels like the GOP is careening today towards a wheels-off moment.

If the people who sent Trump to Washington come to see him as having sold them out, we are going to be at a dangerous political moment. Trump could have used what scant political capital he had to do something big on trade policy, which is what his people wanted more than anything, and arguably needed. But no, they had to mess with Obamacare. Reminds me of George W. Bush using up his re-election capital in 2005 pushing for a Social Security reform that nobody but conservative elites wanted, and that failed.

UPDATE: Note comments in the thread calling into question my math re: white mortality rate. It’s not as bad as I made it sound, I’m told … but it’s still pretty horrible!

241 Comments (Open | Close)

241 Comments To "The GOP Sellout Of Working People"

#1 Comment By GSW On March 25, 2017 @ 8:28 pm

“People like you seem to think all the excess cost in our system is attributable to only a few greedy rich villains…” @Noah172

No, actually its a *lot* of greedy rich villains that both the Republicans and the Democrats are in thrall to.

The canards about “cutting provider incomes, reducing services, and stifling innovation — what the other countries do” are little more than hypberbole in the service of the winners/villains.

#2 Comment By Noah172 On March 25, 2017 @ 9:10 pm

GSW @ 8:28 pm

I see that you have no rebuttal to my factual point that medical professionals in the US — doctors, nurses, and the rest — are much better compensated than their counterparts in single-payer countries.

You also have no rebuttal to my factual point that corporate profits (not total revenue, profits) are only a small fraction of US health care costs.

#3 Comment By CharleyCarp On March 25, 2017 @ 9:11 pm

The President ran around the country last fall touting his plan, which would reduce premiums and deductibles, and cover everyone. A winning strategy, as we all saw. Congressional Republicans didn’t even try to keep this promise.

I don’t think the next turn of the wheel will get all the way to single payer, but I wouldn’t be shocked to see MediCare eligibility dropped to 55, paid for by lifting caps and more progressive taxation. The insurance market would hugely benefit taking those folks — us — out of it.

#4 Comment By CharleyCarp On March 25, 2017 @ 9:18 pm

The President’s next endeavor — huge tax cuts for the rich — isn’t going to match his campaign rhetoric all that well, nor will the working class voters who put him over the top think they’re getting what they wanted from him.

I don’t support the President’s trade and immigration agendas, but the people who put him in the White House did and do. Instead, though, he’s pursuing a 1% agenda. Eventually, this will catch up with him.

#5 Comment By CatherineNY On March 25, 2017 @ 10:25 pm

@JonF: “Most civilized countries have universal healthcare, period. It works, and it’s very popular– Margaret Thatcher at her libertarian nastiest never once suggested putting an end to Britain’s system, although it’s the most socialist such system in existence.” Nope, and nope. Very few countries have “universal healthcare” — if any. They have broader mandated coverage, which is not the same thing. Many of these “civilized” countries have severe rationing, and their wealthier citizens buy their way out with private insurance or direct purchase of healthcare in their own countries, or in the U.S. And Margaret Thatcher tried hard to change her system. I know the people in her government who tried to enact market-oriented reforms, and were thwarted in doing so. If you do the slightest research, you will find the facts.

#6 Comment By Siarlys Jenkins On March 25, 2017 @ 10:47 pm

The President ran around the country last fall touting his plan, which would reduce premiums and deductibles, and cover everyone.

Yeah, a bit like Richard M. Nixon’s secret plan to end the war in Vietnam.

Then why do Medicare beneficiaries keep buying into that private market with Medigap and Medicare Advantage?

Less than 20 percent do, and this market has not in fact saved Medicare money, as was the original intent. My current plan is to skip Medicare Advantage, pay my 20 percent of Medicare Part B costs, and get a Medigap policy with a reasonable deductible for Medicare Part A. I think that’s the best cost control configuration.

Franklin Evans has spoken many times about the distinction between pre-paid medical care and health insurance, and how the practice most Americans are used to blurs the distinction. It is a valid criticism of the ACA that it perpetuates that blur.

Giving people with prexisting conditions “health insurance” is exactly the same thing as letting house fire victims buy “home insurance” after their house has burned down.

Well, sure. That’s why the ACA has a mandate that everyone pay into insurance. It closes out the possibility of waiting until you are really sick and need hundreds of thousands of dollars worth of treatment, then applying for insurance and expecting premiums to be low.

The media (liberal and otherwise) talk about needing young healthy people paying in to keep premiums low for older, sicker people. A more realistic way to describe it is, everyone will get old someday, and most of us will get sick or damaged in some way sometime, so, we pay in from young adulthood on, knowing that most of us will use less early in life and more later in life. Its not much different from urging people to save in their peak earning years to subsidize their retirement years.

Let’s see what I can recall just off the top of my head:

– Everybody will be covered
– The coverage in the new program will be much better
– Premiums will be more affordable
– Deductibles and copays will be lower
– The problem of counties only having a single insurer will go away

Yeah, Trump is all talk, and hasn’t a clue whether what he does actually delivers anything that lives up to the loft rhetoric. He says its going to be terrific, so it is. “Who knew that health care could be so complicated?” Ummm… those familiar with the practical requirements of delivering health care?

Tried that some years back. Everything we could put into it was eaten up by the extra charges the banking plan providers charged for it, and they even tried to bill us beyond that so we lost more than we put into it, without ever being able to use it.

Well Fran, here in the upper Midwest, where “progressive” used to have a real meaning, there are still plenty of credit unions, and one of the oldest and largest (it even buys up failing banks) has a very functional HSA plan with a debit card and hasn’t charge me a darn thing. Even pays de minimus interest, but for the past ten years, all interest has been de minimus.

The problem is that reducing wages and employment, while inflating insurance costs way beyond also rapidly inflating medical costs, doesn’t work.

Of course not. That’s the root of every problem. If net revenue were evenly distributed, then everyone could decide what to spend their money on, and get insurance for really catastrophic events, and we’d all be happy. But this IS a capitalist economy after all.

#7 Comment By GSW On March 25, 2017 @ 10:49 pm

@Noah172 9:10

I don’t know why you think your particular points are so telling as to require rebuttal.

The big picture is that U.S. health care is a wildly expensive train wreck when compared to the health systems of other western democracies. Not only is US health insurance way overpriced by international standards, a scandalous 30 million people (Canada has a population totalling 35 million) are medically uninsured notwithstanding the Obama era reforms.

With political will this can be fixed as it has been for decades now in other rich western democracies: Americans are clever, resourceful, rich and our favourite cousins

The reason it hasn’t been is systemic political dysfunction – Republican and Democrat – in the face of privileged lobby groups who school Americans in the untruth that their health system is the envy the world. Well, that’s just so much spin.

#8 Comment By Karen Harris On March 26, 2017 @ 12:58 am

The Republican “replacement” may have been bad, but Obamacare is an unmitigated disaster. I cautiously supported it at the time it passed because I drank the Kool-Aid that health insurance would be “affordable.” I figured it wasn’t perfect, but at least it was better than nothing. I may have been wrong. It may actually have been worse than doing nothing. Now we’re permanently stuck with this stinkbomb. The only people benefiting from it are people with pre-existing conditions on Medicaid. Everyone else is screwed.

And amid all the blame directed at Republicans or Democrats for the failure of both parties’ programs, I don’t see anyone placing the blame where it really belongs: With us. Americans want all this great stuff, but we don’t want to pay for it. We want other people to pay for it. That’s what it boils down to.

#9 Comment By Karen Harris On March 26, 2017 @ 1:06 am

“That’s why the ACA has a mandate that everyone pay into insurance. It closes out the possibility of waiting until you are really sick and need hundreds of thousands of dollars worth of treatment, then applying for insurance and expecting premiums to be low.”

People are actually doing that NOW, with Obamacare. No one is respecting the mandate, because the plans are too expensive and the mandate is not being enforced. They’re not complying with it because they know they can’t be turned away in the event they get sick. That is the fatal flaw of ACA and why it’s going down the tubes.

#10 Comment By Karen Harris On March 26, 2017 @ 2:09 am

So obviously the Left is now infiltrating the comment boards of conservative publications like they’re infiltrating town halls.

For all you liberals who want a universal “single payer” system: Are you willing to personally pay more taxes for that? Or do you want someone else to pay? The U.S. is not Denmark or Canada: We have 300 million people, and social problems those other countries don’t have like obesity/poor health habits and high poverty rates.

I would only support single-payer if recipients are required to WORK and pay into the system, or at least prove they are trying to find work if able to. Otherwise this is what will happen: People will quit their jobs, move in with their mom or bf/gf, sit on the couch getting high and scarfing junk food all day, watching Judge Judy and soap operas, while the rest of us pay for their “single payer” health care. Don’t think this doesn’t happen in Canada and European countries you think are so Utopian. (Some are already doing this here with the “Medicaid expansion.”) There are a LOT of people out there who simply don’t want to work and would leech off everyone else. Are you okay with that? Because I’m not, and this is where opposition to this kind of scheme comes from and it’s valid criticism.

As much as I hate the employer-based health system, it at least provides some incentive for people to try to find work and to remain working.

If single-payer is implemented, it should work like unemployment benefits: If you lose your job through no fault of your own and are trying to find another job, you keep your coverage. If you quit, you don’t.

#11 Comment By Richard Parker On March 26, 2017 @ 4:26 am

@Sam M

“Finally, I know it sucks… but at some point you HAVE to decrease entitlement spending. You just have to. It’s unsustainable.”

Or reduce military/intelligence spending,

#12 Comment By Lllurker On March 26, 2017 @ 8:37 am

Karen Harris on why single payer won’t work in the US: “We have 300 million people, and social problems those other countries don’t have like obesity/poor health habits and high poverty rates.”

So we Americans are just so fat that medical care won’t work on us? Do you have some figures to back that up? (Frankly I have been going a little gonzo with the pasta lately …)

And you think we are so impoverished that we just can’t afford medical care for our people? (Gosh I wonder how small our economy actually is? Ya think there might be a statistic for that somewhere?)

And because we have sick people … therefore we should not have medical care… (So THAT’S how the other countries do it — they only treat their healthy people! And we didn’t know that, no wonder our medical costs are so high! Well duh! But then how do they keep the sick people from finding out where the hospitals are? Do they hide them somewhere? And if you call 911 and the operator finds out you are sick, does she just hang up on you?)

“So obviously the Left is now infiltrating the comment boards of conservative publications like they’re infiltrating town halls.”

So apparently, in addition to having decided that fat people and poor people shouldn’t get medical care, you’ve also decided that only right wingers should be allowed to attend town halls.

I’m confused. Is this the website for The North Korean Conservative? The Iranian Consevative? The Martian Conservative?

#13 Comment By Sands On March 26, 2017 @ 8:44 am

Otherwise this is what will happen: People will quit their jobs, move in with their mom or bf/gf, sit on the couch getting high and scarfing junk food all day, watching Judge Judy and soap operas, while the rest of us pay for their “single payer” health care.

So you’re saying that the fear of losing health insurance is the only thing keeping hordes of people from from quitting their jobs and getting high all day? You need to get out more.

#14 Comment By Sam M On March 26, 2017 @ 9:17 am

Rod: Really good David French piece about why health insurance doesn’t necessarily mean better health: [4]

Richard Parker: No. that’s not and endless pot of money. We spend more discretionary money on defense than health, but mandatory entitlement spending on healthcare dwarfs defense spending. Also, your idea relies on the notion that we just need to spend more. But the US already spends way more. Why in the world does delivering a healthy baby cost $30,000?

#15 Comment By CatherineNY On March 26, 2017 @ 10:18 am

@Karen Harris, great posts, and I concur with this in particular: “The U.S. is not Denmark or Canada: We have 300 million people, and social problems those other countries don’t have like obesity/poor health habits and high poverty rates.” Our size, economy, society, demographics, culture and politics mean that the health systems of those countries are not workable models for ours. Health care systems generally grow organically out of those multiple factors. You can’t reverse engineer them. The German social insurance system was created by Bismarck to dampen interest in socialist approaches to welfare. It was adopted in the Netherlands and France under circumstances of war and occupation. The British NHS came out of the desperate economic circumstances of post-war Britain, which led them to turn to Labour for a wholly new approach to social welfare. The Canadian Medicare system grew out of simililarly unreplicable political and economic forces. Our own employer-based system came out of post-WWII union-company negotiations, and is no longer a suitable model for an information-age economy, much less one in which the kind of labor members who benefitted from the post-war compromise are now very likely to be unemployed. We need to take a clear-eyed look at what should be retained, and what should be changed, in our system, not look mistily at other countries whose systems cannot be duplicated in a country like ours. Coming here to insult those who would prefer reforms that build on the strengths of the market system is not a substitute for the hard work needed to accomplish real reform.

#16 Comment By CatherineNY On March 26, 2017 @ 10:24 am

@Sam M: “Why in the world does delivering a healthy baby cost $30,000?” Look for answers in the legal system, not the medical system. Our friendly neighbor to the north is able to keep costs for routine deliveries down in part because they have a very, very different legal system than our own — one our own trial bar would find much less plaintiff-friendly: [5] Excerpts: ‘Another deterrent, plaintiffs’ attorneys say, is that the Canadian Medical Protective Association is aggressive in defending its members because it is in the unique position of insuring virtually all of the country’s 76,000 or so doctors.”It’s different from the U.S., where you have a great number of private insurers, each with a different corporate mentality to litigation,” says Richard Halpern, a Toronto attorney.”Here, we don’t see nuisance payments to settle cases, we see where the CMPA is prepared to throw all the money at it to defend it no matter what it’s worth. Litigation in Canada is therefore very, very expensive, and there are very few plaintiff’s lawyers with the wherewithal to carry through with these cases.'”
The association’s legal fees have risen, but its track record is strong: Of the cases tried in 2007, judgments went in the patient’s favor 25 times and the doctor’s 70 times. The median amount of damages was about $91,000. Although Canada allows jury trials, the few cases that go to court are usually tried in front of a judge.”Some of my cases are too complex for a jury, and it does prolong the trial and use up a lot of resources,” Halpern says. “On the other hand, I do believe we don’t make enough use of juries. Juries may be more sympathetic, particularly when you do obstetric cases. There’s the sympathy factor.”
Halpern is awaiting a judge’s ruling in a case in which a baby was born with cerebral palsy because a nurse failed to realize the baby had been starved of oxygen in the womb. Halpern would be surprised if the judge awarded punitive damages.
“We generally don’t pursue that here in Canada because most medical cases involve negligence,” not intentional wrongdoing, Halpern says. “I’ve never seen a punitive damage award in a medical malpractice case.”‘

#17 Comment By CatherineNY On March 26, 2017 @ 11:48 am

Here is a very good article explaining that there is great variety in other countries’ health care systems: [6]

#18 Comment By Lllurker On March 26, 2017 @ 12:10 pm

“Coming here to insult those who would prefer reforms that build on the strengths of the market system is not a substitute for the hard work needed to accomplish real reform.”

Actually Catherine, in a way you’ve hit the nail on the head and maybe don’t realize it. We’ve now spent decades proving — decidedly — that market forces do not contain healthcare costs. You claim to be a bit of an insider in the healthcare field so maybe you’ve seen what I have. There are product categories in the medical field that are served by many providers and where the competition is as aggressive as what you will find in any other product category in the nation. Where the companies are as bloodthirsty as they can possibly be. Where companies routinely go belly up, where the big guys gobble up the little guys, and where the goods are commodified.

Yet none-the-less the products in those categories are and always have been overpriced.

You’ll hear the argument that this is because the markets are not free enough, or the markets are not transparent enough. It’s not a coincidence that when you trace those arguments back to the source, the source often has a financial interest in the game. Sometimes the argument comes from a person who has no idea what they are talking about but who does know how to parrot the talking points of others.

Meanwhile, as our system is bled of trillions of dollars, millions of our citizens aren’t getting adequate medical care. I’ve actually seen situations where people who live within walking distance of some of the nation’s finest hospitals cannot get medical care. And within this nation where much of the provider system is absolutely swamped with wealth it’s a disgraceful and morally depraved way to do things.

Especially depraved are the arguments that medical care should be one of the spoils, that medical care should be connected to productivity. The first people who who we should try to bring back into the system? Some of them are sleeping outside tonight, some are fighting demons in their heads, some are unable to do anything more than a make-work job on an intermittent basis. (IMO our system may be the most unfair to those who are only capable of intermittent work of which we have several million.)

As you are reading this there are people who _technically_ could qualify for some of our existing programs, but they’ll never get on them. They are sitting there right now staring at the forms and paperwork, forms that are of such a demanding nature, and part of a process that is so complicated, that in the end it just won’t get done. And the person won’t get the care they need. Seems unlikely? It happens all of the time, generally among the poorest and sickest and least sophisticated.

This has been going on for decades and it’s time to try things the other way. Maybe after we do it the other way for the next 50 years it’ll make sense to evaluate how things stand and give the “market forces control costs” approach another try.

By the way if yesterday’s bill passed nearly a trillion dollars in care would have been snatched away from those in our society who need it. And where would that money have gone? To those in our society who don’t want for anything.

#19 Comment By bob1968 On March 26, 2017 @ 12:30 pm

“So obviously the Left is now infiltrating the comment boards of conservative publications like they’re infiltrating town halls.” @Karen Harris

Looks like someone needs a safe space.

#20 Comment By JonF On March 26, 2017 @ 1:46 pm

Re: I see that you have no rebuttal to my factual point that medical professionals in the US — doctors, nurses, and the rest — are much better compensated than their counterparts in single-payer countries.

There’s no rebuttal, Noah, because you are right about that. But I don’t see how that translates into the conclusion “Therefore not everyone can have healthcare”. The US is also richer than most other nations, excluding some very tiny nations like Monaco and maybe an oil shiekdom or two. We can afford healthcare for all our citizens if we choose to and without impoverishing our medical professionals. We (and they) do however have to accept that reality that medical professionals cannot simply have carte blanche to increase their income without restraint gobbling up more and more of the economy. I don’t make what I would like to make either but the world will not crash and burn because I don’t. As always, Nothing In Excess.

#21 Comment By JonF On March 26, 2017 @ 1:54 pm

Catherine in NY,
Stop playing word games. There are no valid points to be made in splitting the quarks right out the linguistic hairs. Yes, many nations DO have universal healthcare under any reasonable definition of that term. You can deny it until the stars fall, but all you are doing is branding yourself someone with whom it is impossible to have a reasonable debate since you insist on trotting out your idiomatic definitions whenever you cannot find other means to make your point. What the flaming frack are you afraid of?

And along those lines David Frum has a very good “Wake up and smell the coffee, conservatives” post up at the Atlantic. See: [7]

#22 Comment By Siarlys Jenkins On March 26, 2017 @ 2:58 pm

They’re not complying with it because they know they can’t be turned away in the event they get sick. That is the fatal flaw of ACA and why it’s going down the tubes.

Obviously then, we need to put some teeth in the mandate, and enforce it vigorously. Sounds eminently conservative to me. No freeloaders.

#23 Comment By james On March 26, 2017 @ 3:22 pm

“If the people who sent Trump to Washington come to see him as having sold them out, we are going to be at a dangerous political moment.”

Not “if” but when. This Presidency will not end well.

#24 Comment By CatherineNY On March 26, 2017 @ 4:04 pm

Um, @JonF, I think you are having trouble distinguishing between “word games” and trying to bring a nuanced understanding of comparative systems to the very complex subject of health care reform. As for the Frum article, thanks for the link. Most of it is about how he was right, all the other conservatives were wrong, and he shouldn’t have been fired from AEI, which we’ve heard before, but this sentence is good: “Conservatives have a crucial role to play in shaping the future American health-care system to enhance and support enterprise, innovation, individual responsibility—to resist open-ended spending, state planning, and the risk that social insurance will penalize effort and success.” It’s also what @Noah172, @Karen Harris and I have been saying in this thread, so good to know that David Frum agrees with us.

#25 Comment By Noah172 On March 26, 2017 @ 4:52 pm

JonF wrote:

I don’t see how that translates into the conclusion “Therefore not everyone can have healthcare”

It translates into the conclusion that a shift to single-payer would not achieve the savings its advocates claim without an epic political struggle over provider payments (otherwise we’d have an epic political struggle over historic tax increases or historic reductions in non-health spending to pay for our new, even more expensive system).

We (and they) do however have to accept that reality that medical professionals cannot simply have carte blanche to increase their income without restraint gobbling up more and more of the economy

So how much of an income hit should health sector workers — doctors, nurses, pharmacists, technicians, home health aides, orderlies, and sundry other support staff — accept to make American single-payer stay within 12% of GDP (the top end of single-payer systems)? Give me a number, not a pretty little speech.

Nobody with political ambitions, not even Bernie Sanders, wants to suggest such a number, because to do so is career suicide. Sanders’ Vermont, BTW, tried to implement a single-payer system for the state, but abandoned the effort due to the gargantuan taxes or savage provider cuts which would have been necessary. The progressive voters who elected the Democratic governor who championed this initiative evenutally replaced him with a Republican. Bernie learned the lesson: his single-payer proposal during the primaries carefully avoided comment on provider payment.

#26 Comment By Lllurker On March 26, 2017 @ 6:17 pm

Noah: “…Give me a number, not a pretty little speech…”

Dude, get over yourself. You yourself have yet to respond to:

“And what’s this stuff about Trump “selling out”?
He made it clear a billion times that he was against Ocare. His core people weren’t expecting him to keep it in place. And he didn’t (IIRC) explicitly praise Ocare’s Medicaid expansion (although he said current beneficiaries would have a smooth transition to something new).”

Let’s see what I can recall just off the top of my head:

– Everybody will be covered
– The coverage in the new program will be much better
– Premiums will be more affordable
– Deductibles and copays will be lower
– The problem of counties only having a single insurer will go away

#27 Comment By mrscracker On March 26, 2017 @ 6:20 pm

Wow. I’ve personally been out of the loop for a little while but 3 of my daughters had babies last year and I d be surprised if they paid 30k each for the privilege.
I used to pay our midwife several hundred dollars plus some hamburger from butchering.
I traded meat to the doctor for blood work, too.
Hypothetically, it doesn’t have to cost anything to deliver a child. Women have done it on their own for eons. It’s not a disease, but obviously things can go wrong , so you want to have back up and be responsible. But $30,000 worth sounds a bit excessive. Guess I’ll have to ask my daughters what their bills were.

#28 Comment By Noah172 On March 26, 2017 @ 6:59 pm

Lllurker,

Trump wanted the House to pass an opening offer on health care so it could go to the Senate and be negotiated further. Even as he supported the House effort, he told Tucker Carlson that he would not sign a final bill that was unsatisfactory on breadth of coverage. When the House bill became too politically toxic even among the Republican caucus — precisely because it wasn’t meeting the goals Trump said he wanted from health reform — he killed the initiative.

Happy?

#29 Comment By mrscracker On March 26, 2017 @ 9:28 pm

Well, one of my daughters who lives in a rural area said hospital deliveries there start at 8 thousand dollars and midwives charge between $3,500. and $5,000.

#30 Comment By Siarlys Jenkins On March 26, 2017 @ 11:49 pm

I find a lot of common ground with CatherineNY, when she’s not channeling Grover Norquist or Jim DeMint. Unfortunately, health care financing and legislation can bring out the very worst in many people, and it gets hyperemotional, a lot of waving the flag of my tribe and to hell with the facts.

Anyone with the slightest sense of patriotism, common sense, and concern for the general welfare, would recognize, so we have this badly flawed statute that has made significant progress on a thorny problem we had argued fruitlessly over for some 20-30 years, and now we need to “bring a nuanced understanding of comparative systems to the very complex subject of health care reform.” That would mean small, specific pieces of legislation amending the existing law, carefully, and seeing what improves the net results, or what doesn’t.

But no, we have two brands of knee-jerk response. “Repeal Obamacare” because because because we really wanted it to fail because that would be Barack Obama’s Waterloo and his presidency would be a failure and we’re still addicted to repeal, or, preserve, protect and defend Obamacare, because because because, the Republicans are coming to take it away.

I definitely believe we should keep the mandate, and build on it a little bit. Its not much different than social security being mandatory. My late mother, the fiscally conservative Republican who advocated balancing the budget by making sure there was sufficient tax revenue to pay the bills, remarked that America is too soft hearted a country to kick an elderly person who hasn’t bothered to save anything for old age to the curb and let them die. So, since we’re going to be kind and take care of them, it is only right to require everyone to save something toward their retirement from their earliest working years.

Ditto for health care. Once we have a pattern established that EVERYONE pays into the health care financing system, we can also even out the premiums. No, old people don’t pay more, because when young, they didn’t pay less.

I also suggest that any employer that does not provide health insurance for its employees, should be taxed a portion of any tax credits their employees received. How much? The number of hours the employee actually works in a year, divided by (52 x 40), multiplied by the total amount of the tax credit. This will remove incentive to keep employees under 30 hours, or to prefer 100 half time employees to 50 full time. It will also level the playing field with businesses that do provide health insurance.

It would be even better to disassociate health insurance from employment, but that is a very long term goal. People aren’t going to stand for sudden and comprehensive changes like that.

A lot more should be done with offering a combination of true insurance for unexpected but catastrophic events, combined with health savings accounts to pay for more routine care. Possibly, done right, we could even have a portion of tax credits to subsidize the HSA, on some kind of matching basis against individual contributions.

There is a lot to be done reforming the way billing codes are used respectively by health care providers and insurance companies. I’ve found from personal experience that a routine visit to a primary care physician can suddenly be interpreted as a non-preventive treatment appointment for all kinds of arcane reasons, suddenly raising costs (at least to the patient).

And of course, the sheer idiocy of having cut-off points for tax credits, instead of a smooth sliding transition, needs to be fixed. This is where Democrats show that they too can be the stupid party. How better to set people at each other’s throats than to write the law so that a two dollar difference in annual income can make the difference between substantial tax credits and none at all? I think this would do a lot for the problems Fran Macadam has had.

I’m sure there are many other useful proposals. Let’s get them on the table, as proposed amendments and improvements to the big step forward that was the Affordable Care Act. (No, I won’t call it a Great Leap, not an the American Conservative).

#31 Comment By CharleyCarp On March 27, 2017 @ 2:38 am

Castlight’s data shows that the average national cost for a routine vaginal delivery is $8,775. The national average for c-sections is $11,525, according to the report, which defined price as what an employer-sponsored health plan paid for the delivery plus what the covered person paid out-of-pocket.

[8]

San Francisco is very expensive. Kansas City is cheap. Apparently it costs 10x as much to have a c-section in Los Angeles as Pittsburgh.

#32 Comment By peanut On March 27, 2017 @ 8:09 am

“Hypothetically, it doesn’t have to cost anything to deliver a child. Women have done it on their own for eons. It’s not a disease, but obviously things can go wrong , so you want to have back up and be responsible. But $30,000 worth sounds a bit excessive. Guess I’ll have to ask my daughters what their bills were.”

Historically, about 4% of women could expect dying giving birth, and about 1/3 of children died before reaching the age 6.

#33 Comment By peanut On March 27, 2017 @ 8:16 am

“Stop playing word games. There are no valid points to be made in splitting the quarks right out the linguistic hairs. Yes, many nations DO have universal healthcare under any reasonable definition of that term. You can deny it until the stars fall, but all you are doing is branding yourself someone with whom it is impossible to have a reasonable debate since you insist on trotting out your idiomatic definitions whenever you cannot find other means to make your point. What the flaming frack are you afraid of?

There are plenty ways of skinning that cat, ranging from Britain’s “everyone is state employee” to Singapore’s “forced medical savings” plans, but yes, every wealthy country in the world has medical plans that have 2 universal features:
1. Everyone is enrolled in some kind of universal program that provides low-to-zero cost medicine.
2. There is a whole range of services for people who can afford more: from supplementary insurance to concierge medicine to medical tourism.

#34 Comment By peanut On March 27, 2017 @ 9:24 am

“So how much of an income hit should health sector workers — doctors, nurses, pharmacists, technicians, home health aides, orderlies, and sundry other support staff — accept to make American single-payer stay within 12% of GDP (the top end of single-payer systems)? Give me a number, not a pretty little speech.

The obvious answer to this question is that sure, we can’t bring back spending to 12%, but we can stop it getting to 25%. The now-deceased AHCA meant to cap Medicaid expenditures, knowing that even if you can’t cut the program in absolute dollar terms now, you could slowly reverse its growth over the years. Any real health reform that goes beyond Obamacare could do something like that with provider payments- slow down their growth to something like the general rate of inflation via, yes, price controls. Since, as you point out, American providers get paid vastly more than their counterparts, this will hardly trigger an exodus. And yes, this would cause a tytanic struggle, and can happen only federally, because no state is strong enough fiscally or politically to do anything of the sort, but, you know, difficult things require struggle. Drastically curtailing imports from China would require a tytanic struggle and disruption of market mechanisms and hurt exporters and retailers and farmers, but I suspect you would be all for it..

#35 Comment By icarusr On March 27, 2017 @ 9:29 am

Dear Mr. Dreher:

I have studiously avoided making comments over the past few months, though I do occasionally visit to see how things go.

This was interesting post, and a few enlightening comments, as always. And then I come across a line like this:

“So obviously the Left is now infiltrating the comment boards of conservative publications like they’re infiltrating town halls.”

“Infiltrating”. As if the willingness of those of on the “Left” to read and comment on a conservative writer’s work, and to engage with our political opponents, is some sort of treason. The use of the “infiltrating” is insidious in many other way – it requires “rooting out” and …

Congratulations on the success of your book. I trust your Benedict society will not be afraid of a few old liberals “infiltrating” it 🙂 …

Peace be with you.

#36 Comment By Fran Macadam On March 27, 2017 @ 10:38 am

“As always, Nothing In Excess.”

Not in the Exceptional Nation. As has been said before, most Americans believe that if something is worth doing, it is worth overdoing.

#37 Comment By JonF On March 27, 2017 @ 2:04 pm

Re: But $30,000 worth sounds a bit excessive.

Medical costs can vary enormously across different areas, but that sounds extreme to me too– assuming we are talking about a simple, uncomplicated birth. Add some complications and I can easily see the bill hitting that.

Re: It translates into the conclusion that a shift to single-payer would not achieve the savings its advocates claim without an epic political struggle over provider payments

Noah, I don’t disagree with that much. And in fact I am skeptical that a true single payer plan (e.g., the Canadian system) would be possible in the US. Given my druthers I’d go with something like Germany’s healthcare funds, though I suspect it might be easier to transition to something like the French system (tightly regulated, non-profit insurance combined with a national catastrophic plan attended to by the government).

Re: Give me a number, not a pretty little speech.

Since I am not arguing for single payer I see myself under no obligation to provide a number. I may or may not have said it here before (I have been arguing this topic a lot over on Bloomberg so cannot recall what exactly have said where): We cannot hope that provider incomes will decline in any absolute sense (in that much I agree with you); we can however seek a way going forward where provider incomes will be constrained to rise no faster than the general rate of service sector inflation.

Catherine,
I agree Frum is tooting his own horn a bit. But one thing Frum said that I think is key (and I have said this here before): the rank and file Republican voter does not want “free market health insurance”. S/he wants something like the long-time deal most people had under employer-provided insurance: modest deductibles and copays, and low co-premiums (the employer of course paid the bulk of the coverage cost). The ACA does not do that, hence the one good rational reason many people dislike it. But RyanCare would have made things even worse, often vastly worse, on that front. Trump seemed to understand this in the past. His embrace of RyanCare was a major blunder on his part. He should have called Ryan and his confederates onto the Oval Office carpet, told them he’d veto the monstrosity and they should get back to work on something acceptable to the American people (or at least their own voters).

#38 Comment By mrscracker On March 27, 2017 @ 2:48 pm

peanut,
For sure, historically childbirth like everything else had higher risk involved. Ditto for succumbing to childhood diseases.
Things can still go wrong in spite of all our advances That’s I why I chose a registered nurse midwife to deliver my children.
But the point was that it’s a natural function which for the majority of women doesn’t require intervention. Otherwise the human race would have died out a long time ago. And unnecessary intervention brings its own set of risks.

#39 Comment By icarusr On March 27, 2017 @ 5:13 pm

JonF

“And in fact I am skeptical that a true single payer plan (e.g., the Canadian system)”

There are a lot of misconceptions about the Canadian system. Some points of clarification:

1. There is no “single payer” in Canada. Health is provincial matter; Parliament sets broad guidelines and that, only for block grants to supplement provincial spending. In Canada the idea that the federal government would be responsible for a single health care payer would be anathematic, to say the least.

2. The health budget is set at the beginning of each year by each province. All rates of payment to doctors and nurses are in turn negotiated. And each year the government sets the terms of what it will pay for through the health insurance system. At a minimum, this covers essential health services at no cost or co-pay to the patient with no maximum.

3. There is no “rationing” in the sense that you are entitled to two hospital visits a year, and then no more. So any talk of rationing, for those of use who grew up in a war zone and had to suffer through rationing, is idiotic.

4. There are services you must pay for – like cosmetic surgery. There are services you can pay for to get them faster. But I and others in my family have gone through the health care system for various treatments and surgeries, and the system functions very well. It is quite quick for emergencies, but for “elective surgery” there are weight times. Such is life.

5. I now live in a country where I have to have private insurance. The insurance company gets to vet my scans before I do them. I never had that problem in Canada. So I can have elective MRI tomorrow, instead of four months from now, but some insurance bureaucrat sitting in London gets to decide whether it is justified; never had that in Canada. Insurance companies are in the business of making money; they make money by reducing pay outs and maximizing premiums. Anyone who talks about “gub’mint controlling health care” and so one is talking through their hat – health care is always controlled, and personally, I’d rather it be through parliaments and budgets I vote for rather than insurance companies I have no control over.

6. And that thing about “market” imposing disciplines of whatever kind … for one thing, markets are there to increase demand, not control expenditure. Perverse in the field of health care. For another, markets are not in the business of preventing service delivery; health care policy should have prevention as a pillar. Finally – and this is really for the average non-college educated Trump voter – how often do you comparison shop when you need emergency care or hospital stays?

#40 Comment By JonF On March 28, 2017 @ 6:30 am

Re: The insurance company gets to vet my scans before I do them. I never had that problem in Canada. So I can have elective MRI tomorrow, instead of four months from now, but some insurance bureaucrat sitting in London gets to decide whether it is justified; never had that in Canada.

I would be very surprised if there are no pre-auths for complex procedures in Canada. This is pretty much universal practice these days: Our public programs (Medicare and Medicaid) do as much too. It’s puts a check on providers who might be tempted to do extraneous stuff to pad their bills– yes, there are doctors who operate that way. And no., it is not “some bureaucrat” making the decision but rather someone with a medical degree (often an RN) who understands what is going on*. The [process is usually invisible to the patient– the paperwork is done by the doctor’s office and the payer and you never see it unless there is a problem.

* I worked for a benefits admin company 2003-06. We had four RNs on staff and one MD consulting to handle our pre-auths. These were trained skilled people, not paper pushers. (the nurses were people who were a bit burned out from actual nursing and wanted a break from it for a while in vase you are wondering)

#41 Comment By icarusr On March 29, 2017 @ 4:34 am

JonF:

For anything on the list, the “pre-auth” is done by the doctor him or herself, who:

* has no interest in the scans being done (so there is no risk of padding); and
* is taught about the public health care system from year one in med-school.

Pre-auth is required in Canada where the procedures are novel, costly and uncertain. (Almost all “scandals” in my province are the result of someone being denied full or partial reimbursement for an expensive, experimental and uncertain Hail Mary treatment offered in Tucson or Albany by a private clinic.)

I’m not questioning the need for pre-auth, and I am not questioning the integrity of the people doing them. What I am saying is that what people call “rationing” in Canada is normal practice by insurance companies – no matter how competent or expert. On the whole, I’d rather have the democratic control that I do not have with private insurance companies.