The ObamaCare debate is not about who gets a free ride and who pays the bills. We know who gets the free ride. We know who’s “privileged” to pay the bills. The debate is about arranging healthcare so those who pay don’t get in line ahead of those who don’t pay. We were promised repeal but, put simply, ObamaCare II remains just another way to force working people to subsidize non-working-and-never-will-work people. It’s also to the benefit of the insurance companies who wrote it, natch.
“The people comparing the Republican health plan to what Obamacare said it was going to do are like if passengers on Titanic lifeboats complained that the menu on the Carpathia the next day wasn’t going to be as good as what they had been promised on the Titanic.” â€“ David Forsmark on FB.
New healthcare proposals would result in bridge and command crew keeping access to Medbay, but security personnel being forced to make their own provision.
Members of Starship crew who are â€˜statistically most likelyâ€™ to be shot, stabbed or sprayed by hypnotic plants will have to supply their own cover for treatment of alien parasites in their skulls after Starfleet brought in new healthcare directives yesterday.
Crewmembers who spend their time being beamed to hostile planets have been told that being sent on an away mission into the unknown terrors of a hostile and uncaring universe is being reclassified as a â€˜pre-existing conditionâ€™, meaning they will not be entitled to Medbay treatment should the entirely predictable happen.
Hat tip to Karen L. Myers.
Avik Roy is a graduate of Yale Medical School who has published extensively on the problems of America’s current health system and Health Care Reform.
Republican and conservative leaders failed the cause of free-market health reform in three principal ways. First, they failed to make a moral case for replacing Obamacare, as opposed to purely repealing it. As a result, they then failed to unite the hard-line and pragmatic wings of the GOP around a coherent health-care-reform proposal. And due to the ambitions of the 100-day legislative agenda, and the peculiar legislative calendar associated with the Senateâ€™s reconciliation process, they chose not to invest the time in getting health-care reform right.
Conservatives intuitively understand the moral case for repealing Obamacare. The law significantly expands the role and scope of the federal government in determining Americansâ€™ personal health-care choices. Its individual mandate is a constitutional injury. And its Rube Goldberg-like maze of insurance regulations has made health insurance unaffordable for millions.
But when it came to replacing Obamacare, Republicans usually presented the case in exclusively political terms: Replacement was necessary because the alternative would be daily front-page stories of the millions thrown off of their health-care plans by the GOP Congress. Conservatives rarely attempted to make a moral case for replacing Obamacare. Indeed, if you believe that the federal government has no legitimate role in helping the uninsured afford health coverage, your intuition is that there isnâ€™t a moral case for replacing Obamacare. …
That intuition is understandable, but mistaken, because it is in fact the federal government that has made health insurance so costly through seven decades of unwise policies. Those policies include the exclusion from taxation of employer-sponsored health insurance, an outgrowth of World War II-era wage controls. They include the enactment of the Great Society entitlements, Medicare and Medicaid, in 1965. They include the EMTALA law, signed by President Reagan, that guaranteed free emergency-room coverage to everyone, including the uninsured and illegal immigrants. And they include Obamacare.
This seven-decade pileup of federal intervention in the health-care system is directly â€” and exclusively â€” responsible for the astronomical costs of the present-day American health-care system. It is not right, when confronted with such a state of affairs, to shrug our shoulders and say â€œtough luckâ€ to those who canâ€™t afford insurance. Indeed, we have an affirmative duty to reform federal policies so as to make health insurance once again affordable for the working poor.
Read the whole thing.
Robert Tracinski explains why repealing Obamacare is such an uphill battle. When you replace Conservatism with Populist Nationalism, you’re lacking the necessary conviction to oppose the Welfare State.
If you want to know why Republicans have bogged down, notice one peculiar thing about the Obamacare debate so far. Itâ€™s not really a debate over Obamacare, itâ€™s a debate over Medicaid. Thatâ€™s because Obamacare mostly turned out to be a big expansion of Medicaid. The health insurance exchanges that were supposed to provide affordable private health insurance (under a government aegis) never really delivered. They were launched in a state of chaos and incompetence, and ended up mostly offering plans that are expensive yet still have high deductibles. Rather than massively expanding the number of people with private insurance, a lot of the effect of Obamacare was to wreck peopleâ€™s existing health care plans and push them into new exchange plans.
Ah, but what about all those people the Democrats are claiming were newly covered under Obamacare? A lot of themâ€”up to two-thirds, by some estimatesâ€”are people who were made newly eligible for a government health-care entitlement, Medicaid. But shoving people onto Medicaid is not exactly a great achievement, since it is widely acknowledged to be a lousy program.
Conservative health care wonk Avik Roy explains why: â€œ[T]he programâ€™s dysfunctional 1965 design makes it impossible for states to manage their Medicaid budgets without ratcheting down what they pay doctors to care for Medicaid enrollees. That, in turn, has led many doctors to stop accepting Medicaid patients, such that Medicaid enrollees donâ€™t get the care they need.â€ Partly as a result, a test in Oregon found no difference in health outcomes between those with access to Medicaid and those without.
Then again, a massive expansion of Medicaid fits perfectly with the preferences of the welfare statistâ€™s boosters: lousy free stuff from the government is better than good stuff you pay for yourself.
Yet notice this hits a big Republican weak spot, one I suspect Obamacareâ€™s promoters knew about all along. Obamacare just boils down to an expansion of an old, existing, traditional government entitlementâ€”and Republicans are lousy at rolling back traditional entitlements. …
Democrats create new entitlements, then Republicans reform them. Democrats get all the credit for showering us with benefits, and Republicans accept the role of the mean-spirited accountants who tell us we just canâ€™t afford it. …
[As to the existing bill:] Pradheep Shanker sums it up nicely when he describes the Obamacare replacement bill as a piece of legislation with no ideological point of view.
My biggest complaint about this bill is that there really is no governing philosophy in its writing. It neither pleases conservatives nor moderates. It makes half measures to increasing patient choice, but retains taxes such as the Cadillac tax, while at the same time maintaining the employer based health insurance system. It doesnâ€™t maximize federal support for the poor, nor does it fully adopt the free marketâ€¦. The muddle created by the GOP here makes it very difficult to make a sound, concise argument regarding specifically what their goal is.
That makes sense, in a way. Itâ€™s a bill with no governing philosophy for a party and a president who have no governing philosophy.
Read the whole thing.
Kurt Schlichter has a message for President Obama and the Congressional GOP leadership.
When Paul Ryan and his congressional clown car of alleged conservatives surprised us by just sort of dropping Obamacare Jr. on us, I wasnâ€™t surprised to see them trip all over their Guccis during the utterly inept roll out. These nimrods couldnâ€™t effectively communicate to Elizabeth Warren with smoke signals. But even I was shocked at how transcendently crappy their proposed Obamacare replacement is. Let me put it this way: the only thing that steaming pile of failure would be good for is as the key prop in a very specialized, niche German porno film.
Seriously, how many times do we have to tell you? Obamacare must die. Kill it dead â€“ with fire!
When are you going to get it through your wonk spheres that we donâ€™t want a government-led health care system that leaves the people who infest D.C. in charge? We donâ€™t need a â€œplanâ€ because 85 percent of us already have a plan â€“ itâ€™s called â€œTaking responsibility for supporting ourselves and our families like damn adults.â€
Yeah, we really mean it when we say we want Obamacare gone. DOA. Kaput. Call it over to the mob bossâ€™s house under the pretense that itâ€™s going to be made, then shoot it through the face so its mother canâ€™t give it an open coffin at the funeral.
Are you feelinâ€™ us now?
Ross Douthat, speaking evidently from the irredentist #NeverTrump Right, points out that merely winning one election is no guarantee of the creation of a durable political movement. Policy success matters, and the American Health Care Act, intended to repeal and replace Obamacare, so far, does not seem to represent any such thing.
After the 1976 election, the Democratic Party seemed to enjoy a commanding position in American politics, with Jimmy Carter ensconced in the White House, a Senate supermajority and an advantage of nearly 150 seats in the House of Representatives. Yet over the next four years the Democrats achieved little of consequence, Carter passed into history as a failure, and Ronald Reagan ushered in a lasting rightward realignment.
I have compared Donald Trump to Carter before, but with the release of the House Republican â€œreplacementâ€ (I use that term loosely) for Obamacare, itâ€™s worth returning to the analogy. It rests, in part, on the work of the political scientist Stephen Skowronek, who argues that certain presidencies are â€œdisjunctiveâ€ â€” straddling a political order passing into history and another one struggling to be born. And â€œdisjunctiveâ€ generally means ineffective, because the parties such presidents are leading are likewise trapped between past and future and unable to unify and act.
Carter is Skowronekâ€™s prime disjunctive example, and a variety of writers, including Corey Robin and Dylan Matthews on the left and Reihan Salam on the right, have recently argued that Trump fits the role as well.
Just as Carter sensed that the New Deal-Great Society coalition was no longer viable and campaigned against certain liberal orthodoxies in â€™76, so in 2016 Trump offered a vision of the G.O.P. as a nationalist â€œworkers partyâ€ in which certain Reaganite pieties would no longer set the terms of conservative debate.
But just as Carterâ€™s mix of proto-New Democrat centrism and old-school liberalism never translated into a workable congressional agenda, Trumpâ€™s bridge to a new conservatism will crumble if his party canâ€™t agree on policies that fit his vision.
The health care debate makes this danger particularly clear.
Read the whole thing.