Re: Proposed changes to ACA in the Senate bill

by Idéfix Thu Jul 13, 2017 4:45 pm

Old wine, old bottle, old label, new number penciled in on the label:

http://nymag.com/daily/intelligencer/2017/07/the-more-trumpcare-changes-the-more-it-stays-the-same.html

by MaxEntropy_Man Mon Jul 17, 2017 10:21 pm

http://www.cnn.com/2017/07/17/politics/health-care-motion-to-proceed-jerry-moran-mike-lee/index.html

Senator Turtle in 2009: Our top political priority over the next two years is to deny President Obama a second term.

by confuzzled dude Tue Jul 18, 2017 6:19 am

Idéfix wrote:Old wine, old bottle, old label, new number penciled in on the label:

http://nymag.com/daily/intelligencer/2017/07/the-more-trumpcare-changes-the-more-it-stays-the-same.html

They have been harping for 7 years, telling the whole world how pathetic ACA is; all along without reaching any consensus among themselves as to what the alternative should be, they didn't even had an alternative other than alternative facts, for crying out loud. That sounds like very patriotic, very republican style of patriotism; kill the poor/innocent and then blame others for that.

by Idéfix Tue Jul 18, 2017 9:25 am

confuzzled dude wrote:
Idéfix wrote:Old wine, old bottle, old label, new number penciled in on the label:

http://nymag.com/daily/intelligencer/2017/07/the-more-trumpcare-changes-the-more-it-stays-the-same.html

They have been harping for 7 years, telling the whole world how pathetic ACA is; all along without reaching any consensus among themselves as to what the alternative should be, they didn't even had an alternative other than alternative facts, for crying out loud. That sounds like very patriotic, very republican style of patriotism; kill the poor/innocent and then blame others for that.

Republicans in Congress voted more than 50 times to repeal Obamacare when Obama was president. They were able to do that because they were counting on Obama to veto it. They were freeloading on Obama. Over those years, they did not do the hard work to propose a credible alternative that 50 of their senators can support. They were too lazy to do the hard work, so scored political points simply attacking Obamacare.

Republicans in Congress are lazy freeloaders.

by MaxEntropy_Man Tue Jul 18, 2017 9:52 am

They own whatever happens to healthcare now, just like Obama was made to own the consequences of the two wars. It won't help them to keep saying the ACA was Obama's baby. They are now faced with the unpalatable prospect of propping up a law they hate more than anything else.

by Idéfix Tue Jul 18, 2017 10:08 am

MaxEntropy_Man wrote:They own whatever happens to healthcare now, just like Obama was made to own the consequences of the two wars. It won't help them to keep saying the ACA was Obama's baby. They are now faced with the unpalatable prospect of propping up a law they hate more than anything else.

So the hot new idea is to pass a repeal now, with an effective date two years out, with no replacement in that bill. If Republicans are so smart that they can figure out a replacement in the next two years, something they have been too lazy to figure out in the last seven years of constant attacks on Obamacare, why don't they pass the repeal in two years when they have the replacement figured out?

by MaxEntropy_Man Tue Jul 18, 2017 10:11 am

Idéfix wrote:
MaxEntropy_Man wrote:They own whatever happens to healthcare now, just like Obama was made to own the consequences of the two wars. It won't help them to keep saying the ACA was Obama's baby. They are now faced with the unpalatable prospect of propping up a law they hate more than anything else.
So the hot new idea is to pass a repeal now, with an effective date two years out, with no replacement in that bill. If Republicans are so smart that they can figure out a replacement in the next two years, something they have been too lazy to figure out in the last seven years of constant attacks on Obamacare, why don't they pass the repeal in two years when they have the replacement figured out?

All a big fucking show. Here's what I think -- even the extreme right wingers like Mike Lee and Rand Paul are afraid of the consequences of repealing the ACA. So they stake out a position so far to the right that it has no prayer of passing. That way they'll never be on record as taking away healthcare from the needy and can keep their tea party base vote.

by Idéfix Tue Jul 18, 2017 10:17 am

They will have a vote on repeal-only, likely with an effective date of 2021. Paul, Cruz and Lee will make noises about that not being fast enough, but they will vote yes. I don't know if at least three of Collins, Murkowski, Heller, Portman and Capito will stand up for their constituents.

by MaxEntropy_Man Tue Jul 18, 2017 10:19 am

Straight repeal is dead on arrival. The names you mentioned will vote against it.

by Idéfix Tue Jul 18, 2017 1:19 pm

I hope you are right.

Capito put out a statement that gives me a little dash of hope:

"I did not come to Washington to hurt people... My position on this is driven by the impact on West Virginians. With that in mind, I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians."

It is "SAD!" that more than 40 of the 52 Republican senators did go to Washington to hurt people. Incidentally, Capito was one of the Lazy Freeloaders who voted to repeal Obamacare in 2015.

Collins has already said no to repeal-only, so just one more Republican needs to stand up to kill this harebrained idea. We are looking at you, Heller, Portman and Murkowski.

by Idéfix Tue Jul 18, 2017 1:21 pm

Looks like Murkowski also said no McConnell's Plan A, which is now Plan C, is dead.

https://www.nytimes.com/2017/07/18/us/politics/republicans-obamacare-repeal-now-replace-later.html

by MaxEntropy_Man Wed Jul 19, 2017 5:15 am

The only senators to have openly come out against McConnell's latest straight repeal effort are all women.

by Idéfix Wed Jul 19, 2017 11:47 am

Mitch McConnell is really good at show-votes. He acquired his reputation based on orchestrating show-votes and no-votes. He failed his first real test in governance, passing Obamacare repeal-and-replace, so he wants to proceed with a show-vote on repeal, although three senators have already said they will vote no on the motion to proceed.

https://www.theatlantic.com/politics/archive/2017/07/the-paradox-of-mitch-mcconnells-repeal-only-vote/534129/

by smArtha Wed Jul 19, 2017 1:51 pm

This whole health care debate is silly and stupid to put it mildly. Firstly, why propose repealing of a system when a) you have not see it fail badly or b) why repeal something that you have not thought of a working substitute for yet.

Now some basics to look at
1) How much does it cost (on average) for a person's health care annually?
2) How much will the actual costs be (simulation of demand supply affordability economics needed) if no insurance companies are needed
2a) My take is that the current health costs are more due to insurance than if left for the market place of providers, consumers and affordability decided it
3) Can we guarantee total coverage for children <15 and elders >75 for every ailment - regular cold/flu to life threatening ones? What are the costs for that segment
4) Can the 15-75 year range folks be universally covered with an insurance that triggers after a certain out of pocket expense - say $500/$1000 a month?
5) Is it not some stats and arithmetic to arrive at a maintainable solution instead of mixing ideologies and agendas of needless stake holders?

by Idéfix Wed Jul 19, 2017 3:53 pm

smArtha wrote:This whole health care debate is silly and stupid to put it mildly. Firstly, why propose repealing of a system when a) you have not see it fail badly or b) why repeal something that you have not thought of a working substitute for yet.

It is entirely self-serving. The Obamacare system is market-based, and it is based in conservatives ideas from the Heritage Foundation. They first proposed it as a strawman alternative when the Clintons were pushing for universal coverage in the 1990s. Obama called their bluff, turned their strawman into a law that helps millions. They have no real grounds to oppose it other than short-term politics. This is why no matter how hard they bang their heads they can't come up with a workable alternative that is cheaper or provides more coverage.

smArtha wrote:1) How much does it cost (on average) for a person's health care annually?

Per-capita GDP is $56k and about a sixth of the economy is healthcare, which is over $9k annually per capita, so I think $10k is a good high-level estimate for that average.

smArtha wrote:2) How much will the actual costs be (simulation of demand supply affordability economics needed) if no insurance companies are needed

If you have single-payer, costs will go down. This will lower the cost of medicines and eliminate insurance profits, but it will also hurt shareholders and employees of pharma and insurance companies.

smArtha wrote: 2a) My take is that the current health costs are more due to insurance than if left for the market place of providers, consumers and affordability decided it

There was a recent study on this just looking at California. That study concluded that the amount the state spends on healthcare would reduce by up to 10% under a single-payer system.

smArtha wrote:3) Can we guarantee total coverage for children <15 and elders >75 for every ailment - regular cold/flu to life threatening ones? What are the costs for that segment

We already guarantee coverage for people over 65 with Medicare. It is not "total" coverage because things like long-term care and dental care are not included. Long-term care for people over 65 with no disposable assets is covered under Medicaid. As for children, Medicaid covers the children of poor people, and CHIP covers uninsured children of moderate-income parents. But it is not guaranteed universal coverage.

I think we should guarantee universal coverage for everyone under 18.

smArtha wrote:4) Can the 15-75 year range folks be universally covered with an insurance that triggers after a certain out of pocket expense - say $500/$1000 a month?

Like I said above, we have a path to get there. But most children today are covered through a parent's employer's group plan.

smArtha wrote:5) Is it not some stats and arithmetic to arrive at a maintainable solution instead of mixing ideologies and agendas of needless stake holders?

Conservatives do not agree that we should seek to guarantee universal coverage. Even for children and old people. Their starting position is that government should not do anything in health, that we should dismantle Medicaid and Medicare, not require people to buy insurance, let insurers deny coverage to people with preexisting conditions, and in general let the markets rule. The Republican party is now dominated by people who believe in this. The Democrats put pragmatism ahead of ideology and enacted a market-based maintainable solution, but Republicans seem unwilling at the moment to abandon their quest for ideological purity that may kill millions.

by smArtha Wed Jul 19, 2017 4:43 pm

Idéfix wrote:

Conservatives do not agree that we should seek to guarantee universal coverage. Even for children and old people. Their starting position is that government should not do anything in health, that we should dismantle Medicaid and Medicare, not require people to buy insurance, let insurers deny coverage to people with preexisting conditions, and in general let the markets rule. The Republican party is now dominated by people who believe in this. The Democrats put pragmatism ahead of ideology and enacted a market-based maintainable solution, but Republicans seem unwilling at the moment to abandon their quest for ideological purity that may kill millions.

Thanks for the quick summary of the facts on this. So it seems Universal Coverage is not(or never) part of GoP agenda. Something that Democrats should go to town educating the electorate about. In fact, democrats should state their goals on this in as simpler terms as possible so that the 'best of trumptards' can digest it.

Health Insurers cannot be part of the objectives or goals of a Health Care Plan. They can be part of its implementation. 10% discounting to me seems way less for a single payer system. IMO, savings will be much more. In India, with a higher Patient to Provider ratio, the costs seem much cheaper (even factoring in the PPP) too. And for all practical purposes it is a Single Payer system and so the market is purely decided by Supply-Demand-Affordability economics.

Pharma is another trying to get a big bite on this. Their claims are around costs of drug discovery and returns on them before Generics are allowed. Would the economics be much better, if all research on Health Care - Diet/Nutrition, Causes, Symptoms, Ailments, Treatment Methods - Drugs, Chemical/Natural/Herbal/Hybrid everything is outsourced to the Universities and funds granted towards that for labs, augmenting staff for scientist or professors and research scholars etc? Universities can be allowed to globally collaborate with other educational and research institutes towards this. Pharma companies can then be restricted to the business of manufacturing, sales and distribution. Some long term sustainable royalties can be paid by Pharma to the respective Universities they source the Formulas from.

by Idéfix Thu Jul 20, 2017 1:35 pm

smArtha wrote:Thanks for the quick summary of the facts on this. So it seems Universal Coverage is not(or never) part of GoP agenda. Something that Democrats should go to town educating the electorate about. In fact, democrats should state their goals on this in as simpler terms as possible so that the 'best of trumptards' can digest it.

Yes. Democrats did an awful job of messaging the big picture on Obamacare. Obama chose to harp on "if you like your plan you can keep it." Instead he should have focused on what he talked about during the 2008 campaign: that government does need to play a role in solving the problem of 15-20% of Americans not having healthcare. Other Democrats did even worse.

One good thing about this GOP push to repeal the ACA is that it clarified the difference on goals. The Democratic talking points should be: Republicans don't care about everyone having healthcare.

smArtha wrote:Health Insurers cannot be part of the objectives or goals of a Health Care Plan. They can be part of its implementation. 10% discounting to me seems way less for a single payer system. IMO, savings will be much more.

May be so. If only CA does single-payer, the savings percentage will be lower than if the whole country does it. That's because of pharma pricing. So the opportunity is likely bigger at the national level.

smArtha wrote:Pharma is another trying to get a big bite on this. Their claims are around costs of drug discovery and returns on them before Generics are allowed. Would the economics be much better, if all research on Health Care - Diet/Nutrition, Causes, Symptoms, Ailments, Treatment Methods - Drugs, Chemical/Natural/Herbal/Hybrid everything is outsourced to the Universities and funds granted towards that for labs, augmenting staff for scientist or professors and research scholars etc? Universities can be allowed to globally collaborate with other educational and research institutes towards this. Pharma companies can then be restricted to the business of manufacturing, sales and distribution. Some long term sustainable royalties can be paid by Pharma to the respective Universities they source the Formulas from.

Republicans will call this proposal socialism. I do believe the market does a good job of allocating resources, so would leave the job of pharma innovation to the private sector. But pricing should be negotiated. Did you know that even when Medicare (i.e. the federal government) buys prescription drugs for the old people it covers, the law specifically prohibits it from negotiating prices with pharma companies? Big pharma successfully protected that prohibition during the Obamacare negotiations.

by Idéfix Thu Jul 20, 2017 2:58 pm

Idéfix wrote:
smArtha wrote:1) How much does it cost (on average) for a person's health care annually?
Per-capita GDP is $56k and about a sixth of the economy is healthcare, which is over $9k annually per capita, so I think $10k is a good high-level estimate for that average.

Apparently our predisent thinks healthcare costs $1 a month.

Pre-existing conditions are a tough deal. Because you are basically saying from the moment the insurance, you’re 21 years old, you start working and you’re paying $12 a year for insurance, and by the time you’re 70, you get a nice plan. Here’s something where you walk up and say, “I want my insurance.” It’s a very tough deal, but it is something that we’re doing a good job of.

by smArtha Fri Jul 21, 2017 12:57 pm

Seriously!! This man's idea of Poor is on the lines of ..
"Poor people have poor cars, poor bungalows, poor maids and poor chauffeurs and they holiday at poor resorts while globe trotting in economy class of poor airlines ...."

by Idéfix Sat Jul 22, 2017 2:19 pm

MaxEntropy_Man wrote:The only senators to have openly come out against McConnell's latest straight repeal effort are all women.

Proposed changes to ACA in the Senate bill - Page 2 ?url=http%3A%2F%2Fstatic.politico.com%2F6c%2Fde%2F731b65b4457c8507b8f9b5ecf14c%2Fwuc170720-1160

by Idéfix Tue Jul 25, 2017 3:29 pm

Capito changed her mind about not going to DC "in order to hurt people."

Now that Pandora's box has been opened, I am afraid they will squeak through a repeal that will hurt at least 20 million people. All so that rich people can get a tax cut. If that's not hurting people, I don't know what is.

by Idéfix Wed Jul 26, 2017 4:01 pm

So, now that both repeal-and-replace (The Mean Bill) and repeal-only (The Meaner Bill) are dead, what next?

Apparently the Republicans in the Senate now want to cripple the nation's healthcare system. They are labeling it skinny repeal, but what it does is to eliminate the individual and employer mandates. If you remove those mandates, people don't buy insurance until they need it. If they can get insurance when they get sick, the insurers will have to raise premiums. As premiums go up, more people will drop insurance. So this will set the death spiral that they WANT the country's healthcare system to go into.

https://www.washingtonpost.com/powerpost/senate-embarks-on-new-round-of-voting-to-peel-back-affordable-care-act/2017/07/26/a7206f62-71e8-11e7-9eac-d56bd5568db8_story.html

by MaxEntropy_Man Wed Jul 26, 2017 4:25 pm

If they do the skinny repeal and remove employer mandates dems have an immediate platform for 2018 and beyond.

by Idéfix Fri Jul 28, 2017 12:35 am

Sneaky repeal is dead. By just one vote. The turtle is tearing up now.

by Idéfix Fri Jul 28, 2017 1:02 am

Dogs chasing car for a long time catch it. They get in and try to drive. They can't figure it out.

Incoming tweet storm from Twit-in-Chief... I look forward to enjoying it when I wake up.

by MaxEntropy_Man Fri Jul 28, 2017 12:01 pm

LOLOLOLOLOLOLOLOLOLOLOLOLOLOLOLOLOLOLOLOL!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

ROTFLMAO!

by Idéfix Fri Jul 28, 2017 2:39 pm

Cryin' John called it in February!

http://www.nbcnews.com/politics/politics-news/meet-man-who-predicted-gop-s-obamacare-mess-n787501

"In the 25 years I served in the United States Congress, Republicans never, ever, one time, agreed on what a healthcare proposal should look like. Not once," Boehner said at a health care conference in Florida at the time.

"All this happy talk that went on in November and December and January about, 'Repeal, repeal, repeal, yeah, we’ll do replace, replace,' I start laughing. Because if you pass repeal without replace, first, anything that happens is your fault. You broke it," he added.

by confuzzled dude Sun Jul 30, 2017 10:23 am

By the end of the process, Senate Republicans were in the absurd position of begging House Speaker Paul Ryan for assurances that he would not let the House pass the bill the Senate was sending them.

This never made a lick of sense: If Senate Republicans didn’t want the bill they had released to become law, and they wanted to write a better one instead, why didn’t they abandon the bill they didn’t want to become law, and write a better one instead? How would involving the House — and giving up control over both the policy and the process — make their job easier or the final bill, in their eyes, better?

There was never an answer to these questions. The bill was garbage, and the process was nonsense. And 49 Republican senators voted for it anyway.

It’s important to remember that the Senate did not just reject one health care bill during this process. It rejected, depending on how you count, three, four, or maybe even five.

There was the American Health Care Act, which passed the House but was considered dead on arrival in the Senate.

There was the original version of Majority Leader Mitch McConnell’s Better Care Reconciliation Act, which would have failed on the floor and so was yanked back for revisions.

There was the Ted Cruz-ified version of the Better Care Reconciliation Act, which gutted insurance regulations (including preexisting conditions) and was defeated in a 43-57 vote.

There was the Obamacare Repeal and Reconciliation Act, which would have repealed Obamacare without specifying a replacement, and which failed 45-55 on the floor.

And then there was “skinny repeal” — the Health Care Freedom Act, which would have repealed the individual mandate but left the Medicaid expansion.

https://www.vox.com/health-care/2017/7/28/16055284/gop-massive-health-care-failures-explained

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