This is what American spirit looks like. This is what American anger looks like. This is what American Resistance looks like.
A New Jersey constituent stands up and verbally slays Republican House Rep McArthur calling the Congressman out on his Trumpcare vote, his lies, his working with Paul Ryan and other lawmakers who don’t care and his hypocrisy.
If you accept the premise that everyone should have basic healthcare, providing that boils down to how to finance the entitlement. I am surprised that I have not seen the financing point made by policy experts or by the media (maybe I am not looking hard enough).
However the argument between Republicans and Democrats was not about financing healthcare. The two parties have different objectives: provide for universal healthcare versus reducing taxes and giving tax breaks to higher income groups.
The Trump / Republican’s repeal and replace is a smokescreen to create something federal-budget cheap that looks like universal healthcare. The problem is all of the plans to date would leave millions uninsured. If the debate had been framed as contrasting objectives, healthcare versus tax breaks, the reason for the gridlock would have been obvious and the debate would have been, at least, honest.
In any case Krugman has nice piece on alternatives for providing universal coverage, single payer versus alternatives to single payer: What’s Next for Progressives? In this article, Krugman also discusses the need to “focus on other holes in the U.S. safety net.”
A quote to motivate reading the entire piece:
Now what? Maybe, just maybe, Republicans will work with Democrats to make the health system work better — after all, polls suggest that voters will, rightly, blame them for any future problems. But it wouldn’t be easy for them to face reality even if their president wasn’t a bloviating bully.
And it’s hard to imagine anything good happening on other policy fronts, either. Republicans have spent decades losing their ability to think straight, and they’re not going to get it back anytime soon.
The Sanctimony and Sin of G.O.P. ‘Moderates’. Krugman chronicles John McCain’s actions of the past few days.
In case you haven’t been following the story, what has been going on in the Senate these past few days is one of the most shameful episodes in that body’s history.
We don’t know yet how all this will turn out, but one thing is clear: McCain has been a crucial enabler of the Senate’s shame — and a world-class hypocrite to boot.
- On Tuesday, he cast the decisive vote allowing this whole process to proceed, with no Democratic votes. Then he gave a sanctimonious speech denouncing partisanship and divisiveness, and declared that while he voted to allow debate to begin, he would never vote for the existing Senate bill without major changes.
- And later that day, he voted for that very bill, even though, you guessed it, it hadn’t changed in any significant way.
- On Thursday, Senate leaders reportedly threw together a new bill that would totally restructure health care — health care! — over lunch, to be voted on within a few hours.
- And three senators, including McCain, declared in a press conference Thursday afternoon that they would indeed vote for this “skinny reform” — but only if assured that the House would go into conference rather than simply passing it. That is, they were willing to vote for something they know is terrible policy, as long as they were assured that it wouldn’t actually become law. The dignity of the Senate, 21st-century style.
- Credit where credit is due: two senators, Lisa Murkowski of Alaska and Susan Collins of Maine, have stood up against the effort to betray every promise Republicans have made — and McCain did something right in the end. But every other supposed moderate in the Senate has offered a profile in cowardice.
And the bottom line:
You might ask, why not just vote no and try to come up with actually good policy? Because, as they also know, Republicans don’t have any good policies to offer, so a bum’s rush is the only way they can pass anything. And, until that last-minute vote, McCain, who has demanded a return to “regular order” in the Senate, turns out to be perfectly willing to help the bums get rushed.
A July 24 NYT’s article has looked at the key numbers in six of the proposed Republican healthcare plans as analyzed by the CBO.
In terms of the number of uninsured, there is little difference among the plans. The biggest difference is the impact on the deficit (the ten year estimated savings range from $119 billion to $473 billion).
One of the most important variables — how many people would be without health coverage — is essentially the same in five of the plans that repeal and replace the Affordable Care Act. Those plans would increase the number of uninsured by more than 20 million people in 10 years.
The uninsured would increase by more than 30 million people under a sixth plan, a partial repeal of the Affordable Care Act with no replacement. This plan is similar to a 2015 repeal bill that was vetoed by President Barack Obama in 2016.
Another crystal clear piece on from My Favorite Keynesian: what Trump and some Republicans are trying to do to healthcare, Health Care in a Time of Sabotage
- First, the administration is weakening enforcement of the requirement that healthy people buy coverage.
- Second, it’s letting states impose onerous rules like work requirements on people seeking Medicaid.
- Third, it has backed off on advertising and outreach designed to let people know about options for coverage.
Hard-core libertarians, for example, don’t believe making health care available to those who need it is a legitimate role of government; letting some citizens go bankrupt and/or die if they get sick is the price of freedom as they define it.
But Republicans have never made that case. Instead, at every stage of this political fight they have claimed to be doing exactly the opposite of what they’re actually doing: covering more people, making health care cheaper, protecting Americans with pre-existing conditions.
We’re not talking about run-of-the-mill spin here; we’re talking about black is white, up is down, dishonesty so raw it’s practically surreal. This isn’t just an assault on health care, it’s an assault on truth itself.
Will this vileness prevail? Your guess is as good as mine about whether Mitch McConnell will hold on to the 50 senators he needs. But the mere possibility that this much cruelty, wrapped in this much fraudulence, might pass is a horrifying indictment of his party.
Republican Politicians and Trump are masters at using words to deceive the actual implications of policy actions. No so much with numbers. The house healthcare bill is a good example. In an earlier post I attempted to put in context the pittance of money they were throwing at the problem to justify taking away healthcare for millions of Americans that depend on the ACA – $8 Billion over five years for “High Risk Pools.”
I learned many years ago, while working in the Office of Secretary of Defense for Systems Analysis, that quantifying consequences is critical for laying bare the implications of misleading / self-serving political statements.
Beware of what the Senate Republicans are saying and trying to get through. The Republicans and Trump are attempting to drastically cut Medicaid and make other changes that will take away healthcare for millions of Americans and increase costs for the rest of us. All of this to justify giving a tax break to wealthy people.
Look at the facts and consequences:
- Roughly 70 million Americans depend on Medicaid.
- Medicaid’s costs per beneficiary are substantially lower than if covered by private insurance. Specifically, a Kaiser Family Foundation issue brief sited research results that total healthcare estimated spending would increase nearly 26 percent, from $5,671 per person per year to $7,126, if a typical low-income Medicaid adult were covered by private health insurance for a full year. In addition, total health care spending would increase 37 percent, from $909 per child per year to $1,247, if a low-income Medicaid or CHIP-enrolled child were covered instead by private health insurance for a full year.
- The Center For Budget And Policy Priorities, in Frequently Asked Questions About Medicaid, reported that “Medicaid’s costs per beneficiary are substantially lower than for private insurance and have been growing more slowly than per-beneficiary costs under private employer coverage.”
- We are waiting to hear from the CBO on the latest assessment of the Senate bill, but it is almost certain to report that (1) 20 plus million people will lose healthcare coverage provided through Medicaid and other ACA provisions, (2) The insurance industry will get a pass on providing coverage for people with pre-exsiting conditions, (3) the state insurance markets will fail, (4) insurance rates will increase for everyone except perhaps for young adults, and (5) we will continue to have the most inefficient healthcare system in the western world — one that consumes over 20 percent of our 10 trillion dollar economy.
These are the facts but they will not be in the Republican or Presidential statements and press releases.
This is worth reading. I hope Trump and the Congressional Republicans read it!
If some version of the Republican reconciliation bill to repeal and replace the Affordable Care Act (ACA) squeaks through both the Senate and the House after the July 4 recess, it will be the first major health care law created by Republicans without a single Democratic vote.
Republicans who care about the future of their party should ask themselves whether they want their label on an unpopular, cobbled-together bill that satisfies neither conservatives nor moderates and is easy for opponents to demonize. Do Republicans really want to be sole owners of a law that deprives millions of working class Americans of health coverage, risks destabilizing health insurance markets, hands huge tax benefits to extremely wealthy people, and is opposed by virtually all health provider organizations?
As I have written previously, a single payer system would be less costly and preferred to the ACA or the Republican replacement. But the political reality is not there so we are faced with the alternative, the three legs of insurance-based healthcare. as explained by Krugman: Three Legs Good No Legs Bad.
So the Affordable Care Act went for incrementalism — the so-called three-legged stool.
It starts by requiring that insurers offer the same plans, at the same prices, to everyone, regardless of medical history. This deals with the problem of pre-existing conditions. On its own, however, this would lead to a “death spiral”: healthy people would wait until they got sick to sign up, so those who did sign up would be relatively unhealthy, driving up premiums, which would in turn drive out more healthy people, and so on.
So insurance regulation has to be accompanied by the individual mandate, a requirement that people sign up for insurance, even if they’re currently healthy. And the insurance must meet minimum standards: Buying a cheap policy that barely covers anything is functionally the same as not buying insurance at all.
But what if people can’t afford insurance? The third leg of the stool is subsidies that limit the cost for those with lower incomes. For those with the lowest incomes, the subsidy is 100 percent, and takes the form of an expansion of Medicaid.
So what does Krugman have to say about the Senate bill:
First, they’re dead set on repealing the individual mandate, which is unpopular with healthy people but essential to making the system work for those who need it.
Second, they’re determined to slash subsidies — including making savage cuts to Medicaid — in order to free up money that they can use to cut taxes on the wealthy. The result would be a drastic rise in net premiums for most families.
Finally, we’re now hearing a lot about the Cruz amendment, which would let insurers offer bare-bones plans with minimal coverage and high deductibles. These would be useless to people with pre-existing conditions, who would find themselves segregated into a high-cost market — effectively sawing off the third leg of the stool.
So which parts of their plan would Republicans have to abandon to avoid a huge rise in the number of uninsured? The answer is, all of them.