Walter Russell Mead urges Republicans to think in the longer term:
The Republicans have fallen into a trap. The problem with American healthcare isn’t the way it is paid for, at least not in the short term. The problem is that our bloated system is too inefficient so that it costs too much no matter how we pay for it.
Thus, healthcare policy has to involve two things: A short-term system to help people navigate the current disaster, and a plan to make the system sustainable over time. Obamacare “repeal†should be about temporary reform of the worst features of the law—especially regulations that are unnecessarily cementing bad things into the system.
The long-term cost problem wasn’t created by Obamacare, and it won’t be undone in a single piece of improvised legislation keeps the law’s structure but makes the taxes and transfers less progressive.
In national politics two years ahead is long term thinking. It brings to mind what a boss of mine once said: “If I start engaging in that kind of long term thinking, next month there will be somebody else at this desk thinking in the short term.”
Next let’s ask a room full of cranky toddlers to read Critique of Pure Reason and offer their own insights.
I was always pretty confident the GoP would overreach in a narrow, incompetent way, but they have exceeded even my low expectations for them. They seem poised to do what the Democrats did for Obamacare, only the result is likely to be worse for everyone to include the GoP.
It’s been amusing watching Republicans and conservatives treat the idea of insurance like it’s a logical paradox. “If the set of all sets can not include itself, people, then I ask how it is possible for a young man to pay for a sixty-year old woman’s mammogram?”
Forget about any kind of rational analysis. Both parties are consumed by internecine warfare.
The Democrats still haven’t resolved the battle between its leftist base and the practical wing that is interested in winning elections. That started in about 1968 – remember the Chicago convention.
The Republicans are split between the “establishment” (read moneybags) and the populists. There is nothing so vicious as a family feud.
Nothing is going to happen until after the 2018 election.
I have believed two things since the initial debate on Obamacare:
1) It was the best deal anyone could have gotten given political reality, contra many voices here.
2) Health care had been permanently moved from private problem to government problem.
The proof of #1 is the fact that the GOP could not come up with a plan that was not catastrophically worse.
The proof of #2 is the fact that we are now, still, living with Obamacare.
Related, I’ve said the psychopath in the White House was incapable of persuasion beyond his base. As proof of that: today.
And I’ve insisted, contra many, that Paul Ryan was an empty suit, a pretty boy with a head full of stuffin’. As proof: also today.
Finally, I’ve said again and again that core GOP ideas were not capable of meshing with reality. Once again: today.
The unkind Josh Barro tweets that Paul Ryan should pursue his true destiny as a Men’s Wearhouse model.
Janis:
Is there still an open slot on Dancing With The Stars?
But this failure does none of us any favors. People are basically living with high-priced catastrophic care.
michael reynolds ; is,
Still name calling.
I guess its what you do when its all you’ve got.
Yeah, we Democrats are all desperate now, name-calling and so on.
Your president just got his ass kicked. The Great Negotiator couldn’t manage a negotiation with his own party. And your Speaker is trying to pick his balls up off the floor. You know why? Because they are both exactly what I said they were. Point by point, I’ve been nothing but right. I have literally never been more right.
And over the next couple of months we’re going to start putting Trump’s boys in jail, one by one. Flynn, Manafort, Stone, Sessions, Price, and eventually Cheeto Jesus himself.
Mushrooms, or whiskey, Michael?
I didn’t realize it for a while since work has been busy, but I was just blown away when I realized that their focus was on passing the repeal and replace on the anniversary date of the CA just so it wold look cool. Rather than take the time to craft a bill that could be supported, they prioritized symbolism. What a bunch of idiots.
Steve
Steve:
Oh, you could not be more wrong. Haven’t you read Guarneri’s brilliant riposte? These guys are geniuses who – according to the genius-in-chief – only failed because Democrats wouldn’t get on board with repealing the signature Democratic initiative.
The Donald brought his famous deal-making skills to it and was only tripped up because he knew nothing – nothing, nothing at all – about the subject. Or about the politics.
Who knew health care was so complicated? No one! No one knew that!
Michael- Elections have consequences, so I expected that if the GOP passed something regarding health care, I probably would like it. However, it really never occurred to me that they would not be able to get a bill out of the House. They own the place. I assumed that they would fall in line behind something, after a fairly long, angry debate. Health care is hard, even when you mostly agree. I never expected this as i assumed it would just fail in the Senate.
Also, on a meta-level it is worrisome as I had assumed that the grown-ups in the GOP would be a counterweight to Trump. Looks like that is not happening. To be fair to Trump, which hurts of course, he didn’t really know much or care about health care (like most policy). This really could have been driven by Ryan and Price. Still, you would have expected someone to stop this. Have to agree that his trying to blame the Democrats was beyond funny. Wonder if he was using mushrooms since he doesn’t drink?
Steve
Steve:
There’s an interesting piece at Politico. http://www.politico.com/magazine/story/2017/03/obamacare-vote-paul-ryan-health-care-ahca-replacement-failure-trump-214947
A couple of telling grafs:
Completely unprepared. Trump doesn’t have the intellectual heft or attention span to understand policy issues. Never has, never will. Not on this or on taxes or on trade or foreign policy.
That would be Mark Meadows, chairman of the Freedom Caucus. That was the Great Negotiator at work, making it impossible for his most important potential ally to support him.
I can’t get past long division when it comes to math, but I am seldom wrong in spotting stupid. Trump is as much an empty suit as Paul Ryan, and anyone who thought differently was being conned by two not-very-good con men.
Yes, the republicans blew their healthcare repeal/replace promise and plans. However, being there were so many errors in it’s creation, processing and sell-job, I’ll just let the progressive regulars here continue to have fun jeering and jesting about it’s humiliating demise. Nonetheless, just because this flawed piece of legislative gruel — the AHCA — didn’t make it to the winner’s circle, the reality of “their” flawed piece of legislative gruel — the infamous PPACA — remains listing and in the process of sinking as they snark away at the republicans’ contentious efforts going nowhere..
Powerline’s short commentary, though, brings such a reality more into focus by cautioning that the Democrats Celebration (may) be Premature.
“Democrats are stuck with the Obamacare they passed. It won’t be reformed, and it will limp along for the time being. But the day will come, before long, when Obamacare’s collapse is so complete and so manifest that repeal will be revisited. In the meantime, I see no reason why Republicans should take the hit for the Democrats’ disastrous overreach.”
I think some of the remaining health insurance companies were waiting to see if the Obamacare stone could be lifted off their shoulders by the GOP, rescuing them from the PPACA mandates and onerous regulations, before totally pulling out of the remaining exchanges. Now, though, leaving more states with fewer to no options will happen with alacrity.
As for the expanding number of medicaid patients, grateful for the ownership of a health insurance card, in 2015 only about 67% of physicians took medicaid patients, while 45% of doctors merely took in “new” medicaid patients. That number of attending physicians will shrink as time goes on, premiums and deductibles for the “Unaffordable” Obamacare will rise, and health care for the masses will steadily erode. That is my prognosis for the offensive progressive’s Obamacare that dems so valiantly circled their wagons around, in order to support the PPACA’s ideological health care framework, and secure, for an indefinite length of time, the legacy of their former president — President Obama.
Yes, Jan we’re all gonna die! Only, the thing is, Ryan’s plan would have knocked 24 million people out of the market, and it’s going to take a hell of a long time for Obamacare’s ‘implosion’ to do a tenth of that damage.
In the meantime, Jan, health insurance is now seen as an entitlement, and when is the last time you saw an entitlement really lose ground? The GOP nightmare has come to pass, Jan, the people have chosen to have imperfect government supported health insurance rather than none, and they see it as a right. The people will push back on benefit cuts. And the GOP will be just as brave as they always are in cutting entitlements.
Michael, health care for many will get more difficult to either readily obtain or pay for. The CBO’s 24 million number you cited was a successful canard in scaring people by not differentiating those who voluntarily opted out of health insurance coverage from those who involuntarily couldn’t qualify for it.
Choice, though, is something not valued or oftentimes considered in progressive legislation (except in abortion references). If the numbers don’t work just force people into compliance is their compassionate arm twisting methodology. It really makes no differnce how incoherent, substantially flimsy, or unreasonable progressive policy constructs are in gaining their strong societal footholds. Rather, like you emphasised, health care has now been successfully defined as a “right” by the left, and any attempts to modify it into a more workable, more responsible medical model will probably require a healthcare “crisis” effecting most everyone.
jan- That number is about par for Medicaid. What is interesting is that if the proposed market reforms actually worked, then Medicaid fees would be the norm.
Still, aren’t you the least bit concerned that they priority here was trying to pass your bill on a special day rather than try to get it done correctly? Look, you guys won. Elections have consequences. Why can’t your team actually work with itself?
This deserves its own box. Remember all of those claims about how the Democrats would not work with the GOP? This makes those claims awfully weak. The GOP cannot work with its own party, more or less anyone else. Boehner couldn’t get them to come together on anything but meaningless votes to repeal Obamacare. Now, they can’t do the real thing.
Michael-Yes, it is all about Trump. The real reason to pass the bill was to help Trump, not help voters. This has come as surprise to almost half of the country. Sad!
Steve
I’m beginning to think healthcare distribution, which is really what we are talking about, is too big for the federal government and should be allocated to the states, by per capita medicaid funds distribution with no strings attached except it be used to pay for medical care.
Fifty states as laboratories to see what works best, and emulated by the rest.
Steve, The whole GOP health care attempt was a fiasco as far as I’m concerned. It mirrors how the dems passed their own troubled version on Christmas Eve. Furthermore, trying to pass it on the anniversary of the PPACA may have had a symbolic advantage, but did little for actually achieving a substantive policy that would be mutually condoned by all factions of the the R party, as well as be well received by the public at large.
Personally, though, I don’t know if such a broad goal, making everyone happy, is possible. Nonetheless, I’m still giving both parties an F for honesty, competence, and really looking out for the people rather than their own hide.
“Fifty states as laboratories to see what works best, and emulated by the rest.”
Romney considered his Romneycare to be such a test in one state, the state of MA. In one of his many speeches for the presidential nod I remember him advocating for each state to create their own kind of HC, likening such trials as 50 separate laboratories to see what works best. But, that obviously didn’t happen, and what we now have is one big, fat old government bureaucracy which calls the shots for everyone. Big brother in the flesh! Orwellian in how it all works.
Orwellian.
Jesus H. First, read the book. Second, try to understand what the adjective ‘Orwellian’ means before you use it. I mean, unless the screaming irony was intentional.
“It mirrors how the dems passed their own troubled version on Christmas Eve.”
No, it didn’t. The Democrats spent a year working on their bill. They had actually been working towards it before they even won the presidency. They managed to make the necessary compromises to get enough people to vote of the bill. The two processes were nearly opposite, not mirrors.
As to the 50 states thing, I have long lamented that more states are not willing to innovate with health care. The ACA actually makes it easy to do so, but states weren’t doing it before the ACA and they aren’t doing it now either. Having been involved the health are debate for a long time, even taking a stab at trying to write some policy for our Congressman (Republican), I can tell you that when I suggest that individual states try to address healthcare via market reforms, the most common response by conservative health care wonks is that it won’t work because if you generate lower costs i mean slower salaries of health care workers, and they will leave that state.
Steve
Republican Senator Tom Cotton:
Now, Jan, you can keep arguing your echo chamber points with Cotton.
Save the bytes. There’s a nice line from Veep that pretty much sums up arguing with Jan: It’s like explaining gravity to a chicken.
Just a few more observations:
– I think the big fail here is with the GoP Congress. It will rub off on Trump, of course, but he really didn’t have much to do with this bill besides try to sell it. We’ll see if he learned any lessons on dealing with Congress.
– The GoP actions made no sense to me, not even politically. I think they are actually lucky this didn’t pass – it was such a terrible bill. Ryan is not going to last long as speaker. I’m not sure how this will affect the GoP long-term (ie. 2018 elections), it’s probably better for them to fail this hard early.
– We’ll now find out if the ACA will go into a death spiral. If it does, some kind of action will have to be taken but I have little confidence this Congress could address it adequately. Normally a bipartisan group of moderates would get together and hammer something out, but I’m not sure there are enough left and neither party has shown much interest in bipartisanship when it comes to health care policy. Anything substantive will require Democratic support, at least in the Senate, where the filibuster will still exist.
Just read some comments on this article about Trump’s agenda by Robert Draper.
Here’s one of the comments:
Every rule that government makes that impacts your life, for better or worse, removes a bit of freedom. The fact is that the free market which allows the accumulation of untold wealth must also allow unfettered economic catastrophe. And so, anyone who cannot independently afford healthcare or education or housing or food or…should not be artificially supported voluntarily or involuntarily by others. It goes against nature.
So that’s a deep strain of Republican thought. I’ve never seen any proposals from the right that extended beyond HSAs, selling insurance across state lines and tort reform. That’s what they have to offer.
That article:
https://www.nytimes.com/2017/03/26/magazine/trump-vs-congress-now-what.html?smprod=nytcore-iphone&smid=nytcore-iphone-share
Steve, our memories have recorded different impressions of how Obamacare got through.
Yes, it was a longer work-in-progress bill, as they simply couldn’t get enough “yeses” on board sooner. But, it was not “compromises” that eventually got the needed votes, it was arm-twisting, horse trading, and broken abortion funding promises, to people like Bart Stupak, that finally was able to squeak the vote by unilaterally, resembling the distasteful “sausage-making” process that went on with the recent AHCA bill. And, yes the president did go around the country trying to inform people about the merits of the bill — such as the $2500 reduction in premiums and the whole “like your Dr keep your Dr” mantra, which proved to be total lies. Re: your comments, though, about the 50 state laboratory – they make sense, as so much of the high cost of healthcare is derived from the number of procedures performed, whether or not the pt. needs them.
However, the Obamacare propaganda and misinformation generated to pass the PPACA, IMO, falls into the descriptive universe of Orwellian practices, as does the denial of truth, when all those false statements were sworn by Obama and dem operatives to be true. Furthermore, the current Trump administration — whether you hate or love him — has been plagued, early on, by a rash of unproven accusations and private phone conversation leaks, all leading to speculation about the possibility of untoward surveillance (Orwellian) aimed at the current administration. The questioning of such inappropriate actions only gains traction when you link it to Obama expanding surveillance powers right before leaving office (20 days before Trump’s inauguration, corresponding to when the leaks first started to appear). This executive action resulted in a greater ability to share raw intelligence with a far greater number of people and agencies. Some say there was even the possibility of said intelligence being downgraded in it’s classification in order to be shared with more people. It should be unsettling stuff, even for democrats.
Jan:
I was wrong to engage you. Sam’s right. You are no longer in touch with reality.
Burn, baby, burn.
This is becoming more amusing than I thought possible. Hopefully, the Right will begin holding march-athons against the Democrats for refusing to play the reindeer games.
Republicans claimed that they wanted to get rid of Obamacare, but they were willing to vote with the Democrats to keep `it. They bitched and moaned for 8 years, but it turns out that “there isn’t a dime’s worth of difference between the two parties.” Who could have known?
If President Trump has any sense, he would bring in any Democrats, and then, it really would be Obamacare-lite. His blaming Democrats was just being nice to the Republicans. If he really thought that it was their fault, he would be a tad bit more animated, but anybody with a few brain cells knows it was Republicans who sunk it.
I am going to help out all you “free market this and free market that” conservatives. People who were counting on the Republicans to fix the problem are not going to blame Democrats when their insurance and medical bills arrives with an astronomical price increase. They wanted healthcare fixed.
The Republicans claimed that they could fix it, but all the voters got were Republicans blathering on about their “principles”. People do not want health insurance. They want health care.
Also, I would not plan on President Trump being fazed by this.
You win, TastyBits.
@Dave Schuler
I hope you have not become as cynical as me. I am a contrarian, but you have probably figured that out by now. If nobody was optimistic enough, I would fill in to balance out things.
I am sick and tired of the whole debate. Progressives aggravate me by being alive, and Republicans aggravate me with their slightly less assholishness. They both are clueless to how the world really works, but usually, the Right does not have riots to get their way.
Few people have any idea of how the system works if you need to pay out of pocket. @steve has touched on it, but when you need an MRI or CT scan, your ideology gets tossed out of the window. If we had a market based approach, I doubt that our famous fiction writer or PE investor could purchase the level of healthcare they expect out of pocket.
While I disagree with our famous fiction writer, he is not completely wrong (don’t tell him I said that.) In the US there is an expectation of getting an education with some degree of government assistance – public school system. To my knowledge, this is no right to being educated by a government run system, but somehow, the country has not slid into a Marxist regime.
The US is rich enough to be able to provide a basic level of healthcare to all citizens. Healthcare being the key concept, and public education being the model (or the UK system). As to the cries of socialism and nationalism, I am willing to bet that few of these people fear the public education system, and most of them would have a heart attack at the mention of actually paying for education.
(For my stepson’s grammar and high school education, I used the free-market capitalist system, and it was not cheap. As far as I am concerned, anybody who uses the public education system is a socialist.)
Prior to hurricane Katrina, New Orleans has had a Charity Hospital in one form or another, and it ain’t the paradise envisioned by the Left or Right. There was a means test, and if you passed, you got a plastic “Charity card”. I do not think that there we any private or semi-private rooms, but if there were, they were not for the people with a “Charity card”.
There were clinics and wards (just like in those old black-and-white photos). The emergency room wait period could be as long as 12 to 16 hours, and as more serious patients were delivered, you would be bumped accordingly. It was not all sunshine and rainbows. It sucked, but it was better than nothing.
(The Charity ER trauma care was one of the best in the US, but they got anybody that could not pay. At one time, you had a good chance of living by making to Charity alive, but you would not have the prettiest scars. On the other hand, you would have wonderful looking scars at the other hospitals, but you would most likely be a corpse.)
I get tired of this nonsense because it is not that difficult, but it should be blindingly obvious that the insurance model is not working because of a lack of competence or inclusion. It is conceptually flawed.
A restaurant targeting horses who desire a fine dining experience is probably not going to work very well no matter how much free-market capitalism is applied. Instead of being labeled inane, the Right argues that better service would make it work, and the Left argues that the restaurant owner is charging too much. Trying to fix it is insane.
For healthcare, we have one side proposing a free-market insurance system, and the other proposing a single-payer insurance system. At some point, there will be a public health system. It may be 500 years after the Decline and Fall of the United States of America, but the day will come. These people will look back at today’s debate as we look back at medieval debates.
There is so much in this debate that is conceptually or actually wrong with what is wrong and the fixes, and there is no way to debate either side in a rational argument (objective logical reasoning). The free-market capitalists refuse to even attempt living according to their beliefs, and the other side refuses to being subjected to the systems they create.
I wish anybody good luck trying to fix it.
Now, I will switch back to the monetary and financial systems. Each side’s arguments have the same flaws as the health insurance debate, but I know more about monetary and financial topics.