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"TrumpCare" 1.0 Fails to Pass the House, Leaving "ObamaCare" Intact for the Time Being


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"How the GOP Health Care Failed Without a Vote" by Veronica Stracqualursi and Adam Kelsey on abcnews.go.com

This is a historical thread about an issue of significant national importance; not a partisan thread, except whatever partisanship exists by its very nature. Please reply thoughtfully - it's perfectly fine to discuss the bills themselves, their contents, the implications of this, etc.

For example, if someone wanted to draw a parallel between Trump saying "The Democrats now own ObamaCare" and, in a reverse situation, a Democratic President - who just retracted a bill because (s)he couldn't get the votes - saying "The Republicans now own Climate Change," or, "The Republicans now own Mass Shootings," and back up the assertion up with some substance, that would be perfectly legitimate.

Likewise, President Trump asserting that he acted as a "team player," yet he didn't get a single Democratic vote. What, exactly, did he do to show that he was acting as a "team player?" And, on which team was he playing? See, "teams" involve an "us vs. them" mentality, which is inherently partisan. Larry Bird was the ultimate team player, and you can bet that in every single game he played, he wanted to crush the life out of his opponents - especially Magic Johnson and the Lakers. So, can anyone produce some evidence that President Trump was representing "Team USA" as opposed to just "The Republican Team?" If so, please lay it out for us - I'm not familiar with the contents of the bills.

Let's keep this discussion on a high level - there's too much fighting and name-calling on the internet, and I believe we can do it. And if not, we at least have this marker as a historical record of an important news event.

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There were two options: repeal or repeal and replace.  By doing the repeal and replace, trump tried to save the best parts of Obamacare, but the conservatives want no part of Obamacare.  The Dems didn't help trump either because they want Obamacare intact.  So now we'll see if Obamacare can survive on its own.  As usual, to achieve the best result people need to compromise but none seem willing.  

I think Obamacare was based on sound economic principals.  If insurance has to be provided to everyone, then it makes sense that everyone must buy insurance.  Obamacare didn't go far enough to require participation of the young and healthy.  The young would rather pay the penalty than buy insurance, so the insurance companies had no choice but to raise premiums on the old and the sick.

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The current Congress was handed a relatively new car that needed a tuneup and a few minor repairs.

Instead, they decided they wanted a new car. But the car they wanted to buy was a 30-year-old Yugo for the price of a Joint Strike Fighter.

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11 hours ago, Ericandblueboy said:

I think Obamacare was based on sound economic principals.  If insurance has to be provided to everyone, then it makes sense that everyone must buy insurance.  Obamacare didn't go far enough to require participation of the young and healthy.  The young would rather pay the penalty than buy insurance, so the insurance companies had no choice but to raise premiums on the old and the sick.

I think this is probably correct.  The premiums going up are due almost entirely to the well:less well ratio in the current pools being too low.  I do think the current plan is likely to hit a downward spiral as the administration has already announced that they won't enforce the current penalties against going uninsured.  That's only going to make the problem worse.

The larger problem is that we as a whole still pay (and pay more) for those without insurance.  Emergency rooms are required to provide care regardless of ability to pay - the cost of which is absorbed by those of us that can pay - either on our own or through insurance.  Neither party has any interest in removing that requirement.  In the end, paying for primary health care at urgent care and primary health care providers is just a much better use of money.

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Folks, I'm hopeful we can discuss the plans without using the R-word or the D-word; if not, maybe it's best to stay on the sidelines, and maybe Trump is right: ObamaCare will implode going forward, and renegotiation will be forced back to the surface.

Meh, I thought we could do this, but maybe we can't.

And just as I type that, zgast comes up with something that might prove me wrong.

I get it that this is, in reality, a partisan issue, because there are two proposals, each being owned by one of the parties. I do get it, but let's not make it a partisan issue *here*. There's so much that I don't know about, and would love to learn, but let's please keep this discussion based on truth and not belief. Science and not faith. Issues and not political persuasion.

Nobody of good conscience wants to see anyone else be sick or impoverished - can we start here? This doesn't mean those things aren't going to happen; it just means you don't want to see them happen.

I can easily see someone worth $100 million saying, "Screw you, leave me alone, I can take care of myself." But that's not a solution, and people aren't going to stand for it. This is exactly how rulers, dictators, tsars, and kings get overthrown by force, and it's how dynasties come to an end.

3 hours ago, zgast said:

The larger problem is that we as a whole still pay (and pay more) for those without insurance.  Emergency rooms are required to provide care regardless of ability to pay - the cost of which is absorbed by those of us that can pay - either on our own or through insurance.  Neither party has any interest in removing that requirement.  In the end, paying for primary health care at urgent care and primary health care providers is just a much better use of money.

My brother is a physician (and without making *any* reference to my brother), there are simply too many people taking too much money out of the medical profession, whether they're physicians who don't accept insurance and charge $700 for a consult (I'm pretty sure I could list a dozen of them for you in the DC area off the top of my head), or big pharmaceutical companies charging $2,000 a month for medications needed to treat chronic issues. 

Clearly, there are two types of people working on this lake: The type pouring water into the lake, and the type hauling water out of the lake, and I think a lot of people hauling water out of the lake are using really big trucks - because they can, and they do so with zero guilt. 

And I'm not just talking about wealthy people - there are people taking ambulances to the ER when their kid has the sniffles because it's free for them. Also with zero guilt. I was a Big Brother, and I witnessed this with my own eyes, and simply could not believe it. I actually heard a mom recount to me her having called 911, and having an ambulance come and take her and her child to the ER, for something that was almost surely a common, mild, respiratory virus, because she didn't have a car, she didn't have health insurance, and she would have had to pay for a bus and also for a doctor's visit; instead, they got free transportation and free treatment (and free unneeded antibiotics). This was the first time I'd ever heard of such a thing, and the concept was so foreign to me that I didn't even know how to react, but who am I to judge? I don't live in a housing project, and I'm not on federal assistance - some of these people (and this was probably twenty years ago) essentially had no money at all, and very little hope of getting any.

I know a pediatrician who tells me that 90% of his patients don't need to see him. Also (and this is probably over ten years ago), parents were demanding antibiotics for their kid's runny nose, and becoming openly furious when told the child doesn't need any (of course, it was the medical profession who did the same thing with antibiotics that they're now doing with opioids - same thing, different generation. Wait and see: The same "professionals" who got people dependent on opioids are the ones who will pull the rug out from underneath them, without any type of soft landing for the patients - all to cover their own asses. There are *so many* propaganda videos out there, making doctors and pharmaceutical companies look like saviors and saints, and patients look like liars and drug addicts (I'll be more than happy to share some).

The level of defensive medicine being practiced right now is unbelievably high, and it's only hurting patients.

Everyone wants the best possible care, but nobody wants to pay for it. Physicians are afraid to take any risk, because of blood-thirsty malpractice attorneys, and patients all too willing to use them. 

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I view gaming the system and tort reform as separate issues.  The latter results in higher cost for everyone.  The former will simply prove Obamacare couldn't work.  When the penalty is less than a month's insurance cost, why would someone who thinks he can live without health insurance feel compelled to buy it?  I think Obamacare is an interesting and better alternative to the single payer system; however, it needs to stop people from gaming the system. 

Why Isn't Obamacare Working the Way It Should? Slate article that's not biased, as far as I can tell.

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Edited: I think the statement about blood thirsty attorneys is offensive, and I am just going to say that.  I know you probably didn't mean it the way written, if you really thought about it.  But I just need to say this: There are a lot of cases that do not have the merits to go forward, but there are a lot of cases that do.  We attorneys have our own internal system of investigating and disciplining lawyers so they cannot continue to make mistake after mistake, and I can be disciplined for knowingly letting another attorney in my firm flounder.  The medical profession doesn't require these things.  There are a lot of personal injury lawyers out there who want to help people who have actually been hurt by doctors, they don't make money on cases they don't win generally, so they aren't often betting on cases that are clear losers.  So while the malpractice system isn't the best, and could use reform, I think it is callous to blame it on attorneys wanting to profit.  Often families and patients come to them seeking answers because doctors and hospitals won't provide them answers to questions honestly if they think that a suit may arise from the information.  

On the ACA, almost every single client I have uses some provision of it, whether it is just to cover their kids a while longer or more.  It is great for people going through divorces who might not have other options for insurance.  It is extremely important for entrepreneurs, stay at home spouses, farmers and the self-employed, which are all things we need more of for our economy to grow.  Right now states are going to really feel the toll of the opiate epidemic and I don't think pushing so many costs to them was going to be able to fiscally work.  Is it perfect, by all means no, but I don't believe the solution offered had any benefit to people, states or the economy, truly, and why would you vote for a bill with no obvious benefit to the majority of your electorate that might harm the state you represent for their budgets.  (Although there are a host of bills every year that you could say the same thing for this seems like a much more obvious lack of any of those benefits)  Anyway, my rant is over.  This was a really important cause for me only because I see people normally at their financial worst, and I see their needs, this helps alleviate a huge problem for a lot of people going through the toughest times of their life.

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On 3/25/2017 at 0:19 AM, Ericandblueboy said:

<snip>

I think Obamacare was based on sound economic principals. 

Part of it was originally based on a Heritage Foundation idea (i.e., a conservative think tank).

Oct 20, 2011 - "How the Heritage Foundation, a Conservative Think Tank, Promoted the Individual Mandate" by Avik Roy on forbes.com

Feb 8, 2012 - "Heritage Rewrites History" by James Taranto on wsj.com 

Nov 15, 2013 - "Is the ACA the GOP Health Care Plan from 1993?" by Jon Greenberg on politifact.com

It's the height of supreme irony that we are here at this particular juncture in our nation's history.

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Just as an aside, I'd add that this really isn't a partisan two-sided issue of whether its a good plan that needs some tweaking or a bad one that needs to be repealed.  As someone who spent a career in health care & can be well... let's say, opinionated... and an ardent Obama supporter, to boot.... I think that the current system needed/needs more than a "tune-up" or a "few minor repairs".  To me, it moved care availability forward & was/is significant, progressive & easily supported, but it is completely unsustainable and I don't think it was meant to be (or can be tweaked to be) a long term solution.  It set the stage for what should have been another major change - to single payer, non-job related insurance but, as is the case with government policy, that ain't on the table any longer (unfortunately, in my opinion).  Rock, meet hard place.

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On 4/6/2017 at 12:27 PM, Steve R. said:

Just as an aside, I'd add that this really isn't a partisan two-sided issue of whether its a good plan that needs some tweaking or a bad one that needs to be repealed.  As someone who spent a career in health care & can be well... let's say, opinionated... and an ardent Obama supporter, to boot.... I think that the current system needed/needs more than a "tune-up" or a "few minor repairs".  To me, it moved care availability forward & was/is significant, progressive & easily supported, but it is completely unsustainable and I don't think it was meant to be (or can be tweaked to be) a long term solution.  It set the stage for what should have been another major change - to single payer, non-job related insurance but, as is the case with government policy, that ain't on the table any longer (unfortunately, in my opinion).  Rock, meet hard place.

Steve,

If you could substantiate why, as someone with experience and expertise, you feel the Health Care Plan:

1) "moved care availability forward & was/is significant, progressive (*) & easily supported"

2) "is completely unsustainable"

3) "wasn't meant to be a long-term solution"

I would appreciate it.

Please keep in mind: This is *not* a "challenge"; it's merely a request from an independent person who wishes for more information about the plan, and I value your opinion very much. I suspect that if I - a reasonably well-educated, well-informed person - doesn't know the answers to these questions, then others don't either, and an understanding of them is critical if you're going to discuss or even simply understand what's going on - I, for one, do not have adequate understanding to even think about discussing the plan(s).

Cheers,
Rocks

(*) Also, if you could logically equate "progressive" with "a positive thing," I would appreciate it - I don't necessarily think "progressive" things are by definition beneficial (the old "If it ain't broke, don't fix it" adage), but of course, our health care system *is* terribly broken, so you're at an advantage from the git-go - it would help if you defined what you mean by "progressive."

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Last question first:  When I say "progressive", I'm pretty much sticking to a definition that sees progress as something that helps the overall human condition. Of course, that's subjective and things like Prohibition were seen as progressive, then rejected as not helping.  Basically, I'd like to think that "progressive" means that individuals' access to the things they need to survive &/or improve their daily lives increase.  In that sense, even partially fixing a very broken system (like health care) and making it less broken, even temporarily, is progressive.

Other questions:

#1: the Affordable Care Act increased the # of people who were covered for Health Care (more about this later).  More importantly, it increased peoples' ability to get coverage for their Pre-existing Conditions, for their Mental Health needs and for other concerns.  This alone was progressive, in that the Emergency Room ceased being the primary caregiver for a lot of people.  Not only is this good for the recipients of care, who now have a "plan" and someplace to use other than the ER, but I'd argue that it was/is progressive for taxpaying society as a whole.  For example, without a plan that enables a person to go to a caregiver for a specific issue -- a caregiver who can work on the specific issue directly -- using the ER means that all the general workups required in an "emergency" room come into play (batteries of unrelated tests, for example) & are then billed to the taxpayer one way or another (Medicaid is government funded, indigent use is paid for by State/Local assistance to the ER or raising costs on their other services).  So, for someone with Mental Health needs (for example), instead of being "covered" to go directly to a Mental Health outpatient clinic and be seen, the ER visit becomes 10x the cost (well actually much more) and doesn't necessarily provide anything of value to the recipient except a referral to an outpatient clinic & some emergency meds.

#2: shifting the burden of paying for these folks to the Insurance Companies who would offer the plans is what was totally unsustainable.  Insurance Companies are in business, as are any other businesses, to make profit.  Totally understandable.  Income from those paying premiums has to exceed bills for services being reimbursed + overhead (including salaries) to make a profit.  Trying to force these businesses to accept all these new folks who are known to be in need of services without offsetting it by dramatically increasing the # of folks who will pay premiums but hardly use services, is unsustainable and the companies will (& did) opt out where their income from those paying premiums did not cover all the services being billed for by the needy.  It didn't happen at first because the Federal Govt. added $$ to the pot for several years to "get it going".

#3: becomes obvious if you accept my argument above.  As Insurance Companies opt out, a single payer "Medicare for all" approach becomes the long term successor to the current situation.  Medicare has nothing to do with your employer (if you have one), but is a Govt run or sponsored program that, well, here's a link to a better explanation than I can give:  http://www.pnhp.org/facts/what-is-single-payer

The above is, obviously, just how I see it and there are arguments advanced by those who want to take away benefits from sectors of the population, from those who want to tinker with the current Insurance Company based system to make it somewhat better or retard its regression, etc...  Clearly, its a complicated issue & it doesn't help that the current ACA supporters don't seem to want to talk about the difference between being "covered" by a plan and being able to use it (deductibles, choice of doctors, availability of services in certain areas -- these are just some of the barriers to usage).  Many who signed up & are in the stats used to show that more people are now covered can't afford to go see their assigned physician & get help.  But that's for another discussion.

God, I've gone on long enough.  

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On 4/6/2017 at 6:23 PM, Steve R. said:

...  Clearly, its a complicated issue & it doesn't help that the current ACA supporters don't seem to want to talk about the difference between being "covered" by a plan and being able to use it (deductibles, choice of doctors, availability of services in certain areas -- these are just some of the barriers to usage).  Many who signed up & are in the stats used to show that more people are now covered can't afford to go see their assigned physician & get help.  But that's for another discussion....

Just thought I'd put another of my 2cents in & summarize a current case that's a pretty clear illustration, in my opinion, of the difference between ACA's expanded "coverage eligibility" and its potential "use value" to individuals.   The article if anyone wants it -

"Pizza Waitress Mowed Down by Cyclist Is out of Work and Drowning in Debt" by Gwynne Hogan on dnainfo.com

Summary of case:

-Paulie Gee waitress, on day off, gets knocked unconscious by a bicyclist speeding down the street.  He admits (to the police) he blew past a stop sign and stays to help her.  He is of limited means & carries no insurance.  Police didn't even arrest him & she's gotten legal advice that suing him would be a waste of time/resources.

-waitress is taken to Bellevue and currently has over $10,000 in medical bills and over $2500 in lost wages.  Follow up treatment bills are still coming.  She had no health insurance.

-Paulie Gee's has fewer than 50 employees and offers no employer sponsored coverage.  Paul G. himself is helping her by holding her job for her and assisting in disability filings, etc.  Also working with her on a crowdfunding plea (which currently has raised several thousand & may well be her "savior" on this).

-victim says that she went to NYS's exchange (probably one of the most progressive in the country & containing more options than most) last year to get health insurance, but the "best" option would have been to take a policy that would've cost her $400/month and carried a $7,000 deductible.  She decided against it (says that she really couldn't afford it) & took her chances.  Even if she signed on, she would've spent about $5,000 in monthly premiums to date and another $7000 in deductible.  Roughly the same situation as without... and that's if everything was covered by the plan.

Bottom line: for folks like her, being eligible for a plan and taking the best one offered would not have been of significant help.  Under a single payer system ("Medicare for all"), she doesn't have any of these problems.

I'm only doing this to underscore why more is needed (certainly not less, as in various proposals) & why some folks (who I generally agree with) should stop touting "# of persons covered" stats as equal to good affordable care. 

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This is a little tangential to the foregoing, but stick with it. I'm Irish, and generally a fan of the various EU healthcare services, but truth be told haven't had much interaction with any of them. The Countess who's American and had been a fan of British TV long before I met her, recently stumbled on a Netflix series called Embarrassing Bodies. It's British, and it's reality TV, which she normally dislikes.
 
The premise is stupid. People with ailments that were supposedly too embarrassing for them to mention to their doctor in private, are now going to be exposed for all on national TV. You can guess what comes next. Andy Warhol 15 minutes.........
 
At some point in the consultation the doctor will ask how long have you had this condition? Answers range from six months to sixty years. The Countess has on several occasions expressed disbelief that a modern European would live x years with y problem and not immediately seek treatment. 
 
When I found myself explaining that under these various EU systems health care is sometimes, (maybe often) rationed, and that many people living under such systems are often conditioned, or condition themselves to believe, if it's not free it's not available, even if it is available under supplemental private insurance, I started to have a new appreciation for the US system.
 
I also for the first time recognized a downside to the single payer option that in the past I have maybe been too quick to dismiss, the self censoring of options.
I fully accept that the cases highlighted on this show are likely the worst of their type, and am mindful of the maxim that hard cases make bad law.
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