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Trumpcare is a Lose/Lose situation for Republicans

FieldTheorist

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I have long believed that the deal the Republicans made a grave error when they pushed the Tea Party into the forefront of their party's GOTV apparatus, and made Obamacare a major issue. It set up expectations that they cannot deliver on, at least while keeping their donor class happy and far Right happy.

Now, on the surface Obamacare looks like a great piece of legislation for Republicans to target --Obamacare basically pays for older people's healthcare on the backs of partially the healthy and partially the rich (which then, by Republicans and corporate Democrats, was immediately shifted away from the wealthy donor class and right onto the deficit), it has no meaningful price controls, and it did nothing to curb the price of drugs. In other words, it's your typical milquetoast "moderate reforms" that really only address about 25%-50% of the problems, but makes Democrats feel like they're done a great, noble thing. So, sure, that sounds like low-hanging fruit, politically speaking.

Here's the problem: There is no Republican plan for healthcare, and there can't ever be one. Either you have to go in and place massive legal restrictions on the healthcare industry and publicly subsidize massive portions of healthcare --which will cause a widespread revolt among the donor-class-- or the prices will continue skyrocketing --and it'll start bringing out the 50% of people who normally don't show up to the polls. In either case, they lose. And they've been harping on this issue for 8 years now. The thing is, when I say there "there can't ever be" a Republican plan for healthcare, that's not just my opinion. The Republicans spent 8 years blasting Obamacare and they spend billions on think-tanks and policy institutes. You know what they came up with during that time? What they were ready to enact after they finally got elected to the White House, Senate majority, and House majority? That's right, not a goddamn thing. Over the past few months, they've scraped together a cobbled hodgepodge of tax-breaks and nothing else.

Trumpcare is basically a full admission that they're going to choose to side with the donors, which is pretty funny coming from Donald "Everyone else let donors get away with murder, but I won't!" Trump. What will his voters do when they actually understand how screwed they are? It's why House Republicans are so torn on voting for the bill, because they know they're going to get skewered either way --the far Right extremists that they've been cultivating in their Red districts will hate them if they don't repeal Obamacare (beyond which, Trump will look incredibly weak), but if they do pass it and it destroys people's lives, people will vote them out of office.

There's no win here, because there's no "traditionally conservative" solution to this problem. There is, however, a socialist solution, the one pushed for by Bernie. I'm eagerly awaiting that policy battle following whichever crater Trump leaves behind on this issue.
 
Since I don't have Obamacare, I don't really care what Trump's replacement plan looks like. Some of us were smart enough to position themselves before that disaster went into effect so we would not end up screwed when this day arrived.
 
backpacker said:
Since I don't have Obamacare, I don't really care what Trump's replacement plan looks like. Some of us were smart enough to position themselves before that disaster went into effect so we would not end up screwed when this day arrived.
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Not sure you understand what "Obamacare" is.
 
Napoleon said:
Not sure you understand what "Obamacare" is.
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I am not sure you know there is still insurance in effect that wasn't covered under Obamacare mandates.
 
backpacker said:
Since I don't have Obamacare, I don't really care what Trump's replacement plan looks like. Some of us were smart enough to position themselves before that disaster went into effect so we would not end up screwed when this day arrived.
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That was not fair. Why didn't you just let Obama do it to you and get skrewed?
 
backpacker said:
I am not sure you know there is still insurance in effect that wasn't covered under Obamacare mandates.
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Don't tell me you got to "keep your plan" like Obama said. :lamo
 
iguanaman said:
Don't tell me you got to "keep your plan" like Obama said. :lamo
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Not a single thing changed about it except the premium increases went up to subsidize the obamacare freebies.
 
joG said:
That was not fair. Why didn't you just let Obama do it to you and get skrewed?
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Because I don't need "free" birth control pills.
 
backpacker said:
Not a single thing changed about it except the premium increases went up to subsidize the obamacare freebies.
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So Obama didn't lie to you about keeping your plan. What a surprise. As far as premium increases, that has been going on long before the ACA.
 
It's nice to see so many Right-wingers standing up and defending Republicans and Trumpcare, while displaying such a clear understanding of what's wrong Obamacare. Really, principled conservatives raise the dialogue on this forum.
 
iguanaman said:
So Obama didn't lie to you about keeping your plan. What a surprise. As far as premium increases, that has been going on long before the ACA.
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No but then again, I out maneuvered him.
 
If I remember correct President Truman wished to follow Churchill in having a universal single payer system after WW2 put into place.

Too bad he did not get such a system as it is we spend more money then any other nation on earth for health care and are way down the list when it come to results such as average lifespan and infant mortality.
 

There are complex reasons why our system was too entrenched to convert to single payer back then but it was never because our care was better or costs were lower. The fact that 80% of Americans get their HC insurance as a "perk" from their employer is still why it is so hard to give up. It is sad that some politicians don't care that for profit HC is breaking the bank because of the perks they receive to keep it in place. Nearly $150 million was spent last year on lobbying by HC insurers. If the system is so good why do they need to spend so much to keep it in place? Wouldn't that money be better spent lowering costs to consumers?
https://www.opensecrets.org/lobby/indusclient.php?id=F09
 
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I've been saying this for a long time. Republicans created a talking point that is lethal to their own party. They shoved "Obamacare - BAD!" down their base's throats for 6 years and now you have a base that hates Obamacare, in addition to missing the ****ing point of Obamacare. Trump's base can't see that any free market solution to health care is going to exacerbate the very reason they hate Obamacare so much: higher premiums. They are also incorrect in placing the blame of higher premiums on Obamacare. Conservatives are readily willing to hate Obama for any reason possible. It's part of the cult of personality. Since Obama who avoided all out depression, after Bush (Mr. lets cut taxes, start two wars, grow a housing bubble that pops, which bankrupts Trump mortgage ) handed him a country on life support, Obama has no scandals and did a passable job, as good as you can get with neo-liberalism, conservatives thought perhaps they could pander to those dissatisfied with their insurance and health care.

The long game here, is they have to pass health care reform that people are going to like. Not just what the Koch bros or Sheldon Adelson likes. They're remarkably short sighted and they've really shot themselves in the foot. I've already pretty much convinced every conservative I know that we need to go single-payer, because old conservative spinning strategies,

example: "Canadians come to America for health care" "wait times are unbearable", are just plain false, when you set them against the entire rest of the civilized world, who already has single-payer, and doesn't need to bend over backwards to fellatio big pharma and the insurance lobby, those arguments disintegrate.
 
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These above are, of course, logical winning arguments.

But I believe they are impotent.

The GOP, and now even moreso Trump, have completely brainwashed a sizeable chunk of their contingency. So I believe many of the GOP rank & file will never come around to an understanding of the facts of the matter.

How do you reason with and present facts to individuals that believe Obama doesn't have a Birth Certificate? This is the prevalent belief of the voters that put Trump in office. 41% of the GOP and 69% of the Trump supporters!

So now they're going to deviate from Fox, Breitbart, Limbaugh, Drudge, Beck, Trump, Bannon, et al, and believe otherwise on TrumpCare? I just don't see it happening.
 

A sizable chunk of the Trump base will never leave Trump's side. Trump shows them the way, when all other lights have gone out.. If Trump signs the AHCA, passes a budget that slashes Meals on Wheels, and cuts Medicare and SSC, that portion of the Trump voting block will double down on belief in Trump. You will say, hey Trump cut your Social Security checks, and they will say, Obamacare is bad and Trump fixed it. That's not going to change. They aren't outcome oriented people.

Not everyone is a miserable partisan hack though, people will come around, especially in coal country and the rust belt, if Trump takes their Medicaid from them. "All politics is local" If they get screwed by the AHCA, and their mother dies from preexisting conditions because she got thrown off Medicaid and couldn't afford anything the free market was offering, you may seem some defecting to a leftwing populist. If the Democrats go preaching single-payer, which is the antidote to the free market, the masses will come around.

As far as dyed in the wool conservatives, I mean, here's what I did for a couple of them. I showed them the facts. UK has single-payer, Germany has single-payer, Canada has single-payer. I show them how it will save us money, and I show them how we pay more for prescription drugs than any other country in the world, including countries that uses single-payer. Appeal to their pocketbook, always a winning strategy.

Then they always come back with, well wait times are too long, or people come to the USA for our superior health care system. And I say, show me reports of the horrors of single-payer. They usually can't do that, excepting maybe an anecdote or two, because its a fake talking point they heard Sean Hannity use to fight the evil socialists. Then I say, if our system is so much better than the rest of the world, why doesn't the rest of the world trade their system for our system? If our system is the best, why are we the only ones who use it?

They can't give me a straight answer. It takes them a long time to grasp that single-payer saves them money. I have to explain how we pay for people who are uninsured when they get in accidents and with single-payer, those people are accounted for, details wax and nuance is established.. but, at this point in the conversation they usually run out of talking points. Then the conversation usually turns to "it's politically impossible. and how are you going to do it?" I tell them, especially if they are already around 65, that they are about to have single-payer healthcare. That it's simple we just tell every single damn politician in the country, that their careers are over unless they pass legislation lowering the Medicare age to 0, and fund it through a payroll tax. It's really that simple, and I've got a lot of my family members to come around. I come from a Republican family. Just because they acknowledge that single-payer is the solution to the free market-insurance-health care knot, that doesn't make them a socialist. If they are 64 and have private insurance and firmly a capitalist, then when they enroll in Medicare, do they turn into a socialist overnight? Of course not.. but it does take some careful unwinding of the propaganda.
 

Per the CBO, repealing the ACA represents an $883 billion tax cut, primarily directed toward higher-income taxpayers--some have argued this was the primary objective of the GOP's (thus far failed) AHCA. So no, those costs weren't shifted onto the deficit. And the ACA doesn't contain price controls, but it does contain cost controls; having the former without the latter would be a ticking time bomb.

But to the larger point, certainly the GOP has not had and does not have a coherent health care plan. Seven years of not producing one should've been evidence enough of that. Given the obvious divisions in their caucus, it's fair to question whether it's even possible for them to ever develop one.
 
Great post, and thanks for taking the time to pen it.

I pretty much agree with most here, though I don't see the ACA opponent voters coming around quite so easily. I do believe you are right in that some may, but the problem with ObamaCare was that it was an insurer solution and sucked so bad that many opponents may not see a great difference when it's modified. I think the main difference will be those kicked-off Medicaid, but then the Medicaid rolls have traditionally been raised & lowered so we'll have to see if they relate that directly to the GOP.

Otherwise, I have several comments:

1] When arguing against the claim that single-payer does not work in this country, one needs only to point-out that 43% of Americans are currently on single-payer and it works well enough for them. I'm speaking of course of Medicare, Medicaid, VA, Disability, and the like. Also, it helps to differentiate between single-payer/private-provider (ex: Medicare), and single-payer/public provider (ex: VA).

2] When arguing against a hard-core unrelenting free-market healthcare proponent, I simply ask them: What is the affordable freemarket solution to enable profit on my elderly octogenarian mother with four serious preexisting conditions? This last question has stopped every free-marketer in their tracks, because of course there is no affordable solution. The reply always is "I don't know" or "That's an exception"!

3] I use your Medicare/Medicaid expansion argument all the time. In the period leading up to passing the ACA the Dems actually argued to lower the Medicare qualifying age. A very workable solution to implement it would be to drop the age 'x' number of years per year, allowing a transitional implementation. I've often seen the value for 'x' suggested as '5' (yrs). The same can be done by raising the Medicaid cut-off income level in an incremental fashion.
 

It doesn't matter though. They picked an economic issue, deviating from their standard procedure of "Only discuss identity politics issues, e.g. 'Christian values,' abortion, anti-drugs, denying racial issues, etc." There's a reason they chose these issues, and it's because they can't really ever get called on them. There's no ticking time bomb associated to them.

But when people's healthcare starts going tits up? Yeah, they'll start taking notice of that. It's what helped Obama get through.



1.) Again, if you put the ACA in a vacuum, pretend like there was no legislation passed afterwards that affected it, this is true. But in reality, the tax cuts passed largely by Republicans is literally driving up the deficit.

2.) Again, it's only lowering the deficit relative to doing nothing. It's not like it costs nothing, but it is important to note that, relative to literally all known data points, it's just a fact that medical coverage gets cheaper the more regulated and controlled it is by the government. I think Obamacare is quite ineffectual compared to actual universal healthcare systems, but there's no question it beats what we had before in terms of the deficit, in terms of health outcomes, general coverage, etc.

(And Trump's is even worse than the old system, because it's basically going back to the old system, but adding even more tax breaks on top of it all.)

And the ACA doesn't contain price controls, but it does contain cost controls; having the former without the latter would be a ticking time bomb.
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The only cost control I'm familiar with is the 20-80 rule. Combined with the fact that

Greenbeard said:
Given the obvious divisions in their caucus, it's fair to question whether it's even possible for them to ever develop one.
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I think the problem is that, like corporate Democrats, they don't have a real ideology; they just follow what their donors tell them to do. They do, however, have a nice story that they tell their various voting blocs. In this case, neither the stories nor the donors can match what's actually needed in this situation.
 
FieldTheorist said:
1.) Again, if you put the ACA in a vacuum, pretend like there was no legislation passed afterwards that affected it, this is true. But in reality, the tax cuts passed largely by Republicans is literally driving up the deficit.
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Your article seems to be about the extension of things like the AOTC and EITC--those aren't really directed at the "wealthy donor class." Even so, I'm not sure what they have to do with the ACA. It raised taxes on the wealthy to expand coverage. Repeal will roll back coverage and massively cut taxes on the wealthy.

The only cost control I'm familiar with is the 20-80 rule.
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The root cost to treat someone is on the provider side. The ACA expanded public coverage via the Medicaid expansion and private (commercial) coverage through subsidies available in the exchanges. But if two newly insured patients, one insured via Medicaid and one via a commercial exchange plan, walk into the same practice with the same clinical issue, do you think it costs less to treat the identical condition in the Medicaid patient?

You're conflating the prices those respective insurers pay--and ultimately the amount of reimbursement the care provider receives--with the actual costs incurred. It's pretty universally understood that Medicaid reimbursement does not cover those costs. The care is only "cheaper" for the Medicaid patient relative to the commercially insured patient from the point of view of the insurer cutting the check; it's not cheaper from the perspective of what it actually costs to provide the resources to treat that patient.

Cost control means examining those root costs of delivering care. Which is significantly impacted by the way care is organized and delivered (factors in turn influenced by the way--not just the per unit price--insurers, public and private, pay). That's what the country has been doing under the ACA. It's hard and no one's particularly good at this yet. But the attempt to get a handle on costs is happening to a degree we haven't seen before. There's no magic switch you can flip to make things cheaper overnight.
 

No, that's not what the article said. To wit:

"Since then, Congress passed a year-end spending bill that included making permanent and expanding several major temporary tax breaks for businesses and individuals, including credits for research and development expenses, families with children and the working poor."​

So yes, there are some tax breaks that get directed downward, but it's pretty much universally agreed upon that the extension of the Bush tax cuts, the predominant piece of legislation mentioned in the quote above, is a massive contributor to the deficit. And when you couple that with things like Obamacare (Let's set aside the trillions for the Iraq war, the lingering costs of the bail-outs), even though you're technically lowering the deficit through Obamacare, you end up net losing out on money. To see this, just look at this graph:



So yes, I stand by what I said.


1.) This is a really bizarre rant where you tell me a bunch of things that I already know, punctuated with bare assertions about how I don't know these things.

2.) I never said you could flip a switch and all would be right. But there's zero question that our healthcare outcomes are the lowest among first-world countries (and even some second-world countries), our costs are wildly disproportionately high, and our drugs are the most expensive in the world. It's what happens when you let health insurance and pharmaceutical companies write your healthcare bills.

I'm not pretending like you can flip a switch and all healthcare problems will go away, but I'm also not pretending like a its a giant, unexplainable mystery as to why bad legislation --that protects pharma and healthcare insurers, doesn't seriously regulate on drug prices, and only has a small number of regulations to decrease administrative waste-- all adds up to the most expensive healthcare with the worst outcomes among first world nations. You want to decrease the cost of healthcare and increase the health outcomes? You can start by following what every other first world nations, and even several second world, did. You can institute a national healthcare system that has the right incentives to bid for drugs, regulate the price of drug increases, directly manage administrative costs (fyi medicare has the lowest percentage of administrative cost by an order of magnitude over private insurers), and negotiate for equipment costs. None of this is a mystery, and while it won't fix every problem, it's a massive step in the right direction.
 
You have a bizarre definition of "rant." Anyway, the point is that if our entire health care system has a cost problem, price controls won't address it. And instituting price controls without tackling the underlying cost drivers could be incredibly disruptive and destructive. Which means you have to rely on and build upon the cost controls in the ACA anyway before you can even think about some kind of spending freeze or decrease.
 
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