Republican Healthcare Reform Purgatory

The Republicans keep coming back to healthcare. At the rate they are going, they will match their attempts to repeal and replace under Obama, and with equal results.

Something in the Republican psyche keeps telling them to make this happen, and that mantra apparently makes them forget that they couldn’t get to yes. So they start again, only to remember that the deal isn’t there.

The main problem here is that they haven’t started over. They keep trying to revive a very broken approach, and the blame there is largely on the High-Fructose Corn syrup, err, House Freedom Caucus. That bloc wants a full repeal of the ACA. And they’ve been pushing and shoving their sugar-free colleagues, trying to get them to agree to a move that would be harmful to their own interests.

Before the ACA there was a vibrant scamsurance industry that sold people policies that wouldn’t pay for a lot of things, or where they could kick people off while pocketing their premiums if the person ever got sick. It’s not clear that the HFC is funded by that unsavory element, but it is undeniable that their legislative desires would return us to those bad old days.

If the GOP wants to govern responsibly, the first step is to reject that approach to healthcare. So far, they’ve tried to balance things out, and so far they’ve gotten nowhere. That’s because they need the HFC to pass the bill unless they work with Democrats. Working with the opposition is entirely possible, but they would have to accept a much smaller tax cut for the wealthy.

They would also have to swallow their pride, after going it alone so long. They would have to explain to their constituents that the idea that all Democrats are scum just doesn’t hold water, and, really, they are patriots and have some good ideas. Yuck.

And so the Republicans find themselves in this loop. They really want to cut those taxes for the wealthy, so they can use them to pay for a larger tax overhaul for the wealthy. Meanwhile, Democrats have jumped the gun, already starting to point out that tax reform should include the question of how it would affect Trump’s taxes, necessitating the release of his past returns.

There are actual insurance companies that would like to know how this shakes out. There are people who buy insurance that want to know if they should prepare to be uncovered for a period of time and cancel that skydiving trip. But the Republicans are still pretending that they can govern without some faction or other giving in.

They are pretending that 24 million more uncovered individuals is something people will accept. That they can humor the HFC. That all of this doesn’t end in tears unless they stop these headfakes toward reform and actually start over and tell the HFC that either they work with the rest of the GOP on a moderate reform, or the GOP has no choice but to work with the Democrats.

In all visible scenarios, the GOP faces an electoral reckoning. But they’re the party in power, so their best-case is a responsible, moderate change that makes things better.

Why the Senate Murdered the Judicial Filibuster

Why did the Senate kill off the filibuster for Supreme Court nominees?

I’m asking, because I have no idea.

The filibuster was meant to let the minority block a nominee under circumstances like these. Instead, the Republicans decided it was useless and discarded it all while praising what it represented.

It doesn’t add up. Was the filibuster talking to the Russians?

And what other rules might be at stake? Have the Republicans been bitten by the two-out-one-in rule that the president is using?

They want to add a rule about forcing all Senators to eat bacon, which means no Judicial Filibuster and no pants? Great.

Or maybe the Republicans think that the immediate gain of having no cloture hurdle will pay off. All the liberal justices will die or retire, and Trump will nominate Neil Gorsuch’s five sisters to the bench (all played by Gorsuch in drag). Nobody will notice the crooked lipstick, and the court will finally rule that the Constitution says that Republicans are the cool kids.

But they know full well it’s a matter of when and not if the Democrats will be positioned to confirm another justice. Are they betting that the Democrats are better men than they, willing to be more moderate in their nominations, willing to actually hold real hearings?

Because that’s been true, to a point. But the rhetoric from Democrats is getting harsher. The Democratic streak of Republican-style obstinacy may just be coming out, and the Republicans won’t be safe.

It would have been far simpler to find another Neil Gorsuch. There are at least ten thousand qualified people to sit on that bench. Going to 9 9 9 9 will not threaten our strategic reserve of judges.

Or maybe this was the moment for the Republicans to lay down the law. Cut the head off in the bud, like Barney Fife used to say. Now the Democrats know which side of the pants the bread is buttered upon. Wipes dust off of hands.

Now that the Democrats have been denied all power, they will simply pack it up. It’s not like the Republicans need them anyway. They’re not the Republicans’ real mom.

It all just seems like too small of a fight to upend the rules of the body for. Time will tell and teach.

Garland v. Gorsuch (per curiam)

Diehealthy.org Court of the United States

Merrick Garland v. Neil Gorsuch

ON PETITION FOR WRIT OF CERTIORARI TO THE U. S. SENATE

No. 17—110074. Decided 1 April 2017

Per Curiam.

In both Half-child v. King Solomon, -1179 U. S. 74 (c. 910 BCE), and The nameless, eternal Tao v. Lao Tzu, 16996 U. S. 497 (9349), this court held that “in matters of the eternal law, there shall always be a higher court.” Id. at 93-6.

That is the path this case takes to reach us today. It has accelerated out of the U. S. Senate, escaped the earth’s gravity well, and sped past the Van Allen Belt. We have received it and have decided.

The lower court, which is, unsurprisingly, the U. S. Senate, holds these two respected jurists in mortal combat. The body of Senate Republicans has armed thermonuclear warheads in preparation for what they intend to couch as a retaliatory strike against the body of Senate Democrats. The body of Democrats, for their part, are preparing to filibuster (Can we write such a word?! Pardon us!) the nomination of Gorsuch.

But we must go back. Prior to the Gorsuch nomination, there was another nominated for the seat upon the U. S. Supreme Court: Merrick Garland. And in that nomination… nothing happened! No meetings, no hearings, no vote! This is a tough case. We should have had lunch first.

We are reminded of an earlier case, Bender v. Bender’s Shiny Metal Ass, 542 U. S. 901 (2004), in which another body sought relief against itself. There, ruling contra to our holding in Dandy v. Fine, from the lost and found volumes (available for five proofs of purchase plus shipping and handling), we found that, “You have to love yourself first.” Bender at 904-77. Good advice, but in this case? We’re just not sure that the Senate is ready for polyamory.

Consciousness expansion? Please. We tried that back in the 60s, and what did it get us? Ronald Reagan!

Come on, think, damn it!

This is all your fault! You put them up to this!

The thing is, Ow!, the judge—Off! Get off my foot, damn it!

You started it!

I did not! You—wait! Judge off! That’s it: an old-timey judge off!

The U. S. Senate shall convene both jurors Garland and Gorsuch, and every Senator will provide exactly one exhibit to be adjudged by each (a child’s drawing, an irregular mole on their person, burnt-toast rendition of maybe-Jesus, etc.). The judgments of both will be recorded and presented against a panel of outside experts, and scores will be rendered. Upon the delivery of the average scores of each, the Senate shall vote between the two, either for one or for the other one, without knowing which judgments and scores belong to which robe.

The judgment of the U. S. Senate is vacated, and the case remanded for further proceedings not inconsistent with this opinion.

It is so ordered.

Block Grant It All

Instead of sending money for particular things to the states, the federal government should send a single check, along with letters to every citizen of what they have calculated the statewide improvements should be if the money is responsibly allocated and what the results were over the previous period. If the people do not see the predicted results, they can know their state government is to blame and fire them.


1 October 2016

Dear Citizen of the State of Freedonia,  

We have sent your state $30 billion for 2017-18
as part of the Great America First Transfer Act
(GAFTA).

By our projections, Freedonia should provide
the following improvements:

1. 10% increase in total healthcare enrollment.  
    1. 10% decrease in obesity rates.  
    2. 3% decrease in heart attack fatalities.  
2. Infrastructure improvements:  
    1. State roads improved from D- to C-.  
    2. State bridges improved from C to C+.  
3. Poverty down from 15% to 13%.  
    1. Reduced unwanted pregnancy 10%.  
    2. Improved access to education 50%.  

If these improvements are not realized, the
agency recommends you vote for different people.
Note that failure to see improvements will
result in reduced funding, and if failure
continues, Freedonia will be placed in
receivership.

1 October 2018

Dear Citizen of the State of Freedonia,

We sent your state $30 billion over the past two
years 2017-18 as part of the Great America First
Transfer Act (GAFTA).

They have performed as follows:

1. 2% increase in healthcare (expected: 10%).  
    1. 12% decrease in obesity (10%).  
    2. 4% decrease in heart attacks fatalities (3%).  
2. Infrastructure improvements:  
    1. No change in state roads (D-; expected C-).  
    2. State bridges worsened (C-; expected C+).  
3. Poverty remained unchanged at 15%.  
    1. Unwanted pregnancies up 5%.  
    2. Diminished access to education.  

Due to the overall failure to meet the benchmarks,
the 2019-20 GAFTA grant will be for $24 billion. A
subsequent failure to improve will result in the
state losing control over GAFTA funds and a
takeover by the federal government.

By our projections, Freedonia should provide the
following improvements:

...

We urge you to vote next month. Freedonia may
benefit from new leadership that can deliver the
needed improvements to Freedonia.

Conservatives want smaller government, but they seem reluctant to put their mouth where their money is. Make the government tell people when they’re being screwed by lousy governance. Given that a majority of state governments are Republican-controlled, they should be eager to make such a change.

Under a block-grant-plus-reporting system, the people would know if their government was not effective. They would be able to compare such a report to the other 49 states and see where things stand. It would increase transparency while returning much control to the states, where conservatives say it belongs.

We have good measures of what healthy governance looks like. We just have a complicated system that often thwarts its delivery. And we have endless fighting over whether we should have good governance or more tax cuts. A block-grant system cuts through all of that. It says to conservatives, either you can deliver on your promises, or the public can vote you out.

A copy of the information would be affixed to the top of all ballots, and incumbents would be clearly marked.

An Even More Better Way

Nobody likes the Republican plan. The nerds said it will screw everything up except for rich people. The übercons said it doesn’t harm enough poor people. The bleeding-heart moderates said it harms too many poor people. The liberals agreed with the bleeding-heart moderates, and they added that Jesus also would agree with them.

There’s been talk of some rework before it gets to the House, but with so much division it seems like any fixes will surely tip it too far for two-plus GOP senators. There’s no way they can swing single-payer. What to do?

  1. How to Pay for It
  2. Medicaid
  3. Marketplace
  4. Employer Coverage

How to Pay for It

Republicans hate taxes. That limits the options to some combination of:

  1. Raise the deficit.
  2. National lottery.
  3. Subsidized Time (see Infinite Jest by David Foster Wallace).
  4. Price controls.
  5. Competition.
  6. Carbon Tax.

Or some other things.

But healthcare costs. If you do what the current bill does, the cost of care still goes up when uncovered people need care and everybody else pays for it. We pay when people file for bankruptcy. We pay when people are sicker than they should be and call in sick.

Medicaid

Some people don’t make enough money to buy insurance. Either they can:

  1. Be sicker and raise the costs for everybody else
  2. Be subsidized
  3. Be given a raise such that they can afford insurance

Now, the current plan likes the first option. The ACA does the second. Maybe we should seriously consider the third, though. We could raise the minimum wage enough to ensure that everybody who works full-time can afford coverage. Something tells me the GOP won’t want to do that.

Marketplace (and Private Insurance)

For people who make enough money, healthcare is still very expensive, particularly if they become sick enough to run through their deductible. That’s at least $10,000 on average, per year of being sick. For upper-middle-class folks and above, it’s doable. For anybody lower down, more than a couple years of that will start to wear them down and make bankruptcy inevitable.

Ideally, for anybody who isn’t earning above maybe a couple times the poverty line, there would be a much lower cost guarantee, linked to income. Some sort of stability.

But none of this is entertained by the Republicans.

Employer Coverage

Employer coverage is a hardship for businesses and employees. It keeps people from changing jobs, and it makes it more difficult to start some businesses or grow them. It should be phased out.


The basic choice here ends up being between paying more, covering less, or cutting costs. All three are unpopular, but the current proposal sees kicking people off healthcare as the best choice of the three. It puts budgets and the wealthy before the people. So much for populism.