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We Never Win in Healthcare

The Republicans in Congress are not sending their best bills. They’re sending the pharmaceutical companies—drug dealers—a chunk, the rich get their check, but ordinary Americans? We get screwed again. So little winning, you’re going to get so sick from not winning. Believe me.

We spend more money, and we get less. That’s not winning. That’s getting played. And it’s got to stop. We have to win again on healthcare. We have to pay less money and everyone has to be covered. From the sick poor kid that wants to grow up to be a baseball player to the old lady that used to do radio jingles—back when people still listened to the radio. They all need healthcare.

And cutting red tape is not going to do it. It will save a bunch of corporations money, which they will pocket. We know this because that’s what they have done, time and time again. They pad their portfolios while the rest of the country breaks its back, and it doesn’t get the back treatment it deserves. They don’t pay for infrastructure. They don’t pay to make sure you can even get to the hospital safely if you have to cross a bridge. Pitiful, folks. This is a mess.

The Republicans want to say this isn’t the role of government, that it’s not in the Constitution, but show me where in there it says that old people should suffer, or that a sick kid that can’t afford treatment should have to go beg for her life on a crowd funding site. Tell me where it says that in the Constitution.

And they say that states need more flexibility in Medicaid. Like these precious snowflakes of state governance can’t operate a simple program that says that poor people get healthcare? Please! If they can’t figure it out, we shouldn’t repeal and replace the program, we should repeal and replace them.

Every other country figured this out. They’re eating our medicine, folks. They pay more in taxes, but less overall because they get higher wages and lower costs. That’s winning. If you ask me, the Republicans have turned taxes into a whip to keep people in line. Some late-night bogeyman story to scare people. But the greatest generation paid higher taxes! And they were so tough, they liked it!

These Republicans have gone soft. Sad! We need to win on healthcare again, and if the Republicans won’t let us win, they should at least have the good God damned sense to get out of our way.

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Failing Healthcare Passed the House

The House Republicans passed a bad bill, on purpose. Now we wait through a recess to find out if the Senate has any more sense or integrity.

On purpose, because they want a legislative veto. Because the bill was required to originate in the lower chamber, by passing a bill that will never pass they ensure that it has to come back to them at least once if it is ever to be signed.

Senate Republicans should reject this power play by their colleagues. Playing against your own party is bad form. Passing a bill so reckless, the power to stop it out of the House’s hands unless and until the Senate kicks it back, is a complete abdication of responsibility and leadership by the House Republicans.

But now it goes to the Senate, where it will receive a formal scoring as to how bad it is, which the House Republicans did not wait for. They ought to be flagged and penalized for a false start. Five yards.

Senate Republicans will gut it and rewrite it, if they have any sense or integrity. But will the outcome be any better? More moderate? Anything approaching what Trump has claimed it should be?

All the while, President Trump has said the bill’s great, whatever it is. His promises on healthcare could not be more different than the bill just passed. Still, it’s great. Even as he lauds Australia’s much more progressive system, he says whatever he signs will be great.

Something tells me we can’t trust this Trump fella.

But we can’t trust the House Republicans, either. Their passage of such a horror cements that. That leaves the Senate Republicans to be the redeemers of their party’s good name.

The main way to do that is to ensure coverage parity (both in terms of who is covered and what is covered). That will require major changes to the bill, but it should always have been a requirement for reform. The House Republicans apparently had zero principles in their designs. The Senate should show them up, make them look like the JV team that they are.

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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.

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society

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.

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society

This Healthcare Mess is All Your Fault

Look. God knows you can’t pick a cellphone plan or a cable plan without paying through the nose. But you have to get smarter, America. Stop getting sick, and when you do get sick, spend less on getting better (never mind that, like with cellphones and cable, there is major price obfuscation at play; never mind that, like cellphones and cable, you are shopping for an inclusive product and can’t duck out of one hospital for a blood test at another). If you weren’t so stupid, the very smart Republicans wouldn’t have to take all this time and effort to fix the mess you made.

That, in a nutshell, is the message put forth by the GOP. You should be squirreling your money away in a health-savings account, doing reverse auctions for your care when you get the flu. Set up a proper bidding process, for Christ’s sake! And if amputation is the cheaper option, you didn’t really need that arm anyway! Sigh. I’m ashamed, frankly, to call you an American. The CBO estimate may say it’s not your fault, but the CBO is just a bastard machine full of bleeding heart liberals coddling your snowflake ass.

Fun fact: the Democratic Party is the real anti-abortion party. The Republicans may be pro-life, but the Democrats are anti-abortion. Their support for contraception and for organizations like Planned Parenthood have prevented thousands of abortions. The Republicans haven’t prevented a one.

Fun fact: insurance is when the healthy pay for the sick.

But somehow, abortion is still Planned Parenthood’s fault. They need defunding. Those heathens, how dare they prevent abortions! Their fault! Shame, shame, shame.

But somehow, the sick are the source of the problem. They’re cutting into profits.

We have to fix healthcare, it’s dragging the economy down. The same economy that keeps posting positive, healthy signs from jobs numbers to construction. That economy is in shambles thanks to your wastefulness on healthcare. So we have to fix healthcare by giving the wealthy thousands of dollars a year for every schlub we kick off the insurance rolls. To the tune of hundreds of billions of dollars and ten million newly uninsured.

Because, it’s your fault, God damn it. What are you trying to do to America! Asshole!

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I don’t see a good way around the above conclusion. It’s all our faults. We thought we had a society, when in fact we’ve got a business venture that we’re all just screwing up so badly on. The Republicans have tried to get it through our heads, but somehow we just can’t seem to avoid getting sick. And they don’t want to reward our selfishness by actually paying for the care we need.

Fuck them. It’s idiotic, and their bill is a pile of shit. Anybody who has bothered to look at the whole picture of healthcare knows it. Anybody who has looked at the economy knows that the rich aren’t suffering and don’t need these tax cuts.

The goals for the American Healthcare Act (Aha!, AKA Trumpcare, AKA Republicare):

1. Technically count as “Repeal and Replace”
2. Not wander too far from the status quo as to fuck everything up

The actual bill? Fails on both counts. On Medicaid they will gut the expansion through a sort of sideways rescission. They withdraw it in 2020, but in the meantime bleed it out by making it harder for individuals to remain covered. On the individual market, the subsidies get contorted so that most people pay more for less. Coverage gaps means 30% more, being old means 5× the cost.

And, on top of all of that, it’s not even a real repeal. It leaves the mandate, just zeroes out the tax. It leaves the regulation of insurance. It leaves in place (though delays) the Cadillac tax.

But, to hear the Republicans tell it, this is all your fault. Pathetic.

In a few years when all the Republicans finally admit the existence of global warming, they’ll blame you for that, too. Sad.