RyanCare/TrumpCare

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Pointedstick
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RyanCare/TrumpCare

Post by Pointedstick » Thu Mar 09, 2017 11:27 am

Thoughts? My first impressions are that it's an embarrassing trainwreck. After (accurately) crowing for 7 years about how horrible Obamacare is, the GOP leadership puts together a bill that keeps the same basic structure but just tweaks where the money goes to and comes from. Still got the marketplace, still got subsidies for coverage, still got penalties for going uninsured, no improvements at all to the basic problems of high costs, cost shifting, price transparency, or the gaping maw of the medical regulatory bureaucracy. It's still a cronyistic nightmare that picks winners and losers.

It seems like most of the congressional Republicans are revealing that what they hated most about Obamacare was that it was passed by the Democrats, not themselves.
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Re: RyanCare/TrumpCare

Post by pugchief » Thu Mar 09, 2017 12:06 pm

Agree. If that's the best they can come up with, rather than repeal and replace they should just tweak some of the more annoying aspects of ACA. The problem is that if they do this, it will still be referred to as Obamacare instead of GOPcare or whatever. :P
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Re: RyanCare/TrumpCare

Post by Tyler » Thu Mar 09, 2017 1:16 pm

A few things:

1) The bill is written in such a way that it can pass via reconciliation. So all the things the right really wants (sales across state lines, totally overhauling regulations, etc) aren't possible in the bill. Demanding them as a litmus test for passing any bill means demanding that they negotiate with Dems. Good luck with that.

2) Straight repeal is not politically possible because it would strip coverage from millions. Also, the individual market before the ACA totally sucked and was downright exploitative in many cases. It's a non-starter, and is why Republicans have always talked about repeal and replace.

3) What exactly did hard-liners think "replace" actually meant? ::)

Now whether the doable via reconciliation details of the bill make sense is certainly up for debate. Some sort of guaranteed coverage for preexisting conditions (provided people maintain continuous coverage) is virtually guaranteed to be in any future plan, so that shouldn't surprise anyone. I personally think the 30% premium penalty for one year for those who sign up for insurance only when they get sick is laughably low to incentivize young people to maintain coverage. I also have mixed feelings about the subsidies, as I understand many people need them to afford insurance and much prefer the age-based rate for overall fairness but also believe they only serve to drive up prices. But those types of issues seem fixable without throwing the whole thing out.

Overall, I see the proposal as a concession that changing the healthcare system simply can't be done all at once. I understand why people would dislike the bill in the surface, but I'm not sure doing nothing until Republicans hope to have a super-majority in the senate after 2018 is a tenable plan. "Watch the world burn" is a pretty terrible strategy when you hold the house, senate, and White House. All voters see is complacency. I personally hope that Republicans get their act together and negotiate something reasonable to get us moving in the right direction asap.
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Re: RyanCare/TrumpCare

Post by flyingpylon » Thu Mar 09, 2017 2:13 pm

Tyler wrote:2) Straight repeal is not politically possible because it would strip coverage from millions. Also, the individual market before the ACA totally sucked and was downright exploitative in many cases. It's a non-starter, and is why Republicans have always talked about repeal and replace.
If I'm not mistaken, repeal is also not possible because the Republicans don't have 60 votes. So there's really no option but to try to do things in phases and the reconciliation process limits what kinds of things can be done.
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Re: RyanCare/TrumpCare

Post by dualstow » Thu Mar 09, 2017 2:26 pm

Side question: who gets the website creation contract this time?
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Re: RyanCare/TrumpCare

Post by Pointedstick » Thu Mar 09, 2017 2:37 pm

Tyler wrote:Now whether the doable via reconciliation details of the bill make sense is certainly up for debate. Some sort of guaranteed coverage for preexisting conditions (provided people maintain continuous coverage) is virtually guaranteed to be in any future plan, so that shouldn't surprise anyone. I personally think the 30% premium penalty for one year for those who sign up for insurance only when they get sick is laughably low to incentivize young people to maintain coverage. I also have mixed feelings about the subsidies, as I understand many people need them to afford insurance and much prefer the age-based rate for overall fairness but also believe they only serve to drive up prices. But those types of issues seem fixable without throwing the whole thing out.
So suddenly Obamacare isn't so bad, huh?

That's what's so weird to me. For years conservatives have been voicing cogent criticisms of the law: it's full of perverse incentives; increases the bureaucratic burden on doctors; forces people to buy a product provided by the private market; acts as a permanent subsidy to the insurance industry; etc. Suddenly most of those critics have gone silent, with the exception of perennially-ignored tricksters like Rand Paul.

I don't even see a fig leaf to fixing the actual underlying problem: that retail health care is too expensive in the first place. Instead it's yet another big government program to attempt to mitigate the consequences of this very basic problem with very little hope of succeeding--just like its predecessor.

I get that there are political realities in play, but that's exactly what the Democrats said in 2010 when they passed the original. It strikes me that this kind of sweeping lawmaking it just fundamentally a bad idea.
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Re: RyanCare/TrumpCare

Post by Pointedstick » Thu Mar 09, 2017 4:12 pm

As for the fact that they can only do certain things with Reconciliation, I see this as a dirty trick, abusing the process to push through something they know would get filibustered. If they're willing to play dirty, why don't they just get rid of the filibuster? Serious question.

Heck, I remember a time when it was possible to pass bills with a majority vote because the minority party side didn't filibuster every single thing their opponents supported. IMHO, either the filibuster should be gotten rid of, or else you should need 60 votes to pass anything in the Senate. The status quo is just ridiculous.
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Re: RyanCare/TrumpCare

Post by farjean2 » Thu Mar 09, 2017 4:23 pm

Pointedstick wrote:After (accurately) crowing for 7 years about how horrible Obamacare is, the GOP leadership puts together a bill that keeps the same basic structure but just tweaks where the money goes to and comes from.
I think the average GOP voter didn't need the 7 years of the Obamacare fiasco to realize how full of shit the Republicans were when in it came to what they say as opposed to what they actually do. And that's basically the reason Trump is president today, having vanquished the likes of Bush, Rubio and other "establishment" figures. With Trump I think the voters might have thought there was actually a slight chance that the actions would live up to the rhetoric for a change. I guess time will tell.
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Re: RyanCare/TrumpCare

Post by Pointedstick » Thu Mar 09, 2017 8:41 pm

Yeah, but Trump is putting his weight behind this turd.
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Re: RyanCare/TrumpCare

Post by Desert » Thu Mar 09, 2017 8:53 pm

For the early retirees (Tyler, PS and others), do you see this bill materially changing your healthcare costs, if it passes?
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Re: RyanCare/TrumpCare

Post by Pointedstick » Thu Mar 09, 2017 9:10 pm

Personally it will hurt since we're on Medicaid and don't pay a penny for anything right now. But I don't care about that. I think it's ridiculous that we're on Medicaid. I don't mind getting kicked off Medicaid; what I mind is the lack of any sanity in what they're planning to implement instead.

It looks like my family would get $9,000 a year in tax credits to buy insurance. I don't know how much that would defray the cost of a family insurance plan, but I do know that $9,000 is almost twice as big as the biggest tax refund I've ever gotten. The maximum family credit total is $14,000 (!!!). I strongly suspect that the cost of insurance is going to somehow magically rise to exactly capture 100% of the tax credit in cases where it would currently or otherwise be lower. The amount of money that will flow straight to the insurance companies is unbelievable.
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Re: RyanCare/TrumpCare

Post by Desert » Thu Mar 09, 2017 9:18 pm

Yeah, I understand. It's a bad system. When healthcare is in essence socialized, the insurance companies no longer serve any useful purpose, it appears to me. They simply skim tons of money out of the system and return little value. We should go ahead with single payer and stop paying the insurance companies if we want socialized healthcare.
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