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Post by Deleted on Jul 28, 2017 12:45:32 GMT -5
No one disputes it needs fixing. We dispute that the bills the GOP put forth would have done so, or whether they would have made things worse. Most believe the latter. ETA: Blowing things is not always the way forward, not if there isn't a coherent plan to rebuild. I know this goes against Angie's theory of life, but... I've no doubt we can do better than the ACA, but what the GOP was putting forward was not it, or anything close to it.
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Post by nighttimer on Jul 28, 2017 15:22:44 GMT -5
I'll give Johnny Mac credit. He sure knows how to play a dramatic moment. Jimmy Stewart in Mr. Smith Goes To Washington would have been proud. The only question now doesll Ed Harris play McCain in the movie (again)? However, while liberals and the Washington press corps are doing somersaults over the return of Maverick Johnny Mac, please don't overlook that he arrived late to a place where Susan Collins and Lisa Murkowski already were. They deserve some of the kudos, shout-outs and big ups being lavished on McCain. Well, bipartisan reform or nothing doesn't sound good to me, since I'm not seeing the bipartisan angle to approach this. Which just leaves nothing. Which means we--all of us--are stuck with an horrible piece of legislation, but we'll end up just living with it, acting like it's just the way it is, and--if anything--get some more programs to fix the the problems caused by it. Brilliant. Want some spilled wine to go with them sour grapes, robeiae? McCain is correct that the path forward is not for 13 White male Senators to huddle together in a No Girls Allowed treehouse and put together a shitty "alternative" which only puts more money in the pockets of the wealthy, guts the ACA, leaves millions without coverage and raises the premiums to stratospheric levels. Mitch McConnell gets a lot of credit for being a savvy politician, but he flat-out blew this one when he shut out Susan Collins, Lisa Murkowski and the rest of the Republican women from their scheming. As early as May, there were dark clouds gathering that McConnell's McConnell didn't want Democratic input. He didn't want Republican moderate input. He wanted to craft a nasty piece of work that would give Trump something to boast about while assuring Ted Cruz, Mike Lee and Rand Paul weren't going to wander off the farm. When push came to shove, they all fell in line like the lemmings they are. The only way--the ONLY way to come up with a way forward on healthcare is by doing it as Democrats, Republicans and Independents getting together and doing the hard goddamn work instead of one-party rule. It's the American Way. Or at least that's what they told me in school.
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Post by Don on Jul 28, 2017 16:36:14 GMT -5
The lead-in to that article sounds eerily familiar. 😁 It absolutely amazes me that there are actually people who believe ObamaCare was economically viable over the long-term. Everything that's happening now was predicted in gory detail before the bill was ever passed.
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Post by robeiae on Jul 28, 2017 17:26:14 GMT -5
Want some spilled wine to go with them sour grapes, robeiae? Please. I'm not in favor of the Repub replacement bills. They've had years to figure stuff out and what they came up with has been largely pathetic. But Obamacare is still a wreck. It's legislation that mandates all kinds of stuff that the government has no business mandating, imo. It also has stupidly--and to the detriment of the country as a whole--just about locked in the idea that healthcare and health insurance are the same fucking thing. Single payer is at least a consistent and defensible option. It's beyond me why the Dems didn't ram this through when they had the votes, why they opted for this clusterfuck of a mess filled with time bombs, instead. What we have now is people actually arguing from a starting position where Obamacare makes some sort of sense, where it just needs to be fixed a little, because otherwise is a Good Thing. That's bs too, imo. The whole thing needs to be scrapped, then replaced with single payer (which will require tons of tweaking, to be sure) or with more stripping down of other bs legislation on healthcare that has lead to our current situation, wherein access is tied to insurance and insurance companies are making decisions that should be solely in the hands of patients and doctors. You know, whenever people argue about the role of insurance in healthcare and the mandating of that role by the government, people who defend the current situation often offer auto insurance requirements as somehow evidence in favor of their position. This is a flawed comparison for a host of reasons, but allowing that it's not, here's a question: when you get an oil change, replace a tire, top off your fluids, or just get some gas, why don't you go through your insurance? Simple answer: because that would be stupid, both from the perspective of cost and from the perspective of having a third party--the insurance company--have a say over what you do with your car. Can you be imagine being told that you can't get an oil change because it hasn't been a full twelve months since your last one? That you can only buy gas from approved gas stations? That you have to go on a waitlist for a replacement tire and that you may not get one at all if your car is too old? Yet people accept this bullshit--having decisions controlled by insurance companies--for their own bodies, for their children. Hey, I want health insurance. Because if I get really sick, I don't want to go bankrupt paying for it. And if I have a serious accident, the same. So I'm willing to pay a premium for some coverage in this regard. If the insurance company wants to give me a break because I don't smoke or because I have a yearly check-up, great. And for people who can't afford such a premium but still would like the protection, it's fair and just for the government to help out. But that's health insurance, not healthcare. Imo, I should be able to make an appointment with a doctor and get a check-up, or get a quick once-over if I'm a little under the weather and need some medicine, then pay out of pocket for that service without going into debt. And again, for those who don't have the resources, it's fair for the government to step in with need-based programs like Medicaid to help out. In my mind, there's not too much rocket science involved here. And again, I accept that single payer is a workable alternative. I don't think it's the way to go, but if that was what we had, I could accept it. What we have now is ridiculous. If it's the fault of the Repubs for not having intelligent alternatives/fixes, it's the fault of the Dems fro creating this god-awful mess.
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Post by Deleted on Jul 28, 2017 22:08:30 GMT -5
You know, Rob, I largely agree with what you've said.
But here's our dilemma. If we just yank Obamacare like a tablecloth off a heavily laden table, we'll have a fucking mess. Ditto if we just yank off parts that are essential to enabling it to work even in a half-assed fashion.
And that, unfortunately, was all the GOP gave us.
People are depending on it now. Costs are insane, and without insurance, few can afford a serious illness or accident. If we don't want chaos and terrible, preventable consequences, we need a coherent plan before we can ditch the admittedly imperfect ACA. We need to consider where we are and move from there.
The GOP had seven years to work on that, but God knows what they were doing instead.
Since pretty much everyone agrees there are problems that need fixing, and now that it should be pretty clear to the GOP that just plain old repeal will never happen, at least without a truly better plan to replace it, I'm hoping both parties will turn their heads towards a plan to either fix what we have or replace it with a genuine, viable alternative.
I'm all for a solution that provides a safety net so that no one goes bankrupt for medical care, genuine access to essential care for all, and that drives down costs. And that, moreover, adequately and fairly compensates medical personnel.
ETA:
Also -- while flawed, the ACA is better than what we had overall. Individual plans, if you weren't covered under an employer, were incredibly expensive in New York. The ACA sliced them down.
I think single-payer could work as well here as it does elsewhere, if we could get it through.
I also think a more market-based solution that detached insurance from employment and opened up competition between states could work -- IF Congress could do something to drive down the whackadoodle costs which so much exceed those in other nations.
But even if we could just go back to the world before the ACA (and I submit we cannot), that world sucked.
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Post by robeiae on Jul 29, 2017 13:43:16 GMT -5
But here's our dilemma. If we just yank Obamacare like a tablecloth off a heavily laden table, we'll have a fucking mess. Ditto if we just yank off parts that are essential to enabling it to work even in a half-assed fashion. Imo, we already have a fucking mess. A bunch of them, actually, going from State to State, that are getting temporary fixes that are actually just making things worse across time. The majority of the ACA is just bad, imo. I said that from get-go, many people said that from the get-go (people far more important than me). But complaints were ignored, attributed to partisanship, or "resolved" via highly questionable arguments that relied on future predictions, none of which have come to pass. And the whole thing was sold with lies about the consequences, both immediate and long term. Yet still, people approach this as if the ACA is somehow untouchable now. That is serious problem imo, bad or flawed legislation that--once passed--cannot seemingly be undone because of the consequences. It's akin to "too big to fail" arguments. Well, I disagree...with both. No company is too big to fail and no legislation/government program is too critical to not be tossed in the shredder, if neccesary. Yeah, I said the same thing. I agree that if there was a way to fix the ACA, they should have had it worked out and ready to go. But then, that's every bit as true for the Dems, no? They can see what's going on, too. Of course, most of them voted for the ACA, so maybe it's too much of an ask to expect them to admit to--much less try to fix--their own mistakes. Seriosuly, I don't believe the ACA can be fixed. Not really. It's fundamentally wrong-headed, insofar as it's about health insurance more than it is about healthcare. Any fixes are going to be ones that merely make bad consequences of the ACA look less bad (for a cost). It will be just more legislation, more laws, more programs, piled on top of what is already there. That is all we are going to get, nothing more, even if both parties work together here. Ten years from now, politicians will still be debating how to fix the ACA, mark my words. Imo, it sucked mostly because of bone-headed legislation that pre-dated the ACA. The ACA was supposed to be a fix for that world and it was exactly the wrong approach, imo. I have to give ol' Ted some credit here. He knew a long time ago that single payer was the only workable solution for people with his ideology, with his assumptions about the role of government. But he couldn't make it happen. So--to now take away all of that credit--he opted for things like HMO legislation that would theoretically mirror a single payer world, but actually steadily increased the role of insurance in the market. [/quote]
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Post by nighttimer on Jul 29, 2017 20:59:33 GMT -5
Want some spilled wine to go with them sour grapes, robeiae? Please. I'm not in favor of the Repub replacement bills. They've had years to figure stuff out and what they came up with has been largely pathetic. But Obamacare is still a wreck. It's legislation that mandates all kinds of stuff that the government has no business mandating, imo. It also has stupidly--and to the detriment of the country as a whole--just about locked in the idea that healthcare and health insurance are the same fucking thing. Single payer is at least a consistent and defensible option. It's beyond me why the Dems didn't ram this through when they had the votes, why they opted for this clusterfuck of a mess filled with time bombs, instead. What we have now is people actually arguing from a starting position where Obamacare makes some sort of sense, where it just needs to be fixed a little, because otherwise is a Good Thing. That's bs too, imo. The whole thing needs to be scrapped, then replaced with single payer (which will require tons of tweaking, to be sure) or with more stripping down of other bs legislation on healthcare that has lead to our current situation, wherein access is tied to insurance and insurance companies are making decisions that should be solely in the hands of patients and doctors. Yeah, well you let me know when there is going to be the political will to bring about single-payer heathcare in this country. Obamacare is not a wreck and it would make far more sense to fix what's wrong with it than it would be scrap it entirely and throw millions back into the ranks of the uninsured and filling up the E.R. In the meantime, Obamacare saves lives. That's a simple fact.Rather than junk the Affordable Care Act and leave people to their own devices as the Republicans want, our politicians should be instead trying to find ways to fix it and it can be done.
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Post by maxinquaye on Jul 30, 2017 3:50:16 GMT -5
I think there are two different questions here.
Is ACA good? No. It’s terrible. If they sat down to design the worst system in the world, they would land in something that was pretty close to ACA.
Does the GOP want to remove ACA because it’s bad legislation? No. They don’t. They just don’t people to have healthcare if they can’t afford to pay for it.
You know that joke about designing something by committee? ACA was designed by Committee, and the key design goals had little to do with medicine, efficiency, medical-political goals. It had everything to do with avoiding political outcomes. The Dems spiked any suggestion of single payer because they were afraid that people would run aroud in circles, point, and shout "Communism!"
Single payer is rational. It’s efficient and sane. It allows for ‘different strokes for different folks’ across a vast expanse of a country. It allows for private medicine, if you allow that, and it allows for public medicine in the same system. If you think Angela Merkel or Theresa May runs a command-and-Control Communist dictatorship, you might get away with it, but...
The European Union is not a nation but a trade block (although we’re getting toward the being a Nation bit) but we have a dizzying variety of single payer health care systems, from the completely free NHS in the UK to the hybrid system of private-public system we have here in Sweden (where generally primary care, the first contact care, is mainly private but hospitals are run by the counties). I’m sure there’s one system that suits the sensibilities of the Americans.
Germany, another large federal country, has something similar to what we in Sweden do. If your four year old had the sniffles, you go to your General Practitioner at the Primary Care centre and pay a fee to get it checked. If you break your bones in a car accident, the state swings you by into a hospital and you don’t pay anything.
I don’t know who suggested it, but what I always found sensible was to use the infrastructure you already have in place, and you too can quite easily have a single payer system where the majority still pay for their health care through private insurance, if that’s what you want (and I don’t understand why you’d want it), but if you don’t have insurance everyone gets medicaid, and the Veteran Administration’s hospitals are turned into public hospitals.
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Post by robeiae on Jul 30, 2017 8:36:54 GMT -5
I think there are two different questions here. Is ACA good? No. It’s terrible. If they sat down to design the worst system in the world, they would land in something that was pretty close to ACA. Does the GOP want to remove ACA because it’s bad legislation? No. They don’t. They just don’t people to have healthcare if they can’t afford to pay for it. You know that joke about designing something by committee? ACA was designed by Committee, and the key design goals had little to do with medicine, efficiency, medical-political goals. It had everything to do with avoiding political outcomes. The Dems spiked any suggestion of single payer because they were afraid that people would run aroud in circles, point, and shout "Communism!" Single payer is rational. It’s efficient and sane. It allows for ‘different strokes for different folks’ across a vast expanse of a country. It allows for private medicine, if you allow that, and it allows for public medicine in the same system. If you think Angela Merkel or Theresa May runs a command-and-Control Communist dictatorship, you might get away with it, but... Obviously, I agree with you about the ACA. And I agree about single payer: it is a rational approach. But there remains the other questions, with regard to what the federal government should do, what it is actually empowered to do here. Perhaps those questions are now moot. I don't think they should be, but if they are, then at least single payer makes sense.
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Post by Deleted on Jul 30, 2017 9:02:03 GMT -5
Agree.
Unfortunately, what didn't make sense was abruptly yanking out the ACA only to put in something worse, leaving the healthcare market in chaos and a ton of vulnerable people in the lurch.
The ACA wasn't going to get fixed, whatever the Dems came up with, as long as the GOP was in charge and dead set on repeal or nothing. That's been the case this last several years.
If the GOP can accept they can't move forward without working with moderate Dems, perhaps something can be done.
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Post by poetinahat on Jul 30, 2017 19:51:57 GMT -5
So the ACA is terrible -- being overseas, I have no first-hand knowledge or experience, so I'll take that as a premise.
1. How hard should it be to come up with something better?
2. How bad does it look that, even with a mulligan, the majority party can't even ram through what they have been able to come up with?
They must be so tired of winning that they've decided to lose for a while. Six months into the new regime, already. Either they've been winning at supersonic speed, or we can't say much for their stamina.
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Post by robeiae on Jul 30, 2017 20:04:33 GMT -5
Well, the majority party isn't in agreement on what to do about healthcare. Doesn't excuse the Repub's failure to fashion something (or to just repeal the ACA), but I think it explains--in part--the difficulty here.
And again, the Dems saddled the country with the ACA. They deserve a ton of criticism for that, imo. And some of them deserve some more for not, themselves, offering real solutions across the past 4+ years, but preferring instead to pretend that criticisms of the ACA were all somehow unfair, then get indignant in this regard.
And still again, the Dems were never of one mind, either. Which also explains--in part--why the ACA is so terrible.
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Post by Deleted on Jul 30, 2017 20:23:39 GMT -5
I have to note that the cost of a non-employer-covered individual plan under the ACA in New York was (and still is) dramatically cheaper than the cheapest one you could get before the ACA. When the ACA first came out, the Bronze plan was about one-third the cost of the cheapest plan in New York. Even the Gold plan was cheaper. They've all gone up in price, but they are still cheaper than what was available before.
You also have a range of options for your coverage. And if you qualify, you can get subsidies.
It has dramatically improved things here in New York for most of those who didn't have employer-based coverage, even if they don't get subsidies.
I know it hasn't improved things in all states like that -- it would be interesting to see why.
But as far as New York goes, the ACA, flawed as it is, is an improvement. That being the case, I'm not going to kick the Dems too much for putting it in place, though I do agree we urgently need to consider how we can do better.
ETA:
Worth noting, by the way, that I was initially a yuuuuge critic of the ACA and the way it was pushed through. But over time it won me over, as it has many others -- despite seeing that it has big flaws that needed addressing yesterday. Some of my friends were amazed to see me among those booing the repeal effort. (Indeed, if the Repubs had an actual decent idea, I might not be against it. But they don't. They just want to kill it, and damn the consequences.)
And that's not to say I'm not open to other solutions. They just can't be solutions that make things worse for people instead of better.
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Post by robeiae on Jul 31, 2017 8:06:50 GMT -5
Just because there are improvements for one group (in a limited area), it doesn't follow that the ACA was therefore a good thing. So what if there is some situational improvement for this group or that group? That doesn't mean how the ACA is being funded is therefore right, nor does it mean that the numbers are going to work across time (it's not and they're not, imo).
Again, this a serious problem with instituting large government programs: there doesn't seem to ever be any going back, because someone can always say "aha! this person right here is better off because of this program, therefore it's a Good Thing and we cannot get rid of it!" For instance, we could have legislation that mandates the first $200 of everyone's weekly grocery bill would be free (via vouchers or the like). This would help a lot of people, right? Imagine if that happened, somehow, and went on for several years or more. It would be bankrupting the country like nobody's business, to be sure ($3 trillion + per year). But again, it helps people, it saves lives. Would it be untouchable, maybe just require a fix or two?
People talk about fixing the problems with the ACA but whole thing is a problem, imo. The fixes just represent ways to cover up some of the worst consequences of it.
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Post by Don on Jul 31, 2017 9:02:44 GMT -5
Rob has the crux of it.
"Unsustainable" is a perfectly understandable word when it comes to the ecology, but apparently a lot of people don't believe it applies to economic matters.
The state of economic education is abysmal. I'm pretty much convinced that's not an accident. Here's a perfect example. The education system has no trouble getting across the concept of unsustainable ecology. They should be capable of explaining the same concept in the economics classroom.
Naturally, YMMV.
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