Obamacare: Say goodnight, Gracie...

[T.Lex]

No mandate. That is non-negotiable.

Indeed, this "non-negotiable" attitude is part of the problem with non-political conservatives like yourself. It doesn't work.

You know about the Medicaid expansion portion of this bill and the ACA don't you? Please tell me your research in supporting this bill didn't leave that part out.

I guess there's a fundamental question that needs to be resolved: do you think the health insurance system generally needed reformed before ACA?

I don't mean that to be a trick question, so I'll elaborate.

At the time of the ACA debate, the Republicans proffered a plan that would nominally expand Medicaid/Medicare to achieve some of the same results sought by Obamacare. Some opposed that, believing such changes were not necessary. Were you among them?

If your position is that the government should have NO role in insurance of anyone, then this is a worthless exercise. That is not the current political reality. You would have no viable option to propose.

 

[T.Lex]

Maybe not, but it made it to the president's desk, unlike last week.

Some of those that voted for it in 2016 - the FC - were unwilling to vote for the same effects this year.

I think Ryan should've called the vote so we could see who those people were. I don't see very many publicly offering why this was unacceptable and the prior was.

 

[HoughMade]

I voted for Trump and I am willing to use an incremental approach on this.

We are not all in lockstep on the "all of nothing" mentality.

 

[Woobie]

Indeed, this "non-negotiable" attitude is part of the problem with non-political conservatives like yourself. It doesn't work.



I guess there's a fundamental question that needs to be resolved: do you think the health insurance system generally needed reformed before ACA?

I don't mean that to be a trick question, so I'll elaborate.

At the time of the ACA debate, the Republicans proffered a plan that would nominally expand Medicaid/Medicare to achieve some of the same results sought by Obamacare. Some opposed that, believing such changes were not necessary. Were you among them?

If your position is that the government should have NO role in insurance of anyone, then this is a worthless exercise. That is not the current political reality. You would have no viable option to propose.

Non negotiable on one point. I will not abide government forcing anyone into contract, or any entity having power to do the same. I know in some way that ship has sailed, but this is before us now. It is a viable position to be not be open for negotiation on one point of many. This has been done before.


Certainly government should be out of the insurance business. Though that is unrealistic, it isn't particularly difficult to draw a line on further coverage. That Republicans wanted to buy votes in the past (particularly when they were in more difficult political straits) is neither surprising nor basis for current bad policy. The 138% expansion needs to start drawing back to the 2010 level in the next FY, and that could be done in the next bill.

How about that defense? Or is there one?

 

[Woobie]

I voted for Trump and I am willing to use an incremental approach on this.

We are not all in lockstep on the "all of nothing" mentality.

I don't mind being incremental, but the process needs to be codified. The biggest problem of all with this bill was that it was marketed as step 1. We promise.....

If Republicans had a history of following through on these things, or a guarantee of having the political power to do so when the time came, maybe it the bill would have had more traction.

 

[T.Lex]

Non negotiable on one point. I will not abide government forcing anyone into contract, or any entity having power to do the same. I know in some way that ship has sailed, but this is before us now. It is a viable position to be not be open for negotiation on one point of many. This has been done before.

But that's the point about non-enforceability. Without an enforcement mechanism, there is no mandate.

The 2017 legislation had no enforcement.

Certainly government should be out of the insurance business. Though that is unrealistic, it isn't particularly difficult to draw a line on further coverage. That Republicans wanted to buy votes in the past (particularly when they were in more difficult political straits) is neither surprising nor basis for current bad policy. The 138% expansion needs to start drawing back to the 2010 level in the next FY, and that could be done in the next bill.

But, that's a net zero in terms of why not support the 2017 legislation: that expansion COULD STILL have been addressed in the next bill.

How about that defense? Or is there one?

Dude. Read my last dozen posts in this thread.

The defense of this 2017 legislation - and the 2016 - was incrementalism.

Is it everything I wished? No. Would it be better? Almost certainly.

It is about momentum - much like gun rights initiatives. Take what you can get, then push for more next round.

Obama won again, with the ultimate irony being self-identifying conservatives helped him to do it.

 

[GodFearinGunTotin]

Somewhere along the way, most everyone forgot what precipitated all of this--exploding cost of health care. Rather than attack what's driving the costs, both sides jumped on the insurance bandwagon. They both seem to believe health insurance is the only way in which medical care can be paid. One side believes if only they can make policies cheaper, then the problem is solved. The other wants to use insurance as a gateway platform to universal, single payer of all medical related expenses. The republicans either can't see another way or are simply afraid to offer real alternative for fear of near term losses at the polls. I suppose we're long past the idea of people being to pay as they go and figuring out what factors are in place that force people to want to socialize their costs.

 

[GodFearinGunTotin]

But that's the point about non-enforceability. Without an enforcement mechanism, there is no mandate.

The 2017 legislation had no enforcement.


But, that's a net zero in terms of why not support the 2017 legislation: that expansion COULD STILL have been addressed in the next bill.


Dude. Read my last dozen posts in this thread.

The defense of this 2017 legislation - and the 2016 - was incrementalism.

Is it everything I wished? No. Would it be better? Almost certainly.

It is about momentum - much like gun rights initiatives. Take what you can get, then push for more next round.

Obama won again, with the ultimate irony being self-identifying conservatives helped him to do it.

There wouldn't be incrementalism...there'd be see-saw-ism. One side will fight for middling improvements for the most outrageous abuses when they're in power, the other's going to fight for the poor, single mom, being crushed by the system when they get back into power. Same way with every other entitlement.

 

[Woobie]

But that's the point about non-enforceability. Without an enforcement mechanism, there is no mandate.

The 2017 legislation had no enforcement.


But, that's a net zero in terms of why not support the 2017 legislation: that expansion COULD STILL have been addressed in the next bill.


Dude. Read my last dozen posts in this thread.

The defense of this 2017 legislation - and the 2016 - was incrementalism.

Is it everything I wished? No. Would it be better? Almost certainly.

It is about momentum - much like gun rights initiatives. Take what you can get, then push for more next round.

Obama won again, with the ultimate irony being self-identifying conservatives helped him to do it.

Show me the next bill.

As I said, write the increments down or it won't happen. Conservatives have seen too much one step forward two steps back work from the Republicans to be duped by this lip service. And so it failed. You lost after 6 years of deliberating. Back to the drawing board. Bring a better bill and you'll get the support to pass it.

Thats the funny part part of this. Had this bill been more agreeable to conservatives, it would have passed. The attempt at playing nice with Democrats gained you zero Democrat votes and yet somehow it is the conservatives' fault. Your team is inept. If they learn from this, they will stand a chance next fall.

 

[GodFearinGunTotin]

Show me the next bill.

As I said, write the increments down or it won't happen. Conservatives have seen too much one step forward two steps back work from the Republicans to be duped by this lip service. And so it failed. You lost after 6 years of deliberating. Back to the drawing board. Bring a better bill and you'll get the support to pass it.

Thats the funny part part of this. Had this bill been more agreeable to conservatives, it would have passed. The attempt at playing nice with Democrats gained you zero Democrat votes and yet somehow it is the conservatives' fault. Your team is inept. If they learn from this, they will stand a chance next fall.

This also demonstrates the difference between the democrat view of the long game and that of the republicans. The democrats did what they had to do to get their ball across the goal line. They had to know this could cost them the next election because of its controversy and divisiveness. Yet, they did it anyway and here we are...their bill is still in place and apparently insurmountable. The republicans are so afraid of losing power, here they are...with egg on their face and ObamaCare still law of the land.

 

[jamil]

Oh, I have. And I've hit the max tax bracket many a year. And *****ed about it while completing those returns. But I didn't sit there and blame poor people for my tax bracket.

Who is blaming poor people for whose tax bracket? Your imagination fails you.

Greedy? Voting for politicians who will relieve your conscience for you by making other people pay your moral obligation to help less fortunate than you strikes me as greedy.

Nothing stops you from helping the poor yourself. Don't whine at me because I expect to mind my own obligations to my conscience. You should mind yours rather than voting to have some imagined entity called society do it for you.

 

[churchmouse]

Interesting.

 

[JettaKnight]

Oh, I have. And I've hit the max tax bracket many a year. And *****ed about it while completing those returns. But I didn't sit there and blame poor people for my tax bracket.

Maybe things have changed, but that's over $470K, for married folks this year...

Damn good money for a mechanical engineer.

 

[BugI02]

Here's reality. "Society" is just an aggregation of individuals. Society doesn't have a mind. It can't think. It can't act. It can't desire. Only the individuals which comprise it can do those things. Society did not elect Obama. Only about 20% of the 325,000,000 individuals living in the US society made that choice. A slightly lower percentage of individuals voted for Trump. THAT is reality. People who go around thinking societies are cognizant entities are fools.

There is no such thing as a society. There are individuals and there are families that make up what we call our society. A society has no real voice. A society only has the voices of individual members, some of which have more influence than others. Whoever made you think society thinks or acts as one has duped you with pies in the sky bull****.

And. Truman? I don't think highly of him anyway, but even being in the bottom quartile of presidents, Truman still ranks higher than the cripled socialist ********** you're apparently thinking of.

Jamil(*nhrn) is correct. 'Society' is simply what we call the complex vector sum of each individual pulling toward their desires and goals. One can discern a direction that 'society' is moving in but not control this motion, there is no rudder or tiller, no Archimedian place to stand. That is an illusion. To affect the vector you have to affect a large number of the underlying component vectors, so 'society' can be seen to be a construct or a simplification without object reality

Corporations are a microcosm of the same effects. Each individual employed by the corporation is highly self-focused, thinking of their next promotion or how to make their numbers to maximize their bonuses. Those higher up the hierarchy who supposedly exercise strategic vision are similarly focused on personal goals such as making or beating wall street projections or achieving a certain stock price or pursuing a tempting merger target. There are certainly people that think they steer the corporate ship but in reality the course set is again that complex sum of innumerable tiny force vectors

 

[Woobie]

Jamil(*nhrn) is correct. 'Society' is simply what we call the complex vector sum of each individual pulling toward their desires and goals. One can discern a direction that 'society' is moving in but not control this motion, there is no rudder or tiller, no Archimedian place to stand. That is an illusion. To affect the vector you have to affect a large number of the underlying component vectors, so 'society' can be seen to be a construct or a simplification without object reality

Corporations are a microcosm of the same effects. Each individual employed by the corporation is highly self-focused, thinking of their next promotion or how to make their numbers to maximize their bonuses. Those higher up the hierarchy who supposedly exercise strategic vision are similarly focused on personal goals such as making or beating wall street projections or achieving a certain stock price or pursuing a tempting merger target. There are certainly people that think they steer the corporate ship but in reality the course set is again that complex sum of innumerable tiny force vectors

That is a great explanation. And as my old Econ professor used to tell us, a corporation is a legal figment. If you get mad at GM, you can't spit on it. It's just a construct on a piece of paper. "Society" isn't even a legal figment, it is just a concept to simplify the understanding of general trends. You can't spit on society, you can't give it a hug. And it can't do anything, either. Because it doesn't really exist.

 

[BugI02]

Then what does your non-repeal solution look like?

Or is this another version of nihilism where you don't feel compelled to offer an alternative, just express disdain for what is presented?

I've been wanting to take a shot at this since I was reading this at work. I know the invitation was not tendered to me but hopefully y'all won't mind

Step one is complete repeal of ACA with a sufficiently future effective date ( say, 1 Jan 20) to give room for negotiation to include the main players, but close enough so they can see the cliff. Nothing concentrates the mind like a clearly visible looming train wreck

Step two would be to put in place a series of steps that providers can take to declare the intention to end of and then opt out of provision of universal emergency care, this would be purely voluntary but I expect a significant majority would avail themselves. This is designed to take the place of the mandate in motivating the populace to carry some form of insurance as it closes the loop-hole of medical care always being available in extremis. Knowing you could suffer or die if you don't prepare also concentrates the mind

Step three would be a program designed in consultation with major insurers to create a separate tier of catastrophic insurance, guaranteed by the government. It would be fleshed out in consultation with the insurers, with government providing an upper limit to what any insurer has to pay by stepping in at that level. I envision something perhaps like the $300k limit on liability in auto insurance. Along with various levels of deductible, and in the absence of gov't mandated levels and lists of coverage, the idea would be to come up with a product that provides relatively affordable coverage for all but the indigent. People could select the level of coverage and deductable amount they are willing to pay for. Those who truly can't afford coverage would be shunted to medicaid or similar

Step four would be to bring as much sanity to pricing as possible by applying gov't power, in consultation with insurers, where it can be effective to bring transparency to medical pricing and billing so consumers newly responsible for a bigger portion of their health care costs have the tools they need to make informed decisions. The flip side of this would be to also use gov't power, in consultation with providers, to hold insurers to the promise of coverage they have made (for example, removing the ambiguity about emergency coverage. If you have a heart attack or are in a car wreck emergency services typically chooses the hospital for you. IMO this should be covered regardless of network your policy is with because you were unable to make an informed choice. By accepting you as a patient the hospital should abide by your network's payment schedule and coverage limits. Also I personally would like to see the end of the consulting surgeon/specialist loophole where an ancillary professional chosen by your doctor may not accept your provider. If the hospital accepts your coverage, anyone practicing there and called in on your case should also be required to accept same)

The goal here would be for gov't to negotiate a limited role for itself as health care guarantor of last resort, and to get all the key players to talk about what the playing field should look like post 1 Jan 20. Gov't should have some simple, clear goals in mind such as to disturb the employer provided health care portion of the market as little as possible. I think we would be throwing a large amount of potentially confusing change at people and the key to getting congress on board is to get voters on board. You get voters on board by eliminating the anxiety that they are about to get screwed in some way

I readily admit I don't know how to mesh all the moving parts and get them to work smoothly together. I just tried to come up with a rough outline of something that might work

Repeal. Give providers an opt-out on treating the uninsured. Enlist insurers in reigning in and rationalizing pricing. Enlist providers in reigning in and mitigating the temptation to set predatory re-imbursement parameters. The players work it out among themselves, gov't stands in the background as the honest broker (visibly brandishing a big shillelagh). Everybody knows when the ship hits the iceberg, attempts at brinksmanship ruthlessly smacked down by gov't

 

[Alpo]

Maybe things have changed, but that's over $470K, for married folks this year...

Damn good money for a mechanical engineer.

Engineers make good executives in the Fortune 500 .

Interesting to note that 22 years later, the marginal maximum tax rate is the same as it was back then, albeit on a higher level of income now. But $400k doesn't go as far as it once did.

 

[bwframe]

I was happy to hear the talk that although the Administration may be done with this for now, that the R's in congress aren't. First discussion of a repeal bill coming up before the end of year when premiums increase for open enrollment for Obamacare. That or more announcements from involved companies that will cause or further advance the implosion.

Also mention of doing the bill the way it should have been done the first time. Repeal first, then a separate bill without concern for reconciliation. Make them vote it down, D's and R's.

 

[Alpo]

That is a great explanation. And as my old Econ professor used to tell us, a corporation is a legal figment. If you get mad at GM, you can't spit on it. It's just a construct on a piece of paper. "Society" isn't even a legal figment, it is just a concept to simplify the understanding of general trends. You can't spit on society, you can't give it a hug. And it can't do anything, either. Because it doesn't really exist.

Yet, most on this site spend many hours promoting ideas and entities that have no physical existence. Because a form of organization has no physical existence does not mean it does not exist.

You literalists are painting yourself into a very small box.

 

[T.Lex]

I've been wanting to take a shot at this since I was reading this at work. I know the invitation was not tendered to me but hopefully y'all won't mind

Step one is complete repeal of ACA with a sufficiently future effective date ( say, 1 Jan 20) to give room for negotiation to include the main players, but close enough so they can see the cliff. Nothing concentrates the mind like a clearly visible looming train wreck

Step two would be to put in place a series of steps that providers can take to declare the intention to end of and then opt out of provision of universal emergency care, this would be purely voluntary but I expect a significant majority would avail themselves. This is designed to take the place of the mandate in motivating the populace to carry some form of insurance as it closes the loop-hole of medical care always being available in extremis. Knowing you could suffer or die if you don't prepare also concentrates the mind

Step three would be a program designed in consultation with major insurers to create a separate tier of catastrophic insurance, guaranteed by the government. It would be fleshed out in consultation with the insurers, with government providing an upper limit to what any insurer has to pay by stepping in at that level. I envision something perhaps like the $300k limit on liability in auto insurance. Along with various levels of deductible, and in the absence of gov't mandated levels and lists of coverage, the idea would be to come up with a product that provides relatively affordable coverage for all but the indigent. People could select the level of coverage and deductable amount they are willing to pay for. Those who truly can't afford coverage would be shunted to medicaid or similar

Step four would be to bring as much sanity to pricing as possible by applying gov't power, in consultation with insurers, where it can be effective to bring transparency to medical pricing and billing so consumers newly responsible for a bigger portion of their health care costs have the tools they need to make informed decisions. The flip side of this would be to also use gov't power, in consultation with providers, to hold insurers to the promise of coverage they have made (for example, removing the ambiguity about emergency coverage. If you have a heart attack or are in a car wreck emergency services typically chooses the hospital for you. IMO this should be covered regardless of network your policy is with because you were unable to make an informed choice. By accepting you as a patient the hospital should abide by your network's payment schedule and coverage limits. Also I personally would like to see the end of the consulting surgeon/specialist loophole where an ancillary professional chosen by your doctor may not accept your provider. If the hospital accepts your coverage, anyone practicing there and called in on your case should also be required to accept same)

The goal here would be for gov't to negotiate a limited role for itself as health care guarantor of last resort, and to get all the key players to talk about what the playing field should look like post 1 Jan 20. Gov't should have some simple, clear goals in mind such as to disturb the employer provided health care portion of the market as little as possible. I think we would be throwing a large amount of potentially confusing change at people and the key to getting congress on board is to get voters on board. You get voters on board by eliminating the anxiety that they are about to get screwed in some way

I readily admit I don't know how to mesh all the moving parts and get them to work smoothly together. I just tried to come up with a rough outline of something that might work

Repeal. Give providers an opt-out on treating the uninsured. Enlist insurers in reigning in and rationalizing pricing. Enlist providers in reigning in and mitigating the temptation to set predatory re-imbursement parameters. The players work it out among themselves, gov't stands in the background as the honest broker (visibly brandishing a big shillelagh). Everybody knows when the ship hits the iceberg, attempts at brinksmanship ruthlessly smacked down by gov't

Well first, I rarely ever invite discussion of a topic solely for one person in a public thread. That's what PMs are for. Of course, Bug, you are more than welcome to contribute rational, well-thought out posts. In other words, whenever you have them ghost written. (I keed, I keed, of course.)

Anyway, I actually read your post earlier this evening but wanted to let it simmer for a bit. I guess, first off, I have no conceptual problem with your proposal. Rather, there are effectiveness issues. Some of these may also apply to Woobie's perspective.

First, this idea of setting a future effective date, then hashing out the details is interesting, but makes me wonder what you thought of sequestration. The notion of affixing significant penalties to a piece of legislation dependent on some OTHER legislation is an unnecessary over-complication. But, I also think I figured out how you can get there: it is a very business-y solution. But, it is one that doesn't translate well to government. Which leads to....

Second, that future-repeal-setting legislation isn't cast in stone. ALL legislation is written in sand. After the midterms, or upon whatever whim that moves the legislative motivations, that deadline gets undone/extended/diluted. Rather than a sign of good faith or commitment, it becomes the very illusory promise you see the recently-proposed legislation as.

Finally, what you sketch out would inevitably lead to more government. I thought the last 20 years or so would be enough evidence that "government" cannot act with "simple, clear" goals. No more than a homeowners' association can. An executive can have simple, clear goals - as Obama did - but needs the assistance of Congress. Ask Trump how difficult it is to achieve simple, clear goals.

I love how you guys want to build a utopia of freedom. Honestly I do. It would be really great. But until you can get about 20M people to buy into your dream, we are stuck where we are, doing what we can to make incremental improvements.