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Ze Pollack posted:Genuinely interested in your thoughts on this one, because I keep trying to figure out who the hell this is supposed to appeal to and not succeeding. It's a desperate attempt to satisfy a promise they can't satisfy. It's easiest to think of this in terms of the Senate. They need 50 votes, and you can roughly arrange Republican Senators into three groups: (a) conservative true believers, who hate Obamacare because it is a redistribution of money from the rich to the poor and fervently believe that it is wrong for the government to expand health insurance to people; (b) senators who ran on opposition to obamacare because it was politically helpful but have no strong feelings either way and don't feel vulnerable; (c) 'Moderate' Republicans who either have enough of a soul to wince at the idea of throwing millions off health insurance for no good reason, or who are fine with it but think they'll lose their next election if they do. For a long time "repeal and replace!" satisfied everyone. Group (a) got the repeal and figured the replace would be a token replacement or nothing. (b) has never cared what the end result was, they want credit for repealing Obamacare but don't really care if it's replaced. (c) wanted a legitimate replacement. There has never been a "replace" because groups A and C can't agree on anything. You can't keep Obamacare's expansion of health care without spending money. Group A wants to use that money for tax cuts, Group C wants a real replacement with that money. But as long as you don't present a replacement, you can run on repeal and replace forever. But, now they can. And they're stuck. The plan is trying to thread the needle: it murders some of the poor so group A gets tax cuts, but tries to keep some of the health care expansion for Group C. The hope is that its close enough for both groups they can bluster but won't dare vote against it. It's not like its a well thought out plan. It's desperately trying to satisfy all the bullshit promises they made about how everyone was going to get a unicorn with the replacement - or, if it goes down in flames, that it is someone else's fault, not leadership. It appears that the death2poors wing isn't getting enough in this bargain though and may actually revolt.
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Mar 7, 2017 22:39
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KillHour posted:If they pass the bill, everything breaks. If they don't pass the bill, nothing happens. Not quite, insurance companies need to decide if they're participating next year very soon - and this bill, if it passes, probably creates a death spiral (the 30% markup if your coverage lapses has the perverse effect of, of you trigger it, making it so you don't get insurance until you need it making the insured population sicker). I don't know they have time to wait to see if this fails.
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Mar 7, 2017 22:42
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esquilax posted:I'm with you in that I don't really "get" it - there doesn't seem to be any kind of cohesive thesis behind what it's supposed to do, unlike the ACA itself and prior republican replacement plans. It looks as if it was designed by elected officials who read a few white papers instead of a wide coalition of experts and lobbyists like literally every other piece of major legislation. Yeah that is basically it. It's not a health care plan. Its a "politically, how do we tick the box that says 'repealed obamacare'" plan. I don't actually think it's going to work. I'm cautiously optimistic, but optimistic. I don't think they can thread this needle and I think that instead of pleasing both sides just enough they'll both vote against.
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Mar 7, 2017 22:45
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Monkey Fracas posted:Bill seems to be really pissing off the True Believers at least They're being very loud about being pissed off, but I don't know that the "moderates" are any less pissed off about $600b in medicaid cuts and the replacement being garbage. But I think they'd rather the True Believers sink the ship first.
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Mar 7, 2017 22:57
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Bueno Papi posted:They may not agree on replacement but there is unanimity for repealing all of the taxes and that can be done with reconciliation. Even then, they have a debt ceiling vote that needs to happen and it will occur during all this healthcare reform debate. Republicans really do suck at governing. There is not unanimity for repealing the taxes. The "moderates" won't vote to repeal the taxes without replacement because they know they're not getting any replacement then. That was kiboshed when repeal and replace, maybe, sometime in the future got kiboshed.
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Mar 7, 2017 22:58
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Dr. Angela Ziegler posted:
One of the things that often gets missed is Obamacare made a lot of cuts to things - like hospital reimbursements - that were made up for elsewhere so that all stakeholders were ok with it. Without fail, Republican proposals pocket the cuts and abolish where it was made up elsewhere, and that's one of the things the AHA is furious about. Democrats have wanted to to health care reform for over half a century and failed every time before Obamacare. Republicans don't even want to do it. They just want to oppose it.
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Mar 7, 2017 23:33
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Bird in a Blender posted:Not sure if this was asked and answered already, I didn't see it mentioned. With the 30% premium increase if you go two months without insurance, does that still apply if I go from one employer based plan to another? Just thinking that if I lose my job, and don't get insurance for a few months, and then find another job, would my new employer actually end up paying more for my insurance? I could honestly see companies taking that into effect when hiring someone if so. No. Employer plans are handled entirely seperately.
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Mar 8, 2017 00:13
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Bueno Papi posted:It's insane that the AHCA rollout happened like this. My assumption was that the WH took this as "a good first step", I think that's how Trump put it, and expected it to be worked over with amendments to bring in the other votes. But nope, Costa is saying that the WH is full speed ahead on AHCA. Why didn't the WH do a full court presser to try to shape the narrative? They let house release it and gave the media an entire day before they started their spin. I like to think Boehner is watching this and is screaming at the TV saying, "Amateurs." Because Trump doesn't know or care about the details. He has no idea what's even in it. And Congress is fed up waiting for him to care.
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Mar 8, 2017 00:20
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BarbarianElephant posted:Aside from loving up a war and destabilizing the entire Middle East. Bush hadn't hosed up the war and the entire middle east yet.
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Mar 8, 2017 00:45
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Noctone posted:I mean, only if they torpedo the filibuster, right? The Republicans are using a special procedure that evades the filibuster, but limits the types of things they can put in the bill. They can also only use it once per year. Senate rules are arcane as all hell.
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Mar 8, 2017 03:38
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Mokelumne Trekka posted:Why all the talk of this being DOA in Senate? Sorry, I know nothing despite the reading I've done There's probably at least three diehard give me what i want or nobody gets anything conservatives who will vote against it for not being pure enough and taking away enough healthcare from poor people (Paul, Cruz, and Lee), as well as probably at least three "moderates" who aren't down with the medicare cuts and/or the Planned Parenthood defunding. Three defections kills it because Republicans only have 52 votes + the tiebreaker. If both groups hate it, there is no way to satisfy one without the other one hating it even more.
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Mar 8, 2017 03:44
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hobbesmaster posted:Obamacare itself was passed partly through reconciliation It was mostly passed through normal procedures. What passed through reconciliation was a patch to tweak enough to make the House happy with it. The overwhelming majority of the bill passed with 60 votes before they lost the 60th seat.
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Mar 8, 2017 04:10
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EugeneJ posted:I mentioned a few weeks ago that Bernie should start publicly saying he would like to try and work with Trump on health care, but I got laughed at. No he doesn't. He likes trying to keep driving the wedge between hillary people and berniebros.
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Mar 8, 2017 05:13
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EugeneJ posted:https://twitter.com/NickReisman/status/839230489080778753 The Democrats don't hold the state senate despite having a majority, because a third of the loving democrats caucus with Republicans. If Cuomo was on board he'd be out in front of it.
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Mar 8, 2017 05:36
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esquilax posted:However, for many people the size is roughly comparable to the ACA individual penalty ($695 / 2.5% of income) for a few years . It's a motivator, similar to the individual mandate and inspired by the 1%/month/lifetime Medicare Part D "no coverage" penalty. Even though it's comparable in size to the ACA penalty, it definitely seems less useful from a behavioral economics standpoint (you are mandated to buy this or pay $1500 now vs. if you don't buy this you will eventually pay $1500 when you do buy it) and I'm skeptical. The difference is that the mandate penalty applies each year you go without coverage. The 30% applies once. You're always incentivized to get coverage under the ACA penalty so you stop paying it, while once you trigger the Trumpcare penalty there is no additional penalty for additional time continuing to go uncovered.
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Mar 8, 2017 19:18
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cis autodrag posted:A "network" is simply shorthand for "the providers we have contracts defining rates with". In-network pricing is "good" (better than out of network) because the insurer has a contract with the provider that says "no matter what you bill, you're getting paid this and you can't pass it on to the patient". The only way to have something analogous nationally would be for the government to mandate prices for all services. Which is a thing other countries do, Japan has had success with it, but it wouldn't fly with America's brokebrains free market religious fervor. Also insurers like narrow networks because then you can negotiate steeper discounts (because the provider gets a lot more customers by being in your network since many people then have to go to them).
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Mar 8, 2017 22:26
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Leon Trotsky 2012 posted:Actually, healthcare isn't about money at all. You're being very crass by even bringing money into the equation. Nonsense, he was quite clear about his goals: "Our goal is to make certain costs come down. Specifically, tax costs. Of the rich. No, not ones related to health care, what a silly question, their overall taxes."
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Mar 9, 2017 16:12
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Typo posted:it drops subsidies for young people and raises it for old people, it's the Republicans transferring wealth to their voter base It raises subsidies a little for old people in some cases but not others, but raises premiums a lot for all old people. It's not a transfer of wealth to old people. Its a transfer of wealth from old people to wealthy people, mostly.
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Mar 9, 2017 16:57
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Perestroika posted:I guess that explains the difficulties the GOP had with all this. They just fundamentally do not comprehend how insurances work. They do. What Paul really wants to say, but knows he can't, is that the rich should not subsidize the poor. But he's a good enough politician to not say it out loud, but because he was thinking it at the time he produced that.
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Mar 9, 2017 20:07
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Oxxidation posted:So now they're bringing it to the House floor without even that meager sop to older citizens? I'm pretty sure that amendment was to make things even worse, actually.
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Mar 9, 2017 20:14
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Craptacular! posted:People keep saying this bill "isn't anything" but the GOP plan to changing health insurance has been refundable tax credits forever. It was going all the way back to McCain 08, at least. It only looks stupid because a plan was implemented that went so much further than what they offered eight years ago, and they're still arguing as if we're still under the old model of healthcare when this bill would have at least been a small, ever so tiny incremental step in improving things. But gently caress that poo poo now, Republicans failed to block an entitlement and once people taste the mana of a public service they try to preserve it. The GOP plan has always been nothing. GOP members have proposed plans, but there has never been any sort of "GOP Plan" until now. Why conservatives are furious is that they were never going to sign onto those assorted plans: they understood them to be a talking point that would never be implemented.
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Mar 9, 2017 20:18
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call to action posted:The best part of all of this is that we have to defend Obamacare as something else than a complete handout to insurance companies, lie about how premiums TOTALLY NEVER WENT UP FOR ANYONE EVER, etc. just because the alternative is worse Obamacare is not a complete handout to insurance companies: the alternative is worse because its dramatically worse than Obamacare, not because it's worse than the pre-Obamacare status quo (it's not, the pre-Obamacare status quo was just that loving terrible). Obamacare made life better for tens of millions of people, and that's what people are realizing when the prospect of it getting repealed is in front of them.
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Mar 9, 2017 20:25
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BarbarianElephant posted:They can, and what's more, they can make them beg for it. They can talk about it, but what's making Republicans real nervous (and is part of the reason for the GET THIS DONE BEFORE ANYONE CAN OBJECT) is that a lot of those people are their constituents, and will put 2 and 2 together when they actually lose their health insurance instead of just those other people losing theirs.
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Mar 9, 2017 20:27
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Craptacular! posted:The Republicans had fairly consistently supported refundable tax credits determined by means testing, with a middle finger and a painful death for anyone worthless enough to not have income taxes to file. Refundable is what makes it still apply to people who don't owe income tax. And again, they never actually supported passing that, they supported it as their fig leaf alternative when their actual plan was nothing.
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Mar 9, 2017 21:48
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Lote posted:Any of these three happening would result in people dying and many hospitals across the country closing. It would also primarily hurt rural areas and areas with bad heroin epidemics bigly.. Yes, which is why they're not in the bill because there's enough Republicans who have to worry about getting voted out if they yank all their constituents healthcare to kill those. Actually, I think they would do #3 but it can't be done in reconciliation. I think full Obamacare repeal can't either, which is why they're willing to accept the 2015 bill (which guts Obamacare enough that the health care market ceases to function, and then you hope Democrats help you repeal the rest and "replace" because otherwise look at all those people dying do you want to be responsible for those people dying what, you say its my fault those people are dying, ludicrious i am trying to pass this bill right now to save them from dying and you wont help me).
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Mar 10, 2017 16:19
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eviltastic posted:Ted Cruz, noted student of Senate parliamentary rules, would like to play Calvinball with Mike Pence. Its actually not completely crazy what he's suggesting because its the same basic principle the nuclear option relied on: at the end of the day, the only way to reverse a ruling from the chair on what the rules say is having 51 votes. Expect to see conservatives call for it more and more as stuff that's not going through reconciliation gets blocked. My guess is that its not going to happen because the Republicans in the senate don't actually want to pass the hard-right stuff. It's usually unpopular, and fundamentally Republicans are more happy with government not working than Democrats are so they'll happily sacrifice a few laws (knowing they can get their tax cuts through) to make it harder for Democrats to legislate in the future. So they'll go oh too bad we're totally with you but i guess we just can't pass the Grind Up The Poor And Feed Them To Dogs act because of those mean old senate rules! That way their dumb constituents don't really notice they voted in favor of it like they would if they actually started getting turned into doggie burgers, and their hard right constituents think they're on their side but it's old yertle who is the problem. Part of the job of the Senate Majority Leader is, basically, to be the bad guy for his caucus when they don't want to be the bad guy.
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Mar 10, 2017 16:52
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Cheesus posted:And yet I'm still going to be legitimately shocked when both the repeal and replace pass. I don't think it's happening. I was already feeling vaguely hopeful but if Senator Cotton, noted piece of poo poo and fervent Trumpenstaffel sturmgrenadier, is saying its a stupid piece of poo poo that will make health care worse, I don't see it getting anywhere in the Senate.
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Mar 10, 2017 17:03
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Dmitri-9 posted:And the DNC can't even be bothered to say anything at all. I've heard a lot from Chaffetz, Doll Eyes, Turtle Club, Trump but not Pelosi or Reid. The Democrats' strategy is to stay out of the way and it's a good one. They are letting Republicans savage the bill while Democrats sit off on the side going yep, definitely poo poo whenever asked keeps the focus on a Republican vs. Republican fight instead of a fight against the Evil Liberals that might help unify the Republicans. Then every time one of them says something real dumb, like that, they tweet it to everyone - but making sure the focus stays on Republicans.
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Mar 10, 2017 17:08
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Dmitri-9 posted:Maybe it's the fault of the "liberal media" constantly carrying water for Trump's job creation successes and presidential demeanor when they aren't calling him a lying traitor. It must be hard to cover more than two things. Do you want Democrats loudly opposing this, or do you want the greatest possible chance of it going down in flames and no repeal passing?
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Mar 10, 2017 17:11
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Dmitri-9 posted:Being the silent, passive party with no ideas or beliefs doesn't strike me as a good strategy. If they can't make political hay out of stupid policies no progress will be made, the status quo will be eroded out from under them. I mean look, there's not a Democrat out there who, when asked, isn't repeating the correct talking points. Most importantly, there's not a single Democrat, in the House or the Senate, showing any inclination of giving these idiots any cover whatsoever. They've got the votes on lockdown. They've got a good strategy: gum up the works as much as humanly possible while waiting for the CBO score to drop and officially announce how terrible this is. And to stay out of the way while the Republican party tears itself apart while Ryan and Trump keep vainly trying to get everyone to focus on defeating the Democrats. One of the most helpful things here is that there is a bipartisan consensus this is poo poo. Not Democrats vs. Republicans: Democrats and Republicans vs. Republicans. It's one of the things McConnell identified early on in Obama's presidency: the public assumes that anything that is "bipartisan" is good. Right now, this is bipartisan opposition. Everyone watching sees Republicans on the TV repeatedly castigating this. They see Democrats also saying its bad, but the Democrats aren't crowding out the Republicans or making it easy for people on the right to go "stop fighting, you're helping the Democrats!!" I mean, people are doing that and they're right. But because the Democrats are making it hard for them, so those republicans are not being very effective at it. They have ideas, they have beliefs, and the fact they're sticking to them is what's put the Republicans in this spot. But there's more to a strategy than blindly charging full speed every time at something. Republicans are busy making a very big mistake. The Democrats - who are as far from an election as it is possible to be - are busy making sure that when the election does come around Republicans are in as bad a spot as possible. I am very, very sure they're saving the video footage of these idiots for the 2018 elections. I am very, very sure that they will be loudly denouncing what the Republicans have tried to do/will do. There is nothing, nothing at all, better that could happen for the Democrats (and for the country) than for Obamacare repeal to fail because Republicans ripped off the mask and showed (and said) that their actual health care policy is gently caress you, die in a gutter. Everyone knows the Democrats are in favor of broader health care. What there has been confusion on - because it's an explicit Republican strategy to make sure that confusion exists - is what Republicans are in favor of. Right now, the Democrats are letting Republicans tell you what they are in favor of. And it's not pretty.
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Mar 10, 2017 17:37
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EugeneJ posted:It feels more like they don't want to fight against it, lose, and then take blame as the reason people are dying because of their failure That's a stupid opinion and you should feel dumb for saying it. They're in lockstep opposition to it, even senators from deep red states that Republicans hoped to flip. They aren't giving an inch of ground on this, they will not supply a single vote for it, and they won't supply a single vote for followup laws. They are just also making sure that there's plenty of airtime for Republicans to murder their own. They are doing everything possible to set this bill up for failure, and doing stupid poo poo because it feels good but makes repeal more likely is going to make it more likely people die (but you feel good!).
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Mar 10, 2017 17:39
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EugeneJ posted:You're saying this as if the repeal succeeding and people dying in the streets wouldn't be an easier way for Dems to win over voters True, but if they die they can't vote  . In all seriousness, the Republicans managed two different wave elections in response to heath care reform that failed (clinton) or succeeded but hadn't actually done anything yet (obama). I don't think its necessary to actually take people's heath care away, they just need to know that Republicans tried very, very hard to take away their heath care. Republicans can't run on repeal and replace anymore. They now have to defend this piece of poo poo.
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Mar 10, 2017 17:47
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lol tpm decided to get a little frisky on the image for this article: 
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Mar 10, 2017 17:50
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sharkbomb posted:But let's consider if Republicans are able to nuke the ACA and return us to the bad-old days of 2009. In that case, in the 2020 elections there is absolutely no chance that Democrats will be campaigning on a healthcare platform that calls for returning to Obamacare or 'repairing' it. That was tried and failed - total nonstarter politically. The only thing that's left is single payer (Medicare-for-all)! Well, that's the big thing: the current bill doesn't return us to 2009. That's why conservatives hate it. It is not completely wrong that it's Obamacare lite. It keeps the medicaid expansion around for a while. It keeps subsidies, but makes them cheaper and stingier. It repeals the taxes. But the basic structure of Obamacare is still all intact. And that means that it's very easy for Democrats to fix when all hell breaks loose if it passes: they run on restoring the subsidies, and canceling the sunset of the medicaid expansion. Neither of those things change anything about the health care people currently have. All those regulations that sunseted poo poo insurance? Still intact. All you need is a more viable replacement for the individual mandate. So Republicans are discredited, Democrats restore Obamacare, and the principle that it is the government's job to help all people get health care gets firmly rooted in the law. Where you go from there, assuming that anyone is still interested in touching health care with a ten foot pole after 12 years of nonstop political combat about it, would be a public option. The core lesson from all of this is that people don't like the health care system, but the vast majority of people have coverage that is "good enough" that they are scared of losing it. That's why Obamacare tried so hard to advertise people could keep their insurance. That's why repeal of Obamacare was so much easier before everyone had Obamacare. People do not like uncertainty in their health care and want to, at a minimum, keep everything they have. So the natural outgrowth isn't medicare for all in 2020, it's a public option for under served areas - nobody has to use it. Questionable if you could muscle it through with insurance company opposition, but there are no natural other constituencies that would suffer from one. And you can expand the public option from there: its always going to be somewhat handicapped from the possibility Republicans take over and privatize it or whatever, but its the most obvious next step.
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Mar 10, 2017 19:07
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SousaphoneColossus posted:Given that the medicaid expansion is reasonably popular even in some red states, has anyone thought about making the "public option" just expanding medicaid to anyone who isn't already insured or eligible for medicare/tricare/whatever else? The only real complication I can think of is the SCOTUS decision that made it optional for each state. No that's also a good option, its just expensive so you have to raise taxes, which imposes its own political cost. But that was one of the best aspects of Obamacare and one of the things currently making it hard as balls to repeal, because the expansion red states aren't interested in giving it up.
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Mar 10, 2017 19:24
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Hieronymous Alloy posted:There is only one winning strat right now in health care politics, it is Medicare for All/ public option Medicare, and it is politically impossible until after the Republicans fall on their faces. The party in power does not own the status quo in any real sense. That's the problem: they own any change from the status quo, and (as the last 8 years have taught us) mostly own only the downsides while people with the upsides think voting trump is the way to save their healthcare  So yeah, public option medicare is the way to go, provided that you make sure that nobody is forced into it because even if they're entirely better off forced into it they will hate you for it and blame every little thing that goes wrong on you.
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Mar 10, 2017 19:27
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EugeneJ posted:Would GOP support single-payer if it was entirely funded by the insured? No. Because this isn't entirely funded by the insured, it's funded by the wealthy. The core conservative problem* with Obamacare is that it taxes the rich to help the poor which is why their repeal bill is a massive upper-class tax cut. Fundamentally what conservatives want is that the rich don't have to help pay for medical care for the poor. There's some Republicans who don't share this randian dogma but the randian dogma holds the whip hand. *they pretend to care about a lot of things for political reasons, but this is the core issue: Obamacare raised taxes on the rich to fund health care for the poor. They just needed better political attack lines than that. evilweasel fucked around with this message at 19:45 on Mar 10, 2017 |
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Mar 10, 2017 19:43
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EugeneJ posted:Most drug manufacturers offer their drugs for free or almost free in the US to those who make under a certain amount because if they didn't, the FDA would be all over them about abusing drug patents One of their cleverer scams is charities that pay the co-pay for people on insurance who can't afford the co-pay.
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Mar 10, 2017 22:08
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Hollismason posted:How is that a scam? The drug company pays a small amount for the co-pay in exchange for getting the full drug price from the insurance company. That its "charity" is the scam part, it's naked self-interest and highly profitable.
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Mar 10, 2017 22:11
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call to action posted:It's sort of weird seeing people defend PPACA as a jobs program when they'd never do the same for the F-35 program. unsuprisingly your view on government spending money on things to create jobs tends to vary with your view on the value of the things being made
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Mar 10, 2017 22:33
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