Robert Laszewski is analyzing the recent Republican “plan” to replace Obamacare with Hatch/Burr/Upton. I analyzed the basic projection last year in three parts (Part 1, Part 2, Part 3). The basic analysis is that Hatch/Burr/Coburn assumed that the big problem with the US healthcare system is that us peons have it too good as it is now, and the actuarial value of our coverage is way too high. Low value coverage would be provided with small tax credits, and then everything else would allow the invisible hand of the free market to fist us.
There are a couple of things worth talking about (Medicaid demonstration waivers, price transparency etc) on purely technocratic grounds, and then there are a lot of conflicting values being displayed by budgetary committments between Hatch/Burr/Coburn or Upton vs. current baseline of PPACA.
Laszewski makes a decent point with the following:
They will have an uphill battle. Not because these Republicans don’t have a lot of good ideas, but because they have put a list of big and complicated changes on the table. Lots of people may not like Obamacare but Republicans have now really muddied the waters with a huge take it or leave it alternative that will have plenty of its own reasons to give voters pause….
Status quo bias is immensely strong in healthcare politics as Democrats have been getting kicked in the groin on status quo changes for the past three election cycles. However he goes off the rails when he says the public would like a bit of PPACA and a bit of Hatch/Burr/Upton but there is one big block to that:
If Democrats would just admit Obamacare needs some pretty big fixes, and Republicans would be willing to work on making those fixes by putting some of these good ideas on the table, the American people would be a lot better off
Democrats have been offering fixes, tweaks and changes to PPACA since the ink dried on Obama’s signature in March, 2010. Just in 2013/ 2014, there was a proposal to add a Copper plan level, there was a proposal to tweak ministry plans, there was a proposal to delay the sunsetting of non-compliant plans, there was a proposal to tweak expatriate coverage, Democrats have been proposing numerous fixes, tweaks and modifications to a basic structure of a guarantee issue, subsidized, mandated insurance tripod. Right now the Republican response has been fuck you, let’s revert to status-quo of the Bush Administration.
There has been no serious Republican thinking that meets the following two criteria: Does not reduce the current level of coverage for Americans and has at least 10 sponsors or champions in the GOP caucus. One side wants to engage in healthcare policy and the other does not.
The “both sides do it” reference made me laugh because just yesterday I encountered the most ludicrous example of “both sides do it” I have ever seen. There was a story from earlier in the week about how JEB! had released all his gubernatorial emails for “transparency” and in the process released a lot of sensitive personal information about other people. And on Facebook, some yokel who is brother to a FB friend of mine commented that it was hypocritical of Democrats to make fun of Bush over it because if bush hadn’t accidentally released the information, some Democrat would have just hacked his email and released it deliberately. He didn’t take it well when I called him a moron.
If I’m having a heart attack, it’s a little late to be doctor shopping. You might be able to research, G.P’s but the rest not so much.
You tell the truth.
TELL THE TRUTH
By now, the people who want to repeal Obamacare would do it if the alternative was a law that everyone gets their hand chewed off by a meat grinder. The law isn’t opposed on rational grounds.
The Democrats offered plenty of opportunity for fixes, tweaks, and changes while PPACA was working its way through Congress. The Republican responses were twofold. First, a handful of them toyed with the Democrats, suggesting they might vote for it if it were watered down even further. Then, when the chance came to back that up with actual votes, they unanimously said no. They had no interest in constructive changes when those changes would have been easiest to implement.
Hell, they had control over both houses of Congress and the Presidency during the George W. Bush administration. That was the perfect opportunity to give us the Republican version of health care reform. The closest we came was the giant, unfunded giveaway to Big Pharma that was Medicare Part D. All the available evidence is that the Republican version of HCR is a big fat pile of nothing.
well thank God we have the media out there providing fair and balanced reporting on the whole gamut of Health Care issues from Benghazi to Deflategate, because that’s what the public demands, the ability to make informed decisions.
I think the number of times the House Republicans have voted to completely repeal the ACA without offering any alternative is in the mid-50s. Taking them seriously is only for idiots and zombie David Broders.
ETA: I’m not suggesting those are disjoint sets.
It’s amazing to me that a thinking human could still claim with a straight face that there is a way to work with Republicans on healthcare. My Id wishes I were capable of this level of willful blindness
The Republicans are not going to support anything that they can’t claim was their idea, because they have so inflamed their electorate as to hatred of anything seemingly leftist that any bargain is tantamount to bargaining with the Devil, and who, for many of these folks, is a real, live being in their world view.
This really is a zero-sum game for them. How do you collaborate with that?
Assumes two major facts not in evidence:
1. Republicans have good ideas for healthcare (I guess they were just sitting on them during the Bush years when they ran the whole show)
2. Democrats just need to compromise (See 2008 to present).
“One side wants to engage in healthcare policy and the other does not.”
Remove the word “healthcare” and you cover every issue facing the federal government since 2009.
This. On NPR Valerie Jarrett did push back some when asked why Obama could not compromise on things that the GOP wants. I wish she had been more clear on saying: “If the GOP is proposing some change that improves the ACA goal of insuring more people, Obama would be happy to consider it.”
The unsaid part was “The GOP hates the ACA and is only proposing things that will tend to break it and will not lead to more people economically insured. We have no interest in compromising on those items.”
Villago Delenda Est
@C.V. Danes: Hell, they won’t support something that was their idea. ACA is basically what the fucking Heritage Foundation proposed as an alternative to HilaryCare two decades ago, and the Marquis of Mittens implemented in Massachusetts in the early aughts.
The poors need to be punished under all circumstances and kept in their place, in the fucking dirt. So do the Outer Party members…the shrinking middle class.
You cannot collaborate with them. You can only load up tumbrels with Rethugs and give the knitting ladies something to chat about.
Republicans don’t want health care (which is a misnomer anyway since what we really have is sickness care). The old-school types want every dollar spent on them in their last few years of life. Libertarian types don’t want any dollars spent on anybody. Corporate types hope to profit from the system as it is already. No matter which combination applies to a particular Republican, it doesn’t include anything to keep Other People or the economy healthy.
Much closer to the truth.
The GOTea seems compelled to shovel the entirety of federal receipts into some private sector coffer: health insurance is just one avenue for that effort. Medicare Part D shifted funding the way it was intended: from the people and away from pesky healthcare providers, and toward Big Pharma where it belongs. The slapdown that proposals to enable SSA to negotiate drug pricing was given is proof of that. There is no healthcare reform for the GOTea beyond ensuring that the needy get grifted by the industry segment least responsible for their well-being, as just punishment for the unElection of said needy which is proven by their being sick. If anything, Hatch/Burr/Upton is unpalatable to the GOTea simply because it’s too inefficient and too slow in achieving the desired end.
This is, and has been without meaningful interruption or deviation, the standard GOTea posture since PNAC and Gingrich’s Contract On America. The shrillness of the Teahad masks the decades spent less loudly pushing the same sh!t, and the ACA debate is but one round in the campaign of outright rejection of the principles of equality and fairness built into the documents these sociopaths claim to revere.
Villago Delenda Est
@boatboy_srq: They will not be truly happy until the United States of America is reverted to the Confederate States of America with chattel slavery for those with too much melanin and low wage slavery for the white trash.
The society depicted in Game of Thrones is their ideal.
It should be clear that HCR goes far beyond that. If there was any topic where they could rightly claim that the policy Democrats passed was a Republican idea, it would be health care reform. After all, Obamacare is based on a Heritage Foundation proposal originally dreamed up during the Clinton administration and first implemented by the Romney administration in Massachusetts. If it were only about credit, they could proudly and correctly claim it as a Conservative victory. Or, for that matter, they could have implemented their version of HCR during the GWB administration when they had control over both houses and the presidency. Their opposition to HCR is about not wanting HCR, not about wanting to deny the Democrats the credit.
mai naem mobile
Lest we forget, the ACA is a Republican plan. This is their plan. Now that its in action and not a plus for their side, like everything else they start and don’t like the result of (e.g Iraq War), they run off like little boys playing a prank on the grade school teacher.
As you correctly point out, the Republicans have zero interest in meaningful health care policy. The problem is that they have been allowed to constantly repeat that they want to repeal and replace and that they have solutions for healthcare, blah, blah, blah. The media never call them on this BS and so many in the public believe that Republicans do have a plan to replace ObamaCare.
I don’t know if anyone has read the article in Mother Jones about the Plaintiffs in King v. Burwell but one of the Plaintiffs in particular is so ignorant of the consequences of this case and of the PPACA that it is just mind blowing.
@Villago Delenda Est:
No, it’s not. Ask Mayhew. The only similarity is the mandate. The gigantic raft of regulations and systems that are the real Obamacare were not in it. Of course, you’re right that the mandate is actually their first target in complaining now!
And while it’s fun to call it Romneycare, it was drafted by Democrats and passed by Democrats who had a supermajority over his repeated veto attempts.
EDIT – @mai naem mobile:
It really isn’t. Don’t give the Republicans even that much credit. They NEVER wanted to fix health care. They did not even offer a ‘but we won’t actually support this’ fix. Just like this time, they offered crap and pretended it was an alternative.
Looking at the Wonkette titles, can we get “Over Reach Around” as a Before & After on Wheel of Fortune?
Villago Delenda Est
@Frankensteinbeck: OK, you didn’t comment on the tumbrels part, so I think we’re still friends. :P
richard, have you yet seen Laszewski detailed the end product he would like? Any time I’ve scoured his blog I come to criticisms of plans (on both sides), and he really seems to hate single payer.
So what does Laszewski even want?
The ACA does need tweaks and improvements. It’s a MASSIVE improvement from the status quo, but some folks are still falling through the cracks.
I live in California. Thanks to the ACA, I was able to purchase Bronze-level coverage last year on the exchange. I picked Bronze because I am not sure if I’ll qualify for subsidies this year, but I can afford the unsubsidized premiums to cover myself and my husband. I am grateful to have this coverage.
An older co-worker is not as fortunate. Both he and his wife are in their 50’s, and they both have chronic conditions. She cannot work because of her condition. They’ve been insured off-and-on over the past decade, and now they’re both saddled with thousands of dollars of debt from necessary dental work (and, I suspect, an emergency room visit that occurred when they were uninsured). Like all VFX artists, he cannot predict his income nor his employment for this year. Based on last year’s income, he probably wouldn’t qualify for subsidies up-front.
He was insured through his employer last year, but they laid most of their workforce off. Our current employer doesn’t offer coverage to new employees unless they’ve been here for a year. He looked at the policies on CoveredCA. The most affordable unsubsidized premiums (Bronze) come with the least up-front coverage, and he’s not sure paying $8400/year in Bronze premiums is worth it for himself and his wife at this time. He’s viewing the situation as out-of-pocket costs vs out-of-pocket costs + $8400/year in premiums. He understands that the $8400/year in premiums will protect him from an unforseen $40,000-$1.5 million medical expense, but he still doesn’t think they can afford those premiums.
Right now it’s most likely that they’ll choose pay the 2015 penalty for not being insured, and use the savings on premiums to pay for medications and doctor visits out-of-pocket. They’ll also use the savings to pay down their dental debt. He’s fatalistic about his situation.
Another co-worker is frustrated because he and his family only qualify for $16 in subsidies. He, too, considers CoveredCA health insurance to be priced too high, though not as high as COBRA. For him, COBRA would cost $1500/month. He was previously insured through his employer, and now he’s learning what it costs to insure a family of four.
I blame the rent. The rent is too damn high in Southern California. It doesn’t leave much left over for health insurance. An increase in subsidy assistance would greatly help both of my co-workers, but the existing political pressure (ex: King) wants to remove subsidy assistance. :-(
I am sure Richard could tell us the numbers. But I work for myself. Healthcare was always hard to get. Expensive. I am now paying a lot less for a better plan. Far better. If Republicans have a better plan I am all ears. I say this not as a liberal but a realist that can see a tenable benefit from said plan. I am getting a better plan for less money and more people are insured. How is that not a win, win.
@Tommy: Because That One passed it, and he cannot be allowed to succeed. Ever.
To paraphrase an old quote by Cole on bipartisanship, it’s a bit difficult do decide where to go to eat when one side suggests Chinese food and the other side demands anthrax and tire rims.
I think the most shocking thing is that they think eliminating pregnancy coverage is correct because being pregnant is a choice, but they, or at minimum their supporters, don’t want to cover any birth control either. It’s the biggest FU to half the citizenry that they could give, yet no one mainstream seems to be pointing out that they basically want to uncover women and all their future potential snowflakes.
I was gobsmacked reading that. I just wonder how exactly those lawyers explained the lawsuit to the plaintiffs. Clearly at least one was clueless.
@MomSense: There’s a substantial percentage of the GOTea following who cannot grasp the inherent selfishness, self-centredness and mean-spiritedness of the movement’s leadership and primary backers. The idea that their leaders could be so – well, evil has too many ethical connotations, but little else seems to fit – just doesn’t occur to them.
I feel for Ms. Levy: it’s pretty clear from her interview that she isn’t really that opposed, has no idea how she became a plaintiff, isn’t viewing the case as the Struggle for Civilization the Teahad makes it out to be, has no idea whatsoever the consequences should her case go in her favor, and still blithely trusts that her elected officials will do the Right Thing by all concerned. This is not a tried-and-true culture warrior; this is a misled person fooled by people she trusts into doing something that will harm her and myriad others needlessly. I may not approve of the case, and I think her ignorance is inexcusable, but it’s ignorance carrying her along and not malice relentlessy driving her, that’s keeping her in lockstep with the party diehards.
@Villago Delenda Est: Russia circa 1400 would be a good model, too. It’s as if they think the best way to thwart Marx is not to enable capitalism to grow and empower all, but to roll it back and reinstate feudalism so that the revolt of the proletariat is infinitely delayed. The GoT comparison is mere proof that the Teahad doesn’t expect its followers to know history (Hundred Years War, anyone?) let alone read fiction (perhaps we should refer to Republican policy efforts as the Game of Tea?).
Gobsmacked here, too. And all three would benefit from ObamaCare. I don’t know what those lawyers said but it certainly wasn’t the whole truth and nothing but the truth. All three of those Plaintiffs would benefit from the PPACA.
I found Ms. Levy’s participation to be so heartbreaking on the one hand because, like you, I don’t get the malicious intent from her. BUT… Why on earth would she participate without doing at least minimal research on the subject? I’m willing to try and understand where she’s coming from but I just can’t excuse it. She’s a teacher for FSM sake.
Edited your last paragraph for clarity and brevity.
@Frankensteinbeck: Agreed, there is some DNA in PPACA to Heritage only in that once you reject single payer, and once you reject mandated employer coverage, you need some mechanism to get the healthy into the risk pool, and an individual mandate is one of the most straightforward mechanisms to do so.
The big differences between Heritage and PPACA (in PPACA not Heritage):
1) Medicaid expansion
2) CHIP re-authorization
3) 3:1 age banding
4) Guarantee issue without medical underwriting
5) Much richer subsidies
6) much higher actuarial value (PPACA once we blend Exchange with cost sharing assistance AND Medicaid Expansion will have a blended AV someplace in the mid-80s, Heritage would have been happy with AV in the 40s or 50s)
7) Exchange (minor quibble)
8) Essential health benefits including those that only benefit either sluts or my wife
@seabe: He is an interesting character in that he really only criticizes or offers vague platitudes for what he wants to see. You have to remember two things about him: 1) He is a fairly standard issue Republican in his politics and analysis, and 2) His job is to be a fixer/connector/explainer, and not a technical wonk.
His USA Today Op-Ed seems to advocate for selling across state lines, no essential health benefits, much lower acturial value coverage, far less tax benefit to employer sponsored coverage, wider age banding and more underwriting ability. His ideal point is far closer to Avik Roy than it would be to my ideal point.
And when the Democrats try to turn things like this into campaign issues, by and large the media rolls their eyes and changes the subject to [batshit Republican candidate]’s winning smile and small town sensibilities.
@Richard Mayhew: IMHO, Roy often veers into scam BS artist territory. And you say Laszewski is a standard issue Republican and far closer to Roy. So, am I warmer or colder?
As far as I can tell the idea that in health care the problem is that ‘us peons have it too good as it is now, and the actuarial value of our coverage is way too high’ comes from two sources. Poltical operatives telling Nixon that if they could dupe the rubes, the rubes would get less care for more money, and Mark Pauly assertion that health care provider and insurance market is just like the ice cream market, then drawing an X on a piece of paper and asserting that the free market would get us to where the lines crossed.
Unless there have been a lot of new details released in the last week, the GOP has no actual plan or no ideas about how to implement their wish list. It is a nice wish list, but not a plan at all. It is a wish list.
The conservatives have not had any real new ideas for decades, and what they advertise as new ideas are actually old ideas (and that is giving them a very generous definition of ‘idea’) that have failed miserably, resulted in astoundingly high prices by world standards and astonishingly poor outcomes by world standards. And by world standards I mean over 20 other high income industrialized countries. Middle income countries that have recently experienced huge economic and political disruptions, like Estonia, will soon surpass us in population health if we go back on ACA. Portugal already has matched us on life expectancy, and its health care system was a mess with horrible outcomes as recently as the early 1980s..Neither of these countries did it the pre ACA USA way.
@Richard Mayhew: Agreed. Especially on: 1) Medicaid expansion
would never be in a GOP plan.
Your friend needs to talk in-person to a healthcare navigator — he should be able to find one through the local hospital. There should be options for him other than overpaying based on last year’s income, especially since he can show he was laid off and won’t have that same income this year.
You know, there may be a lot to this whole ‘confederate’ meme that gets tossed around here. Where else, but in a plantation owner’s head, could come the idea that you can run a government ‘for free’. I guess all these ‘no taxes’ people, all think that government workers should work for free.
Think about it. They seem to want slave labor as the governments work force, and anything else to be the “good ole boy’ system of crony capitalism.
@jl: I should add that Pauly has admitted that his mystery X analysis was ‘incomplete’ and he put his name on a brief signed by 20 or so prominent and competent health economists to the SCOTUS to leave the ACA allloooonnnnneee!!!
@MomSense: Because she gets her name in the paper, and she gets to go to Washington! People talk about her and she gets a holiday somewhere exciting (like Vegas!). Plus some nice man told her that ni-CLANG in the WH was doing something uppity again, and she’s not happy about it. The way she describes it you’d think she was misremembering a high school field trip.
@Villago Delenda Est:
Exactly.How do Republicans spell compromise?
@Roger Moore: True enough. But not letting the Dems have any credit makes it that much sweeter for them.
@jl: Warmer — I was having a very interesting dicsussion with a health policy reporter and wonk over some excellent beer a week or two ago, and he got brought up into the conversation. A very good point was made that he is slightly better than a carnival medium in how he makes predictions as he massively hedges and says things “could” be a problem.
Roy is a scam artist as he knows or should know better on most of his assertions and “policy” “think” pieces.
mai naem mobile
Don’t the plaintiffs in this lawsuit basically not like the Musleemy Blah Kenyan in the White House because, you know, it’s called.the White House for a reason? I say this snarkily but I’m serious. This shit goes back to Princess Snowbilly of the Northwoods going on about domestic terrorism and Jeremiah Wright and Alinsky, the birthers etc etc
@mai naem mobile:
All the while being married to a muthaphucka that belonged to a goddamned SECESSIONIST GROUP.
@Richard Mayhew: That was what I thought. Thanks for confirming that he has never actually spelled out a policy proposal he would like enacted.
Not only have Democrats been offering tweaks, but when Obama delayed the employer mandate, John Boner sued him!!
O-care could use some big fixes. Going to a single payer system would be a big improvement. OK Repubs, get cracking on making that work.
Villago Delenda Est
This will happen about the same time I’m crowned Tsar of all the Russias.
Villago Delenda Est
@rikyrah: The quitta apparently tried to persuade John McCain’s campaign manager, Steve Schmidt, that it was “a lie” that Todd was a member of the Alaska secessionist party, when it was painfully obvious that he was. Schmidt tried to tell Mooselini how to handle it without getting all the eggs at the nearest egg processing plant on her face, and the bimbo kept fighting to do what she always does when confronted by an unpleasant truth…lie her way out of it and hope no one notices that the entire Anchorage fire department has been called out to deal with her flaming pants.
@Roger Moore: This really isn’t true and has been extensively debunked over at Lawyer’s Guns and Money. The Heritage foundation plan was not the Massachusetts Plan which passed with a veto proof majority, btw. The Heritage plan did not try to cover the very poor through medicaid and there are many other differences including the fact that the Heritage foundation, IIRC, has always wanted to block grant and destroy Medicaid and Medicare both.
Thanks, Mnemosyne. I passed that information on to him today. He and his wife are going to make a decision this weekend, and they may have some time past Open Enrollment. People are supposed to get 60 days’ time to enroll on CoveredCA after a job loss, and he was laid off in December before starting a new job this January.