The House unveils its Obamacare replacement plan—and have you heard about it?
[NOTE: I suggest reading this previous post for some background information on why the repeal of Obamacare took so long, and why most people don’t even realize that Congress actually did repeal it in January of 2016.]
A few days ago I wrote a post about Paul Ryan and the accomplishments of this GOP Congress under him. Now, a lot of people can’t stand either of those entities—Ryan, or almost all of the Republicans in Congress—and are quite vocal about that. I have my own quarrels and disappointments with them, as I have with pretty much all politicians over time. But in my continuing effort to look at what they’ve actually been doing or not doing rather than focusing on what other people would have you think they’re doing or not doing, I’m calling your attention to the fact that a couple of days ago they presented their plan to replace Obamacare.
Let’s pause for a moment to reflect on the fact that the lack of an alternative plan was a big big criticism of the GOP, from left and some on the right, and certainly from the press. In this post from about a year ago, I discussed the fact that although they lacked a single, agreed-on plan, they actually had a variety of them that had been proposed by different GOP factions over time. Back in January, right after Paul Ryan became Speaker, I wrote a post quoting his promise to release a “long-awaited replacement plan for the health care law” (he’s also promised “a tax reform proposal; welfare reform; and other major policy initiatives”). It could not have been the least bit easy for him to get them to agree on this, and if nothing else it represents a formidable feat of cat-herding.
Ryan knew that Obama will veto any bill based on these measures if it ever passes, but he wanted to “go on offense in 2016 and we have to offer a bold agenda…The people of this country who do not like the direction America is heading, which we don’t ”¦ we owe them an alternative.”
And yet I wonder how many people on the right even know of any of this. And I wonder how many people on the right hate Ryan and Congress so much—for whatever reasons—that they’re not interested in anything they say or do at this point, and dismiss it automatically. I also wonder whose interests this serves.
It was easy to miss the news of the rollout of this plan, wasn’t it? You can blame Paul Ryan for that, too, or you can reflect on how very difficult it is to get coverage for your wonky proposals from an MSM that’s largely against you, and to compete with all the sexier and more dramatic news of the Trump statements du jour and the Brexit upheaval.
Oh, and if you’re interested in learning some of the details of Ryan and the GOP’s proposal (which you will no doubt find imperfect, as all such things are), go here and here. IF you’re feeling especially ambitious and thorough (not to say OCD), the entire 37-page document can be found here.
[NOTE II: I have been impressed by how relatively little attention this has gotten. Even I, who follow the news closely, didn’t know this had happened (on June 22) until today, when I noticed an email about it in my Inbox. The fact that the GOP Congress actually did repeal Obamacare—a repeal that Obama then vetoed, of course—has been relatively unknown and unappreciated, as well.]
[ADDENDUM: I just noticed that Megan McArdle has written a piece discussing the plan.
Something I think is especially attractive is this: “Getting rid of…a lot of the regulatory mandates for benefit levels.” Obamacare took away the option of buying catastrophic insurance, for example, something people with good health often have found to be a very good deal and should be allowed to select, IMHO.]
We did hear about the granola bars the dems ate, though. The press prefers the Pelosi approach: you have to pass the bill to find out what is in it. And, of course the Trumpsters write off any info about Ryan’s work as Ryano propaganda.
To reform healthcare in this country the costs have to be rationalized. Getting costs out in the open would promote real competition.
I had colon cancer surgery in March. (The cancer was 1st stage and hadn’t spread. So, I’m cured of cancer. 🙂 ) I have Medicare and Tricare For Life. A couple of weeks ago I received the statements from Medicare and Tricare. The total bill for the surgery, 9 days in the hospital, and follow up care was $113,000. Medicare and Tricare paid $18,500. My share is $2,500.
The question is, “How can the hospital send out such an outrageous bill?” At least it seems totally outrageous compared to what Medicare and Tricare allowed. Either the hospital and surgeon’s fees are out of line or the amounts Medicare and Tricare will pay are out of line. I suspect that the answer is that both figures are irrational and only transparency of costs will ever change that. Give healthcare consumers more information and watch the system change.
EMTALA, the ubiquitousness of employment related insurance, and the lack of transparency of costs has led to this game of phony numbers.
Here’s an article about the irrationality of medical charges:
http://www.huffingtonpost.com/2013/05/08/hospital-prices-cost-differences_n_3232678.html
When clinics open up that publish their fees for various procedures, they immediately become successes unless their fees are exorbitant. This one issue ought to be a no brainer for any medical reform law.
The reforms cited in the GOP plan are not new, but they will provide a more competitive atmosphere in the medical field, which could lead to a slower rise in costs.
J.J.:
I doubt the fees in the non-Medicare bill were irrational, although they certainly were exorbitant.
I would guess that they are based on an attempt to offset the cost of providing care to everyone, including those with no insurance and no assets, as well as offsetting the lower-than-cost fees paid by Medicare. My guess is that they are way out of line with what Medicare pays because what Medicare pays is also out of line with the actual costs, and of course those who pay nothing are paying an amount that’s out of line with actual costs. But I don’t think either the underpayment or the overbilling are irrational. Medicare sets its prices based on what it has the resources to pay, and what doctors and hospitals will agree to. And the hospital probably bases its prices on its need to cover costs and make some sort of profit. I suppose in some cases the profits are exorbitant, but a lot of hospitals are struggling, and I doubt many people actually pay those full prices anyway.
Glad your surgery went well!
I currently don’t have medical insurance and am paying for tests and doctors visits myself. I am routinely offered between 40% and 75% discount on the rates charged to insurance carriers.
The reason no one is paying attention to it is that as the American Enterprise Institute link says, it is merely an outline for discussion during the election season and is not now and will not become legislation. Every Republican candidate, GOPe or not, can use the talking points and no one is committed in any way to doing a bloody thing. And a few weeks ago the House Republican Task Force on health policy reform members who wrote it and Ryan himself emphasized that it was not legislation or the basis for legislation.
We have been promised, explicitly, a whole lot of things by Republicans. And none of them have been delivered or even attempted. Until the Republican Party, which has the majority in both Houses of Congress, DOES something instead of promising there is no point in listening to them. The key to that is returning to Regular Budget Order so that there will not be a government-wide shutdown if Congress does not roll over for the Democrats on everything. Ryan himself personally promised to return to Regular Budget Order twice, and then gave us two more Comprehensive Omnibus Resolutions funding everything Obama wanted at higher levels than asked for. And he is about to give him another one this fall, just before the election recess [putting voters in a good mood, I’m sure]. The Speaker can return to Regular Budget Order with a signature. The fact that he does not is because he does not want to.
Until they actually do something besides dog and pony shows, they are just the Democrats’ junior partners.
Subotai Bahadur
I read – well, skimmed – the long version and wasn’t impressed. Most of it was telling us how bad Obamacare was, like we didn’t know already. There were a few good things in the plan – breaking the link between employment and insurance (ESI), expanding HSAs, and tort reform. Ryan gave lip service to the fact that insurance is a state issue, then proceeded to mandate that the states do this or that – like mandating that insurance companies insure people with pre-existing conditions. I’m not sure how that’s going to work. Well, yes, I am sure. It’s not going to work.
The plan neglected the herd of elephants in the operating room. First, as J.J. mentioned, is EMTALA. Hospitals are growing broke having to treat every snotty-nosed illegal alien. Secondly – as the republicans are afraid to mention for fear of being called racists – is “birthright citizenship”. That needs to end. Thirdly, the only way to “bend the cost curve” is to get the government out of “managing” the practice of medicine at all levels and this plan just adds more levels. Fourthly, If I want to pay a doctor in cash for an “unapproved” procedure while on Medicare, I should be able to. It’s my money. Fifthly, let’s get totally rid of the FDA. They are a drag on innovation and add nothing to health care. There is so much that needs to be done, and Ryan is just tinkering around the edges.
Even though I work in pharmaceutical testing, I’m not sure we should get rid of the FDA completely. Yes, they make my job indirectly more complicated, but they also keep egregious stupidity from hurting patients. Take the Ranbaxy fiasco from a few years ago, for example. See here and here for details.
So I think that it’s an ignorant assertion to say that the FDA doesn’t do anything for health care. The questions raised in the Fortune article about why the FDA didn’t just bar Ranbaxy from the U. S. market completely, if things were really as bad as they said, are worth asking. So the FDA doesn’t perform its consumer protection job with as much consistency as desired. But do the traffic cops catch every speeder, every jaywalker? Can they? Would civil-liberties devotees really want them to? Or is it at least a positive contribution that they catch enough to at least keep most of the rest somewhat honest?
snopercod; Philip:
Please take a look at this.
snopercod:
The present plan is not all-inclusive of everything that would be in a final plan. And a number of the things you mention aren’t about replacing Obamacare; they concern other issues.
The trouble with Any replacement is that it will be subject to Endless Tinkering and Fiddling, and the citizens will get the shaft, again and again. Just watch England’s “Prime Minister’s Question Time” on CSPAN: the National Health Service is nearly all they talk about. So dreary, so endless.
Come to think of it, Question Time should be riveting this week. CSPAN airs it on Sunday evenings, IIRC.
Oh, and what Subotai said.
/sigh
I knew the fix was in two years ago, when I saw Justin Amash, Tea Party darling, address a donors’ group in NYC and “promise to repeal and REPLACE Obamacare.” I wanted to jump up and shout “No REPLACE!”
As long as they’re futzing around with socialized medicine, it’s still the government’s stockyard and we’re still the cattle.
Neo, I read your article on the FDA and it was good. Certainly the FDA has had occasional successes at protecting the American public harmful products, but at what cost? If you throw $1.37 billion per year at a problem (2016 budget for human drugs), you’re bound to succeed occasionally. I agree with commenter Illuminati who alluded to the many FDA-approved drugs which were later pulled off the market because a side effect was discovered years later (list here). But these successes and failures aren’t the real issue. The real issue is the deadly effects of socialism on the drug industry. As Ayn Rand once wrote, “When you see that in order to produce, you need to obtain permission from men who produce nothing…you may know that your society is doomed.” I’m sure you’re aware that the FDA came into existence based upon the book The Jungle, written by socialist/community organizer Upton Sinclair and at the urging of progressive Teddy Roosevelt. And here we find ourselves 110 years later with needed drugs not being produced because it takes too long to get them approved and as a result, there’s just no money in it. As Illuminati wrote at your link:
“Back in January, right after Paul Ryan became Speaker…”
Paul Ryan rushed a 2000 page, $1.1 TRILLION omnibus through the House that Obama and the Democrats praised.
Perhaps the Obamacare alternative is unknown because it is a mere token gesture to conservatives, and Ryan and the GOP leaders do not really have any intention of following through. Once trust is broken, it is hard to rebuild. And the GOP leadership has broken trust with a large portion of their base (see Trump, Donald).
Wasn’t Paul Ryan for amnesty? Isn’t he still for amnesty?
jetty:
I wrote a post on that very subject. Take a look, and follow the links in it.
jackson:
See this as well as this, and this.
And you will have no problem finding articles that say he favors amnesty.
Elected GOP elites do not want to bring attention to things they do, they consider it undignified to do so. In the tradition of W they choose never to respond or boast so consequently they get their arses handed to them routinely by the Dems and the Dems surrogates in the media.
They have spent decades perfecting the “good loser” pose and are comfortable in that role.
Neo: a good writeup on the Thalidomide affair back then. Thanks for the link. I didn’t know or had forgotten that you wrote on the subject so recently.
On the point of improving the speed at which medications are developed and marketed, I think the FDA has learned in recent years. There are so many moving parts in pharma that you can’t just get a Trump-type to flip a switch and suddenly things move with incredible efficiency. There’s the issue of the multilayered phase approach, which is because you deal with fairly hard science; there’s the issue of ongoing harmonization (or harmonisation, if you like) of requirements between the world’s various health regulatory agencies. With all that, the FDA’s approach is changing a bit, at least domestically.
In pharma and health care, we haven’t had a genuinely free market for a long time, and given the various pros and cons, a lot of patients and consumers seem okay with that. Maybe expectations are just too high, as well as contradictory, as you pointed out.
I will say that, of the various government alphabet-soup agencies, I think the FDA’s role is one that conforms better than most to the Constitutional goal of providing for the general welfare, since anybody could in principle end up needing a given drug or eating a given food product.
The Republicans have been the loyal opposition to the Democrats, even when Republicans control some seats, since FDR’s time at least.
Hard to detect why, maybe because the FBI and other federal intel agencies were ordered to spy on Republicans and get dirt on them. That just sort of got “handed down” to certain Democrat successors. It’s not as effective on Democrats, because Democrats don’t care how many rapists, prostitute ring runners, and child molestors are with them. Just look at Ted Kennedy, KKK Byrd, and Clinton.
P Gig:
I disagree.
They’re not street brawlers; that’s true. But they try very hard to get the word out. I documented one effort here. I suggest you read it.
You are committing the fallacy of assuming that if you haven’t heard of it it hasn’t happened. Criticize them for how they did it—not stridently enough or creatively enough, for example—but don’t assume that there is some sort of nefarious conspiracy behind it all and that they don’t want to get the word out.
Beverly, June 26th, 2016 at 3:35 am:
Obamacare: Repeal. NO REPLACE!
You are exactly right in your pithy statement.
. . .
Subotai! How absolutely great to see you again! We have been missing you at your old haunts Across the Water, and hoping you are well and thriving. :>)
Even now, no-one is commenting on 0-cares WHOLESALE DESTRUCTION of the growth of the money supply.
It’s because of this that the Fed is compelled to spew out fiat — rather directly — ie keep interest rates flat to the floor.
YES, the two a DIRECTLY connected.
See “The Big Short” to see how DENSE Wall Street and Big Thinking Keynesian economists can remain.
We’re living in a moment of Cargo Cult Economics.
Our shamans haven’t a CLUE as to what Barry has unleashed.
The Best and the Brightest are still conflating momentum with economic drive.
Which see: Venezuela.
Maybe you can also point out that most of what is in this package is also in Trump’s repeal-and-replace plan. Therefore, Trump would support this initiative out of Congress. Once again, very important to vote in November for the Republican candidate despite your feelings.
““How can the hospital send out such an outrageous bill?”
The answer is complicated. The short version is that the bill has to be structured according to the rules of Medicare and insurance. Doctors and hospitals have contracts with Medicare and insurance companies (When I retired 20 years ago, I had 276 contracts all at different rates and rules) and those contracts cannot be violated. With Medicare it is either a crime or your “profile” will be rest at a lower level and you will be paid 10% of that lower rate. With insurance, you will be terminated.
Since I retired much has changed, Most doctors are no longer in independent practice and work for salary from large “vertically integrated” plans that own hospitals. They have no, absolutely no, freedom to alter the status quo.
When clinics open up that publish their fees for various procedures, they immediately become successes unless their fees are exorbitant. This one issue ought to be a no brainer for any medical reform law.
This is why so many older docs are going to cash practice. The medical groups all have contracts that do not allow them to publish prices as they are “trade secrets.” The contracted rate for your hospital bill is a fraction of the price you saw on the bill. Many people have health “insurance” that includes a provision for the insurance to pay 80% and you pay 20%. Think about it for a moment. You pay 20% of that high bill and your payment may, and often is, more than the “80%” the health plan pays.
Maybe I should do another blog post on this. My previous posts are over at Chicagoboyz and my own blog.
http://abriefhistory.org/?cat=184
And some schlub who sits beside me at work has the audacity to claim the media is biased IN FAVOR OF conservatives.
Yeah, yeah, repeal with one vote, fund with the next. And it’s taken what, seven years for the GOP to come up with an Obamacare replacement plan? Color me skeptical. GOP likes Obamacare as much as democrats, for the power, money and control.
Dantes:
It took a long time to repeal Obamacare for reasons described here.
And in fact there were many replacement plans proposed over the years, as I described here (and linked to in the present post).
One reason for the change is that Paul Ryan was able to get the GOP members of the House to agree on one. His predecessor Boehner was unable or unwilling to do so.
With Obama as president, any bill passed (if it manages to clear the Senate) would automatically be vetoed by Obama. That’s what happened to the repeal bill. Ryan has decided it’s important to try to pass them anyway to show people what the GOP would be able to do with a Republican president in the White House signing bills instead of vetoing them. This was a different philosophy than Boehner’s.
Bad news, Beverly. The fault is not in conspiracies but in ourselves, i.e. the voters generally. The great majority of voters have a covet thy neighbor’s goods problem which manifests itself particularly intensely in matters of access to health care. Until your neighbors shake their greed (the desire for the unearned) completely, a politician who loves the Republic and wishes to rescue it will have to shepherd greedy voters bit by bit back to a habit of honestly paying the health care providers whose services they consume. This is not easy, 40 years it took God to change the hearts of the Israelites so they’d stop pining for their old lives as slaves in Egypt. The alternative to slowly walking the majority of voters back from their desire for the unearned* is losing races completely to the politics of greed and corruption (a.k.a. Mainstream Democrat Politicians, the crooked Mrs. Clinton is an example of such).
I feel your pain, Beverly. Unfortunately, the struggle to turn our neighbors away from the tempting promises of Democrats (and all their false show) is never ending. The story of Pinocchio is illustrative, Pinocchio and the boys who fell for the tempting false promises of The Land of All Play and No Work became donkeys ruled by, of course, animal-enslaving and whip-cracking Donkeycrats!
* recall Ambrose Bierce’s definition of an election in The Devil’s Dictionary
That’s true but that doesn’t bother me. What I’d like from the hospital, group practice, or individual practitioner is a price up front. An honest car mechanic does that, even without a law to impose such a requirement on him or other tradesmen. But ask for the price for non-emergency surgery, to correct an inguinal hernia for example, and no one knows the answer to the question in advance of actually doing it. Whaddya know, medical charges are more bizarre and unpredictable than Heisenberg quantum mechanics!
Whaddya know, medical charges are more bizarre and unpredictable than Heisenberg quantum mechanics!
It’s intentional. The unions can’t skim off the top and sides without that layer of complexity.
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“What I’d like from the hospital, group practice, or individual practitioner is a price up front. ”
They are not allowed to do so. That’s what I was trying to say. The hospital rates are a trade secret. I ran a trauma center for 7 years. One year, Blue Cross refused to agree to a fair rate for our hospital. They contracted with another hospital that cut a better deal for them and all subscribers had to switch hospitals. However, all trauma cases came to our hospital and we charged them “retail.” Two years later, they came back.
Doctors will be dropped from the plan as “Not suitable for managed care” which usually means you spent too much time with your patients. Medical groups now provide “bonuses” to GPs which are half their annual income for following “guidelines” that minimize hospital stays and complex care. The incentives are all against the patient these days. Now that I am a patient, I am lucky I still know some older docs I can go to.