HCR: repeal and replace
I’m glad to see that Republicans are busy strategizing how to repeal Obamacare after the 2012 elections. I hope they aren’t assuming that Republicans will have to win both Congress and the White House in order for that to occur, because I believe there is grave doubt about both but especially the latter.
I’m also glad to see that the “replace” part of the equation is not being neglected:
Other conservative healthcare experts are developing an alternative to the law, an effort that could protect Republicans from past critiques that their healthcare plans left tens of millions of Americans without medical coverage.
“The window for action comes and goes,” said Tom Miller, a senior fellow at the American Enterprise Institute, one of several conservative groups involved in the effort. “We need to be ready.”
When Republicans were (briefly) in charge of both the presidency and Congress, they should have tried harder to put their own solutions in place. If they had succeeded (and it is unclear whether they would have), the HCR debacle might have been pre-empted.
Contrary to leftist rhetoric, Republicans do not thirst for the deaths of granny or the poor; the problem is that there is no free—or even inexpensive—health care lunch. From now on, Republicans had better be a lot more smart than in the past, and a lot more focused. But if health care insurance reform had been easy to design without massive expense, it would have been accomplished a lot sooner.
Other than perhaps a federal law allowing insurance companies to sell the same policies across state lines, I don’t know you would “replace” Obamacare with.
Conservatives don’t believe in mandates of this sort; it’s not the proper role of the federal government.
I could see a “replace” that consists of stripping away other laws and regulations that impede the liberty of individuals to purchase health insurance for themselves, but that’s about it.
“When Republicans were (briefly) in charge of both the presidency and Congress, they should have tried harder to put their own solutions in place. If they had succeeded (and it is unclear whether they would have) . . . ”
Such as when the Republicans (in charge of both the presidency and Congress) tried to reform social security. Yes. Quite unclear. Granny eating cat food and all that.
Barring the SCOTUS tossing the entire law out, the Republicans will need to win majorities in both the Senate and the house and also win the presidency to repeal ObamaCare.
I’m curious as to why you “believe there is grave doubt about both, but especially the latter”.
Several Senate seats look pretty good as Republican pickup and Obama is a wounded candidate. While there is a long time to November 2012, at this point things look pretty good for the Republicans to hold the house, take the Senate and the WH.
If today I had to make a call on the outcome I’d say the Republicans pick up 7 or 8 Senate seats and the presidency.
Dear Jean, I’m glad you are still soldiering on. I pretty much deserted my blog because I just couldn’t stand writing every day that we were ruled by an evil person who was intent upon undoing everything which made this country a miracle among nations.
However, from both a strategic and a tactical side I must demur. I don’t think Obamacare can be repealed. There were some pretty smart proggies involved in its unholy gestation and there are probably years worth of challenges ahead to any attempt to undo.
So – instead of undoing how about passing ANOTHER law which reaffirms, as did O and his minions time and time again, that if you like your health insurance you can keep it? I seem to recall that being a feature, no? That knocks the legs out from under IPAB.
Kind of a judo thing. turn its overweening techno-certainty against it.
Why does the government have to do anything about healthcare to begin with? I really don’t get it. Why can’t people just buy medical insurance if they want it or not buy if they don’t? If you can’t afford med ins then go to the free clinic, there are lots of them around.
1. I hope they aren’t assuming that Republicans will have to win both Congress and the White House in order for that to occur, because I believe there is grave doubt about both but especially the latter.
Agreed. I’ve typed before and will type again that it takes something close to a perfect storm to remove an incumbent President. Intrade’s Presidential odds tilt slightly against Obama but are basically a toss-up.
2. M J R@October 18th, 2011 at 2:23 pm:
IMHO Neo addressed your point with From now on, Republicans had better be a lot more smart than in the past, and a lot more focused.
3. I’m not sure how hard Romney, if elected together with a GOP Congress, would try to repeal Obamacare. Romney strikes me as a competent version of the George Bushes, the second of whom expanded Medicare (and in effect lied to his Republican Congress about the cost).
I read somewhere (? NRO) that both Romney and Santorum were planning to use reconciliation to get rid of Obamacare if they didn’t have enough senate votes. Apparently there is enough in the law that is tied to financing and thus falls under reconciliation procedures that Obamacare can be gutted one provision at a time.
My greatest fear is that the replacement will be a Republican (R) originated system of care for all (Omni) by an all-caring (cough, cough), all-knowing (cough, cough, cough) government bureaucracy.
I call this feared, fearsome HCR (Health Care Replacement): “R-Omni-Care”.
Obamacare is in the process of repealing itself. The Class Act has already collapsed because it is unsustainable.The rest of Obamacare isn’t much better. The CBO cost analysis was based on gimmicks to make it look like it would reduce the deficit. The huge number of Obamacare exemptions, granted to unions and the like, undermine its viability.
The Democrats passed Obamacare using reconciliation so they could avoid a filibuster. The GOP can use the same methods to repeal it. They may not need to win the White House to make it happen. If Obama wins but loses the house and senate big-time, Democrats will lose any willingness to stand up for its retention.
The Tea Party has to do what it it did in 2010; put the fear of God into every back-sliding GOP Senator and Congressman that they will be primaried and replaced by conservatives.
As of this writing, Intrade has the probability at 75.5% that Republicans will control the Senate. It’s not a deep market, but the people who are willing to put their money where theeir mouth is think Republicans have a good chance. At least as things stand today.
http://www.intrade.com/v4/markets/contract/?contractId=639655
Republicans to maintain control of the House is currently at 77.5%.
http://www.intrade.com/v4/markets/contract/?contractId=639652
As gs said, the race for the White House is a virtualy toss up, with the Republican challenger having a tiny, frog’s hair, edge.
One reason that the intrade numbers for Obama have yet to crater is the fact that the Republicans have yet to select a nominee. Pretty hard to bet a race before you know who is running. Once both candidates are known you’ll see intrade move.
It does not require a “perfect storm” to remove an incumbent president, when things are not going well. When the economy is good and people are generally happy with their lives and the direction of the nation, incumbents are pretty much impossible to beat. That is not the current situation and things are likely to continue to deteriorate.
Since we started keeping track, no president has ever won reelection when his approval numbers were floating around 40%. Barring an almost miraculous turn about, or the most amazing stumble by the Republican, Obama is very likely to lose and possibly lose in a landslide.
NeoCons support the Troops and Support Law Enforcement — but do they really when it comes to making sure bad ideas for pension reform are rejected?
This YouTube Video shows case in point:
http://youtu.be/_mWG3yYOIjU
UncleFred, good points but I suppose you were playing it safe by suggesting Obama could lose in a landslide rather than he WILL lose in a landslide. I suspect there is a very good change he will lose PA, NM, NV, NH, ME and CO. That would give A Repub 314 to Obama’s 224. Considering, as discussed here at neo, rock bottom for any President seems to be 35% and since Obama’s Gallup is now at 38% the game seems pretty much up.
The real problem with healthcare is that there is no price competition at point of service. That’s due to government intervention, mostly the tax code that encourages employeer provided insurance, but also medicare and mediciad.
Fixing healthcare is politically infeasable; it certainly was several years ago when Bush was in office. Bush’s “Part D” plan was the $400B counter to the Democrats $800B to $900B (over ten years, per the CBO).
The fact is Bush put forward a rather moderate approach. While he pissed conservatives and libertarians off in doing so, realistically the conservative and libertarian approach was simply not a starter.
The reality is that routine healthcare should not be paid for by insurance. Insurance makes sense only for high cost but relatively uncommon events. It might make sense for catastrophic types of care or long term care, but not typical doctor visits.
Selling policies across state lines is a phantom cure.
When I was in the business, a company I used sold policies in, iirc, seventeen states. Other companies did the same, deciding if the business climate justified opening in one state or another.
So if you buy a policy in Michigan from Company X, and you could buy it in Arizona from Company X, what’s the big deal?
Only consideration is that most private insurers charged premium rates that differed by overall local medical costs. So in the counties surrounding a big city, the rates are high because the costs are high. Live outstate where the costs are lower and the premium will be lower.
Across state lines: I must be missing something.
Whole life health insurance. You pay for premiums for yourself with a portion going to a health savings account. Over time, that accumulates and your premium goes down as your HSA goes up. Also pay for premiums for when you can’t afford to pay- insurance for insurance. Voila! Holmes fixes it all!
The Trent Lott Republican years were some of the most wasted in our history. They really were a revisitation of the know-nothing party.
Don gets it; the others, not so much.
If Obamacare can’t be repealed, then replace it.
Some suggestions:
!. Medical malpractice tort reform.
2. Level playing field for purchasing insurance. Give everyone the same tax break that employers get now for providing insurance.
3. Make high deductibles attractive.
3. Increase low cost clinics where Medicaid and other low income patients can get care.
4. The really biggie. Repeal the Emergency Medical Treatment & Labor Act (EMTALA) of 1986 that ensures public access to emergency services regardless of ability to pay. That would drive most people to get at least catastrophic health insurance and would no longer require that illegal immigrants be treated. (A magnet for illegals.) This would relieve a lot of the cost shifting that occurs under the present law. (I know, I know, it’s tough. We managed okay until 1986. IIRC 1986 was when all medical costs started to rise more rapidly.)
5. Increase premiums for Medicare (presently $96/mo. – a lot of people don’t know that Medicare recipients pay an annual premium now.) and raise co-pays.
6. Block grant Medicaid funds to the states.
7. Encourage Medical Savings accounts.
I would call it the Personal Responsibility Medical Reform Act.
“…the HCR debacle might have been pre-empted”
Haven’t the Democrats been dreaming of universal health care for decades? I doubt there’s anything that Republicans could have done to shake them from this goal (not that this excuses their wasted opportunity to do so).
Now that’s it’s here, I imagine it will be near impossible to repeal – which is why the next president & congress must be willing to repeal all of it instead of trying to fix it.
If the Republicans want to repeal Obamacare, they must not only win the Presidency, the Senate and the House, they must do so in truly historic landslide fashion.
You need 60 votes in the Senate to force a vote on anything. However, the Republican party has numerous RINOs in the Senate and will get more. So in practice the Senate Republicans probably need something like 67 to 70 votes.
And a willing President. Would Romney, the most likely Republican President, support repeal?
Some sort of modification to Obamacare is likely even if Obama is reelected, but repeal by legislation is impossible.
Remember, the House, dominated by Republicans, could not repeal the 100W light bulb ban.
@bob sykes: Obamacare was passed using reconciliation and other tricks to avoid a filibuster. It can be repealed the same way. The Democrats won’t be able to cry foul, and those that are left probably won’t want to. Our main task is to replace Progressive republicans with Conservative Republicans.
In the Soviet Union, the preferred term was “socialist medicine”; the Russian language has no term to distinguish between “socialist” and “socialized”
But now we have to be equal with them!!!
(what? did you think that they around the world would allow the improvements and things to be equal with us? no no… that is not how Procrustes works (ever)!!!)
We copy them on health…
How’s that GOING to work out?
well, just see where COPYING free love, no fault divorce, our educational system, the newspaper serving the state, the abolishment of religion and so on has brought us?
To freedom or soviet living?
Joseph Stalin
en.wikipedia.org/wiki/Joseph_Stalin
Is that the truth? Or is that Pravda?
are women and families better off than when they were farmers under the czar? not really… as it takes parents AND grandparents to raise a kid there, and your life expectancy is low… (58)… alcoholism is rampant as we are discovering here with welfare, and economy.
really? maybe if you decide to cherry pick the best year after penicillin from the west and hygienic methods spread through the population… after that… no…
[by the way, every one of these points on the wiki of Stalin asks for required citation. ie. people are putting up the glorious revisioned history, with no references…]
see… it was so wonderful. and the US collapsed its economy, and now its collapsing ours… (tit for tat)
what they don’t say up there is that forced abortions, death camps, forced labor, murders, state usage of medicine as a weapon, no real products, no product safety, and more was in all that wonderfulness….
WE COPIED AND ARE COPYING THAT…
and what explains the situation we are in?
Moshe the Beadle
en.wikipedia.org/wiki/Night_%28book%29
In Night, everything is inverted, every value destroyed. “Here there are no fathers, no brothers, no friends,” a Kapo tells him. “Everyone lives and dies for himself alone.”
“A world where men and women would be equal is easy to visualize, for that precisely is what the Soviet Revolution promised.” — Simone de Beauvoir, The Second Sex, (New York, Random House, 1952), p.806
Un di Velt Hot Geshvign (“And the World Remained Silent”) – Elie Wiesel
Night is the first book in a trilogy–Night, Dawn, and Day… “In Night,” he said, “I wanted to show the end, the finality of the event. Everything came to an end–man, history, literature, religion, God. There was nothing left. And yet we begin again with night.”
“Jews, listen to me! It’s all I ask of you. No money. No pity. Just listen to me!”
Witness the défaite du moi
and not even know what that means historically as if its fresh and new and we are witness to the first dawn
how much the same?
is Rev. Jim Wallis our Bishop Mueller
Does the healthcare bill and its “rationing” which will happen along the lines of the protected classes vs the unprotected classes, or the volk vs the oppressors… resemble other laws and times when such was done?
we cant expect it to be a copy… and so its infantile to require an exact copy before one believes that its the same… ie, unless you see a short Austrian fellow leading the crowd, and know his name is not Charlie Chaplain, and he is sporting a funky tiny mustache. nothing can be the same… right?
diversity, the idea of focusing on differences, makes sure we refuse to see similarities.
its interesting “action for healthcare”
and Googles very helpful in blocking you from finding things…
after healthcare was nationalized, then came Aktion T4…
then this
but note… take away the specifics, and see the system… ie, the state declares the actions in medicine… and so, redistributes outcomes from some classes to other classes where the bureaucracy decides, and can make exceptions when it feels like it for its own purposes (like the bribery of key people by not subjecting them to the same system)
today, you have a protected class dialectic. not only that but its the same division for other justifications as before…
the state is dismantling alternative power structures, from religion, to the dynasty of capitalism (Judeo christian thought – as under this system they are synonymous to all but the useful idiots)…
Why We Must Ration Health Care
http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html?pagewanted=all
Notice that like the pseudo moral argument in the thread as to the isreali release of prisoners for one man…
the whole of these arguments pit ACTUALITY of now, against an infinite selection of future potentials, that may or may not every happen the way they say, or if so, will not happen that way forever.
[edited for length by n-n]
i guess if one cares not to read bout Muenzenberg, then Otto Katz is probably out too….
just as WAR was really not about an american arms dealer but about victor bout…
well, wag the dog, was really telling the story of Otto Katz…
and Otto developed all the kinds of things we have now in msm that confuses us and directs us…
The people in their overwhelming majority are so feminine by nature and attitude that sober reasoning determines their thoughts and actions far less than emotion and feeling.
and
of course… everyone pretty much is completey in the dark as far as relating the sex communes of harmon, the sex debasement of germans and the sexual revolution in the US…
anyone want to make up a reason why?
anyway… he did NOT like the nazis…
and he was not a nazi… (he had to flee to france at the same time the frankfurt school fled to columbia university in the USA)
Curiously, he never cites the work of Franz Boas and his disciples against “racism,” though that work was available in Europe at the time, nor does he invoke the ideas of the Frankfurt School, though Hirschfeld’s own claim that “racism” is rooted in fear, loss of self-esteem, and other social and psychological pathologies resembles the ideas the Frankfurt School was formulating.
Hirschfeld describes his own political ideals as “Pan-Humanism,” a version of political, cultural, and racial universalism. The Pauls themselves write, “we think that the readers of Racism will detect a very definite orientation to the Left… [Hirschfeld] was one who fully realized that sexual reform is impossible without a preliminary economic and political revolution.”
ah.. so the idea that women and feminists would never truly be free under capitalism but have to make a communist state to achieve their supposed ends… came from a lineage of thought… a thought the true believers and followers know, but the common man who is a pawn does not…
(nor does he not want to be a pawn, for the COST of that is to study!!!! and not just what they recommend)
understanding the origins of the word “racism” in Hirschfeld’s polemic also makes clear the uselessness of the word for any other purpose.
No one seems ever to have used the word to describe his own ideas or ideas with which he agrees; its only application has been by the enemies of the ideas it purports to describe, and hence it has no objective meaning apart from its polemical usage.
If no one calls his own ideas “racism” and its only application is to a body of ideas considered to be untrue and evil, then it has no use other than as a kind of fancy curse word, the purpose of which is simply to demonize anyone who expresses the ideas it is supposed to describe.
IE… racism never had a real meaning other than as a pejorative of others actions…
a game with no meaning but seems to
a game that once you sign on to that meaning, without noticing, you also sign on to what? medical rationing? abuse of psychiatry, media, etc?
Lawrence Dennis
en.wikipedia.org/wiki/Lawrence_Dennis
Lawrence Dennis was an mixed raced American diplomat, consultant and author. He advocated Socialist fascism in America after the Great Depression, arguing that capitalism was doomed
now, where have we had a mixed race person who commands racism as a thing, and then used it for political advantage siding with protesters arguing that capitalism is doomed and has to end?
Can anyone figure that one out?
how many here have even heard of these people i mention?
Following a notable career as a child evangelist, he was sent to Phillips Exeter Academy and then to Harvard.
oh.. and went to Harvard too..
well, here is a comment from a blog in 2008 from the fellow traverlers.
Mutatis mutandis is a Latin phrase meaning “by changing those things which need to be changed” or more simply “the necessary changes having been made”.
inconsistency of action is the camouflage of consistency of purpose
My wife is a conservative and a healthcare practitioner. She works at a free clinic in addition to teaching; she sees it all. There are poor people who make terrible decisions… and need health care. There are working poor who try do to the right thing, but tragedy strikes. There are rich people who have unneeded first dollar coverage. There are middle class people who pay $10k premiums per year (yes, it’s subsidized, but it otherwise would be wages minus the tax subsidy), never use it…until one bad thing happens. It’s all a mess because the government runs 60% (now really 100%) of health care. The costs are hidden in insurance and it’s not really even insurance. I agree with the suggestions above for more markets…but that’s only part of the story too. People just need some access to care. If the government had a sliding scale subsidy and was actually able to say no to some things b/c it’s charity (medicaid is better insurance than most working people have)…then OK. I’m a free marketer, but that’s not to say we should leave people in the cold either. You can do both if the health service goods are bought honestly in the free market. Medicare is just price controls now which then shifts costs to the private sector and/or results in shortages.
The Left doesn’t want to acknowledge that there is such a thing as limited resources. Controlling prices, making mandates, having “indepedent panels”, doesn’t change that. The Right needs to acknowledge that a totally free market means leaving some people without care- whether through poor planning or just bad luck. And I’m a righty/libertarian…but these concerns have to be addressed.
Sorry, somewhat incoherent. My wife and I discuss these issues all of the time. Her graduate course of study basically included 3 or 4 classes that devolved into how wonderful the Affordable Care Act was, so she often argued and brought home the discussions about alternatives. Having established my wife’s authority on such topics, I proceed… 🙂
Premiums are like paying rent. You rent into the health care service industry in this strange hybrid insurance kind of way. I’d like to see more ownership. I think that means health savings accounts. I think it could also mean my suggestion above about whole life health insurance. Basically an ever-growing health savings account that can only be used for health care (nannyish, I know). As you accrue more and more (and think of how much premium ‘rent” people waste year in and year out simply to cover other people who are sick and paying premiums…), you are really only insuring over that amount and thus the risk of insuring you drops along with the price. Imagine health care premiums being less expensive when you were older!
But as it stands, health insurance, due to the tax subsidy, attaches to the employer and not the person. Until that changes, the kind of product above cannot exist.
holmes@10:54 “The Right needs to acknowledge that a totally free market means leaving some people without care- whether through poor planning or just bad luck. And I’m a righty/libertarian…but these concerns have to be addressed.”
Before the EMTALA in 1986 people who could not pay were treated through charitable hospitals. And most hospitals were connected to charitable organizations that helped with the indigent. Those who had resources but could not pay a humongous hospital bill, were set up with a payment plan. It worked pretty well as I recall.
In the 30s and 40s when I was a kid, few people had insurance. It began as a benefit for workers in war industries where there were wage controls. It was a way to attract and hold good workers. It became the norm in large companies after WWII ended and was widely accepted as a wonderful thing. Individuals could buy health insurance, but the insurance companies rapidly raised the premiums on those over 60 and then dropped elderly people who became ill. The resultant “fix” was Medicare in 1964. Even then many Republicans could see it would be a financial fiasco eventually. We’ve reached that point.
The medical-industrial complex has a need for more – money, high tech equipment, doctors, nurses, effective drugs, and so on. It is a black hole of need. The only way to ration it all is by fiat or by ability to pay. IMO, that is where the debate is going.
@J.J. – True, there is a long history here and now the bill has come due. But I don’t think going back to the romantic notions of 1930’s and 40’s doctors and their little black bag and a bottle of morphine in lieu of effective treament has too much relevance today. People will get cancer and cancer treatment is expensive. Thank goodness we now have the technology to do so, however.
And I think “ability to pay” for services in a free market is fine, but why the all or nothing approach? Why not offer some access by offering say, sliding scale vouchers for health care that is then bought in a free market? Basically food stamps for health care, only not as “one size fits all.” The main thing my wife’s free clinic patients need is mental health care. If they can break depresssion, they can work again and be productive. There’s not a lot of charitable mental health care, so the cycle continues…and these people make for expensive prisoners or wards of the state. Oh, and we live in a quasi-remote area so simply getting transportation access to health care would be a huge improvement.
Basically, I think we do a government charity approach, only with real limitations. Private charity just won’t do it and I don’t think the population will accept it; mainly because they will project their own anxieties about not having health care themselves and being a charity case.
Ah, well. We won’t do anything about anything until we are flat broke.
holmes@0930 “The main thing my wife’s free clinic patients need is mental health care.”
True that. My daughter is a clinical psychologist. The need for mental health treatment is huge. Unfortunately, just like the MDs, she can only handle a few low/no payers because she has overhead to cover. She is working on trying to do more group therapy for those on vouchers. (The state of Washington issues vouchers for care much like food stamps.) However, the state and insurance companies want mental health to be like a disease with a beginning, a treatment phase, and a cure. And they want it done in X number of sessions. Oh, that it was that easy.
“Ah, well. We won’t do anything about anything until we are flat broke.” Also true.