March 7, 2017

The GOP replacement for Obamacare.

Usefully depicted in chart form at the NYT.

145 comments:

Seeing Red said...

It's bullshit.

Michael in ArchDen said...

The good news is that you don't have to pass it to see what's in it!

The bad news is that this may be the only good news.

traditionalguy said...

It's in negotiation now. The final product will add the stuff everyone wants to see when they promise to support it if it is added.

(See, The Deal, Art Of)

Hagar said...

It still is a major new entitlement program.

It used to be a rule of thumb that an employee had to generate twice his/her salary in order for his/her employer to break even. This has grown to two and a half times, and will now grow to three times.

Don't know that business can support that.

I expect that most self- and non-employed people will choose to "go bare" and pay cash for medical treatment.

Possibly most basic medical services will go to some sort of "fast care" clinics staffed by nurses and medical technicians where that is permitted by law.

Hagar said...

People work for the net amounts printed on their paychecks.

Employers look at the total cost per employee, including benefits, building rent, and janitorial services, etc., etc.

AprilApple said...

NYT - lies.

Employer mandate
Repeal
Under the A.C.A., larger companies must provide affordable insurance to their employees or face financial penalties.



LIE!

Under Obamacare, employer insurance premiums have sky-rocketed, and choice has bottomed out.

rhhardin said...

Really bad.

There's a reliance problem they have to address, but other than that just kill the whole thing.

The reliance problem is preexisting conditions. Somebody who had insurance before Obamacare and got sick was booted out of his policy, which amounted to a bet he won against the insurance company. Obamacare came along and he was still covered albeit with a different policy. Then if Obamacare is repealed, he's out on the street, losing the winning bet he had.

Such people ought to be covered by the government making good on their bet, continuing to cover them. Their preexisting condition continues to qualify, but nobody else's does.

It's not costly because you only have to cover those people and they're going to die out eventually.

All other coverage ought to be opened up to the market. Buy it or not.

AprilApple said...

All the assumptions and good intentions of the ACA are not reality, NYT.

Rusty said...

A A @ 10:58
It was all based on lies. Furthermore the people that pushed this the hardest knew it was all a lie.
It's a piece of shit.
Tear it all down and start over.

Robert Cook said...

"I expect that most self- and non-employed people will choose to 'go bare' and pay cash for medical treatment."

A quick way to go bankrupt, unfortunately.

Chuck said...

They've made it easier for young and healthy people to stay out of the health insurance marketplace. Which will surely and inevitably drive up overall costs for an older and sicker demographic.

I make no judgments about whether that is fair or unfair. But it is a fact.

Let's face it; the last few years of the ACA have seen people from all sectors of health care consumption complaining about how much more they have to pay. Even the Medicare patients (largely untouched by the ACA) are sitting at home watching Sean Hannity and nodding in agreement that "Obamacare" is a disaster.

In passing the ACA, the Democrats had only planned on getting close to universal coverage through Medicaid, Medicare and markets. They had no serious plan to bend the cost curve, unless it was to eventually use government power to forcibly drive down prices and hurt providers.

But where is the cost-curve approach in this new Republican bill?

Two other things: First, there's no new initiative to "sell insurance across state lines," as Trump parroted during the campaign. That's actually hard, as many people who know more than Trump does tried to warn him.

Second, Trump is again talking about using federal government power to drive down drug prices in Medicare and some other federal systems. That's a Democrat idea; in fact a kind of a radical Democrat idea. One of the first (of many, I expect) policy ways that Trump will find little to no Republican support for something Trump promised in the campaign. Maybe Trump can find new friends among the Democrats.

Henry said...

Republicans know a third rail when they see one. Or four.

The plan keeps the popular parts of Obamacare that the original law landed first to drum up support for Obamacare before the unpopular parts arrived. I'm not surprised, and frankly, I don't see how you can roll those back. If you know one person who has a child with type 1 diabetes, you know the pain a roll back of the preexisting condition provision would be.

The rest is just gilding, but the important thing is that there is no real reform. The big next step is to remove health insurance as a benefit of employment.

Henry said...

A quick way to go bankrupt, unfortunately.

But with good odds.

Nyamujal said...

They've replaced the individual mandate with a "continuous coverage" provision which means that insurance companies can charge up to 130% extra on premiums for up to a year if there's a gap in your coverage.
They've changed the age rating metric which means that insurance companies can now charge seniors 5 times what they charge a young healthy person. Used to be 3:1. Fine if you're young like me, sucks if you're old like a lot of people commenting on this blog.
So far, it seems pretty shitty.
I still see no provisions to address healthcare exchange collapse in certain predominantly red state areas (AZ, Texas, etc). Areas that insurance companies won't touch with a stick unless they're guaranteed a monopoly and certain freebies.
I don't see this plan going anywhere. Some senate republicans are already backing out.

Original Mike said...

"I expect that most self- and non-employed people will choose to 'go bare' and pay cash for medical treatment."

Add a catastrophic insurance plan and you have real insurance. Obamacare did away with them and it looks like they are still not allowed under the replacement plan (new plan keeps the ridiculously named "Essential Health Benefits").

Hagar said...

A quick way to go bankrupt, unfortunately.

The young couple next door who "walked away" from their house and mortgage apparently did not see that as any big deal.
Nor do the number of college students who have no intention of ever paying back their student loans.
At that, in my situation, I can't say I worry much about it either.

I am afraid you are a bit behind the times, Cookie!

Michael K said...

"I expect that most self- and non-employed people will choose to 'go bare' and pay cash for medical treatment."

A quick way to go bankrupt, unfortunately.


"The 10 basic elements" is the problem and must be removed. That was the fundamental problem with Obamacare.

This would allow bare bones catastrophic policies again which are cheap for the young and all they need,.

The "pre-existing conditions" means it is not insurance, That has to be taken out and a separate program needs to be used for that.

Michael K said...

Without those changes, it is "Obamacare not very light."

AprilApple said...

NYT dutifully reports that ACA's intentions are REAL man!

Chuck said...

I see some intelligent and non-flaming sorts of comments here. So far. Talking rationally, about the hard choices and realities of health insurance.

So let's pause and remember that Trump's campaign promise during the election that he would "cover everybody" (providing no details how he would do it) was mostly bullshit. As was so much of his campaign.

People will continue to face hard choices. For a 56 year old guy who was laid off from his union job with benefits, and who is now working independent part time jobs and making about $35,000 a year with no health insurance, he is going to continue to face hard choices. His choices may be a lot worse now, than under the ACA. Nine years away from Medicare, looking at a shutdown of the exchanges (where he probably got some kind of deal on a health insurance policy); and that was the kind of guy in Pennsylvania, Ohio, Michigan or Wisconsin who gave Trump his victory.


AprilApple said...

Baloney - Nyamujal

The insurance providers are whittled down to the big 3, thanks to the ACA. We don't have choice and competition in the marketplace when it comes to health insurance and that was the plan. The ACA was designed to fail. The left predictably blame the very insurance companies who crawled into bed with it. These mega insurance companies were the beneficiaries of Obama's selective treasury raiding bailouts.

The failures and collapsing state exchanges - poor saps could not get that bailout.

Unknown said...

They had how many years to come up with a replacement? This is the best they could do?

Original Mike said...

"The "pre-existing conditions" means it is not insurance, That has to be taken out and a separate program needs to be used for that.

I disagree, if they replace the Individual Mandate with Continuous Coverage. If you've kept yourself insured, you deserve to be allowed to continue insurance after a diagnosis. Unfortunately, as with the Individual Mandate, the proposed penalty for getting re-insured after dropping insurance is not nearly onerous enough to accomplish the intended goal.

AprilApple said...

Make health care affordable by removing the "Insurance must pay for everything" part of it.

I personally want to pay for my own health care. I want to buy insurance to cover the catastrophic stuff.
The way it should be....

buwaya said...

I have posted this several times -
The effect of Obamacare on Cost of employment (gets to Hagar's point above) presented graphically.

https://data.bls.gov/pdq/SurveyOutputServlet?request_action=wh&graph_name=EC_ectbrief

This shows the effect on Cost of employment as a result of Obamacare mandates on employer medical plans. This is due partly to mandated coverage rules, partly to coverage of pre-existing conditions, etc.

This reform plan may reduce/reverse this cost of employment somewhat, but it won't, as far as I can see, remove the cumulative effect of the rapid cost escalation that occurred 2010-2015.

AprilApple said...

Here - let me give you the leftwing group-think narrative:

'Insurance Company CEO's make too much money! waaaaa.'



LOL - yeah - the mega insurance companies that WE ARE ALL FORCED TO BUY our insurance from.

mockturtle said...

I like Rand Paul's plan better.

CWJ said...

Obamacare is not insurance. Neither is this. Now that health "insurance" has been federalized, I'm afraid that no political majority has the stomach to reinstitute anything that could honestly be styled insurance. And frankly, neither do the insurance providers, I'm afraid.

AprilApple said...

Our health care policy could be 1-2 pages.

A healthy free market for health care?-- the government killed that.

Michael K said...

" If you've kept yourself insured, you deserve to be allowed to continue insurance after a diagnosis."

That's not "pre-existing conditions."

I disagree with canceling coverage after illness and that should be banned. If you let it lapse and then get sick, you are put of luck.

Michael K said...

"A healthy free market for health care?-- the government killed that."

Actually, Obamacare helped bring some of it back, that and the EMR. A lot of doctors, and I think there are more in Tucson than California, have dropped all insurance. There is an "Urgent Care" on practically every corner here.

Cash practice is about 50% cheaper to provide, depending on the specialty.

That's why I like the French system.

Thorley Winston said...

Looking at the summary of the bill (haven't read the entire thing which would take weeks as much of it refers to other sections of the law that are being changed), this appears to have been designed as something that could pass through reconciliation (e.g. can't be filibustered) in the Senate which means that they can change provisions about spending and taxes . . .but not much else. Hence no repeal of a lot of the regulations that drive up the cost of insurance or allowing consumers to purchase across State lines.

The danger of this approach is that Republicans will be passing a bill that makes them responsible for the Obamacare mess while at the same time not implementing most of their ideas that might actually fix health care. My preferred approach for healthcare reform is to break this into separate standalone bills (one for Medicaid, one for Medicare, one for private insurance, etc.) but I understand that reconciliation can only be used once per session of Congress. Unless Republicans are able to hold off until they have a filibuster-proof Senate (possibly after the 2018 elections but by no means guaranteed) or end the filibuster entirely (which opens the door for Democrats to pass something like single payer when not if they regain control of Congress at some point in the future).

Original Mike said...

"I disagree with canceling coverage after illness and that should be banned."

How about changing jobs? (Employment-based health insurance has really turned out to be a bad idea.)

"If you let it lapse and then get sick, you are put of luck."

I agree, in principle.

Original Mike said...

"this appears to have been designed as something that could pass through reconciliation (e.g. can't be filibustered) in the Senate"

If that's the case, it's a bad idea in the long run. Better to write a good bill and pull out the nuclear option.

Achilles said...

We had two options: Free Market and Obamacare lite. And guess what the republicans in congress chose.

We will replace subsidies for the poor with subsidies for everyone. -10 points for thinking central planning solves problems.

30 year olds can stay on parents insurance. SO? Why don't you let groups of people buy insurance together regardless of age or familial association? -10 points for lack of creativity and stupidity.

Insurance companies have to take on people with pre-existing conditions andthey can't charge them extra. Do these people understand the meaning of the word INSURANCE? -1,000,000 points for abject idiocy and facile pandering.

There needs to be another program for people who have congenital/developmental issues. The people who shirk insurance and wind up with a huge bill have bankruptcy which has a lot of protections for individuals in it.

Why are we cursed with tools like Ryan? Ugh. Where is the free market leadership?

Yancey Ward said...

Until we are willing to treat health insurance like true insurance, we will create worse and worse legislation. It was a hard hurdle to cross, but the Republicans in Congress have drawn up something even worse than the ACA.

My guess is that if anything passes, it will be far different than this first offering. Will what passes be greatly improved? I have no idea.

Angel-Dyne said...

Henry: The rest is just gilding, but the important thing is that there is no real reform. The big next step is to remove health insurance as a benefit of employment.

I assume you mean a big step in real reform, not just gilding.

I'd like to read more discussion about this. Is anybody even putting it forth as a possibility?

Nyamujal said...

@AprilApple

"The insurance providers are whittled down to the big 3, thanks to the ACA. We don't have choice and competition in the marketplace when it comes to health insurance and that was the plan. "

When you say whittled down to big 3, do you mean in terms of market share? There are way more than 3 players in the insurance space (25 or more the last I checked). I'll grant that some of those companies have more of a regional presence.
"More competition" doesn't always help. There's a reason why all the credit card companies are located in Delaware and can charge up to 20% or more in interest on payments. Imagine a similar scenario in which all the health insurance companies locate to Nebraska and jack up their premiums. Still doesn't solve our problem unless we have strong national regulations - price controls and anti-monopoly provisions.

"The ACA was designed to fail. The left predictably blame the very insurance companies who crawled into bed with it. These mega insurance companies were the beneficiaries of Obama's selective treasury raiding bailouts. The failures and collapsing state exchanges - poor saps could not get that bailout."

The state exchanges are collapsing in the places with predominantly poor, unhealthy people. There's a mechanism to subsidize the people who can't afford the plans. Unfortunately the subsidies don't apply if you're over a certain income level which is still pretty low. It should have been easy to give people like that access to medicaid through the medicaid expansion program, a program that a lot of governors were opposed to. If I were redesigning the ACA I'd make the public option a part of it. If I remember that was a political impossibility in 2009...

Angel-Dyne said...

Chuck: I see some intelligent and non-flaming sorts of comments here. So far. Talking rationally, about the hard choices and realities of health insurance

I guess you weren't happy with that state of affairs, since you immediately returned, in the same comment and in the very next paragraphs following the one above, to characterizing Trump supporters, both here and in their Rust Belt millions, as true-believin' simpletons who supported Trump only because they uncritically consume campaign-speak and just didn't understand the complexities of the health-care problem.

There are no Trump true-believers here, Chuck, and never have been, but that doesn't ever stop you from shitting up a discussion with this snide bitch act of yours. And yet you go into hysterics at the very suggestion that you yourself are an blinkered, uncritical true-believin' partisan! Every time.

But hey, that's what snide bitches, do, I guess.

Unknown said...

The Donald loves it. That should be good enough for you folks, no?

Donald J. Trump‏ @realDonaldTrump

Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster - is imploding fast!
6:13 AM · Mar 7, 2017

Unknown said...

"But hey, that's what snide bitches, do, I guess."

And she should know!

Once written, twice... said...

For those who would like to see a government funded universal healthcare system in this country then yesterday was a watershed event.
House Republicans kept Trump's promise to keep the "preexisting conditions" part of Obamacare. As long as that continues to be sustained, then we will continue to transition to a universal healthcare system. Republicans further enshrined that principle as being a national value and commitment.

For progressives who would like to see a fully government funded system (I am not one) the news is even better. What Republicans are proposing will not be sustainable by the market. When that becomes fully clear and the private market has collapsed, then the argument for a government funded system will be almost inevitable.

Yesterday, Republicans did what Democrats could never have done, they have completely made "preexisting conditions" now politically untouchable, while vowing to dismantle the only private market framework that would make it sustainable.

Yesterday Republicans accomplished what Democrats never could do. They now also own it.

Good day yesterday.

Unknown said...

"Ugh. Where is the free market leadership?"


Donald J. Trump‏ @realDonaldTrump

Our wonderful new Healthcare Bill is now out for review and negotiation. ObamaCare is a complete and total disaster - is imploding fast!
6:13 AM · Mar 7, 2017

Nyamujal said...

@AprilApple
"Our health care policy could be 1-2 pages.

A healthy free market for health care?-- the government killed that."

The free marker isn't a panacea for problems with our healthcare system. It's hard for people to be "rational actors" and maximize their utility functions when confronted with life altering diagnoses or with the prospect of a loved one losing coverage because the "free market" commands it.

mockturtle said...

Michael K reports: There is an "Urgent Care" on practically every corner here.

Cash practice is about 50% cheaper to provide, depending on the specialty.


These are the right idea, IMO. Ever try to get in to see your doctor when you actually need one? I can see Walmart opening 'walk-in' clinics in their Superstores.

Let me ask you this: What can be done to bring down the costs of health care? Neither the ACA nor the GOP plan do anything in this regard. I would like to see an end to the ravenous medical corporations who are buying up [forcing out] all the competition. Why should they be immune to anti-trust laws?

AprilApple said...

Nyamujal-

Intervention has killed the free market.
No - nothing is a panacea, but 40+ years of government meddling has turned something attainable into something that isn't. The ACA was the death blow and they knew it as the sacred golden cow of "single payer" tax payer funded health care/government doled-out and controlled = next.

Achilles said...

Once written, twice... said...

Yesterday, Republicans did what Democrats could never have done, they have completely made "preexisting conditions" now politically untouchable, while vowing to dismantle the only private market framework that would make it sustainable.

Yesterday Republicans accomplished what Democrats never could do. They now also own it.


You see this people? Once Written is for Once, correct. "Pre-existing" conditions are going to destroy our health care system.

People used to come to the United States from all the other "government pays for it" health care countries when they needed medical care.

The inevitable conclusion to this will be Health Centers in foreign countries maintained and operated for wealthy people who will travel to them while everyone else is stuck here with government health care.

HoodlumDoodlum said...

Chuck said...So let's pause and remember that Trump's campaign promise during the election that he would "cover everybody" (providing no details how he would do it) was mostly bullshit. As was so much of his campaign.

Chuck, Obama's promises about the ACA were bullshit (keep your Dr., save $2,500/family/year, free ponies for everyone). Hillary Clinton's promises about fixing Obamacare were bullshit. It's all been bullshit, for years and years now, ok?

The poison of Obamacare is that it gave away "free" stuff and asserted that people deserve "free" stuff. Actually $0 cost stuff, of course, but also subsidies. It only took a little bit of that...and suddenly we can't even discuss going back to a time before we all got such great free stuff. It's unthinkable!

Because it's unthinkable pretty much no candidate for president can say or promise anything that's not bullshit, ok?

The Republican plan, as many here have pointed out, is mostly bullshit. The ACA was mostly bullshit--but, crucially, at the time it was introduced and being sold to the public what was discussed was not the reality of the ACA (the obvious bullshit) but the PROMISES and intentions of the ACA. That's how Obama's assertion that you can keep your plan if you like it was rated True or Half-True by PolitiFact & others 5 or 6 times before finally becoming the Lie of the Year in 2013.

So yeah, Trump's campaign promises re: terrific, free health insurance and/or health care were bullshit. So were Hillary's. So were Obama's.

MikeR said...

Sad but true: Holding House, Senate, and Presidency is not enough to get rid of Obamacare against a filibuster. Just using reconciliation does not enable them to get rid of the regulations.
Blaming Republicans for this is maybe a little silly, especially given that they are not monolitic. Let's stick to what they can actually do: what is that?

AprilApple said...

Exchanges are collapsing because not enough sign-ups.

Chuck said...

There are no Trump true-believers here, Chuck, and never have been...

Well, THAT'S a relief to know! I feel better already! Have a nice day!

Michael K said...

"How about changing jobs? (Employment-based health insurance has really turned out to be a bad idea.)"

McCain's plan in 2008 was much better than this. Employer plans escaped Obama and Reid's attention because they feared a Democrat revolt.

Do some reading about the evolution of the cash market.

"The free marker isn't a panacea for problems with our healthcare system."

This is always hard for Socialists to see. The free market deals with 95% of the healthcare system. The other 5% needs ways to insure people with catastrophic illness and to deal with the poor.

Asking insurance companies, or any bureaucracy, to process claims for minor office visits is fine with insurance companies and bureaucrats. It gives them work but it is incredibly inefficient and invited moral hazard. The cost of a claim for a $16 office visit is about $25. The cost is shared by the doctor or clinic and the insurance company. Medicare will tell you they have low overhead. I;ve read 5% or so. That's because all the work is pushed onto the doctors' office or the hospital's billing office.

Doctors I know who have dropped all insurance have cut their overhead by 50%. When I was in practice 25 years ago, my practice overhead was about $10,000 a month. That's what it cost to run my office and surgeons have relatively low overhead compared to internists and GPs. The group I left when my back began to bother me had 14 employees and all but three or four were doing nothing but insurance and Medicare billing. I had three and only two were full time.

When I was a kid, back when medical practice did not require all this overhead, a family friend was a very busy Orthopedic Surgeon. He was the team physician for the Chicago White Sox. His office was in a building with a lot of doctors' offices with a big waiting room and a telephone in the center. His office was two rooms and he had one nurse. Those were the days of only real insurance.

Robert Cook said...

"What can be done to bring down the costs of health care? Neither the ACA nor the GOP plan do anything in this regard. I would like to see an end to the ravenous medical corporations who are buying up [forcing out] all the competition. Why should they be immune to anti-trust laws?"

What anti-trust laws? They've all been essentially moth-balled.

buwaya said...

"Republicans did what Democrats could never have done, they have completely made "preexisting conditions" now politically untouchable"

This is the age-old government benefits ratchet, which goes back to (at least) when the Gracchi started state interventions in the grain markets as a populist measure. One ratchet after another, and the end was the perpetually unemployed Roman mob.

The Democrats clicked the ratchet ahead one, as they are always trying to do, and the also age old phenomenon of public choice economics makes it impossible to go back.

This is not an achievement. This is the process of social entropy. The Democrats, as is true of all parties of their ilk, are agents of entropy, of chaos. Conservatives, almost always, are anti-entropic, anti-chaotic. But entropy, decadence and destruction are inevitable.

AprilApple said...

The democrats and their lobbyists don't give a crap about what they claim to care about. That's why Obama lied so easily when he said "if you like your plan you can keep your plan." "Average savings 2,500.00 year" I pay 4,000 more per year than I used to. AND FOR NOTHING MORE.

Democrats only do what they do so they can line their pockets first.

Hagar said...

Insurance is risky also for insurance companies. Just look what happened to Lloyds of London.

"Insurance" companies are happy to act as public utilities for processing government mandated services with a guaranteed mark-up and government assurance that they will be reimbursed for any losses. But then they also essentially become government agencies with no interest in efficiency, and their costs will rise accordingly.

The magic word is TANSTAAFL.

HoodlumDoodlum said...

MikeR said...
Sad but true: Holding House, Senate, and Presidency is not enough to get rid of Obamacare against a filibuster. Just using reconciliation does not enable them to get rid of the regulations.
Blaming Republicans for this is maybe a little silly, especially given that they are not monolitic. Let's stick to what they can actually do: what is that?


You say sad, I say potentially politically advantageous. The Republican dog caught the Repeal and Replace car thanks to the unexpected election of Trump (and expansion of the Congressional lead) and now, as the full effects of shitty Obamacare policies and unsustainable Obamacare promises are finally being felt...it's Republicans who get to take the blame. Obamacare was intentionally front loaded--benefits first, cost MUCH later, and even with that design Obama's admin had to cheat to push the pain back and pretend things were ok (delaying the individual mandate, then instructing the IRS not to collect penalties, etc). Still, here we are, and Republicans are left in a very difficult spot. Any change they make will piss off a lot of people, and any nod to the reality that Obamacare can't continue (as exchanges fail, insurers pull out, premiums continue to rise) will be roundly condemned by a Media just WAITING for a chance to run all the "medical expenses ruined my life" stories they've been sitting on for most of a decade now. Hey, it's "Trump's America" so all that shit's going to get the front page treatment.

So, what're the Republicans to do? If they act responsibly and acknowledge reality they'll end up doing away with the only popular parts of Obamacare. Those parts are popular, of course, because they're giveaways--free stuff and subsidized stuff paid for by others...but that doesn't change the fact that they're popular. If you leave in the popular stuff you'll have to pay for it somehow, and that means more taxes on the rich people who underwrite the government...pissing them off and undercutting Republican support (why vote for Repubs if they're just going to tax and redistribute like the Dems)? The Repubs are screwed. They don't have enough juice w/the Media to sell the few good ideas they have. They don't have enough votes to steamroll their full plan into being. They don't have an articulate, popular President to sell the nation on their ideas. And, crucially, they don't have enough time to smoothly transition to something good--almost any change they make will need to be done abruptly, now, and that alone will cause problems.

From a political standpoint the Republicans would be best served by proposing a big plan with lots of supposed benefits, talking up the dangers and downsides of Obamacare, forcing the Media to cover actual current Obamacare problems and future Obamacare problems that are right around the corner...and then having their full plan blocked by uncompromising Democrats. The Repubs can complain loudly while making the point that they respect filibusters, etc (unlike those underhanded Dems, see) while working to put the blame for current problems squarely on the Dem's shoulders. Make Obama own Obamacare problems--we tried to fix it, but you wouldn't let us, so all of this is your own doing.

Sucks for the actual citizens, of course, but who really cares about them?

Achilles said...

Michael K said...

This is always hard for Socialists to see. The free market deals with 95% of the healthcare system. The other 5% needs ways to insure people with catastrophic illness and to deal with the poor.

Health savings accounts for insurance, cash visits, and deductibles.

Turn medicare into a voucher to buy insurance for the elderly and coverage for any costs over ~$100,000 in calendar year for everyone else.

Set up a separate program to deal with congenital health problems.

Loser pays tort reform.

Details.

Achilles said...

MikeR said...

Blaming Republicans for this is maybe a little silly, especially given that they are not monolitic. Let's stick to what they can actually do: what is that?

1. Grow a spine.

2. Take a position based on principles that matches the market and the people. Let the free market work.

3. Make the case for that position and try to pass it. Push the issue into the 2018 elections where you have a massive advantage.

4. Let the democrats stonewall the solution while Obamacare collapses.

AprilApple said...

Investors has an interesting take on the new draft.


Nobody wants to tell a sick person to pound sand, but if you don't buy some level of health insurance for yourself when you are healthy - how is it fair to get all the benefits of coverage, but you never paid a dime - ever?
it's not fair and it doesn't work.

Chuck said...

Achilles:

If Trump and his HHS Secretary Dr. Tom Price are all on board with the current GOP proposal, is that a dreadful mistake by Trump?

Hagar said...

And of course - that which no one wants to mention: You cannot control health care costs without controlling the health care industry; i. e. doctors, nurses, hospitals, clinics, pharmaceutical companies, etc.

eric said...

So far this isn't great.

There are a few simple things they could do to bring down costs.

The single most important thing is finger rid of what insurance must cover. Allow people to purchase catastrophic plans only. This insurance that covers the pill and condoms and chiropractors, etc isn't really insurance. It's just a pre paid plan.

Some people don't care about all of that crap. Just let them buy a plan for in the rare case they get cancer or something.

eric said...

The next thing they could do is lower costs by getting rid of administrative overhead. One way to do this is to get rid of the insurance company completely. Give each citizen x number of dollars to spend on healthcare or save for the day they need it. This spreads the admin overhead out tongue people. Let people spend it on each other also. Let churches pool their money, for example.

And then when it's needed, it's there and ready to go.

Achilles said...

Chuck said...
Achilles:

If Trump and his HHS Secretary Dr. Tom Price are all on board with the current GOP proposal, is that a dreadful mistake by Trump?


Yes. It is hard for me to imagine these people are so blind.

Anything that includes "pre-existing" conditions is guaranteed to fail. Anything that relies on central planning is guaranteed to fail. Anything that removes responsibility for poor decision making will just lead to poor decision making. That will fail.

Birches said...

Republicans are complete idiots. How will anything change if "insurance" is required to cover everything?

Chuck said...

Wow, what a bad day it's been for Trump at Althouse!

Trump's a weakling for nominating a closet elitist like Gorsuch.

And now Trump is making a career mistake for endorsing what will become TrumpCare.

mockturtle said...

The next thing they could do is lower costs by getting rid of administrative overhead. One way to do this is to get rid of the insurance company completely. Give each citizen x number of dollars to spend on healthcare or save for the day they need it.

I like this idea, Eric. Tax exempt dollars to use for health care. If my daughter didn't have to spend one or two days a week just doing insurance audits, she could see more patients.

AprilApple said...

single payer will save us!

Tax payer funded government mandated perfection-care. It's freeeeeeeee!

harrogate said...

According to the Republicans, if only poor people made better consumer choices (those pesky phones!) they'd be able to afford health insurance.

They know no shame.

rehajm said...

Prefect is the enemy of good.

...and Don't Underestimate the Value of Rearranging the Deck Chairs.

There are several strong elements of the GOP plan that encourage broad participation, especially amongst the young, healthy and higher income- in other words a big group that's not participating in Obamacare.

rehajm said...

Perfect is the enemy of sustainable.

AprilApple said...

This is an intersting read, as well.

I think they need to scrap their ObamaCare lite plan and just repeal Obamacare.

Then, write something that gets the government the fuck out.
yes yes - we will keep the programs that help low-income.

AprilApple said...
This comment has been removed by the author.
William Chadwick said...

I have an idea for the replacement of Obamacare. Replace it with liberty, where people pay for their own medical care, and freely choose to pay for someone else's medical care, or not.

Hagar said...

I have medical insurance and I demand my rights! I insist you cure my irritable bowels right now! I am an American citizen and I am entitled to the same level of care as Mr. Trump or any other hugh-faluting billionaire!

AprilApple said...

Scroll all the way down for Rand Paul. He makes the most sense and we should be looking at his bill. He says he has one.

BTW - Rand and I agree. Repeal it first.

AprilApple said...

If Trump pushes this, he's a fool. He should put Rand in charge.

Brando said...

From the early reports this looks like a mess, and worse it would be a mess the GOP now owns. They'd be better off just leaving the status quo and letting the death spiral put an end to the whole thing. Then whatever they pass might look like an improvement.

Sure, it'd burn them for the next election cycle or so, but if they pass a mess that screws over enough people that would hurt them worse. At least with a natural death they can blame it on the Dems.

Hagar said...

Once government gets into it, it is a civil rights issue too, and common sense goes you know where!

Unknown said...


"If Trump and his HHS Secretary Dr. Tom Price are all on board with the current GOP proposal, is that a dreadful mistake by Trump?"

"Yes. It is hard for me to imagine these people are so blind."

Blind adherence to Trump. Hahahaha, who would thunk it? That's what you get when you put all your eggs in his basket.

Hagar said...

High-faluting, or Yuuugely-faluting, whatever.

3rdGradePB_GoodPerson said...

All this jabber about little details is a waste of time. And, that stuff seems like a stretch for reconciliation. Be safe, stick w/ true budget stuff.

In the end, the important things seem like perfect fits w/ reconciliation.

All Rs can agree on the job creator tax cuts in this package. Duh. And all Rs know it's bad to subsidize folks who don't pull bootstraps. Focus on agreement. Just get tax cuts and subsidy/medicare/medicaid eliminations through.

Then, the job creators will have more dough and they'll create greater economic growth and better job creatoree situations. Not to mention that gov revenue goes up because Laffer was wrong, there's never too low of a tax rate for max gov revenue collection: less tax (esp re job creators/capital) = more gov dough.

Problem solved.

You're welcome.


Carry on.

Unknown said...

"The next thing they could do is lower costs by getting rid of administrative overhead. One way to do this is to get rid of the insurance company completely."

There is a proposal. It's called Medicare for All.

AprilApple said...

Unknown voted for Hillary and has blind adherence to all things corruptocrat.

AprilApple said...

"Medicare for all" - is that the new way to say "Single payer!" without saying "Single payer"? weeee- tax payer funded government controlled... Medicare - FOR ALL.

GLORY BE.

3rdGradePB_GoodPerson said...

"There is a proposal. It's called Medicare for All."

Medicare as an option that can, w/ a total equal footing (i.e. no gov crutch), compete w/ existing private providers seems sensible.

So, forget about that.

AprilApple said...

Who do you trust more? Ryan and McConnell? or a Libertarian.

Unknown said...

Apple Ass,
Excuse me? I did not vote for Hillary. I was a Bernie supporter and I voted Green Party.

3rdGradePB_GoodPerson said...

April,

Not to mention a doc.

Unknown said...

Apple Ass, calm down you sound manic in this thread.

Unknown said...

Trump said he had a plan he would unveil in January that covered everyone. What happened to that plan?

Unknown said...

http://www.redstate.com/absentee/2017/01/16/health-insurance-everybody-government-will-pay-says-republican-president-elect-donald-trump-again/

“We’re going to have insurance for everybody,” Trump said.

“There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”

Scott Pelley: Universal health care?

Donald Trump: I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.

Scott Pelley: The uninsured person is going to be taken care of how?

Donald Trump: They’re going to be taken care of. I would make a deal with existing hospitals to take care of people. And, you know what, if this is probably–

Scott Pelley: Make a deal? Who pays for it?

Donald Trump: –the government’s gonna pay for it."

AReasonableMan said...

Unknown said...
Apple Ass,
Excuse me? I did not vote for Hillary. I was a Bernie supporter and I voted Green Party.


Facts? Not April's strong point. Hatred is her forte. Hate. Hate. Hate. Not on her team? Must hate.

3rdGradePB_GoodPerson said...

Issa wants to open FEHBP to all Americans.

Achilles said...

AReasonableMan said...
Unknown said...
Apple Ass,
Excuse me? I did not vote for Hillary. I was a Bernie supporter and I voted Green Party.

Facts? Not April's strong point. Hatred is her forte. Hate. Hate. Hate. Not on her team? Must hate.

Hard to tell the unknowns apart.

And the irony of this post. You are a caricature.

AReasonableMan said...

It is hard not to feel a tiny, miniscule, minute, nano amount of pity for the Republican leadership. They can't win this one, whatever they do it hurts them, and they end up owning health insurance.

Brando said...

"Donald Trump: –the government’s gonna pay for it.""

Trump can easily bail on this plan--it doesn't come from any specific proposals of his (looks more like a Paul Ryan brainchild) and he can always just say this doesn't do what he wants it to do. Then back to the drawing board.

I don't see how this can pass when you have conservatives trashing it for its unknown cost, governors putting pressure on the congressional delegations not to cut back on Medicaid expansions, and the Dems wanting no part of it. And does Ryan want to use up his political capital on this?

Brando said...

"It is hard not to feel a tiny, miniscule, minute, nano amount of pity for the Republican leadership. They can't win this one, whatever they do it hurts them, and they end up owning health insurance."

I have to agree with you insofar as they did have 8 years to figure out what their plan was, and to sell it to the public. Now that they have their opportunity, they come up with...this?

AReasonableMan said...

Achilles said...
Hard to tell the unknowns apart.


If so, wouldn't the prudent course of action be to not call them names?

April degrades every thread she participates in with her blind hatred. I can't see how this improves Althouse as a forum for debate. She acts neither in the interests of rational debate nor in the interests of the blog hostess who would no doubt like to attract more well informed commenters like Unkown(#?).

3rdGradePB_GoodPerson said...

"They can't win this one, whatever they do it hurts them, and they end up owning health insurance."

I wonder if the Ds will save them re the debt ceiling increase.

Lots of folks speculate re a real shut down, i.e. after the maneuvering and prioritizing and emptying this and that stash of Fed dough, what that would mean for America.

We may have hard data, soon.

3rdGradePB_GoodPerson said...

This governing stuff is hard.

Who knew?

Unknown said...

Achilles, you are an idiot. All these months of you yammering about how Trump will save your sorry ass from the oligarchs, lol. Now your hero puts for Trump Care, otherwise known as Obamacare Light.

Looks like the Congress Critters are not going for it. You thought that Trump would be your answer to all that is wrong with the Government. Oops.

Unknown said...

"No one knew healthcare was so complicated."
~Trump

LOL

Unknown said...

Trumpcare, "really really important". Fantastic.

Nyamujal said...

"Achilles said...
Hard to tell the unknowns apart."

There are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns – the ones we don't know we don't know.

I kind of like the unknown presence. Lends some much needed balance...

AprilApple said...

Poor ARM - He's a dedicated prog and my mere presence sends him into fits of rage and jealousy.

harrogate said...

Nobody knew health care was so complicated!

AprilApple said...

Perhaps the red-scare again? When was the last time you spoke to a Russian, ARM? Nancy Pelosi and Claire McCatkill demand an answer.



AprilApple said...

3rdGrade
April,

Not to mention a doc.

Yep, a doc. I say we let him try. The left botched it royally.

Unknown said...

Thank you Nyamujal,

If I may be so bold, I will speak for the rest of us Unknowns, it's a pleasure to rattle cages daily. It's much needed in a 90% conservative comment section.

Cacimbo Cacimbo said...

In NYC non-cosmetic medical care is so far removed from the free market it is difficult to get a price in advance. Each insurance carrier negotiates their own rates and hospitals are required by the "Hospital Financial Assistance Law" (HFAL) to provide prices based on income. The result is when an actual cash customer comes through the door they just make up a price, if you negotiate you may get a better deal. All the worst aspects of buying a car. I have never heard of anyone going bankrupt as a result of medical bills. They have gone bankrupt as a result of loss of income due to illness - but that is not the same thing.

harrogate said...

" I have never heard of anyone going bankrupt as a result of medical bills."


And there you have it. Someone make this commenter a GOP congressperson!

Chuck said...

Unknown said...
"No one knew healthcare was so complicated."
~Trump

LOL


I knew that Trump had said something like this. But I actually thought that the quote above was a misquote. Or taken out of context. So I looked it up. It's a perfectly accurate quote. And it is in context.

And, on video:

http://www.msn.com/en-nz/health/other/nobody-knew-healthcare-could-be-so-complicated-trump/vp-AAnxtOP

mockturtle said...

The truth is, Chuck, that health care shouldn't be this complicated.

Cacimbo Cacimbo said...

@harrogate. Where I live in NYC bankruptcy from medical bills has basically been outlawed. You can owe the Hospital millions, they can not take your house. A co-worker had preemie twins that resulted in several million of uncovered medical bills. As long as he paid $5 a week (a good faith effort) they could not seize his $1,000,000 home or assets. It may be different in red states, but in deep blue, NJ/NY that has not happened in decades. This outlines the rights of debtor. Keep in mind - the hospital would still have to go before a far left judge to seize any of your assets and that is pretty much unheard of here.
http://www.citybarjusticecenter.org/wp-content/uploads/images/stories/publications/a-guide-to-medical-debt-your-rights-and-options.pdf

Rusty said...

Chuck said,"In passing the ACA, the Democrats had only planned on getting close to universal coverage through Medicaid, Medicare and markets. They had no serious plan to bend the cost curve, unless it was to eventually use government power to forcibly drive down prices and hurt providers."

Thereby adding even more expensive layers between the buyer and seller.Thr market has been so distorted over so many years that noone knows where the baseline is.

AReasonableMan said...

Jonathan Chait on the current bill.

The GOP leadership have made it clear that they are going to play chicken with their right wing and force them to vote against this 'repeal'. Might work. Might not.

Hagar said...

The result is when an actual cash customer comes through the door they just make up a price.

I have long suspected this. The last couple of times I had tests done at a hospital, they immediately backed down when I began asking questions about what was this for, and why did they do that, when my doctor had not asked for it.

n.n said...
This comment has been removed by the author.
mockturtle said...

When I incurred a wrist fracture a few years ago, the orthopedist said he could just set it but that it would heal better with surgery. I asked him how much it would cost. He laughed, and said, 'I can't tell you that'. I asked, 'Who can, then'. He responded, 'I don't know'. No one would/could tell me. What other service would we buy without having any idea of the cost? If health care is a business [which it is], we need to act like the consumers we are. Maybe without insurance, we'll find out the real cost of medical services so we can shop around. I've been doing that with prescription drugs for many years. Once, calling 15 different pharmacies, I found as much as a $45 difference for a given antibiotic.

n.n said...

One proposal. [unqualified] progress. We'll see if they raise the privacy veil, try to preserve Obamacare's monopolies, and deny people a choice of medical care, not Choice of abortion rites.

rehajm said...

I asked him how much it would cost. He laughed, and said, 'I can't tell you that'. I asked, 'Who can, then'. He responded, 'I don't know'.


Tough information to find but here's a start. An Oklahoma hospital posting prices for surgery.

Michael K said...

He laughed, and said, 'I can't tell you that'. I asked, 'Who can, then'. He responded, 'I don't know'. No one would/could tell me. What other service would we buy without having any idea of the cost?

The prices are set by the insurance company. They are trade secrets. The prices that you will get on your EOB form will be "retail." The surgeon and the hospital or surgery center do not get those prices.

If you have a "managed care" insurance plan and have a 20% copay, the "20%" may, in fact, be more than the amount the insurance company pays the hospital, or surgery center. The 20% is 20% of "retail" and the insurance company pays "wholesale" to the doc and the surgery center.

If the doc tells you what he is paid and the insurer finds out, he can be dropped from the panel and the panel may be the only game in town.

Two years ago, the hospital where I practiced for 30 years fired my old group of surgeons. I had set up the trauma center in 1979. The group had run the trauma center since then and was also the busiest group in that hospital.

A couple of years before that happened, the hospital tried to buy the group. They had bought up all the other doctor practices, most of which were 30 to 50 person group practices. The surgical group was 7 guys. They turned the hospital down.

A year later, when renewal of the trauma contract was up, it was not renewed. The ER docs were told not to refer any emergencies to the group and the medical groups were let know that referring to that group was not a good idea.

A new trauma group arrived by July 1, when the contract expired. They were 5 women surgeons from northern California. Nobody knew any of them and nobody had any information on where they trained or what their experience was. I have heard from hospital employees that things have no gone well but there is no talk.

There is one male surgeon with the new group. He had applied to my old group several years before and turned down as not good enough.

That's why he can't tell you what it costs. That's medicine in Obamacare world.

Michael K said...

the center does not accept Medicaid or Medicare.

That's a cash surgery center. I've been writing about this trend for years since Obamacare began.

A major consideration for the HSA patient is the fact that medical fees are grossly inflated by Medicare and insurance companies that draw up contracts with physicians including “discounts” from imaginary retail prices. When I retired from private practice, I had 176 contracts with various insurance companies and HMOs. Medicare will punish a physican who provides a cash discount to a patient. Balance billing is also prohibited.

The result has been reluctance on the part of physicians to see Medicare patents or HMO patients, both of which have poor reimbursement schedules.

Michael K said...

Private insurance has followed Medicare into the toilet since Obamacare.

AReasonableMan said...

mockturtle said...
Maybe without insurance, we'll find out the real cost of medical services so we can shop around.


But that burden will fall on the poorest and least well equipped to deal with it. Well off people with good jobs have good health insurance.

Michael K said...

"Well off people with good jobs have good health insurance."

Lyndon Johnson, as usual, screwed the poor by killing off the big public hospitals that were teaching centers.

The two medical schools with the largest number of graduates these days are in the Caribbean. One is St Georges which graduates about 450 a year. Grenada.

No clinical facilities at all. Just lectures.

Cacimbo Cacimbo said...

"Well off people with good jobs have good health insurance."

Depends what you mean by "well off" and "good" insurance. In the NYC metro area premiums are so high that even extreme left $$$$ law firms are switching their non-lawyer employees to super high deductible policies.

mockturtle said...

ARM whines: But that burden will fall on the poorest and least well equipped to deal with it. Well off people with good jobs have good health insurance.

BS on both counts. Medicaid still covers the poor. They are, in fact, better covered than most people with private insurance. 'Well off' people might have a deductible of nearly $10K per year and pay nearly $1K/month in premiums. It's plain unaffordable for most working people.

Hammond X. Gritzkofe said...

The only merciful thing to do for the American People as re. the Afraudable Care Act is DRIVE A STAKE THROUGH ITS HEART.

Frankly, and realistically, what we are getting now is about what I expected.

Nonetheless, a disappointment.

n.n said...

With unprecedented transparency and democratic processes, this may be an effort to troll Democrats, [deep] plunge the water closets, phish journolists from the fourth estate, and other monopoly-oriented special and peculiar interests.

Achilles said...

Unknown said...
Achilles, you are an idiot. All these months of you yammering about how Trump will save your sorry ass from the oligarchs, lol. Now your hero puts for Trump Care, otherwise known as Obamacare Light.

Looks like the Congress Critters are not going for it. You thought that Trump would be your answer to all that is wrong with the Government. Oops.


Since supporting someone and not agreeing with someone 100% of the time is possible, and it is not really that difficult a concept to grasp I am going to skip it. Someone who can't grasp that by intuition probably wont get it if you spell it out in crayon.

Instead I want to talk about this thing I saw in a tool box. I was bent and looked like some parts were missing and it was quite useless. We called it the "unknown" tool.

Achilles said...

Nyamujal said...

I kind of like the unknown presence. Lends some much needed balance...

I prefer intelligent comments that are backed by critical thought. There seem to be a couple unknowns at the moment. One of them resembles an old poster here named Inga. A font of emotionally tinged idiocy. This current unknown seems full of blind rage and unconscious projection.

It is boring.

And by the way:

Hillary sent this tweet a week before the election and just after hubby met with Lynch in their private plane meeting.

Mook, Clinton's campaign manager, also just admitted to Fox he knew about the electronic surveillance. There is going to be some squealing soon.

Rusty said...

AReasonableMan said...
mockturtle said...
Maybe without insurance, we'll find out the real cost of medical services so we can shop around.

"But that burden will fall on the poorest and least well equipped to deal with it. Well off people with good jobs have good health insurance."

And your solution was to lie to the American people and force them to buy something they didn't want.
Again. Tear it all down and start from scratch.
Your concern for the poor is laudble until it requires others to fund your empathy.

damikesc said...

Shocking that the GOP leadership can't craft a decent bill. Kill this disaster.

Brando said...

"Shocking that the GOP leadership can't craft a decent bill. Kill this disaster."

Amen to that. I thought Tom Price or someone had a proposal going around already? Why is that not up for consideration?

I just can't believe they had all this time and they basically reaffirm the worst parts of Obamacare and if anything make it more likely to death spiral. I'd have to believe Paul Ryan is intentionally sending this down in flames for some long game, or he is incredibly incompetent at levels I'd never have expected.

CWJ said...

Brando,

Agreed. R's will get no credit for what they preserve and now shift the blame to themselves as the death spiral continues. Doing nothing would be better for them than this.

You write as if the death spiral is still in the future. You're wrong. It's well along. Latest local example. KC's largest hospital chain no longer accepts BC/BS insurance bought on the exchange.

Brando said...

"You write as if the death spiral is still in the future. You're wrong. It's well along. Latest local example. KC's largest hospital chain no longer accepts BC/BS insurance bought on the exchange."

Yes, it's certainly been happening--each season of new premium increases and insurers dropping out of exchanges will continue until this thing collapses completely. Why the GOP would want to own this is beyond me.

Also surprising was Trump tweeting about it being a great plan--he had no obligation to support this (it does fly in the face of his only promises re: health care, and he could easily triangulate on this issue).

Angel-Dyne said...

Brando: I just can't believe they had all this time and they basically reaffirm the worst parts of Obamacare and if anything make it more likely to death spiral.

Can't believe? Why? I'd be shocked it they had put forward anything but what they did put forward, the good-for-nothing SOBs.

Brando said...

"Can't believe? Why? I'd be shocked it they had put forward anything but what they did put forward, the good-for-nothing SOBs."

I guess I shouldn't be surprised, but for political preservation alone you'd think they'd have come out with something they could at least sell to some part of their constituency. This one seems to please no one.

mockturtle said...

Also surprising was Trump tweeting about it being a great plan--he had no obligation to support this (it does fly in the face of his only promises re: health care, and he could easily triangulate on this issue).

Brando, I agree. I'm disappointed that Trump has accepted, sans argument, the GOP plan when it doesn't appear to do what he promised to do--lower premiums and deductibles for working people.

Brando said...

"Brando, I agree. I'm disappointed that Trump has accepted, sans argument, the GOP plan when it doesn't appear to do what he promised to do--lower premiums and deductibles for working people."

I guess I'm more puzzled than disappointed--what's the possible upside for Trump? Backing this bill won't shore up his support among conservatives (they hate it, with good reason) or moderates (they also hate it). Does he think he owes something to Ryan? Though again I don't know how this even helps Ryan. It just attaches Trump to this mess, which he didn't have to do. I could much easier have seen him just say "this isn't accomplishing what I wanted, hopefully it changes significantly before it gets to my desk" which signals that he may veto it if it passes that way.

Though it probably won't make it to his desk, not in the present form.

Robert Cook said...

"'Brando, I agree. I'm disappointed that Trump has accepted, sans argument, the GOP plan when it doesn't appear to do what he promised to do--lower premiums and deductibles for working people.'

"I guess I'm more puzzled than disappointed--what's the possible upside for Trump? Backing this bill won't shore up his support among conservatives (they hate it, with good reason) or moderates (they also hate it). Does he think he owes something to Ryan? Though again I don't know how this even helps Ryan. It just attaches Trump to this mess, which he didn't have to do. I could much easier have seen him just say "this isn't accomplishing what I wanted, hopefully it changes significantly before it gets to my desk" which signals that he may veto it if it passes that way."


You act as if he knows what he wants and knows how to implement it. He doesn't know shit. He spewed a lot of promises out of his ass in the campaign and now anything that can be passed that he can claim fulfills his promise is a "wonderful" thing, the "greatest thing" ever! Trump is simply a gasbag and a flimflam man. I'm shocked anyone really sees him as anything other than that. He and his gaggle of oligarchs and know-nothings have only just started their devastation (in an already devastated society).

Robert Cook said...

"Trump said he had a plan he would unveil in January that covered everyone. What happened to that plan?"

The same thing that happens to every promise ever made by a cad to a maiden that he would "respect her in the morning." Being hot air, it rises into the ether and disappears.