October 12, 2017

"With these actions... we are moving toward lower costs and more options in the health care market..."

"... and taking crucial steps toward saving the American people from the nightmare of Obamacare... This is going to be something that millions and millions of people will be signing up for... and they’re going to be very happy. This will be great health care."

Said President Trump, quoted in "Foiled in Congress, Trump Signs Order to Undermine Obamacare" (NYT).
Mr. Trump directed three cabinet agencies to develop rules that would expand access to less expensive, less comprehensive insurance, including policies that could be sold by trade associations to their members and short-term medical coverage that could be offered by commercial insurers to individuals and families....

Mr. Trump’s order could eventually make it easier for small businesses to band together and buy insurance through new entities known as association health plans, which could be created by business and professional groups. A White House official said these health plans “could potentially allow American employers to form groups across state lines” — a goal championed by Mr. Trump and many other Republicans.

97 comments:

mccullough said...

More pen and phone bullshit. Can't wait to watch the liberals and Roberts find the authority for this shit somewhere in the thousands of pages of legislation.

Now I Know! said...

Trump and the Republicans now own healthcare.

holdfast said...

Oh noes!!!

He's gone Full Obama! Never go Full Obama.

buwaya said...

A necessary step.

Any Obamacare reform would have had to do this, even a Democrat one.

The policy cost is excessive, the local markets are extremely restricted and insurers are dropping out of markets constantly. Also note there was no way of consolidating coverage via non-employer bargaining.

It would be interesting to see a substantive argument against this. I don't think one can be made.

gspencer said...

Didn't Obama himself begin this game of changing the law all by himself? In 2014 he unilaterally abandoned the Employer Mandate, first by delaying its implementation, then jettisoning it altogether.

All without any statutory authority.

So there.

AlbertAnonymous said...

gspencer:

shhhh.....

We're not supposed to talk about that.

Lance said...

This will be great health care.

Once again, with emphasis: health INSURANCE is not the same as health CARE.

donald said...

Bingo Lance. The whole discussion is a fraud.

Kevin said...

Creating choice = undermining Obamacare.

The Vault Dweller said...

I don't know how anyone can not think that the NYT is hopelessly biased, when they read a headline like that. Why even pretend like you are an honest broker. There is no way you can claim you strive for neutral objectivity when you have a headline like that.

mockturtle said...

Also extension of short-term policies.

TreeJoe said...

Wait so Trump is promoting collective bargaining to allow groups of individuals to band together and use their combined power to negotiate better terms with large, evil corporations..

And this is not good?

My required mental framework is all screwed up now. Thanks NYT!

Dickin'Bimbos@Home said...

Democrats do not want to fix their crap sandwich. hurting Americans is what they do best.

Dickin'Bimbos@Home said...

Hilarious how fast coruptocrats want to unload their economic disasters.

Smilin' Jack said...

Once again, with emphasis: health INSURANCE is not the same as health CARE.

Sure it is. When you get your insurance card you can eat it, and the fiber is good for you.

The Godfather said...

I don't know how much can be done by regulations alone to undo the Obamacare monstrosity, but it seems worth a try. I bet some of the changes being talked about, if they can be implemented, will be popular with some groups. Perhaps that can build a constituency for legislative changes. Maybe the Republicans could actually try to talk to the American people about improving health care, not just "repealing Obamacare."

rehajm said...

If the minimum definition of insurance is an all you can eat buffet those who can’t afford it choose not to participare at all which makes it prohibitively expensive for many more...and so on. The death spiral...

When you allow for i surance to also mean just the bread plate you allow more people to participate, even enough to have a vuabile risk pool, which will allow premiums to drop 40% to 50%. A meaningful improvement in quality of life for many people.

Bitch about the politics but this is constructive.

Ralph L said...

Live by the EO, die by the EO.

The Cracker Emcee Activist said...

"Hilarious how fast coruptocrats want to unload their economic disasters"

Oh, they are frantic to get their fingerprints off this turd.

buwaya said...

Health CARE is indeed different from insurance. Actually I think its better referrd to as medical services.

The basic US problem is not insurance but excessive cost of medical services delivery. You all are arguing about the wrong thing.

How its paid for hasn't got a lot to do with this. There are all sorts of funding systems around the world that pay for medical services. All of them are cheaper, usually much cheaper (by 50% and more) than what the US manages, on a comparable cost basis. The US is vastly inefficient.

To illustrate, the Federal government, alone, is already collecting more than enough via Medicare and other payroll taxes to pay for a single payer system comparable to that of Canada, adjusting for price levels. The problem is that medical services delivery in the US is so much more expensive.

To put it another way, if you can make your medical services delivery as cheap as the Canadian system you would not be arguing over who is paying for what. But no, you just want to eat each other livers arguing over the wrong things.

Michael K said...

I have thought that the way to do this is to make Obamacare optional.

Then the Medicaid piece, which is what all the supporters want, is left alone. Then the second step is to block grant Medicaid to states. That probably requires legislation.

Then the governors are in control and can reform Medicaid depending on what their voters want.

If California wants a gold plated version, which MediCal has been for years, they can pay for it.

This is the first step.

Earnest Prole said...

It's pen and cell phone time again.

Trump is the White Obama, an empty vessel into which we pour our hopes and fears.

Michael K said...

"if you can make your medical services delivery as cheap as the Canadian system "

The Canadian system is purely political. Primary care is well funded because that is what most voters see and interact with.

Specialty care, which only interacts with sick people, is poorly funded. There are far fewer sick people at any one time than the "worried well" who fill doctors' offices.

The "worried well" are the voters who like the Canadian system.

For a while, the Canadian system paid more for animal CAT scans than for humans. There was a move to use animal CAT scans for people who were on long waiting lists.

The US system has high transaction costs because every small office visit has 80% of the price as transaction cost.

A cash system with catastrophic insurance would remove 70% of the transaction coasts.

Nyamujal said...

"Mr. Trump directed three cabinet agencies to develop rules that would expand access to less expensive, less comprehensive insurance.."

So basically really, shitty insurance with low actuarial values and high deductibles that many can't afford.
Fact: "Most people in the U.S. are living in financially precarious circumstances. Half of all Americans have nothing put away for retirement and the vast majority of them have under $1,000 saved, total."
https://www.cnbc.com/2017/06/19/heres-how-many-americans-have-nothing-at-all-in-savings.html
So, lower income folks get to buy a plan that results in a premium that's relatively affordable, but if they suddenly fall sick they might have to pay a deductible that's simply not affordable.
The three legs of Obamacare are:
1. Getting rid of pre-existing conditions,
2. Subsidies that limit the cost for those with lower incomes, and for those with the lowest incomes, the subsidy is 100 percent, and takes the form of an expansion of Medicaid and,
3. An individual mandate that people sign up for insurance, even if they're healthy. And that the insurance must meet minimum standards (the Bronze plan).
Take any of these legs off and Obamacare collapses. Trump's actively trying to sabotage it and replace it with something that won't work.

Vox has a good explainer on this which is a little more policy focused: https://www.vox.com/policy-and-politics/2017/10/12/16458184/trump-obamacare-executive-order-association-health-plans-short-term-insurance

@Now I know:
"Trump and the Republicans now own healthcare."

Yeah, and the repercussions won't be pretty if they sabotage it and hurt people.

buwaya said...

An idea for a comparable cost study:

Take a random sample of over-65 Canadians and Americans over a 1 year period.
Track their medical procedures over that time, and the amounts charged to their insurance providers (public and private).
Compare.

This would be a rather expensive study but should get at the meat of your problem.

n.n said...

A step to address the Obamacare gap, displaced responsibility, and the economic status quo without establishing another economically unviable monopoly that feeds the foreign and domestic 1%.

buwaya said...

Obamacare plans already have extremely high deductibles.
The only thing it does for the poor is to stick them in public systems.
And in the meantime it exploded the cost of employer insurance.

You are being lied to consistently and viciously.
As Dr. Mike says, your delivery costs are being inflated by mandated overhead.

Nyamujal said...

"Mr. Trump’s order could eventually make it easier for small businesses to band together and buy insurance through new entities known as association health plans, which could be created by business and professional groups. A White House official said these health plans “could potentially allow American employers to form groups across state lines” — a goal championed by Mr. Trump and many other Republicans."

Why is this a good thing? There's a reason why all the Credit card companies cluster in Delaware and why that's bad for consumers. I see the same happening with healthcare.

rehajm said...

There's a reason why all the Credit card companies cluster in Delaware and why that's bad for consumers. I see the same happening with healthcare.

Are you getting your healthcare in Deleware too?

Leora said...

I have never understood why any group couldn't be formed to purchase insurance equivalent to that offered by large employers. Actuarial projection is actuarial projection no matter how the group is formed. It wasn't so long ago that people bought insurance through professional organizations and social organizations like the Bar Association or The Odd Fellows. Apparently these arrangements were made untenable by Federal laws and regulations though AARP and union benefit plans persisted. I never got the public policy benefit of forbidding actuarialy sound insurance plans other than through strong regulation about disclosing what exactly is covered and not covered.

gadfly said...

But healthcare remains mandatory and Donald Trump likes it when the government he presides over is totally in control of everything and anything that comes to his attention today. Tomorrow may never be and yesterday didn't happen.

gadfly said...

@buwaya said..."there was no way of consolidating coverage via non-employer bargaining."

I am sure that somebody understand this choice wisdom but I am clueless. Any association plan would be designed by the association leadership and then offered to individual members. The American Association of Certified Public Accountants (AICPA) might offer a group plan that allows individuals and small firms high deductible plans to be used in conjunction with HRAs (health reimbursement arrangements) to minimize premiums, maximize coverage and customize insurance benefits. If you like it buy it; otherwise look elsewhere; whats so hard about that?

Nyamujal said...

@Buwaya

"Obamacare plans already have extremely high deductibles."

That's where the cost sharing subsidies and reductions come in. A lot of low income families qualify for those subsidies. Besides, the deductibles top out at $6000 for individuals.

"The only thing it does for the poor is to stick them in public systems."

A system that is quite popular and works quite well for them.

"And in the meantime it exploded the cost of employer insurance."

Umm, no. I've been tracking the employer provided insurance cost of my plan and my wife's plan over the past few years and I haven't seen the explosion you're talking about. Do you have any white papers to back your claim?

"You are being lied to consistently and viciously. "

I was told that employers would dump their employees onto the marketplace because of Obamacare. Didn't happen. I was told that Trump would deliver amazing low premiums and deductibles, and a great healthcare plan. Didn't happen(he doesn't know the difference between health insurance and life insurance lol!). I was told that the GOP had a great plan ready to replace Obamacare after they complained about it for eight years. Didn't happen. They had jack and were left with their dicks in their hands when they actually had to craft and pass something. And the list goes on.
Over the past year I've had to deal a lot with our healthcare system after an accident. I'm pretty sure I'm quite good at telling the difference between fact and fiction at this point.

Nyamujal said...

"As Dr. Mike says, your delivery costs are being inflated by mandated overhead. "

Not really. Besides, cost controls will be great, but that's bad gooberment regulation and the GOP doesn't like it. Every alternative suggested by right wing healthcare wonks has some cost controls (Singapore, Switzerland, etc). You can take care of the rising cost issue if you just let the government negotiate prices for Medicare and medicaid recipients. Then you have a public option and voila! problem solved. (maybe)
The federal government is prohibited "from negotiating lower prescription drug prices for our senior citizens." http://www.politifact.com/wisconsin/statements/2017/jan/17/tammy-baldwin/tammy-baldwin-federal-government-prohibited-negoti/

n.n said...

The issue is anti-capitalist practices (a la Fannie/Freddie) that create cost disparities through redistributive change and government regulated monopolies and practices (e.g. single-payer), and asset inflation schemes that force decadal economic resets (i.e. economic dislocations).

The issue is the Democratic establishment of class, sex, rights diversity schemes, racism, sexism, and "=", respectively, that create inhospitable conditions to provide medical care.

The issue is, first and foremost, the conflation of medical services, financial schemes, and health care, where health care is subordinated to industry and Democratically-operated financial businesses that profit from involuntary participation.

Chuck said...

I'm still laughing at how Trump said today that almost half of the counties in the USA would have only one insurer. That's a lie. The douchebag doesn't even know what he's talking about. (What he was supposed to be referencing was the choice among exchanges, which are a relatively small part of private insurance.)

Then, fucking idiot Trump said that his executive order was going to help people get "great coverage, really great coverage." Baloney. What Trump is doing is allowing people to buy really shitty coverage. Trump -- and there are principled conservatives like Rand Paul who can advocate the position -- is moving toward an option where presumably healthy young people can buy low-grade/low-coverage/low-cost plans with poor coverage and large copays and coinsurance costs. Basically, catastrophic coverages. Which is defensible if you are a libertarian like Rand Paul, but not if you are a populist and an arrogant salesman like Donald Trump.

Of course, the side effect of this Trump order is that it hurts, and perhaps catastrophically so, the current exchanges. Trump will not be able to avoid the charge that he is actively hurting the ACA, and not just allowing it to fail on its own.

The capper was watching Trump -- for a second time -- get reminded by Vice President Pence that he was walking out of the signing ceremony without actually signing the order that was being announced. It is at least the second time that the senile fuckhead Trump has done it.

And I just want to add that today marks the point at which Ann Althouse has authored more posts on Harvey Weinstein's sexual affairs than on Trump's reform of the one-sixth of the American economy occupied by the health care sector.

I don't complain about Althouse's choice of topics. She has every right to post on topics that she finds interesting, compelling, and... sexy. If she thinks that the readership is more likely to read a post about Harvey Weinstein's coverage in the New York Times, than about co-insurance problems in health care, I expect she's right.

It is the raison d'etre of the Trump Administration, isn't it? To fight a culture war with the NYT. (Which is a bit odd in the case of Althouse, since I gather that she's a longtime subscriber, reader and fan of the Times.) To hit back, when hit by the media.

Trump doesn't really much care about health insurance reform, and neither does Althouse, and neither does much of the Trumpkin Althouse readership.

Marcus said...

I only have my experience (but I have that going for me): I took the first year of Obamacare. Decent plan, decent cost, decent deductible. The next year, same plan, much higher cost, much higher deductible. The third year, I could not afford it or the lower cost Bronze Plan. So I have been without health insurance for about five years AND they want me to pay a penalty? Thanks, Obamacare.

Luke Lea said...

I wish I could have an informed opinion, but the subject is way too complicated. I did read recently that Americans (and their doctors) order twice as many procedures as Europeans and Canadians, which is one of the reasons we spend twice as much for healthcare. Whether this is true or not I do not know. I certainly haven't read it in the papers.

JayDee77 said...

Trump now scrapping the illegal subsidy to insurance companies.

Obamacare now effectively gutted through executive fiat. Pen and phone, pen and phone.

Lucien said...

Chuck makes me laugh.

The Cracker Emcee Activist said...

"Yeah, and the repercussions won't be pretty if they sabotage it and hurt people."

Surely you jest. The people who are heavily subsidized by Obamacare never have, and never will, vote Republican. There's no political cost attached to shitcanning the AHA. There's a considerable political cost to not shitcanning it, as the GOPe members of Congress are going to discover in 2018.

Lucien said...

Insurance should be insurance. A $5k-6k deductible for major conditions sounds about right. You protect yourself against the $200k or $1 million cancer or auto accident situation and otherwise foot the bill yourself for the rest. Premiums would be scaled appropriately. Unfortunately health "insurance" has become pre-paid health care subsidized for the sick by healthy people. E.g. people are buying "insurance" to cover maternity care when the vast majority of women will get pregnant at least once in their life. They should be absorbing standard birthing costs on their own dime, with insurance covering extreme situations, premies, etc. instead people who can't/won't get pregnant pay for it. And insurance covering birth control? FFS?

Similarly, routine check-ups should be on your own dime, not "insurance". They're routine, how can you insure against it?

Nyamujal said...
This comment has been removed by the author.
Jeff said...

We have two problems with health care in the US. One is demand, the other is supply. Everyone learns in Econ 101 that if you hold supply constant but increase demand, prices go up. If you hold demand constant and decrease supply, again prices go up. If you want lower prices, you have to either limit demand or increase supply, or both.

Health insurance increases the demand for healthcare. Somebody else is paying part or all of the bill, so you consume more. Not only that, along with the insurance comes a lot of bureaucracy. And once you get the government involved, you also have to contend with rent-seeking providers who want to boost the demand for their particular services. So you get formal and informal rules requiring huge amount of costly imaging and lab tests, overprescribing of expensive drugs, and mandated coverage of lifestyle illnesses.

At the same time, our system limits the supply of health care. You cannot practice medicine in the US unless you have first done a residency in this country, and the number of those residencies is limited. Most of them are funded by Medicare, and that funding has been capped at the same $10 billion level for the last twenty years. That funding covers about 30 thousand new residencies per year, and most of those residencies last about four years. In 2015-16, there were about 119 thousand residents. For $10 billion per year, we get about 30 thousand new doctors per year.

The number of residencies have barely changed in twenty years, while the population has grown both larger (by 19 percent) and older. Older patients need more care, and the practice of medicine itself has become more complicated. Just to stay even with where we were twenty years ago, we should have at least 20 percent more doctors than we do. Instead, we've empowered doctors to charge ever higher prices every year, while most of them see so many patients that it's a miracle they can manage to do anything at all for any of them.

Screwing around with health insurance is not going to make much difference. Unless and until we radically increase the supply of doctors, healthcare costs are going to go up.

Michael said...

Read the stats on cancer survival in the U.K. Versus the U S If you get the bad biopsy you want to get it here.

LYNNDH said...

Luke Lea, one of the reasons that American Doctors order more test is something called "The Trial Lawyers Association" (not real name, but it is a group). Suing is the American pastime, not Baseball. At one time there was effort to limit liability or payouts. Got nowhere.
Reading some of the comments tells me there are a lot of deliberate misinformation out there being pedaled by Liberals.

n.n said...

The first step to health care, and medical care, not medical insurance, reform, is education reform. Medical insurance is regulated by the government.

The conflation of these separable concepts and practices are a cause of progressive costs and subsequently payments.

There is evidence that the medical product is in excessive demand, priced too high, and the supply is too low. So, since medical insurance is regulated, and so is the education system, and immigration reform (e.g. illegal aliens, CAIR forced by social justice adventures) compensates for an aging People and Planned Posterity, the cause is likely an overpriced medical product.

That said, what are the advantages and disadvantages of an authoritarian monopoly (e.g. single-payer), of a democratic economic system (e.g. capitalism)? The risks?

There is also the issue of availability, which is in part limited by the progressive doctrine of diversity (e.g. racism).

Baby Lives Matter... throughout human evolution from conception.

Ray said...

Trump will be rewarded because at least he did something, after giving the house and senate a chance to work on Obamacare.

Ray said...

I wish Trump is would remove congresses Obamacare exemption...

rcommal said...

Mr. Trump’s order could eventually make it easier for small businesses to band together and buy insurance through new entities known as association health plans.

One can hope, and we most certainly do. However, as wishin' ain't gettin', hopin' ain't gettin', either.

Also, that "eventually" word is extremely loaded, and don't we know it, and haven't we known for decades.

Just sayin'.

rcommal said...

I do agree that both Congress and the individual Senators' and Representatives' young staffers ought not be protected from the...um, pain. I, myself, would describe it as a needed astringent. It stings, but possibly can start a healing.

Achilles said...

Nyamujal said...

So basically really, shitty insurance with low actuarial values and high deductibles that many can't afford.

Impossible to get any worse than before.

Opening sales across state lines can do nothing but help. You people are just acting like idiots.

Vox is not a source of information.

Michael K said...

Trump's actively trying to sabotage it and replace it with something that won't work.

Silly comments from lefties who have no clue about health care.

Obamacare was written buy 25 year old lawyers on the Democrats staff and Insurance company lobbyists.

The Hillarycare plan failed because she excluded all providers and insurance companies from her secret commission.

The Obama/Pelosi/Reid plan included the insurance companies who thought they would get a captive population who would be forced to buy their crappy product,

Insurance companies hated health insurance because it was a money loser. They liked employer funded plans because they made their money by processing claims, which was lucrative. They saw Obamacare as another opportunity to process claims and have the USA pay them.

The health insurance industry in the US is in the business of processing claims, not insurance.

Claims processing is 70% of the cost because that is how they make their money.

Costs are kept high to keep the money flowing and doctors are no more in control than patients.

The comments about increasing supply and residencies are nonsense. The flood of new doctors from all over the world has been huge.
My wife's new internist in Tucson graduated from St George's medical school in Grenada.

I interview students applying for military medical school scholarships and they are applying to medical schools I never heard of.

If you keep the price near zero, demand approaches infinity.

Achilles said...

Nyamujal said...

That's where the cost sharing subsidies and reductions come in. A lot of low income families qualify for those subsidies. Besides, the deductibles top out at $6000 for individuals.

That doesn't include premiums which for my brother add up to around 6k a year.

He doesn't have insurance. Neither does my mom.

12k out of pocket before you get to pay 20%. That is garbage compared to what they all had before Obamacare. She is waiting to get on medicare. He is waiting for someone to save us from you douchebag lefists and your crony insurance companies.

Michael K said...

A useful summary of the Trump changes for those who want to know what it means.

The lefty Obama fans won't bother. They want the issue, not a solution,

rcommal said...

The health insurance industry in the US is in the business of processing claims, not insurance.

Of course! And this started at least--AT LEAST--35 years ago. And at that time, doctors were jiggy wit' it.

rcommal said...

We are so very interested in how much our premiums are going to spike up, starting in January. Sheesh.

@Michael K: And you won't bother to pay attention to our situation. The righty Trump fans won't bother, either. You and yours (as they and theirs do, the leftys do) want the issue, not the solution.

Quit zoomin'. Stop being full of shit.

Kevin said...

Trump doesn't really much care about health insurance reform

Why are you so angry about this? Every president is given a grab bag of issues when they take office. Many of those are a shit sandwich the guy before you cared about but you do not.

You think Obama really cared much about Iraq or Afghanistan? He wanted to be the guy who kept the oceans from rising.

Trump ran for President because he wanted to fix immigration and trade. He did not, and would not have, run for national insurance commissioner.

He will do something about the insurance market because, like dealing with North Korea, he has to.

Kevin said...

Trump and the Republicans now own healthcare.

People said that about Obama, the Democrats, and Iraq. You should consider the parallels before you make a blanket statement like that.

Mark said...

Powerline blog claimed as a fair arbiter lololol.

Unknown said...

> find the authority for this shit somewhere in the thousands of pages of legislation.

The reason "we have to pass it to find out what's in it" is that Congress is incapable of pre-planning 1/6 of the US economy.

They voted that regulators should write most of it later.

Well, there's a new sheriff in town: you don't have to amend the law to make many changes, because the ACA abdicated on so much of the detail.

Rusty said...


"Trump's actively trying to sabotage it and replace it with something that won't work."

ACA isn't working now so how can giving people a choice without coercion be bad?

Dickin'Bimbos@Home said...

ObamaCare is Detroit and Illinois

Rick said...

"Trump's actively trying to sabotage it and replace it with something that won't work."

It's revealing Obamacare supporters choose this criticism. By its own standards Obamacare "doesn't work", hence the constant call by its supporters to change it. Yet they have no criticism of the program or those who designed it.

Why it's almost like their support or opposition is entirely based on the party under discussion instead of the policy itself. What a strange coincidence.

Dickin'Bimbos@Home said...

Illinois - What democrats do with one party rule

Dickin'Bimbos@Home said...

Corruptocrats hate choice (expect Planned Parenthood choice - that stye like)

From your link, Michael K

"In just three short years, Obamacare has severely damaged health insurance markets across the country, leaving some markets on the brink of total collapse. Going into 2018, consumers will have access to just one health carrier in nearly half of the counties across America. In many cases, this sole health carrier does not include local doctors in its network, forcing people to switch doctors and drive long distances for care. Average premiums on the individual health insurance market have doubled since 2013, escalating premiums beyond what most people can afford.

To address these severe problems, Trump’s executive order directs executive agencies to take three major steps. First, the order directs the Secretary of Labor to consider expanding access to association health plans. This move has the potential to allow Americans to more easily form groups through existing organizations—such as a trade organization—to gain access to more insurance options at lower rates in the large group market or on a self-funded basis.

Second, the order directs agencies to consider expanding access to lower cost health coverage options by easing restrictions on short-term limited duration insurance. This type of insurance generally exists to provide health coverage to people between jobs. After Obamacare became law, the Obama administration shortened the allowable duration of these plans from 364 to 90 days, a move opposed by the National Association of Insurance Commissioners. Because these plans are not subject to costly Obamacare regulations, they cost remarkably less than standard coverage. Moreover, as normally structured, they provide access to any doctor, a very important benefit for people living in those counties with very narrow networks."

Oh no - choice! We can't have that. We need corruptocrats to strangle choice so that we can cry for more corruptocrat justice.

Dickin'Bimbos@Home said...

ObamaCare regulations - progressives don't give a crap who they hurt.

Chuck said...


Blogger Lucien said...
Insurance should be insurance. A $5k-6k deductible for major conditions sounds about right. You protect yourself against the $200k or $1 million cancer or auto accident situation and otherwise foot the bill yourself for the rest. Premiums would be scaled appropriately. Unfortunately health "insurance" has become pre-paid health care subsidized for the sick by healthy people. E.g. people are buying "insurance" to cover maternity care when the vast majority of women will get pregnant at least once in their life. They should be absorbing standard birthing costs on their own dime, with insurance covering extreme situations, premies, etc. instead people who can't/won't get pregnant pay for it. And insurance covering birth control? FFS?

Similarly, routine check-ups should be on your own dime, not "insurance". They're routine, how can you insure against it?

You're talking like Senator Rand Paul. I'll be the first to say that is a perfectly respectable position for debate; a libertarian view of health insurance. And the practical consequences can be discussed and debated.

But what is unarguable is that Donald Trump ran for office on something else and promised the opposite. Trump promised that "everybody" would be covered, with lower company's and lower deductibles.

Rand Paul's skin must have been crawling, standing behind Trump and listening to Trump's shit.

tcrosse said...

Rand Paul's skin must have been crawling, standing behind Trump and listening to Trump's shit.

Rand's used to hearing shit from his Dad.

Chuck said...

"lower co pays..." Damn auto-correct.

Kevin said...

We have two problems with health care in the US. One is demand, the other is supply.

The typical government response is to restrict supply and subsidize demand, thus sucking money from the taxpayers into the corporation while hassling the citizen and telling him he must do it for health, safety, or "the poor".

Obamacare is no exception.

Owen said...

Excuse me while I ask about the future. The US has been the engine for technological "advance" in healthcare. The drugs and devices that have made a difference in people's lives, came from a combination of circumstances that the planet has never seen before: the breakthrough in antibiotics in the 20th C, the industrial base and relatively open economy that powered a lot of innovation, the explosion of technologies like IT and datamining and genetics and gene editing and precise (nano) manipulation of biological structures, the availability of crazy amounts of capital and a large market to support it over decades.

Many other countries got something of a free ride on that, either from differential pricing or from outright piracy. But somebody has to pay for it. Somebody has to take the chance.

In the world of Obamacare or Trumpcare or Whoevercare, will that virtuous cycle continue? If the price of my medicines is driven down to the marginal cost of one more pill (a fraction of a penny), who will take the big chance on the next thing?

Asking for a friend.

Larry J said...

It seems pretty certain that ObamaCare was designed with failure in mind. It's ultimate failure would lead to demands to implement a single-payer system. There's a strange manner of thinking that failure of one program is justification for an even larger program designed by the same people. I call it "failing upwards". Obama himself said he couldn't get to single-payer in one step.

Before we think about letting the US government take total control over health care, perhaps we should look at how well they've done when they controlled things. There are large government operated health care systems in the US already. Are they examples of high-quality, cost-effective care? Judging from the stories about the VA system, I think not. How about the medical services provided on Indian reservations? Is that something to point to with pride? Nope. Medicare and Medicaid are in dire financial trouble and awash with fraud.

I served in the military for 13 years. The health care available to ordinary military personnel and our families ranged from excellent (if you happened to be stationed near Washington DC) to horrendous. Talk to anyone who served and you'll likely get your own set of horror stories.

There are two variations on an old joke.
Q: What do you call the person who graduated at the bottom of his class in medical school?

A1: Doctor

A2: Captain (MDs come into the military as O-3s, which is a Captain in the Army and Air Force and a Lieutenant in the Navy.

gregq said...

This is the closest I've ever come to liking President Trump.

Gorsuch was his best action so far, but that was merely fulfilling a promise. This was an actual good move.

It should have been done Jan 21. But at least he did it. And I'm pretty sure that "President Rubio" would never have dreamed of doing this."

Drago said...

NIK: "Trump and the Republicans now own healthcare"

"...now own..."

LOL

Weren't we told BEFORE the election that the Republicans "owned" healthcare? By lefty posters on this very blog?

Yes, yes we were.

Weren't we told just after the election that Trump "owned" healthcare? By lefty posters on this very blog?

Yes, yes we were.

Weren't we told in Jan, Feb, March, April, May, June, July, August, September of this year that Trump and the republicans "owned" healthcare? By lefty posters on this very blog?

Yes, yes we were.

So we that once again the lefties (with rhetorical support from their lifelong republican allies) making their evergreen assertions about "insert issue here" and republican ownership.

It's an interesting little bit of Jedi-mind trickin'-reverso-logic. Suddenly Stalin was a "conservative", Lincoln was a democrat, Jim Crow era dems were all republicans, slavery was a republican thing, Ho Chi Minh was a vietnamese George Washington, etc.

It's almost as if the leftiess and their lifelong republican allies have one playbook and only 1 play in that playbook.

Almost.

And by "almost" I of course mean "exactly".

gregq said...

Blogger Now I Know! said...
Trump and the Republicans now own healthcare.

Nope, it's still ObamaCare.

It's not TrumpCare until we get an actual law passed through Congress.

President Trump is merely obeying a Court order, one that's Constitutionally and legally entirely correct: No money may be spent by the US Gov't absent an appropriation from Congress. Congress explicitly refused to pass an appropriation for these payments. It was illegal for the Obama Admin to ever make them.

This is what happens when you spend all your effort on "how can we lie to the CBO, Congress, and the American people in order to get something through?", rather than, oh, actually trying to do something good for America.

Balfegor said...

Re: Larry J:

It seems pretty certain that ObamaCare was designed with failure in mind. It's ultimate failure would lead to demands to implement a single-payer system. There's a strange manner of thinking that failure of one program is justification for an even larger program designed by the same people. I call it "failing upwards". Obama himself said he couldn't get to single-payer in one step.

I think it's not quite right to think of Obamacare as it ultimately emerged as "designed" -- remember that midway through the process, Massachusetts voters replaced Ted Kennedy with a Republican (Scott Brown), giving Republicans the ability to block action by the Senate. So they ended up using a procedural trick (reconciliation) to get something through, so they could declare victory and go home. Their original plan had not, I think, been to stick with what we got, but to revise it further. The voters just foiled their clever plan before it reached fruition.

Re: Trump turning to executive orders -- that's basically the late Obama administration strategy in a nutshell. And like with Obama, it's a sign of basic political weakness. Executive orders can be reversed once the administration changes, so it's a policy change built on sand.

gregq said...

Blogger Nyamujal said...
"Mr. Trump directed three cabinet agencies to develop rules that would expand access to less expensive, less comprehensive insurance.."

So basically really, shitty insurance with low actuarial values and high deductibles that many can't afford.

No, that's the Bronze and Silver plans, except they also have narrow networks,

What these won't have is all the BS EHBs, which really drive up the cost and are nothing but payoffs to Democrats preferred groups

Oh, and previosu comments were a semi-brain fade, I was mostly talking about Trump ending the CSR payments. :-)

Drago said...

Democrats: obamacare is the most beautiful and wonderful and magnificent (LLR Chucks word to describe obama) legislation ever to pass and we amazing dems had to pass this much needed legislation over the objections of every nazi republican and thank goodness we did because we are such astonishingly smart and insightful legislators and.....and....and.....and...

...and... uh, its all yours and we have nothing to do with it!!

gregq said...

@Balfegor:

1: Kennedy died after the Senate fully passed ObamaCare. There would have been some negotiations in the reconciliation committee, but this was what they were going with.

Where the Democrats blew it was they decided that the voters wouldn't completely hammer them, and GOP would be wimps, so they'd be able to make more changes, later.

That's the part of their "clever plan" that failed.

2:Executive Orders are policy change built on the political strength of those you help.

Every person who choses to get a TrumpPlan over an Exchange Plan is going to be a firm supporter of this order. And there will be no "if you like your plan, you can keep your plan" BS. Repealing the order will be a direct "F you" to everyone with the plans, and everyone will know it.

Politicians don't like to do that

gregq said...

Nyamujal said...
"Mr. Trump’s order could eventually make it easier for ...American employers to form groups across state lines” — a goal championed by Mr. Trump and many other Republicans."

Why is this a good thing? There's a reason why all the Credit card companies cluster in Delaware and why that's bad for consumers. I see the same happening with healthcare.

It's a good thing because entrenched monopolies use their power in State legislatures to force every insurance plan to cover their bills. If you can buy across State lines, you can buy from a State that doesn't make you pay for other people's care that you don't ever want for yourself.

IOW, it moves health insurance back to being insurance, rather than payoffs for politically connected groups.

You know, it helps protect the powerless from the powerful. Which we understand is something the Democrats always oppose

Jeff said...

The comments about increasing supply and residencies are nonsense. The flood of new doctors from all over the world has been huge.

Actually, the "flood" has been abating for at least ten years now. Here is an extended quote from Mullan, Salsberg and Weider writing in the Dec 2015 New England Journal of Medicine:

"Traditionally, there have been many more entry-level positions available than there have been U.S. medical graduates (M.D. and D.O.) to fill them. Large numbers of graduates from international medical schools (international medical graduates, or IMGs) also compete for positions; they include U.S. citizens who study abroad as well as foreign nationals. According to our analysis of data from the Accreditation Council for Graduate Medical Education (ACGME), the Association of American Medical Colleges (AAMC), and the American Association of Colleges of Osteopathic Medicine (AACOM), between 2004–2005 and 2013–2014, the number of filled entry-level GME positions grew from 24,982 to 28,962, an increase of 3980 positions, or a 1.66% annual rate of growth. During the same period, the number of U.S. graduates with M.D. and D.O. degrees grew from 18,542 to 22,960, an increase of 4418, or a 2.40% annual growth rate. According to the ACGME, there were 6846 entry-level positions filled by IMGs in 2014–2015."

And the best evidence that there is no "flood" of physicians is that physician compensation has been rapidly rising for several years. Here is a slideshow on Medscape showing that average physician compensation has risen from $206K in 2011 to $296K in 2017. That's a 43 percent increase in only 6 years. What other line of work has seen this much of an increase over that short a period of time?

Drago said...

Lucien: "Chuck makes me laugh."

Chuck indeed has been grumpy lately.

One can discern a perfect inverse correlation between democrat party woes and Chucks happiness levels.

As dem woes increase, Chuck's grumpiness increases, and vice versa.

Plus Chuck is probably upset that his preferred patsy to lose to Stabenow is not yet "lighting it up" electorally.

Balfegor said...

Re: gregq:

1: Kennedy died after the Senate fully passed ObamaCare. There would have been some negotiations in the reconciliation committee, but this was what they were going with.

Ted Kennedy died August 25, 2009. Obamacare was amended by the Senate and passed December 24, 2009 (a Democratic temp, Paul Kirk, filled Kennedy's seat until the special election to replace him, giving the Democrats the 60 votes they needed). Note that these amendments weren't trivial -- Senate Amendment 2786 (approved 60-39) is literally 200 pages of revisions to the text. Senate Amendment 3276 (also approved 60-39) is another 40 or so pages. The "amendment" was basically a rewrite by the Senate.

Because the House and Senate versions were inconsistent, that would normally lead to a conference after which House and Senate would vote on the resulting conference report. That was no longer an option for Democrats once Scott Brown (R) was elected on January 19, 2010 to replace Ted Kennedy (D). Ultimately, the House just gave up passed the Senate version as-is (March 21, 2010). As a substitute for the negotiations that would have taken place as part of the conference process, the House passed a negotiated budget reconciliation bill that passed the House on March 21 and the Senate on March 25. But of course, because of the rules around budget reconciliation, the changes they could make were limited.

I've seen articles trying to make the claim that the Democrats didn't pass Obamacare through reconciliation. The argument isn't totally meritless (the main bill was, yes, the Senate version as-is), but it is misleading in its effort to portray what happened as normal. Reconciliation really was their procedural dodge to avoid putting the amendments they wanted up for a normal vote where it could be blocked by the Republicans.

Balfegor said...

Re: gregq:

1: Kennedy died after the Senate fully passed ObamaCare. There would have been some negotiations in the reconciliation committee, but this was what they were going with.

Ted Kennedy died August 25, 2009. Obamacare was amended by the Senate and passed December 24, 2009 (a Democratic temp, Paul Kirk, filled Kennedy's seat until the special election to replace him, giving the Democrats the 60 votes they needed). Note that these amendments weren't trivial -- Senate Amendment 2786 (approved 60-39) is literally 200 pages of revisions to the text. Senate Amendment 3276 (also approved 60-39) is another 40 or so pages. The "amendment" was basically a rewrite by the Senate.

Because the House and Senate versions were inconsistent, that would normally lead to a conference after which House and Senate would vote on the resulting conference report. That was no longer an option for Democrats once Scott Brown (R) was elected on January 19, 2010 to replace Ted Kennedy (D). Ultimately, the House just gave up passed the Senate version as-is (March 21, 2010). As a substitute for the negotiations that would have taken place as part of the conference process, the House passed a negotiated budget reconciliation bill that passed the House on March 21 and the Senate on March 25. But of course, because of the rules around budget reconciliation, the changes they could make were limited.

I've seen articles trying to make the claim that the Democrats didn't pass Obamacare through reconciliation. The argument isn't totally meritless (the main bill was, yes, the Senate version as-is), but it is misleading in its effort to portray what happened as normal. Reconciliation really was their procedural dodge to avoid putting the amendments they wanted up for a normal vote where it could be blocked by the Republicans.

Chuck said...

There is just no reconciling all of the far right, libertarian-adoring comments here about how health care insurance ought to be minimalistic catastrophic coverage only, with freedom across state lines so that some less-regulatory states can say that even less coverage can be offered...

...And Donald Trump's dozens of campaign pledges about how his reform of healthcare and his consummate dealmaking would provide better coverage to "everybody." With lower deductibles, lower premiums, better care, better choices, etc., etc., etc.

All of which is now plainly bullshit. No, worse than bullshit; a bald-faced lie.

Again I say that if some Republicans want to run in primaries where they favor those particular planks of a healthcare policy platform, they can go for it. Somehow or another, Rand Paul (who has forgotten more about health care than Donald Trump will ever know) has gotten elected and re-elected on that streak of libertarianism.

But I don't think it will ever work, without Rand Paul's personal charm, in Michigan, Wisconsin, Ohio or Pennsylvania or name-your-state.

Drago said...

Trump is simply doing what he can at this moment in time as the "lifelong republicans" in DC have come out clearly in support of keeping obamacare in place.

As they intended all along despite their nonstop lying to the base for 7 years all of which was abetted by the "lifelong republican" members of the base.

Talk about BS and lying!

This is the sort of thing that begat the Tea Party and is very much the reason for Trump winning the nomination. Bernie would have won the dem nomination as well had the dems not hacked their own nominating process.

Just wait, we will see just enough "lifelong republicans" shutting down tax reform too, just as their dem allies desire.

Chuck said...

gregq said...
Blogger Nyamujal said...
"Mr. Trump directed three cabinet agencies to develop rules that would expand access to less expensive, less comprehensive insurance.."

So basically really, shitty insurance with low actuarial values and high deductibles that many can't afford.

No, that's the Bronze and Silver plans, except they also have narrow networks,
...

Well you are revealing hour ignorance about Silver plans in particular there. A Silver plan is every bit as good as most employer-based private plans. I've studied them.

It is a funny thing; the people in private employer-based plans have been getting hit very hard with increased premiums and co-insurance requirements. But all that Trump ever talks about (without understanding even the basics of what he is talking about) are the ACA marketplace options.

As a Republican, I know very well that what Obamacare never dealt with was the "cost" side of health care. All that Obamacare ever attempted to address was the universal coverage angle.

There were some left-wing ideas about lowering costs. Things like the federal government unilaterally dictating reduced drug prices by its market and regulatory powers. Stupid ideas, that naturally Donald Trump pays favorable lip service to on a semi-regular basis.

gregq said...

Blogger Chuck said...
There is just no reconciling all of the far right, libertarian-adoring comments here about how health care insurance ought to be minimalistic catastrophic coverage only, with freedom across state lines so that some less-regulatory states can say that even less coverage can be offered...

...And Donald Trump's dozens of campaign pledges about how his reform of healthcare and his consummate dealmaking would provide better coverage to "everybody." With lower deductibles, lower premiums, better care, better choices, etc., etc., etc.

But it is all those things, other than the lower deductibles. Because you don't need a horribly narrow network, when you have reasonable, as opposed to ObamaCare, health insurance.

And I doubt teh deductibles are going to be any higher than the Bronze plans

gregq said...

Balfegor said...

I've seen articles trying to make the claim that the Democrats didn't pass Obamacare through reconciliation. The argument isn't totally meritless (the main bill was, yes, the Senate version as-is), but it is misleading in its effort to portray what happened as normal. Reconciliation really was their procedural dodge to avoid putting the amendments they wanted up for a normal vote where it could be blocked by the Republicans.

1: You're right, Kennedy died earlier than ObamaCare passage. But the key event wasn't his death, it was Scott Brown's victory, which as you said didn't happen until after the Senate passed ObamaCare.

2: So long as Demos had 60 Senators, republicans couldn't stop anything. The reason why they didn't go to reconciliation after Brown won was they needed 60 votes for its results.

So anything they could have gotten through Reconciliation, they could have put in the original bill.

We got the ObamaCare Senate Democrats wanted. We didn't get the ObamaCare that House Democrats said they wanted. But I don't believe it's fair to claim "this isn't the real ObamaCare", because it was exactly what all 60 Democrats in the Senate were willing to agree on.

gregq said...

Blogger Chuck said...
gregq said...

So basically really, shitty insurance with low actuarial values and high deductibles that many can't afford.

No, that's the Bronze and Silver plans, except they also have narrow networks,
...

Well you are revealing hour ignorance about Silver plans in particular there. A Silver plan is every bit as good as most employer-based private plans. I've studied them.


Really? Which do you have, the Silver plan, or the employer based insurance plan. Because I have the latter, and it's far superior to Silver plans

How's teh network on that "second lowest cost" Silver plan?

dreams said...

I think Trump is doing something that will really be an improvement of the current mess. Trump is bold and decisive, a real leader.

Drago said...

LLR: " All that Obamacare ever attempted to address was the universal coverage angle."

False.

obamacare was designed from the ground up to "fail" and lead to direct govt control over all healthcare in the US.

That was its purpose.

As any "real" republican should know. But once someone climbs into bed with the democrats, as in a Weinstein scene, those fundamental realities and understanding can be lost amidst the sturm and drang of sheet-flailing democrat talking points.

Balfegor said...

RE: gregq:

I think we have some terminological slippage here. 1. conference is what they sidestepped by using budget reconciliation. 2. Reconciliation isn't subject to the filibuster; the conference report is. I think you're using "reconciliation" to refer to the conference, which would usually be fine, but in this case just adds confusion given the use of the budget reconciliation tactic.

Scott Brown winning was why the Democrats opted for reconciliation, which Republicans could not block, rather than a conference, which Republicans could.

That said, given that the reconciliation bill actually lost a couple Democratic votes in the Senate, Democrats would probably have had difficulty getting the final bill as-amended past their own Senators even if they had gone to conference. It's hard to say, since the election of a Republican senator from a solidly Democratic state also revealed to Democrats in the Senate just what a mess they were blundering into. So they might have ended up using reconciliation anyhow.

Drago said...

LLR: "I've studied them."

And you've studied them every bit as effectively as you've studied MI electoral politics.

EMyrt said...

Owen, brilliant comment, but you skipped right over the revolution in biotechnology and medical device engineering, which have been at least as revolutionary as antibiotics and imaging.

gregq said...

Blogger Balfegor said...
RE: gregq:

That said, given that the reconciliation bill actually lost a couple Democratic votes in the Senate, Democrats would probably have had difficulty getting the final bill as-amended past their own Senators even if they had gone to conference. It's hard to say, since the election of a Republican senator from a solidly Democratic state also revealed to Democrats in the Senate just what a mess they were blundering into. So they might have ended up using reconciliation anyhow.

1: You're right about my incorrect / sloppy terminology use. Sorry

2: Enough House Democrats voted for a rule blocking ObamaCare from coving abortions that the restriction won in the House. The restriction wasn't in the Senate bill.

When it came time to vote on the Senate bill in the House, enough of those "pro-life" Democrats gave up on their "principles" in order for ObamaCare to pass.

At every step of the way, Democrats got as many Democrat votes as they needed, and allowed some Democrats to CYA and not vote against their constituents. So I don't believe for a moment that any Democrat Senator would have voted against the version of ObamaCare that came out of the Conference Committee.

In short, i'm not willing to cut the Democrats one shred of slack on ObamaCare. They could have worked with Republicans to pass a bill that did not suck. They chose not to. As such, Republicans have every moral, ethical, and political right to burn it to the ground, and I will cheer every effort Republicans make to do so.

And attack viciously any Republicans who try to save that vile mess of a law.