ACA Repeal/Replace: Progressives Face Moral Dilemma

[Kinser79]

Bob Wrote:I do see a problem if those who have a particularly light burden don't want to share the burden.

I don't.  I see a much larger problem with the initiation of force to make those who don't want to share the burden share it.  Given the choice between liberty and equality I'll always side with liberty.  Equality is always the equality of the lowest acceptable standard.

Bob Wrote:And, yes, there are those who benefit from the old system, and those who don't want to risk a change to the system.  Part of the problem.

Tradition has deep roots, so deep that often reason cannot dig them up.

Bob Wrote:Some don't trust the government.  Some don't trust corporations, including the insurance companies. There is no lack of reasons for such distrust.  I'd note that which group is more distrusted has become a cultural and political thing.  You can state your particular prejudice, but take note that there are many with just a strong a distrust of big pharmacy and the insurance companies. 

I trust neither.  But if the choice is between trusting one over trusting the other I'll pick the corporations every time.  A corporation without the compliance of the government cannot force me to buy my product, but the government compels me through force of arms to comply with their taxation.

Bob Wrote:The proper goal might be to minimize bureaucracy all together, public or private.

If that is the goal, and not one I necessarily agree with or disagree with (it depends on the context of this reduction), then the last thing to do is to have the government involved with it.  Bureaucracies have a nasty tendency to expand to fit the needs of the bureaucracy.

Bob Wrote:A disaster?  I'm doing all right.  Massachusetts seems quite ready to shift back to Romney Care.  It might be a disaster by the standards of Florida culture, but not all see it that way.  Some are ready to share burdens.

You missed my point.  Let me try to put this more simply.  When I learned the process by which it was passed--which was by bypassing the usual methods of law making (of which I'm very familiar, seriously the BF and I watch CSPAN for fun) I knew that the reason they were doing that is because using normal procedure they couldn't pass it at all.

Whenever the House and/or Senate leadership hides the bill and prevents debate to force an up or down vote it almost always ends up being terrible.  So yes it was, and is a disaster.

I will say that MA might fare better than FL due to having already implementing Romneycare.  You'd be going back to status quo ante, for FL things are more murky.

Bob Wrote:I have an equal dislike for how big pharmacy and the insurance companies meshed with the Republican desire to make Obama look bad.  Passing the ACA wasn't Congress's finest hour.  My current vaguely wistful hope is that the Republicans will be too divided to work without the Democrats.  The middle of both parties might have to work together for a change.

Possible, but unlikely.  The Democrats have no reason to work with Ryan on Obamacare 2.0.  The Freedom Caucus plus 30 other Reps are already actively opposing it.  Put simply Ryan lacks the 218 to pass it in the House, and Rand, Cruz and Collins say that it's DOA in the Senate.

When a Libertarian Senator, an Evangelical Senator and a North-East Moderate Conservative Senator all oppose a bill in a GOP dominated Senate...the bill is doomed.  Likewise in the Senate the Democrats have no reason to help the GOP leadership.

Bob Wrote:I can agree the Democrats didn't play their cards very well, but there is more than enough blame to go around.  That's water over the dam, though.  The question is whether the Republicans are united enough to push their own ideas on the country, or whether there will be some real give and take this time around.  So far, no such give and take.  It feels like the Democrats are waiting for the Republicans to discover they aren't united enough to railroad.

In the GOP the problem is the Replacement issue.  The Repeal would be passed, and signed by President Daddy within a week.  Rand has a repeal bill in committee now.  The issue is that Ryan either has to come up with a plan where he gets 218, or he needs to find someone with a plan who can get 218.  

I've already emailed Rep. DeSantis ® [FL-6], my Rep, my view that the perfect replacement to Obamacare is to simply mandate the states have to come up with a universal healthcare program for their residents and that the federal government bow out entirely.  Of course that proposal requires a full repeal of existing law.

Of course I didn't tell him that we're already lining up people to primary him should he vote for Obamacare 2.0.  In FL primary challenges coming like a bolt from the blue are not uncommon.

Bob Wrote:I am taking advantage of the fact that it is far easier to state displeasure of this plan or that's lack of perfection than it is to find a plan that is perfect.  I'm also not expecting the Republicans to let go.  They'll try to push their values on the entire country, as Obama did.  

It seems possible that if the two parties are forced to work together, the problem might get solved.  Fifty different solutions will leave it unsolved in parts of the country.

I expect the GOP to do what they were elected to do, which is repeal Obamacare.  If they don't they're going to face a lot of primaries in 2018.

I don't expect the Democrats to work with the GOP.  They have every reason not to--Obama already imposed their vision, and in their districts they are likely to be primaried if they get too friendly with even the moderate Republicans.  (Yes there still are some, not many but there still are some.)

Expecting the two parties to work together in DC is a pipe dream.  As for the states, I'm sure that if they are told they have to figure out a system to cover everyone, they will figure it out.  It may take a while to get it done, but I imagine that State Capitols are more responsive than the Hill.

Bob Wrote:This is one reason I oppose the approach of emergency rooms also becoming general practitioners for the poor.  Emergency rooms don't, can't and shouldn't do preventative maintenance without anyone paying for such services.

For a while, after I was young, healthy and immortal, but before Romney Care kicked in, I did out of pocket health care.  When I got insurance again, my health care provider started doing full preventative maintenance, something I'd never considered important when I was younger.  There was a skin specialist checking for surface cancers, a sleep specialist checking for apneas, a diabetic specialist, and someone who looks up people's rear ends for a living.  If one hasn't a solid form of coverage, one isn't going to get these things, certainly not in an emergency room.

I've always opposed it, but it was a law passed under Reagan back in 1986. I can't speak for MA, but outside of there, generally if you're too rich for Medicaid but too poor for insurance (or it isn't offered by your employer) everything from bronchitis to a bad cold is taken to the ER.  I've heard from my mother that during cold and flu season it isn't uncommon for her to administer up to 50 or 60 shots of common broad spectrum antibiotics to non-trauma patients.

I would say you're seeing too many specialists.  Really one needs to see a GP regularly, and see a specialist only if the GP detects something wrong beyond his pay grade.  I'd argue that the abundance of specialists actually results from lots of CYA in the insurance companies and naturally that drives up costs.

Bob Wrote:I'm doubtful that either region would even try the other's approach at this point.

I doubt either region ever would, not just now.  My state fought against your state a century and a half ago.  (Granted it was a backwater then and basically "South Georgia" but still.)

The proposal I've stated here several times of free/low cost clinics for the poor (to get them connected to GPs) along with patient centered personal insurance plans would probably work down here.  We have some advantages in such an approach, most employers down here don't offer health care, as such the people currently working have nothing to lose except perhaps medicaid if they make too much money, and apart from the elderly on Medicare (which isn't going to be repealed ever--its been too long) it is the working aged people that need to be looked at.

As such if the insurance follows the patient from job to job, he doesn't have worry about layoffs or the economy going bad, or not getting enough hours to be called "full time".  Indeed in FL a lot of people who would have theoretically gotten employer based health care insurance under Obamacare instead found that they had their hours cut to under the 30 hours per week threshold.  I hope I don't have to explain to you how being cut from full time to part time effected people.