Trump Promises Megathread: Kept or Broken

[BigRedBuster]

 

 

Curious to see your response to my post, BRB. There's a ton of people that aren't dying right now that are incredibly thankful for the ACA.

 

But it was after all a HuffPo piece. They're one of the most liberal outlets out there.

I have said many times on this board that getting more people insured was a good thing. However, there are major issues with the bill that needs to be fixed. I have never been in favor of repealing it. But, it needs fixed.

 

 

I'm with you on this. But it won't happen because they're so gung ho to say they killed it and get something with their name on it in there.

 

From your story:

 

 

 

If you get a subsidy, and you’re willing to switch plans, you won’t have to pay these big increases. More than 80 percent of Obamacare customers get subsidies that help them pay the cost of their premiums. Those people do not pay the full cost of insurance out of their pockets, and they will not feel the full brunt of these increases, as long as there is a less expensive plan available in their market and they are willing to switch.

 

My understanding is a lot of people qualify for subsidies to help offset those premium increases. That's an expensive way to do it, but it definitely helps the consumer and I feel it's justified with something as crucial as healthcare. I could be wrong though -- I honestly don't know who qualifies and who doesn't.

 

Who do we think they should focus on helping with the next plan? IMO the ACA was pretty rough on small business owners. Hopefully they get a more friendly alternative this go around.

 

Maybe I'm in the minority here. But, That is a big part that concerns me.

 

Yes, to those individuals, they get subsidies so they don't feel the brunt of the increases. But...guess who does? WE do.

 

There is a lot of people who get the subsidy...great.

 

However, for those people who DON'T get the subsidy, they get the increases PLUS pay for the subsidy of others. Now, as a humanitarian....that sounds all warm and fuzzy. BUT, at some point, those people get royally screwed in this and it becomes extremely expensive.

 

One of the biggest issues with the ACA is that it doesn't control costs. Sure, it got more people insured, but those people still cost one hell of a lot more than it should to provide health care.

 

The Republicans are on the clock with this. I think if all they do is repeal it, they are going to be demolished politically. They have got to come up with a solution that employs everyone AND keeps costs down.

[Danny Bateman]

See my post above. On average, it drove down premiums growth. But they haven't decreased and particular groups are getting hammered a lot worse than others. Unfortunately you might be in one of those groups.

 

I don't know, man. It's incredibly, incredibly difficult to draw up a plan that doesn't sacrifice quality, affordability or number of people covered. There's just not a great way to achieve great marks in all three areas. They definitely have to do the best they can.

 

It is a little worrying that there are still so many mixed signals. Rand Paul and a few others are saying that repeal and replace IMMEDIATELY is the only viable option. Rand says Trump supports him in this.

 

The majority of Republicans are trying to push for repeal and delay. I imagine they're trying to time it after elections so they don't feel the move electorally. But a delay could crash the markets due to uncertainty and blow the whole thing up in everyone's face.

 

You've got Trump saying he'll do it immediately. Pence said their will be an orderly transition over weeks to months. His press people won't commit to an immediate replacement.

 

It's clear to me no one is on the same page. They've got a bunch of different plans floating out there -- Price's, Paul Ryan's, Cruz's -- but they still haven't settled on one after 6 years.

Seems to me they should've spent less time bludgeoning the ACA and more time solidifying an alternative.

[zoogs]

More subsidies in the right places and fewer in the wrong ones. Public health is a utility and one of the right places, IMO.

 

It's always possible to say "we can in no way afford this", whether it's true or not. I think I favor more narrow and specific statements, like "We can't afford this while at the same time maintaining the level of wealth consolidation at the top that is a massive priority for us politically". For the GOP, that's considerably more honest. The costs borne by the rest of society both in financial burden and health outcomes is nothing.

[BigRedBuster]

It makes people feel all warm and fuzzy to sock it to the rich and pay for health care for the poor. But, my argument is, we should be looking the other direction. We are taxing and taxing everyone more and more to pay for this while health care providers and pharma companies...etc. are laughing all the way to the bank.

 

We need cost controls of some kind. It shouldn't cost $20,000 to have a knee replaced here when it costs $5,000 in other countries. THOSE are the things we need to fix.

 

Without that, the premiums just keep getting higher and higher and people just want to tax the rich more and more for it. The insurance companies don't give a crap because health care gets more expensive??? Raise premiums. Why not, the government will just tax the rich more and give more people subsidies to pay to the insurance companies.

 

And, none of this even begins to discuss the burden this puts on industry. People in favor of the ACA baulk at complaining about what this costs companies, but it's a real costs and it's not just to these mega huge corporations.

[zoogs]

I think we need to be clear about the status quo before characterizing something as "socking it to the rich."

 

I do agree about controlling costs. I don't agree really with what you're suggesting about the ACA. At least, relative to the prior status quo. What puzzles me slightly is that I don't think from what I know about your thoughts that you are arguing for a return to that. But your assessment of the ACA is fairly aligned with the arguments of those who do want to go back.

 

I think this is the most recent in-depth piece I read about it. It outlines some of the positive arguments better than I can: http://nymag.com/daily/intelligencer/2016/12/before-trump-tries-to-kill-it-obamacare-just-got-stronger.html

 

I feel like every argument for improving the system, and there exist very good ones, involve more funding and a larger government role. Blanket opposition to that on principle seems like what has led to healthcare reform in America being as tardy, compromised, and inadequate as it has been.

[BigRedBuster]

How is me saying that I am not for repealing the ACA (because I understand the value of insuring everyone) but we need to over haul it so that it controls costs.....agreeing with the people who want to go back to the status quo?

 

Just because someone thinks the ACA is a horrible bill, doesn't mean they want to go back to the way life was before the ACA.

 

Something clearly needs to happen on health care. The overall costs of it is causing a big negative affect on individuals, businesses and the broader population in the US. Meanwhile, it's cheaper elsewhere in the world.

[zoogs]

I said your assessment of the ACA (it's horrible, we can't afford it, it's socking it to the rich, etc) is in line with people who do want to repeal it, even though I didn't think those were your conclusions. I guess I'd ask this, then: in what substantive ways do you think they feel differently about the ACA compared to you?

 

Perhaps the distinction was just unclear to me. Given the same starting point, the logical conclusion to me seems like it would be to move in the same direction as a means of solving the healthcare problem -- and yet, again, I don't think you're nearly as committed to that idea as the GOP. Particularly with your positive appraisal of how it's done elsewhere in the world.

[BigRedBuster]

Well, if claiming we need a major overhaul of the ACA is the same as the people who claim it needs "repealed" then I guess we are moving in the same direction. That's a pretty big swath of ideas you painted there.

 

But, that doesn't mean I believe the end goal or that the process to get there is the same.

 

So, your assessment is the ACA is fantastic and the only thing we need to do is tax the rich more to pay for it????

[zoogs]

Well, it's just that you sound part Bernie Sanders, part Paul Ryan, and those are really opposite directions. I'm not quite sure what to make of it.

 

I'd say the ACA was an important, but compromised step in the right direction. I don't think solutions are simple, but generally, yes, more funding and a larger public role seem like practical steps to keep the pace of American healthcare catching up with the rest of the world.

[BigRedBuster]

You should stop trying to figure out who I align with politically.

[Danny Bateman]

That was a nice article Zoogs, thanks. I'm thinking you view Congressional GOP members in the same way as the article viewed them - stubbornly ignoring statistics and evidence that run counter to their claims in order to justify that their course of action is best. BRB has successfully divorced himself from that type of myopic logic that leads people barreling full steam toward "repeal and replace", although all three of us would agree the ACA is not without its faults.

 

It's true that other nations provide both cheaper care and universal coverage. We've suffered bad inflation in our insurance industry, and that's a heck of a lot easier to prevent than reduce after the fact. So this will be a rather difficult task.

 

However the US system is not without its strong suits. We tend to get much quicker coverage here with a wider degree of latitude to choose our own course of treatment. Part of how other countries drive down costs is people waiting longer for care and having less freedom to help decide their own treatment.

 

Where I have a hard time is BRB seems to be arguing to let the conservatives have their crack at fixing things because we need to do SOMETHING. But the ACA got conservative'd down to the ACA in the first place! An excellent cost control would've been a public option for healthcare, both driving down costs by forcing more competition on the private insurers and offering a much bigger stick to bargain over drugs with Big Pharma. But that's a progressive policy because it requires more government administration, so conservatives can't go for that. Nevermind the public sector job growth that would be created.

 

Freaking Lieberman.

[Landlord]

I don't know a ton about the actual legal provisions of the ACA, so hopefully someone can help me answer this - what would the ACA look like if it was passed in the form it was originally drawn up in before the compromises gutted a lot of it? Do you think it would have been better or worse than it currently is, or in other words, did the compromises actually improve it, or did they work to the detriment of the bill and of Americans?

[BigRedBuster]

 

 

Where I have a hard time is BRB seems to be arguing to let the conservatives have their crack at fixing things because we need to do SOMETHING. But the ACA got conservative'd down to the ACA in the first place! An excellent cost control would've been a public option for healthcare, both driving down costs by forcing more competition on the private insurers and offering a much bigger stick to bargain over drugs with Big Pharma. But that's a progressive policy because it requires more government administration, so conservatives can't go for that. Nevermind the public sector job growth that would be created.

 

 

Hmmmmm....well.....you probably only have that feeling because I've come to the realization that this is the situation we are in. The GOP controls everything and they have the ACA in their crosshairs. I am not comfortable with that due to their past history on this subject along with the crap they have been spewing ever since the Trumpster was elected.

 

However, I am also uncomfortable with just a liberal led government doing it because it seems like their minds are always on the idea of providing everything to everyone and if we need money...tax the rich. It baffles me when I see more liberal leaning people not be concerned about the costs associated with a program. After all, the more efficient and less expensive we can provide something, the more money we have to do other things.

 

So, in summary, I've actually grown very uncomfortable with either side having total control over fixing health care (or anything).

[zoogs]

You should stop trying to figure out who I align with politically.

I apologize if it seemed like I was making accusations; I wasn't. I'm well aware that you reject political alignment, which is partly why I argued my point this way.

 

If you advocate certain positions, then whether they're part of a certain school of thinking or not is a factual matter. If you reject that school's conclusions, then I do think it's interesting to figure out where, or if, there's the point of divergence.

 

So, if you're critical enough of the GOP's position, perhaps it's time to question rather than buy into their axioms. On the other hand, if you maintain the validity of those arguments, then maybe follow them to their logical conclusion and defend those grounds. To be clear, one of the axioms I'm referring to is this idea that the liberal approach advocated (either via the ACA, or single payer, or so on) constitutes "providing everything and not worrying about the costs and just socking it to the rich."

 

I can certainly empathize with a position of "This is a really tough situation, and I'm skeptical of either party having their way." That's far more neutral ground than what it seemed like you were expressing previously, though. You don't have to be neutral, of course, I just think it does make sense to justify what aspects of the debate make you not neutral. Like, for me, it's my position that we're nowhere close to a situation where it's not fiscally possible for the government to either spend more, or take a larger role. My goal is for healthcare to be regarded as a true public utility and as a right.

[Danny Bateman]

I don't know a ton about the actual legal provisions of the ACA, so hopefully someone can help me answer this - what would the ACA look like if it was passed in the form it was originally drawn up in before the compromises gutted a lot of it? Do you think it would have been better or worse than it currently is, or in other words, did the compromises actually improve it, or did they work to the detriment of the bill and of Americans?

 

Here's what I THINK I know about healthcare and the ACA. I've had some schooling on the matter, but pretty preliminary so far. I try to pull from balanced, reputable sources when I do my reading, but I get a lot of options from Vox. I honestly think they do a pretty good job, though.

 

From what I understand, Republicans wanted a more market-based approach with less government involvement. This is conservative insurance orthodoxy. So they scuttled the public option for insurance Obama BADLY wanted to implement. As BRB said, opinions on the public option are very mixed, but personally I feel it is the best way to drive down costs, particularly meds. It would allow people on the public plan to have the government negotiate their drug prices, and the government has vastly more negotiation power than any other entity - they're just about the best negotiator you could get. This means cheaper drugs and cheaper coverage overall!

 

They VERY nearly got the public option. They missed it by one single vote. At the time, Joe Lieberman was an independent from Connecticut who caucused with the Dems on pretty much anything. But he voted against it. CT is a state that relies a lot on the insurance industry, so I believe that was his justification. But we were THAT close to vastly different healthcare system being put in place.

 

Here's an article on the changes Republicans wanted to see. As usual great stuff from the Atlantic. However, the main two things they mentioned Republicans pushing for before they stopped cooperating were A) the individual mandate and B) marketplaces:

 

 

 

Baucus very deliberately started the talks with a template that was the core of the 1993-4 Republican plan, built around an individual mandate and exchanges with private insurers—much to the chagrin of many Democrats and liberals who wanted, if not a single-payer system, at least one with a public insurance option.

 

They were probably also supportive of risk-pooling in the plan, that's just necessary economics to make a mandate work.

 

But that's basically it right there. The Dems wanted a single-payer system or a public option, in that order. Republicans pulled the mandate and marketplaces from a 1993 healthcare bill they drew up.

 

Obama tried to make concessions since they were facing stiff obstruction on the matter, and the result was the ACA we have today. Kind of silly when you think about Republicans kneecapping exchanges in a lot of states when it was their idea, but these are the times in which we live.