Repealing the ACA under Trump

[JJ Husker]

We shouldn't be reinventing the wheel.

 

Every first-world nation - except America - has single-payer healthcare. We're the only major world government who thinks corporations should be in charge of their citizens' health care.

 

This is a mistake. Corporations have less hands-on controls than government. They are purely driven by profit, whereas government is still controlled by the people.

 

It's ludicrous to think otherwise. We must centralize healthcare.

 

I agree with everything you said except the part about government still being controlled by the people. Sure, we have elections and that may give the illusion of actually having a representative government but you really don't believe we the people are in complete control of this train wreck, do you?

[zoogs]

Again, we have VASTLY different understandings of the history of the healthcare debate in America and what was in the realm of possible in 2010.

 

Single payer was the progressive dream. It was the case in 2008, it was the case in 2010, it is the case now. If conservatives and Republicans were on board with it, it would have been the compromise solution. Why? The ACA was politically costly to push through, and the only avenue Obama felt he had was to go with the Republican template. That's how he won over the AMA and industry groups, and even then he faced enormous opposition.

 

If you're saying anything other than "the Republicans didn't stop single payer", I can't figure out what it is. It's true only to the extent that the U.S. has always been so, so far away from single payer being viable.

 

And please acknowledge that single payer is not the only avenue available for cost fixes.

I'll make the "don't reinvent the wheel" appeal as well. I am happy to see you point out what existing alternative proposals exist.

 

Please realize what you are saying when you agree with centralizing healthcare. Recognize what sorts of political forces have for ages made every effort to block this -- and any other -- sort of 'centralizing'.

[JJ Husker]

Again, we have VASTLY different understandings of the history of the healthcare debate in America and what was in the realm of possible in 2010.Single payer was the progressive dream. It was the case in 2008, it was the case in 2010, it is the case now. If conservatives and Republicans were on board with it, it would have been the compromise solution. Why? The ACA was politically costly to push through, and the only avenue Obama felt he had was to go with the Republican template. That's how he won over the AMA and industry groups, and even then he faced enormous opposition.If you're saying anything other than "the Republicans didn't stop single payer", I can't figure out what it is. It's true only to the extent that the U.S. has always been so, so far away from single payer being viable.

And please acknowledge that single payer is not the only avenue available for cost fixes.

I'll make the "don't reinvent the wheel" appeal as well. I am happy to see you point out what existing alternative proposals exist.Please realize what you are saying when you agree with centralizing healthcare. Recognize what sorts of political forces have for ages made every effort to block this -- and any other -- sort of 'centralizing'.

You've got it figured out very well. It's right there. You listed two things other than the Republicans that stopped it, the AMA and industry groups. Or are you considering them "Republican" because they have a profit motive?

 

And we'll just have to disagree on Obama and other dems actually, and not just conveniently, being willing to cut off their nose to spite their face. Those campaign coffers sure wouldn't look very healthy for any politician that gets sideways with the AMA, big pharma or any industry groups.

[zoogs]

Policy cannot ignore reality. When the status quo is entrenched, it's not a matter of simple "will" to completely rewrite the system -- and an intermediate step does not make the effort half-assed.

 

The ACA put us on a path towards single payer. As conservative and industry-friendly as the idea was, it still for its entire life has been under threat because there's plenty of will to undo its progress and move further away from centralized solutions.

 

They took on what they could, which is to say not everyone, and constructed a system that even the makeup of this current government has found impossible to undo.

 

I am not sure what we're tussling over here, but it seems to be how much blame should be concentrated at the Republicans' feet. We both seem to be aware of how entrenched the system was. Letting that diffuse the blame that should be shouldered by the Republicans for their consistent efforts at going the other direction on this...I don't see what utility that has other than to make it seem okay to keep the current makeup of Congress. There's absolutely a difference.

[zoogs]

Lastly: the status quo has everything to do with the people, too. The US is very conservative by makeup. Whether that's a good or bad thing depends on one's politics, but it is what it is. You and I and some of the conservatives on this board may all agree about the merits of centralized healthcare but the people at large are (to put it lightly) ferociously opposed to this.

 

I think it's much more useful to see it through this lens than to simply say "all politicians are screwed up". There's truth to that, too, but politics is ugly and flawed no matter the country. We are where we are because we're not a country that tends to believe in government solutions to things. Moneyed interests don't just have outsize power, they also have the genuine, organic loyalty of a ton of the population.

[JJ Husker]

Policy cannot ignore reality. When the status quo is entrenched, it's not a matter of simple "will" to completely rewrite the system -- and an intermediate step does not make the effort half-assed.The ACA put us on a path towards single payer. As conservative and industry-friendly as the idea was, it still for its entire life has been under threat because there's plenty of will to undo its progress and move further away from centralized solutions.They took on what they could, which is to say not everyone, and constructed a system that even the makeup of this current government has found impossible to undo.I am not sure what we're tussling over here, but it seems to be how much blame should be concentrated at the Republicans' feet. We both seem to be aware of how entrenched the system was. Letting that diffuse the blame that should be shouldered by the Republicans for their consistent efforts at going the other direction on this...I don't see what utility that has other than to make it seem okay to keep the current makeup of Congress. There's absolutely a difference.

I agree with this. I guess we're tussling because I've gotten the impression you want to place all the blame solely on the republicans. I no longer align with them and I'll admit that they are the lion's share of the problem here. But where we may diverge a bit is where we think we'd be on healthcare without them. I may be too jaded and possibly flat out wrong but I really believe that we would be in significantly the same boat if it was just dems in control. That is what I mean when I say it is convenient for them to have the repubs to blame. I'm not convinced they would tackle the cost issues if they could. However, I do think we would stand a much better chance moving to single payer and reforming healthcare without the repubs. And this is what I mean when I say we may accidently get cost reforms. Not because the dems would willingly tackle the cost problems head on but rather they would come as a consequence of the power grab of going single payer. I guess we basically agree but I'm just trying to drive home the point that neither side, the way things currently work in DC, is going to go after the AMA, pharma and industry interests. I fear our government is too broken to be able to do anything meaningful when it comes to this issue. Maybe it is going to require numerous baby steps, like the ACA but I perceive the problem to be too urgent for that to be a sufficient approach. I realize that you and some others don't feel it is that urgent and that the ACA was some sort of leap forward. IMO it was too little and too late even if it was a necessary step in the right direction. The one thing we both know is that the current administration sure isn't up to the task so it will be quite while longer before anything good happens with healthcare. I don't think we have that long.

[zoogs]

I guess I see it this way: by whatever name/party affiliation/etc, it hasn't been possible for there to be enough progressives in Congress to push healthcare. I lay most of it at the feet of the people rather than the system, which I think is where we differ the most. It takes political capital to do this and some ideas are just too toxcic. Nobody's willing to sign on because they'll get voted out.

 

If we weren't so conservative I don't think we have this problem. But we are deeply, fundamentally attached to this "bad government" train. In some ways it probably serves America really well compared to the rest of the world. In other ways not.

 

[Tangentially, I think the ACA went after some parts of the industry but spared Pharma. Criticism worthy to be sure, but there's no way to accomplish this without picking and choosing. It's a consequence of government not really being very powerful, which is also a good thing -- with drawbacks such as this.]

 

I'm glad we do agree, JJ/ED I just feel great leaps haven't been possible here. Would that they were. I absolutely believe there's urgency here. That's the entire reason I'm so adamant about not ceding any of the gains that have been so hard-fought in the past few years. The knives are out for them, particularly with the results of this election. I wish people could have realized this -- but then, maybe they did.

[Rusty Shackleford]

the corporations control our health care and force us to pay outrageous sums to the point it would be just as expensive to have a medical procedure done with no coverage at all so they tacked a penalty onto not having the coverage. pretty convenient for everyone playing pocket pool with eachothers wallets and laughing at us middle classers while they light their cubans with our measely 9-5 paychecks they tax the bejesus out of.

[RedDenver]

the corporations control our health care and force us to pay outrageous sums to the point it would be just as expensive to have a medical procedure done with no coverage at all so they tacked a penalty onto not having the coverage. pretty convenient for everyone playing pocket pool with eachothers wallets and laughing at us middle classers while they light their cubans with our measely 9-5 paychecks they tax the bejesus out of.

Depends on the medical procedure. Check out the costs of cancer treatments (and I'm sure many other treatments). Here's a link for just the drugs (not the rest of the care):

"Newly approved cancer drugs cost an average of $10,000 per month, with some therapies topping $30,000 per month, according to ASCO, which discussed the costs of cancer care at a recent meeting."

 

Nobody is paying $10k/month, let alone $30k/month, for their coverage.

[Redux]

And what would those treatments and drugs cost if you took away the ×5000 (or whatever) markup price they add to them? Seriously wondering.

[Nebfanatic]

If you took away the financial benefit of having no cure maybe they would find a cure for cancer

[zoogs]

Frankly I find it heartening how openly amenable to socialism some of our board's more conservative members seem to be. It shows we're politically open-minded.

[JJ Husker]

Frankly I find it heartening how openly amenable to socialism some of our board's more conservative members seem to be. It shows we're politically open-minded.

Trust me, I wouldn't be for it if the free market hadn't totally f'd it up. Unfortunately they've proven it's beyond their capability, or more fairly, they got too damn greedy gouging us for drugs and services we have no choice but to buy. I still don't like the idea of it but it seems to be the only remaining solution.

[JJ Husker]

And what would those treatments and drugs cost if you took away the ×5000 (or whatever) markup price they add to them? Seriously wondering.

4999x less?

 

True story, I had about 4 infusions of Entyvio. You probably have seen their ads on tv. One infusion... $24,000 list price. It looks like a small bag of saline solution and takes about 1 to 1.5 hours to drip into you via IV. They discount it to $14,000 for my insurance company and my insurance paid it down to where my share was about $4,000. Signed up for the manufacturer's copay assistance program and they tell you your final cost will be $50. And that's the way it works. However, you cannot qualify for that assistance program if you don't have insurance or if you're on Medicare. There is something wrong with a system that let's them vary the price about $14k without batting an eye all while they're soaking the insurance company for $10k. And this isn't typically something a person would only take a few times like I did. It's basically a long term maintenance drug that you get infused with about every 8 weeks. You can thank our FDA for helping protect these pharmaceutical companies profits at the same time you blame the gouging drug companies.

 

I found out all these costs the hard way as the last infusion I had while I unknowingly had lost my insurance coverage. When my insurer didn't pay, they tried billing me the full $24,000 for one bag of what looked like water that wasn't helping my condition. Luckily I got my coverage resolved about 4 months later and everything got taken care of. My doctor prescribes this stuff all the time but he had no idea what it cost other than he knew it was a newer drug and that it probably wasn't real inexpensive.

[Redux]

That's just f'ing horrible. Seriously. How these people sleep at night is beyond me.