The Bishop and the Butterfly: Murder, Politics, and the End of the Jazz Age
    Michael Maiello's picture

    What They've Wanted To Repeal For Seven Years

    Ever since the Affordable Care Act became law, Republicans have sought to repeal it. In the most recent failed attempt, I've seen numerous references to the difficulty of repealing an "entitlement" once people have grown used to having it and the use of that word mostly reminds me of just what a paltry entitlement the ACA is for most people.

    Now, I'm not saying the ACA is insignificant. It greatly reduced the uninsured population and that means the ACA is a good thing. The no-cost annual physical, requirement that insurers cover pre-existing conditions and the elimination of lifetime expense caps were also great improvements.

    But, at its core, the ACA is no entitlement. The ACA obligates all citizens to buy health insurance from a private insurer, whether it is provided as part of employment compensation or purchased over a publicly run exchange. The ACA, for all the good it does, is no entitlement.  It's really a law that cements the role of private health insurers in healthcare, in exchange for a few (good) concessions.

    It's not health insurers trying to repeal this thing.  Though they have their complaints and would love to win concessions here or there, they mostly support the ACA. Oddly enough, the ACA really gets the government out of our healthcare. Private insurers rule the industry and just have to obey some rules in order to do so forever. The Republican vitriol against this incredibly business friendly regime is the real answer to why we can't have nice things.

    There really should be a public option, open to everybody, whether or not they are offered health insurance as employment compensation. Even that would have been a compromise with the right.  The left wants single payer medical coverage for everyone from cradle to grave. A public option would have been a far cry from that and is only the modest suggestion that if people would rather have health coverage from their government than from a private corporation, they should get to choose.

    That's how compromised the ACA really is... we started out asking for single payer and came up with something where there isn't even the option of using a public program. Yet its opponents have still spent 7 years trying to get rid of it and the media covering this guffaws that, "you can't take away an entitlement!"

    The ACA is good and worth defending but it is amazing to me how we have spent 7 years battling for something that is really not a big deal. It's a requirement that people either get health insurance through work or buy it. That's what it is. It's effective but it's not radical, not socialism, and is in many ways a subsidy to for-profit businesses.

    But they've spent seven years fighting it and I am under no illusion that they're done.  The ACA really should have been an entitlement. There should have been some sort of high priced give-away to everyone.  Then it really would have been something Republicans wouldn't dream of tearing down. In the end, the ACA may be vulnerable because it doesn't give enough so that people will support it.

    Whenever Democrats get into power and want to do something nice for people, they need to go big or risk having their deeds undone. Forget a "better deal," we need a "bigger deal."



    what strikes me right away when you say this

    just what a paltry entitlement the ACA is for most people.

    I think: but it really is quite expensive, all of those subsidies are expensive for all taxpayers and we aren't getting that good of a deal for our money.

    This is actually what has to eventually sink in with everyone, including the left, for us to move on to a better system. All this defense of Obamacare that's been forced on us by the GOP nuts is actually detrimental in a way. But I guess from history that this is what has to happen to reform health care in this country: two steps forward, one step back, rinse and repeat many times. It's complicated. cheeky

    And maybe add a paraphrase of a quote from another crazy: people can't handle the truth, not all at once. Medicare itself gonna have some crises a ways down the road once all boomers stop paying into and start demanding the absolute best in care and the millenials gotta pay for it....

    I think you're right that being forced to defend Obamacare as it is has been bad for us.  We're not thinking about how to make things better, we're just playing defense.  The subsidies are expensive and the people I've spoken to who have purchased coverage off the exchanges have all complained about their out of pocket costs, usually both in terms of their post-subsidy premiums and because of very high deductibles.

    On your deductible/copay costs points, it's just this simple: people on Bronze plans, which most lower income are, have to come up with $6,700 per year before they are fully covered. That means if they have a serious illness, they have to come up with $6,700 while being treated.

    Edit to add: it's not like vanilla Medicare without a supplemental isn't a big stretch for lower income with serious illness either, that's why nearly everyone on it has a supplemental, sometimes taking over complete control, like an HMO. So the for-profit insurance industry has basically become an integral part of Medicare.

    Great post, nothing to add

    This is just my take on McCain

    First he feels obliged to represent Arizona.

    Second he feels obliged to represent ?

    the GOP; right or wrong.

    Third he feels obliged to represent the Pentagon?

    Fourth he feels obliged to represent US Citizens?

    And where is Lindsey in all of this; His favorite Bro?

    So I figured that McCain figures he aint runnin for anything ever again.

    Lindsey probably is and SC constituents hate anything with Obama's name on it. hahahah

    And they probably spoke intimately and since McCain was going to be the last vote sending this stupid bill to Hades....Lindsey was free to vote fraudulently



    FUCK EM. 

    In this case, McCain found a great way to play "pull my finger" with 49 Senators and the Prez/VP. Trump got his pithy insulting remarks in, McCain got in a sucker punch. Glad it worked out good for us.



    I hereby render unto Peracles the Dayly Line of the Day Award for this here Dagblog Site, given to all of Peracles from all of me.



    Just for the record, what mind bending substances do you ingest? hahhhaah

    Lattes by the gallon-full like any good liberal?

    I disagree that the ACA is not a big deal. It saves lives. Like my daughter's as I discussed elsewhere.There's no bigger deal than that.


    Not trying to make light of it, Flavius.  It's good and worth defending.  But it's time to move it forward.

    The democrats' new policy platform is encouraging. Schumer has been floating the idea of Medicare buy in for those over 55 as a compromise between the status quo and single-payer. That would help save money for Obamacare and be an easy sell. And a more plausible testing ground for /pathway to single payer.

    I was against Obamacare way back when because I saw it failing long-term to move the debate in a progressive direction. It was setting a precedent for two things: subsidies for for-profite corporations* on the one hand, and the moral imperative of universal health care coverage on the other. I saw the first taking hold and the latter falling to the wayside as costs spiraled out of control and subsidies started to be difficult to finance. It's starting to look like I was wrong, but it was a close call. A more competent GOP would have passed a repeal bill or hobbled Obamacare and condemned it to a slow death. 

    At least the rhetoric on the Democrats' side is moving in the right direction. If we begin to hear the likes of Booker, Feinstein and Harris endorsing this kind of talk, then maybe there is room for optimism. 

    *Edit to add: This point stuck out for me, because a fundamental part of the Swiss system, which resembles Obamacare in many ways, is that insurance companies are not allowed to make a profit on the basic mandated health care policies. They participate anyway because, participating in the Obamacare style individual markets here is a prerequisite for offering complementary health care policies for extra coverage, and on these plans they are allowed to make a profit. 

    Schumer has been floating the idea of Medicare buy in for those over 55 as a compromise between the status quo and single-payer

    I am in this group and I truly believe that it is smart in another way: that for-profit Insurers would support this because they'd really prefer we were out of the pool! We skew everything as we start having the bodies-falling- apart problems.

    Problems for which money-driven medicine is coming up expensive "solutions" for hand-over-fist (many of which may cause iatrogenic illness and therefore end up costing even more, but that's a whole 'nother thing.) They've got to spend a lot of time and labor now challenging stuff doctors prescribe for this group, wildly expensive new drugs and procedures (that a for-profit company has advertised on TV that boomers should "ask your doctor about" and salesmen have touted to them.) Medicare is the king at handling this, I believe they'd rather have Medicare handle this, take on the risk of approving or not, it is already the king of the rules of what gets covered and what doesn't. If Medicare feels that a new drug is truly offers something that old ones don't, it has the power to say: yeah, okay, we'll put it in the approved formularly for this diagnosis code or that one, but we ain't gonna pay $400 a month for it!

    For-profit insurers would rather sell supplemental, as they do with Medicare age now, same as the Swiss system you describe.Taking out this age group would leave them with a much healthier pool to which they can push preventive care to keep healthy. Which is the principal behind Obamacare Romneycare after all, that they should profit if they keep people healthy. (Libertarians like me aren't exactly fans of the nanny state aspects of this, but then that's life with insurance, neither do car insurers like it when you prefer to live fast and get lots of speeding tickets. Just because you get lots of speeding tickets doesn't necessarily mean you are going to have lots of accidents, you may be a skilled race car driver, but underwriters aren't into the individualism game.)

    Perhaps I'm senile, but didn't we pitch this Medicare buyin 10, 20 years ago? Everything looks like a re-run. Even Trump, think I saw the Borgias series on PBS or maybe it was Caligula with orange-haired Malcolm McDowell...

    We can't get there from here. Given Citizens United at best it will be decades before we have any prospect of 60 seats.

    So ,sadly, we're stuck with the need to act strategically. 

    Obama got us in the ball park. The son of Obamacare  of course has to be  better for our voters , but only to the extent consistent with recruiting at least some Republican support. Ideally enough  to get us to 60 but in any rate  more. . 

    Operate at that level while proving ourselves to this larger audience. Then go for it.

    "God sees the truth. But waits".

     A. Chekhov   

    Flavius, political fortunes can turn faster than you think. At the dawn of the Progressive Era in 1909, Republicans dominated the Senate (59-32), House (219-171), White House (Taft), and the courts--as they had for decades. Corporations controlled the political machines that elected the politicians, and the progressive ideas seemed like pipe dreams.

    But by 1913, the situation was reversed. Democrats controlled the Senate (49-42), House (291-134), and the White House (Wilson). The next eights years saw one of the biggest bursts of progressive legislation in U.S. history, not just laws but also 4 constitutional amendments. (OK, one was prohibition, but the others were huge: one to create an income tax, one to elect senators by popular vote, and one to let women vote.)

    How did this happen? Not through strategic action. The early attempts under Theodore Roosevelt to pass mealy compromise measures with conservative obstructionists achieved little of significance. What turned the tide were hard, seemingly hopeless campaigns for big ideas. I give you this quote from Fighting Bob La Follette, one of the pioneers of the progressive movement:

    “In legislation no bread is often better than half a loaf...Half a loaf, as a rule, dulls the appetite, and destroys the keenness of interest in attaining the full loaf.”

    La Follette harnessed the growing frustration of voters to get rid of the obstructionists, allowing progressive legislators to pass historic "full loaf" bills that we still depend on today.

    My problem is aside from "easy affordable healthcare", I find many of these "full loaf" ideas a bit wanting. The "minimum income" is more compelling to me than the $15 minimum wage argument (what if you're unemployed and unemployable? or simply not worth $15 an hour however hard you try?). And I don't get how most people are preparing philosophically/economically for our future.

    Perhaps so, but that's a different question--a better one. If we stop pushing aside ideas that today's Congress won't pass, we can have a productive debate about what the right solution should be. That said, I don't think minimum wage and minimum income are mutually exclusive. In fact, they complement each other.

    We've spent 9 years passing and defending Obamacare even though it was always a redhaired stepchild from what we thought we needed - not quite affordable, still not quite universal, even though 1000x better than anything the GOP offered.

    How's minimum wage if you need minimum income? @that point someone's going to complain.

    "It's jam tomorrow and jam yesterday but never jam today".

    In many cases, sure. Make a tough minded trade off for more jam tomorrow.

    Health care is a very special case,  Kenneth Arrow's basic 1963 argument . One way its special is that  your wait for the full loaf may last forever.  Because you die first. Unnecessarily



    It's a tough call, of course, but I think Mike's right. A public option should have been a non-negotiable part of the plan. Instead it became a bargaining chip for negotiations with the insurance industry.

    Maiello... Good points... And about Single Payer?

    Now here's what Single Payer/Improved Medicare for All would entail.

    There is little debate that Representative John Conyers’s Medicare-for-All bill here would be a very heavily lift to properly introduce and implement.

    Note the date. I posted this quite awhile back here at Dag.

    - - - - - - - -

    By oldenGoldenDecoy on Sat, 11/02/2013 - 9:32pm

    Under a Single-Payer System Would People Be Buying Government Health Insurance Policies?

    Howdy Daggers... How're you all doing . . .

    It's been quite awhile since I dropped a post here at Dag, two months to be exact. I've been busy helping people (in 3D) navigate the real world of the ObamaCare sign up process here in California.

    Now about buying government health insurance under single-payer. What caught my attention was a small point that I mildly disagree with that Michael posted earlier today at 12:22 pm in the thread of his well written "Dear angry American..." post. Here is the sentence.

    "How is single-payer, which would require people to buy government health insurance, less excessive than ACA, which requires people to buy private health insurance."

    Simply stated, the main point I'd like to make is this. Under a single-payer system people don't buy government health insurance, per se. The government pays the costs directly to a person's health services provider. There are no middle-man private health insurance companies.

    Being that I'm in my 60s [I'm now 70] I may never see it in my lifetime, but eventually we won't be able to afford NOT to implement the following.

    To help fully understand what the single-payer system is, the following info is quite helpful. Take the time and immerse yourselves in the nuts and bolts sections of... [The following is the original session of Congress when first introduced.]

    H.R.676 - Expanded & Improved Medicare For All Act 113th Congress (2013-2014)


    Make sure you at least take notice of:


    Sec. 101. Eligibility and registration.
    Sec. 102. Benefits and portability.
    Sec. 103. Qualification of participating providers.
    Sec. 104. Prohibition against duplicating coverage.

    And the following is a quick overview from GovTrack:

    Introduced in House (02/13/2013) [And it has been reintroduced every session since then.]

    Expanded & Improved Medicare for All Act - Establishes the Medicare for All Program to provide all individuals residing in the United States and U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care.

    Prohibits an institution from participating unless it is a public or nonprofit institution. Allows nonprofit health maintenance organizations (HMOs) that deliver care in their own facilities to participate.

    Gives patients the freedom to choose from participating physicians and institutions.

    Prohibits a private health insurer from selling health insurance coverage that duplicates the benefits provided under this Act. Allows such insurers to sell benefits that are not medically necessary, such as cosmetic surgery benefits.

    Sets forth methods to pay institutional providers of care and health professionals for services. Prohibits financial incentives between HMOs and physicians based on utilization.

    Establishes the Medicare for All Trust Fund to finance the Program with amounts deposited: (1) from existing sources of government revenues for health care, (2) by increasing personal income taxes on the top 5% income earners, (3) by instituting a modest and progressive excise tax on payroll and self-employment income, (4) by instituting a modest tax on unearned income, and (5) by instituting a small tax on stock and bond transactions. Transfers and appropriates to carry out this Act amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).

    Requires the Medicare for All Program to give first priority in retraining and job placement and employment transition benefits to individuals whose jobs are eliminated due to reduced administration.

    Requires creation of a confidential electronic patient record system.

    Establishes a National Board of Universal Quality and Access to provide advice on quality, access, and affordability.

    Requires the eventual integration of the Indian Health Service into the Program, and an evaluation of the continued independence of Department of Veterans Affairs (VA) health programs.

    Like I said earlier, being that I'm in my 60s [I'm now 70] I may never see it in my lifetime, but eventually we won't be able to afford NOT to do it.

    Everyone have a good weekend.



    I found this very short interview extremely helpful as regards everything going on with this. Especially on what Trump thinks. He met with Trump personally on it 3 times,and with Trump aides many times, and with many Dems.

    The Future of Obamacare: Zeke Emanuel, an architect of the ACA, has some thoughts.

    @, July 28
    He's clearly not panicking, rather, he's " nothing if not optimistic" including about the Congressional GOP, that they will now come around to acting responsibly on the ACA.

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