Saturday, November 12, 2016

Guaranteed Issue

Predictably, Donald Trump is starting to say silly things about repealing Obamacare.  (Okay, he didn't just start, but now we're paying closer attention.) As reported in the Wall Street Journal, he's willing to keep parts of the health care law.  In particular, he likes the stuff about pre-existing conditions, as well as extra years of coverage for (adult) children on parents' insurance policies.

Obamacare has several interlocking parts, some give, some take.  Overall, the whole thing is a mess that's far too intrusive, and has the effect of making health care worse for just about everyone in the long run (and for many in the short run).

But you can't keep the carrots and throw away the sticks.  "I've studied the 'Rob Peter To Pay Paul Act (While Keeping 10% For Ourselves)' and I must say I'm not crazy about robbing Peter, but I've talked to many Pauls and they seem to like the pay part, so we may keep that."

Trump says a big reason for his change of mind came from the White House meeting he just had with the President, who suggested some of the ACA be preserved.  So Trump now says "Either Obamacare will be amended, or repealed and replaced."

No, just repeal. I don't even like replace.  Before anything else, get rid of the law.  Bury it and salt the earth so it doesn't grow back.  Only after it's completely gone should we discuss what to do next.

Yes, I know the press will attack you, and seek interviews from people allegedly harmed by this.  But they'll attack no matter what.  And I've seen the numerous editorials now popping up saying it won't be easy to get rid of Obamacare.  Tell them "just watch." Rip it off like a bandage, and make it the first thing you do, because they want you to wait and "consider alternatives" and have the pressure grow against any real change.

I recognize that dealing with pre-existing conditions is maybe the trickiest thing about health care coverage, yet there are ways to address this--none of them are perfect, but it'll be a lot harder to get to them if Obamacare isn't dead and gone.

And by the way, Congress forced Obamacare on an unwilling public by doing an end-run around the filibuster, so Congress can repeal it in the same way if necessary.

PS  At the very least make sure to kill the mandate and any subsidies.  Then you'll make an unworkable law completely impossible.  That still won't be dead enough because it'll remain on the books, but maybe it'll set up a situation where someone can actually get rid of Obamacare after we've impeached you.


Anonymous Anonymous said...

So it will stay.

4:35 AM, November 12, 2016  
Anonymous Denver Guy said...

I still think someone should propose expanding the VA medical system to the poor. Build more Fed. Hospitals and clinics (refurbish the many vacant hospitals and clinics of the last decade or so) and directly provide health care at low cost to people who can't afford it. The construction would be an economic stimulus, and so much of the middleman costs of insurance would be cut out that the inherent inefficiency of government run programs would be counter-balanced.

7:53 AM, November 12, 2016  
Anonymous Lawrence King said...

I wonder what Hillary would have done, assuming he had Democratic majorities in Congress. Would she have tried for single-payer (a position she ridiculed Sanders for advocating)? Or would she have tried to "fix" Obamacare?

I suspect that President Hillary would have proceeded in two steps: (1) Decide what kind of government health care program was most desirable. (2) Enact that program, while insisting that it was a "slight tweak of Obamacare" -- regardless of how radical the change was.

If Trump had any loyalty to his voters, his tactic should have been the mirror image: (1) Decide what government health care regulations should exist. (2) Enact them, while insisting that he was "repealing and replacing Obamacare" -- regardless of whether large chunks of Obamacare remained part of the new law.

But he is doing the opposite. Preserving part of Obamacare may be good or awful policy: that's a complicated question, and you've made a good argument that a fresh start would be better. But publicly announcing that he is preserving part of Obamacare -- a massively unpopular program whose unpopularity helped him win the presidency -- is bad politics.

1:40 PM, November 12, 2016  
Blogger ColumbusGuy said...

Of course the dimwit Republicans have been saying this for years--"we'll keep the pre-existing coverage." Well then it's not fucking insurance, you nitwits.

And DG, how exactly do you do that without destroying insurance? You can't socialize halfway.

4:38 PM, November 12, 2016  
Anonymous Denver Guy said...

You make "Govcare" means tested. You can't get free or subsidized health care without evidence of poverty. And you can only get it at the designated Govcare hospitals and clinics. Most people will continue to have insurance, and choose private hospitals and medical groups, because frankly they will offer better care. Just like wealthier veterans often don't use VA hospitals.

the point is, it's a safety net, not a fruitless effort to absolutely equalize the level of care every single person in America gets. Efforts to equalize anything across a vast, highly diverse population nationwide inevitably results in equalization by lowering the bar for everyone (except the very rich who can afford to forego "free" services from the government.

9:30 PM, November 13, 2016  

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