There is a structural flaw in modern capitalism. Tremendous income gains are going to those in the top 20 percent, but prospects are diminishing for those in the middle and working classes. This gigantic trend widens inequality, exacerbates social segmentation, fuels distrust and led to Donald Trump.
Conservative intellectuals were slow to understanding the seriousness of this structural problem, but over the past few years they have begun to grapple with the consequences. Basically, many conservative intellectuals have come to terms with income redistribution.
.. Over the past several years many plans have emerged from the various right-leaning thinking tanks that imagine consumer-driven health care that also has universal or near universal coverage.
These plans, from places like the American Enterprise Institute, use tax credits or pre-funded health savings accounts or some other method to give middle- and working-class people coverage, while reducing regulations and improving incentives throughout the system.
.. First, conservative policy intellectuals tend to have accepted the fact that American society is coming apart and that measures need to be taken to assist the working class. Republican politicians show no awareness of this fact
.. The Senate health care plan would throw 15 million people off Medicaid, according to the Congressional Budget Office. (This is the program that covers nearly 40 percent of America’s children.)
.. The current Republican Party has iron, dogmatic rules about the role of government, but no vision about America.
.. Because Republicans have no governing vision, they can’t really replace the Obama vision with some alternative. They just accept the basic structure of Obamacare and cut it back some.
.. Because Republicans have no governing vision, they can’t argue for their plans. Health and Human Services Secretary Tom Price came to the Aspen Ideas Festival to make the case for the G.O.P. approach. It’s not that he had bad arguments; he had no arguments, no vision for the sort of health care system these bills would usher in. He filled his time by rising to a level of vapid generality that was utterly detached from the choices in the actual legislation.
.. Under the Senate bill, deductibles for poor families would be more than half of their annual income.
.. the atomistic mentality described by Alexis de Tocqueville long ago:
“They owe nothing to any man, they expect nothing from any man; they acquire the habit of always considering themselves as standing alone, and they are apt to imagine that their whole destiny is in their own hands. Thus not only does democracy make every man forget his ancestors, but it hides his descendants and separates his contemporaries from him; it throws him back forever upon himself alone and threatens in the end to confine him entirely within the solitude of his own heart.”
They’re not ‘losing’ insurance; they just won’t be forced to get policies they don’t want.
.. That’s not quite accurate. CBO doesn’t believe that millions will “lose” their insurance in 2018. Instead, the agency thinks that millions will happily cancel their coverage — even those who get it for free. The reason: The Senate bill would repeal the Obamacare tax penalty on the uninsured, known as the individual mandate.
The insurance company model drives up prices and fragments care. Rather than rejecting this jerry-built structure, the Democrats’ Obamacare legislation simply added a cracked support beam or two. The Republican bill will knock those out to focus on spackling other dilapidated parts of the system.
.. the leaders of the American Medical Association saw early health care models — union welfare funds, prepaid physician groups — as a threat. A.M.A. members sat on state licensing boards, so they could revoke the licenses of physicians who joined these “alternative” plans. A.M.A. officials likewise saw to it that recalcitrant physicians had their hospital admitting privileges rescinded.
.. President Harry Truman proposed a universal health care system, and archival evidence suggests that policy makers hoped to build the program around prepaid physician groups.
the process will lead to devastating results for millions of Americans who won’t know to speak up until after the damage is done.
.. potentially bringing lifetime limits back to employer-sponsored coverage, which could mean a death sentence for some chronically ill patients who exhaust their insurance benefits... Senate Republicans do not appear to be focused on carefully crafting policy that reflects a more conservative, free market attempt at achieving President Donald Trump’s goals of covering every American at lower cost... They’re focused on passing something, by whatever means necessary... “There were hundreds of hearings and markups that lasted days — or in the case of the Senate Health, Education, Labor and Pensions Committee, months,” Rovner recalls in her piece... the bill had been amended to allow states to opt out of the requirement to charge people with preexisting conditions the same prices as healthy enrollees, a move that will almost certainly price some patients out of coverage... The White House has decided to deal with an unpopular bill by refusing to acknowledge the parts of it that the public doesn’t like. When asked in interviews about the expected loss in coverage or cuts to Medicaid, administration officials simply act as if they don’t exist.