If you want health-care reform to cost the U.S. government less than the status quo, that requires less money to go out the door to pay for other people’s health care and/or health insurance. This means someone else has to pay more, or someone else has to pay for their care or insurance entirely by themselves.
This is the core conflict of all health-care debates.
.. Everybody screaming “Medicaid for all!” basically means, “I don’t want to pay anything for my health care.” They think of themselves as being generous.
.. “found no evidence that Medicaid caused new enrollees to substitute office visits for [emergency room] visits; if anything, Medicaid made them more likely to use both.”
.. In 2010, when the Affordable Care Act was passed, CBO estimated that 21 million people would enroll in the ACA exchanges in 2016. The actual number was closer to 10 million. Even now, CBO believes that 18 to 19 million people will soon be enrolled in the exchanges, when in fact enrollment is degrading under current law, and will likely end up stabilizing at about 10 to 11 million.
Decision Time Approaches for Republicans on Replacing Obamacare
A lot of conservatives want to get rid of the Medicaid expansion enacted under Obamacare. If you’re in a state that hasn’t expanded Medicaid, then to be covered you have to be at or under the poverty level. For a family of four, that’s $24,300 or less. If you’re in a state that did expand Medicaid, you qualify if your family of four gets by on $33,534 or less. Right now, 10 million to 11 million people are covered under Medicaid who wouldn’t be covered under the old rules. I’d bet a healthy chunk of those folks voted for Trump.
.. But right now, too many markets don’t have plans that most consumers consider anywhere near “affordable.” (It’s fair to argue whether people have a realistic definition of “affordable” when it comes to on-demand access to the miracles of modern medicine.) The conservative philosophy has argued, correctly, that competition brings prices down. The problem is that in a lot of places, there isn’t much competition at all. In 2016, 85 percent of people using the marketplace on Healthcare.gov had at least three insurers to choose from in their area. This year, it’s down to 57 percent. Even if you believe competition will bring prices down, that rarely happens overnight.
.. He said that Aetna’s heaviest utilizers of health care — the top 1 percent to 5 percent — are driving half of the costs in the exchanges.
.. Even worse, whenever a legislator has the courage to tell the public that trade-offs and compromises are necessary, a political challenger will insist that it is not, that it represents lawmakers being stupid, or spineless, or selling out.
.. In 2018, congressional challengers will declare that if elected, they will give you excellent coverage for all of your health care needs and lower premiums, co-pays, and deductibles, and a tax cut, and a pony. Because it is very easy to promise a better health-care system with no compromises and trade-offs; it is pretty much impossible to deliver it.
As President Trump is no doubt learning.
.. Michael Flynn, who was fired from his prominent White House job last month, has registered with the Justice Department as a foreign agent for $530,000 worth of lobbying work before Election Day that may have aided the Turkish government.
.. How do you “forget” that you did a half-million dollars’ worth of work for a foreign company?
Liberals Won the Argument on Healthcare
A 2016 study found the average percent of health insurance paid by employers is 83 percent for single coverage and 72 percent for family coverage. How do you design a plan where the party that’s covering 72 percent of the cost can be removed – the employee is fired, laid off, or quits – and the employee can maintain the coverage until they find a new employer?
.. Health savings accounts? They’re a terrific idea. But a lot of people don’t have good impulse control and don’t save money the way they should. They don’t save for retirement, they don’t save for their children’s college educations, and they don’t save for unexpected expenses.
For the past few weeks, I’ve been joking, “Republicans are set to replace Obamacare’s system of subsidies, where the government gives you money to help pay for health insurance, with a system of refundable tax credits, where instead, the government will give you money to help pay for health insurance.”
.. Klein concludes, “Liberals, in other words, have won the central philosophical argument, and Republicans are reduced to fighting over the mechanics.” He is right, but we shouldn’t be surprised, because the conservative argument is thoroughly unappealing. The liberal argument is “somebody else” should pay for your health care (meaning everyone through taxation). The conservative argument is that you should pay for your health care.
.. Trump’s new skepticism about brokering a deal with Moscow also suggests the rising influence of a new set of advisers who have taken a tougher stance on Russia, including Defense Secretary Jim Mattis and new national security adviser H.R. McMaster. During his first meeting with National Security Council staff, McMaster described Russia — as well as China — as a country that wants to upend the current world order
.. European officials have tailored their rhetoric to appeal to Trump’s business background, including emphasizing the risks of negotiating a bad deal, rather than more nuanced arguments, according to one Western diplomat. Given Trump’s “America First” mantra, foreign officials emphasize how U.S. standing in the world could be diminished by making concessions to Russia instead of focusing on the importance of the U.S. and Europe sticking together to counter Moscow.
Authoritarian: Based on what you do, not what you say
It’s not hard to find people who insist Trump is authoritarian because of the things he says. But authoritarians are not defined by the things they say; they’re defined by the things they do. The judicial branch already struck down Trump’s executive order on refugees. Despite Trump’s hyperbolic denunciations of the media, America’s press remains as free and vibrant as ever. The first weeks of the new presidency have not been marked by a meek and obedient Congress but by one that can’t unify behind a single legislative agenda.