It's high time that we push for a single-payer solution. People shouldn't have to worry about their health care coverage. It should be considered a "basic human right".
130
you ask:
what was the constant refrain of “repeal and replace” all about?
Short memory Krugman.
Timing is everything.
Don't you remember the news that came out just before the election that Obamacare premiums were going to double in some places like Arizona? Even if the party had no viable plan at that time it was guaranteed that they would pounce on that news for political advantage.
what was the constant refrain of “repeal and replace” all about?
Short memory Krugman.
Timing is everything.
Don't you remember the news that came out just before the election that Obamacare premiums were going to double in some places like Arizona? Even if the party had no viable plan at that time it was guaranteed that they would pounce on that news for political advantage.
12
Dr. Krugman is just telling everyone about a "conservation law," another way of saying "no free lunch." It is hilariously depressing that people who call themselves "conservatives" engage in such bizarre "purple fairies riding pink unicorns are the solution" thinking ... on so many topics. Said mythical creatures being the way to get any free lunch you can imagine.
But in any discussion of American health care we do need to appreciate that we spend somewhere between 150% to 200+ % of what other G20 nations spend on healthcare, and by standard metrics deliver worse outcomes in the mean.
It's NOT "rocket science" to understand why this is so -- most of the American healthcare underperformance is due to those who are not served, or are underserved -- the failure to do simple routine things for them (that even nations like Cuba can afford to do for everybody!) result in disastrous statistical impacts, particularly on maternal/neo-natal/infant outcomes.
Lost in the anger and disfunction of the moment is that there are clear paths toward cutting the costs of the American health care system, AND increasing the quality, but these paths mean copying socialized medicine systems that are proven to work ... and apparently not only will hell have frozen over, but the Devil will be driving the Zamboni at half-time ... before the Republicans will think about that.
But in any discussion of American health care we do need to appreciate that we spend somewhere between 150% to 200+ % of what other G20 nations spend on healthcare, and by standard metrics deliver worse outcomes in the mean.
It's NOT "rocket science" to understand why this is so -- most of the American healthcare underperformance is due to those who are not served, or are underserved -- the failure to do simple routine things for them (that even nations like Cuba can afford to do for everybody!) result in disastrous statistical impacts, particularly on maternal/neo-natal/infant outcomes.
Lost in the anger and disfunction of the moment is that there are clear paths toward cutting the costs of the American health care system, AND increasing the quality, but these paths mean copying socialized medicine systems that are proven to work ... and apparently not only will hell have frozen over, but the Devil will be driving the Zamboni at half-time ... before the Republicans will think about that.
A lot of times it looks more like the Rs are trying to stuff a box into a balloon.
1
It looks as if most Americans would welcome single payer, and that would be the best solution. What I haven't seen yet is an analysis of how we would make the transition: winding down the complicated system we have now, avoiding a disruption in the market; dealing with unemployed insurance workers. Mr. Krugman, would you please address this issue?
In reading Paul Krugman's column today, I suddenly realized why the GOP and Donald Trump are so bent on "repeal and replace" - and the problem is one of their own making: They labeled it OBAMACARE in the hopes that when it failed, the disaster would carry his name down with it. Polls have shown that many people say they support the Affordable Care Act, but they don't like Obamacare without realizing they are one and the same. In trying to frame the Affordable Care Act negatively as Obamacare, the Republicans are now stuck with their name for a program that has brought the number of uninsured Americans to a record low while recognizing the man who helped accomplish that marvelous achievement. They are chocking on it because it is OBAMACARE!
81
Once there was a country called the United States of America,
a bastion of democracy and freedom for all.
She seems to be losing her way.
The city on the hill has shut its gates to the rest of the world
and that beacon of light that could be seen from around the world
is fading away.
a bastion of democracy and freedom for all.
She seems to be losing her way.
The city on the hill has shut its gates to the rest of the world
and that beacon of light that could be seen from around the world
is fading away.
The Republicans early on, accused Democrats, unjustly, of setting up "Death Panels". In fact, it was an effective diversion from the truth that the old ways of health insurance and the return to the Republican old ways ARE the real "Death Panels" that pick and choose healthy people and discriminate against unhealthy people.
68
This ignores a basic question the Republican leadership doesn't want considered: How do you keep the population angry at "big government" if you give them access to insurance that could literally be the difference between life and death?
They've sabotaged implementation, they've demonized the whole enterprise, they've wasted millions in taxpayer dollars on 60+ pointless, symbolic votes.
Of course they can't fix it. They've wanted it broken.
They've sabotaged implementation, they've demonized the whole enterprise, they've wasted millions in taxpayer dollars on 60+ pointless, symbolic votes.
Of course they can't fix it. They've wanted it broken.
89
How can that be? After all the President said the new health plan would reduce premiums and deductibles, and that "everyone would be covered".
40
I always believed that, if the Republicans were smart, they would repeal the ACA as soon as they gained control of Congress and the Presidency, and then immediately re-enact the ACA word-for-word the same day but rename it after the new Republican President (i.e., Trumpcare). It would have been the shrewdest political bait-and-switch in history. The Republican base never understood what was in the ACA in the first place, they only knew they didn't like the thing called Obamacare, and they would have celebrated the "repeal" and the renaming to Trumpcare. Everyone else would have sighed a breath of relief that the Republicans did the only real smart thing they could, given the hole they dug themselves. The fact that this didn't happen is a pretty strong indicator to me that there really aren't that many smart people left in the Republican party.
62
We'd hate to disrupt anyone's business model of controlling the market via monopoly. At stake here is sooo much money but of course no politician will go against their wealthy sponsors.
20
They waste not only money but time with these ridiculous attempts. And do any of them actually believe it themselves that they can come up with a plan? It seems less likely each day.
By now, the Republican healthcare "plan" is simple to stragle and/or starve Obamacare to death. They'll then be able to blame Dems and be left with no healthcare plan, both of which were probably their actual goals, conscious or not.
By now, the Republican healthcare "plan" is simple to stragle and/or starve Obamacare to death. They'll then be able to blame Dems and be left with no healthcare plan, both of which were probably their actual goals, conscious or not.
27
The answer to this GOP "self inflicted" conundrum is simple: single payer system period. but this is not the real issue here. The GOP has turned into something toxic for the American people. They really would like to hurt the folks in a horrible way, leaving them without any health care coverage at all. Instead they are trying to design a suit employing such a fashion that doesn't "look like" what they are really trying to achieve. This is why they call it cynically the " American Health insurance" when is reality is just a huge transfer of wealth from the folks to top rich people of this country. Deceivers, liars, thugs, un- American and traitors to the people's interest, government and constitution.
42
Mr. Krugman, there's a box or two that ballon will fit in. The Japanese have one. The Canadians have one. The Germans have one. the Swedes have one. The irish have one. The Italians have one. The South koreans have one. These boxes from all the different continents of Earth are called single payer systems. Senator Sanders proposed to the Democratic Party that they make one for us. You and this paper ran (and still run) nonsense editorials referring to those boxes as pie in the sky. You're 100% right about the stupid, cruel nature of the Republicans. Yet, you're wrong about those boxes.
53
Maybe Trump voters can eat cat food and grass soup, to pay for doctor bills. Yeah, I stopped worrying about them.
36
Single payer may be too civilized for those in control.
36
In other words, Bernie Sanders had/has it right.
37
Well it's obvious why Republicans can't come up with a "workable" plan that will deliver the same benefits to the same people that the PPACA has: Frank Luntz hasn't come up with the words to describe it yet.
15
At some point, when it's had enough, the balloon pops.
There is such a vast ideological divide between the Democrats and the Republicans, particularly with issues involving healthcare and how best to deliver it.
On one extreme, which I happen to agree with, you have a significant number of Democrats who believe that the only real solution to our healthcare problem is to make it "Single-payer, Medicare-for-all". They argue that it's time we join the rest of the civilized world by providing a universal solution that covers every living soul within our borders.
Hardline Republicans, on the other hand, are on the opposite side of the ideological spectrum. They take an entirely different view by embracing a sort of Darwinian approach that essentially defers to nature to sort everything out -- a "survival of the fittest" type of approach where it's up to each individual to secure the necessary healthcare coverage.
To my way of thinking, the Democrats have it right and the Republicans are still stuck in the past in some sort of romantic identification with the notion that we must all individually claw our way to the top of the pyramid scheme. They fail to recognize or accept the idea that modern society requires cooperation to achieve important social objectives...that we can't do it on our own given the complexity and hurdles involved.
It's high time that we push for a single-payer solution. People shouldn't have to worry about their health care coverage. It should be considered a "basic human right".
On one extreme, which I happen to agree with, you have a significant number of Democrats who believe that the only real solution to our healthcare problem is to make it "Single-payer, Medicare-for-all". They argue that it's time we join the rest of the civilized world by providing a universal solution that covers every living soul within our borders.
Hardline Republicans, on the other hand, are on the opposite side of the ideological spectrum. They take an entirely different view by embracing a sort of Darwinian approach that essentially defers to nature to sort everything out -- a "survival of the fittest" type of approach where it's up to each individual to secure the necessary healthcare coverage.
To my way of thinking, the Democrats have it right and the Republicans are still stuck in the past in some sort of romantic identification with the notion that we must all individually claw our way to the top of the pyramid scheme. They fail to recognize or accept the idea that modern society requires cooperation to achieve important social objectives...that we can't do it on our own given the complexity and hurdles involved.
It's high time that we push for a single-payer solution. People shouldn't have to worry about their health care coverage. It should be considered a "basic human right".
55
Insurance is a way of defending assets in the event of an unforeseen and unlikely event. Given actuarial study, it's possible for a community to defend its members who pay the premiums against the results of such events. But we're all going to get sick: an event not unforeseen, and the opposite of unlikely. Which is why France, UK and Canada, etc., have single payer systems. Private (read for-profit) insurance is not a viable way for a community to deal with its health care needs. It never was, and never will be. The health insurance crisis will endure for as long as health insurance as we know it exists.
52
Health care is meant to help the unhealthy.
The Republicans are discriminating against the unhealthy as their ideas are presented. The same holds true for the system of private insurance that picks and chooses between healthy and unhealthy people.
Anyone would have an easy time proving discrimination based on health characteristics such as girth or pre-existing conditions.
The old an Republican systems are discriminatory while Obamacare sought to make everyone equal, as it should be.
The Republicans are discriminating against the unhealthy as their ideas are presented. The same holds true for the system of private insurance that picks and chooses between healthy and unhealthy people.
Anyone would have an easy time proving discrimination based on health characteristics such as girth or pre-existing conditions.
The old an Republican systems are discriminatory while Obamacare sought to make everyone equal, as it should be.
21
There is one area of significant cost reduction that both parties seem loathe to tackle, and that is pharma. This elephant is so huge, so bloated, that at this point it will take a bipartisan phalanx to carry it out of the room.
Why this gold mine continues to remain untapped is beyond my comprehension. The subject isn't even raised any longer in discussions of cost-cutting. If you'll pardon one more metaphor, we are like a person dying of thirst in the desert by a beautiful shady oasis, crying, "Water! Someone please give me water!"
We most certainly can cut costs, dramatically, but not until we take on pharma.
Why this gold mine continues to remain untapped is beyond my comprehension. The subject isn't even raised any longer in discussions of cost-cutting. If you'll pardon one more metaphor, we are like a person dying of thirst in the desert by a beautiful shady oasis, crying, "Water! Someone please give me water!"
We most certainly can cut costs, dramatically, but not until we take on pharma.
35
Trump supporters will continue applauding him no matter what he does or doesn't do. In polls their opinion is that he is "exceeding expectations".
But it’s not about jobs. It’s not about health care. It’s not about education. What it IS about is racism, bigotry, sexism, and xenophobia. In short, it's all about keeping non-whites from entering America and making sure women 'know their place'. It’s real, and it’s not going away as long as this class of people draw breath. It’s no coincidence that Trump gathered a disproportional number of white males. They knew Trump couldn’t give them their jobs back. They knew he wouldn’t build a bridge. They knew he wouldn’t lower their health insurance premiums. What they DID know was that he was the first presidential candidate in decades that openly proclaimed that he would bring back an America where white males are the only ones that count. Where racist and sexist actions could be performed openly like badges of honor in a brotherhood of bigoted misogynists. And that’s what they truly want: a country run by a fellow "poorly educated" Archie Bunker just like them. And this social identity is more important than having a job, or affordable healthcare, or an education to advance themselves. Claiming themselves to be 'victims' is an easy out, an excuse to hide their lack of personal initiative.
Their “leader” shares their belief in White Supremacy as the ultimate achievement. And that's their real goal in life.
But it’s not about jobs. It’s not about health care. It’s not about education. What it IS about is racism, bigotry, sexism, and xenophobia. In short, it's all about keeping non-whites from entering America and making sure women 'know their place'. It’s real, and it’s not going away as long as this class of people draw breath. It’s no coincidence that Trump gathered a disproportional number of white males. They knew Trump couldn’t give them their jobs back. They knew he wouldn’t build a bridge. They knew he wouldn’t lower their health insurance premiums. What they DID know was that he was the first presidential candidate in decades that openly proclaimed that he would bring back an America where white males are the only ones that count. Where racist and sexist actions could be performed openly like badges of honor in a brotherhood of bigoted misogynists. And that’s what they truly want: a country run by a fellow "poorly educated" Archie Bunker just like them. And this social identity is more important than having a job, or affordable healthcare, or an education to advance themselves. Claiming themselves to be 'victims' is an easy out, an excuse to hide their lack of personal initiative.
Their “leader” shares their belief in White Supremacy as the ultimate achievement. And that's their real goal in life.
27
""it has in fact been much more successful at containing costs than even its proponents expected.""
[citation needed]
I'm sure Krugs will whip out claims about 'premium growth' while ignoring deductible inflation.
The fact is that under the ACA, millions of people are forced to buy insurance they can't afford to actually use because of those far-higher deductibles.
People like PK pretend this is some great accomplishment because premiums for the unusable insurance aren't growing quite as fast as when that same citizen was actually choosing their coverage/cost needs themselves.
Merely having insurance coverage is no great accomplishment of public-policy when all it serves to do is shuffle people's money around while providing no more-affordable/more-accessible care than was available previously.
The ACA is a failure that does little more than dress up a vast expansion of Medicaid in an overly complex and ineffective package. If Democrats were honest they'd admit that, and the GOP would (and will) probably end up making the Medicaid expansion permanent, while getting rid of the regulatory nightmare that hurts everyone else. But instead all they want to do is play politics and blame each other for the gigantic mess they've both created.
[citation needed]
I'm sure Krugs will whip out claims about 'premium growth' while ignoring deductible inflation.
The fact is that under the ACA, millions of people are forced to buy insurance they can't afford to actually use because of those far-higher deductibles.
People like PK pretend this is some great accomplishment because premiums for the unusable insurance aren't growing quite as fast as when that same citizen was actually choosing their coverage/cost needs themselves.
Merely having insurance coverage is no great accomplishment of public-policy when all it serves to do is shuffle people's money around while providing no more-affordable/more-accessible care than was available previously.
The ACA is a failure that does little more than dress up a vast expansion of Medicaid in an overly complex and ineffective package. If Democrats were honest they'd admit that, and the GOP would (and will) probably end up making the Medicaid expansion permanent, while getting rid of the regulatory nightmare that hurts everyone else. But instead all they want to do is play politics and blame each other for the gigantic mess they've both created.
8
Why is our "balloon" twice the per capita cost of those of other advanced countries? Our health care is being held hostage to the greed of hospitals, drug companies and highest compensation of health care providers in the world, and for this we have a heath care system that is almost as good as that of other countries.
9
Republicans are not trying to make health care work, they're trying to make it fail. That's number one. They want to undermine confidence in government provision of health insurance. Their health care plans are meretricious.
13
Republicans have no desire to improve our access to health care, never have, and are unlikely to in the future.
Every other industrialized society has some form of Universal Health Care. We could by expanding Medicare to include all.
What are the odds of Republican indorsing this? 1000 to 0?
Every other industrialized society has some form of Universal Health Care. We could by expanding Medicare to include all.
What are the odds of Republican indorsing this? 1000 to 0?
11
One more thing. Not having universal healthcare kills entrepreneur-ism. we are the only country in the world where people have to work for health insurance instead of opening their own business or being consultants. A female doctor friend of mine works 3 days at a hospital and 3 days at her private practice. She loves being her own boss and would love to expand but can't because she would not be able to get health insurance that was worth any thing since her and her husband are around 60. The hospital currently provides her insurance. She jokes, "I could legally kill my husband anytime I want, all I would have to do is quit my job at Beaumont Hospital."
14
Your one anecdote does not a fact make. The medium sized business that I have worked at for nearly 40 years has endured losses that easily top half a million dollars over that time as a result of high turnover. The government does enough to hinder businesses. They shouldn't ease employee movement too.
2
It is important for unbiased observers never to forget that the Republican party has now became a class-warfare party fighting against the poorer 65% of the whole nation--a political organization now officially dedicated to blind greed, constant shameless lying, and an irresponsible lack of real patriotism. We can't continue to be sentimental about this sad fact. The Roberts Supreme Court, the Ryan House of Representatives and the Trump Excecutive fit the definition of neo-fascisn to a tee.. That's what the party of Eisenhower, Earl Warren, and Lincoln has become in 2017.
23
Our problem?
It's the republicans, stupid.
It's the republicans, stupid.
12
I like the physics metaphor, Dr. Krugman. You could have continued with it: the only way to make said balloon fit in the box is to change the temperature of the air inside by making it much colder (read: unfeeling) and, therefore, less dense (read: substantive). Then it will fit.
Only to potentially pop when the heat generated from the ire of all the victims of this ridiculous effort expands it rapidly.
Nope; still doesn't work. Insanity. Cruel insanity.
Only to potentially pop when the heat generated from the ire of all the victims of this ridiculous effort expands it rapidly.
Nope; still doesn't work. Insanity. Cruel insanity.
17
Fact: 70% of all medical treatment in Canada is paid by the government.
Fact: Everyone there has insurance that covers everything except prescriptions, dental, and vision.
Fact: 67% of all medical treatment in the US is paid by our government.
Fact: 15% have no insurance while another 35% our under-insured which is worse because it means you are getting ripped off by a private insurance company.
People in Canada usually receive there Prescription, Dental, and Vision thru their employer. They have to accept it and it is taken from there pay. Similar to here but the insurance is cheaper due to regulations of private insurers. $170 per month(approximately) for a family. If both Husband and wife work only one has to pay for a plan. If they don't have a job or are privately employed they can by Prescriptions, dental, and vision for about $170 a month for a FAMILY. Again this insurance has no deductibles. Bottom line is the private insurance companies in the United States are an unnecessary middle man with a license to steal. We need to expand Medicaid(name it something else if it makes people feel better) and eliminate the private insurance companies from having ANY say as to what is covered and how much it costs. They would still be around but only to process claims as they do now for Medicaid and Medicare which is about 20% of their business. That is something they could do cheaper than government employees since they would pay them minimum wage and would pay them minimum wage
Fact: Everyone there has insurance that covers everything except prescriptions, dental, and vision.
Fact: 67% of all medical treatment in the US is paid by our government.
Fact: 15% have no insurance while another 35% our under-insured which is worse because it means you are getting ripped off by a private insurance company.
People in Canada usually receive there Prescription, Dental, and Vision thru their employer. They have to accept it and it is taken from there pay. Similar to here but the insurance is cheaper due to regulations of private insurers. $170 per month(approximately) for a family. If both Husband and wife work only one has to pay for a plan. If they don't have a job or are privately employed they can by Prescriptions, dental, and vision for about $170 a month for a FAMILY. Again this insurance has no deductibles. Bottom line is the private insurance companies in the United States are an unnecessary middle man with a license to steal. We need to expand Medicaid(name it something else if it makes people feel better) and eliminate the private insurance companies from having ANY say as to what is covered and how much it costs. They would still be around but only to process claims as they do now for Medicaid and Medicare which is about 20% of their business. That is something they could do cheaper than government employees since they would pay them minimum wage and would pay them minimum wage
18
Evangelical miraculous capitalism in action. It is the unofficial state religion of the United States and until we unbelievers admit that its adherents have a deeply felt belief system and world view, and not a rational analytical system, we will make no progress. Dr Krugman's bringing a slide rule to a revival meeting reminds me of Ms. Clinton's bringing a casserole to a gun fight. We might not want to take a hard look at what makes most people in this country tick, but until we do things will not improve.
12
The US badly needs to flush the conceit that it is "under God".
8
Republicans are the little kid who is trying all too hard to hide his chocolate smeared fingers behind his back while claiming he didnt raid the cookie jar.
Just fess up and work with democrats to improve Obamacare.
Just fess up and work with democrats to improve Obamacare.
12
So if you keep pushing on that balloon without adjustments it will pop in your face leaving you with only the shriveled memory of a balloon.
The at least partial success of Obamacare has pushed Republicans into a corner that demands they give us a better plan. As others have said Medicare for all is the best option, but that plan will need to upgrade its payments and demand that some providers take less something that doctors with their powerful lobby will never do.
Reverting to our old system of allowing health care insurance companies to set up their death panels will only show us how miserable our system was pre ACA. the only real solution is government regulated programs which are allowed to bargain with providers to obtain bulk rates. if the government provides basic insurance for all, insurance companies can fight over additional coverage policies as they do in the UK.
My UK trained nurse wife says the care in public hospitals in that country is better than private but that is another story.
The at least partial success of Obamacare has pushed Republicans into a corner that demands they give us a better plan. As others have said Medicare for all is the best option, but that plan will need to upgrade its payments and demand that some providers take less something that doctors with their powerful lobby will never do.
Reverting to our old system of allowing health care insurance companies to set up their death panels will only show us how miserable our system was pre ACA. the only real solution is government regulated programs which are allowed to bargain with providers to obtain bulk rates. if the government provides basic insurance for all, insurance companies can fight over additional coverage policies as they do in the UK.
My UK trained nurse wife says the care in public hospitals in that country is better than private but that is another story.
7
Professor Krugman expresses more eloquently and more specifically what I have been saying more succinctly: "There is no health plan out there that is more conservative and as effective as the ACA (aka Obamacare)." Obamacare is The Conservative healthcare plan, devised by the Heritage Foundation and implemented in Massachusetts by Mitt Romney.
There are more liberal plans, such as Hillarycare, public option or Medicare for all, but there is no more conservative plan.
There are more liberal plans, such as Hillarycare, public option or Medicare for all, but there is no more conservative plan.
21
The reality is that the ACA is actually a conservative approach to health care reform, a "market-based" alternative to "socialist" solutions like single-payer, promulgated by the Heritage Foundation and piloted by Mitt Romney.
Another reality is that Republican opposition to it is based entirely on two things. The first is that a Black Democratic president put it in place. The second and most important reason is that wealthy donors bitterly resent paying taxes that redistribute their entitled wealth to "takers." Thus, Republicans are duty-bound to destroy "Obamacare" because of partisanship, bigotry, and a longstanding commitment to be the Party of the Rich.
The right-wing propaganda apparatus spent 7 years incessantly spewing lies about the ACA. With the help of acquiescent Democrats who did nothing to refute the lies or sell the ACA's genuine benefits, the ACA officially became "socialist takeover of health care." As Republicans really have nothing to offer 99.9% of Americans, repealing the "disaster" became their key campaign pledge.
Now that they've won, they must deliver what they've promised. But reality is finally catching up with them, as there is no viable "replacement." They must choose between angering the "base" they've lied to for so long, or a voter backlash from millions of people losing their health care (some Republicans are eager for them to lose it). The box is between a rock and a hard place. The complete absence of leadership only makes it worse.
Another reality is that Republican opposition to it is based entirely on two things. The first is that a Black Democratic president put it in place. The second and most important reason is that wealthy donors bitterly resent paying taxes that redistribute their entitled wealth to "takers." Thus, Republicans are duty-bound to destroy "Obamacare" because of partisanship, bigotry, and a longstanding commitment to be the Party of the Rich.
The right-wing propaganda apparatus spent 7 years incessantly spewing lies about the ACA. With the help of acquiescent Democrats who did nothing to refute the lies or sell the ACA's genuine benefits, the ACA officially became "socialist takeover of health care." As Republicans really have nothing to offer 99.9% of Americans, repealing the "disaster" became their key campaign pledge.
Now that they've won, they must deliver what they've promised. But reality is finally catching up with them, as there is no viable "replacement." They must choose between angering the "base" they've lied to for so long, or a voter backlash from millions of people losing their health care (some Republicans are eager for them to lose it). The box is between a rock and a hard place. The complete absence of leadership only makes it worse.
20
The balloon metaphor is great. It works for the entire Trumpish Administration: The foreign policy fiasco, the refugee stupidity, The Kelly Homeland Security thing, and I can't wait for the budget and the tax reforms with out Trump's returns.
What this makes really easy to see for those who look, is that there is no going back. The entire thrust of evolution is to go forward.
Yes, the unconscious but very powerful few will try to impede it, derail it, manipulate it for their own gains. However, their recent gross and stupid efforts ( like today's initiating a "sweeping investigation into whether steel imports are harming America’s national security", but not doing anything about Russian meddling with the elections) have finally awakened the People to their insane presence. Their days are numbered. Actually, every tweet, every signing of an executive order is a new hole in the balloon of their existence.
What this makes really easy to see for those who look, is that there is no going back. The entire thrust of evolution is to go forward.
Yes, the unconscious but very powerful few will try to impede it, derail it, manipulate it for their own gains. However, their recent gross and stupid efforts ( like today's initiating a "sweeping investigation into whether steel imports are harming America’s national security", but not doing anything about Russian meddling with the elections) have finally awakened the People to their insane presence. Their days are numbered. Actually, every tweet, every signing of an executive order is a new hole in the balloon of their existence.
11
Mr. Krugman:
You fail to mention the elephant in the room, and it isn't the Republican Party. It's the health insurance industry, which is not the same as the health care industry. Basically, 98% of those who make their living from health insurance, selling it, administering it, being CEO's in it, are featherbedding. They are extraneous and unnecessary. Calculate the number of people employed by this industry--my own figure is 3/5 million--and their salaries in total, and divide that by the number of practicing physicians, nurses, technicians and I think you will find we could pay for the lion's share of healthcare by eliminating this industry and all its employees.
Who do you think you can get to vote for that?
You fail to mention the elephant in the room, and it isn't the Republican Party. It's the health insurance industry, which is not the same as the health care industry. Basically, 98% of those who make their living from health insurance, selling it, administering it, being CEO's in it, are featherbedding. They are extraneous and unnecessary. Calculate the number of people employed by this industry--my own figure is 3/5 million--and their salaries in total, and divide that by the number of practicing physicians, nurses, technicians and I think you will find we could pay for the lion's share of healthcare by eliminating this industry and all its employees.
Who do you think you can get to vote for that?
23
Then we have 3-5 million unemployed. Don't eliminate it. Just nationalize it. I'd like to see a health insurance CEO working on a public servant's salary.
8
Medicare enrollment already includes older and disabled Americans with an inclination to need health care and use it. If you opened up enrollment to younger and healthier Americans now paying private insurance "For Profit" companies, Medicare will benefit and enrollees as well from a very good cost controlling and preventive care inclined program. Make Government sponsored Medicare optional buy-in for everyone.
21
Republicans once again demonstrate the wisdom or not of trying to pound square pegs into round holes.
2
GOP plan (as they wish it to be): if you get really sick, you go broke first and then you die. Death panels brought to you by the "free market."
16
Yes, Donald is too ignorant to realize that something as pliable as a balloon--as with a goal pf providing Affordable Health Care to All Americans--it's not as simple as it seems. President Obama's Team, in accomplishing this complex feat was goal-based. Their whole mission was to do what was right--what was needed.
Donald Trump has displayed his complete ignorant in doing what was right--what is vitally needed. Trump's AHCA was totally based on screwing the average American, and shifting the proceeds of his scam toward Health Care Insurers and returning the Bush Tax Cuts to the uber-wealthy.
Trump's version of Health Care for All is, and was, a total scam. It was centered on him, and there is not one bit of understanding of how insurance can, and does, work. No insurance company would eve provide coverage for "Pre-Existing Conditions" to Americans--or anyone--who doesn't join the Risk Pool, until AFTER they are diagnosed with a major illness or disease!
https://thetruthoncommonsense.com
https://thetruthoncommonsense.com
Donald Trump has displayed his complete ignorant in doing what was right--what is vitally needed. Trump's AHCA was totally based on screwing the average American, and shifting the proceeds of his scam toward Health Care Insurers and returning the Bush Tax Cuts to the uber-wealthy.
Trump's version of Health Care for All is, and was, a total scam. It was centered on him, and there is not one bit of understanding of how insurance can, and does, work. No insurance company would eve provide coverage for "Pre-Existing Conditions" to Americans--or anyone--who doesn't join the Risk Pool, until AFTER they are diagnosed with a major illness or disease!
https://thetruthoncommonsense.com
https://thetruthoncommonsense.com
Excellent article. And amusing for such a grim topic. Like deadly -- serious.
Here's a plan that would cover everybody for everything. We need a NATIONAL health insurance commission or commissioner who could set the coverage and price for all the health insurance companies have to follow if they want to sell insurance in the U.S. The controlling majority in Congress of course is all about states rights, so this idea has the proverbial snowball's chance.
The state commissioners would hate this idea for a big chunk of their most politically sensitive work, where they can be heroes to many, is in health insurance. But, put this little caveat aside for a sec.
Let's admit that if you have stage one colon cancer in Terre Haute, Indiana or Brooklyn NY, you need access to the same range of treatment by competent doctors. Especially since stage one colon cancer is curable. State insurance regs will enter, and, if you're less than well off in Mike Pence's former realm, my fellow Hoosiers are screwed.
Summing up then, all private sector (warms the hearts of the pro-market crowd), national health insurance market, guaranteed coverage for everyone, and real competition among insurance companies for your bucks. Throw in the fact that the insurers could offer more benefits to say folks with kids, and you might choose Kid Friend Insurance. Or, bennies for folks getting on in years, like more rehab and wellness stuff. Real competition, ya know!
Here's a plan that would cover everybody for everything. We need a NATIONAL health insurance commission or commissioner who could set the coverage and price for all the health insurance companies have to follow if they want to sell insurance in the U.S. The controlling majority in Congress of course is all about states rights, so this idea has the proverbial snowball's chance.
The state commissioners would hate this idea for a big chunk of their most politically sensitive work, where they can be heroes to many, is in health insurance. But, put this little caveat aside for a sec.
Let's admit that if you have stage one colon cancer in Terre Haute, Indiana or Brooklyn NY, you need access to the same range of treatment by competent doctors. Especially since stage one colon cancer is curable. State insurance regs will enter, and, if you're less than well off in Mike Pence's former realm, my fellow Hoosiers are screwed.
Summing up then, all private sector (warms the hearts of the pro-market crowd), national health insurance market, guaranteed coverage for everyone, and real competition among insurance companies for your bucks. Throw in the fact that the insurers could offer more benefits to say folks with kids, and you might choose Kid Friend Insurance. Or, bennies for folks getting on in years, like more rehab and wellness stuff. Real competition, ya know!
For almost 40 years, since Reagan introduced the idea, a great swath of Americans and almost all republicans have this crazy notion that we can run this vast enterprise called the United States of America on the cheap. That somehow the money will come.....from heaven like manna?
They have refused to reinvest in infrastructure to keep this a world class Nation.
They have refused to tax those who have the means to be taxed relying instead on traffic tickets and fines.
They have been able to get away with this because of one issue voters on abortion and gay rights being reliable votes (against their own interests) for their party and because the Main Stream Press has refused to report on this vast inequality, resorting instead to reporting on opinions and talking points instead of facts and statistics.
We are one election away from becoming a full blown fascist Third World Nation, I just don't know if it is the election coming next year or the election we had last year.
They have refused to reinvest in infrastructure to keep this a world class Nation.
They have refused to tax those who have the means to be taxed relying instead on traffic tickets and fines.
They have been able to get away with this because of one issue voters on abortion and gay rights being reliable votes (against their own interests) for their party and because the Main Stream Press has refused to report on this vast inequality, resorting instead to reporting on opinions and talking points instead of facts and statistics.
We are one election away from becoming a full blown fascist Third World Nation, I just don't know if it is the election coming next year or the election we had last year.
You're Right ... It's Not Surprising
Back in November 2016, Nate Silver summarized the root cause of the Balloon, the Box, and the Boob phenomenon quite well ...
http://fivethirtyeight.com/features/education-not-income-predicted-who-w...
Then again, as Mark Twain so wisely mused, "Suppose you were an idiot, and suppose you were a member of Congress ... but I repeat myself."
Back in November 2016, Nate Silver summarized the root cause of the Balloon, the Box, and the Boob phenomenon quite well ...
http://fivethirtyeight.com/features/education-not-income-predicted-who-w...
Then again, as Mark Twain so wisely mused, "Suppose you were an idiot, and suppose you were a member of Congress ... but I repeat myself."
9
Paul's balloon analogy isn't quite right. The GOP isn't having trouble fitting heathcare into the box because they were too cheap and got too small a box. They're having trouble because their balloon is too full of hot air to fit into the box.
80
So, you're the minority party in Congress, and your biggest opponent sits in the White House. Together, they pass a massive law that they've been trying to push through for decades, but which contains several things you are deeply, ideologically opposed to. The law helps a lot of people and achieves most of its major goals, but due to the complexity of the law and the industry it regulates, there are also plenty of shortcomings.
So, do you work with your opponents to fix what's wrong and make the law work so that even more people benefit, even though you hate the law in the first place? Or do you adamantly oppose any and all efforts to fix the problems in the law, and instead allow these shortcomings to escalate so you can use them for political advantage, no matter who gets harmed in the process?
I'm pretty sure we all know the answer. Mitch, Paul & Co. are out for one thing: political advantage. Somewhere in their warped philosophy there may be some altruistic notion that if we just allow the unregulated market to function all by itself, then more people will eventually benefit (in spite of all evidence to the contrary), so they are willing to sacrifice people in the short term for some mythical long-term good.
But never was there a more appropriate application of Keynes' admonition, "But this long run is a misleading guide to current affairs. In the long run we are all dead."
So, do you work with your opponents to fix what's wrong and make the law work so that even more people benefit, even though you hate the law in the first place? Or do you adamantly oppose any and all efforts to fix the problems in the law, and instead allow these shortcomings to escalate so you can use them for political advantage, no matter who gets harmed in the process?
I'm pretty sure we all know the answer. Mitch, Paul & Co. are out for one thing: political advantage. Somewhere in their warped philosophy there may be some altruistic notion that if we just allow the unregulated market to function all by itself, then more people will eventually benefit (in spite of all evidence to the contrary), so they are willing to sacrifice people in the short term for some mythical long-term good.
But never was there a more appropriate application of Keynes' admonition, "But this long run is a misleading guide to current affairs. In the long run we are all dead."
9
The system as is is an insanely dysfunctional farce, clearly to the advantage of insurance companies that soak you for exorbinant premiums for worthless "coverage" and would rather you die than make a claim. The only thing worse would be the GOP "plan" that would strip millions of coverage and leave us dying in the streets. Where are the protests for single-payer and why are Americans such sheep?
8
we see the evidence each day...... they do not know how to legislate or govern. they control the government and they still can't do anything. the reason for this is that a whole government of full of politicians that ran against government and nothing else? never thought far enough to contemplate what would happen if they got complete control. we now live in a dictatorship. we are governed by tweet and executive order..... it will not end well.
6
What about medicare starting at age 55. That would solve a lot of problems....
6
A few years ago I heard an army wife being interviewed about the possibility of government health care i.e. ACA and she said that she hated the idea. When asked to explain she said that being an army wife she received government health care and sometimes she had to wait in line. You can't fix stupid.
I hope her hubby is still in the Army or running for office because if her elected demagogue gets his way she will also get her wish. No government health care or any other kind of health care. The silver lining will be that their will be no lines.
I hope her hubby is still in the Army or running for office because if her elected demagogue gets his way she will also get her wish. No government health care or any other kind of health care. The silver lining will be that their will be no lines.
7
Easy way to pass the legislation: just lie about the amount of air in the balloon, or the size of the box. For example:
"The balloon may look bigger now, but once we pass this law it will get much smaller because... hmmm... market forces! individual responsibility! declining health costs! extra revenue! magic! hey look, a squirrel ! "
You get the idea. Lying worked for the Bush tax cuts. Lying worked to get Trump elected. Why not continue using the strategy?
"The balloon may look bigger now, but once we pass this law it will get much smaller because... hmmm... market forces! individual responsibility! declining health costs! extra revenue! magic! hey look, a squirrel ! "
You get the idea. Lying worked for the Bush tax cuts. Lying worked to get Trump elected. Why not continue using the strategy?
4
Perhaps because of my age, back when such things were common, I see it, not as a balloon, but a square inner tube. It's shaped like a box, but it's got so much hot air in it, it's not gonna fit. Let the hot air out and it's still not going to work--because it's a square inner tube. It can't do what it's supposed to because it's designed not to do it. Ryan and his cronies don't want us to have good health care because they and their constituents would make more money repealing and shoving a square inner tube down our gullets. Pssssssssss. It's just hot air. Nope, still don't fit.
3
Another important point that Paul didn't mention is that the ideas for the ACA came from Massachusetts under Governor Romney. It is a Republican plan. No wonder they can't fit the balloon in the box.
5
A good start toward universal coverage would be allowing people of all ages to buy into Medicare in states where only one or two companies are willing to offer coverage.
7
If you really want a through experiment, see how many people would have medical coverage is all taxpayer supported medical coverage (that is, MedicAid, Medicare, every pensioner covered by retiree taxpayers, disabled, ad nauseam). Trump himself is sucking at the Medicare and Federal taxpayer medical teat, and will be for the rest of his life, and Ryan is just behind him (no Medicare yet).
The bottom line is that federal, state, and local taxpayers already support what is probably a majority of the population with medical coverage right now, just most "voters" don't seem to realize the fact. The theoretical leverage over cost is titanic; instead we the people are stuck in a quasi single payer inferno fed by wasted tax dollars presided over by greedy demons in Congress.
The bottom line is that federal, state, and local taxpayers already support what is probably a majority of the population with medical coverage right now, just most "voters" don't seem to realize the fact. The theoretical leverage over cost is titanic; instead we the people are stuck in a quasi single payer inferno fed by wasted tax dollars presided over by greedy demons in Congress.
4
Change the name of the law to the Trump Affordable Care Act. Take credit. Mission accomplished. Isn't that what a con man does?
3
Republicans lied for eight years and during that time the ACA took hold with the people who needed it and now want to keep it. Republicans continue to lie -- "it's a disaster!" and it will soon "collapse." Republicans do a very good job at lying -- the head of their party is an outstanding liar.
9
Air is pretty compressible. With sufficient effort and ingenuity, you can probably get the balloon into the box. Just sayin.
"it has in fact been much more successful at containing costs than even its proponents expected."
I literally spit coffee out of my nose laughing at Krugman's statement above. Is he lying here to make a silly point or is he indeed that ignorant?
I literally spit coffee out of my nose laughing at Krugman's statement above. Is he lying here to make a silly point or is he indeed that ignorant?
2
Where's your data if he's so ignorant?
7
Dr. Krugman and other knowledgeable folk: I have two questions. If we go to single-payer, or Medicare for all, does this mean that the wealthy will still receive the tax deduction that the Republicans are angling for? Discuss. And, second, if we take this option of Medicare for all, what do we do with the millions of people employed in the insurance industry? I think the medical/hospital employees will continue to be employed at the same rate; but, those in insurance? I would like to see reasonable answers and discussion.
1
I get why the Repubs oppose the public option -- it conflicts with their anti-big-government ideology (an ideology that's more important to them than the public interest). But Trump owes nothing to the Repub establishment and, further, sold himself as being a transactional candidate who just cared about getting things done. If Trump modified the public option to allow Medicare to pay providers at Medicare rates (unlike the public option back in 2009, which "would pay health care providers at negotiated rates, not at substantially lower Medicare rates"; see http://www.factcheck.org/2009/12/public-option-vs-single-payer/), the federal govt could offer the public the equivalent of current bronze, silver, and platinum plans at significantly reduced premiums.
At the same time, he could allow private insurers to sell across state lines. These could both be spun as market-based, since they increase competition. And to conservatives who complain it's unfair for the federal govt to compete with private insurers, say: "Here's your chance to prove private companies are more efficient."
This wouldn't just be a great win for the public; it would also serve Trump's selfish interests, since he'd get the three things he craves: winning (a legislative victory--he could probably get all the Dems on board, plus some Repub moderates); bragging (he could say he promised he'd reduce premiums, and he did); and popularity (the plan would be an improvement on the ACA).
At the same time, he could allow private insurers to sell across state lines. These could both be spun as market-based, since they increase competition. And to conservatives who complain it's unfair for the federal govt to compete with private insurers, say: "Here's your chance to prove private companies are more efficient."
This wouldn't just be a great win for the public; it would also serve Trump's selfish interests, since he'd get the three things he craves: winning (a legislative victory--he could probably get all the Dems on board, plus some Repub moderates); bragging (he could say he promised he'd reduce premiums, and he did); and popularity (the plan would be an improvement on the ACA).
4
The GOP are masters at slogans but total failures at accomplishments. They are naysayers, constant cynics, fear mongers, petulant dissidents, human impediments and self-serving con artists. Sad to see how so many citizens of the this country have become so disillusioned that they would support the party of no morals, no ideas and no direction.
9
Private health insurance adds 20% the the total cost of health. Malpractice suits add another 25% because of overtreatment and overdiagnosis.. Everyone wants and expects health care with no limits and insist on the best available rather than the most cost effective treatment. The US doe more organ transplants the the rest of the world combined at a cost of $100,000-10,000,000 which last about 5 years. Almost all kidney dialysis and nursing homes are paid by Medicaid and cost$100,000/year. There is corruption is hospitals and health companies ($1-20 million/year for CEOs), unnecessary helicopter rides ($10,000-100,000 each,) over pricing of medicines ($1000 for a $10 pill, $10 for an aspirin), itemized billing costs $5=10 per item., Radiology and lab have a 2-10 times cost/profit margin. $300,000 for a medical school means young doctors have to speciallze and overcharge, while other countries have free tuition and then their doctors immigrate here to get rich.
3
Geez, this is not rocket science. Health insurance would be affordable if the insurance companies were not for-profit entities. The insurance companies need to provide an adequate return to their investors or the investors will move their money to companies that will provide a better return on the investors' money. The return on investment has absolutely nothing to do with providing health care to their insured. The insurance companies achieve their goal by artificially raising their premiums higher than what would be necessary to actually provide health care to their insured. That, coupled with the unconscionable tens of millions of dollars paid to their executives, explains why health "insurance" in the US is in such an unsustainable crisis & needs to move to a single payer platform.
6
If we had a saner political culture, we would have Republicans arguing for a system like Obamacare and Democrats arguing for a single-payer system. It's sometimes forgotten that the ACA originated as a conservative approach. If the ACA is substantially dismantled, I think the Democrats should agree that when they regain power, they should implement a single-payer system. I would like to think that Republicans, seeing this potential outcome, would put some support behind the ACA and make it work better. But I don't think they have any interest in governing responsibly.
9
The real Republican plan all along is to try to trick the American people into accepting something that totally rips them off.
This is what the Republicans have been very good at since the days of Reagan.
This is a glimmer of hope. It appears that, for a change, the American people are refusing to fall for it.
They seem to realize that Paul Ryan and Mitch McConnell are not on their side.
Here's hoping that this is just the beginning.
This is what the Republicans have been very good at since the days of Reagan.
This is a glimmer of hope. It appears that, for a change, the American people are refusing to fall for it.
They seem to realize that Paul Ryan and Mitch McConnell are not on their side.
Here's hoping that this is just the beginning.
8
There is a great deal of banter, promises and analysis of the GOP healthcare effort going on.
But there are two things that will guarantee the failure of any policy they put forth. And by guarantee I mean guarantee...sure thing....it's a lock!
First, the GOP continues to view healthcare as a privilege and not a fundamental right for every citizen. Until they drop the "access" idea and insure that people have coverage worthy of the richest nation on earth, they are sure (or guaranteed) to fail.
Second, the GOP views and enacts all that they do thinking party before people. For decades they have put the wealthiest among us and the GOP before the interests of the people they are elected to serve.
As long as those two aspects remain in place there is zero chance of passing a policy that will actually help more people at a lower cost. No chance!
Til then Dems should continue to refuse to help with the destruction of the ACA.
Single Payer Now!
But there are two things that will guarantee the failure of any policy they put forth. And by guarantee I mean guarantee...sure thing....it's a lock!
First, the GOP continues to view healthcare as a privilege and not a fundamental right for every citizen. Until they drop the "access" idea and insure that people have coverage worthy of the richest nation on earth, they are sure (or guaranteed) to fail.
Second, the GOP views and enacts all that they do thinking party before people. For decades they have put the wealthiest among us and the GOP before the interests of the people they are elected to serve.
As long as those two aspects remain in place there is zero chance of passing a policy that will actually help more people at a lower cost. No chance!
Til then Dems should continue to refuse to help with the destruction of the ACA.
Single Payer Now!
8
How far away are we from day that the Koch Brothers puts a dollar amount on the table to repeal and not replace the ACA, elimination of inheritance taxes and elimination of
Corporate taxes?
All they really need is 215 votes. What can that really cost? How much do they need to pay so these guys don't care if they get reelected?
We are in full on kleptocracy mode
Corporate taxes?
All they really need is 215 votes. What can that really cost? How much do they need to pay so these guys don't care if they get reelected?
We are in full on kleptocracy mode
Paul's correct about the balloon in the box, but he mistakes the basic issue defeating the Ryan-McConnell machine.
They are not defeated by trying to provide healthcare without paying for it: putting healthcare in too small a box.
They are defeated by trying to take healthcare away while fooling.voters that they aren't taking it away. The struggle is over how to disguise deception, not over how to devise healthcare.
How to put a balloon full of hot air in the box, instead of boxing an actual plan.
They are not defeated by trying to provide healthcare without paying for it: putting healthcare in too small a box.
They are defeated by trying to take healthcare away while fooling.voters that they aren't taking it away. The struggle is over how to disguise deception, not over how to devise healthcare.
How to put a balloon full of hot air in the box, instead of boxing an actual plan.
The Republicans should get credit for being endlessly creative in trying one scam after another to convince voters, and health-care users, that cutting health care is somehow in their interest. It isn't, of course, but that sure hasn't stopped the Republicans from trying! They just hope that eventually voters will stop paying enough attention to whatever they can ram through and not notice its built-in problems.
4
An issue for getting people behind the public option: for a small but vocal minority it's single payer or nothing. It doesn't help when the single-payer-or-nothing crowd is led by Bernie Sanders. Voters who are wary (for whatever reason) of "socialism" aren't going to be swayed on healthcare by a Democratic socialist (Which is not a Democrat; Sen. Sanders confirmed he wasn't a Democrat in interviews this week). Can't someone like Joe Biden take the public lead on this vital topic?
And how can Sen. Sanders plug his universal healthcare proposal with a straight face when he campaigned yesterday for Omaha, Neb. mayoral candidate Heath Mello, a former Nebraska state senator. According to the Wall Street Journal, Mr. Mello "in 2009 sponsored legislation requiring women to look at ultrasound image of their fetus before receiving an abortion. At the time Mr. Mello called the proposal a 'positive first step' toward reducing the number of abortions in Nebraska. It became law months later. Eight years later Mr. Mello remains opposed to abortion..."
https://www.wsj.com/articles/democrats-reload-for-georgia-runoff-but-par...
Mr. Mello has a consistent history of voting against anything pro-choice yet Sen. Sanders refers to him in the article as a "progressive Democrat". Progressive for whom? (The Daily Kos withdrew its Mello endorsement.) Is this really the way to build a national Democratic farm team to pass healthcare for all - including women - someday?
And how can Sen. Sanders plug his universal healthcare proposal with a straight face when he campaigned yesterday for Omaha, Neb. mayoral candidate Heath Mello, a former Nebraska state senator. According to the Wall Street Journal, Mr. Mello "in 2009 sponsored legislation requiring women to look at ultrasound image of their fetus before receiving an abortion. At the time Mr. Mello called the proposal a 'positive first step' toward reducing the number of abortions in Nebraska. It became law months later. Eight years later Mr. Mello remains opposed to abortion..."
https://www.wsj.com/articles/democrats-reload-for-georgia-runoff-but-par...
Mr. Mello has a consistent history of voting against anything pro-choice yet Sen. Sanders refers to him in the article as a "progressive Democrat". Progressive for whom? (The Daily Kos withdrew its Mello endorsement.) Is this really the way to build a national Democratic farm team to pass healthcare for all - including women - someday?
6
Medicare for all makes the most sense. Medicare is not free, but the fees are modest and predictable. A master plan could be styled so that if you take care of your heath and don't use it, you are eligible for a partial rebate. That is one way to a healthier nation. Everyone wins.
5
"Americans will do the right thing...only after they've tried everything else."
(hint - the right thing is a Public Option).
(hint - the right thing is a Public Option).
4
There was only one thing wrong with the ACA from the beginning for Republicans: the color of the president in the White House at the time. Essentially the same package, as many pointed out, had been introduced by Mitt Romney in Massachusetts.
http://www.npr.org/sections/itsallpolitics/2015/10/23/451200436/mitt-rom...
But the ACA provided a rallying cry for the resentful who chose to believe the Birther slander, and who wanted to "take back their country" from the progressives, starting with the Tea Party. Trump threw them more red meat, attacking Hispanics, immigrants, and Muslims, reveling disgustingly in his Tweets after terrorist attacks, and bundling up prejudice and resentment into a newly acceptable badge of honor and membership in a supposedly liberating (but really reactionary) force to change America and the world.
http://www.npr.org/sections/itsallpolitics/2015/10/23/451200436/mitt-rom...
But the ACA provided a rallying cry for the resentful who chose to believe the Birther slander, and who wanted to "take back their country" from the progressives, starting with the Tea Party. Trump threw them more red meat, attacking Hispanics, immigrants, and Muslims, reveling disgustingly in his Tweets after terrorist attacks, and bundling up prejudice and resentment into a newly acceptable badge of honor and membership in a supposedly liberating (but really reactionary) force to change America and the world.
4
The Swiss had one answer: a law prohibiting profits from health insurance.
7
Wait, wait! Make government -- that blasted box you're talking about -- smaller! The balloon is freedom! Everyone wants that, and freedom will never get smaller, and never should! If we didn't have government, we wouldn't have a box frustrating all our market-based efforts at promoting the sweet balloon of freedom! Make government smaller then find me the bathtub! All will be well!
1
Mr. Krugman, did we see a subtle mention of single payer & Medicare for all in your piece?
Now we're making progress!
Now we're making progress!
4
Question to Republican voters: What have Republicans done in the last 30 years to try to EXPAND Health-care coverage for Americans? Make a list. In which direction are they making their efforts -- toward expanding it or reducing it?
2
Bottom line...The Republicans should recognize that Obamacare (Romneycare) was the Republican defense to Medicare for All and if they destroy Obamacare, they will get their worst nightmare, and perhaps our best answer, Medicare for All.
3
I've said this before, I'll say it again: As long as health insurance/care remains a for-profit commodity, there is no solution scenario in which someone does not get gouged. You simply cannot build a system that provides the level of profitability demanded by investors while providing services and products at a price that is universally affordable and the same for everyone, regardless of age, health, and income level. The absolute inelasticity of the necessity for health care --- there is no alternative, except non-treatment --- invites the kind of price inflation and periodic gouging we see, and demands a single payer system which, in Mr Krugman's analogy, is the definition of a bigger box.
The way you get the balloon to fit in the box is not to take air out of the balloon; that air in there represents not only the money being spent, but also the health care services being provided. The way you get it to fit is to make the box bigger.
The way you get the balloon to fit in the box is not to take air out of the balloon; that air in there represents not only the money being spent, but also the health care services being provided. The way you get it to fit is to make the box bigger.
3
The argument against a public option was that it would be unfair competition for the insurance companies. Now that the insurance companies are pulling out of some markets because they are losing money, there is a compelling rationale for a public option, at least in those states where a private market is not available. The perverse opposition is based on the fear that a public option would be successful and work for people and might ultimately expand across the country.
4
Single payer would:
cover every American.
save (conservatively) 1-2 trillion dollars annually (infrastructure anyone?)
end "medical bankruptcy"
result in a healthier population
reduce sick days
reduce the number of people on disability
end "employment for health coverage only"
give people the freedom to start their own businesses
make all businesses more competitive by lifting the burden of providing coverage
Is there anything here not to like?
Alas--this is a pipe dream. It will never happen--certainly not during my lifetime (age--66 y.o.)
Why will it never happen?
Let's be real and face it. It would wipe out a large, powerful industry with enormous power and influence--health insurers. If done properly it would deliver a severe blow to drug manufacturers as well. These entrenched players with their lobbyists and (Citizens United-enabled) campaign contributions will never allow it to happen. And they are supported by many who don't benefit by the current set-up thanks to propaganda which brands single-payer as "socialist".
Sad. Very, very sad.
cover every American.
save (conservatively) 1-2 trillion dollars annually (infrastructure anyone?)
end "medical bankruptcy"
result in a healthier population
reduce sick days
reduce the number of people on disability
end "employment for health coverage only"
give people the freedom to start their own businesses
make all businesses more competitive by lifting the burden of providing coverage
Is there anything here not to like?
Alas--this is a pipe dream. It will never happen--certainly not during my lifetime (age--66 y.o.)
Why will it never happen?
Let's be real and face it. It would wipe out a large, powerful industry with enormous power and influence--health insurers. If done properly it would deliver a severe blow to drug manufacturers as well. These entrenched players with their lobbyists and (Citizens United-enabled) campaign contributions will never allow it to happen. And they are supported by many who don't benefit by the current set-up thanks to propaganda which brands single-payer as "socialist".
Sad. Very, very sad.
13
Pure ignorance, bigotry, stupidity and fear put the Republican Party and Donald Trump in power, and it was all about having had a Black man in the White House and the possibility of having a woman to replace him, end of story.
All other issues facing this country are superfluous, and a detraction. The White men and women of this country refuse to admit that other races and cultures exit, and that they are living here as lawful, taxpaying citizens.
These bigoted haters can't get past their "whiteness". They mistakenly think that they are the chosen people, the keepers of the flame of righteousness and superiority.
Between their xenophobia and hatred and obnoxious hypocritical religious beliefs, they are a plague on this country. Their god is the only god, and all others are wrong and must go.
Until this country and its current government comes around to civility and acceptance of others, nothing will be done or accomplished for the common good. Stop the hatred and progress will follow.
All other issues facing this country are superfluous, and a detraction. The White men and women of this country refuse to admit that other races and cultures exit, and that they are living here as lawful, taxpaying citizens.
These bigoted haters can't get past their "whiteness". They mistakenly think that they are the chosen people, the keepers of the flame of righteousness and superiority.
Between their xenophobia and hatred and obnoxious hypocritical religious beliefs, they are a plague on this country. Their god is the only god, and all others are wrong and must go.
Until this country and its current government comes around to civility and acceptance of others, nothing will be done or accomplished for the common good. Stop the hatred and progress will follow.
4
It's surprising that Krugman didn't note our current "fee for service" model as a key cost-driver of our current system. Any mention of high costs should note that factor. Single-payer alone won't reduce costs to the levels of other industrialized countries. Health care is not a "free market" in the sense of other consumables, and should not be treated as one.
3
Krugman assails the right for politicizing health care coverage, but he is guilty of the same sin. His arcane balloon story displays his hypocrisy.
He admits that it is impossible for anyone to stuff the US healthcare farce into any box because someone has to pay for it. The ACA is no more able to stuff the balloon that anything the Republicans can come up with. Krugman acknowledges this, but sidesteps the real issue by suggesting a leap to the left without exploring the problems that such a monumental institutional shift would create in the US economy.
Krugman also refuses to accept that health insurance is not health care is not health. The paradox of millions of Americans with health insurance deductibles that won't seek normal care because they have to pay so much to reach their deductible ceiling escapes Mr. Krugman.
US healthcare costs $2.6 Trillion a year for an inferior, expensive product. Bashing Republicans because they can't get the balloon in the box is not a solution. Just a lot of hot air.
He admits that it is impossible for anyone to stuff the US healthcare farce into any box because someone has to pay for it. The ACA is no more able to stuff the balloon that anything the Republicans can come up with. Krugman acknowledges this, but sidesteps the real issue by suggesting a leap to the left without exploring the problems that such a monumental institutional shift would create in the US economy.
Krugman also refuses to accept that health insurance is not health care is not health. The paradox of millions of Americans with health insurance deductibles that won't seek normal care because they have to pay so much to reach their deductible ceiling escapes Mr. Krugman.
US healthcare costs $2.6 Trillion a year for an inferior, expensive product. Bashing Republicans because they can't get the balloon in the box is not a solution. Just a lot of hot air.
3
Taxation is the only rational way to collect from everybody for it, but taxation is anathema to Republicans.
2
The Republican Party has decided to run the country like a country club. Specifically, using an exclusive metric. The more exclusive the membership, the more desirable the club. For a party made up of more and more beneficiaries of inherited fortunes and undisclosed tax breaks, it seems natural to build walls, escort nonmembers of the property, and then weed out the riff-raff with high fees and cancelled membership. If a birth certificate is presented, declare it invalid. Healthcare is is a central issue because it is best solved with an inclusive solution. It doesn't fit with Mar-a-laro, or for that matter, any game show philosophy that gleefully celebrates exclusion and elimination. American is at its best when we move forward together, propose big tent ideas, reject bullies, and always, always, always, strive for inclusion.
4
The Republican "health care plan" is well described by the great-Depression folk song from Newfoundland: "Hard Hard Times" with the verse
"Then come the doctor, the worst of them all,
Saying, "What's been the matter with you all the fall?"
He says he will cure you of all your disease.
When your money he's got, you can die if you please,
And it's hard, hard times."
And the Republicans will not think of anything that is better than this.
"Then come the doctor, the worst of them all,
Saying, "What's been the matter with you all the fall?"
He says he will cure you of all your disease.
When your money he's got, you can die if you please,
And it's hard, hard times."
And the Republicans will not think of anything that is better than this.
The US taxpayers are paying for most of the nation’s healthcare now. Local taxes create and support local free hospitals (ala our Harris County Hospital District taxes here in Houston, Texas) and free medical care for the poor that cannot otherwise afford medical care or have insurance.
I am a fiscal conservative, but I am now in favor of National Socialized healthcare, like the European “Nanny States,” rather than rely on local taxpayers to pay for US citizens and illegal immigrants without insurance.
Free Medical Care seems to now be considered to be a government taxpayer provided right, like Freedom of Speech and the right to life, liberty and the pursuit of happiness!
There are real limits to how much can the taxpayers afford to pay for any kind national taxpayer paid for healthcare in addition to other government activities before the US nation becomes bankrupt!
We could eliminate the costs of the Health Insurance Companies and all of their employees if the USA had National Socialized healthcare.
Government employees could then be hired to limit and control the amount that is paid nationally by the government for medical care (Death Panels) at less cost that the insurance companies.
People wanting free medical treatment for sex change surgery, repeated drug overdoses, mental health issues, addictive drug treatment, cosmetic surgery, expensive experimental surgery, abortions, and/or fertilization treatments could pay for it themselves or not have it.
I am a fiscal conservative, but I am now in favor of National Socialized healthcare, like the European “Nanny States,” rather than rely on local taxpayers to pay for US citizens and illegal immigrants without insurance.
Free Medical Care seems to now be considered to be a government taxpayer provided right, like Freedom of Speech and the right to life, liberty and the pursuit of happiness!
There are real limits to how much can the taxpayers afford to pay for any kind national taxpayer paid for healthcare in addition to other government activities before the US nation becomes bankrupt!
We could eliminate the costs of the Health Insurance Companies and all of their employees if the USA had National Socialized healthcare.
Government employees could then be hired to limit and control the amount that is paid nationally by the government for medical care (Death Panels) at less cost that the insurance companies.
People wanting free medical treatment for sex change surgery, repeated drug overdoses, mental health issues, addictive drug treatment, cosmetic surgery, expensive experimental surgery, abortions, and/or fertilization treatments could pay for it themselves or not have it.
1
As to your last point - addiction is considered a disease and citizens in Nanny States also buy private insurance at their own cost.
There is a lot that is simply incorrect about your statement. Starting with taxpayers footing the bill for illegal immigrant care...No that would be costs passed on to people WITH insurance in the form of higher charges. Hospitals are often required to take on anyone in the emergency room - this is how the poor usually see a doctor when they have no coverage, Medicaid or ACA, and the costs are passed on to the insured. Sex change surgery is covered by some insurer, not all, cosmetic surgery is never covered unless it is related to a medical condition, fertilization treatments are not covered, though Viagra is, abortions are not covered unless its a life or death matter - and taxpayers DO NOT pay for any abortions performed at Planned Parenthood, most experimental surgery is done as a part of a research with volunteers on the verge of death not at cost to others.
3
Abortion saves the system lots of money.
Unfortunately, we have a person who believes God mandates bearing children with conditions like spina bifeda selecting Supreme Court justices for us now. He's had two with this condition. Their early years are filled with painful surgery, and one has already died young. Their medical care has run past $1 million. To me this is cruel and unusual.
The "Federalist Society" is a movement to make the US a theocracy.
Unfortunately, we have a person who believes God mandates bearing children with conditions like spina bifeda selecting Supreme Court justices for us now. He's had two with this condition. Their early years are filled with painful surgery, and one has already died young. Their medical care has run past $1 million. To me this is cruel and unusual.
The "Federalist Society" is a movement to make the US a theocracy.
2
There is something called the Federal Employees Health Benefit (FEHB). As I understand it, this plan makes a variety of options available to government employees and their families. Why not open the plan to those without health insurance provided by their employer?
1
The only thing that I can see impacting your metaphor is the unspecified contents of the balloon. It should be a water-filled balloon, as water is an relatively incompressible liquid, certainly compared to air, which I imagine gives people the idea of fitting the balloon into the box by compressing it.
But otherwise I like it.
On another issue, climate change, Katherine Hayhoe, the evangelical physicist climate change change scientist, makes the point that those who cite a cold day to deny climate change are like those on the stern of the Titanic as its bow and mid-section filled with ocean water, causing the stern to rise (momentarily of course!).
But otherwise I like it.
On another issue, climate change, Katherine Hayhoe, the evangelical physicist climate change change scientist, makes the point that those who cite a cold day to deny climate change are like those on the stern of the Titanic as its bow and mid-section filled with ocean water, causing the stern to rise (momentarily of course!).
1
I hope she is just evangelical about physics, not about propagating the notion that idolizing Jesus improves one's prospects for a better life after death.
1
Calling on all those blue state AGs and strategists -- Eric Sneiderman, Bob Ferguson, Xavier Becerra, et al. -- who were going to adopt the tactics of the right by suing the federal government when faced with these types of issues…
Trump has threatened to withhold the subsidies and other things to deliberately undermine the ACA, which is a federal law he is sworn to uphold. It is already creating uncertainty in the insurance markets, which already is negatively harming states and their residents.
So states like NY and California have standing to go in and sue the federal government right now, and to seek an injunction that the law be upheld and that this kind of detrimental talk and actions cease…
Trump has threatened to withhold the subsidies and other things to deliberately undermine the ACA, which is a federal law he is sworn to uphold. It is already creating uncertainty in the insurance markets, which already is negatively harming states and their residents.
So states like NY and California have standing to go in and sue the federal government right now, and to seek an injunction that the law be upheld and that this kind of detrimental talk and actions cease…
3
Many, perhaps most, of the Republicans have no intention of making the balloon fit in the box. They aim to keep on stuffing it in for the sake of appearances, planning that it will burst.
3
With so much discussion of health care costs, I've not seen a single article addressing one of the biggest parts of the problem: the two-tiered pricing of medical services. Uninsured people are charged mythical rates that are up to 10 times higher than the insured rate.
I just had a blood test that was billed at $205. After the "insurance discount", I paid just $18. Insurance paid zero. Why is this legal?
I just had a blood test that was billed at $205. After the "insurance discount", I paid just $18. Insurance paid zero. Why is this legal?
5
Too bad for Republicans' wretched plans: The Affordable Care Act is poised for stability these days.
"ACA marketplaces are on track for smaller annual rate increases and growing competition going forward....
(But) Progress could be easily reversed if the Trump administration continues to sabotage the individual market."
"In a joint letter, the Chamber of Commerce, American Hospital Association, Federation of American Hospitals, Blue Cross Blue Shield Association, America’s Health Insurance Plans, American Academy of Family Physicians, and American Benefits Council implored President Trump and Congress to offer certainty regarding cost-sharing reduction payments. Otherwise, “choices for consumers will be more limited … premiums for 2018 and beyond will be higher … [and] providers will experience more uncompensated care.."
Here's the link.
http://www.cbpp.org/research/health/aca-marketplaces-poised-for-greater-...
"ACA marketplaces are on track for smaller annual rate increases and growing competition going forward....
(But) Progress could be easily reversed if the Trump administration continues to sabotage the individual market."
"In a joint letter, the Chamber of Commerce, American Hospital Association, Federation of American Hospitals, Blue Cross Blue Shield Association, America’s Health Insurance Plans, American Academy of Family Physicians, and American Benefits Council implored President Trump and Congress to offer certainty regarding cost-sharing reduction payments. Otherwise, “choices for consumers will be more limited … premiums for 2018 and beyond will be higher … [and] providers will experience more uncompensated care.."
Here's the link.
http://www.cbpp.org/research/health/aca-marketplaces-poised-for-greater-...
1
The problem also has a goal dimension. If the goal is to provide adequate health care to as many Americans as possible, the drivers of those aims would be considered. If the goal is to provide tax cuts to the wealthy, without regard to who else gets hurt, then obviously other things will be considered. The GOP is looking at the tax-cutting side, as usual. The only reason they don't just get on with it is because there are some humane beings in the GOP who cannot stomach throwing millions back into the ranks of the uninsured. Bravo for them.
3
While I strongly believe the best option would be to move to a Medicare for all (a.k.a. single payer) system, I would venture to say there are alternatives to either doing that or the more limited step of introducing a public option to compete with private insurers.
A starting point could be the system that New York State utilized before the A.C.A. ever existed.
Basically, the state required any company selling health insurance to businesses in the state to also sell health insurance to individuals--and that in selling to the individual market, the insurance companies had to issue policies using a "community rating" pricing system--that severely limited the ability of the insurers to price people out of coverage.
That approach instantly solved two of the biggest complaints the GOP has seized upon about the ACA--lack of choices (competition) and rising premiums.
What truly makes the balloon impossible for the GOP to stuff in the box is that the notion "the free market" can work in health care is clap trap--the nature of health care needs makes it impossible for individuals to successfully act as free agents and fully informed players in the market.
As the rest of the developed world learned decades ago, in health care, there is a real need for government involvement.
A starting point could be the system that New York State utilized before the A.C.A. ever existed.
Basically, the state required any company selling health insurance to businesses in the state to also sell health insurance to individuals--and that in selling to the individual market, the insurance companies had to issue policies using a "community rating" pricing system--that severely limited the ability of the insurers to price people out of coverage.
That approach instantly solved two of the biggest complaints the GOP has seized upon about the ACA--lack of choices (competition) and rising premiums.
What truly makes the balloon impossible for the GOP to stuff in the box is that the notion "the free market" can work in health care is clap trap--the nature of health care needs makes it impossible for individuals to successfully act as free agents and fully informed players in the market.
As the rest of the developed world learned decades ago, in health care, there is a real need for government involvement.
3
Despite the fact that, even for the young healthy, health care isn't cheap, the Republicans will need a biblical-strength miracle to deliver. They could, I suppose, ram a Christian theocracy down our throats, but then the "Great Physician," Christ, by all biblical accounts never charged for his services. Somehow, I don't think Pharma, the medical equipment and device manufacturers, doctors, nurses and dozens of other medical specialty workers are willing to continue their labors for the same compensation Christ asked from his patients. Bills to pay and all that. And not just a few of these folks can't afford the care they deliver.
The only thing of biblical proportions I see coming from the Republican party is its cynicism. The Hippocratic oath says, "First, do no harm." The Republican oath must surely read: First, cut taxes.
The only thing of biblical proportions I see coming from the Republican party is its cynicism. The Hippocratic oath says, "First, do no harm." The Republican oath must surely read: First, cut taxes.
3
Spot on, and isn't the Republican oath of "First, cut taxes," really the Hypocritic Oath?
1
In fear that my insurance coverage, obtained through the ACA Market, was about to implode courtesy of Republican boneheads, I scheduled and completed the diagnostic tests my physician recommended during my annual exam. Luckily, all results were negative. But, if these weren't and I had no insurance coverage, would my next choices have been bankruptcy to pay for medical care or a declining health status or death? Americans are not upset over some esoteric topic but the reality of what can happen to us and our loved ones. GOP, get your balloon's fat axis out of the box and get real.
5
It was pretty clear to me that Obamacare was merely another way of providing insurance coverage and spreading the risk of health care costs. I went through analyzing it for my son who enrolled and got a subsidy his first year, but enrolled and didn't get one the second. The question I just realized is why have medical costs gone through the roof. It is quite evident that the reason is because we as civilization have advanced to the point where we have been able to cure, alleviate and treat sickness and diseases. However, those advances cost money and so as a society we have reallocated a larger piece of the pie for health. If the right to same or similar health care is a basic human right, then it will necessarily require a bigger piece of the pie, but if not then so be it. It is OK to discriminate as to the what brand of car you drive, but is it to whether you live or die because you can't afford health care services is the question. I guess one political party does believe in death panels after all. What is the evangelical stance on this issue and does that comport with their abortion position.
3
The reason Republicans can't find ideas that work on the right is that most of them were incorporated into Obamacare. The ACA was based on truly free market principles, not the neo-conservative kind of market that's free of regulation, but the market that seeks to expand access. Until Dems can change the public rhetoric about what a free market is, they'll keep fighting unnecessary (and often losing) battles. Bernie is right about his party not having a cogent message.
Obamacare was never about affordable care so much as accessible care, and the ACA should have been named the Accessible Care Act, if truth-in-advertising ever held in politics. Policy wonks have always known that true affordability was the next step in the reform process, but now everything is up for grabs as reasonable people try to defend the reasonable step that the ACA was, but not in a climate of debate that's open to it. When will professional media do its job and call out the GOP for its failed politics? Krugman's column would appear to be a start.
Obamacare was never about affordable care so much as accessible care, and the ACA should have been named the Accessible Care Act, if truth-in-advertising ever held in politics. Policy wonks have always known that true affordability was the next step in the reform process, but now everything is up for grabs as reasonable people try to defend the reasonable step that the ACA was, but not in a climate of debate that's open to it. When will professional media do its job and call out the GOP for its failed politics? Krugman's column would appear to be a start.
4
Dr. Krugman got it right.
I think the Republicans are full of hot air.
We need the Public Option now and Medicare for all a bit later- if we wish to provide medical care for all citizens of this Country.
But that's not the central question. The question is why have the people elected representatives to run a National Government they hate? Why would anyone hire someone who hated its business and aimed to destroy it? It does not make common sense. The people need to hire those who believe in a Government which serves their social responsibilities willingly.
I think the Republicans are full of hot air.
We need the Public Option now and Medicare for all a bit later- if we wish to provide medical care for all citizens of this Country.
But that's not the central question. The question is why have the people elected representatives to run a National Government they hate? Why would anyone hire someone who hated its business and aimed to destroy it? It does not make common sense. The people need to hire those who believe in a Government which serves their social responsibilities willingly.
10
The Republican problem with the ACA is that it provided a governmental benefit that was funded in large part by their upper income constituents. These constituents did not like paying to subsidize health care for the working poor so they came up with the unfounded argument that the ACA was undermining the foundations of our society and that they would replace the ACA with something better. When the ultimate repeal and replace legislation reaches the Republican Congress and President, they will be forced to satisfy their constituents by sacrificing the health of the people that put them in office.
6
Me. Ted Cruz already warned his Republican peers to repeal Obamacare before people realize it is good for them. Too late now Mr. Cruz.
The same thing happens with Medicare, Mr. Ronald Reagan warned the American people in a video aired nationwide that Medicare would lead to a Soviet style sociaty. Everybody knows by now what really happens.
The same thing happens with Medicare, Mr. Ronald Reagan warned the American people in a video aired nationwide that Medicare would lead to a Soviet style sociaty. Everybody knows by now what really happens.
7
"They can’t admit that they have no ideas without, in effect, admitting that they were lying all along."
This would describe every GOP administration since Reagan with his "trickle down theories' to Bush's WMDs, and now trump's "most productive administion in its first 90 days". Some past presidents have had their lives relived on film or the stage and trump will be no different, his will be called
:HELLO, FOLLY".
This would describe every GOP administration since Reagan with his "trickle down theories' to Bush's WMDs, and now trump's "most productive administion in its first 90 days". Some past presidents have had their lives relived on film or the stage and trump will be no different, his will be called
:HELLO, FOLLY".
8
Obviously, they just POP the ballon. Trickle-out healthcare.
9
The concept of a "pre-existing" condition is insane if the goal is to provide health insurance and care. As everyone knows, insurance (of any kind - health, auto, home) works only if there's a large enough pool of contributors so that payouts do not exceed premiums. Generally it works, although there are situations that cause problems - such as a weather catastrophe or, with health insurance, the constantly rising costs of health care.
The insurance industry invented the notion of a pre-existing condition to minimize the number of sick people they have to cover. Their goal wasn't to provide health insurance, but to ensure their profitability. Their behavior was in direct opposition to their (supposed) purpose.
Republicans, rather than actually try to provide health insurance and care for all, want to ensure their friends in the industry continue to make money. If that means leaving millions with useless or no coverage, so be it.
Republicans are a pre-existing condition which is metastasizing. The host (the USA) is in danger. Our immunity needs to be strengthened in 2018 by electing Democrats. It's the only way to halt the this deadly disease.
The insurance industry invented the notion of a pre-existing condition to minimize the number of sick people they have to cover. Their goal wasn't to provide health insurance, but to ensure their profitability. Their behavior was in direct opposition to their (supposed) purpose.
Republicans, rather than actually try to provide health insurance and care for all, want to ensure their friends in the industry continue to make money. If that means leaving millions with useless or no coverage, so be it.
Republicans are a pre-existing condition which is metastasizing. The host (the USA) is in danger. Our immunity needs to be strengthened in 2018 by electing Democrats. It's the only way to halt the this deadly disease.
9
After learning the importance of marketing, spin, hype, etc. --isn't it time to stop using the term 'single payer?'
Few voters understand this wonkish term or think governemnt clinics.
Single payer simply means we pool resources, everyone is in and we eliminbate costly overhead & profiteering.
The same doctors, hospitals and- plausibly- administrative structures will remain intact.
'Medicare for All' captures the public option/single payer solution in a phrase that everyone can understand. To build support- rational policy needs savvy marketing.
Few voters understand this wonkish term or think governemnt clinics.
Single payer simply means we pool resources, everyone is in and we eliminbate costly overhead & profiteering.
The same doctors, hospitals and- plausibly- administrative structures will remain intact.
'Medicare for All' captures the public option/single payer solution in a phrase that everyone can understand. To build support- rational policy needs savvy marketing.
5
You underestimate the ability of the GOP to be cruel. They are just looking for the best way to take away coverage from many without it appearing to be so; by making it complicated and/or lying about the effects.
4
Like it or not, the R's continue to rely on the notion, held by many Americans, that says people ought to be able to look out for themselves. When one believe this then the wholesale rejection of government support, for ANYTHING, is easy. This notion fuels the R's. It allows them to continue to manipulate the balloon because their voters view those efforts as being their own best interests. It's called stubborn ignorance. There is no cure.
5
After 75 years of debate we're still arguing over who should have health care in America and who's going to pay for it. It's ridiculous. Our health insurance system evolved as an employer "benefit" during WW II and then codified as a "benefit" to mostly union employees beginning in the late 1940's. And for some reason this employer based system is sacrosanct. Why?
We need a new system not just a Band-Aid system that allows providers the luxury of setting prices while the public foots the bill. AND MORE IMPORTANT we need to spend much more time talking about why so many Americans, young and old alike, are chronically ill and constantly in need of medical attention. The ONLY thing we seem to talk about in how to pay the bills when we get sick. There is a public health crisis in this country as tens of millions people suffer the devastating effects of an environment and a food production system that robs many of us of our health. We need to do two things; regulate prices and develop and deploy a truly effective public health strategy, one that focuses on keeping us away from the doctor and out of the hospital.
We need a new system not just a Band-Aid system that allows providers the luxury of setting prices while the public foots the bill. AND MORE IMPORTANT we need to spend much more time talking about why so many Americans, young and old alike, are chronically ill and constantly in need of medical attention. The ONLY thing we seem to talk about in how to pay the bills when we get sick. There is a public health crisis in this country as tens of millions people suffer the devastating effects of an environment and a food production system that robs many of us of our health. We need to do two things; regulate prices and develop and deploy a truly effective public health strategy, one that focuses on keeping us away from the doctor and out of the hospital.
4
The dubious assumption here is that the Republicans want to replace ACA, that is, fit the balloon in the box. No, they simply want to design a Trojan Horse that *looks* like it will fit into the box, enough so that Congress will pass it, and voila! Destruction!!!
133
You mean to say Trump, Kid Rock, Ted Nugent, and Sarah Palin weren't hammering out the details of some new genius health care plan over their fancy White House dinner and baked Alaska?
9
"The truth is that while Republicans have portrayed Obamacare as a crazy, inefficient scheme, it has in fact been much more successful at containing costs than even its proponents expected."
Professor, we should be honest in our dealings with the voters and we should be brutally honest in regards to repubs.
So, in the interest of truth...
The truth is that while Republicans have portrayed Obamacare as a crazy, inefficient scheme, it has in fact been much more successful at containing costs than republicans FEARED.
Yes, the repubs in the know, like Mitch McConnell for sure, suspected exactly that - ObamaCare would be less expensive than for-profit health care. So they cynically lied and have tried to kill our health care as well as us in the process.
There. Fixed it for ya'!
Professor, we should be honest in our dealings with the voters and we should be brutally honest in regards to repubs.
So, in the interest of truth...
The truth is that while Republicans have portrayed Obamacare as a crazy, inefficient scheme, it has in fact been much more successful at containing costs than republicans FEARED.
Yes, the repubs in the know, like Mitch McConnell for sure, suspected exactly that - ObamaCare would be less expensive than for-profit health care. So they cynically lied and have tried to kill our health care as well as us in the process.
There. Fixed it for ya'!
3
Not prominently mentioned in this article is the GOP claim that health care costs have risen sharply with Obamacare. What is needed in a future article is the comparison of the increase in health care costs before and after the introduction Obamacare.
3
Bite your tongue, Paul Krugman. Republicans are indeed trying to let air out of the balloon, and are trying to distract the public. They may succeed. Remember how certain liberals were that Hillary Clinton would be elected President?
Eternal vigilence is required to ward off Trump termites, just as it's required to ward off wood-eating termites.
Eternal vigilence is required to ward off Trump termites, just as it's required to ward off wood-eating termites.
2
For a long time I thought the GOP's obsession with repealing the ACA/Obamacare was purely about the political theatrics of doing so. What has become clearer as Trump has spoken about it, and what you've articulated several times that I now grasp is that it was supposed to be the FIRST step in a massive tax cut for the rich/billionaires. Destroying Obamacare and federal health care spending was to be followed by more massive W Bush-era style tax cuts for billionaires and corporations, and other rollbacks that would funnel money into the pockets and pocketbooks of the super-wealthy.
The abject failure of the GOP's and Trump's attempts to destroy Obamacare, however, halted that goal in its tracks. In addition, it showed how incompetent and incapable of governing the GOP are, and also revealed, for anyone who'd missed it, what a complete sham Donald J. Trump is. As a result they both have a huge stake in getting *something* to pass. I hope and pray they can't and won't.
What I don't understand is why the Democrats are so silent on how devastating not just the repeal of Obamacare/ACA will be, but also how destructive those massive GOP tax cuts will be. Or do the Democrats really only care about helping their wealthy Wall Street and Silicon Valley supporters as well? Their silence is telling.
The abject failure of the GOP's and Trump's attempts to destroy Obamacare, however, halted that goal in its tracks. In addition, it showed how incompetent and incapable of governing the GOP are, and also revealed, for anyone who'd missed it, what a complete sham Donald J. Trump is. As a result they both have a huge stake in getting *something* to pass. I hope and pray they can't and won't.
What I don't understand is why the Democrats are so silent on how devastating not just the repeal of Obamacare/ACA will be, but also how destructive those massive GOP tax cuts will be. Or do the Democrats really only care about helping their wealthy Wall Street and Silicon Valley supporters as well? Their silence is telling.
6
Right, with one exception. It ALL began with Reagan!
1
A more cynical viewpoint is that the GOP wants to get something passed that so obscures what is really going that people won't notice how bad it is until after 2018. That way they can declare victory ("We repealed the commie job killing Obamacare" and replaced it with something great") before people realize what is going on at the detailed policy level. We can only hope that this debacle prepares the country to go full bore on a single payer system.
149
And they keep lying. Lying is part of the Republican DNA. And the biggest liar of all is, of course, Donald "Pinocchio" Trump. Mitch "Traitor" McConnell and "Lying" Paul Ryan, it rhymes, are not far behind.
5
Speaking of gaseous metaphors: Nature may abhor a vacuum, but the Democratic Party clearly does not. Where's the bold alternative that actually addresses costs, or the improvements package that will clearly separate the Parties in the eyes of the public?
*crickets*, dammit.
*crickets*, dammit.
5
Paul, you say the Republicans can't admit they were lying all along - that they have no ideas. Why do you say that? Why can't they just say "Healthcare is hard, nobody knew"? Why do you say can't they lie? Trump does, and it doesn't affect the worship from his base. This whole hing is tribal. They could say "yeah, we lied to get power, aren't you Trumpie's glad we knocked out those evil Democrats" and the Trumpies would go "Yeah, we won! Healthcare would be nice, but so be it".
2
And they will continue to try to stuff, while they are all stuffing their pockets with our dollars. They never had a plan. The best that they can come up with is to leave most of the population without health care. This is their "great" plan. Fools.
5
Obamacare has doen one thing: it has caused almost everyone to accept the false premise that improved health insurance equals improved health care. We will get nowhere until we think outside the box and figure out a way to improve health care.
1
One thing that could appeal to Republicans, but is not talked about is the huge impact Medicare for all would have on personal injury and workers' compensation. Without medical bills, the costs of covering injuries, which is now subject to the inefficiencies and waist of the court system, the insurance coverage for these things - enormous expenses for business - would diminish tremendously.
In other words it would be good for business.
In other words it would be good for business.
2
Republican pronouncements of "bigger, better and cheaper' just like those of their billiard ball of a president in the White House are increasingly becoming like the boy who constantly cried "wolf". Just a lot of hot air with no substance. Never has a political party shown itself to be so irrelevant to world events and the needs of its citizens.
3
The Republican Party members of Congress are worse than liars because they actually believe their own lies.
3
A fine point but a bad analogy. Since air is compressible, if you can get yourself all around it, you can make a balloon as small as you like. A water ballon is different; water is not compressible, hence ... "splash". So is money like water or like air??
A beautiful analogy. I believe that it does not matter whether or not the balloon fits. All that matters is massive tax cuts for the wealthy. The GOP tirelessly searches for a policy with enough complexity to hide the parts of the balloon that stick out.
2
They hate Obama more than they hate the law. The best thing that probably can happen is that they repeal Obamacare and suffer the consequences. I would do anything never to hear these guys names ever again. Send them all to Russia where they belong.
2
Stop the nonsense, Medicare for all.
5
And this is where Trump is a breath of fresh air: "And now they’ve trapped themselves: They can’t admit that they have no ideas without, in effect, admitting that they were lying all along."
Trump can admit he was lying all along, and be proud of it.
Trump can admit he was lying all along, and be proud of it.
1
The Democrats have always cared about everyone.
The Republicans have always believed in "Survival of the Fittest".
Who is better at promoting health care?
You answered correctly if you chose Democrats.
The Republicans have always believed in "Survival of the Fittest".
Who is better at promoting health care?
You answered correctly if you chose Democrats.
4
The elephant in the living room: A single payer system / Medicare for all.
Everybody wins, except for insurance companies, which have no business being in the healthcare business in the first place.
Everybody wins, except for insurance companies, which have no business being in the healthcare business in the first place.
7
Many, maybe all, countries that have government provided healthcare, still have robust markets for health insurance. A government managed system is necessarily basic. The healthcare services available are everything you need to be healthy or have a baby or get patched up after an accident, but there is always more that could be provided. Private rooms rather than shared rooms at the hospital. Coverage for things that could be considered unnecessary for your health but you may want anyway.
In those places you might buy supplemental coverage to pay for things not covered by the government. Many wealthy people buy private insurance even in places like England so they can go to private hospitals with private doctors and be treated in what amount to more luxurious and comfortable surroundings.
There is even, oddly enough, an insurance market catering to travelers visiting the US. If you come here on vacation from England and need medical care, you have to pay for it somehow. We rarely think of that because when we visit other countries they usually have public healthcare so we just go to the hospital same as someone who lives there.
You're right though in that in this country insurance is designed to derive profit from the need to use healthy people's money to pay sick people's bills. Layered in top of that is the fact that insurance companies can increase profits not only by denying coverage but also by delaying coverage.
In those places you might buy supplemental coverage to pay for things not covered by the government. Many wealthy people buy private insurance even in places like England so they can go to private hospitals with private doctors and be treated in what amount to more luxurious and comfortable surroundings.
There is even, oddly enough, an insurance market catering to travelers visiting the US. If you come here on vacation from England and need medical care, you have to pay for it somehow. We rarely think of that because when we visit other countries they usually have public healthcare so we just go to the hospital same as someone who lives there.
You're right though in that in this country insurance is designed to derive profit from the need to use healthy people's money to pay sick people's bills. Layered in top of that is the fact that insurance companies can increase profits not only by denying coverage but also by delaying coverage.
1
Today's NY Times story on the differing success of the ACA in two states, Oklahoma and New Mexico, illustrates the problem Republicans have with the law. Oklahoma, a red state with a Republican governor did everything it could to make the ACA fail, and was reasonably successful in that endeavor. New Mexico, a blue state with a Republican governor, actually tried to make it work, and it does.
You can make even the best programs fail if you intentionally sabotage them, as many red states have done.
If 45 manages to turn the whole country into Oklahoma (or Kansas), the ACA really could fail.
You can make even the best programs fail if you intentionally sabotage them, as many red states have done.
If 45 manages to turn the whole country into Oklahoma (or Kansas), the ACA really could fail.
4
The fact is this present Republican party just cannot govern.
They do not care if they harm people or not.
They are the wrong people for these times.
They do not care if they harm people or not.
They are the wrong people for these times.
6
I know this sounds crazy, but in the end, the only real possibility the Republicans have is to blame Americans for needing healthcare...Like, what's wrong with you, are you that weak?...Where are the strong real Americans, like back when they were tough and full of grit...
We will get the blame, we always do.
We will get the blame, we always do.
3
The republicans have had 8 years and made 61 attempts to kill ACA, but for all that they have no result because they have no ideas. They are motivated only by hatred of the guy who invented the plan.
Oh yeah, that was Mitt Romney. Oops, and bigly.
Now, they are acting like an animal in a trap. Best they can do now is chew their own leg off. Of course, that will serve them well next time they try to run for anything.
Oh yeah, that was Mitt Romney. Oops, and bigly.
Now, they are acting like an animal in a trap. Best they can do now is chew their own leg off. Of course, that will serve them well next time they try to run for anything.
2
Best...analogy...ever! So few people even know that this fight is for big tax cuts, health care is secondary. As Krugman says, we cannot take billions out of the system and have a better system.
This makes it easy to evaluate proposals - if they include a tax cut, they will take away health care for some.
This makes it easy to evaluate proposals - if they include a tax cut, they will take away health care for some.
3
Beyond the immediate crisis to resist Trump's and Ryan's efforts to eliminate or undermine the ACA, there's the left-undone part of "health care reform" -- reforming health care providers, device makers and the pharmaceutical industry. The foundation of our flawed, we're-so-US great health care approach is cost, driven without any controls by these greedy corporations.
2
Many people (e.g., John T) seem to think the Republicans are stupid or obsessive about Obamacare. No, they are playing a well-constructed shell game (see jimbo's comment) to keep the public in confusion about their true aim, which is -- surprise -- reducing taxes on the rich and services for everyone else. There is a little problem at present, that Obamacare repeal is too big to hide under a shell of deception, but they will persist because it is the reason their party exists.
2
Exactly: "reducing taxes on the rich and services for everyone else"! That is their ultimate goal. Let's thank Trump's and their incompetence, disarray, and far right-wing members, as well as that tiny and shrinking band of not so extreme-right Republicans, for bumbling in pulling this horrorshow off!
2
It is incumbent on Dems to fan out across the country and call this spade a spade. The GOP's goal has always been simply to repeal Obamacare. They don't care one whit about the poor, the sick, the elderly or anyone, for that matter, who is not white, christian, male and rich, and aiming to get richer. But they know that there are fewer and fewer people who inhabit the rarefied ether known as the wealthiest among us. So, they need to dupe the masses into falling in line and voting for them. So, first they attack public education, and attack any efforts to teach the masses to think critically. Then, they whip up fear, xenophobia, racism, and bigotry. Add a dose of religious zealotry, and convince these people that guns and religious are far more important than their economic interests and, "voila"! They have concocted a perfect brew for GOP self perpetuation. Until ... their hubris generates the reaction it always has, eventually, throughout history. Think American Revolution, French Revolution, Hitler's Germany, the Ancient Greeks. Game over. Can't happen soon enough. But in order to ensure that it does, Dems must persist, and educate, and protest, and resist, and revolt. The clown in chief said he welcomed a revolution. Except this won't be the one he hoped for!
2
A beautiful analogy. It should be a Youtube video. I have one quibble, and I have it with almost everyone who talks about healthcare. "The healthy" are really "the not sick yet". Everybody, sooner or later, one way or the other, gets sick. You get insurance for when that day comes. If insurance companies can charge for pre-existing conditions, then nobody actually has insurance, because the minute you need it, they can kick you off or charge you more than you can pay. In short, it's not insurance. You won't know that until you get sick, but that's how it works. If healthy people are buying actual insurance, they have to pay more than rock bottom, because the rock bottom price is not insurance; it's what you pay when the insurance company knows they can dump you like a stone and let you die in a ditch the minute you actually need insurance.
Therefore, healthy people HAVE to pay for sick people if they actually want to buy insurance. Republicans don't care if you have insurance. They want insurance companies to be able to swindle you again with a thing they call insurance but isn't. It's just like how they want banks to be able to swindle you on loans and investments again. Republicans thrive on rip off capitalism, where rich people can use their inside knowledge to screw the rest of us over.
It's what they do. It's their Jam. It's in their DNA. It's who they are.
Therefore, healthy people HAVE to pay for sick people if they actually want to buy insurance. Republicans don't care if you have insurance. They want insurance companies to be able to swindle you again with a thing they call insurance but isn't. It's just like how they want banks to be able to swindle you on loans and investments again. Republicans thrive on rip off capitalism, where rich people can use their inside knowledge to screw the rest of us over.
It's what they do. It's their Jam. It's in their DNA. It's who they are.
4
All true, true and true.
1
Nothing could be easier! Carry the balloon into the House chambers and shut the doors. Emit sufficient hot air to quadruple the pressure within. Allow to cool to ambient. Drop the, now half-sized, balloon into the box and wrap the whole several times in strapping tape. Presto! PV = nRT!
Or you could 'accidentally' burst the balloon on President Trump's fangs and drop the scrap in the box. Whatever!
Or you could 'accidentally' burst the balloon on President Trump's fangs and drop the scrap in the box. Whatever!
1
Great analogy.
Of course, there is one other way to do it. Pop the balloon and screw everyone. I think this next phase of Republican negotiation will try to do exactly that. After all, that's better than admitting defeat.
Of course, there is one other way to do it. Pop the balloon and screw everyone. I think this next phase of Republican negotiation will try to do exactly that. After all, that's better than admitting defeat.
2
I'm in agreement with PK and most of the commentors but there is a bigger picture here. We Dems know that the GOP is allergic to facts and truths, yet they control both houses, the presidency and a strong majority of state governments. It took almost forty years to accomplish their goals which could not happen without the successful GOP policy to dumb down our electorate by primarily defunding many agencies, particularly the department of education. Despite what we think of the GOP, they know what they are doing as the have achieved their goals. Furthermore, with the addition of judge Gorsuch and possibly more right wing judges, we bid a fond farewell to the good old USA.
3
Republicans don't want tax money to go to anything that helps the individual citizen, be it healthcare or Meals on Wheels or PBS or, for that matter, anti-pollution controls. Corporations rule, capitalism is king, and politicians live high on the hog. It's the only way to interpret the Trump effect--which the Republicans have been pushing to this peak ever since Reagan.
It seems that Republicans want an unhealthy, illiterate, hungry, frustrated population. But they want us all to have guns...
It seems that Republicans want an unhealthy, illiterate, hungry, frustrated population. But they want us all to have guns...
6
They should deflate the balloon, put it in the box and then store the box in the Atlantic.
"And each time the plan turns out to have a fatal flaw."
Oh where is that Invisible Hand when you need it?
They keep looking for a magic mushroom in keeping with their economic mythology--instead of looking at health care systems along the world that have worked for years--albeit imperfectly. And they make mountains out of molehill imperfections--while hunting for their magic mushroom.
Of course it's all smokescreen for freedom as feudalism. Corporate-Lords have replaced Land-Lords and the GOP is their Dark Knight round table.
Oh where is that Invisible Hand when you need it?
They keep looking for a magic mushroom in keeping with their economic mythology--instead of looking at health care systems along the world that have worked for years--albeit imperfectly. And they make mountains out of molehill imperfections--while hunting for their magic mushroom.
Of course it's all smokescreen for freedom as feudalism. Corporate-Lords have replaced Land-Lords and the GOP is their Dark Knight round table.
4
The fact remains that the quiet democrats are the caring party easily bullied by the rough and tough party of death that prefers to spend their money on the killing machine military while they believe in survival of the fittest and wish to leave the disadvantaged people of America to fend for themselves. The Republicans are just not wired to care for people like the Democrats. They'll never get that balloon in any box, no matter the size.
2
they're hoping to wear people's attention span out with their stupid antics and then pass the inevitable junk. The media will enable it.
1
An interesting metaphor and fair analysis.
But we should recognize that Republicans don't care if there are nails in that box, and if the balloon simply pops ... and lots of American citizens lose health insurance and face potential disaster.
Really. Simply. Plainly. They don't care.
It's pretty easy to drop a deflated shard of dyed latex into a box.
But we should recognize that Republicans don't care if there are nails in that box, and if the balloon simply pops ... and lots of American citizens lose health insurance and face potential disaster.
Really. Simply. Plainly. They don't care.
It's pretty easy to drop a deflated shard of dyed latex into a box.
4
The Republicans don't care about people (at least after they are born) but they do care about power and being reelected. They don't care about whether or not a member of the great unwashed 99% or their children die. They do care about what would happen if one of their plans were enacted into law and the whole American health dare system collapsed. That might lead even their dumbest most loyal voters to vote them out of office and someone else in.
That is ultimately why they won't be able to get a right wing health care plan through Congress.
That is ultimately why they won't be able to get a right wing health care plan through Congress.
1
Balloons pop when they are squeezed hard enough.
1
I just pray that compromise minded Democrats don't fall into the trap of again being sucked into a GOP morass in their congenital belief that THEY must be, for the good of the nation, the adults in the room.
2
Either pop the ballon or get a bigger box.
Such an easy solution.
Don't call the balloon a "balloon."
Call it, "Freedom."
And anyone who tells you you can't fit freedom into that little box?
Call them "socialists," "haters of America," or even better, "Muslim sympathizers."
If you don't think this will work, wait till the mid-terms.
Or, start working with people you know to make sure that the people who can see the balloon is too big to fit in the box - in other words, people who can see clearly the emperor has no clothes.... that these people vote.
We can either spend all are time blaming the "other" side (and thus, in our dualistic black-and-white thinking adopt their mentality - or, start taking responsibility.
www.remember-to-breathe.org/Breathing-Videos.htm
Don't call the balloon a "balloon."
Call it, "Freedom."
And anyone who tells you you can't fit freedom into that little box?
Call them "socialists," "haters of America," or even better, "Muslim sympathizers."
If you don't think this will work, wait till the mid-terms.
Or, start working with people you know to make sure that the people who can see the balloon is too big to fit in the box - in other words, people who can see clearly the emperor has no clothes.... that these people vote.
We can either spend all are time blaming the "other" side (and thus, in our dualistic black-and-white thinking adopt their mentality - or, start taking responsibility.
www.remember-to-breathe.org/Breathing-Videos.htm
2
A con to convince the folks who desperately wanted "that kind" of president to fail, and when he succeeded they doubled down on the con. About 60 times....
President is the polar opposite of Mango. He quietly and without much fanfare made the country better in myriad ways. Reduced energy imports, increased gas mileage with a simple rule change, brought the cost of alternative energy down with well constructed supports, cleaned up to the degree it was possible the debris left behind by his predecessors fiscal, and foreign policies, and of course had great success with ACA despite consistent and persistent obstruction and sabotage by the disloyal opposition. The good old boys are still fuming that "that kind of guy" was so much smarter than any of them and was such a great leader.
President is the polar opposite of Mango. He quietly and without much fanfare made the country better in myriad ways. Reduced energy imports, increased gas mileage with a simple rule change, brought the cost of alternative energy down with well constructed supports, cleaned up to the degree it was possible the debris left behind by his predecessors fiscal, and foreign policies, and of course had great success with ACA despite consistent and persistent obstruction and sabotage by the disloyal opposition. The good old boys are still fuming that "that kind of guy" was so much smarter than any of them and was such a great leader.
3
Never underestimate a human's ability to lie to itself.
4
When a substantial portion of your electorate is either ignorant, greedy, or both, you get big balloons and small boxes. And you also get photo ops in the White House that consist of Trump, Kid Rock, Ted Nugent and Sarah Palin.
7
That is a disturbing picture indeed. Wow
1
There's an analogue here to an old NASA saying that goes: "Cheaper, better, faster ... pick two."
3
"There are some things we could do that would probably make [health care] even cheaper, but they would all involve moving left — say, introducing a public option, or going all the way to single-payer. The G.O.P., which is determined to move right instead, reducing the public sector’s role, has offered no reason for anyone to believe that it could do better." Krugman nails it again!
6
Exactly. I always thought of this health-care puzzle as being like the old pre-digital SLR (single-lens reflex) cameras. You could adjust the shutter speed, focal length, aperture size, and film speed. But every choice in one of those measurements meant a corresponding reduction of quality in another one.
The only way to make the universal coverage puzzle work is to cover everyone, cover every condition on day one of enrollment, make participation mandatory, and only allow policies that meet certain standards. Hard truth, but truth.
Republicans want to close their eyes and cross their fingers and wish it weren't so. They don't mind lying to the public to eradicate Obamacare, but that will only hurt people.
The only way to make the universal coverage puzzle work is to cover everyone, cover every condition on day one of enrollment, make participation mandatory, and only allow policies that meet certain standards. Hard truth, but truth.
Republicans want to close their eyes and cross their fingers and wish it weren't so. They don't mind lying to the public to eradicate Obamacare, but that will only hurt people.
4
My suggestion is that the cost of insurance should be a percentage of everything you earn, whether you are poor, or filthy rich. Say 2%. But, that means, for the wealthy, 2% of of any salary they make, any investments that make money (no deductions for losing money), interest they get from bank accounts, or loans they give those less wealthy (it's income), i.e. ANY incoming money or assets. So the poor will pay almost nothing (they make almost nothing, some make nothing so they should get insurance for free), & the filthy rich will pay small fortunes, every year. Say the make $1Billion dollars, $50million dollars a year, family plan would be the number of family members times that amount. If you are making that much money you can afford it. Period. Make $60thousand dollars, pay $3thousand. At some point make the 2% the total for the whole family. Say at $1million earnings? As employer offered premiums are taken out of your pay, so can these.
Not having a decent system means that the next pandemic will hit the rich hardest, because many of us will suggest it is time to have the sick get up close & personal with the rich. Protests, infected clothing or blankets (the rich know about that, they did it to get rid of the Native Americans, so now the poor can get rid of the rich the same way. They want the poor dead, once infected the poor can MAKE the rich dead.
Not having a decent system means that the next pandemic will hit the rich hardest, because many of us will suggest it is time to have the sick get up close & personal with the rich. Protests, infected clothing or blankets (the rich know about that, they did it to get rid of the Native Americans, so now the poor can get rid of the rich the same way. They want the poor dead, once infected the poor can MAKE the rich dead.
1
Obama and the Dems are the ones who overinflated the balloon by thinking that everyone could be insured through a network of government subsidies and raising premiums. Anyone can look like a hero rolling out an entitlement program but making any modifications to it once it's law is next to impossible. The only way out of this mess is single payer health-care.
1
On healthcare more than any other issue, Republicans are prisoners of their own "government bad, free market good" ideology. Where are healthcare costs lowest? In the Medicare program, a government-run system. What does that vaunted competition among providers do, say when multiple MRI clinics open in the same area? Costs rise, because the lower volume of scans being performed at each clinic forces the owners to raise prices to cover their capital expenditures. For many reasons, healthcare is different, but Republicans just refuse to admit it.
8
The GOP is counting on every few weeks reporting a "sighting" of the plan, (on the frequency of a Sasquatch or Elvis sighting) at which President Clarabell will loudly pronounce "This is the best-est plan ever. It will solve all illnesses and injury without fail!".
Once proven to be a complete and total failure, the "plan" will quietly sink below the surface, only to be replaced by a slightly worse version, with the Armada's wise "Commodore" boldly proclaiming "This one's even better tyhan the last one!"...
Rinse & Repeat, until eventually all will be so overcome by baseless information, the general public will lapse into a "alternative facts" coma and plead to talk to the newly instituted "Health Advisement" panels to beg for mercy (a.k.a.-death ).
Health Care, GOP style...
Once proven to be a complete and total failure, the "plan" will quietly sink below the surface, only to be replaced by a slightly worse version, with the Armada's wise "Commodore" boldly proclaiming "This one's even better tyhan the last one!"...
Rinse & Repeat, until eventually all will be so overcome by baseless information, the general public will lapse into a "alternative facts" coma and plead to talk to the newly instituted "Health Advisement" panels to beg for mercy (a.k.a.-death ).
Health Care, GOP style...
6
Meanwhile, the insurers will all jump ship due to the uncertainty of it all, and the ACA can sink all on its own..another self-fulfilling prophecy
3
Will it be within the four years of this Presidency that Kansans (as in "What's The Matter With Kansas?") finally realize that they have been duped ever since they elected Ronald Reagan?
And if Obamacare is not repealed, and is mostly kept as it is now, when will Democrats realize that the Obamacare balloon is only slightly smaller than the ones Republicans are trying to stuff in the box?
The big balloon Krugman describes is more adequately described as the money that is currently stuffed into health insurers' and pharmaceutical companies' CEO's pockets. The balloon will fit beautifully when the for-profit hot air is released from it--when we move to a single-payer system and we're focused more on healthcare outcomes than on healthcare incomes.
And if Obamacare is not repealed, and is mostly kept as it is now, when will Democrats realize that the Obamacare balloon is only slightly smaller than the ones Republicans are trying to stuff in the box?
The big balloon Krugman describes is more adequately described as the money that is currently stuffed into health insurers' and pharmaceutical companies' CEO's pockets. The balloon will fit beautifully when the for-profit hot air is released from it--when we move to a single-payer system and we're focused more on healthcare outcomes than on healthcare incomes.
9
Why oh why do Republicans insist on going down a road that's too expensive to maintain and gets too few of us where we need to go? Their only answer is to try to save money by making the road even more dangerous, particularly for those already less fortunate. Grimly proclaiming it's all about freedom, choice, and personal responsibility ignores that it's the wrong path in the first place (and more about massive tax cuts for the wealthy).
The 'magic of the marketplace' invoked by the right ignores that there's no place on earth where this approach matches results of single payer universal coverage. There's a superhighway of healthcare within sight but the turnoff is blocked by libertarian obstinance. The superhighway is far cheaper (by many hundreds of billions EACH YEAR) and covers everyone with equal or better results. We just need a critical mass of congressional statesmen committed to making a pretty simple but very consequential turn.
The 'magic of the marketplace' invoked by the right ignores that there's no place on earth where this approach matches results of single payer universal coverage. There's a superhighway of healthcare within sight but the turnoff is blocked by libertarian obstinance. The superhighway is far cheaper (by many hundreds of billions EACH YEAR) and covers everyone with equal or better results. We just need a critical mass of congressional statesmen committed to making a pretty simple but very consequential turn.
5
You know what they're ultimately going to do. They're going to pop the balloon. Unless we take it away from them first by voting them out.
7
The reason Republican "health" care doesn't work is simple: they don't give a fig if the people they represent have healthy lives.
Republicans only care if constituants vote at election time.
Republicans only care if constituants vote at election time.
6
Before he left office Obama said he'd be the first to sign on, if the GOP could come up with a better plan than the ACA.
He said it with an assured smile, for he knew his adversary well.
His true genius was knowing that these fools would be trying to stuff this absurd balloon into the box and they couldn't do it with all that hot air.
He knew it would be beyond them to let it out.
No wonder he can sip wine and bask in the sun on a big yacht as the GOP squirms and screams.
Barack gets the last laugh; he knows that McConnell's smirking days are coming to an end.
He said it with an assured smile, for he knew his adversary well.
His true genius was knowing that these fools would be trying to stuff this absurd balloon into the box and they couldn't do it with all that hot air.
He knew it would be beyond them to let it out.
No wonder he can sip wine and bask in the sun on a big yacht as the GOP squirms and screams.
Barack gets the last laugh; he knows that McConnell's smirking days are coming to an end.
I have come to conclude from observation that, American voters ARE stupid.
Eventually, the Republican politicians and their pundits will make their supporters believe that the ballon is in the box ( when it's not) and any problems arising from that is....Obama's fault! Because the American voters are really that clueless and that easily manipulated.
I am trying very hard not to, but I just can't help feel totally angry and disillusioned.
Eventually, the Republican politicians and their pundits will make their supporters believe that the ballon is in the box ( when it's not) and any problems arising from that is....Obama's fault! Because the American voters are really that clueless and that easily manipulated.
I am trying very hard not to, but I just can't help feel totally angry and disillusioned.
Single payer 100% coverage would save billions of dollars JUST FROM universally available family planning and birth control: all that obstetrical care, pediatric care, child protective services, special education, and juvenile justice services costs a lot of money.
Unwanted children are at greater risk for family chaos, for abuse and for neglect. All these factors increase the risk of educational dysfunction, mental illness, drug addiction, and criminal behavior.
SAVE MONEY: vote single payor 100% coverage.
Unwanted children are at greater risk for family chaos, for abuse and for neglect. All these factors increase the risk of educational dysfunction, mental illness, drug addiction, and criminal behavior.
SAVE MONEY: vote single payor 100% coverage.
6
All we have to do is vote for the other guy (or gal.)
That's it. Nothing more. Then we'll stop at least some of this nonsense.
That's it. Nothing more. Then we'll stop at least some of this nonsense.
3
In today's NY Times article that compares health insurance in Oklahoma and New Mexico one ardent conservative says he does not like the government "picking winners and losers", the winners ironically being those poor enough to get a subsidy from the ACA.
This is a common complaint with a simple solution. Everyone should have free access to basic health care. Then there are no winners and losers, and those who want and can afford better coverage can buy it. Medicare for all with the option of buying a Medicare supplement is the answer.
This is a common complaint with a simple solution. Everyone should have free access to basic health care. Then there are no winners and losers, and those who want and can afford better coverage can buy it. Medicare for all with the option of buying a Medicare supplement is the answer.
The Republican problem is twofold: 1) They didn't like Obamacare because they don't like Obama, and this dislike is, for some, fueled by racism and white supremacy. 2) They don't want to foot the bill for those they deem lazy, having bought into the Ayn Rand myth that a person's worth is demonstrated by his upward mobility.
8
The Dow is up at a new high, corporations are doing well this quarter, no terrorist acts have been committed on US soil, healthcare costs haven't gone up - so Krugman has to grasp at straws and invent straw men to vent his frustration.
1
And as we all know, the first quarter of a new president is actually the result of the policies of the previous one...
2
Health care costs haven't gone up????????
1
I've never seen a better description of health care than this balloon-in-a-box comparison. Someone ought to show it to Trump. Even his tiny brain could wrap around this analogy.
We need single-payer. Mitch McConnell will never allow that to happen.
We need single-payer. Mitch McConnell will never allow that to happen.
4
A side note, a (critical) semantic point:
When we talk about the healthy - in the context of the health care debate - let's start using the phrase:
"the currently healthy."
- - -
We may be healthy now, and it might seem to some of us that we're paying money for something we don't use.
But if we are lucky - and live long enough - we will.
Or... If a drunken, opiod-addicted anti-health care fanatic drives into us with their car... [ smile ] ...we will then.(!)
"...CURRENTLY healthy..."
OK?
When we talk about the healthy - in the context of the health care debate - let's start using the phrase:
"the currently healthy."
- - -
We may be healthy now, and it might seem to some of us that we're paying money for something we don't use.
But if we are lucky - and live long enough - we will.
Or... If a drunken, opiod-addicted anti-health care fanatic drives into us with their car... [ smile ] ...we will then.(!)
"...CURRENTLY healthy..."
OK?
2
I don't think the Republican health care embranglement could be explained more simply and clearly than this.
2
The current idea the GOP has come up with is to let states give insurers the go ahead to strip coverage from their plans, yeah that's a winner, not. Seriously how evil are these people?? Real evil is my take and seriously stupid.
The Trump administration, Ryan, and the Republican's best efforts have shown us their best effort on healthcare is a to create a Frankenstein Trumpcare -- that neither cares about patients citizens, or healthcare. "Risk pools for people with pre-existing conditions." Look in the mirror folks: every one of us is TAB, temporarily able bodied. We have no guarantees we won't incur life-altering health situations. And above all, we can't count on not getting old when we'll need Medicare we can afford.
4
Why is it that Dr. Krugman wants to dance around this issue and cannot say the simple truth? Single payer for all is the only reasonable, economical, fair, and appropriate end to this shameful dereliction of duty by our Congress.
288
Krugman did mention single payer. That is probably the best solution but it is still not politically viable. I hope it soon becomes so.
James, the problem with single-payer, at least back in 2009-10 when Obamacare was being considered, is that it would have caused thousands of employees of insurance companies to lose their jobs. This at the same time that we were losing hundreds of thousands of jobs per month. Switching to single-payer is probably now the right thing to do but to suggest as many do so easily while typing on our computers that switching to single-payer would be some easy transition is short-sighted.
1
Isn't that what he just said? "There are some things we could do that would probably make it even cheaper, but they would all involve moving left — say, introducing a public option, or going all the way to single-payer." I would have liked him to say it stronger. I would like one of the economists that gets published to lay out the cost numbers. But my wishes mean nothing. However, Krugman's statement today, there is a way out for the Republicans and its single payer is much more skewed in the correct direction that what I have previously read from Krugman.
1
Remember that Republicans have tried to repeal the ACA many times. It was only the run up to the election that they switched their rhetoric to "repeal and replace". I marveled that anyone actually bought that line. Sure; let' repeal it (easy, we have those votes), then work on a replacement (we know that will never happen, but we can then blame the democrats). When Trump ran on the platform of "simultaneous " repeal and replace with the healthcare version of Christmas, you could see the repealers wince. They had been trapped. The good thing about all of this is that it exposes just how wrong they have been about ACA. It fundamentally is the right idea, but the one piece necessary to make it work has been elevated by the Republicans to an ideological juggernaut; the mandate.
2
Krugman talks about the Republicans needing a way to dramatically lower the cost of healthcare in order to get the balloon into the box Problem is that the Democrats need to find a way to do the same thing; the ACA doesn't fit the balloon into the box either. Of course the answer is Medicare for All, which covers everyone and slashes prices significantly. Time to pull the plug and tell the insurance and pharmaceutical industries that the party is over.
4
It is true that the Republicans try to fit a big balloon to a box but Mr. Krugman is trying the same exercise with a different balloon. He keeps saying that public options will keep premiums down while ignoring that almost all COOPS (ACA financed insurance entities) went out of business trying to keep premiums "low". In addition he forgets that Medicare Advantage ( a private option Medicare) attracted 1 in 3 medicare members in 2016, and its share keeps increasing because in many instances it offers better options than the traditional Medicare. The problem with conservatives and liberals is that they are trying to solve the problem with ideology rather than rationality.
How about starting with Medicare for 62 year olds and up? Align it with Social Security. If the eggheads feel the need go ahead and scale the pricing by age up to 70, the way Social Security pays its pensions. Work in health savings accounts to discourage cavalier spending. Give everyone below 62 a free catastrophic plan if they aren't in a group or on Medicare. Let them opt out if they have better options -- joining their wife's plan for instance. And please, make the pricing fair for young and healthy Americans who work for themselves. The 3-to1 formula is cruel.
Rather than striving to make the insurance more affordable we should be acting to make the care more affordable, as many other developed nations have done. Many of those nations also have a better quality of health care!
2
PK said it right. This is really about repeal of the Obamacare taxes. GOP could not care less about your health care just the elimination of the taxes that help pay for the premiums.
2
Someone please answer the question why the Republican program is ALWAYS to take something away from Americans: health insurance, health care, medicaid, medicare, social security, clean air, clean water, ethics, privacy. The list goes on and on. I have a theory, but perhaps Mr. Krugman can provide an answer.
3
Does anyone else besides me see the irony in the healthcare situation? The ACA is a Republican plan. Obama and the democrats knew they couldn't get a single payer plan with a government option through the house and senate so they chose going with a republican plan. Remember Romneycare in Massachusetts? The Republicans hated Obama so much that they started calling the ACA Obamacare thinking it would fail and they could saddle him with that failure. It did not fail and now they are in the awkward position of trying to replace a plan that was theirs to begin with. This is irony my friends.
2
Paul Ryan let the cat out of the bag when he admitted that he didn't want government to have any role in health care so that pretty much explains why he isn't committed to a workable solution. If you introduce a plan that is so bad for so many people, then it will prove that government can't do anything right so let's just get out of the health care business.
These people all think that if the government is involved in health care, Lenin is going to show up at the front door the next day.
These people all think that if the government is involved in health care, Lenin is going to show up at the front door the next day.
2
Yes we do need to "repeal and replace". But not Obamacare. We need to
repeal Trump and Ryan and replace them with smart and caring leadership.
repeal Trump and Ryan and replace them with smart and caring leadership.
2
I can see how the GOP is planning to lower the cost of health insurance They will be able to provide a policy for $10/month. - Don't cover anything.
2
Trump and Congress will pass the buck to the states, and declare victory. This is the best they can do.
2
Why aren't the biggest purchasers of drugs getting a volume discount? Big pharma's lobbyists. It's the money in politics again. Allowing pharmacies to purchase drugs from outside America would go a long way to health care savings.
Health Insurance= the well paying for the sick. when your employer takes your premium out of your check it is the same for every employee in your grade and in your plan. When the insurance company determines the rates they take into account all the illnesses and how much they cost, a profit amount and all employees in that plan pay the same so the well pay more to bolster the sick.
Car insurance: Based on where you live and the accident level so even if you never had an accident you pay more in an area where there are a lot of accidents so you pay for those that have accidents.
House insurance: if you live in an area with a lot of crime or natural disasters, if you can get house insurance, you pay more even if you have never been robbed or had a natural disaster harm your home.
If you are healthy you pay for those who are not. If you are careful and vigilant you pay for those who are not. If you are lucky you pay for those who are not. That is how insurance works and all the railing against the well paying for the sick will not change this. If you think you are paying for yourself in insurance you are fooling yourself or having the wool pulled over your eyes by unscrupulous people.
Car insurance: Based on where you live and the accident level so even if you never had an accident you pay more in an area where there are a lot of accidents so you pay for those that have accidents.
House insurance: if you live in an area with a lot of crime or natural disasters, if you can get house insurance, you pay more even if you have never been robbed or had a natural disaster harm your home.
If you are healthy you pay for those who are not. If you are careful and vigilant you pay for those who are not. If you are lucky you pay for those who are not. That is how insurance works and all the railing against the well paying for the sick will not change this. If you think you are paying for yourself in insurance you are fooling yourself or having the wool pulled over your eyes by unscrupulous people.
The greatest irony of all is that the ACA is essentially a plan worked out by the Heritage Foundation, a right wing think tank! Romneycare, which first implemented the idea is likewise a right wing configuration. Any Republican who thinks otherwise is ignorant of his own history, but this always seems to be the case lately with this wrecking crew.
1
Nice analogy. I've been thinking of healthcare as a length of rope. Pull it to the right, and congressional moderates drop away. Pull it to the left, and the Freedom Caucus and others on the extreme right lose their grip.
Ryan has already thrown up his hands and admitted that there's no way to stretch that rope to gain enough votes to pass. Trump doesn't care at all what is actually in the bill, just that something gets passed. The last bill was very unpopular, and judging from the mood of the GOP town halls, many in Congress have gotten the message that the people want what ACA does, and Trumpcare doesn't.
Ryan has already thrown up his hands and admitted that there's no way to stretch that rope to gain enough votes to pass. Trump doesn't care at all what is actually in the bill, just that something gets passed. The last bill was very unpopular, and judging from the mood of the GOP town halls, many in Congress have gotten the message that the people want what ACA does, and Trumpcare doesn't.
108
It's not just healthcare.
The balloon analogy also holds to Republican policy (stupid as it is) regarding the economy. After all, they've spent almost four decades screaming and crying about taxes - taxes are too high on the rich, they're going to cut taxes, they're going to eliminate "entitlements", they're going to cut government spending. It's an economic ideology of slash and burn. The problem is, you can't get something for nothing. If we want to have a workable society that is actually worth living in, we have to pay for it. Especially those who have been gaming the system and stuffing their pockets for decades. Yet, the GOP keeps trying to push Grover Norquist's dream balloon into that box.
The more these "repeal and replace" shenanigans run into the wall of reality, the more I think Obama's passage of the ACA was a politically brilliant move. By adopting the Republican position (the ACA came out of the Heritage Foundation, after all) it gave the GOP nowhere to move. They can't go further right on healthcare, and attempting to dismantle it would be political suicide and a catastrophe for millions.
The real solution to the healthcare issue is a single payer, Medicare For All system. That is the only way we can both bring down costs and make access and higher quality of care equal for all Americans. Enough kabuki, enough shenanigans, and enough tantrums from the greedy. It's past time we join the rest of the civilized world with truly universal healthcare.
The balloon analogy also holds to Republican policy (stupid as it is) regarding the economy. After all, they've spent almost four decades screaming and crying about taxes - taxes are too high on the rich, they're going to cut taxes, they're going to eliminate "entitlements", they're going to cut government spending. It's an economic ideology of slash and burn. The problem is, you can't get something for nothing. If we want to have a workable society that is actually worth living in, we have to pay for it. Especially those who have been gaming the system and stuffing their pockets for decades. Yet, the GOP keeps trying to push Grover Norquist's dream balloon into that box.
The more these "repeal and replace" shenanigans run into the wall of reality, the more I think Obama's passage of the ACA was a politically brilliant move. By adopting the Republican position (the ACA came out of the Heritage Foundation, after all) it gave the GOP nowhere to move. They can't go further right on healthcare, and attempting to dismantle it would be political suicide and a catastrophe for millions.
The real solution to the healthcare issue is a single payer, Medicare For All system. That is the only way we can both bring down costs and make access and higher quality of care equal for all Americans. Enough kabuki, enough shenanigans, and enough tantrums from the greedy. It's past time we join the rest of the civilized world with truly universal healthcare.
3
Let's go back to the balloon and the box. If you let the Republican Party out of this equation, you still have at least two operating pieces. One is the ACA, with all of its moving pieces. Then we have Donald Trump, who has no allegiance to the Republican Party and has said, publicly, that he's going to negotiate over drug prices. Bringing drug prices into conformity with prices in the other advanced countries alone could save hundreds of billions. Remember, Americans are spending almost twice as much for healthcare as the other advanced countries. We're talking about several trillion dollars a year. Almost as much as the national budget. Bernie Sanders has also been talking about drug prices and healthcare costs.
What we end up with is a balloon that we can take half the air out of and it will fit easily into the box.
What is needed is to teach the American public to angrily shout, "We pay twice as much." and the healthcare wall will begin to crumble.
It won't happen overnight. It took decades for the same American public to memorize, "Government is the problem."
But, it will come to pass. Now repeat after me Mr Krugman, "We pay twice as much!!!" for healthcare and "We're not going to take it anymore!!!" Say that thousands of times and the American public will begin saying it and finally even reporters on the evening news will begin saying it and then it will change.
What we end up with is a balloon that we can take half the air out of and it will fit easily into the box.
What is needed is to teach the American public to angrily shout, "We pay twice as much." and the healthcare wall will begin to crumble.
It won't happen overnight. It took decades for the same American public to memorize, "Government is the problem."
But, it will come to pass. Now repeat after me Mr Krugman, "We pay twice as much!!!" for healthcare and "We're not going to take it anymore!!!" Say that thousands of times and the American public will begin saying it and finally even reporters on the evening news will begin saying it and then it will change.
3
The analogy of fitting a balloon in the box can be helpful if we respond by thinking out of the box. Mr. Krugman seems limited to the belief that, “things we could do … would probably make it even cheaper, but they would all involve moving left — say, introducing a public option, or going all the way to single-payer.”
To advance the conversation we need to separate health insurance, provider economics, family wealth and family income. The interaction of these four economic parts are incentivized and tweaked largely by the tax code and health insurance regulations. The solutions do not require movement to the left, or right, but rather movement out of the box you’re stuck in.
• Eliminate all medical discounts which unfairly raise prices on others
• Require providers to advertise fixed prices
• Require all patients to pay what they can afford based on both family income and family wealth
• Provide free prescription medication to all who agree to either participate in trials of new medication or agree to donate their organs at death
• Government will pay provider difference between what patient can afford and 80% of cost of procedure (up to average cost).
• Limit medical malpractice recovery
• Expand insurance products so those with wealth and little government subsidy may protect their assets.
• Allow insurance companies to set rates based only on risk.
To advance the conversation we need to separate health insurance, provider economics, family wealth and family income. The interaction of these four economic parts are incentivized and tweaked largely by the tax code and health insurance regulations. The solutions do not require movement to the left, or right, but rather movement out of the box you’re stuck in.
• Eliminate all medical discounts which unfairly raise prices on others
• Require providers to advertise fixed prices
• Require all patients to pay what they can afford based on both family income and family wealth
• Provide free prescription medication to all who agree to either participate in trials of new medication or agree to donate their organs at death
• Government will pay provider difference between what patient can afford and 80% of cost of procedure (up to average cost).
• Limit medical malpractice recovery
• Expand insurance products so those with wealth and little government subsidy may protect their assets.
• Allow insurance companies to set rates based only on risk.
2
I will make a startling statement: President Trump is unique position to actually deliver single payer to America if he choose to. He would have to toss aside the far Right and make a deal with the Center and Left. The leverage he has against the Republicans is that he has a voter block that they don't have and has delivered the Presidency. I am assuming that the classic 'Trump Voter' will be very receptive to the idea, hence retaining his base while gaining new voters. He would truly make a positive difference for all Americans.
I am not a Trump fan by any means (I consider him very dangerous to democracy and some of his moves: secrecy, changing rules to allow political appointees to fire people without cause, etc. smack of what David Frum wrote about in his article regarding authoritarianism in the Trump age). But he is in a unique position to be successful in this area if he choose to be.
I am not a Trump fan by any means (I consider him very dangerous to democracy and some of his moves: secrecy, changing rules to allow political appointees to fire people without cause, etc. smack of what David Frum wrote about in his article regarding authoritarianism in the Trump age). But he is in a unique position to be successful in this area if he choose to be.
2
Imagine if ACA was taxed and funded properly with a 2-3% bump in payroll taxes, or a universal VAT tax on everything. Imagine if the "writers" of this law actually funded the law 100% and built non-competing rules that actually bolstered coverage.
Imagine if they just extended medicare with an option and built a jobs package that republicans could have signed up for. Also imagine if they were smart enough not to force reproduction care as a "core" item so religious people wouldn't feel attacked and minimized. A guaranteed government option for reproduction could be offered to ensure things were protected; however, importantly it could allow "safe space" for those that have strict moral codes in their life.
Imagine if they actually read the bill.
Any failures since 60 votes can not be garnered, is a failure of the democrats 100%. They own this, and every failure is theres "period". Cry about funding to insurance? Well the courts ruled it was illegal, end of story.
How about those projections, 26 million paying customers with 9-10 million 18-35 years olds. What we have is 9-10 million of older sicker people on it with an infinite service guarantee and a tight you only have to pay this setup.
The failure to execute and plan is bordering on criminal, and yet this is the republicans fault? Last I heard if someone tells you no and repeats it over and over ... it means no. Be thankful we are talking about it though, if Clinton won, it would be same news of no.
Imagine if they just extended medicare with an option and built a jobs package that republicans could have signed up for. Also imagine if they were smart enough not to force reproduction care as a "core" item so religious people wouldn't feel attacked and minimized. A guaranteed government option for reproduction could be offered to ensure things were protected; however, importantly it could allow "safe space" for those that have strict moral codes in their life.
Imagine if they actually read the bill.
Any failures since 60 votes can not be garnered, is a failure of the democrats 100%. They own this, and every failure is theres "period". Cry about funding to insurance? Well the courts ruled it was illegal, end of story.
How about those projections, 26 million paying customers with 9-10 million 18-35 years olds. What we have is 9-10 million of older sicker people on it with an infinite service guarantee and a tight you only have to pay this setup.
The failure to execute and plan is bordering on criminal, and yet this is the republicans fault? Last I heard if someone tells you no and repeats it over and over ... it means no. Be thankful we are talking about it though, if Clinton won, it would be same news of no.
Imagine if the Republican leadership had said "No!" at every step along the way, no matter what President Obama and other Democrats proposed. Oh, wait....
1
Republicans should declare victory, after all, HeritageCare has been a huge success. With 20+ million covered, the uninsured rate below 10%, a slight deficit reduction, and all paid for by taxes on the top 5% so 95% don't pay more.
It's brilliant. Take credit for the idea and move on, or try to make it better.
It's brilliant. Take credit for the idea and move on, or try to make it better.
3
Why is why is embracing a single payer plan moving to the left? Why is distributing health care in a much more equitable fashion, and much more economically, a leftist notion? In the 27 years I lived in Europe, not once did I hear anyone, liberal or conservative, support privatizing the national healthcare system. And if we had a Democratic Party which truly served the interests of the people, and not their corporate masters, that is what we would be fighting for.
6
I've got a brilliant idea. It just hit me. Why not make medical care available to everyone in the country? We could pay for it with taxes on billionaires. The coverage would be similar to what's available in most other countries.
I wonder why no one is proposing anything like it. Could it be that billionaires now control our government? Could it be that life in America will keep on getting more difficult until Citizens United is repealed?
I wonder why no one is proposing anything like it. Could it be that billionaires now control our government? Could it be that life in America will keep on getting more difficult until Citizens United is repealed?
7
You stated the dilemma of the modern Republican for almost all their policies. Tax reforms make no sense if they believe in balanced budgets. Building up the military makes no sense if you're really not interested in nation building. The contradictions are boundless for the party of no intelligence.
4
The problem is simply the medical fee-for-service system model currently employed. As long as the focus is on the insurance end of the delivery of medical services, the box will always be too small. Some years ago, the "New Yorker" published an article showing that the Mayo and Marshfield Clinics delivered the best care at the lowest Medicare reimbursable cost because they employ salaried doctors and other medical resources that cooperate collegially. When insurance will pay for it, the fee-for service delivery of healthcare is the least inefficient health market system possible.
3
There is a way to make healthcare cheaper--less care. Republicans will allow states to opt out of covering lots of conditions which will create cheap policies that cover very little. Low coverage policies will be appealing to young healthy people who don't think they need coverage so a lot of people will end up with what is essentially fake coverage--but statistically will still count as insured. Now, this won't generate enough money to subsidize less healthy older people, but that's OK because they will have been pushed into state high-risk pools. States won't fund these adequately (because they don't have the money and/or don't care (see Medicaid expansion)), but Congress can claim it's not their fault. So Federal healthcare spending goes down so they can fund tax cuts for rich people--which is the important thing.
3
The Republicans should get smart and adopt a single payer healthcare system. This would produce enough savings for some corporate tax reform, both would truly benefit corporations and workers.
4
It seems that tying health insurance reform to tax cuts for the rich is unlikely to work, ever. Too bad the GOP won't admit there is no good economic reason to cut taxes while throwing money at the military and trying to revise health insurance and rebuild infrastructure. They will say that tax cuts miraculously create jobs, but even they don't really believe that anymore, after decades of trying it and finding all it does is increase the deficit.
3
Lyndon Johnson and Barack Obama tried to fit the balloon into a box, with only partial success. Our public/private tax-subsidized hybrid programs, like FannieMae and the 401k system and the medical system and defense procurement, are intended to keep powerful constituents reasonably happy, and to be consistent with our economic tenets. But they are complex, inefficient, game-able Rube Goldberg machines, victims of politics, and consistently fall short of some major policy goals. But the beneficiaries of the trillion-dollar medical boondoggle--for-profit insurers and hospital chains, big Pharma, the AMA, people with great employer-provided plans--will spend or do whatever it takes to preserve it.
4
So long as our fellow citizens vote for Republicans first because of abortion, gun rights, fear of others, racism etc. we will continue to see problems like health care bedeviling us. If we want right wing attitude we have to live with the fact that many will suffer because of it.
3
The balloon analogy is perfect but it assumes that there is a serious political effort to make American's healthy. There are lots of factors that contribute to good health: nutrition, agriculture, food processing, safety in food storage/ shipment, global disease control, concentration and manufacture of toxic substances for cleaning, lawncare, etc. making hydrogen bombs and nuclear waste that we really don't know what to do with. I worked in isolating nuclear waste from the biosphere because it was stored in 149 million gallon tanks that age and leach into the biosphere, threatens salmon and other fish that use the Columbia River.
So, I rant on the real health issues, including whatever we are doing in our biosphere to reduce the healthy sperm count of our own species. Clearly, we must eat well and reproduce, this is fundamental and much more important than the health insurance industry.
A lot of government is the mission of good health, food safety, agriculture, defense production. A biggie is electricity from coal. Besides the extinction issue of global warming, the endangering chemicals in the ashes is a problem.
Another biggie are the number of injuries and fatalities from transport systems. In terms of years of mortality lost, a lot trauma that costs very much comes with econmic growth. This health hazard is related to the design and control of our transport system infrastructure. So stuffing the real health balloon in the "fiscal box" is tough.
So, I rant on the real health issues, including whatever we are doing in our biosphere to reduce the healthy sperm count of our own species. Clearly, we must eat well and reproduce, this is fundamental and much more important than the health insurance industry.
A lot of government is the mission of good health, food safety, agriculture, defense production. A biggie is electricity from coal. Besides the extinction issue of global warming, the endangering chemicals in the ashes is a problem.
Another biggie are the number of injuries and fatalities from transport systems. In terms of years of mortality lost, a lot trauma that costs very much comes with econmic growth. This health hazard is related to the design and control of our transport system infrastructure. So stuffing the real health balloon in the "fiscal box" is tough.
4
This is a perfect description of the problem.
The only alternative to Obama Care, which is imperfect,
is a Universal, Single Payer system based on the notion that healthcare is a right for all Americans and is the best investment we can make as a nation to promote economic health and prosperity.
The only alternative to Obama Care, which is imperfect,
is a Universal, Single Payer system based on the notion that healthcare is a right for all Americans and is the best investment we can make as a nation to promote economic health and prosperity.
4
Obama Care is a health program which is very skillfully designed to help a vast majority of people - poor, average, and rich. The majority of Republican law makers (rather law breakers) are racist and they hate to think that this profoundly designed program is designed by a colored person. The Republicans are not interested in the country; they are just jealous and burning inside. Instead of working on Repeal and Replace, a law maker who is concerned of this country should work to Embrace and Enhance the Obama Care so that this country becomes a healthy country.
6
The part that doesn't get mentioned is how single payer would help increase the global competitiveness of industries such as the auto industry. Employers would no longer be paying for health care - sometimes at Cadillac rates - for their employees allowing them to increase profit (I am assuming that whatever tax structure is put in place to finance single payer would be less than the cost of the current insurance plans because of the greater efficiencies and reduced costs) or increase wages to employees or both.
Which sounds like Republican rhetoric.
However in a country that believes that government should not do anything that the private sector can do .. I cannot see the elimination of the private insurance market.
Unfortunately.
Which sounds like Republican rhetoric.
However in a country that believes that government should not do anything that the private sector can do .. I cannot see the elimination of the private insurance market.
Unfortunately.
5
The ACA requires government subsidizes but added no tax revenue stream to fund them. It instead uses the 'Unfunded Mandate' tactic of a tax penalty for those who do not have private coverage, but otherwise does not add tax revenue to fund its necessary low-income subsidies. An ACA tax like the Medicare tax would fix this, but the GOP always gets their tighty-whities in a Norquist twist about any new tax.
Healthcare could be kept private-based by properly funding the inevitable subsidies needed by low-income families. If keeping the health insurance companies profitable is the objective, a health care tax to cover subsidies will do so. Or we could skip enriching insurance companies and go straight to Medicare for all, but not this term.
Healthcare could be kept private-based by properly funding the inevitable subsidies needed by low-income families. If keeping the health insurance companies profitable is the objective, a health care tax to cover subsidies will do so. Or we could skip enriching insurance companies and go straight to Medicare for all, but not this term.
6
ACA actually includes income based subsidies for working families to purchase insurance, with sliding scale up to 400% FPL. And it pays for those subsidies with a host of new taxes, headlined by an increase in taxes on high incomes and capital gains.
So ... those things you wish ACA would do, it does.
So ... those things you wish ACA would do, it does.
1
As the flipping editorial says--right at the start!--the PPACA is largely funded by smallish taxes on wealthy people.
And the premiums, with subsidies or tax credits, are extremely affordable.
And the premiums, with subsidies or tax credits, are extremely affordable.
Tom Jeff
"If keeping the health insurance companies profitable is the objective..."
Which it is, for Republicans, then you're not talking about health care at all.
You're running off at your collective mouth about the same old shibboleths: free markets; private enterprise; business always good; government deserves to die.
So, they apparently believe, do the people. Because any fool can see health care is not a classical market, it can never be, and any attempt to act like it is ends up killing people.
What this sorry debate has given us is clear evidence that the majority of Republicans, and our President, value cash over human life. There is no arguing that point.
"If keeping the health insurance companies profitable is the objective..."
Which it is, for Republicans, then you're not talking about health care at all.
You're running off at your collective mouth about the same old shibboleths: free markets; private enterprise; business always good; government deserves to die.
So, they apparently believe, do the people. Because any fool can see health care is not a classical market, it can never be, and any attempt to act like it is ends up killing people.
What this sorry debate has given us is clear evidence that the majority of Republicans, and our President, value cash over human life. There is no arguing that point.
2
Thanks Dr. K for the perfect analogy. Your genius is making the complex easy to understand and visualize. All of us who support the ACA can now use this example. In fact, the next time I attend a social event populated with my conservative acquaintances (friends is too strong a term) I am taking a big balloon and small box with me. I'll label the balloon "Healthcare" and the box "Small Government." This will be fun!
6
The Republicans have Trump the consumate Art of The Deal deal maker, and Paul Ryan, the brilliant policy wonk. What could possibly go wrong? Let's see. There is the fundamental issue that Republicans don't believe in health care as a basic right, they believe in the magic of the free market in all circumstances (even for healthcare, which is clearly not a free market), and have leaders who would much rather give tax breaks to the rich (the richer the better) and take health insurance and healthcare away from the poor and older Americans (amazingly the core base of Republican voters, at least the white ones). And, of course, both Trump, whose great deal making skills are based purely on lying and cheating, and Ryan, who only plays a policy wonk on TV, are complete frauds and phonies. After 7 years of screaming that Obamacare is horrible and will destroy the country, they have absolutely nothing to offer as a replacement.
9
"...what was the constant refrain of “repeal and replace” all about?" Conventional wisdom suggests the GOP resistance to the ACA is based on the disdain for the included government mandates and complicated policy. However closer examination revels their true objection is centered on the ideological objection to the creation of another entitlement. The entitlements of Social Security and Medicare are indeed very large, consuming vast percentages of the budget. The self inflicted political environment makes it very difficult to fund and manage the programs in a manner that assures their survival and this self-servingly adds fuel to the objections to the ACA. Creation of another entitlement is a weighty topic and it is a conversation the nation needs to have.
So why isn't the nation having that discussion? Instead of defining what it takes to have a healthy population and developing policy to deliver that objective in the most efficient manner the discussion is confined to a limited series of political talking points regarding the cost of a program but carefully avoiding the objective. Its no wonder the conversation is circular in nature. Perhaps the politicians sense they would be perceived as too crass and uncaring if the discussion would wander into the realm of the richest nation on earth can't afford to keep its population healthy. The nation needs better! We need to demand better! The cost of poor health does not magically disappear with the repeal of the ACA.
So why isn't the nation having that discussion? Instead of defining what it takes to have a healthy population and developing policy to deliver that objective in the most efficient manner the discussion is confined to a limited series of political talking points regarding the cost of a program but carefully avoiding the objective. Its no wonder the conversation is circular in nature. Perhaps the politicians sense they would be perceived as too crass and uncaring if the discussion would wander into the realm of the richest nation on earth can't afford to keep its population healthy. The nation needs better! We need to demand better! The cost of poor health does not magically disappear with the repeal of the ACA.
5
The wonder of it all is never discussing the costs of each war we so improvidently enter..our "leader" just keeps poking sticks at other crazy leaders of small countries to justify massive military spending; ergo, our "leader" can blame health care costs for unbalanced budget..
1
It's technically possible a Democratically-controlled House and Senate *could* propose a single payer system à la Medicare but once the health insurance companies got finished buying off Congressmen with campaign contributions it would *never* happen. We have the best Congress unfettered money can buy and we're all stuck with it.
9
That's because the system is so unfairly apportioned that the money can be concentrated in the relatively few places that make a difference.
6
Thank you Prof. Krugman for putting this complex topic in very simple language. It is very soothing to think than reason is surely going to prevail this time around. Am I the only one though, who gets a sinking feeling, every time the Republicans start talking about a new repeal bill? Are these not the same people who did repeal ACA 50+ time during previous administration without offering any improvements, yet got elected again?
6
Trump suggested adding infrastructure to Trumpcare to get the Dems onboard (to share the blame)! Clearly the GOP has no intention of providing a viable health care plan--even as camouflage for a wealthy tax cut. Equally clearly, they have little respect for the electorate in thinking a bill with neither health nor care will fool us as long as it's labelled "HealthCarePlan".
Want to cut money from health care? 18% saved by Medicare with its 2 % overhead vs 20% for private insurance companies. 60 % of bankruptcies are caused by medical bills--end that disaster. The inability to set up your own business or move from fears of losing your insurance--end that. The use of hospital emergency rooms as the doctor of last resort--end that. Keeping adults employed because diseases are caught at a treatable stage (plus curtailing the enormous costs of end-stage treatment)--good plan. Medicare would standardize costs, allow bargaining--just as insurance companies presently do--for lower treatment costs and medicine prices.
1/2 US births, 1/4 US children, almost 2/3 nursing home care provided by Medicaid--THESE ARE THE PEOPLE CONGRESS WISHES TO ROB FOR A WEALTHY TAX CUT. Aren't theft, misrepresentation, and "bait-and-switch" crimes?--Except when it's Congress!
Want to cut money from health care? 18% saved by Medicare with its 2 % overhead vs 20% for private insurance companies. 60 % of bankruptcies are caused by medical bills--end that disaster. The inability to set up your own business or move from fears of losing your insurance--end that. The use of hospital emergency rooms as the doctor of last resort--end that. Keeping adults employed because diseases are caught at a treatable stage (plus curtailing the enormous costs of end-stage treatment)--good plan. Medicare would standardize costs, allow bargaining--just as insurance companies presently do--for lower treatment costs and medicine prices.
1/2 US births, 1/4 US children, almost 2/3 nursing home care provided by Medicaid--THESE ARE THE PEOPLE CONGRESS WISHES TO ROB FOR A WEALTHY TAX CUT. Aren't theft, misrepresentation, and "bait-and-switch" crimes?--Except when it's Congress!
6
when republicans suggest that it is "them" that are gaining benefits at your expense, the rallying cry of repeal is moving. But when the details are discussed, and it is not about them getting benefits, but us losing them, the repeal crowd gets a bit more reflective.
4
You should always remember that all this is just fiddling around the edges of a very inefficient health care system. Here is an analogy to what we are doing:
Imagine a country, US, that has a problem with sewerage ditches. Now suppose for decades we have been digging our ditches with teaspoons. Also suppose the rest of the world has been using mechanized equipment.
Eventually we see that they have been getting better ditches, dug more quickly and at much lower cost. So after a big fight, we pass the ASA, the Affordable Shovel Act in which we use shovels instead of teaspoons. Yuge improvement.
But wait, there are people who hate improvement and also have donors in the spoon industry. Somehow they get in power and propose a "compromise." We will ditch the ASA and go back to spoons, but this time we will use TABLESPOONS.
Here is some of the data:
All other industrialized countries have some form of universal government run health care. They get at least as good care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person. If our system were as efficient, we would save over $1.5 TRILLION each year.
www.pnhp.org & www.oecd.org, especially
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
Here are some per capita figures for health care costs in 2013 in PPP dollars
OECD average - 3463
US - 8713
UK - 3235
France - 4124
Australia (similar obesity) - 3966
Canada - 4361
Imagine a country, US, that has a problem with sewerage ditches. Now suppose for decades we have been digging our ditches with teaspoons. Also suppose the rest of the world has been using mechanized equipment.
Eventually we see that they have been getting better ditches, dug more quickly and at much lower cost. So after a big fight, we pass the ASA, the Affordable Shovel Act in which we use shovels instead of teaspoons. Yuge improvement.
But wait, there are people who hate improvement and also have donors in the spoon industry. Somehow they get in power and propose a "compromise." We will ditch the ASA and go back to spoons, but this time we will use TABLESPOONS.
Here is some of the data:
All other industrialized countries have some form of universal government run health care. They get at least as good care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person. If our system were as efficient, we would save over $1.5 TRILLION each year.
www.pnhp.org & www.oecd.org, especially
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
Here are some per capita figures for health care costs in 2013 in PPP dollars
OECD average - 3463
US - 8713
UK - 3235
France - 4124
Australia (similar obesity) - 3966
Canada - 4361
As long as Republicans, corporate Democrats, and the wealthy, insist on grabbing more for themselves, while causing ever increasing harm to the majority of Americans, they will not succeed. We will resist this immoral behavior, at any cost.
5
Wouldn't the balloon just break?
5
Let 45 and GOP keep floating that balloon because it's a battle cry for resistance to the regressive policies these old white men are enacting right now. Call, write, go to town halls. Spread the word! There's a lot on the line, not just the dire need for healthcare.
3
It's easy to understand once you accept that the fundamental principle of the GOP is greed. It only exists as a political party to enrich its wealthy supporters and destroy the lives of as many poor people as they can with tax cuts for people who don't need them and eliminating any support for the poor or sick. Freedom = greed. Look who they put at the top.
4
Once again we have Krugman analyzing Republican fraudulence instead of applying his expertise to a better policy proposal. Pointing out the obvious -- that Ryan's plan cannot but harm -- wastes 800 words on the Times's readership. We're well aware of Obamacare's 3-legged stool.
But the exchanges cover just 6 million people. They're a bandaid on a corrupt system. What to do?
Krugman should be making the relentless case for a single payer system. I would be interested to read his analysis of HR 676, for example. If he believes it's viable, he should say so, and explain how supposedly left-leaning politicians are or are not supporting it. If not, why not, and what then?
Krugman claimed during the election that Bernie Sanders's healthcare proposal was too expensive. HR 676 -- also Medicare for All -- claims to save $1 trillion annually in national healthcare expenditures. Only one claim can be true.
I would like the Conscience of a Liberal to start analyzing and advocating true liberal healthcare proposals. He would hold Democrats' feet to the fire, and give them a point of reference during the coming campaign.
But the exchanges cover just 6 million people. They're a bandaid on a corrupt system. What to do?
Krugman should be making the relentless case for a single payer system. I would be interested to read his analysis of HR 676, for example. If he believes it's viable, he should say so, and explain how supposedly left-leaning politicians are or are not supporting it. If not, why not, and what then?
Krugman claimed during the election that Bernie Sanders's healthcare proposal was too expensive. HR 676 -- also Medicare for All -- claims to save $1 trillion annually in national healthcare expenditures. Only one claim can be true.
I would like the Conscience of a Liberal to start analyzing and advocating true liberal healthcare proposals. He would hold Democrats' feet to the fire, and give them a point of reference during the coming campaign.
10
Krugman has nothing to offer; just criticisms.
And he'll never admit Bernie was right and he was wrong re: single payer.
History will tell....
Bernie' s legacy will be as the one legislator who thought single payer was not only possible but the right thing to do and who fought for it and got the rest of it to ask for it. And we'll eventually have single payer b/c of him.
Krugman will be remembered as an Enron consultant and the man who predicted on election night 2016 that Trump's election would cause the US to sink into a depression from which it never recovered.
And he'll never admit Bernie was right and he was wrong re: single payer.
History will tell....
Bernie' s legacy will be as the one legislator who thought single payer was not only possible but the right thing to do and who fought for it and got the rest of it to ask for it. And we'll eventually have single payer b/c of him.
Krugman will be remembered as an Enron consultant and the man who predicted on election night 2016 that Trump's election would cause the US to sink into a depression from which it never recovered.
3
He has. General guess is that Bernie's figures are off by 50%, and it'd cost at least double what he claims.
Doesn't mean it's a bad idea--it's a good one--but pricey, and fahgeddabout the politics of getting single-payer enacted. That's a balloon and a box, too.
Doesn't mean it's a bad idea--it's a good one--but pricey, and fahgeddabout the politics of getting single-payer enacted. That's a balloon and a box, too.
1
The Democrats are also in cahoots with Big Insurance and Big Pharma. The Democrats will never support single payer. It doesn't matter what the people want.
The Republican War of Unspeakable ideology has continued for decades and shows no sign of abating.
It involves a continuing effort to rewrite history and to propagandize the American people. Their enemy is and always was government that didn't work - not because it didn't work but because they said it didn't.
Teddy Roosevelt's progressive movement triggered one internal revolution within the party of "it's all about us" against the people.
FDR became their enemy and in furtherance of that war, they created generations off lies including their scurrilous conspiracies accusations. Think not? They spent decades forcing a rewriting of history to proclaim Admiral Kimmel and General Short as scapegoats for a Roosevelt Conspiracy. The reality was that they failed their country but not deliberately - they just fell short.
The Republicans Great Red Scare never ended with false tales of Americans conspiring with Russia to overthrow the American government from within.
Now we are facing the reality of the American government effectively being destroyed from within. Their objectives widen - now is Health care, but they are determined to end Social Security and Medicare. At the same time, they discovered over the decades the virtues of socialism for the rich. Our bloated defense contracting reflects corruption and internal offshoring of government contracts to states without unions or labor laws.
Oddly, those states remain poor, as intended.
Their r
It involves a continuing effort to rewrite history and to propagandize the American people. Their enemy is and always was government that didn't work - not because it didn't work but because they said it didn't.
Teddy Roosevelt's progressive movement triggered one internal revolution within the party of "it's all about us" against the people.
FDR became their enemy and in furtherance of that war, they created generations off lies including their scurrilous conspiracies accusations. Think not? They spent decades forcing a rewriting of history to proclaim Admiral Kimmel and General Short as scapegoats for a Roosevelt Conspiracy. The reality was that they failed their country but not deliberately - they just fell short.
The Republicans Great Red Scare never ended with false tales of Americans conspiring with Russia to overthrow the American government from within.
Now we are facing the reality of the American government effectively being destroyed from within. Their objectives widen - now is Health care, but they are determined to end Social Security and Medicare. At the same time, they discovered over the decades the virtues of socialism for the rich. Our bloated defense contracting reflects corruption and internal offshoring of government contracts to states without unions or labor laws.
Oddly, those states remain poor, as intended.
Their r
5
I pay 8.5% of my income in health taxes. Assuming a salary of $50,000 that's a monthly payment of $354. That's it. No co-pays, no deductibles. I can see a doctor the same day for something urgent and non-urgent stuff is usually a wait of between a few days and one month, usually closer to a few days.
Single payer works.
Single payer works.
8
If you're younger, and you limit what docs make.
1
In 2012, the "PBS Newshour" did an a series on the state of American healthcare. Data was based on 2007 statistics. Though no surprise, some of the many disturbing facts were:
1 People in the U.S. spent 2 1/2 time the amount of money per person than in the average Western country.
2 The U.S spent more, in fact the most per person than 34 Western Countries.
3 The percentage of health care costs made up the largest percentage of the GNP than in 34 Western Countries.
4 On rating the quality of health care, we rated somewhere in the 30's, among western countries.
5 On infant mortality we rated in the 20's.
However we rated number 1 in certain health areas.
1 We are the only Western country without some form of Generalized National health care.
2 We have the most obese population in the world.
3 We spend the highest prices on pharmaceuticals than any other western countries.
4 The U.S. along with New Zealand are the only 2 countries in the world that allow Direct to the consumer Pharmaceutic Advertising to the consumer. They use TV, Radio, The print media etc.
Interestingly, Presidents Truman, Eisenhower, Nixon, Clinton and Obama (republican and democratic presidents) attempted to handle these problems and in all cases they were thwarted by Republican congresses.
Trump and Ryan are attempting to destroy healthcare access once in for all.
Thus, due to corporate and congressional greed, we're willing to sacrifice our health and well being. Inexcusable and shameful!
1 People in the U.S. spent 2 1/2 time the amount of money per person than in the average Western country.
2 The U.S spent more, in fact the most per person than 34 Western Countries.
3 The percentage of health care costs made up the largest percentage of the GNP than in 34 Western Countries.
4 On rating the quality of health care, we rated somewhere in the 30's, among western countries.
5 On infant mortality we rated in the 20's.
However we rated number 1 in certain health areas.
1 We are the only Western country without some form of Generalized National health care.
2 We have the most obese population in the world.
3 We spend the highest prices on pharmaceuticals than any other western countries.
4 The U.S. along with New Zealand are the only 2 countries in the world that allow Direct to the consumer Pharmaceutic Advertising to the consumer. They use TV, Radio, The print media etc.
Interestingly, Presidents Truman, Eisenhower, Nixon, Clinton and Obama (republican and democratic presidents) attempted to handle these problems and in all cases they were thwarted by Republican congresses.
Trump and Ryan are attempting to destroy healthcare access once in for all.
Thus, due to corporate and congressional greed, we're willing to sacrifice our health and well being. Inexcusable and shameful!
15
Yes. Everybody knows the facts. But Republicans AND Democrats owe Big Insurance too much. What the people want, what would be good for the nation doesn't mean anything.
3
We absolutely do NOT have the most obese population in the world. Look it up! The top nation for obesity is Australia -- WITH national health care. The next is New Zealand, ditto. The third is Israel (who knew?), where they have socialized medicine. The USA was no. 4 in obesity rates.
I can't explain why New Zealand has permitted drug ads -- I think they are an abomination that has helped lead to to our present-day mess of a system. But they are a tiny, mostly white nation of 4 million vs. the USA which is very diverse and 330 million.
I can't explain why New Zealand has permitted drug ads -- I think they are an abomination that has helped lead to to our present-day mess of a system. But they are a tiny, mostly white nation of 4 million vs. the USA which is very diverse and 330 million.
Don't know where you got that figure, but according to the CDC we are the most obese.
Would you care to explain how New Zealand (as you say, a small 4 million people coutry) is in someway responsible in leading the U.S. into our health care mess?
Thank you.
Would you care to explain how New Zealand (as you say, a small 4 million people coutry) is in someway responsible in leading the U.S. into our health care mess?
Thank you.
"if you want to make care available to Americans who have pre-existing medical conditions — including the condition of being not rich and being relatively old, but not yet eligible for Medicare — you have to find some way to subsidize them."
Exactly so, Professor. The Medicare tax, for example, is income-based, not age-based. Insurance companies base life & health rates on age, but the tax structure should not. Many people have their highest incomes near retirement, but many do not. Low income older workers and retirees are impoverished by health care rates that favor the young, that is, rates that age-based.
What other taxes do we have that are age-based? Not income, sales, FICA, estate, or capital gains. There are some age limits on deductions or entitlements, eg. 70 and 65, but a health care tax rate that penalizes older people for their "pre-existing condition" of being older undermines the whole system. A health care tax rate must be age-independent or it is unfair, immoral, and violates the 14th Amendment. Making it income-based would do just as much to incentivize the young as making it age-based.
The government is not a 'for profit' business. Tax fairly.
Exactly so, Professor. The Medicare tax, for example, is income-based, not age-based. Insurance companies base life & health rates on age, but the tax structure should not. Many people have their highest incomes near retirement, but many do not. Low income older workers and retirees are impoverished by health care rates that favor the young, that is, rates that age-based.
What other taxes do we have that are age-based? Not income, sales, FICA, estate, or capital gains. There are some age limits on deductions or entitlements, eg. 70 and 65, but a health care tax rate that penalizes older people for their "pre-existing condition" of being older undermines the whole system. A health care tax rate must be age-independent or it is unfair, immoral, and violates the 14th Amendment. Making it income-based would do just as much to incentivize the young as making it age-based.
The government is not a 'for profit' business. Tax fairly.
6
I ran against an incumbent Republican for Congress this past November. I specifically pointed out that originally Republicans cried "REPEAL" but soon changed it to "REPEAL & REPLACE."
My point was that the Democrats actually won the argument because Republicans by claiming "replace' admitted defacto that what we had before the PPACA wasn't working.
At a recent Town Hall the Republican who beat me and got re-elected admitted "what we had before didn't work" but their health care plans do NOT solve the issues which they and we all complained about.
Krugman is spot on with his analysis.
My point was that the Democrats actually won the argument because Republicans by claiming "replace' admitted defacto that what we had before the PPACA wasn't working.
At a recent Town Hall the Republican who beat me and got re-elected admitted "what we had before didn't work" but their health care plans do NOT solve the issues which they and we all complained about.
Krugman is spot on with his analysis.
298
And Michigan voters continue to behave like turkeys voting for Thanksgiving. i'm sorry you lost, Sir. We need politicians like you. This country is circling hte drain on the way to becoming a Third World hellhole.
1
Those with pre-existing conditions unable to qualify for any affordable insurance should be allowed to join Medicare, rather than a cumbersome, ineffective, inefficient high risk pool. Simple. Efficient. Workable. Fair. Push for this Democrats. Once the Medicare door is open a crack, younger (50+) citizens can join and free-market insurance will become more and more affordable for the rest of us, and Medicare for all can become reality.
6
I like it. The shift to Medicare for All might not even take that long. If the way to have my healthcare covered by Medicare required nothing more than a pre-existing condition, I would find a way to get one. Suddenly I would be a lot more supportive of genetic testing to predict predilection for future health issues.
Insurance companies would probably help. Even with the ACA insurers have all sorts of rules to limit or delay payment for services, but their employees are still people with compassion. These employees often help the insured find ways to get coverage in spite of the rules. If those employees knew that denying coverage meant the person on the phone could now get Medicare, saying "no" would become a gift rather than a health crisis.
Many doctors would probably help as well. Right now doctors spend a lot of time fighting with insurance companies to help their patients get coverage for the care they need. All doctors would have to do is stop fighting. It isn't even an ethical dilemma for them. They make the appropriate medical recommendation. If insurance won't cover it, refer them to Medicare.
I probably sound like I am trying to be sarcastic. I am not. This scenario is one of the reasons insurance, especially a system that is largely employment-based, doesn't work. We get help paying medical bills from companies whose profits increase by successfully denying coverage to paying customers. That arrangement is guaranteed to cause problems.
Insurance companies would probably help. Even with the ACA insurers have all sorts of rules to limit or delay payment for services, but their employees are still people with compassion. These employees often help the insured find ways to get coverage in spite of the rules. If those employees knew that denying coverage meant the person on the phone could now get Medicare, saying "no" would become a gift rather than a health crisis.
Many doctors would probably help as well. Right now doctors spend a lot of time fighting with insurance companies to help their patients get coverage for the care they need. All doctors would have to do is stop fighting. It isn't even an ethical dilemma for them. They make the appropriate medical recommendation. If insurance won't cover it, refer them to Medicare.
I probably sound like I am trying to be sarcastic. I am not. This scenario is one of the reasons insurance, especially a system that is largely employment-based, doesn't work. We get help paying medical bills from companies whose profits increase by successfully denying coverage to paying customers. That arrangement is guaranteed to cause problems.
1
Medicare for all is the only way out of this box. It would cost half as much as we are now paying (since it would eliminate the vast administrative red tape caused by the health insurance industry). It would also cut costs because, with everyone covered, primary prevention of more serious health risks would be possible. Republicans would get credit for bringing the U.S. into the modern world while significantly improving the lives and health of everyone. It could make them a majority party for many, many years to come...in much the same way that the New Deal established Social Security and the Great Society established Medicare. Are Republicans smart enough to see the possibilities here? Not a chance!!!
6
I am not sure lowering costs is the reason to support a single-payer solution. Removing a large, for-profit industry from the healthcare marketplace, especially one that serves no other purpose than facilitating the payment of a sick person's medical bills with several healthy people's money, will no doubt reduce the amount of money spent by the country as a whole on healthcare. I would be surprised if we, as individuals felt we were spending less money.
I get insurance through my employer. I pay about $800 a month for my family. My employer basically matches that as a benefit to me. So I pay $1,600 a month for health insurance. When I use it I have co-pays so the more I use it, the more it costs me. My employer and I both pay lower taxes because of that $1,600.
If tomorrow everything changed and Medicare paid my medical bills so I no longer needed insurance, I don't think I would suddenly have $1,600 more a month. My employer, who now loses the tax deduction would probably keep most of its $800. My taxes will go up probably at least $800 a month. I may no longer have co-pays which would be nice.
I would love to spend less money on health insurance. But I would be happy if what I spend on insurance now went to taxes instead. I wouldn't really have any more money than I do now, but that is ok. What I get in return is a system who mission is facilitating health care payments (rather than making a profit) regardless of my current employment status.
I get insurance through my employer. I pay about $800 a month for my family. My employer basically matches that as a benefit to me. So I pay $1,600 a month for health insurance. When I use it I have co-pays so the more I use it, the more it costs me. My employer and I both pay lower taxes because of that $1,600.
If tomorrow everything changed and Medicare paid my medical bills so I no longer needed insurance, I don't think I would suddenly have $1,600 more a month. My employer, who now loses the tax deduction would probably keep most of its $800. My taxes will go up probably at least $800 a month. I may no longer have co-pays which would be nice.
I would love to spend less money on health insurance. But I would be happy if what I spend on insurance now went to taxes instead. I wouldn't really have any more money than I do now, but that is ok. What I get in return is a system who mission is facilitating health care payments (rather than making a profit) regardless of my current employment status.
2
There are ways to reduce health care expenses but that would mean reducing the price of drugs, reducing the profits of insurance companies, reining in extravagant hospital charges, subsidizing medical studies and making loans interest free, generalizing preventive care to reduce more serious illnesses later.
We have managed to make health care a very expensive, profitable and uncontrolled market enterprise from which many derive huge profits, and that is why it is so difficult to do something about i. There are too many associations, agencies, producers and marketers that drink from this plentiful spout and it is near impossible to remove them.
We have managed to make health care a very expensive, profitable and uncontrolled market enterprise from which many derive huge profits, and that is why it is so difficult to do something about i. There are too many associations, agencies, producers and marketers that drink from this plentiful spout and it is near impossible to remove them.
7
I like the box metaphor. Let's think out of it for a moment. Some easy steps to reduce health costs that are insufficiently discussed in the debate:
(1) Let Medicare reimburse physicians for Americans treated abroad (don't the Republicans like competition?);
(2) Legislate euthanasia (don't the Republicans like choice?);
(3) Promote vaccination (the most cost-effective measure in the history of medicine);
(4) Have government assume the cost of pharmaceutical R&D and then put the results in the public domain for medicines to be produced at lowest cost (well demonstrated in the economic literature as much cheaper than the current system);
(5) Promote public awareness on healthier lifestyles (no more Taco bowls Mr. President)
(6) Tax sugar, salt, all-you-can-eat buffets and oversized restaurant portions (taxes still allow the option of high sugar, etc. instead of an outright limit, one just has to pay the predictable health costs associated with sugar, etc.)
These half-dozen measures could be given a spin that would make them consistent with Republican ideology. Alas, it won't happen because the Republicans do not want to solve the problem. Republicans just want to maintain their political status quo which depends on campaign financing from the diverse interests that would be negatively affected. It's tragic.
(1) Let Medicare reimburse physicians for Americans treated abroad (don't the Republicans like competition?);
(2) Legislate euthanasia (don't the Republicans like choice?);
(3) Promote vaccination (the most cost-effective measure in the history of medicine);
(4) Have government assume the cost of pharmaceutical R&D and then put the results in the public domain for medicines to be produced at lowest cost (well demonstrated in the economic literature as much cheaper than the current system);
(5) Promote public awareness on healthier lifestyles (no more Taco bowls Mr. President)
(6) Tax sugar, salt, all-you-can-eat buffets and oversized restaurant portions (taxes still allow the option of high sugar, etc. instead of an outright limit, one just has to pay the predictable health costs associated with sugar, etc.)
These half-dozen measures could be given a spin that would make them consistent with Republican ideology. Alas, it won't happen because the Republicans do not want to solve the problem. Republicans just want to maintain their political status quo which depends on campaign financing from the diverse interests that would be negatively affected. It's tragic.
7
Superb analogy, Mr. Krugman. Thank you. Bravo. Encore please.
3
The big lie is in a death spiral.
4
To continue in Prof Krugman's analogy what the Republicans will do is pop the balloon to get it in the box....
15
If you innocently call an Asian-American an Oriental they're offended but If you ask them why they cannot elucidate. By the same token I never hear exactly why Republicans are so opposed to single payer other than to describe anecdotes.
1
Ask yourself, when did health insurance start? Early 1900's? Regardless, at one time when you got sick you went to see whatever passed as a health provider. It may have been someone who had a jar of leeches!
In the aftermath of the industrial revolution, it became common that a large enough company would provide some form of health benefit as a part of employment.
So the idea that it is the job of the federal government to provide health care for the citizens really didn't gain traction until sometime after WW2.
The far right might believe that this was a mistake and that we should go back to letting all citizens fend for themselves in matters of healthcare.
This of course ignores the fact that healthcare has radically changed, getting much more expensive in the last 50 years.
100 yrs ago we didn't know much about viruses and little about bacteria. Today we are growing human brain tissues in petri dishes to study and test new medicines.
Unfortunately, the far right wants to go backwards in time, while the rest of us want to continue forward.
Just my two cents worth...
In the aftermath of the industrial revolution, it became common that a large enough company would provide some form of health benefit as a part of employment.
So the idea that it is the job of the federal government to provide health care for the citizens really didn't gain traction until sometime after WW2.
The far right might believe that this was a mistake and that we should go back to letting all citizens fend for themselves in matters of healthcare.
This of course ignores the fact that healthcare has radically changed, getting much more expensive in the last 50 years.
100 yrs ago we didn't know much about viruses and little about bacteria. Today we are growing human brain tissues in petri dishes to study and test new medicines.
Unfortunately, the far right wants to go backwards in time, while the rest of us want to continue forward.
Just my two cents worth...
2
An image popped into my mind mind of a big, fat GOP elephant sitting on the balloon in an attempt to force it into the box...
4
What's it all about, you ask? The tax cuts; it's about the tax cuts.
7
The right answer here is single payer. Like Bernie said. All along.
6
Brilliant analogy. The question remains: why did any intelligent, thoughtful, moderate Republicans vote for Donnie and the Trum-pets?
5
Pent up bile, apparently.
2
Dr. Paul - so many limp unblown balloons can be stuffed into a square box - but blow up just one balloon - Obamacare - and the repeal and replacement of President Barack Obama's Affordable Health Care can't be accomplished by the Republicans. They keep trying to fit the square peg in the round hole. And our 45th President promised that on DAY ONE of his administration he would "repeal and replace Obamacare". So much for his promises - all chaff and no wheat, all foam, no beer, all hammer, no nail. Constant bloviating and Big League promises, cons and scams from the King of Mallomar in Palm Beach, the Southern White House. So tell us, o Griot, and our oracle and entrails-reader - Dr. Paul - if push comes to shove, how can we fit that big fat mendacious Trump into a piano-case?
4
And we have a balloon head for president.
5
Dear Mr. Krugman,
With due respect, your wrong...
It's not a balloon, it's us (the working poor).
And the box is rather oddly shaped, and made of pine, and seems to disturbingly resemble a coffin.
With due respect, your wrong...
It's not a balloon, it's us (the working poor).
And the box is rather oddly shaped, and made of pine, and seems to disturbingly resemble a coffin.
8
A great metaphor for helahtcare--republicans trying to stuff a ballon into a small box. Sadly, there is one way they can do this, and I don't put it past them: just pop the ballon... it won't matter then the shape or size of the box. And our healthcare will be just a useless shriveled thing, but they'll be able to claim victory.
7
Of course they can fit the balloon into the box. They can just pop the balloon and it will fit In easily. After all, hasn't this been the objective all along, to destroy Obamacare?
9
Eventually one of those republicans will find a pin. They will pop the balloon, and throw its airless carcass in the box and call it healthcare...fooling no one except the usual suspects. It's only a matter of time.
3
The analogy makes me nervous because eventually the pressure will pop the balloon.
3
It's important to remember that the Trump Administration has no ideas, or principles to which it is committed. Trump's rise was based on his ability to serve as a megaphone for a few very angry people; Arizonians upset with immigrant trespassers, healthy narcissists compelled to pay for health insurance; racists viewing an elegant Black President;'rust belt' workers abandoned 20 years ago. Some of that anger was justified. Some was beneath contempt. Didn't matter, he ust turn up the volume and half of America had a hissy fit. He had no intention of making and implementing policy. But goaded by Bannon he is perfectly willing to pull down regulations painfully and patiently erected to provide meager protections from the street gangs of the marketplace. The difference with health care is that Republicans threatening to act out Ryan's wonky sadism are feeling the kind of anger they've been stoking. It's visceral. Penetrates the reptilian brain. A little Payback.
4
If Republican leaders are stupid enough to bring a "replacement" bill back for a vote in Congress, it will be based upon different deceptions. But it is even harder to fool people twice.
Their "MacArthur Amendment" is really just:
Rule 1: Our bill retains Essential Benefits, Community Rating, protection of those with Pre-Existing Conditions, etc. of Obamacare
Rule 2: States can waive Rule 1
And this time their most harmful provision, giving states the option to override the protections in Rule 1 - will more likely be invoked by the Red states that are their power base. Really stupid.
Their "MacArthur Amendment" is really just:
Rule 1: Our bill retains Essential Benefits, Community Rating, protection of those with Pre-Existing Conditions, etc. of Obamacare
Rule 2: States can waive Rule 1
And this time their most harmful provision, giving states the option to override the protections in Rule 1 - will more likely be invoked by the Red states that are their power base. Really stupid.
3
There's method to the madness. If there are no Medicaid extensions in your state, the people won't get to experience the ACA for themselves. They won't know what they're missing - unless they check with their out-of-state friends.
1
I have a friend, a divorced single mom raising two teenage daughters. She works two part-time jobs with no health care benefits.
When times get tough, she sells blood. They are waiting for the eldest daughter to turn 18 so she can sell blood, too, when the need something like a car repair.
These are real people out there.
When times get tough, she sells blood. They are waiting for the eldest daughter to turn 18 so she can sell blood, too, when the need something like a car repair.
These are real people out there.
502
Heaven help us Independent. I haven't read about this in years. In a very old book titled "A Surgeon's World" by William Nolan MD, there are a couple of paragraphs devoted to homeless patients and a few to homeless people. This was in the 1960s at Bellevue and Nolan wrote about how the homeless would fake an ailment or take advantage of a real one on extremely cold nights in order to have a warm place to sleep. He also wrote about how many of them would sell their blood as often as possible to pay for whatever it was they needed. That this is what some people are being reduced to is a disgrace in what is supposedly the richest country on the planet.
And if South Caroline had accepted the FEDERALLY funded Medicaid this woman and her children would have healthcare and South Caroline would only be paying for 10% of the cost. The states that refused Medicaid were idiots.
1
I am sorry to hear of your friend and her family's struggle. This may not be very comforting, but she may want to look up the positive health benefits (to her) of giving blood. At least there is that.
May she find more financial success soon.
May she find more financial success soon.
The real problem nobody is talking about is that we spend twice as much per person on health care as other countries.
I support a government single payer but even that won't cut our costs in half. But it is definitely better than nothing.
I support a government single payer but even that won't cut our costs in half. But it is definitely better than nothing.
5
Now now imagine a reckless and rude boy named Don with a pin. He is just mocking the balloon stuffer, the balloon, as well as the weird box. At some point he decides to just poke the balloon with his pin and watch the resulting dismay with glee.
5
The balloon in the box is also another way of saying Republicans are full of hot air.
2
The Big Problem the Republicans have is that the ACA was promoted by a black president and the plan's name is "Obamacare"-forever reminded Americans what party cares enough to try and start a national health plan.
5
When it comes to health care, Congressional Republicans are collectively as smart as Sarah Palin, Ted Nugent and Kid Rock, who posed beneath of a picture of HRC after a White House dinner with Trump. As Keith Olbermann noted in a now-famous tweet: "Honest to God, had the painting fallen off the wall and hit this Trailer Park Trash trio, the national IQ would've gone up 25 points." The only way to improve Obamacare is single-payer Medicare for all.
5
A simple and devastating analogy lays bare the cynicism and futility of Republican dogma. Brilliant.
5
"They were lying all along." Amen! Republicans never wanted to provide Americans with an alternative to the ACA. All they want to do is give a big tax break to the richest people in the U.S. This has nothing to do with average Americans, or working class Americans.
5
Of course the answer is we need a working class American in the White House. But, could this ever come to pass?
1
" They can’t admit that they have no ideas without, in effect, admitting that they were lying all along."
Rs are usually proud of documenting their lengthy track record of lying. Although I agree Paul Ryan has too much self-image wrapped up in his career of ... self-image propagation.
Rs are usually proud of documenting their lengthy track record of lying. Although I agree Paul Ryan has too much self-image wrapped up in his career of ... self-image propagation.
2
Politicians who dance to their tunes get big money from the rich and their PACS. That's why politicians keep trying to repeal and replace what is essentially a beneficial program.
3
A bully and a nerd are in the house, members of the same family. Mom lets the bully in the room and he chases the nerd out, and then breaks everything in the room. He opens the window and throws a rock through the neighbors glass door. Mom and dad are fed up, and throw the bully into his room and lock the door for 4-8 years. The nerd cleans everything up, fixes and repairs what can be fixed, sets up a plan to get back the neighbors trust and goes out. Meanwhile, Mom lets the bully out feeling sorry for him. He promptly goes back down to the room and starts to break everything that was cleaned up or fixed. Lookout dad! He's opening the window and aiming for the neighbors glass door! Why is it that bully's never learn?
8
Evil people exist all over the world. In this country we call them republicans.
6
and Donald Trump and la famiglia.
1
I know somewhere else the Republicans could try to stuff that balloon. Oh wait. They already did that and it was filled with smoke.
4
They just may puncture the balloon. And then we will all cry.
4
Your big balloon in a little box reminds me of how hunters trap monkeys. They place a treasured food say peanuts inside a box that the monkey can sliver his hand into to grasp the treasure. The monkey then grabs the food thereby creating a fist which is too big for him to slide out of the trap unless he is willing to let go of the prize. The Republican monkeys are caught in the trap because they are unable to let go of their lies which has caused their hand to fist up. Come back tomorrow or anytime and the monkey Republicans will still be trapped by their self created fist.
7
Medicare for ALL paid for with a Value Added Tax.
This would solve the healthcare problem and the budget problem.
This would solve the healthcare problem and the budget problem.
1
And on the other side, it is like:
A Democrat and a Republican walk into a bar. Democrat orders a beer and the bartender asks the Republican if he wants one too. Republican answers, "if my friend here is paying".
Same thing with healthcare. Turns out that some people who vote Republican really like some good ideas that cost some money. Their preferred officials do not. And those pols build their boxes - give them this, give them that, give them a tax break......oooops, pop!
A Democrat and a Republican walk into a bar. Democrat orders a beer and the bartender asks the Republican if he wants one too. Republican answers, "if my friend here is paying".
Same thing with healthcare. Turns out that some people who vote Republican really like some good ideas that cost some money. Their preferred officials do not. And those pols build their boxes - give them this, give them that, give them a tax break......oooops, pop!
1
Congressional Republicans voted nearly 100 times to repeal Obamacare care and not once to replace it. Anyone with a cup of brains can see that they had nothing to offer and no interest in providing something. The his is what happens when you elect anti-science, alternative fact rabble to positions of power.
7
Good analogy. The bad news is Republicans actually want to pop the balloon, shove it in the box, and mail it to Antarctica. That way they can use the freed up mandatory spending to fund another round of corporate tax cuts. They just haven't found a pin sharp enough yet.
7
The Republicans find themselves in a tight spot. On the one hand, they know that if they take medical insurance away from millions of people, they will lose control of Congress. On the other hand, if they don't decrease taxes on the well off, they will lose millions of dollars in campaign contributions. It's the classic case of being between a rock and a hard place.
If only they would accept that we are all in this together, that those who are fortunate enough to have financial security have an obligation to help those who are less fortunate, that a country is only as strong as its weakest population, that income inequality is a source of discontent and unrest, then they might be able to come up with a solution to the health care dilemma.
Will the Republicans come to their senses? Not a chance!!
If only they would accept that we are all in this together, that those who are fortunate enough to have financial security have an obligation to help those who are less fortunate, that a country is only as strong as its weakest population, that income inequality is a source of discontent and unrest, then they might be able to come up with a solution to the health care dilemma.
Will the Republicans come to their senses? Not a chance!!
4
The GOP is similarly constrained Paul. They are as a party trying to stuff reality into a box of lies that they've created. But they can't.
Health care focuses the problem.
And the problem is inequality. The GOP represents the class that owns America. That class in the GOP is opposed to using their wealth for public health. But to control the GOP that small group of people in the U.S. have relentlessly waged a campaign since FDR to convince Conservative minded middle class voters to think like they do.
The campaign has worked at a municipal, county and state level allowing the GOP to gerrymander to the end that they also can control the electoral outcome at a federal level. Individuals such as Grover Norquist further seduce voters with the promise of low to no taxes.
But reality increasingly constrains this house of cards. Inequality has grown to the point that even GOP voters have to abide by reality. If they want to have health insurance, as just one example, they need AC. If the GOP wants to destroy AC they have to destroy their voters.
The house of cards is beginning to crumble in other GOP bastions such as Kansas, as well, as voters realize that they need to have tax revenue and that all of the money belongs to the class that controls the GOP.
By 2015 just the Forbes 400 controlled $2.34 trillion of U.S. wealth. It's far worse now.
Trump promised more, and better for less and those he deluded want it.
It's all about the worst inequality in our history.
Health care focuses the problem.
And the problem is inequality. The GOP represents the class that owns America. That class in the GOP is opposed to using their wealth for public health. But to control the GOP that small group of people in the U.S. have relentlessly waged a campaign since FDR to convince Conservative minded middle class voters to think like they do.
The campaign has worked at a municipal, county and state level allowing the GOP to gerrymander to the end that they also can control the electoral outcome at a federal level. Individuals such as Grover Norquist further seduce voters with the promise of low to no taxes.
But reality increasingly constrains this house of cards. Inequality has grown to the point that even GOP voters have to abide by reality. If they want to have health insurance, as just one example, they need AC. If the GOP wants to destroy AC they have to destroy their voters.
The house of cards is beginning to crumble in other GOP bastions such as Kansas, as well, as voters realize that they need to have tax revenue and that all of the money belongs to the class that controls the GOP.
By 2015 just the Forbes 400 controlled $2.34 trillion of U.S. wealth. It's far worse now.
Trump promised more, and better for less and those he deluded want it.
It's all about the worst inequality in our history.
3
There are ways to reduce the air in the balloon, but they do come with some 'costs' in terms of loss of flexibility. My son's MD recently requested an MRI for an injury. The hospital based MD was happy to refer to the hospital based MRI at a cost of 2700. With an hour of my time and help from the insurance company I found an alternative location that could do it for 900. I ended up going for the 2700 hospital one for 2 reasons- it's 3 miles away instead of 100, and the cheaper option would have required that we take a day off school and work. But if my insurer had instead provided me with the options and either a carrot (reduced out of pocket) or a stick (they're only paying 900 but I could go anywhere I want), I may have chosen differently. Now will people like this? Of course not- they want all the benefits and none of the hassles. And the cheaper version would have entailed a real cost on us- losing income and the cost of driving. But the assumption that the balloon has a fixed amount of air is simply not true- there are ways to reduce spending. Now the question every voter (and policy maker) should ask is- are their ideas going to reduce the air in the balloon with minimal 'pain' for patients and consumers. If yes, they are worth trying. But ideas like high risk pools and allowing interstate selling don't accomplish these dual goals.
1
Hot air can fill a balloon. Hot air however, cannot make up for a lack of understanding, the complete unwillingness to understand, or the refusal to look at the facts when it comes to health care and many other issues that ought to be of concern to our elected officials. Unfortunately for American citizens America is no longer being run for the benefit of its citizens (if it ever truly was). It is quite obvious that the wealthiest families and wealthiest corporations are buying and selling our elected officials and, therefore us with no interest in the fall out except to secure their own fortunes.
3
"The answer, surely, is that it began as a cynical ploy; at first, the Republicans hoped to kill health reform before it really got started."
The Republican opposition on ACA started as a reflex against Obama's election in 2008.
Somehow ACA made it through.
After the midterm elections in 2010 the official line of the party was openly stated: make Obama a one term President. The supreme goal, the silver bullett that will solve all the(ir) problems.
The rest is obstruction.
The Republican opposition on ACA started as a reflex against Obama's election in 2008.
Somehow ACA made it through.
After the midterm elections in 2010 the official line of the party was openly stated: make Obama a one term President. The supreme goal, the silver bullett that will solve all the(ir) problems.
The rest is obstruction.
2
It has become obvious an American health care system based on employment has reached the end of its shelf life & is no longer effective in providing cost-effective, affordable medical & pharmaceutical care for citizens. The GOP can carp all they want about the ACA (mostly Conservative think tank ideas), but returning to the status quo ante would bankrupt many who seek care. We may have all the access to effective medical care in the world, but without affordability we are just pounding sand.
A single payer option is the most sensible answer to expand care, reduce overhead & actually be cost effective, rather than chasing ever-escalating profits & prices. We would get a much bigger bang for our healthcare dollar. Medicare could bargain for drug prices with Big Pharma as the VA system already does, & allow everyone to put their health care dollar into something that will work in the long term, without bankrupting families & individuals. Private health insurance companies can market affordable supplemental policies similar to current Advantage plans.
A single payer option is the most sensible answer to expand care, reduce overhead & actually be cost effective, rather than chasing ever-escalating profits & prices. We would get a much bigger bang for our healthcare dollar. Medicare could bargain for drug prices with Big Pharma as the VA system already does, & allow everyone to put their health care dollar into something that will work in the long term, without bankrupting families & individuals. Private health insurance companies can market affordable supplemental policies similar to current Advantage plans.
8
Everything fits like a glove in the government run plan that 535 members of congress enacted for themselves.
2
"They’re popping up because the G.O.P. is"...cruel. Let's admit it. In order to give massive tax cuts to the rich, the GOP has to be cruel not only to the poor, but the vast majority of people that voted for them. Sure, many, maybe 30% will go along with their bankruptcy, and early death (many are going to heaven don't forget), but most will notice. Instead of trying to stuff that balloon in the box, they should try and stuff their pinheads in the box.
With regard to single payer, that the GOP will never go for unless there's some catastrophe, that would be the best way to lower costs, as if they care about that.
With regard to single payer, that the GOP will never go for unless there's some catastrophe, that would be the best way to lower costs, as if they care about that.
1
Great illustration. Exactly what they are doing. Stupid.
The mantra of I'm healthy ask I shouldn't have to pay for someone else's bad health is pretty stupid. I'm guessing that they change their minds when they get sick. But the ultimate stupidity comes from those who say they're men, so they don't need maternity coverage. Where do they think babies come from? Unless they're planning on smiling out on their pregnant wives or girlfriends, then it's for their benefit too.
3
The GOP plan is simple - everybody has the right to get health insurance, if, and only if, they can afford it. (Yes, there will be a pretense of giving care to the very, very needy.)
In short, health care will be like a yacht --- if you have to ask what it costs, you can't afford it.
In short, health care will be like a yacht --- if you have to ask what it costs, you can't afford it.
2
The Republicans constant refrain of "repeal and replace" Obamacare has always been not-so-subtle code for "repeal and replace" Obama.
2
The Greed Over People party and their front man
Paul Ryan, the boy who cried, "Repeal-and-Replace"
are anti-American sock puppets for the 0.1%.
Send them all packing in '18
Paul Ryan, the boy who cried, "Repeal-and-Replace"
are anti-American sock puppets for the 0.1%.
Send them all packing in '18
7
Without a way to control costs, no system other than one that can dictate what it will pay for healthcare will work. The tradeoff: you have to wait for things that are not essential. Is that worth it so that all citizens are covered? Absolutely.The Affordable Care Act was a good start towards taking us to something better. The Republican plan( if that is what you deem to call it ) about as close as us traveling to another planet with intelligent life.
2
Waiting for nonemergency care is not a fact of life in countries with socialized medicine. That's a myth.
People in Sweden and France and Canada see doctors and dentists every day, schedule appointments just like we do. They just don't worry about being "in network" or co-copayments.
We already know how to run nationalized healthcare, and we know it's cheaper than the private system. The wonder is that Democrats, including Krugman, aren't making the case for it.
People in Sweden and France and Canada see doctors and dentists every day, schedule appointments just like we do. They just don't worry about being "in network" or co-copayments.
We already know how to run nationalized healthcare, and we know it's cheaper than the private system. The wonder is that Democrats, including Krugman, aren't making the case for it.
3
Single-payer, universal coverage is better and cheaper--just look at other industrialized countries on the other side of the Atlantic or north of our border
3
Simple solution. Prop the Pres in place at his desk with a sharpie at the ready. Place a piece of paper with the glaring headline 'Repeal of the ACA' in a leather binder. Doesn't matter what words are on the paper, he won't read them anyway. Let the VP present the binder to the Pres with all the aplomb of the best waiter in the world. Putting on his stern 'we're getting something done' look he'll sign the paper and proudly hold up the binder declaring it's the most terrific health care in the world. Health care problem solved.
1
Walk around NYC and look at who owns most of the landmark skyscrapers, insurance companies. Not for profit insurance companies, what a scam.
1
they want to de-legitimize our first black president. it was always about that.
2
They're still kicking themselves for allowing McCain to choose Sarah Palin rather than a conventional male Republican as his running mate in 2008. Obama was supposed to be the fall guy then.
1
Problems brewing all around him, and what did Trump do for most of yesterday? Entertain the Beverly Hillbillies at the White House.
Surely, the spirits of past presidents that haunt the place will soon rise up and force a return to dignity and a semblance of leadership--with or without the current occupant.
Surely, the spirits of past presidents that haunt the place will soon rise up and force a return to dignity and a semblance of leadership--with or without the current occupant.
1
Why don't Democrats, Republicans, and Mr. Krugman study the way Singapore manages healthcare, universal coverage while spending 5% of GDP? Their time would be better spent, rather than the constant whining of progressives in the NYT.
Advocates of reform should have invited directors of successful foreign systems to testify to Congress how they do it, to educate the US public as well as Congress, before any legislation was drafted.
2
Because Republicans aren't actually interested in fixing health care (unless, of course, it results in massive tax cuts for the wealthy).
4
The AHCA failed a few weeks ago, and here we go again with a "compromise" measure that's all smoke and mirrors and as downright heartless and cruel as every GP measure to unwind the ACA. How are so-called "moderate" GOP members going to support this? They won't. Trump is desperate for a "win" in the House and is recklessly rolling the dice again - lets pray that after his attempt fails that this unhinged man won't look to lobbing "beautiful" bombs into North Korea for the "win" he covets. We have entered Strangelovian times.
3
You can fit a balloon into a box, but this balloon is too fat! Let out some of its useless air. Profits for insurance companies, profits for pharmaceutical companies, unnecessary procedures performed on the elderly, corrupt profits for doctors who scam medicare and probably so much more. Just as the American people need to slim down for better personal health, so does our so called health care system. The only other option? Pop!
2
The religion is called neoliberalism it is neither new nor liberal . It does not work for healthcare and it will not work for education and it will not work for the military. If America will not abandon the belief in the all knowing private sector it will die. It will probably die sooner now that all the competent people have been chased from the public sector.
5
When you make relief of distress a profit center, you motivate the expansion of distress to grow profits.
3
One's health is personal. It's private and is only really discussed socially when it becomes a dominant concern such as with age. What has really happened is having it discussed so prominently in the news for over seven years, which, at long last, has made Americans aware of what is needed for their national health care system to work for everyone! Mr. Krugman with his balloon analogy has made it even simpler to grasp.
And that is the Republican dilemma... and possibly what might save us: sunshine on the issue.
And that is the Republican dilemma... and possibly what might save us: sunshine on the issue.
1
"All of this raises the obvious question: If Republicans never had a plausible alternative to Obamacare, if this debacle was so inevitable, what was the constant refrain of “repeal and replace” all about? . . . They can’t admit that they have no ideas without, in effect, admitting that they were lying all along."
And there you have it. Republicans thrived on obstruction. They're failing miserably in governance. We now have the "gang that couldn't shoot straight" in full control of and pulling al the levels of power. We're in for rocky times.
And there you have it. Republicans thrived on obstruction. They're failing miserably in governance. We now have the "gang that couldn't shoot straight" in full control of and pulling al the levels of power. We're in for rocky times.
1
While the balloon and box is certainly an apt metaphor, I'd be more inclined to go with carnival game of whack-a-mole. While the Republicans just keep hammering away with their lone ideological mallet, those pesky moles (i.e., aspects of Obamacare) simply won't stay underground.
3
The Republican anthill is in deserved disarray and their crazy new
queen has no clue about being the queen.
Republican stubborness and ignorance and backward notions
and anti-Obama racism and party-first/country-last determinations
are, gratefully, headed for the trash heap of history. Right along
with their trashy president who is costing more in lost tourism
alone than will ever be recovered.
Finally, bring on universal healthcare because the people need it
and want it and they are fed up with the GOP.
queen has no clue about being the queen.
Republican stubborness and ignorance and backward notions
and anti-Obama racism and party-first/country-last determinations
are, gratefully, headed for the trash heap of history. Right along
with their trashy president who is costing more in lost tourism
alone than will ever be recovered.
Finally, bring on universal healthcare because the people need it
and want it and they are fed up with the GOP.
1
Nobody wants the balloon to fit in the box. This exercise is designed to appease Trump supporters who railed against the ACA without changing it. The only further action required is to place the blame.
2
If I remember correctly from my childhood, eventually all of the the pushing and shoving and squeezing bursts the balloon. Thousands of Americans will suffer and thousands of Americans will die because the Republican Party decided to oppose healthcare reform. That is no child's game. That is serious.
2
The fact is that the Obamacare box and balloon fit perfectly together for the Republicans. It's their plan.
The great thing is their pathologically destructive bent is increasingly exposed and the longer it is, the more people say to themselves
'Yeah , why don't we have single payer?'
The great thing is their pathologically destructive bent is increasingly exposed and the longer it is, the more people say to themselves
'Yeah , why don't we have single payer?'
1
But wait, there's more. Behind door number three is....ah oh..the same old thing. They need to start over on healthcare and look at fixing what's wrong with the ACA. That would be a start. For that they need a few key elements missing from the current debate: an analysis of what is working and what isn't, a discussion and a consensus, then a plan followed by a vote. The next element, critically missing from the current debate, would be leadership. There is none. Ryan has proven he cannot entertain new thoughts, HHS Price is glued to his tired old right wing conservative physician influenced thinking, and the POTUS is merely seeking a win to show for the first 100 days of a disastrous administration. The last element is to depersonalize the ACA discussion. This isn't about Barack Obama the man, which is what has fueled their hate of the ACA to date perhaps as much as anything else and their attempts to wipe out any vestige of his accomplishments related to healthcare. So, until they get these things fixed the healthcare debate will be stalled, and they'll default to their previous inhumane and mean spirited changes. The balloon-box problem again.
Threatening poor people and their ability to afford healthcare with government help is truly vicious. The rest of the country has started to finally wake up to the complexity of providing as coherent healthcare system. "No one get's left behind" should be the starting point of the discussion. Then something might fit.
Threatening poor people and their ability to afford healthcare with government help is truly vicious. The rest of the country has started to finally wake up to the complexity of providing as coherent healthcare system. "No one get's left behind" should be the starting point of the discussion. Then something might fit.
2
The ACA is horrible and should just be repealed. What good is "insurance" when nothing is covered. I have a Silver plan and I have never paid so much out of pocket in my entire life after paying the highest premiums of my lifetime.
1
I agree that the premiums are outrageous, but for those who previously couldn't get insurance for any price, it's far better than nothing.
2
Roy Cohn was a lawyer. He was very aggressive, hurt people, and eventually was disbarred for unethical practice. He also gave D. Trump legal and strategic advice and
guidance. Here are some of Cohn's ways of dealing, which I place alongside D. Trump's:
"-I bring out the worst in my enemies and that's how I get them to defeat themselves."
[D. Trump behaves undiplomatically and aggressively toward whom he perceives to be opponents].
"-Go after a man's weakness, and never, ever, threaten unless you're going to follow through, because if you don't, the next time you won't be taken seriously." [D. Trump may have behaved this way during business dealings. It is not clear if he has behaved this way yet in the role of president. I'm not sure if what he has done in regard to Syria, apparently differing with Russia, is like this tactic (?); or, is it a behind-the-scene maneuver with Russia ?]
- "I don't want to know what the law is, I want to know who the judge is." [Could "the judge" be for D. Trump the court of public opinion, public opinion which does not equal reasonable good judgment (?) ]
- "I don't write polite letters. I don't like to plea-bargain. I like to fight." [There is evidence from D. Trump's campaigning and tweets that he adheres to these methods].
guidance. Here are some of Cohn's ways of dealing, which I place alongside D. Trump's:
"-I bring out the worst in my enemies and that's how I get them to defeat themselves."
[D. Trump behaves undiplomatically and aggressively toward whom he perceives to be opponents].
"-Go after a man's weakness, and never, ever, threaten unless you're going to follow through, because if you don't, the next time you won't be taken seriously." [D. Trump may have behaved this way during business dealings. It is not clear if he has behaved this way yet in the role of president. I'm not sure if what he has done in regard to Syria, apparently differing with Russia, is like this tactic (?); or, is it a behind-the-scene maneuver with Russia ?]
- "I don't want to know what the law is, I want to know who the judge is." [Could "the judge" be for D. Trump the court of public opinion, public opinion which does not equal reasonable good judgment (?) ]
- "I don't write polite letters. I don't like to plea-bargain. I like to fight." [There is evidence from D. Trump's campaigning and tweets that he adheres to these methods].
1
When the new GOP plan comes out, let's make sure it gets extreme vetting. How will it affect us? What does the Congressional Budget Office say? Will people lose coverage now, 2 or 4 years down the road?
Details man, details.
Pay no attention to the man in the palace who says something innocuous like "this plan keeps improving, it's going to be really really good".
Details man, details.
Pay no attention to the man in the palace who says something innocuous like "this plan keeps improving, it's going to be really really good".
3
Soon enough "repeal and replace" will become "tweak and rename" so Republicans can declare mission accomplished and move on.
2
"And because the task Republicans have set for themselves is basically impossible, their ongoing debacle over health care isn’t about political tactics or leadership. Even if Donald Trump were the great deal maker he claims to be, or Paul Ryan the policy wonk he poses as, this thing just can’t work."
Two comments:
First, Republicans have never supported universal health care, and they don't now. Formerly they oppose it outright, but now they cover by lying about their real anti-government aims. Second, because "this thing just can't work", they try to fake it.
The result offers another test of American gullibility, while much of the rest of the developed world stares on in amazement.
Two comments:
First, Republicans have never supported universal health care, and they don't now. Formerly they oppose it outright, but now they cover by lying about their real anti-government aims. Second, because "this thing just can't work", they try to fake it.
The result offers another test of American gullibility, while much of the rest of the developed world stares on in amazement.
2
The GOP's philosophy on health care reform seems to be, "Throw enough stuff on the wall and some of it might stick." They cannot make a silk purse out of a sow's ear no matter how they try to dress it up. Metaphor's aside, it all goes back to their intent to do away with anything that is associated with President Obama.
2
Here I am, having a job all my life. Never needing any "government" programs to keep me afloat. Putting money away for my retirement. Doing everything right by GOP standards. Then the unexpected happens and I have a major healthcare crises. ALL of my hard earned retirement funds now need to be used to pay my medical bills. My paid off house is now on the auction block, my rental house is now on the same block. I'm in this predicament because the Republicans changed health insurance into a worthless payout to for-profit insurance companies in the name of free market economic theory. The rest of my life I will be working to payoff any left over bills and living off a number of government programs to survive. Is this now the American dream end game?
6
The balloon analogy is accurate. Another one would be a carpenter making a square picture frame. He cuts one wood edge too short, so he shortens all of the edges. But now the picture is too big. So he trims the picture but trimmed it too much. So he shortens the wood edges again. As you can see, if you are not accurate from the beginning or during the corrections things just get worse and worse. More and more benefits get cut and the picture is now cropped and unrecognizable.
But remember, the plan has no presidential input. Mr. Trump cannot bother with the details or rationalize any of the policies that would correspond to his repeated campaign promises of great inexpensive healthcare for everyone. He can't get involved because any presidential input would take too much of his time away from being a talking Twitter head pundit, with his latest prediction today commenting on the outcome of the French election following a shooting in Paris. The bottom line is we have a leader who knows little of the job, is not curious about delving into policy, and behaves like an ignorant buffoon.
But remember, the plan has no presidential input. Mr. Trump cannot bother with the details or rationalize any of the policies that would correspond to his repeated campaign promises of great inexpensive healthcare for everyone. He can't get involved because any presidential input would take too much of his time away from being a talking Twitter head pundit, with his latest prediction today commenting on the outcome of the French election following a shooting in Paris. The bottom line is we have a leader who knows little of the job, is not curious about delving into policy, and behaves like an ignorant buffoon.
1
Thank you Dr. Krugman. You are at your best when explaining our health care crisis and defending/explaining the ACA. It remains incredibly sad to me that the USA is the only large Western nation that does not provide its citizens with universal health care. The irony, of course, is that universal care would lower the cost of health care. The right wing is so anti-public sector that they would rather have private insurance coverage costing a higher percentage of our national resources and providing health care to fewer citizens, than to guarantee health care to all through Medicare for all.
3
Single-payer can honestly be framed as a conservative, pro-business, deficit-reducing plan. Health care delivery remains market-based as now, and more free-choice than ever, with no more limited provider panels. Eliminating the wasteful private health insurance industry provides enough funding to cover all AND reduce the deficit several hundred billion/year. Separating insurance from employment allows businesses to budget more predictably and end haggling with labor over this misplaced benefit. What's not to love, GOP?
13
The Republican dog caught the bus. The problem for them is the bus is full of Republican voters and so it's not a good idea to run it off the road. Their latest gambit apparently is to leave the essential requirements and no denial of coverage protections in place but give states a waiver power to void them thus rendering the protections totally worthless. It's so transparent that even the dumbest Republican voter/recipient is likely to see through it so it's probably going nowhere. It's going to come to head in the next week or two because of the budget and the need to tell insurers about the subsidies.
7
“And the result is that they just keep trying to stuff the balloon into that box.”
Our political dysfunction taken to new heights.
Frankly, the ACA wasn’t such a great deal, and remains so — largely due to the unyielding, blockheaded resistance of the GOP throughout the Obama presidency. Even absent that it is almost certain that there would have been little willingness to substantially tinker with Obama’s signature legislative accomplishment.
As usual the biggest losers are the tens millions of Americans between the rock and the hard place healthcare wise. Bad and getting worse.
Solution:
Healthcare unambiguously for the people, not for the benefit of the vast healthcare related corporate interests.
Robust Medicare for all from conception to the grave. Credible taxes to pay for it. No restriction on negotiating drug and treatment rates.
Allow supplemental coverage from the marketplace, either employer provided, or individually purchased.
Our political dysfunction taken to new heights.
Frankly, the ACA wasn’t such a great deal, and remains so — largely due to the unyielding, blockheaded resistance of the GOP throughout the Obama presidency. Even absent that it is almost certain that there would have been little willingness to substantially tinker with Obama’s signature legislative accomplishment.
As usual the biggest losers are the tens millions of Americans between the rock and the hard place healthcare wise. Bad and getting worse.
Solution:
Healthcare unambiguously for the people, not for the benefit of the vast healthcare related corporate interests.
Robust Medicare for all from conception to the grave. Credible taxes to pay for it. No restriction on negotiating drug and treatment rates.
Allow supplemental coverage from the marketplace, either employer provided, or individually purchased.
4
The USA ranks dead last of the 11 industrialized nations using multiple variables such as quality, safety, access, costs. There is not one category that we are #1. All those other countries have some form of single payer systems that grant care at a high standard for all. The concept is simple. Granted the implementation is hard and expensive, but not not nearly as expensive as our current system that ranks last in cost. Obama care bent the cost curve but the cost is still growing, at a lesser rate.
Our problem is Trump is an idiot and the GOP are evil.
Single payer with a guaranteed level of coverage for all. Those who want a platinum plan will always be able to find it, and pay for it themselves
Our problem is Trump is an idiot and the GOP are evil.
Single payer with a guaranteed level of coverage for all. Those who want a platinum plan will always be able to find it, and pay for it themselves
3
When are voters going to take responsibility for the ballot they cast? They saw how mentally incompetent trump was during the campaign. His lack of world knowledge. His narrow isolationist thoughts. His bigotry. His pandering to violent actions at his rallies. His constant deflection from the facts. He hated everything President Obama accomplished just for the sake of hatefulness. Then there is his secretive financial world. His manic associates.
Why didn't voters see this? Because they saw themselves in his being. He became every common person. Common being the operative word, but vulgar being more to the point. This is what America is becoming.
Why didn't voters see this? Because they saw themselves in his being. He became every common person. Common being the operative word, but vulgar being more to the point. This is what America is becoming.
2
Lovely article, but it ignores the reality that it is the American Way to attempt (over and over) all unworkable ideas before surrendering to one that is a proven success.
There is a kind of nobility in this stubborn stupidity isn't there?
There is a kind of nobility in this stubborn stupidity isn't there?
Today's cynical GOP mindset has much in mind with our former Axis enemy: rid America of anyone they deem unfit and should be victimized. The criteria seem to be money, age, race, and sexual orientation--rather than simply religion and ethnicity. And they want to do it at little or no cost, with total ignorance of a well-established concept known as public health.
The "American Health Care Act," which stands to shorten the lives of up to 24 million fellow Americans for the profits of middlemen like the insurance industry, has been correctly seen by most Americans as a horror, the descendant of the Wannsee Protocol, which provided the procedures to snuff six million Jews, Gypsies and others seventy-five years to the day before Trump's inauguration. This is why it failed.
The "new" iteration pushed for by Trump and Ryan will be even worse.
The "American Health Care Act," which stands to shorten the lives of up to 24 million fellow Americans for the profits of middlemen like the insurance industry, has been correctly seen by most Americans as a horror, the descendant of the Wannsee Protocol, which provided the procedures to snuff six million Jews, Gypsies and others seventy-five years to the day before Trump's inauguration. This is why it failed.
The "new" iteration pushed for by Trump and Ryan will be even worse.
1
It's telling about the extent to which the GOP is enslaved to anti-government dogma that they have spent years advocating for the repeal of healthcare on the grounds that it's "big government," instead of spending those years advocating for single-payer on the grounds that it's good for the economy to have healthy workers.
2
Isn't doing the same thing over and over again and expecting a different result define insanity? These are the people who are presently in charge of our government who seem to be also seeking yet another war in order to justify spending billions to build up what is already the largest most powerful military in the world. They are putting our lives at risk with this dangerous game in the age of abundant nuclear weapons. I don't know who is more corrupt and/or ignorant - the republican politicians or the people who voted for them.I
3
I would like to extend the metaphor to failing attempts to fit an orange balloon overstuffed with ego into a small box of the Oval Office.
2
Even Dr. K, of all people, writes as though Republicans genuinely want to improve the health care system but are just wrong in their approach. They don't. Everything they do is to transfer cash from the lower to the upper classes. Please let's quit pretending Republicans are just wrong and face the fact of their immoral, inhumane, predatory, and--yes--evil agenda.
6
They want to transfer cash to themselves from other rich people, remember Bernie Madoff? He didn't target poor people. No money there.
"...Trump and the Republicans have painted themselves into an even bigger corner regarding Obamacare. Every day it becomes increasingly clearer that the immutable laws of economics mean that unless the Republicans want to allow medical underwriting, that is where insurance companies can reject applicants with preexisting conditions, something very close to Obamacare must be retained.
Demand for medical care is inelastic. Controlling prices charged by doctors and hospitals via the use of monopsony like the rest of the developed world does is an anathema to Republicans. Monopsony, meaning "single buyer" is the flip side of monopoly. A monopsonist sets prices below free market equilibrium. It does not matter if there is an actual single payer or many buyers (or payers) whose prices are set by the government or by insurance companies in collusion with each other. see: Obamacare And Beyond: The Outlook For The Healthcare Sector. http://seekingalpha.com/article/1647632
As it is dawning on the Republicans, any system that does not explicitly control prices must have mandates and subsidies similar to those in Obamacare. Otherwise, most individual insurance policies would be far beyond the reach of middle class Americans since, without medical underwriting insurance companies would have to price their policies based on the assumption that the applicant has a costly preexisting condition...."
http://seekingalpha.com/article/4042715
Demand for medical care is inelastic. Controlling prices charged by doctors and hospitals via the use of monopsony like the rest of the developed world does is an anathema to Republicans. Monopsony, meaning "single buyer" is the flip side of monopoly. A monopsonist sets prices below free market equilibrium. It does not matter if there is an actual single payer or many buyers (or payers) whose prices are set by the government or by insurance companies in collusion with each other. see: Obamacare And Beyond: The Outlook For The Healthcare Sector. http://seekingalpha.com/article/1647632
As it is dawning on the Republicans, any system that does not explicitly control prices must have mandates and subsidies similar to those in Obamacare. Otherwise, most individual insurance policies would be far beyond the reach of middle class Americans since, without medical underwriting insurance companies would have to price their policies based on the assumption that the applicant has a costly preexisting condition...."
http://seekingalpha.com/article/4042715
1
A nice metaphor, Paul.
It is also an on-going lie that health insurance premiums are the "cost" of health care. The only way to reduce premiums is to reduce the underlying cost in the system which means making a lot of doctors, nurses, hospitals, pharmaceutical companies, medical equipment manufactures, etc. poorer. Inevitability, someone loses. Yes, there are small ways to make the market more efficient, but even an decrease in cost of 10% (hundreds of billions of dollars) would disappear within a few years as the extra money is sucked into other portions of the medical industrial complex.
Europeans and other countries have not "solved" the heath care problem with single-payer, they have solved the health care market by not allowing medicine to be the route to the upper class for doctors, pharma executives or shareholders. Until the US bites the bullet and forces the medical industrial complex to become the public service it should be, nothing (neither free market nor single payer) will address the challenge. That is the biggest lie in the room.
It is also an on-going lie that health insurance premiums are the "cost" of health care. The only way to reduce premiums is to reduce the underlying cost in the system which means making a lot of doctors, nurses, hospitals, pharmaceutical companies, medical equipment manufactures, etc. poorer. Inevitability, someone loses. Yes, there are small ways to make the market more efficient, but even an decrease in cost of 10% (hundreds of billions of dollars) would disappear within a few years as the extra money is sucked into other portions of the medical industrial complex.
Europeans and other countries have not "solved" the heath care problem with single-payer, they have solved the health care market by not allowing medicine to be the route to the upper class for doctors, pharma executives or shareholders. Until the US bites the bullet and forces the medical industrial complex to become the public service it should be, nothing (neither free market nor single payer) will address the challenge. That is the biggest lie in the room.
6
I'm with you, there is no real public health care system in the US like other countries have. We are arguing about how to pay the bills but not the source of the bills. An MD friend has repeatedly told me about other doctors he knows who are invested in testing labs, for example, and all their patients seem to require lots of tests. Unlike the doctor, testing is paid for 100% by Medicare. It's a racket and it's going to bankrupt us all. Including the wealthy. They are not immune from being fleeced and in fact are more vulnerable as those with money are the targets.
1
The Republicans are still playing "fantasy football". The only good thing about this process is that voters are getting a thorough, painstaking education regarding ACA benefits (despite its faults) and, more importantly, the cynical goals of Ryan and the far right (tax cuts for the wealthy).
2
Yeah sure. But come the next election cycle, majority of these same voters will be riled up by some bogus issue like transgender bathroom or abortion laws or iminorities or immigrant's are reasons for the American downfall and these same voters will vote by their factfree gut reaction and vote against their own self economic interests, as they have been doing for a while now. Republicans have mastered this art.
To make an important point - every member of Congress should recuse themselves from making policy that doesn't directly affect themselves. It is painfully obvious that all these politicians going through political machinations to justify their position on health care in America have no personal incentive to get it right - not now, not ever! They have health insurance in perpetuity. They worry and want for nothing regarding health care. And, presumably they are incapable of empathy for millions upon millions of the people they are supposed to be serving - people who collectively elect them to office, pay their salaries and provide them with generous benefits including health care. No wonder that 90% of the country disapprove of their performance or lack thereof.
Trump is in a category of his own making - he's a swarmy con artist who cheated and lied his way to the presidency. Within his first 100 days in office he has disavowed every campaign promise he made.
It doesn't help that the many if not most at the NYT and almost all of the media are engaged in misdirection, bashing the Republicans while implicitly giving Democrats cover over devising weak and costly health care solutions. The answer for affordable healthcare for everyone is single payer - millions of people need it yesterday because their lives and well-being depend upon it. Where is the urgency? In my mind, failure to solve this issue is tantamount to a crime against humanity.
Trump is in a category of his own making - he's a swarmy con artist who cheated and lied his way to the presidency. Within his first 100 days in office he has disavowed every campaign promise he made.
It doesn't help that the many if not most at the NYT and almost all of the media are engaged in misdirection, bashing the Republicans while implicitly giving Democrats cover over devising weak and costly health care solutions. The answer for affordable healthcare for everyone is single payer - millions of people need it yesterday because their lives and well-being depend upon it. Where is the urgency? In my mind, failure to solve this issue is tantamount to a crime against humanity.
5
Simply put, the Republicans have been lying all along.
But they have not just been lying about healthcare.
Among their many, Many, MANY lies are those about Social Security, Medicaid, and Medicare.
These programs don't significantly contribute to the deficit because they're funded primarily by payroll taxes. Payroll taxes (a shared burden on workers and employers) are regressive, but they help insulate necessary expenditures from the political power of corporations and the idiot elite (0.1%) who (for short term profit) would destabilize our politics, undermine our economy, and relegate the majority of the population to hopeless misery.
But they have not just been lying about healthcare.
Among their many, Many, MANY lies are those about Social Security, Medicaid, and Medicare.
These programs don't significantly contribute to the deficit because they're funded primarily by payroll taxes. Payroll taxes (a shared burden on workers and employers) are regressive, but they help insulate necessary expenditures from the political power of corporations and the idiot elite (0.1%) who (for short term profit) would destabilize our politics, undermine our economy, and relegate the majority of the population to hopeless misery.
2
Add to that Trump's attempts at extortion to force democrats to partner in his poker game, and one can see this for what it is: a grotesque attempt to harm the less fortunate and give a lot of money to the rich.
2
For Republicans, repealing the ACA was always a perfect scenario that played right into their base; a black President and the expansion of a government benefit. Mr. Krugman always speaks to the actual facts concerning the economics of health care. Of coarse facts have been in short supply for the current issue of Republican lawmakers, but one fact that they cling to will never go away and will also prevent them from passing any meaningful health care reform. It is impossible to create a health care system for all when your goal is to reduce the number people that are eligible for that care. They do not want everybody to have equal access to health care because someone will have to pay and their wealthy donors will have to pay their fair share.
3
As I said in earlier comments, not all argument needs to be logical and deductive. Sometimes an extended analogy, if well controlled and carefully thought out, can be just as revelatory and educative.
I keep hoping (my friends say I am nuts) that eventually Trump will realize how to deliver his promises, and embrace single-payer healthcare as a populist measure. Sort of a "Nixon goes to China" moment. Given his past social positons and his transactional nature, that may not be impossible. And it would break the longstanding spine of Republican refusal to do what is right for the Country concerning health care cost and services. A phase-in, sure, but an eventual plan that brings us into line with other developed countries.
How do all of these business types---the captains of industry---not understand how insurance works. Insurance companies are in business to make money--the only way you make money in insurance in the management of risks: either you 1) charge exorbitant rates for high risk health problems or 2) do not cover high risk health problems---it is that simple. The only way around this "small box" problem is government subsidies and/or increasing the pool of those insured. Obamacare is designed to address the small box problem, which, our President and his party still appear to be confused about.
4
Most other forms of insurance are backed by reserve funds that yield income to the insurance company, which sets premiums to meet current obligations to pay benefits. Profit comes from the earnings of the reserve fund, not premiums collected.
1
The right toys with a couple of approaches. The one that strikes me as most ideologically authentic to the conservative heart is to cut sick people loose; tell 'em they're on their own.
When it becomes necessary to acknowledge and pretend to care that people actually do and will get sick, conservatives sometimes make a show of doing something about it by segregating sick people into their own categories. High risk pools and their ilk are an example:
http://amorpha.blogspot.com/2017/03/sick-people-unite.html
But it's all either smoke and mirrors or ignorant alchemy (the magic of aggregation) -- which is worse? As PK says, ultimately the thing has to be faced head on and paid for.
Ultimately we are all in the same boat. Why don't we start acting like it?
When it becomes necessary to acknowledge and pretend to care that people actually do and will get sick, conservatives sometimes make a show of doing something about it by segregating sick people into their own categories. High risk pools and their ilk are an example:
http://amorpha.blogspot.com/2017/03/sick-people-unite.html
But it's all either smoke and mirrors or ignorant alchemy (the magic of aggregation) -- which is worse? As PK says, ultimately the thing has to be faced head on and paid for.
Ultimately we are all in the same boat. Why don't we start acting like it?
1
Religion. Some people think they are more blessed than others. They don't comprehend that nature is equally indifferent to everyone. Mercy and compassion are products of people, not nature.
3
Single Payer with responsible, fact-based government servants enacting the peoples will is the most cost effective and compassionate answer. These corporate financial parasites needed to be flushed from our system.
3
I would posit that the fundamental problem with their balloon and box is that the GOTP is really trying to engage in an ultimate sleight of hand scheme, by pretending that they intend to repeal and replace, while they never had any plan, let alone desire, to ensure health insurance for their constituents. Their goals have always been to nullify President Obama's entire legacy, and to shovel billions of dollars into the platinum-lined pockets of their plutocrat puppet handlers, for whom the GOTP are the quintessential handmaidens. 4/21, 9:31 AM
6
It is interesting to see the calls for "single payer" increase throughout this current policy debacle. The right has not done themselves any favors in this debate and I think the ballon in box metaphor is perfect. The part of their party who (thankfully) killed their bill thought that the one proposed was too generous! Wow.
One of my refrains is this: "Good stuff costs money and some good stuff is worth the cost". To me it seems so basic to have an at minimum healthy-ish country. Just this one concern would remove a lot off peoples plates. And don't forget, healthcare is going to be especially important if we are going to increase pollution trying to make coal great again. We are going to need all the healthcare we can get. Any coal miner will tell you how important benefits are.
One of my refrains is this: "Good stuff costs money and some good stuff is worth the cost". To me it seems so basic to have an at minimum healthy-ish country. Just this one concern would remove a lot off peoples plates. And don't forget, healthcare is going to be especially important if we are going to increase pollution trying to make coal great again. We are going to need all the healthcare we can get. Any coal miner will tell you how important benefits are.
5
While reading Dr. Krugman's column, I was watching Morning Joe on MSNBC. Maryland Congressman, Elijah Cummings was telling his experience of speaking with a 20 year old woman with stage 4 colon cancer who was pleading with him to continue the ACA or she would die. How many thousands of people are in her position? Debating health care is like debating food. Think of conversations about how much food people should be provided. Come to think of it, there are conversations like that in terms of food stamps, welfare, et. al. We are talking of peoples' live here, not some esoteric issue.
While people are dying, already unable to afford the deductibles and co-pays charged by for profit insurance companies, the weak charactered Neros of Congress are fiddling. These "representatives" did not have the courage to meet the very constituents who voted for them. Neros should be reminded early and often of the real import of what is being debated. Just as during the Vietnam War, there were weekly reports of soldiers' deaths, the same should happen here.
While people are dying, already unable to afford the deductibles and co-pays charged by for profit insurance companies, the weak charactered Neros of Congress are fiddling. These "representatives" did not have the courage to meet the very constituents who voted for them. Neros should be reminded early and often of the real import of what is being debated. Just as during the Vietnam War, there were weekly reports of soldiers' deaths, the same should happen here.
4
Reducing the cost of health care? Move U.S. costs closer to those enjoyed by the Canadians, the English, maybe even the French? But that would require actually doing more of what the other developed countries do - socialized medicine - and less of what the Republicans want - allocation of health care through "free market" prices paid by consumers. Admitting they've been lying about replacing Obamacare is a small thing relative to admitting that their basic ideology is wrong about health care.
4
Perhaps the answer here is to somehow make sure that the health care package for the legislators themselves is no better than the average coverage for all Americans. Then they'll have some skin in the game.
531
Unfortunately that doesn't work. Congress is required to use the same Health Care markets the rest of us use. The problem is Congress is full of rich people. Not billionaires but millionaires. The average net worth, in 2013, was $1,029,505. This allows them to purchase the best plans or supplement the coverage as they like.
1
Matt, first you need to cut their incomes. Rich folks can find multiple health care solutions. And show me one, single Congress member that is poor. ACA helps the not so rich. And that is what disturbs the Rs so much. If only those damn poor folks would just go away. But wait, those folks voted for Trump. Hmmm, now we have a problem. Well, gee, I guess the best way to fix this problem is to cut my taxes so we won't be able to afford to keep them around.
They currently must purchase on the exchanges and pay 25 %. They are all wealthy so they choose gold or platinum plans with lower copays and deductibles
Paul, the answer to your riddle is to chill the balloon until it shrinks into the box and then close the box. Too many people are trying to do what you are describing (brut force) instead of really thinking about other alternatives (single payer), defined societal goals (real health care) and inefficiencies in the system (few people know what it truly costs to do a medical procedure, even the doctors, until billed). The health care industrial complex is fine tuned to maximize return at our expense and Congress is not helping to alleviate this due to special interest group influence.
7
Mark, you are correct. Unfortunately the GOP does not "think" or appear to "believe" that by simply chilling the air in the balloon is anything more than a magic trick or fake news.
It is amazing that on Medicare, that I was able to receive last August when I turned 65 - and thank God, for carrying my own health insurance policy cost $640 a month with a $2,000 deductible which, because I am still relatively healthy, I never met (CHA CHING!) was eroding my retirement income faster than my favorite ice cream bars going up $1.20 in one week for a box of 3. (I don't buy them any more). My health care cost for Medicare, plus a separate policy for drug coverage, plus a supplemental insurance plan that fills in some of the "gaps," cost less than half of what I was paying. So why can't we do this for EVERYBODY? Why why why? The answer is - we can. Get rid of the damn Republicans in Congress.
64
It's not hard to understand why the GOP doesn't want to fix or replace the ACA. It's not in their best interests or in the best interests of their corporate masters/owners, especially those in the wealth care industry. For all the marketing research and resulting ads it's clear in the way that the wealth care industry behaves that its interest in the bottom line outweighs any "concern" it has for patients. Patients are merely vehicles for it to amass mountains of money, overpay its CEOs, and continue to advertise lies.
The assumptions made by the GOP and the wealth care industry about patients, patients as consumers, and how patients use health care are completely off base. They can get the medical care they need when and where they need it. We cannot because we don't have the money to do whatever we want or what needs to be done. Unlike our pets, we have to wait for an approval to see specialists, to go outside the narrow network. Unlike other countries, our doctors advise us to go to the ER during off hours. Unlike other countries, we don't regulate or cap the cost of medications. Unlike other countries neither of our political parties is willing to fight for health care as a right rather than either a luxury or a privilege to be granted if we can pay the premiums, the co-pays, the deductibles, and shop for medical care like we do for cars.
The American way of health care is this: you get the best care money can buy.
The assumptions made by the GOP and the wealth care industry about patients, patients as consumers, and how patients use health care are completely off base. They can get the medical care they need when and where they need it. We cannot because we don't have the money to do whatever we want or what needs to be done. Unlike our pets, we have to wait for an approval to see specialists, to go outside the narrow network. Unlike other countries, our doctors advise us to go to the ER during off hours. Unlike other countries, we don't regulate or cap the cost of medications. Unlike other countries neither of our political parties is willing to fight for health care as a right rather than either a luxury or a privilege to be granted if we can pay the premiums, the co-pays, the deductibles, and shop for medical care like we do for cars.
The American way of health care is this: you get the best care money can buy.
11
Prescription drug advertising sure puts the media into a conflict of interest in its reporting of health care funding issues.
Single-payers don't advertise prescription drugs.
Single-payers don't advertise prescription drugs.
2
Yes! The best solution is single payer or a national Medicare for all which lets 20 per cent of the air out of the balloon by eliminating the unnecessary and expensive and frustrating activities of health insurance companies who are performing administrative functions with little value added except to make profit from illness.
15
How the single payer collects the necessary revenue to pay out is very much part of the issue.
1
What is the difference between paying a premium to a private company or an employer taking his contribution and yours out of your pay OR paying a tax to a government financing mechanism? That latter amount is likely to be substantially smaller! Those folks making a profit through private insurance companies have confused their advantage with political and economic ideologies.
Ah, but if you allow insurance companies to sell lousy coverage on a state by state basis and you don't care about facts, you can pretend that the bright, shiny new Republican health plan will lower costs and repeal Obamacare...poof, problem solved!
But if it bleeds, it leads and the people that will lose coverage or have terrible coverage and die or suffer as a result will create tens of thousands of stories that can't be swept under a rug of orange hair...
But if it bleeds, it leads and the people that will lose coverage or have terrible coverage and die or suffer as a result will create tens of thousands of stories that can't be swept under a rug of orange hair...
9
Well, a big balloon won't fit in a small box. But the "so-called" president and almost all the Republicans have so far proven than a small brain will fit in a big head.
5
Congress has it easy. Just give the ordinary citizen the same health plan as
it has. But of course this will not happen. By the way Paul, thanks for your
silly "The Balloon, The Box and Health Care" opening paragraph. It's comforting to be given a high school lecture by a Nobel Prize winner.
it has. But of course this will not happen. By the way Paul, thanks for your
silly "The Balloon, The Box and Health Care" opening paragraph. It's comforting to be given a high school lecture by a Nobel Prize winner.
2
It is remarkable to me that a political party with such disregard for its country's constitution, constituency and mankind in general has any kind of clout left in any arena. What is it about us that allows the GOP any success whatsoever? In any other world this clown posse would be chased into the street and beaten with sticks.
4
Were that the Republican's balloon was only filled with air rather than what we all know it is actually full of.
7
nice analogy Krugman,
Right now, the capacity of the Republican Congress to avoid a government shutdown next week is in doubt.
Competence isn't wanted by these people. They are just a network of leeches.
Competence isn't wanted by these people. They are just a network of leeches.
5
Boy, those missiles that I fired into Syria haven't done that much for my rep., the big bomb in Afghanistan was a bomb, and not knowing that our aircraft carrier heading away from North Korea was yet another embarrassment! I need the cover of a distraction that will push buttons and get the press off those subjects!
I know!! It's time for another pointless attack on Obamacare! Works every time and even better than a traffic jam on the George Washington Bridge!
I know!! It's time for another pointless attack on Obamacare! Works every time and even better than a traffic jam on the George Washington Bridge!
2
They're going to need a bigger box.
1
Republicans have a beautiful solution, the most beautiful terrific solution, believe me. I never said there was a box. There is no box. I'll just stick a big beautiful pin in the balloon, the most wonderful pin ever, believe me. Pop!! Now the balloon will fit in any box, if there were a box and nobody has ever had a better box than me. The lying media made up the box. Next problem!!
8
Scammers gotta scam. And, the GOP has perfected the art. Seriously.
Republicans are trying to kill obama care but Obamacare is actually derivative of Romney care.
It is an original republican idea.
It is an original republican idea.
2
Trumplicans will fit that beautiful balloon into that tiny box, even if they have to pop (destroy) it - like they will with the ACA - instantly transferring the air (money) to those who do not need it.
The balloon actually represents the wealth of the country and the tiny box represents the avarice of the few of the wealthiest - trying to "box" so much wealth in, it does not fit (morally) and away from the rest of us left out of the box. In fact, there is so much concentrated wealth in so small a volume it is essentially a collapsing black hole of wealth.
Yes, they want to preserve the good stuff - tax cuts for their benefactors - while taking away the bad stuff - health care coverage for most. Call it redistribution of wealth and health to the richest.
"Repeal and Replace" is a typical Trumplican tactic of combining a truth followed by a lie to confuse their base. Bait and switch.
The balloon actually represents the wealth of the country and the tiny box represents the avarice of the few of the wealthiest - trying to "box" so much wealth in, it does not fit (morally) and away from the rest of us left out of the box. In fact, there is so much concentrated wealth in so small a volume it is essentially a collapsing black hole of wealth.
Yes, they want to preserve the good stuff - tax cuts for their benefactors - while taking away the bad stuff - health care coverage for most. Call it redistribution of wealth and health to the richest.
"Repeal and Replace" is a typical Trumplican tactic of combining a truth followed by a lie to confuse their base. Bait and switch.
8
The Republicans are a one-trick pony--tax cuts for the wealthy. And the current trick they've been so far unsuccessful in pulling off is to miraculous transform health care reform into a giant Medicaid-killing tax cut labeled the American Health Care Reform Act. So they've truly boxed themselves in. Of course, the ultimate irony is that "so-called" Obamacare" was originally "Romneycare"--a Republican, free market, corporate-based insurance industry plan that was endorsed by all the major corporate entities from Big Health Care Insurance to Big Pharma. But, the greed of the wealthy is insatiable and with the Narcissist-in-Chief desperate for a "win" even if it costs millions their health care and more cruelly, in some case, their lives, look for him, as he is now threatening, to pop the balloon and blow-up the entire health insurance system.
29
INCREDIBLE! That the GOP would even consider a "win" for Trump worth destroying health care for millions of US citizens! They seem to discount the hundreds of deaths this would lead to. Who needs to worry about terrorist attacks when we have the GOP ready to do their work for them?
The seven deadly sins: (in Christian tradition) the sins of pride, covetousness, lust, anger, gluttony, envy, and sloth can still be applied - used to explain - what is preventing our legislators from acting an behalf of all Americans. Yes, even "sloth", lazy, can be applied to the careless and poor attempts by the GOP to make "health care great". But, of course, there really isn't any desire to provide care for all but rather to reduce it so those who are already wealthy can enjoy even more gluttony. Many Americans can barely put food on their table and we talk about staying in hotels that cost more than a person's mortgage. Chocolate cake that is better than any - just visit one of Trump's hotels - which few can afford. Clearly Trump is competitive and is angry and hates not being able to completely annililate Obama's legacy. We can never improve health care or take seriously infrastructure or climate change or ... as long as pride and jealousy (covetousness) and lust and ... dominate among those who should be leading this country.
14
The GOP has been peddling fear of a single payer system by pointing out long waits for procedures in countries like Canada, France and Great Britain. Well, here's an example of how our system works. My doctor recently established "concierge service" at a cost of $1,200 per person per year. Among other things, this would give an "individualized healthcare plan" and "preferred appointment times". My wife and I have been patients of this doctor for 20 years, but chose not to pay for "concierge service". Last week, I called to schedule my annual check-up and was told that the soonest I could be seen for this is the last week of July. So despite being longstanding patients, we are now relegated to second-tier priority. Yep, the American healthcare system is the greatest in the world!
34
Just as I turned 65, my longterm doctor also went to concierge, and stopped accepting Medicare patients, however long we had been seeing her. I hear from my neighbors that this is now happening as well with a popular group practice in our community, although they will continue to see their pre-concierge patients.
1
And the present American health care system is now being blamed for the US falling to the bottom compared to other industrialized countries in terms of diseases outcomes. Wouldn't it be amazing to see a doctor out of concerns for your health--rather than avoid it because of cost until your life is compromised?
159
and in those countries the long waits are for things that are not immediately necessary.
7
continuing to do the same thing and expecting a different outcome is the definition of idiocy. Einstein
7
Insanity, not idiocy.
I would much rather have directed taxes than let Congress take in immense sums and direct it toward their cronies. There are now several social safety net programs that have tax directly tied in for program maintenance, and all are under threat. First, as we know, ACA taxes are the biggest incentive for appealing ACA. Without them, we will never stuff the balloon in the box. Second, Trump proposes to do away with the payroll tax, which is the direct funding for social security. This tax falls on everyone who works, even at minimum wage jobs. Rather than raise minimum wage, Trump proposed to get rid of the payroll tax. This is the back alley way to reduce and kill social security. The third directed tax is Medicare, which is always under threat. Like social security, the government has borrowed from the medicare funds to pay for disability. Rather than pay for nursing homes for the frail, they use Medicaid. Healthcare is a mess in this country, because the people have reached consensus that healthcare is a right, but have not elected the representation.
16
As I watched the ACA, from start to finish, I saw a President bargain away elements critical to a successful healthcare bill to Republicans intent on its destruction. The result was a bill lacking in basic coverage but with sufficient benefits to create a lasting efect on those who could benefit.
Blame it on the Republicans and the Democrats who were cooptedi nto acepting the Republican compromise instead to insisting on medicare for all.
Blame it on the Republicans and the Democrats who were cooptedi nto acepting the Republican compromise instead to insisting on medicare for all.
9
That's unfair, Rose. You are condemning an entire group of people for not all agreeing to implement a law exactly the way you would have preferred. The truth is that President Obama bargained with insurance companies and Democrats in the House in order to gain the support needed to pass the law. If he'd had support for a single payer system, then that's what would have been passed. Instead we have the ACA, which has provided so many protections to citizens who need them. Yes, the ACA needs to be improved upon, but when this law is under constant threat from the GOP, the answer cannot be to complain that people didn't do what you wanted 8 years ago.
1
The Caring Democrats put forth health care reform, and given time, the financial conditions would improve with gradually increasing enrollments. But, as evidenced by the ridiculous number of times the Republicans attempted to repeal it, the Republicans simply see Obamacare as a success they want to take credit for. The Republicans are insecure people who are trying to rewrite history so that their name appears on healthcare reform. They are trying to steal the Democrats winning strategy and thunder.
11
Very interesting take. Not usually a conspiracy person, but this has the odor of truth to it.
The problem is that the Republicans who want to decimate Obamacare are stingy, unfeeling people who lack empathy and respect. Therefore, there is no solution while they are in charge.
9
Why did VP Cheney have his heart surgery at Socialist Walter Reed? The risk of a blood transfusion from a liberal should have too risky itself.
Let's move right to completely vindicate conservative claims:
1) Repeal government financed health care for the Congress and staff
2) Repeal the tax deduction for health insurance premiums/costs
4) Repeal fully socialized medicine for the military
5) Close the VA system and give vouchers for their premiums
Socialism for the rich has us where we are. Off the slippery slope.
Let's move right to completely vindicate conservative claims:
1) Repeal government financed health care for the Congress and staff
2) Repeal the tax deduction for health insurance premiums/costs
4) Repeal fully socialized medicine for the military
5) Close the VA system and give vouchers for their premiums
Socialism for the rich has us where we are. Off the slippery slope.
14
Here in Germany, our principle of solidarity is doing a great job. We pay roughly 14.6% of our income for our health insurance, and every year, we have to submit an assessment of our income for premiums to be adjusted accordingly. This system works very well, ensuring that the poorest can get treatment of the very same quality as the well-off. If you want to have extras, there are enough insurance companies which offer supplementary insurances at relatively low cost. Of course, the very wealthiest have private health insurance which means they have to pay up front, and get their costs repaid later. I may be one of those paying a high premium every month, but consider the entire system fair and equitable. Who could ever be so callous as to leave people without health care only because they are poor?
6
I was just reading the related article on the ACA in Oklahoma and New Mexico & it seems appropriate to note how Oklahoma is so typical of current Republicanism. Oklahoma fought the ACA tooth and nail at both the state and federal level and did everything to undermine it. Whatever they could do to NOT cooperate with the ACA, they did. And now Trump holds up Oklahoma as an example of what's wrong with "Obamacare". In fact, what's wrong with Obamacare in Oklahoma is that they didn't utilize it optimally. Now individuals see rates double or more. Everything Trump is trying to do will make it far, far worse for them, yet Oklahomians still fervently support him and blame Obama for their troubles, despite the uninsured dropping 4% from about 17.5% to 14.5%
Meanwhile, in New Mexico, where they embraced the ACA and utilized every option they could, rates have come down and the uninsured rate dropped from about 18.5% to 10.5%--an 8 point drop. Rates have stayed low and they love Obamacare there.
Oklahomans got EXACTLY what they voted for, what they support and what they paid for, are hard-core Republicans and Trumpists, yet they STILL don't get that what's happening to them will only get far, far worse and they refuse to see it. There's ignorance, willful ignorance, and downright stubborn ignorance, & the last is what we see in Oklahoma Republicans. I once was sympathetic and empathetic to their plight, but no longer. They have no excuse, and no one to blame but themselves.
Meanwhile, in New Mexico, where they embraced the ACA and utilized every option they could, rates have come down and the uninsured rate dropped from about 18.5% to 10.5%--an 8 point drop. Rates have stayed low and they love Obamacare there.
Oklahomans got EXACTLY what they voted for, what they support and what they paid for, are hard-core Republicans and Trumpists, yet they STILL don't get that what's happening to them will only get far, far worse and they refuse to see it. There's ignorance, willful ignorance, and downright stubborn ignorance, & the last is what we see in Oklahoma Republicans. I once was sympathetic and empathetic to their plight, but no longer. They have no excuse, and no one to blame but themselves.
103
Precisely the point: Oklahomans knew ( or deliberately ignored) what the deal was with the ACA. They got instead a nonsystem that fails all but the very wealthy, who don't really care about the rest of the state's population anyhow. So why on earth are all those who demeaned and blocked the ACA somehow now entitled to complain and whine--it may not be polite to say they are getting what they deserved, but it surely is on point to say they got what they wanted.
183
Exactly. In fact no state which refused to sign on to the Medicaid expansion has the right to complain about "Obamacare" because they haven't actually implemented "Obamacare." They have "Obamacare minus Medicaid Expansion."
21
Even McConnell's state of Kentucky took advantage of the ACA and it works well--must gall him every time he goes home and no longer sees people dying in the street!
26
The GOP is big on guns. We can see why, they love shooting off their mouths while shooting themselves and each other in the foot. The noise they make firing off their rounds that they can't hear their constituents shouting at them to not destroy the ACA.
9
Obamacare was always, from the instant it was signed, the tar baby for the GOP. The Dems knew it would create something untouchable, just like Social Security. The more the GOP engage, the more entangled they become. The choice the Republicans have is the one the Democrats left them: either total abolition or total commitment to the state medicine model. As more time passes, abolition becomes less likely.
And to all our Swedish correspondents: so your country is a paradise, but 50 cents of every dollar you earn goes to the state. We don't like that.
And to all our Swedish correspondents: so your country is a paradise, but 50 cents of every dollar you earn goes to the state. We don't like that.
2
Well, yes, the Swedes pay a great deal in taxes--but they get great benefits from those payments. Of course, they're not supporting the world's largest military machine. I would gladly pay more in taxes--much more--IF I knew it wasn't going to be spent on another aircraft carrier, and if those taxes were spent on programs which directly benefit people. Alas, such won't/can't happen: the 1% must be fed.
1
And the Swedish system does not motivate people to improve their situation as they are covered from cradle to grave.
For "Swedish", read Western civilized democracies. It clearly doesn't include the "for profit" USA. Health care really should be health care , not big business, corporation care.
Single payer is the only bottom line. But it isn't favoured by the party of the 1%.
Single payer is the only bottom line. But it isn't favoured by the party of the 1%.
It looks like the other way to get even the worst health care plan passed is to do what Trump does so well: con people. Simply tell people it is great, and they will believe it. Hide the ugly parts like the no preexisting conditions exemption under a small print clause that lets states out, and we have it.
9
Who knew that trying to stuff a big balloon into a small box could be so... complicated?
But there's been a redemption. One of Steve Miller's staffers discovered that if an aircraft carrier keeps going south long enough, it eventually starts going north, then south again until it arrives at a place north of where it started!
Complicated? Not at all. Consultation of the globe in Jared's office proved it could be done if you ignored a few substantial land masses along the way. Beautiful! Tremendous!
Now, where's that balloon again...
But there's been a redemption. One of Steve Miller's staffers discovered that if an aircraft carrier keeps going south long enough, it eventually starts going north, then south again until it arrives at a place north of where it started!
Complicated? Not at all. Consultation of the globe in Jared's office proved it could be done if you ignored a few substantial land masses along the way. Beautiful! Tremendous!
Now, where's that balloon again...
13
Seriously doubt that Trumpcare 2.0 will be going anywhere. Why? It will continue to be opposed by doctors, hospitals, AARP, Democrats, Republicans in swing districts that supported Clinton, right-wingers that have an interest in repeal without the replace. In addition, any Medicaid rollback would likely be killed in the Senate, as was indicated previously when Trumpcare 1.0 was being promoted by Ryan as the "Better Way," which should have been named the "Dopey Way."
4
The analogy I use is "you can't square a circle", but stuffing a balloon in a box works just as well. The real mystery is why the Republicans keep trying to stuff the balloon in the box. A slow learning curve is part of it, but to fully understand it, I think we need to remember the song from "The King and I" which I would rename "Whistle an Anti-Obama Tune": "The result of this deception, Is very strange to tell, For when I fool the people I fool, I fool myself as well!"
1
All Republican plans eliminate the mandatory coverage requirement, which is critical to its viability. Yet they don't repeal mandatory car insurance in most states. Why, so drivers have insurance in case of an accident, there is money to pay for bodily harm & car repairs Many people get sick over the course of their life to age 65, just like many people have car accidents over their driving lifetime. Similarly Health Care insurance pays for accidents or illness to your body. Either your employer and/or you pay for it. Obamacare covers those who are not covered by their employer or are self-employed. Just like auto insurance.
Republicans just Change the name to whatever you like just DON'T change the insurance plan. Keep every one under age 65 insured whether by Employer, Medicaid, Obamacare, & some other specific programs. Continue reducing Medical Care Costs now nearly double European Costs.
Republicans just Change the name to whatever you like just DON'T change the insurance plan. Keep every one under age 65 insured whether by Employer, Medicaid, Obamacare, & some other specific programs. Continue reducing Medical Care Costs now nearly double European Costs.
3
HHS has to create at the very least a Public Option policy plan that mirrors the ones offered by the private insures on the exchanges and that eliminates the 15% allowable operating profit margin. Let's call it Medicare II. The same subsidy formulas can be used -- it's a no-brainer. There can be both individual and small business plans.
If the private insurance providers cannot preform in the current political environment this surely is the way to go. This will allow the worried or withdrawn insurers to go back to serving the more well-balanced and predictable private group insurance market.
If the private insurance providers cannot preform in the current political environment this surely is the way to go. This will allow the worried or withdrawn insurers to go back to serving the more well-balanced and predictable private group insurance market.
3
Krugman - "All of this raises the obvious question: If Republicans never had a plausible alternative to Obamacare, if this debacle was so inevitable, what was the constant refrain of “repeal and replace” all about?"
It's about the fact that the Republicans fundamentally were against another government funded social program. They took it another step further, labeling it "Obamacare" putting the face of the black president on the ACA thereby providing an opportunity to excoriate the legislation and our black president. Thirdly, and most importantly, the trillion dollars going to ACA is desperately needed to fund their tax cuts for the wealthy and corporations.
It's about the fact that the Republicans fundamentally were against another government funded social program. They took it another step further, labeling it "Obamacare" putting the face of the black president on the ACA thereby providing an opportunity to excoriate the legislation and our black president. Thirdly, and most importantly, the trillion dollars going to ACA is desperately needed to fund their tax cuts for the wealthy and corporations.
8
We're the only developed country in the world where a cancer diagnosis is the number one cause of personal bankruptcy.
1004
Long--term care, particularly for dementia, is probably also hihg on that list.
For several years I liquidated businesses that defaulted on loans. I never saw a company fail because of "oppressive government regulations." I saw several businesses fail because an owner or a relative had an uninsured medical crisis. (As an aside, I also saw several fail because an owner or an employee had a gambling addiction.)
3
You hit the nail on the head, Isabel. I lost my son to leukemia 17 years ago. His treatment was primarily paid through a special grant. However, my former wife and I still had to pay for 10% of the costs and it took us over 10 years to pay all the bills. I cannot complain about the quality of care but that was a horrible financial burden at a time when I should've been saving for retirement. The financial reality of health care is a paradox of an unlimited number of business interests forcing the hand with consumer/patient issues rarely discussed or resolved. Let's hope and pray this nightmare comes to and end.
1
The problem the Republicans have with health care is the same problem with all of their legislation - they are busily working to destroy anything that involves collective action on behalf of individuals in favor of letting corporations make money. They understand that individuals have no bargaining power, so their goal is to divide and conquer, or in this case divide and make poor and sick. And having sold the alleged benefits of "free choice," they are now surprised that the voters have finally understood that Republican efforts to kill the ACA and their proposed "solutions" will make their lives worse, not better. Rather than have the government protect and foster the collective needs of the American public, Republicans' message is "you're on your own," with the result that: "Freedom means there's nothing left to lose." The only way to keep health care costs down while providing care to everyone is through collective action - large coverage pools and bargaining power in large employers and the government. The Republicans can't deliver on their promises because the needed solution is antithetical to their whole agenda. And don't get me started on public schools and the environment.
8
"There are other possible ways to achieve the same goal, but the money has to come from somewhere."
No, we could cut the cost by near half. We don't have to waste all that money on Big Pharma and medical insurance administration and insurance company profits. Other nations do for under 10% of GDP a better job than we are doing with 18% of our bigger GDP.
By the analogy, he could get the balloon in that box if he could raise the air pressure inside the balloon, confining it in the box. We need to confine medical costs inside a box. Unconfined, the greed is destroying all of our efforts. We can't pay the unlimited greed that is running rampant.
No, we could cut the cost by near half. We don't have to waste all that money on Big Pharma and medical insurance administration and insurance company profits. Other nations do for under 10% of GDP a better job than we are doing with 18% of our bigger GDP.
By the analogy, he could get the balloon in that box if he could raise the air pressure inside the balloon, confining it in the box. We need to confine medical costs inside a box. Unconfined, the greed is destroying all of our efforts. We can't pay the unlimited greed that is running rampant.
4
Republicans are forever bent on inserting profit-driven middleman bureaucracy into the healthcare system, rather than getting them out of the way, where appropriate. How many of us have spent hours, even days, on the phone in an attempt to navigate through the bureaucratic mess that much of corporate America, especially insurance companies, have become. The idea that the private enterprise option will always and in every case lead to the cheapest and most responsive solution is a myth that is disproved over and over again.
Just ask anyone on Medicare. A single payer system works just fine, thank you very much.
Just ask anyone on Medicare. A single payer system works just fine, thank you very much.
2
As a senior, in Canada, I've watched with interest the healthcare debate saga in the U.S., and sadly, I must say that I'm appalled at the dishonesty of so many of your leaders.
When I got to 65 years of age, I had a complete assessment done of my health, establishing a base line as I aged. Since then, I've done all the pertinent examinations including for the heart, pancreas, kidneys, prostate and more. The total out of pocket cost to my family was $0.00.
I read where dialysis clinics were closed last year in Texas where there was a shortage of beds already. Because of all this abhorrent behaviour, the misleading, the lies, - death panels - I've lost any respect I had for your elected officials who lie, and distort information. Why, as a Canadian, should I care?. Because our countries go to war together, we tend to support your international agenda because of treaties etc., but perhaps the time has come to not expect the best from you anymore, especially when no one can trust the words coming from your president, and those who would enable him.
When I got to 65 years of age, I had a complete assessment done of my health, establishing a base line as I aged. Since then, I've done all the pertinent examinations including for the heart, pancreas, kidneys, prostate and more. The total out of pocket cost to my family was $0.00.
I read where dialysis clinics were closed last year in Texas where there was a shortage of beds already. Because of all this abhorrent behaviour, the misleading, the lies, - death panels - I've lost any respect I had for your elected officials who lie, and distort information. Why, as a Canadian, should I care?. Because our countries go to war together, we tend to support your international agenda because of treaties etc., but perhaps the time has come to not expect the best from you anymore, especially when no one can trust the words coming from your president, and those who would enable him.
40
As your column so brilliantly explains, the real issue here, the one that has been lurking behind all the propaganda all along, is that the GOP is predicated entirely on deception. From its economic policies, its strutting promise to "reform" the tax code, to the zombie effort to repeal ACA, it's all based on the Big Lie. And the Big Lie is that the GOP remotely cares about the greater good for the most citizens. Its one and only "policy" is to decrease as far as possible taxes on wealth, period, full stop. That explains the balloon and box - the GOP continues to struggle to package the destruction of ACA as in improvement, to frame the Big Lie in a way that the base doesn't see it for what it is. I for one was delighted to read this week that the effort to destroy ACA shuffles on, because the longer it does so there is a chance, slim though it may be, that enough citizens will take the smelling salts and fully realize the con for what it is, and has been since Reagan. At least that's my fervent hope, and just now it's about all I have left.
20
The only way to ''let some air out of the balloon'' is to make delivery of health care more efficient. According to the Institute of Medicine, 40% of our health spend is inefficient--it produces no medical benefit. The $1.2 trillion+ we could recover would go a long way toward paying for good care for everyone.
But remember who profits from our current ''system,'' especially the physicians who have enjoyed the fastest increase in pay of all professions over many decades. Add health insurance companies, drug and medical device makers, each seeking a big piece of the pie, and it becomes clear why the profit motive can never be reconciled with the Hyppocratic Oath, ''first, do no harm.''
Republican orthodoxy--to give the ''free market'' even more power in health care--clearly caters to those who profit from our system (and donate disproportionately to Rebublican election coffers) at the expense of their constituents.
Millions of American eyes were opened by the failure of Trump/Ryan care, the American Health Care Act, following weeks of well-informed protest. The White House wants to give it another go next week, even as we stumble toward another government shutdown deadline on April 28.
Has there ever been a worse start for a presidential term?
But remember who profits from our current ''system,'' especially the physicians who have enjoyed the fastest increase in pay of all professions over many decades. Add health insurance companies, drug and medical device makers, each seeking a big piece of the pie, and it becomes clear why the profit motive can never be reconciled with the Hyppocratic Oath, ''first, do no harm.''
Republican orthodoxy--to give the ''free market'' even more power in health care--clearly caters to those who profit from our system (and donate disproportionately to Rebublican election coffers) at the expense of their constituents.
Millions of American eyes were opened by the failure of Trump/Ryan care, the American Health Care Act, following weeks of well-informed protest. The White House wants to give it another go next week, even as we stumble toward another government shutdown deadline on April 28.
Has there ever been a worse start for a presidential term?
10
Look who is running the show, Tom Price, a former physician. How many physicians are in the Freedom Caucus. Just looking after their own and it is perfectly legal and totally corrupt.
While the Republicans continue trying to repeal the ACA (which has been a failure mostly), the Democrats refuse to negotiate better terms of their inadequate ACA. Both parties are failures at working for the people who elected them and are paying them. Both parties are in the pockets of the corporations, the banks, and in this case, the health insurance companies.
5
Regarding the ball and box metaphor, what is simultaneously funny and sad is that I remember as a kid watching an episode of "Sesame Street" where Big Bird is trying to pack to go on a trip. He has an inflated beach ball and he's trying to get it to fit into his suitcase. Naturally, it won't work. Snuffleupagus, trying to be helpful, says, "Maybe if you turned the ball around, Bird."
4
In regard to healthcare and the Affordable Care Act, my patience for the cruel Republicans has about put me (and many Americans) over the edge.
I've written here so many times about being a nurse and seeing the devastation of the recession days when people were jobless, suddenly without insurance.
I've written about my friend's child born without an ear and tried to exemplify the rights and concerns of those with pre-existing conditions.
I've called and written my state and federal legislators.
I sent a packet of information to each of my state finance committee members about healthcare insurance concerns in our governor's proposed budgets.
I sit on local community boards and plead my concerns regarding our constituents' needs and healthcare concerns and the future of meeting their needs.
I've attended town hall meetings and spoke to healthcare concerns with state legislators. I even was on national TV speaking up to Paul Ryan at one of his past town halls regarding his decimation of "Medicare as we know it" and stupid Medicare voucher proposals.
At 68 years old I marched in the Women's March in DC and held a sign that said "SAVE OUR HEALTHCARE!"
I'm sick of picking up the papers and turning on the TV and seeing men and women ok with continuing to take healthcare away from others, the United States Republicans, and have people still vote for them.
I am pretty much just left wishing something awful healthwise would happen to them.
I've written here so many times about being a nurse and seeing the devastation of the recession days when people were jobless, suddenly without insurance.
I've written about my friend's child born without an ear and tried to exemplify the rights and concerns of those with pre-existing conditions.
I've called and written my state and federal legislators.
I sent a packet of information to each of my state finance committee members about healthcare insurance concerns in our governor's proposed budgets.
I sit on local community boards and plead my concerns regarding our constituents' needs and healthcare concerns and the future of meeting their needs.
I've attended town hall meetings and spoke to healthcare concerns with state legislators. I even was on national TV speaking up to Paul Ryan at one of his past town halls regarding his decimation of "Medicare as we know it" and stupid Medicare voucher proposals.
At 68 years old I marched in the Women's March in DC and held a sign that said "SAVE OUR HEALTHCARE!"
I'm sick of picking up the papers and turning on the TV and seeing men and women ok with continuing to take healthcare away from others, the United States Republicans, and have people still vote for them.
I am pretty much just left wishing something awful healthwise would happen to them.
28
mima,
I do not wish something dreadful, healthwise to happen to the republicans. I only suggest that they be only entitled to the health care they want to pass, and to let everyone else be signed up for universal medicare. since they have obviously no empathy for the rest of us, maybe their inherent selfishness and regard for rich people will disappear if they lose their government health plans that they get when the rest of America doesn't.
I do not wish something dreadful, healthwise to happen to the republicans. I only suggest that they be only entitled to the health care they want to pass, and to let everyone else be signed up for universal medicare. since they have obviously no empathy for the rest of us, maybe their inherent selfishness and regard for rich people will disappear if they lose their government health plans that they get when the rest of America doesn't.
1
Take that balloon and shove it!
We want health care, not insurance policies, not block grants, not health care savings accounts, not subsidized premiums, not tax deductions for insurance premiums, not provider networks, not high deductibles and scanty coverage, and not a bunch of splintered government programs to support private health care insurance.
Just health care! Just Medicare-for-all!
Medicare already covers the costliest segment of the population, those from age 65 to death. Why should it not cover the most promising segment, the children? Why not the productive tax-paying segment, the working-age adults?
The management and administrative support for universal Medicare is already in place. The civil service management staff maintains the rules and procedures, and private insurers, operating under Medicare Advantage plans, compete to provide the clerical functions for eligibility verification and claims payment.
Let’s demand that the Congressional Budget Office calculate the cost of Medicare-for-all and the cost savings from terminating private health care insurance and complex federal/state programs like Medicaid. Then we can find any needed additional outlays by eliminating tax favors for Big Business and the Filthy Rich, and cutting back the development of sophisticated weapons for which we have no worthy enemies.
We want health care, not insurance policies, not block grants, not health care savings accounts, not subsidized premiums, not tax deductions for insurance premiums, not provider networks, not high deductibles and scanty coverage, and not a bunch of splintered government programs to support private health care insurance.
Just health care! Just Medicare-for-all!
Medicare already covers the costliest segment of the population, those from age 65 to death. Why should it not cover the most promising segment, the children? Why not the productive tax-paying segment, the working-age adults?
The management and administrative support for universal Medicare is already in place. The civil service management staff maintains the rules and procedures, and private insurers, operating under Medicare Advantage plans, compete to provide the clerical functions for eligibility verification and claims payment.
Let’s demand that the Congressional Budget Office calculate the cost of Medicare-for-all and the cost savings from terminating private health care insurance and complex federal/state programs like Medicaid. Then we can find any needed additional outlays by eliminating tax favors for Big Business and the Filthy Rich, and cutting back the development of sophisticated weapons for which we have no worthy enemies.
40
The Congressional Budget Office works for you. Email them directly (Just don't use the email for the public; that goes to PR). Use the email senators are invited to use. Then ask away. They work for YOU!
Absolute moral bankruptcy describes the Republican approach to governance. They have had seven years to try and create a better way to provide this basic service to American citizens all the while voting to repeal a service for which they have no replacement plan. How can they be viewed in any other way? We are getting the government we deserve.
10
The balloon is Donald Trump and he is full of hot air - after 100 years of trying to obtain quality healthcare for all Americans it is about time to utilize the best option, Medicare for all. To satisfy the republicans it can be made optional to join or not to join with penalties for bailing out and returning later. Let's do it.
11
The real problem here is that the G.O.P. doesn't have a plan.
Even though they've had seven years to come up with a replacement -- That's how long they've been champing at the bit to take the Affordable Care Act down.
Make no mistake about it. Their real interest isn't coming up with something better.
It's all about getting rid of a bill that has President Obama's name associated with it, while cutting themselves and the wealthy a bigger piece of the pie, at the expense of those who need affordable care the most.
Nothing about this will make America great again.
Even though they've had seven years to come up with a replacement -- That's how long they've been champing at the bit to take the Affordable Care Act down.
Make no mistake about it. Their real interest isn't coming up with something better.
It's all about getting rid of a bill that has President Obama's name associated with it, while cutting themselves and the wealthy a bigger piece of the pie, at the expense of those who need affordable care the most.
Nothing about this will make America great again.
14
Beyond exploiting the issue to motivate an ill-informed base, the Republican approach to health care remains what it has always been: "If you want good health care, be rich enough to not need insurance or at least have enough money to buy good insurance. If you can't even afford good insurance, stay healthy or, if you do get sick, die quickly and at minimum expense to others."
5
Republicans have fought for generations to dismantle government. Based on Trump's "win" Brexit and possibly France, they have succeeded in destroying liberal democracy. Once again, they favor destruction without considering the alternatives, in other words the Iraq War. Now they are petrified of the results of their victory, as we all should be.
4
The Republicans are relentless in reaching their goals. They will keep chipping away at health care no matter how long it takes or how long the odds. If millions lose coverage, they will find a way to blame the Democrats. They will change one piece at a time, if necessary, and if the legality of their tactics is challenged, they will have the Supreme Court to help them out. The resourcefulness of Republicans to get what they want should never be underestimated.
When they finally give up and admit they can't find a cheaper way to provide coverage, when they can no longer even pretend to think our for-profit system is better than the cheaper, more effective systems employed virtually everywhere else . . . they'll probably just go back to repeal, forgetting about replace, and hope they can weather the storm.
They've already picked their winners (the insurance industry) and their losers (the American people). All the rest is spin.
They've already picked their winners (the insurance industry) and their losers (the American people). All the rest is spin.
9
PV=nRT. Increase the pressure and the balloon will fit in the box (put the lid on). Another analogy might work better: ten pounds in a five pound bag.
Seriously doubt that Trumpcare 2.0 will be going anywhere. Why? It will continue to be opposed by doctors, hospitals, AARP, Democrats, Republicans in swing districts that supported Clinton, right-wingers that have an interest in repeal without the replace. In addition, any Medicaid rollback would likely kill it in the Senate, as was indicated previously when Trumpcare 1.0 was being promoted by Ryan as the "Better Way," which should have been named the "Dopey Way."
6
And yet, people will keep voting for these guys. That's because a rock-hard minority of voters can apparently be "fooled all the time." Slap the 'conservative' label on something, run it through Fox News and the right-wing echo chamber, and they are for it.
It won't surprise me if the Republicans pass something they trumpet as "repealing and replacing" the ACA. This is all about optics now and delivering a 'win.'
The good news is that a single-payer plan may not be all that far away. People are starting to believe that basic healthcare is a right for all, not a luxury for the wealthy.
If the ACA is a stepping stone to that reality, we can truly call it a success.
It won't surprise me if the Republicans pass something they trumpet as "repealing and replacing" the ACA. This is all about optics now and delivering a 'win.'
The good news is that a single-payer plan may not be all that far away. People are starting to believe that basic healthcare is a right for all, not a luxury for the wealthy.
If the ACA is a stepping stone to that reality, we can truly call it a success.
10
Something bigger is being revealed. While the balloon metaphor is apt, look at the logical contortions the GOP has to deal with. It starts with an invalid premise, that you can make the situation better, cost less, and all the rest. You can't that's the balloon. The false premise strategy works great when you are out of power, as it did for Trump. But when you have to play in the real world, not so much. Flawed premises inevitably lead to flawed conclusions which is what's happening not just in healthcare but in every area where the GOP tries to assert a difference. It is the thinking of a permanent minority party that woke up in power by accident. Thanks Vladimir.
4
Using "premiums paid by the healthy to cover the cost of caring for the less healthy" is essentially what insurance IS. As with any other kind of insurance, the people who don't need it cover the costs of those who do, which sounds unfair to the half-educated who don't consider the other critical fact in the formula: no one is permanently, comfortably affixed in one category or the other. I'm helping you pay for your fender-bender today because I may be the one who gets side-swiped tomorrow. Shared risk is the whole POINT. Anyone who proposes "high risk pools" is essentially declaring that they don't understand what insurance is. Or hoping that their voters don't. And that those voters are stupid enough to think that just because they're healthy now, that's a permanent condition.
The other problem the Republicans have is that they can't govern in general. They have deformed themselves into a party of permanent opposition, which is fine as long as you don't control all three branches of the federal government. They could have gone on ad infinitum had Hillary won, having their little rallies, chanting "Lock her up!", and hating the Democrats.
The worst thing that happened to the Republicans - and, in the short run, to the country - is that the GOP won the whole shebang. The party that has campaigned against the idea that government can do anything good now is the government, and the people expect - no, demand - that it does good things.
The Democrats will have a wonderful opportunity in the midterms, and next week we'll all be holding our breath and watching to see if the Republicans can even keep the government funded.
Pass the popcorn.
The worst thing that happened to the Republicans - and, in the short run, to the country - is that the GOP won the whole shebang. The party that has campaigned against the idea that government can do anything good now is the government, and the people expect - no, demand - that it does good things.
The Democrats will have a wonderful opportunity in the midterms, and next week we'll all be holding our breath and watching to see if the Republicans can even keep the government funded.
Pass the popcorn.
6
If the Rs really want to change the cost is to allow people to get into medicare earlier like maybe 45 or 50 years old. I hear people in their 60s pay over a $1,000 a month for coverage(my 64 year old sister is around $1200) and when they get into medicare at 65 the true cost is around $600.
I still believe the only reason the Rs are attacking the ACA so fiercely is because of the 3.85% tax on "other income", which is a form of the FICA tax on all payroll income. It's an easy, fair tax that should be really be at 7.65% for all other income to fund SS and Medicare and a single payor medicaid for all 0-65 years of age would make all solvent and hopefully the Ds will make it happen in 2021.
I still believe the only reason the Rs are attacking the ACA so fiercely is because of the 3.85% tax on "other income", which is a form of the FICA tax on all payroll income. It's an easy, fair tax that should be really be at 7.65% for all other income to fund SS and Medicare and a single payor medicaid for all 0-65 years of age would make all solvent and hopefully the Ds will make it happen in 2021.
4
"All of this raises the obvious question: If Republicans never had a plausible alternative to Obamacare, if this debacle was so inevitable, what was the constant refrain of “repeal and replace” all about?"
In order to understand what 'repeal and replace' was all about, one needs to know the trump doctrine: What Serves Me Best Right Now
Trump started saying it at rallies, the crowds liked it, and he repeated it over and over. Obviously he never knew what he was talking about and I doubt that he cared. What he did know was that it was a popular feature, which was the only thing that mattered because it served him best at the time.
In order to understand what 'repeal and replace' was all about, one needs to know the trump doctrine: What Serves Me Best Right Now
Trump started saying it at rallies, the crowds liked it, and he repeated it over and over. Obviously he never knew what he was talking about and I doubt that he cared. What he did know was that it was a popular feature, which was the only thing that mattered because it served him best at the time.
2
Professor Krugman has the GOP motivations all wrong. Republicans don't believe health care is a right. They want the government to have no hand in it. This would result in tens of millions losing access to health care and hundreds of thousands dying prematurely, but really they don't care. To the GOP it's FREEDOM.
5
The brilliance of Obamacare is the balance struck and compromise made between single payer and no plan. The great negotiator - PRESIDENT O - figured out that providing coverage for pre-existing conditions was both a financial noose and a life saving liberation. Yes, Single Payer does the trick. But the real trick was balancing the coverage for all with the money to pay for it from the private sector.
Oops! The Republicans haven't figure any of this out yet so their balloon keeps getting bigger while their box closes in around them.
Oops! The Republicans haven't figure any of this out yet so their balloon keeps getting bigger while their box closes in around them.
5
While living in Europe for a year my husband and I purchased an international health insurance policy that cost about $4,000 for coverage of both for 12 months. I slipped in the dark and shattered my wrist. I saw a hand specialist in the morning and prepaid for surgery and a 3 day hospital stay. Total cost was about $3,000 including surgeon, anesthesiologist, multiple X-rays, and gorgeous cast. Excellent care, brilliant surgeon, wonderful hospital from which I was discharged after 1 night. The same scenario in the US would have cost close to $30,000. That's your balloon.
Oh, I was fully reimbursed by my insurance company.
Oh, I was fully reimbursed by my insurance company.
10
I've often wondered if the real reason the Republicans are against the ACA and a public option is that if moved from job-based healthcare coverage to universal coverage, workers would feel more empowered to change jobs. In our current contorted workplace, some people stick with jobs just to maintain healthcare coverage and when trying to assess whether to accept another job, understanding the opaque healthcare coverage (co-pays, deductibles, in-network, out-of-network) and its cost is darn near impossible. A "Medicare for all" arrangement would force companies to compete on actual cash compensation and benefits like pensions and 401ks. Perhaps one way to restore mobility in the workplace is to go for a single payer system.
5
Republicans really only focused on the desire to eliminate taxes on the wealthy needed to pay ACA costs. All the false concern for individual premium costs and the like are just window dressing to make it appear that they were concerned to do something beneficial for the American people. So they complicated their task by putting up a smokescreen of concern for average Americans. Maybe it is time for the GOP to put down their protection of the wealthy and work in a bipartisan manner to improve the ACA to benefit Americans or better yet go to single payer and get the insurance company goal of maximizing profits out of the health care equation.
4
"There are some things we could do that would probably make it even cheaper, but they would all involve moving left — say, introducing a public option, or going all the way to single-payer. The G.O.P., which is determined to move right instead, reducing the public sector’s role, has offered no reason for anyone to believe that it could do better."
This paragraph says it all.
President Obama said the following in 2003:
“I happen to be a proponent of a single payer universal health care program.” (applause) “I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”
Obama speaking to the Illinois AFL-CIO, June 30, 2003.
This is the pragmatic approach. While president Obama might have wanted single-payer he had to take what he could get. This is what politics, the art of compromise.
This paragraph says it all.
President Obama said the following in 2003:
“I happen to be a proponent of a single payer universal health care program.” (applause) “I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”
Obama speaking to the Illinois AFL-CIO, June 30, 2003.
This is the pragmatic approach. While president Obama might have wanted single-payer he had to take what he could get. This is what politics, the art of compromise.
5
We have a government that has been bought off by Big Pharma, the health industry and insurance companies. Doesn't this explain why we pay more for drugs and medical procedures and don't have a single payer system? Much ado was made during the presidential campaign about our high drug prices relative to the rest of the world. One meeting between Trump and Pharma execs put and end to that movement.
13
We have an ersatz democracy that is so twisted up into weird, profoundly malapportioned districts, that most of our votes effectively don't matter at all, like the 3 million votes discarded by the Electoral College scheme that admits only whole states to the count.
2
Yet another deception by Krugman. With deductibles unaffordable, telling us that so many more people have insurance is an absolutely meaningless statistic. What matters is how many folks have healthcare and instead of allowing folks to hire a doctor for a reasonable fee, the ACA steals poor folks money to pay premiums for insurance with up to a $12,000 deductible that nobody can afford. The result is the ADCA takes their money for what little healthcare they could afford and leaves them with nothing.
4
I think the deception is your post.
A year ago, through no fault of my own, I lost my job and insurance. When I went to sign up for ACA - which didn't save my life, but probably saved me from bankruptcy - and the possible plans were presented, there was a very helpful explanation that, if you think you'll be going to the doctor more than 2 times a year, you should not sign up for a high deductible plan.
In addition, it asked what meds I need, and number of visits I anticipate, and the gave me an estimate on total out-of-pocket costs for each plan.
So if they're "trying to take folks' money," via deductibles, that sure is an odd way way of doing it, warning you in advance about the dangers of high deductibles for some patients and presenting multiple plan options, with estimated out of pocket costs, based on your current needs.
A year ago, through no fault of my own, I lost my job and insurance. When I went to sign up for ACA - which didn't save my life, but probably saved me from bankruptcy - and the possible plans were presented, there was a very helpful explanation that, if you think you'll be going to the doctor more than 2 times a year, you should not sign up for a high deductible plan.
In addition, it asked what meds I need, and number of visits I anticipate, and the gave me an estimate on total out-of-pocket costs for each plan.
So if they're "trying to take folks' money," via deductibles, that sure is an odd way way of doing it, warning you in advance about the dangers of high deductibles for some patients and presenting multiple plan options, with estimated out of pocket costs, based on your current needs.
4
James, are you covered through the ACA ? I am, because I'm self-employed, middle aged, and not wealthy, and I can tell you that your criticism is misguided.
First, there are subsidies for low-income people, and policies with deductibles lower than $12K. Second, my insurer negotiates lower fees for care than I could get on my own. And if I get seriously ill or injured, a $12,000 debt is a lot better than a $120,000 debt. I have glaucoma and needed a complicated surgery once already, so this is not theoretical for me.
I'd prefer Medicare for all, but the ACA is a whole lot better than what I had. if the Republicans and red-state governors wanted to fix the problems you describe, they could. But they won't, because to them, our lives matter less than padding the bottom lines of their billionaire sponsors.
First, there are subsidies for low-income people, and policies with deductibles lower than $12K. Second, my insurer negotiates lower fees for care than I could get on my own. And if I get seriously ill or injured, a $12,000 debt is a lot better than a $120,000 debt. I have glaucoma and needed a complicated surgery once already, so this is not theoretical for me.
I'd prefer Medicare for all, but the ACA is a whole lot better than what I had. if the Republicans and red-state governors wanted to fix the problems you describe, they could. But they won't, because to them, our lives matter less than padding the bottom lines of their billionaire sponsors.
1
Every President wants to leave a long-lasting legacy that the public and history will judge to be highly admirable and good for the nation's citizens. President Obama achieved that with his successful passage of ACA. The boisterous backlash Congressional Republicans endured in their last town hall meetings killed Republican efforts to dismantle ACA. The public wanted ACA and Donald and the Republicans should have moved on to their next legislative agenda. Trump can't let go because his ego can't accept defeat. If he persists, Republicans will be punished during the 2018 mid-terms.
Donald boasted he would be the greatest job creator that God ever made. Now that is an agenda that could become a highly admired legacy of his administration. What has he done so far? Zippo, nothing, That should have been his first agenda that would have added to his political capital. Instead he squandered it on stupid misguided racist policies that have been checked and will come to nothing. Just another indicator that Donald is in way over his head and has surrounded himself with inept advisors that do not know the ins and outs of Washington politics.
Donald boasted he would be the greatest job creator that God ever made. Now that is an agenda that could become a highly admired legacy of his administration. What has he done so far? Zippo, nothing, That should have been his first agenda that would have added to his political capital. Instead he squandered it on stupid misguided racist policies that have been checked and will come to nothing. Just another indicator that Donald is in way over his head and has surrounded himself with inept advisors that do not know the ins and outs of Washington politics.
12
The fact is that Republicans and especially TrumpoTheClown have convinced their base that up is down and wrong is right and bad is good and dumb is smart. They convinced them that Obamacare was killing jobs even though it isn't. They convinced them that Obamacare was going to include death panels which it doesn't. They convinced them that 2.0% GDP growth was weak and that 200,000 jobs created a month was a slow economic recovery although trumpo's first fiscal quarter GDP is truly anemic at 0.5%. They convinced them that Obama would take their guns even though gun sales were at historic highs and so was ownership. They convinced them that cutting the unemployment rate in half was weak even though it put 16 million people back to work. They convinced them that Obama was a Muslim who was intent on destroying our nation and at the depths of the Second Great GOP Depression when Obama took office the first official act was to bailout the economy. Anyone with any degree of commonsense would have recognized that if Obama wanted to destroy our Nation a good start would have been to allow the US auto industry to collapse like Republicans wanted to do. Someday America will wake up from the nightmare known as the TrumpoTheClown administration and that day cannot come soon enough.
10
When we have only the one opposition party, and that party is not prepared to bet their entire political fortunes on healthcare issues, we'll continue this Myth of Sisyphus.
President Obama bets his Presidency on the issue and backed it fully and still gets relected. Yet his party scattered from the issue like roaches when running their campaigns and lost.
We need a political party that will embrace health care without backing down. That has the backbone to face the fact that we'll never resolve anything decisively as long as one party uses false promises, pompous reality TV stars, and slogans; and the other one just skitters away.
I'd call for a rational discussion for the formation of a new political party to address the gaping hole of sensibility between right and left, but it appears that most people like inaction and don't have the resolve to change history.
“So we beat on, boats against the current, borne back ceaselessly into the past.”
President Obama bets his Presidency on the issue and backed it fully and still gets relected. Yet his party scattered from the issue like roaches when running their campaigns and lost.
We need a political party that will embrace health care without backing down. That has the backbone to face the fact that we'll never resolve anything decisively as long as one party uses false promises, pompous reality TV stars, and slogans; and the other one just skitters away.
I'd call for a rational discussion for the formation of a new political party to address the gaping hole of sensibility between right and left, but it appears that most people like inaction and don't have the resolve to change history.
“So we beat on, boats against the current, borne back ceaselessly into the past.”
5
@Politix
At least Obama and yes, even HRC tried to come up with a viable U.S. Healthcare Plan -- did the G.O.P knock it down?
Of course, that's what they do best.
Given those odds, don't hold your breath waiting for some magical political party to come along and do any better.
At least Obama and yes, even HRC tried to come up with a viable U.S. Healthcare Plan -- did the G.O.P knock it down?
Of course, that's what they do best.
Given those odds, don't hold your breath waiting for some magical political party to come along and do any better.
1
Hot air is just as apt a metaphor for Trump and the right wing. He exaggerates everything to the point that he can't tell the truth without lying. He and his blowhard friends are going to make better health care for more people for less money! Any who believe that , I've got a bridge I'd like to sell you! I am old enough to remember the great scapegoater in the 1940"s. That loony toon had a whole country goose stepping to his music. Thank heaven we are more diverse. Only 30 something percent are tripping the light fantastic to his music. Trump's pal Ryan read Ayn Rand when he was too young and mistook her fiction for philosophy. In a party bereft of ideas Ryan passes off as an intellectual. He proudly supports 19th century economic theory that finally ended in the Great Depression. From my point of view the rich are rich enough. Why pass laws making them richer?
20
Campaigning and governing are two different things.
Promising and delivering are two different things.
Criticising and creating are two different things.
Demolishing and building are two different things.
In each case, the Republicans are expert at the former and fail miserably at the latter.
To govern, deliver, create, and build requires understanding, knowledge, expertise, and compromise which the Democrats employ.
The Republicans have none of these attributes. They can only campaign, promise, criticise and demolish.
Such is the tale of GOP healthcare. They not only don't realize that it is impossible to stuff that big balloon into a small box, they don't even know how to build the box.
But it will be a great box! Let me tell you. A fantastic box. The best ever! Believe me when I tell you. It will be great!
That they can do.
Promising and delivering are two different things.
Criticising and creating are two different things.
Demolishing and building are two different things.
In each case, the Republicans are expert at the former and fail miserably at the latter.
To govern, deliver, create, and build requires understanding, knowledge, expertise, and compromise which the Democrats employ.
The Republicans have none of these attributes. They can only campaign, promise, criticise and demolish.
Such is the tale of GOP healthcare. They not only don't realize that it is impossible to stuff that big balloon into a small box, they don't even know how to build the box.
But it will be a great box! Let me tell you. A fantastic box. The best ever! Believe me when I tell you. It will be great!
That they can do.
14
The only question is how much of the nation’s time, attention and opportunity costs Republicans will waste before they come to this realization. Instead, we keep watching the same bad movie over and over.
Republicans can screw sick and older voters and never hold office again or they can repair ACA. Seems like a simple decision.
Republicans can screw sick and older voters and never hold office again or they can repair ACA. Seems like a simple decision.
5
Except for selling supplemental policies to folks who can afford them, the insurance companies need to get out of the health insurance business, rather than asking taxpayers to underwrite their profits. A single payer system is coming. It is economically inevitable.
6
According to the BMI calculation that insurance companies use to measure obesity, about 35 percent of US adults would be classified as obese; obesity being a pre-existing condition. Under the Republican attack on the pre-existing condition prohibition, they are basically saying to over a third of Americans, many of whom are perfectly healthy individuals, you should not be able to purchase insurance in a free market; these folks would either be excluded outright or have to pay such a high surcharge that the insurance would be out of reach. Same thing for someone who had cancer ten years ago and has a good chance of living out their days without a relapse. Let's deny insurance to the folks that need it most. The important thing is that the bottom line of the insurance companies will be a lot healthier.
6
Paul Krugman's example of the ballon in a box is interesting but maybe it would be worth while to talk about the box. A part of the health care crisis comes from a changing shape of the box that is supposed to contain health care funding. The origins of health care funding has changed dramatically due to the huge loss of heath insurance through employers, the stagnant wages americans have lived with for twenty years, the dramatic increase in life style disorders like obesity that are associated with diabetes, and the aging american population.
The box that contained the "old sources of funding" is getting smaller and smaller , while costs and demand for health care rise. The only solution is a bigger box, or simply put another source of funding. That funding must come from taxation. Single payer systems do not get around this fact. Private insurance is so expensive that subsidies are needed and here too taxation is the only solution.
It is time for republicans to come to the table as adults, face up to these realities and propose sources of revenue which will make health care possible for all americans. If they fail they will have to confront election after election where they will lose as americans catch on to what is wrong with the republican party and what is right with other party choices.
The box that contained the "old sources of funding" is getting smaller and smaller , while costs and demand for health care rise. The only solution is a bigger box, or simply put another source of funding. That funding must come from taxation. Single payer systems do not get around this fact. Private insurance is so expensive that subsidies are needed and here too taxation is the only solution.
It is time for republicans to come to the table as adults, face up to these realities and propose sources of revenue which will make health care possible for all americans. If they fail they will have to confront election after election where they will lose as americans catch on to what is wrong with the republican party and what is right with other party choices.
8
Paul,
Your balloon analogy is apt, but I think of the problem as cattle ranchers trying to rebuild the cattle pen without losing any cattle. Originally, they just wanted to slaughter the animals (repeal) but found that their constituents had became vegetarians and wanted to keep them. So now their problem has become how to keep certain core principles (pre-existing conditions, near universal coverage, etc.) in a new pen that looks different enough from the old pen so that it won't be labeled Obamacare light (replace). But it's hard to contain the cattle and build a new pen at the same time. Whole lot of mavericks in that herd.
Furthering their difficulty is the fact that their head cowboy is not up to the task of finding cows. He can't even find his aircraft carriers.
Your balloon analogy is apt, but I think of the problem as cattle ranchers trying to rebuild the cattle pen without losing any cattle. Originally, they just wanted to slaughter the animals (repeal) but found that their constituents had became vegetarians and wanted to keep them. So now their problem has become how to keep certain core principles (pre-existing conditions, near universal coverage, etc.) in a new pen that looks different enough from the old pen so that it won't be labeled Obamacare light (replace). But it's hard to contain the cattle and build a new pen at the same time. Whole lot of mavericks in that herd.
Furthering their difficulty is the fact that their head cowboy is not up to the task of finding cows. He can't even find his aircraft carriers.
8
And let's also remember that every other modern country solved the healthcare problem decades ago for one-half to two-thirds the price of the Great American Health Care Rip-Off.
The only thing holding back American healthcare human decency is good old-fashioned Greed Over People that demands sadistic, misanthropic health care coverage for twice the price.
Country and Healthcare Costs as a % of GDP
United States 16.9 %
Switzerland 11.5
Japan 11.2
Germany 11.1
Sweden 11.1
France 11.0
Netherlands 10.8
Denmark 10.6
Belgium 10.4
Austria 10.4
Canada 10.1
Norway 9.9
United Kingdom 9.8
Finland 9.6
New Zealand 9.4
Ireland 9.4
Australia 9.3
Italy 9.1
Spain 9.0
Portugal 8.9
These other countries understand that government regulation of healthcare extortion and a public option make the system work for everybody, just as it should in a 'democracy'.
Only in America, land of fake freedom, real 'free-dumb', fake news and international healthcare news blackouts, is health care a sadomasochistic national sport where right-wingers line up to punish others with medical extortion and premature death.
Remember the Republican healthcare clarion call: we will give you half the healthcare for twice the price !
The 'free-dumb' to drop dead for rich men's tax cuts is a powerful right-wing narcotic that kills millions in the name of Holy Mammon, praise the Lord !
Nice people.
The only thing holding back American healthcare human decency is good old-fashioned Greed Over People that demands sadistic, misanthropic health care coverage for twice the price.
Country and Healthcare Costs as a % of GDP
United States 16.9 %
Switzerland 11.5
Japan 11.2
Germany 11.1
Sweden 11.1
France 11.0
Netherlands 10.8
Denmark 10.6
Belgium 10.4
Austria 10.4
Canada 10.1
Norway 9.9
United Kingdom 9.8
Finland 9.6
New Zealand 9.4
Ireland 9.4
Australia 9.3
Italy 9.1
Spain 9.0
Portugal 8.9
These other countries understand that government regulation of healthcare extortion and a public option make the system work for everybody, just as it should in a 'democracy'.
Only in America, land of fake freedom, real 'free-dumb', fake news and international healthcare news blackouts, is health care a sadomasochistic national sport where right-wingers line up to punish others with medical extortion and premature death.
Remember the Republican healthcare clarion call: we will give you half the healthcare for twice the price !
The 'free-dumb' to drop dead for rich men's tax cuts is a powerful right-wing narcotic that kills millions in the name of Holy Mammon, praise the Lord !
Nice people.
409
Those countries ration healthcare in order to control costs as there is no other way to keep the "free healthcare" system solvent. I personally know the Canadian and UK systems and both would be unacceptable to Americans.
1
James...hundreds of millions of Europeans/Canadians/Japanese and other global citizens are largely satisfied with their universal healthcare....and few are clamoring for American-style healthcare extortion.
Keep on saying 'America is #1' and see where it gets you and how many problems you continue to fail to solve because of American ignorance, greed and a basic refusal to change American's international health care extortion disgrace.
'Rationing' is a scare tactic.
Put your fear tactic down, and your thinking cap on.
Keep on saying 'America is #1' and see where it gets you and how many problems you continue to fail to solve because of American ignorance, greed and a basic refusal to change American's international health care extortion disgrace.
'Rationing' is a scare tactic.
Put your fear tactic down, and your thinking cap on.
4
And remember; Portugal got to the bottom of that list, in part, by treating drug use entirely as a public health issue and not with their criminal justice system. They ended their WarOnDrugs to achieve better public health and better policing outcomes. That and universal health care has worked well and we should pay attention. Paging AG Sessions & SHS Kelly?
1
Repeal and replace? The Republicans voted sixty-odd times to repeal Obamacare but none of those plans said anything about a replacement. It was only after the CBO pointed out that they were about to cause 24 million Americans to lose their health insurance that they proposed a replacement, an atrocious replacement that was basically a tax cut for the rich disguised as an insurance plan. The whole thing famously went down in flames. No, they are not even trying to replace Obamacare with any sort of effective alternative.
14
Love the metaphor, but call it like it really is, ok? Obamacare is a viable program created by a cool black dude with a Muslim sounding name, and that drives the party of old white male bigots crazy. That's why they want to kill it.
22
You left out "rich". Rich old white male bigots.
Nice metaphor: the big balloon and the small box. To shrink the balloon you need to reduce the irrational drivers of high US healthcare costs, but each irrational driver of cost is sponsored by a well funded lobby, i.e, for: insurance companies, drug companies, malpractice lawyers, nursing homes, and the tormenting the dying for profit industry.
18
What is a Fire Department but a socialist organisation dedicated to the health of the town/city that it serves? We all pay taxes to support it, and the FD puts out the fires (and does much more) wherever they occur. It is Single Payer Health Care. And we all, Democrats and Republicans, love the Fire Departments of America. We love the people who risk their lives to protect our "health". Why cannot we get over the conceptual hump that has us stalled on the other side from the rest of the developed world?
34
Ancient Rome had for-profit fire departments. That did not work out well at all. It can be done, it just does not work. Health care is exactly the same.
We often use the balloon analogy in our licensing negotiations. "Here's the deal. You can change it, but if you push down in one place it'll pop up somewhere else." This works in business because money in a licensing deal is uncertain and each side views risk differently. There are many ways to trade off more certainty in payments for more risk.
Republicans are attempting this approach with health care. The problem is that there is no uncertainty about the money. All of the parties know what the aggregate costs will be. Thus they are playing a disingenuous game by bringing into question the very premise of insurance itself. If they can delegitimize the concept of insurance they believe they will be able to get the majority of healthy people to abandon those who are unhealthy and thereby reduce the amount of money needed by the system... and take the money saved give a tax break to the "president" and his friends.
That's the art of the steal.
Republicans are attempting this approach with health care. The problem is that there is no uncertainty about the money. All of the parties know what the aggregate costs will be. Thus they are playing a disingenuous game by bringing into question the very premise of insurance itself. If they can delegitimize the concept of insurance they believe they will be able to get the majority of healthy people to abandon those who are unhealthy and thereby reduce the amount of money needed by the system... and take the money saved give a tax break to the "president" and his friends.
That's the art of the steal.
7
As far as I can tell, Republican objections to "Obamacare" rests on two principles: 1) It offends their radical libertarian view that government should not compel anyone to do anything and 2) It was proposed by Obama. At some level, however, they do seem to recognize the guiding dilemma of health care -- that no one outside of the billionaire class (which Trump and many of the people around him inhabit) can afford it and that illness is a genuine misfortune, for which the natural tendency even among Republicans is to try to be helpful. It is agonizing to watch this group trying to reconcile these contradictory impulses. It is even more agonizing to watch them to try to change an imperfect but functioning system to something consistently worse solely out of animosity to the person who proposed it.
19
They believe federal government should not collect taxes to pay for anything except police, courts, and national defense.
1
In reality the Republican assault on the ACA was never really about health care. It was more about a large government program that was put forth by a Democratic president and passed with no GOP support. While their conviction that "government is the problem" consumes them day to day actually accomplishing any solutions to the "problem" continue to run into constituencies within their own party in addition to absolutely no support from Democrats.
6
The disgusting racket that passes for 'Health Care' in the US has it all backwards. All the profits that can be strip mined from an increasingly strapped public are in people getting sick and then becoming dependent on the drug companies. Faced with criminal deductibles, most cannot afford to even use the system - they just pay ever increasing premiums.
Time to wrestle away this grotesque money-extraction scheme from these pigs and go to some highly regulated market system like Switzerland.
Time to wrestle away this grotesque money-extraction scheme from these pigs and go to some highly regulated market system like Switzerland.
13
Well said. The problem is that when ogilarchs with grand schemes write your legislation, it ends up having no practical application for the vast majority of your constituents.
7
Please Paul, for once write a column comparing the ACA to the Canadian system instead of to the Republican idiocies that are only slightly more idiotic that the ACA in this comparison. If liberals can't imagine a health care system
not dominated by parasitic special interest it will never happen.
not dominated by parasitic special interest it will never happen.
7
One doesn't even know what the word "liberal" is supposed to mean anymore.
For those who philosophize on matters of "fairness", the Value Added Tax is the no-brainer way to fund a health care infrastructure. This approach causes everyone to pay approximately the same percentage of their gross living expenses into the health care system.
For those who philosophize on matters of "fairness", the Value Added Tax is the no-brainer way to fund a health care infrastructure. This approach causes everyone to pay approximately the same percentage of their gross living expenses into the health care system.
1
Why can't we all relax and fight for single payer? That would bring along some Trump voters as soon as they understood that it's just an expansion of Medicaid, a program many voters know because nearly everyone, except those who don't want to pay their fair share of taxes, knows.
With enough to pressure on Republican congressmen, perhaps we could give everyone a win.
With enough to pressure on Republican congressmen, perhaps we could give everyone a win.
9
"Single payer" really means "single collector". This whole issue really revolves around how the money is raised to defray health care costs.
And let's not forget it is harder for Republicans as their balloon is filled with hot air.
30
The Republicans' are so wedded to their ideology - that government is necessarily inefficient or bad - that they cannot see how they are trying to stuff the balloon into the box. What are they? Stupid? They don't understand that the concept of insurance requires shifting costs over a larger population to minimize the risks of an individual getting financially ruined?
Additionally, they are politicizing health care far too much: it is too important an issue to try to win points with the base on, yet they stubbornly try to put it into their win column. As a byproduct, there is no intelligent debate, no intelligent discussion, on the subject. Instead, it is ram, ram, ram.
VERY SAD.
Additionally, they are politicizing health care far too much: it is too important an issue to try to win points with the base on, yet they stubbornly try to put it into their win column. As a byproduct, there is no intelligent debate, no intelligent discussion, on the subject. Instead, it is ram, ram, ram.
VERY SAD.
10
The only thing that could be added to this excellent analysis (metaphor?) would be to add the quote most often attributed to Albert Einstein; "Insanity is doing the same things over and over, and expecting different results."
1
Complaining about the cost of health care ignores the other side of the equation: what does it cost not to cover citizens with healthcare. Since the only thing that matters in many circles is dollars, and not human needs or human suffering, let's just look at dollars. What are the costs of lost work hours, how many productivity hours are lost, what is the cost of medical bankruptcy and what are the costs to the GDP.
8
Until I turned 65 last summer, I was one of those Americans stuck with a plan with expensive premiums, high deductibles, and scanty coverage. I breathed a big sigh of relief when I got my Medicare card. My daughter and her husband have insurance through his employer. The premiums go up constantly, the deductible is out of reach for their middle class income, and the coverage skimpy. They simply don't go to the doctor or dentist unless it is an absolute emergency. We don't have enough doctors in our area so only a few of us have family physicians. Most of us rely on urgent cares, small clinics, and the ER. I cannot imagine and hope never to live through what the Republicans will do to make this situation worse for most of my family. I will never, ever vote for a Republican again. I can't understand people who do.
226
There is no question that health care is becoming unaffordable. And this is because the profession of medicine has become the business of medicine. Why isn't anyone looking at the huge and financially draining bureaucracy that medicine has become. I see huge buildings that support health care "plans", but do not provide an iota of patient care. What is the administrative cost of medicine? I have no doubt that it is by far the highest consumer of the health care dollar.
We need to get rid of the Unaffordable Care Act just to raze this monster of administrative costs.
We need to get rid of the Unaffordable Care Act just to raze this monster of administrative costs.
4
This is why we need single payer (i.e. government) healthcare or its equivalent just like the rest of the "civilized" world. What we need to do is get rid of insurance companies and have the government set fees for hospitals, suppliers, drug companies and doctors. This is how the rest of the world does it.
10
Actually one of the provisions of the ACA was to limit administrative costs that insurance companies could spend. Before that, there were no controls. "Insurers must spend at least 80–85% of premium dollars on health costs; rebates must be issued to policyholders if this is violated."
The administrative costs of Medicare, a government-run program, are a fraction of those incurred by both for profit (e.g, Aetna) and not-for-profit (e.g., Blue Cross/Blue Shield) companies that sell medical insurance. The amount of money that would be saved IN ADMINISTRATIVE COSTS alone by adopting a single-payer system would surprise most people.
As our nation continues to kneel at the altar of free market (no such thing actually exists) capitalism, we stubbornly refuse to accept the fact that every other advanced nation has acknowledged: decent healthcare is a basic right access to which should not be left to the vagaries of the "free market" or to one's personal economic circumstances.
39
Almost 20 million Americans opt to pay the annual tax penalty, more than half, 12.2 million are granted a hardship exemption by the IRS. The revenue from that fine, or as the SC declared "tax" is nowhere near enough to support the subsidies on those who do buy insurance.
Worst, those are the healthy bodies needed to buy into the risk pools and keep them viable. What's left are sick people who can now move in and out of the risk pool at will.
You don't need a degree in Economics from Princeton to realize that doesn't work.
So there are basically two choices, fix it, or do nothing. Mr. Krugman has no solution other than single payer. "Medicare" for all!
Medicare is financed via a payroll tax, lumped together with SS. Right now it is 15%, with an earned income cap of $127k. You can always raise the earned income ceiling, in fact that is what is done every year. But at some point you will run out of earners.
Now here's the kicker, Medicare covers about 55 million people, not 319 million. So that payroll tax would need to be? Krugman never explains.
The other way to do it is the Sanders Plan, simply nationalize the insurance companies and providers. And if you read things other than this column you would know it's not going very well right now in Venezuela.
Which ironically has produced a field of crickets from The Bern.
Worst, those are the healthy bodies needed to buy into the risk pools and keep them viable. What's left are sick people who can now move in and out of the risk pool at will.
You don't need a degree in Economics from Princeton to realize that doesn't work.
So there are basically two choices, fix it, or do nothing. Mr. Krugman has no solution other than single payer. "Medicare" for all!
Medicare is financed via a payroll tax, lumped together with SS. Right now it is 15%, with an earned income cap of $127k. You can always raise the earned income ceiling, in fact that is what is done every year. But at some point you will run out of earners.
Now here's the kicker, Medicare covers about 55 million people, not 319 million. So that payroll tax would need to be? Krugman never explains.
The other way to do it is the Sanders Plan, simply nationalize the insurance companies and providers. And if you read things other than this column you would know it's not going very well right now in Venezuela.
Which ironically has produced a field of crickets from The Bern.
4
You can always count on a Republican die hard to call us Venezuela and forget the most Venezuelan thing about us is that we have elected a man just as bonkers as Hugo Chavez was. Here's the fact: every industrialized country but the US has managed to provide health care for all its citizens without going bankrupt. Some have single payer; some have insurance company. All have better health outcomes at lower cost than we do. It's not rocket science; it's not impossible. It just means believing that your citizens are worth valuing even if they aren't crooked real estate and casino developers.
5
So there are basically two choices: fix it or do nothing. The fix it choice does not have to mean single payer, but the comparison to Venezuela is silly. Why not compare single payer to countries where is has and is working? But I digress.
There are serious proposals to fix it that address your issues. For example, the legislation can be amended to prevent people from leaving and entering and good ideas abound as to how to address that issue.
As to the healthy young people who would rather pay the tax penalty--nne solution is simply to raise the penalty to an arbitrary cost of insurance which would then be more expensive than the insurance itself. And, I'm tired of hearing how this takes their freedom away: the only freedom it takes away is the freedom to freeload on the medical system should they fall ill with a major illness.
I'm not sure why the solution to a law that is mostly working is to destroy it. Actually, I am sure. The reason is that ideology blinds people to reality.
There are serious proposals to fix it that address your issues. For example, the legislation can be amended to prevent people from leaving and entering and good ideas abound as to how to address that issue.
As to the healthy young people who would rather pay the tax penalty--nne solution is simply to raise the penalty to an arbitrary cost of insurance which would then be more expensive than the insurance itself. And, I'm tired of hearing how this takes their freedom away: the only freedom it takes away is the freedom to freeload on the medical system should they fall ill with a major illness.
I'm not sure why the solution to a law that is mostly working is to destroy it. Actually, I am sure. The reason is that ideology blinds people to reality.
4
Rather than Venezuela, rather than socialized medicine (which not even Bernie is proposing, e.g., doctors wouldn't become government employees), why don't we look at all the other developed nations that have much better (based on outcomes) and cheaper health care (France, Germany, Canada, Denmark, etc.). As to raising the cap, check what percentage of overall income is earned by people making over $127K a year. The top 1% alone make 20% of the income. ACA isn't perfect, ACHA looks even worse (for health coverage), the for profit nature of health care doesn't seem to be working for the benefit of all. Health care is complicated - who knew?
Republicans are notoriously hostitle to the laws of physics. i say hostile because they believe in superior laws that require the denial of reality (i.e., global burning) and which infer that those who do not believe in their superstitions are their inferiors. Their condescension towards those who don't embrace their world of alternative facts started with Reagan's intellectually vacuous retort of "There you go again." to a thoughtful answer by President Carter to a presidential debate question.
Republicans do however believe in the simple math of counting money or the esoterica of multidimensional quantum theory to draw district maps that lock in their electoral advantage in perpetuity.
Republicans do however believe in the simple math of counting money or the esoterica of multidimensional quantum theory to draw district maps that lock in their electoral advantage in perpetuity.
20
Republicans believe that reality can be transformed by sheer force of will. They believe "Let there be light..." was all it took to call the whole universe into existence.
Obamacare did not work period. That/was the issue. A "public option" is the same as a "single payer." Whenever big government gets involved in any major program/industry be prepared for the consequences.
2
The phrase "big government" is a meaningless distractor. People who claim to hate "big government" also seem to love the military, which is about as big as it gets. I have many relatives who depend on Medicare and Social Security. Every time I fly, I'm grateful for the FAA's role in ensuring that my plane doesn't collide with another mid-air. Locally, I'm grateful for public safety, trash collection, clean water, and public health. I could go on. Accept that a lot of what Govt does is good and necessary. It isn't always efficient, but at least I have a chance to do something about that. In contrast, my cable and wireless companies are huge and inefficient, but there is nothing I can do about that unless I want to disconnect.
4
The consequence is that millions of people who could not afford health insurance could. The consequence is that the curve of health care costs went down. The consequence in countries with better programs than Obamacare is that they insure everyone at lower cost with better results than we get. The Republican Party is dedicated to making sure that ordinary people get nothing for their taxes except more wars and more bombs while the Kleptocrat in Chief monetizes his position.
2
US health care would work much better if supply were matched to demand by direct management.
The frantic Republican tail-chasing exercise to "repeal and replace" is like all their legistlative efforts and executive orders so far. They have nothing to do with bettering the country, the goal is simpy to erase the Obama presidency. From the environment to education to foreign policy to human rights to immigration to health care, the Republican agenda is quite simply to attack the Obama legacy. It would be pathetic if it weren't so damaging to the country. With a president in the White House who has no coherent ideology and a party in Congress that is so split it sabotages its own bills, the party can unite consistently around one irrational goal -- undo the Obama presidency, no matter the consequences. From the moment Mitch McConnell stated his intention to make Obama a one-term president, and during the eight years when Republicans obstructed Obama at every turn -- even when he was promoting their ideas -- I believed then and believe today that reason was racism.
50
There really is a moronic cult in the US that fervently believes the government simply destroys the money it collects by taxation.
7
I'm not in a moronic cult but I do believe that the government simply pays for Mar a Lago weekends from the money it collects by taxation. Just think how many insurance subsidies could be covered by one, I repeat one, weekend at the so-called southern WH.
Dr. K., the real problem with ' repeal ' Obamacare is an even bigger cynical ploy by GOP'ers - the cynical ploy of dogma overriding all evidence to the contrary.
As an article of faith, GOP'ers don't want healthcare as a universal right, instead promoting voodoo healthcare, when there is no place on the entire planet they can point to where their type plan works.
Nowhere.
GOPers' insistence on ignoring ' best practices ' as seen in other economies around the world defies all free market principles of adopting what works, as evidenced by the fact that Obamacare is pretty much based on a conservative plan originally put forth by Heritage, the promoted by Bob Dole and GOP'ers 25 years ago to counter ' Hillary-care '.
The same plans are the foundation of Romney-care in Massachusetts.
GOP'ers have let their rabid dogma override free market/capitalistic principles like ' best practices '; their 60 plus votes against Obamacare were nothing more than kool-aid drinking by cultists.
As an article of faith, GOP'ers don't want healthcare as a universal right, instead promoting voodoo healthcare, when there is no place on the entire planet they can point to where their type plan works.
Nowhere.
GOPers' insistence on ignoring ' best practices ' as seen in other economies around the world defies all free market principles of adopting what works, as evidenced by the fact that Obamacare is pretty much based on a conservative plan originally put forth by Heritage, the promoted by Bob Dole and GOP'ers 25 years ago to counter ' Hillary-care '.
The same plans are the foundation of Romney-care in Massachusetts.
GOP'ers have let their rabid dogma override free market/capitalistic principles like ' best practices '; their 60 plus votes against Obamacare were nothing more than kool-aid drinking by cultists.
16
I just can't figure why they don't pay bounties to designated heirs for medically-assisted suicides, since they so obviously want so many people to drop dead.
The only viable solutions for Republicans involve some sort of degradation of the country's health care system, such as it is. Those who voted Trump in the last election failed to see that Obamacare put a temporary halt on out-of-control costs, which was evident (and provable). One issue that's not talked about much, but will become reality if the GOP is successful in passing a law where the premiums for health care increase by orders of magnitude, yet degrade the services covered to a significant degree is that people intelligent enough to realize it will stop buying coverage. Given my financial situation, I would have to include myself with those who would face a tough choice heading into what we had hoped would be retirement in a few years. Take the leap of faith, and hope that nothing which requires health care happens prior to being eligible for Medicare, or pay exaggerated prices for nothing, with the meager hope that somehow a major health care issue is covered.
Ryan's "A Better Way" is nothing of the kind.
Ryan's "A Better Way" is nothing of the kind.
20
The obtuseness of the Republican base is spectacular. Almost any hint of success will be hailed as a breakthrough of apocalyptical proportion. The party duly congratulates itself on its success only to realize that it was another road to nowhere.
As long as the Republicans declare a raise of taxes for the super rich as the holy cow that cannot be slaughtered, no matter how logical it would be, an improvement (not replacement) of Obama Care will forever be elusive.
One can only hope that by November 2018 even the staunchest Trump follower will have walked away from a Party that has not internalized in 40 years that it is on the wrong track and the mutilation of the middle class has been infinitely more than just some inevitable collateral damage.
As long as the Republicans declare a raise of taxes for the super rich as the holy cow that cannot be slaughtered, no matter how logical it would be, an improvement (not replacement) of Obama Care will forever be elusive.
One can only hope that by November 2018 even the staunchest Trump follower will have walked away from a Party that has not internalized in 40 years that it is on the wrong track and the mutilation of the middle class has been infinitely more than just some inevitable collateral damage.
14
On every issue Trump sees the world in binary forms (us vs. them), thinks issues are informed by conflict, and equates winning to "good" and "beautiful." In 92 days, and during the campaign, he has never offered a single policy detail, never discussed a single benefit or incident or example--he weighs in only with blame and denigration. His promises mean nothing.
Trump's supporters drift even further from the facts. They blame his critics and ignore the details; they hang on the promises even as the substance disappears and what is real hurts the people promised to be helped.
Healthcare has shown Trump is not only narcissistic but also a sadist. He enjoys inflicting pain. He revels in hurting others at every turn, individually and collectively, whole groups of Americans and ones he has singled out--and he supports others who mete out torture and agony.
Healthcare for him is a vehicle to hurt others. He has no sense of help, no concept of charity, no will to improve the quality of life for others--for others (all!) are his enemies! His basic thought process (built on false promises and binary opposition) will always result in the denial of broad benefits in healthcare and other areas.
Of course, he will deny this, but the record shows he only works to ensure the rich (his "we") win, beginning with himself--and he cannot bring himself to help others.
Trump's supporters drift even further from the facts. They blame his critics and ignore the details; they hang on the promises even as the substance disappears and what is real hurts the people promised to be helped.
Healthcare has shown Trump is not only narcissistic but also a sadist. He enjoys inflicting pain. He revels in hurting others at every turn, individually and collectively, whole groups of Americans and ones he has singled out--and he supports others who mete out torture and agony.
Healthcare for him is a vehicle to hurt others. He has no sense of help, no concept of charity, no will to improve the quality of life for others--for others (all!) are his enemies! His basic thought process (built on false promises and binary opposition) will always result in the denial of broad benefits in healthcare and other areas.
Of course, he will deny this, but the record shows he only works to ensure the rich (his "we") win, beginning with himself--and he cannot bring himself to help others.
57
You have hit on the core of the matter. It is not only that trump enjoys inflicting pain, it is that many of his cult followers live for little else; at least that is what one gathers by reading comments at places like AOLNews. At times it seems like the over-riding purpose of the "policies" put forth by this crew is simply to upset "liberals", no matter how inconsistent, unconstitutional, inept, or insane said policies may be.
A refrain keeps running through my head:
"I don't know what they have to say,
It makes no difference anyway,
Whatever it is, I'm against it.
No matter what it is or who commenced it,
I'm against it."
This should be the anthem of the Trump Administration --- but Groucho Marx was a lot funnier.
A refrain keeps running through my head:
"I don't know what they have to say,
It makes no difference anyway,
Whatever it is, I'm against it.
No matter what it is or who commenced it,
I'm against it."
This should be the anthem of the Trump Administration --- but Groucho Marx was a lot funnier.
1
"But health care costs money. In particular, if you want to make care available to Americans who have pre-existing medical conditions — including the condition of being not rich and being relatively old, but not yet eligible for Medicare — you have to find some way to subsidize them."
I agree with every thing said about G.O.P. fecklessness around designing a plan to replacing a law it's been railing against for six years.
That said, yes health care costs money but it should not cost almost DOUBLE the average cost of health care per person as our OECD peers.
A problem with ObamaCare is like its daddy RomneyCare it was designed by and for providers who have no stake in reining in health care costs. And, for all it's coverage success, rising premiums, co-pays and deductibles continue to rise. And don't get us started the those 'Because we can' triple digit percent increases in critical drug prices.
Sure coverage matters but for those who have health insurance, "It's the health care costs, stupid!."
I agree with every thing said about G.O.P. fecklessness around designing a plan to replacing a law it's been railing against for six years.
That said, yes health care costs money but it should not cost almost DOUBLE the average cost of health care per person as our OECD peers.
A problem with ObamaCare is like its daddy RomneyCare it was designed by and for providers who have no stake in reining in health care costs. And, for all it's coverage success, rising premiums, co-pays and deductibles continue to rise. And don't get us started the those 'Because we can' triple digit percent increases in critical drug prices.
Sure coverage matters but for those who have health insurance, "It's the health care costs, stupid!."
16
The GOP plan for health care is the same for every other issue, transfer cost from wealthy to less wealthy or eliminate it.
My question is why business that provides health care, knows the rising health care costs in private plans are rising faster than in Obama care, doesn't push for single payer for everyone. That would do more for making America more competitive than any of Trump's thoughts.
My question is why business that provides health care, knows the rising health care costs in private plans are rising faster than in Obama care, doesn't push for single payer for everyone. That would do more for making America more competitive than any of Trump's thoughts.
49
Yes, but why not just repeal ACA and let the "free market" take care of people? It's not that the GOP has been lying to us. It's just that their basic position is amoral at best, immoral at worst. Most believe we have a common obligation to one another when a crises strikes -- e.g. an earthquake or hurricane or another act of god. The devastation is "not their fault" and we the people feel the need to provide humane relief. Health care is a bit fuzzier. There are health issues where people are at fault -- e.g. smoking, alcoholism, bungee jumping accidents -- but for the most part they too are "acts of god," and many feel the need to provide humane relief to those arbitrarily struck. The GOP position is essentially "can't afford cancer treatment? A shame, but you should have worked hard, saved, and been prepared." The problem? Except for the wealthiest, it's impossible to prepare. Even for the insured, the effects of a prolonged illness can be devastating, especially when it impacts on one's employability and hence one's insurability. Why is it impossible? Because health care costs are so egregiously high. Why so high? Because health care is not really a "consumer product" where competition can keep the prices low. When you're having a heart attack, you're not taken to the Walmart of health care where you can deliberate thoughtfully between 12 different brands. You very quickly become captive to a byzantine monopolistic system. The solution? It's complex.
32
Everything that causes expenses to a public health plan can be taxed to defray these expenses, and discourage the costly practices. It is only fair, for instance, that the gun industry collect sufficient taxes to defray all the costs it imposes on the medical system.
7
The free market isn't "free." Simple as that. Fifteen years ago when I began consulting, it cost us nearly $50 a DAY to get coverage for me and my wife, and both of us were healthy people. Thank goodness for the ACA, because without it we couldn't get coverage now, just for my wife. (I'm retired and on Medicare.) The GOP simply doesn't care to help ordinary people. The rich are the only ones who can afford health insurance without the ACA.
1
There will never be a lowering of health care costs so long as it is a for-profit industry. Thirty percent of our health care dollar goes to support a bloated, incompetent and maddeningly complicated insurance bureaucracy which is designed to make health care LESS accessible, not more.
A single payer option is the only way to go.
A single payer option is the only way to go.
99
What is the annual cost of the average health insurer CEO? $25 million?
The for-profit hospital chains are stockholder advocates, not patient advocates. The idea is to make more profit so when the stock is traded on Wall Street, the billionaire owners can make more money they do not pay taxes on as they need not sell their stock, Wall Street can skim its unearned share,and the cost goes to the patient, who they care damned little about.
The system of capitalism is loaded with inherent cruelties, but who cares as long as the rich get richer.
It was time for single payer before Obamacare, but the politicians, think traitors Max Baucus and Joe Lieberman for starters, were already bought and paid for by the insurance industry that still owns most of congress.
The system of capitalism is loaded with inherent cruelties, but who cares as long as the rich get richer.
It was time for single payer before Obamacare, but the politicians, think traitors Max Baucus and Joe Lieberman for starters, were already bought and paid for by the insurance industry that still owns most of congress.
2
Most Americans don't want the semi-coverage, somewhat affordable health care balloon, whether it's stuffed into a box or not. They want universal health care. Paul Krugman, as an economist, you know that universal health care is the only economically viable health care system, and it's been proven in every industrialized country except ours for decades. So why are you ignoring economics? Why are you not promoting universal health care? Please don't call yourself an economist anymore. Call yourself a Wall Street lackey.
7
Hear, hear. Krugman can't bring himself to admit Bernie was right!!
1
How do you know he is against universal coverage. I will bet you anything that he is for it.
The GOP wants to PRETEND that it believes in universal coverage as a philosophical exercise, but then IN PRACTICE seeks to block that from becoming policy reality. Conservatives are trapped by their own lies.
7
The Republicans blew that darned balloon up to its astronomical proportions in the first place, by making sure every wealthy source of support for them could get richer.
7
This is the only country where citizens wish to be 65 y/o to have health coverage through Medicare , alias socialized medicine .
Republicans are playing with fire and have no clue how to provide affordable and accessible healthcare for every American .
ACA has to remain in place , with some changes and improvements.
It's frame is solid and comprehensive.
Health insurances and big Pharma have to be strictly regulated and must provide healthcare within the frame of honesty and morality.
Predators and vultures should be aggressively fined and fired !
Republicans are playing with fire and have no clue how to provide affordable and accessible healthcare for every American .
ACA has to remain in place , with some changes and improvements.
It's frame is solid and comprehensive.
Health insurances and big Pharma have to be strictly regulated and must provide healthcare within the frame of honesty and morality.
Predators and vultures should be aggressively fined and fired !
13
Unfortunately some of the very same people who crow about finally attaining Medicare also rail against socialized medicine and Obamacare. I have heard this with my own ears. Even health care professionals sometimes are that clueless.
3
In my mind ,a simple fix. Raise medicare taxes for all slightly and remove the income cap on medicare withholding. Open medicare for a slightly higher premium to all 55 to 65, if not covered by employer group health. Most problems with ACA would resolve. 55 persons might feel confidence in retiring younger and pursuing other long held dreams. Younger people would be able to fill those long held jobs and start families and buy homes of their own.
It might be worth a,shot.
It might be worth a,shot.
12
There is no cap on Medicare withholding; you are thinking of Social Security, which has a cap of around $118K (but also a cap on what you can RECEIVE in benefits at retirement).
Medicare as it stands now, requires a $100K (average) pre-payment through pay roll taxes -- how do you make up for that huge shortfall?
Medicare as it stands now, requires a $100K (average) pre-payment through pay roll taxes -- how do you make up for that huge shortfall?
The GOP adheres to the philosophy that if you can't afford it, you don't deserve it. It works for mansions and Mercedes, but a lot less so for insulin and ambulances.
They fundamentally cannot buy into a communitarian plan of shared risk. It is odd, because they are just fine with communally funding missiles and MOABs and corn and banking, private schooling on the public dime, but not so much food and medicine.
With any GOP plan, the solution will involve a random selection of people we will choose to let suffer and eventually die, maybe we will bankrupt them first, so that others can thrive.
It is Shirley Jackson's "The Lottery" writ large: no one thinks they are going to pull the short straw.
But since reality is that millions are already holding the short straw, and any GOP plan will add to that, not decrease it, the GOP is trying to figure out a plan that will assure that the ones with the short straws are the ones who vote for Democrats already.
They fundamentally cannot buy into a communitarian plan of shared risk. It is odd, because they are just fine with communally funding missiles and MOABs and corn and banking, private schooling on the public dime, but not so much food and medicine.
With any GOP plan, the solution will involve a random selection of people we will choose to let suffer and eventually die, maybe we will bankrupt them first, so that others can thrive.
It is Shirley Jackson's "The Lottery" writ large: no one thinks they are going to pull the short straw.
But since reality is that millions are already holding the short straw, and any GOP plan will add to that, not decrease it, the GOP is trying to figure out a plan that will assure that the ones with the short straws are the ones who vote for Democrats already.
22
It's important to remember the source of GOP motivation. Obamacare became a proxy for Obama, obviously, and denouncing it was just another racial dog whistle for the GOP base.
Underneath it all lies another savagery: if you cannot afford a doctor, then you deserve to suffer or die.
This is what every GOP voter voted for. Let's not sugarcoat it.
Underneath it all lies another savagery: if you cannot afford a doctor, then you deserve to suffer or die.
This is what every GOP voter voted for. Let's not sugarcoat it.
70
Thank you, Mr. Henry! You've said it all, succinctly, in three sentences.
1
"The result is that they just keep trying to stuff the balloon into that box .. ." And every time they do that, they confirm, to their chagrin, that there is such a thing as reality.
7
You need to remember that Obama started out to reform health care and that reform included a public option which would compete with for profit private insurance. First thing he did was a back room deal with Big Pharma to make sure that the govt wouldn't negotiate drug prices. That was engineered through then Dem Senator Max Baucus who got millions in support from big pharma. Then former Dem, then independent Sen Joe Lieberman of Conn. who got millions in support from insurance companies made his vote conditional on removing the public option. The ACA became health insurance reform and Obamacare became that designed by the conservative Enterprise Institute. The emphasis id AFFORDABLE Health care, structured like the abusive airlines, with care teared as Platinum, gold, silver, bronze--just like airline passengers--remember United's treatment of that passenger, 69 yr old doctor? Republicans and now Trump are engaged in Kabuki theater. Pharma and insurance stocks have doubled since the ACA came in. Think those donors are going to let anyone take away their profit. So.. if you want sensible universal health care..let ACA go, my people, let it go.
2
And replace it with...???
Medicare for All is the only solution to the healthcare debacle America faces. If the Republicans really wanted to hobble the Democrats, they'd embrace Medicare for All. But the GOP is so captive to the healthcare as a commodity/privilege framework that they are unable to see what a potent thing Medicare for All would be.
Democrats need to aggressively pursue Medicare for All, and make it their issue. Forget the private insurance-favoring incrementalism; go all-in with single-payer, and enjoy the political benefits of doing the moral thing by recognizing that healthcare is a human right that impacts life, liberty and the pursuit of happiness.
Democrats need to aggressively pursue Medicare for All, and make it their issue. Forget the private insurance-favoring incrementalism; go all-in with single-payer, and enjoy the political benefits of doing the moral thing by recognizing that healthcare is a human right that impacts life, liberty and the pursuit of happiness.
16
Both sides are about the money.
Having traveled all over the world and seen universal health care in action in other countries, it is clear that is the only solution. Everyone I talked to in those countries loves it, contrary to the scare tactics Republicans use to tell us how bad it is. But the Republicans I know would rather have 32 root canals than agree to government-sponsored health care, and it's not going to happen until they're voted out of office. Right now they control the House, Senate, and presidency. They're not going to get voted out in the House because of gerrymandering, which makes it next to impossible to defeat the most extreme "Freedom Caucus" "Tea Party" candidates. We can talk about "Medicare for all" until we're blue in the face, but it's not going to happen. That's why Democrats have to detach themselves from Bernie Sanders and his supporters and their pie-in-the-sky promises. All they serve to do is divide the party. They put Donald Trump in the White House, but they'll never admit it.
12
The Democratic Party put the most disliked candidate (from the get go, before Sanders entered the race) at the top of the ticket. Bernie Sanders had nothing to do with that. Stop blaming progressive Democrats. They and Sanders are the only ones working now at the grassroots to elect Democrats. Your Democratic Party isn't lending one dime. They're just collecting money for 2020 and the Wall Street lackey they parade before us next. But with a Democratic Congress, we can still get things done. So join us. And by the way, in the general election, progressive Democrats voted Democratic. So stop with your alternative facts.
One should always examine the premise: the Republicans never wanted to address or even recognize that there was a national health care problem. The premise of their senseless and relentless campaign was nothing more than raw animus toward President Obama that too easily became a "winning" effort that cast Obamacare as code for racism. Republican leadership and brain power never seriously addressed actual substantive health care issues. Instead, Republicans constructed a coded straw man that they've now found is far sturdier than they believed. Their obvious hatred and visibly false pride prevent them from actually improving health care. Equally visible is the Republicans' abandonment of any effort to use their power to benefit our citizens. Their clear and obsessive choice to coddle the wealthy at seemingly all costs (which are paid for by the lower and middle classes) is now becoming obvious to their base but hasn't caused Republicans to change their positions or tactics. They are well and truly detached from our nations' realities and in the form of their current elected officials serve no constructive purpose.
24
I dunno. I don't think the Republicans take their promises that seriously. So the constraint on the problem space might not really be there. They'd ditch the box if they could.
I think Republicans in general would just like to get rid of Obamacare. But moderate Republicans are scared of the backlash if they insure fewer people. Not because they promised not to do this, but just because it would be politically bad for them given their constituencies. And extremist Republicans don't want any of the things you'd actually have to include in the law to make sure that you don't lose coverage. And again, this isn't because they've promised their way in a corner. It's because they or their constituents don't like those things. So on its face, there's not much room for a bargain.
However, I think a general strategy of at least a lot of the Republican party is to hold out for long enough that weary moderates, or weary voters, come to accept that we'll insure fewer people under the Republican plan and be done with it. I think they might be banking on the prediction that the well-off youngish people who are subsidizing less well-off older people will be the more politically influential of the two groups, so it's better to have their support than to irk a few million people who can't afford healthcare.
I think Republicans in general would just like to get rid of Obamacare. But moderate Republicans are scared of the backlash if they insure fewer people. Not because they promised not to do this, but just because it would be politically bad for them given their constituencies. And extremist Republicans don't want any of the things you'd actually have to include in the law to make sure that you don't lose coverage. And again, this isn't because they've promised their way in a corner. It's because they or their constituents don't like those things. So on its face, there's not much room for a bargain.
However, I think a general strategy of at least a lot of the Republican party is to hold out for long enough that weary moderates, or weary voters, come to accept that we'll insure fewer people under the Republican plan and be done with it. I think they might be banking on the prediction that the well-off youngish people who are subsidizing less well-off older people will be the more politically influential of the two groups, so it's better to have their support than to irk a few million people who can't afford healthcare.
6
There should be a better chance for more real Americans (who care about the people more than the corporate interests) to win elections in 2018 if Democrats win in keeping (AND improving!) ACA - and make sure everyone knows how and why it got done.
As long as the party in power blusters with Alternate Truths and plots to enrich the powerful even more while the power out of power blends timid objections with sighs about the misfortune of being impotent, it seems like that the people who bother voting will continue to gamble on the party that tells the most powerful Alternate Truths.
As long as the party in power blusters with Alternate Truths and plots to enrich the powerful even more while the power out of power blends timid objections with sighs about the misfortune of being impotent, it seems like that the people who bother voting will continue to gamble on the party that tells the most powerful Alternate Truths.
2
I was a Registered Nurse for more than 40 years, working in a hospital, rehab, home care, nursing homes, and finally as VP of Nursing for a privately-owned company that managed nursing homes. With my last company I saw how a private company can twist the regulations for its profit-making advantage. I'm not proud of that. It was what it was. Unfortunately, it still is.
The specter of their constituents dying caused some Republicans to back away from Trumpcare. Coming out of the Republican Bubble and into their own town hall meetings made them realize that Obamacare was not the devil's doing (even with the name "Obama") and that many of their constituents were actually saved by it.
I'm old enough to remember the fight against Medicare and how that fight was led by the AMA. Instead of turning us into a socialist nation, Medicare made our elderly healthier and physicians wealthier. Interesting now to note that many physicians and hospitals back Obamacare.
We've become a society that values money over life. Only a complete reordering of our values will change that. Maybe we need to start with the idea, that health is a right....the care of that health is a right.
The Preamble to the Constitution states "...to promote the general welfare..."
The specter of their constituents dying caused some Republicans to back away from Trumpcare. Coming out of the Republican Bubble and into their own town hall meetings made them realize that Obamacare was not the devil's doing (even with the name "Obama") and that many of their constituents were actually saved by it.
I'm old enough to remember the fight against Medicare and how that fight was led by the AMA. Instead of turning us into a socialist nation, Medicare made our elderly healthier and physicians wealthier. Interesting now to note that many physicians and hospitals back Obamacare.
We've become a society that values money over life. Only a complete reordering of our values will change that. Maybe we need to start with the idea, that health is a right....the care of that health is a right.
The Preamble to the Constitution states "...to promote the general welfare..."
75
If the GOP implemented Medicare for All, they would be everyone's heroes. Health care will forever be too expensive for too many as long as our current system involving the profits of insurance companies remains the model for doing business. Until we're willing to live with an entirely different model, this will be a problem. Other countries have figured out better solutions, but for some reason here in the US (our supposed exceptionalism?) we simply will not even consider something different.
26
And bingo!! Thank you, Kimberly...your delineation of the health care "problem" and it's pssoble "solution" could be applied to much of what ails this nation. That is, the current model isn't just unworkable it's just flat wrong. but that's what profits are all about.
"The answer, surely, is that it began as a cynical ploy;"
Correct. And it worked. And the American people will suffer. And health care will languish.
It always amazes me that Republican voters continue to vote for those that are against their best interests. Blind obedience I guess.
Unfortunately the rest of us have to suffer along with them.
Correct. And it worked. And the American people will suffer. And health care will languish.
It always amazes me that Republican voters continue to vote for those that are against their best interests. Blind obedience I guess.
Unfortunately the rest of us have to suffer along with them.
17
"the dramatic expansion of coverage that has brought the percentage of Americans without health insurance to a record low" ~ woohoo! Down to only 25 million or so without coverage. We've sure got great priorities in this country.
10
Nancy Pelosi nailed it. The only thing the GOP refrain of Repeal and Replace had going for it was aliteration....which is a lesson democrats need to get much better at. Simple slogans that make good marketing tools (who cares whether they actually make any sense) can convince vast swathes of voters. Snake oil sales are booming in America today.
21
In his comment, Richard Luettgen admits the failure of the Repugs approach but doesn't seem to realize it. For the necessary illumination of conservatives (well, radicals actually), his suggestion (tightly regulate a few insurers) is more correctly characterized as "retain and amend" the ACA and is a step in the direction of single payer.
9
The Republicans had it right in the first place. The only way the balloon fits in the box? Burst it. BTW, wasn't it the Donald's big idea to have a replacement ready at the time of repeal. And that's not a Republican idea. So they had it right in the first place.
2
Go left! Single payer!
31
Bill Gates and Steve Jobs were walking in the woods when all of a sudden they encountered a huge bear. They ran. Gasping for air, Jobs asks Gates, "How are we going to outrun that bear?" And Gates replies, "I don't have to outrun that bear, I just have to outrun you!"
Similarly, the GOP doesn't need to develop a plan that works, they just need to develop a plan they can pass.
Similarly, the GOP doesn't need to develop a plan that works, they just need to develop a plan they can pass.
2
You can say that again!
45 is flailing and will continue to fail, anger solves
Little Stupidity even less
Little Stupidity even less
2
Neither Obamacare nor any of the stillborn monsters the gop proposed addresses the out-of-control healthcare expenditures in this country. It spends far far more than any other country in the world and delivers outcomes that are not even average; in fact, I would bet that any single developed Western European country has far better health indicators than the US and spending less (in some cases, substantially less)
Some would counter-argue the "waiting lists" in several of those countries as an illustration they are no good.
Well, what about the waiting lists right here?
People without insurance have to WAIT before seeing a doctor and getting treatment
People with high deductibles have to WAIT before undertaking treatments involving large sums of money - this happens even today, but will become worse with whatever contraption the gop finally manages to kill obamacare
Of course, none of those "waiting lists" show up anyplace so they are conveniently ignored.
But they EXIST.
Some would counter-argue the "waiting lists" in several of those countries as an illustration they are no good.
Well, what about the waiting lists right here?
People without insurance have to WAIT before seeing a doctor and getting treatment
People with high deductibles have to WAIT before undertaking treatments involving large sums of money - this happens even today, but will become worse with whatever contraption the gop finally manages to kill obamacare
Of course, none of those "waiting lists" show up anyplace so they are conveniently ignored.
But they EXIST.
7
I suppose this is why Mr T now want to blow up the balloon. Fit it at any cost.
1
The Republicans are caught in a trap of their own making. As others have pointed out, if they pass a bill with worse coverage they lose control of Congress and lose badly. If they pass a bill with better coverage, they get primaried and lose their seats to someone who is father to the right. Either way, current incumbent Republicans lose. The question is the amount of damage they do before they lose.
183
Two conclusions from this:
(1) The GOP really wants a single-payer system, but many of them are too myopic to know it and those who do know it need to give it a name more acceptable to their ranks, such as Trumpcare!
(2) It's been obvious for the seven years that the GOP spent attacking Obamacare, that they had no plan at all. None. Zip. Yet they've been able to fool many in the media and a significant percentage of voters into believing that they did have a plan. That is very depressing for what it says about communication and thinking in this country.
(1) The GOP really wants a single-payer system, but many of them are too myopic to know it and those who do know it need to give it a name more acceptable to their ranks, such as Trumpcare!
(2) It's been obvious for the seven years that the GOP spent attacking Obamacare, that they had no plan at all. None. Zip. Yet they've been able to fool many in the media and a significant percentage of voters into believing that they did have a plan. That is very depressing for what it says about communication and thinking in this country.
6
Hmmm?
Dr. Krugman left out the possibility that the Republicans in Congress repeal the ACA, replace it with nothing, say the electorate is better off without it, the electorate accepts repeal and re-elect the Republicans to Congress.
Crazy? Maybe not; after all Mr. Donald Trump is president of the USA.
Dr. Krugman left out the possibility that the Republicans in Congress repeal the ACA, replace it with nothing, say the electorate is better off without it, the electorate accepts repeal and re-elect the Republicans to Congress.
Crazy? Maybe not; after all Mr. Donald Trump is president of the USA.
9
That is very likely the actual outcome, and Democrats will OWN IT, for pushing the ACA lies and distortions on us in 2009.
There is no free lunch. If you were to total up all the payments you have made for auto insurance and subtract all the money paid to you in claims for property or health arising from auto accidents, you would have a positive number in all likelihood. We all pay for our car accidents, just spread out over time. That is the essence of insurance. It's the same with health care. It's just more expensive for many reasons including the monopoly of Big Pharma, a fee-for-service system struggling to evolve to a value-based system, direct to patient advertising and the technological imperative of using the "newest thing" even if it is only more expensive.
Justice Oliver Wendell Holmes said it best: "I like paying taxes. With them, I buy civilization!" A healthy population is a civilized one. The "I have got mine so screw you" Republican zeitgeist is not civilized. I will happily let the Republicans slice the pie if the poor, sick and disadvantaged among us get to pick the first piece.
Justice Oliver Wendell Holmes said it best: "I like paying taxes. With them, I buy civilization!" A healthy population is a civilized one. The "I have got mine so screw you" Republican zeitgeist is not civilized. I will happily let the Republicans slice the pie if the poor, sick and disadvantaged among us get to pick the first piece.
12
Stuff a buffoon in a box? An attractive alternative to impeachment and conviction.
Even if the ACA is "a crazy, inefficient scheme" at least it's a start. The GOP has had 7 years to come up with an alternative and, so far, all they have produce is verbal flatulence. Can't inflate a balloon with that.
Even if the ACA is "a crazy, inefficient scheme" at least it's a start. The GOP has had 7 years to come up with an alternative and, so far, all they have produce is verbal flatulence. Can't inflate a balloon with that.
4
Clever analogy.
My favorite line, "There are some things we could do that would probably make it even cheaper, but they would all involve moving left — say, introducing a public option, or going all the way to single-payer." Is this a quote from Sanders? I thought his ideas were absurd, especially when compared to HRC's brilliant and realistic compromises.
Of course single-payer is cheaper. Of course the public option is better. Duh. Why weren't you, Mr. Krugman, emphasizing these solutions back in June instead of hammering TRUMP and shoving HRC down our throats? Ultimately, her best policies were cribbed from Sanders. Why did you betray us? I'm still so angry that you played into the DNC conspiracy... and it clearly was a conspiracy.
Please. I really need a mea culpa from you. I read your columns of late and they make sense. But they don't acknowledge your involvement in our current fiasco. Come clean. Your liberal conscious must be feeling mighty guilty these days. You are deluding yourself. You owe it to your loyal readers.
My favorite line, "There are some things we could do that would probably make it even cheaper, but they would all involve moving left — say, introducing a public option, or going all the way to single-payer." Is this a quote from Sanders? I thought his ideas were absurd, especially when compared to HRC's brilliant and realistic compromises.
Of course single-payer is cheaper. Of course the public option is better. Duh. Why weren't you, Mr. Krugman, emphasizing these solutions back in June instead of hammering TRUMP and shoving HRC down our throats? Ultimately, her best policies were cribbed from Sanders. Why did you betray us? I'm still so angry that you played into the DNC conspiracy... and it clearly was a conspiracy.
Please. I really need a mea culpa from you. I read your columns of late and they make sense. But they don't acknowledge your involvement in our current fiasco. Come clean. Your liberal conscious must be feeling mighty guilty these days. You are deluding yourself. You owe it to your loyal readers.
1
Hillary proposed single payer in the '90s.
Paul, I think the biggest problem with healthcare in this country is that so many people now assume that they are entitled to treatment for major maladies such as cancer. What the Republicans are trying to do is to take us back to the time in which it was conceivable that you may have a life-threatening illness that will kill you painfully, slowly, or even quickly, and that if you do not have the money you are not entitled to treatment for it.
So the problem is that what Republicans ultimately want to do is to burst that balloon so that they can throw the mangled shreds into the box, and cease to trouble the very rich and corporations with taxes to support a decent standard of healthcare for everyone.
So the problem is that what Republicans ultimately want to do is to burst that balloon so that they can throw the mangled shreds into the box, and cease to trouble the very rich and corporations with taxes to support a decent standard of healthcare for everyone.
8
And there it is laid bare. Only the wealthiest among us deserve to live. Life is cheap. Humans are disposable and expendable and the tragedy of preventable death and the human suffering that causes in its wake are simply inconsequential compared to the deep and abiding immorality of redistribution of wealth of any kind. Ultimately money is more important than other human beings and our society should encode that in its norms and laws. The folks that hold this view have n moral standing to call themselves pro life in any context.
The Republican Party will make the Rapture a self-fulfilling prophesy in this nation of juveniles and ignoramuses.
7
Single payer in some form or other is the ultimate answer because ir covers everybody AND reduces costs by eliminating shareholders and their dividends, CEOs and their multi-million dollars salaries and stock options, their employees whose's job it is to sell insurance coverage and then deny coverage because of preexisting conditions or whatever other reason. It also does away with co-pays, deductibles and life-limits. It allows the exact same doctors to exercise their shills in the same way they do now, but to all who need them.
What's not to like about such a system? Well, Republicans and some Democrats (Hillary, I'm talking to you) view healthcare as a business first and foremost, a bastion of free entreprise, rather than a basic right seeming from a sense of justice, compassion and solidarity.
What's not to like about such a system? Well, Republicans and some Democrats (Hillary, I'm talking to you) view healthcare as a business first and foremost, a bastion of free entreprise, rather than a basic right seeming from a sense of justice, compassion and solidarity.
8
I'm healthy, so O'Romneycare discriminates against me. I earn $10.31 an hour or so, so I could use the thousand a year or whatever employers have been paying for my insurance the last 20 years or so.
Remember Econ 101, Mr Krugman? To cut costs, reduce demand and/or increase supply.
Reduce demand: use health savings accounts to reward health instead of rewarding sickness. Let people use HSAs for preventive care, health care, or health insurance, or keep the money. A layer of HSAs (backed up by a layer of insurance) would improve health and reduce costs. Make insurance an individual thing as an available-on-demand alternative to corporate insurance, since each of us knows our own circumstances.
O'care has reduced life expectancy: by subsidizing sickness it made us sicker. Health is worse, not better. Insurance is better; you used to work for Enron, do you now work for insurance companies?
Increase supply: import medical people--maybe the Philippines could spare us some nurses; let nurses, pharmacists, even informed laymen compete freely with the doctors' cartel. $450 for a prescription I could've written myself is a totally wasted 'health care cost.' I've taken out stitches myself.
Outside the liberal bubble, nasty researcher Ann Coulter says health cost support groups cost about $50/month to pay for needed health care.
Remember Econ 101, Mr Krugman? To cut costs, reduce demand and/or increase supply.
Reduce demand: use health savings accounts to reward health instead of rewarding sickness. Let people use HSAs for preventive care, health care, or health insurance, or keep the money. A layer of HSAs (backed up by a layer of insurance) would improve health and reduce costs. Make insurance an individual thing as an available-on-demand alternative to corporate insurance, since each of us knows our own circumstances.
O'care has reduced life expectancy: by subsidizing sickness it made us sicker. Health is worse, not better. Insurance is better; you used to work for Enron, do you now work for insurance companies?
Increase supply: import medical people--maybe the Philippines could spare us some nurses; let nurses, pharmacists, even informed laymen compete freely with the doctors' cartel. $450 for a prescription I could've written myself is a totally wasted 'health care cost.' I've taken out stitches myself.
Outside the liberal bubble, nasty researcher Ann Coulter says health cost support groups cost about $50/month to pay for needed health care.
1
Andrew, think it through a bit more and you'll find that Single Payer is really the only solution for the problems you highlight here.
"I'm healthy, so O'Romneycare discriminates against me."
Wow. Do you think you will be healthy forever?
Wow. Do you think you will be healthy forever?
The balloon analogy is excellent--when I got landed a job at one of the first major pharmacy benefit managers in the 90s, my boss and I hade endless discussions on the crazy, inefficient healthcare system. She used the balloon image to define the insanity of trying to contain costs that continually escalate.
I just read about the Arkansas executions that are just beginning. It struck me how cavalier this country has become about the most vulnerable. we claim to so highly value the sanctity of life but execute because drugs are due to expire. We deny healthcare to the sick because it's just expensive and tax breaks for the rich has become so more important.
Healthcare is not complicated despite the president's assessment. It just demands the will of elected officials to value the lives of the economically inconvenient.
I just read about the Arkansas executions that are just beginning. It struck me how cavalier this country has become about the most vulnerable. we claim to so highly value the sanctity of life but execute because drugs are due to expire. We deny healthcare to the sick because it's just expensive and tax breaks for the rich has become so more important.
Healthcare is not complicated despite the president's assessment. It just demands the will of elected officials to value the lives of the economically inconvenient.
23
As long as health-related industries keep pouring cash bribes and graft into Washington via lobbying and campaign contributions, our so-called representatives will represent the industry, and not the average American citizen. It's gotten to the point where practically all of the bills coming before Congress are written by lobbyists, while the members of congress spend their time gathering funds for their re-elections. And American taxpayers not only pay their salaries, but pay for their health care. Disgusting!
40
A succinct analysis.
People who want to moan about their health care premiums need to take five minutes to look up the data on US average health care spending per capita, by age. Those numbers aren't fiction. That's what it costs, on average. And somebody has to pay that.
Even using 2012 data, average personal health care expenditures for two working-age adults and two kids would average just over $20,000.
https://www.cms.gov/research-statistics-data-and-systems/statistics-tren...
If you insure a random cross-section of the US population, that's what the total cost is going to be, more or less. Pay for it out-of-pocket, pay for it with premiums, pay for it with taxes covering the cost of uncompensated care. One way or the other, somebody's paying for that.
People who want to moan about their health care premiums need to take five minutes to look up the data on US average health care spending per capita, by age. Those numbers aren't fiction. That's what it costs, on average. And somebody has to pay that.
Even using 2012 data, average personal health care expenditures for two working-age adults and two kids would average just over $20,000.
https://www.cms.gov/research-statistics-data-and-systems/statistics-tren...
If you insure a random cross-section of the US population, that's what the total cost is going to be, more or less. Pay for it out-of-pocket, pay for it with premiums, pay for it with taxes covering the cost of uncompensated care. One way or the other, somebody's paying for that.
9
I think your number is inflated. That may be the cost for care in our broken system where each medical step of the way is coded to bring absurd amounts of money to the insurance companies, but that is not the cost in more advanced countries.
What is the per capita cost in Finland, for example?
What is the per capita cost in Finland, for example?
I think it's likely that the Republicans didn't think about whether they were lying about health care or not. The "constant refrain of “repeal and replace”" was mostly about hatred for Obama by rural county Republican legislators. The rest was hostility for any government-based solution at all.
Their lying they probably felt was just politicking. Of course, they won't succeed in stuffing the balloon into the box. They need thoughtful help for whatever they try to do, and, unfortunately for them, that appears only to come from Democrats.
Their lying they probably felt was just politicking. Of course, they won't succeed in stuffing the balloon into the box. They need thoughtful help for whatever they try to do, and, unfortunately for them, that appears only to come from Democrats.
17
IOW, they were using "code words" to exploit hatred of a Democratic President, much less a BLACK Democratic President, to whip up primal tribal racial bigotry solely for short-term political gains and control of the elements of power.
Now the chickens have come home to roost and the Republicans in power cannot possibly do what they've promised. Something's got to break and with Republicans, it's ALWAYS the ordinary man and woman who will suffer the brunt of that break. As PK points out, the REAL solution is lowering health care costs. When total hip replacement including air fare to Belgium costs under $15,000, but in the USA it costs $100,000 to $150,000 using the same prosthesis (which costs to Americans what the whole procedure costs in Belgium), the same level of medical training, and the same quality of hospital equipment and care, it's clear where the lion's share of the problem is.
"Medical Vacations" have already become a feasible alternative for middle-class folks who lack coverage because it's actually affordable.
The problem is that insurers, consumers, practitioners, and payers don't have to all answer to each other so the hospitals, doctors and, worst, anesthesiologists, charge whatever they can get away with. And do.
Now the chickens have come home to roost and the Republicans in power cannot possibly do what they've promised. Something's got to break and with Republicans, it's ALWAYS the ordinary man and woman who will suffer the brunt of that break. As PK points out, the REAL solution is lowering health care costs. When total hip replacement including air fare to Belgium costs under $15,000, but in the USA it costs $100,000 to $150,000 using the same prosthesis (which costs to Americans what the whole procedure costs in Belgium), the same level of medical training, and the same quality of hospital equipment and care, it's clear where the lion's share of the problem is.
"Medical Vacations" have already become a feasible alternative for middle-class folks who lack coverage because it's actually affordable.
The problem is that insurers, consumers, practitioners, and payers don't have to all answer to each other so the hospitals, doctors and, worst, anesthesiologists, charge whatever they can get away with. And do.
1
How can the Republicans still chant, repeal and replace, when they cannot even agree among themselves, on what the replacement for the ACA should look like?
The Republican Party are all about appearance rather than substance. Opposition for opposition sake, without coming up with well thought out, costed policies, that would improve the lives of most Americans.
For seven years the Republicans attacked the ACA. They had been working on a replacement from day one of the ACA. Trump promised better, cheaper health insurance for everyone. Their first, disastrous attempt at repealing the ACA in 2017, was torpedoed by their own oddly named, 'Freedom Caucus'.
What is puzzling is that millions of those who voted for Trump, will be worse off after the Republican tinkering with the ACA, while the 0.1% will be much richer, due to tax cuts they don't need.
Millions who voted for Trump cannot see their vote was wasted. Elections have consequence. Apart from a lot of noise and heat from Trump, there has been no light shone improving the standard of living of most Americans.
The Republican Party are all about appearance rather than substance. Opposition for opposition sake, without coming up with well thought out, costed policies, that would improve the lives of most Americans.
For seven years the Republicans attacked the ACA. They had been working on a replacement from day one of the ACA. Trump promised better, cheaper health insurance for everyone. Their first, disastrous attempt at repealing the ACA in 2017, was torpedoed by their own oddly named, 'Freedom Caucus'.
What is puzzling is that millions of those who voted for Trump, will be worse off after the Republican tinkering with the ACA, while the 0.1% will be much richer, due to tax cuts they don't need.
Millions who voted for Trump cannot see their vote was wasted. Elections have consequence. Apart from a lot of noise and heat from Trump, there has been no light shone improving the standard of living of most Americans.
23
The rust belt folks are going to have to 1 believe that single payer is the answer and 2 vote for the Democrat who is willing to promote it as a campaign promise. Then the House and Senate have to be overturned by candidates who will commit to single payer. We could do this and should do it. Single payer has to be a national commitment like getting to the moon. There's plenty of money in medicine even with single payer. We are just so inefficient and sort of sloppy in how we fund health care in America.
37
For profit health care is like for profit education - neither makes sense except to corporate"persons."
1
Two thoughts:
First, the Republicans knew that this would happen. They fought so hard against the ACA in the first place because they understand that people like the affects of good government.
Second, the Republicans are wedded to corporations. There are two simple ways I can see to lower the cost of healthcare--1) go to single payer, which removes the administrative overhead and profit margin of large health insurance corporations; 2) put more bargaining in place, like reigning in the cost of pharmaceuticals. But this would hurt the bottom line of corporations.
First, the Republicans knew that this would happen. They fought so hard against the ACA in the first place because they understand that people like the affects of good government.
Second, the Republicans are wedded to corporations. There are two simple ways I can see to lower the cost of healthcare--1) go to single payer, which removes the administrative overhead and profit margin of large health insurance corporations; 2) put more bargaining in place, like reigning in the cost of pharmaceuticals. But this would hurt the bottom line of corporations.
31
Oh, they have ideas - at least the right-wing & libertarian thread do - healthcare only for those who can afford it (after all, those who can't are probably lazy, right?) in a totally 'free market' system with zero gov't involvement. The more moderate GOP is more tender hearted, but caught between their free-market will fix all economic tendencies and the wish for things to be 'ok' for the less well-off. They are really the ones trying to fit the balloon into your box. The former group would simply take a pin to that balloon, if they could get away with it.
31
The Party of Stupid and anti-intellectualism continues to hate "common people" who now know what our con-man of a president represents. Yes, our so-called president represents the Party of Stupid. Ask all the African American people who continue to be stiffed, demeaned, and ignored.
So, President Stupid is the Party of the Few. Thus, in a nutshell, the current make-up of the Republicans do not like being called stupid.
But Republican supporters continue to fall for that "same old chesnut" -- a popular phrase bantered about in the 19th century --- when fools were recognized as fools, and real leaders were recognized as leaders.
Remember President Abe Lincoln -- when America was truly great, when a few educated Americans had a dream about how great their country could be.
We're now stuck in the stupid swamp, and must climb back out before it's too late. "It's time to roll."
So, President Stupid is the Party of the Few. Thus, in a nutshell, the current make-up of the Republicans do not like being called stupid.
But Republican supporters continue to fall for that "same old chesnut" -- a popular phrase bantered about in the 19th century --- when fools were recognized as fools, and real leaders were recognized as leaders.
Remember President Abe Lincoln -- when America was truly great, when a few educated Americans had a dream about how great their country could be.
We're now stuck in the stupid swamp, and must climb back out before it's too late. "It's time to roll."
12
It seems reasonable to me that if we want to find the best healthcare solution for the people of the United States, we would look at the plans worldwide which have been in existence for many years, which are the most cost effective and which offer the best health outcomes. All healthcare systems that I know of that fullful those objectives are universal healthcare systems with a strong government involvement. Many of these plans have been around since the 30s and 40s. None, not one, is totally a free-market system. In spite of horror stories that conservative like to circulate about many of these plans, they are in fact very popular in their respective countries, and they offer better health outcomes at far lower costs than in the U.S. Why can't we examine these plans, adopt the parts which would work best for us, and come up with a universal healthcare plan? I think the answer is that many conservatives are opposed to any social program with strong government involvement, and in spite of what history and facts show about the success of these programs, they will oppose any plan involving a major role for the federal government. We won't have a healthcare plan based on the criteria I mentioned above or even have a fix for Obamacare until the Congress is populated with people who believe that healthcare coverage is a right for all citizens and who believe that the federal government does have an important role to play in the creation of universal healthcare.
83
His deftness and clarity in pointing out how people's cynicism always winds up exploding in their faces makes him a national treasure.