It’s Time to Worry about Health Care in the Senate

May 23, 2017 · 582 comments
Lance Brofman (New York)
In the USA we have attempted to deal with the combination of inelastic demand and unregulated medical care prices in various ways. One method of keeping medical care expense as a percent of GDP to "only" double that of other developed countries was to have a significant portion of the population uninsured and denied medical care in some circumstances. The existence of large numbers of uninsured (conscripts in the war against rising medical costs) did moderate the growth in health care costs.

HMO's were once thought to be a way of dealing with the inexorable price increases. The problem is that HMOs have to compete against each other for services of doctors and hospitals. As long as medical prices are set by market forces, the inelasticity of demand will force market prices inexorably higher. In a "mixed system" with both free-market and controlled health care prices like the USA, prices inexorably are driven upwards to the market level as long as demand is inelastic. Prices such as payments from Medicare that are "controlled" have to be increased continuously with legislation such as the "doctor-fix" to stay competitive with market prices. Medical prices can only be effectively controlled either by direct price controls or with systems where everyone gets care for "free" from the government. In those countries only the extremely wealthy can chose not to use the government paid health services that they have already paid for with t .."
http://seekingalpha.com/article/1647632
gratis (Colorado)
Liberals need to understand this: Conservatives believe with all their hearts that healthcare is a privilege. If you cannot afford it, you should not have it. Money over human lives.
Period.
It has been in the GOP legislation for several generations now, against Medicare, Medicaid, Social Security, any kind of safety net.
Andrew Zuckerman (Port Washington, NY)
We are not going o save the ACA. Even if there is no formal replacement for it, the Republicans will cause ACA to literally die the death of a thousand cuts. They will destroy it in the budget and by administrative actions that insure that more health insurance companies with withdraw from the market and the exchanges will be untenable.
The mere threat posed by the Republicans in Congress to destroy the ACA is enough to make the market too unstable to survive. Insurance companies cannot offer decent policies that conform to the ACA's requirements at a price that the average person can afford.
It's time to give up the ghost. I don't want to see the ACA fail when there is no Republican replacement. That failure will be blamed on the ACA's long predicted "death spiral." The Republicans will wistfully sigh and argue that if only the Democrats had cooperated with them, a much better health insurance plan would have replaced the ACA and all would have been well.
I say stand aside. Let the Republicans do what they will. Then they will own the mess that their new purely Republican will create. I realize that this would mean not fighting to save the millions who will suffer and die because the ACA and Medicare will be destroyed. But they are doomed anyway. We will not be able to protect them. We can only show America what they bought when they gave the Republican Party control of the government and pick up the pieces after the disaster we American citizens voted for.
DebbieR (Brookline, MA)
The time to start worrying about healthcare in the Senate was when the Republican party decided not to cooperate on healthcare reform. Supposedly moderate Republicans decided to cast their lots with the people who made it perfectly clear that what they meant by reform was that healthy people should pay less for it, and that taxing the wealthy to pay for it was also off the table.
I am not sure whether or not Republicans who say they want real healthcare reform (citing the Jimmy Kimmel rule) are being cynical or are just not very bright. Or perhaps the more depressing reality is that many politicians are just not independent thinkers and have opinions that shift depending on who is around them.
I get that politicians need to be team players, but unfortunately for Republicans, their team is toxic.
ken (CA)
All this Republican Congress and President care about is "winning" no matter the cost in human suffering. What unprincipled and immoral con men they are.
Jahnay (New York)
Evil at work.
Mikee (Anderson, CA)
There are 52 GOP senators who need to be sent out to the woodshed.
Slr (Kansas City)
November 2018. That's my new focus.
bcer (vancouver bc canada)
As a Canadian who has lived with public medical insurance for 50 years I do not understand why Americans think it is so wonderful not to have a medical system. I realize it is the wealthy who believe this...they do not want to support their poorer brothers and sisters. How do you square this with trump giving 300 billion dollars to the saudis for weapons of mass destruction. No money for foreign or American medical.care or aid but money for war and killing.
Cathy (PA)
1) Blowing stuff up is fun.
2) America might say it's the land of equality, but it's pretty much always been the opposite. It's a land where the strong live and the weak die, that's always been the reality the republicans strive for and it's a great cosmic joke that the people closest to the dying end of the stick vote Republican.
Mike (SLC)
Why are we not hearing from Democrat Senators more on this? They cannot be as far in the dark as we citizens are. Why are we forced to rely on columnists like Mr. Leonhardt and others to work on our behalf?
Steve (Seattle)
Here's the full text of the letter I sent to [email protected] this morning:

Dear Senators:

If you pass ANY bill that...

1) Eliminates even ONE person from receiving health care, now or in the future

2) Makes the term "pre-existing condition" less clear, more ambiguous or provides a loophole around it

3) Raises the cost of health care for ANYONE over the age of 40

you will NOT be receiving my vote in any future election.

Don't MESS with this awful Trumpcare Bill, or we will MESS WITH YOU the next time you, or your party runs for office in the future.

Is that clear?

Don't try any little tricks or "political sleight of hand" either; we're on to you.

You won't get away with this and you WILL suffer accordingly next time you run for anything.

Don't test us on this.

Got it?
gordy (CA)
The very idea that the congress has even a good health play not to mention a very good health plan is absolutely disgusting beyond anything.

What cheaters and grifters are in congress!
Carl Ian Schwartz (Paterson, New Jersey)
When I think of the GOP proposals for health care and the budget, I can see the modern prototype as murder camps, with the cynical slogan "Arbeit Macht Freie" (work will set you free) across the front gates from which so few returned.
Enrique Woll Battistini (Lima, Peru.)
The stealth of Republicans in the Senate, described here, is typical of thieves, so why would that surprise anyone? The power to determine the future of the U.S. must be equivocatingly determined in the Constitution if the latter's prime objective is to prevent any of the three branches of the State to prevail over the others without recourse, as one could conclude from the evident need to limit the seemingly limitless power and independence of the Presidency and its apparent exoneration from accountability. When the Presidency and its Party can freely march in lock step, why should either care about the people or their health care? Clearly, to preserve Democracy under these circumstances, Constitutional reform would be mandatory.
biomuse (Philadelphia)
Full disclosure: I'm diabetic, and I like and stand to benefit from the pre-existing conditions provisions of the ACA ("Obamacare"). On the other hand, I stand to benefit from the tax cuts that republicans apparently want to make part of their "fix."
But I don't want to live in a society that works like that. And if you care about policy and the future of this country, neither do you. The AHCA bill just passed by the house ignores most of the data, which indicates that forcing people with low incomes back into emergency rooms is expensive; we've already been there; it didn't work. The CBO analysis of Obamacare stated that, absent Republican steps to tank the health care exchanges, they'd stabilize on their own as insurers adjusted: there's no "death spiral" unless the GOP makes it happen. The perverse incentives that result from Obamacare as it stands, in the narrow windows where they do exist, can be fixed by allowing small business reclassification as a communal tax entity and more generous benefits for those on the threshold where they must choose between employment and insurance. But trashing Obamacare whole-cloth makes absolutely zero sense other than as political theater (speaking of perverse incentives). The trickle down fix is a false fix in a society this big: if you don't know who's down the block from you, you can't help them.
If the Senate can't come up with something more realistic and responsible than the house did, it's political malpractice of the first order.
Louis V. Lombardo (<br/>)
Thank you for this excellent article. Right on!

This proposed Republican legislation and budget will result in many more early deaths in the U.S.A. The data on the rankings of Life Expectancy in Red and Blue States can be used to defeat these inhumane Republican proposals.

See https://www.careforcrashvictims.com/blog/where-are-we-going-blue-and-red...
Ann (California)
The Republicans tax break for the rich (in the guise of a health care "withhold" bill) doesn't just kick 24 million off of insurance coverage. It also denies the vulnerable millions covered by Medicaid--the poor, children, the disabled, the elderly. Some 32 million additional lives will be adversely impacted. This is predictable even without the CBO findings.
lure1 (O'ahu)
Baloney. The mandate will be gone. The 24 million you speak of have mandated coverage. The GOP will not take their healthcare. They will do that to themselves. If they choose to drop what is now mandated. I doubt all 24 million will do this. But many younger and healthier folks will. Choice. Democrats love it. Except when when it doesn't conform to their infantile delusions. If Leonhardt and the NY Times are worried, than you can be sure the GOP is, remarkably, on the right path. Book on it
fran soyer (georgia)
And they will succeed.
Steve Hunter (Seattle)
Maybe it's time to take the free gold plated health plan away from the congress.
Julie Walsh (Cherry Hill, NJ)
Appreciate the column, including the email address to send feedback to the Senate. Here's the email I sent:
The AHCA will cost lives. The ACA has saved lives.
Fix the ACA, don't kill it.
geezer117 (Tennessee)
Let it go, Republicans. Simply let ACA continue as it is, until all its warts and flaws make it impossible for the Democrats to stay unites in its defense. Only then will they participate in crafting something better. Until then, let them rub their noses in what they have done.
Ziplips (<br/>)
Mitch McConnell is an obstructionist and is clearly UN-AMERICAN. He's bot and paid for by Trump who is employing his wife. His legacy will not be as a "master political operator" but as "Mitch the Destroyer" of the democratic process and the Great American Way.

The Republicans are preparing to hurt me, my family and millions of Americans with their health care reforms, while enriching their wealthy constituents, who will most certainly make sure they share in the wealth. (when you retire from the Senate Mitch, you get to pocket what's in your re-election fund...don't you?)

Do you really think this will end well for Mitch McConnell, Paul Ryan and the Republican party? Remember Trump won with only 40% of the vote. That means that 60% of the people are against them. Maybe the Republicans need to pay more attention with what is happening in Venezuela?

I'm a Capitalist and we believe that bulls and bears make money, but Pigs get slaughtered. We believe this to be a truth in the market!

Mitch, Paul and fellow Republicans....keep squealing! The Truth will be done!
Back to basics Rob (Nre York)
The Senate bill should provide that members of the Congress and their families shall no longer be eligible for health insurance coverage just as soon as any person in their state (for Senators) or in their district (for Representatives) loses coverage that would have been available under Obamacare, but for this bill.
Maureen McGuire (<br/>)
Why are we not hearing from Democrats about the people's business being done in the dark? I remember when Hillary Clinton was trying to craft a health care bill in the 90's I heard daily diatribes from Republicans. Democrats need to keep their eye on the ball, not the shiny ball of Trump campaign transgressions. That train is on track. Keep the people safe from Republican leadership this Congress
AnnaJoy (18705)
Nice little hospital you have there. Be a shame if something happened to it. And all of the jobs it provides. Oh, that's right, they're healthcare jobs, not fossil fuel or manufacturing jobs. Never mind.
BLM (Niagara Falls)
In the long term it would be better if the House Bill passed as it currently stands. Let the conservative voter and the Trump base live with the consequences of the premise -- that decent, affordable and accessible public health care is a positive evil -- which the Republican's effectively campaigned upon in the last election.

It will be a painful process, but If that doesn't drive them in droves away from the GOP and the neo-fascist rump called the "Freedom" Caucus which appears to be running that party -- well then nothing will. At which point the entire political process will stop mattering and American democracy will be shown as a demonstrable failure. And if that is indeed the case -- well then, the sooner we (and the rest of the world) know that, the better!
Harry Toll and (Boston)
Wouldn't it be nice if the members of the house and senate were required by law to have health insurance no better than what the least of us has?
AW (Minneapolis, MN)
And minimum wage.
Marlene (Sedona)
Let us hope that some (enough) moderate Repubs find their conscience and vote with Democrats against this bill. The audacity, lack of empathy and any conscience of repubs today is beyond imagining. They 're depending on ignorance that they have spent 2 generations supporting. To this woman who has been watching this stupidity develop for 60 years, it is appalling.
David Payne (Cedar Grove, NC)
We have a government where if I'm not mistaken only 46.1% of the people voted for this Emperor, D's picked up 2 Senate seats and 6 or 7 house seats. Was this a mandate for the GOP? Increasingly, I'm convinced that without the Russian influence with the steady leaks on Hillary, he wouldn't have gotten the 46.1% of the popular vote. Bottom line, the majority of Americans who voted did not vote for this hard-right extremism and don't we deserve a voice at the table? Now, I see it likely millions will lose health coverage and tens of thousands will die. The only economic winners in this game will be the funeral home industry. Oh, no, maybe not, these people who die will not have the money for a proper burial will they? They'll all be in bankruptcy and being chased by collection agencies till the grave. Of course the Imperial Congress and Senate will still have their government paid health care won't they? How many of those old geezers in Congress have a pre-existing condition? Remember, We are the 53.9%! Don't let them forget it!
John P. Jensen (Seattle)
My email sent (length reduced):

Gentlemen:
Respectfully, but with deep disappointment that I write to you today regarding your closed door deliberations on the future of American healthcare. Your unwillingness to share your thoughts with the American people is the type of action expected of Russia or some Third World republic.
With millions of American LIVES at stake due to the consequences of your actions, we deserve better. WE DEMAND BETTER! If your bill resembles the poor quality bill sent up by the House with an OMB estimated 20 million losing healthcare coverage, you should be ashamed. You cannot believe that you represent us here.
Billions in tax cuts for the richest among us is not health care legislation. It is subterfuge. End this "supply side voodoo economics" nonsense. It is beneath you. And proven wrong. The richest among us do not require additional tax cuts. The shrinking middle class deserves good paying jobs and tax cuts, not the 1%. Plus a well-positioned middle class will bring in many more billions in tax revenue then all the rich in this country. Billions in cuts to Medicare and Medicaid is not the answer to any healthcare question posed.
Please open your hearings to the public NOW! Think about what is best for ALL AMERICANS. There is no viable healthcare marketplace, almost no competition and healthcare is not responsive to capitalism ideals.
Therefore treat healthcare in America like the Public Utility it is.
Charley horse (Great Plains)
May I copy this and send it to my representative?
Bill (Durham)
"Being the Republican who brought down Trumpcare wouldn’t be fun."

Being in the a set of Republicans who bring down the Affordable Health Care Act won't be fun either because you would the have to face the voters who will be as angry as a nest of hornets that got whacked by a 10 year old kid who didn't know any better.
ockham9 (Norman, OK)
"A small group of Senate Republicans has shown signs of being persuadable, and only three are likely needed to stop a bill. The group includes Lamar Alexander, Shelley Moore Capito, Bill Cassidy, Susan Collins, Dean Heller, Lisa Murkowski and Rob Portman." In my dreams, I live in Tennessee, West Virginia, Louisiana, Maine, Nevada, Alaska, or Ohio. I wish I had a Senator who was persuadable. Then I wake to find that I live in Oklahoma, and my two senators, James Lankford and Jim Inhofe, are the most resolute, unyielding, and yes cruel members of the US Senate. And according to their most recent elections, apparently 68% of my neighbors are fine with that, because they keep electing these guys term after term. And yet, Oklahoma has one of the highest rates of residents with pre-existing conditions, chronic disease, and drug and alcohol abuse; the House and Senate plans will make these conditions worse. What is wrong with a super-majority of this state?
AW (Minneapolis, MN)
Fox News. Seriously. Nothing else is on in your state when I pass through. As far as these people know, listening to FN and crazy-talk radio, all their ailments are due to liberal and progressive policies in DC.
august siemon (atlanta)
But by talking almost exclusively about trump they (we) are making the same mistake Hillary did; being distracted by Trump as Trump. Time to focus on the issues that people (including Trump voters) worry about. Democrats will be the problem if they don't quit preaching to the choir.
Pat (Texas)
I await the scoring of the Congressional Budget Office. It should come out soon and that will be a BIG discussion that the Republicans do not want to have.
Ron Mitchell (Dubin, CA)
The Republicans shouldn't be making long term drastic changes, such as fixing Obamacare, while the President in in the last year of his administration. They should just wait until the next administration is in place.
sdt (st. johns,mi)
And if they do this, America might burn.
claudia (new york)
"An American sickness" by Elisabeth Rosenthal is a must read for anybody who is interested in our health system. Recently published. A scary account of how the medical industrial complex (including our enabling government, doctors, hospitals, AMA, multiple agencies) has proliferated on the back of patients and tax payer.
The fact that the NYT portrays the American Medical Association, American Hospital Association, AARP as concerned parties is a sad joke
NavyVet (Salt Lake City)
This is helpful, thank you. Trump acts as the Distractor in Chief, thus enabling Mitch McConnell and Paul Ryan to fly under the radar to achieve what has NEVER been done before: the large scale-rollback of a major entitlement program -- in this case, medicaid, medicare, and ACA subsidies. The same template would then be used to attack social security. In tandem, taxes will decline and there will be massive wealth transfers to the top one percent.

These changes will happen even if Donald Trump is impeached or resigns, since his replacement, Mr. Pence, is even more closely tied to these Republican establishment goals.

And the band played on.
Hey Joe (Somewhere In The US)
Medicare for all, only answer. It works, there is premium sharing, and it can be covered in part by keeping the ACA taxes where they are.
Sallie McKenna (San Francisco, Calif.)
Large numbers of people have already passionately protested their all too obvious wish to not lose or degrade their health care..to little avail. The Republicans work solely for their piratical overlords and/or their pinched ideology....and they cynically legislate accordingly when given the opportunity.

Their mendacious "we promised" claim is based on the Ailes/Fox/etc. supported smear mischaracterizations about the ACA. It was a detail-free broad-brush scare campaign designed to hurt it for no honest reason. Now they hide behind their engineered promise to justify the unjustifiable.

And its all to give their overlords their obscene tax cut (and of course jab Obama). What a bunch of fine fellows.

2018 is our next opportunity to relieve them of their ill-used governmental responsibilities.
Hey Joe (Somewhere In The US)
Once an entitlement is given, it can't be taken back without political fallout. McConnell and his stooges can keep this in the dark if they want, but it will be career suicide if they pass it.

One more time - Medicare for all, shared premiums, leverage or unleash big government purchasing power and move on!
Dsail1 (Jacksonville, Fl)
Everyone of these clowns who voted and support this bill needs to be removed from office. Wake up America and get rid of these clowns vote them out of office.
Hey Joe (Somewhere In The US)
This is all starting to make me really ill. Oops, that's a pre-existing condition. Sorry Hey Joe, go to the back of the back of the line.
Robby (NC)
You liberals are going to oppose every bill out of the next two Congresses with little thought, so the NYT/Democratic Party line isn't relevant and definitely isn't newsworthy.

You can lie all you want, but the truth is that Americans are tired of having to prop up the massive ACA failure, and we voted conservatives into the House and Senate for the last 7 years for this very purpose.

So whine and cry all you want, but the fact remains that vulnerable senators will lose more votes by rejecting a change to the ACA than by trashing the POS law (which, by the way, is going to crash and burn regardless of what Trump or Congress does).
Hey Joe (Somewhere In The US)
Good points. The GOP has failed to point out how costly the ACA has been We who work pay for those who simply don't want to work.

Healthcare is NOT a right. Get over it America.

I actually think Medicare for all, with premium sharing, would be the least expensive option if we can let the government negotiate healthcare and prescription prices with hospitals, doctors, and big pharma. It's silly this isn't allowed.

Regardless, we have become a welfare state. As someone who has always worked and always paid taxes, I refuse to support those who can work, but don't because of liberal largesse.
Jerry Engelbach (Mexico)
The ACA doesn't support "those who don't want to work."

It gives subsidies for premiums based on income, and expands Medicaid for the poor. Both of those require the passing of serious means tests.

You willingly spend most of your tax dollars to help the Defense Department devise more efficient ways to kill people, but balk at paying a dime to help save the lives of your fellow Americans.

What a pathetic human being you are.
Edward_K_Jellytoes (Earth)
The Great Mass of UNwashed and UNeducated along with the "Lock Her Up" trailer-trash home-schooled evangelicals have elected the people who will take away first the basics then the mid-class "luxuries".

They stroked themselves with "Lock Her Up"...and the Dems were too lazy to turn out the vote....so....

So Sad, Too Bad...BYE-BYE Miss American Pie
P Kelly (New York)
We'll see what's in the bill... but your panicky point about the lobbying and interest groups is just silly. These are the interests that are bilking the US healthcare system currently. The people who are getting screwed are the employee (wage stagnation) and the taxpayer. Get with the program.
toom (Germany)
I am not affected by this McConnell maneuver. I hope the AARP will gather a large group of opponents. This will be the only hope. As to Trump's promises, the Trump voters should remember that he was going to make Atlantic City a paradise!
MJS (Atlanta)
Let's out Senator Isackson R of Georgia, who wants to keep a lid on the fact that his 22 year old Grandson committed suicide or died of a drug overdose in his dorm room at Georgia Southern University this Winter. Instead of using his position as Senator as a voice for mental health issues or the Opioid problem. That we need Healthcare that we need funding. This is a grandchild that his wife raised as their child not a Grandchild. But the Senator wants to keep it Private!

You can't keep it private Senator and take away people's health insurance.
Hey Joe (Somewhere In The US)
Well Trump was explicit during the campaign - the insurance would provide more coverage, more services, and at reduced premiums.

If it sounds too good to be true...... Fool us once.......

This will kill the GOP come 2018. Just as it did the Dems in 2010, IF the Dems can get organized. Well, not behind Nancy Pelosi they can't.
Frank W Smith (Boston MA)
The deplorable voted for this. They were told this was coming. Give it to them.
Carolyn (MI)
The republicans conducting their business with no input from the public and the very groups who dedicate their lives to helping the millions of citizens who will be affected by this bill, with McConnell imploring members not to leak information, are like cockroaches who sneak out from their crevices after dark, afraid to be seen in the light.
GAO (Gurnee, IL)
Finally, we know who the members of that famous Obamacare Death Panel are! The Republican members of the Senate Finance committee, responsible for repealing the ACA.
Shayladane (Canton, NY)
While we all sit at our computers writing comments in the NYT and WaPo, the Senate Republicans are creating a secretive, punitive, and unevaluated bill to take health care from the poor, elderly, and working poor to provide giant tax cuts for the rich, just as the House did.

I believe it is imperative that you let your Senators know how you feel about this; they probably don't read these comments. Write or call them to let them know how you feel and what you think.

Do you want to know what the bill says before they vote? Do you want public hearings? Do you want a CBO assessment? Do you have family, friends, or even yourselves who are in danger of losing coverage, having high premiums and large deductibles or being priced out of the market?

Let your Senators know, regardless of which party you support. Perhaps Republicans will think a little more clearly. Perhaps Democrats can tell the other Senators how many comments they have received.

You can easily obtain contact information on your Senators' web sites.
Great American (Florida)
The corrupt Senate will always as it has for half a century rule and produce legislative actions which favor the insurance, pharmaceutical, med mal, hospital and Electronic Health Records industries over the well being of patients and their doctors.

Finite subsidies will always be guided into industry rather than patient care by the Senate.

In Canada a waiter can get pneumonia, get treated and return to work no worse fiscally or physically.
In New York City if a waiter in a restaurant gets pneumonia, they either die, get sicker or go bankrupt.
The same is not true for our Senators.
Jack (San Antonio)
Really?? How many waiters in NY die or go bankrupt each year due to pneumonia?
Ami (Portland)
If we want healthcare we must stop voting Republicans into office. We get the government we deserve.
The Dog (Toronto)
Can we just call this the largest theft in American History (perpetrated by the usual suspects)?
NY (New York)
Its also time to worry about local Republican State Senators in NY who refuse to address the affordable healthcare for their constituents. To publicly name one we have in the Hudson Valley the silent majorities Terrence Murphy. How is it that a chiropractor by trade seems unwilling to address the concerns of this constituents when it comes to single payer healthcare. Being silent is not a good attribute especially when you are representing many diverse constituents who need healthcare. The Trumpster Republican refuses to host a town hall meeting with constituents to discuss this topic.
Brentley (Oakland CA)
While this is a truly awful piece of legislation it is not surprising. Given the frenetic "undo everything that happened since Jan 2009" approach to governing it is not shocking that the party that is in charge wants to steal from the poor to give to the rich. However, all attempts to fix healthcare are doomed to fail until we can get to a point where the profit motive goes away and no one (either democrat or republican) cares enough about the people of the US over their own reelection to do something as radical as single payer.
Ralphie (CT)
The primary problem with healthcare costs is they keep increasing at a rate that outpaces inflation. Some of this is due to med advances that increase costs, but a lot is due to price gouging, excessive preventive testing, and a lack of transparency re costs. Obamacare never delivered on the promise to control costs. Price increases slowed, but only because overall inflation slowed.

If you focus primarily on insurance and say the government will pay -- there will be no incentive to drive down costs. And while I tend to think a single payer system would eliminate costs associated with for profit insurance companies -- + cost of every company having to have highly paid benefits staff -- I have no faith expanding insurance component will affect costs.

As far as the GOP goes -- the democrats were not transparent, they made promises they knew they couldn't keep re ACA, insurance costs have skyrocketed and Obamacare is failing -- not because of Trump but because the ACA was poorly thought out and implemented.

I don't think anyone should be denied medical care because they lack insurance or can't afford it. BUT -- how much?

Remember, the state doesn't pay for top flight legal defense for the poor. They get a public defender or someone doing pro bono work. But as critical to an individual as their defense in a criminal case is, the poor get a minimum guarantee.

We should hope for better re health care -- but what would an acceptable minimum guarantee?
Laura Reich (Matthews, NC)
How about reducing the profit motive for one? There is no need for hospital CEO's, insurance CEO's and medical device CEOS to make millions. Having said that, what about a two tier system? Catastrophic coverage like hospital care would be government paid. Americans would then buy private insurance for doctor visits, etc. the pharmaceutical industry would be negotiated with like every other country. It's a start.
Pat (Texas)
There are a lot of things you said that just are not true. The ACA slowed the growth of premiums. It also saved many hospitals in rural areas, thus saving the jobs of everyone who worked in those small hospitals. It got people who had never had health insurance into the care of a Primary Care Physician, thus creating jobs in that area, AND lowering the use of ERs as primary care sites.

And those checkups helped do away with major costs later on. After all, it is easier to prevent problems like out of control diabetes than it is to merely pay for those people's ER interventions.

The ACA did a lot of good, but letting states opt out of Medicaid expansion was a sabotage plan by governors. Texas, for example, has over 1/4 of its citizens living without healthcare insurance.
Louis A. Carliner (Lecanto, FL)
In the future, one of the substantial price that may be the price for degrading, diminishing accessibility and affordability for truly adequate healthcare coverage and reversing improvement to the healthcare will be the shortage of recruits of sufficiently healthy candidates for the military.
Douglas F. Hadra (Denver, CO)
The abject cruelty and disregard demonstrated almost daily by Trump and the Republican congressional majority for the best interests of its residents, citizens and undocumented persons alike, is astonishing, although perhaps just reflective of the growing "us vs. them, what's in it for me?" sentiments that seems now to predominate in the US today. Thoughts of the greater good and what is best for the country as a whole (regardless of party) just do not seem to matter anymore.
Pat (Texas)
Let's see. the Democrats are trying to get healthcare for all and the Republicans want to do away with it while they give tax breaks to the wealthy....hmm.
So, stop with the "everybody does it" excuse.
Malcolm Kantzler (Cincinnati)
I sent this to my Republican senator, Rob Portman:

Mitch McConnell has no scruples when it comes to deception, lies and placing party above nation, and the restraint of moderate Republicans, like yourself, is appreciated, and I hope it will be in opposition to any of the Republican tricks in the passage of the House’s deeply flawed healthcare bill.

A bill which is rushed, which is kept under cover from public scrutiny and debate, and which seeks to set standards other than an improvement to the ACA in both coverage and cost will not be acceptable, and if you choose to align yourself with such attempts to pass a bad bill, I will know it, will share it, and I will act accordingly when I vote.

Healthcare is too important to be a method of providing more wealth for the wealthy, and is certainly not a cause to be sacrificed because of pressure from the bullies McConnell or Trump.

I expect you to act for what is right and best for the most Americans, those the Constitution and your oath demand you represent, not party or special interests, and I will be more than disappointed if you do not.
TheOwl (Owl)
Where were you, Mr. Kantzler, when Harry Reid and Nancy Pelosi were cobbling together the kluge that became Obamacare in the back rooms and plush offices of the Democratic leaders in Congress?

Yes, healthcare is too important for all, but your method end up costing almost as many people their insurance as it added.

Remember the "you can keep your health care plan if you like it" statements from Barack Obama?

Those made Lie of the Year.

I would far prefer the Republicans putting together a plan that can be considered than the ones that put YOUR plan together...people might actually get some health care.
Malcolm Kantzler (Cincinnati)
There's no comparison between the way Obama and Trump have developed their versions, and where Obama made a mistake in his claim, Trump has lied, beyond any doubt of error.

When Democrats passed the Affordable Care Act, it took them two years, during which time they held 78 meetings, heard testimony from 179 witnesses, and debated 230 amendments, 121 of which were adopted. Theirs wasn’t a bill delivered from the left with a hallmark for speed, rushed through the House even before the nonpartisan Congressional Budget Office could report how many Americans it would bury, not at all like the hastily concocted, abortive, right-tilted, wholly Republican, legislative porn with which the Senate is now confronted. A problem so complex as healthcare, and a need so critical for the well-being of American families, cannot possibly be rushed or crafted from any extreme of the political spectrum, let alone a single party, unless, at the core of the process, there really is no care for the outcome that finally confronts living, breathing people, only care for the politics and the priorities of the far-narrower concerns of special interests, concerns which are also totally illegitimate when the financial equation of the outcome means that the already obscenely wealthy will benefit at the expense of those who are far removed from any scale of right or reason on the economic ladder, and so much in need of a more equitable playing field.
Roxie (San Francisco)
This is a reply to The Owl.
I've read all 12 of your replies to others' comments. Each one was recommended by one reader. No more. No less. Suspicious.
I've come to the conclusion you are a troll for the Cato Institute.
Just so you know, that tired right wing reference to Obama's "lie" that "you can keep your health care plan if you like it" was in reality what the insurance companies promised Obama. He just passed it on. Passing on someone else's lie that you may naively believe does't make you a lier.
Lois Kuster (Lynbrook)
Thanks so much for providing the contact information. I wrote to all the senators and the committee and this is what I said:
I would like to speak to you about my two grandchildren, Christian,
age 8 and Jayden, age 7. Together with their mother, they live with us. My husband and I have supported this little family since the children were born. My daughter works but does not make enough money to live on her own. We share our small house here on Long Island, provide food, pay school taxes, and help out financially whenever necessary. The one service the government provides is health care. Thanks to Medicaid, they and their mother can go to doctors for both wellness visits and for sick visits. Jayden had successful ear surgery two years ago. The services are not white glove medical care. For example, they rarely see the same doctor twice when they go to the clinic. But, they do receive good services. Moreover, we have peace of mind, assured that they will always get treated. This is one of the many programs threatened not only by the insurance program working its way through the Senate, but also by the proposed budget.
I urge you to not support the changes which threaten health services for so many. The proposals are draconian. Please keep the needy in mind when you cast your vote.
TheOwl (Owl)
Can we ask why you daughter had two children without the income to support them?

What is she going to do if you somehow become unable to pay her bills?

She has to have some skin in the game, you know, otherwise she is just going to continue to sponge off of society.

Here's a suggestion...Throw daughter out and take all of the money and put it towards raising your grandkids.

They will be the better for it.
Judy (NYC)
Whatever Trump might have wanted to do to help his voters will no longer be done. Trump cannot afford to cross Mitch McConnell and Paul Ryan if he hopes to stay in office. Many Republicans would be just as happy with Pence.

Trump will just follow the hard line help the rich program kill the poor and destroy the environment agenda, pushed by the Republicans in Congress. This agenda has the additional advantage of helping Trump and his family.
Tom (Idaho Falls, ID)
This strategy is despicable! Any politicians that use it should be absolutely ashamed of themselves and voted out. Imagine! Ramrodding through legislation that is detrimental and unpopular to serve political ends. Pot, meet kettle. If it is unacceptable for the Republicans to do this, then why was it acceptable for Democrats to do it 7 years ago? Not being willing to call out the Democrats before takes away all credibility in playing the moral high ground. This article is nothing more than political hackery, even if it makes a valid point.

I personally think it's foolish politically for the Republicans to try and fix Obamacare, because Obamacare will almost undoubtedly collapse under it's own bureaucratic weight and the bandaid will at best only prolong the suffering.

As far as changing Obamacare hurting the middle class, I can't help but laugh in your faces. What good is health insurance if all of the money you can spare in your budget is going to pay the premiums? If you have a need to use it, you won't be able to afford the copays. That was my experience with it, and the same experience as many others. With premiums rising exponentially because of the government meddling with the healthcare system, Obamacare is the problem, not the solution. This doesn't mean something shouldn't be done, but this isn't it!
Pat (Texas)
Are you familiar with the old COBRA system of health insurance? The ACA is an improvement.
Sergei (AZ)
After President’s return to Washington he may advise Senate Republicans on the tremendous success Saudis had in improving health care of the people of Yemen.
Amazingly it was achieved as a side effect of their effort to improve American trade balance!
DRS (New York, NY)
Step 1: Pass a huge entitlement on party lines, paid for exclusively by the wealthy.

Step 2: When entitlement and taxes referred to in #1 are repealed, no matter how unjust shriek that it's being done to give fat cats a tax break, as if it's not just #1 being undone.

Step 3: Be satisfied that entitlements can never, ever be reformed or repealed no matter how necessary because the political strategy in 1 and 2 works.
Phil Zaleon (Greensboro,NC)
Good for the GOP! Those millionairs and billionaires need relief. It's not cheap to lead a life of the rich and famous AND pay taxes.

Good for the GOP! They might have bamboozled the desperate and less-well-educated and won the Presidency in the process, but this Unhealth Care they are conjuring behind closed doors will surely be their undoing. They might as well be chiseling the GOP tombstone with their machinations. They can't blame this one on Obama or Clinton, it's going to be ALL THEIRS! Too bad so many will die first.
Erica Smythe (Minnesota)
For all you Medicaid for All fans out there, relax.

California has just shown that for a mere $400 billion a year (they have a $180 billion a year budget), they can provide Medicaid for All in California (also known as single payer..since everyone hates Aetna, United Health, Kaiser, etc..).

Whatever the Senate does, it must create the incentive for each and every citizen of this once great nation to take personal responsibility for living a healthier life. Our healthcare is expensive because our lifestyles are expensive and carry with it a huge burden on health care providers.

If we collectively lost 10-15% of our BMI, we'd have an extra $100 billion in lower health care expenses and we could afford to take care of those who can't truly take care of themselves, and those with illnesses that are no fault of their own.

However, if you're running 100 miles a week and doing marathons every 3 weeks, don't whine when you premiums go up since they know you're going to be knocking on their door for new knees once you hit 50.

Without rationing, the only way to bend the cost curve of health care is to include moral hazard in the pricing of premiums. People who drive cars know that getting a DWI drives up premiums, as does getting 3-4 speeding tickets or 1-2 accidents. You live a risky life...you pay for it in increased premiums.

Put the onus of buying health insurance on every person in the country and let's restore a level of personal responsibility we each can handle.
Hey Joe (Somewhere In The US)
You're right. But the ACA set the expectation of low cost (affordable) insurance, paid for by everyone but the people who benefit from it.

Health insurance is not a right. It has to be purchased or attained through employment, and we live in a welfare state and created a "Gimme, Gimme, Gimme Monster" - a monster who won't work or take initiative.

End the welfare state for all but the truly needy, provide free or subsidized care for those who truly can't work, and tap the uber rich a little bit.
Pat (Texas)
Sorry, but your scheme totally fails to account for accidents, transmitted diseases, and problems related to DNA inherited. Your idea is too simple.
Jerry Engelbach (Mexico)
No, chum. There's no such thing as perfectly taking care of yourself.

People are constituted diferently, and a well conditioned athlete could die at 50 while a habitual drinker dies at 90.

Your scheme is absurd, given that the richest country in the world can easily take care of all its people, but its government chooses instead to buy more weapons of death than spend its revenue on saving lives.
StanC (Texas)
"There is an alarmingly large chance that they’ll decide to...[take]... health insurance from millions of Americans. But if they do, they will almost certainly rely on a political sleight of hand to disguise their bill’s damage."

To put it more candidly, they'll lie. Lying is the new normal. I wonder why.
Paul (Bellerose Terrace)
Democratic and Independent Senators who share states with some of those "reasonable" Republucans should call for hearings. If not that, open town halls back home. Think Sherrod Brown of Ohio, and Angus King of Maine, to name just two.
They should invite representatives from AARP, AMA, and all of those groups to explain what the plan actually means.
Create real pressure.
lechrist (Southern California)
Thanks Mr. Leonhardt. I just got done writing an email to [email protected].

I told the Republican senators to consider using their own government-supplied healthcare as a template for their bill. Or perhaps they should just consider the bill they are writing to be their own coverage that they and their families would have to live on, as scary as that thought might be.
Pauly (Shorewood Wi)
Being a Republican who brings down Trumpcare (aka GOPcare) would be fabulous. Start erecting statues for the members of this small group. Start naming the schools and libraries after the members of this small group. This small group will be rewarded for looking after the citizens of their state.
KarlosTJ (Bostonia)
Both PPACA and AHCA are more get-something-for-nothing laws: One group gets something for nothing, and another group gets nothing for something.

If Mr Leonhardt wants to hand over his NYT salary to someone who needs health insurance but cannot afford it, that's his prerogative. But he does not have any right to put a gun to my head and take my wallet away because he believes I should do the same. That's theft.

The US government did well for more than 100 years without income taxes (the exception being the Civil War, and its income tax was revoked by the SCOTUS after the war ended). Only Socialists (aka Progressives) believe that your money was better spent by the US government before it reached your pocket. The last 100+ years of entrenched forcible charity has wrecked this country's economy and has intentionally deprived Americans of better lives with cheaper goods and services, including health insurance.

If you want cheaper health insurance, cheaper medicine, cheaper medical services - then you want the one thing that has always delivered these and other products and services: Laissez-Faire Capitalism. Every other -ism has only and always made products and services cost more.
Pat (Texas)
There is NO advanced country in the world that has used capitalism to solve its health insurance and health care problems. None. Libertarian ideas only make sense on paper; they simply do not work in the real world.

When you live in a society, you incur the sharing of many aspects of that society. You want Laissez Faire Capitalism? You first need to remove yourself from society.
New World (NYC)
Welcome to the new and improved Great America.
Land of the free.
You like whisky, buy it. Don't like it, don't buy it.
You like the expensive stuff, buy it; you can only afford the cheep stuff, buy that.
Same goes for healthcare insurance !
WEH (YONKERS ny)
Wartime: this is a class war, by law. Sufferning is a reglious problem, ownerships a governmental. The owners do not care what others suffers unto death. Such is Captialist Darwinism.
TheOwl (Owl)
Yep. Wartime it is...

And you're the cannon fodder, WEH.
Daniel Hudson (Ridgefield, CT)
Why don't Republicans want good, affordable health care for all Americans? They seem to believe there is some character flaw in anyone who cannot afford the health care he or she needs or in a family which cannot provide same for one of their members. Let's not make believe that we cannot afford it as a nation or that the "free market" system will not provide it. We can afford it, and the markets that we have - hardly "free" - would rather allocate to toys and luxuries and entertainment, as would our politics. What kind of people are these Republicans?
Diane Ranes (Maine)
Daniel,
I could not agree more. Single payer does not have to be 'owned' by the government. Look at Germany which has a system that builds on private companies but is single payer -- and takes far better care of it's people than we do. This is ignorance - harming and hiding behind greed.
Diane
janye (Metairie LA)
Thank you for this informative editorial. When will Congress start to pass legislation that favors their voters?
sarss (texas)
Remind everyone that the Republicans in the Senate and House have excellent,the best,government subsidized health care in the US. They don't have to worry about somebody taking away their health care. Remind everyone that Republicans have one priority,tax cuts for the rich. Tax cuts for the rich. Tax cuts for the rich.
MissyR (Westport, CT)
Good point! Congress has the Gold Standard of health care plans for themselves and their families for LIFE.

How can they justify the mean and cheap alternative they offer the rest of us?
Joseph C Bickford (Greensboro, NC)
I have been warning friends for weeks that the entire Republican agenda will be done under the cover of Trumpian chaos, and when each piece is done the buffoon in the White House will pit his silly illegible signature on it although he will have actually read none of them. How long must we endure this trump, Ryan, Pence, and McConnell outrage?
ck (cgo)
No, NO, NO! DO NOT TAKE OUR HEALTH INSURANCE AWAY.
WAKE UP. WE NEED SINGLE PAYER!
Iver Thompson (Pasadena, Ca)
And I know just how I'm going to get it . . . .orphan myself on Norway's doorstep. My parents and their families all spoke Norwegian when I was a kid growing up and I still remember a few words. Maybe I can lie my way in. Looking to Washington is like looking to Santa at the North Pole. If I'm lucky and get in and I run across Santa up above the Arctic Circle I'll put in a good word for you. Uff da to this place.
Prairie Populist (Le Sueur, MN)
Besides the humanitarian and social reasons, government-supported healthcare is good business.

Here were the twelve biggest employers in Minnesota in 2016 in order of number of employees: Mayo Clinics, State of MN, US govt., Target, Allina Health Systems, U of M, Health Partners, Fairview Health Services, Wells Fargo/MN, MN State Colleges and Univ., United Health Group, 3M.

Five of the twelve are healthcare providers. Mayo employs over two and a half times as many people as does 3M. Mayo and the state are in the process of investing one billion dollars to expand the Mayo complex and to renovate the surrounding downtown area in Rochester. Mayo also has a large chain of community clinics like the one here in my town that are integrated with Rochester. Over half of Mayo's patients are publicly funded.

Healthcare work is good skilled work and wages reflect that. It is hard to offshore, and our aging population will require more of it. It is a growth industry. Unlike say investment banking, where enormous amounts of money go to just a few professionals, healthcare wages go to a large number of workers.

Healthcare is good business. Why try to kill it?
hawk (New England)
Mr. Leonhardt, try to figure out what 'guaranteed issue" means. It's in Ocare, as well as AHCA.

Without a major repair, which basically involves taking it apart, Ocare will fail for thousands of the now insured in January.
Venkates Swaminathan (San Francisco)
Thank you. Here's the letter I wrote.

Dear Senators,

I write to urge you to please support and enhance the Affordable Care Act, better known as Obamacare. While it is flawed, those flaws can be fixed, and it is much better mended than ended.

The House of Representatives passed the awful American Health Care Act, which would:

- Take away health insurance and the peace of mind it brings from 24 million Americans. By educated estimates, 40,000 people would die unnecessarily each year as a result.
- Make insurance un-affordably expensive for millions with pre-existing conditions
- Cut Medicaid, which not only insures 70 million low-income Americans, but also provides nursing home care to tens of millions of senior citizens
- End funding for Planned Parenthood, which provides reproductive health care services to millions of American women
- Make it possible for insurance companies to offer junk insurance policies that don't cover hospitalization, ambulances, emergency care, or maternity care

The purpose of the AHCA is really to cut taxes on wealthy Americans, not to improve health care in America.

The Senate should reject this approach. Pass a plan instead that is bipartisan and fixes the flaws in Obamacare to improve healthcare. Cutting taxes for rich people shouldn't be a priority, especially when weighed against health care and lives.

Sincerely,
Venkates Swaminathan
S.R. Simon (Bala Cynwyd, Pa.)
Some of the kindest and most compassionate people I know are hoping the bill passes in its most extreme form, and that as many individuals as possible thereafter lose their health coverage, on the theory that, as one committed member of the cloth ruefully expressed it, "If a fool but persist in his folly, he will yet become wise."
Sheila (3103)
Thank you for the article and your link to the Senate email on this issue. I made sure to make my opinion loud and clear that we the people do not want this stupid healthcare proposal to ever see the light of day again and universal single payer is the only option we have now. Mitch McConnell is more of a threat to this country than even Trump, and that's really saying something since I can't stand Trump and his idiocy. McConnell has been a cancer in the Senate for far too long and his constituents really need to take a long hard look at what evil he's done to them and our country and vote him out.
hawk (New England)
Apparently you missed the proposal from CA, $400 billion per year, or about twice the entire state budget for a single payer system.
djt (northern california)
That's about 10K per person. Sounds cheaper than what we have now. Obviously the state would collect the money my company pays for my insurance, instead of my insurer collecting it.

I don't think a single state can undertake this because it will result in lower salaries throughout the medical delivery part of the industry. Doctors will move elsewhere to make more.
TheOwl (Owl)
If you squeeze the sausage too hard on one end, the stuffing comes out the other end.

That's the problem with most healthcare plans, and Obamacare proved that decisively.

The Republicans' version of healthcare would seem to suffer from the same.

This conservative believes that Medicare-for-all with appropriate taxes WITHOUT INCOME RESTRICTIONS and stripped of all tax exemptions and write-offs is the only way to that it will ever be paid for.

And, even then, the healthcare of the nation may well take on the appearance of a rationing system.

Everyone can't have everything for too long without something having to give.
kat (perkins)
Our taxes pay for healthcare of our senators.
Why can't we vote on the type of insurance they get?
Why are none of our elite senators being asked about universal healthcare that works quite well in other countries?
They certainly are not listening to what the people want.
august siemon (atlanta)
Democrats are elbowing each other out of the way to go on camera to talk about Trump's latest antic but we haven't heard anything lately from them about healthcare!
N.Smith (New York City)
Consider this. The fact that they're talking about "Trump's latest antic" is the same as talking about healthcare ... Or did you miss the fact that Democrats are uniformly voting against it???
Lisa (Brisbane)
The Dems aren't the problem. They're all voting no.
TheOwl (Owl)
a.) None of the leadership of the Democrats have even taken time to study the bill's provisiona; and

b) Scoring political sound-bytes is the only power the Democrats have left in Congress.
JerZGrl (NJ)
How is it that there are so many people in Congress and elsewhere who all have this same way of thinking? How do they justify in their minds that the best course of action is to strip healthcare and other important services from millions of people?
RAB (Florida)
I hope that everyone who commented here actually wrote to the Health Reform committee and expressed their views. This "echo-chamber" venting in the "comments" section does nothing to impact our elected officials. Write to them, now.
N.Smith (New York City)
Or call them.
U.S. State Capitol Switchboard: (202) 224 3121
N.Smith (New York City)
And if you don't want to write -- CALL them.
U.S. State Capitol Switchboard: (202) 224 3121
marian (Philadelphia)
First, Trump and the GOP slash Medicaid- next it will be Medicare and Social Security. If you don't stand up to them now, it will be too late. The oligarchs are taking over.
Twin Cities (Minneapolis, MN)
People will die – people who would have lived – because the tax cut bill called American Health Care Act will pull insurance away from those who can least afford to lose it. The senate should be public and hold hearings. Hear from the AMA, AARP, health care providers, unemployed coal miners, and the many who will lose their insurance due to the tax cut bill masquerading as a health insurance bill. Stop playing with other people’s lives. To Republicans it is all a game. But to use an old, Greek quotation, “Boys throw stones at the frogs in jest, but the frogs do not die in jest, but in earnest.”
G. Stumpp (Edison, NJ)
The bill should be called TrumpCare or the Republican DeathCare Act so the blame will be known for generations to come.
TheOwl (Owl)
People have died because they haven't had the money under Obamacare.

Why the double standard?

Or, is it just no standard at all?
Jerry Engelbach (Mexico)
That sounds like a prime cut of baloney.

Please document how people have died because they could not afford the ACA.

And if you find any evidence for it, please compare it to how many have died before the ACA, as well as the number who went bankrupt from medical bills.
L’Osservatore (Fair Verona where we lay our scene)
David will be pleased to know that the health crisis is over in California.
CA can achieve perfect nirvana in creating a single payer program, and ALL they have to do is triple the state budget, from around 200 billion to 600 billion. A year.
Andy (Currently In Europe)
Is any part of this making it through Fox News? I say this because unless the message makes it through Fox and its truth-censorship zealots, there is virtually zero chance that the large mass of Trump voters will even notice what's being done to THEIR health care.

And when they eventually WILL notice, they will probably be about to die quickly and painfully, and won't be able to cast a vote against the Republicans anyway.
Lee Harrison (Albany/Kew Gardens)
Are you kidding? FOX is still all about the Seth Richards conspiracy theory.
G. H. (East Texas)
A hell of a lot of us who support the majority of Trumps vision do not get all our news from FOX. In case you haven't noticed, their viewership is way down. So you need to come up with some other excuse. Ask Hillary, she has a ton of them.
William Roberts (Ellicott City, MD)
Thank you, Mr. Leonhardt, for alerting your readers to the opportunity to comment on Senate Republicans' lack of transparency. I have sent an email expressing my thoughts. The New York Times does a great service to us all by amplifying, in articles such as this, our opportunities to be heard, whether or not those in power care to hear from us.
Anne Rutherford (Washington, DC area)
Well said. It should be about health care reform and access, not profits and tax cuts. Our public health will be endangered by the bills currently proposed. The only thing accomplished by the House bill is a gift to the wealthy as tax cuts, denials of access to others, and endangering the entire nation. If we have a basic level of healthcare as a nation, it would certainly encourage rather than discourage investment in the United States.
David Paquette (Cerritos, CA)
The recent Republican argument for getting rid of safety net programs like healthcare is that there are many people who are just resting on their laurels and feeding at the public coffers. So if we get rid of the safety nets, they'll just get up off their behinds and get to work.

The majority of Republican lawmakers are so far up in the lofty clouds with their ethereal theories they can't even see down to the average folks. Take someone who has a minimum wage job of $10/hr and works hard every single day. They take home less than $18K/yr. If rent is $700/mo. and utilities another $100, that leaves $8.4K per year for everything else. The very idea that these folks can afford $5000/yr. for health insurance is ludicrous. And the arrogant stupidity of Republican Congrespeople to suggest that something else is the case is nauseating. The fact that they are sneaking their bill through is beyond repulsive.
A Reader (US)
Let me preface my comments by stating that I am in favor of single-payer health care for all citizens. This would be a redistributive program that would actually work well, primarily because it would eliminate the insurance companies as middle men. However, although that is my preference, and although the bills proposed by the GOP leave much to be desired, some of the conversations about those bills in left-leaning media don't seem much less biased than conversation on the right. By depicting the GOP's approach as simply "taking away" health care from people in order to provide "tax cuts for the rich", you're not acknowledging the fact that Obamacare is itself a redistributive program that functions, to the limited extent it does, only because it levies large tax increases on higher income earners (most of whom aren't "the rich"), which fund subsidies for others. The problem is that Obamacare leaves the insurance companies entirely in the driver's seat, so that many of the anticipated benefits of extending insurance to millions of lower income citizens haven't materialized. In order to make redistributive safety net programs politically viable, those asked to pay higher taxes to assist their fellow citizens should feel confident that those funds will in fact have that effect the vast majority of the time.
TheOwl (Owl)
The payer, A reader, is always going to be the one in the driver's seat.

And if you think that government is capable of actually MANAGING medicine and insurance schemes, you need only look that the Veterans Administration and its medical system to understand that government is woefully incapable of handling even a limited healthcare system.
A Reader (US)
Correct, TheOwl, the payer is in the driver's seat. But when the payer is the government, the objective is no longer to maximize shareholder profits above all else.
Ray (Virginia)
The elephant in the room that you Democrats never, ever get around to addressing with so many issues, this one in particular, is how you propose to PAY for your lofty utopian "ideals." There are many, many good and even great things in life that most people might quite likely agree are good and even great. However, if those things are not affordable, nor sustainable over the long term, to recklessly pursue them without even the slightest bit of concern for the COST involved might very reasonably be deemed exceedingly unwise. This is EXACTLY what Obama and the Democrats did in 2009 and 2010, and they paid a very steep price for their lack of sound fiscal judgment. You Democrats dreaming of a comeuppance in 2018 better come up with a better way of explaining how your proposals are affordable and sustainable over time (good luck with that, by the way...), or you are not going to have a shred of credibility with the fiscally responsible, fiscally sane electorate between the coasts who are actually paying the country's bills.
G. Stumpp (Edison, NJ)
Ray - Please explain how other, less wealthy nations pay for universal healthcare willingly. Could it be that it is the right thing to do?
Margaret A (New York)
How about the rich pay their fair share of taxes!!!
N.Smith (New York City)
By reducing everything to party politics ("You Democrats..."), you are missing the big picture -- And unless you are part of the über-wealthy 1% who will be able to afford health coverage under the G.O.P. plan, you had best start paying attention.
Doc in Chicago (Chicago, IL)
Mr. Leonhardt, Thank you for reminding your readers today about this work of the Senate on this important bill! Americans should not forget that a revised health care system in the US -- call it Trumpcare or Ryancare or McConnellcare if you wish -- should not toss healthcare protections to the curb for the sick and the poor. This was the net effect of the House bill. In return for the humiliation of being uninsured along with the threat of bankruptcy, what would these 20,000,000 (4x the size of the Chicago metro area population) people get? Nothing.

Instead, people who can afford health insurance would get a massive windfall. It is literally an example of shortening the lives of the poor for profit to the wealthy.

My patients, with AIDS and other chronic infections will be among the first to have shortened lives if the Senate passes a similar bill.

In the name of my patients and 20,000,000 others, I want to shout, implore, beg, and demand that we preserve health and not crush it in 2017! Tell your Senator!
TheOwl (Owl)
Excuse me, sir. Have you read the bill?

Can you tell us where this bill is "shortening the lives of the poor for the profit of the wealthy"?

Please be as specific as you can, citing verifiable sources for your claims.

This is an important issue for The People of our great nation, and the subject needs some specificity about your claims so as to make an informed decisions.

If you cannot provide this information, then I would suggest that your remarks are nothing more than opinion, and not necessarily as informed as you might present it to me.
Jerry Engelbach (Mexico)
On the contrary, his "opinion" is based on facts that are public knowledge, including the taking of $800 billion from Medicaid in order to make up for massive tax cuts on the rich.

You can pretend to be ignorant, but no one here is fooled.
Sally (Denver, Colorado)
Thank goodness for the press.
I think it is our only hope to get information about the CBO score, changes to the House bill, a new Senate bill, etc.
Trump's flailing, idiotic, so-called 'presidency' must not distract us, as it is intended to do.
Andrew G. Bjelland, Sr. (Salt Lake City, Utah)
Shades of North Korea! The terminally credulous followers, to their own detriment, and should-know-better compliant Party leaders, to their short term benefit, continue to support their absolutely incredible Glorious Leader.

"It Can't Happen Here" is now "It Has Happened Here"?
TheOwl (Owl)
Yes, Mr. Bjelland, it has happened hear.

It happened with the passage of the Affordable Health Act, also known as Obamacare.

Unfortunately for Obama and the Democrats, there were neither short term benefits or political successes that followed their parliamentary tyranny in its enactment.
jdh (ny)
I have taken your advice and have sent my thoughts to the [email protected] email you have provided.

Subject: Be advised that your service is being watched and it will be accounted for by voters in coming elections.

"If you continue to try and do this behind the countries backs, you will not only harm the people you so ardently say you are trying to protect, but you will also suffer the consequences in the mid term elections. The lack of transparency you have shown reflects your unwillingness to have your plan be seen by the public so that you can pass on your tax cuts shifting more wealth upward. It will be seen for what it is.
That you can look your families in the eye while serving the people of this country in this way is beyond my understanding. Have you no honor?
Please, do the right thing. Serve the people not your lobbyists. Stop being lapdogs and be honorable men and women who have been given the privilege to serve your country. We still have the right to vote. It is what put you where you are and it is what can remove you from your current position. Do not underestimate the power of the vote. "

I highly recommend that other follow suit and let them know via this email your thoughts about how they are choosing to get this terrible bill passed.
In the end it is up to us to vote for people who will honorably serve the will of the people. We still have the right to vote. Please do so in all elections. It is the only way to turn this around.
Robin Foor (California)
If the Supreme Court says political gerrymandering is constitutional, and if a gerrymandered minority party controls the government - where the majority of the voters have voted against that party - then the system isn't a democracy.

Deciding in secret is not democracy.
Rich DuBois (Tacoma, WA)
My letter to the Senate committie. I have never contributed to Senate campaigns. If you take insurance coverage away from the less fortunate, I will contribute to your opponent's campaigns.
SLBvt (Vt.)
It would be a great service to this country if all these medical associations, the AARP, etc. would get together and hold their own public "hearing." where they would lay out the problems for Americans in a clear, straight-forward way (recognizing that it is not simple).

Perhaps a televised information special?
Paul W (Denver)
I stopped reading at the mention of the CBO not scoring the healthcare bill until after the House passed it. The CBO that projected that 21 million people would sign up for the Obamacare exchanges, versus the 11 million that actually have, that CBO. Ya, what a tragedy to not wait for such an accurate office to weigh in.
Mark (Milwaukee)
If all the states expanded Medicaid then that number would have likely been accurate. But as we know many Republican governors including mine in Wisconsin declined, denying care to many poor people.
Citixen (NYC)
@Paul W
Of course, Paul, you conveniently forget that the CBO scored the ACA that way because it assumed states (26, by last count) would *NOT* opt out of the state exchanges--even when the federal government would pay 90% of the cost (to the states) of those signing up to the ACA through the exchanges.

That's political sabotage masquerading as principled opposition in my book. (who would refuse receiving 90 cents on the dollar to help people?) And you're using it as an excuse to claim the CBO is 'inaccurate'? Sounds like you're expecting more of a mind-reader than a government agency honestly scoring a bill.
Smslaw (Maine)
The CBO assumed that states would set up their own exchanges and would expand Medicaid. When the CBO scores a bill, it is required to make assumptions that the bill will be fully implemented once it becomes law. And even if the CBO isn't perfect, it's the only non-partisan entity that is available to predict the impact of a bill.
Trader Dick (Martinez, CA)
I hope they enjoy the email barrage.
N.Smith (New York City)
I hope they respond to the email barrage -- and remember that we will, when it's time to vote.
Frosty (St. Charles, Mo.)
As with all aspects of our nation's governance our Republicans always do as they wish. When they are caught red handed doing their usual dirty deeds they call up their owned media outlets to aid in masking their crimes. We all can recall the tactics Republicans use to deflect the nation.
I am baffled that any Republicans exist today. With the election fraud they indulge in they are the rulers now. Our nation is facing horrid times ahead.
Jean Cleary (NH)
Where is any evidence that these Senators have a heart? Let alone not representing most of the voters in the US. Most of us expect all Americans to have a health insurance policy that is sensible and covers us for all of our medical needs. This includes those with pre-existing needs, children under the age of 26 and the rest of us who need good health care. The worst mistake the Democrats made in developing the ACA was to allow for --profit insurance companies to be involved on any level. I know this from the magical Part D drug program instituted by the Bush Administration. The insurance companies keep changing the tiers of medicine every year and the co-pays as well.
If we had a single payer program offered to all this would not be happening.
And while we are at it, the Congress and Senate has to stop raping the Medicare system. They should change to symbol of The Republican Party.
Elephants care about their families.
Gary Valan (Oakland, CA)
I did, "You too can become a permanently minority political party if you take away our healthcare and pretend you are doing us a favor. We can see through your chicanery. Even the Trump voters will at some point know only so much can be "blamed" on Pres. Obama. Please take the responsibility and do the right thing. I am unfortunately a voter in Blue California, maybe I will move to Ohio before the next election."
judy vaz (Cape Cod, MA)
As important as the Russia investigation into the election of 2016 is I am afraid that it is sucking all the oxygen out of the room.
My biggest fear is what the Congress is doing in the quiet meetings uncovered by the press.
Thank you Mr. Leonhardt, please continue to speak about this. We have Trump as president. Yes I want to find out what went wrong. But Congress is not as many would say sitting idly by. They are using this uproar to hide behind and secretly get the things on their agenda put into law.
Trump is the curtain and we need to look behind it at the Congress to see what is going on. That is what we need to worry about because what they do now on healthcare, Medicaid, climate, immigration are what will really hurt us in the end.
Mar (Atlanta)
It's like I'm reading an article from 2009. Remember? Town Halls canceled and we'd just have to wait until it passed to read the bill?

I too am disgusted with DC, but have been for over a decade. And had I paid better attention, I'd probably have been disgusted for a couple of decades.
SR (Bronx, NY)
Sadly, the Manchester attack and the Boss Tweet Victory Lap World Tour will provide perfectly convenient, and perfectly hideous, cover for the GOP to pass this atrocity.
Ray (North Carolina)
Pass it, the sooner the better. America voted for the Republicans to be the majority, so let's see what we get. Once this goes 'live' and millions loose their health care, we will all that much closer to Medicare for all.
N.Smith (New York City)
No offense, but your logic is flawed.
And just for the record, not all Americans voted for Republicans to be the majority.
Hope they enjoy it while they can.
Lisa (Brisbane)
That is an incredibly privileged stance -- I take it that you have no pre-existing conditions, and maybe even have employer-provided insurance (for now).
Peter Tobias (Minnesota)
I sent them also an email to hold public hearings.
Kingfish52 (Rocky Mountains)
The Republicans - in their entirety, regardless of what body the "serve" - are only, and ever, interested in one thing: WEALTH care.

It has been so ever since their inception, and they have become experts at putting lipstick on pigs and selling them as Victoria Secret models to the gullible. Sending letters, calling them, and texting them will not change their mission, only removing them from power will do it. But columns and articles like this one will help inform, and mobilize voters who can begin to take back the power from these oligarchs, and give it to the people.
Grove (California)
It would seem that the divide in this country is between those who think that we can solve our problems by working together, and those who believe in "survival of the fittest".
MC (USA)
Thank you for the article and especially for the email address!

This is what I sent:

Dear GOP Senators,

Do not appease a narcissistic president and extreme ideologues by condemning millions of Americans to fear, suffering, sickness, bankruptcy, and death.

Do not accept voodoo economics and magic numbers that you know make no sense.

Do not be the death panel for those who need your help so you can lay further billions at the feet of people who don’t.

Please, do not do those things. For the sake of our country, our people, your conscience, your place in history and the oath you took.

What will you tell your constituents when you ask again for their vote? What will you tell your children when they ask you what you did to make America truly great today?

Thank you.
npomea (MD)
The fact that there were no hearings tells you what you need to know -- we are being scammed.
Andrew G. Bjelland, Sr. (Salt Lake City, Utah)
Trump's supporters and legislative enablers leave me aghast.

Shades of North Korea! The terminally credulous followers and should-know-better Party leaders continue to support their absolutely incredible Glorious Leader--or, in the case of the leaders, often attempt to use him to promote their own ends.

"It Can't Happen Here" is now "It's Happening Here."
Bruce Stern (Petaluma CA)
Such activities by Mitch McConnell and the Senate GOP in general point out, once again, major problems in the Senate and the House: inadequate self-oversight, and the creation and exercise of rules without citizen understanding and concurrence.
The House and Senate operate as self-governing regimes, who all too often do their work in the dark or by other means for their benefit. Where's is the oversight of the ways and means of both houses. Now, Congress get barely 10% approval in polls. Surely, Congress can and should do better. Perhaps with the transparent and thorough scrutiny of their operations, Americans will come to trust more our supreme legislative bodies.
Jefflz (San Franciso)
Donald Trump has turned the Oval Office into a TV spoof of American politics and he is the Entertainer-in-Chief with a loyal following Acting as a major media distraction, Trump serves the needs of the GOP. They will allow him to pervert the Constitution while they pursue the undoing of Medicare and Social Security. In the background we can hear Trump's loyal fans cheering as Trump plays golf while the GOP takes away their health care and empties their pockets to fill those of the rich.

In addition to the full frontal assault on health care, it has been reported that the Social Security FICA tax is to be eliminated under the Republican plans, and Social Security will only have a slashed federal budget to fund it - no more worker contributions which its major source of income. Paul Ryan and Mitch McConnell are squealing with joy at the prospect of killing Social Security. Donald Trump can be a clown and/or a tool of the Russians. They couldn't care less while as long as they can serve their ultra-wealthy masters.
Lee Harrison (Albany/Kew Gardens)
There's only one way this will be stopped: people who voted for Republicans or live in states with Republican senators make it clear to these senators that they will be voted out of office by the people they harm.

The people who lose the most under the AHCA are two classes:

* 50 to 65 year olds with modest incomes, particularly those in rural states with lots of people like themselves.

* Medicaid recipients

The first of these describes a lot of Trump voters. They will be savaged if the AHCA or anything like it passes.

We are going to find out just how stupid, gullible, and passive these voters are in states with Republican senators. If they are really the chumps that the GOP and Trump think they are ... that's that.

I don't think they are though. They took Trump's promises, but they aren't dumb or crazy enough to accept the Republican bill -- it amounts to a sentence of death or impoverishment to many.

We will find out though....
H E Pettit (<br/>)
An amendment needs to be added to any healthcare legislation proposed, simply,any elected official have the same insurance as those in the highest risk category proposed. PERIOD. No more elected officials to get better insurance than the most at risk citizens of this country.
Henry Miller, Libertarian (Cary, NC)
"...members of the Senate have spent the last two weeks talking about taking health insurance from millions of Americans."

The "millions of Americans" whose health insurance is being subsidised either by taxpayers or by outrageous premiums others are forced to pay, or who are getting health care "free" via Medicaid, are basically stealing their health care from the rest of us. Their health care/insurance SHOULD be taken away--theft should not be rewarded.
Kay Johnson (Colorado)
Put down the comic book.

Every modern country but the US is able to leverage health care for its citizens, not as a gift but as what free citizens in a free country WANT and have elected officials to provide.
Henry Miller, Libertarian (Cary, NC)
When you devise a universal health care system that doesn't look like the VA, that isn't a Welfare State redistribution scheme that forces some Americans to pay the bills of others, and that provides high quality health care, let us know. Until then, you're invited to leave the US for any of those other countries you seem to like so much better.
Lisa (Brisbane)
Forcing people to pay the bills of others is EXACTLY what insurance is all about. Everybody pays in, and if you're lucky, you won't need much back -- for a while, maybe a long while. But sooner or later you will need it, and then someone else will be griping about paying your bills.
Iver Thompson (Pasadena, Ca)
I'm tired of reading about health insurance like it was synonymous with health. As far as I'm concerned they're like apples and oranges. I'm sure we have no idea what health even is, just about the money associated with the discussion of it.
N.Smith (New York City)
"I'm sure we have no idea what health even is...."
I think it best if you only speak for yourself.
Many Americans know what it is, and they want to keep it.
Iver Thompson (Pasadena, Ca)
N. Smith, So if your definition of healthcare is keeping someone way past death's door technically alive just as long as they possibly can just to bill and drain every cent out of them and their family, you're welcome to keep and live that nightmare just as long as your heart desires.
John (Stowe, PA)
Everyone with a social media account should post this on any and all you have.

Anyone without one, maybe start one to post things like this.

Short of that, make sure to talk to people about what Republicans are planning to do TO them, not for them.
Steve Gauthier (State College, PA)
Don't forget where many health care organizations are headquartered in large expansive new campuses. They are in Kentucky. Mitch McConnell must be rolling in the campaign contributions.
Dan88 (Long Island, NY)
Why don't Democrats in the House and Senate put together a bill that improves Obamacare and includes a Medicare option on the exchanges? Or one that simply proposes replacement of Obamacare with a single payer option?

Such a bill would obviously go no where, but would provide a stark contrast for the midterms next year with the tax cut health bill the Republicans are currently hashing around in the name of "improving" health care.
PETER EBENSTEIN MD (WHITE PLAINS NY)
You could even use the public option as a "fix" for Obamacare. For any region that is unable to provide say three private insurance choices in the exchange an additional choice, a public option, should be added.
Razor (GA)
The Republicans apparently have pulled the email address [email protected] since it does not work for me. No surprise, of course, the Republicans do not really want feedback. They know what they like: TAX CUTS FOR THE RICH.
Anything else is piddling.
William R. Everdell (Brooklyn)
Behind the scenes and below the chaos, the Trump administration has a singular and unambiguous policy: cut the costs to private capital because Revenue minus costs equals Profit. This is done by cutting taxes on the rich and making them flatter, reducing the powers of labor keep employment secure and real wages from declining, reducing regulations (which not only reduces costs but also externalizes more and more of those costs for the public to pay for), and finally by allowing private interests to simply take over the cabinet so that our public law can be rendered ineffective. Commodify everything, privatize it and take it away from the people; that's the plan; and if you can make it seem like a matter of principle, or even religious duty, so much the better.
David Paquette (Cerritos, CA)
The Republican message: Everyone could get the same superb health insurance as Congresspeople if they would just put out the effort to get elected -- like they did. Everyone else doesn't deserve health insurance, particularly if they are sick.

Why are there so many people arrogant enough to buy into that message?
Kathy Balles (Carlisle, MA)
Imagine the medical trials and tribulations for any future US citizen that is a victim of terrorism. Those prosthetic arms and legs, the rehab therapy, etc.
TopCat (Seattle)
The GOP way is that they should have saved up the million dollars for just such a situation.
Bzl15 (Edinburgh, Scotland)
Trumpcare is patterned after Trump university--promise riches to everyone and take their hard earned money! Now Trumpcare promises better, cheaper....insurance while taking away 24 million poor Americans insurance. The only difference here is that you cannot sue the politicians to get your old coverage back. Whereas, (thanks to our courts) some people were able to get part of their money back from "Trump university". And the sad thing is that Republicans will most likely fool people to vote for them in 2018 and beyond!
Robert (SoCal)
They "claim" to care about you before you are born (an unabashed ploy for votes), but once into the world they drop the charade and you are on your own. Worse still, they actively work against you, unless you are wealthy. It's amazing so many Americans are taken in by their con . . .
susaneber (New York)
Dear Republican Senators:

I write to the Republicans because I know only you are crafting the current Health Care bill. The Democratic senators are not taking part.

You've been quiet about your plans, but what I've seen so far is rather alarming for the welfare of those unfortunate rich people who believe they will benefit from your slashing funding for health care. They're happy about lower taxes but don't realize how harmful that will be for them.

When only rich people can afford health care the quality of that care will decline. Hospitals will have to close--perhaps the one that would have saved Mr. Rich Guy's life after a car accident. Doctors will have less experience--perhaps the one that will some day perform Mr. Rich Guy's open heart surgery. Drug companies won't be able to do careful research; perhaps the drug needed to cure Mr. Rich Guy's cancer will never be developed.

There's still time for you to educate those rich people--you know, your donors. Tell them that investing in health care for everyone is the best way to preserve their own lives, and they must value their lives more than their money. They'll start clamoring for single-payer. If you pass a single-payer bill, you'll be heroes to all Americans, including the rich.
H Mansfield (Florida)
Dear Congress: Picture a passel of overfed white men in dark power suits, each having world class health care coverage, celebrating a toxic pile of dog droppings called the American Health Care Act, applauding and posing for photo ops on the lawn of OUR White House. This to me was one of the most blatant displays of arrogance and “Animal House” class PR that most of us have ever witnessed. The solitary female in attendance was staring downward and seemed to be either ashamed, or praying.

The image of these grinning, bobble-head dolls is indelibly printed on our collective consciousness however short you so-called "servants-of-the-people" may believe it to be.

Fortunately, thanks in part to this back slapping Gloat-Fest on the lawn of the White House, even your constituents are watching more closely (read microscopically). It’s going to be difficult for you to hide this mess.

Distractions and sleight of hand will not work this time. A bill that will seriously hurt the middle class and the poor, the sick and elderly, children and disabled, and which was evidently designed to favor yet another industrial-grade money grab must not stand. Its passage will be a direct invitation for you to join the remaining swamp creatures in that same overcrowded swamp that your fearless leader laughingly pledged to drain.

Ignore the American public in favor of your puppet masters at your political peril.

Sincerely, A disgusted citizen
olyjan (olympia)
Also keep in mind - this is only round one of tax cuts for the top 2% - it will be followed by the so-called "tax reform" bill. That too is a Trojan Horse of more redistribution of cash to the super rich. Be particularly watchful if you have a family member in a 'nursing home' with dementia or Alzheimers - imagine if there is a cap on their care. We do care about the Russian connection, but don't take your eyes off the Republican Party's number one goal: "MORE FOR US, LESS FOR YOU". I am so enormously sad that the R's have turned so cold and become so greedy, beyond anything since the Gilded Age.
RNW (Albany, CA)
Every parent is well aware of the power of distraction. Since November, like innocent babes, we remain transfixed by the antics of an orange-faced circus sideshow freak. All the while we vacillate between laughter and boos while our most precious possessions, like our rights, health care and public education mysteriously disappear. Just who are these people groping in our pockets? Thanks, David for sounding the alarm.
Beatriz Volpe (Seaford)
Take action! Contact your representatives, follow Mr. Leonhardt's suggestion to write to the Committee at the address he provided. AND VOTE.
bellstrom (washington)
3,000 were killed on 9-11. 40,000-50,000 Americans will die if insurance is taken away from 20M. The weak, poor, and old will die. Children will die. 9-11 was plotted in secret, as is the senate healthcare bill.

This is real terrorism.
David (Cincinnati)
We need to remember that there are only two types of people in the USA; makers and takers. Not giving something to the takers, so government can let the makers keep it, is the reason the Republican party exists. Just because someone was getting something for free doesn't mean that it needs to continue. Voters have overwhelmingly indicated, through elections, that individualism and being responsible is the American way. If you want something, you work for it; not petition the government to give you it to you for free.
Arnie Cisneros (East Lansing MI)
If allowed, a majority of Americans like yourself will rationalize the country as a group of givers and takers as you have. All the while oblivious of the way they have filled the role of taker themselves. I would purport the commenter has been quite a taker, using federally subsidized Post Office that loses money. Or maybe student loans, social security, meals on wheels, or after school programs that changed the life of a classmate, teammate or coworker. This rationale wears thin when you arrive at the ER of a hospital that uses federal funds.
TopCat (Seattle)
Nothing is "free". Almost everyone pays taxes. Maybe we should go back to the days of toll roads all over the place.
Lauren (NJ)
Where do disabled people fit in the scheme of things that you've outlined? Where do children born into poor families fit? How do you categorize the people who are working as hard as they can for a minimum wage but who still cannot make ends meet? Perhaps you need to get out a bit more and realize that "makers and takers" might be a bit too simplistic?
LMGold (Portland, Or)
My email:

I am against any effort to pass a healthcare bill destined to take away coverage from millions of Americans. It is immoral and unethical. Every major industry involved in providing care, from doctors to nurses to hospitals and clinics, is against this madness.

Americans will not be railroaded into giving away their care in order to give billions in tax cuts to the very rich. It sickens me to know my country's leaders are in the process of doing so.

No other great nation considers healthcare a privilege. That is because it is a basic right, without which families will bankrupt themselves and people will literally die in the streets. Or, they will receive care and ordinary Americans will end up paying for it anyway.

Please remember what it was like to live like before this mass selfishness overcame our country like a disease. Do the right thing. Don't take away healthcare from millions and call it a choice.
Michael (Dutton, Michigan)
Why people continue to reelect Republican representatives is a mystery. Well, not really; I do know why. But it just seems that the more and more partisan we become, the wider and wider the gap between the two "sides" becomes.

Yes, the Democrats are by far not a party in good shape. Yes, the deficit is a huge problem for our children and their children. And you bet! Politicians of all makes and models become far too enamoured with the power and prestige that comes with their elected positions, no matter at what level.

But at least someone has looked out in some small way for those who are less able to look out for themselves. There is one group of people who think that taking care of your neighbor really is a good thing, that paying taxes for services we may not personally use is what a society does.

That group, unfortunately, is not the one in power. So while "the rest of the country has been transfixed by the Trumpian chaos," this group goes quietly into a corner and bends to the will of their billionaire CEO owner-bosses.

Is there any hope for our country? I lose hope that there is.
Eduardo B (Los Angeles)
What Republicans get wrong is a misguided hostility regarding government that conservatives in other democracies simply don’t share. When they obsess over the size of government, they both fail to comprehend that it isn’t size but value to citizens that matters, and that their focus on size prevents them from making good choices for citizens. Rather than the merits of issues, they start with not increasing the size of government and cutting the size of government.

They keep talking about saving America, but all they’re saving America from is solving issues in an intelligent, reasonable, realistic manner. It really is the party of no when it comes to anything but business and wealth. Their ideology is myopic and ineffective when it comes to real world solutions to real world issues for 90 percent of citizens.

Eclectic Pragmatism — http://eclectic-pragmatist.tumblr.com/
Eclectic Pragmatist — https://medium.com/eclectic-pragmatism
Julie Stroeve (<br/>)
Trumpcare is a tax cut bill -- not a healthcare bill. What is completely abysmal about it is that the wealthy don't need tax cuts nor did they ask for one. They're doing just fine, thank you. It's the middle class, working class, and the people living in poverty that need affordable healthcare, something that was at the core of the ACA. Though still not affordable, it's the first step in the right direction.
Lenny (Pittsfield, MA)
Hopefully this tax-cuts-for-the-rich-plan, [yes the Republican health plan is also part of this], will educate all of us Americans about how the rich who for time immemorial have practiced predatory capitalism continually underpay the people who work for them, lay the people who work for them off for the sake of these kinds of rich peoples' own profits, , and, as well, amass so much personal profits, that the rest of the people, workers and potential workers become or remain unemployed, and become or remain poverty stricken; all this greed leading to unnecessary and obscene amounts of money and wealth for capitalists who are predatory. (Not all capitalists are predators).

And, further more: In the spirit of the words of Yaweh:

"Donald Trump, Thou Shalt Release To The American People Your Back Tax Returns ! And Shalt Thy Children and In-laws !"

Donald Trump is a predatory capitalist , as are some of the members of his administrations, as are some of Trump's major backers, as are some of the members of the Senate and The House.
Melvin Baker (Maryland)
Vote for your interests not against them. Until someone takes away your right to vote, you have the chance to change things.

You gotta VOTE.

As bad as ryan, mcconnell and DJT are- people actually voted for them. Every elected official that supports GOP policies needs to be voted OUT starting in November 2018.

You get the government you vote for.
Occupy Government (Oakland)
Why are people still amazed to find a Republican Party that tolerates racism and sexism or that hopes to end welfare and entitlements and clean air and public schools?

The vision of the GOP no longer coincides with the majority of Americans. But who cares? The money keeps rolling in and people keep voting for them. Promoting the general welfare is lost in history's dustbin.
Posey Nelson (O'ahu)
I am on Medicare and pay USAA 400 bucks a month for supplemental for the two of us elders. We feel fortunate enough to say that if Congress destroys real health care for so many, as they now propose, we will go to the streets with the
“Losers,” as Trump would happily call them. Empathy? Conscience?
libel (orlando)
Senator Schumer please contact CNN and FOX to set up a two hr roundtable special with a special broadcast featuring the leaders of these groups, every one of which opposes the House bill: the American Medical Association, American Nurses Association, American Hospital Association, American Academy of Pediatrics, American Cancer Society, American Heart Association, American Diabetes Association, American Lung Association, March of Dimes and AARP.
purpledot (Boston, MA)
Dear Senators, As a public school principal, I have seen first hand, for over thirty years, the significant strides that Medicaid, Medicare, Social Security for Children with Disabilities, and the Affordable Health Care Act has made to improve the health and well-being of America’s children and their families. Unhealthy children cannot learn. Their absences from school increase, when health care is not an option. Many students need health care, both at home, and school. Medicaid reimbursements to towns, which are required, by law, to educate all children, in public schools, has saved countless lives, and most importantly, created school environments that are safe and secure for medically fragile students. Public schools are on the front lines of medical care for children. I cannot tell you how many of our school nurses have referred very ill children to physicians when hearing loss, vision loss, or other undiagnosed situations occur. These school-based observations are often revealed, for the first time, to families without health care. We can do better. Open your Senate doors to hearings on the ACA and allow your constituents to learn your plans for keeping the lives of students, and their families, healthy and insured. Keeping Americans healthy is a team effort, not perfect, but with continued realizations, that a new health care bill needs to expand, not eliminate health insurance, for as many Americans as possible. Their lives are in your hands, now. Thank you.
JMWB (Montana)
Unfortunately Purpledot, the Tea Party and Freedom Caucus wings of the Republic party have all the power now, and truly, they don't care.
Bill Mosby (Salt Lake City, Utah)
From time to time I have thought Trump's main job was to act as the main distraction. And at that he's succeeding brilliantly.
Richard Head (<br/>)
This is not about medical care. They don't need advise in that area. Its about a tax cut. Its an economic plan. They need money for a huge tax cut and more dollars to the military-industrial guys. The real advisors are the accountants to do the math to figure how to take the money from the health care progra, and many other programs and give it to those who have paid the system .
Jeff Fine (Sacramento)
You are probably right about what will happen but there will be an aftermath. This giant take away will not be greeted favorably by those, including the so called Trump voter, because while some are upset that others get things that they don't deserve, those who get things believe that they deserve them. So naturally Republucans think the wealthy deserve their tax cut, after all they are the job creators even if they put their windfall into an investment in China or wherever, but when the rest of us wake up Republicans office holders will be taken aback.
Sea Star RN (San Francisco)
If Obama and the DEM super majority in 2009 had given us a single payer health care system, we would not be here.
Instead they let the Insurance industry write the bill to preserve and prosper the Health industrial complex and retain the 'benefit' that employers use to keep us an indentured labor force.

Congress knew they were immune from the draconian results and passed it without even reading it. Then the Dems actually wondered why they lost the House in 2010.

As long as we let either party treat Health care as a business and privilege , we will not have good Care and a healthy society!
TC (Ann Arbor)
The name Trumpcare is misleading in every way. Better: "Trump doesn't care,"
Martha E. Ture (Fairfax, California)
These Congress members lack integrity and a sense of public service. Whatever malice in their upbringings created their power-loving animus toward the rest of humanity, whatever compassion they deserve as needing therapy and rehabilitation, at the moment they need to be removed from office so they can stop hurting people.
wc (usa)
This plan is proposed to commence after 2018 and 2020 elections.
Unbelievable.
What is with ugly, old, mean men that wear their impotency on their shoulders?
Andrew G. Bjelland, Sr. (Salt Lake City, Utah)
The Trump-Ryan-McConnell approach to healthcare is symptomatic of a deeper problem.

Trump, Ryan and McConnell must engage in mis-governance by way of stealth and chicanery. This approach further demoralizes and desensitizes an already cynical public, and thus serves the GOP's pro-plutocratic interests.

In the wake of Trump-GOP alienation many have cited Orwell's "1984" as currently relevant. That novel may now be passé. As Michael Idov--a Russian-born, American journalist who has spent years in Moscow--recently commented:

". . . [T]he residents of a hybrid regime such as Russia's--that is, an autocratic one that retains the facade of democracy--know that the Orwellian notion [of autocratic rule] is needlessly romantic. Russian life . . .[is] marked less by fear than by . . . the all-pervasive cynicism that no institution is to be trusted, because no institution is bigger than the avarice of the person in charge."

Michael Idov, "Russia: Life After Trust," New York Magazine (January 23-February 5, 2017), p. 22.

President Trump, Mr. Putin's ardent admirer, is now in office. To what extent has the U.S. become one more autocratic regime with a facade of democracy? GOP donors, Ryan, McConnell and conservative jurists have already assured that the U.S. has become a plutocracy with a democratic facade. It is not much of a stretch from that political situation to autocracy.

Who will author "Trump's, Ryan's and McConnell's America: Life After Trust"?
lostroy (Redondo Beach, CA)
The voters have spoken and they voted in Trump and an R House and an R Senate and now the American people deserve the consequences.
JAL (CA)
I just sent the following to the email you provided:

To the so-called Republican Christians:

Where in the Bible does it say: “Take from the poor and give to the rich”?

Where in the Bible does it say: “Blessed are the rich for they shall inherit the earth”?

Where in the Bible does it say: “He who does it to the wealthiest of these, will enter into the kingdom of God”?

It is past time to actually be a Christian in policy not just on Sunday or when you feel like it.

J A Larson
david (<br/>)
I refer the conservatives to Matthew 25: 34-38
Leonard H (Winchester)
I took the author's recommendation and emailed the following to [email protected]
I hope others will do similarly
To whom it may concern,
Regarding health insurance legislation, I implore you to hold public hearings so that your constituents understand the consequences of the actions you take on their behalf. It does not make sense to omit this most basic and critical aspect of legislating. If you omit such hearings, please hold a press conference announcing that you will not hold hearings in which you respond in substance to questions about that decision. This legislation will have an enormous impact on 350 million people whom you represent. In government of, by and for the people, the people's representatives must be accountable to the people from whom they derive their power. Otherwise, we no longer have a democracy.
If you reply to this email, I hope you reply in substance and not with a form letter merely thanking me for my email. Such a form letter is not worth the paper that I won't print it on.
Sincerely,
Ann (Mechanicsburg, PA)
Just sent an email with my feedback. Thank you for including.
willw (CT)
Why is it whenever I encounter the visage of Mr. McConnell I want to see him tared and feathered on a flatbed bound for a public housing project in Louisville
Mose vasco (Chicago)
If the taking away of healthcare causes 20 million Illegal Aliens to lose healthcare then that might be preferable to deportation. I urge the Senate to pass the bill now!
Zejee (Bronx)
Do you really believe that only illegal immigrants will lose their health care? And by the way, Mexico offers health care to all its citizens.
D.P. (California)
The lens through which we view this entire issue is tragically warped. It is supposed to be healthcare, not profitcare.

Everyone will encounter health issues in their lifetimes. EVERYONE. It is guaranteed.

I get my insurance through my union, so this current set of despicable Republican plans will not affect my family; but we owe it to our fellow citizens to fight like hell to see that they aren't stripped of something that is a basic human right.

And some time down the road, let us fight for a government option, or single payer. But let's not lose this fight along the way.

The message needs to be crystal clear: our government is supposed to PROTECT US from those who would take advantage us in the name of profits, not help those companies make even more money.
Ann Lacey (El Cerrito, Ca)
Thank you for the heads up, just sent my email
jflores (nyc)
Republicans accused the Democrats and the Obama administration of creating the ACA in secret and ramming it down the throats of all Americans. This was totally false but they stuck to their false narratives. Now they are meeting in the dark planning on passing the same bill that the house passed. Now who is planning in secret, not holding any public hearing, and ramming whatever they come up with down the throats of all Americans. Disgustingly hypocritical!
Charles (Clifton, NJ)
Good, detailed discussion of the making of the Republican healthcare sausage by David Leonhardt. Republicans complained about the establishment of ACA and now they are in the same situation. The truth is that they are unable to draft a healthcare bill. They should have focused on improving ACA.
david (ny)
Trump's cuts to Medicaid plus SNAP over ten years is 1 T.
Not taxing dividends and capital gains as ordinary income costs 160 B /year and not taxing unrealized capital gains at death costs 40 B /year.
Over ten years this is 2T , twice what Trump wants to cut.
ClearEye (Princeton)
Grover Norquist sounded crazy in 2012 when he said this:

''We don't need someone (a President) to think (Republican policy) up or design it. The leadership now for the modern conservative movement for the next 20 years will be coming out of the House and the Senate. . . . [We just need to] pick a Republican with enough working digits to handle a pen to become the president of the United States . . . [and] to sign the legislation that has already been prepared.''

But Norquist got his wish and before too long we will see our notably unqualifed President sign into law bills passed by the Republican Congress that reduce health coverage for millions while cutting taxes for the very wealthy. With all respect to Mr. Leonard, there is little that can be done to delay or prevent this result.

As things are today, there are no checks or balances in national policy making. The only solution is to flip one or both Houses of Congress on November 6, 2018.
Jordan Davies (Huntington Vermont)
The budget proposal includes massive cuts to Medicaid and other social programs such as SNAP, etc. The "health care" bill before the Senate goes further, taking probably more than 20 million away from health insurance, depending on what the C.B.O. decides on Wednesday. This budget and health care bill will have devastating effects on the poor. Let them eat cake.
Christine McM (Massachusetts)
"The effort to take health insurance from the middle class and poor and funnel the savings into tax cuts for the rich is a little like mold. It grows best in the dark."

Thank you for this important column. It's too easy to focus on all the damaging political stories encircling this president and forget that bills are making their way through the Senate.

Never underestimate the ugliness of Mitch McConnell, determined along with Ryan to exact their pounds of flesh from those least able to afford it. Between this "TrumpCare" nihilistic vision of slow death through denied access and Trump's proposed budget eradicating virtually every poverty program the poor depend on, it's pretty clear that the entire GOP would love to just see the poor go away.

They may get their wish: draconian cuts in social programs coupled with a healthplan designed solely to repeal the ACA taxes in order to hand them over in tax reform, means there is no longer any room for the lower classes in America.

They are numerous (44 million depend on food stamps--a genuine blight on the richest nation in the world), they are struggling through no fault of their own (yes, Paul Ryan, some people get downsized into oblivion), and they largely voted for Trump, dreaming he'd make their lives better.

If healthcare "replace" passes in any Senate version discussed in this article, it's hard to see how that will happen.
Mark (Cheboyagen, MI)
The republicans are thieves, crooks and criminals with no regard for human life beyond themselves and their families.
HL (AZ)
The author fails to mention that since the ACA was passed the Democrats have been slaughtered in elections. First the House than the Senate and finally the President.

You can't have Universal coverage without everyone in. The ACA while mandating that insurance companies can't rate people on pre-conditions didn't mandate that healthy people buy in. That can't work.

The Republicans think by allowing insurance companies to sell policies with no standards of coverage at cheap prices that will bring everyone on board. The reality is people won't buy crappy policies even at cheap prices because they won't have any real value to consumers.

In order to have universal coverage with any value you need both a mandate and standards. The Democrats got it half right the Republicans got it half wrong.

We need both standards and a real mandate. Neither side has been willing to step up. I suspect the Republicans will be slaughtered just like the Democrats were.
Manuela (Mexico)
One word jumps out at me (third paragraph from the bottom up), and it is one that is overused by the Left to describe the Right. It is the word "cruel." We often paint the Republicans as cruel and uneducated, i.e., stupid, and politically incorrect. And while their tactics often appear that way, and all too often have the effect of being cruel and heartless, those words have alienated the Right even more, and it was that sense of alienation which contributed most to the vote for Trump.

Republicans are (for the most part) church-going people, and like for church-going people over the centuries, church doctrine gives them insulation from thinking of themselves as cruel. Church-going people, by in large, think of themselves as kind, and many of them are. And as much as I despise religious dogma of any kind, I cannot deny that many churches also help the poor, attempt to teach a kind of morality, and perhaps above all, offer a sense of tribal unity which forces strong bonds that can be useful in times of crisis.

This article offers enough critizism of the Bill's ineffective and self-serving properties. It should go without saying that the Bill is cruel and inhumane. The statistics speak for themselves. Inflammatory language only pushes away those people who might otherwise be persuaded to think objectively.
Jansmern (Wisconsin)
Church and religion have also been responsible for the Spanish Inquisition, witch hunts, Henry the VIII and his purges of those not religious enough for his views. In recent times, ISIS, AL QAEDA, TALIBAN, BOKO HARAM, adulterous tv ministers, the Jim Jones massacre, LGBT persecution, my personal favorite priestly abuse of minors, I could go on. If it looks like a duck, etc... The religious Right likes to think of itself as the Moral Majority. As the bumper sticker of the 80's used to read, it is neither moral nor the majority. Today they want their cake and want to eat it too. The Republican Party IS cruel in their views and actions to everyone but themselves. Not calling them a duck does not make them less so. Neither does not seeing it in themselves.
Rojo Colorado (Midwest)
Folks. "Health" is not happening in this country.

We subsidize poison.

Meat, dairy, oil, processed food. Simply remove as much of these as possilble and watch the difference. Health is possible through diet. It is PAST time to reverse the corporate welfare these companies have enjoyed for YEARS while POISONING the public.
MVH1 (Decatur, Alabama)
As Warren Buffett is quoted having said recently in a gathering of the most wealthy and those concerned about responsible government and its stewardship, the tapeworm in the healthcare story is the cost of healthcare, which is exactly what makes Obamacare or any label you want to put on attaining health insurance coverage that isn't just a money pit with no return and lots of sabotage if you try to make claims through it absolutely critical for the care of many just to live. There is real evidence people will die if they can't obtain affordable healthcare coverage. What the Republicans wish to do is take the money that helps people get affordable coverage and cut the taxes of the already very wealthy who will never feel the horror of having no insurance and a horrible illness, or those whose insurance will inform them their illness is a pre-existing condition and will therefore not be covered. How would you like to have that job?
Joan McCusker (Benicia, CA)
Thank you, again, Mr. Leonhardt...words of wisdom. It is always amazing to me to see what the Senators and Representatives think (not sure they actually do) regarding their constituents. The impression I have is that they do their jobs for themselves and NOT the people they represent. What we the people need to show them is what we think at the ballot box. The majority of these so called politicians need to return home and find a "real" job...I'm sure that would never happen, but wouldn't that be nice. They need to touch reality and find goodness in their hearts for their common man (woman). How would they like to be treated, not in this manner I'm sure.
George Foo (LA)
If this is indeed what the core Trump supporters (presumably, according to reports, those who would be most impacted by the Senate bill), should we not lose any sleep over this?

Perhaps we should not assume to know what is best for others.
Norm Spier (Northampton, MA)
Thanks for pointing out that the current behind=closed=doors Senate activity on a health bill is likely a deceptive ploy designed to delay recognition of the bill's malevolence.

I haven't seen this angle addressed elsewhere, and it is good that you brought it to our attention.
JW (Colorado)
If only there was a real opposition party... and even then, if only our votes mattered....

But we have no real opposition party.

I have no voice. My vote doesn't count in my gerrymandered district. My letters and emails are answered with platitudes and lies. I have family members who will likely die early and unnecessarily because of the Republican Agenda.

But it won't matter. At least the rich will be happier. The self-righteous can gloat. Many of the poor, the disabled, the 'throw-away' people will die or just become shadows under bridges and on street corners, holding signs.

Encourage your family to move to a CIVILIZED country, if they can. This ship is going down for most of us, because as hard as we work, there will always be someone taking from us to give to those who already have so much. Bombs will always win over babies.. most especially after they are born.

I wonder if the few will enjoy it more... when they have it ALL???? I do wonder about who will cut their grass and clean their toilets, but then maybe that's how Congress can finally start doing something worthwhile....
WABBA (Holly Springs, NC)
I honestly can't believe that at the dawn of the twenty first century, this is what we are discussing in America. We may feel a moral superiority to the rest of the world because this country was founded by enlightened (albeit salve-owning) individuals while Europe had to contend with monarchs. Well, that was over 200 years ago, and at this point, the roles have been reversed, We have massive inequality, a concentration of power, and an arrogant dismissal of the will of the people that is reminiscent of the glory days of Versailles. Europe has moved way past us on the path to a fair and enlightened society, and we know that this is the path that awaits us. The question is how many more years, and how much suffering will we inflict on our citizens before we come to our senses?
Steve Rogers (Cali)
Taking health insurance from the poor in order to give tax breaks to the rich is morally bankrupt. If America keeps the GOP in the majority of Congress in 2018, then we as a Nation are morally bankrupt. You reap what you sow.
C. Morris (Idaho)
This has been the Republican party since TR walked out, disgusted with the GOP willingness to drop the mantel of reform, and become the party of interests.
LMGold (Portland, Or)
Here's my letter.

I am against any effort to pass a healthcare bill destined to take away coverage from millions of Americans. It is immoral and unethical. Every major industry involved in providing care, from doctors to nurses to hospitals and clinics, is against this madness.

Americans will not be railroaded into giving away their care in order to give billions in tax cuts to the very rich. It sickens me to know my country's leaders are in the process of doing so.

No other great nation considers healthcare a privilege. That is because it is a basic right, without which families will bankrupt themselves and people will literally die in the streets. Or, they will receive care and ordinary Americans will end up paying for it anyway.

Please remember what it was like to live like before this mass selfishness overcame our country like a disease. Do the right thing. Don't take away healthcare from millions and call it a choice.
Silent majority rules (Portland)
Where's the outrage over the tens of millions of individuals who lost or had healthcare become unaffordable from Obamacare? They were the silent voters who angrily elected Trump. They also didn't like the massive tax increase Obamacare was on the middle class - essentially $10k per year on incomes of about $100k, middle class with two incomes. To give 20 million poor gold plated coverage was never going to be affordable. But the rich liberals in their bubbles were too out of touch to see it.
Brendan Burke (Vero Beach Fl.)
Just an observation but republicans seem to be wearing blue ties these days ,I don't think that will help !
BCP (Maryland)
Yes, they should hear a LOUD MESSAGE AGALINST THEIR HEALTH BILL. Here's mine! In the great country that is the USA, all citizens should have access to modern health care. A-L-L !!! And that health care should be the same for all citizens. Members of the House and the Senate should have the same care as the rest of us, not that super-cooper plan they currently have access too. Time, friends, to speak loudly for a sensible, bi-partisan plan, the same for ALL! Time for statesmen in the Congress, not the swamp we have of political bandits!
DornDiego (San Diego)
Thank you, David Leonhardt, for parting the curtains drawn over the nation's business by the All Trump All the Time presidency-- a never-ending campaign to separate Americans from the truth. While Republicans make sure that millions of Americans will be dropped from health insurance, we learn that the White House Occupant can wave a ceremonial sword and take a few bows before retiring, exhausted, from the first leg of his visit to the Saudi's. Then, after being revived, we saw Israel's Netanyahu smiling coyly as Don the Con praises ... something. The only thing permanent about this debacle is the GOP's insistence on proper camera angles and higher profits from wrfare and disease.
Former Hoosier (Illinois)
And so this country continues its rapid descent. trump has only been in office 4 months, yet the country is becoming unrecognizable. trump has sullied the presidency and brought immeasurable shame to this country. Outrageous scandals have followed trump since before he took office and, they show no sign of letting up.

In spite of the fact that trump & company are doing the exact opposite of what they pledged to their voters (affordable health care for everyone!), 79% of GOP voters approve of trump's efforts. As long as GOP voters continue their blind allegiance, the republican congress will continue to take from the poor and give to the rich.

TrumpDoesn'tCare is nothing more than a huge tax break for the rich, masquerading as a health bill. That's why congress doesn't care that millions will loose their health insurance. This isn't about insurance, it's about a tax break. Once the senate passes this draconian bill (and they will pass it) and GOP voters start loosing their insurance, perhaps then they'll start turning on trump and his minions.
Kay Johnson (Colorado)
I just called our Senator Cory Gardner's office: Clueless.

They know nothing. Can tell the citizens nothing about the Senator's views healthcare; "He hasnt told me". Whatttt? They can cite that premiums went up.

No answers, hiding the fact that there are no hearings.
How these people claim to representative Colorado is bizarre.
Dan88 (Long Island, NY)
Why aren't groups like the

"American Medical Association, American Nurses Association, American Hospital Association, American Academy of Pediatrics, American Cancer Society, American Heart Association, American Diabetes Association, American Lung Association, March of Dimes and AARP"

out there educating the American public on what this means to them? For example, by holding town halls in red districts whose MOCs voted for the AHCA?
Andrew G. Bjelland, Sr. (Salt Lake City, Utah)
The GOP: The Party of mis-governance by means of stealth and chicanery.

But the Republicans are pro-gun, anti-gay, anti-minorities, anti-abortion and pro-Christian, so their hearts must be in the right place. The advancement of plutocracy and kleptocracy are just unavoidable side effects of their regressive laissez-faire-capitalist ideology.
George Olson (Oak Park, Ill)
Are not we seeing a desperate Senate leader in pursuit of a "win" regardless of the stakes, the costs, the logic or the "good" of that win? With the Trump administration in a tailspin, the clock is ticking, and this Health Care "Thang" must be done quickly. Don't expect senators to "beat the rats" off this sinking ship. Expect them, instead, to hold onto their "seats" with their fingernails. Health Care, tax cuts for the rich, Tax Reform - these are the "wins" that the right must have to survive, regardless of the consequences for most citizens, even their base. And they must be "won" in record time. The House set the tone and has shown the way - the method. Thank you Fred Upton. Under the cloud and cloak of the "Russian" debacle, McConnell will say: "Go for it senators!". That will be McConnell's message. It is a jobs message to the Senate - "protect your job"! Hang up your values for a short time, hold your nose, and get a few wins before Trump goes under. Is desperation a good motivator? It is the opposite of common sense. Calm down senators, take a breath, and please consider the consequences of what you are about to do. The phrase, presiding over a wake, comes to mind.
Bob Laughlin (Denver)
I did send an email, thanks for including the address.
If I remember correctly republicans, in spite of gerrymandered districts that more resemble pretzels than geography, lost seats in both houses of Congress last year.
Are they really so arrogant and short sighted that they will try to destroy health care for millions of their voters as we roll into another election?
Do they rally think We the People are that stupid?
Do they not know that the face of their party is perhaps the most hated person on the planet?
Do they just assume Democrats voters are just going to stay home again in a midterm?
Has this Nation collectively lost its mind?
Glen (Texas)
Why is there any form of secrecy involved in the provision of healthcare to Americans? We are not the enemy, some foreign power bent on destruction of the rights guaranteed by the Constitution, scheming to kill millions and lay waste to the landscape.

Party loyalty? Can you say "Excuse to ignore your conscience, not to mention the facts?"
PAGREN (PA)
What kind of health care package will the Senators and Congressmen get?
galtsgulch (sugar loaf, ny)
Not only is the law going to be awful, the GOP wont fully implement it until after the next Presidential election.
Evil is as evil does.
Donald Bermont (Newton, Massachusetts)
I can't think of another country that operates like this. A country where a small group of very rich people make all the decisions, and all of the decisons favor them, and allow them to get richer at the expense of everyone else.
Oh wait, yes I can ..Russia, Saudi Arabia, hummmm
Che Beauchard (Lower East Side)
Ah, the reverse Robin Hoods, stealing from the poor to give to the rich. May their souls find eternal discomfort. May the Americans find the courage to send them packing.
Roxie (San Francisco)
I recall that the right wing media couldn't stop talking about the Obamacare Death Panels.
Turns out the Trumpcare Death Panel is the GOP Senate.
Jordan Davies (Huntington Vermont)
Nothing, but nothing is "good" about this health care plan, unless of course, you are rich.
Ralph (Florida)
I saw a statistic that is important if true. The statistic is that for every 459 people who go without medical insurance someone dies a preventable death. Let's have some fun with numbers: if we take insurance cards away from 24,000,000 people then 52,287 people will die. The next time President Trump goes to one of Rev. Franklin Graham's prayer breakfasts I would like to hear them send up a few prayers for those who gave their lives so that the 1% could get the tax break that will make us a great nation again.
just Robert (Colorado)
When the majority Republicans start out with the idea that tax cuts for the rich are the ultimate goal, medical care for the middle class and poor is a nonstarter. The only thing important to them is to hoodwink their voters into thinking they have received a Mercedes rather than a rusted out old clunker. If you buy this you deserve what you get. from these wanna be used car sales people.
Val Colenso (Helena, MT)
Unfortunately, so do the rest of us...
james lowe (lytle texas)
There is nothing in the article, and I have seen nothing in the comments, about participants in the individual market whose income is above the subsidy thresholds. For some, no insurance is available. For the remainder, it is unaffordable, having gone up by multiples since the ACA was enacted. This is because the burden of community rating with the subsidized insurees is borne by these individuals rather than all insurees.
WABBA (Holly Springs, NC)
You're absolutely correct. A family of four making above $97 will have to foot the full premium (over $20k per year), not to mention up to $14k in out of pocket expenses. That's almost an incentive not to make more money than that. But the ACHA is not even trying to address tht problem. It's making the parts that work (sometimes with a significant limp) far worse.
Dorla (Bellingham, Wa)
I applaud the NYT's and the Post's journalistic excellence in the Trump/Russian fiasco, but the destruction of the nation's healthcare system for the average citizen, is the story that will bring about a Democratic victory in the 2018 elections. Please keep these related stories front and center everyday until November 2018. This is the story that directly affects the Trump supporters (and the core GOP voters). They need to be inundated with the fact that Trump and the GOP need their help to self-inflict damage to themselves and their families in order to transfer healthcare dollars to another tax cut for themselves.
John Holmes (Oakland, California)
Yes indeed, passing this monster bill could result in Democratic victories in the 2018 elections.

One wonders if this is the reason why the there has been such a Democratic Party obsession over the Russian election influence comedy, basically meaningless to anyone outside the Beltway. To distract public attention from the health bill, enabling it to pass? Would be horrible for the people of America, but excellent for the Democrats in 2018.
Suzanne (California)
My students wrote and performed their final debates on "Should health care be a human right". The extreme conservative view (aka libertarian view) was depicted as a negative intervention. In other words, non-imposition on another's person hood. If followed that would mean no public institutions, right?
no fire protection
no police protection
no subways or metro
and so forth.
I think these students should advise our congress.
Harry Avila (Fremont, CA)
After decades of negotiations and public debates between the "Big Players", a US health access bill was passed affording care for all. Not perfect, however when you consider the multitude of lobbying interests, the Affordable Care Act was a start and working. Now the Political Party of which I was supporter for years is determined to toss out these efforts. It's obvious, as a health care provider, the United States has no system for the delivery of health care, the most expensive health care in the world, less than satisfactory health metrics and too many disparate interests. The Senate must be made to understand the significance of their actions
David Weinschrott (Indianapolis, IN)
Mr Leonhardt is right to keep the "debate" on health care policy in the Senate front and center. That emerging abominable strategy needs the cleansing light of scrutiny

Elsewhere on these pages is a piece by Bruce Bartlett who finds it necessary to rehearse an old shibboleth about the beginnings of employer-based health care. This "accident" is marshaled as a rationale for ending tax deduction for health benefits. Perhaps this is a reasonable argument.

However that employer based benefit was a boon to the insurance companies and provided a powerful means to expand insurance coverage when there was no government will to offer help. The fact that employee workforce membership (a) was unrelated to the incidence unrelated to individual health status (except in a positive way), (b) that groups of employees made for a more heterogeneous insurance risk pool and (c) that payroll deduction along with employer subsidies facilitated regular premium payment was instrumental to widespread insurance coverage in the decades after the war. The destructive principles of experience rating applied to individuals and small firms developed later as commercial insurance firms encroached on the non-profit Blue Cross/Blue Shield programs.

Employer based markets are still the stable portions of Obamacare and should not be undone lightly. The distortion caused by the tax deduction may be a reasonable price to pay until we have strong individual and small firm insurance markets in place.
laurie (san francisco)
I would suggest that all concerned citizens send an email to the address that David has posted in this article. If you would like to copy and paste the note I sent, that's just fine with me. Here 'tis:

Dear Senators:

I am writing to urge you to pass a healthcare bill that will improve on the Affordable Care Act. My understanding is that you are working on a plan that will do just the opposite. Any plan even close to the House bill is an affront to the citizens who put you in office. To pass something that would essentially make it impossible for millions of poor and middle class people to afford healthcare, while taking the savings from this draconian plan and giving tax cuts to the wealthy is obscene.

Please pass a bill that is truly universal healthcare. My suggestion would be to gradually lower the eligibility age for Medicare with the eventual goal of making everyone eligible.

Thank you for your consideration,
Bruce Higgins (San Diego)
I have a way to change the dynamic of the health care debate. Make Congress and the government abide by the heath care rules they pass. No more congressional exemptions, you must live in the same world as the rest of us.
sapere aude (Maryland)
A small correction, Republican senators don't work for citizens, they work for their donors. It doesn't matter if they hear a message from concerned American citizens.
ubcome (NY)
When we read that the health care bill will deprive people of health insurance as it gives tax cuts to the wealthy we should ask whether there is something even more sinister. To me it seems that giving healthcare to the population is not an objective. In fact it may make more sense that the goal is to deprive people of health so that they don't live as long, vote for the opposition and collect their social security and medicare into old age. (Another way of shifting money towards the wealthy) This goal of diminished health would also explain the inferior school lunches and taking the emphasis off healthy lifestyles. Am I too cynical or seeing the big picture?
DAB (encinitas, california)
Sadly, your closing statement doesn't ring true. The senators do not work for their fellow citizens, they work for McConnell, Ryan, Trump, and last but not least, for the GOP.
Doug Terry (USA)
If Americans wish to take up residency in Canada, they can't, at least not without difficulty. Why? They don't want people pouring over the border to take advantage of the Canadian health care system, especially the elderly who obviously have more need for health care than the young.

We are an "exceptional" nation in many ways, but one of the unfortunate ones is that we can't, politically, find a way to drill into the insurance/hospitals/doctors system to provide health care for all while, at the same time, reducing the share of GDP (17%) that currently goes to the medical establishment. We spend more on care than any highly developed nation on earth, but we don't manage to cover everyone.

I am a pessimistic-optimist on this and other issues. Pessimism says the Republicans are brewing up disaster for millions. Optimism says they won't get away with it and from this disaster will rise a real, lasting solution to this dastardly problem.

To be in the 1% these days, you have to have an annual income at or above around $650,000 per year. Think about it. That's a minimum of 6.5 million dollars every ten years. Those folks can buy anything they want and they can afford to buy members of Congress to do their bidding, too. They get tax breaks, but, without a good national program, we will still pay for health care but only the kind that comes too late and near the end of life instead of proactive, useful care.
Ana (Rockies)
At the very least there needs to be as much if not more coverage of this in every media outlet possible. The more light the better. This is a US equivalent of genocide move. It is class warfare. The only value the masses without money own is their votes and their voices. The vote power is limited to periods of campaigning and expire on election nights. Voices are at the ready 24 hours a day, all year long.
W (Cincinnati)
It would be a small step for President Trump to forget all his campaign promises of bigger and more beautiful health care for everybody but a giant step backward for a large part of the American people who as a consequence would receive no, reduced, or unaffordable health care. In fact, it would move the US well below the level of health care an average citizen receives in every other developed country. How can this be? Trump proposes to spend hundreds of billions of dollars more on defense spending over the next 10 years and that investment may or may not protect the country against attacks from the outside. The attacks from the inside on the social fabric and the livelihood of millions of patriotic Americans doesn't seem to be worth caring about. O tempora, o mores.
David Mattson (New York, NY)
As Mr Leonard states, today is the final day for citizens to send comments to the Senate committee drafting revisions to House health care bill.

Let's send our comments to 'exercise our duty' as citizens to tell committee members to do the same as Senators.
Here is what I emailed to the committe's email to
The committee

I strongly endorse the work of your committee to independently revise the bill passed by the House

To do this correctly, you must
correct the House committee's lack of public debate before completing your efforts to ready a revised bill for a Senate vote.

This requires that you make a reasonable to hear testimony from the groups like the AMA that deliver health care, AARP that represents citizens, and insurance industry groups.

You also must wait for the CBO to independently analyze the impact of your final bill.

Do your work in an Honorable way and not attempt to rush an amended bill. All citizens will be affected by your work!!

Sincerely

David Mattson
New York, NY
JClouseau (Orlando)
Despicable! When will the American electorate realize that the Republican Party now exists for only two purposes: (1) Eliminate/reduce taxes for the wealthy and the corporations, and (2) deregulate everything so that "free market capitalism" can run amok. For 364 days of the year, the Republican Party does not care in the least about the health and well-being of 99% of Americans (the sole exception being Election Day).
N. Smith (<br/>)
Thank you, Mr. Leonhardt for repeating what those of us who have been following this situation, already know.
But in truth, it's time to worry about the Senate more than health care -- after all, they're the architects of the monstrosity they seem so willing to inflict on us all.
Of course the real problem is that Republicans are in full control, so they don't see the need to take an interest in what anyone else thinks.
Which is why it's now incumbent upon the PEOPLE to remind them why they are Senators to begin with.
And given what we have witnessed so far with the Trump administration's pay-to-play ethics, it should be clear that they would never come to this conclusion on their own.
Wake up, AMERICA.
Suzanne (Indiana)
I am disgusted by the secrecy of this Congress, especially with the healthcare bill. I have written my Senators and Congressman more in the past few months than I have in the past few years. They answer in vague platitudes about letting the free market provide solutions and wanting to do what is best for vulnerable Americans, but if their solutions are so great, why not tell us in detail what the plans entail? Why not show up at town hall meetings and let us ask questions? Surely a plan as great as they say theirs is will be easily explained, right? You'd think they'd want to shout it from the mountaintops not hide it in a muddy pit.
LAURA FROHMAN (MIAMI, FLORIDA)
Every time I see this conservative Congress acting in such an un-Christian way I am amazed. Where are the evangelical leaders screaming to care for the poor and the needy. Why don't I see the church leaders urging their flocks to stand up for what is right - caring for the least among us. This is a non-issue. We are Americans. We proclaim to be the richest most powerful nation in the world. If we act against so many of our citizens, putting our children, our elderly, our helpless at the end of the line. Then I wonder how we dare proclaim ourselves the BEST.
wa (atlanta)
quoting my letters sent this morning to Senators:
Americans need to know that they and their families can sustain an illness without being ruined. They need to be able to concentrate on care rather than worry constantly about their ability to pay. They need to be able to get quality care now rather than waiting until they are much sicker and possibly receiving first treatment in an emergency room. They need to know that they can get health care for their families if they lose their job. They need to have security knowing that they have access to health care regardless of the other challenges of life.
The House Plan will do none of these. However, it will give a tax break to people than don’t need it. I hope the Senate has some better ideas.
Steve Hunter (Seattle)
It is difficult to understand leadership that is so consumed by power and greed that they would sacrifice the health of the people they are sworn to serve. There is enough money and resources to provide health care for all, there is not enough to sustain everyone's greed.
Joe (Chicago)
"A bill that takes away health insurance from 15 million, 10 million or one million Americans — rather than the 20 million or so of the House bill — still deserves defeat."
Without question.
But you still must remember the Republican motto: No one deserves anything they can't pay for themselves.
So, if 20 million Americans lose health insurance, too bad. Trump and all the top GOP crowd don't care, because they can afford to pay for their own. And let's not forget that all members of Congress have their own doctor with his own office IN their building. (For ANY services they get, they all only pay $500 a year.)
Even if they overturned Roe v. Wade, Republicans would still find ways to secure immediate, needed, emergency abortions for their daughters or girlfriends, the way they did for decades before the 70s. All it takes is money.
Their hypocrisy knows no bounds.
James Holloway (Casper, Wyoming)
I wrote and sent the following, please others, add your voice.

Your pending bill, discussed in secret and aimed at the destruction of the Affordable Care Act and by proxy the elimination of health care for millions will not be forgotten. Your political victory, if it is to be had, will only cause the needless death and suffering of many (among them many of your own supporters) in the name of relieving the ‘burden’ on the most fortunate and exploitive in our society. This is pyrrhic and spiteful. Can the same be said (truthfully) of the Affordable Care Act? What is your true motivation? Where is your loyalty? This petulance is no path forward, it is not a basis of policy, it is not the character of a government seeking to make a nation great. This is not the nature of America. It will not be forgotten or blamed on others.

This is a moment of reflection, a moment of self-examination, a moment of empathy. None of these things should be overridden by party doctrine. That is not the highest oath. Honor your humanity, honor your morality, be humble in your actions and the executions of your responsibilities.

If not for the luck of birth and station, where might you be?
Richard (Mancos, Colorado)
interesting. All these associations that are against this bill, the American This or That Associations, there's two conspicuously missing. The American Insurance Association, and the American Pharmacological Association. So, not everyone dislikes this piece of legislation.
carrobin (New York)
The only good thing about a capitalistic "healthcare bill" developed by Republicans is that it might destroy the Republican party, though a lot of people might suffer badly before that comes to pass.
Gianni Rivera (San Jose, CA)
So, let me get this straight: So the "HEALTHCARE BILL" pushed through the GOP-controlled House (with NO hearings) and now being considered by the GOP-controlled Senate, is actually about cutting budgetary costs to enable Tax Cuts for the wealthiest Americans? The SOLUTION? Ask for Congressional HEARINGS from those in the Medical industry! This "NO Healthcare" charade is bound to become a "disaster" for those in the GOP seeking re-election in 2018.
Vesuviano (Los Angeles, CA)
I've said it for decades, and the Republicans I have known have denied it for decades.

I'll say it again.

The Republican Party is evil, anti-American, and its policies kill American citizens. What they are doing around health care simply affirms my statement.
Dave Cushman (SC)
I you are not rich the republican in congress do not care about anything of you except your vote, which they will contrive to get by any means possible.

They have even learned how to flatter stupidity.

Picture the hat: "MAGA... I'm stupid and proud of it."
Chris Parel (Northern Virginia)
The Republicans' MUSHROOM health reform bill is tantamount to Premeditated Morbidity and Murder. It will inflict untold injury on the sick, elderly and vulnerable. It will deprive those who lose coverage of millions of days of productive life, income, increase suffering. It will result in premature death, MURDER. It remains merely to estimate the extent of the carnage from disease incidences and actuarial tables.

All of this so so rich people who pay for GoP politicians' campaigns and define their agenda will pay less in taxes aggravating skewing of income distribution, retarding economic growth.

It's not "mold" Mr. Leonhardt, the proper metaphor is 'mushrooms' (apologies to mushroom aficionados...) ...'.keep them in the dark and feed them sh_t'.....

The US already ranks at the bottom of OECD countries in healthcare and on important benchmark indicators like infantile and maternal health it ranks only around 48-50 in the world. This is already shameful for one of the wealthiest countries in the world. But it's worse than this. Depriving people of healthcare contradicts United Nations' Millenium Development Goals predicated on the basic human right to health care access. This is a crime against humanity. No country in the world is doing what Trump Trumpcare proposes to assuage their greed.

So could we please use the proper terms--"premediated morbidity and mortality", "crimes against humanity". We can stop it if we will only name it...
MacFab (Houston, Texas)
To all the Senators working on repealing and replacing Affordable Care Act (ACA),

Stop!

Have you no morals? Have you no fear of God? You told us that you love this country, act like it. Why are punishing your fellow citizens by trying to take their healthcare away and redirecting the tax fund to people in our society who do not need the money? Why?

Why not try fixing whatever you think needs fixing in ACA by passing a law that will let Americans buy health insurance policies across state lines? Why not work on increasing access instead of decreasing it? Yes, you may have campaigned on repealing and replacing ACA but if you do not have something better to replace it with, why do you still want to march on?

We will all have to answer for our actions if not here then in the life to come. You have an incredible opportunity to improve the lives of your fellow human beings, please stop squandering it.
Jsbliv (San Diego)
The republicans don't care. They have promised tax relief to the rich and the end to repressive regulations, so they will walk over the huddled masses to make sure they get what they want; just as they criticize the poor for their mistakes in life and unwillingness to pull themselves up. Along with this comes repression of women's rights, because no one has more power to say what a woman can do with her body than an angry white man. Jim Crow laws seem to be making a comeback too, only now they also include gay and transgender citizens in the mix of hate. Welcome to the regressive, oppressive rule of republicanisim with their rabid cheerleaders at fox and conservative talk radio keeping the base in a frenzy. For this, Oh Lord, we are thankful.
Francis Bagbey (Cary, NC)
What are the Democratic proposals to "fix" the ACA? Costs are out of control, insurers are leaving the individual marketplace, the younger, healthier people needed to subsidize the care of the older and chronically ill are not signing up. Many of the criticisms voiced in all those hearings Mr. Leonhardt lauds are coming true. The insurers made a Faustian bargain--we'll support passage of the ACA because we see the mandate to sign up or pay a "tax" as the driver of tens of millions of new customers to us. Hasn't happened in any where near the numbers required to make this "insurance" scheme work. An admirable goal -- affordable, quality healthcare for all -- delivered in an incredibly complex law badly implemented. The ACA is collapsing and single payer is on the horizon notwithstanding the scheming described by Mr. Leonhardt.
Raul Campos (San Francisco)
The problem is that the Times and the Washington Post have generated so much distraction away from important issues by fanning the flames of unsubstantiated leaks concerning anything Russian. I suggest that you focus on the healthcare bill in the senate because it is complicated and requires everyones full attention. Let me also remind you that even the best case scenario concerning the Russian investigation will most likely not result in impeachment and in any case not alter the present power structure, but the republicans healthcare law will be with us for a long time given the rarity of one party controlling both houses of congress.
Ron Randall (Edgewater NJ)
KEEP IT UP, REPUBLICANS

I think that passage of a horrible bill along party lines, while painful for the nation in the short run, will soon thereafter completely destroy public support for Tea Party values and the viability of the Republican Party.

As much as I fear for those affected in the short run, I think the greatest good for the greatest number would come from the Republican Party's self-destruction by passing Trumpian legislation.
Eileen (<br/>)
I couldn't agree more. At the heart of it all is the fundamental belief by the GOP that it is not the responsibility of the government to ensure or provide health care or health insurance for its citizens. It's only because of the popularity of the ACA (at least by many) that they are "stuck" and have to "pretend" they care about healthcare. The reality is they believe in "every man for himself" and if you're sick, somehow it's your fault. We are the only developed, first-world country that has this attitude. We can spend all of our resources on tax cuts for the rich, and bombs and war, but not take care of our poor, sick, elderly, and other vulnerable groups of people. And, if you've been fortunate enough to be successful in life, you can lose it all in your later years if you are struck by illness. SAD!
Jeff Guinn (Germany)
Wow. An entire column without a single fact about exactly how this bill will produce such draconian results.

Children's helium balloons have more substance.
Aderemi Adeyeye (Adelphi, MD)
I have always felt that Mr. Trump is the distraction. Senator Mitch McConnell is the real danger.
Pat Fourbes (Naples)
Where are the Dems?where are the Dems!!!
Why aren't they out there selling universal health care. Medicare for all.
The common good. Where are the Dems? Bernie ........ where are you.
Zejee (Bronx)
Bernie is the ONLY Democrat talking about single payer. He is introducing a bill calling for Medicare for all.
Demosthenes (Chicago)
It's pretty clear that the GOP Senate isn't the slightest bit interested in obtaining public input on its bill to fund tax cuts for the rich by stripping millions of health insurance. The GOP House already did the same thing. The idiot on the White House is fine with anything that passes, and likely forgets his campaign promise of health care for all.

We've learned a valuable lesson about the GOP when it has power. It doesn't care about what the people want. It's equally unconcerned about input from experts. All that matters is adherence to its regressive ideology that the poor are undeserving and the rich deserve more.
Chris Parel (Northern Virginia)
“So many young beautiful, innocent people living and enjoying their lives murdered by evil losers in life."

Trump could just as well be talking about Trumpcare. Ironically the winners who hold sway over the House and Senate are the same GoP losers who will murder the young, beautiful and innocent but also the poor, elderly, sick and vulnerable.

Let us call it what it is, PREMEDITATED MURDER. There is no bomb, no automatic weapon spewing death but the resultant morbidity and death will be accompanied by untold suffering, pain and curtailment of productive lives. It will end in premature death. The least we can do is to report accurately what economic induced behavior probabilities, disease incidence and actuarial tables assure us will happen. We need to start naming it--PREMEDITATED MURDER--to stop it. Media?...
Richard Conn Henry (Baltimore)
OK! I sent my email to
[email protected]
Here it is:
Please have public testimony from:
the American Medical Association,
American Nurses Association,
American Hospital Association,
American Academy of Pediatrics,
American Cancer Society,
American Heart Association,
American Diabetes Association,
American Lung Association,
March of Dimes
and AARP.
Please reply and let me know that you have decided to have public testimony from these important organisations!
This is not a political matter, it is a matter for the American character.
Dick Henry
Yer Mom (everywhere)
If only congress was required by law to have "Trumpcare".
Molly O'Neal (Washington, DC)
The NYT should consider putting this unfolding but unsexy tragedy on the front pages rather than, or at least alongside, the daily drip-feed of anonymous leaks about Russia and Trump. Democracy dies in darkness, remember?
William E. Keig (Davenport, FL)
Dear Republicans:
Your secret's now no secret anymore (apologies to George Michael).
MikeMav (Waynesboro, PA)
Why is The New York Times letting the Republican Senate leadership get away with this maneuver? This newspaper can choose to use its journalistic power to run a four-to-six-column above-the-fold front page story giving the facts of this story. It can choose to accompany the story with a News Analysis article explaining the motivation for avoiding hearings in order to to evade public scrutiny while preparing a tax cut for the wealthy and calling it reform of the health care system.
Jon Powell (Portland, OR)
The Democrats are fantasizing about impeachment. Waiting for poor constituents or media to sound an alarm before they fight back.
jkj (Pennsylvania RESIST ALL Republican'ts no matter what)
Health care, like education, is a right not a privilege. Just like in civilized countries where they keep people alive not the arrogant selfish deplorable Americans where they kill people on purpose.

Go ahead take away the health care and then see what happens. But here is what everyone must do once these masochistic sadistic heartless Republican'ts take away your health coverage one way or another or it becomes too expensive to aford because of the greedy selfish corporations; do not use the doctors or nurses or specialists, instead, only use the ER and each time make up a name, address, etcetc never give SS# or birtdate or make these up too, and then no bill or anything else sent because they will never know the truth. They will never be able to turn you away no matter what names you use because of the Hippocratic Oath. See it works out just fine! And you won't need insurance either. As far as medicines, go across to Canada and buy them there at hugely discounts. Or if you are too sick or poor, then get samples from the hospitals and lie to them too. Works out just fine for all. Do whatever it takes to hurt the rich, the corporations, the Republican'ts and those who support and vote for them.

See consequences.
Zejee (Bronx)
The medication I take for a chronic infection costs over $200 for 7.5 ml (a tiny bottle of ear drops that does not last one week). Thankfully, I found a Canadian pharmacy where I get the SAME medication for $48.
billsett (Mount Pleasant, SC)
What is wrong with these people? Have they no shame? "Conservatism" is killing us. Literally.
Steve Bolger (New York City)
There is nothing but insult to intelligence coming from the whole stupid mob of Republicans. The idiocy of a nihilistic minority casts a pall over the whole USA.
Andy (Fairfax)
email sent. do it, people!
L’Osservatore (Fair Verona where we lay our scene)
Mr. Obma's PPACA is exploding into destruction exactly as planned, and this will finish off the Democratic Party. The louder the progressives try to make it everybody BUT the Democrats' problem, the more obvious their guilt glows in the dark.
This disaster, an actual attack on the American middle class, will sink the Democrats just as they think people are starting to forget the terrible no-growth economy of our dance with socialism.

Redistribution never works and the people who foisted it on the USA will be forgiven in a century or two. Maybe.
Obamacare is the New York Times' baby, Dianne Feinstein's baby, Nancy Pelosi's baby, and Charles Schumer's baby. C'mon rich people, what is your next attack on the American middle class going to be?
Beth (<br/>)
"Redistribution never works". That goes both ways.
short end (<br/>)
Mr. Leonhardt's disasterous mistake.
He continues to confuse Health Insurance for Health CARE.
Mandatory Health Insurance is precisely why Health CARE costs automatically sky rocket.
Worse for people of Mr. Leonhardt's ilk......the Senate is conspiring to exceed its Constitutionally limited authority.
the Senate has no power to write a "bill of revenue".....its cut and dried. Article 1 Section 7.
The Supreme Court, timidly, explained this in their ruling on ObamaCare.
No....ObamaCare does not violate that nebulous vague "Commerce Clause".....rookie lawyers should never have been allowed to use that tack.....so the Supreme Court additionally coached the inexperienced by pointing out that ObamaCare is in fact a "bill of revenue"......I defy you to say otherwise....as every single provision of ObamaCare is enforced by....the Internal REVENUE Service.
....
ObamaCare was written, in its entirety, in the Senate, not one single punctuation mark added by the House of Reps.
The Senate destroyed the Constitution with this act.....done 100% by the DNC as a demonstration of POWER....and for no other reason. Now the tables are turned, and the power mad RNC wants to demonstrate that they too, can ram through an UNconstitutional Tax Bill and fool the people into believing its "Health Care".
....
Mr. Leonhardt is only smuggly kidding himself...as self-righteous fools oft times do.
avatar (New York)
The GOP leadership reminds me of cockroaches. They live in the dark. They have an affinity for garbage, They carry disease. They are impossible to corner. And they keep coming back. The best remedy is disinfectant and light. VOTE THE BUMS OUT!
CEC (Pacific Northwest)
When they began their elected terms, House and Senate Republicans swore an oath to the US Constitution which is all about forming a more perfect Union, establishing Justice, insuring domestic Tranquility, promoting the general Welfare, and securing the Blessings of Liberty to ourselves and our Posterity. I don't see anything in there that talks about working exclusively for rich people, the poor and middle classes be damned. But that's clearly what Republicans are doing- their obsessive attempts to destroy the now-popular ACA to enable massive tax cuts for the rich shows they no longer even try and hide the obvious. So that makes them traitors to the vast majority of their constituents and to the Constitution, right? By any objective measure, Republicans are willfully breaking their solemn oath to the Constitution all in the name of ensuring that a small cabal of aristocratically wealthy self-serving elites can control our country's levers of power- exactly what the Constitution was designed to prevent from happening. If Republicans could somehow get a glimpse of themselves through some magically objective, ideology-free binoculars, they would be horrified by their own piggish treachery.
E (USA)
The Koch brothers, Sheldon Adelson and their ilk can make a lot of money screwing the poor out of health care. And the GOP will do the bidding of their overlords. This will pass and poor people will suffer. Hopefully a majority of those who lose healthcare will be Trump voters.
Carol Mello (California)
Since the majority of US citizens are not GOP voters (too many do not vote at all or are blocked by unfair voting laws at state levels),
statistics and probability say the majority of those losing health care will be not GOP voters.

Hopefully, this will be a wake up call for those who are GOP voters who lose the health care coverage.

Hopefully, this will also be a wake up call for those who could but don't vote.
Jan Kohn (Brooklyn)
In case you missed the message, and it was loud and clear, call the Senators listed below and urge them not to vote party line, but to do the right thing and not push through a horrible healthcare bill that will lead to increased illness and even death for American citizens:

Call these senators at their D.C. Offices - Lamar Alexander ( (202) 224-4944) Shelley Moore Capito (202-224-6472) Bill Cassidy (202-224-5824) Susan Collins (202-224-2523) Dean Heller (202-224-6244) Lisa Murkowski (202-224-6665) and Rob Portman (202-224-3353)

And write to:
[email protected]

Demand they support all American citizens by supporting full, fair, and affordable healthcare, stressing no lock out or higher premiums for those with pre-existing conditions!!!'
Phyliss Dalmatian (Wichita, Kansas)
MEDICARE for ALL- 2018- A Healthy America. That's the winning issue. PEROID.
John LeBaron (MA)
Make your voice heard, fellow Americans. Follow Mr. Leonhardt's current suggestion and e-mail your concern to [email protected]. It matters. Even if your opinion fails to produce immediate results, your voice matters. Get into the habit of participation and then hold that thought by voting in 2018, 2020 and ever more thereafter.

Thanks so much!
JS (Minnetonka, MN)
Recognizing that Senator McConnell could arm twist the Senate to declare that the sun revolves around the earth, and knowing that a scarily large number of citizens would agree, it's profoundly important to educate everyone as to the seriousness of the Senate's current game of 3-card monty.
Banicki (Michigan)
it is all about reducing taxes for the rich. The solution is to reverse Citizens United and revert income taxes to 1968 levels. We have room. Look where we stand compared to other countries. ... https://goo.gl/photos/CLxW2uXgCQtGFgP96
Almighty Dollar (Michigan)
3 Senators are needed, but 49 are solid....it shows everyone once and for all the depraved nature of the Republican party. They offer no answers, just discredited supply side economics for the rich, favors to mega corporations, unending war that the poor and recruited (not volunteers) fight in and flag waving. They will even cast their lot with Donald Trump to get what their paymasters demand.
Joel Pond (Cape Elizabeth, Maine)
Taxes on the wealthy are too high. Obamacare was basically one big income transfer -- giving people Medicaid while taxing the rich. People like Paul Krugman tout that as one of its successes. How else are taxes supposed to be lowered for the "rich" when they constitute such a small slice of voters? But paying a third to half of your income in taxes is empirically unfair and something needs to be done about it.
Pat (Texas)
I wonder how many upper income folks are paying above 1/3 their income in taxes. I am fortunate to have earnings that put me in the top 5%, and without any fancy tax strategies, I pay between 20% and 25%.
Carol Mello (California)
Wealthy people do not pay the highest % taxes because they can afford the best tax lawyers and accountants.

My husband and I are not wealthy. Due to AMT and being a dual income family, we are in the highest tax bracket even though we are merely middle class. Even when we earned much less at our professional jobs, we have always been taxed at the highest rate. We are not going to benefit from this tax cut. We do not earn enough to benefit from it. So we will continue to pay over 30% in taxes.

This tax cut benefits those who are hurting the least by increasing the burden on those who earn less.
David (California)
"There is no precedent, outside of wartime, for passing a bill this important in such haste."

While this is but a nit, I believe that some of the new deal legislation was passed in equal haste.
John Brews ✅__[•¥•]__✅ (Reno, NV)
Ryan laid out the plan, though the execution was flawed, and the Senate will polish it up. The plan has only two parts: Part 1 is to delay implementation until after 2020; Part 2 is to pass a beautiful plan without Federal funding and pass the cost on to the States as simply an à la carte menu from which they can choose what they want to pay for.

The GOP Congress comes out all beneficent, giving the States a healthcare "plan" (that is, a plan for what they might think of doing and paying for themselves) and a big tax deduction for the corporate elite.

What's not to like for the GOP??
GEM (Dover, MA)
Beautifully done, step by step. The cynicism and hypocrisy of the Republican Congressional and Senate leadership is simply staggering, and catastrophic for America. Kind of like Trump, except that their ignorance has been carefully camouflaged for specious political rhetoric.
Carey (Brooklyn NY)
OK Democrats, Liberals, President Obama, and Hillary it’s past time for blaming conservatives, the alt-right and the Koch brothers for the mess the country finds itself in. It was us that did it! We ignored the needs and complaints of the middle class. We ignored the crumbling condition of our failing cities. It’s time to turn our attention away from divisive rhetoric and move to inclusive action.
Starting with the premise that the health of our middle class is a priority - any Federal action or legislation must include a middle-class impact statement akin to the environmental impact statement required for construction projects. Are our middle-class citizens deserving of less careful consideration than a new factory, or pipeline?
Will stricter immigration enforcement help or hinder our middle-class citizens? Will changes in the tax code benefit the middle class, or not? What is the impact of interest rates on the economic health of our middle class? How do our energy and environmental policies impact the middle class? Etc., etc. etc.… These are not political issues they directly affect the health and future of our Republic.
“We the people…” is the original people’s impact statement.
Our middle class is a special interest group that has been ignored, and we are paying the penalty.
AJ (CT)
Republicans control Congress and the White House. The president wants wins regardless of the pain inflicted. The only way to stop the upcoming reverse-Robin Hood tsunami is to figure out how to break the lock FOX news and the extreme right wing media have on the brains of trump supporters who will be hurt by these changes. (Really, you are willing to give up everything good government does for a stupid wall?) Good luck with that one.

I suppose we can pray that moderate Republicans will have some courage, but their leader, McConnell, continues to be the most disgusting of the lot.
hm1342 (NC)
"They did not hold a single hearing, because they knew that attention would have been devastating."

And Nancy Pelosi famously said about the ACA that we had to pass the bill in order to know what was in it.

"...members of the Senate have spent the last two weeks talking about taking health insurance from millions of Americans."

No matter what health bill passes, liberals will never be happy. They will always want more and more until they get single payer system that pays for everything. Mr. Leonhardt would do well to look at the history of Medicare. Specifically, the fact that when Medicare first started, there were absolutely no restrictions and taxpayers paid every last penny of every claim. Congress estimated the first year's cost at $1.3 billion. Actual cost was over $4 billion. Ever since then, Congress has been trying to figure out how to control ever-rising costs. Medicare now consumes over half a trillion dollars of the federal budget, and Social Security is just as bad.
Sea Star RN (San Francisco)
The failings of Obamacare were deliberate...written by an Insurance executive, it was meant to preserve and prosper the Health Industrial Complex and retain the employer health care 'benefit' that keeps us an indentured Labor force.
The HIC has prospered with its Market Cap doubling from $750 B to $1.5 Trillion since the ACA passed.
Most of American workers are still dependent on health care from their employers, but with increasingly higher deductibles and copays. And employers are still not paying taxes on these bloated 'benefits' and workers are literally writing a check in lost real wages.

If only Obama and the Dem super-majority in 2009 had come up with a single-payer plan like Medicare.
If only they had cared about Care instead of Business!
Beth (<br/>)
Ah, but when they went to Medicare Advantage to help control those costs, by enlisting the help of private insurers, look what happened. Fraud and corruption from those private insurance companies that then drove up costs even higher.
hm1342 (NC)
@ Sea Star RN: "The failings of Obamacare were deliberate...written by an Insurance executive, it was meant to preserve and prosper the Health Industrial..."

This is an excellent argument to get the government out of trying to manage health care as well as all the lobbying from the medical industry.

"Most of American workers are still dependent on health care from their employers..."

This was a perk from World War II...maybe it's time we got rid of that requirement, to include the federal government.
Bonnie (Sherwood, WI)
Thanks for sharing the email address! I immediately availed myself of it!!!
Gaucho54 (California)
Our country is on a very dangerous path. Until the Trump Base and rest of the public see themselves exluded from health care, see the social services they depend on dissappear, find it impossible to find work, to educate their kids, to pay for the necessities of life, to own a home, find their union protections gone......Until these people actually feel the effects of the Trump/GOP movement in their wallets and their day to day lives, not much will change. This much is clear.

However, when they do wake up...watch out! We'll see rioting and violence the likes of which we haven't seen since 1968 or even the Northern Civil War Draft riots. It won't be pretty!

Sorry I can't be more optimistic, but I've seen no reasons over the past years to believe otherwise.
PAN (NC)
Unfortunately the GOP have a an easy and ready to go scapegoat - they will blame others, the liberals, Hillary, and Obama for their misery - and the will believe. Like you, I am not optimistic.
Ray Zielinski (Champaign, IL)
"The effort to take health insurance from the middle class and poor and funnel the savings into tax cuts for the rich is a little like mold. It grows best in the dark."
Maybe the best summation I've ever read. Indeed, sunlight disinfects many things. And the details of TrumpCare need sunlight.
Andy W (Chicago, Il)
Like all GOP legislators, republican senators took a hippo-critic oath. Standard issue for the talk-radio driven, twenty first century party of greed and dishonesty. Pathetic is too kind a description.
Cumaea (VA)
Any tax cuts resulting from this will be blood money.
bjn1495 (St. Augustine, Fl)
My email to the Senate: Senators, on purely cynical grounds, I would implore you to kill Trumpcare, not let it pass, for it will forever remain the political albatross around your neck, to be remembered long after the Trump fever has been consumed by the swamp. You WILL pay the price. But if you are patriotic Americans, who profess to care for the people who elected you, those who pay your salaries, who through their taxes fund our government and who are under immense financial stress, you will listen to your consciences and kill this House bill. Let it die and leave Obamacare as the law of the land. Better still, improve it. Improve it so it works, and don’t try and cut out its legs with a plan to see it fail. Come on, this is America. And if any country can fix things and make healthcare better than in Canada, the UK, and every other industrialized nation in the world. Then it is the United States of America. Prove to us that you know, this, believe it, and will act on it.

Thank you.
PAN (NC)
Giving a tax cut to wealthy doctors while taking away health coverage to his patients. Hmm - maybe that doesn't work out too well.

Yes, it is wartime - war on the poor, the vulnerable, disabled and the sick. Add to that taking food way from the hungry! These people want to turn our country into South Sudan. I am surprised these political gangsters do not simply use their second amendment rights to just shoot these innocent people.

The Republicans should stop feeding the wealthiest cancerous growth at the top before it kills the entire nation.
Cecelia Sumlin (Reno, Nevada)
Everything they do is malicious. I don't understand it.
Alan (Eisman)
Rather than simply pointing out all the problems with the R health plan the D's should expose the utter hypocrisy of providing tax reductions to business funded by cuts to healthcare by offering a budget neutral alternative to fund the tax cuts by eliminating the tax deductibility of providing healthcare to their employees

The biggest threat to business competitiveness is the cost of providing healthcare to employees a burden not faced by other nations with single payer healthcare. This would expose the R's utter hypocrisy and false narrative, that of the party of fiscal responsibility. The D's could even use Trumps own words praising other country's health systems such as Australia that are single payer.

This would create an uproar in the business community and further launch the debate about why business should even be in the business of providing healthcare at all. With the prospect of business dropping healthcare as a benefit the larger population (not just the 24M the R's will effect) will realize that the only logical conclusion is to offer Medicare for all which would eliminate the stigma associated with Medicaid (and the R's political canard), eliminate the portability issue that stifles career moves, and make business more globally competitive.
MVH1 (Decatur, Alabama)
I pray everyone makes that pause as many of us have to send our emails imploring the Senate not to bring to fruition a bill so wretched that it can't be exposed to the light of day. A Congressman from Kentucky was featured in an article over the weekend because of his town halls his fellow representatives told him not to have so they avoid the wrath of the voters in their districts who didn't vote for them so they are only considered a problem to be avoided. The best attended town hall he came to a man with two ports in his body to give him the medication he needs to survive was there, raised his shirt to beg his representative not to take life away from him and the Congressman could only say, "I hope there's healthcare for my children and they don't have to go through this." Wow. Congress is now, as Ryan and McCarthy were outed saying, a "family that needs to keep secrets inside the family." I'm at a loss as to how to deal with the government of and for the people is now their private family secret keeping pack of lawmakers that have the power to lead or destroy. It appears they are leaning toward destruction. I fear for my country in every way as the days unfold horror after horror, from healthcare to foreign relations to refusals to reveal ethics challenges in the appointments the president is making. The message is becoming clearer by the day, we are losing our democracy and a powerful small collection of us-and-them people are taking everything for themselves.
E W (Phoenix)
Arizonans, don't forget Senator Jeff Flake! He is running again in 2018 and he may not be able to hold on. A vote leaving millions uninsured could tip the scale. Also, the new budget recommendations from Trump includes millions more losing funds for care.
Jackie (Big Horn Wyoming)
In Wyoming, there are no senators nor representative that will hold a town hall or meet with people to discuss the health care bill or any other issue for that matter. Rep. Liz Cheney has been called by many of us to come and explain the house bill and has declined. The only Planned Parenthood office in Wyoming is closing its doors, and the financial reduction in Title X funding for reproductive healthcare in the Bighorns is being reduce by 40%. Wyoming chose not to expand medicaid so there are thousands of people that will be without primary care. And, with these these draconian changes to health care, what happens to rural hospitals? The silence displayed by the elected officials is frightening. I recently searched 'Maplight' for a look at the dark money spent on these so called senators and reps. - and now I understand what is happening and why.
Sally (Portland, Oregon)
Increased Prosperity comes with healthy and secure citizens. Access for all to affordable healthcare, an efficient social safety net, quality education and a safe environment should be the primary goals of government. Tax cuts for the rich and more million dollar bombs will do nothing. Improving government is hard work, takes enormous time and effort, requires careful thought and debate, input from experts and ordinary people, and cannot be done by one political party in private. Dismantling government is easy, takes months. #Resist
AR (Atl)
I have not read whether under the new bill, members of Congress get to go back on the insurance for federal employees or stay with the revised plan. I suspect the latter. It has been written more than once that their chief gripe about Obamacare was that they were covered by it, not the more munificent federal employee plan. Just wondering.
MidtownATL (Atlanta)
I sent my email to [email protected]

The U.S. healthcare system is a market failure. These problems pre-date Obamacare. The problem is out-of-control healthcare costs. Our system is a cartel - like OPEC.

The only affordable health insurance today is through large employer-based pools. The American economy is changing; people no longer work for the same company their entire life. Many people are contractors, self-employed, or work in the gig economy.

Today, people with affordable insurance through their job are slaves to their employer. We need the freedom to change jobs, or to start a small business, without the fear of losing health coverage. This freedom will unleash the economy.

The U.S. healthcare system is not, and has never been, a competitive marketplace. We do not have a choice of provider - especially for urgent or emergency care. There is no transparency in the upfront pricing of medical services. And we cannot simply walk away from the transaction. No one wants to see a doctor or go to the hospital; rather, we are reluctant consumers and a captive market when we need healthcare.

The role of Congress is address the out-of-control cost of healthcare. We pay twice as much per capita as people in other modern economies. The AHCA does nothing to address this market failure or the pricing-fixing healthcare cartel.
XaurreauX (New York, NY)
I make it a point to never impute cleverness to the American voter.
swartc (PA)
I am a nurse. For 42 years I have witnessed first hand, the plight of those without health insurance or with inadequate policies. It is heartbreaking.

In the last year, I have taken every opportunity to share my experiences and enlighten others to what I have seen - the knowledge deficit is profound. I am educating others as best I can.

I am guided by the oath of VERACITY:

VERACITY is the principle of truth telling, and it is grounded in respect for persons and the concept of autonomy. In order for a person to make fully rational choices, he or she must have the information relevant to make his or her decision. Moreover, this information must be as clear and understandable as possible.

Truth telling is violated in at least two ways:

1. The first is by the act of lying, or the deliberate exchange of erroneous information.
However, the principle of veracity is also violated by omission, the deliberate withholding of all or portions of the truth.

2. Finally, the principle of veracity can also be violated by the deliberate cloaking of information in jargon or language that fails to convey information in a way that can be understood by the recipient or that intentionally misleads the recipient.

(http://rhchp.regis.edu/HCE/EthicsAtAGlance/Veracity/Veracity.pdf)
Paul Wortman (East Setauket, NY)
Master Machiavellian, Mitch McConnell, should not be underestimated in pretending that a nearly $1 trillion cut in Medicaid to be used of tax cuts to the wealthy and healthy is a major reform that allows states to tailor health care insurance to the needs of their citizens. I'm skeptical that there are three courageous Republican Senators who will not succumb to special deals similar to the ones made to get Obamacare passed. It's time for states like California and New York, which account for over 20 percent of the population, to step forward an state in unison what they insist on as genuine health care insurance reform, including no pre-existing conditions, two preventive care wellness visits per year, catastrophic care, and a single-payer option for starters. We can't let McConnell work in darkness. We must have a countervailing force and the Senate Democrats have not presented one. So, let Govervors Jerry Brown and Andrew Cuomo do it.
tbriggs47 (Longmont, CO)
Hah! Just sent the requested email. Basically I urged them to adopt the House plan because that will motivate hundreds of thousands of activists to oust them in 2018. Thanks for the tip.
John Q (N.Y., N.Y.)
The attempt by GOP leaders to take basic medical insurance away from low income citizens is disgraceful. How any voter could support their blatant attempt to hand yet more riches to the super-rich is beyond belief.
RK (Long Island, NY)
It is foolish to think that outreach and advocacy will change the minds of Republicans.

Despite all the town hall meetings where their constituents were vociferous in their opposition to the TrumpRyanCare bill, the Republicans persisted and passed it in the House in their second attempt.

There is no reason to believe that the Senate Republicans will be any different.

McConnell, he of the never-give-Obama-a-legislative-victory school, will do what is best for his party's contributors, which is essentially tax cuts for the rich at the expense of the poor, big defense spending coupled with spending cuts to social safety net programs and other regressive policies.

Marches and protests won't change the Republicans. Extreme vetting of candidates at the ballot box is required. Voting them out of office will perhaps make them think about the errors of their ways, although even that is expecting too much.
Cristino Xirau (West Palm Beach, Fl.)
I do not understand this country.

CEO's of big corporations, movie, TV and rock stars, professional athletes, and others make enormous sums of money - more money than can be spent in a number of lifetimes and yet some Republicans and ultra-conservative far right politicians justify takiing away educational, health care and other "entitlements" from both the middle classes and the poor in order to give the favored few at the top even more tax benefits. It seems to be a sort of reverse-Robin Hood situation in which the poor are robbed in order to give to the rich.

I can understand the glories of greed and how the rich are tempted to become ever more and more richer but I don't understand the wretched fanatics at the bottom of the pile who rah-rah Trump and continue to vote for a political party that, like cigarettes, is dangerous to their health.

If the US is a democracy I"m not so sure democracy is worth the price. I certainly wouldn't advise other nations to follow the US example.
B (Minneapolis)
The Republican repeal of Obamacare is only about delivering huge tax cuts to the wealthy. Republicans in the House and Senate don't care much about what they "replace it with, just that they get it through Congress.

So it's a waste of time to predict how Republicans will change coverage provisions of the Senate bill. The House bill cut $575 billion in taxes on the rich and corporations plus made room for an additional $1.5 trillion in tax cuts by eliminating Medicaid expenses and subsidies. What matters to Republicans is how much of the $2 trillion the bill will maintain in order to make room for more tax cuts for the rich as part of "tax reform".

Democrats will be more effective in protecting Obamacare if they insist that Republicans pay for their bill. Republicans are leaving the basic budget authorization from the Treasury that funds much of Obamacare in place but reallocating it to cover their replacement provisions. Their repeal of taxes on the rich and other tax expenditures cost $711.1 billion. Plus, their tax credits, high risk pool funding, etc. cost $693 billion.

When Senate Republicans put a bill on the floor, Senate Democrats should propose an amendment which states that if any Obamacare funding is repealed, all funding must be repealed and replaced with a new budget authorization of $1.404.1 billion ($711.1 + $693) to pay for their bill

They would vote it down, and Americans would see all they care about is making room for tax cuts for the rich
JMM (Ballston Lake, NY)
"The right standard is whether the bill improves the health care system. A bill that takes away health insurance from 15 million, 10 million or one million Americans — rather than the 20 million or so of the House bill — still deserves defeat."

Oh David - how quaint. What exactly makes you think the GOP Congress and Trump care? That said - I don't really care anymore. Obama and the Democrats passed the ACA and lost in two midterm elections as a result. And the man who vowed to repeal the ACA won in 2016. As far as I'm concerned, have at it.

And please - spare me any more articles or references to the Trump voters in PA, MI, WV who will be hurt by these policies. They own this. The GOP owns this. Trump owns this.
karen (bay area)
I totally agree with you JMM. The entire democratic party and the MSM needs to stop sucking up to the deplorables who have brought us GOP strongholds, and even worse, trump. Let these people suffer. I have health insurance-- go get yours, trump voters.
Marc Wagner (Bloomington, IN)
This is happening all over the country. North Carolina is trying to negate the vote of vast numbers of citizens of color. Indiana is reducing the number of "early voting" sites to make it harder for working-class people to get to the polls. Texas is attempting to deny the right of transgender people to protect their privacy. Texas has made it harder for poor women to gain access to their legal right to choose to terminate a pregnancy. Republican legislatures all over America are using gerrymandering to negate the voting rights of those who do not share their views. It just gets worse and worse! Meanwhile, back in Washington, DC, a Republican-controlled Congress is going to attempt to take health insurance away from 20 million Americans - and then cut Medicaid for the poorest of the poor. How heartless can these people be - in the name of party loyalty. No wonder so few Americans have any faith in the institutions once created to protect them.
like2017 (Springfield, VA)
Thank you for posting the email address. I sent an email, the gist being that I am a low-income, fully employed individual who had emergency surgery that removed a head tumor last year (among other things, that tumor shut my left eye down temporarily). Now I require lifelong, ongoing medical treatment. Under ACA, I was able to have surgery and not go bankrupt as well as pay for medication and see doctors. My future looks bleak under the new "plan." My future and millions of others.
Janyce C. Katz (Columbus, Ohio)
The harm to people from the proposed health care, if enacted as described, would be massive. As one who has survived two lymphomas due to the ability to access excellent doctors through insurance and who has watched others without good insurance, but with the exact same disease not make it, my heart cries for those unable to afford good health care, let alone excellent health care. I remember during my first treatment a friend nurse practitioner with tears in her eyes telling me that they had to stop treating someone because this individual's insurance wouldn't cover the care. Without being specific about the patient, the nurse said the individual, like me, had a very high percentage chance of being cured with care and zero without, and by having to take time to fight the insurance ruling, she would lose the time and the edge needed to live. This "freedom" from having to obtain health care insurance, the "freedom" to chose what care one has like a consumer decides in which grocery store or farmer's stand to buy tomatoes, sentences some people to bankruptcy and/or death. One example to distinguish health from buying food, most people wouldn't know a small squishy growth on the side of the neck could be a lymphoma that could kill in a year, or, if money was a problem, might avoid finding out what this was until too late to do anything or to costly to try, which has the same result. Why do we need a law giving us the freedom to die or lose all trying to live?
Wind Surfer (Florida)
Today I have found two healthcare related articles. One is about 20 million Americans now enjoy healthcare coverage because of Obamacare, and the other is about the latest global healthcare scorecard by Healthcare Access and Quality Index. The latter tells us that, in spite of the progress done by the Obamacare, our country ranks 35th in the world and the bottom among the G-7 countries. Imagine the deterioration after the change of our healthcare system after the change by the Republicans. I don't understand the Republicans. Are they proud of this rank?
EMS (Boynton Beach, FL)
No, they are not proud of it. They just DO NOT CARE. It is ALL about pay offs they get from the health care industry corporations for keeping prices high. If we had single payer, all these health care corporations, and doctors, as well, would not be able to make as huge sums of money as they do now; they would still do VERY WELL...but they would not be able to financially rape patients anymore. And they do not want to see that day come, and neither do their republican buddies...because the republican buddies get paid off by these health industry corporations for hurting the people. It is that simple. It is called profits, pay offs, kick backs, bribes, you-scratch-my-back-and-I'll-scratch-yours, corruption, graft, and cruelty before human life. It is the republican way!!!!! AND NOTHING ELSE MATTERS MORE THAN POWER AND MONEY. NOTHING! GOP PRIDE, GO!
gratis (Colorado)
The Conservative argument is that Americans have Freedom.
Freedom to not have healthcare.
Freedom to choose between medicine and food.
No other industrialized countries will give people this freedom. Mommy governments take Freedom away from people. People are just slaves to the liberal elite.
hen3ry (New York)
The GOP is very clever in hiding its efforts to deprive Americans of access to health care, access that, in other countries is viewed as a basic right. Another article in today's paper shows just how far behind we are other first world countries when it comes to medical care for our citizens. This administration and Congress is more interested in leaving people without any benefits even as they lie and tell us that their replacement for the ACA will be a beautiful plan. It's not. It's a return to the "good ol' days" when not having insurance through one's job meant not being able to afford health care or health insurance.

The GOP must despise Americans who aren't rich. They favor a wealth care system that functions solely for profit, without regard to what the patients need, provides fragmented care, and forces patients to hire someone to navigate the payment maze or go into debt or fight by themselves just as they need to recover. In this case freedom is another word for the phrase drop dead because that's what the GOP wants us to do. If we can't afford to pay for treatment, the condition is serious enough, and it worsens we will die. In their eyes dead working class citizens are better than healthy productive citizens raising families, working, and questioning them.

Free dump is what they are doing. Worst of all, other Americans seem to agree with this philosophy, especially those who would benefit from a real HEALTH care system.
Rev. John Karrer (Sharonville, Ohio.)
Is it possible to sue a political party for not fulfilling their pledge to follow the Constitution of the U.S. and for doing everything possible to hurt their fellow citizens? The Repubs are clearly out to kill the middle class and are not afraid of
doing so in open view for all to see. They smugly push their agenda to enrich the wealthy and take away what little the rest of us need to survive. I'd like to take all of their US flag lapel pins , make one big pile and burn it on their side of the aisle in congress. For my money they are traitors and should be treated as such. Where do these cretins come from and why do voters continue to inflict their ilk on the rest of us? McConnell, Ryan, etc... UGH!
skeptonomist (Tennessee)
Each Senator will vote according to the reaction he/she expects in the home district. There seems to be little interest in the media in pinning this down. Overall the leaders may decide it is the party's best interests to delay to avoid the blame for cutting off healthcare - they can still put the matter back in the hands of the House.

But do not expect a failure to realize actual savings from cutting healthcare to prevent Republicans from passing major tax cuts. They have the power to change any rules necessary and it should be obvious by now that they can include completely fictitious revenue projections in budgets.
Pat (Somewhere)
Incredible that health care is still a political football in this country. It's a cliche, but without good health nothing else matters. Better outcomes for more people for less money in various universal coverage systems around the world has been observed for years and yet our system stays in place thanks to the entrenched interests that keep it that way.
emm305 (SC)
" The senators work for those citizens, not for Mitch McConnell, Paul Ryan and Donald Trump. "

No, ALL 'Republican' senators work for the dog eat dog radical business libertarians such as the Kochs, Mercers, Ricketts, Thiel and the like...who want a constitutional convention to rip our constitution to threads as they tell us they alone are the constitutionalists and patriots.

They don't even work for the health care local businesses and advocacy groups that oppose this bill. They work for the libertarians and are driven by their pathological adherence to that ideology.

Journalists in Blue states have almost entirely missed this metamorphosis of the 'Republican' Party from the Party of Lincoln into the Party of Ayn Rand Billionaire Libertarians.
JC (oregon)
I found this healthcare fight quite pointless. Of course politicians need to please their base. Why should they care about people on the opposite side or people who never vote?! The base of GOP was highly motivated in the last election. On the contrary, many Democrats stayed home. What do you expect?! Hopefully, enough people will be affected and realized that their voice are important in the democratic process. They should always engage in the process in order to advance their own interests. If they are too lazy to do that, then so be it.
David (California)
"Why should they care about people on the opposite side or people who never vote?"

How pathetic. They work for all of us.
David Gregory (Deep Red South)
As tragic as the loss of insurance will be, the impact could extend far beyond to those with private insurance.

When the PPACA (Obamacare) was passed things far beyond the extension of health insurance to the working poor was involved as it changed much of how Hospitals, Clinics and Practitioners get paid and operate. Providers from the smallest Clinics to the largest Hospitals made long term investments and staff changes based upon the financial imperatives dictated by the PPACA. Changing the rules could seriously undermine the finances and viability of many places all of us- not just those using the exchanges or Medicaid- go to get healthcare.

Many Clinics and Hospitals expanded facilities and staffs to accommodate the new patients and add new services. To do this, they borrowed money like any expanding business and based their business plan on the PPACA and the provisions in the Bill. Pulling the rug out from under them- especially in short notice- could not only cause the loss of services as the businesses contract, but could cause some to close entirely. Many communities could lose the only Clinic or Hospital they have because of Republicans.

So we could see tens of millions lose coverage, a severe financial crisis for many small Hospitals, Clinics and Providers, a loss of jobs at those facilities and a huge loss of services to patients of all kinds. All for a thinly disguised tax cut for Billionaires brought to you by The Republican Party.
James Lee (Arlington, Texas)
The Republican strategy, as described by Mr. Leonhardt, represents one of the oldest ploys in the playbook of dishonest politicians. Deceive your constituents by modifying a deeply unpopular bill in such a way that it makes you appear reasonable by comparison. While a skeptic might dismiss the 'reforms' as nothing more than cosmetic in nature, you can market them to the voters as fundamental, proof that you place their interests above all other considerations.

A politician like Mitch McConnell, who opposed the expansion of Medicaid in his own state of Kentucky, would never support amendments to the House bill that would truly protect vulnerable Americans. All the verbiage about re-writing the House measure never amounted to anything more than smoke and mirrors. Whether the GOP succeeds in gutting the ACA will depend on the empathy and political calculation of a handful of Republican senators.

It the bill does become law, no plausible outcome of the 2018 election will resurrect Obamacare. Trump would veto any Democratic measure that crossed his desk, forcing the country to wait until after the 2020 election for any hope of effective reform. In the meantime, many thousands of people would die needlessly, part of the authentic legacy of the Trump presidency.
Maggie Mae (Massachusetts)
Thank you for outlining this legislative sight of hand so clearly. Because it often takes time for results to play out in society, legislators who create and promote damaging laws can skate away from responsibility. The Constitution charges government "to promote the general Welfare." But there is nothing about the Republicans' proposals on healthcare that meet that obligation. I hope we have finally reached a point where voters recognize how they fail us and hold them accountable.
Chris Bayne (Lawton, OK)
Have never been more ashamed of my country. We finally begin to catch up to the rest of the civilized world by insuring more of our citizens have health care, only to have it ripped away, or made utterly useless for our citizens, just so some folks can get a tax break. Add to that, Trump's budget blueprint. Domestic cuts for the needy, tax breaks for the greedy, more weapons for death and less protection for the environment. How can anyone continue to say they're proud to be an American.
Deborah (NJ)
Mr. Leonhardt, the middle class already lost their healthcare. It was the failure of Obamacare that took from the middle class to give to the expanded Medicaid defined poor. My high deductible plan with increased premiums has reduced my access. There are Medicaid recipients for whom my tax dollars pay who see doctors more than myself. THAT IS NOT FAIR. Stop ignoring this reality. It is one of the reasons that got Trump elected!!!
DebinOregon (Oregon)
You conflate the entire middle class with your personal experience.

" the middle class already lost their healthcare.". But this is demonstrably false. Millions in the middle class received healthcare benefits they did not qualify for under their employer. You have nothing to back up your grand assertions except to say that YOUR plan costs more, and YOUR tax dollars, and OTHER people now get something! Waaaaaa!
maisany (NYC)
So in your view, it's much "fairer" when millions of poor people or people with pre-existing conditions could not get *any access at all*, as long as your access was unaffected?

And if you think Trumpcare is going to reduce your healthcare costs, you have another thing coming.
Donna (Glenwood Springs CO)
I agree. This was one of the biggest areas that needed to be fixed. I am right there with you! My premium is 4 times higher than before the ACA. The Republicans are refusing to fix...they only want to destroy and unless you are wealthy everyone will be hurt in some way.
Bethed (Oviedo, FL)
I wouldn't trust McConnell to even attempt to take the right actions to preserve health care for Americans. His only goal, and the goal of most Republicans, is to give tax cuts to their wealthy supporters and build more war machinery. Trump's plan is working by squeezing more insurance companies out of the health care consortium's by putting into affect plans that shrink their bottom line. Soon there will be no insurance companies in the existing ACA. You know to health insurance companies if people's health interferes with their bottom line the people get kicked to the side. You can have jobs and health care for Americans too. It takes the will of a number of right minded people in Congress to stand up for us, the people they are supposed to be representing.
Phyllis Mazik (Stamford, CT)
The Senate should propose steps to modernize and economize healthcare is various productive ways before trying to dismantle the Affordable Care Act. These improvements could be applied to any future changes in healthcare legislation. A five percent savings in costs, a ten percent improvement in efficiency or elimination of hospital transmitted infections would be real and permanent. Enlist experts and get started. This is not politics, just common sense. Waste and flaws in healthcare cannot be sustained under any plan. Get to work.
THB (NYC)
We're tried Obamacare but premiums kept rising. From all reports, Trumpcare will throw millions off their insurance.

How about trying what works in nearly every other developed country in the world--single payer, Medicare for all?
ExPatMX (Ajijic, Jalisco Mexico)
I implore all of you who care about the well being of others to take the two minutes it would require and email your response to the Senate. Click on the link provided in the article and just say NO!. Tell the Senate that they will pay the price of your vote when they come up for reelection if they vote for this bill. This bill has the potential to kill or bankrupt many people. Please stand up and be counted.
Mary Ann Fenderson (Seal Beach CA)
Email sent. All fingers crossed that the Senate will save us from the House. Again.
Bob L (New Hampshire)
Elite schmelite. Trump ran against minorities. He is the ultimate elite. Flaunting his wealth and pursuing policies to obscenely increase it at the expense of the uneducated masses.

It's not that hard to understand or explain what's happening. Mike Judge does it pretty well in Ideocracy. You cannot make sense where there is none.
nzierler (new hartford ny)
This is an acid test for Republican senators who know the devastating consequences of this bill. Let's see who has the courage to represent the people of this country and not their warped party.
Paul Raffeld (Austin Texas)
Why do we still not have a CBO report for the latest House attempt?
Robert Karasiewicz (Parsippany NJ)
I sent an e-mail. I hope everyone reading this article does the same.
It is time for the Republicans in the Senate to be AMERICANS first!
Thanga (NJ, USA)
Both of NJ senators are Democrats. Is there a general public organization which protests the bills in the congress and senate? I would like to donate small amount. I am too old to go and protest.
jprfrog (New York NY)
There are some very sick people who will actually benefit (or so they think) from this abomination. They are those already so wealthy that in a thousand years they could not spend it all, yet must always have more. They are those who will scheme, bribe, and cheat to add a few million to their hundreds of millions (or more) because they have a wasting disease.

It is not simply greed; money --- which is really nothing more than ones and zeroes in a computer memory --- is just the way to keep score. At work rather is a very human characteristic run amok: status anxiety. That is also why very sick and insecure people like Donald J Trump must display their wealth: it is a way of parading the sizes of their "equipment" to each other, and why they show off their trophy wives if they are male.

For the rest of us, it is a cancer, which happens in a body when individual cells no longer work together for the benefit of the whole, but war with each other. The result is that body itself dies, usually in great pain.

And the cancer cells die too. How shall we cure ourselves of this malignant disease?
PCS (Williamsburg VA)
Anyone that is against the attempt to reduce/eliminate health insurance for our fellow citizens must contact their senators. Let them know your thoughts.
Mike (New York, NY)
i have a solution for the our brainless "representatives" in DC which would cut millions of dollars of waste. Eliminate life time benefits for the thousands of former elected representatives, cover only the representative while they are in office, eliminate most of their staff and cut the representatives' salaries to reflect the average wage in the area they represent.
I applaud the thought of running the government as a business. So do just that. Instead of throwing money at the Defense Department have them justify their need for the funds.
I laugh at the buffoon in charge. He was born rich and how he managed to stay rich in spite of himself is mystery.
lynne (Ohio)
Sent email, too. Told them that I'm active and I vote.
Ed (Washington, DC)
Thanks David,

You note: "A bill that takes away health insurance from 15 million, 10 million or one million Americans — rather than the 20 million or so of the House bill — still deserves defeat."

Agreed - but the Republican position has not changed on this point. The Republican Party does not support any plan that covers the uninsured. Period. Anyone that says otherwise is burying their head in the sand.

President Trump has done everything possible to gut support for the ACA passed under President Obama. Over the past four months, Trump has pulled the rug out from under the ACA.

Until the Republican party, led by President Trump, Speaker Ryan and Majority Leader McConnell, decides that it is more important to provide health care insurance to the uninsured rather than supporting wealthy people and corporations, their health care insurance plans are dead in the water. Just ask the 29 million uninsured U.S. voters and millions more voters who finally were able to get health care insurance under the ACA.

During 2018 midterm elections, you can bet uninsured voters will ask themselves whether elected Republicans served their interests better than the Democratic Party.

If elected Republican officials can not see the light on this topic and change their priorities to make sure that the primary goal is to provide insurance to the uninsured, they should take a long look at their offices - since they'll be booted out of office and/or out of the majority next election cycle.
Jack (Asheville, NC)
Slashing billions of dollars from the Federal healthcare budget will no doubt create a healthcare recession as hospitals, doctors, nurses, device manufacturers, pharmaceutical companies, and other healthcare industry feeders are forced to cut back. These cutbacks will ripple out into local economies across the country and make everyone's economic life harder. Killing Obamacare has become such an ideological holy grail for the modern conservative movement that I doubt Republican leadership can stop themselves, even if a few of them can see the edge of the cliff they are about to run off. Republicans are relying on the hope that a majority of Americans hate Obamacare's inclusion of the "undeserving poor" and despised minorities more than they will hate the ensuing pain to their own families and friends. Who knows, maybe they're right.
TheraP (Midwest)
On the morning after a terrible act of terrorism against innocent people coming from a concert out there to pick up family, I hope the senators keep in mind that a healthcare system is not there on the basis of how much THEY think a person deserves or worked for, but it's there for society as a whole, every single individual.

60 ambulances answered the call last night in Britain. 6 hospitals are caring for the wounded. Each person taken to a hospital will receive compassionate care. But never a bill!

Whether due to accidents or natural disaster or illness or disability or childhood or old age or pregnancy, people deserve healthcare of equal compassion and delivery. Full stop!

It is heartless and cruel to deny healthcare to a single person, let alone millions. It is sick to give tax breaks to the wealthy for the purpose of depriving anyone of healthcare or food or good education, a place to live.

I am ashamed of my country! I grieve for suffering people.

Senators, stand up for the suffering! Stand up to the lobbyists and the greed and wealth that breeds callousness.
Anna (NY)
TheraP, thank you so much for your comment. I copied and pasted it and sent it to [email protected], of course with proper attribution.
P4 (Palm Harbor, Florida)
Well stated, TheraP.
We are at least as vulnerable to accidents, disease, and domestic enemies as we are to the ill intents of our foreign enemies. We have physical protection for all, why not health protection for all? If those that govern won't protect our health then it's time to change those that make the laws.
Beth (<br/>)
So true! And will terrorist attack become a pre-existing condition under Trumpcare? Yes.
MaryEllen (New York)
Trump supporters need to wake up. Millions of you will not have health insurance if this bill becomes law. Yes, maybe your taxpayer dollars will not be used to help others have health insurance. That might feel good for a nanosecond. But in the next nanosecond, the truth will hit you. YOU won't have insurance either. Or if you can get it, through high risk pools that have never, ever worked, the cost will bankrupt you.

Illness comes down the pike for all of us, at some point.

Why would you prefer making the rich richer with your taxpayer dollars rather than helping yourself and those you love?
richard (Guil)
At least we know that if there's a tie in the Senate Pence will be able to cast his vote. And we know he proposed that Indiana make all women with miscarriages have to have a funeral for the fetus. A man such as this with such concern for grieving mothers would certainly vote for universal health care for the rest of us.
EMS (Boynton Beach, FL)
Pence is a moron. We have such problems in this country, and in this world, and that moron is trying to make all women who have had miscarriages and abortions have FUNERALS for the fetus?! And just how is going to enforce this lunacy? Have armed guards escort each woman from wherever she miscarried or aborted to various funeral homes, in various states, to make arrangements? And what would that armed guards scenario cost in taxpayer dollars? OR DO THEY HAVE TO SEND THE FUNERAL BILLS TO THE FEDERAL GOVERNMENT, AND IF THEY DO NOT, THEY ARE FINED OR ARRESTED? And are hospitals and abortion clinics going to have to report women who have miscarried or aborted to the federal government? OR ELSE WHAT? Not to mention, many women have abortions because they just cannot afford another child. Do you know how much a funeral costs? I would say if Pence wants this, he is welcome to pay for all the fetal funerals, and if he does not want abortion, he is welcome to care for all the unwanted children born into this country. If the women cannot afford a funeral (and pence does not want to pay for it), he can take all the fetuses, and have the funerals in his backyard. I am sure it is lovely. You know what he would do? HE WOULD HIDE; HE WOULD RUN THE OTHER WAY! -- That authoritarian, misogynistic, hypocritical, sadistic, feather-brained MORON, WHO HAS NOTHING MORE IMPORTANT ON HIS MIND.
JFarwell (CA)
Lol? Unreal.
manfred marcus (Bolivia)
Thank you for explaining, in as simple a term as possible, the utter cruelty of the republican healthcare bill under consideration. It was passed in the House hurriedly, hoping nobody would notice it's hate-filled fraud towards their fellow men, removing 'forcefully' the chance of the poor, the sick, and the elderly, for a chance to be taken care of, in this rich but highly unequal capitalistic society (where the republican congressmen/women take their own healthcare insurance for granted, a glaring hypocrisy!). This bill was passed "entre gallos y medianoche" (between roosters and midnight) so hypocrites Ryan and McConnell, and Trump, could hide the hand that threw the fateful fatal stone. Is there no decency left in this town, no compassion either? This government is deplorable, and does not represent the needs nor wishes of the majority. What a swamp of ignominy, cruelty personified.
Sec (Ct)
What kind of country are we that can ping pong like this on healthcare?? Something is wrong. Obamacare may not have been perfect but it is an attempt to solve a serious problem of delivering healthcare to our citizens. The Republican version takes us back to when if you didn't get employer insurance you pretty much couldn't buy insurance that covered much. Our country has changed. There is a huge 'gig 'economy now and we are global citizens as well as citizens of this country. You can't put the genie back in the bottle, guys. We like to think we are so exceptional as Americans - but when putting your child through college or taking care of a serious medical condition can bankrupt you, I ask - How exceptional is that?
klm (atlanta)
Tell me--what would happen to Congressional members healthcare? I suspect nothing, the hypocrites.
Dan Teel (Houston)
Ok I sent the mail to the Senate. Not sure what feedback they are wanting (and it sounds like not from somebody like me) but told them to make American Great by improving ACA so NO ONE lost insurance and to keep their process open.
Nick Adams (Laurel, Ms)
The crassness and cruelty of Republicans is astounding. They still hate Obama so much they would sentence people to suffer and die.Health care is not the only tax cut Republicans are trying to jam down the throats of Americans. Wait until they get around to "tax reform".
PETER EBENSTEIN MD (WHITE PLAINS NY)
One brief additional thought. Hospitals, still required to provide care to those thrown off Medicaid, will go bankrupt. Once your hospital has closed its doors, you will not be able to get care there, regardless of your ability to pay for it.
Terry (ct)
On the other hand, if everybody either loses their coverage or cancels because premiums are unaffordable, hospitals and other providers will scream so loudly that we may finally get universal care.
PETER EBENSTEIN MD (WHITE PLAINS NY)
They are already screaming. Look at the list of organizations in the fifth paragraph of the article. My own view is that we will eventually settle on universal coverage because nothing else makes sense. But once you destroy a hospital, it does not come back.
Melvin Baker (Maryland)
Time to make it universally known that any politician from any party that supports legislation that takes away existing healthcare will be voted out of office in their next election. Period!

Millions of people voted for DJT and the rest of the GOP establishment, they can just as quickly vote them out.

This really is not that complicated but it takes some thought and a small bit of homework on every citizens part.

The days of voting against your best interests should be gone since DJT. It is no longer cool to vote republican (to prove a point) and then complain about it!!

Vote for what you want, not against what you hate.
In deed (48)
Party loyalty and power is what republicans worship. They don't like the majority of Americans.

Many congressional republicans don't even like their own voters. Certainly don't hang with them. Hang separately.
ACJ (<br/>)
I was of the opinion to resist, resist, resist. But, now coming around to the view that maybe we should let the Republicans let it all hang out---really be Republicans--rich get richer, subject middle class to GOP death panels, set off trade wars with China, et.al., eliminate public schooling, and throw in another middle east war---and do all of this as soon as possible, so 2018 can be a grand demonstration of the GOP in action.
Paul Leighty (Seattle)
This was a great line and all to true.

"The effort to take health insurance from the middle class and poor and funnel the savings into tax cuts for the rich is a little like mold. It grows best in the dark."

The solution here is to expose all these shenanigans to the strong light of day. The off year elections is the cudgel to hang over the Grand Old Pirates heads. At some point soon the Senate Do Baders will have to show just what it is that all those tired old white boys have cooked up. And then we go after them. Bet it won't fit in a 'Reconciliation Bill' either making it possible to filibuster the whole stinking mess.

Just remember that the only way to stop this train is to keep resisting at all levels. Have you called your senator today?
Martin (Brinklow, MD)
America has the government is deserves. The masses that don't vote are just that, masses. They don't care what happens to them or their children, living with the consciousness of barn animals that get fattened up for slaughter.
A responsible government would make responsible decisions for the benefit of all, but now we have a tribal government, that only wants to serve their tribe, rich whites. The progressive forces are outnumbered and I fear there is no option but to watch this drama unfold. It will take a few years before higher death rates, financial ruin and a lower level of public health will wake up a few from their stupor but I wouldn't even count on that. I for one don't expect guillotines on the Mall in the near future.
Etienne (Los Angeles)
I am simply disgusted with Republican politics. Never has a party sunk to such a mendacious level as they have. To say they should hang their heads in shame is a waste of breath..they have none. American voters have a clear picture of what is in store for us over the next four years. If that doesn't energize the voting public then nothing will.
Ed (Oklahoma City)
There's a strong case for a health care bill that addresses mental health, specifically malignant narcissism disorder.
Leigh (Qc)
Seemingly lost in the discussion (such as it is) is what's likely to happen to patient's rights as detailed and enumerated in the ACA. What part will such currently guaranteed protections play in the new law as designed by Mr Turtle and his pasty faced male friends in the Senate? It was an American who wrote "you don't miss the water until your well runs dry". The time for action is now!
Barry b (Queens NYC)
This healthcare bill will be so detrimental to the health of our country that it will result in a huge Republican political defeat in 2018 and beyond. Senators who disagree with this bill but vote for its passage will in essence be falling on their swords, taking one for the Gipper. Hope their health coverage pays for the necessary Tetanus Shot. B
Martin Veintraub (East Windsor, NJ)
I get furious hearing the phony Republican argument that the social safety net is too expensive based on its upfront costs. A lot of that expenditure comes back in employment taxes, not to mention keeping the country healthy. Win/win for healthcare. Health services employ a lot of Americans. So far those jobs seem stable. (OK maybe robots are being designed right now to staff nursing homes, etc.) Krugman estimated once that for every dollar put into the safety network, five dollars in GNP were created. Give a poor person some money and it will be spent, put back into the economy. Taking away health care hurts the economy, Republicans. So why do it? Krugman calls it sado-economics, a desire to inflict great pain on us. Yeah, the people who have been enjoying the bulk of liberals' tax dollars for generations are angry at the middle class. For subsidizing them? Reason doesn't enter into it. Jobs don't matter. No wonder they are in hiding.
Sarah O'Leary (Dallas, Texas)
Yet again, the GOP has taken their eyes off the ball, setting their sights on what's best for them, not the American people.

As a healthcare advocate, I can tell you that the system is already wildly dysfunction, thanks to the non-efforts and "let them eat cake" stance of GOP congressmen.

50% - 80% of all medical bills contain errors, and it's been that way for decades. Where's the legislation to hold healthcare providers accountable for that? Where is the outrage?

Insurers REGULARLY deny claims that should be paid, and nothing happens to them when they're caught. Where are the patient protections?

Pharmaceutical companies price gouge patients, typically those with chronic conditions. Overseas, where prices are regulated, this doesn't happen. Arguably, we are bankrolling affordable medicines and medical devices for the rest of the world.

The conservative estimates are that American patients overpay nearly 70 billion dollars we don't owe every year because our government does not put laws in place to protect us from unscrupulous insurers and healthcare providers. Instead, the GOP is trying to game the legal system to give tax cuts to the rich and block millions of Americans from getting quality insurance and care.

The result? Patients suffer and patients die. The GOP should take the flag pins off of their lapels. They are not patriots.
utahOwl (Salt Lake City)
Thank you! Your points are so good that I included some of them in my email.
Steve G (Bellingham wa)
Yes, WE are bankrolling many of the medicines and devices the rest of the world benefits from. We as in the people, not the pharm companies. Most research in new drugs (not copycats to get a piece of the next big breakthrough drug)) is done with public funding through the National Institutes of Health. Big Pharm spends more money on marketing than they do on research. They take control of patents on drugs largely developed at public expense through relatively small endowments to the institutions doing the research, or other cost savings tactics,
cardoso (miami)
The abuse and cottage services with bill without appropriate services exists and should be criminalized.
et.al (great neck new york)
The Senate approach of silence and secrecy is frightening, and may be deadly for hundreds in the end. There is every reason to believe that these narrow minded, partisan, rich guy Senators are fine with taking away health care for millions. The middle class will get a shocking jolt in the end, but too late! It is on the President's desk! The media is duped again by the Trump/Ryan/McConnell approach to crowd control: manipulate the witless by distracting from real policy discussions with outrageous, meaningless statements. And the fox guts the hen house.
Lynda (Gulfport, FL)
One advantage the Republican senators have that is often overlooked is the "I can't believe they would do that" factor. Even opponents of the radical Republican agenda who know these men well find their motivation to take life-saving access to health care from millions so a few already wealthy will be richer.

After years and too many examples of the failure of "trickle down" economics in every sector of the economy, can the Republican leadership still believe that tax cuts for the rich and the rich corporations contribute to long-term economic growth? Do they all still believe the alternative facts their newsletters spin to the rest of us?

Just as many of us know or come from families who bought the Trump lies, many of us know the decent people who automatically vote Republican. It is one of the choices they made long ago in a confusing world of too many choices and has become such a part of their identity that they refuse to believe the Republican party, its leadership or a Republican president would purposely pursue an agenda that will harm so many people including them. These people are often apolitical and have not read the Republican party platform or looked beyond the "I am your good person" newsletter to voters

I remember well in the midst of 9/11 trying to comprehend the mindset of people who would kill by flying planes into buildings. I feel the same sense of shock as I listen to the Republican senators and their plan for US health care. I can't believe it.
c (ohio)
"The effort to take health insurance from the middle class and poor and funnel the savings into tax cuts for the rich is a little like mold. It grows best in the dark."

'mold' is the polite way of putting it. I'm thinking more like mushrooms.
JSK (Crozet)
The CBO score for the House Republican health care "plan" should come out tomorrow: http://thehill.com/policy/healthcare/334269-week-ahead-cbo-score-of-gop-... . It is improbable that event will reassure an already skittish public. The public's protests are likely to escalate.

Taking health care from millions of citizens would fit within the mold of the budget plan recently announced. There is a strong, central thread: take away from social programs for those less fortunate and give more tax breaks to those more affluent. Among the latter group are likely to be the families of our congressional representatives. This is part of the twisted vision of freedom pushed by the House "Freedom" Caucus--much of which may be endorsed by significant numbers of Republicans in the Senate. We can hope that we do not get the sort of disinformation campaign undertaken by the likes of Speaker Ryan--but do not hold your breath.

We have a generation, or more, of college graduates in so much debt that many will have trouble affording homes. Will it come to a choice between a home and basic health care? Will they even have the capacity for either one.

What a vision for the nation. As far as the call for more understandable protests, I see that Secretary of Commerce Wilbur Ross is laudatory of their absence during his recent trip to Saudi Arabia. What will he and others in Trump's cabinet praise next?
Theodore Seto (Los Angeles, CA)
I pledge to contribute to the opponent of any Senator from a state that went Democratic in 2016 or went for Trump by a small margin who votes in favor of a bill that reduces the number of Americans insured. I urge others to do the same. Sign up to go door to door. Pack town meetings. Republicans will stop engaging in this sort of nonsense only if they pay by losing elections. It's not enough to post outraged comments. Put your money and your time where your mouth is. The Kochs certainly are.
BETSY SYWETZ (<br/>)
In the shadows of the Medicaid provisions are large numbers of senior citizens who will be needing nursing home care very soon. How many of them have long-term care insurance? How many of them have the resources to keep them for more than a few months when the time comes if they are not lucky enough to drop dead when that heart attack or stroke hits?
Multiply that number of vulnerable people by their families who will have to either spend their resources or watch their loved ones suffer and die in abject poverty. That pain will extend into every community, whether Republican or Democrat.
Once-upon-a-time families cared for the elders in their homes. That does not seem to be a likely alternative when everyone in a family has to go out to work in order to survive. This is not just about that ne'er do well who lazes around in dependency on the government. And it's not about the meager number of people who get health insurance in the individual market.
jbk (boston)
Let them pass the bill. Given the consequences, no Republican will elected to office for the next fifty years. Sure, folks will be hurt in the short run, but Democrats will then institute Universal Health Care, Medicare for all.
Darby (WV)
“McConnell’s strategy is to keep the debate within his conference for as long as possible. There will be no public hearings as a bill is drafted, according to several Republican senators and aides, and he’s imploring senators not to leak.”
This pretty much sums up the Republicans...stall, stall, stall. I don't know how much more anxiety people are going to be able to tolerate surrounding this issue. And it is not just who is going to lose their healthcare--it includes who will lose their jobs when hospitals close, who will take care of the mentally ill and addicts, and elderly?

Where is the humanity in this bill? Where is the health in this bill?
jimbo (Guilderland, NY)
All the articles pointing out what us . happening, all the protests, all the CBO estimates will do little to change things. The Republicans recognize that despite how low their approval ratings go, they get re-elected. They could shoot someone on Main St. in their district and not lose a vote. What will send the loudest message is if people register and vote in numbers more indicative of a society that cares.
Jay Strickler (Kentucky)
Thank you for giving the UPTON GAMBIT strong presence here. I watched that unfold with dread. It seemed that no one cared or understood -- Upton got credit for compassion and still signed off on the bill. Disgusting and predictable. Where are you Democrats? Where is the Medicare for all legislation? Mentioning it once in a while on the campaign trail won't cut it. Get busy and do your job.
Oh, right. They're all doing their job. Staying in office and making money. No one in power cares about us. Not a single one.
Anne Villers (Jersey City)
If they succeed in destroying health care in this country, Medicare will be next. The GOP loathe the program. They appear to want to go back to pre-WWII when only rich people could afford doctors. The rest died young.
Rhea Goldman (Sylmar, CA)
The clock is ticking and time is at a premium. Trump Care, if passed, will be devastating to tens of millions of Americans. We cannot allow this bill to pass in the Senate.

It is mandatory now that those opposed to this horrible, painfully hurtful so called health care bill use the power-of-the-purse to stop its passage. I propose a boycott of every single media source that does not immediately put forward the salient facts of this bill and a list of those Senators whose intent it is to vote for it.

Print media must do so on its front page/pages, television and radio media through a series of intensive announcements. The American public must be made aware of the severe damage this bill if passed will do to lives. Those opposed to this bill must now inform all media it subscribes to of its intent to cancel its subscriptions. This includes your cable supplier.

This is not a game to be taken lightly. This bill must be stopped. JUST DO IT.
Richard (Arizona)
Don't count on any of the "small group of Senate Republicans" to stand up for the American people and vote against stripping them of health care.

Instead, direct your attention to the "DeVos maneuver." You will recall that occurred when McConnell allowed Senators Collins and Murkowski to vote against confirming Devos as Secretary of Education. In this regard, McConnell knew that their votes would give them cover for re-election purposes and that Crooked Pence would cast the tie-breaking vote anyway.

Sorry Mr. Leonhardt, you must learn that all Republicans march in lockstep to their ideology. And when it comes to repealing the hated Obamacare, nothing will stand in their way. This includes the demonstrable fact that their action in this regard will wind up costing constituents their lives.
Deirdre Diamint (New Jersey)
Democrats have been too quiet. Time to stand up and get all in on single payer. Be for something. Stand for something so that others can get strongly behind you - waiting for the republicans to fall apart is a terrible, failing strategy. You can't just be against the republicans you have to be loud and out front on what you are for.
Psst (overhere)
While I would encourage all to phone and write their reps, it's going to take a couple of million people on the National Mall (trumps dream come true) to drive home the point that the majority of American voters are not happy with their representation in Washington.
leeserannie (Woodstock)
Thanks for the email address! I just sent this:

Dear Republican Caucus:

The House should not have voted on their health care bill without finding out from the C.B.O. what the costs will be and how many Americans will lose insurance. They also should not have done this without taking the time for public hearings. Now I am very concerned that the Senate is moving forward with drafting a health care bill without involving public discussion, as well.

There should be public hearings so that voters will know what is going into the bill and can communicate with the senators who represent us. We want to hear public testimony from groups who will be directly affected by any changes to the Affordable Care Act, from the people covered by it to those who provide health care. This discussion should incorporate the analysis from the C.B.O.

If your motive is truly to provide affordable health care to all Americans, then you should have no problem with seeking input in an open and transparent manner.

Sincerely,
OldBoatMan (Rochester, MN)
Tweet! Tweet! Tweet! That's the sound of The Republican President providing cover for the clandestine work of his Republican Congress.

Go online, turn on your TV or turn on your car radio. Watch, listen and read about the tweets. That's the sound of them media ignoring the train wrecks in Congress. Tax reform, health care reform and election reform will all be enacted before the media realize that The Republican President and the Republican Congress are working together to enact the Republican Agenda.
SJM (Florida)
These guys seem to be coopting the Mafia's approach to leadership. McConnell and Ryan are the godfathers of this enormous crime against the people of the United States. Sadly, and angrily, I must admit to being a United Healthcare customer. Indications are that UH has been bilking BILLIONS OF DOLLARS from Medicare and who knows how much more from other veins of public funds. It makes me sick, but not stupid.
Peter Lewis (Avon, CT)
Readers should understand that the impressive group opposed to the Trump healthcare plan are all essentially lobbying groups. The American Medical Association, American Nurses Association, American Hospital Association, American Academy of Pediatrics, American Cancer Society, American Heart Association, American Diabetes Association, American Lung Association, March of Dimes and AARP were mentioned. Under this plan, their organizations and well paid constituents stand to make less money. That is the heart of their opposition. The patients really don't matter.
ER (Almond, NC)
We have a system that depends on lobbying. Wish we didn't, but we do. That said, these organizations you mention either represent those who help people or are organizations that directly help people. That means they do advocate for patients and believe they matter. There is not moral or ethical equivalence between the lobbyists who work to dismantle the ACA, medicare and medicaid, and, the lobbyists who work for better healthcare availability in the nation.
Contractor (Richmond)
So to help patients you want to cut millions from getting access and cut the benefits? I question your thought process.
DF Paul (Los Angeles)
Not true. Most of those groups would make more money under the Republican plan, because the very point of the ACA which the GOP wants to repeal was to reduce medical costs. It's arguable that what motivates those groups in common is that they oppose major disruptions to the medical system so soon after the implementation of the ACA.
Mark (New Jersey)
Trump is just the circus act to distract us from Republicans gutting the government and depriving the poor of healthcare. They need Trump to keep the media focused on the ratings driven machine that Trump is. The last thing McConnell wants is a press covering the actions of the House and Senate pass bills without a CBO impact report, without hearings or publicity. Publicity kills bad bills so Trumps job is to fill in the news cycle with tweets, rants and the ravings of a lunatic to distract Americans from their tax cut scheme masquerading as healthcare reform. The media created Trump to make profits and still are benefiting from the "distraction". Why do you thing he makes so many unforced political errors? It is not because he has so many stupid advisors, but rather its just him doing the only job he can do - be the center of the biggest reality show in the world as being the worst President in history. He even gets to makes his family richer in the process - what a deal. And tax cuts to boost. Time to march on Washington to let the lying liars face the music.
Mike B. (East Coast)
Mr. Leonhardt, thank you for the heads-up. I expected as much from the Republican Party. And once America becomes familiar with the specifics of their Darwinian inspired health care proposal that is essentially designed to sentence millions of the sick and elderly to an early grave, the GOP will suffer substantial losses at the polls, not only in 2018, but well beyond. They could very well lose control of the House and the Senate with the next election. They will have effectively voted themselves to political minority status for years, perhaps decades, to come...And good riddance to them! They, and their truth-impaired leader, Donald J. Trump, deserve a permanent "thumbs down" from "We, the people". Amen.
Ralph Braskett (Lakewood, NJ)
Mike don't count on their reaction, especially if there are no hearings that would be on the TV night after night like Obamacare was ia few years ago
do (mi)
Sadly, this hope is misplaced. Republicans simply have a better PR machine with lots of money behind. I am sure there would be something wrong with the next democratic candidate. And, if not, they will makeup something

Clinton - emails
Kerry - swift boat, can speak french
Gore - knows too much and throws many facts in the discussion. Boxy!

They went after a guy for `palling around with terrorists' when the guy had lost body parts in serving for a war for USA
Anthony (Orlando, Fl)
We can only hope. You think after the disaster of GW Bush's adminstration which resulted in the quagmire of Iraq, the deficit exploding and a financial collapse threatening the world's economy people would of had enough. But here we are.
VJBortolot (Guilford CT)
The perhaps 40k+ unnecessary deaths per years that would result from passing this legislation could be called stochastic manslaughter in contemporary jargon, or more traditionally (from the Wikipedia):

'In United States law, depraved-heart murder, also known as depraved-indifference murder, is an action where a defendant acts with a "depraved indifference" to human life and where such act results in a death. In a depraved-heart murder, defendants commit an act even though they know their act runs an unusually high risk of causing death or serious bodily harm to someone else. If the risk of death or bodily harm is great enough, ignoring it demonstrates a "depraved indifference" to human life and the resulting death is considered to have been committed with malice aforethought. In some states, depraved-heart killings constitute second-degree murder, while in others, the act would be charged with varying degrees of manslaughter.'

House and Senate Republicans, you deserve to be tried, to be convicted, and to suffer a lengthy imprisonment for what you are attempting to inflict on the American people. The tragedy, as if you actually cared, would fall disproportionately on the very people who elected you.
Nadim Salomon (NY)
Pure Trumpian strategy. The WH will make extreme proposals, the republican congress will make some cosmetic changes, and people will feel relieved that worse has been avoided. But the long term damage will be real. So yes watch the Senate.

BTW: can someone stops the Republican spin that emergency room will be a source of medical care for uninsured. Emergency room are required to address emergencies. But at discharge, you still need medications and follow up for chronic conditions like diabetes, heart failure, hypertension, etc. Unless you pay out of pocket no insurance = no medical care for chonic conditions.
Terri Smith (USA)
Thanks for providing the email to the Senate health committee. I just sent them a list of 15 questions that I had already put together for my mom who sent a letter to her Senator asking the same. Its unconscionable that the Republicans are passing such draconian legislation that HURTS not only their constituents but the rest of us. What is wrong with the people voting for them who will be getting hurt? I ask this because it is very clear the republicans and Trump don't care a bit about the more than 70 plus million of us who did NOT vote for them.
Richard Luettgen (New Jersey)
I agree with the essentials of David’s argument. If all the Senate does is warm-over the AHCA sufficiently to provide political cover for Republicans to pass it and move on to a House conference in which an entitlement is repealed on which millions of Americans now depend, then not only will Republicans have failed to govern effectively but they may commit political suicide – as Democrats did in 2010.

The proper move is to recognize that one-sided solutions to healthcare in America are not productive. They should call for a two-year bipartisan commission charged with defining a healthcare framework that replaces the ENTIRETY of our patchwork programs with another framework that works for America and that is fiscally sustainable. My own preference would be for a single-payer component that provided basic healthcare (not insurance) for all Americans, with all else provided by nationally-chartered insurers on subsidized exchanges. It wouldn’t be “Medicare for all”, because America didn’t elect Republicans to dedicate MORE than the 50% of federal outlays that we already dedicate to our social safety net, but it could be far more sustainable, effective and universal than what we have now.

We’ll see how the Senate moves. Whether it’s to start the process of effectively addressing our third-rail of politics and get on with the OTHER things Americans elected Republicans to do, or to repeat hubristic Democratic mistakes … could define WHO sits in the wilderness four years hence.
Wesley Brooks (Upstate, NY)
"It wouldn’t be “Medicare for all”, because America didn’t elect Republicans to dedicate MORE than the 50% of federal outlays that we already dedicate to our social safety net"

America also didn't elect Republicans to implement the narrow minded radical Libertarian ideals of the Koch Brothers. Poll upon poll shows support for a social safety net including Social security, Medicare and Medicaid. Of course that doesn't mean reforms are not necessary, but what the GOP is doing is not reforming but trashing government programs in reward for the hundreds of millions of dollars of legal bribery foisted on them by the Koch brothers, including the Freedom Caucus, and the numerous other shadow groups sponsored by them that have infiltrated all levels of our government.

It is highly doubtful that the average American would support the larceny these groups are promoting if our "free" press had done anything to prevent it. Alas, advertising dollars matter, and these groups have successfully used their ties to corporate America to suppress free speech through controlling the cash flow.

Is this why you voted Republican?
B. Rothman (NYC)
We already have such a "solution." We call it Medicare. Expand and update it and eliminate the profit driven insurers ruling the roost, which is one reason the Republicans find a "correction" so hard to achieve. They start with the premise of supplying patients for insurance companies and not healthcare for patients. But you and the Republicans KNOW that and don't give a damn anyway: depraved indifference indeed.
John (Hartford)
Another lengthy smoke screen. A bi-partisan commission? Are you unaware the Republican party has spent the last 8 years promising to take health insurance off tens of millions of Americans in order to fund tax cuts for the wealthy? The house bill does that and as Leonhardt explains at some length (did you actually read and understand this article?). This is what happens when it become impossible to reconcile slavish devotion to Trump and Republican dogma with the reality of what he and the Republican party are attempting to do to healthcare on which millions of Americans depend.
John Smith (Cherry Hill NJ)
US UNDERGOING SNEAK ATTACK By GOP members in both the House and Senate. Rather than holding any public hearings on the Trumpcare monstrosity, they are keeping it under wraps. The damage this sneak attack will inflict will dwarf Pearl Harbor by many orders of magnitude. The current estimate is that somewhere above 20 million people in the US will LOSE their health coverage, while the 1% will be given the gift of major tax cuts. We're not talking about some benign change! We're talking about the sickness and dying of millions of Americans. The GOP has, up till now, silenced all the major healthcare groups' protests against the new bill. Handing Trump a victory on Trumpcare will not be political suicide, but rather societal suicide. The GOP atrocity beggars description. History will judge Trumpcare as causing the US Holocaust in which millions die by the strokes of the presidential pens, handed out to those who attend its signing.
Prunella Arnold (Florida)
It's time to call out the Senate and House on their own priviledged Cadillac healthcare and demand they live on the same gruel they want to feed us.
Babel (new Jersey)
It is really hard to get your mind around the inherent evil of a Party that will take health coverage away from the poor and middle class in order to give tax cuts to the rich. It is even more insane to believe that the groups that suffer the most will continue to vote Republican.

But the media has a major responsibility to. And that is to inform the public of what the Republican bill will mean to millions of people. Watch the medias' their wall to wall coverage of a terrorist attack. The air waves are flooded with an army of experts covering every angle of that story. If the Republicans will not call to the Hill all the leaders of the major groups opposing this bill, what prevents the news outlets from giving these individuals the air time to sound the alarm.

The stealth silence you speak about is also aided and abetted by an unresponsive media.
Carl Hultberg (New Hampshire)
The Republicans on Medicare and Medicaid who voted for Donald Trump thought the GOP would only take Obamacare away. They shudder now to realize the power brokers are going to take their health insurance away as well.
LSL NY (New York)
Mr Leonhardt makes a strong case for discarding the term "Trumpcare" for whatever legislation emerges from Congress and adopting a nickname that more accurately reflects the fact that the full weight of the Republican party stands behind this duplicitous assault on the welfare of millions of Americans. I propose "Republicare."
jprfrog (New York NY)
"Deathcare" is more to the point. And easier to say for those who are flummoxed by words of more than two syllables.
Loomy (Australia)
Has anybody ever asked themselves why all the countries that provide Universal Health Care to all their Citizens and their Politicians/Leaders have Never and will Never make changes to their Health Care Systems that would result any of their older, poorer, disadvantaged or sicker citizens being denied coverage or unable to be covered for all eventualities regarding their health and treating their needs, whatever they are or become?

Of course not! They have never and would never do such a thing! It would be considered political suicide and most likely seen as a criminal act.

No one would dare or even lack the humanity to even think about doing anything like that!

Now ask yourselves why in America you elect and allow your leaders to not only do such a thing, but do it so that those who already are rich receive more money they do not need, to deny and affect so many who their actions will hurt, endanger and risk. What kind of people would do such a thing? Consciously know what their actions will mean and do to so many less fortunate Americans?

Even worse...The U.S is no Venezuela where lack of money and economic collapse is causing so many to suffer. In the U.S they take the money already there and give it to those who don't need it, to make sure that those who were being looked after/able to get by, no longer able to be protected or helped and as a result, suffering or dying because of such actions.

American Exceptionalism at it's very worst and beyond belief.
QueenofPortsmouth (Portsmouth, NH)
I don't recall seeing any rich people out in the streets holding placards demanding tax cuts.

We are just plain stupid if we accept any part of this plan!
Jeeze, what am I thinking? We ARE spectacularly stupid!
We are paying for this ridiculous man to stay at his own resort and golf.
Please, can someone tell me ONE thing that is good for me in this budget.
david (ny)
The GOP does not want to improve heath care.
They want to reduce government expenditure on health care.
To reduce expenditures they must reduce health care.
steven (durham)
The sad ironic truth is that there proposal would actually increase the government expenditure on healthcare because once people are dying we spend billions to try to keep them a live with or without insurance. Then if by some chance they survive they will be placed on Medicaid or Medicare if they now have serious medical conditions. So the debate shouldn't be about if we are going to spend but when should we spend. Most other countries spend it up front to keep people healthy causes they know it's cheapest that way. We Americans want to keep everyone alive once they dying but too short sited that keeping them healthy is better for society and cheaper.
YogaGal (Westfield, NJ)
AND they want tax cuts for the wealthy too!!! Come to think of it, that includes most of them currently "serving" in Congress.
Marc (vT)
The Repubs want to destroy all government supported programs for any but corporations. They will do whatever it takes to achieve this goal, including colluding with a foul mouthed, corrupt, incompetent, sexist, racist man.
Nothing will stand in their way, and the propaganda machine of Fox and right wing radio will support them every step of the way.
When the working men and women who believe their lies wake up to what has happened to them, it will be too late.
Steve Bolger (New York City)
It is already too late for these fools. Robots are smarter than they are now.
Richard Mclaughlin (Altoona PA)
Don't forget Pat Toomey, Pennsylvania giveth, and Pennsylvania taketh away.
Tony (Boston)
I'm outraged at the devious and shameful behavior in the Senate. It's time for the Democratic leadership to grow a spine and sound the alarm. Access to quality Healthcare is a basic right. I just sent an email to [email protected] and I encourage you to do your part if you feel the same way.
M. Gamel-McCormick (Washington, DC)
Every time I read a column about health care I do not see the core issue addressed. The House bill is not a health care bill. It is a tax cut bill. A tax cut built on Medicaid cuts of over $800 billion over ten years. The approach of the House was to gut an entitlement program--not the expansion part of the program, the fundamental structure of Medicaid. The bill kills Medicaid as intended by Congress in 1965. Please, please, please write and talk about that. Not the expansion. Talk about how the change to Medicaid will remove basic services to those with chronic health conditions, those with disabilities, and those older Americans and how their lives will be worse--far, far worse. This is the dismantling of a program that has served Americans well and no one is talking about it.
Denis Coleman (Florida)
Obamacare increased Medicaid by taking $500million from Medicare. It's all a shell game
Moira Green (Portland)
Thank you, thank you. So well said.
shrinking food (seattle)
The right wing owned "press' runs this sort of thing so that you believe there is a voice given to views other than the GOP views all press promulgate.
We allowed 6 companies to own all news in the USA - we have been suffering the consequences since the 80's
Tom (California)
In other news, GOP eliminates funding for anesthesia, replaces it with a bottle of bourbon and a "bite stick."
YogaGal (Westfield, NJ)
There's a $50 co-pay for the bourbon, and the "bite-stick" is an extra $35!
WFGersen (Etna, NH)
Thank you for providing the email address. I wrote a very short message:

"In the name of democracy, I urge you to hold public hearings on whatever law you develop in the coming weeks. Failure to do so will dramatically undercut the public's confidence in government, confidence that is imperative in a democracy."

I doubt that it will get much traction, though... since the GOP has run on the platform that "Government is the problem" they are probably not going to be interested in restoring the public's faith in democracy.
MVH1 (Decatur, Alabama)
I would propose the GOP's cynical public pronouncements that government is the problem are showing us that government is the problem only when they don't have complete control of it to do with entirely as they please, which means for themselves and the people who line their pockets and not for the voters who put them there. They have been very successful with their brainwashing. Fox has delivered a diehard cluster of supremacist, racist and bigoted voters who continue to vote against their own best interests and when they're shafted, they blindly blame the Democrats. One wonders if they will ever wake up and shake this off and see what is before their eyes as clear as day.
Melvyn Magree (Duluth MN)
My own message was:

Just over two months ago, the Senate "listened" to Washington's "Farewell Address". Have you already forgotten his warning about factions?

The Senate has been called "the world's greatest deliberative body". It has now become the deliberate mouthpiece of the Koch brothers and their ilk.
Bill (Durham)
Sir, I stole your statement, modified it to express my concerns and sent it in. I hope you don't mind. I gave me a start on a message when I was gobsmacked by the fact that the senate might even consider following the strategy of the house. I expect much more of the senate.
Anna (NY)
The Blue states should organize and prepare to offer their own single payer Blue State health care plans, based on employer and employee contributions, the way they do in most all Western countries. Let the Senate pass their plan. The Trump voting states can have the Senate plan. It's what they voted for. And if the federal government tries to outlaw single payer State plans, sue their pants off. If the Senate cannot pass the current plan, so much the better, but the progressive states need to be prepared.
Bruce (USA)
Obamacare is failing. The only people happy about Obamacare are those who don't pay anything. That is neither fair nor ethical.

What democrats want is for society to cage the doctors and force them to work at gunpoint. If they can't get that, then anyone with money is forced, at gunpoint, to hand it over so that others can get what they have not earned. It all boils down to that. Force and theft.
Sam Ashbrooke (Tampa FL)
.... and the alternative? Jammed emergency rooms, millions without insurance, the poorest among us left with no recourse? You'd best build your own wall around your gated community: it's going to get ugly out there....
Robert Ljungquist MD (Goshen, CT)
This is nonsense. Look at Europe and Canada. Are their doctors "caged and working at gunpoint"? Or are their citizens better cared for at lower cost than in America? Open your eyes to reality and stop believing this reactionary nonsense!
PGM (Barrington RI)
this doctor, who pays obamacare taxes in his paycheck, is happy about obamacare. Your metaphor of "caged doctors" is part right - it is the insurance companies, driven by profit, that interfere in our lives. This started way before obamacare.
Most importantly, you don't understand the concept of insurance, and social safety net - everyone pays for the protection of others, as you do with your car insurance. Those of you who would deny medical care to 15 million people in the richest country on earth have no compassion or moral compass. Those of us who are willing to pay a little more so that people won't die for lack of medical care (and they Do, Bruce- I've seen it) can't force compassion on you. It's a basic piece of character that you are missing.
And by the way - no guns involved, despite your mentioning it twice.
B (DC area)
Sunlight, the best disinfectant.

All reporting on these shenanigans should include, not only all those listed here who support the ACA's underpinnings of universal health insurance with the mandate and specified list of coverages, but also those who don't.

That would be the Koch Network, as reported in the Washington Post a few months ago, with their decision to spend more than $200 million to repeal the ACA (and not replace it). They don't represent themselves, and they don't just represent those few Americans whose after-tax income shrank by 0.8% because of a tax to improve Medicare's longevity. (That is from The Economic Report of the President, January, 2017, available on line.) No, they probably represent those interests whose revenue growth already has slowed because there are 20-plus million more people not needing a load of prescription drugs, 60-million Medicare patients no longer having return hospital visits within 30 days, etc. (Also from the Economic Report of the President)
Thomas Renner (New York)
The goal of the GOP is not to provide better health care to more Americans. The goal is to repeal the ACA at any cost. The goal of the DEM's should be to be sure everyone understands who did this and how trumpcare is really a tax cut for the rich.
Jean (Wilmington, Delaware)
Thank you for the e-mail link. Probably won't help but gives me some solace that I can do something to save lives. My two senators from Delaware are working hard to preserve the best of the ACA and Medicaid. For the GOP, the healthcare bill is needed to jumpstart their push for big tax cuts. Shame on them!
DJ (NJ)
Americans have to wake up to the fact that legislation never applies to the legislators. If there is any chance that a bill may affect their lifestyle, they include some sort of immunity from the law.
Americanism has become a thin veil. An illusion. A congress of cowards.
Blue Moon (Where Nenes Fly)
What is the expectation here? We get sick and die so the rich can get ever more money for themselves. Trump gets a “win” to realize our unrequited “love” for him and to help motivate him not to bomb the rest of the world – to keep him adequately smug and content, as if that’s actually possible. We all buy Trump family products in order to stroke their egos – gaudy material objects like Ivanka jewelry, shoes and handbags. That way people will know that as we lay dying, at least we were surrounded with their beauty.

Ugly stuff. Ugly conspirators. An ugly example for the rest of the world. And a sad tale for future historians and archaeologists when they study whatever will remain.
Loomy (Australia)
" It’s a time for all those groups that oppose the bill, and for the engaged progressive base, to put senators on notice..."

Agreed! But given the opposition of almost all health related professions and experts in their areas including Insurers (off the record) the very fact that the House approved such an offensive and damaging to millions Bill to be presented to the Senate...
...says it all and tells us all that the Nations GOP Leaders have no care or regard for the opinions of experts or the wellbeing of the majority of citizens on such an important issue that will literally determine the fate of many thousands of people every year.

It's criminal.

In any other advanced Country, if politicians denied millions of Citizens the ability to have Health Insurance/Care because of/by awarding the already wealthy with Tax rebates/cuts... they would be Jailed for Murder.

No one can tell me that by their direct actions and in particular the reasons why they have proposed such a bill, will for millions of people which already enjoy coverage etc take away/make impossible for them to keep it and by such Deny them of Life, Liberty and the Pursuit of Happiness.

Unbelievable.
Jacki (Ct.)
Imho we have no hope to change this onslaught.
While the only real adequate response is
Universal healthcare they refuse to give up their wealth. The congress wants more of us. They are greedy . Wall St. And Insurance companies will destroy our protections.
Allow this to happen. Only then will the trumpites realize they too must fight with us not against us to get our country back on track.
Jane Rivers (Rockaway NJ)
Until they are required to "drink from the same swill" they are forcing down our throats, nothing will change.
Linda (Michigan)
The Democrats need to hold their own public hearings. Bus in those coal miners, seniors, disable and disadvantaged to testify and put numbers and faces to the misery that trump and the republicans in the senate support. Run adds in every vulnerable republican district. Start naming wealthy individuals and the corporations that would benefit by destroying our safety net to provide tax breaks for the rich. We must fight fire with fire.
G.E. Morris (Bi-Hudson)
Ditto.....
I didn't understand how Medicaid works until my teenage son had a severe brain injury . MSM needs to understand that there are already 50 varieties of Medicaid as states already have a lot of flexibility.

Please have hearings with empty suits but bring on the AARP, the nurses, the doctors, the hospitals both rural and urban, the nusring homes, the disabled,the frail, etc.
Jon (Skokie, IL)
I agree. The Democrats can make their own news by holding such events. The media were complicit in Trump's election because of their focus on Hillary's emails instead of the substance of her proposals on jobs, healthcare, retirement security, etc. It was the media that shaped the impression that the Democrats were only concerned with identity politics. They need to help correct their own mistakes by covering what really matters.
JMM (Ballston Lake, NY)
No we don't need to do a damn thing. This is what MI, PA, WI et. al. voted for. I live in NYS and my vote means next to nothing. As far as I'm concerned, every Trump voter and the state they reside in owns this White House and Congress. Every scandal. Every screw up.
WaPo had an article about a KY Congressman who actually held town halls and the Trump voters are still on the bandwagon. Why should we care if they are hurt by his policies?
Woofy (Albuquerque)
It is demagogic to say they are "taking away health care" from people, not all of them poor. What they are actually doing is "not taking away money from other people," not all of them rich. Obamacare was a big confiscation program that took away people's money and gave it to other people. It is not obvious that letting people decide whom they want to buy health care for is a bad thing.
Anna (NY)
Woofy, you pay for other people's health care one way or the other: Either higher premiums because the only way hospitals can provide unfunded emergency care to the uninsured, is to bill the insured for it. Or share the responsibility for health care for everybody. Just like auto insurance. You never know if or when you get sick and you never know if or when you get into an auto accident. Why do you think most Western countries, including those under conservative governments, have universal health care?
Loomy (Australia)
Woofy,

Most other civilised countries in the world never thought to decide which citizens get Health Care and which do not.

Funny thing.It was always going to include ALL Citizens, who would ever decide or think otherwise?

And in many or most of these countries, revenue from taxes are used to achieve everybody being able to get coverage, with those earning more, paying more tax and in some cases, those earning the most paying an extra tax to help ensure the system covers Everybody...especially the sick, poor and disadvantaged who need help and coverage even more than most.

And there is no outcry or discontent from the better off to pay less or contribute just as much as everyone should or must if they are to be covered, almost all recognise that for a society to prosper and help all its people to attain the basic necessities that it can or should, the wealthy or more fortunate can and should help make this happen.

A selfish Society cannot prosper and will create its own failures until the consequences of such thinking affect all and diminish everybody.

It is no surprise that America is one of the most unequal Society's in the World and is no surprise that almost all it's people are being affected and suffering from it's causes.

More Americans that can afford to do so, need to decide to share more and take less than they often do, at the expense of others who have nothing or need support.
Richard (Spain)
Thanks for the very appropos warning about what may transcur. We need to keep our eye on the ball with this one. Thanks as well for the link to the Senate. I immediately sent a message and encourage everyone to do the same.
By the way, I've been missing the CBO report. Glad to hear it's coming!
billd (Colorado Springs)
These deplorable senators are just doing what their owners have paid for.

Follow the money.
Mary (Albany, NY)
Thank you, Mr. Leonhardt, for update. I am so disgusted with this Congress. Their intent to pass ugly, secretive bills like this, their deafening silence regarding the imposter in chief and his aides/admin assaults on our democracy, and this utter loyalty to themselves, their pockets, and their party (Ryan telling McCarthy to keep quiet, "don't leak, we're family" upon hearing the news that Russians might be helping to fund djt's election campaign). I hope and pray the American people vote them out in 2018 and perhaps intelligence/prosecutors will seek and find those guilty of crimes and misdemeanors because we all know the House in it's present for with that "faux American" leader won't do it. Corruption seems to be very widespread these days.
shrinking food (seattle)
dems refuse to vote in mid-terms - they would rather whine about bad outcomes. They will hand several more states to the GOP and then be gerrymandered out of existence in 2020
Mark (Rocky River, OH)
I find it almost too hard to believe. I have encountered many voters who sent Trump to office who receive Medicare, as I do. They all but admit their own cruelty when talking with me. They literally cannot fathom the role that luck has played in their lives. They are cruel. Yet, they really think that this is about something else. The something else is money,...... and they won't admit that either. My House rep Jim Renacci wrote me the other day in response to my letter. His answer is that Medicaid is collapsing under it's own weight. Never once did he consider adding to the revenue side of the scale. He thinks ( he is very rich) we need tax cuts.
Sharon (San Diego)
Now that Trump, Comey and Sean Spicer have upped the ratings for C-Span, it's time progressive Democrats in Congress held their own hearings, with or without Republicans in attendance. People will watch, if not when C-Span airs it, when it's picked up by YouTube and podcasts around America. The conservative Democratic leadership would rather mumble their dissent than upset their Wall Street donors. So progressive Democrats must lead. All those families at all those Town Hall meetings, at all those protest marches? We will support you.
johnny p (rosendale ny)
McConnel is one scary dude. I'm sure last nights terror attack is just the distraction and cover he appreciates as he prepares to mug the American middle class and poor.
Peter (CT)
Taking health care away from 25 million people was too much. Will the American people accept 12.5 million as a reasonable compromise? Ten million would be meeting the Liberals, socialists, and welfare queens more than half way. Surely nobody cares about a few million diseased old people. How about 8 million?
My point is that they are simply trying to find the number of people they can throw under the bus and still hope to get re-elected. Every person under the bus increases the size of the tax cut for the wealthy. Health care has nothing to do with it - this country is perfectly capable of providing universal healthcare to its citizens, but the Fortunate Ones would rather just take the cash.
David Henry (Concord)
Taking health care away from ONE PERSON is one too many.

Supporting this idea so one can gain a tax cut is savagery.

The dead on Normandy Beach didn't sacrifice for this.
dad2rosco (south florida)
David, if the Senate Republicans really think that they'll do another Houdini's act in their chamber by holding no hearings or conducting any Debate on their Trumpcare bill like the stupid Paul Ryan did in the House, then they better write their chances to nil of holding on to the Senate.

There is no way the rest of the Americans, who'd been struggling and fighting their fights to keep some semblance to their lives by having some decent treatments for their various illnesses,are now going to abandon their hopes by these attacks on their well being from the heartless Republican Senators and their shameless House members.

This terrible anti-poor, anti-elderly anti-Black,Hispanic or Asian attitudes that most of the Republicans grown with, has to be taken out of their head if this country ever wants to move forward.

It is not a mystery anymore that these bunch of yahoos in the Republican party are still loitering in their dark past with most of their bases living in isolated rural counties where they're still living their lifestyles that their parents and grandparents lived in before the '50s.

Through total illegal Gerrymandering practices,the crooked Republican State Senate and Assemblies have insulated their counties from the immense diversity that we saw in the major cities of this country.

Although lately the Supreme Court is realizing these unconstitutional measures to keep the minorities out of the Republican areas,especially in NC,Texas,Virginia,but that's not enough.
JT FLORIDA (Venice, FL)
Thank you for asking readers to send a letter along with a link to the email address. Here is my letter to the committee:

"The Republican Senate health care bill must be open to public hearings and a CBO scoring mechanism before the American people have their chance to vote for Senators and House members next November.

Remember this: with President Trump's Russia scandal getting worse not better combined with the public perception that the GOP's health care initiative is simply an excuse to promote another tax cut for the wealthy, the verdict of the electorate will be harsh and swift next year.

Do the right thing. Make the Senate a responsible place to do the people's work with public, open hearings, including a CBO scoring process."
Jo-Anne (Santa Fe)
JT - thank you. I am copying and pasting your email message to the Senate for my rapid response team to use today.
Maureen (Boston)
Unfortunately, people who vote for these men are going to have to be personally hurt before they wake up. The stupidity is astounding.
Jan (NJ)
The left can only blame themselves with self-inflicted drama they project on a daily level. The senate will get to healthcare and pass a bill this year. Then the left can drum up another drama.
Jane Rivers (Rockaway NJ)
Unless you are one of the wealthy, your words will make you sick after this gets through.
shererje (MD)
You are so predictably wrong and mean-spirited every time. You used to be Janice from Ridgewood, didn't you? I guess if you can afford to live in Ridgewood you personally have nothing to worry about and you conveniently forget the part about "common welfare" in our social contract.
Zejee (Bronx)
Do you think people will happily forego healthcare for their families?
Mike Boyajian (Fishkill)
If you want something to fail you will do everything in your power to see that it does fail.
terry brady (new jersey)
Why bother? If fully constituted Republican Senators do not care about good healthcare, why should the rich and middle class. Why not just watch the uninsured tumble into disease induced bankruptcy and extended family poverty. We could index a new investment fund that buys and sells embalming fluids and cheap caskets.
Jack Sonville (Florida)
We all would have a better health care system if members of Congress and their families were forced to also live with the same system the rest of us do.

If they had any real empathy for their constituents they would abolish the sweetheart health care benefit plan they enjoy as Congressmen and women and have to deal with high premiums and deductibles, lack of pricing transparency, incoherent hospital bills, ever-changing drug costs and insurance company bureaucracy like the rest of us.

Perhaps if these "leaders" had to spend hours on the phone fighting with their insurance companies about denial of coverage for their child's medical treatment, they would appreciate a different viewpoint.

But putting themselves in the same shoes as their constituents would take real leadership. Something our Congress has not shown in a long time. So I am not holding my breath. Just my wallet.
Patrick Stevens (MN)
I listen to public radio news and watch cable most days. I hear very little about the Senate and what they are up to. Why aren't the Democratic Senators and House members on the air 24/7 in opposition to what the Senate Republicans are doing.
This is exactly why voters are turning away from the Democratic Party. Are these people opposition, or are they complicit in what the Republicans are doing to our healthcare system? Democratic voters are sick of seeing their democratic legislators being sucker punch by the Republicans. Democrats and their party need to get their act together and fight before the battle is lost. Mitch McConnell isn't the brightest politician in the Senate. He's just the meanest. Fight back.
Dart (Florida)
Of course they want to take as much away from the poor, and ever - dwindling working and middle classes---unless there will become a reason to truly fear them.
VJBortolot (Guilford CT)
When the impoverished, and the beleaguered members of the middle class who are destined to join them, have had enough, I am afraid there will be blood in the streets and in the halls of Congress. If there is, the horrendous loss of life resulting will still be dwarfed by the carnage destined to be wrought by this near-criminal legislation.
northwoods (Maine)
Americans voted for the Republican Agenda, and elected their representatives and President Trump on the basis of what they told the voters they wanted to do.

Why are you suddenly surprised that they are actually doing what they promised.

American's must want to see health coverage taken away or removed completely so that the money can be used to reduce the taxes of the rich, otherwise they never would have voted these representatives into office in the first place.

The same goes true for the gutting of environmental standards, women's rights, educational reform.... the list goes on and on.

Isn't this way democracy is supposed to work?
David Henry (Concord)
Who said the writer is "surprised."

Your idea of "democracy" is wrong. Trump lost by 3 million votes.
Tim (NJ)
Republicans to Americans..."Let them eat 'healthcare' cake..."
Doug Mc (Chesapeake, VA)
Thanks for the link, Mr. Leonhardt. As a retired family doctor, I have sent in my screed to [email protected] as suggested.

I have done that despite the certainty they will stovepipe the "answers" justifying their chosen and destructive path to a mean-spirited bill.

Single payer! Medicare for all.
person46 (Newburgh, New ork)
It is just heartbreaking. The Republicans are preparing to send us back to healthcare and social Gothic times to increase the wealth of the lords and ladies. Despite the will of the people (well, despite the "election," only 17% of Americans approve the direction that Republican aristocrats are taking their bills), they seem prepared to sneak it through. Then what, folks, then what? I ask, then what - imagine the landscape of American life then!
Aunt Nancy Loves Reefer (Hillsborough, NJ)
My prediction.
The Senate Health plan will feature massive tax breaks for the wealthy funded by taking away the Healthcare benefits of tens of millions ordinary Americans.
The biggest difference between the Senate
and House bills will be the number of people sacrificing their healthcare on behalf of the rich.
Republican Senators, humanitarians to a man, will only want to sacrifice 10-12 million of their fellow citizens, the House Republicans will want at least twice that.
Johnson T. Plum (Left of California)
When will the democrats go on the offensive? When do they plan to shout from the rooftops that this Trumpcare bill is nothing more than the usual GOP playbook of robbing paycheck-to-paycheck Peter to pay politically-connected Paul? Ryan and otherwise.

The recent town hall protests throughout the country have made it clear that this legislation is a loser among Trump supporters that have suddenly seen the light, albeit six months too late. Make Americans aware that the AHCA is not about healthcare at all, but a cleverly disguised plan to redirect tax dollars from helping the poor and uninsurable to instead increase the wealth of the already wealthy.

Explain that preexisting conditions will discriminate again. That the lack of competing health insurers in some markets was by GOP design. That their new 'affordable' Trumpcare plan will be the equivalent of a degree from Trump University.

This draconian legislation must be defeated. How will democratic party leadership make sure of it?
Zejee (Bronx)
Bernie has introduced legislation to make Medicare available for all. Will the Dems support him? Doubt it.
Carla (Brooklyn)
People wanted trump . They got him.
And now he and his criminal gang are destroying the country.
What are we, the hard working tax paying citizen to do
in the face of this travesty? I wish someone would tell me
because I don't know how I'm going to able to live.
I need SS, and Medicare and I've worked since I was 14.
Living under this constant stream of daily horrendous
news is very depressing, so much so that I am trying
to figure out a way to live in France.
mymymimi (Paris, France)
Hello! I moved to France in 2001, and it has worked out well--until now. Please do your research carefully. Things have changed for the worse for expats in France.
Chanzo (UK)
"People wanted trump . They got him."

... remembering always that millions more people didn't want Trump but got him anyway.
Jane Rivers (Rockaway NJ)
Let me know and include a link to that!
Jack (East Coast)
It also has not yet dawned on the GOP Senate that they and Trump have declared war on the self-employed by failing to stabilize the individual market. Instead they are undermining the market in a futile effort to force change.
JanTG (VA)
Single payer. Medicare for all. Get on it, Democrats!
David Henry (Concord)
As if stating the obvious will magically make it reality.

The GOP is the problem, not the Democrats, many of whom supported a Medicare buy in or a "public option" in Obamacare.

Your exhortation when the GOP controls all three branches of government is puerile, and worse, unhelpful.
Zejee (Bronx)
I only hear Bernie calling for Medicare for all. The Democrats, for the most part, are all talk-no action.
pedigrees (SW Ohio)
Unfortunately Rob Portman is my senator. I can pretty much guarantee, based on his past performance, that he will roll over and put party before country. Again. I have emailed him repeatedly (gave up calling, voicemail is eternally full and the humans in his office won't actually answer the phone) and I get emails in return talking about access to health insurance, patient choice and market-based solutions. And we all know what that means. When it comes down to it he's no better than the rest of them. He's still a Republican first, American second. If he does stand up for universal health care/single payer (the only rational solution) I will quite happily eat my words. But it ain't gonna happen.
Patricia Mueller (Parma, Ohio)
In reply to my fellow Ohioan... Rob Portman voting against party? I wouldn't make that bet.
I write or call Rob Portman's office daily. I get robo replies with an Orwellian reason why he ...voted for DeVos and other Trump's hand-picked cabinet, voted for Trump healthcare, voted against women's right to choose, voted in the interest of corporate America over middle-class America,...
Portman's only redeaming quality is that he openly garnered sympathy for LGBTQ marriage equality rights because his son is gay.
SMB (Savannah)
Twenty-four million Americans would lose their healthcare according to the original House version (52 million in 20 years). Forty-five thousand will die unnecessarily every year. Ten million will be cut from Medicaid which covers about 40% of births in this country, and most of the elderly in nursing homes. All medical associations support the ACA. Only 21% of Americans approve the last version of the House bill which had no CBO rating, and only 17% approved the previous version.

This is an enormous tax cut for the wealthy. They are the ONLY ones who benefit. This bill betrays Trump's promises (which are never worth the air time they occupy anyway).

At town hall meetings and in comments, Americans tell their representatives how they will die, or how their family members will die, without healthcare or the medication or treatments they cannot afford.

This is about lives and suffering and anxiety. It cannot be matched by the lies and sleight of hand if shuffling another trillion to the wealthy. When 3,000 Americans were killed on 9/11, there were wars fought and a fortune spent and major changes.

Yet now secretly in the dark, Republican politicians plot how to kill Americans by the tens of thousands, even after hearing and seeing the personal testimony, the voices and faces of some of those they will be actively killing with malice aforethought.
Aunt Nancy Loves Reefer (Hillsborough, NJ)
Republicans despise ordinary Americans and exist solely to serve the rich.
At this point how could anyone be unaware of this?
They call it the Kudlow doctrine, you can look it up.
Arlene Romoff (New Jersey)
The GOP are domestic terrorists, for the loss of life their policies will cause - far beyond the tally of 9/11.
Blue Moon (Where Nenes Fly)
SMB:
"When 3,000 Americans were killed on 9/11, there were wars fought and a fortune spent and major changes."

Ironically, these wars were another way for the wealthy to make more money for themselves.
Denis Coleman (Florida)
The standards that you are criticizing are reminiscent of how Obamacare was first passed( Pelosi - We have to pass the bill to know what's in it). How is one to honestly think about your goals in writing this article, when the piece is set up so disingenuously.
Ellen (WA)
Did you miss the part where the author alluded to a multiple year process, more than 40 open hearings on the ACA? Whether you agree with that law in all particilars or not (and most people agree it should be improved), it is disingenuous on your part to suggest that the current process, conducted in a secretive rush, is equivalent.
SMB (Savannah)
Denis, did you read the article? As Mr. Leonhardt wrote, the Democrats held 44 hearings during the ACA deliberations which last one and a half years and were public. Republicans have held NO hearings, and all committee meetings are secret. 161 Republican amendments were adopted in whole or revised form.
This is a drastically different process: it is being held secretly and kept in the dark. The House ACA repeal bill was posted around 9 pm, and the vote was the next day (which meant even Republicans admitted they did not read it). You are quoting Pelosi completely out of context, and it doesn't reflect the year and a half of public proceedings on the ACA. Please be careful of fake news and false information that is just propaganda. Instead try reading the New England Journal of Medicine about the 20+ million Americans who benefited from the ACA, and its success.

At least the CBO scoring will provide some transparency tomorrow.
tony zito (Poughkeepsie, NY)
Mr. Coleman has thoroughly absorbed the phony version of ACA history repeated by right wing sources ad nauseam since its inception. What actually took place fades from memory, while repeated lies remain fresh and overtake reality. I can guarantee you that Mr. Coleman would be shocked to review contemporary accounts of the many months during which hearings were held, debate undertaken, and input from sources of all persuasions sought; it would give him a jolt to read through the accounts of how the public option was jettisoned in the (vain) hope of garnering bipartisan support. And so on. Six years of subsequent mythology easily beats out the many months of blood, sweat and tears that went into making the ACA.
PogoWasRight (florida)
The Senate is controlled by Republicans. The Republicans are controlled by a few ultra-wealthy men whom we might possibly learn the names of. The crackling and crumbling of America's foundation is picking up speed. We may not have a country by the end of the Trump Banana Republic and its faceless leaders. No, No, not Trump.....he is certainly not a leader or a planner.........
Terri Smith (USA)
You are right that Trump is not a leader but he is a very powerful wrecking ball and is going at it full force. By the time he and republican majority is gone they will have caused a whole lot of destruction.
Neildsmith (Kansas City)
The American people, via their votes for republicans from 2010 through 2014, voted to empower them to repeal the ACA. It's not a choice I support, but it is the choice they made. So be it. Repeal it. Don't replace it. Let's move on.
SMB (Savannah)
The election of 2016 was tampered with by Russians according to all 17 intelligence agencies and tainted with fake news and billions in corrupt money. Voter suppression efforts included GOP laws that are now being systematically overturned by courts due to their patently obvious racism.

THREE MILLION more Americans voted for Hillary Clinton. Trump lost the popular vote by historic margins, and has had the lowest approval numbers in his first months of office than any predecessor.

This was a stolen election, and the great majority of Americans consistently in polls want the ACA improved and not repealed. There will be an enormous backlash against Republicans when they take away the healthcare of tens of millions of people.
Eric Schneider (Philadelphia)
Oh, you mean all those people who didn't even know that the ACA and Obamacare were one and the same? I wouldn't call this an informed choice, and take a look at current polling on the Republican bill. The majority appear to have woken up, but now they are being ignored.
Bruce West (Belize)
I don't know. The majority of Americans are proving not to be intelligent.
Meredith (NYC)
More of the same---party power plays, and we hope for the best, if only a few Republicans can find some humanity in their hearts. This is a democracy?

We're not getting what we need. The media hasn’t informed the public of the real world data from dozens of countries who operate universal health care for generations at lower cost. How do they manage this, which would refute all the Gop's excuses and objections? Give us a clue. These countries are capitalist democracies like us, but they might as well be on another planet.

Why doesn’t the Times branch out a little and just send a few reporters over the border to near by Canada and gather some real world facts from the natives? Canada started h/c for all in the 1960s. Maybe by 2017 Americans could learn something from them? Before we have more unnecessary deaths, illness, disabilities and medical bankruptcies?

Basic journalism 101. Just ask a variety of actual people at various income levels how they pay for and use medical care.
Ask them how they like their system, and would they want to change to the US system designed for max profits? No? Why not?
How do they deal with budget cuts from their conservative parties?
How do their parties differ on health care?
Do any of their conservatives want to destroy their systems?

Last but not least, do Canadian insurance/drug corporations donate millions to subsidize their candidates for election like in America, Land of the Free?

“All the news fit to print", NY Times?
Norman (NYC)
You ask why the Times doesn't cover the Canadian system.

At a lecture, I asked Elisabeth Rosenthal, who wrote the Times series on health care, why she never mentioned single payer in the entire series. Literally hundreds of reader comments would say, "The solution is single payer." Shouldn't your coverage acknowledge somewhere the interests of your readers?

Rosenthal told me that she didn't cover single payer because (1) It was outside the mainstream of the debate, just as she didn't cover the people who want to repeal Obamacare because that was outside the mainstream of the debate. (2) News reporters aren't allowed to editorialize or express their opinions.

I think you know the answers to your rhetorical questions.

Your real question is, "How do we get single payer health care in America?" For the answer to that, look at the primary campaign of Bernie
Sanders, who supported single payer and got 13 million votes (43%).

Right now, the Democratic Party is engaged in an internal struggle between the progressive wing that supported Bernie Sanders, and the "centerist" wing that supported Hillary Clinton, Barak Obama, and (some would say) the party's billionaire supporters like the insurance companies. http://www.politico.com/states/california/story/2017/05/21/democratic-di...
Jackie Shipley (Commerce, MI)
Excellent suggestions, Meredith! What do you say NYT? Time to get out and do some real research into health care across the globe?
Gignere (New York)
Unless Fox does it 40% of voters won't believe it.