The author has a suspiciously pronounced bent for ignoring reality (poor people don't need tax credits, nothing in these bills replaces the individual mandate, tax cuts disastrously cut funding for Medicaid, Medicare, and premium support,) and repeating Republican pronouncements that are doublespeak. This is not bipartisan legislation.
4
The notion that a competitive market exists in health insurance is ludicrous.
4
the problem with tax credits is that poor folks can't use them in any significant way. you can't use a tax credit if you don't pay more in taxes than the credit is worth. Dr Roy knows this so does Speaker Ryan. The law 8s what it is, a tax credit for the rich.
5
more 1984 talk!
2
Mr Roy, of what use are tax credits to people who are poor enough so that they barely pay any taxes in the first place? Tax credits aren't health care. Insurance also is not health care. Americans are a bit sharper than you give them credit for.
3
It has been widely recognized that congress men or women who are expecting
next reelection bid generally geared toward their constituent's want in his or her state in casting vote for obvious reason. However, this situation is a test for true statesmanship. Whether they vote for what their constituents want to get reelected or for what they believe the the whole country need in the long run.
next reelection bid generally geared toward their constituent's want in his or her state in casting vote for obvious reason. However, this situation is a test for true statesmanship. Whether they vote for what their constituents want to get reelected or for what they believe the the whole country need in the long run.
Mr. Roy fails to note that the "individual mandate" that is part of Obamacare is a conservative idea promoted vy the Heritage Foundation. Universal participation is essential for heakth insurance to work in that it allows risk to be shared. Unfortunately, both the House and the Senate bills do away with the mandate tbus destroyi g the basic concept of insurance. If the Republicans were really serious, they would have propose giving everyone a basic catastrophic health insurance plan perhaps including two wellness visits per year. This is nare bones, inexpensive insurance that would avoid problems with mandates. At lesst, they could call this reform and allow insurance companies to offer add-ons to this basic plan.
1
It shouldn't be surprising that Dr. Roy authored such a blatantly misleading piece on legislation critical to the life of our country. He willing distorts the facts of the House & Senate's effort to steal health care, billions of dollars, peace of mind from over twenty million Americans to fund tax breaks for a handful of the wealthiest in our country.
Prior to joining the Foundation, Dr. Roy served as an advisor to the Gov. Perry, who denied his state's citizens the opportunity for better health care through his refusal to allow Texas to join the Medicaid expansion enabled by Obamacare.
Dr. Roy's obfuscation even extends to meeting the basic requirements non-profits are obligated to meet under US law. The Foundation for Research on Equal Opportunity (a truly Orwellian name) like all non-profits is required to file IRS Form 990 each year, listing their finances, employees salaries, and other related data. The IRS and the major charitable transparency sites have no filings for this organization.
Since its highly likely that the funders of this Foundation claim their donations as deductions on their own IRS returns, perhaps since the New York Times knows how to contact Dr. Roy it might ask when his employer will comply with the law of the land.
Prior to joining the Foundation, Dr. Roy served as an advisor to the Gov. Perry, who denied his state's citizens the opportunity for better health care through his refusal to allow Texas to join the Medicaid expansion enabled by Obamacare.
Dr. Roy's obfuscation even extends to meeting the basic requirements non-profits are obligated to meet under US law. The Foundation for Research on Equal Opportunity (a truly Orwellian name) like all non-profits is required to file IRS Form 990 each year, listing their finances, employees salaries, and other related data. The IRS and the major charitable transparency sites have no filings for this organization.
Since its highly likely that the funders of this Foundation claim their donations as deductions on their own IRS returns, perhaps since the New York Times knows how to contact Dr. Roy it might ask when his employer will comply with the law of the land.
9
Hogwash. What have you written here to back the preposterous claim that "It's likely that, if the Senate bill passes, more Americans will have health insurance five years from now than do today?" This bill will bring chaos to America's hospitals and nursing homes. Elderly Americans will have to off themselves rather than meet fates WORSE than death. Those of us who understand how health insurance markets and our nation's health care system work are not buying the absolute nonsense that is being peddled by people like Avik Roy. Welcome to America under the doctor of death, Stephen Bannon and the right wing ideologues of the Tea Party. They haven't even read the bill.
4
A little con I used to play on my little brother:
I'll trade you my nickle for your dime, it's bigger, it's shinier, ....
Republicans to folks at the bottom who have little money and pay virtually no tax:
I'll trade you tax credits for your health insurance.
I'll trade you my nickle for your dime, it's bigger, it's shinier, ....
Republicans to folks at the bottom who have little money and pay virtually no tax:
I'll trade you tax credits for your health insurance.
6
OBAMA CARE Began as a deeply bipartisan bill, namely because Obama had the respect, conservatism and perspicacity to borrow the parameters of the bill that then-Governor Mitt Romney in 2007, used to structure the universal healthcare bill in Massachusetts. The sky didn't fall. The earth did not implode. No government, federal, state or local collapsed under the pressure of the economic demands made by Romney Care. That the current GOPper extremists fail to realize that they are betraying their own party's legacy is a glaring indicator of just how cannibalistic GOP politics have become. I'd say that the GOP is like a bunch of mother gerbils eating their young, but I think gerbils are cute. The idea of putting a picture of McConnell's bivalvian face behind a cage of innocent gerbils is the epitome of animal cruelty to me. But we all knew that the GOPpers believe in cruelty to animals. Elementary my dear voters--the human species is among those of the animal kingdom.
4
What is wrong with Universal Health Care for our citizenry? Too civilized?
6
This guy can SPIN!
6
The only way American will ever have a "free market" in healthcare is if they take away the premise of employer group insurance. Change the whole thing to individual market - one big one - only then will you see true competition! Only then will you see the falling prices that only true competition can give us. Until then this is all just a boon for the insurance companies and the top wealthiest people in America.
Pinning the success on projected participation of private insurance companies to insure the indigent just isn't going to work.
The insurance companies won't go for it, and they cannot be forced to participate. (They are private companies!). And for this reason, the Republicans won't back it.
We are back to Medicare, and increasingly a single payer system.
The insurance companies won't go for it, and they cannot be forced to participate. (They are private companies!). And for this reason, the Republicans won't back it.
We are back to Medicare, and increasingly a single payer system.
6
This columm
This column is a lie from start to finish, too long for me to refute in detail. Let me note two items, however: first, what good are "robust" tax credits if you're too poor to pay taxes? Second, the original ACA required all states to expand Medicaid. When the Supreme Court nullified this, only then did spiteful states such as TX choose not to expand, even though 90% would be paid by the Feds. You've got chutzpah, Mr. Roy!
This column is a lie from start to finish, too long for me to refute in detail. Let me note two items, however: first, what good are "robust" tax credits if you're too poor to pay taxes? Second, the original ACA required all states to expand Medicaid. When the Supreme Court nullified this, only then did spiteful states such as TX choose not to expand, even though 90% would be paid by the Feds. You've got chutzpah, Mr. Roy!
7
When I initially read this, comments were not yet allowed. Glad they opened it up because like you, I saw it for what it is.
4
Thanks. Now I have another reason to dislike the Clintons.
No thanks on your Clinton-Romney Care.
No thanks on your Clinton-Romney Care.
1
Hang on - Has anyone out there ever gotten a notice from their insurer saying their premium was going down? If so please tell us... Adding to the insightful comments below... Roy states: "If the Republican plan increases participation by the young, premiums will become more affordable for everyone, because insurers set premiums to reflect an average of the costs of covering everyone who signs up for a given insurance plan. If only older people sign up, average costs in the plan are higher, leading to higher premiums. If young and old sign up, average costs are lower, and premiums go down". Roy has a lot of fake facts and this is magic thinking - insurers reducing your premium payment? LOL... What has not been said- I find this irresponsible dissemination by the NYT - to publish and not have a counterpoint. More magic thinking: "bipartisan" (bill) - President Obama lost momentum after he took office in thinking he could get bipartisan approval - a congress working together for America... No kumbaya in Washington...
3
Many of the so-called Democratic ideas were already compromises intended to attract GOP voters. Obamacare itself was such a compromise.
3
The Times should be embarrassed after publishing this piece of piffle. I know that this is the opinion page which should afford wide latitude to allow for the broadest possible range of opinion, but . . . there should be some base level of honesty and integrity required of contributors and their pieces.
Not only does this contributor and this piece fall well below even the basest of such standards, the piece does not even pass the laugh test.
Not only does this contributor and this piece fall well below even the basest of such standards, the piece does not even pass the laugh test.
7
Mr. Roy, here is something you will love from the father of free market capitalism:
He referred to the the merchants and manufacturers of that time (who
were the 0.1%then) as "the principal architects of policy" and "the masters of mankind". Their pursuit of "all for ourselves and nothing for other people,
seems, in every age of the world, to have been the vile maxim of the masters of mankind".
That's what you and your ilk are.
He referred to the the merchants and manufacturers of that time (who
were the 0.1%then) as "the principal architects of policy" and "the masters of mankind". Their pursuit of "all for ourselves and nothing for other people,
seems, in every age of the world, to have been the vile maxim of the masters of mankind".
That's what you and your ilk are.
6
they're doing all they can to avoid losing their health industry donations and freebies. at least one of them does it to help his daughter get richer, though he represents one of the sickest, poorest, most underserved states.
2
According to the article: "Republicans should appropriate additional funds to help low-income enrollees afford their deductibles."
I might believe that Republicans would to that if the Republicans first dropped their lawsuit to stop the payments of subsidies that reduce the out-of-pocket costs made by low-income enrollees that is part of the current law.
I might believe that Republicans would to that if the Republicans first dropped their lawsuit to stop the payments of subsidies that reduce the out-of-pocket costs made by low-income enrollees that is part of the current law.
5
Mr. Roy employs gracious, "feel-good" language to attempt to persuade the reader that this is a pretty good bill; but his argument is built on a house of cards.
It takes him until paragraph 8 to briefly acknowledge just a few of its fatal flaws, but like a sleight-of-hand artist, attempts to distract the reader from the following harsh truths:
Republican leadership is telling America that we can spend less (!) and have better healthcare outcomes by:
1) Giving a huge tax cut to the rich, and taking that money from healthcare.
2) Passing the resulting fiscal responsibility/liability from the US Government to the states, making Medicaid unsustainable in the process, and then saying "Nothing to look at here, everything is great" while 20+ million souls lose their healthcare and countless rural hospitals either close, or stop providing needed, money-0losing care such as obstetrics.
It will be impossible to deliver better US healthcare at a lower cost until the underlying, special-interest protected causes are addressed. Here are a few that other countries have wisely eliminated: Private Insurers add a minimum of 20% of the cost; we protect big pharma's immense profits by prohibiting negotiation on drug prices (!); We have too few doctors, and saddle them with immense student loan debt, so they charge way too much, and continue to do so after their debt is retired; and, our employer-based healthcare system is inefficient and unfair to both businesses and the poor.
It takes him until paragraph 8 to briefly acknowledge just a few of its fatal flaws, but like a sleight-of-hand artist, attempts to distract the reader from the following harsh truths:
Republican leadership is telling America that we can spend less (!) and have better healthcare outcomes by:
1) Giving a huge tax cut to the rich, and taking that money from healthcare.
2) Passing the resulting fiscal responsibility/liability from the US Government to the states, making Medicaid unsustainable in the process, and then saying "Nothing to look at here, everything is great" while 20+ million souls lose their healthcare and countless rural hospitals either close, or stop providing needed, money-0losing care such as obstetrics.
It will be impossible to deliver better US healthcare at a lower cost until the underlying, special-interest protected causes are addressed. Here are a few that other countries have wisely eliminated: Private Insurers add a minimum of 20% of the cost; we protect big pharma's immense profits by prohibiting negotiation on drug prices (!); We have too few doctors, and saddle them with immense student loan debt, so they charge way too much, and continue to do so after their debt is retired; and, our employer-based healthcare system is inefficient and unfair to both businesses and the poor.
7
Nope. The Individual Mandate did not come out of Romneycare. The truth is much more disturbing.
Although long denied, the Conservative Heritage Foundation DID introduce the Individual Mandate as part of its “plan for national health care” 1989. Romneycare was based on it.
The plan included financial help for the low-income to purchase insurance, as well as an IRS penalty for those who didn't, even if they could afford it.
Among those who advocated the Mandate: MILTON FRIEDMAN. NEWT GINGRICH. ORRIN HATCH. ARLEN SPECTER. BOB DOLE. GEORGE H.W. BUSH.
Democrats wanted a nonprofit plan and weren't advovating for a Mandate. Republican support was far from universal, but all of its advocates were Conservative Republicans.
Their rationale was based in Conservative values.
Being uninsured, tossing one's own
health expenses to society, violated PERSONAL RESPONSIBILITY.
The higher costs resulting from a lack of universal health care lacked FISCAL RESTRAINT.
The plan said Americans have an "implied social contract" that no one should suffer and die simply because they can't or haven't purchased coverage. But fulfilling the contract would require a Mandate, and those with means would have to contribute on behalf of those without.
Essentially, it was the price one paid for the priveledge of being an American.
The concept wasn't seen as unconstitutional, thievery or taxation without representation until Barack Obama proposed it in his plan.
Although long denied, the Conservative Heritage Foundation DID introduce the Individual Mandate as part of its “plan for national health care” 1989. Romneycare was based on it.
The plan included financial help for the low-income to purchase insurance, as well as an IRS penalty for those who didn't, even if they could afford it.
Among those who advocated the Mandate: MILTON FRIEDMAN. NEWT GINGRICH. ORRIN HATCH. ARLEN SPECTER. BOB DOLE. GEORGE H.W. BUSH.
Democrats wanted a nonprofit plan and weren't advovating for a Mandate. Republican support was far from universal, but all of its advocates were Conservative Republicans.
Their rationale was based in Conservative values.
Being uninsured, tossing one's own
health expenses to society, violated PERSONAL RESPONSIBILITY.
The higher costs resulting from a lack of universal health care lacked FISCAL RESTRAINT.
The plan said Americans have an "implied social contract" that no one should suffer and die simply because they can't or haven't purchased coverage. But fulfilling the contract would require a Mandate, and those with means would have to contribute on behalf of those without.
Essentially, it was the price one paid for the priveledge of being an American.
The concept wasn't seen as unconstitutional, thievery or taxation without representation until Barack Obama proposed it in his plan.
10
Leaving out all of the other unsupported drivel in this piece, just this puts it into the fantasy world:
‘...this increased spending on the uninsured was paid for through reforms of the Medicare program’
In what alternate universe would that be possible? Medicare already has lower administrative costs than private insurance. There is some fraud by service providers, but most of it is caught by the existing system. The benefits are already lean enough that auxiliary insurance is needed.
Also, the “robust system of tax credits” is imaginary. Nothing I have seen allows for one of the most important parts of the ACA - the reduction of the monthly premium cost by applying the tax credits in real time.* Even a refundable credit like the Earned Income Credit one wouldn’t help much if it is only paid after the fact, at the end of the tax year.
* The system isn’t perfect, I had to repay part of mine despite having entered correctly all of the information requested.
‘...this increased spending on the uninsured was paid for through reforms of the Medicare program’
In what alternate universe would that be possible? Medicare already has lower administrative costs than private insurance. There is some fraud by service providers, but most of it is caught by the existing system. The benefits are already lean enough that auxiliary insurance is needed.
Also, the “robust system of tax credits” is imaginary. Nothing I have seen allows for one of the most important parts of the ACA - the reduction of the monthly premium cost by applying the tax credits in real time.* Even a refundable credit like the Earned Income Credit one wouldn’t help much if it is only paid after the fact, at the end of the tax year.
* The system isn’t perfect, I had to repay part of mine despite having entered correctly all of the information requested.
6
The biggest cause of death is life. This may be too broad of an empirical truth for some to understand its' relevance to the American Healthcare debate. Please indulge me here for a moment. Every living thing including citizens of the USA will eventually die and will most likely need healthcare. Some sooner than later. Many will require healthcare to simply live longer or close to normally. Death and poor health can be a messy business often preceded by sometimes long and great suffering. In a free and civilized society, allowance of some sort for dealing with this harsh truth in an equitable fashion is absolutely mandatory. The USA is currently without this equality and is therefore bereft of a national sense of common decency which is also known in some circles as political correctness. Does anyone here see a problem with this idea?
5
Well, the citizens of every other developed nation see a huge problem with your idea.
Humans have used medicinal plants and even surgery to alleviate suffering and prevent death since prehistoric times. No era or society throughout history simply accepted preventable pain and death.
By your reasoning, 10,000 years of rescuing snd pain relief have been frivolous and unnecessary. So why do we do it? Because it's evolutionary. Our species would not have survived otherwise. Even dogs lick their wounds.
My father was kept alive far, far longer than he should have been. It was a nightmare. Our obsession with prolonging life no matter how low its quality or effect on limited resources is a huge problem.
But you're suggesting something completely nihlistic. Seriously, do you have loved ones? If your 8-year-old daughter was screaming because of an intestinal obstruction, would you leave her to die because everybody has to die sometime?
And do you realize many conditions cause great suffering but don't result in death? Epilepsy, rheumatoid arthritis, schizophrenia ... we should just ignore?
You entirely miss the point. We aren't angry because the bill doesn't let us live 1,000 years or make us look like movie stars.
We're angry because it takes away something even citizens of Romania, Romania, the Czech Republic, Serbia, and Ukraine have.
We have more resources than all those countries combined, more than any other nation on earth. You think we're asking too much?
Humans have used medicinal plants and even surgery to alleviate suffering and prevent death since prehistoric times. No era or society throughout history simply accepted preventable pain and death.
By your reasoning, 10,000 years of rescuing snd pain relief have been frivolous and unnecessary. So why do we do it? Because it's evolutionary. Our species would not have survived otherwise. Even dogs lick their wounds.
My father was kept alive far, far longer than he should have been. It was a nightmare. Our obsession with prolonging life no matter how low its quality or effect on limited resources is a huge problem.
But you're suggesting something completely nihlistic. Seriously, do you have loved ones? If your 8-year-old daughter was screaming because of an intestinal obstruction, would you leave her to die because everybody has to die sometime?
And do you realize many conditions cause great suffering but don't result in death? Epilepsy, rheumatoid arthritis, schizophrenia ... we should just ignore?
You entirely miss the point. We aren't angry because the bill doesn't let us live 1,000 years or make us look like movie stars.
We're angry because it takes away something even citizens of Romania, Romania, the Czech Republic, Serbia, and Ukraine have.
We have more resources than all those countries combined, more than any other nation on earth. You think we're asking too much?
3
You have totally misunderstood my meaning. I'm on your side. I live in Canada and am very happy with our single payer system.
Have a good day.
Have a good day.
1
Yes, I'm certain that people below the poverty line are jumping up and down at the prospect of "...a robust system of tax credits for which everyone under the poverty line is eligible." Fat lot of good tax credits will do if they can't afford care or insurance in the first place.
8
The Republican alternative-facts based spin continues with this ridiculous article.
The so-called Better Care Reconciliation Act is not a health-care bill at all. It is a tax cut to the very rich with just a weak attempt made to disguise it as a something "care" bill.
The only people who will get Better Care if it passes will be the very rich, and that too because of the tax-cuts they receive. The rest will only see their healthcare costs (premiums + deductibles + not covered care costs +copays) increase over their lifetime relative to what they would be under Obamacare (ACA).
The so-called Better Care Reconciliation Act is not a health-care bill at all. It is a tax cut to the very rich with just a weak attempt made to disguise it as a something "care" bill.
The only people who will get Better Care if it passes will be the very rich, and that too because of the tax-cuts they receive. The rest will only see their healthcare costs (premiums + deductibles + not covered care costs +copays) increase over their lifetime relative to what they would be under Obamacare (ACA).
8
Health care as seen by the Right only exists in imaginary locales. Noplace practices what the GOP preaches. In fact American healthcare comes closest. We let the market price millions out, we let drug companies charge what the market allows. We give supply and demand a greater say than any public unit, local, state, federal in delivering and pricing care. And what does this most market friendly system buy us? The most expensive and least effective health system ever designed. The rest of the civilized world pays less and gets more.
Only America still debates this. The world decided in the last century that health care is a utility, best delivered via a heavily regulated system. The modern world settled this, and moved on.
Among civilized nations, only in America do kids die from preventable, treatable causes. Only American kids lose parents to conditions and accidents that are routinely treatable. Only in America do families fall into dire poverty due to medical bankruptcies.
There are three-count 'em three health care delivery systems in place around the globe that deliver far better outcomes than we suffer--we rank 37th out of less than 40 advanced nations on the planet. AND, they’re cheaper.
Others pay a third less, some pay as little as half our rate. Got it? Cover everybody. Pay less. Improve outcomes. Everyplace but America.
And the GOP mumbles about ‘liberty’, and ‘free market’ and ‘can’t let it happen here’.
Talk about pathetic losers
Only America still debates this. The world decided in the last century that health care is a utility, best delivered via a heavily regulated system. The modern world settled this, and moved on.
Among civilized nations, only in America do kids die from preventable, treatable causes. Only American kids lose parents to conditions and accidents that are routinely treatable. Only in America do families fall into dire poverty due to medical bankruptcies.
There are three-count 'em three health care delivery systems in place around the globe that deliver far better outcomes than we suffer--we rank 37th out of less than 40 advanced nations on the planet. AND, they’re cheaper.
Others pay a third less, some pay as little as half our rate. Got it? Cover everybody. Pay less. Improve outcomes. Everyplace but America.
And the GOP mumbles about ‘liberty’, and ‘free market’ and ‘can’t let it happen here’.
Talk about pathetic losers
6
Four words sum up this entire hypocrite's exercise:
Mitch McConnell, polio survivor.
His neuromuscular junctions have more right to live long compared to the people on Medicaid.
For that matter:
John McCain, melanoma survivor.
I bet a long list can be constructed of the fortunate republicans.
Mitch McConnell, polio survivor.
His neuromuscular junctions have more right to live long compared to the people on Medicaid.
For that matter:
John McCain, melanoma survivor.
I bet a long list can be constructed of the fortunate republicans.
3
The op-ed wanders all through the universe to defend the increasingly complex system of providing healthcare for varying age groups with costs that increase as they age rather than just saying we need a single-pay plan that covers everyone with a healthcare premium determined by total costs divided by the number of beneficiaries.
Considering that back in 2009, the Conservatives went to great pains to tell us that health care reform will lead to denying treatment to elderly". They have achieved it with the current legislation. The conservative and Republican fallback to kicking millions out of health coverage and nursing home assistance would be the "death camps" they raised as an issue in 2009.
Considering that back in 2009, the Conservatives went to great pains to tell us that health care reform will lead to denying treatment to elderly". They have achieved it with the current legislation. The conservative and Republican fallback to kicking millions out of health coverage and nursing home assistance would be the "death camps" they raised as an issue in 2009.
4
This guy is such a shill. Everything he says is twisted, untrue or misleading. Sad!
3
All you have to do is follow the money. In this case, the money is moving, lots of it, from healthcare for the American people to 500 or so of the richest Americans and to corporations. Tax credits? Really? Avik Roy is selling the old snake oil. News flash, Avik: Tax credits for those under the poverty line are meaningless if you have to have money to spend to get the credit. They're just sending out surrogates and obfuscators to muddy the waters and talk up the "magic of the marketplace," when long experience has shown the marketing of healthcare has failed miserably to provide meaningful healthcare for 335 Million people. Only the rich need apply.
So here's the money trail. The Koch brothers manage billionaires' and corporate donations and they just announced they're cutting off any more money to Republicans (stooges) unless they get 2 things passed: Health Care repeal/replace and tax reduction (I won't call it "reform"). One Texas donor in their corral, Doug Deason, said that his,
"Dallas piggy bank” was now closed, until he saw legislative progress.
“Get Obamacare repealed and replaced, get tax reform passed, Get it done and we’ll open it back up.”
So here's the money trail. The Koch brothers manage billionaires' and corporate donations and they just announced they're cutting off any more money to Republicans (stooges) unless they get 2 things passed: Health Care repeal/replace and tax reduction (I won't call it "reform"). One Texas donor in their corral, Doug Deason, said that his,
"Dallas piggy bank” was now closed, until he saw legislative progress.
“Get Obamacare repealed and replaced, get tax reform passed, Get it done and we’ll open it back up.”
4
While I read your opinion in the Times, my wife read a column in the Post. She told me about your citing a study showing no benefit from Medicaid. There was a headline yesterday that someone cited that many would get sick without Medicaid coverage. So what is the True Truth?
I was able to read the article you cited while she read your article to me. It was in the New England Journal of Medicine, which is well edited and refereed, so usually pretty sound. Unfortunately, from the data that I read and the comment, you cherry-picked the data. While there was no significant change in lab data on patients, there was a very significant improvement in Financial stress; Diabetes, was diagnosed more frequently; and the authors were not intending to challenge benefit. In other words, your interpretation of the data was quite faulty, misleading and in this world of epistemological malpractice, a bold untruth.
I was able to read the article you cited while she read your article to me. It was in the New England Journal of Medicine, which is well edited and refereed, so usually pretty sound. Unfortunately, from the data that I read and the comment, you cherry-picked the data. While there was no significant change in lab data on patients, there was a very significant improvement in Financial stress; Diabetes, was diagnosed more frequently; and the authors were not intending to challenge benefit. In other words, your interpretation of the data was quite faulty, misleading and in this world of epistemological malpractice, a bold untruth.
8
Mr. Roy is absolutely correct. Moreover, he has missed the opportunity to explain that because the Senate Wealthcare (oops I really meant healthcare) bill is written in English and contains punctuation just like the United States Constitution, clearly the Founding Fathers would have approved and adopted the Senate bill as they did the Constitution.
I love Republican logic. It is like mixing George Orwell with Lewis Carroll without any of the difficult thinking!
I love Republican logic. It is like mixing George Orwell with Lewis Carroll without any of the difficult thinking!
8
Combine "Single Payer" + "Cost-effectiveness" + "Doctor-Patient Interaction Support" + "Insurance Reform" + "Patient Responsibilities"
1) "Single Payer": A) Direct Universal Primary Care(DUPC) using "Intelligent Smart Card" payment of subscribed care via multiple payers & competitively priced care administered by "MUTUAL Health Fitness Insurance Company" supporting prevention, self-care, 24 x 7 primary/chronic/palliative care; B) "Medicare for All Catastrophic Care" for high cost care administered by "MUTUAL Health Recovery Insurance Company". 2) "Cost-effectiveness Innovation":A) Comparative Effectiveness (CE) intervention study capability using open source, AI enabled& customizable EMR/EHR/ HIE/CE; B) PHARMA sponsors 340B Drug Pricing for those <= 400% of Poverty Level Income; C) Narrative notes entered by clinicians thus facilitating doctor - patient time & quality of interaction with help of trained Clinical Medical Assistants, Community Health Workers, Comparative Effectiveness Facilitators, Psychiatric Social Worker Assistants; D) Community-based adjudication of health care injury claims with obviation of tort system & with national claims data roll up; E) DUPC pricing of medication/lab/ imaging/ referral...services without facility code add-on; F) 24 x 7 evidence-based lowering of unnecessary ER visits/Hospitalizations with Clinical Practice Guideline feedback. 3) Patient Responsibilities: Entrepreneural support of community-wide fitness/self-care/public health ethics.
1) "Single Payer": A) Direct Universal Primary Care(DUPC) using "Intelligent Smart Card" payment of subscribed care via multiple payers & competitively priced care administered by "MUTUAL Health Fitness Insurance Company" supporting prevention, self-care, 24 x 7 primary/chronic/palliative care; B) "Medicare for All Catastrophic Care" for high cost care administered by "MUTUAL Health Recovery Insurance Company". 2) "Cost-effectiveness Innovation":A) Comparative Effectiveness (CE) intervention study capability using open source, AI enabled& customizable EMR/EHR/ HIE/CE; B) PHARMA sponsors 340B Drug Pricing for those <= 400% of Poverty Level Income; C) Narrative notes entered by clinicians thus facilitating doctor - patient time & quality of interaction with help of trained Clinical Medical Assistants, Community Health Workers, Comparative Effectiveness Facilitators, Psychiatric Social Worker Assistants; D) Community-based adjudication of health care injury claims with obviation of tort system & with national claims data roll up; E) DUPC pricing of medication/lab/ imaging/ referral...services without facility code add-on; F) 24 x 7 evidence-based lowering of unnecessary ER visits/Hospitalizations with Clinical Practice Guideline feedback. 3) Patient Responsibilities: Entrepreneural support of community-wide fitness/self-care/public health ethics.
1
Yea right. You can cut $800 billion out of national health insurance and throw more than 20 million Americans under the bus with no insurance and yet improve the whole scene as Avik states unabashedly. Spoken like a true Trump and Rick Perry fiction writer/apologist. Take a more careful look at Avik's misuse of figures and see that they add up to the same Republican priorities we've always seen. Benefits for the rich at the expense of the quality of life for the rest of us.
7
Mr. Roy is defender of the rich and wealthy. He and his organization have zero interest in planning and providing health care to average Americans. he does why the Republicans are trying every is possible to provide tax cut to the wealthy in guise of health care bills. Also there ample evidence that Medicare and Medicaid provide much better coverage than private insurance plans. He also like all USA to become Texas which one of worse health coverage for middle class and poor. I will have more respect for Mr. Roy if tells us that he interested in tax cut for wealthy as he is.
4
Avik Roy, the president of the Foundation for Research on Equal Opportunity, is the author of “How Medicaid Fails the Poor.”
==========================================
What does the above say about his political leanings (hence, biases) and his financial interests, not to mention his actual experience?
Our country is in poor shape, like it or not, because, or at least in spite of, these so-called experts and their so-called expertise. It is time we came clean on everyone's biases and inclinations since it is clear we do not have any objective and fair-minded policy experts anymore. Just paid shills of one stripe or the other.
==========================================
What does the above say about his political leanings (hence, biases) and his financial interests, not to mention his actual experience?
Our country is in poor shape, like it or not, because, or at least in spite of, these so-called experts and their so-called expertise. It is time we came clean on everyone's biases and inclinations since it is clear we do not have any objective and fair-minded policy experts anymore. Just paid shills of one stripe or the other.
4
So.... explain to me how the "Free Market" works in the Health Care arena where:
1. Purchasing Medical care, especially in an emergency [ie: heart attack, accident], or a chronic illness [ie: cancer] is a "Life or Death" not a discretionary decision.
AND
2. There is no ability to compare cost/price between vendor,,,... or even find a cost/price from any vendor.
?????
Purchasing Insurance may allow for more "comparison shopping" [free market]..... but not by much.
1. Purchasing Medical care, especially in an emergency [ie: heart attack, accident], or a chronic illness [ie: cancer] is a "Life or Death" not a discretionary decision.
AND
2. There is no ability to compare cost/price between vendor,,,... or even find a cost/price from any vendor.
?????
Purchasing Insurance may allow for more "comparison shopping" [free market]..... but not by much.
3
The "heritage" of the A.C.A. started with the Heritage Foundation.
Market-driven primary care insurance is illegal in most of the world, in part because it is immoral for investors and corporate management to take primary healthcare premiums stuff it in their pockets. That's about $400 billion a year here in the United States. Also, there is no reason for stock capitalization of the program.
Primary care would be most affordable and be most efficient for economy expansion, and most of all for the people, were it universal. Hospitalization, rehab, non-primary and elective coverages would be available in the marketplace, as in most industrialized countries.
Problem is the GOP and most neo-liberals are beholden to Wall Street, instead of the people.
Market-driven primary care insurance is illegal in most of the world, in part because it is immoral for investors and corporate management to take primary healthcare premiums stuff it in their pockets. That's about $400 billion a year here in the United States. Also, there is no reason for stock capitalization of the program.
Primary care would be most affordable and be most efficient for economy expansion, and most of all for the people, were it universal. Hospitalization, rehab, non-primary and elective coverages would be available in the marketplace, as in most industrialized countries.
Problem is the GOP and most neo-liberals are beholden to Wall Street, instead of the people.
2
I'm not sure that's true... just ask Sec of Health Tom Price.
1
Mr. Roy marshals thoughts but not facts. Moreover, no matter whose ideas are reflected in it, the Senate bill is a bad bill. As it languishes over the July 4 holiday, it will start to rot and smell like what it should be: dead.
2
Let's stop bothering even asking what the GOP agenda is.
Let's demand answers from the lobbyists who actually write these bills, the 400 families who will benefit enormously on the back of working class, poor, ill and elderly, and finally, the dark, deep state funding it. Let's shed some light on those 400 families and the Kochs and Mercers. Let's put them under a microscope, warts and all, like the rest of us will be.
Let's demand answers from the lobbyists who actually write these bills, the 400 families who will benefit enormously on the back of working class, poor, ill and elderly, and finally, the dark, deep state funding it. Let's shed some light on those 400 families and the Kochs and Mercers. Let's put them under a microscope, warts and all, like the rest of us will be.
4
In this "alternate universe," does the "Baucus-Collins Act" also give hundreds of millions in tax breaks to people who make over $500K/year? Strange that wasn't mentioned here...
2
It is deceptive to the point of lying to say that the CBO score is wrong about 15 million losing insurance because it doesn't take into account "what senators do to direct more financial assistance to the poor and the vulnerable." Obviously the CBO can only score the bill that is in front of it, not some hypothetical future financial assistance package that does not exist. And most likely never will exist as long as Republicans in are in charge. Ridiculous!
4
"Bipartisan Health Bill" Right maybe in an alternate universe. This bill has zero democratic support, which is what one expect of a mean-spirited bill that tramples on the poor while giving the super-rich yet more tax breaks. The only person that would like this Bill outside of the republicans in Washington would be Ebeneezer Scrooge.
3
Fortunately for you Mr. Roy, and unfortunately for the the rest of us, your constituency is ignorant enough to believe these lies wrapped in false equivalency.
First, unlike the Dems, the Republicans pointedly shut out ANY input from the Democrats, and held all their hearings secretly. In fact, the Dems decision to not go for Single Payer, and to adopt the Romney Care approach, was to try and win some Republican support. I still hold the Dems responsible for their misguided belief that the Republicans didn't really mean it when they said "We will obstruct every single piece of legislation presented by the Democrats and Obama". They would've been much better off - and the country would certainly have been much better off - if the Dems had done what the Republicans are now doing: ramming their uncompromised plan - Single Payer - through and let the Republicans squawk till the cows came home.
Second, "Two wrongs don't make a right". As I said above, keeping a for-profit health care system is working at cross purposes. There is no workable "supply and demand" mechanism - the providers will always be able to charge whatever they want because patients are in no position to argue, due to lack of medical knowledge, and their preservation instinct that will drive them to spend whatever it costs to be whole and well. If the Republicans truly want to fix the ACA - and they don't, they want to abolish it but lack the courage to do so - they would adopt Medicare For All.
First, unlike the Dems, the Republicans pointedly shut out ANY input from the Democrats, and held all their hearings secretly. In fact, the Dems decision to not go for Single Payer, and to adopt the Romney Care approach, was to try and win some Republican support. I still hold the Dems responsible for their misguided belief that the Republicans didn't really mean it when they said "We will obstruct every single piece of legislation presented by the Democrats and Obama". They would've been much better off - and the country would certainly have been much better off - if the Dems had done what the Republicans are now doing: ramming their uncompromised plan - Single Payer - through and let the Republicans squawk till the cows came home.
Second, "Two wrongs don't make a right". As I said above, keeping a for-profit health care system is working at cross purposes. There is no workable "supply and demand" mechanism - the providers will always be able to charge whatever they want because patients are in no position to argue, due to lack of medical knowledge, and their preservation instinct that will drive them to spend whatever it costs to be whole and well. If the Republicans truly want to fix the ACA - and they don't, they want to abolish it but lack the courage to do so - they would adopt Medicare For All.
4
"Imagine an alternate universe...." We don't have to imagine it. Just turn on Fox News, right-wing radio, and right-wing think tanks like Mr. Roy's. The whole purpose of the Republican health bills is to give the wealthy a huge tax cut. Right-wingers can try to dress up and put lipstick on that pig, but it's still going to be a pig. No developed country in the world has a market based healthcare system because they don't work. They all regulate healthcare costs and they all require everyone participate, either through a mandated insurance plan, tax funded single-payer plan, usually covering about 80% with supplemental insurance available to pay the rest; or a true socialized medical system like the UK's.
4
What a sorry excuse for an essay. It reads like some exercise in debate class, where one side is forced to defend the indefensible through sheer creativity of argument.
The very first paragraph gives the lie: "Democrats responded by [...] the centerpiece of their plan came from a Republican governor". Wrong. The Democrats responded by pointing out 18 months of public House and Senate hearings and debate, nearly 100 Republican amendments adopted into the final legislation, which only garnered zero Republican votes in the final months when they were INSTRUCTED by party leadership not to vote on it. Why? Because the Democrats had finally called their bluff on what were quickly becoming 'poison pill' amendments, meant to either slow down debate (after 18mos??) or kill the ability for the ACA to do what it was designed to do: make health insurance more affordable to more people.
Many of the flaws of the ACA then, and still today, are caused by the GOP's non-stop attempts to kill, maim, poison,or destroy the law's ability to work.
And now, we have Avik Roy trying to put lipstick on that pig by claiming the Democrats are really on board with all this, it's just 'posturing' by Pelosi for political effect. When they can no longer defend the indefensible, I guess it's best to blame your opponent for the result?
Guess what, GOP? Governance and government is not a classroom exercise! Real lives are at stake. Heck, the fate of civilization hangs in the balance.
The very first paragraph gives the lie: "Democrats responded by [...] the centerpiece of their plan came from a Republican governor". Wrong. The Democrats responded by pointing out 18 months of public House and Senate hearings and debate, nearly 100 Republican amendments adopted into the final legislation, which only garnered zero Republican votes in the final months when they were INSTRUCTED by party leadership not to vote on it. Why? Because the Democrats had finally called their bluff on what were quickly becoming 'poison pill' amendments, meant to either slow down debate (after 18mos??) or kill the ability for the ACA to do what it was designed to do: make health insurance more affordable to more people.
Many of the flaws of the ACA then, and still today, are caused by the GOP's non-stop attempts to kill, maim, poison,or destroy the law's ability to work.
And now, we have Avik Roy trying to put lipstick on that pig by claiming the Democrats are really on board with all this, it's just 'posturing' by Pelosi for political effect. When they can no longer defend the indefensible, I guess it's best to blame your opponent for the result?
Guess what, GOP? Governance and government is not a classroom exercise! Real lives are at stake. Heck, the fate of civilization hangs in the balance.
4
Note to Mr. Roy: If you now feel it acceptable to "borrow" successful ideas about health care, why don't we simply borrow the proven, cost-effective program that is working perfectly in much of the civilized world? Single payer for all....
5
So, another taxpayer subsidy of for-profit businesses, in this case, insurance companies and Big Pharma. Why not support for direct-delivery entities, like Kaiser Permanente or a consortium of health care providers? Or quantity drug prices negotiated by the VA or Medicaid? Oh, right, they don't fund campaigns. This is our first step in reducing the deficit and representing People. My proposal is draft legislation at www.thefairelectionsfund.com.
1
Mr. Roy managed to omit a central portion of the Trumpcare bill - huge tax cuts for the upper 1%. That's a major focus of this bill and one that he oh, so conveniently fails to justify.
3
Avik Roy has been all over the airway for a week peddling this claptrap. CBO report makes it clear the republican plan will result only reduce premiums (for some) by lowering the value of the benefits covered. Poor people won't fork over their limited funds for worthless policies with outlandish deductibles and out of pocket costs. This is nothing but a cynical ploy to 1) give a tax cut to the well off, and 2) cut back on medicaid as they've been trying to do forever. There's nothing in the bill that would improve care or lower the overall cost of healthcare.
2
From Wikipedia:
"FREOPP was founded in 2016, its mission is to consider "'he impact of public policies and proposed reforms on those with incomes or wealth below the U.S. median.' The organization portrays itself as non-partisan, "our aim is to become a credible bridge between those on the left and the right who genuinely want to expand opportunity to those who least have it,"[2] yet its staff and Board is comprised of conservative and Republican party insiders.
It appears that the organization's policy focus is healthcare and the repeal of the Affordable Care Act"
"FREOPP was founded in 2016, its mission is to consider "'he impact of public policies and proposed reforms on those with incomes or wealth below the U.S. median.' The organization portrays itself as non-partisan, "our aim is to become a credible bridge between those on the left and the right who genuinely want to expand opportunity to those who least have it,"[2] yet its staff and Board is comprised of conservative and Republican party insiders.
It appears that the organization's policy focus is healthcare and the repeal of the Affordable Care Act"
2
So how does he account for the 22 million who the CBO projects will lose insurance coverage under this bill?.
1
"If the Republican plan increases participation by the young, premiums will become more affordable for everyone.."
Big if.
Big if.
2
Imagine an alternate universe in which, in 2009, Democrats and Republicans passed a bipartisan health bill. - Yes, Bennet-Wyden, Medicare For All. Sure, the Kochs and their shills would have rolled in the dirt - as would those in the Democratic party who are in thrall to Big Pharma and the Med Device and Insurance Racketeers. In that universe many employment/underemployment problems vanish as people are free to try out new jobs without the risk of losing their insurance or the insurance coverage of their families. In that universe the Government uses some of that Free Market bargaining power the Randroids and Neo-Liberals go wild over to get us pharma prices more in line with what the rest of the World pays rather than the list-price sucker prices we pay now. In that universe the insurance companies would still be able to sell top-off insurance for those who do not wish to wait in line with the Little People for their x-rays, etc.. A Universe we can have right now if we toss this current stupidity of for-profit healthcare into the biohazard bin where it belongs.
3
Mr. Roy is an employee of the Koch Bros. The only purpose of the organization that he represents is to repeal the ACA and lower taxes for rich folks.
11
This article well represents the fantasy of market perfection and false equivalency tripe often illustrated by "conservatives".
6
Mr. Roy is certainly a dreamer for believing in this tax-cut masquerading as a health care bill.
6
I want to live in a culture where the idea of debating health care for all is ridiculous, not where we have ridiculous arguments parsing the fine points of why some people should and others shouldn't have health care.
6
No amount of apologist propaganda can make up for the shameful secrecy surrounding this bill's creation. The GOP's approach is an affront to democracy. Note that during the creation of the ACA the GOP were invited to craft it, but chose instead to 'resist' the 'not-born-here' Obama.
The slant of this paid opinion is completely in line with its financial source: the Koch brothers. As such, the "Foundation for Research on Equal Opportunity" must have warehouses full of lipstick. That, along with the morally weak, ethically delusional, and logically challenged arguments of Mr. Roy, should make for an interesting session with this pig of a bill.
The slant of this paid opinion is completely in line with its financial source: the Koch brothers. As such, the "Foundation for Research on Equal Opportunity" must have warehouses full of lipstick. That, along with the morally weak, ethically delusional, and logically challenged arguments of Mr. Roy, should make for an interesting session with this pig of a bill.
8
Where was Roy, 9, 19, and 29 years ago? This is today and applying today's math against a "would-have, could-have" approach that he suggests is still viable is so stupid, I am amazed that he has a voice to be heard.
Nine years ago, the first baby-boomers where under 65. Their ranks will flood the health care system in the decades to come. Nine years ago, insurance companies didn't have the same blank check they have today. Nine-years ago, the MIDDLE CLASS was a completely different picture entirely. STUDENT DEBT wasn't nearly as deep as it is today. Having a WORKING WAGE was much more in line with lifestyle. And WALL STREET was just about to bust under their own GREED!
Wake up Mr. Roy! Times change and so the do requirements to the greater good when this does happen. FDR, a silver-spooned child of the Great Depression knew enough that federal efforts would require greater sacrifices from his well endowed relatives, friends and countrymen.
We are finally emerging from our GREAT DEPRESSION with a growing elderly base that will challenge historical standards. "Would-have, Could-have" propositions are just stupid. They avoid staring the future in the face and finding real ways to attack the challenges ahead.
You can thank the NYT for your five minutes. But by my clock, your time is up.
Nine years ago, the first baby-boomers where under 65. Their ranks will flood the health care system in the decades to come. Nine years ago, insurance companies didn't have the same blank check they have today. Nine-years ago, the MIDDLE CLASS was a completely different picture entirely. STUDENT DEBT wasn't nearly as deep as it is today. Having a WORKING WAGE was much more in line with lifestyle. And WALL STREET was just about to bust under their own GREED!
Wake up Mr. Roy! Times change and so the do requirements to the greater good when this does happen. FDR, a silver-spooned child of the Great Depression knew enough that federal efforts would require greater sacrifices from his well endowed relatives, friends and countrymen.
We are finally emerging from our GREAT DEPRESSION with a growing elderly base that will challenge historical standards. "Would-have, Could-have" propositions are just stupid. They avoid staring the future in the face and finding real ways to attack the challenges ahead.
You can thank the NYT for your five minutes. But by my clock, your time is up.
5
Why is something like this allowed to be published without a fact checking? Just as when a politician tells untruths in an interview, it is the job of a serious journalist to report what the politician said while also pointing out any inconsistencies with the facts. Why is the New York Times held to a lower standard than Facebook - for crying out loud???
The GOP was consistently invited to participate in the creation of the ACA (ObamaCare), but they refused. Republicans were certainly not locked out of the process, nor was was the bill rushed through.
And how can Mr. Roy claim the Senate Atrocity Bill is not a cut to Medicaid that will not even reduce the budget deficit as it throws retirees out of nursing homes. The Senate Atrocity Bill will not cut the deficit because the savings from trashing Medicaid will go into the pockets of the 1%
Hopefully Mr. Roy does not believe he is deceiving any serious, sentient observer of the political process. Hopefully, he is only currying favor with corporate and foundation malefactors who do the bidding of the rapacious idiot elite (0.1%).
Unfortunately not everyone does pay serious and careful attention to the political process because if that were the case the GOP (and the Dems too) would operate much differently - and more in the public interest.
Mr. Roy should be ashamed and also shamed for this insult to common sense and common decency.
The GOP was consistently invited to participate in the creation of the ACA (ObamaCare), but they refused. Republicans were certainly not locked out of the process, nor was was the bill rushed through.
And how can Mr. Roy claim the Senate Atrocity Bill is not a cut to Medicaid that will not even reduce the budget deficit as it throws retirees out of nursing homes. The Senate Atrocity Bill will not cut the deficit because the savings from trashing Medicaid will go into the pockets of the 1%
Hopefully Mr. Roy does not believe he is deceiving any serious, sentient observer of the political process. Hopefully, he is only currying favor with corporate and foundation malefactors who do the bidding of the rapacious idiot elite (0.1%).
Unfortunately not everyone does pay serious and careful attention to the political process because if that were the case the GOP (and the Dems too) would operate much differently - and more in the public interest.
Mr. Roy should be ashamed and also shamed for this insult to common sense and common decency.
5
It doesn't matter if the bill has bipartisan aspects to it if it destroys people's lives. Mr Roy knows that; he's just hoping for cover.
6
It makes sense that there would be a component of bipartisanship to the bill, for health itself is a bipartisan issue. We are all people first but political jargon in a polarized system makes it easy to forget that.
Conflating the use of tax credits to buy health insurance in Maine with a 1995 proposal by President Clinton to tie increases in Medicaid spending to increases in the CPI can hardly be described as "bipartisan" as the former was an actual policy, whereas the latter was merely a proposal that was - wisely - never enacted. Likewise, Mr. Roy seems to confuse the cost of health insurance with the cost of health care. Legislation may well lower the cost of health insurance for some (but not all) consumers, but this will likely be due to the ability of insurers to once again offer policies with limited coverage and/or high deductibles. Such policies will not, however, lower the actual cost of health care, but will merely shift the burden to consumers and health care organizations who must treat the uninsured. The Senate bill would also significantly reduce Medicaid spending, but this can only be achieved by shifting more of the cost of health care to states and/or reduced coverage. Again, GOP proposals to repeal and replace the ACA focus primarily on the cost of health insurance and reduced Federal health care spending, but will do little to reduce overall health care spending.
9
Then again, theACA did little to reduce health care spending either
Whether one agrees with the details of Roy's analysis or not, he has done us a service by reminding us that there are more similarities between Obamacare and Trumpcare than advocates of either want to admit.
In both, private insurance companies stay firmly in control. Networks, restricting your doctor choice, remain. My tax payer dollars subsidize private insurances, whose executives earn millions yearly. Both plans have prominent roles for Medicaid, an insurance that many doctors aren't happy to accept because of low payments and hassles in getting those payments. (I know. I managed a family medicine office for 11 years.)
Medicaid is a national disgrace, not only for the hassle that it is for doctors, but especially because it requires patients to demean themselves by proving they're poor before they can get healthcare for themselves and children -- in the world's richest country. No one should have to grovel to get necessary healthcare.
Looking at 3 possible systems, Obamacare, Trumpcare, and Medicare for All, the first 2 look essentially alike. The one system which will bring the most meaningful and positive change for all of us is Medicare for All, with no networks, no subsidies to private insurances, and no 2 tiered system of one for the poor (Medicaid) and one for the rest.
In both, private insurance companies stay firmly in control. Networks, restricting your doctor choice, remain. My tax payer dollars subsidize private insurances, whose executives earn millions yearly. Both plans have prominent roles for Medicaid, an insurance that many doctors aren't happy to accept because of low payments and hassles in getting those payments. (I know. I managed a family medicine office for 11 years.)
Medicaid is a national disgrace, not only for the hassle that it is for doctors, but especially because it requires patients to demean themselves by proving they're poor before they can get healthcare for themselves and children -- in the world's richest country. No one should have to grovel to get necessary healthcare.
Looking at 3 possible systems, Obamacare, Trumpcare, and Medicare for All, the first 2 look essentially alike. The one system which will bring the most meaningful and positive change for all of us is Medicare for All, with no networks, no subsidies to private insurances, and no 2 tiered system of one for the poor (Medicaid) and one for the rest.
8
Why is all the middlemen necessary? Why is it a good thing to increase the role of private insurers? Why is it that "a robust (hah!) system of tax credits" is a better way to pay for health care of those below the poverty line? Isn't the simplest solution a well-regulated single-payer system?
We should be cutting out the vampires sucking on the blood of the people: the insurance companies, and all the congressmen, senators and lobbyists who have been bought and paid for by those who profit off the "business" of providing health care. Their quest for profits should no longer be allowed to interfere with our health and well-being.
We should be cutting out the vampires sucking on the blood of the people: the insurance companies, and all the congressmen, senators and lobbyists who have been bought and paid for by those who profit off the "business" of providing health care. Their quest for profits should no longer be allowed to interfere with our health and well-being.
7
Private insurers hire "claims managers" whose job it is to find ways to deny claims. The claims managers are paid well. Medicare for all would be able to hire claims managers whose job would be to examine claims for fraud, or excessive use of expensive medical machinery, etc. Private insurers are middle men in the business of managing health insurance, not health care. 33 years working in benefits for a large NE based corporation taught me a lot about insurance companies, claims managers, and the profit margins earned. Brokers made a lot of money selling various insurance plans; insurance companies spent a lot of money marketing their plans. Health care as provided by insurance companies is a for profit enterprise.
"If the Republican plan increases participation by the young"
It won't. We know this already. You can't start with a false assumption then imagine your way to a prosperous outcome. Even economists have more shame than Avik Roy.
I brought the point up earlier in a response but I'll mention it in general comments as well. If young adults are so compelled to buy insurance under the tax credit plan, why does the Republican bill still provide parental coverage until age 26? You're caught in your own lie. You know it won't work. History will not look kindly on this bill's proponents.
By the way, I was never a fan of the Clinton health care proposal.
It won't. We know this already. You can't start with a false assumption then imagine your way to a prosperous outcome. Even economists have more shame than Avik Roy.
I brought the point up earlier in a response but I'll mention it in general comments as well. If young adults are so compelled to buy insurance under the tax credit plan, why does the Republican bill still provide parental coverage until age 26? You're caught in your own lie. You know it won't work. History will not look kindly on this bill's proponents.
By the way, I was never a fan of the Clinton health care proposal.
6
I want to be part of a culture that removes capitalism from health care.
11
You conveniently omit the huge tax cut for the rich and the 6 month waiting period penalty the Senate bill includes. You are right to question the CBO data because the plan is unlikely to reduce the deficit at all--knowing the incompetence and greed of your party they will figure out a way to destroy any positive outcomes. They will simply blame Obama and the democrats as usual.
4
The author's living is paid for by the Koch-Bros.
It is sad to see the classic naming of a stealth org. as such.
It is sad to see the classic naming of a stealth org. as such.
5
"But the core planks of the Senate Republicans’ health bill . . . borrow just as much from Democratic ideas as Obamacare borrowed from Republican ones. The Senate bill’s plan to reform Medicaid . . . was borrowed from a nearly identical 1995 proposal by President Bill Clinton."
That's because Bill Clinton was a Republican in all but name.
"We're gonna end welfare as we know it." "The era of big government is over." Repeal of Glass-Steagall. Prescription drug ads. Dick Morris and triangulation. Big Macs and SUVs.
The Democratic healthcare plan is (or should be) Medicare for All.
All of you Democrats who advocate for a centrist, moderate plaform, LOOK AT WHERE THAT GOT US:
- The Republicans moved further to the right, and oppose their own previous plan: the ACA/Obamacare (written by the Heritage Foundation, based on Romneycare).
- The Democrats are left holding the bag for what used to be a center-right policy.
You don't open a negotiation by advocating for what you expect the ultimate compromise outcome to be. The Clinton "third way" has ruined the Democratic Party. All of this "moderation" and incrementalism is really just a frog in boiling water, a Republican wolf in Democratic sheep's clothing.
If you've been sitting at the table for 20 minutes and you don't know who the sucker is, YOU ARE THE SUCKER.
Wake up, Democrats!
Medicare for All.
That's because Bill Clinton was a Republican in all but name.
"We're gonna end welfare as we know it." "The era of big government is over." Repeal of Glass-Steagall. Prescription drug ads. Dick Morris and triangulation. Big Macs and SUVs.
The Democratic healthcare plan is (or should be) Medicare for All.
All of you Democrats who advocate for a centrist, moderate plaform, LOOK AT WHERE THAT GOT US:
- The Republicans moved further to the right, and oppose their own previous plan: the ACA/Obamacare (written by the Heritage Foundation, based on Romneycare).
- The Democrats are left holding the bag for what used to be a center-right policy.
You don't open a negotiation by advocating for what you expect the ultimate compromise outcome to be. The Clinton "third way" has ruined the Democratic Party. All of this "moderation" and incrementalism is really just a frog in boiling water, a Republican wolf in Democratic sheep's clothing.
If you've been sitting at the table for 20 minutes and you don't know who the sucker is, YOU ARE THE SUCKER.
Wake up, Democrats!
Medicare for All.
See response in Lies and the Lying Liars Who Tell Them (Franken, A. 2004). Roy seriously distorts the data and unimpeachable economic theory to support his and Congressional Republicans wrong headed conclusions on how the healthcare system works and how to fix it. Every single word that comes from the presses of conservative think tanks and their authors must be fact checked. To borrow a phrase from our intellectual President: "Sad."
What is Mr. Roy's expertise about this issue? He seems to be saying that he knows more than the CBO's combined expertise on such issues. This piece is completely illogical and wishful lack of thinking. Please don't waste NYT readers time by allowing such alternative universe habitants, devoid of any logical arguments. Thanks
3
He apparently works for a Koch-funded think tank. No further credentials are necessary.
4
I continually fail to understand how insurance can be bought via tax credits by people who do not pay taxes. I would make it a law that everyone running for political office was made to live without a job, without affordable housing, and without Medicaid, for 1 month in the poorest section of their districts. I also fantasize about bringing every baby who was born because abortions are illegal, or too difficult to obtain, to D.C. and dropping them off on the Capitol steps. Lets see those [mostly] BOYS jump in put their money and their selves where there mouths constantly are.
4
I'd admire the Republicans more if they stated their true feelings -- everyone should be on their own regarding their own health. The government should play no part in it. That would cost many lives, but these are lives the Republicans are willing to lose. As a person who believes that abortion should be universally available on demand, I am accused of accepting the deaths of many embryos. I accept that argument. We accept the deaths of our own forces and hundreds of thousands of civilians in our wars, and Republicans champion the deaths of people convicted of certain crimes.
At the moment, the Republicans are pretending that they mourn the loss of health coverage for millions, but they really don't. They should be honest about that.
At the moment, the Republicans are pretending that they mourn the loss of health coverage for millions, but they really don't. They should be honest about that.
3
"make no mistake: If the Senate passes this bill [...] we will look at the 2010s as a period of substantial progress in American health care."
A testable proposition with a potentially terrible cost.
A testable proposition with a potentially terrible cost.
3
The problem with both Dems and Pubs plans is that there is no "personal responsibility" component. A person who lives a healthy lifestyle has the same rate as a person that doesn't. Until we all take personal responsibility for our health then health care costs are going to continue to skyrocket.
1
Personal responsibility is important, but many peoples' poor health conditions or high health costs are a result of factors outside their control.
5
And genetics and the environment.
3
The links this author provides, claiming they document his assertions, contradict his own false claims.
He states "The Senate bill’s plan to reform Medicaid by tying per-enrollee spending to medical inflation through 2025 and to consumer inflation thereafter was borrowed from a nearly identical 1995 proposal by President Bill Clinton." But click on the link "a nearly identical 1995 proposal by President Bill Clinton" which contains the following statement that contradicts his claim "The average Federal payment for each category would be allowed to increase each year by the average annual change in economic output over the previous five years, before adjusting for inflation." Clinton, who was fighting to preserve Medicaid, offered that Medicaid funding would increase by the 5 year average increase in GDP (growing by 3.9% per year) plus inflation (about 3.5% per year) for an increase of about 7.4%. Republicans who were fighting then as they are now to cut Medicaid rejected Clinton's offer. They aren't offering a GDP increase, only a CPI increase (which is about 1.9% this year).
Nice try, Mr Roy. And this is just one of a number of false equivalence arguments in your article.
Your only statement that I agree with is the last phrase in your article "we will look at the 2010s as a period of substantial progress in American health care."
Yes, Obamacare has been and, I think, will continue to be the American approach to health coverage throughout the 2010's!
He states "The Senate bill’s plan to reform Medicaid by tying per-enrollee spending to medical inflation through 2025 and to consumer inflation thereafter was borrowed from a nearly identical 1995 proposal by President Bill Clinton." But click on the link "a nearly identical 1995 proposal by President Bill Clinton" which contains the following statement that contradicts his claim "The average Federal payment for each category would be allowed to increase each year by the average annual change in economic output over the previous five years, before adjusting for inflation." Clinton, who was fighting to preserve Medicaid, offered that Medicaid funding would increase by the 5 year average increase in GDP (growing by 3.9% per year) plus inflation (about 3.5% per year) for an increase of about 7.4%. Republicans who were fighting then as they are now to cut Medicaid rejected Clinton's offer. They aren't offering a GDP increase, only a CPI increase (which is about 1.9% this year).
Nice try, Mr Roy. And this is just one of a number of false equivalence arguments in your article.
Your only statement that I agree with is the last phrase in your article "we will look at the 2010s as a period of substantial progress in American health care."
Yes, Obamacare has been and, I think, will continue to be the American approach to health coverage throughout the 2010's!
3
You, sir, are delusional and have been drinking that GOP Kool-Aid for far too long. Stop maligning the mostly Republican CBO and recognize this "wealthcare" bill for what it is - another tax break for people who don't need it while the rest of us suffer. I was not able to afford an ACA plan the first two years it was in effect because of the limited availability of insurers in my area and the high cost of the plans and their high deductibles. By the end of 2015, many more cost effective plans were added to my state (NH) to include the one I have been paying for the past two years out of my own pocket as I'm self-employed. Prior to the ACA, I would have been excluded from buying most insurance plans because of "pre-existing" conditions and if I was able to get an insurance company to cover me, the monthly cost plus high deductibles would have made it ridiculous for me to pay for insurance. I opted instead to find health care providers who would take me as a self-pay. While I was able to afford my yearly physical so I could get my meds and keep a check on my health, I could not afford mammograms, eye exams, a colonoscopy, MRIs for my cervical disc degeneration, or the bunion surgery I recently had. I pay $500 with a $66 federal subsidy and have no deductible at all. I doubt very highly that the GOP's plan will beat that unless they find the compassion and soul they sorely lack and convert us to universal healthcare with a single payer like the rest of the first world countries.
2
Another Kool Aide drinker. Where do you get these guys. No,don't tell me, he is from a "think" tank, or, since no thinking goes on in these tanks, a data processing tank.
"But make no mistake: If the Senate passes this bill...." Many thousands will die for want of health care. The billionaires will become even more bloated, and sycophant data processing tanks will prosper perhaps even making their "founders" or chief sophists millionaires, well it's no t everything, but ...
"But make no mistake: If the Senate passes this bill...." Many thousands will die for want of health care. The billionaires will become even more bloated, and sycophant data processing tanks will prosper perhaps even making their "founders" or chief sophists millionaires, well it's no t everything, but ...
5
IF the young and old sign up. IF pigs could fly. Does the Times pick these poorly reasoned essays to placate some theoretical conservative reader or just to make them walk around intellectually naked in front of the clothed. It's like reading letters defending slavery written before the civil war. The cruel lies underlying both makes them indefensible. Enslaving people for free labor is evil.
Exploiting the sick and injured for profit is evil.
Exploiting the sick and injured for profit is evil.
7
We should just go back to the system we had prior to 2010, that was better for most people.
I am sick of both parties lying about health care.
Democrats: "If you like your health care plan, you can keep it." "The average family will see their premiums go down by $2,500 per year."
GOP: Won't admit that they believe healthcare is a privilege and that taxation is theft.
I am sick of both parties lying about health care.
Democrats: "If you like your health care plan, you can keep it." "The average family will see their premiums go down by $2,500 per year."
GOP: Won't admit that they believe healthcare is a privilege and that taxation is theft.
1
I am always amazed at what people will swallow as the truth.
"The Congressional Budget Office believes that solely because Republicans would repeal the A.C.A.’s individual mandate, by 2026, more than 15 million fewer people will buy health insurance, regardless of what senators do to direct more financial assistance to the poor and the vulnerable. That’s not a flaw in the Senate bill; it’s a flaw in the C.B.O.’s methods."
I am supposed to believe that you are smarter than an entire department of academics who use other experts to review their methods? When is the last time that your methods were peer reviewed? Most likely answer = Never!
"The Congressional Budget Office believes that solely because Republicans would repeal the A.C.A.’s individual mandate, by 2026, more than 15 million fewer people will buy health insurance, regardless of what senators do to direct more financial assistance to the poor and the vulnerable. That’s not a flaw in the Senate bill; it’s a flaw in the C.B.O.’s methods."
I am supposed to believe that you are smarter than an entire department of academics who use other experts to review their methods? When is the last time that your methods were peer reviewed? Most likely answer = Never!
2
I am amazed that the NYT would publish this opinion, a few days after the author published an almost identical story a few days ago in the Washington Post, which was called "pathetically dishonest" and completely disproved in this story by Jonathan Chait in New York Magazine:
http://nymag.com/daily/intelligencer/2017/06/defenses-of-senates-health-...
NYT readers deserve better than this!
From the Jonathan Chait story:
"Roy’s tactic of cherry-picking one (disputed) faceNYT readert of a single study in order to justify withholding access to medical care from the poor and sick is exactly the kind of rhetorical contortion necessary to justify a plan lacking any widespread public support."
From Wapo:
https://www.washingtonpost.com/opinions/the-senates-health-care-bill-cou...
http://nymag.com/daily/intelligencer/2017/06/defenses-of-senates-health-...
NYT readers deserve better than this!
From the Jonathan Chait story:
"Roy’s tactic of cherry-picking one (disputed) faceNYT readert of a single study in order to justify withholding access to medical care from the poor and sick is exactly the kind of rhetorical contortion necessary to justify a plan lacking any widespread public support."
From Wapo:
https://www.washingtonpost.com/opinions/the-senates-health-care-bill-cou...
6
Mr. Roy reportedly had a hand in drafting this atrocious bill so he has every incentive to lie about it. The GOP hypocrisy surrounding this process knows no bounds.
4
"voluntary-but-regulated individual insurance market"
What happens to someone who opts out and then has some health problem? Do you let them die? I suspect not, which leads to a huge free rider problem and the collapse of the proposed system.
I don't know why right wingers cannot get their minds around this sort of problem. There is a reason why the US is the *only* developed nation with a free market system and the *only* developed nation with serious healthcare problems.
What happens to someone who opts out and then has some health problem? Do you let them die? I suspect not, which leads to a huge free rider problem and the collapse of the proposed system.
I don't know why right wingers cannot get their minds around this sort of problem. There is a reason why the US is the *only* developed nation with a free market system and the *only* developed nation with serious healthcare problems.
2
Forty-nine percent of births in this country are covered by Medicaid. Sixty-four percent of nursing home residents are dependent on Medicaid. In states such as Alaska, Mississippi and West Virginia that number is upwards of seventy-five percent.
Trumpcare will not deliver good outcomes for either of those groups, Mr. Roy, no matter how much lipstick you smear on the face of the pig that is the AHCA.
Trumpcare will not deliver good outcomes for either of those groups, Mr. Roy, no matter how much lipstick you smear on the face of the pig that is the AHCA.
A combination of deception and abject uncaring. Not an "alternative opinion", but an apologetic for greed.
2
As I started to read this Op Ed, I began with an open mind honestly believing that perhaps the author was right - that Democrats and Republicans were closer on the issues than perhaps I had imagined. But I soon lost track of the logic, thinking I wasn't smart enough to follow. Then it dawned on me. I realized this writer was a right-wing shill trying to make credible a Senate bill that is nothing but a disaster for America's health care system. This is the problem with the right today (not always the case in the past). They throw logic and reason out the window in the service of politics. What a shame.
5
He fails to mention that one Republican contribution to the ACA was failing to expand Medicaid in all states, if they hadn't contributed this bit, then the people around the poverty line would have been covered by the ACA, not needing to meet premiums or deductibles.
I also doubt that there is a consensus that Medicaid and Medicare costs need reduction; I feel we need tax increases to fund them fully, but that is a different matter entirely.
I also doubt that there is a consensus that Medicaid and Medicare costs need reduction; I feel we need tax increases to fund them fully, but that is a different matter entirely.
2
Avik Roy’s framing is that there are two polarized partisan views of reform and that somewhere in the middle is the compromise on which we can all agree. Nonsense.
If we are to use linear polarization to frame the debate, then the two sides are health care policies that benefit the patients - all patients - versus health care policies that cater to special interests, whether they be the medical-industrial complex or the political ideologues.
The similarities noted by Roy are due to the fact that the neoliberal views of the Democrats are not that far from the conservative views of the Republicans, in spite of all the noise generated by this debate. Trying to establish policies that benefit the various special interests results in the profoundly expensive, highly wasteful, inequitable, fragmented, dysfunctional system that we have.
A well designed single payer system takes care of patients first, with much greater efficiency, effectiveness, and equity. The special interests that might otherwise appropriately benefit would do well in such a system though they would have to set personal greed and vacuous ideology aside.
If we are to use linear polarization to frame the debate, then the two sides are health care policies that benefit the patients - all patients - versus health care policies that cater to special interests, whether they be the medical-industrial complex or the political ideologues.
The similarities noted by Roy are due to the fact that the neoliberal views of the Democrats are not that far from the conservative views of the Republicans, in spite of all the noise generated by this debate. Trying to establish policies that benefit the various special interests results in the profoundly expensive, highly wasteful, inequitable, fragmented, dysfunctional system that we have.
A well designed single payer system takes care of patients first, with much greater efficiency, effectiveness, and equity. The special interests that might otherwise appropriately benefit would do well in such a system though they would have to set personal greed and vacuous ideology aside.
2
The key phrase in this article is "alternate universe", because this guy is living in one.If back in 2009 Republicans participated in creating Obama Care, and if in the 8 years since they worked with Democrats to improve Obama Care we might actually be providing health great health care to all Americans.Back here in the real world, The Republican Party wants to end Medicare, medicaid and social security. Then they can reduce the taxes on the Kochs, Trumps and those other poor unfortunate people who's daddys gave them all of their money.
3
"It’s likely that, if the Senate bill passes, more Americans will have health insurance five years from now than do today." In what universe would this be true? People will not be able to afford the high insurance premiums or high deductibles so will go uninsured by the millions causing hospitals to close their doors. With the Medicaid cuts nursing homes will also close as they have in Iowa in the past year when the private companies chosen to run Medicaid for the state didn't bother to pay them!
1
Roy makes a case for supporting BCRA however specious it is. He argues that we are to believe Republican senators and shills and disbelieve the nonpartisan CBO. That only works with the deluded and delusional Republican base.
Nowhere does Roy make a verifiable case that the BCRA will improve upon or be better than the ACA. And nobody in the Senate believes what Trump claims - everyone covered, better coverage and lower costs. I didn't vote for Trump but if I did and I was routinely lied to or misinformed, I would be angry and feel betrayed.
It is very possible that a few million lives will be ruined, and thousands will needlessly suffer or lives will end prematurely to satisfy the Republican's obsession with dismantling and debasing government while increasing an unprecedented level of income and wealth inequality. BTW, the effects of this legislation won't discern how you vote - R's and D's will be punished equally.
Nowhere does Roy make a verifiable case that the BCRA will improve upon or be better than the ACA. And nobody in the Senate believes what Trump claims - everyone covered, better coverage and lower costs. I didn't vote for Trump but if I did and I was routinely lied to or misinformed, I would be angry and feel betrayed.
It is very possible that a few million lives will be ruined, and thousands will needlessly suffer or lives will end prematurely to satisfy the Republican's obsession with dismantling and debasing government while increasing an unprecedented level of income and wealth inequality. BTW, the effects of this legislation won't discern how you vote - R's and D's will be punished equally.
34
Everyone knew the AHA was a huge endeavor and it would need tweaking after the dust settled. The problem is, after the dust settled the Democrats didn't own up to the fact it wasn't perfect. They didn't list what needed to be changed. If they had done that then we would be in a better place today. The Republicans couldn't have a reason to overhaul the whole thing.
3
Actually democrats including President Obama reached out to republicans in congress to fix the ACA. The republicans in Congress in turn basically said, no thanks, we'd rather just repeal it than fix it. They made it clear they wanted the ACA to have problems to help get people behind them to repeal it and to beat democrats with those problems. Keep in mind that since 2011 republicans have been in control of the House of Representatives and have had the ability to filibuster in the Senate then gaining control in 2014.
3
On another note - after the ACA was passed, thanks to massive conservative propaganda, the Republicans gained control of the House in 2010. Most of the provisions of the ACA came into effect after 2010, so by the time it was clear what tweaks were needed, the possibility of any tweaking had long passed.
3
That's not correct. Republicans fought the ACA at every turn. They defunded the 'risk-corridors' for example. The ACA was never allowed to function as designed. Democrats knew how to fix it but the idea that Republicans would have helped files in the face of Republican obstruction for the past 8 years.
3
If you can show me a truly free market anywhere, I'll show you a corporation trying to manipulate it to their own benefit and prevent competition from anyone. Creating barriers to entry into a market by others is one of the key elements of modern corporate strategy.
4
If you own the means of production, you control the market. There is no such thing as a "free" market. There is no such thing as a "free" market in insurance; the corporations which own the insurance providers/plans attempt to set pricing and standards for claim management. Individual States have entered into this by mandating certain benefits, as opposed to the plans offering fewer benefits. I lived in CT for 33 yrs., and there were mandated benefits; there were mandated benefits in Mass., VT and NH. Florida also had mandated benefits. If a provider wanted to sell plans in those States, they had to offer plans reflecting those mandated benefits. There is more than one way to skin a cat, no matter what the Republican wish list is.
Mr. Roy talk a good game, but if implemented the Senate bill will provide flexibility to healthy people by draining the funds from the risk pool. That will make insurance for those who actually need to use it to pay health bills unaffordable and less reliable.
Republicans and Mr. Roy keep trying to add up the same numbers and get a different result. They discuss average premiums in the abstract without talking about the coverage provided and who is going to pay what. If passed, we will see how this experiment works out, but since we've been here before, I don't expect a better result.
Republicans and Mr. Roy keep trying to add up the same numbers and get a different result. They discuss average premiums in the abstract without talking about the coverage provided and who is going to pay what. If passed, we will see how this experiment works out, but since we've been here before, I don't expect a better result.
4
The private sector cannot profitably provide health care insurance that is simultaneously affordable and universal. No country has ever been able to do it. Ours won’t either. The reason can be summed up in one word that economists are quite familiar with: externalities (Google it!).
A private insurance company expects, and rightly so, to make a profit. It receives premiums and pays out for medical, marketing, and other operating expenses. The problem is that all of its income comes from premiums. Therefore, to make a profit it has to charge very high premiums (not affordable), and/or limit benefits through exclusions, preconditions, deductibles, copays, etc. (not universal), or a combination of both.
When a person is healthy, that person can work at a job, make money, purchase goods and services, which create jobs, and pay taxes. But no part of those benefits accrues to the private sector insurance company. They all accrue to society in general. Thus, a public sector insurer (Medicare, Medicaid, single-paer) can afford to charge lower premiums than a private insurer, or even no premiums at all.
A private insurance company expects, and rightly so, to make a profit. It receives premiums and pays out for medical, marketing, and other operating expenses. The problem is that all of its income comes from premiums. Therefore, to make a profit it has to charge very high premiums (not affordable), and/or limit benefits through exclusions, preconditions, deductibles, copays, etc. (not universal), or a combination of both.
When a person is healthy, that person can work at a job, make money, purchase goods and services, which create jobs, and pay taxes. But no part of those benefits accrues to the private sector insurance company. They all accrue to society in general. Thus, a public sector insurer (Medicare, Medicaid, single-paer) can afford to charge lower premiums than a private insurer, or even no premiums at all.
5
More healthcare delivery advice from a(nother) free market conservative. Great. Let's look at the success the last conservative proposal enjoyed. The one put together by the Heritage Foundation which was adopted by Massachusetts and labeled Romneycare, then adopted by the federal government and labeled Obamacare, then roundly excoriated by virtually every conservative in the nation and labeled as a failure by virtually every Republican.
Well, if the Avik Roy/Collins-Baucus proposal is such a good one, they should have no trouble persuading one of the 30 states that Republicans control to give it a try. It worked so well for Mitch Romney.
Well, if the Avik Roy/Collins-Baucus proposal is such a good one, they should have no trouble persuading one of the 30 states that Republicans control to give it a try. It worked so well for Mitch Romney.
5
"Secretly bipartisan:" This bill takes the worst ideas from both parties.
3
Avik Roy is and has been a shill for so-called "market driven" health insurance, and health care, from time immemorial. You can Google it.
Roy has no deep professional background in healthcare. He started in the biz by being a tout for medical device investment opportunities.
He is a smart guy who is forced, to maintain his connection with the conservative right wing of the Republican party by going on Fox News from time to time and make cringingly distorted statements about healthcare policy.
Can he cherry pick the Senate health care Obamacare replacement bill to try to put bi-partisan lipstick on that pig?
Of course. That's what he does for a living.
Does it have any relationship to the predictably disastrous outcome of the Senate-cum-House replacement for Obamacare? A disaster already forecast by the mercifully somewhat contained melt down we have already seen resulting from Obama having sold out to PhRMA and Big Insurance by having Max "the knife" Baucus kill the Public Option in Committee. Or the flop of Medicare Part C, which provided as a risk free playground for private insurers who claimed they could compete against Medicare Part B - if they, um, got subsidies.
Not at all.
Trust the CBO and Paul Krugman on this, not someone who has made his living mainly by advising medical device manufacturers, you know, the public spirited crowd whose stocks Tom Price made a killing on, which was viewed by Trump as a feature, not a bug, for his becoming HHS Secretary.
Roy has no deep professional background in healthcare. He started in the biz by being a tout for medical device investment opportunities.
He is a smart guy who is forced, to maintain his connection with the conservative right wing of the Republican party by going on Fox News from time to time and make cringingly distorted statements about healthcare policy.
Can he cherry pick the Senate health care Obamacare replacement bill to try to put bi-partisan lipstick on that pig?
Of course. That's what he does for a living.
Does it have any relationship to the predictably disastrous outcome of the Senate-cum-House replacement for Obamacare? A disaster already forecast by the mercifully somewhat contained melt down we have already seen resulting from Obama having sold out to PhRMA and Big Insurance by having Max "the knife" Baucus kill the Public Option in Committee. Or the flop of Medicare Part C, which provided as a risk free playground for private insurers who claimed they could compete against Medicare Part B - if they, um, got subsidies.
Not at all.
Trust the CBO and Paul Krugman on this, not someone who has made his living mainly by advising medical device manufacturers, you know, the public spirited crowd whose stocks Tom Price made a killing on, which was viewed by Trump as a feature, not a bug, for his becoming HHS Secretary.
5
it seems like Roy skimmed through the CBO report. the report says _22 million_ fewer people will have insurance by 2026. 15 million is the number of people who, according to CBO, will lose insurance _by next year_.
Roy claims the CBO report is based on faulty assumptions, but doesn't bother to defend his thesis. instead, he just proclaims that people who will be thrown off medicaid will purchase insurance on the free market using subsidies. this won't happen. in the senate bill, subsidies only cover plans with very high deductibles ($6000 or so). someone who makes 15000/year or less would be stupid to buy a plan with such a high deductible. so virtually nobody who gained medicaid due to obamacare but loses it after this bill will transition to a private plan. if Roy has a different opinion, he might as well defend it, since it's not clear at all how this is supposed to work.
even Roy's claim that young and healthy people are more likely to join the exchanges and thus drive down premiums seems false, or at least widely misleading. sure enough, the senate bill allows insurers to sell skimpier plans (higher deductibles and/or narrower coverage) and thus people who but those plans will enjoy lower premiums - but that's just because they will buy a crappier product. what's more, premiums for the more generous plans might in fact become _more expensive_, as the existence of the very skimpy plans will allow segmentation of the market based on health status.
Roy claims the CBO report is based on faulty assumptions, but doesn't bother to defend his thesis. instead, he just proclaims that people who will be thrown off medicaid will purchase insurance on the free market using subsidies. this won't happen. in the senate bill, subsidies only cover plans with very high deductibles ($6000 or so). someone who makes 15000/year or less would be stupid to buy a plan with such a high deductible. so virtually nobody who gained medicaid due to obamacare but loses it after this bill will transition to a private plan. if Roy has a different opinion, he might as well defend it, since it's not clear at all how this is supposed to work.
even Roy's claim that young and healthy people are more likely to join the exchanges and thus drive down premiums seems false, or at least widely misleading. sure enough, the senate bill allows insurers to sell skimpier plans (higher deductibles and/or narrower coverage) and thus people who but those plans will enjoy lower premiums - but that's just because they will buy a crappier product. what's more, premiums for the more generous plans might in fact become _more expensive_, as the existence of the very skimpy plans will allow segmentation of the market based on health status.
4
Thanks for exposing Mr. Roy's nonchalant writing. Such nonsense piece would never see light of day in a peer-reviewed publication. NYT op-ed pieces should include
1
"It’s likely that, if the Senate bill passes, more Americans will have health insurance five years from now than do today.". You've got to be kidding. Right???
3
No one is buying this nonsense. There is no other CBO and it is non partisan it is led by a Republican Trump appointment and ignoring political noise is respected and trusted by all parities. It's like an angry little league parent shouting at the ref.
No democrat is going to cheer the rollback of the expansion. If they have reform ideas that will lower costs while keeping quality and keeping or expanding covered lives great. They don't have that so we should focus on shoring up the system as it is and make what cost reforms we can.
No democrat is going to cheer the rollback of the expansion. If they have reform ideas that will lower costs while keeping quality and keeping or expanding covered lives great. They don't have that so we should focus on shoring up the system as it is and make what cost reforms we can.
17
There is no "quality" to keep. Our medical system performs in the bottom half of all industrialized nations, mostly due to cost and access. This whole idea that "America has the best health care anywhere" just is not born out by the facts.
3
The biggest reason why Democrats are against the Senate bill is because of the massive transfer of wealth from the poor to the rich. What's striking is that if a middle class person goes out on their own, they could quickly become poor because of the cost of insurance.
I'm sure that if the current taxes were left in place, there is plenty of room for discussion on per capita caps and other performance based mechanisms that could decrease cost while improving care. A grand compromise is possible.
I'm sure that if the current taxes were left in place, there is plenty of room for discussion on per capita caps and other performance based mechanisms that could decrease cost while improving care. A grand compromise is possible.
12
The Senate bill doesn't take from the poor and give to the rich. It just causes the government to steal a little less from the rich and to give less to the poor.
Everybody understands that there are reasonable limits to what government can afford. But the health care debate bring to light the judgments, values and priorities. I believe that providing truly affordable coverage for all Americans - which not even the ACA does - is more important than $800 billion in tax cuts for wealthy persons and the nearly $700 billion spent annually on defense, the latter of which can and should be cut by 20 or 30%. Which side are you on?
6
Once again we see Republicans and apologists like Roy touting tax credits for people below the poverty level as a benefit. How do tax credits help people who do not file tax returns help them? Please explain.
Tax policy is not economics. Tax cuts do not cure cancer or stimulate greater investment by the wealthy either. I certainly don't get up each morning looking forward to a tax refund once a year. Not being wealthy means even tax cuts that affect my low wages barely register. The last time taxes were cut, under Bush, I saw I could afford the buy one Starbucks latte a week as a result.
This has nothing to do with keeping Americans healthy. "Freedom's just another word for nothing left to lose," sang Janis Joplin year ago. In Roy's world her words are more relevant than ever.
Tax policy is not economics. Tax cuts do not cure cancer or stimulate greater investment by the wealthy either. I certainly don't get up each morning looking forward to a tax refund once a year. Not being wealthy means even tax cuts that affect my low wages barely register. The last time taxes were cut, under Bush, I saw I could afford the buy one Starbucks latte a week as a result.
This has nothing to do with keeping Americans healthy. "Freedom's just another word for nothing left to lose," sang Janis Joplin year ago. In Roy's world her words are more relevant than ever.
7
Saying that this health care bill is bipartisan because it takes a page from a plan the Clinton Administration put forth in 1994, over twenty years ago, is pretty lame. The world has changed plenty since then. Here are the very real questions not addressed in this op-ed which prevent this bill from a true bipartisan approach: 1) why can't we have single payer for all like other civilized nations 2) why does a tax break for the wealthy have to come at our most vulnerable citizens expense 3) why won't the Republicans who were in charge when we got into the endless war in the middle east get us out and used those saved and plentiful dollars to improving the lives of citizens in the USA?
4
After swearing for decades on their loving value of babies, the truth about Republicans is out: Don't give a fig.
Half of ALL births in this country are handled through Medicaid.
HALF. 50%. One in two.
So, they strip out close to a trillion dollars from Medicaid.
At the same time that they are zeroing out Planned Parenthood.
Republicans: Do not EVER again mouth your smarmy platitudes about those "babies" you claim you love.
Never again are you to even speak of the pre-born OR the born.
You ripped off your mask and stand revealed as pathological sociopaths.
Get out of my political world, creepy men.
Go home. Go back where you came from.
We don't need men like you sentencing pregnant women and the children they carry because they CHOOSE to or women wishing to abort the zygotes they carry to back-alley abortions OR back-alley deliveries.
We were right all along: It's not the woman, the zygote or the infant that you care about.
It's all just power, blind, stupid, unreasoned power.
Get out.
We don't need you.
Half of ALL births in this country are handled through Medicaid.
HALF. 50%. One in two.
So, they strip out close to a trillion dollars from Medicaid.
At the same time that they are zeroing out Planned Parenthood.
Republicans: Do not EVER again mouth your smarmy platitudes about those "babies" you claim you love.
Never again are you to even speak of the pre-born OR the born.
You ripped off your mask and stand revealed as pathological sociopaths.
Get out of my political world, creepy men.
Go home. Go back where you came from.
We don't need men like you sentencing pregnant women and the children they carry because they CHOOSE to or women wishing to abort the zygotes they carry to back-alley abortions OR back-alley deliveries.
We were right all along: It's not the woman, the zygote or the infant that you care about.
It's all just power, blind, stupid, unreasoned power.
Get out.
We don't need you.
13
Bill Clinton's plan? Is this the same Bill Clinton that threw those that needed public assistance under his campaign bus?
1
Trump and his henchmen (particularly McConnell) epitomize the worship of force and the practice of cruel intolerance, an ugly spirit now emerging and taking hold in the US. It is the antithesis of securing a national minimum of civilised life ... open to all alike, of both sexes and all classes, by which we mean sufficient nourishment and training when young, a living wage when able-bodied, treatment when sick, and modest but secure livelihood when disabled or aged. What’s so unreasonable and unjust about that?
4
The author is probably right, if the GOP pulls off this abomination Americans will have a better plan in 5 years. It will be called single payer, Medicare for all, and will be the first bill passed in 2021 by overwhelming Democratic majorities in the House and Senate and signed by the Democratic president, whoever she may be. The Republicans will be irrelevant because there will be so few of them.
6
We can hope.
1
Does the Times (and other elite "mainstream media", e.g., Meet the Press, PBS Newshour) ALWAYS have to have some right wing think tank payrolled apologist token talking head spout ideological fact and logic free malarky to prove that they are do not suffer from "liberal bias"?
7
It's a democracy. Everybody gets a chance to talk. And it's good to hear what the other side thinks so you can fashion the most perfect rebuttal.
To conservatives: If market forces for the delivery of healthcare worked we wouldn't be having this "discussion." Market forces in healthcare haven't worked in the past and they don't work now. Market forces might work for medical hard goods and RX. Maybe.
Market forces, applied to health care delivery, is how we got so many uninsured going to the ER for regular medical treatment, thus over burdening the hospital systems, that we needed to start this discussion way back when, a'la Hillary Clinton, or farther back even than that.
To conservatives: If market forces for the delivery of healthcare worked we wouldn't be having this "discussion." Market forces in healthcare haven't worked in the past and they don't work now. Market forces might work for medical hard goods and RX. Maybe.
Market forces, applied to health care delivery, is how we got so many uninsured going to the ER for regular medical treatment, thus over burdening the hospital systems, that we needed to start this discussion way back when, a'la Hillary Clinton, or farther back even than that.
1
Listening to Roy's interview on NPR. His argument boils down to "this bill is good enough and could be improved" and justifies moving forward because the same was said of the ACA. Head exploding in 3...2...1.
2
You know, all this would really be quite humorous if it weren't so sad. Every advanced nation has long since solved the riddle of healthcare delivery - every advanced nation except one, that is. And that one is indeed exceptional, devoting nearly twice the percentage of its GDP to healthcare than do the rest. There is no need for these divisive contortions, but there is a reason - greed, plain and simple. Let the sacred free market operate in the medical equipment and pharma sectors, but let's balance the market power of medical providers with the buying power of an entity with but one objective - the health and well-being of its citizens. Insurance companies cannot serve two masters, their insured base and their shareholders, and invariably place profits over care. As Harvard Medical School professors Jerome Groopman and Pamela Hartzband describe in the current issue of NYRB, many industrialized nations (Germany, Japan, Belgium) utilize uniform negotiated fee schedules, as does Medicare - and without the substantial administrative costs. A public option, stripped from ACA to appease the GOP, would demonstrate the viability of government administered coverage that places patients rather than money or profit at the center of our healthcare system. We are wasting precious time, resources, and most of all lives. It's time for our country to grow up and join the rest of the world.
82
Let the free market work all across the system, especially in the individual interaction between the patient and the physician. Back the market with a limited regulatory system to protect against problems like gouging patients who need emergency care. Further back the market with universal (yes government sponsored, taxpayer supported) insurance that provides a financial cushion across the board for those who suffer extraordinary medical expenses and index that insurance to income and/or wealth. Our legislators continue to dodge a key issue which is that the health insurance system itself, as currently structured is probably the largest single drain on healthcare dollars and contributes almost no value in terms of improving healthcare.
1
It is an empirical fact that the greatest cause of death is life. The greatest cause of horrible things humans are capable of doing to each other in the name of wealth is nothing more than simple greed at the bottom line. Fear can be a useful motivator used by cynical world leaders like Trump and Putin but the bottom line is always greed for them and their ilk. Difference is that in Russia the population has been so demoralized by a long line of despots they have lost any illusion that they have any control over their lives. So called deplorables in the USA are not deplorable at all but are misguided and goaded by people like Trump to express their disappointment inappropriately ie: "Politically Correct", a term also known as "Common Decency". A single payer system would go the longest way to making America really exceptional by taking care of all Americans especially those that now suffer and will suffer even more from the morally bankrupt crew now in control of the USA.
1
Roy writes, "It’s likely that, if the Senate bill passes, more Americans will have health insurance five years from now than do today."
The CBO, a non-partisan research organization claims that 22 million will lose health insurance.
Whom do you believe, the CBO or Roy?
The CBO, a non-partisan research organization claims that 22 million will lose health insurance.
Whom do you believe, the CBO or Roy?
4
Calling a subsidy "robust" does not make it so, wishful thinking nonetheless.
8
When you cut Medicaid by @25%, and devote the savings to tax reductions and defense spending, there is no way to avoid murdering a great many poor, disabled, and disadvantaged people. Republicans talk about cutting costs, but decreeing that patients pay less is hardly a rational way to do it unless you actually wish to murder those people. Maybe Republican policy makers do. But to anyone concerned for the public welfare and the value of human life, better to do what business does when what it provides costs too much. Cut the costs. Insurers take 20% off the top; Medicare takes 3%. Fee for service costs vastly more than alternatives, and gives incentives to increase the costs of providing "services." Congress forbids Medicare and Medicaid from negotiating drug prices. Countries that do negotiate those prices, like Canada, get drugs for a fraction of what we pay. Tackle those problems, Mr. Roy, and you will be on the right track.
9
I guess, it takes pay checks from a conservative employer to equate, with straight face, the Republican healthcare bill with the Democratic bill. It may justify one's continued employment, but it does nothing to advance an honest comparison of the two bills. Democrats had dozens of open hearings, and invited Republicans' input again and again for the fine tuning of the Obama Bill, while the Republican proposals were until this week not even known to a majority of their own Senators or Congressmen. There's no comaparison here. But then the real purpose may be to muddy the public discourse that this piece does - to a degree.
15
Interestingly in the same period of time during which Mr. Roy asserts that Pres Clinton was proposing Conservative friendly Medicare changes there were a number of other studies and reports prepared on the topic of healthcare. I'd list them individually but KOS has done an admirable job of discussing them in one spot.
https://www.dailykos.com/story/2009/6/23/746091/-
My point Mr. Roy is that you wear blinders. If you and other Conservatives were really interested in healthcare for the nation we'd have single payer. It works, is far less expensive, produces better health outcomes, and covers every single human being using government efficiency and private system care.
Republican politicians aren't about healthcare. They're about looking like they care without having to produce coverage that costs your wealthy clientele and ideological bedmates money.
https://www.dailykos.com/story/2009/6/23/746091/-
My point Mr. Roy is that you wear blinders. If you and other Conservatives were really interested in healthcare for the nation we'd have single payer. It works, is far less expensive, produces better health outcomes, and covers every single human being using government efficiency and private system care.
Republican politicians aren't about healthcare. They're about looking like they care without having to produce coverage that costs your wealthy clientele and ideological bedmates money.
9
Mr. Roy,
Some years ago my 24 year old unmarried son noticed a lump on his testis. He did not have health insurance at the time so he told no-one . A number of months later he accepted a job (at $10/hour) that offered the ability to purchase through the company unsubsidized group heath insurance at a rate he could afford ($1800/year). After a 90 day waiting period he went to see a doctor and his diagnosis was cancer of the testis. He underwent surgery, hospitalization, chemotherapy and multiple CT scans. Then he discovered that his $1800/year premium bought him an annual limit of $4,000n worth on benefit. That was of course used up in the first few hours of treatment. Worse he now had a pre-exiting condition so even if he could, in the future, find a heath insurance company that would offer him coverage, he could never afford the premium. Then came the ACA. He felt immeasurable relief. Now you try to tell us that the Senate Health Care Bill is a blessing to us all. Probably only you can imagine the boundless joy my son will experience when he gets to return to worse health insurance conditions than he experienced before the ACA. Mr. Roy, you are behaving like an idiot.
Some years ago my 24 year old unmarried son noticed a lump on his testis. He did not have health insurance at the time so he told no-one . A number of months later he accepted a job (at $10/hour) that offered the ability to purchase through the company unsubsidized group heath insurance at a rate he could afford ($1800/year). After a 90 day waiting period he went to see a doctor and his diagnosis was cancer of the testis. He underwent surgery, hospitalization, chemotherapy and multiple CT scans. Then he discovered that his $1800/year premium bought him an annual limit of $4,000n worth on benefit. That was of course used up in the first few hours of treatment. Worse he now had a pre-exiting condition so even if he could, in the future, find a heath insurance company that would offer him coverage, he could never afford the premium. Then came the ACA. He felt immeasurable relief. Now you try to tell us that the Senate Health Care Bill is a blessing to us all. Probably only you can imagine the boundless joy my son will experience when he gets to return to worse health insurance conditions than he experienced before the ACA. Mr. Roy, you are behaving like an idiot.
41
Why anyone listens to Avik Roy is beyond me. He is someone who has benefitted from the generousity of the United States from immigration of his parents to an elite education and uses those gifts to promulgate a cruel and selfish worldview.
Some actually believe McConnell and much of the Senate and house republicans as well as the dear leader actually give a care. They DO NOT. What they do care about are 2 things in no particular order: 1. Destroying any Obama achievements and 2. Tax cuts for the wealthy. If, like the current Trumpcare proposal/opportunity, they can do both at the same time then happy days!
7
@Peter Voshefski
re "equivocation that our media has overlaid on our circumstances."
Equivocation?
Deflection and projection defense mechanisms a la trump is de rigeur among the GOP base. The most aggregious of these by far is this ‘fake news’ moniker so liberally bandied about attributed to the media where in truth we really have a tragically unprepared and dangerously unprincipled ‘fake’ president who is an unabashed leech and an unrepentant liar.
re "equivocation that our media has overlaid on our circumstances."
Equivocation?
Deflection and projection defense mechanisms a la trump is de rigeur among the GOP base. The most aggregious of these by far is this ‘fake news’ moniker so liberally bandied about attributed to the media where in truth we really have a tragically unprepared and dangerously unprincipled ‘fake’ president who is an unabashed leech and an unrepentant liar.
6
Romney was right because such efforts as gov't-aided health coverage was a STATE responsibility. It was NEVER supposed to become a federal responsibility. Check your Constitution for how many mentions of medical or health there are.
The solution to the attack on Americans known as Obamacare is for states to do what they think works for them. Just remember neither California's legislature nor the state of Vermont have ever devised a workable single-payer system that even looks solid enough to try out.
You'll have to double or triple sales and income taxes to do here what they do in Scandinavia, and young worker families will realize they have no money to try to have children.
The solution to the attack on Americans known as Obamacare is for states to do what they think works for them. Just remember neither California's legislature nor the state of Vermont have ever devised a workable single-payer system that even looks solid enough to try out.
You'll have to double or triple sales and income taxes to do here what they do in Scandinavia, and young worker families will realize they have no money to try to have children.
1
No, they'll have less money to spend on gadgets that they don't need and their children don't need. Take away the fool......
Nonsense. All countries that have single payer or two tier pay on average two thirds of what it costs here, with better health outcomes. They regulate costs of medical procedures, care and prescription drugs, and the USA can do it too. We don't need to subsidize insurance middle men without getting anything in return in terms of health care.
4
How is it that all the other nations in the world -- every one poorer than we are by any measure -- can afford universal health care when our leaders tell us we cannot?
The answer is, we spend the money on tax cuts for millionaires instead.
Sooner or later, voters will understand Congress works not for the people, but for the money.
The answer is, we spend the money on tax cuts for millionaires instead.
Sooner or later, voters will understand Congress works not for the people, but for the money.
10
Avik Roy is the author of "How Medicaid Fails the Poor". Enough said.
We pay more for medical bills than any other western nation, hence the need for Medicaid to cover the poor. There is a profit margin built into all medical services in this country. Some of those margins, as with pharmaceuticals, are very, very high. That is the problem. Fix that or any system, except Medicaid, will deny poor people health related services. Market based supply and demand is an awful policy to apply to a "product" that is a life sustaining necessity, not a luxury. If you want self, friends and family safe and healthy, all else must be sacrificed to combat disease so that shareholders can profit. Sounds like extortion to me.
We pay more for medical bills than any other western nation, hence the need for Medicaid to cover the poor. There is a profit margin built into all medical services in this country. Some of those margins, as with pharmaceuticals, are very, very high. That is the problem. Fix that or any system, except Medicaid, will deny poor people health related services. Market based supply and demand is an awful policy to apply to a "product" that is a life sustaining necessity, not a luxury. If you want self, friends and family safe and healthy, all else must be sacrificed to combat disease so that shareholders can profit. Sounds like extortion to me.
9
The CBO analysis puts the lie to Mr. Roy's misdirected ramble.
We got the ACA as an attempt at a bi-partisan approach with only aggressive opposition from the Republicans because as Mitch McConnell stated, the Repub's primary goal at that time was to make Obama a one-term President. So these so-called "public servants" shut themselves out of the most meaningful legislation in decades with the broadest effects on Americans in favor of intractable self-service that dramatically widened the partisan divide; definitively not public service. Mr. Roy's random mix of ideas from different sources and baseless opinions on outcomes of alternatives bears no resemblance to the actual roots of the ACA nor to the current legislation.
The current legislation is the opposite of health care. It is dramatic reduction in health care for the poor, the disabled and the elderly. It is the Unaffordable Care Act that will raise premium costs for older Americans and raise deductibles for most others while significantly reducing the coverage. It is the "We're not going to talk about the hundreds of billions of dollars of tax breaks to the already-rich" Act. It is the "Trump-Don't-Care (and Neither Do We)" Act. It is the "We'd rather enrich our cronies and see you die" Act.
No supporter of this cruel legislation merits being referred to as a "public servant".
We got the ACA as an attempt at a bi-partisan approach with only aggressive opposition from the Republicans because as Mitch McConnell stated, the Repub's primary goal at that time was to make Obama a one-term President. So these so-called "public servants" shut themselves out of the most meaningful legislation in decades with the broadest effects on Americans in favor of intractable self-service that dramatically widened the partisan divide; definitively not public service. Mr. Roy's random mix of ideas from different sources and baseless opinions on outcomes of alternatives bears no resemblance to the actual roots of the ACA nor to the current legislation.
The current legislation is the opposite of health care. It is dramatic reduction in health care for the poor, the disabled and the elderly. It is the Unaffordable Care Act that will raise premium costs for older Americans and raise deductibles for most others while significantly reducing the coverage. It is the "We're not going to talk about the hundreds of billions of dollars of tax breaks to the already-rich" Act. It is the "Trump-Don't-Care (and Neither Do We)" Act. It is the "We'd rather enrich our cronies and see you die" Act.
No supporter of this cruel legislation merits being referred to as a "public servant".
16
This is the nonsensical apologia one would expect from a conservative pundit defenseless and without the intellectual resources or courage to explore beyond the McConnell universe.
It's one in an endless line of attempts by Republicans to pull their sorry bacon out of the fire by saying "See, it's a Democrat idea! We do all that caring stuff, too!"
Brings back the days when that rascal Trump would physically threaten the press and then run around like a little boy with balloon quoting whatever positive crumbs he could dig out of that same dastardly press.
Saying this health insurance debacle is really a bipartisan effort is like Republicans saying "Muslims are people, too. We're all brothers here. Let 'em. Let 'em all in!"...an impossibility.
But even if wasn't impossible, Republicans have again fallen back on their quintessential Trumpian characteristic: making words mean whatever they want them to mean.
So, when they say "freedom of choice", they mean you're free to choose between a $20,000 a year premium or clothes.
When they say "affordable insurance" they mean anybody can afford a policy under their plan, just the policy won't cover anything. By law.
When they say "help poor folks get insurance" they mean penalize them with big fines and cut off their insurance for six months if they fail to pay their unaffordable premiums.
When they say "no cuts to Medicaid" they mean if we close the roles so you can't get Medicaid then your Medicaid can't be cut.
It's one in an endless line of attempts by Republicans to pull their sorry bacon out of the fire by saying "See, it's a Democrat idea! We do all that caring stuff, too!"
Brings back the days when that rascal Trump would physically threaten the press and then run around like a little boy with balloon quoting whatever positive crumbs he could dig out of that same dastardly press.
Saying this health insurance debacle is really a bipartisan effort is like Republicans saying "Muslims are people, too. We're all brothers here. Let 'em. Let 'em all in!"...an impossibility.
But even if wasn't impossible, Republicans have again fallen back on their quintessential Trumpian characteristic: making words mean whatever they want them to mean.
So, when they say "freedom of choice", they mean you're free to choose between a $20,000 a year premium or clothes.
When they say "affordable insurance" they mean anybody can afford a policy under their plan, just the policy won't cover anything. By law.
When they say "help poor folks get insurance" they mean penalize them with big fines and cut off their insurance for six months if they fail to pay their unaffordable premiums.
When they say "no cuts to Medicaid" they mean if we close the roles so you can't get Medicaid then your Medicaid can't be cut.
16
When they say "access", they mean if you can afford to have the insurance needed for that access. ER services are not meant to substitute for primary care insurance. And, ER services are not free; in fact, they can be very expensive; ER services will be billed, and payment pursued, even to putting a lien on payroll checks. A friend in CT went to an ER for a sore throat getting worse; it was diagnosed as Strep; the bill from the ER was $2,000 for visit, doctor, antibiotics, and one follow up visit. An insurance provider would have had a list of doctors available, and they would not have charged $2,000 for that visit, antibiotics and follow up care. Hospitals will get money wherever they can, gouging insurance companies for money lost from uninsured patients. If you were fortunate to live in Greenwich, CT, ER care was free.
The real secret is the equivocation that our media has overlaid on our circumstances.
The Google bill "should" be passed because it borrows from a playbook 7 years old? Different times now, your argument is a stretch of logic to reality. I like to rename this bill... "American Care for Health and Enterprises", or ACHE.
The proposed legislation will have a predictable outcome. People dying in the street who have no money for health care and no affordable place to live. And the rich will get richer.
Is this the country we want to live in??
Is this the country we want to live in??
6
Avik Roy, where do you get your insurance from? Are you self-insured or on a corporate plan? Your answer will define the point of your essay.
Please reply and Let us know
Please reply and Let us know
4
Mr. Roy, rather than wishful thinking about an unlikely, if possible, outcome of this bill, I would be most interested to hear why you are one of only a few conservative health policy experts who actually really like this bill. What is it that you see in this bill that the vast majority of your other colleagues, whose responses range from tepid, at best, to disgust, do not see?
Mr. Roy seems to leave out the roll back of Medicaid used to cover the massive tax cuts for the 0.5%. The CBO stated that their 22 million figure is the average of estimates based on different assumptions. Mr. Roy's methodology seems to be fantasizing.
In a way, I would like one of the GOP plans to pass. The resulting collapse in the delivery of health care would finally push the US to adopt a single payer system, hopefully a Bismarck type plan. Problem would be thousands of preventable deaths in the interim. What a mess!
In a way, I would like one of the GOP plans to pass. The resulting collapse in the delivery of health care would finally push the US to adopt a single payer system, hopefully a Bismarck type plan. Problem would be thousands of preventable deaths in the interim. What a mess!
6
I think the GOP health care plan is actually a tax and government revenue reduction plan. There will be huffing and puffing from a few GOP senators but since tax reduction for the wealthy and corporations is the prime goal of the GOP it will pass in the end. And like you I agree that its scorched earth effect will permit the possibility of something much better in the future. But what a foolish way to create policy aimed at expanding a stabilizing a public good.
Exactly. Perhaps that's Mr Roy's proposal: Leave Medicaid alone, cancel tax cuts for the rich, and see how many Republicans Senators vote for it.
While I understand the need to present diverse opinions, I am disappointed to see outlets like the Times and NPR giving a respectable platform to a phony wonk like Avik Roy. His disingenuous nonsense adds little to enhance debate or enrich your readers' understanding of this complex topic. Mr. Roy is a partisan hack who has built a second career out of facile attacks on attempts to broaden coverage (particularly ACA) and plausible-sounding defenses of miserly alternatives. He has mastered the vocabulary of social science while abandoning any semblance of rigor. He lacks substantive expertise in any relevant field, and approaches the most profound challenges of public policy with the skill set of a Wall Street spreadsheet jockey - which, once you strip away the lofty name of his so-called "think tank", is all he actually brings to the table.
Yes, there is a vague similarity between one component of BCRA and an idea Bill Clinton floated more than twenty years ago. The context is completely different, and the comparison is entirely misleading. You have given Mr. Roy a prestigious forum to ply his specialty: taking a dauntingly complex topic, and piles on enough obfuscation to render the subject completely opaque. Who's next on the Op-Ed page? Alex Jones?
Yes, there is a vague similarity between one component of BCRA and an idea Bill Clinton floated more than twenty years ago. The context is completely different, and the comparison is entirely misleading. You have given Mr. Roy a prestigious forum to ply his specialty: taking a dauntingly complex topic, and piles on enough obfuscation to render the subject completely opaque. Who's next on the Op-Ed page? Alex Jones?
21
Who cares where the ideas come from that improve Rombama Care? What Americans need and want is high quality health care that is effective and affordable. Why can other countries do this but America can't? It's because the profit motive is more important than quality of life in America coupled with the extreme hatred of anything that looks like socialism. You want competition to bring down prices and improve quality? Then allow cheap foreign competition to flood the health insurance market just like they did with the steel, appliance, shoe, clothing, and electronics markets.
3
Make no mistake, Mr. Roy is a partisan apologist for failed Republican healthcare policies. This is not in any way an objective analysis.
3
"It’s likely that, if the Senate bill passes, more Americans will have health insurance five years from now than do today."
No it isn't.
It's certain that tens of millions of people will be without health insurance and tens of thousands (at least) will die as a result.
No one values bipartisanship except that people who perceive themselves as being on such an elevated plane that government policy will not affect their lives. People care about what government does and how it affects their lives. Nobody wants government officials to "put aside their differences and get things done" without caring about whether the things that "get done" are good for America or not. In this case, the Republicans want to take people's health care away. People will die. Fighting against that isn't "partisan noise," and the New York Times reaches a new nadir by giving space to this mendacity.
No it isn't.
It's certain that tens of millions of people will be without health insurance and tens of thousands (at least) will die as a result.
No one values bipartisanship except that people who perceive themselves as being on such an elevated plane that government policy will not affect their lives. People care about what government does and how it affects their lives. Nobody wants government officials to "put aside their differences and get things done" without caring about whether the things that "get done" are good for America or not. In this case, the Republicans want to take people's health care away. People will die. Fighting against that isn't "partisan noise," and the New York Times reaches a new nadir by giving space to this mendacity.
3
If AHCA is so good, why are the REPUBLICAN senators not extolling it's virtues? Why did McConnell, who cried hoarse about how the Dems pushed ACA through without enough debate (despite more than 100 committee hearings, and an year of public debates), held NO public hearings? I will tell you why - this bill reeks of republican cruelty and double speak - after 7 years of criticizing Obamacare and voting more than 50 times to repeal it, they are caught with no viable policy alternative. Only one solution to fix this- throw these bums out, when they do not have healthcare funded by us, we will see how quickly their opinions will change.
6
"It’s likely that, if the Senate bill passes, more Americans will have health insurance five years from now than do today."
What? I think you're the only person to reach that conclusion through this entire Wealthcare debacle.
What? I think you're the only person to reach that conclusion through this entire Wealthcare debacle.
5
No this is not bipartisan. Because a fish has a head, two eyes . . . it does not mean it is a unicorn - which supposedly also possessed these exact same features.
But Avik Roy does a service with this palliative piece. We need to look no further than this article to get a glimpse into the causes of lasting republican majorities.
When Americans feel powerless - either because of the choices they made, or because of factors beyond their control, or both - they lash out, vote republican, and enjoy the injury and meanness in which they engage.
When the center and left feel powerless, as does Avik Roy, they claim that what is happening is what they intended all along. People have coined the vocabularies of victimhood, effeteness, and moral cowardice on display in this article. They also say things like: this is the best thing ever, things happen for a reason, behind every dark cloud . . . and other huzzas.
Kalidan
But Avik Roy does a service with this palliative piece. We need to look no further than this article to get a glimpse into the causes of lasting republican majorities.
When Americans feel powerless - either because of the choices they made, or because of factors beyond their control, or both - they lash out, vote republican, and enjoy the injury and meanness in which they engage.
When the center and left feel powerless, as does Avik Roy, they claim that what is happening is what they intended all along. People have coined the vocabularies of victimhood, effeteness, and moral cowardice on display in this article. They also say things like: this is the best thing ever, things happen for a reason, behind every dark cloud . . . and other huzzas.
Kalidan
Since Avik Roy secretly wrote the Senate bill, he'll do just about any twist to put some lipstick on it. A pig all dolled up is still a pig.
3
"The Senate bill replaces the A.C.A.’s Medicaid expansion with a robust system of tax credits for which everyone under the poverty line is eligible. Under Obamacare, you could enroll in private insurance exchanges only if your income exceeded the poverty line."
Oh come on, Avik. First of all, how is that a Democratic idea, and secondly, that's because Medicaid was intended to cover everyone up to well above the poverty line. Or had you forgotten?
It seems like even knowledgeable people, once sucked into the Black Hole of Republican ideology, are no longer able to emit truth.
Oh come on, Avik. First of all, how is that a Democratic idea, and secondly, that's because Medicaid was intended to cover everyone up to well above the poverty line. Or had you forgotten?
It seems like even knowledgeable people, once sucked into the Black Hole of Republican ideology, are no longer able to emit truth.
2
I am looking for some light summer reading. This guy Avik Roy seems to have a good touch for fiction. I think I will see in he wrote a good "who done it."
You're counting on the generosity of the Republican Party to provide additional funds (paid for how exactly when this is also slashing huge amounts of taxes on the rich) to cover folks for whom tax credits would do exactly ZERO (low income families). That's cute. And hilarious. And terrifying. It's hysterrifying!
Why is there any expectation of compassion or sense that the Republicans have any interest in the general social welfare?
Why is there any expectation of compassion or sense that the Republicans have any interest in the general social welfare?
This essay is cherry picking for rhetorical purposes.
Both the Senate and House Republican versions are tax give-aways to those who do not need it, and benefit take-aways (whether by rolling back Medicaid expansion, allowing premiums for the late middle-aged to rise dramatically, and by allowing states to remove coverage for maternity care ((not a special interest -- we all need mothers!)), mental illness, addiction, etc., and by defunding Planned Parenthood) from those who most need it. Roy obscures this basic truth.
Guess who was an outspoken supporter of the individual mandate when the idea was first debated in Congress? Newt Gingrich!
Conservatives, please read David Brooks' very thoughtful column this morning.
Both the Senate and House Republican versions are tax give-aways to those who do not need it, and benefit take-aways (whether by rolling back Medicaid expansion, allowing premiums for the late middle-aged to rise dramatically, and by allowing states to remove coverage for maternity care ((not a special interest -- we all need mothers!)), mental illness, addiction, etc., and by defunding Planned Parenthood) from those who most need it. Roy obscures this basic truth.
Guess who was an outspoken supporter of the individual mandate when the idea was first debated in Congress? Newt Gingrich!
Conservatives, please read David Brooks' very thoughtful column this morning.
1
For the love of God (or deity of choice) will the NYT stop trying to show how "balanced" it is by giving space to right wing hacks. You can have as many article as you want by climate deniers and ACA opponents, but you're still not going to get Trump voters to subscribe. All you do is pander to pseudo-intellectuals.
Mr. Roy, your arguments for the Republican bill are both facile and disingenuous.
Neither of us inhabits a universe where having 20%, or even 50% more of $0 is helpful. Tax credits for the poor and lower-middle class are an insult.
And if we were to inhabit that alternate universe you conjured for a moment, we are still left with a reconciliation bill that can't reconcile what happens when your 'fiscally sustainable' model cuts-off spending? Kicking the responsibility to the states simply forces someone else to choose whom to throw out of nursing homes when the dollars run out.
You and other conservatives continue to operate in a box of ideology--the wider world has well-regulated, single-payer systems at substantially lower cost. In our shining city on the hill, we have two Dunce Parties, all busily railing over the minutia of a failed system. Mr. Roy, you should know better.
Neither of us inhabits a universe where having 20%, or even 50% more of $0 is helpful. Tax credits for the poor and lower-middle class are an insult.
And if we were to inhabit that alternate universe you conjured for a moment, we are still left with a reconciliation bill that can't reconcile what happens when your 'fiscally sustainable' model cuts-off spending? Kicking the responsibility to the states simply forces someone else to choose whom to throw out of nursing homes when the dollars run out.
You and other conservatives continue to operate in a box of ideology--the wider world has well-regulated, single-payer systems at substantially lower cost. In our shining city on the hill, we have two Dunce Parties, all busily railing over the minutia of a failed system. Mr. Roy, you should know better.
3
Really really???
Try again ,once again Conservatism shoots itself in the foot.
Try again ,once again Conservatism shoots itself in the foot.
1
Stop calling it a healthcare bill
3
Mr. Roy needs to come clean about the FACT they he helped write the senates bill! Publishing this without that critical piece of information makes the Times complicit in advancing right wing propaganda. That's why Fox exists
2
So-called president trump's reassuring words still ring in my ears ... "Obamacare is an utter disaster folks. I will repeal it entirely and replace it with something much much better, believe me ... and very quickly". Ringing ringing ringing ... like an unanswered telephone.
1
This column is filled with lies. Not just opinions, or debate points, but verifiable lies. I thought you weren't supposed to do that, New York Times!
What a real bipartisan approach would be/would have been is the GOP and their shills not actively sabotaging the ACA.
Odd that Mr. Avik Roy doesn't mention the $6 Billion tax give away to the wealthiest Americans. And yet, he claims that somehow, magically, the numbers will all work out and everyone will be better off. Mr. Roy, what are you smoking?
Why was this partisan hack allowed to publish this here? It makes no sense. It's a lie. It's garbage. It runs counter to the facts and to the realities of both how people behave and what their incomes allow them to afford. Like NPR, the NYTimes seems hell bent on proving itself a forum for ideas from both sides of the aisle. Well, hooray for that. But the ideas on some sides of the aisle are based on lies. You don't have to publish them. They have Breitbart and Drudge and Fox.
1
So, this is really a bi-partisan sort of bill that the Democrats should embrace.
You must mean except for the part that would cause 22 million people to lose health care.
Oh right, that.
You must mean except for the part that would cause 22 million people to lose health care.
Oh right, that.
Avik Roy is a partisan shill ... SHAME on the Times for promoting him as a thoughtful policy wonk.
The ACA expansion of Medicaid worked. The individual market didn't. The Republican plan will not fix it. Granted making it cheaper for younger healthier people to buy insurance and making it tougher to buy insurance wants you get sick should be an incentive to make the entire pool healthier. That assumes those who don't buy coverage won't be treated if they become sick without insurance.
Making policies cheaper for the young and putting fear into people that they can't buy coverage if they get sick is a big incentive to buy insurance when you're healthy. A huge failure of the ACA is allowing healthy people to opt out while sick people can buy in has skewed the pool toward older, sicker people.
The problem is the huge cut in Medicaid to pay for the tax cut for the wealthy.
You can argue that the Republican plan may well be better for some but it comes at a huge cost for the most vulnerable.
The ACA and the Republican plan aren't Universal and that's the real problem. Both pick winners and losers. The ACA winners are the most vulnerable the losers are those who have to buy insurance on the open market without subsidies.
You also can't ignore how the Republican plan treats women who are more than 50% of our country. That in itself is a national disgrace.
Making policies cheaper for the young and putting fear into people that they can't buy coverage if they get sick is a big incentive to buy insurance when you're healthy. A huge failure of the ACA is allowing healthy people to opt out while sick people can buy in has skewed the pool toward older, sicker people.
The problem is the huge cut in Medicaid to pay for the tax cut for the wealthy.
You can argue that the Republican plan may well be better for some but it comes at a huge cost for the most vulnerable.
The ACA and the Republican plan aren't Universal and that's the real problem. Both pick winners and losers. The ACA winners are the most vulnerable the losers are those who have to buy insurance on the open market without subsidies.
You also can't ignore how the Republican plan treats women who are more than 50% of our country. That in itself is a national disgrace.
71
Thanks to the NYT for publishing a viewpoint like this and again to the NYT for allowing readers to comment while screening out irresponsible contributions. The march to universal government healthcare will not be stopped, only delayed by the foolish workarounds that have been inflicted on the American public in the recent past and presumably near future. This has not been a golden era of reform in this area. Take your lame tax credit nonsense and toss it in the trash. You keep telling us that you want the tax system to be simpler yet you happily add a level of complexity that will affect every single American's tax return. Why would young people ever buy coverage if they're not legally compelled to do it? We don't allow anyone to drive a car without insurance, why do we allow anyone to walk around without health insurance? And without the participation of young healthy people there is no chance that this plan will be successful.
96
It's a bad analogy because everyone has a body and health. There's no choice.
True, but it can also be argued that a health care system built on the profit motive will never work anyway. The more the GOP mangles the ACA to disastrous effect, the greater the likelihood of more people finally demanding some kind of single-payer system for everyone. An expansion of Medicare with an individual mandate, premiums based on income and maybe life-style habits (for example smokers may need to pay more) and including many ACA-like provisions to control costs, improve record-keeping and information gathering, would do the trick nicely.
The author misrepresents the levels of cooperation among the parties in designing 2009's ACA and 2017's Better Care Reconciliation Act, suggesting that the Republican participation in the former was limited simply to the Democrats' borrowing of GOP ideas. In fact, Republican input on the crafting of the bill was sought out throughout the process, and many Republican-sponsored amendments made it into the final form. In contrast, the GOP not only prevented any Democratic members' input, they actively hid the contents of the bill until they had finalized its form. There is no comparison between the relative openness of the two processes. Opening his argument with such a misleading assertion sets the stage for his main argument, that any change to Obamacare by the GOP, even absent any input from Democrats, represents an achievement in bipartisanship that should be celebrated. Bipartisanship isn't simply an assessment of the historical origin of component ideas, but a completed assemblage that is agreed upon by both sides. The Better Care Reconciliation Act is far from that.
11
I think Mr. Roy should read the CBO analysis - prices for seniors go up not down as the subsidies are removed/replaced. As far as lower costs, that would be because the plans that would be available would have much higher deductible and a much lower service level.
The very rich benefit as usual with republican plans by a massive tax cut that the elderly and poor will then shoulder as higher premiums for less coverage.
The very rich benefit as usual with republican plans by a massive tax cut that the elderly and poor will then shoulder as higher premiums for less coverage.
5
yes, CBO offers a bunch of very persuasive, well-thought reasons why a lot of people will lose insurance, and all Roy has to say about the report is that its methods are flawed. even smart people sound like hacks whenever they try to defend conservative health-care 'ideas'.
I notice that Mr. Roy, much as was done with Trump's "budget," is double-counting the same thing.
See where he argues that if younger people get cheaper plans, that'll balance out the risk pool with more healthy members, and thus insure cheaper premiums for all?
Problem is this: Mr. Roy also proposes (as the House bill actually does) to separate those very younger, healthier people from a "high-risk," pool into which go all the older and sicker.
That's why the CBO estimates all tell you that you're see premiums and deductibles shoot up in the 55-64 age bracket: their risk pool would be counted separately.
In or out, Mr. Roy. But not both.
See where he argues that if younger people get cheaper plans, that'll balance out the risk pool with more healthy members, and thus insure cheaper premiums for all?
Problem is this: Mr. Roy also proposes (as the House bill actually does) to separate those very younger, healthier people from a "high-risk," pool into which go all the older and sicker.
That's why the CBO estimates all tell you that you're see premiums and deductibles shoot up in the 55-64 age bracket: their risk pool would be counted separately.
In or out, Mr. Roy. But not both.
11
precisely. the only way for healthy people to bring down premiums for sick people is for them to buy _the same kind of plans_. if you bring healthy people in the market by allowing them to buy skimpier plans, that will not decrease premiums for the more generous plans. in fact, it might increase them, as previously insured healthy people will now flock to the skimpy plans. the level of willful stupidity in this column is just breathtaking.
80 billion a year less in spending on health care, but more people covered? Magical thinking.
6
It is easy to cut 80 billion in spending and cover more people, you simply give them insurance that doesn't cover a wide range of things. Before ACA, there were a ton of health insurance 'plans' that proudly advertised family coverage for 69 bucks a month..and basically subsidized routine office visits. The brutality of the GOP 'plan' is that it takes away requirements for plans to meet certain minimum standards, and that is the crux of the problem Mr. Roy doesn't talk about, that the GOP is perfectly happy with giving people snake oil and crowing they are a plan, rather than making sure they are covered.
2
This is one of the most disingenuous columns about the healthcare bill that I've read in a reliable media source. There are so many red herrings and tenuous assumptions that I lost count after the halfway point. Here's a good one:
"The CBO believes that solely because Republicans would repeal the ACA's individual mandate, by 2026, more than 15 million fewer people will buy health insurance, regardless of what senators do to direct more financial assistance to the poor and vulnerable. That's not a flaw in the Senate bill; it's a flaw in the CBO's methods."
So the CBO should project forward and incorporate in its evaluation the heartless desires of the Republicans to do whatever it takes to keep people from getting healthcare? Hmmm, maybe you're right, it would highlight even more how heartless they are and set on making it nearly impossible for many people to get healthcare any way they can.
"The CBO believes that solely because Republicans would repeal the ACA's individual mandate, by 2026, more than 15 million fewer people will buy health insurance, regardless of what senators do to direct more financial assistance to the poor and vulnerable. That's not a flaw in the Senate bill; it's a flaw in the CBO's methods."
So the CBO should project forward and incorporate in its evaluation the heartless desires of the Republicans to do whatever it takes to keep people from getting healthcare? Hmmm, maybe you're right, it would highlight even more how heartless they are and set on making it nearly impossible for many people to get healthcare any way they can.
10
Unlike the Republican plan, hatched in secret, Democrats spent months holding public hearings, inviting (and often adapting) input from not only Republicans but health care professionals.
If the ACA was not a bipartisan plan, it was because the GOP decided, as a political matter, to vote in lockstep against it, not because of any unwillingness on the part of Democrats to listen to them.
How typical of a conservative columnist to willfully ignore this
If the ACA was not a bipartisan plan, it was because the GOP decided, as a political matter, to vote in lockstep against it, not because of any unwillingness on the part of Democrats to listen to them.
How typical of a conservative columnist to willfully ignore this
8
Our country will not move forward until we remove free market theology from our political debates, root, stem and leaf. People like Roy are living in a fantasy of rational decision making at the margins, precisely the behavior that the Senate bill is designed to make impossible -- if it ever occurs at all. Best to ignore them, not give them prominent real estate in the paper of record.
3
Why would a thinking person go back to 1995 to find an example of the current Democratic thinking on healthcare? Wouldn't they go to Obamacare, or to the statements of those currently in office? Many commentators believe that Mr. Roy is simply defending a plan that he himself helped to draft -- could the editors please explain whether this is the case? I think it's relevant.
8
Chait had the same question for Roy here:
http://nymag.com/daily/intelligencer/2017/06/defenses-of-senates-health-...
Roy's response was that "as a matter of policy" he doesn't "discuss with the press [his] conversations with policymakers."
http://nymag.com/daily/intelligencer/2017/06/defenses-of-senates-health-...
Roy's response was that "as a matter of policy" he doesn't "discuss with the press [his] conversations with policymakers."
If so many ideas of the parties are similar, why don’t Republicans work with Democrats to fix Obamacare, rather than throw it out wholesale? What is “bipartisan” about that?
And trying to undermine the CBO won’t wash. It is obvious Republicans believe the score, that’s why moderate Republicans are so concerned about the harm to their constituents, especially those on Medicaid. It’s obvious right-wingers believe the CBO, that’s why they’re so upset that the bill doesn’t slash spending enough.
Bottom line, Roy is a right-wing darling peddling the standard Republican gospel that healthcare can be a “free market,” which is a total myth, and that for our own good we the poor and middle class must suffer, perhaps even die, for years and years to finally see all those wonderful rewards from the magical workings of the free market, while the rich must immediately benefit from huge tax cuts now.
And trying to undermine the CBO won’t wash. It is obvious Republicans believe the score, that’s why moderate Republicans are so concerned about the harm to their constituents, especially those on Medicaid. It’s obvious right-wingers believe the CBO, that’s why they’re so upset that the bill doesn’t slash spending enough.
Bottom line, Roy is a right-wing darling peddling the standard Republican gospel that healthcare can be a “free market,” which is a total myth, and that for our own good we the poor and middle class must suffer, perhaps even die, for years and years to finally see all those wonderful rewards from the magical workings of the free market, while the rich must immediately benefit from huge tax cuts now.
15
Consider the source of this article:
"The Foundation for Research on Equal Opportunity (FREOPP) is a right-wing 501(c)3 think tank based out of Austin, Texas and an associate member of the State Policy Network (SPN)....FREOPP was founded in 2016, its mission is to consider "the impact of public policies and proposed reforms on those with incomes or wealth below the U.S. median." The organization portrays itself as non-partisan, "our aim is to become a credible bridge between those on the left and the right who genuinely want to expand opportunity to those who least have it,"[2] yet its staff and Board is comprised of conservative and Republican party insiders.
It appears that the organization's policy focus is healthcare and the repeal of the Affordable Care Act."
"The Foundation for Research on Equal Opportunity (FREOPP) is a right-wing 501(c)3 think tank based out of Austin, Texas and an associate member of the State Policy Network (SPN)....FREOPP was founded in 2016, its mission is to consider "the impact of public policies and proposed reforms on those with incomes or wealth below the U.S. median." The organization portrays itself as non-partisan, "our aim is to become a credible bridge between those on the left and the right who genuinely want to expand opportunity to those who least have it,"[2] yet its staff and Board is comprised of conservative and Republican party insiders.
It appears that the organization's policy focus is healthcare and the repeal of the Affordable Care Act."
5
He wrote a book called How Medicaid Fails the Poor. That's all I need to know. More phony hand-wringing about liberals failing the poor. Ugh.
Even if more people have health insurance in five years, which I think is doubtful under this plan, what kind of insurance will it be? Roy doesn't go there.
6
Fake insurance. High deductibles and lots of things not covered.
This is game-playing. It does not matter where an idea originates, what matters is bipartisan, open, robust, and legitimate discussion of every idea to craft a compromise, consensus measure that covers EVERY American with actual, affordable health insurance.
2
Per capita health care costs in developed countries where there are universal health care systems in place are half those in the US. A key objective of the ACA (Obamacare) was to bring health care costs down in alignment with these other countries, and was well on its way to achieving this aim had it not been stymied by deliberate GOP efforts to sabotage the program.
Now instead we are faced with the prospect of millions being thown off unable to afford it, as well as per capita costs actually going up precariously.
Now instead we are faced with the prospect of millions being thown off unable to afford it, as well as per capita costs actually going up precariously.
6
If this whole thing lives or dies based on whether young healthy people sign up for insurance, then why not just require them to do it? It's like if you made taxes voluntary. Sure, people would benefit in the long run from continuing to pay taxes because public services like police and schools wouldn't shut down from lack of funding, but presented with the option of not paying taxes this year, would you really still pay anyway? This dilemma is so well-understood and acknowledged in economics that it even has its own name, the "tragedy of the commons". We ignore it at our own peril.
15
A writer loses my attention when the writer's evidence requires determination that the CBO be incorrect on a fundamental and major future event.
25
Akiv Roy - from under what rock did you crawl?
1. Democrats did not borrow GOP ideas for the health plan willingly - The subsidies and keeping Billion$$$ of middle-men (Insurance, Networks, etc.) was a GIVE to conservatives and business. ACA eliminated the (MUCH more efficient idea - ie. less costly for TAXPAYERS!) single-payer system from progressives.
2. The reason Democrats can't take the GOP bill is it does not grow fast enough for economy. People would be denied coverage. That is not a Democratic idea just because it came from another consensus driven effort. Bill had Republicans to sate too!
3. If it borrowed soo much from Democrats - why then did Mitch write it in secret and try to pass it a hurry - in secret?
Hmm - smell tests are failing this one. Crawl back under your Brietbart rock Avik - I don't have time to read false news.
1. Democrats did not borrow GOP ideas for the health plan willingly - The subsidies and keeping Billion$$$ of middle-men (Insurance, Networks, etc.) was a GIVE to conservatives and business. ACA eliminated the (MUCH more efficient idea - ie. less costly for TAXPAYERS!) single-payer system from progressives.
2. The reason Democrats can't take the GOP bill is it does not grow fast enough for economy. People would be denied coverage. That is not a Democratic idea just because it came from another consensus driven effort. Bill had Republicans to sate too!
3. If it borrowed soo much from Democrats - why then did Mitch write it in secret and try to pass it a hurry - in secret?
Hmm - smell tests are failing this one. Crawl back under your Brietbart rock Avik - I don't have time to read false news.
19
OMG. The ACA was a republican plan from the get go, modeled on Romney care in MA, and came out of a republican think tank. It's always been about salvaging a for-profit system with millionaire health insurance executives still at the helm reaping their wealth off the suffering of their victims. Salvaging because we were clearly headed towards universal healthcare. Nice try to muddy the waters. The "bipartisanship" is all about democrats that have been playing the entire game on the republican playing field. But we did get our foot in the door and it drives republicans NUTS as their fatal mistake was to - in their minds - institute any form of socialism, no matter how watered down. We still are clearly headed towards universal healthcare.
12
Did Avik Roy work with House or Senate Republicans in drafting the current bill? Did the Times' editors even ask?
7
We might be dealing with robot/AI "editors". It's becoming difficult to tell. It seems that human skills deteriorate at the same time that robot mimicry of humans improves.
Please stop allowing this person to use the Times as an add for his consulting services. "The bill is secretly bipartisan" said the guy whose job is to write and sell Republican legislation. This mendacity fools no one but fools.
21
So sick of reading outright lies like this column. You just can't strip money out of a program, give it to the rich, and then keep your promise to preserve that program. The "market" is never willingly going to insure older citizens and the sick.
12
Under no circumstances should Avik Roy be allowed to speak as if he's such an unbiased voice in the paper of record.
10
Avik-
Try being really poor for a while... and dial back your ideology and education to date. I know it won't happen, but if it did, you would not deal with the tax system except in a cursory way (maybe to claim a refund); you would not know what to do with a tax credit. And you may not even file. You would be too busy trying to make ends meet- to pay for food, car and cell phone (which you now can't live without). Suppose someone in your family gets really sick- cancer, or something like that- you would be awash in a path-forward world you really did not understand; and you would be faced with wrenching decisions- treatment (that may or may not affect the outcome) or personal bankruptcy.
This plan is a recipe for disaster for millions, regardless of history and notional pedigree.
Try being really poor for a while... and dial back your ideology and education to date. I know it won't happen, but if it did, you would not deal with the tax system except in a cursory way (maybe to claim a refund); you would not know what to do with a tax credit. And you may not even file. You would be too busy trying to make ends meet- to pay for food, car and cell phone (which you now can't live without). Suppose someone in your family gets really sick- cancer, or something like that- you would be awash in a path-forward world you really did not understand; and you would be faced with wrenching decisions- treatment (that may or may not affect the outcome) or personal bankruptcy.
This plan is a recipe for disaster for millions, regardless of history and notional pedigree.
This is just more of the same ridiculous noise.
2
The reporting on this alleged health care bill (which is really just a tax cut for the rich bill) indicates that while gross premiums might go down -- the amount payable after Fed subsidies -- goes up. It is a fraud from the first word to the last one.
" It’s likely that, if the Senate bill passes, more Americans will have health insurance five years from now than do today."
You have got to be kidding.
You have got to be kidding.
When you say secret senate health care bill, are you referring to this one, or the other secret senate healthcare bill encated a few years ago? Lets vote it in so we can see whats in it.
2
How silly are you? The ACA was basically the Republican plan for healthcare INCLUDING the individual mandate. There were REAL hearings. It was a NOT secret and the Republicans still wouldn't participate in their own plan. The only thing that wasn't Republican about it were the things that made it an even better healthcare bill such as wellness benefits etc
2
Welcome back to Earth - 10 years on Mars can really wreck havoc with ones head.
3
Why does not the Times accurately identify who Avik Roy is and what he sells for a living?
How does this practice of backscratching serve journalism?
How does this practice of backscratching serve journalism?
7
This is a very skewed and biased article by a Republican toady.
This article does not educate and does not help American families. It is intentionally chaotic.
Very GOP communication style. Many words. Say nothing.
This article does not educate and does not help American families. It is intentionally chaotic.
Very GOP communication style. Many words. Say nothing.
4
This is so ridiculous. Medicare for all, allow CMS to negotiate with pharma and move on.
2
After reading this OpEd by Avik Roy all I can say is, Whaaaaat?
4
Please don't kill the messenger. The CBO knows what it is doing to a considerably greater extent than any policy wonk. Oh, and by the way, whatever you've been smoking, can I have some please?
1
When you start with an almost trillion dollar tax cut and call your effort a health care bill, doe sit matter one whit what concepts get included in the bill? The Rs intended to crash the system, and the "how" really doesn't matter if you pull the funding.
6
This writer, author of “How Medicaid Fails the Poor,” is misusing the word "bi-partisan" for propaganda purposes.
Just because the GOP keeps some elements of Obamacare while simultaneously adding other undermining GOP elements doesn't make this bill "bipartisan."
The Democrats do not support this bill in it's current form.
This writer is being deceptive.
Just because the GOP keeps some elements of Obamacare while simultaneously adding other undermining GOP elements doesn't make this bill "bipartisan."
The Democrats do not support this bill in it's current form.
This writer is being deceptive.
7
It's simple. Anything with Obama's name on it is bad anything that doesn't have Obama's name on it is better. it's simply simple for the simple-minded.
9
Mr. Roy's primary role, in this op-ed and in frequent media appearances, is that of a snake oil salesman - one who confabulates and distorts, with hidden agendas and without any value to move the substantive conversation forward. It reflects badly on the Times that they have provided him this megaphone for his dissembling.
9
It's a shame that you get the chance to spin and mislead about this massive tax cut paid for by those losing health care coverage.
1
We must assume Mr. Roy and his entire extended family are wealthy or that he hates them.
1
While the New York Times should promote active debate on issues of the day and present a balance of arguments representing the spectrum of opinions on an issue, it has no obligation to forward misleading arguments designed to confuse.
Avik Roy is the lead health policy editor for FREOPP, a right-wing think tank with ties to the Koch brothers and ALEC. He is presenting a highly selective and distorted picture of the BCRA to give the false appearance of bipartisanship. The fact is that Democrats unanimously and strenuously disagree with almost everything that the BCRA looks to do and are aghast at the prospect of 22,000,000 of their constituents losing insurance in order to fund a millionaire tax cut. The laughable attempt to find moral balance between the Republicans' cynical and purely political rejection of the ACA (remember "Death Panels") and the Democrats' bona fide concern that the BCRA will do exactly what the non-partisan CBO say it will is truly a low for the NYT's opinion page.
Avik Roy is the lead health policy editor for FREOPP, a right-wing think tank with ties to the Koch brothers and ALEC. He is presenting a highly selective and distorted picture of the BCRA to give the false appearance of bipartisanship. The fact is that Democrats unanimously and strenuously disagree with almost everything that the BCRA looks to do and are aghast at the prospect of 22,000,000 of their constituents losing insurance in order to fund a millionaire tax cut. The laughable attempt to find moral balance between the Republicans' cynical and purely political rejection of the ACA (remember "Death Panels") and the Democrats' bona fide concern that the BCRA will do exactly what the non-partisan CBO say it will is truly a low for the NYT's opinion page.
9
NY Times editors:
I keep seeing this clown on CNN and MSNBC because supposedly he is some type of "expert" on the GOP Trumpcare bill. He keeps claiming that it is the best thing since sliced bread WITHOUT any proof, just his interpretation of how economics is supposed to work.
I thought these op-ed pieces were supposed to be based on facts. This fool is just another Donald Trump sycophant, and not a very good one. In fact he maintains a ghoulish smile while he spreads his fantastical tales about how Trumpcare is going to solve all our health care ills.
He only talks about piddly little tax credits intended to fool us peons into thinking our health insurance is cheaper. Nothing about the higher deductible plans that treat fewer conditions which will lead to higher out-of-pocket costs for us peons.
And absolutely nothing about the massive amount of tax dollars that will be given to the rich when the ACA is repealed. Vox figured out that the amount of taxes that will be given back to the 400 richest people could pay for health care for four states:
https://www.vox.com/policy-and-politics/2017/6/26/15862002/tax-cuts-ahca...
NY Times editors, being balanced does NOT mean giving valuable column inches to people like Avik Roy. It means giving that same space to people using FACTS to support their opinions.
It seems like the New York Times has noticed that Faux News is no longer calling themselves "Fair and Balanced" and wants to adopt that motto.
I keep seeing this clown on CNN and MSNBC because supposedly he is some type of "expert" on the GOP Trumpcare bill. He keeps claiming that it is the best thing since sliced bread WITHOUT any proof, just his interpretation of how economics is supposed to work.
I thought these op-ed pieces were supposed to be based on facts. This fool is just another Donald Trump sycophant, and not a very good one. In fact he maintains a ghoulish smile while he spreads his fantastical tales about how Trumpcare is going to solve all our health care ills.
He only talks about piddly little tax credits intended to fool us peons into thinking our health insurance is cheaper. Nothing about the higher deductible plans that treat fewer conditions which will lead to higher out-of-pocket costs for us peons.
And absolutely nothing about the massive amount of tax dollars that will be given to the rich when the ACA is repealed. Vox figured out that the amount of taxes that will be given back to the 400 richest people could pay for health care for four states:
https://www.vox.com/policy-and-politics/2017/6/26/15862002/tax-cuts-ahca...
NY Times editors, being balanced does NOT mean giving valuable column inches to people like Avik Roy. It means giving that same space to people using FACTS to support their opinions.
It seems like the New York Times has noticed that Faux News is no longer calling themselves "Fair and Balanced" and wants to adopt that motto.
7
This is an extremely deceptive piece. How the New York Times presents this without context is beyond me. Everyone involved should be ashamed.
2
Roy is telling us, "Man, that's a pretty shade of lipstick - and on a good-looking swine, too."
During the original ACA debate and aftermath, Avik Roy was an important voice. Most conservatives couldn't be bothered with addressing the merits of the actual policies being debated - Roy did, and offered real perspective on the pros and the cons of the proposals. It's all the more disheartening, then, to watch him flail around trying to pump up the ACA repeal bills with all the finesse of Sean Hannity praising Donald Trump.
The bills flat-out stink. The ACA needs a cash infusion to support markets in rural states - that's a real issue, but it's not a reason to set the entire health care system on fire and have ouselves weenie roast.
During the original ACA debate and aftermath, Avik Roy was an important voice. Most conservatives couldn't be bothered with addressing the merits of the actual policies being debated - Roy did, and offered real perspective on the pros and the cons of the proposals. It's all the more disheartening, then, to watch him flail around trying to pump up the ACA repeal bills with all the finesse of Sean Hannity praising Donald Trump.
The bills flat-out stink. The ACA needs a cash infusion to support markets in rural states - that's a real issue, but it's not a reason to set the entire health care system on fire and have ouselves weenie roast.
Roy is a right wing scoundrel on the payroll of the Koch Brothers. His articles belong in the Onion not the MSM.
3
Avik Roy's foundation FREOPP is part of the State Policy Network and has direct ties to the Koch Brothers. FREOPP's main goal is to dismantle the ACA. This article should come with a warning label.
7
I am utterly shocked that The Times would print this essay with so many blatant lies. It's impossible to even begin unraveling the distortions and outright lies.
Why do Times editors believe it is acceptable to publish such dishonest essays from blatant liars? Many readers were shocked that The Times would employ Bret Stephens, who deliberately dissembles about climate change. And now this one from Avik Roy?
Truth and facts should be absolutely required to get published in The Times. Sadly, neither is required any longer.
Why do Times editors believe it is acceptable to publish such dishonest essays from blatant liars? Many readers were shocked that The Times would employ Bret Stephens, who deliberately dissembles about climate change. And now this one from Avik Roy?
Truth and facts should be absolutely required to get published in The Times. Sadly, neither is required any longer.
5
"If the Senate passes this bill...we will all look at the 2010's as a period of substantial progress in American health care."
Except for the people who died along the way because of it....
Except for the people who died along the way because of it....
1
Wow... the very definition of spin and false equivalent. Don't believe a word of this silliness.
3
Who is paying this author's salary? I am betting not the little old lady in New Orleans living on Social Security and Medicaid - because that tax credit isn't in her conversation with survival.
This bill is a a 'synthesis of cruelty. The so-called 'Democrats' you cite, like Max Baucus - were fiscal sadists indistinguishable from their Republican golfing partners. And Max was quick to trade in his old model wife for the new improved little tart just like Donald.
This bill is a a 'synthesis of cruelty. The so-called 'Democrats' you cite, like Max Baucus - were fiscal sadists indistinguishable from their Republican golfing partners. And Max was quick to trade in his old model wife for the new improved little tart just like Donald.
Mr. Roy: What kind of pipe are you smoking? This bill is a giveaway to the rich and greedy, pure and simple. Those who vote for it should resign from whatever religious group they profess to belong to and McConnell and Rylan should lead the parade.
1
Roy is speaking from a Bizarro Universe:
1. No justification in the slightest for the repeated assertion that repealing the individual mandate would not result in millions fewer buying insurance. Wrong and disingenuous. How many healthy, vigorous young adults on a strict budget would even buy car insurance, wear a helmet or buckle up if these weren't statutorily required? And now these have become socially responsible expectations.
2. Ongoing prating about individual tax deductions for those who pay little or no income tax. Ho hum junk thinking driven by the agenda: do and say anything but just make government, its agencies, smaller.
Thank god for the Bizarro Rand-Cruz-Koch axis. They force the Right's real predilection into full view, its knee-jerk, utterly inappropriate"solution" to the management of one of the most complicated systems in America, healthcare management.
When will NYT publish a review of Professor Pollin's (UMass Economics Dept) astute analysis of the single payer bill pending before the California state Assembly? (Google it) Time for something moral and workable.
1. No justification in the slightest for the repeated assertion that repealing the individual mandate would not result in millions fewer buying insurance. Wrong and disingenuous. How many healthy, vigorous young adults on a strict budget would even buy car insurance, wear a helmet or buckle up if these weren't statutorily required? And now these have become socially responsible expectations.
2. Ongoing prating about individual tax deductions for those who pay little or no income tax. Ho hum junk thinking driven by the agenda: do and say anything but just make government, its agencies, smaller.
Thank god for the Bizarro Rand-Cruz-Koch axis. They force the Right's real predilection into full view, its knee-jerk, utterly inappropriate"solution" to the management of one of the most complicated systems in America, healthcare management.
When will NYT publish a review of Professor Pollin's (UMass Economics Dept) astute analysis of the single payer bill pending before the California state Assembly? (Google it) Time for something moral and workable.
3
Roy's entire argument rests on the very shaky assertion that the
Congressional Budget Office's estimate is flawed. Unlikely to say
the least. A Republican wish and prayer as the alternative is what shakes.
Congressional Budget Office's estimate is flawed. Unlikely to say
the least. A Republican wish and prayer as the alternative is what shakes.
2
I am no longer willing for MY Federal Government to continue pouring good money after bad. The "for profit" model of health care has had twenty years to make good on their promises – and "the Senator from HCA" has been in office that entire time – but they have in fact neither produced satisfactory returns for their shareholders nor, most importantly, succeeded in providing health care.
I submit that it is axiomatically impossible to provide health care "for profit," and/or to pay for it using insurance that is also "for profit." These fundamentals cannot be evaded, no matter how much money you throw at it.
And this is precisely what both versions of this wretched bill would do: give billions of dollars to private, for-profit companies with no strings attached. It would also allow them to become even worse at providing ... health care.
"Health Care for Everyone" is the fundamental objective here, not propping-up a failed business model. The British know how to do it, as do many other countries. Health Care is a public service, not a profit-seeking business. Given that we spend billions of dollars a month on "killing people" in far-away lands, we can start spending money "saving people" in our own.
Senator Frist or no Senator Frist, their concept is not working and it is clear that it never will. I'm willing to spend public money on "health care for everyone," but I'm not willing to spend any more money on THIS.
I submit that it is axiomatically impossible to provide health care "for profit," and/or to pay for it using insurance that is also "for profit." These fundamentals cannot be evaded, no matter how much money you throw at it.
And this is precisely what both versions of this wretched bill would do: give billions of dollars to private, for-profit companies with no strings attached. It would also allow them to become even worse at providing ... health care.
"Health Care for Everyone" is the fundamental objective here, not propping-up a failed business model. The British know how to do it, as do many other countries. Health Care is a public service, not a profit-seeking business. Given that we spend billions of dollars a month on "killing people" in far-away lands, we can start spending money "saving people" in our own.
Senator Frist or no Senator Frist, their concept is not working and it is clear that it never will. I'm willing to spend public money on "health care for everyone," but I'm not willing to spend any more money on THIS.
1
One way or another critical medical care is paid for and if it's not through personal funds or insurance one way or another all who are insured pay for it.
Let's see the Republicans start with the premises that health care is a right, and that it must be provided. Now the job of the government is to figure out how to do that as efficiently as possible.
Let's see the Republicans start with the premises that health care is a right, and that it must be provided. Now the job of the government is to figure out how to do that as efficiently as possible.
1
The profound dishonest of this piece can be found, most obviously, in this paragraph:
"The Senate bill replaces the A.C.A.’s Medicaid expansion with a robust system of tax credits for which everyone under the poverty line is eligible. Under Obamacare, you could enroll in private insurance exchanges only if your income exceeded the poverty line."
Under Obamacare, there was no need to enroll in private insurance exchanges, because the ACA expanded Medicaid to everybody under the poverty line and to millions above it as well. The lack of credits for those under the poverty line is a transparently false straw man, set up just for knocking down.
"The Senate bill replaces the A.C.A.’s Medicaid expansion with a robust system of tax credits for which everyone under the poverty line is eligible. Under Obamacare, you could enroll in private insurance exchanges only if your income exceeded the poverty line."
Under Obamacare, there was no need to enroll in private insurance exchanges, because the ACA expanded Medicaid to everybody under the poverty line and to millions above it as well. The lack of credits for those under the poverty line is a transparently false straw man, set up just for knocking down.
5
I understand that this is an Op-Ed but it would have been nice if Mr. Roy had included support for many of his claims. This opinion article essentially amounts to multiple invalid presuppositions and "just because" statements.
The means-tested tax incentives for low income/elderly was touted by Roy as "robust" but ignores the net negative impact as detailed by the CBO analysis. Also the comments on premium changes conveniently ignores the quality of coverage that goes with those premiums. In fact the paragraph on "premiums" fails to mention what the changes are relative to, whether that is the ACA or pre-ACA coverage.
Ultimately Mr. Roy is heavy on assertions and light on support.
The means-tested tax incentives for low income/elderly was touted by Roy as "robust" but ignores the net negative impact as detailed by the CBO analysis. Also the comments on premium changes conveniently ignores the quality of coverage that goes with those premiums. In fact the paragraph on "premiums" fails to mention what the changes are relative to, whether that is the ACA or pre-ACA coverage.
Ultimately Mr. Roy is heavy on assertions and light on support.
1
This bill limits spending on health care, it does nothing to control the costs of healthcare. Nothing will improve until we address the costs side of the equation. I take a cancer drug that costs 40% less in Canada than it does in the US. It was developed at UCLA most likely with government grant money. Now Pfizer is selling a monthly supply of 28 capsules for $10,000. A Canadian patient pays $6,000. This is the problem in a nutshell. The Republican bill gives companies like Pfizer huge tax breaks. Why? This is a tax bill not a health bill.
3
Right. Solving the Medicaid problem with tax credits for folks with incomes so low that they have little or no tax burden. Mr. Roy is the Arthur Laffer of health care financing - redistribution upward justified by fairy tales - always enriching the rich along with fantastical constructions of how this will work for everyone. Puh-lease.
162
Avik Roy is as useful to the debate on health care as Nancy Reagan was to the debate on drugs ("Just say no").
Roy is given space in respectable publications because he is *respectable*--just as Nancy Reagan was quoted because she was respectable. They are, in Lenin's delectable term, "useful idiots."
You'd think that in nation with 250 million adults, the NYT could find *somebody* with enough knowledge and expertise to argue the conservative case for health-care reform, but, no, the only person the NYT could find was Avik Roy, who has been selling his snake oil in every media outlet naive enough to print him. (He appears on TV all the time, too.)
But don't fret--the best is yet to come: Pretty soon, Scott Pruitt will achieve his goal of destroying his own EPA, and the NYT and the Washington Post will give him space to explain what a great idea that was.
Roy is given space in respectable publications because he is *respectable*--just as Nancy Reagan was quoted because she was respectable. They are, in Lenin's delectable term, "useful idiots."
You'd think that in nation with 250 million adults, the NYT could find *somebody* with enough knowledge and expertise to argue the conservative case for health-care reform, but, no, the only person the NYT could find was Avik Roy, who has been selling his snake oil in every media outlet naive enough to print him. (He appears on TV all the time, too.)
But don't fret--the best is yet to come: Pretty soon, Scott Pruitt will achieve his goal of destroying his own EPA, and the NYT and the Washington Post will give him space to explain what a great idea that was.
Nice try, Spin Dr. Roy. The CBO refutes your claim that more people will have coverage under the proposed bill.
Until we get to a single-payer system, jettison the fee-for-service model of health-care delivery, and use the federal government's volume leverage and regulatory power to end big pharma's predatory pricing, fixing the flaws in Obamacare is the only sane course of action.
Until we get to a single-payer system, jettison the fee-for-service model of health-care delivery, and use the federal government's volume leverage and regulatory power to end big pharma's predatory pricing, fixing the flaws in Obamacare is the only sane course of action.
3
The reason Florida and Texas residents don't have more insurance coverage is BECAUSE their state government decided not to expand Medicaid. Don't water it down suggesting that somehow this was a problem with the ACA. Why would anyone ignore a 90+% payment for their citizens?
8
I am honestly not certain what reality Mr. Avik Roy lives in, and which bill he has been reading. If I was being kind, I would say his opinions are optimistic in the extreme, however the term "delusional" appears more appropriate.
Until we start recognizing that a for-profit insurance industry and a medical model that pays for interventions performed is not a sustainable model, we are going to have growing problems with affordability in healthcare.
I work in healthcare. I am not paid for keeping people well - I am paid for treating people only once they are hurt or unwell. I receive no reimbursement under either the ACA or the proposed Trumpcare for the interventions that actually prevent illness.
This is not sustainable or smart.
Kind of like our current political climate...
Until we start recognizing that a for-profit insurance industry and a medical model that pays for interventions performed is not a sustainable model, we are going to have growing problems with affordability in healthcare.
I work in healthcare. I am not paid for keeping people well - I am paid for treating people only once they are hurt or unwell. I receive no reimbursement under either the ACA or the proposed Trumpcare for the interventions that actually prevent illness.
This is not sustainable or smart.
Kind of like our current political climate...
4
This is a tapestry of intellectual dishonesty. For example:
"If the Republican plan increases participation by the young, premiums will become more affordable for everyone, because insurers set premiums to reflect an average of the costs of covering everyone who signs up for a given insurance plan. If only older people sign up, average costs in the plan are higher, leading to higher premiums. If young and old sign up, average costs are lower, and premiums go down."
Except that insurers are allowed to place younger consumers in separate pools and charge older folks higher rates. Average costs won't matter that much and, at the same time premium support for older folks will not make up for allowed differentials in insurance rates.
"If the Republican plan increases participation by the young, premiums will become more affordable for everyone, because insurers set premiums to reflect an average of the costs of covering everyone who signs up for a given insurance plan. If only older people sign up, average costs in the plan are higher, leading to higher premiums. If young and old sign up, average costs are lower, and premiums go down."
Except that insurers are allowed to place younger consumers in separate pools and charge older folks higher rates. Average costs won't matter that much and, at the same time premium support for older folks will not make up for allowed differentials in insurance rates.
2
One way or another every American will pay more regardless of how you try to manipulate the market and distribution. Eventually the costs of the stresses created by the lack of security that is growing each and every day will cost everyone more than they anticipated. Including the rich. Even Saudi Arabia has this one right. They have universal care for all their citizens because they know that keeping people satiated and somewhat healthy is what has allowed them to keep the charade of the King in place.
Republicans, if you want to make most rich people more rich and have it be ok with the electorate at large you have to at least keep the people somewhat satiated so that you don't have strife and uncertainty. Your transparent tax cuts and austerity for the people who can't afford anything anyway is not the path forward. Shifting costs to states can only get you so far. Deregulating also has its limitations coupled with a lot of potential risk in the future.
One way out of most of this quagmire? Single payer.
Republicans, if you want to make most rich people more rich and have it be ok with the electorate at large you have to at least keep the people somewhat satiated so that you don't have strife and uncertainty. Your transparent tax cuts and austerity for the people who can't afford anything anyway is not the path forward. Shifting costs to states can only get you so far. Deregulating also has its limitations coupled with a lot of potential risk in the future.
One way out of most of this quagmire? Single payer.
5
Isn't the problem with obamacare that it borrowed too many Republican ideas? Single payer!
4
Here is a better "means test": Are you an American citizen, an undocumented person who is in the process of becoming an American citizen, an undocumented person who is allowed to live in America as such because you provide cheap labor to an American enterprise, or a person legally visiting America? Then you get health care for free, or at a cost that you can easily afford.
This is an interesting oped because it highlights the complexity of the issue. I am frustrated by how hard it is to have a conversation on this without rhetoric. I really want a good republican explanation for their goals because I find everything they say and do to be intentionally misleading. It seems there has been a calculation that their goals are not popular so they are trying to bamboozle everyone...but maybe I am wrong. I just don't know.
I would love for all bills to have an honest mission statement (I understand this is unlikely/impossible), like the ACA would be "Our goal is to increase the number of people who have insurance and we are not really going to pay attention to costs, with a hope that the byproduct of more insurance is lower costs". I think the democrats were pretty honest about this for the most part.
From this oped, it seems that the conclusion is the new bill will increase coverage...but is that only because certain states refuse federal funding to expand Medicaid? Which was basically a "anything Obama does or says is bad" policy so we are going to do our best to make sure the ACA fails? What would the mission statement of this new bill be? "We just don't think as a country we can afford to have universality of coverage and still have growth/be profitable"? or is it "kill kill kill Medicaid"?
I just don't have enough information...which I believe at the end of the day means true intentions are being hidden.
I would love for all bills to have an honest mission statement (I understand this is unlikely/impossible), like the ACA would be "Our goal is to increase the number of people who have insurance and we are not really going to pay attention to costs, with a hope that the byproduct of more insurance is lower costs". I think the democrats were pretty honest about this for the most part.
From this oped, it seems that the conclusion is the new bill will increase coverage...but is that only because certain states refuse federal funding to expand Medicaid? Which was basically a "anything Obama does or says is bad" policy so we are going to do our best to make sure the ACA fails? What would the mission statement of this new bill be? "We just don't think as a country we can afford to have universality of coverage and still have growth/be profitable"? or is it "kill kill kill Medicaid"?
I just don't have enough information...which I believe at the end of the day means true intentions are being hidden.
1
Wow. The CBO makes the assumptions it makes because they have long experience and expertise doing what they do. They state their assumptions clearly, and then they SHOW THEIR WORK. The author makes bold, unsubstantiated claims about what the CBO gets wrong, but does not back the criticisms with anything other than partisan opinion, wishes and hope. If the CBO's assumptions and calculations are wrong, Mr. Roy, clearly state your own and your calculations.
You're held out as a Republican "expert" on healthcare policy. Let's see your complete assessment of the proposed bill. Oh, you don't have one? Yeah, thought so.
You're held out as a Republican "expert" on healthcare policy. Let's see your complete assessment of the proposed bill. Oh, you don't have one? Yeah, thought so.
4
Avik Roy believes the bill about to be voted on will give more people health insurance, contrary to the C.B.O.'s report. He simply states:"That’s not a flaw in the Senate bill; it’s a flaw in the C.B.O.’s methods." This is another example of unsubstantiated opinion parading as fact with no hint of reasoning. It is so because I say so, seems to be the prevailing opinion.
1
In the Clinton administration, "The average Federal payment for each category would be allowed to increase each year by the average annual change in economic output over the previous five years, before adjusting for inflation."
So identical in the sense that a panda resembles a skunk, then.
So identical in the sense that a panda resembles a skunk, then.
3
For reference, Avik Roy is a longtime critic of the Affordable Care Act and has been an advisor to two Republican presidential candidates: Mitt Romney and Rick Perry (http://thehill.com/homenews/campaign/239399-perry-lands-ex-romney-health....
Mr. Roy's efforts to skirt around the 22 million Americans who would lose health insurance by 2026 from the Senate's health care bill is intellectual dishonesty at best and partisan propaganda at worst.
Mr. Roy's efforts to skirt around the 22 million Americans who would lose health insurance by 2026 from the Senate's health care bill is intellectual dishonesty at best and partisan propaganda at worst.
8
So the propaganda of linking this failure of a bill to 'Democratic' ideas begin. I'm sure as people start to really suffer, Fox and other unscrupulous media outlets will begin to blame its failure on the Democrats in any way they can. Articles like this are the advance wave of this propaganda.
I'll tell you what senate Repubicans - if you want to borrow a Democratic idea on healthcare, 'borrow' single payer so we can finally join the rest of the industrialized first world in having a health care system which works for its citizens, and not just mega corporations and the wealthy.
I'll tell you what senate Repubicans - if you want to borrow a Democratic idea on healthcare, 'borrow' single payer so we can finally join the rest of the industrialized first world in having a health care system which works for its citizens, and not just mega corporations and the wealthy.
8
Have to ask theTimes why you'd give voice to Dr Roy when his argument is so misleading that it verges on propaganda? His "argument" about Medicaid is easily refutable. Simply put, the new Medicaid subsidies are not adequate to cover all those in need. And when poor people don't get insurance, they die
4
Did Mr. Roy fail to read the CBO analysis, the part about 15 million losing insurance in the coming year, and more as we cross into the next decade? In what alternate world does he live where he can baldly state that millions more will be covered in the coming five years? Apparently this is what happens when the product of a Republican education writes a column.
Why did the Times publish this piece? It makes assertions about costs and coverage that are contradicted by the CBO. He provides no backup analysis to support these assertions. The CBO has extensive analysis supporting their conclusions. I expect Fox to be a fact free zone, but not the Times
3
I'm sorry but this article makes no sense! You, obviously, don't know what the outcome of this bill will be. No one does. Yet, you advocate we take an extraordinary risk on this bill instead of the rational, wise path of improving our present imperfect but vastly superior to pre-Obamacare healthcare system.
Why? Why take such a huge risk with so many peoples' lives at stake?
Why? Why take such a huge risk with so many peoples' lives at stake?
Just look at the funders, Board of Directors, and Think Tanks associated with the Foundation for Research on Equal Opportunity and you will know what credibility it deserves.
3
Brazenly untrue account of a bill designed to do nothing more than transfer public wealth to the 1%. It has nothing to do with health, choice or serious public policy.
3
What Senate Health Care Bill? Oh, you mean the Koch brother's health care bill? How comforting to know we have such busy, concerned citizens doing Congress's work and we didn't even have to vote for them!
Imagine Medicare for all. Then get back to us.
1
This analysis is disingenuous. In stating that more people might have coverage 10 years from now, it doesn't include the fact that that "coverage" may not cover anything in reality and deductibles and out of pocket costs would skyrocket for any decent coverage levels. This is just more "alternative facts" from the Death care panels. I expect better Op-Eds from the NYT.
3
Wha6 a joke of an article,depending on the good will of Republican governors "to deploy additional funds as direct cost-sharing subsidies" to those locked out of health care. It has rarely happened that GOP governors willingly help the poor. That's why so few expanded Medicaid. This bill is a travesty.
2
"It’s likely that, if the Senate bill passes, more Americans will have health insurance five years from now than do today."
What economic analysis did the author use to come to this conclusion, which is starkly at odds with the CBO's analysis? While the main tenant of the article may be true, that there are borrowed components in both bills, to make this claim is pure speculation based on wishful thinking. I'm sure a lot of young people will sign up for health insurance in a world where it's not mandatory.... Tell me, have you met many young people lately? Do they seem to you to be clamoring to purchase health insurance?
What economic analysis did the author use to come to this conclusion, which is starkly at odds with the CBO's analysis? While the main tenant of the article may be true, that there are borrowed components in both bills, to make this claim is pure speculation based on wishful thinking. I'm sure a lot of young people will sign up for health insurance in a world where it's not mandatory.... Tell me, have you met many young people lately? Do they seem to you to be clamoring to purchase health insurance?
1
"It increases the role of private insurers, and decreases the role of state-run Medicaid programs in covering the uninsured."
What alternate universe are you from? My entire working career has had to endure the indignities of our "for profit" private insurers. United Healthcare's 7.2 billion dollar profit in 2016 could provide care and lower premiums for many needy Americans.
The rest of your comments are as confusing as the quote above. You must be related to Mitch McConnell.
What alternate universe are you from? My entire working career has had to endure the indignities of our "for profit" private insurers. United Healthcare's 7.2 billion dollar profit in 2016 could provide care and lower premiums for many needy Americans.
The rest of your comments are as confusing as the quote above. You must be related to Mitch McConnell.
2
It would appear that Mr. Roy is simply a surrogate for Mitch McConnell's talking points. Attempting to justify this bill as bipartisan is contemptible and disingenuous.
The American people truly deserve better....
The American people truly deserve better....
1
Why does the Times feel obligated to publish these puff pieces for organizations that are only superficially bipartisan? The proliferation of these so-called "think tanks" operating under the false flags of bipartisanship and objectivity is no reason to promulgate their ideas.
Would you believe any policy agenda bankrolled by the Koch brothers has any claim to objectivity? Yet the Foundation for Research on Equal Opportunity is run by individuals who are also board members of institutes bankrolled by the Koch brothers, a fact which is not even mentioned in the byline of this farce. Even the name is an insult, and has as much relevance to the organization's mission as the Democratic Republic of North Korea has to democracy.
Would you believe any policy agenda bankrolled by the Koch brothers has any claim to objectivity? Yet the Foundation for Research on Equal Opportunity is run by individuals who are also board members of institutes bankrolled by the Koch brothers, a fact which is not even mentioned in the byline of this farce. Even the name is an insult, and has as much relevance to the organization's mission as the Democratic Republic of North Korea has to democracy.
3
Two words: Oh, PLEASE!
1
New York Magazine's Jonathan Chait did the necessary research to determine that Roy probably helped write the bill that he is touting in terms of purest fantasy here in the New York Times. Why couldn't you guys do that basic research and make that note in your description of his role in this bill? If you had a Public Editor I could raise that question with them, but now that you've eliminated the position I guess your editorial decisions are impregnable and opaque. Wonder why that is.
2
Both sides!
Avik Roy sees the "free market" as a solution to health care in the United States. As if young, healthy millennials will happily fork over a significant chunk of their barista paycheck because they might get a tax credit in April for some portion of it.
Ridiculous. Look, every other developed country in the world figured this out decades ago, and all of them REQUIRE that their citizens are covered. Volunteering to pay for coverage if you're young and healthy and not making much money is a conservative fantasy.
Ridiculous. Look, every other developed country in the world figured this out decades ago, and all of them REQUIRE that their citizens are covered. Volunteering to pay for coverage if you're young and healthy and not making much money is a conservative fantasy.
193
"Volunteering to pay for coverage if you're young and healthy and not making much money is a conservative fantasy."
Just like the trickle down theory of republican economics.
In my 20's I was more concerned with what bar I was going to and trying to screw around. Health insurance? Not even on my top 100 concerns. I was young and wasn't going to die.
Do Republicans live in our world or a universe far far away?
Just like the trickle down theory of republican economics.
In my 20's I was more concerned with what bar I was going to and trying to screw around. Health insurance? Not even on my top 100 concerns. I was young and wasn't going to die.
Do Republicans live in our world or a universe far far away?
2
If a young person chooses not to purchase coverage with their meager paycheck, Republicans can either pass it off as them not exercising personal responsibility, or having the "freedom" to not be insured.
That's why Republicans left the 26 year old coverage provision in place. Aside from benefiting wealthy parents with robust income and insurance, the gesture explicitly acknowledges the inability of people younger than 26 to afford health insurance on their own. They're on their parents' plan, medicaid, or uninsured. I would argue 26 is even too low. Most millennials aren't successfully "launched" until 30 or even later. Perhaps never. Republicans don't want to admit this uncomfortable truth. As a result, they're hiding it in plain sight.
1
With the Senate bill "States will be able to easily waive the requirement to cover Essential Health Benefits, without any careful conditions to ensure the quality and affordability of coverage.
As a result, insurers will offer skinny plans with less coverage that falls far short of the needs of those with serious health conditions. This is how it used to work: Before the Affordable Care Act, Young and healthy people will opt for those plans, leaving those with pre-existing conditions in their own, much more costly, market. In the end, the effect is the same as if companies could just outright discriminate against those with serious health problems."
https://www.theatlantic.com/business/archive/2017/06/ahca-senate-bill-pr...
As a result, insurers will offer skinny plans with less coverage that falls far short of the needs of those with serious health conditions. This is how it used to work: Before the Affordable Care Act, Young and healthy people will opt for those plans, leaving those with pre-existing conditions in their own, much more costly, market. In the end, the effect is the same as if companies could just outright discriminate against those with serious health problems."
https://www.theatlantic.com/business/archive/2017/06/ahca-senate-bill-pr...
Mr. Roy comes close to the truth in his hypothetical case - a bipartisan bill a decade ago would have cut the number of uninsured significantly and started to address the long-term funding issues surrounding Medicaid. But...
1. Sen. McConnell chose obstruction over bipartisanship and killed the consensus Mr. Roy fantasizes. The Republicans had a great opportunity to address a legitimate policy goal of reining in Medicaid spending through reforms, not by simply kicking people out of the program. But the Majority Leader, ultimately, didn't care about policy as much as he cared about naked partisanship.
2. Mr. Roy clearly goes off the rails with his fanciful assertion that more people would be insured under the Senate bill in 5 years than under current law. No reasonable person (and, tellingly, no current Republican Senator!) can reach a similar conclusion. Healthy young people will drop coverage absent a mandate. States will contract their Medicaid eligibility requirements in the face of fewer federal matching dollars. Insurance companies, seeking better profit margins, will shed sick policy holders to the degree they are permitted to do so. Offering poor people skimpy tax credits is a fig leaf to mask the fact that the poor still won't be able to afford health insurance. The CBO analysis may not be 100% accurate, but its projection of 22 million fewer insured is certainly the best estimate out there and belies Mr. Roy's delusional increase.
1. Sen. McConnell chose obstruction over bipartisanship and killed the consensus Mr. Roy fantasizes. The Republicans had a great opportunity to address a legitimate policy goal of reining in Medicaid spending through reforms, not by simply kicking people out of the program. But the Majority Leader, ultimately, didn't care about policy as much as he cared about naked partisanship.
2. Mr. Roy clearly goes off the rails with his fanciful assertion that more people would be insured under the Senate bill in 5 years than under current law. No reasonable person (and, tellingly, no current Republican Senator!) can reach a similar conclusion. Healthy young people will drop coverage absent a mandate. States will contract their Medicaid eligibility requirements in the face of fewer federal matching dollars. Insurance companies, seeking better profit margins, will shed sick policy holders to the degree they are permitted to do so. Offering poor people skimpy tax credits is a fig leaf to mask the fact that the poor still won't be able to afford health insurance. The CBO analysis may not be 100% accurate, but its projection of 22 million fewer insured is certainly the best estimate out there and belies Mr. Roy's delusional increase.
2
Buried within the obvious is yet another lie: that tying Medicare to GDP or CPI will reduce health care costs. Instead, it will increase the current divergence: those who can afford insurance get better care. And by reducing eligibility, Republicans will expand the pool of individuals who receive no care whatsoever.
Medicare is already more cost-effective than almost any private insurance, and the best way to give quality care to everyone - at the best value - is to open Medicare to anyone who wants in.
Medicare is already more cost-effective than almost any private insurance, and the best way to give quality care to everyone - at the best value - is to open Medicare to anyone who wants in.
4
Obamacare did not "borrow" from the GOP or Romneycare. They were forced to abandon many of the ACA's strong ideas & replace them with Republican ideas as a condition of breaking Mitch McConnell's filibuster. In particular, Romney's Individual Mandate, complete with Romneycare's tax on people who didn't have insurance (originally proposed by the uber-conservative Heritage Foundation in 2 papers in 1989) was a substitute for the highly popular "Public Option" or "Medicare for All" that finally would have offered people an alternative to for-profit insurance. In USA Today, 9/31/2009, Romney wrote an op-ed urging Obama to adopt Romneycare's Individual Mandate in place of the Public Option. A quote from Romney:
"First, we established incentives for those who were uninsured to buy insurance. Using tax penalties...encourages 'free riders' to take responsibility for themselves rather than pass their medical costs on to others."
You CAN'T get rid of the pre-existing condition restriction if people think they can simply go without insurance until they get sick & leave insurance companies paying out more than they charge. The healthy have to support the sick, knowing that one day, other healthy people will be supporting them & their loved ones when they become ill. If young healthy people did not have to buy health insurance until they became sick, then only the old or sick would buy it, and the cost would be out of almost everybody's range.
Single-payer works better & costs less.
"First, we established incentives for those who were uninsured to buy insurance. Using tax penalties...encourages 'free riders' to take responsibility for themselves rather than pass their medical costs on to others."
You CAN'T get rid of the pre-existing condition restriction if people think they can simply go without insurance until they get sick & leave insurance companies paying out more than they charge. The healthy have to support the sick, knowing that one day, other healthy people will be supporting them & their loved ones when they become ill. If young healthy people did not have to buy health insurance until they became sick, then only the old or sick would buy it, and the cost would be out of almost everybody's range.
Single-payer works better & costs less.
4
The proposed plan takes an already hobbled Health Plan built by trying to appease insurance companies and leads it in the wrong direction. There is nothing here that controls healthcare costs.( I don't consider throwing people off of insurance as controlling costs). Quality control is lost and premiums continue to skyrocket. People are already stretched in order to pay premiums and out-of-pocket deductibles. This is not rocket science. In fact, as we all know, every other industrialized country in the world does this better and less expensively than we do with better outcomes for health. Today David Brooks eloquently points out that our legislators are more interested in the political world than the world the rest of us live in.
2
Avik Roy has made a pretty good career out of being consistently wrong about health care in this country, and still getting pretty good gigs out of it.
I guess those who can rationalize the right-wing's brutal policies while not sounding brutal are few and far between, so therefore very much in demand.
Doesn't stop him from being wrong, though.
I guess those who can rationalize the right-wing's brutal policies while not sounding brutal are few and far between, so therefore very much in demand.
Doesn't stop him from being wrong, though.
18
About 15 years ago, the company that I worked for offered an insurance benefit for part time employees. It cost about $30 per month, had a deductible of $1000 and had a maximum benefit of $10,000. I bought it because I could no longer afford the close to $400 per month I was paying for actual health insurance. As I was still in my mid-thirties at the time and healthy, I basically decided to assume almost all of the risk that actual insurance is designed to mitigate. Had I not won my gamble, my "health insurance policy" might have bought a couple of band aids.
So yes, Mr. Roy, more people might have health insurance if such low cost policies can once again be offered for sale. But, that really means that more people will have policies that are basically worthless.
So yes, Mr. Roy, more people might have health insurance if such low cost policies can once again be offered for sale. But, that really means that more people will have policies that are basically worthless.
12
Yesterday it was said by someone ' The government can't afford U.S health care, the businesses can't afford it and individuals can't afford it.'
Yet we continue to attempt ideologically driven, so called, "market inspired' solutions - this while the rest of the modern world does the job much better
for half the price.
We need to finally get it through our heads - the health of our nation is not prey for our predatory capitalist economic system.
The 1 percent cannot continue to own us in that way. It is anathema to life liberty and the pursuit of happiness. It is a moral sin of our capitalist system
Yet we continue to attempt ideologically driven, so called, "market inspired' solutions - this while the rest of the modern world does the job much better
for half the price.
We need to finally get it through our heads - the health of our nation is not prey for our predatory capitalist economic system.
The 1 percent cannot continue to own us in that way. It is anathema to life liberty and the pursuit of happiness. It is a moral sin of our capitalist system
24
Mr. Roy criticizes the CBO for analyzing the Senate bill as it stands and making projections based on what it does. He, instead, makes projections based on what he hopes might happen ("...what senators do to direct more financial assistance to the poor"). Flawed reasoning, flawed conclusions.
14
"The Congressional Budget Office believes that solely because Republicans would repeal the A.C.A.’s individual mandate, by 2026, more than 15 million fewer people will buy health insurance, regardless of what senators do to direct more financial assistance to the poor and the vulnerable. That’s not a flaw in the Senate bill; it’s a flaw in the C.B.O.’s methods." - Roy
"CBO and JCT have endeavored to develop budgetary estimates that are in the middle of the distribution of potential outcomes. Such estimates are inherently inexact because the ways in which federal agencies, states, insurers, employers, individuals, doctors, hospitals, and other affected parties would respond to the changes made by this legislation are all difficult to predict. " - CBO
Unlike the author, the CBO admits the uncertainty of their estimates. If there were no uncertainty, they would not be estimates. The author seems to have no qualms ignoring uncertainty when it comes to his preferred analysis, as these bolster his preferred policy choice; however, the author's assumptions about human behavior presume that people will act in a particular way which empirical data does not support.
Thank you NYT for publishing this viewpoint. It may be wrongheaded, but it is important to bring it out in the open.
"CBO and JCT have endeavored to develop budgetary estimates that are in the middle of the distribution of potential outcomes. Such estimates are inherently inexact because the ways in which federal agencies, states, insurers, employers, individuals, doctors, hospitals, and other affected parties would respond to the changes made by this legislation are all difficult to predict. " - CBO
Unlike the author, the CBO admits the uncertainty of their estimates. If there were no uncertainty, they would not be estimates. The author seems to have no qualms ignoring uncertainty when it comes to his preferred analysis, as these bolster his preferred policy choice; however, the author's assumptions about human behavior presume that people will act in a particular way which empirical data does not support.
Thank you NYT for publishing this viewpoint. It may be wrongheaded, but it is important to bring it out in the open.
17
Tax credits are the worst incentives for the poor to access healthcare. If I were unable to get healthcare today, and I needed but lack the resources, I really can't wait for tax season for the credit to kick in. The only real answer to America's healthcare crisis is socialized medicine. In many other countries it works.There's no reason not to enable it here — other than the opposition from special interests. It's OK, we'll just treat healthcare like every other big problem we face: kick it down the road.
18
My local grocery store is stocking cherries, so Roy's cherry picked facts and contentions are as timely as they are predictable. One would think that the best measure of what "Democrats" would like in health care legislation is the most recent legislation that Roy is eager to dismantle rather than one cobbled together 20 years ago in an attempt by the Triangulator in Chief to ward off a calamitous Republican counter proposal. And the tired reference to one conclusion of the Oregon study, which also concluded that Medicaid coverage dramatically reduced financial ruin and that it improved mental health outlooks, is what they say in the law is an "incomplete hypothetical" at best. Roy is correct though that the plan discloses a difference in values--the prime directive here, as always, is a massive redistribution of wealth back upwards, like God intended it.
20
Mr. Roy says nothing of the 60-65 year old cohort who might no longer find employment that provides adequate health insurance, and to whom insurance companies have been given free rein to hike their rates above what many can afford. What will it take for the people of this country to get mad enough to say to our elected representatives that we want the same health coverage they and their families enjoy?
17
Here we are again, America trying to reinvent the wheel. The rest of the civilized world has shown us that there is a way too better, cheaper and more sustainable healthcare. There are many ways to accomplish universal health, Let's have that debate. It is inconceivable that a country like the United States of America allows almost 50,000,000 people no access to healthcare. In essence driving the cost of minor illnesses to a crisis stage, and shortening the lives of every day working Americans. Universal healthcare would lessen the burden on employers allowing employees to make more money and corporations to garner extra profit. It would eliminate Medicare and Medicaid at the same time saving billions in duplicate office overhead. The insurance companies the middleman, who extract in enormous sums from the healthcare system would be taken out of the mix. People would stop going bankrupt, losing their homes and future retirement savings. Yes the wealthy will need to pay more, boo-hoo. Profit has no place in a persons health crisis. Innovation, research and expansion can easily be built in to any healthcare negotiation. It need not be an either or dichotomy. Let the real debate begin.
37
Mr. Roy's fundamental premise is that taking two steps back after taking three steps forward (in terms of people covered by health insurance) is an adequate net gain. That would be akin to having the Republicans take the right to vote away from women, and then saying we're still better off than we were in 1860 because at least African-American men can still vote. Undoing progress is a step backwards no matter how you look at it. The fact that the GOP is undoing progress while simultaneously giving away a tax cut to those with incomes over $200,000 is all the more galling. And the fact that Mr. Roy supports such a notion shows where his priorities lie.
33
I wish I could give this more than one upvote.
And where is the protection for "pre-existing" conditions?
And where is the ability to keep children on family policies until age 25?
And where is the assurance that aged, infirm, are not thrown out of nursing homes for lack of Medicaid subsidies?
Oh but no mention of the $250 million each of the 1 percent gain from passage of this bill?
The CBO gives lie to each of the points made by Roy.
The utter disregard for fellow Americans in this GOP is appalling. United we stand, divided we fall. We're falling people and we may never regain our footing.
And where is the ability to keep children on family policies until age 25?
And where is the assurance that aged, infirm, are not thrown out of nursing homes for lack of Medicaid subsidies?
Oh but no mention of the $250 million each of the 1 percent gain from passage of this bill?
The CBO gives lie to each of the points made by Roy.
The utter disregard for fellow Americans in this GOP is appalling. United we stand, divided we fall. We're falling people and we may never regain our footing.
17
Mr. Roy wrote an Op-Ed for the Washington Post last week lionizing all the brilliant conservative ideas in this plan, and suggesting that it would become a crown jewel of the GOP's legacy. A few days later, analysts at the CBO and elsewhere have highlighted the intellectual bankruptcy and breathtaking cruelty at the heart of the plan, and he proclaims the bill is chock-full of liberal and progressive ideas. I think that spin just gave me whiplash (which I'd better get treated while I still can).
178
Unfortunately this Op-Ed is light on actual evidence as to make it hard to truly evaluate the claims that Roy makes. How are the CBO methods flawed and how are the claims made here any more valid? I would be inclined to trust the CBO over some unvalidated claims in an NYT op-ed.
19
Not to mention that the man making those claims is a paid mouthpiece for the Republican Party, while the CBO is a respected, non-partisan organization.
1
Democrats did more than model the ACA on the Massachusetts program, they bent over backwards to include things that Republicans wanted. Republicans simply sandbagged them by voting against the watered-down law. Democrats then wanted to improve what wasn't working but Republicans did not want to improve it, they wanted it to fail.
To say that the current proposed law has Democratic elements is like sayiing that slaves have the freedom to sing or not sing during the day, so there were elements of a free society for slaves. The spirit of the Republican law completely ignores not only Democratic values but basic human values.
To say that the current proposed law has Democratic elements is like sayiing that slaves have the freedom to sing or not sing during the day, so there were elements of a free society for slaves. The spirit of the Republican law completely ignores not only Democratic values but basic human values.
71
You are correct. Republicans never wanted a healthcare planat all. The one they've now [roposed makes that abundantly clear.
1
In this newest plan, if young people do not sign up they are penalized by being locked out of insurance coverage for six months.
How is this going to level the insurance marketplace?
All this is going to do is put more of a burden on emergency rooms.
How is this going to level the insurance marketplace?
All this is going to do is put more of a burden on emergency rooms.
19
If increased enrollment by young people is a key component of this bill, then why no mandate? The majority of young people will absolutely not buy insurance by choice. Especially given today's economy many young people are doing well just to provide housing and food; they do not see health insurance as a priority.
14
The true Democratic idea of a healthcare system is, and long has been, single payer. All of the other ideas Democrats have put forward, including Obamacare, have been attempts to forge practical compromises with those who find it inconceivable that there is any problem in the world that cannot best be solved by markets -- including problems created by markets.
I run a business. I'm a capitalist. I believe in markets. But at this point, what would make me believe they could create the single, nationwide risk pool that is obviously the chief prerequisite of a successful national healthcare system -- especially when none of the nations who have such systems have achieved them that way?
I run a business. I'm a capitalist. I believe in markets. But at this point, what would make me believe they could create the single, nationwide risk pool that is obviously the chief prerequisite of a successful national healthcare system -- especially when none of the nations who have such systems have achieved them that way?
26
The brutality of this bill's Medicaid cuts -- both the rollback of the ACA expansion and the block-granting of federal funding -- do not suddenly become bipartisan because Bill Clinton proposed something similar to the latter 22 years ago. In 1995 Clinton was in maximum triangulation mode, listening to Dick Morris as his key adviser and searching for deals with congressional Republicans to re-establish his relevance after the disastrous 1994 midterms. On Medicaid, he wasn't speaking for his party, then or now.
25
You want to tinker with a broken system. Healthcare is a consortium of monopolies whose focus is profits rather than patient outcomes. The number of doctors is controlled by medical societies, the FDA grants unlimited pricing to new medical devices and pharmaceuticals, and health care facilities are granted exclusivity by region through certificates of need. This consortium of monopolies then receives financial support from insurance companies who pass on the cost of this uncoordinated system through rate increases to consumers. We have to stop tinkering with a broken system and move to a single payer health care system to not only regulate, but also coordinate the disparate elements of our healthcare system. We should follow the example of european healthcare systems whose per capita healthcare costs are 50% less than the healthcare costs in this country.
43
Single payer should be the CONSERVATIVE position on healthcare! Europeans spend 9-11% of GDP on healthcare and have better outcomes whereas we spend 18% and have large populations that remain uncovered and have poor outcomes. Single payer is the fiscally conservative choice!
12
In case Avik Roy missed something in the last 7 years here it is: the GOP wants to repeal the ACA, put their own bill in its place, and feed the health care industry well so it remains fat, happy, and donates tons of money to GOP coffers. The rest of it is window dressing that, if put into effect, will hurt millions of Americans across every economic class but the uber rich. There is no effort here to make health care more accessible, affordable, less fragmented, or more user friendly. Bottom line: the GOP, Greatly Overpaid Pirates, is not doing this for America. They are doing it to enrich the well tended, economically healthy wealth care industry whose hands feed them.
126
Every time Roy writes or speaks, he sounds phonier than ever. He peddles a very partisan viewpoint under the guise of bipartisanship.
79
22 million people losing health insurance is a bad thing no matter which party suggested bits or pieces of a proposal that results in such loss.
39
Mr. Roy is good at turning all the facts upside down to support his arguments. He cherry pick the facts when they favor him otherwise he ignores them. Such false hopes that he gives to the 22 million that would be kicked off health insurance. Mr. Roy the 22 million reduction is just like what the ACA did. Right?
37
Well, you may be right that Obamacare and Trumpcare have pulled ideas from both sides of the aisle. The problem is that neither side of the aisle have Americans' best interests in mind when it comes to health care reform (if they did they would actually mandate that members of Congress use the same system they designed in these bills. That means they should legally be required to use the individual market under Obamacare and Trumpcare. I have a feeling you would see very different laws passed when they actually have to consider their own families). If they did have our interests in mind, we would have single payer (or something like it), which is what countries like France, Canada and the UK enjoy. Make no mistake, single payer wouldn't solve all our problems, we need to reform lots of things: the cost of medical school (it costs too much and takes too long); inane lawsuits against doctors (and therefore the medical malpractice insurance they must carry); drug costs, patents and monopolies, and many more things.
11
Members of Congress are required to use Obamacare.
Not like us "normal Americans" do! Obamacare demarcates huge differences in how "normal Americans" vs. members of Congress shop and obtain healthcare on the exchanges:
The federal government subsidizes over 70% of the insurance premiums for members of Congress.
Members of Congress can get free or very low cost care from a special medical office.
They can get free healthcare at any military facility.
They can utilize flexible spending accounts, which "normal Americans" on the individual market do not typically have access to (since it depends on your employer's benefits package).
The federal government subsidizes over 70% of the insurance premiums for members of Congress.
Members of Congress can get free or very low cost care from a special medical office.
They can get free healthcare at any military facility.
They can utilize flexible spending accounts, which "normal Americans" on the individual market do not typically have access to (since it depends on your employer's benefits package).
1
Judges have the power & responsibility to dismiss any inane lawsuit - including medical malpractice suits (like the woman who claimed that a CAT scan at Temple U. Hospital took away her psychic powers - nobody thought to ask why her "powers" didn't warn her in advance about the effect). Malpractice suits & their payouts remain pretty stable, yet insurance companies use hyperbole to raise rates. California instituted "tort reform" decades ago, severely limiting the size of judgments. And, guess what? Their insurance companies raised malpractice insurance rates as high, and often higher, than states with no legal limitations on judgments. It's just a one-way market mechanism where Doctors have no choice but to buy malpractice insurance, & that allows the companies to charge whatever they can get away with. Another argument against marketplace solutions where coercion nullifies free-market principles & allows providers to charge customers anything they want. Required insurance & education are two classic areas where the free-market simply doesn't work, since the consumer has no choice except to pay the supplier's price. Unlike with, say, a car, you can't just walk away & decide to buy next year, or buy a used car instead of a new one. All essential services fail to work under free-market values of supply and demand because demand is inelastic.
The key is to get the younger generations to buy health insurance to prevent premiums/ deductibles from going up or level the playing field. I do not see that in this generation or the next younger generation. That's what Obamacare was hoping for the younger generation will buy into the program but not. So what next? Either tax the young if they don't buy their own health insurance, pay a penalty if they get serious sick and need to Medicaid first time, gov't pays half and they pay half, or everyone pay taxes to support Medicaid. No matter what, Medicaid will be gone gradually or gradually limited benefits within 5-7 years under the new republican healthcare regardless. Many do not know that people will their loose their jobs in the healthcare business as well that creates more people without health insurance too.
6
I'm not sure I understand the logic behind the idea that tax credits will ensure the poor can afford health insurance under the senate plan. If your income is already so low that you that you pay little, if any, state or federal income tax, then I'm not sure any amount of tax credit will increase the ability of low income households to purchase a utility whose prices already exceed the total of what many of them pay in income tax.
60
Exactly.
Roy and the rest of the GOP ignore this reality of no income regardless of tax credits at their own peril.
Roy and the rest of the GOP ignore this reality of no income regardless of tax credits at their own peril.
What intentional confusion!
Of course in a complex health care system pieces of it will have come from all sorts of ideas, practices, unintentional consequences, mistakes, and inertia from the past. So technically you can say part of it is Democratic, part Republican, part Socialist, part Libertarian, part mindless, part altruistic, etc.
That should not be confused with discussion, debate, amendments, compromise, agreement, and even agreeing to disagree. In the Senate Republicans' health care proposal there were none of these with Democrats.
So what is this op-ed all about? All you have to do is look at the name of the organization for which Avik Roy serves as president: "Foundation for Research on Equal Opportunity." It is not primarily interested in equal opportunity, but rather "individual liberty [no taxes and regulations], free enterprise [no taxes and regulations], and technological innovation [while denying science where it does not serve their cause = global warming, health care]" [based on the fantasy that] "economic freedom [trickle-down economics] has done more to lift [rich people] people out of [their obligations to others] [so that those in] poverty [will stay there and work for low wages]. [What a bargain. Better} than any other human invention [that serves the selfish greedy rich and morally bankrupt.]."
What a brilliant leader! Just like our president.
Of course in a complex health care system pieces of it will have come from all sorts of ideas, practices, unintentional consequences, mistakes, and inertia from the past. So technically you can say part of it is Democratic, part Republican, part Socialist, part Libertarian, part mindless, part altruistic, etc.
That should not be confused with discussion, debate, amendments, compromise, agreement, and even agreeing to disagree. In the Senate Republicans' health care proposal there were none of these with Democrats.
So what is this op-ed all about? All you have to do is look at the name of the organization for which Avik Roy serves as president: "Foundation for Research on Equal Opportunity." It is not primarily interested in equal opportunity, but rather "individual liberty [no taxes and regulations], free enterprise [no taxes and regulations], and technological innovation [while denying science where it does not serve their cause = global warming, health care]" [based on the fantasy that] "economic freedom [trickle-down economics] has done more to lift [rich people] people out of [their obligations to others] [so that those in] poverty [will stay there and work for low wages]. [What a bargain. Better} than any other human invention [that serves the selfish greedy rich and morally bankrupt.]."
What a brilliant leader! Just like our president.
107
There are basically two approaches to thinking. Using Critical Thinking (or Scientific Method), one starts by gathering all of the known facts & observations, carefully weighing them for bias. Then one applies a chain of logic, being careful not to fall into any of the traps of formal or informal logical fallacies. One emerges with a conclusion that is as close to the truth as one can get, given the existing knowledge. This is reasoning.
The opposite approach is to start with the Conclusion you want to prove and work backwards, constructing a rickety chain of logic, using logical fallacies to get around any reality that contradicts the conclusion you have already decided on, and then cherry-pick or mischaracterize facts & observations until you have built a false but seemingly plausable "proof" of the conclusion you want to "prove." This is rationalization.
Avik Roy's column is a textbook case of rationalization. This technique of pseudo-reasoning is also the core of every right-wing think tank. You start with what you want to be true and then construct arguments to "prove" it.
For example, Conservatives believe that tax cuts to billionaires will spur new investment & create jobs. Yet these billionaires already have more money than they or their heirs can ever dream of spending, & they are busy keeping their money off-shore. If already having more money than you can spend doesn't lead to investment & job creation now, only an idiot would claim that giving them more will.
The opposite approach is to start with the Conclusion you want to prove and work backwards, constructing a rickety chain of logic, using logical fallacies to get around any reality that contradicts the conclusion you have already decided on, and then cherry-pick or mischaracterize facts & observations until you have built a false but seemingly plausable "proof" of the conclusion you want to "prove." This is rationalization.
Avik Roy's column is a textbook case of rationalization. This technique of pseudo-reasoning is also the core of every right-wing think tank. You start with what you want to be true and then construct arguments to "prove" it.
For example, Conservatives believe that tax cuts to billionaires will spur new investment & create jobs. Yet these billionaires already have more money than they or their heirs can ever dream of spending, & they are busy keeping their money off-shore. If already having more money than you can spend doesn't lead to investment & job creation now, only an idiot would claim that giving them more will.
"It’s likely that, if the Senate bill passes, more Americans will have health insurance five years from now than do today."
From the author who has a conservative agenda and was an advisor to both Romney and Rick Perry. Interestingly, the CBO predicts the following on their website:
"Effects on Health Insurance Coverage
CBO and JCT estimate that, in 2018, 15 million more people would be uninsured under this legislation than under current law—primarily because the penalty for not having insurance would be eliminated. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 22 million in 2026. In later years, other changes in the legislation—lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market—would also lead to increases in the number of people without health insurance. By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent and an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law."
From the author who has a conservative agenda and was an advisor to both Romney and Rick Perry. Interestingly, the CBO predicts the following on their website:
"Effects on Health Insurance Coverage
CBO and JCT estimate that, in 2018, 15 million more people would be uninsured under this legislation than under current law—primarily because the penalty for not having insurance would be eliminated. The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 22 million in 2026. In later years, other changes in the legislation—lower spending on Medicaid and substantially smaller average subsidies for coverage in the nongroup market—would also lead to increases in the number of people without health insurance. By 2026, among people under age 65, enrollment in Medicaid would fall by about 16 percent and an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law."
10
He was referring to the imaginary Senate bill he was proposing.
According to sourcewatch.org, Mr. Roy's Foundation for Research on Equal Opportunity is: " is a right-wing 501(c)3 think tank based out of Austin, Texas and an associate member of the State Policy Network (SPN)...FREOPP was founded in 2016, its mission is to consider "the impact of public policies and proposed reforms on those with incomes or wealth below the U.S. median." The organization portrays itself as non-partisan, "our aim is to become a credible bridge between those on the left and the right who genuinely want to expand opportunity to those who least have it," yet its staff and Board is comprised of conservative and Republican party insiders...It appears that the organization's policy focus is healthcare and the repeal of the Affordable Care Act."
179
This is not relevant to the credibility of Roy's argument, but rather a well-known logical fallacy.
Mr. Roy is one earnest voice in favor among in a chorus of very credible voices opposed to the bill.
It would have been normal procedure for the senate to hold hearings to debate all sides of the issues.
Mr. Roy could be heard as favoring.
His reasoning fleshed out.
And the AMA, numerous hospital organizations, Cancer Societies, AARP, Nurses Organizations, Church Organizations, The Kaiser Foundation, advocates for the poor, Planned Parenthood, various health insurance companies, Governors, State Representatives, health care economists, other health care experts and individual Americans who gained coverage through the ACA (Obamacare) could have explained their opposition.
See how that works?
It's called sanity.
It's called Democracy.
It would have been normal procedure for the senate to hold hearings to debate all sides of the issues.
Mr. Roy could be heard as favoring.
His reasoning fleshed out.
And the AMA, numerous hospital organizations, Cancer Societies, AARP, Nurses Organizations, Church Organizations, The Kaiser Foundation, advocates for the poor, Planned Parenthood, various health insurance companies, Governors, State Representatives, health care economists, other health care experts and individual Americans who gained coverage through the ACA (Obamacare) could have explained their opposition.
See how that works?
It's called sanity.
It's called Democracy.
26
I fail to see how Avik Roy can claim that this proposal is an example of "equal opportunity" (the name of his organization is Foundation for Research on Equal Opportnity). A nation has equal opportunity only when all of its citizens (especially children) have the same opportunity to achieve the best life they are capable of achieving, regardless of the circumstances of their birth. A child born in Appalachia or South Los Angeles should have the same opportunities -- including access to health care as a child born in Manhattan or Beverly Hills even if their parents are dead broke, drug-addicted, divorced,
In short, true equal opportunity demands an extension of the provisions of Medicare to ALL of our citizens. Anything less, especially the convoluted proposal advanced by Mr. Ray, does not come even close to equal opportunity.
In short, true equal opportunity demands an extension of the provisions of Medicare to ALL of our citizens. Anything less, especially the convoluted proposal advanced by Mr. Ray, does not come even close to equal opportunity.
21
This is very clever dissembling by a legitimate policy expert who surely knows better.
The two elided points are: 1) most of the low-cost insurance plans available through the McConnell plan will do about as much good in the face of serious illness as a water gun would do against a forest fire, and 2) the reason ACA was pushed through on partisan grounds was because Republicans decided en masse to mindlessly oppose President Obama in 2009, despite his substantial margin of victory. Something like the Baucus-Collins (or rather Baucus-Grassley) bill absolutely could have passed then, and very likely would have, were it not for McConnell's conviction that partisan gain was preferable to public service through consensus-driven policymaking.
The man is nothing if not consistent.
The two elided points are: 1) most of the low-cost insurance plans available through the McConnell plan will do about as much good in the face of serious illness as a water gun would do against a forest fire, and 2) the reason ACA was pushed through on partisan grounds was because Republicans decided en masse to mindlessly oppose President Obama in 2009, despite his substantial margin of victory. Something like the Baucus-Collins (or rather Baucus-Grassley) bill absolutely could have passed then, and very likely would have, were it not for McConnell's conviction that partisan gain was preferable to public service through consensus-driven policymaking.
The man is nothing if not consistent.
91
We need to stop calling outright dishonesty "clever".
1
The only way to make this work is with robust subsidies to lure young customers into a market they don't naturally want to join. The GOP plan doesn't include this measure, and so these offsetting elements will not occur.
It'll be less care for more money. Period.
It'll be less care for more money. Period.
13
No system without a strong mandate will ever work, certainly no voluntary system.
The reason why Obamacare never worked as well as it could is because the penalties are too low.
The Swiss, who have an Obamacare-like system, have a compliance rate of 99.5%.
Why?
Because if you don't sign up, your wages are garnished, the government sues you, etc.
All you have to do is take the current system, radically increase the penalties, and in a year the uninsured rate will be 2%.
The reason why Obamacare never worked as well as it could is because the penalties are too low.
The Swiss, who have an Obamacare-like system, have a compliance rate of 99.5%.
Why?
Because if you don't sign up, your wages are garnished, the government sues you, etc.
All you have to do is take the current system, radically increase the penalties, and in a year the uninsured rate will be 2%.
32
Obamacare shares tactics with Romneycare but it also shared the strategy (goal) of expanding coverage. Trumpcare apparently reduces coverage by 22 million. To say it shares ideas with democratic proposals in the same way that Obamacare shared ideas with Romney care is a bit disingenuous since Trumpcare seems diametrically opposed to the strategy of expanding care. Also, the democrats ultimately passed the ACA, so there's another reason it's odd this op-ed tries to pass off like Republicans are reaching across the aisle or something. Bizarre. But not as bizarre as the statistical murder of thousands of fellow American human beings at the heart of Trump(doesn't)care
20
The author assumes that the bill he proposes increases enrollment by a young, healthier and therefore cheaper population. That is a big assumption. One that CBO does not share. Without the young, his proposal fall flat and premiums rise.
Single payer is used in all other developed countries for a reason. It creates a large pool of risk sharing (all residents...) to fund healthcare and a single organization to wield the power to negotiate with providers, devise makers and drug companies to keep cost down... Blind belief in free market ideology will not solve our healthcare systems problems. The most successful healthcare systems mix gov't regulated single payer institutions with private deliver of healthcare...
Single payer is used in all other developed countries for a reason. It creates a large pool of risk sharing (all residents...) to fund healthcare and a single organization to wield the power to negotiate with providers, devise makers and drug companies to keep cost down... Blind belief in free market ideology will not solve our healthcare systems problems. The most successful healthcare systems mix gov't regulated single payer institutions with private deliver of healthcare...
150
I caught that too...
"If the Republican plan increases participation by the young, premiums will become more affordable for everyone, because insurers set premiums to reflect an average of the costs of covering everyone who signs up for a given insurance plan. If only older people sign up, average costs in the plan are higher, leading to higher premiums. If young and old sign up, average costs are lower, and premiums go down."
Well, yes... and if broccoli tasted like lollipops, we would all be our target swimsuit weight.
"If the Republican plan increases participation by the young, premiums will become more affordable for everyone, because insurers set premiums to reflect an average of the costs of covering everyone who signs up for a given insurance plan. If only older people sign up, average costs in the plan are higher, leading to higher premiums. If young and old sign up, average costs are lower, and premiums go down."
Well, yes... and if broccoli tasted like lollipops, we would all be our target swimsuit weight.
8
What I want to know is why can't the government simply open their coverage to all? It would be a private insurance, but a very large pool which should keep rates low. Individuals could either buy in or not, but the pricing should be competitive.
On the other hand, as many have suggested previously, why not offer a public option that is self funded and not for profit?
On the other hand, as many have suggested previously, why not offer a public option that is self funded and not for profit?
1
The private sector cannot profitably provide health care insurance that is simultaneously affordable and universal. No country has ever been able to do it. Ours won’t either. The reason can be summed up in one word that economists are quite familiar with: externalities (Google it!).
A private insurer expects, and rightly so, to make a profit. It receives premiums and pays out for medical, marketing, and other operating expenses. The problem is that all of its income comes from premiums. Therefore, to make a profit it has to charge very high premiums (not affordable), and/or limit benefits through exclusions, preconditions, deductibles, copays, etc. (not universal), or a combination of both.
When a person is healthy, that person can work at a job, make money, purchase goods and services, which create jobs, and pay taxes. But no part of those benefits accrues to the private sector insurance company. They all accrue to society in general. Thus, a public sector insurer (Medicare, Medicaid, any other single-payer) can afford to charge lower premiums than a private insurer, or even no premiums at all.
A single-payer’s deficit does not vanish into a black hole. Because of the multiplier effect much of it, if not all or more, returns to the government’s coffers. Obamacare was not only not a “job killer”; it turned out to be an impressive “job creator”. Repealing Obamacare would result in the loss of many, perhaps millions, of jobs, and possibly another Great Recession.
A private insurer expects, and rightly so, to make a profit. It receives premiums and pays out for medical, marketing, and other operating expenses. The problem is that all of its income comes from premiums. Therefore, to make a profit it has to charge very high premiums (not affordable), and/or limit benefits through exclusions, preconditions, deductibles, copays, etc. (not universal), or a combination of both.
When a person is healthy, that person can work at a job, make money, purchase goods and services, which create jobs, and pay taxes. But no part of those benefits accrues to the private sector insurance company. They all accrue to society in general. Thus, a public sector insurer (Medicare, Medicaid, any other single-payer) can afford to charge lower premiums than a private insurer, or even no premiums at all.
A single-payer’s deficit does not vanish into a black hole. Because of the multiplier effect much of it, if not all or more, returns to the government’s coffers. Obamacare was not only not a “job killer”; it turned out to be an impressive “job creator”. Repealing Obamacare would result in the loss of many, perhaps millions, of jobs, and possibly another Great Recession.
1
The reason the CBO said 22 million more would be uninsured is for two reasons, primarily:
1) Many younger persons, who would no longer be required to enroll, in absence of a penalty, won't
2) Increased premiums and pre-existing condition exclusions will make insurance unattractive, un-affordable, or both.
That's not a flawed CBO analysis, Mr Roy. It's you, failing basic economics.
1) Many younger persons, who would no longer be required to enroll, in absence of a penalty, won't
2) Increased premiums and pre-existing condition exclusions will make insurance unattractive, un-affordable, or both.
That's not a flawed CBO analysis, Mr Roy. It's you, failing basic economics.
227
It is for one reason primarily. It assumes reduced medicaid roles. The cost of medicare and Medicaid has to be reduced. There is consensus on that.
Consensus among whom, Daphne? Medicare and Medicaid are the most cost efficient mechanisms of providing healthcare coverage in the country. And a medicare for all system would not only create a near-universal health care system in this country, it would do so at far LOWER cost than the system we have now. Among non-partisan economists, there is consensus about THAT.
12
Federal catastrophic coverage is the first step towards federal single payer.
If adequately funded and well managed and addresses health needs ie pre-existing conditions.
A bit odd to be coming from the Republican party.
The major downside to the bill is that premiums are reduced because insurance coverage is reduced because minimum standards (coverage of pre-existing conditions etc) are being reduced and deductibles will be raised. Overall health costs to the citizen may increase or use of health care will decrease.
Also, it is doubtful that private insurers will want to cover long term nursing home coverage for old people. Dementia nursing care is only covered by Medicare when there's a chance of recovery, ie in the short term. Medicaid does the lifting on long term nursing care for dementia. Perhaps Medicare should be extended to cover ongoing nursing care.
If adequately funded and well managed and addresses health needs ie pre-existing conditions.
A bit odd to be coming from the Republican party.
The major downside to the bill is that premiums are reduced because insurance coverage is reduced because minimum standards (coverage of pre-existing conditions etc) are being reduced and deductibles will be raised. Overall health costs to the citizen may increase or use of health care will decrease.
Also, it is doubtful that private insurers will want to cover long term nursing home coverage for old people. Dementia nursing care is only covered by Medicare when there's a chance of recovery, ie in the short term. Medicaid does the lifting on long term nursing care for dementia. Perhaps Medicare should be extended to cover ongoing nursing care.
14
Tax credits for the poor are the equivalent of offering a person dying of thirst a gallon of water for a day's work. Get real GOP!
62
Ha! Try a spoonful, half-filled, and probably tainted with lead.
3
All of Avik Roy's fantasies, fuzzy statements, and outright lies cannot hide the reality that the ACA sharply reduced the number of uninsured people, and that the Senate bill will roll back much of those gains, with more people uninsured, and with those having insurance getting markedly worse coverage, with higher deductibles and other out-of-pocket costs.
270
There is no scenario where tax credits lead to more Americans being covered by the Republican Health Care Plan. The most likely scenario is that fewer people will be covered, premiums will go up, states will go bankrupt trying to cover the gap left by reductions in federal aid.
This is bill is a blueprint for how to crash and burn the private health insurance market. It will then hopefully be sweep it away, and we will end up living in a country with Universal Health Coverage, like most of the rest of the civilized world.
This is bill is a blueprint for how to crash and burn the private health insurance market. It will then hopefully be sweep it away, and we will end up living in a country with Universal Health Coverage, like most of the rest of the civilized world.
118
I agree with most of what you wrote. I see one flaw. States might not go bankrupt. The states might not reimburse hospitals who are forced to treat people in their ERs but cannot pay. I'm not saying the states won't go bankrupt, but I think there are other possibilities including hospitals closing their doors and, far more likely, more people dying earlier.
3