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Is There a Solution?


© Tom Tomorrow

The Republican health care bill is wildly unpopular with Americans. There have been two recent polls: in one 16% approve to 58% disapprove. The other shows only 12% approve, while 53% of Americans want the Republicans to either leave Obamacare alone or fix any problems it might have.

So if Trump repeals Obamacare like he promised he would, quite a few Americans will be pissed off at him, especially those who lose their insurance, see their premiums increase, or their coverage get slashed. But if Trump doesn’t repeal it, his base will revolt.

Is there a solution for Donald Trump? If he were a thoughtful person (hah!) he would talk to his base and find out what they want. I suspect they just want to kill everything that Obama did, but they still want good health insurance for less money. That’s exactly what Trump has promised them: “No cuts to Medicaid”, “No one will lose coverage”, “Nobody will be worse off financially”, and “Everybody’s going to be taken care of”.

Sound impossible? It isn’t. Trump just has to get single-payer passed. Of course, he shouldn’t call it single payer, he should call it “Medicare for everyone”. It wouldn’t be that hard. The bill would only need to be a few pages long. Democrats would support it, and so would many Republicans. Yes, taxes would need to increase to cover it, but if Trump were clever (hah again!) he would set it up so that each person’s Medicare taxes would increase about the same amount that they currently pay for health insurance, so it would be financially neutral. Yes, the doomed health insurance companies would hate it, but Trump would be wildly popular. It might even be the worst thing that ever happened to the Democrats.


Also published on Medium.

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27 Comments

  1. Bill Markley wrote:

    I wouldn’t say the insurance companies are doomed (although I would support that) because they could still offer premium plans to people who want more than would be covered in medicare for all.

    Friday, June 30, 2017 at 9:06 am | Permalink
  2. Thatguy wrote:

    Paul Krugman has a good editorial along the lines of your post. It goes a ways toward explaining why the GOP will probably not turn things around the way you suggest.

    https://www.nytimes.com/2017/06/30/opinion/understanding-republican-cruelty.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-left-region&region=opinion-c-col-left-region&WT.nav=opinion-c-col-left-region

    Friday, June 30, 2017 at 9:58 am | Permalink
  3. ebdoug wrote:

    People who don’t work (retired) no longer pay Medicare taxes. There still has to be sliding scale for the retired.

    Friday, June 30, 2017 at 2:34 pm | Permalink
  4. David Freeman wrote:

    Why would it be, “the worst thing that ever happened to Democrats”? Medicare for All is serious policy to us not some political ploy. Obamacare was basically a Republican counter to Single-Payer. Obama offered Republicans their own plan and they freaked out because they largely define themselves in opposition to Democrats. I dare Republicans to try and psyche us out by offering us what we want!

    Friday, June 30, 2017 at 9:59 pm | Permalink
  5. Jwhat wrote:

    I think the “worst thing” being referred to is eight or more years of a Trump reign. Although I didn’t and never would vote for someone like Trump, I was conflicted when he was nominated and elected. My thinking was that to accomplish every thing he promised would require creating a coalition of center democrats with center republicans to work together. They would intelligently bring taxes up to where they are needed, fix all of the things Republicans have let fail and get our country back on track. This would be my dream but Trump would then be the most popular president since FDR and I don’t think I could handle more than 4 (or less) years of him.

    Saturday, July 1, 2017 at 4:06 am | Permalink
  6. PatriotSGT wrote:

    IMO we don’t need the unnecessary overhead of Obama care in the exchanges. It might be best as Trump stated to repeal the AFfordable care act first and give it a “dead on” date in the future. Those that can afford their own insurance, let them decide how much they want to buy and from who and do away with the state territory restrictions. If people, the young adults, don’t want full insurance they can buy a cheap catastrophic plan and pay for the occasional Dr visit. For those that can’t afford their health coverage, expand Medicaid/Medicare and just raise the Medicare tax, phase it like Ebdoug said, and add a small Medicaid tax to cover it.

    If the keep trying to reinvent the ACA it seems to costly and difficult. Repeal, then replace is the best way

    Saturday, July 1, 2017 at 5:49 am | Permalink
  7. Thatguy wrote:

    Repealing the ACA now and kicking the can down the road is not a good idea. Losing preexisting condition protections, essential benefits, and community rating would mean a lot of people, even if they have coverage, would have meaningless plans.

    The whole pressing need to repeal it at all is just a Republican shell game. The ACA is “bad” because of situations they created: refusing the Medicaid expansion in their own states, not providing the agreed-upon subsidies to insurers, threatening, as Trump has, to cut subsidies further. All this destabilizes the insurance market and leads to premium increases.

    Expanding Medicaid/Medicare would be an awesome idea as a supplement to further insurance reform. Unfortunately, the party in power instead prefers to gut it. Which is either a terrific plan or a mean one, depending on which Trump you talk to.

    Saturday, July 1, 2017 at 10:42 am | Permalink
  8. ebdoug wrote:

    Cutting taxes on the rich refers to the extra 3. something % tax that the rich pay towards health care.. I got caught once on this going into six figures due to Buffett buying Heinz. We got our very old family Heinz investment back with large capital gain. I was happy to pay the extra $100 a month for the year.

    The kind of rich in NYC who pay the extra percent, don’t mind and don’t and never have invited Trump to their inner circle. I chose to eschew the social register, boarding school and debutants and don’t count as the rich, but I was born into them. I gave birth to a genius who made a fortune in the .com business and has since given that up to have a lower salary. Meanwhile he fixed me up to have heaven on earth where he paid for the residence in his name, I pay all expenses. Just sort of happened.

    Saturday, July 1, 2017 at 5:36 pm | Permalink
  9. Iron Knee wrote:

    OMG! PSgt, you really are drinking too much kool-aid. I will not respond to your claims, but I will point out the simple fact that repealing Obamacare cannot be done through budget reconciliation, so it would take 60 senators to do that. There are only 52 Republican senators. If you think any Democratic senators are going to vote to repeal Obamacare, let alone 8 of them, you are delusional. Assuming Trump is not delusional (and that is becoming a big assumption), then the only reason he would suggest this is because he knows that the repeal of Obamacare has failed, and he is just trying to cover his ass, so he can say he tried to repeal it, and it isn’t his fault it failed. And — judging by your response to his proposal — it appears to be working.

    Saturday, July 1, 2017 at 11:22 pm | Permalink
  10. Anonymous wrote:

    I have a whole extra $20 a month rider on my Medicare. Extra isn’t much.

    Sunday, July 2, 2017 at 3:54 am | Permalink
  11. Jonah wrote:

    That repeal then replace is a good idea seems a tad far-fetched and that’s putting it mildly. Most moderate republicans dont want the senate version of trumpcare because it reduces the number of insured and lowers the amount of medicaid. Are those saying that R&R is possible serious aware of what would happen to the number uninsured and costs? The only way to get this to happen is to elect senators and reps as stupid as trump.

    The intellect (or lack of) american voters for voting in a majority of republicans can only be matched by that of the british. They voted for brexit but now cant decide whether they want it to be hard or soft. Sometimes its dangerous giving ill informed voters the power to make a choice.

    Sunday, July 2, 2017 at 3:54 am | Permalink
  12. Iron Knee wrote:

    That’s why we have a representative democracy.

    The Founders didn’t even trust us to elect the president, and we finally proved them right!

    Sunday, July 2, 2017 at 8:12 am | Permalink
  13. Dave, TN wrote:

    IK, the intelligence is not the problem with American public but how isolated we have become taints our ability to see the big picture. We may live in a social communication age but the ability to actually socialize person to person and listen to each other has become hindered. But instead of listening to each other either they listen to paid talking fountain heads or their echo chambers they have created. My personal experience of trying to provide an alternative view to the echo chamber only serves to ensure that co-workers don’t spout silly political nonsense around me anymore and in the end avoid me altogether. While I enjoy the silence at times and I even find the awkward stares humorous, the absence of meaningful discussion is contributing our downward spiral. When a major political party has hocked it’s moral compass to a foreign entity which has been a sworn enemy to our way of life and a large (not majority) of Americans blindly follow them down this garden path is a sad testament to where we are.
    In this neck of the woods the number of comrade cannon fodders greatly outnumber the people willing to push for a progressive way of governing. This fact contributes to my reluctance to try to lift the fog from their eyes but the blank stares I get in return to when I attempt to provide an alternative narrative to what their echo chamber provides gets old and ages me.
    I have come to the conclusion that these cannon fodders are going to have to fall in great numbers on the firing line before the falsehood of the trickle-down economic fairy tail will dawn on them and a willingness to even discuss alternatives to the blame game echo chamber.

    Sunday, July 2, 2017 at 9:09 am | Permalink
  14. Iron Knee wrote:

    Single payer for the Win! https://www.washingtonpost.com/news/the-fix/wp/2017/07/01/the-biggest-winner-in-the-current-health-care-debate-single-payer/

    Sunday, July 2, 2017 at 9:56 am | Permalink
  15. PatriotSGT wrote:

    As the article says, we are a long way from single payer. I’ll say this, let’s study California’s universal healthcare. They have an economy and population similar or larger then many nations. If in 15-20 years they haven’t gone broke or chased 100’s of thousand of people away because of super high taxes then I’ll consider it and the country should too.
    Our most pressing problem is not healthcare, it’s our debt and even though we’ve collected record revenue the last few years we still run a large deficit. We need to stop that bleeding and get back to a close to balanced budget. The interest on our debt will begin to crush any hope of considering single payer.
    We need to have the opportunity for every American to have the opportunity to earn a decent living, they do not currently. There are still way too many in poverty. The is in part to the loss of middle class jobs, so much so that local areas have to raise minimum wage because there aren’t enough decent jobs. Let’s study Seattle. Good intentions have actually lowered worker pay instead of boosting it.
    We cannot fix one thing without taking into account everything. It must all be considered to come up with a real long term solution.

    Sunday, July 2, 2017 at 10:59 am | Permalink
  16. Dave, TN wrote:

    Then lets be serious and talk about thw elephant in the room budget wise. Time to be serious about our wasteful defense spending. The amount of money being thrown at defense and yet we are no more protected from hsrm than countries that spend a fraction of what we do.

    Sunday, July 2, 2017 at 5:13 pm | Permalink
  17. ebdoug wrote:

    Kaish says that throwing money at opioid abuse is like spitting in the ocean. I agree.

    I have two neighbors who smoke and ruined their backs. One actually gets the pain meds in the mail from the government, then passes what she doesn’t use to someone who sells them on the streets an hour away.

    The other is just zonked out all the time on prescription pain meds.

    In Pennsylvania, a woman was jailed for drug abuse, stupid court let her out of jail a month before baby was born, Mother (now clean) takes opioids, delivers baby who is now on life support at our expense.

    Sunday, July 2, 2017 at 5:37 pm | Permalink
  18. notycoon22 wrote:

    I’m not convinced that a single payer system is the only way that all could be covered. I’d prefer that we look at a range of universal health care systems and figure out a way to create one in this country. There are several models out there that appear to be running successfully that aren’t single payer systems.

    Sunday, July 2, 2017 at 8:20 pm | Permalink
  19. PatriotSGT wrote:

    Dave, I don’t disagree. In fact, they are very wasteful and I can tell you that from experience. Back the late 90’s congress mandated every agency subject themselves to an outside audit within 20 years. Gusss who is the last agency, yep defense. They have until the end of the year which is the end of 20 years. They’ll never make it, but I’m not sure what congress can do about it. Here are 2 arrival and a report.

    https://federalnewsradio.com/dod-reporters-notebook-jared-serbu/2017/01/key-deadline-approaches-dod-remains-biggest-obstacle-governmentwide-audit/

    https://www.gao.gov/mobile/key_issues/dod_financial_management/issue_summary

    Monday, July 3, 2017 at 4:28 am | Permalink
  20. ebdoug wrote:

    If everyone could remember just three things: 1)Trump worships only one person: Himself. He is 99% hate, 1% toward himself 3) and he wants to win. His Holy Trinity.

    Whatever happens to anyone else or to the earth makes no difference to him. So his minders set up winning situations. He is almost totally unbalanced. He just has to be pushed the rest of the way before he does no damage. That is the solution asked for above.

    Monday, July 3, 2017 at 5:02 am | Permalink
  21. ebdoug wrote:

    1% love toward himself “That was a good tweet”

    Monday, July 3, 2017 at 5:02 am | Permalink
  22. Ralph wrote:

    So let me get this straight. After 6-7 years or so of this constant refrain of “repeal and replace”, Republicans now want to just do the “repeal” part because they still can’t figure out after all this time what the “replace” part is yet? And people who lose their coverage in the interim are supposed to do exactly what while they wait for this new and improved awesome replacement program to emerge from a unified majority Republican Congress (no laughing please) under this awesomely competent and professionally run no-nonsense, business-savvy White House that its voters installed to drain the swamp and make America…you know? Maybe after he’s done trashing Mika’s bloody face or wrastlin’ with CNN on twitter? All righty then…you can laugh now. Our President just turned 71 and still has the emotional maturity of a 7 year old.

    So let’s grow up ourselves and get real. After the truly barbaric House bill that immediately crashed and burned, followed by the marginally less barbaric Senate bill that they didn’t even put up for a vote, it should be more than obvious to all but the most hardened partisans that Republicans are more interested in providing tax cuts to their uber wealthy benefactors than crafting a healthcare system that truly works for the economy and a majority of our citizens who don’t come under the umbrella of employer-sponsored health insurance (which is also groaning under the weight of unrelenting premium inflation).

    So instead of reaching across the aisle to craft a bill that addresses the flaws in the ACA and make it better (they could even call it Trumpcare or whatever the fuk, who cares so long as it works), they go behind closed doors (remember when they flayed Hillary for that, back in the Clinton era?) only to come up with something even they can’t support within the party.

    They could have addressed healthcare and tax reform separately, but conflating their sacred tax cuts paid for with massive cuts to Medicaid and Medicare exposes their true “family values” for all to see. We keep hearing about “market solutions” and “competition” to solve our healthcare issues, but the proposed bills that I saw did NOTHING to address the flawed and opaque market, with its hidden and inflated costs and profiteering that runs rampant throughout. It was always all about the repeal, tax cuts and their perverse obsession to erase any and all legacy from the Obama era. For such an “exceptional country” we exceptionally suck at healthcare.

    As was alluded to in several other comments here as well, our national priorities are nothing less than obscene when it comes to the military, IMHO. Our budget there is bigger than the next dozen countries COMBINED, and it’s still not enough for some, including Agent Orange now, of course. It’s an easy patriotic refrain in an election year, which seems to be every year these days. But our military, as impressive and awesome as it is, has become largely a jobs program, when it’s not a cudgel to pave the way for global corporatism or political expediency. Our grandchildren will still be going to Afghanistan, Iraq and who know where else by then. We go in and never leave. It’s perpetual war, and to what end? Weapons programs are spread throughout all 50 states, making it near impossible to cut or cancel them in Congress, even when The Pentagon says it doesn’t need them. The 2005 documentary “Why We Fight” is as relevant now as then, as I may have mentioned on this blog before. But I digress.

    So that’s my long-winded health rant and I’m stickin’ with it! My doctor said to get in more ranting.

    Peace, good health and Happy Independence Day all.

    Monday, July 3, 2017 at 10:50 am | Permalink
  23. PatriotSGT wrote:

    Ralph- you hit the nail on the head with your insight into the defense budget. It has become the secret santa program for congress and the senate. Everybody has their own pet project that is traced back to its origin would connect to a donor group. It’s not necessarily the fault of DOD. As it has been stated in the blog several times about the F35, the pentagon said they don’t need it, yet it gets appropriated. That happens at every level by all sides. It’s the last place they can deeply bury their pork spending and how dare anyone take away from our valiant military. When the call comes to trim the budget however, it’s never those special programs that fall under the axe, but just like in every city facing cuts, it the people, soldiers, firemen or cops who must go.

    Monday, July 3, 2017 at 1:59 pm | Permalink
  24. notycoon22 wrote:

    Thanks, PSgt. Couldn’t have said it better except for the part about in not necessarily being DOD’s fault. DOD turns out the retired officers and bureaucrats that then move to the industrial part of the military/industrial complex where they make hay while the sun don’t shine on them and the audit ain’t done.

    Monday, July 3, 2017 at 8:17 pm | Permalink
  25. Jonah wrote:

    Given there seems to be universal agreement that the defence budget should be reduced, I’m perplexed about what seems to be excessive animosity against ocare including the individual mandate than there is against excessive spending on defence related matters. The iraq war has cost the US ~2.5 trillion. Intervening in Syria has likely cost us more since the fear of incoming refugees has seemingly contributed towards Trump’s popularity. Even Trump promised a less interventional approach but his rhetoric has seemingly increased the likelihood of confrontation in the middle east and south east asia. These interventions are also contributing towards stress in healthcare spending. https://www.forbes.com/sites/aroy/2012/03/12/how-health-care-spending-strains-the-u-s-military/#348e8cf12c54

    Trump supporters and trump haters seem to agree on one thing. Hopefully all can get together at least to reduce unnecessary defence spending and urge our leaders to reduce the rhetoric. Unfortunately our president is more eager to trumpet the evils of ocare than that of excessive defence spending and his supporters are distracted enough by that to think that ocare and the individual mandate is the biggest issue facing our country.

    Tuesday, July 4, 2017 at 2:05 am | Permalink
  26. PatriotSGT wrote:

    Here is a report that says it all. I think I may have posted it a while back.

    https://www.google.com/amp/s/www.washingtonpost.com/amphtml/investigations/pentagon-buries-evidence-of-125-billion-in-bureaucratic-waste/2016/12/05/e0668c76-9af6-11e6-a0ed-ab0774c1eaa5_story.html

    Basically, DOD had an outside agency perform an audit of business practices to show Washington it was policing itself. They thought the audit might find 10-15 billion and the could say they were doing well. Trouble is the report found 125 billion in wasteful and redundant spending. They didn’t even weigh in on the merit of individual programs.

    Problem will be they’ll want to take out on the backs of Soldiers and not the DOD itself. But the congress will protect their special projects. We got to get term limits enacted to fix that.

    Tuesday, July 4, 2017 at 8:55 am | Permalink
  27. Ralph wrote:

    Thanks Pat – that’s a mind numbing article and substantiates everything and more brought up on this board. There’s a section in the documentary I mentioned above, “Why We Fight”, that also addresses the issue of bureaucratic bloat and the predictable, inevitable cost overruns. The average or median salaries of these contractors and back-office personnel is particularly astonishing. I’ve been working in drug R&D for over 30 years as a Ph.D. chemist in pharma big and small and never came close to banking what many of those pencil pushers make. In hindsight, obviously picked the wrong field! But grateful for the opportunity to chase a dream and have the luxury of sleeping well at night, mostly. So far.

    But even more disheartening is how deeply baked into the system this all is. It’s easy to see the math, on paper anyway, of cost savings in the military being put to much better use in healthcare here at home which, granted, has its own share of waste and bloat needing reform.

    But given how entrenched both systems have become it’s hard to see how significant reform in either sector could come about, let alone help salvage the other. Savings or cuts in one department have a curious habit of disappearing into the woodwork, and some creative accounting practices have becomes something of a dark art.

    So I wouldn’t expect any reform in the military to affect healthcare one way or the other, save an improvement in veterans healthcare perhaps. And then, of course, there’s Congress, which not only engineered or allowed these Rube Goldberg contraptions into place over the years, but sports its own unique brand of gridlock and corruption that only seems to make things worse.

    When you factor it all in, the social and political disruptions driven by growing income disparities driven largely by technology, automation and globalization, plus a failing representative government, it’s not a stretch to see why we’re also in the middle of an opioid addition epidemic. Many people are really hurting out there and they’re not getting relief from the system. I digress, as usual, but that’s just how it looks through my prism here on Planet Ralph these days. Mostly, so far.

    Wednesday, July 5, 2017 at 10:24 pm | Permalink