Republicans are trying to ram their Obamacare replacement bill down the throat of Congress as quickly as possible. The bill was only introduced on Monday, and already the House Ways and Means committee was kept up until 4am (that’s 18 hours) so they could approve the bill. Which they did, even though the Congressional Budget Office (CBO) hasn’t even scored the bill. Very strange!
Why are they in such a rush? One big reason is because they don’t want anyone looking at the bill too closely. It is likely that the CBO will discover that the new bill will cause around 10 million people to lose their health insurance, while at the same time costing more money than Obamacare and also increasing the deficit. That’s supposed to be an improvement?
Another reason is to get the bill passed before the opposition can get organized. How’s that working out for them? It is only Thursday, but already the American Medical Association, the American Nurses Association, the American Hospital Association, the Association of American Medical Colleges, the US Catholic Health Association, the Children’s Hospital Association, and the AARP (American Association of Retired People) have come out against the new bill. The AARP is even running a TV ad against it.
It seems like the only significant organizations that are for the bill are the US Chamber of Commerce and Grover Norquist’s anti-tax group, the Americans for Tax Reform. They like it because it offers large tax cuts for big corporations and the wealthy, which caused a Democratic Congressman to ask “Is this health care, or is this a tax-cut bill?”
Even conservatives don’t like the bill, which they are dubbing Obamacare 2.0 or Obamacare Lite. Surprisingly, even Breitbart News, formerly run by “President Bannon”, attacked the bill.
Even press secretary Sean Spicer is having problems defending the bill. Spicer is claiming that the bill is a “full repeal of Obamacare”. When a Breitbart reporter responded to him that it was hardly a full repeal, Spicer said “I don’t care”.
Also attacking the bill are conservative commentators Laura Ingraham, who complained that the bill doesn’t increase “transparency in pricing” or “competition across state lines”, and by Ann Coulter, who remarked “Who wrote this piece of crap Obamacare replacement bill?”. The bill was even attacked by Fox News, with host Eric Bolling noting “You’ve had six years to come up with a replacement. Fix it!”
Even Donald Trump doesn’t seem sure about the bill. Even though Trump officially supports the bill, he seems to be hedging his bets already. In a White House meeting with conservative groups, he told them that if the bill doesn’t pass, then Plan B is to let Obamacare fail and blame it on the Democrats. The only problem with this is that Obamacare isn’t actually in any danger of failing unless Republicans find some way to purposely sabotage it, in which case it would be obviously hypocritical of them to try to blame it on Democrats.
Also published on Medium.
The Trump administration is also resisting attempts to call the new bill “Trumpcare”. I guess he doesn’t want to be associated with it. See http://thehill.com/policy/healthcare/322978-battle-erupts-over-trumpcare
Personnally I don’t mind this bill. It looks like my taxes may come down. Though it looks like Trumps voters may be adversely affected. Well, they voted for it so they own it now.
Jonah, without the subsidies, the less fortunate who voted for Trump will drop their insurance. Neighbor, diagnosed with colon cancer. Doctor opened him up and closed him up. “With you having no insurance, I can’t operate.” Neighbor goes back to work, gets operated one. Can’t work, drops insurance. Cancer comes back. Within hours until the next surgery, he has me sign what I know is a lien on his property. “Who is going to pay for this if you have no insurance?” “Oh, the hospital will pick it up.” he says. Now had he been mandated to have insurance, he wouldn’t be a burden to the rest of us. He was able to buy a rental property and nice motorcycles, etc.
I think it entirely possible for them to kill the ACA anyhow; and with it, kill myriads of Americans per year, and also kill their own careers. Maximize the killing, you see; mission accomplished.
They could repeal and replace Obamacare with something better if they wanted; the problem is, it involves adopting single payer healthcare and it’s like replacing all American flags with photos of Karl Marx to them. Also, their handlers at the banks and insurance companies would never allow them to do so.
Remember when Republicans whined and complained time and time again about how the ACA was rushed through Congress (among many other things)?
I want to have an open mind in the future, but I have a hard time seeing a future in which I can possibly trust a national politician willing to put an (R) next to their name. The hypocrisy and love of party and power over country over the last decade is just too much, and it keeps getting worse.
If you read this article — http://www.vox.com/policy-and-politics/2017/3/7/14841580/obamacare-american-health-care-act — one of the conservatives has proposed a system similar to what Switzerland has, which is not single payer. Let’s not limit ourselves to single payer.
Okay, you know there’s something wrong when your healthcare bill clearly marginalizes the less healthy, while providing enormous tax breaks for insurance execs and your other uber-wealthy overlords and donors. They cobbled this thing together in the dark of night behind closed doors (isn’t that what they slammed Hillarycare and Obamacare about?) and now expect everyone to happily buy into it, virtually sight unseen. The little we have seen clearly escalates costs for the sick, besides generally other less advantaged demographics like the elderly and poor. How sick is that?
After having more than six years to come up with something ostensibly better than the ACA, it should now be crystal clear Republicans are not interested in reaching across the aisle to produce a viable healthcare insurance and delivery system the country can live with. They are obsessed only with minimizing costs to their upper-crust donors and securing corporate profits, even if it entails being carried on the backs of those who are one illness away from bankruptcy or homelessness. They literally reject the primary definition of insurance, which is to spread risk, not concentrate profit, let alone profiteering, from those less fortunate.
I’ve worked in drug discovery R&D for nearly 30 years, so have personally experienced some of this system from the inside, including three waves of downsizing and outsourcing at pharmas both large and small. Because, you know, cheaper and more profitable to operate abroad, if you aren’t acquired and dismantled first in the service of Wall St. and the quarterly bottom line. And, adding irony to injury, experiencing only steeply escalating drug and healthcare costs far and above the rate of inflation for the intervening decades. Meanwhile, more money is spent on marketing and legal maneuvering these days than R&D.
There really are many wonderful advances and discoveries being made in pharmaceuticals and the medical sciences generally, especially in the areas of cancer and infectious diseases (like hepatitis, HIV and even Ebola). We desperately need effective treatments, let alone a cure, for Alzheimer Disease, which is becoming epidemic as our population ages. In fact, there is no effective treatment on the horizon that stops or reverses ANY neurodegenerative diseases, like ALS (Lou Gehrig’s), Parkinson’s, or Huntington’s. These are tough medical challenges that are only getting worse and a true breakthrough on any one of them would be revolutionary and change the face of healthcare.
OTOH, market manipulation of life-saving generics like epinephrine (adrenaline), which cost pennies to produce but winds up in a $300 Epipen (available only as a 2-pack!), insulin or other such examples (like the Skreli scandal) we’ve seen in the news recently, make otherwise older and cheaply made essential drugs beyond the reach of many. And we’re not even talking about the $20 aspirins or $30 hospital bandages. Is it any wonder the public has a jaded view of pharma and the healthcare market in general?
Here’s just one personal anecdote, but I’m sure it’s not unique. My daughter went to her university clinic recently, presenting with a routine UTI. They gave her a bolus shot of a generic antibiotic for the UTI. A shot, not an oral Rx, mind you. They also threw in some prednisone, a generic steroid, which I couldn’t rationalize as a viable treatment for a UTI, but it began to make some sickly sense after hearing that the clinic didn’t, wouldn’t, or couldn’t (not clear there) handle return visits. Bad for their stats and operating grants, perhaps? Suggesting they hammer anything they see with just about everything they’ve got, within some modicum of reason I presume, as a hedge against lower “cure” rates. The charge for this brief visit? $350, and they don’t take insurance, thank you. So much for the $2200/mo. insurance premium I’m paying this year under the ACA for a family of four, even more than my mortgage!
Yes, premiums under the ACA have soared but can be traced back to Republicans hobbling the bill instead of working across the aisle to make it more viable over the long term. But as we all know, they couldn’t let Obama appear to succeed at any level, at all cost, and they weren’t about to cut out their private insurer benefactors. As I write this, I’m watching Paul Ryan on TV almost gleefully pointing to a chart showing premium increases and fewer options over the past few years under the ACA, while ignoring any responsibility his party had in sabotaging it from Day One. And now he’s arguing how the new and improved AHCA will be so So SO much better. How? The magic of the free market of course! As if we hadn’t been doing that all along those previous years, and “trying” (if that’s what you can call it) since the Nixon years – Nixon! – to fix it.
Single-payer systems in other industrialized countries may not be perfect, but they don’t pay twice as much or more per capita for lesser service and outcomes, and they don’t deny coverage to anyone because of their station in life. We will never solve the problems with our healthcare system to the satisfaction of most until Republicans in Congress stop reflexively bowing to the altar of their flawed economic mantra that everything good for society at large magically emerges only from the unhindered, virtually unregulated, profit-driven free market forces of supply and demand. Anything else in their warped collective minds is akin to the evils of socialism, the first cousin of communism. Healthcare is arguably a national security issue, one that speaks not only to our personal health but our economic well-being overall.
As if we don’t already have enough national security concerns with Agent Orange in the White House.
Sorry, but that’s my uber-long-winded rant for the week and I’m stickin’ with it!
Ralph, thank you. Well written.
You start to make a point that I’ve been thinking about recently, which is that the Republican had to oppose everything Obama did. As a result, they have painted themselves into a corner.
Obamacare is based on Romneycare, and the hated individual mandate was a Republican idea. But because Obama took it on, they had to hate it. The Republicans spent so much time and bluster comparing their own ideas to socialism, that now it looks like there is no bill that can possibly get through Congress (at this point, not even a simple full repeal of Obamacare).
I even found myself agreeing with Laura Ingraham, which doesn’t happen very often. I would like it if anyone (including the Republicans) passed a bill to increase transparency in pricing and competition. Because the “free market” cannot save our current system. What kind of “free market” refuses to even tell you what something will cost before you agree to buy it? Of course, Republicans won’t allow a bill like that to even be considered, because it would piss off their rich donors.
Ralph, I’m 72 1/2. My question is “what is wrong with dying at my age?” I live in a high 23% cigarette smoking area so most of the people dying are younger than i am. Having worked in nursing homes and watching my mother go downhill with Alzheimer’s, I find in the elderly as long as they are nice with their Alzheimers, it is a nice way to go. It seems as though they forget their relatives, forget their life and just fade away. Not their turn anymore. Move out and let the young live.
I watched a patient with Alzheimer’s attend her husband’s funeral. She came back, waved to her three children who she no longer recognized and went back to the folding of linen that she so enjoyed.
My mother went to her second husband’s funeral. “I don’t know why they are making such a fuss, just because we have the same last name.” We gave her a big well attended 90th birthday. A few weeks later “How old am I?” “Well, you are 90 now Mum.” “Shouldn’t there be a party for me or something.” “We had one three weeks ago, Mum.” What is the sense? That is what DNR is for. She didn’t know she was dying.
I’m treating a diabetic cat who is 18 now. She can’t remember by the time she gets to the room to eat or use the cat box why she came there. Again what is the sense? I’ll give her all the palliative care I can give her, but she has gone beyond her time on this earth.
A different story is someone who gets Alzheimer’s in the 50s. That is what the cures are for.
I pay $4.80 for 20 of 20 mg. of Prednisone instead of seeing PCPs for asthma attacks if I get exposed to cigarettes to which I am highly allergic. The Prednisone is killing me so I will have a shorter life. The albuterol nebulizer is 3 cents a day instead of a $100 or so for an inhalator. What the doctors could do if they wanted to lower the cost of medical care. My prescription drugs were $60 last year.
EB, my mother-in-law had dementia for a long time. She was a happy person generally and continued to be that way until the end. It’s harder on the family, more often than not, than it is on the one with dementia. The problem with so many with dementia, is the cost of caring for them when it happens. That is why we need a cure. She lived a long time, much of it with us, but also a long time in a nursing home. The costs added up over the years and we were lucky that we found a decent place that would take Medicare.
It sounds as though you found some wonderful caretakers for your mother. I often thought that those jobs taking care of your mother and the mothers and fathers of this year were “employment” On my firs t job as a nurse in California, I was passing meds. This wonderful caretaker was taking care of a new mother and cleaning up the mess. “i’m sorry for the mess,” said the new mother. “Honey if you didn’t make this mess, I wouldn’t have a job.”
The nursing home I signed up for and for which I’ve paid long term insurance since I was 49, is $300 a day. The insurance right now is paying slightly more than the cost per day. I have “in home” care on another policy, more expensive because they didn’t offer it when I was 49.
Your worst nursing homes are the private, (a clue is that Money magazine recommends you in vest in them, I.E. what the patient pays goes to the investors, not the care.) Your better ones are the county/state (at least in New York) your best are any REligious home. Non profit.
We were lucky finding her a place. We live on the outskirts of St. Louis and we went into the next county, which is more rural to a home that we both ended up happy with. This was a long time ago and things might have changed, but our first choice was closer to us, was a Catholic run home and they would not take Do Not Resusicate orders. So we chose the other option.
EBDOUG – I believe you’ve put your finger on the heart of the matter, or as the late great Frank Zappa might put it, “the crux of the biscuit”.
One of the great ironies of our time is that medical science has provided a longer average life span for our species than ever before while also handing us escalating medical expenses that typically accompany longevity with the physical and mental challenges that inevitably arise. It’s been estimated recently that up to 50% of our healthcare dollars go to about %5 of the population, particularly for the elderly and chronically ill (http://bit.ly/2nn6clW), though this estimate has been challenged (http://bit.ly/2mJslOj).
In any case, it’s no news that as we grow older various parts tend to wear down or out, and on average spend more hours and money seeing doctors or the scalpel. Zeke Emanuel, oncologist, bioethicist and a vice provost at U. of Penn, recently wrote an article proposing 75 as a reasonable life span. Much beyond that, he argues,and a variety of health and social issues, many related to those you bring up regarding your Mum, often make life for many more of a drudgery or even a curse. (https://www.theatlantic.com/magazine/archive/2014/10/why-i-hope-to-die-at-75/379329/). He asserts that when/if he reaches 75, he will opt out of the annual routine diagnostic tests they like to run at that stage and would refuse chemo or other heroic life saving measures if needed (the DNR option). For this he received some harsh criticism, particularly from those he calls the “American immortals”, a rather unique American cultural type that, through exercise, supplements, diet, mental gymnastics, etc., pursue “valiant efforts to cheat death and prolong life as long as possible”. Of course, we all age at different rates and Emanuel concedes the exceptions in modern society of more people than ever attaining old age and still generally healthy, happy and productive. The right genes and family support often make all the difference. The survival instinct is strong. Everyone want to go to heaven but no one want to die to get there.
Or as they say, “it’s not the years in your life, it’s the life in your years”. My mother is also in her 90s, will turn 91 in a week actually, and until her early to mid-80s enjoyed a relatively healthy life. Over the past 5-7 years, however, she’s run into numerous medical challenges, a few life threatening. Still, she remains fiercely independent and living on her own (with daily assistance from her three sons, who she helped send through college running a business out of our home), fortunate to still have most of her mental faculties (most days), and her perseverance and positive attitude is an inspiration to us all. Without Medicare, though, I’ve no doubt she would have been long gone, given the extent and expense of all her numerous medical procedures and meds she would otherwise have not been able to afford.
So how do we measure the value of a buck vs. the value of a life well-lived into a well-earned retirement?
EBDOUG, I take it from your “Mum” that you are a British citizen and would be very interested to hear your opinion of the health care system there. What are it’s primary accolades and shortcomings, in your opinion? Are there interminably long waiting lines, akin to the “death squads” Republicans like to scare us about with single payer? Do Brits often take “medical vacations” abroad to find cheaper medical care or drugs, like some do here?