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Thursday, June 29, 2017

Obamacare

As most of you know, I was not a huge fan of Obamacare -- or of Obama himself, for that score. But even those of us who favor single-payer should not allow our vision of the ideal to eradicate an existent (and endangered) good.

This post on DU reminds us of some history that everyone seems to have forgotten:
Remember: Obamacare had to pass with a 60-vote super majority in the Senate

Remember: Ds held months of debate on Obamacare

Remember: President Obama held televised hearings on the ACA with all the major R pols in attendance

Remember: Rs were allowed to propose amendments to the ACA - over 100 made it into the legislation

Remember: Ds asked for and received input from numerous healthcare groups to fashion the ACA

Remember: the CBO scored the ACA very favorably, well before a vote was taken

Remember: the ACA outlined how it would be funded down to the last clause

Remember all of the above when you hear the talking heads drawing their false equivalencies between then and now.

But most of all, remember that the ACA passed without a single R vote.
Years of Republican propaganda have convinced millions of a false history. Many people believe that Obamacare was passed rapidly, covertly, without discussion, without any input from non-Democrats.

By contrast, the Senate's version of Trumpcare was (until very recently) kept secret from all Democrats and Repulicans who were not members of a 13-person secret cabal. When the Senate bill was finally unveiled, the leadership's mad rush to pass was impeded only by some key Republican defections.

Should we even call this legislation "Trumpcare"? Trump himself seems to know little about it.

We've all heard that famous sound clip in which Trump, sounding like a restaurant owner shmoozing with his patrons, says "How d'you like the healthcare, folks?" My metaphor falls apart: Restauranteurs know their menus, while Trump is clearly unprepared to discuss the details of the House or Senate version of his plan. Whenever he says "It keeps getting better and better," he sounds as idiotic as Chauncey Gardner. Or worse. The man is so inarticulate he often reminds me of "Dougie" in the new Twin Peaks.

(Here's an example of his ignorance: He expressed anger at the fact that no Democrat would support the Senate version -- even though no Democrat, at that time, was allowed to see the legislation!)

A clever reporter should ask Trump: "How did you manage to lower deductibles for working class families?" You know damned well that Trump would find some way to take credit for that "accomplishment." He would brag and boast, blissfully unaware that deductibles will actually rise.

If this bill passes, Trump's voters will be the ones paying those sky-high deductibles. Or rather: They won't be able to pay them. Yet when they face disaster, they will not blame their woes on either Trump or the Republican party, because GOP propaganda will give them someone else to blame.

In a way, it's a perfect system: The complete triumph of brainwashing over lived experience. If Trump shot one of his own followers on 5th Avenue, that follower would go to his maker blaming Obama or Hillary for the gaping wound below his ribcage 

Obamacare has (by some polling) a 50 percent approval rate, as opposed to the 12 percent who favor the bill now in the Senate. (Keep in mind that the disapproval number includes quite a few purists who insist on single-payer-or-nothing.) Yet Team Trump's strategy requires the pretense that Obamacare has been an abject failure -- that the present system is beyond rescue.

Obamacare is "doomed" only in the sense that Mary Kelly was doomed when she came under the control of Jack the Ripper. From Slate:
Trump isn’t just forecasting imminent demise. He’s doing what he can to speed it along, scaring insurers out of the market and driving up premiums by threatening not just to kill the program in Congress but to unilaterally yank the subsidies on which insurers and policyholders depend. At the White House on Wednesday, Trump issued another threat: “Obamacare is dying. It’s essentially dead. If you don’t give it the subsidy, it would die within 24 hours.”

In the last two weeks, as Republicans braced for a bad CBO score on the Senate bill, they escalated the Obamacare death watch. Since June 19, Trump has tweeted three times that “Obamacare is dead.” At a June 21 rally in Iowa, he scoffed, “Obamacare is a disaster. It’s over. And there’s nothing to compare [to] what we’re doing.” On Monday, as CBO issued its assessment of the Senate bill, Spicer lectured reporters: “We need to accept that Obamacare is dead.” On Tuesday, at a Capitol press conference, Republican senators said the program was “collapsing” and “going off a cliff.” On Wednesday, Trump reminded everyone that Obamacare would die if he pulled the plug.

Trump’s campaign to declare Obamacare dead, and possibly kill it himself through executive action, is grotesque. In the context of caring for sick people, it’s morbidly ironic, particularly coming from the party that shrieked about “death panels.” It’s also a betrayal of Republican principle. Conservative health insurance reform was supposed to be about better care through competition. Trump isn’t trying to beat the competition. He’s trying to erase it.
Although some of Obamacare's troubles stem from the original recipe, the most pressing current problems derive from the fact that the program is now being run by people who want rid of it. Similarly, Trump placed the nation's schools in the hands of the inane Betsy De Vos precisely because the Republicans hope one day to say: "See? Our education system is falling apart. We need to go to a voucher system." The libertarian approach to governance is to destroy all faith in government. The engineer is trying to derail the train -- and after it goes off the track, he hopes everyone will blame the very concept of railroads.

In its report on the Senate bill, the CBO told the truth about Obamacare:
Although premiums have been rising under current law, most subsidized enrollees purchasing health insurance coverage in the nongroup market are largely insulated from increases in premiums because their out-of-pocket payments for premiums are based on a percentage of their income; the government pays the difference between that percentage and the premiums for a reference plan (which is the second-lowest-cost plan in their area providing specified benefits). The subsidies to purchase coverage, combined with the effects of the individual mandate, which requires most individuals to obtain insurance or pay a penalty, are anticipated to cause sufficient demand for insurance by enough people, including people with low health care expenditures, for the market to be stable in most areas.
Comments:
To get that 60-vote super majority, Arlen 'Single-Bullet-Theory' Spector had to flip from Republican to Democrat.

Required viewing: Miss Sloane (2016), a super fast-paced non-action mystery thriller, starring Jessica Chastain as a first tier DC lobbyist. On second viewing, you realize that the movie is just like the main character.
 
Regulatory capture, as a policy.
 
Regulatory capture—it's the republican way.

Look at Don Rumsfeld being hired to oversee the Office of Economic Opportunity under Nixon...
 
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