The GOP bill to replace ObamaCare landed with a thud. Of course, the Democrats hate it because it eliminates taxes on the wealthy, but conservatives are deriding the bill as ObamaCare 2.0, RINOcare and TrumpCare because it contains all new entitlements and is still too intrusive on the private health care insurance markets.
The Cato Institute’s Michael Cannon notes that the bill does little to derail the expansion of Medicaid and, even expands ObamaCare by appropriating funds for the law’s so-called “cost-sharing” subsidies and retains the very regulations “that are threatening to destroy health insurance markets and leave millions with no coverage at all.”
GOP ObamaCare replacement presented (AP pix via WSJ)
In a similar vein, Heritage’s Edmund F. Haislmaier says the bill tries to protect those who picked up subsidized coverage under ObamaCare but fails to remove the market damaging insurance regulations of ObamaCare that have driven up premiums.
“This bill misses the mark primarily because it fails to correct the features of Obamacare that drove up health care costs,” Haislmaier writes. “Congress should continue to focus on first repealing the failed policy of Obamacare and then act to offer patient-centered, market-based replacement reforms.”
Both writers criticized the decision to retain the Cadillac tax on expensive health insurance plans.
But a Wall Street Journal editorial, while admitting the bill is flawed, points out that Republicans have a narrow window for repeal and replace and failing to pass some kind of bill might doom efforts to rid the nation of ObamaCare at all.
“In other words, the House bill is the only heath-care show in town,” WSJ advices. “If conservatives join Democrats to defeat the measure, the result will be to preserve ObamaCare as is—and probably torpedo the rest of the GOP agenda including tax reform. Good luck running for re-election in 2018 with a record of failure.”
The 123-page bill is full of federal government interference. It could be trimmed to a few pages and simply allow health insurance premiums to be deducted from income taxes, and leave any insurance regulations to the states, while exercising its Commerce Clause role and allowing insurance to be sold competitively across state lines.
Cannon doesn’t agree with WSJ.
“The House Republican leadership bill does not replace ObamaCare. It merely applies a new coat of paint to a building that Republicans themselves have already condemned,” he writes. “Since the most important asset health reformers have is unified Republican opposition to ObamaCare, at least in theory, it would set the cause of affordable health care back a decade or more if Republicans end up coalescing around this bill and putting a Republican imprimatur on ObamaCare’s core features. If this is the choice, it would be better if Congress simply did nothing.”
But the bill can be drastically amended, and should be. Having health insurance is not the same as having access to healthcare. In fact, one study found that the health of those added to Medicaid roles in Oregon had no health improvement.
In most cases, ObamaCare has resulted in little more than cost shifting.
4TH ST8 
what is the difference between wanting to eliminate tax on the wealthy than taxing those who don’t pay. I still have my feet because of Obamacare. I hope those who lose their insurance in this plan have funeral insurance in place.
Hank, if you live in Tennessee you might have no insurers on the ACA….and this is coming to many states.
What would you propose doing to fix that?
http://www.mercurynews.com/2017/03/06/aca-issue-what-if-theres-no-affordable-insurance-to-buy/
Both Obamacare and the Republican plan fail to address the elephant in the room: The costs charged by the providers for medical services. A hysterectomy and a dog spay are essentially the same surgery. I charge about $300.00 – $450.00 to spay a 90 lb dog while a hysterectomy for a 90 lb woman costs about $20,000. During my 30 years in practice I have yet to lose any dog to this surgery, and I’ve done an awful lot of them, so it’s a safe procedure at $300.00 – $450.00. I’m not saying canine medical standards are good enough for people, but to charge 45 times as much for a surgery that I’ve performed with excellent safety certainly sounds excessive to me.
Obamacare and the Republican plan are trying to save money by altering who makes payments and how, while the real problem is obvious: The medical industry is gouging us. The pundits and media rarely cite this and the citizens shrug their shoulders. Politicians of both parties refuse to stand up to them because of their power. They control 17% of our entire economy and the American Hospital Association alone spends more on lobbying that all defense contractors combined. As long as we, the people see it as Republican vs Democrat or liberal vs conservative, the fleecing will continue unchecked.
BTW, I went to the ER a month ago to have my finger sutured. The suturing took maybe 20 minutes plus a local anesthetic, an antibiotic shot and an X-ray. The bills are still coming in, but are near $2,000 so far. Not bad for 20 minutes worth of work and $20.00 worth of supplies. But nobody squawks about the medical establishment. It’s always about insurance companies and the evil government. Are we really that blind?
Rincon.
yes
The problem is not the medical providers, the problem is insurance companies.
Insurance companies make money, in the simplest terms, by paying out less than they take in.
The ensure their return by charging people too much, and paying out, to medical providers as relates to health insurance, as little as they can get away with.
Insurance companies are the problem.
Yeah?
Then explain why it is the providers charge ten time more when they think they have you uninsured for the service and once they are shown you are insured they accept only pennies on the dollar in comparison?
I speak from experience, MRI uninsured was going to be 2000.00, insured it was charged at 200 and no copay.
So, Patrick, what’s your spin on that?
Also, what’s your spin on Tennessee ACA insurers dropping out of the exchange?
Not that I expect anything comprehensible, I really think you need to address these queries.
It is the free market. Insurers negotiate rates. The uninsured is a captive customer.
Government programs like Medicaid and Medicare pay below cost. That’s why many doctors are dropping.
Medicare and Medicaid do not pay “below cost”.
And the point wasn’t about whether in a “free market” insurers make a profit, because they do. And the profit they make is the reason healthcare costs what it does.
Providers are also part of “the free market” but because the vast majority of services provided in the healthcare industry are provided to patients who are insured, the ONLY way for an insurance company to make a profit is to receive higher premiums from their insured, than they pay out to providers.
This puts the insurance companies in a place of such undue bargaining position that they corrupt whatever “free market” might be said to exist.
As evidence, all anyone need do, is see which industry is the largest in the world. Possibly only behind banking, although the two are so intwinded you might never know the difference. (AIG received more than 150 BILLION dollars in the bank rescue in 2008)
Not quite a free market. The number of practicing physicians is greatly limited by our lack of medical schools, our immigration policy and possibly an unreasonable licensing system. Shortage in supply leads to higher prices.
One example of many: One of my veterinarians was diagnosed with hyperthyroidism, but the family practitioner refused to treat. Instead, the patient was referred to an endocrinologist, who would not see her for 5 weeks. This vet clearly understood the undesirability of being hyperthyroid for over a month without treatment and struggled with the doctors and the insurance company to treat sooner. Her requests fell on deaf ears. In the end, she suffered ocular complications due to the untreated hyperthyroidism and these were treated to the tune of $20,000.00. Stoopidity with 2 O’s.
Lessons learned: 1) When patients wait for unacceptable periods to be seen, especially in the Chicago suburbs, there is a doctor shortage 2) Medical costs go up when patients are delayed in their quest for medical help. 3) Delaying diagnoses and treatment leads to poorer outcomes and increased risk of lawsuit.
BTW, hyperthyroidism in cats is common. They are generally treated on the same day as the diagnosis, which is usually the day following their first visit. The cost for the whole thing is a few hundred dollars.
Well then, by all means lets be more like Canada then, eh Rincon? They have nationalized health care like you, Patrick and a wide majority of liberals claim to want so badly.
http://www.ctvnews.ca/health/healthcare-wait-times-hit-20-weeks-in-2016-report-1.3171718
Get the government out of the business of gate keeper and free up the market like it is for veterinary providers, competition makes those cats treatable for a few hundred dollars.
And of course, when these “for profit companies” lose money doing one thing, (lending money like a bank, and doing so by lending the premiums they have taken in to provide healthcare insurance) what’s a “poor” company to do, but raise the premiums on their healthcare insureds even though it has nothing to do with the “risk” the have insured?
Predictably, the insurance companies then blame the “skyrocketing legal fees and costs” or “greedy doctors and increased medical costs” as the reason they “must” increase their premiums. Even though, the reason is that these companies lost money, making risky investments, in industries that have nothing to do with healthcare.
And why did insurance companies, takng in premiums from customers wanting healthcare coverage, start making loans in unrelated industries you ask? Simple; it’s because the compensation to the companies highest paid executives is based mostly on the companies SHAREPRICE. Without more and more risky “investments” an insurance companies SHAREPRICE wouldn’t be increasing to the levels “necessary” for the top executive to make tens or hundreds of millions of dollars. So what’s a “poor” executive from AIG supposed to do?
https://www.bloomberg.com/news/articles/2016-07-28/as-banks-spurn-risk-insurers-emerge-as-financial-supermarkets
“In 2006, per-capita spending for health care in Canada was US$3,678; in the U.S., US$6,714.”
https://en.wikipedia.org/wiki/Comparison_of_the_healthcare_systems_in_Canada_and_the_United_States
Their system is far from perfect, but they pay a lot less and as a bonus, they live longer than we do. According to my Australian wife, whose parents recently received two knee and a hip replacement, Australia’s system takes much better care of patients than ours does and is way less expensive. I tend to believe her. Australians also live longer than we do, like almost everyone else who doesn’t live in a third world country. Couldn’t we use Australia’s system as a model rather than Canada’s?
Insurance companies certainly contribute mightily to the problem, but demonizing them while ignoring the greed of the medical establishment misses the mark.
From what I found, Australia has almost the same problem as Canada.
US wait times appear to be increasing the more our government becomes involved with the availability of services.
Perhaps people are living longer in other countries by taking better care of themselves due to a lack of health care services….;)
Sorry Steve. I gotta believe my wife on this one. Domestic tranquility and all that.
How long has it been since she was living in Australia?
Perhaps things have changed.
The opportunity for the Republican party to keep its promise to repeal Obamacare should not be missed. Once repealed, a replacement bill could then be crafted. Both the repeal bill and the replacement bill can be voted on the same day. Without a full repeal, no Democrat will support any type of replacement. Keeping any of the ACA is not what the Republicans ran on or promised would happen.
Having now read the proposed health care bill, it is evident the Republicans are continuing the basic structure of Obamacare. This will do nothing to reduce the cost of health care or health insurance premiums. It continues and builds on creating a new entitlement program and a welfare program. What it is not is insurance.
One cost driver is the mandate to cover those with pre-existing conditions. This is akin to mandating insurance companies cover you for an auto accident when you did not have auto insurance or mandating that an insurance company rebuild your home and replace your personal possessions destroyed in a fire when you did not have home insurance. This is an unfunded liability the government is foisting on insurance companies and does nothing but raise the cost for everyone else. How much higher would auto insurance and home insurance be if such a mandate existed for these type of policies as well?
If society wants to provide health care to those with pre-existing conditions it should not be done through private insurance. Likewise, there should be no mandate that insurance companies must cover my child until a certain age.
We are being told other reforms will come during Phase 2 and Phase 3. Nothing the Republicans have done deserves the public trust that reforms will be enacted at a later date. Nothing government has accomplished in this area warrants this trust.
Obamacare could be repealed in its entirety but for the liberal / moderate Republicans that in reality do not want it repealed. The excuses have finally run out and the curtain has been pulled back. We have two national parties that believe in big, centralized government. What we don’t have is any party that is grounded in constitutional, free market, republican governance.
Well said.
Johnson and Weld were on the ticket….
“Taxes are the price we pay for a civilized society”
There has never been, and will never be a “free market” and for good reason.
If you want to live in a “world” where freedom means letting your neighbors die in the streets for a lack of healthcare, while billionaires throw another billion on the pile, be gone and find your paradise among savages.
We don’t need you.
Barbara is focusing on a crux of the problem: What to do with those people who don’t bother with insurance when they’re young and healthy and thus, are not paying into the system at all, and who have a low income and few assets and then acquire some medical problem along the way. Suggestions, anyone?
I think the issue of how to cover those with pre-existing conditions is being used as a pretext for the entire takeover of the health care system. The number of those who truly fall in this category is small compared to general population.
For now this category needs to be capped and those currently covered grandfathered in for a limited time period. Then Congress could concentrate on a full repeal of all the other onerous regulations, taxes, and mandates. A true free market bill such as suggest by Rand Paul could be adopted. Once in place this would bring down the cost of health care and insurance to affordable levels for everyone else.
At that point, Congress should go back and tackle the problem of providing health care to these high cost uninsurable individuals – through direct payments to the states – not through insurance. The states should craft their own programs to deal with the needy.
Once a covered condition occurs, the insurance company with the plan should be made to continue coverage for that issue for the rest of the patient’s life or until the issue is cured.
Of course, premiums the patient was paying should be maintained and not allowed to be changed, either increased or lowered.
Consider this a cost of doing business. Insurance companies rely on the whole to cover the few while attempting to make some profit along the way.
52 million Americans with preexisting conditions that could hinder coverage if ObamaCare is elminated. Hey a million there and a million here, pretty soon that starts adding up.
And does anyone know how many states there were, since say the contry was established, that provided anything but emergency healthcare for it’s citizens without help from the federal government?
Let’s face it, in the “free market” the choice for the poor is simple; die and don’t make too much of a mess when you go.
https://www.usnews.com/news/articles/2016-12-12/1-in-4-americans-have-pre-existing-conditions-that-could-hinder-coverage-if-obamacare-repealed
That goes double for the communist system, Patrick.
No matter what the system, the poor always lose.
In all my years of reading Thomas blog, while I have heard many, strong, boisterous voices near demanding a “free market” economy, I have never heard, nor uttered, any support for a communist one.
As I said though, an undisputed eventuality of a free market, for the poor, as relates to healthcare, is that they die for a lack of it. And supporters of the free market argue that billionaires are not only justified, but near heroic, in throwing another billion on their piles, while this happens.
You never used the word, but all your messages point directly towards it.
No matter what the system, the poor always lose.
The only answer to my question, what to do about people who develop medical issues while uninsured was Rand Paul. So far as I can find, Rand Paul addresses this only by giving a tax deduction for up to 10% of a physician’s income for charity work, which they may or may not choose to do. What percentage of physicians will volunteer to work charity cases? Whatever. It’s a mere detail. Giving a tax deduction costs exactly as much as the government paying outright for charity cases and the potential for fraud is huge. And, of course, tens of millions of presently healthy people will simply opt out, leaving mostly the old and sick to fund the system. Those old and sick people though, will be forced to subsidize the health care needs of the young and well when some of them become ill or injured. The economics just won’t work.
The conundrum is simple: If we give people who have no health insurance quality medical care, then most young, healthy people will opt to simply not pay into the system until absolutely necessary, rendering it financially unworkable. If we give them inferior medical care, then millions will receive essentially third world medical care in one of the world’s richest and supposedly Christian countries. Does anyone here actually think either is acceptable?
I just talked with my wife’s Australian parents. Their knee and hip replacements were done without a significant waiting period and were paid for by their private insurance, which the Australian government encourages. They told me they felt the Australian health care system is, in their word, “wonderful”. Why are we so many of us convinced that no one in the whole world could possibly have a health care system that works better than ours when the evidence is so strong?
[…] I’ve already protested that RyanCare is contains too many of the market manipulating machinations of ObamaCare, lamented the efforts to make sure no one ever has any handout taken away. […]
[…] I’ve already protested that RyanCare is contains too many of the market manipulating machinations of ObamaCare, lamented the efforts to make sure no one ever has any handout taken away. […]