A lot of people thought ACA repeal was a no brainer done deal when Trump won. What happened?

Great Debates
21

If you’re on the right it’s because of squishy RINOs or because Cthulhu only swims left. If you’re on the left it’s because the GOP consists of lying incompetents who only know how to obstruct, so now they’re happy enough to obstruct each other.

This is an optimistic take, given the GOP’s talent for PR, deflection, and gaslighting. AFAIK most of the repeal plans have the fun feature of delaying the effects until 2020 when there might be a Democrat in the WH. Plus they can always blame Obama for destroying American healthcare, which they’ll explain was a shining paragon of free market innovation before he came along.

22

Moderate, please. There is no such thing as a liberal Republican anymore. She (and a handful of other GOP in Congress and the Senate) is moderate…they’ll go along with anything GOP leadership wants as long as they get to have an occasional “save” vote to ensure their continuing elections.

23

This is why I’m surprised they haven’t just done a full out repeal without replace. When the repeal goes through and everyone loses their health care, Pubbies will just say it’s Obama’s fault and everything was great before, but Obamacare ruined everything and that’s why the public is worse off. They’ll never publicly admit that the poor and middle class losing health care so the ruling class can save money has always been their heart’s desire.

24

Right, but as I said, that was at least partly what the people in the thread, and maybe the GOP themselves, were expecting when they were swept into power. So are you saying that this was their plan from the start? Does that mean you think the current situation is actually going according to their expectations?

(In addition to the post above.)

25

Luckily, we can point to excellent articles written just before passage of the ACA, like this one where the author takes a comprehensive outsider’s look at the healthcare system from a businessman’s perspective after his father died in a hospital from a hospital-acquired infection. (Contrary to the title, that part isn’t really the focus of the piece, just its impetus.)

The article is amazingly insightful and good at detailing how screwed up our healthcare system was pre-“Obamacare” in a very accessible (if long) unwonky way.

26

They realize that they can’t repeal without replacing and they can’t agree on what to replace it with.

27

Yeah, they can’t decide between “shitshow” and “horrorshow”.

28

The reason is very simple: It is much easier to create an entitlement than to destroy it. It’s much easier to increase an entitlement than to decrease it.

Those politicians have constituents, and those constituents will not stand for cuts to their benefits. Partisanship goes out the window when your paycheck is involved. Especially if you are a blue collar worker in a depressed economic area - the very people who voted in some of these Senators and congresspeople.

The rhetoric of ‘repealing Obamacare’ ran into the reality of politics.

This is one of the best arguments for not creating the entitlements in the first place.

29

“Here’s a policy everyone likes and nobody is willing to do without. We never should have created it in the first place.”

:dubious:

30

Everyone would also like a free pony. That doesn’t mean giving it to them is good policy.

31

Uh, plenty of people dislike the ACA.
Anyway, getting back to the OP - healthcare reform is a third rail in politics. No matter how broken or inept it is, reforming it will bring you heavy backlash for the first few years. So the GOP has been reaping the political benefit of criticizing the ACA for years, but now that they suddenly have power to reform healthcare, they’re staring the tiger in
the eye - any healthcare reform that they enact will probably be politically catastrophic for them.

32

Yes, because a free pony is comparable to universal health care.

33

The Democrats’ biggest mistake with the ACA was to enact a two-pronged strategy:

  1. Making insurance mandatory to purchase/acquire

AND

  1. Steeply raising insurance premiums.

If there had been 1# and not 2#, then folks would have been OK with it. If there had been 2# but not 1#, then folks could opt out of the high premiums. But by making a product mandatory to purchase, *and *drastically hiking the product’s price, what do you expect, other than a massive backlash?

34

Of course, the major point of that article is that the system was screwed up because of existing government regulation and that Obamacare will only make the system even more screwed up.

35

I’m sure there is some universe and some meaning of these words that places a pony on the same level as universal health care. But it is not this one, and it is not standard definitions of those words. Perhaps you meant “Everyone in Equestria would also like to be a free pony”? What’s more, I think you’ll find that the “free pony policy” would be quite easy to overturn in times of need, because nobody needs a pony. This is in distinct contrast to, say, Medicaid, which is hard to overturn precisely because “Making sure that poor people can afford their heart medication” is not something that people can live without.

36

Terrific article. Everyone on the board should read it.

A few notes:

First, about the cleanliness thing: here in CA, that has been the standard for many years now, so obviously it varies with state regulation.

Also, as for the crazy scheduling, that comes about primarily because nurses are and have been in great demand, and in many cases, so long as they fulfill a set minimum number of hours per week (usually 40-48), they’re able to request and get whatever schedule they ask for, within the limits of possible scheduling and shift requirements. (And for the same reason, they tend to have very strong unions.)

Finally, the major issues I see with the plan are that it’s difficult to project the effect of competition with much accuracy given that it would be a totally new playing field, and it’s unfortunately easy to predict the reaction of many Washington politicians. Otherwise, I like the idea a great deal. (Many of the other issues raised could be resolved by education of the public, which they would seem to have a pretty solid incentive to undertake.)

37

Are you talking about premiums or prices? They aren’t the same for most people who buy through an exchange. If your “household” (this word has a weird definition and might or might not include your actual household) is under 400% of the federal poverty line, a premium increase on an exchange plan doesn’t come out of your pocket.

38

Quick comment : a more right wing form of (mostly) UHC does actually exist. It has flaws and I am not recommending it, but I realized that health care costs is an economics problem that can be solved.

To summarize : the reason health care is so expensive is the providing of it (number of doctors and nurses) are restricted by the government, and the providing of pharmaceuticals is artificially limited as well.

So the more right wing plan would be to
a. Open up mass importing of foreign doctors, similar to H1B, with no visa limit and no requirement that the foreign doctors perform residency.
b. Open up mass importing of foreign generic drugs
c. Since (a) and (b) mean there will be lower quality doctors and drugs flooding the market, force hospitals and clinics to disclose when they are using cheaper foreign physicians.

This would cause a lowering of prices, in the long term, they would lower down to ‘cost’. By cost, I mean for doctors, it would be the average worldwide cost for a unit of a person’s labor who can pass medical school. For drugs, the cost would be the cost to synthesize and package the substance in a licensed facility, with just enough profit to enable the pharmaceutical plant to stay in business.

39

It’s easy enough to repeal Obamacare.

And then what?

Millions of people lose their health insurance, and for everyone else premiums get higher and coverage gets worse.

The reason Obamacare passed in the first place is that the health care system in the United States is a fucking mess. If the Republicans had embraced Obamacare and wanted it to succeed we probably could have avoided some of these problems, but for the past 8 years they’ve instead spent a lot of energy making sure Obamacare fails, because if it succeeded then Obama would get the credit.

If the Republican vision for health care is “we were doing fine until Obama got elected and fucked everything up”, then that’s a vision for disaster.

But that is their vision. How do they plan to get cheaper premiums? By letting insurance companies raise deductibles. What’s the point of cheaper premiums if you have to pay more in total?

Or are we supposed to have a free market in health care? I typed up a huge critique of the idea, but then deleted it because this isn’t about health care in general, it’s about why the Republicans can’t repeal Obamacare in five minutes.

The answer is that Republicans aren’t going to propose some sort of free market capitalist health care system where everyone pays the doctor out of pocket for all treatment. Whether that would be a better system or not (it wouldn’t be) is irrelevant, because Republicans aren’t proposing it, because they’d be strung up from lampposts if they did.

The real answer is that it’s easy to say “Obamacare is a disaster, and when we get a chance we’re going to repeal it and replace it with a real fix.” That lets everyone who is unhappy with any part of Obamacare imagine that the Republicans are going to fix the parts they don’t like and keep the parts they do like. But the problem has always been that while lots of people don’t like certain parts of Obamacare, they don’t dislike the same parts, and they’re massively in favor of other parts.

So take pre-existing conditions. Massively popular to force insurers to cover pre-existing conditions. But the problem there is that if you don’t buy health insurance, and then get cancer and decide to buy health insurance, now they have to cover your hugely expensive cancer treatment. So doesn’t it make sense to not buy insurance until you get sick, and then buy? And so maybe we don’t allow that? Except it’s unpopular to “force” people to buy health insurance. Maybe they’re not going to get sick?

It’s a truism that the median person will have paid more into insurance premiums over their life than they’ll get in payouts, otherwise the system couldn’t work. Healthy people who don’t get sick have to get less than the people who do get sick, because if the sick people have to pay more then it’s not health insurance. Just like in property insurance, the people whose houses don’t burn down pay in but get nothing, while the lucky duckies who lose their houses get all the benefit. It cannot work any other way.

So the point is, the current Republican plan is literally: We need to cut taxes for the rich, because obviously, and so we’re going to pay less for health insurance for everyone else.

And that would be fine if they had a plan that solved the problems of out of control health costs and gave better outcomes for less money.

Except they have no such plan. Their plan is to keep things the way they are, just spend less. Which means worse health care for millions and millions of registered voters. Which is why they don’t want to repeal Obamacare. But they promised to repeal the satanic Obamacare. But they’re scared that people who lose their health insurance, or who have much worse health insurance, will be upset that they lost their health care so the Koch brothers can have a lower taxes. So they can’t repeal Obamacare. But they must repeal Obamacare.

It’s a dilemma. The only way out would be a plan that would, as I mentioned, figure out a way to deliver better quality coverage at lower costs.

If we look around the world, we find that lots of other places have managed to have better coverage for most people with lower costs. Just like it’s expensive to try to buy insurance as one guy, it’s a lot cheaper when a large organization that is presumably a actuarial cross section of health buys insurance for everyone. And when you scale that up to a whole country it’s a lot cheaper. And then you can use your monopsony power to push down costs. It’s not perfect, but it turns out to be much cheaper than the system we have today.

So if Republicans really want that tax cut for the rich, they should be embracing some sort of single payer system. Think of the savings for all those corporations who no longer have to pay for incredibly expensive insurance for their employees. Think of the free market benefits when entrepreneurs and small businesses and sole proprietorship are freed from this massive burden that causes so much economic friction, when you can finally open that cupcake stand without worrying about your health insurance.

40

All of this speaks to the practical difficulty of repealing the ACA, but it doesn’t really address why the dire predictions were so wrong. It’s assumed that the politicians will lie or exaggerate or attack the easy targets. But the posters in the linked thread in the OP aren’t those politicians.

SDMB on Nov 9: the ACA is doomed.
SDMB Today: ACA probably won’t be repealed?

A less interesting question is what changed with the politicians involved that were calling for repeal. A more interesting question is what changed with the posters on the SDMB that predicted certain repeal and in what way their outlook has changed.