# House passes "repeal and replace" **URL:** \ **Category:** Great Debates\ **Created:** [May 4, 2017, 8:53pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871 "2017-05-04T20:53:38Z")\ **Posts on this page:** 20\ **Page:** 25
**Author:** ![QuickSilver](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/quicksilver/32/7832_2.png) [@QuickSilver](https://boards.straightdope.com/u/QuickSilver)\ **Post date:** [May 6, 2017, 4:02pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/481 "2017-05-06T16:02:16Z")
> [@Bricker](#): > > OK. > > Right now my healthcare is provided through Aetna. My employer and I each contribute money to Aetna to cover me and my family. Aetna also has struck deals with doctors and pharmacies to provide services to me at reduced rates, which they accept because of the volume of traffic they expect Aetna to send their way. > > So I suggest several different alternatives. Here is one: > > My state, Virginia, sets up Virginia CommonCare. (“Cause we’re a Commonwealth - get it? Get it?”) Virginia CommonCare strikes deals with doctors and pharmacies to provide services at reduced rates which they accept because of the volume of traffic they expect CommonCare to send their way. > > Virginia law mandates that every Virginia resident buy health insurance, either through an employer plan such as Aetna, through CommonCare itself, or through another non-employer plan that provides minimum essential coverage (Tricare / Peace Corps / VA / Medicare, as examples). > > Virginia can subsidize the plan to make the rates competitive, and directly subsidize low-income purchasers. As a matter of wise public policy the subsidy should not make the rates (for non-lower income purchasers) substantially lower than the private (“Aetna”) rates. If non-subsidized rates are lower than other options, that’s fine. > > Virginia may find it financially viable to join Maryland, DC, and Delaware in a multistate CommonCare initiative. That would be good: the more the merrier. > > The federal government may augment Virginia’s dollars spent to subsidize CommonCare with their dollars. The more the merrier. > > Questions? Obviously one post cannot create the detailed description that legislation and implementing regulation does, but that’s my first idea. Fair enough… so: > [@QuickSilver](#): > > What makes state healthcare mandates preferable to federal healthcare mandates? > > What material difference is there between federal and state mandated healthcare? ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [May 6, 2017, 4:04pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/482 "2017-05-06T16:04:25Z")
> [@QuickSilver](#): > > What makes state healthcare mandates preferable to federal healthcare mandates? > > What material difference is there between federal and state mandated healthcare? State-mandated healthcare derives from the legislative power of the state, which is plenary in nature. We need not find a list of allowable state powers and confirm that “provide healthcare,” is on such a list, because there is no list. States’ powers are not listed. Federally mandated healthcare derives from the legislative power of the federal government. If it has this power, it must be either explicitly listed as a federal power, or inferred from the powers that are listed. In my view, it is unwise to adopt precedents that liberally construe federal powers, or that justify powers under broad rubrics, because each such assumption eviscerates that distinction and leads to a generation of Americans that are genuinely surprised to learned that such a distinction even exists. ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [May 6, 2017, 4:07pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/483 "2017-05-06T16:07:56Z")
Too late to add: 4. What stops those who can’t get that level of help elsewhere from flooding in, bankrupting the system? 5. What stops those who don’t want to play the game from flooding out, bankrupting the system? ---
**Author:** ![Bryan\_Ekers](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bryan_ekers/32/183_2.png) [@Bryan\_Ekers](https://boards.straightdope.com/u/Bryan_Ekers)\ **Post date:** [May 6, 2017, 4:17pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/484 "2017-05-06T16:17:39Z")
> [@Czarcasm](#): > > Too late to add: > 4. What stops those who can’t get that level of help elsewhere from flooding in, bankrupting the system? > 5. What stops those who don’t want to play the game from flooding out, bankrupting the system? Every state builds a wall around itself. Mexico will kick in. ---
**Author:** ![Budget\_Player\_Cadet](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/budget_player_cadet/32/205_2.png) [@Budget\_Player\_Cadet](https://boards.straightdope.com/u/Budget_Player_Cadet)\ **Post date:** [May 6, 2017, 4:18pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/485 "2017-05-06T16:18:26Z")
> [@Bricker](#): > > No. I don’t. In the long term health of the nation as a whole, I think adhering to the wisdom of recognizing proper federal roles is vastly more important. Great. Then the right way to do this is to challenge Obamacare in court. Oh wait, you can’t. Because we already went there. And your side of the argument _lost_. > [@Bricker](#): > > This argument cannot be won by simply declaring your opponents are immoral, cruel, or sociopathic. Those are examples of poisoning the well, ad hominem attacks that do nothing to show the merits of your arguments. I’m really sorry that your position is being characterized as sociopathic simply because it’s supporting legislature which will strip tens of millions of their health care - mostly the poor, needy, and chronically ill - on the basis that it’s an erosion (albeit not a constitutional one) of the separation of federal and state powers. :rolleyes: Here are a few mild suggestions if you don’t like that characterization: [ul] [li]Solve the problem without stripping 24 million fucking people of their health care[/li][li]Rethink how important it is to fight a bill this hard on grounds that can’t even be considered a constitutional challenge[/li][li]Rethink how important federalism is[/li][li](Just repeating this for emphasis) **Solve the problem without stripping 24 million fucking people of their health care** [/li][/ul] It would be one thing if this was a supreme court case, and the judges agreed that Obamacare had to go because it violated the constitution. But it isn’t. We _had_ that case. Obamacare lived through it. We’re not looking at some huge, unprecedented erosion of some fundamental structure of government, let alone a person’s constitutional rights. We’re looking at what in your opinion is somehow not okay. And we’re supposed to care about that more than about the lives of countless people who this legislature should kill. And by the way, if we’re going to start complaining about the erosion of government structures, maybe you should start by taking a long, hard look at Mitch McConnell’s senate record. :mad: Again, I reiterate. If you think this bill is unconstitutional, challenge it in court. If you don’t, then _what the fuck is the problem that’s so goddamn dire that it requires throwing 24 goddamn million people off their fucking health care?!_ > [@Shagnasty](#): > > Do you realize that the only solid argument that ObamaCare supporters have is that it gave (greatly subsidized) healthcare to a very small minority of the population? Even if this were _remotely_ accurate (and I’m not in fact convinced it is), the fact that this “repeal-and-replace” monstsrosity will shove _24 million people_ off health care should be enough to make you realize what a red herring this is. If all the bill is is “repeal-and-replace” and Obamacare did virtually nothing, then how the hell is it throwing 24 million people off health care? ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [May 6, 2017, 4:19pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/486 "2017-05-06T16:19:35Z")
What good has the “states’ rights” ideology ever accomplished? It maintained slavery, it supported Jim Crow, it continues to support the desires of the wealthy over the needs of the many … and for what? It needs to be left in the past, not used as an excuse any longer, as in the “federal health care bad, state health care good” claim. That’s how we continue to be held back, as the GOP ideologue faction and the party-first faction they drag along with them have just shown us. Besides, supremacy clause and Grant v. Lee. So there. ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [May 6, 2017, 4:19pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/487 "2017-05-06T16:19:55Z")
> [@Bricker](#): > > You don’t get to define “mistake.” You don’t get to ignore that I do rely on 3rd party scientific conclusions to report that. (and not only on evolution and climate change) > [@Bricker](#): > > You, and many of your fellow travelers, assume you can simply declare that your opponents are immoral, or sociopathic, or represent mistakes. No. That may be what you’re trying to prove. But you cannot simply assert it as a given. I see that you want to just make me fall into a trap to get me a warning. It will not work. I already said that it is the current republican leadership is the weakest link (and so much for requesting others to do read what was said before) Here is Hans Rosling on how uncompetitive and wasteful American Health care system is and how politics are a big reason for it. [![](https://img.youtube.com/vi/auSFX0o3uFU/maxresdefault.jpg "Hans Rosling's answers to the TED and Reddit community interview") ](https://www.youtube.com/watch?v=auSFX0o3uFU) (stop when Hans gets to point 7) ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [May 6, 2017, 4:43pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/488 "2017-05-06T16:43:10Z")
> [@elbows](#): > > …Wondering where it says that in your Bible. “Suffer! The little children to come unto me…” advises that children be hustled off into the next life while they are still innocent and eligible for Heaven. ---
**Author:** ![Budget\_Player\_Cadet](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/budget_player_cadet/32/205_2.png) [@Budget\_Player\_Cadet](https://boards.straightdope.com/u/Budget_Player_Cadet)\ **Post date:** [May 6, 2017, 4:44pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/489 "2017-05-06T16:44:43Z")
> [@ElvisL1ves](#): > > What good has the “states’ rights” ideology ever accomplished? It maintained slavery, it supported Jim Crow, it continues to support the desires of the wealthy over the needs of the many … and for what? It needs to be left in the past, not used as an excuse any longer, as in the “federal health care bad, state health care good” claim. That’s how we continue to be held back, as the GOP ideologue faction and the party-first faction they drag along with them have just shown us. > > Besides, supremacy clause and Grant v. Lee. So there. “Hey, it’s fine. If you want to move the country forward, just get 2/3rds of the senate and house and 3/4ths of the states on board.” Someone here said that, can’t remember who. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [May 6, 2017, 4:52pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/490 "2017-05-06T16:52:35Z")
> [@Czarcasm](#): > > Too late to add: > 4. What stops those who can’t get that level of help elsewhere from flooding in, bankrupting the system? > 5. What stops those who don’t want to play the game from flooding out, bankrupting the system? The answer is: I’m not sure, yet, but believe a solution is workable. It seems to me that in other discussions, such as abortions, the suggestion that states may not be abortion-friendly is considered a huge barrier, and the idea that people who desired an abortion friendly regime would flock to abortion-friendly states was derided as being unlikely for reasons I don’t really remember understanding. So I’ll start by adopting whatever answer you gave to that concern. What was it? ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [May 6, 2017, 4:55pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/491 "2017-05-06T16:55:20Z")
> [@Budget\_Player\_Cadet](#): > > Great. Then the right way to do this is to challenge Obamacare in court. > > Oh wait, you can’t. > > Because we already went there. And your side of the argument _lost_. Sure did. So now the right way is to repeal Obamacare in Congress. And guess what post started this thread? > [@Bricker](#): > > House just passed the “repeal and replace” bill that reverses key portions of Obamacare. > > I believe this is a wise policy move. > > But my finely trained sense of the SDMB suggests that a few here may disagree. ---
**Author:** ![Budget\_Player\_Cadet](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/budget_player_cadet/32/205_2.png) [@Budget\_Player\_Cadet](https://boards.straightdope.com/u/Budget_Player_Cadet)\ **Post date:** [May 6, 2017, 4:57pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/492 "2017-05-06T16:57:49Z")
> [@Bricker](#): > > Sure did. > > So now the right way is to repeal Obamacare in Congress. > > And guess what post started this thread? > [@Bricker](#): > > This argument cannot be won by simply declaring your opponents are immoral, cruel, or sociopathic. Those are examples of poisoning the well, ad hominem attacks that do nothing to show the merits of your arguments. I’m just gonna line these two posts up _riiiiight_ here. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [May 6, 2017, 4:58pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/493 "2017-05-06T16:58:00Z")
> [@Budget\_Player\_Cadet](#): > > Again, I reiterate. If you think this bill is unconstitutional, challenge it in court. I don’t. I think it’s unwise. It’s clearly constitutional. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [May 6, 2017, 5:00pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/494 "2017-05-06T17:00:53Z")
> [@Budget\_Player\_Cadet](#): > > I’m just gonna line these two posts up _riiiiight_ here. Why? They are unrelated. The first post recaps the OP, which was also mine. The second notes that a debate side cannot unilaterally define terms. Neither post contradicts itself or the other. ---
**Author:** ![Budget\_Player\_Cadet](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/budget_player_cadet/32/205_2.png) [@Budget\_Player\_Cadet](https://boards.straightdope.com/u/Budget_Player_Cadet)\ **Post date:** [May 6, 2017, 5:02pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/495 "2017-05-06T17:02:50Z")
> [@Bricker](#): > > I don’t. I think it’s unwise. I could name something else which is “unwise”. It involves tens of millions of people. ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [May 6, 2017, 5:03pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/496 "2017-05-06T17:03:24Z")
> [@Bricker](#): > > The answer is: I’m not sure, yet, but believe a solution is workable. It seems to me that in other discussions, such as abortions, the suggestion that states may not be abortion-friendly is considered a huge barrier, and the idea that people who desired an abortion friendly regime would flock to abortion-friendly states was derided as being unlikely for reasons I don’t really remember understanding. > > So I’ll start by adopting whatever answer you gave to that concern. What was it? Inconsequential, because the abortion question is an entirely different problem to solve, involving entirely different solutions. Now, to stay on topic-can you address _any_ of the five questions I put forward? Remember, _you_ are the one that asked “questions?” at the end of your proposed solution. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [May 6, 2017, 5:11pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/497 "2017-05-06T17:11:58Z")
> [@Czarcasm](#): > > Inconsequential, because the abortion question is an entirely different problem to solve, involving entirely different solutions. I’d still like to hear that response, because I din’t have an answer in mind right now, and perhaps your answer will suggest one to me. > [@](#): > > Now, to stay on topic-can you address _any_ of the five questions I put forward? Remember, _you_ are the one that asked “questions?” at the end of your proposed solution. My answer to #4 and #5 is pending your reminder to me of how you answered the abortion question. \*1. “Virginia CommonCare strikes deals with doctors and pharmacies to provide services at reduced rates which they accept because of the volume of traffic they expect CommonCare to send their way.” Unless it is mandatory, then it is entirely possible(I would even say probable) that doctors and pharmacies, with no previous history to work from, will not sign on without a guarantee that they will receive at least what they receive now. \* It would be mandatory to this extent, then: a doctor must give to CommonCare the lowest rate he’s negotiated with any other insurance company. That rule would be intended to be temporary only to establish a track record. - 1. If this insurance company is not forced to accept preexisting conditions, then this is just a sham, and if this insurance company is forced to accept preexisting conditions, what is to stop them from saying “Screw you. We refuse to be the only ones to do this because the base is too small to support this. Byeee.”?\* Forced to accept pre-existing conditions, and subsidized in doing so by the state. \*3. Will the cost of this healthcare be based on what you earn, with governmental support for those who are destitute, or are you just talking about a fixed discount? \* Means-tested. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [May 6, 2017, 5:13pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/498 "2017-05-06T17:13:17Z")
> [@Budget\_Player\_Cadet](#): > > I could name something else which is “unwise”. It involves tens of millions of people. In my opinion, leaving standing precedent that vitiates the federal/state distinction is even more unwise. ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [May 6, 2017, 5:15pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/499 "2017-05-06T17:15:57Z")
Hmm, saving people’s lives vs. vitiating the federal/state distinction … what to do, what to do … ---
**Author:** ![Okrahoma](https://avatars.discourse-cdn.com/v4/letter/o/90db22/32.png) [@Okrahoma](https://boards.straightdope.com/u/Okrahoma)\ **Post date:** [May 6, 2017, 5:24pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/500 "2017-05-06T17:24:38Z")
> [@ElvisL1ves](#): > > What good has the “states’ rights” ideology ever accomplished? Legalization of marijuana? [Previous page](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871.md?page=24) [Next page](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871.md?page=26)