# 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:** 26
**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, 5:30pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/501 "2017-05-06T17:30:54Z")
> [@Bricker](#): > > In my opinion, leaving standing precedent that vitiates the federal/state distinction is even more unwise. Says the _lawyer_. I wonder what _your_ net worth is. ---
**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, 5:40pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/502 "2017-05-06T17:40:00Z")
> [@Budget\_Player\_Cadet](#): > > Says the _lawyer_. I wonder what _your_ net worth is. I wonder how that’s relevant. ---
**Author:** ![Tee](https://avatars.discourse-cdn.com/v4/letter/t/73ab20/32.png) [@Tee](https://boards.straightdope.com/u/Tee)\ **Post date:** [May 6, 2017, 5:40pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/503 "2017-05-06T17:40:22Z")
> [@Budget\_Player\_Cadet](#): > > 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? I supported the ACA, but **Shagnasty** gave a perfect example of a very real problem. This thread is a kind of logical morass where health coverage is believed equal to health care, but the two are really not interchangeable. ---
**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, 5:44pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/504 "2017-05-06T17:44:34Z")
> [@Bricker](#): > > 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. You’ve been very thorough in explaining the separation of powers (F v. S) as outlined in the constitution. I understand why, from a legal p.o.v., you see the ACA as a federal over-reach: > [@Bricker](#): > > In my opinion, leaving standing precedent that vitiates the federal/state distinction is even more unwise. You’ve still not addressed why state mandated healthcare is better than federally mandated healthcare, if at the end of the day the objectives are achieved, i.e. comprehensive healthcare coverage of constituents. Can you make the case that the states have better understand of healthcare needs of their constituents that cannot be addressed by the federal healthcare mandate? ---
**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, 5:46pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/505 "2017-05-06T17:46:07Z")
> [@Tee](#): > > I supported the ACA, but **Shagnasty** gave a perfect example of a very real problem. This thread is a kind of logical morass where health coverage is believed equal to health care, but the two are really not interchangeable. I wanted to address that post but I didn’t want to get off on a tangent. His experience with ACA does not reflect mine to date. ---
**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, 5:52pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/506 "2017-05-06T17:52:17Z")
> [@QuickSilver](#): > > You’ve been very thorough in explaining the separation of powers (F v. S) as outlined in the constitution. I understand why, from a legal p.o.v., you see the ACA as a federal over-reach: > > You’ve still not addressed why state mandated healthcare is better than federally mandated healthcare, if at the end of the day the objectives are achieved, i.e. comprehensive healthcare coverage of constituents. Can you make the case that the states have better understand of healthcare needs of their constituents that cannot be addressed by the federal healthcare mandate? No, and I’m not claiming that. I don’t know that the outcomes would be better, and I accept that the outcomes may be worse. But I argue that we should accept those potentially worse outcomes because of our other concerns. You remember when I made the analogy to the Fourth Amendment before? Let’s use the Fifth Amendment this time, for variety. We accept the outcome that we can’t say to a jury, “This guy won’t even take the stand to deny his crime!” We accept that there are criminals we cannot convict, because they are shielded by the Fifth Amendment, and without those protections hobbling our prosecutions, we could convict more criminals. BUT – we accept that worse outcome because we care about criminal convictions, but we also care about not compelling a person to be witness against himself. That’s an analogy for my point here: we should, in my opinion, accept the possibly less-than-perfect state solutions because we care both about health care and about maintaining the wise distinction between federal and state roles. ---
**Author:** ![John\_Mace](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/john_mace/32/185_2.png) [@John\_Mace](https://boards.straightdope.com/u/John_Mace)\ **Post date:** [May 6, 2017, 5:56pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/507 "2017-05-06T17:56:11Z")
> [@QuickSilver](#): > > You’ve still not addressed why state mandated healthcare is better than federally mandated healthcare, if at the end of the day the objectives are achieved, i.e. comprehensive healthcare coverage of constituents. Can you make the case that the states have better understand of healthcare needs of their constituents that cannot be addressed by the federal healthcare mandate? For me, it goes back to the very reason states are sovereign in the first place. Obviously, if you don’t accept or like that idea, then it’s not going to resonate with you. I live in CA, and the less the fine folks in Mississippi have to do with the way we run things in CA (from schools to hospitals), the better. But you can also approach it from the purely pragmatic point of size. Economies of scale are great and everything, but one often finds that at some point, size becomes a hinderance. The US is such a large, diverse country that getting all the players to agree on something as complex as health care is just too much. Let the feds take care of those things that must be federal by their very nature (e.g., the military, foreign policy, interstate commerce,…). And let the states take care of those things that needn’t be federal. If we need to set up some overall principles, that’s one thing, but let the states work out the nitty gritty details themselves. If they desire to band together (as some smaller states might want to), then fine. I can imagine the New England sates setting up some regional system, or some of the land-large but population-small western states doing the same. ---
**Author:** ![aldiboronti](https://avatars.discourse-cdn.com/v4/letter/a/9fc348/32.png) [@aldiboronti](https://boards.straightdope.com/u/aldiboronti)\ **Post date:** [May 6, 2017, 6:13pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/508 "2017-05-06T18:13:30Z")
I recently slammed health coverage in the UK on this board and it’s true that the NHS has big problems. But having found out more about the mess that is US healthcare I’m beginning to appreciate our system far more (and by extension Canada’s which seems quite similar to ours). Help me out here, guys. Would Democrats and Republicans agree that Obamacare badly needs fixing or would the Democrats be quite content to leave things as they stand? And for the Republicans would they accept that the government in any civilized society _has_ to be involved in some degree with healthcare? If so doesn’t it make sense in a federal system for the federal government itself to be involved? Leaving it to individual states would almost inevitably result in inequalities in health treatment, some Americans receiving excellent care and some not, depending on which state they live in. (I’m talking about basic healthcare here, not the natural and inescapable differences that depend on income.) I have to say that the more I learn about your system the more grateful I am to be English. How the hell can anyone afford to be sick over there? ---
**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, 6:20pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/509 "2017-05-06T18:20:02Z")
That’s a fair analogy and it seems to favour the individual(s) being accused. The burden is on the state to provide maximum good to society by assuming each individual is deserving of assumption of innocence until proven otherwise. While the need for healthcare is not a criminal matter, why not take the same benevolent (you call it charitable) approach and assume each individual is deserving of a comprehensive healthcare benefit? ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [May 6, 2017, 6:27pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/510 "2017-05-06T18:27:13Z")
> [@DrDeth](#): > > Certainly we do need to understand _what works in other countries with similar economies and democratic structures_. But just because they do it one way, doesnt mean we have to either. The economy and demographics of say Sweden is hugely different than the USA. > > I find “xxxx countries do it so the USA is wrong by not doing it” posts completely unpersuasive. Well. There are quite a few developed countries out there. Iceland. Germany. Portugal. Japan. Norway. South Korea. United Kingdom. Finland. Australia. Switzerland. They are all very different from each other, in size, demographics and economy. Some are closer to the US, some are further away. Some are closer to the US than to the more different developed countries. And they all have cheaper health care than the US. And more efficient. Across all those differences. The US is not such a special snowflake that it follows economic laws different from every other country. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [May 6, 2017, 6:35pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/511 "2017-05-06T18:35:13Z")
> [@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? Just wanted to answer that question real quick for you. Many of the people who are effected either way are poor or otherwise marginalized people. If you want an abortion, and can’t get one in your state, you have to travel to another state to get that particular procedure, that you still have to pay for, and may need to make several trips out of state for pre and post appointments. This is difficult for a person of limited means to accomplish. It also does not actually consume much if any of the resources of the state that they go to, in fact, it may be a net contribution, if they are required to pay for the service. So, it is inconvenient to the person who wishes the abortion, but costs nothing to the state. If someone has cancer, they are just going to head to the state that provides cancer treatment for free, and stay there until they are better (or dead). This may also be difficult for a person of limited means, but it is less difficult, and has a much higher payoff. This is going to be a major drain on the resources of the state to keep the rest of the populace healthy. So, you end up with all the sick, old, and poor people moving to your state from states that do not wish to provide healthcare to their residents. Unless you create some sort of residency restriction to receive state funded healthcare, no individual state can ever run its own system, at least, not a system that is significantly superior to the hodgepodge healthcare system that we enjoyed pre(or post)-ACA. Ideally, my goal is complete coverage and universal healthcare. If anyone who is residing in the country gets sick or injured, they can go to a doctor and a hospital, and we will do our best to make them well. Maybe have a nominal co-pay, as people do tend to take things too much for granted when they are free, but $5-10 is actually enough to keep the vast majority of people from abusing the system for PCP or urgent care, and maybe $50-100 for ER visits, so that it’s not so cost prohibitive that if you think that you are having a health emergency, you don’t gamble that you’ll be able to make it to a doctor’s appt the next day, but also encouraging people to use cheaper services if their health issue is not critical. Now, how to end up with that is a much bigger problem. I don’t disagree with Bricker’s assessment that the way that ACA was implemented was somewhat unwise, but I do see it as the only way to go about it that fit within the framework of the constitution, as well as dealing with political realities. I kind of agree with Bricker that the house’s bill is a step in the right direction, but only to the extent that screwing up the healthcare system even more may end up breaking it, and then we can rebuild it from scratch, rather than constantly building upon and bandaging all of the problems with the original system that was more or less accidentally implemented over half a century ago. We have yet to see what the senate puts out, and it is possible (unlikely, but possible) that this is the one campaign promise that trump keeps, and that he will not sign into law a bill that does not at least attempt to fulfill his promise on healthcare. It may not be possible to fulfill his promise of better, cheaper, and covering everyone, but this bill does the opposite of that. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [May 6, 2017, 6:36pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/512 "2017-05-06T18:36:45Z")
> [@aldiboronti](#): > > Help me out here, guys. Would Democrats and Republicans agree that Obamacare badly needs fixing or would the Democrats be quite content to leave things as they stand? There are very few democrats who feel that the ACA is the best we can do. However, it was the best we could do at the time. There is plenty of room for improvement, but this bill is the opposite of that. ---
**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, 6:41pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/513 "2017-05-06T18:41:48Z")
> [@aldiboronti](#): > > I have to say that the more I learn about your system the more grateful I am to be English. How the hell can anyone afford to be sick over there? On several occasions we can’t. Here I have to point out that Obama was criticized for not telling the truth when he claimed once that every 30 seconds a bankruptcy took place in America due to health care costs. The study he cited was looked with the worst outcome numbers to get that number and fact checkers did pounce on him. Turned out that looking at the numbers carefully meant that in reality there was **one health-related bankruptcy every minute** before Obamacare… Oh well, that meat that everything was OK then! [/sarcasm] AFAIK even under Obamacare there are bankruptcies still, but “[currently](http://amjmed.org/under-aca-medical-bankruptcy-continues/) 20 percent of people under 65 with health insurance had trouble with medical bills in the last year. By comparison 53 percent of people without health insurance had trouble”. ---
**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, 7:14pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/514 "2017-05-06T19:14:35Z")
> [@QuickSilver](#): > > That’s a fair analogy and it seems to favour the individual(s) being accused. The burden is on the state to provide maximum good to society by assuming each individual is deserving of assumption of innocence until proven otherwise. > > While the need for healthcare is not a criminal matter, why not take the same benevolent (you call it charitable) approach and assume each individual is deserving of a comprehensive healthcare benefit? When I spoke of the Fifth Amendment and the need to convict criminals, I was identifying the two competing concerns that were in play: (1) the desire to not subject people to the requirement to convict themselves with their own words, and (2) the desire to convict those guilty of a crime. The analogy is to two different concerns with healthcare: (1) the desire to provide each individual a comprehensive healthcare benefit, and (2) the desire to preserve the distinction between federal and state powers. ---
**Author:** ![Ramira](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ramira/32/344_2.png) [@Ramira](https://boards.straightdope.com/u/Ramira)\ **Post date:** [May 6, 2017, 7:17pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/515 "2017-05-06T19:17:06Z")
> [@Bricker](#): > > That’s an analogy for my point here: we should, in my opinion, accept the possibly less-than-perfect state solutions because we care both about health care and about maintaining the wise distinction between federal and state roles. from the issue of the economies of scale, the standardization of the market to ensure greater efficiency across a common market - which is what your country is and a primary reason for its wealth - it is not with any doubt that a fragmented market of sub-national entities is a less economically efficient solution in a case where your health care system is already the least economical of any large developed economy and has the global health results that are more in the keeping of a middle income economy. But why is your Federalism so much more fragile than the federalism of the German state or of the Australia that it risks so much from having a national common basic health care framework? It is strange, the fearful lack of confidence in its own system… ---
**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, 7:19pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/516 "2017-05-06T19:19:14Z")
> [@John\_Mace](#): > > For me, it goes back to the very reason states are sovereign in the first place. Obviously, if you don’t accept or like that idea, then it’s not going to resonate with you. I live in CA, and the less the fine folks in Mississippi have to do with the way we run things in CA (from schools to hospitals), the better. > > But you can also approach it from the purely pragmatic point of size. Economies of scale are great and everything, but one often finds that at some point, size becomes a hinderance. The US is such a large, diverse country that getting all the players to agree on something as complex as health care is just too much. Let the feds take care of those things that must be federal by their very nature (e.g., the military, foreign policy, interstate commerce,…). And let the states take care of those things that needn’t be federal. If we need to set up some overall principles, that’s one thing, but let the states work out the nitty gritty details themselves. If they desire to band together (as some smaller states might want to), then fine. I can imagine the New England sates setting up some regional system, or some of the land-large but population-small western states doing the same. I hear what you’re saying but pre-existing conditions are the same whether they needs treatment in Mississippi or California. People in Miss. should be assured of the same level of basic care and coverage as in Cali. So those overall principals, including risk pools, should be federally managed and mandated. That would go a long way to eliminate the need of states having to band together. Thus, if I want to move from one end of the country to the other, whether or not I’ll get the same health coverage for me and my family should not be one of the variables that factors into that decision. ---
**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, 7:22pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/517 "2017-05-06T19:22:04Z")
> [@QuickSilver](#): > > …While the need for healthcare is not a criminal matter… It is not a crime to be poor in America. Might as well be. ---
**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, 7:41pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/518 "2017-05-06T19:41:14Z")
> [@Ramira](#): > > But why is your Federalism so much more fragile than the federalism of the German state or of the Australia that it risks so much from having a national common basic health care framework? > > It is strange, the fearful lack of confidence in its own system… It’s only fragile when we dismantle it. The German and Australian systems are not remotely similar to the United States’ version of federalism . . . although Australia started as almost identical to ours. But beginning with _Amalgamated Society of Engineers v Adelaide Steamship Co Ltd_ the Australian High Court began chipping away at the jointly sovereign principle. And when Australia forbid its own states from collecting income tax, this model fractured even further; the Labour Party in Australia was adept at eviscerating the federal distinctions by tying federal spending grants to limitations on the power of states. Australians are of course welcome to whatever government they wish. But I don’t regard the Australian progress away from federalism as remotely desirable. ---
**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, 8:20pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/519 "2017-05-06T20:20:52Z")
Wouldn’t the be something to hear from a doctor? “Tests are in, you have a serious medical condition that is easily treatable with reliable and inexpensive medicines. Regrettably, I must deny you this treatment because it does theoretical violence to a sacred tenet of federalism.” ---
**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, 9:07pm UTC](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871/520 "2017-05-06T21:07:34Z")
Injuries to human bodies don’t matter. Injuries to the body politic, like felon voting, are lethal. [Previous page](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871.md?page=25) [Next page](https://boards.straightdope.com/t/house-passes-repeal-and-replace/785871.md?page=27)