Okay, you and others have accurately said what the Trump voters think. But the reason the ACA got even considered in the first place was that many people were without health care, and this was a serious issue. AND THAT GOT CHANGED FOR A NOT INSIGNIFCANT PERIOD OF TIME. Now the “new normal” is gone, and all those “millions” of people are just going to roll over and die quietly? And absolutely nobody else in DC or anywhere else will care enough to change anything? No political price to pay at all for telling “millions” of people who ACTUALLY got their lives saved and improved that they’re screwed now?
I find that difficult to believe. I think that’s demeaning - not to Trump supporters, but to the now uninsured families and anyone who cares about them. I think you can argue that it won’t be of sufficient force to bring about single payer, but to dismiss it entirely is wrong, IMO.
Besides, this sort of assumes that the old system was sustainable, and I’m not so sure it was or is.
It was sustainable in the sense that a steady percentage of fatal car accidents or school shootings was sustainable - losing some small number of the population was deemed acceptable compared to the cost of reducing that number.
My goalpost is exactly where you put it with the statement “And the Republicans have signed to various forms of replacement/reform measures in recent years, in some of their various “repeal ACA” bills.”
That is your claim that there were replacement provisions in the “repeal ACA” bills. I asked you to show me a bill where they were doing more than just repealing, and you show me a “plan”. A plan that few if any have actually signed onto. A plan that is no where near being worded as an actual bill. A plan that is no where near getting to the floor to be passed.
If your contention was that after repealing ACA then the republicans might think about replacing it with something, then that is possible. But to make a claim that they have an actual bill that they are considering is something of a stretch.
So, it is not me moving the goalposts here, and your claim that “And the Republicans have signed to various forms of replacement/reform measures in recent years, in some of their various “repeal ACA” bills.”" is incorrect.
Unless you are ready to show an actual bill that the republicans were looking to pass, then my point still stands.
So far as I can tell exactly one bill dealing with the ACA was passed by both the House and the Senate (Obama vetoed it, of course).
It repealed the following provisions of the ACA: “the individual and employer mandates, the subsidies to help people buy insurance, the Medicaid expansion to cover low-income people and the taxes on medical devices and high-cost health plans”.
Now, clearly that leaves in place many provisions of the bill - the ban on denying coverage for pre-existing conditions being the most obvious one.
But to pretend that the GOP will not pass a repeal without a replacement denies what they have already done. You could argue that they only passed it because they knew it would be vetoed, but a cite on that would be helpful.
As to what is likely to happen, I think it’s pretty clear the Democrats in the Senate will filibuster any full repeal. So the question is whether the reconciliation repeal that passed previously would be passed again. I see no reason to think it would not be. The good news for folks worried in this thread is that would leave many of the new regulations largely in place and the health care exchanges as well.
My “pie in the sky” dream is that the GOP finally attempts to craft a serious plan to address health care in this country. I am not holding my breath.
The number one thing the voters overwhelmingly said last night was “Repeal Obamacare”. It’s going to happen, and the shit show that results will be blamed on Obama. Republicans aren’t reasonable, and they aren’t holding back. We’ll be lucky if the Civil Rights Act survives. We’ll be lucky if the 15th and 19th amendments survive. ACA is already gone. There’s nothing to consider, nothing to guess. 60 million people voted to repeal it yesterday.
These differences are not significant in the context of this particular discussion. The issue here is the claim that the Republicans have promised supporters a straight up repeal. This has been shown to be incorrect. Everything else is irrelevant to this point.
So your answer to the OP is that you believe the GOP will propose, debate upon, and attempt to pass a health care bill that includes repealing and replacing the ACA with something that will cover those that are currently only insured due to the ACA? And that if they cannot come up with a passable “repeal and replace” bill that they will not pass a “repeal only” via reconciliation?
That is generally not the sense of “sustainable” most people understand when talking about health insurance. The private health insurance industry is in a death spiral, as rising premiums cause healthy people to opt out and take their chances. The sick and old stay in, because their medical expenses exceed the premiums, but there are fewer health members of the group to fund their needs, so companies must raise premiums again to cover the shortfall. More healthy people drop out, lather, rinse, repeat until the system collapses. That is the unsustainability being debated here.
I wouldn’t go that far. There are winners and losers in every change, and I’m sure there will be winners and losers from any “repeal and replace” bill. But there will be some reforms - laws that did not exist pre-ACA - and some elements of the ACA itself will be maintained.
I hope you are right. But I don’t see it happening. I don’t think there is any way that the GOP wants to tie themselves to the fate of the US healthcare system in any meaningful way. Being able to blame the whole thing on Democrats has been a political gold mine.
But again, I hope you are right - the only way the problems get solved is by having both parties invested in fixing them (even if there solutions are different) rather than just blaming the other side for all of the problems. Maybe Trump gives enough cover for the GOP to sign on to a Medicaid-like expansion to cover catastrophic care for those that can’t afford private coverage. Add in some HSA freebies and keep the pre-existing conditions bans and maybe you get something that goes far enough to meet the “repeal and replace” mantra without totally fucking over tens of millions of sick people.
But who leads this charge? Who tries to get Democrats on board? Paul Ryan?
I dunno, I think a partial repeal with continued blame on Democrats every time premiums go up is a better political play. You make the death spiral inevitable by removing the mandates, but I’m not sure that matters politically.
I hope that some months or a year or so down the road, you can push this thread in our face and say “I told you so.”
I care more about the health of the people, and of the country, than about being right on an argument on the internet. My feelings of shame and despair from being found to be wrong will be nothing compared to my elation that we will not go back to the situation we had before the democrats stepped up and did something about it. Something that republicans had plenty of time and opportunity to address, and refused every time.
so, the republicans may not follow through on their campaign promises to their base. They may allow empathy and compassion to stay their hand. I have my reservations on that possibility, but I will admit it is not an impossibility.
On the other hand, if in 6 months to a year or so, and ACA has been gutted or repealed, nothing has been replaced, and there are millions of Americans without insurance, it will give me very very very little pleasure to know that I was right in this conversation.
The big issues: What happens to the marketplaces? What happens to Expansion/MAGI Medicaid? What happens to CMMI? What happens to Health System Transformation?
I think that’s exactly what the people who bothered to vote voted for last night in every vote for the Republican candidate for President, in every seat that the Republicans kept in the Senate, and in every incumbent who is returning to the House. I think that the people who are benefiting either didn’t vote or decided that something else was more important than health insurance and were willing to sacrifice this for that something else. I think that given the new make up of the three branches of government at the federal level, there’s not a damn thing that can be done.
This may be Wednesday afternoon resignation talking.
If we’re being honest, neither the old nor the current system are sustainable. The cost of health care in the US has continued to rise as a percentage of GDP. The ACA slowed down that rise, but didn’t halt it. If nothing changes, it will continue to rise, and that rise is not sustainable, long term. If the ACA is repealed, it will rise faster and become unmanageable sooner.
A true single-payer system would help, but experts disagree as to whether even that, by itself, is sufficient to address this problem.
If you really think that thousands, if not millions of people will go bankrupt or die, and their voices will be completely unheard by anyone of importance… I guess you’re right, it’s all over, there’s no hope for anything anymore. If you think those people are that weak and powerless, and that everyone who matters will just ignore them at best and scorn them at worse… Well, at least I understand why you’re wondering if it’s worth it to go on, because that’s pretty bleak.
It’s not, in my opinion. The big, important steps the PPACA put into motion for changes to how we pay for (at the provider level), evaluate, and deliver health care are one third of the puzzle. Moving to a single payer system is another third. The third third is about long-term care, and it’s a doozy of a problem that will never be solved without real political will.
Just not the 60 Million that voted in Trump and held the line on republicans holding both houses.
That is the republicans base.
That is who they are answerable to.
That is who they will cater to.
You tell me. Who will be in power, who will listen to the plight of the 22 million who are to lose their insurance? They are going to be largely Democrat voters, and the republicans in the mix are more worried about gay marriage and abortion than their own healthcare, much less that of others.
The disconnect here is that I don’t understand how anyone can be shocked that the republicans will do exactly what they have been saying they would do for the last 6 years if given the opportunity.
I’m a little confused about what you are arguing. No, the voices will no go unheard. But they will be largely heard by the same people who have been talking about them all along. The ideological position of the GOP is that those voices matter less than repeal of the ACA. As ignorant as I tend to think the Republicans are about a lot of things, it’s not that they don’t know those people are out there. It’s that they think that they matter less than their ideology. We’ve seen plenty of evidence of that, I think. What makes you think that they matter more than ideology?
I guess what I’m saying is that I assume the GOP pols are smart and informed enough to be perfectly aware of the repercussions of repeal. What makes you think they don’t know?