Trumpcare, in its majesty

by Henry on January 28, 2017

The NYT on the artful language of Republicans looking to repeal Obamacare.

Before Mr. Trump stepped into the debate with his call for “insurance for everybody,” Republicans were choosing their words with utmost caution: Their goal in replacing the health law was to guarantee “universal access,” they said, not necessarily universal coverage.

“We will give everyone access to affordable health care coverage,” Mr. Ryan said in early December when asked if Republicans had a plan to cover everyone.

… “No one who has coverage because of Obamacare today will lose that coverage,” Representative Cathy McMorris Rodgers of Washington, the chairwoman of the House Republican Conference, said on Jan. 10. … The congresswoman “didn’t deliver her remarks exactly as prepared,” the spokeswoman said. In the prepared remarks, Ms. McMorris Rodgers included an important qualification: “No one who has coverage because of Obamacare today will lose that coverage the day it’s repealed” — in the transition to a new market-oriented health care system.

… We’re all concerned, but it ain’t going to happen,” Mr. Cornyn said. He amplified the point, adding: “Nobody’s going to lose coverage. Obviously, people covered today will continue to be covered. And the hope is we’ll expand access. Right now 30 million people are not covered under Obamacare.” A spokesman for Mr. Cornyn said he “meant no one will lose access to coverage.”

It hardly bears mentioning that the Republican party is trying to pull off the reverse triple Anatole:

The law, in its majestic equality, forbids rich and poor alike to sleep under bridges, beg in the streets or steal bread.

Republicans are pushing for a scheme that will provide both the very rich and the extremely poor with perfectly equal “access” to healthcare markets, just as they have equal access to Cartier jewelry, haut couture fashion houses and hopping on a plane for an overnight trip to get measured for bespoke shirts at Charvet’s. The small difference being, of course, that people’s lives and deaths don’t depend on whether they have nicely fitting shirts in their wardrobes. Similarly, those with perfect health and those with serious pre-existing conditions can rejoice in the knowledge that they will enjoy exactly the same principled equal right to purchase healthcare, even if the outcomes might differ very slightly, depending on the specifics of the cases.

The reason that some of the Republican rank-and-file are getting nervous is that their leadership is trying to sell a con, and a pretty obvious one. Still, some of them aren’t nearly nervous enough – the stakes are very high for very large numbers of people who would lose coverage, and can be expected to mobilize. It will be particularly interesting to see what happens in red states like Kentucky which have opted for some version of Obamacare. I started blogging in the run up to the Iraq war, when it sometimes seemed as if only a small minority of Americans had any understanding of the craziness that was being unleashed, and where critics and demonstrators had great difficulty tapping into large scale media. The political situation is in many ways far worse now, but the potential for large scale mobilization – and sustained media attention to it – is similarly far greater.

{ 21 comments }

1

medrawt 01.28.17 at 3:13 pm

One recalls the media experience of 2012, only a couple of years into the now epic charade of “the Republican plan to replace Obamacare will be available any … day … now …” when Democrats discovered that their bipartisan focus groups refused to believe that Paul Ryan’s legislative agenda was as Paul Ryan himself had described it, because it was obviously a cartoonish exaggeration to make him sound evil.

Some people won’t accept they’ve been conned, even when the con man looks them in the eye and tells them so.

2

Fats Durston 01.28.17 at 4:26 pm

Please call it “Republicare,” not “Trumpcare.” It belongs to the party as a whole.

3

bruce wilder 01.28.17 at 4:31 pm

I started blogging in the run up to the Iraq war, when it sometimes seemed as if only a small minority of Americans had any understanding of the craziness that was being unleashed, and where critics and demonstrators had great difficulty tapping into large scale media. The political situation is in many ways far worse now . . .

Organizing protest never seemed to progress to governing. Is there any reason to think people could get to . . . you know, actual governance?

4

Glen Tomkins 01.28.17 at 5:05 pm

They don’t have to pull this particular con to give the industry everything it wants, because universal coverage is not at all in opposition to the interests of the industry. If everyone has insurance, with the industry guaranteed that someone will pay the premiums, but the industry controls what medical services that insurance delivers, that would actually be the ideal arrangement for the industry. Medicare Advantage for All, if you will. Such a system would maximize socialization of the risks and privatization of the profits.

The con to worry about is managed care, any system that lets the insurer control costs by dictating how and what medical services are delivered. Whoever the insurer is in such a system, the govt or private insurers, it can only achieve significant cost savings by managing demand, by structuring care to make access to highly utilized services so difficult for the patient or provider that they tend to forego those services. There are more sophisticated ways of doing this, ways that appear benign, but even a system designed by our side, the ACA, also allows blunt instrument demand management in the form of copays and deductibles. All but one of my patients who got ACA insurance except one, got Bronze Plans with $6,000 deductibles, and none of them have $6,000, so none of them actually have coverage that pays for any medical service. The one exception bought a Silver Plan, but he doesn’t have the $3,000 deductible in his pocket, so he doesn’t have actual insurance either.

5

Stranger 01.28.17 at 5:16 pm

I think those in red states like Kentucky will love and admire Trump whether they have healthcare or not. Such people are religiously devoted to the idea of the white Christian nation they see Trump (and Bannon) trying to bring about.

6

Salazar 01.28.17 at 6:06 pm

Bruce Wilder #3

“Organizing protest never seemed to progress to governing. Is there any reason to think people could get to . . . you know, actual governance?”

The Tea Party, which in many ways is now calling the shots, began as a series of protest rallies.

7

bob mcmanus 01.28.17 at 6:11 pm

3: Strikes and riots are about showing or exercising power, protests and demos are about appealing to those who have and wield power. The two have opposite relationships to authority, and leadership emerges in the process of creating or enforcing discipline and dangerously challenging existing authority in strikes and riots.

If all the women who marched would just stay home, they could make Trump resign in a month.

8

engels 01.28.17 at 6:27 pm

Organising protest never seemed to progress to governing. Is there any reason to think people could get to . . . you know, actual governance?

Actually they did

9

P O'Neill 01.28.17 at 6:29 pm

In terms of being well informed for the blizzard of misinformation into which we’re headed, it’s worth reading about EMTALA, misinterpretations of which is a regular source of zombie talking points about healthcare reform. In particular back to the time when Hillary Clinton tried health reform as first lady, the counter-claim was “we don’t need healthcare reform because emergency rooms have to treat everybody!” Trump’s knowledge base on many issues is very old and this nugget is probably in there somewhere. Paul Ryan is probably working on a “sophisticated” version of the same racket.

10

Raven Onthill 01.28.17 at 6:36 pm

“Organizing protest never seemed to progress to governing. Is there any reason to think people could get to . . . you know, actual governance?”

This seems to be a new problem of democratic governmental forms: how do we go from the vast expressions of policy goals that have been enabled by modern telecommunications to actual policy?

No answers yet, only questions. One answer, I suppose: there is still a role for leaders and rulers.

BTW, I note that people in those red states are heavily armed, and not likely to be restrained when it is their family members dying. I am starting to imagine pro-health-care terrorism.

11

alfredlordbleep 01.28.17 at 7:41 pm

You’ll know there has been progress in media when Paul Ryan (as a few like to say) is recognized broadly (or bigly) as his party’s ideologist. (I haven’t been holding my breath since at least 2010).

12

Lord 01.28.17 at 8:06 pm

I think even Republican voters assume this, many of whom want this, but the rest that Trump will protect them from it.

13

PD 01.29.17 at 2:55 am

On the triple Anatole: Christina Onassis sent her private jet from Paris to New York to stock up on diet Coke. She thought the diet Coke sold in Europe didn’t taste the same.

I suppose some of the money trickled down . . .

14

marku52 01.29.17 at 4:34 pm

It’s obvious that the Pubs are hoist on their own petard. There is no way to square the circle they are in because they are committed to a free market solution where none exists.

They needn’t have bothered to kill the ACA, it was already dying. Insurers were fleeing in droves, and rates were skyrocketing. That 25% average increase just before the election was one more nail in HRC’s coffin.

The while idea of an insured solution to health care delivery makes no sense. Imagine if you were an insurer writing home fire insurance when you knew to a fair certainty that every five years or so, a room of the insured’s house would burn down, and inside of 25 years or so the whole thing would go. It’s not possible.

The InsCo would spend all its time trying to guess whose house was likely to burn, and denying coverage. A massive waste of resource from society’s perspective.

Here is a data point on just how wasteful the administrative load can be. Just last week my wife had stitches removed at the eye doc’s. We could either pay the negotiated insured rate (counts towards the deductible) , or cash. Cash was one half the negotiated rate.

So in this case, the doc was willing to cut the price in half just so as not to have to deal with the InsCo. That is some massive waste.

15

Jason Weidner 01.29.17 at 5:19 pm

@ Fats Durston #2: More like Republi-don’t-care.

16

Raven Onthill 01.29.17 at 8:33 pm

They could, however, keep Trump’s promises of less-expensive better coverage by implementing a single-payer system. (Or adding a public option and highly regulating health insurance.)

17

Tom M 01.30.17 at 12:32 am

Re marku52 and the “Insurers were fleeing in droves,” one of them, Aetna, was fleeing markets where they were profitable in order to try and win the case that the FTC brought

“.The court also faulted Aetna for its efforts to pull out of Obamacare marketplaces in Florida, Georgia and Missouri, saying the insurer intentionally left the public exchanges in order to avoid antitrust scrutiny.” https://www.bna.com/aetnahumana-decision-highlights-n73014450218/

18

Matt 01.30.17 at 6:34 pm

@ 4 I may biased as I recently entered the managed care industry, but one of my main reasons for doing so was to see how the sausage is made. I have to say, for the systemic flaws, managed care is the only way the US health system will ever improve if the end goal is better care for more people at a lower cost. Honestly, I still feel that the profit motive needs to be removed from the industry to really generate efficiency, but the country isn’t ready for that it seems. At least from where I’m standing, managed care isn’t about preventing people from getting the services they need. It’s about encouraging them to get preventative services, and when that fails providing the most cost-effective evidence based medicine. It’s the same principle that drives socialized health systems. That’s my 2 cents for whatever it’s worth.

19

Layman 01.31.17 at 6:24 pm

“We could either pay the negotiated insured rate (counts towards the deductible) , or cash. Cash was one half the negotiated rate.”

It’s hard to understand how this isn’t a case of the doctor defrauding the insurance company, as well as the customer.

20

Alec 01.31.17 at 6:54 pm

As an aside to P O’Neill at #3, in the UK all visitors are entitled to receive free treatment at emergency rooms (“A&E departments”) and in a family doctor’s office (“GP surgery”). If you are admitted to hospital or need specialist care you will be billed. (https://www.gov.uk/government/publications/guidance-on-overseas-visitors-hospital-charging-regulations/summary-of-changes-made-to-the-way-the-nhs-charges-overseas-visitors-for-nhs-hospital-care)
So American citizens visiting the UK who find that they need emergency treatment are actually treated more generously by the NHS than they are when in their own country under EMTALA.

21

Alec 01.31.17 at 6:55 pm

Sorry, that should be P O.Neill at #9.

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