So, Healthcare, 7/28/17

Some various thoughts on where things are today:

1. Hooray for senators Murkowski and Collins and McCain, and also every single Democratic senator for knocking back this bullshit that was so egregious that they literally had to take the vote in the middle of the night because it couldn’t stand up to scrutiny in the light of day. The fact that 49 GOP senators voted for a bill that they knew was trash is depressing, but, horseshoes and handgrenades.

And yes, I know that there’s a good chance that some of them voted “yes” because they were confident that an 80-year-old man with cancer not long for his job would give them cover against frothy primary voters back home, but there’s only so far that sort of thing goes. Rob Portman, the Republican senator from Ohio, isn’t up for re-election until 2022. “Primary cover” isn’t a thing he needs at the moment.

(His excuse: He wanted it to go into committee with the House GOP. Uh-huh. This would be the same House GOP that passed a bill so awful that the Senate wouldn’t touch it. This is the group they were hoping to punt to, in order to come up with something better. Yeah, okay.)

2. I’m especially pleased that this is an only-barely-metaphorical kick in the nuts to Mitch McConnell, who basically flouted every lawmaking convention the Senate has in order to present a series of top-down, heartless “let’s repeal Obamacare because fuck that dude” bills, only to have them stuffed back in his face with every vote. In his rush to eradicate the major policy achievement of a black man, McConnell did appear to forget that the ACA does, in fact, help millions of Americans, including Republicans, have insurance, and helps the rest of us with that whole “no more of that pre-existing conditions or payment caps bullshit” thing it has going. McConnell didn’t give a shit about his constituents, or Americans in general with this. He just wanted the win, to have a win and to kick at a man who isn’t in politics anymore. He got what he deserved with this monumental and serial defeat.

(“But how is what McConnell did any different than how the ACA was passed in the first place?” Well, for starters, there’s a difference between an entire political party actively deciding not to participate in the crafting of legislation, as is what basically happened with the ACA, and the senate GOP deciding not to involve the Democrats, or indeed, most of the members of its own caucus, as happened with the Senate repeal bills. There’s more, but let’s move on, shall we.)

3. And no, I don’t expect this to be the end of it. On a practical level, the GOP wanted to gut the ACA because it would make it easier to get its upcoming budget deal done. On the impractical level, Trump loathes Obama and anything to do with him, not only because Trump’s a bigot but because every day he’s in office makes it clearer how much better a president Obama was than he is. McConnell also hates Obama for being Obama, and Paul Ryan just wants to destroy the social net for the old and sick because he’s an awful inhuman bucket of turds. They’re going to find their way back to the ACA even if the vast majority of Americans want them to leave it alone or — heck! — maybe even make it work better. They can’t leave it alone. They are constitutionally unable to. I’m happy this round of nonsense has been beaten back, but I’m not under the illusion they won’t try again. They will try again.

4. All of this nonsense does again bring to the fore a thing we already knew about the current GOP, which is that it isn’t for anything, other than shoving as much of America’s wealth as it can into the hands of the very rich. For the last eight years, its major policy theme was “whatever Obama wants, we’re against,” and now that it is in power, its major policy theme is “Whatever Obama did, we’ll repeal.” The problem they’re running into, as this dundersplat of a vote shows us, is that Obama’s policies did actually make people’s lives better, and also that sooner or later “not that” has to be replaced by something.

There was no there to the GOP’s proposals — nothing that would do what Trump and they promised, which was to make health care better. There wasn’t a single proposal the GOP offered that didn’t involve millions of people losing insurance, Medicaid being slashed and costs climbing for everyone else, and all but the “skinny repeal” basically were stalking horses for wealth transfer and setting the social net on fire. It’s not in the least surprising that at the end of the day, the excuses the Senate GOP gave for fronting these atrocious bills were “Look, we said we were going to repeal it” and “We know we’re going to pass a horrible shit bill but maybe the House GOP will save us from ourselves.”

I’m not going to say that there’s nothing in the GOP and/or Trump administration’s policy portfolio that isn’t explicitly about making the rich richer or just rolling back Obama policies without regard to the sensibility of those policies, but I have to admit right off the top of my head I can’t think of all that many, and even the ones that I theoretically would be before (infrastructure, rural broadband) I simply don’t trust Trump or the GOP to do without basically devolving them into a crony feed.

5. On a personal note, here’s a true fact, which is that the last week has been shit for my productivity because I’ve been waiting for the Senate to basically take health care away from a whole bunch of my friends, who as creative people buy their insurance policies on the individual market and who would (depending on which version of this bullshit passed) been priced out of insurance, would have had to deal with pre-existing conditions or policy caps coming up again, or would have found it impossible to find an insurer. And not only creative people, I will add. I live in an area where a number of my neighbors are farmers or independent contractors (truck drivers, etc). They would go onto the repeal trash pile as well. It’s hard to focus on writing when your friends are talking about how losing their insurance, or, having pre-existing conditions or caps reintroduced, might kill them.

“Oh, well, that’s melodramatic.” Fuck you, it’s not. Not having the “right” job (i.e., a job with a company large enough to have a decent-sized risk pool), or losing a job, should not come with the increased risk of death or incapacitation or bankruptcy due to medical needs our fucked-up system has decided to price out of range of normal humans’ ability to pay. The only reason I wouldn’t be in the same boat as my other creative, self-employed friends had the ACA cratered is my wife’s 9-to-5, benefits-paying job — and even then ditching the ACA would have still had an impact on us due to caps and pre-existing conditions.

6. Here’s something that is possibly melodramatic, also involving me: If any of these bullshit senate health care bills had passed, it might have made a difference regarding whether you’d get my next book on time. Not just because I’d be worrying about health care for all my pals (and my family, to a lesser but real extent). It would also be because Mitch McConnell would have learned that creating bills in a back room, filling them with completely punitive bullshit and not showing them to anyone yet still expecting his caucus to vote straight-line for them is a thing that works. I mean, shit. It came within one vote of working this time; had McCain not decided to do his maverick shtick one more time for shits and giggles, McConnell would right this moment be planning to do up his tax bill entirely in a back room with him and maybe five or six special friends. We already have an executive branch with an alignment of “chaotic authoritarian”; the last thing we need is a functionally authoritarian branch of government to go with the incompetent authoritarian branch we already have.

I’m less than 100% inclined to give McCain too much credit for his downvote — he could have nipped all this shit in the bud earlier in the week, and in any event his modus operandi to date has been “talk like a maverick, vote the party line,” and I think there was more than a whiff of personal aggrandizement going on. Depending on his cancer treatment, McCain may not ever come back to the Senate, and McCain wanted a dramatic moment for the movie of his life, when Tom Cruise finally wins the Oscar on the strength of his portrayal of McCain’s “thumbs down” moment. But to the extent that he excoriated McConnell’s bullshit process to produce these bills and then voted down the bills produced by this bullshit process, good on him. That may have been even more important in the long run than the particular vote, and the particular vote was extraordinarily important.

If McConnell’s authoritarian gambit had worked, he would have known he could continue to get away with it for everything — and he would have kept at it. And that’s not something I could have just tuned out. I’ve been having a hard enough time concentrating as it is. It’s hard to write about the future when the present is on fire. If I can get a nice stretch of time where I’m not worrying about a non-trivial percentage of the people I know freaking out about whether lack of insurance is going to kill them or a family member, I can focus on, you know. Actual work.

Yes, in fact, that’s the secret to getting work out of me: A functioning, democratic government that isn’t actively trying to screw over a whole bunch of people I know and care about. Who knew?

95 thoughts on “So, Healthcare, 7/28/17

  1. What would happen if Trump decided to really “replace ObamaCare with something better”, by either copying any one of the plans of all of the other modern countries – or by doing Medicare for All? But the Insurance Companies wrote Obama’s version of RomneyCare, and McConnell only cares about power (and his bosses – follow the money). Trump could actually make himself look good and Obama worse if he was able to get that change, which he would love. But Trump would need to be a competent politician to do that.

  2. Yep. Came here thinking I’d have an “I agree but don’t forget ______” to make any you cover it all.

    I’m not an outspoken feminist but I’m fairly pissed that all the ~maverick glory is going to McCain the it was Collins & Murkowski who did the right thing from the start and endured so much bullshit from their party & President. McConnell’s remarks to them during his speech were repugnant.

    And Lindsey Graham no longer gets to parade around as the kindly old senior memeber of the Grand Old Party. All his bullshit posturing about “let’s just get it to conference and make it better” was just that – bullshit. I will NEVER believe for one moment that Paul Ryan had any other intention than taking this travesty straight to a vote. Why else invoke the martial law option?

    Thanks for a great summary, the fight continues.

  3. Spot on as usual. I know you are pretty much preaching to the choir in here, but I often come back to your in depth and articulate analysis when discussing issues with my right-wing extended family and old friends.

  4. https://en.m.wikipedia.org/wiki/Reconciliation_(United_States_Congress) There may be some silver lining here. It looks like they can’t try anything with Healthcare for another year because the bill got to an actual vote. If it had not had the vote to move to debate, they’d just try again, since they had the 20 hours of debate, we’re good until 2018.

    I could be wrong, and probably am missing some detail, but it looks like McCain really did kill this with fire by voting how he did.

  5. Thank you, John! A functioning democratic government that is working FOR the best interests of its citizens instead of AGAINST them is important to me, too.

  6. Exactly. The Republicans have no ideas to help people. They only want to take things away, especially if Obama had anything to do with it. How people can vote for this current crop of corporate ass-kissers is beyond me.

  7. Re: the conclusion of part 2, I liken it to the difference between taking your ball and going home (what the GOP did in 2010) and saying “Shove your ball up your @$$ and go away” (what the GOP did in 2017).

  8. “If McConnell’s authoritarian gambit had worked, he would have known he could continue to get away with it for everything — and he would have kept at it” He may actually be worse than trump since he knows better. Did you see him standing there daring McCain to vote no? So glad he got sucker punched. I just don’t understand why we cant work together-Im sure some Dems have some good ideas to contribute. Just because the Dem party was defeated doesn’t mean they have no say! Remember trump didn’t win the popular vote!

  9. One thing I’m glad for, and not just for Kameron Hurley’s sake, is that the tide of public opinion has changed in the USA, and ‘Let’s go back to the old model with sucky plans, exclusion for pre-existing conditions, lifetime caps, and the rest’ has become wildly popular with the electorate — even if this weren’t just a sleazy vehicle for funding huge tax credits for plutocrats at the expense of working people. That’s the background reason why, even with massive GOP gerrymandering in the House following the coup they pulled with Project REDMAP and McConnell discarding every inconvenient Senate tradition for tactical reasons, it’s still been a non-starter. Thank heavens. So far.

    I seriously hope people in those 49 Senators’ states noted carefully their attempted sellout of their own constituencies, and explain it to them at the next election.

  10. i’m having trouble concentrating and as an old, white, straight male, I technically gonna be alright. I cannot imagine how others who don’t fit those criteria are feeling.

    and geez, it’s only been 6 months, which means we are still, what, 18 months away from the mid terms? and what if those don’t shift the Balance of Power as we hope?

    Plus I have a FIL who has suddenly decided to go full racist mode with his FB posts.

  11. I don’t have much faith that the vast majority of GOP voters realize how close they came to getting their healthcare taken away. And if it did, they would probably blame democrats. Just wait and see.

  12. I think you nailed it on the head, especially with McCain. There was definitely a bit of showmanship involved. If this leads us back to a properly functioning government, that’s a pretty good legacy. It will certainly be interesting to see how things end up with Arizona Senators in the next few years. Flake is up next year and depending on when McCain steps down, things could change quickly in AZ.

    As someone who is approaching 60 with multiple pre-existing conditions, not to mention a spouse, lots of friends and a great niece who would be negatively impacted, seeing this shot down is definitely a good thing.

  13. I’m quickly becoming to a conclusion that the Republicans can’t govern. If I was a conservative, which I will never be, I’d be embarrassed. Every high profile “thing” they’ve tried since His Orangeness rose to lead them has been a failure mostly because of their own doing. It’d be one thing, if Democrats had any spunk and beat them fair and square, but the failures aren’t because of that. They are failing entirely on their own. They control basically all branches of the Federal Government at this point and they still can’t get anything done. It boggles the mind.

    This is reminding me more and more of the way communists ran their countries. Everything was about ideology. If you weren’t on board, you were an enemy of the state. If things failed, scapegoats were readied to blame. People suffered for decades and their leaders didn’t give a shit.

  14. Trump and McConnell are now sad that McCain recovered from cancer surgery in time to attend debate and vote. The real mavericks are the two Republican women who’ve been voting against “ignore the Democrats completely” bills for months now.

    “My” Texas senator Cornyn (who generally votes the opposite of what I request) posted the old Scoolhouse Rock “I’m Just a Bill” cartoon with a reminder that bills do have to pass both houses to become law. He’s since deleted it, but it doesn’t get much more condescending than telling constituents engaged with the current abnormal process how it normally works.

  15. I could not agree more about McConnell. Ugh. He and Rand Paul do not give even a fraction of a f*ck about their constituents (of whom I am one), even though Obamacare and the Medicaid expansion have both significantly improved the lives of Kentuckians. Obamacare let me stay on my parents’ insurance until a couple years ago, which helped pay for my psych hospital stay in 2014. Right now Medicaid pays for the medications I need to deal with my depression and anxiety. If I ever manage to get a job and keep it, I will have to fit into the Medicaid expansion, which it appears basically all my elected officials want to take away. I’ve spent the last several months with a tiny screeching anxiety in the back of my head: am I going to lose my insurance? And honestly, I’ve never even bothered calling my senators during this whole mess. It’s obvious that they don’t give a damn about what I think or what happens to me.

  16. I’m 60, recently retired, and buy my insurance through an ACA exchange. I went to bed last night assuming that I would have to go ask for my old job back and work for several more years until I could get Medicare. The first thing I saw when I turned on my tablet this morning was a NYT news alert that the repeal vote had failed. I’ve been smiling all day! We’re not out of the woods yet but this feels like an important win.

  17. Got nothing to add, John. Except to urge everyone to register and vote. Losing their cushy jobs is the only message that will register with them. What scares me is that McConnell and the rest of his ilk act like they don’t have to worry about losing elections any more. We need to change that attitude.

  18. Once upon a time congress would have gotten a bi-partisan group together and recommended changes which the current plan might need, and simply updated the current plan. Most everybody (i.e. The Country) would have been better off. Now the GOP wants a new bill simply because the democrats passed it, and the democrats oppose changes because, well, they’re the GOP.

    I have lost some faith in my democratic party. Anymore they don’t seem to STAND for anything. They just want to foil the republicans (Whatever Trump does, we’ll vote against). Hell of a way to run a country.

    John, I know you would as well cut your head off as to get into politics, but remember, “Many are called, but few are chosen.” The party needs a new voice!!!

  19. Regarding McCain’s votes on the bills introduced after he voted to proceed to debate, he did NOT vote “no” on all of them. He voted “yes” on repeal and replace, which would have been a disaster had it passed. The only Republican senators who voted “no” on all 3 were Murkowski and Collins, and they did it without the huge dramatic (and unnecessary — he could have voted quietly from his seat, as most of his colleagues did) flourish of McCain.

  20. Ron:

    That’s not entirely fair. The Democrats have been fairly consistent in saying they’re willing to work with the GOP on healthcare for months now. Here’s a paragraph from a Politico article:

    When GOP Sens. Susan Collins of Maine and Bill Cassidy of Louisiana — who had been shopping around their own Obamacare replacement proposal — asked centrist Democrats including Manchin, Heidi Heitkamp of North Dakota and Joe Donnelly of Indiana to chat about health care, Schumer gave the moderates the green light to go ahead, as long as they stressed that complete repeal was off the table.

    (http://www.politico.com/story/2017/06/28/schumer-democrats-unity-obamacare-240020)

    And everything else I’ve seen says that Dems are ready and eager to help fix Obamacare, but it’s awfully hard when they get shut out of the process. They’ve also said they’d work with Trump if he wants to work with them, but they have conditions on which they will. Compromise is not “We make the bill without you and then you vote for it.”

    (And before anybody says that the Dems did the same on the ACA, that’s BS. The Dems ran everything through the normal committee process, not write the bill in secret and bring it to the chamber two hours before the vote.)

  21. Those who know me are shocked that I might say anything positive about John McCain, but:

    I’m less than 100% inclined to give McCain too much credit for his downvote — he could have nipped all this shit in the bud earlier in the week

    The way he did it had the bill voted down, not just kept in the oven longer. Some reports from Democrats whom he apparently discussed this beforehand indicate that was his intention. If so, then that makes two decent things he did in his public life. Credit where due.

  22. I agree shooting down the GOP healthcare bill was the right thing. I want to believe that the senators that voted for it were patriots who have a different view. This healthcare bill has made me a liberal. I have come to see healthcare as a basic human right. It is not a luxury. The big problem is how do we pay for it? The ACA used the stick. The GOP used tax breaks or the carrot. Unfortunately the GOP’s plan sacrificed Medicaid to fund those tax breaks. That’s what made the GOP’s plan evil.
    Thanks to Obama national healthcare is part of the fabric of the nation, just like Social Security and Medicare. Now fight shifts to what’s funded and how we pay for it. It’s no longer a question of if we have national healthcare. No matter what it is ultimately called Obamacare or Trumpcare. Or how it’s funded and what it covers. It still a win for Obama. Long after Trump is gone in 8 or 4 years. Obama’s dream of National Healthcare, will live on.

  23. Ben Evans – It only closes off the Reconciliation process. They can still attempt to pass anything with the standard process, but then they need 60 votes for cloture (ending debate), so they would need some Democratic support.

  24. Why pass the bill first and *then* go to conference to fix it? Why not start with the negotiation and then pass a workable bill? It seems pretty self evident that the plan was never to actually go to conference, but to pass whatever, just to get the win.

  25. The rule requiring 60 votes for cloture has already been changed for Supreme Court justices, and if McConnell wants his way with healthcare badly enough to ditch the filibuster for ordinary legislation, it’ll go too.

    Last night, though, he couldn’t even get 50 votes. We can hope that that tempers his temptation at least somewhat.

  26. Well said. And you’re not the only one who has difficulty working while it seems the world is on fire. Some days my job feels like rearranging deck chairs on the Titanic.

  27. Terrific summation of this particular piece of insanity – thank you!
    I mostly wanted to say to skyewriter30 and anyone else who has not felt your voice was important: I live in SC. Not only do I have the jump-to-the-party-line Tim Scott and Lindsey I-toss-in-just-enough-rational-statements-to-give-you-hope-before-dashing-them Graham AND my House Rep is the obnoxious Trey Bengazhi-forever-and-ever Gowdy. This state is RED-RED-RED. But I still call. It could be that one call which puts the tally of constituent opinion over the edge.
    Do not be silent. Always tell them what you think. Complacency about our civic matters is how we got to this point.

  28. If they do get the Cloture rule changed to majority, they’ll regret it the next time they’re in the minority and don’t want something passed.

  29. I’m self-employed. I don’t make a huge amount of money. I have pretty nice healthcare, which I pay for privately, for a (very) decent monthly payment…not awesome healthcare, but I don’t spend my nights worrying that I’ll be without what I need if I really need it someday. All thanks to Pres. Obama and his terrible, awful, failing healthcare system. I DO spend a lot of time (lately) worrying what I’ll do if that all gets yanked out from under me, and a few tens of millions of others. What the actual f*ck, GOP?

  30. Also – Ron, you’re wrong here about Democratic participation. The Democrats keep requesting positive changes to Obamacare and have for years. They’ve continued during this long protracted fight under the new Congress. Hell, even Obama has said that he’ll back Republican efforts if they can improve Obamacare.

    Pretending that ‘both sides’ are at fault here is what causes nihilists like Trump and McConnell to rise to power in the first place. This is one of those instances where the fault is almost entirely with one side, and that should be noted.

  31. I like to think that the three senators have some vestige of human decency left and voted as they did because of noblesse oblige.

  32. Katster: Also worth noting, the ACA has a couple hundred Republican amendments, and Republicans (such as Collins) actually had quite a bit of input on the initial versions of the PPACA, before the Republican Party made it clear that no one in their party would vote for the bill under any circumstances.

    Granted, most of those amendments weren’t terribly impactful. Many other amendments were considered and rejected, especially the poison pill amendments. But they absolutely had input on the bill and were allowed to debate it in open session. They also had the most current version of the bill available at most times, unlike this latest effort.

  33. There is exactly one solution to fix healthcare that will work, and neither the Republicans nor the Democrats are proposing it. It involves going after the medical providers for violations of the law, laws which have been on the books for a hundred years (15 USC Chapter 1, the Sherman, Clayton, and Robinson-Patman Acts), and which the medical industry has tried twice to argue didn’t apply to them, and the Supreme Court shot them down both times. Doing this will force medical costs down by as much as 80%. We know this because there are people who have done it; look up “Surgery Center of Oklahoma.”

    Of course, a full, comprehensive plan requires a bit more than this: look at the “Denninger Plan” for health care reform. Look it over and start lobbying your Congresscritters to pass it or something very much like it…because, if they don’t, the present system will utterly collapse within a fairly short period of time (five years or so), detonating both our economy and the Federal Budget, and it might just take our government and our way of life with it.

  34. one thing that makes this event more epic than all the previous attempts at R&R was that it came after enough time and conversation for Americans to be aware of the implications for the future. Like a few of your posters, I am a Democrat but I’ve always been able to listen to the Republicans because conservatism has some good points that are worth listening to and heeding. The Dems have been trying to get some form of health care going for decades upon decades and we’re inching our way forward yet the conservatives have fought tooth and nail… why? Because its not a clear issue that everyone agrees upon but it is expensive to fix. Anytime something is expensive to fix, conservatives only want to deal with simple answers. Nuance is not part of conservatism. Because nuance is about moving forward and accepting that imperfection has costs. Conservatism is about staying simple and cheap. The Republican party has lost sight of their true goal which is to be the brakes on enthusiasm. They seem to believe their existence is to be the brakes on all movement.

  35. Can we please end the myth that the GOP wasn’t involved in the drafting of the ACA? Because they very much were & added multiple amendments to it. It was just at the last minute they decided en mass to not cast any Yes votes.

  36. As a fellow Ohioan, I have to say that I’m particularly frustrated, if not actually sickened, by Rob Portman’s weaselly vote and his explanation. I’ve been calling his office just about every three days for the last two or three weeks and expressing my opinion and now I’m wondering if it’s worth my time.

    See this (http://thehill.com/policy/healthcare/344190-key-senator-backs-skinny-obamacare-repeal), where Portman said that he’d vote for the so-called skinny repeal since it would go to conference (and thus possibly be made less nasty). Of course, his point left out the fact that if the Senate approved it, the House could just adopt the skinny repeal and go home, or as John pointed out, made slightly less worse, but not really. So Portman was either a) completely unaware about how Washington works, or b) lying through his teeth about the results of his vote, in the hope that no-one would call him on it. Hell, I’ll call him on it. It was a cowardly and cheesy thing to do. I never had much respect for the man, but now he’s sunk into negative numbers, at least as far as I’m concerned

  37. Thanks for the skillful and articulate way you skewer this bunch of inhuman asswipes and thanks also for a great quote of the day!

  38. I’m going to quibble over the ‘hooray’ for McCain, because, if you look at what preceded the camera-grabbing thumbs-down, it looks a great deal less impressive: First, on Tuesday he cast the decisive vote opening debate on an ACA repeal (only) proposal. Then, he gave a blustery speech attacking divisiveness and stressing he’d never vote for the Senate bill without major changes — and then a couple of hours later did exactly what he said he wouldn’t ever do. Then, Thursday, he said he’d vote for ‘skinny reform’ provided he got an ironclad guarantee the House wouldn’t also pass it. Only then did he do the high-drama last minute ‘no’ vote late at night.

    With more leadership like this, we will be undone. Hooray for Sens. Murkowski and Collins, sure. (Their states would be devastated by Medicaid cuts.) McCain, not so much.

    The Alaskan’s pretty bad-ass in other ways, too, John. Check out how she won re-election most recently.

  39. John,

    We’ve heard you say a lot of your neighbors vote Republican, and here you’ve said a lot of them also have insurance thanks to Obamacare. Have you been able to talk to any of them about how they reconcile the two?

    My sister and my sil both hate Obama and Obamacare even though both have insurance due to it. I honestly can’t bring myself to discuss it with them for fear it’ll poison what relationship we still have. Has anyone here been able to have “the talk”?

    I’ve listened to Ana Marie Cox’s podcast (With Friends Like These) about this very dilemma but even that often devolves into an echo chamber.

  40. Ever since Saint Ronnie, the Republican mantra has been “Private sector good, government baa-a-a-ad.” They could get away with it as a minority party, but now that they’re in power, it means they can’t actually do anything positive.

  41. Also, to sum up what John wrote, I quote P.J. O’Rourke:

    “The GOP is the party that says government doesn’t work, then gets elected and proves it.”

  42. Hi Amygalert,

    I’ve seen the Denninger plan and it makes sense, so it will never become a law

    It has been my observation over the last 40 years that NO problem gets solved in the U.S. until it begins to affect the rich. The medical mess is not quite there yet. Maybe in another 20 years.

  43. “It would also be because Mitch McConnell would have learned that creating bills in a back room, filling them with completely punitive bullshit and not showing them to anyone yet still expecting his caucus to vote straight-line for them is a thing that works.”

    This was one of Prime Minister Harper’s methods: cobble together giant frankensteinian omnibus bills, ram them through Parliament with his majority. The dumpster fire south of the border reminds me a lot of both Harper’s ReformaTories and Toronto’s Mayor Ford. Only meaner.

    Our guys were burning libraries and proposing snitch lines by the time they were forced out.

  44. Don’t downplay how strongly in denial some Obama-haters in the electorate can be.My (very Conservative, Obama-hating and Hillary-hating, though also Trump-hating, highly-educated) ex- insists that our son with tons of pre-existing conditions wouldn’t have his post-grad school options limited by the Republican’s legislature. No way to counter people like that.

  45. One rather science-fictional point: I don’t think this could have been stopped without the internet-enabled national flash mob, 86% women, that was led against it.

    And, of course, the Republicans are talking about trying again. Because, Republicans.

  46. Ye gods. I dont know if this country can take 3.5 years of this bullshit. Pretty sure I cant.

    “Has anyone here been able to have “the talk”?”

    And made any difference? No. One person had lots of surgery covered by medicare, but wants young people to earn their way on an unregulated capitalistic market. Another was a benghazi fanatic, but thinks the “Russia Thing” is a witch hunt. Who knew health care was so complicated, was a serious question another one asked. Trump is failing not because he is incompetent, but because we havent given him a chance enough, according to another. Did he support even a single thing by Obama? Of course not, but he was just so *wrong*.

    There is a large chunk of folks who voted Trump who have absolutely no principles at play. It is all tribal politics. If Obama did it, bad. Trump did it, good. Democrat does it, bad. Republican does it, they’re trying their best.

    They’re not supporters of the idea of rule of law. If the law helps republicans, good. Hurts republicans, bad. When Trump thought the electoral college gave the presidency to Obama and took it from Romneys popular vote, he called the EC a disaster. When the EC got him into office over Hillarys popular vote, he called it genius.

    Seriously. Anyone who still supports Trump now (and there is still a chunk) has the needle of their moral compass spinning like a top.

    If we could generate electricity from it, wed solve the energy crisis.

  47. Although the repeal did not work, the ACA can still “implode” as Trump wishes, if the Feds do not continue the necessary subsidies. It can be killed through inaction. Call me unhopeful.

  48. The ACA will implode without the auxiliary services provided. Those are gone, primarily the navigators to lead people through the morass of government software that has stymied so many that tried to sign up during those assine roll-out periods.

    The democrats need to make the ACA a better thing and start promoting that or it will still be too late to matter.

    A start would be to make America have just one health care system. The other one is the VA system. Integrate the two and you would have enough of a base to make the insurance companies happy and start us back down the road to a free market.

    The second thing it to put in some regulations to control costs, starting at hospitals.

    Do that and them shoot a bird at the loser of the popular vote.

  49. I think that this week was all theater, and that McCain knew all week that he was going to be (at least) the third vote against ACA repeal.
    Yes, he could have stopped it all Tuesday by voting no on the first of two procedural votes. He could have stopped it by remaining at home, preparing to start treatment for his brain tumor. On Friday morning when the skinny “repeal” vote was taken, he could have voted no from his chair, but he let the roll call continue so he could walk to center stage.
    I guess I can’t begrudge him too much being a drama queen. He’s run for the presidency twice, which requires a certain amount of narcissism. This may turn out to be his final vote of his political career. (My mother died two years ago of the same kind of cancer, so I have witnessed the toll the disease and the treatment take on GBM victims.)
    Another, more charitable, view of McCain’s performance this week is that he came back to give his fellow Republicans cover. Murkowski and Collins were solid NO votes, but no other Republican senator wanted to cast the vote that killed the bill. I suspect there were at least a few who didn’t want this bill coming back to haunt them.

  50. Speaking as someone who considers himself a centrist independent, but thinks the entire Republican party at this point has gone batshit insane:
    Firstly, the people who say “the Democrats should do xxxx”….you do realize they can’t, currently, do anything right? They don’t have either house or the president? Why not hold the Republicans to the same standard? Like, the people saying “well the democrats didn’t co-operate”. Guess what, the bill was written in secret, even most Republicans didn’t get to read it until the last minute. What, exactly, do you think the Democrats should do/have done?
    Secondly, look, the ACA isn’t perfect. It’s got a lot of bugs; It doesn’t do anywhere near enough to reign in costs for starters. But it was a start, and the hope was you fix bugs as time goes on. But there’s a chunk of the left who are purer-then-though and used phrases like “neoliberal sellout” or “vichy left” because it wasn’t actually a reimplementation of Canada or the NHS (even though those was impossible to pass at the time) (as a side note, as far as I can tell, at this point “neoliberal” means “someone not quite as left wing as me who doesn’t pass my purity test”, ie the left version of “cuck” or “rino”). There’s even some truth in that: It’s based loosely on Romneycare which in turn was based on some Heritage Foundation ideas (that somehow suddenly became ubertoxic to the right when Obama picked them up). Somehow these people were still panicking over the potential repeal of this “neoliberal sellout” however. Seriously, the purer then thou left needs to realize that you can either a) spend your time in pissing contests as to who is more intersectional, or b) get things done. I realize to some degree it’s always been like this (Life of Brian was mainly written as a parody of the British left of the 70s). And yes, I’m well aware the Right is doing the same thing right now (see earlier comment about “batshit insane”) but I’d really like the left to succeed in dragging us back from the precipice.

  51. I’ve been seeing a claim today that the GOP might be a little behind the 8 ball now, because the senate can only do a reconciliation bill once each fiscal year for each of the three topics it can be voted on. Allowing this to finally get to vote (rather than committee vote) means it’s back-burnered unless they want to try to get the 60-vote majority needed to just do a new bill.

    I say all that to ask — can anyone comment as to how true that is? I’d like to hear John’s take, of course, but I’d be happy to hear anyone else who knows what the heck they’re talking about. It’s certainly not my field.

  52. Whatever else are the merits of this thesis, at the very least I find it comforting and reassuring. If freakin’ John Scalzi is wigged out by this whole mess, maybe I’m not an ignorant wimp by being frightened about this last year…?

  53. …I’m not so sure I’d go along with the idea that health care is a human right. Roads aren’t a human right: they have to be built. They have to be maintained.

    But goddamn do they make everything else so much easier!

    That’s kind of the way I think about health care. It’s not a right so much as a practical necessity.

    But if thinking of it as a right is what gets it done—sure! I’ll go along with that.

  54. I’m another one of those who would lose his insurance if the ACA were repealed. I have a host of chronic health issues which makes me very unattractive to an insurer. Even better, since I live in Oklahoma, there is no real competition for insurance (Thanks, Gov. Fallin).

    Why bring this up? Because ACA is indeed a flawed piece of legislation, just as every other piece of legislation is. And (IMHO) the way to fix it is by making small, targeted changes and not with sweeping bills like the ACA. Yes, it would take more time but in the long run each we’d gain because each change would be examined on its own merits and not as part of a prix fixe menu.

    Or, if we want to go with sweeping changes, let’s peg the irony meter and have the GOP pass a universal care bill, similar to the system in Canada. (Please.) Then they could claim victory for repealing the ACA, the Democrats could claim victory for increasing the number of insured, and we could all breath a sigh of relief.

  55. Greg: yes, they can only do reconciliation once per fiscal year and they have to do it before the end of September. They can also only do one topic, so they can’t dodge by introducing a different healthcare bill. If the vote to proceed had failed, it would have just gone back for revision, but instead it went to a vote and failed — so until next fiscal year they don’t get to try again without risking(!) filibuster.

    They were planning to run healthcare through in this fiscal year and save reconciliation for a big tax cut next year. Oops. Healthcare next year is not nearly so close to their hearts(?) as tax cuts, and of course next year is an election year when the public will be paying a lot more attention to unpopular bills — like taking away their health care.

    Caveat: this all assumes that they don’t simply change the rules to get rid of the filibuster and all of the other inconveniences that stand in their way.

  56. The US spends around 18% of its GDP on healthcare, where the usual (European) cost is around 12%. The results are about the same; the US child survival rate is slightly worse than the UK, and cancer survival times slightly longer. But if the US goes to eg. a single payer system a lot of that surplus will go away; and 6% of of a 2016 GDP of $18.46 trillion is around 1.1 trillion, well worth a little effort from healthcare lobbyists. (In fact there are two registered healthcare lobbyists for every Senator.) Because of the fragmented system administration costs are also high, estimated around 30%.

    However, two very smart, skillful and hardworking Presidents, Presidents Clinton and Obama have broken their teeth on the problem and produced at best a partial solution. President Trump is not, frankly, in their league and the chances of him producing some effective health care policy are slim and none.

    Whether healthcare is a right is more difficult question; I’d certainly argue that it’s something that a government should supply, or make arrangements to supply, rather as the VA does in the US. A number of legislators feel, or say that they feel, that requiring valid health insurance is a gross interference with the liberty of the subject. However, car insurance to fixed minimum standards is a legal requirement and I can’t see that health insurance differs much. As far as I can recall drivers in the US are even legally required to wear seatbelts.

    Over the years successive administrations have fallen into the healthcare hole and kept on digging. Any solution will now be partial and difficult to implement, with amendments being needed as problems become apparent. Given the current political climate in the US such an approach to the problem is the stuff of fantasy.

    Will

  57. We need to make something clear to Congress. If they try to harm our healthcare, they will not be re-elected to office. Their positions on other issues do not matter. Try to take our healthcare, you won’t be back. I’d love to start with Portman (also my senator), but he will have to wait for 2022. We can’t forget, or let this slide, unless we want to see this happen over and over. Ryan & McConnell won’t give up. We can’t either.

  58. DC Sessions, Greg

    From what I gather (e.g. @Taniel, @BrianBeutler, etc.) the votes that failed were technically on amendments to the underlying bill. The underlying bill is still under reconciliation and McConnell returned it to the Senate calendar and can try to move it to a vote again under reconciliation rules.

  59. @C W Rose – The reason car insurance is required is not so much for you, but for the person you hit. If you look at the laws you’ll notice they specify a minimum level of liability coverage. Whereas healthcare is entirely for your own benefit. As for seatbelts, I think that ends up being an easier to write law then “you must make sure your kids who aren’t legally able to make responsible decisions are buckled up”, so it was more of a bonus rather than the government caring about adults.

  60. The best part is just how hard Yertle was screwed here. McCain voting for the Motion to Proceed under Reconciliation, and then spiking it in his face, has huge repercussions. One of them is that you can only bring a bill to the floor under Reconciliation once a year!

    That’s why all the other votes were Motions to Proceed. If the bill didn’t make it to the floor, they could try again with a different bill. But once they brought this one, they used the budge reconciliation shot this year.

    Now they have to pass everything — their precious tax cut, the budget, every single thing — with 60 votes. The whole reason for this was the massive cost cuts that was going to let them do a massive tax cut for the rich. Now, they don’t have that room, which means even next year’s reconciliation chance won’t help — a bill brought under that rule needs to not increase the deficit.

    Plus, McCain basically cut him down right in the center of the chamber, in public, on camera. It was almost like watching a wresting match….

    BAH GAWD THAT'S STEVE AUSTIN'S MUSIC pic.twitter.com/vfTwNAC9F3— Timothy Burke (@bubbaprog) July 28, 2017

    //platform.twitter.com/widgets.js

  61. Christ, I love coherent writing. Two, quickly. First, although the phrase is accurate and correctly used, ‘constitutionally unable’ might confuse those new to the game, or to the usage. Having a hard time proposing an alternative, especially to an excellent writer. Hell, you own a Thesaurus.
    Second, I learned a truly infield-fly type rule about this vote which explains how thoroughly McCain knee’d McConnell. By voting Yes on the motion to proceed (MTP), thus letting this bill come to the floor, McCain let McConnell use the ONLY reconciliation bill allowed during this ‘year’ of this Congress. The law/rule that created this can’t-be-filibustered type of bill says it can only happen once a year.
    So McCain knew the rules as well as McConnell, and screwed him with them. Crafty bugger.

  62. The reason car insurance is required is not so much for you, but for the person you hit. […] Whereas healthcare is entirely for your own benefit.

    Medical bankruptcy is not without victims.

  63. There’s a distinction not being made between medical insurance and medical coverage. Insurance, analogous to car insurance, covers catastrophic events. Coverage takes in routine and preventative care, lab tests, chronic conditions and medications. Imagine, for example, how much car insurance would cost if it had to cover all routine maintenance, tires, repairs and some fuel. In the US, we say “insurance” but we MEAN “coverage.” So, terms matter.

    Addressing another misnomer, no, medical care is not a right. Rights are things like voting, bearing arms, free speech, equal protection, etc. Things that as a citizen, you may do or participate in. Benefits of citizenry (or presence) are things like common roads, border protection, police, fire protection, food inspection, public parks, well, the list goes on. Health care falls under this category. It SHOULD be a benefit of citizenship or (legal) presence in the US. That is is not is a drag on our society. Until this is satisfactorily resolved, the controversy will only escalate. It cannot go back to the way it was, and the Republicans cannot seem to even imagine what “forward” looks like.

    Hopefully, cruelty will not win the day. We should join the rest of the civilized world, and provide our citizens with one of the major benefits of civilization.

  64. Columnist Tabatha Southey in The Globe and Mail neatly summed up Canadians’ response, watching Americans try to deal with the whole health care issue:

    ‘Canadians watch Americans grapple with health care and it’s like we’re watching early man, standing frozen half to death in midwinter. We’re all like “Guys, just rub two sticks together!”

    ‘But, no, 300 million Americans stand there, teeth chattering, each holding a stick, arguing day-in-day-out, “What is to be done?”’

  65. Above, Lynn says medical care is not a right.
    I’m not a U.S. citizen, but doesn’t your constitution say the right to “life, liberty and the pursuit of happiness?” Health care is what gives every member of the body politic a life. (Your army has no qualm about forcing every member to take anti-malarial pills)

    As a North American, besides gritting my teeth at McConnel, I can laugh at you-all. As you know, Americans have a reputation for isolationism towards the world in general…

    There was a Canadian editorial cartoon of the U.S. health care plan, next to a stack the hardcover pristine plans for all the developed nations. Only the U.S. plan had rumbled pages and sticky notes.

    The joke was that you folks were, as usual, too isolated to do your research.

  66. The joke was that you folks were, as usual, too isolated to do your research.

    “American exceptionalism” means that what works for every other nation on Earth won’t work for us, so there’s no point in looking elsewhere.

  67. @Doukas – well, no. Healthcare (and insurance) is not entirely for the benefit of the individual, never mind such things as immunisation. A healthy citizenry is a more productive citizenry, and everyone is better off.

    Will

  68. @Erik V. Olson, that video is a thing of beauty. OK, I think I’m sold on Sen. McCain having pulled off a beautiful upset, executed masterfully.

  69. @C W Rose – That’s a long term societal benefit, though you are correct regarding herd immunity. I was merely trying to illustrate why auto insurance is a requirement of driving; you plow into someone else’s car or business you are culpable and the damage tends to be high. If you don’t have insurance then the innocent victim of your inability to control your vehicle will be SOL. A catastrophic health care charge is only going to affect you and your family, and since we don’t mandate people needing to carry life insurance (the primary breadwinner falling off a cliff is also going to royally screw their family) it seems reasonable for medical insurance to be in the same boat.

    @Lym is the one who’s really getting to the crux of just how messed up our system is. There is a huge swath of routine and out-of-the-ordinary-but-not-unexpected care that’s far too expensive. A good example would be a broken leg; to go back to auto insurance you might see it as analogous to a rock chip putting a big crack in your windshield that needs replacement. Something that you should reasonably be able to pay for should it happen. The medical insurance should be paying for the really extraordinary things, like cancer treatments, just like you tend to save your auto insurance for that major wreck you got into.

  70. As an American this was pretty appalling. The Republican Party, with a handful of exceptions (the two or three Senators, several Governors and perhaps a dozen members of the House) was willing to take healthcare away from millions of poor people and senior citizens, deceitfully and for no good reason.

    It seems pretty clear that the Republican Party is unlikely to pay a price for doing so, which suggests a fairly serious failure of the democratic process as most of us like to think of it.

    There are a number of things that should be changed about the ACA including putting the stabilization payments to insurers on a firmer legal footing and repealing the medical device tax. There are also problems that need to be solved relating to lack of competition in certain rural insurance markets.

    None of these problems appear likely to be solved by the Republicans in Congress.

    As for the Democrats: It’s great that all of them met the minimal standard of resolutely opposing the utterly toxic and batshit insane Republican proposals.

    But they also need to be advocating a realistic positive agenda with a coherent narrative to solve the problems with the ACA, which would most likely be allowing a Medicaid buy-in for people where there are inadequate private insurance options. (Politically suicidal fantasies like single payer don’t cut it.)

  71. Excellent blog post. Really interesting discussion.

    Speaking as someone who lives in Kentucky, I am confident there are no depths to which McConnell will not sink. I also think whatever intelligence or knowledge he possesses or used to posses has been completely swamped by his hubris, his greed, and also his obsession with “winning” against the successful black president who left office as a two-term president and popular figure despite McConnell’s furious years-long focus on trying to make him a failure. Even now, with Obama out of office for the past 6 months, McConnell is still furiously focused on trying to make Obama’s presidency a failure.

    So I think it’s entirely possible McConnell will, if he can, try to change Senate rules so that he can pass regular legislation with only 51 votes.

    And that would be crazy. Ethics and principles aside (and they certainly are in everything McConnell does), the GOP currently has an incredibly narrow majority in the Senate, as well as some Senators (though only enough to count on the fingers of one hand) who’ve already demonstrated they’re perfectly willing to vote against GOP party line. Even between now and January 2019, less than 2 years away, it’s not clear McConnell would gain -much- advantage by changing those rules; and his party could very easily become the “victims” of a 51-votes-to-pass system as early as 2019.

    So the question is whether his hubris and obsession have made him short-sighted enough to try it. I think the answer is probably “yes.”

  72. I think the only thing I can add to the excellent discussion above is that I really, really NEED a t-shirt with that photo at the top of this post.

  73. Sean Crawford, the phrase “life, liberty, and the pursuit of happiness” appears in the U.S. Declaration of Independence, a document that, while foundational, is not a part of Constituional law.So while life and the pursuit of happiness may be “unalienable” rights, they are not enumerated rights.

  74. [Deleted for being off topic. Let’s not do that “Why aren’t you talking about the thing I think you should be talking about?!?” thing, please — JS]

  75. Fortunately, this writer has the VA (hopefully still), but for sure all the other writers I know would have been SOL if this had passed. Hell, even my fellow WGA members now have a health plan that has gone from solid platinum 30 years ago when I became a member, to one that is (maybe) painted with highly-thinned platinum-colored watercolors.

    Good post, sir.

  76. Well, here I am on day 23 of my latest hospitalisation; on this side of the pond the fact that I’m here as a result of a pre-existing condition, first diagnosed when I was 5, is not an impediment to my healthcare, which is paid for by my taxes.

    I’m 66 and I lost count of my hospital admissions years ago; I would not be alive had I been born in the US. I’m glad that Trump and his buddies have failed, at least for now, to ensure the deaths of people like myself. That death panel they are so keen on really freaks me out…

  77. Kudos to McCain for voting for the bill to go to debate to use up the once only reconciliation bill slot for this year. Now all Senate legislation needs 60 votes for cloture to bring them up for debate. With no bipartisan work by the Senate then not a thing will pass for the balance of this annual cycle. Wheeeee!

    Here is hoping that the Medicare single payer from cradle to grave will become our healthcare system of the future. Then the Medicare officials can essentially price fix every single medical procedure going forward and eliminate the unholy high prices that our medical insurance industry fights with the medical care providers over and always seem to lose the battles to the medical care providers seeking to unjustly enrich themselves at our expense. Just try to get your medical care service providers to give you a pre-estimate of your entire bill (plus or minus 5%) for any procedure before you go under the knife. They simply cannot do so because the current pricing system is so convoluted and complex. They cannot price estimate even a simple no complications procedure for you before you are wheeled into the operating theatre. Would anyone sign a contract to buy, say a car or a house, before you knew what you were going to pay for the car or the house. No, none of us would do that. But we do it every time if the service is a medical procedure. We are fools to put with this. We are fools to elect to office a second time any representative or senator who keeps the current system in place. Okay, venting completed.

  78. The Republicans sabotaged the ACA when the Dems were trying to get it through as blackmail negotiating. Then they sabotaged it some more by refusing to provide funds that had been promised to the insurers in subsidies and Repub governors refusing to expand Medicaid, etc. Having impoverished their state populations, some of these governors are now getting that they’ve created giant deficits for themselves and started reversing some of the sabotage. If the ACA was removed, they’d be looking at state economies cratering into the pit of doom.

    One of these was the governor of Arizona, head of a state with an enormous percentage of people on Medicaid and/or Medicare, and he more or less ordered McCain to vote no. McCain still wants to get rid of the ACA and said that the big problem with the skinny repeal is that it wouldn’t wipe the ACA out — i.e. wouldn’t kill and uninsure a lot more people. But he wants to move on to his beloved defense appropriations that his defense buddies want and his governor needed the bill squashed, and whatever else McCain might have wanted to be bribed from his sickbed, McConnell didn’t give it to him. Murkowski and Collins are in the exact same situations — they didn’t vote no out of the goodness of their hearts. It’s just that further killing people in their states would be too much of an economic deficit.

    Whomever:

    And yes, I’m well aware the Right is doing the same thing right now (see earlier comment about “batshit insane”) but I’d really like the left to succeed in dragging us back from the precipice.

    Instead of trying to pawn this off on the Left, of which there are much fewer, how about all the centrists get up off their asses and drag us back from the precipice for once? It’s centrists, mainly the white ones, who helped put Trump in office and who helped Republicans into office to control whole states that they’ve sent financially into the dirt. It’s centrists who held up support for the ACA and Medicaid expansion. It’s centrists who are the frigging swing vote when they bother to show up to vote. It’s centrists who insist that the Dem candidate be a centrist instead of a straight liberal or they’ll go to the hordes of kill-happy Republicans, even if it’s against their own economic interests. And when they do, they always scream at the Left for not doing this or that and saving everybody from the damage that they voted for. Better yet, stop being a centrist and support the left. Maybe we’ll actually get something done for a change. :)

  79. I think a really big part of the problem is too many people think this is an academic discussion, because they have insurance through an employer. But they don’t know that if the GOP had been able to pass its bills, employers would be able to do things like only offer crappy insurance plans from a different state or that insurance companies could stop covering pre-existing conditions and many other things.

    For example, my husband’s employer got me 100 physical therapy visits per year (up from 20) by invoking the habilitative services part of the policy. This is something insurance companies are now required by law to offer to people who “need help recovering or have other special health needs”. My physical therapist doesn’t just give me exercises, she manually realigns my hips and shoulder blades and puts my first ribs back in place. I have a chronic, degenerative disease and my ribs/hips/shoulder baldes are going to keep moving out of place. If I only got 20 visits a year, that’s not even once a week for 6 months and the rest of the time, my bones would be pulled further and further out of place. But because of the law and a clever HR person, I can get pain relief that allows me to try and strengthen muscles to hopefully stop the bones being pulled out of place.

    Maybe the Dems need to do a better job at educating people as to what the stakes really are.

  80. My GOP ‘ boyfriend’ or whatever I’m supposed to call a senior more than a friend has sent me forwards of Republican comments about the vote yesterday.
    Mean spirited to say the least, right now they seem to be running with Trumps dogs and interested only in letting ACA ‘fail on its own’.
    We haven’t wine anything but time to reorganize.
    Continue to fight!
    #medicareforall
    #iamapreexustingcondition

  81. Thanks John for your excellent thoughts. Just need to add one more scary piece — if they had succeeded at this it would be only the beginning. After destroying the ACA and Medicaid — Medicaid would take a big hit in all the repeal plans: grandma in the nursing home thrown out; disabled kid from a low income family, forget getting the care s/he needs.
    Medicare and Social Security would have been next. (Note: and that doesn’t even include the fact that an ACA repeal alone would have hurt Medicare funding).
    The Republicans have been going after Medicare and Social Security for some time now and that terrifies me as much as the ACA repeal attempts.
    These people have no conscience, no empathy, no concern for others.

  82. @ Stevie
    I hope you feel better soon!

    @ Doukas
    Health care is not solely an individual issue. Populations are more productive if they are healthier, and prevention is not only more effective but also cheaper than cure. Health is a social benefit.

  83. @Doukas – “In the long run we are all dead”, but I prefer a more hopeful approach. BTW herd immunity in the US for measles is on the skids, with immunisation rates below 50% in some communities (and I can’t find the reference, dammit).

    Anyhow, more years ago than I care to recall I designed intracranial pressure monitors, probes run through the skull and into the brain to measure the pressure changes in a (possibly) damaged brain. A significant proportion of these brains had been harmed in motorcycle crashes, and in a fairly frivolous discussion it was decided that we really ought to lobby against helmet laws, since they cut noticeably into our profits.

    Setting aside this rather specialised viewpoint, the general view is probably that head injuries should be avoided where possible. So, given that individuals have the resources to fund a lifetime’s care, so that there is no monetary penalty involved, what should the state do?

    There seem to be three possibilities; firstly do nothing, accepting that individuals may harm themselves as much as they wish, secondly make information on the risks widely available, accepting that individuals may ignore it, and thirdly make helmets a legal requirement.

    I can see no general way of choosing between these alternatives; each has been applied in analogous situations. In the first case, that of self-harm, suicide is still generally illegal; in the second case, that of warning, many governments (including the US?) have gone out of their way to make the risks of smoking widely available, and have limited the areas in which it can be practised; and in the third case, that of compulsion, window cleaners, for instance, are generally required to wear safety harnesses.

    Turning back to healthcare, all three of the above alternatives are in use in different places; the current US administration feels that healthcare is entirely a matter for the individual, most European countries require some form of insurance, and the UK funds healthcare from general taxation. The problem is made more difficult by the fact that insurance needs to be applied to large groups to spread the risk and make costs more predictable; if healthcare is to be run on an insurance basis, then some sort of compulsion will be needed so that the healthy, as well as the sick, pay premiums. This problem is avoided by the UK’s approach of funding from general taxation, but there is no prospect of that solution gaining acceptance in the US.

    I think that there is a general feeling that people shouldn’t die for lack of healthcare. How to fund such healthcare, in a country as rich as the US, is a political problem with a political solution, and one which requires skilled politicing to solve. The current crop of US politicians lack those skills.

    Will

  84. Whomever: “Speaking as someone who considers himself a centrist independent”

    You know what, thats a meaningless label in current america. The historically accurate Ronald Reagan would today be considered by Republicans as way too liberal for some of the policies he supported. This country has moved so far to the authoritarian right that torturing thousands of prisoners of war and holding them in violation of international law was something Obama decided wasnt so bad as to require any kind of prosecution. America hung people for that a few decades ago. Now? Meh. Obama pushed Romneycare, something that republicans actively supported a couple decades ago.

    There are currently two parties in America: the party that actively defends Trump and actively supports his agenda of bigotry and oligarchy and nepotism and opportunism, and the rockefeller republicans who are now the Democrat Party.

    Anyone calling themselves a centrist-independent in America is just kidding themselves about the realities of the country they live in.

    The republican party of today is an existential crisis for America. Seriously, they’re about dismantling everything to the point that government cant do its job, so that people believe government SHOULDNT do its job. Thats their goal right now. The democrat party of today are glorified rockefeller republicans. Military hawks who support regulated market based solutions for econmic issues (i.e. obamacare),

    Choose.

    Now, if you were someone poltically aligned with Bernie, you’d be way over in the progressive-left corner of the political spectrum, and there would be substantial differences between you and the Dem/Rep partiee of America today.

    But a “centrist”? Nope.

    “Seriously, the purer then thou left needs to realize”

    Ah, and so now we see why you are a “centrist”. Because the left is too snooty for you. Sorry, no. The “liberal elite” only exists in Republican propaganda. Certainly, if one were to interview the entire American population, we might find a few individuals who might fit the “liberal elite” stereotype. But that doesnt define who the Democrat party is today.

    The dem party of today is rockefeller republicans of a few decades ago.

    But it sounds like you’ve consumed enough republican propaganda to think of dems as latte sipping, politically correct, hoity toity’s, so you’re a “centrist”.

    And thus, we have the shit show that is American politics today

    https://www.theguardian.com/commentisfree/2016/nov/28/the-latte-libel-is-a-brilliant-strategy-the-left-cannot-counter-it-with-facts-alone

  85. How to cope remains the challenge. My guts need unknotting. My children and two grandchildren’s future in the balance.
    Today it is a long walk in the woods and listening to Fairport Convention the Millenium Collection.
    “Turn turn to the rain and the wind.”
    Later,a long Pete Seeger LIve session.
    Protest music that uplifts the spirit, gives a direction for action and support.
    The sorrow of the Irish repressed, the lowly oppressed by the Lords and the fifteenth brigade fighting aginst Franco.
    Do not let these sad, fearful , power mad misery of human beings steal your fire.

  86. @Kat Goodwin

    Fair point. I actually think I came off as attacking the left more than I
    intended. What I actually meant was “I want the left to succeed” I really
    did mean it not as “they suck” but “they are our only hope”. And yes, for
    what it’s worth I’ve been moving much more left in recent years; I actually
    think ACA repeal may be a wake-up call for a LOT of people.

    @Greg

    I obviously didn’t do a good enough job explaining here. I’m not
    talking about the “latte sipping liberals” who I agree are a myth.
    I actually meant the exact opposite of what you seem to be reading
    in my post. In fact I agree 100% that at this point the Democrats
    are the centrists; I’ve got zero interest in supporting the Republicans
    (see “batshit insane” comment). What I was talking about the
    people who say things like “voting for Hillary is just as bad as
    Trump” (seriously?). Jill Stein just as an example has said pretty
    much that a number of times. Or “The ACA is a neo-liberal sellout
    so it should die” (I’ve heard those exact words said, I think the
    logic is similar to “we need to make conditions so bad the masses
    will revolt” which history has shown never actually happens). Yes
    we all wanted single payer, Lieberman for one would never have voted
    it.

    Remember, every Democrat voted against the ACA repeal. We need to support
    them in this, not attack them. Whether you like it or not, there are 2 main
    parties in this system and realistically always will be.

    (I also realize I kept using “then” when I meant “than”, embarrassing on the
    blog of a writer)

  87. Msb

    Thank you!

    By the time Galileo went on trial for heresy the Italian city states had been providing free healthcare for centuries. Those ruling the city states were not, by the wildest stretch of the imagination, liberals, or socialists; they were rulers. But they recognised that health is a social benefit which makes everyone better off…

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