Paul Ryan: Obamacare repeal is first priority under Trump

The Repugs got nothing. Just tax breaks for wealthy folks who already can buy insurance and their free market propaganda.

They will be hastening the advent of national healthcare as Romney Care aka as the ACA was the last attempt to keep for profit healthcare.

 

Democrats lost Congress because of health care reform. A large enough portion of middle-class and white Americans had health care before ACA that there was a critical mass more anxious about the hypothetical draining of system resources or unpleasant service environments caused by the inclusion of marginalized groups.

 

It all comes down to costs, why is healthcare so expensive? Is thee a reason why a emergency visit should cost couple thousand dollars and an operation could cost couple hundred of thousand dollars? The healthcare industry is just begging for national healthcare system in the future.

 

If that's accurate, then there isn't a problem. I don't know that he's saying the repeal and replace should be in the same bill though. He did talk about a replacement bill, but I don't think mentioned that it would have to come at the same time.

If it was just repealed and then insurance companies no longer had to cover pre-existing conditions, would they be able to drop people who were able to join Obamacare and have a pre-existing condition?

 

I'm just going to pick on one aspect of the plan. The plan said it cover preexisting conditions, with no details. But we have heard what Ryan said. Ryan has said that those with preexisting conditions should go back to risk pools run by each State and it is up to each State to set them up, if at all. We had this prior to Obamacare. Those risk pools, which aren't available in all States, had a long wait list, cost a fortune to buy into and cost a fortune to the State. So I read that as going back to the way it was prior to Obamacare, meaning those with pre-existing conditions - good luck. For this aspect, it's repeal with no plan to replace. Maybe Ryan intended to do more than that, but the GOP congress has also said they aren't willing to foot the bill for these risk pools (and I think you imagine how costly it would be). So again, back to what it was.

As for Trump - he has said some stuff but offer too little details. But he has hinted that he want the fed government to pick up the tab for pre-existing conditions. This would be against what traditional GOP want.

 

I'm not talking about Obamacare. I'm talking about the promise to replace (pre-existing condition as the biggie one). Going back to the way it was isn't a replacement. It's only a repeal.

 

May yes. Maybe no.

Methinks they lost in 2010 because the economy is still way in the shitter (which the Repubs should have been made to own by the Dems).

 

BTW, the Republican "plan" you link is 3 pages of bullet points, light on details and heavy on dogma.

The Republican had 6 years (2010-2016) to build their replacement and this is as far as they got. I posit that the Republicans do not have enough votes in the House to pass *any* ACA replacement plan.

Maybe in three more years, the Republicans can add a fourth page of bullet points to their plan.

The Repeal and Delayed Replace plan is really just a Repeal and Never Replace plan.

Remember the Sequester!

 

If you think the Republicans actually want to pass a health care plan, I suggest that you have not being paying attention.

 

It's a strange comment. Whatever you think of Obamacare, pages enough to fill a novel can't simply be compared to a marketing slide.

Ryan do want a health care plan. It's basis is all-in on capitalism. Medicare would be privatized and folks eligible for it would get a voucher to buy into a marketplace of health plans (hum... doesn't sound so different from Obamcare marketplace) is a great example of what he want. He believe market competition will take care of everything - deliver the best health options at the best price. I said the world has shown that to be foolish.

 

If they repeal without having a replacement to take place concurrently, then their plan sucks. It will instantly dump a ton of people who currently have health insurance to having nothing. What a stupid idiotic idea that is. BOO!

 

I took the time to read this carefully. Some of it looks like fluff (reduce bureaucracy for wellness programs?), some of it is trying to take credit for stuff we are already doing (like electronic health records), some stuff that might sound good but doesn't really move the needle in the big picture (like dependents until age 26), and some of it states intentions that don't seem to have a path to achievement (improving Medicare's fiscal health sounds great and all, but I don't see how being "responsive to patients' needs" and "updating payment models" gets you there). But, this looks like the essential elements to me:

• Depend on current employer-based insurance to do most of the work. This by itself means mostly a return to pre-ACA policy; the rest is fussing around the edges. The ACA provided a framework to allow the country, in the long-run, to move away from this patronage arrangement. I guess that's dead.
• No subsidies for the poor.
• No mandate to spread the cost over the entire populace.
• Some favorable tax treatment for those who choose to participate.
• Tort reform. You can't pass a Republican plan without tort reform!
• Allow states to cut spending on Medicaid.
• And the real crux of it all, though I can't be sure what exactly they mean by it: insurance companies cannot deny coverage and must charge individuals "standard rates." Depending on how people are grouped, you may find yourself with an astronomical standard rate.

Still struggling to understand why Ryan -- and Republicans out there -- would think this would genuinely work (or does he think it won't?). This does not reduce the cost of health care. Tort reform would reduce financial risk for hospitals and take some cost out of their budgets (at the expense of maimed or killed patients). Aside from that, there's a couple of things to improve efficiency, but I can't believe there is so much opportunity in the FDA and NIH and in wellness programs that we'd see some marked decline in the cost of treating a patient. The real cost savings promised here is in the reduction of services -- no mandated coverage, no subsidies for the poor, reduction of Medicaid. Those people can just do without (curiously unaddressed was the uplift cost of treating the uninsured at the emergency room). Our society will save money on volume, not rate.

The benefits I saw in the ACA were that (1) even with high costs, they'd be spread over the whole population and be more bearable, (2) with high participation, there's economies of scale, (3) with more preventive care we'd have fewer expensive treatments, (4) long-term, we could move from an employer-based system to a direct marketplace system, allowing consumers to be more exposed to the costs of their decision-making and leveraging market forces to drive costs out of the system, and (5) it's humane to provide care to the indigent. With Ryan's plan, none of those things would hold true. Costs will remain high and fewer people will have coverage. The one benefit from Ryan's perspective I see is that people who are doing alright for themselves don't have to subsidize fellow Americans. Probably good enough to get him re-elected, but I don't see it as a benefit to the nation.

After thinking about it a bit, I don't really care about the fate of A Better Way after the ACA is repealed. It looks like a total repeal to me.

 

the way to improve quality and lower cost is always choice and competition

coincidentally...

 

Read about it the other day. Likely due to drug overdose deaths by rural whites and homicides of inner-city blacks. Since the life-expectancy at 65 has not gone down, it is very likely that this is affecting the 20-45 crowd.

Coincidentally, Hillary supporters have been in complete denial about both the need to combat drug use and the fact that violent crime is increasing in the US.

 

prohibition has proven to not be an effective means of combatting drug use

 

It's mostly fluff and does nothing to address costs. ACA was the way for a quasi private system but that will soon be repealed for something very ambiguous and most likely less effective for your average American.

 

I agree as a truism. That's why I liked the ACA. The ACA was an attempt to make a robust and liquid individual market for health insurance to allow for competition. But, I would say there were 3 elements of ACA that distort the market and make it less efficient (1) policy regulation was too prescriptive, (2) subsidies create a principal/agent problem, and (3) mandate disallows a customer's choice to not buy (though many millions chose to not buy regardless). However, without these elements you don't have a robust and liquid market at all. Instead, you have to continue to rely on company plans where (1) individual consumers still have little choice on policy type, (2) there's still a principal/agent problem, and (3) the customer's choice not to buy rests with the employer and not the consumer. So what does A Better Way do to increase real choice and competition?