“Uppity news wench” sounds like a character you’d find at a Renaissance Fair in Nutley, New Jersey (“Bring me my Uppity News Wench, for I wish to be informed of the goings on in my fair realm!” “Yes, Sire, I shall summon her at once!”)
As an already old (but fortunately still aging) Neanderthal conservative and in general a Trump supporter, I have to sadly nod my head in agreement with Mr Maurer: President Trump and Republicans really do have no plan. That is due to neither malevolence nor incompetence . . . just that no plan actually works to provide the healthcare people think they deserve with the funds actually available, even printing money as fast as the Treasury's printing plates will spin. On the other hand, Obamacare itself S'es the Fat D as Mr Maurer so memorably puts it. I still have to shop the Obamacare Marketplace for my hot young wife's policy and can guarantee that Obamacare itself, every single year, "expos[es] people to higher premiums and less coverage." I have no idea how to fix this, nor does anybody else, as long as unlimited healthcare from conception to grave, unyoked from any responsibility for individuals to actually pay for it, is considered a basic human right for citizens and non-citizens alike.
Boy that sure is weird how so many other countries are able to pull off such a fantastical trick. They just must be smarter and more right righteous I guess. The strawman of "if it's not perfect then f*** it" is hack and so is your unfrozen caveman lawyer intro.
You can constrain prices with 1) government price controls, or 2) market forces.
The root of Obamacare was to let those market forces work to bend the cost curve. Create a competitive market for insurance so people could shop with their dollars.
Well, of course the grass is always greener. And I have no idea what the reply's strawman/caveman last sentence means. About other countries' health care: the UK NHS is in shambles, the Canadians are just euthanizing their folks. The Scandinavians used to do well when they were low population, racially homogeneous, and high-trust societies--but not so much anymore.
homogenous societies tend to be higher-trust, and have less free-riding. This is relevant for healthcare policy because it leads directly to fewer people claiming bogus "disabilities" to unlock SSDI-funds in lieu of work, or straightforwardly defrauding people. They also tend to be more accepting of a higher level of taxation to provide for general social services, as well as providing more non-monetized communal care which eases the burden on the formal healthcare system without making it into dollars-and-cents statistics.
This is a tendency and not a guarantee; different groups have different norms and different customs.
Sure, easy enough, glad to help . . . the original homogeneous folks had the same values of personal hygiene and self care and about taking care of themselves as much as possible and not being a drag on wider social bonds.
Hey man, checking in from Canada here! The healthcare is fucking great. Sure, we kvetch and moan like anyone else but a good friend of mine was just hospitalized for sixteen days with brutal pneumonia. Walked out last night without paying a dime. My wife and I just had our first baby two months ago and haven't paid a single bill for the pre-natal, delivery, or pediatric care we've recieved. Stop listening to the propaganda, your puppet masters have come to the conclusion that it's cheaper to lie to you than provide services and as long as you are willing to believe it they will be right.
Ignoring that this is approximately the least revelatory revelation, i.e. that Trump talks a bigger game than he actually has a plan for, dont accept the premise that Republicans have to have "a better plan". The PPACA (Obamacare by any other name) sucks. Full stop. It was an unworkable, manipulative, half baked and unconstitutional piece of cat vomit dragged from the bowels of Nancy Pelosi's policy fever dreams. President Obama happily let the Democrats of the era write whatever they wanted and he touted it happily. It was never meant to "work" . It was always destined to fail, and in its failure, Dems with their new era of "Demography is Destiny" majorities would have "fixed it" with MFA or some other single payer option.
I as a Republican dont need dick of a shit plan to understand and make the argument that repeal and return to the status quo of 2011 is better, no matter how much disruption it would cause. Setting aside the wildly unconstitutional mechanisms of it, it was also terrible policy, cooked from the beginning to produce the lowest of all possible CBO scores by kicking all the costs of it down the road, and assuming the rosiest of economic forecasts. Yes, these are bipartisan hack tricks, but the PPACA would be better for American health care if ti was taken out back and shot.
Do I, as a Republican, have some ideas about what we could do Sure. Malpractice reform and transparency in health costs would be good places to start but I flatly refuse to play the game where my reform plan gets debated against this unholy mess. The PPACA is so bad 14 years later Democrats are shutting down the government until Republicans (who weren't supposed to ever be in power again) make Obamacare their own and do the work to save it that was always going to be needed.
Remember, the open goal of people who passed the ACA was Socialized medicine and something like MFA. This was openly sold as a "first step" sort of legislation to Democrats with the subtext being "Once Republicans are weaker then we will reform this bill with what we really want".
Repeal the ACA and replace it with what was going on before it was passed. That is a better plan and will produce better outcomes, full stop.
You'd think they would, you know, stop saying they do have one then. Unless you're a cynical person who thinks it's so important to be elected that lying to people is the best plan. And if you believe that, then I hope you have a lot more sympathy for the COVID hawks who lied and exaggerated "for our own good." I have no respect for either.
No where in the world is it unyoked from any responsibility of individuals to actually pay for it. In countries with socialized systems tax payers pay for it. Dollars go in. Services are provided. In the US, more dollars go in for these services. What percentage of those dollars go to providing care, and what percentage go in to providing profits to the insurance companies? At the same time, as a Medicare recipient, your health insurance is paid for by my tax dollars. The most expensive users, paid for by a bargain level payroll tax of 2.9%. How much would it cost to expand that coverage to the rest?
Very few countries are genuine single-payer. While the government is significantly involved -- hey, even in the US the government pays over half the bills -- many have private markets or copays or make purchasing insurance compulsory.
Obamacare is supposed to make buying insurance compulsory, too, except that the mandate was never enforced. The system is unbalanced without that and we're seeing the system break. Young healthy people are opting out. (And why not? The boomers are the ones with the money.)
Whose fault that the mandate is no longer present (it wasn’t unenforced, it was ruled illegal by a partisan court. But it managed to survive despite the removal of a crucial part of the plan. By now removing the subsidies, the hope of the Republicans is the system will collapse. With no replacement. The party in control of all branches of government is still trying to undermine the ACA instead of putting forward something to replace it. Everyone would love for the prices to be lower, as long as everyone has a right to be insured for a reasonable price. Not locked out by virtue of a pre-existing condition. Put forth a plan. Then you can replace. What the fuck happened to “repeal and replace?” They only care about politics. Not policy. Not helping our society.
Thanks for belittling me. I appreciate it. It moves the conversation forward. And makes you feel better too!
The penalty was removed by a partisan Congress in 2017. The point is that they knocked out a leg of the ACA but have yet to propose a better system. We are still waiting.
Administrative costs imposed by regulation just in the private healthcare sector are more than 10x profits; add in administrative overhead for inefficient programs like Medicare and Medicaid and profits shrink to insignificance.
I’m surprised that no one has commented this: Obamacare (vg ACA, the creation of individual insurance markets, subsidies and penalties) *was* the healthcare plan of the Party Formerly Known as Republican. Implemented first by Mitt Romney in Massachusetts, then adapted by the Obama administration and later repudiated by the new (and no so new) Republicans.
The idea was originally the idea of the Heritage Foundation, and Republicans loved it because it was a market-based alternative to socialized healthcare. When Obama endorsed it as a compromise measure, however, the Heritage Foundation “reconsidered” and repudiated it as socialism. Funny how that works.
It's remarkable how many times I've been reduced to simply saying "how the FUCK do people believe this guy???", but seriously, how??? It's as if people are simply not wired to believe that someone would lie to them so blatantly for so long with absolutely nothing to back it up.
Haven’t you heard? The new plan is you tweet out into the void and then you will be hooked up by the Secretary of HHS, Captain Chemtrails himself, who forwards it to El Presidente through a helpful billionaire. Then it is like a magic spell from a fairy godmother, only way more macho, and with the speed of a man vaporizing a Venezuelan fishing boat “You shall have your cancer treatment!”
The part about exposing people to higher premiums and less coverage really gets to the heart of it. When the ACA subsidy extensions expire and insurers like UnitedHealth adjust their pricing models without any replacement framework, millions of people will face that exact scenrio. The decade-long promise of something terrific right around the corner would be almost funny if it weren't so damaging to people who actually need comprehensive coverage. At this point the healthcare plan is basically Schrodinger's policy, both existing and not existing depending on which rally you attend.
"I simply can’t fathom why Trump wouldn’t present a plan."
Come on man, really?
The answer to this question is one you already answered pointing out the nasty and disrespectful hack job that O'Donnell did. Just look at what the Democrat media is doing today with Trump's work to build a much-needed indoor event space at the White House. A resource for the people and yet the media has enflamed those with poor emotional regulation capability to froth at the mouth about it.
Here is the thing. Half the nation are people owning cognitive behavior deficiencies. The are generally females but also feminized males. They can be gaslit to high emotive negativism about anything.
Look what they did to Project 2025. Trump could come up with a plan to end cancer, homelessness and hunger, and they would twist it into food for their derangement syndrome.
For Trump to lay out a plan, they would have a treasure trove of content to hystericize, hyperbolize and frighten people with.
I have been a professional corporate project manager. That is the profession that implements big change across the organization. We understand that in all big change there are generally three groups: For it, against it and don't know or don't care. The tend to be about equal thirds. However, without diligence and a lot of energy, those against will create a negative campaign against the change and pull some from the support group and many more from those uninformed.
If the media was good, moral and honest... not at all like the crap that O'Donnell is... maybe it would make sense to telegraph this plan. But Trump does not need to do so for campaign reasons. And it would likely backfire for that purpose anyway. And it would suck all the air out of the room and distract the Administration's agenda.
There is a way to blow past the challenge of enemies of change... that requires leveraging the decision authority of top power to make it so. It takes a visionary and someone that just steamrolls the critics. I am reading Apple in China right now and it paints Steve Jobs as taking that approach to save Apple from the failure of "decision by committee"... the approach that Democrats always take except when they pushed Obamacare, but fucked it all up because the vision of Democrats was always disingenuous... they saw it as a step toward government-run healthcare... because it would end up being a money and wealth-making bonanza for Democrats.
Trump can just wait until the mid-terms and if he still has a majority in Congress, he can just start executing on a plan.
Cost savings parts of the plan are already well underway. Eliminating the waste, fraud and abuse in Medicare and Medicaid. Getting illegal immigrants off Medicare and Medicaid. Deporting illegal immigrants. Stopping the flood of illegal immigrants. Adding work requirements for all entitlements.
The general plan approach for Republicans includes legal reforms to reduce malpractice costs, privatization moves to increase competition for providers, making it so states cannot restrict insurance and healthcare companies from competing in other state markets, tuition assistance for medical students and changes to our immigration policies to a merit-based system that favors non-woke medical doctors for example.
The general idea is going to be that the US will end up with a two-tier system where subsidized healthcare costs less than it does today, but the service levels will be lower... longer waits, etc. The other tier will be private and higher service levels. This is the same in all other countries.
> Eliminating the waste, fraud and abuse in Medicare and Medicaid
DOGE already failed. It failed a generation ago, too. Literally, "waste fraud and abuse" is a cliché.
(You should keep on applying pressure to find the fraud, and we gradually find it place by place, but it's savings on the order of a few percentage points. So far the investigations pay for themselves but turn up the WFA meter much more and you're spending more finding the fraud than you are saving by getting rid of it.)
> Getting illegal immigrants off Medicare and Medicaid
How many illegal aliens do you think are on Medicare?
> Deporting illegal immigrants
Sure, I can go with this one, but it doesn't really do much to save medical costs. It'll cost more to get hospitals built but whatever.
> Adding work requirements for all entitlements.
Okay, this is something that actually saves money. It does it by covering less people. If Joe is out of work for 6 months, he now has neither a job nor medical coverage, which technically goes into the "costs less" column. Especially if Joe dies.
> legal reforms to reduce malpractice costs
I can't believe we're still doing this one. I was you, 30 years ago, arguing that we just needed to stop malpractice suits. This is handled by the states, so how is that going? We've had enough time to see it work so there's got to be at least 1 success story. Where can we look to find it? How much cheaper is coverage in Texas?
> making it so states cannot restrict insurance and healthcare companies from competing in other state markets
This means one of two things:
1. states cannot regulate what coverage is/isn't required in their states.
2. each state gets to keep doing its own flavor of what's required, and all that you're saving is the back-end costs by having 1 company manage the many different front-ends.
Which of those 2 did you mean?
> tuition assistance for medical students
I'd rather constrain the medical schools costs but subsidizing demand is a common way of dealing with costs.
We could also stop requiring a 4-year-degree before medical school. Other countries train doctors just fine without requiring an undergraduate degree. I think you would enjoy the "Against Tulip Subsidies" essay https://slatestarcodex.com/2015/06/06/against-tulip-subsidies/
> changes to our immigration policies to a merit-based system
Great. Co-sign.
> that favors non-woke medical doctors
You accidentally typed this one out loud. I think it was meant to be part of a guest column for Jeff.
> The general idea is going to be that the US will end up with a two-tier system where subsidized healthcare costs less than it does today, but the service levels will be lower... longer waits, etc. The other tier will be private and higher service levels. This is the same in all other countries.
This is a fine idea for an overall shape of our health care system but it doesn't have much to do with all the other things you said.
Medicaid is pretty poor coverage, but it can serve as a floor, and people should want to buy themselves out of it as soon as possible. We can do that one right now.
In general, we need policies to generate massive competition with private healthcare while reducing the expensive and constraining regulatory burdens and reduce the number of people that require public assistance to supplement or pay for their healthcare. We need to accept a two-tier system with clinics taking Medicaid payments.
And yes, there is a massive amount of fraud, waste and abuse... and no DOGE did not fail... it has resulted in savings and it still ongoing. You are wrong in your opinion that there is not much savings to be had eliminating Medicare and Medicaid waste, fraud and abuse. Minnesota for example is refusing the HHS request to report on their Medicare and Medicaid recipients after a 174% increase, the largest in the nation. Minnesota joined 20 other Democrat-run states to find a liberal judge to block the HHS demand for healthcare records... clearly because these blue states are providing health insurance to illegals. California did so and admitted it. King Newsom had to reverse it after the CA budget surplus vanished into a massive deficit.
The other part of this illegal immigrant cost is those that don't have insurance and use the emergency rooms thus jacking costs. It is ridiculous to deny that 35+ million illegal immigrants in this country (including their family members), 12 million over the last four years, are not a big driver of healthcare costs.
The northern European countries with socialized healthcare are the population and climate of Minnesota but people work and until recently they had little immigration. That has changed a bit (why Sweden is now the rape capital of the world) and now these countries are starting to see the same problem... massive cost increases taking care of all these unemployed or low wage immigrants.
I'd love to get market forces to work more but it's going to take lots and lots of changes. The whole system is built up to never offer any price transparency to the consumer, to force a learned helplessness so that people give up. It's what lets there be a $25,000 MRI https://archive.is/vFTuo
> The other part of this illegal immigrant cost is those that don't have insurance and use the emergency rooms thus jacking costs
Emergency departments are less than 2% of total health care costs in the country. Believe me, I used to be thinking "well, the problem is too much people using emergency care" and if they had a PCP they could use it would be a savings, and the ED billing is admittedly whack, but magically make all the ED bills paid for by magic aliens and it doesn't really change health care costs in the country. It's even less than the health insurance company profits.
So, yes, it *is* ridiculous to blame ED use for the explosion in health care costs.
Note, because I have cancer and am alive today because of the great US healthcare system (if Canadian or a Brit, I would likely already be dead), I have a bias.
So, this long analysis is concluding that we don't really pay more per service, but we consume more services and that we consume more services because we are less healthy because of poor lifestyle choices... but that those additional services don't improve overall healthcare outcomes overcoming the poor lifestyle choices.
Okay, well then what is the political policy direction to combat this? I am a foodie... always have worked out and eat healthy. I have good friends that are obese. I have worked on them for decades to get them to eat healthy. They are stubborn. Americans are that way... tell them they should not eat something, and they will give you the finger and eat more of the junk just to show you that they have power. I remember Jamie Oliver did a show where he would go to grade schools to teach the food service staff to create healthy meals for the students. The food service staff were all egg-shaped people, and they fought Oliver at every step. The kids, many of them egg-shaped, didn't like it and wanted their pizza and soda returned. Oliver gave up.
My point here is that I think this conclusion is just pissing in the wind or shouting at a wall. If we Americans tend to make unhealthy choices and thus consume more healthcare because of it, then that seems to be our reality.
You can look at what Trump is doing to help remedy this... reducing the number of poor illegal immigrants consuming US healthcare, reducing the government benefits that trap families in generational poverty and Making America Work Again... and RFK Jr., attempting to Make America Healthy Again... and they are being ripped to shreds by the American establishment as powered by the Democrat Party.
Low-income people have much higher rates of obesity. Low-income people are much more likely to be victims and perpetrators in violent crime. Low-income people are more likely to be involved in accidents. The health outcomes of low-income people drag down the overall statistics for Americans in general, and we keep flooding more of them into the country.
It would be a great thought experiment to reduce the number of low-income people, either deporting them or getting more of them working so they move up into the middle class and calculate the impact to healthcare spending relative to outcomes.
Over here in the UK we had Boris Johnson, who promised to fix social care (basically, care for the elderly) as he literally stood on the steps on his first day in office.
“Uppity news wench” sounds like a character you’d find at a Renaissance Fair in Nutley, New Jersey (“Bring me my Uppity News Wench, for I wish to be informed of the goings on in my fair realm!” “Yes, Sire, I shall summon her at once!”)
You forgot “Big ‘The Midnight Sky’ fan”
It was in a draft! (decided to go with the more general, gettable reference)
As an already old (but fortunately still aging) Neanderthal conservative and in general a Trump supporter, I have to sadly nod my head in agreement with Mr Maurer: President Trump and Republicans really do have no plan. That is due to neither malevolence nor incompetence . . . just that no plan actually works to provide the healthcare people think they deserve with the funds actually available, even printing money as fast as the Treasury's printing plates will spin. On the other hand, Obamacare itself S'es the Fat D as Mr Maurer so memorably puts it. I still have to shop the Obamacare Marketplace for my hot young wife's policy and can guarantee that Obamacare itself, every single year, "expos[es] people to higher premiums and less coverage." I have no idea how to fix this, nor does anybody else, as long as unlimited healthcare from conception to grave, unyoked from any responsibility for individuals to actually pay for it, is considered a basic human right for citizens and non-citizens alike.
Boy that sure is weird how so many other countries are able to pull off such a fantastical trick. They just must be smarter and more right righteous I guess. The strawman of "if it's not perfect then f*** it" is hack and so is your unfrozen caveman lawyer intro.
You can constrain prices with 1) government price controls, or 2) market forces.
The root of Obamacare was to let those market forces work to bend the cost curve. Create a competitive market for insurance so people could shop with their dollars.
Well, of course the grass is always greener. And I have no idea what the reply's strawman/caveman last sentence means. About other countries' health care: the UK NHS is in shambles, the Canadians are just euthanizing their folks. The Scandinavians used to do well when they were low population, racially homogeneous, and high-trust societies--but not so much anymore.
Pop culture reference that's at least 30 years old and a reference to your fallacious argument.
Can you walk me through how being racially homogeneous is relevant to health care policy?
homogenous societies tend to be higher-trust, and have less free-riding. This is relevant for healthcare policy because it leads directly to fewer people claiming bogus "disabilities" to unlock SSDI-funds in lieu of work, or straightforwardly defrauding people. They also tend to be more accepting of a higher level of taxation to provide for general social services, as well as providing more non-monetized communal care which eases the burden on the formal healthcare system without making it into dollars-and-cents statistics.
This is a tendency and not a guarantee; different groups have different norms and different customs.
Sure, easy enough, glad to help . . . the original homogeneous folks had the same values of personal hygiene and self care and about taking care of themselves as much as possible and not being a drag on wider social bonds.
Hey man, checking in from Canada here! The healthcare is fucking great. Sure, we kvetch and moan like anyone else but a good friend of mine was just hospitalized for sixteen days with brutal pneumonia. Walked out last night without paying a dime. My wife and I just had our first baby two months ago and haven't paid a single bill for the pre-natal, delivery, or pediatric care we've recieved. Stop listening to the propaganda, your puppet masters have come to the conclusion that it's cheaper to lie to you than provide services and as long as you are willing to believe it they will be right.
Ignoring that this is approximately the least revelatory revelation, i.e. that Trump talks a bigger game than he actually has a plan for, dont accept the premise that Republicans have to have "a better plan". The PPACA (Obamacare by any other name) sucks. Full stop. It was an unworkable, manipulative, half baked and unconstitutional piece of cat vomit dragged from the bowels of Nancy Pelosi's policy fever dreams. President Obama happily let the Democrats of the era write whatever they wanted and he touted it happily. It was never meant to "work" . It was always destined to fail, and in its failure, Dems with their new era of "Demography is Destiny" majorities would have "fixed it" with MFA or some other single payer option.
I as a Republican dont need dick of a shit plan to understand and make the argument that repeal and return to the status quo of 2011 is better, no matter how much disruption it would cause. Setting aside the wildly unconstitutional mechanisms of it, it was also terrible policy, cooked from the beginning to produce the lowest of all possible CBO scores by kicking all the costs of it down the road, and assuming the rosiest of economic forecasts. Yes, these are bipartisan hack tricks, but the PPACA would be better for American health care if ti was taken out back and shot.
Do I, as a Republican, have some ideas about what we could do Sure. Malpractice reform and transparency in health costs would be good places to start but I flatly refuse to play the game where my reform plan gets debated against this unholy mess. The PPACA is so bad 14 years later Democrats are shutting down the government until Republicans (who weren't supposed to ever be in power again) make Obamacare their own and do the work to save it that was always going to be needed.
Remember, the open goal of people who passed the ACA was Socialized medicine and something like MFA. This was openly sold as a "first step" sort of legislation to Democrats with the subtext being "Once Republicans are weaker then we will reform this bill with what we really want".
Repeal the ACA and replace it with what was going on before it was passed. That is a better plan and will produce better outcomes, full stop.
You'd think they would, you know, stop saying they do have one then. Unless you're a cynical person who thinks it's so important to be elected that lying to people is the best plan. And if you believe that, then I hope you have a lot more sympathy for the COVID hawks who lied and exaggerated "for our own good." I have no respect for either.
No where in the world is it unyoked from any responsibility of individuals to actually pay for it. In countries with socialized systems tax payers pay for it. Dollars go in. Services are provided. In the US, more dollars go in for these services. What percentage of those dollars go to providing care, and what percentage go in to providing profits to the insurance companies? At the same time, as a Medicare recipient, your health insurance is paid for by my tax dollars. The most expensive users, paid for by a bargain level payroll tax of 2.9%. How much would it cost to expand that coverage to the rest?
Very few countries are genuine single-payer. While the government is significantly involved -- hey, even in the US the government pays over half the bills -- many have private markets or copays or make purchasing insurance compulsory.
Obamacare is supposed to make buying insurance compulsory, too, except that the mandate was never enforced. The system is unbalanced without that and we're seeing the system break. Young healthy people are opting out. (And why not? The boomers are the ones with the money.)
Whose fault that the mandate is no longer present (it wasn’t unenforced, it was ruled illegal by a partisan court. But it managed to survive despite the removal of a crucial part of the plan. By now removing the subsidies, the hope of the Republicans is the system will collapse. With no replacement. The party in control of all branches of government is still trying to undermine the ACA instead of putting forward something to replace it. Everyone would love for the prices to be lower, as long as everyone has a right to be insured for a reasonable price. Not locked out by virtue of a pre-existing condition. Put forth a plan. Then you can replace. What the fuck happened to “repeal and replace?” They only care about politics. Not policy. Not helping our society.
> Whose fault that the mandate is no longer present
The Republicans who aren't enforcing the mandate.
> it was ruled illegal by a partisan court
Every single part of this sentence is wrong.
Thanks for belittling me. I appreciate it. It moves the conversation forward. And makes you feel better too!
The penalty was removed by a partisan Congress in 2017. The point is that they knocked out a leg of the ACA but have yet to propose a better system. We are still waiting.
Administrative costs imposed by regulation just in the private healthcare sector are more than 10x profits; add in administrative overhead for inefficient programs like Medicare and Medicaid and profits shrink to insignificance.
I’m surprised that no one has commented this: Obamacare (vg ACA, the creation of individual insurance markets, subsidies and penalties) *was* the healthcare plan of the Party Formerly Known as Republican. Implemented first by Mitt Romney in Massachusetts, then adapted by the Obama administration and later repudiated by the new (and no so new) Republicans.
The idea was originally the idea of the Heritage Foundation, and Republicans loved it because it was a market-based alternative to socialized healthcare. When Obama endorsed it as a compromise measure, however, the Heritage Foundation “reconsidered” and repudiated it as socialism. Funny how that works.
It's remarkable how many times I've been reduced to simply saying "how the FUCK do people believe this guy???", but seriously, how??? It's as if people are simply not wired to believe that someone would lie to them so blatantly for so long with absolutely nothing to back it up.
the garter snake, yes...
I have no fucking idea who's being serious in this comments section and who's trolling.
Haven’t you heard? The new plan is you tweet out into the void and then you will be hooked up by the Secretary of HHS, Captain Chemtrails himself, who forwards it to El Presidente through a helpful billionaire. Then it is like a magic spell from a fairy godmother, only way more macho, and with the speed of a man vaporizing a Venezuelan fishing boat “You shall have your cancer treatment!”
no one has an amazing health care plan.
out of such crooked timber, nothing can be made straight.
Trump has Ivanka working out the plan as a launch pad for her own political career.
The part about exposing people to higher premiums and less coverage really gets to the heart of it. When the ACA subsidy extensions expire and insurers like UnitedHealth adjust their pricing models without any replacement framework, millions of people will face that exact scenrio. The decade-long promise of something terrific right around the corner would be almost funny if it weren't so damaging to people who actually need comprehensive coverage. At this point the healthcare plan is basically Schrodinger's policy, both existing and not existing depending on which rally you attend.
Donnie “Two Weeks”
The plan is to just talk about the plan, but the plan is no plan :(
"I simply can’t fathom why Trump wouldn’t present a plan."
Come on man, really?
The answer to this question is one you already answered pointing out the nasty and disrespectful hack job that O'Donnell did. Just look at what the Democrat media is doing today with Trump's work to build a much-needed indoor event space at the White House. A resource for the people and yet the media has enflamed those with poor emotional regulation capability to froth at the mouth about it.
Here is the thing. Half the nation are people owning cognitive behavior deficiencies. The are generally females but also feminized males. They can be gaslit to high emotive negativism about anything.
Look what they did to Project 2025. Trump could come up with a plan to end cancer, homelessness and hunger, and they would twist it into food for their derangement syndrome.
For Trump to lay out a plan, they would have a treasure trove of content to hystericize, hyperbolize and frighten people with.
I have been a professional corporate project manager. That is the profession that implements big change across the organization. We understand that in all big change there are generally three groups: For it, against it and don't know or don't care. The tend to be about equal thirds. However, without diligence and a lot of energy, those against will create a negative campaign against the change and pull some from the support group and many more from those uninformed.
If the media was good, moral and honest... not at all like the crap that O'Donnell is... maybe it would make sense to telegraph this plan. But Trump does not need to do so for campaign reasons. And it would likely backfire for that purpose anyway. And it would suck all the air out of the room and distract the Administration's agenda.
There is a way to blow past the challenge of enemies of change... that requires leveraging the decision authority of top power to make it so. It takes a visionary and someone that just steamrolls the critics. I am reading Apple in China right now and it paints Steve Jobs as taking that approach to save Apple from the failure of "decision by committee"... the approach that Democrats always take except when they pushed Obamacare, but fucked it all up because the vision of Democrats was always disingenuous... they saw it as a step toward government-run healthcare... because it would end up being a money and wealth-making bonanza for Democrats.
Trump can just wait until the mid-terms and if he still has a majority in Congress, he can just start executing on a plan.
Can you give us a hint as to what's in the plan?
Where do the cost savings come from?
Cost savings parts of the plan are already well underway. Eliminating the waste, fraud and abuse in Medicare and Medicaid. Getting illegal immigrants off Medicare and Medicaid. Deporting illegal immigrants. Stopping the flood of illegal immigrants. Adding work requirements for all entitlements.
The general plan approach for Republicans includes legal reforms to reduce malpractice costs, privatization moves to increase competition for providers, making it so states cannot restrict insurance and healthcare companies from competing in other state markets, tuition assistance for medical students and changes to our immigration policies to a merit-based system that favors non-woke medical doctors for example.
The general idea is going to be that the US will end up with a two-tier system where subsidized healthcare costs less than it does today, but the service levels will be lower... longer waits, etc. The other tier will be private and higher service levels. This is the same in all other countries.
> Eliminating the waste, fraud and abuse in Medicare and Medicaid
DOGE already failed. It failed a generation ago, too. Literally, "waste fraud and abuse" is a cliché.
(You should keep on applying pressure to find the fraud, and we gradually find it place by place, but it's savings on the order of a few percentage points. So far the investigations pay for themselves but turn up the WFA meter much more and you're spending more finding the fraud than you are saving by getting rid of it.)
> Getting illegal immigrants off Medicare and Medicaid
How many illegal aliens do you think are on Medicare?
> Deporting illegal immigrants
Sure, I can go with this one, but it doesn't really do much to save medical costs. It'll cost more to get hospitals built but whatever.
> Adding work requirements for all entitlements.
Okay, this is something that actually saves money. It does it by covering less people. If Joe is out of work for 6 months, he now has neither a job nor medical coverage, which technically goes into the "costs less" column. Especially if Joe dies.
> legal reforms to reduce malpractice costs
I can't believe we're still doing this one. I was you, 30 years ago, arguing that we just needed to stop malpractice suits. This is handled by the states, so how is that going? We've had enough time to see it work so there's got to be at least 1 success story. Where can we look to find it? How much cheaper is coverage in Texas?
> making it so states cannot restrict insurance and healthcare companies from competing in other state markets
This means one of two things:
1. states cannot regulate what coverage is/isn't required in their states.
2. each state gets to keep doing its own flavor of what's required, and all that you're saving is the back-end costs by having 1 company manage the many different front-ends.
Which of those 2 did you mean?
> tuition assistance for medical students
I'd rather constrain the medical schools costs but subsidizing demand is a common way of dealing with costs.
We could also stop requiring a 4-year-degree before medical school. Other countries train doctors just fine without requiring an undergraduate degree. I think you would enjoy the "Against Tulip Subsidies" essay https://slatestarcodex.com/2015/06/06/against-tulip-subsidies/
> changes to our immigration policies to a merit-based system
Great. Co-sign.
> that favors non-woke medical doctors
You accidentally typed this one out loud. I think it was meant to be part of a guest column for Jeff.
> The general idea is going to be that the US will end up with a two-tier system where subsidized healthcare costs less than it does today, but the service levels will be lower... longer waits, etc. The other tier will be private and higher service levels. This is the same in all other countries.
This is a fine idea for an overall shape of our health care system but it doesn't have much to do with all the other things you said.
Medicaid is pretty poor coverage, but it can serve as a floor, and people should want to buy themselves out of it as soon as possible. We can do that one right now.
In general, we need policies to generate massive competition with private healthcare while reducing the expensive and constraining regulatory burdens and reduce the number of people that require public assistance to supplement or pay for their healthcare. We need to accept a two-tier system with clinics taking Medicaid payments.
And yes, there is a massive amount of fraud, waste and abuse... and no DOGE did not fail... it has resulted in savings and it still ongoing. You are wrong in your opinion that there is not much savings to be had eliminating Medicare and Medicaid waste, fraud and abuse. Minnesota for example is refusing the HHS request to report on their Medicare and Medicaid recipients after a 174% increase, the largest in the nation. Minnesota joined 20 other Democrat-run states to find a liberal judge to block the HHS demand for healthcare records... clearly because these blue states are providing health insurance to illegals. California did so and admitted it. King Newsom had to reverse it after the CA budget surplus vanished into a massive deficit.
The other part of this illegal immigrant cost is those that don't have insurance and use the emergency rooms thus jacking costs. It is ridiculous to deny that 35+ million illegal immigrants in this country (including their family members), 12 million over the last four years, are not a big driver of healthcare costs.
The northern European countries with socialized healthcare are the population and climate of Minnesota but people work and until recently they had little immigration. That has changed a bit (why Sweden is now the rape capital of the world) and now these countries are starting to see the same problem... massive cost increases taking care of all these unemployed or low wage immigrants.
I'd love to get market forces to work more but it's going to take lots and lots of changes. The whole system is built up to never offer any price transparency to the consumer, to force a learned helplessness so that people give up. It's what lets there be a $25,000 MRI https://archive.is/vFTuo
> The other part of this illegal immigrant cost is those that don't have insurance and use the emergency rooms thus jacking costs
Emergency departments are less than 2% of total health care costs in the country. Believe me, I used to be thinking "well, the problem is too much people using emergency care" and if they had a PCP they could use it would be a savings, and the ED billing is admittedly whack, but magically make all the ED bills paid for by magic aliens and it doesn't really change health care costs in the country. It's even less than the health insurance company profits.
So, yes, it *is* ridiculous to blame ED use for the explosion in health care costs.
If you're ready to do a really deep dive into the economics, https://randomcriticalanalysis.com/why-conventional-wisdom-on-health-care-is-wrong-a-primer/ will load a bunch of graphs at you. We're very rich and consume a lot of health care, even if we don't benefit that much from it.
Note, because I have cancer and am alive today because of the great US healthcare system (if Canadian or a Brit, I would likely already be dead), I have a bias.
So, this long analysis is concluding that we don't really pay more per service, but we consume more services and that we consume more services because we are less healthy because of poor lifestyle choices... but that those additional services don't improve overall healthcare outcomes overcoming the poor lifestyle choices.
Okay, well then what is the political policy direction to combat this? I am a foodie... always have worked out and eat healthy. I have good friends that are obese. I have worked on them for decades to get them to eat healthy. They are stubborn. Americans are that way... tell them they should not eat something, and they will give you the finger and eat more of the junk just to show you that they have power. I remember Jamie Oliver did a show where he would go to grade schools to teach the food service staff to create healthy meals for the students. The food service staff were all egg-shaped people, and they fought Oliver at every step. The kids, many of them egg-shaped, didn't like it and wanted their pizza and soda returned. Oliver gave up.
My point here is that I think this conclusion is just pissing in the wind or shouting at a wall. If we Americans tend to make unhealthy choices and thus consume more healthcare because of it, then that seems to be our reality.
You can look at what Trump is doing to help remedy this... reducing the number of poor illegal immigrants consuming US healthcare, reducing the government benefits that trap families in generational poverty and Making America Work Again... and RFK Jr., attempting to Make America Healthy Again... and they are being ripped to shreds by the American establishment as powered by the Democrat Party.
Low-income people have much higher rates of obesity. Low-income people are much more likely to be victims and perpetrators in violent crime. Low-income people are more likely to be involved in accidents. The health outcomes of low-income people drag down the overall statistics for Americans in general, and we keep flooding more of them into the country.
It would be a great thought experiment to reduce the number of low-income people, either deporting them or getting more of them working so they move up into the middle class and calculate the impact to healthcare spending relative to outcomes.
Mostly it's about making a permission structure so people can argue "there's a better plan, uh huh."
Over here in the UK we had Boris Johnson, who promised to fix social care (basically, care for the elderly) as he literally stood on the steps on his first day in office.
Would it shock you to hear it was never even described in vague terms? https://news.sky.com/story/does-boris-johnsons-pledge-to-fix-social-care-system-stack-up-11879015
What do you expect from a real estate salesman? Details? LOL
Correction: Norah is a hot wench.
#takebackromance!