The Healthcare Rabbit Hole...

[Chase]

Today, the United States Senate got the closest the Republican Party has come to demolishing President Obama's crowning achievement - the Affordable Care Act.

 

In actuality, they were BARELY able to pass a vote in order to debate the measures of the Affordable Care Act, which means the Republicans - as of right now - are set to try and do as much damage from -inside- the bill as possible.

 

This comes after "x" vote on "repealing and replacing" the legislation tanked unceremoniously hours after Vice-President Pence broke a 50-50 tie to open debate - forced by two Republican Senators (Susan Collins and Lisa Murkowski) defecting and voting Nay with the entirety of the Democratic conference. Senator John McCain had to venture back to Washington shortly after being diagnosed with brain cancer for the Republicans to even get the tie needed to summon the VP.

 

Shortly after that - the so-called "Cruz Amendment" (that would have enabled cheaper, non-ACA-regulated healthcare plans to be sold alongside the ACA plans) was struck down unanimously.

 

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Why this is BETTER than the Trump endorsement of "Let Obamacare blow up." for the Republicans - AND for the American people.

 

If one were to have a baby, keep it, but subsequently not raise it - that would bring certain negligence charges against the parents at best.

 

By winning the levers of power through the electoral process - Trump and the Republican Congress effectively "adopted" the Affordable Care Act's responsibilities - such as enforcing the individual mandate and working with the insurers to insure the market is stable and appealing enough for them to stick around.

 

Trump's suggestion of "letting it blow up" would indicate that the government would very loosely -if at all- enforce the individual mandate, which would actively CONTRIBUTE to the already high rising premium costs of insurance and would make the market unstable, causing insurers to bail on coverage at all. This is bad for Americans, because the supply of health insurance goes away, while the demand remains 100% merely because the government isn't regulating the insurance at all, while the market still has to follow the already established regulations in order to exist. It would threaten the end of health insurance for many more Americans than even Republican-friendly alternatives to the ACA.

 

While "moving" on Healthcare is a dangerous political game - the GOP dodged a bullet by moving - they promised their constituents from the start they would act. They also avoid neglecting the ENTIRETY of the American people who need healthcare - simply in an effort to guilt trip Democrats into supporting a repeal and replace plan (or just a repeal!) that they want no part of.

 

Trump effectively was saying "screw the people we represent, my campaign promises are more important" by offering such bluster - and it's those statements that reaffirm my not voting for him - as a Republican.

 

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Why the GOP is troubling me...

 

 

DEMOCRATS HAVE BEEN EFFECTIVELY BARRED FROM DISCOURSE

 

in a manner that can only be viewed as retaliation for being held away from Obamacare discussion and decision when they were the minority, the Senate Republican leadership has worked -around- the Democratic conference in order to make this "initial" healthcare bill one where only close Republican allies have input. The Democrats haven't had any work to do - because their colleagues are not allowing them to work. As someone who hated seeing Majority Leader Schumer pull this - it is no less awful when done by Majority Leader McConnell.

 

RED STATE SENATORS ARE BEING OBNOXIOUSLY AGGRESSIVE

 

Looking at you, Rand Paul, Mike Lee, and my very own Senator Ted Cruz.

 

Areas where movement conservativism is a popular practice have given folks like these the brazen authority to show their deep red. Rand Paul - who eventually did vote yes to open debate on the ACA - only did so in order to secure a vote for a repeal (the same one that failed hours later.) Mike Lee failed to endorse the last coherent replacement plan McConnell presented on the floor even after his buddy Cruz threw in his amendment. That same amendment would be voted on again when applied to the ACA itself - and again would fizzle out.

 

Like in the House of Representatives, conservatives are being mighty bullish on the wording "replace" - and they want to swing their axe at as much of the legislation as possible.

 

BLUE STATE REPUBLICANS ACTUALLY KINDA LIKE OBAMACARE - SOMEWHAT.

 

Collins, Murkowski, Shelly Anne Capito, and Dean Heller are characters that represent the centrist wing of the GOP - who have been repeat "no" votes largely because of the details of the healthcare bills that died prior.

 

Previous attempts at the replacing of the ACA featured significant cuts to Medicaid, and were brazen enough to "defund" Planned Parenthood outright - turning these folks along with all of the Democrats off.

 

While these are surface issues - it's undeniable the constituents in these states are more centrist than even some of the senators on this list. Nevada is actually a fairly liberal state - and one that Heller is clinging on to for a year and a half. West Virginia was a swing state not long ago. Missouri is volatile. Many of the Affordable Care Act's provisions protect sizeable amounts of those constituents - even those that voted for Trump. Capito put her opposition to Republican efforts succinctly and tellingly - "I didn't come to Washington to hurt people."

 

THE MOST CERTAIN THING THAT WILL HAPPEN IS NOTHING.

 

With the speed of this Congress to achieve any of their goals being next to none - this debate process will run dry unless McConnell is a wizard. It would be another "win" (in actuality near-miss) for the Democrats and their floundering healthcare legislation, but it won't put the ACA back in the ocean so it can breathe. If the ACA is left as is, Republicans will likely take President Trump's advice and let the bill kill itself - dragging down the Republicans who failed to get rid of it and absolutely didn't care enough to make it work rather than harm Americans.

 

How many people get denied life saving treatment then?

 

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How to fix the Affordable Care Act

 

1. Drop the repeal and replace ball gracefully.

2. Allow Democrats to sit at the table and play.

3. Flex your majority muscles where you can -and- where it doesn't scare Democrats -AWAY- from said table.

4. Media coverage the whole thing so Democrats that -are- only in it for the obstruction game are spotlighted as denying Republican olive branches.

5. Don't defund Planned Parenthood (yet.)

6. Make sure to put your foot down on the worst parts of the legislation (the individual mandate is a good example of this.)

7. Porkbelly, Porkbelly, Porkbelly with any waffling votes in the GOP conference you need to keep.

8. Pick a god and pray.

[Maelstrom]

You know, the scariest thing about repeal and -not- replace is that Republicans would hold healthcare, any healthcare at all, hostage until democrats would have no choice but to sign because some healthcare is better than none... but obviously far worse than if they let Obamacare stay. Even republicans can see that if Obamacare was repealed without replacement... healthcare would literally be dead and too many US citizens would be dead outright along with it. And using that to make democrats agree to the ridiculously uncaring legislation is how republicans hope to force others to pass in the meanwhile would be absolutely horrific. Except for the ones who thankfully voted to block that nonsense.

 

The reason Trump wants to repeal and not replace is because even bad healthcare would be better than none at all, and that's just holding American lives hostage. So seriously... F that guy. The guy who said "Who knew healthcare was so complicated?" and then has refused to answer real questions about healthcare ever since...

 

How many times do I have to tell you... I told you so. He's a friggin' moron.

 

And how's that claim about draining the swamp, btw? He can't stop hiring people who represent the swamp, can he?

[Chase]

I've got a trump rant...but I'm going to save that for another thread because I want to use this one to talk about healthcare.

 

Today, Republican senators are engaging in a "Vote-a-rama" - or forcing a gazillion interest check votes to see what measures would be viewed as 'Passsable" in a replacement bill. On the other side of hall, Democratic senators are pledging they will not participate in the amendment process UNTIL the GOP leaders release a bill for them to amend.

 

What this tells me - is that Republican leadership doesn't have a replacement plan and is looking for the bare minimum repeal bill they can send to the House of Representatives for conference. If a bill gets sent to conference, that becomes the new "closest" thing to the ACA getting destroyed, because the bicameral bill (which is likely to be fleshed out during conference) would get sent to an all eager president who is willing to sign a repeal and replace into law.

 

The issue here though - is that the GOP better have someone taking notes if they expect any Democratic support at the end of it all when they unveil a bill. If they are trying to pass a replacement bill by party line - they need to send a copy of said bill to the Congressional Budget Office -and- meet a savings threshold. The CBO has been the bearer of bad news for the GOP, telling the world the large numbers of lost insured Americans after each and every draft they've been sent and making centrist senators skittish.

 

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The first issue they are likely to vote on is a strange one for a GOP-led Senate - the interest in Congress to move to a single payer healthcare system. Single payer is the liberal's healthcare DREAM situation, so many Democrats will actually vote YEA on this measure. If the Democrats avoid making the smart political play and decide to vote truthfully however, there -ideally- will be a few NAY votes from center-leaning Democrats, giving the Republican leadership more potential votes to target when they have a bill in place. If Democrats want to avoid contributing to the amendment process as they have said - it would be smart for the entire Democratic conference to bite the bullet and vote YEA on this measure to deny Republicans targets. This will assuredly not pass in Congress, because no Republicans want anything to do with single payer healthcare - and they hold the Senate majority.

 

If Dems squad up, expect a 48-52 vote in favor of nay. If they don't, the Nays will win by a larger margin.

 

 

[Maelstrom]

https://vittana.org/15-pros-and-cons-of-single-payer-health-care

 

Edit:

@Chase, looks like they all voted it down. http://www.cnn.com/2017/07/27/politics/health-care-single-payer-senate-vote/index.html

 

[Chase]

Man, if little 'ole -ME- knew the Dems weren't going to take that bait - they H A D to know that was a setup. All "Present" works too.

 

Game respects game - but I didn't know deciding the future of healthcare for this country was something of a game of gotcha....

 

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Very well written article.

 

My first concern with single payer personally is that health insurance costs don't evaporate under the system. This article plays rather coyly with the subject, as the eighth pro proclaims costs disappear - yet the seventh con states that the costs may not.

 

My second concern is a huge one - and this article states this one plainly as a con. Innovation is desperately needed in medicine if we are ever going to solve some of the largest killer maladies humanity struggles with. If people are in a system where innovation is discouraged, that makes finding those cures a longer shot than a system where people get fair compensation for their breakthroughs.

 

The other cons are valid points, but I feel a working single payer system can address those no issue - or the con doesn't stem from a healthcare perspective (such as taxation or bigger government.)

 

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For what it's worth, single payer care would be more effective than the Affordable Care Act at covering everyone if it were instated properly - and if that's the case the argument that it's a bad system because it doesn't do what it set out to do is gone - and there's merit in having bigger spending leverage. I still have my issues with the idea for now though.

[Chase]

Wow.

 

Senator John McCain was solely responsible for the last-ditch effort to pass the "Skinny" ACA repeal to the House for bicameral conference, delivering the third and fatal nay vote.

 

The Affordable Care Act lives on. As someone who would have been extremely tempted to vote "Yes" if I were in McCain's shoes simply because the things that WERE in the bill were issues I had with the ACA - I can respect the Arizonan's reasoning. He killed the bill solely on the reasoning that Republicans had repeated the mistake of their Democratic colleagues and excluded the minority party in deliberating the tenants of a major healthcare bill for all Americans - and believes that all people have a say in what kind of healthcare they receive. As someone who wants to see Republicans and Democrats not loathe each other and be willing to get things done - I am impressed.

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Here's why the bill ultimately failed.

 

The White House did very little to help Congress with direction.

 

President Obama had his vision already mapped out - and having been a senator prior he knew how to draft his bill and present it to Congress. Democratic majorities back then had the utmost support of their allied president and were willing to share his vision, even if many Democrats took exception to some of Obamacare's nuances. Passing the Affordable Care Act ultimately took all three branches of government (the Judiciary took cases from conservative challenges and delivered two 5-4 rulings in favor of the ACA.) to pass - but the executive was knowledgeable and willing to roll up his sleeves along with the legislators.

 

President Trump's administration has yet to pass on his own draft of the replacement plan to Congress. During the campaign, we heard Candidate Trump promise to replace Obamacare with "something great" and that he wouldn't "let people die in the streets" - but his plan seemed ripped from his Republican opponents. When he got to the White House - he abandoned his own plan and allowed the House of Representatives to try and pass their own legislation, while spending his time attacking the character of non-rank-and-file Republicans on both the far right and the center. When the bill got to the Senate, Trump seemed to be most visible cheerleading from the Twittersphere - while his VP wasn't much more involved holding pressers and casting tie breaking votes simply to WRITE a bill.

 

Moderates are done being pushed around.

 

In most circumstances, centrist legislators are the leadership's "teachers pets". They don't hold too many controversial opinions, and they usually opt to do what makes government work over rocking the boat.

 

Moderates have been forced to take tough votes in the House of Representatives because the far-right wing of the party pulls out all the stops to ensure conservatism bleeds out of every measure they take. It was centrists however, that ultimately killed the bill in the House by pulling those same stops the first time the House tried to pass healthcare reform. In the Senate, the repeat offenders of slowing Republican progress were Lisa Murkowski of Alaska and Susan Collins - women who held reservations about the hyper conservative notion of spending cuts, particularly to Medicaid and Planned Parenthood. These women -too- had to take tough votes for the will of the party, endangering their standing back home. All of that however, evaporated throughout all of last week. The women voted "No" on the motion to debate the bill - contributing to Mike Pence having to tiebreak, and voted "No" on passing the skinny repeal to conference along with McCain.