Saturday, April 9, 2016

Annals of derp: There is question, and Imma try to avoid it

Surreal Turtle, by jallen02 at DeviantArt.

Robert Pear and Maggie Haberman at the Times are so scandalized by the incoherence and insubstantiality of the Trump health care proposals:
This whipsaw of ideas is exasperating Republican experts on health care, who call his proposals an incoherent mishmash that could jeopardize coverage for millions of newly insured people.
Oh, really?
“If you repeal the Affordable Care Act, you’ve got to have a serious way to expand coverage to replace what you have taken away,” said Gail R. Wilensky, who was the administrator of Medicare and Medicaid under President George Bush from 1990 to 1992. “There’s nothing I see in Trump’s plan that would do anything more than cover a couple million people.”
Robert Laszewski, a former insurance executive and frequent critic of the health law, called Mr. Trump’s health care proposals “a jumbled hodgepodge of old Republican ideas, randomly selected, that don’t fit together.”
Gosh, thanks for the heads up, Republican experts on health care! I'm so glad the Times is onto this surprising and unpleasant development which no one would have predicted. I guess Republican primary voters need to be looking at one of those candidates with a serious way to expand coverage to replace what they're taking away when they repeal and replace Obamacare. Which one would you recommend?

Like Governor Kasich?
let’s not only oppose Obamacare but also put in motion real solutions that will work to improve health care access by holding down costs and help Americans live healthier lives. The Ohio model provides a path forward for the nation: patient-centered care, choices, market competition, decentralized decision-making, higher quality, respect for individuals and an end to Obamacare’s big government interference.
Oh, the Ohio model. Introduced since Kasich became governor of Ohio, you know, in 2010, as the Affordable Care Act slowly came into effect, with its provisions for improving health care access (expansion of Medicaid, the Marketplace to insure people who don't get coverage through their employers, and $217,319,926 as of November 2015 for community health centers in Ohio to offer a broader array of primary care services, extend their hours of operations, hire more providers, and renovate or build new clinical spaces; and in just the one year of 2014, saving $235,018,764, or an average of $980 per beneficiary, on drugs for Ohio Medicare patients), patient-centered care (including no-copay preventive care for 2,814,000 Ohioans with private insurance). The only Ohio model I can find out anything about is the one that begins with Obamacare's big government interference, the one where the latter ends is imaginary.

And there's no word here about replacing the coverage that repeal will take away (for 450,000 in Ohio between 2010 and 2015). In February 2015, when it seemed possible that the Supreme Court was going to make the federal Marketplace unworkable and in essence close it, they asked Kasich what he'd do in Ohio, and he replied that he'd "chatted" about that:
we haven't made any determination on that, but—I'm gonna try to avoid your question—I've got good people working on this. We've chatted about this. If the court makes a decision that these exchanges get shut down, then we're gonna have to figure something out in Ohio.
Now he's been running for president for the past year or more and claiming that he has figured out something for the entire nation, and all he can tell us is that he'll use "the Ohio model". Sure.

Or Ted Cruz? Asked by Fox's Brett Baier in a January debate,
if you repeal Obamacare, as you say you will: Will you be fine if millions of those people don't have health insurance, and what is your specific plan for covering the uninsured?”
He replied,
If I am elected president, we will repeal every word of Obamacare. Now, once that is done, everyone agrees we need health care reform. It should follow the principles of expanding competition, empowering patients, and keeping government from getting between us and our doctors. Three specific reforms that reflect those principles: No. 1, we should allow people to purchase health insurance across state lines. That'll create a true 50-state national marketplace while will drive down the cost of low-cost catastrophic health insurance. No. 2, we should expand health savings accounts so people can save in a tax-advantaged way for more routine health care needs. And No. 3, we should work to delink health insurance from employment...
So I guess he would be totally fine with that, because his plan for covering the uninsured doesn't have one word about covering the uninsured.

"Drive down the cost of low-cost catastrophic health insurance" sounds crazy (you just said it was already low-cost), but it seems to be alluding to bringing back a kind of health insurance that the ACA has banned because it isn't coverage, applying only to catastrophic events and not to normal care. "Health savings accounts" are the standard Republican technique of putting your extra money in a tax-deferred place so you don't need insurance, which will save you lots of money if you're wealthy and don't ever need any health care that costs more than you can spare. And "delinking health insurance from employment" (to make your insurance "portable", the rationale says) means getting rid of the ACA's requirement that employers pay for it.  It also doesn't mention preexisting conditions, or Medicaid expansion, or dependents under 26 but over 21. To a great extent, Cruz's program really is that 1990s Heritage Foundation proposal. Each provision clearly leading to more uninsurance, not less.

And in a February interview with Fox News's Chris Wallace,
WALLACE: Senator, the fact checkers say you’re wrong. Since [the Affordable Care Act] went into effect, the unemployment rate fell from 9.9 percent to 5 percent, as 13 million new jobs were created and 16.3 million people who were previously uninsured now have coverage. Now, don’t get me wrong, there are plenty of problems with Obamacare. But more people have jobs and health insurance than they did before Obamacare.
CRUZ: Chris, the media fact checkers are not fair and impartial. They are liberal, editorial journalists. And they have made it their mission to defend Obamacare. 
WALLACE: There’s certainly no question that more people have jobs and more people have health insurance coverage.
CRUZ: Yes, there is question.
So his real plan for covering the uninsured is to deny that Obamacare covered them. It's all a fraud perpetrated by those "liberal, editorial journalists" like Bret Baier and Chris Wallace.

And what about the party's Great White Hope, House Speaker Paul Ryan? He's led the House Republican Caucus or, more recently, the entire House, in repealing Obamacare 62 times since 2011—most recently this last Groundhog Day—so we know he's skilled at that. How's he doing with the replacement part?

Ryan wasn't kidding: just weeks after the Groundhog Day vote, on February 25, Ryan announced a great big step: there's going to be a committee (Tom Price, John Kline, Fred Upton, and Kevin Brady)! They're totally going to come up with something! These guys have already come up with a 250-word mission statement! It's all somewhat not together yet, but it's definitely going to feature—wait for it—"portable" coverage, no mandates, "innovation", unspecified means of "saving" Medicare and Medicaid (saving them from what?! the biggest threat is Republicans), unspecified means of providing care to people with preexisting conditions, and, yes, moar refundable tax credits!

So yes, Robert and Maggie, Trump's health proposal is pretty pathetic, but that doesn't make it unique. It's typical of all this year's (and 2012's) Republican answers to the ACA,
a jumbled hodgepodge of old Republican ideas, randomly selected, that don’t fit together
an incoherent mishmash that could jeopardize coverage for millions of newly insured people
all the way down. And you and your Republican experts shouldn't be implying otherwise.

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