Here is Charles Krauthammers column, my comments as usual are in red.
Single-payer, here we come: The health care revolution in waiting
Repeal-and-replace (for Obamacare) is not quite dead. It has been declared so, but what that means is that, for now, the President has (apparently) washed his hands of it and the House Republicans appear unable to reconcile their differences.
No sir, they were just caught in a moment where they had to act and for once do something but knowing their ultimate goal was Single Payor they believe they acted correctly.
Neither condition needs to be permanent. There are ideological differences between the various GOP factions, but what’s overlooked is the role that procedure played in producing the deadlock. And procedure can easily be changed.
The House leadership crafted a bill that would meet the delicate requirements of “reconciliation” in order to create a more achievable threshold of 51 rather than 60 votes in the Senate. But this meant that some of the more attractive, market-oriented reforms had to be left out, relegated to a future “phase three” measure that might never actually arrive.
If "Phase three" means Single Payor then yes it may arrive but any phase that sends healthcare back to the private market is as DOA as the last bill they "debated".
Yet the more stripped-down proposal died anyway. So why not go for the gold next time? Pass a bill that incorporates phase-three reforms and send it on to the Senate.
Because it might pass the Senate and if it did, Trump would sign it and that's the last thing they need.
September might be the time for resurrecting repeal-and-replace. That’s when insurers recalibrate premiums for the coming year, precipitating our annual bout of Obamacare sticker shock. By then, even more insurers will be dropping out of the exchanges, further reducing choice and service. These should help dissipate the pre-emptive nostalgia for Obamacare that emerged during the current debate.
No way. You can't try to negotiate a near wholesale replacement of health coverage while actuaries are busy constructing rate structures to be approved by state government banking and insurance committees. No, the time is now unless the goal is another charade then yes, by all means wait until September to try and pass a bill that will not become effective until at minimum 2019. By then, the Dems may win the House back and reverse it all....meaning Single Payor is closer than ever.
At which point, the House leadership should present a repeal-and-replace that includes such phase-three provisions as tort reform and permitting the buying of insurance across state lines, both of which would significantly lower costs.
Tort Reform may lower premiums because it would lower reimbursement costs to the doctors because docs would begin to pay less for their own Malpractice coverage. Crossing state lines may increase competition but as long as networks are in place and utilization costs are what they are, there is no guarantee Reciprocity will get us to where we need to be. No, I believe it will end up being a group of issues combined that will help lower rates.
Even more significant would be stripping out the heavy-handed Obamacare coverage mandate that dictates which medical benefits must be included in every insurance policy, regardless of the purchaser’s desires or needs.
Yes, "ala carte" is the new conservative buzzword. Ok, how do you rate that? Where will the actuarial numbers fall on 2,000 potential plan descriptions available and how do you do that on a guaranteed issue system?
Best to mandate nothing. Let the customer decide. A 60-year-old couple doesn’t need maternity coverage. Why should they be forced to pay for it? And I don’t know about you, but I don’t need lactation services.
True but actuarial science may have problems with this.
This would satisfy the House Freedom Caucus’ correct insistence on dismantling Obamacare’s stifling regulatory straitjacket — without scaring off moderates who should understand that no one is being denied “essential health benefits.” Rather, no one is being required to buy what the Jonathan Grubers of the world have decided everyone must have.
This sounds nice and all Libertarian but you will end up running into a form of adverse selection when the folks who need the once mandated "Essential Health Benefits" go to build that new "Ala Carte" plan only to find out that because of utilization ratio numbers, this plan will be monstrously expensive because the odds are the people who buy this plan will use it...a lot. Once again, unchecked utilization with no underwriting to accurately price this plan will cause renewals to spike as they chase prior year losses.
It is true that even if this revised repeal-and-replace passes the House, it might die by filibuster in the Senate. In which case, let the Senate Democrats explain themselves and suffer the consequences. Perhaps, however, such a bill might engender debate and revision — and a possible compromise. This in itself would constitute major progress.
Doubt it. Any attempt to dismantle Obama's legacy will be met with open warfare.
That’s procedure. It’s fixable. But there is an ideological consideration that could ultimately determine the fate of any Obamacare replacement. Obamacare may turn out to be unworkable, indeed doomed, but it is having a profound effect on the zeitgeist: It is universalizing the idea of universal coverage.
Yep and that was the plan all along. We warned you guys but the Wizards of Smart told us we were silly. We told you to watch for Blue Cross. We told you to watch for spiked renewals on plans whose new business numbers were not based on anything in reality. We told you this plan was designed to falter and give Democrats and Single Payor advocates the opportunity to say "well, we did it your way and it failed. Now it's our turn."
Acceptance of its major premise — that no one be denied health care — is more widespread than ever. Even House Speaker Paul Ryan avers that “our goal is to give every American access to quality, affordable health care,” making universality an essential premise of his own reform. And look at how sensitive and defensive Republicans have been about the possibility of people losing coverage in any Obamacare repeal.
And it worked exactly as it was supposed to do. You gave away free stuff to voters and now you want to take that free stuff away. It'll never work. We are stuck. You hate Trump but Trump is the only one who is willing to do battle with an openly hostile press. Congress on the other hand will whimper and run the first time the NY Times editorial board calls one of them "evil, greedy, heartless and a pawn for Big Insurance".
A broad national consensus is developing that health care is indeed a right. This is historically new. And it carries immense implications for the future. It suggests that we may be heading inexorably to a government-run, single-payer system. It’s what Barack Obama once admitted he would have preferred but didn’t think the country was ready for. It may be ready now.
Of course the people think that. You did that when you allowed healthcare to be given away...oops, I mean "subsidized". We are absolutely heading towards a Single Payor system. I have been telling my liberal friends they are looking very foolish with all of their yelling and screaming because the fact is, they won and don't even realize it.
As Obamacare continues to unravel, it won’t take much for Democrats to abandon that Rube Goldberg wreckage and go for the simplicity and the universality of Medicare-for-all. Republicans will have one last chance to try to convince the country to remain with a market-based system, preferably one encompassing all the provisions that, for procedural reasons, had been left out of their latest proposal.
Again, that's the plan. Let the plan fall apart and instead of taking the blame for being the architects, they will simply come up with a new solution which will be the plan they wanted all along...Single Payor. Oh and it will appear like it works because Congress can do something the private carriers can not; deficit spend. Congress will enact Single Payor, take control of those trillions of dollars, decide how they get spent and when they run out of money instead of eliminating plans or going out of business, Congress will raise the debt limit and keep chugging on.
Don’t be surprised, however, if, in the end, single-payer wins out. Indeed, I wouldn’t be terribly surprised if Donald Trump, reading the zeitgeist, pulls the greatest 180 since Disraeli dished the Whigs in 1867 (by radically expanding the franchise) and joins the single-payer side.
Like I said, Chuck. You were warned 7 years ago. You guys chose not to listen.
Talk about disruption? About kicking over the furniture? That would be an American Krakatoa.
Don't blame Trump for nonsense that precedes him by 7 years. You Establishment Republicans had all the time to craft a bill to be ready the moment a Republican is ever elected. You chose not to which tells me one of two things. It is either you are incompetent and have no idea what you are doing or those 68 bills were shams to make it look like you wanted repeal to the gullible voters when in fact Single Payor and the trillions of dollars that would be made available to you was the REAL goal. In either case, we are on to you.
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