Trumpcare Unveiled

[WillBrink]

The CBO has scored Trumpcare. According to their estimates, it will increase the number of uninsured by some 20 million over the next decade mostly by limiting the expansion of Medicaid. Since Medicaid is largely paid by the federal government, this will reduce the budget deficit by $330B.

Now, a couple of points.

1) Very few people will actually lose insurance. That is because Medicaid is not insurance; it is a payment plan where the government picks up the tap and below market rates for most treatment.
2) There is not a lot of evidence that further expansions of Medicaid are cost effective or change clinical outcomes. A NEJM article looking at the Oregon experience showed that a couple years after that state expanded Medicaid, healthcare utilization went up, but outcomes were actually flat. This is not all that surprising to me since our country consumes healthcare resources at a remarkable rate compared to the rest of the world but our outcomes are not dramatically better than other developed countries. That is because the driving factor behind healthcare outcomes is personal behavior, and simply adding more use of doctors and medications are not going to overwhelm a personal choice to engage in unhealthy behaviors. Thus, curtailing Medicaid is not a bad thing; it is in fact necessary for our survival.
3) Trumpcare does very little to change the trajectory of healthcare cost. The will be some modest dip, but it's cost savings are delayed. That is largely because of a) the prohibition against insurers discriminating against those with pre-existing conditions is maintained, and b) the need for cost sharing to cover the losses from those with Medicaid or no coverage.
4) The CBO analysis may be wrong. The CBO is very weak at dynamic analysis and can only score what it sees on paper. Thus, it overestimated the number of people who would be covered by Obamacare and may underestimate the number of people who will be have decent access to healthcare provided by Trumpcare.

Without cost containment of some type, be it by market forces or regulation (I know, a dirty word), or combination of both, it will be short term improvements at best, or none at all. Each industry passes the buck and blame as to who is driving costs. As you and others have said, also includes expectations of people who want latest greatest tech to diagnose all aches and pains, etc.

[TAZ]

It sounds like this bill it toast. Ryan will take most of the blame, Trump will get his nose bloodied a little, and some of you will likely get screwed as Obamacare continues its downward spiral.

Trump should hold a press conference (or Tweet) tomorrow morning that he is calling on the House to retract the healthcare bill since the Dems plan to filibuster Gorsuch. Once the Senate unleashes the nuclear option for Gorsuch, it will be much easier to do the same for a more aggressive healthcare bill.

Call me a pessimist, but this is exactly what was planned. He tried to fix healthcare, but congress didn't go along with him. Political posturing. Obamacare, TrumpCare, Ryancare, whoever care are all destined to fail. It's just how steep an angle they take when augering the healthcare system into the ground.

Unless the government can figure out how to turn shit into diamonds there is no way to economically sustain paying for advanced healthcare for a higher and higher % of the population. We are all living longer and as we age we draw on the system so we can live longer. People retire and move onto Medicare/Medicaid and suck the government tit dry living into their nineties having cataracts surgery, artificial joint implants, open heart surgery and god knows what else. I'm no economist, but even I can figure out that when you have a HUGE imbalance of withdrawals vs deposits bad stuff happens.

We will have single payer soon enough and then EVERYONE except the political elite will have VA style crap care and go back to dying from previously curable conditions. Either that or we are going to have a retirement type system where if you don't save in your youth you're going to suffer after retirement.

[austinN4]

Either that or we are going to have a retirement type system where if you don't save in your youth you're going to suffer after retirement.

^^My choice as I did scrimp and save in my youth. Tired of paying for those that didn't.

[skywalkrNCSU]

Maybe we should look to implement policies that address the supply side vs always looking at the demand side

[Averageman]

The Federal Government needs to understand that they aren't good at this and back out with a bill that returns the system to a somewhat pre Obama-Care condition. The problem seems to be that Obama-care passed in the first place, the Federal government made a promise and the promise is circling the drain for many reason.
It's not as difficult to knock some of the cost out for healthcare for most people who want insurance in the United States.
Deregulate Health Insurance so that it can be sold across State Lines.
Allow small Business's to band together and buy at the rates of larger business's.
Turn the Business of providing care for the poor and elderly who cannot afford insurance over to the States.
Allow all monies spent on Health Care and Insurance to be Tax Free. This would include charitable monies given to folks to help cover pre existing condition expenses.
Streamline the FDA drug approval process and allow terminal patients to "volunteer" to be a part of these programs.
Allow Emergency Rooms to turn away those with non life threatening cases.
Tort Reform.

That seems pretty common sense and a good place to start.
The problem is many people want Health Care, but don't want to either pay for Health Care or do the necessary things to stay healthy.

[tb-av]

http://www.redstate.com/sweetie15/20...enate-written/

Cruz confirmed what I suspected, the House's original turd sandwich can't pass the Senate. In fact, I doubt it would pass the House. However, I'm anxious to see the final version that comes to a floor vote.

Sensei, have you heard, read anything lately from Dave Brat regarding all this. He seems very level headed but he is also not talking in specifics of health care. He's speaking from an economics point and also from the point of don;t hang the loss of health care around the Rs neck. IOW he is saying that if not careful all will collapse and be hung around Trumps neck... which I am sure would please every Dem and 50% of Rs... but aside from that I was wondering if you had any thoughts on where he's coming from. He doesn't seem to have an agenda other than to say hold up, we can do this, but it has to be done in certain order to work, otherwise it will likely go wrong in a bad way. I can't really follow it. I'll try to find a few links from him. Just curious if you have heard him and think he's on the right track, or is even defining his track for that matter. Again, this over my head real fast.

https://www.youtube.com/watch?v=acrsrc4AEEI

https://www.youtube.com/watch?v=JRlBiVIo-5A

https://www.youtube.com/watch?v=fQKIeO11Yg4

https://www.youtube.com/watch?v=a12blRpydPo

[Alex V]

Looks like the bill was pulled from the house floor.

This looks like a major failure for Ryan. He needs to stop being a RINO and get a real repeal and replace bill in there.

[Sensei]

Sensei, have you heard, read anything lately from Dave Brat regarding all this. He seems very level headed but he is also not talking in specifics of health care. He's speaking from an economics point and also from the point of don;t hang the loss of health care around the Rs neck. IOW he is saying that if not careful all will collapse and be hung around Trumps neck... which I am sure would please every Dem and 50% of Rs... but aside from that I was wondering if you had any thoughts on where he's coming from. He doesn't seem to have an agenda other than to say hold up, we can do this, but it has to be done in certain order to work, otherwise it will likely go wrong in a bad way. I can't really follow it. I'll try to find a few links from him. Just curious if you have heard him and think he's on the right track, or is even defining his track for that matter. Again, this over my head real fast.

https://www.youtube.com/watch?v=acrsrc4AEEI

https://www.youtube.com/watch?v=JRlBiVIo-5A

https://www.youtube.com/watch?v=fQKIeO11Yg4

https://www.youtube.com/watch?v=a12blRpydPo

I think that Brat is essentially correct but sometimes intentionally vague. Let's be honest. When he says things like "remove regulations" and "a free market solution" he is referring to the regulation that requires insurers to offer coverage despite pre-existing conditions. This specific regulation is why healthcare premiums went way up after the ACA's passage. Imagine what would happen to your auto insurance premium if companies like Allstate had to offer equivalent cost coverage to everyone regardless of driving record, DUI history, age, etc.

Trumpcare keeps this provision and it goes back to Trump promising everyone great coverage back in the campaign. Well, this the a sticking point for the Freedom Caucus because that one provision in Trumpcare essentially kicks the rising cost time bomb down the road a decade longer than Obamacare (Trumpcare buys some time by removing other regulations in keeping a quasi employee mandate). However, Brat and other Freedom Caucus members are afraid to mention this particular regulation by name because it has become a defacto entitlement that is popular with the Free Shit Army which is comprised of soldiers with a bunch of pre-existing conditions.

[Averageman]

Looks like the bill was pulled from the house floor.

This looks like a major failure for Ryan. He needs to stop being a RINO and get a real repeal and replace bill in there.

For this to work Ryan is going to have to get over himself.
There is no reason why after seven years of saying they were going to repeal this the GOP hasn't gotten on the same sheet of music.
Don't try and fix the ACA, repeal it.
Come up with something that would fix the issues that 85% of the American Citizens have with affordable medical care. Work together, include all other members of the GOP and push forward.
Instead Paul wants to spike that ball.
This whole thing and the way Ryan is handling it, leads me to believe Tax Reform and a real budget are going to end up the same way.

[glocktogo]

I have no faith or confidence that Paul Ryan will accomplish anything, ever.