Quote of the Day: Seth Meyers On Donald Trump’s Reaction To The Senate Health Care Bill

Senate Republicans today released a draft of their bill to repeal and replace Obamacare, which would cut taxes for richer Americans and insurance companies, and defund Planned Parenthood for one year. The bill is so bad, President Trump said, “Does anyone have any questions for me about Russia?

Alternatively, I could show you my tax returns. Do you guys want to see that?”  –Seth Meyers

(More seriously, not all Senate Republicans were happy with the bill, necessitating a delay in the vote until after the 4th of July recess. Some Republican governors also opposed it.)

Why The CBO Report On The Senate Republican Health Care Bill Is Devastating

The Congressional Budget Office released its scoring of the Senate health care bill. The New York Times summarizes:

The Senate bill to repeal the Affordable Care Act would increase the number of people without health insurance by 22 million by 2026, a figure that is only slightly lower than the 23 million more uninsured that the House version would create, the nonpartisan Congressional Budget Office said Monday.

Next year, 15 million more people would be uninsured compared with current law, the budget office said.

The legislation would decrease federal deficits by a total of $321 billion over a decade, the budget office said.

The results can be seen in the above graph.

The American Medical Association gave this assessment of the bill:  “Medicine has long operated under the precept of primum non nocere, or ‘first, do no harm.’ The draft legislation violates that standard on many levels.”

The increase in uninsured would come from reductions in the number of people covered by Medicaid and by private coverage. Beyond the severe cuts in Medicaid, the Senate bill would provide less assistance in purchasing private plans. One devastating paragraph from the CBO report has been receiving attention:

Under this legislation, starting in 2020, the premium for a silver plan would typically be a relatively high percentage of income for low-income people. The deductible for a plan with an actuarial value of 58 percent would be a significantly higher percentage of income — also making such a plan unattractive, but for a different reason. As a result, despite being eligible for premium tax credits, few low-income people would purchase any plan, CBO and JCT estimate.

The plan also fails to lower premiums for most people, or help to increase the number of insurance plans offered. In other words, it fails to solve the problems which Republicans criticize Obamacare over.

The Republicans face two fundamental problems in trying to develop their own health plan. The first is that Obamacare is essentially the Republican alternative to Hillary Clinton’s health care plan. Obamacare does more than the old Republican plan to regulate insurance companies, but the basic structure is the same. Republicans widely supported the individual mandate and the other aspects of Obamacare which they now attack before it was proposed by Obama. This forces them to come up with something different, and there really are not that many ways to handle health care coverage.

The other problem is that the problems we now see on the individual market were not created by Obamacare. Insurance coverage has always been expensive for those buying coverage on their own, as opposed to being in an employer or government plan, provided that the insurance provided decent coverage. The market has never been able to solve this problem and the only realistic options short of a single-payer plan are ones which involve further government involvement, such as a public option or Medicare buy-in. Republicans are not going to back this.

It is also questionable if enough Republicans will back their current plan for it to even pass in the Senate.

Both Political Parties Have Abandoned Principle

The 2016 election was a low point in our politics, with each party totally abandoning principle. Donald Trump ignored key ideas of the conservative movement, while Hillary Clinton became the establishment neocon candidate, running for George W. Bush’s third term. Newspaper columnists have noted this, with each party vulnerable to criticism for a lack of principles.

At Politico, Bruce Bartlett wrote Trump Is What Happens When a Political Party Abandons Ideas:

…conservatives—who, after all, believe in liberty and a system of checks and balances to restrain the government to its proper role—have plenty of reason to be upset by those actions Trump has taken that transcend our traditional right-left ideological divide. He’s voiced not only skepticism of NATO, but outright hostility to it. He’s pulled America back from its role as an international advocate for human rights. He’s attacked the notion of an independent judiciary. He personally intervened to request the FBI to ease up on its investigation of a former adviser of his, then fired FBI Director James Comey and freely admitted he did so to alleviate the pressure he felt from Comey’s investigation. For those conservatives who were tempted to embrace a “wait-and-see” approach to Trump, what they’ve seen, time and again, is almost unimaginable.

And yet as surprising as this all has been, it’s also the natural outgrowth of 30 years of Republican pandering to the lowest common denominator in American politics. Trump is what happens when a political party abandons ideas, demonizes intellectuals, degrades politics and simply pursues power for the sake of power…

One real-world result of the lobotomizing of conservative intellectualism is that when forced to produce a replacement for Obamacare—something Republican leaders had sworn they had in their pocket for eight years—there was nothing. Not just no legislation—no workable concept that adhered to the many promises Republicans had made, like coverage for pre-existing conditions and the assurance that nobody would lose their coverage. You’d think that House Speaker Ryan could have found a staff slot for one person to be working on an actual Obamacare replacement all these years, just in case.

With hindsight, it’s no surprise that the glorification of anti-elitism and anti-intellectualism that has been rampant on the right at least since the election of Barack Obama would give rise to someone like Trump. Anyone who ever read Sinclair Lewis’ “It Can’t Happen Here,” which imagined a fascist dictator taking power in 1930s America, recognizes that Trump is the real-life embodiment of Senator Buzz Windrip—a know-nothing populist who becomes president by promising something for everyone, with no clue or concern for how to actually accomplish it. Windrip was“vulgar, almost illiterate, a public liar easily detected, and in his ‘ideas’ almost idiotic,” Lewis wrote. “Certainly there was nothing exhilarating in the actual words of his speeches, nor anything convincing in his

While  I might not agree in all of his goals, Bruce Bartlett did express ideas as to what he wants the Republican Party to represent. The Democratic establishment lacks such a vision. Hillary Clinton’s campaign suffered from never being able to express a good reason why she should be present beyond the mistaken view that it was her turn. Democrats have lost every special election, most recently in Georgia with a centrist campaign which failed to stand for anything. Their strategy is limited to attacks on Trump, and raising hysteria about Russia which has gained no political traction.

Dan Baltz wrote in The Washington Post that Beyond opposing Trump, Democrats keep searching for a message:

The loss in last week’s special congressional election in Georgia produced predictable hand-wringing and finger-pointing inside the Democratic Party. It also raised anew a question that has troubled the party through a period in which they have lost ground political. Simply put: Do Democrats have a message?

Right now, the one discernible message is opposition to President Trump. That might be enough to get through next year’s midterm elections, though some savvy Democratic elected officials doubt it. What’s needed is a message that attracts voters beyond the blue-state base of the party…

History says a president with approval ratings as low as Trump’s usually sustain substantial midterm losses. That could be the case in 2018, particularly if the Republicans end up passing a health-care bill that, right now, is far more unpopular than Obamacare. But Trump has beaten the odds many times in his short political career. What beyond denunciations of the Republicans as heartless will the Democrats have to say to voters?

Though united in vehement opposition to the president, Democrats do not speak with one voice. Fault lines and fissures exist between the ascendant progressive wing at the grass roots and those Democrats who remain more business-friendly. While these differences are not as deep as those seen in Trump’s Republican Party, that hasn’t yet generated a compelling or fresh message to take to voters who aren’t already sold on the party.

Hillary Clinton, whose rhetoric often sounded more poll-tested than authentic, never found that compelling message during her 2016 campaign. She preferred to run a campaign by demonizing Trump and, as a result, drowned out her economic platform. This was a strategic gamble for which she paid a high price…

The long-running debate over the Democrats’ message probably will intensify as the party looks to 2018 and especially to 2020. It is a debate that the party needs. Democratic pollster Stan Greenberg, writing in the American Prospect, sees a problem that goes beyond white working-class voters to those within the Democratic base who also were left behind by the post-2008 economic gains. He argues that the party’s problem is with working-class voters of all types, not just whites.

Greenberg has long been critical of the tepidness of the party’s economic message and puts some of the blame on Obama. He believes the former president’s economic message in 2012 and 2016 focused on progress in the recovery largely to the exclusion of the widespread pain that still existed. “That mix of heralding ‘progress’ while bailing out those responsible for the crisis and the real crash in incomes for working Americans was a fatal brew for Democrats,” he argues.

For progressives, the answer to this problem is clear: a boldly liberal message that attacks big corporations and Wall Street and calls for a significant increase in government’s role in reducing income and wealth inequality. Sen. Bernie Sanders (I-Vt.) has been aggressive in promoting exactly that, as he did during the 2016 campaign, with calls for a big investment in infrastructure and free college tuition at public colleges and universities. He has said he intends to introduce legislation he calls “Medicare for All.”

Unfortunately, as has been the case in many articles of this nature which point out the lack of a message from the Democrats, Baltz ignored some key matters. Americans have become so accustomed to the wars started under George Bush and continued under Barack Obama that this was barely mentioned during the campaign. Even worse, Hillary Clinton has backed far further military interventionism than has been supported by Barack Obama–or George Bush and Dick Cheney.

It is sad that Reaganite Bruce Bartlett wrote that conservatives “believe in liberty and a system of checks and balances to restrain the government to its proper role,” but we see little concern among Democrats regarding these matters. Democrats don’t even think of opposing the increase in government surveillance and restrictions of civil liberties in the name of supposedly fighting terrorism. Neither major party candidate had any respect for First Amendment liberties, and Clinton has a far right record in backing restrictions.

With neither party standing for anything, we are seeing an unprecedented degree in dissatisfaction with both major parties, with a recent icitizen poll showing that, “seven in 10 Americans believe the two major parties do not represent them well and that a third party is necessary.” While Hillary Clinton calls third party voters crazy, showing a disdain for democracy in attacking voters for being unwilling to vote for her, this might be the only principled option unless the major political parties are reformed. One of the most vile arguments from establishment Democrats is that we must vote for the Democrats as lesser of two evils to stop Republicans while ignoring the evil promoted by their own party. This is a sick argument to say that we should have voted for a corrupt war monger like Clinton, endorsing her wars, right wing views on the First Amendment, and economic policies, while ignoring how she has used government positions to amass a fortune through influence peddling. Voting for the lesser of two evils over the years has only led to increasing how evil the nominees of both parties are.

Republicans Vote To Deny Health Care Coverage To Millions But It Is Far From Certain That Democrats Can Take Advantage Of This

The lie of the week is that the Republican-controlled Congress voted to repeal and replace Obamacare. Repeal yes, but the law they passed is too worthless to seriously be called a replacement. Republicans voted to deny health care coverage to millions, and to open the door for insurance companies to deny coverage for preexisting conditions. Doctors, insurance companies, hospitals, AARP, and many consumers groups are unified in opposing this legislation. Fortunately even some Senate Republicans realize that this is a terrible plan and want to start from scratch.

To summarize the effects of the House plan:

  • Tax cuts for the wealthy–always a Republican priority
  • Defunds Planned Parenthood for one year
  • Allows older Americans to be charged more
  • Cuts benefits to Medicaid recipients
  • Cuts school services for disabled children
  • Could weaken employer sponsored health care along with plans sold on the exchanges, including removing coverage for the essential health benefits now in Obamacare, and removing prohibition on annual limits of coverage

The House plan could return us to the days when insurance companies made their profits by taking in premiums but finding ways to avoid paying out money on claims. Only selling insurance to the healthy very well could result in lower premiums, but this defeats the purpose of having health insurance. Republicans claim to be funding high risk pools to care for those with preexisting conditions, but they are only providing funding to cover five percent of those with preexisting conditions.

Of course, this will depend upon what happens in the states, and how many red states actually do opt out of the current requirements. Scott Walker has already stated he might apply for a waiver for coverage of preexisting conditions in Wisconsin.

Democrats are excited that this will help them politically, with some saying that the GOP just doomed itself. Even those who support many of the GOP goals see this plan as being politically damaging for Republicans.

Health care should dominate politics in upcoming cycles, but Democrats cannot count on this by itself being the key to retaking control of the House. Democrats need to keep up the pressure and do a far better job of making their arguments than they did when the Affordable Care Act was initially passed. It is questionable if anything resembling the House plan will ever pass the Senate and become law. (Presumably Donald Trump will sign whatever the Republicans pass, regardless of how much it violates his campaign promises).

Democrats could have the same problem in capitalizing on this as they did in promoting Obamacare. While some might lose insurance coverage immediately, many others might feel safe, not realizing that developing a medical problem could put them at risk of losing coverage in the future. Some will even be happy as young, healthy people very likely could wind up paying less–as long as they remain young and healthy. The adverse effects of this law won’t be fully apparent in 2018.

The Democrats could also lose due to their political cowardice. During the 2016 presidential campaign, Hillary Clinton opposed Bernie Sanders’ proposal for Medicare for All. Truthout debunked Clinton’s arguments. Now Nancy Pelosi and the Democratic establishment are refusing to take this opportunity to push for a single payer plan. The Observer’s view of Pelosi and mainstream Democrats is quite close to that expressed previously by Truthout:

Their failure to support a proposal that the majority of their base wants illuminates the growing disconnect between elected officials and their constituents and the massive influence of the health insurance and pharmaceutical industries. Americans want single payer health care, and the obstacles blocking them from the system they want are special interests, which are bought and paid for Democrats in office who avoid taking principled stances on issues. Democrats like Pelosi don’t stand for anything because fighting for something like single payer health care would upset the party’s wealthy donors.

Pelosi’s and other Democrats’ arguments excuse themselves from supporting progressive policies and reaffirm the Democratic Party as a corrupt entity tied to the wealthiest 1 percent of Americans. On May 1, the Washington Post reported a poll conducted in January among Trump voters who had previously voted for Obama. When those polled were asked what the Democratic Party stands for they gave responses like, “The 1 percent,” “The status quo” and “They’re for the party. Themselves and the party.” One woman, asked whether the Democratic Party is for people like her, flatly declared, “Nope.”

As Donald Trump has learned, health care is complicated. You cannot reduce costs without reducing coverage, unless you make fundamental changes in the system. The most obvious way would be a single payer plan which both removes the huge profits of the insurance industry and places everyone in the same risk pool. In hiding from this reality, Democrats show why they tend to lose and Republicans have been winning. Republicans did not care that their ideas have been far out of the mainstream. They pushed their ideas until they won over enough people to win, even if it has been on fallacious arguments. The party which stands for something, regardless of what it stands for, has an advantage over a party which stands for nothing. Thus we have seen the Democratic losses in 2010, 2014, and now 2016.

Quote of the Day: Conan On Neanderthals

A new study says that the first humans to arrive in what is now North America may have been Neanderthals. Apparently they came here to vote in the 2016 election. –Conan O’Brien

Late Night Comedians On Republicans & Internet Privacy

Yesterday, the House of Representatives voted to get rid of internet privacy rules. Members cast their vote, then immediately ran home to delete their browser histories. –Conan O’Brien

I guarantee you there is not one person, not one voter of any political stripe anywhere in America who asked for this. No one in America stood up in a town hall and said, ‘Sir, I demand you let somebody else make money off my shameful desires. Maybe blackmail me someday.’ –Stephen Colbert

Aren’t we passed this point now? Our phones are already spying on all of us. Today I just looked at a bowl of fruit and two minutes later my Facebook page was covered with ads for Banana Republic–James Corden

This bill has been passed by the House and the Senate and will now go to Trump for signing. And Trump says he is going to sign it, because remember, privacy only matters when we are talking about his tax returns. –James Corden

Another Prediction That Trump Could Cost Republicans Control Of The House

The failure of Donald Trump to repeal and replace Obamacare, as he repeatedly claimed he would do as soon as he took office, has led to a further deterioration in public perceptions of Trump’s job performance, and risks hurting the entire Republican Party. I have previously looked at predictions that a low approval rating for Trump could cost Republicans control of the House. National Journal has another prediction that Dems Could Take House in 2018:

Demo­crats now have a real­ist­ic shot at re­tak­ing the House in 2018. Each of the past three midterm elec­tions have swung wildly against the party in power—re­flect­ive of the long­stand­ing dis­sat­is­fac­tion of voters to­wards polit­ic­al lead­er­ship, no mat­ter who’s in charge. Trump’s job ap­prov­al rat­ing is hov­er­ing around 40 per­cent, a tox­ic level for the dozens of Re­pub­lic­ans run­ning for reelec­tion in swing dis­tricts. Re­pub­lic­ans would be fool­ish to as­sume that Pres­id­ent Obama’s co­ali­tion of mil­len­ni­als and non­white voters—many of whom stayed home in past midterm elec­tions—re­mains dis­en­gaged giv­en their aver­sion to Trump.

Polit­ic­ally speak­ing, the health care bill couldn’t have been more dam­aging for Re­pub­lic­ans. In a dis­cip­lined Con­gress, safe-seat Re­pub­lic­ans would be more will­ing to take risky votes so those in com­pet­it­ive seats could main­tain some in­de­pend­ence from the party. But this time, hard-line con­ser­vat­ives in the Free­dom Caucus de­clared their un­stint­ing op­pos­i­tion early on, for­cing some vul­ner­able Re­pub­lic­ans to go on re­cord in sup­port of the un­pop­u­lar le­gis­la­tion—which didn’t even come to a vote. Adding in­sult to in­jury, Trump bragged on Twit­ter that the health care ex­changes would col­lapse as a res­ult of his in­ac­tion—the worst pos­sible mes­sage to send to any­one who viewed Trump as a can-do ex­ec­ut­ive…

There are already signs that Trump’s sag­ging ap­prov­al rat­ing is rais­ing the pos­sib­il­ity of a stun­ning up­set in an up­com­ing con­gres­sion­al elec­tion in sub­urb­an At­lanta. The race, to fill the va­cant seat held by Health and Hu­man Ser­vices Sec­ret­ary Tom Price, couldn’t be more rel­ev­ant to the health care de­bate. One pub­lic poll shows the Demo­crat­ic front-run­ner, Jon Os­soff, nar­rowly lead­ing sev­er­al of his GOP op­pon­ents in a run­off—this in a con­ser­vat­ive dis­trict that has elec­ted Re­pub­lic­ans to Con­gress for over four dec­ades. Fear­ing an em­bar­rass­ing de­feat, the party’s lead­ing House su­per PAC is spend­ing over $2 mil­lion on at­tack ads con­nect­ing Os­soff with Nancy Pelosi.

Of the 36 at-risk House Re­pub­lic­ans, ac­cord­ing to The Cook Polit­ic­al Re­port’s rat­ings, 28 rep­res­ent urb­an or sub­urb­an dis­tricts where Trump isn’t par­tic­u­larly pop­u­lar. In last year’s elec­tion, most of these GOP rep­res­ent­at­ives sig­ni­fic­antly out­per­formed Trump as voters dis­tin­guished between the pres­id­en­tial nom­in­ee and the re­cord of their own mem­ber of Con­gress. But with Trump as pres­id­ent, that dis­tinc­tion is harder to make…

Demo­crats need to net 24 seats to win back the House ma­jor­ity, which sounds a lot more im­pos­ing than it ac­tu­ally is. As polit­ic­al ana­lyst Nath­an Gonzales noted in a re­cent column, the pres­id­ent’s party has lost House seats in 18 of the last 20 midterms, with an av­er­age loss of 33 seats in those 18 los­ing cycles. Two of the most im­port­ant big-pic­ture factors—pres­id­en­tial ap­prov­al and par­tis­an en­thu­si­asm—are now point­ing against the GOP.

Un­der nor­mal cir­cum­stances, Re­pub­lic­ans would ex­per­i­ence some early gov­ern­ing suc­cesses and rally be­hind their pres­id­ent. With Trump, Re­pub­lic­ans have come up empty-handed so far. We’re more than a year away from the next big elec­tions, but there are already signs that a Cat­egory 5 hur­ricane is build­ing.

The Republicans risk further losses following their defeat on health care. Trump continues to lose credibility, and is losing in his attacks on the press. Many sources, including The Wall Street Journal, have discussed the difficulties they will have on rewriting the tax code. Trump’s executive order to reverse Barack Obama’s efforts to fight climate change could also turn out to harm Republicans. The New York Times, in an editorial describing the harm which Trump’s actions will do, concluded in noting the possible public opinion backlash:

And then there is public opinion. It punished the Republicans severely in 1994 when Newt Gingrich and his allies tried to roll back environmental laws. It punished them again in 2008 after eight years of denialism and prevarication on climate change under George W. Bush and his fossil fuel acolyte, Dick Cheney. There is time enough before Mr. Trump’s ignorance translates into actual policy for the public to make its opposition to this anti-science agenda felt again.

It is possible that the Democrats might benefit from Trump’s unpopularity regardless of what they do, but it must also be kept in mind that the Democrats did lose to Trump in 2016 despite all the blunders from Trump during his campaign. That might be written off as the consequence of the Democrats fielding a weak candidate against him, but it also must be kept in mind how the Democrats also  lost badly in 2010 and 2014 when they ran as a Republican-lite party. The Democrats need to have the courage to stand for something, giving voters a positive reason to vote for them rather than counting on dislike of Republicans to be enough.

Republicans Out Of Step With Majority On Transgender Bathroom Laws

Texas is considering following North Carolina in passing conservative legislation regarding transgender bathroom use, but Republicans remain out of step with the majority of the country in caring about which bathroom people use. Reuters reports:

Fifty-three percent of the Americans surveyed oppose laws requiring transgender people to use bathrooms that correspond to their sex at birth, according to the national poll by the Public Religion Research Institute.

The survey showed that 39 percent of respondents favored such laws, and almost one in 10 of the 2,031 adults surveyed in February by telephone had no opinion.

The issue of transgender bathroom rights has become the latest flashpoint in the long U.S. battle over lesbian, gay, bisexual and transgender rights.

Significant partisan divisions remain, the survey found. While 65 percent of Democrats and 57 percent of independents oppose laws limiting transgender bathroom rights, 59 percent of Republicans support the laws, according to the poll. Thirty-six percent of Republicans oppose them.

“This is a case where it really is Republicans kind of pulling away and being more of an outlier to the rest of the country,” said Robert P. Jones, chief executive of the Washington-based group.

Public opinion also has gone heavily against conservative Republicans on same sex marriage with  63 percent in support, increased from 52 percent in a 2013 poll. Even a majority of Republicans under the age of 50 support legal same-sex marriage.

The Republican Health Care Plan Screws Many To Help Very Few

It looks like Republicans think that America has been demanding a new health care plan which will greatly reduce the number of people who are insured, increase costs for poor and older Americans, destabilize the individual insurance market, and cut taxes for the wealthy. While waiting for the CBO scoring, the Brookings Institute has made their calculations as to how terrible the Republican health care bill is, predicting that at least 15 million people will lose health care coverage:

There is significant uncertainty about exactly how CBO will model these provisions and how it will expect the various provisions to interact with one another. Nonetheless, we conclude that CBO’s analysis will likely estimate that at least 15 million people will lose coverage under the American Health Care Act (AHCA) by the end of the ten-year scoring window. Estimates could be higher, but it’s is unlikely they will be significantly lower.

 

Many will suffer from the cuts to Medicaid. Many of those who purchase private coverage on the exchanges will suffer because of how the subsidies are restructured, based on age as opposed to income and the actual costs of insurance. The Kaiser Family Foundation has posted projections regarding this.

Medical organizations and those representing the elderly including AARP, the American Medical Association and the American Hospital Association have objected to the Republican plan. AARP issued a statement opposing the “House plan that would make changes to our current health care system, such as shortening the life of Medicare, hiking costs for those who can least afford higher insurance premiums, risking seniors’ ability to live independently, and giving tax breaks to big drug companies and health insurance companies.”

The less affluent voters who backed Trump will be hurt by the changes. Of course some people do benefit. “Nearly everyone in the Top 1%, who earn more than $774,000 a year, would enjoy a hefty tax cut, averaging $33,000, according to the non-partisan Tax Policy Center. Those in the Top 0.1% would get an average tax cut of about $197,000.” Insurance companies also benefit:

Obamacare allowed insurance companies to deduct only $500,000 of their executives’ pay as a business expense. The GOP bill would repeal that limitation, starting in 2018.

Top insurers pay their leaders millions in compensation every year so this provision could mean a nice tax savings for the companies.

One excuse given by Republicans for repealing Obamacare is the increased cost of premiums. However, most people receive health care coverage through either government programs or employer programs, which have not had major increases in premiums. The individual market had frequent jumps in premiums, and that has continued, except under Obamacare most people receive subsidies to help cover this. As a consequence, only about three percent of the country is actually facing the increases in premiums which Republicans are using to justify their plan. In return, we receive more comprehensive coverage which cannot be denied based upon medical problems.

As one of the three percent who purchases health insurance without qualifying for subsidies, I certainly do not see the Republicans as doing me any favors. My premiums will be higher under the Republican plan than they are now, and the even bigger problem is that the plan may “threaten the stability of the individual market” per the Brookings report, possibly making it impossible to obtain coverage.

 

Discussing Obamacare Replacement With A Republican Congressman

House Republicans have finally released their plan to replace Obamacare. I have a lot of concerns about the plan, such as whether the tax credits will be sufficient for low income families to afford health insurance, and their attack on Planned Parenthood.

I am going to wait until I have a chance to look at the details of the plan to discuss it in depth, but for other reasons I have found it a good day to blog about health care. Hours prior to the release of the plan, I met with my conservative Republican Congressman, Bill Huizenga, along with a few colleagues, to discuss health care. I figured it would be futile to change the mindset of a conservative Republican, but when I received the invitation I also thought I should make the attempt to try to explain how health care really works. After all, there is zero chance of changing anyone’s mind if no attempt is made to persuade them. I was also appreciative that he was willing to meet with a group which strongly disagreed with him on the issue, while many Republicans around the country are reportedly hiding from their constituents.

The first time I spoke today I made a point of explaining how I am self-employed and have purchased health care on the individual market for my entire life. Therefore I could definitely state that high premiums and high out of pocket expenses, often cited as a failing of the Affordable Care Act by Republican, have always been a characteristic of the individual market–and are not something created by Obamacare.

Discussion got bogged down for quite a while over philosophical issues, especially when someone referred to health care as a right. Congressman Huizenga disagreed. While I managed to get out most of what I wanted to say today, in a conversation with multiple people present, sometimes the topic changed before I got a chance to speak. I didn’t get a chance until after the meeting while speaking to a colleague that I can understand a Republican’s position in not seeing health care as a Constitutional right in the same way as civil liberties specifically expressed in the First Amendment. After all, the Founding Fathers would have never conceived of health care being as expansive, and expensive, as it is now. However, regardless of whether you want to call it a right, access to affordable health care is both highly desirable, and something which is expected in a modern, advanced, industrialized society such as the United States. We should do it regardless of whether you want to label it a right.

The limited nature of assured coverage in the United States, compared to the rest of the world, was an underlying thought in many of our comments. It did come up that 1) the sick can show up to the Emergency Room and will not be turned away and 2) a significant portion of the Medicare population consists of the disabled. In typical Republican dodging of the issue, the Congressman at one point tried to claim that this does provide some form of basic health care as people can go to the Emergency Room. I pointed out that it is one thing to receive coverage in the Emergency Room, but this does not mean that people will receive necessary follow up medical care, especially for the types of chronic medical conditions I typically treat, such as diabetes, heart failure, and emphysema. Initial stabilization in an Emergency Room is both costly and not adequate health care. Plus an Emergency Room physician present pointed out that being seen does not mean patients do not receive large bills, which could be well beyond their ability to pay.

Congressman Huizenga responded that the disabled can receive coverage on Medicare, but I pointed out that people with chronic medical problems are not necessarily disabled, especially if they receive adequate medical treatment. Someone with diabetes, for example, can live and work for many years with the condition. However, without adequate care, twenty years down the road they are far more likely to develop problems such as heart attacks, strokes, and renal failure.

The Congressman’s philosophy on limited government (which, like most Republicans, is terribly selective, ignoring everything from infringements on reproductive rights to today’s revised anti-Muslim travel ban), also influenced his responses. Before his arrival I had discussed with others how market solutions have not worked well, with insurance companies having developed a business strategy based upon collecting premiums and then finding ways to deny care. Congressman Huizenga brought up irrelevant matters such as restrictions on choice present in Canada and other countries which Americans might not tolerate. The typical Republican scare stories. My response was simply that we do not have to adopt the restrictions which he mentioned, regardless of what other countries have done. One point I did not manage to get in was that in the United States, private insurance plans are often far more restrictive on the choices which patients and physicians can make than the government Medicare program is.

The physicians present generally saw Obamacare as an improvement over the previous system, but not going far enough, with Medicare for All being seen as a preferable solution. As a couple of us discussed afterwards, this is a far easier sell for physicians, who see first hand the amount of time and money wasted in having to deal with multiple different insurance companies, with  multiple different sets of rules. Plus this has the huge advantage of taking the astronomical profits received by the insurance industry, and using that money to actually provide health care. (Medicare for All was promoted by Bernie Sanders in the 2016 nomination battle, leading to politically-based opposition from Hillary Clinton.)

If Medicare for All is too hard a sell immediately, I, and others, suggested phasing it in. I also mentioned ideas such as the public option and the Medicare buy-in which were considered when the ACA was being written, but died when the two most conservative Senators voting with the Democrats (Joe Lieberman and Ben Nelson) opposed the ideas. Either would help with the high costs on the individual market.

The  higher cost for caring for older individuals, with some of that cost spread to the premiums of younger purchasers, is a major problem in health care coverage.  I doubt insurance companies even want to cover their older customers, who are responsible for the bulk of their costs. Either outright lower the Medicare age (even if gradually, such as initially to 50 or 55, and ultimately to around 40) or allow a Medicare buy-in.

After the Congressman left, his Legislative Director remained for a brief time and suggested that Americans would not go for expanding a government program such as Medicare. While a typical Republican thought, it does not hold up. I pointed out that we all do wind up on a government program, with most people going on Medicare at age 65. Not only are Americans failing to rebel at the though of going on Medicare at age 65, many look forward to the opportunity. Remember all those tea party protests with signs like “Keep Government Out Of My Medicare.”

My parting comment to Congressman Huizenga before he left was that Republicans must move beyond their anti-Obama rhetoric and actually address the problem. I related how for the past eight years I have often heard patients blame Obama for anything wrong with the health care system, even if it was over matters not even related to the Affordable Care Act. However, in early January, before Donald Trump even took office, I started to hear patients blame Trump for their healthcare problems. Republicans now “own” healthcare and must deliver.

I have my doubts as to whether the plan released today does deliver, but I do want to take a look at the details beyond what is in the initial news stories I have read.