Thursday, January 5, 2017

Trump tweet slows GOP down on ACA repeal & replace


Looks like the Trump tweet yesterday telling them to 'be careful';





... slowed the GOP down to take some more time to let the Dem's ACA play out this year for a while... fiscal status quo on Healthcare for now as GOP gets some more kicks in...


Ryan: "If you have a massive deductible it doesn't really feel like you have insurance in the first place..."





37 comments:

Tom Hickey said...

Still no GOP plan to replace.

Actually, the ACA was the GOP plan that the Heritage Foundation developed and Mitt Romney put in place in MA.

Original 1989 document where Heritage Foundation created Obamacare’s individual mandate

The choices are:

1. Go back to the old system in which many people re uninsurable other than at unaffordable rates and provide "universal access" though emergency rooms.

2. Adopt an individual mandate like the Heritage plan.

3. Have states fund state programs with with taxes

4. At least partially fund state programs with federal block grants.

5. Some combination of 2, 3 and 4. ("shared burden")

6. Federally funded single payer — Medicare for all.

Penguin pop said...

If Trump had any sense, he'd figure out a way to push public option or single payer through and call it TrumpCare and package it in such a way that the GOP won't even care about what was passed. He can be THE president to sign single payer into law, though I imagine that would only happen if there were enough people protesting for it and if Bernie Sanders had more clout in getting him to consider it.

The other likely option is either #4 or #5.

Matt Franko said...

With insurance schemes you cant have an "Individual Group" its like an oxymoron in the first place... my state splits out the "individuals" into their own "group" so we are looking at a 33% increase in that 'individual group' while the small business group actually went down this year and we actually got a small refund on premiums for the past year as they didnt spend 80% on direct care here in my state so they have to refund the amount under 80%...

Textbook bad use of math 101 as usual....

The best people to get involved are MDs and actuaries if you are going to do it via an insurance scheme... and everybody has to be in a large group for insurance type thing to work...

Population of the group probably must be in the denominator of the equation to compute premium in some way... ie larger the denominator the lower the premium...

Best to get qualified people involved as usual if you want to be successful... doesnt look like Gruber had the correct training...

Penguin pop said...

Think about what this would do for his ego. That's what he craves more than anything. Approval, approval, approval. It's what he's been trying to do for his entire life.

John said...

Trump doesn't have a replacement! His whole first year is going to be a mess! If he gets there...because UK television is going heavy with the fake news that ALL the US intelligence agencies preparing to OFFICIALLY point the finger at Putin.

What is this, some lame dumbass ham-fisted coup? If so, this is the dumbest cockamamie coup in history, and US agencies are the world heavyweight champion's at cockamamie coups. This may just be a shot across the bows, which spells real trouble. This is Trump they're dealing with! He holds grudges about jokes (his alleged small fingers) for decades! And he's crazy enough to go to war with these guys!

I need to buy a nuclear shelter, canned goods, ammo, oh a gun, and some gold from Peter Schiff. This is turning nasty!!!

Matt Franko said...

With the single payer they can call and bill for unnecessary/marginal procedures and run up the bill... this is what they do now with the single payer...

So the debt morons cut the reimbursement for an MRI so the doctors are regularly briefed on YoY revenues vs. what the yearly nut is of the provider system so they add an xray or CAT scan to the MRI and get revenues back up when they fall behind what they need for $$$ flow to operate the system...

these people are not stupid...

John said...

Penguin,

If Trump did that, he'd go down as the greatest prez ever and he'll win hands down in 2020. He'll never do that, although I have a sneaking suspicion that he favours single payer. He knows it works better than any other system. The GOP would go to war with him and the mad right would howl COMMUNISM or anything they think is worse like POL-POTISM.

As I said above, it looks like all the intelligence agencies, state and DoD are going to officially state that Putin undermined the general election. They don't need to say that it favoured Trump. It's implied. What's also implied is that Trump is in love with Putin. So the great institutions of the nation have decided it's bare-knuckle to the bitter end! Frightening stuff.

Matt Franko said...

John it looked like the Ryan teaparty idiots were going to repeal first and then come up with something later...

so Trump pointed this out and slowed them down... now Ryan is saying at his press conference this AM they are going to take their time and be very deliberative, have hearings, etc ... if they would have done something immediately as Trump warned them then GOP would own it when it all went to shit this year ...

Now with doing nothing and the ACA going to shit the Dems still wear the shit and GOP can put the boots to them on the ground for a while until GOP actually does something...

and Trump is supposed to be the novice? idk....

Noah Way said...

Matt - the entire system is gamed, just like everything else. Until we go from profit-based healthcare to outcome-based there is no hope. As Pope Francis said, capitalism is terrorism. In this case it is extortion, too.

Matt Franko said...

There is very little profit based healthcare ...

My state the 2 big providers are Johns Hopkins and University of Maryland .... both non-profit institutions so what is the left talking about?

NO HEART SURGERY in State of Maryland other than at UMMC as state will not permit other systems to get into it... pools all the $$$ into one main center of excellence....

Look who Trump had at his meeting: Mayo Clinic? Johns Hopkins? Cleveland Clinic?

Are you saying these institutions are for profit? c'mon...

Vendors are for profit... not providers.... so Trump wants to negotiate on guaranteed volume deals with vendors and probably leave providers alone... maybe do something with how they do the actuarial pools so they get bigger pools... have to wait and see...

John said...

Matt, on health care clearly Trump is obviously more thoughtful than the GOP, but that isn't too difficult. But will anything other than a full repeal satisfy them? The party's gone full retard and will not allow anything resembling Obamacare, which is basically what Trump wants. Obama's done the hard work in getting it passed, and all Trump wants to do is tinker with it a smidgen and then call it Trumpcare. That's my inkling from what I saw on the campaign trail. Perhaps I'm wrong in seeing it that way.

At the end of the day, people aren't that stupid: if it looks, walks and talks like Obamacare, then it's Obamacare, but renamed Trumpcare. Will the GOP go along with that? I can't see how that's remotely possible. Will the base go along with that? Hardly. And both the GOP and the base are going to have to contend with the "conservative" media who will flip. And suppose Trump instead moves towards the GOP position, what then? Full repeal or years of bitter haggling over what health care in America should look like. Trump is very much at odds with the GOP over this. If he can figure a way out of this, then he really is the negotiating genius he claims he is.

Ryan's probably going to meet with McCain to plan how to use the anti-Trump Putin intelligence smear to full effect. Ryan's a piece of shit. McCain's a huge turd. I hope Trump can find a way of shitting on both of them. You get the feeling that Trump is going to be fighting for his life every second of his presidency. He may do a Clinton and go over to the crazies just to get some peace. Trump's already a heart attack waiting to happen! Maybe that's the GOPhers plan...and replace him with that numbskull of a veep.

Tom Hickey said...

There three reports that are going to be realized.

1. Unclassified = fake new = no actual evidence for claims.

2. Secret = to dupe the fools in Congress with "evidence" they are not permitted to talk about except confirm.

3. Beyond top secret = no one will ever know what's in it outside the deep state because "national security."

Wait for it.

Let's see if DJT and Mike Flynn fall for it.

Matt Franko said...

I dont think the public is with Ryan and McCain anymore... so Trump will just use public opinion against them... this is the Romney "47%!" people... as opposed to Trump who created a meme out of Romney's "47%" comment and used it against Jeb in the primaries...

I follow this pretty closely as GOPer and all I have heard from Trump is that he wants to negotiate directly with the vendors (he has said this will save "$300B" tho I dont know over what time period he has in mind with this...) and will supply direct subsidy to some citizens....

He said "the government is going to pay for it..." here:

https://www.youtube.com/watch?v=6inQmf96SYQ

So this subsidy and direct negotiation with vendors is all we know about what he wants to do at this point... and he had a meeting with some MDs from non-profit providers and some actuaries from the insurance industry in Palm Beach a few days ago...

That is all we know... maybe he has run some numbers and thinks the savings from direct negotiations with vendors is enough to pay premiums for uninsured when added to what we are already paying in Medicaid... also need to get the illegal aliens accounted for.... have to see...

John said...

Tom, they're coming out all guns blazing then. They've come to the conclusion it's him or them, and it sure as hell ain't gonna be them. So the whole apparatus of the US government has come together in an attempt to kneecap him for good. And that's their worst case scenario. Their best case scenario is he'll resign because of a surprising new health problem or fuck him until he has a heart attack.

Mad Max world here we come...but I may need to buy some gold from Peter Schiff before that...wait a minute...I won't need gold in a post-Apocalyptic world...I'll need shotguns and lots of them...

Salsabob said...

- 85% of people on the ACA exchanges are subsidized so immune to "big" premium increases. Of the remaining 15%, most got screwed by their state not expanding Medicaid or not promoting insurer competition because, well, that Kenyan in the WH is just too uppity. These people are vocal and amplified through the rightwing hate media; but they are a small minority
- the 15 million plus under the Medicaid expansion have no premium
- altogether about 30 million people will lose insurance that they had very little complaints about; 2017 enrollments are breaking 2016 records
- 8 of the top 10 states for people losing coverage voted for Trump
- Trump sees the danger because he has a 2020 national election; GOP House have gerrymandered districts where not repealing Obamacare means incumbent is going to 'primaried' in 2018 midterms to an even bigger t-bagger hole
- with repeal, hospitals slated to lose $300B; doctors, $150B
- Medicare savings from ACA of $200B will be lost; moving up date for "insolvency" by a decade
- reconcilation bill repealing Obamacare and setting guidelines for tax cuts to add $10T to deficit over next 10 years will happen in late March - the timetable for the next debt ceiling vote
- Pass the popcorn, this is going to be good.

Salsabob said...

John, it won't be him or any immediate blood family.
If I was Jared Kushner, I'd be a tad nervous.
The message will be clear to any bully, but particularly the p-grabber.

John said...

Matt: "I dont think the public is with Ryan and McCain anymore..."

Yes and no. In poll after poll, the public is way out to the left on this: about 70% want Canadian-style health care, and that's in a population that's been made to fear that anything but the status quo is socialism. The other 30% believe that it's Maoism on steroids. He's really got his hands full. I get the impression that's why the great institutions of state and the Republican establishment are hitting him with the Putin allegations at the same time that he's all tied up with healthcare and everything else. They'll fuck with him on Ukraine and Syria next.

John said...

Salsabob, didn't Jared Kushner's father do federal time for fraud or something? Yeah, Jared should be scared! The SEC will find something if it digs...hint, hint, Donald...if we decide to dig...HINT FUCKING HINT...

Salsabob said...

Obamacare questions (e.g., "if they repeal Obamacare, how do I get insurance?") are peaking on Google searches.

Old White guy in doctor's waiting room - "they're going to repeal that uppity Obamacare; I'm glad I got my Affordable Care Act insurance!"

Salsabob said...

John, I thinking more along the lines of a plane crash - bigger hint.

Penguin pop said...

John and Salsabob,

I agree this is gonna be quite a farce unless Trump magically becomes The Great Negotiator and works out some deal keeping Obamacare and calling it something else and making a few tweaks to it. To me, the hardcore Trumpers don't really care what Trump does as long as they get their border wall built. They are single-issue voters. You can go look at Ann Coulter's Twitter to see this.

Tom Hickey said...

Trump will end up with essentially anew party under the GOP label that will be an amalgam of populist GOP, Dems and independents, or he will go down and the old establishments will regain power. That the dynamic operative now. It's a ballsy move.

Matt Franko said...

He has to repeal Obamacare as under that the "individual group" they have in there is F-ed up.... and against the whole basis of insurance theory...

He will take that "individual group" and turn it into a big group even if it crossed state line so the premiums go way down...

He could go to UNH and say "how much PER PERSON to cover 5 million people anywhere in the US? How much? and btw I am calling around for other quotes..."

Watch the video in the link above he would like to negotiate directly with vendors and get quotes from hospital systems to cover people not agree to reimburse them for fee for service... that is how you get nickel and dimed from vendors/providers...

And another thing: the vendors will STILL make $bazillions as they will know what the requirements are up front and can manage the operation better than single payer where they never know UP FRONT what their revenues are going to be for the year... its a different management model...

Matt Franko said...

If you go to get a quote from a contractor to build a high rise and you wont tell him how many floors you want you instead want him to quote the job "per floor!" you wont ever get a good deal....

That is what single-payer does.... so it ends up expensive looking ex post....

You tell people up front what you want GUARANTEED and you get YUGE savings when you look back at it ex post... vs. leaving the deal open-ended like we do with the Medicare/Medicaid....

art of the deal....

Andrew said...

Matt,

Whether a hospital or heath system is set up as a for-profit or not doesn't necessarily change the way it behaves. Most hospitals act as if they were for-profit even though most are non-profit. They have little incentive to hold costs down and you can see this in the way they act and the way they spend their money.

Matt Franko said...

"How much health care do you want this year?"

"We dont know we're too stupid to figure that out... how much for an individual procedure?"

this is what they are doing and it doesnt work this way nobody competent would ever structure this type of deal on the buyer side...



Matt Franko said...

Well when the providers have full discretion to prescribe some procedure or not which they get reimbursed for then if they need revenues then they prescribe more procedures.... its simple...

You get a system that needs $1.2B per year to turn the key and they have their June review and show revenues at $550M the providers are not stupid they crank it up a bit and then check again where they are after September... this is not rocket science...

John said...

Old White guy in doctor's waiting room - "they're going to repeal that uppity Obamacare; I'm glad I got my Affordable Care Act insurance!"

Hilarious, but unfortunately probably also true. Limbaugh will lead tomorrow with that: repeal Obamacare but keep the ACA. Remember that placard "Keep Government Out Of My Medicare"? That's what a huge number of people have been reduced to in a country that sent men to the moon, created the H bomb, mapped the human genome, and have Al Gore create the internet.

I can't see how this ends up being anything other than a shambles. It'll be the proverbial dog's breakfast. Talking of dogs, this proverb is particularly apt for the GOPhers: "As a dog returneth to his vomit, so a fool returneth to his folly." The folly of the GOPhers over healthcare has come back to haunt them. Cue old white people in the streets demanding the return of the ACA! It's gonna be a bloody battle royal. At least 'trump is trying to avoid the battle, but then that's because he doesn't have a very different plan to Obummer's.

Ignacio said...

Is pretty funny how 90% of the civilised countries have figured this one out (no worries, the "out of monies" crowd is relentlessly working to destroy the working system in a couple decades, we soon be there with you in "stupid land") and the USA is still endlessly debating itself on this issue because "socialism!!!".

Need help cause politicians there too useless to figure it out? Look at how 99% of civilised countries with higher standard of living and life expectancy do it with "socialism!!!" and maybe you can come with something that works (plenty of working models out there to choose from, all of which work ). Or if you prefer to watch inside because "USA is exceptional" (maybe exceptional in this context means being a little bit "special", if you know what I mean...), maybe extend Medicare to start with? (maybe there is some racketing with that one too, but still better than the status qui and I read is pretty popular).


Biggest example of nation-wide self-scam in, supposedly, developed nation must be the healthcare industry in the USA.

Matt Franko said...

Might be a scam but if Trump restructures it and somehow ends up with a 500B savings in Meds (which would mean productivity gains) then that would hit non-discretionary flows hard and people would get thrown out of their jobs if they dont use the savings to increase discretionary in other areas... this is a risk imo...

Tom Hickey said...

Trump has excellent political instincts, and he is notoriously a gut guy rather than a head or heart guy.

He can see that 1) a good portion of the US public and an overwhelming portion of the people that voted for him are opposed to Obamacare, 2) that almost no one want to go back the status quo ante, and 3) the benefits of Obamacare and Medicare are overwhelming popular.

He is not going to get on board with anything that doesn't address all three, in spite of a strong urge in the GOP establishment to self-sabotage on this issue and piss off a whole lot of people just to stand on principle.

This really is the art of the deal and maybe DJT is the guy to structure one. Obama couldn't get it done right, so someone else is going to have to. That doesn't look to be the GOP congress and DJT just saved them from repealing without replace. That's the second fiasco he's saved them from in a couple of days, the independent ethics committee kerfuffle being the first.

Matt Franko said...

Right Tom and yet they try to paint him as the novice?

And meanwhile he is saving THEIR bacon all the time....

shows you how looney tunes the incumbent GOP elite is...

Matt Franko said...

Remember Ryan famously washed the dishes at the soup kitchen that were already washed by the women volunteering there when he showed up to help with lunch at 2:00 pm....

So that was revealing....

Andrew said...

Whether Trump can make a deal or not isn't really the issue. Nobody wants to face the fact that healthcare is unaffordable for many and it's not getting better. Generally speaking, what people object to now isn't the government being involved. I don't think they even care that there's only one choice for insurance. (Do people really get excited about choosing an insurance policy?) People just want to have their treatment covered when they're sick or hurt without worry.

Neither the incoming or outgoing administrations or congress really seem to realize that this problem needs a non-market solution because there is no real market in many places for something like healthcare, especially when it's most necessary. If the U.S. government wants to federalize things with block grants, so be it, but it's not like that's going to make things necessarily affordable unless they either throw a lot more money at it or find a way to substantially cut costs.

Neil Wilson said...

There is only one way to do public Healthcare.

You say if you want to work in Healthcare, this is the price for it. Otherwise you are banned from working in Healthcare or selling goods/services into healthcare. No price per procedure, just a time price - all socially determined.

You switch the system from rationing by price, to rationing by time and priority queuing. (Our famous "provision by need, not ability to pay").

That's it. Everything else is messing around at the edges, because the limiting factor is supply side restrictions on trained personnel. And there can be no functional market in anything without spare burst capacity and capacity to allow failures.

Matt Franko said...

"No price per procedure,"

Well that is how we do it over here Neil for Medicare and Medicaid... the providers submit a bill for the different and various procedures and the govt has a payment schedule they maintain for all the different procedures... this is what is termed 'single payer'...

The private insurers get large pools of customers and also negotiate with providers per procedure in cases... but because their pools are large they get good results and can get the premiums per patient down to reasonable levels...

Problem with ACA imo is this concept they have in there where they have an "individual group".... they have "large group", "small group" and "individual group"...

The shit is hitting the fan over here this year in the "individual group" which is getting the big increases and yuge deductibles this year as ACA continues to phase in... which is not surprising as "individual group" is an oxymoron and anti insurance theory ... leaves too small a small number in the denominator...

Tom Hickey said...

no price per procedure

If the bookkeeping were in terms of labor time (same for all) and labor power (differentiated by knowledge, skill and experience), then the barriers to entry would be solely on labor power, and it would make sense to educate and train more people appropriately to supply expected demand in the future based on democraphics.

Now the supply of licensed providers is insufficient for the demand because society is not producing enough when it easily could by allocating available resources to this.

Presently, licensing acts as a barrier to entry more than a socially necessary qualification on labor power allocated to various tasks in health care.

The US been loosening up on this by creating subsidiary positions such as nurse practitioners and physicians' assistants. China did this with the barefoot doctors.

Cuba provides free medical training to those who are willing to serve other than focus on making money.

It's entirely doable.