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The Ryancare Rout -- Winning by Losing?
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Did the Freedom Caucus just pull the Republican Party back off the ledge, before it jumped to its death? A case can be made for that.

Before the American Health Care Act, aka “Ryancare,” was pulled off the House floor Friday, it enjoyed the support — of 17 percent of Americans. Had it passed, it faced an Antietam in the GOP Senate, and probable defeat.

Had it survived there, to be signed by President Trump, it would have meant 14 million Americans losing their health insurance in 2018.

First among the losers would have been white working-class folks who delivered the Rust Belt states to President Trump.

“Victory has a thousand fathers; defeat is an orphan,” said JFK.

So, who are the losers here?

First and foremost, Speaker Paul Ryan and House Republicans who, having voted 50 times over seven years to repeal Obamacare, we learned, had no consensus plan ready to replace it.

Moreover, they put a bill on the floor many had not read, and for which they did not have the votes.

More than a defeat, this was a humiliation. For the foreseeable future, a Republican Congress and president will coexist with a health care regime that both loathe but cannot together repeal and replace.

Moreover, this defeat suggests that, given the ideological divide in the GOP, and the unanimous opposition of congressional Democrats, the most impressive GOP majorities since the 1920s may be impotent to enact any major complicated or complex legislation.

Friday’s failure appears to be another milestone in the decline and fall of Congress, which the Constitution, in Article I, fairly anoints as our first branch of government.

Through the last century, Congress has steadily surrendered its powers, with feeble resistance, to presidents, the Supreme Court, the Federal Reserve, the regulatory agencies, even the bureaucracy.

The long retreat goes on.

Another truth was reconfirmed Friday. Once an entitlement program has been created with millions of beneficiaries, it becomes almost impossible to repeal. As Ronald Reagan said, “A government bureau is the nearest thing to eternal life we’ll ever see on this earth.”

Nor did President Trump escape unscathed.

Among the reasons he was elected was the popular belief, which carried him through scrapes that would have sunk other candidates, that, whatever his faults or failings, he was a doer, a man of action — “He gets things done!”

To have failed on his first big presidential project has thus been an occasion of merriment for the boo-birds in the Beltway bleachers.

Yet, still, Trump’s Saturday tweet — “Obamacare will explode and we will all get together and piece together a great healthcare plan … Do not worry!” — may prove prophetic.

Now that “Trumpcare” or “Ryancare” is gone, the nation must live with Obamacare. A Democratic program from birth, it is visibly failing. And Democrats now own it again, as not one Democrat was there to help reform it. In the off-year election of 2018, they may be begging for Republican help in reforming the health care system.

After what he sees as a wonderful win, Minority Leader Chuck Schumer now intends to block a Senate vote on Judge Neil Gorsuch for the Supreme Court, and thus force Majority Leader Mitch McConnell to muster 60 votes to halt a Democratic filibuster.

Should Schumer persist, Senate Republicans will exercise the “nuclear option,” i.e., change the rules to allow debate to be cut off with 51 votes, and then elevate Gorsuch with their own slim majority.

Why would Schumer squander his political capital by denying a quality candidate like Judge Gorsuch a vote? Does he also think that a collapsing Obamacare — even its backers believe is in need of corrective surgery — will be an asset for his imperiled colleagues in 2018? The last time Democrats headed down that Radical Road and nominated George McGovern, they lost 49 states.

While the Republicans have sustained a defeat, this is not the end of the world. And there was an implied warning in the president’s Sunday tweet:

“Democrats are smiling in D.C. that the Freedom Caucus, with the help of Club For Growth and Heritage, have saved Planned Parenthood & Ocare.”

What Trump is explaining here is that, if Republican majorities in the House and Senate cannot or will not unite with his White House behind solutions on health care, taxes, infrastructure, border security, he will seek out moderate Democrats to get the work done.

This humiliation of Obamacare reform may prove a watershed for the Trump presidency. What he is saying is simple and direct:

I am a Republican president who wants to work with Republicans. But if they cannot or will not work with me, I will find another partner with whom to form coalitions to write the laws and enact the reforms America needs, because, in the last analysis, while party unity is desirable, the agenda I was elected to enact is critical.

The health care defeat yet may prove to be another example of winning by losing.

Patrick J. Buchanan is the author of the new book “The Greatest Comeback: How Richard Nixon Rose From Defeat to Create the New Majority.”

Copyright 2017 Creators.com.

 
• Category: Ideology • Tags: Donald Trump, Obamacare, Republicans 
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  1. I usually agree with Patrick Buchanan but I think that there are a couple of fallacies lurking in this article. If Obamacare becomes insufferable due to premium increases next year, people are not going to blame Barack Obama and the Democratic Congress that enacted the program. They will blame (rightly) the party in power, who couldn’t come up with a reform. Second, Pat still seems to think we’re living in the United States of the early 1970s. The demographics have shifted irretrievably in favor of the Democrats’ coalition of the fringes. Trump’s victory was by a very thin margin and he’ll have to deliver on jobs, economic prosperity, and affordable medical care to win again in those Rust Belt states in 2020. The Democrats will have a more attractive candidate (think Kamala Harris) and Trump will be 74. Things will be even worse by 2024, which is why the longer Trump waits to tackle immigration, the more hopeless the long-term situation will become for Republicans.

    Read More
    • Replies: @J1234

    Things will be even worse by 2024, which is why the longer Trump waits to tackle immigration, the more hopeless the long-term situation will become for Republicans.
     
    Trump needs to confront the "despotic oligarchy" of the courts on this issue, but I'm not exactly sure of the right approach. One thing is for sure...rank and file conservatives are lousy activists on all issues except guns. They will, however, write letters and make phone calls. Thirty or forty million letters and calls to Supreme Court justices - state and federal - might make those justices take notice. The robed ones talk like they're insular and immune to public pressure, but it's obviously all an act. Justices frequently acquiesce to their political surroundings.
    , @Pericles

    If Obamacare becomes insufferable due to premium increases next year, people are not going to blame Barack Obama and the Democratic Congress that enacted the program. They will blame (rightly) the party in power, who couldn’t come up with a reform.

     

    Weird analysis. I don't buy it. I don't buy your defeatism after that either. But I do agree with your subsequent point that immigration is a key issue.
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  2. Nah, there’s no win here. The supposed “reform” didn’t reform anything. It didn’t even delete the mandate. The same old partisan hacks made the same old meaningless noises based on branding instead of ideology. “Liberals” ferociously defended the Heritage Foundation’s plan rebranded by Obama. The Heritage Foundation ferociously fought to “repeal” the Heritage Foundation’s plan.

    Trump was elected because people are tired of the standard partisan noises and rebranding and fakery. He didn’t help himself by sponsoring more of the same old fakery.

    Read More
    • Replies: @densa

    Trump was elected because people are tired of the standard partisan noises and rebranding and fakery. He didn’t help himself by sponsoring more of the same old fakery.
     
    It was a vote, some said desperate, against the bipartisan status quo. Yet, back came the Republicans with their tired old agenda as if they had not noticed that even the Republicans had rejected Ryan, Jeb!, Graham and the rest of the sorry mess.

    If Trump is actually practicing akido here, and comes back with shaming the Democrats into supporting single payer, then I will take my hat and hair off to him. He's a genius if he pulls that off, and I'm pretty sure the Democrats would greatly prefer to burn down the country than make the Orange Buffoon appear a genius.
  3. The Democrats own nothing Pat. The Republicans are in power. The Democrats could not do single payer (the only way forward) because corruption. Now it’s the Republicans who cannot do single payer. Because Communism. The people are the big losers.

    After the crash and the (much) greater depression nobody will admit to ever having been a Democrat or a Republican.

    Read More
    • Replies: @densa
    Both parties have had their chance to change the failed healthcare system, and both answered the call of lobbyists. For decades polls showed bipartisan support for getting money out of politics so that Congress could focus on solving problems instead of raising money.

    Both parties built a system that enriches them and impoverishes us, while still not delivering care or preventing medical bankruptcy. They started with exempting healthcare from anti-competitive laws in the 80s, allowing hospitals and supply chains to have overlapping ownership. Profits disappear down private ratholes in public companies, and unlike any other business, hospitals set prices at whim instead of cost, and can charge customers different prices based on their protection racket.

    Until Congress can pull their snouts out of the trough, there is no hope of either party reforming their creation. They are destroying America to pay for insurance, not care. Unfortunately, the term 'single payer' has been branded as 'government run health care' by the GOP when it could also be described as a capitalistic disruption of a failing system--no different than the internet bankrupting malls. Free market stuff, no? The insurers have failed to serve their market. Single insurer flattens their racket, makes access to care direct from provider to consumer. The current insurance middleman system overs no value and overcharges for it.

    Medicare still has a broad marketplace of healthcare services. In theory, (although less and less in practice as Medicare becomes more like other insurances) no one proscribes what doctor you choose or what course of care you and your doctor decide on. Medicare didn't end the health care market, but the single insurer does intervene to control costs. As horrible as price control is to the GOP, shoveling money into an uncontrolled system of profit has been disastrous.

    But neither party wants to own up to the Frankenstein they have created by cashing checks instead of representing the public's interest. And yes, this next recession will be epic, and one of the reasons so many people are vulnerable is because healthcare has been one big racket at our expense.
    , @Hibernian
    Yea, let's go single payer. I have a modest proposal. Put veterans and non-veterans alike in the VA medical system (with which I have some personal experience.) We'll all have healthcare, right? It'll be universal, won't it? What's not to like?
  4. The only “real” solution is to go back to the old model, where doctor’s visits and routine procedures are not covered by insurance.
    Health insurance should be based on a high deductible, catastrophic model, where any expenses above a certain amount are covered. Such a policy would cost much less than our present insurance system.
    Today’s HMO model distorts the whole system. If automobile insurance were based on the HMO model, insurance companies would pay for oil changes, tune ups and other ordinary maintenance repairs.
    All one has to do is to look at the cosmetic surgery and LASIK eye surgery industries to see how health care should work in the real world. The cost for cosmetic and eye procedures is constantly dropping, due to efficiencies and competition.
    Of course, people would have to be dragged, kicking and screaming, into the “old” system, but would soon realize that their expenses for health care are much less than our present system.

    Read More
    • Replies: @Antiwar7
    Isn't that what the high-deductible plans do now? And a high-deductible PPO has a higher premium than an HMO. How do you explain that? How is that good?
    , @WorkingClass

    All one has to do is to look at the cosmetic surgery and LASIK eye surgery industries to see how health care should work in the real world.
     
    With respect this is apples and oranges. Wanting bigger tits is not the same thing as needing a bypass.
    , @MarkinLA
    Except that the biggest problem is the billing scams run by the providers. The idea that paying a few hundred dollars of your own costs for routine visits to the doctor is going to save you thousands of dollars a year in insurance premiums is the snake oil the GOP has been pushing ever since Obamacare started.

    How do you fix a system when a simple visit to the emergency room was billed at 6500 dollars and the HMO paid 400 and my Mom a 75 dollar co-pay. Legally my Mom would have been obligated to pay the 6500 if she didn't have insurance. These markups are routine even if this is on the high side.

    I get calls every day for non-underwritten medical insurance where they pay for basic office visits and up to two surgeries a year (capped at 10,000 each) and the premium is only 300 dollars. These policies are worthless because they won't protect you from a medically induced bankruptcy. That is the thing the insurance companies fear the most - the 1,000,000 bill to pay for cancer treatments and why people with pre-existing conditions can not get any insurance at any realistic price.
  5. @anarchyst
    The only "real" solution is to go back to the old model, where doctor's visits and routine procedures are not covered by insurance.
    Health insurance should be based on a high deductible, catastrophic model, where any expenses above a certain amount are covered. Such a policy would cost much less than our present insurance system.
    Today's HMO model distorts the whole system. If automobile insurance were based on the HMO model, insurance companies would pay for oil changes, tune ups and other ordinary maintenance repairs.
    All one has to do is to look at the cosmetic surgery and LASIK eye surgery industries to see how health care should work in the real world. The cost for cosmetic and eye procedures is constantly dropping, due to efficiencies and competition.
    Of course, people would have to be dragged, kicking and screaming, into the "old" system, but would soon realize that their expenses for health care are much less than our present system.

    Isn’t that what the high-deductible plans do now? And a high-deductible PPO has a higher premium than an HMO. How do you explain that? How is that good?

    Read More
    • Replies: @anarchyst
    PPO's and HMO's are actually one and the same. The key is to get the insurance industry out of paying for routine check ups and minor injuries. A catastrophic police can be had for about $100.00 per month.
    , @Hell_Is_Like_Newark

    Isn’t that what the high-deductible plans do now?
     
    Yes, but HSAs have been authorized by half-measures. The problem is that the HSA portion is voluntary, which mean many people save nothing. Singapore addressed this issue with their system. The mandatory savings rate is about 36% of salary. The government run system (kind of like our Medicade) only kicks in when all other resources are exhausted. It is only a bare-bones care at best.

    A basic overview of the Singapore system:
    https://sg.get.com/sg/blog/healthcare-singapore-medishield-medisave-medifund/

    A more in depth description here:
    http://healthblog.ncpa.org/medisave-accounts-in-singapore/#sthash.QXMsZFFm.dpbs
  6. First and foremost, Speaker Paul Ryan and House Republicans who, having voted 50 times over seven years to repeal Obamacare, we learned, had no consensus plan ready to replace it.

    This would be funny if we hadn’t had seven years to get used to it. The party of no. The Knights who said Ni! Obamacare is just the top layer of a seven layer shit sandwich. The alternatives are Medicare for all or abandon health care entirely to the States. The ridiculous freedom party can prevent the former but cannot achieve the later. They are therefore the protectors of Obamacare which they voted to repeal 50 times!

    Read More
  7. Trump’s not right on much. But he’s absolutely right on Obamacare self-destructing. And, it was destined to self-destruct as soon as it was passed and signed into law.

    Why?

    Because there are no cost controls (as there are in Medicare and Medicaid) on what the medical arts providers can charge. The sky’s the limit.

    Who the Hell designs a massive program without cost controls? Dopes. Only dopes do.

    LF

    Read More
  8. @anarchyst
    The only "real" solution is to go back to the old model, where doctor's visits and routine procedures are not covered by insurance.
    Health insurance should be based on a high deductible, catastrophic model, where any expenses above a certain amount are covered. Such a policy would cost much less than our present insurance system.
    Today's HMO model distorts the whole system. If automobile insurance were based on the HMO model, insurance companies would pay for oil changes, tune ups and other ordinary maintenance repairs.
    All one has to do is to look at the cosmetic surgery and LASIK eye surgery industries to see how health care should work in the real world. The cost for cosmetic and eye procedures is constantly dropping, due to efficiencies and competition.
    Of course, people would have to be dragged, kicking and screaming, into the "old" system, but would soon realize that their expenses for health care are much less than our present system.

    All one has to do is to look at the cosmetic surgery and LASIK eye surgery industries to see how health care should work in the real world.

    With respect this is apples and oranges. Wanting bigger tits is not the same thing as needing a bypass.

    Read More
    • Replies: @Hell_Is_Like_Newark

    With respect this is apples and oranges. Wanting bigger tits is not the same thing as needing a bypass.
     
    The improvements in quality for non insured services goes beyond cosmetic surgery and LASIK. Fertility treatments (generally not covered by insurance) have gotten less expensive and far more effective. i.e. Genetic screening of embryos used to cost $10k+ a few years ago. My wife and I spent $1,700 for a much more comprehensive test than you got for spending $10k in the past.

    Now back to major, non elective surgery such as your heart bypass example:

    If the general public cannot afford have the procedures, how will surgeons and hospitals survive if nobody is buying their product? The answer is the service must be made affordable. An example of this happening when the patient is the customer instead of an insurance company or a government:

    Bumrungrad International
    https://youtu.be/zzsXNCwgfuM

    I went there myself, using a night clinic they offered. 45 minutes to get registered, treated, and meds from the pharmacy. Cost: $71. No insurance accepted. My job takes me into a lot of hospitals.. this was by far the best facility I have ever seen.

    There is an American outfit also going the no insurance route. They put pricing online for many common surgeries / procedures.

    https://surgerycenterok.com/
  9. @Antiwar7
    Isn't that what the high-deductible plans do now? And a high-deductible PPO has a higher premium than an HMO. How do you explain that? How is that good?

    PPO’s and HMO’s are actually one and the same. The key is to get the insurance industry out of paying for routine check ups and minor injuries. A catastrophic police can be had for about $100.00 per month.

    Read More
    • Replies: @MarkinLA
    A catastrophic police can be had for about $100.00 per month.

    I think you are dreaming there unless you mean healthy 18 year old.
  10. @WorkingClass
    The Democrats own nothing Pat. The Republicans are in power. The Democrats could not do single payer (the only way forward) because corruption. Now it's the Republicans who cannot do single payer. Because Communism. The people are the big losers.

    After the crash and the (much) greater depression nobody will admit to ever having been a Democrat or a Republican.

    Both parties have had their chance to change the failed healthcare system, and both answered the call of lobbyists. For decades polls showed bipartisan support for getting money out of politics so that Congress could focus on solving problems instead of raising money.

    Both parties built a system that enriches them and impoverishes us, while still not delivering care or preventing medical bankruptcy. They started with exempting healthcare from anti-competitive laws in the 80s, allowing hospitals and supply chains to have overlapping ownership. Profits disappear down private ratholes in public companies, and unlike any other business, hospitals set prices at whim instead of cost, and can charge customers different prices based on their protection racket.

    Until Congress can pull their snouts out of the trough, there is no hope of either party reforming their creation. They are destroying America to pay for insurance, not care. Unfortunately, the term ‘single payer’ has been branded as ‘government run health care’ by the GOP when it could also be described as a capitalistic disruption of a failing system–no different than the internet bankrupting malls. Free market stuff, no? The insurers have failed to serve their market. Single insurer flattens their racket, makes access to care direct from provider to consumer. The current insurance middleman system overs no value and overcharges for it.

    Medicare still has a broad marketplace of healthcare services. In theory, (although less and less in practice as Medicare becomes more like other insurances) no one proscribes what doctor you choose or what course of care you and your doctor decide on. Medicare didn’t end the health care market, but the single insurer does intervene to control costs. As horrible as price control is to the GOP, shoveling money into an uncontrolled system of profit has been disastrous.

    But neither party wants to own up to the Frankenstein they have created by cashing checks instead of representing the public’s interest. And yes, this next recession will be epic, and one of the reasons so many people are vulnerable is because healthcare has been one big racket at our expense.

    Read More
  11. @Antiwar7
    Isn't that what the high-deductible plans do now? And a high-deductible PPO has a higher premium than an HMO. How do you explain that? How is that good?

    Isn’t that what the high-deductible plans do now?

    Yes, but HSAs have been authorized by half-measures. The problem is that the HSA portion is voluntary, which mean many people save nothing. Singapore addressed this issue with their system. The mandatory savings rate is about 36% of salary. The government run system (kind of like our Medicade) only kicks in when all other resources are exhausted. It is only a bare-bones care at best.

    A basic overview of the Singapore system:

    https://sg.get.com/sg/blog/healthcare-singapore-medishield-medisave-medifund/

    A more in depth description here:

    http://healthblog.ncpa.org/medisave-accounts-in-singapore/#sthash.QXMsZFFm.dpbs

    Read More
  12. @Diversity Heretic
    I usually agree with Patrick Buchanan but I think that there are a couple of fallacies lurking in this article. If Obamacare becomes insufferable due to premium increases next year, people are not going to blame Barack Obama and the Democratic Congress that enacted the program. They will blame (rightly) the party in power, who couldn't come up with a reform. Second, Pat still seems to think we're living in the United States of the early 1970s. The demographics have shifted irretrievably in favor of the Democrats' coalition of the fringes. Trump's victory was by a very thin margin and he'll have to deliver on jobs, economic prosperity, and affordable medical care to win again in those Rust Belt states in 2020. The Democrats will have a more attractive candidate (think Kamala Harris) and Trump will be 74. Things will be even worse by 2024, which is why the longer Trump waits to tackle immigration, the more hopeless the long-term situation will become for Republicans.

    Things will be even worse by 2024, which is why the longer Trump waits to tackle immigration, the more hopeless the long-term situation will become for Republicans.

    Trump needs to confront the “despotic oligarchy” of the courts on this issue, but I’m not exactly sure of the right approach. One thing is for sure…rank and file conservatives are lousy activists on all issues except guns. They will, however, write letters and make phone calls. Thirty or forty million letters and calls to Supreme Court justices – state and federal – might make those justices take notice. The robed ones talk like they’re insular and immune to public pressure, but it’s obviously all an act. Justices frequently acquiesce to their political surroundings.

    Read More
  13. @polistra
    Nah, there's no win here. The supposed "reform" didn't reform anything. It didn't even delete the mandate. The same old partisan hacks made the same old meaningless noises based on branding instead of ideology. "Liberals" ferociously defended the Heritage Foundation's plan rebranded by Obama. The Heritage Foundation ferociously fought to "repeal" the Heritage Foundation's plan.

    Trump was elected because people are tired of the standard partisan noises and rebranding and fakery. He didn't help himself by sponsoring more of the same old fakery.

    Trump was elected because people are tired of the standard partisan noises and rebranding and fakery. He didn’t help himself by sponsoring more of the same old fakery.

    It was a vote, some said desperate, against the bipartisan status quo. Yet, back came the Republicans with their tired old agenda as if they had not noticed that even the Republicans had rejected Ryan, Jeb!, Graham and the rest of the sorry mess.

    If Trump is actually practicing akido here, and comes back with shaming the Democrats into supporting single payer, then I will take my hat and hair off to him. He’s a genius if he pulls that off, and I’m pretty sure the Democrats would greatly prefer to burn down the country than make the Orange Buffoon appear a genius.

    Read More
  14. @WorkingClass

    All one has to do is to look at the cosmetic surgery and LASIK eye surgery industries to see how health care should work in the real world.
     
    With respect this is apples and oranges. Wanting bigger tits is not the same thing as needing a bypass.

    With respect this is apples and oranges. Wanting bigger tits is not the same thing as needing a bypass.

    The improvements in quality for non insured services goes beyond cosmetic surgery and LASIK. Fertility treatments (generally not covered by insurance) have gotten less expensive and far more effective. i.e. Genetic screening of embryos used to cost $10k+ a few years ago. My wife and I spent $1,700 for a much more comprehensive test than you got for spending $10k in the past.

    Now back to major, non elective surgery such as your heart bypass example:

    If the general public cannot afford have the procedures, how will surgeons and hospitals survive if nobody is buying their product? The answer is the service must be made affordable. An example of this happening when the patient is the customer instead of an insurance company or a government:

    Bumrungrad International

    I went there myself, using a night clinic they offered. 45 minutes to get registered, treated, and meds from the pharmacy. Cost: $71. No insurance accepted. My job takes me into a lot of hospitals.. this was by far the best facility I have ever seen.

    There is an American outfit also going the no insurance route. They put pricing online for many common surgeries / procedures.

    https://surgerycenterok.com/

    Read More
    • Replies: @WorkingClass
    Thanks. This is encouraging in that it shows it is insurance that drives up cost. It has reached the point where we can afford neither the insurance nor the care. And it's a racket sustained by graft. I'm 72. When I was a kid in third grade I needed an appendectomy. My father was able to pay for it out of pocket. But I had a father and he had a middle income pay check. I would like to see a free market in health care with the States providing assistance for those in need. Food, water, shelter and health care are necessary to sustain the lives of our families and our countrymen. It is shameful that healthcare is a political football and a gun at our heads. Your money or your life is not a choice if you have no money.
  15. Healthcare should probably be a public utility, i.e. a government run enterprise with NO profits in the system.

    Perhaps with a dual system based on pure free market for the richie$.

    Right now we just have the worst of all worlds, the worst crony capitalist nightmare.

    Read More
  16. @Hell_Is_Like_Newark

    With respect this is apples and oranges. Wanting bigger tits is not the same thing as needing a bypass.
     
    The improvements in quality for non insured services goes beyond cosmetic surgery and LASIK. Fertility treatments (generally not covered by insurance) have gotten less expensive and far more effective. i.e. Genetic screening of embryos used to cost $10k+ a few years ago. My wife and I spent $1,700 for a much more comprehensive test than you got for spending $10k in the past.

    Now back to major, non elective surgery such as your heart bypass example:

    If the general public cannot afford have the procedures, how will surgeons and hospitals survive if nobody is buying their product? The answer is the service must be made affordable. An example of this happening when the patient is the customer instead of an insurance company or a government:

    Bumrungrad International
    https://youtu.be/zzsXNCwgfuM

    I went there myself, using a night clinic they offered. 45 minutes to get registered, treated, and meds from the pharmacy. Cost: $71. No insurance accepted. My job takes me into a lot of hospitals.. this was by far the best facility I have ever seen.

    There is an American outfit also going the no insurance route. They put pricing online for many common surgeries / procedures.

    https://surgerycenterok.com/

    Thanks. This is encouraging in that it shows it is insurance that drives up cost. It has reached the point where we can afford neither the insurance nor the care. And it’s a racket sustained by graft. I’m 72. When I was a kid in third grade I needed an appendectomy. My father was able to pay for it out of pocket. But I had a father and he had a middle income pay check. I would like to see a free market in health care with the States providing assistance for those in need. Food, water, shelter and health care are necessary to sustain the lives of our families and our countrymen. It is shameful that healthcare is a political football and a gun at our heads. Your money or your life is not a choice if you have no money.

    Read More
  17. What part of this does no one here understand? ObamaCare is not a health care program. It is a tax. It is a tax on White people. That’s all.

    There is no loss to repealing ObamaCare, since all you are doing is repealing a tax…a tax on White people. Even John Roberts called O-Care a tax.

    All these people who supposedly will “lose their insurance” will simply go back to what they had before: Medicare, Medicaid and EMTALA. No one will be any worse off than they were before.

    The last thing you should want is single-payer. That is a system of government bureaucracies run by Democrats deciding whether old white people in the Red States get healthcare. The Los Angeles Unified School District just decided that a school that was too white would have its funding cut…and you think the same model won;t be applied to health care?

    Read More
    • Replies: @anon
    We've had Single Payer in Australia since 1975, and it didn't take long for people here to get used to the idea of the Federal Government paying for their visits to the doctor's surgery, and ferociously resisting the idea of any co- payment.
    As a consequence, spending on Health is now the biggest single item in the Federal budget.
  18. Hey WC,

    It is shameful that healthcare is a political football and a gun at our heads.

    We could potentially try to save healthcare by not paying for the guns pointed at the heads of poor Yemenis – at some point we’re going to have to decide; empire or the people at home.

    Peace and may God grant you many more years of good health.

    Read More
  19. @WorkingClass
    The Democrats own nothing Pat. The Republicans are in power. The Democrats could not do single payer (the only way forward) because corruption. Now it's the Republicans who cannot do single payer. Because Communism. The people are the big losers.

    After the crash and the (much) greater depression nobody will admit to ever having been a Democrat or a Republican.

    Yea, let’s go single payer. I have a modest proposal. Put veterans and non-veterans alike in the VA medical system (with which I have some personal experience.) We’ll all have healthcare, right? It’ll be universal, won’t it? What’s not to like?

    Read More
    • Replies: @densa
    I don't think single payer insurance is the same thing. The VA is a state-run healthcare system. Medicare, the model being used, is not. In fact, maybe vets should be liberated from the VA to make their own provider choices through Medicare if they aren't being served. This would make the VA have to compete and justify its costs and quality.

    Nor is it a universal or free access system. You pay a premium and copays. I think all users of healthcare need to be deputized to control costs. They should come up with some scheme that asks non-emergency patients to check costs and maybe rebate part of the savings.

    We also need more aggressive fraud prosecution at the institutional level, not just retail. But that is just one of many other strategies that could be employed to bring down costs.
    , @Jonathan Mason

    I have a modest proposal. Put veterans and non-veterans alike in the VA medical system
     
    The VA already has a very hard time recruiting enough qualified doctors, nurses, and other professionals in many areas and it would probably be impossible to vastly expand the size of the VA. Having said that, the British National Health System is somewhat similar to a vastly expanded VA.
  20. There are a lot of stifling laws in medicine. The AMA monopoly limiting the number of graduates from medical school. The laws making insurance a non-taxed benefit, which caused overinsurance in the first place.

    But the one that really pisses me off is disallowing pharmacists from prescribing. In a lot of countries I can walk into a pharmacy and in ten minutes have antibiotics for my near-annual sinus infections. And the antibiotics are a fraction of the cost here.

    My children get them too, and this year we had to spend 12 hours total on the road driving through bad weather to doctors for prescriptions filled in our own locale. Then you get to go to the pharmacy and pay three times as much as overseas for the antibiotics. You have to see an “urgent” care doctor because making an appointment means the infection will be FAR worse by the time of the appointment.

    The urgent care doctors like to give us five day prescriptions so we have to go back for another $155 appointment to knock out the infection. In the past we got two-week prescriptions and were admonished to take all the medicine even if we felt better.

    We don’t need insurance. We need the freedom to choose our own medical care, and it is one reason I am retiring abroad.

    Read More
    • Replies: @Jonathan Mason

    We don’t need insurance. We need the freedom to choose our own medical care, and it is one reason I am retiring abroad.
     
    Totally agree with your post.

    The problem with healthcare insurance is that you have two totally different populations, healthy families with working parents who need occasional antibiotics, preschool physicals, preemployment physicals, childbirths, occasional surgeries for appendicitis and broken bones, occasional suturing for deep lacerations, tetanus shots, vaccinations, and so on, and the other population of people who have chronic lifelong diseases like diabetes, leukemia, cancer, epilepsy, various deformities and brain damage from birth, and so on who need millions of dollars worth of medical treatment to keep them alive.

    Commercial insurance that makes group 1 pay for group 2's health care does not seem like the answer. Having said that, when I was living overseas in Bermuda and the Dominican Republic, I did have commercial insurance both as a single man and later for a family of 4, and in both cases it was affordable with reasonable copays and minimal deductibles, but that was probably because the healthcare was much cheaper.

    It might still be worth looking at the healthcare system in Bermuda. While the population is small, the healthcare system is self contained because of the remoteness of the island, the cost of living is 95% higher than in the US, but the healthcare spending per capita only slightly more than in the US.

    In Bermuda all employers must pay $50% of health insurance premiums for all employees, but there is no equivalent to Medicare. There is a government fund that pays for urgent healthcare for indigents.

    http://www.bermuda-online.org/healthcare.htm

  21. @Hibernian
    Yea, let's go single payer. I have a modest proposal. Put veterans and non-veterans alike in the VA medical system (with which I have some personal experience.) We'll all have healthcare, right? It'll be universal, won't it? What's not to like?

    I don’t think single payer insurance is the same thing. The VA is a state-run healthcare system. Medicare, the model being used, is not. In fact, maybe vets should be liberated from the VA to make their own provider choices through Medicare if they aren’t being served. This would make the VA have to compete and justify its costs and quality.

    Nor is it a universal or free access system. You pay a premium and copays. I think all users of healthcare need to be deputized to control costs. They should come up with some scheme that asks non-emergency patients to check costs and maybe rebate part of the savings.

    We also need more aggressive fraud prosecution at the institutional level, not just retail. But that is just one of many other strategies that could be employed to bring down costs.

    Read More
  22. @densa
    I don't think single payer insurance is the same thing. The VA is a state-run healthcare system. Medicare, the model being used, is not. In fact, maybe vets should be liberated from the VA to make their own provider choices through Medicare if they aren't being served. This would make the VA have to compete and justify its costs and quality.

    Nor is it a universal or free access system. You pay a premium and copays. I think all users of healthcare need to be deputized to control costs. They should come up with some scheme that asks non-emergency patients to check costs and maybe rebate part of the savings.

    We also need more aggressive fraud prosecution at the institutional level, not just retail. But that is just one of many other strategies that could be employed to bring down costs.

    The VA is run by the federal government…

    Read More
    • Replies: @woodNfish
    So is obamacare.
    , @densa
    Yes, I meant state-run in the sense of The State, aka as government-run healthcare. My point being that it is not what is being advocated by "single payer."
  23. @anarchyst
    The VA is run by the federal government...

    Yes, I meant state-run in the sense of The State, aka as government-run healthcare. My point being that it is not what is being advocated by “single payer.”

    Read More
  24. Trump glad Ryancare failed.
    Trump will deliver single payer.

    Read More
    • Replies: @Jonathan Mason

    Trump glad Ryancare failed.
    Trump will deliver single payer.
     
    It seems possible if Trump's pre-and-post election manifesto is anything to go by. It sounded like he was hinting at single payer, or something very similar. It is a mystery to me why Trump was urging anyone to vote for Ryan's dreadful health care bill that would replace Obamadon'tcare with something even worse. Out of the frying pan and into the fire.
  25. anon says:     Show CommentNext New Comment
    @map
    What part of this does no one here understand? ObamaCare is not a health care program. It is a tax. It is a tax on White people. That's all.

    There is no loss to repealing ObamaCare, since all you are doing is repealing a tax...a tax on White people. Even John Roberts called O-Care a tax.

    All these people who supposedly will "lose their insurance" will simply go back to what they had before: Medicare, Medicaid and EMTALA. No one will be any worse off than they were before.

    The last thing you should want is single-payer. That is a system of government bureaucracies run by Democrats deciding whether old white people in the Red States get healthcare. The Los Angeles Unified School District just decided that a school that was too white would have its funding cut...and you think the same model won;t be applied to health care?

    We’ve had Single Payer in Australia since 1975, and it didn’t take long for people here to get used to the idea of the Federal Government paying for their visits to the doctor’s surgery, and ferociously resisting the idea of any co- payment.
    As a consequence, spending on Health is now the biggest single item in the Federal budget.

    Read More
  26. @bjondo
    Trump glad Ryancare failed.
    Trump will deliver single payer.

    Trump glad Ryancare failed.
    Trump will deliver single payer.

    It seems possible if Trump’s pre-and-post election manifesto is anything to go by. It sounded like he was hinting at single payer, or something very similar. It is a mystery to me why Trump was urging anyone to vote for Ryan’s dreadful health care bill that would replace Obamadon’tcare with something even worse. Out of the frying pan and into the fire.

    Read More
  27. @Backwoods Bob
    There are a lot of stifling laws in medicine. The AMA monopoly limiting the number of graduates from medical school. The laws making insurance a non-taxed benefit, which caused overinsurance in the first place.

    But the one that really pisses me off is disallowing pharmacists from prescribing. In a lot of countries I can walk into a pharmacy and in ten minutes have antibiotics for my near-annual sinus infections. And the antibiotics are a fraction of the cost here.

    My children get them too, and this year we had to spend 12 hours total on the road driving through bad weather to doctors for prescriptions filled in our own locale. Then you get to go to the pharmacy and pay three times as much as overseas for the antibiotics. You have to see an "urgent" care doctor because making an appointment means the infection will be FAR worse by the time of the appointment.

    The urgent care doctors like to give us five day prescriptions so we have to go back for another $155 appointment to knock out the infection. In the past we got two-week prescriptions and were admonished to take all the medicine even if we felt better.

    We don't need insurance. We need the freedom to choose our own medical care, and it is one reason I am retiring abroad.

    We don’t need insurance. We need the freedom to choose our own medical care, and it is one reason I am retiring abroad.

    Totally agree with your post.

    The problem with healthcare insurance is that you have two totally different populations, healthy families with working parents who need occasional antibiotics, preschool physicals, preemployment physicals, childbirths, occasional surgeries for appendicitis and broken bones, occasional suturing for deep lacerations, tetanus shots, vaccinations, and so on, and the other population of people who have chronic lifelong diseases like diabetes, leukemia, cancer, epilepsy, various deformities and brain damage from birth, and so on who need millions of dollars worth of medical treatment to keep them alive.

    Commercial insurance that makes group 1 pay for group 2′s health care does not seem like the answer. Having said that, when I was living overseas in Bermuda and the Dominican Republic, I did have commercial insurance both as a single man and later for a family of 4, and in both cases it was affordable with reasonable copays and minimal deductibles, but that was probably because the healthcare was much cheaper.

    It might still be worth looking at the healthcare system in Bermuda. While the population is small, the healthcare system is self contained because of the remoteness of the island, the cost of living is 95% higher than in the US, but the healthcare spending per capita only slightly more than in the US.

    In Bermuda all employers must pay $50% of health insurance premiums for all employees, but there is no equivalent to Medicare. There is a government fund that pays for urgent healthcare for indigents.

    http://www.bermuda-online.org/healthcare.htm

    Read More
  28. @Hibernian
    Yea, let's go single payer. I have a modest proposal. Put veterans and non-veterans alike in the VA medical system (with which I have some personal experience.) We'll all have healthcare, right? It'll be universal, won't it? What's not to like?

    I have a modest proposal. Put veterans and non-veterans alike in the VA medical system

    The VA already has a very hard time recruiting enough qualified doctors, nurses, and other professionals in many areas and it would probably be impossible to vastly expand the size of the VA. Having said that, the British National Health System is somewhat similar to a vastly expanded VA.

    Read More
  29. This may sound odd, but maybe he supported it knowing it would fail. He was elected to take a wrecking ball to the establishment. This began the process by putting an unruly Republican faction on display. It also proved that they didn’t oppose Obama because he was a Democrat or Obama, but based on an ideological purity standard. These are the people who attempted to hijack the Obama administration. My takeaway is that the Repubs should reign in the ideologues before they go the way of the Dems who are hijacked by their ideologues. This may be a good time for moderate Dems (and Repubs, for that matter) to make a comeback. I was always skeptical of Ryancare because PR is known as a fiscal policy wonk. What would he know about healthcare? Rand Paul would be a much better point person for this because he is a doctor and knows the profession. Any healthcare law should be written with at least one Dr. as a consultant.

    Read More
  30. This was a massive loss for Trump.

    Ryan has been undermining Trump from the Get-Go. It was Ryan who founded this idiotic plan of first spend a month on regulations (did Congress actually do anything about Regulations?) and then move to Healthcare.

    The plan is to waste time and run out the clock on quagmires before important issues that matter (the wall, immigration, trade, infrastructure) ever get heard.

    Up next for Ryan is another losing quagmire on taxes.

    As for Ryancare, the bill was decent: it amounted to a major middle class tax decrease. All sorts of taxes and other cost drivers were eliminated. Cost Driving Regulations were promised to be removed by Trump’s HHS secretary who does have credibility. (although user premiums wolnt go down unless the ‘pre-existing condition’ clauses are removed).

    Ryancare didn’t remove Obamacare, but what was left of Obamacare only existed as a shell. Nobody had their Obamacare plan yanked from them, but nobody left would have still been on Obamacare a few years in the future, as cheaper private plans would have emerged.

    The Freedom caucus, making the perfect the enemy of the good, screwed over Republican voters. But the Freedom caucus itself was a part of the Washington shell game of creating a quagmire.

    Read More
    • Replies: @bjondo
    this was a victory for President Trump.
    Paul Ryan lost and will be on his way out
    to the lobby streets of DC
    to be the shyster huckster that he really is
    and the bill was sh*t like Ryan
    , @MarkinLA
    (although user premiums wolnt go down unless the ‘pre-existing condition’ clauses are removed).

    The one thing Ryan said that made sense was that the chronically ill are 1% of the population and 27% of the healthcare spending. Then he waved his arms and announced he would somehow remove them. How much is that 27%, probably around 500 billion dollars. Of course, if insurance companies have an immediate reduction in costs of 500 billion premiums can go down. OK, how are those people covered and how does one determine chronically ill? I can't get any insurance because of the overly broad definitions of pre-existing conditions by insurance companies yet last year I paid 7200 in Obamacare premiums and used 800 dollars of my 4500 deductible and 300 of that was because I asked my cardiologist to request a test that was likely not going to show anything simply because I knew I was going to pay for the whole thing anyway.
  31. @Diversity Heretic
    I usually agree with Patrick Buchanan but I think that there are a couple of fallacies lurking in this article. If Obamacare becomes insufferable due to premium increases next year, people are not going to blame Barack Obama and the Democratic Congress that enacted the program. They will blame (rightly) the party in power, who couldn't come up with a reform. Second, Pat still seems to think we're living in the United States of the early 1970s. The demographics have shifted irretrievably in favor of the Democrats' coalition of the fringes. Trump's victory was by a very thin margin and he'll have to deliver on jobs, economic prosperity, and affordable medical care to win again in those Rust Belt states in 2020. The Democrats will have a more attractive candidate (think Kamala Harris) and Trump will be 74. Things will be even worse by 2024, which is why the longer Trump waits to tackle immigration, the more hopeless the long-term situation will become for Republicans.

    If Obamacare becomes insufferable due to premium increases next year, people are not going to blame Barack Obama and the Democratic Congress that enacted the program. They will blame (rightly) the party in power, who couldn’t come up with a reform.

    Weird analysis. I don’t buy it. I don’t buy your defeatism after that either. But I do agree with your subsequent point that immigration is a key issue.

    Read More
  32. More than a defeat, this was a humiliation.

    Nah. One has to have a brain to be humiliated.

    Read More
  33. @Rotten
    This was a massive loss for Trump.

    Ryan has been undermining Trump from the Get-Go. It was Ryan who founded this idiotic plan of first spend a month on regulations (did Congress actually do anything about Regulations?) and then move to Healthcare.

    The plan is to waste time and run out the clock on quagmires before important issues that matter (the wall, immigration, trade, infrastructure) ever get heard.

    Up next for Ryan is another losing quagmire on taxes.

    As for Ryancare, the bill was decent: it amounted to a major middle class tax decrease. All sorts of taxes and other cost drivers were eliminated. Cost Driving Regulations were promised to be removed by Trump's HHS secretary who does have credibility. (although user premiums wolnt go down unless the 'pre-existing condition' clauses are removed).

    Ryancare didn't remove Obamacare, but what was left of Obamacare only existed as a shell. Nobody had their Obamacare plan yanked from them, but nobody left would have still been on Obamacare a few years in the future, as cheaper private plans would have emerged.

    The Freedom caucus, making the perfect the enemy of the good, screwed over Republican voters. But the Freedom caucus itself was a part of the Washington shell game of creating a quagmire.

    this was a victory for President Trump.
    Paul Ryan lost and will be on his way out
    to the lobby streets of DC
    to be the shyster huckster that he really is
    and the bill was sh*t like Ryan

    Read More
  34. @anarchyst
    The only "real" solution is to go back to the old model, where doctor's visits and routine procedures are not covered by insurance.
    Health insurance should be based on a high deductible, catastrophic model, where any expenses above a certain amount are covered. Such a policy would cost much less than our present insurance system.
    Today's HMO model distorts the whole system. If automobile insurance were based on the HMO model, insurance companies would pay for oil changes, tune ups and other ordinary maintenance repairs.
    All one has to do is to look at the cosmetic surgery and LASIK eye surgery industries to see how health care should work in the real world. The cost for cosmetic and eye procedures is constantly dropping, due to efficiencies and competition.
    Of course, people would have to be dragged, kicking and screaming, into the "old" system, but would soon realize that their expenses for health care are much less than our present system.

    Except that the biggest problem is the billing scams run by the providers. The idea that paying a few hundred dollars of your own costs for routine visits to the doctor is going to save you thousands of dollars a year in insurance premiums is the snake oil the GOP has been pushing ever since Obamacare started.

    How do you fix a system when a simple visit to the emergency room was billed at 6500 dollars and the HMO paid 400 and my Mom a 75 dollar co-pay. Legally my Mom would have been obligated to pay the 6500 if she didn’t have insurance. These markups are routine even if this is on the high side.

    I get calls every day for non-underwritten medical insurance where they pay for basic office visits and up to two surgeries a year (capped at 10,000 each) and the premium is only 300 dollars. These policies are worthless because they won’t protect you from a medically induced bankruptcy. That is the thing the insurance companies fear the most – the 1,000,000 bill to pay for cancer treatments and why people with pre-existing conditions can not get any insurance at any realistic price.

    Read More
  35. @anarchyst
    PPO's and HMO's are actually one and the same. The key is to get the insurance industry out of paying for routine check ups and minor injuries. A catastrophic police can be had for about $100.00 per month.

    A catastrophic police can be had for about $100.00 per month.

    I think you are dreaming there unless you mean healthy 18 year old.

    Read More
    • Replies: @Hell_Is_Like_Newark

    I think you are dreaming there unless you mean healthy 18 year old.
     
    As a healthy man in my early 30s I was quoted a catastrophic plan ($10k deductible with coverage up to $3 million) that was HSA qualified: $125 per month. Lower coverage plans were available for under $100.

    The trick was I had to move out of NJ (which at the time, banned high deductible plans) to PA (where such a plan was legal). For reasons (I managed property on the side in NJ) such a move was not practical. A coworker of mine did take advantage of a similar plan from the same company (Golden Rule Insurance) when he moved to PA.
  36. @Rotten
    This was a massive loss for Trump.

    Ryan has been undermining Trump from the Get-Go. It was Ryan who founded this idiotic plan of first spend a month on regulations (did Congress actually do anything about Regulations?) and then move to Healthcare.

    The plan is to waste time and run out the clock on quagmires before important issues that matter (the wall, immigration, trade, infrastructure) ever get heard.

    Up next for Ryan is another losing quagmire on taxes.

    As for Ryancare, the bill was decent: it amounted to a major middle class tax decrease. All sorts of taxes and other cost drivers were eliminated. Cost Driving Regulations were promised to be removed by Trump's HHS secretary who does have credibility. (although user premiums wolnt go down unless the 'pre-existing condition' clauses are removed).

    Ryancare didn't remove Obamacare, but what was left of Obamacare only existed as a shell. Nobody had their Obamacare plan yanked from them, but nobody left would have still been on Obamacare a few years in the future, as cheaper private plans would have emerged.

    The Freedom caucus, making the perfect the enemy of the good, screwed over Republican voters. But the Freedom caucus itself was a part of the Washington shell game of creating a quagmire.

    (although user premiums wolnt go down unless the ‘pre-existing condition’ clauses are removed).

    The one thing Ryan said that made sense was that the chronically ill are 1% of the population and 27% of the healthcare spending. Then he waved his arms and announced he would somehow remove them. How much is that 27%, probably around 500 billion dollars. Of course, if insurance companies have an immediate reduction in costs of 500 billion premiums can go down. OK, how are those people covered and how does one determine chronically ill? I can’t get any insurance because of the overly broad definitions of pre-existing conditions by insurance companies yet last year I paid 7200 in Obamacare premiums and used 800 dollars of my 4500 deductible and 300 of that was because I asked my cardiologist to request a test that was likely not going to show anything simply because I knew I was going to pay for the whole thing anyway.

    Read More
  37. @MarkinLA
    A catastrophic police can be had for about $100.00 per month.

    I think you are dreaming there unless you mean healthy 18 year old.

    I think you are dreaming there unless you mean healthy 18 year old.

    As a healthy man in my early 30s I was quoted a catastrophic plan ($10k deductible with coverage up to $3 million) that was HSA qualified: $125 per month. Lower coverage plans were available for under $100.

    The trick was I had to move out of NJ (which at the time, banned high deductible plans) to PA (where such a plan was legal). For reasons (I managed property on the side in NJ) such a move was not practical. A coworker of mine did take advantage of a similar plan from the same company (Golden Rule Insurance) when he moved to PA.

    Read More
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