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Republicans can't answer basic questions about an Obamacare replacement — because they're not serious about governing

President Donald Trump, Vice President Mike Pence, Speaker Paul Ryan
REUTERS/Jonathan Ernst
From left to right: President Donald Trump, Vice President Mike Pence and House Speaker Paul Ryan.

Why, exactly, do the Republicans and/or President Trump not have a plan ready to repeal and replace the Affordable Care Act, aka Obamacare? Are they serious about governing or not?

You can ask them, and they’ll say it’s in the works but isn’t quite ready for a detailed rollout. One of them even said they are “not congealing around ideas yet.”

If you press them, it turns out a real plan doesn’t exist. In fact, if there is anything beyond rumors that could be called a plan, the Republicans aren’t able or willing to specify much of what it will look like.

If you ask about whether certain specific provisions of the ACA, like the way it treats pre-existing conditions or the fact that insurers can’t set a lifetime cap on the amount they will cover, they express admiration for the value of those provisions without quite issuing a clear statement that they will be fully retained. It’s pretty basic stuff.

If you press them even harder about what their plan will cover, how it will work, what it will cost, they will say that when it is implemented, every American will have “access” to health care that is “affordable.” (Here, I’m talking mostly about Speaker of the House Paul Ryan, for whom “universal access” and “affordable” are very key words in his every version of an answer. And those words sound good. But those words raise obvious further questions that have not been answered.)

You could say that everyone has “access” to Hamilton tickets, too. But unless you have a lot of money or really good connections, it might be years before you get to see the play. Is that how it’s going to work with your doctor?

To me, their magic words are less than nothing. Define “access.” Specify what you consider “affordable.” Tell us anything coherent about how it will work, what it will cover, what it will cost. Give us some clue as to how many people who have health insurance now will lose it. How many will pay less for something just as good? How many will pay more for something a lot worse?

These are not gotcha questions. There are obvious questions that must be answered so Americans can decide whether this big change the Republicans have been promising for six years will be changes for the better or the worse. Yes, liberals and Democrats and plenty of moderates and independents are biased against Republicans, or at least skeptical that they have a better plan. But that won’t get any better if Repubs keep talking about a better plan but never produce it. Where’s the beef?

Ryan is almost as good as Kellyanne Conway at keeping his cool and a smile on his face and talking as if he is answering a question. But when he (or she) is done, you will find you have not learned anything about the plan. (I almost said “if there is a plan,” but surely there is something at some level, of development). Still, the whole point of this post is: Why won’t they show it to us? Ryan and other leaders have begun to suggest that we won’t see it until 2018. 2018. They’ve been repealing Obamacare since 2011.

A small, silly, rhetorical war has erupted within Republican ranks about whether to “repeal,” to “repeal and replace,” or even just to “repair” the Affordable Care Act. Who cares? Tell us what’s in the plan. We won’t judge it on how much of the ACA is retains. We’ll judge it on whether, on balance, more people are helped than harmed.

The United States has long had a higher portion of its population without health insurance than any of the wealthy industrialized nations, which I consider to be a disgrace, or at least a serious problem (especially considering that we spend more, per capita, on health care than any of the others, even though we are far from the best in overall health outcomes).

Thanks substantially to the Affordable Care Act, the portion of Americans that have health insurance is currently at an all-time high. Will that percentage go up or down when the replacement plan is implemented? How much will costs go down and will anyone’s costs go up, and if so who, and if so how much? What will be covered and what, that is covered now under the mandates of Obamacare, will not be covered?

Since they took control of Congress, Republicans have voted dozens of times to repeal the Affordable Care Act (aka “Obamacare”). Why don’t they already have a replacement plan ready? Are they not serious?

All of those repeal votes were just cheap political point-scoring, but it didn’t matter much because they could count on President Obama to veto the repeal bills.

Now, obviously, they have the votes to repeal, and a president of their own party, and whatever the system is after the dust clears, they will own it. If Americans who are now insured become uninsured, that will be a Republican accomplishment. If Americans find they are still insured but less well-covered than before, that will be on the Republicans. If most people are happy with the new plan, that will be a big step toward securing and extending their mandate into the future and other big issues.

President Trump will soon have some skin in this game. He has ridiculed the problems of Obamacare, but has also said more than once (I’ve written this before, but it may still surprise you because it is staggering) that under his plan “everybody's got to be covered” and “ the government's gonna pay for it.”

I’ll be very surprised (and impressed!) if those promises are fully kept. He has also said that his plan will be unveiled as soon as his HHS secretary is confirmed, which happened Thursday. 

Trump managed to get all the way through the campaign without putting out a detailed plan. He did give his plan a name: “Healthcare Reform to Make America Great Again,” and some provisions were mentioned but not at a level of detail that could be scored.

By the way, if you think I’m exaggerating the degree to which the Republicans are tiptoeing away from their big talk, here’s what Sen. Bob Corker (R-Tenn.) told a gaggle of reporters on Tuesday about the latest on a new health care program (as quoted in this Huffington Post piece):

“To be honest, there’s not any real discussion taking place right now…”  Corker told reporters. He said he has “no idea” when a replacement plan will be ready. “I don’t see any congealing around ideas yet.”

That’s pretty choice. No “congealing around ideas yet.”

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Comments (76)

Watch for the congealing

Watch for the congealing around the idea of block-granting all federal medical spending (ACA, Medicare, Medicaid)--let 50 flowers bloom !!

More Like 50 Weeds

Turning federal health care spending into block grants is a way for the Republicans in Congress to cut spending, but deflect responsibility for doing so. There isn't enough allocated for Medicaid? Talk to your state representatives--they're responsible for it now!

something is congealing alright

The new NOC (not Obama care), seven years in the making, and really terrific, is either being held hostage by a hostile press corps (aka - the opposition shut up and listen party) or was eaten by the same dog that ate the presidents tax return.

If You Ask Me

And nobody has, I say they will tinker around the edges, give it a new name, baptize it and declare their efforts a success.

Their professed goals are contradictory, so they have no other options.

And their working class base will be glad they got rid of Obama-care.

The Republican problem

is the affordable care (under any name) is dictated by economic realities.
The only alternative approach which would provide adequate health care to all Americans is single payer, which is even less politically palatable (call it the cod liver oil healthcare plan).
....
And of course 'block granting' is just punting the problem to the states, who will in turn blame inadequate health care on too little federal money with too many strings attached (watch for them, coming to a health care provider near you).

congealing?

From the article:

Corker told reporters. He said he has “no idea” when a replacement plan will be ready. “I don’t see any congealing around ideas yet.”

When I think of congealing, i think of the fats that congealed in my left descending aorta, forcing me to have open heart surgery some years back. Not good.

What ever Republicans actually do in health care reform, I'd avoid using the term "congeal" as part of the marketing pitch, just saying.

It all depends on how you classify

health insurance. Do you call it health insurance if you have a $850 dollar a month bronze plan (you pay $50, tax payers pay $800 a month) with a $8,500 deductible, you get in an accident and can't pay the deductible. What good is that plan? This is happening all the time. Do you call it insurance when you have Medicaid and over 50% of doctors either won't see you or your care is rationed? Is that insurance? This is the state of Obamacare and the expansion of Medicaid today that folks on the left tout as health insurance.

RE: Medicaid acceptance - your info is of poor quality

Please check out the major provider organizations - Fairview, Health Partners, Mayo, etc. and you will find (last I checked) that they accept Medicaid patients, no questions asked.

Of course, you might find some smaller practices which reject the payment schedules, because it doesn't suit their business plan. Is that where you'd like to get your health care ??

Get serious....

I guess the GOP will have to act and pass a replacement bill that increases cost, maintains unaffordable premiums, reduces choice, restricts access, is unstainable for financially moderate deficit hawks, maintains yearly massive increases in deductibles, provides no taxes increases on Cadillac health care plans for union members and the establishment, jam it through congress with no bi-partisan support, and call it the "affordable care act."

This should surely please the DFL since they have already voted for this plan.

This is

…a rare column headline I can get behind. Six (or is it seven?) years after they began voting to repeal the Affordable Care Act, they have no plan. Six or seven YEARS to develop a full-fledged alternative to a plan (and a philosophical position that makes Paul Ryan nauseous) they loathe, and Senator Corker, in a rare moment of Republican candor, says that “To be honest, there’s not any real discussion taking place right now…”

That doesn't just suggest that the GOP isn't serious, it screams it from the rooftops. They're not capable of governing, only of obstructing. Or, as I've phrased it previously, they don't want to govern (and this seems especially apropos of the new President), they want to rule. Kings and princes don't have to explain things to "the little people." It's our job to shut up and do what we're told, much as Mr. McConnell told Senator Warren to do a couple days ago.

Nevertheless, she persisted. So should we all.

Welcome to Trumpcare.

The Republicans, who have spent 8 years and 60 plus very insincere tries to repeal the ACA, Obamacare, are very quietly backing away from doing so because they can’t figure out how to do it. They have been caught in their own misguided trail of fear mongering. Now those with Obamacare are speaking out and speaking out forcefully. Of course the ACA needs to be improved, but what have the Republican's done to help, NOTHING. They will claim they tried to help but every time they were playing poison pill politics by including abortion, deregulations, reduced taxes for the wealthy, etc. knowing it would go nowhere. There never has been a major bill like the ACA that didn't need revisions once launched. When they are done with whatever they are going to do with the ACA, it will look a lot like Obamacare. Trump has already signed the repeal order so now the “REPUBLICANS OWN IT” no matter what happens from here on. Welcome to Trumpcare.

The party of "NO"

Which can tear down but not build up, is not a party, it's a mob.

In 6+ years they haven't had the intellectual capacity - or respect for the American people - to come up with a rational alternative.

To suggest that this is the party of Lincoln, or of Eisenhower, or even of Reagan is an insult to their memory.

The republicans are unable

To help the poor and lower middle class on health care - they simply do NOT care.

This wash post story details

This wash post story details the chaos you can expect with "leaving it to the states"-- Idaho has total R control, but unable to come up with any alternative. Oops.

Forgot

The Republican plan

The reason why there is no Republican plan is that Obamacare is mostly what Republicans want. And the reality is, most of what Republicans complain about are due to the most Republican features of Obamacare. Health care is too expensive, we are told. Indeed it is, but the Republican solution to high costs in increasing the competition between health care insurers. But Obamacare does little or nothing to stop competition. The real problem is that health insurance is enormously complex and difficult business, and few companies are willing to get into it. That was true before Obamacare, it's true now, and that will be true under any Republican successor plan.

Obamacare is a complete Democrat debacle

Eric writes over 1,000 words but never gets around to mentioning Democrats rammed through the so-called Affordable Care Act without a single Republican vote. Revealingly, the establishment news media never mentions that relevant fact in stories regarding the current situation. Democrats passed Obamacare simply because they could, which is never a good idea.

The idea of government being in health care is absurd. Liberals claim people have a "right to health care." If so, don't they also have a “right" to food, housing and clothing, which are just as important to survival?

If government should provide health care insurance why is it not also responsible for life, property and car insurance?

Republicans should focus on getting government out of the health care business. And Democrats/liberals should apologize for the mess they created all by themselves.

We're still waiting

for a Republican apology for the total and complete mess George W. Bush left us.

Actually, some of us think...

...that providing health care, food, & housing are core responsibilities of government, right along with "security".

How can government assure "life, liberty, and the pursuit of happiness" without any of these ??

ACA Vote

If non of the Republicans voted for the ACA, then that's on them, not the Democrats. Obama invited them to the table and they refused, preferring instead to fight everything Obama did, no matter how beneficial it is to society. They even fought against extending unemployment benefits for six months because it would cost a 60 billion dollars. This was in the height of the recession when people were hurting the most.

ACA was the market solution the Republicans were looking for, but it didn't have the guy they wanted to propose it.

I disagree with your assessment that government should get out of the health care business entirely. Now before you have a meltdown, let me explain. If you still disagree afterwards, then we can have a civil discussion about the points.

The government does a much better (and cheaper) job of managing insurance than the commercial market. Typical government programs have 3% overhead costs whereas the commercial programs run 28% or greater. ACA stipulated that they keep costs to 28% or they had to issue refunds to their customers.

With a government program, you get all in. Not only is everyone insured, but all doctors, clinics, and hospitals are also all in. No "out of plan" fees--you can go anywhere in the country to get your care.

This also allows the work force to more easily relocate to find better jobs without having to worry about health insurance for their family. That in turn lets people take jobs at small companies who today don't have plans, take part time jobs that don't typically offer benefits, and even start their own businesses, complete with health insurance intact.

Depending on how it's set up, Universal Health Care can (and should) come with no $8500 deductibles, no lifetime limits, and no co-pay.

Let me know what you think about that slate of items. I've got many more points and details to go over, but that's a good start.

Homelessness

Oh, I'm glad you mentioned homelessness too. Did you know that the VA is working to eliminate homelessness among veterans? The VA built 57 apartments in historic buildings at Fort Snelling and veterans can go there to stay for a month or the rest of their lives, if they so choose. They also have access to substance abuse programs, job training, computer skills training, and a whole host of other programs while they're there.

Along the same lines, Minneapolis is working to eliminate homelessness too, bringing together diverse agencies to tackle the problem together.

So yes, the government is helping people to take care of their basic needs.

Really that's what we have government for: to tackle problems that people are unwilling or unable to do on their own.

I remember it differently

I remember a naive president asking Republicans to come to the table like adults so that bipartisan bill that covered all Americans could be hammered out. And you know what happened? The children had meltdown over the fact that they were invited to the grown-up table and refused to leave the breakfast nook. And then they screamed and cried when the adults made the decisions because the children had no real power, anyway.

In fact, there was a bi-partisan committee, dubbed the Gang of Six, that actually came up with a bipartisan bill (which became the basis for the ACA). It covered all the bases. But, since Obama didn't fit into McConnell's idea of "president" (take that as you will), he threatened the 3 Republicans on the Gang of Six and forced them to walk back their support. And then whipped the rest of the GOP into a childish frenzy. And, that was that. So, the whole "rammed down throats" story was fairy tales (which is just a nice way of saying a lie). Still is. "Rammed down throats" is double-speak for "we didn't want to play ball with the wrong guy in the White House."

FYI, just saw architect of Obamacare

Jonathan Gruber on a financial show touting that business insurance coverage has risen at historically lower levels under the ACA. Gruber who famously said "Americans are too stupid to figure out what the ACA was about", forgot to tell the public that businesses changed to higher deductibles for employees to keep costs for their coverage down. So when your insurance given to you by your employer goes from a $1,200 deductible to a $5,500 dollar deductible, is that considered a success by the liberals? So much money manipulation in liberals arguments it is hard for folks to take them seriously.

You know:

Some of this stuff is just pathetic! Looks like success by republicans is, forget the the health insurance completely, except for the execs gold plated package, make sure it is 100% tax deductible, and for everyone else, work them until they drop over dead or can't move, kick them to the curb and get another new body, preferably in the 12-14 year old area, easier to exploit and get more mileage out of them. that medicare for old farts, drop those guys as well. they aren't producing, kick them to the curb as well, Fair enough successful Liberal vs Conservative comparison?
.

Joe . . . Again . . . Relax . . .

The election's over. Obama's not in office anymore, none of his advisors have any say in anything anymore and, most importantly, the people you believe in and stand with have complete control of the government and will soon be rectifying the health care problems you keep saying (and saying and saying) Obama and Democrats caused.

We all thought that would be happening this month with the appointment of the new HHS Secretary because we all remember the president saying repeal and simultaneous ACA replacement (with a fantastic new plan every American would be able to afford) would happen right after his confirmation. But even though that time-line seems to have slipped a little (until sometime just after the 2018 mid-term elections, it sounds like), that doesn't change the most basic and important fact: Your guys are in control and they're totally free to fix health care (and all those other things you've been blaming on Obama and Dems for years) because there's no one -- no Obama, no Gruber, no Democrats -- standing in their way.

So you can relax and stop banging the Obamagong and start letting everyone know about all the great things your heroes are going to be doing and, as they roll those things out, all the great things they're getting done instead.

Societal values

I agree that having "higher portion of its population without health insurance than any of the wealthy industrialized nations," is a disgrace. Worse, it's part of a pattern.

We also have a higher proportion of citizens in prison than any other country:

https://www.washingtonpost.com/news/fact-checker/wp/2015/07/07/yes-u-s-l...

And are first or second among industrialized countries for wealth inequality:

http://fortune.com/2015/09/30/america-wealth-inequality/

I suspect that these are not simply coincidental but are the result of our national value system, which rewards the rich for being rich while punishing the poor, blaming them for their own poverty.

Inequalities in our justice system and our economy were not the subject of this column. They're far too complex to address in a comment. But I wanted to make the point that health care inequality is part of a societal pattern.

Affordable care

is a system constrained by health care economics.
You can't change part of it without changing the whole thing.
So, in the real world, the only alternative that can provide affordable health care to all Americans would be a single payer system (a national health service), and the Republicans are not going there.

That's show biz

If you need tickets to "Hamilton" right now you should sell your house or car, then either buy a cheaper house or car or use the remaining funds to become a renter or take the bus, or walk. Or you can take a chance and hope to live until the movie comes out. It probably won't be as good as the play, but at least you won't be guilty of practicing socialism.

Sounds reasonable for access to tickets but if the object is health care further discussion may be warranted.

Oh, they have a plan. The guy

Oh, they have a plan. The guy just approved for Sec'y. of Health has had a plan before Congress for some time, just like Paul Ryan. They're vague on those plans only in the "this is it" mode in public.

What will be impacted is not only Obamacare itself, but Medicaid (block grants to states to use as they will, tighter eligibility to exclude millions of working poor from coverage, and so on), Medicare (elimination of standard Medicare for all and substitution of an array of private insurance plans for which each elderly person will get an annual voucher to buy insurance; no provisions for inflation in the vouchers; imposition of an annual cap on benefits provided and a lifetime cap on any insurance coverage from Medicare; elimination of free preventive or subsidized health care for the elderly like annual flu shots and cancer screenings like mammograms and colonoscopies--these were provided as part of Obamacare).

In Obamacare, you must provide policies that cover maternity benefits (duh! but yeah, insurers insist that you pay for all of that expense but Obamacare protects the consumer) and you can't discriminate against people because they're old (insurers insist they must charge four to five times the premiums for people in their forties and fifties who tend to develop age-related illnesses) and they also charge higher premiums to women because women tend to go to the doctor more than men do.

Insurers used to charge higher premiums for people of color, but it's been decades since that practice has been outlawed.

Obamacare is a good start on providing health care to Americans who will die destitute without it (check how many bankruptcies because of healthcare expenses there were before Obamacare was set up!). The Republicans are hoping they can sneak through a dismantling of Obamacare little bit by little bit, over a long stretch of time so people won't notice. They are also depending on Donald Trump to keep tweeting his nonsense to distract people from what the GOP Congress is doing to Obamacare pretty much behind our backs.

All we've got to protect us from the plans the Republicans have in their pockets is the news media to inform us, and then our own pressure on GOP Congresspeople!

I have to say one thing from personal experience: Medicare WORKS. Just the way it is. It holds medical costs down, but it needs the authority to negotiate outrageously high drug prices. We can diddle Medicare to bring in more funding, but this universal elder health care saves lives. And if we want to ration health care for the elderly under Medicare (a proposal Republicans have made), then we ought to have a broad and serious public discussion about who, precisely, is left to die under rationing.

Most Americans don't know that Obamacare is based on a Republican health insurance plan put into law when Mitt Romney was governor of Massachusetts, and that it is based on private, for-profit insurance companies' needs and preferences. Private insurance demands a broad pool of clients so that the healthy subsidize the sick. Remove the "you must pay for health insurance" mandate, and the whole house of cards falls down because you reduce the pool of insureds to just the sick.

The only humane, decent alternative to improving on Obamacare, and Medicare, and Medicaid by strengthening them, is single-payer universal health care.

What's the problem ?

According to the President 'Obamacare is a complete and total failure'. So of course Trump Care is going to great, fabulous - I think you are going to be very happy with it ! So why worry ?

To congeal (v.i.)

"to change from a soft or fluid state to a rigid or solid state, as by cooling or freezing;
"to curdle, coagulate;
"to make or become fixed, as ideas, sentiments or principles"

A strange word for Sen. Corker to use, but maybe he was thinking of his and his colleagues' sentiments about the Affordable Care Act and its Chief Instigater.
And of how they tried for years to curdle and freeze it by voting repeatedly to repeal it.
Yet it's still here, serving people who wouldn't otherwise be able to get or afford health insurance, and protecting all of us from the worst excesses of corporate health insurance.
We know the "republicans" have no idea how to replace it, and we know why: (besides the facts that it ought not to be repealed and doesn't need to be replaced) Eric is right -- they have no interest in governing. And they're not good at it after years of shutting down the government, and preventing President Obama and Congressional colleagues from accomplishing more of what needed to be done.
Now they have a president with the same principles they've demonstrated all these years. Go for it, give it your worst. Those of us who care about human rights and our Constitution will continue to stand in your way.

Don't hold your breath

They don't even know what will happen next week, let alone by mid-term election season. Trump is so unstable and incompetent that the ACA might even be a back burner issue as they try to figure out what governing even means!

It's a simple three point plan

The Republicans have a plan to completely revamp American healthcare.
1. Repeal Obamacare
2. Rebrand it "Trumpcare"
3. Pass it again

No plan

Duh and Duher

"One-Third Don’t Know Obamacare and Affordable Care Act Are the Same

"A sizable minority of Americans don’t understand that Obamacare is just another name for the Affordable Care Act.

"In the survey, 35 percent of respondents said either they thought Obamacare and the Affordable Care Act were different policies (17 percent) or didn’t know if they were the same or different (18 percent)."

www.nytimes.com/2017/02/07/upshot/one-third-dont-know-obamacare-and-affo...

Heard that on the radio the other day and saw a Jimmy Kimmel segment a while back in which they asked people on the street the same kind of question -- "Do you favor keeping Obamacare or repealing it and replacing it with the Affordable Care Act?" -- and couldn't help but laugh at all the, "Affordable Care Act, definitely, because Obamacare really sucks!" answers, but never imagined somewhere around a third could possibly not know the difference (outside of an "edited-for-effect" comedy show).

I guess it's no wonder that whenever Republicans take over a state the first thing they do is cut taxes and cut education spending . . . It helps keep "the base" base growing and properly informed.

Surveys

I caught a survey on the radio the other day that says 60% of Republicans hate ACA. By contrast, 80% of Republicans hate Obamacare.

Of course they can't

The realities of any universal health care plan are constrained by the economics of health care. It's a system; you can't pull out one part without making the whole entity fail. So the only viable alternative to the Affordable Care Act would be a single payer system -- in other words a national health care system. And the Republicans aren't going there.

Just steal a plan from Switzerland

High health care costs but still billions cheaper than what we have and universal coverage

We're already on Trump Care

The repeal of the ACA has already started. Trump's Executive Orders and the exemptions that are in the pipeline are enough to create uncertainty in the market. That uncertainty is going to get priced into 2018 premiums. The Democrats need to start messaging that we're on Trump-Care now. Make it so the administration owns the premium increases that are coming.

An offer we can't refuse

Pay more (if you're rich)
or die.

ACA

From Erik Paulsen's website - he lists this as some of the reforms he would like to see:

" Expand access to health care by protecting patients with pre-existing conditions, allowing dependents up to age 26 to stay on their parent’s plan".

Gosh, Erik, stunning ideas, and how misleading of you.

Paulson actually said this?

If so, how disingenuous can one get???

"Not Serious"?

More like NOT CAPABLE.

The GOP, due to the efforts of the "Tea Party," Rush Limbaugh, and weasel news,...

have long since run anyone capable of complex thought OUT of the party.

Slogans, quips, fake news conspiracy theories, and one liners are all they're capable of understanding.

They can't devise how to tweak Obamacare (let alone replace it) because they are incapable of comprehending how it even works.

It's as incomprehensible to them as the inner workings of the B.I.O.S. on the system board of their computers,...

a system which most of them don't even know exists.

But, unlike with their computer systems, where they might seek assistance with repair,...

their ideology forces them not to trust anyone ELSE to help them,...

when they can't comprehend the workings of complex, interlocking systems of business and government policy,...

especially when those helpers try to wake them up the reality that what they've spent so long falsely promising,...

is impossible to deliver.

They, together with their "conservative" media outlets and supportive religious leaders,...

have filled their followers' hearts, minds, souls and imaginations with nothing but facile lies, dishonest-unworkable-simple solutions, false promises, and extreme hostility toward anyone who dares to disagree.

They can't govern on Obamacare or anything else because NONE of their ideas can be put into practice without crashing the entire system,...

and probably doing it twice as fast as George W. Bush managed it.

Those who used to know better are long gone,...

and certainly not welcome to return.

President Trump is, of course, no help to them,...

because that "poor high school student" he was describing,...

who would be able to understand why the judges who ruled against him were wrong,...

was HIMSELF,...

(A BETTER student would know why the judges were and are correct),...

and his chief concern, one which he shares with so many of their wealthy supporters,...

is "How can I make money off the coming chaos?"...

together with, "Will increasing the chaos enable me to make MORE money?"

It's a Plan That Has Already Been Made

The most recent comments I saw from any senate members that will even talk about it has everything in it that the Affordable Care Act had in it, except the requirement to have insurance. Since insurance companies already said the reason they had to raise rates so much is because the healthy folks aren't getting insurance I am not sure how anyone things this will offer relief. Now everyone who is healthy might risk not having insurance for a period of time. So does that mean the Republican senators owe the Democrats an apology? OK--I know it won't happen.

That means

that it will have to be so expensive that only the rich can afford health care.
That is assuming that even more insurance companies don't drop out of the market.

The Challenge

The challenge of course is that many aspects of the ACA were good. I mean the biggest problem was that the financial penalties for not carrying insurance were no where near high enough.

The idea that people could wait until they needed an expensive procedure, apply and be guaranteed insurance, have the procedure and then drop the insurance was a terrible flaw.

Here is further analysis of the GOP concerns.
http://money.cnn.com/2017/02/13/news/economy/republicans-obamacare/index...

Of course now that GOP has been fighting it for so long, just fixing it is unacceptable to their egos and their supporters. I am not sure where this will end.

The Biggest Problem

That's an interesting take on the law. Fixing it should be a relatively simple act, but as you point out, it would require political will and swallowing seven years of rhetoric.

Ironically

Ironically, my truly Conservative Mother thinks that government requiring people pay for health insurance is the biggest problem. I am a bit more pragmatic.

Alternative to forcing people to buy insurance

The alternative to forcing people to buy insurance is allowing hospitals to reject anyone who doesn't have insurance. You don't HAVE to buy insurance, but nobody will give you any health care without it.

However

For better or worse our society insists that everyone receive care no matter their poor personal life choices.

Since we have mandated that society will cover the costs, we really need to mandate that everyone pays in.

Not to hijack....

I almost didn't bother to open this article because the title...:

"Republicans can't answer basic questions about an Obamacare replacement — because they're not serious about governing"

... is simply a truism and requires no further explication. The only thing I would add is that republicans not only lack an interest in governing, but also lack even a capacity to govern in any responsible way.

I think the most important observation we can make about Obamacare is that it's passage and subsequent shortcomings were the product of a democratic party that had abandoned liberal initiatives and even liberal mentalities to a certain extent.

It's important to remember that both Obamacare and it's predecessor "Hillarycare" were essentially republican/neo-liberal attempts to preserve existing health care markets rather than create an actual health care plan. As it turned out Obama ended up sharing Hillary Clinton's neo-liberal/republican delusion that private sector markets could be the only possible solution for the American health care crises. These delusions are based on a faith in private sector efficiency that liberal's actually challenge and often reject.

The fatal flaw with Obamacare is it's bizarre assumption that uninsured American's formed the backbone of the health care crises, and that simply getting more people "insured" would end that crises. This market mentality is so predominate among both republicans and democrats that makes the true nature of the crises nearly incomprehensible.

Be that as it may the fact remains that Obamacare's central features are all derived from republican principles and initiatives. The reason republican's are having so much difficulty repealing Obamacare is that they're discovering that Obamacare, at it's core, is their own plan. Aside from removing some features that industry objects to regarding things like pre-existing conditions, all the republicans can really do is change the name and call it a day.

I suspect that wherever Barack Obama is right now he's getting nice chuckle out of all of this but the problem is we're still left with a health care crises. Amazingly despite the fact that enrolling more people in health insurance policies was the overriding and primary objective of Obamacare; it still left 30 million American's uninsured. Health care costs continue to explode after a short pause, and as many as 30 million Americans still can't afford to go to the doctor DESPITE having health insurance. Meanwhile the cost of all that insurance that was supposed to solve the problem keeps going up instead of down like it was supposed to.

For the record, the real backbone of the health care crises is and always was the exploding and unaffordable COST of American health care. American's spend almost twice as much for health care than Canadians, Japanese, or European's and setting the disparity of health care quality aside, millions of American's simply can't afford it. The cost is so high that insurance premiums, deductible's, and co-pays put even basic health care beyond reach for as many as 60 million Americans. At a time when every other liberal democracy on the planet provides health care to 100% of it's citizens one fifth of our population can't afford health care. And I'm still not really describing the full extent of the crises. Even people with "good" insurance flirt with financial disaster IF they get seriously injured or sick, and the machinations and inefficiencies inherent in competitive health care markets end up denying health care or better quality health care to millions of Americans whether they have insurance or not. All of this AFTER Obamacare has gone into effect. The problem is that Obamacare didn't resolve the health care crises, on the contrary it kept that crises on the table. But that's what democrats do.

The liberal solution is to expand Medicare and Medicaid to cover everyone. This was actually the democrats plan back in 1965. The fact that so many "liberal" Americans couldn't imagine that Bernie Sanders's Medicare For All was anything other than an unrealistic fantasy simply reveals the dull nature of "liberal" imaginations and THAT'S the lesson to be learned from this republican quandary regarding Obamacare.

First democrats left the health crises on the table rather than resolving it. Then they pretended to have resolved it by celebrating it's minimal accomplishments (In many ways all Obamacare really did was establish some basic insurance regulations that were decades over-due anyways) while ignoring the continuing crises. There was simply no follow through. Six years AFTER the passage of Obamacare, with health care STILL a major issue for most Americans; Hillary Clinton steps into the ring with absolutely no agenda to improve health care in America or address any of Obamacare's deficiencies. For six years Obama himself was to say time and again: "Obamacare's not perfect. We know that... there's still more to be done." Yet they did... nothing. They proposed... nothing. Worse, in order to get Obamacare passed they made deals with industry that kept costs from being controlled. Once again democrats stepped across the "aisle" recently to join the republican vote against letting Americans by their prescription drugs from Canadian pharmacies. Why? Because that was the deal they made with big pharma to get Obamacare passed in the first place.

The lesson? We need liberals who will promote and fight for liberal policies that actually resolve crises like the one in health care. If you can't imagine anything more liberal than Hillary Clinton, you need let someone else take a whack at this. Democrats need to follow through, they need solve problems when they're in power not leave them on the table for fear of "over-reach". If you have to settle for a compromise today fine, but come back tomorrow and keep fighting for the end game, don't just walk away like your job is done. Don't make deals that prevent you from coming back and fixing problems in the future. You're going to lose elections sooner or later anyways, better to lose an election after solving problems than leave the problems on the table and lose the election anyways. Do the poor bastards who vote for you a favor and fix stuff when have a chance.

You know:

You have to start someplace, and if you don't start someplace you are no place. The start may not be perfect, the good news is, the multi year critics got what they asked for, and no surprise are clueless. The real issue is, got a far right mentality committed to financial enslavement of the populous for the benefit of the few. Solution: you need folks that are worried about the average American before, corporations and the 1%, don't care which party they come from.

Not solving it

To begin with, health care insurance issues are solvable, at least not in the sense of finding solutions that will make everyone equally happy. The fact that we have a consensus based system, one that requires the support of super majorities to get things done, is the reason why the United States, alone among the advanced industrial nations, went without universal health care for so long. I assure you, none of those countries with universal care have the support of all their citizens, and I assure you all of them are capable of improvement. The difference is, their political systems are organized in such away that decisions are possible. In our system of government, decisions are never definitively made, nothing ever get done. It's the price we pay for our wonderful balances and checks.

You can't hide behind our "system" forever.

We got the New Deal done. We got civil rights done. We got Medicare and Medicaid done. We got to the Moon. We got public education, and the EPA, GI bills and public universities and I could go on. But we got those things done when we had a liberal party on the field. Then the DLC and Clintonite neo-liberals took over the democratic party and suddenly if it wasn't a republican idea it wasn't workable. The problem is republicans don't have the best ideas.

No one tries to build systems that make everyone happy, but we do build systems that work.

By the way, consensus doesn't require unanimous approval. Liberal democracies rely on majorities. And by the way, the majority of Americans say the want Medicare For All.

We can get stuff done in our country either because or despite our "system". We just need leaders who actually want to get stuff done rather than simply cater to the elite.

Work

Okay, I'll bite...

Do you really think the VA or public school systems work acceptably?
I personally don't think I want a medical system that fails that many patients.

Now Medicare and Medicaid do work pretty well, but mostly because they make use of the Private Healthcare system.

Now if you believe this is the problem. "For the record, the real backbone of the health care crises is and always was the exploding and unaffordable COST of American health care."

Do you see the answer as government mandated cost controls? Please remember that historically that fails terribly and leads to rationing and waiting lines.

Or do we want governmental diet and exercise controls so that all citizens live healthier?

Rationing and waiting lines

Segregating healthcare to only those who can afford it is NOT rationing how? It's a limited resource, rationing is always involved, it just comes down to which type of rationing benefits the most people. Beyond that one is making value judgements on the worth of other people's lives.

Unfortunately

For better or worse humans respond to rewards and consequences, and there are humans who will happily live off the efforts of others.

Do you have a better way than capitalism to promote hard work, learning, saving, investing, healthy living, etc by the citizens who live in our society? Or do you think it is okay for a subset of citizens to live a minimalistic lifestyle off the efforts of every one else?

Unfortunately I do not. If someone chooses to not learn, not work, not save, to have too many kids, etc, society can not continually shield them and bear the natural consequences of their poor choices. To do so leads to a very dysfunctional society.

Just imagine if a Parent did this for a child... That would be irresponsible and terrible for the child.

Its not, nor has it ever been, nor will it ever be

Yours, or my place to make that judgement. Worry about your own life, and quit demanding others conform to your values. I get it, you think you've stumbled upon some great secret to life, and if only those lazy sob's would just listen to you everything will be all right. Life doesn't work that way, and complex problems will not be solved with simple solutions. For all the dithering about we liberals being the fans of a "nanny" state, when are you cons gonna acknowledge your own wish to be everyone's parents.

No Judgment Required

Please remember that I have no desire to punish anyone for their choices. I just want to stop people like yourself from judging who should pay and who should receive...

I am a big fan of natural consequences... If you don't learn, don't work, spend too much, etc you will likely be poor. This is a natural consequence, not a judgment...

I'm not judging anything

Society decided that a large derelict population, unable to feed, clothe, or house themselves due to poverty was problematic for its continued survival. It then decided that a duty of membership to its members was payment in the form of taxes from those able to pay to allieviate this problem. No one forces us to remain members of this society, your are free to leave at any time, should you find the cost of membership too high.
Btw, there is nothing "natural" about any aspect of human society. All is a consequence of multitudes of interconnected systems, often spanning multiple generations. Something incomprehensible in your black and white world.

Unable

I think you wrote the keyword... "unable"

Please remember that folks like me are all for helping people who are "unable" to provide for themselves. (ie disabled, elderly, children, etc) The question is what does society owe healthy people who have chosen to not learn, work, make responsible choices, and the other things that help our society to be successful so we can care for the truly "unable"?

It seems that you would prefer to have society give them things anyway. The good thing about our society is that we can discuss and disagree about these topics instead of people leaving.

Just curious. If you were one of 100 people rowing a boat and time was of the essence. (maybe you are bringing unabled people for care), and you saw 5 people who were obviously distracted and/or not helping to their full capability. What would you do? Would you tell the other 95 to work harder?

I would

Concern myself with rowing, thankful that the boat would reach its destination. The alternative being to stop rowing altogether to waste time chastising the few who won't follow orders.

What if the boat's motion

What if the boat's motion slowed because of the current increasing and if the unable still needed urgent help? Would you still just keep pulling harder at your oars? Is it logical or fair? How will your morale and willingness to keep going be impacted?

By the way, my answer is to keep rowing while using the 95 rowers and positive peer pressure to bring the 5 along.

I ask because the significant increase in global competition and the improved capabilities of people / processes in other countries are going to continue to make it ever harder for Americans to keep a much higher standard of living. It would be nice if every "able" person here would start rowing the boat.

Now how to encourage them?

Unfortunately

The conclusions make sense, but the playing field doesn't necessarily equate to the conclusions:
Meaning we have ~ 330 M people in the US, that represents 330 million variables, now, add in the economic, interpersonal relations, family situations, neighborhood situations, skin color situations (yes, some of us believe racism/prejudice is still very prevalent in America) etc. etc, thus the possibilities derivatives get (very very very large). And the natural consequences theory pretty much falls apart after a dozen folks or so. Kind of like, given the "natural consequences" , How/why did Danny Heinrich end up as a child rapist and murder? Suspect he had all/majority of those key fundamentals.

Variabiliy

I don't know about Heinrich, maybe he was abused as a child or had a genetic predisposition of some kind.

And yes there are many factors and some luck involved. However letting people experience the natural consequences of their actions is an effective way to encourage learning and improvement.

To continually save them from the natural consequence just allows them to stay uninformed and dependent. To me that is very cruel.

Some people have an innate desire to learn, work, change and improve. Unfortunately others need some form of carrot / stick to help motivate them. If you disagree with this view, please explain.

Sorry:

Struggle with "natural consequences"! Rural America, you grimace at a bully in school and probably the worst is a black eye or bloody nose, "natural consequences", do it inner city perhaps the best "natural consequence" is your only wounded in the drive by shooting. Yep, its all part of the learning process.
The point is lots of variables, in lots of different situations, meaning "natural consequences" is in our mind, not necessarily, "natural" i.e. plant the seeds in good soil, water, weed, and you get a good plant. Don't have all those elements in all sectors of society in proper proportions,

Remember

I am a big fan of changing social / welfare policy to dissuade people from being a single parent, and to encourage them to raise children in stable 2 Parent homes. (ie good soil & water) Unfortunately our current policies seem to promote single parent homes given the huge increase in the number of them since 1967...

So maybe some of our negative consequences are government policy generated? And not so natural...

Could be:

May be its just the "natural consequences" of people getting freedoms, they didn't have? Not going to argue the single head of household issue, there are many, many ways to look at it, best opinion, the result of unintended consequences, What should be addressed, the core analogy issue: Much more difficult to grow in the desert than Minnesota Farm land, fact of life/nature. And that is today, no sense in reminiscing about 1950s, suspect it wasn't all Ozzie and Harriet, probably easier to beat your wife, kids and get away with it, amongst other things, back there in the good old days (depending on who is looking).

Public Schools

Actually public schools are perfect example of American "liberals" converting themselves into moderate republicans.

Everyone seems to have forgotten the basic history behind our current situation. American public schools in the 70s were full of innovation and experimentation. Curriculum's contained classes on everything from philosophy and human values to science and literature. My high school in St. Louis Park had "modular scheduling" that provided more flexibility for class schedules and students. Our campus was "open" meaning that as long as we didn't need to be in class we could leave the school without being truant. We had a mini-school for students who had trouble with traditional class regimes and a special track for students with disabilities. Some students got on a buss half way through the day and went to "Vo-Tech", i.e. Hennepin County Vocational School out in Brooklyn Park. In the early 80s St. Louis Park Public Schools opened the first Spanish language immersion school in the state, and began a program that let qualified students take classes at the U of M.

And it wasn't just St. Louis Park, every high school in the twin cities had different regimes and innovations. In Hopkins they built a high school with it's own telescope. Hopkins also build a High School without windows in the classrooms based on the theory that student would find it easier to focus on their lessons. Bloomington had innovative programs designed to boost self esteem and compassion.

I graduated in 1981 and by 1990 almost all of features and programs were gone, erased from public schools. Even the high school with the telescope wasn't a high school anymore. Why? Because American liberals started drinking republican cool-aid. In the late 70s republicans began an hysterical outcry about the "failing" public schools and blamed actually blamed all of the innovation and experimentation. Remember the: "Back to Basics" movement? The idea was that all this experimentation and innovation and expansive curriculum was distracting students from core material. Liberal educators were experimenting with our children and it had to stop! We'd drifted too far from the school of the 40's and 50's that had churned out the great generations!

And liberals bought into all of it. We had to get back to basic curriculum's and remove all of these distractions. We had to start testing to make sure that we had gotten back to the basics and control the campus.

Well, like most republican ideas this was bad one. by the late 80's our back to basic schools with their stripped down and homogenized curriculum's weren't even teaching the basic and couldn't accommodate student diversity. Having already drunk way too much republican cool-aid liberals bought into another old republican bad idea... charter schools and vouchers. Having forgotten or somehow repressed the memory of diverse and innovative public schools of the 70's; liberals bought into the notion that schools could ONLY be saved by entrepreneurs who knew nothing about education but could think outside the box.

The rest is history... here we are. Vouchers and charter schools were old republican initiatives specifically designed in the early 70's to racially segregate and re-segregate the public school system. They were also designed to promote Christian fundamentalist curriculum in the public schools. Guess what? The schools are re-segregating, we're STILL arguing about evolution, and no, the schools are still NOT providing state of the art college prep educations to poor and minority students. If you're a liberal and this surprises or frustrates you it's because you drank the cool-aid and didn't pay attention.

As for the republicans, the sad fact is that to the extent that our schools are failing, it's all on folks like you because this was ALL your idea in the first place. Had we continued with the liberal innovations and science driven teaching techniques and environments we had in the 70's we would established a far more effective and successful education regime by now. We would have been able to deploy our resources far more effectively and far more rationally. As it is we've been wasting resources and energy for decades trying to re-invent a wheel that we threw out the window decades ago.

Now to be sure, I'm not just waxing nostalgia here. I don't share the opinion that our public schools are a disaster, in fact I do that think by and large they continue to serve our students very well and some of the innovations I've described have been replaced by superior innovations and course offerings. To the extent that we need improvement those improvements will not come from superman, superman is a fictional character. We need to stop drinking cool-aid and get back to rational and informed education policy. We know how to do this, we're just not doing it.

Well

Well here are the Mn Dept of Education report cards for the Mpls and St Paul school districts. I think they pretty clearly indicate otherwise.

http://rc.education.state.mn.us/#mySchool/orgId--30001000000__groupType-...

not all republican propaganda

The failures of the experimental era of the late 70s were legit and not just Republican propaganda, though.

As a generation, Americans who graduated high school in the 1980s fare very poorly in educational achievement, worse than the previous generation and much worse than current generations. SAT scores hit an all time low in 1981. The late boomers / early gen-X are America's "dumbest generation." WaPo did an article about it eight years ago.

http://www.washingtonpost.com/wp-dyn/content/article/2008/12/05/AR200812...

Furthermore, the 1980s were when the Japan economy was booming and their kids were destroying Americans in science and math. Singapore was on the rise in the same manner, and even the Russians with their superior math and science were poised to be a similar kind of threat under Gorvachev's Glastnost. Thus, the sense of educational failure, especially in math and science, was palpable and economically frightening.

Minnesota didn't wholly do away with all of it's 'experimental' educational programs, either. There was the PSEOA when I was in high school in the mid 90s. I went to two years at the U of MN for free, during high school. Students could even go to private schools like Augsburg for free. In my home town nearly every college bound student did the PSEOA. Without it, we would have been up the creek without a paddle with all the goofball teachers we had!

Well...

You'll forgive me if I don't accept Neil Howe (The author of the article you cite) as the definitive authority regarding intelligence. The fact that he would even make such a claim (i.e. that one generation or another) is "dumber" than others, actually disqualifies him as any kind of legitimate authority on the subject. Furthermore, given the fact that Howe's "smartest" generation broke for Trump in the last election, his "analysis" is obviously suspect.

it's a good article

The article is backed up by a lot of stats. Plus the generation he's discussing comprised Trump's main base (50-60 year olds with no college degree)

Actually no...

This is not a "good" article in the sense that it's a garbage analysis from a scientific perspective. Howe is an English major from Yale, and an amateur historian, he clearly has little scientific training and has published no peer reviewed articles or studies. This article falls along the Charles Murray- "Bell Curve" spectrum of "analysis". Sure he has "stats", but his stats are garbage. This is the problem with debate gaming pretending to be informed analysis.

I could write a detailed critique of Howe's flawed analysis but instead I'm simply going to point out the fact that the gap or lead Mr.s Hanson points to that Japanese and European students hold over US High School students is a wide today as it was in the 70's. Back to basics, vouchers, and charter schools have completely failed to bring American student to par with their peers world wide as far as those measurements are concerned. Meanwhile all those dumb kids went into their garages and basements and created one of the greatest technological booms in human history.

Getting back to the matter at hand the point is that republican cool-aid obviously didn't to the trick. Everyone's still complaining about the same problems they thought they were solving with vouchers, charter schools, and basic curriculum's.

The stats are accurate.

The article is just reporting stats, not claiming to do any sort of scientific analysis. Those graduating from high school around 1980 have lower SAT scores than both the previous and subsequent generations. Fewer went on to college than both the previous and subsequent generations. Fewer even graduated from high school than previous and subsequent generations. Facts are facts...

Perhaps "back to basics" didn't deliver as promised, but the 1970s era educational experiments had even worse outcomes.

There are educational models across the globe that work well enough. However, the USA is stuck with its ingrained cultural belief that we are so exceptional that we can't learn anything from other countries.

Yeah, that's the problem

"The article is just reporting stats, not claiming to do any sort of scientific analysis."

Stats without analysis are garbage. We're not talking about batting averages here, in order to draw valid conclusions about causation you have to analyze the data... scientifically. If you're not going to do analysis you can't make any rational claims about outcomes so you don't get to tell us how the "outcomes" in the 70s compared to other eras.

A lot of people confuse "data" with "stats". Howe doesn't actually provide any "stats", his article contains some data that's been collected. Data in and of itself doesn't reveal relationships between different observations, you had to do a statistical analysis. For instance simply looking at batting averages can't tell you why some people are better batters than others. You can collect SAT scores but those scores don't tell you WHY some are higher or lower than others. In order to figure that out you have to do research and analysis.

As for other countries, those models were derived from the experimentation and innovations in the lat 60s and 70s. The difference they didn't try to turn back the clock or dismantle their public education systems. The difference is we went republican, and they went liberal.