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Finally, a plan from House Republicans for replacing the Affordable Care Act — sort of

House Speaker Paul Ryan
REUTERS/Yuri Gripas
Although the Republicans control the House, there is no guarantee that the bill, when it actually turns into a bill and is introduced, will pass even in the House, and certainly no indication whatsoever of how it will fare in the Senate.

A month ago, I wrote a pretty harsh critique of the new administration and its Republican congressional majority because they didn’t have a health care bill ready to replace Obamacare.

Yesterday that changed, sort of but not really, and fairness requires that I acknowledge that several leaders from the House Republican caucus released an outline of what might turn into their big, long-promised repeal-and-replace bill.

It’s important to note that, although the Republicans control the House, there is no guarantee that the bill, when it actually turns into a bill and is introduced, will pass even in the House, and certainly no indication whatsoever of how it will fare in the Senate.

And although President Trump’s spokesman, poor Sean Spicer, released an encouraging statement, the House outline is far, far, far different from the plan that Trump promised during the campaign, that would cost less, cover “everyone” and that the “the government” would pay for it.

It’s important to note that in this release, the backers didn’t provide enough details for neutral parties (like the Congressional Budget Office) to score it so we might know how many people will gain or lose coverage and how much it will cost. That’s the development we need to assess how many of the Republicans’ oft-repeated promises they can fulfill.

The New York Times had a thorough piece about the emerging House Republican leaders’ plan this morning, which I recommend. It is highly noteworthy that, as the Times piece makes clear, it is easy to identify (in fact, they came forward immediately and made statements) Republican senators who are opposed to what they know of the bill because it didn’t get rid of enough elements of Obamacare, and others who are opposed because it gets rid of too much, and the same apparently in the House.

The United States is “exceptional” among the wealthy industrial nations of the world because a large portion of its population lacks health insurance. Obamacare (really, the Patient Protection and Affordable Care Act) cut that portion roughly in half. Personally, I would say that in order to be called an improvement on Obamacare, any replacement program would have to reduce further the ranks of the uninsured.

The House Republican outline would probably not do that, in fact the uninsured number seems likely to go up (for example, it does away with the “mandate” requiring most people to get insurance or pay a penalty), but as I mentioned above, the outline released yesterday withholds many, many of the details necessary to clarify that.

Because the medical device industry is so big in Minnesota, MinnPost’s Washington correspondent Sam Brodey put up a smart piece this morning focusing on what can be inferred about how the partial draft outline might effect that industry. The big news there is that the draft suggests that the bill will repeal the tax on medical devices that had been used to offset some of the costs of Obamacare.

Anyway, because of the harsh tone of my own last piece on the where’s-the-bill topic, I just wanted to acknowledge yesterday’s small news which at least suggests that someday there might be a more complete replacement program that can actually be analyzed. 

If you would like to read an unreserved attack on what the House Republicans are up to by the liberal lobby group ThinkProgress, here it is. ThinkProgress has decided to nickname the program “HellCare,” which I take to be a play on “health care.”

But some of the harshest criticism of the came from the right, as rounded up here by The Daily Beast. The Heritage Foundation, the Club for Growth, the American Enterprise Institute, the Tea Party Patriots and Sen. Rand Paul are among those ripping the outline. 

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Comments (75)

The debate begins....

Why did the Dems pass Obamacare?

Do not most Dems really want socialized medicine for all?

Should not a DFL candidate for Governor in MN run on the platform of State sponsored insurance for all in MN?

Can we all agree that Obamacare is failing and we were "lied" to about its benefits?

Some answers

The Democrats passed the Affordable Care Act in order to provide health care for more people. It succeeded in doing so. This is of course also good politics.

I think that you have a word inversion in your second question: most Democrats do NOT want 'socialized medicine' (that is, medicine provided completely by the government, with all medical providers paid by the government).

I will not tell DFL candidates what platforms to run on. You have not defined what you mean by 'state sponsored (health) insurance. It would be consistent for DFL candidates to run on platforms designed to provide subsidies (beyond what Federal ones remain) to enable all residents of Minnesota to afford health insurance that meets some minimum standards.

Finally, the Affordable Care Act succeeded in its main purpose of increasing the number of people who could afford health care. There is some indication that this has been translated into better health (it's too soon to have adequate data to draw a conclusion). This is why it is becoming increasingly popular -- hence Republican pie-in-the-sky claims to be able to provide equivalent health care more cheaply (in fact, all plans presented so far would price the poor out of the health care market).

The Debate is Over

At least, the debate Obamacare is over.

The Republicans say they want to repeal the ACA, and replace it with something better. That is what the debate is about. Focus on what is before us.

Rehashing old arguments is a tacit admission that the Republicans have nothing to offer but opposition.

Trusting liars to tell the truth?

The debate on Obamacare is not over. If a new plan isn't better than Obamacare, it has more business being approved.

1. Eligibility and coverage. Trump said the new plan would cover everyone. In fact, millions fewer will be insured, even best case. Worst case, the percent who are insured will more than double and end up being the highest ever - mire than 60 millions - and worse than before ever before. It is clear that insurers want to offer lower cost products with minimal benefits, but higher profits as less is covered.

2. Cost to the consumer. With the new plan, think less coverage for more money. With subsidies cut or eliminated, those with less money will pay more for premiums, which will leave many uninsured, Those who are middle aged and older will be charge more. And those with really expensive issues will be forced onto catastrophic plans that will be very expensive charge huge deductibles before anything is paid. The young will benefit as will some upper middle income groups that will get tax credits, but when Trump said lower costs, he was not being truthful.

3. Outcomes. Those who lack insurance are far more likely to suffer through untreated illness and die prematurely. Double their number and our mediocre ratings in terms of health and longevity will decline, possibly to the level of emerging third world countries like Cuba and Brazil, This reform takes away basic Carr for many on the bottom so those on the topic get all their needs met quickly and completely.

These are the three major aspects used in evaluating how our system operation - access, cost and outcome. There are two clear winners - not based on health, but tax cuts. Medical device companies and the 1% of households, which are slated for large tax savings as consumer subsidies are sharply reduced or eliminated. Medical device companies are likely to lose revenue as those without good insurance won't be able to afford their devices. Any discounts they chose to offers will neutralize the tax benefits. The top 1% almost never comes out bad, unless severe financial declines happen. If this reform wrecks the healthcare industry, it is enough to cause a depression. At that point, the Trump empire will collapse, as any failure falls on his lap.

Why? Because people were

Why? Because people were dying due to the lack of healthcare. Because hospitals were struggling with providing even the minimal emergency required without compensation. Because healthcare costs were rising drastically.

Socialized medicine? No, I don't think most Dems want socialized medicine. Many, maybe even most, favor single payer - but that is not socialized medicine.

Failing? No, not failing as more people were covered and costs, as bad as they were, were still less than the private market. Problems? Yes, cost was a problem and while there are programs in place to control costs (like Accountable Care Organizations), they didn't go far enough fast enough.

Lied to? Obama said "you can keep your doctor" which was often not true. But nothing in the ACA required you to change your doctor; that was a function (albeit predictable) of the narrow provider networks health plans imposed. And if you consider that a lie, you must have a heart attack whenever Trump speaks.

That said, the Trump plan is better as - according to him - it features:
- Lower premiums
- Coverage for everybody
- Better health care

Unless he lied.

Keep your Doctor

The vast majority of Americans were able to keep their doctor after the ACA was passed.

and doctors

clinics and insurers always did a three way circle dance, periodically changing pairings.
You were NEVER guaranteed that your insurance company would always cover all billings from your physician, or that a given company would always offer you a policy.

not in 2017

they weren't,,,have you seen the little networks left?

Point is what?

That an employer changes plans and your existing doctor isn't in your new plan, blame Obama? The insurance companies offering products are changing products and offerings (as what happens in a free market) blame Obama? As insurance companies change their networks (as what happens in a free market) blame Obama?

Reverse evolution of the human spirit

The Dems passed Obamacare because they had a mandate to do so in the 2008 election -- it was in all the papers -- a verdict reaffirmed in the 2012 re-election. It was compromised from the get-go by enough corporate Dems beholden to the insurance industry and the party of No so that no public option and no single payer system was entertained.

Such an enormous change can't be expected to survive if the opposition party refuses to accept election results and instead fights progress tooth and nail. The Affordable Care Act needed tender loving care to succeed, instead the party of No persisted in defiance and powerlust and now it owns the debacle that will befall millions of people. They could have worked with Democrats to make improvements to avert the problems that developed. That would have been progress in a mature democracy. Instead they stab democracy in the back, led by the most anti-democratic president in history.

So now we have a step backward in human social progress led by a party of fake Christians who thirst not for millions of uninsured to die in the streets, no, they want people to degrade themselves into poverty then accept the status of welfare queens and charity cases, people who will be mocked. The charities these fakers give to will shelter their money, feed their narrow social agendas, gin up good feelings and provide great public relations.

Wow

Roy, great theory/observation, as a "Y" type, a hard bullet to swallow, but the dot connecting feasibility has a reasonable and plausible conclusion.

So what do you think of the political side: Most of these folks are poor etc. and easily if not already marginalized, thus, the overall objective is, kick them to the curb, and then continue to take away their voting privileges through voter suppression, no retaliation! What is coming is(a card showing you have health insurance is acceptable to vote, but not a rent receipt! Devious republicans.

It's not a healthcare plan,

It's not a healthcare plan, it's a "limit healthcare expenditure by the federal government so tax cuts can be made" plan.

Mr. Trump is happy,

Mr. Trump is happy, though...

(quote)

...“I think really that we're going to have something that's going to be much more understood and much more popular than people can even imagine,” Trump continued, during a meeting with the House deputy whip team, the Republican congressional team charged with tallying votes on the proposal.

“It follows the guidelines I laid out in my congressional address: a plan that will lower costs, expand choices, increase competition, and ensure health care access for all Americans.”

“This will be a plan where you can choose your doctor, this will be a plan where you can choose your plan. And you know what the plan is, this is the plan,” he added. “And we're going to have a tremendous, I think we're going to have a tremendous success. It's a complicated process, but actually it's very simple: It's called good health care.”....

http://talkingpointsmemo.com/livewire/trump-praises-health-care-its-actu...

(end quote)

However, it does not lower the cost of healthcare, or increase choice, or increase competition, or ensure healthcare access for all. But it does enable tax cuts.

Well

"However, it does not lower the cost of healthcare, or increase choice, or increase competition, or ensure healthcare access for all."

Neither did the ACA. And while touting that the ACA increased the number of insured (it did) by around 20 million people, nobody bothers to mention that another 15 million still don't have health insurance, even though the law mandates that everyone purchase it. Eric says that nothing will be considered an improvement unless more people are insured, but we made it against the law to not have health insurance and we still have 15 million lawbreakers. Will we have to round them up and physically make them sign up, just to claim improvement?

No Need To Round Them Up

Just increase the penalties and the subsidies. Both are too small.

Paying the Penalty

Actually the number of folks that chose to pay the penalty in 2016 was 10m, and recent numbers show that for 2017 2.5m more signed up for coverage...so that number may go down. Both numbers are far less that the GOP talking points (yesterday the Sec. of HHS said 19m), earlier in the week one of the GOP talking heads used 20m. What will be interesting to see is how many sign up with no mandate, and how many insurance providers take the BCBS route and exit the private market.

not really ron

Romneycare, aka ACA, is what it is. Most dems would be happy with universal single payer healthcare (see what I did there?). Alas they trend toward the tired, old school, reality based community which realizes that if you can't get Secretariat for christmas you can still ride a pony.

A small pebble

Let me toss a small pebble into the pond and see where the ripples go. As a certified old person, I’m MUCH more interested in health CARE than I am in health INSURANCE. One of those items benefits me directly. The other benefits a variety of capitalists who have no interest whatsoever in my health or longevity.

I claim no medical expertise whatsoever, but I come from a medical family: Mom was an RN for 50 years; stepdad was a family practice physician for about that same length of time; one of my sisters is herself a family practice physician, and my daughter-in-law is an RN working at a local hospital ER. All that really means is that I recognize some of the terminology used by practitioners.

Personally, I’d be fine with “government-run” health care, and I’d also be fine with doctors, nurses, and other medical practitioners being employees of the state. Along those lines, I’d like to see medical school be state-subsidized, along the lines of the NDEA loan with which I got through college in the early 1960s. That is, 10% of student debt (in this case, from med school) would be forgiven for every year the loan recipient spent practicing medicine in an area (whether geographic, economic, or medical practice) the state deemed necessary. A low-income clinic, for example, whether rural or urban, or an underserved rural community, or in a geographic area (e.g., an Indian Reservation) with demonstrated healthcare needs and little income), as well as the more usual urban and suburban areas from which most patients are drawn, or perhaps encouraging graduating physicians to take up a specialty that the society needs, but has too few practitioners. For years, that would have been what’s now called “Family Practice,” but there are other areas of specialization that are also short-handed, mostly because they’re not as lucrative as thoracic surgery or oncology.

At the other (i.e., patient) end, I’m pretty much in favor of single-payer insurance, following, and perhaps being an addition to, Social Security, so that everyone would be covered, everyone would be paying at least some minimum amount into a health care pool every month, and we could dispense with the fiction that most people have enough discretionary income to have meaningful and sufficient “health savings accounts,” a mirage dreamed up by Republicans who are wealthy enough to afford whatever health care they need, for the most part.

I expect the above would be politically impossible, for a long list of reasons, but if it were me raving in the White House instead of the current occupant, that’s the direction I’d like to see it go.

As is often the case, Mr. Gotzman knows not whereof he speaks. I’m not personally opposed to “socialized” medicine, but I’m not in the mainstream on this issue. I don’t know, offhand, any actual Democrats who are in favor of it, particularly as Paul Brandon has described it.

I’d argue that not just a DFL candidate, but ANY candidate for Governor ought to endorse, enthusiastically, the idea the everyone in Minnesota should have easy and inexpensive access to health care, whether that involves health insurance or not. That endorsement ought to come from DFL, GOP, Independent, and any other candidate who makes it to the ballot for that elective office. To be intellectually honest, Mr. Gotzman ought to admit that, implied in his rhetorical question, is the notion that some people in Minnesota should just die because they can’t afford health care and/or health insurance.

Regarding the alleged “failure” of the ACA, to the degree that it’s true (which is not very large), it’s because of the complexity forced into the bill by both Republican opposition and effective lobbying by various medically-related groups, not least of which was the health insurance industry itself, which was being guaranteed a sizable market increase. On the whole, I like the response of Mr. Brandon, but also those of Mr. Goldstein and Mr. Everson. I like Mr. Thompson’s pony metaphor, as well.

One question I have is this: Serious consideration of the ACA began in the Obama administration within a few months of his election in 2008, and it’s at that point that Republican opposition to what became the ACA began. The ACA became law in 2010, and in the years since – 7 years, more or less – Republicans in the House have taken numerous meaningless votes to scrap the law, knowing all along that, should they gain control of the White House, they’d dispense with it forthwith.

So, what Paul Ryan waved in front of the cameras today is presumably not just the product of a dozen weeks of work on the part of Republican Congressional staffers, it’s the sum total of SEVEN YEARS of Republican thought regarding health care for the nation. And this was the best they could manage? A proposal that is probably already dead in the water, taking fire from both left and right? That covers fewer people, at greater cost? Truly, this is definitive proof that the GOP is a party incapable of governance.

And Mr. Ryan says that

And Mr. Ryan says that millions of people falling out of insurance is not the correct metric, “What matters is that we're the lowering costs of health care and giving people access to affordable health care plans”

By what mechanism does this plan lower the cost of health-care and improve access?

A basic willful lack of understanding of how insurance work--if you have optional enrollment, and penalize people for buying insurance before they need it, your insurance is going to be more expensive. If the insurance offered to older people can be 5 times as expensive, of course your insurance is going to be more expensive. If you are in a rural area, of course your insurance will be more expensive. If you limit/block-grant Medicaid, of course you are going to cut access to health care. If the only payment assistance is a tax credit available in the following year, how does that promote utilization in a country where almost half of the people cannot come up with $400 to cover an unexpected expense?

Liars.

This proposal is a starting point.

As opposed to Obamacare (written by insurance companies, lobbyists and DC elites) hopefully this proposal hits the light of day, is debated and a cohesive healthcare plan that folks have read and understand will come. This bill hopefully will be readable for the very folks who will use it, us the people. The roll out of this GOP bill will be smoother than Obamacare if they debate it, take their time to think about un-intended consequences and actually read it. Remember in the liberals rush to do something, nobody in congress read the ACA and the rollout was a disaster. Pelosi is still looking for the goodies in the bill.

Opening up Medicaid to everyone is not the answer (it will go broke), save Medicaid for those who truly need it and get plans that people want and can afford for the rest. Having a healthcare card and having a plan you can afford the deductible, get the care you need are 2 different things. Even the honest Dems say the ACA needs a major redo. The Dems and GOP should try to work together and come up with a plan that works for voters. Now that would be a change most would enjoy.

Starting point, perhaps.But

Starting point, perhaps.

But the majority of Republicans objecting to this plan want to do even LESS.

Rand Paul, the "Freedom Caucus", and major funders like the Koch brothers do not want any form of federal subsidy of insurance or expansion of Medicaid (and, by the way, would be quite happy to privatize Medicare via turning it over to private insurers).

So now they have to come to an internal Republican party agreement between this plan and a worse plan.

So it's quite likely then that the ending point will be even worse.

Medicaid is not Medicare

The more common proposal is to open Medicare to everyone by gradually reducing the starting age.
And who is currently trying to rush a health care bill through Congress?

Of course Medicare is not Medicaid ..

One, Medicare is age determined, the other is need based. When you lower the threshold for acceptance to Medicaid you open it up to more folks and it threatens the program financially. All Obamacare did was lower Medicaid standards and paid Govt subsidies for plans that the recipients couldn't afford the $10,000 deductible payments. In the need for the liberals to find good in the ACA they proclaimed this Healthcare. Unfortunately for the folks receiving Obamacare through Medicaid, they found 1/3 of the Doctors wouldn't take Medicaid patients, they couldn't pay the deductibles and ended up in emergency care at the same rate prior to the ACA. As I stated, having a card saying you have health insurance and getting healthcare are two completely different things.

Why should the democrats work with

Republicans who have accomplished nothing on health care and NEVER will? They don't care if the poor or lower middle class die in the streets - just remember the cheer for that result in the recent campaigns by republicans

Myth, myth, myth...

...in the liberals rush to do something, nobody in congress read the ACA...

The process for ACA began in March 2009 with a summit of 350 health-care leaders.

In July 2009, a thousand-page bill was presented.

The final form of the bill was introduced in late October, 2009.

The bill was passed in the house in November 7th, 2009

There was a 25-day debate in the Senate and the ACA was passed by the Senate on December 24, 2009.

After some more maneuvering, the bill was finally signed by Obama in March 2010.

https://www.washingtonpost.com/news/politics/wp/2017/03/08/when-the-whit...

Is a year long process a "rush" ? After all, it was partially what the President and the Democratic congress had been elected on .

So why wasn't the final bill read in the 2 months from October to December ? Who is derelict in their duties -- especially when it was the hottest topic in politics those days?

for all

medicaid/medicare/minnesota care for all would never be acceptable to the health care providers, especially the highest priced ones like Mayo. The fee schedules for these programs is far below what they feel the market is and they are not willing to take the pay cut, they have way more clout than insurance companies. I am not an advocate for those folks, just stating a fact.

Lowering costs

The Republicans think that the cost of health care will be lower because fewer people will have health insurance. In effect, they think it's important to protect the freedom of all of us to sleep under bridges.

But Will it Pass?

This bill is a poorly-drafted mess. I don't think fixing it, and getting it through Congress, is high on the list of Republican priorities. There are two reasons for this.

First, the Republicans would have to own the result of any health care bill they pass. While Obama was President, they could put congressional sessions to good, productive use by staging votes to repeal the ACA, knowing those votes would have no more practical effect than filler for a news item released to their constituents. It was theater, not legislation. The symbolic votes, and opposition to the ACA, were useful rhetorical tools. Now, the utility of the ACA as a way of whipping the base into a frenzy is limited, although there still are some types who will trot out the old "No Republican votes, and they couldn't read it!" canard to no clear purpose.

Second, just as the Republicans have feared all along, Americans are finally starting to like the ACA (note to conservatives: "starting to like" does not mean "voicing unanimous approval"). A fight to take away insurance coverage and replace it with, basically, nothing, is not going to play well. The Republicans already face the prospect of losing seats in 2018. Taking away health care could make those losses even worse. If too many seats are lost, the ultimate goals of eliminating Social Security and Medicare as we know them, giving the wealthy massive tax cuts, and replacing existing programs with easily-grifted block grants, will never be reached.

It's all a question of what is most important.

the words

Both of your articles this year on the topic make me chuckle a little, especially the use of the word "finally!" in the headline of this one. I mean really, the guy has been in the office 6 whole weeks and his DHS secretary even less than that and they don't have a bill passed yet? Gotcha Republicans! Isn't the strategy of dems right now to stonewall and keep Trump and Republicans from doing anything? How many months in with a majority did it take dems to get the ACA passed?

The other dem media message is OMG there are republicans who don't agree with each other. I call that democracy and an idea exchange, it is 1/6th of our economy we are talking about, right?

Finally!

How long have the Republicans promised a substitute for the ACA?

Are the President and HHS Secretary responsible for introducing legislation now?

Are there enough Republicans to pass this absurdity, OMG?

Immediately! Fast! Quick!

....On 60 Minutes in September of 2015, Trump vowed that everyone would be covered if he won. “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

Pressed for specifics, he explained that “people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.”

Trump reiterated his pledge that every American would get coverage at a February 2016 MSNBC town hall. “We’re going to take care of them. We’re going to take care of them. We have to take care of them. Now, that’s not single payer. That’s not anything. That’s just human decency.”

“You will end up with great health care for a fraction of the price and that will take place immediately after we go in. Immediately! Fast! Quick!” he told supporters at a Las Vegas rally that month....

Did that thing just move -- or am I hallucinating?

While the blinding pace at which Republicans are moving on this is something to behold (who knew they could move at all?), I'm pretty sure Eric was alluding to the old thing about Republicans having spent the past six years passing ACA repeal bills sixty-some times but not having time to produce a coherent alternative.

Which, it's looking like, they STILL haven't done. But that's not slowing them down because, "They made a promise to the American people!"

Out of all the "ancient Chinese sayings" I've heard or read, there are only two that have stuck:

1) The faintest ink is better than the best memory

2) Hurry is the basic error

If I had to guess, I'd say senor Holbrook's assessment of the situation is pretty close to where things are at for your buddies in Congress.

And while you may be impressed that they've "put it together" and are moving at light speed just six weeks in, it's looking like they've never heard that second bit of (alleged) Chinese wisdom or it's American counterpart, "Haste makes waste."

But yes . . . You're right. After eight years of moving at glacier speed (and getting paid $175,000 per year -- plus great health insurance -- for doing that), Republicans actually ARE at least doing SOMEthing.

(Finally!)

Why

Just curious, why are people so adamant that subsidized healthcare should be funded and managed by the Federal government?

I was listening to NPR on the way in and the MN Healthcare Dept head was going through how much reduction in funding the state would get under the different scenarios. And my first thought was "why does this matter"?

As we have noted before, the citizens of MN pay more into the Federal coffers than they get back. So I guess I am fine if the Feds get out of the healthcare business and leave it to the States. Then if any of your neighbors do not have adequate care, you can ask your State government to address the issue.

Not sure how many people decided that their local governments were incapable of caring for the State's citizens?

What are you referring to

by "local governments"?
Are you saying that the City of Mankato should provide health care?

Maybe

Maybe, but I think more likely states should be able to help their unsuccessful citizens to be cared for and assisted in becoming successful.

I have never understood the logic of having the Feds collect a huge amount of money from the citizens of the States, just to help them fund the Federal bureaucracy which determines how to give the money back to the States to care for their unsuccessful citizens...

SS and Medicare make some sense because they are long term programs and people move. But the immediate collection and reward programs, not really.

Read the Preamble to the Constitution

Something about "...promote the general welfare..."

Promote

"Promoting" can be done in many ways. Robbing from Peter and giving to Paul is likely neutral at best.

It may be better to help Peter and Paul both succeed by encouraging company expansion in the US, removing illegal workers from the employee pool and thereby increasing wages.

Industrial Robots

don't need health care.

True

We had better change policies to strongly encourage people to develop skills beyond those that a robot can replicate. Because the robots are coming slowly but surely.

Right

But the number of people required to design and manufacture the robots are far fewer than the factory workers that the robots replace.
And they are certainly not the people displaced by illegal immigrants, although the children of those immigrants seem better educated than the population as a whole.
...
And a modest proposal:
those skills start with MATHS.
We should radically increase the pay of teachers so we can attract people to the field who have the skills to teach the skills. The more successful Europeans do just that.
Right now, elementary education is the major of last resort for students who can't cut it in any other field. I saw this in a 45 year teaching career in public higher education (not education). I remember a Dean of the school of education trying to get his students excused from the math requirements that all of the other students had to meet.

Different

I have a different view. Make education a competitive pay for performance field where young gifted Teachers can make good money and not have to wait a decade to earn what they are worth. And allow class sizes to grow based on the capability of the Teacher so they can justify even higher wages...

I am pretty sure steps, lanes and tenure would never attract a smart "over achiever" type...

Unfortunately

I know of no law either physical or economic that says that the number of jobs necessary to produce the nation's GDP must equal the number of potential workers in the population. In other words, there is such as thing as structural unemployment where there are simply not enough jobs to go around.
One solution (the socialist one) is to estimate the number of working hours necessary for society to function, and divide it by the number of workers. You will then have full employment. I don't think that that is what you are advocating.

Another

Another is to ensure that your country is the most competitive in the world and let the unemployment occur elsewhere.

Of course that requires eliminating bureaucratic wastes and ensuring that all able bodied citizens work to continuously improve their knowledge and skills. Having a bunch of folks sitting in the wagon as 90% of the citizens are striving to make our country successful sure doesn't help.

So then

You'll be all for the massive influx of healthcare refugees from states less enlightened than our own? Funny, I seem to recall an old conservative trope regarding buses from Chicago? A OK now I suppose... Seriously, we tried your line of thinking, recall the Articles of Confederation? It was such a disaster it nearly ended our country before it began.

Well

I am sure we are smart enough to prevent non-residents from committing fraud and just moving here for benefits. (ie maybe a 1 year waiting period)

And States that want to grow their work force can use it as another tool. And it may encourage more people from poor red states to relocate. Thereby helping their families succeed, reducing the work force in those States and increasing their incomes.

In essence it encourages States to compete with each other for the good of us citizens.

There's a reason why the

There's a reason why the county poor-house system and the county hospital system have gone away. And the concentration of health-care centers in high-population areas means more of a hub system where patients cross many jurisdictional lines to get care.

But in a more generalized point, are you saying that conservatives like you are going to welcome paying more of the share of the cost for the poor because they are Minnesota's poor ? Somehow, I'm cynical enough (realistic enough?) to doubt that would happen.

But, in light of the proposed federal legislation, any discussion of tax cuts from the Minnesota legislature should stop immediately. That surplus will be going away mighty fast.

Personally

Personally I pay more by supporting charities that help the unsuccessful. And yes I think we would have a better chance of helping these folks if the MN tax payers knew exactly where their money was going, what the results are, etc.

Please remember that there are 2 forms of help:

1. Giving the unsuccessful folks money and services at the expense of the successful people for an indefinite period of time. (ie buying them fish)

2. Giving the unsuccessful folks money and services at the expense of the successful people for a limited period of time. While pressuring them hard and supporting them to learn, change and improve their self sufficiency. (ie teaching them to fish)

I really dislike option 1 because it allows and encourages continued dependency and poor self confidence. Option 2 is much better.

Standard conservative line

Successful people got there strictly by their own efforts (they carefully chose their parents like Trump did),
while unsuccessful people owe their problems specifically to their own actions.
Classic victim blaming -- disregarding the significant role that chance plays.
And since Clinton, most 'welfare' money has gone to children and the handicapped, not to people capable of entering the work force.

Luck

I agree that luck is a huge factor. I mean we are all incredibly lucky to be residing in the USA. And you are correct that some people are born into financially wealthy families and some are born into financially poor families. And this is good but it is not the best luck... The best luck is being born into a family with 2 caring hard working responsible educated Parents who model the values that will encourage the child to succeed in school, work and life.

And yes most of the funds to go to support kids/adult in single Parent household's...

The war on poverty and spending more on Option 1 helped to decimate the 2 Parent households in many communities. Which of course propagates those behaviors and the problems it further promotes for generations.

With this in mind, how do we change policies to reduce the number of single parent household's? (ie teach them to fish)

Please cite data (not anecdote)

show that the children of single parents do more poorly in school?
The children of poor parents do, but that is largely because they go to poorer, less well funded schools. And giving them $3000 vouchers won't buy them a $12,000 education.

One of Many

Well here is one...
https://www.insidehighered.com/news/2015/02/25/report-marks-growing-educ...

Now are you serious? I mean just think of the challenges that the kids in many single parent households face...
- likely more time in daycare or home alone
- likely financially poorer (ie if absent parent does not pay)
- likely less emotional stability in household (ie changing boyfriends, girl friends, etc) (ie stressed out parent)
- likely that parent maybe challenged to help with homework (ie time, capability, money, etc)
- often the parent is young and maybe less mature and independent (still a kid themselves)

Please note that the most expensive best funded schools in our state are in Mpls... They go to poorer schools does not ring true.

See

Easy

Repudiate religious doctrine in all forms that pushes couples into poorly planned and ill concieved long term relationships before they are ready or should do so. Institute a basic income to disincentivize relationships created for financial survival only. Institute mandadatory comprehensive sex education starting as young as is feasible, no abstinence only or religious based curricula allowed. Mass distribution of free contraception, such that any person who desires it can have it. I won't hold my breath waiting for you to pitch it to your fellows, I suspect it's not what you had in mind.

From Feb2016

From one my posts last year in response to a Conservative commenter. Please remember that I am a Centrist.

"You are happy to encourage big government to get between this woman and her doctor to prevent an abortion. And yet after the baby is born you are against government ensuring that the baby is kept safe, healthy, fed and educated..."

Continually you blame the Public Schools and the Social System for being responsible for the achievement and wealth gaps when in my view the Religious Conservatives are equally or more responsible. Continually Religious Conservatives fight against making birth control and emergency contraception cheap and readily available to girls and women of child bearing age. (ie not to mention early term abortions)

All because of the Religious values argument. When for the good of our society these methods should be free and readily available so that as few children as possible are born into households that are not wanting or ready for them.

And then after fighting inexpensive steps that could help prevent these unwanted births, the Pure Religious folks espouse that "the babies are not their responsibility" and that the irresponsible, sinful, immature, often poor and/or stupid Parents should be responsible. All the while somehow preaching that these irresponsible, sinful, immature, often poor and/or stupid Parents can do right by their children.

In fact often stating that these irresponsible, sinful, immature, often poor and/or stupid Parents "know better what is right for their kids than the trained Social Workers, Early Ed professionals and K-12 teachers."

I'll never understand how Conservatives rationalize their views... Either one values and takes responsibility for the life of a baby or they don't. Ensuring the baby is born and then turning ones back on it has to be one of the least Christian things I can think of...

It is kind of like ensuring the baby is safely in it's car seat, before you let the very drunken Father drive off with it... It makes no sense. Thoughts?" G2A (ie John A)

I especially like the

I especially like the "teaching to fish" analogy with respect to medical care.

What "fishing" techniques do you propose to teach ?

A) Do-it-yourself surgery ?

B) Home-made cancer remedies ?

C) Personal MRI googles ?

D) Or most important of all in today's medical marketplace---how to run a home printing-press to print the money to pay for the hundreds of thousands of dollars that can be incurred with serious illness or accident ?

Funny

Those examples are humorous, though I am more interested in getting household finances to a level where they can pay for their own health insurance.

I always think of Paul Ryan

If there's a staunch advocate for your point of view, it's Paul Ryan. His entire legislative career has, in huge part, been based on that idea: "Government dependency" is, according to him, the true root of most practical evil.

But the thing he always seems to forget, or the elephant in his room he doesn't seem to see, is the fact that every single paycheck he's gotten since shortly after he graduated from college (25 or so years ago) has come from, of all things, the government.

I'm okay with that, sort of . . .

"Ryan officially accepted the gavel and assumed his new role as Speaker of the House. As such, his annual salary will get a healthy bump from $174,000 to $223,500" (and I still don't know what it is he's ever actually DONE to benefit the American people)

. . . but it's always grating to hear and see him making HIS living by pontificating on the subject of how destructive it is for OTHER people to be dependent on the same thing he is.

Back to Fishing

Please remember that Paul is working for his money, whether you agree with his politics or not. (ie earning his fish)

Please explain to me what all of the recipients of welfare, Medicaid, etc are doing in exchange for the money and/or services? (ie free fish?)

Now I have proposed having people work for their benefits and usually I am told that would be unfair, judgmental, demeaning, etc... One idea was having them clean up their neighborhoods.

Working hard for the money

I'm not going to take the bait on whatever it is or isn't "recipients of welfare, Medicaid, etc." are doing, but I'd sure like to know what it is you consider the "work" Paul Ryan has been doing that warrants the $170,000 to $220,000 per year he's been paid since becoming a Representative.

"Paul Ryan has actually proposed three — total, three — bills that have become law in his entire career dating back to 1999."

www.politifact.com/wisconsin/statements/2016/aug/10/david-canon/professo...

Even though I'm not sure what it is, or how important or productive it is, I realize there's other "work" involved but, if I'm not mistaken, the main work legislators are "hired" to do is get things done legislatively that: A) benefit their constituents; and B) benefit the broader country.

I'm sure there are a vast number of recipients of welfare, Medicaid, etc., who would be more than willing to trade-in their government fish for a $174,000 per year whale of a job (not to mention health care insurance that makes Medicaid look like awfully skimpy coverage) in which the main work requirement is to get three things done in 17 years.

That translates to a total of $2,958,000 of taxpayer money spent on one person over that time period; or $986,000 per piece of (primary) work done.

How do you think whoever you work for would feel about paying you that kind of money if your performance record showed you had successfully completed three projects in the 17 years you'd been working for them?

Maybe Paul should put on an orange vest and join the crew cleaning up the neighborhoods of America when he's not crafting and passing legislation, aye?

Please

Please remember that I am a supporter of reducing the pay of bureaucrats and politicians... So I am fine cutting their budgets...

Remember that one of the great things that Rep Ryan and crew did was stop spending increases that Rep Ellison and his peers would have liked to pass. Seemed to me that Rep Ryan earned every dollar. And now he is working to cut government spending aggressively.

But back to the point, he was hired and rehired by the voters. So they must think he is earning his salary.

Where as welfare recipients, we keep buying them fish and enabling their dependency. Unless you are willing to break your silence and explain how they are earning it.

So:

How about some factual support for all these "Welfare kings and queens" other than the same old Republican: it is because I know it is. Get your county commissioner to provide the data, on how these folks are living so high off the hog, same complaint year after year, and the solution is? Kick them to the curb and let them die on cardboard boxes outside the hospitals right? The county qualifies these folks, aren't they doing their job?

Where

Where did I say they were living "high off the hog"?

I actually feel sorry for them. Imagine spending your life feeling not smart and dependent on others. Be it looking for that right guy to love you, or another baby to fulfill you, or that government check. As I said, I can think of nothing crueler than to allow people to stay trapped in this cycle of generational poverty.

As for how to break the cycle, I assume it would take some very tough love to let them hit bottom and then offering them a hand up when they are serious about wanting to work hard to improve their lives.

Unfortunately the county personnel are likely swamped and they have little incentive to reduce poverty... The more fish they have to hand out, the more secure their jobs are.

He'd probably work only on roads

that made right turns only.

I will agree

with the fishiness of much of what Ryan says (has he actually ever done any work in his life)?

Basic background

This 2012 L.A. Times article provides a pretty good summary of Ryan's basic family, work and financial background. It's just the tip of a long, winding and, if you ask me, "extremely disturbing" track record that is directly connected to his (and I do mean HIS) Republican health care plan, but that's too much to go into here.

http://articles.latimes.com/2012/aug/25/nation/la-na-ryan-assets-20120826

Paul Ryan

Actually, he did have two private sector jobs: McDonalds, wait for this...you will love it...He drove the Oscar Meyer Weiner-mobile.

Actually

I am not sure why you are picking on him, it looks like he had quite a few jobs early in life. (salesman, fitness trainer, waiter, etc. And don't pick on working at McDonalds, that is what many hard working college students do. I enjoyed my year of flipping burgers and learned to appreciate service employees greatly..

https://en.wikipedia.org/wiki/Paul_Ryan

Few problems with that old saw

1. Assumes there is still a body of water to fish in.2. Assumes those not of a certain class will be allowed to fish 3. Assumes the fish won't just be stolen by folks controlling access to the lake upon return to shore. 4. Presumes that a simplistic analogy in any way approximates the vast uncertainity and complexity of actual life, but of course that precludes simplistic black and white worldviews, so we can't have that...

ACA replacement

And it's called "H.R.1275 – World’s Greatest Healthcare Plan of 2017." Not a joke (well, maybe it is).

Getting it right by debating, fighting,questioning

is the best way to get a plan that works for the voters. If the Dems learned anything from the disaster that is Obamacare, it should be group think with no input equals a disastrous roll out, over promise under deliver and a beat down in every election since 2009 introduction of the ACA. I find it funny that the liberals think the GOP fighting to get it right is somehow a bad thing. I'm happy to have multiple groups coming together to question every aspect of a legislation that will control 18% of our countries GDP. The old Speaker of House (Pelosi) has the distinction of saying the most honest but frightening phrase on Obamacare I have every heard, "pass it to find out what is in it" ...

Gotta believe debating and fighting over healthcare, which each of us will have to use at some point, is the proper way to go about it. After the fight put it in a bill that readable for the consumers, debate it a bit more then pass it. If it takes an extra 1/2 year who cares, get it right.

'fighting to get it right" is

'fighting to get it right" is hardly the case.

Fighting to get it passed and signed before people understand what a turkey it is is more likely.

No Neal, the pass it fast trick has

already been done with Obamacare. Remember who wrote Obamacare, it wasn't elected officials, it was insurance companies, DC elites and lobbyists.... Hopefully the law makers that we elected will write this plan ... The old bait and switch has already been thrown on us by the previous administration.

Not This Again!

The great themes never die, do they, Mr. Smith?

Why are the Republicans pushing their bill through before the OMB can review it and report on the likely costs of the legislation? Is it because of what the Democrats did seven years ago?

Sorry, Joe, read

Sorry, Joe, read "myth,myth,myth", earlier in this comment section...

The timeline is months for the ACA, not days like the current bill.

And it was scored several times along the way.

"Fighting to Get it Right"

Is that why they hid the only copy of the draft for so long?