The Follies Begin

Last night, the Senate passed a budget resolution. This budget included the first step in repealing Obamacare: setting the situation so that key parts can be repealed by reconciliation. Contra the Left, this did not repeal any part of Obamacare; it set the stage for repeal.

The budget has significant issues, mainly in that it adds $9 trillion in debt over the next ten years, with no significant cuts to spending or entitles and no tax increases or changes. That’s just the baseline right now. If Trump is serious about enacting a giant tax cut when he gets into office, we could be staring down $20 trillion in debt over the next decade, a budget hole that makes Obama and Bush look like models of fiscal rectitude.

As for the Obamacare repeal, I am against a naked repeal of the bill without a replacement in place. Simply repealing the law would throw insurance markets into chaos, throw at least 20 million people off of insurance and roil a sixth of our economy. Indeed, a number of people — including hospitals, insurance companies and state governors — are lining up against a naked repeal for just this reason.

The model I prefer is repeal and replace, enacting a new healthcare reform act. There are several proposals out there but the problem here is getting it passed as one bill. Democrats will oppose and while Obamacare can be repealed with a simple majority, a new bill can not be enacted without a supermajority.

That brings us to the current strategy which is called “repeal and delay”. The idea is that the GOP would repeal Obamacare now, sunsetting it in two years. That would give them two years to come up with a replacement and put Democrats in the position of either supporting the GOP bill or letting Obamacare die.

It’s also one of the most reckless things I can imagine.

Look, we’ve been here before. We have seen Congress enact laws to try to force future Congresses to make tough choices. And it always been a disaster. Because there is no reason to think that future Congress will be any bolder or smarter than present Congress. So we enact tax cuts hoping to “starve the beast” — a trick akin to eating a huge slice of cake to try to force yourself to go the gym. And deficits explode because Congress decides massive debt is politically easier than spending cuts. We enact a sequester thinking that such a dumb way of cutting spending will force Congress to do it more wisely. And the sequester is enacted anyway because choices are hard. “Repeal and delay” is simply shoving 20 million people out of an airplane with a vague promise that you’ll get a parachute to them at some stage.

Trump appears opposed to “repeal and delay” as do many key members of Congress. But they can only delay so long as we are already seeing the beginning of a death spiral in individual insurance markets. This is a problem I have been shouting about ever since Obamacare passed: the GOP needed an alternative. Not a bunch of conflicting vague plans, but an actual plan that the entire caucus had agreed to.

My prediction? I think Trump isn’t so dumb as to think “repeal and delay” is a great idea. I suspect what will happen is that the GOP will pass a series of fixes to Obamacare to gradually repeal and replace it with a sounder and more market-oriented system (step one: allow insurance to be sold across state lines). And as long as it gets rebranded “Trumpcare”, I expected the President to go along with it.

Update: There’s a great tweetstorm from Justin Amash — rapidly becoming one of my favorite members of Congress — about why he voted against the bill.

To read it, click on the date at the bottom of the tweet and then scroll down through the points he makes.

Comments are closed.

  1. AlexInCT

    As for the Obamacare repeal, I am against a naked repeal of the bill without a replacement in place. Simply repealing the law would throw insurance markets into chaos, throw at least 20 million people off of insurance and roil a sixth of our economy.

    That’s nothing but a democrat talking point. If they repeal this shit and go back to what things used to be, there will be some original transitional changes and bumps in the road. Those most affected will be the people least capable of affording this shit and that so far have already been fucked over by Obamacare anyway. The insurance industry, which rotates around stability and predictability, would find itself back on a model it knows very well and was far more successful at operating under.

    If they really want to fix things however, they would change the idiotic portability rules that prevent insurance plans to be sold across state lines. Healthcare is a mess and ridiculously expensive because states make us all pay for so much shit we don’t need or ever would be bothered with if the choice existed so others people that would otherwise have to pay a ton for their own care can get shit (too often idiotic elective and ultra-expensive shit) at our expense.

    Treat insurance like insurance. Create a system that has a catastrophic healthcare  offering all people pay into (privately) that kicks in when people get hammered with medical conditions that would break all but the ultra rich. Say if you find you have a catastrophic event over $20K a year or are looking at expensive coverage for your existence, this kicks in. For everything else, people pay out of pocket or buy basic plans that cover those things that all of us would need at one point or another. The rest of it is on your own.

    There is no right to healthcare. It is a limited resource/commodity. Those that can overcome the high qualification requirements to work in this field (you need to be smart and hard working to get the training needed), and then go on to offer these services despite the risks, have made an enormous investment to become proficient, which is coincidentally why they get paid so much. No silver bullet solution will ever solve these realities in any way. Ever. Attempts to forcibly social engineer it anyway, as the western world is finding out, always fail miserably. Being able to social signal by claiming you have “free healthcare” that is neither free or of decent quality, is not worth the disastrous systems we see out there.

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  2. InsipiD

    When something is as bad as the ACA has been, nobody should make repealing it contingent on replacing it.  Like Alex said, it would put us back to pre-Obama health insurance (if you liked your doctor, can you go back to your doctor?), and I would call that an improvement.  At least that way, if you can’t afford insurance you aren’t forced to buy it anyway and aren’t taxed for not doing so.

     

    Hal, your roots are showing.

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  3. Hal_10000 *

    Like Alex said, it would put us back to pre-Obama health insurance (if you liked your doctor, can you go back to your doctor?), and I would call that an improvement.

    But it won’t.  That’s the rub.  I used to say to the Democrats all the time when they were saying, “let’s leave Iraq”: that leaving Iraq was not the same as never having invaded it in the first place.  And we saw what happened with the rises of ISIS.

    Repealing Obamacare is not the same as never having passed it.  Insurance companies are not going to suddenly cut their rates or shrink deductibles or anything else. The death spiral has begun. You have to fix the system we have.

    And I don’t know what to say if you guys don’t see throwing 20+ million people off of insurance as a problem.

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  4. AlexInCT

    But it won’t.  That’s the rub. 

    Then they are not repealing Obamacare. If they repeal it, all aspects of it go away. If they only do away with parts of it then they are fucking us all over. Obamacare was passed to destroy healthcare as we know it and allow government own and control us through a single payer system they would use to deny or provide care to people that did what our elite wanted. All of it needs to go.

    After they get rid of all of it, if they really want to do something that improves healthcare and controls or lowers costs, they implement what I talked about.  This will always be a commodity that is limited, because of how complex it as a system is (unless we just want to go back to the days of shamanism), leading to the reality that it can never be available for everyone. Let alone be available for everyone, regardless of how much it costs society, and then given for “free”.

    And I don’t know what to say if you guys don’t see throwing 20+ million people off of insurance as a problem.

    Won’t bother disputing the number which I think is bullshit anyway, but as I already pointed out: the problem is that healthcare is neither a right nor a free commodity. They should have never put those people on it. And the great lie is that these people – many of them illegals – couldn’t and weren’t already just crashing emergency rooms and making us pay for their care, before Obamacare made that cost even higher to us all. Instead we now have a system that will leave all of us eventually (except for the elite in government and the ultra rich) without any real coverage while the social justice virtue signalers claim how great things are because healthcare is free. You know, like in Great Britain, Canada, Cuba, Venezuela, North Korea, or the USSR of yonder years.

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  5. Hal_10000 *

    Hmmm.  Trump today indicated that he wants universal coverage.  Who knows if he actually means it.  But if Putin starts saying we need socialized medicine, I might start worrying.

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  6. stogy

    Hmmm.  Trump today indicated that he wants universal coverage.  

    Heh! I wonder if that would that be a deal breaker for Alex? A knife through the heart of the bromance?

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  7. stogy

    If they only do away with parts of it then they are fucking us all over.

    Lack of coverage for pre-existing conditions is one of the biggest barriers to genuine competition between HMOs. You want to do away with that too?

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  8. Slothrop

    To supplement Hal:

    “We’re going to have insurance for everybody. There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us,” he said of his incoming administration.

    I pay less attention to what Trump says than even Trump does, so it’s almost certainly nonsense, but it’s interesting he’d even say this.

    (Source: WaPo, as if it mattered)

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  9. Hal_10000 *

    Incidentally, new CBO report says Obamacare repeal would mean 32 million uninsured and soaring insurance rates.  (Reason: young people would drop out w/o subsidies making the death spiral worse).  Would also increase the deficit because of the elimination of the tax cuts.

    This is what I meant: repealing Obamacare is not the same as having never passed it in the first place.  You have to deal with the situation you have NOW, not the situation we wanted back in 2009.

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  10. AlexInCT

    So people with a vested interest in keeping a social program that will fuck us over have a report that claims getting rid of it is worse than keeping it, when we all clearly see that keeping it will be worse? Sounds like more of this. At this point you can forgive me for not trusting the CBO nor people with a vested interest in keeping the Obama legacy. It smacks of rigged shit.

    My big question is how many people that lost what they had when the ACA became law, with it gone, now have a chance to go back to what they had (and liked), are counted in that ridiculously large number touted by those claiming the repeal will be catastrophic? I suspect that if we get that breakdown this number touted by the people that are selling Obamacare is just too big to fail suddenly becomes meaningless too. Like the claim it will cost more to repeal than to keep. I am betting that a lot of people stuck with shitty coverage because of Obamacare would rejoice that they now have an option to go elsewhere for something like what they had before being doomed to this crappy thing.

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  11. AlexInCT

    The CBO has no vested interested either way. 

    Really?

    You are correct that they usually score what they are asked for, and my point is that it was the same people that rigged the request that allowed them to score Obamacare as something that would lower costs and provide more service when they wanted to sell us that crap – you remember those days and the promises, right – that now provided the criteria for this scoring request. Not surprisingly, we again get something telling us the exact opposite of what is blatantly obvious to anyone with two firing neurons and a grasp of reality, math, and economics. It’s bull.

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