Category: ACA Repeal

The Death of the GOP as a Functional Conservative Party

George S LedyardTraditional conservatives, the non-insane ones that aren’t racist Neo-Fascists, continue to be dismayed, not just about Trump and company but the lack of experienced leadership in the GOP in general.
This is still democratic system. The ability to negotiate, to compromise, to horse trade is how government of such a diverse population must work.
The Tea Party has sent a number of people to Congress who are religiously and ideologically motivated extremists who have no such ability.
Add to that a So-called President whose personal style would be better suited to a dictatorship. Trump and his minions seem to labor under the misconception that all that is required is for the Great Leader to publicly pronounce his support for a measure and Congress, at least the GOP portion should simply use their majority to pass it.
There is a difference between “conservatism” as a type of governing philosophy and what conservatism as an extreme right wing movement that is anti-government, isolationist, xenophobic and radically socially reactionary.
William F BuckleyBarry GoldwaterOld style conservatives were influenced by conservative “thinkers” like William F Buckley. They were represented in government by highly experienced men like Barry Goldwater and George H W Bush. These men represented a governing philosophy yes, but they also deeply believed in the democratic process. They knew how to work with the people on the other side of the aisle move the business of government forward.
LBJ and Sam Rayburn
LBJ and Sam Rayburn legendary legislators

There was a time when all politicians seemed to recognize that they really did represent all of their constituents. They had their agendas, the policies that they wished to put forward, but they knew that the end result would inevitably be a compromise and that was actually the way the system had been designed by the founding fathers. Skill in governance involved the ability to push ones agenda through the legislative process, to use ones experience, ones connections, ones negotiating skills to succeed in getting legislation passed.
The Freedom CaucusOver the course of the last eight years, we have seen a steady loss of both actual government experience with extremist Tea Party outsiders replacing establishment GOP candidates in Congress. One could see the result over the past eight years in which the GOP simply became the Party of “No”. Their philosophy of government has been to simply oppose anything and everything the other party supports.
Trump AdministrationThese same voters sent the least qualified and experienced President in US history to the Presidency. Trump is a President who has surrounded himself with advisers who have no government or legislative experience. Some are political extremists and some are merely billionaires whose interest is only in helping the wealth be wealthier. None are terribly interested in compromising with the other side.
So, the loss of real statesmen and the overall lack of real experience in the GOP has virtually destroyed the party as a party able to govern. With both the Presidency and the control of Congress, they are still unable to unite in order to pass important legislation. The administration’s radical agenda offends the fiscal conservatives and those moderates still left in the party. The move to compromise on issues offends the extremists in groups like the Freedom Caucus who refuse to budge on attempts to make extremist legislation more moderate.
The result is a party that was unified enough to put a President in the white house but has shown itself to be quite dis-unified and unable to functionally govern. We see traditional Conservatives like George F Will publicly leaving the party. We see the Trump administration governing through executive order, something for which Trump strongly criticized President Obama. The administration is becoming increasingly frustrated with Congressional inability to deliver and is showing more sympathy for totalitarian style leadership.
This blog from Sheila Kennedy is another take on this issue from a former Republican supporter who wonders where her party went.

Hidden Costs – You Are Already Paying for It

George S LedyardToday, Donald Trump and the GOP failed to achieve the single most visible part of their agenda, namely the repeal / replacement of the ACA. This means that, at least for the foreseeable future the ACA remains in place. This is great news but it doesn’t mean we can stop worrying.

There are any number of problems with the ACA. In the short run the Democrats should immediately start proposing legislation to make needed adjustments to the program. At least a few Republicans having seen that their own party won;t produce anything positive, might come along to make the current system better.

But the fact is that we are simply not going to get what we want without creating a single payer system, which I prefer to call Medicare for all. Every other country of any note in the world has a national health care system. Somehow, we as Americans were convinced that anything that came from the government was Socialism and we were terrified of it. The rationale for not having a Medicare for all system is that we can’t “afford it”. If one understands the facts, one can readily see that this is a completely false narrative.

Like many things in American society, we have basically hidden the true costs of how we do things which creates a false impression of what reality is. First of all, the United Sates has the highest per capital health care costs of any major nation in the world. The narrative that says that a single payer system would cost us more is easily disproved by looking at any other major nation. They all spend less on health care than we do. That’s a fact.
Now it is true that a Medicare for all system would increase your taxes. But it is an illusion that you would actually pay more out of your household budget. It would simply be a cleaner system without all the hidden costs. We have what is called an employer based system in which most people get covered through their place of work. For the vast majority this isn’t completely without charge, usually the worker pays a portion of the premium and supposedly the company pays the rest as a benefit.

But the fact is, this is an illusion. Companies do not pay for your health care. The consumers of the products those companies produce are paying for your health care. Companies pass on the costs of insuring their workers, assuming that they do provide benefits, into the cost of the products or services they sell. They have to. That’s how a business makes a profit.
So, in every single thing you buy, every service you purchase is the cost of the insurance that is supposedly being provided as a benefit by the employer. They aren’t really paying for your health insurance, you are paying for it indirectly through the cost of goods and services. It is a hidden cost which artificially creates an illusion of what you are paying for health care.
The fact is that you are paying a whole lot more than you think you are for health care in the US. I’m sure you have already experienced the ridiculously high premiums which seem to go up every single year. I am also sure you’ve noticed those deductibles which also seem to get larger all the time. What many people are unaware of is what they are paying indirectly via the hidden costs that do not get labelled as health care costs when they pay them.
First of all is the cost to the rest of us of every uninsured person. The folks who do not get any health care coverage typically do not have the money to buy their own. So, they end up not getting the preventive care they should, which leaves them less healthy and when they experience their inevitable health crisis, they use our emergency medical system as their health care provider.  This is far and away the most expensive way to provide care and it typically is un-affordable for these people, who then cannot pay, and the hospitals end up writing off the debt. Those losses get passed on directly to the consumers of health care who can pay. You and I are already paying those costs in the prices we are paying.
Then there is the cost of the inadequate insurance that many people have because it is the only thing they can afford. Before the ACA many people’s plans were inadequate to really protect them, especially against catastrophic illness. The ACA had provisions which set certain minimums services that had to be covered in an insurance policy to be considered as adequate. The repeal effort specifically targeted these provisions. The repeal would have put us back to the days when people would have insurance and feel secure only to find that their coverage didn’t come close to covering their real needs in a crisis.
But even with the ACA in place, it is a fact that the number one cause of personal bankruptcy in the United States is medical costs. It is still the case that in our country we have decided that it is acceptable for families to be wiped out financially, a disaster that actually effects multiple generations not just an individual or a couple, due to the cost of medical care. Quite apart from the social cost of family bankruptcy, every time an individual declares bankruptcy, someone, like the banks and their other creditors eat that debt. So. once again, those costs get passed on to the rest of us via increased interest rates, higher service charges, and the increased cost of goods and services. We do not see them as costs associated with health care but they are.

If we can get to a Medicare for all system, we would have none of those hidden costs. We would know exactly what we were paying for. Yes, Federal Taxes would go up. But there could be some relief at the state level as Medicaid, which is administered through the states would not be necessary anymore. The states could save a huge amount.
We wouldn’t have the costs of the uninsured or costs of the bankruptcies being passed on to everyone else. But most importantly, it Medicare for all would almost certainly bring down costs. For profit health care has an automatic built in pressure to raise rates and decrease service. That is precisely how a business increases its profits. Anyone who thinks that competition and market forces are sufficient to bring costs down simply hasn’t looked at the realities of private health care. There is no evidence whatever that this works.

Not having an employer based health insurance system could also drive wages up bu giving the worker more freedom to choose employers. Right now, many folks stay at jobs they hate, or work at pay the is inadequate to cover their expenses simply because they hesitate to lose theior insurance. Essentially, they are held hostage by the employers who offer benefits and don;t feel free to move around. With ┬áMedicare for all system, it would be much cleaner with workers making their decisions about staying or leaving a work place based on wages and work conditions and not on trying to protect the family’s benefits. Over time, this greater choice would create an upward pressure on wages.
Insurance works by distributing or spreading the risk pool. A medicare for all system would mean that 100% of our citizens would be participating in the system. Everyone who pays Federal taxes, either themselves or indirectly via the cost of good s and services they purchase would effectively be paying into the system. Federal income tax is a progressive system so the wealthy would pay proportionally more and the poor might pay very little.
This isn’t rocket science. Every body else has figured this out but us. Are there issues in other countries? Certainly. Every system can be tweaked and improved on. But it is just plain true that the down side of our health care system, which is fast getting un-affordable by anyone but the elites, really outweighs the upside. There is a very good reason that in no other country in the world are they looking at the US system and saying that they want what we have. When you hear any foreigner extolling the US system it is invariably a rich person who can afford to pay whatever the market as asking to get their care. It sure as hell is not the average person. They look at us and think we are crazy.
Let’s get behind Bernie Sanders and make single payer the issue of the day. Help educate the working class folks out there who are being hammered by the current system and educate them why this is in their direct self interest. Help them see through the right wing propaganda and scare tactics. If one gets passed all the BS, it is actually a rather straight forward issue.