It’s Not Just Complicated…

Trump generated a lot of well-deserved criticism–not to mention sarcasm–for his recent expression of surprise at the complexity of health policy, saying “Who knew it was so complicated?” The universal response was “Apparently, everyone but you!”

Which brings us to the bill currently before Congress.

Virtually every headline about Paul Ryan’s proposed ACA replacement has been negative: NBC’s said bluntly “Experts: The GOP Healthcare Plan Just Won’t Work.”

While their objections vary depending on their ideological goals, the newly introduced American Health Care Act (AHCA) is facing an unrelenting wave of criticism. Some experts warn that the bill is flawed in ways that could unravel the individual insurance market.

Among other problems, the article pointed out that the bill is almost certain to reduce overall coverage and result in deductibles increasing. It will also phase out Obamacare’s Medicaid expansion. Older, sicker and lower-income patients will be the bigger losers.

The headline of the Washington Post’s Plum Line was equally direct: “The New Republican Health-Care Plan is Awe-Inpiringly Awful.”  

Noting that Trump had campaigned on a promise to replace the ACA with “something terrific,” Paul Waldman, who authors the Plum Line, observed that the bill is

so far from terrific that there doesn’t seem to be anyone other than House Speaker Paul D. Ryan (R-Wis.) himself who thinks this bill isn’t a disaster. It’s being attacked not just from the left but from the right as well. Heritage Action and the Club for Growth, two groups that exist to browbeat Republicans into upholding hard-right principles, have just come out against it.

Waldman marveled that

House Republicans have accomplished something remarkable: They have written a bill that would make every problem they’ve complained about much, much worse. If there’s any saving grace, it’s that almost no one will be happy about it, except for the wealthy people to whom it gives a gigantic tax cut.

So… Republicans are going to drastically reduce the number of Americans with health insurance while increasing costs pretty much across the board:  individuals, state governments and the federal government will all pay more. According to insurance experts, the bill will also do enormous damage to the insurance market. The GOP is evidently willing to inflict all that pain in order to give rich people a tax cut.

The problems with the bill range from the ludicrous to the outrageous, and you can all decide for yourselves which parts you find more horrific or ridiculous, but as a number of observers have pointed out, the promises of a genuine Republican replacement for Obamacare were always impossible to keep.

Today’s GOP is an increasingly uncomfortable amalgam of true believers who oppose the very notion that government has an obligation to provide access to health insurance, and who are working frantically to eliminate Medicare and Medicaid, and the party’s realists, who know that taking health insurance away from Americans who finally have been able to access it–not to mention Medicare recipients– is political suicide.

That’s a political fence that can’t be straddled.

What Ryan and his minions are trying to do is square the circle: drastically reduce coverage while pretending they are doing no such thing.

Some day–if and when sanity and a modicum of honesty return to American government– the United States will join virtually every other first-world country and provide universal coverage. I’ve previously posted about the multiple benefits and clear superiority of Medicare for All.

In 2006, the Economist—hardly a leftwing publication—had this to say about the U.S. healthcare system:

“America’s health care system is unlike any other. The United States spends 16% of its GDP on health, around twice the rich country average, equivalent to $6,280 for every American each year. Yet it is the only rich country that does not guarantee universal health coverage. Thanks to an accident of history, most Americans receive health insurance through their employer, with the government picking up the bill for the poor (through Medicaid) and the elderly (through Medicare).


In the longer term, America, like this adamantly pro-market newspaper, may have no choice other than to accept a more overtly European-style system.”

Obamacare was a step in the right direction, but America still spends more per person on healthcare than any other country–and we still rank 37th in outcomes. (If our infant mortality rate was as good as Cuba’s—Cuba’s!—we would save the lives of an additional 2,212 babies every year.)

Other countries have opted for more efficient–and more humane– national systems.

In 2017 America, we are still arguing over whether healthcare should be viewed as a right (or at least a utility), or whether we should continue to treat it as a consumer product, available to those who can afford it and “tough luck” to those who can’t.

That circle can’t be squared.


  1. Will the American Health Care Act (AHCA) be the deciding factor to answer the primary question before the America people at this time; is the GOP comprised of Americans or Republican Trump supporters? This is a decision they, other than Ryan and McConnell, are afraid of and refuse to make at this time. Will they wait till they are pushed over the edge of Trump’s Flat Earth Society administration and it is too late to stand up for the Constitution? That is the situation at this point in time and the AHCA decision can either save democracy by being denied or become the death knoll of America as we know it.

    I have no idea what my Medicare and the IU Health Care Medicare supplemental provides, has deleted or what any remaining care provisions will cost in my out-of-pocket co-pays. Of course; they know no more than I do at this time. Rather than add that distressful situation to my current stress and fear levels thanks to the current administration; I will wait till I need health care and hope I have any provisions remaining…and that my barely above federal poverty level income can afford. I have no fears of death or funeral costs because I have willed my pitiful mortal remains to Indiana University Medical Research to dispose of. I will leave this world getting the last laugh on one area of big business.

  2. Jo Ann is right. With the American Health Care Act (Trumpcare) on the table the truth about American values will be decided once and for all.

    Are we a nation of good and decent people whose fundamental goal is to live out the teachings of Judaeo Christian teachings through democracy and a constitutional process? Or, are we in fact a people who have abandoned those beliefs in favor of greed, lies, deceit and a group narcissism that continues to blind us to reality. Right now, we have elected to our country’s leadership a political party that represents the latter persuasion… and they are well on their way toward destroying not only the United States but also the world.

  3. “…live out the …Judeo Christian teachings through democracy and a constitutional process.” Ah, there’s the rub. That misunderstanding of our history makes possible the corruption of the American republic. Which sect of christianity gets to determine its teachings as normative? Which image of god of the Jews becomes predominate? Paine’s Age of Reason is only one of the writings of the American heritage largely unknown to the public. Consumer capitalism, not a confused set of “teachings” is responsible for our corrupt and corrupting society.

  4. Time after time, on his way to being elected, 45 violated tenets of human decency. For 8 years prior to that, Republicans did everything they could to stop government from doing its job. As a result 45 is President and Republicans have control of both House and Senate.

    Every time it seems the Republicans have gone a bridge too far, they come out on top. Why? I can give you two good reasons for it. The first is marketing, which Republicans do very well. Take the example of Kentucky, which had the best roll out of Obamacare in the nation. Kentuckians loved their new health care plan, but they hated “Obamacare” That’s marketing. Second is the ennui of the American public. For months, we heard Obama exhort people, “Don’t boo! Vote!” Still, about half of Americans of voting age didn’t show up.

    Now we stand horrified by the moves made by our new government. Will we continue in horror mode long enough even to take back the House and Senate from the nihilists who are systematically destroying govenrment from the inside? That remains to be seen.

  5. Wayne, no doubt my understanding of American History differs from yours, but that does not make yours right and mine wrong. Hopefully, what we can agree on is the point of my contribution to today’s blog, and that is that the country is at a crossroads of moral dimensions, and the way we go will show us and the world what kind of people we really are.

  6. Ryan is working very hard on all aspects of enacting his Ayn Randian vision of what America should be! Sick, sick, sick!

  7. Given how Ryan always seems to get everybody to agree with him does he hand out Ayn Rand scripture in a form like Chairman Mao’s Little Red Books to his caucus? Between him, the Heritage Foundation, The Club for Growth, and Guccifer 2.0 we’re in deep trouble.

  8. Wayne; that “misunderstanding of our history” you referred to. began long before there was an America to make history. The denial, yet today, of the Judeo beginnings of Christianity is at the crux of the outdated laws (such as RFRA) being passed today in this country. The hatred of Muslims; whose beginning, like Jewish and Christian religions, is based in the first five books of the Bible. Genesis, Exodus, Leviticus, Deuteronomy and Numbers; on which the subjugation of women and our rights, racism and homophobia are being used to pass so-called “religious freedom” laws for some but are denial of rights for others. Medical care for all is part of the loss of “religious freedom” when doctors can deny treatment to LGBTQs, blacks, Hispanics, Muslims and Jews.

    Theresa is correct in recognizing that this country is at a “crossroads of moral dimensions” which we believed to be past history…twice. We believed the “moral issue” of racism to be decided at the end of the Civil War only to be faced with the same “crossroads of moral dimensions” during the civil rights movement – another Civil War, fought on our streets and in our homes.

    Is basic health care a civil right or, as the Republicans are trying to prove, a drain on the tax dollars of all and that not every American deserves health care. The same question applies to the right to have food to eat, a source of quality education, the right to have a job and to be paid a living wage. These issues are all part and parcel to the the health care system in this country; including education for the disabled which is being dismantled at this time. We will also be losing mental health care at the same time the gun control reform begins to allow the mentally ill to purchase any and all weapons they can pay for.

    Was Trump the only person in his administration stupid enough NOT to know health care issues are and will always be, complicated? Or the only sitting president stupid enough to admit his stupidity so publicly? Health care is a moral and a humanitarian issue now because it has become totally political in nature and is now big business. My memories are of “family doctors” who provided actual medical care of all levels. Today “family doctors” have the title “primary physician” and they are glorified information and referral providers – providing no medical care after years of expensive medical care training. I see this situation as being complicated, beyond comprehension and usually beyond once reasonable medical costs for actual medical care.

  9. What ever happened to the push for a single-payer system? Why are insurance companies part of the mix?

  10. OMG @ 11:05, there is a proposal for Single- Payer, The Expanded and Improved Medicare for All Act in the House of Representatives. I posted information on it and links on this blog this week.

  11. “The GOP is evidently willing to inflict all that pain in order to give rich people a tax cut.”

    No, they are willing to do so to continue to disparage Obama who isn’t even in office anymore.

  12. Medicare for all is a great idea but a better one is single payer, which is the means by which nearly all civilized states handle their healthcare problems, financed by fair taxes on the inordinately rich, who have been and are milking our pro-corporate/banking tax code for trillions via their campaign-contribution hungry congressional stooges, trillions that could have been utilized for healthcare, infrastructure needs etc. The idea that we cannot afford to have universal health care is false; it is propaganda designed to keep the virtually taxless rich in control. We are the richest country in the world; our problem is not lack of wealth but the political will to fairly distribute the income and wealth our economy provides.
    Trump’s response? Give the rich and corporate class more tax breaks and less regulation of their activities while continuing to tell the rest of us he is making America great again. Apparently the design is to make the streets and sidewalks of American cities look like those in Calcutta, littered with the dead and dying. We can do better – much better. Have we no shame?

  13. I have spent much of the last few days in a large Florida hospital tending to the consequences of my sister in law’s tragic stopped at a light auto accident.

    Here’s what I have observed about what’s at risk from Republicans without adult supervision in DC.

    Probably 3/4s of the hospital medical staff are immigrants from every place imaginable.

    The critical care she is getting and will continue to need is first rate from every perspective.

    There is more technology in her room than in many companies. I’m sure that that room cost more than any house that I will ever own.

    Nobody in the entire system in any way limits care for financial reasons.

    Many patients in the rooms around her will never see the light of day again.

    The whole experience is a tribute to relentless progress and now that it’s been revealed as possible it is the standard everyone with a relative needing acute care expects.

    Extending that experience to the GOP: There is no way out of the corner into which they have painted themselves.

    Advice to self: Try to stay healthy (like that’s possible) while the system collapses and watch the country and the Republican Party implode. Hope that our kids are up to the job of rebuilding a democracy.

  14. The basic problem is that in our capitalist system Healthcare is a cash cow which spins off excessive amounts of cash into the hands of the participating parties. That’s insurance companies, pharma, hospitals, medical device manufacturers, doctors and about everyone associated with healthcare in any way. The big question is how do we break the lock which the capitalist system holds over healthcare?

  15. Pete,

    Advice to self: Try to stay healthy (like that’s possible) while the system collapses and watch the country and the Republican Party implode. Hope that our kids are up to the job of rebuilding a democracy.

    You’re probably right. However, it’s going to be very difficult to rebuild what will amount to be a third-world country. It might be wise to try another alternative.

  16. Clearly the GOP strategy is based on their confidence that they can manage fake news in a way that blames Obamacare for the fallout from repealing it.

    I’m betting that we aren’t that stupid.

  17. Pete,

    “I’m betting that we aren’t that stupid.”

    It’s not that we’re stupid. It’s that we are FOOLS by failing to COUNTER-DEMOCRACY.

  18. Pete,

    I would recommend that you purchase a copy of “Counter-Democracy: Politics in the Age of Distrust” by Pierre Rosanvallon and Arthur Goldhammer (Cambridge: Cambridge University Press, 2008).

    From “Counter-Democracy” page 33: “To be watchful, alert, and on guard are essential attributes of citizenship-attributes present from the beginning since the ancient ideal of citizenship would have been unimaginable if reduced to MERE PERIODIC PARTICIPATION IN ELECTIONS. Vigilance first of all means MONITORING; permanent close scrutiny of the actions of government [ and the political NGO’s on both the right and the left.”

  19. Pete,

    I’m finding it much more productive by “twitter(ing)” in Europe. The Europeans are much more acceptable to reality than we are when it comes to Trump/Pence/Bannon.

  20. I have believed for a few years that the only way we can obtain Single Payer insurance is for Congress to eliminate the corporate tax deductions for providing health insurance to their employees. Employer sponsored health insurance would abruptly end and then the majority of citizens would loudly demand Single Payer insurance.

  21. So sorry, Pete, to hear about your sister’site accident, and glad she is receiving compassionate and competent care….our system Is Great for acute care.

    And Marv, thank you for the lead on the book.

    We seem to be experiencing a changing paradigm. Dynamical systems theory does a great job of explaining much of the non-material dynamics we seem to be experiencing. And Michael Conforti, Assist Institute, is working with archetypal field dynamics and human systems pattern recognition, to help himself, and others, attempt to have some map of the lay of this new land we are experiencing.

  22. I was in Havana last week with a group of physicians. Yes. They are definitely doing some things right there. Not only is their infant mortality rate significantly better than ours, but they have diabetes treatments that make ours look 3rd world. A diabetes patient in the US with decubiti has an amputation risk of about 30%. In Cuba, it is about 1.8% due to some new drugs and protocols that they have developed. The key to their success? The family practitioner knows all of their patients. They visit them regularly in their homes. They have a negligible HIV problem, a negligible drug problem, and virtually no one is killed by guns. I think we need to stop patting ourselves on the back and try to improve the lives of US citizens in any way we can.

Comments are closed.