Serious problems in public discourse about health care issues are: 1) people conflate health care with health insurance and 2) people conflate Medicare with Medicaid. Effectively, everyone has access to some type of health insurance, albeit often too expensive but health care still sucks. One of the prime reasons that health insurance is so expensive is that health care sucks. The problem is on the supply of health care professionals and I don't just mean doctors. It was pretty easy to see this coming as a consequence of an aging population (and an aging cadre of providers) and an immigration surge but little was done to ramp up the supply. In fact, it was screwed up further by the COVID response. You see the same problems in a universal system up in Canada, maybe worse because they have also underinvested in technology. As for Medicare-Medicaid, one is a semi-prepaid, semi-premium paid plan and the other is welfare. We probably need a welfare system but Medicaid isn't the only way to do it.
As for health care being a Republican vulnerability the first four issues are also policies of the Trump administration and only when you get down to #5 do you get a deviation. And note that that issue is only about pre-existing conditions. That is so popular it was in place in many states before Obamacare. Someone has to pay for it however-either the premium payers or the tax payers which is often lost in the discussion. Democrats are also going to pay a price for opposition to MAHA or at least to the leadership thereof.
I have two chronic health conditions and doctors have worked tirelessly to get me on medication that works. I'm in chat rooms with UK and Canada patients and they tell I've hit the lottery, and I agree. I feel so lucky to receive U.S. healthcare.
Emergency medicine is decent but overconcentrated. For more routine stuff the problem is wait times and admin SNAFUs. These are directly related to staffing shortages which should have been avoided. They also drive cost increases which get baked into insurance premiums. I don't know what is wrong with the electronic systems that were supposed to make things easier but every doctor I have ever encountered either in person or on the Internet complains bitterly.
The ACA was never needed, was a way for Democrats to control more of the health care system not for the people but for votes. True False?
Obama care has cost this country billions, probably trillions by now, while building and supporting it's own support system.
The FEHB is the Federal Governments Health Benefits plans for federal employees including the elected people. With all the permutations, single, married etc there are 220 plans. The system is there and has been long before Obama care. The government pays 75% of the premiums. And Obama care leaves around 20 million still uninsured. What would it take to roll the uninsured, maybe even Medicade and Medicare saving the overhead of two agencies, or is it one massive one, making sure all citizens have afford health care with only one place to go to get it all done. I've never seen the numbers run but then it again,this was never even considered.
So the question is, why is the health insurance plans for government employees including the elected representatives of House and Senate good enough for those folks, but not every citizen who needs health insurance coverage? The only reason I can see is becasue it wouldn't give the elected representatives the control they crave over the health care sector of our country.
Real saving with real coverage of all citizens, how can anyone say no to that? Because between pundits, MSM and politicians, it doesn't fit anyone's needs except for the need of more control by the few.
When I retired at 50 before the poorly named Affordable Care Act became law, no health insurance companies would cover pre-existing conditions. The ACA changed that and I was able to obtain coverage through my husband's plan. So I do not agree that the ACA was not needed.
They could have passed a carve out law, forcing insurance companies to accept all applicants, with a federal subsidy, and with the federal government backstopping extraordinary insurance losses, for people otherwise uninsurable. Everyone needed access to insurance , but there was no reason to blow up the entire system, except a select group of people became very, very wealthy, in the process.
10 years later, we are the unhealthiest as a nation, in all of US history. Our lifespans have actually declined,( although they seem to be slightly better now), with far more chronic illness, beginning at younger ages. All at extraordinary financial costs. Obamacare has been an expensive failure, with respect to healthcare outcomes, coverage and cost.
"More attention to health care means less attention to these other causes. The Democrats’ educated, liberal base and infrastructure may resist that—even if a net enlargement of their coalition would result."EXACTLY!!! Upper middle class professionals have no problem accessing medical care. They may not be willing to sacrifice their "pet projects" for boring old healthcare.
"Upper middle class professionals have no problem accessing medical care." That does not mean that they can pay the full sticker price. They do need health insurance.
Really, there is no GOP "achilles heel". The Social Security Administration, under DOGE, just found almost 600,000 ballots sent out that shouldn't have been---to the dead, missing, etc. 600,000.
At least 475,000 of these qualify as "felonies."
These names are COMING OFF voter rolls, not just in Florida, but virtually everywhere. I am 100% serious when I say that Democrats just lost millions of voters off their rolls at a time when in every single state we track, except CO, the GOP was already gaining net significant numbers of new voters. Removal of these dead or other voters would instantly change at least a half-dozen states from slightly blue to slightly red, whereas states such as NJ that have a high number of "old line" traditional Democrats are going to be jolted. VA, NM, NH, are all instantly in play with no other changes.
You make valid points about the first order impact of cleaning up voter rolls in various states. But Ruy's point is also valid: cut off millions of living, breathing people from necessary medical care and there will be a huge public backlash that will overwhelm the effects of purging voter rolls of fraudulent/ineligible voters. Republican candidates criticized Obamacare/ACA when campaigning, but when push came to shove they didn't dare eliminate the provision that requires covering people with pre-existing conditions. A huge majority of the public - including a large majority of Republican voters - wants their fellow citizens to receive necessary medical care without having to fear being ruined financially. This fact really is a huge advantage for Democrats and Trump knows it.
Nice to see a focus on the Liberal Side of The Liberal Patriot, for a change. This seems to have freaked out some of your Maga-adjacent readers, however.
Ironically, I think a very large portion of TLP's readership are alt-right readers who come to here to bathe in the publication's criticism of Democrats. They get easily triggered when the authors remind them that they are still largely center-left (small d) social democrats, who are arguing for the party to reform itself so that it is more effective in *defeating* the creep of right-wing illiberalism.
I also think the 'liberal' in 'liberal patriot' doesn't mean 'liberal' in the sense of 'left-wing'. I believe it's a reference to 'liberal nationalism', which is the tolerant, non-xenophobic form of nationalism that took classical liberal principles as its starting point. Which is most certainly *not* the type of nationalism Trump is selling. (but also definitely not what woke-ism is selling, either)
I suspect Trump will veto any serious cuts to Medicaid. Also, even though I voted for Trump, I despise Elon Musk. I look forward to the day when Trump does to him what he has done to so many other "friends" in his former administration. Musk will be lucky to escape jail time.
Serious question, would someone please explain the difference between highly subsidized Obamacare and Medicaid? Wasn't Obamacare suppose to solve our insurance problems? I thought it suppose to make coverage available, even after someone was diagnosed with something horrible, with subsidized premiums, affordable for all, regardless of medical history? So why would Medicaid, a program designed to cover very poor women and children, still be growing, a decade after Obamacare?
We have the highest cost healthcare in the world, with some of the worst outcomes, so what makes Medicaid so popular? Along with the possibility of a RIFed federal worker, falling homeless due to cancer, it also seems a potential outcome, will be hundreds of billions in fraud and needless treatment. AI has the potential to see massive patterns, sitting under everyone's noses. Ditto for Medicare.
The ball is in the Republican court to come up with $2 trillion in cuts to federal programs. That target will not be reached without substantial cuts to Medicaid.
Most voters will not view 1/2 trillion in cuts, as a failure.
To a certain extent, Musk has already accomplished his most important goal. Prior to his revelations, if 1000 people had been polled, and asked if US taxpayers were spending millions for 3rd world sex change operations, 990 people would have answered with a definitive no, and said, it was a ridiculous question. Now we know, however extensive, we might have imagined the waste, its' a lot worse. And they are just getting started. Imagine what they will find in Education and Defense.
Also, it's a given someone is cataloging, the worst of the worst. A skilled PR firm will, eventually, start bathing the public, in the most indefensible examples of waste. The only Dem defense, is these programs were "insignificant" in the total budget. Am betting that will be a hard sell, in a country where 1/2 of all families live on less than $77K a year.
Electorally, I see health care issues as being related to voters' feelings about the economy and their personal finances. For example, a lot of people lost their jobs, and thus their health insurance, during the Great Recession. So people were worried about access to care and insurance coverage.
More recently, the major economic issue was inflation, not unemployment, so people's health care concerns were related to their out of pocket costs. The political response was to push policies that lowered people's health care costs, and controlling drug prices seemed to be the easiest way for elected officials to show they are doing something.
As an aside, after this past week and especially today you can tack on foreign policy as a medium- to long-term problem for the Republicans (along with Elon) if they aren’t willing to openly break with Trump on some of what he’s doing. Breaking up NATO and signing treaties to give away Eurasia to a Putin-Xi axis, while giving Russia carte blanche to continue to expand into Europe, is a decision that is not going to age well. If he winds up ending the dollar as the global reserve currency he’ll easily damage the party’s brand for several cycles. (Nevermind displays like today’s, where aside from disgracing his office on live tv the man also very clearly demonstrated that he is not mentally nor temperamentally fit to be making foreign policy decisions, and does not have any adults around him anymore to tell him no)
Serious problems in public discourse about health care issues are: 1) people conflate health care with health insurance and 2) people conflate Medicare with Medicaid. Effectively, everyone has access to some type of health insurance, albeit often too expensive but health care still sucks. One of the prime reasons that health insurance is so expensive is that health care sucks. The problem is on the supply of health care professionals and I don't just mean doctors. It was pretty easy to see this coming as a consequence of an aging population (and an aging cadre of providers) and an immigration surge but little was done to ramp up the supply. In fact, it was screwed up further by the COVID response. You see the same problems in a universal system up in Canada, maybe worse because they have also underinvested in technology. As for Medicare-Medicaid, one is a semi-prepaid, semi-premium paid plan and the other is welfare. We probably need a welfare system but Medicaid isn't the only way to do it.
As for health care being a Republican vulnerability the first four issues are also policies of the Trump administration and only when you get down to #5 do you get a deviation. And note that that issue is only about pre-existing conditions. That is so popular it was in place in many states before Obamacare. Someone has to pay for it however-either the premium payers or the tax payers which is often lost in the discussion. Democrats are also going to pay a price for opposition to MAHA or at least to the leadership thereof.
"health care sucks"
Proof please.
I have two chronic health conditions and doctors have worked tirelessly to get me on medication that works. I'm in chat rooms with UK and Canada patients and they tell I've hit the lottery, and I agree. I feel so lucky to receive U.S. healthcare.
Get well!!!!
Emergency medicine is decent but overconcentrated. For more routine stuff the problem is wait times and admin SNAFUs. These are directly related to staffing shortages which should have been avoided. They also drive cost increases which get baked into insurance premiums. I don't know what is wrong with the electronic systems that were supposed to make things easier but every doctor I have ever encountered either in person or on the Internet complains bitterly.
The ACA was never needed, was a way for Democrats to control more of the health care system not for the people but for votes. True False?
Obama care has cost this country billions, probably trillions by now, while building and supporting it's own support system.
The FEHB is the Federal Governments Health Benefits plans for federal employees including the elected people. With all the permutations, single, married etc there are 220 plans. The system is there and has been long before Obama care. The government pays 75% of the premiums. And Obama care leaves around 20 million still uninsured. What would it take to roll the uninsured, maybe even Medicade and Medicare saving the overhead of two agencies, or is it one massive one, making sure all citizens have afford health care with only one place to go to get it all done. I've never seen the numbers run but then it again,this was never even considered.
So the question is, why is the health insurance plans for government employees including the elected representatives of House and Senate good enough for those folks, but not every citizen who needs health insurance coverage? The only reason I can see is becasue it wouldn't give the elected representatives the control they crave over the health care sector of our country.
Real saving with real coverage of all citizens, how can anyone say no to that? Because between pundits, MSM and politicians, it doesn't fit anyone's needs except for the need of more control by the few.
When I retired at 50 before the poorly named Affordable Care Act became law, no health insurance companies would cover pre-existing conditions. The ACA changed that and I was able to obtain coverage through my husband's plan. So I do not agree that the ACA was not needed.
The FEHB would have covered it.
They could have passed a carve out law, forcing insurance companies to accept all applicants, with a federal subsidy, and with the federal government backstopping extraordinary insurance losses, for people otherwise uninsurable. Everyone needed access to insurance , but there was no reason to blow up the entire system, except a select group of people became very, very wealthy, in the process.
10 years later, we are the unhealthiest as a nation, in all of US history. Our lifespans have actually declined,( although they seem to be slightly better now), with far more chronic illness, beginning at younger ages. All at extraordinary financial costs. Obamacare has been an expensive failure, with respect to healthcare outcomes, coverage and cost.
give us cost estimates please....recognizing that the National Debt grows larger every day.
https://www.cbo.gov/system/files/2023-09/59273-health-coverage.pdf
Look at it tomorrow. Thanks!
"More attention to health care means less attention to these other causes. The Democrats’ educated, liberal base and infrastructure may resist that—even if a net enlargement of their coalition would result."EXACTLY!!! Upper middle class professionals have no problem accessing medical care. They may not be willing to sacrifice their "pet projects" for boring old healthcare.
"Upper middle class professionals have no problem accessing medical care." That does not mean that they can pay the full sticker price. They do need health insurance.
Really, there is no GOP "achilles heel". The Social Security Administration, under DOGE, just found almost 600,000 ballots sent out that shouldn't have been---to the dead, missing, etc. 600,000.
At least 475,000 of these qualify as "felonies."
These names are COMING OFF voter rolls, not just in Florida, but virtually everywhere. I am 100% serious when I say that Democrats just lost millions of voters off their rolls at a time when in every single state we track, except CO, the GOP was already gaining net significant numbers of new voters. Removal of these dead or other voters would instantly change at least a half-dozen states from slightly blue to slightly red, whereas states such as NJ that have a high number of "old line" traditional Democrats are going to be jolted. VA, NM, NH, are all instantly in play with no other changes.
You make valid points about the first order impact of cleaning up voter rolls in various states. But Ruy's point is also valid: cut off millions of living, breathing people from necessary medical care and there will be a huge public backlash that will overwhelm the effects of purging voter rolls of fraudulent/ineligible voters. Republican candidates criticized Obamacare/ACA when campaigning, but when push came to shove they didn't dare eliminate the provision that requires covering people with pre-existing conditions. A huge majority of the public - including a large majority of Republican voters - wants their fellow citizens to receive necessary medical care without having to fear being ruined financially. This fact really is a huge advantage for Democrats and Trump knows it.
The fact (if it is a fact) that 600K ballots were sent out does not prove, or even imply, that anyone voted with those 600K ballots.
"Really, there is no GOP "achilles heel".
***
"Great Depression? Won't ever happen again. Real estate always goes up."
-Every banker and financial analyst in the world, 2006
Color me skeptical.
Nice to see a focus on the Liberal Side of The Liberal Patriot, for a change. This seems to have freaked out some of your Maga-adjacent readers, however.
Ironically, I think a very large portion of TLP's readership are alt-right readers who come to here to bathe in the publication's criticism of Democrats. They get easily triggered when the authors remind them that they are still largely center-left (small d) social democrats, who are arguing for the party to reform itself so that it is more effective in *defeating* the creep of right-wing illiberalism.
I also think the 'liberal' in 'liberal patriot' doesn't mean 'liberal' in the sense of 'left-wing'. I believe it's a reference to 'liberal nationalism', which is the tolerant, non-xenophobic form of nationalism that took classical liberal principles as its starting point. Which is most certainly *not* the type of nationalism Trump is selling. (but also definitely not what woke-ism is selling, either)
I suspect Trump will veto any serious cuts to Medicaid. Also, even though I voted for Trump, I despise Elon Musk. I look forward to the day when Trump does to him what he has done to so many other "friends" in his former administration. Musk will be lucky to escape jail time.
Oh brother. Jail time?
Musk can retire and practice learning all of his children's names.
Serious question, would someone please explain the difference between highly subsidized Obamacare and Medicaid? Wasn't Obamacare suppose to solve our insurance problems? I thought it suppose to make coverage available, even after someone was diagnosed with something horrible, with subsidized premiums, affordable for all, regardless of medical history? So why would Medicaid, a program designed to cover very poor women and children, still be growing, a decade after Obamacare?
We have the highest cost healthcare in the world, with some of the worst outcomes, so what makes Medicaid so popular? Along with the possibility of a RIFed federal worker, falling homeless due to cancer, it also seems a potential outcome, will be hundreds of billions in fraud and needless treatment. AI has the potential to see massive patterns, sitting under everyone's noses. Ditto for Medicare.
Medicare cuts could really impact the Republican's majority health.
The ball is in the Republican court to come up with $2 trillion in cuts to federal programs. That target will not be reached without substantial cuts to Medicaid.
Most voters will not view 1/2 trillion in cuts, as a failure.
To a certain extent, Musk has already accomplished his most important goal. Prior to his revelations, if 1000 people had been polled, and asked if US taxpayers were spending millions for 3rd world sex change operations, 990 people would have answered with a definitive no, and said, it was a ridiculous question. Now we know, however extensive, we might have imagined the waste, its' a lot worse. And they are just getting started. Imagine what they will find in Education and Defense.
Also, it's a given someone is cataloging, the worst of the worst. A skilled PR firm will, eventually, start bathing the public, in the most indefensible examples of waste. The only Dem defense, is these programs were "insignificant" in the total budget. Am betting that will be a hard sell, in a country where 1/2 of all families live on less than $77K a year.
There is no transparency at DOGE so you can believe anything you want including that Must will cut the federal budget by ½ trillion.
Electorally, I see health care issues as being related to voters' feelings about the economy and their personal finances. For example, a lot of people lost their jobs, and thus their health insurance, during the Great Recession. So people were worried about access to care and insurance coverage.
More recently, the major economic issue was inflation, not unemployment, so people's health care concerns were related to their out of pocket costs. The political response was to push policies that lowered people's health care costs, and controlling drug prices seemed to be the easiest way for elected officials to show they are doing something.
As an aside, after this past week and especially today you can tack on foreign policy as a medium- to long-term problem for the Republicans (along with Elon) if they aren’t willing to openly break with Trump on some of what he’s doing. Breaking up NATO and signing treaties to give away Eurasia to a Putin-Xi axis, while giving Russia carte blanche to continue to expand into Europe, is a decision that is not going to age well. If he winds up ending the dollar as the global reserve currency he’ll easily damage the party’s brand for several cycles. (Nevermind displays like today’s, where aside from disgracing his office on live tv the man also very clearly demonstrated that he is not mentally nor temperamentally fit to be making foreign policy decisions, and does not have any adults around him anymore to tell him no)