Trump's Full Court Press on healthcare

[pr0ner]

Trump must be bored. He's tweeting about McConnell and the failed Obamacare repeal again.

[LawBeefaroni]

Trump isn't to blame for this but, yeah, single payer... We wonder where RM9's $6000 bills come from...

https://www.nytimes.com/2017/07/24/upsh ... p_1=746006

I have a Cadillac plan that mitigates out of network fiascos but I can easily imagine based on the code fuckups I've fought in my lifetime what people can go through thinking they are visiting an in network hospital only to find someone looked at their chart and can bill them whatever because the in network hospital contracted out of network staff.

Most hospital's would rather get paid the in network rates in a timely manner than chase down patients for billed charges they probably won't pay, it will fight for years. The problem is when second party providers are involved. Like the company in the article, who are only after money (and who don't have to worry about reputations since the hospital will get blamed). Or just per diem or non affiliated providers who they have no control over in terms of what plans they are in. Smaller hospitals can't just go out and hire every doctor they need. Hell, but hospitals can't a lot of the time. So they rely on independent providers or mercenary hospital based groups like in the article.

Contracting out is fine, but in most other industries, the subcontractor does not get to bill the customer using different terms and conditions. If someone went to an in-network hospital for care, all care provided in that hospital should be covered in network and all billing done through the hospital. The way it happens now is near-criminal bullshit.

It's the plans that define their networks. And a hospital can't misrepresent a contracted provider as their employee and can't say they did the procedure when they didn't.

The arms length stuff with outsourced providers (I'm using that term instead on "contracted" to avoid confusion with providers contacted with the plan) is most ly due to liability, regulations, and credentialing.

[LawBeefaroni]

Trump must be bored. He's tweeting about McConnell and the failed Obamacare repeal again.

Guess he figured out that war is hard too. Maybe harder than healthcare.

[ImLawBoy]

Trump must be bored. He's tweeting about McConnell and the failed Obamacare repeal again.

Guess he figured out that war is hard too. Maybe harder than healthcare.

Who knew? Nobody knew.

[hepcat]

For some reason, I always envision him painting his toe nails and wearing a bath towel on his head while he's tweeting.

[Fitzy]

For some reason, I always envision him painting his toe nails and wearing a bath towel on his head while he's tweeting.

That's a deeper dive into the fantasy life of an OO member than I expected to see in R&P.

[stessier]

Not quite dead yet.

Two GOP senators have a new plan.

[stessier]

An analysis of where it appears the votes currently are from 538. Man they are close.

[El Guapo]

As the article says, they're always close, but that 50th vote is hard to get, so the fact that they are probably just a couple votes short in the Senate doesn't really tell us that much about the odds that this passes, especially because if this bill continues to move ahead there will be more press coverage and scrutiny, which is not helpful for GOP health care bills.

That said, because they're always close, the risk that they finally do is non-trivial. What I worry about most with this is that Arizona Gov. Ducey has endorsed it and Graham is pushing it, which are both things that could plausibly cause McCain to flip. Though on the other hand Paul has been saying he's a hard no on the bill for awhile.

[$iljanus]

I guess when in doubt just cover even less people with every version of this bill because that's what America wants.

[Chaz]

It's mind-blowing that a bill that's even more ridiculously cruel and non-partisan than the last two that died has even a remote chance of passing.

Then again, it mostly impacts the Libruls in blue states, and gives money to the Real Americans in red states*, so I guess that's easier to sell to GOP Senators.

*Never mind that the ones who are getting extra under this plan are only getting extra because their state leadership turned down the offer of more money before. They seem perfectly happy to accept it now that Obama's not the one handing it out. And since it's only for the next ten years, I guess that's okay too.

[Holman]

A civilization with books, music, and the internet should understand healthcare to be a human right.

A civilization with cars, air conditioning, and fast food should be ashamed even to question it.

[malchior]

What's even more disgusting is that the system is massively inefficient, unfair, and not competitive. And before the ACA it was worse. The GOP's bills so far promise to return us to a worse state and unleash massive chaos. And yet we are barely avoiding this so far despite it being a massively unpopular undertaking.

[El Guapo]

Jimmy Kimmel tears into Cassidy.

I was wondering if he was going to do something like this. Good for him.

[Carpet_pissr]

Nothing for Graham? Guess I will take him on at the local level with a strongly worded letter.

[Zaxxon]

Nothing for Graham? Guess I will take him on at the local level with a strongly worded letter.

I imagine he's not a Graham fan either, but Cassidy's the one who bullshitted him to his face on his own show after his own kid had open-heart surgery, then went on a roadshow where he used Kimmel's name to espouse all the healthcare goodness he'd fight for. And then co-authored a bill that flies in the face of all of that.

[Octavious]

Eh screw it. Let it go through and watch as all Trump idiots lose their coverage and wonder what happened. I'm so disgusted with everything at this point that I can't even watch the news. I'm going to break my tv one of these days.

[El Guapo]

So Collins seems pretty clearly to be a firm no. Rand Paul - while I hate counting on this - has been consistently not just criticizing the bill but saying that he's a firm no. Questions are whether Murkowski remains a no - she was pretty firm on skinny repeal, but as far as I know she hasn't said much on this yet. And there's McCain - he was beating the 'regular order' thing the other day that evidently led him to vote down skinny repeal, and this is obviously not going through regular order...but now his governor and Graham are pushing this, so I hate counting on him either.

[GreenGoo]

One of the natural outlooks of capitalism is viewing your fellow man as competition. This is the opposite of what we teach our children, so the conflicting messages can be hard to reconcile as you grow up. I understand that people value strength and that we all expect people to pick themselves up by their bootstraps, not withstanding that the system actively tries to keep some people down, while those in charge work to keep the system actively keeping them afloat. It's not fair, but anyone who fails at it is just not trying hard enough.

I get that mindset. I mostly...agree with it, but I also understand that people need help and that as part of the human race, helping "just enough" those who are failing through no fault of their own is what we should be doing. Obligated to do, even.

What I didn't realize, outside of this dog eat dog mentality where we expect everyone to be an island despite being a social species, is that a large number of people actively hate other people and want them to die. Or, at a minimum, do not give 2 shits what happens to them.

That's freakin' nuts.

[Chaz]

Eh screw it. Let it go through and watch as all Trump idiots lose their coverage and wonder what happened. I'm so disgusted with everything at this point that I can't even watch the news. I'm going to break my tv one of these days.

But the (constant) problem is that it's not just "Trump idiots" that will be hurt, and possibly die, because of this. Trump voters were more likely to be above their state's median income level. It's more likely that the people hurt the worst will be the poorer ones who benefited from the Medicaid expansion, and that demographic is less likely to be Trump supporting than their more affluent neighbors.

So saying "well, you supported Trump, so deal with it" ignores the vast swathes of people who didn't vote for Trump, but still get to deal with it.

[Defiant]

While Republicans have been busy with this, Sanders has been pushing his single payer medicare for all bill that has zero chance of passing right now, and which has had a whole bunch of 2020 hopefuls co-sponsoring so it can show they have "progressive" creds.

And now some Democrats are questioning the timing:

One Senate Democratic aide wondered whether the single-payer splash could have waited until next month, when the GOP's window to repeal Obamacare with 50 votes will have closed.

“It’s the timing that’s the problem,” the aide said. “If this was introduced Oct. 1, that’d be one thing, but this is almost perfectly timed to make it harder to defend the ACA.”

“We should be trying to save the most progressive health care overhaul in decades, because it’s really at risk. But instead, they’re riling up the base over single payer, making the perfect the enemy of the good at the worst possible moment,” the person added.

A liberal activist whose group supports single-payer health care sounded a similar note, saying that the timing of Sanders’ rollout had handed “Republicans a lot of space” to quietly twist arms on the Cassidy-Graham repeal plan.

[Isgrimnur]

So saying "well, you supported Trump, so deal with it" ignores the vast swathes of people who didn't vote for Trump, but still get to deal with it.

Of those that didn't, over 2/3 of them didn't vote at all. I'm not saying that makes them more deserving of the ensuing shitstorm, but they certainly didn't take a relatively simple (simpler for some than others, I know) action to try and head it off.

[Zaxxon]

Just a friendly reminder to call your senator(s) to register your objection--202-224-3121. No more posting until you've taken the literal 1-2 minutes and done this.

[El Guapo]

While Republicans have been busy with this, Sanders has been pushing his single payer medicare for all bill that has zero chance of passing right now, and which has had a whole bunch of 2020 hopefuls co-sponsoring so it can show they have "progressive" creds.

And now some Democrats are questioning the timing:

One Senate Democratic aide wondered whether the single-payer splash could have waited until next month, when the GOP's window to repeal Obamacare with 50 votes will have closed.

“It’s the timing that’s the problem,” the aide said. “If this was introduced Oct. 1, that’d be one thing, but this is almost perfectly timed to make it harder to defend the ACA.”

“We should be trying to save the most progressive health care overhaul in decades, because it’s really at risk. But instead, they’re riling up the base over single payer, making the perfect the enemy of the good at the worst possible moment,” the person added.

A liberal activist whose group supports single-payer health care sounded a similar note, saying that the timing of Sanders’ rollout had handed “Republicans a lot of space” to quietly twist arms on the Cassidy-Graham repeal plan.

Yeah, this worries me. But then, tactics and practicalities have never really been Bernie's thing.

[Carpet_pissr]

Just a friendly reminder to call your senator(s) to register your objection--202-224-3121. No more posting until you've taken the literal 1-2 minutes and done this.

Done

[Isgrimnur]

Senate Majority Whip + Ted Cruz

[Moliere]

Proof that Rand Paul is a hero!

[hepcat]

If disagreeing with Trump is all you need for hero status, prepare to send me my goddamn medal of honor, pal.

[Moliere]

If disagreeing with Trump is all you need for hero status, prepare to send me my goddamn medal of honor, pal.

Steps to receive your medal of honor:

1) Have a political career.
2) Be in the same party as Trump.
3) Publicly and repeatedly oppose Trump's initiatives.

Until then, this is all you get:

[Max Peck]

Proof that Rand Paul is a hero!

My understanding is that Paul is opposed to it because it still doesn't go far enough. Wouldn't that make him more of an antihero?

[hepcat]

If disagreeing with Trump is all you need for hero status, prepare to send me my goddamn medal of honor, pal.

Steps to receive your medal of honor:

1) Have a political career.
2) Be in the same party as Trump.
3) Publicly and repeatedly oppose Trump's initiatives.

Steps for Rand Paul becoming a hero in any sense of the word:

1) Stop being Rand Paul.

[Scoop20906]

Proof that Rand Paul is a hero!

My understanding is that Paul is opposed to it because it still doesn't go far enough. Wouldn't that make him more of an antihero?

God, this tweet. Such a half-assed attempt to promote this bill. If he can't do it in a tweet or in front of his adoring zealots at a rally, he just can't be bothered to do his job.

[El Guapo]

So...basically now we get to spend a week or so waiting for Murkowski and/or McCain to say something relatively definitive on the G-C bill.

[malchior]

Don't they only have 10 days to pull this off too with the fiscal year ending at month's end?

[stessier]

Yes, they have to pass it before Sept 30.

[El Guapo]

To use this year's reconciliation bill (there being one per year). They could start over on Oct. 1st with a new reconciliation bill, though then they would be using up next year's reconciliation bill (is my understanding).

Or they could work out a bipartisan bill.

[El Guapo]

Apparently democrats are going to try to use procedural obstacles to run out that Sept. 30th clock, though I haven't seen much on whether they have any reasonable chance of success at that (my guess being that they don't).

[stessier]

To use this year's reconciliation bill (there being one per year). They could start over on Oct. 1st with a new reconciliation bill, though then they would be using up next year's reconciliation bill (is my understanding).

Or they could work out a bipartisan bill.

And next year's reconciliation is slated for their Tax Cut plan. I can't see them punting on that for another shot at Obamacare.

[El Guapo]

To use this year's reconciliation bill (there being one per year). They could start over on Oct. 1st with a new reconciliation bill, though then they would be using up next year's reconciliation bill (is my understanding).

Or they could work out a bipartisan bill.

And next year's reconciliation is slated for their Tax Cut plan. I can't see them punting on that for another shot at Obamacare.

Can't they do both, though? Parts (1) - (10) of the bill destroy the health care system; then parts (11) - (20) implement a massive regressive tax cut.

[milo]

The advantage of doing it in two separate bills is that you get to use the assumptions generated by the first as the new baseline for the second. Each reconciliation bill must be "revenue neutral" or the changes it makes must expire in ten years. Removing government expenditures for ACA this year would enable them to implement a permanent tax cut next year. Otherwise, the tax cuts would be temporary, as they were under GW Bush.