Trumpcare 2.0 Passes The House

Well, the Rethuglicans finally did it.  On May 4, 2017, they passed a new and even crueler version of Trumpcare in the House.  Apparently it was cruel enough to win over the arch-conservatives, since it guts Medicaid and throws people with pre-existing conditions and chronic conditions under the bus.  It will ultimately result in roughly 24 million people losing their healthcare coverage if it becomes law.

Fortunately, though, it does not seem likely to pass the Senate.  Thus the Senate is working on their own milder version of it to appease the moderates, which means that if it passes, they will still have to hammer out the differences between the two bills.  It's either alienate the moderates to appease the conservatives, or alienate the conservatives to appease the moderates.   And that will likely be the sort of catch-22 that ultimately kills Trumpcare once and for all.

And So We Learn What the Republican Alternative to Obamacare Really Is

In case you missed it, the Republican replacement for Obamacare is basically Obamacare-Lite, which is a giveaway to the rich and the insurance industry, who will see gratuitous tax cuts, but not so much for We the People, who will see less healthcare coverage overall.  Officially called the American Health Care Act, this bill does the following, among other things:

• Replaces the unpopular individual mandate with a "continuous-coverage" provision that allows insurers to impose a 30% surcharge on customers with more than a 63 day gap in coverage
• Replaces the income-based and price-based tax credits with (weaker) flat tax credits that vary only with age of the customers
• Phases out the Medicaid expansion after 2020, pissing off both Democrats and Republicans in the process
• Jettisons the employer mandate (a relatively minor component of Obamacare)
• Removes the Obamacare taxes (that fell primarily on the wealthy)
• Scraps the tax deduction cap on executive pay for health insurance companies
• And of course, defunds Planned Parenthood, despite the fact that the funds really go to birth control, STD tests, and cancer screenings.

Outside of Trump loyalists, generally the only people who really support the bill are the greedy insurance industry.  The American Medical Association and many others have come out against it, given that it will most likely reduce coverage and increase costs across the board.  Ironically, some of those most hurt will be Trump's white working-class supporters, especially in the red states.  In other words, it is at best a solution in search of a problem, if not a new problem in itself.  At worst, it's classic Trumpian chaos manufacture.

There is some nuance that we should note, however.  The very fact that the insurance industry is not worried about an impending "death spiral" should the bill pass is a good indication that we shouldn't worry about that either.  If there is in fact one, it would likely be a result of weakening the subsidies and other aspects of Obamacare, not a result of replacing the individual mandate with the surcharge for not maintaining continuous coverage.  The effectiveness of that provision, for all its flaws, is likely equivalent to that of the mandate it replaces, thus largely preserving that particular "leg" of the "three-legged stool".  The TSAP does support that particular change to the law, even though we oppose the rest of the Republican bill for the most part.

The TSAP, as you know, supports single-payer healthcare for all as the only real alternative.  We also support a public option as a steppingstone to this ultimate goal.  But as long as those are not on the table, we do not believe that we should rip out the heart and soul of Obamacare as the Republicans are trying to do, as that will result in disaster and chaos, doing far more harm than good.  We do support making any incremental improvements in the meantime, however, so long as they do not lead to a significant number of Americans losing health coverage, especially for the most vulnerable members of society.  Every Republican alternative to date, including this one, has failed to meet this standard, and thus we will oppose it.  Because people literally die as a result of losing their healthcare.

One thing is for sure.  This replacement should indeed be called Trumpcare, or perhaps Ryancare.  That way, they get to OWN it.  BIGLY.  Believe me. 

Obamacare Has Republican DNA

With all the latest fuss about the Affordable Care Act, better known as Obamacare, one key fact seems to fly over everyone's heads.  Despite all the Republican attempts to dismantle it, even going so far as to hold the government hostage to do so, many of its core provisions were originally Republican ideas, no matter how much they like to deny it today.  Even some of those who are against it today supported something very similar in the 1990s.  In fact, one can even say that the healthcare law was largely written by the insurance industry for the GOP, since it is virtually a clone of the plan that the industry had originally wanted all along.  Here's a brief history lesson for those who still don't know.

While many of the more progressive Democrats (as far back as Truman and FDR and even Obama himself as recently as 2008) have long wanted some type of universal single-payer system, most Republicans have traditionally balked at the idea, and have proposed their own alternatives that would leave the for-profit private health insurance system intact.  The first alternative came from Nixon, the same guy who gave us the plague known as HMOs.  Nixon's idea was basically equivalent to Obamacare's employer mandate as well as the Medicaid expansion.  (Of course, despite being Republican, Nixon was actually to the left of both Clinton and Obama.)  The next Republican idea was proposed by the Heritage Foundation in 1989, which was the individual mandate that many despise so much, also combined with a Medicaid expansion.  The insurance industry loved it so much (for obvious reasons) that several Republicans from Gingrich to Romney have at attempted to implement some form of it in the 1990s and early 2000s, often including subsidies or tax credits.  When Romney implemented Romneycare in Massachusetts in 2000, by that point most of the plan was largely identical to what eventually became Obamacare.  When Congress finally put it together, the version that passed in 2010 was essentially inspired by Romney who was inspired by Gingrich who was inspired by the Heritage Foundation and who were all inspired to some degree by Nixon.  And that, my friends, is the long and checkered history of the most controversial aspects of Obamacare, which actually turns out to be somewhat of a misnomer.

The TSAP currently supports a truly universal, single-payer system instead of Obamacare or the status quo.  Clearly, Obama never should have trusted the insurance industry in the first place, and should have stuck with his original plan rather than approve the Faustian bargain that would become his namesake law.  In the meantime, however, we believe that Obamacare could become a steppingstone to single-payer if it is given a chance to work, and the Republicans should give up trying to thwart it.  Of course, we still do not support the idea of the individual mandate on principle, and we believe that it should be delayed by a year if not longer, or better yet jettisoned entirely as it is really not necessary.  As we have noted before, the problem of adverse selection is not nearly as large as the mandate proponents believe, and can be greatly ameliorated by simply providing carrots rather than sticks.  In fact there are already such incentives built into the Affordable Care Act, namely the tax credits and subsidies that make health insurance more affordable.   The relatively narrow "open season" for enrollment would also reduce the problem as well.

Additionally, thanks to the law of unintended consequences, the employer mandate should also be further delayed, truncated, or jettisoned since it appears to have led to part-time employees having their hours drastically cut so their employers don't have to offer benefits, and this is a huge deadweight loss.  But everything else in the Act should remain as is until Congress finally gets the intestinal fortitude to implement a single-payer system despite what their corporate masters want.  Anything less would be uncivilized.

Default Averted, For Now

Finally, after 16 days of being shut down, the federal government has officially reopened on October 17.   At the 11th hour, Congress finally passed a bipartisan deal to fund the government through January 15, 2014 and suspend the debt ceiling enough to get us through February 7.   Thus, the risk of default is nil for the next few months, until the next inevitable battle on the horizon of course.   The President stood his ground, and no significant changes were made to Obamacare as Bonehead and most Republicans finally backed down for now.  Our economy, and indeed the world's economy, has been saved from the brink of catastrophe.  So, cue the music, Maestro:

HALLELUJAH!  HALLELUJAH!  HALLELUJAH, HALL.......err, wait a minute.  Seriously?  There is really nothing to be rejoicing about, since true progressives gained absolutely nothing from the deal, the sequester cuts are still in place, and the crazy fanatics who held our government hostage and nearly drove us over the debt cliff get to walk away unpunished, salivating like Pavlov's dog at the next chance to do it all over again.  The antics of the past few weeks have already done significant damage to our economy, and made America look like a dysfunctional laughingstock around the world.  We must not tolerate this kind of outrageous and unacceptable behavior from any of our elected representatives, ever.  Period.  So, one more time, we will say it again to them loud and clear:

"YOU'RE FIRED!!!"

Now pack your bags and get the hell out before we primary each and every one of you.  We the People have spoken.  Don't let the door hit you on the way out.

Dear Congress: You're Fired!

It's official.  The much-feared government shutdown has begun.  All because Congress couldn't get their act together and pass a continuing budget resolution by the October 1 deadline.  They have gone way too far this time.  And we are all paying a heavy price for it. 

The most blame lies with the Republican Party, especially the Koch-funded Tea Party members.  Wanting desperately to repeal, defund, or at least delay Obamacare, among other demands, they insisted on playing chicken with the economy because they didn't get their way.   Led by John Boehner and Ted Cruz, they refused repeatedly to pass a "clean" bill to fund the government for even a few weeks beyond October 1.  Well into September 30, they made one outrageous demand after another as a condition for passing a continuing resolution.  But the Democrats are not entirely innocent either.  They let it get to this point for quite some time now, and even took the weekend off knowing a shutdown was likely imminent.  And when Boehner offered a surprisingly reasonable 11th-hour request to allow the shutdown to be avoided if 1) only the "individual mandate" part of Obamacare would be delayed by a year and 2) Members of Congress would not get any healthcare subsidies, the Democrats (led by Harry Reid) still refused, and Obama still threatened to veto it.  Of course, the Republicans then punted again, and still refused to even allow a House vote on a "clean" bill.  Despicable!  Why both sides couldn't come to a compromise is beside the point.  The real issue is that shutting down the government just because you don't get your way should NEVER be done, period.  And the longer the shutdown lasts, the more damage is done to our economy and society at large.

But it appears that an even bigger fight is on the horizon.  We are just weeks away from defaulting on our national debt if the debt ceiling is not raised in a timely fashion.  Such a default would be unprecedented and would likely lead to another Great Depression.  And if Congress's current unacceptable behavior is any indication, we are in for a VERY rough time ahead in the weeks to come.  They are essentially putting our nation in distress, hence the inversion of the American flag on the TSAP blog.

Thus, the TSAP hereby gives virtually all 535 members of Congress (regardless of party) a vote of "no confidence", and we will take their government shutdown to imply the resignation of such members.   We encourage every reader of this blog to sign the following petitions:

Dear Congress:  We Accept Your Resignation
No Pay for Congress During Shutdown
Minimum Wage for Congress

Let them know that We the People have had ENOUGH of the gridlock, grandstanding, backstabbing, corruption, venality, follies, lies, recklessness, childishness, and otherwise outrageous behavior of Congress.  And we will support a primary challenge to ALL of them, with the only exceptions being Elizabeth Warren and Bernie Sanders.  If we weren't clear, we'll say it again:

YOU'RE FIRED!!!

So what's the opposite of "progress" again?  You guessed it. 

What the Obamacare Ruling Means

NOTE: This post is on both the TSAP blog and the Twenty-One Debunked blog

The recent Supreme Court ruling on the Affordable Care Act ("Obamacare") was a mixed bag overall. The individual mandate (which the TSAP does not support) was upheld, but as part of the government's taxing power rather than under the Commerce Clause. While it is clearly a stretch to say it is constitutional because it is a tax (just think of poll taxes), and thus unfortunately provides a roadmap on how to make an end-run around some parts of the Constitution in the future, at least the Court recognized that the Feds do not have unlimited power under the Commerce Clause. Thus, the ruling took some of the wind out of the sails of the dangerous Gonzalez v. Raich precedent in 2005.

One thing the Court did strike down was the primary mechanism for ensuring state compliance with the Medicaid expansion, namely the withholding of existing federal Medicaid funds as a penalty for noncompliance. This was basically the same form of coercion used by the feds to force states to raise the drinking age to 21 in the 1980s, which was upheld by South Dakota v. Dole in 1987. Since then, this power has been used to coerce the states to follow other mandates as well, and not just ones related to highways. Thus if there is any silver lining to the Obamacare ruling, it is the fact that it may make it easier for states to lower the drinking age (and possibly even legalize cannabis) without federal interference.

As we have noted before, the TSAP supports a single-payer healthcare system similar to what Canada currently has, which is also what President Obama originally wanted as recently as 2008. Anything less would be uncivilized.

Will Healthcare Deform Survive the Supreme Court?

The healthcare reform deform bill that was signed into law in 2010 and whose most controversial aspect, the so-called "individual mandate", will be phased in starting in 2014, is now being taken to the Supreme Court after an appeals court recently struck down the mandate.  And much more is at stake than just this particular law.  Regardless of which way they rule, a landmark precedent will be set that will influence future court decisions, rightly or wrongly.

We at the TSAP believe that the individual mandate is unconstitutional and must be struck down.  There are several reasons why such a mandate is wrong on principle.  Not least of which is that forcing people to buy an overpriced, defective product from a private company year after year under penalty of law is about as constitutional as a poll tax.  But what about the rest of the 2400 page law?

Many folks, especially those in the insurance industry, are terrified that getting rid of the mandate but leaving the rest of the law intact would create an unsustainable death spiral where people will wait until they get sick to buy insurance (due to the another provision that requires community rating and guaranteed issue, i.e. everyone pays the same and no one can be turned down), making costs skyrocket out of control.  While it would most likely hit the insurance industry's bottom line quite hard, the fear is really quite exaggerated.  For example, while Massachusetts currently has an individual mandate along with community rating and guaranteed issue, New York does the same but without the individual mandate, and yet the latter actually has lower premiums than the former.  Granted, both states have ridiculously high rates, but individual mandates don't appear to make rates any lower or make the system any more successful.   And New York's insurance industry is hardly in a death spiral.

The best solution, of course, is a single-payer system similar to Canada's.  An excellent plan can be found here, for example.  But will Congress have the intestinal fortitude to finally stand up to the greedy insurance industry and its deep-pocketed lobbyists, who will do everything they can to fight it?