Republicans' failure on health care is even greater than they realize

[mahatmakanejeeves]

Repeal of individual ACA mandate is upending health-care politics, writes @paulwaldman1

Link to tweet

The Plum Line Opinion

Republicans’ failure on health care is even greater than they realize

By Paul Waldman December 27

President Trump is under the impression that he just repealed the Affordable Care Act, an illusion for which he will receive much well-deserved mockery. The truth, however, is that he and the Republican Congress have made a dramatic impact on the future of American health care, not to mention health-care politics. With every step they take, the arrival of a universal government health insurance system gets closer.
....

Needless to say, repealing the individual mandate does not repeal the ACA; most of the law’s provisions are still in place. Does the president actually believe that Democrats and Republicans are going to come together to pass a health-care plan? Who knows. Perhaps he has a firm grasp on the politics of the moment but is trying to give Americans hope for a future of bipartisan cooperation. Or perhaps he is as much a fool as he appears. It also might be that he knows full well that he hasn’t repealed the ACA, but finds political utility in proclaiming victory when his actual repeal effort was such a spectacular failure.

But as Robert Pear of the New York Times notes, the elimination of the individual mandate has the effect of making the ACA more of a government insurance plan than it was under Barack Obama:

In short, President Barack Obama’s signature domestic achievement is becoming more like what conservatives despise — government-run health care — thanks in part to Republican efforts that are raising premiums for people without government assistance and allowing them to skirt coverage.

By ending the tax penalty for people who do not have coverage, beginning in 2019, Republicans may hasten the flight of customers who now pay the full cost of their insurance. Among those left behind under the umbrella of the Affordable Care Act would be people of modest means who qualify for Medicaid or receive sizable subsidies for private insurance.

....
Paul Waldman is a contributor to The Plum Line blog, and a senior writer at The American Prospect. Follow @paulwaldman1

[Sophia4]

1. What price do Americans pay for sticking with for-profit health insurance?

Life expectancies:

Monaco 89.40 (years) 2017 est.

The Monegasque health care system is similar to the French system, whereby it is run on a private basis through which everyone must contribute. The Caisses Sociales de Monaco (CSM) is the compulsory social security system for employed and self-employed citizens working in The Principality of Monaco.
Monaco Health Insurance 2017 | Best Expat Health Plans - Pacific Prime
https://www.pacificprime.com/country/europe/monaco-health-insurance/

https://www.google.com/search?q=Monaco+health+insurance+system&ie=utf-8&oe=utf-8&client=firefox-b-1

Japan 85.30 2017 est.

All residents of Japan are required by the law to have health insurance coverage. People without insurance from employers can participate in a national health insurance programme, administered by local governments. Patients are free to select physicians or facilities of their choice and cannot be denied coverage. Hospitals, by law, must be run as non-profit and be managed by physicians. For-profit corporations are not allowed to own or operate hospitals. Clinics must be owned and operated by physicians.

https://en.wikipedia.org/wiki/Health_care_system_in_Japan

Singapore 85.20 2017 est.

The government of Singapore planned, built, and continues to develop and maintain the nation’s public health care system. It regulates both public and private health insurance in the country. The health care system is administered by the Ministry of Health, which has responsibility for assessing health needs and for planning and delivering services through networks of health and hospital facilities, day care centers, and nursing homes. The ministry manages, plans for, and maintains staffing throughout the system and is responsible for the financing policies and governance of the public health care system.

http://international.commonwealthfund.org/countries/singapore/

Macau 84.60 2017 est.

Macau’s health care system is separated between public and private facilities. There are 3 hospitals, 2 private and 1 public. Macau’s health care is under a lot of strain due to improper spending and a lack of growth, especially within the public sector. Doctor-patient care has degraded over the last 10 years due to lack of funding and governmental support. The single public hospital is under constant strain and has trouble keeping up with the growing needs of the Macanese people, having an average occupancy rate of 87% in 2007. There is no medical board in Macau that regulates medical professionals, which has allowed reoccurring mistakes to happen within medical facilities. Also with no medical board it is extremely difficult to fully grasp the scope of the problem. As an expatriate you can receive care at any facility but an international health insurance plan is recommended with the cost of care in the private facilities having the potential to be very expensive.

The city does have over 477 private clinics and public health centers, making it easy to access basic medical care almost anywhere in Macau. The Conde Sao Januario General Hospital is the only public hospital, and has been having issues with bed shortages in the last few years. This hospital is also suffering from understaffing of both doctors and nurses, causing a quick patient turnover and long waiting lists for patients. Macau also has two private hospitals, Kiang Wu hospital and M.U.S.T hospital, which provide sufficient care for medical needs but can have higher medical costs. Out of three hospitals in Macau, none have earned an International Healthcare Accreditation. When faced with issues of serious injury or illness requiring complex medical procedures in Macau, you may need medical evacuation to the nearest centre of medical excellence in Hong Kong and an international medical insurance plan that incorporates medical evacuation in its coverage.

https://www.pacificprime.com/country/asia/macau-health-insurance-pacific-prime-international/


San Marino 83.30 2017 est.

State healthcare is provided through the Azienda Sanitaria Locale national health insurance fund. All employees must register with it upon starting a job, and upon registration, are issued with a health card and number, and are automatically registered with a doctor in their neighborhood. Employers pay a contribution for each employee, deducted from their salaries, while the self-employed must pay the full contribution. Employed persons' dependent family members are covered by their insurance. Vulnerable people, such as the unemployed, aged, diabetics, and those on long-term maternity leave, do not need to register with an employer, and are entitled to free treatment without paying contributions.

The state health system covers most basic healthcare, such as hospitalization, specialized care, prescription drugs, pregnancy and childbirth, and rehabilitation services.
Private insurance
Private health insurance is widely used, and there is a series of private clinics in the country. Private insurance grants shorter waiting lists than in the public system, a choice of one's doctor, and more comfortable facilities in hospital, with those who have private coverage entitled to their own single or double room, while those under state coverage must share a room.

https://en.wikipedia.org/wiki/Healthcare_in_San_Marino

Iceland 83.10 2017 est.

Healthcare in Iceland is universal. The healthcare system is largely paid for by taxes (85%) and to some extent by service fees (15%) and is administrated by the Ministry of Welfare. A considerable portion of government spending is assigned to health care. There is almost no private health insurance in Iceland and no private hospitals.[1]

. . . .

United States: 80.00 2017 est.

The US is number 43 on the list. I repeat: NUMBER 43 ON THE LIST. CIA LIST.

I'm not going to list all of the countries on the list. You will find them at the CIA website linked to below.

There are many ways to fund and administer a healthcare insurance system that GUARANTEES that every person in the country has access to good healthcare.

Good healthcare is a major factor in determining how long you live, how long you can enjoy holidays with family, loved ones, friends and how long you can contribute to the lives of others, walk your dog, play with your cat, watch movie or sports events, whatever you enjoy.

And here in America, we like to scream USA and claim to be No. 1 and rich, etc., etc. How rich is a country that is 43rd when it comes to life expectancy?

Our healthcare system is a criminal enterprise. Well, I'm exaggerating a little, but really? What excuse do we have? Why do we put up with this?

My brother-in-law died recently at an age considerably lower than even the life expectancy in the US. He drank too much. He was overweight. He had not seen a doctor in 30 years. Wasn't insured. Couldn't afford it. We miss him very much -- cancer and sclerosis of the liver. In my book, neglect and the greed of the very rich and very right-wing in our country.

Why do we choose to allow a certain number among us to die without decent medical care and in abject poverty and misery?

That is a moral question on which maybe even the atheists and Christians and others who believe in a God and in right and wrong can agree on this website.

There are many ways to pay for healthcare. The American way condemns us to be 43d in terms of life expectancy. How much are those additional 4 years worth to you? to your husband or wife? to your children? to your parents? to your co-workers? to all Americans?

It's up to you to do something about this.

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

[duforsure]

2. They don't realize...

The majority of the people really hurt from this is trump supporters, children, and seniors. It'll devastate rural area's when their health care centers close up , or their smaller hospitals shut their doors for good, or the probably closer to 25-30 million people that'll end up losing their ability to have a health care plan, then watch the domino's start falling, and they will destroy Medicaid , Medicare, and Social Security, and that would snowball the shutting down of a larger portion of health care facilities, then add a spiraling downward economy from that and people will not be able to support it any more. and other things people will no longer be able to afford. They are pulling the rug out from children's , women's, and seniors health care,and think everything will be ok. The wealthy will again drive this country's economy into a severe recession, or depression, and then try to blame the Democrats , but the American people already see what they've done, and who's responsible for it. Its going to be worse than w Bushes recession. A lot worse.

[dalton99a]

5. +1

[question everything]

3. What is interesting is that the 3.8% surtax on investment for high earners remained

I thought that this was in part to pay for Obamacare..

[Hortensis]

4. No time soon at best. Senate Republicans relatively wisely

held off slamming the middle class on healthcare, the vast majority of whom are among the 70% who still get their healthcare through their employment. The hugely popular ACA coverages are still mostly in effect for them.

House Republicans had wanted to eliminate the deduction for healthcare costs over 10% of income (not including insurance premiums), and many middle class families would have "felt the pain." Instead, the 10% is briefly reduced to 7.5%, a boon for some to chat happily about as we head toward the 2018 midterms.

Crucially, the FDR "revolution" took place after the Great Depression expanded to hurt the middle class. The hard times that had come before with the Gilded Age had mostly hit people who already had and expected little and thus not generated change.