GOP Hard-liners’ Obamacare Incoherence

Dennis Sanders

Dennis is the pastor of a small Protestant congregation outside St. Paul, MN and also a part-time communications consultant. A native of Michigan, you can check out his writings over on Medium and subscribe to his Substack newsletter on religion and politics called Polite Company.  Dennis lives in Minneapolis with his husband Daniel.

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82 Responses

  1. Morat20 says:

    I’m honestly starting to think Ryan designed this bill to fail. (I admit, it’s really speculative, but….it seems designed to fragment his own base, was built with no buy-in by either the GOP factions or lobbyists — it’s really weird for to push a major bill where you haven’t already gotten at least the relevant stakeholders in your own party on board).

    Once it fails, he can say “We tried”, blame the filibuster or RINOs, and then move on from an unwinnable fight.

    Best of all? If it fails and he blames Democrats or RINOs, the GOP can still campaign on how the ACA needs to be repealed and how awful it is for at least another cycle.Report

    • Stillwater in reply to Morat20 says:

      Ya know, that was my thought as well when the parameters of the bill were first leaked/trial-ballooned a couple weeks ago. It struck me as so bad, yet miraculously still being seriously considered by Republican Leadership, that I imagined the leak was intended to be a poison pill, letting Ryan fully realize how badly it would be received.

      At this point I don’t know who’s crazier: me for thinking the bill aint going nowhere or Ryan for thinking it will.Report

    • Troublesome Frog in reply to Morat20 says:

      Best of all? If it fails and he blames Democrats or RINOs, the GOP can still campaign on how the ACA needs to be repealed and how awful it is for at least another cycle.

      That’s a very, very good plan. It’s like making sure that there’s always at least one city that wants an NFL team but doesn’t have one so you can repeatedly extort stadiums out of your current city. Catching that particular car and actually taking ownership of health care policy is a whole lot less useful than being able to run against it cycle after cycle.Report

    • Michael Cain in reply to Morat20 says:

      Alternatively, he’s walking a narrow line between conflicting interests that he hopes will provide for two specific goals: unwrap the PPACA and preserve the Republican Congressional majorities. We don’t know what kind of conversations are happening behind the scenes. I expect that he’s telling people in his caucus, “Say what you want now, but vote for the bill. Because nothing is going to actually get finished before June, and if (1) we tell the insurance companies that the individual policy market rules change radically in six months; (2) we tell a bunch of (R) state legislatures, many of which have finished their 2017 sessions, that we’re blowing a billion-dollar hole in their FY 17-18 budgets; (3) we tell the hospital associations, and the rural hospitals in particular, that they’re bankrupt at the end of 2018; well, a bunch of you won’t be back in 2019, and despite having the Senate (D)s in a hole, we could lose that majority as well. Patience is required.”Report

    • Saul Degraw in reply to Morat20 says:

      @morat20

      Fails Occam Razor.

      Ryan and his cohort are simply true believers in the fact that they don’t think the Government should have a role in subsidizing or providing healthcare. They are libertarian fanatics who believe only in the free flow of capital.

      The problem for the GOP is that the above stance is deeply unpopular with most of the population.Report

      • Stillwater in reply to Saul Degraw says:

        Ryan and his cohort are simply true believers in the fact that they don’t think the Government should have a role in subsidizing or providing healthcare.

        That’s actually not correct. Ryan’s plan includes subsidies to purchase insurance and includes Fedrul block grants to states for the provision of medicaid services. His goal, and I don’t think he’s been shy about saying this, is to reduce the federal costs in healthcare provision. And in fact, the most resistance he’s received on the subsidy side of the debate is from truer-believers than he apparently is. Folks who don’t want any subsidies at all (or something, I think it’s incoherent myself). There are also complaints about the provision of block grants for medicaid, but those appear to be more pragmatically based.

        The problem for the GOP is that the above stance is deeply unpopular with most of the population.

        More importantly for Ryan right now is that it’s deeply unpopular within his own party.Report

        • Francis in reply to Stillwater says:

          The only way to reduce the federal cost share, without price caps or the functional equivalent, is to shift costs to another participant. Major players include:

          a) the states (who cannot run deficits and who don’t have the tax base to do so);

          b) hospitals (which will go broke);

          c) employers (who will be just delighted to pass on surging insurance costs onto their employees); and/or

          d) of course, individual consumers who will consume less care (needed or otherwise) in the face of rising deductibles and premiums.

          Yes, this is what passes for conservative thinking these days. (Vox sent me to a column by Yuval Levin, who believes that the government should support catastrophic policies only. Necessary but uncovered care — diabetes for example — should be paid for by ????Report

          • Marchmaine in reply to Francis says:

            I see your comment on Levin… Catastrophic coverage the universal baseline; he’s not saying that that’s all there is. He’s also talking about reducing (possibly eliminating) the Employer tax credit, and his point in this one article is not to propose an alternative plan in toto but to look at the proposal on the table and the limitations it faces if they Republican congress insists on moving forward with Reconciliation. He’s not exactly sure that’s the right path, but that’s also outside the scope of the article.Report

          • Stillwater in reply to Francis says:

            Yes, this is what passes for conservative thinking these days.

            “Who knew healthcare reform would be so hard?”

            More seriously, I can see that Ryan’s plan in broad outline is probably the most liberal-appeasing as well as practical/functional plan the GOP could possibly pass. And that might be why Ryan himself is trying to hammer it thru: he recognizes that the infighting will only get worse from here, and any likely alternative, even more conservative plan will lead to potentially catastrophic electoral results in the next few election cycles.Report

          • Kim in reply to Francis says:

            Francis,
            Number two is unintentionally hilarious?
            You’re missing the insurers, of course.Report

        • Marchmaine in reply to Stillwater says:

          Yes, @stillwater this is a good restatement.

          If you haven’t already, folks should read Yval Levin’s critique from the right of the proposal… sure its NRO, but Levin is worth reading.

          He’s not saying its a good bill, and he’s clear that it suffers from a lack of vision and fails as sort of the obverse of ACA… a bill that still doesn’t address the primary concerns of American health care… and it is making the exact same mistake that the Democrats made in legislating without the other side through Senate procedurals.

          But he suggests that if you squint at it just right you can discern what it might almost do better. That’s hardly a ringing endorsement, but I think a better place to start the critique.Report

          • Stillwater in reply to Marchmaine says:

            I agree with Levin that passing a reform bill under reconciliation creates a lot of constraints to what they might otherwise do. Personally, I think Ryan’s probably correct in both a tactical as well as broader political sense to use that constraint as a leverage point to limit the Party’s ambitions here. If I were him, I’d also wanna get that hot potato outa the House and into the Senate’s hands as quickly as possible.Report

  2. Road Scholar says:

    FWIW, and perhaps a bit off-point, but this is why liberals have trouble trusting libertarians. I mean, I know libertarians that will say we need to start on the road to their economic libertopia by removing barriers for the poor while removing subsidies for the wealthy.

    But then you have Rand Paul, who does stuff like this. And, like it or not, he’s currently the most visible face of libertarianism. And quite frankly, he comes off as Roy writes, as a total hypocrite and, if I may add, not just a little bit of an a$$hole.Report

  3. Stillwater says:

    I”m not super familiar with Roy’s writing and views, but I think he hits on an important issue: that what passes for status quo, Washington-based GOP conservatism is really a grift for the rich. Which puts Roy’s conception of what a “real conservative reformer” desires wrt healthcare reform – to shift the focus away from the wealthy – squarely at odds with the core ideology upon which contemporary conservatism is constructed.

    Which is why we have Trump!!Report

    • Saul Degraw in reply to Stillwater says:

      @stillwater

      But everything Trump has done so far has been The biggest Con of all the Cons. He is a grifter par excellence.

      Of course I am a lefty so my views on this count for nothing….Report

      • Stillwater in reply to Saul Degraw says:

        His con was dependent on the long-game GOP con, tho. If the GOP hadn’t sold the grift for so many years, Trump’s con wouldn’t have any bite in the electorate.Report

  4. LeeEsq says:

    Conservatives and libertarians just need to give up on trying to get the magic market (TM) to provide healthcare for people. It doesn’t work. It has been proven not to work again and again. Healthcare is an area where socialism really does work. Ken Arrow was right in 1962 and he continues to be right int the present. Yet we have people who insist that the magic market is always the answer.Report

    • Jaybird in reply to LeeEsq says:

      You misunderstand what the magic is that the market is producing.

      It’s not the magic of “everybody gets whatever they want, forever!”

      It’s the magic of medical research, the magic of magic drugs and magic procedures that we have that we wouldn’t have had otherwise.

      Is it measurable? Lord knows, I’ve tried. Various tricks like “number of medical patents held” and “number/percent of Nobel Prize winners from various countries” or what have you but those aren’t very good measurements anyway.

      But the magic isn’t “providing healthcare for people”. The magic is “creating new and improved healthcare that might be provided, if people had the cash”.Report

      • Francis in reply to Jaybird says:

        Oh lord jb your comments are extra aggravating this morning.

        There are lots of neat ways to improve healthcare that don’t involve Americans paying a disproportionate (and unequally distributed) burden of the development cost. Many of those ideas are just a google away. (e.g., prize money, increased federal grants, increased cooperation between federally funded and private research, patent reform, increased international cooperation on the financing of drug development and distribution.)

        But to add in what you left implicit:

        are there any neat ways to improve healthcare that don’t involve Americans paying a disproportionate (and unequally distributed) burden of the development cost? I dunno. I’m just asking questions. I’m not going to bother doing any research on that point. also, I’m not going to do any digging into any aspect of Ocare which is dedicated to effective cost reduction.

        Also I’m going to relentlessly blend the issues of policy and perception to the point that no one has any idea what I’m talking about.

        Report

        • Jaybird in reply to Francis says:

          I wasn’t making the point that you think I was making.

          I was, instead, arguing against the point that Lee was making.

          The whole “markets are magic!” thing does *NOT* lead us to “everybody has a Ferrari!”

          It, instead, leads us to “everybody has a car, and some people have good cars and some people have crappy cars and the magic of the market is that the average cars bought in 2017 are much better (and not merely newer) than the best cars available in 1987.”

          When you said that I left a question implicit and then said that I was just saying that I was just asking questions, you veered off into points that I wasn’t making and wouldn’t make.Report

          • greginak in reply to Jaybird says:

            So it’s a good thing we all dig markets and are for them. Are there any communists here? Don’t think so. Markets are fine they just aren’t the complete answer for every thing. It’s not like anybody thinks markets solve 100% of every problem or are the only thing we need. I mean that would be just wing nutty to think markets are the be all and end all. Right?Report

            • Jaybird in reply to greginak says:

              And you’re arguing against points that I’m not making.

              I was arguing against Lee’s statement that, here, let me copy and paste it:

              Conservatives and libertarians just need to give up on trying to get the magic market (TM) to provide healthcare for people. It doesn’t work. It has been proven not to work again and again.

              Report

              • greginak in reply to Jaybird says:

                I couldn’t begin to count how many times i’ve heard conservatives and libertarians say that the answer to our HC problems is more market; we just gotta get markets going and then it will be fine. Heck Paul Ryan says it all the time and likely says “markets” in his sleep. Markets are great things but have limits and do not provide all the solutions. Double Hecks, the ACA was all about markets. What did those market loving conservatives and libertarians say when markets raises rates……they complained.

                There is no evidence markets and markets alone will answer all the issues/problems people have with health care.Report

              • Jaybird in reply to greginak says:

                The proposition that “we need more markets” and the proposition that “markets and markets alone will answer all the issues/problems people have with health care” are two kinda different propositions.

                I mean, if I argued “there is no evidence that socialism and socialism alone will answer all the issues/problems people have with health care”, would that get a “what the hell?” from the gallery?

                I think it would.Report

              • greginak in reply to Jaybird says:

                Freddie has been gone for years. Do we have any socialists here? Nobody has been saying markets don’t work for some things, they just ain’t the complete answer.

                Paul Ryan:

                “In January, Trump vowed “insurance for everybody.” On Friday, Price also promised, “We don’t believe that individuals will lose coverage at all.” But that same day, House Speaker Paul Ryan (R-Wis.) seemed to acknowledge his plan won’t cover as many people, in an interview with conservative radio host Hugh Hewitt.

                “We always know you’re never going to win a coverage beauty contest when it’s free market versus government mandates. If the government says thou shall buy our health insurance, the government estimates are going to say people will comply and it will happen,” he said. “And when you replace that with we’re going to have a free market, and you buy what you want to buy, they’re going to say not nearly as many people are going to do that. That’s just going to happen. And so you’ll have those coverage estimates. We assume that’s going to happen. That’s not our goal.”

                http://www.huffingtonpost.com/entry/tom-price-obamacare-repeal_us_58c54bc2e4b054a0ea6b2756

                I didn’t even go looking for this. I just followed a link from twitter.Report

              • Jaybird in reply to greginak says:

                Which brings me back to what I said earlier: And you’re arguing against points that I’m not making.Report

              • DensityDuck in reply to Jaybird says:

                But Jaybird he really really wants you to argue those points, because he’s so good at countering them and it makes him feel so good when he does!Report

              • Stillwater in reply to DensityDuck says:

                OR! He doesn’t think Jaybird has countered anything by offering arguments against points he actually holds.

                See, DD, this whole “go meta or go home” nonsense is just that: nonsense. Plus, I bet you felt really good posting that dig at greg, too, right?Report

              • DensityDuck in reply to Stillwater says:

                “See, DD, this whole “go meta or go home” nonsense is just that: nonsense. ”

                So it seems like what you want to happen here is what happened with Tom Van Dyke, where people decided that they’d just scream garbage in his threads and then ask why he was still allowed to post here when his threads always turned into people screaming garbage.Report

              • Stillwater in reply to DensityDuck says:

                No, DD. It’s more that your screaming about what other people do is exactly what you do yourself, but you ain’t smart enough to see it that way. Unlike the folks you critique, you think what you’re doing is valuable.Report

              • Jaybird in reply to Stillwater says:

                Next time I’ll just yell “strawman!” and run with how that’s in itself an argument in its own right.Report

              • Stillwater in reply to Jaybird says:

                1) You might as well, given how well your arguments are usually received by your interlocutor.

                2) DD should just yell gibberish, on the same analogy, tho he usually says that stuff to you. So maybe you can decode it for the rest of us.

                3) Which takes us back to 1.Report

              • Jaybird in reply to Stillwater says:

                I have the interlocutors I deserve.

                As do they, I suppose.Report

              • Stillwater in reply to Jaybird says:

                Keep it up then.Report

          • Francis in reply to Jaybird says:

            JB:

            Of all the sentences you have written in this thread, how many start with “if”? Of those, how many are followed with any attempt to answer the question you posed, with actual research and analysis not hypothetical hand-waving?

            “points that I wasn’t making”. Correct, you’re not actually making any points at all. You’re just going through one of your riffs about policy vs perception without any saying anything at all.Report

            • Jaybird in reply to Francis says:

              Of all the sentences you have written in this thread, how many start with “if”?

              I put my comment here into Notepad and did a search on the string “if”. Same for this comment here.

              There wasn’t a single instance. The answer to your question is “none”.

              Of those, how many are followed with any attempt to answer the question you posed, with actual research and analysis not hypothetical hand-waving?

              Given that the answer was “none”, I’m not sure that this question has a meaningful answer.

              I did hint at attempts to answer the questions in the past when I said:

              Various tricks like “number of medical patents held” and “number/percent of Nobel Prize winners from various countries” or what have you but those aren’t very good measurements anyway.

              Correct, you’re not actually making any points at all. You’re just going through one of your riffs about policy vs perception without any saying anything at all.

              I think you’re wrong. I think that I’m making points about what ought to be expected from a “magic market”.Report

              • Francis in reply to Jaybird says:

                ahem:

                How close is Obamacare to how every other western country does it?

                If it’s not…

                Because if it’s the case that the WWC (or a chunk of it, anyway) had health insurance

                But if they’re measurably better off, shouldn’t *THAT* be what we focus on?”

                If we go back to the “hey, you’re getting 10 grams of chocolate!”,

                If there are people who found themselves unable to keep their doctor despite assurances that they could,

                if there are people who used to be able to afford their premiums but now find themselves unable to afford them,

                if we find ourselves focusing on the whole “yes, it went up but according to the CBO,

                Report

              • Jaybird in reply to Francis says:

                Of all the sentences you have written in this threadReport

              • Francis in reply to Jaybird says:

                yep, all of these are in THIS very set of comments. and, to reiterate, none have any meaningful responses.Report

              • Jaybird in reply to Francis says:

                Those are in Kazzy’s thread, not Lee’s. If you’d like to complain down there, I’d be happy to join you.Report

              • Francis in reply to Jaybird says:

                seriously? Seriously?

                Do you think that this is the kind of response that earns respect?Report

              • Jaybird in reply to Francis says:

                If you want to argue about comments I made in that thread using the phrase “the comments you made in this thread”, then we’re going to spend at least 5 or 6 comments arguing about the meaning of words and that won’t help either of us.Report

              • Jaybird in reply to Francis says:

                But, fine. I’ll meet you halfway.

                In that thread, yes. I used “if” a lot.

                It was mostly in service to disambiguate the use of the term “the poor” to include multiple groups of poor folks (delineated here by Kevin Drum) because saying “the poor” to refer both to the WWC and to the poor folks that the WWC resents to the point where they’d be willing to vote for Trump(!) strikes me as ambiguous to the point where it’s not particularly useful as a concept.

                And, at the end of the day, it turned out that Kazzy and I agreed on his original point anyway.

                We hammered that out in *THAT* thread. The one down there.Report

              • Kazzy in reply to Jaybird says:

                “…saying “the poor” to refer both to the WWC and to the poor folks that the WWC resents to the point where they’d be willing to vote for Trump(!) strikes me as ambiguous to the point where it’s not particularly useful as a concept.”

                This is an interesting position though. I’m all for self-identifying and allowing folks to choose their labels and what not. But we soon reach a point where words lose all meaning. If “poor” is no longer an economic term but instead a social term so as not to offend certain folks who fit the definition of the economic term because they don’t like other folks who also fit the definition of the economic term, than we shouldn’t be using the term “poor” at all.

                Now, if the point is to say that the economic term “poor” covers so many disparate subgroups and that the people it covers are in no way a monolith and thus it is a useless term… I’m okay with that. But then we shouldn’t be using the term at all.

                But I’m not really on board with “poor” being defined as “certain poor people but not all poor people”.Report

              • Jaybird in reply to Kazzy says:

                Well, there’s the old nine sector grouping (of which I think two have stuck around):

                Lower Lower Class (The Poor)
                Middle Lower Class (The Poor)
                Upper Lower Class (The Poor)
                Lower Middle Class (The Poor)
                Middle Middle Class (Doesn’t exist)
                Upper Middle Class (Middle Class)
                Lower Upper Class (Middle Class)
                Middle Upper Class (Middle Class)
                Upper Upper Class (three quarters of these people are Middle Class, the last is The Rich)Report

              • Kazzy in reply to Jaybird says:

                Perhaps to be more clear, did the author of the originally quoted piece mean to include the WWC when he discussed “the poor”? Was he using it as an economic term or as a social/political term?Report

              • Jaybird in reply to Kazzy says:

                That’s a pretty good question because, as far as I can tell, he’s split things up between “the rich” on one side and “the poor and the sick” on the other and… yeah. There are a lot more sides than that.

                The so-called “Blue Wall” was won because of “the poor”.

                And, presumably, some of the sick.Report

              • Kazzy in reply to Jaybird says:

                I just can’t keep up with terms-that-don’t-mean-what-they-say-they-mean.

                Urban means black and includes rural blacks. Poor doesn’t include the WWC. And, hell, the C is WWC isn’t even really about economic class but now some weird slurry of what type of job you have and what your political leanings are. You’re only rich if you can hire a nanny for your nanny. I can’t keep up!Report

              • Jaybird in reply to Kazzy says:

                This is the eventual problem with Newspeak.

                It’s better this way, of course.Report

              • Kazzy in reply to Jaybird says:

                It’s better this way, of course.

                Double-gooder afterbefore.Report

              • Francis in reply to Jaybird says:

                “It was mostly in service to disambiguate …”

                well, here is where we disagree. My perception of many of your comments is that you raise a series of question — some rhetorical but many factual — then fail to make any attempt to respond to them. Then, in the face of overwhelming (but artificially created) uncertainty, you fall back on a small number of rhetorical tricks that lead to a facile but false conclusion. (e.g., divorce or war, but never compromise or just muddling through)

                So, no, for me your questions serve to increase ambiguity, not decrease it. And this is especially aggravated by your persistent refusal to make any attempts to answer your own questions.

                Let’s cut through all your peripheral questions and focus solely on the main points:

                1. The largest single complaint about the ACA by the users thereof is that the cost and the deductibles are still too high, so too many people find that they face significant barriers to obtaining medically necessary care. The proposed Republican solution is to reduce existing subsidies and thereby raise the barriers to care even further. Now what?

                2. Some people who voted for Trump have been helped by the ACA, by the Medicaid expansion and/or by the changes in the rules regarding employer insurance and/or by the creating of exchanges. Some of that group are now showing signs of disbelief that the President is supporting a bill that does not promote what he said on the campaign trail. What are the possible consequences of that dissonance? Will people continue to believe what they want to believe? Obviously many will, but many Congressional districts are pretty close and it won’t take much additional Democratic turnout to flip seats in 2018.Report

              • Jaybird in reply to Francis says:

                1. The largest single complaint about the ACA by the users thereof is that the cost and the deductibles are still too high, so too many people find that they face significant barriers to obtaining medically necessary care. The proposed Republican solution is to reduce existing subsidies and thereby raise the barriers to care even further. Now what?

                Okay, I wrote an essayish thing in a series of comments about how to deal with the health care problem here (bonus: I specifically mention Donald Trump! Like, back in 2011!) and I still pretty much stand by that.

                We’re dealing with a supply problem and the government’s response is always to stimulate demand rather than stimulate supply.

                I read an article the other day that talked about new residents working 28 hours in a row. That seems to me to be a market failure.

                2. Some people who voted for Trump have been helped by the ACA, by the Medicaid expansion and/or by the changes in the rules regarding employer insurance and/or by the creating of exchanges. Some of that group are now showing signs of disbelief that the President is supporting a bill that does not promote what he said on the campaign trail. What are the possible consequences of that dissonance? Will people continue to believe what they want to believe?

                The possible consequences of that dissonance seem to be most likely either involve changing one’s mind or doubling down.

                Will people continue to believe what they want to believe? Obviously many will, but many Congressional districts are pretty close and it won’t take much additional Democratic turnout to flip seats in 2018.

                Hurray! Something measurable!

                So is there a number of seats below which we’d be able to say “okay, we expected more Democratic seats to flip…”? Is there a number below *THAT* where we’d be able to say “Okay, we didn’t understand the dynamics”?

                (Also, you know what I saw the other day? An article in TNR talking about divorce. Wacky.)Report

              • Francis in reply to Jaybird says:

                So is there a number of seats below which we’d be able to say “okay, we expected more Democratic seats to flip…”? Is there a number below *THAT* where we’d be able to say “Okay, we didn’t understand the dynamics”?

                This is a really great question. I’d be interested to hear from the new DNC chair and Nancy Pelosi what their answers are.

                (As to your 2011 comment, the idea behind the ACA was to create a reliable income stream to the necessary providers and then let the market fix. Any attempt to mandate supply-side fixes — beyond opening more med schools — would have been even more disastrous.)Report

              • Jaybird in reply to Francis says:

                Oh, I also wrote an essay here about medical care.

                I remain a huge fan of more med schools and ceasing to stop artificially limiting the number of residency slots (and the fact that residents are working 28 hours in a row tells me that there’s wiggle room when it comes to whether a hospital can handle another one… maybe two residents working alternate 14 hour shifts or something).

                (Of course, this assumes that the reason behind the spiraling costs associated with health care have little to do with doctor salaries.)Report

          • Jaybird in reply to Jaybird says:

            (And, yes, I know that not everybody has a car. That’s an overstatement. But 88% of Americans do.)Report

          • Saul Degraw in reply to Jaybird says:

            I don’t think anyone would disagree with the Ferrari notion. What liberals would say is that there some things that are so basic that they shouldn’t be seen as luxury goods. These are access to food, shelter, clean water, heat, and healthcare.

            No one is arguing that everyone should have a Ferrari, an excellent house with top line appliances and a magnificent view. That is a strawman.

            What liberals are saying via healthcare is that there should be a decent level of insurance coverage that can’t be denied to people because of their income level and/or preexisting conditions or some other thing and this is quite easy to do because every other western country does it.

            The argument you made above is not one that I heard from the GOP or from libertarians. The argument that libertarians and the GOP make is that by letting capital run free, everything will be rainbows and everyone will have access to the best medicines and doctors, just the best. They don’t say “We will develop really cool medicine but not everyone will get access to it” because that is not a politically winning argument

            At what point can we say that libertarian hardliners are like the academics in the 1980s who insisted that Marxism was fine but the problem was the people implementing the Marxism. They weren’t doing it in a pure enough way. Market failure is a real thing but libertarians just seem endlessly capable of ignoring it all.Report

            • LeeEsq in reply to Saul Degraw says:

              Exactly. Jaybird might be making the more realistic magic of the market argument but he is not making the common one. The usual magic market one is that by unleashing the juices and energies of the market we will guarantee everybody gets stellar care. Thats what Trump and Ryan and many conservative pundits advocated.Report

            • Jaybird in reply to Saul Degraw says:

              No one is arguing that everyone should have a Ferrari, an excellent house with top line appliances and a magnificent view. That is a strawman.

              As is “markets are magic”. Which is why I brought up the Ferrari in the first place.

              What liberals are saying via healthcare is that there should be a decent level of insurance coverage that can’t be denied to people because of their income level and/or preexisting conditions or some other thing and this is quite easy to do because every other western country does it.

              How close is Obamacare to how every other western country does it?

              If it’s not, when we’re arguing about Obamacare, then I’m not seeing how every other western country is relevant.

              The argument you made above is not one that I heard from the GOP or from libertarians. The argument that libertarians and the GOP make is that by letting capital run free, everything will be rainbows and everyone will have access to the best medicines and doctors, just the best.

              I find this difficult to believe.

              They don’t say “We will develop really cool medicine but not everyone will get access to it” because that is not a politically winning argument.

              That’s why they’re libertarians.

              That said, the argument that other countries are free riders on America’s R&D is, very much, an argument that exists out there in the wild.

              I’m tempted to google whether you and I have tangled on it on this very website. Think we have?

              At what point can we say that libertarian hardliners are like the academics in the 1980s who insisted that Marxism was fine but the problem was the people implementing the Marxism.

              How about the libertarian softliners who ask “why in the hell does Europe have 8 epipens available and approved by their European Medicines Agency when the FDA in the US has only approved one, one that recently jacked their prices by 800%?”

              Oh, yeah. *THIS* is where “every other western country” gets interesting.

              Shouldn’t we be more like Europe when it comes to Epipens? Shouldn’t the FDA be a lot more like the European Medicines Agency?Report

              • greginak in reply to Jaybird says:

                To carry forward the analogy, we also have public transport for many people. We also have various kinds of services that use the public roads to give rides to people who are disabled. Those public roads/infrastructure and help for disabled people, or school buses, either aren’t’ or won’t be provided without gov help.

                So we’re back to markets and gov intervention are both needed, is their anybody arguing against that other than that.Report

              • Jaybird in reply to greginak says:

                Sure. But, I don’t know about your city, but in my city, there are parts of town that the buses don’t go to. There’s probably a lot to mine with this analogy.

                I don’t think that anybody is arguing that the government get entirely out of the business of medicine, Greg.

                I think that people are arguing that it getting into it the way that it has gotten into it is worse than it not doing what it did would have been.

                (Of course, at this point, we get to start asking “but what about this anecdote?” and “what about that other anecdote?”)Report

    • Don Zeko in reply to LeeEsq says:

      Why are we accepting the premise that conservatives view universal access to health care or universal health insurance coverage as goals worth spending money to achieve?Report

      • LeeEsq in reply to Don Zeko says:

        Somebody like Avik Roy probably believes in universal health care and that the market its the best way to achieve this. Many others are not for universal healthcare but have to pretend to be for it because of the nature of politics.Report

  5. Kazzy says:

    Did the WWC benefit from Obamacare? How many of them are considered “poor”? How many of them receive some sort of subsidy to pay for their health insurance?

    It is my sense that the GOP would be suffer greatly without the support it enjoys among the poor, who vote R despite the fact the party’s economic policies work against their interests. Which is totally fine… there are plenty of things to vote on other than economic issues. But it seems silly to insist that these are votes they don’t need. Where would Trump be if the WWC didn’t swing his way? How many economically depressed rural areas put Republican senators or congresspeople in DC?Report

    • Jaybird in reply to Kazzy says:

      Did the WWC benefit from Obamacare? How many of them are considered “poor”? How many of them receive some sort of subsidy to pay for their health insurance?

      This is one of those very important sets of questions.

      Because if it’s the case that the WWC (or a chunk of it, anyway) had health insurance prior to the PPACA’s passage, then the questions become tied to “compared to what they had before”.

      Did the WWC benefit from Obamacare compared to what they had before? How many of them are considered “poor” compared to how they were considered before? How many of them receive some sort of subsidy to pay for their health insurance compared to what they received before?

      I’ve heard, over and over again, how many more people are insured now than were insured prior to the PPACA’s passage… but that strikes me as uninteresting given that the PPACA, effectively, made “not having insurance” *ILLEGAL*.

      Add to that the whole wacky dynamic of “measurably better off” vs. “do they feel, with their feelings, like they’re better off” and you’ve got yourself another problem. “But if they’re measurably better off, shouldn’t *THAT* be what we focus on?”

      Yeah, I used to think that way too. I totally understand why we’d think that that’s what we should be focusing on.Report

      • Kazzy in reply to Jaybird says:

        “Did the WWC benefit from Obamacare compared to what they had before?”

        Isn’t that sort of what the word “benefit” means? Are they better of now than they were before?

        And frankly I don’t care how it’s framed. The question remains: Does the GOP need “the poor’s” votes or not? Or is this one of those things where they mean something other than “the poor” when they say “the poor”?

        I’m not arguing the Democrats are definitely better for the poor or the WWC than the GOP. I’m asking if a strategy grounded in, “We don’t need the poor” is a sound one for the GOP?

        Of course… this might not *actually* be the GOP’s strategy. Even if their economic policies are good for the rich and bad for the poor, they may still recognize that they need a certain segment of “the poor” to vote for them and have other means of drawing their support.

        My question is more about this particular analysis. Looking at a given policy and saying, “That’s bad for group X” and determining that the people pushing the policy don’t feel they need the support of Group X seems like wrongheaded thinking.Report

        • Jaybird in reply to Kazzy says:

          Isn’t that sort of what the word “benefit” means? Are they better of now than they were before?

          Two ways to look at it. “Better than nothing” vs. “better than where you were yesterday”.

          If, under the old system, you got 15 grams of chocolate and, under the new one, 10 grams of chocolate, you’re still getting chocolate. You’re still getting the benefit, right?

          And frankly I don’t care how it’s framed. The question remains: Does the GOP need “the poor’s” votes or not? Or is this one of those things where they mean something other than “the poor” when they say “the poor”?

          The problem is that there are dozens of ways to be poor and I’m going to link to this old Kevin Drum essay again.

          The gist of that essay is that the WWC makes distinctions between “the deserving poor” and “the undeserving poor”. Saying “the poor” doesn’t make this distinction.

          Yes, yes. They’re racists and all that.

          I’m asking if a strategy grounded in, “We don’t need the poor” is a sound one for the GOP?

          Well, this comes back to the whole issue of what we mean when we ask “Did the WWC benefit from Obamacare?”

          If we go back to the “hey, you’re getting 10 grams of chocolate!”, we very well find ourselves explaining that there are a lot of people now getting chocolate who never had chocolate provided to them before and we need to look at how many more people now have chocolate who didn’t rather than myopically focus on the people who remember getting 15 grams.

          But we really need to hammer out the whole “benefit” question.

          If there are people who found themselves unable to keep their doctor despite assurances that they could, if there are people who used to be able to afford their premiums but now find themselves unable to afford them, if we find ourselves focusing on the whole “yes, it went up but according to the CBO, it would have gone up even more without this program so they’re better off than they would have been!” rather than on how they’re sitting there with 10 grams of chocolate…

          Well, we might find ourselves wondering why they voted for the GOP instead of the Democrats. Again.Report

          • Kazzy in reply to Jaybird says:

            “If, under the old system, you got 15 grams of chocolate and, under the new one, 10 grams of chocolate, you’re still getting chocolate. You’re still getting the benefit, right?”

            Not the benefit. Did they benefit? 15 grams to 10 grams is not benefitting.

            Honestly (and yet again), you aren’t really engaging my points.

            I’m not making the case for Obamacare Or against Obamacare. I’m not making a case for the Democrats. Or a case for the GOP.

            This analysis concludes that the GOP does not feel they need the support of the poor. My questions are:
            1.) Is this analysis correct (i.e., Does the GOP really feel they do not need the support of the poor)?
            2.) IF this analysis is correct — if the GOP does not feel they need the support of the poor — are they correct in that feeling? My belief is that they are not correct because the WWC are a subset of “the poor” and without strong support among the WWC, the GOP would be toast.

            I think the GOP needs support among the poor. And I think they know they need this support. I do not feel that the analysis is correct. I think they have different ways of drumming up that support, some of which are economic and some of which are non-economic.Report

            • Jaybird in reply to Kazzy says:

              15 grams to 10 grams is not benefitting.

              Okay, good. Good that we hammered that down.

              When it comes to Obamacare, if it turns out that the WWC was the group that ended up being hardest hit by premiums increasing and hardest hit by the whole “if you like your doctor, you can keep your doctor” thing, they could easily see Obamacare as moving from 15 grams to 10 grams.

              So let’s look at your questions:

              1.) Is this analysis correct (i.e., Does the GOP really feel they do not need the support of the poor)?

              I’d say that if there are two kinds of poor, the poor who went from 0 grams of chocolate to 10 grams of chocolate and the poor who went from 15 grams of chocolate to 10 grams, then there are two groups of poor who will have *VERY* different kinds of support.

              Does the GOP really feel they do not need the support of the poor? Are they correct in that feeling?

              They probably feel that they do not need the support of the 0 grams to 10 grams poor. They might feel like they never had it.

              My belief is that they are not correct because the WWC are a subset of “the poor” and without strong support among the WWC, the GOP would be toast.

              And this is why the “two kinds of poor” is important to this discussion.

              If there are two kinds of poor according to the WWC (as Kevin Drum seems to indicate), then saying something like “the WWC are a subset of ‘the poor'” is true but uninteresting if the WWC sees themselves as a distinct subset of “the poor”.Report

            • Will H. in reply to Kazzy says:

              15 grams to 10 grams is not benefitting.

              That sort of thing isn’t always directly applicable.

              Say, I’ve got an 8″ dick, and I get laid.
              Am I really getting any more pussy than I would be getting if I only had a 5″ dick?

              Rhetorical question, of course, though I suppose it would be subject to tests of falsification.Report

  6. Damon says:

    I came across this while trolling the intertubes…

    “The Ring is Tempting and Corrupting”Report