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Aside from the fact that Republicans don't want it, it's a surefire political loser. It'd piss off the health industry whose profits would be impacted. It'd pis

by makomk 10y ago

Aside from the fact that Republicans don't want it, it's a surefire political loser. It'd piss off the health industry whose profits would be impacted. It'd piss off anyone who was already happy with their healthcare. It'd piss off their wealthy donors, who would have to pay more in taxes for it. It'd give a whole bunch of fuel to the activists and journalists who're already going after the Republicans, because single-payer is only workable elsewhere by refusing to pay for expensive stuff that doesn't help patients, and that stuff comes in vital-sounding guises like "essential healthcare benefits" and cancer screening and treatment. Setting it up would also be a massive, unprecedented task. Also, I think a fundamental problem with any Republican healthcare plan is that the opposition to it doesn't have a politically coherent set of principles that they could bargain with. For example, one of the features of the ACA is that it subsidises all elderly people regardless of wealth through the 3:1 cap on age-based premium differences. This is indirectly taxpayer-funded through subsidies to buy the insurance plans that subsidise it (for people who often can't afford to use their insurance), but the trick used to hide who's being subsidised also makes insurance unaffordable for young people. So Republicans want to replace the whole mess with a straightforward taxpayer-funded, age-based subsidy. Cue press attacks about how the evil moustache-twirling Republicans want to send seniors' insurance rates skyrocketing and hand out subsidies to people regardless of wealth.

maxerickson 10y ago
Here are the ACA essential healthcare benefits: https://www.healthcare.gov/coverage/what-marketplace-plans-cover/ https://www.healthcare.gov/coverage/what-marketplace-plans-c... Which ones do you see as the least helpful for patients? edit: There are several that aren't particularly insurable, but they are generally useful services.
- makomk 10y ago
  Probably some of the "preventative and wellness services" and coverage for prescription drugs, surgeries and other treatments with the worst cost-to-benefit ratios. That's how it's always worked here in the UK. For example, breast cancer screening is only offered every three years here compared to 1-2 years as required by the ACA and for a narrower age window too, some of the other screenings probably aren't offered at all, and the more expensive chemotherapy treatments aren't covered either.
  - wahern 10y ago
    Those are minor details. The political debate isn't over how often to provide breast cancer screening, but whether "preventative and wellness services" should be mandated at all. And the _real_ dilemma in the GOP is that most Republicans don't think the government should be subsidizing any of this at all. If you gave all the Republicans a chance to pass a bill free from any kind of political consequence, they'd repeal the ACA along with all the entitlements and taxes. But that's not politically tenable for a million different reasons. This fundamental mismatch between Republican policy preferences and the reality of modern political and economic life means Republicans are incapable of governing in a sane manner. Even _if_ their various political-economic theories were correct, you can't arrange the system into a state where those theories could be applied. Reality is path dependent, and your available solutions are limited by the past. But the thing is, when you and your constituents are convinced that the modern bureaucratic state is fundamentally irredeemable[1], there's always a convenient excuse for why things never pan out. It's like an employee who never gets anything done, always has an explanation about how somebody else is thwarting his designs, and can talk endlessly about all the changes he would make to improve things. His excuses may be individually defensible, and his ideas may be interesting, but they're irrelevant. [1] And I don't just mean favoring small government. I've never met a person, liberal or conservative, rich or poor, who doesn't express a nominal preference for smaller government.

by makomk 10y ago

maxerickson 10y ago

Here are the ACA essential healthcare benefits: https://www.healthcare.gov/coverage/what-marketplace-plans-cover/ https://www.healthcare.gov/coverage/what-marketplace-plans-c... Which ones do you see as the least helpful for patients? edit: There are several that aren't particularly insurable, but they are generally useful services.

makomk 10y ago
Probably some of the "preventative and wellness services" and coverage for prescription drugs, surgeries and other treatments with the worst cost-to-benefit ratios. That's how it's always worked here in the UK. For example, breast cancer screening is only offered every three years here compared to 1-2 years as required by the ACA and for a narrower age window too, some of the other screenings probably aren't offered at all, and the more expensive chemotherapy treatments aren't covered either.
- wahern 10y ago
  Those are minor details. The political debate isn't over how often to provide breast cancer screening, but whether "preventative and wellness services" should be mandated at all. And the _real_ dilemma in the GOP is that most Republicans don't think the government should be subsidizing any of this at all. If you gave all the Republicans a chance to pass a bill free from any kind of political consequence, they'd repeal the ACA along with all the entitlements and taxes. But that's not politically tenable for a million different reasons. This fundamental mismatch between Republican policy preferences and the reality of modern political and economic life means Republicans are incapable of governing in a sane manner. Even _if_ their various political-economic theories were correct, you can't arrange the system into a state where those theories could be applied. Reality is path dependent, and your available solutions are limited by the past. But the thing is, when you and your constituents are convinced that the modern bureaucratic state is fundamentally irredeemable[1], there's always a convenient excuse for why things never pan out. It's like an employee who never gets anything done, always has an explanation about how somebody else is thwarting his designs, and can talk endlessly about all the changes he would make to improve things. His excuses may be individually defensible, and his ideas may be interesting, but they're irrelevant. [1] And I don't just mean favoring small government. I've never met a person, liberal or conservative, rich or poor, who doesn't express a nominal preference for smaller government.