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Probably some of the "preventative and wellness services" and coverage for prescription drugs, surgeries and other treatments with the worst cost-to-benefit rat

by 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

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.