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Yep, the ACA was originally RomneyCare. Mitt Romney took the plan from the Heritage foundation (yes, the conservative neocon think tank). Hard low-controls cap

Yep, the ACA was originally RomneyCare. Mitt Romney took the plan from the Heritage foundation (yes, the conservative neocon think tank). Hard low-controls capitalist plan. Heritage foundation made this plan after Hillary Clinton pushed universal healthcare in 1994, as first lady. Howls of 'death panels' were heard all over republican talking points and radio shows. (The 'death panels' aka rationing was seen as bad for government to do. However, we see a new type of rationing, based upon how much patients cost, and then denying care. That lead to the UHC execution, then approving more procedures, then getting sued by shareholders for that. Personally, government death panels are preferred to capitalist death panels.) Put simply: Obama passed republican legislation put forth by a republican governor and a republican thinktank, and was deemed a socialist. And now, the program is basically destroyed.

toomuchtodo 1y ago
Bipartisanship is dead. If you want to win, play to win.
- brookst 1y ago
  Playing to win is dead. Current climate is play to kill yourself, so long as your opponent also does but suffers more.
  - toomuchtodo 1y ago
    I'm somewhat hopeful with Gavin Newsom's posture making an example, I wouldn't vote for him, but I like the aggressive PR position he's taken, his willingness to gerrymander just as the other side has been doing forever. That's what I mean by bipartisanship is dead. You can't negotiate with the other side, they do not want to negotiate, they want to win at all costs for ideology, so you can only do your best to disempower them. If you try to play fair with a counterparty who does not believe in acting in good faith or playing fair, you have default lost. You can't have a functional democracy when one side rejects democracy (massive efforts to disenfranchise voters, gerrymandering, etc) because they can't win democratically. There is no reason you can't have empathy while punching down at bullies, because if the tables were turned, the bullies would put their boot on your neck ("paradox of tolerance"). So, start punching down. Edit: In the context of this topic and the near term, this looks like blue states implementing universal healthcare, and letting red states figure it out themselves (considering how dependent red states are on the federal government [1] [2]); Oregon is up first [3]. You can increase state taxes to fund this, reducing tax dollars sent to the federal government, if properly engineered. [1]. https://time.com/7222411/blue-states-are-bailing-out-red-states/ https://time.com/7222411/blue-states-are-bailing-out-red-sta... [2] https://usafacts.org/articles/which-states-contribute-the-most-and-least-to-federal-revenue/ https://usafacts.org/articles/which-states-contribute-the-mo... [3] https://www.hcfawa.org/oregon_s_path_to_universal_health_carerecap https://www.hcfawa.org/oregon_s_path_to_universal_health_car...
    - ceejayoz 1y ago
      > In the context of this topic and the near term, this looks like blue states implementing universal healthcare, and letting red states figure it out themselves… The risk here will be sick people (and their high costs) moving. As with how Chicago's illegal gun problems mostly come from Indiana.
      - kelseyfrog 1y ago
        We already deal with this problem in higher education by having out-of-state tuition and in-state tuition priced at different levels. A period of residency is required to access in-state tuition. Does residency fraud exist? I'm sure of it. Despite the UC and CSU systems not publishing residency fraud statistics, such fraud is universally described as being extremely difficult to execute. I cannot overstate this point. Students routinely depict residency fraud as being more difficult to do than simply paying out of state tuition. The high cost of committing residency fraud makes cancels out any expected payoff. Furthermore, most instances of detected fraud appear to be technical and clerical errors, not intentional deception. What are in-state residency requirements, and how difficult is the requirement? Evidence for residency includes: - Obtaining a California driver’s license or ID card - California vehicle registration - California voter registration - California state tax returns - California bank accounts - Employment in California - Lease, mortgage, or property ownership in California - Severing residential ties to your former state (e.g., closing out-of-state bank accounts, surrendering non-CA licenses) Additionally, one year and one day of residency is commonly the required threshold to qualify for in-state tuition. The question becomes, is this effective enough at reducing fraud rather than can fraud be eliminated. I'm sure, like with any system, fraud detection and remediation are part of the operating costs and measured in terms of recovery rate/rate of return - the KPI we're discussing.
        ceejayoz 1y ago
        I'm not talking about fraud, though. I'm talking about genuinely moving.
        1y ago
potato3732842 1y ago
People need to take a step back and take the red/blue team fanboy emotion out of it. It wasn't "destroyed" because it was "deemed socialist". It was destroyed because it used tricks of law to get something that didn't have broad enough support at the time done and those regulatory tricks were not durable. Same exact story as Roe v Wade but in a much more compressed timeline. Unfortunately, the whole debacle has likely hardened the resolve of everyone who is against it even though a functional Romneycare system would likely be satisfactory to them (and needless to say an improvement over the status quo). Turns out "the perfect is the enemy of the good, ship it" isn't how you run a society. This is a common theme. Stuff that's 50-50 either gets gutted or repealed with time. Something needs to be truly popular, like will lose you votes if you undo it, in order to stick around. For example no amount of pothead deadbeats or drunken wife beating is bringing weed or alcohol prohibition back at the state level. We're 15yr on from the ACA and with very few exceptions things are worse. The nation likely would have been better served by letting the states that were inclined to run such systems continue doing so without federal meddling.
- ceejayoz 1y ago
  The regulatory tricks were upheld by SCOTUS. Republicans just zeroed out the penalty in the individual mandate after that decision. They knew what that would do; that's why they did it.
  - potato3732842 1y ago
    And where did they get the political capital to do that? They got it from the approximately half of society that they could pander to by saying "look, we did that, vote for me and I'll take it even farther" at the next cycle. The ACA is going to go down in history as something that caused some yet unknown number of decades of suffering because it was just barely too much just barely too soon. If they'd have kept it in their pants another decade or maybe even less, or legislated a more incremental solution at the time we'd probably be 5yr into something workable by now.
    - mystraline 1y ago
Aunche 1y ago
Romneycare wasn't really Republican , which was why it was it only passed in the overwhelmingly blue state of Massachusetts. Nixon signed OSHA, but nobody calls that Republican. The healthcare marketplace was proposed by the Heritage Foundation, but the state legislature added a lot of regulations and government assistance.
- schmidtleonard 1y ago
  Yes, we know. It's not truly Republican unless it leaves the poor to die in a corner of bootstraps-itis. However, at the time the Heritage Foundation was still wearing the mask of caring because they hadn't pushed Single Payer out of the Overton window yet. It's bad optics to admit that you want the poor to die in a corner, so they had to pretend to have a solution and assistance was a cornerstone of the solution they pretended to have. The mask is off now, but history is history: it was part of their proposal.
- wat10000 1y ago
  The Heritage Foundation pushed a plan with the same key features. Get it straight from the horse's mouth here: https://www.heritage.org/health-care-reform/commentary/dont-blame-heritage-obamacare-mandate https://www.heritage.org/health-care-reform/commentary/dont-... That article purports to disprove the idea that the ACA is based on their proposal, but it actually does a good job proving it.
bpt3 1y ago
> However, we see a new type of rationing, based upon how much patients cost, and then denying care. This is not at all new. It's how every other market operates. For healthcare, which is not a normal market by any means, it might make sense to approach rationing differently because most people refuse to accept that rationing occurs at all, but cost will always be part of the picture.
- mystraline 1y ago
  Its not JUST cost. Insurance company covers person. Person gets chronic ill, with covered disease. Person is now 'less profit' or a cost. Company, against contract, refuses to cover medication/procedures. Company waits out patient to die. The person is demonstrably wronged, but these companies can just wait sick people out. And that's precisely what happened with UHC. You know, Delay Deny Defend.

toomuchtodo 1y ago

Bipartisanship is dead. If you want to win, play to win.

brookst 1y ago
Playing to win is dead. Current climate is play to kill yourself, so long as your opponent also does but suffers more.
- toomuchtodo 1y ago
  I'm somewhat hopeful with Gavin Newsom's posture making an example, I wouldn't vote for him, but I like the aggressive PR position he's taken, his willingness to gerrymander just as the other side has been doing forever. That's what I mean by bipartisanship is dead. You can't negotiate with the other side, they do not want to negotiate, they want to win at all costs for ideology, so you can only do your best to disempower them. If you try to play fair with a counterparty who does not believe in acting in good faith or playing fair, you have default lost. You can't have a functional democracy when one side rejects democracy (massive efforts to disenfranchise voters, gerrymandering, etc) because they can't win democratically. There is no reason you can't have empathy while punching down at bullies, because if the tables were turned, the bullies would put their boot on your neck ("paradox of tolerance"). So, start punching down. Edit: In the context of this topic and the near term, this looks like blue states implementing universal healthcare, and letting red states figure it out themselves (considering how dependent red states are on the federal government [1] [2]); Oregon is up first [3]. You can increase state taxes to fund this, reducing tax dollars sent to the federal government, if properly engineered. [1]. https://time.com/7222411/blue-states-are-bailing-out-red-states/ https://time.com/7222411/blue-states-are-bailing-out-red-sta... [2] https://usafacts.org/articles/which-states-contribute-the-most-and-least-to-federal-revenue/ https://usafacts.org/articles/which-states-contribute-the-mo... [3] https://www.hcfawa.org/oregon_s_path_to_universal_health_carerecap https://www.hcfawa.org/oregon_s_path_to_universal_health_car...
  - ceejayoz 1y ago
    > In the context of this topic and the near term, this looks like blue states implementing universal healthcare, and letting red states figure it out themselves… The risk here will be sick people (and their high costs) moving. As with how Chicago's illegal gun problems mostly come from Indiana.
    - kelseyfrog 1y ago
      We already deal with this problem in higher education by having out-of-state tuition and in-state tuition priced at different levels. A period of residency is required to access in-state tuition. Does residency fraud exist? I'm sure of it. Despite the UC and CSU systems not publishing residency fraud statistics, such fraud is universally described as being extremely difficult to execute. I cannot overstate this point. Students routinely depict residency fraud as being more difficult to do than simply paying out of state tuition. The high cost of committing residency fraud makes cancels out any expected payoff. Furthermore, most instances of detected fraud appear to be technical and clerical errors, not intentional deception. What are in-state residency requirements, and how difficult is the requirement? Evidence for residency includes: - Obtaining a California driver’s license or ID card - California vehicle registration - California voter registration - California state tax returns - California bank accounts - Employment in California - Lease, mortgage, or property ownership in California - Severing residential ties to your former state (e.g., closing out-of-state bank accounts, surrendering non-CA licenses) Additionally, one year and one day of residency is commonly the required threshold to qualify for in-state tuition. The question becomes, is this effective enough at reducing fraud rather than can fraud be eliminated. I'm sure, like with any system, fraud detection and remediation are part of the operating costs and measured in terms of recovery rate/rate of return - the KPI we're discussing.
      - ceejayoz 1y ago
        I'm not talking about fraud, though. I'm talking about genuinely moving.
        1y ago

potato3732842 1y ago

People need to take a step back and take the red/blue team fanboy emotion out of it. It wasn't "destroyed" because it was "deemed socialist". It was destroyed because it used tricks of law to get something that didn't have broad enough support at the time done and those regulatory tricks were not durable. Same exact story as Roe v Wade but in a much more compressed timeline. Unfortunately, the whole debacle has likely hardened the resolve of everyone who is against it even though a functional Romneycare system would likely be satisfactory to them (and needless to say an improvement over the status quo). Turns out "the perfect is the enemy of the good, ship it" isn't how you run a society. This is a common theme. Stuff that's 50-50 either gets gutted or repealed with time. Something needs to be truly popular, like will lose you votes if you undo it, in order to stick around. For example no amount of pothead deadbeats or drunken wife beating is bringing weed or alcohol prohibition back at the state level. We're 15yr on from the ACA and with very few exceptions things are worse. The nation likely would have been better served by letting the states that were inclined to run such systems continue doing so without federal meddling.

ceejayoz 1y ago
The regulatory tricks were upheld by SCOTUS. Republicans just zeroed out the penalty in the individual mandate after that decision. They knew what that would do; that's why they did it.
- potato3732842 1y ago
  And where did they get the political capital to do that? They got it from the approximately half of society that they could pander to by saying "look, we did that, vote for me and I'll take it even farther" at the next cycle. The ACA is going to go down in history as something that caused some yet unknown number of decades of suffering because it was just barely too much just barely too soon. If they'd have kept it in their pants another decade or maybe even less, or legislated a more incremental solution at the time we'd probably be 5yr into something workable by now.
  - mystraline 1y ago

Aunche 1y ago

Romneycare wasn't really Republican , which was why it was it only passed in the overwhelmingly blue state of Massachusetts. Nixon signed OSHA, but nobody calls that Republican. The healthcare marketplace was proposed by the Heritage Foundation, but the state legislature added a lot of regulations and government assistance.

schmidtleonard 1y ago
Yes, we know. It's not truly Republican unless it leaves the poor to die in a corner of bootstraps-itis. However, at the time the Heritage Foundation was still wearing the mask of caring because they hadn't pushed Single Payer out of the Overton window yet. It's bad optics to admit that you want the poor to die in a corner, so they had to pretend to have a solution and assistance was a cornerstone of the solution they pretended to have. The mask is off now, but history is history: it was part of their proposal.
wat10000 1y ago
The Heritage Foundation pushed a plan with the same key features. Get it straight from the horse's mouth here: https://www.heritage.org/health-care-reform/commentary/dont-blame-heritage-obamacare-mandate https://www.heritage.org/health-care-reform/commentary/dont-... That article purports to disprove the idea that the ACA is based on their proposal, but it actually does a good job proving it.

bpt3 1y ago

> However, we see a new type of rationing, based upon how much patients cost, and then denying care. This is not at all new. It's how every other market operates. For healthcare, which is not a normal market by any means, it might make sense to approach rationing differently because most people refuse to accept that rationing occurs at all, but cost will always be part of the picture.

mystraline 1y ago
Its not JUST cost. Insurance company covers person. Person gets chronic ill, with covered disease. Person is now 'less profit' or a cost. Company, against contract, refuses to cover medication/procedures. Company waits out patient to die. The person is demonstrably wronged, but these companies can just wait sick people out. And that's precisely what happened with UHC. You know, Delay Deny Defend.