Has the penny dropped? No repeal for ‘Obamacare’ _ a humiliating defeat for Trump

Update 27th March 2017: The Republican Waterloo by David Frum of Atlantic opines: Conservatives once warned that Obamacare would produce the Democratic Waterloo. Their inability to accept the principle of universal coverage has, instead, led to their own defeat.

Seven years and three days ago, the House of Representatives grumblingly voted to approve the Senate’s version of the Affordable Care Act. Democrats in the House were displeased by many of the changes introduced by Senate Democrats. But in the interval after Senate passage, the Republicans had gained a 41st seat in the Senate. Any further tinkering with the law could trigger a Republican filibuster. Rather than lose the whole thing, the House swallowed hard and accepted a bill that liberals regarded as a giveaway to insurance companies and other interest groups. The finished law proceeded to President Obama for signature on March 23, 2010.

A few minutes after the House vote, I wrote a short blog post for the website I edited in those days. The site had been founded early in 2009 to argue for a more modern and more moderate form of Republicanism……

…It seemed to me that Obama’s adoption of ideas developed at the Heritage Foundation in the early 1990s—and then enacted into state law in Massachusetts by Governor Mitt Romney—offered the best near-term hope to control the federal health-care spending that would otherwise devour the defense budget and force taxes upward. I suggested that universal coverage was a worthy goal, and one that would hugely relieve the anxieties of working-class and middle-class Americans who had suffered so much in the Great Recession. And I predicted that the Democrats remembered the catastrophe that befell them in 1994 when they promised health-care reform and failed to deliver. They had the votes this time to pass something. They surely would do so—and so the practical question facing Republicans was whether it would not be better to negotiate to shape that “something” in ways that would be less expensive, less regulatory, and less redistributive….

…So, when the Democrats indeed did pass the law without Republican input, just as I’d warned they would, a fury overcame me. Eighteen months of being called a “sellout” will do that to a man, I suppose. I opened my computer and in less than half an hour pounded out the blogpost that would function, more or less, as my suicide note in the organized conservative world.

The post was called “Waterloo.” (The title played off a promise by then-senator and now Heritage Foundation president Jim DeMint that the Affordable Care Act would become Obama’s Waterloo, a career-finishing defeat.)

Even more provocatively to Republicans already fixed on a promise to repeal the Obamacare abomination, I urged: “No illusions please: This bill will not be repealed.”…

In that third week in March in 2010, America committed itself for the first time to the principle of universal (or near universal) health-care coverage. That principle has had seven years to work its way into American life and into the public sense of right and wrong. It’s not yet unanimously accepted. But it’s accepted by enough voters—and especially by enough Republican voters—to render impossible the seven-year Republican vision of removing that coverage from those who have gained it under the Affordable Care Act. Paul Ryan still upholds the right of Americans to “choose” to go uninsured if they cannot afford to pay the cost of their insurance on their own. His country no longer agrees.

Mark P Cussen for Investopedia in 2011 reports that over 60% of American bankruptcies are due to health costs…. Insolvency is handled differently in different countries.. In Canada it is usually die to occupational hazards, or financial mismanagement. In Australia and other countries with universal coverage they are rarely due to health costs. The UK health services may be losing us all money, but it does not yet affect individuals’ finances…. We can save our services if we pragmatically accept that there are some things we cannot afford and others that we should pay for individually. It can still be universal but only if standards are high and waiting lists short enough to ensure that even the richer citizens choose to use it. This may mean some form of adverse selection through charges related to means, but these charges need to be less than what it would cost for private care, or cover. The penny may have dropped in the US.

ERICA WERNER and ALAN FRAM from The Washington post, the Hamilton Spectator and all the 50 state newspapers, reported  March: No repeal for ‘Obamacare’ – a humiliating defeat for Trump. This was reported in Florida (where they want it to expand) and Michigan, in Alaska and even Texas, where the threat to repeal was acknowledged as based on a lie.

This is the rejection of the Trump plan to abolish the Affordable Care Act (ACA) (Obamacare). This decision alone, which confirms the value of the votes of 70 million citizens already covered (and rising annually) by the ACA. The republicans were rightly concerned that they would not be elected next time. The value of socialised medicine, the only way to cover a country, and one of the fundamental duties of government, was thus confirmed.

These figures are from several years ago and the trend has continued.

Image result for obama care open enrollment graphic

The weakness of the ACA is due to the influence of big business, pharma and insurance industries. They have asked for the continuation of the current plans. This means that the self-employed without cover, the elderly, the sick and the poor and unemployed remain (see Hawaii News – Big Island Now), and they are exactly the highest risk and demand patients. The moral hazard is too big, and the solution is universal coverage. Big pharma and insurers need to be given due notice – and ignored.

The benefits of a large mutual apply to all insurance. Streets or housing estates would be cheaper for motor than individuals. The same is true of health… and smaller mutual such as Wales and N Ireland should take note.

The wording of the article is below:

WASHINGTON — In a humiliating failure, U.S. President Donald Trump and Republican leaders pulled their bill to repeal “Obamacare” off the House floor Friday when it became clear it would fail badly — after seven years of nonstop railing against the law. Democrats said Americans can “breathe a sigh of relief.” Trump said the current law was imploding “and soon will explode.”

Thwarted by two factions of fellow Republicans, from the centre and far right, House Speaker Paul Ryan said president Barack Obama’s health care law, the Republican Party’s No. 1 target in the new Trump administration, will remain in place “for the foreseeable future.”

It was a stunning defeat for the new president after he had demanded House Republicans delay no longer and vote on the legislation Friday, pass or fail.

His gamble failed. Instead Trump, who campaigned as a master deal-maker and claimed that he alone could fix the nation’s health care system, saw his ultimatum rejected by Republican lawmakers who made clear they answer to their own voters, not to the president.

He “never said repeal and replace it in 64 days,” a dejected but still combative Trump said at the White House, though he repeatedly shouted during the presidential campaign that it was going down on Day 1 of his term.

The bill was withdrawn just minutes before the House vote was to occur, and lawmaker said there were no plans to revisit the issue. Republicans will try to move ahead on other agenda items, including overhauling the tax code, though the failure on the health bill can only make whatever comes next immeasurably harder.

Trump pinned the blame on Democrats.

“With no Democrat support we couldn’t quite get there,” he told reporters in the Oval Office. “We learned about loyalty, we learned a lot about the vote-getting process.”

The Obama law was approved in 2010 with no Republican votes.

Despite reports of backbiting from administration officials toward Ryan, Trump said: “I like Speaker Ryan. … I think Paul really worked hard.”

For his part, Ryan told reporters: “We came really close today but we came up short. … This is a disappointing day for us.” He said the president has “really been fantastic.”

But when asked how Republicans could face voters after their failure to make good on years of promises, Ryan quietly said: “It’s a really good question. I wish I had a better answer for you.”

Last fall, Republicans used the issue to gain and keep control of the White House, Senate and House. During the previous years, they had cast dozens of votes to repeal Obama’s law in full or in part, but when they finally got the chance to pass a repeal version that actually had a chance to become law, they couldn’t deliver.

Democrats could hardly contain their satisfaction.

“Today is a great day for our country, what happened on the floor is a victory for the American people,” said House Minority Leader Nancy Pelosi, who as speaker herself helped Obama pass the Affordable Care Act in the first place. “Let’s just for a moment breathe a sigh of relief for the American people.”

The outcome leaves both Ryan and Trump weakened politically.

For the president, this piles a big early congressional defeat onto the continuing inquiries into his presidential campaign’s Russia connections and his unfounded wiretapping allegations against Obama.

Ryan was not able to corral the House Freedom Caucus, the restive band of conservatives that ousted the previous speaker. Those Republicans wanted the bill to go much further, while some GOP moderates felt it went too far.

Instead of picking up support as Friday wore on, the bill went the other direction, with several key lawmakers coming out in opposition. Rep. Rodney Frelinghuysen of New Jersey, chair of a major committee, Appropriations, said the bill would raise costs unacceptably on his constituents.

The defections raised the possibility that the bill would not only lose on the floor, but lose big.

The GOP bill would have eliminated the Obama statute’s unpopular fines on people who do not obtain coverage and would also have removed the often-generous subsidies for those who purchase insurance.

Republican tax credits would have been based on age, not income like Obama’s, and the tax boosts Obama imposed on higher-earning people and health care companies would have been repealed. The bill would have ended Obama’s Medicaid expansion and trimmed future federal financing for the federal-state program, letting states impose work requirements on some of the 70 million beneficiaries.

The nonpartisan Congressional Budget Office said the Republican bill would have resulted in 24 million additional uninsured people in a decade and lead to higher out-of-pocket medical costs for many lower-income and people just shy of age 65 when they would become eligible for Medicare. The bill would have blocked federal payments for a year to Planned Parenthood.

Republicans had never built a constituency for the legislation, and in the end the nearly uniform opposition from hospitals, doctors, nurses, the AARP, consumer groups and others weighed heavily with many members. On the other side, conservative groups including the Koch outfit argued the legislation did not go far enough in uprooting Obamacare.

Ryan made his announcement to lawmakers at a very brief meeting, he was greeted by a standing ovation in recognition of the support he still enjoys from many lawmakers.

When the gathering broke up, Rep. Greg Walden of Oregon, chair of the Energy and Commerce Committee that helped write the bill, told reporters: “”We gave it our best shot. That’s it. It’s done. D-O-N-E done. This bill is dead.”

The Associated Press

Image result for health trumped cartoon

 

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This entry was posted in A Personal View, Medical Education, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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