Paul Ryan is the only Republican with a serious plan to reform health care — and even that addresses only part of the problem.

by James A. Bacon

Yeah, I’m bummed out by the Supreme Court ruling on Obamacare, although it does contain a silver lining in declaring that there is a limit to Congress’ ability to invoke the Interstate Commerce Clause to regulate anything and everything. That’s no small consolation.

And, yeah, I do feel lied to. The health care mandate is legal because it’s actually a tax? Really? How, then, do we account for President Obama’s response when George Stephanopoulos interviewed him in September 2009?

Stephanopoulos: But you reject that it’s a tax increase?
Obama: I absolutely reject that notion.

Obama seems to embrace the tax descriptor now. So, Obama lied. But what else is new? Americans are so inured to politicians’ lying that the only people who care that Obama lied in 2009 are those who oppose Obamacare anyway.

Here’s what really makes me upset. Congress never would have passed Obamacare if Republicans had articulated a credible alternative to making health care more affordable and accessible. The elephant clan floated some ideas but they never cohered in the public discourse. Obamacare prevailed because there was a vacuum of ideas. Here’s the approach that I advocated in “Boomergeddon”:

  • Get employers out of health care, Eliminate the tax preference for health care insurance purchased through employers. When people see their health coverage paid for by a third party, they don’t care what it costs. Health insurers need to design health plans adapted to the needs of the patients, not their employers. (Rep. Paul Ryan, R-WI, proposes to eliminate the health care tax exemption and to reform Medicare but does not go beyond that.)
  • Promote the right kind of insurance competition. State and federal mandates of insurance benefits must stop, and people must be allowed to acquire insurance that fits their needs and their budgets. Meanwhile, insurers need to reinvent their relationship with the patient. Instead of acting as HMO-like gatekeepers that say, “No,” they need to empower patients to seek the best value (cost and quality) for treatment of their medical conditions.
  • Create market transparency. One of the biggest obstacles to market-driven health care is the fact that, er, there is no market.  We must make price and outcomes data more transparent.
  • Eliminate barriers to business innovation. The future belongs to multidisciplinary teams that specialize in treating chronic diseases and complex medical conditions with superior efficiency and superior outcomes. But over-regulation of the health care industry impedes the ability of health care providers to reorganize themselves into “focused factories” that excel in treating specific maladies. Those barriers must be pulled down.

In the wake of the Supreme Court ruling, Republicans have renewed their rallying cry to repeal Obamacare. But they can’t replace something, no matter how flawed, with nothing. If Obamacare were repealed, health care would remain unaffordable to tens of millions of Americans. How do Republicans propose to make it more affordable? Sprinkling “free market” fairy dust on the health care system won’t do anything. Free markets will not spontaneously arise from the regulatory wreckage that this nation has created over the past 60 years. Republicans need to put in the hard work of figuring out how to make markets work. If they fail to do so, Democrats win the debate by default.

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  1. Yup. More competition. Doctors and hospitals need to have 500 different insurance companies’ rules and regulations and forms to take in to account.

    Ever wonder why 3% of medicare goes to overhead and the rest to patient care, whereas in the private sector its 20-30% to overhead?

    1. Yes, Will, I have wondered. And I found out.

      One reason Medicare overhead is so low is that it spends so little combatting fraud. But that’s also why the rate of Medicare fraud and abuse is so high compared to private insurance. What a great trade-off!

      Another reason private insurance overhead is so high is that private insurance plans assemble networks of the most cost-efficient providers. Medicare doesn’t. While, private insurers seek to control costs in this way, Medicare pays everybody, no questions asked.

      Another reason is that private insurers spend more money on customer service. Have you ever tried getting a Medicare question answered? It’s more painful than the medical malady!

      The only negative you can point to for private insurers is that they spend money on advertising and marketing. This is one expense that Medicare does not bear.

      1. I’m not sure that Medicare pays “everybody. No questions asked.”

        I have worked with and around health care providers for a few years. In every case, they have had to hire staff–sometimes multiple staff–just to handle the Medicare claims that get rejected on the first go-around. Now this is particularly bad with Medicaid claims, especially if the state has privatized the processing, but the problems around Medicare have also appeared. You might be right. But it sure doesn’t look that way from the bottom of the pile.

        1. Sloppy wording on my part. I don’t mean that Medicare pays all *claims* — actually, Medicare rejects a higher percentage of claims than private insurers do. I meant that Medicare pays all *providers*. It doesn’t discriminate on the basis of quality of outcomes.

    2. accurate Avatar

      I have a brother-in-law who is a doctor, I have two sisters who are nurses several other members of the family in the medical industry (meaning doctors, nurses, physical therapists, etc). Everyone of them HATES working on Medicare patients, first they don’t pay quickly (my family tells me that private insurance pays MUCH quicker). Second, they pay lower, much lower than what the doctor normally charges, to a point where two doctors in my family refuse to accept any more medicare/medicaid patients. They are expecting more of the same from the state run pools, most expect to NOT take those patients. Obamacare WILL be another blow to our country. Obama, the WORST president in my lifetime, which included Nixon and Carter so you can see how low Obama is.

  2. larryg Avatar

    FINALLY !!! Bacon has it RIGHT!!!

    ” Here’s what really makes me upset. Congress never would have passed Obamacare if Republicans had articulated a credible alternative to making health care more affordable and accessible. ”

    But here is the problem. The GOP is fundamentally opposed to the govt “interfering” with free markets…. telling companies they cannot deny people coverage or shed costly subscribers”.

    I think the ONLY reason the GOP continues this charade is that they know if they come right out and admit that they are opposed to regulating health care insurance, that they’ll lose the middle independents that they must have to prevail downstream.

    So.. the GOP is fundamentally hypocrites by basically being opposed to the only real way to effect coverage for those who are unlucky, vulnerable,etc.

    There is no way to have any semblance of coverage for all without government. Some would say this is a purpose of govt – protecting the health and welfare of those who would be governed and that we have indeed voted for it since we already have govt involved in health care – for those lucky enough to benefit.

    The GOP cannot prevail if they tell the truth about their philosophy of health care. They know this, so they misrepresent their own positions as they demonize the oppositions positions with just outright lies about what ObamaCare does and does not do.

    Again – listen to the GOP on TV and listen to what the Eric Cantors are saying. If that guy is not selling snake oil to the gullible, I’ll be a monkey’s uncle.

  3. larryg Avatar

    ” One reason Medicare overhead is so low is that it spends so little combatting fraud. But that’s also why the rate of Medicare fraud and abuse is so high compared to private insurance. What a great trade-off!”

    let’s see the numbers! My understanding is that the fraud between the two is not that different.

    The big problem that Medicare is starting to address that has not been addressed by the private sector except by some managed care companies is the fee-for-service, each procedure is paid for, even if it’s duplicative or already determined by other diagnostics, etc.

    Our problem is that we incentivize as much medical care and services as the providers can figure out how to order and receive reimbursement for no matter if it is cost-effective or not.

    and no ..don’t bore me with death squadology or “we don’t want a govt bureaucrat between you and your doctor – but a private insurance bureaucrat is just fine….

    My frustration with this whole issue is how it has been demonized, propagandized and just outright lied about as if we don’t already have private insurance gate-keepers who will deny you coverage, toss you off all together or all manner of getting “between you and your doctor”.

    The whole thing is a giant stinking crock of guano that the right wing has absolutely no problem lying about as long as they stop that bad old govt socialism from creeping into health care.

    This is not an honest debate. It’s all about convincing the gullible about things that simply are not true…to get them to essentially be opposed to their own interests.

    All because the right is convinced that universal health care is socialism that will lead to the demise of civilization as we know it.

    Nevermind that the entire fricken industrialized world has had such systems for more than 100 years and includes such free-market bastions as Singapore and Hong Kong…

    These folks used to hide in the woodwork but now we’ve had a serious know like an explosion of roaches or termites.. or locusts…

    and as long as the right can continue to fool the gullible.. we’ll be at loggerheads.

    The SCOTUS decision will have no impact on the right and their commitment to fight against health care.

  4. larryg Avatar

    ” And, yeah, I do feel lied to. The health care mandate is legal because it’s actually a tax? Really? How, then, do we account for President Obama’s response when George Stephanopoulos interviewed him in September 2009?”

    Can Obama have one view and the Chief Justice another without Obama being accused of “lying”?

    this line of reasoning is IMHO bizarre but I’ve come to expect it from those who are disaffected with Obama, now days.

    So.. the SCOTUS verdict is that Obama…..”lied”?

    Who Knew?

    to point out – once again – that if you are self-employed, that when you file your income tax, there is a column called “social security/Medicare TAX”.

    and YES, it IS a tax that you have to pay that is then used to fund Social Security and Medicare.


    Imagine that. Social Security is a tax AND, hold on to your panties – an individual mandate ALSO. Good thing that enough on SCOTUS saw that connection, eh?

    HOLY MOLY! Who in Hades said the govt could charge you money and decide whether or not to call it a fee, penalty or tax and that if you called it the wrong thing – no matter if the law was developed in a tax committee, passed via budget reconciliation nor how it actually functioned, it would be determined to be UnConstitutional”?

    Indeed, the GOP came right back and said that if it passed via the reconciliation process, it could be overturned legislatively the same way (assuming they gained control of the Senate – which they could).

  5. Richard Avatar

    I agree with Larryg on the so-called lying. I disapprove when you call the President a liar, when it was the S.Ct. that called it a tax, not the President – you’re being illogical (except through a partisan lense) here. Have some manners!
    The elephants have been in default on everything for 3 1/2 years, except that they are for reduced taxes (without regard for what that does to the budget).
    Most of your suggestions for a health outcome- based system are going into effect now, facilitated by ACA and incentives for digitized health information. ACA will foster competition among insurers and exchanges (of course your elephants will keep Virginia out of the exchange business out of spite).
    Finally, your suggestions don’t do anything about the uninsured, which means your suggestions don’t address pre-existing conditions or coverage for anyone who can’t get group coverage. That’s why the mandate is required. You sound like Scrooge – “are there no poor houses, no prisons?” (or something like that). Is your solution to deny care to the uninsured?

    1. My solution for the uninsured? (1) Make health care more affordable by driving the inefficiencies out of the system and improving patient outcomes. The potential gains in productivity and quality are breathaking. (2) Eliminate mandates so people can afford to buy plans they fit their personal circumstances.

      As for saying Obama lied, I think he said whatever it took to get the Affordable Care Act (ACA) passed. If you like your health insurance plan, you can keep it…. The ACA will reduce the budget deficit…. Seniors won’t lose any Medicare benefits…. Personal mandates aren’t a tax…. Simply breathtaking.

      1. Richard Avatar

        That’s not much of answer – just turn it over to the private sector? As your elephantine nominee might say – “I can’t give you any details, just trust me.”

        My question to you is what will happen when some young person who doesn’t have a rich family and doesn’t have insurance has an accident or some horrible illness but who could be cured by health care? Are you saying that health insurance will be so cheap and wonderful if the capitalist system is entirely freed up that that person will always have insurance? If so, you’re wrong. You’ll never have the type of competition for health services that you have for groceries unless you have fundamental changes in the system, and mandatory coverage is the most fundamental change necessary.
        We don’t let old people go untreated, but it’s ok for everyone else?

      2. Richard Avatar

        Your so-called lies aren’t incorrect (lies) at all, unless you’re talking about the budget deficit. That wasn’t a lie because it was based on Congressional Budget Office estimates. Estimates change because they’re estimates. I don’t recall any Medicare changes except reduction of payments to Medicare Advantage plans so that the costs were more in line with regular Medicare coverage. Apparently the plans haven’t changed, only the reimbursements. Plus, and I think you would agree, the current Medicare system, and its funding have to be looked at and made sustainable.

        Sometimes I think that you are advocating the current health care system which innovates by throwing cash at everything. If you overpay for everything you’re going to get a lot of attention from entrepreneurs, and health procedures, medical devices, and drugs have all gotten better under the current system, but it’s been expensive, many of the changes have been only slightly incremental and not worth it in terms of significantly better health, and there’s too much waste.

  6. larryg Avatar

    well… as I said… the GOP is fundamentally opposed to the govt being involved in health care. As a philosophy, I do not agree but I could respect it if they stood tall on it.

    Instead, they play disreputable games trying to hide their true philosophy – because they know – if they actually told the truth – they’d be rejected. So instead, they play sleazy little games.

    and I cannot abide that….

    I note, and give credit to Romney for saying that he’d give the same tax-free break to purchased insurance for individuals that employers receive. It won’t fix the pre-existing condition problem but at least it’s more principled than most of the GOP.

    But I have a question for folks. What is the rationale for the Feds/IRS to limit what you can deduct from your taxes to those expenses that are above 7.5% of your AGI? Why not 2% or 22%?

    If everyone could write off any/all of their health care expenditures what would happen to the Federal budget? Why doesn’t the GOP support that as an alternative?

    1. Actually, Republicans/conservatives have pushed consumer-based health care and market-based reforms — Health Savings Accounts are the most prominent example — but Dems/libs/progs have fought them bitterly. The Dems fought tort reform. They fought insurance deregulation. Their ultimate goal is universal health care, or even nationalized health care, and they will do everything they can to squelch market-based health care in the cradle. They don’t even want to give market-based reform a chance.

      While Republicans haven’t been totally AWOL, they could have made a much stronger push.

  7. larryg Avatar

    but the Dems are straight forward on what they do support whereas the GOP is a bunch of less-than-honest posers who pretend to want to deal with people denied coverage but in reality are opposed to it so instead of offering a specific alternative that people can look at, kick the tires on, compare to the Dem plan – they talk about vague “ideas” that “could” be done.

    That’s why I believe they are playing rope-a-dope on health care.

    They’ve had multiple opportunities including when Clinton was Prez and they hated HillaryCare and the Heritage Folks touted the Individual Mandate as a better approach.

    So what happened? Isn’t that a much more serious “lie”than anything Obama has said when the GOP essentially pretends to want to do health care but somehow they never really get around to it?

    Even now, their Repeal and Replace begs the question and their response instead of a real proposal is to “figure out some free market principles” and of course blame the Dems for their plan and the things they won’t do that the GOP wants to do.

    Why not put forth a REAL PLAN that allows voters to actually choose instead of playing hit and run propaganda games?

    Jim Bacon – you know the truth here. Your boys are scofflaws on health care.

  8. We are still going to have the worst health care in the first world–fewest people adequately covered, highest costs, worst outcomes. It will be slightly better than the Republicans do nothing burger.

    It’s OK for me though, I’m rich.

  9. larryg Avatar

    well I think it’s nothing short of scandalous that we have a party that claims to be fiscal conservatives and they are seemingly more than happy to preside over a system that costs twice as much as any other system in the world and molly coddle scofflaws who refuse to buy insurance but then walk right into the ER to bill the rest of us for their needs.

    so Obama “lied” . These guys are living a lie. They’re hypocrites to their own philosophy.

    They point to Greece as the ultimate hell for universal health care while conveniently ignoring the economic powerhouses of Singapore and Hong Kong – both of whom are 100% individual mandate payroll taxes and 100% universal health care.

    Basically they are basically “blockers” to any real solutions. They don’t like nor want the Dem solutions but they SO hate the idea of govt being involved in it that they’d rather walk away from it all together if it did not get them tossed out of office so they play these propaganda games with the independents – and – it works.

    Turns out you CAN fool a lot of people a lot of the time …. and essentially gridlock govt.

  10. larryg Avatar

    re: “cutting Medicare to fund ObamaCare”

    Richard has it right and here’s the irony. They’re cutting the subsidies for Medicare Advantage so that seniors pay more of their fair share of the costs of the advantage plans – something the Conservatives themselves have advocated when not discussing ObamaCare.

    but in the context of ObamaCare, they argue the opposite. They cite it as yet another reason ObamaCare is “bad”.

    So they essentially change their argument 180 degrees depending on the context.

    I watched Romney do this when he gives his laundry list of reasons to kill ObamaCare – he actually cites the cuts to Medicare as “bad”. It’s almost if he does not recognize what he is saying as he goes down the list of reasons to oppose ObamaCare.

    so if we cut Medicare, it’s a bad thing and if we don’t cut Medicare,it’s also a bad thing.

    You have to give the right wing propaganda machine due credit.

    they have successfully and very effectively made this argument and as a result much of the opposition – does not even understand what ObamaCare does and does not really do – but they are opposed which has been the goal all along.

  11. Health insurers need to design health plans adapted to the needs of the patients, not their employers.
    Not gonna happen without government regulation, and my experience proves it won’t happen with regulaton at the state level.


    State and federal mandates of insurance benefits must stop, and people must be allowed to acquire insurance that fits their needs and their budgets.

    Without mandates there won’t be any products that fit peoples needs and insurors will continue to rip people off, kick them out, sell policies they have no intention of continuing


    Congress never would have passed Obamacare if Republicans had articulated a credible alternative to making health care more affordable and accessible.
    But they would have pased something, and in the end it would not look too much different. The Republican plan for tax credits is financially equivalent to Obamacare.


    Get employers out of health care,


    Why? If they wan to provide a benefit they should be allowed to. That isn;t the problem, the problem is that individiual insurance will always be much more costly to administer, hence the Republican call to allow for health care co-ops.


    they need to empower patients to seek the best value (cost and quality) for treatment of their medical conditions.

    Pfffft. What is their incentive to do this without government interference? We are more likely to get collusion than competition.


    We must make price and outcomes data more transparent.
    Agreed. It is hard for consumers to act rationallyh when they do not know what the price is.
    But they can’t replace something, no matter how flawed, with nothing.

    No, but watch them try. This is the only political stick they have at the moment.

    One reason Medicare overhead is so low is that it spends so little combatting fraud. But that’s also why the rate of Medicare fraud and abuse is so high compared to private insurance. What a great trade-off!

    Fighting medicare fraud isn’t Medicares job. that job belongs to the FBI, because it is a federal fraud. It is more proper to say that medicare has outsourced that cost in a way that it is off the books.

    But the real trade off is that private insurors in their zeal to prevent fraud will exclude proper claims and medicare won’t. When I go for treatment I am less concerned that someone else cheated than I am that I will be cheated, as I was on three seperate occasions. One occasion took eight years to resolve in court.

    The question is which is a worse waste, medical fraud, or legal fraud. I would rather see health insurance moneyh go to health care, than legal costs, even if some of it is questionable. And by the way, most medicare fraud comes on the part of DOCTORS, not patients.


    they have had to hire staff–sometimes multiple staff–just to handle the Medicare claims that get rejected on the first go-around.
    Unfortunately, this is a common government tactic and it is not limited to medicare. Call it administration by aggravation.

    If you apply for disability under social security, you will ALWAYS be turned down, until you engage a lawter to submit your application. This is the opposite of Jims fraud claim: it is a waste of resources through wxcess zeal.


    If conservatives want to offer up an amendment, let them offer up an amendement that would allow people to opt out. But opting out would be a permanent condition: if you go broke or die as a result, oo bad – no free emergency care.

    See how many people take them up on that idea.

  12. They point to Greece as the ultimate hell for universal health care while conveniently ignoring the economic powerhouses of Singapore and Hong Kong – both of whom are 100% individual mandate payroll taxes and 100% universal health care.


    I liked the story that Rush Limbaugh claimed he would leave the US if Obamacare is upheld. He would go to costa rica, he said.

    Costa Rica has universal health care.

  13. Republicans/conservatives have pushed consumer-based health care and market-based reforms — Health Savings Accounts are the most prominent example


    Anyon with a brain can see this won;t work. the median net worth in the us is $77k. A heart bypass is $84k.

    Where do Republicans think the savings will come from? Even if you think that catastrophic insurance will pay for your bypass, what is the economic argument for selling insurance that only pays out for the major hits?

    The way it is now, insurors gladly pay for the small stuff, (keeps the natives happy, thinking they have insurance) and throw you over the side if a big problem happens.

  14. Hydra Avatar

    In 2007 Republican Jim DeMint sent a letter to George bush.

    DeMint said he wanted to work to insure that all. Americans had affordable private insurance, while protecting government programs.

    “We believe the health care system cannot be fixed, he said, without providing coverage for everyone. Otherwise the costs for those without coverage will be shifted to those that do”

    What happened since then, and how did Republicans pull off such an about face since the passage of romneycare, without getting whiplash?

    DeMint was essentially saying pay for what you get, and get what you pay for. Good advice them, and good advice now, and pretty much what will happen under Obamacare. Well, at leas t it will be more likely than under the present system.

    Having been stiffed by health insurors three times, and home insurors once, (four for four, folks) I figure almost anything could improve that batting average. As far as my experience goes, we would be better off to nationalize the insurors and be done with the crooks.

  15. Hydra Avatar

    American Heritage institute on talk radio. Still talking about private market based insurance as the only way to get the middleman out from between you and your doctor.

    HELLO – the insurance company IS the middleman.

    They talk about keeping government out, and in the same breath say theywould make certain insurance practices illegal. HELLO – who will enforce the rules but government?

    Their plan is to make medical care affordable by allowing you to save up for it.

    Lets see, the average net worth in us is $77k. A bypass is $80 k. YEAH, that should work. What do you save with, when you have no job? Or have no job because you are sick?

    And they think market rules will fix everything if we just let employers and the government off the hook. Everyone will get just the policy they need and can afford.

    Sorry folks, health care is different. In what other market do yu have to make market decisions while screaming in pain (other than your lawyer, maybe). I am not shopping for another doctor when I am in the emergency room screaming in pain. I will take whover is there, even if he is a veternarian. Lets get real folks.

    They should change their name to Americans in La La Land.

    After enough calers jumped down his throat, he was eventualy forced intot he position of saying, “Here is what I beleive…(favorite claptrap here).

    I really don’t care what he believes. I want some real suggestions.

  16. larryg Avatar

    re: Docs hate Medicare, Canadians come here for medical care, we fly to India for medical care – and other lovely anecdotal right wing canards.

    Doctors in all major industrialized countries deal with “Medicare” not only for seniors but everyone.

    We are living in self-imposed dark ages in this country deceiving ourselves to the realities that we have a seriously broke system that costs us twice as much as any other country and at the same time our life expectancy in comparison sucks big time.

    It might well be true that ObamaCare and even Medicare are not the answer but real, live, alternative proposals that provide reasonable and affordable access to people are not forthcoming from the Neanderthals in this country who continue their rope-a-dope strategy of holding off any meaningful reforms because they basically are opposed to govt and want us to revert to a 3rd world status where only the rich receive health care and if you are born poor, you’re just plain screwed.

    That’s the “vision” of the Neanderthals who have lots of “ideas” but no spine to actually put them together into an actual competitive “Replace”proposal.

    This is not a new thing. They’ve been playing this game since the time of Ronald Reagan and before only as of late, the hypocrisy is rampant.

    The big question heading into the election is that with the country more or less split, what will undecided independents do?

    The right wing propaganda machine has no qualms about how to deal with this potential. It’s called lying through your butt – over and over and to continue to promote the anecdotal canards.

    Show me a legitimate competitive conservative alternative to what we have now and we can talk seriously. Otherwise, just admit that you have no answers and more important, you don’t really care if we don’t have better answers.

    We are under heavy internal attack these days from Neanderthals and Luddites who are opposed to govt, reject science, and in general believe with all their heart that 3rd world is the best world for the USA.

  17. larryg Avatar

    re: the “middleman”

    this is another corrupt and disingenuous construct from the right that they us instead of providing legitimate competitive counter proposals for health insurance.

    they have effectively convinced the gullible that the only “middleman” is the Govt and not the private guy who tells your doctor what treatments and therapies they will and will not pay for.

    The right claims that we will get this if we have govt health care as if we don’t have it already right now and the HELL of it is that we have a bunch of supposedly whole-brain people who willingly buy this tripe.

    The Tea Party folks famously blather “keep your stinking govt hands off my Medicare”.

    This kind of dialogue and thinking is what passes for a “debate on the merits”.

    It’s lie, propagandize, misrepresent, lie some more and see how many gullible will buy it much like they’d buy other junk advertised in sly and deceptive ways i.e. “but WAIT, get a 2nd rankco rectal router for FREE – just pay separate shipping and handling”!!!

    The right has cynically (but correctly) sized up the relative intellect of a sizable segment of citizens – enough of them to tip the scales when added to their philosophical base.

    So, we’re basically held hostage by the segment of the public that can be fooled with sound bite ideas about health care.

    Anytime you can convince people that there is no middle-man in the current system but there will be if we get ObamaCare – shows us the basis upon which the “debate” is being conducted.

  18. Darrell Avatar

    So employees now have one less incentive to pick one company over another. Let’s see for full time, no health insurance, no pension plan, a generic 401k, limited vacation that is taken away if you don’t use it, sick time that is actually vacation, little to no chance for promotions or raises. And the name now is TEMPS. Why exactly should someone even bother to work? They can get all that from the government. When employers no longer have to pay for health insurance do you think the employee will benefit? Or will the money just go into the next CEO bonus? Companies are setting themselves up for revolving door employees that grab what they can and scat. But looking at today’s business model, maybe that’s what the companies want.

  19. larryg Avatar

    no. not at all. Companies can STILL compete – and WILL for the help they need. It will benefit workers and sharpen the competition for highly-sought skills.

    In some ways, this will allow workers to leave if they feel they can do better somewhere else – without being essentially held hostage by the employer-provided health care.

    This will provide economic mobility for people to leave to strike out on their own, to have more opportunity IMHO.

    I’ve known too many folks who have stuck with an employer even though they wanted to move but they were afraid it would put their family at risk on the health care front.

    The most bizarre thing about this conundrum is that the job mobility is the WORLD STANDARD for industrialized countries where workers are free to pursue economic opportunity without the employer health care “hook”.

    We are the exception. We are the outlier. We are the country where some folks would have us revert to a 3rd world type health care insurance environment.

    That’s the truth. Lip Service and hypocrisy are their tools in trade – and these folks are not “new”. Their philosophy has existed ever since we established Social Security, Medicare and MedicAid.

    They live in a dream world where they pretend we do not have EMTALA or other “free” health care that is paid for by transferring costs to those who do have insurance.

    These folks have known this to be the reality since 1993 when they fought vociferously against HillaryCare and proclaimed that single-payer was wrong and the individual mandate was right.

    So they’ve had the opportunity for 20+ years to actually put a competitive alternative on the table and for 20+ years they’ve played rope-a-dope and the best they can manage is “ideas”.

    Each opponent is asked for the alternative and each opponent will give his/her ideas – but at the end of the day – not even the opponents can come up with a plan that they can, as a group, support and promote as a viable alternative to those nasty Liberal approaches.

    So, it’s not like the opponents have never had the opportunity to show how to do health care insurance “right”.

    Nope. The truth is the opponents are basically opposed to the govt having a role in it – even as they blather on about how a “good” system would not deny people with pre-existing conditions and people could have portable health care that went with them from one job to another.

    Nope. A large number of the opponents are dead set against any govt rules.

    They keep blathering about a “free market” for health care but one that does not discriminate against those who are sick or could get sick.

    The most amazing thing to me about this is …and I hate to say it but it’s true – just how dumb and gullible some of the American Public is with regard to the GOP’s REAL views that they take pains to hide and are quite successful at it.

    If the GOP has it way – we’re going to end up like a 3rd world country where every 7-11 will sport gallon jars for some local schmuck who has come down with a bad sickness but has no health insurance.

    It’s almost if the GOP is opposed to the CONCEPT of Insurance itself unless of course it’s subsidized flood insurance for their beach homes.

  20. Hydra Avatar

    So employees now have one less incentive to pick one company over another.


    How could you have any less incentive than now? If you can find a job, you take it.

  21. DJRippert Avatar

    Obama – the competence of Carter along with the honesty of Nixon.

  22. larryg Avatar

    The GOP – have moved so far right and have become so anti-govt that people like Olympia Snow and other moderates have been essentially invited to leave.

    This has nothing to do with Obama other than as a propaganda campaign by the same hard-right GOP who have used everything from the birther argument to “he lies” campaigns as personal attacks on his character rather than actually deal with substantive issues.

    ALL Presidents LIE folks. Bush LIED and people DIED. No Tax Ronald Reagan as well as Bush “read my lips” BOTH raised taxes substantially.

    What is going on now is plain ordinary character assassination RATHER than deal with the actual issues. What the GOP has been doing is obfuscating, blocking, refusing to compromise as well as deny Obama even on simple non-controversial judicial and agency appointments.

    People have essentially aligned themselves with the “birther” folks.
    Same church. different pew.

  23. Peter Galuszka Avatar
    Peter Galuszka

    The problem with all of these ideas is that they are the stuff of think tanks and have little basis in reality.

    They would call for a tremendous upheaval in the managed care system which would be a good thing, but they ignore the reality of what really needs to be done.

    What needs to be done is clarity and transparency on prices. Patients simply don’t have the time to go through this all.It is too complicated. They do not have the background to do it. The only consistent price determiner out there is Medicare and everyone hates them.

    This not like buying a car or a laptop. The conservatives cannot and do not tell you how they would have harried ordinary Americans of varying IQ levels and education poring over plans and price lists and making intelligent choices. They can’t. It is not their fault. What’s more, how can an ordinary American involved in a car wreck or other accident make these choices when he or she is in shock or unconscious? Ditto and Alheimers patient? Or someone in shock?

    You can laud the free market all you want but you see no concrete ideas here or anywhere about how to go about this.Unless we get our noses out of the Cato and Heritage Foundation White Papers and get our asses into the emergency rooms and doctors’ offices, we will never know what we are talking about.

  24. larryg Avatar

    I’m willing to give the benefit of the doubt to ANY alternative proposals as long as they are legitimate efforts and not propaganda ploys.

    It’s one thing for the think tanks and their hard right supporters to draw up a laundry list of what is wrong with ObamaCare and why it should be killed.

    It’s quite another to challenge ObamaCare with a better proposal which is what the think tanks and the right will not do.

    Their agenda is basically not Repeal and Replace, it’s Replace ..and then we’ll horse around for another decade playing rope-a-dope with the gullible.

    I’d drop support of ObamaCare in a New York minute if I saw a better proposal. I have no allegiance here at all to the Dems OR to Obama but I have no allegiance, ZIPPO to the feckless who oppose but have nothing more to offer.

    How can you characterize any opponent of ObamaCare who has no real alternative plan?

    Some of the folks here – they vociferously oppose ObamaCare but their alternatives are less than half-hearted – more “idea” than any single proposal that the opposition would unite behind.

    How can anyone say they want changes for the better when they oppose something , but will not support something else or what they support has no chance of implementation – without serious compromise.

    We seem to have reached a point in our politics where people support “winner take all” … and if there are no winners – we’ll just wait – years, decades…if need be.

  25. larryg Avatar

    yet another example of the far right GOP rhetoric:

    ” ‘Obamacare’ is ‘the largest tax increase in the history of the world”

    turns out that Ronald Reagans (and Clintons and Bushes) tax increases(s) easily topped this one.

    but what are facts when you’re propagandizing the willingly gullible anyhow?

  26. larryg Avatar

    re: Obama Lies … Obama is PIKER … look at these which are just a few that are being promoted.

    ” A company with “20 employees” could go “out of business” because of health care law requirements to buy insurance”

    Pants on fire:

    ” Businesses with fewer than 50 full-time employees are not required to offer coverage. (See sections 1513 and 4980H of the Affordable Care Act).”

    ” Rick Scott says the health care law rations care, like systems in Canada and Great Britain”

    ” The current health care system — whether it’s private insurance, Medicare or Medicaid — does not allow people to have all the health care as they want. Under the new law, people still can’t have all the health care they want.

    We rate Scott’s statement False.”

    “Several readers asked whether there was anything to a claim that the health care law would allow microchips to be implanted in Americans. (Yes, they really asked us this.) In 2009, we fact-checked a chain e-mail that claimed that data-storing microchips “would be implanted in the majority of people who opt to become covered by the public health care option” and rated it Pants on Fire.”

    “One reader asked for assistance in evaluating a claim that the IRS is hiring phalanxes of new agents to enforce the tax provisions of the health care law. We have taken up that claim in various forms. Here’s a fact-check that rated it Mostly False.”

    “On CBS’ Face the Nation on July 1, 2012, House Speaker John Boehner referred to the health care law as “government taking over the entire health insurance industry.” We gave our 2010 Lie of the Year to the claim that the law was “a government takeover of health care.””

    ” Finally, readers never really stopped sending us the chain email that claims that “if you sell your house after 2012 you will pay a 3.8 percent sales tax on it.” In fact, it’s probably the most frequent email readers send us. We have ruled it Pants on Fire on a couple occasions.”

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