President Trump Does Something GOOD on Health Care!

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Unlike the Clintons, Bush, and Obama, President Trump did something good for U.S. Health Care....very good.

But you might not even realize that fact with the heavily focused Mass Media narrative going on about cuts made in the sacred Insurance Subsidies (financed by U.S. Taxpayers paychecks) to "help poor people".

It is true that Trump has made those cuts. But what he has also done is wise up and finally listen to Senator Rand Paul (rather than Paul Ryan / Mitch McConnell, and the corrupt GOP and DEM Establishment).

In doing so he has now opened up a new channel for individuals that will allow people to form buying pools or join health group associations across U.S. State lines (instead of being dependent on "ACA"). This will finally provide badly needed competition within the Insurance Marketplace, and the give the consumer new buying leverage that they have not had before. Through the power of numbers and collective bargaining (a progressive concept) this will reduce of cost of Health care, and create a competitive model, and make the Obama Care exchanges (which were ineffective and failing) now unnecessary.

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The Obama Care exchanges did not work well anyway. They only consolidated and solidified the Insurance Company stranglehold over the U.S. Population and their Doctors, by holding an IRS Gun to peoples heads to force people (or mandate them) to be victims of overpriced and unreasonable plans. That is neither freedom nor democracy nor consumer-based economics.

The glorified subsidies only just papered-over the fact that costs were continually escalating up and up and up with no recourse, and that the whole system was unsustainable. So Obama Care was just a big Corporatist boondoggle and Bailout mechanism for the U.S. Insurance Monopoly structure. It was never true "Reform" of any kind. In most States, there would be only one or two options available for these exchange policies. In some States, the Insurance companies were pulling out of the exchanges altogether.

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Competition and Collective Bargaining is one giant step towards the cure. Granted this alone does not address all of the many ills of the U.S. Health Care System. But it is a new opening to a more pragmatic and common sense way of giving the U.S. Consumer new leverage and purchasing clout over the (otherwise corrupt) Insurance Companies. And this step didn't even cost Taxpayers a dime.

Rand Paul explains it well here, so have a listen....

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8 users have voted.

Comments

Meteor Man's picture

Well there still appear to be a few details to hash out. I have to wonder if the First Amendment right to associate also covers the right to collective bargaining.

Will our individual right to "associate" in health care plans be subject to arbitration in case of a wrongful denial of benefits or arbitrary price increases?

Time will tell.

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11 users have voted.

Cali Kush: a bowl a day keeps the doctor away.

mimi's picture

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5 users have voted.

"History is what the present chooses to remember" - Carl Becker

@mimi keep allowing insurance companies to do what they do worst?

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dfarrah

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Big Al's picture

meant to help keep insurance rates down for the poor and by all accounts this is meant to disrupt Obamacare by causing pain so people will accept the next corporate health care "solution" from the republican party. Not to mention moves toward greatly reducing Medicaid and Medicare.
I don't see anything good about it.

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@Big Al
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  1. Collective bargaining, and the new ability to form inter-State buying associations gives power not to the Insurance Monopoly, but to the Consumers who are doing the buying. So this is not a "corporatist" move on the part of Trump and Rand Paul.

  2. The GOP Congress could of course still make the situation worse in spite of this action. But weep not for the strategy of no longer subsidizing a Monopoly! What we should be doing is breaking the Monopoly. If the poor has new collective buying powers that they did not have before, then their costs will become lower. On the other hand, what we have seen with steps of protecting the Monopoly Interest (ObamaCare, RomneyCare) is that the costs then do not go down at all.
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CS in AZ's picture

@FreeSociety

His order directs Labor Secretary Alexander Acosta to consider expanding access to association health plans, which could possibly allow American employers to form groups across state lines, according to the White House. The order could also allow employers in the same line of work to join together to offer health care to employees, no matter their state.

Nothing about consumers or individuals being allowed to form associations to engage in "collective bargaining" (nice way to make it sound good to progressive ears though).

This sounds like a way for companies to be allowed to buy the cheapest shitty insurance they can find from some far-distant company (good luck with getting any customer service!) and their workers will continue to have no say in what insurance they get stuck with.

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Centaurea's picture

@CS in AZ @CS in AZ So apparently, employers might be allowed to collectively bargain for health insurance. "Allow" is not the same as "require". Also, once again, those of us who are self-employed would be left to fend for ourselves.

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10 users have voted.

"Don't go back to sleep ... Don't go back to sleep ... Don't go back to sleep." ~Rumi

@Centaurea

Rand Paul has said (see the video) that the self employed can get out of the (overpriced) individual market altogether, and join in with new intra-State health care buying associations to get the economy of scale, and the same desirable type of plans that the large corporations have.

In other words, it creates a level playing field for the self-employed and puts an end to the very unfair "individual market".

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@Big Al out oh so well.

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dfarrah

should NOT be subject to "free market" forces? I'm sorry, but why on earth after all we've seen out of Obamacare would the idea that "competition" would somehow solve the problem of people being required to participate in a "market" for healthcare is simply beyond me. And it sure as hell won't solve that little problem of actual access to actual care.

Rand Paul may have a few rational ideas regarding our wars for profit, but I for one would not EVER trust a hard core libertarian to realize that once again, healthcare isn't just another commodity one can buy on the market. We pay taxes, why in hell can we not have healthcare as a RIGHT and not a privilege of the "free market" which is a joke anyway. we don't live in a "free market" at all, do you realize that?

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thanatokephaloides's picture

@lizzyh7

We pay taxes, why in hell can we not have healthcare as a RIGHT and not a privilege of the "free market" which is a joke anyway. we don't live in a "free market" at all, do you realize that?

"Free Markets", as Libertarians beLIEve in them, do not and cannot exist. All markets have rules. The only question is: who gets to make those rules? Either markets are regulated by a democratically empowered government or the law of the jungle prevails, and the wealthiest and the strongest dictate how everyone else will live.

De-regulation moves in the latter direction, of course.

And you're right: healthcare needs to be a RIGHT, equally available to all! The market-based alternative amounts to what Alan Grayson described it as:

Bad

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21 users have voted.

"Some members of the government are now investigating opioid pain killers but they are investigating the wrong thing. Despair-masking drugs are not the problem. Despair is."
-- featheredsprite

jobu's picture

@thanatokephaloides

All markets have rules. The only question is: who gets to make those rules? Either markets are regulated by a democratically empowered government or the law of the jungle prevails, and the wealthiest and the strongest dictate how everyone else will live.

Adam Smith of all people advises who should NOT be making the rules:

The proposal of any new law or regulation of commerce which comes from this order (the traders, in todays world, Wall Street), ought always to be listened to with great precaution, and ought never to be adopted till after having been long and carefully examined, not only with the most scrupulous, but the most suspicious attention. It comes from an order of men, whose interest is never exactly the same with that of the public, who have generally an interest to deceive and even oppress the public, and who accordingly have, upon many occasions, both deceived and oppressed it.
Adam Smith Wealth of Nations

Surely he meant Big Pharma, no?

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13 users have voted.

Is very bad to steal Jobu's Rum, is very bad...

@lizzyh7

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  1. ObamaCare was not reform at all. It just strengthened the Monopoly death grip over the people (by design) by the "requirement" (IRS abuse), and created no true competition at all.

  2. But collective bargaining, and inter-State buying pools does create a new purchasing advantage for the consumer, and (for the first time) a financial incentive (based on the scale) to compel Insurance businesses to offer much more reasonably priced plans. This is a good thing.

  3. Should Health Care just be free? Perhaps. That would be nice. But before that can ever happen we have to stop spending away and wasting away Trillions and Trillions of U.S. Taxpayer Dollars Overseas on Foreign Mass Murder, "Regime Change", Weaponizing the Middle-East, "Foreign Aide" (often misapplied and corrupt), and on a "New World Order" Global Monopoly structure. So I'll take small domestic victories where I can find them.
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@FreeSociety so really, that whole bit about healthcare being "free" is just one more RWNJ line to once again enforce the idea that we're all on our own, it is our "choice" whether to live or die, and if we don't make the right choice, too damned bad. And that WE should individually be responsible for something that by its very nature is NOT a commodity to simply be purchased by shopping around.

Of course you are correct that ending the wars would make this more than possible. But by once again accepting the idea that we should all compete for healthcare you're merely buying into the same old RW idea. Neo-liberalism is all about competition - compete or die, and if you die, well, that's your own damned fault.

I do not and never will trust any one of these people on this issue until they really start pushing for a nationalized health service like every other "civilized" industrial nation. So for me, I guess that means I never trust one ever again.

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Citizen Of Earth's picture

Lemme guess. He volunteered to dig the mass graves and will provide to bulldozers to plow the dead bodies in.

The funniest thing about DonnieCare is that the fools who voted for him are hurt the most.

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11 users have voted.

Donnie The Douchebag. The Douchebag Who Would Be King.

@Citizen Of Earth is nothing more than a huge giveaway to the insurance companies who have made out like bandits.

As Trump has noted, insurance companies have been very profitable over the years. We don't need insurance companies sucking the life out of health care.

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dfarrah

@dfarrah "free market" solution to this problem? Since when has that worked out for us? Of course Obamacare was just one more push of government money to the already bloated and valueless insurance industry, but does that mean then that we simply give up on truly universal care for the latest and greatest new scheme to "enhance competition?" And really, just how long do you think prices will remain "competitive" while guaranteeing actual access to actual care? I'd bet about as long as Obamacare remained "competitively" viable, not very damned long was it?

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edg's picture

It's a "shared responsibility". I just learned that last night while doing my taxes. 1984 has truly arrived.

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Centaurea's picture

@edg @edg I noticed that last week, too, while working on my tax return, specifically that mess of craziness called "Form 8962 Premium Tax Credit".

Being self-employed, I can deduct from my gross income the amount of health insurance premiums I pay. That's a good thing, since as a self-employed person I pay double the amount of FICA tax a W-2 employee would pay.

However, if my adjusted gross income is below the ACA eligibility cut-off (in 2016 that was a bit under $50,000 for a one-person household), I can also receive a partial subsidy.

In my tax return I have to account for the advance premium tax credits. That's the subsidy payments that were made by the feds to my insurance provider during the year, for the dandy Bronze Plan that I use as catastrophic coverage. I have to figure out if the advance PTC was overpaid, in which case I owe a repayment to the IRS.

I also have to figure out the amount of health insurance premiums I can deduct. This gets complicated, because that amount will include the amount of any repayment I have to make. It's a vicious circle. My final subsidy amount (and thus the amount of repayment) is based on my adjusted gross income. However, the AGI takes into account the health insurance premium deduction. But the amount of health insurance deduction can't be determined until I figure out the repayment amount, which is based on my AGI. Wacko

If you find all this mind-boggling, don't worry, so does the IRS. The Form 8962 instructions include a convoluted formula, involving a series of interpolations where you try for a close approximation of your repayment and health insurance deduction amounts.

Yep, that's what you enter in your tax return and actually pay taxes on: a close approximation of what these amounts should be. Because the actual amounts are unknowable. An exact calculation cannot be done.

I have an image of the poor person at the IRS who had to create Form 8962. At some point they threw up their hands and said "Just do it any way you want." That's actually what the instructions say. "You can use this formula, or calculate it any way you can."

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"Don't go back to sleep ... Don't go back to sleep ... Don't go back to sleep." ~Rumi

@Centaurea borne by consumers and their time because of Obamacare.

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dfarrah

Alligator Ed's picture

The comments elicited above are quite meritorious, deserving of more complete iteration. Basically, if implemented in a way to benefit people (as opposed to large corporations seeking to reduce insurance costs by reducing benefits), this proposal would have potential to reduce cost by cutting or reducing ONE factor of the price/benefit equation. That factor is pruning, to a limited extent, insurance company rapaciousness. BUT Big Pharma is not affected. This one factor alone is a huge cost driver, let alone insurance company collusion/rate manipulation.

Therefore, at least two things are necessary under this scheme:

1. Maintaining choice for health benefit benefits by offering differentially priced plans, administered by group co-operatives.

2. Reining in Big Pharma (and Medical Device) prices.

This approach could be superior to ACA--BUT it is inferior to Medicare for All/Single payer.

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@Alligator Ed

I agree with everything you said here. I see this new action (Trump / Paul) as just one step in a bigger process that unfortunately requires Congress to help do the other important pieces -- like change the Law to permit the importing of generic brand drugs and break down and stop the price gouging from Big Pharma, and finally create a fair price marketplace for prescription drugs.

Trump promised to do this, and support this during the 2016 Campaign. But will the GOP Congress let him? Will the Dems even let him?

Obama and the Dems did not even try to do this in 2009 (with majorities of both branches of Government).

Where I hope single payer will break through is on a State Level. If a few big States succeed with this, then this may eventually have a sweep effect across the Country. But even California had this blocked by .... Democrats.

In the meantime, consumer driven based reforms to the existing system may at least stop the runaway price gouging, and Cartel based corruption of the marketplace.

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talking point is about as ridiculous as right wing/libertarian talking points get.

Like most of what our friends on the right have been conned into believing, it has no basis in reality. Zero.

Some states already allow plans to be sold across state lines and insurance companies don't do it because it's a logistical nightmare that doesn't make any sense (not because of some evil big gummit regulatory barrier).

And even if they did find a way to make it work the only **ONLY** effect would be a race to the bottom. Someone in whatever state has the weakest regulations would get rich(er) selling junk plans that don't cover anything. It wouldn't help anyone get better health care. A race to the bottom.

Here's a pretty good explanation of the "across state lines" lie.

When Theory Collides with Reality

While the frustration with the costs of our current health care system is well-founded, proposals to allow cross-state sales will do nothing to encourage greater competition or address the underlying drivers of health care costs. Just like politics, health insurance is local. Today’s health plans essentially provide enrollees with access to a local network of doctors and hospitals at a discounted price. According to many insurance experts, the primary barrier for an insurer looking to enter a new market is not the state’s regulations, it’s the cost of building up a provider network at discounted prices.

To date, six states have enacted laws to allow cross-state sales: Georgia, Kentucky, Maine, Rhode Island, Washington, and Wyoming. Yet none of these states has had a single new insurer enter its market because of its law. When asked about their laws, state officials and insurance industry experts in those states agreed that establishing a competitive provider network is the primary barrier to new market entrants.

This talking point has been debunked six ways from Sunday, for years, but like most bullshit right wing talking points it just never goes away. The purveyors of all this nonsense aren't
interested in facts or reality, just half plausable factoids they can use to cloud the discussion. It's repeatad ad nauseum by every GOP huckster politician that gets his mug in front of a tv camera and every screaming talk radio lunatic until it becomes one more part of the alternate reality conservatives live in.

I'm no fan of the ACA. It was a weak, flawed half measure from the start but it absolutely improved upon what we had before. Conservative framing says everything was great then ACA ruined it. Bullshit. Our health care system was a disaster and ACA didn't do enough so it remains a disaster (but still better than it was before).

As flawed as ACA was, it was made much worse by GOP sabotage first as it was drafted, then at the state level from its inception, and now at the federal level by Trump. It was already an insufficient fix, then Republicans blew holes in it every chance they got, caring more about scoring political points than providing health care to anyone.

The way Rand Paul wants to go is the opposite of what needs to happen. What needs to be removed from the system is the profit motive. Our health care system is built around blood sucking middlemen who maximize profit by providing the least amount of care they can get away with. That's the problem, and crackpot ideologues like Rand Paul will only make it worse.

What a waste of fucking pixels.

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14 users have voted.
lotlizard's picture

@Dopeman  
The European Union neolibs’ goal nowadays is “free trade in services”. They claim it’ll be immense progress when a company based in any E.U. country X can sell services, for example, insurance policies, to individuals in any other E.U. country Y.

It seems more like an immense headache. You already can’t get a human being from Amazon or Google Germany on the phone in Germany — good luck getting hold of customer service in Malta or Estonia.

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Daenerys's picture

@Dopeman if you live in say, Kentucky, buying a plan from Georgia does you absolutely no good if nobody in Kentucky accepts that plan. Just seems obvious to me.

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Well-behaved women rarely make history.

Steven D's picture

Providers where you live must accept the insurance you carry. If they do not, too bad, you may have insurance but no one (Hospital, doctor, etc.) who will accept it as payment for treatment of your medical conditions.

Why only employers? Why not unions, churches, or groups of people in general - think AARP as the model - who can form association to provide coverage?

What about pre-existing conditions?

My thought is Trump could do more by issuing an executive order to allow people to buy drugs from Mexico and Canada where they are cheaper. You want market forces to apply, why not expand the market? Same drugs as they sell here at higher prices we could buy at lower prices from other countries and require insurers to count the cost of said drugs wherever purchased toward the medical deductibles that all our damn insurance policies seem to have in them these days (unless you are extremely wealthy and can afford Cadillac health insurance).

As I said, just some thoughts as to why this action by Trump is not as wonderful as you portray it. Others have given you their own in this thread.

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6 users have voted.

"You can't just leave those who created the problem in charge of the solution."---Tyree Scott

Unabashed Liberal's picture

@Steven D

who can also band with others in their profession. IOW, a self-employed plumber (including one who has no employees) could band with other self-employed folks in the same trade. See summary below.

Trump would direct the Departments of Labor, Treasury and Health and Human Services to make changes to regulations so more people could band together to buy "association health plans" which would allow individuals or small businesses to band together, such as members of a Chamber of Commerce, to buy plans sold across state lines.

The order also would allow people to buy short-term health insurance plans for longer than the Obama administration allowed and would encourage the use of health savings accounts.

Agree with all your other points!

Mollie


“I believe in the redemptive powers of a dog’s love. It is in recognition of each dog’s potential to lift the human spirit--and therefore, to change society for the better--that I fight to make sure every street dog has its day.”
--Stasha Wong, Secretary, Save Our Street Dogs (SOSD)

The SOSD Fantastic Four

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"The power of accurate observation is commonly called cynicism by those who have not got it."
--George Bernard Shaw, Irish Dramatist & Socialist
"We [corporations] are the government!" Actor John Colicos (1978)

has been a libertarian wet dream for decades. It precedes Obamacare.

Health insurance companies do not compete to offer the best services at the lowest price. They compete to get the least expensive people enrolled. (In states with little regulation they also do such things as throwing people out of the plan when they come down with an expensive medical problem because they forgot to disclose the pre existing condition of acne they had in high school.)

The out of state competitor will always come through with a better price and the benefits will sound comparable. You won't know the true "cost" as opposed to the "price" until you need expensive health coverage desperately. Then you go bankrupt.

Think of the credit card industry. We can now get credit cards from any issuer we want in the entire country. Before federal intervention states used to impede trade and restrict competition with regulations like usury laws that set maximum interest rates that could be applied. Some states created other obstacles like requiring the card user to have a certain amount of time to make payments before penalties kicked in. Some states even guaranteed the right of a consumer to have a dispute resolved in court rather than in front of an arbitrator paid by the company. It was sad. Thanks to the magic of competition you can now get a card with a double digit interest rate and an expanded package of fees anywhere you want.

When Donald Trump makes a proposal don't waste time asking whether you're being screwed. Figure out how you're being screwed.

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