I know that President Trump, his administration, and his die hard supporters will just scream "fake news," but can't help but be somewhat stunned when a well established conservative publication like The National Review publishes something like this article. I suppose, however, that it is unavoidable due to the complete ineptitude displayed by the Trump Administration nearly three months into assuming the office.
The first 100 days is typically a time where a new administration passes a good many new initiatives, strengthened by the political capital and "mandate" stemming from the election. In the case where the President has entered office without a resounding mandate, such as the 2000 election and George W. Bush, the administration has typically worked aggressively with the other party to achieve bipartisan legislative achievements. These are the two options, historically and for good reason: if you have the capital you should use it before circumstances dictate that you lose it. If you don't have the capital, working with the other side can garner respect and support in the event that you gain it in the future.
The Trump Administration, inexplicably, has seemingly settled on a third option: go to war with everyone. Accordingly, it seems likely at this point that they will end their first 100 days without a single headline achievement on which to rest their hats. The buildup to the midterm election will be fast and furious this time around, similar to what was observed in 1994 or 2010. An Administration without a mandate (no President in modern times has had less of a mandate than President Trump did upon taking the oath of office) has decided to try to operate by strong arming people. He has served to stir up the opposition to the point where they are apparently poised to oppose nearly everything. He has also served to further fracture his own party, splitting off extreme and moderate portions of his party already.
In sum, it is inarguable at this point that this administration is ill equipped for the responsibility of governing. With issues spiraling out of control in the realm of foreign policy (Syria and North Korea most disconcertingly), and with their own administration in the line of fire for a series of apparent lies told by campaign and administration personnel regarding their own involvement with Russia, as well as the President's own inability to stay out of his own way on social media, it seems simultaneously essential that the administration somehow rush through their own steep learning curve and catastrophically impossible that they can learn at all. Three months in things look bad. They are poised to look a lot worse in three months if there isn't a miraculous turnaround hidden just out of sight.
Wednesday, April 12, 2017
Wednesday, April 5, 2017
What The Health Care Failure Means
An insane amount has happened in the last twenty plus days. I'm back, albeit in a shortened version due to time constraints. That said, I wanted to dip my toe in and give some brief analysis on the failure of the GOP to pass their own "health care" bill, leading to Speaker Ryan saying that the Affordable Care Act would be the law of the land for the foreseeable future.
The fundamental flaw in the GOP attempt was that the bill, while positioned as a health care reform bill, was actually anything but. The bill fundamentally did a few things. It cut taxes, predominately on the wealthiest of Americans. It shifted the cost of healthcare from the federal government to state governments. It rolled back many regulations in the ACA which were put in place to help control costs. And it ultimately projected to reduce the deficit over ten years, while controlling the rising cost of healthcare within a decade, ever so slightly, at the cost of roughly 24 million Americans losing insurance.
None of that actually tackles the problem of health care in this country. The USA is by and large one of the least heavily taxed nations in the industrialized/western world. In fact, the other nations, taken together and averaged, have a tax rate roughly ten percent higher than the US rate. Only two counties (Mexico and Chile) have lower rates than the USA. In spite of significantly reducing the tax burden on citizens over the last fifty years, the government has not reigned in spending. Accordingly, deficits continue to grow, damaging the country's financial stability long term. That, in turn, leads to a great hesitation to spend in areas like health care, where it is an unassailable fact that the uninsured lead to the greatest degree of unpaid cost in the system, which, in turn, is the primary contributing factor to the increasing cost of health care that everyone else feels.
Since the end of the Reagan years the top tax rate in the USA has sat between 39.6% (Clinton years) and 28% (end of Reagan's second term). More specifically, through the last three Presidency's the rate been no higher than 39.6% and no lower than 35%. Prior to Reagan, however, the tax rate sat between 70% and 77% for nearly 20 years, and was significantly higher than that throughout world war two and the ensuing two decades. Many of the "Reagan Democrats" in the Rust Belt talk of wanting to go back to an economy that existed in the 1950s and 1960s. I've talked here before about some of the reasons why that is impractical and impossible, but looking at the tax rates that were involved during that period of time is yet another factor.
What does all this have to do with health care? Well, first, the GOP "attempt" to "repeal and replace" the Affordable Care Act was actually an attempt to repeal parts of the ACA and to cut taxes. There wasn't any functional aspect to it that dealt with the issues facing our health care system. In no particular order, those issues are:
1. Costs which are spiraling out of control, due to;
2. Malpractice lawsuits being around every corner, leading to
3. Increasing costs for malpractice insurance for medical providers.
Additionally:
4. Uninsured people going to the ER to get medical care for any medical concern, because hospitals cannot refuse them care, then
5. Not paying their bills, leading to
6. Hospitals losing money, leading to
7. Medical providers increasing the price they charge for services, leading to
8. Government health care providers refusing to pay the high price, leading to
9. an ever smaller network of providers who will accept Medicare and Medicaid, leading to
10. Fewer choices and
11. High costs in premiums and deductibles for everyone.
I could go on and on with this list, but that's the general gist. In the midst of this the GOP claims to want to reform healthcare, but if their first attempt is any indication they haven't even really given the problems with the system much thought. In fact, given that their first attempt would have uninsured another 24 million people, one could argue that they were willing to exacerbate many of these problems to give the best off in this country even more money in their pockets. But look back at those tax rates I mentioned earlier: do people really, really need that additional money in their pockets? And, if they have it, will it even pay for their increased medical costs?
Ultimately, the two extremes of this debate are to go with a government run single payer system (universal health care as a right), or to remove all legislation mandating care, making it so that health care is truly governed by the forces of capitalism (if you can't pay you don't get the service, period). In between is where we've been for sometime, and where we figure to be for sometime more. Ultimately, what his failure to pass a repeal and replace means is that the GOP spent seven years running against the ACA without actually coming up with a plan to replace it. It also means that they might be far better suited to being the minority party than the majority. Governing is hard after all.
The fundamental flaw in the GOP attempt was that the bill, while positioned as a health care reform bill, was actually anything but. The bill fundamentally did a few things. It cut taxes, predominately on the wealthiest of Americans. It shifted the cost of healthcare from the federal government to state governments. It rolled back many regulations in the ACA which were put in place to help control costs. And it ultimately projected to reduce the deficit over ten years, while controlling the rising cost of healthcare within a decade, ever so slightly, at the cost of roughly 24 million Americans losing insurance.
None of that actually tackles the problem of health care in this country. The USA is by and large one of the least heavily taxed nations in the industrialized/western world. In fact, the other nations, taken together and averaged, have a tax rate roughly ten percent higher than the US rate. Only two counties (Mexico and Chile) have lower rates than the USA. In spite of significantly reducing the tax burden on citizens over the last fifty years, the government has not reigned in spending. Accordingly, deficits continue to grow, damaging the country's financial stability long term. That, in turn, leads to a great hesitation to spend in areas like health care, where it is an unassailable fact that the uninsured lead to the greatest degree of unpaid cost in the system, which, in turn, is the primary contributing factor to the increasing cost of health care that everyone else feels.
Since the end of the Reagan years the top tax rate in the USA has sat between 39.6% (Clinton years) and 28% (end of Reagan's second term). More specifically, through the last three Presidency's the rate been no higher than 39.6% and no lower than 35%. Prior to Reagan, however, the tax rate sat between 70% and 77% for nearly 20 years, and was significantly higher than that throughout world war two and the ensuing two decades. Many of the "Reagan Democrats" in the Rust Belt talk of wanting to go back to an economy that existed in the 1950s and 1960s. I've talked here before about some of the reasons why that is impractical and impossible, but looking at the tax rates that were involved during that period of time is yet another factor.
What does all this have to do with health care? Well, first, the GOP "attempt" to "repeal and replace" the Affordable Care Act was actually an attempt to repeal parts of the ACA and to cut taxes. There wasn't any functional aspect to it that dealt with the issues facing our health care system. In no particular order, those issues are:
1. Costs which are spiraling out of control, due to;
2. Malpractice lawsuits being around every corner, leading to
3. Increasing costs for malpractice insurance for medical providers.
Additionally:
4. Uninsured people going to the ER to get medical care for any medical concern, because hospitals cannot refuse them care, then
5. Not paying their bills, leading to
6. Hospitals losing money, leading to
7. Medical providers increasing the price they charge for services, leading to
8. Government health care providers refusing to pay the high price, leading to
9. an ever smaller network of providers who will accept Medicare and Medicaid, leading to
10. Fewer choices and
11. High costs in premiums and deductibles for everyone.
I could go on and on with this list, but that's the general gist. In the midst of this the GOP claims to want to reform healthcare, but if their first attempt is any indication they haven't even really given the problems with the system much thought. In fact, given that their first attempt would have uninsured another 24 million people, one could argue that they were willing to exacerbate many of these problems to give the best off in this country even more money in their pockets. But look back at those tax rates I mentioned earlier: do people really, really need that additional money in their pockets? And, if they have it, will it even pay for their increased medical costs?
Ultimately, the two extremes of this debate are to go with a government run single payer system (universal health care as a right), or to remove all legislation mandating care, making it so that health care is truly governed by the forces of capitalism (if you can't pay you don't get the service, period). In between is where we've been for sometime, and where we figure to be for sometime more. Ultimately, what his failure to pass a repeal and replace means is that the GOP spent seven years running against the ACA without actually coming up with a plan to replace it. It also means that they might be far better suited to being the minority party than the majority. Governing is hard after all.
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