Thanks for the perspective Katy! As you know, there is a large force of people in the insurance business that benefit from the opaque misaligned incentives that would see their golf club memberships and income drop.Those agents and others benefiting will hang on to anything to lobby their customers to keep the gravy train going. There is one thing on the list that they will grab on to because of rampant TDS. They and others will use that to lobby against changes. All of the others are spot on and should bring votes from both sides. Instead of “cutting out the middlemen (PBMs and GPOs)“, how about repealing their safe harbors ? This brings transparency and competition back to the industry.
I am heartened when anyone mentions GPO alongside PBM! So thank you MLevi! It has taken years to get Americas to pay attention and (somewhat) understand PBM. I hope their understanding of GPO happens more quickly, as it is crucial to their understanding of how hospitals are such cost drivers.
100% would love to see some of the changes you mention! I think the president is totally right and that all subsidy money should go into accounts that people can use to buy ACA plans, off-exchange plans, health care sharing ministry memberships, DPC, or just cash-pay. School choice for health care!
I was in the House when this entire sad saga unfolded. Healthcare was tackled first because Speaker Ryan was focused on Tax reform, and getting rid of the Obamacare taxes seemed to be the best way to free up space in the CBO estimates to maximize the opportunities for a major tax overhaul. So the relevant House committees undertook what became known as The American Health Care Act- or AHCA. This passed through the committees of jurisdiction(in the House) as well as the Rules Committee in March of 2017, and was on the floor in April. The opposition, in addition to every Democrat, was the House Freedom Caucus, as well as several right-leaning think tanks. The complaint was that it was not a complete repeal of the ACA. The Mandates-both individual and employer, the taxes, the medicaid expansion, prohibition on Physician Owned Hospitals, as well as funding for Planned Parenthood were all satisfactorily addressed, but the insurance provisions remained. So Speaker Ryan pulled the Bill. It was revived several weeks later, with the now infamous “pre-existing conditions” protections removed, and it finally passed in the House. Unfortunately during the delay Senator McCain became ill, and whether that affected his vote, we will never know. But I have always felt that is the House had passed its original Bill in early April, prior to Sen McCain’s diagnosis, the outcome would have been different. And of course the insurance provisions could have been addressed in subsequent legislative efforts. And of course Republicans lost the majority in the 2018 midterm elections, which also had disastrous repercussions.
Yes Dr. Burgess, I remember conspiring with you and colleagues at the CH Club and struggling with all these tensions you describe. This is truly the hardest issue to work on and the factions within the party make it particularly hard. We don’t have majority votes for what the fiscal conservatives (or frankly, the social conservatives) want - I count myself and you among them. But these political realities need to be respected I think more than your former colleagues recognize. The voters aren’t dumb and if certain policies don’t have more support, such that swing district members can’t go out on those limbs, then there’s usually a reason. It’s just really hard to mess with people’s health care. They hate it like the cable company but they are understandably terrified of losing even the broken, unaffordable coverage they have now. I worry that our guys won’t swing for the fences on getting big policy wins because of the (unfortunately) minority-supported fiscal/social concerns.
Another great read and thank you for bringing us to ‘the inside’. This from the piece:”it must be the conservatives in safe seats who sacrifice their priorities more than the moderates in swing seats. Those moderates are the ones who’ll lose their jobs if this goes sideways. And then you lose your majority anyway.” I understand, but it seemed to me that there were several so-called Republican moderates who over shot the target is there attempt to appease the public. A three year subsidy extension or increasing the subsidies for those 700% of the poverty level seemed to be utter fiscal folly to me. Or am I reading that wrong?
They understood that making people’s insurance more expensive is a loser. It’s not their fault that the only option out in front of them to do that was a 3-yr clean extension. They might have voted for something else if it were offered but that’s what they had. I think the evil of letting Ds win elections is that they keep doing this - they give more and more stuff to people that is politically impossible to take away. Even if it’s unreasonable. I’d rather vote right now to keep that in place just to keep them out of office again where they can make it worse. That way we can craft some other reforms that will make those subsidies less perceived as so necessary in the future.
Thanks for the perspective Katy! As you know, there is a large force of people in the insurance business that benefit from the opaque misaligned incentives that would see their golf club memberships and income drop.Those agents and others benefiting will hang on to anything to lobby their customers to keep the gravy train going. There is one thing on the list that they will grab on to because of rampant TDS. They and others will use that to lobby against changes. All of the others are spot on and should bring votes from both sides. Instead of “cutting out the middlemen (PBMs and GPOs)“, how about repealing their safe harbors ? This brings transparency and competition back to the industry.
I am heartened when anyone mentions GPO alongside PBM! So thank you MLevi! It has taken years to get Americas to pay attention and (somewhat) understand PBM. I hope their understanding of GPO happens more quickly, as it is crucial to their understanding of how hospitals are such cost drivers.
So true!!!
100% would love to see some of the changes you mention! I think the president is totally right and that all subsidy money should go into accounts that people can use to buy ACA plans, off-exchange plans, health care sharing ministry memberships, DPC, or just cash-pay. School choice for health care!
I was in the House when this entire sad saga unfolded. Healthcare was tackled first because Speaker Ryan was focused on Tax reform, and getting rid of the Obamacare taxes seemed to be the best way to free up space in the CBO estimates to maximize the opportunities for a major tax overhaul. So the relevant House committees undertook what became known as The American Health Care Act- or AHCA. This passed through the committees of jurisdiction(in the House) as well as the Rules Committee in March of 2017, and was on the floor in April. The opposition, in addition to every Democrat, was the House Freedom Caucus, as well as several right-leaning think tanks. The complaint was that it was not a complete repeal of the ACA. The Mandates-both individual and employer, the taxes, the medicaid expansion, prohibition on Physician Owned Hospitals, as well as funding for Planned Parenthood were all satisfactorily addressed, but the insurance provisions remained. So Speaker Ryan pulled the Bill. It was revived several weeks later, with the now infamous “pre-existing conditions” protections removed, and it finally passed in the House. Unfortunately during the delay Senator McCain became ill, and whether that affected his vote, we will never know. But I have always felt that is the House had passed its original Bill in early April, prior to Sen McCain’s diagnosis, the outcome would have been different. And of course the insurance provisions could have been addressed in subsequent legislative efforts. And of course Republicans lost the majority in the 2018 midterm elections, which also had disastrous repercussions.
Yes Dr. Burgess, I remember conspiring with you and colleagues at the CH Club and struggling with all these tensions you describe. This is truly the hardest issue to work on and the factions within the party make it particularly hard. We don’t have majority votes for what the fiscal conservatives (or frankly, the social conservatives) want - I count myself and you among them. But these political realities need to be respected I think more than your former colleagues recognize. The voters aren’t dumb and if certain policies don’t have more support, such that swing district members can’t go out on those limbs, then there’s usually a reason. It’s just really hard to mess with people’s health care. They hate it like the cable company but they are understandably terrified of losing even the broken, unaffordable coverage they have now. I worry that our guys won’t swing for the fences on getting big policy wins because of the (unfortunately) minority-supported fiscal/social concerns.
Another great read and thank you for bringing us to ‘the inside’. This from the piece:”it must be the conservatives in safe seats who sacrifice their priorities more than the moderates in swing seats. Those moderates are the ones who’ll lose their jobs if this goes sideways. And then you lose your majority anyway.” I understand, but it seemed to me that there were several so-called Republican moderates who over shot the target is there attempt to appease the public. A three year subsidy extension or increasing the subsidies for those 700% of the poverty level seemed to be utter fiscal folly to me. Or am I reading that wrong?
They understood that making people’s insurance more expensive is a loser. It’s not their fault that the only option out in front of them to do that was a 3-yr clean extension. They might have voted for something else if it were offered but that’s what they had. I think the evil of letting Ds win elections is that they keep doing this - they give more and more stuff to people that is politically impossible to take away. Even if it’s unreasonable. I’d rather vote right now to keep that in place just to keep them out of office again where they can make it worse. That way we can craft some other reforms that will make those subsidies less perceived as so necessary in the future.
Fascinating! And great job with the voiceover.
Thanks so much Moorea!! The voiceover is so fun to do.