
Who Wins and Who Loses in the Latest G.O.P. Health Care Bill - mcguire
https://mobile.nytimes.com/2017/05/04/upshot/who-wins-and-who-loses-in-the-latest-gop-health-care-bill.html
======
a_humean
I think the cynical and only correct interpretation of this bill is that
Republicans ultimate priority is to cut health provisions for largely sicker,
older, and poorer Americans in order is to cut taxes for households with
incomes above $200k via a budget reconciliation process that requires less
than 60 votes in the senate.

The Republican public campaign against ACA/Obamacare is a fraud masquerading
as a campaign against all of the things people don't like about the ACA, which
is its high premiums and deductibles, and incomplete networks. In fact this
bill will literately deliver even higher premiums, higher deductibles, and
more restrictive networks all to allow Paul Ryan to cut taxes without getting
the Senate to press the nuclear button on the last vestiges of the filibuster.

~~~
flukus
Considering everyone knew this was coming and had time to prepare, can you
point out how many blue states had legislation for single payer health systems
ready to go?

Either democrats don't seem to want it or they just want a nice wedge issue
without actually doing anything.

~~~
klipt
Won't that encourage red state inhabitants to not buy insurance, then when
they get sick move to blue states and drain their systems?

~~~
flukus
Limit it to people that have been residents for a certain period, say 2 years.
Maybe even limit it against prior conditions for even longer.

And verify it's a real problem. How many poor, sick people in red states have
the economic mobility to move to a blue states?

------
credo
I have no pre-existing health problems (that I know of) and I get no
government subsidies. The scorecard lists people like me as winners in the GOP
health care bill.

However, I think, most of us will lose from this bill, because we'll live in a
country that is _less fair_

* less fair ( _if you believe that a market-based approach to healthcare is unfair to people who are born with - or acquire - serious health problems, aka pre-existing conditions ...... and if you believe that poor people should get subsidies to let them get affordable healthcare_ )

~~~
notacoward
> most of us will lose from this bill, because we'll live in a country that is
> less fair

Most of us will lose, even financially. Uncertainty is a huge drag on
business. Insurance is all about reducing uncertainty, and _universal_
insurance is even more potent in that regard. Millions of Americans will now
be less likely to change jobs or take other risks that might leave them
exposed to a greater risk of catastrophic medical expenses. Lenders and
businesses will have to adjust for an increased number of people defaulting on
loans because medical expenses forced them into bankruptcy. In these and a
dozen other ways, this regression on insurance is going to hobble the economy
and end up hurting us all.

BTW, I'm not at all trying to imply that it's only bad because it's bad
economics. Far from it; I think the moral objections are even stronger. I'm
just trying to explain how this change is wrong even according to the one
criterion its proponents still (arguably) care about.

------
BigChiefSmokem
I'm "rich" (I make way over 250k) and even I feel this is completely wrong and
unjust. I pay hundreds of thousands in taxes each year and am still thankful
and grateful just to be in this country because I understand historically what
it took to get us here. These people are truly heartless and self-interested
in the most un-American of ways. I'm no Democrat by any measure but my party,
the Libertarians, need to stand for more, stand in numbers, and replace the
Republicans once and for all as the new face of conservatism in the 21th
century.

What these people are doing to our underclasses and disenfranchised groups is
wrong.

------
llamataboot
I look forward to going back to the days where I couldn't buy insurance at any
price because of pre-existing mental health conditions.

Because you know what makes me a productive member of our glorious workforce?
Not being able to get care.

------
kcorbitt
This legislation is a complete mess. That said, I'm bleakly optimistic that if
it succeeds in breaking healthcare for enough people badly enough, the
pushback may give us an actual shot at a single-payer healthcare system in the
US in my lifetime.

~~~
noobermin
Thousands of people will die in the process, it's a high price to pay for a
political win.

~~~
mobiplayer
Single payer is not a political goal, it objectively saves and improves lives.

~~~
dragonwriter
It is a political goal. It maybe shouldn't be a divisive, partisan political
goal for the reasons you describe, but in fact it is that, too.

~~~
mobiplayer
Then the argument of "too high for a political goal" is moot, because
everything is a political goal.

------
LyndsySimon
The biggest deal here is that it removes the "individual mandate". Without the
mandate, costs on the exchanges will got through the roof, so basically no one
who doesn't qualify for a subsidy will be able to afford them. That said,
catastrophic plans will once again be a viable option for many people.

In short - it changed a flaws nationalized healthcare program into an
expensive entitlement program for low-income earners.

~~~
maxerickson
It depends on what you expect the catastrophic plans to cover.

In a lot of ways, the expensive, high deductible ACA plans are catastrophic
plans. It just happens to be the case that they will actually cover a medical
catastrophe, so they are expensive. A catastrophic plan that leaves the
patient dead or declaring bankruptcy didn't really provide enough insurance.

Also, it depends a lot on what you mean by low income earners, but a family of
4 on $65,000 is getting a bigger subsidy than a very low income single adult
in a state that didn't expand Medicaid ([http://kff.org/uninsured/issue-
brief/the-coverage-gap-uninsu...](http://kff.org/uninsured/issue-brief/the-
coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/) ).

------
kmicklas
Can someone explain to me how this can be passed off as anything but pure
evil?

~~~
tunesmith
Well, the 2% Medicare tax is, from their perspective, something that should
never have passed in the first place. So repealing it is going back to a
previous form of status quo.

Beyond that, I think it's the basic philosophy that government should not be
involved in funding health care for citizens (I think those high-risk pools
are basically being set up to fail/abandon). I don't really understand it,
because I don't see how the normal arguments of self-reliance and
accountability translate to sickness, which is by definition out of our
control no matter how self-reliant and accountable we are.

~~~
barrkel
Here's a different perspective: if the government is involved in paying for
your healthcare, that gives voters a say in how you live your life. Taking too
many risks? Like wine or soft drinks a bit too much? Maybe you enjoy rock
climbing, or horse riding, or skiing, or some other dangerous activity? Well,
maybe I don't want to pay for your risks, and I get to call you a drunk, fat
and lazy, or foolhardy and reckless, needing more regulation and laws to keep
you in your place - and your health costs low. We'll ban tasty food, nice
drinks, and any activities that are more than a standard deviation or two out
of the normal risk profile. We'll have a nice gentle bland life mapped out for
you with low health costs.

IMO the biggest elephant in the room is rationing. We can't give infinite
healthcare to everybody for all their lives, particularly in very old age. We
need to make hard trade-offs. In a free market system, the rationing is done
by affordability and price levels: we choose who's more worthy of living
longer by how much capital they've accumulated. In a more centralized system,
we might choose to pay for interventions based on how much extra "life" they
give, and ration by selecting a threshold for how much we pay for extra life
year - this is how the UK NHS works, where life year is a QALY, quality-
adjusted life year. But anything that doesn't address this elephant in the
room, and appeals to emotions about the poor, sick, elderly, dying because
they can't afford the treatment they need without considering who exactly
we're going to leave to die and why, because we can't all be each other's
caregivers for life, is intellectually bankrupt.

~~~
mobiplayer
This law literally tells you how to live your life, especially if you're a
woman: No kids, no reporting sexual assault, ...

As per your claim on the NHS I'm not sure what are you trying to imply. Do you
think the NHS or other similar systems choose to let people die based on
economic reasons? Because that'll be a surprise. Disclosure: I live in the UK
and grew up in Spain, where last night my grandmother passed at the age of 99
after A LOT of healthcare was poured into her (despite the fact she never had
"a job"), of course paid by taxes.

~~~
nextweek2
The NHS does have a guidelines published by NICE. Doctors would follow those
when deciding care. It's not about your contribution to the economy, but about
the patients quality of life and future life expectancy. Being 99 means she
could have had another decade if an acute illness was corrected.

Things get difficult when patients have longer term chronic illnesses​. If she
had kidney failure and heart desease the doctors who probably discuss a
different care plan.

------
tn135
The healthcare bill was a lipstic on a bulldog to begin with and now it is
more like a crayon on bulldog. Everyone is a loser here.

~~~
rbanffy
I can assure you a lot of people who don't need to worry about paying health
insurance will make some very handsome bonuses out of this.

~~~
tn135
I don't think there is anything wrong in people making handsome bonuses out of
this. In fact apriori I would love to invest in those companies. It is mostly
the law firms I suppose.

~~~
rbanffy
Don't you think it's fundamentally wrong to cause thousands of deaths every
year for profit?

~~~
tn135
> Don't you think it's fundamentally wrong to cause thousands of deaths every
> year for profit?

Depends on the alternatives.

------
llamataboot
It's a GOP Bill? I don't even need to read the article.

Winners: Rich people Losers: Everyone else

------
Overtonwindow
I'm torn about this legislation. Since obamacare passed I've had continually
higher premiums which is pushing me to the breaking point. I support insurance
for preexisting conditions, I don't believe insurers should be able to turn
anyone away, for any reason. That said, I don't want the government running my
healthcare, I don't want to have to buy insurance from the government, and I
don't want to pay for the bad mistakes of others - that's difficult to do but
that's my opinion. That all said, I think the media is still in the "fuck
Trump" mode and no matter what the republicans or trump comes up with, the
media is going to take a shit on it.

All that being said, I don't think the issue is republicans, democrats, or
trump. I think the issue with our healthcare is the insurance companies
themselves, doctors, medical device companies, pharmaceutical companies, and
everyone else who takes a cut, adds a surcharge, and has generally done all
they could to squeeze every last dime for their shareholders. Like the big
banks, I want to see reform of the health care INDUSTRY, and strict limits
placed on what they can charge, whom they can charge, and the whole pile on,
surcharge habit.

~~~
unprepare
>and I don't want to pay for the bad mistakes of others

When some moron nail guns a board to his head and goes to the ER you are still
paying for that.

What you are now not paying for is people fighting cancer, MS, AIDs, and other
long term and terminal diseases.

What made you believe that this legislation would enable you to avoid 'paying
for the bad mistakes of others'?

~~~
Overtonwindow
Technically, since you apparently missed my point by writing a post on pure
emotion, If I don't have to buy insurance then I'm not forced to pay for
insurance and thus my money does not go towards someone who drinks to excess,
smokes cigarettes, or engages in deliberate behavior that will likely increase
their chances of going to the hospital.

~~~
unprepare
> my money does not go towards someone who drinks to excess

except that you absolutely will be paying for them not seeing a doctor and
waiting until they have to go to the emergency room.

People who drink in excess go to the ER and get their stomachs pumped - thats
paid for by the taxpayers if the person doesnt have insurance. My point was
exactly that - you cannot avoid paying for these emergency rooms visits by
changing how insurance works, the way to pay less for these emergency room
visits is to decrease them by promoting more holistic care - and how does the
government promote things? by providing economic incentives in the form of tax
breaks, subsidies, etc.

I guess you missed my point by responding with pure emotion...

~~~
Overtonwindow
Again slow down, think carefully and try to stay rational. You'll never have
universal health care or coverage. Someone had to pay for it. You can't force
people at the end of a bayonet to pay for the mistakes of others. Well,
perhaps in your socialist dream world. Keep voting for Bernie and maybe
someday you'll grow up.

------
davidf18
People who drive their cars recklessly and who speed pay higher auto insurance
premiums. People who choose poor lifestyle behaviors (smoking, drinking daily
Cokes, not exercising, drug use) were subsidized by those who "drove safely."
Only with smoking were plans permitted to charge more (50%), but it was
unverified and many plans did not offer different rates for smokers.

~~~
frgtpsswrdlame
And to those born sick? Are we going to make our society a double jeopardy
where not only do they have to contend with illness for their entire lives but
also crushing medical debt?

~~~
Overtonwindow
I split the difference: Those who indulge in risky, generally recognized
unhealthy behaviors, should pay more. Those born sick, no, absolutely not. We
should do more to incentivize people to lead healthier lives. Since when has
health insurance ever gone DOWN?! I lose fifty pounds my insurance rates won't
go down, while some guy that doubles the amount he smokes and drinks won't
necessarily see any increase.

~~~
davidf18
I only stated that people who indulge in unhealthy lifestyles should not have
their healthcare costs subsidized by those who choose to not indulge in those
unhealthy lifestyles, just as those who drive unsafely should not have their
costs subsidized by safe drivers.

Issues of genetics should be covered by insurance, but by far most healthcare
costs are from chronic diseases caused by smoking, obesity/lack of exercise,
alcohol abuse, etc. and air pollution.

