Tag Archives: Republicans

A Retrospective on Healthcare, and Where Do We Go from Here?


800px-Capitol_Building_Full_ViewRegular readers of this blog know that I am not a fan of Obamacare. It is overly prescriptive, too costly, and has been poorly implemented. Readers also know that I have said from the beginning that it needed corrections.

I have never been hung up on whether Congress called it repeal or replacement, as long as our healthcare system was fixed . . . or at least improved.

In November 2013, I recommended the following reforms:

  • Put all forms of health insurance (employer-based and other) on an equal footing
  • Permit a wide variety of insurance plans, from catastrophic plans to high-deductible plans to those with varying levels of coverage and exclusions
  • Provide direct subsidies to the poor and seriously ill so they can purchase healthcare coverage on the open market
  • Repeal the individual and employer mandates

I said,

“In short, the type of healthcare insurance to buy should become a decision that individuals make, not the government. Insurers should be free to design policies that consumers want, and to price them at levels that are profitable. We should abandon the notion that the federal government knows what one-size-fits-all insurance programs are ‘best’ for Americans.”

The Republican bill that Congress could not pass, the American Health Care Act (AHCA), was far from perfect in addressing my concerns, but it addressed some of them. I thought it was better than the Obamacare statute as it exists now. Frankly, the fact that no one liked it made me think the AHCA was as good as we were going to get.

But it went nowhere. Apparently, the split between the ultra-conservative and the establishment branches of the Republican Party is wider than 218 votes, and no bill could bridge the gap.

As the Wall Street Journal stated on March 24, 2017, in The ObamaCare Republicans:

“[The AHCA] worked off the reality that the U.S. health system has changed under ObamaCare and thus an orderly transition is necessary to get to a free-market system without throwing millions off insurance. The GOP also is a center-right coalition with competing views and priorities. The bill had flaws but was the largest entitlement reform and spending reduction in recent decades.”

So, given that Obamacare needs reform, where do we go from here?

I don’t know.

HHS sealHHS Secretary Tom Price can work on regulatory reforms, but only within the confines of the Obamacare language. Some of the most pressing issues are part of the statute and cannot be changed (though the Obama administration delayed some of them, or gave exceptions, and perhaps the Trump administration will do the same). Some of these issues include:

  • The tax on medical devices
  • The details of the mandated benefits (“essential health benefits”)
  • The Cadillac tax on employer healthcare plans, which, if implemented, will suck in more and more employers over time as the cost of mandated benefits rises

The fundamental problem with healthcare in the U.S. is that most Americans have not paid the full cost of their care since the 1930s, when employers began offering medical insurance as a benefit. As with all consumer goods and services, Americans want high quality, high quantity, and low prices on healthcare. Any economist can tell you that you can’t have all three—two of the three is the best you can hope for. The ideal system is often a compromise on all three. When healthcare prices are artificially lowered for the consumer, they make irrational decisions on quantity and quality—overusing the system and expecting Cadillac care for Fiat prices.

In my opinion, our healthcare system will not be fixed until employer-based plans are no longer the preferred way of covering the cost. Don’t get me wrong, many employers do an excellent job of managing their healthcare benefit plans. But the distortion in the market caused by these plans is increasing and is only made worse by Obamacare.

The different tax treatment of employer-based premiums and premiums for individual plans is unfair. The proposed AHCA would have helped in that regard, though it wouldn’t have fixed the problem entirely.

As the Wall Street Journal editorial said:

“An ideal free health-care market is never going to happen in one sweeping bill. The American political system is designed to make change slow and difficult, thank goodness. Republicans have to build their vision piece by piece, carefully gauging how to sustain their policy gains politically—the same way Democrats expanded the welfare and entitlement state over the last century.”

I suppose that’s where we go from here.

What do you think?

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Filed under Benefits, Law, Politics

Historical Patterns of Party Power


wsj-graphic-1-21-17

As I have watched and read about the events of the last week unfold, from the confirmation hearings to the inauguration to the marches around our nation, I was most struck by one graphic in The Wall Street Journal, published on p. A5 of the U.S. edition on January 21, 2017. This graphic shows the distribution of power between Republicans and Democrats in the White House, Senate, and House of Representatives from the Eisenhower era to the present—essentially, for my entire life.

I’ve pasted a copy of this graphic above. Here is a link to a PDF of the graphic, if you need better resolution to view it. The information in this graphic really deserves some time and thought—and better commentary than I am able to give.

We are a nation of divided power, and have been for most of the last forty years. Lyndon Johnson and Jimmy Carter could count on Democrats in the legislature to back them (and vice versa—Congress could count on a President of the same party to sign their bills). But since Ronald Reagan’s election in 1980—now 36 years ago—here is the sum total of the periods in which we have had a Presidency united with both houses of Congress:

  • Bill Clinton got two years, 1993-1995
  • George W. Bush got six years, 2001-2007 (if you count the Vice-President breaking the tie)
  • Barack Obama got two years, 2009-2011

Only ten of the past thirty-six years have seen our executive and legislative branches united. Four of those years have had Democrat leadership, and six have had Republican.

And now Donald Trump in 2017 . . . for how long?

Another fact jumped out at me from this visual. Congress was a Democrat institution from the 1950s until the 1990s. I knew this intellectually, but seeing it in red and blue in this graphic hit me in the face. No wonder there was a steady trend toward more liberal policies through that forty-year era.

I remember watching the election returns in November 1980 with some conservative coworkers (who were more conservative than I was at the time). As it became apparent that the Republicans would take the Senate, they became increasingly elated—something was happening that most of them had not seen in their adult lives. They were giddy with the possibilities.

The shift toward Republicans began in the Senate with Reagan in 1980, but it didn’t infiltrate the House until Bill Clinton’s administration. The Democrats took Congress back in 2007, and kept it through the first two years of Barack Obama’s administration. Given their forty-year history of control, they must have felt they were taking back their birthright (though, of course, it never was that). But our memories are not so short that we forget that Democratic hubris during the passage of the Affordable Care Act led to the loss of first the House and then the Senate.

As I perused this chart, I wondered if there wasn’t more moderation in both parties when the Democrats could count on holding Congress. There was certainly more breadth to both Democrat and Republican legislators in that pre-Clinton era. Now that both parties can see the possibility of having the majority in the legislative branch, they pander more to their bases. As each takes power from the other, they try to capitalize as much as possible on enacting their goals in the short-term, because they cannot count on the long-term. And they do everything they can to blame the other party, in the hopes of swaying voters to give them back (or let them keep) the reins.

Perhaps we need to consider how parliamentarian systems transfer power without total lurches from one extreme to the other. Or how to deal with those lurches when they happen. The U.S. does not have any institutional memory on how to cope with total shifts in power.

Of course, Donald Trump comes to his term in office as an outsider, with few connections to the Republican Congress that will serve with him. I wonder how his populist strategy will fit with the Washington insiders. Will he reap the benefit of a compatible legislature, or will he distance himself from the Republicans in Congress he will need to implement the changes he says he wants?

Those are my major takeaways as I look at this historical picture of our nation’s distribution of power.

What thoughts to you have about this graphical history of U.S. politics?

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My Political Quandary: How Do I Choose the Good?


american-politics party imagesLike many Americans, I find myself in a quandary, now that it appears that the two main presumptive Presidential candidates are Donald Trump and Hillary Clinton. I find myself wanting neither of the above.

I do not see Mr. Trump as an acceptable Presidential personality, I do not think he has sufficient political experience, and I do not trust that his positions will match most of my own. I do not find his bullying braggadocio attractive, and I do not want to listen to it for the next six months, let alone four (or eight) years after that.

I have disagreed with most of Mrs. Clinton’s positions for more than two decades, I do not think she is a trustworthy candidate, and I despised her husband’s peccadilloes in office and don’t want him anywhere near the White House again. Although she has a good political pedigree, she is as paranoid as Richard Nixon and about as charismatic.

I don’t typically write about religion in this blog, but I find myself reflecting on a bit from Thomas Merton this week:

“We find ourselves more and more backed into a corner in which there seems to be no choice but that of a ‘lesser evil’ . . . . But an evil choice can never have wholly good consequences. When one chooses to do good irrespective of the consequences, it is a paradox that the consequences will ultimately be good.”

Merton continues:

We must recover our inner faith not only in God but in the good . . . In the power of the good to take care of itself and us as well.”

From Conjectures of a Guily Bystander, part 2.

And so I have decided that my task over the next several months is to decide what the “good” is. I will not stoop to picking the lesser of the two evils.

I don’t know yet what the “good” will be for me.

Can I find one of these candidates acceptable? Will one of the two contenders rise above “lesser of two evil” status and make me think he or she will be a good President?

Will a third option become appealing? Who are the other candidates, and what do they have to offer?

Should I choose not to vote in this election? I can’t allow my dissatisfaction with the top of the ticket to harm other candidates for state and local races, but I can choose to leave the first spot on the ballot empty. That may be the “good” this year.

I have until November 8 to decide. Whatever I decide, however, I will remember that I do not need to choose the lesser evil. If I do, it will not have wholly good consequences.

When have you faced only unfortunate choices?

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Filed under Philosophy, Politics