March 22, 2017

IF GOD DID NOT WANT THEM TO BE FLEECED...:

The Republican Health-Care Unraveling (PAUL STARR, MARCH 22, 2017, American Prospect)

Imagine if Donald Trump had been a genuine populist and followed through on his repeated promises to provide health insurance to everybody and take on the pharmaceutical and insurance industries. Populists in other countries have done similar things, and Trump might have consolidated support by emulating them.

Of course, Trump's promises about health care weren't any more genuine than his promises about Trump University. But even if he had been in earnest, he would have still faced a problem. Unlike right-wing populists elsewhere, Trump did not come to power with a party of his own or well-developed policies. He came tethered to the congressional Republicans, entirely dependent on them to formulate and pass legislation. That dependence will likely complicate Trump's ambitions in such areas as trade policy. But nothing so far has made more of a mockery of Trump's populism than the health-care legislation introduced in early March by Paul Ryan and the House Republican leadership and fully backed by Trump.

The Ryan bill is abhorrent for many reasons. It calls for a massive tax cut for people with high incomes, while costing millions of other Americans--24 million by 2026, according to the Congressional Budget Office--their health coverage. It would turn Medicaid from a right of beneficiaries into a limited grant of funds to the states, and it pays for the tax cuts for the rich with cuts in health care for the poor. The bill's reduced tax credits for insurance make no adjustment for low income, while some credits would go to people with incomes over $200,000.

But what is most amazing about the bill is how badly it treats constituencies and states that voted for Trump and the GOP.

The quicker Trumpcare dies the sooner Ryan can move to the Third Way program he actually supports.




MORE:
Mitch McConnell's Trumpcare Plan Is to Lose Fast (Jonathan Chait, 3/22/17, New York)

Trumpcare may or may not grind out enough votes to pass the House. In the Senate, it's hopelessly short of the 50 votes it needs. Senate Majority Leader Mitch McConnell has laid out a wildly aggressive time frame, under which his chamber would essentially xerox the House bill and pass it into law within a few days -- no hearings, no negotiations. A few weeks ago, I suggested the possibility that McConnell's plan was not wildly aggressive but actually designed to fail. His latest comments make this scenario seem far more likely.

"We're not slowing down," McConnell told reporters Tuesday. "We will reach a conclusion on health care next week." And while he is brimming with certainty about the speed of the process, he is hardly confident of its outcome: "We'll either pass something that will achieve a goal that we've been working on," he said. "Or not."

Ron Wyden and Paul Ryan's Bipartisan Plan for Health Care and Medicare Reform (Avik Roy ,  12/15/11,  Forbes)


The heart of the Wyden-Ryan plan is to use competitive bidding to allow private insurers to compete with traditional, 1965-vintage fee-for-service Medicare. If you want to learn more about competitive bidding, see this piece I wrote about Mitt Romney's proposal for Medicare reform. If that doesn't quench your thirst, you can read the definitive book on competitive bidding: Bring Market Prices to Medicare, by Robert Coulam, Roger Feldman, and Bryan Dowd.

The basic idea behind competitive bidding is that, say, on a county-by-county basis, you let private plans and traditional Medicare offer plans with the same actuarial value compete, to see who can offer the same package of benefits the most efficiently. Each plan in a given county will name a price for which they are willing to offer these services, and seniors are free to pick whichever plan they want. However, the government will only subsidize an amount equal to the bid proposed by the second-cheapest plan. If you want a more expensive plan, you have to pay the difference yourself.

As I mentioned in the Romney post linked to above, competitive bidding has some left-of-center fans; indeed, a form of competitive bidding was part of the Senate version of Obamacare. It also has fans on the Right, most notably Yuval Levin, dean of the conservative entitlement-reform wonk set. A key concern I mentioned in the Romney post is that competitive bidding, if not structured correctly, puts private insurers at a disadvantage to the government plan. It would be important to ensure that there is a level playing field between the public and private options under such a system.

The plan would only go into effect for people aged 55 or younger today. These future seniors would buy insurance on a "Medicare Exchange," which would require plans to guarantee coverage regardless of pre-existing conditions, and require plans to charge similar premiums to those who are healthier or sicker.


The Art of the Trump: Call It Corum's Law (Jimmy Breslin, 6/07/90, Newsday)

Trump survives by Corum's Law. This is a famous, well-tested theory and is named after Bill Corum, who once wrote sports for the Hearst papers when they were in New York. He had a great gravel voice and did radio and television announcing for the World Series and heavyweight championship fights. He was a round little guy who was the youngest Army major in World War I, and when he came back he announced, "I just want to smell the roses." He read Balzac at the bar, often wrote exciting English, drank a ton of whiskey and lost as much money as he could find at the racetrack. He was a tough guy who understood weakness. 

Corum was asked to become the head of the Kentucky Derby by Louisville businessmen who said they had a grave problem. Newspapers all over the world claimed Louisville was a place where Derby visitors were robbed. Prices were tripled, touts were everywhere and women who were supposed to be available and uncommonly glamorous turned out to be nothing more than common thieves.

Corum glanced at the clips and threw them in the air. "This is great. There is nothing better for a championship event than a treacherous woman. If a guy from North Dakota goes home from here after the race and has to be met because he doesn't even have cab fare left, that guy is going to say to himself, 'Wow. I must have had a hell of a time. I can't wait for next year.' But if that same guy goes home and he still has half his money, he is going to say 'I guess I didn't have such a great time at the Kentucky Derby after all.'

"Because, gentlemen, this is the rule. A sucker has to get screwed." Corum ran the Kentucky Derby on this premise for years, and the game was good for all of Louisville. No sucker ever wept.

Today, Corum's Law runs all of Donald Trump's situation.

Posted by at March 22, 2017 5:40 AM

  

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