The policy and politics of Trumpism

CharminTide

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Oct 23, 2005
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Trump on why he doesn't need daily intelligence briefings:
You know, I'm, like, a smart person. I don't have to be told the same thing in the same words every single day for the next eight years. Could be eight years — but eight years. I don't need that. But I do say, 'If something should change, let us know.'

Trump previews how he will handle his conflicts of interest:
My executives will run [my various companies] with my children. It's a big company, it's a great company. But I'm going to have nothing to do with management.
 

CharminTide

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Oct 23, 2005
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Okay, back to actual policy conversations: the fate of the ACA. I feel like the GOP has painted themselves into a corner on this, and I'm not sure how they're going to escape it. They've spent the last 7 years publicly criticizing the failings of the ACA: too many people were left uncovered, many areas of the country have a shrinking number of insurer choices in the marketplace, premiums and deductibles are too high, many plans don't cover what people would want or expect.

And to be clear, I agree with all of that criticism. McConnell and Ryan made the calculus that instead of trying to fix those problems, they would just complain about the law. It ended up being a great political strategy in the short-term, but I've always anticipated long-term repercussions that I think are now starting to manifest.

There is no single GOP replacement plan, but all the proposals are very similar: the ACA was largely funded by increasing taxes on the wealthy, and all the GOP replacement plans roll that back. The result is that their replacement plans actually worsen many of the criticisms the party has leveled at the ACA for years. They result in, at best, the same coverage level as the current ACA; in truth, the vast majority of plans would actually reduce the number of Americans covered with healthcare. And no plan reduces premiums. There are some interesting ideas, like healthcare saving accounts and various forms of rebates, but nothing that actually makes the delivery of care less expensive to the individual. Which is completely understandable when you consider that the major source of ACA funding is removed in all GOP replacement ideas.

Assuming their fundamental tax reform idea will not change, here's how I see their options:

1) Repeal and immediately replace: This will be tough, not only because the party hasn't unified behind a single plan, but also because the political price of telling millions of Americans that they're suddenly off healthcare is pretty steep. Given the chaos in Congress around this option, I don't see it as a likely outcome. Especially given that a repeal vote seems imminent and a replacement plan is nowhere in sight.

2) Repeal and delay a replacement: This will be initially easy, but a terrible burden in the long-term. First, the idea that markets will remain stable in the interim between repeal and replacement has been debunked by every health policy expert. The marketplaces will destabilize, premiums will hike, and GOP congressmen will rightfully start to get tons of angry phone calls from their constituents. It also 100% ties the GOP to formulating and owning a replacement plan. In general, it's easy to have ambitions towards enacting a huge sweeping governmental reform of an existing system (think social security privatization with Bush); but when that ambition fails, as it did with Bush, you can always just walk away and leave the existing system in place. The problem with repeal and delay is that the GOP would never be able to just walk away. They'll be stuck having to find a replacement plan, which is very, very hard. Because of the difficulty, I would anticipate that the delay timeline would be continually pushed back again and again as no consensus gets reached, and piecing together a new healthcare system would become the issue that defines this Congress.

3) Keep the ACA and fix the broken aspects: This is the most reasonable option, and what I've been hoping they would do for years. But politically, this is now impossible. They've demonized the law and promised a repeal for so long that they cannot simply keep and reform it.

4) Repeal and do nothing: Political suicide.
 
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MattinBama

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Jul 31, 2007
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I don't care about the long term problems as much as I care currently about not having to pay the tax penalty yearly. That penalty just slaps a vicious cycle on those people that want insurance but can't afford it under ACA.
 

bama_wayne1

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Jun 15, 2007
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I think the real need of for the ACA was brought on by:
#1 Loss of major industry that once insured their employees and their families. This is a direct result of NAFTA.
#2 Millions of illegal aliens not being able to get or demand fair treatment from employers or care providers.
I believe that our president elect is interested in solving both of these issues. I also realize that there are many who are worried about what will happen to these people, I am one of those people. With that being said I still can't allow myself to be too bought into the plight of someone who is breaking the law. I realize many of you will think me harsh and frankly brand me as an idiot. I will pray for these people. I will do anything I can to apply pressure to get a smoother immigration policy. That still doesn't mean it is okay to break existing law. I also believe he is going to work to gain employment for more Americans in heavy industry. Employer insurance will increase the cost of products but it was there once upon a time and we all lived.
 

92tide

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May 9, 2000
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I think the real need of for the ACA was brought on by:
#1 Loss of major industry that once insured their employees and their families. This is a direct result of NAFTA.
#2 Millions of illegal aliens not being able to get or demand fair treatment from employers or care providers.
I believe that our president elect is interested in solving both of these issues. I also realize that there are many who are worried about what will happen to these people, I am one of those people. With that being said I still can't allow myself to be too bought into the plight of someone who is breaking the law. I realize many of you will think me harsh and frankly brand me as an idiot. I will pray for these people. I will do anything I can to apply pressure to get a smoother immigration policy. That still doesn't mean it is okay to break existing law. I also believe he is going to work to gain employment for more Americans in heavy industry. Employer insurance will increase the cost of products but it was there once upon a time and we all lived.
many of those heavy industry jobs have been lost to productivity improvements.
 
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tattooguy21

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Aug 14, 2012
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I can't speak too intelligently regarding ACA, because I

1) don't have it
2) will never have it
3) don't pay any penalties for not having it.

But the wife, who is vp of a company for over 17 years, is acutely aware and familiar with it, from both a business and private standpoint.

From a business standpoint, the requirement to insure workers (based on them being full full time/ x number of hours worked a week) gave businesses the loophole to

1) reduce hours for individuals so they didn't meet the requirement to insure them.
2) this reduced wages for employees, resulting in the need for additional jobs and the individual forced into getting insurance via the ACA exchange

For the individuals, they're screwed. Why?

1) limited insurers on ACA (meaning higher prices)
2) you're NOT keeping your dr
3) benefits/plans not a good as those offered to business
4) high premium/ high deductible (yay, you get to pay more on the front and back end
5) people can opt out with "penalty" pay, thus making the pool of people insured even smaller, and more expensive for those in it

At the end of the day, my biggest issue regarding all this was that it was mandatory (with exceptions like me). Isn't this the first time the gov't has said, "you will buy our product or you will be punished."
 
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NationalTitles17

Super Moderator
May 25, 2003
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Mountainous Northern California
Okay, back to actual policy conversations: the fate of the ACA. I feel like the GOP has painted themselves into a corner on this, and I'm not sure how they're going to escape it. They've spent the last 7 years publicly criticizing the failings of the ACA: too many people were left uncovered, many areas of the country have a shrinking number of insurer choices in the marketplace, premiums and deductibles are too high, many plans don't cover what people would want or expect.

And to be clear, I agree with all of that criticism. McConnell and Ryan made the calculus that instead of trying to fix those problems, they would just complain about the law. It ended up being a great political strategy in the short-term, but I've always anticipated long-term repercussions that I think are now starting to manifest.

There is no single GOP replacement plan, but all the proposals are very similar: the ACA was largely funded by increasing taxes on the wealthy, and all the GOP replacement plans roll that back. The result is that their replacement plans actually worsen many of the criticisms the party has leveled at the ACA for years. They result in, at best, the same coverage level as the current ACA; in truth, the vast majority of plans would actually reduce the number of Americans covered with healthcare. And no plan reduces premiums. There are some interesting ideas, like healthcare saving accounts and various forms of rebates, but nothing that actually makes the delivery of care less expensive to the individual. Which is completely understandable when you consider that the major source of ACA funding is removed in all GOP replacement ideas.

Assuming their fundamental tax reform idea will not change, here's how I see their options:

1) Repeal and immediately replace: This will be tough, not only because the party hasn't unified behind a single plan, but also because the political price of telling millions of Americans that they're suddenly off healthcare is pretty steep. Given the chaos in Congress around this option, I don't see it as a likely outcome. Especially given that a repeal vote seems imminent and a replacement plan is nowhere in sight.

2) Repeal and delay a replacement: This will be initially easy, but a terrible burden in the long-term. First, the idea that markets will remain stable in the interim between repeal and replacement has been debunked by every health policy expert. The marketplaces will destabilize, premiums will hike, and GOP congressmen will rightfully start to get tons of angry phone calls from their constituents. It also 100% ties the GOP to formulating and owning a replacement plan. In general, it's easy to have ambitions towards enacting a huge sweeping governmental reform of an existing system (think social security privatization with Bush); but when that ambition fails, as it did with Bush, you can always just walk away and leave the existing system in place. The problem with repeal and delay is that the GOP would never be able to just walk away. They'll be stuck having to find a replacement plan, which is very, very hard. Because of the difficulty, I would anticipate that the delay timeline would be continually pushed back again and again as no consensus gets reached, and piecing together a new healthcare system would become the issue that defines this Congress.

3) Keep the ACA and fix the broken aspects: This is the most reasonable option, and what I've been hoping they would do for years. But politically, this is now impossible. They've demonized the law and promised a repeal for so long that they cannot simply keep and reform it.

4) Repeal and do nothing: Political suicide.
Good thoughtful post. It looks at it all from political aspects. It totally discounts pass and delay of the ACA itself and the fallout from that. No real solution proposed. But it's still a good thoughtful post and I mean that. The R's can't govern and they're about to prove it. They will do no better than the D's.

I think the real need of for the ACA was brought on by:
#1 Loss of major industry that once insured their employees and their families. This is a direct result of NAFTA.
#2 Millions of illegal aliens not being able to get or demand fair treatment from employers or care providers.
I believe that our president elect is interested in solving both of these issues. I also realize that there are many who are worried about what will happen to these people, I am one of those people. With that being said I still can't allow myself to be too bought into the plight of someone who is breaking the law. I realize many of you will think me harsh and frankly brand me as an idiot. I will pray for these people. I will do anything I can to apply pressure to get a smoother immigration policy. That still doesn't mean it is okay to break existing law. I also believe he is going to work to gain employment for more Americans in heavy industry. Employer insurance will increase the cost of products but it was there once upon a time and we all lived.
NAFTA gets all the blame, but you can take one look at the regulatory burden and see that is perhaps more responsible for the problem you site. Trade is good. Free trade is better. But when you price yourself out of the market it hurts.
 

tattooguy21

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Aug 14, 2012
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College .

3) Keep the ACA and fix the broken aspects: This is the most reasonable option, and what I've been hoping they would do for years. But politically, this is now impossible. They've demonized the law and promised a repeal for so long that they cannot simply keep and reform it.

4) Repeal and do nothing: Political suicide.
Regardless of ones feeling on the ACA, at this point, to completely repeal or to repeal and at a later date replace would screw over millions of Americans. Whatever is done would need to be immediate to prevent any gaps.
 

chanson78

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Nov 1, 2005
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Regardless of ones feeling on the ACA, at this point, to completely repeal or to repeal and at a later date replace would screw over millions of Americans. Whatever is done would need to be immediate to prevent any gaps.
So I have a couple questions. These are not aimed directly at you tattooguy21, but you happened to give me a handy jumping off point. I would be interested in anyone's point of view on these.

Aren't the people who are getting ACA now, typically considered people who didn't deserve/need health care by those who were arguing against the ACA? I seem to recall many people saying that it is something that should be a personal responsibility.

If that is the case, and you believe that it would "screw over millions of Americans" isn't it really just bringing it back to the status quo of what it was beforehand?

Considering all of the above, do you believe that the stance of those on the right has sufficiently changes such that health care is something that should be within the domain of the government, or is it more of a perception thing? Now that you have given the poor health care it is too politically costly to take it away now.
 

NationalTitles17

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May 25, 2003
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So I have a couple questions. These are not aimed directly at you tattooguy21, but you happened to give me a handy jumping off point. I would be interested in anyone's point of view on these.

Aren't the people who are getting ACA now, typically considered people who didn't deserve/need health care by those who were arguing against the ACA? I seem to recall many people saying that it is something that should be a personal responsibility.

If that is the case, and you believe that it would "screw over millions of Americans" isn't it really just bringing it back to the status quo of what it was beforehand?

Considering all of the above, do you believe that the stance of those on the right has sufficiently changes such that health care is something that should be within the domain of the government, or is it more of a perception thing? Now that you have given the poor health care it is too politically costly to take it away now.
I understand your point and it's valid, but you are pretending nothing has changed since ACA passed and that no "responsible" person was impacted by the ACA. My MIL, for instance, always carried insurance for a reasonable cost but the premiums sans subsidies have grown to the point she could no longer afford them without big brother's help. I'm amazed by this woman's frugality. There are many others in her position or a similar one. Screwing these people would be bad for everyone involved. I just wish our elected leaders on all sides would have tried to find common ground in the beginning before using tricks to pass a bad law.
 

tattooguy21

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Aug 14, 2012
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Like I said, I'm ignorant too much of it, bit I'll respond to what I can.

So I have a couple questions. These are not aimed directly at you tattooguy21, but you happened to give me a handy jumping off point. I would be interested in anyone's point of view on these.

Aren't the people who are getting ACA now, typically considered people who didn't deserve/need health care by those who were arguing against the ACA? I seem to recall many people saying that it is something that should be a personal responsibility.

If that is the case, and you believe that it would "screw over millions of Americans" isn't it really just bringing it back to the status quo of what it was beforehand? .
The milk has been spilled. We can't act like it didn't happen. Taking away the ACA without something to replace it will have a negative impact on those currently utilizing the system.

Considering all of the above, do you believe that the stance of those on the right has sufficiently changes such that health care is something that should be within the domain of the government, or is it more of a perception thing? Now that you have given the poor health care it is too politically costly to take it away now.
I believe that in a perfect society, everyone gets healthcare. Then I wake up and realize that I could get shot for the color of my skin or decapitated fire my religion and realize ain't nothing perfect. As such, the healthcare plan CAN be made into a better product.

The fix could start by removing state lines (companies currentlycan't sell in certain states because xyz). If you make it easier for them to sale everywhere, then a few companies didn't have a monopoly and prices decrease in favor of the consumer, and then more people join, and more insurers want in....and see where this is going?

I believe that the gov't can work well with PRIVATE industry. Several states have removed the gov't from certain situations (jersey in the 80s-90s with their DOT, cities in Florida with certain utilities) and opened them up to private companies. Why? Because having well built infrastructure is a great idea, but the gov't sucks with all the red tape, bureaucracy, etc of implementing. Versus business xyz, that's bells to a contract, a timeline, a cost, it they're fired and sunshine replaces them. Yay capitalism
 

Tide1986

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Nov 22, 2008
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3) benefits/plans not a good as those offered to business
This may technically be true, by I think you'll find that plans being offered by businesses have been degrading since ACA adoption and converging toward looking like exchange plans. The primary cause? The Cadillac tax and other expenses being loaded up on businesses, which are the key mechanisms of the wealth transfer that is occurring in order to pay for all the goodies being handed out.
 

Tide1986

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Nov 22, 2008
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Regardless of ones feeling on the ACA, at this point, to completely repeal or to repeal and at a later date replace would screw over millions of Americans. Whatever is done would need to be immediate to prevent any gaps.
I assume the so-called "political fallout" will be no more than the fallout that occurred after ACA adoption and implementation, which screwed over millions more Americans than it ended up "helping".
 

Bamaro

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Oct 19, 2001
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The problem has always been that there are some people who are too lazy, cheap or poor to get their own insurance and ready to take the chance that they wont need it. When bad tings happen to some of them, they wind up getting free treatment since they never repay while the rest of us wind up subsidizing their bills through paying higher costs for ours.
 

tattooguy21

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Aug 14, 2012
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This may technically be true, by I think you'll find that plans being offered by businesses have been degrading since ACA adoption and converging toward looking like exchange plans. The primary cause? The Cadillac tax and other expenses being loaded up on businesses, which are the key mechanisms of the wealth transfer that is occurring in order to pay for all the goodies being handed out.
Again, I can't speak intelligently. The wife's company had insurance prior, so they didn't have to play ACA games. She says they did compare in case it was cost/service effective, but saw that it was not, Shi they stayed with what they had.
 

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