Category Archives: medical news

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So many lessons to learn from health care failure

Where in this world does one start to sort through the wreckage created by the Republican failure to repeal the Affordable Care Act and replace it with … something else?

Most of know the story by now. Donald J. Trump got elected president and promised to “repeal and replace” the ACA. Congressional Republicans, having retained control of both legislative chambers, finally had a president on their side. Repeal and replacement were slam dunks.

Or so they thought.

Then they cobbled together something that didn’t pass conservative and progressive muster. They couldn’t round up the votes to repeal the ACA, let alone approve something called the American Health Care Act.

Arm-twisting, threats and last-second negotiation resulted in the president’s first major legislative failure. House  Speaker Paul Ryan — a partner with the president on this fiasco — canceled the vote today.

Lessons learned here? Let’s take a peek at some of them.

* Trump bitched today at the White House that he had “no Democrat votes.” Really! He said that out loud to a room full of “enemy of the people” reporters. Well, irony apparently isn’t something that’s on Trump’s radar. President Obama didn’t have a single Republican vote when he got Congress to enact the ACA in 2010; but he damn sure tried to get some GOP support.

* Trump campaigned for the presidency on his record as a take-no-prisoners business mogul. He had no public service experience prior to running for president. His whole adult life had been geared toward personal enrichment. Then he discovered something about politics: It is that politicians have their own constituencies to worry about. If the voters who elect them don’t like what they’re doing, they have this annoying habit of voting them out of office.

Congressional Republicans didn’t like the AHCA because their voters back home didn’t like it. Do you get that, Mr. President? Your Republican colleagues don’t work for you; they work for the citizens in their congressional districts and in their states.

This ain’t reality TV, Mr. President. Politics is practiced by those who know what the hell they’re doing. Just because you’re the president doesn’t mean you get your way whenever you demand something of others.

* The ACA isn’t perfect. I’ll concede that along with anyone with half a brain. But as Speaker Ryan conceded today, it is “the law of the land.” Here’s a thought for the speaker and for the president: Why not try to tinker with the ACA? Fix what’s most egregiously wrong with it. If premiums are costing too much, find a method to cap them. If Americans are having trouble finding medical care within certain networks, find a way to streamline the process.

Throwing out a landmark health insurance overhaul simply because it was the creation of a president from the “other” party isn’t smart. What’s more, the ACA is patterned after a plan adopted in Massachusetts, which at the time was governed by a real Republican, Mitt Romney; you remember him, correct? The ACA in fact has Gov. Romney’s fingerprints all over it.

Ryan said today that “doing big things is hard.” No kidding, Mr. Speaker. Barack Obama learned that lesson, too. Indeed, as Vice President Joe Biden once said, “This is a big f****** deal.”

So … the Affordable Care Act remains on the books. Now the president and Congress can turn their attention to something else.

I just hope there aren’t more screw-ups on the horizon.

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Trump tries to stampede GOP into replacing the ACA

I think I understand what Donald J. Trump is trying to do to persuade his Republican colleagues in Congress to repeal the Affordable Care Act.

The president said a vote on Friday is the drop-dead event. If House of Representatives Republicans do not have the votes to enact the GOP alternative, then that’s it.

The Affordable Care Act will stand. President Barack Obama’s signature domestic policy initiative will remain. The president will move on. He’s done negotiating.

Don’t you get it?

Trump is now trying to persuade balky Freedom Caucus Republicans to vote for the American Health Care Act, or else face the prospect of failing to deliver on the president’s top-drawer campaign promise.

Will he do it? I have no clue. Whether he goes through with his threat likely depends on whether someone gets his attention long enough to persuade him to keep up the fight.

The AHCA is not an improvement over the ACA. The Congressional Budget Office says the AHCA will throw 24 million Americans off their health care plans. GOP lawmakers have been hearing from their constituents for weeks now about how much they hate the Republican alternative to the Affordable Care Act.

Trump throws down the gauntlet

Now it has come down to whether House Republicans actually care enough about health care “reform” to enact an alternative to what’s already on the books. It’s also an open question about whether the president actually cares about health care — at all!

Does he want to enact an actual improvement over the ACA or does he simply want to replace a health care plan promoted and pushed forward by his immediate predecessor? Does he really care about what the alternative contains?

Trump said he is done negotiating with his fellow Republicans. Either pass what’s on the table, he is saying, or we’ll just forget the whole thing.

What a way to lead.

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GOP turns tables on Democrats

John Boehner was a year away from becoming speaker of the U.S. House of Representatives in 2010, but he stood on the floor of the House to express his intense anger at his Democratic colleagues.

They were rushing the Affordable Care Act into law, the then-House minority leader declared. Democrats were shoving this “down our throats,” he hollered. He bellowed that no one had “read the bill!”

The ACA passed with no Republican votes.

Now the GOP is in charge of Congress. Boehner became speaker in 2011 and served until 2015. Republicans sought to repeal the ACA many times during Boehner’s tenure. They failed.

Now it’s Paul Ryan’s House. Speaker Ryan is working with a Republican president to enact something called the American Health Care Act.

What is the GOP strategy being mapped out by Ryan and Donald Trump. Why, they’re trying to rush this to a vote. They’re trying to “shove this down the throats” of conservative lawmakers who oppose it. They aren’t bothering to persuade Democrats, who are lined up en masse to oppose the AHCA, just as the GOP locked arms against the ACA in 2010.

Is it good enough now for Republicans to do the very thing they accused Democrats — with good reason, candidly — of doing?

Of course it isn’t!

The president declared that repealing and replacing the ACA was his top priority. The House was supposed to vote tonight on the AHCA. Ryan backed away from the vote. It’s now scheduled for Friday.

The president says a Friday vote — up or down — will be the end of his negotiating a replacement for the ACA. He said today he’s going to “move on” to other issues. Whether he does will depend on who gets to him. Trump does have this way of changing his mind.

Has there been sufficient comment and analysis on this Republican alternative to ACA, which was trotted out less than a month ago?

Nope. Not even close.

One difference between now and 2010: You aren’t going to hear the current House minority leader, Democrat Nancy Pelosi, screaming on the House floor about not having enough time to consider this health care insurance replacement. Rep. Pelosi is actually chuckling at what she calls the president’s “rookie mistakes.”

That’s the major difference. The tactics of today’s Republicans certainly resemble those employed by yesterday’s Democrats.

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Picture speaks volumes about nature of health debate

This might be the most instructive picture taken during Donald J. Trump’s still-young presidency.

It cracks me up!

The picture shows a collection of individuals gathered around a White House conference room table. The topic at hand? Women’s health issues and whether the Republican-sponsored health care overhaul — the American Health Care Act — would cover certain aspects of health issues germane to women.

Pop quiz: Who is absent from this White House meeting.

Time’s up. The answer? Women. There isn’t a single woman present in this meeting of middle-aged men who are talking about whether the AHCA should include women’s health matters.

Media reported today that the white guys stood and gave Trump an ovation as he entered the room. I guess they were offering a show of respect for the president of the United States.

The person who should have gotten an even bigger round of applause would have been any female member of Trump’s policy team.

I have to wonder: What in the world would any of the people in the picture — even those who are actually married to women — bring to any serious discussion about women’s health?

They use a word in Washington to describe how certain gatherings appear to those who see them: They call them “optics.”

The optics of this meeting were stunning.

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Everyone has a limit, right, Sean Spicer?

Every man or woman — even White House press secretaries — would have their limits on the dissembling, confusion and outright lies with which he or she must contend.

Isn’t that right, Sean Spicer.

The current White House flack came to the podium today and declared that the House of Representatives would vote tonight on the American Health Care Act.

Then word came out that, nope, ain’t gonna happen — tonight! It’s been delayed. House Republicans are still trying to gather up enough  votes to send Trump/Ryancare to the Senate, where it faces an even less friendly pool of politicians.

Chaos, anyone?

It’s fair to wonder out loud about Sean Spicer, a man for whom I’m beginning to develop a certain level of sympathy. How much more of this can he take? How much longer will he be able to defend a president’s policies and the seat-of-the-pants process that produces them?

I don’t know much about Spicer, other than he served as Republican National Committee press secretary before joining the White House flackery machine.

Still, is this guy reaching his limit?

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Trump the ‘deal-maker’ faces grievous setback

Donald J. Trump told us — many times — during the 2016 presidential campaign that the greatest skill he would bring to the presidency would be his ability to close the deal.

He made a fortune working out the “best” deals in the history of business … he said.

Here we are. Trump is now the president of the United States. He promised to “repeal and replace” the Affordable Care Act with something more “affordable” and that no American would be left without health insurance.

Trump and congressional Republican leaders have produced something called the American Health Care Act. But there’s this little problem with it.

The Congressional Budget Office’s “scoring” of it pegs the number of Americans who would lose health insurance at 24 million. What’s more, the conservative Freedom Caucus in the House of Representatives hates the AHCA. They call it “Obamacare light.”

So do congressional Democrats. No surprise there.

Crucial vote coming up

The AHCA goes to a vote Thursday in the House. Freedom Caucus members aren’t budging. The president went to Capitol Hill to pitch the AHCA. He threatened some House members that they’d lose their seats in 2018 if they oppose the bill.

Freedom Caucus leaders say they now have enough votes to kill the AHCA. Which means that a Senate vote won’t matter.

Wasn’t this supposed to be the president’s main selling point? Is this how he closes the deal?

The Affordable Care Act, which has brought 20 million Americans into the health insurance system who previously couldn’t afford it, appears to much harder to “repeal and replace” than Donald Trump predicted it would be.

I will await the president’s response to what appears to be a stunning political setback in the making. I’m wondering if he’s going to say the House vote was “rigged.”

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It’s his fault, no … it’s his fault, no …

I don’t know whether to laugh, curse or slap my forehead over what I perceive is transpiring in Washington over the development of this so-called “replacement” of the Affordable Care Act.

House Speaker Paul Ryan and his troops want to call it Trumpcare; the president’s allies want to label it Ryancare.

No one wants to touch the American Health Care Act with a hot poker.

The Congressional Budget Office has given the AHCA a bad “score.” Donald Trump’s budget director says the CBO’s numbers are faulty, that 24 million Americans really and truly won’t lose their insurance if the AHCA becomes law.

Meanwhile, Speaker Ryan is having to fend off the TEA Party wing of his Republican congressional caucus, because they hate the AHCA almost as much as they hate the ACA, which they say was forced down their throats in 2010 by President Obama and those rascally congressional Democrats.

Trumpcare or Ryancare? How about Tryancare?

It doesn’t matter what you call it. The GOP had seven bloody years to come up with an alternative to the ACA. The Republicans were too damn busy trashing the initial health care overhaul and its author — Barack Obama — that they didn’t give nearly enough thought to how they would actually replace it.

Now they have something that no one on their side seems to favor.

I’ll give Republicans credit, though, at least for their “diversity” of thought on this issue. Some of ’em like the AHCA, some of ’em hate it. Isn’t there some middle ground to be discovered here?

I think I know what I want to do. I’ll say a few curse words … under my breath, of course.

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ACA just might survive GOP in-fighting

The Affordable Care Act has been called as good as dead, a goner, a “miserable failure.”

The Republican majority in Congress fought it tooth and nail for the past seven years. Then a Republican got elected president in 2016 and the GOP became downright giddy at the prospect of repealing the ACA, President Barack Obama’s chief domestic achievement.

Then it happened.

The Republicans cobbled together something called the American Health Care Act. Then they sent it to the Congressional Budget Office for some “scoring.” The CBO then delivered some numbers the GOP didn’t want to hear: 24 million Americans would lose health insurance, the CBO declared.

The GOP’s response? The CBO doesn’t know what it’s talking about, congressional leaders said.

But isn’t the CBO the gold standard for determining these matters?

Now the TEA Party wing of the GOP is rebelling against the AHCA. It’s “Obamacare Light,” they say. They hate the AHCA. Of course, they hate the ACA even more, which is no surprise, given that a Democratic president happened to be its founding father.

Oh, and Democrats? They’re unified against any effort to repeal the ACA and replace it with something that relies heavily on “tax credits” for Americans to buy insurance; Democrats call it code for “tax relief for the wealthiest Americans.”

Which brings me to this point: If the Republican Party’s congressional elders cannot come up with an alternative to the ACA that all its members can endorse, can this party actually govern?

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CBO numbers are in: not good for AHCA

Donald Trump promised that no one would lose their health insurance under a re-crafted plan to replace the Affordable Care Act.

The Congressional Budget Office’s verdict? Wrong, Mr. President!

There goes a major campaign promise.

As predicted, the Trump administration dismisses the CBO report, which is supposed to be the gold standard in determining the fiscal viability of sweeping, landmark public policies.

The CBO projects that 24 million more Americans will lose their health insurance by 2026 under the American Health Care Act. Not good, right?

Health and Human Services Secretary Dr. Tom Price — a leading critic of the Affordable Care Act — says the CBO report is incomplete and inaccurate. Well, of course he would say that.

As the New York Times has reported: “The much-anticipated judgment by Capitol Hill’s official scorekeeper did not back up President Trump’s promise of providing health care for everyone and was likely to fuel the concerns of moderate Republicans. Next year, it said, the number of uninsured Americans would be 14 million higher than expected under current law.”

The president has said “no one” would lose their health insurance. If it were anyone else, I would stand and applaud such a declaration. The problem, though, with this president is that I cannot trust that his word is true, that he’s actually speaking from his heart.

I just do not know any longer when or whether he’s telling the truth.

Therefore, I shall rely on the analyses of others, such as the CBO.

***

One more point …

The White House doesn’t want the AHCA to be nicknamed Trumpcare, much the way the ACA was given the name of President Barack Obama, who signed the ACA into law in 2010 and has become identified as the former president’s signature piece of domestic legislation.

Well, too bad. Trumpcare it is!

The Republican leadership in Congress has crafted it. The president has signed on to it.

Let’s hang the president’s name on it.

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Politics, the art of the payback

The game of politics can be called the game of payback.

Consider the process that has produced something called the American Health Care Act, the Republican-sponsored overhaul of the Affordable Care Act, which the GOP faithful says it wants to repeal.

In 2009, Republicans griped themselves hoarse over the way congressional Democrats “shoved the ACA down our throats.” They bitched that Democrats crafted the ACA in the “dead of night” and then, using their then-congressional majority, got it approved without a single Republican vote.

Fast-forward to 2017. Republicans now are in charge. They control Congress and one of their own occupies the White House. What do they do? They produce the AHCA also in the “dead of night” and then they try to cram it down Democrats’ throats without knowing how much it’s going to cost.

You see, the Congressional Budget Office — the non-partisan agency — hasn’t “scored” the AHCA. We don’t know how much impact it will have on the annual federal budget deficit.

Was it wrong for Democrats to flummox Republicans with a health care overhaul? Sure. Is it wrong now for Republicans do essentially the same thing to their “friends” on the other side of the aisle? Absolutely.

This is yet another demonstration of how much of a contact sport politics can become.

As for the CBO “scoring” of the AHCA, how about waiting to see how much it would cost Americans before putting it to a vote?