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Showmanship and Sales
The Placebo Politics of Healthcare?

The healthcare bill that the House passed this afternoon—and which Donald Trump celebrated in a victory-lap press conference—was for all intents and purposes empty. As the Washington Examiner reports, the Senate is planning to simply craft its own bill from scratch:

Senate Republicans said Thursday they won’t vote on the House-passed bill to repeal and replace Obamacare, but will write their own legislation instead.

A Senate proposal is now being developed by a 12-member working group. It will attempt to incorporate elements of the House bill, senators said, but will not take up the House bill as a starting point and change it through the amendment process.

In other words, the House passage of the AHCA represents the start of the healthcare fight, not the end of it. The final product, if there is one at all, will likely bear little resemblance to the legislation passed today.

President Trump’s Rose Garden performance, along with the cheering of his media allies (Drudge’s homepage banner has a picture of a “Promises Kept” sign at a Trump rally), doesn’t yet reflect a real policy victory. It looks once again that Trump is engaging in another display of placebo politics—an attempt to make his constituents feel like they are winning without massive upheavals to the status quo.

But there is a further canniness to this strategy. By taking a victory lap, Trump has increased the sense of momentum, and has ratcheted up pressure on any Republican Senators (and later, once again, House Republicans) to not stand in the way of a “win”. But at the same time, legislators by now know that Trump is not a details guy; he just wants a win to sell to his constituents. He is confident in his skills as a salesman. After all, they have served him well thus far.

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  • Andrew Allison

    “The healthcare bill that the House passed this afternoon—and which Donald Trump celebrated in a victory-lap press conference—was for all intents and purposes empty.” was obviously written by a product of today’s so-called “higher education”. A literate version might have read: The healthcare bill that the House passed this afternoon—which President Trump celebrated in a victory-lap press conference—was, to all intents and purposes, meaningless.” Whether or not it was meaningless remains to be seen. At the end of the day, both houses need to agree upon something which the President will sign. As a reminder to the TAI management and staff the convention is, and courtesy demands, that the first reference to the President in a commentary include his title.

    • ljgude

      Andrew, I find the journalists over at The Federalist are doing a better job of reporting what Trump is actually doing and failing to do while retaining their ability to critical analyse those actions. “for all in tents and purposes empty” – really who does TAI think they are? The New York Times? I for one read TAI precisely because it usually does a much better job at avoiding incontinence than the propaganda media.

      • Andrew Allison

        It’s subtle form of TDS (Trump Derangement Syndrome).

        • ljgude

          I am saying that I believe ‘subtle TDS’ is precisely what the Federalist avoids. But perhaps you are referring to TAI’s not always so subtle TDS? I continue to read TAI because I understand that academics – even rare right of center birds like WRM – are thinkers and pretty well blind to intuitive types like Donald who have spent their lives turning their hunches into pots of gold rather than their thoughts into piles of paper. Compared to the entirely fictive TDS that dominates 90% of the commentariat, WRM and Co is still excellent value to me. Besides if Trump is getting as much right as he appears to be to me, then it will be very entertaining to watch the thinking types at TAI come to their senses well in advance of their illegitimate brethren in the propaganda media.

          • Andrew Allison

            I was referring to TAI, and entirely agree with your sentiments.

      • D4x

        A fine label: “the propaganda media”. The Federalist has the advantage of a different mission and different ideological foundation than TAI. However, TAI has a better commentariat, no trolls, and this website works so much better.

        Americangreatness.com shows great potential https://amgreatness.com/2017/05/05/trump-laughing-establishment/

  • Arkeygeezer

    “…the House passage of the AHCA represents the start of the healthcare fight, not the end of it. The final product, if there is one at all, will likely bear little resemblance to the legislation passed today.”

    I wouldn’t bet on it. So far, TAI’s predictions of President Trump’s effectiveness have been very wrong. I don’t thing that your track record is going to improve on the AHCA battle.

  • ——————————

    “Senate Republicans” can say a lot of things, but they mean very little at this time. Trump has achieved what he wanted at this point, and will get a good part of what he wants with it in the end.

    You don’t achieve what he has in life (including taking the presidency away from the the well capitalized and politically entrenched Clinton machine), without being extremely insightful and savvy.
    This sky-is-falling article was obviously written by someone who is not….

    • We have certainly smashed the “Trump can’t work with Congress” meme.

      So far Trump has done a great deal more for conservatism than real conservatives have since Reagan. That’s kinda pathetic but he’s certainly exceeding expectations at this point. I like his style. It’s not “normal” but “normal” has a mightily poor track record.

  • MarkE

    On another site, a list of Obama Care associated taxes repealed add up to $1 trillion. It is amazing how little benefit the country received from the $1 trillion tax. Also it has been broadly suggested that these tax cuts will stimulate the economy even if “tax reform” isn’t achieved in the near future. Both observations may recruit more Senators than you think to some version of the House Bill.

  • FriendlyGoat

    Now would be a good time for people to realize that the real Republican goals with health insurance are 1) the repeal of national policy standards for all plans, including both individual market and group, 2) an arrangement where the policy standards approved in ANY one state are forced on the market in ALL states. The competition is to be between legislatures and insurance commissioners to see which state can politically produce the worst (cheapest) insurance for employers to buy in all states. This never changes.

    • seattleoutcast

      Well, everyone I know now has the worst insurance thanks to Obamacare. As I’ve told you, a friend of mine is now in debt thousands of dollars because Obamacare screwed him over.

      The sooner you realize this is greater than partisan politics the sooner you will see what is really happening. Crony capitalism involves both sides of the aisle, not just the republicans. It’s a shame you can never see that.

      • FriendlyGoat

        I’d need to know exactly HOW the PPACA “screwed over” your friend, and compared to what realistic other outcome was likely for him/her with no PPACA. What I “know” is that insurance for profit HAS TO make money for the insurer, that not-for-profit insurance has to break even except to the extent we socialize and subsidize it, that employers are constantly seeking to control or reduce costs, that people are gullible about under-insuring themselves with cheap policies and that we are silly to invite cheapie coverage to be offered in either groups or individual markets. It’s great as long as “nothing happens”, but when a person is seriously ill or injured is NOT the time to be discovering that the fine print has forty gotchas.

        • Sounds good in theory, but it creates insurance with $12k annual premiums with $12k deductibles. That’s insurance you’re supposed to buy but can never afford to use.

          The real question is not the insurance terms but why medical care is so expensive. It is so expensive that I would not feel bad at all about stiffing an emergency room if I had no insurance. $100,000 hospital stays for a few days? That’s insane. That’s as much as a house (admittedly not in the best area here in Miami) you can live in for an entire lifetime.

          • FriendlyGoat

            Well, you’re right about the costs. I’m gonna be a little silly here, but for a serious purpose. We could try deregulated medicine. No licensing of doctors. Very short or no patents. No lawsuits no matter what. Very (very) stiff income taxes on incomes north of $200k. No direct-to-consumer advertising of drugs. No “networks” where providers agree to secret pricing—–discounted from what they would charge at retail. Just sayin.

            You might wonder about the idea of stiff income tax. I wonder why we have some 2700 officers/executives of not-for-profit (not-for-profit) organizations who are receiving over $1,000,000 per year in compensation with a LOT of those in the medical field. See:

            https://nonprofitquarterly.org/2017/03/08/million-dollar-compensation-nonprofit-ceos/

          • Well, I tend to think that if people do a good job, they should be compensated with some reasonable degree of generosity. And of course that income tax on $200k plus incomes would reach people totally unrelated to the medical field, so it seems like a meat axe to do what a scalpel could do better.

            Other than the tax, I actually like your program and would like to see something similar implemented. Especially the secret pricing part. I think that a patient, if conscious, should have a right to know how much he is being charged for what services. The medical establishment should not have a right to pile up the bill without giving the patient some idea of what is happening.

            There is an interesting new product called Blink Health that lets you get insurance style negotiated prices for medications without actually having to buy insurance – you just pay as you go. I was afraid it was too good to be true, but it worked at my Publix pharmacy in West Palm Beach. I think it’s a really great idea and more people should be aware of it. blinkhealth.com/i/EIGPIX gets you started.
            (Note that although this is an affiliate link, this content is entirely appropriate to the message being responded to.)

          • FriendlyGoat

            Thanks for the blink link. Six months ago, my wife and I hit 65 and went to Medicare (advantage plan with drugs incl). Pleased to report for now that her meds are generic and cheap to both us AND to the plan’s part, and we otherwise have no claims. I’m just telling you that as a chance to say we’re thankful to have insurance and thankful to not be costing it money.

  • Angel Martin

    Trump had Ryan pull the health care vote in March to “show them the downside”. That is, they gave the Congress a month to gauge the reaction of failing to repeal Obamacare after all the votes to repeal, campaigns etc.

    Ridicule, accusations of failure and declining poll numbers concentrate the minds of politicians…

    The same dynamic is in place for Repubs in the Senate. They all voted umpteen times for repeal and featured it in their campaigns etc.

    One other point, if you watched the vote live, there were two Democrat votes at one point, which were pulled off the board after the Repubs got to the winning number. It is also clear that endangered moderate Repubs got a pass if their vote wasn’t needed.

    I don’t think this vote was as close as it appeared.

    • ——————————

      I was watching live and also saw the 2 Dem votes. When they switched those 2 votes in the last few minutes as it became clear that the Repubs wouldn’t need them, I knew they were just negotiated backup votes in case they were needed.

      The art of the deal….

  • Pait

    The tactic must be to have it die in the Senate and then blame Democrats.

    I am sure a good number of Republicans – not all! – know that they are lying about the plan, that many voters will lose insurance. Some also know that they can lie with impunity in campaigns but that lies will not pay for their voters’ insurance.

    I suspect that their tactic will be successful though. The so-called president will sabotage Obamacare, they’ll blame the Senate Democrats, and survive the next election.

    They will destroy the country but they don’t care.

    • ——————————

      Such bitterness.
      Let’s give it some time and see how it works out. The Dems slammed the original ACA through without Repubs being involved…mistake. Now the Repubs are involved.
      After this gets through the Senate, the Dems and Repubs will have the next many years to tweak it and refine it as it goes along.

      Actually we just had a “so-called president” for the last 8 years…and he has already destroyed the country.

      It can only get better from here….

      • Pait

        Yes, it may get better for the people who get a tax windfall at the expense of those who lose health insurance. For a short time, while the damage works its way to national peace and security….

        • Isaiah601

          We may go to the dark days of 2009, when people were dying on the streets.
          Pro tip: over the top hyperbole may make your TDS tingle, but it really is not helping your argument.
          think of a smelly bum on a subway screaming the world is over. Not very effective, now is he?

          • Pait

            Are the people who post under anonymous references to bible chapters that don’t even exist all the same person, or is it a common practice of the otherwise impious meant to claim credentials while hiding their identity when trolling?

            http://www.usccb.org/bible/isaiah/601

          • Isaiah601

            Perhaps you are not as smart as you think you are.
            Isaiah 60:1
            http://biblehub.com/isaiah/60-1.htm
            Arise, shine; for thy light is come, and the glory of the LORD is risen upon thee.
            But good way to deflect and not answer my point. Pretty obvious ploy, but i admire the effort. So who’s ready to return to the dark days of 2011, before Obamacare was in effect. People were lying on the streets, dying for lack of healthcare. Is that what you recall happening?

          • Pait

            If you are looking for guidance in the Bible, and so few of those who hide behind it do, then you might find a more topical guide in 58:6 and 7.

            Is not this the fast that I have chosen? To loose the fetters of wickedness, To undo the bands of the yoke, And to let the oppressed go free, And that ye break every yoke?

            Is it not to deal thy bread to the hungry, And that thou bring the poor that are cast out to thy house? When thou seest the naked, that thou cover him, And that thou hide not thyself from thine own flesh?

          • Isaiah601

            Once again, you are ignoring my point that nobody was dying on the streets before Obamacare and nobody will be dying on the streets after its repeal.
            As for the Bible, everyone is free to learn whatever lesson they want. If you want to subsidize the lazy, go right ahead. My kids’ college fund is infinitely more important to me than yet another harebrained wealth redistribution scheme masquerading as health care.

          • Pait

            That’s a very low standard, not dying in the streets. I believe most Americans aspire to something better. If that’s all you want, then there’s little point debating.

            And if all you care is about your trust funds, I do hope you make a lot of money. To spend it all on doctors.

          • Isaiah601

            I have employer based insurance. See, I’m employed. I actually pay for my own stuff, as opposed to asking others to pay it for me. Radical, no?
            As for what I want in terms of healthcare for the masses, as long as you are the one paying for it, I want the best. Once i start paying for it, the bare minimum will just have to do. Sorry, if you are lazy and make bad decisions, you have to live with bad consequences. Them’s the breaks.

          • Pait

            Your answer is beautiful. It encapsulates everything in the minds of the House Republicans.

            They really should all state things as clearly as you do. The voters will love it.

            Once again, thank you for being so clear. It justifies the time spent trying to understand your opinions.

          • Isaiah601

            Thank you. My answer is also an honest one that 99% of the people will give. Everybody is generous with other people’s money. When it comes to their own money, people are a lot less willing to spend it on others. It’s called human nature.
            But like I said, feel free to take homeless into your home, offer to pay for other’s doctors visits and such. Just don’t expect me or anyone else to join you. Also, stupid and lazy bad decision makers always end up with bad outcomes. I wasn’t aware stating an obvious truth would be a bone of contention. If you want equality of outcomes, go to Venezuela. They achieved that equality there.

          • Pait

            It is very honest, I appreciate that.

            The goal of the repeal is to let people who lose jobs, and those who fall sick and are unable to work, go without medical insurance until they lose all their assets and qualify for poverty assistance. Next goal is to repeal Medicare and remove that assistance.

            If the Republican party made this as clear as you do, then we would have a much more honest and simpler debate. Thanks again!

          • Isaiah601

            Repeal Medicare? See, this is your derangement syndrome talking again. nobody is proposing that. Nobody is proposing a repeal to Medicaid either. The problem with all derangement syndrome sufferers is that you and people like you don’t look at the facts bur rather at what your biases need the facts to be. Republicans have horns. Therefore, they are for repealing Medicare. Evidence? You don’t need no stinkin’ evidence. you have your belief.

          • Pait

            Sorry, that was a typo. I meant repeal (or as a provisional measure restrict) Medicaid. Thanks for pointing it out, I corrected the statement.

            Once again, thanks for spelling out clearly what the end goal of the Obamacare repeal is.

          • Isaiah601

            So are you saying the goal of Obamacare is to create an equality of outcomes? No wonder it has been such a dismal failure.
            Oh look, here’s another Obamacare provider that wants to hike rates 50% in a year. I can guarantee that this bit of information will not be processed by you, since your biases will prevent it from penetrating the brain matter.Let’s see if I’m right.
            https://www.washingtonpost.com/news/wonk/wp/2017/05/04/one-of-marylands-biggest-obamacare-insurers-wants-to-hike-rates-50-percent-next-year/?utm_term=.e65a31b203f1

          • Pait

            The goal of Obamacare is to make sure that people who lose their job or their health don’t have to go without insurance.

            The goal of the repeal is to let them go without insurance, unless they are independently wealthy. You articulated it very clearly. Don’t spoil your record by overexplaining.

          • Isaiah601

            Well, if that is the goal of Obamacare it has failed spectacularly. Good intentions are not enough.

          • Angel Martin

            “Are the people who post under anonymous references to bible chapters…”

            I think I am going to start posting under the handle “Romans1:21”

            “For although they knew God, they neither glorified him as God nor gave thanks to him, but their thinking became futile and their foolish hearts were darkened.”

            Seems appropriate considering some of the audience.

        • ——————————

          Look, this ACA is way too complicated for any one side to have all the solutions…and I am sure you know that…I would hope anyone would, no matter what side of the isle they are on.
          As I said in my previous comment;
          “After this gets through the Senate, the Dems and Repubs will have the next many years to tweak it and refine it as it goes along.”…and that is what will happen…fact….

          • Pait

            Yes, it is very complicated, as everyone who followed the discussions at any time in the past 20 years knew.

            Which is why the House repealing Obamacare without leaving time for any serious discussion and without waiting for a analysis by the competent congressional offices is an act of bad faith.

          • ——————————

            Both sides act in “bad faith” all the time…that is politics…just like each side does what they can to make the other look bad, etc. I look past all that nonsense, and find it amusing at times.

            My point is that this ACA will all work out in the end (as best as could be expected from government), and both sides will have at it for years to come.

            There will be winners and losers, as with anything, but no one will be dying in the streets….

          • Pait

            As you wrote it is all very complicated. It is also a matter of life or death for people who happen to get sick

            The cavalier attitude “it will all be fine in the end” is neither supported by your arguments nor otherwise justified.

          • ——————————

            It will all work out in the end…another fact.

            And your disquiet and mean-spirited attitude about the Repubs being liars, the party that does what it can to harm voters, people will be dying in the streets, etc., is not supported by your arguments and is also not justified.

            Unfortunately you had to go down the typical lefty dismissive road…I was shocked you lasted this long….

          • Pait

            I have to violate the rule “let the troll have the last word” by noticing how you explicitly state that a discussion is a game where the goal is to outlast the other side. The admission that no rational good faith discussion is thus possible ends the conversation.

          • ——————————

            Oh, so now I am a troll!
            And “I explicitly state…”?

            More leftist dismissive commentary.
            At least I can have spirited yet civil discourse with FG.

            I believe that those who come here to read will read through our exchange and see who is the level- headed and who is ad hominem….

        • seattleoutcast

          Many have already lost their insurance. You refuse to see it.

          • Angel Martin

            Not only have many lost their insurance, but whole states have lost all their insurers.

    • Anthony

      Two fold argument that I’ve considered: 1) the republican base needed to see a win (placebo0 no matter the final outcome of the AHCA legislation – and this is 1st time in my memory that u.S. House Members gather in Rose Garden after Bill has passed only one legislative body (a photo op of success – placebo perhaps); 2) there are certainly Republican Congressmen who are craven enough that facts and country are secondary considerations to short-term political point scoring if it briefly (ostensibly) satisfies 7 years of Obamacare futility (placebo again perhaps).

      • Isaiah601

        Craven enough? you mean like all those Democrats lying about keeping your plan and your doctor?
        I guess that was done by the right people, so it doesn’t count.

      • Pait

        You’re right, but remember that the Party benefits from fighting for and approving bills that harm voters as long as they can serve the purpose of maintaining their lies – that’s why they wish to speed things before a congressional report on the consequences. Some congressmen actually believe the lies they tell, but many realize that if the bill actually becomes law, people will lose insurance – voters will notice the facts rather than keep believing the propaganda.

        • Isaiah601

          Insurance doesn’t equal health care. You seem to not get that point.

          • Pait

            Health care is expensive. If you are sick and not rich, you cannot afford health care without insurance.

            I suppose many wealthy and healthy people don’t understand that. Or pretend not to. It is a very simple point.

          • Isaiah601

            If you are sick and not rich we have Medicaid. So while I get the point, we also have a program that deals with JUST THAT situation.

          • Pait

            Which is of course why the House bill opens the way to sharply cut Medicaid.

          • Isaiah601

            Well, that’s the thing about not having infinite resources. You have to pick and choose. You can’t just expand things indefinitely. I see no problem to rolling it back to the level of 2011, before ACA took effect. I don’t remember anyone dying on the streets.
            In short, that’s the problem with all voter buying schemes. You run out of money a lot quicker than you think.

          • seattleoutcast

            Health care is expensive mainly because of subsidies. It’s a simple economic fact that is easily provable if you look at the history of medicine since government involvement in the 1960s. This is a progressive tactic–ruin something and say we need more government involvement to make it better.

        • Anthony

          The CBO scores next week but it’s not the lies Pait (regrettably that’s the representation many desire); The Party as you imply is generally bought and paid for, I agree. Yet, speeding things up won’t change the reality – we don’t know how the AHCA will be changed or whether it even becomes law. Still, the current piece of legislation guarantees to hurt millions if enacted as written (which is an improbability). Thursday’s vote brings to the public’s eye just how craven our politics has become – maybe voters you reference will began to pay attention to the costs of such politics.

          • Pait

            Brings to the public’s eyes, yes. The problem is that many don’t want to see. If and when it becomes law, it will be harder for them to ignore.

          • Pait

            Look at what prophet Isaiah wrote in the other thread here:

            “I have employer based insurance. See, I’m employed. I actually pay for my own stuff, as opposed to asking others to pay it for me. Radical, no?

            As for what I want in terms of healthcare for the masses, as long as you are the one paying for it, I want the best. Once i start paying for it, the bare minimum will just have to do. Sorry, if you are lazy and make bad decisions, you have to live with bad consequences. Them’s the breaks.”

            I wish all Republicans should always be that clear. “I can afford. Owe to those who cannot.” The arguments would become much simpler. Why do we waste time debating?

          • Anthony

            I suggested to FriendlyGoat unless you enjoy the banter and have the time to waste, “don’t waste time debating.” Instead, I suggested that one ought to be adamantly curt to any that opt to becloud. That said on the other hand, you can handle yourself.

            Here’s something apropos from Abraham Lincoln: “if we could first know where we are, and whether we are tending, we could then better judge what to do and how to do it.” Waste time sparingly Pait.

          • Pait

            My point is that in this case it was worth while – I had never seen the pro-repeal position articulated so clearly by its defenders.

            The goal of the repeal is to let people who lose jobs, and those who fall sick and are unable to work, go without medical insurance until they lose all their assets and qualify for poverty assistance. Next goal is to repeal Medicaid and remove that assistance.

            If all Republicans said that clearly, we’d save a lot of time discussing.

          • Anthony

            Oh, I got your point and FG has made it similarly with your antagonist. But, what’s said anonymously (as you always state) will only hesitantly if at all be said in view of a witnessing public. So it’s safe to say it online or so it’s presumed – the online discussing provides entertainment and veiled venue.

      • Angel Martin

        “there are certainly Republican Congressmen who are craven enough that facts and country are secondary considerations to short-term political point scoring…”

        If you think this sort of behavior is confined only to “Republican” politicians – that explains a lot

        • Anthony

          Too simple and subjective a conclusion on very little content, Martin.

    • Isaiah601

      Your bitter tears are still yummy. President Trump is running circles around Democrats who just spent the past month saying that not passing the replacement is the worst thing in the world. Now the replacement is the worst thing in the world. Unless a person as TDS addled as you are, it will be impossible not to notice the 180% turn.

      • f1b0nacc1

        I suppose that this is the part where we see our enemies driven before us and listen to the lamentations of der wimmen?

        Not tired of winning yet…

        • Isaiah601

          That’s the thing about winning. You never get tired of it.

        • Angel Martin

          ” the lamentations of der wimmen? ”

          Who dat ? Chelsea Manning ? Kaitlin Jenner? Chaz Bono ?

          • f1b0nacc1

            I stand in awe of that one….you win the thread!

    • seattleoutcast

      But many have lost insurance due to high premiums and high deductibles. It’s a shame you can’t see beyond your partisan viewpoint.

      • Pait

        Most congressmen know this is a lie. You probably do as well. They can keep saying unless and until the repeal of Obamacare becomes law. If and when it does, then people will lose insurance for a fact, rather than as anecdotal fiction.

        Which is why I believe that the House repeal is a tactical ploy, and the “victory laps” were taken before a Senate vote.

  • Eurydice

    Well, the thing about showmanship is that it forces the audience to pay attention. Everyone, whether left or right, has known that Obamacare has problems and can’t continue in its current form but the partisanship reduced the argument to all or nothing – either Obamacare is evil or it’s sacrosanct. It’s taken a bull in the china shop to get Congress and the parties to wake up and start doing their jobs.

  • Jacksonian_Libertarian

    Placebo? I’m thinking this sounds like sour grapes. What little Obama could claim as a Legacy, is already being sh_tcanned.

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