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Republican Health Care Policy In A Nutshell

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114debatewrap

An instructive exchange from yesterday’s debate:

CRUZ: Did you say if you want people to die on the streets, if you don’t support socialized health care, you have no heart.

TRUMP: Correct. I will not let people die on the streets if I’m president.

CRUZ: Have you said you’re a liberal on health care?

TRUMP: Excuse me. Let me talk. If people…

CRUZ: Talk away. Explain your plan, please.

TRUMP: If people — my plan is very simple. I will not — we’re going to have private — we are going to have health care, but I will not allow people to die on the sidewalks and the streets of our country if I’m president. You may let it and you may be fine with it…

CRUZ: So does the government pay for everyone’s health care?

TRUMP: … I’m not fine with it. We are going to take those people…

CRUZ: Yes or no. Just answer the question.

TRUMP: Excuse me. We are going to take those people and those people are going to be serviced by doctors and hospitals. We’re going to make great deals on it, but we’re not going to let them die in the streets.

CRUZ: Who pays for it?

RUBIO: Well, can I just clarify something?

BLITZER: Gentleman, please.

RUBIO: Wolf, no. I want to clarify something.

BLITZER: Gentlemen please. I want to move on.

RUBIO: This is a Republican debate, right? Because that attack about letting people die in the streets…

BLITZER: I want to talk about the economy.

Will Trump please repudiate his heretical idea that the government has a responsibility to prevent people from dying because they lack access to health care? (I’m sure Cruz and Rubio would say it’s not that they want people to die in the streets but that the magic of TORT REFORM and SELLING INSURANCE ACROSS STATE LINES would prevent that from happening. The only actual distinction between the positions is that the handwaving is more insulting to the intelligence as it would lead to the same place of unnecessary death and suffering.)

Trump’s discussion of health care was, of course, gibberish. But, this being Trump, it was a shrewd appeal to the incoherent preferences of Republican constituents — essentially, ACA benefits like guaranteed issue, somehow without a mandate, and plus “erase the lines around the states” pretending that this would increase consumer choice rather than effectively eliminating regulation of the insurance industry. But it’s also true that the health care discourse of Cruz and Rubio was also a bunch of gibberish about states’ rights that would lead to tens of millions of people losing their access to health care, even if they think that nobody should point that out at a Republican debate.

It is easy — an accurate, as far as it goes — to point out that Trump is a reality TV star with little knowledge or understanding of public policy. But it’s not like there’s a serious wing of the GOP he’s competing with.

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  • CP

    I will not let people die on the streets if I’m president.

    … and this, in the Republican debate, is what marks one as completely unacceptable.

    But remember, it’s Trump, not Rubio, who’s the dangerous and unserious candidate.

    • Cheap Wino

      Cruz’ line of questioning/argument seems to be that paying for not letting somebody die on the streets is worse than letting a person die on the street. What else could be his point? “Who pays for it?” is dripping with “‘cuz it sure ain’t gonna be me, amirite fellow rich white Rs?”

      Rubes seems to be trying to interject something about Republicans are not going to let people die in the streets but we all know that would just be lip service to something about HSAs, and some market magic fairy bullshit.

      • osceola

        Cruz has a rep as a constitutional expert. So maybe he means there’s nothing in the constitution that permits the government to prevent people from dying in the streets. Leave it to the states?

        • dr. hilarius

          You’re giving him way too much credit here. Not that he isn’t smart, but he was going for the stupid Republican bullshit, not constitutional analysis.

          • osceola

            I was just kidding. Kind of a riff on Scalia’s notion that “actual innocence” is no bar to an execution if the proper procedure was used at the trial. I also meant it as a sarcastic take on the Tenthers.

            As the old saw goes, if you have to explain a joke….

        • Yes. Rescuing somebody from dying in the street is a serious violation of the 11th Amendment. Though without Scalia the Supreme Court may never recognize it.

        • AB

          President Buchanan thought there was nothing in the Constitution to prevent States from seceding, as they had begun to do after the election won by Lincoln. Note that (until the G.W. Bush Administration) Buchanan was generally considered the worst president ever.

      • Pseudonym

        Obviously families, churches, and private charities should be taking care of these people (or at least the subset who deserve help), not the federal government.

      • Pseudonym

        Or maybe Trump will just get Mexico and China to pay for that too. He’s a great dealmaker.

    • JKTH

      Well, Trump is full of shit since his policies are bog-standard Republican: HSAs, state lines, hand waving.

  • Nobody fret – Trump doesn’t mean it. He will be happy for folks to die on the streets.

    • Snarki, child of Loki

      …especially if he gets to shoot them. Classy!

      • Charlie S

        But not before he gets to punch them in the face!

        • so-in-so

          He’ll have ‘people’ to do all that for him.

          With really classy uniforms.

    • twbb

      But not because of lack of healthcare, at least.

  • Murc

    Oh my god, that picture.

    Trump looks like he’s MC’ing a bachelor auction!

    “Ladies, what are we bid for these fine, fine slabs of conservative man-meat? Bidding starts at a thousand dollars! If we make it to five g’s, Marco promises to take his shirt off and Teddy promises not to take his off!”

    ::cue “It’s Rainin’ Men” for the catwalk sequence::

    • MAJeff

      ::cue “It’s Rainin’ Men” for the catwalk sequence::

      and Martha Wash was heard to proclaim, “If it’s raining those men, get me to the desert.”

    • twbb

      The most accurate description of the Republican field this season was Huckabee’s comment that it was like a Golden Corral buffet.

      Apparently, though, he meant it as praise.

      • Murc

        We just got a Golden Corral up here.

        I went once just to go. There sure was a lot of food. Some of it was good. It’s the kind of place I would have really loved right up until I was 22 or so. Now it’s like “for the same price I can eat better food elsewhere that will fill me all the way up, because I’m not young and active and burning calories like a furnace anymore.”

  • Crusty

    “…Trump is a reality TV star with little knowledge or understanding of public policy. But it’s not like there’s a serious wing of the GOP he’s competing with.”

    And that there just about sums it up perfectly.

    • random

      Yeah I think this is a big part of Trumpism.

      Decades of reliance on Atwaterist strategies, combined with the inherently anti-Enlightenment tendencies of conservative ideology itself have transformed the GOP into a completely post-policy party.

      For me, the previous culmination of this phenomena was that moment Mitt Romney realized that he needed a concession speech, but didn’t have one prepared because his campaign had completely bought into Unskewed Polls. Then Trump came along and cranked the amp up to 11.

      • CP

        For me, the previous culmination of this phenomena was that moment Mitt Romney realized that he needed a concession speech, but didn’t have one prepared because his campaign had completely bought into Unskewed Polls. Then Trump came along and cranked the amp up to 11.

        Me, too. Or rather Karl Rove’s moment when he had an epic meltdown. I mean, sure, I knew “unskewed polls” was bullshit but until that point I thought there might be some campaign strategy behind it – that they were just pretending not to believe the polls in order to avoid demoralizing their supporters, and thereby lowering turnout. It’s only on election night that I knew for sure: no, they really do believe that all they have to say is “yeah but Nate Silver’s a homo” and pay some of their own think tanks to come up with numbers they like to change the fabric of reality.

        • D.N. Nation

          I lost my job the day after Election 2012 (unrelated to it; definitely related to our CBO being a moron). The night before, I got to see that Rove meltdown *live* because the election party I was at had FOX on for the yucks.

          At the time I believed, and I still believe, that if losing my job was the price I’d pay for watching Karl Rove quiver and melt into a puddle of toxic goo, it was still worth it.

        • twbb

          Rove’s own political future was hinging on his Crossroads PAC having succeeded at something; that was some very real, very delicious fear.

        • ForkyMcSpoon

          Now, some people might argue that the reason Romney and Rove so thought they would win was that they thought Republican electoral fraud would make up the difference.

          But the “glitches” in the voting machines didn’t materialize.

        • joe from Lowell

          I’ve watched it happen over and over again:

          1. The right-wingers make something up because it’s momentarily useful to say it for some political purpose.

          2. They all obediently parrot that line they just made up in an effort to catapult the propaganda.

          3. They all then come to believe that thing they just made up, because now they’ve seen it confirmed by 3 or 4 different sources that they consider quite reliable.

          4. They then incorporate the concept into their political strategy.

          I think that’s what happened with the Unskewed Polls. It started out as bullshit to keep their supporters from being demoralized and a smallish disadvantage from causing a downward spiral, but then they started believing it.

    • efgoldman

      But it’s not like there’s a serious wing of the GOP he’s competing with.”

      The Republiklown klowns in the klown kar are nothing frivolous. Paranoia, hate, spite, and fear are damned serious, and it’s all they have.
      Crazy? Yup.
      But serious as hell.

  • Denverite

    Excuse me. We are going to take those people and those people are going to be serviced by doctors and hospitals. We’re going to make great deals on it, but we’re not going to let them die in the streets.

    I just want to point out that this isn’t gibberish. It’s Medicaid.

    • Crusty

      Its gibberish because he’s speaking as if its something he’s inventing.

      • Philip

        In a GOP debate, he might as well be.

      • Denverite

        Oh sure. But the idea that we’re going to enroll people who can’t take care of themselves in a program that meets their minimum health care needs, and we’re going to finance it by entering into great deals with providers to pay for that care basically at cost, makes perfect sense. It’s been the law everywhere except Arizona since the 60s (and Arizona in the early 80s).

      • tsam

        It’s huge and beautiful. Therefore, he DID invent it.

    • Joe_JP

      and expanding it is part of PPACA

  • Warren Terra

    Wasn’t it an audience-favorite applause line in one of the 2012 Republican debates when one of the candidates said they would let people die in the streets?

  • dm

    If those bullies had only given him a chance to finish …
    he would have told them he’d make sure ‘those’ people would be removed by a decree of eminent domain. Dying people are not just disgusting, they also spoil the view. Especially with all the blood coming out of their whatevers.

  • Rob in CT

    2012 GOP debate (in SC?): “let him die! let him die! let him die!”

    That’s the nutshell.

    edit: Warren kinda got there first. *shakes half a fist*

  • pianomover

    Im not sure if it’s fair to call Trumps speech gibberish I think he needs a classification all his own nor is it neccesarily correct to say he misunderstands public policy.

    From Matt Taibibi
    “He talks, for instance, about the anti-trust exemption enjoyed by insurance companies, an atrocity dating back more than half a century, to the McCarran-Ferguson Act of 1945. This law, sponsored by one of the most notorious legislators in our history (Nevada Sen. Pat McCarran was thought to be the inspiration for the corrupt Sen. Pat Geary in The Godfather II), allows insurance companies to share information and collude to divvy up markets.
    Neither the Republicans nor the Democrats made a serious effort to overturn this indefensible loophole during the debate over the Affordable Care Act.”

    Translated to Trumpspeak this means “get rid of the lines”

    • Denverite

      No, this isn’t what he was talking about. He was talking about allowing insurance companies that are licensed in one state to sell policies in other states WITHOUT COMPLYING WITH THE REGULATORY REGIME OF THAT STATE. (Insurance companies already can sell policies across state lines, they just have to, well, comply with the laws in those other states.)

      This has all sorts of fraud and deceptive trade practices implications, but probably the biggest concern is insurance reserves. Basically, all insurance companies have to have assets on hand sufficient to meet their actuarial liabilities. Usually it’s in the 105% or so range. The theory is that if the underwriting is bad and there are heavy losses, we want them to be able to pay those losses. What these assets can be is highly regulated. It’s usually mostly government bonds plus highly rated commercial bonds plus 10% or so can be aggressive investments like stock. The theory THERE is that the reserves are worthless if they could crater overnight. If the GOP approach was ever adopted, I’m like 95% certain that there would be some states that would SIGNIFICANTLY relax this. They’d let insurance companies gamble and invest heavily in risky investments. Some of those companies would be wildly successful at first, allowing them to drop their premiums. They’d grab a big piece of the market nationwide — and then when the 20% returns become 50% losses, they’d default on their policies and it would be an absolute crisis the likes of which we haven’t seen since the Great Depression.

      • D.N. Nation

        The response, of course, would be to blame the poors and the browns for purchasing insurance that they shouldn’t have purchased.

      • pianomover

        You can spend your time number crunching yourself into oblivion yet the fact remains that the platitudes that Hillary offers to the disenfranchised working class still stink to high heaven.
        It’s like she is wrapping up and regifting the same shitty present you got four years ago. Donald Trump meanwhile is a gin soaked and cigarette breath of fresh air delivered by the priest who fucked your brother.

    • Sly

      Trump speaks fluent Advertising 101. Sentence content consists entirely of platitudes designed to appeal to the predispositions of the target audience, relying heavily on monosyllabic words with a limited multi-syllabic vocabulary (for instance his extensive repetition of the word “tremendous”).

      Imagine the voice-over of a children’s toy commercial, but as a political campaign.

  • CrunchyFrog

    As we all know, the GOP itself has become bizarre and this debate exchange only exemplifies that.

    On the surface it appears Trump has real principles. Some of them vile and nuts (throw out all immigrants), some of them admirable (planned parenthood helps people, everyone should have health care). He’s fuzzy on details and I suspect he’ll sacrifice these principles in a heartbeat if it makes sense to him. But I might be wrong on that.

    But what contrasts him from the rest of the GOP is that he still has principles rooted in things the working class wants. What are the GOP’s principles that they won’t abandon? There are only two: 1) Get power, 2) use power to help the funders. Everything else – even the tax pledge – are breakable if they conflict with (1) and (2).

    You can see why GOP politicians think that Trump is really a Democrat – they haven’t seen a Republican politician who actually cared about such things since Jim Jeffords became independent.

    • howard

      other than i would call them “instincts” rather than “principles,” since principles suggests more thought than he is capable of, i agree.

  • hickes01

    CRUZ: So does the government pay for everyone’s health care?

    Can we talk about this statement, because this is the heart of the matter? I have this argument with my Republican friends all the time and the Democrats have done a very poor job explaining the benefits of “Socialized Healthcare”. We are ALREADY paying the health care costs of the poor and uninsured, in the form of emergency room visits, which is the most expensive way to treat people. (Google Homeless people + emergency room visits) What’s more, this form of “healthcare” is essentially a give-away to hospitals, insurance companies and drug manufacturers because there’s no accounting and they can charge anything. Until you tackle this issue, you can’t pay for health care. But Republicans tell their base that Socialized Health Care is an ADDITIONAL expense, which really isn’t true if it reduces the cost of health care.

    • Denverite

      Not to mention the government already pays the health care costs of the old, sick and disabled. But those are the groups that have the highest health care costs! That — along with high health care inflation — is why we spent more government money on health care than almost any other country does. And they have universal coverage.

    • Srsly Dad Y

      So does the government pay for everyone’s highways?

      So does the government pay for everyone’s courts and prisons?

      So does the government pay for everyone’s Defense Department?

      So does the government pay for everyone’s Social Security?

      I mean what the actual fuck, sometimes. But I agree that Dems haven’t sold this properly. You can buy stuff individually, or you can buy stuff collectively. Lots of times it makes more sense to buy collectively. Like a big health care Groupon.

      • Rob in CT

        I had a conversation with my best friend from grade school a few years ago… actually probably in 2012, before the election. Anyway, we’d had a couple of beers and he went into standard a “I hate the government!” (exact quote, that) rant.

        I went off on a rant of my own, loudly arguing (did I mention beers had been consumed?) that the government is *US*, not some alien thing, and is merely a vehicle for collective action. He was taken aback by my vehemence. I doubt I convinced him of much of anything, of course, but you never know.

        Anyway, that sort of knee-jerk anti-government sentiment is what you’re up against when you try to explain that it makes sense to do certain things collectively. Things are changing to a certain extent, thankfully. Younger people seem to avoid the knee jerk reaction.

        • Srsly Dad Y

          Yeah, I know. Polarization and all. One way to map the D/R divide is probably between people who think of government as “us” versus those who think of it as “them.” But if there is anyone left in the middle there who might be persuadable (hello? [echo]), it could help, and couldn’t hurt, if Dems would articulate this stuff. (“Collectively” is admittedly too wonky a word though, and evokes “collectivization” — I like how Bernie says, “We are in this together,” that’s basically it.)

          • Rob in CT

            To be fair to my friend with the overactive knee, we do live in a high-tax state. Connecticut passed “Taxachusetts” some time ago. And we have seemingly perpetual budgetary problems despite that.

            • Srsly Dad Y

              So what, Connecticut is a nice place, tell him to move to Alabama.

  • notahack

    Scott made this up right? There’s no way that each of them said “die in the streets” on live television five times apiece.

    • Kenny Rogers

      The best that you can hope for
      Is to die in the streets

      • Denverite

        Or to have an age 41 season where you go 17-8, make the All-Star team, finish 5th in Cy Young voting, and your team goes to the World Series.

      • pianomover

        It was a fantastic argument that Cruz was ready to have with Trump.
        Whether a person was dying in the street or not there would be no way in hell that the federal govt. would or should pay for it.
        I think Cruz was saved by the bell on that one, could have been Cruzs Dead Zone moment.

        • Pseudonym

          Doubt it. The easy answer is “health care is too expensive because there’s too much regulation” and “this is a job for private charities” (who can therefore proselytize). “Only liberals would think that people would die in the streets if it weren’t for big government, and that Americans would be too hard-hearted not to help them [privately]. Besides, those people only can’t care for themselves because they’ve spent too long sucking on the government teat, so they need to be weaned off it, not encouraged to be more dependent.”

    • LeeEsq

      The attack ads make themselves.

  • ChrisS

    The Republican Primary debate 2016
    “Pure Gibberish”

  • Hells Littlest Angel

    Republicans won’t let people die in the streets. They’ll unleash their entrepreneurial spirit to die anywhere they want.

  • Joe_JP

    Josh Marshall thinks Trump won the debate and Republican operatives trying to spin it otherwise are wrong. In part:

    I’m willing to believe that Trump lost some of his support from the part of his coalition which is made of people who thought he was a leading public policy mind. But I’m figuring there weren’t that many of those people. So probably not a problem.

    And, maybe the die on the street brigade. The state of the party is such that Trump is the best you got when it comes to appealing to what the members of the party wants. So, Republicans will, if waterboarded or something (well, they think it works), say Planned Parenthood does some good things, but it’s not a good idea to fund them. Abortion!

  • NonyNony

    But, this being Trump, it was a shrewd appeal to the incoherent preferences of Republican constituents — essentially, ACA benefits like guaranteed issue, somehow without a mandate, and plus “erase the lines around the states” pretending that this would increase consumer choice rather than effectively eliminating regulation of the insurance industry.

    I don’t actually think those preferences are incoherent at all. What they want is basically:

    * A guarantee of the ability to purchase health insurance coverage when they need it
    * No requirement to buy coverage if they don’t need it
    * No restrictions on prior conditions, or for how long their kids can stay on their insurance while they’re in school
    * That the insurance coverage be affordable – and optimally free
    * No taxes be raised to pay for any of it
    * That the law putting it into effect is passed by a Republican Congress and signed by a Republican President

    Unless you have enough knowledge to understand how the first 5 bullet points all interact with each other you might not even realize that this list of demands is unreasonable, let alone paradoxical.

    (That last one is petty, but you can pretty much include it on any Republican list of demands post-Gingrich. You can give them EXACTLY what they ask for and they still won’t be happy if it comes from a Democratic Congress and/or a Democratic President).

    • Joe_JP

      be sure to toss in something to shame the poor, burden abortion rights and probably favor certain religious rights somehow (particularly to hurt gays)

      • Incontinentia Buttocks

        Exactly. They also want to be sure that certain “undeserving” categories of people are denied access to healthcare

    • twbb

      (That last one is petty, but you can pretty much include it on any Republican list of demands post-Gingrich. You can give them EXACTLY what they ask for and they still won’t be happy if it comes from a Democratic Congress and/or a Democratic President).

      Reminds me of when Obama was deciding what to do during the Libyan revolution and most of the GOP just could not take a position for or against intervention before they knew what Obama decided.

    • Sly

      That ain’t workin’ that’s the way you do it
      Get your money for nothin’ get your chicks for free

      • NonyNony

        I mean, I have to admit that if it weren’t for my innate skepticism of anyone promising me something for nothing, the “money for nothing and the chicks for free” platform would definitely have an appeal.

        And a portion of the GOP voting base are definitely susceptible to the “something for nothing” sales pitch – there’s a reason that Fox News and Talk Radio advertisers are mostly shady-but-legal-scammers of various stripes.

        • Rob in CT

          Reagan sold them on it. Tax cuts, spending increases, Morning in America! You can have your cake & eat it too, just vote R!

  • On my first day in office I will repeal Obamacare and replace it with some non sequiturs and random talking points and it will be fabulous.

    • Incontinentia Buttocks

      …and Mexico will pay for it!

      • NonyNony

        or tell us to pay for our own f..ing non sequiturs and random talking points.

      • MAJeff

        The FUCK they will!

        The slight pause after the emphatic pronunciation is really golden.

      • weirdnoise

        You know, maybe this time we’ll have Canada pay for it.

    • joe from Lowell

      Those death panels, they’re gone. First day in office, gone. (Pause for applause) They’re gone.

  • gratuitous

    I find it interesting that Sen. Cruz is absolutely stuck on the notion of who is going to pay for making sure our citizens have access to health care, but he never seems too concerned about what it might cost or who will pay for it to make the sand glow in the Middle East. Considering we’re still shouldering a large financial burden for the last two invasions and occupations of foreign countries, that would seem to be a fit subject for discussion.

    • Rob in CT

      It’s worth spending eleventy billion dollars to “keep us safe” so long as it’s not from illness or some other bit of mundane misfortune.

      • howard

        i intend to steal this comment and use it as though i were smart enough to have come up with it.

        • Rob in CT

          Feel free! I actually don’t even think that’s nearly as good as it could be. Someone wittier than me should be able to improve it.

          Providing healthcare to poor people is boooooring. No explosions. More importantly, there’s no “yeah, get some!” as you watch Bad Guys ™ get blown up. Instead, you have to contemplate the horror of possibly giving something to someone who is undeserving.

          I’ll never, ever forget seeing people sitting 2 cubes over from me chortling as they watched videos of strafing runs from Iraq. Moral compass something something.

      • Pseudonym

        Avoiding infectious diseases is a matter of personal responsibility.

        • The Temporary Name

          You can have my electron microscope when you pry it from my cold, dead fingers.

  • leftwingfox

    Isn’t Trump’s position the same argument made by conservatives when pointing out the current system isn’t too bad?

    Hospitals cannot turn you away. They can bill the ever-loving shit out of you when they’re done though. Then you declare bankruptcy and let the other losers foot the bill indirectly. It’s the Trump Way.

    • Rob in CT

      I saw a Trump supporter post “look up EMTALA!” as if it was an argument ender recently.

  • Joe_JP

    This seems a big deal:

    http://www.buzzfeed.com/kyleblaine/chris-christie-endorses-donald-trump-for-president?bftwnews&utm_term=.opjJjMe4x#.dfQqXpO7W

    Chris Christie was kind of a back-up Scott Walker, the sort of Northern Republican choice you might at least have as your v.p. As governor alone he has some cred.

    • NonyNony

      That seems like Christie responding to the Republican base and establishment.

      As in a “What did you say to me? Did tell me to go eff myself? No YOU go eff YOURSELF” kind of way.

      I’m also willing to believe he’s angling for a VP slot. Trump is a legal resident of New York and not New Jersey, right?

      Trump/Christie 2016. I can almost see the bumper stickers now.

      • Joe_JP

        Trump would be the most logical for him to endorse if he did endorse any of them. A bit interesting he did it now.

      • Rob in CT

        The Blustering Asshole Unity Ticket.

      • Mayur

        As I told the wife, jeebus doesn’t love me enough. No way BOTH those assholes run on a single ticket.

  • Breadbaker

    The best line is still Wolf Blitzer’s. He makes Rubio and Cruz seem to have excellent timing and social skills. This would be like Johnny Carson asking for a cut to a commercial before the laughter died down on a skit that just killed. “Let’s talk Ex-Lax rather than showing how much we’re enjoying this.”

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