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Beauty Contest

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Paul Ryan, Serious Policy Wonk, everybody:

But we always know you’re never going to win a coverage beauty contest when it’s free market versus government mandates. If the government says thou shall buy our health insurance, the government estimates are going to say people will comply and it will happen. And when you replace that with we’re going to have a free market, and you buy what you want to buy, they’re going to say not nearly as many people are going to do that. That’s just going to happen.

And so you’ll have those coverage estimates. We assume that’s going to happen. That’s not our goal. Our goal is not to show a pretty piece of paper that says we’re mandating great things for Americans. Our goal is to get a vibrant health-care system that’s patient-centered, that brings down costs, that increases choices, that has a marketplace so that we lower the costs and increase, and therefore increase the access to affordable care. That’s our goal, and it’s not to win some coverage beauty contest.

Let’s not bicker over whether plans might increase or reduce preventable death and suffering. In its majestic equality, TrumpCare will assure that rich and poor alike can buy as much health insurance as they can afford!

I guess it’s time for more pictures of Paul Ryan cleaning already-clean dishes at a soup kitchen. The top Republican in Congress being an amoral monster can’t really fit into Both Sides Do It narrative easily enough.

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  • SoRefined

    And when you replace that with we’re going to have a free market, and you buy what you want to buy, they’re going to say not nearly as many people are going to do that. That’s just going to happen.

    I mean, isn’t this what they’ve been saying all along? Why would you describe the mandate as a burden or an injustice or whatever if you thought everyone would just buy in in a ‘free market’ system? Why would you present the very idea of “insurance,” eg that healthier people and sicker people alike buy in and the former subsidize the care of the latter as an absurdity if you didn’t expect many healthy people to opt out of insurance in a ‘free market’ system?

    • Those poors! If they would just stop with the iPhones and big screen TVs they could afford more than cardboard for a shelter!

      • To be fair, there’s some good shelter to be found in the packing material of a big screen TV!

        • Bitter Scribe

          Except you’d have to be pretty slender to fit.

          Oh well, after a few months of not being able to eat, that should be no problem.

    • royko

      Why would you describe the mandate as a burden or an injustice or whatever if you thought everyone would just buy in in a ‘free market’ system?

      Well, it’s kind of like how all those southern states were OF COURSE going to abolish slavery on their own eventually, it was just the federal government telling them they HAD to (historical note: that never happened) that stuck in their craw and made them secede.

  • N__B

    Let’s not bicker over whose lack of insurance killed who…

  • Cheerfull

    I was thinking about the reported remark of Representative Duncan Hunter:
    “We’re not guaranteeing health care for everyone. We’re guaranteeing access to health care for everyone.”

    http://escondidograpevine.com/2017/03/12/duncan-hunters-town-hall-from-hell/

    It’s such a perfect representation of the Law’s Majestic Equality extended to those living under a bridge.
    The underlying theory is that the costs of insurance can be lowered so that the access is actually available to practically everyone, but the process seems to involve creating “insurance” that does not insure, and we are back to the conservative’s love for the form of equality that overlooks any concern about its substance. And then I start thinking about Plessy v. Ferguson.

    And then it’s time to go back to work.

    • guthrie

      They clearly have no understanding of the english language, because to many people those sentences are functionally the same.

  • Vance Maverick

    “Increase the access” sounds for a second as though he’s willing to discuss actual effects of the plan (rather than quasi-aesthetic properties like “vibrant”). But I doubt you could pin him down on it.

    • Vance Maverick

      Cheerfull’s quote from Duncan Hunter makes it clear that access is something other than healthcare itself. If I can look through the windows of the hospital and see nurses helping patients, is that access?

      • Derelict

        Everyone has access. Just like everyone had access to a Ferrari, but only those who can afford a Ferrari get to buy one.

      • SoRefined

        I’m sure looking through the window will inspire you to bootstrap your way into a policy, and if not, well. I guess the Invisible Hand just didn’t want you to get that care and it is a blameless, holy creature.

  • DocAmazing

    In related sociopathy, Rep Jim Jordan of Ohio wants people off Medicaid as well, ‘cuz they’re getting healthcare and that’s not what the Invisible Hand wants:

    http://www.rawstory.com/2017/03/rep-jim-jordan-on-coverage-for-11-million-i-dont-view-success-as-keeping-americans-on-medicaid/

  • Area Man

    I have yet to understand what “patient-centered” is supposed to mean, even when it’s not being promulgated by obvious bullshitters. Is there a form of medicine in which treating patients isn’t the ultimate objective?

    • Vance Maverick

      There’s apparently a literature (even a Wikipedia section). It’s stuff that sounds reasonable, assuming you’re getting care in the first place.

      • Area Man

        Yes, but it’s empty pablum. “Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.” With the possible exception of situations where the patient can’t give consent, is there a form of medicine that doesn’t do these things by definition of being medicine? I mean, is there a model of medicine in which doctors are trained to disrespect patients?

        • muddy

          Anti-abortion OBGYNs.

          • DrDick

            That and no required vaccinations and full access to the Woo (naturapathy, homeopathy, chiropractic, acupuncture, ad nausem).

        • were-witch

          I can’t tell if you’re being sarcastic, but yes, most medicine dehumanizes the patient, by putting focus on symptoms and illnesses that can be generalized across patients. Treat the disease, not the person. This is necessary on the back-end for treatments to be scientifically tested for effectiveness, obviously, but it leads to patient dissatisfaction on the front-end. People feel “like a number” etc. It also doesn’t mesh well with holistic wellness care that tries to prevent illness by investigating patient behaviors / lifestyle and proposing modifications — if you are providing symptom-focused care, a lack of symptoms means you have nothing to do.

          • I don’t know if this is what’s intended by “patient-centered”, but you don’t have to look very hard to find reports of doctors being trained and habituated to disrespect patients. Whether it’s ignoring symptoms reported by women because they’re assumed to be exaggerating, black patients getting less pain management than white ones, fat patients being treated as if any complaint stems from their weight, or trans patients having to fight their carers to get referrals for transition drugs and surgery, I’ve heard more stories about horrific doctor-patient experiences than positive ones.

            • Derelict

              My personal favorite was the new doctor subbing at my primary care physician’s office. He got very upset when I told him my thyroid was not functioning and that’s why I needed Synthroid.

              “How do you know that?,” he snapped.

              “Because I’ve had this condition for 15 years?” I answered. “You know, you might want to at least glance at my file before you come in here.”

              Oddly, I’ve never seen that guy again.

            • Area Man

              I believe these things are typically referred to as “being a bad doctor”. That doctors should not act like dicks and check their egos and biases seems obvious enough. Whether it requires new terminology that evokes an entirely different treatment philosophy is not so obvious.

              • DocAmazing

                Ah, but the healthcare paradigm must synergize its potentialities just like the rest of the corporate world.

              • No, that’s precisely the point. Blaming this on “bad doctors” is not at all unlike blaming police brutality on “a few bad apples”. This is a systemic problem, not an individual one, and dismissing it as “doctors shouldn’t be dicks” is hugely insulting to real people who suffer because of it. There is a long history of medicine that discounts the experiences of everyone who isn’t a white man (see, for example, the paucity of research into conditions that afflict only women), and of doctors being affected by the prevailing prejudices of the time (such as fat-phobia). This is not a problem that can be solved by telling people not to be dicks, or we’d have gotten rid of racism, misogyny, and all other prejudices the same way.

    • farin

      When the likes of Ryan say it, they mean “patient’s-budget-centered.”

  • Derelict

    And, of course, they’re trotting out the Golden Oldies:

    “Nobody is denied healthcare! Federal law still requires hospital emergency rooms to treat everyone, regardless of ability to pay!”

    Good luck getting your chemotherapy at the ER, or treatment for any other chronic condition.

    My fondest wish in the whole wide world is that all of the policy proscriptions that Ryan and the rest are pushing actually become the law of the land. At which point Ryan and the rest lose ALL of their money and are forced to live under those policies.

    • At which point Ryan and the rest lose ALL of their money and are forced to live under those policies

      and bridges, too, please.

    • Not to mention that treating urgent care centers as catch-all clinics for all medical needs is bad for everyone – the people who aren’t getting proper medical attention, including preventive treatment, until it’s urgent, and the community at large whose ERs are critically overloaded. Even people who can afford insurance should object to the idea that their emergency rooms will go back to being the port of last call for people who really need a GP or a psychiatrist.

      • vic rattlehead

        I have a high school friend whose older brother is an emergency specialist invested in a regional chain of urgent care centers. He loves it-no long term patient relationships and if its a real emergency he sends them to the ER. I guess I shouldn’t have been surprised that he thought of himself as an entrepreneur first and doctor second.

        That said, I’ve used them when I didn’t have a PCP. Faster and cheaper than an ER. And if it’s not quite emergent but your PCP can’t squeeze you in and you don’t wanna blow your day and your wallet at the ER.

        • DocAmazing

          Trust me, your PCP does not appreciate that reasoning. Now we have records scattered across several institutions and your care deliver by someone who doesn’t know you from a sack of wheat. See if you can get hooked up with a PCP and avoid things like drug-drug interactions.

          • vic rattlehead

            Thankfully I have insurance and a PCP now. And I have been pretty scrupulous about getting all my old records.

        • They have these in France too, within the Sécu system. My experience of these has been positive. The style is upmarket garage mechanic: problem fixing not a sympathetic ear.

    • vic rattlehead

      policy proscriptions that Ryan and the rest are pushing

      Excellent typo.

  • dmsilev

    Under RyanTrumpCare, millions of people will lose affordable access to health care. Some fraction of those people will die before their time of something that would have been prevented had they had access to that care. Let’s hope that, ala A Christmas Carol, all of the spirits of those dead people haunt the sleep of Paul Ryan.

    Though I think the chance of him learning something from said spirits would be somewhat sub-Scroogian. Tiny Tim is just a moocher, after all.

    • Hogan

      Tiny Tim is just a moocher, after all.

      But he’s so spunky! And white!

  • howard

    it’s impossible to read remarks like this and not think that ryan is a blithering idiot, but i will at least give him that unlike trump or price, he’s not pretending this is bill is going to do anything good.

  • NeonTrotsky

    If you price someone out of the health insurance market that really isn’t creating choices for them

    • vic rattlehead

      Ah but that’s just the free market determining that your life isn’t worth enough for healthcare!

      • vic rattlehead

        ie your “choice” is pull yourself up by your bootstraps and have more money, or die! Freedom!

  • Stan McGee

    Politics comes down to two questions: (1) who’s getting fucked in the ass?, and (2) Who is doing the fucking?

    Paul Ryan gets this. “Liberals” either don’t, or think that the only problem isn’t getting assfucked by rather the problem is the dicks are all white, and the working class will come to enjoy it when they get some black and brown plutocratic dicks doing the fucking.

    The Alt-Left days: “assfuck the rich!”

    • were-witch

      Please ban this person, their rape-fantasy metaphor obsession is sickening.

      • Stan McGee

        Tone police much?

        • were-witch

          “politics is my rape fantasy” is not a matter of “tone”

        • This confirms my earlier call of Poe. A hyper-masc brocialist complaining about “tone policing” is just too rich.

        • joel hanes

          Tone police much?

          Fine.

          I refer you to the reply made in the case Arkell v Pressdram

      • Seconded.

        ETA: Here’s a previous instance of this guy’s creepy psycho-sexual political take.

      • Yeah, I’ve rarely wanted a new commenter banned this quickly.

    • Steve LaBonne

      Assfucking might damage your brain, such as it is.

    • Hogan

      Subtext rapidly becoming always text.

    • D.N. Nation

      Poe’s Law. Gotta be.

      If not: I wish your daddy would spend money in something that wasn’t his son’s Brooklynite podcast.

  • Seitz

    This morning Ryan characterized this approach as “you buy what you want to buy. That’s freedom!” Good to know that the Continental Army fought for your right to eschew health insurance, get sick, go to the emergency room, and make everyone else pay for it. I’d actually have a little respect for some of these guys if they ever had the balls to repeal the EMTLA. I mean, it would be absolutely heartless and terrible policy, but at least it would be consistent.

    • SoRefined

      I can’t say I will ever have any respect for these jerks, but if “choice” and “buying what you want to buy” were things they cared about even a little, they would be advocating seriously for decoupling access to health insurance from full time employment. The vast majority of Americans under Medicare age don’t really have any choice as to what their health insurance looks like, because their employer chooses it for them.

      But since what they actually want is for you to die at your desk, afraid to quit a job no matter how awful it is because your access to healthcare would be effectively eliminated.

      Anyway, if the free market is the only way to get RESULTS, they ought to drop everyone into the individual market, and yet somehow it never even comes up.

      • The vast majority of Americans under Medicare age don’t really have any choice as to what their health insurance looks like, because their employer chooses it for them.

        First you have to choose to be a maker (boss), not a taker (employee).

        • SoRefined

          That is so fair; back to the drawing bootstrap.

      • Derelict

        they would be advocating seriously for decoupling access to health insurance from full time employment.

        Well, HHS Secretary Price certainly believes in this. He has advocated for doing away with employer-provided insurance for years. He’s also been pushing for allowing balance billing, which lets your doctor or hospital bill you for the balance your insurance refuses to cover. (For example, you get a hangnail removed and the doctor charges $36,000 for it but your insurance says it will only pay $25, YOU are on the hook for the remaining $35,975.)

        • SoRefined

          He seems like a sober intellectual who is in non-tenuous contact with reality.

        • vic rattlehead

          It seems like I already get billed for this. I just got a hefty bill from my dentist (yeah I know dental insurance is a little funkier sometimes). I looked at my EOB and it just seemed so arbitrary, what my insurance refused to cover above a certain amount. I had thought I just had my copay for the cleaning and x-rays, but the insurance company decides to stiff my dentist for part of it, or my dentist overbills, and I’m left holding the bag. Fuck that – sort it out with the insurance company. If they’re being dicks, take it out on them, not me. If you’re billing too much, fuck you.

          • Derelict

            I don’t know about dental insurance viz. federal law, but balance billing for health insurance is currently illegal. Price (who is, at least nominally, a doctor) believes that he and his fellows should be allowed to bill whatever they want, and be able to collect the entire amount from your insurance, you, your estate, and even your descendants down to the third generation, for all I know.

            • Price (who is, at least nominally, a doctor)

              Orthopedic surgeon. Tenuous relationship to actual medicine.

              • DocAmazing

                Great for being the butt of jokes, though.

                How do you hide a $20 bill from an orthopedist? Put it in the patient’s chart.

                How do you know that an orthopedic surgery office has gotten an electronic medical record system? Wite-Out on the screens.

                To be an orthopedist, you must be strong as an ox and at least as smart.

                …and so on.

                • Shortest ortho note: BBMF (bone broke, me fix)

                  Ortho rounds: LGFD [patient] looks good from door

                  etc.

        • sharonT

          This is one of their big Medicare reforms. Balance billing and vouchers.

      • vic rattlehead

        My employer doesn’t pay a portion of my health insurance but my new plan is virtually the same as my former exchange plan except: it’s not an HMO (hallelujah!) and it’s about 30% cheaper. I don’t quite get why virtually the same shit is so much cheaper through my employer. Probably some tax law or some other bullshit that has the effect of punishing the marginally employed and those who don’t have insurance through work.

      • Scott Lemieux

        I can’t say I will ever have any respect for these jerks, but if “choice” and “buying what you want to buy” were things they cared about even a little, they would be advocating seriously for decoupling access to health insurance from full time employment.

        Oh, this is what they want. This was a central goal of the Heritage Plan, and initial proposals for the AHCA would have taken away the tax incentives for employer insurance.

        Of course, decoupling employment from insurance would be salutary if the alternative was public or at least heavily subsidized and tightly regulated private insurance. Needless to say, that’s not what Ryan et al. want.

      • los

        “free market”:
        hobby lobby decision: altcuck CEOs shall force politically correct healthcare onto employees.

  • Crusty

    At the risk of stating the obvious, it really seems like we’re going backwards, in every possible way.

    • rea

      That’s what electing Republicans means.

      • LosGatosCA

        Car wrecks build character.

        Look at what Cheney/Bush did for national security, economic management, and natural disasters.

        And just eight years later they came up with someone even less prepared, of even lower character, and even more willfully ignorant.

        You can never overestimate the Republican appetite for evil.

        • los

          And just eight years later they came up with someone even less prepared

          And the oligarchs already began turning things backwards in 2009.

          To hit the altcucks hard enough, the corrective pain must be multiples harsher than 2007 .

  • NewishLawyer

    The GOP does not think that the government should provide people with healthcare. They also are smart enough to know this is a political non-starter. They will always be trying to square this circle except for a few people at think tanks who are walled off from electoral politics.

  • vic rattlehead

    Could be worse, but even if I can’t be discriminated against for having a pre-existing condition is cold comfort if I can’t afford any goddamned policy.

    Sadly, we have too many ignorant and selfish assholes to have a civilized healthcare system anytime soon. Case in point

    Janice Phelps, a 60-year-old disabled factory worker in Evansville, Indiana, knows how expensive healthcare is.

    Each month, shots for her severe asthma cost $3,000. Quarterly injections for knee pain cost $3,200. Medication for depression costs $900. She has had seven back surgeries, two shoulder surgeries, and two knee surgeries since 1985. The largest public health programs in America – Medicaid and Medicare, which aid the poor and the elderly – paid for nearly all of it.

    Yet, those programs are now threatened by the men she voted for: Donald Trump and former Indiana governor Mike Pence.

    “I’m all in favor of repealing it,” she said about Republicans’ push to do away with the Affordable Care Act, popularly known as Obamacare. But, she said when you talk about cutting Medicaid: “I don’t agree with that at all.”

    No, don’t cut healthcare for me. It’s those lazy blahs and moochers who don’t deserve it. Selfish piece of shit.

    • Q.E.Dumbass

      The violins that play for these subjects can be measured in gluons and are inaudible outside of anechoic chambers.

    • Harkov311

      No, don’t cut healthcare for me. It’s those lazy blahs and moochers who don’t deserve it.

      Whenever I encounter this argument, I usually end up saying something to the effect of “have you considered the possibility that maybe you’re not the only person who has worked hard and deserves things? Should we take things away from 99 people if we found out one person was cheating?”

      • GeorgeBurnsWasRight

        Should we take things away from 99 people if we found out one person was cheating?

        Let me take upon myself to speak, I who am but dust and ashes. Supposing five of the 99 hardworking people are lacking. Will you destroy the whole healthcare plan for the lack of five?

        • los

          Throw the baby out the 3rd floor window. Drink the bathwater.

          • leftwingfox

            That needs to be a wolf meme.

  • Cheerfull

    Well you would have less health care but more freedom. And freedom is priceless, while health care is merely very expensive.

    • weirdnoise

      Ah, yes. The freedom of the grave.

      • los

        great full-dead fan

  • lhartmann

    To repeat the old cliche, “stupid or evil? no need to choose.”

  • FlipYrWhig

    Is this another one of those beauty contests where the sketchy organizer walks in on the contestants while changing?

  • DamnYankees

    We are in literally year *eight* of the GOP engaging on this issue in nothing but bad faith. Why do we keep pretending otherwise?

    The GOP never had a plan for health care reform. They didn’t have one in 2009, and they don’t have one now. They don’t care about health care reform. They never have. They have done amazingly well over the pas 8 year by intentionally and knowingly poisoning the well of government.

    Being asked to continue to pretend like this party cares about policy in any good faith sense, and watching the media continue to do so, is just so very tiring.

    • nemdam

      You mean they have been arguing in bad faith for 20 years. They claimed to have a health care plan in the 90s in contrast to Hillarycare. Yet even though they have now twice controlled the government, they haven’t lifted a finger to actually pass it. And they never worked with the Democrats in good faith to do so either.

      • DamnYankees

        Fair enough, but there was enough of a gap between the two attempts at reform (over 15 years, from 1993 to 2009), that this round feels somewhat self-contained. Though that might just be my personal impression given my age – I don’t remember the first go around.

      • Murc

        They claimed to have a health care plan in the 90s in contrast to Hillarycare.

        What’s ironic is that this was actually a big step up from where they were during the Obama years and, really, right now.

        Because they did in fact have a credible plan. It wasn’t one they ever planned on implementing of course. But their think tanks and policy shops did in fact put together a coherent health care plan that at least looked like the sort of document a serious governing party would produce.

        I guess the effort plumb exhausted them.

        • nemdam

          Right. And it’s just weird that they never tried to work with Bill to try and get it passed? Then again, Bill was always known as a fierce ideologue who went for all-or-nothing.

          • nemdam

            ETA (since I don’t know where that function went): It’s also weird that W never spent a second trying to get it passed wither.

        • vic rattlehead

          If we lived in a world where the ACA was something the Republicans all agreed with and passed in good faith, and that was our starting point…oh what a world. I could live with that. And Obama’s heavy lift in 09-10 could’ve been a medicare buy-in or something. What a world. We apparently live in the universe where “fuck em. let em die” is something even many economically precarious and unhealthy people support, knowingly or otherwise.

          • LosGatosCA

            We apparently definitely live in the universe country where “fuck em. let em die” is something even many economically precarious and unhealthy people support, knowingly or otherwise because they expect that the folks dying will be the undeserving poor, blahs, immigrants.

            You are what your record says you are.

            For America, that’s Republican control of Congress for most of the past 36 years and a White House with a Republican for 24 of the 40 years from 1980 to 2020.

            Massachusetts elected Scott Brown, knowingly endangering the ACA, to replace Ted Kennedy FFS.

            Americans, even in liberal Massachusetts, are not the people they think they are.

            • GeorgeBurnsWasRight

              But Brown had a truck, and that mattered more than health care.

              The label homo sapiens is highly inaccurate, at best.

      • Scott Lemieux

        You mean they have been arguing in bad faith for 20 years. They claimed to have a health care plan in the 90s in contrast to Hillarycare. Yet even though they have now twice controlled the government, they haven’t lifted a finger to actually pass it.

        Still, the ACA was totally a Republican plan. They secretly favored that all along, and the evidence is a Heritage health care proposal to end Medicare, Medicaid and employer based insurance and replace it with insurance that doesn’t cover anything.

        • nemdam

          If Obama’s opening position was to pass single payer, then Republicans would’ve had no choice but to offer the 90s Heritage Foundation plan. Every expert negotiator knows this is true because I once read in a book about negotiating that you always offer your dream position first. Please ignore that I skipped over the part where your opening position must be credible because the other party always has the option of deciding you aren’t negotiating in good faith and can walk away.

          In a slightly more serious tone, it’s amazing how many people say they believe this about negotiating in general. To which I always reply if you actually believe this, you should demand your boss double your pay because he or she will then have no choice but to give you a raise instead of questioning your general judgement and commitment to the job.

          • DamnYankees

            Double your pay? You neolibereal sellout. A true liberal would demand he hand over ownership of the company entirely.

            • nemdam

              Probably why it never worked for me…

          • Hogan

            They also skipped the section about what to do when the other party’s BATANA (best alternative to a negotiated agreement) is the status quo.

          • Scott Lemieux

            If Obama’s opening position was to pass single payer, then Republicans would’ve had no choice but to offer the 90s Heritage Foundation plan. Every expert negotiator knows this is true because I once read in a book about negotiating that you always offer your dream position first.

            If you walk into a Maserati dealer and and offer $500 for a new Quattroporte, they have no choice but to sell it to you for $1,000. That’s obvious. Similarly, Obama making a totally credible offer to produce 60 Senate votes for single-payer would have led to a universal Medicare buy-in, but he Didn’t. Even. Try.

            • los

              That’s obvious.

              That’s (the dealer’s) access to the politician “buying” the Maserati.

              like some of trump’s incredibly bizskills real estate deals…

    • Derelict

      When it comes to Republicans, the media are always painfully credulous. “We Republicans have our own healthcare plan that’s better than Obamacare!” The media duly reports it because Republicans said it.

      And then just leaves it at that. No “Can we see your plan?” No pushing for details or even vague outlines.

      • vic rattlehead

        They could fire 99% of journalists (particularly the tv personalities) and replace them with court reporters, and: 1) there would be no difference and 2) a lot of money would be saved.

        • LosGatosCA

          When Tucker Carlson out reports you on a Republican pillar issue you are a total pile of steaming shit. Period. Full stop.

    • Dr. Ronnie James, DO

      Yeah, it’s weird that there’s no annual “physician choice index” or breathless handwringin reports about “Are America’s Networks Getting Narrower?” that could show how concerned they are about this vital issue.

  • Harkov311

    I guess it’s nice to have it clearly spelled out that Republicans really do just love more capitalism just for it’s own sake, and not because they have some sort of illusion that it makes the country or society better.

    • Hogan

      For SOME REASON last night I was re-reading John Holbo’s takedown of David Frum’s Dead Right:

      “The great, overwhelming fact of a capitalist economy is risk. Everyone is at constant risk of the loss of his job, or of the destruction of his business by a competitor, or of the crash of his investment portfolio. Risk makes people circumspect. It disciplines them and teaches them self-control. Without a safety net, people won’t try to vault across the big top. Social security, student loans, and other government programs make it far less catastrophic than it used to be for middle-class people to dissolve their families. Without welfare and food stamps, poor people would cling harder to working-class respectability than they do now.”

      The thing that makes capitalism good, apparently, is not that it generates wealth more efficiently than other known economic engines. No, the thing that makes capitalism good is that, by forcing people to live precarious lives, it causes them to live in fear of losing everything and therefore to adopt – as fearful people will – a cowed and subservient posture: in a word, they behave ‘conservatively’. Of course, crouching to protect themselves and their loved ones from the eternal lash of risk precisely won’t preserve these workers from risk. But the point isn’t to induce a society-wide conformist crouch by way of making the workers safe and happy. The point is to induce a society-wide conformist crouch. Period. A solid foundaton is hereby laid for a desirable social order.

      • Harkov311

        Risk makes people circumspect. It disciplines them and teaches them self-control.

        I swear, it’s like every conservative completely missed the Russian Revolution, and missed that time when poor people decided to just take things from the rich at gunpoint and then kill them afterwards.

        But sure, tell the Romanovs how very cowed and disciplined all that conservatism made the Russian peasants.

        • Sly

          I swear, it’s like every conservative completely missed the Russian Revolution, and missed that time when poor people decided to just take things from the rich at gunpoint and then kill them afterwards

          To be fair, the entirety of neoconservative ideology is predicated on avoiding exactly this kind of outcome. Also in fairness, neoconservatism is really shitty at avoiding this kind of outcome.

        • Hogan

          Like so many things, it works until it doesn’t.

    • LosGatosCA

      Milton Friedman did that decades ago – roughly –

      ‘Even if free market capitalism wasn’t the most efficient way to organize a country economically, I WOULD STILL PREFER IT, because it’s the system that allows for the greatest freedom’ (for rich people).

      That’s the nut of market worship right there. Add in a simpleton like Ayn Rand and her disciples and you have all the evil, masquerading as something else, you would ever need.

      The Laugher Curve and supply side worship are just the whipped cream and cherry on top.

  • anonymous

    Americans are inherently selfish. When they are young and healthy, they don’t want to put money into the common pot to pay for healthcare for others. But when they are inevitably old or sick, they suddenly appreciate ACA, Medicaid and Medicare. Ultimately they only care about things when it impacts them.

    Everytime an ACA-hating Repug gets sick and becomes pro-ACA, they are lauded by Dems like Obama. But really Dems should condemn them as selfish assholes who would have never changed their minds otherwise. A Dem needs to tell such people that since they didn’t like paying for “other’s” healthcare when they were well, others now want to do the same so fuck off and die. It’s harsh but somebody’s​ got to say it.

    The only way to turn this around is to let people opt out of coverage. In return, they lose access to any public funding for healthcare. Insurance can deny for pre-existing conditions. And ER can now deny care. Then let people who opt out suffer and die.

    Maybe contradictions need heightening before we can have the kind of healthcare that’s on par with the developed world.

    • Er…to adopt a “we don’t care about your health…why should we?” stance is to adopt the Republican stance in its purest form, so I’m not sure what we’re winning by doing that. I mean, there’s “heightening the contradictions ” in society, and then there’s “heightening the contradictions ” in our own philosophy, making it an impenetrable muddle that will convince no one at all. That’ll show them!

      • LosGatosCA

        There’s also the possibility that you get enough assholes (i.e. Republicans) to say – look even the liberals think you should die, and then it becomes the permanent program from a bipartisan perspective.

        Then when Democrats change their mind – oh, we were just trying to teach you a lesson – it’s too late.

        Universal health care is going to take something like WWII did to get general access to higher education via the GI Bill, etc. And look how long that lasted (45-50 years?). Now kids are screwed on the way into college (cost wise) and screwed on the way out (under employment).

        There’s only one way for people with a real conscience – forward. Unfortunately, there are too many people without a real conscience so it takes a long time to get things done. 80 years before slavery was gone from the US. Another 100 years before the institutional terrorism was outlawed. Another 50 and counting before mass incarceration/institutional racism is corrected. And that’s just for basic human rights.

        A benny like universal health care? 2250 at the earliest.

    • DamnYankees

      This is a very unfair characterization of young people, who are overwhelmingly liberal and support these programs in great numbers. There’s not a reciprocal hypocrisy here.

    • joel hanes

      Americans are inherently selfish

      Some Americans are selfish.

    • DAS

      While I agree that too many Americans are too selfish, I don’t think it’s selfishness that makes young Americans (c.f. DamnYankees’ comment) not “want” to pay towards health care for others. It’s that young Americans don’t have much money.

      E.g. how much money is a young, single, healthy American making $35K/year expected to pay for health insurance under the current subsidy regime of the ACA? How much money could said person, paying off student loans and paying exorbitant rent, actually afford?

  • Pretty slick how in that statement Ryan implies that if fewer people and up being covered by health insurance it will be entirely by choice.

    • “End up”, not “and up”. Autocorrect strikes again!

    • vic rattlehead

      Maybe we should take away health insurance from those lazy government moochers like members of Congress. Make them pay for shit insurance with shit subsidies.

  • LosGatosCA

    I’m surprised that no insurance company is giving 90% discounts to everyone who can run a 3 hour marathon to the top a Fourteener or 40.

  • trnc

    Our goal is to get a vibrant health-care system that’s patient-centered, that brings down costs, that increases choices, that has a marketplace so that we lower the costs and increase, and therefore increase the access to affordable care.

    Well, it does increase choices since it gives people the opportunity to obtain policies that don’t do anything to keep people healthy and that can be dropped by the insurance company any time a patient starts to expect them to actually pay for care.

  • herewegoagain3

    When Trump said he was going to deliver healthcare for everyone, you just have to understand who “everyone” is. It’s his base. Upper middle class racists who are tired of the blahs and poors (but I repeat myself) getting everything handed to them while they are busting their asses at work.

    And this is a good plan for them. Takes money from the blahs. Gives them a tax break. Penalty goes down so you can just hop on at any time you like and only have to pay it once. Bye bye medicaid for the poors. Choose whatever plan and benefits you want, no min requirements. Older people with higher incomes (WHITE WHITE WHITE) get more cash. I mean, that whole linked Vox article screams “hey white people, this is going to work out for you” – literally every one of the seven points.

    The problem is that liberals think minorities and the poor “exist” in Trump/Ryan world. They don’t. So yeah, they’re covering “everyone.”

    Trump/Ryan are delivering the goods. We need to get a fucking plan together or the next election we’re going to be worrying about is 2024.

    • Scott Lemieux

      The problem is that liberals think minorities and the poor “exist” in Trump/Ryan world.

      It’s weird how different the liberals in your head are from any actually existing ones.

      . So yeah, they’re covering “everyone.”

      Well, except for the white people without college degrees who are Trump’s most important marginal voters — they’re getting completely fucked.

      • Chetsky

        Uh, I think you might be misreading him. I read him as saying:

        Liberals think that, even in T/R world, poor/blahs exist. Implicitly, T/R don’t think this, and this is why they come up with their brutal/inhumane policies.

        • Scott Lemieux

          I understand what’s he’s arguing; it’s just wrong.

  • DAS

    I know a health care reform package that will lead to the realization of Paul Ryan’s stated goals! It’s called the ACA, aka, Obamacare.

    If the GOP wants to accomplish their stated goals without a mandate to purchase health insurance, why don’t they just increase the subsidies to the point where no reasonable person would not just purchase health insurance, mandate or not?

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