I KNOW! COMMUNICATIONS!!

It reminds of FireFly when someone asks Mal what Jayne does on the ship and he says 'PR'.

That's who the White House has running the comms department?

Ha ha yes, it's beyond parody. Though thank heavens Colbert, Meyers, Oliver et al are still giving it their best shots.

I don't think that conservative pundits have any idea what this whole orange fiasco is doing to the US's reputation in the world. Or perhaps they are just so convinced of American Greatness that they can't imagine anything could affect it. But the current administration seems to be doing its darndest.

I do have a question though. By most metrics, the US healthcare system is one of the worst in the developed world, and Obamacare was at least a step in the right direction. But 45 and many Republican Senators, including McCain in his statement, repeatedly claim that it is "failing". On what evidence? I mean, other than "rich people have to pay more".

Edited for clarity.

My wife told me I had to read that New Yorker article, and I was blown away. That's who the White House has running the comms department?

In tonight's sketch, the part of Sean Spicer will be played by John Cleese, Anthony Scaramucci by Graham Chapman and the White House Press Corps by Michael Palin. [link]

The White House infighting is amazing to watch. Once again, every day, they keep surprising me.

But 45 and many Republican Senators, including McCain in his statement, repeatedly claim that it is "failing". On what evidence? I mean, other than "rich people have to pay more".

These are people who think school lunch programs and Meals on Wheels aren't getting results. What other metrics would they use than how much rich people might conceivably be paying and whether or not it causes them to become richer?

And let's be serious: if we could develop a single-payer system that rich people could opt-out of the taxes for so it would not cost them anything but that in any way shape or form put limits on the profits of health care corporations, they'd fight like it was Omaha Beach. Let's be realistic: they'd fight not because it might cost them anything but because they strong,y believe they have insufficient control over who prospers and who lives in abject misery.

Some people seriously believe that government health care and programs for the poor is against the "tradition" of American self-sufficiency and make people dependent on the government instead of, I don't know, picking up stakes and moving to the frontier and carving out a new life for themselves free of interference. Or, in other words, being able to cut and run and yell "I'm out of here, suckers!"

But 45 and many Republican Senators, including McCain in his statement, repeatedly claim that it is "failing". On what evidence? I mean, other than "rich people have to pay more"

That's complicated. Here in the U.S. we have a patchwork of healthcare systems.

There's the big government programs which are mostly single-payer: Medicare that takes care of older Americans and Medicaid for the very poor.

Then, there's employer-provided healthcare that handles the majority of people in-between. That's private market, but employer pools together all of its employees and provides a group rate. Big companies generally self-insure and then hire an insurance provider to administer the program.

There's also the VA for veterans. That's entirely government run so it's socialized care.

That leaves a small percentage of population that fall into what we call the individual market. These lucky folks are left to buy individual plans from Insurance providers. Before Obamacare, or the ACA, it was getting really bad. If you were young and healthy, you could get a cheap plan that didn't cover much or an affordable plan that did cover you pretty well. However, if you were older or had some issues, you were quickly priced out of the market. Furthermore, insurance companies often denied coverage of existing conditions (for a pretty good reason, people would go uninsured until they developed a medical condition and then would buy insurance right be treating it).

So, the ACA came around and did a lot of things, but did two major things to work toward universal coverage. One, it expanded Medicaid to apply to more people and provided funding to the states to cover most of that cost. (Paid for with taxes that primarily hit the more affluent) That part has worked very well, but the courts ruled that states could opt out of the expansion and a lot of states controlled by Republicans didn't take part so it didn't work as well as it could.

The second thing was to create the exchanges for the that individual market I talked about. Each state has an exchange (run either by the state or by the feds) that pools together everyone in that state's individual market. Insurance providers then provide plans that meet minimum requirements for coverage at a single price for everyone. Not great if you are young and healthy, but life-saving (sometimes literally) for those who couldn't get insurance before. The ACA also didn't allow providers to deny covering existing medical conditions. To prevent the problem of people buying insurance just when they need it, the government mandated that everyone had to have health insurance. If not, then they suffered a tax penalty.

So that's what the ACA set up. Now to the failing part in my next post.

So what about the failing part?

Shoot. I forgot another part. The government also provides subsidies so people without a lot of income, but too much to qualify for Medicaid can afford coverage on the exchanges. The subsidy is based on income level and the cost of plans on the exchange in question.

Here's the what's up with the failing. One of the flaws in the ACA is that the penalty for not getting insurance isn't very high. (And now the Trump administration has announced it won't enforce it at all) So, participation in exchanges by young, healthy people isn't that great. That has driven up the prices on the exchanges and hurt the profitability since the insured population is older and less healthy than anticipated. Aside from higher prices, this has led to providers pulling out of the exchanges leaving some with only one or even no providers. That is what the failing part is all about.

Also there are a lot of lot of complaints that the deductibles in the plans are too high, though that boils down to the fact that health care is super expensive here.

Another problem is, well... remember how a bunch of states opted out of Medicaid expansion? Well, those people don't make enough to qualify for the subsidies since the law assumed they would be covered by Medicaid. They are out of luck.

The Dems have wanted to adjust the law to help, but since never had control of congress after passing it and no Republican dares show any support for the ACA, that isn't possible.

I hope that helps.

Very nice, Gud!

I would also add that the fact that future of the system has been so up in the air for the last six months has made companies even more squirrely, so people in some places have very few options for "Obamacare" plans on the individual market. Edit: Which is not necessarily a reflection of the profitability of the system, just the uncertainty.

I do think it's important to reiterate that most people have either employer-based insurance or Medicare/Medicaid government insurance.