[Discussion] Health Policies and ACA Reform/Repeal

The existing health thread is for discussion on how changes to current policy will/have personally affected you or those you know. This thread is for more general discussion of the subject.

I've been around these parts for a while now, and learned a whole lot about US hot button issues like gun control, abortion, different interpretations of free speech, market regulations, and so much more. Independent of whether my opinions on these matters have shifted or not, I at least understand much better why certain political or interest groups hold certain opinions.

Not so for healthcare though. I don't get how the Republicans and their propaganda industry got away with labeling ACA - basically a first step in plugging the worst offenses of a horrible healthcare system - a left-wing government overreach.

Because all the other BS the GOP and Fox spout at least plays into a certain emotional tendency to protect your own interests (middle class vs the poor) or plays into racial resentment. That's horrible, but I can grok it at least. The effect of your atrocious healthcare is so direct and so important (life and death!), hits the middle class the most and causes huge governmental (taxes!) and personal expenses. And literally everyone knows a loved one who's impacted. And that's not even taking into account more rational arguments like the impact on economic growth due to small businesses postponing new hires or people not starting on their own or switching jobs for fear of losing access to basic health services.

(by middle class being hit the most I mean that they usually have some kind of insurance and thus pay out of their nose for almost no coverage at all. At least when you're poor and uninsured you know where you're at. /cynic)

So yeah. Don't get it.

In the story, America is shaken by a wave of terrorist violence as angry, traumatized white dudes start to suicide-bomb health insurance companies and take shots at senators funded by them.

Angry incels suicide bombing insurance companies and corrupt, evil senators? Instead of taking an AR-15 to college aged women?

What is my takeaway here? That this is bad news?

dejanzie wrote:

Not so for healthcare though. I don't get how the Republicans and their propaganda industry got away with labeling ACA - basically a first step in plugging the worst offenses of a horrible healthcare system - a left-wing government overreach.

The sad irony is one of the big reasons is the Individual Mandate, which required almost everyone to have insurance or pay a penalty.

The Individual Mandate is an idea from Republicans in the 90s, that the Democrats added in because they were too meek to tax the rich more to fund health care insurance or even just break one of Obama's campaign promises (he also promised no Individual Mandate, but they chose the 'no new taxes on incomes under 250k' promise over that one).

As one Supreme Court Justice put it, this law asks the young and healthy to pay for the old or the sick right in the middle of the Great Recession.

tl;dr: all the usual plays into a certain emotional tendency to protect your own interests (middle class vs the poor) or plays into racial resentment? They were there, too. From the Medicaid expansion refusals to coverage of birth control to 'death panels', it was all there.

And not to knock all the good the ACA has done, but you're still buying insurance from private health insurance companies who deal with private companies selling health care, with plenty of confusion and surprise expenses still in the system.

dejanzie wrote:

So yeah. Don't get it.

Capitalism is their true religion, not Christianity. Profit above all else. And those poor insurance and drug companies are struggling making only hundreds of millions a year instead of billions.

Stele wrote:
dejanzie wrote:

So yeah. Don't get it.

Capitalism is their true religion, not Christianity. Profit above all else. And those poor insurance and drug companies are struggling making only hundreds of millions a year instead of billions.

That's simply not true. Apparently capitalism and small government are not that important when it comes to farming/oil company subsidies, Social Security, ... Actually, not a single one of those GOP 'principles' are ever followed consistently, so that's not the explanation. It usually boils down to, like I said, I gots mine and don't let the out-group profit.

There are a couple more factors:
* There's leftover damage from the Cold War continued by decades of Fox- for a lot of Americans, "socialized" anything is reflexively bad. And the people against the ACA have that thoroughly racialized.
* Relatedly, the kind of distrust of government popularized by Reagan is still really popular.
* Racial resentment is even more powerful than you're saying. This is anecdata, but from Jonathan Metzl, author of "Dying of Whiteness", in an interview with Chris Hayes:

JONATHAN METZL: The flip side of the question of when are Trump supporters going to wake up is when are people who are liberal going to wake up themselves to the depth of these ideologies that people are willing to put their lives on the line. That case of Trevor is a perfect example. This was a focus group I was doing in a low income community in Tennessee and this guy was on death's doorstep, had an oxygen mask under his nose, had liver failure, and even at that time, I asked him, "Gosh, if you live 20 minutes away in Kentucky, you would get much cheaper medications and better healthcare because they adopted the marketplace and expanded Medicaid." And he said, "I don't want any part of that because I don't want my tax dollars going to Mexicans and welfare queens." The guy wasn't crazy. He was basically saying, "Here's a choice I'm making, that I'm a kamikaze in a way. I'm laying down on a line for something that's important to me, and that thing is an ideology, a construction of whiteness where I might not be at the top of the pyramid, but I'm certainly not at the bottom." And in a way, whatever benefit ... I mean, obviously there is a benefit to being white in this country, and he was willing to die for that.

It comes down to that Republicans are a LOT better at selling and propaganda than the Democrats. Like you said, health care should be an easy sell, almost everyone has a family member affected or has been affected themselves. The Democrats suck at selling.

LeapingGnome wrote:

It comes down to that Republicans are a LOT better at selling and propaganda than the Democrats. Like you said, health care should be an easy sell, almost everyone has a family member affected or has been affected themselves. The Democrats suck at selling.

They’re increasingly ineffective every day.

The Trump admin has figured out that Pelosi is terrified of “losing the middle” and is just shutting them down at every opportunity.

And Trump himself will burn every single operator under him. Barr, Mnuchin, Miller; he’ll burn them all and not lose a wink of sleep.

Pelosi came in with a lot of grand gestures and has made zero headway in asserting the balance of power. He’s mostly got the Supreme Court. The Senate is effectively neutralized. All she has accomplished is the alienation of the far left and progressive wings of the party.

The Dem strategy so far seems to be “2020 - Terms of Our Surrender.”

qaraq wrote:

There are a couple more factors:
* There's leftover damage from the Cold War continued by decades of Fox- for a lot of Americans, "socialized" anything is reflexively bad. And the people against the ACA have that thoroughly racialized.
* Relatedly, the kind of distrust of government popularized by Reagan is still really popular.
* Racial resentment is even more powerful than you're saying. This is anecdata, but from Jonathan Metzl, author of "Dying of Whiteness", in an interview with Chris Hayes:

JONATHAN METZL: The flip side of the question of when are Trump supporters going to wake up is when are people who are liberal going to wake up themselves to the depth of these ideologies that people are willing to put their lives on the line. That case of Trevor is a perfect example. This was a focus group I was doing in a low income community in Tennessee and this guy was on death's doorstep, had an oxygen mask under his nose, had liver failure, and even at that time, I asked him, "Gosh, if you live 20 minutes away in Kentucky, you would get much cheaper medications and better healthcare because they adopted the marketplace and expanded Medicaid." And he said, "I don't want any part of that because I don't want my tax dollars going to Mexicans and welfare queens." The guy wasn't crazy. He was basically saying, "Here's a choice I'm making, that I'm a kamikaze in a way. I'm laying down on a line for something that's important to me, and that thing is an ideology, a construction of whiteness where I might not be at the top of the pyramid, but I'm certainly not at the bottom." And in a way, whatever benefit ... I mean, obviously there is a benefit to being white in this country, and he was willing to die for that.

I might still be underestimating racial resentment (aka racism). A (depressing) pet theory of mine is that Europe would not have such a solid safety net if it hadn't been 99,99% white around the time it was implemented - and that its erosion the last few decades was tolerated by the voting populace because 'we' now think of a beneficiary as an out-grouper.

LeapingGnome wrote:

It comes down to that Republicans are a LOT better at selling and propaganda than the Democrats. Like you said, health care should be an easy sell, almost everyone has a family member affected or has been affected themselves. The Democrats suck at selling.

I don't personally believe that people will buy anything sold to them, unless they want to. Republicans are indeed a LOT better at selling and reinforcing what many people still WANT to believe: that non-whites are lazy leeches.

qaraq wrote:

* There's leftover damage from the Cold War continued by decades of Fox- for a lot of Americans, "socialized" anything is reflexively bad. And the people against the ACA have that thoroughly racialized.

I meant to say "internalized" here- I guess I got ahead of myself thinking about my third point. What don't know for sure is whether people understand at a gut level that if you start paying for healthcare with taxes then you and the employer stop paying directly. It seems obvious, but a lot of people just don't pay that close attention or are motivated to reason otherwise. Also the employer portion is hidden; I know my employer pays 70% or whatever but that just gets mentioned once a year.

Now I do suppose that most of are pretty cynical about the portion that our employers pay for health benefits suddenly being added to our paychecks, and even if that does happen it'll appear as a smaller amount because it's no longer tax advantaged.

Reaper81 wrote:
LeapingGnome wrote:

It comes down to that Republicans are a LOT better at selling and propaganda than the Democrats. Like you said, health care should be an easy sell, almost everyone has a family member affected or has been affected themselves. The Democrats suck at selling.

They’re increasingly ineffective every day.

The Trump admin has figured out that Pelosi is terrified of “losing the middle” and is just shutting them down at every opportunity.

And Trump himself will burn every single operator under him. Barr, Mnuchin, Miller; he’ll burn them all and not lose a wink of sleep.

Pelosi came in with a lot of grand gestures and has made zero headway in asserting the balance of power. He’s mostly got the Supreme Court. The Senate is effectively neutralized. All she has accomplished is the alienation of the far left and progressive wings of the party.

The Dem strategy so far seems to be “2020 - Terms of Our Surrender.”

Sounds about right.

I just don't get people who say anything "socialized" is bad but are actually kind of okay with Russian interference.

Nevin73 wrote:

I just don't get people who say anything "socialized" is bad but are actually kind of okay with Russian interference.

Russians are capitalists. Soviets were the socialists.

Also, Russians are white.

Whoah, no pun intended! Historical or cinematic!

dejanzie wrote:

So yeah. Don't get it.

A big part of it is that everything you know is a lie. That includes your own experiences at your own health providers.

Healthcare is the second best area of seeing the extent to which US conservatives have divorced themselves from reality. (The best is climate change). That entire body of evidence which shows that other countries have better health systems are just taken as fabrications and exaggerations.

Personal stories of better outcomes, or cheaper costs abroad (whether by people who have experienced both systems or just the non-US one) must be people that are misinformed, got uncharacteristically lucky, or are ignorant of the vast weight their healthcare put around the neck of their economy. Larger datasets and studies are created by biased organizations skewing their results for nefarious purposes.

Americans like my parents know that other countries have huge lines and waiting periods for their care, they know that those foreigners get worse care. They know that foreigners with the means flock to the US to get the best care in the world that no other location can provide.

It's a mindset that is firmly rooted in delusion and world events that were happening 40 or 50 years ago.

dejanzie wrote:

I don't get how the Republicans and their propaganda industry got away with labeling ACA - basically a first step in plugging the worst offenses of a horrible healthcare system - a left-wing government overreach.

Because Republicans and their propaganda industry had years and years to make up FUD about Obamacare. It took from 2008 to 2010 to pass the law, which was really just a framework that was fleshed out with details over the next four years before it actually went into effect. During those six years Republicans and conservative media could--and did--say any crazy thing they wanted Obamacare and some of them stuck, like Obamacare's going to euthanize your gam gam when her healthcare gets too expensive.

They also labeled it Obamacare after the scary black man who was sitting in the Oval Office--the same scary black man Mitch McConnell publicly vowed to make a one-term president. Which is why we ended up with polls that showed chunks of Americans didn't know the ACA was the same as the Obamacare and polls that showed Obamacare had slightly more people saying they felt "very positive" or "somewhat positive" about it than the ACA, but also had a lot more people saying they felt "somewhat negative" or "very negative" about the Obamacare than they did the ACA.

dejanzie wrote:

I might still be underestimating racial resentment (aka racism).

I think you are. It took me well over a decade of living in the USA to come close to understand how thoroughly racial animus permeates structures here.

The bottom line is a lot of folks won’t support any kind of public benefit if there’s a chance those people would also get it.