Remember the South Park Underpants Gomes? Phase one, steal all the underpants. Phase three, profit! The problem is that nobody knows what phase two is supposed to be, or how collecting all the underpants leads to profit. They just have absolute faith it will work.
The Republican Party seems to have an Underpants Gnome problem. There are several news stories out today saying that congressional Republicans are panicking about rising health care and other costs, and they don’t know what to do about them. Politico:
Republicans want to put the economy at the center of their midterm message as they seek to protect their majorities in Congress. But as cost-of-living concerns mount across the political spectrum, the GOP is struggling to act decisively to address them.
Already top Republicans acknowledge they haven’t done enough to sell the “one big, beautiful bill,” the party-line centerpiece of their economic agenda they enacted over the summer. Now internal divisions and the need for bipartisan support in the Senate are threatening any attempt to follow up on it.
For Republicans, cutting taxes on corporations and the wealthy is always phase one that will take us to phase three, someday, although payoff day never seems to arrive. The Big Ugly Bill was kind of an enhanced phase one, in that it is cutting a lot of safety net benefits, notably health care subsidies, along with taxes on the rich. It was blazingly obvious to anyone Not a Republican that this was going to price millions of Americans out of their health insurance and possibly set off a wave of insurance hikes for everybody. It was also predicted that several other provisions such as cuts to green power tax credits would push up energy prices, which is already happening. All that, combined with Trump’s nutso tariffs and deportation of the immigrant labor pools is sending the cost of living up, up, up.
Lots of people saw this coming. What did Republicans expect?
The GOP is struggling to coalesce behind a health care plan that would prevent Obamacare premium hikes set to kick in next month and efforts to rein in President Donald Trump’s tariffs have run aground in the House. Meanwhile, the administration’s proposal to distribute $2,000 rebate checks has gotten a lukewarm response on Capitol Hill and the fate of other smaller bills to address things like housing prices and student debt have sparked intraparty sparring.
Republicans are always coming up with little band aids that they think will cure the problem. This morning I read that Josh Hawley has proposed making all out-of-pocket health care expenses tax deductible. So does that mean that if Jim loses his insurance and has to pay $100,000 in 2026 for his cancer treatments, the IRS will refund the $100,000 in 2027? And let’s say Jim makes the annual median salary for the U.S., which is $61,984. And in 2026 he doesn’t have $100,000. Will his health care providers treat him on the promise that he’ll pay them when he gets his refund?
Somehow, I don’t think that’s what Hawley means.
And that takes us to the bigger issue, which is that Republicans don’t ever seem to understand how anything works. They cannot ever come up with a usable health care policy because the only way they seem to be able to view the issue is through the prism of reducing the hit to the federal budget. That means all of their solutions come down to dumping more of the cost onto patients and health care providers. And ultimately the Republican insistence that health care must be paid for by a private, for-profit insurance system and not taxes has left us with a Byzantine monstrosity of a patched-together system that is far and away the most expensive in the world but fails to actually deliver health care to too many people. The administrative costs alone are staggering.
And it can drive all crazy maneuvering through the maze of programs and insurance plans that too often still leave patients with medical debt. Sorry to vent, but New York likes everyone on Medicaid to be in some kind of “Medicaid Advantage” plan administered by an insurance company. That means I’m in a dual eligible Medicare-Medicaid D-SNP plan, and the plan I was in was screwing up my bills. So I spent hours this year researching one to move to, and since they’re all HMOs I had to find one in which all of my providers are in network. The companies don’t all let you search their physician database before you join, so you have to call or do those endless online chats to check them out. It’s insane. And the whole time I’m thinking wouldn’t it be great if there were just ONE BLEEPING SYSTEM AND EVERYONE IS IN IT? Anyway, I’m in a new plan now for 2026. Wish me luck.
Even though of us who support the Affordable Care Act usually acknowledge it fell short of what we really wanted, but it was at least a step in the right direction. The thing that needs doing is to step back from all the programs, public and private, and just consider the most cost-effective way to provide necessary medical care to Americans in all income brackets. Going by what works in other countries, that would be a system in which the private insurance companies are kicked aside in favor of a taxpayer supported system. And in most such countries the system pays for health care for citizens and legal residents. Other people may have to either pay into the system or expect to get help only for serious emergencies. For those who would rather die from a ruptured appendix because they couldn’t afford surgery than to have a single penny spent on illegal aliens, — we really need massive immigration reform also. But that’s another rant.
The point is, though, that it’s obvious a unified, taxpayer-supported system would be less of a financial burden to both the government and to citizens. And I doubt even a bad system would be any worse than what we’ve got now. Most nations with a national health care system of some sort get better results than we are getting. Yes, you can get first-rate health care in the U.S. if you have lots of money and/or a really great company benefit plan. But everyone else falls through too many cracks.
The only industrialized country other than the U.S. that expects health care to be paid by private insurance is Switzerland. The Swiss system is basically Obamacare on Steroids. Everybody is mandated to buy insurance, and the insurance is regulated up the wazoo to keep it honest. It works for the Swiss, but I understand the Swiss pay more as a percentage of GDP in health care than other European countries..
Still, the Republicans are frantic to stop a health insurance apocalypse that could cost them lots of votes in next year’s midterms. What are they going to do? Let’s look at Cassidy projects optimism on winning bipartisan support for his health care plan
Sen. Bill Cassidy (R-La.) said he planned to present Republican leadership with his health care plan as soon as Sunday night, predicting that the divisive proposal to put money directly in Americans’ health savings accounts could clear the 60-vote threshold needed to pass in the Senate.
“We’re working to deliver to Leader Thune and Speaker Johnson a plan, which I think could get 60 votes, which gives the American people the power, and they can choose a lower premium and an HSA,” he said in an interview on “Fox News Sunday” with host Shannon Bream. “We’re working on that. And I’ll give them a piece of paper probably by e-mail tonight.”
This was published yesterday. Whether Cassidy delivered his “piece of paper” last night I do not know.”
Cassidy is pushing for congressional leadership to advance his health care plan, which encourages Americans enrolled in Obamacare to switch to lower-premium, bronze-level plans with the hope that they would be able to afford higher out-of-pocket health care costs with new funding in their HSAs.
That’s it. That’s the brilliant plan. That’s the best they’ve got.
My understanding is that HSAs really only benefit healthy people with few medical expenses; if you are older or have a condition that eats a lot of money you really need insurance that pays for it, not an HSA. See Five Reasons Lawmakers Should Reject Expansions of Health Savings Accounts from the Center on Budget and Policy Priorities.
Sen. Cassidy should sit down with Jim, with his $61,984 annual income and $100,000 medical bills — or even half that — and work out how his HSA and high-deductible policy will work for him. I suspect it won’t. And Cassidy is a bleeping physician, for pity’s sake. He should know how the system works. But after all this time, after the decades of fighting over health care in Congress, the Republicans still have absolutely no idea how any of this stuff actually works. They’re still looking for some easy tweak that will make the problem go away.
O.T. Shocked, I'm shocked, shocked I tell you!
Donald Trump Violated Own Mortgage Fraud Standards: Report
Politics for the GOP is one big reality TV show – detached from reality. It's all about the impression and feelings. Actual solutions to actual problems are 1) usually expensive and 2) usually hard. So we'll give them (the voters) a show, promise that they will have everything they want plus more – tomorrow. Finish with the Star Spangled Banner and fireworks, and they will forget that they are hungry.
A few Republicans in the House may have been serious about resttoring the Obamacare subsidies, at least until after the midterms. It was/is survival politics – they know how bad things will get back home. Most Republicans favor passing something quick, cheap, and inadequite. They will promise that this is a perfect replacement, then promise the next versions is actually gonna be perfect. Rinse and repeat until voters forget that there was a better (though flawed) system. Cassidy is more devious. He's proposing a 'solution' that's so flawed, the Democrats won't support it in the Senate. Which is his goal – to have a version defeated by the Democrats that they can pretend would have fixed everything but the Democrats want to make you suffer.
Bush passed Medicare drug coverage with the support of big pharma because it included a provision that guaranteed big pharma would charge the government at the HIGHEST rate – no negotiationg for price allowed. Bush would not have gotten it passed if it wasn't the gift that keeps gouging the consumer. Obama made the same deal to pass Obamacare, except with big insurance. That's why single-payer wasn't an option on any of the marketplace websites. And like Bush, there was no other way to get it passed.
Until big money is chased out of politics, we can't have nice things like health care.
And after the same decades of time, show less respect for those who do know how this and other stuff actually works. What little they do know tends to be quite outdated also.
Their quest for an easy out is more an obsession that prevents them from even constructively communicating. Many times, their solutions to problems are a bigger problem than the one that they do not solve.
Yet they never seem to learn from their blunders. Is that because they never really admit they ever blundered?
The GOP's problem on heath care is, essentially, the con didn't work this time. The BBB is a good thing only if you are a corporation and/or are wealthy and not working for a living, otherwise its all pain. Selling it meant coming up with lies to mask the pain to be absorbed by their own voters. They used to sell that as "freedom," e.g. you're free to go without, as a solution. "Freedom of choice." Their selling point, on the bill’s removal of damn near a trillion dollars from Medicaid, was that it would prevent "illegals" from getting care they never received in the first place, indulged their voters innate hatred of minorities, and there was the initial sugar high they got from that. But then reality hit that they're taking it from them as well, and causing premiums to increase several times over for others. The irony is the ACA was based on their own plan, and the easy button was to just extend the subsidies, at least for now. But they spent the last 15 years trashing it, for ideological reasons, particularly that government should only help the rich, not to mention that it had to be abandoned for the stupid reason it was successfully implemented by a democrat, a black one at that.
As bad as all this is, the one silver lining in it is it has now become obvious that the "market based" approach with insurance companies taking a decent chunk of health care dollars off the top for profit and admin costs at the expense of denying care for policy holders does not, and cannot work. A system that spends that much money and still leaves millions either without care, substandard care, with a choice of bankruptcy or death is not working. The republican party is not built to fix this, and hopefully more will begin to see that now.
I saw a clip of Bernie suggesting we extend the subsidies for now, and do a study based on interviews with other countries who have delivered better outcomes for less money. HOW? Then, design a system for the US that would meet the needs of citizens on a bipartisan basis. He's so sane, polite, and reasonable it scares me.
I don't expect anyone will take him up on it. My opinion is that the speech was for sane Democrats, that a better system is possible and the aspiration should not be abandoned. On a related note, I'm seeing more articles on blowing up the Senate filibuster rule to expand the USSC. This would be essential to have a Health Care law that priortizes citizens survive the legal challenges that the insurance companies would make.
My plan is to expand the number of federal appeals courts from 12 to 15, and then add six Supreme Court justice so that there is one justice for every appeals court. This is logical. You can find commentary going back years calling for expanding the federal court system, because it's overburdened and slow, which certainly applies to the SCOTUS also.
> then add six Supreme Court justice so that there is one justice for every appeals court
I think this is not close to enough new Supremes. There need to be enough so that the votes of the Illegitimate Six are buried and irrelevant, their opinions no more forceful that the barking of a dog. I say triple the size of the Court, and if you insist that's too many, then allow the size to decrease with attrition after that jump, so that it declines eventually to your ideal.
> … the bigger issue, which is that Republicans don’t ever seem to understand how anything works
Amen.
O'Care was already the absolute minimum solution that could deliver improvements on the previous status quo. It was the most conservative possible move to make an intolerable situation tolerable, but because Cleek's Law is a real thing and not a joke, it became anathema to the conservatives its architecture was supposed to appease. Because there's no longer any appeasability remaining on the Right.
I would say the root of the problem is that as a group, Republicans don't know how to know things, as opposed to merely having views and opinions and beliefs. So of course they can't understand how anything works. And they can't formulate workable policies in any area.