Interesting, you have to wonder if this will help accelerate a push from rural voters for government-run health care where gov run hospitals have a mandate to stay open and the cost is spared across the system.
The tribal politics in the comments here are obnoxious and myopic.
Rural hospitals are receiving the majority of their money from Medicare and Medicaid. They don't pay enough. There was a great NPR show on this a few weeks ago.
Hospitals in the US overcharge (cost shifting is the technical term) patients with private insurance to offset losses from offering services at below cost to Medicare/Medicaid patients.
Too few private insurance patients means they close their doors.
Long live nuance.
- cheap loans to terrible creditors that nobody else in the world would loan to
- not allowing governments to negotiate prices, even when they’re the buyer (drug prices)
- extra taxes, errr, tariffs, on their competitors
- exemptions from those same tariffs when its their input
- access to cheaper labour pools that no small business could possibly do the paper work for (various visas)
It could have been the plan all along to engineer a "market failure" so these people have no choice but to accept socialized healthcare even if they're vehemently opposed to it.
Many democrats thought (and said so) that there was a huge problem of all this money moving around without government control. The first attempt, which failed badly under Hillary Clinton's leadership during her time as First Lady, failed because it tried to do everything at once. It could therefore be seen as a massive power-grab.
The ACA on the other hand, delivered an incremental approach that included lots of things people wanted: ignoring pre-existing conditions, broadening coverage. But it also did things like say there could be no new doctor-run hospitals, and existing ones could not add beds. Doctor-run hospitals, at the time, were actually a success of the free market in health care. Their outcomes in terms of patient recovery and survival rates were higher than state run hospitals. They were a direct threat to the idea that the government should run health care.
The ACA also set the stage for the failure of private medical insurance. We're in limbo on that score, but the needle has moved toward that failure.
I swear modern Republicanism is just agreeing with Donald Trump and blaming anything that goes wrong on Hillary or Obama.
I don't think Donald Trump is truly fit to be president, and I don't think the modern Republican party represents my views. Nor do I think Hillary Clinton was a suitable choice either. But disagreeing with the modern Democrat party is often met with derision, even if it is reasoned objection.
I actually remember the political discourse during President Clinton's first term, having been part of it back then. I remember the speeches Hillary Clinton gave as chair of the task force, including the notion that it was tragedy to allow so much of the economy to flow outside the purview of government. The notion of regulatory capture is not new [2].
It is my opinion that the purpose of the ACA was to lead to single-payer. It was the kind of boiled-frog strategy that Democrat party leaders had been using successfully for decades at the point ACA came a along.
The restrictions on doctor-owned hospitals are part of the law [3].
That the law would cause increased costs and dramatic deficits was predicted by the Congressional Budget Office (CBO) [4, 5].
The way I formed my opinion was taking all of this into account, including the model Hillary's task force put forth in the 90s as being what Democrats actually wanted. It is a reasonable opinion that if the ACA didn't deliver all of the things from the original plan, yet it opened up many unsolved problems, that the intent was to "continue reform" and make the "natural solution" a single-payer system.
I do wish we could have discussion without every comment on politics becoming a college paper.
[1] https://en.wikipedia.org/wiki/Clinton_health_care_plan_of_19...
[2] https://en.wikipedia.org/wiki/Regulatory_capture
[3] https://www.cms.gov/medicare/fraud-and-abuse/physicianselfre...
[4] https://www.cbo.gov/topics/health-care/affordable-care-act
[5] https://www.factcheck.org/2017/03/cbos-obamacare-predictions...
https://dash.harvard.edu/bitstream/handle/1/22856850/4558297...
TLDR; Previous research found that speciality physician owned hospitals (POHs) are treating less Medicare patients that are also healthier and focusing on more profitable patients while still receiving whatever benefits being a Medicare provider gets them. This lead to a blanket restrictions on all POHs in ACA. The above paper compared both specialty and non specialty POHs, which is what ACA actually targets, and found no significant differences between them and non POHs in terms of types of patients, cost of care and outcomes. This suggests that the policy has been too broad and is in need of a revision.
FYI RomneyCare was passed by a supermajority of Democrats in the MA state legislature. They negotiated some parts with Governor Romney but the reform was not a “republican idea”. ObamaCare in general was not a republican plan - it was a moderate Democrat plan.
People at conservative think tanks coming up with an idea doesn’t make it “republican”. In reality the party ignores many things that the heritage foundation or various other foundations or think tanks say, they’re much more focused on politics than on ideas.
https://en.m.wikipedia.org/wiki/Massachusetts_health_care_re...
And if we skip ahead 4 years to 1993, a Republican Senator introduced, a bill with 20 Republican co-sponsors including Bob Dole, Orrin Hatch, and Charles Grassley called the HEART bill.
That bill included an individual mandate, vouchers for low income individuals, and protection for prexisting conditions.
Not all Republicans supported this plan, but almost half of the Republican Senators including most of the leadership supported it. I'd call that a Republican plan--a plan based squarely on the proposal from the heritage foundation.
Costs should be cut, regardless of urban/rural, if we're being overcharged. Not sure what this has to do with killing off rural hospitals though.
> generally pretty hostile to the idea of subsidising rural folks
I have seen no evidence of this...do you care to elaborate or provide some links or something?
It will be too difficult to square their political convictions with economic realities. Providing healthcare in rural areas will always be economically difficult. There aren't enough consumers in rural areas to support modern hospital facilities. Admitting this isn't a problem markets will solve, and that government taxes and spending might be the answer, is something that will prove very difficult indeed.
[1] https://www.kff.org/wp-content/uploads/2018/11/status-of-sta...
I am still in favor of doing that though. And ignoring that part, there are huge cost reductions to be had elsewhere, say, for example, an entire industry of medical billing and debt collection - though it'd sure be a shame to see all those nice folks out of work.