Health care stakes for 2020

Health care and the distribution of consequences of bad luck will be a major clear differentiator between parties in the 2020 election.

The Democratic Party is running on spreading the costs and consequences of bad health luck to broader populations. There are several different ways that this can be accomplished but Medicare for All, Medicare for anyone who wants to buy it, Medicaid Buy-in, and ACA 2.0 bills would all spread risk across wider pools that span society. These plans all differ greatly in details. Those details matter and they are fascinating, but the core concept is similar.

The Republican Party’s historical healthcare proposals are designed to minimize the spreading of the costs of bad luck and make the people who get hit with bad luck pay more.

That is a fundamental difference up for decision in 2020.

Open Thread as I’m going to the mountains for the next five days.

36 replies
  1. 1
    rikyrah says:


    I don’t even understand how this is even up for debate.



  2. 2
    Mathguy says:

    Is there a more nausea inducing politician than Graham? [Ok, aside from the shitgibbon.]

  3. 3
    jl says:

    @Mathguy: True, but if a guy like Graham wants to be the face of the GOP for the 2020 election and the GOP wants to make taking away health care an issue for the campaign, instead of lying about it, that is probably good. Then we can ask them what their plan is and watch them run about like panicked chickens.

  4. 4
    StringOnAStick says:

    My husband and I could retire a few years before age 65 if we knew the ACA would still be there for us, but until the 2020 elections happen, we know we can’t. My husband has been diagnosed with a chronic from of leukemia and we live completely for our outdoor pursuits; his diagnosis, while being in an extremely early stage, makes us want to maximize what good time we have left, so fuck Lindsey Graham crosswise with a rusty chainsaw. I’m sure he can figure out a way to make that into yet another horse he can ride for political prominence, so it had better be extra rusty.

    I’m donating as much as we can and once I’m done recovering from knee replacement (both,, one in March and the other in early July) I will be volunteering like our lives and future depend on it, because they do.

  5. 5
    Chyron HR says:

    You had control, Aunt Lindsay. You decided to spend your magic ticket on tax hikes for the working class instead.

  6. 6
    Brachiator says:

    Lindsey Graham vows to repeal Obamacare if GOP takes control in 2020

    It’s good that the GOP is stuck on this. It should make it ridiculously easy for the Democrats to kick GOP ass.

    The GOP is out of touch with ordinary people. They promised to replace Obamacare with something better and failed miserably. Every proposal the GOP came up with benefits insurance companies and hurts consumers.

    Congress has good health care. How come Republcans don’t want the people to have it as good as they do?

  7. 7
    Sab says:

    @rikyrah: You sound like another-church- lady, only more excited. Don’t take that as criticism.

  8. 8
    JMG says:

    I’m sure Graham’s Republican Senate colleagues who’re up for re-election in less-red states than South Carolina (which is most states) are thinking if not saying “thanks a lot, you jackass.”

  9. 9
    Turgidson says:

    You forgot one huge part of the GOP health care plan:

    he Republican Party’s historical healthcare proposals are designed to minimize the spreading of the costs of bad luck and make the people who get hit with bad luck pay more.

    …and lie endlessly and shamelessly about all of it.

    Hopefully 2018 shows they’re not getting away with it as much anymore, but we’ll see. They’re sure to lie their asses off about M4A or a robust public option or whatever the nominee ends up running on.

  10. 10
    StringOnAStick says:

    @Brachiator: Remember when tRUMP said that insurance companies were “beloved” by us out here in the real world? I have a complex set of feelings about my insurance provider, but “beloved” is not even remotely accurate. My feelings are more along the line of “why do you assholes keep sending me daily letters asking why I’m getting PT when I JUST HAD MY FUCKING KNEE REPLACED AND YOU APPARENTLY HAVE YET TO INTEGRATE THAT INFORMATION, YOU MONEY WASTING MORONS?!?!?! JFC, the amount of money being spent to endlessly generate letters annoys the shit out of me. “Beloved” is how exactly no one feels about their health insurance company.

    D’s won big in 2018 on health insurance issues, so hang Lindsey’s promise around the neck of every single R from now until the end of time.

  11. 11
    Brachiator says:


    Remember when tRUMP said that insurance companies were “beloved” by us out here in the real world?

    I confess that I missed that, or read it and discounted it since everything that Trump says about the issue is nonsense.

    But the Democrats should dig this up and nail Trump with it. ‘Trump cares more about insurance companies than he cares about the people,”

  12. 12
    Ella in New Mexico says:

    Is it just me or does pretty much every headline about Lindsey or the rest of the Republicans threatening some shit “when they win in 2020” seem like a huge cry of “Democrats: please, God almighty we’re begging you to please stop us”?

    I mean, seriously, they double, triple and quadruple down on every issues that polls tell us has a majority of the country’s support. It’s like he’s blinking SOS or talking in code. Next thing we’ll hear Lindsey threaten is he’s gonna “take my own AR-15 and start shootin’ them illegals myself”

  13. 13
    Baud says:

    The Republican Party’s historical healthcare proposals are designed to minimize the spreading of the costs of bad luck and make the people who get hit with bad luck pay more.

    So disappointing. I remember when Trump ran to Hillary’s left in 2016. Now this.

  14. 14
    L85NJGT says:

    The house GOP has voted for repeal… seventy times? Keep on fuckin’ that chicken, Senator…..

  15. 15
    catclub says:


    True, but if a guy like Graham wants to be the face of the GOP for the 2020 election and the GOP wants to make taking away health care an issue for the campaign, instead of lying about it, that is probably good.

    Campaigning on Taking away healthcare (repealing the ACA) worked wonders for the GOP in 2014 and 2016, not as much in 2018.
    But things that worked wonders once, get tried over and over.

  16. 16
    the Conster says:

    The Dems picked up the House by running on covering pre-existing conditions. Everyone has a pre-existing condition, and when I heard GOP Reps and Senate candidates like McSally all the way up to Trump outright lying that they always wanted to keep that coverage, I knew it was going to hurt them. Thankfully they didn’t learn a thing. That’s why I wish Dems would stop with the repeal and replace Obamacare with the Medicare 4 All bullshit. It gives Dems zero political advantage to propose half baked pie in the sky.

  17. 17
    Turgidson says:


    There is some truth to there idea that people are “happy”’with their health care and fear the unknown. But I am pretty convinced that the “happy” people are mostly those who don’t have to use their insurance all that much for more than regular visits and relatively small health issues. The people with serious injuries or conditions who spend so much time it might as well be a part-time job fighting to get their bills covered are probably not in the “happy” pool. And the thing is, all of us will be in the latter category at some point.

  18. 18
    Butch says:

    @Turgidson: I’ve spent the last 4 months in a frustrating appeals process with Blue Cross of Michigan because they denied coverage for preventive and wellness care based on a single sentence on page 111 of the policy. (I’m not kidding or exaggerating; I can send you a copy of the denial letter). I want to see Blue Cross burned to the ground and the ashes scattered in a pigpen. I have no idea about the identity of these mythical beings who supposedly “love” their private insurance.

  19. 19
    frosty says:

    @Sab: to quote DCL:


  20. 20
    Uncle Cosmo says:

    What kind of shocks me is that the Global Oligarchy Plutocratic party hasn’t hit on the obvious base-affirming tactic of promising to fund topnotch healthcare-coverage for “them good folks as deserve it” (wink wink nudge nudge) by taking it away from “them not-really-people as don’t” (nudge nudge wink wink). (With the added appeal of when “them as don’t deserve it” ain’t swarming the ERs, “them as do” won’t have so long to wait!)

    Of course what they’d do if they could is to rip healthcare away from both groups & shovel the money to the HIP (Health Insurance Plutocrats). Details, details…

  21. 21
    rp says:

    Like everything else Graham and the rest of GOP say, this is a completely empty and meaningless comment. there’s approximately zero chance the GOP retakes the House, so he can promise to repeal ACA all day long and will never actually have to do anything about it.

  22. 22
    gene108 says:


    I remember Trump’s 2016 election promise for getting everyone cheaper health coverage than Obamacare, which will cover damn near everything, at a negligible out of pocket cost to consumers.

    But that’s gone by the wayside, and no one even bothers holding him or any Republican accountable for that flat out lie.

  23. 23
    Ruckus says:

    Republicans at this point are running against whatever helps the most people and for whatever helps the wealthiest. And a portion of them will also be thinking racism, OK not a portion, every fucking one of them. They are selfish, plain and simple. That’s three traits by the way……
    On to new.
    I’d actually like to hear what people think Medicare for All actually means. Is it to just expand the program we have to everyone? Is it a description of something that people think they know how it works when they really don’t?
    Medicare is not a great program, at least not as it exists currently. It is far, far, far better than what seniors would have without it. But it is not in any way free, it is not in any way totally inclusive, it is not a great program, especially the way republicans have fucked with it over the years. I started working before Medicare existed and have been paying for it since it’s inception. I’m 70 and still paying in weekly. And it would probably wipe out everything I own well before I died if I had to use it. It did for both my parents and for far too many adults who live over 65. Of course it’s not the program alone that does that, but it hasn’t kept up with the medical costs of living. It’s why we have Medicare Advantage.
    Professional republicans want to suck every dollar possible from every human. The rank and file republicans may not understand that they are included in this wallet vacuuming but they are. Along the way they don’t mind being racists, especially if it helps them in their vacuuming and in getting their supporters not to notice that they are being fleeced as well. That’s why trump plays well in their arena. They have found out that their racism bits said out loud gets them rousing support. Strong, very thin support. It’s why the FTFNYT supports all the shitty republican politicians, it’s not about the racism, it’s all about the benjamins. And how to get them.
    OK it is also a little bit about the racism.

  24. 24
    gene108 says:


    When the comments came out Twitter was flooded w/ conservatives and/or bots proclaiming their love for private insurance, and how private insurance, in America, is better than any socialist M4A proposal.

    Not a representative sample, but interesting enough.

  25. 25
    Fair Economist says:


    I want to see Blue Cross burned to the ground and the ashes scattered in a pigpen.

    Why do you hate pigs? Exposing the poor beasts to foul toxins, shame!

  26. 26
    Mike in NC says:

    Today we visited the town of Lerwick and vicinity in the Shetland Islands. Cold and windy! Our European tour ends tomorrow in Bergen, Norway and we fly back home very early on Sunday morning (9-1/2 hours from Amsterdam to Atlanta). The cats are going to ask “exactly where the hell have you two been for the last 15 days?”

  27. 27
    Elizabelle says:

    David: Enjoy the mountains! Hope you have a lovely vacay.

    @Mike in NC: Speaking of vacays, you have certainly had a great one. Safe travels back to the US of cray cray.

  28. 28
    StringOnAStick says:

    @Mike in NC: Yes, they will be asking that, possibly with a side of “I can still get along fine without you, 2 legged weirdo, now watch me ignore your advances”.

    My first cat (at age 6) was very attached to me and every year we would go away for 2 weeks to see grandparents. The first few years she would bad vibe and ignore me for days after we’d get back home but as she aged that time shrunk until she was just plain happy to see me again. Cats get offended by such stuff and the beta types need to not be left alone. That’s why we got two sisters this last time we signed up to become cat staff again; it’s good that you have more than one. At least they have each other if we’re not around, plus our cats absolutely love the cat sitter.

  29. 29
    Amir Khalid says:

    Sorry for going off-topic, but the Goldman Sachs International CEO Richard Gnodde and 16 other employees have been charged here in Malaysia in connection with the 1MDB scandal.

  30. 30
    Brachiator says:


    There is some truth to there idea that people are “happy”’with their health care and fear the unknown. 

    OK. But this notion, and Trump’s claim that insurance companies are “beloved” by people, are perhaps more reactions to single payer and Medicare for all proposals. But let’s put that aside for a moment.

    Most simply, the GOP has shown that they lie and can’t be trusted about health care. Trump promised to repeal and replace Obamacare with something better. I don’t know, maybe this also would include changes to “beloved” insurance companies. No matter. This promise was a lie.

    Instead, what the GOP actually did was to try to repeal Obamacare and to restore insurance company power over healthcare.

    The GOP lied to people and Republican Congress people and governors ran away from town hall meetings when people demanded solutions and expanded coverage.

    The GOP has also deliberately and consistently lied about supporting two elements of Obamacare that everyone likes. Coverage of children up to age 26 and coverage for pre-existing conditions. Every GOP proposal gets rid of this, no matter what the GOP tells people.

    So, even if people are deliriously happy about their current health insurance, all GOP proposals would undermine these plans and deliver defenseless customers to insurance companies like lambs to the slaughter.

    The GOP openly take the side of the insurance companies. They cannot be trusted with respect to healthcare, even if voters simply want to keep what they have now.

  31. 31
    jl says:

    @Turgidson: @Butch: I think you two are basically correct. Google ‘Commonwealth Fund’ and take a look at their international surveys on health care. They do surveys of entire population, those who have had recent experience with health care, those with chronic conditions.

    Sick people in the US who actually have to use their health care insurance and navigate the US health care system are not very happy, compared to healthy people in the US, compared to other sick people in comparable countries, and the numbers don’t look good in terms of common sense for a good health care.

    There is polling evidence that in the US there is confusion among many about whether ‘keeping your insurance’ is the same as ‘keeping you doctor’ or ‘having a choice of doctors’. Some unions have very good policies, and among them I can see legit concern. But for most people, I don’t think we really know how popular some of the more stringent Medicare for All proposals that do away with most private insurance will be until voters have a better understanding of what that means.

    I think only way to get there is to have a robust honest debate in the Democratic primaries. So, I don’t fear that at all. And IMHO, how a country decides to pay for insurance isn’t very important when other policies needed for a good health care system are in place.

    Edit: think is, with health care, 80 percent of care used by 20 percent of population. So, can make case the majority of voting age people don’t understand what they’ll go through when the get seriously hurt or sick.

  32. 32
    the Conster says:


    Medicare For All is conflated with single payer (that’s Medicaid; the VA) which is conflated with universal health care (which in most countries works like the ACA, except without far right politicians trying to kill it with every chance they get.)

    That’s why politicians need to stop pandering to the lefty hashtag virtue signalers, who don’t know how anything works or what anything is.

  33. 33

    @Mike in NC: It sounds like such a great trip. If you’re lucky, the cats will snub you.

  34. 34
    Sab says:

    @Mike in NC: Perhaps they will forgive you if you come home reeking of herring.

  35. 35
    Butch says:

    @Fair Economist: I’m an animal lover. I wasn’t thinking. I’m sorry. Maybe spread in a vacant pigpen?

  36. 36
    Joe Falco says:

    What gets me are folks against any kind of a public safety net in the event of loss of employment or catastrophic emergency. As if they alone are immune to chance. I’d want to have any kind of help available if I lost my job. If Graham wants to prove Alan Grayson correct that the Republicans’ plan is to avoid getting sick or die quick, by all means, please proceed, Senator Huckleberry.

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