Posted tagged ‘obamacare’

2010 All Over Again?

March 13, 2014

A special House of Representatives’ election in Florida yesterday went the GOP way.  The results raised Democrat fears, that like in 2010, Democrat voters would not turn out.  On top of that, Obamacare (the Affordable Care Act) as a campaign issue would motivate Republicans to vote in numbers.  Even though one rose does not make a summer, this early loss raises some disappointing possibilities.

It is entirely possible that the best person won in Florida.  What is truly worrisome, however, is the implication the GOP is sending when they raise the Affordable Care Act as a campaign issue.  In fluff filled campaign speeches, the GOP is cleverly conflating debt, deficit, and healthcare cost.  Their message is their candidate, if elected, will work to repeal Obamacare, and all will be better.  Hmmm.

The Congressional Budget Office has already estimated that the Affordable Care Act will actually lower the deficit, not increase it.  Industry reports have also predicted lower increases in insurance premiums (although this claim will require the test of time to confirm).  So what’s the issue?

First, why are not Democrats advertising the many positive aspects of the Affordable Care Act and asking how the GOP would provide?  In 2010, Democrats cowardly tried to hide from this landmark legislation and see how well that tactic work.  In 2014, there is little reason to think acting like a mushroom will work this time.

Entrepreneurs, dependents under 26, and those previously denied insurance coverage can now obtain health care policies.  And most people have still kept their same coverage since most people are covered by their employer.  While some have lost coverage because their employer has opted to cut hours or in some cases, eliminated coverage for all, those impacted have viable options to get coverage through the exchanges.  Under the pre-ACA system, if your employer dropped coverage you were on your own to get coverage if you could qualify.

Second, where is the message about fairness?  Under the pre-ACA system an individual seeking health care insurance was in essence placed in a pool.  The larger the pool, usually the lower the rates.  So, someone with a pre-existing condition who tried to obtain individually insurance coverage was doing so as a pool of one.  The consequences of this type of system is the individual is unlikely to be able to afford coverage if they could in fact find a company willing to insure them.

The message here is those favoring repeal of ACA are in essence saying “we don’t care about those unemployed or those with pre-existing conditions because we already have coverage”.

It is true that some GOP spokesmen say “repeal and replace”, and say they would keep coverage for pre-existing conditions.  Tell me how.  Insuring those with pre-existing conditions will result in higher insurance company spending and those cost must be covered in some manner.  There is no such discussions like that from any GOP Congressional candidate.

The Affordable Care Act stops far short of what I would like for healthcare.  ACA when compared to healthcare in two dozen other modern industrial countries remains far more expensive and likely to be inferior in health outcomes.  Never the less, ACA represents important reforms which should improve care for the average American (the rich will still be able to obtain worldclass care), provides a rationale for controlling to growth in healthcare costs, and provides a partial answer to the question of how the riches country in the world can spend so much on healthcare and have so many without coverage.

Democratic candidates better wake up.  Keeping silent does not ensure victory.  Speaking up in support of ACA, while not guarantying victory, will at least preserve their reputation as a courageous and honest person.

Health Care Insight

December 2, 2013

Last evening I had dinner with a millennium niece.  The conversation turned to health insurance, and then things exploded.  “Obamacare is the worst ever(!!!)”, my niece stated.  “This is the worst law ever”, she continued.

My niece is medically compromised with a complicated diabetes disease.  She works but earns relatively low wages.  She also has two children and the expense that go with them.  At her income level, she also receives State aid for her daily needs.  Fortunately, her employer provides health insurance which covers a large part of her medical costs.  She must, however, cover deductibles and certain durable goods related diabetes costs.

In her outburst, my niece claimed she would be taxed because her medical expenses were so high.   She would be categorized as having a “Cadillac insurance plan”.  She claimed her entire medical expense would be taxed.  Hmmm.

She moved on to the claim that policies found on the health exchange would simply be too expensive for her on her salary.  She wanted to keep her current plan.  Hmmm.

Now it must be said that my niece’s situation is extreme.  She is a brittle diabetic and earns a relatively low wage.  She is, however, not alone in the US’ 320 million population.  What is unique is in medical terms she is a sick person while her fiance comes from the young healthy camp who use little of no medical services.

She is also a young republican and quite aside from health care, thinks President Obama is a mistake.  Hmmm.

In an ironic way, my niece and her fiance are poster children for single payer, universal healthcare.  He is healthy and will use little medical services until he becomes injured or sick later in life.  She is genetically sick and will consume health care services throughout her life.  How can it be expected that a private, for profit, insurer can assign appropriate risk to each and offer a rate they could afford?

With this couple, there is the combination of “I don’t need insurance” and “I need a lot of coverage”.  Said differently, “I don’t need to pay anything” and “I can only afford this much premium cost”.

This is a microcosm of America.  It is also a microcosm of the industrial world.  In order to deal with this type of differences, single payer, universal healthcare systems evolved.  Modern countries have elected not to let the sick or poor starve or die needlessly.  To date (and including the Affordable Care Act), the US has not elected to follow that path.

Obamacare (Affordable Care Act) represents a step forward compared to what preceded it.  In my nieces situation, her employer’s plan is not a “Cadillac Plan” despite how much annual medical expense she consumes.  She will not face new taxes.  In addition, her employer employs less that 20 and is not required to provide health insurance.  (As my niece subsequently explained, her employer had already decided to eliminate coverage and instead provide an annual stipend to their employees.  This was an option before ACA and is an option with ACA.)

What my niece (and her fiance) fail to acknowledge is that medical costs are high and rising.  Employers are being squeezed and across the board are adopting methods which maximize their financial exposure.  There is nothing about ACA that is accelerating this trend nor delaying it either.

The underlying message my niece has unknowingly sent is that politics and healthcare do not mix.  It may be ok to dislike or disapprove President Obama and his policies, but to indict the Affordable Care Act on anything other than comparisons to what preceded it or some ideal (such as Germany’s) health care delivery system will lead to false conclusions.

Distance Makes The Mind See Clearly

October 6, 2013

On October 1, I left the US for a short vacation in Europe.  There’s nothing special about this event.  What has, however, made this trip somewhat special is to hear about the American government shut down from those from other countries.  “What are they thinking” might summarize Spanish views of Congressional behavior succinctly.

Here in Spain, hardly Europe’s number one economy, life is good.  With over a quarter of the Spanish work force unemployed, one would expect an angry population.  And that is not the case.

To be sure, younger Spanish workers long for a stronger economy.  Spaniards are proud people.  Work is honorable, and the money comes in handy.

Government aid has been part of a carefully designed balance between “stimulus” and “austerity”.  Efforts are aimed at growing out of debt while still putting on the debt brakes.  Trains run, cleanly and on time.  Shops are open and street tables are full.  Spain is working.

Newscasts report here in astonished terms the US government shut down.  Why, they ask.  Why is the most powerful country so paralyzed?  They hear that a minority is strongly opposing President Obama but in contrast to their parliamentary government where a majority does have the ability to bring down a government, a minority cannot.

And what is the issue causing all this, they ask?  Health care?  And what is the issue that is in disagreement?

Astonishment gives way to bewilderment when a Spaniard learns that the conservative minority wants to return to “pre-affordable care act” policies.  Why would any civilized nation be comfortable with preventive health care being denied many because they cannot afford insurance or they already have known “pre-existing” diseases.  How can the most powerful and most wealthy nation turn its social back on some of its citizens?  How can some America’s citizens opt to not participate in health care coverage knowing that if they suddenly became ill, they would be cared for and might avoid all financial responsibility?

Hmmm.

Americans like to refer to both themselves and their country as “exceptional”.  I should say that might be true.  Unfortunately, America appears here exceptional for the wrong reasons.

Most Congress members (but not all) know this.  I wonder when their actions will follow their minds?

 

Teacher Seniority and The Budget Crisis

October 1, 2013

Philadelphia has a crisis.  It can’t fund it schools. Both State and City officials cannot agree on how to bridge the gap between how much money is available and how much money is said to be needed.  One answer offered by a “concerned citizens group” is to eliminate teacher seniority rules.  Hmmm.

Of course these are two unrelated issues.  It may be arguable that strict seniority is a practice that has outlived its usefulness.  It is simply part of another conversation.

Teacher seniority is center to any discussion about improving educational outputs and building a staff of good to great teachers.  That conversation also has many other associated dialogues.

What about the quality of supervision (like evaluating teachers to determine who is not meeting standards), or the continuing education training that could keep older teachers current?  Don’t overlook the possibility school districts might adopt industry practice of removing older and higher paid teachers in favor of the younger and less well paid.  Human nature is human nature.

So whether the core belief of almost all unions that seniority rules is the best approach or not has nothing to do with whether funding for the 2013/14 school year is sufficient.  The same can be said for the current crisis around the budget and most likely the debt limit increase.  It makes no sense to connect unrelated issues if anyone is serious about solving either problem.

Philadelphia Schools, like the overall US K-12 education system is among the most costly in the world.  There are simply more fundamental problems that will remain even if a fix for Philadelphia School Districts short fall is found.

Tying the Affordable Care Act to the overall US budget is just as misguided… unless the argument was to move the US to a Universal healthcare model.  Universal healthcare, as practiced by over two dozen other modern countries produces health outcomes as good or better than the US, covers all residents, and cost per capita half as much as what the US spends.  The argument to delay or defund is simply shameful.

While I believe it is time for changes to strict teacher seniority and also believe that Obamacare only represents a marginal (but morally important) improvement, these are both complicated subjects which need to be hashed out on their own merits.

 

Innocent Victims

September 30, 2013

Medical ethics teaches “do no harm”.  It turns out this is superior advice in a wide range of other matters.  None could be more apropos than the current Washington DC “death watch” over the budget and the debt limit.  When in doubt about the next step, take one that “does no harm”.  I wonder why this has not occurred to more legislators?

Shutting down the government does a lot more than just make headlines.  It certainly will inconvenience a lot of Americans who wished to visit government parks and museums.  Tea Party zealots, of course, glow with pride at this opportunity to get a message to Americans.  But what message?

The hostage ransom is a delay in implementing the Affordable Care Act.  This will leave thousands of Americans denied healthcare because of pre-existing conditions.  It will leave millions more without insurance and one illness away from bankruptcy.  Doesn’t sound like “do no harm” to me.

Stepping back for a moment.  The fundamental issue seems to be a minority with exceedingly strong beliefs is stymied and cannot get its way.  This group opposes Medicare, Medicaid, social safety net programs, and most other government regulations.  They do not represent enough Americans to elect a majority or to elect the President.  Their share of elected positions, however, is enough to gum up the Congressional process.

The proper place and time for a budget debate is on the floors of Congress.  If agreement cannot be struck (because opposing views are held just as strongly), then a “clean” Continuing Resolution (CR) does little or no harm.  The opposing minority has a chance every two years to elect Representatives and one third of the Senate.  If their idea is a winning one, time will cure all ailments.

Each of these radical acting conservatives (and the closet Republican moderates who are shamefully keeping their mouths shut) will also hurt a more concentrated group of Americans.  As each government department closes or furloughs its “non-essential” workers, the burden of the Tea Party tactics will hit their pocketbooks.  This will bring real harm.

Pundits might say, “don’t worry”, Congress can pass a resolution to grant back pay once this Congressional impasse is broken.  Hmmm.

The Tea Party tactics are not only hurtful, they are dim.

With respect to healthcare, the uninsured frequent the emergency room.  These costs are subsequently spread over all other hospital and doctor fees.  Guess who pays?

But even wilder is the idea that we shut down the government, send home the workers without pay, and then later agree to pay them for no work.

Hmmm.  I am not sure the Tea Party will ever be ready for prime time.

 

National versus Personal Goals

September 27, 2013

Wouldn’t it be gratifying to see Congress working on overarching national goals?  Ones that are important to most Americans.  Wouldn’t it be stimulating to see debate about how to achieve these mandates?  Wouldn’ the American tax payer feel he/she was receive an honest day’s work for a day’s pay from Government?

The question might properly be asked, “what are the top national goals” and “why are they important”?  Hmmm.

Here’s a straw man for just three national goals.  In my world, everything else is subordinate to these goals.

A safe and secure environment – The objective is that everyday life is unimpeded by criminal activity or from invading marauders.  The intention is to free Americans to seek freely life, liberty, and the pursuit of happiness as unfettered by Government as possible.  Debates over guns would in this sense be focused upon achieving this goal.  Does extra large magazine clips enhance or decrease the goal of a safe and secure environment?

A Place for Social and Economic Mobility – The most central American value is the capability of each resident to work hard and achieve a just reward for these efforts.  Some residents are recent immigrants, others do not look like their neighbors.  For all, the nature of regulations, taxes, and availability of government services must be seen in whether it enhances or detracts from social and economic mobility for the overall population.

An ever declining poverty rate. – In a capitalist, free enterprise system there will always be winners and losers.  Given little or no government rules, the winners will devour other winners and soon there will be but a few big winners and everyone else will be a loser.  There will be social and economic mobility is words only.  Society will be frozen between a few haves and the rest, have nots.  Without large scale social safety nets and targeted programs to reign in “too big to fail” and “too uneducated to succeed”, the great American experiment will be extinguished.

So what meaning do these words of idealism have?

Think about the last 12 months where reasonable gun controls were proposed only to get rejected.  Why?  Because some interpreted unconstrained gun ownership was a given (Second Amendment).  There was no discussion of managing a safe and secure environment.

Or, think about efforts to take away food stamps, head start, and Medicaid.  The rationale was “we can’t afford” the cost.  Hmmm.  While some argue that providing a “crutch” only encourages more dependency, and others argue that it is cruel and heartless to cut these programs, both sides miss the real point.  In a country as large as America, we cannot be sure why any one person is poor or needs these assistances.  So why does it make sense to continue them or to abruptly stop them?   Clearly there needs to be other policies if we are to reasonably expect the need for these safety net policies (and their cost) to be decreased.

And lets not forget “defense spending”.  Most all Congress members seem eager to vote for spending on “defense”.  It sounds noble.  It is just curious that the spending is usually generously spread to most Congressional Districts.  Hmmm.

One is left with the nagging feeling that our Congress members are smart enough to recognize these contradictions.  Yet, one group is comfortable saying “stop spending on these programs (everything except defense)” and the other group is just as adamant saying “we must keep these programs going (including defense)”.  Neither group seems interested in the underlying problems nor in connecting these efforts to some greater national goal.

There seems inescapably only one explanation.  Our Congress members are more interested in the personal goals than facing the difficult task of defining and then acting on National goals.

 

Love Him or Leave Him

September 24, 2013

Senator Ted Cruz is just where he wants to be.  (Maybe if he knew what was good for himself, he would not want to be where he is.)  Never the less, Cruz’s supporters and fellow Senate Republicans are faced with the proposition, “love him or leave him”.  We may learn in the next few days which verdict is made.

Cruz has been very vocal, for a long time, that the debt limit should not be increased.  Others feel that way too.  Cruz’s view, however, is that the debt limit should not be increased unless there is some large tribute paid.

Previous Republican demands were any debt limit increases must be accompanied with equal or greater offsetting budget decreases.  On the surface this made sense.  The subsequent problem has been Congress (as well as Republicans) cannot agree on where to cut.  Rejection of any new tax revenue has made these decisions much more difficult.

Cruz now portrays himself as the defender of job creators.  In his anthem, “defund Obamacare”, he suggests this answer should be tied to both the continuing budget resolution and any increase in the debt limit.

As a notion of “one man, one vote”, one might accept Cruz’s right for this demand.  The notion, however, that “I” will not allow any other option by blocking a vote departs from the realm of democratic process.

Republicans in general, and specifically those Republicans who must run for re-election in 2014 have been reluctant to take Cruz on publicly.  Pundits claim these GOP members fear a Tea Party primary challenge.  As self interest goes, this is easy to believe.  To the GOP regret, however, they are beginning to realize they have made a deal with the devil.

Were the GOP leaders insist that all caucus members following “Party” policies, the Tea Party members would bolt.  Without the Tea Party members the current majority Republican Party would fail to have a majority.  Bingo, Democrats back in charge.

So what is a self respecting Republican to do?

The GOP seems comfortable with its immigration, no new taxes, and anti woman’s rights positions.

Without the Tea Party, the GOP majority prospects do not look promising.  A split with the Tea Party would likely ensure a decade or more of Democrat rule.  Staying with the Tea Party, might offer the GOP a few more years of shared rule, but without enormous changes in GOP policies, demographics coupled with the lack of Washington action will doom them anyways.

So who will be the big losers?

Without a strong loyal opposition, the American people will be the losers.  Democrat support for all sorts of social issues are usually unsupported with sound financial measures.  Healthcare, protecting the environment, regulating banks and commerce, affirmative action, and immigration are all worthy goals.  Without two constructive Parties, it is unreasonable to expect effective and efficient solutions will be found.

Senator Cruz is clearly a self centered promoter.  Sooner or later, the GOP will figure out how to deal with him and others who think the same but are not so in your face.  The GOP’s recovery, however, will only have just begun when the GOP revisits its list of priorities.

Love him or leave him.  That’s the first step.

The Role Of Government

September 13, 2013

I spoke this week with a friend.  He pointed out numerous problems with Medicare, Medicaid, and healthcare in general, which if corrected would produce a lower cost and just as effective delivery of health care services.  I suggested an alternative approach might be to adopt a system drawn from the experience of over two dozen other modern countries around the world which offer all residents health care at one half the cost the US spends, and produce outcomes equal to or superior to those of the US.  He dismissed this notion with “I just wouldn’t trust the government with doing anything”.

My friend is intelligent, informed, and a genuine decent person.  I could not help ask, “what was he thinking?”

As we talked further I got a clue.  My friend spoke of corrupt or self centered elected officials.  Hmmm.  He said these members of Congress are only interested in their own best interests and would make healthcare decision that directly or indirectly enriched themselves.  Why would he think that?

The next few weeks should remind us of why.  Congress has two deadlines.  One concerns how to fund daily government operations.  In the perfect world Congress would be debating a budget (like any normal corporation).  Instead Congress members cannot agree on a spending plan compatible with an effort to balance the budget so they will resort to the infamous “continuing resolution”.  The CR allows Congress to avoid any real cuts and keeps things as they are.  No risk for the Congress members.

There is a second deadline coming right behind.  The national debt is about to exceed the limit set by Congress.  Even though the debt is about money already spent (authorized by Congress itself), Republicans want to “negotiate” an extension.  The GOP says it wants offsets for any agreement to increase the deficit.  At first this sounds plausible until it dawns on you that the budget discussion is the place to incorporate reduced spending.  Hmmm.

A good number of Congress members are quite vocal about holding spending hostage if they were to agree to increase the debt.  But now even more (all Republicans) are saying they would accept a delay in implementing the Affordable Care Act (that is delaying the availability of health care insurance to millions) in exchange for increasing the debt limit.  Hmmm.

The implied message here is that if the President does not negotiate, the GOP will allow the Country to default and in the process shut it down.  Is that governing?

Motives are always hard to know.  Why would some members of Congress tie healthcare to the debt?  Why wouldn’t Congress have discussed and debated budget alternatives sufficient to reduce the deficit over time earlier in 2013?  Why wouldn’t the GOP have published position paper after position paper on how it would propose to balance the budget?  Why wouldn’t men/women of good intentions not have openly discussed how the deficit and debt could be dealt with?

Ironically, most experts have said that any compromise to balance the budget or bring the debt under control runs right through healthcare.  Medicare, Medicaid, and Defense are the three largest Government expenditures.  A national healthcare fix such as found in Germany, France, Japan and some 20 other countries would eliminate the need for Medicare and Medicaid and could drive costs down for individuals as well as the Government.

My friend’s fear of government involvement, if based upon the performance of 113th Congress, is sadly understandable.  I guess we will be left with mediocre but expensive healthcare and third world like Congressional governance until the Country bankrupts.

The Affordable Care Act represents a noble advance from what preceded it, but falls far short of universal healthcare and will cost a lot more.

I continue to think Congress “could” do better, and my friend continues to hold that Congress “would not” do better.  Hmmm.

 

2014 Mid-terms High Risk Poker

September 11, 2013

It doesn’t look at this point like President Obama’s coattails will provide many Congress members seeking election any guaranteed help.  His strongest supporters have never wavered but they are a minority anyways.  The great middle that elected him in 2008 and again in 2012 do not feel the pull to get out and vote Democrat.  It is less they indorse the GOP but given the President as the head Democrat, they feel little motivation.

That is not good news for anyone.  The GOP sees sunlight in the Senate races and can envision picking up enough Senate seats to gain control.  At this point, the House is almost certainly going to remain GOP controlled.  And given the GOP performance since 2010, that’s not good news for the nation.

Smart money would argue that the GOP should act statesmen-like now, and in November 2014, humbly ask for America’s vote so they can govern.  That strategy would bring the GOP into power across the Congressional board.

Instead, the GOP has selected a different strategy.  They are betting the mortgage upon the American electorate believing the Affordable Care Act is both poor legislation and will lessen the overall quality of American healthcare.  Consequently the House has voted 40 times to repeal or defund Obamacare.  Hmmm.

The most pressing question now is, what to do about the looming fights over the budget and any increase in the national debt.

Republican Majority Leader Eric Cantor has just announced that the House will kick the budget can down the street (for a couple of months) until mid December.  But extending the limits on the debt, that is another story.  Cantor said the GOP would be willing to raise the debt limit providing the President delays implementing the Affordable Care Act.  Two totally unrelated issues.   Hmmm.

This is a deal the President can (and should) refuse.  President Obama has already said he will not negotiate over increasing the debt limits but his track record on liking to negotiate at the last minutes gives reason to pause.  But refuse he must.

Default and an ensuing Government shutdown will follow.

There is mounting evidence that already the Affordable Care Act is not the disaster Republicans have claimed.  Costs have not gone through the roof (they have not come down either).  And despite Republican State Governors efforts to block key Obamacare provisions, it seems like most Americans will experience more than satisfactory healthcare (especially those currently without).  These Americans will ask, “what were those Republicans talking about?”

So the high rollers are getting ready to bet the mortgage and risk shutting down the government when the debt limit is reached.  If the President has any sense, he will ensure that GOP States will suffer the first loss of services and Republican friendly industries like Defense and Energy are hit too.  As the postal service slows and national parks close, and, and, and, Americans will conclude the GOP is not fit to govern.

The President ought ask one question…  Mr Boehner, Mr Canter, what are your proposals to replace the Affordable Care Act and how will you fund it?

If the GOP wants to govern, then the responsible way is to adjust the budget (and accept the consequences).  For many reason, the GOP has refused to follow that course previously.  At this late hour, it does not look like they will this time.

 

GOP’s Death in Slow Motion

August 31, 2013

The waning days of August are usually quiet and bring a mixed bag of emotions.  There is sadness that summer is ending, and an offsetting excitement that fall is about to begin.  The Washington political stage will bounce back to life.   But unless matters change considerably, we may be looking at the dissolution of a political party.

Being a member of Congress is not as easy a job as it might sound.  Like the Mayor of any city, there are pot holes to fill.  Hmmm.  For Congress, the Middle East is a mess with one week Egypt grabbing the headlines and the next week Syria is in first place.  Turkey, Libya, Lebanon,  and Iran have jockeyed amongst each other for share of mind.  So much for Congress members to worry about.

Domestically immigration reform, voting rights, the sequester, the Federal Budget, and the necessary increase of the federal debt limit are all vying for the attention of Congress.  This is quite a list and are not trivial in nature.  It will take the best from each Party to find the best solution.  Tough situations often bring the best from those confronted.  What about this time?

Hmmm.

Congress, however, has been spectacularly impotent with respect to governing and the current situation seems not to be different.  The Republican “just say no” approach has ground the wheels of government to a halt.   This Republican behavior is said to be the result of several minority constituencies (Tea Party, ultra conservatives, and evangelicals) all pushing their own agenda and not the least bit interested in compromising for the purpose of governing.  In other words, these GOP members do not care to fill the pot holes.

This week, John Boehner said there would be a “whale of a battle” over any increase in the Federal Debt limit.  Boehner said this was a valuable chance “to leverage” GOP positions on other issues (namely Obamacare).  If this resulted in Government default, so be it.

What did he just say?

The debt is about money already authorized by Congress and spent by the Government.  It is not about next year’s budget or any existing laws.  And most of all, the debt is just like our personal debt.  Default carries consequences much broader than not paying owed money.

The GOP seems locked into a misguided death watch over the Affordable Care Act.  Clearly there is a valid concern over whether American healthcare will improve under the ACA.  For every GOP proposal to hinder the ACA, there ought be a corresponding counter proposal.  Hmmm. Not there.

The debt increase issue seems of much less a concern about the fiscal health of the Country than the possibility that Obamacare may begin to function.  What is the GOP so concerned about?

Is their concern that the individual mandate, or the tax on Medical Equipment companies, or the requirement for businesses to provide health insurance coverage for their employees are too onerous?  If so, what is the GOP’s ideas about providing the benefits of ACA but with different requirements?

Or, does the GOP simply reject the idea that health care should be available for all residents?  (It would appear that some within the GOP do)  Does the GOP subscribe to the notion that an American can have as good health care as they can afford?  If so, why do they not say so?

It is becoming increasingly likely that the GOP brand is broken.  It appears that the amalgam of Libertarians, ultra right wingers, evangelicals, along with the rump fiscally conservative Republican faction is in fact today’s GOP.  This is not a party but a combination of three or four distinctly different cohorts.

Saying no to immigration reform, saying no to gun controls, saying no health care reform, saying no to sensible, and balanced budget reforms is a prescription for stagnation or retrogression.  This is an unstable situation for any party that harbors so many internally inconsistent goals.   Unless one likes pot holes, it is hard to see a future with his collection of desperate political views.

The big question is whether the GOP will simply, like the Soviet Union, one day just stop being, or whether under the pressure of the real world in which we live, the GOP will crack and split into so many pieces so fractured they can not be reassembled?

Hmmm.

Stranger yet, the possibility of dissolution does not seem to be an apparent concern as judged by the GOP spokespersons who pass as the Party’s leaders.  I see the GOP ultimately splitting into pieces.   I also see the possibly the more moderate parts of the Democrat Party might combine with this rump Republican faction an form a new majority.  Hopefully it will be a majority that knows it must fill pot holes.

Of course this might just be a last minute summer dream.