Is there some way aside from the obvious mistruths they can demonstrate its the democrats fault, and achieve some electoral advantage?
Wyoming is extremely "red" according to Web searches (I am not an american)
My default assumption here is, it cannot, and this is going to cost them seats.
> Is there some way aside from the obvious mistruths they can demonstrate its the democrats fault, and achieve some electoral advantage?
You discount the skill republicans have at lying -- regardless, when people are feeling the pinch in their pockets, they will blame whoever is in power. Currently it is the republicans.
Trump received 49.8% of the popular vote.
My guess is this doesn’t help or hurt either party at the voting booth. If you are ACA aligned or participate in that program you probably already vote Dem or not at all.
I suspect a lot of FIRE people ( being excellent money managers / penny pinchers ) are in this boat.
Us FIRE types depend on stable, consistent markets and positive (real) interest rates, and conservatives haven’t delivered on that in recent memory.
But if you are younger, perhaps with a chronic condition, in a job that doesn’t provide a health insurance benefit, and with minimal 401k…you are weighting ACA costs…and are in a demographic that historically votes more blue.
If AI and tariffs don’t result in substantial market losses for me (and they haven’t yet) why should I care?
The honeymoon is over, but he has not become excessively unpopular.
A cursory look says Wyoming has a population of ~580k and ~340k registered voters. The article says Wyoming has 46k people on ACA. Republicans win landslides in Wyoming (40%-50% margins) and 46k people is 12% of voters max (likely closer to ~4% at risk).
When people don’t have access reliable healthcare, they tend to use even more expensive (for society) options like emergency rooms and grey/black market. People who become disabled or die from lack of healthcare don’t tend to pay much in the way of taxes.
https://www.census.gov/library/stories/2022/01/who-makes-mor...
> Individuals who were unemployed made roughly 2.5 times as many preventable emergency care visits as those who had a job (Figure 3).
> Lack of health insurance coverage was another factor that appeared to play a role in preventable ER visits.
> According to the study, individuals without health insurance had more preventable visits to the ER than those with health insurance (Figure 4).
> This suggests that uninsured individuals may not seek primary care for chronic conditions ahead of an urgent episode or they may rely on emergency rooms for general health care needs.
What about more marginal states? The reduction in subsidies is nationwide, after all.
The real problem for Trump and Republicans is they do great when Trump himself is actually on the ticket. That's his power. Unfortunately for him, he will never be on a ticket ever again. But he still holds considerable influence over primary voters. Primary voters don't win marginal States. Trump is a paper tiger but because of his control over primaries Republicans are trapped.
Also, propping up ACA ( I say this as an ACA user ) is not the answer, either. The subsidies were temporary, making them permanent only adds to the never ending flood of red ink.
Healthcare needs a complete reboot. As someone on the right, I am open to a reasonable big government solution. ( After all, even Nixon wanted public healthcare. ).
It’s long past the time for patching. We need a reboot.
Nixon's plan would have passed except for Ted Kennedy, he stopped it in its tracks. Then when the Clintons came in something flipped, the GOP was all against what Hillary was trying to push. I forgot what it was but I think it was some kind of single payer.
So under Obama, the democrats took the Massachusetts plan created by Romney (GOP), which I believe the Heritage Foundation even endorsed, thus created the ACA.
So here we are. Now I think we are in a sad place where for-profit healthcare is entrenched, bribing both side of the aisle to keep their profits high.
It was not, despite universal single payer having, at the time, outright majority support in polling. That’s one reason it lacked popular support on either side of the political spectrum.
> So under Obama, the democrats took the Massachusetts plan created by Romney (GOP), which I believe the Heritage Foundation even endorsed, thus created the ACA.
IIRC, it wasn't created by Romney, it was created by the insurance lobby and became a (rhetorical) Republican alternative during the debate over the Clinton plan; once that was killed, the Republicans didn't push it nationally (though I think Bush briefly, maybe only during the campaign, pushed a similar mandate-and-subsidy plan that was restricted to only including High-Deductible plans tied to HSAs.)
If I went to management with the dev plan of 'throw all the source away, start over with a new stack, new devs, from scratch, but also I don't know what the new stack will be, and haven't found new devs' I would be called a moron. But if you are a conservative, it's somehow called rational policy and a plan and it's worth the lifetime lasting damage/potential deaths is will cause a shit ton of people and financial ruin it will cause many.
Edit: Throttled so replying by edit. In the example below, Steve Jobs LITERALLY had a stack in mind, a plan, and people/talent lined up.
US healthcare is broken. Most attempts to fix it make it worse because they don't address the root causes. That doesn't mean everyone who points it out needs to present a 300 page plan for how to address it.
Not everyone needs to have a 300 page plan, but the Steve Jobs/Politicians pushing to blow things up need to. Or in Job's case he started with way, way, more than just a 300 page plan.
I think nobody believes that now. Healthcare is broken. It’s time to make things better, not patch the termite infected boat one more time.
Remember the bold spirit of ‘we have to pass the bill to see what’s in it’? If you think ACA is better than what preceded it, then you favor bold steps.
I favor logical progress. I don't favor 'blow it up so magic can do it's work'.
https://abcnews.go.com/Politics/republicans-unveil-health-ca...
The insurance companies do what insurance companies do.
It isn’t even a difficult boogeyman to find.
It does not add to the red ink, at least according to the accounting rules Republicans used to justify the so-called Big Beautiful Bill's (BBB) costs.
The BBB made many of the 2017 Trump tax cuts, which were temporary and set to expire at the end of 2025 (just like enhanced ACA subsidies), permanent.
Republicans argued that the loss of revenue from making the tax cuts permanent should not count when accessing the effects of the BBB on the deficit because extending something that is expiring doesn't really change anything.
They want poor(er) people to hurt, so that rich people can have more. It really is as simple as that.
The US is bleeding out because its government spends so much more than its society can generate via taxes. Its has a debt of 38 trillion dollars. The subsidies were adding to that.
People who say "we'd like to give you free money but can't afford it" aren't motivated by ideology, they're motivated by the money not being there. Borrowing just delays the inevitable and makes it worse - it's literally stealing from children and it doesn't fix anything.
There are ways to fix US healthcare but adding ever more debt won't do it.
He is blatantly cutting spending on the many in order to give more to the wealthy few. Especially himself.
What about rest of Trump's policies? Are tariffs also a "so that rich people can have more" policy, contrary to the "globalization only benefit the rich" rhetoric of the 2000s?
(I've tried to find who it was again, but it's hard to search for simply "who convinced Trump that tariffs are a good idea?")
https://www.bloomberg.com/features/2025-cancer-drug-markups/
Another contributing factor is that Americans consume a LOT of healthcare, often well past the point of diminishing returns:
“Why conventional wisdom on health care is wrong (a primer)”
https://randomcriticalanalysis.com/why-conventional-wisdom-o...
Finally, basic preventative health care — at least for children — could save more than it costs when we take into account the overall economic effects of poor health outcomes. We should consider making it an entitlement.
Individual doctors and nurses etc may very well want people to get good treatment, especially children. But they are just the hired labor, the owners of the medical services and insurance industries just want the money and so likely lobby for the worse outcomes. It also has the bonus of further tying people to their employers who offer health plans making them more pliant workers.
> Individual doctors and nurses etc may very well want people to get good treatment, especially children
It's individual doctors and nurses who are most incentivized to over-treat. They make more money the more healthcare is consumed. It's insurers who have an incentive to keep healthcare costs under control. A big part of the reason US health insurance is so expensive compared to the rest of the world is that Americans stage a massive freakout every time insurers try to control costs. It's a cultural thing and done by both Democrats and Republicans, look at how they call the UK's NICE committee a "death panel".
If you can't afford it on your own, there should just be a palliative care mandate after some age. We shouldn't save the soon-to-be-dead at the expense of the people with a long time horizon.
Or, we should pay doctors far less. I don't think they're multi-millionaires in other countries. Not all of them are in America, but many of them are.
Nobody can ever imagine a better system, even if it’s used in literally every advanced nation in the world. Nope, instead we have to let Grandpa die painfully to keep those stock prices up.
I’m starting to think Capitalism as it’s practiced here is a death cult of some kind.
I would much rather doctors just get paid less. I took my son to the ER. He had a very high fever. They gave him a child's aspirin and me a $700 bill.
I just don't know what the answer is. And really, if you go into a hospital, you get the sense that there's people basically taking advantage of subsidized health insurance providers and patients both. Health insurance in America is absolutely atrocious. Next to gun fanatics, it's the worst thing about this country.
Also the ER is always going to be the most expensive setting to get care.
Why not take him to a pediatrician, if there are no warning signs that he needs immediate attention?
The US system works well if you can pay the bills. It doesn't have the undercapacity issues the UK has, for example. The unique problem is costs. Controlling costs would mean consumers strongly supporting aggressive action by insurers if they take actions to push costs down. What Americans do is the opposite: they stage protests and demand immediate political retaliation on insurers who try to control costs. Then left wing politicians condemn the insurers, and they fold in the face of public pressure. Medical staff know the public acts this way and so bends insurers over the barrel, knowing people will blame the "capitalists" (who have tiny margins) over the frontline doctors and nurses who are actually taking the money.
https://www.vox.com/policy/390031/anthem-blue-cross-blue-shi...
In other countries the public doesn't act this way and costs are more reasonable. Sometimes insurance premiums even fall. Switzerland has a two tier system with basic mandatory health insurance that's basically controlled by the government (private firms provide it but there are price controls and they can't refuse customers). And it has supplementary insurance for higher quality care that's almost free market. This year basic premiums went up 5% and supplemental premiums fell 0.9%
https://www.bfs.admin.ch/bfs/de/home/aktuell/neue-veroeffent...
Cost control requires private sector discipline without people like Kathy Hochul getting involved, but healthcare even in the USA does not have that.
You think hospitals aren't full of old people getting care in other countries? And do you think it's possible that young people in the US don't go to the hospital because they can't afford to?
Easy enough for someone who thinks they have a “long time horizon” to say.
[1] https://www.wrvo.org/health/2019-09-30/ten-percent-of-all-he...
Those end-of-life patients paid into the system, earlier in their lives, financing the cost of earlier generations of end-of-life patients. It would be unfair to change the social contract now.
In my opinion, it is no different from how adult taxpayers finance public education for children. It is a rolling responsibility from generation to generation.
You may be able to alleviate this financial issue (and not any other ethical issues) by phasing-in this policy change with the youngest generation of Medicare taxpayers, somehow.
> In my opinion, it is no different from how adult taxpayers finance public education for children. It is a rolling responsibility from generation to generation.
This hits upon the core issue: the next generation is substantially smaller than the last and relative costs have ballooned due to greater availability of therapies. The generational contract is that you pay your taxes a percentage of wages -- in effect, a PAYG mechanism. If wages do not rise sufficiently to cover increased costs, that does not imply that the generational contract was unfulfilled; the taxes were paid.
The demographic pyramid and weaker than necessary wage growth really renders the care demanded burdensome to the point where we have already provided elderly cost advantages in insurance in the form of cost premium multiple maximums and medicare from payroll taxes while beggaring the rest of the population in the process.
> In my opinion, it is no different from how adult taxpayers finance public education for children. It is a rolling responsibility from generation to generation.
Fundamentally, children are an investment. They produce cash flow (taxes) from increased public health. The end-of-life are not; by definition, they will be dead soon. It's a horrible thing to say, but in the face of ever increasing elder care burdens and weak public debt/gdp ratios, what real choice is there?
That's an interesting alternative view I had not considered. I think it is debatable. I believed the generational contract to be "healthcare for 65+ with 20% copay, etc., no gov. expense spared" whereas you argue the generational contract to be "Medicare payroll tax of X% is constant over all time; spend it wisely." I would argue the first option was the original intent of the Medicare law.
> Fundamentally, children are an investment. They produce cash flow (taxes) from increased public health. The end-of-life are not
You could argue the same for the end-of-life, in at least two ways: * the end-of-life patient has already produced cash flow to the government, just in reverse order from the student * Good education produces a higher taxpaying adult, the investment you refer to. I would argue the assurance of end-of-life healthcare also produces a higher taxpaying adult.
I acknowledge the costs have gone up faster than wages+population.
I appreciate this view, but it is ahistorical and does not reflect the history of Medicare law.Taken from [1]:
> By the late 1970's, the growing expenditure trends and the changing demographics (an increasing proportion of the U.S. population 65 years of age or over) combined to endanger the solvency of the Medicare Trust Fund. The rapid increases in expenditures for the Medicare program, as well as health care services in general, constrained the ability of the Federal Government to fund other health and social programs. To a certain extent, the growth in expenditures also endangered the Nation's overall economic productivity.
> At the same time as health care expenditures were escalating, some say uncontrollably, the political landscape began to change dramatically. The national mood brought calls for fewer taxes, for reduction of budgets, and for deregulation of market sectors, such as transportation and health. This conviction of less general involvement by Government was reinforced by mounting public pressures surrounding growing budget deficits; Medicare, like other Federal programs, increasingly competed with more global policy objectives. In the space of a few years, the Nation moved from an era when health care was considered a right for all citizens to an era when cost considerations became the dominant issue.
And bear in mind, this was just ~10 years after Medicare was introduced. The nation has always prioritized the future over the past, and has either reduced or restructured benefits to ensure a healthy economy ahead of Medicare.
> You could argue the same for the end-of-life, in at least two ways: * the end-of-life patient has already produced cash flow to the government, just in reverse order from the student * Good education produces a higher taxpaying adult, the investment you refer to. I would argue the assurance of end-of-life healthcare also produces a higher taxpaying adult.
This lacks an understanding of Medicare. Medicare is fundamentally a PAYG mechanism; the trust fund was a short term surplus which is slated to be depleted by 2033 [2]: a mere 8 years from now. Part of this occurs due to poor investment strategy (treasuries only, effectively) but the biggest contributing part of this was the demographic boom. The time for "more cash flow to save for Medicare" isn't today it was 30 years ago. A failure to raise taxes 30 years ago should not constitute an obligation on the youth of today and placing the burden of an excessive tax because of poor demography and unwillingness of prior generations to raise taxes on themselves only harms economic growth at the expense of the elderly.
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC4195088/#:~:text=By...
One is that US healthcare cost inflation is very high. The average family premium in 1999 was $6k, it is now $27k, for an annual cost increase of 6.1% per year. The long term rate of productivity increase is much lower than that, at only 2.1% per year.
https://www.bls.gov/productivity/images/pfei.png
So costs have just risen a lot more than productivity has.
Another reason is that productivity increases aren't evenly distributed. Most productivity growth has been in other sectors, primarily oil+gas and tech i.e. sectors dominated by men who aggressively automate. Healthcare has seen no increase in worker productivity for decades:
https://x.com/DrDiGiorgio/status/1834317735943438835/photo/1
Output is up, but only because of more hours worked. And much of that output is growth of administrative overhead, not actual healthcare as most people perceive it.
Soaring demand + zero productivity growth + cost inflation 3x higher than inflation + no political will to control costs = a death spiral in which the lowest risk decide to go it alone and drop out, leaving ever higher premiums for the rest.
Fundamentally what is the purpose of society if the improvements it makes over time don't improve its's citizens lives? If even with tripling it's economic output it can't care for it's people (just because they are old doesn't make people not part of society)?
This argument is a moral event horizon and the problem should be resolved by other means.
Once one decides to ration healthcare based on estimated remaining QALY, the same logic says we shouldn’t subsidize, e.g., healthcare for people who suffer from cystic fibrosis, or HIV, or aggressive cancers, or. . .
Or if you’d rather, there are millions of children without healthcare in the United states. Would you forgo your access to healthcare for them?
> $365 billion of it went for end-of-life care. [1]
That’s all? Musk alone is worth twice that, and who knows how many QALYs he has left but it can’t be that many. He seems pretty miserable most of the time.
Not everybody gets cystic fibrosis, or HIV, or aggressive cancers. These are a risk. That is fundamentally an insurable risk. However, we will all die. No matter how much money is spent, death comes for us all in old age. Discussing how much is an appropriate cost for end-of-life care when aged is very much a societal question.
> Or if you’d rather, there are millions of children without healthcare in the United states. Would you forgo your access to healthcare for them?
This remains a question, even in Europe. See [1] for a discussion as early as 2000 regarding rationing in the NHS.
> That’s all? Musk alone is worth twice that, and who knows how many QALYs he has left but it can’t be that many. He seems pretty miserable most of the time.
That is a cost each year, and Musk is currently at 244B [2]. We have roughly 20 years of this level of spending or greater. Even if we assumed we could tax Musk 100% (which isn't practically possible because who liquidates his positions), where do you propose to acquire that level of ongoing cashflow? Within 7 years, we would fully exhaust the wealth of the 25 wealthiest American families, even at 100% tax rate. End-of-life care is mind-bogglingly expensive for the United States economy. This either needs to be a tax hike which realistically will it everybody or a benefits cut.
[1]: https://pmc.ncbi.nlm.nih.gov/articles/PMC1173526/
[2]https://en.wikipedia.org/wiki/List_of_wealthiest_Americans_b...
Those are risks. Risks are insurable. However, death is a certainty. It is very reasonable to discuss what we believe society should subsidize for end-of-life care as it will impact everybody, myself included.
> Or if you’d rather, there are millions of children without healthcare in the United states. Would you forgo your access to healthcare for them?
I don't see what pediatrics has to do with end-of-life care in the context we are discussing (Medicare), but I would much rather subsidize pediatrics than elder care.
> That’s all? Musk alone is worth twice that, and who knows how many QALYs he has left but it can’t be that many. He seems pretty miserable most of the time.
Musk is worth 244B [1]. Even if we could tax wealth 100% into cash, we would fully exhaust the wealth of the 25 wealthiest American families within 7 years. These expenses, however, will likely continue for the next ~20 years. We need to discuss benefit cuts or tax hikes on the American population writ large.
[1] https://en.wikipedia.org/wiki/List_of_wealthiest_Americans_b...
(This isn't a free pass to younger people either, they don't vote as much as they should)
They are on an ACA plan, whereas an 80-year-old would be on medicare. They are also photographed in the article and.... obviously are not 80.
What does the medical expenses of 80-year-olds have to do with the situation described in the article?
Perhaps we could just have a 'poor people incinerator' for those whose expected medical expenses exceed their net worth?
Thanks for putting that out there. Give it 10 years, and I'm thinking we'll see the first "bio-repurposing vats". Never mention crap like that on HN. Too many closet psychopaths looking for a big break.
Understand the attempt at shaming. But there are likely a non-trivial number of readers here with such Methuselan inclinations.
Politics? We don't need no stinking politics because there are already US troops deployed in this country, and do you for one minute think that immigrants and non-white citizens are going to go through checkpoints at voting lines without harrassment or detention or arrest on Trumped up charges? Few states have vote by mail.
Courts have not taken action to defend the constitution. In one particular case, quite the opposite.
So here we are, yet the idiot US politicians still do not want real health care support for their constituents because they will lose their bribes.
Edit: Now I am wondering if they were talking about Nixon's proposed plan. I had forgotten all about that plan until I saw a comment about it.
I've got a suspicious feeling Nixon WAS in fact a crook.
RoadieRoller•1mo ago