The KHIT Blog: Senate GOP ObamaCare Repeal bill goes "poof"

Tuesday, July 18, 2017

Senate GOP ObamaCare Repeal bill goes "poof"

a.k.a. "Trumpcare," though The Donald is "not going to take ownership."

John Irvine at THCB:

Senators Mike Lee and Jerry Moran said yesterday that they would not vote for the Better Care Reconciliation Act, effectively killing the legislation. As anybody who has been following this story would have predicted, President Trump reacted publicly on Twitter on Tuesday morning, vowing to let the ACA marketplace collapse and then rewrite the plan later.

Senate Majority leader Mitch McConnell attempted a quick punt this morning, calling for an immediate Senate vote on the House bill, a trick card that if it worked, would give Republicans two years to work things out.

Unfortunately for McConnell, it probably won’t.

The White House sees the failure as saying more about the political establishment in Washington than itself, which shouldn’t be all that surprising…

So much for Article II, Section I of the Constitution and owning the faithful execution of the laws. The ACA remains the law.

"You're going to have such great health care, at a tiny fraction of the cost, and it's going to be so easy." - Donald Trump, Oct 2016 Florida campaign rally.

As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!
— Donald J. Trump (@realDonaldTrump) July 18, 2017

Right.

Two words, #Obamacare largely fixed. "Public Option." Denying that is purely ideological. #KillTheBill #Medicare4All #HealthcareBill #BCRA
— Bobby Gladd (@BobbyGvegas) July 18, 2017

See my old post (2009) "Public Optional."

FREE BEER TOMORROW?

Dr. Adrian Gropper posted an interesting comment at THCB under the foregoing post:

The substantive changes that are about to happen in US healthcare will be driven by technology (artificial intelligence, telemedicine, blockchain identity, longitudinal health records), not politics.

Our institutions have little choice but to pretend they are still in control of their traditional roles. Congress may be the most obvious example today, but insurers, employers, and hospitals are also lost in the ether. None of these institutions is pitching a solution.

To stabilize healthcare in the face of massive technological change start with the tech, not the incumbents.

Well, one hopes, anyway. I guess we'll see.

Interesting observations from Bob Cesca -

At some point, congressional Republicans will entirely abandon President Donald Trump. How do we know this? If you look closely, you’ll notice that it’s already happening. One by one, Republicans on the Hill are growing tired of Trump’s poorly-informed, lazy, self-centered lack of leadership, and it’s a safe bet that more than a few members are wondering whether the 2018 midterms will turn out better without Trump dragging them down.

Whether this precipitates a Barry Goldwater Watergate moment in which Republican leadership hikes down the block to insist upon Trump’s resignation remains to be seen, but what’s immediately observable is that the Trump coalition is rapidly vaporizing, leaving the chief executive with fewer and fewer influential defenders in Congress. The rapid, awkward demise of Trumpcare and the president’s confounding reaction in the aftermath might’ve been the last straw in an already ungainly relationship between both ends of Pennsylvania Avenue.

Frankly, if I were Senate Majority Leader Mitch McConnell or Speaker Paul Ryan, I’d strongly consider cutting bait with Trump given the way he has repeatedly set them up to fail while doing little to exercise any kind of meager leadership. Without a substantive ally in the White House, it becomes less likely they’ll continue to tolerate and backstop his uneducated, rookie gibberish and social media outbursts, embarrassing the party and tainting it with the stink of his failed administration. How much longer will they continue to tolerate Trump playing honk-honk-goes-the-truck and tweeting on the john while they spend valuable political capital on legislation he barely understands and, despite his marketing acumen, has repeatedly fumbled?

The failure of Trumpcare was partly about the president’s lack of even a basic, entry-level sense of how a bill becomes a law. It was also partly about Trump’s running-on-fumes political capital. The whole concept of repealing and replacing Obamacare with the snap of his short fingers merely set up Trump and Congress to fail. Not only is it nearly impossible for conservatives to create a affordable, universal health care program, but it was never going to get done within a few short months, much less “on day one.” Since Congress was unable to match a lofty goal established by a political amateur, Trump set them up to fail…

Yeah.

I just wanna sing...

I wrote and recorded that five years ago after SCOTUS upheld the Constitutionality of the ACA.

Links to some relevant prior KHIT posts:

House Calls, STAT!
Paying for Health Care
#ShowMeTheBill
An American Sickness
Rationing by 'Price.'

There are more. That's enough for now. And, oh, yeah, review "Making the world a better place."

JULY 19TH GOP ZOMBIECARE UPDATE

"Nice little Senate seat ya got there. Be a shame if something bad happened to it."

ON "TAKING OWNERSHIP"

What a difference four years makes, 'eh?

BREAKING

GOP Arizona Senator John McCain has been diagnosed with a glioblastoma brain tumor. Hate to hear that. Blogged about those here.
____________

More to come...OafTrumpcare

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
___

"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
___

"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
___

"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
___

"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
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Tuesday, July 18, 2017

Senate GOP ObamaCare Repeal bill goes "poof"

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