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As I wrote on March 27, 2017, Speaker of the House Paul Ryan’s plan for healthcare was pulled on Friday, March 24, 2017. There wasn’t enough support to even hold a vote in the House of Representatives.
It wasn’t a very good plan, anyway: too many vested interests. In fact, much of it was not too different from Obamacare.
Ryan’s plan — Ryancare — was the AHCA, the American Health Care Act of 2017.
Obamacare is the ACA or PPACA, the Patient Protection and Affordable Care Act, signed into law in 2010.
Below is a brief review of healthcare in the United States.
Before the 1980s
When I was growing up in the US, until the 1980s, general practitioners (family doctors) had their own practices. You made an appointment and paid for it. The doctors also made house calls, when necessary. The charges for both were reasonable. Those men knew you, your family, your health problems. They were also friendly and reassuring.
There also used to be community hospitals in most towns, even small ones.
Hospitalisation insurance — for catastrophic and/or unexpected healthcare — was affordable.
During the 1980s
In the 1980s, HMOs became popular and most employers paid for their employees’ insurance.
I left the US during this time and was not on an HMO plan myself, although I did have employer-paid insurance with a reasonable $100 per annum deductible (‘excess’ for my British readers).
Everything was straightforward.
I didn’t even have a family doctor.
I saw two specialist physicians during that decade by ringing their offices for an appointment. I used a walk-in clinic once. Walk-in clinics were new that decade.
I can’t comment further personally.
After the 1980s
American readers are free to comment on HMOs and PPOs.
It seems that, by the 1990s, everything was run by big healthcare corporations or a large consortium of local doctors.
A new development in primary healthcare arose around the turn of the century: concierge medicine.
Concierge medicine differs from the walk-in clinic or other types of direct primary care in that one pays a membership fee monthly, quarterly or annually for one’s healthcare.
This type of primary care was developed in 1996 by the two physicians who founded MD2 (pronounced “MD Squared”) International in Seattle.
Concierge medicine expanded from there, particularly after the Millennium. Initially, it was rather exclusive and expensive. Patient membership was limited.
However, that has been changing over the years. Some concierge care is incredibly affordable. Visit the YourChoice Direct Care site to see one example. YourChoice Direct Care is in Brighton, Michigan, and is referenced below. The membership fee covers much of the care provided. Drugs dispensed are generic and dirt cheap.
Of course, even if one is a member of a concierge or direct care medical practice, one still needs health insurance.
Health insurance under Obamacare
The obligation to purchase health insurance has become a problem with Obamacare, because premiums skyrocket this year. I have read only one anecdotal account online of someone who was grateful for Obamacare. That person is in a different situation to most, however. All the other accounts I’ve read are from middle class people who are now hit with five-figure deductibles in addition to eye-watering premiums. And we mustn’t forget the co-pay when seeing the doctor. A patient must pay for his part of the doctor’s visit on the day.
My readers who are not American should note that Obamacare is insurance, not treatment.
Another point worth remembering is that American legislators have their original healthcare plans and are not subject to Obamacare.
One can see why Americans are disgruntled with Obamacare — ACA, PPACA.
The proposed Ryancare — AHCA — was no better.
Why did Americans need Obamacare?
In a post from March 22, 2017, Karl Denninger of Market Ticker explains that the bottom is falling out of healthcare. Excerpts follow, emphases in the original.
Denninger has studied figures released by the Treasury Department which show:
the Federal Government spent $1,417 billion last fiscal year on Medicare and Medicaid, up from $380 billion in 1998, which incidentally was 37% of all federal spending last year — and it’s accelerating at ~8-9% a year as it has been for the last several decades (with some notable outlying years.)
At this rate it will cross $2,000 billion, or more than half (by a good margin) of the current federal budget within 5 years. That will blow a $600 billion additional annual deficit hole in the budget into a rising rate environment which the government will not be able to finance.
That’s math, not politics.
This is because high-risk pools of patients began increasing in the 1990s:
That’s a fact, and it was cited as one of the reasons we had to pass the PPACA – to put a stop to their collapse by forcing everyone into paying for those who were very sick or nearly dead! The stories of people who were unable to get into those pools at all due to lack of funding were well-circulated and the crimp put on treatments paid for by them were both well-documented and publicized — again, due to lack of funds.
By 2008, he says the medical and insurance industry were quickly heading towards collapse:
See, while health care counts toward GDP, and is nearly 20% of it today (up from about 3% 30ish years ago) most of it doesn’t produce anything. Not one car, one house, one television set. Oh sure, it might allow someone to keep making those things — maybe — but at what cost? Yes, there are exceptions, but most of those exceptions (e.g. childbirth) are actually quite cheap in percentage terms.
The ugly part is that much medical care is actually negative to GDP. Why? Consider the drug addict who mainlines opiates and destroys his heart valves. “Fixing” it costs upward of $500,000, all said and done. Will that person ever produce more value than that with their remaining life? Definitely not if they keep using drugs; they’ll die. The sad reality is that most of them do exactly that.
How about the Type II diabetic that winds up running through a quarter-million bucks in drugs, amputations, dialysis, blindness and death because they won’t change their food intake and stop eating carbohydrates? How far does he or she go before the ability to produce is destroyed, at which point they’re on disability and go from producing something to a net consumer of everyone else’s production? By the way that specific instance when you add it all up nets out to somewhere around $400 billion a year for Medicare and Medicaid now! That’s crazy on any objective basis; you could literally give everyone in the country — man, woman and child $1,000 a year instead with money left over — or adequately feed everyone who is hungry in sub-Saharan Africa (all ~230 million of them!) with a lot of money left over.
Ethical considerations aside (emphasis in purple mine):
you can’t escape the mathematical outcome that results from allowing these people to impose their costs on everyone else. There are plenty of people in the lower and middle economic strata — in fact, most — who can easily wind up being a net negative to GDP and the problem becomes much worse when medical costs ramp by a factor of six compared against GDP and not all of the conditions in question come as the result of voluntary lifestyle choices.
But in all cases you eventually run out of people who can and will pay when exponential cost expansion occurs, especially when at the same time you ramp cost the income base you rely on to pay taxes to fund it is being destroyed one drug addict or Type II diabetes sufferer at a time.
Why Obamacare failed
The PPACA was basically a bailout of the medical industry engineered to force a more-level slam of the cost on everyone in the country.
But… it failed. It failed because nothing was done about the actual problem and costs continued to ramp. The PPACA managed to get a lower spend in Medicare and Medicaid for one year (and a modestly-better increase in the two bordering it) but spending then returned to its previous trend! The negative GDP problem got worse rather than better in aggregate and moved even further up the income scale on an individual basis. The government tried to finance that through even more deficit spending but doing so just destroyed productivity and tax receipts.
Obamacare does not solve the cost problem:
It just moves the problem somewhere else. Where it moved it was on the back of productivity and tax receipts, both of which have been horrifyingly bad since the 2008 crash. Last fiscal year tax receipts rose by less than 1% despite all the new taxes in the PPACA and higher rates generally while productivity improvements have all but disappeared.
Why the AHCA was a bad remedy
He notes that the AHCA did not address cost, either, and:
if we do not address cost and thus drop that $1,417 billion precipitously the government’s budget will be destroyed and thus collapse on the clear evidence and trends published by our government’s own Treasury Department.
The AHCA failed to even achieve a vote partly for this reason and, had it passed, would have helped to:
further advance the collapse of our federal government’s ability to fund itself, and thus operate!
The AHCA cannot resolve this problem because it intentionally refuses to address the driver of the problem in the first instance. Returning to “High Risk Pools” is idiotic because those very pools were on the verge of collapse prior to the PPACA and were a big part of why Obamacare was written and passed! The insurance and medical lobbies wrote the PPACA to get rid of those problems and pools, or so they thought.
They tried denying math but failed because the laws of mathematics are not suggestions. You can’t get rid of a cost by making someone else pay it; you simply move it and eventually it comes back and bites you.
… It just moves money around, something I noted back when it was first released (and much to the detriment of state budgets.)
What needs to happen
Denninger says 15 USC as well as State Consumer Protection laws must be enforced.
Prices and charges must be posted and must be uniform:
Forcing published pricing and charging everyone the same price for the same service or product of like kind and quantity, disconnecting it from alleged “insurance” using existing law, will force competition into the market immediately.
He says prices will drop dramatically and links to the aforementioned Your Choice Direct Care:
Medical costs will instantly drop like a stone. How much? Let me point out that from one “direct concierge care” site we have some examples of what market prices for common services and drugs look like – $4 for an A1c test, $3.13 for a CBC (complete blood count), $7 for a PSA screen, $275 for an MRI (damn close to what you can buy it for in Japan – cash, of course), $37 for an X-ray and $167 for a CAT scan. On drugs how about $1.98 for 90 Prozac pills, or $1.44 for 30 Prilosecs? This place claims these offers are “at their cost” with your “membership”; note that they are not selling at a loss and the maker/operator of same is still making a profit! Why would you fork over a “co-pay” of $10 or $20 when you can pay $1.50 for your prescription in cash?
Why would you need “health insurance” to cover routine medical care and prescriptions if you could buy services and drugs at prices like that — or at a 20% markup from them with a bunch of competitors in a given area?
We can have that sort of pricing for medical care today, right now, right here, everywhere in the country: Enforce the damned law today and that’s the pricing we will have for medical services and drugs TOMORROW.
Let me make this clear for you because we have proof of what the outcome will be: The known pricing we will obtain if we were to do this is, for most treatments and drugs, 80 to 90% LESS than paid today. In fact most of the drugs listed on that concierge site are 10-20% of your copay under existing so-called “insurance” and so are the imaging and lab prices!
He says any reform legislation should cover — and President Donald Trump has mentioned this — prescription drugs:
repeal the reimportation ban on pharmaceuticals, and we need to add to Robinson-Patman inclusion of international sales. That will force “best price” everywhere and pharmaceutical costs will fall like a rock here in the United States. Oh, those other nations? They’ll get to pay their ratable share of the development of drugs — and it’ll be about damn time.
Conservative media remain silent
For some reason, no conservative commentator ever discusses healthcare reform.
Here’s a list from Denninger’s readers:
Hannity HAS NOT brought it to the forefront.
Rush HAS NOT brought it to the forefront.
Levin HAS NOT brought it to the forefront.
Beck HAS NOT brought it to the forefront.
Savage HAS NOT brought it to the forefront.
O’Reilly HAS NOT brought it to the forefront.
Hewitt HAS NOT brought it to the forefront.
Malkin HAS NOT brought it to the forefront.
Ingraham HAS NOT brought it to the forefront.
Cain HAS NOT brought it to the forefront.
Bruce HAS NOT brought it to the forefront.
Bennett HAS NOT brought it to the forefront.
Boortz HAS NOT brought it to the forefront.
Let me add to your list of those who refuse to address this.
Hannity and Ingraham have been sent this info a dozen or so times as well as my Congressman which gets a “generic” health care response letter.
Tucker Carlson HAS NOT brought it to the forefront.
Ann Coulter HAS NOT brought it to the forefront.
Stuart Varney HAS NOT brought it to the forefront.
Even the “supposed” legal commentators have not touched this.
Judge Napolitano HAS NOT brought it to the forefront.
Judge Jeanine HAS NOT brought it to the forefront.
Kimberly Guilfoyle HAS NOT brought it to the forefront.
Then lets not even get started on the inability to actually contact or send a real email to any of these people. You have to go through some inane message system on social media or use some ridiculous web form that will not even recognize hyperlinks or colored, bold, italicized text for emphasis …
It appears social media accounts for all of these above are mostly designed for promoting book sales and personal aggrandizement and “look at me” posts.
At this point, every person that seemed like they might actually be willing to listen or discuss this has been notified and has revealed themselves by their refusal to discuss any of this.
Someone replied with regard to those in the list who work for Fox News:
Start asking the wrong questions on that network and you are gone. These media organizations exist not to promote freedom or uncover truths to protect the people but to inflame passions and promote propaganda. This is what happens when only a few large corporations control the majority of the media.
Someone else blamed it on the public:
Because TV , Facebook, Youtube and Twitter have reduced John Q Public’s attention span to about ninety seconds
… fact based essays don’t get traction.
Karl Denninger answered many of the questions I had been asking myself about healthcare in the US.
I hope he has answered some of yours, too.
The other day, I responded to a comment on a conservative American website with regard to diet.
The context was in regard to the reform of Obamacare in the Trump administration. The initial comment referred to Speaker of the House Paul Ryan’s (R-Wisconsin) possible approval of a health auditor, a stranger, to visit someone’s house to assess a family’s lifestyle prior to their obtaining health insurance. Apparently, this is one health insurance idea that has been discussed before.
Ryan’s father died at an unexpectedly early age from heart disease. Consequently, Ryan focussed on diet and exercise to ensure he himself didn’t end up that way. It is thought that he also might well consider that a stranger going into someone’s home to assess their lifestyle — perhaps to check cupboards for snacks or alcohol and sniff walls for evidence of smoking — is entirely acceptable.
That is every bit as frightening as the Vault 7 Year Zero CIA document dump by WikiLeaks on March 7.
There are two things here.
The first is that, as a legislator, Paul Ryan will never have to be part of Obamacare or Trumpcare. He and his colleagues get a traditional health insurance plan.
The next thing is obesity, which Paul Ryan — a thin man — desperately opposes.
As I told the person on this particular conservative website, this notion of a healthcare audit is a plan for the ‘little people’. (They, in Ryan’s estimation, do not understand what their betters do. This, by the way, is Ryan’s ‘magnificent home’ in Janesville, Wisconsin. It has an extensive border fence around it.)
I further commented (same link):
To counter Ryan’s dictating to Americans on their health: my father also died of heart disease at an early age. So did his father, whom I never met. So have some of my friends in the present day. That doesn’t give the right to go around snooping in people’s homes as a precursor to getting health insurance!
Then, I discussed obesity:
Re obesity: severely limit or stop eating starch and sugar, eat more fat (including animal fat) and less protein. Watch the pounds roll off. It’s called the ketogenic diet, which is a permanent eating plan, not a fad diet. I’ve been on it for three years. I lost weight and stabilised. Cholesterol and triglycerides go down with keto.
As we know, there is a particular association between Americans and obesity. It is unclear whether this can be connected with the increase of obesity in other Western countries, because who knows how much corn syrup — rather than sugar — is in their food? Emphases mine below, not in the original comment:
Someone on here was talking about corn. It’s all the corn syrup used in place of sugar which also leads to obesity. Sugar makes you feel more sated than corn syrup. We owe the proliferation of corn syrup to the Nixon administration in the 1970s. Corn farmers, IIRC, had a glut of crop then, so were bailed out with companies producing corn syrup for commercial cake, cookie and candy manufacturers.
Note when obesity started to climb: the late 1970s to early 1980s. It was no big deal at the time. Most people attributed it to Americans giving up smoking. Although that was a factor, I would posit that the increase of sweet snacks and cakes made with corn syrup were a greater contributor — and continue to be today.
Yes, I know I should have said ‘was’ instead of ‘were’ in the last sentence, but only caught it now.
Regardless, that message got through. My sincere thanks to the moderators. I didn’t think anything of it until later. Now read on.
The commenter, with whom I was corresponding, replied:
Salty snacks like crackers and chips also contribute, along with soft drinks and the rest of our favorites (fast food, etc). Eat at home family meals with vegetables and salads have diminished with women working, divorces, unwed mothers with no Dad in the home, increase of addictions, etc.
I’m not in favor of a one-food group diet (animal fat/low carb) diet. Whole grains and vegetables/fruit contain important phytonutrients. Did you know heart attacks diminished in Britain, in WWII, despite the stress of the bombings, when sugar was rationed?
So, appreciating this reply, but differing because of my keto experience — and that of thousands of others — wrote back.
I retyped my reply twice. Both immediately went into spam. A subsequent message, on a different topic, went through, by the way.
The text below is similar to what was spammed. Once again, emphases mine below, not in the original comment. For the overweight:
All starch — whether salty or sweet, from carbohydrate to sugar — should be sharply curtailed or eliminated.
It should be noted that the ketogenic diet — a way of eating and not a fad diet — is not a one-food group diet. It works with a proportion (depending on the individual) of 50% fat, 35% protein and 15% carbohydrate per day. Vegetables should provide most of the 15% carbohydrate. The more you weigh, the more you lose.
Starch comprises bread, cereal, cakes, oatmeal, salty snacks (etc.). Sugars, including those in fruit, are also starches.
Corn syrup has replaced sugar in most sweet snacks. Corn syrup is less satisfying than pure sugar. Americans are eating more corn syrup in cakes, cookies and candies. Therefore, they are getting fatter because the corn syrup is less satisfying.
Eating more fat — including fat from cheese, eggs and dairy products, especially butter — will be more satisfying than eating starches or sugar.
I agree very much with your point on ready-made meals, however, another problem is that Americans — along with many other Westerners — eat five times a day.
I take your point that, during the Second World War, Britons got their nutrients from whole grain bread. However, they needed all the sustenance they could receive. They also had no central heating. They had to walk or ride bicycles to and from work. Rationing in the UK did not end until 1954.
Westerners live an entirely different lifestyle in the 21st century. They eat too many carbohydrates, including sugars — especially corn syrup products, which leave them less full than sugar would. They have heated homes and offices. They drive nearly everywhere.
Low fat foods are another problem. For a decent flavour profile, low fat needs to be offset with high sugar content, most often corn syrup.
My message must have had wording or syntax that instantly caused it to end up in spam — twice.
There is a political point about corn syrup that I want to make concerning the law of unintended consequences. No one could foresee in the Nixon administration that corn syrup would result in a national weight problem.
I know from experience. In the early 1960s, when I was five years old, I was a guest of a young friend at her house for Saturday dinner — pancake night. My mother always bought maple-flavoured syrup made with sugar. This family always bought corn syrup. I still remember eating a plateful of pancakes with syrup and feeling hungry before I went to bed that night. The hosts even told my parents that I had an incredible appetite for such a little tyke. Yet, that was the only time I was ever hungry after eating twice as many pancakes as I would have done at home. The only difference was the type of syrup.
If Americans were still eating sweets of any kind made with sugar, they would be of normal weight.
Corn syrup is making people fat. So are other starches. Anyone who wants to lose weight should try a low-carb high-fat — LCHF — eating plan.
For more information on the ketogenic diet, please read the following. If you are in any doubt or under regular care of a physician, seek medical advice first:
Does low animal fat intake increase hostility or depression? (a hypothesis)
Fat and a balanced mind (low-fat diets can imbalance serotonin and nerves)
High carbohydrate intake and depression (also epilepsy related [Dr Richard A Kunin’s paper])
High-carb, low-fat diets might cause Western diseases (cancer related)
Dietary advice: the old ways are the best (my own story on the ketogenic diet)
High carb, low fat diets bad for brain health — and moods? (more testimonials for the ketogenic diet)
Whilst I cannot guarantee that my original correspondent on the conservative website will see this, I hope that others might find this of interest.
Obamacare has pushed many Americans’ insurance premiums and deductibles (‘excess’ in the UK) through the roof.
Jonathan Gruber helped develop and present the Affordable Care Act, otherwise known as Obamacare. Some say he was its ‘architect’.
In 2014, both Gruber and the Obama administration denied he had much of a role in that policy, however, he gave several interviews and public speeches on the topic. It was also known in January 2010 that he had a $297,000 contract with the US Department of Health and Human Services. He was promoting Obamacare during that time. Some journalists and pundits called this a conflict of interest.
Gruber has long had an interest in economics and health care. After earning a Bachelor of Science degree in economics from MIT (Massachusetts Institute of Technology), he went on to obtain a PhD in the subject at Harvard University. His thesis was Changes in the Structure of Employer-Provided Health Insurance.
Gruber has been teaching economics at MIT since 1992. He took leaves of absence to work for the public sector, initially for the US Treasury in 1997 and 1998. He later worked for the Commonwealth of Massachusetts in devising Romneycare between 2003 and 2006 when Mitt was governor. In 2008, he advised three Democratic Party campaigns. Between 2009 and 2010, he worked on Obamacare.
After that, he worked for the State of Vermont in crafting Green Mountain Care, the first state-level single-payer health care scheme. That was in 2010 and 2011. N.B.: Vermont governor Peter Shumlin cancelled Green Mountain Care in 2014, because it was too expensive!
Odd that an economist should get his numbers wrong, don’t you think?
Obamacare Facts has a page on Gruber, featuring quotes and videos.
In 2013, at a lecture at the University of Pennsylvania, Gruber at one point explained that it was essential for the Congressional Budget Office not to portray the Obamacare bill as a tax or a mandate, even though it is (emphases mine):
This bill was written in a tortured way to make sure CBO did not score the mandate as taxes. If [Congressional Budget Office] scored the mandate as taxes, the bill dies. Okay, so it’s written to do that. In terms of risk-rated subsidies, if you had a law which said that healthy people are going to pay in -– you made explicit that healthy people pay in and sick people get money — it would not have passed… Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter, or whatever, but basically that was really, really critical for the thing to pass. And it’s the second-best argument.
Remember Nancy Pelosi saying, ‘We have to pass it to find out what’s in it’?!
The media pushed Pelosi’s lie.
Going back to Gruber’s statement, it was important to not present Obamacare as a tax, otherwise Joe and Jane Public, understandably, would have been on the blower to their legislators demanding the bill not be approved.
However, there was a more important legal reason:
It wasn’t until the National Federation of Independent Business v. Sebelius that the mandate’s fee was declared a tax. Given the status of Gruber this statement could not only be used to sway public opinion away from the Affordable Care Act, it could be used in lawsuits against the ACA moving forward …
CNN’s S E Cupp has more Gruber quotes. Her article was published in November 2014, when all his proclamations were first broadcast to the American public. That was the point when some in government began to distance themselves from him. Pelosi denied knowing who he was even though, in 2009, she had praised his work. Obama referred to him vaguely as ‘some adviser’.
In 2010, Gruber told the following to an audience at the College of the Holy Cross:
… quite frankly the American public doesn’t actually care that much about the uninsured…..What the American public cares about is costs.
Indeed they do. Shouldn’t an economist?
In 2012, at the Honors Colloquium at the University of Rhode Island he said:
It’s a very clever, you know, basic exploitation of the lack of economic understanding of the American voter.
Cupp was rightly aghast at Gruber’s arrogance:
For one, it was hardly a secret that the law relied on healthy people to pay in so that sick people would get coverage. Most of us — even the stupidest — know that’s how insurance works.
And just to be sure it was clear, Republicans and opponents of the law reiterated this fact ad nauseam during the public debate of the Affordable Care Act. Heck, even Obamacare supporters were insistent on explaining this point for the express purpose of getting healthy people to sign up for it. The administration spent millions on a marketing pitch to convince young, healthy millennials to invest in health insurance many didn’t appear to want.
For another, despite Gruber’s insistence that the administration maintained a necessary opacity about the law, there were plenty of warnings about its potential fundamental problems, and numerous advocacy groups, impartial economists and media outlets were steadily fact-checking the President’s rosy predictions about the law.
The point at which Gruber became unstuck on Obamacare was when he spoke with great certainty of state-specific health insurance exchanges in 2012. People who could not afford the premium would be able to apply for tax credits that the exchanges would honour. Obamacare Facts has the quote, excerpted below, then explains how wrong it all went in reality. At the time their page was published, there were three lawsuits (emphasis in the original here):
Gruber: Yeah, so these health-insurance Exchanges, you can go on ma.healthconnector.org and see ours in Massachusetts, will be these new shopping places and they’ll be the place that people go to get their subsidies for health insurance. In the law, it says if the states don’t provide them, the federal backstop will. The federal government has been sort of slow in putting out its backstop, I think partly because they want to sort of squeeze the states to do it …
The problem here is that in Gruber’s opinion, and remember he helped to create the law, that if a state doesn’t set up an exchange then its citizens can’t get tax credits. Well that is exactly what three lawsuits are currently charging. Two of those lawsuits have initial rulings against citizens getting tax credits.
FACT: About 87 percent of people enrolled in ObamaCare’s Health Insurance Marketplaces receive subsidies.
When asked in November 2014, Gruber said he made a mistake. He told the New Republic:
I honestly don’t remember why I said that. I was speaking off-the-cuff. It was just a mistake. People make mistakes. Congress made a mistake drafting the law and I made a mistake talking about it.
During this era, at this time, the federal government was trying to encourage as many states as possible to set up their exchanges. …
Breitbart wrote about the Gruber controversy in June 2015, confirming that he really was the architect of Obamacare, observing:
once again, the media eagerly helped Obama shape a painful news cycle with falsehoods, and the truth comes out literally days before the Supreme Court rules on the subsidies – too late to influence the Court, while Obama was given a clear field to bully them into protecting his health care con job again.
Cupp nailed Gruber with this:
Gruber’s misguided sense of accomplishment reflects not so much elitism as it does the arrogance of liberal “solutionism,” or the tendency of technocrats to assume they can solve complex social problems easily …
… he decided what the problem was (in this case, that healthy people were paying too little for insurance) and assumed we were all too dumb to ask any questions.
There is only one presidential candidate who promises to repeal Obamacare. You know who it is. And, if elected, he will ensure it’s done.