Jeb Bush’s Social Darwinism

The effort by the state, by the government, ought to be to try to create catastrophic coverage, where there is relief for families in our country, where if you have a hardship that goes way beyond your means of paying for it, the government is there or an entity is there to help you deal with that. The rest of it ought to be shifted back where individuals are empowered to make more decisions themselves.

This is how assumptive 2016 Republican Presidential candidate, Jeb Bush, summarized his replacement for Obamacare.

While we don’t have all of the details, there is a lot to parse in this particular statement.

At first blush, the discussion of catastrophic coverage is at the heart of the Republican message.

Bush advocates replacing the ACA “with a model that is consumer-directed, where consumers, where patients, have more choices … where the subsidies, if there were to be subsidies, are state administered … where people have more customized types of insurance based on their needs; and it’s more consumer-directed so that they’re more engaged in their decision making, and they have more choices than what they have today.”

This was the same message the Romney presented when asked about healthcare for the poor during the 2012 campaign.

Well, we do provide care for people who don’t have insurance. If someone has a heart attack, they don’t sit in their apartment and — and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.

That is the healthcare system that we had. One where those who couldn’t afford insurance could receive the most expensive form of care our healthcare system had to offer. Those that attempted to pay those bills often ended up bankrupting themselves. Most of those bills were passed on to those with insurance through higher hospital costs.

Catastrophic Coverage
Catastrophic coverage as envisioned by Mr. Bush is just one step away from this model. The stated goals are to make insurance more affordable by introducing high deductibles and cost sharing. In the minds of conservatives, this makes people more thrifty healthcare consumers, since much of the cost of everyday care is coming out of their pockets. The reality is that high deductible plans in many cases are not much different from no coverage at all. They discourage people from seeking preventative care.

While high deductible plans may flow some additional dollars into the hands of hospitals for the expensive emergency room visits that will result from failure to employ preventative care, it will not mitigate the financial risk of those who have a medical emergency. That’s because, as this graph shows, fewer than half of those who are likely to purchase these plans have the money to pay the deductible if in fact they DO experience a medical emergency that their plan covers.

high deductible

Individual Customization
The second problem in Bush’s unraveling of Obamacare is wrapped in the clothing of “more customized types of insurance based on their needs”. This is another conservative hot botton. They have a philosophical problem with the way that insurance works. They feel that people should be free to purchase only the amount of insurance they feel they need without regard to the risks or costs. They don’t seem to have a problem with Banks requiring homeowners to insure their homes up to a particular standard in order to get a mortgage. But they do have a problem with the government setting minimum standards on the sorts of healthcare coverage insurance companies must offer. Bloomberg explains that government standards preserve large risk pools which effectively reduce the costs for everyone.

Republicans are really saying that people should be free to avoid carrying insurance for problems they don’t expect to have (a bout of depression, maybe, or a stroke that requires rehabilitation) or don’t want to help pay for (pediatric and maternity care for men with no children, say). The former view shifts costs onto the unlucky; the latter shifts costs onto women and parents. Both undercut the purpose of insurance, which is pooling risk. Neither saves money. Yet in the abstract the argument sounds compelling. And it’s going mostly unchallenged.

Single Payor
What IS interesting in Bush’s plan is the suggestion that the government either directly or indirectly is the source, or underwriter of these catastrophic plans. This particular statement goes WAY further than Obamacare toward the single-payor socialism fears that birthed the Tea Party. Under Obamacare, the government does not issue insurance. The insurance comes from private companies. Those companies are regulated, but they ultimately get to set their own rates and determine in which markets they are going to participate and which populations they are going to target. The government only offers to subsidize the cost to purchase that insurance for those who don’t have the means to purchase that insurance on their own.

Obamacare is market-driven. The government works to make the insurance market in every state sufficiently lucrative that consumers in every state have choices. It has no mechanism to compel an insurance company to offer coverage in any particular state. Participation by insurance providers is entirely voluntary.

If the government is going to guarantee that every individual is able to purchase some form of catastrophic insurance at a rate that they can afford, who is going to provide that insurance? Who decides what that rate is? Who decides what the minimum coverage should be? How to do you handle the “free riders”, or does everyone get a minimum plan paid for by the government whether they like it or not? How does Bush plan to pay for all of this? A new tax?

That’s how Medicare works. One plan for everyone paid for by a payroll tax. We don’t require seniors to enroll in Medicare, but 85% of seniors do. Medicare doesn’t cover all expenses, but it does allow most seniors to retire without the worry of having to pay increased medical costs.

Jebcare is not a REAL plan. It is simply a set of talking points that allow Jeb Bush to appeal to the reptile brain of the Republican Party without actually working out any of the details.

Republicans DO NOT want to offer any kind of subsidized care for anyone. This isn’t an issue of cost or efficiency. Obamacare has already demonstrated that this approach saves money and improves health.

This is about philosophy. Republicans are social Darwinists who feel that poverty is the appropriate punishment for bad decisions made by people or their parents. Disease, in their minds, is just another motivation for making better decisions that should be preserved if we want to have a more responsible society. The rich are the vanguard for this righteous society. Their success is proof of their character.

Those of you who read the Bible, might recognize some similarity to the Pharisees. They felt that poverty and disease were punishments God meted out on the sinful. Jesus rejected that whole philosophy. Instead he reminded his disciples that His work (and the future work of all Christians) was to enlighten the world to a new way of thinking where love is the rule.

And as Jesus passed by, he saw a man which was blind from his birth. And his disciples asked him, saying, Master, who did sin, this man, or his parents, that he was born blind? Jesus answered, Neither hath this man sinned, nor his parents: but that the works of God should be made manifest in him. I must work the works of him that sent me, while it is day: the night cometh, when no man can work. As long as I am in the world, I am the light of the world. Matt 9:1-5

There is obviously a lot of work still to be done.

13 Responses to “Jeb Bush’s Social Darwinism”

  1. Keith says:

    What I find most interesting is your analysis of republican candidates lack of details on healthcare. I’m not certain I remember you concern for lack of details when it came to Obamas. In fact at one point, if memor servers me well you said in effect “who cares, more people will be covered.”

    As to Obamas comments
    No mandate
    Not a tax (saved by justice Roberts by calling it one)
    You can keep your coverage
    You can keep your doctor

    Jeff you nearly commented on those MAJOR issues. You have zero credibility to question or ask for any detail from republicans. Zero.

    I take it your recent comments directed at certain republicans are a preemptive strike at possible presidential candidates, looking for Spritual wickedness. How about addressing Hillarys Q&A the other day. My goodness she simple stood up and couldn’t make eye contact and parsed words and gave dishonest, less then complete, and outright false answers. I also believe 97% of all dems would vote for her.

    On most all media the word racists and republican are being used almost interchangibly. On face book good friends of mine are using the word racist more and more and more. Now 47 repub senators wrote a open letter to Iran. Instead of arguing they are wrong they are being called racists. Happy with the narrative your progressive friends have created?

    Let’s try this. Freguson MO kinda is the tipping point for this anarchy directed at authority and at conservatives. Mainly because conservatives supported the cops, even the DOJ did, over they’re own best efforts not too. They did make sure to write a scathing report saying the police department there is racist. This justifies the left portions. However upon closer look WR find what is much more reveling. at Louis is overwhelmingly dem. so is Ferguson. Most all elected officials are dems. The population is 80 black. The cops overwhelmingly white. However what they have in common is they are all overwhelmingly dems. So are most all, if not all, elected officials in ferguson are dem… So as the DOJ has clearly pointed out but I don’t seem to hear it anywhere, is it seems the racists are dems… How can that be.

    If I understand the media recently income inequality is still creating more distance between the bottom and the top. What specifically did President Obsma do to create this situation? It seems his policies have only thrown fire on the situation. And you thought Bush was bad.

  2. Jeff Beamsley says:

    Let’s deal with the substance of my post first and then all of the other things that you feel are wrong with the world.

    If I understand your post correctly, you are saying that because of things that bother you about the ACA, I have somehow lost the right to comment on the substance and credibility of Republican “replacements” for Obamacare.

    As you might imagine, I’m not all that concerned about whether or not you think I have credibility.

    But I am happy to take your objections in order.

    1. No mandate. Obama campaigned on “no mandate” much to the dismay of Hillary Clinton. He didn’t win the nomination on that point. Exit polling suggests that his early opposition to the Iraq war was the reason more dems voted for him than Hillary. He did change his stance on the individual mandate during the negotiations on crafting the ACA and ADMITTED that it was a change from his position during the campaign. Individual mandate became important when the plan shifted fairly early on from a single payor concept to state-based marketplaces for private insurance. That shift was driven by Obama’s hope to get some Republican support. It never happened.

    2. Tax. This is simply semantics. The SCOTUS used the constitutional taxing authority of Congress to render the ACA constitutional, but their ruling didn’t change the basic substance of the law. If you choose not to purchase health insurance and you file a tax return (individual this year company next year), you will pay a fine. The CBO calculated how much money the law would generate every year from those taxes/fines. That calculation was part of the first scoring that the CBO did and has been widely discussed since. The only people who care about the difference between the word tax and fine are the Supreme Court and conservatives who need to manufacture another example of Obama telling a lie to explain how he managed get re-elected. Exit polls support that Obamacare was one of the reasons he won. The same conservatives trying to make a big deal out of this tax/fine issue completely IGNORE the fact that the SCOTUS ruled that the law IS fundamentally constitutional. That ruling blew the basic claim that spawned the Tea Party out of the water. This law was and is constitutional.

    3. You can keep your coverage and you can keep your doctor. This won the lie of the year award in 2013. Here’s politifact’s summary – Instead, he (Obama) fought back against inaccurate attacks with his own oversimplifications, which he repeated even as it became clear his promise was too sweeping.

    I have already posted the data supporting the claim that Obama is significantly more honest in his statements than any other major political figure in the country. We’ve also talked about the impact of this lie versus “we don’t torture”, “we’ll be welcomed as liberators”, and “Saddam possesses WMD’s” lies of the previous administration.

    IMHO, on the big issues Obama got it right. He promised to reform Healthcare in his first campaign and he delivered. He promised to get our troops out of Iraq and Afghanistan and he delivered. He promised to pass financial reform and he delivered. He promised to pass legislation to mitigate the damage from the financial collapse. He did that. He promised to save the domestic auto industry. He did that. He promised to take action on immigration. He did that.

    So before we engage on any of the other issues that you have raised, let’s get through this one.

    First let’s agree that the ONLY honest way to compare any proposal to replace Obamacare is to have it scored by the CBO.

    Second let’s also agree that ONLY way something gets scored by the CBO is when it is put in legislative language so that the CBO can perform an apples-to-apples comparison.

    Third, finally let’s agree that only ONE Republican plan has been scored. The result of the 2009 CBO scoring showed that the ACA was both cheaper and more efficient than the Republican proposal.

    Those are the facts. If we can’t agree on them, then there really isn’t any reason to continue this particular discussion.

    If we can continue, then I have a couple of questions.

    When Paul Ryan said in 2012 in his run with Romney that he was going to hold meeting across the country to gather feedback about Obamacare and no meetings occurred, did he lie or not?

    When he promised during the 2012 campaign to replace Obamacare, but never produced even a proposal outlining what that replacement would look like, did he lie or not?

    When Ted Cruz promoted Teddycare as a replacement to Obamacare, but the plan effectively eliminates many of the protections that make healthcare effective and affordable, and is not in a form that would allow the CBO to do a comparison, did he lie in calling it a “replacement”?

    When Jeb promoted Jebcare as a replacement for Obamacare, but the plan leaves half the country with a deductible that they can’t afford in the event of a catastrophic event, and his proposal is also not in a form that the CBO can use, is he lying when he calls it a “replacement”?

    When Upton, Hatch, and Burr put out what the Examiner called “the first real Republican ‘Obamacare’ alternative” a month ago, but it turns out to be exactly the same plan, virtually word for word, that was introduced last year by Hatch, Burr, and Coburn (since retired) – even the first 359 words of their news release was the same, are they lying when they call it “new”?

    My posts on this subject have a simple point.

    Republicans ARE NOT serious about replacing Obamacare. They are no more serious about replacing Obamacare than they are about negotiating a compromise deal on immigration.

    There are two things motivating this flurry of plans.
    1. Some Republicans are running for the presidential nomination and feel that they must demonstrate that the Republican Party can be trusted to do something more than just repeal Obamacare. What distinguishes these plans is that they all effectively gut the law in one way or another.
    2. Republicans are hoping against hope that the SCOTUS will eliminate subsidies for about 80% of those covered under the law because of some contradictory language. One of the criteria that the SCOTUS will use to make their decision is how much harm it will cause. Republicans are scrambling to demonstrate they have some ways to mitigate the harm. I find that particularly comical, since the past five years they were happy to pass repeal legislation 50+ that contained no language on what would happen if a repeal actually happened. Now because they failed to take the whole prospect of repeal seriously, they have been caught flat-footed with no agreed replacement plan. Instead everybody who is anybody in the Republican party has a plan. They are hoping all of these plans will convince the SCOTUS that ruling against the administration won’t hurt anyone.

    I don’t claim that this is the only hypocrisy in government, or that hypocrisy is a uniquely Republican trait.

    Nor do I claim that I will write about every hypocritical event that occurs in this country.

    I write about things that interest me.

    Right now this interests me.

  3. Jeff Beamsley says:

    Ok on to Hillary. As I’ve said before, I think this email revelation is a short term issue as far as the public is concerned. We’ll never know whether or not there was any damaging information in those deleted emails. Those who hate her will just add this to her list. For those who don’t, it will quickly become old news because there is just no more to say than what has already been said.

    She currently has a big lead among Democrats, but she had a big lead going into the 2008 primary and ultimately failed to get the nomination. She lost, not because her last name is Clinton, but because of her record in the Senate. She voted to invade Iraq and she was running against a guy who was against the war from the beginning.

    Republicans are going to launch the same set of pre-emptive strikes against her, but they will draw no more blood this time than they did during Benghazi. These attacks will also further galvanize her Democratic support, particularly among women.

    The BEST thing that can happen to her is that she gets a strong primary challenge from somebody (maybe O’Malley from Maryland). Then all of the negatives about email and foundation funding from foreigners, and the fact that she and Bill made a lot of money giving speeches, will all come out.

    As far as my personal opinion, I think it is time for a female President. Hillary has certainly earned the right to run. Her strained relationship with the press, questionable character, deeply suspicious nature, and bunker mentality when under attack; are all weaknesses she brings to the table. Her strengths are her determination, intellect, and ruthless ambition. Whether or not she can overcome her weakness and wage a successful campaign that highlights her strengths, we will see.

    Because of the improving economy, Republicans have recently been focusing their attention in foreign affairs. If foreign policy is going to be the focus of the 2016 campaign, the Republicans are in trouble. None of the leading candidates have any experience in foreign affairs. Certainly nothing to compare with Hillary’s tenure as Secretary of State. Unless Obama makes hash of things in the next year or so, Dems are going into the election with an Iranian Nuke Deal, ISIS contained through an international coalition, trade deals with China and India, a weakened or maybe ousted Netenyahu, continued low oil pricing, a lot of economic pressure on Putin, and climate change being viewed more and more as a world destabilizer. Republicans are also learning that the obstructionism that they have demonstrated over the last five years, just doesn’t work as well for international issues.

    Elections are about choices. We rarely elect the best person in the country for President. We often elect the lesser of two evils. Campaigns can be brutal affairs where the character of the candidates are severely tested in full public view of the electorate. Obama won his first term primarily because McCain publically “blinked” when the economy collapsed. Obama won again because Romney couldn’t shed his rich guy skin.

    If the Republicans run somebody from the wing nut end of the spectrum (Cruz, Paul, Walker, etc.), Hillary will walk away with it by making a simple pivot to the center. If Jeb Bush runs, it will be after a brutal primary where he will have to demonstrate that he is conservative enough. Whether or not he can successfully pivot to the center after that will determine the outcome.

    My prediction is that NO candidate promising to repeal Obamacare will win. Also no candidate promising to send troops back into Iraq will win. I really doubt that Republicans will be able to nominate someone with those views. As a result, I seriously doubt that Republicans will do any better in 2016 than they did in 2012.

    So yes I am concerned about transparency and honesty in government. I am concerned about governmental over reach with the NSA and drones. I am concerned about a “revenge” culture that Clinton may bring with her. But I am WAY more concerned about repealing Obamacare, sending troops back into the Middle East, wrong-headed policies that empower a reckless Israel and result in Iran getting nukes, and continued denial of climate change.

  4. Jeff Beamsley says:

    I’ll post something more substantial on the racist topic later, but in response this little part of your rant, I don’t recall seeing anything in any credible media outlets that labeled the misguided Republican letter to Iran as racist.

    Please post a link to an article.

    I have seen a lot posted regarding the charge of treason, besides the general clumsy nature of the whole thing. All in all it was an embarrassing moment for Republicans. Some (McCain) have backtracked blaming the signing on a hasty read prompted by an imminent snow storm.

    If there is any narrative currently in play regarding Republican racism, I would suggest that Republican knee jerk reactions to events over the past year have helped re-enforce whatever “angry white man” stereotype that Republican Party already had.

    The demonstrations that we have seen around the country are not the result of narratives. They are the result of unarmed black men being shot and strangled by police. They are the result of racist chants by dimwitted frat boys (not just in Oklahoma). They are in response to states making it more difficult for minorities to vote. They are in response to racists statements by Donald Sterling and Cliven Bundy. They are in response to the daily indignities and disrespect that minorities still suffer in this country every day whether they are homeless or the President of the United States.

    I’ll respond to Ferguson in a different post, but the general suggestion that those who are taking to the streets to demonstrate are being motivated by a progressive political agenda is EVIDENCE of the problem, rather than the cause of the problem.

  5. Keith says:

    YS) If I unde your post correctly…,,,,,

    MR) you miss understood my post. (And my on going larger point) I am not referring to what I don’t like about The ACA. What I am pointing out is your criticism of republicans for lack of details on healthcare replacement. The same criticism that was lacking when dems were running on the platform of healthcare and further trying enacting it into law. Who can ever forget, not even the most left leaning liberal nancy Polosi says “I can’t wait to pass this bill so we can tell you what’s in it.” So Jeff, my good friend since you didn’t care for details of the dems, you have no credibility to ask it of the republicans.

    This is my largest point with you and your use of the words Cristians and spiritual. You choose it where you see it. In fact you ignor or refuse to acknowledge to see it on no side, but you see it in nuenced detail on the other. So why should you demand detail from Bush, Walker or anyone else on the repub side when you didn’t ask for it from the dems?

  6. Keith says:

    To follow up on your comments regarding ACA. The tax is not semantics. If they would have called it a tax it would more then likely would not have passed. That’s debatible. If Roberts did not call it a tax then he would have struck it down.

  7. Jeff Beamsley says:

    You have a very skewed version of Ferguson. Perhaps this is how FOX is portraying it, which is part of the problem. Wrapping yourself in the mantle of the disadvantaged group, however, is the height of conceit.

    What drove the people of Ferguson into the streets was decades of exploitation by the police, city government, and the judiciary. I already wrote about this in some detail, so I won’t repeat it here. This was confirmed in the DOJ report. The last straw was a white police officer killing an unarmed black kid. Whether the shooting was justified or not, in the context of what the population in Ferguson had already endured – corrupt cops, corrupt courts, and corrupt city management – they refused to take it anymore.

    The only political aspect of this was that conservative Republicans around the country rallied to support the police and liberal Democrats rallied to support the citizens. But you are correct that racism doesn’t know any political boundaries.

    In Ferguson this was a racial issue, not a party issue – a white minority oppressing a black poor majority.

    What it highlights is that racism is alive and well in this country. What it also highlights is the backlash that conservatives have to even the mention of the word. That’s because conservatives have depended on racial politics since the civil rights act to preserve their positions of power against a rising tide of minorities. Obama was the first national candidate to use those same racial politics against the party of “angry white men”, and they still sputtering in anger about it. The power that angry white men had over this country is rapidly eroding. They won’t give up without a fight, but as the remaining pockets of oppression are exposed and dissolved, a new democracy will emerge where people of color, women, and the LGBT community will wield real political power. Hopefully they will do a better job than the angry white men they are replacing.

  8. Jeff Beamsley says:

    Didn’t miss your point at all. Just don’t agree with it.

    The congress worked on the ACA for a year. During that period of time lots of different parts of the bill were discussed, but the one consistent touch point was CBO scoring. That, and political deal making, are what guided the creation of the bill.

    You have tried numerous times to claim that this bill was a mistake because those that voted for it didn’t understand every detail of what was in the bill. But you are wrong. The healthcare wonks who wrote the bill knew exactly what was in it and they did a good job (except for the language about exchanges). Obamacare is working and accomplishing all of the goals that it set out to accomplish.

    You are also suggesting that Republicans should get a pass now on their proposal making, because Congress (not just Democrats) took a year to pass a bill. That’s baloney.

    At any point since the 2010 when Republicans got a majority in the House, they could have started the same process that Congress went through in 2008-2009. They could have produced a comprehensive replacement for Obamacare that was more to their liking. They could have had it scored and all voters could have compared the advantages of the Republican plan with the features of the current bill.

    They never did.

    That failure to act is what I’m criticizing and I really don’t care whether or not you think it is fair.

    What I’m also criticizing are those Republicans who claim that they have a plan to replace Obamacare, but are clearly unable or unwilling to put it through the same review process that Congress applied to Obamacare.

    So NO what Congress did from 2008-2009 and any confusion that may have happened during that time, IS NOT what Republicans are doing today. The Republican proposals today are a sham, a fraud, insincere, and never intended to become legislation – but in the conservative echo chamber (where you appear to be most comfortable) they take all of the trappings of serious legislation because they come from a side of isle that you trust. Sorry, you are again being misled by a group that is and has been cynical from the start of healthcare reform about making any substantive change to the existing system.

  9. Jeff Beamsley says:

    Regarding tax. Please provide some credible source suggesting that if the penalty for failing to either purchase or provide insurance was called a tax, that it would not have passed Congress. At the end of the day it was a strict party line vote. No republicans voted for it anyway. You telling me that a Democrat would have objected to the word “tax” rather than “fine”? Wishful thinking at best (BTW Gruber doesn’t count as a credible source).

    I’ve already complemented Roberts on his clever use of Congresses taxing capability to affirm the constitutionality of the ACA. Again, unless you have some credible source that you can quote that suggests that this is the only way that Roberts could get a majority, you are again whistling in the wind. This was also a “party line” 5-4 decision in the court with Roberts being the swing vote. The much more likely scenario is that Roberts was just looking for a way to justify the vote that he had already decided to cast. Tax was the easiest way to do that. If that wasn’t available to him, he would have found another of the half dozen or so methods that were speculated at the time.

    This is really all just conservative sour grapes. Accept your losses and move on rather than trying to blame someone else. Conservatives certainly didn’t have any problems with what was probably the most politicized SCOTUS decision in history (Bush V. Gore), so please don’t nit pick something that actually had some basis in law.

  10. Keith says:

    From the guy who opposed Condi Rice. Another example of race baiting.
    Dick Durbin today on the floor of the senate accused repubs of putting mrs Lynch at the back of the bus. Please join me in calling him a race baiter.

    Above if you reread my comments I said “even good friends on Facebook are calling the 47 senators racist.

  11. Keith says:

    Until the day arrives where we are not judged by the color of our skin then we have not arrived. Currently your side still see color in everything.

  12. Jeff Beamsley says:

    There is all sorts of crazy stuff on facebook. I rarely even bother there anymore because of all of the trolling that goes on.

    The fact that you found some people there describing the 47 Republican senators who did something stupid and disrespectful as racist, only supports my claim that when it comes to political discussions, nothing intelligent happens on facebook. Sorry it doesn’t support your claim that liberals have unfairly labeled conservatives as racists.

    Second, there are also lots of unfortunate things said in the Senate. If Durbin indeed suggested that Republicans were holding up the nomination of Mrs. Lynch because she is black, he’s wrong. They are holding up the nomination of Mrs. Lynch because they are spiteful. It has nothing to do with her race.

  13. Jeff Beamsley says:

    Liberals care about people.

    Conservatives care about rules.

    That’s the way that we both are.

    Liberals care about the fact that minorities are mistreated. Many care about the FACT that many police departments treat people of color differently than white people. Many care about the FACT that poverty destroys families and harms children. Many care about the FACT that it is cheaper to give someone a home than it is to let them live on the street.

    Conservatives care about the crime rate in minority communities. Some also fear that some minorities may be getting assistance that they don’t deserve. Some certainly are concerned that ANY assistance creates a culture of dependence.

    The fact that you view this as one-sided IS part of the problem.

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