The US Senate has rejected a Republican plan to replace President Barack Obama's signature healthcare policy.
The 57-43 vote defeat marks the start of a days-long debate on a sweeping overhaul that critics fear could deny healthcare to millions of Americans.
The Better Care Reconciliation Act (BRCA) was crafted over two months but attention now turns to other options.
President Donald Trump has urged senators to pass a bill, without indicating which one he supports.
A repeal-only bill, which would consign so-called Obamacare to history in two years, to give time to Republicans to devise a replacement, could be debated and voted on next.
But that measure - which non-partisan analysts say will take health insurance from more than 30 million people - has already failed to win enough support in the Republican party.
Other attempts to replace Obamacare have collapsed in recent weeks due to divisions in the party.
President Trump had made scrapping the policy a key campaign pledge. He says the system is "torturing" Americans.
He secured a victory on Tuesday when the Senate agreed to allow the debate on health care legislation reform to go forward, but only after Republican Vice-President Mike Pence cast the tie-breaking vote in support of the bill.
Senator John McCain, who was recently diagnosed with an aggressive brain tumour, received a standing ovation as he returned to Congress to cast his "Yes" vote.
President Trump tweeted his thanks to the Arizona senator for playing "such a vital role" in the vote.
But in an early morning tweet on Wednesday, Mr Trump lambasted Senator Lisa Murkowski of Alaska for opposing the Republican plan.
What bills could come forward?
The key repeal-and-replace bill, the BCRA, has fallen by the wayside.
Next could be a repeal-only bill with a two-year delay, in the hope of finding agreement before that time elapses.
But senators will also consider a "skinny bill", a far narrower measure that would scale back some of the more controversial elements in an effort to get a wider consensus.
A special Senate-House of Representatives committee would then be tasked with finalising a bill that could still see changes during negotiations.
If successful, the full House and Senate would again have to approve the measure.
US Health and Human Services Secretary Tom Price told CNBC on Wednesday that Senate Republicans should aim for the "lowest common denominator" to secure the 50 votes need to pass a bill.
What have Republicans proposed?
Republicans have long railed against Obamacare as government overreach, criticising the system for introducing government-run marketplaces, where premiums have risen sharply for some people.
The party's proposed alternative includes steep cuts to Medicaid, a healthcare programme for the poor and disabled. REUTERS Mitch McConnell said senators had "a duty to act"
And it removes Obamacare's individual mandate requiring all Americans to have health insurance or pay a tax penalty.
About 20 million people gained health insurance under former President Obama's Affordable Care Act.
The non-partisan Congressional Budgetary Office (CBO) found the bill would strip 22 million Americans of health insurance over the next decade.
If Republican senators elect to repeal key provisions of the law without immediately replacing it, the CBO estimates about 32 million consumers would lose insurance over the next 10 years.
Poster Comment:
The Democrat Republican Party's love for Senator McCain knows no bounds, but the Trump GOP's latest effort to expand and enhance Obamacare has failed.
#2:Hondo68
To: Pinguinite, Medicaid, Medicare, Part D druged voters(#1)
Does "stripping" 22 million of health insurance mean they would no longer be forced to buy it?
Sort of, but we still have to pay taxes to provide healthcare for everyone.
Someone's got to pay for government mandated socialized medical care, and it's us. They need to go back a lot further than Obamacare and get rid of government meddling which drives the costs up, stifles innovation, and ultimately yields expensive lousy service.
"No man's life, liberty or property are safe while the Legislature is in session." ~Gideon J. Tucker
If everyone was honest about it, they might as well admit that the best way to get everyone insured is to simply nationalize health care system and make it free for everyone by just sending all bills to the Fed gov.
That would at least put all the health insurance companies out of business which would be a good thing, at least. They wouldn't be taking a cut of health industry payments.
"Does "stripping" 22 million of health insurance mean they would no longer be forced to buy it?"
Correct. This is also known as "losing" health insurance.
Now, compare this to the 20 million who "gained" health insurance under Obama's expanded Medicaid program, despite the fact that they can't find a doctor within 200 miles who will accept Medicaid patients.
But the CBO says they're covered ... which they are ... so therefore they are.
Well, excluding those who pay taxes. It's not free for them. They have to pay for their own healthcare and everyone elses. So it's definitely not free for them.
Of course. The French health care system is the best in the world, bar none. It has American- level and American-quality medicine, without HMOs and screening and waits, at only about 2.3rds of the price.
At that price, it's STILL very expensive: you have to pay for quality and modern research and technology. But that 1/3 additional cost in the US is the cost of "the 'bezzle". THat's where the profit taking from an trapped audience by insurance companies and doctors occurs, it's where the cost of malpractice and and large billing departments is absorbed. Those pieces can be taken out of American health care, streamlining it and leaving it a matter for patient and doctor. It'll STILL be expensive, and with everybody in the system it will be more expensive than what we have now. But everybody will be covered, and it will be about 1/3rd less cost than what we have now.
So that's the way to go.
Of course, to get there the Republicans will have to completely betray what they ran on, and the Democrats would have to betray the trial lawyers. So we'll end up instead with Canadian or British style health care, that will be very expensive and still have lines and lack of choice and death panels. Americans will not choose the best model. They'll choose what they perceive to be the model that makes them most able to control who gets the benefits so that nobody but the politically well-placed "takes advantage" of the system.
We do the same thing in welfare. In order to ensure nobody "cheats", we have a MASSIVE welfare distribution bureaucracy that devours 75 cents on the welfare dollar...and people cheat anyway.
That's how AMERICA will do national health care. Unintelligently, with maximum employment for government officials and payer agents and monitors, at maximum expense. We won't reform the tort law, and we will still have a strongly two tier system, one for the well-to-do who can pay to avoid it, and the other for everybody else.
Our government does everything badly. We skew towards the byzantine, the corrupt, and the abusive. It's the way we are as a people.
I have done a little reading on the French system, since you mentioned it to me. I am not done yet (been busy). Preliminarily, it looks like it has melded elements of government insurance with private incentives. It's development is still recent and has been going through some changes.
Essentially the French system is this: take American Medicare (you choose your own doctor, no HMO), everybody over 65 is on it, you buy gap insurance to cover the 20% co-pay).
Now make it cover everybody under 65 also. This eliminates all private insurance (or need for it) except for GAP insurance.
Now eliminate the role of insurance companies in paying the doctors. YOU pay for all your care. You get a receipt and send it to the government. They reimburse 80% of it. You send the rest to your Medigap insurer and they pay the rest back to you. Doctors offices in France do not have large billing staffs, and don't have to hike the cost of medicine to pay for the staff to get themselves paid.
Now take the medical schools and make them all free - no student debt, but you get in by competitive national examination, with number 1 getting his first choice, number 2 his choice, etc. Once you run out of spots, that's it. Doctors in France do not have student debt.
Now take the court system, strip out the jury system for torts, and have courts of experts assign specific, regular values to various forms of injury, standardizing what can be expected from medical malpractice and making the insurance about 75% cheaper. Doctors in France do not need to earn as much money, because they don't have massive malpractice insurance bills.
Now hike the Social Security tax to cover two things: (1) Universal retirement (no 401(k) or IRA) - everybody gets a pension from the Social Security program. (2) Disability insurance for people who cannot work, and (3) Universal health insurance, as described above.
The French Social Security tax is about 25% of all wages.
Have you read Rand Paul's plan? There is a link to the full plan (PDF) at that summary link.
He has been experiencing some success in his efforts. He deserves vocal support, IMO.
I don't understand the Medicaid portion.
The most important feature of any health care system is that it has to cover everybody, including those who cannot afford to pay for health care. That's what Medicaid does.
I don't think that it is possible to economically cover the whole population while leaving large profit margins for private insurance companies in the space. The only way to do it is single payer.
I think that ideologically many Americans cannot bear the thought of that, so the Republicans will be unable to do anything effective with health care. They cannot politically vote to nationalize health insurance.
I think that because of the health care fiasco, they will be turned out of office and the Democrats will come in and impose single payer, which Trump will sign. It's a pity that the Republicans have to lose the rest of their agenda to avoid single payer, but they do, and they won't avoid it in the end anyway.
#1: Pinguinite To: hondo68 (#0)
Does "stripping" 22 million of health insurance mean they would no longer be forced to buy it?
Pinguinite posted on 2017-07-26 17:35:04 Reply Private Reply
#2: Hondo68 To: Pinguinite, Medicaid, Medicare, Part D druged voters (#1)
Sort of, but we still have to pay taxes to provide healthcare for everyone.
Someone's got to pay for government mandated socialized medical care, and it's us. They need to go back a lot further than Obamacare and get rid of government meddling which drives the costs up, stifles innovation, and ultimately yields expensive lousy service.
"No man's life, liberty or property are safe while the Legislature is in session." ~Gideon J. Tucker
Hondo68 posted on 2017-07-26 18:45:22 Reply Private Reply
#3: Pinguinite To: hondo68 (#2)
That would at least put all the health insurance companies out of business which would be a good thing, at least. They wouldn't be taking a cut of health industry payments.
Pinguinite posted on 2017-07-26 19:15:04 Reply Private Reply
#4: misterwhite To: Pinguinite (#1)
Correct. This is also known as "losing" health insurance.
Now, compare this to the 20 million who "gained" health insurance under Obama's expanded Medicaid program, despite the fact that they can't find a doctor within 200 miles who will accept Medicaid patients.
But the CBO says they're covered ... which they are ... so therefore they are.
misterwhite posted on 2017-07-26 20:25:51 Reply Private Reply
#5: misterwhite To: Pinguinite (#3)
Well, excluding those who pay taxes. It's not free for them. They have to pay for their own healthcare and everyone elses. So it's definitely not free for them.
misterwhite posted on 2017-07-26 20:33:42 Reply Private Reply
#6: Vicomte13 To: Pinguinite (#3)
At that price, it's STILL very expensive: you have to pay for quality and modern research and technology. But that 1/3 additional cost in the US is the cost of "the 'bezzle". THat's where the profit taking from an trapped audience by insurance companies and doctors occurs, it's where the cost of malpractice and and large billing departments is absorbed. Those pieces can be taken out of American health care, streamlining it and leaving it a matter for patient and doctor. It'll STILL be expensive, and with everybody in the system it will be more expensive than what we have now. But everybody will be covered, and it will be about 1/3rd less cost than what we have now.
So that's the way to go.
Of course, to get there the Republicans will have to completely betray what they ran on, and the Democrats would have to betray the trial lawyers. So we'll end up instead with Canadian or British style health care, that will be very expensive and still have lines and lack of choice and death panels. Americans will not choose the best model. They'll choose what they perceive to be the model that makes them most able to control who gets the benefits so that nobody but the politically well-placed "takes advantage" of the system.
We do the same thing in welfare. In order to ensure nobody "cheats", we have a MASSIVE welfare distribution bureaucracy that devours 75 cents on the welfare dollar...and people cheat anyway.
That's how AMERICA will do national health care. Unintelligently, with maximum employment for government officials and payer agents and monitors, at maximum expense. We won't reform the tort law, and we will still have a strongly two tier system, one for the well-to-do who can pay to avoid it, and the other for everybody else.
Our government does everything badly. We skew towards the byzantine, the corrupt, and the abusive. It's the way we are as a people.
Vicomte13 posted on 2017-07-27 06:48:58 Reply Private Reply
#7: Deckard To: hondo68 (#0)
Lindsey Graham: "John McCain is the kindest, bravest, warmest, most wonderful human being I've ever known in my life."
Deckard posted on 2017-07-27 08:51:55 Reply Private Reply
#8: Anthem To: Vicomte13 (#6)
Anthem posted on 2017-07-27 10:03:37 Reply Private Reply
#9: Anthem To: Vicomte13 (#6)
He has been experiencing some success in his efforts. He deserves vocal support, IMO.
Anthem posted on 2017-07-27 10:09:19 Reply Private Reply
#10: Vicomte13 To: Anthem (#8)
Now make it cover everybody under 65 also. This eliminates all private insurance (or need for it) except for GAP insurance.
Now eliminate the role of insurance companies in paying the doctors. YOU pay for all your care. You get a receipt and send it to the government. They reimburse 80% of it. You send the rest to your Medigap insurer and they pay the rest back to you. Doctors offices in France do not have large billing staffs, and don't have to hike the cost of medicine to pay for the staff to get themselves paid.
Now take the medical schools and make them all free - no student debt, but you get in by competitive national examination, with number 1 getting his first choice, number 2 his choice, etc. Once you run out of spots, that's it. Doctors in France do not have student debt.
Now take the court system, strip out the jury system for torts, and have courts of experts assign specific, regular values to various forms of injury, standardizing what can be expected from medical malpractice and making the insurance about 75% cheaper. Doctors in France do not need to earn as much money, because they don't have massive malpractice insurance bills.
Now hike the Social Security tax to cover two things: (1) Universal retirement (no 401(k) or IRA) - everybody gets a pension from the Social Security program. (2) Disability insurance for people who cannot work, and (3) Universal health insurance, as described above.
The French Social Security tax is about 25% of all wages.
Vicomte13 posted on 2017-07-27 14:15:10 Reply Private Reply
#11: Vicomte13 To: Anthem (#9)
I don't understand the Medicaid portion.
The most important feature of any health care system is that it has to cover everybody, including those who cannot afford to pay for health care. That's what Medicaid does.
I don't think that it is possible to economically cover the whole population while leaving large profit margins for private insurance companies in the space. The only way to do it is single payer.
I think that ideologically many Americans cannot bear the thought of that, so the Republicans will be unable to do anything effective with health care. They cannot politically vote to nationalize health insurance.
I think that because of the health care fiasco, they will be turned out of office and the Democrats will come in and impose single payer, which Trump will sign. It's a pity that the Republicans have to lose the rest of their agenda to avoid single payer, but they do, and they won't avoid it in the end anyway.
Vicomte13 posted on 2017-07-27 14:23:02 Reply Private Reply