(03-28-2017 11:15 AM)OldOwlNewHeel2 Wrote: As to the whole "Well, this was just a liberal turd shoved down republicans' throats with no compromises" thing, I can think of a few counterpoints off the top of my head. First, nobody can reasonably deny that the ACA was based, in large part, off the Heritage foundation model from the early 1990s that had substantial republican support.
The differences between the two are pretty vast to make that stretch. The only thing that was even near common was a requirement to carry insurance.
When you look beyond the 100,000 foot level the differences are stark.
1) As 69 said above, the Heritage was couched in terms of the credit pushing sales of insurance as opposed to the tax penalty of the ACA ;
2) The Heritage plan was focused on ensuring at least catastrophic care as opposed to the very different plans that ACA mandates which essentially transform the concept of insurance into one pushed far more in the corner of pre-paid health services;
3) Heritage plan assumed and wanted to keep minimal regulation of insurers, and the plan envisioned the continued existence of almost all health plans -- even today's mandated 'you pay for everything under the sun' types -- in conjunction with a mandated minimal level of what could be described as 'catastrophic + small portions of other services' plans. ACA pushes heavy regulation of insurers at the Federal level coupled with very strict enforceable Federal consumer rights, and further it simply kills catastrophic plans and most other plans that don't sit neatly in the Gold, Silver, and Platinum definitions.
4) The Heritage plan was facially neutral for employers' roles in healthcare, albeit that the tax changes were proposed to eliminate empoyer-provided insurance and move the purchase to the family. ACA. In distinction, not only preserved the employers' role, but heavily handed essentially landed the brunt of the cost directly on the employers through the employer mandate. Essentially not only did they stop the elimination of the employer in the role, but they put the employer firmly in the crosshairs of an implied tax through the mandate.
5) Heritage proposed gutting Medicaid. ACA resulted in an historic expansion of Medicaid.
6) Heritage proposed removing Medicare and replacing it with a voucher system. ACA kept Medicare as an integral part of the plan.
There are other points, some discussed by Owl69, but this should be sufficient. To belabor it anymore would be a Sysiphean task that I will leave it to you to complete. The plans are radically dissimilar and to argue that the ACA is based on the Heritage plan is nonsensical.
Quote:The democrats could have just pushed for single-payer, but decided to start with something that, at least at some point, was grounded in conservative thought.
False premise in the last clause as shown by the above comparison and Owl69.
Quote:How is this not a compromise from the inception?
Because of the incorrect description of the ACA as "grounded in conservative thought." The only thing in common was a mandate, and even so the mechanism of the Heritage plan had grounding in supply side economics, as opposed to the more statist mechanism that the ACA employs. At best, both have mandates. The other salient points, including the mechanisms relating to the mandates are fundamentally different. Again, a bad description of the the Heritage plan does not make your statement correct.
Quote: Second, the bill that passed was not the bill that was introduced. For instance, the public option was removed from the version of the bill passed by the Senate - obviously a nod to moderate republicans (and Joe Lieberman). How was this not a compromise?
For instance, the public option was proffered for reinclusion by Schumer in committee, where it failed. This is no more of a sign of a "nod to moderate Republicans" than "they couldn't even get their own side on board in committee."