A description of GOP opposition to ACA that is coherent, from David Frum.

[Hamlette]

As much as I hate Republicans, I can't believe they just want poor people/minorities/women to die for lack of care. David Frum explains it in this rather long read and he proposes "conservative" fixes to ACA, most of which I can live with if it gets buy in.

"If Republicans are most offended by the way the ACA is paid for, then instead of repealing the whole ACA, they should concentrate their energy on changing its financing.

Two financing measures especially irk Republicans: the tax of 3.8 percent on net investment income and the surtax of 0.9 percent on earned income for individuals who earn more than $200,000. It is above all to end these taxes that Republican anti-ACA energy has been committed for more than seven years."

He then explained that the revenue stream is not big enough and the ACA "forces" healthy young people to subsidize people in their 50s and 60s. He also complains that while the ACA helps the working poor, it doesn't really help those who are making $40-$50 per year who can't afford insurance either. Then he explains, convincingly enough for me:

"The people who pay the surtaxes may not quite muster the clout to repeal the program. But they are more than sufficiently powerful to continue challenging it for a long time to come. The lesson of Daniel Ziblatt’s book on democracy resonates here: The price of stability is buy-in from opponents. So long as the ACA fuses the twin goals of health-care coverage and large-scale income redistribution, that buy-in will not be forthcoming.

The ACA needs a replacement funding stream that yields more revenue and that taxes more broadly."

He suggests an internet tax which will bring in much more than the taxes in the ACA. I believe the rich should be taxed more but maybe the ACA wasn't the right vehicle for that. If we can never live in peace because we paid for health care by taxing the rich, I could be convinced that a different funding stream might work. Who knows, we might even get some GOP votes which would go a long way to keeping the damned peace!

https://www.theatlantic.com/politics/archive/2017/06/how-republicans-can-fix-american-health-care/532251/

[maxsolomon]

1. there isn't an alternative to progressive taxation.

why tax the rich more?
1. they can afford it.
2. they took all the money and are hoarding it.

investment income doesn't get taxed at the same rate as income from wages. why? if anything, it should be the opposite.

the flat tax is a scam.

[Hamlette]

3. this isn't a flat tax, I don't support a flat tax, what about the "buy in" argument?

I think the "buy in" argument has some validity. I think his argument that tying health care to taxing the rich is what pissed the right off is worth looking at. We should separate the two thoughts and goals. Keep health care away from the battle over progressive taxes and at least not do a regressive tax. Taxing internet sales seems sane to me. I estimate what I buy online and pay taxes on them when I file but I would guess I am one of the very few. And trust me, the poor are not consuming from the internet as much as the rich are.

It is neither a flat tax nor a regressive tax.

[maxsolomon]

5. i should have said the flat tax is ALSO a scam.

Sen. Sanders proposed a financial transaction tax on stock trades to:
1. dampen computerized high-frequency trading programs.
2. pay for free college tuition.

it would be better put towards health care, but that's academic. it is a non-starter. the stock market believes it deserves special treatment, even when it's machinations crash the economy.

[Moostache]

2. Medicare for All solves these "funding issues" by broadening the pool to include everyone...

Single-Payer Health Insurance is the only solution that will stabilize the premiums and lower costs across the board (but definitely raises costs on the young and healthy that would prefer to skip the "paying into the system" phase of its intended use.

You pay in while young and healthy so that if can fund those who have already paid in and who are now older and in greater need.

This concept works very well as long as the politicians are kept away from the money that may accrue in excess of expenses (the 'surplus' that politicians immediately want to spend...like they did with the Social Security trust fund). The excesses are to be invested into the program's long term stability and only after it is secure should they EVER be used for anything else and NEVER for tax cuts.

The GOP fealty to the gospel of trickle down economics is pathetic if you bother to look at the actual results of the policies that support the idea. The rich do NOT reinvest more into the economy or businesses when their profits rise, they squirrel the money away or park it in large off-shore cash pools to avoid other taxes. If they were truly the benevolent creators of jobs and fair incomes, then the economy after 40+ years of largely trickle-down based economics would be in a much different place. Trickle down allows capitalism to more efficiently achieve its major aim - INCREASED PROFITS FOR FEW, DECREASED WEALTH FOR MANY. Capitalism is a wealth concentrating scheme of the highest order. Unchecked and unregulated, its power to make people vastly disparate in opportunity AND outcomes is unparalleled.

We need to start controlling the capitalist beast and put it in its proper, regulated and controlled cage or it will devour us all and enrich the very few that are already at the cusp of seizing everything for themselves as it stands today. Democratic republics are a fragile and vulnerable system of governance, we should all be very much more aware of THAT today that we were 6 months ago.

[Hamlette]

4. I agree single payer is best but I don't think that is attainable, maybe this is.

Let's put on the rose colored glasses and say we get buy in from at least some republicans if we change the tax structure to something like Frum suggests, internet sales tax. If we have some republicans, it will make it easier to move to single payer later.

Of course, if single payer is your goal and you think it is best served by killing ACA, you could be right. I don't want the pain that might bring.

If it is the tax structure they don't like, let's give the crybabies a lollipop so that we can get on with the business of running the country.

[Moostache]

6. I finished reading Frum's full article...

God help me, I find myself thinking "that sounds like a rational person and a place to actually START negotiating.

There is hope if men like Frum can reclaim the GOP from the crazies and bomb throwers that have been running the circus since Gingrich first sharted onto the stage...

I agree that single payer in one move remains very unlikely. It is going to take adoption at the state level to work out a system that can be converted to a national one, similar to the path taken in Canada not too long ago...but if there are enough Republicans that are willing to start discussing OPTIONS and ALTERNATIVES to the current structure that don't kick millions to the curb and don't give back horrible controls to the insurance companies (like losing preventative care or pre-existing condition protections and outlawing life-time limits), then the discussion can and should be held....candidly and in open session with vigorous debate.

[Hamlette]

7. Agree. It's a start.

My father was a republican, Reagan turned my Dad into a Democrat and he became very liberal. That's probably why I listen to/read former republicans who are pulling away. Frum was on Lawrence last night and referenced an article he'd written on "conservative" fixes to the ACA. Trust me, I didn't expect to agree with him, at least as a way forward.