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Frank Free's avatar

Congressmen from solidly red states or districts are counting on their constituents being too damned stupid to punish them at the ballot box. Unfortunately, they have an abundance of historical precedents to support that view.

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PipandJoe's avatar

I think they were not so confident and they put a 1 year delay in the start of these cuts to get them though the midterms.

If you have to worry that what you are passing is so bad that you need to delay it to get elected.....well wouldn't it be better to just vote no?

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Judy Steiner's avatar

They believe the marketing spin from the administration and congress. They like to told what to think instead of how to think.

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Mark Huber, Redmond OR's avatar

Oligrarchy with a heavy flavor of Autocracy? Let's just call it what it is: Fascism.

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Stephen Penquite's avatar

"Trump is not Reagan 2.0"? Trump is likely Hitler 2.00.

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Winston Smith London Oceania's avatar

He's the worst of both worlds.

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Jared's avatar

The thing about Abundance that I find so frustrating is this. Their entire idea is basically just two things: (i) the government should not do things the government is not good at and (ii) the government should only pass rules/laws/etc that create a net benefit. This is trivial. No serious person disagrees.

Yet they take these pretty much self-evident positions and layer it with rhetorical nonsense. Derek and Ezra are pretty much the perfect manifestations of Will McAvoy’s “if liberals are so smart, why do they lose so god damn always” bit.

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Conor's avatar

I have no idea where you got those two points from because they’re don’t bear any resemblance to the book. You make it sound like the book is arguing for the government to do less when the whole idea is to expand state capacity so it can accomplish *more*.

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Pam Birkenfeld's avatar

I have had encounters like this in Substack comments, argumentative, non-responsive and slightly insulting. I think they are AI. They seem to stop when I accuse of being bots.

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Diana Chapman's avatar

I agree

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Pam Birkenfeld's avatar

And I am referring to Jared.

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Jared's avatar

Just a quick preliminary item. Do you know how a contrapositive works?

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Conor's avatar

Just make your point please

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Jared's avatar

I did. My question makes the point. Now are you going to answer the question?

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Conor's avatar

Your question does not make your point because what you said is not the contrapositive of what I said, as you seem to be implying. Either spell out exactly what you mean or just stop commenting.

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Charley Ice's avatar

I hope it will dawn on people sooner than later that this fascist Trumpian administration is consciously embarking on a new holocaust, to eliminate all the non-whites on the planet. Why are we dancing around this? I realize that people need to be shocked into recognition, because this is such a wild outlier -- a dedicated cabal of devil-worshipers. I mean really: Stephen Miller? Peter Thiel? Barbies Leavitt and Noem?

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Winston Smith London Oceania's avatar

I don't think he has his sights on the whole planet, just the United States - which is bad enough.

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Diana Chapman's avatar

Yes and they want to get rid of disabled elderly autistic and so on .,.

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Badgerblue's avatar

One of the things I wonder about is how the healthcare industry will change with fewer people covered by insurance. For example, prescriptions used to be affordable for the most part. That changed when insurance started covering them, and big pharma saw dollar signs. If healthcare isn't covered by insurance, will it become more affordable? Will the cost of pharmaceuticals come down if no one buys them? The healthcare industry (which I worked in for 30 years) is not innocent. Don't mistake me, I think these cuts are immoral, and stupid. It won't help anyone if more hospitals close and fewer beds are available. But our healthcare system has alot of room to improve, both is process and care.

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Mickie Morganfield's avatar

Physician services in the US only make up a fraction of total healthcare spending, with estimates ranging anywhere from 8% to 14%. Around 34% of our total healthcare cost in the US is made up of administrative and billing expenses incurred by all providers of service. Canada's administrative cost is 17%.

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Pam Birkenfeld's avatar

My doctor husband had to hire extra admin people just to handle preauthorizations for surgery.

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Patricia Lothrop's avatar

And preauthorizations may

be coming to [original] Medicare . . .

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Pam Birkenfeld's avatar

Oh great😡

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Jeffrey L Kaufman's avatar

More use of the ER for chronic problems, and that will lead to more hospitalization. I state this based on my detailed experience as a physician. In turn, this will lead to ore physician burnout, greater difficulty with chronic downstream care in skilled facilities and rehab units. Why? Because ER's cannot decline to see people who show up (under EMTALA), but office practices, especially private practices, can decline to see uninsured people. Adding to the chaos will be more loss of time at work, because people will not have the means to obtain elective care. We will quickly return to the patterns of care commonly found in the '70's, and I expect the average age at death to decrease quickly. If we have another pandemic (and this is guaranteed, but we don't know when), our healthcare system is already insufficient to that task, and it will lose resilience quickly under this administration, as the leadership at HHS seemingly has no interest in any such preparation. Congressional leadership has abdicated any role in thinking about such preparedness.

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antoinette.uiterdijk's avatar

So health insurance for all - incl. illegal immigrants - would be the solution?

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Jeffrey L Kaufman's avatar

That is functionally exactly what is happening now. Historically, uninsured people, irrespective of immigration status, who showed up in an ER received care, and if they needed a specialist, that doctor on call for emergencies would be called and would render service, even if never paid. There are huge problems with such a system, which is why MA moved to Romneycare, which was the basis for the PPACA, commonly known as Obamacare. Uninsured patients are bad for every aspect of the healthcare system.

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antoinette.uiterdijk's avatar

Obamacare did not help illegal immigrants, nor was it available to people earning less than $ 16,000/year. Because of co-pays/deductible ACA was too expensive for some low-earners. Some states did not expend Medicaid to single people and two-people households. Obamacare was a big step forward, but then it all stopped and did not move forward any further.

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LeonTrotsky's avatar

False. ACA was set-up to help all who could not afford health care and it was overwhelmingly successful, as long as you were a US citizen. The reason some states did not enact all provisions of ACA was simple: your Republican elected officials rejected ACA.

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antoinette.uiterdijk's avatar

The ACA subsidized policy is usually not written for a person earning less than $ 16,000 (Fed. Poverty Level). The reason: he/she is not eligible for the tax credits. They are supposed to get Medicaid. But not all states expanded their program. Some states that extended also included illegal immigrants either completely or to some degree.

One does not need to be a US citizen to be eligible for an ACA policy - legal presence is enough (the five years requirement is not applied here). As I said, Obamacare was a big step forward. But not all who need it are "affordably" covered yet.

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Gato Feliz's avatar

The ACA doesn't cover Medicaid patients because they're covered by Medicaid. They're both covered for medical care, so you're making a distinction with no difference.

Likewise, if you are unfortunate to live in a state whose government wants to see you sicken and eventually, die before your time, then you REALLY need to think about pushing to get those (Conservative) leaders out of office. Eject these monsters, turn your state purple (or, even, Blue!)

But don't run around blaming Obamacare. It's not IT'S fault that some states repeatedly elect homicidal leaders to run their state.

FWIW, some states cover undocumented residents. It makes sense since they're part of our communities (think of communicable diseases and other social concerns), part of our economies (sick people can't build your homes, farm your food, care for your elderlies, etc.), and part of us (many mixed families exist: don't these families w/ citizens also "deserve" to live longer and healthier?).

Regards uninsured people not having their chronic diseases treated in emergency rooms, poppycock. Of course they will. They have to. You're simply wrong about this.

However, HOW they're treated differs: instead of getting cheap insulin shots, they get none until they need to have their feet amputated, or go blind, or other horrific, unnecessary outcomes. For a *lot* more money for these invasive, expensive procedures.

I.E., the uninsured WILL treated, but only in the most stupid, expensive and morally reprehensible fashion. Because Conservatives HATE everyone, including and especially, those that vote for them.

If you live in these states run by these monsters, you need to work at changing things. They're not disguising their contempt, and loathing, for their fellow citizens. Stop rewarding them for this. Convince your neighbors to stop rewarding these monsters for their monstrous behavior.

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antoinette.uiterdijk's avatar

People earning less than 16,000 are not covered for health insurance if they live in a state that did not extend the Medicaid program - to single people and couples without children. The can still buy an ACA policy, but at full price.

Currently a few states cover illegal immigrants for health insurance, some completely, some to a certain degree. The states that completely cover will probably curtail these programs as they are more expensive than expected.

Basically, I have no idea what you are ranting about. And I have a suspicion you do not know either. Also if you want rant, do it in your own thread please. All I did was add some information.

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antoinette.uiterdijk's avatar

But even if uninsured people can go to an ER in case of emergency, that does not help him/her when the issue at hand leads to a chronic medical problem or aggravates an existing problem. When your life is saved, you do not immediately become healthy. (Been there, done that.)

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Jeffrey L Kaufman's avatar

Precisely the point, if you look at the issues from purely an up-front expenditure (Wall Street Journal, historically red-state) point of view, a social Darwinian point of view. It is cruel, frustrating for the patient, and it leads to total burnout of the providers of care -- all of them, nurses, social workers, doctors, all. It is the lowest of a multiple-tier healthcare system, the way things were in the '60's and '70's. Based on my N=1 experience in the move into Romney care, with nearly 98% of people having at least minimal insurance, is that care was easier, less disjoint, and certainly more dignified for the patient and their family members.

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antoinette.uiterdijk's avatar

I think so too.

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Winston Smith London Oceania's avatar

Prices will have to come down when large numbers of people start croaking from lack of healthcare. And that's just the beginning of it.

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RandomHuman's avatar

Why can't we get rid of this guy? How broken is our system or what? Our Congress are cowards. Or are they being paid off (yes) or are they being threatened by a mobster? (yes). So what do we do?

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LeonTrotsky's avatar

Any Republican who challenges tRump will be primaried by the villain.

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Ann Marie's avatar

Thanks for the tip on avoiding ai when I use google!

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Thomas Patrick McGrane's avatar

Trump and his TV Nutworks instigations may result in political violence as he intends to effect a military takeover of which the federal courts were "feverishly packed" for in his first administration. The strategy is to spark violence to appear justified for a military takeover so that our allies could not justify coming to our aid to their own people. It is a mission creep military Coup. Did the soldiers in the June 14th military parade carry ammunition?

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Winston Smith London Oceania's avatar

I don't know if they carried ammo, but I do know that they deliberately >walked< not marched, at that parade. They were very casual. I saw an animated gif of it side by side with soldiers training to march. The ones training were crisp and marched in perfect lockstep. The ones at the parade were just strolling casually, totally out of lockstep. It was actually really funny to see the two side by side.

The point being that if The Orange Scourge orders them to shoot civilians - he will very likely be in for a rude surprise.

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Richard Bielak's avatar

Heather Cox Richardson compares the state of the country today, to what it was in 1850s. Then Southern Democrats had Congress and the White House and they pushed through some terrible laws - mainly to allow slavery to spread. And within less that 10 years, they were out of power and slavery was abolished. You can hear explain this on this podcast: https://www.youtube.com/watch?v=UHK7YTsLt2A

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Linda cheramie's avatar

Trump will declare Marshal law when Americans revolt. No more election!

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Janet Littell's avatar

We libs are all going to end up in prison when the new ICE system is in place. The only possibly mitigating factor is how long it takes to put the system in place?

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Winston Smith London Oceania's avatar

Not if we Rise! Resist! ✊✊✊

The next nationwide rally is The Fourth of July, Independence Day! Be there or be square!

We need 3.5% of the population, or around 12,000,000 people to be present. So bring all your friends and families. Spread the word as far and wide as possible. Let's all get out there with a Howard Beale spirit and yell "We're as mad as hell, and we're not gonna take it anymore!".

https://substack.com/home/post/p-166495524

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Jeff Luth's avatar

Mitch McConnell told Republicans to pass the bill. Their constituents will get used to it.

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USAF Ret.'s avatar

Yeah, McConnell is thinking that when their constituents back home are faced with the next bogeyman/woman on the ballot with a D by their name, they will still pick the R candidate no matter how badly they've been hurt before. McConnell has been observing that behavior for a long time.

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Louise Montgomery's avatar

It looks like djt’s personal vendettas against Obama and Bush.

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Fred Paprin's avatar

Derek, talk to folks who live in Atlanta Ga!! No one gives two shits about Rural Ga and for dirt poor in in ATL!! We never expanded Medicaid under ACA!! And no one in ATL and metro seems to be much bothered!! We don’t care about those folks cause they are out of view out of sight!!😢

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Andrew Goldstein's avatar

When ATL folks embrace the fact that when millions more Americans including women of childbearing age, the elderly, etc. succumb to the lack of access to healthcare, the more affluent city dwellers will start feeling the effects on their own health care as hospitals and other services shut down. This will further burden healthcare providers in places like ATL. Ignorance will stop being bliss.

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Fred Paprin's avatar

Agreed Andrew but it’s just my observation at 64 that most folks not involved in hospital work have had little to no experience with hospitals other than the occasional er visit for relatively minor problems …….so it will take 3-5 years from now for folks to wake up and start asking questions!! Much much pain and suffering will first have to occur!! I’m a “Damn Yankee”—-we’re the ones that move south and don’t immediately turn tail and head back north!! Over past 20 years I’ve experienced watching over 1 million folks mostly young move to the 20 county metro area!! In fact most have moved here after 2015 when the economy finally picked up from the crash in 2008 !! And in that time I’ve watched not just Trump MAGA but the very popular Gov Kemp whose enacted a series of very cruel policies with the most banal of public persona’s !! He reminds me of Hannah Arendt’s “the banality of evil” 😈……most folks contemplate 🤔 their own navel and live in their own info/news bubbles…..and at least 40% of ga are in the Fox Fake News propaganda space!!!

I think I’m one of few that notices things like crowding of hospitals 🏥….ive been going to Emory Midtown (Atlanta) for the past 10 years for initially Sinus surgery and then a couple of times to have my hearing checked….i used to like going there…..but ever since they allowed 127 year old Atlanta Medical Center to go out of business because Kemp refused to allow the expansion of Medicaid under ACA/Obamacare the other hospitals in area are now being forced to pick the massive overflow of the very poorest patients and Grady Hospital is. Now the only Level 1 Trauma center in the area!! Hoping I never get shot!! 😱😮 my neighbors are totally clueless and seemingly all is for the best in the best of all possible worlds as Voltaire’s Dr Pangloss said in “Candide” 😢

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Andrew Goldstein's avatar

Thank you Fred for your thoughtful reply. I just finished watching the excellent PBS documentary, "Hannah Arendt: Facing Tyranny." It is remarkably prophetic. The comparisons she drew between the rise of Hitler, the McCarthy era and the Watergate scandal are striking. If she were alive today, I suspect Arendt would be aghast but sadly, not shocked by what is happening to our country as Trump corrupts our democracy and the rule of law, given her observations about "the banality of evil.".

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Fred Paprin's avatar

Have not heard of the PBS documentary on Hannah Arendt!! Will check it out!! Appreciate your informative reply!! Fred

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June Taylor's avatar

I wish intelligent people would stop expressing astonishment at the Medicaid cuts because they affect red states. The rich get their tax cuts NOW. The Medicaid cuts don’t bite for several years…at which point, especially if the Dems manage to take control of the House in 2026, Republicans will blame the Dems for everything - as they always do, with remarkable success, because the Democratic Party is so incompetent in formulating a vision for America that’s as appealing as MAGA & in communicating it to citizens.

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