Republicans seem to be doing everything they can to turn the US into a third world country where billionaires will thrive and everyone else will eat dirt. It’s on all of us to do something. At a minimum, show up for the 10/18 NO KINGS protests and be a voice for something better.
Yeah, the bottom line is that Republicans are *perfectly happy* turning the entire United States into Venezuela's right-wing twin, with horrific levels of poverty, corruption, and isolation maintained at the point of a gun by the ruling class, so long as they get to be the ruling class. And most of their voters will ultimately be okay with all of that too because of a combination of "it's all these Other People's fault" and "it'll hurt these Other People more."
Not Venezuela, the model is Chile under Pinochet . They hate Latin American immigrants, but they would just love to have one of those old style Latin American governments.
So did millions of others of us. Trevor is brilliant, yes, but I was one of those millions who said, "The Republicans can't seriously let this guy in" and then Mitch McConnell.
yep, who remembers his so-called 'conviction'of the jan.6th attack on the Capital and then with some unexplanable logic and irrational nonsense just sets this guy free. One of the most hypocrite and cowardly dogs of them all..
I keep wondering if a “separated at birth” social media campaign comparing Trump and Robert Mugabe side by side might give MAGAs some pause. Showing Trump side by side with Mugabe might shock their sensibilities enough to get the white “Christian” nationalists to stop for a moment.
Given that they routinely brush off fascism comparisons when regime members routinely paraphrase famous fascists, I think that they are safely in their epistemic bubble, inoculated from any suggestion that they might be the bad guys.
All those comparisons are with white dictators. A separated at birth campaign with an African dictator might briefly pause their mental rut, forcing them to think for a moment. At the very least their racism could cause them to come up with excuses for why Trump isn’t like a Black dictator. Comparisons to white dictators don’t cause any disruptions to their thought processes at all.
I know who he was. A longtime colleague was born in Southern Rhodesia to a family of small shopkeepers, some of whom still live there. So I heard a lot about their experiences trying to keep afloat during the worst of Zimbabwe’s inflation, including selling at a loss due to Mugabe’s directive to keep retail customer prices stable. That’s why I chose Mugabe as the comparator after Trump started strong arming businesses to eat the tariffs.
It probably wouldn't help. For starters, MAGA doesn't know Robert Mugabe from a hole in the wall. And even if they did, they wouldn't see the comparison anyway because Fox News, X, and Newsmax wouldn't show it.
Because Dems need to create serious buzz with No Kings to overcome FOX News counterprogramming. Which will be explaining the Dem decision as anything but trying to keep healthcare affordable for the 90%. As Paul says, they'll blame exploding premiums on Soros, or Antifa, or 'because they hate or freedoms', or any other manner of nonsense--to distract from their gutting ACA funding. Dems must stay on message about this, or the RW media lie machine will carry the day.
Unfortunately, the right wing media lie machine is the only source of information the right wing ever listens to. There is no breaking through that bubble. WWIII could break out and the wingnuts wouldn't have the vaguest clue if Fox et. al. decided not to cover it.
I had an example of this thought the last time I visited my doctor. As I went to sit down in the lobby, I sat close to a cute, white-haired lady and spoke to her. She said "and how are you today?" I told her I'd be better if Trump was dead, and she said "Oh, no, he's here to save us!" Then I asked her how she's going to feel if relatives or friends of hers are removed from Medicaid. She said "Well, I'm on Medicaid but that's fake news, anyway". At that point she went on suggesting a later moment of 'Rapture', and I picked up a magazine!
I have just wrote a comment about the Brazilian universal health care system. Please rethink what you said about poorer countries. Brazilians experienced a dictatorship and are appalled watching what happens in the Usa now.
The Democrats, as well meaning as they try to be, are fed by the same oligarchs as the Republicans, so they will never take the steps needed to kick the legs out from underneath the oligarchs and their enablers.
Find real concrete actions you can take against the businesses/grifts that feed the oligarchs. Stop using Amazon for a month. Stop using Facebook for a month. Stop using X for a month. 100 million small acts make a big impact on balance sheets.
Vote with your wallets. Use local where possible. Do business with Co-ops where possible. Form Co-ops to fill needs in the community. Buy used, buy at thrift shops, go to garage sales in the neighbourhoods of your community. Carpool when possible.
And get informed about local politics. Find information about the city council’s business. Find information about the State’s business. Write to elected officials and ask well-informed questions. Start organizing to get small improvement projects done in your neighbourhood.
It takes time and energy, but little money to pay attention to what’s going on. But if you don’t start doing it, no one else will.
And if all else fails, you still have the 2nd Amendment’s rights and responsibilities.
Amazon is easy. Always look for alternates sources, & you save money. Don't get caught in their monthly fee trap.
Facebook isn't hard. Share one on one, using whatsapp can help.
X/twitter. Getting banned for unknown reasons (maybe polite non-offensive opinions?) helped, but after being with Bluesky for a while, going back to X was a reason to quit. Substact is much better for intelligent exchanges.
I just did it, cold turkey. I didn’t miss Amazon for a second, and X and fb, well, I’m still addicted to the online world or the iphone, but spend all my time reading news or listening to music. I also quit Spotify and changed to Tidal. Tidal is a bit more expensive but they pay the artists better and the sound quality is superior. I really never missed anything. You might lose contact with some people, but the ones you truly care for you should have them in whatsapp or your phone
Right! Don't stop for a month. Just stop, period. What do we need all that crap for anyways? Pursuit of all that crap is what gave gave them their power in the first place.
Why, he’s running the country like one of his 6 or 7 companies that have gone bankrupt! Who could have imagined that? The stench of GOP support for this loser will stick on them for decades.
Unfortunately he didn’t go far enough. People who don’t get health insurance through the ACA exchanges will eventually see their premiums rise too, because hospital ERs will return to acting as primary care providers. Those costs will be distributed across insured patients whose policies will pay indirectly for the uninsured. This was one of the main reasons for passing the ACA. Insured (employed) people had started raising a ruckus about their own premium costs.
Again subsidizing corporations that refuse to pay a wage that would allow their workers to buy insurance. Taxpayers pay for the increased hospital costs, not corporations.
Why business doesn’t see healthcare as a business investment has always baffled me.
Krugman has written previously (years ago), noting that Obamacare is the logical result of keeping a private system of health insurance. Such a system really could be no other way, if everyone were to be covered. The Republicans damaged it when they removed the penalty for not being insured. I have wondered whether the law presented this incorrectly. Perhaps it ought to have been a tax to cover emergency services for those who were otherwise allowing the insured to pay for the uninsured.
It was presented as a tax; that was the only way to get it done. Congress doesn't have the right to assess penalties like that, but Congress does have the right of taxation.
It’s not just the ACA participants who are at risk. I got a letter from my Medicare supplemental insurance carrier the other day, letting me know they have applied for a rate increase of 17.9% for 2026. When Social Security cola is 2.5% this increase, if it’s approved, immediately becomes unaffordable and I’m considering taking my chances and going without supplemental insurance. Healthcare shouldn’t have to be a gamble in the USA.
I've slowly moving away from using my employer health insurance to fill my Rx. Unfortunately it's part of the package I pay for but cash price with GoodRx or SingleCare is cheaper than my With Insurance price.
But starting to wonder how Rx coverage in medical plan is a benefit. I take three meds, all generic and have been around for 20 years or more.
If you have an unexpected medical event that requires an expensive drug, I guess that’s where insurance can make sense vs out of pocket. But then you better hope the drug you need is on the covered list. Again, it’s all a gamble.
At one point last year I filled my prescription for Atorvastatin and my pharmacist pointed out that the discount price at her pharmacy was about 10% of the price if I used my Medicare provider. I'll take it!
And, fwiw, I’ve had 2 family members who needed a $1k a day drug for 6 weeks (not exaggerating). Both had to argue & jump through hoops at an already stressful time to get the insurance company to cover at least part of the cost.
Thank you Paul, good article and a gorgeous musical coda, one of my favorites.
Viewing everything that's happening in the US from here in Europe, I'm every time struck by the Republicans' almost infinite capacity for inflicting pain and suffering on others less fortunate than themselves, and their refusal to pay (in taxes) for what most other developed countries in the world consider essential government services like education, public health, social security and welfare, and infrastructure. And these heartless charlatans have the gall to call themselves Christians.
Based on examples in my family, people seem to react to early life adversity in two ways: hurt others as retribution for how you were hurt or try to prevent others from suffering the way you suffered. Republicans have become the party of the first reaction.
They have always been "so-called Christians." They worship the vengeful God of the Old Testament. Sadly, the name "Jesus Christ" does not appear in those books.
A quarter of ranchers and farmers get their health insurance via the Exchanges...add that to the catastrophe they are facing with plummeting corn and soybean prices and things are going to get ugly indeed in rural America.
Always remember that, according to Republicans, the only thing wrong with the American healthcare system is the fact that YOU get too much healthcare. There's only a fixed amount of healthcare, so if we can prevent people from using healthcare, then there will be more healthcare left for the others!
If you read that and think "Wow! That's about how a small child might understand things," congratulations: You're now starting to think like a conservative.
Republicans hate anyone who is not wealthy and white. Their actions will harm a large number of their base, and they know that. This, along with Kennedy’s policies, will see many people die prematurely, which I believe is also part of the plan. Fewer resources owned by “the people” means more wealth hoarding for themselves.
Let's be clear...they are not conservative, but rather radicals. The ACA was based on Romney's (someone who is in line with a more classical definition of a conservative) implementation in Massachusetts, but walked away from it once Obama proposed the equivalent at the Federal level.
I just don't understand the appeal of Republicans desire to inflict as much pain on people as possible. It is truly sociopathic.
The appeal is that "I'm hurting, so the only logical way to deal with that is to make someone else hurt, too." And that's why Republicans run on a platform of "Elect me and I will not make your life better. However, I WILL make someone else's life worse, AND I'll let you watch!"
It's actually, "I've never hurt before and I never will because I have too much money to be hurt and I think empathy is a made up new age word that has done a lot of damage."
Well, Fat Donnie did say, last Friday before he took off to watch the Ryder Cup golf tournament, that the Democrats were the ones who were shutting the government down because they want "transgender for everyone." We're looking at late-stage dementia here.
How long before Democrats realize that they have to have an equivalent successful media enterprise to FOX. Polite PBS and the like are boring as hell. MSNBC etc are intellectually weak.
Ask James Murdoch to put down the seed money, he may be in the right frame of mind now that he’s lost the Succession battle with Father.
A few comments are needed to better explain why health insurance is different. We start with the comparison of auto insurance and home insurance. If you have no mortgage, you can choose not to have home insurance. If your home is destroyed by fire or flood, that is your risk, not your neighbor's and not society's, in general. Almost all states mandate auto insurance, because society has learned that most accidents involve the property (or body) of someone other than the driver. Since risk equates to a dollar amount (what actuaries do), you can't shove your risk onto someone else for free. Health insurance would fall somewhere else, were it not for two realities: First, we have a biblical, moral, societal mandate not to let someone in need just die in the street. Were Republicans to adhere to this alone, there would be no debate on a law to have universal coverage, like the NHS in the UK. Secondarily, doctors and hospitals have a legal and moral responsibility to care for anyone who shows up in an ER. Because that has been abused in the past, we have a law, EMTALA to enforce that. So, if someone chooses not to have health insurance or cannot buy it, and they show up in the ER, they get care. They may be dunned to the ends of the earth by the hospital on those (full freight, exorbitant -- but that is another discussion) bills, but the care up front must be given. So, uninsured people take resources from a financially stressed system and add their risk of illness into the system without giving money or premiums into the pool of those creating that risk. That violates the fundamental rules of insurance. The Republicans know this but refuse to acknowledge it, because it has been all to easy to allow the care of uninsured people to be cost-shifted onto hospitals and doctors. When medical care was simple, no fancy scans or costly meds, those costs could be borne. Modern medicine is just too complex and expensive, so the cost shifting does not work. And, to make it worse, we know clearly that the most expensive care of all is when chronic problems fester and end up in the ER. In a sane healthcare financial system, we would have insurance of some sort for everyone, so everyone creating risk is putting some amount into the insurance pool, and we would then decrease the financial stress on that pool by appropriate premiums and by having controls on what doctors, hospitals, pharmacies and other providers do in order to get the most value from the care given (and that is a huge, huge, huge discussion).
Do you honestly believe that the hospitals give care to the homeless and addicts? I watch the cams on the streets in Philly and often see people passed out on the street wearing hospital gowns and arm tags. They sure don't get MRIs or operations if they need them. The hospitals just put them back on the streets unable to care for themselves.
I can't speak to other states, but in MA and widely in places like NY and CA, hospitals and doctors certainly do provide the care. As a retired doc, I can note that we built the overhead of uncompensated care into our finances, as did the hospitals I worked at. The uncompensated care was, at times, a huge stressor.
Inner city hospitals cannot afford to give free care to the homeless. I doubt they can charge exorbitant fees to others to pay for the homeless because in the cities the residents can't pay them.
Hospitals are required to admit the patient until stabilized and ready for discharge to “outpatient follow-up”.
Of course, the hospital systems don’t have to pay for outpatient follow-up, so “until stabilized” means something different depending on the results of the wallet biopsy.
Professor Krugman: thank you for the clear, understandable and brief explanation of how the ACA healthcare insurance works in our broken country. it always surprises me that americans decided that healthcare was a human right, so people everywhere else in the first world, anyway, have guaranteed access to affordable healthcare, whereas americans DO NOT. this is one of the heavy prices we pay for living as modern slaves to the oligarchs.
"americans decided that healthcare was a human right, so people everywhere else in the first world, anyway, have guaranteed access to affordable healthcare"
I have trouble understanding this. So you believe that people in the first world have access to affordable healthcare BECAUSE americans decided that healthcare was a human right?
(1) SOME americans believe that healthcare is a human right, but AFAIK it is not enshrined in any US law, nor does it reflect an unanimous public opinion.
(2) When first world countries have universal healthcare, the idea of human rights doesn't necessarily have anything to do with it, and certainly NOTHING to do with what Americans think.
For instance, Germany introduced universal healthcare in 1883 because its conservative government deemed it politically expedient to deprive the Social Democrats of a talking point that was liable to influence elections.
US voters on the other hand are sufficiently allergic to anyting reeking of "socialism" that they don't even want any such thing, which is why the US will never have it.
Also a clear explanation of the complexity of Obamacare. The only rational alternative is Medicare-for-All-Who-Want-It, as Sanders has been saying for years, now AOC and Mamdani.
"Americans will always do the right thing in the end, but only after exhausting all other possibilities."
"provide help to Americans who need it" yea I wont be holding my breath for any republican to "'help the Americans who need it". My wife,, who has work insurance is turning 65 in March and because her employer raised her rates to an unaffordable amount (not their fault it's trumps for what he's done to the market!) she will go onto Medicare instead of keeping an insurance she really likes. At least she has a choice pity. the millions who will not be able to afford ANY insurance next year. How many people will die because of this hot mess because they don't have insurance? Trump and the repubs do not care at all about the poor or middle class we are expendable to them. Time is coming (I hope) for the American people to rise up against all the atrocities this admin has done TO us and in our name. They have killed enough people worldwide and now they are bringing it home too. Shame on US if we sit for it.
Keep in mind that if your wife's employer employs more than 20 people, the employer group health plan (EGHP) is primary by law.
She is free to drop it, but that means the employer may not offer a secondary plan unless it solely provides services Medicare doesn't, which means it won't pay 20% Part B deductibles or any Medicare co-pays. You need to go into the marketplace for secondary insurance.
If you live in a state like NY, you'll have a fully trained staff at an aging office such as the Office of Aging. They can advise what secondary plans are available from statewide to national. These plans are organized by what they cover from simply supplementing only what Medicare covers to offering additional coverage in addition like prescription coverage. If you haven't already, you should contact a specialist as soon as possible.
Medicare has a concept called equitable relief. Basically it says that if you don't work with Medicare or a trained Medicare recognized specialist, any misinformation you receive from an unofficial source (including yourself) cannot be reversed until the next window of opportunity opens. Medicare (or a specialist) can better advise you on secondary payer issues.
I worked at SSA and am only sharing what SSA employees were trained to advise Medicare recipients.
/appreciate this a lot! But she will take the extra plan (her work insurance kind of sucks, they keep raisin the price while also lowering the things covered and the detestable are crazy!) so she'll probably take the medicare and the marketplace for the extra like i do being retired already but your info is GREAT)
Be very careful to choose an independent insurance broker, and not one who works for insurance corporations. Totally avoid Medicare Advantage plans, as they are neither Medicare, nor advantageous. They are simply insurance as usual, but meaner because you’re older.
When choosing a Medicare supplemental, (termed a Plan G) don’t choose BCBS, United or Aetna- those premiums increase annually. Rather look at Allstate, American Heritage or State Farm. They are age based when you’re first enrolling, so preexisting conditions don’t count, and very affordable.
If you’re not paying for advice, ask your broker who pays them. And if the answer is INSCOs, you’ll understand why they haven’t mentioned the other non INSCO plans.
I've been retired/disabled since i was 54 YO (now 68) the FIRST time /I signed up i went through a broker, an independent broker but since then I have become educated enough to know my options. However I DID tell my wife to go to the independent broker i used or another one soon as the first time signing up is. a bitch and a half. I have Priority health right now and they have been pretty good to me (being disabled i take a LOT of scipts just to keep me alive basically and i have never once been denied...so far...)
By law, she must sign up for Medicare when she turns 65. If she does not, she will start paying late signup penalties when she does finally sign up. I made that mistake, and my penalties are a bit more than $80/month.
I know and it's why I've been on her ass for several weeks about it and she keeps procrastinating! Told her to get with a broker VERY soon as she turns 65 in early March
Well, perhaps she thinks she won't live long enough to need Medicare; she'll just die in harness. The penalties get larger the longer she waits after turning 65. I only waited a few months, and the penalties were something like $120 at first. They've gradually come down a bit. And, compared to what my insurance cost before I turned 65, $1,200 a year was a bargain.
Yes i've sent her copies (cut paste) to her at work about all these statements hoping she will listen to someone! If not I will be pone pissed off hubby if she has to pay those kind of fees because she procrastinated
Am I ever glad I live in Canada! My Ontario Health Insurance Plan, paid for by taxation, paid every nickel of the cost of my endovascular surgery, including a hospital room for a night, a few months ago.
Thank you for laying this out so clearly. My wish is that we eventually offer Medicare-like coverage to everyone. I know it is a major uphill battle, but I do not think anyone should have to go without health care.
It seems that Democrats may “win either way, even if the subsidies go away. Of course the American public loses, but they should get credit for fighting and more importantly the Republicans get the blame.
Republicans seem to be doing everything they can to turn the US into a third world country where billionaires will thrive and everyone else will eat dirt. It’s on all of us to do something. At a minimum, show up for the 10/18 NO KINGS protests and be a voice for something better.
Yeah, the bottom line is that Republicans are *perfectly happy* turning the entire United States into Venezuela's right-wing twin, with horrific levels of poverty, corruption, and isolation maintained at the point of a gun by the ruling class, so long as they get to be the ruling class. And most of their voters will ultimately be okay with all of that too because of a combination of "it's all these Other People's fault" and "it'll hurt these Other People more."
Not Venezuela, the model is Chile under Pinochet . They hate Latin American immigrants, but they would just love to have one of those old style Latin American governments.
Many MAGA are insisting that those losing subsidies are illegal migrants or people who play video games all day rather than work.
Trevor Noah on the Daily Show had Trump pegged as an African Dictatorial President NINE YEARS AGO -https://www.youtube.com/watch?v=2FPrJxTvgdQ.
So did millions of others of us. Trevor is brilliant, yes, but I was one of those millions who said, "The Republicans can't seriously let this guy in" and then Mitch McConnell.
yep, who remembers his so-called 'conviction'of the jan.6th attack on the Capital and then with some unexplanable logic and irrational nonsense just sets this guy free. One of the most hypocrite and cowardly dogs of them all..
I keep wondering if a “separated at birth” social media campaign comparing Trump and Robert Mugabe side by side might give MAGAs some pause. Showing Trump side by side with Mugabe might shock their sensibilities enough to get the white “Christian” nationalists to stop for a moment.
Given that they routinely brush off fascism comparisons when regime members routinely paraphrase famous fascists, I think that they are safely in their epistemic bubble, inoculated from any suggestion that they might be the bad guys.
All those comparisons are with white dictators. A separated at birth campaign with an African dictator might briefly pause their mental rut, forcing them to think for a moment. At the very least their racism could cause them to come up with excuses for why Trump isn’t like a Black dictator. Comparisons to white dictators don’t cause any disruptions to their thought processes at all.
Along with the picture of Mugabe
they should post the 100 trillion dollar note - that was issued in
Zimbabwe. I have one - I paid about
$3.50 US for it . Can MAGA
spell “ hyperinflation “ ?
Do you know who Robert Mugabe is?
I know who he was. A longtime colleague was born in Southern Rhodesia to a family of small shopkeepers, some of whom still live there. So I heard a lot about their experiences trying to keep afloat during the worst of Zimbabwe’s inflation, including selling at a loss due to Mugabe’s directive to keep retail customer prices stable. That’s why I chose Mugabe as the comparator after Trump started strong arming businesses to eat the tariffs.
It probably wouldn't help. For starters, MAGA doesn't know Robert Mugabe from a hole in the wall. And even if they did, they wouldn't see the comparison anyway because Fox News, X, and Newsmax wouldn't show it.
Trump as an orange Idi Amin is looking more plausible daily.
October 18!!! I will be there!
This.
Because Dems need to create serious buzz with No Kings to overcome FOX News counterprogramming. Which will be explaining the Dem decision as anything but trying to keep healthcare affordable for the 90%. As Paul says, they'll blame exploding premiums on Soros, or Antifa, or 'because they hate or freedoms', or any other manner of nonsense--to distract from their gutting ACA funding. Dems must stay on message about this, or the RW media lie machine will carry the day.
Unfortunately, the right wing media lie machine is the only source of information the right wing ever listens to. There is no breaking through that bubble. WWIII could break out and the wingnuts wouldn't have the vaguest clue if Fox et. al. decided not to cover it.
I had an example of this thought the last time I visited my doctor. As I went to sit down in the lobby, I sat close to a cute, white-haired lady and spoke to her. She said "and how are you today?" I told her I'd be better if Trump was dead, and she said "Oh, no, he's here to save us!" Then I asked her how she's going to feel if relatives or friends of hers are removed from Medicaid. She said "Well, I'm on Medicaid but that's fake news, anyway". At that point she went on suggesting a later moment of 'Rapture', and I picked up a magazine!
But it’s not mostly oldsters. Many of us are aware and never have even watched more than a minute of Faux News.
True enough. My mom passed away two years ago at age 93 and despised Trump with the burning heat of a thousand suns to her last breath.
I agree, and will just add Please don't call us cute!
Ah, reverse psychology. You are adorable!
The regime propaganda mouthpiece
I have just wrote a comment about the Brazilian universal health care system. Please rethink what you said about poorer countries. Brazilians experienced a dictatorship and are appalled watching what happens in the Usa now.
Many poorer countries do have better health outcomes than we do.
Yes! Rise! Resist! ✊✊✊
The Democrats, as well meaning as they try to be, are fed by the same oligarchs as the Republicans, so they will never take the steps needed to kick the legs out from underneath the oligarchs and their enablers.
Find real concrete actions you can take against the businesses/grifts that feed the oligarchs. Stop using Amazon for a month. Stop using Facebook for a month. Stop using X for a month. 100 million small acts make a big impact on balance sheets.
Vote with your wallets. Use local where possible. Do business with Co-ops where possible. Form Co-ops to fill needs in the community. Buy used, buy at thrift shops, go to garage sales in the neighbourhoods of your community. Carpool when possible.
And get informed about local politics. Find information about the city council’s business. Find information about the State’s business. Write to elected officials and ask well-informed questions. Start organizing to get small improvement projects done in your neighbourhood.
It takes time and energy, but little money to pay attention to what’s going on. But if you don’t start doing it, no one else will.
And if all else fails, you still have the 2nd Amendment’s rights and responsibilities.
Defiance until death.
For a month? Quit Amazon, X, and fb for good. I did months ago and don’t miss them at all
Do you have any tips to share or ‘gotcha’s’ to share that helped you cut them off?
Amazon is easy. Always look for alternates sources, & you save money. Don't get caught in their monthly fee trap.
Facebook isn't hard. Share one on one, using whatsapp can help.
X/twitter. Getting banned for unknown reasons (maybe polite non-offensive opinions?) helped, but after being with Bluesky for a while, going back to X was a reason to quit. Substact is much better for intelligent exchanges.
I just did it, cold turkey. I didn’t miss Amazon for a second, and X and fb, well, I’m still addicted to the online world or the iphone, but spend all my time reading news or listening to music. I also quit Spotify and changed to Tidal. Tidal is a bit more expensive but they pay the artists better and the sound quality is superior. I really never missed anything. You might lose contact with some people, but the ones you truly care for you should have them in whatsapp or your phone
Right! Don't stop for a month. Just stop, period. What do we need all that crap for anyways? Pursuit of all that crap is what gave gave them their power in the first place.
Why, he’s running the country like one of his 6 or 7 companies that have gone bankrupt! Who could have imagined that? The stench of GOP support for this loser will stick on them for decades.
Put the SCOTUS edifice on the itinerary for the No Kings march!
Yes! Resist and protest wherever and whenever you can.
That has already happened. Started under Reagan and is now a fact, behind all the mass-media whitewash.
This isi Krugman at his best. A concise and understandable explanation of the why behind Obamacare.
Unfortunately he didn’t go far enough. People who don’t get health insurance through the ACA exchanges will eventually see their premiums rise too, because hospital ERs will return to acting as primary care providers. Those costs will be distributed across insured patients whose policies will pay indirectly for the uninsured. This was one of the main reasons for passing the ACA. Insured (employed) people had started raising a ruckus about their own premium costs.
I saw headlines today. Hospital ERs are already primary care providers again.
Yep - just like the Fram air cleaner for your car’s engine intake system.
“ Pay me now - or pay me later “
See your primary care physician now
- or suffer a stroke ( in the ER ) later .
Which costs more ? MAGA doesn’t get that the ER costs are passed on
- TO THEM
and all of us
I would bet their solution would be to kick people out of the ER.
Again subsidizing corporations that refuse to pay a wage that would allow their workers to buy insurance. Taxpayers pay for the increased hospital costs, not corporations.
Why business doesn’t see healthcare as a business investment has always baffled me.
And the rethuglicans have been out to destroy it from the get go. The Big Horrible Bill is a wooden stake driven through the heart of ACA.
Krugman has written previously (years ago), noting that Obamacare is the logical result of keeping a private system of health insurance. Such a system really could be no other way, if everyone were to be covered. The Republicans damaged it when they removed the penalty for not being insured. I have wondered whether the law presented this incorrectly. Perhaps it ought to have been a tax to cover emergency services for those who were otherwise allowing the insured to pay for the uninsured.
It was presented as a tax; that was the only way to get it done. Congress doesn't have the right to assess penalties like that, but Congress does have the right of taxation.
Yep - and forfeit their immortal souls in the process
It’s not just the ACA participants who are at risk. I got a letter from my Medicare supplemental insurance carrier the other day, letting me know they have applied for a rate increase of 17.9% for 2026. When Social Security cola is 2.5% this increase, if it’s approved, immediately becomes unaffordable and I’m considering taking my chances and going without supplemental insurance. Healthcare shouldn’t have to be a gamble in the USA.
Yup, they need to protect their margin, not your health.
Yes! I got my drug plan info last week and the increase is huge!
I've slowly moving away from using my employer health insurance to fill my Rx. Unfortunately it's part of the package I pay for but cash price with GoodRx or SingleCare is cheaper than my With Insurance price.
But starting to wonder how Rx coverage in medical plan is a benefit. I take three meds, all generic and have been around for 20 years or more.
It is a puzzlement.
If you have an unexpected medical event that requires an expensive drug, I guess that’s where insurance can make sense vs out of pocket. But then you better hope the drug you need is on the covered list. Again, it’s all a gamble.
Right. My mother took Gleevec for years. I just looked up the price. Over $9,700/month. Medicare made it quite affordable for her.
At one point last year I filled my prescription for Atorvastatin and my pharmacist pointed out that the discount price at her pharmacy was about 10% of the price if I used my Medicare provider. I'll take it!
Nice pharmacist.
And, fwiw, I’ve had 2 family members who needed a $1k a day drug for 6 weeks (not exaggerating). Both had to argue & jump through hoops at an already stressful time to get the insurance company to cover at least part of the cost.
Let’s try to stick around awhile longer huh ?
And just wait till those 100% tariffs hit.
Thank you Paul, good article and a gorgeous musical coda, one of my favorites.
Viewing everything that's happening in the US from here in Europe, I'm every time struck by the Republicans' almost infinite capacity for inflicting pain and suffering on others less fortunate than themselves, and their refusal to pay (in taxes) for what most other developed countries in the world consider essential government services like education, public health, social security and welfare, and infrastructure. And these heartless charlatans have the gall to call themselves Christians.
It is because YOU have not found Republican Jesus.
Oh, I found him long ago. He's the Mexican skag dealer down on 10th Street in Atlanta.
I don't go there hardly at all. 350 miles away.
Wait, you mean he's MISSING?!?
Apparently so. People keep coming to my door and asking if I have found Jesus...
Based on examples in my family, people seem to react to early life adversity in two ways: hurt others as retribution for how you were hurt or try to prevent others from suffering the way you suffered. Republicans have become the party of the first reaction.
They have always been "so-called Christians." They worship the vengeful God of the Old Testament. Sadly, the name "Jesus Christ" does not appear in those books.
The OT is full of advice to help strangers and the poor too. These people pick and choose from it as well.
Thanks for sharing Charles Gaba's terrific work.
A quarter of ranchers and farmers get their health insurance via the Exchanges...add that to the catastrophe they are facing with plummeting corn and soybean prices and things are going to get ugly indeed in rural America.
But they'll keep voting for the Republicans as if their lives depend on it.
And they’ll keep blaming scapegoats instead of looking in the mirror.
and the shortness of their lives does depend on it.
Not to mention all the rural hospitals shutting down in droves.
But they will still vote for Chump Republicans in 2026
Always remember that, according to Republicans, the only thing wrong with the American healthcare system is the fact that YOU get too much healthcare. There's only a fixed amount of healthcare, so if we can prevent people from using healthcare, then there will be more healthcare left for the others!
If you read that and think "Wow! That's about how a small child might understand things," congratulations: You're now starting to think like a conservative.
Republicans hate anyone who is not wealthy and white. Their actions will harm a large number of their base, and they know that. This, along with Kennedy’s policies, will see many people die prematurely, which I believe is also part of the plan. Fewer resources owned by “the people” means more wealth hoarding for themselves.
It's a form of mass murder. They're psychopaths.
Or just resources available to white people and christians.
Yes, but only >affluent< white christians.
Wealthy, white, male and ”Christian”.
Nailed it. 💯
Let's be clear...they are not conservative, but rather radicals. The ACA was based on Romney's (someone who is in line with a more classical definition of a conservative) implementation in Massachusetts, but walked away from it once Obama proposed the equivalent at the Federal level.
I just don't understand the appeal of Republicans desire to inflict as much pain on people as possible. It is truly sociopathic.
The appeal is that "I'm hurting, so the only logical way to deal with that is to make someone else hurt, too." And that's why Republicans run on a platform of "Elect me and I will not make your life better. However, I WILL make someone else's life worse, AND I'll let you watch!"
It's actually, "I've never hurt before and I never will because I have too much money to be hurt and I think empathy is a made up new age word that has done a lot of damage."
I think it's we need to maintain and preserve the best healthcare for the best people. The rest of you are on your own.
With "best" being defined as "those born to great wealth".
Republicans believe if you're sick and poor, you should just die. In fact, they believe if you're poor you should just die.
Sad but true
Unless this message gets on Fox most Americans will be unaware.
Oh, this one is ready to hit them in the pocketbook just as they are preparing to go to the exchanges to renew for next year.
Don't you know these increased costs are all because of the evil trans pronouns?!?
🤣
Well, Fat Donnie did say, last Friday before he took off to watch the Ryder Cup golf tournament, that the Democrats were the ones who were shutting the government down because they want "transgender for everyone." We're looking at late-stage dementia here.
How long before Democrats realize that they have to have an equivalent successful media enterprise to FOX. Polite PBS and the like are boring as hell. MSNBC etc are intellectually weak.
Ask James Murdoch to put down the seed money, he may be in the right frame of mind now that he’s lost the Succession battle with Father.
MSNBC is intellectually weak but Fox isn’t. 😂
No he won the succession battle.
Fox lies by omission and is highly biased. No thanks.
This is THE problem that Democrats don’t seem to be able to solve, pathetic
This is the problem that Americans don't seem to want to solve: free speech without boundaries.
But I don't think most of the Republicans believe in the refrain "Free Speech without restrictions".
A few comments are needed to better explain why health insurance is different. We start with the comparison of auto insurance and home insurance. If you have no mortgage, you can choose not to have home insurance. If your home is destroyed by fire or flood, that is your risk, not your neighbor's and not society's, in general. Almost all states mandate auto insurance, because society has learned that most accidents involve the property (or body) of someone other than the driver. Since risk equates to a dollar amount (what actuaries do), you can't shove your risk onto someone else for free. Health insurance would fall somewhere else, were it not for two realities: First, we have a biblical, moral, societal mandate not to let someone in need just die in the street. Were Republicans to adhere to this alone, there would be no debate on a law to have universal coverage, like the NHS in the UK. Secondarily, doctors and hospitals have a legal and moral responsibility to care for anyone who shows up in an ER. Because that has been abused in the past, we have a law, EMTALA to enforce that. So, if someone chooses not to have health insurance or cannot buy it, and they show up in the ER, they get care. They may be dunned to the ends of the earth by the hospital on those (full freight, exorbitant -- but that is another discussion) bills, but the care up front must be given. So, uninsured people take resources from a financially stressed system and add their risk of illness into the system without giving money or premiums into the pool of those creating that risk. That violates the fundamental rules of insurance. The Republicans know this but refuse to acknowledge it, because it has been all to easy to allow the care of uninsured people to be cost-shifted onto hospitals and doctors. When medical care was simple, no fancy scans or costly meds, those costs could be borne. Modern medicine is just too complex and expensive, so the cost shifting does not work. And, to make it worse, we know clearly that the most expensive care of all is when chronic problems fester and end up in the ER. In a sane healthcare financial system, we would have insurance of some sort for everyone, so everyone creating risk is putting some amount into the insurance pool, and we would then decrease the financial stress on that pool by appropriate premiums and by having controls on what doctors, hospitals, pharmacies and other providers do in order to get the most value from the care given (and that is a huge, huge, huge discussion).
Do you honestly believe that the hospitals give care to the homeless and addicts? I watch the cams on the streets in Philly and often see people passed out on the street wearing hospital gowns and arm tags. They sure don't get MRIs or operations if they need them. The hospitals just put them back on the streets unable to care for themselves.
I can't speak to other states, but in MA and widely in places like NY and CA, hospitals and doctors certainly do provide the care. As a retired doc, I can note that we built the overhead of uncompensated care into our finances, as did the hospitals I worked at. The uncompensated care was, at times, a huge stressor.
Inner city hospitals cannot afford to give free care to the homeless. I doubt they can charge exorbitant fees to others to pay for the homeless because in the cities the residents can't pay them.
Hospitals are required to admit the patient until stabilized and ready for discharge to “outpatient follow-up”.
Of course, the hospital systems don’t have to pay for outpatient follow-up, so “until stabilized” means something different depending on the results of the wallet biopsy.
Professor Krugman: thank you for the clear, understandable and brief explanation of how the ACA healthcare insurance works in our broken country. it always surprises me that americans decided that healthcare was a human right, so people everywhere else in the first world, anyway, have guaranteed access to affordable healthcare, whereas americans DO NOT. this is one of the heavy prices we pay for living as modern slaves to the oligarchs.
"americans decided that healthcare was a human right, so people everywhere else in the first world, anyway, have guaranteed access to affordable healthcare"
I have trouble understanding this. So you believe that people in the first world have access to affordable healthcare BECAUSE americans decided that healthcare was a human right?
(1) SOME americans believe that healthcare is a human right, but AFAIK it is not enshrined in any US law, nor does it reflect an unanimous public opinion.
(2) When first world countries have universal healthcare, the idea of human rights doesn't necessarily have anything to do with it, and certainly NOTHING to do with what Americans think.
For instance, Germany introduced universal healthcare in 1883 because its conservative government deemed it politically expedient to deprive the Social Democrats of a talking point that was liable to influence elections.
US voters on the other hand are sufficiently allergic to anyting reeking of "socialism" that they don't even want any such thing, which is why the US will never have it.
I think you left out a “not.”
As in "Americans decided that healthcare was NOT a human right"?
That seems plausible, it would make much more sense.
clear explanation of the cost of medical insurance with and without government intervention
Also a clear explanation of the complexity of Obamacare. The only rational alternative is Medicare-for-All-Who-Want-It, as Sanders has been saying for years, now AOC and Mamdani.
"Americans will always do the right thing in the end, but only after exhausting all other possibilities."
Medicaid is the better program.
What if they come after your future assets for pay back?
"provide help to Americans who need it" yea I wont be holding my breath for any republican to "'help the Americans who need it". My wife,, who has work insurance is turning 65 in March and because her employer raised her rates to an unaffordable amount (not their fault it's trumps for what he's done to the market!) she will go onto Medicare instead of keeping an insurance she really likes. At least she has a choice pity. the millions who will not be able to afford ANY insurance next year. How many people will die because of this hot mess because they don't have insurance? Trump and the repubs do not care at all about the poor or middle class we are expendable to them. Time is coming (I hope) for the American people to rise up against all the atrocities this admin has done TO us and in our name. They have killed enough people worldwide and now they are bringing it home too. Shame on US if we sit for it.
Keep in mind that if your wife's employer employs more than 20 people, the employer group health plan (EGHP) is primary by law.
She is free to drop it, but that means the employer may not offer a secondary plan unless it solely provides services Medicare doesn't, which means it won't pay 20% Part B deductibles or any Medicare co-pays. You need to go into the marketplace for secondary insurance.
If you live in a state like NY, you'll have a fully trained staff at an aging office such as the Office of Aging. They can advise what secondary plans are available from statewide to national. These plans are organized by what they cover from simply supplementing only what Medicare covers to offering additional coverage in addition like prescription coverage. If you haven't already, you should contact a specialist as soon as possible.
Medicare has a concept called equitable relief. Basically it says that if you don't work with Medicare or a trained Medicare recognized specialist, any misinformation you receive from an unofficial source (including yourself) cannot be reversed until the next window of opportunity opens. Medicare (or a specialist) can better advise you on secondary payer issues.
I worked at SSA and am only sharing what SSA employees were trained to advise Medicare recipients.
See: https://secure.ssa.gov/poms.nsf/lnx/0600620177
/appreciate this a lot! But she will take the extra plan (her work insurance kind of sucks, they keep raisin the price while also lowering the things covered and the detestable are crazy!) so she'll probably take the medicare and the marketplace for the extra like i do being retired already but your info is GREAT)
Be very careful to choose an independent insurance broker, and not one who works for insurance corporations. Totally avoid Medicare Advantage plans, as they are neither Medicare, nor advantageous. They are simply insurance as usual, but meaner because you’re older.
When choosing a Medicare supplemental, (termed a Plan G) don’t choose BCBS, United or Aetna- those premiums increase annually. Rather look at Allstate, American Heritage or State Farm. They are age based when you’re first enrolling, so preexisting conditions don’t count, and very affordable.
If you’re not paying for advice, ask your broker who pays them. And if the answer is INSCOs, you’ll understand why they haven’t mentioned the other non INSCO plans.
Good luck.🍀
I've been retired/disabled since i was 54 YO (now 68) the FIRST time /I signed up i went through a broker, an independent broker but since then I have become educated enough to know my options. However I DID tell my wife to go to the independent broker i used or another one soon as the first time signing up is. a bitch and a half. I have Priority health right now and they have been pretty good to me (being disabled i take a LOT of scipts just to keep me alive basically and i have never once been denied...so far...)
Ed S aren’t you glad we didn’t choose Medicare Disadvantage!😂
This is unbelievably complicated! (Canadian here).
The paperwork must be monstrous.
Medicare is great.
And in danger!!!
By law, she must sign up for Medicare when she turns 65. If she does not, she will start paying late signup penalties when she does finally sign up. I made that mistake, and my penalties are a bit more than $80/month.
I know and it's why I've been on her ass for several weeks about it and she keeps procrastinating! Told her to get with a broker VERY soon as she turns 65 in early March
Well, perhaps she thinks she won't live long enough to need Medicare; she'll just die in harness. The penalties get larger the longer she waits after turning 65. I only waited a few months, and the penalties were something like $120 at first. They've gradually come down a bit. And, compared to what my insurance cost before I turned 65, $1,200 a year was a bargain.
Yes i've sent her copies (cut paste) to her at work about all these statements hoping she will listen to someone! If not I will be pone pissed off hubby if she has to pay those kind of fees because she procrastinated
Am I ever glad I live in Canada! My Ontario Health Insurance Plan, paid for by taxation, paid every nickel of the cost of my endovascular surgery, including a hospital room for a night, a few months ago.
I'm envious, just on the other side of the Great Lakes from you...
I don't understand why Republicans even exist.
Welp, the haters need some place to call home...
Because they have figured out how to get people to vote against their own best interest.
Greed.
Racism. The South was mainly Democratic until the Civil Rights laws were passed. Most of the "Dixiecrats" changed parties shortly thereafter.
The plan seems to be to make us sicker (rfk jr.), make healthcare unaffordable, watch us die.
Thank you for laying this out so clearly. My wish is that we eventually offer Medicare-like coverage to everyone. I know it is a major uphill battle, but I do not think anyone should have to go without health care.
It seems that Democrats may “win either way, even if the subsidies go away. Of course the American public loses, but they should get credit for fighting and more importantly the Republicans get the blame.
If only it were that simple.
Heads I win, tails you lose proposition seems to be the way of Republicans and our oligarchs.
The Democrats are to blame too. They didn't fight for anything just gave in to the GOP.