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I am 71, and I have a lot of medical expenses, none a result of lifestyle. My income is low according to the average. My taxes are going to go up if I cannot deduct my medical expenses. This is one reason I will never vote for another Republican. To hit seniors, who are on fixed incomes, so the rich can get low taxes and corporations can get EVEN more profit, while the changes to the tax code explode the national debt is obscene, and, I predict, will lose Republicans elections for a long time to come.I can cite an example of what the difference in eliminating medical deductions can do to the ill and elderly. I took care of my parents for the last 14 years of their lives. They both had a lot of medical expenses over their last few years, as can be expected of almost all human beings. My mother had a colon resection, which required a 3-month stay in a rehab facility following the surgery. Medicare and her private insurer paid all of that. HOWEVER, after discharge and because of other physical problems, she grew weak in her limbs, and she had to go into a rehab facility for one month on three occasions, for leg strengthening. One of those facilities cost her $7,500 for the month. The last facility she was in cost $11,000 just for room and board. he costs I have cited do NOT include doctor’s charges, medicine, physical therapy, nursing care, or anything but her room and her food. The prices I have cited were typical for this less-expensive Midwestern region. (We live in St. Louis.) My mother had to pay those costs herself because she had exceeded her Medicare and private insurance coverage for the year (because of her prior 3-month rehab following the colon resection). I know how much those costs were because I wrote the checks to those facilities. If she had not had the tens of thousands of dollars in savings, she could easily have lost the home she and my father shared since 1949. It would have devastated her. Those prices were in 2009. Costs for these kinds of services have soared astronomically in the past 8 years. More and more seniors and sick people are losing their homes and everything they built up over their lifetime because of enormously high medical/healthcare costs.CAN YOU PAY THE KIND OF MONEY THAT MY MOTHER PAID?If not, you stand to lose everything. My mother was able to deduct all medical expenses she had at tax time, so she could get money back. Under the Republican and Trump tax plan, no one can even deduct those outrageous costs, and many will end up having to PAY income tax on top of those losses. My personal experience with my parents gives me the authority to speak out on this issue.Those of you, who voted for Trump and the Republicans, have no idea yet what you have voted for. But, you will find out. Every single person gets sick or becomes debilitated/disabled at some point before we die. For some, those years go on for a long time, even until death. More and more ill and elderly will lose what they have, and their children will be forced to take them into their homes and care for them until the end of their lives. That means, they will have to give up their income to do that. I did so willingly. How many of you are willing to impoverish yourselves to do that? The government is cutting Medicaid, which pays for rehab/nursing facilities. The result will be fewer affordable beds in rehab/nursing facilities and more elderly or sick patients being cared for by their families. This abominable tax reform bill will impoverish not only the sick and elderly, but also their families for generations to come.People must look at the effect of any law as it relates to them and their families far into the future, as well as for the moment. A tax savings of a couple of hundred dollars per year for the present, but which will ultimately dispossess you and your family of everything you have and everything you hoped to have - ESPECIALLY when it only further enriches the wealthy - is a travesty on humanity. Think carefully, and then contact your representatives in Washington. You WILL be adversely affected by this law, if passed in its current form, whether you have realized that or not.

I'm not conservative (I like change!), but I'll lay out my perspective since my concerns as a Left Wing/Liberal Mixed Capitalist seem to frequently align.Here are the facts:The Patient Protection and Affordable Care Act mainly aims to secure universal health insurance coverage – but lack of coverage is only a part of the issue. Sprialing costs are the bigger issue. Aside from creating an Independent Payment Advisory Board for Medicare (which is only empowered to make recommendations to Congress) and a Center for Medicare & Medicaid Innovation which has a mandate to conduct certain demonstrations for new payment and service delivery models (but would require Congress to act on the results), the act does very little to address the rising costs of doctors, nurses, and hospitals.It adds additional layers to an already highly dysfunctional market. We already have insurance companies AND in most cases employers standing between the relationship patients and doctors. The rising cost of health care costs has increasingly forced insurance companies to become more like health subscription providers. I am a big fan of the exchange concept, but that's not the only thing that the law does; Obamacare sets coverage requirements on plans – which adds yet another layer to a business relationship that should ideally be direct pay as much as possible.Throwing subsidies and payment middlemen into the mix is a really foolish way to address cost increases. Those things historically tend to lead to MORE cost increases – which is the opposite of what we want. We want greater insurance coverage and participation – but less need for people to actually have to use their insurance coverage to pay for services.A lot of supporters like to point to the "success" of the 2006 Massachusetts Health Care Reform. While it has been successful at expanding insurance coverage, what it has NOT done is reduce the cost of care. From NPR (public radio): Health Care In Massachusetts: 'Abject Failure' Or Work In Progress?; From ABC News: Evaluating Romneycare In Massachusetts; From the Boston Globe: ‘RomneyCare’ — a revolution that basically workedUp until now, the basic reality of employer-sponsored healthcare in the U.S. has been driven by a massive carrot in the form of the employer healthcare tax deduction. Under the PPACA, employer-sponsored healthcare becomes mandatory at the Federal level (once you have more than 50 employees, and assuming that you don't qualify for any one of countless exceptions). Despite Municipalities and States already having their own local mandates, this is a pretty significant imposition on businesses at the highest level. On that note, the number of exceptions and waivers is aggravating since that alone indicates that the law is not equitably designed. (Everyone must do this! Except.... you...and you...and you and you and you...)The Medicaid expansion is a significant r̶e̶q̶u̶i̶r̶e̶m̶e̶n̶t̶ expectation placed on States with tight budgets as it is. Medicare is entirely Federal; Medicaid is State-run with Federal support. States and their citizens tend not to like it when the Federal Government orders them to spend money.That brings us to the question of the individual mandate. Those of us who live in population-dense urban environments are much more accustomed to having to deal with Government regulations and requirements in our daily lives; the underlying concept of the Individual mandate may not feel like a big deal. Government is frequently a good thing since it provides formal mechanisms for all of these people living on top of one another to not trample on one another. For those who live in more population-sparse rural settings, there is a lot less need for Government activity and intervention since there's simply less people – and more space for people to do their own thing. For them the individual mandate, requiring people to engage in a private commercial activity, is a pretty big change in the relationship between the individual and the government – and conservatives are wary of such changes. To be conservative on a given issue, you're generally invested in conserving the status quo. (Realistically, the individual mandate + penalty was a contrived series of rhetorical backflips in order to not have a "Federal Health Insurance Tax" and then allow people with insurance to waive the tax. The Democrats didn't want the word tax being hurled at them in the 2010 U.S. Elections. The gymnastics didn't help them much.)I'd personally rather step forward into something new rather than stick with an approach to providing care that is definitely broken and has been for nearly fifty years – but I can understand why some would strenuously object to changing from something broken to something else that's still broken.With regard to other ways forward.I'll borrow from a comment on Health Care Policy: What does the private health insurance industry contribute to the health care of Americans? and add a few more. What I offer here is directional – not comprehensive.Many more Retail Health Clinics/Convenient Care Clinics. Convenient care clinic,Will CVS, Walgreens retail clinics replace physicians?, Popularity of 'Walk-In' Retail Health Clinics Growing: Poll, Analysis: ObamaCare will bring flood of retail health clinics - The Hill's Healthwatch This also requires continued expansion of who can serve as primary care providers. We need to make sure that state-level licensure for Nurse practitioners and Physician assistants allows for them to do work that they are perfectly qualified to do. Pharmacies ought to be hiring Registered Nurses to take vitals, conduct a basic check-up, and draw blood for send out to labs Unfortunately, the AMA and other groups that advocate for doctors are rather protective of their turf and reserved authorities. Anyhow, let's get Walmart (company), Target, Costco, Walgreens, CVS, Publix Super Markets (company), Safeway, Albertsons, Kroger Products and Services, Sears Products and Services/Kmart, whomever wants to deal with Westfield, and so forth all competing in this area. People should be able to walk in, get a routine check-up, pay $25 - $75, and that's it. Not a $25 - $75 co-pay; $25 - $75 total. A lot of these chains are already providing vision exams, so it's not a huge stretch.An end to our system of employer-sponsored insurance coverage. The "system" is an outgrowth of the wage controls that were imposed during World War II as corporations competed for labor, but weren't allowed to raise wages. Health insurance in the United States, Employer-Sponsored Health Insurance and Health Reform As a consequence, the individual market is inflated and non-functional. As I've said elsewhere, I have solid hopes for the health care exchanges on this. The chance to unwind employer sponsored care is probably the biggest reason that I ultimately support the PPACA. (That is correct; I support the Act not just for what it seeks to fix, but because of what it might break and provide a better path forward on.)Public disclosure of negotiated rates between hospitals and insurers. There's now disclosure of the "chargemaster" rates, which is a step, but it's not an accurate reflection of the market. Procedure pricing should be as transparent as publicly traded stock prices. See One hospital charges $8,000 — another, $38,000. Also, here's a timely column from our very own Dan Munro: Healthcare Pricing Transparency Gains MomentumStandardized & portable electronic medical records that can either be self-maintained or used with a secure (and certified as such) data management service. These could be modeled after stock brokerage houses, who maintain sensitive information – but can transfer that information between one another when a client wants to change. I could also potentially see private insurance companies offering this service.Medicare reform. There are a lot of critiques out there, but ending the fee-for-service reiumbursement model is the big one and everyone already knows it. However, there's a lot of entrenched resistance to actually doing anything about this. (See #1 on my first list.)We need a mechanism to directly account for the requirements of the Emergency Medical Treatment and Active Labor Act, rather than forcing hospitals who take Medicare patients to absorb and distribute those costs. There is a really whacked out economic incentive here that is leading some hospitals to close their Emergency Rooms as they try to trim costs. States who that are looking to trim budgets – most notably Texas (state) – are also limiting Medicaid reiumbursements for "non-Emergency" Emergency Room visits. (Emergency Room Closures Hit Minorities, Poor Hardest; Factors Associated With Closures of Emergency Departments in the United States.) This is one where getting universal insurance coverage for actual emergency/catastrophic situations is important – but, to echo my point about retail health care & convenience care – we need way better, more actually affordable options for primary care.Finally, there is a big hairy social/economic issue that we need to deal with: Death and Dying. We've gotten stunningly good as a society at prolonging people's lives over the past 50 years. As a social imperative, it is moral and correct to try to preserve and prolong life...right??? (Imperative enough that the PPACA bans lifetime caps on insurance payouts.) Unfortunately, the moral imperative is very very very expensive. The most expensive care that people typically receive is in the final three months of their lives. Perhaps only people who can afford it should have every possible measure taken to extend their life... which is unlikely to strike any sane person as remotely just or the kind of society we collectively want to be. Science and medicine have gotten ahead of our ability to tackle this question as a society; we need to collectively catch up and reset our expectations. Maybe it's something like requiring certified EMR providers (see #4 in this list) to collect Advance Health Care Directives??? That at least gets people to have the conversation. This is tough Gordian Knot, and I'm currently short on brilliant ideas on how we go about slicing it. (I will note that when Republican politicians and pundits worked people into a foolish frenzy over "Death panels," it was a sad setback for this public conversation.) Humanity has had a philosophically tough relationship with mortality since the beginning; now we're at a point where it's economically tough.Bottom line: universal insurance coverage is a noble goal, but we ought to focus a lot more on the core care costs so that insurance pools can be called on less frequently to pay out for things. In principle and design, people should be buying insurance to mainly deal with serious risks – not to handle everything that ought to be routine.See also:Ian McCullough's answer to What are the most convincing arguments in favor of Obamacare?Ian McCullough's answer to What should be the next step in American healthcare?

The same Lyndon Johnson that destroyed the black community? The same Lyndon Johnson that opposed every single civil rights initiative for 20 years as a Senator? That’s the same Lyndon Johnson that pushed for a weaker version of the voting-rights section in the Civil Rights Act of 1957. Lyndon Johnson also told Nixon and Eisenhower that he had the votes to kill the entire bill unless the president dropped part three, which proposed to grant the Attorney General unprecedented authority to file suits to protect broad constitutional rights, including school desegregation.In the 1960s Democrats realized that things like segregation weren’t a winning strategy. Lyndon Johnson said “I’ll have those N****** voting Democrat the next 200 years.” From this time forward Democrats would use government largess to win the votes of the minority community.During LBJ’s Presidency, they went knocking door to door, telling black women that if there was no male in the home that they could draw money from the State. Black families went from 17% having no father in the home in the 1960’s to 74% having no father in the home today. This has everything to do with the problem in upward mobility in the black community. The welfare state has increased while their success has decreased. The system was designed to punish those who try to escape poverty, effectively adding a huge marginal tax burden in the form of diminishing benefits. This way Democrats could keep them right where they want them for a vote.Here’s the bargain LBJ offered African Americans: We Democrats are going to create a new plantation for you, this time in the towns and cities. On these new plantations, unlike on the old ones, you don’t have to work. In fact, we would prefer if you didn’t work. We are going to support you through an array of so-called poverty programs and race-based programs. Essentially we will provide you with lifetime support, just as in the days of slavery. Your job is simply to keep voting us in power so that we can continue to be your caretakers and providers.Here’s the part LBJ did not say: We are offering you a living, but it’s going to be a pretty meager living. Basically you get public housing, food stamps, retirement checks every month and medicare for the poor. More than this we can offer you, because we have to make sure that you stay on the new plantation. This means that we need you to remain dependent on us so that you keep voting for us. Your dependency is our insurance policy to make sure that this is an exchange, not a giveaway.What Lyndon Johnson created was communities in a state of lasting intergenerational dependancy. Back in the day you had the old slave plantation. Today it’s multi-cultural plantations from sea to shining sea. You have the latino barrios, native American reservations, and inner city black ghettos. Despite trillions of federal dollars under Democrats they remain poor and intergenerational.It has all the features of the old plantation: such as dilapidated housing, broken families, high degrees of violence, murder, drugs, a sense of nihilism, and no one gets ahead. This is where institutional racism really lives. As racism and phobias have declined among Americans, Democrats have struggled to keep it alive. The Achilles’ heel of the left has been its dependence on menace for power. How many times have you heard them cry fake racism in the last year? It’s like the little boy who cried wolf. They have cheapened the fight against evil.Think of all the things they can ask for in the name of fighting menaces like “systemic racism” and “structural inequality.” But what happens when the evils that menace us begin to fade, and then keep fading? That is a profound problem for the political left whose existence is threatened by the diminishment of racial oppression. It’s on life support. Racism is no longer menacing enough to support its own power. The great crisis for the left today, the source of its angst and hatefulness, is its own encroaching obsolescence dying from lack of racial menace.