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What the heck is going on with health care reform?

What the heck is going on with health care reform?

Politics is supposed to be the art of the possible

Six months into Trump’s presidency and Congressional Republicans have fumbled the Obamacare repeal ball four times (by my count).

The rundown:

No one liked the House’s first attempt at Obamacare overhaul (AHCA), so the bill was pulled from the floor at the last minute. Congressional Republicans wait, reintroduce the bill with a few tweaks, it barely passes the House. House Republicans cheer and then the Senate scraps the bill to create their own. Senate Budget Committee works behind closed doors to draft a bill which is only slightly better than the House version but still doesn’t have support to make it to floor debate, much less an actual vote. Finally, leadership caves to clean repeal a la a 2015 bill (which isn’t a clean repeal, but the internet is pretending as much), and then a handful of Republican Senators decide maybe they can’t support ‘clean’ repeal after all. Leadership trots out Libertarian Senator Rand Paul to sell their repeal bid, and Senate Majority Leader McConnell says he’s holding a vote anyway. Trump, annoyed, just wants Congress to get it done so he can move on.

And that brings us to today.

So what the heck is going on?

No one seems to know exactly, not even Senate Republicans.

I’m torn between loving a fractured, independent-minded caucus which, in a perfect world would encourage debate and innovation, and desperately wishing Congressional Republicans were more like their Democratic counterparts, willing to sacrifice small asks in favor of a shared goal.

Regardless, watching the Republican health care reform novella unfold makes it hard to understand why Senate GOP leadership hasn’t attempted getting everyone in the same room to hash out what’s possible for passage. At this point, it’s painfully clear that what’s possible for a legislative success is not what voters were sold in 2012, 2014, or 2016.

It’s the same strategic trap Republicans have haplessly stumbled into for some thirty years now — pressing for radical transformation overnight rather than accepting incremental, possible reforms now. Democrats get this, it’s how they’ve successfully transformed policy across the board in their favor for decades. When the tides turned in their favor granting them large majorities (most recently 2008), Democrats spent a year working on Obamacare before unrolling and shoving it through the legislative process. Even then, Democrats presented a united public front with uniform messaging and talking points.

Why can’t the GOP start with the few items the caucus agrees on, pass that, then move on to the next?

In January of 2012, before he was elected, I interviewed then candidate Ted Cruz. We discussed compromise. What he said then is what the Senate should be doing now:

My view on compromise is the same as Ronald Reagan’s. Reagan used to say, “if they offer you half a loaf, what do you do?” And his answer was, “you take half a loaf and then you come back for more.” I’m interested in moving the cause of liberty forward. So if we are advancing in a positive way, if we are shrinking the size of the federal government, if we are moving towards fundamental tax reforms, simplifying the tax code, moving towards a low uniform rate towards everyone, then I’m willing to compromise and accept less than 100% if we are moving forward. Now I intend to come back and keeping getting it, but I want to affirmatively move the ball forward. The problem is some of the Republicans in Washington compromise, moving backwards.

“Repeal and replace” as it has been sold will not happen. If Republicans can’t accomplish that seemingly simple task (one they voted for repeatedly under the shield of presidential veto these past years) with chamber majorities and the White House at their disposal, it’s never going to happen. So why not focus on the possible? Sure, the possible isn’t sexy, but it’s certainly better than whatever is happening now.

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Overlapping and convergent interests. Fear of massive dislocations and reduced profits caused by restoring market functions to regulate price and availability. Dread that the ball of yarns they have been spinning will unwind with progressive force a la Fannie/Freddie, elective wars/regime changes, catastrophic anthropogenic immigration reform, etc.

What’s going on is that the lying douchebags in Congress are proving to conservatives that they have been full of shit for years.

They had no plan and no intention of doing anything but make pathetic show votes they knew would never pass, because they never expected to actually be in a position to repeal Obamacare.

Now they’re making more pathetic show votes and praying that they can avoid fallout by claiming they really wanted to repeal it but gosh dangit they just didn’t have the votes!

Subotai Bahadur | July 19, 2017 at 3:24 pm

The GOPe has no desire to repeal Obamacare or accomplish ANY of the items in the Republican platform. There are no programs, principles, or goals in the last 10 years at least where the GOPe differs in reality from the Democrats. Look at what they do, and have done, not what they say.

They are literally as much the enemy as the Democrats. React and plan accordingly.

They didn’t fumble the ball. On 1st and goal, they spiked the ball four on consecutive downs. That’s how you manage to be the only team on the field and still can never score.

McConnell will not support any bill that does not include chin implants and testicle transplants.

Kemberlee, excellent post. I just think you are missing a key part of the puzzle.

Google up Ace of Spades re “failure theater”. It’s more than just one post, two or three I believe. Go through them all so you get the depth of meaning.

Short version – the GOP Congress has a pattern and history of pretending to support something for the base, but sets up the process so that their attempt fails, while making it appear they tried everything possible to get it done.

In this particular instance, I would chat up lobbyists for the Insurance industry. I suspect that the current status quo is exactly what they hoped for, and that large sums of money are being kickbacked into campaign war chests of the GOP.

Its very much like college loans and the resulting skyrocketing cost of tuition. If it costs me $5 to make a widget but I know the government will give you $5000 in taxpayer dollars (free money!), I’m going to charge you $5000 for that widget.

Insurance company profits have doubled and trebeled. I would really like to see a list of their donations for the 2018 midterms.

This isn’t a case of advancing incremental reforms. This is a much more straightforward case of eliminating a Democratic-engineered and inflicted disaster. No incremental reform is possible under the weight of such a pig. Any possible improvement requires that that dead weight be removed first.

The Democrats will not cooperate in this, and fantasizing otherwise is just a waste of time and opportunity. Either the Republicans get off their “privileged” butts and do it, or it won’t be done at all.

Good analysis, Kemberlee. If McConnell had any testicles, right now he would be stripping McCain, Collins, and Murkowski of their committee assignments and vowing to massively fund the primary opponents of any senator who refuses to vote for a clean repeal. But the Turtle does nothing.

No. I have known McConnell. He has balls and he has spine. He is highly intelligent and very shrewd.

He has been a US Senator for 30 years. A whip for 5 years. The GOP minority/majority leader for 10 years.

You don’t accomplish all that via cowardice or incompetence.

He’s just not on our team.

    Old Patzer in reply to Fen. | July 19, 2017 at 4:55 pm


    “He has balls and he has spine…”

    – Yeah, when he doesn’t have to face a real challenge – much boehner, who sold out his own base to get along with obama; and obama, who sold out our country to avoid getting involved in anything that would interrupt his eight year vacation and White House partying.

    McConnell is a bureaucratic hack – like a cockroach, his kind of hack is hard to get rid of once they’re established.

    McConnell is the LAST general anybody would follow into battle.

    Remember, boehner rose to the top in the House. It doesn’t take much except time and being corrupt enough.

    McConnell is at best, a school marm. And he looks worse. Every time his shows his face, the GOP loses a thousand voters.

My bad, 32 years as US Senator, not 30.

LOL. Trump just told Congress to cancel their August recess and get back to work! I’m loving this guy.

Maybe Trump can shame them into rejecting exemptions from all the laws they inflict on the rest of us. I’ve always hated that.

    YellowSnake in reply to Fen. | July 19, 2017 at 5:57 pm

    When is Trump going to get to work? Didn’t he say he had a ‘great’ plan that was better, cheaper and would cover everyone? Isn’t it time he rolled it out?

Toomey said that they didn’t have a plan because they didn’t expect to win.

This health care non voting is Washington Kabuki that exists so that Congress will have an excuse for not addressing the Trump legislative agenda. It’s a pre planned quagmire.

    DieJustAsHappy in reply to rotten. | July 19, 2017 at 6:51 pm

    Too bad Toomey isn’t up for re-election anytime soon. Another of the Washington Elite who needs to go.

      Matt_SE in reply to DieJustAsHappy. | July 20, 2017 at 11:14 pm

      Don’t let that stop you. Toomey, Collins, Murkowski, Portman, et. al. may not be up this cycle but some of their allies are. Primary the RINOs and replace the Dems with nothing but conservatives.

      Make all the candidates promise to 1) vote for a clean repeal and 2) promise not to vote McConnell as Majority Leader again.

All they have to do is vote yes to advance debate on the bill. They can add amendments if they like. But to not vote yes is beyond stupid. This is a vote to begin discussion on the bill. That’s it.

A no vote is literally taking the football off the field and running away with it so no one can play.

The health care fiasco in Congress is allowing the MSN to denigrate Trump in the court of public opinion. Our newspaper today has laudatory articles about Jerry Brown as being a real leader with his ability to work with the opposition and push his agenda through the California Assembly, all while simultaneously portraying Trump as flopping around like a fish out of water. The only problem with that rationale is that both chambers of the Assembly are controlled by a super-majority of Democrats. The only real opposition and debate occurs when taking the lunch order: shall we have white or rye and mustard or mayo.

They ought to put forward a simple bill, giving a tax credits equal to the AHCA penalty. Together with the Cruz/Lee provision, Obamacare would be gutted. No need for repeal, voters and tax-payers and consumers get relief. Demorats get to wear their Obamacare boat-anchor until 2018.

Bucky Barkingham | July 20, 2017 at 8:30 am

With McConnell and the Roll-Over Party in charge politics is “the art of why nothing can be done”.

None of this is the fault of the Congress. It is the fault of the voters. They believed the lies of the politicians masquerading as real promises. They elected a Democrat majority and twice elected the most anti-American President in history. They reelected the same people who have done nothing for the citizenry for the last 20 years. You get what you pay for.

Since the 1930s the government of the United States, and most state governments, have used the same political playbook. And, it is really simple. They establish social welfare programs and then expand them until the people are totally dependent upon them. This allows the politicians to control the citizenry without resorting to overt force. Social security was originally intended to supplement the retirement income of people who had lost everything during the Greta Depression. It was expanded to provide a near living stipend for retirees. Medicare, Medicaid, Welfare, the Food Stamp program have gone the same way. Government subsidized healthcare insurance is simply another step down that road. And, most of the people who want it repealed are all for it, if they can get it for free or at reduced cost. The Congress is giving the people what most of them want, subsidized healthcare. Their problem was that the planned-for insurance crash, which would justify the imposition of a government controlled, single payer healthcare plan, came too soon. The politicians were not in a position to easily justify such a move. And, they were faced with a populist Republican President who ran as an anti-Establishment, anti-corruption candidate. The politicians NEED the collapse of the healthcare industry to survive, because the majority of people NEED subsidized healthcare. And, they will not eliminate the provisions of the ASA, while they are in office.