Slightly Modified Promises

“Of course I’ll respect you in the morning.” Don’t make promises you can’t keep. There’s a reason the divorce rate is so high in America, and spectacularly higher in the Bible Belt – where extravagant promises of faithfulness, and faith, come with the territory. Those folks are enthusiastic, but good intentions and enthusiasm always meet reality. John Barrymore put it nicely – “Love is the delightful interval between meeting a beautiful girl and discovering that she looks like a haddock.”

Everyone looks like a haddock eventually. That’s reality, but that lesson is hard, and it’s particularly hard in politics – the world of extravagant promises. Obamacare is awful – the Republicans promised to repeal it and replace it with something wonderful. Damn! Trump repeatedly said that everyone would be covered by this new wonderful whatever, and the coverage would be far cheaper for them, and far cheaper for the American economy, and it would be wonderful – but he ended up with haddock anyway. Fourteen million people will lose coverage in the first year, twenty-four million in ten years, the poor and elderly will get hammered. Medicaid will all but disappear – the very poor and the disabled, and the majority of those in nursing homes, waiting for the end, will be on their own. It stinks. It’s a haddock.

America should have known better. The man had said Trump University was wonderful, and then paid an out-of-court settlement of twenty-five million dollars, to reimburse all those who had good proof that they had been defrauded, and to make the whole thing go away, as his campaign began. He admitted nothing, but he wrote the check. And he wasn’t going to fix health care. He made promises, he was enthusiastic, but then it wasn’t just him. Republicans had been trying to repeal Obamacare since 2010 – and yes, the Affordable Care Act was passed fair and square, long ago, by both houses of Congress, and survived a major Supreme Court challenge too, and then a few more. It is the law, and there are normal procedures for repealing a law. You find the votes to pass something else in its place, but if you don’t have the votes, you don’t have the votes. They tried that fifty or sixty times, knowing that would go nowhere – but now, finally, they have votes – and their guy in the White House to sign what they come up with. They’ve been promising their voters they’d finally do this, and now they can keep their promise.

Don’t make promises you can’t keep. Josh Marshall explains the problem:

When a party has a huge amount staked on passing a piece of legislation, they usually find a way to do it, even if it seems all but impossible on the surface. A big counterexample to this rule of thumb was the failure of health care reform in 1994 when Democrats failed Even to hold a vote on a bill and were promptly crushed in the 1994 midterms. The success of reform in 2010 is a good example of the rule of thumb I’m talking about.

With all this said, on its face, things are looking pretty dicey at the moment for Obamacare repeal.

The reasons are obvious:

It is becoming increasingly clear that millions of people, actually tens of millions of people will lose health insurance under the bill supported by the House GOP leadership and the White House. This was obvious. But the CBO scoring, followed what is apparently an administration analysis showing even worse numbers, makes it all but impossible to deny.

That has led a growing number of Republican Senators to reject the bill, at least in its current form. The latest is that the Senate GOP leadership is actually putting together an amendment to make subsidies somewhat more generous. Clearly the current bill will be hard pressed to pass the Senate.

The problem is there’s a mounting rebellion on the right in the House. Why? Basically, the current bill isn’t ideologically pure enough. So it’s not clear the current bill can pass in the House either.

These folks don’t know what to do with this haddock:

The Senate GOP wants to push the bill to the left and the House GOP wants to push it to the right. A different way to put it is that it’s too stingy for Senate Republicans but too ideologically impure for House Republicans. Either way, it’s very hard to see how you get one bill through both chambers and to the President’s desk. For the moment, the White House seems inclined to let House Republicans take the ball and push the bill further to the right, even though this seems all but certain to make it an even harder sell in the Senate.

If that weren’t enough, we are also seeing some defections to the left in the House. But for the moment at least, pressure to make the bill more generous is coming from Senate Republicans.

They have a stalemate on their hands:

On its face, it looks hard to figure how Republicans will be able to pass anything on Obamacare. If they don’t pass anything, the law stays in place and that’s that. But here’s where the rule comes in. I think it is no exaggeration to say that if the ACA remains on the books untouched in 2018, it will be a political catastrophe for the GOP, whatever its impact on humans. Parties do a lot to avoid catastrophes like that.

So it will be avoidance now:

For the vast majority of players – elected officials – legislative politics is about avoiding exposure. Like in the wild, there’s safety in the pack, safety in the school. [Everyone seems to be talking about fish these days.] This is in part what Sen. Cotton of Arkansas was getting at as he’s been warning his former House colleagues not to vote on a politically perilous bill that’s going to die in the Senate anyway. We’re already seeing the first examples of fairly conservative Republicans distancing themselves from this bill.

Here’s the key. No one wants to be the last one holding on for an unpopular or dead bill. The more electeds pull their support, the more perilous the situation gets for those holding on.

That puts them in a tight spot:

If the bill goes down, you want to say you were always against it. If an unpopular bill goes through and everybody in the party supported it, at least then you have all the party machinery and all the forces of partisanship making the case for the vote. If you supported the legislation but the party abandons it, you’re really on your own in your next reelection fight.

What this all amounts to is that the political pressure against repealing Obamacare is working. Senators see the consequences in their states and are either moving into opposition to Trump care or getting skittish. The more those people (and the same applies to those getting cold feet in the House) are confirmed in their opposition, the better. Just as important, the more move into that camp the more intense the pressure gets on those that remain. More pressure to cave and more bad electoral consequences down the road.

And then the unthinkable happens:

It’s not impossible at all now that Obamacare will either not be touched at all or amended in very limited ways. If that happens, not only is that great for those who retain their health insurance, it is also disastrous politically for the GOP. Republican base voters have turned out in three straight elections around a unifying message of repealing Obamacare. If they can’t make that happen with full control of the entire government, it will turn the party’s wings against each other and be profoundly demoralizing to its voters.

Just as important, for a President victory begets victory and power – and vice versa. Of all President Trump’s capture on his voters, a huge amount is tied up in his claim to be a man of action, someone who gets things done. If he can’t manage this, it will hurt him a lot.

So that led to this:

The White House launched an intensive effort Tuesday to salvage support for the Republican plan to revise the Affordable Care Act, even as a growing number of lawmakers weighed in against the proposal.

One day after the Congressional Budget Office released its analysis showing that 14 million fewer Americans would be insured next year under the GOP plan, Vice President Pence and Health and Human Services Secretary Tom Price went to Capitol Hill to rally backing for the proposal.

But widespread dissatisfaction among House and Senate lawmakers – conservatives and moderates alike – showed no signs of dissipating, increasing the chances that House Speaker Paul D. Ryan (R-Wis.) will have difficulty passing the bill if it goes to the House floor in the next two weeks, not to mention whether it can collect a majority in the Senate.

“I have serious concerns about the current draft of the House bill,” Sen. Ted Cruz (R-Tex.) said in an interview Tuesday. “As written, I do not believe the House bill would pass the Senate.”

The White House is putting its political capital behind the Ryan proposal, however, sending emissaries to the Hill and meeting with skeptical lawmakers – including Cruz, who went to the White House on Tuesday along with a small group of conservatives.

There a lot of hard work going on, political hard work – if those three words actually go together – and then there’s fantasy:

Senate Majority Leader Mitch McConnell (R-Ky.) attempted to play down the severity of the GOP split after a closed-door party lunch attended by Pence, Price and some of the architects of the House bill, including Ways and Means Committee Chairman Kevin Brady (R-Tex.).

Following the lunch, McConnell tried to shift the focus from the coverage numbers to more favorable terrain for Republicans: the CBO’s projection that Ryan’s plan would reduce the federal budget deficit over the next decade and produce a 10 percent average decrease in premiums after that.

“Regarding the projection of fewer people purchasing, I think that’s the inevitable result of the government not making you purchase something you may not want,” McConnell told reporters. “And so we are hoping to have a more vibrant market that will attract a greater number of people to actually be able to buy, at an affordable cost, insurance that actually makes sense for them rather than one prescribed by the government.”

The government will save a lot of money, the deficit will shrink dramatically, the economy will take off like a rocket and everyone will be rich, and then everyone in America can buy wonderful insurance of all kinds, even the most expensive kind, and everyone in America will be happy. The Republican replacement for Obamacare isn’t a haddock, shining and stinking in the moonlight (John Randolph on Henry Clay: “So brilliant! So corrupt! Like a rotten mackerel in the moonlight, he shines and stinks.”) – the Republican replacement for Obamacare is a unicorn that farts rainbows.

Others disagree:

Sen. Bob Corker (R-Tenn.), who is normally chatty with reporters, was more guarded than usual coming out of the meeting. He declined to discuss specifics but said House leaders and the White House were making a good-faith effort to hear the concerns of Republican senators.

“They really are taking input. So I don’t think they would be over here unless they really do want to take input from folks,” Corker said.

Others think they shouldn’t take input, as Robert Costa and Philip Rucker report here:

A simmering rebellion of conservative populists loyal to President Trump is further endangering the GOP health-care push, with a chorus of influential voices suspicious of the proposal warning the president to abandon it.

From headlines at Breitbart to chatter on Fox News Channel and right-wing talk radio, as well as among friends who have Trump’s ear, the message has been blunt: The plan being advanced by congressional Republican leaders is deeply flawed – and, at worst, a political trap.

Trump’s allies worry that he is jeopardizing his presidency by promoting the bill spearheaded by House Speaker Paul D. Ryan (Wis.), arguing that it would fracture Trump’s coalition.

In short, this is Ryan’s haddock, not yours, so get back to being who you are, and keep your damned promises:

Trump loyalists warned that the president was at risk of violating some of his biggest campaign promises – such as providing broad health coverage for all Americans and preserving Medicaid and other entitlement programs – in service to an ideological project championed for years by Ryan and other establishment Republicans.

“Trump figures things out pretty quickly, and I think he’s figuring out this situation, how the House Republicans did him a disservice,” said Christopher Ruddy, a longtime Trump friend. “President Trump is a big-picture, pragmatic Republican, and unfortunately the Ryan Republican plan doesn’t capture his worldview.”

Ruddy, the chief executive of Newsmax Media, published a column Tuesday urging Trump to “ditch” the current bill.

And then there are the mystery men:

Keeping Republicans on edge are several Trump advisers with tenuous ties to Ryan and the party establishment who might be more responsive than others to outside pressure, including chief strategist Stephen K. Bannon and senior policy adviser Stephen Miller.

That’s not quite right. There’s nothing tenuous here:

The cascade of opposition within Trump’s movement started flowing soon after the bill was unveiled last week and picked up speed this week. On Breitbart – the anti-establishment, conservative news site that has been a platform for Trumpism and was once run by Bannon – article after article has railed against a bill its headline writers excoriate as “RyanCare.”

One heavily promoted story said that RyanCare was “a perverse economic system” and featured an interview with Rep. David Brat (R-Va.), a tea party hero who unseated then-Majority Leader Eric Cantor in 2014.

Breitbart published leaked audio of Ryan on Monday that could undermine his relationship with Trump. The recording is of Ryan on a conference call with House Republicans last year, immediately following the release of the “Access Hollywood” video in which Trump bragged about sexually assaulting women. Ryan said on the call that he was “not going to defend Donald Trump – not now, not in the future.”

Bannon and Miller really do despise Ryan, and they’re not alone:

Fox News host Eric Bolling, who once considered joining the Trump administration and is friendly with the president, published an op-ed Tuesday on the network’s website that said Ryan and the “establishment GOP have pulled a fast one on President Trump.”

“It’s time for President Trump to scrap the GOP health-care bill,” Bolling wrote.

Conservative talk-radio host Laura Ingraham, a friend of Trump’s who was considered for a job in the White House, said Tuesday on Fox News that the Ryan bill is a “trap.”

“I think Donald Trump is going to get caught on this in 2020,” she said, referring to the next presidential election. “I’d like to spend an hour talking to him about it. I think this is a trap set for Trump, and it’s going to be bad.”

Paul Ryan really is an evil person, isn’t he? That’s the word, but Christopher Ruddy, the Newsmax guy, really did write an odd op-ed, with these two key points:

Reject the phony private health insurance market as the panacea. Look to an upgraded Medicaid system to become the country’s blanket insurer for the uninsured.

Tie Medicaid funding to states with the requirement that each pass legislation to allow for a truly nationwide healthcare market.

Kevin Drum finds this curious:

In other words, Medicaid for All. It’s not Medicare for All, but it’s pretty interesting coming from a stone conservative.

Now, Ruddy also wants some other stuff. That “truly nationwide” health care market is, I assume, code for allowing insurers to sell across state lines. He also wants “modest” tort reform and expansion of HSAs.

But those are minor things that could be negotiated. The interesting thing here is Ruddy’s belief that hatred of insurance companies is what really drives Trump supporters. Needless to say, plenty of liberals hate insurance companies too. I don’t especially share this hatred, but private health insurance companies are inefficient, confusing, and administratively costly. I’d be happy to see them go away.

That makes this an interesting proposal. I doubt that liberals (or the medical industry) would support it unless Medicaid was bolstered in some way, but it certainly has the virtues of being (a) really simple and (b) truly universal if done right. I wonder if something like this has any chance of passage.

No, that’s not happening:

It’s worth pointing out that it does have one fatal flaw: it would cost a lot of money. That’s the one thing conservatives are dead set against.

Don’t make promises you can’t keep. Obamacare works well enough for now, but of course it may be dead already, as Kevin Drum notes here:

Paul Ryan and President Trump have been insisting for months that Obamacare is collapsing, failing, imploding, spiraling quickly into death. This is ridiculous, of course. It’s covering more than 20 million people at a lower cost than originally projected, and by any fair appraisal it’s been hugely successful.

But that’s not to say it has no problems. The Obamacare insurance pool is skewed toward the old and sick, and this has made it hard for insurers to turn a profit. Several smallish insurers have already left the market, and there are hundreds of counties in the US with only one insurer left on the exchanges. This is probably not fatal – the CBO says the Obamacare market is stable – and it’s a problem that could be addressed fairly easily and inexpensively. Still, it does put the Obamacare market in modestly perilous shape.

Actually, its days may be numbered:

Even if the godawful Republican repeal effort fails, there’s every reason to think that Congress will try again. What’s more, it’s clear that they’ll do everything they can to undermine Obamacare along the way. In a few months, insurance companies have to decide whether they want to participate in the exchange market in 2018, and I wonder what they’ll decide. The uncertainty is sky high now, and that means they have little incentive to continue. Remember, most insurers swallowed big losses early on in hopes of building a stable, profitable market later. But what’s the point of absorbing losses if it looks like – at best – years and years of chaos ahead?

It may be that 2018 is safe. The exchanges are pretty close to profitable now, and it’s probably worth it for most insurers to stay on board for at least another year to see what happens. Still, I wonder. Merely by upending everything and making it clear just how dedicated they are to cutting taxes on the rich and cutting health coverage for the poor, have Republicans already managed to effectively repeal Obamacare without passing a single page of legislation?

Josh Marshall did say that if Obamacare remains on the books untouched in 2018, it will be a political catastrophe for the Republicans, whatever its impact on humans, so they really do have get rid of it – for their own survival. One way or another, they will keep their promise. And they’ll wake up with a haddock. We all will.

Advertisements

About Alan

The editor is a former systems manager for a large California-based HMO, and a former senior systems manager for Northrop, Hughes-Raytheon, Computer Sciences Corporation, Perot Systems and other such organizations. One position was managing the financial and payroll systems for a large hospital chain. And somewhere in there was a two-year stint in Canada running the systems shop at a General Motors locomotive factory - in London, Ontario. That explains Canadian matters scattered through these pages. Otherwise, think large-scale HR, payroll, financial and manufacturing systems. A résumé is available if you wish. The editor has a graduate degree in Eighteenth-Century British Literature from Duke University where he was a National Woodrow Wilson Fellow, and taught English and music in upstate New York in the seventies, and then in the early eighties moved to California and left teaching. The editor currently resides in Hollywood California, a block north of the Sunset Strip.
This entry was posted in Republican Alternative to Obamacare, Uncategorized and tagged , , , , , , , , , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s