You get a bunch of idiots ready to rev up their chainsaws but finding out they have neither the gas to rev them nor the trees they'd like to cut down.
Just to note what Brian Beutler is saying over at New Republic:
For seven years now, the mantra “repeal Obamacare” has been both a spasm of revanchist rage and a cynical ploy to keep a segment of the electorate motivated to vote for Republicans. It was also frequently deployed in the belief that the GOP would not be unexpectedly thrust into a position where their voters could expect them to make good on the promise.
But Donald Trump’s Republican Congress convened only three days ago, and members are already finding that eliminating Obamacare will be far messier, politically, than devising and implementing it was for Democrats.
As Republicans hurry to repeal the law, “they’re not even close to agreement about what comes next - or even when the repeal should take effect,” Politico reported late Wednesday. “Republicans are reckoning with the reality that dismantling a nearly seven-year-old law that reshaped a $3 trillion health sector and covers millions of Americans is more daunting than simply campaigning against it.”
Republicans got themselves into this mess at least in part because of a broad, conservative failure to treat Obamacare on its true terms rather than as an evil abstraction conjured by a political foe. In an important sense, there is no Obamacare anymore; there’s just the health care system Republicans are inheriting, and the one they will leave behind.
When Democrats controlled the government in 2009, they could have theoretically passed legislation that opened an existing public insurance system like Medicare or Medicaid to working-age people. But that would have unspooled existing insurance markets, creating significant disruption for consumers and relentless opposition from carriers and other powerful interests.
Democrats instead struck bargains with stakeholders across the health industry, which created political and economic space for a major coverage expansion but left most existing arrangements untouched. They subjected insurers to more regulation, but guaranteed them millions of new customers; they cut reimbursement rates to hospitals, but with the understanding that a spike in insured patients would help them recoup lost revenues. Most of those patients were expected to be poor people who would be added to state Medicaid rolls, in an expansion paid for almost entirely by the federal government.
The political downsides to this approach were fairly obvious at the time, and have become more clear as the law’s been implemented. It’s complex and inequitable; it doesn’t cover everyone; it turns people into customers in an amoral and unpopular market, rather than into users of a simple public utility. But the upside was that it could be slowly blended into the existing fabric of the health system without rending the whole thing and starting over. It’s not a single patch in a strange patchwork. Removing the stitching won’t just re-create a hole, but leave the rest of the quilt more tattered than it was before.
Eliminating a program that covers 20 million people will create a backlash on obvious humanitarian grounds, but that’s far from the only challenge Republicans now face. Repealing the Medicaid expansion will confront hospitals with an uncompensated care crisis; repealing private insurance subsidies will collapse the individual marketplaces; repealing the coverage guarantee will allow insurers to again discriminate against sick people. Delaying these repeal measures with no promise that they will be replaced with an alternative that makes providers and patients whole, will create major disruptions in the health care system anyhow. This is a stickier wicket than many strident Republicans in Washington realized, and the ones who did know were cynical enough to over-promise anyhow.See, it was all fun and games using Obamacare as a dartboard to take shots at. Now that the Republicans have to, you know, live up to their threat of killing off Obamacare they're realizing this shit is real for 20-30 million Americans, that any hit to the health care system will cost jobs, and people who otherwise are angry at the Dirty Librul Dems could turn around and get angry at the Evil Greedhead Rethugs.
It doesn't help that a lot of professional organizations and businesses reliant on Obamacare are in a position to punch back:
The American Medical Association (a powerful doctors association), and the even more powerful hospital lobby have warned Republicans not to repeal Obamacare unless an alternative is enacted in tandem. When GOP repeal plans are described to them, Trump-supporting Obamacare beneficiaries in key swing states are rightly horrified. This week, Trump adviser Kellyanne Conway told CNBC, “we don’t want anyone who currently has insurance to not have insurance,” but according to Politico, “Republicans are now realizing how hard it will be to replace the law, and many of them have plainly settled on the fact that they will never be able to craft a plan to insure as many people as Obamacare does.”I mentioned this before back in 2015:
Which leads me to wonder about how much of this Obama knew about ahead of time when he pushed for the ACA "Obamacare" package in the first place all those years ago. True, by 2009 our Health Care system was facing utter collapse without any substantive reforms. With a Democratic majority in both houses of Congress, Obama could have pushed for a more liberal - read: single-payer - package. But he insisted on pushing an agenda modeled on the conservative reform alternative that the Republicans offered and never followed up on back in 1993 to oppose Clinton's ultimately doomed plan.
At the time, it looked like Obama jumped out too early for a compromise package in an attempt to secure Republican votes for a bipartisan "victory" bill. It seemingly backfired because the Republicans decided in toto to deny Obama any "victory" at all, sticking to an obstructionist position that painted themselves into a corner...
Because by going for a "compromise" bill like the ACA - based on market-based reforms that Republicans themselves argued for in 1993 - Obama took away the one real alternative Republicans today could offer. They've got nothing else, other than basically eliminating the reforms altogether... which basically brings back the out-of-control costs and lack of health care for far too many Americans. Republicans keep saying they can "Replace" Obamacare after the "Repeal", but when pressed on what the replacement can be the Republicans can't offer a legitimate plan.
This is 2017, two years later. The Republicans practically had six-seven years to come up with an alternative plan, an honest-to-God Replacement package to placate the medical/health care industry and the nation as a whole. SIX YEARS. They still can't, because Obamacare WAS the plan they had.
The Republicans are reportedly still arguing among themselves about what to do, and the Replace part hasn't gotten any specifics confirmed. This is insane. You'd think after SIX YEARS and fifty-odd REPEAL votes that they'd HAVE a REPLACE plan figured out. But they never put their asses on the line to come up with one (either they were never really serious about it when they knew Obama would stop them, or they didn't want to offer something that would outrage the wingnuts).
All we have for the LAST SIX YEARS is that Republicans hate it. They hate it because it doesn't have their name on it. But they can't get rid of it because they don't have anything else that works.
Back to Beutler:
Republicans must now choose between walking onto what they acknowledge is a political minefield and reneging on the political promise that has defined them—that became their organizing principle as an opposition party—during the Obama years. In a more sane environment, they would accept Democrats’ offer to improve Obamacare in ways that Trump voters say they want, and then claim victory in the repeal fight...What's really at play here is that the Republicans want the Democrats to jump in with a Replacement package for them, or somehow give them some political cover from the fallout that's bound to happen. If there's any good news right now for the Progressive Left, it's that Obama and the Democratic Senate Leadership isn't giving the Republicans any safety nets (via Washington Post):
The president, who was accompanied by Senate Minority Leader Charles E. Schumer (D-N.Y.), House Minority Leader Nancy Pelosi (D-Calif.) and Rep. Frederica S. Wilson (D-Fla.) as he entered the Capitol, took no questions from reporters before or after the nearly two-hour meeting. But participants said he told members of his party that they did not have to “rescue” Republicans and that they should “stay strong” as the GOP strives to replace the law...
Schumer and other Democrats echoed Obama, saying they did not feel any responsibility to craft a substitute health-care bill...
The Democrats' position should be this: Obamacare works to cover most Americans. Obamacare works to improve access to health care to most Americans. Obamacare works. And stick to that message.
The Democrats need to remember that the Republicans sold a fearmongering campaign, demonizing the health care reforms even as those reforms kicked into gear and made our nation's existing health care system function at better value (lower costs, more coverage for people who NEEDED it). Now that the Republicans can't campaign on that fear anymore - now that THEY are the ones responsible for what happens to our nation's health care - it's their own damn fault that too many people believe the wrong things about it.
David Frum wrote about this years ago when he called Obamacare the Republicans' Waterloo. It wasn't going to doom Obama or the Democrats, he noted, it was going to doom a Republican party whose reflexive opposition to ANYTHING was going to leave them unable to lead or fix this issue any time soon (and that time is NOW):
We followed the most radical voices in the party and the movement, and they led us to abject and irreversible defeat.
There were leaders who knew better, who would have liked to deal. But they were trapped. Conservative talkers on Fox and talk radio had whipped the Republican voting base into such a frenzy that deal-making was rendered impossible. How do you negotiate with somebody who wants to murder your grandmother? Or – more exactly – with somebody whom your voters have been persuaded to believe wants to murder their grandmother?
I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government. Talk radio thrives on confrontation and recrimination. When Rush Limbaugh said that he wanted President Obama to fail, he was intelligently explaining his own interests. What he omitted to say – but what is equally true – is that he also wants Republicans to fail. If Republicans succeed – if they govern successfully in office and negotiate attractive compromises out of office – Rush’s listeners get less angry. And if they are less angry, they listen to the radio less, and hear fewer ads for Sleepnumber beds.
So today’s defeat for free-market economics and Republican values is a huge win for the conservative entertainment industry. Their listeners and viewers will now be even more enraged, even more frustrated, even more disappointed in everybody except the responsibility-free talkers on television and radio. For them, it’s mission accomplished. For the cause they purport to represent, it’s Waterloo all right: ours.
The Republicans in Congress are now flailing with few sound options. They WANT to kill Obamacare but can't completely because 1) the legislative rules can only allow them to kill portions of it, 2) there ARE popular parts of Obamacare that even the wingnuts would be stupid to kill off, and 3) there are signs that ANY tampering with Obamacare will kill jobs and hurt an economy already doomed by a slash-and-burn Republican budget guaranteed to raise deficits and the national debt.
There's no glory in what the Republicans realize the position they've put themselves into.
Screw them. They asked for this.
They got 62 million Americans to buy their bullsh-t. Now the bill's come due, and nobody else should be forced to pay it.
1 comment:
Trump is the denouement of the takeover of the Republican party by the right wing media. Now we get to see what happens when the man behind the curtain is exposed. My guess is "not much."
From what I gather, the strategies for repeal of the ACA are:
1) Repeal and delay, that is disassembling it now and replacing it later, while maybe leaving some of it in place for CYA purposes. Politically this is the easiest and comes with the side benefit of causing it to unravel so as to support a lot of "See, we told you it wouldn't work" narratives.
2) Outright repeal by passing the Ryan budget. This is a disaster on so many levels I won't even go there. It comes with the advantage to Paul Ryan of turning him into an important historical figure and validating his masturbation fantasies involving Ayn Rand.
Yup, the mutt has caught the car, and in this case the car is an armored personnel carrier with 30 million American citizens in it.
Whatever they do is likely to suck, especially to folks like me who have both Medicare and Medicaid: Not only will half of my health insurance disappear, but $104 a month will be deducted for Medicare premiums from the $1246 I get from Social Security Disability, the only income supporting two adult human beings (+ an adorable cat). And to all of those WWC voters who voted for Trump because their premiums went up this year, surprise, surprise, surprise! The ACA was actually suppressing the inflation of your premiums and without it, you will be screwed even harder than I will be.
The only bright spot I can see in this awful scenario is that option 1) might crash the health insurance market hard enough to make nationalization necessary, something Trump would most likely favor as long as his name goes on it and he gets to look like the hero in front of the media. That would almost be worth it just to see the looks on Ryan and McConnell's faces.
-Doug in Oakland
Post a Comment