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Zombie Trumpcare Is Dead, In The Senate, Again, For Now, Again

All the fundamental theorems in one place

As you know, John McCain is not the favorite Republican Senator here. That being said, his moment last night was a rare piece of Congressional theater that lived up to and beyond the hype. Never a strong voice on health care, his quick buy emphatic thumbs down adds a complex piece to a complex and occasionally apocryphal legend. Past sins are not all forgiven in one fell swoop, but few people in history have been in a position to singularly, in an instant, do so much for so many. Credit is due.


But plenty will be written about the senior Senator from Arizona; like him or not, you don’t think he lacks for media coverage. To paraphrase something I read, giving McCain credit for a decision that two of the female members of the GOP caucus had figured out long ago is basically a microcosm of gender in the American workplace today. In that vein, let’s look at some of what is showing up less frequently in the reporting, see what we know and what we learned.

First, without question, we now know that Donald Trump is really, really bad at being President. I’m not saying he is a bad person (he is). Or that he is corrupt, using the office for personal gain (he is). Or that, in the best interpretation, he and his campaign did everything possible to encourage our chief geopolitical rival to become involved in our electoral process (they did). Or that it isn’t his goal to curtail representative government (it is; the only question is if he succeeds). The job of the President is to change things in the country (or maintain things) in a manner consistent with what they are trying to achieve. Forgetting that I disagree with what he is trying to achieve, he is just incompetent at doing so.

Let’s talk about Lisa Murkowski. If you live South of Juneau, you probably don’t know much about her, but between her and her father, there has been an Alaska Murkowski in the Senate since 1981. They are an institution. In 2010, a nutjob (technical term) named Joe Miller beat her in the GOP primary as she ran for re-election. She began a write-in campaign; 101,091 Alaskans (39.5% of the vote in a 3-way race) learned how to spell “Murkowski.” This was crazy. But, despite her being the definition of a good soldier so far, national GOP leadership did nothing to help her, and actually strongly supported Miller. So, she owes the GOP establishment little. Also, because Alaska has the highest health costs in the country (makes sense if you think much of the state is accessible only by airplane), this was always going to be a tough vote for her.

And, not to stereotype, but I’m going on a limb to say that as people who live in basically a frozen wasteland, they are fairly tough to bully. So, having Secretary of the Interior Ryan Zinke call Murkowski, threatening funding if she voted against the bill, seems like a bad strategy. Calling Alaska’s other Senator also – Dan Sullivan, who didn’t seem to be a key vote – was even dumber. Of course he was going to leak it! Now, if Senator Murkowski changed her position it would have looked even worse.

But this doesn’t even reach the end of the stupidity from one Donald Trump. Lisa Murkowski is literally the chair of the committee that determines funding for the Interior Department! She doesn’t even need to lift a finger to show that such a threat is a bluff hollower than a beach ball. I don’t want to speak for the Senator, but, like every time the White House has gotten involved, the heavy-handed behavior has just pushed Members away. Oh, and Murkowski is unlikely to forget this, in my opinion.

[Susan Collins was obviously pretty important too, I just thought Murkowski had a better story this time. I'll put in a picture of Collins though, to make up for it:]

Maybe, just maybe, Trump should have spent the most critical legislative period of his Presidency selling the bill on its merits, rather than getting in a fight with his own Attorney General or giving speeches to the Boy Scouts that could remind one only of black-and-white videos of Hitler preaching to the Hitler Youth. But that continues a pattern: at no point did any member of the GOP talk about the good things their various proposals would do. Their arguments were either ad hominem (“Obamacare is a disaster”) or damning-via-faint-praise (“coverage losses won’t be quite as bad as the CBO says”), or flat out lies (“pre-existing conditions are protected”; “Medicaid isn’t being cut”). There must have been some good ideas in there. I mean, I read each one, cover to cover, and didn’t see any, but after seven years, they must have had something?

Which leads us to process. In theory, among other reasons, the vote failed last night because the House couldn’t provide assurance that it wouldn’t become law. Forgetting the general lunacy there (“we’ll vote for this law only if you promise you don’t”), there is no way for the House to make such an assurance. Paul Ryan’s statement on the topic had more holes than Swiss Cheese – as it should have, because for once he was being honest. He had no way to see the future.

Negotiations between the House and Senate (that’s the “Conference”) could have failed, and the House passed so-called Skinny Repeal. This was a very likely scenario; neither the House nor the Senate had yet come up with a bill that they liked, with both Leaders promising that his counterpart would improve it. Even had negotiations succeeded, either chamber could have voted down the compromise; the House could have passed Skinny Repeal right after. Any Senator who says that they voted for it but only because they didn’t want it to become law knows less about how Congress works than I do.

Had they been serious about “just moving the process” forward, as ridiculous an idea as that was, it would have been pretty easy to ensure the vehicle used didn’t become law. Just include a poison pill. Include raising marginal tax rates to 99% on incomes over $5 million. Provide $1 trillion to fight global warming, paid for by Big Oil. Add a provision outlawing the NFL. Require all doctors’ offices to become Planned Parenthood clinics. Rename our nation’s capital “Obamaville.” Although that last one is probably not germane according to the Byrd Rules, you get the point. If you want to make sure a bill doesn’t pass, it’s not hard – you can even have a bit of fun with it.

Here’s the thing – Skinny Repeal was not so skinny. It included a number of provisions – GOP priorities – that had been presumed omitted based on rumors earlier in the day. Defunding Planned Parenthood, permitting states to waive Obamacare’s protections, ending the individual and employer mandates – all in the Skinny Bill. If you take the GOP at its collective word, this was the bill they wanted. Now, it was terrible policy – there is little question the individual market would have cratered, even if Medicaid mostly survived. But why wouldn’t Paul Ryan put it on the floor and pass it? It literally meets all of his stated goals in terms of repeal. Do you doubt Trump would have signed it, had it passed both Chambers?

This brings us to the politics. For a long time, many, myself included, said that the bill would either pass with exactly 51 votes or fall far short (perhaps with 40-45 votes, similar to versions earlier in the week). This version was released too late for polling, but previous versions had approval rates in the range of 15-30%; people generally preferred keeping Obamacare over the GOP plans by at least a two-to-one margin. If the bill was going to have 49 votes and fail anyway, why not “release” Senators to vote no? Perhaps because McCain’s vote was truly unexpected, this isn’t what happened. You don’t need to be a political genius to make the campaign ads. I’ll pick on Senator Lindsay Graham, because it is too easy:

[Open on press conference, John McCain, Lindsey Graham and Ron Johnson.]

Graham: The skinny bill is a disaster.

[Cut to Senate floor]

Senate Clerk: Mr. Graham?

Graham: Aye.

Senate Clerk: Mr. Graham is an “aye”.

[Cut back to the conference again, same quote in case you haven’t made your point clearly enough.]

This is great stuff. Maybe I’m in the wrong line of work.

But not only is it devastating, it’s perfectly fair! Like we said, relying on assurances from House is not a thing – the House has no way to provide such an assurance. Are they going to claim they don’t know the rules as well as I do? Lindsay Graham has been in the Senate fourteen years, if he hasn’t figured it out by now, no reason to think he ever will. There are terrible quotes about this bill and this process from so many Senators; terrible even with any context that can be attributed. All of those Senators who knew this looked bad – some of whom had voted against previous version earlier in the week – why did they stay on a bill whose pitch was “this is the lowest common denominator”?

My best answer – that 51st vote against truly was a shock.

After infamously predicting a premature death for the House’s AHCA, I’m loathe to say this is over. For me, it won’t really be over until a Republican body – either Congress or the President – makes an attempt to improve the ACA system within its own confines. They could fund the CSR’s permanently (or at least for a couple years). They could encourage their states to expand Medicaid, if they haven’t already done so. They could honestly sit down with Democratic lawmakers as well as other stakeholders, come to understand what is still wrong with the system and try to fix it.

Or they can keep doing what they’ve done. For four months, each bill proposed has been monotonically worse than its immediate predecessor. There is a reason why: health insurance is hard. It involves trade-offs. When you are unwilling to make trade-offs – and admit that you are doing so – legislation will be like a puzzle with pieces that don’t fit. It can’t be improved by cutting corners. So, for those of us who care about our healthcare system, which should be all of us, this is at best a battle won and definitely not a war won. The GOP base, be it the billionaires or the various red-hat-wearing gullibles, are unlikely to give this up. The GOP position is badly wounded. But like other wounded animals, this may make it even more dangerous.

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