Wednesday, March 22, 2017

Listen: what is the healthcare fight looking like?

Where does the national battle over healthcare stand, right now?  Well, it's looking pretty good.  Don't get complacent, but we might be able to do this.

First, a review of the situation.  Then, a discussion of how it could play out.

A month ago, I put myself out on a limb and said that I thought that Obamacare would be fine -- either the law itself or its principle (the newly-established idea that ensuring healthcare for everyone is part of a government's responsibility).  My reasoning was based on the notion that, despite its own imperfections and the concerted sabotage of the Republican party, the law has actually worked fairly well: the uninsured rate is lower than it has ever been, healthcare costs have increased at a slower pace than any time since the seventies, medical bankruptcies have plummeted like a rock, and a large number of young people have been nudged into the markets to help balance out the newly-covered sick people.

Obviously, I couldn't be certain.  After all, the country just elected a Republican president with majorities in the Senate and the House, all of whom had sworn up-and-down that they were going to repeal Obamacare.  The idea that it is a "disaster" has become a point of faith on the right, no more subject to the arbitration of reality than any other theological matter.  It was entirely possible that the GOP could try to push through a simple repeal bill, shoving it through Congress before momentum could really build against it.

Then the Republicans announced their bill -- one that is unconstitutional, impractical, and almost universally despised -- and I felt a lot better.  Within a few days, the bill was denounced by every major conservative organization, every single liberal organization, almost every major medical association, almost every insurer (except the one seeking government approval for a merger), every far-right media outlet, and so on.  There's only one major group in favor of the bill, as far as I am aware: the Chamber of Commerce.  Since then, the Congressional Budget Office estimates for the uninsured under Trumpcare went on to reveal truly shocking numbers.

So here we are.  The administration and GOP leaders have managed to get the bill through three committees, and now they're getting ready for a floor vote to pass it in the House.  If they can pass it there, then (1) the Senate will pass their own version, (2) the two bodies will send delegations to work out a joint compromise version, (3) that version gets another vote in both the House and Senate, and (4) the president gets a chance to sign it.

The problem for the president is that they don't appear to have the votes for the House vote, much less the Senate.  The bill keeps some entitlement funds -- money for the poor or old to get insurance -- and so a lot of conservatives hate it.  But it slashes others in an idiotic way, so a lot of moderates hate it.  And while leadership says they are certain they have the votes and the president has been threatening holdouts, every count I can find suggests that this bill can't pass tomorrow: NYT, Vox, Washington Post, NPR.

Remember that many times a legislator who says they are "leaning towards no" are just being strategic: they want something.  Maybe they want some money for their re-election campaign, and so they're holding out for leadership's promise to send some NRCC or PAC funds their way.  Maybe they want a change to the bill that shows their power or helps their constituents, like the Buffalo Bribe amendment added yesterday for upstate Republican representatives.  Or maybe they just want to make headlines in a big show.  There are a lot of carrots to persuade the uncertain.

There are also a lot of sticks to punish the recalcitrant.  Leadership can suggest that they will withhold support in the future, send money elsewhere, or even (at the most extreme) encourage a primary opponent.

So the whip numbers can definitely change on the bill.  But it seems as though every single one of these methods has been used... to no avail.  With something like fifty hold-outs, you can't bribe them all.  You can't effectively threaten to withhold money or support -- we're only in the second month of the term, and you'll need their vote later.  And you can't threaten to primary someone from the right for being too conservative.

In other words, they can't even get to the Senate at this point.  Things can change on this -- they can change very quickly indeed! -- but it doesn't look good for this bill.

I don't know what they do now.  They can try to amend it a second time to make it more acceptable to conservatives without losing moderates, but that's very difficult.  They can send it to the floor for a vote, hoping that the pressure of accountability will hold sway, but that's risking a big embarrassment.

Trump certainly doesn't seem to know what to do.  Remember my prediction about his purported evil genius and this bill?
The CBO score was announced today.  It's devastating... the CBO estimates that 12 million Americans will lose health insurance by next year, and 24 million would lose health insurance within eight years.  If Trump now reveals his own secretly-developed plan, vastly superior and treacherously persuasive... then you might have a case.  But if the current iteration of Trumpcare just spins around, getting hacked up and amended and going nowhere, or Trump just decides to cut his losses and tells them to try again (rather than introducing his own bill)...
The bill is getting hacked up and amended, and right now it doesn't seem like it's going anywhere.  No brilliantly malevolent secret Trump plan has been announced -- there isn't one.  He's got nothing.

And without some sort of evil genius, right now it doesn't look like this bill is going anywhere.  Do your part to help ensure it dies.

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