LOOKING FOR THE PONY

LOOKING FOR THE PONY

About a decade ago, I was speaking to one of my best friends.  Like me, he is an Irish-Catholic from the middle class.  He excelled in high school and then went to a top-ranked college and an Ivy League law school.  Today, he is a partner in a major white-shoe law firm.  And all those years ago, in the course of giving some advice, he offered a pessimistic aside.

"Just remember," he said, "things can always get worse."

That's the sort of prognosis we Americans tend to reject out of hand. We see ourselves as a can-do people, constantly marching forward in an un-ending spiral of progress.  We roll our eyes at the pessimists among us, pretty much casting them aside for failing to sing from the hymnal of American exceptionalism.  We praise the optimists, those boys happily digging through the proverbial pile of horse manure on the theory that there's got to be a pony in there somewhere.

And then comes yesterday, and the "by one vote" repeal in the House of Representatives of Obamacare . . .

And, with that, my friend from all those years ago is looking more prescient than pessimistic.

Things can get worse.

In fact, they just did.

The American Health Care Act passed by the House yesterday is an unmitigated disaster, both as a matter of policy and for what it says about the sorry state of American politics.

The Act itself was born in the aftermath of the Republican Party's failure six weeks ago to bring an Obamacare repeal bill to the floor for an up or down vote.  Hard right conservatives did not like the bill that was then being proposed because it did not repeal enough of the Affordable Care Act, and some moderate Republicans did not like it because it repealed too much.  

The principal dispute between the two groups appeared to be whether insurance companies would be freed from enough requirements so that the GOP could claim premiums overall would fall.  The hard right wanted to allow states to allow companies to charge higher rates to those with pre-existing conditions, arguing that requiring subsidized state based high-risk pools for that group could be used to cover a group that Obamacare now precludes insurance companies from excluding, and that charging more for that coverage would allow companies to charge less for everyone else (or, principally, less for the younger, healthy folks who are not at as great a risk for getting sick in the first place).  The moderates claimed that those high-risk pools would not be remotely adequate to insure those with pre-existing conditions, and that an Obamacare replacement resulting in 24 million un-insured -- which is what the non-partisan Congressional Budget Office (CBO) said would be the result of the GOP replacement bill over time -- was unacceptable.

So, unable to corral enough Republicans in favor of replacement, no vote was taken.

This was viewed, predictably and accurately, as a major failure for the Republicans in general and for the Trump Administration in particular.  Trump himself had made a vigorous, albeit last quarter, effort to convince the GOP's hard-right Freedom Caucus to accept the bill, and when he failed, his "I alone can fix it" braggadocio took its first -- but by no means last -- direct hit.  The dealer -in-chief had produced . . .

No deal.

Now, when Trump fails, he doesn't accept it.  Instead, he assigns blame.

To everyone but himself.

And so he did here. 

The culprits he held responsible for this failure were Paul Ryan, the Speaker of the House, and Reince Priebus, Trump's chief staff.  The pair had been unable to herd the cats that constitute the GOP's House majority in order to vote for the repeal of Obamacare and thus honor a promise the GOP has been making for the past seven years.  

The fact that Priebus and Ryan  had to herd only Republican cats was, of course, part of the problem. No Democrats would vote for the replacement bill, or for that matter for any bill that eliminated the individual mandate and cut Medicaid expansion, both of which are the principal reasons Obamacare reduced the number of un-insured by more than 20 million over the past seven years but neither of which are or will be part of any GOP replacement.  In fact, though the individual mandate was their own Heritage Foundation's idea, and was actually turned into law in Massachusetts by none other than its Republican then-Governor Mitt Romney, once Barack Obama endorsed the mandate, the Republican Party, in an act that gave hypocrisy new meaning,  decided it wouldn't. Similarly, though Obamacare used federally-funded Medicaid expansion to cover those who would still be unable to afford policies marketed through state-based insurance exchanges, nineteen Republican-controlled states refused to accept the money in an intentional effort to make Obamacare fail.  

Thus did GOP politics trump -- and for many actually kill -- health care in those nineteen states.

As they did with the Donald in the aftermath of the failure of the House to hold a vote on repeal and replace. 

The order from His Hairness afterward was to pass a bill, any bill.  His petulance demanded it and his ego required it.

So they passed one.

Yesterday.

By a one vote margin.

After no hearings, and no CBO score on how many would lose coverage (the number was 24 million with the first bill six weeks ago).

And then all the House Republicans got in a bus and drove to the White House to celebrate.

In truth, there was nothing to celebrate.  Yesterday's bill was no better than the bill they couldn't get to the floor six weeks ago.  In fact, it is worse.  Like the first bill, it eliminates the individual mandate and rolls back Medicaid expansion.  Unlike the first bill, however, it also effectively eliminates the ban on exclusions based on pre-existing conditions.   The first bill retained the ban but eliminated the individual mandate, which was the Obamacare provision that made the ban affordable in the first place; insurance companies obtained a larger, healthier overall pool of premium paying policyholders in exchange for being required to cover everyone.  In the first bill, the GOP tried to mitigate the elimination of the mandate with subsidies and a provision that taxed those who re-applied for insurance after allowing their coverage to lapse.  It's this last subsidy and tax provision that the right wing couldn't stomach.  So they replaced it with one allowing states to allow companies to charge more to those with pre-existing conditions and then added money to the stabilization fund designed to help states create high risk pools. The subsidies, however, are not remotely adequate to fund those pools, so the net effect is that the exclusion for pre-exisitng conditions has been re-born.  

Meanwhile, it is likely that the new bill will have the same overall effect as the first one.

In other words, more than 20 million will over time lose their insurance.

We do not know for sure yet what the actual numeric loss will be because the new bill has not been "scored" yet by the CBO.  Along with the GOP's refusal to hold any hearings at all on any version of repeal-and-replace, this too, however, was intentional.  Republicans know that the CBO score will show millions losing coverage and did not want that data available as Trump, Priebus and Ryan sought a vote on a measure they knew could fail and would succeed, if at all, only by the thinnest of margins.

Trump's and the House's victory dance at the White House was, of course, obviously premature. The House bill is by no means law and the issue must now go to the Senate.  Optimists are predicting the Senate will kill the House bill;  in fact, Senate Minority Leader Chuck Schumer yesterday said the House bill is "going nowhere fast" in the Senate.  

I, however, am not as sanguine.

We live in a country where, as a practical matter, an aggressive and strategically located minority is now governing the majority.  The last two Republican Presidents,  Bush II and Trump, have been elected only because a piece of 18th century arcana known as the Electoral College allowed the majority-vote loser to assume the office inasmuch as his votes were located more optimally than his opponent's.  Similarly, because of computer-based gerrymandering, the GOP has a sizable forty-five vote majority in the House even though it only gets about 45% of all the votes cast in House elections. Though the Electoral College has only produced a President without a popular vote victory on five occasions, two of them have come in the last sixteen years; and though gerrymandering has always existed, technology has improved line-drawing to the point where the districts themselves may no longer allow for majoritarian corrections.

In this world, anomalies such as these would not threaten democratic governance were the winners -- in this case, the Republicans -- cognizant of them and willing to tailor their program accordingly. Jefferson once said that "Great innovations should not be forced on slender majorities."  And that is doubly the case when those who would do the forcing enjoy no majority at all.

And when the forced result hardly amounts to an "innovation."

Which is the case here.

60% of America likes Obamacare. And, given that more than 80% did not approve of the GOP's first replacement, yesterday's second act by the House is not likely to fare any better.  Especially in view of how bad the first measure was and the second is.

But this Republican Party is not humble.  The Senate last year literally stole a Supreme Court appointment from President Obama; the House yesterday approved a measure without a single Democratic vote, or even any effort to craft reforms to Obamacare that Democrats might have approved; and the GOP agenda going forward is all right wing all of the time  -- tax cuts for the wealthy who do not need them (including those for Trump himself, who would have paid $31 million less in 2005 had the GOP's current tax plans then been law), draconian cuts in funding for environmental protection and education, and the continuing denial of science that allows them to ignore climate change even as its consequences regularly announce themselves in hundred-year floods, dying coral reefs, arctic ice melts, species extinctions, and warmer temperatures.

And on top of all that, Trump is a fact-free President interested only in the perceived "win."  That's why he celebrated yesterday.  He didn't get a new law but he got a win and a picture.  And though Republicans showed up to stoke his ego on the White House lawn, it's not even clear he understands what is in the bill or why it is so ridiculously bad. Indeed, later yesterday evening, at a black tie press conference with Australia's Prime Minister Turnbull in New York City (where the two were meeting at dinner on the Intrepid to celebrate the American/Australian alliance during World War II),Trump launched into his usual tirade about our currently "failing" health care system, only to stop himself mid-way and turn to the Prime Minister. Said our policy-challenged President: "Right now Obamacare is failing. We have failing health care. I shouldn't say this to our great gentleman and my friend from Australia cause right now you have better health care than we do."

Trump was right about that.  Australia's system is better than ours.

Australia has Medicare for all and provides universal coverage.

Something Obamacare approached but the House bill passed yesterday does not remotely come close to providing.

In other words, something that already exists down under.

But about which Donald Trump obviously had . . .

Not a clue.

Under all these circumstance, I am having a hard time finding my inner boy . . .

Looking for that pony.