Friday, March 24, 2017

Republicans Suck at Governing

Ezra Klein explains how the GOP failure on health care may be a template for future trouble on other issues on

Let’s be clear about what happened here. The American Health Care Act failed because it was a terrible piece of legislation. It would have thrown 24 million people off insurance and raised deductibles for millions more — and the savings would’ve gone to pay for tax cuts for millionaires. It broke virtually all of Donald Trump’s campaign promises, and was opposed not just by Democrats but also by Republicans.
Here, for instance, is what Michael Needham, head of the very conservative Heritage Action, wrote: “It is an awful bill that will impact millions of Americans’ lives and is opposed by nearly serious conservative health care analyst. This legislation is a policy, process, and political disaster.”
This is a failure for Speaker Paul Ryan on many levels. He wrote this bill, and when the speaker takes over the process like that, the upside is it’s supposed to create legislation that can pass. On this most basic task, Ryan failed, and failed spectacularly.
Some legislation fails even though the party faithful love it. For the Democrats, the Waxman-Markey cap-and-trade bill was like that — it went nowhere in the Senate, but liberals appreciated that Nancy Pelosi tried. The American Health Care Act wasn’t like that. Republicans were glad to see it die.
But beyond the legislative and tactical deficiencies, the AHCA reflected a deeper failure of moral and policy imagination. Ryan spent the latter half of Barack Obama’s presidency promising to repair the Republican Party’s relationship with the poor (remember Ryan’s “poverty tour”?). He’s spent every day since the passage of Obamacare saying the Republicans could do better. This is what he came up with? The GOP put their greatest policy mind in charge of the House of Representatives and they got ... this?
Throughout the AHCA’s short life, the limits of Donald Trump’s attention span were on sharp display. He never bothered to learn enough about the AHCA to make a persuasive case for it, which is part of the reason it failed. But perhaps more tellingly, he seemed exhausted by what was, in ordinary political terms, an incredibly fast legislative process. The bill is less than 20 days old, but Trump is already telling reporters, "It's enough already.” That’s what you say after working on health reform for years, not days.
It is remarkable that after spending seven years establishing repeal and replace as their top priority, Republicans are abandoning the project less than 70 days after taking power. Doing difficult things in the American political system takes patience, and it is not clear the GOP has any.
Trump’s line on the bill’s failure is it’s Democrats’ fault. “We could have done this, but we couldn’t get one Democrat vote, not one,” he toldRobert Costa. Of course, neither Trump nor Ryan nor anyone else ever tried to get a Democratic vote. They didn’t meet with Democrats, and from the beginning, they used the reconciliation process precisely because it meant they wouldn’t have to deal with Democrats. Trump is going to have a very frustrating presidency if his strategy is to not try to get the Democratic votes he needs and then complain when his priorities don’t pass.
Trump’s new approach appears to be telling the country Obamacare is set to “explode” and, once that happens, Democrats will want to deal. That would all be fine, but Trump isn’t a disinterested bystander — he’s the guy running Obamacare. There’s a lot he can do to sabotage the law — there are things he’s already doing to sabotage the law — and it’s dangerous if that’s his strategy for attaining negotiating leverage.
It’s also unlikely to work. “Here’s the good news,” Trump told Costa. “Health care is now totally the property of the Democrats.” Putting aside the spectacle of the president passing the buck and calling it “the good news,” he may think that — he may want to think that — but when you’re president of the United States of America, and you run the Department of Health and Human Services, and you decided to move on to tax reform rather than come up with something better when your health plan failed, voters tend to blame you for what goes wrong. Trump promised the country results, not excuses.
Republicans would be wise to reflect deeply on what happened here. As Jonathan Chait writes, “Republicans have spent eight years fooling themselves about Obamacare. They have built a news bubble that relentlessly circulates exaggerated or made-up news of the law’s shortcomings and systematically ignores its successes.” Their attacks on Obamacare have been opportunistic and cynical in ways that made its replacement nearly impossible — having promised better coverage for more people, they were flummoxed by the fact that none of their plans achieved, or even attempted, that outcome.
Big policy change is hard. The modern Republican Party has built itself in opposition. Paul Ryan won fame designing budgets that were never meant to pass, and by criticizing Barack Obama. Donald Trump established himself as a political force through his leadership of the crackpot birther movement. This is a party that has forgotten how to do the slow, arduous work of governing. Perhaps it’s worse than that. This is a party, in many ways, that has built its majority upon a contempt for the compromises, quarter-loaves, and tough trade-offs that governing entails. They need to learn from this defeat, or they are doomed to repeat it, and repeat it, and repeat it.
In the interviews Trump is giving today, it is clear he has somehow convinced himself tax reform will be easier. It won’t be. And soon, Republicans will have to raise the debt ceiling, and pass their appropriations bills, and, if they’re going to hold to any of Trump’s budget proposals, find 60 votes to bust the budget caps. And they’re going to do all of that with the myth of Ryan’s policy genius and Trump’s dealmaking skill shattered.

Monday, March 20, 2017

Chait on the Disappearing GOP Health Care Plan

Jonathan Chait reports on a political unicorn, aka the Republican Health Care plan, in New York Magazine.

The greatest advantage the Republican Party held, through eight years of political war over the provision of health care, was not having a plan to defend. After November’s elections handed them full control of government, Republicans designed a strategy to retain that advantage: repeal-and-delay, which would have allowed them to eliminate Obamacare without specifying the replacement. Repeal-and-delay failed, forcing them instead to pass a replacement plan. That plan has proven wildly unpopular. Indeed, it is so deeply unpopular that Republicans have given up defending the plan at all. Instead, they are back to promising an unspecified, future plan that will be revealed only after Obamacare has been gutted first.
The most significant development to come out of the last week is that Republicans no longer defend the American Health Care Act. When confronted with the fact that his plan would make counties that supported him far worse off, Trump acknowledged, “Oh, I know.” Paul Ryan, appearing on Fox News Sunday, echoed Trump. “We do believe we need to add some additional assistance to people in those older cohorts,” he told Chris Wallace. “We believe we should have more assistance, and that’s what we are looking at.” Secretary of Health and Human Services Tom Price told CNN, “This is not the plan.”
By “this,” Price meant the plan that the White House and Republican leadership had claimed as its plan. The real plan has “three prongs,” of which the bill is only the first. The other two involve a combination of regulatory moves that may or may not be legal and a package of legislative changes that stands a zero-percent chance of being passed into law. (They’re omitted from this bill because they cannot be included in a reconciliation bill, and thus are subject to a filibuster and require Democratic support, which will not be forthcoming.)
Fixing the Republican plan is not a technical problem akin to rejiggering some wires in the shop. It means allocating real-world resources. The GOP plan makes coverage unaffordable for the old and poor because they’re expensive to cover, and Republicans don’t want to pay for it. They insist their plan repeal Obamacare’s taxes on the rich, reducing the amount of resources available for coverage. They also insist their plan expand “choice” and “freedom,” which in practice means having the choice and the freedom not to pay for other people’s medical care. But if you don’t make somebody pay for it — either forcing insurers to give them artificially low premiums, or by taxes, then it won’t be paid for.
The regulations Republicans tout, which would allow insurers to sell skimpy plans to healthy people, would exacerbate the problem. Healthy people would get cheaper plans that don’t cross-subsidize medical care needed by the old and sick. That would force the old and sick to bear even more of their costs. If there was a “real” Republican plan in writing, its effects would be even more gruesome. And so it must remain an abstraction.
One Republican member of Congress hilariously stated that he would vote for the plan on the basis of unspecified assurances from Trump to eliminate features that would punish older, poorer Americans. “The President listened to the fact that a 64-year-old person living near the poverty line was going to see their insurance premiums go up from $1700 to $14,600 per year,” said Alabama representative Robert Aderholt. “The President looked me in the eye and said, ‘These are my people and I will not let them down. We will fix this for them.’”
So, like every Republican alternative to Obamacare, this one has vaporized upon contact with the real world. The real Republican plan, once again, exists on an ethereal plane. Its features cannot be quantified but they can be described in generalities. Everybody who has seen it says it is, or will be, wonderful.

Wednesday, March 15, 2017

GOP Collides With Reality on Health Care

Ezra Klein and Sarah Kliff have a terrific post up on on health care that is long but a worthwhile read. It reviews the lessons Democrats learned through the process of implementing the Affordable Care Act. It makes the case that the failure of Republicans to learn the same lessons underlies their imploding failure in realizing their oft-repeated "repeal and replace" promise.

The lessons of Obamacare:

Lesson 1: Everything in health care is a painful trade-off. Own it.

This was what health policy felt like: trying to slot together competing priorities in a way that was just as maddening as trying to get the color sides of a Rubik’s cube to line up.

Lesson 2: Bipartisanship — can’t live with it, nearly impossible to do reform without it.

This is why Republicans are using the budget reconciliation process, which hamstrings their plan from the start, rather than even trying to find eight Democrats to work with in the Senate.

Lesson 3: If you change the health care system, you own it.

The last party to reform the health care system owns the good and the bad.

Lesson 4: Benefits might not get popular, but they are very hard to take away.

Obamacare canceled 4 million plans, and the outcry was massive. The GOP’s bill is going to drive people out of tens of millions of plans, and the outcry is hard to even imagine.

Lesson 5: Partnering with the private sector, and private insurers, can be risky — in a way expanding government-run programs isn’t.

The marketplaces, the focus of more publicity and promotion, have consistently underperformed expectations...The Medicaid expansion, meanwhile, launched with little fanfare — and it has proved more successful than anyone thought.

Lesson 6: Affordability doesn’t mean what Washington thinks it means.

Republicans were right that this was one of Obamacare’s core weaknesses. But they have never figured out how to bridge the distance between their opportunistic criticisms of the law and the basic fact that their plans lean harder into high deductibles, high copays, and letting people who can’t afford good insurance get by with bad insurance. Their plan makes the most unpopular parts of Obamacare worse, and they will own the results.

Lesson 7: Prices are the fundamental challenge in American health care — and reform will remain an exasperating exercise until that changes.

The reason we spend so much money isn’t because we go to the doctor a lot. On average, Americans actually see the doctor slightly less than people in other developed countries.
The reason American health care is expensive is because when we go to the doctor, it costs more than when someone in Canada or England or France or any other developed nation goes to the doctor.
The test: What comes after Obamacare?
In September 2009, President Obama called a joint session of Congress to sell his health reform bill. “I am not the first president to take up this cause, but I am determined to be the last,” he said.
He will not be the last.
But those who come after Obama would be wise to heed the lessons of his health reform effort. For Democrats, those lessons are relatively straightforward. It is easy to imagine the next Democratic president passing a health care bill that does four things: expand Medicaid coverage up to 200 percent of poverty, boost subsidies in the exchanges, add a public option that can use Medicare or Medicaid’s pricing power, and let people above age 50 buy into Medicare.
A bill like that could pass the Senate with 51 votes, it would build on what has worked both in America and elsewhere, and it would be straightforward for the government to administer and voters to understand.
Obama’s successor, however, isn’t a Democrat. Trump has often hintedat expansive instincts on health care, praising Canada’s single-payer system, promising he wouldn’t cut Medicaid or Medicare, worrying that the government is getting ripped off by hospitals and pharmaceutical companies, and telling 60 Minutes that “everybody's going to be taken care of much better than they're taken care of now” and “the government’s gonna pay for it.”
The plan he has lashed himself to cheerfully breaks those promises, and it is unclear whether Trump realizes it. The AHCA replaces Obamacare while learning nothing from its difficulties. It covers fewer people with less generous insurance, relies on complex arrangements with private insurers, does nothing to address the high prices that drive the cost of US health care, and is being rushed through a hyperpartisan process that ensures Democrats will unwind it as soon as they have the power to do so.
These problems reflect a larger issue the Republican Party must resolve. The Democratic Party’s basic health reform goal is to tax richer people to provide generous insurance to poorer people. This is a broadly popular aim, and many of Obamacare’s problems come because Democrats didn’t lean into it hard enough. The Republican Party’s goals are more diverse, and often less popular.
Fundamentally, Republicans are suspicious of high levels of redistribution in the health care system and frustrated by generous plans funded by third-party payers. GOP proposals tend to envision a health care system based around catastrophic plans and health savings accounts, where people are protected from financial calamity, but otherwise are pushed to shop cautiously for care, and must make do when they simply can’t afford it at all. Republicans want a market where consumers push the cost of health care down, and one reason they push the costs down is because they often can’t afford the pricier options.
There are reasonable arguments for the conservative health care vision, but Republicans don’t make them. Instead, they have attacked Obamacare for being insufficiently generous, for covering too few people, for canceling plans people relied on, for failing to solve the problem of affordability in health care.
While all these criticisms are correct, the Republican replacement plan will make them worse. If it passes, voters are going to find that out, and the reckoning will be severe.
This, above all, is the lesson Republicans need to learn from Obamacare: Don’t overpromise, and don’t mislead.
To the extent that Republicans have a different vision of health care than the Democrats or even the voters, they need to be making that case, and building consensus around a health care system that offers less so it can cost less and tax less. Building that system while promising the opposite will result in disaster, both for them and for the voters who rely on them.

Sunday, March 12, 2017

Pitts on Conservative Resentment

Leonard Pitts comments on the resentment powering the conservative movement in The Miami Herald.

Consider for a moment how often in history that change has been forcefully imposed on conservatives. It has been done by statute, by court decision, by executive order and, once, by war.
This is not an apology for that. In every instance, force was necessitated by the intransigence of those who defended that status quo because they were not ready for change.
If change must wait until all parties are “ready” for it, then change will never come.
So no, the foregoing is just an observation: Resentment is the residue of forced change. And this particular resentment is old, deep and festering. Worse, it is useful. Republicans have found the maintenance and exploitation of that resentment to be a political gold mine. For instance, it helped elect Donald Trump.
But resentment is not identity. Or at least, it never was before. These days, people seem to wear their resentments — and more to the point, the ideological labels that give them voice — the way they wear gender or ethnicity, i.e., as an immutable marker of self. Suddenly, “conservative” is not about what you believe, but what you are. Small wonder the feud between ideologies comes to seem as mindless — and about as amenable to amicable resolution — as the one between the Hatfields and the McCoys.
Then you see a George W. Bush cozy up to his friend Michelle Obama and it stirs some vague, vestigial hope, some reminder that none of this is destiny, some realization that we must resolve this hate — it is not too strong a word — if we want to continue as one nation, indivisible. You see them buddied up across their vast ideological divide and you wonder why we can’t all be like that.
Still, with due respect to Kristof and Blades, I don’t know that progressive outreach alone can get us there. I find it noteworthy that I’ve seen no prominent conservative columnist or activist issue a similar call to the political right. Maybe I missed it. If so, I look forward to the correction. It would be a hopeful thing.
Because it’s a fallacy to believe progressives can fix America’s acrimony by changing their attitudes. I am all for reaching out.
But it helps to have someone else reaching back.

Read more here:

Still, with due respect to Kristof and Blades, I don’t know that progressive outreach alone can get us there. I find it noteworthy that I’ve seen no prominent conservative columnist or activist issue a similar call to the political right. Maybe I missed it. If so, I look forward to the correction. It would be a hopeful thing.
Because it’s a fallacy to believe progressives can fix America’s acrimony by changing their attitudes. I am all for reaching out.
But it helps to have someone else reaching back.

Read more here:

Read more here:

Read more her