Which Republican Will Play Gandalf to Trump's Balrog of a Health Care Bill?
As the president throws the Freedom Caucus under the bus by reportedly calling the AHCA a "mean, mean, mean…son of a bitch," Rand Paul says he'll vote against any "new entitlements," and the swing vote shifts to…Ted Cruz?


At a meeting with more than a dozen GOP senators Tuesday, according to anonymous attendees quoted by the Associated Press, President Donald Trump described the House version of the American Health Care Act (AHCA) as "mean, mean, mean," decorating his negative characterization with what the AP delicately termed "a vulgarity." (Jim Acosta later clarified that said phrase was "son of a bitch.") The president also reportedly said to the senators working on the secretive Obamacare revamp, "We need to be more generous, more kind."
This all doubtlessly comes as rude news to those 217 Republicans who pulled the lever for the impressively unpopular AHCA, particularly those in the fiscally conservative House Freedom Caucus (HFC) who held their nose and voted for an admittedly flawed bill (and process that produced it) in part to assuage a mercurial president who went after them collectively and individually after they'd scuttled a previous version. One day you're all smiles in the Rose Garden behind a POTUS crowing that this "great plan" is "very, very incredibly well-crafted," the next month he throws your loyalty under the bus just 17 months before you have to face an increasingly angry electorate.
"To call a bill that he pushed 'mean' leaves us scratching our heads," Rep. Dave Brat (R-Virginia), an influential Freedom Caucuser who like all but one member voted yes, told the AP in a follow-up. "In terms of strategery, I hope he's just trying to motivate the Senate….Because he put all sorts of pressure on us to move the bill we passed." (Re: that pressure, recall that Caucus Chair Mark Meadows [R-N.C.] said at the time, "When you get a phone call from the president and that's followed up by a phone call from the president, followed up by a phone call from the vice president—it needs to get done.")
Trump is clearly confident that he can similarly bully 50 of the Senate's 52 Republicans into line, despite the bill being (in the words of Reason's Peter Suderman, echoing the sentiment of many free-market health policy analysts) "almost entirely indefensible." The question is who, if any, are—unlike the Freedom Caucus at this point—willing to withstand Trumpian pressure? Who will resist the temptation to throw the hot potato to a bicameral conference committee?

Probably Rand Paul (R-Kentucky), for one. This afternoon, the libertarianish senator slammed the latest conception of the ephemeral bill, according to The Hill:
Paul denounced as "new entitlements" two core elements of the Republican bill in both the House and Senate: a refundable tax credit to help people buy insurance and a "stabilization fund" of money to help bring down premiums.
"I think we shouldn't have new entitlements that will go on forever in a Republican plan to fix healthcare," Paul told a small group of reporters. "We can't pay for what we already have: Medicare, Medicaid and Social Security."
Asked if he would vote "no," Paul said: "What I'm telling them is if they get to an impasse, come talk to me, because I'm more than willing to vote for a partial repeal if I can't get complete repeal, but I'm not willing to vote for new Republican entitlement programs."
Paul has taken some lonely stances against the administration's positions on Saudi arms sales, medical marijuana, indefinite detention, mandatory minimums, and more, so he would seem more temperamentally suited for opposition than most of his colleagues.
Since the GOP's moderate faction is reportedly warming up to the legislation, that leaves the more Freedom Caucusy/Tea Party types as the likeliest defectors. Sen. Mike Lee (R-Utah), for example, said two days before the Trump comments, and four days before the latest word that negotiators were looking to keep some Obamacare taxes in place, that he had "some grave concerns about what we're doing so far," and that "If we bring forward something that doesn't repeal Obamacare and doesn't bring down the cost of health care, that's probably something I won't be able to vote for [it]." The Utah senator was one of Trump's most withering GOP critics throughout the 2016 campaign, calling on the party's nominee to "step aside" just one month before the election.
So assuming Paul/Lee as no, that leaves a 50-50 split, with Vice President Mike Pence poised to be the tiebreaker. So who stands to be the swing vote? Would you believe…Ted Cruz?

According to a Washington Post report Tuesday, with Republicans increasingly writing off Paul and Lee, hopes now rest on the "fragile alliance between Senate GOP leaders and a man they have clashed bitterly with for years." Cruz, the famously disliked Texas Tea Partier who helped shut down the government over Obamacare funding in 2013 and called Majority Leader Mitch McConnell a liar in 2015, is shaping up to be the last, best hope for opponents and dealmakers alike. How's he leaning? "I've said from Day One that I want to get to yes," the senator, who unlike Paul and Lee faces re-election in 2018, told the Post. "The consequences would be terrible to fail."
Cruz has a more slippery record than his Tea Party Senate colleagues when it comes to Donald Trump and his own political ambitions: Recall that while running for president he knifed his good friend Lee in the ribs over a criminal justice reform proposal that Cruz had previously backed.
McConnell had previously said he hoped for a bill before July 4; that now looks to be pushed back to the end of next month. And the moderates are hardly overflowing with enthusiasm, either: Just this afternoon Sen. Lisa Murkowski (R-Alaska) told reporters she still hasn't decided. "I just truly do not know, because I don't know where it's going," she said.
One thing seems certain, though: The core group of Tea Partiers who have punched so far above their weight in national politics since entering the Senate will be smack dab in the middle of the most momentous legislative fight of Donald Trump's presidency. Bring popcorn.
Related video from January: "5 Republicans Liberals May Learn to Love in the Trump Era."
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May I help you?
Back to Valinor with you. Smoke a pipe.
Great suggestion. I am quite partial to pipeweed.
Can someone explain to me why it's supposedly so hard to just flat out repeal Obamacare?
Because our political leaders have a deep concern on how such actions would impact the lives of the average American.
Sorry, couldn't say it with a straight face.
Because they need Democratic votes to repeal it according to the current rules in place. If there were 2/3's Republicans, then they would technically be able to repeal it, but that would require them all to act like responsible adults for a day or two, which seems like a very long shot... the best you can reasonably expect is for the current thing to become a slightly different but probably equally crappy something. Rand Paul has the right idea, but not many others have the actual intellect to acquire and sustain ideals and principles.
Because entitlements are always hard to repeal. Ask Teresa May.
Oh yes, please do.
But not T*h*eresa May - who isn't as . . . photogenic.
"I've said from Day One that I want to get to yes," the senator, who unlike Paul and Lee faces re-election in 2018, told the Post. "The consequences would be terrible to fail."
What would be the Texas equivalent of the Cornhusker Kickback?
A Cabinet position?
By the way, why aren't Fifth Column "broadcasts" being posted here anymore. I had many things to say about the previous episode, How Kmele Foster Encouraged Me to Start Dropping N-Bombs Everywhere, and the one prior to that, When the Fifth Column Went Full Godwin and Pretended it Didn't. Unless you want me airing your dirty laundry on the social medias for everyone to see.
Maybe I'll just boycott today's and see how you like it.
The AHCA is an amazingly excellent bill for three reasons:
1) It kills the individual mandate.
Forcing people to buy insurance or have the IRS sicced on them is morally unconscionable.
2) It kills the ObamaCare Medicaid expansion.
Moving people from Medicaid onto private plans with subsidies is exactly like moving public school students into private schools with vouchers.
3) It gets rid of the ObamaCare 29 hour work week.
Talk about mean and nasty--what's meaner and nastier than forcing employers to either cut the hours of the working poor to 29 per week or give them free health insurance?
To this, I might add a fourth--the reason people think it's mean and nasty is because it's so entirely libertarian.
It would be unreasonable to expect a non-libertarian congress to pass a more libertarian bill. This is as good as political realities will allow under these circumstances.
Those are good things, but frankly it would have been a much wiser course (long term, that is) to wait out the ACA and allow it to fold, but it would also hurt a lot of people before a full repeal became a political possibility which is the fly in the ointment.
The Republicans are essentially telling everyone that they're more responsible than the Democrats, because this is going to cause uproar within the party without a doubt as (R) voters become absolutely disgusted with their inability to enact real change. They're also going to feel the full force of the inevitable failure of any national health legislation, as Democrats can now claim it would have succeeded without Republican interference and the Public will happily swallow the lie.
I'm really not happy about defending Republicans on this because I wanted, and continue to want, full repeal but its equally obvious that it simply does not have the votes for a full repeal. Depending on how you feel about the willfully stupid being hurt by their own stupidity will determine how you feel about a 'repeal and replace' I suspect.
"It would have been a much wiser course (long term, that is) to wait out the ACA and allow it to fold, but it would also hurt a lot of people"
I think about that, too.
Two considerations:
1) Fiscal conservatism is like this.
Eventually, we will cut our spending. Ultimately, either we'll cut it ourselves by choice, or we'll end up like Greece, being forced to cut spending because the world won't carry our debt anymore at interest rates we can afford.
A lot of people suffer in Greece because of that. Pointless suffering makes me sad. The whole purpose of fiscal conservatism is to avoid that kind of suffering.
That's the way I see the AHCA, too. I want to avoid that suffering.
2) If and when ObamaCare completely collapses, it may not be replaced by free market capitalism. It may just become a single payer, nationalized healthcare from shore to shore. I want to avoid that kind of suffering, too. That's why I support the excellent reforms of the AHCA.
The problem with point two is that it's an inevitability at this point. The impetus is clear, and while I think we all like to pretend that isn't the case there is absolutely no way a party can go wrong in promising the impossible here and that is exactly what Democrats have been doing for decades, often with Republican support.
In my opinion, the suffering is inevitable and in fact it becomes worse over time as well as becoming more divorced from the people who institute the programs that eventually cause said suffering. Right now there is the opportunity to make the same people who created the mess pay for the mess politically at the cost of less suffering overall.
That's my calculus anyway.
Oh, and I should perhaps note that I get my way if nothing happens at all which is what I'm pretty much banking on since I sincerely do not believe that this legislation will pass without Democrats crossing the aisle in the Senate which is about as likely as the sun exploding tomorrow in my opinion.
A little bit of reform can go a long way.
Moving people from Medicaid onto private plans (even subsidized ones) is a clear path to getting rid of the rest of Medicaid, too.
We could do that with Medicare!
Milton Friedman would be all over that.
I'm old enough to remember the time of stagflation. I remember when my dad wasn't allowed to buy gasoline on even numbered days because his license plate ended in an odd number.
I remember when whole industries that exist today hadn't even been invented yet.
I remember when the idea of people being free to buy marijuana for recreational purposes was a ridiculous fantasy.
I remember when more than half the world was communist.
Welch and Gillespie may have pushed their libertarian moment rhetoric a little too far, but let's not throw the babies out with the bathwater. Things have been much worse than they are, and if we do the right things, the future will be better than today.
You know who else had memories that effected his policy preferences?
It isn't amazingly excellent, but regardless of cannon's petulant purism and suderman's typically weak analysis (can we get his wife please and let him play video games while robby colors?) it is better than the status quo. I'm not entirely sure what Paul's beef is. His grand plan had tax credits/subsidies too. I guess the difference hinges on the word "new."
And trump wanting to be more generous is the trump i expected to see from day one.
Those three points are both amazing and excellent.
We couldn't reasonably expect anything more libertarian from a non-libertarian congress, and those three points are clearly libertarian.
The incompetence of the GOP is simply breathtaking. It's as if every step of the process, from the details to the complete lack of transparency, has been formulated to piss off as many people as possible.
And then you have to consider what this means for the competence of the Democratic Party that they've let these people dominate them in elections for the last 8 years. A truly remarkable collection of people in power in Washington DC.
There isn't anything about transparency that makes the process of making sausage more beautiful,and if the process were fully transparent, there's very little chance anything would get passed--certainly, whatever got passed wouldn't be anywhere near as libertarian as the AHCA.
ObamaCare was passed because the process wasn't transparent, so it shouldn't surprise us if tearing it out by the roots requires a similar treatment.
Incidentally, ObamaCare wasn't unpopular because people didn't know what was in it. It was unpopular when people found out what was in it, we saw premiums and deductibles skyrocket, saw insurers fleeing the exchanges, found out you couldn't keep your doctor if you like your doctor, etc.
If ObamaCare had delivered on its promises, it would have been much more popular.
If the AHCA delivers on its promises (and/or Trump and the Republicans deliver on their campaign promises) we'll see the AHCA become much more popular. Believe me, the reason I love or hate legislation has little to do with transparency. If the Iraq War, TARP, or the Paris Climate Accord had been perfectly transparent, I'd have still hated them all anyway.
By their fruits ye shall know them!
Oh so it was a problem the last 8 years that Obamacare was crafted and passed in a non-transparent manner, but it's not a problem that the AHCA is being done in an even less transparent manner, because you like it. Such great principles there Ken!!
My biggest problem with ObamaCare was not its lack of transparency.
My biggest problem with ObamaCare was that it was shitty regulation, immoral in its treatment of fundamental rights, and it made the healthcare system unnecessarily more expensive than it needs to be.
My biggest problems with ObamaCare are that it's socialist and authoritarian.
If ObamaCare had surprised the hell out of me by being all about individual freedom and free market solutions, believe me, a lack of transparency is the last thing I'd be complaining about.
The problem is that no program will succeed the way the populace wants it to succeed (free visits to easily booked Doctors without any lines, and any pills or procedures you want no charge and no questions asked) so it's going to be rated negatively no matter what. The party who last touches the time bomb will be the party who gets the blame when it explodes.
Yeah, but just about everybody can still remember when it was better.
It was only a few years ago.
Perhaps, but you'll also need to admit that most people didn't really like the 'before' situation either. Sure, it looks better now but people don't recall it as some utopian paradise either. Thus the cycle moves endlessly towards nationalized health care. You can slow the boulder coming towards you, but inevitably it will crush us.
The only possible outs I can see is if widespread clear failures of nationalized systems the world over truly begin, and frankly I believe the U.S. has enough hubris to say 'we're different' even in that scenario. Scenario 2 is where enough states try it out and it's recognized that none of them are able to make it work. Even there, though, I suspect they'll want to try it using the full juggernaut of the Federal government through their printing press, but we'll see in my lifetime I wager.
Ezra Klein (yeah I know his name is mud around here, but hear me out) makes what I thought was a fairly compelling case that what Republicans are doing now is making single-payer, probably a Medicare/Medicaid buy-in, much more likely. People losing access to Medicaid, elderly people have to pay way, way more in premiums, insurance companies charging extra for pre-existing conditions; the average person hates this stuff. The Republican plan is going to make all of that happen. Combined with the more ideological left gaining steam within the Democratic party, it seems fairly likely that something like single-payer is passed in the next 10 years.
Even as a liberal, I somehow can't be super hopeful about this ending well.
Which maintaining the current death spiral woild have avoided? You know, the death spiral that ezzie failed to predict. The rabid left will push for single payer regardless if reality. They've never let it intrude before.
RE: Which maintaining the current death spiral woild have avoided? You know, the death spiral that ezzie failed to predict.
The ACA could have been much more stable than it is now. There are ideological criticisms of the ACA, there are substantive criticisms to make the of the ACA, but one criticism that I don't buy is the one that says it was inevitably going to collapse. It's a massive piece of legislation governing the most complex portion of our society; low and behold, it needed to be adjusted. Political gridlock prevented that - along with a healthy dose of pure sabotage from Republicans. With that said, "the ACA is in a death spiral!" is an overblown concept. It needs some help, but it is far from beyond saving.
RE: The rabid left will push for single payer regardless if reality. They've never let it intrude before.
Yeah, duh. That's because they think it'll work better, for more people, than any healthcare strategy we have now.
The only 'sabotage' conducted by the republicans is not violating the law by illegally paying out even more subsidies to insurance companies. Premiums have doubled in the last 4 years, enrollment is about half of what cbo projected, and per capita medicaid costs are 50% higher than cbo projected. Take your alternative facts back to vox. It's in a fucking death spiral based on the intrinsic design. There is no 'adjustment' that can save this abominationn only ever increasing bailouts.
RE: The only 'sabotage' conducted by the republicans is not violating the law by illegally paying out even more subsidies to insurance companies.
Congress passed a law, 100% following all of the rules and norms that are associated with passing laws. It that included provisions of money to be funneled to insurance companies for X and Y reasons. These payments' legality were affirmed, several times, until Republicans finally found a judge to say otherwise.
Republicans have also blocked all attempts at correcting anything that needed correction.
But yeah, the bill was totally designed to fail. OK, then. Whatever you say.
Comgress did not pass the appropriations to pay for that bailout. Congress also passed a law expressly restricting non revenue neutral paymemts to insurers. The judge ruled in congress' favor because those payments ARE illegal no matter how much you and ezzie want them.
You don't note a single 'correction' which is very telling. The very problems you whine about in the ahca you think aren't problems in barrycare, i.e. perverted community ratings and guaranteed issue. But they can be 'fixed' the same way that socialists always want to 'fix' reality: by stealing more taxpayer money to paper over their disasters.
"Thus the cycle moves endlessly towards nationalized health care"
I would support it, but I just can not see it working here. I think there are just too many people that would work to see it fail just on principle.
It is my understanding that HMOs started to dominate in the late 70s, does it coincide with the fall of the small, independent hospitals and networks, or did they fail due to other financial pressures? Something about the HMO model that bothers me, but I am very ignorant on the subject.
Single payer is nothing more than a single, national hmo.
*hot potato
"President Donald Trump described the House version of the American Health Care Act (AHCA) as "mean, mean, mean," decorating his negative characterization with what the AP delicately termed "a vulgarity." (Jim Acosta later clarified that said phrase was "son of a bitch.") The president also reportedly said to the senators working on the secretive Obamacare revamp, "We need to be more generous, more kind."
This all doubtlessly comes as rude news to those 217 Republicans who pulled the lever for the impressively unpopular AHCA, particularly those in the fiscally conservative House Freedom Caucus (HFC)"
Why should Trump care about what the House Freedom Caucus says at this point--they already voted for the bill. The hold up right now is in the Senate, and the hold up isn't because of fiscal conservatives who think it doesn't do enough to cut Medicaid. The hold up is over moderate Republicans in the Senate who think the AHCA is a mean son of a bitch.
If Trump is being conciliatory towards those Senators at this point in time, that's because it's their support that will decide whether a bill gets passed. Why worry about an obstacle you've already cleared? He's working on the next obstacle in the way.
Smart man.
The problem is, given the Freedom Caucus almost didn't vote for the AHCA because it didn't go far enough, any changes that go through the Senate will almost certainly moderate the bill and some of the good things about it that you mentioned in your previous post.
I suspect this will make it dead on arrival in the House unless the plan is to get more moderate House Republicans or moderate Democrats to vote for it.
I think healthcare is a bust most likely.
"5 republicans liberals may grow to love in the Trump era"
Forgot the /sarc tag on this one.
something something perfect something of good something something
I keep seeing people around here say that charging people extra to get back on a subsidized plan after they've stopped paying their premiums amounts to keeping the individual mandate.
I'm nostalgic for the days when they were telling us not to let the perfect be the enemy of the good. Nowadays, I'm not sure these folks are sold on the idea that cutting Medicaid eligibility is really a good thing.
If these senators don't give Trump what he wants, he'll say nasty shit about them on the twitters. AYFKM? How about repeal Obamacare root and branch or I'll whack you in the head with a goddamn ball-peen hammer? You fucking pussy-ass sonsabitches, this is how you got Trump in the first place, you dickless wonders. If you had a single ounce of principles or courage or leadership you'd start dragging worthless cunts like Murkowski into the Senate cloakroom and beating them to death with a chair leg.
To the extent that ObamaCare is unpopular, it's unpopular because middle class people know their healthcare isn't as good as it used to be--and it costs more.
Get into specifics, and people like certain aspects. They don't necessarily want to see Medicaid cut. They don't want to see people with preexisting conditions refused insurance, etc., etc.
The best thing about democracy isn't that you get what you want. You get what you want from capitalism, entrepreneurs, and online shopping.
The best thing about democracy is that you get to kick the bums to curb periodically. If Congress were trying to do something unconstitutional or start an unpopular war, I might feel differently, but taking the lead on making the healthcare system better in various ways maybe isn't like that.
They'll have to face the voters for whatever they do. If the healthcare system improves because of their changes, in quality and price, they'll get to take that to the voters, too. I have no problem getting out ahead of the voters on spending and regulation issues like this. There is a place in the world for leadership.
You know, 50% of the American people have a below average IQ. They should still have their rights respected, and they should still be free to make choices for themselves--even if it's only a qualitative basis. But, you know, 50% of the American people do have a below average IQ.
The best thing about democracy is that you get to kick the bums to curb periodically.
I don't see much of this happening lately. Or really throughout my whole life for that matter.
Go ask John Boehner.
Ask George H.W. Bush.
Go ask Hillary Clinton.
All these bums were kicked to the curb.
If these senators don't give Trump what he wants, he'll say nasty shit about them on the twitters. AYFKM?
I don't understand how a bot that selects randomly from any of the almost 70 times Trump promised to repeal and replace Obamacare and retweets it every time he mentions your name, district, opponent, etc. wouldn't solve this problem.
I mean, he either shuts the hell up or proliferates a bunch of his own quotes with words like 'terminate', 'end', 'big lie', 'day one', 'horror show', 'totally and absolutely', etc.
Zed's Scalia's dead, baby.
I don't have medical insurance, I have Kaiser.
Kaiser only operates in California and Colorado, so you might not be aware of this. And even there it's spotty.
Kaiser works on a membership model. If you join Kaiser you get what get what Kaiser offers. There is zero paperwork involved. They will treat you from anything from a blister on your finger to terminal cancer with palliative care with no paperwork. Your green fees, so to speak, go up with age, weight, smoking, and a number of other actuarial considerations. But not through the fucking roof. Medicare is required for that boundary.
They may not entertain your desire for a full body scan if you have a winter cough, but I don't see anything lackluster in their treatment.
I just want point out that Kaiser is another business model aside from private and public health care.
We also have Kaiser, and I have to say they're not half bad. There are cracks in the system, but I think of them like the mcdonalds of health care, you won't be wowed but they'll get the routine stuff done competently.
Kaiser only operates in California and Colorado
I have Kaiser and I live in Maryland.
I just want point out that Kaiser is another business model aside from private and public health care.
It's an HMO, which is private.
Whu . . . why?
Seperate but equal branches my arse. This is a hangup on the bastard scenario if I ever saw one.
Thought the same thing.
When you get a phone call from the president and that's followed up by a phone call from the president, followed up by a phone call from the vice president?it needs to get done.
Or you could grow a spine, tell them you don't work for them, and talk to some constituents.
Reason Magazine has almost as much spine as the Republican Congressmen. Once again, we have this article about healthcare with not one scintilla of a suggestion about what to do. REPEAL the damned thing and tell Americans to buy catastrophic healthcare insurance. Remove the barriers to interstate sales and non-traditional insurance groups. Problem solved. It'll get cheap in a big, big hurry. End the requirement for a prescription. Outlaw the necessity of certificates of need for healthcare facilities.
Healthcare will get cheap when the government quits paying for it.
You are right, but you stumbled into an iron law:
[Fill in the blank] will get cheap when the government quits paying for it.
If that's not an iron law, it should be. We can all it the "Johnimo/ace_m82 law". Rolls right off the tongue.
Not sure why it's taken for granted that Jeff Flake and Ben Sasse are automatic "YES" votes on this either.
Flake's pretty libertarianish as senators go, and Sasse is among the top five fiscal conservatives.
Even more importantly, both explicitly refused to endorse or vote for Trump, have been singled out by Trump for scorn, and I'd think are impervious to Trumpian pressure.
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