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The GOP’s Obamacare Repeal Bill Is Dead Because Trump Doesn’t Understand How Health Policy Works

It's hard to make a deal on a policy deal when you don't care about the policy.

Nobody knew health care could be so complicated! Molly Reilly/SIPA/NewscomThe House bill to partially repeal and replace Obamacare is officially dead.

The American Health Care Act (AHCA), which was scheduled for a vote this afternoon, has been pulled from consideration. The move means that GOP's years-long quest to repeal and replace the health care law has failed. For the foreseeable future, at least, Obamacare will stay on the books.

President Trump stumped for the bill aggressively over the last several weeks, and White House Press Secretary Sean Spicer said today that the president "left everything on the field when it comes to this bill." But in the end Trump couldn't make it happen.

The GOP legislation was ill conceived from the start. Partly as a result of the need to follow a special process that would allow the bill to pass with a simple majority in the Senate, it left much of Obamacare's essential structure in place—including insurance regulations, subsidies paid through the tax system for individuals purchasing coverage on the individual market, and a mandatory penalty, assessed by insurers, for those who go without coverage and seek to regain coverage.

The bill would have transformed Medicaid into a per-capita block grant system, but not until the next decade, and in its initial form would have created incentives for states to expand the health program. It also would have resulted in individual insurance premiums rising 15 to 20 percent in the short term, and some 14 million people losing their insurance as of next year, according to the Congressional Budget Office. A final amendment to the bill, released late last night, might have sent the individual market into a complete and immediate meltdown.

The bill failed in part because it could not establish a balance between the concerns of moderate Republicans, particularly with regard to the way it treated the Medicaid expansion, and more conservative members of the House Freedom Caucus, who argued that the bill was too much like Obamacare, retaining its core scheme of subsidies and regulations.

But it also failed because Trump proved himself an ineffective negotiator and dealmaker—one whose preference for shallow political victories over substantive policy wins ultimately proved insufficient in a complex policy negotiation.

Throughout his life, Trump has portrayed himself as a master dealmaker. As far back as 1984, for example, he argued that the U.S. government should let him manage the nuclear arms negotiations with Russia. "It would take an hour-and-a-half to learn everything there is to learn about missiles," Trump, who on the campaign trail did not know what the nuclear triad was, told The Washington Post at the time. Trump has never been focused on details. The deal itself was always more important than what was in it.

As House Republicans moved towards a vote on the health care bill, GOP lawmakers characterized his role similarly. This week, in advance of meetings with Republicans who opposed the bill, Rep. Patrick McHenry (R-North Carolina) called Trump "the closer." Final support for the bill would be won by Trump, who would use his skills as a dealmaker to push it over the finish line.

Trump repeatedly promised to repeal and replace Obamacare with "something terrific." But he never described the policy mechanisms of the replacement he preferred. And the outcomes he described—coverage for everyone, lower premiums, no changes to Medicaid—had little or no connection to the bill that House Republicans eventually drew up.

That didn't seem to matter to the president. As has always been the case with Trump, making a deal—any deal—was all that mattered.

In the end, though, the bill died. Trump couldn't close the deal. And one of the biggest reasons that Trump couldn't close the deal is that he didn't understand or care about the details.

There was little evidence that Trump understood the bill, or that he cared much about what was in it.

"[Trump] is more interested in a win, or avoiding a loss, than any of the arcane policy specifics of the complicated measure, according to a dozen aides and allies interviewed over the past week who described his mood as impatient and jittery," The New York Times reported today.

Trump spent the last two weeks selling the House plan. He met with specific individuals and with various congressional factions opposed to the bill. He personally called the offices of more than 100 legislators. He has cajoled and threatened, telling those who refused to back the legislation that they would lose their seats. He threw the entire weight of his personality and the office of the president behind the vote, saying that he backed the bill "one-thousand percent."

But he never took the time to explain to either the public or congressional Republicans what the bill actually did. He did not make a case for the bill's policy merits, preferring instead to describe it using generic superlatives. Contrast that with President Obama, who traveled the country making the case for his health care overhaul, and made a major prime time address outlining its provisions.

Trump, in contrast, was, by virtually all accounts, indifferent to the policy content of the bill so long as it passed and he could say that he had fulfilled his promise to repeal and replace Obamacare.

Even that claim, however, would have glossed over important details. The bill only repealed parts of Obamacare, and it left many of its fundamental assumptions about the nature of health policy firmly in place. If anything, it made those assumptions even more difficult to upend by giving them bipartisan cover.

The bill Trump backed made no attempt to balance either the policy or political interests of the legislators, influence groups, or stakeholders involved. Trump spent the week negotiating changes to the bill, but because he neither cared nor understood what was in it, and what lawmakers wanted from the bill, he couldn't act as an effective negotiator. A handful of last minute updates to the bill intended to pick up holdout votes backfired: One reduced the bill's projected deficit reduction, while another was so imprecisely drafted that it ran the risk of killing the individual insurance market entirely, while leaving the federal government in control of the regulations it was supposedly devolving to states.

Trump, of course, shares some blame with Speaker of the House Paul Ryan. Ryan led the drafting of the bill, and the legislative process. The bill he put together didn't really make sense, in large part because it was never really a health policy bill. The AHCA was a setup for tax reform designed to make it easier to permanently cut taxes in a future piece of legislation.

But it was Trump who managed the negotiations. It was Trump who was expected to seal the deal. And it was Trump who ultimately couldn't make it work.

Health policy is hard because all of the policy pieces are interconnected. The various policy pieces, meanwhile, are just as interconnected with the politics, which is just as complex. You can't separate any of it, and adjusting any one part of the system inevitably means a cascade of additional adjustments will be necessary further down the line. It's a system of trade-offs, and Trump didn't know or care what those trade-offs were.

This is the danger of a president who is so disinterested in policy particulars, especially when, like Trump, he expects to maintain a central role in the process. Trump's character—his personal style and his habits of mind—prevent him from effectively negotiating complex legislation. And in this case, it meant that even with control of the White House and both chambers of Congress, Republicans couldn't put together an Obamacare repeal bill that could pass, or was worth passing. It's a problem that is likely to continue to haunt conservative policy goals for as long as Trump is president.

Trump didn't care about the details. But health policy is all details. And it turns out it's hard to make a policy deal when you don't understand the policy.

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  • Citizen X - #6||

    I like making deals, preferably big deals. That's how I get my kicks.

    Now we know: Donald Trump's euphemism for peeing on a hooker is "making a deal."

  • Quixote||

    They have known all along, of course, that this absurd plan would fail. It was designed simply as more disorientation, more "kicks," the fundamental purpose of which is to distract the American public from the outrageous "First Amendment dissent" of a single, isolated, so-called judge in our nation's leading criminal "satire" case. See the documentation at:

    http://raphaelgolbtrial.wordpress.com/

  • DenverJ||

    That poor dead horse still won't pull the plow? Beat or some more, I guess.

  • Austrian Anarchy||

    It was never asserted that the pee receivers were hookers either. The assertion was the pee givers, to a bed, were the hookers.

    However, the Chuck Berry video clearly shows a male as the pee giver. Seems many a commentator is convoluting these men.

  • colorblindkid||

    For Christ's sake can we just put Amash in charge of the House. Rand Paul's an actual fucking doctor. How about we let him help out? For Christ's sake these Republicans are useless. Let the freedom caucus write a bill.

  • Damned||

    Rand Paul's an actual fucking doctor
    Pretty sure he fucks. Say, wasn't Tom Price a fucking doctor too? And Price did not self-certify his degree.

    Amash (or Massie) would be awesome, if you want to get nothing done, but have generally the consistent principles one would expect of conservatives.

  • BYODB||

    Getting nothing done sounds pretty good. Rolling things back sounds even better. Unfortunately, at this point we have about 100 years of government interference in the health markets to roll back.

    Odd how idiots seem to think that this next centralized command and control scheme will fix all the problems that arose from the last scheme. Around and around they go.

  • Damned||

    Getting nothing done sounds pretty good.
    The mantra of Republicans who do not get their way!

    I'd be all for voting in people who run on the platform that they'll not let anything get done. That is never the case. So what happens is this ideological obstruction, that increases in volume every couple of years till one side breaks through and ramrods every single wish on their wishlist. That then collapses, and we start back at one.

    Rolling back is great as long you announce that there likely will be consequences that are disastrous because the rollback is all immediate and all now to a point 100 years ago that no one can relate to. Not even the ones who are more than 100 years old.

    And when one bickers too much about the phasing, well, nothing gets done.

  • epsilon given||

    Actually, Calvin Coolidge ran on being nothing done, and that's how he ran his Presidency. His Presidency did very well, too.

    The two Presidents who came after him insisted on meddling with the economy, and have a decade-long Depression and a World War to show for it.

    So we have at least one example of "Getting nothing done" being good for the country.

  • Diane Merriam||

    No, Dr. Paul didn't self-certify. He originally certified under the old group. He simply got together with a group of like minded doctors that thought different and more modern areas and methodologies were more important than the old ones to create a new organization. Somehow I don't really see that as a problem.

  • JFree||

    Republicans now own Obamacare. If/when it goes down, so will Republicans. And the GOP will kill off the Pauls/Amashes even before that.

  • epsilon given||

    I don't think this is true at all. The Democrats are still the ones who own ObamaCare; they are still the ones who passed it. Republicans are the spineless jerks who couldn't repeal it.

    Had they passed this bill, they would have been the spineless jerks who claimed ObamaCare as their own, and destroyed the market to boot. I was glad the bill died, and that was before I knew details like the last-minute amendment. The more I learn about the bill, the more I'm *very* glad it died.

  • Get To Da Chippah||

    As long as Progressives CLAIM to be seeking what people have wanted for over 400 years, they'll keep kicking ass of the today's fraudulent free marketers.

    Progressives CLAIMED that the people wanted Obamacare. How'd that work out for them in the next three elections?

  • Fist of Etiquette||

    That was never the quest. It was a years-long quest to garner votes over the apparent attempt, at which they were very successful. I have a feeling that streak has just come to an end.

  • Damned||

    They could have passed the December 2015 repeal because that passed.

    But that was just because the black guy was in office

  • Jerryskids||

    That bill only passed because they knew it would be safely vetoed, they were betting on having eight years of Hillary to campaign against and they never expected their bluff to be called.

  • colorblindkid||

    Not all of them. Just Paul Ryan and most of the mainstream GOP guys. Freedom Caucus guys mean business. Let them run the show for awhile. The insanity of this last year made people forget that the GOP is comprised of two warring factions.

  • JFree||

    There is no such thing as a party with warring factions. If they have warring factions then they are two parties not one. And if the freedom caucus is at war with the GOP, then they will be primaried and eliminated in 2018.

    GOP is now the party that owns Obamacare.
    Dems are the party that can offer an alternative - single payer.
    Freedom caucus are the traitors who forced the GOP into being the party that owns Obamacare.

    That's how the storyline will play out.

  • Trumptard||

    Glad the crappy bill is dead. Obamacare is not safe, though. Legislators will work toward a better bill over the next six months.

  • Fist of Etiquette||

    One would hope. But then, one hoped that they had been working on a better bill for the past six years.

  • Damned||

    While they were busy railing against the black guy for everything ?

    They had no time.

  • MarkLastname||

    "The black guy...'
    I suppose it doesn't occur to you that you're inadvertently satirizing your own racism more than anyone else's.

  • Trumptard||

    Depends on who "they" are. There are plenty of good ideas out there that range from tinkering to a full-blown scrapping of the system. We can get a much better bill, it needs to come from outside the House/Senate leadership and the white house.

  • Tak Kak||

    Or because he didn't really care.

  • Trumptard||

    Suderman? Has Suderman ever put forward his ideas for reform? I have never seen anything from him. Would love to. Nick, Matt, and Katherine please make it happen.

  • Sevo||

    "Suderman? Has Suderman ever put forward his ideas for reform? I have never seen anything from him."

    'tard, Suderman isn't in congress. He writes about what has happened.

  • Trumptard||

    He has no opinions on what to do? I thought he was some healthcare expert? I see him poo-pooing ideas, but I never see his ideas.

  • Damned||

    He is a reason.com libertarian. What did you expect?

  • Sevo||

    Trumptard|3.24.17 @ 4:02PM|#
    "I thought he was some healthcare expert?"

    Never saw such a claim.

  • Citizen X - #6||

    Simple Mikey's obsession with other dudes' dicks once again, uh, rears its head.

  • Crusty Juggler - #2||

    Jerking his rigid, veiny man-meat, over and over, and over and over, syncing powerful hip thrusts with each stroke.

    YOU'RE ALL GAY!

  • Trumptard||

    Let health care actuaries write the bill.

  • Damned||

    Laughable

    It is easy to make a deal when you don't care about policy.

    Drumpf wanted a bill, any bill. He failed at the simplest of deals in deal-making: all deals were acceptable and he could not get one

  • Sevo||

    Damned|3.24.17 @ 3:55PM|#
    "...Drumpf wanted a bill..."

    Oh! Oh! Look how clever our lefty loser is!
    She lost, loser. Get over it.

  • Damned||

    Whereas you won?

    Go suck Drumpf's taint

  • BYODB||

    This is actually a cogent thing to say, frankly, at least according to Sudermans article and from the rolling disaster we've watched for a few weeks now. For once I think he might have hit the nail on the head as well. Trump is a hot mess of idiocy, I think everyone saw that coming and most of us said the one good thing we hoped for were decent Supreme Court picks.

    So far, that seems pretty prescient.

    Of course, I still think you're an idiot troll but even a stopped clock can be right twice a day.

  • Not a True MJG||

    What about that EO of his stopping the IRS from penalizing the uninsured, if I'm remembering it correctly? Is that still in effect in our perpetual PPACA world?

  • Fascist loofa-faced shitgibbon||

    IIRC, the law remains. The EO stopped the IRS from "rejecting" tax returns from those who left the insurance question blank.
    The punishment is dormant, but alive.
    Like Tony's syphilis.

  • Adam330||

    You just didn't realize that when Trump said "You're going to get tired of winning," "you" was referring to Democrats. This guy is proving to be even more incompetent than I thought possible.

  • ||

    "Trump didn't care about the details."

    With all due respect neither did Obama or Pelosi.

  • Jerryskids||

    Bingo. Obamacare was all about getting the camel's nose in the tent and anything more than that was gravy. The details were merely window-dressing for getting everybody to accept the idea of socialized medicine and single-payer universal healthcare and now we're just arguing over the details of how to make it work. (Spoiler alert: It'll work just fine once we discover the necessary magical powers.)

  • JilliBrown||

    Bullcrap.

    Obama was able to speak cogently and comprehensively on the aca, he did multiple pressers responding to questions.

    The aca was an actual healthcate bill, unlike the ahca. There were set goals when the aca was crafted, constructive goals like reducing costs, which it has done, and reducing the rate of uninsured, and providing quality care and improving medical efficiency and effectiveness. The repub "plan" that, btw, took over 7 years was nothing but tax cuts for millionaires. Big fail.

    Denying reality doesn't change the actual reality. You get that, right?

  • Palin's Buttplug||

    Rufus is the site's moron.

  • JilliBrown||

    She was certainly proven to be a much better leader and deal maker than trump.

  • ||

    As this health care bill drama has been playing out, I've been struck by the degree to which this has been exclusively a Republican exercise. I haven't seen even the tiniest hint of an effort to swing any Democrat votes in favor of the bill.

    During the election, Trump may not have done much, but he did make some efforts at collecting Democrat voters to his side, possibly swinging the different in one or more swing states. I've been surprised to see no such efforts involved in governance.

  • Jerryskids||

    The Dems are no more interested in helping the GOP eat this turd sandwich than the GOP was interested in helping the Dem's eat the original turd sandwich.

  • BYODB||

    It is actually a mystery on why they wouldn't seek Democrat support in reforming the ACA since effectively the GOP gave up on any pretense of repealing it.

    That being said, it's not much of a mystery. If you're a Democrat right now, you are 100% safe in going full-block obstructionist against Donald Trump. There is zero risk. Now, even if you cross the aisle for a good idea (and make no mistake, in health policy there are no good decisions possible) you will still get primaried by someone who says 'they worked with TRUMP'.

    Essentially, the GOP voted in the Anti-Obama in a lot of ways. He's a lightning rod that will polarize voters and will serve as a 'get out the vote' to allow the Democrats to get their majority back. Leaving the ACA in place might be their best option if they can not repeal as promised (no replacement jerkweeds), because if they alter the ACA in some fundamental way (or even just superficially) it will empower the left to institute a full-on takeover of the health system. If the ACA is still in place, Democrats will have a hard time replacing their own program.

  • MarkLastname||

    I think the essence of it is this:

    The GOP wants to repeal Obamacare for symbolic reasons but is willing to keep the bulk of the substance of it.

    The Dems want to oppose any Republican alternative for symbolic reasons but are willing to compromise on some of the substance of the actual ACA.

    Progress could be made in the right direction (less government regulation of service and prices, more consumer choice, more fiscally sensible) by peeling off a few Democrats if the GOP stuck to nominally keeping the ACA but overhauling it.

    The problem is, keeping it at all is seen as a concession to the Dems.

    Meanwhile, if the GOP proposed the exact same thing as the ACA under a different name, most Dems would find some fault with it and veto it because they want to be seen as sticking it to the GOP.

    In the end it's mostly about 'optics.'

  • JilliBrown||

    The dems will oppose, for good reason, any crap sandwich that increases instead if decreases the number of uninsured. They'll oppose plans that reduce benefits and increase costs.

    Basically, they'll oppose proven failures and destructive policy. What's the problem? It's what responsible legislators, adults, would do.

  • JilliBrown||

    The dems will oppose, for good reason, any crap sandwich that increases instead if decreases the number of uninsured. They'll oppose plans that reduce benefits and increase costs.

    Basically, they'll oppose proven failures and destructive policy. What's the problem? It's what responsible legislators, adults, would do.

  • JFree||

    Democrats are in pig heaven now. They have an alternative - single payer. They can get it passed - unlike the GOP. And they no longer need to worry about ACA failing - cuz that responsibility is now on the governing party the GOP. They are going to go fullthroated single payer now with no need for half measures like ACA.

  • JFree||

    Rather - they can get it passed once that's what they campaign on in 2018 and get the majority back.

  • Get To Da Chippah||

    The R's only have 8 Senate seats up for reelection in 2018, while the Ds have 25. No way Team Blue retakes both houses in 2018.

  • ||

    I was going to laugh at your stupidity, but then I remembered the Trump is actually a Democrat. Good point.

  • ||

    As this health care bill drama has been playing out, I've been struck by the degree to which this has been exclusively a Republican exercise. I haven't seen even the tiniest hint of an effort to swing any Democrat votes in favor of the bill.

    During the election, Trump may not have done much, but he did make some efforts at collecting Democrat voters to his side, possibly swinging the different in one or more swing states. I've been surprised to see no such efforts involved in governance.

  • Jury Nullification||

    adiggs says "I've been surprised to see no such efforts involved in governance."

    A tool, fool and a stool. Congrats on your personal trifecta. Roll like a troll.

  • ||

    Good. Maybe next time they will actually try to repeal ObamaCare.

    The bill failed because it didn't do what it claimed to do. It wasn't a repeal. It was a half-assed repackaging that left all of the key features of the ACA completely intact.

    Try harder.

  • Citizen X - #6||

    This is very important to note:

    It wasn't a repeal. It was a half-assed repackaging that left all of the key features of the ACA completely intact.

    Which is the Stupid Party and which is the Evil Party is often very, very hard to tell.

  • Delius||

    One is stupidly evil, and the other is evilly stupid.

  • Fatty Bolger||

    ^^^ This

  • mortiscrum||

    At a basic level, the ACHA was too conservative for one faction of the GOP, and not conservative enough for another faction. I fail to see how doubling down on the very thing that ultimately led to the ACHA going down in flames (stripping away popular regulations on the insurance industry) is going to get a bill passed.

  • MarkLastname||

    Well plenty of good alternatives have been proposed to such regulations such as tax credits for some pre-existing conditions, which would be consistent with a voucher type system.

    But your right; more generally, no fiscally sensible reform ever will be passed because that's not what the voters want. They erroneously blame insurance companies for high costs, so they want a bill that fucks the insurance companies (then of course subsidizes them discreetly to make up for it) and gives them free stuff that they will never have to pay for.

    For this reason almost by definition whatever passes will be horrible.

  • Gracchus||

    Well plenty of good alternatives have been proposed to such regulations such as tax credits for some pre-existing conditions, which would be consistent with a voucher type system.

    How is that substantially different from the ACA? Tax credits for preexisting conditions only work if you keep the ban on discriminating against preconditions; no tax credit will be big enough to get insurers on board.

    The way I see it, there are only two ways to reform healthcare. One is single-payer. The other is high-deductible plans with catastrophic coverage and HSA's (along with keeping Medicaid for the poor). And the ACA seems a lot closer to option (B) than option (A).

  • MarkLastname||

    Insurers would at least be able accurately price risk.

    I'd prefer as much as possible be paid for with HSAs and the like, but I think it's inevitable at this point that there is going to be some kind of redistribution toward people with pre-existing conditions as that's where the public sentiment is at. I'd rather it be in the form of tax-and-redistribute than regulations and price controls.

  • ||

    There are a few things they could have done that would have won over libertarians. Number one, they could have made it tax neutral to buy your own insurance and killed the employer mandate/penalties. Now, that wouldn't kill the employer-based system right away, but it would have removed the incentives that favor it. Then you top that by stripping down the essential benefits and the community rating mandates so that people can self-select their insurance plan depending on their self-assessed risk level (buy a stripped down plan if you're healthy). Then lastly, you leave the individual mandate technically in place but make it so catestrophic-only coverage counts to avoid the penalty.

    The surcharge thing was bullshit. Thing is we WANT to cause a death spiral in most of the individual market. We want everyone to wind up with catestrophic coverage and HSAs. But if we want people off their employer based plans first. Otherwise you solve nothing. The R's couldn't bring themselves to kill the tax deduction for employer-based care, but they could at least have made it tax neutral so that employees could opt out and buy their own policies.

  • JilliBrown||

    Cmon, it was a means to deliver tax cuts to the wealthiest, not a healthcare bill.

  • Azathoth!!||

    I don't recall ever actually hearing Trump say he wanted this bill--oh, make no mistake, I heard the media screeching that he wanted it, that he wanted this bill badly--and that if it didn't pass it would reflect poorly on him.

    But I didn't see the usual tweetstorm. Or the snide comments.

    So I'm thinking that Trump didn't actually like it, but the media needs to act like he did so they can maintain the screeching that seems to be all they've got left since November.

  • Adam330||

    Is this going to be story? He never really supported it? The media just made it up? Wow.

    Just go on over to his twitter page. It's got dozens and dozens of tweets in support of the bill.

  • Jerryskids||

    That's always the story when you don't get what you want - you don't care because you didn't really want it in the first place. If you had cared enough to want it, you could have easily gotten it, though. Don't you remember when you were about 8 years old and used that line when you lost, hoping nobody would see how close to crying you were? Trump remembers.

  • Not a True MJG||

    TDS goes both ways.

  • Damned||

    Oh how the Drumpfistas are spinning this already!

    Just from this morning, http://bit.ly/2nNPQ9C

  • ||

    And I thought that it was conservatives who were being cuckolded.

    Trump could fuck someone people's wives and they would thank him for the privilege.

  • Diane Reynolds (Paul.)||

    The GOP's Obamacare Repeal Bill Is Dead Because Trump Doesn't Understand How Health Policy Works

    This statement makes perfect sense in a logical world. But why didn't the same logic kill Obamacare?

  • Fatty Bolger||

    The problem with Suderman's thesis is that the more negotiation there was, the worse the bill got.

    One of the reasons the ACA is so awful is because the extended negotiations piled in more and more bullshit until the bill was a monstrosity. And Obama's stumping around the nation trying to drum up support actually had the opposite effect, and created strong opposition. I mean, Massachusetts elected Scott Brown for the sole purpose of defeating the ACA. Massachusetts, fer chrissakes! The only reason it passed was because voters were stupid enough to give Dems a filibuster proof majority in the Senate, and even then they had to pull every trick in the book to ram it through.

  • UCrawford||

    Except, as Thomas Massie noted, those negotiations didn't actually include very many people who planned to oppose the bill. They were selling it to people who didn't care about repeal. That's not enough votes to pass...and it's certainly not a pitch that's going to cause conservatives to betray the people who demanded they repeal.

  • balff||

    Trump repeatedly promised to repeal and replace Obamacare with "something terrific." But he never described the policy mechanisms of the replacement he preferred. And the outcomes he described—coverage for everyone, lower premiums, no changes to Medicaid—had little or no connection to the bill that House Republicans eventually drew up.

    And now that Trump's term is up, the promised deal will never materialize.

  • loveconstitution1789||

    Health policy is hard because all of the policy pieces are interconnected. The various policy pieces, meanwhile, are just as interconnected with the politics, which is just as complex. You can't separate any of it, and adjusting any one part of the system inevitably means a cascade of additional adjustments will be necessary further down the line. It's a system of trade-offs, and Trump didn't know or care what those trade-offs were.
    Its not hard unless you want government involved in every facet of health care and health insurance.

    Repeal everything and let free market right the ship.

  • american socialist||

    That would be nice but it won't fly. Also i think they need 60 senate votes

  • Rational Exuberance||

    Repeal everything and let free market right the ship.

    Actually, we can do the same thing some other countries do: give people the choice between a highly regulated "public" system (similar to the ACA) or a private system. If you pick the private system, you're on your own. And if the public system isn't properly managed, it simply collapses as people flee it.

  • Bob Meyer||

    People hated Obamacare until the Republicans threatened to end it. They forgot about having been lied to. They didn't get to keep their plans or their doctors. They didn't get premium reductions of $2500. What did the Republican plan do to address this?

    Did the Republican plan offer new choices in insurance coverage? No. Did it offer lower premiums? No. Did the Republicans explain that the system would collapse because young people weren't willing to buy insurance that they didn't need? Did they explain that Obamacare was a massive redistribution of wealth from the relatively poor young to much wealthier older people?

    Trump couldn't explain this because he didn't understand it. Ryan couldn't explain it because he didn't care about it. He only wanted to pass a bill. Amash and Massie understood this but no one listened to them.

  • american socialist||

    This

  • AlgerHiss||

    "People hated Obamacare until the Republicans threatened to end it."

    No, they've never hated it. Never.

    When this socialist shit passed in 2009, the "American people" may have blown some tail feathers and acted all "American Freedom" like. But that was nothing but bluster. The current citizen is quite comfy with huge, mammoth government.

    Yeah, the "American Citizen" hated OC so much, they re-elected the little Marxist in 2012.

    All of this freedom and liberty talk is nothing but meaningless twaddle. Leftists have nothing to worry about.

  • Bob Meyer||

    The House turned around in 2010 primarily because of Obamacare. The TEA (Taxed Enough Already) parties got their boost from Obamacare and it took the combined efforts of the Democrats and the Republicans to break the Tea parties up using social issues as the wedge.

    The first tea parties were 50/50 splits between libertarians and social conservatives. Inject a little abortion, some gay marriage and just a pinch of marijuana and presto! the Tea parties are gone. We're left with Katrina Pierson looking for a leader to latch onto.

    If you want to know how much people reviled the ideas behind Obamacare then remember what Peter Gruber said was necessary to pass it - lies and gullibility. How much love would there be for Obamacare if it was sold honestly:

    "We got a program here to rob your children to subsidize your parents, a program that will drive costs through the ceiling and cause doctors to retire. A program that will double insurance company profits, increase unemployment, crush small business and guarantee you a lower standard of living."

  • Fascist loofa-faced shitgibbon||

    "The GOP's Obamacare Repeal Bill Is Dead Because Trump Doesn't Understand How Health Policy Works"

    What exactly does Trump have to do with the Bill at this point in the process, besides cheerleader?

  • Fascist loofa-faced shitgibbon||

    I said "besides cheerleading". WTF are you talking about?

  • David B.||

    "We have to pass the bill to see what is in the bill" doesn't fly with the Republican constituency. It made me laugh about how Obama went around the country and sold it's details. Who voted for this garbage to begin with???

  • Palin's Buttplug||

    A dumbass comment.

    The actual Pelosi statement was "We have to pass the bill so YOU can see what is in it". The ACA had been a victim of lies like "Death Panels" for over a year.

  • MarkLastname||

    Poor ACA, always getting mean things said about it when deep down we all know it's the bestest thing ever.

    Also, what lunacy makes you think that context makes the statement better? You're trying to convince me that Pelosi is a deceptive cunt who concealed information from the public to pass that atrocious bill as opposed to merely a gullible moron who doesn't know how to read legislation.

    Alright I'm convinced. Now what.

  • Rational Exuberance||

    The ACA had been a victim of lies like "Death Panels" for over a year.

    The fact that the ACA doesn't have death panels is actually one of its major problems: if you have government guarantee health care and care for preexisting conditions, you need to set conditions under which health care is not provided anymore in order to control costs. Death panels is how other nations make their highly regulated health care systems work; they are essential.

  • Bob Meyer||

    Rahm Emanuel's brother Ezekial wrote a paper about this which advocated cutting "scarce" medical services for people over the age of 50. There was an exception however, for VIPs. Important people could get that care.

    Members of the Inner Party can always get what they need under ENGSOC.

  • DavidS-T||

    "Deals are my art form"? So GW Bush isn't the only recent Republican president to be a bad artist....

  • XM||

    "President with a penchant for ego doesn't get his way because principled members of his own party won't be yes men"

    OMG what the heck is that? I bet if Trump was black, all the republicans would have voted for the bill, just like nearly all democrats voted for Obamacare when he Obama was in office. That Obama, he did really good job outlining his plans, like all of us being able to keep our plans and enjoy incredible reduction of premiums while choices and competition multiply like wild rabbits without contraception.

    Now the GOP will be forced to craft something better and avert election disaster, unlike those democrats who did whatever Obama wanted to do and got shellacked in anything that didn't directly involve Obama. I'm so mad that I want to kick someone in the nuts.

  • Longtobefree||

    Trying to use reconciliation was the strategic mistake that doomed this from the start. Obamacare was skillfully designed to fail, on the assumption that the democrats would be in power and could claim only single payer could "save" us. All of this republican trashing around was within the confines set up by the democrats, not starting with a true blank slate. The "only" problem before Obamacare was paying for the poor to have healthcare. Obamacare was a fascist takeover of 18% of the economy disguised as a healthcare bill.
    Just realize there is no competitive pressure on health insurance because only corporations or governments actually "shop" for insurance. And there is no competitive pressure on providers, because only insurance companies shop for providers, to set up networks. To allow individuals to shop, all insurance must become individually owned.
    Anyway, just forget reconciliation, and use the real legislative process to repeal Obamacare entirely, eliminate employer provided health insurance, allow insurance companies to sell whatever policies people want, and allow use of any provider.

  • MarkLastname||

    Ironically Obamacare's 'planned obsolescence ' may end up still working in the Dems' favor even though they lost the election since now the GOP is liable to get a lot of the blame for continued cost increases due to Obamacare.

  • american socialist||

    True. I think it would have been worse though had the GOP passed the AHCA and premiums continued to rise and then they would have been labeled as trumpcare or ryancare.

  • Sanjuro Tsubaki||

    Mmmm. Long live Obamacare, Reason Mag's favorite dead bill walking that for some reason won't die.

  • Palin's Buttplug||

    Remember, Obamacare is in a DEATH SPIRAL!!!

    Yet they won't let it just die because they don't even believe that bullshit.

  • MarkLastname||

    Because premiums haven't been going up fast the last few years? What alternative universe do you live in?

  • Sanjuro Tsubaki||

    ...and by the time it becomes unmanageable, the Democrats will suddenly have the power they need to ram through another fix to Obamacare. Maybe even with the help of Trump and Ryan.

  • Bruce 6225||

    Ryan and lizard boy (Mitch) are NOT the best leaders for this revolution. They stand in the way of all good things. They are the soul of the shadowy elite. They must be pushed aside before Trump can even be presented with constitutional alternatives about ANYTHING.

  • David Sims||

    It appears that there are a lot of traitors among our Republican office holders. The Democrats are traitors, too, of course. But at least they are open about it.

  • Robert||

    OK, smarty pants, tell us how you'd do it.

  • creech||

    Do you see a role for catastrophic insurance so your $250,000 proton therapy treatment for cancer doesn't break the bank at the charity hospital?

  • Dizzle||

    You're fatal flaw is your referencing a period that no longer exists and acting like we could return to it. These Christian charities no longer exist in the scope you're referencing because the churches that supported them no longer exist on that scale. The dynamics of the charitable and the amount of causes involved limit the ability to focus on a single issue the way church sponsored hospitals did.

    Even in the case of the Shriner's, who are the best example of what you describe and most certainly NOT wholey Christian, they need to partner with other Health insurerers/providers or Universities, as in the case at Rainbow Babies in Cleveland, the Shriner Hospital my girlfriend works at that's affiliated with Case Western Reserve University, in order to fully fund and execute their goals.

    If the Shriner's can't independently fund and run their own hospitals anymore, let alone maintain the cutting edge standards we expect, with all their experience in the area, it's doubtful and church or charity can.

    While your premise seems good, without MASSIVE reductions in cost or major subsidies charity won't be providing health care on its own anytime soon. And you're back to the same problem we have now.

  • american socialist||

    The logic some folks use is baffling to me. First they complain about how terrible the AHCA is (it is), and then whine when they pull it. If it was terrible wouldn't this be a good thing?

    The problem is people want goodies for themselves and others but don't want to pay for it. There is no magical bill that pols can or will do that will substantially lower premiums. This bill got rid of some things while keeping virtually all of the goodies. Thus the premiums will keep increasing and the GOP will be blamed.

    This is the best decision they have made. To not ram a crappy bill thru....it would have been nice if the dems had done it. The GOP would have hanged themselves politically for no benefit.

    The fundamental issue is people don't want free market healthcare as they are used to goodies and their emotion suggests it will be the wild west.

  • Not a True MJG||

    Damn it, Suderman, something must be done! And this was something.

  • Rational Exuberance||

    I don't get why repealing ACA is so complex. Simply give people the possibility of opting out.

    That is, if you stay within the ACA compliant insurance market, then you get the benefits, including coverage for preexisting conditions.

    If you declare (say, on your tax return) that you opt out permanently, you're on your own in the free market.

    The ACA market would quickly implode without having to repeal it.

  • XM||

    If you give people the option of opting out (meaning the individual mandate would be effectively dead), a lot of people will cancel their insurance. As Suderman noted in the past, a little over 20 percent in the pool do not receive subsidies. If premiums continue to go up, these people are screwed. And people receiving subsidies still have to deal with out of pocket costs, which is why many of them skip check ups.

    People chose to go uninsured before ACA. I was uninsured for 90% of my life. These people could turn to cheaper plans available from the market and their employers that are now cancelled. ACA limited your choices to expensive plans that guaranteed a bunch of benefits that most people didn't need. Killing the individual mandate, restoring the choices and adding even MORE choices to the market is a natural libertarian solution, or just one of them.

    What was this state of "free market" you wish to return to? You're telling me there was a time in America when the people of color, women, and the poor were all treated equally regardless of income and "paid voluntarily"?People used to pay for treatment out of pocket more and doctors used to come visit your house, but a return to those days are highly unlikely.

  • Dizzle||

    I addressed this above but it's funny you keep coming back to this charity idea. It won't work because the infrastructure for these charity hospitals no longer exists (read churches) and there are too many causes spreading the charity too thin. Even the Shriner's need partners (health insureres, providers, or universities) to offer the care they do and push for advancement, which you never mention in your theory.

    How good was that charity care? Did it maintain standards with the increasing medical advancements of its time? Did it lead to greater life expectancy?

    Most of the former charity hospitals in my area, Pittsburgh, have been defunct for a long time because they ran out of money. And most were obsolete long before that for anything other than hospice care because they weren't able to maintain the technological standards (read compete) of the health network funded hospitals that began popping up. Let alone afford any in-house research. So most became glorified nursing homes that would never have been the first choice for care for anyone.

  • Rational Exuberance||

    Why not skip all the crazy bullshit and transition back to a free market

    That is precisely what I'm advocating. I'm simply providing a politically possible way of getting there, namely for people to move voluntarily from the ACA to the free market.

    You would intentionally accelerate the death spiral -- then blame progressives for the damage YOU created.

    Progressives created the death spiral: the ACA simply isn't sustainable. The only question is whether it spirals towards a single payer public system, like Democrats intended, or whether it spirals towards a free market solution. In order for it to spiral towards a free market solution, you need to give people the option of leaving the ACA.

    Why do you oppose the proven outcomes of a free market?

    I do favor the proven outcomes of a free market, you're simply too senile and hostile to recognize it, as usual.

  • Elwar||

    This article just goes on and on about how Trump is to blame for a bad bill not going through.

    Would it have been a success for Trump if it had?

  • Anarchist||

    Oh look, another (((Suderman))) hit piece on Trump. He and The Jacket are as predictable and tiresome as CNN and Huffpo. The responsibility for this ill-conceived bill lies squarely at the doorstep of Paul Ryan and his cadre of RINO establishment statists. Corrupt, spineless, ineffectual cucks.,,the lot of them.

  • Anarchist||

    Trump never released a detailed healthcare bill while campaigning so your description of MASSIVELY larger gummint is just a lie. Keep spreading your yeshiva-sponsored bullshit Hihn.

  • buybuydandavis||

    It failed because half the Republicans are the Washington Generals, addicted to losing.

    "I wanna unicorn pony that craps diamond gum drops!"

    It's just idiotic. They could pass *something* anytime they want to through reconciliation. They could have made the US incrementally better, and given the administration more legal authority to do more on the regulatory side to make things *better*.

    Instead, they threw a tantrum for their magic unicorn pony, with which they accomplished *nothing*.

    For all the predictable TDS bitching about Trump from Suderman, he didn't have a vote in the House. This is a complete failure of House Republicans to get their shit together. They have effectively voted for status quo Obamacare. They managed to send a bill to Obama's desk. Didn't manage to send one to Trump's desk.

    Washington Generals.

  • SelecaoUSA||

    And not being a comment section bully isn't yours, it seems.

  • ipolitics123||

    The Republitards had SEVEN YEARS to figure out an Obamacare replacement. Trump isn't the problem, they are. They've gotten so used to being perpetual losers that when they actually have a chance to win, they collapse like a house of cards.

  • wareagle||

    and in that seven years, perhaps it became glaringly obvious that no replacement is possible: http://www.investors.com/polit.....re-system/

    The NHS is falling apart, O-care's existing problems will only worsen, and there are the examples of VA and Medicaid. Around here, we often talk about how "do something" is often the worse reason for doing something. Even the Stupid Party might eventually learn that.

  • SelecaoUSA||

    Right, so your plan, which you can't get through anyway because you are a washed-up politician yourself, is what exactly?

    Ha, the Reason comment section cry-BULLY! strikes again.

  • SelecaoUSA||

    Something tells me that even transition would be borked. The current system isn't even going to allow it with the losers that are in right now.

    In essence, we're screwed until the whole system gets gutted out from under these "progressive" losers.

  • eyeroller||

    Look, the point of this whole thing is that Republicans have the power to repeal Obamacare, and they're not going to do it.

    Of course they aren't going to do it. They were never going to do it. Republicans love socialized medicine. (It's a bonus if Democrats take the blame for the problems, but the illusion can only be maintained so long.)

  • Praveen R.||

    Obamacare needs to be revamped big time. But Donald seems to have no idea what to do.
    As far as his business genius, easy to be one , when you get multiple opportunities to go bankrupt, rip apart agreements, use lawyers to wear out small businessmen from collecting from you what you owe them. The guy is a spoiled brat who was allowed to get his way for decades without any accountability. He is not learning anything new now.

    And now on display is this guy's lack of focus on anything. He just rambles on hoping something will stick, can't even stay focused for a weekend, has to take frequent golf breaks(funny how this guy liked to bash others for that).

    Seriously, we have so many brilliant businessmen. Cant we get just one who can be willing to run for politics? The Donald is no dummy. But he has become one because he is allowed to be mentally lazy.

  • ||

    This article just assumes healthcare policy "works" in the first place.

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