The prospects for the ‘repeal and replace’ Obamacre plans

I wrote a month ago that I expected that after all the posturing ends and the dust settles, all 52 Republicans in the US Senate would do what they always do, and that is dutifully fall in line and vote as demanded by the party leadership and president Donald Trump to gut the health insurance of tens of millions of people while giving the wealthy a tax cut.

The fact that Republican senate leader Mitch McConnell failed last week in his efforts to get sufficient party votes to bring his health care bill to the floor or even the more simple bill to just repeal the Obamacare legislation with nothing to replace it would suggest that this is just the latest of my wrong predictions.

Stephen Colbert walks us through what happened.

But the issue is not dead. The problem is that bills can be resurrected by the leadership any time they want. We saw in the case of the first version of health care reform that came out of the House of Representatives, speaker Paul Ryan was similarly forced to withdraw consideration of his bill because of the lack of votes, even though his party has a huge 240-194 majority. Commentators said that the issue was now dead for at least a couple of years. But after some arm-twisting and bribery, a slightly modified bill came back in a couple of weeks and was passed.

There were similar suggestions that after his embarrassing defeat, McConnell and the senate would not take up health care again during this Congress but now there are reports that another bill or another replacement or repeal-only bill may be brought up again as early as next week. The usual bribery-and-coercion methods are already being applied to resistant Republican senators and given that they are not people of principle, they usually have a price for which they can be bought.

So as much as I would like my prediction that Republican plans will fail to pass to be wrong, it is far too early to tell. After all, it is clear that Trump does not care at all about this issue or that he knew anything about the bills that have been proposed and withdrawn. All he cares is about giving the image of winning and having something to sign that he can claim as a win. Given that flexibility, it should be possible for the Republicans to put together a patchwork of giveaways to recalcitrant party members that will cobble together the votes to pass, even if the bill makes no sense at all or hurts many people. The joint report of the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) says that the latest July 19 version of the ‘repeal and replace’ bill will have large numbers losing insurance and the rest facing steep premium increases

  • The number of people who are uninsured would increase by 17 million in 2018, compared with the number under current law. That number would increase to 27 million in 2020, after the elimination of the ACA’s expansion of eligibility for Medicaid and the elimination of subsidies for insurance purchased through the marketplaces established by the ACA, and then to 32 million in 2026.
  • Average premiums in the nongroup market (for individual policies purchased through the marketplaces or directly from insurers) would increase by roughly 25 percent—relative to projections under current law—in 2018. The increase would reach about 50 percent in 2020, and premiums would about double by 2026.

Max Fine, one of the architects of Medicare and now aged 91, says that single-payer is the way to go and that Medicare was seen as the first step on that road but that plan was done in by the neoliberals in the Democratic party.

Fine, now 91, wrote to The Intercept recently to explain that Medicare was never intended to cover only the elderly population, and that expanding it to everyone was a goal that its architects long campaigned for.

“Three years after the enactment of Medicare, in Dec. 1968, a Committee of 100 leading Americans was formed to campaign for single payer National Heath Insurance. The campaign leaders were UAW pres. Walter Reuther, Dr. Michael DeBakey, Nat. Urban League Pres Whitney Young and Mary Lasker, a leader in the formation and funding of NIH,” he wrote.”The NY Times and other newspapers gave front page play to the announcement of the campaign for ‘Medicare for All’ but the Committee gained even more attention when, shortly before xmas, pres-elect Nixon, emerging from his doctor’s office in San Diego, denounced us as socialists who were trying to create a problem when none existed.”

Fine noted that this movement towards single payer has “risen and fallen over the years,” reaching a high point in the early 70s when former Democratic Massachusetts Sen. Ted Kennedy’s bill covering all Americans with government health insurance had 36 co-sponsors.

But the Democratic Party decided to go a different direction, turning instead to private insurance to cover Americans. Fine said he met with former First Lady Hillary Clinton’s health care task force in the early 1990’s, and advised them to incrementally expand Medicare, starting first with children and then lowering the age for the elderly.

“They had the money but not the interest in the idea,” he lamented, “instead spending a year developing a complex bill that was DOA on [Capitol] Hill.”

Fine then made a surprising prediction.

After the death of the Senate healthcare bill yesterday, The Intercept reached out to Fine for comment about where Congress should go next. “Single payer is the only real answer and some day I believe the Republicans will leap ahead of the Democrats and lead in its enactment,” he speculated, “just as did Bismarck in Germany and David Lloyd George and Churchill in the UK.”

Otto Von Bismarck, a conservative German leader known as one of the fathers of the welfare state — the Social Security Administration even maintains a webpage honoring him for establishing the first public retirement program in the world — helped establish the foundations of the modern German health insurance system in 1883.

David Lloyd George was a member of the British Liberal Party (the successors to the Whigs, not to be confused with the Labour Party) who was inspired by Von Bismarck’s work in Germany. He spearheaded the passage of the National Insurance Act of 1911, which created a system of health insurance to cover industrial workers.

And although Winston Churchill was not the driving force behind the establishment of the United Kingdom’s National Health Service, he both supported it in theory and later prevented his fellow Tories from strangling it during his 1951 to 1955 tenure as prime minister.

All three are examples of conservative politicians coming to terms with popular demands for the government to act to prevent their citizens from being financially destroyed by sickness and injury. It remains to be seen whether the GOP will learn the same lesson.

Now that is what I call a bold prediction! While I would like to think that Fine is right, we see that appealing to history to see how Trump and Republicans will react is a mug’s game. They have proven that they are nothing less than fanatical in their devotion to enriching the wealthy at the expense of everyone else, beyond anything that we have seen in the past in democratic societies. The Republicans are not conservatives in the traditional sense of the word. They are right-wing extremists. In addition, we are well into kleptocracy territory here.

It would be nice to see the Democrats seize on single-payer as the flag under which their candidates run in 2018. Right now, they really have not offered any coherent platform of their own. But given how beholden they too are to financial interests in the health insurance industry, it will be up to a few people like Bernie Sanders and Elizabeth warren who take up this cry.


  1. Chiroptera says

    Mano Singham: Given that flexibility, it should be possible for the Republicans to put together a patchwork of giveaways to recalcitrant party members that will cobble together the votes to pass, even if the bill makes no sense at all or hurts many people.

    The bills that just failed were already a patchwork of giveaways. The problem for the Republican leadership is that one side’s “giveaway” is the other side’s deal breaker. The two sides are so opposed on these bills that I don’t see how it’ll be possible to cobble together one that will pass. Adding or deleting any provision that will increase support on one side will end up increasing opposition on the other.

    They may be able to pass a bill, but I think it’s going to take more than writing up a compromise bill. The Republican leadership is going to have to start issuing credible threats against the members’ re-election chances.

  2. Jenora Feuer says

    The Republican leadership is going to have to start issuing credible threats against the members’ re-election chances.

    The problem with that is that all the most recent threats against re-election chances have been from the fanatical side and getting rid of the moderates. And given the fanaticism of some of Trump’s support, and the way that mid-term elections seem more likely to go to the fanatics, I have little reason to believe that the leadership would have any teeth if it tries to threaten the Freedom Caucus types. Which makes any attempt at enforcing conformity more likely to swing in the direction of gutting health care.

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