Never were the words of the Grateful Dead so fitting in the world of politics. "Trouble ahead, trouble behind" is indeed a perfect description of the spot Paul Ryan and Donald Trump found themselves in today. Because Casey Jones faced precisely the same no-win situation, and it didn't work out so good for him, either.
Is on the wrong track and
Headed for you
So you'll have to forgive the rather disjointed (and derailed) nature of today's column, since it was written in snatches, in between watching Ryancare explode into a million pieces throughout the day.
Because it's been such an extraordinary day, we're not even going to attempt writing a normal Friday Talking Points column this week. Instead, we've just got an extended rant on the first big failure of the Donald Trump administration (and the Paul Ryan speakership, to boot).
The following was written in fits and starts, which is about as cohesive as was possible today. Because even though legislative death and destruction were in the air, when the collision happened it was almost impossible to tear our eyes away from it. Call us legislative rubberneckers if you will, but we'd bet a fair amount of readers also couldn't tear themselves away from the news today. So with a few final apt lines from the Dead, we'll just get started, shall we?
Come 'round the bend
You know it's the end
The fireman screams and
The engine just gleams
Casey Jones you better watch your speed
A trainwreck is a spectacular thing to see, isn't it?
There's a reason for this, so I thought I'd open with a little physics, just to lighten the mood a bit. I've always thought it ironic that the one physics formula just about everyone recognizes is also one of the most impenetrable concepts, in terms of real-world application. Everyone knows that "E = mc(squared)," but how many understand what it means?
There's a formula that isn't nearly as well-known, however, which has all kinds of real-world applications. I speak of "F = ma," which is actually fairly easy to comprehend even by non-physicists. Written out in full, it becomes: "Force equals mass times acceleration." What this means is there are two basic ways (or some combination thereof) to create a massive amount of force. You can have a very tiny amount of mass (or "weight") with a very high amount of acceleration. Like a bullet, for instance. A very small weight, but it can be a deadly force because it's moving so fast. Or if you have a very large mass, it takes only a small amount of acceleration to create a powerful amount of force. Think of a glacier, which barely moves -- but because it's so massive, it can permanently change the landscape.
Trainwrecks are a combination of a very large mass and a decent amount of acceleration. When you have a lot of mass and a lot of acceleration, you get a whale of a lot of force. So the results of a trainwreck are pretty spectacular, and can be deadly for anyone unlucky enough to be caught in the wreckage.
Which brings us to the monstrous wreckage of the GOP's long-awaited replacement plan for Obamacare. The Ryancare train sped towards an immovable Tea Party object on the tracks all week long, while everyone held their breaths waiting for the inevitable disaster. Today, Ryancare hit this solid brick wall of obstruction within the Republican Party alone (no matter how Trump tried to spin it, after the fact).
Even if Ryan had pulled off a miracle and passed the Ryancare bill through the House, it still faced a brick wall of public opposition, which likely would have doomed it to failure in the Senate. Recent polling showed only 17 percent of the public approves of Ryancare. A whopping 56 percent oppose it. And that's after only three weeks. By comparison, this is far, far worse than Obamacare has ever polled -- before or after its implementation. It's stunning, in fact -- a ratio of over 3-to-1 against Ryancare.
And that poll was taken before Ryan was forced to tinker with it to make it even worse. The Congressional Budget Office put out a quick score on the first round of changes to the bill, and -- astonishingly -- it showed that Ryan was moving in the direction of making it cost more without covering any additional people. Meaning those 24 million will still be losing their insurance under Ryancare, while it costs almost $200 billion more. And that's Ryan trying to make it more acceptable to his fellow Republicans, mind you.
Stepping back a bit, what's always amazing is the chutzpah Republicans are capable of, when doing exactly the same things they routinely denounce Democrats for doing -- whether those complaints had any validity or not. Remember the days when Republicans used to complain about Democrats not involving them in important legislation? Remember when they (inaccurately) complained that the Patient Protection and Affordable Care Act had been "too hasty" and "jammed through Congress"?
Allow me to refresh your memory. John Boehner famously gave a very impassioned speech on the House floor right before the Obamacare bill House vote, seven years ago to the week. Here are excerpts from that speech (bonus points if you can spot why his own words give the lie to the "too hasty" GOP talking points):
Today we should be standing together reflecting on a year of bipartisanship and working to answer our country's call and their challenge to address the rising costs of health insurance in our country. Today, this body, this institution, enshrined in the first article of the Constitution by our Founding Fathers as a sign of the importance they placed on this House, should be looking with pride on this legislation and our work. But it is not so.
No, today we're standing here looking at a health care bill that no one in this body believes is satisfactory. Today we stand here amidst the wreckage of what was once the respect and honor that this House was held in by our fellow citizens. And we all know why it is so. We have failed to listen to America. And we have failed to reflect the will of our constituents. And when we fail to reflect that will, we fail ourselves, and we fail our country.
Once again, recent polling puts Ryancare at a dismal 17 percent approval rate with the public. Boehner then got extremely worked up (video clips of this segment have been circulating all week, for obvious reasons) at the failures of the legislative process, railing at Democrats for their perfidy:
[L]ook at how this bill was written. Can you say it was done openly, with transparency and accountability? Without backroom deals and struck behind closed doors hidden from the people? Hell, no, you can't!
Have you read the bill? Have you read the reconciliation bill? Have you read the manager's amendment? Hell, no, you haven't!
Boehner was then admonished from the chair that everyone "would do well to remember the dignity of the House."
Boy, those were the days, eh? Republicans incensed because of backroom deals cut and not enough time to read and understand the bill. Takes you back, doesn't it?
Boehner builds to a rousing finish, while once again undercutting what would become a regular Republican anti-Obamacare talking point:
My colleagues, this is the People's House. When we came here, we each swore an oath to uphold and abide by the Constitution as representatives of the people. But the process here is broken. The institution is broken. And as a result, this bill is not what the American people need nor what our constituents want.
Americans are out there making sacrifices and struggling to make a better future for their kids, and over the last year as the damn-the-torpedoes outline of this legislation became more clear, millions of Americans lifted their voices and many, for the first time, asking us to slow down, not to try to cram through more than this system could handle, not to spend money that we didn't have. In this time of recession, they wanted us to focus on jobs, not more spending, not more government, and certainly not more taxes.
But what they see today frightens them. They're frightened because they don't know what comes next. They're disgusted because what they see is one political party closing out the other from what should be a national solution. And they're angry. They're angry that no matter how they engage in this debate, this body moves forward against their will.
Shame on us. Shame on this body. Shame on each and every one of you who substitutes your will and your desires above those of your fellow countrymen.
Strong words indeed. Extraordinarily, though, except for one rather large detail, this same complaint could easily have been made today by just about any Democrat, since everything Boehner lists as being wrong with the Obamacare process was worse -- by several orders of magnitude -- in the Ryancare fiasco. But did you catch how Boehner actually admits the truth -- that large detail -- of what had previously taken place? Here are the two key quotes, with emphasis added:
Today we should be standing together reflecting on a year of bipartisanship and working to answer our country's call and their challenge to address the rising costs of health insurance in our country.
Americans are out there making sacrifices and struggling to make a better future for their kids, and over the last year as the damn-the-torpedoes outline of this legislation became more clear, millions of Americans lifted their voices and many, for the first time, asking us to slow down, not to try to cram through more than this system could handle, not to spend money that we didn't have.
Got that? "Cramming" the legislation through took over a year. Boehner even admits it.
Ryancare has existed for three weeks. Three freakin' weeks, from its public unveiling to the House vote.
No public hearings were held where stakeholders were allowed to offer their input. None. One-sixth of the American economy is being completely changed, and the insurance industry was not consulted. The hospital industry was not consulted. The drug industry was not consulted. Doctors were not consulted. Nurses were not consulted. Pharmacists were not consulted. To say nothing of the patients and other members of the public who would be directly affected. Paul Ryan didn't even bother to get the buy-in from his own membership. Three weeks doesn't leave a lot of time for all that sort of thing, does it?
It is more than enough time, however, to stage a rather spectacular trainwreck.
Dealmaker? Hardly. Wonky conciliator? Don't think so.
We're now left with the aftermath. The wreckage is strewn across the countryside, and the search and rescue teams are still looking for possible survivors, but without much hope. Most severely damaged by the Ryancare trainwreck are the political reputations of both Paul Ryan and Donald Trump.
President Trump has always sold himself as the king of the dealmakers, but he couldn't close this deal no matter how hard he tried. To his credit, he did indeed try. Barack Obama never really enjoyed the schmoozing-with-Congress part of the job of being president, but Trump took to it like a fish to water. He spent hours on the phone with over 100 Republican House members, he invited them up repeatedly to the White House, he even went down to the Capitol and appeared on their turf (a very big deal indeed, in Washington). Trump did everything he could to woo GOP members into giving him a big victory early on in his administration. Everything, that is (according to some Republicans), but actually learn what was in the bill so he could do some dealmaking on the specifics. Trump, according to people in these meetings, made a purely political argument and didn't seem interested at all in any of the concerns or complaints, or indeed interested in any policy details at all. In the end, Trump's politics-only appeal failed, because there are so many things wrong with Ryancare that it is a veritable cornucopia of reasons to oppose (no matter where you happen to fall on the Republican political spectrum). In the end, Mister Dealmaker couldn't close the deal. That's going to hurt his image with the public in the future, possibly in dramatic fashion.
There's also going to be a lot of re-examination of Paul Ryan's political persona as well. The inside-the-Beltway crowd (in both politics and the media) built up Ryan on two separate pedestals. The first was Ryan-as-uberwonk. Ryan was supposed to be the numbers guy who could successfully translate conservative ideology into actual legislation that would then go on to create the conservative dream world. Of course, anyone who ever examined the details of all the past Ryan budgets knows full well he's never been able to actually live up to his wonky-genius billing, and Ryancare just shined a big, bright spotlight on his own inability to deliver. When the numbers on Ryancare were added up, the sum total was precisely what Democrats have been saying all along -- that it was impossible to reach the goals of more people covered, cheaper costs for both the patient and the government, and better care by following nothing more than orthodox conservative ideology. Democrats all said it couldn't be done, and Ryancare proved it beyond a shadow of a doubt. Costs would skyrocket for patients, and tens of millions would not be able to afford health insurance -- a long way from the Utopia that Republicans have been promising their voters for seven straight years.
The proof of this fact was even more stark because Ryancare was the Republicans' only shot. There were no competing House bills. There was no competing Senate bill. Republicans have been terrified to write actual legislation up until this point because they knew the outcome would be worse than Obamacare. They knew the Congressional Budget Office was going to pour the cold water of reality all over their dream fantasies. It was Ryancare or nothing because after seven years, this is all they've got. Ryan was supposed to be the wonkiest guy in the party, and even he couldn't make the numbers add up.
The second part of the Ryan myth that now lies shattered on the ground is that he was going to be the great conciliator, the ultimate go-between for all the various Republican factions. He'd get the Tea Partiers to go along with the moderates, through sheer force of personality. He was going to make the House work again, after the Tea Partiers drove John Boehner crazy for so long. This wasn't supposed to happen under Ryan, but it just did. Once again, the Tea Partiers showed that saying "No!" is all they're capable of. Oh, you can add to that list above: "There was no Tea Party bill," because, as always, there is never a Tea Party bill. They don't create, their sole power is the power to destroy.
And now, they're going to be even more powerful. There's a cheerful thought. Ryancare didn't fail within the Republican caucus in the House because it was so awful -- it failed because it was not awful enough. Don't believe this? At the end, the Tea Partiers were trying to strip things like "hospitalization coverage" from health insurance plans. To state the obvious, health insurance that doesn't pay when you have to go to the hospital is not health insurance. And yet that's what the Tea Partiers were in there fighting for.
If the Tea Partiers didn't exist, Ryancare likely would have passed, with a few tweaks. We've been saying it for a few weeks now, but today others are starting to speculate about how much longer Ryan will hold the speaker's gavel. If Ryan can't get enough Republicans to agree on how much they hate Obamacare, then how is he going to get them to agree on much of anything? Ryancare's failure may be the harbinger of lots of government shutdowns to come, to put this slightly differently. Somewhere (in Ohio), John Boehner is sipping merlot, smoking a cigarette, and laughing. One can imagine a private text message from Boehner to Ryan, in fact: "Told you so."
Snark aside, though, if Paul Ryan and Donald Trump are the biggest losers of the death of Ryancare, then the Tea Party certainly has to be seen as the biggest winners by far (other than the obvious winners of "Obamacare and the American people," of course). The Tea Partiers are now the official tail that wags the Republican dog. Nothing will pass the House without their say-so. Not only have they proven they can stick together even under relentless pressure from a president popular among Republican voters, they've also proven they don't care one whit about his political threats. It's really tough to picture anyone trying to "primary" a Tea Partier from the right flank, after all. With that option off the table and with comfortably-gerrymandered districts, the Tea Partiers really have nothing to fear, at this point. As Trump and Ryan lose political capital, the Tea Party gains even more. This is going to make Ryan's already-tough job virtually impossible.
The new third rail
Healthcare reform is the new third rail of American politics. The old Washington saying needs updating (it used to be: "Social Security is the third rail... touch it, and you die").
Republicans were so all over the map on Ryancare that they were simultaneously worried about a voter backlash if they passed the bill and worried about a different type of backlash it they didn't pass it. More correctly, different factions were worried about different backlashes. Republicans from swing districts were terrified of voters reacting to throwing 24 million people back into the ranks of the uninsured and skyrocketing out-of-pocket costs (especially for seniors, who regularly turn out to vote). Republicans from Tea Party districts were worried that conservative talk radio (and powerful conservative donors such as the Koch brothers) were lining up to label Ryancare "Obamacare Lite," and that their voters might punish them for not repealing enough of Obamacare. Ryan was between this rock and a hard place, because any move he made towards either faction lost him votes with the other.
Even now, many House Republicans are worried that their voters may turn from them in disgust because they once again proved that House Republicans are completely incapable of delivering on their campaign promises. They've been swearing they'll repeal Obamacare for years now, while their voters lapped it up like candy. Now that they've failed to do so, how will their voters react?
Democrats already know the lethality of healthcare reform. When they passed Obamacare, they had (depending on how you count) either 59 or 60 seats in the Senate. They now have 48. Nancy Pelosi used to wield the speaker's gavel. Now she's merely minority leader. Republicans successfully demonized Obamacare in order to cause that sea change.
Healthcare reform is the new third rail of American politics. It may turn out to be deadly for the Republicans, because no matter what happens next, they've already massively disappointed a large segment of their own base.
A Democratic opportunity
Donald Trump's spin on the Ryancare trainwreck was downright laughable. "It's all the Democrats' fault" -- really? Is that all you've got? Wow. Good luck with that one. That and ten bucks will get you a cup of coffee down at Starbucks, Donny. Nobody in their right mind is going to buy this particular spin. Oh, sure, the Republicans can try to parrot Trump's knee-slapper, but it just ain't gonna fly. The public's a little smarter than that.
But Trump did open an interesting door for Democrats today. He threw down a gauntlet in the midst of all the finger-pointing attempts, and if Democrats are smart they'll call his bluff. More on that in a minute.
The first thing that Democrats really need to frame quickly is that the death of Ryancare should mean the death of the "repeal and replace" slogan from the GOP. Repeal just is not going to happen, because the new bar any replacement plan has to hit is that it must be as good as Obamacare. Period. Democrats are already making this plain, and they need to hammer it ceaselessly. Democrats are open to improving Obamacare, but they will stand as one against any suggestion that it has to be repealed. That should be their initial bargaining position -- "We'll work with Trump or the Republicans on fixing some problems, but we will not work on any bill that even hints at repealing Obamacare."
Luckily, Republicans seem to already be pivoting away from the phrase "repeal and replace." They think they've got a brilliant sequel to this: "collapse and replace." They are so absolutely convinced that Obamacare must (as Trump put it) "explode" soon that their Plan B is to just sit back and wait for it to happen. This is a logical flaw technically known as "starting to believe your own P.R." What happens to their wonderful slogan when Obamacare fails to explode? Well, they haven't thought that far ahead -- or they refuse to, since they are so confident of Obamacare's inevitable demise. Whatever -- Democrats can use the fact that the GOP "repeal" slogan seems to be dead to their advantage.
There was another shift in rhetoric during the debate over Ryancare that was interesting. Both sides started using new metrics to measure what they considered to be acceptable outcomes. Well, that isn't totally true, both had been around long before Ryancare existed, but these two did seem to be the ones that got the most focus in the past few weeks.
Democrats concentrated on the number of people insured. Obamacare has been wildly successful at bringing people into the insurance market, with 20 million more Americans insured today than when Obamacare passed into law. That impressive statistic is the easiest way to measure the success of Obamacare, especially when the C.B.O. so starkly showed how awful Ryancare was in this regard. Ryancare not only would have booted 24 million off insurance, it would actually have resulted in one million people more not being insured than if Obamacare had never existed. That's stunning incompetence -- to reach a worse result than if no healthcare reform had ever happened. Obamacare's obvious success in getting tens of millions more insured coupled with Ryancare's utter failure in this regard put this metric front and center for Democrats during the debate.
Even more interesting, on the Republican side their biggest complaint was a fairly new one (for them). After all, they couldn't very well complain about "death panels," since they never actually existed in the first place. All the rest of their complaints had the same stale flavor, because they were always nothing more than scaremongering which had no basis in reality in the actual Obamacare legislation. Remember, Republicans were predicting that Obamacare would already be dead by now, so it's a little hard for them to make that argument again. Instead, they focused on the number of places in America which only have one provider on the Obamacare exchanges. People who live in (according to them) "one-third of American counties" only have one choice on the exchanges -- which, in a capitalist marketplace, is really no choice at all. You take it or you leave it, that's your only choice.
This also leaves an interesting opportunity for Democrats to make a move, at this point.
The public option to the rescue
Donald Trump just threw down a gauntlet in front of the Democrats (in the midst of laughably trying to pin all the blame for Ryancare's defeat on them). Trump clearly stated that he was open to any ideas from either party, since Ryancare is no longer viable. So Democrats should immediately put together a plan to bring back the public option, and present it to the White House (in a very public way). They could entice Trump by telling him that their plan would go a long way to allowing all those unrealistic promises Trump made during the campaign actually come true. It could "cover everybody." Costs could come down. People would have more choices. Health insurance would improve, through competition. If Trump is being serious about considering anyone's plan, he may actually be tempted by such an offer (especially if Democrats graciously offered to start calling it "Trumpcare" on television).
While the Obamacare bill was being debated, Democrats had their own factions to deal with. Where Republicans now have Tea Partiers, Democrats had Blue Dogs. Their intransigence meant Obamacare was nowhere near as good as it could have been. In particular, Senators Max Baucus and Joe Lieberman forced the entire rest of the Democratic Party to abandon the public option before they'd vote for the bill. To be completely accurate, Baucus and Lieberman should be called ex-senators, since (thankfully) neither one of them holds public office anymore.
The public option was a compromise to begin with, which is why these Blue Dogs are indeed comparable to the Tea Party. Even this compromise was too much for them to agree to. The real progressives were pushing for single-payer, which would have removed the insurance companies from the equation altogether, as most Western democracies have done. But single-payer has always been the Democrats' bridge too far. They can't get agreement even among themselves over such a radical redesign, so it is probably not going to be the next step now, either.
Instead of obliterating the private insurance market, though, if the choice of buying in to Medicare was made available to all it would be a lot more politically feasible. Every American, whether insured through their employer or through the Obamacare exchanges (in every county in the country) should have the choice of buying into the Medicare system, no matter what age they happen to be. This could solve multiple problems all at once.
Baucus and Lieberman balked at even the public option because they had accepted so many large donations from the health insurance industry that they did what they were told to do. The insurance industry hated the concept, because it would have meant they would have had to compete with the government to sign people up. They swore that the exchanges would be truly competitive through just the free market alone.
Well, they had their chance. Democrats could even just propose a Medicare buy-in option in places with only one remaining insurer, for starters. If more than one insurance company isn't interested in the market, then the government will step in to provide a guaranteed level of choice. This would also undermine the biggest talking point Republicans now have, it's worth pointing out.
Democrats could even be magnanimous and offer Republicans a few of their favored ideas in the mix as well. If you have the safety net of both Medicaid (with the expansion intact) and the Medicare public option, then letting the GOP tinker on the edges wouldn't be as bad, in other words.
If some Democrats in the Senate sat down with some moderate Republicans (Susan Collins, perhaps), some sort of workable compromise could probably be hashed out. Once you take the inflammatory "repeal and replace" rhetoric out of the equation, then both sides could take a long hard look at Obamacare and try to fix the problems which have arisen now that it has been fully implemented. These problems are not insurmountable, as long as the new ideas don't kick millions off their health insurance and as long as the individual states don't get billions less from the federal government. Both were fatal flaws in Ryancare, but both can easily be avoided if "repeal" isn't the watchword from the Republican side.
Democrats seriously care about outcomes. Most Democrats are willing to make sane and sensible adjustments to Obamacare. While the Tea Party got most of the attention in the Ryancare trainwreck in the House, it might have been even more interesting if it had passed, because most of the pushback from Republicans in the Senate was from the moderate faction, not the hotheads. Some Senate Republicans wanted to see something that worked -- not just some ideological conservative fantasy that didn't add up to a better outcome.
Pushing any compromise bill will be hard to do, since Democrats are in the minority and don't control congressional schedules or committees. But they could do an end-run around all of that if they put together a decent plan with a few sensible Republicans and then got Trump on board. Trump could use the power of his Twitter audience to force Paul Ryan and Mitch McConnell to allow such a plan to move forward -- even if many Republicans are against it. Trump's really the key to all of that, because it'd certainly be an "only Nixon could go to China" moment.
Democrats now have the opportunity to call Trump's bluff. If they start off with only one dealbreaking demand and a set of core principles, perhaps truly bipartisan agreement could actually be reached, at least in the Senate. The dealbreaking demand would be: "Don't ever call it a repeal of Obamacare." The core principles would be: "We have to have at least as many people insured as under the current law, and we must work for a better outcome, not a worse one -- but we'll consider any suggestion that achieves that."
In other words: "No more trainwrecks."
-- Chris Weigant
Cross-posted at: The Huffington Post