If you read the last post on this blog, you know that I was glum at the prospect of Mitch McConnell’s preparations to announce that he had finally succeeded in repealing (most of) the Affordable Care Act (Obamacare). Secret drafting of a “replacement” bill that was actually a huge tax cut for the truly wealthy, and equally secret rehearsals by Republican Senators for their bravura performance–great drama over their sensitivity toward the elderly and the sick, or the opioid-addicted, etc., followed by McConnell’s moves to direct funds to the states where those Senators come from–would end with relatively fast passage of his bill. Obamacare would be (mostly) dead and the USA would once again be safe for huge profits by pharmaceutical companies and health insurance company executives! USA! USA!
An odd thing has taken place in Washington, though. In a Senate where two Republicans could have voted against McConnell’s bill in order to save face with enraged constituents, then tut-tutted when it passed, for some reason, more than two of them said they would not support the bill. And they did not follow the script I spoke of, at least not right away. All this week I have waited for all but two Republican dissenters to return to the fold and announce their support. But it has not happened. At least not yet.
There are rumblings behind the scenes and even some out front that the legislation was no good. Notably, Ohio’s Governor John Kasich forthrightly condemned it as nothing more than a tax cut for the rich while the less fortunate would lose. The Republican tandem in Nevada of Republican Governor Sandoval and Senator Dean Heller have not wavered publicly in expressing doubt at the intent and effect of the bill. You will not be surprised to learn that Heller is up for re-election next year, and that this office has been besieged by calls urging him not to support it.
Have some high-ranking Republicans acquired a conscience? Or perhaps they have considered what civic duty entails? More likely there are some few of them who worry that casting a vote in favor of this legislation might do grievous harm to their re-election chances, and, further, that it is fruitless to think that President Trump will somehow “have their back” down the line. In fact, none other than Senator Lindsay Graham of South Carolina has been quoted as saying (out loud!) quite the opposite. Trump, in other words, has shown himself to be concerned mostly with Trump. Further, many party elders may be more concerned that the Donald may not last even one term as president, and thus will not be able to stand behind anyone among Republicans in any meaningful way. (How many Republicans were elected to the Senate, House, or State House in 1976 with the support of Richard Nixon?)
So, is the McConnell bill dead? I doubt it. Donors to his many campaigns, on one hand, and Political Action Committees funded by the Koch Brothers and others are not happy at this turn of events, and they are not going to give up. I still think we will see passage, but perhaps with some more rounding off of the roughest edges than we might have otherwise seen.
One interesting sidelight, though, to this whole piece of performance art is that other voices are being raised, not least of which is that of Bernie Sanders, the Independent Senator from Vermont, whom I heard voice some thoughts just yesterday on the current impasse. Sanders, though known to favor a single payer “Medicare for all” solution to health insurance, said that perhaps a gradualist approach would be timely, specifically, lowering the Medicare eligibility age from the current 65 to 55. This would have the effect of creating a larger, comparatively healthier pool of those insured by Medicare. Looking, as always, at whose ox would be gored, you will see health insurance companies at the front of the line, as many not-quite-golden-agers would opt for Medicare at reduced rates (even with perhaps higher deductibles) than they pay now. The CEO’s of Blue Cross/ Blue Shield and their colleagues with other insurers will howl against the idea for years to come, and, of course, their donations flow not only to Republicans. Don’t look for this to happen any time soon. But hearing it injected into the discussion is a beginning.
Further, if the idea of health care/insurance reform is for real at all, costs must be reduced. How? Start with the cost of prescription drugs. Sanders (again) points out that Americans pay the highest prescription drug costs in the world. Canadian drugs, virtually identical to the versions sold on this side of the border, are often one-half to one-third the cost of their American counterparts. Why is that? And Medicare itself, the largest buyer of prescription drugs in the country, is currently prohibited from negotiating drug discounts with any suppliers. Or importing many drugs from Canada or anywhere else.
Politicians who talk long and loudly about the virtues of cost reduction in government, where are you? Many have acted hypocritically, refusing to change current regulations on procuring medicine, citing risks to American consumers from medicines manufactured by other than American companies. (Cory Booker, I’m looking at you…) OK, but–Canada? We can’t trust Canada’s controls? Give me a break.
There will be a lot of strutting, preening, and citing danger to Americans if any changes are made to monopolistic practices in procurement and delivery of health care. It still will probably not end well. Don’t count McConnell’s vision out yet. And don’t give up, on the other hand, on improving a system that is failing many while making a few rich. Er, richer.