Who knew health care could be so complicated?


By Scott Robertson

“Obamacare is the law of the land.” So said House Speaker Paul Ryan last week after pulling the doomed repeal-and-replace bill from consideration before it could be voted down.

How could it be that the cornerstone of the Obama presidency could remain in place despite having to run the gauntlet of a House that took action more than 50 times to repeal, slow, mitigate, or prohibit funding for the Affordable Care Act from 2011-2016? How could Obamacare still be the law of the land after Donald Trump said in almost 70 campaign speeches words such as, “We’re gonna repeal and replace Obamacare with something great,” and “On my first day in office, I am going to ask Congress to send me a bill to immediately repeal and replace, I just said it, Obamacare.”

Obamacare is still the law of the land because everybody involved acted exactly like who they are.

First, the President: I said in this space before the election that Trump is not a true conservative, and he’s certainly no policy wonk. Remember, last month, he said, “Nobody knew health care could be so complicated.*”

Trump is an experienced businessman, but a healthcare tyro and a presidential newbie. I said I hoped Trump would surround himself with people like Bob Corker, statesmen with the experience to navigate complex situations. He instead brought on fellow neophytes including Steve Bannon, who was supposed to be the best and Breitbartiest when it came to corralling the Freedom Caucus conservative ideologues. We see now how that turned out.

Second, the Freedom Caucus conservative ideologues: Government, sadly, isn’t business. Businesspeople, for the most part, overlay their dealings with rational desire to do what’s best for their own bottom line. Congressmen are in no way obligated to adhere to such sensibilities.

So when the President thought he was thiiiis close to having a handshake deal with the caucus last week, they came back to the table with another condition. Then they did it again. That’s why Trump lost patience and demanded a Friday vote. He knew the Freedom Caucus would never take yes for an answer. The GOP got the nickname, “the party of ‘No’” in large part because of these folks.

Say what you will about their negotiating tactics; caucus members are committed to their conservative principles – except for one. They have often talked about the repugnance of having to subsume their own sentiments to whatever position the House leadership demands they take. Yet when the vice president went to them at the 11th hour on Friday to ask individual members to change their vote, multiple reports say the members remained silent, preferring to let the caucus chair speak for them. They traded one brand of being silenced by leadership for another. Interesting that one can be courageous and cowardly at the same time.

Third, the House leadership: It’s a shame and a sin the full House GOP membership wasn’t fully up to speed on what the specific issues addressed in the AHCA were long before the scheduled vote, as well as how to defend the bill to their constituents. That falls on the House leadership, specifically Ryan. Phil Roe has been working on this for eight years. For Ryan to come out after the non-vote and say the GOP had only three months to put together its repeal-and-replace bill was disingenuous at best.

In Ryan’s defense, until Congress goes back to old-school pork trading, there will never be another strong Speaker of the House. When Jim Wright needed something from a recalcitrant Congressman, he could say, “James, I need your vote on H.R. 1156. If I get it, your fish hatchery is guaranteed another ten years of funding.” Ryan has no such carrots to dangle in front of the members of his herd.

Finally, House Democrats: What, you thought they were going to line up to vote to repeal what they spent seven-plus years putting into place and defending? Trump blaming the bill’s failure on them is like shaking his fist at the sun for having the temerity to rise in the east.

So what are the best and worst cases moving forward? Well, the worst would be that the President decides it’s more important that he be able to say, “I told you so,” than to protect Americans, and allows Obamacare to “explode,” putting the health and safety of millions of taxpayers at risk in the process, because make no mistake, Obamacare is fatally flawed and will fail.

The best-case scenario would be that Trump stops pretending to be a conservative, quietly reaches out to the remaining Blue Dog Democrats in the House, finds the few who are willing to admit that Obamacare is, in fact, creating higher premiums, higher deductibles and a diminution of choice, and actually does what he told us he would do the first time – a deal.

Regardless, it won’t be easy, but then nobody knew governing could be so complicated.


*This statement was followed by the slapping sound of every healthcare payor and provider in America performing the world’s largest simultaneous face-palm.


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