What would a win look like?

The AHCA is supposed to come up for a vote this week. The House Republicans want a vote on Thursday as that would be seven years to the day that the ACA was signed. As of now, it looks like the GOP does not have the votes to pass it through the House. They definitely don’t have the votes to pass it through the Senate. The votes in the House might be found if the Medicaid provisions are made harsher and
shorter. And for every screw tightened on Medicaid to get a House Freedom Caucus vote, the further the bill moves away from 51 votes in the Senate.

If the AHCA is to be defeated, it will be defeated by a coalition of unanimous Democratic opposition and Republicans who face state wide electorates and know that there is value in what the ACA does. So what does a win look like if and after the AHCA is defeated?

Right now, a repeat of the Social Security strategy of 2005 of Hell NO is the Democratic Alternative makes a lot of sense. The goals of the two parties are diametrically opposed and clear partisan and policy responsibility align incentives nicely.

The Social Security strategy of 2005 of offering nothing and listening to nothing is a tempting strategy but I think it is a flawed strategy for one critical differentiation if the AHCA is defeated. In 2005 the Bush Administration did not have the legal nor administrative tools to wreck Social Security on their own. The checks were still going to be processed on time, the electronic fund transfers would still go out and the money would still be collected by the IRS. The program was on auto-pilot and immune from administrative wrecking.

The ACA is not like that. It can be administratively wrecked. The easiest way to wreck the Exchanges is for CMS to declare that they will not pay the Cost Sharing Reduction subsidies. If the CSRs are not paid, the market is empty as soon as state law allows insurers to terminate policies. No carrier would offer. The only downside to that approach to a Repeal but not Replace Republican is that there are too many bloody fingerprints on the knife. More subtle attacks include a quiet campaign of telling insurers that the mandate will not be enforced, decreased maintenance or improvements to Healthcare.gov, active advertising against enrollment and other ways of making the risk pool horrendous while highlighting the high rates that non-subsidized individuals pay to compensate for the increased variance and sicker risk pool.

The Medicaid expansion is vulnerable as well given the recent guidance that CMS will allow non-health related conditions to tie to 1115 waivers. An actively opposed CMS can significantly decrease Medicaid enrollment by encouraging work requirements, frequent re-determination, and more complex enrollment procedures.

The ACA is administratively vulnerable. It can not be killed administratively, but it can be lamed.

So the way to protect the fundamental goal of the ACA is to get the Republicans who would have voted against the AHCA onboard with modifications that make those Republicans key stakeholders and defenders of health care reform against their own party.

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79 replies
  1. 1
    Baud says:

    I don’t see anything that would be acceptable to us passing the GOP House.

    ReplyReply
  2. 2
    DougJ says:

    Who’s being naive, Dave?

    ReplyReply
  3. 3
    JPL says:

    Tom Price will have no problem tanking ACA.

    ReplyReply
  4. 4
    Sab says:

    Didn’t Sen Bennet in Utah lose his seat after he voted for the ACA? Would any GOP person risk being a stakeholder in a compromise?

    ReplyReply
  5. 5

    @DougJ: I might be— but the problem is the ACA can be administratively tanked unless there is a strong enough coalition to stop it from being tanked. So my conditional speculation is IF the AHCA can be defeated — what is next given that a Repeal/No REPLACE can be somewhat simulated by active administrative wrecking

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  6. 6

    @Sab: @Sab: He lost his seat not because he voted for the ACA, but that he was not foaming at the mouth against it.

    ReplyReply
  7. 7

    @Baud: If that is the case, then exploration after an AHCA defeat is not harmful. If there is something that could get through the Senate and forces Ryan to either kill it or Boehner himself, that can be an acceptable outcome.

    ReplyReply
  8. 8
    Another Scott says:

    i think you summarize the problem very well, but I don’t know that there is a solution from our side.

    Donnie’s minions at DHS can wreck the ACA, as you say. But they can do that no matter what Congress does. They’re already trying (the EO about the penalties, etc.) to do that under the existing ACA laws and rules.

    We’ve got lots of smart cookies in the Team D leadership in the House and Senate. But we’re also in uncharted territory here. It’s hard to know how much the past can guide our actions now.

    My gut still tells me that:

    1) The GOP has the votes to do whatever they want. We know that they will eventually vote as a block and pass something. That’s what they do.

    2) The best (and maybe only) way to protect the ACA (IMO) is to fight them every day and to vote them out in every special election and this November (in state races) and in 2018. We may suffer quite a bit of damage until then. But we have to look at the long-term political consequences.

    3) Yes, the press will spin whatever the Democrats do as “more of the same” / “hyperpartisanship” / “refusal to work to make the bill better”, and that will have some resonance with some people, but I think having a clear choice for voters is important. No “bipartisan” compromise in gutting the ACA and throwing tens of millions off their insurance, and increasing costs and decreasing coverage for tens of millions of others, is going to be a compelling defense.

    4) We need voters to be paying attention, to be horrified and angry about what the GOP majority is doing and trying to do. That means making the GOP own their actions and policies.

    5) No matter what happens with these upcoming House and Senate votes, it’s just a battle in a long war. They’re going to keep trying to gut the ACA not matter what happens. We have to fight them every single day.

    6) Unfortunately, the country is divided ~ 45%/45%/10% and liberals do not have a majority. If normal times ever return, we will have to compromise and accept non-optimum solutions. That’s fine, that’s the way progress always works – it’s incremental. But sometimes we have to be a brick wall of opposition to protect hard-fought gains.

    My $0.02.

    Cheers,
    Scott.

    ReplyReply
  9. 9
    Hunter Gathers says:

    Nothing is the only way forward.
    Making sure this bill fails in either the House or the Senate puts the loser stink on Trump.
    “Low-T Beta Cuck can’t get his agenda passed.”
    He’ll lash out, making himself a lame duck less than 100 days into his administration.

    So, so much winning.

    ReplyReply
  10. 10
    MattF says:

    I don’t expect subtlety from either the Congress or the Trumpites. I predict they will try to strangle the ACA and then point to the Democrats as the guilty party, because… Democrats are always the guilty party.

    ReplyReply
  11. 11
    JMG says:

    Sabotaging government is a strategy that works when you’re in opposition. But when you’re the government, not so much.

    ReplyReply
  12. 12
    MomSense says:

    @David Anderson:
    Can’t Price just change what is considered a medical expense for the purposes of the MLR and weaken it that way?

    I heard Collins on Meet The Republicans This Week and they seem to be full steam ahead on Cassidy Collins. They have been fear mongering and promising repeal for so long that they are going to be hell bent on doing something. UGH. We are going to have to figure out how to get as much as we can from Cassidy Collins.

    ReplyReply
  13. 13
    JPL says:

    @MomSense: Of course, he’ll blame Obama, and the media will play along.

    ReplyReply
  14. 14
    OzarkHillbilly says:

    @JMG: This. When Aunt May loses her healthcare subsidies everybody will know who is responsible.

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  15. 15
    OzarkHillbilly says:

    @OzarkHillbilly: And saying it was fatally flawed from the beginning won’t work because they now have the ability to “fix” it. If they don’t fix it so that sweet Aunt May can get the chemo she needs to beat her cancer, that will be on them.

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  16. 16
    Aimai says:

    No: no assistance. GOP senators and house members will NEVER not stab their constituents and democrats in the back. Any compromise will simply be used by them to blame shift when they blow up the system. Only a strong and public campaign in favor of the ACA as obamacare can keep the disaster sitting at republican feet. It can’t be saved from their covert and overt attacks.

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  17. 17
    rikyrah says:

    What would a win look like?

    1. Throwing as many poor people off Medicaid as possible
    2. Taking away as many subsidies as possible
    3. Ruining Medicare sooner so that they can use this as the excuse to turn it into a voucher program.

    ReplyReply
  18. 18
    MomSense says:

    @Aimai:

    The problem is that “keeping the disaster at Republican feet could” could cause a lot of collateral damage in the form of lives lost and financial ruin. We should prepare all of our options.

    ReplyReply
  19. 19
    artem1s says:

    any addition/change suggestion has to come from the Dems and it has to be one that will strengthen ACA, not weaken it. It has to widen the pool, not diminish it. It has to move toward more subsidies, more funding (state and federal). More funding for PP and women’s healthcare. It should seek to repeal Hyde and any measure that brought us religious exclusions like Hobby Lobby. The goal here is not to appeal to the WWC voter or whoever the GOP rep needs to vote for him to keep his seat so he can cross over. The ONE AND ONLY goal here should be communicating to the people who voted for Democrats that they have their back. That they are not going to compromise on anything that their constituents need and want. That they are not willing to help the ignorant and the uniformed and the willfully malignant voter ruin this program. The goal for Dems here should be to keep themselves from getting primaried from the left. I sincerely hope this is the message that the DNC, Perez, and Ellison are sending this week for ACA and Gorsuch. It is the message that I have been sending to my Democratic Senator and Reps. NO MORE. I will not accept one more yes vote on any of this administrations messes. And I am fighting for my life and I expect the Senators and Representatives to be doing the same or I will make sure they lose their jobs. If this isn’t worth making enemies in the press, or funders, or whoever it is they are afraid of, then nothing is.

    And in the mean time the WWC gets to see exactly who Paul Ryan and the Freedum Caucus is. I don’t think that is a bad thing. Draw that out for as long as possible. The more good stuff we throw at ACHA, the longer it will take for the GOP to clean it up so it is acceptable to Norquist. If the Dems fight for us now, their is a chance we will keep us voting and working on these special elections and thru the midterms. If they abandon us now, Ossoff can kiss his campaign goodbye as can every other Dem running in special elections and the midterms. 2005’s strategy worked for the 2006 midterms. To make sure that the voters and the Congress understand that elections matter. that is the goal. Not saving some watered down version of ACA that the GOP or WH will kill administratively anyway.

    ReplyReply
  20. 20
    JPL says:

    OT The President is tweeting up a storm this morning. He appears to be nervous about the upcoming intelligence hearing.
    SAD

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  21. 21
    cmorenc says:

    @JMG:

    Sabotaging government is a strategy that works when you’re in opposition. But when you’re the government, not so much.

    THIS. A big part of the problem with the demographic that has drifted from voting D to voting R is cultural – they’ve been primed by resentment against social and economic change to resent and rebel against government, but at the same time have been insulated from feeling tangible consequences of voting for politicians who actually do want to tear down the social safety net around them. When the impacts begin to be felt by them personally, and not merely visited upon undeserving “others”, a change in attitude tends to follow – even if it’s sparked initially by selfish impulses rather than broad community-mindedness.

    ReplyReply
  22. 22
    oldster says:

    David A.–

    I’m not sure what you’re telling me to do as a voter.

    I have been calling my Republican congressman all winter long to say “don’t touch Obamacare.” He’s a wing-nut and a Trump lackey, but I can at least make my voice heard. When he had a town hall, I went and made my voice heard, literally.

    Sometimes I call my two Senators to urge them on, but they’re Schumer and Gillibrand, so they are already doing the right thing. The most I can do there is stiffen their spines, a little.

    Are you saying that I should stop saying “no” to the Republican rep? That I should stop saying “say no!” to my Dem senators? That I should say something more subtle?

    My access to the levers of power is very slight, and my tools are very weak. All I can do is phone and holler. If you tell me what to holler, I’ll do it. But what should it be? I did not get a clear picture from this post.

    ReplyReply
  23. 23
    rikyrah says:

    @rikyrah:
    Please understand that this is the GOP version of WIN.

    sociopaths.
    the.entire.lot.of.them.

    ReplyReply
  24. 24

    @oldster: RIght now I am telling you to start thinking about what compromise is plausibly acceptable as the current situation is an unstable equilibrium.

    ReplyReply
  25. 25
    JMG says:

    @David Anderson: The status quo is unstable because of the split you described in the Republican party. Anything acceptable to the likes of Susan Collins wouldn’t even be allowed a vote in the House by Paul Ryan, because he’d lose his job. Defense of the status quo, therefore, is the only possible Democratic position.

    ReplyReply
  26. 26
    Chris says:

    @Another Scott:

    1) The GOP has the votes to do whatever they want. We know that they will eventually vote as a block and pass something. That’s what they do.

    Yep, unfortunately, that’s what I’m afraid will happen. The pressure, both peer and self-imposed, is just too strong.

    3) Yes, the press will spin whatever the Democrats do as “more of the same” / “hyperpartisanship” / “refusal to work to make the bill better”, and that will have some resonance with some people, but I think having a clear choice for voters is important. No “bipartisan” compromise in gutting the ACA and throwing tens of millions off their insurance, and increasing costs and decreasing coverage for tens of millions of others, is going to be a compelling defense.

    Let’s also be clear that we’re going to be blamed for that no matter what happens. As we saw in eight years of Obama, partisan problems are always our fault, no matter how much we bend over backwards to compromise. Might as well earn it.

    ReplyReply
  27. 27

    If Democrats compromise on this or any other GOP legislative agenda then they are fools. How many times do you need a knife in your back to know that the other side does not practice good faith.

    ReplyReply
  28. 28
    oldster says:

    David A.–

    Okay, thanks for the response, and for clarifying your advice.

    I don’t do much thinking at the best of times, so I will find it hard to put into practice.

    I’m more into yelling, on the phone and in person, and since you did not tell me to *stop* doing that, I think I’ll continue.

    And if the upshot of this post is simply, “resign yourself to significant loss,” well so be it–I have known since a late night last November 8 that the whole world was going to suffer a lot of significant losses.

    I’m not a legislator or a lobbyist or a policy-maker like you are. I won’t have any input into any eventual compromises, and nothing that I can do will make them better or worse.

    Now if you’ll excuse me, I have some phone calls to make.

    (I love your posts, by the way–incredibly informative, and one of the best things about Balloon-Juice.)

    ReplyReply
  29. 29
    SRW1 says:

    @David Anderson:

    If there is something that could get through the Senate and forces Ryan to either kill it or Boehner himself, that can be an acceptable outcome.

    I’m reasonably sure you meant the Turtle rather than Boehner there.

    If ACHA passes the House, but then fails in the Senate, maybe the D’s should (secretly!) nominate a Grassley equivalent for negotiations and see what’s being offered.

    I have a hard time seeing, though, what could pass the House, cause while Turtle might be persuadable to do some sort of deal, can anybody see Ryan pull a Boehner and pass something contingent on support by Pelosi?

    ReplyReply
  30. 30
    cmorenc says:

    @David Anderson:

    @oldster: RIght now I am telling you to start thinking about what compromise is plausibly acceptable as the current situation is an unstable equilibrium.

    How do you compromise with people whose fundamental belief is that health-care is not a right, and whose fundamental goal is to engineer a Potemkin “solution” specifically designed to unravel and dissolve, only just slowly enough to duck taking responsibility and prove their belief that broad government social-safety net programs are unworkable? The analogy of trying to achieve “Peace in Our Time” via the “plausibly acceptable” solution of permitting the partition of Czechoslovakia comes to mind….

    Paul Ryan’s fundamental goal is to set the unraveling in motion of not just the ACA, but social security and medicare as well over the next decade. He realizes he can’t get away with instant detonation, but rather plots to insure that any plan passed contains fatally corrosive elements. He sees the next two years as the one window in which it’s achievable before the opportunity disappears for a couple more generations.

    ReplyReply
  31. 31
    OzarkHillbilly says:

    63% of current Medicaid spending is on the aged and disabled. 21% more is for children.

    Every health care letter to every congress critter should cite these numbers.

    ReplyReply
  32. 32
    daveNYC says:

    Yeah… you’re never going to get any Republicans on board for anything that improves the ACA. Far more likely that the ACHA gets shot down, the administration spends the next year using the various levers to break the ACA, and then runs in 2018 on a message that they tried to fix the ACA but the Democrats and squishy RINOs wouldn’t let them.

    ReplyReply
  33. 33
    James Powell says:

    @Another Scott:

    4) We need voters to be paying attention, to be horrified and angry about what the GOP majority is doing and trying to do. That means making the GOP own their actions and policies.

    Getting voters to pay attention to harm caused by GOP policies has been a task for Sisyphus. I’m never sure whether it’s the Democrats reluctance to take on policy differences for fear of alienating suburban voters or the voters reluctance to spend any time listening to policy arguments. In any case, I’m betting that “Other people, most of the poor, are losing their health insurance” isn’t the type of argument that wins elections.

    ReplyReply
  34. 34
    Patricia Kayden says:

    @JPL: And there should be consequences for that. He would be hurting Trump supporters.

    ReplyReply
  35. 35
    OzarkHillbilly says:

    @SRW1:

    I’m reasonably sure you meant the Turtle rather than Boehner there.

    No, he was using Boehner as a verb, as in, “to Boehner oneself” meaning to “work across party lines”.

    ReplyReply
  36. 36
    D58826 says:

    Both items talk about the legitimate pain and suffering of the middle/working class in America today. And yet they continue to elect political leaders who make the pain and suffering worse by transferring income/resources/power to the 1%.

    A long piece about a Trump voter and healthcare:

    Both liberals and conservatives have reason to ponder this embittered voter who needs more help with her insurance.

    https://www.healthinsurance.org/blog/2017/03/20/trump-voter-would-have-large-aca-subsidy-but-is-too-busy-raging-at-undocumented-neighbors-to-care/

    and

    Still bereft of an industrial alternative to coal, West Virginia has been reduced to almost feudal destitution.

    https://newrepublic.com/article/141435/eternal-sunshine-spotless-white-mind?utm_content=buffer7264e&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer

    ReplyReply
  37. 37
    SRW1 says:

    @OzarkHillbilly:

    You mean like ‘Bogart that joint’? Learn something new every day.

    ReplyReply
  38. 38

    Driving a wedge (or wedges) into the Republican Party looks like a means to an end.

    But at this moment, and until an unforeseeable tipping point occurs(*), it is not feasible. Therefore, it cannot be identified as a dependency for any other goal, because to do so makes those goals infeasible.

    So driving wedges into the Republican Party must be, as long as it remains infeasible, an end in itself.

    When it becomes feasible, it can then be interpreted and exploited as a means to whatever end.

    (*) The tipping point may come this afternoon, or years out. It may be obvious or subtle. It may be substantive or affective. If it is substantive, its substance may be connected with healthcare or with some other issue that has appeared to be salient at any point over the past four+ months, or it may be something entirely new.

    ReplyReply
  39. 39
    JPL says:

    @Patricia Kayden: The intent is to deregulate the insurance company, which takes away states rights. In GA they passed autism coverage, but that would be moot, since most policies would originate from Alabama. That’s Price’s intent.

    ReplyReply
  40. 40
    JMG says:

    I will not read another article about diehard Trump voters who’re screwing themselves over because for them, a sense of racial superiority is what comes first. When are reporters going to find squishy Trump voters rather than going to East Nowhere which has been in depression for 40 years and do the same stupid story over and over and over. I don’t want anyone to suffer, but what is the news value in noting that hate and stupidity continue to exist, usually inside the same people.

    ReplyReply
  41. 41
    OzarkHillbilly says:

    FYWP x 2. Apparently I am no longer able to link to the Kaiser Foundation.

    Medicaid Spending by Enrollment Group

    Aged: 21%
    Disabled: 42%
    Adults: 15%
    Children: 21%

    ReplyReply
  42. 42
    Louise B. says:

    Richard, have you done a post on “what does the optimal technical corrections act for the ACA look like?” I understand that republicans will never pass it, but it might help us make arguments to our representatives about what we want.

    ReplyReply
  43. 43
    OzarkHillbilly says:

    @Frank Wilhoit:

    So driving wedges into the Republican Party must be, as long as it remains infeasible, an end in itself.

    It is always feasible. There are competing interests within the GOP coalition (as there are in the DEM) and those are the wedge points. No politician wants to be responsible for his/her constituents losing their healthcare, just the healthcare of those people.

    That is where we drive the wedge home with a f’n jackhammer.

    ReplyReply
  44. 44

    @D58826: I am not interested in reading yet another story about the terminally stupid. They had a choice in November, they could have chosen the party that gave them healthcare but they didn’t.

    ReplyReply
  45. 45
    sdhays says:

    What’s the end game here? Any acceptable bill will pass with 100% Democratic support and pocket-lint Republican support. But pocket-lint Republican support won’t have the support of the leadership (so it’s hard for me to figure out how it even comes up for a vote in the House) and won’t “repeal” Obamacare. What will be Tom Price’s investment in no longer destroying Obamacare? The Republican Preznit may be interested in just declaring victory, but it would be over the howls of the Freedumb Caucus and it will piss off his base, something he hasn’t been willing to do.

    I suppose that if the Preznit is desperate for a victory, he could demand a vote in both Houses, but the Preznit has a lot less political juice than he thinks, and he has less by the day. I don’t see him even trying to do this before it’s too late, mostly because it’s pretty clear he has no idea what he’s doing and doesn’t really care about what any bill actually does.

    But maybe applying the Chuck Grassley strategy of negotiating with no intention of providing any votes (as suggested by @SFAW at #29) is a good plan, as anything that wastes this Congress’ time is a win and might at least postpone the worst administrative attacks on the ACA.

    ReplyReply
  46. 46
    rikyrah says:

    @cmorenc:

    Paul Ryan’s fundamental goal is to set the unraveling in motion of not just the ACA, but social security and medicare as well over the next decade. He realizes he can’t get away with instant detonation, but rather plots to insure that any plan passed contains fatally corrosive elements. He sees the next two years as the one window in which it’s achievable before the opportunity disappears for a couple more generations.

    Tell it over and over and over again.

    ReplyReply
  47. 47
    JPL says:

    DAVID, Yesterday Price suggested that children and single parents be treated different than those disabled and infirmed? What’s the overall reason for this?

    ReplyReply
  48. 48
    Bill in Section 147 says:

    The goal of the Republican Party is to destroy the Democratic Party. They require unconditional surrender. There is nothing to negotiate. After the 2008 election some people thought with the President and House in the hands of the Democratic Party their would be negotiations. There were no negotiations.
    Imagine living in a world where, as you watched the famous bunker scene, you knew that the Generals who were trying to convince the hard-liners that all was lost were wrong and the crazy, deluded guy was right. After playing defense and obstructing the aims of their armies, he did defeat the enemy eight years later by the strength of his will. The people living in that world would know the value of trusting in the will. In that world 1955 would not be suddenly a turning point for the rise of liberal democracies.

    ReplyReply
  49. 49
    CaseyL says:

    Was it Snow or Collins who used to make a big deal of being open to negotiation on a bill put forth by Democrats? One of them. She got a lot of press attention, a lot of Democratic attention, and – without exception – ended up voting with the GOP. I think her most famous “achievement” was convincing Obama to restructure the ARRA to include more tax breaks and fewer outright grants, essentially halving the overall program… and then she voted against it anyway.

    That’s how I see the GOP twisting and turning over this atrocity of Ryan/Trump Don’t-Care. They’ll hem and haw and talk about how terrible it is, and how it hurts their constituents…. and then they’ll vote for it. I don’t believe they won’t, because the only thing that really motivates them is fear of being primaried.

    (Which, by the way, tickles me no end, in a bitter way. The GOPers don’t want to be cut loose to make their way in the economy and society they created.)

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  50. 50
    rikyrah says:

    @JPL:

    Yesterday Price suggested that children and single parents be treated different than those disabled and infirmed? What’s the overall reason for this?

    Because the parents are to blame for being poor. Remember, Price doesn’t even agree that SCHIP is a good program, because if we say that CHILDREN have a right to healthcare…well….

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  51. 51
    JMG says:

    Cong. Barry Loudermilk (R-Ga.) gives interview in which he urges Trump to ignore court rulings on travel ban because “it’s not true” there are three equal branches of government. Of course if Obama had ever ignored a court order Loudermilk would’ve squealed for impeachment. You cannot negotiate with people like this. They aren’t just authoritarians, they’re totalitarians.

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  52. 52
    Neldob says:

    @MomSense: those lives lost are people who voted for Trump generally maybe. Do we lose lives now to save more later?

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  53. 53
    gvg says:

    The republican self trap of promising what is impossible to deliver out of both sides of their mouths has done better than I feared at derailing them so far. I say encourage it. Yes they can administratively hurt the program but I think much of it will take time to kill it completely and they don’t offer anything that isn’t tire rims and anthrax so I think stalling until they learn to think (the republican lawmakers) is the best we can do. If they realize the trap they are in and begin to think ways out, they will have changed so much I don’t see much use in predicting how to negotiate with them. It’s like trying to list all the alternate universes that might exist.
    I don’t know how to get the story out in plain language, but that is what is going on. GOP has been over promising for awhile now, even beyond having quack ideas about economics. Someone needs to be showing ordinary voters the both sides GOP promises and simple, “no one can do both”. explain the trap and why nothing is happening. Repeat it alot.

    Start running simple social studies kid shows that are pertinent like “I am just a bill” and historical documentaries that are old but relevant and we saw before but have forgotten. Even certain fictional movies old ones, being shown now. New ones could be considered slanted. The voters seem to have become mind bogglingly stupid for some time. Can we sneak in some education? Maybe about the Great Depression and why Unions? Is there anything on what Adam Smith really said? How about the history of insurance?

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  54. 54
    Cermet says:

    When you say

    subtle attacks include a quiet campaign of telling insurers that the mandate will not be enforced

    Uh!? the small handed ass-wipe has already told the IRS not to enforce the mandate so exactly how does ACA survive and weren’t you reading the news the last few months?

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  55. 55
    gvg says:

    Oh and can we stop some administration sabotage by court orders so the regular employees can just keep on as they have been? like stopping the travel bans

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  56. 56
    Chet says:

    I think it’s time to move the Overton Window to the left. Why not bring up the Public Option again? IIUC it was designed to compete with the private insurers to keep premiums down. It was dropped as an olive branch to the republicans (I think, one of the aforementioned Collins or maybe Snowe), who of course voted against it anyway. And rising premiums are one flaw that everybody acknowledges.

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  57. 57
    MomSense says:

    @Neldob:

    Um fuck off.

    ReplyReply
  58. 58

    @OzarkHillbilly: I was of course talking about the effectiveness of the wedges; the effort to drive them must continue with all energy even despite the fact that no cracks have as yet been created. On the latter point, you underestimate the ability of the Party to shift blame. So far its track record in that regard is exactly 100%. I have always said that no one has changed party since 1980 or ever will again. Any apparent “swings” from one election cycle to another are entirely due who who sits home, not to changes in party affiliation.

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  59. 59
    OzarkHillbilly says:

    @Chet: It was dropped at the insistence of blue dog DEMs.

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  60. 60
    PaulW says:

    I have faith that if the GOP thinks about sabotaging the administrative aspects of any ACA that survives this week, they’ll STILL get blamed for it because people will see who’s responsible for letting it fall apart.

    The reason they couldn’t fck with Social Security back in 2005 was because enough white folk realized they were going to get screwed by the changes, and the same thing should apply here.

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  61. 61
    Original Lee says:

    Important for when you call your Congresscritters: the bill number is H.R. 277. An alternative bill worth taking a look at and possibly mentioning as being worth your support (with the caveat that I’ve only read the summary so far and there might be nasty surprises in it) is H.R. 676, which is the Medicare for All Act, sponsored by Conyers (D-MI).

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  62. 62
    MomSense says:

    @Chet:

    Actually Snowe was trying to keep a version of the public option alive while the bill was still in the Senate Finance Committee. It was complicated and probably would have been ineffective but it was Baucus, Nelson, and Bayh who were opposed to the public option.

    Collins was serving on HELP at the time, chaired by Teddy Kennedy, and that version included a public option.

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  63. 63
    Sunny Raines says:

    Oy! You would have thought 8 years of republican intransigence against Obama would have made it abundantly clear there is NO DEALING WITH TODAY’S REPUBLICANS. It’s delusional lunacy to think otherwise. Democrats MUST defeat them and win all their battles in the streets with the people – NOT with the disloyal republican opposition in Congress.

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  64. 64
    Another Scott says:

    @gvg: Yup, they painted themselves into a corner with radioactive paint, then set the room on fire.

    Just like Obama said they were doing in 2010:

    BALTIMORE — President Barack Obama on Friday accused Republicans of portraying health care reform as a “Bolshevik plot” and telling their constituents that he’s “doing all kinds of crazy stuff that’s going to destroy America.”

    Speaking to House Republicans at their annual policy retreat here, Obama said that over-the-top GOP attacks on him and his agenda have made it virtually impossible for Republicans to address the nation’s problems in a bipartisan way.

    “What happens is that you guys don’t have a lot of room to negotiate with me,” Obama said. “The fact of the matter is, many of you, if you voted with the administration on something, are politically vulnerable with your own base, with your own party because what you’ve been telling your constituents is, ‘This guy’s doing all kinds of crazy stuff that’s going to destroy America.’ ”

    Two of the 3 guys in the chairs in the picture are gone, and the only reason why the 3rd isn’t is because he ran away from his state.

    Cheers,
    Scott.

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  65. 65
    OzarkHillbilly says:

    @Frank Wilhoit:

    So far its track record in that regard is exactly 100%.

    I give you the (2nd) Iraq war. And the effort to privatize SS. And the 2007 economic collapse. DEMs can be their own worst enemies, with their circular firing squads and cowardly ass covering votes, but it can be done.

    And in the health care debate it is being done. How successful it is in the end will remain to be seen but somebody somewhere should be working on Aunt May and Uncle Ben ads.

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  66. 66
    OzarkHillbilly says:

    @OzarkHillbilly: @Frank Wilhoit: On further thought, I’m going to take back the 2007 economic collapse. While most voters correctly blame the GOP economic policies for the collapse (with some blame for DEMs of course) the GOP still fronts the same trickle down nonsense that they’ve been pushing for decades and they still get the votes because,

    “HEY! LOOK OVER THERE! T-BONE BUYING BUCK IN A CADILLAC!”

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  67. 67
    catclub says:

    @Another Scott:

    We know that they will eventually vote as a block and pass something. That’s what they do.

    Like they had the votes in 2005 to pass SS privatization?

    IN contrast to the nothing response, which worked in 2005, on SS privatization. IN this case, the Democrats can bring up lots of examples and say:
    how do you fix this, or, your way makes this much worse.
    I would emphasize big-government-one size doesn’t fit all GOP bill.
    1. Rural Alaskans whose insurance will go up over $10k, no matter what their age or income.
    2. A single, 27 Y.O who makes $74.9k gets the same subsidy that a 45 YO with a family, making $27K makes.
    Democrats can keep asking: “Why are you making inequality worse?

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  68. 68
    catclub says:

    @PaulW:

    I have faith that if the GOP thinks about sabotaging the administrative aspects of any ACA that survives this week, they’ll STILL get blamed for it because people will see who’s responsible for letting it fall apart.

    me too.

    I would emphasize that the GOP claims they have a better idea and know how to fix it, but refuse, and instead sabotage it.

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  69. 69
    WereBear says:

    @JMG: Sabotaging government is a strategy that works when you’re in opposition. But when you’re the government, not so much.

    And it is still the only strategy they’ve got.

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  70. 70
    Brachiator says:

    The Republicans are uniting behind the principle that you cannot and should not force someone to buy health insurance who does not want it. The Republicans also do not believe that health insurance is a right that should be provided by the federal government.

    Any Republican compromise (compromise with other Republicans) will be on the level of subsidies offered, with Tea Party Republicans and conservative fundamentalists against any subsidies at all.

    Further, the Republicans believe that insurance companies have a fundamental right to be able to cut their costs and maximize their profits, and that it is the duty of the Republican Party to assist and support insurance companies to the greatest degree possible. This also applies to other members of the health industrial complex (especially the drug companies). That federal support is antithetical to any supposed concern for the free market and competition is a trivial detail.

    So, the Republicans have to kill the ACA, or let it die, and convince citizens that people who cannot afford insurance don’t deserve to live.

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  71. 71
    Neldob says:

    @MomSense: Ouch, a little touchy. nice answer, though to what question?

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  72. 72
    Another Scott says:

    @catclub: 2005 was ancient history in many respects. The GOP didn’t vote as a block on just about everything back then. The GOP hadn’t been running for 7+ years on repealing the ACA in 2005, either.

    I agree with the tactic that Nancy implemented (roughly): “Our plan is to protect Social Security.” I agree that helping the GOP carry out their long-standing promise to gut the ACA would be a mistake.

    All the signs are that the Teabagger Congress is different from the past. During Obama’s terms they could let their Freak Flag fly without policy consequences because they knew he would veto the bills and they didn’t have the votes to even try to over-ride. Now they’re in the corner of the radioactive burning room of their own construction and looking for help. They know nothing but sticking together and saying NO to everything the Democrats might propose to make things better, so I say NO to them in return.

    We should remember that most of the people in the House have huge advantages come re-election time (gerrymandering, huge campaign chests, all the advantages of incumbency). They decided long ago that their main risk is their right flank, so they will stick together (we hope until it is too late for them to save themselves). Unless there is a sea-change, most of them will be re-elected. The best way to have a sea-change is for them to own their own policies.

    But we’ll see what happens.

    Cheers,
    Scott.

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  73. 73
    TenguPhule says:

    @David Anderson:

    If there is something that could get through the Senate and forces Ryan to either kill it or Boehner himself, that can be an acceptable outcome.

    If there is something that can get Ryan to kill Boehner, we’ll party like its 2008.

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  74. 74
    TenguPhule says:

    @Brachiator:

    The Republicans are uniting behind the principle that you cannot and should not force someone to buy health insurance who does not want it.

    And the Democrats need to unite behind “Emergency Rooms should not be default Healthcare for the Public.”

    The Free Rider problem needs to be hammered home, across the board. Republicans are parasites who want free stuff. All the benefits, none of the responsibilities.

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  75. 75
    J R in WV says:

    Ignorance is one of the major problems here.

    People don’t understand that successful insurance in the long term needs to be universal. From home-owners fire insurance, auto insurance, life insurance, the people who don’t have horrendous traffic accidents make their payments to fund those who do have wrecks.

    If you think you need life insurance, you had best purchase that policy while you are young and healthy, because they won’t sell you a policy at a price you can afford when you are older, especially if you have a health care diagnosis of any sort.

    And how many mortgages do banks provide to people who refuse to purchase home owner protection against the more common events that could cost the bank their investment in your home? Zero is the answer to that question!!

    But people with car insurance somehow can’t relate their knowledge of that financial transaction to their health insurance? Really? Ignorant, pig ignorant.

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  76. 76
    Raoul says:

    The votes in the House might be found if the Medicaid provisions are made harsher and shorter.

    The GOP are just evil. Straight up merchants of suffering and death. Detestable, the lot of them.

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  77. 77
    Chet says:

    @MomSense:

    Actually Snowe was trying to keep a version of the public option alive while the bill was still in the Senate Finance Committee. It was complicated and probably would have been ineffective but it was Baucus, Nelson, and Bayh who were opposed to the public option.

    Thanks for setting the record straight. Could a less complicated public option be more effective? My general point is that Dems shouldn’t be afraid to negotiate from a starting position that is to their advantage.

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  78. 78
    goblue72 says:

    Your technocratic naivete won’t save you , David.

    The current iteration of the GOP that we have been living with at least since the “Teabag Your Face” Caucus spawned itself from inside a Koch-funded PAC are zero-sum “competitive” negotiators. You gain absolutely nothing in a business negotiation from compromising when faced with a zero-sum counter-party. The proper response is an equally aggressive zero-sum negotiating style in which you give no ground and make the other side earn every penny they squeeze out from you. There is ZERO opportunity for goodwill generation at the table via concessions, as the counter-party does not recognize any value in goodwill. All concessions by a party to the zero-sum counter-party comes out of the conceding party’s pockets.

    If Democrats want to fake accommodation in order to get something from the GOP and then still vote against the bill in order to just slow things down – fine. But other than that? No.

    Negotiating with zero-sum / competitive counter-parties is an exhausting, aggravating, and painful process. But when faced with a counter-party who as much monumental douchebags as the current GOP, you just have to dig in and be even bigger douchebags. Its a war of attrition as this point.

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  79. 79
    Brachiator says:

    @J R in WV:

    Ignorance is one of the major problems here.

    People don’t understand that successful insurance in the long term needs to be universal.

    People either don’t understand, or don’t care.

    From home-owners fire insurance, auto insurance, life insurance, the people who don’t have horrendous traffic accidents make their payments to fund those who do have wrecks.

    People let their car insurance lapse and continue to drive. Hell, people drive without a license. They think the odds are that they won’t get into an accident.

    In California, people must have homeowner’s insurance, but are not required to have earthquake insurance. I’ve heard rock solid Reagan conservatives brag about not carrying sufficient insurance on their homes and saying that in the event of an earthquake or other damaging disaster that they would have no problem with taking advantage of any federal disaster relief programs. Because they deserve whatever they can get.

    And back to your larger point. The Republicans lie about the nature, purpose and financing of insurance as though somehow individual “liberty rights” nullifies the group benefits of insurance.

    @TenguPhule:

    And the Democrats need to unite behind “Emergency Rooms should not be default Healthcare for the Public.”

    Unfortunately, most people don’t care about hospitals and don’t see how it connects with their taxes.

    With one big exception. Racist assholes think that any Latino who goes to the hospital is an illegal alien who is taking the bed away from a “real” American.

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