Heh, yes, how did Ryan get it so wrong, it wouldn't have anything to do with strict (though obviously not hard right as most of the Freedom Caucus) ideological fixations, would it .. lol, i understand why you almost feel sorry for the guy who couldn't be bothered with doing his homework as his 'i am the greatest deal maker ever' has taken a real hit .. though i know that's not why you have that 'feel sorry' tickle .. ha, it's only because in spite of being such a shit-ass, still he is sorta human and he is in a pickle .. of course i 100% agree Ezra Klein is a beauty! .. he cares .. which brings me to this of yours ..
"Politico reports that Trump doesn’t even like talking about health care — and his staffers have started, amazingly, to see that as a good thing"
and this from the one i was reading when you posted yours ..
-- 5) Just how committed are they to this thing, anyway?
A Tea Party protest against Obamacare in March 2010. NICHOLAS KAMM/AFP/Getty
When Democrats tackled health reform in 2009, expanding health coverage had been a core value of their party for decades. As mentioned above, that was helpful because it helped them clarify their goals for the legislation.
But another important consequence of that is that many in the Democratic coalition, from the president on down, deeply believed they were doing something good that would help people.
Because of that, Democrats were willing to make sacrifices and take risks. So when Tea Party protests swept the nation and it became clear that the Affordable Care Act would be a really tough vote, many Democrats even in moderate states and districts turned out to be willing to walk the plank.
[.. in other words a number of Democrats put the welfare of their constituents ahead of their own ..]
Republicans have gotten a lot of mileage out of criticizing Obamacare. The party is enthusiastic about, in broad terms, cutting taxes, regulations, and government spending.
But health policy specifically has never particularly inspired the GOP coalition. There’s a reason why, in the nearly seven years since Obamacare became law, the party has never managed to get together a consensus replacement plan.
For many, the commitment to repealing Obamacare is only slogan-deep. Accordingly, there’s already a sense of exhaustion and frustration among some Republicans on the Hill who would much rather focus on cutting taxes but instead feel like they’re stuck in an Obamacare mess.
So what happens after a wave of new protests at town halls? What happens if the GOP’s bill gets a bad CBO score? What happens if President Trump derails the process with a tweet?
I went for it on the question 'what specifically is in that the GOP are having so many conflicts about?' .. Ezra mentioned some of them in his .. actually there is a fair amount of overlap .. here is the rest.
The 5 biggest disagreements Republicans have on Obamacare
Updated by Andrew Prokopandrew@vox.com Feb 16, 2017, 9:10am EST
An anti-Obamacare protester outside of the Supreme Court in 2012. Bill Clark/CQ Roll Call/Getty
Deep uncertainty and serious divisions within the Republican coalition about the way forward on Obamacare have surfaced in the new Congress, and they’ve put the future of repeal and replace in doubt.
It’s become evident that there is little GOP unity on how much a replacement plan should cost, how to pay for it, whether the Medicaid expansion should be rolled back, or how to fix the individual markets.
Furthermore, there is no evident agreement even on extremely broad questions such as, “What should the goals of the GOP’s replacement plan be?”
Accordingly, many Republicans in both the House and Senate are increasingly fearful about moving to roll back Obamacare too quickly when so little is settled about what comes after it. And their problems are compounded by the fact that while a reasonably comprehensive repeal bill could be rammed through with just 50 Senate votes plus Vice President Mike Pence, a serious replacement bill would need 60 Senate votes, at least eight of which would have to come from Democrats.
It is not impossible that President Trump and the Republican Party will overcome all these problems. But to do so, they will have to come up with consensus answers to these five very serious unsettled questions.
1) What is the goal here?
President Trump has said he wants “insurance for everybody,” even those who “can’t pay for it.” Republicans in Congress are not so sure they agree on that. Bastiaan Slabbers/NurPhoto via Getty
When Democrats tackled health reform in 2009 and 2010, their primary goal was to expand useful health coverage to millions more people. Their strategy to achieve that goal was complex in its particulars, but broadly quite simple — they’d spend a lot more government money on health care, and pay for it with new tax increases and spending cuts elsewhere.
Now that Republicans are tackling the issue, their goals are far more muddled.
But these are, to some extent, opposite problems with opposite solutions. Realistically, if you slash government spending on health coverage, at least some of those constituents will end up paying much more out of their own pockets. And many Republican health wonks don’t think high deductibles are actually so bad .. http://new.www.huffingtonpost.com/entry/trump-administration-affordable-care-act-rules_us_58a487c8e4b094a129f12af9?y9qz27aj53lodjwcdi , since they would theoretically incentivize people to spend less on unnecessary care. (Congress members listening to their constituents’ complaints about high out-of-pocket costs may not be so persuaded by this argument.)
Then there’s the crucial question of whether any GOP replacement should maintain Obamacare’s coverage levels, or even seek to expand them. Trump has said he wants his replacement plan to “have insurance for everybody,” even those who “can’t pay for it.” Yet Republican congressional leaders reportedly think the goal should instead be to provide everyone access to coverage — a much more nebulous objective.
Drafting and passing a comprehensive health reform bill is incredibly difficult even when you do have clear goals, as Democrats found out in 2009. The GOP’s current lack of consensus on coverage goals or just what lowering costs means compounds the difficulty.
2) What will they do about money?
In happier times — January 2016 — Speaker Paul Ryan (right) and now-HHS Secretary Tom Price (center) brag about passing an Obamacare repeal bill that is headed for President Obama’s certain veto. Al Drago/CQ Roll Call/Getty
Repealing Obamacare naturally means repealing those taxes and fees, and many Republicans are eager to do that. The problem, though, is that if Republicans also replace Obamacare with anything that spends anywhere close to as much on coverage, they’ll need to come up with new sources of funding to pay for it.
Coming up with what in Hill parlance is known as a “pay-for” is tremendously challenging for legislators, because there will be some constituency or group very vocally opposed to essentially any new tax hike, fee, or spending cut that’s proposed.
And while Republicans do have one idea here, it looks to be an extremely tough sell. In leaked audio .. https://tinyurl.com/m6kbptu .. from Republicans’ closed-door retreat last month, House Ways and Means Committee Chair Kevin Brady said that he’s “looking at” limiting “the biggest tax credits we have ... the tax break you get for health care” provided through employers, to help fund a health care tax credit that would be more portable.
The problem is that changing it is terrible politics. That’s because the majority of Americans who have insurance currently get it through employers and therefore benefit from this tax break. Past administrations have shied away from messing with it as a result, with Obama’s one major attempt to do so — the never-yet-implemented “Cadillac tax .. http://www.commonwealthfund.org/publications/issue-briefs/2016/june/cadillac-tax ” — predictably ending up incredibly unpopular.
The optics of repealing taxes targeting rich people, while capping a tax break enjoyed by a much broader section of Americans, could be devastating. Indeed, Sen. Bill Cassidy (R-LA) pushed back against Brady’s idea in the audio from the retreat .. https://tinyurl.com/m6kbptu . “It sounds like we are going to be raising taxes on the middle class,” Cassidy said.
But what Republicans can do on the replacement side will in large part be determined by how much money they can dredge up to pay for it. So if they’re dead set on repealing Obamacare’s pay-fors and can’t come up with their own, they will likely have to deal with a whole lot of people either losing coverage or seeing even greater costs.
3) What’s to be done with Medicaid?
Sen. Shelley Moore Capito (R-WV) has concerns about repealing the Medicaid expansion. By Bill Clark/CQ Roll Call
Out of the money question comes another very clear division that splits Republicans in Congress: the fate of Obamacare’s Medicaid expansion.
The health law expanded coverage to millions more people in two main ways.First is what we generally think of as Obamacare — the restructuring of the individual insurance markets, and the subsidies to help people buy insurance on those insurance exchanges. But second, the law expanded Medicaid eligibility to people making up to 138 percent of the federal poverty line .. https://www.healthcare.gov/glossary/federal-poverty-level-FPL/ , including childless adults, with the federal government shouldering the vast majority of the cost.
Currently, 20 of the 52 Republican senators represent states that expanded the program. Several have been vocal about their lack of interest in rolling this particular part of Obamacare back. “That’s 184,000 people in my state,” Sen. Shelley Moore Capito (R-WV) told Politico .. http://www.politico.com/story/2017/02/obamacare-republicans-repeal-replace-234821 . “That’s problematic.”
But other Republicans in Congress are from states that didn’t expand, or are ideologically opposed to continuing the expansion. “Getting ahold of the Medicaid expansion and repealing that is absolutely critical if we’re gonna have control of the growth of entitlement spending,” Rep. Bob Goodlatte (R-VA) said in the retreat’s leaked audio .. https://tinyurl.com/m6kbptu . Republicans in states like his, he continued, “want to be proven that they were correct originally, that we can’t afford this when we have a $20 trillion national debt.”
Beyond the question of the Medicaid expansion’s fate in repeal legislation, there’s the question of what will be done with Medicaid as a whole in any replacement for Obamacare. Republicans have long proposed overhauling the program by handing over much more authority to the states to run their Medicaid programs as they see fit. The catch is that such proposals from the GOP .. http://kff.org/medicaid/issue-brief/5-key-questions-medicaid-block-grants-per-capita-caps/ .. are almost always accompanied by changes that would also cut or cap Medicaid spending — which would mean people lose coverage.
Then there’s the further hiccup that if the GOP’s Medicaid overhaul caps payments per enrollee, the states that expanded Medicaid will effectively be rewarded with more federal cash. So you get the potentially bizarre situation where, as Politico’s Jennifer Haberkorn and Rachana Pradhan report .. http://www.politico.com/story/2017/02/gop-medicaid-spending-235018 , the party might end up having to placate those non-expansion states by throwing more money at them, so they can hopefully cut the program as a whole.
4) How will they try to make the individual markets work better?
Orrin Hatch of Utah chairs the Senate Finance Committee. Al Drago/CQ Roll Call
When it comes to reforming the individual insurance markets, there is at least some Republican consensus on what to do. Everyone from HHS Secretary Tom Price to Speaker Paul Ryan to Senate Finance Chair Orrin Hatch agree on the basic premise that the government should give people buying insurance on the individual market a tax credit to help them afford it.
Indeed, the fundamental problem at the heart of the GOP’s replacement conundrum is that health care in the US is expensive, and health care for sick people is especially expensive.
One thing Obamacare tried to do was prevent so much of these costs from falling on sick people — by spreading them around to healthy people (by way of regulating how much insurers can charge and what benefits they must provide) and by having the government spend more too.
Now, Republicans have at least a reasonably good case that Obamacare’s individual markets aren’t working well, with insurers pulling out of some areas and costs rising to the point where many healthy people are less likely to find insurance worth their while. Some sort of fix appears to be necessary.
The GOP’s preferred reforms generally involve rolling back Obamacare’s regulations so that insurers have more flexibility to sell different types of insurance products and charge different rates.
But the devil will be in the details. How big should the tax credit be? How much should it vary for different populations (for instance, should it vary by age or income)? What, if any, policy tools will be used to encourage young and healthy people to get insured? Just how many regulations on what products insurers can sell will be rolled back? And if regulations are rolled back, how will the GOP’s replacement avert an outcome in which sick people are charged exorbitant rates or denied coverage altogether?
.. the GOP and Trump should forget the bullshit antagonistic and ideologically cemented repeal crap and concentrate on one thing only, tweaking Obamacare to have it working better .. period .. they can't though can they .. 7 years .. 68? calls for repeal, to this ..
Donald ‘The Closer’ Trump didn’t know how to close the deal
"How Paul Ryan played Donald Trump"
President Donald Trump speaks before signing an executive order establishing regulatory reform officers and task forces in US agencies in Washington, DC on February 24, 2017. Olivier Douliery - Pool/Getty Images
03/24/17 04:58 PM—Updated 03/25/17 12:20 AM
By Steve Benen
Not long before launching his presidential campaign, Donald Trump identified what he saw as his greatest strength. “Deals are my art form,” the Republican boasted . “Other people paint beautifully or write poetry. I like making deals, preferably big deals. That’s how I get my kicks.”
The Rachel Maddow Show, 3/24/17, 9:26 PM ET Schumer: 'Art of the Deal is out the window' .. [is the first YT below]
Many voters actually believed this. There was never any evidence that Trump actually excelled in negotiations or deal-making, but he kept talking about his expertise in a way that managed to persuade quite a few people.
It was, however, all nonsense. He started with an unrealistic promise to the nation that Trump would never be able to keep – insurance for “everybody,” which would be far better than the status quo, at a lower cost – and he proceeded to break his commitments left and right. As the pressure mounted, the president further abandoned his own stated principles and effectively offered recalcitrant Republican all kinds of enticements, in exchange for nothing, which they discarded as pathetic.
- You don’t walk into a negotiation and tell your counterparty that you’re desperate to make a deal fast and on any terms. But Trump did just that, which is why Freedom Caucus members knew the White House was bluffing when it claimed the bill was closed and wouldn’t be amended further.
Trump invited the Freedom Caucus to squeeze him dry. Weak! Bad! -
To understand the costs of having a clueless, amateur president, look no further than today’s developments.
It’s never been altogether clear that Trump knows what a “deal” is, in a literal sense. He’s accustomed to private-sector agreements in which he leverages his celebrity status to make money, but can anyone think of a situation – from any point in his entire career – in which Donald J. Trump has set a goal, delved into complex details, and persuaded a variety of groups to work cooperatively along mutually agreed upon terms?
- The answer can be found in Trump Steaks. And Trump University. And Trump Vodka. And Trump Suits. And Trump’s fragrance line, his board game, his ghostwritten books, his energy drink, his eyeglasses, and his chocolate bars.
Yes, these are all real Trump products. And they expose the reality of Trump’s dealmaking. Trump is not a guy who makes particularly good deals so much as a guy who makes a lot of deals — many of which lash his name and reputation to garbage products.
Trump, a lifelong teetotaler, didn’t scour the globe to find the very best vodka. No — someone offered him an opportunity to make a quick buck by putting his name on a product he wouldn’t ever touch and he took it. Trump University was a far darker scam. Trump Steaks were, and are, a joke.
This is Trump’s pattern: He licenses his brand and lets others worry about the details of the products. Trump’s partners often end up going out of business and his customers often end up disappointed, but Trump makes some money, and he gets his name out there, and it’s all good. -
Trumpism never existed. That's why the party won out over the president.
By Graham Vyse April 15, 2017
After Donald Trump addressed a joint session of Congress last month—a high-water mark .. https://newrepublic.com/minutes/141034/donald-trump-read-teleprompter-wore-nice-suit-suddenly-hes-presidential .. for the president’s popularity with elite political pundits—conservative New York Times columnist David Brooks penned a piece titled “Trumpism at Its Best, Straight Up .. https://www.nytimes.com/2017/03/03/opinion/trumpism-at-its-best-straight-up.html?_r=0 .” Brooks attempted to define Trump’s political philosophy as an “utter repudiation of modern conservatism,” which he defined as foreign policy hawkishness, social conservatism, and fiscal hawkishness. “For the last 40 years, the Republican Party has been a coalition of [these] three tendencies,” he wrote. “Trump rejected or ignored all of them.”
National Review contributor Victor Davis Hanson wrote in January .. http://www.nationalreview.com/article/443667/trumpism-tradition-populism-american-greatness-strong-military .. that in Trump “we can see a coherent worldview emerging, something different from both orthodox conservatism and liberalism”—a supposed combination of “tradition, populism, and American greatness.” (Indeed, American Greatness .. https://amgreatness.com/ .. is the name of one of the pro-Trump publications trying to intellectualize .. https://newrepublic.com/article/140933/failure-pro-trump-intellectualism .. his politics.) With Trump capitulating to conventional conservatism, though, talk of a consistent Trumpism looks increasingly misguided. The man who won the Republican nomination by bucking conservative orthodoxy is now proving the pull of the GOP is as strong as ever.
- [H]ow much do you expect to be able to both run an administration and negotiate with a Republican-led Congress as a different kind of Republican. And do you worry that you’ll wake up three years from now and go back to campaigning in the Rust Belt and people will say, well, he governed more like Paul Ryan than like Donald Trump. -
Trump insisted he wouldn’t let down the Rust Belt, which had “proven ... to love Donald Trump, as opposed to the political people.” Now more than ever, though, “the political people” are steering his agenda. Chief strategist Steve Bannon—the white nationalist pushing an “America first” philosophy in the administration—is reportedly on the outs .. https://newrepublic.com/minutes/141992/sounds-like-trump-step-steve-bannons-body , potentially a casualty of conflict with more establishment figures like senior adviser Jared Kushner, Trump’s son-in-law. Moreover, Bannon’s waning influence coincides with Trump moving in a more establishment direction on a myriad of issues.
Increasingly, Trump is validating voices like Tamara Draut, the vice president of policy and research at the progressive group Demos Action, who published a piece in The Hill last week titled “Don’t call Trump a populist: ‘Trumpism’ is just ‘Republicanism’ .. http://thehill.com/blogs/pundits-blog/the-administration/327392-dont-call-trump-a-populist-trumpism-is-just .” Despite his populist campaign rhetoric, Draut writes, “He’s president, and his policy decisions and proposals are, for the most part, ripped straight out of the Republican Party’s playbook of tax cuts for the wealthy, deregulation and attacks on government.”
Healthcare is a perfect example. As I wrote on Wednesday morning .. https://newrepublic.com/minutes/141984/repealing-obamacare-trumps-groundhog-day , Trump could have pushed an infrastructure plan at the start of his presidency, pressing the populist case for putting Americans to work and rebuilding America. But he caved to House Speaker Paul Ryan, a conventional conservative, for whom repealing Obamacare was the top priority. Trump’s proposed budget is further proof that this supposed populism is nowhere to be found. And despite Trump’s fanciful claims that Mexico will ultimately pay for his proposed border wall with Mexico, he’s now asking Congress .. http://www.cnn.com/2017/03/16/politics/trump-budget-mexico-wall/ —and ultimately taxpayers—to fund it.
These about-faces stunned the media. CNN marveled .. http://www.cnn.com/2017/04/12/politics/trump-russia-china-nato-syria/ .. at Trump’s “extraordinary political shape-shifting,” with which he “abandoned stances that were at the bedrock of his establishment-bashing campaign.” Commentators said Trump was abandoning what distinguished him from traditional Republicans in the election. MSNBC devoted multiple segments to the topic.
- Matt O'Brien @ObsoleteDogma
Trumpism lasted what, all of 80 days? The generals and Goldman guys are running things now. 6:41 AM - 13 Apr 2017 -
But even as pundits continued to invoke “Trumpism” this week, few grasped the reality that Coaston nailed in her article: “Trumpism has still been largely defined by its observers and adherents rather than by its purported creator. Perhaps that’s because there was never any such thing as true Trumpism to begin with.” One clear-eyed conservative commentator was National Review senior editor Ramesh Ponnuru, who wrote in Bloomberg View .. https://www.bloomberg.com/view/articles/2017-04-13/a-lesson-for-trump-s-intellectual-vanguard :
Some of Trump’s intellectual defenders say it’s refreshing that he’s not wedded to a philosophy, arguing the president isn’t imprisoned by dogma. “I think it’s better if he doesn’t become too ideological,” Julius Krein, editor of the pro-Trump journal American Affairs .. https://americanaffairsjournal.org/ , told me. “I don’t think the philosophy or ideology exists,” he added. “It does need to be created.... We do need to have a vehicle and a way to think through these issues on the intellectual plain.”
For now, though, Krein acknowledges Ryanism and other conventional conservative forces are winning out on certain issues. “Healthcare was definitely a disappointment to me,” he said, “and it could be called a deviation from various suggestions Trump made during the campaign.” A supporter of universal health care, Krein sees the GOP’s failed American Health Care Act as an attempt to fulfill Trump’s campaign promise of repealing Obamacare without proper preparation. “I’m glad there is at least time to try to come up with something better and hopefully move away from the failures of Ryan conservatism,” he added, “but I would certainly admit that there’s a long way to go on that one.”
For all the talk .. https://tinyurl.com/lwyzhpt .. last year of the Republican Party’s death at the hands of Trump, current evidence suggests it’s very much alive. The ultimate outsider president is already playing the insider game. When the Times’ Douthat asked Trump in November if he worried about the consequences of doing so, the president-elect replied: “No, I don’t worry about that.” For now, it seems he was right not to fear the fallout. The Times reported .. https://tinyurl.com/lhafrlw .. Friday that “many conservatives say they do not think Mr. Trump will suffer much as he abandons some of his policy stances.”
- No matter how many people try to tell them they have been played for fools, much to their annoyance, that is not a conclusion they seem likely to reach before Mr. Trump even marks his 100th day in office.
They knew all along that they were not voting for a man with concrete convictions. And they continue to see that lack of rigidity—his preference for the transactional over the dogmatic—as a quality they want in a chief executive. -
But it’s early yet. Trump may become more conventional, or reverse his positions anew, putting him at odds with conservative orthodoxy again. David Brooks may have been wrong about Trumpism, but he was right when he wrote, “We’re in a state of radical flux.” What Trump does next is anyone’s guess. His decisions, though, won’t be guided by a unique, coherent ideology—because it doesn’t exist. He cares only about winning .. https://newrepublic.com/article/142053/trump-isnt-interested-learning-just-winning , and his best hope of doing so is to continue to cave to the Republican Party.
Graham Vyse is a staff writer at The New Republic. @grahamvyse
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