Wednesday, March 29, 2017

Why Obamacare bill passed and then the Ryan-Trump bill was a disaster

Let's start by acknowledging the vast difference in what the two bills do in terms of offering real help to the American people.   Then add that the times are different and that Barack Obama and Nancy Pelosi did not have anything comparable to the Republican Freedom Caucus (aka Tea Party) to try to wrestle into the voting corral.

But put all that on the table, and there still is a world of difference in the process that led to the Democrats' success and the Republicans' failure.   Jonathan Cohn, political writer for Huffington Post, wrote an interesting piece on this last weekend.   I'll be quoting liberally from that article.   Cohn writes:

"Somehow, despite the intense political forces arrayed against it, and the mind-boggling policy problems it tries to solve, the 2010 health care law keeps defying efforts to wipe it out.  That says something about the people who wrote it -- and what they have achieved . . . .

"Trump and the Republicans in Congress had spent all of 63 days trying to pass their Obamacare repeal -- less than three weeks of which were spent actually debating the text . . .  They held votes before Congressional Budget Office evaluations were ready, and were about to ask the full House to decide on the proposal just hours after making major changes to it. . . ."

In contrast, President Obama and the Democrats spent more than a year crafting their bill, including ongoing consultations with all stake-holders:  hospitals, insurance companies, unions, and patient advocacy groups.  They repeatedly made adjustments as analyses from the Congressional Budget Office came in.   As Coen points out, they were doing what the party had been trying to accomplish since Franklin Roosevelt was in the White House;   and they gave it the seriousness that it demanded.

Various attempts had been made through the years, both for a universal coverage policy, as well as more limited plans.    The failure of the Clinton attempt in 1994, as well as a plan that Senate Finance Chair Max Baucus had been working on, served as a solid basis this plan.

With all of this experience in planning, as Cohn puts it, "it meant that when the actual legislating started, the channels of communication were already open and the groundwork for a common vision was already in place. . . .

"And still it was a nearly impossible task.  Like the Republicans this year, Democrats found consensus difficult to achieve -- among the outside groups and within their own ranks as well.   Liberals wanted a more generous program and a public option.  Moderates wanted to avoid too much government spending and too much meddling with the way independent businesses operate.

"But unlike the Republicans, the Democrats' reaction was to work with the different groups and slowly bring them along. . . .  [Efforts to woo moderate Republicans] helped secure moderate Democrats who needed to tell their constituents that, yes, they had tried to be bipartisan. . . .

"[And Democratic leaders] understood, at all times, where they were trying to go -- and were fluent enough in the policy to handle direct negotiations on their own.  One of the enduring images of Obama during the Affordable Care Act fight was his visit to a Republican Party policy retreat . . . where he fielded questions and parried criticisms from the assembled members for roughly 90 minutes.

"Trump, by contrast, seemed to lack anything beyond a superficial understanding of the bill, to the point where allies worried about letting him negotiate details. . . ."

Senator Tom Cotton (R-Ark.), one of the more conservative senators, appearing on CBS's "Face the Nation" following the Republican's withdrawal of the House bill, conceded that "maybe the Democrats knew what they were doing. . . .  I am not saying we needed 14 months to do this," he added, "but I think a careful and deliberate approach . . . would have gotten us further down the path to a solution."

Cohn also includes a point that I think is crucial to understand:   "[T]he Republican failure wasn't just about process.  It was also about policy -- and a failure to realize just how profoundly the Affordable Care Act has changed public expectations for how the U.S. health care system operates."

The anti-Obamacare rhetoric of the Republicans began to crack as more and more people experienced -- and publicly shared -- their stories of having their lives saved by medical care they wouldn't have had without Obamacare.   People now began to think differently about what it meant and the new expectation that everyone could be covered.

Surveys began to show increasing support for the ACA, because more and more people were deeply grateful for it.  By the time of the vote-counting, support for the Ryan-Trump had dropped to 17%.

But Paul Ryan and his team didn't change their policy or their rhetoric.   Instead, their true motives behind the Ryan-Trump bill became clear.  It really was not about the needs of the people.   It was a tax cut in disguise for the wealthy.   So, instead of adapting to the needs, they tried to ram the bill through before even their own caucus knew how bad it was -- for their constituents and, thus, for their re-election chances.  Then President Trump came in for the last-ditch push -- and all he knew how to do was to bully and threaten.   It didn't work.

Cohn sums up with this:  "This, in the end, is what Obama, Pelosi and their allies achieved with the Affordable Care Act . . . .  The true legacy of Obamacare is the principle that everybody should have health insurance."

The effect was that human stories -- of how Obamacare changed people's lives -- changed people's minds and hearts about this, as it usually does in big societal changes.   More and more people now consider health care as a basic human right.   That is a major change;  and, if Republicans do not accept that and adapt their policies, they will continue to fail.


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