When National Healthcare is Not Mean, but Vindictive, Not Policy, but Politics

New Orleans  Healthcare is a huge part of the overall US economy and, arguably, of critical importance to every American. Regardless of the cliché, it is in fact a question of life and death. Yet we are watching a horror show spectacle of a White House that is clueless about anything but whether or not it can claim a “win,” and a Congress that is cunning and calculating without any field of vision that can see past 2018 and the midterm elections.

Meanwhile the public is treated to media coverage that, rather than focusing on the complexity of the bill and its evisceration of any semblance of public policy, treats the whole affair as if this were an extra innings baseball game and the only real issue was whether or not Majority Leader Mitch McConnell can get enough votes to pass the Senate version before the totally arbitrary deadline of July 4th. Well, perhaps not totally arbitrary, since McConnell is worried that when his caucus goes home for the recess their constituents will kick their asses so badly his whole secret legislative architecture will collapse.

Remember Kellyanne Conway, so discredited as a Trump aide that we’ve been spared her doublespeak recently. Well, she was back on this bill with the outrageous claim that no one can support, that, oh, no, there are no cuts to Medicaid in the Senate bill, which everyone knows is wrong. Good try, Kellyanne, now go hide out again, because this time there weren’t even any headlines following such an outrageous claim.

How about we look at how the Senate went from mean to downright vindictive? Their bill restored funding for what is known as “disproportionate share” money to hospitals. Pay attention in class now, friends, this is important. In places like Louisiana where I live we know a bit about “disproportionate share” payments because in their heyday they figured so prominently in statewide political scandals. Ever popular, former multi-term Governor Edwin Edwards did court and prison time on the issue of having unduly helped some friends get such money to build hospitals in poorly served and lower income areas of the state. Indeed, disproportionate share payments were designed to subsidize health care costs in lower income and ill-served areas originally in order to assure communities that these institutions could survive, because a “disproportionate share” of their patient base was poor. Obama’s Affordable Care Act flipped the script here. By assuring that everyone would have to get insurance and providing subsidies for lower income families and Medicaid expansion, disproportionate share payments would be phased out to pay for Obamacare. In fact now is the time when $43 billion would be reduced between 2018 and 2025.

What did the Senate do in their bill? They buckled to the lobbyists and restored these disproportionate share payments, but, now get this, only to states that had not expanded Medicaid coverage. This allows them to punish those states and their people by cutting the subsidies to Medicaid in their bill and rewarding the scofflaws by restoring the disproportionate share payments.

Now it’s politics that inflicts real pain and terrible consequences. Need a vote in Alaska or Maine, then sweeten the pot on opioid money even though states throughout the country are reeling under such a crisis. Take away support for mental health coverage, but throw some dollars out here and there to get a vote. Cutback money for the elderly poor on Medicaid, but kick the can down the road past 2018 so that you can keep the votes with a wink and a nod until the oldsters figure out the con.

None of this is good policy, and, frankly, I’ll be darned if I even understand how it is good politics, when all of these repeal bills are wildly unpopular in every poll of the American people. The public wants to live, not die, at the hands of government. Why isn’t that news everyone understands?

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Is There any Silver Lining in Republican Class Divide?

10repubs-JP-01-ALT-master675New Orleans   The talking heads, the pollsters and pundits, and political reporters for the largest national newspapers, and one distinguished contributing editor after another have finally come to a consensus that this Donald Trump – Ted Cruz hater machine resonates with the red meat part of their base, and, worse, and these mad dogs want to be fed, rather than taken for granted by Wall Street, big donors, and the party establishment. They may not agree on what it takes to glue the pieces of their Humpty-Dumpty back together again or if that is even possible, but they at least agree that it’s broken, and there is now a class divide in their largely stale and pale base that they can’t just paper over and ignore.

Trump and Cruz and the fact that they are not fading away, even if they may have capped out on the growth of their base, spells trouble for all of the Republican establishment candidates and could put one of these mean boys in the final vote for President. A former Bush speechwriter and now senior writer for The Atlantic magazine in a recent issue makes the case that the establishment most critically misjudged the depth of antipathy the lower and moderate income part of their base, essential to their success in the West and South, feels about immigration reform. He argues that the megadomes in the wake of their defeat in 2012 thought all they needed to do was soften their hate speech around immigration reform and adopt the Jeb Bush “not soon, but someday” supporting immigrants and a path of legalization. Marco Rubio has recanted any role in immigration reform under the new calculus and Cruz and Trump want to go past security and engage in mass deportations. This is all very bad news and argues poorly for immigration reform in a Republican Congress, even if a Democrat is successful, and, friends and neighbors, not matter what you read, that’s never a sure thing!

On the other hand, the Trump base which is rebelling against the Republican establishment wants to protect Medicare, wants more guarantees that trade doesn’t mean the loss of good jobs, and wants to make more money from the jobs they have. None of this will make Wall Street, the donors, or the corporate chieftains and Old Guard of the GOP happy, but perhaps there is a silver lining that might bring some dividends to the rest of us for a change in a Congressional compromise.

More job protections for trade would win applause across both sides the aisle, if some of the elephants come heavy footing in our direction. There probably isn’t a groundswell for $15 per hour, but after more than an 8-year drought on raising the minimum wage, how can Republicans not deliver a real raise in 2017 for their base and ours? The rebels in their base are also clear that they aren’t crazy enough about their guns to want to fire them up on another war in the Middle East or anywhere else, and we can probably all agree on that as well. Protecting Social Security and Medicare are also issues where we could make progress, and for all of the storm and fury about Obamacare, the working class part of this radical, rebel horde is not willing to die hard without health care.

The radicals in the conservative’s working class base are being clear in the Republican primary finally and are saying they want theirs, too. Some of what they want meshes with some of what we want, and there might be some deals to be made on some issues, even if we have some mountains to climb on others in 2017.

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