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Wednesday, March 15, 2017

Trump's finest hour nears

Do not worry about the repeal  and replacement of Obamacare. President Trump will cut a deal that will make it so by July 31.

For now, though, Trump is letting House Speaker Paul Ryan lead the way. This is how Trump pays Ryan back for all that help Ryan gave him in the Wisconsin primary and the general election.

The people in Washington D.C. don't get what is going down. But here in Poca, West Virginia, I can see what Trump is doing -- as I have for almost two years now.

Donald Trump became president despite Ryan. President Trump just began taking the speaker down a peg or two as Trump pays the speaker back.

In the Wisconsin primary, Ryan and Governor Scott Walker supported Ted Cruz, who trumped Trump. The president has made his peace with each man over that.

But then there was the Billy Bush tape released in October in which Trump bragged that because he was rich, beautiful women let him grab them by their -- well, readers know the quote.

“Speaker Paul Ryan told House Republicans on a conference call Monday morning that he’s done defending Donald Trump and will focus on maintaining his party’s increasingly imperiled House majority, according to sources on the call,” Jake Sherman and John Bresnahan of Politico reported on October 10.

To say that annoyed Trump understates the situation. Now that Trump is president, he can teach Ryan a lesson.

And so Trump let Ryan roll out the plan, and the president let Ryan take the heat from both the Freedom Caucus in the House, and the RINOs in the Senate.

Ryan made the opening bid.

President Trump will make his counter-offer, likely letting Secretary Dr. Tom Price take the heat for it. Then Trump will enter later, cut, and close the deal.

This looks more like a Lyndon Johnson move. If we had sane Democrats -- say a half-dozen who are willing to cut a deal -- things would go smoother.

By the way, I noticed Chuck Schumer has threatened The Wall with a government shutdown. Don't leap on that. He is looking for a way to throw Trump off his game.

Thus far, Schumer has not succeeded.

The slow-walking of the Cabinet (the Senate still has not seated four Cabinet members nearly two months into the presidency) drew nary a tirade from Trump. That's unusual. Perhaps Trump's disinterest shows the unimportance of the Cabinet to President Trump.

More likely, Trump is picking his battles better these days. Presidential appointments are where the president kisses the ring of the Senate. He's not in the mood.

At any rate, I like Ryan Care but I see the plan lacks support.

Trump does too.

This is not the final plan.

From the New York Times:
House Speaker Paul D. Ryan, facing a formidable new impediment thrown in his path by the Congressional Budget Office, worked Tuesday to line up support for his bill to repeal the Affordable Care Act.
The C.B.O. on Monday predicted an increase of 24 million people without health insurance by 2026 under the Republican plan, but also forecast $337 billion in deficit reduction over the same period, a better-than-anticipated assessment that House Republican leaders hoped would help quell a revolt from their most conservative members. A vote could come next week.
Mr. Ryan was counting on that deficit reduction — as well as tax cuts for high earners and insurance and medical device companies — to entice members whose Republican constituents have been itching to see the law crumble.
“I think what we unite upon is much greater than what divides us in this,” Representative Kevin Brady, Republican of Texas and the chairman of the Ways and Means Committee, which is responsible for part of the repeal measure, said on Fox News on Tuesday. “We have some ideas that have been brought to us, and I certainly have worked with our House conservatives to make major changes already in this.”
Mr. Ryan’s calculus at this point is less strategic — how to actually get a bill that would replace the health care law to final passage — than tactical: how to muster enough votes to get the measure through the chamber he leads. If he can do that, the Senate would almost certainly alter the bill significantly, a fight likely to take weeks.
What the New York Times misunderstands is that 14 million of those 24 million will leave willing.

They do not want to pay for health insurance.

So the Republican plan has far more support than the Democratic plan. Republicans need to realize that.

And President Trump does.

Right now, President Trump is watching Ryan spend his political capital on a plan to nowhere.

That has to amuse Donald Trump almost as much as playing Rachel Maddow last night like a French horn. Trump released those two pages from his 2005 tax return, just like he gave the New York Times his 1995 return last October.

In both cases, Trump came out ahead.

People keep falling into his traps because they think they are better than he is. But they are fools.

Ryan is good. Very good. Washington insiders tagged Ryan as an up-and-comer when he moved to Washington after college and became a staffer.

He served six years, then went home to campaign for Congress, and he has been there for 18-plus years. In fact, this is his tenth term.

The rookie candidate president is schooling him on how things work outside Washington. Welcome to the bigly leagues.

Ryan may not realize that now, but when he does, he may want to thank Donald Trump for what will be a very expensive lesson.

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  1. That seems a bit convoluted, Don, but after the election I will concede you know Trump-think better than me.

    1. Actually this is very straight-forward. If you studied European diplomacy at all, or the American presidency, this is right in line with common tactics. Let someone else lead and take the hail of fire, watch where it comes from, zero in your own guns, and take the hill.

  2. Thanks, Dennis. Think starting pitcher, relievers, closer. The first guy gives up 3 run in 6 IP (a quality start as they say). Relievers give up another run in 2, and the closer saves the game by setting them down in order.

  3. It seems to me that the main problem with the AHCA is that the federal government is still stuck right in the middle of everything. Add to that 50 state insurance commissioners with their state regulations and you can see why it is so difficult to purchase health insurance across state lines. Any health care law on the national level will require that all 50 states sign on to it so the playing field is level for everyone. The demographics and actuarial risks may mean that the same plan may be priced differently in different states, but the cumulative effect of 50 legal barriers will be out of the way. Unless this problem is corrected there will never be true competition among health insurers, just 50 or more ways and reasons to force up the costs for insurers and policy holders alike. - Elric

    1. Nobody likes having the feds in the middle of health insurance but from a certain perspective it's actually in or near the Constitutional powers. Each state having differing health insurance commissioners and regulations make interstate commerce impossible. The commerce clause, seems to me, to be applicable here. States won't play nice in interstate insurance markets then, citing the commerce clause, the feds create a framework for insurance companies to offer interstate insurance policies. The fed invites the states to participate in the framework but not block the sale and purchasing of insurance between state lines. If/when the states decide to place nice together the feds can bow out.

  4. The NYT don't know what day it is. So Don, when you're done cleaning their clocks, maybe you could start on their calendars?

  5. I do trust President Trump on this. He said he won't let us down. I trust Don S. on this too. I also trust Senator Cotton and look to him for what is good/bad/ugly in the bill. I don't trust my republican reps and senators.

    I think PT has drawn Ryan in close so he won't even see the knife.

    1. If Trump satisfies most of the concerns of the freedom caucus, and turns this from Obamacare lite, to reach change, I will be happy. If Trump ignores the freedom caucus and sticks with Ryan, I wont be happy, and any trumpie trying to blame any bad outcome at that point only on Ryan, without including Trump, will cut no ice with me. Until I see which way this goes, I am in semi optomistic wait and see mode.

  6. Good post Don. The person who wrote this just last week should take note regarding this issue:
    "Repeal of Obamacare rocks: The House Republican plan to repeal Obamacare goes beyond that and will truly reform and reduce America's health care prices.
    “The dirty little secret no one in politics or the press will mention is that Medicaid -- the free health care for the poor -- is the biggest driver of inflation in medical prices, and is slowly driving state budgets into the ground.
    “In repealing Obamacare, Republicans will fix that. President Trump AND House Speaker Paul Ryan have a battle cry that will trump them on that: Repeal Obamacare.”

  7. Fine. Trump cuts some deal. The thing that ALWAYS matters is what the deal looks like. If it's not better than Ryancare, who cares?

    1. It is a huge deal and you should care. Failure to do something (even if doesn't meet the standards of all holier-than-thou conservatives) would be a huge win for Chuckie Schumer and a major embarrassment for Trump and that dynamic would carry over into other areas of policy. Take what you can get and fight another day. It is STUPID to participate in kneecapping the new President because you don't like some provisions of the replacement for Obamacare.

    2. Sorry, no, going with Ryan Obamacare lite is worse than doing nothing, and much worse than just doing total Obamacare repeal, without replacement. If Trump goes with Obamacare lite, it will fail just as bad, but this time the whole repub party gets blamed for it, and the dems are off the hook for the failure of Obamacare.

  8. You know me. Burn the whole thing down.
    Realistically there is going to be a political outcome. Note I did not say solution. Anyone care to go see how sausage is made?
    Now think this way: If there is one thing you want out of this, what is it?

  9. Seems spot on to me Don, and I see no reason to think the R party swamp regulars will figure it out very soon, even if they were perceptive enough to read your words.

    1. Unless Trump sides with the freedom caucus, against the Ryan swamp, he is acting like a swamp creature as well.

  10. Good post. But you'd better swap out metaphors.

    French horns are extremely hard to play. Kazoos are not. Rachel Maddow is more like the latter.

  11. I hope you are right. I truly do. I also hope that, at some point, the emphasis changes from "cost of insurance" to "cost of medical care". Seem kinda silly to even have the debate without naming the problem.
    It would be so simple to fix all this. So simple it I doubt will ever happen. But who knows; stranger things have happened. See election, 2016.
    Most, and very nearly all of the cost issues could be solved with just five pieces:
    1- Full price disclosure by every health care provider; every single medication, service, or procedure. Gas stations and restaurants have to tell you ahead of time. Most do it on their website (or on the sign on the street in the case of gas stations). Areas of healthcare that are not generally covered by insurance, such as Lasik surgery, routinely do this, and the cost has dropped considerably over time. Competition will do that. The Free Market Medical Association and Surgery Center of Oklahoma are already leading this charge, producing savings from 15% to 60% depending on the type of surgery. Their price list is on their website. People fly in from all over the world. It can be done.
    2- allow HSAs funded by employers, self employed, or tax credits for the unfortunate. For argument's sake, say $7000, far less than the typical employer pays for an employee's health insurance in a year.
    3- Routine health care expenses are paid directly by the patient from their own account, in cash, for the posted price.
    4- A shared risk pool, high deductible (equal to the tax credit or employer funding limit), catastrophic insurance policy with guaranteed issue and interstate barriers dropped. Similar to the health-care-sharing ministries (Medishare, Samaritan, etc.) that already exist, so no argument can be made that it can't be done.
    5- the KEY piece. Every dime that is left at the end of the year in the HSA, or unused from the tax credit, is refundable to the employee/taxpayer. And NON-taxable.
    Together, these five pieces would turn a nation of healthcare consumers into healthcare shoppers. Prices would immediately find their true value. A Yelp-For-Healthcare-Providers would pop up out of nowhere so people could compare value. And insurance would actually go back to being insurance, rather than a channel for free stuff.

    1. I like those ideas, completely reasonable. Too bad there is no chance in hell it'll ever happen.

      My own idea is to eliminate third party price fixing. But that seems the same as advertising prices.

  12. Some say he's just waiting for it to collapse completely, so the democrats can take the blame.

    "Perhaps Trump's disinterest shows the unimportance of the Cabinet to President Trump.

    The theory goes Trump is waiting to see how many positions in the departments are unnecessary.

  13. As long as the RobertsCare employer and individual mandates are eliminated to correct the horrendous Constitutional error made by the SCOTUS, I could go for almost any plan. I haven't a clue why the cost of health care grows each year, and I suspect there's only a handful of astute people inside the Beltway who know the answer, which means any broadly supported plan that comes out of DC is likely to bend the cost curve up instead of down.

  14. there is always a method to the madness when it comes to trump. like travel ban II. of course he knew that some Podunk judge would block it, so what is the endgame? like the dude, the Donald abides.

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  16. I could maybe believe Ryan that we couldn't pass a straight repeal and replace it they had been men about it and tried. Fought hard, tried, and failed. Yeah, then I would buy Ryan's argument. But they DIDN'T EVEN TRY! These blessed sweet gents didn't try. Lord help us.

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