A Quick Post Mortem on the Better Health Care Reconciliation Act (BCRA)

By Lambert Strether of Corrente

As readers know by now, the Senate Republican health care bill, the BCRA, went down to defeat last night as Senators Mike Lee (UT) and Jerry Moran (KS) simultaneously defected as firm “No” votes. In this brief post, I’ll do three things: Briefly document the defeat, briefly describe what could be coming next, and do a modest happy dance on method (developed in this post, here).

McConnell’s Defeat

After Paul Ryan’s AHCA debacle, McConnell took point in the Senate by rewriting the bill. But here’s Politico on McConnell’s defeat:

Trump blindsided by implosion of GOP health care bill

(The Financial Times also points the blame cannons at Trump: “Trump suffers stinging defeat as Obamacare overhaul collapses.” Such an account is at best incomplete; recall that major right wing forces weren’t threatening defectors with “outside money”; and that major donors like hospitals and the insurance companies came out against the bill.) More from Politico:

President Donald Trump convened a strategy session over steak and succotash at the White House with senators Monday night, trying to plot an uphill path to repealing Obamacare and replacing it with a GOP alternative.

He made an impassioned pitch on why Republicans needed to do it now — and the political peril they could face if they didn’t “repeal and replace” after promising to do it for years. He also vented about Democrats and the legislative process. “He basically said, if we don’t do this, we’re in trouble,” said one person briefed on the meeting. “That we have the Senate, House and White House, and we have to do it or we’re going to look terrible.”

And it does look terrible!

Meanwhile, two senators [Moran and Lee] — neither invited to the dinner — were simultaneously drafting statements saying that they couldn’t support the current Senate health care bill. They released the statements just after Trump’s White House meal concluded.

Trump had no idea the statements were coming, according to several White House and congressional officials. His top aides were taken aback, and the White House was soon on the phone with Senate Majority Leader Mitch McConnell.

Trump has privately wondered why legislators don’t seem to listen to him, and the blow from Moran and Lee illustrated the limits of the president’s capacity to master the art of the Washington deal.

Well, not to defend Trump — if I were a Senator, I wouldn’t listen to him either — but if a deal is not there to be had, there’s no blame to affix for not making it. And with the BCRA, my view is that what Yves calls a “solution space” did not exist. McConnell’s bill was crafted to appeal to the rich (taxes), youth (lower rates), and swing states (in the Rust Belt), plus whatever goodies McConnell could dole out. That wasn’t enough to overcome local and particular reasons for Senators to defect. Of course, if policy [cough] wonk Paul Ryan and the whackos in the Freedom Caucus, in their eight years of opposition, had managed to create a solution space and tee up a workable bill in the House, McConnell and/or Trump wouldn’t have been left holding the bag. But so it goes![1]

In summary, defeat has many fathers. I think the real story to watch is not Trump, or McConnell, or even the odious Paul Ryan, but structural factors within the Republican party. The Atlantic:

Republicans Aren’t Turning on Trump—They’re Turning on Each Other

The House is mad at the Senate. The Senate is mad at the House. Various factions in the House and Senate are mad at each other or mad at their leaders.

Republican lawmakers have yet to turn on President Trump in any meaningful way. But they’re starting to turn on each other.

On Monday, the Republicans’ tortured health-care effort hit a seemingly permanent snag. But that was only the latest blow; after half a year of consolidated GOP control, not a single major piece of legislation has been enacted. With other priorities similarly stalled, legislators’ frustration is mounting.

“We’re in charge, right? We have the House, the Senate, and the White House,” one GOP member of Congress told me. “Everyone’s still committed to making progress on big issues, but the more time goes by, the more difficult that becomes. And then the blame game starts.”

Meanwhile, many senators are annoyed with Majority Leader Mitch McConnell for the rushed, secretive process that produced the health-care bill, and for threatening to cancel their August vacation for a potentially fruitless legislative session. And everyone is annoyed with the House Freedom Caucus, which has also demanded that lawmakers spend next month in D.C.

But everyone is always mad at the Freedom Caucus. Divisions between Republican factions are nothing new; nor is friction between the House and Senate. In an oft-repeated fable, a new Republican member of Congress, eager to go after the “enemy” Democrats, is corrected by an old bull: “The Democrats are the opposition,” he says. “The Senate is the enemy.”

James Madison would be proud!

Still, some wonder whether the current sniping isn’t better directed to Pennsylvania Avenue, where the scandal-mired president creates new headaches with every passing day. “We’re a big-tent party, so of course there are divisions,” the member of Congress told me. “But the only thing that could unite the clans is consistent and engaged leadership from the president. And it’s fair to say we’ve gotten mixed signals.”

A House Republican staffer described the fractious mood on Capitol Hill as “Republican-on-Republican violence.” As for why lawmakers don’t train their ire on the real root of their problems, the staffer shrugged: “Maybe it’s just easier to attack people without 13 million Twitter followers.”

Pass the popcorn. Gridlock is our friend.

What Next on Health Care

Predictably, McConnell, having received the baby from Ryan, is passing the endiapered, squalling effluent — I mean the bill, not Ryan — to Trump. The Financial Times:

[McConnell] said he would adopt a strategy advocated by Mr Trump: moving to repeal Obamacare but with a two-year delay, which leaders hope would buy them time to come up with the replacement they have been unable to find thus far. 

They had eight years to figure it out in opposition; why will an additional two in power help?

The Senate passed similar legislation in 2015 when it knew Mr Obama would refuse to sign it.

Games people play… Anyhow, the latest is that McConnell tried that this morning, and it didn’t work. WaPo, at 10:52AM:

Senate Majority Leader Mitch McConnell (R-Ky.) opened the Senate on Tuesday morning touting his latest plan — to vote on a pure repeal, with a two-year delay, by taking up the House’s health-care bill. But while conservatives and Trump have been pushing for such a repeal as a last resort, it appeared unlikely that the vote would succeed.

Two Republican senators, Susan Collins (Maine) and Shelley Moore Capito (W.Va.), expressed opposition Tuesday to the repeal-only option, apparently burying it.

“I did not come to Washington to hurt people,” Capito said on Twitter. “I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.”

Et tu, Shelley? So we’re in an overly dynamic situation[2]. Of course, Democrats have their own games to play. Matt Yglesias:

The thing that would really kill Obamacare repeal — and preserve its insurance coverage gains — is what McConnell has warned his fellow Republicans against: bipartisanship.

This would be a very achievable goal if a dozen or so Republicans decided they wanted to work with Democrats to make it happen. A stronger mandate, guaranteed cost-sharing reduction money, and a few simple tweaks like bringing back “risk corridors” and expanding reinsurance funding would set off a virtuous circle. Plans would become slightly cheaper, and going uninsured would become slightly more expensive, pushing healthier people at the margin into joining the exchanges. That, in turn, would lower average premiums and push even more healthy people into joining the exchanges, which would further lower costs — lather, rinse, repeat. The result wouldn’t be a health care utopia, but it would be an improvement over the status quo, which is what people want.

No. That’s not what people want. People want (even some Republican poeple want (and more people can be persuaded to want)) — #MedicareForAll, not some gussied-up version of ObamaCare that takes another decade of lathering, rinsing, repeating, and virtuous cycling (along with virtuous cycling’s twin sibling, virtue signaling).

As I keep saying, ObamaCare is the worst possible Republican bill.

On Method

And now I would like to do a modest happy dance on method (which is the most important part of this post, to me. This tweet from a Philadelphia Inquirer reporter:

[Lambert blushes modestly]. As I wrote in “All Politics is Local: Why the Odds Are Against TrumpUncare (BCRA, BCRA + “Consumer Choice,” and AHCA)“:

Third, if you do the math and take each unique case into account, I read Heller as a solid “no,” since he’s bucking the leadership on everything else and he’s backed by his governor, I read Collins as a solid “no,” since not only does she — Lambert gets sentimental here — care about the constituents of her small, rural state, she wants to run for Governor, and I read Capito as a solid “no,” since $45 billion won’t buy her off; she wants more, but there’s no more to be had. McConnell can afford to lose two; that’s three. I’m pleasantly surprised by Moran, and he’s a bit like Collins, in that he too, seems to care about his rural constituents, and his state seems split, at the state level, between “too far,” and “not far enough” on issues like taxes. I rate Moran as a possible “no.” That’s four. I rate Portman as weak, so still four (depending on what pressure Kasich can bring to bear). And that’s before we get to Cruz, Lee, Johnson, and Paul. I might throw Paul in, since McConnell will not meet his price, bringing the number of defectors to five.

With a caveat that I’m relucant to make calls, the judgment:

With the caveat out of the way, passage of TrumpUncare as BCRA, as BCRA + “Consumer Choice”, or as a revised AHCA seems highly unlikely to me, as does the simple repeal of ObamaCare with no replacement. (Even if the repeal didn’t take effect until 2019, or even 2021, that would be a terrible look that proves Republicans are unfit to govern.)

(I suppose that, instead of “highly unlikely” I should have written “highly unconfident,” but it was late.) Anyhow, I got a refined set of names that included the right names, Moran and Lee (and today Capito) although my analysis was light on Lee. Note also that Collins and Capito didn’t flip back, despite McConnell’s inducements. And after ruling out a boatload of monocausal explanations, this was my method:

[The post is] designed to show that the drivers for TrumpUncare’s success or failure are predominately local (and as a corollary, that most of the coverage you read in the Beltway press is worthless)… by taking a look at the local state of play for each defector.

Others in retrospect agree. An ABC reporter:

“Two very different sets of concerns.” And CNN has a long article (even longer than “All Politics is Local”) belatedly using the same method to make the same point. “Why Senate Republicans can’t agree to repeal Obamacare, in charts.” Their conclusion:

Senate Republicans have been trying to thread the needle on health care reform for weeks, but their latest efforts collapsed on Monday when it became clear they couldn’t rally the votes to pass the bill.

So why can’t they find agreement? Each senator has a different reason to oppose the legislation — from ideology to re-election concerns to the demographics and health nuances of individual states.

(Note that this method is very different from a simple whip count, no matter how checklist- and graphics-heavy, as here.)


As the chorus sings in The Music Man, on their train to River City, Iowa: “You gotta know the territory”[3]. There’s a lesson for the left here: If you want to take advantage of elite factional splits — and who doesn’t? See the Duc d’Orleans — you’ve got to know what those splits are, and why they exist.


[1] No, McConnell has not been hospitalized; Andy Borowitz is what passes for a humorist at the sadly diminished New Yorker.

[2] It will be interesting to see if there’s a leadership crisis in the Senate. Lee and Moran held hands and jumped off the cliff together:

Moran and Lee didn’t give the leadership, or Trump, a heads-up; they also gave cover to Senators in trouble in purple states or tight districts, like Heller. Then today Capito, part of the leadership team, sticks the shiv in. And some Senators complain about McConnell’s secretive tactics. It will be interesting to see if McConnell is defenestrated. “When you play the game of thrones, you win or you die,” as Cersei Lannister says.

[3] An American patter song:

Only a con man doens’t know the territory….

APPENDIX: Against “Resistance” Triumphalism

We will no doubt see a good deal of triumphalist claims from “Resistance” types like Neera Tanden, et al., that protest was central to the defeat of the BCRA; that is only natural, since AstroTurf organizations need to show results to their funders. Others play along:

I believe such broad claims, though sometimes made in good faith, border on political malpractice. First, an account for the defeat of the BCRA can be made solely by examining internal contradictions in the Republican Party (after all, the BCRA was only and ever going to get 50 votes plus Pence in any case; that’s why “R” for “Reconciliation” is in the title of the bill). Occam’s Razor would dictate I stop now, but in reality events are driven by multiple causes, so I’ll go on. Second, there’s no contemporaneous evidence that protest affects legislative outcomes (which is an entirely separate question from whether legislators show up at Town Halls, and so forth). John Laurits:

Though observations by past protesters appeared to support the hypothesis that elected officials can be forced to change policies by organizing a protest big enough to prove the public wants it — the results they achieved have rarely been repeated since the ’60s. And when results are not repeatable, either the experiments are flawed — or the hypothesis is flawed. If large protests influence public officials & policies, then why do we observe that anti-nuclear protests in ’83 had less influence over policy while organizing more protesters than the two largest ’60s era protests combined? Sure, in this instance, you could say “it was an issue of national security” — but why, then, did public officials take 14 years just to start redressing the grievances of 1 million who protested for LGBT civil rights?

Demonstrations which result in partial change to public policy 14 – 23 years later cannot be called viable protests for the same reason food which takes a year to cook is not a viable option for tonight’s dinner.

Since protest demonstrations haven’t worked in forty years, it would certainly be strange that they had an instant effect in 2017. Why would anybody believe they did (other than wishful thinking or the post hoc fallacy)? I’m guessing that liberal Democrats and some of good faith on the left are trying to emulate the Tea Party, certainly with their focus on town halls. But the Tea Party is a flawed analogy: It was a rebellion by conservatives within their own party against its leadership; although its form was a protest, its content was electoral. Why would any elected Republican legislator pay the slightest attention to a bunch of people who would never vote for them anyhow, even if they are waving clever signage? The only Republican who would is one in a marginal district, like Dean Heller, and even there I’d want firm anecdotal evidence from an actor speaking against interest before I believed it. (Note, however, a proper analogy to the Tea Party: Single payer advocates, presumably or at least possibly voting Democrat, threatening Democrat legislators. That might work, which is doubtless why “Resistance” organizations like Indivisible take care to erase the idea.)

A caveat: I think other electorally focused tactics can be said to work: Letters to the editor, for example. But not “protest” as such. “When Feeling Good is Bad” shows how empty the calories of protest are.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


    1. Lambert Strether Post author

      Ha ha. I generalized :-)

      That said, I don’t think attending a Town Hall and making a point especially as a constituent and to an official of your own party is the same as protest. I just don’t.

      1. flora

        It fits with the “all politics is local” angle. :-)

        “That wasn’t enough to overcome local and particular reasons for Senators to defect.”

    2. shinola

      Moran had to do something to distance himself from the (Ks. gov.) Brownback/Kobach debacle if he wants to be re-elected.

    3. Matt Platte

      In Kansas, Kobach is thumbing his nose at the State Supreme Court and that pesky Legislature isn’t voting the way Brownback demands; Moran isn’t the only one who senses shifting breezes.

  1. Jim A

    “We’re in charge, right? We have the House, the Senate, and the White House,” one GOP member of Congress told me. To evoke the old Lone Ranger joke, “What’s this ‘We’? Kemosabe?”

  2. jsn

    Micah White published “The End of Protest” sometime last year, it covers Laurits ground and a lot more.


    But the only thing that could unite the clans is consistent and engaged leadership from the president. And it’s fair to say we’ve gotten mixed signals.

    A guy who ran on a message of Congressional Republicans being incompetent losers isn’t uniting the party? I’m so, so surprised.

    1. reslez

      If Trump were competent he’d be lining up a bunch of supporters to run in primaries right now. But he can’t even manage to staff the bureaucracy, so…

  4. dbk

    Well, “Repeal” is now DOA before arrival. Lisa Murkowski (who didn’t, apparently, take McConnell’s sweetener for AK), Susan Collins, and Shelley Moore Capito have come out and said they wouldn’t vote for “Repeal” to proceed to a floor vote.

    Schumer just held a presser and several senators spoke. They’re urging a bipartisan series of fixes to the ACA. Klubacher seemed pretty up on things they need to work out: CSRs (lock them in), reinsurance, Medicare Part D, drug prices (something something — I caught it when she said it, but can’t re-express it now; plus that bill about re-importation of drugs from CA), and providing solutions to those living in bare shelf counties (buy insurance on the federal exchanges).

    So, an interesting late afternoon. Could the ACA be subjected to triage by a bi-partisan group of Dems and moderate Republicans? Could the conservative freedom Republicans be shut out of the process?

    I’m of two minds about this prospect. If it happened, it might turn a bad piece of Republican healthcare legislation into a not-quite-so-bad piece of Republican healthcare legislation, and stabilize markets somewhat.

    OTOH, “fixing” the ACA would put the shiv in Medicare for All. And that’s disheartening, just at the moment it was gaining popular momentum.

  5. hemeantwell

    In a world of finely-gradated policy options, it would have been interesting to see how much support the bill would get as the coarse tradeoff between “Tax breaks for the everdeserving wealthy” and “put the poor in their graves” was explored. It’s not clear from the above, or other coverage, what the dissenters might have been willing to accept. Was it impossible to gauge because the rightmost ideologues declared themselves to be absolutely unwilling to accept further compromise, blah blah? Was there a more qualitatively defined provision that the dissenters objected to?

    1. L

      Given that the senate bill was drafted in secret by 13 hand-picked “party leaders” it is not clear that McConnell even asked them what they wanted. As a case in point one of the no votes, Murkowsky, was publicly complaining about the process months ago and practically threatened to walk for that reason alone. At the last minute McConnell offered her a huge pork chop (big spending for Alaska alone) but only after the initial failure.

      To some extent I wonder if he even cared what others’ wanted or if he was just determined to do something and assume that the hate would carry them through.

  6. dcblogger

    I think you underestimate the role of protests in all this. Every politician knows that for everyone who shows up at a protest, a dozen will show up on election day, and these protests were w/out precedent for being widespread and sustained. The healthcare protests started before Trump took office and continued, in one for or another, right up to now. And I suspect there will be additional protests as long and Republicans control the House. mebbe as long as they control the White House. Or so say I.

    1. tongorad

      Every politician knows that for everyone who shows up at a protest, a dozen will show up on election day.


  7. L

    With respect to the Republican on Republican Violence I think that it is hardly surprising.

    For 8 years one party was united in their hatred of a president whom they saw as corrupt, unreliable and downright dangerous. That unifying bile kept them together and allowed them to make promises that they would never keep. It also allowed people to project onto them the very ideal of opposition and a dream that they would be better.

    Then Bush Obama left office and it all came crashing down.

  8. XXYY

    Second, there’s no contemporaneous evidence that protest affects legislative outcomes.

    Everyone is suddenly going around parroting Laurits’ piece and nodding sagely about how popular protests don’t have any effect. I don’t get this. Obviously popular protests have an effect; the question is whether they have an instant or decisive effect.

    Hardly anything has a decisive effect in politics. Generally, political outcomes result from a hodgepodge of factors, from late night calls from rich donors to media coverage to massive uprisings in the street. Popular protests are just one of the many factors. I claim popular protests and town hall uprisings against ACA repeals the last few months have been an an important factor in staving off the repeal efforts, not only by scaring certain GOP politicians and making the popular mood more vivid, but also by giving Dem politicians the spine to act as an unified opposition bloc in the various votes (very unusual for Dems). So I would be very hesitant to go around spouting off about how popular protests played no role in getting us to where we are in the ACA repeal.

    Popular protests also frequently take some time for their effects to be felt. Large-scale protests often involve hundreds of thousands or millions of people, many of whom who have never done anything “political” before. So these protests commonly have an activating effect on large numbers of people. Many of them will go on to attend or organize other protests, do other kinds of organizing, start blogs, write books, run for political office, etc. So popular protests are an important (indeed, perhaps the only) school for latent organizers and activists in our society. These new organizers may need years or decades before they have an effect themselves.

    I think it can also just take time for the effects of protests to seep into the popular consciousness. The Occupy movement, while seeming to have “no effect” at the time, was a big turning point in US history; it is now accepted wisdom that the US is an extremely unequal society, and it is no longer possible to claim “we are all in it together” or whatever the former pablum was. This is quite new. Similarly, the protests against the Vietnam invasion, not themselves terribly helpful in ending the war, nevertheless helped cement the understanding that the US was an imperial power. The idea that we were “just trying to help” or whatever has been an extremely tough, perhaps laughable, sell in the subsequent decades.

    So let’s soft pedal the questionable and, IMO damaging, meme that popular protests are not helpful. There are one of the only things that are.

    1. Mark Anderlik

      Agreed. In my experience protests are more effective in changing the protesters involved than the immediate target. This recasts political opinion and will in society at large. Because of the intense grassroots nature of this change, it’s effect on the macro political scene may take years or decades.

    2. tongorad

      Regarding your claim that Occupy produced a “quite new” understanding of inequality, that’s simply ignorant. See US labor history, The War on Poverty and MLK’s Two Americas speech just for starters.
      Also, see our perma-wars and Support The Troops regarding that cement of understanding.

      1. XXYY

        Of course there was tons of previous work on inequality in the United States. I’m certainly not saying there wasn’t. However, Occupy was the first broad-based protest dedicated to popularizing the idea that US society is comprised of an extremely wealthy 1% against the “rest of us.” Since the Occupy protests, you can go up to any random person on the street in the United States and make this claim and people will nod.

  9. ekstase

    I have to agree with some of the comments above. Watching the slow slow processes of change after the protests of the Civil Rights Movement, the Women’s Movement, Act-up, it seems there is some underlying, invisible current that lifts people up to do the right thing. The growing perception, now, that the time for Medicare for all has finally arrived, is one example of this. “Other people think it,” is very powerful, especially if “it” happens also to be kind and self-helpful. The trifecta in life.

    Anyway, thank god this thing went down. Now let’s get Medicare for all.

    (Also, since you’re doing musicals, here’s how to keep our hopes up, from “Guys and Dolls.”):

  10. mrtmbrnmn

    What a tribute to the great horror film director George Romero who died two days ago. The GOP Zombies continue to perform The Night of the Living Dead. Complete with a creepy cast of thousands of Dementedcrats. Despite the endless PutinPutinPutin waterboarding of The Trump, he has sucked all the political oxygen out of the air. The entire corrupt Congress are dead men, women, dogs walking. They will get nothing passed and eventually devour themselves. That’s not a bad deal!

  11. Marco

    Not to go all girl-power on this but three female senators are nailing the coffin shut on BRCA (all NO on repeal only) but everyone wants to focus on Moran and Lee as the turning point.

  12. Darius

    Expand Medicare and Medicaid. That’s the “bipartisan” solution. The Republicans will get this before the Democrats do, if ever.

  13. Northeaster

    Obamacare sucks for my family. We pay through the nose in premiums and get little in return as going to the doctor is simply not affordable. We use nearly all of our deductible due to spouse condition, meaning that’s 100% out of pocket BEFORE I even get to use it.

    There is no cost controls (price discovery anyone), middle-class like myself get crushed, I could actually consume/spend, but instead it all goes to health care costs.

    The GOP plan was worse, but neither Party is interested in a fix. Wealthy donor cronies get, and will continue to get paid.

    1. Northeast

      Addendum: If anyone thinks small businesses are not looking at their bottom line, think again. I recently got a new job (I’m almost 50), and during the three (3) interviews, in the second one, they asked if I needed health insurance (I didn’t, covered by spouse for now). While I can’t prove it, I would bet that was the deal breaker for me getting the job over others, as a lot of the office is filled with “independent contractors” (i.e. no benefits – of any kind).

    2. Edward E

      It was so bad it doesn’t even cover all the people who are already so sick of winning.

  14. Beans

    SInce Medicare / Medicaid are largely subsidized by private insurance patients, pray tell how we get Medicare for all without the Obamacare price tag?
    Once private insurance is gone, Medicare gets a LOT more expensive.
    Not to defend the status quo, which is horrible. I just don’t think Medicare for all is the silver bullet it is being made into.

    1. Jon S

      The federal government essentially becomes a monopsany. So what ever the federal government decides the price is, that’s the price. If you don’t like it, leave the medical field. 50% of medical spending in the USA is pure fluff. That all goes away.

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