Check out the latest episode of The Editors, in which Rich Lowry, Reihan Salam, Ian Tuttle, and David French discuss the House health care bill, the continuing “wiretapping” saga, and more!
And we expect more of the same next week. And you can expect to be totally shut out if you don’t act quickly to do what you know you really want to do: Namely, to reserve a sweet cabin on the National Review 2017 Trans-Atlantic Crossing, aboard Cunard’s remastered and gorgeous Queen Mary 2, sailing from Southampton in the U of K August 31st and arriving in Brooklyn in the US of A on September 7th.
You can find complete information about this on-my-bucket-list, once-in-a-lifetime, yes-it’s-really-that-affordable experience at www.nrcruise.com.
Here are three things you should know about this tres bon voyage. The first: Prices start at just $2,577 a person (based on double occupancy), and “single” cabins start at $3,916. There’s a comfortable and spacious stateroom for every taste and wallet.
The second: There is a terrific array of conservative speakers, writers, thinkers, doers who will be with us, including Judge Michael Mukasey, former U.S. Senator Tom Coburn, Heritage Foundation founder Ed Feulner, acclaimed novelist Mark Helprin, British author Douglas Murray, NR editor in chief Rich Lowry, media critic Brent Bozell, NRO editor Charles Cooke, ace conservative counsel Cleta Mitchell, domestic policy guru Sally Pipes, defense expert John Hillen, Claremont Review of Books editor Charles Kesler, conservative academic Daniel Mahoney, NRO editors-at-large John O’Sullivan and Kathryn Lopez, NR senior editors Jonah Goldberg, Jay Nordlinger, Ramesh Ponnuru, and David Pryce-Jones, NR essayists David French, Kevin Williamson, Reihan Salam, and Ian Tuttle, NR ace reporter Jim Geraghty, and NR columnists Rob Long and James Lileks.
The third: NR’s spectacular program includes daily seminar sessions in which our all-star speakers will discuss current pressing issues, plus several cocktail receptions, a smoker, and intimate dining on at least two evenings, and likely three, with our conservative celebrities. We’ve joked before about shuffleboarding with Rich and Jonah, but we’re thinking, yeah, let’s have a tournament. Is that’s not a deal-sealer, I don’t know what is.
Anyway, do sign up today – visit www.nrcruise.com for complete details about the National Review 2017 Trans-Atlantic Crossing.
We’re beginning to get some indication of the White House reaction to Ryan:
“We want to force the vote.” A top WH official to @washingtonpost at 1:18pm— Robert Costa (@costareports) March 24, 2017
Mass legalization of assisted suicide is not inevitable.
A lack of specifics in the current draft of the controversial ‘Death with Dignity’ bill is partially the reason some lawmakers decided to table the issue.
Lawmakers table controversial ‘death with dignity’ bill following intense debate House Health Committee chair Della Au Bellati told a packed hearing the seven-member committee was killing the Medical Aid in Dying bill because it lacked specifics and didn’t do enough to balance the right to choose death with the need to protect vulnerable people.
“We’re concerned about safeguards, the record-keeping, the physician training to be able to do this prescribing for aid in dying,” Bellati said.
Faithful readers might recall I warned here at The Corner that the then draft Hawaii measure would be substantially lacking in safeguards, because, well assisted suicide boosters only promote safeguards to mask their more radical agenda of moving toward a broad assisted suicide/euthanasia license, as seen in Canada and overseas.
But sometimes, as the trite saying goes, in their zeal, they get over their skis. That appears to have been the case in Hawaii.
Repeat after me: “NOT inevitable!” Onward.
Probably not a good sign for the bill, but we’ll know more soon. The push for this bill was a momentum play and it may be that the momentum is running the wrong direction such that a floor vote would not be a narrow loss, but a big one. CNN is reporting that Ryan is trying to put the ball back in Trump’s court, asking him what he wants to do given that the votes don’t seem to be there now.
In recent weeks, I have written about the “Marine Corps,” by which I mean Marine Le Pen and her body of supporters and peers. For instance, GOP congressmen Steve King and Dana Rohrabacher met with her. King tweeted that they had discussed “shared values.”
She has now gone to Moscow, to visit with Vladimir Putin. She has received millions in Russian loans. She must think that an appearance with Putin is good for her politically. (She would know better than most.) Le Pen has an election — a presidential election — on April 23.
Shortly before President Trump’s inauguration, she was in Trump Tower, but by all accounts did not meet with the president-elect.
After her meeting with Putin, she said, “A new world has emerged in these past years. It’s the world of Vladimir Putin, it’s the world of Donald Trump in the United States, it’s the world of Mr. Modi in India.”
Does Modi belong in Le Pen’s pantheon? Anyway, this is an interesting triumvirate.
About the meeting with Putin, an aide to Le Pen said, “We felt they understood each other, they were on the same wavelength.” I believe this is so. The Russian president wished the French leader good luck in the upcoming elections.
(To read a news story, go here.)
In a recent podcast, Daniel Hannan and I discussed Madame Le Pen. She has pledged to pull France out of NATO, of course. She is an unblushing admirer of Putin — a total fangirl. She believes that Western sanctions against his regime are unjust. And, as Hannan said, she is to the left of the French Socialist party on economics.
What’s more, said Hannan, “she mingles this socialism with an element of nationalism, and we’ve seen that before, and it’s a fairly ugly cocktail.”
Putin’s critics and political opponents tend to drop like flies, you may have noticed. In the past couple of weeks, there have been at least three incidents.
Yevgeny Khamaganov, a journalist, 35 years old, died in an emergency room. This death has so far been unexplained. Two years ago, thugs jumped him and broke his neck. Yet, when he recovered, he continued his work. Amazing, that people do this.
In Kiev, Denis Voronenkov has been shot dead in the street. He was once a member of the Russian parliament. He fled to Ukraine and sought asylum there. He was a key witness in the treason case against Viktor Yanukovych, the former Ukrainian president, who is now protected by Putin in Russia. Voronenkov will testify no more.
Nikolai Gorokhov had an important court date. He is the lawyer for the family of Sergei Magnitsky, the lawyer and whistleblower who was tortured to death in 2009. The day before his court appearance, Gorokhov was tossed from the fourth floor of his apartment building. He is still alive. But he ain’t going to court.
“A new world has emerged,” says Marine Le Pen. A good world? There are people, in Russia and elsewhere, who are working for a better world. A much better world.
One of them is Vladimir Kara-Murza, a Russian democracy leader. I first met him at the Oslo Freedom Forum last year. He had been poisoned and almost died. He was walking with a cane. In early February — February 2017 — he was poisoned again. Again, he almost died. He is now in the United States, and I met with him a few days ago. Will have much to say about him in coming weeks.
Madame Le Pen may be right that the tide of history is with her and her ilk. (A favorite Bob Novak word, “ilk.”) But tides can be changed — for good or ill — by determined people.
Among the standard claims made on behalf of putting kids in college is that they’ll learn “critical thinking.” (As if plain old thinking isn’t critical, but let that go.) But do they? It’s increasingly evident that instead of turning out sharp reasoners, colleges turn out dullards who believe that their emotions are a substitute for logic.
That’s the argument Georgia State English professor Rob Jenkins makes in today’s Martin Center article.
“Clearly” he writes, “colleges and universities across the country aren’t adequately teaching thinking skills, despite loudly insisting, to anyone who will listen, that they are. How do we explain that disconnect?”
His explanation is that more and more of the college curriculum consists of shabby courses where the professor does the very opposite of teaching critical thinking, but rather instills in students ideas that encourage them to rely on feelings as a guide to what’s right and what isn’t. The “deconstruction” fad is a big part of that, as students are taught that texts have no inherent meaning, but only what the reader sees in them. Same for the notion that truth is relative.
That view runs contrary to the purposes of a “liberal arts” education, which undertakes the search for truth as the academy’s highest aim. Indeed, the urge to deconstruct everything is fundamentally illiberal. Heritage Foundation’s Bruce Edwards calls it “liberal education’s suicide note” in that it suggests the only valid response to any idea or situation is the individual’s own — how he or she “feels” about it.
(Strangely, if a student happens to feel that there’s no such thing as social justice or doubts that climate change is a looming disaster calling for vastly increased government powers, a professor is apt to berate him.)
It’s because students are taught to use their emotions rather than logic to guide their actions that we get so much of the silliness and even vicious behavior (as at Middlebury College and Berkeley) we now witness on college campuses. Jenkins drives the point home, writing, “All of this has a profound impact on students and explains a great deal of what is happening on colleges campuses today, from the dis-invitation (and sometimes violent disruption) of certain speakers to the creation of ’safe spaces’ complete with Play-Doh and ‘adult coloring books’ (whatever those are — I shudder to think). Today’s students are increasingly incapable of processing conflicting viewpoints intellectually; they can only respond to them emotionally.”
Wouldn’t it be fascinating to see what would happen if a parent sued a college that had advertised that it teaches students “critical thinking” for false advertising?
Members of the House Freedom Caucus have shown they want the moon, or nothing, when considering reform of health-care policy. They aren’t going to get the moon, so what they should do is nothing. If they won’t vote “yes,” they also should not vote “no” and not vote “present” either. Just put out a press release making all their usual assertions that everybody else is a weak-kneed coward unwilling to stand on principle, and then, in a great show of moral purity, walk out of the House chamber in protest just as the vote is being called.
That way, they will be able to signal their disgust without actually killing the only extant vehicle to replace Obamacare with something that tremendously improves Medicaid, expands health-savings accounts, re-introduces market forces into the system, repeals numerous taxes, and reduces the federal debt (compared to current law) bytens or even hundreds of billions of dollars over the next decade.
For the bill to pass the House at this stage, it does not need a majority of all elected House members; it needs a majority of those present and voting. So for every two congressmen who walk out in protest, the number of votes needed for passage drops by one.
A walk-out thus would signal that they strongly disapprove of the bill as currently constituted and that they will oppose it when it comes back from the Senate unless it has been substantially improved. But it wouldn’t undermine their leadership and a new administration of their own party, poke a finger in the eye of fellow conservative Republicans trying sincerely to navigate difficult legislative terrain, or relegate 320 million Americans to a continuation of an unimproved Obamacare system that is a job-killing, choice-destroying, premium-hiking nightmare.
What the Freedom Caucus must understand is that this vote today essentially amounts to a procedural ballot. It merely provides a blueprint from which the Senate can work. The Senate will probably take several months, if the bill is sent its way, to re-mold it and fix any flaws while the Freedom Caucus weighs in from across the Capitol, knowing that its block of votes eventually will be crucial. When the Senate has done its work, the bill will go back to the House — and then, not before, will come the vote on final passage at which time the Freedom Caucus can decide once and for all if the new legislation well serves the American public.
Of course most of the Freedom Caucus believes the Senate will make the bill worse rather than better. But what’s the harm in finding out? Whom does it hurt? To repeat: This vote scheduled for today is not a vote to send a bill to the Oval Office for the president’s signature. This is merely a vote to keep the process going. If the Freedom Caucus doesn’t want to signal assent, fine — but there is no reason it should deny the ability of the vast super-majority of their Republican colleagues to try to uphold their own pledges to replace Obamacare with something better.
There are times to stand firm — and other times to cooperate for the good of the order while at least showing respect for the efforts of usually allied colleagues, even if cooperation just means temporarily getting out of the way.
1. The great City of God Twitter experiment continues. (Background on Chad Pecknold’s #CivDei challenge to anyone within the reach of social media here.)
2. On The Federalist: “We parents of disabled children know the pain. The fear. And the pull of despair. But we also know the love. True love doesn’t take the ‘out’ provided by a ‘compassionate’ doctor.”
3. Frank Rocca in the Wall Street Journal: Why Abortion Doesn’t Resonate in European Politics:
The election of Donald Trump has boosted the profile and prospects of the U.S. antiabortion movement. A wave of right-wing populism is also hitting Europe, but on the continent, abortion is almost invisible as a political issue. No major party in the coming elections in France and Germany, or in last week’s vote in the Netherlands, has proposed more restrictive abortion laws.
The disparity between the U.S. and Europe reflects sharply different popular attitudes toward abortion. A 2015 BuzzFeed News/Ipsos poll found that two-thirds of French and British respondents thought abortion should be permitted “whenever a woman says she wants one”—compared with only 40% of Americans. A 2013 survey by the Pew Research Center found that only 19% and 14% of German and French respondents, respectively, saw abortion as morally unacceptable—compared with nearly half of Americans.
4. Sohrab Ahmari in America: DeChristianization in the West is a real threat. But Putinism isn’t the answer.
5. Also in America: Confessions of a Porn-Addicted Priest
6. Ryan Anderson & Melody Wood: Gender Identity Policies in Schools: What Congress, the Courts, and the Trump Administration Should Do
From the last Morning Jolt of the week:
Why No GOP Health Care Bill Will Ever Be Really Popular
The conventional wisdom this morning is that Republicans are on the verge of suffering a colossal defeat by failing to unify behind the American Health Care Act. It’s only a colossal defeat if they let it become one. President Trump has offered a bold ultimatum: if the House doesn’t pass the American Health Care Act, he’s abandoning Obamacare. If this isn’t a bluff to win passage and he genuinely means it, it means he’s more reckless, capricious and more unworthy of conservative support than even his skeptics thought. A presidential declaration that repeal and replacement efforts are kaput for the remainder of his presidency would be the anti-Gorsuch, a giant vindication of his critics from the primary. He denounced Obamacare over and over again on the campaign trail. Now, in the face of predictable problems of a Republican Party divided on how best to replace it, he’s willing to abandon the effort?
Different Republicans are going to have different priorities in what replaces Obamacare. The U.S. health care system is big and complicated and has a lot of problems because it’s trying to address a lot of contrary desires. Americans want health care to be excellent, widely-available, and cheap. Experience tells us we can only pick two of those qualities.
A gigantic lingering problem for any reform effort is that many members of the public have wildly unrealistic expectations about what their health care should be and how much they should pay for it, and no politician in either party has much incentive to be honest about hard truths. There’s a strong argument that the entire concept of insurance doesn’t work well for health care, compared to, say, auto insurance. The vast majority of drivers will not get in a major accident in any given year, and plenty of drivers will go years and years without an accident. Consumers are comfortable with a system where most years, they will pay in a considerable sum and get nothing from their auto insurer for that year.
Auto insurance works because a lot of people pay in and get little or nothing in return (other than peace of mind and meeting the legal requirements), but a few people pay in a little and then wreck their car, and the company can afford the costs of repairs or replacing it and make a profit on top, enough to run lots of ads with that little gecko.
Everyone needs health care eventually. And even if you’re healthy and don’t foresee health expenses in the near future, you can get hit by a bus or fall off a ladder or slice your finger with a steak knife at any time. (That’s one reason why “preventative care” rarely saves as much money as the reformers hope.) Obamacare decreed that insurance should cover birth control, which is a monthly expense. Quite a few Americans take prescription drugs regularly to control chronic conditions. Significant health expenses aren’t as rare as car wrecks, meaning the insurers have to pay out more… which means they have to charge more in premiums.
The way to bring down prices is most markets is supply and demand, but that’s difficult to apply to health care costs compared to, say, shopping for a plane ticket on Expedia. If you’re hit by a bus, you need emergency care and it’s difficult to request the ambulance take you to the less-expensive hospital. People get very attached to the doctors they know and they’ve been seeing for years – thus the importance of Obama’s pledge, “if you like your doctor, you can keep your doctor.” Pediatricians watch kids grow up. People don’t like the idea of breaking off an established care relationship and shopping around.
On paper, we can increase supply, and you’ve seen market forces improve health services not covered by insurance; LASIK surgery and plastic surgeries are the most-cited examples. But while you can increase the number of doctors in the country (and nurse practitioners, etc.) it’s difficult to increase the number of the very best doctors. Even if we somehow forced medical schools to admit more students and produce more doctors, U.S. demand for health care is only going to increase as the Baby Boomers age.
The popular argument on the Left is to declare that health care is a right, and thus shouldn’t be subject to the pressures of supply and demand. It’s a lovely thought, until you start thinking through how this would work, because all health care is the result of someone’s labor. Somebody’s got to go through college and medical school and spend all those years studying to become a doctor or nurse or specialist. Somebody’s got to research and develop the prescription medication. Somebody’s got to invent, design, and build the MRI machine, robotic surgery arm, artificial limb, etcetera. And all of those people expect to get paid, and almost everyone would agree that considering their skill, education, talent and hard work, they deserve to be paid well.
When you declare something is a right, it means it cannot be denied, particularly due to an inability to pay. Which means someone else, i.e., the government is in charge of payment.
Put aside the exorbitant cost of having the government pay for everyone’s health care for a moment. You could argue the “government pays” system is close to what we have with Medicaid… except a lot of doctors find Medicaid payments to be way below far market value, “around 50 to 85 cents on the dollar of the actual cost of medical care.” Many doctors say that they’re still willing to take the personal financial loss that comes from treating Medicaid patients, up until the point that they can’t afford it. As of 2015, only 67 percent of doctors take Medicaid, and only 45 percent of doctors take new patients on Medicaid. Even the illustrious Mayo Clinic announced it is going prioritize non-Medicaid and non-Medicare patients.
The Democratic solution? Introduce laws forcing doctors to accept Medicaid payments. Some gratitude for the caring profession, huh? Making health care a “right” means that doctors are forced to work for reimbursement set by the government. It reduces them to tools of the state.
But this hasn’t sunk in with much of the general public. They still believe that there’s some system out there where they can get the very best care, choose any doctor they like, see any specialist they prefer, and pay little or nothing for it. And until that perception is dispelled, any health care reform proposal will be greeted as a disappointment.
Long before there was the expression “fake news” — or, as the president tweets it, “FAKE NEWS” — there was the National Enquirer. This was pretty much understood to be the definition of fake news. The Lindbergh baby might have been carried off by the Loch Ness monster — that sort of thing.
While the president labels many outlets “fake news,” he speaks with nothing but respect about the National Enquirer. He did so in his recent interview with Time magazine, whose Washington bureau chief brought up the tale of the Cruz family and the JFK assassination.
Believe me, if the Enquirer ever turned on Trump, instead of supporting him, Trump and his spokesmen would jump on that rag as not worth blowing your nose on.
The Enquirer is one of the issues I take up in Impromptus today, along with Iran, the Gorsuch hearings, the Koreas, and much else.
One of my items is about David Rockefeller, who has died at 101. He was a rare thing, in my experience: a scion of wealth — an inheritor of wealth — who both understood and defended capitalism. (The same is true of Pete du Pont and Steve Forbes.) DRock said, “American capitalism has brought more benefits to more people than any other system in any part of the world at any time in history.”
True. And this point, by the way, was stressed by Arthur Brooks, the president of the American Enterprise Institute, in our recent podcast.
Rockefeller studied with Schumpeter and Hayek, among others. Of DRock’s many privileges, that was one of the biggest.
Alexandra notes that Chuck Schumer intends to filibuster Neil Gorsuch.
Schumer said he remained unconvinced that Gorsuch would “be an independent check” on President Donald Trump. Gorsuch, he asserted, is “not a neutral legal mind but someone with a deep-seated conservative ideology. He was groomed by the Federalist Society and has shown not one inch of difference between his views and theirs.”
So far, no senators have officially agreed to join Schumer’s filibuster, but Bob Casey Jr., a Democrat from Pennsylvania, announced this morning that he will oppose Gorsuch’s nomination. In his statement, Casey cited as a concern Gorsuch’s “rigid and restrictive judicial philosophy that employs the narrowest possible reading of federal law and exercises extreme skepticism, even hostility, toward executive branch agencies.”
Schumer can, of course, do whatever he likes, and for whatever reason. The Senate is an equal partner in the judicial appointment process, and the filibuster applies in this case. If Schumer can convince enough of his fellow senators to join him, he can kill the nomination fair and square. That’s the American system.
Practically, though, he’s going to have to get his party to pick a lane. Look at the two claims that Alexandra quotes above. According to Senator Schumer, Gorsuch is unsuitable because he won’t check President Trump. But according to Bob Casey, Gorsuch is unsuitable because he’s a “rigid and restrictive” separation-of-powers zealot who “exercises extreme skepticism, even hostility, toward executive branch agencies.” Well, which is it? Either Gorsuch will act in lockstep with the president, or he’ll be implacably hostile toward his administration and gum up the works at every step. But he can’t do both.
And what of the broader threat that Trump presents — another Democratic theme? Is the president a dangerous, power-mad authoritarian who must be stopped at all costs — including by the courts? Or he is a run-of-the-mill ideologue whose biggest flaw is his preference for Congress and his dislike of the Chevron Doctrine? Again: He can’t be both. Before he rises to speak through the night, Schumer should probably have a good answer to these questions.
Uninspirational Quotes for People Who Hate Inspirational Quotes.
Flying Water Taxis are coming to Paris this Summer.
Found: A Colossal Statue of Ramses II Hiding Under a Cairo Street.
Dead Men’s Teeth: A History of Dentures.
Humanure: The Next Frontier In Composting.
ICYMI, Wednesday’s links are here, and include the secret plan for the days after Queen Elizabeth’s death, William Shatner’s birthday, why we don’t (generally) eat horses, the science of facial hair, and how far back in time you could go and still understand English.
Trump wants a vote no matter what tomorrow and says he’ll abandon Obamacare repeal if the bill doesn’t pass. This is highhanded and, if sincere, reckless. A loss would be a major blow but there would be other avenues available to get a repeal bill–the Senate could go first, or the House could try again with something better crafted. This Trump tack, together with the reporting about how the White House is beginning to point its finger at Speaker Ryan for the legislation’s struggles, is a sign of how his relationship with Congress could sour quickly. On the other hand, the threat might just shake loose enough votes for the bill to squeak through. One problem with the House’s salesmanship is this vote isn’t really the binary choice that it says–as noted above, there are other ways to proceed even if this bill fails. The Trump threat appears to make it truly a binary choice, and there is some talk among journalists tonight that the resolve of the Freedom Caucus is softening. The gambit is typical Trump–high-stakes, unorthodox, and instinctual. We’ll know more about its efficacy, and perhaps about the course of his presidency, tomorrow.
That’s the approve-disapprove of the Republican health-care bill, per a new Quinnipiac poll. If that number is anywhere close to accurate, it makes the analysis on why Republicans are having trouble passing the bill much simpler–major legislation this unpopular doesn’t become law. Per Fred’s point below, Sahil Kapur points out the numbers among key Trump demographics:
AHCA approval is underwater by 26 points among non-college whites; underwater by 46 points among voters age 50-64. This is Trump’s base. pic.twitter.com/Z31jBVmeJN— Sahil Kapur (@sahilkapur) March 23, 2017
After over two weeks of deliberation, House leadership has postponed a vote scheduled for sometime today on the American Health Care Act (AHCA), the GOP bill to repeal and replace Obamacare. According to the most recent information, the vote will be rescheduled for tomorrow, but no time has been set.
The AHCA rollout, which began on March 6, was plagued by controversy, as moderate Republicans and hardline conservatives alike found a variety problems with the first draft. Despite textual changes and further negotiation, the far-right House Freedom Caucus (HFC) remains the last big roadblock, as most of its members have yet to come around to accept the ACHA as it stands.
Given numbers in the House, the GOP could only afford 21 defections, and according to most reports, somewhere around 30 members were still unwilling to vote for the AHCA as of this afternoon, with another handful of members leaning toward voting “no” as well.
Hardline conservatives continue to insist that the bill leaves too many of the Affordable Care Act’s structures in place, failing to live up to the GOP promise of repealing Obama’s signature health-care bill. Members of the HFC — including its chairman, Mark Meadows (R.-N.C.) — held an extended meeting today with President Donald Trump and his White House advisors, but still were unable to strike a deal to give the GOP the votes necessary to pass the bill today as they had intended.
Meanwhile, over a dozen moderate GOP representatives recently have announced their intention to vote against the bill, some of whom are concerned that it would inhibit their constituents’ access to affordable health-care options.
Much of today’s discussion over the bill centered around the plan’s provisions for essential health benefits, which the White House offered to strip out of the legislation in a move to win HFC votes. This offer might’ve been a reason for some of the dwindling support from moderate members.
Although the process has devolved into some confusion, and the future of the bill seems somewhat unclear, Meadows assured reporters at a press conference this afternoon that he and his members are “desperately trying to get to yes” and promised “we are going to get to the finish line.”
It’s obviously not a great sign. The tactical problem Ryan has is that he needs to win over both conservatives and moderates, which means that every action creates a reaction. It’s not clear, for instance, that the White House offer to the Freedom caucus yesterday to strip out the “essential health benefits” of Obamacare won more conservatives or lost more moderates. The bigger problem is that it’s not a good bill, so no one is eager to make compromises or sacrifices to get it over the top.
Making even Internet memes look durable, the American Health Care Act seems a quickly evolving legislative artifact. Whatever it is, though, it faces a key political problem: Will it blow up the potential alliance between conservatives and working-class-oriented populists (perhaps not two entirely distinct categories)?
In some respects, the AHCA is a very generic Republican bill. One could see a similar measure being supported by a President Jeb Bush, for instance. The AHCA embodies in many ways a version of Republicanism that likes to lead with fiscal issues, focusing on tax cuts and entitlement reform. It would cut capital-gains taxes for upper-income households (to the tune, the Congressional Budget Office estimates, of over $16 billion per year by 2020 — or a big chunk of the estimated price of a border wall). In one of its most transformative provisions, the AHCA would block-grant Medicaid to the states, a mode of entitlement reform long desired by many conservative wonks.
While it achieves many longstanding priorities for Beltway Republicans, it contains some provisions that could alienate members of the working class, such as Medicaid cuts. It is telling that elements of the Right who have been very sympathetic to populist themes — such as Ann Coulter, many Breitbart writers, and Arkansas senator Tom Cotton — have been unsparing in their criticism of the AHCA. The bill itself is currently extremely unpopular, supported by only 17 percent of Americans according to the latest numbers from Quinnipiac.
It might be especially divisive for the Republican coalition. Donald Trump’s presidential campaign was premised upon outreach to working-class voters, and an improved performance with this demographic was crucial for breaking the “blue wall” at the presidential level and for the GOP’s successful defense of its Senate majority. Perhaps a key slice of the working class is what Pew calls the “Hard-Pressed Skeptic,” a type of voter skeptical of international trade and large institutions but also anxious for government support (even as Skeptics have grave doubts about the efficacy of the government). In many ways, Donald Trump campaigned as a Skeptic, and this group likely formed a key element of his electoral coalition in Rust Belt states.
Republicans risk grave political danger if they lose the faith of working-class voters because of GOP decisions on health care and other policies. These voters might enjoy President Trump’s combative approach to institutional Washington, but that pleasure could soon sour if they think that the administration is not advancing their policy priorities. It’s possible that the most dangerous position for Republicans on health care is that the GOP passes some reforms to the financing of health care, enough for Democrats to accuse them of denying care to people, while also failing to pass any reforms that could expand access to health care (such as expanding the insurance market). That is to say, Phase 1 without Phase 3 might be a very uncomfortable position for the GOP.
Sometimes, political dangers can be gone around rather than faced head on. If the House remains at an impasse on the AHCA, congressional leaders could return to the table with a legislative strategy that defers some reductions in Medicaid expenditures in order instead to offer some targeted reforms to the insurance markets and other elements of the medical-delivery system in the United States. If health-care costs are brought down and if the economy improves, Republicans could then have more space for a thoroughgoing reform of the Medicaid system; a vibrant economy was a key context for the welfare reform of the 1990s, and entitlement reform can often proceed more effectively in a time of economic optimism.
A bad bill passed quickly might be far more damaging to the policy agenda of Republicans than a better bill (or set of bills) passed more slowly, and, as Ramesh Ponnuru has noted, Republicans might be able to add more regulatory elements to the AHCA if they take the time to do so. As they continue to negotiate the AHCA, Republicans might remember that the who’s-up-who’s-down newscycle has an increasingly small half-life; policy accomplishments — and shortcomings — live on.