How Obamacare Became a Preexisting Condition

From Esquire

(Optional Musical Accompaniment To This Post)

WASHINGTON-You knew things had gone sideways when they locked up the House. The corridors that lead through the heart of the Capitol, from Senate chamber to House chamber, were still an unnavigable mass of tourists and staffers and journalists, all clustered by the walls and in unruly knots below the various graven images in Statuary Hall. The echoes were an impossible gabble of crying children, overmatched tour guides, angry parents, and television stand-ups from many lands. At about 3:30, when the voting was supposed to start, a small, tough-looking woman from the Capitol Police turned out the lights in one of the small foyers leading to the chamber. She swung the big doors shut and slammed the locks down into the floor. And that was pretty much it. Until, of course, Speaker Paul Ryan, the zombie-eyed granny starver from the state of Wisconsin, took to a podium in the bowels of the Capitol and said the following.

"Obamacare is the law of the land for the foreseeable future."

That statement should have come with a sword for Ryan to hand over to Nancy Pelosi who, let it be said, is one legislative badass. She somehow kept her caucus united. There wasn't even a hint of blue-doggery from her caucus as it sat back and let the Republicans rip each other to shreds, let the president* get exposed as a rookie who should be sent back to A-ball, and let the conservative movement expose itself as graphically as it ever has as the soulless creature of the money power that it's been for 40 years. Usually, there are some Democrats who either want to make a deal so that Fred Hiatt will send them a Christmas card, or simply because Democrats occasionally can't help themselves from trying to make the government, you know, actually work. (That nervous tic already is at work concerning the nomination of Neil Gorsuch to the Supreme Court.)

There was none of that over the past month, while Ryan was trying to formulate what he gamely referred to as a "member-driven" process. That's precisely what it was. The Freedom Caucus cultist had Ryan by the member and they drove the process over a cliff. Watching in that great Caucus Room In The Sky, Sam Rayburn, Lyndon Johnson, and Tip O'Neill poured out another round and hoisted their glasses at what Pelosi and her team accomplished.

"Today is a great day for our country," Pelosi said during a news conference. "It's a victory. What happened on the floor is a victory for the American people-for our seniors, for people with disabilities, for our children, for our veterans."

A strange week came to a bizarre conclusion. The way word first got around that the healthcare bill was dead was that the president* called Robert Costa of The Washington Post, told him "We pulled the bill," and Costa then tweeted it out into the great maw of the universe, most notably, those precincts of it that had gathered in the halls of the Capitol. It is a remarkable political defeat suffered by a Republican president at the hands of a Congress controlled by his own party. George W. Bush got bipartisan support for his massive tax cut, Ronald Reagan for his radical 1981 budget. For a historical precedent for what happened Friday, you have to go back to the rocky relationship between Democratic President Jimmy Carter and Democratic Speaker O'Neill in the mid-1970s. Carter walked into the White House with a 149-seat majority in the House and an equally massive advantage in the Senate. Then, as essayist Walter Karp pointed out:

That was a simple institutional, insider-outsider brawl. What happened to the Republicans this week was different by an order of magnitude. They cored themselves out as a party. They allowed the most extreme element in their caucus to set rules that became untenable and would have been even if Paul Ryan was as good a Speaker as Nancy Pelosi once was. By the middle of the week, the bill was caught in an impossible whipsaw of political imperatives. To get the Freedom Caucus cultists on board, the president* and Speaker Ryan had to make the bill even more cruel and punitive-Work requirements for Medicaid? Men asking why they had to pay for some woman's maternity care?-and, having done so, it scared the daylights over what passes for a moderate faction in the House Republican caucus. The negotiations bounced impotently back and forth for three days, going absolutely nowhere. On Friday, the White House took its ball and went home.

"We were a 10-year opposition party where being against things was easy to do," Ryan said. "And now, in three months' time, we've tried to go to a governing party, where we have to actually get ... people to agree with each other in how we do things." Of course, since 2010, the House has had a Republican majority and a Republican speaker. There have been two of them-John Boehner and Ryan. The crazy caucus ran Boehner out of office and now, they've handed Ryan his head. Pro Tip: it's not you, boys. It's your party.

"I always thought the House was going to be the easier part," said Brendan Boyle of Pennsylvania. "I thought they'd run into tremendous difficulties in the Senate but I always assumed, given their pretty big majority in the House, that they'd be able to get this through. I also think all the people who showed up at the town halls, and flooded our congressional offices with phone calls, or in person, made a big difference. These were people who wanted to save their healthcare."

So, it turns out that Butcher's Bill Kristol was right, all those years ago, when he wrote his famous strategy memo advising the Republicans in Congress to do everything they could to derail President Bill Clinton's try at reforming healthcare. Kristol warned that, if Clinton succeeded, then people would find they enjoyed having good health insurance and it would be impossible to dislodge them from it, and the Democrats would have a generational advantage the way they built one with Social Security and Medicare. At least Kristol made more sense than Ryan, who went on the radio and bragged that getting rid of a federal entitlement was a epochal political triumph of the same order as, say, the Louisiana Purchase.

There are still several ways for the Republicans to sabotage further the ACA. They're still talking like automatons about buying insurance across state lines and about tort reform, as if either of those will expand coverage or bring down costs in such a way as to maintain a decent quality of care. Secretary of Health and Human Services Tom Price is as extreme as anyone in the Freedom Caucus, and he's in charge of the second and third prongs of the Republican healthcare strategy. Of course, it's possible that the president* simply will blame Ryan or the Democrats and then move on to something else. The man has the attention span of a flea.

To be fair, the president* took the defeat rather better than I thought he would, which is to say he blamed the Democrats, repeated claim that the Affordable Care Act is gasping its last breath, and was so fulsome in his sympathy for Paul Ryan that, were I Ryan, I'd hire a food taster. Somebody's going to pay for this. You can be sure of that. Meanwhile, as Paul Ryan said, Obamacare remains the law of the land. The Rotunda was still packed with tourists when the news came down and you wondered how many people there had somehow been helped by the Affordable Care Act. Maybe it's that elderly gent looking up at the statue of Huey Long, or that kid in the wheelchair paused beneath Norman Borlaug. Obamacare is now a pre-existing condition, and a damned stubborn one at that.

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