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  September 21, 2017

Congress Spars on Healthcare, Unites to Fund War


As Republicans attempt a last-ditch repeal of Obamacare, Democrats have joined them to overwhelmingly pass massive spending on the military and war. We speak to economist Dean Baker
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biography

Dean Baker is co-director of the Center for Economic and Policy Research in Washington, D.C. He is the author of several books, his latest being "Rigged: How Globalization and the Rules of the Modern Economy Were Structured to Make the Rich Richer".


transcript

AARON MATÉ: It's The Real News. I'm Aaron Maté. Senate Republicans say they're close to winning the 50 votes they need to repeal the Affordable Care Act. They're rushing to do so before the end of the month. That's when, under Senate rules, they can no longer pass their bill with less than 60 votes, which means not just by themselves. Now the bill, from Senators Lindsey Graham and Bill Cassidy, was so rushed its full scope has been slow to emerge.

What is for sure is that, like its previous version, known as Trumpcare, the Graham-Cassidy bill would strip millions of people of their health insurance and replace Obamacare subsidies and Medicaid expansion with block grants to states. Now, because many Republican states refused the Medicaid expansion, 14 of 15 states that would stand to gain from block funding are Republican. It also means at least 34 states stand to lose healthcare funding, and most of them have voted Democratic.

On Tuesday, Senate Minority Leader Chuck Schumer blasted the Republican plan.

Chuck Schumer: The latest version of Trumpcare may live under a new name, Graham-Cassidy, but no matter how many ways they try to dress it up, they try to hide it, it's even more dangerous and more reckless than the previous bill that was defeated. Simply put, Trumpcare is a sham. They're crafting it in the dark of night. To say one hearing on one day without a CBO score and only two witnesses against the bill, that's a hearing, that's a full airing of the bill? Come on. They're ashamed of this bill.

AARON MATÉ: Now, while Republicans and Democrats spar over healthcare spending, they did agree this week on another very big expense. On Monday, the Senate overwhelmingly passed a measure that would spend more than $700 billion on the military. That's about $61 billion more than President Trump even asked for in his record-setting request a few months ago. The Senate vote was 89 to 9.

Dean Baker is an economist, author, and Co-Director of The Center for Economic and Policy Research. Welcome, Dean.

DEAN BAKER: Thanks for having me on.

AARON MATÉ: Let's start with the politics of the Graham-Cassidy bill. Right now, they're trying to rush this through, as I said, because they only have a limited window to do so before they will start to need Democratic support and not just Republican support with the 50 votes that they have now, or they would have now if all Republicans vote for it. But they're running into some opposition. They're running into about six Republican governors have comes out against this bill so far, and also Senator Rand Paul, who's opposed to it not because it will strip people of health insurance, but he says that it doesn't go far enough in repealing the Affordable Care Act. Your sense of what's happening now?

DEAN BAKER: It's going to be very close. The two people who had voted against earlier bills, the two Senators, were Collins from Maine and Murkowski from Alaska. Murkowski has pretty much indicated she's going to vote against it. Her governor was one of the governors who spoke up very strongly against the bill. Collins from Maine, she will have a tough time voting for it, but she's been on record having been an opponent of these repeal and replace efforts, which basically get rid of the system. There's not much replace, it's getting rid of it. I think she'd have a very hard time turning around and voting for it. Ron Paul, if he sticks with his no vote, they're not at 50.

On the other hand, many of us thought the House bill was dead. You might recall back in March they tried to get it through and they came up short. Then they came back and I think caught a lot of people by surprise and they were able to get it through. I won't call it dead till we're having this discussion October 1st, and then we'll know it's dead. But right now it doesn't seem they have the votes.

AARON MATÉ: Were you as surprised as most other people were by this last-ditch attempt from the Senate Republicans? A week ago, this was not on the agenda. Then, all of a sudden over the weekend it emerges, trying to push this through before the Senate Republicans can't rely just on their own caucus.

DEAN BAKER: I thought they'd given up. Obviously, they're doing political calculation. It's an embarrassment for them. After having railed against Obamacare is the worst thing on earth for seven years, and now they control both Houses of Congress and the White House and they don't do anything about it, that does make them look foolish. Obviously, they were lying. They were just making stuff up. They didn't have a way to replace it that made sense. They didn't have a plan on the shelf or anything close to a plan on the shelf.

In any case, they were looking really bad. If they could get something through, they could at least take credit, saying, "Hey, we did it." That's what they're thinking. On the other hand, when all these people wake up after this goes into effect and they find out they don't have health insurance, they're not going to be very happy. They're going to decide for themselves the politics. It's easy for me to say as an economist this is really awful policy, but they're the ones who are running for office. They'll figure out what makes sense for them.

AARON MATÉ: Let's look at how they're trying to sell this to those people, to their constituents, including those who would lose health insurance. Speaking about this, on Tuesday, Senator Lindsey Graham, one of the co-sponsors, he billed it as empowering the states.

Lindsey Graham: I'm trying to take the money and power in Washington and send it back close to the patient. If you believe government closer to the people is the best government, why not health care? Finally, we know how this movie ends if we don't change. We're going to have a single-payer healthcare system in this country that's going to bust the budget, and we're going to start rationing care like you've never seen. Obamacare is failing for a reason. It's a bad idea. State control of healthcare will work because the people in charge will be accountable to you, unlike Obamacare, where the person in charge could give a damn of what you think.

AARON MATÉ: Dean, that's about a 30 second soundbite, but a lot in there to respond to. One, that this Republican effort is a way to empower the states. Two, that Obamacare is failing. Three, Graham says that this is a way to avoid the other path, which he warns is inevitable if Republicans don't act, which is single payer.

DEAN BAKER: A few things. First off, Obamacare seems to be working just fine in states that are controlled by Democrats: California, New York, a long list of states where you have Democratic governors, Democratic legislatures that have tried to make it work. It's quite successful there. People are getting coverage. They're seeing the benefits of Obamacare. The Republican states where they've tried to sabotage it, they know how to sabotage it, so it's much less successful. You have much less competition in the exchanges.

In terms of this principle that you're going to make it closer to the state, two points here. One, they're having big cutbacks in spending, so it's not just that they're turning over the money to the state, they're talking about very large cutbacks in spending. Unless these people could do some magic, they can't do the same coverage. And, of course, they can't.

The other point is they're not willing just to turn it over to the states. There's an amendment in there, I don't know if it's gone through yet, that would say states don't have the option to do single payer, hard to do at the state level in any case. But they obviously feel they don't think it can be left up to states. This idea that governments govern best that are close to the people, they don't adhere to that consistently, because there are any number of states that have passed preemption laws preventing city governments from having higher minimum wages, having rent controls. Basically, what they're just saying is they want power at the level where they can best control it. There's no principle here.

Third point, single payer. Well, if your goal was to get single payer, I would probably say, hey, pass this, because these guys are probably going to get many of themselves voted out of office when people wake up and find out they don't have healthcare insurance. Because, again, it's one of these things. I'm from Chicago, and there was a mayor that lost an election because he argued and said that ... There was a big snow storm, and people asked him, "How come you didn't get the snow off the streets? How come the streets aren't clear?" He said, "They are clear." Well, everyone could see the streets weren't clear.

Same thing. People wake up and they're on healthcare insurance, and they realize the Republicans took it away from them, they're not going to be happy. My guess is that will cause a lot of them to lose office, and that probably will be a good way to move single payer forward. I want to see single payer move forward, but not by seeing tens of millions denied healthcare insurance.

AARON MATÉ: Dean, what you say there about Obamacare does speak to this debate that's going on inside the left, inside the Democratic Party, over what is the best path forward, because there are some who would look at Obamacare as a reason for single payer, because, A, of course it doesn't cover everybody, and, B, even in the states where it's not being sabotaged, isn't it fair to say that for a considerable number of people, premiums have gone up as a result of it?

DEAN BAKER: Well, it doesn't cover a lot of people. Premiums actually haven't gone up as a result of it. Premiums were rising quickly beforehand. Any measure of premium growth before and after ... Now, whether you want to give Obamacare credit for that's an open question, but premium growth has actually grown more slowly since the bill's been passed. That one doesn't fit. Again, you could argue whether they deserve credit for that or not, but they've actually been rising less rapidly.

Surely it's not a great system. A lot of people still have very high healthcare bills. I don't think anyone ... Well, I shouldn't say, I can't speak for everyone, but it doesn't make sense to say, "Okay, we're in a good place, we want to stay there." We want to get the premiums down. It'd be great to restrain insurers more, great to put more check on the drug companies. I'd like to see us pay for the research upfront so all the drugs are sold as generics. This shouldn't be the final place for healthcare, but I'm not sure that getting rid of it somehow makes it easier to get to single payer. Maybe in some long run, but it's not as though we get rid of Obamacare and then we'll see single payer tomorrow.

AARON MATÉ: You know, Dean, on that point you made about single payer being passed in states individually, there's a piece up on The Intercept that notes that Republicans are trying to include a provision that would specifically ban states from passing single payer. Louisiana Republican John Kennedy wants to add that as an amendment, even though he's already been told by the bill's cosponsors that that provision to ban states is already in there. But it raises the question, who really is committed to states' rights if, in this measure that they're supposedly empowering the states, you have such a strong measure that would ban states from taking their own action on healthcare if it goes in the direction of single payer?

DEAN BAKER: Yeah. Clearly, states' rights is not a principle with these people. It's purely one of convenience. They're happy to say, "Okay, we'll give states more authority." One of the things they want to let states do is have a work requirement for Medicaid so you have to work to get Medicaid. A lot of people obviously have bad health, that's why they're getting Medicaid. They'll make a work requirement. They're banning funding for Planned Parenthood. They're not leaving that to the states' discretion.

It's not that these people believe in states' rights. We could argue whether that were a good thing or bad thing, but there is no principle about states' rights, state government here. It's pure and simple. They have their right-wing agenda, and if that means taking away authority from the federal government and giving it to the states in some areas, they're happy to do that, but that's not a principle.

AARON MATÉ: Finally, Dean, let's contrast this bipartisan discord over healthcare to the concord they found this week over military spending. As mentioned, a budget was passed on Monday overwhelmingly in the Senate. The vote was 89 to 8 for $700 billion in military spending, $60 billion more than Trump asked for in his record-setting request just a few months ago. One component of this is that the Pentagon asked for about 70 F-35 jets made by Lockheed Martin. This measure from the Senate would deliver them 94, so 24 more than the Pentagon even asked for.

DEAN BAKER: Yeah. This is a lot of money even by Washington standards. We just have an obvious comparison here. We're talking about $700 billion over the next decade in additional spending for the military. That's more than the amount of money at stake in these Obama repeals. I haven't seen the score. Well, we don't have a score on the latest Graham-Cassidy bill, but it's somewhere in the neighborhood of $650 billion presumably over the decade. We're actually talking about more money going to the military. Again, that's additional. That's in addition to their current spending level would be, I don't have the number in front of me, but probably on the order of $8 trillion over the next decade.

Congress is apparently very quick to be willing, and this includes the Democrats, to be willing to give more money to the Defense Department with very questionable uses. When we start give them more planes than what they asked for, you wonder, are all the members of Congress such great military experts that they could determine the generals didn't ask for enough planes? That really sounds like we're just handing money to Lockheed. Maybe we should just do that and leave the planes out of it.

AARON MATÉ: Yeah. It's just striking to note the Democratic consensus behind this. Just five Democrats voted against this, without the party putting up any kind of fight to stop this bill or even to try to reduce the $700 billion in spending to maybe something a little bit lower, perhaps maybe to the number that Trump wanted, which is about $60 billion less, and still a massive amount.

DEAN BAKER: Yeah. I'm not happy, but I will say one thing that they've ... I forget whether it was Schumer who said this, but someone on the Democratic side said this is part of a strategy, that they're going to say, okay, they want a quid pro quo. Because this is not a final, in contrast to what will go through the Senate if it does go through. That will be a final version. They won't have an opportunity to change that. This is not final. This will go back to the House and they'll have to come up with some compromise package.

They're saying that they're going to use this to get increased funding for a variety of domestic spending programs. Whether that's a good trade-off or not, you could argue, but they are at least in principle getting something for it. Again, we'll have to see, and they'll have another chance to vote on what ultimately comes out of the House, but that's their rationale.

AARON MATÉ: Be curious to see what happens with it. Dean Baker, economist, author, and Co-Director of a Center for Economic and Policy Research, thanks very much.

DEAN BAKER: Thanks for having me on.

AARON MATÉ: And thank you for joining us on The Real News.



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