What if Republicans and Democrats worked together?

Republicans can't cobble together enough GOP votes in the Senate to pass a law to repeal Obamacare and replace it with something else. They can't even cobble together enough Senate votes to simply repeal Obamacare — a goal they've been boasting about for seven years. So the Senate's Republican leaders don't know what to do about it. They are at an impasse. Even though their party controls the House, the Senate and the White House, they can't pass legislation they've been promising for seven years.

What CAN they do?

Here's an idea: Instead of insisting on legislation that is supported only by Republican votes, what if they tried putting together legislation that could attract the requisite number of Republican AND (gasp!) Democratic votes? They'll need 51 votes, but Republicans have been able to hold onto about 47 or 48 GOP votes for whatever version of repeal-and-replace legislation they dream up. Suppose the GOP leadership approached the Democrats and asked for their support, with a willingness to compromise on some details of the health care legislation that would make the new bill palatable to conservative or moderate Democrats.

That's the way congressional legislation used to be passed. The 1964 Civil Rights Bill, the creation of the Interstate Highway system, the creation of NASA and the race to put astronauts on the moon, and the Voting Rights Act were all passed with votes from both sides of the aisle. Why not do it again?

It's possible that otherwise sympathetic Democrats will refuse to participate in any Republican deal. After all, the atmosphere has been so poisoned by harsh rhetoric that both parties are wary of any deal that might help the other side. But it's the only effective way to get legislation in the national interest passed. Democrats should have learned the dangers of partisan voting in the passage of the Affordable Care Act and the resulting nearly decade-long assault by the other party.

But bipartisan leadership and legislating has worked before. It can work again. Won't somebody give it a try?

Campaign promises get in the way of legislating

When you stake your entire political being on the repeal of one legislative act, and you keep banging that drum for six or seven years, you paint yourself into a corner. 

The Republican efforts to repeal the Affordable Care Act, also known as Obamacare, have come to this: With control of the White House and majorities in both the House and the Senate, Republicans can do what they have tried to do dozens of times since 2010 — repeal the Affordable Care Act. Doing so, the GOP leaders remind their colleagues persistently, carries out a long-standing campaign promise repeated during four congressional elections. Failure to keep their promise about repeal would reveal them as ineffective, or as Spiro Agnew might have said it, "effete snobs."

The problem, which the GOP leadership ignored for seven years, is that American voters care more about their health care than they do about campaign promises. And many Americans, despite Republican attempts to persuade them otherwise, liked the ACA. It made it possible for them to have health insurance for the first time in years. The percentage of covered Americans topped 90%.

So the GOP leadership backed off a little. Instead of just repealing Obamacare, they shifted their rhetoric to "repeal and replace" Obamacare. Replacing the expansive law was not so easy. As President Trump confessed, "who knew" health insurance could be so complicated?

Republicans now have two Obamacare replacement bills, one in the House and one in the Senate. Both would sharply curtail the ACA promise to make it possible to get insurance coverage if you have a pre-existing condition. Both would knock down the fiscal underpinning of the ACA, the taxes on medical devices, insurers and others, and both would sharply cut Medicaid, which millions of Americans depend upon.

Republicans may have the votes in the Senate to pass their replacement legislation, but they don't have the magical ability to persuade Americans struggling to find medical coverage that they are better off with the Republican solutions to that campaign promise the GOP had kept making over and over like a mantra. Because of those promises, the GOP could not do the sensible thing, which would be to make adjustments to Obamacare so that it is more fiscally stable and practical.

Promises, promises.

Freedom Caucus sells out constituents

The House Freedom Caucus succeeded yesterday in stopping a vote on the Republican bill to replace the Affordable Care Act. Even after President Trump met with the coalition and begged them to come around and allow the bill to pass, the caucus refused. They wanted more concessions. Already, they had wrangled enough concessions out of the GOP leadership to frighten some more moderate members of the party.

The Freedom Caucus leaders criticized the GOP replacement for the ACA as "Obamacare Light." They wanted more than just a halt to some of the essential elements of the ACA; they wanted every vestige of the 2010 legislation ripped from federal law. A ban on pre-existing conditions as grounds for refusing coverage? Out! Allowing 26-year-olds to remain on their parents' insurance? Gone! Coverage of contraception? No! Coverage of mental health as well as physical health? Nope! Limits on higher premiums for older people? No way! Ending limits on lifetime coverage? Out!

The Freedom Caucus is getting its way (even as Republicans in and out of Congress work to find a way to shove their bill through the House), but Republican candidates everywhere might rue the day when the Freedom Caucus succeeded. For all the criticism of "Obamacare" and the GOP's ridiculously redundant votes to repeal "Obamacare," much of the legislation in the ACA has been quite popular. As Americans pay more attention to the details of the law that is being eliminated, it is growing in popularity, even as conservatives in Congress try to eliminate any clause that has any resemblance to the ACA. 

Republicans have a quandary. They can vote to destroy every whiff of "Obamacare" and hope the electorate does not rebel against the loss of decent health insurance coverage, or they can leave the ACA or popular parts of it in place and face questions about why they wasted time voting against the ACA dozens of times but couldn't pull the trigger given the opportunity, at last, to destroy it.

The Freedom Caucus, a basically Libertarian organization, has taken an odd role as the defender of insurance companies' profits. Instead of quashing government intrusions into personal lives (the Libertarian philosophy) and cutting federal spending, the Freedom Caucus is demanding changes that hurt individual taxpayers and benefit wealthy insurance companies.

Have the high principles of the Freedom Caucus been sold out to the insurance industry's billions in campaign donations?

Health care for all has only one option

After dozens of votes to repeal "Obamacare," Republicans in Congress have gotten their wish. They have the votes to repeal the Affordable Care Act, but they now face the reality that repealing the act does not improve health care. The repeal leaves huge gaps in health care and eliminates many popular aspects of the Affordable Care Act, such as protecting patients from being punished for having pre-existing conditions.

The reality has hit the GOP leadership: They can't just repeal Obamacare. They have to replace it. A proposed replacement was rolled out this week, but the Congressional Budget Office has found that the GOP health care plan leaves an additional 24 million Americans without health insurance. That figure frightened some less ideological Republicans, and votes to pass the GOP plan are dissipating.

The GOP plan is under attack from the left, as Democrats decry numbers of people who are left out of the new plan, and from the right, as far-right Republicans complain that the new plan is just warmed-over Obamacare.

Maybe this is an opportunity for a bold new approach. Both the Obama plan and the new GOP (Paul Ryan) plan are built on an inherently flawed premise — that America has to keep its network of employers paying premiums for employees and insurance companies paying the bills (or part of the bills) for U.S. healthcare. This system leaves out the unemployed, under-employed and just plain unfortunate. Obama's plan, like the one Hillary Clinton tried to push through during her husband's first term, tried to force the uncovered into buying insurance. Obamacare used tax penalties and government subsidies to make people get health insurance. It increased the percentage of people with healthcare but still left many people uncovered. The new GOP plan uses the same basic strategy but uses incentives to get people to buy health insurance rather than penalties and subsidies. It would leave even more people uncovered.

Perhaps the time is right for a new strategy — one that was rejected in earlier debates, but the only one that will truly cover "all Americans," which President Trump promised the GOP plan would achieve. That option is "single-payer," which is the model nearly all Western democracies use to provide truly nationwide coverage. In this option, all Americans would pay into the system, just as we all pay into Social Security and Medicare, and a federal agency would disburse payments to health care providers. Overhead would be sharply cut with just one agency handling accounts payable rather than hundreds of insurance companies, many of whom pay their CEOs multi-million salaries.

Taxes would rise, but health insurance premiums would be eliminated for both employees and employers. How much does the average worker pay for health insurance? $500 a month? $1,000 a month? How much do employers pay? That amount (or less) would be collected in taxes and used to pay for health care of everyone. The uninsured, who are a drain on the system now, would be eliminated. Taxation could be designed to be fair to all, with the lowest-income paying lower taxes and the most affluent paying more. Making the healthcare tax a separate form of tax on both employees and employers just like Social Security and Medicare, would keep the system transparent. Some co-pays would be appropriate to keep the public from abusing the system.

This is the only way everyone would be covered. Everyone would share the risks in a risk pool of 300 million-plus people. Insurance companies would fight for their survival, but the advantages of this system is too great to allow one interest group to sabotage it.

Supreme Court resuscitates health care act

The U.S. Supreme Court, to the surprise of many, validated the Affordable Care Act Thursday. The 6-3 decision held that it was not the intent of Congress to limit subsidies for health care premiums to only those states with state health exchanges. Residents of states without exchanges, who had to go to the national health exchange to get coverage, would continue to receive subsidies under the ACA. Chief Justice John Roberts provided a key vote and wrote the majority opinion.

Ironically, then-Sen. Barack Obama had voted against Roberts' nomination to the Supreme Court. Now Roberts has twice saved Obama's signature legislation. Three years ago, Roberts' perception of the statutory penalties for not buying health insurance as a tax saved the ACA.

Republican opponents of the ACA immediately jumped on Thursday's decision, declaring that the ACA was "broken" and would have to be repealed in its entirety. None of the GOP spokesmen explained how the legislation was "broken," which seemed to be an odd description considering the millions of people who have signed up and who are receiving health care insurance because of the 2009 legislation.

Republicans may get their chance at repealing the bill if they retain control of Congress and can win the presidency. Congress has taken dozens of votes to repeal the act, but none of them have taken effect because they could not pass in the Senate or because President Obama would veto the repeal if it ever passed Congress.

A controlling majority in the Senate and continued control in the House could make it possible for repeal legislation to pass after the 2016 election. If voters put one of the dozen or more GOP presidential candidates in the White House, then the ACA could be repealed without threat of veto.

But would GOP leaders really go that far? Already millions of Americans are depending on the ACA for health care coverage. Repealing the act would revoke their health insurance, and that would certainly pose a political risk for the party responsible for taking away a benefit Americans want and need, especially if the GOP has no alternative legislation — only a vitriolic hatred of "Obamacare."

Women will survive the Hobby Lobby decision

Women's advocates have been apoplectic about the Supreme Court's Hobby Lobby decision, but they are reading more into the decision than is there. The court majority was careful to craft a narrow decision, one that applies to Hobby Lobby's highly unusual, if not unique, situation. Attorneys and judges will have a difficult time expanding this decision to apply to other, somewhat similar situations.

Much of the criticism of the decision fell into the category of religion-bashing, and that's a shame. Relatively few Americans subscribe to the Pentecostal religious beliefs of the Hobby Lobby family, but all should be able to agree that a person's sincerely held religious beliefs should be respected by others who disagree with those beliefs. Other religious beliefs, the justices said, such as prohibitions against vaccinations or blood transfusions, would not be affected by this decision. Religious conflicts have led to discrimination, violence and wars throughout history, and religious conflicts remain a powder keg within Islam and in conflicts between Islam and Christianity.

The Hobby Lobby issue would never have been raised were it not for the Affordable Care Act's retention of employer-sponsored health insurance, a system that is exceptional, if not unique, among all advanced economies. If Congress had opted for a single-payer system financed through taxes, such as Canada, France and Great Britain have, an employer's religious beliefs would never have mattered.

Critics who are claiming that women will be denied health care grossly overstate the case. The court ruled that an employer cannot be required to provide health insurance covering specific prescriptions or procedures that conflict with the employer's sincerely held religious beliefs. Female employees of Hobby Lobby can still obtain prescriptions for contraception, which was the service at issue, from any physician and can have that prescription filled. The narrowly proscribed function in the decision is that employers may not be forced to pay for types of contraception that they consider to be equivalent to murder. The government can solve the whole issue, if it so chooses, by making payments for contraception the responsibility of the federal government.

Campaigning is not the same as governing

It has been said before — American elections put the emphasis on campaigning skills and not on governing skills. We tend to elect the best campaigners, not the best managers or administrators or legislators.

Barack Obama is making himself a classic example of this flaw in the system. Obama presided over an exceptional 2008 presidential campaign, and he won again in 2012, despite having a lot of odds stacked against him. But his legislative or governing achievements are slim, with the exception of the Affordable Care Act, which seems to be slipping deeper and deeper into trouble.

Obama's instinct for addressing every governmental problem is to hit the campaign trail. He is doing it now to try to beat down the complaints about the problems with the launch of health care exchanges. After the tragic mass shooting in Connecticut a year ago, Obama pushed strengthening gun laws by, once again, hitting the campaign trail. A former neighborhood organizer, Obama seems to see every problem as a call for grassroots organizing and marshaling public opinion against or in favor of a particular issue.

I've said it before, that Obama should read Robert Caro's fourth volume of his Lyndon Johnson biography, "The Passage of Power." LBJ was the consummate legislator, able to wheel and deal on the Senate floor and willing to manipulate people and issues to achieve his legislative goals. Johnson had his repellent qualities, but he got things done. He got legislation passed — the 1964 Civil Rights Bill, the Voting Rights Act, the Fair Housing Act, Medicare, etc. — when more skilled campaigners (the adored John F. Kennedy) could not.

President Obama could take a lesson from LBJ, who was vice president when Obama was born, and concentrate on the 100 voters in the Senate and the 435 voters in the House instead of appealing to the millions of voters in 50 states to pass legislation.

Affordable Care Act needs some tinkering.

The rollout of the Affordable Care Act is a month old, and it's winning few friends while attracting a lot of critics. The logjams at the website for choosing an insurance plan, the cancellation of policies that fail to meet the ACA's requirements for minimal coverage, and the realization that the costs may be greater than expected all suggest that the ACA needs some tinkering under the hood to get it running smoothly.

Unfortunately, no one is talking about making adjustments. Republicans, especially those in the House of Representatives, who have voted dozens of times to repeal the ACA, are not in a mood for tinkering; they want nothing short of demolition. Democrats, at least most of them, insist that the law is fine just the way it is. They fear that giving in to demands for changes will open the floodgates that will allow the Republicans to sail through toward demolishing the act. President Obama has said he is willing to consider changes, but at the same time, he has denied that changes are needed.

Since the 1990s, I've thought that a national health care plan made sense. American health care is far more expensive than in any industrialized country in the world. Prices keep rising exponentially, and only the health care conglomerates, pharmaceutical companies and insurance companies seem to be happy with the system. The ACA sought to mollify the insurance companies by keeping private insurance as the payer in the system (instead of a single-payer system like Medicare) and to mollify the health care industry by not pushing too hard on pricing. On top of that, the act included provisions to attract voting blocs, particularly women, with free contraceptives (not even a co-pay) and mandatory maternity coverage. Little was done about efficiency and effectiveness.

I still think a national health care plan makes sense, but it's obvious the ACA needs revisions. Unless those revisions are made, the electorate could turn against the entire program, and health care would revert back to where it was, with the pharmaceutical, hospital and insurance giants ruling the country.