I was asleep. Slumbering peacefully away, between sleep cycles, probably. And I heard a news alert beep on my phone. Rolled over, picked it up. And learned that the most recent Senate attempt to rescind and replace Obamacare had failed.

It was, of course, alwys an idiotic bill. They were calling it ‘skinny repeal’; repeal without ‘replace.’ Basically, it would get rid of the generally unpopular individual mandate part of the ACA, plus get rid of Planned Parenthood. The mandate is unpopular, but also essential; without it, it’s difficult to imagine the ACA surviving. The only way Mitch McConnell could sell this to his caucus was to promise that it would never become law. It would set up a conference with the House, where everything would get fixed. But could this be guaranteed?  At least some Senators suddenly remembered their junior high civics classes, and realized that if they passed this thing, and the House voted for it too, it would, with the President’s signature, become law. Yikes. Paul Ryan was asked for guarantees that that wouldn’t happen; he couldn’t offer any. And so the vote became very dramatic. 52 Republican Senators, 48 Democrats. But with two known Republican defectors, Senator Lisa Murkowski of Alaska and Susan Collins of Maine, it was really 50-50, with Mike Pence poised to exercise his one constitutional duty. It looked like it would pass; 51-50.

And then, riding in on his white horse, John McCain entered the chamber, said some things that made Chuck Schumer happy, said some other things that made John Cornyn less happy, shrugged off Pence’s last second lobbying, and voted against the bill. 49-51. It’s dead. Who knows how long it stays dead–Obamacare repeal and replace schemes have resembled political zombies; shambling and stupid, but hard to kill. But at least for now, McCain is our hero.

We have better heroes to thank for this. Murkowski and Collins have stood steadfastly against their party’s leadership for weeks, despite tremendous pressure. Murkowski was even threatened with a loss of federal funding for her state of Alaska. Of course, it was awesome to have McCain, diagnosed with brain cancer, make his dramatic return. But the real heroine of the night, to me, was another cancer patient, Hawaii senator Mazie Hirono. She has stage four kidney cancer, for which she’s undergoing treatment, but still, she flew in to vote on these measures. Having cancer tends to focus the mind, and Hirono decided she was going to do what she could to preserve health insurance for her constituents. It worked. Barely, but still.

It had been a crowded newsday anyway. President Trump’s new communications director, less than a week on the job, gave an unhinged interview with a New Yorker reporter, demanding to know the reporter’s source for a story he’d posted. In that interview, and later, on TV, Anthony Scaramucci came across as, like, the very caricature of a New Yorker tough guy. He has, I’ll admit, a creative way with the King’s English, and although his understanding of the legalities of news leaks is positively Trumpian in its ignorance, he did at least get his boss’s ideas across. He’s going to be an entertaining figure for the few weeks that he’s on the job.

In my opinion, though, yesterday also brought some small, almost overlooked news items that strike me as being of much greater consequence, Signs that, at least on the margins, Republicans are standing up to Trump.

Item: Congress just passed a bill that would have strengthened economic sanctions against Russia. The bill would also restrict the President’s ability to ease previous sanctions. Trump now has ten days to sign or veto. But it passed both the House and Senate with huge, veto-[roof margins. Also, how pro-Russia does Trump want to appear right now? And that’s where this gets interesting. Sanctions against Russia; fine. But if Putin owns Trump, this is exactly the kind of bill he wouldn’t want passed. Trump looks terrible if he vetoes, and Congress, at least for now, has the votes to override any veto anyway. We’ll see.

Item: Trump is clearly not enthralled with his Attorney-General, Jefferson Beauregard Sessions, and he’s been pressuring Sessions to resign. Specifically, he hates the fact that Sessions recused himself from dealing with the Russia scandal. Trump seems to regard Sessions recusal as, uh, disloyal. Apparently, Trump thinks the Attorney-General’s job includes shielding him, the President, from scandals. He doesn’t like being investigated, and thinks Sessions should head that off, and also, obviously, go after Hillary Clinton. Just for clarification, the Attorney-General of the United States is the nation’s chief law enforcement officer. He investigates crimes. He doesn’t work for the President, and no part of his job involves preventing the President from being investigated. Just to remind us of, you know, reality-land. Of course, Richard Nixon’s Attorney-General, John Mitchell, actually sat in meetings with Nixon’s campaign committee and helpfully discussed the various felonies they would all be committing. So that happened. But Mitchell went to prison for it, so maybe that’s not an historical example Trump wants to consult.

Item: In any event, Trump is clearly imagining a scenario in which he fires Sessions, get’s a more pliable AG confirmed, then gets the new guy to fire Robert Mueller, the special counsel currently investigating him. And he wants to do it quickly, before Mueller can get his hands on Trump’s tax returns. Except that last night, the Chair of the Senate Judiary Committee, Chuck Grassley, sent out a tweet saying that there was just no way his committee could schedule hearings for a new AG until, at the earliest, January. Just no time for it, doncha know.

Item: best of all, this. Lindsay Graham, (R-South Carolina) and Cory Booker (D-New Jersey) have co-sponsored a bill that would make it impossible for a President to fire a special counsel without judicial review. As I understand it, their bill would require a three-judge panel to review whatever cause a President tried to use to fire a special counsel. Of course, the bill still needs to pass the House and Senate, and then Trump could always veto it. But it also enjoys pretty broad support, at least initially. Wouldn’t that be something?

For political reasons, Republicans are reluctant to challenge this President openly. But more quietly, in the background? They have to know what a train wreck he is. And how damaging to the institutions of American democracy.

 

The Senate today held a vote on a procedural measure that would allow for debates and amendments on, well, something. No one is quite sure what measures will be debated and amended, This Vox explainer did a nice job of helping me understand what’s going on. The final vote was 50-50, with Vice-President Mike Pence performing his one constitutional duty by breaking the tie. There was also some high drama, as Senator John McCain, recently diagnosed with brain cancer, nonetheless showed up and voted. He then gave a powerful, stirring speech, in which he launched an all-out attack on the bill he had just voted for. “I will not vote for this bill,” he said in a powerful, if wavering voice. Uh, okay.

I’m hardly the first person to point this out, but Republicans currently control the House, the Senate, the White House, and likely hold a 5-4 advantage on most Supreme Court votes. And after voting to repeal Obamacare a jillion times when Obama was President, they can’t seem to pass a health care bill now. No Democrats will vote for a bill repealing the single most important legislative achievement of the Obama administration, though Democrats do have bills ready for a vote that would fix the problems the ACA undoubtedly has. But those bills will never be allowed on the floor for debate or votes. Republicans have made it clear that they have no interest in bi-partisan cooperation on health care. And they haven’t been able to get much done. Today’s vote in the Senate was procedural. Will it lead to a final bill? Probably not, but you never know. I certainly hope not; every bill out there, including the House bill that passed, the Senate bill that didn’t pass, and the various bills under current consideration, all of them are terrible bills. If the goal is to expand the numbers of Americans with adequate access to affordable health care, these bills all fail. In fact, they fail pretty spectacularly. They reduce the numbers of healthy people buying insurance through the ACA exchanges. They cut Medicaid. They will take health insurance from 20 to 25 to 35 million Americans. Which means, in all likelihood, that people will die.

As a loyal Democrat, it’s tempting to conclude that these bad bills exist because Republicans are bad people. These bills are variously described as ‘mean-spirited,’ ‘cruel,’ vicious’ and ‘lethal.’ The implication is that Republicans are uniquely indifferent to basic human suffering. Republicans want to cut taxes for rich people. (They always want to cut taxes, and rich people pay higher taxes than poor people). And in these debates, they always look terrible, like a party of nasty, uncaring Scrooges, out to hurt, or even kill poor people. Of course, they try to defend their various bills, insisting that CBO scores are wrong, that poor people won’t lose their insurance, that what they’re doing is allowing states more flexibility and providing people with more freedom. It never works. They look terrible in every instance. These are historically unpopular bills.

I don’t think, though, that Republicans are meaner than Democrats. I think that’s a dangerously hubristic way of looking at it. Preening about our moral superiority is a temptation most progressives have given into at least occasionally. But it isn’t true. There are philosophical differences between the parties, and we’re never going to get anything done if we insist that those differences are also moral. I know lots of Republicans. Good folks. They’re just real bad at health care policy.

And the reason isn’t hard-heartedness or indifference to suffering. It’s conservatism. Republicans tend to be conservatives, and a lot of Republicans are deeply committed, ideologically conservative. In fact, I believe that Republicans are far more committed to ideological conservatism than most Democrats are to ideological progressivism, which I don’t think is even a thing. You will often hear Republicans, talking about some policy or another, say things like ‘that policy is incompatible with the basic principles of conservatism.’ I’ve never heard a Democrat say the equivalent. Never once.

If you know enough conservatives, and you listen long enough, you’ll hear them admit to this: they don’t think health care is a right. They think health insurance is a commodity, like any other commodity. If you can afford it, great. If you can’t, well, then live without it. If you get seriously sick, and don’t have insurance, there are any number of charitable organizations that can help out. (And in my experience, Republicans give generously to those charities). When we talk about universal health care, conservatives don’t believe it’s something government can or should provide. Big government, the federal government, is inefficient, corrupt and overly expensive. Putting government in charge of health care is likely to hurt a health care system that generally works pretty well. And Obamacare doesn’t just expand health care, it mandates that private citizens purchase policies (sin number one), and provides federal funding to subsidize such purchases (sin number two).

That’s a hard philosophy to argue for, though. It sounds terrible. It makes it sound like rich people should get better health care than poor people should. It makes it sound, in fact, like the lives of rich folks are more valuable than the lives of poor people. I think the conservative stance on health care is actually a principled one. But it’s based on bad theory, and on bad research.

The fact is that government-provided health care programs–specifically Medicare and Medicaid–are more efficient and effective and cost-effective than the care private insurers provide. Medicare is so efficient, in fact, that doctors don’t much like it. It doesn’t compensate them all that generously.

As to the philosophical point; is health care a right? Do all Americans have a right to affordable, effective health care? Should every American citizen have government provided-or-mandated health insurance? The answer to that question is ‘sure, probably.’ Health care is a right if sufficient numbers of citizens believe it to be a right. Besides, if we have a right to ‘life, liberty and the pursuit of happiness,’ that would seem to include a right to see a doctor without being bankrupted. The Framers wouldn’t have agreed, of course, because their health care sucked. The idea that going to a doctor was likely to make a sick person better is a reasonably recent one. But yes, health care is a right. How do I know that? Polling data says so. If 60% of Americans think health care is a right, then it’s a right.

Conservatism is on the wrong side of history on this question, which is hardly surprising, because conservatism is generally opposed to change. I mean, the most fundamental difference between liberalism and conservatism would seem to be ‘should things change, or should they not change.’ So, as change happens, conservatives tend, at least initially, to oppose it.

The other hallmark of conservatism is a commitment to free markets, a commitment which, of course, I share. I don’t want the government to regulate the prices of cell phones, or DVRs. I want the market to do that. But providing some commodities and services is generally beyond the capacities of markets. Roads should be built by the government, as should electric grids and sewage systems. And health care fits in that category. Health care is a service that is uniquely unresponsive to market ideology.

That’s why one consistent conservative answer to health care includes the expansion of health savings accounts. They’re not that terrible an idea. They’re also no panacea. You’d be able to put some of your money in a savings account, tax free, which you could then use to defray health care expenses. See, that way you would be incentivized to shop around, to ask several hospitals to quote you their best price for that MRI, for example.

Except very few people are ever going to do that. The relevant economic principle is ‘asymmetry of information.’ Doctors know more about our health than we do. If my doctor says ‘you need an MRI,’ I’m going to get one. Even if I ask for a second opinion, I’m not really reducing the asymmetry of relevant knowledge. i[‘m just seeing a second person who knows more about it than I do. That’s why insurance companies pay a lot of money to medical experts who determine if a proposed course of treatment is likely enough to work for it to be covered. And so does Medicare.

Does this reduce freedom? Yeah, some. We’re put our family’s health in the hands of these people, these doctor folks. It’s frustrating, and yes, we should (and do) inform ourselves, and research, and talk to people, and do whatever we can to take control of our own health. I agree with every effort to inform ourselves. But when the doc says ‘get an MRI,’ I’m getting one.

So what we’re currently seeing is conservatives trying to provide universal health care when they don’t believe in any part of it. Of course they look bad. Of course the results are bad. Barack Obama tried the most conservative, most market-oriented approach to increasing access to health care he could possible manage. The result is the ACA, and it’s not great. And all of its problems, all of them, stem from the fact that it’s a conservative, market-oriented approach to health care. We can and must do better. All Americans have a right to affordable health care. Time for us to do better.

 

Following the various ins and outs of the multiple scandals and misstatements and gross ineptitudes of the Trump administration is just exhausting. Every day there’s something new; if only a new Trump tweet. The President apparently spends his days watching cable news, and fuming. Every once in awhile, he vents. Most recently, he vented to the New York Times, where, among other absurdities, he claimed “I’ve given the farmers back their farms. I’ve given the builders back their land to build houses and to build other things.” None of which is remotely true, in any sense whatsoever.

Of course, the Russia scandal must seem like Chinese water torture to Trump, who is not known for his patience anyway. Drip, drip, drip; every day, new revelations. Right now the press is primarily focusing on the various, previously undisclosed meetings members of the Trump campaign and administration held with various Russian entities. The national media is good at that kind of story; who met with whom, for how long, when. For the most part, these meetings merely suggest possible collusion, but don’t prove that collusion took place. The meeting between Donald Trump Jr., Paul Manafort and Jared Kushner with a raftful of variously skeevy Russian figures comes closest to proving some kind of actual inappropriate or illegal interaction between Trump staff and Russians. Of course, we don’t know what they all talked about. Oh, yeah, adoption. That’s suspicious enough. Did the Trumpskies promise to consider reversing the Magnitsky act in exchange for dirt on Hillary? Hello, collusion.

But the ‘meetings with Russians’ angle, though certainly fascinating, has always seemed to me something of a sideshow. The real action, I think, is likely to be financial. The relevant questions, it seems to me, would include some version of these: how many deals did the Trump organization conclude with Russian oligarchs? How much Russian funding did the Trump organization receive? Did any of these transactions involve money laundering? Were there violations, by the Trump organization, of the Corrupt Foreign Practices Act? And finally this: does Vladimir Putin own Donald Trump?

Those kinds of questions are difficult for the national media, in large measure because very few such transactions are in the public record. To dig into those kinds of details requires someone with subpoena powers, and expertise in forensic accounting. These are the kinds of questions that Robert Mueller’s investigation is supremely well equipped to answer.  Mueller’s staff has precisely that kind of expertise. And Mueller himself has subpoena powers. It’s just impossible for me to imagine Mueller not asking for Trump’s tax returns.

And if he does, all hell could break loose.

Donald Trump is a fighter. Does anyone think he’ll just mildly turn over personal financial records? No. He may claim executive privilege. (A first step, and one he will lose). He could pressure the Justice department to fire Mueller. He could fire Jeff Sessions. He could pardon his family members. And he could pardon himself.

Does he have the authority to pardon himself? No one knows. It’s never been adjudicated. Probably not, but that doesn’t mean he won’t try.

And so, as has been the case since last November, the real question is this: if this President acts so egregiously, so nakedly in his own self-interest, if he behaves so far outside American political norms, what will Congress do? Will the Republican-controlled Congress act? Put another way, can we rely on the patriotism and integrity of Paul Ryan, Mitch McConnell and the rest of the Republican caucuses in the House and Senate?

And the answer to that is also pretty clear. No. We can’t. They won’t act. Trump can abuse the pardon power of his office, and they will let him do it. A constitutional crisis only exists if the political will exists to force the issue. I see no sign of either integrity or patriotism among the current Republican leadership. Man, that’s scary.