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Virgil: How Republicans Can Stop Losing and Start Winning on Healthcare Reform

First of a Series…

In military history, the quote “Get there firstest with the mostest”—that is, strike first, and strike hard—is often attributed to the Confederate general Nathan Bedford Forrest. Forrest apparently never said it, but for sure, he practiced it. In the Civil War, he was the leader most skilled at combining mass and maneuver.

A century later, another Tennessean, Howard Baker, made much the same point, although admittedly in a vastly different context.  Whereas Forrest was a warrior’s warrior, Baker was a politician’s politician.

Baker was the leader of the Republicans in the Senate from 1976 to 1984, and he, too, had his share of victories. Most notably, in 1981, Baker guided President Ronald Reagan’s big tax cut through the Senate; indeed, later in the 80s, he served as Reagan’s White House chief of staff.

Baker liked to say that he learned the secret of politics in the first grade: “I learned how to count.”  That is, you have to know your own strength and, of course, the strength of your opponent.  Then, when and where you have the advantage, you make your move.  As has also been said of strategy, both martial and political, the goal is to “Hit ‘em where they ain’t.”  That is, where they’re weakest.

Baker’s point about counting might seem painfully simple, but it’s actually not so simple; its basic truth has eluded many in politics.  After all, if there’s a “fog of war,” there’s also a “fog of life.”  When events are swirling, it’s hard to keep track of one’s friends, let alone one’s foes.

To illustrate, once again, the supreme importance of correctly counting votes, we can cite the two latest attempts to repeal-and-replace Obamacare—that is, the push that failed on March 24, and the push that failed (at least for the moment) on April 27.  In each instance, Republicans had high hopes as they pushed different versions of the American Health Care Act (AHCA); for clarity, we can call them AHCA 1.0 and AHCA 2.0.

The politics of health care have long been challenging to both parties.  Yes, the Republicans won big in the 2010 and 2014 midterm elections on an anti-Obamacare message.  Yet at the same time, Barack Obama and the Democrats won big in 2008 on a pro-national-health-insurance platform, and in 2012, Obama won big a second time, defending, of course, his 2010 enactment of Obamacare.

Yes, it’s true that after the 2016 elections, Republicans could claim they had a national mandate to repeal Obama’s signature program.  And yet at the same time, Democrats could just as rightly claim that they still had their mandate to protect Obamacare. Just about every Democrat with a seat in Congress today has campaigned as a strong champion of national health insurance.

Meanwhile, the voters, bless ‘em, have given Republicans their majorities, but not overwhelming majorities, of the sort that would let the GOP go buck wild.  Thus we have a case, one could say, of dueling mandates, relatively closely matched.

To further illustrate this dueling-mandate reality, we can recall that in last year’s presidential election, Donald Trump won with 46 percent of the popular vote (although, of course, he earned a clear majority in the electoral college).  In the meantime, on that same day, Senate Minority Leader Chuck Schumer won re-election in New York with 70 percent of the vote, and House Minority Leader Nancy Pelosi won re-election in her California district with 81 percent.  So we can see: These Democrats, among many others, feel zero imperative to bow down to the White House.

Moreover, Republicans in Congress—including those opposed to one or both of the AHCAs—can make the same argument: They, too, have a mandate.  One such is Rep. Leonard Lance of New Jersey, who was re-elected last year with 54 percent; that is, he ran more than 13 points ahead of Trump’s Garden State showing.  In the middle of the latest AHCA debate, the independent-minded Lance declared:

I ran in support of a plan that lowers premiums, increases access and lowers health care costs across the board.  Until I see a Congressional Budget Office score that says the revised bill achieves those goals, I remain a “no” vote.

To be sure, the victories of Schumer, Pelosi, and Lance weren’t national, as was Trump’s triumph.  And yet under our constitutional system, the Executive and Legislative branches are equal.

Indeed, if anything, the Legislative branch is ultimately more powerful—if and when it chooses to exert its power, as it has with AHCA 1.0 and 2.0.

We can further note: Per the Constitution, the Chief Executive actually has little institutional leverage over Congress; there’s a reason that legislators are also known as “lawmakers.”  As the wise say in DC, The President proposes, and the Congress disposes.

Of course, in the real world, any president possesses enormous power.  And yet as the famed political scientist Richard Neustadt put it, The power of the presidency is the power to persuade;  that is, the President can use the “bully pulpit” to set the agenda and advance his program. The phrase “bully pulpit,” of course, comes from our 26th president, Theodore Roosevelt; he knew how to get his way.  Still, the words have no basis in the Constitution, and it’s up to each president to find, if he can, his leadership voice.

Thus we can see today: If President Trump wishes to wield power, he must wield words—words of persuasion.  And so in the past few months, Virgil has been struck by the fact that Trump has chosen not to give a big speech, or speeches—from the White House, or from podiums across the country—on behalf of AHCA.  To be sure, the 45th president has said plenty and tweeted plenty, but those actions haven’t had the same impact as would a nationally televised address to the nation, in which the Commander-in-Chief laid out his case to the nation.

In the meantime, in the absence of such rhetorical “air cover,” support for AHCA fell.  It will be remembered that AHCA 1.0 suffered from a severe popularity deficit; according to a Quinnipiac poll released on March 23, the day before 1.0 was pulled, public approval for the bill stood at just 17 percent, while 56 percent disapproved.  Lopsided numbers such as that never fail to get the attention of re-election-minded Members.

For its part, AHCA 2.0 didn’t seem to be popular, either.  The latest version came and went so quickly that specific polling didn’t have time to catch up, but according to one compendium of polls, overall approval/disapproval of administration healthcare policies stands at a dismal 36:53.

Moreover, the biggest healthcare constituency organizations, including AARP,  the American Medical Association, the American Hospital Association, the American Nurses Association, and a great many patient-advocacy groups, were all  lining up against AHCA 2.0, just as they had opposed 1.0.  The weight of that opposition, we can be sure, would likely have further depressed the polling numbers.

In addition, one particular headline, from The Los Angeles Times, was not encouraging: “GOP shuts out doctors, experts, Democrats—pretty much everybody—as they work on Obamacare repeal.”  Some might ask: Was this downer of a headline an example of media bias?  Maybe even “fake news?”  To start answering such questions, the best thing to do is read the article, including this quote from Sister Carol Keehan, president of the Catholic Health Association, which represents hospitals and health systems:

To think you are going to revamp the entire American healthcare system without involving any of the people who actually deliver healthcare is insanity.

Unless Keehan was misquoted, it would seem that she, at least, agrees with the headline.  We can readily observe: It’s hard to enact a bill in the face of such opposition.  And we can further observe: If Republicans wish to win an Obamacare fight in 2017 or  beyond, they will have to work to bring at least some of these groups around, at least to a point of neutrality.  It’s called “politics.”

For more political perspective, we can turn to The Washington Examiner’s Byron York.  In York’s telling, the bottom line of AHCA can be stated simply: Absent any cooperation from the Democrats, the House Republican leadership doesn’t have the votes even within the GOP Conference to move forward.  Once again, we see the importance of counting votes.  In his wrap-up on Thursday night, York went through the numbers, and closed with a hard-to-answer question:

There are a lot of Republicans, say 40 to 50, who don’t want to repeal Obamacare.  Given unanimous Democratic opposition, that means that there are somewhere around 190, or maybe 195, House members who actually want to repeal Obamacare.  That will never get the job done.  . . .  And if that is the case, the question is, why are Republicans trying? [emphasis added]

Still, even in the wake of this second failure, some Republicans will bravely insist that AHCA is still alive.  That is, House Republicans will spring it again, however further modified, when they can get the votes.  And yes, someday—maybe even tomorrow—they might be able to eke out a majority in their chamber.  Or maybe not.

Still, even if a health bill ever does clear the House, its prospects in the Senate—where Republicans have a much narrower margin—will be dim.  As Senator Lindsey Graham has said of AHCA 2.0:

I don’t know if this bill is better . . . the worst thing we can do is replace it with a Republican-only alternative that doesn’t drive down costs, that doesn’t improve access to care.  A Republican-only bill to replace a Democratic-only bill is not what I hope for.  I hope for a bipartisan bill.

We can conclude: Any bipartisan bill that succeeds in the Senate (or the House) would not be a repeal at all; it would be, at best, “mild reform.”  To be sure, some conservative activists deride Graham as a RINO.  However, that label—or any label—doesn’t change the fact that Graham is a U.S. Senator, with, yes, his own mandate from the voters of the Palmetto State.

In the meantime, back in the House, the Loyal Opposition is on the hunt.  Here’s an April 26 headline in a Capitol Hill publication that undoubtedly got the attention of any Republican in a swing district: “Democrats Make Campaign Issue out of GOP Health Care Proposal: As soon as House Republicans started talking about another vote on a revised health care plan, Democrats began sharpening their knives.”  The article detailed the efforts of the Democratic Congressional Campaign Committee, plus allied groups, to weaponize Obamacare as a way of winning back the House for the Dems in 2018.

Are the Democrats kidding themselves if they think that Obamacare has gone from being a losing issue to a winning issue?  We’ll know the definitive answer to that question in a year-and-a-half.  But in the meantime, it’s obvious that many Congressional Republicans believe that on health care, they’re now on the defensive.  Moreover, the RealClearPolitics rolling average for the generic Congressional ballot shows Democrats with a 5.4 percent edge over the GOP.

Of course, the status quo of April 2017 doesn’t have to define the electoral lay of the land in November 2018.  There’s plenty of time for Republicans to improve their political prospects.  However, such positive change will likely have to come from within the GOP.  And that means, to cite one urgent f’rinstance, a renewed commitment to pro-growth policies, as a way of counteracting the slowdown of the economy.

In other words, Republicans will have to start doing things differently: They’ll have to think of ways to get back on the offensive—hitting the Democrats firstest with the mostest.

Without a doubt, such change will be an adjustment, and perhaps at times it will even be a difficult adjustment.  But then, of course, losing the Republican House majority—and even, remotely but still conceivably, the GOP Senate majority—would be vastly more difficult.  Indeed, such losses would be downright painful.

In the coming installments, Virgil will look at some policy successes of the past, and how they were achieved, with an eye toward outlining potential successes in the future.

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