There is something wrong with this picture - all white men discussing health care with the Veep.
EDITOR'S NOTE: I've argued that one can't negotiate with a bully and a thug. I used the example of FDR and Churchill negotiating with Stalin at Yalta. Aside from his "love" for all things Russian - The Donald reminds one of a petty dictator.
So far he's been held back by the courts, the failure of Trumpcare 1.0 and now public opinion which is at an all time low for a new president - in the mid 30% range.
But the Ds can't sit idly by and just let health care implode. Just today Trump hinted at another run - Trumpcare 2.0 - which will be worse than Trumpcare 1.0.
You can argue he's delusional, which he is and that he narcissistic, which he is and that's yes he's a bully, a liar, a thug, which he is and that he suffers from Attention Deficit Disorder and other mental health issues (which his constant tweeting illustrate).
But until he's impeached Trump is the "illegitimate POTUS" who occupies the Oval Office minus his spouse. So the Ds need a plan.
I laid out some of my own ideas on my March 24th FB post last week - go to Russ to see it.
But here is an idea by a certifiable smart political operative who plied his trade in Pennslvania for over 20 years and has chops on how you make health care sausage. Even Biil Clinton noted his work. It's good reading.
The Art of the Deal for the Deal Dude-in-chief:
By PA Slick:
Today, I saw both Sen. Schumer and Sen. Sanders suggest they were willing to talk and negotiate with POTUS over health care reform. Despite the vehement objections that it will bring from the D left, I think Schumer should try.
First, it’s the right thing to do. And 2nd, I still think the D’s can play a winning “divide and conquer” strategy.
POTUS promised lower drug prices—that’s a simple offer to make—let Medicare negotiate directly with the drug companies. Sell it to him saying he can be seen again as a real “negotiator in chief”—the art of the deal. It’s HIS team that will negotiate; sell it to him that way. That’s “free market” competition at it’s finest. And it is EXACTLY what the POTUS said he would do while on the campaign trail—many times!
The drug companies will HATE it, but the vast majority of D’s will vote for it despite the pharmaceutical industry’s powerful opposition, and I think there are now enough “moderate” R’s (you only need 20-25 in the House; and 4-5 in the Senate) to give Trump a true “win” on one of his promises.
Offer up “insurance competition across state lines (something both POTUS and virtually all R’s support, in exchange for them giving something on a public option. The public option will bring more competition, especially to the geographic areas that are down to only 1 insurance company. Trump has NEVER been against this on principle. He said, more than once, that he was going to give EVERY American health care.
You could throw in some form of a “high risk pool” (something Mitch really likes) and end up with a public option for anyone 50 or 55 and older; and the risk pool concept for those under that age. R’s who have supported the risk pool concept quietly acknowledge that it only works if the government subsidizes it. So you could even offer SOME form of reducing various of the Obamacare taxes in exchange. One bite of the apple at a time!
Why not just insist on Medicare for all?? Because there simply aren’t the votes in either the House or the Senate; notwithstanding Bernie and Liz and Al. Schumer knows this.
Work quietly with the Republican Governor’s who expanded Medicaid and who were vehemently against the Medicaid cost shift to the states in the Ryan bill. The moderate R’s in both the House and Senate will support you on that. Schumer could easily use one of the R House or Senate “moderates” as the go between. I can name several who would take that opportunity.
And despite hard core conservative opposition; it’s one provision that you can factually demonstrate actually reduces health care costs; by providing low income American’s health care at the primary care level that significantly reduces the use of the emergency room as the PCP, and the hospitals will strongly support because it has reduced their uncompensated care debt, big-time!!! That’s exactly what the R Governor’s were arguing.
DON’T offer health care savings accounts up front. In fact, your start point should be “the one thing we can’t sell in the D caucuses is health savings accounts.” Make the R’s think that THIS is the make or break issue. It will make them want it, even more!!
I learned early in my political career to listen carefully to what the opposition REALLY needs; and then make thoughtful policy decisions about what principle it is that would truly prevent you from wanting to offer it up. In virtually any political negotiation; each side needs SOMETHING that they are fighting FOR, simply because they think YOU are against it.
Decades ago, I played a key part in creating a new, state, health care agency. With all the truly difficult policy and political considerations; I knew EARLY that the one thing the major political opponents, the Chamber, the Insurance industry, and the Hospital Association were HUNG UP ON was the name of the organization. They were vehemently against a “Commission”. Because to them, it represented “government regulation” at the highest level. In their minds, “commission” was interchangeable with “government regulation”.
Honestly, the game hasn't changed in 30 plus years.
So, in each one of the first 6 drafts I produced for the Majority Leader, and for behind the scenes negotiations with both the House Republican staff and the interest groups; I titled the organization as a COMMISSION!! In fact, in the last draft I had my executive secretary type up, I told her to type COMMISSION in cap letters!! lol
And for the 18 months it took to negotiate the bill; the opposition was convinced that my boss and I thought the word “Commission” was the one thing that we would die over. And so did (with one truly brilliant exception) all the people who I was negotiating with. They became obsessed on focusing on THAT. Because, they became obsessed with defeating ME!! EGO and personality counts in politics 101. **winks**
Meanwhile, all the truly important issues, the ones that truly made policy distinctions for us, I was winning concessions on.
In those 18 months, the bill went through at least 50 drafts. And in EACH of those drafts, the Agency remained a COMMISSION.
At the final hours of the budget negotiations in 1986, I got a phone call directly from THE key leader of all the interest groups that were opposing the legislation; and he requested that I come to his office for a ‘one on one’ meeting.
I’d been a staff member in the PA House for more than 12 years at that point; and the key staff member on 3 or 4 major pieces of major legislation that were critical politically to this political interest group. I’d been involved in many small group meetings with him. But this was the first time I’d ever been asked to a one on one meeting with him. And, my title at the time was only “Acting Chief of Staff.”
That was the meeting that turned my opinion of him from “political enemy” to “a true politician and gentleman”; he treated me as if I WAS the Majority Leader—with total respect and honesty. He was as straightforward and brutally honest as I’d ever heard ANYONE in that position of political leadership be. He laid out, in clear, simple and honest terms what his POLITICAL problems were, and what he needed; and at the end of the meeting, he asked me to consider HIS needs, and let him know if I could do anything about them, to help him get his people from “no” to “yes”.
I told him I was more than willing to do that; and I asked him if he was willing to produce a list of “amendments” that he needed. I truly believed, when I asked the question, that it would take him a couple days to work with his staff and produce the legislative language he needed.
Without hesitation, he pulled a one page sheet of paper from his desk and said, “I took the liberty of already doing that”, and handed it to me.
For a moment, I was taken aback; as I thought he was going to say—”Let’s negotiate these right now”, and he knew I wasn’t in a position to do that. I thought I’d been out maneuvered, because he was about to place me in a position of it being ME (and by implication, my boss) that killed the legislation.
But before I could even look at his language, he continued: “I know you’ll need time to review these, and talk with your supporters and your boss, so please look at these in the context of what we’ve talked about today, and then give me a call and let me know ‘which, if any’ you could accept.”
Political smarts! Political class...equal to any I’d ever seen from the Majority Leader!!
As I walked back to my office I read his proposals. There were 23 specific “amendments” that he “needed”. Virtually ALL of them fell into the legislative category of “technical”: change “this” on p.3, line 32, to “that”. Change “and” on page 5, line 14, to “and, or”... And when I got to the last one, I broke out in laughter: 23-- Change “Commission” on page 1, line 4 (and in every other place it appears in the bill, to “Council”.
And #23 was typed completely IN CAPITOL LETTERS!!
As soon as I got into the office, I called the President of the AFL-CIO and told him—we’ve got a deal.
If I recall correctly, we ended up being able to agree with 18 or 19 of the 23. And, as I called him back the next morning, I kept his words “call and let me know ‘which, if any’ you could accept.”, in the forefront of my mind. I already knew what that “flexibility” in his words meant! I ended the conversation by saying: “And, this one hurts bad, but I convinced the Majority Leader that we can call it a Council.
It was 10 years later, when this interest group leader was supporting me for Executive Director of the agency, that I learned he was pretty sure all along that commission/council was nothing more than a negotiating position with me; and that he’d actually waited until the end to talk to me because he was actually testing his 2nd in command to see if he would figure that out; and to see what kind of negotiating skills he really had.
It was already known that he was very close to announcing his retirement, and it was his 2nd in command who was widely believed to be his replacement. It was only then that he quietly told me that it was his #2’s inability to “get it”, that stopped him from “handing the crown” to him. Instead, several months later, he anointed another to be his successor, and It devastated the #2. The #2 left the organization several months later.
Legislative Reference Bureau drafted the amendments; the following night a House/Senate conference committee meeting was called; and the amendments were adopted on a 5-1 vote. The bill passed both House and Senate the following day—unanimously in the House, and on a 48-1 vote in the Senate. (The one vote against is a political story, in and of itself!)
Within an hour of passage, the interest group had it’s own press release on the front page of it’s weekly publication: “We gain 19 critical changes in legislation; Bill passes.” Others of the interest groups followed suite quickly.
Can any of you guess which ONE, and only ONE, specific ‘critical change’ they specifically talked about?? **winks**
To me, that’s the Art of the Political Deal!!
If Schumer wants to substitute insurance across state lines in place of health savings accounts, no problem.
The actual facts on the two issues are these:
1. For the millions of people who’s deductibles have gone through the roof, now averaging $5000, health savings accounts aren’t an option. If you don’t have the ability to save $5000 a year to cover the deductible; you can’t save anything close to that in a H.S.A. It might help a couple hundred millionaires save some money on premiums, but it won’t do anything for the millions who barely survive, paycheck to paycheck. But, that’s EXACTLY the political point. It’s an easy political give. Because it doesn’t HURT any of them either. And it’s a “Big DEAL” to the R’s.
2. Competition across state lines is a “free market” myth for several reasons. First, insurance is regulated by EACH of the 50 states. And depending on which state the company is charted in, they would still have to offer products that meet the individual state minimum mandates and any rate pricing regulations the state has. So what it will do in reality is start a “race to the bottom” by allowing companies to relocate, allowing them to look at the most profitable areas with the healthiest risk profiles, and the absolute LEAST state regulations.
Anyone remember all the big banks scrambling to relocate corporate headquarters to Delaware, and then South Dakota, when we “de-regulated” them??? Exactly what will happen with insurance companies.
Second, insurance company profits/losses are significantly dependent on what payment contracts they can negotiate between themselves and hospitals and doctors. There are less than a handful of insurance companies who are large enough and with financial resources enough to even want to CONSIDER going outside of their current geographical area of operation; especially the Blue companies.
Third, in the long term, it will actually REDUCE insurance company competition and options, as it would allow the few largest insurers to price policies that can entice “healthy enrollees” OUT of the current/existing risk pools of the insurers, leaving those smaller insurers with consumers who are much sicker. It will force more insurers to merge, or go out of business; without creating any truly NEW competition.
So, trade that for some sort of public option...which moves us 1 step closer to a single payor system.
Finally, if I were Schumer today, I’d go secretly and directly to Trump and try and convince him that infrastructure, and not tax reform, should be the next item on the agenda. Why?
Because infrastructure is far easier for the D’s to unite around than tax reform. And here, I’m applying the #1 rule in politics: “Everything is related to everything else.”, when it comes to negotiations.
There are so many things in an infrastructure bill that both the D’s, and Trump, could add or give up on. By quietly offering the opportunity to Trump to bring in an infrastructure bill as part of the overall deal, POTUS becomes a hero. I can’t think of a deal I was able to close in all my years that didn’t, in the end, include passing legislation (many times, a significant # of bills), absolutely “unrelated” to the theoretical policy issue in the forefront of the negotiation. Not one.
That’s how one gains votes—give your members something they want/need, in THEIR district. Not threating your members you’ll campaign against them in the next primary election.
Tax reform has far, far, fewer options for Schumer and the D’s to trade on.
One further point that I know. It’s actually far EASIER to negotiate with a bully and a thug (and sometimes even a liar), than with political ideologues and demagogues. If you understand the personal characteristics of the person (people) you’re negotiating with; you can use those very characteristics to your advantage!! I’ve done it, many times!!
POTUS could use this exact strategy as easily as Schumer. Rather than letting Obamacare collapse on it’s own (which, in 2018 will be put on POTUS and the R’s); he could end up looking to his supporters like the most brilliant President we’ve ever had: getting 2 BIG wins that he promised. And putting him in a STRONG position to negotiate tax reform.
Now, THAT, is the art of the deal!! That won’t happen because neither Priebus nor Bannon have any “political sense”.