So what
is in the pending healthcare bill?
Nobody really knows -- not even the people who are writing it -- except that it's bound to contain a bad mix of
bureaucracy and
horse trading.
Roughly seven and a half years ago,
Mike Pence--now
Vice President of the United States -- tweeted: "
It's simply wrong for legislation that'll affect 100% of the American people to be negotiated behind closed doors." There was a reason the
Democrats negotiated much of the substance of
Obamacare in closed-door meetings. It was because they didn't want
the public to see members of
Congress having their votes blatantly bought by largess for their districts and favors for their friends. Most famously,
Bernie Sanders' vote was cajoled by the addition of $10 billion for health clinics in
Vermont, a benefit not extended to, quite frankly, much needier states. The
Republicans simply put this on steroids for their own healthcare drafting process. This is in a sense similar to what happened with the judges. Democrats were miffed that Republicans were stonewalling Obama Cabinet nominees, so they changed the rules to eliminate the filibuster for them, allowing nominees to pass with 51 votes. Then the Republicans turned around and extended that to Supreme Court nominees as well. The same now goes for lawmaking -- the Republicans have simply taken the process the Democrats carried out, dispensed with the hearings (which are, often, simply a formality or public relations exercise, and contrary to appearances have far less influence on the final outcome of legislation than lobbyists acting in private) and kept the
entire process behind closed doors.
And what is it that's going on behind closed doors? In this instance, the Republicans have a preciously slim 52-vote
majority in the
Senate -- something of an odd position to be in. The "majority rules" atmosphere means that this slim margin gives the Republicans absolute control over what Congress does, but only insofar as they can bring their party together. If all of the Republicans can get behind something, then Democrats are literally powerless to do anything about it. But this means as well that every single Republican knows that they can gum up this bill by not voting for it, and those who have something to gain by forcing the buying of their vote will be glad to do so. And that means earmarks, pork projects, little extras stuffed in to the benefit of one especially big campaign donor or another. And this doesn't even mean spending necessarily. For the purists, we don't know what if anything it does about contentious social issues like
contraception and
vaccination, medical rights of gay couples, or religious objections to various medical procedures. For the less pure, there are myriad manipulations of legislation available. For example, if a Senator has a buddy who owns a hospital which happens to have, let's just throw out there, an extra-large storage room for urine samples. That Senator will then get put in the bill a requirement that some certain kind of funding can only go to hospitals with a storage room for urine samples of X size (which just happens to include his buddy's hospital, and exclude its competitors). Rationalization for arbitrary and meaningless measures like this can easily be dreamed up after the fact. And it is really this sort of favor-buying which makes bills like these a bureaucratic mess, more than any effort to legitimately improve access to markets or the like.
So what will be in this bill? It will undoubtedly clock a book's worth of pages into which such provisions are well hid. So we might not know for years down the road. By which time, things always being cyclical, the other party will have taken over again and reversed this with whatever their new, similarly bought program is.