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Abraham Lincoln and Healthcare Reform

Abraham Lincoln is reported to have said in 1856 that “you can fool all the people some of the time, and some of the people all the time, but you cannot fool all the people all the time." 

Change “fool” to “please” and you have the essence of the current stalemate over the bill under consideration in Congress to replace the Affordable Care Act, known informally as ObamaCare. Congress is currently considering a Republican-crafted replacement bill dubbed the American Healthcare Act.

On one side of the divide are the congressional Republicans who have sworn for 7 years that upon assuming the majority in Congress and capturing the White House they would immediate dismantle the ACA and replace it with a more free market-oriented healthcare system.

On the other side are the Democrats, still smarting from 7 years of withering criticism of the failing ACA, which was passed and signed into law without any effort to engage Republicans on a bi-partisan healthcare solution. The Democrats are divided into establishment Dems and a more liberal bloc built around supporters of socialist Vermont Senator Bernie Sanders.

This bloc largely favors a European-style Democrat Socialist, single-payer healthcare system that would eliminate private insurance companies from the healthcare market making the government the only health insurer. Establishment Democrats see this as a losing political hand in the same way they saw Sen. Sanders as a losing candidate vs Hillary Clinton is the 2016 Democrat primary

Back on the Republican side. We have a further split. The Republican caucus is divided into the mainstream Republicans and more conservative Republicans. These conservatives are themselves split into one group calling itself The Freedom Caucus and the other, known as the Republican Study Committee. 

Back to Mr. Lincoln. The parliamentary maneuvering to either pass the bill into law or block its passage continues as the bill’s sponsors look for ways to entice recalcitrant Members to support the measure. This effort involves amending the legislation to make it more pleasing to the various factions. 

The issue is whether the Republican House leadership can please enough Members to cobble together the required votes to pass a bill that has been promised for 7 years. 

Earlier this week, the bill was amended to allow states the flexibility to impose work requirements on Medicaid recipients and to block-grant Federal Medicaid funding to the states, which would then decide the best way to spend the grant in each state. 

This more Federalist approach to Medicaid seem to have gotten Republican Study Group members seats on the American Healthcare Act train, but do not appear at this late hour to have been enough to get the Freedom Caucus on board. And liberals and some moderates do not favor allowing states set the administrative rules of the program.

We may be at a point where House leadership in order to please enough Members to pass the bill is facing the prospect of having to fool enough Members in order to get their votes. Also, changing the bill to please one faction may make it less likely that an opposing faction will sign on. 

Pleasing, fooling, it’s all the same in politics. Trying to fool or please all the people all the time is a zero sum game. Every vote you win may cost you a vote you lose from another faction.