« The Weeds

High-Risk Podcasting

2017-05-03

Sarah, Ezra, and Matt talk about Congress's big spending deal, Republicans' newest Obamacare repeal idea, and research on what happens when abortion providers shut down. 

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
This absurd of the weeds sponsored by the great courses plus sign up today at the great courses plus dot com, slash weeds, just a sponsor by helix sleep, gotta helix sleep. Accomplish weeds and get fifty dollars off your order and by wink we is offering our listeners twenty hours off. You first order when you got it I winked out com, slash weeds. I have no idea what a high risk police I've been confused by this whole discussion attire here. Yes, Although what comes another episode of the weeds, the policy podcast on the box media podcast network, I Matthew Acclaim Yes, I by my colleagues here I fear the studio and also by as recline from San Francisco. How is it at their it's beautiful? it doesn't just like smell, like p everywhere on the streets. That's usually my experience there. Now it smells like technology like bites flowing through the air
I really have you had some new technologies, I have not I've heard a lot of Jew juice jokes out here, the sounds very a mixture of people think it's actually funny and also feel somewhat wounded. the coverage of it here in the nations capital. Of course, where were far too busy for four juice, and people have been talking this week about the big deal on government spending that was reached a weekly, This is the sort of prison annual appropriations process, the government, down, unless Congress affirmatively votes to continue spending money, this year because of a number of continuing resolutions. We have only a five month year that is going to end in September. but as a continuing resolution, man in a continuing resolution Congress just says: ok, we're gonna keep spending, but we had said before firm another Why so during the lame duck, they did. One that brought us to March
when negotiations need a little bit more time, they did a one week cr so that there's no government shut down. But what, where's of Congress really really love to do is not pass continuing resolutions, but instead pass a real all appropriations Bell, because that lets the different members of the appropriations Committee mess around with things right and optimum so that programmes that they like get more money programmes that they don't like getting money. It's also in it in a weird way like super inside the beltway people just consider it like better you here alive, scolded like Congress, has done its work on time and stuff, even though I think from the normal persons viewpoint, and nobody really cares If there are there see hours or or of their real appropriations a bit. This case. The military had been getting pretty hot and bothered about the.
language, not bothered military yeah. What this was an important factor in this, so that the military brass had been saying for a while now that they are annoyed by this sort of. Uncertainty, that's inherent to the continuing resolution process and that it was difficult for them to eat, of bike plan for their various wars and things, and actually, Oh managers in all government agencies feel this way. But almost nobody in american politics cares about what Seville Civil servants think about things that certainly nobody in the Republican Party cares but generals and admirals have a lot of juice and capital hell, and so that motivated John Mccain and a bunch of other defence hawks to really sort of wanna, get this diet and through a regular order, us ass and then in turn sort of
started, shaping a series of events that gave Democrats a fair amount of practical political leverage in in this whole process. And so what you, wound up. Seeing this week was a deal. That was definitely a big win for the military they got out continuing resolution land, they got a hefty amount of extra defence money. They got released from some of the terms of the sequestered deal, but beyond that. It was like a huge defeat for the Trump Administration stated priorities they put out this budget document. They called for all kinds of huge cuts to this that, in the other, and basically none of that happened. They wanted money too. Build a wall that featured Heaven in the presidential campaign that didn't happen, I heard a lot of noise during the negotiations from back bench, liberals who were like you know leadership they're, going to stop the wall, but they're gonna sell us out on some other asp,
immigration enforcement, but that didn't happen either they, You know there's some extra border money in their, but but really not much had not. For anything that advocates are particularly concerned about Democratic got a bunch of extra money for scientific research. They got the Joe Biden, Cancer Moon, shot initiative funded and when parent I've got to keep its landline and who did not get defended, it would be wrong to kids This is like this is what liberals would do if they ran the government, but considering, you're talking about a democratic party that has not one. Many elections. Recently they scored a lot of sums. victories out of a relatively we sort of electoral base it and a pretty remarks,
One of the things that amazing to me about the sea are is just how it does not have a White House footprint on it in any meaningful way. Like the White House, it you said man, they put forward their priorities and Congress kind of like set. Those assign we're like we'll just sort this out and was handed over to you and I was listening to great interview with Carl Hall sues. The New York Times is, I believe there is their capital held Bureau Chiefs design the deal. this morning kind of talking about some of the best story here, and he said one thing that's, hi someone who's covering this is a Democrat publicans were saying really nice things about each other in the budget negotiation process. Would you don't hear a lot of right? Look, there's a lot of yelling about here in the replacement plan, but he was kind of surprise when give Democrats opportunity to trash the White House or trash Republicans. They just wouldn't take the bay and in other boarding he's been doing suggest that they very much
together on Capitol Hill and worked out and budget deal that they could both live with and in a just did not think that the White House priorities were important in any way like really brush them aside and like a quaint, quite he's in way when you actually look at what gets wondering. What I think is interesting about this budget deal. Is that it speaks to the path the Trump Administration And- and this Republican Party did not take so this budget deal such as it is, I think, is evidence that there was a world in which Democrats in Congress would have been happy to work with the White House with Republican later the passing of or not by any means a liberal, but are you know they get something Republicans get something you have been kind of goes home in and has some kind of a win that this budget is evidence that the opposition is not gonna, be lockstep. I instead easy on things like health care and, on the other, the other projects, whether husband
in pushing forward on a real effort to not negotiate with the Democrats from the beginning, and so there is no reason for Democrats to come on board and then they go into a full mode of opposition. But if I were the White House, I would be looking at this in saying: hey you know. Maybe this is not as intractable as well. thought. It was. Maybe this is actually a question of substantively giving them things we don't care. About. So we get things we do care about as opposed to what what I've heard for them before which has ended. They shouldn't even try negotiating with the Democrats, because, of course, Democrats aren't gonna work with them. Anyway, at any point dirt for any reason It was also, though, an example of something that that we talk about before the show, which is the way the presidential aloofness, can be useful right. Then you know
Washington, cliche is always that you know it was like. Why doesn't Barack Obama Lee it in and you know you could imagine versions of of that with Trump, but even though Trump put out that site budget plan and made these requests? Congress ignored them and the fact that Trump did not make a serious effort on his own budget was critical getting this done, because you could imagine another world in which Donald Trump tried to demonstrate leadership, and Donald Trump priorities and spoke very heavily and very frequently about what it was. He wanted to do here and that would have made it hard for Republicans to ignore him on key points, and it would make it hard for Democrats to give any kind of ground to him who, by creating this construct where it was like Trump really wants the wall, but then like Trump card, it ignores the whole process and then the negotiators just focus on like
hours and sense for these various things you were able to two gonna go, get it done right and if Donald Trump attract so much at all gin and the attention is so necessarily polarizing, then it's hard for him or any modern president too, like DR bipartisan compromise, whereas on Capitol Hill. There's just a lot of different stakeholders involved and is completely possible for politicians who have different philosophies and different priorities to sit together in a room and work out trades it and work at deals, and it's funny that Trump, you no kind of portrayed himself at various times is something Bastard deal, make or something like that. But hopefully the members of Congress are perfectly good at making deals with each other and they are better at it when there is less presidential engagement and one of trumps, great blessings for legislating, maybe that he doesn't seem to really care much about it and is at times willing to completely ignore stuff,
as every time he intervenes in things. It does not appear to be constructive in any way, now. So I want to mention the one thing that surprised me as a principle: tell me more about the deal they're coming to an end. It is the fact Secondly, we talked about on the last episode of the weeds Dillon. Dead, live from box conversations about these Obamacare payments. These cost sharing reductions, which I had gone into the budget negotiations? Thinking, Democrats, we're gonna go to the matter for like they're going to say you have to appropriate these that's a line in the sand and they didn't. They got assurances from the White House that they were unit would continue paying these. The Democrats backed off it essentially ends up where you ve been. ass you years, where there's a lawsuit challenging these, but the White House keeps paying them that out He seems to be having a negative ripple effect on Obamacare. It looks like I was on big market.
Ensure is talking about pulling out now that there is uncertainty around these funds. That way it would leave. Ninety four of I was ninety nine counties without any ensure on Obamacare, so be like the Tennessee patient on on steroids ends up I'm looking back and Emma loved Surprise Democratic really didn't make this their thing, and I think what was going on as they felt like they were saying. You know trumps knock and exploit the marketplace, he's not going to take them. Away, but the thing the administration has been doing is essentially waffling on it saying maybe we'll maybe we won't and that's making health insurance companies quite nervous, So it's eleven surprising to me when I look at- the sea are that that they are going to not funds as part of the health care lot actually seems quite damaging to the I am curious if you are democratically suffer who listens, has put us in his thoughts on this please.
Me I'm curious. Why democratic didn't make that a priority in in their negotiations for this. What one thing you seem to me to be a dynamic of these negotiations. Is both sides it's something we don't always do, which is simply say: okay, if you got a no go zone or does not going to go there, so Democrats Princeton's will really go to the mat to protect planned parenthood funding and there a lot of Republicans who that is really their key objective and in these negotiations, has been defending plant pound recently laughed outright. Republicans seem to have made a decision that, if I'm just gonna be a place for Democrats, would go to complete all out war. That is we're not gonna. Spark and it looked to me through the sea- ass, hard caution, reduction negotiations that that was so of the dynamic there to that. That was one of those things where democrats- we're not gonna get at this point to the Trump Administration Republicans in Congress. To do something positive for public
here in these in these negotiations and going to war over it was probably just knock and leave them with much uttered- allows a good decision or bad decision. But one reason that this seems so unusually smooth is it that we become used to in american politics in recent years. Both sides printed Republicans, but but but but sometimes Democrats to just deciding that, even though they knew something was a absolute non starter for negotiations, they were going to insist on it anyway. This is been at a constant thing with the house. Freedom caucus, but, but you see it all over and here it just had a very unusual dynamic where they did. What you do in negotiation, which is you just don't include those issues Yeah, I mean the other thing, though, is that I think that the Trump administrations very public efforts to try to say that it's going to you is the threat of sabotage as a tool to get democratic votes for some kind of,
health care legislation has southward congressional democrats on trying to do anything to save the affordable care act by their committed to fighting the works, your bill. But did they really want to maintain the construct that Donald Trump is the President of the United States and the Donald Trump should not of his own volition? liberally, do things that will engineer worse health care, how comes specifically for residents in rural areas and red states that they don't want to make that, like an ask right that, like Trump, has as far as they are concerned, the authority to make these payments, and they want him to make the payments they're happy to criticise him for waffling bout it and things like that, but they're not going to say that it sir, it's it's an ask of their or sits on a favour to them. For that
Administration to do its job of administering the Department of Health and human services correctly because it has already tried to put it out there as it as a negotiating stick and I think you're seeing I mean you're, seeing with what's happening, and I awhile with what's already happened in Tennessee that they are going to be bad consequences. Swear to the nexus of these straightens sort of may be kind deliberately liberals self sabotaging the marketplaces combined with the Democrats deciding that they are going to? U know let Trump hang Trump country, if that's what he wants to do is going to make pulls lives worse, but it's also hard for me to see. What's that other outcome? If Democrats can't be sort of begging Trump, too, as a favour to them, like do his do his job correctly or to put them in an untenable situation.
Our own constituency and with just there there need to take on a bargain with things on a consistent basis, and so you know I mean it's it's bad. I mean, I think, I think we ve seen a lot of the stories, but we haven't yet seen the kind of human consequence of these stories, but we're going to over the next year. But just one thing: that's, Weird about this. To me, as is something like House, There have been a republican democratic leaders agreed on the going into this he's all out of Republicans, and yet we should appropriate, this money to make sense of in a way it kind of like fit with a lot of the other. Things are going on in the budget negotiations. Where wasn't Republicans verses Democrats was Congress verses White House where the White House later, despite he's congresses out its priorities and Congress Piety seem too when here, but even though this was on the Congress priority side, it did not make it through in the negotiations, and when I think of this from the point of view of democratic legislator,
I think, when things are kind of banking on, is that this is like a tear boss, strategy by the gate, in former Obama restoration person describe it to me as essentially handing Trump a suicide vast and bedding that he's not going to detonate you know, he's busy, saying maybe I'll that name it. I won't. Who knows where people are obviously like standing back you're not gonna, stand super close to someone who sang we're not really sure yet, and it seems it goes, a Skeer move to give this up then I'd have initially thought. We ve got some more help. Your coming up summit to pull back from a health care talk fermented here, so I want to- talk about what I think is sort of an interesting emergent structure between the two parties in what they really in what their bottom lines are negotiations. I know I can say that this will always be true, but really it seems to me the basics, underlying structure of the deal here with It turned out. The wet Republicans really want in budget negotiations is more money for the military and what Democrats really want
in budget negotiations, is more money for, like the basket of things, you might call sites right, it's not all hard science, but but but it's there trump had wanted. I think it was like a thirty billion dollar increase in military funding and he got twelve point five with which can actually go up to fifteen if the military comes up with a plan to fight ISIS is a pretty big increase. If, if billion dollar increase and I'm. On the other hand, Democrats were really able to stop chums trumpets, gonna cut the National Institutes of health. In fact, the national its of health and updating a two billion dollar funding, increase, trumpets, gonna, slash the EPA, the Athena gets a one percent d recent funding, which it is a decrease, but is nothing compared to what the Chop administration was pushing. So just like this is an outsider, some things that were used to seeing argued about and in politics. I think Racine here a little bit of a bottom line on what the two parties emotionally feel most passionate about funding would
four publicans. They really do believe that Obama guided the military and in some powerful way in the military, needs more money. They ve not really yoke. This to a strategy for what to do without money, as far as I can tell, but they are giving the mid term or money and, on the other hand, Democrats really strongly that the science and research functions of the government, the an age, the EPA etc like vat is core. I think Brok Bomb, like he's a term seed corn like that, is the future and they they were able to hold to that in a pretty significant. Way- and I think this is gonna- be, I think, there's something here in this line being drawn. That is also useful, because Democrats, by the same token, do not really oppose military spending and Republicans do not really oppose, say the National Institutes of health. So this is one of us This is where, unlike in a lot of parts of politics, the two parties sort of bottom line Surgeons are not necessarily contradictory, they're, just different and that's a place. We can actually have positive some compromises,
it's worth, remembering how we, how we got here in the first place, though, which was that years and years and years ago, House Republicans decided that they were not going to raise the statutory dead seal Unless the Obama administration agreed to big spending, cuts, and then the Obama administration decided not to use any of the many many many tools at their disposal that would have brush this threat aside, but to instead embraced the threat as part of a really hare brained scheme, to get Republicans to agree to raise taxes, and then that didn't work and they wound up with this sequestered deal. in which you had big cuts to commissioner discrediting the missionary discretionary being kind ass. The two exactly two programmes are, you were talking about Azra right, so
Republicans had taken to saying that Obama guided the military, but it was actually Republicans who got the military as their price for raising the dead ceiling. And then the Obama White House had hold the line on the view that were publicans could only get their defence spending increases if they were match dollar for dollar with domestic money? So the big thing that were, against it. When in this deal was that the military spending increase was bigger than the domestic spending increase, which violated a conception will framework that Barack Obama and his staff we sort of single handedly keeping place. Because, about administration, for reasons that, frankly, baffle me fear that its whole series of technical and strategic choices that laid down the sequester pipeline made some kind of sense, and so what
The big things that Congress is doing here is just finally throwing all of that aside rate- Democrats are now saying that what they want is to spend money on things that they like and that they are now going to refuse to get that done as part of some like weird, gauge with other kinds of concerns? Republicans used to be insisting on big entitlement cuts, as the only way to avoid economic catastrophe are now saying they don't want to cut social security. Medicare either body back when the unemployment rate was high and the macro economic case for big budget deficits was really really solid. Every body of both parties claim to be really concerned about the deficit that now overruns is decided. They don't care, and that's part of it makes these deals much much easy ride if
everybody decides that they don't have any trade offs or things like that, then you can. You can make a deal right. Trump says I want money for a wall. Democrats are like known, or no, we really don't want to wall. So you just make a deal everything else back. When Obama was president, we had a lot of structures. There were a lot of people who had a you, know: big red lines, about deficits, about taxes, about parity between defence and on defence, and with Obama gone from the sea and and Republicans drawing overboard all of their alleged ideological principles it's much easier to get things done as this never been a more important time to keep learning to stain foreign by the world, and that's why I'm a big fan of the great courses plus and- and I want you to sign up for two- this is
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in the realm of observe cyber security and in the way that that he gives it hot I voice or see, MRS as little one side or another. He kind of puts the whole thing together, for you know in a really interesting way, I'm so if you sign up for the great courses plus as a listener, the weeds you get it for you month by using our. Special, you are out the great courses plus dot com, slash weeds, you get a free month, they think you're really going to like it and you're gonna keep paying the money so sign up today at the great courses plus dot com. Slash weeds: that's the great courses plus dot com, slash weeds to talk about some healthcare How do we never let healthcare in maritime? Sarah cannot, can I confess something to you: yeah destroy and are listeners I have seen the subject of high risk fools a lot in healthcare coverage, I've seen a lot on the tweets. I where that these smart, high minded correct thing that people who are like
we are supposed to say about it. Is that higher ports are no solution to the problem when existing conditions But I have no freaking idea what a high risk pool of hay. Well, that's that's! What I'm here for so. I really cause of kind of become the focus points of the republican debate over its own healthcare plan, which is moving very quickly. At this point, I mean we're recording this way. Say. Early afternoon we ve seen for adoption in the spam we're hours go from opposing the bill to supporting the bell. Republicans our act ensuring towards a possible vote in the house so end what alive if it is sending on, is more funding. That states could spend on high risk balls iris balls are in a blue, actually pretty simple. They are busy just covering really expensive patients through a government subsidized programme, and there is
could have nothing, I'm structurally problematic about that. You know: there's nothing inherent in a high risk, poor programme that would stop it from working the problem of high risk pools historically before the affordable care act and the thing that you know the people who it be that talking, white man would say that there is certainly very under funded that they often do not have enough money. These are incredibly sick people with very high medical bells and in order to pay them you, you know either after at the moment or put in some lifetime limits not advertise. The high risk was actually very popular strategy to control costs, and I risk was the concern is that you know people would be, they would have a place to go, but there be treated quite different, and not everyone would get in, and I think that is the reason why you hear about the negative reaction and the fact that it doesn't seem like the American Healthcare ACT, Republicans plan as written
the funds, the Irish paused level. They would need to be funded to work. There are estimates from the blending centre on american progress in the right, leaning American Enterprise Institute. That both agree, actually that there is not enough Funding in this bell to be no satisfactorily set up these rules that shortly before Fred Upton, agree that this amount of money was good enough to make him comfortable with the bill. He checked with the experts of the congressional budget office to see what what's what the math is right now, of course, this is one of them: atheling things as we like occurred old hordes of vote and the American Healthcare ACT, as there is still no congressional budget the score on this We have no idea how they would work on the sea, be, oh, you know, has scored something similar to the bill that they're looking at passing. Right now and one of the noble things about this, one of the reason they dont think the funding is strong enough is because the high risk pool for
it is in this fund that states could use for one of seven purposes. One of those high risk pools there's other stuff they could. With the two: it's like literally everything from offsetting the price of preventive care to reducing co pays too reinsurance programmes. Scipio thing That states aren't going to choose the high risk, pull option that they're gonna put their money towards other programmes, but we don't know what they are about the new changes, because there is not currently a scipios score, the revised bill, so those it there's a lotta. Pack euro, I wanna do something of a high risk pool, specifically one of things. It is peculiar about them. the station around high risk pulls is that if you have the kind of politics that would make them work, you wouldn't need them in the first place, if you had a political,
census that was committed to spending enough money on covering health care for people who are sick and can't afford it? It is a lot of different ways. You can do it I, but you probably there wouldn't be having this argument that we're having at all these with of high risk pools is that, in addition to them, just being conceptually a little tricky, to design well, a lot of different states have tried them before they always always always fail, and they always fail, because What are doing is you: are corn cleaning out sick people in a space for just one need is endless. Government, subsidy and one of the things that I think healthcare experts you like like stick em sodium pentothal, will say about high schools is one reason people don't like them is that by segregating sick out from the market. They reduce their political power, and so a situation where everybody or not everybody been a lot of people are in the tail bomb care insurance marketplaces and you have a healthy and the second. You have people were middle income and people who are low income.
that's a situation where, if those marketplaces are being badly run, if subsidies are under funded, if there's something wrong, there's a lot of political pressure to fix it. Overtime, maybe not immediately, but but over time, certainly issue. If you just pull all the six people out over into this money pet over here and then the money pet is underfunded. Well, be the sick. People have Vienna some out of political power, but it's going to be a lot less and we see that again and again at the sun from lack of August. It does have not forgotten the came out his little while ago, but it had a pretty good report on this and they ve talk, for instance, about the California high risk put which actually thinks a pretty good example has. California is a state that has a political consensus. It is very proud oh universal health care. In fact, wanting California was trying to do before Republicans won the election was get a waiver, so they can use their
money to extend Obama care to undocumented immigrants, and that is where the California Healthcare consensus tends to rest, but covering ahead I risk bull and so what they did when it at high risk full was too to manage costs. They created a three month waiting period once you and rolled in it before an unruly could receive treatment for preexisting condition and one thing about the three month: waiting periods that was low, Than that normally so often when you got a high risk bull, they do not let you get treatment for your preexisting condition for three months six months, sometimes even more, because they are worried that you're gonna get alot ever selection only com, as soon as you need a lot of care In addition, will count for needed was imposed. A seventy five thousand dollar limit on benefits and a seven hundred fifty thousand dollar lifetime limit. They captain Roman too. There are very long waiting lists, on the premiums, ended up being pretty high allowed people had to drop out these. They just haven't worked well before they haven't worked well before, because the politics of them are really bad
just like that, just a place you put money on and that money just goes way site so outcome. We want to give one counter example TAT s. What we think is actually helpful for understanding these, because I think the one example of a high risk poor that works well right. Now is the Medicare Programme for Kitty failure for both and stage disease right now? They are allowed to unroll Medicare, and that is essentially a high risk pool for people with this one particular costly condition and that's been for a number of years? It is never under funded and works quite well for the people in it, but I think you know the difference as between that like the California one or really any state one you're described. It isn't as much structure its just like an unending commitment of money which the Medicare high risk wool. people of kidney failure has and every state risk, or we ve had before, and usually you know, funded by some kind of assessment on health insurers in you're, stuck within a particular
and that will most certainly be the case with the ones at the Republicans proposing which have to live within. Am I think it's about hundred thirty billion dollar budget over eight years at this point and would have to compete with all these other programmes and it's not clear they're gonna get all that So, if we do have examples of at least one well funded high risk programme by the federal government, but it is the exception, and I think it's instructive- that that one has absolutely limit. No no budgetary limits is estimated. Went that yes, that's what I was going to ask you about that, because I've always heard I've heard healthcare experts has continuously shit on Medicare pool for four and states renal failure that it take feel like it was his random amendment, the cup put into a bill, I dont eggs, Actually I you will pay knows better than I do. I dont know exactly how its funded, but my understanding is that its funded like Medicare and and Medicare Fund, it is basically an open, ended and government that does not require the government go back every year and any appropriate budget ready. I think
it works is because it s this unending commitment of both the EU towards what is that? almost back a little bit it to my original plan, which is it if you'd politics just create an unending lake, an unending uncap entitlement for sick people's health care. I mean that we can put it in a high risk, pull. We can make a substance better, yes, but the politics were info like they're they're, not they're, not suited for the slight envisioned words, words coming back to the sort of basics of a car, and and the politics, which is that there's a lot of argument, around the sort of structural elements that you know how does the Rube Goldberg machine work exactly under Obama CARE and how do Republicans made me want to change it and those are employed questions. I mean it. It doesn't matter how the system is designed, but the fundamental disagreement between Democrats and Republicans on the score is just about money right that the affordable care act,
and a lot of money on subsidizing, the purchase of health insurance by people with below average incomes, and it raises that money with a lot of taxes. Premier falling on individuals with households of over two hundred thousand dollars and various different classes of of companies, medical advice, makers and, and others republicans want to spend lot less money than that in order to enact a big repeal of those taxes, and they also want to restructure some of these things, but it's it's a little bit of that. a shell game and, in my opinion, right that, if what they were saying was ok, we're gonna do not change anything. on the tax side or on the spending side that we're going to take money out of certain kinds of affordable care act. Subsidies, I'm going to put it in high risk pools. That would be an interesting thing to talk about. I personally have
a strong opinion on whether that would be a good idea. I guess I would like to see a c b o analysis, but all of these things like we're talking about eight billion dollars relative to like a trillion dollars in in cutbacks. here and that this is no way of wound. The fact that you cannot take hundreds of billions of dollars. There are currently going to subsidize the purchase of health insurance. Plough that money into a capital gains tax cut and not come out with people having less access to healthcare. Right, and this like an endless search fur verbal formulas on the part of Republican. where they can say that they are still taking care of people. Are people still have quite equal access to health insurance or they're gonna do contemplate
something argument. Donald Trump, you just say, cover everybody. You got your terrific, but it's like their replacing. You know huge pot of money with his way smaller pot of money and It means that sick or people lower income. People are gonna, get less healthcare. There's nothing! You know how easy it would be fascinating. I guess to argue equal dollars, should we do things less, do an insurance mechanism and more through a high risk, or mechanism. But that's all It's happening here were comparing like a huge bushel of apples to like one old shitty apple and it s kind of like Richie AIDS, that the whole project it is far too can see right, think that's always gonna be the tension and any health care effort as like. What do you do with the really sick people? The healthy people are easy, like their chief the United States the status as fifty percent. of Americans, account for ten percent of healthcare spending, but the timbers
de the Moroccans, our most expensive take up the two thirds of healthcare spending. That's like the people, you are it out. The healthy people are just like small team Any apples that are really and you're, and you re think it's a good debate of particulars of how do you cover those people anything you generally see right now. Liberals fail as you know, last segregating out the sick people more dealing with it. On the back and if you have a health insurance company who happens to get a super, Second Rowley, that you know you give that insurance company some money in a sort of reinsurance programme you know. One thing I was surprised I've been doing interviews about. I risk posed for the past few am few days as these of cop again in the two, aid, and it wasn't as much from kind of the more left leaning proposed, two it wasn't as much knee jerk reaction like this is a terrible way to do healthcare. It was more of this is the way we ve done care that we ve also constantly under funded?
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point. So Upton is smart guy. He ran energy in commerce, he's dealt with healthcare before and you know how in put out a amendment putting a little bit more money. The high risk pools and- and I dont understand what he thinks- he's gonna- be saved there, so republican seem to be in a process for what they are hoping happens. Is it as bad as this legislative process is as poorly? informed as it is as Hershey. Turkey, as it is, has derived it as it is that at each point, nobody's gonna wanna be left holding the hot potato. So, like the House, Freedom caucus up to the bill fell but left her the hot potato, and so it was like on them and to get the potato over to someone else ass. They came up with steel. Where states can waiver out The insurance regulation that great art were were on board. We don't want to be blamed for killing or repeal place. So then, it goes over to the more moderate in the moderates. Now this bill, that is, a total dumpster fire.
and then they come up with his answer like ok, but a little bit more money, the high risk pools. So we can say we did being there and then well, maybe throw the hot potato over the Senate. now, maybe the Senate just like precipitate on the trash, but maybe it doesn't. Maybe they decide. They also can't be the ones who stopped repealing place from going forward, and so you would go through this process we're at every point. Everybody knew this was a bad bill. Didn't want to be the one blamed for killing it, then you would actually have a terrible thing happen where you accidentally with nobody ever realising this possibly could have happened, pass this terrible bill and then you're going to have this day you are literally going to have a day will be one day and time where people's subsidy checks go out or they don't go out. Where the insurer markets to reconstruct themselves around. You know what they think is going to happen and all of these people millions and millions of people tens it like. I we keep using the twenty four million number, but I was at the crazier number. Was it in twenty eighteen
the original version of the eighty eight fourteen million people, whose health insurance fourteen million, in twenty eighteen an election year, and I dont know what for Upton thinks. I'm gonna happen. I don't know what he thinks of this high risk pool amendment two underfunded high risk, Take people out of insurance? They have now moved on to something they dont want somewhere else. I dont know what he thinks he's going to protect him from. I don't think they anybody thinks is great policy, so I honestly can I I cannot model out the theories hospital the people and when I talked to them and when I ask him a question, they also do not have something to tell me they will judge to say all well. You know the Senate hey if something out- or you know nobody sick and not far had I've heard nobody's thinking out far ahead, a lot, which is a scary thing to hear. but I really don't understand what these pretty experienced. Savvy politicians think is gonna happen here, like they are just trying to get something. So it's not blamed on then that this fails, but if it passes
It will be blamed on them which arise. When are you coming around the idea? This kid is could pass. I don't think so bill, I am haggle, pretty pretty low on that, but We know you never know I mean that is that is. But what I am saying is that that is the theory. They are going off right, not right, they have not got into a legislative process. Would but they're trying to do is come of the bill they like they ve got into a process where one group, after the others, trying to pass it back. I dont know if that will work. I continue to believe that the Senate, even if they dig it out the house, the Senate will get a sepia score and lettuce and wolves like oh, but I guess you never know what I don't understand and all this is what someone like Upton is doing. Maybe he just agrees with me that it is can pass them, as will not be on him for passing it, but the thing that I could imagine happening. Is it everybody keeps thinking? This terrible thing won't pass, but what they dont want is for it to be on their back that it failed, and so you have an almost a collective action mistake whereby these
the visually and rationally doing this thing to not be the problem and by doing that, the accidently and the passing a terrible bell, and then everybody so that nobody gets blamed for it seeing here the real, profound institutional weakness of the more moderate House Republican, swayed that and would Democrats had the majority in the house them both, of their members were liberals from safe seats, because that's how house districts are drawn, but the blue dog caucus was very cognisant of the fact that it held the pivotal but what's, and also that its members had the most to gain or lose in any kind of outcomes, and they organise themselves in a very clear and consistent and powerful way and they really drove the agenda. In terms of you know what
we're going to pass what bills were not going to pass. What amendments they were going to insist on what they weren't going to insist on in the republican clock is the Freedom caucus is like that They are prominent in the media. People understand who they are. They articulate demands they forced negotiations whereas the more moderate or origin more vulnerable members are like scattered to the winds so times they just like lose one like Alien, Ross Lehtinen just got off the healthcare repeal bus, a long time ago, and they have completely written her off, but others you can pick off one by one. In these weird ways, like you call Fred upturn in you work this thing out that doesn't appear to make sense. He declares vet three at an off you go and they don't have any mechanism of standing together as a group formulating an agenda as a group and trying to actually drive it there instead,
all in the position of believing that Susan Collins and listen Rakowski and Rob Portman are more competent, ledge, leaders than they themselves are and that they can count on these Senate proxy is to do their job for them, which you know I mean that may be true. I do think that those senators are more competent legislators, then the House Republican Moderates, who have had the years to come up with some kind of strategy and and simply failed to do it, but it, sir. it's a curious kind of game. I mean up there on capital hill. You stood for election multiple times over the years. You think you would want some kind of theory, of what, if our pretty obtains cook governing majorities and me, and by similarly situated colleagues, hold the pivotal role. What
is it we're going to say and do like? What will we want? What will our red lines B and they just didn't like do any of that so Paul Ryan Kind, Shack this thing out their laps. They knew it was a problem, but they they ve I mean in this hope, ass man, they ve never like established. What look look? What are they after like when? What is the point? up to seems to have gotten for themselves the anybody to say in a press release that he got the bill changed to do more for people with pre existing conditions, but he hasn't actually John anything, why? Like a weird way, you know like address, you know how he was talking through. No one wants to be the one to kill it, but they all like aren't like super jazzed. We don't want to pass the option. Heart is just it makes no sense to me like what is. He is doing he is giving moderates.
Over to join on the bill with a super, a tiny amount of money that doesn't really move the need of you. Even if you live in to say the sooner this eight billion. Doesn't in much of our document, a billion dollars extra for high risk walls is not going to be. The thing that, like us, I didn't like the Scipios, quick to say? Oh well, now everyone has coverage in. There won't be any coverage laws under this bill, so he's adding on this. I liked, I think it was Dan Diamond Politico- has started calling the calling it the Michigan more saw, and I want to make that a thing. Of course, it's time you like this thing that doesn't do anything but gives covered a people who want to join on the bill. and there are still doing this all well, there's no scipios score and they think that seems the most insane this to me is that you know they might this vote and it might pass and then the scipios come out and say. However, many million people lose coverage under this
I will end the bill probably will move through this. In its office in the house has taken this like incredibly tough they'll, just aired incredibly to vote That is just fodder for attack, adds particularly for people on tufted, more moderate districts offer nothing like I just don't understand why someone like Fred Upton, what would cave on This eight billion dollar provision went like clearly articulated what he thought was wrong with the bell and the thinking, God does not fix it in any way wink. I ain't you guys know wink. I used to be club w now it's called wink gets its great new design, its great new product. What it's all about it is about customized wine recommendations being ship directly.
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It was this abortion law that essentially closed about half of the clinics in Texas, and this created a really good natural experiment to look at what happens to abortion access. What happens to a motion rates when you have fewer abortion clinics and the thing there to look at in this paper is distance. How much distance do you need to create an abortion clinic too? why do people just don't go, and the finding I was pretty interested in here is that they find out of you, move. The distance to the nearest abortion clinic from twenty five miles to fit miles away, it doesn't really change any, People are just as likely to get abortions. The abortion rate stays the same, but when you move and abortion clinic from fifty miles away to hunt miles away. The abortion rate goes down. Sixteen percent, you move it a hundred miles. Two hundred miles away. The abortion rate falls thirty, two percent, and if
go to over two hundred miles away, then the abortion rate falls in about half and too I thought this was an interesting way to quantify something that a lot of abortion cases at the Supreme Court deal with there's this standard that the Supreme Court uses when it decides. Abortion cases and they look at abortion restrictions about whether they what an undue burden on the woman and the definition of undue burden is constantly coming up. If you look at Rovers waiter, plan parent address is crazy and all really big abortion cases we ve seen there always document. Will. What is the burden on the web and this is actually bringing some data too bad. This is saying you know if you create a small increase in distant? If you have some abortion clinics, clothes and you know it slightly more travel that doesn't seem we are born and it doesn't seem like there's fewer abortions. But if you kind of get up to the fifty miles a hundred miles away range
Then you really are changing the access people. I have one other thing: I'm here this paper to see you know how it is received by pro life groups, who might be really excited about these results there actually showing that this law in Texas was, able to reduce the abortion rate and I will say, there's other data not in this paper from other researchers that has found a number of unintended pregnancies. it up. So does not suggest people are getting Pregnant last are having less sexy, just suggest there having fewer abortions and they do become pregnant by it. It really is the first paper I've seen that kind of quantifies the relationship between. since you, an abortion clinic and how much that distance has an effect on what the abortion It is in a given area, so I would characterize what this paper says as the abortion clinic closures or having the effect that the people closing the clinic wanted to have
Right I mean that that's what this is saying, that this is a this appears to be an effective way of cutting the overall number of abortions. People are not able to do a one to one substitution, just go to another state. I mean that's expensive, it's very difficult, oftentimes you put on the transportation or the time from work, or even the knowledge necessary to do it that it is in fact a and effective strategy to reduce abortion by attrition to just go come up with these laws. It say all these clinics do not follow our regulations. For women's health and clean enough, there closets aren't big enough all the door. Jobs need to be stainless steel, but instead there you know of an aluminum composite and get healthy sings closed and you actually have some version to be effected pro life. Folks, one half way I mean do one of two things: it's interesting about that the delay standard forces. Everyone to play these kind of like weird, triple games where, like you have to say
oh, I and all of my antiabortion colleagues, with the backing of all these antiabortion advocacy groups just past This law that abortion forget say, will drastically restrict access to abortion. But that's totally now what we were trying to do, but clearly its what you're trying to do right an end, and so let me one other charge that I think you could frequently raise against measures along these lines is that it won't actually do anything to do so. Since that you are merely creating annoying humiliating expensive hoops for women to jump through to no avail but in this case it appears that there is a real purpose right that, if you are someone who thinks that abortion is murder or other serious wrongdoing- and you really passionately want to drive down the quantity of abortions in the United States,
but you cannot. Hundreds were import rules make it illegal there, We are now seeing that if you make people drive far enough, they in a statistically meaningful way. Not go, do add, and this strategy Guenaud works right, I mean that's, selling with meaning. It is also interesting and important that. this strategy does not appear to enough we're looking sense, induce more conservative behaviour on the part of people, read him, and I think, in that social conservatives would like to be true. Is that if you really crack down on the availability of abortion, that everybody would have sex last, particularly outside of marriage, and that there would be many fewer pregnancy is, but I think in a number of different things that were able to study and look at. We don't see that kind of a fact that the unpaid,
pregnancies to happen that the? U have far more more children being borne by women who don't feel that their in funding shall or other circumstances add to raise them effectively, and I mean to to me I don't see what benefit there is too reshaping society in this way, but but that site, where these strategies Parker S wedding. I'm curious of the paper like this is how it ends factoring into how the Supreme Court thinks about abortion, which is an issue there well frequently ass, to revisit, wondering, interesting things. They note in this paper is that you, Supreme Court has taken its best guessed at what A undue burden of distant says. There was, in plan pair forces Casey, which was a case in the early nineties. There was a big abortion case Supreme Court of Justice.
leader. He said that he thinks it's up to a hundred fifty miles, that if women are to travel up two hundred fifty miles, that's fine anything above the threshold would be can in his view and undue burden, but that seems to be something he's just kind of coming up with a little bit on the fly, and this is really the first time that some data has been brought to this. And this is something in a lot of different ways that abortion such a grapple with science in. Usually and looking at feudal development and looking at you know when, when can a foetus reasonably be expected to survive on its own, which is a benchmark that keeps changing as medical technology? the advances in kind of challenges, the rulings from forty years, the cow where we had a lot less ability to the liver, extremely premature babies than we do now. I think one of the hard things were and are doing jurisprudence on abortion is that you constantly have a lot of the rulings really do rely,
science and a lot of we're different ways like everything from like how far of travellers undue burden to? U dont one point: can a foetus be expected to survive on its own ends, those in a scientific decisions. They they matter to how the Supreme Court is deciding abortion LA and I'm crazy. If this this seems like a paper that could easily end up cited and unaware in case in the future as it the paper that could as Mount was saying, you know both embolden abortion rates. Opponents, a little bit by suggesting hey these bills, really work, but also give abortion rights advocates a stronger case in court sing like look clearly like this is creating an undue burden on women or hurt, but do we got This has been another episode of the weeds, a policy Pakistan, the Box media Pike, s network think is always to my co host, Cliff and Matthew Iglesias producer Bird Pinkerton. You should be checking
I think your interesting, the new podcast by Todd Vander of also on the box media, but gas network. It is a wonderful network and we'll be back either next week or depending on healthcare votes. Maybe even sooner.
Transcript generated on 2021-09-13.