« The Weeds

Skinny repeal and Trump's management by tweet

2017-07-26

Sarah, Ezra, and Matt talk about yet another Obamacare repeal plan, Trump's feud with Jeff Sessions, and new research on retail health clinics.

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
Last summer there were tons of trump bumper stickers around here and they all seem to be gone now, while boldly extrapolating from that sums finished blow welcome to another. So did the weeds and box media pug cast network Matthew Places, and we have asked as recline and Sarah Clip with us, so that the usual castor characters spend our national place. Where are you mad? I'm in Bangalore Mean Trump Country Sourdough, but also Susan Clowns country visit my dad and you know, working and podcasting remotely. it was a lovely here at the Ladys at their blue hill. Historical society are very excited about modern republicans. What happened with matters of hover kitten, systematic Susan Collins, she's doing things
is we gotta, get episode, we're gonna, get to Jeff sessions and has very I'd position, and he administration we chose banishment and generally is made his odd manager who has been stuck with as a boss. We are going to talk about retail clinics and emergency health care in a very exciting white paper, but we are going to start where all the news is, which is once again health care where the republican Senate Healthcare ever has. You came back from Detroit in it, came out of the grave and reared its head, and we are so that's. It must start by kind of summarizing where we are going to talk to you a little bit about what what might happen next. So it became clear over this weekend going into Day, that Republicans were starting to cobble together the votes to open debates, iron Healthcare Repeal Bell what
the things I was very confusing in this process, as they are not making clear which healthcare bill they were opening debate on. At this point, I count at least three completely separate approaches to appeal that are being considered and within that a lot of them have like to point out we point out, like versions have amendments not just quickly defined with opening debate means in this context. So opening debate means that you will start having this. Twenty. Our debates on you know different sort of health care issues. Technically Their opening debate on the house past Bill the American Healthcare ACT, but they are not planning to vote on that. They quickly substitute in bells in amendment so where we are right now- and this is like ten- Hocker, so on Wednesday morning. It will near certainly actually be different time. You listen to this podcast is debate. Opened on Tuesday afternoon, I'm in a very dramatic fashion
and where Senator Mccain flew back Arizona coming out of brain cancer treatment to cast the final They need to open debate. Debate opens Tuesday afternoon around the thirty they move. Reading about the bills are today very long, arduous processors and poor Senate Clark and then ass night, around nine beyond they held a vote on the better CARE Reconciliation act. It was technically at first drove out by everyone voting they understood at as a vote on unit. Should we continue forward on this bills, mainly these Senate's repealed and replace Bell. This one has the new tax credits, therapy medicated Jen that bill went down by nine votes this morning, opened up to debate again. We are expecting at Levin thirty, I am which is in the future when we are recording this, but will be in the past. When you listen to this well well, we are expecting a vote.
on the Obama, care, repeal and reconciliation act. This is a bill that just repeals Obamacare does not do replacement. That is also expected to fail, and then we get to work expecting to be a flood of amendments, and things get really weird and unpredictable. We don't really know. What's going to happen were told and again this is our future. In your past there will be a vote around three hundred and thirty today, on sending this process back to committee meant to I'm offered by Democrats meant to embarrass Republicans but skipping the whole committee process. Here the ultimate goal seems to be to move towards a final vote on what is now been called, skinny repeal, which is really the bare bones version of scaling back the affordable care act that would get rid of the individual mandate, get rid of the medical device taxes because they apparently of them wonderful lobbyists at the medical device industry who have kept this issue alive
get rid of the employer mandate, and that would be essentially what the Senate moves forward. If that happens, if Mcconnell is able to get those, devotes fur skinny repeal, which seems like the only thing that has a chance of moving forward. You then go to conference committee, and there is this ethos developing that you know, I think, reminds alive us of what happened in the house where a lot of senators saying we can't agree on something is really hard, but let's you send skinny repeal the conference and we'll work it out there like will make it better there, and this is something till so familiar there's been this constant attitude of well will fix it at this next step bull fix it there and we know there's problems, but you have to take this vote because we have to keep moving forward. We have to keep the debate open and you don t worry about this vote. It's not that product, but we're running out of moments to fix it conference Committee is the last step before sending back to the chamber's than sending it to has it what is conference committee com?
committee is where the house in the Senate bring their versions of a bell, and they can hash out the differences and send something back to the two chambers to vote on its unclear. How exactly this would doubt in this case because the elected we do have skinny repeal pass, basically the how shows up what the American Healthcare ACT, which is this really complex like changing the text, credit subsidies, turning on Medicare into a per capita can eradicate into a per cap. cap programme, and the Senate shows up with their two page. Velvet does repeal individual mandate, and We don't know how that checks out. I've heard both the theory from republican Hell staffers. That's they might just send skinny repeal straight to the house and say like this is what we got like this were working at. Let's take this incremental step and like counted as a win. If they try and conference that you'll, probably something like the American Healthcare ACT go to the Senate. We don't know if I can pass again This argument, like we have to do something we have to get a win but conference committee.
That is where they all decide what the final product that both houses need to approve looks like and if something makes it through conference and through the House and Senate President Trumpets said like he will sign of anything. He is there with his pen. He is ready to sign something that has the words of my care repeal in it, and you know, as we move further this process liquors and earlier there is less points to do what the sad again and again, it's like fix it at a later step. We are running out of the later steps at this point, So it is worth saying that you know conference committee as an institution has sort of withered over the years white, but that the classic idea was that have somewhat different versions of bills passed by the house and passed by the Senate. Prob we with some level of by partisan support in both chambers, and then you would appoint a committee
of members from all sides, the aisle from both chambers and they would work in a deliberative way. It is very unlikely they were going to see a conference committee process in that sense, if only because we ve we ve dispensed with all the other asp. of regular order in Congress. So in practice this means we're gonna punt once again and give leadership another opportunity to work something out behind closed doors, try to presented to their members as a fait accompli, and it seems like even the narrative changed. Among Republicans said thirty. ex hours ago, when this skinny repeal concept was first floated, the idea was really ok, we'll punted forward to conference Committee and why sitting out there, but now, as of this morning, there talking more about will. Maybe, if
any repeal is what passes the Senate will actually get the house to just go. Do that and that will be what they call repealing the replacing Obamacare is blowing up. The individual market may be cutting some taxes and leaving Medicaid expansion in place. I learn couplings deserve others want wonders on quick on a narrow converts committee point. The theory here, if it went through converts committee, is a little bit like what happened with Medicare Party, and you guys can correct me if I'm get my history here, but Medicare Party that the bill the became Medicare Party, was pretty by partisan. The Senate of the original version passes so in this way to differ, It's a more moderate version in the Senate. The original version passes with TED Kennedy support. Actually at that time, then it goes to conference committee and they end up becoming much much much more conservative to pass a house and so comes back to the Senate, and all these Democrats feel super betrayed novice, even though Democrats on this bill. But what Mcconnell is,
doing is passing a very minimalistic version of Obamacare Reform, as I think the right way to talk about it out of the Senate right here, he's basing hey boat for this almost nothing happening here, except we are repealing v least popular part of Obamacare, totally heedless of the consequences for for insurance markets. And then what will happen is that what would come back? is a yes or no upper down. You know: do you make good, I'm your promise? appeal, Obamacare or not bode for always Senate no quorum quote. Moderates is more mainstream Senate Republicans. It is not going to be skinny repeal right, there's gotta be something much more conservative and so you're Rob port and your Dean Heller's there. You know they were The advances only to give themselves a much harder choice down the road, something that's one thing worth saying here that we ve seen this play run before were conference committee. Something pass out, the sentence more moderate conference can be comes back to something much more conservative and then,
republican leadership jams, just a gender moderate members and veto in, and it has worked for them before the other thing, and it just goes to the The essential insanity of this entire process, like just take a step back on skinnier appeal when we did that peace a couple weeks ago. When asked republican senators. What are you trying to achieve in this whole process? And we discussed these gobbledygook answers one of the answers we gonna lie down. Chuck Grassy was one of people said this is like Obamacare individual markets are exploding their imploding there as stated in our work. We need stabilizing the individual markets better ways you might do that Lamar Alexander, the Republican. Surely help committee has a hearing on the books for some time in the future and how to stabilize individual markets but what everybody agrees on. Is it just taken? The individual mandate out without any kind of replacement, is going to destabilize and individual markets further, and so, if reports
Can I did do the other version of this red? They just pass guinea repeal they jammed the house on it somehow and they send it to Senator Donald Trump, and they declare win. There's gonna, be this moment. The Comstock not long ago From now, depending on how the bill structured, where premium just skyrocket, I think not event. I think it This will open in Roman starts on November fifteen this year, and I think, if you pass a bill, I believe the mandate repeals starts immediately. but that's it even if they decide to delay at a year because you're worried about market stability, what insurance company like wants to stay in that market, where their customers are being told, the individual mandates being repealed. You didn't buy insurance, they ve just got the arms round the coup assigning health care, and now they have to go into this markets where people are told you don't actually to by healthcare. Even if you know that's technically on the books in even a skinny,
appealed doesn't pass unit were in really the crunch time for insurance companies, design and whether they want to sell Obama CARE or not. I was talking to you of the Tennessee insurance regulator, who is the president of the National Association of Insurance commissioners it was outlining to me in about MID August or so she and all these other insurance regulators are going to have to send a contract to their insurance plans. You sell on Healthcare Sakharov and say: ok, here's the rates we ve have proved you send this back signed in MID September. If you want to sell coverage- and she is really worried that looking at what's going on, she has to insurance plans on the Tennessee marketplace. They're gonna say like I'm, not signing that contracting. I dont want to sell Obama care. I think the effects would be very. quick like January, quick, just put some numbers to it: Scipios analyze a bill
is similar to that suddenly did it back and twenty fifteen. They estimate that fifteen million people would lose coverage if you had something like skinny repeal go into place and museums in the individual market, whether in that, ancestors by twenty twenty would rise. Twenty percent a few years out, because our moving a few years out so the when they are one of the big picture I want to put on this is if I've never really seen anything like this in politics like this is not policy making its anti policymaking. I have never watched a process where what the legislators are doing by their own at this point, explanation is taking a problem that they identified to solve and passing something they all agree will make it worse. Right. No Republican is out there making the case that skinnier pillow stabilizer market anywhere were now That's why? Maybe this is really just a procedural move to get the conference committee blah blah blah blah, but even so
usually the things you pass have a fig leaf of. Like I'm gonna make the problem I have set out to solve the better, and I know There is an argument that the only profit try to solve is what can get fifty one votes, and you know something that we can say is a bomb carpio replace, but this is insane I I am have her cast head, that they would pass something like look like republics like the environment. That's fine big came up with that they turn on it. It's where, where we are like we'll get that replace it, something we're I mean early on in the process there you're writing these great pieces. Looking at you know, they're worth thinking about what role men to end continuous coverage in their way,
As you might, we argue tat this, but there are little stock, and although this is something else, that's important. That's happened since our last at the soul. Is that the parliamentarian, who can it sets the rules for what can be debated and reconciliation, which aspires to be limited to budgetary legislation, came out with a list late Friday evening around six pm. Saying here is all this stuff that you can't do in reconciliation and one of the things those ruled out was its continuous french require battened, so they are trying to undo a bell that passed with sixty votes with only fifty votes, and it is very, very hard to undo all of it, so they are in a place where the better CARE Reconciliation act. They're gonna build European, replace Obamacare, where they is actually very hard to replace individual mandate and convince the parliament and that it is a matter of budget to their little a little stuck, and I don't think this is like an excuse. They decided to use reconciliation. This is the process they are using and these are
consequences of it, but they are a little hamstrung, unlike moving forward. Those proposals Why in Srebrenica is what I mean that, like it's a normal thing in politics, that you don't have enough votes to pass a guy, you wanna ask, then you don't get the doesn't like it happens, all the time like it's not like, I don't have the votes to pass a bill, I want to pass to solve the problem. I won a dissolve but plan B, as I do, how the votes to pass I dont want to pass. It will make the problem. I want to solve worse so like let's go with that. Just weird also mean this sixty votes, I think, is a little bit of almost a red herring here right because if, if you were able to slow this process down They cut right Mitch. Mcconnell does not need to be moving at this pace, and if he wanted to have our Alexander walk across the hall and speak to. I forget whose whose Wang
howdy, Murray, Patty, Murray and say Paddy. You know we ve got a problem here right, the president, the base everybody expects us to do something that repeals and were places Obamacare. what we would like to make, that mean is that we take this individual mandate. That has become a symbol of what is hateful about this. We would like to take it out and we would like to replace it with a different mechanism that will help us stabilize the markets. Can Democrats work with on doing that- and maybe also taking out this medical device tax. That several Democrats also want to appeal and in exchange we're like not go to impose drastic cuts on Medicaid. I think I don't Oh, what Democrats would say that, but I think they were cuts will be crazy to not. You know, help Republicans bail themselves out right. if what they really want is just a kind of a fig leaf for appeal that gets rid of the individual mandate and comes up with some other mechanism to stabilize the market.
Ices. They could and should do that as a bipartisan sixty vote bill, but they are making I mean they are literally saying different things to different people as to whether the purpose of this legislation is to become law, because I think it will be better than the status quo or whether the purpose of this legislation is to serve as a Trojan horse for passing a much more comprehensive, total rollback of of health insurance for low income families. And this has been like Mcconnell for four weeks now has been doing one version or another of this where he is telling moderates Don't worry these medicate cuts won't be implemented and you have Republican senators John Mccain, one Is incredible plaudits on cable television for this speech he gave where he came back and he was guys like this is and how we should be doing things, but then, after having sex-
we shall do things this way. He voted to open debate. Even voted for the busy are able which he had previously denounced, and everyone is operating on so many different levels of bad faith. That is its but to give any credit to anything that they're doing. If They wanted to state some objectives and work on them. I think a lot of these mutual impediments would get out of their way but they're trying to they try to pull a fast one and I dont think they're even being clear to their own caucus as to what the full nature of the fast one. When a pull really is why don't think they know baby they do, Maybe like, there's some cunning behind the scenes. Came it
clear to me that leadership like knows which fast when they are attempting to Paul aside from the one that is able to get fifty one votes and move out of the Senate, which, as you mentioned, is a very bad way to do legislation and leads to these weird outcomes of pushing a bill that no one agrees as well. Effects that the problems with the affordable care act. I do think in a way it actually please quite well and a trump predatory, all along which, as he has really been one, to highlight the failing marketplaces an insurance company quits. Whenever premium go up Peter, he will say looking Obamacare ceiling above clarifying apart. It isn't
really at certain Hadley has its weak spots. There's some marketplaces that have some empty county is, but a lot of that is actually a reflection of all the uncertainty in the market place. The Trump administration not being clear about in a weather is going to pay these caution reduction subsidies that alive this is being self inflicted. But if you are trying to make the case, we have to pass a bill because Obamacare is failing, certainly helps your case to make Obamacare fail a little more one. Other thing I want to mention it surprised me about this week is the resilience of Medicaid. If you told me, you know, and we wonder this process- that the final play in the Senate be demolishing the individual market, but like leaving medicate expansion totally intact, I probably would not have believed because Medikit has often been a programme has been quite susceptible to budget cuts. It has a low income population as its veto in Rosalie Base. It doesn't have the strong lobby of Medicare but medicated
really surprising way resilient in this process. We now, I dont, think all the way yet like. Obviously, there is a house past bill that cuts Medicaid by about eight hundred billion dollars, so not out of the but I think it is notable and interesting that, because of a handful of moderate senators, been on the fence. A little beds. Medicate had to be taken up he off the table for the Senate, when they get to like the last thing, they think might be able to get enough support. So one thing I do think is interesting. Therein and again I wanna be cautious, because I would not at all be surprised to see the conference bill go back to full, bore, medicate cuts. But, as you say like at the moment, rat right now, what they are trying to pass out of the Senate, they ve just taken medicate out, and in Belgrade amounts. Ruler point
sure has said that if you just want, have a conversation but stabilizing individual markets and not have a conversation by cutting Medicaid Democrats be happy to have that conversations. It's not even like a hypothetical. They could just start talking to Democrats and the fact that their not implies to me that this skinny repeal bill is not a real thing like this is not where they're going. This is a way to get the conference, but putting that aside for minutes, one thing I think we're seeing a lot of what Republicans right now is are being very tactical without being an all strategic. They do not have a vision in their head of what a working healthcare market would look like. They don't have vision. Their head of a conservative healthcare policy should look like they do not like have an idea of what all of this is supposed to lead to six years. on the line or ten years time. Lemme give you, sir you and I have a lot of work on what the Obamacare architects believed, Obama Her would create, and in many ways they were wrong right, you're at this great Pisa, maybe now, six months ago, about the way in which they
dreams for the exchanges and in fact it's been Medicaid. That has been in many ways the success story of a bomb care, but there was a theory of if it all worked out. What would happen? Republicans don't have that theory and without that theory, as he just wanna, get fifty one votes for fucking, something there actually discrediting the ideas that they really needed to build up. So if you look at most republican healthcare policy, thinking, leg taken Paul Ryan's premium support plans for Medicare. What that basically does it takes Medicare and makes it into Uno bomber care like individual market exchange structure, and if you look it really like all the republican plans there all based on exchanges working. They wanna have private insurance plans competing on centralized marketplaces, regulated by states subsidized by some kind of tax credits scheme and an that's supposed to work, and so Republicans really need in order to create not a single a bill. The can
house right now, but a model that will withstand the eventual return of a democratic majority that will want to and is moving more towards something like Medicare for all or medicate by UN, or one of these much more government based plans it. That, I think, is where the left his trending and right for correct reasons. What Republicans actually need is a working model that they can defend. If what who, instead is they destabilize individual markets? Further, they discredit exchanges, they make air, but I believe you actually cannot make a government regulated market based on private insurance work there not only going to have created the conditions for Democrats to come in place whatever they built, but they have nothing to say right, they're, not gonna, be able. say no like we ve got this much better idea over here. They will have like got in can to try their idea and, like both the democratic vote-
that idea, they will said failed and then they will be on their version of a bad idea and it will have failed as it was going to be. No private insurance based health care policy model left, like all they will have left, is Medicaid Medic hair and variants thereof. I may I would beg p. I write a piece a couple weeks ago about how I think how I think this strike could end in some version of single pair, not maybe not quite Medicare, by and medicate, by an etc and a couple of years the Republicans detonate everything in the next democratic presidential uses Mitch Mcconnell process like pass, and go care nationally. I dont think they are thinking about this clearly at all like this, is not how an ideological movement build a structure for its future success. This is robbing your future to try to get out of a very short term political jam. Responsibility is twenty. Three me dotcom. Twenty three meta
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I was in the mountains for for a couple days, which is very nice, not thinking about most of the stuff, and when I came back I came back and said: oh God, and a civilization on Monday that hit at I turned on my computer and now every time you go away, if you actually and about his cellular, an internet service for a couple days. Turning on the news has occurred. Looking at that gift from no community or dollar Glover like why back into the room with pizza, like everything is on fire and everybody is running around like its total fuckin chaos, but I turn on my computer Agis, VIT Donald Trump, it's for the past couple of he's just running down his own attorney general. He gave an interview to the New York Times where he said you are. I think it's very unfair. The Jeff sessions, took the job and then were accused himself from the Russia investigation. Then, after we got criticism that he doubled, How, in a series of tweets any began talking about it,
such an amazing formulation guys nothing, if not good, at getting. Some stick in your mind, Our beleaguered Agee Jeff sessions in his tweets are beleaguered a jeep Just sessions is only beleaguered because Donald Trump keeps talking about it. this just gave it a new to the Wall Street Journal where he likes I am to Jeff sessions more and it toppled jumps. Attack on job sessions is a hundred per cent. Did Jeff sessions took this job but then later turned out to be not able to protect Donald Trump. personal investigation and that really unfair that all the that his his attorney general should be much much better at stopping investigation into him personally, which is another way and Madison about this little bit in which you you find Donald really does not believe in the rule of law. Applying to him, like really has deeply illiberal instincts when it comes to the stuff,
but an entire- want a bracket per second else. You want to talk about the idea of Donald Trump. His manager here, Donald Trump, just got a new coms actor scare me. It Anthony's garlicky, Anthony scammer Jeff, who is he Hedge fund guy right man, you also here, he runs or was called a a fund of fright and swayed. So it's I give you can have access to investing in a high fee, hedge fund, that will lose you money, because you're, not quite rich enough for that you can pay a fee. To Anthony scare Muti. Who will then pool your money with the money of other suckers and invested in high fees vehicles, so that your pain, two rounds of high management visas for not that great investments so that that's the new communications dregs of this guy became calm because he sort of a player Like New York, tabloid media and CNBC he gives good quotes but is really not got cons. Experience
he went on to try to defend this today and is you know he thinks is grade. It's real New York way of doing business, Adamo Chubbs doing he's out stab in anybody in the back. You like, he stabbed him in the front in public now, Donald Trump could fire his attorney general has power to do that. He could go and talk to his attorney general. He could go manage this situation. quietly with his attorney general, and instead of doing any of that he's gone on a public campaign to humiliate of sessions until Jeff session I guess resigns or unrecognised health from the Russia Investigation or something one thing. This is I'm is sent shock waves to all the other cabinet officials and senior staffers working for Donald Trump, who are giving both blind and on the record quotes about how their terrified now, the Donald without stand by them.
Enable instead like try to he believed them publicly as soon as he become liability of any sort to him. There's a lot of talk directs. Tell us in the Secretary of State, has just reached a personal FED up point. he's apparently taking around a little crazy little break as you do in your secretary, stable. But one thing I think it's interesting about close to doing this is pillar. Send you guess what he is he's an executive right I mean he's an x on career guises in oil and gas guy, but is also very talented, ceo, it's like he believes in ways of managing people. I think it sometimes. I missed how much managers are like who will rise up and nodded your ranks like event, you that's what they think about its, how they see the world and Donald Trump eat. He is actually betraying every principle in every idea of how you would manage an organization how you would keep people loyalty, you hate people from writing things or leaking things, have hurt you later
how you would keep the rest of your staff feel like they should be on your side, as opposed to like protecting their backside. In case you come after them, some other way, and I mean is the most chaotic counter productive I've insane and in some ways, scary way to run a government that I could imagine all of it coming from the guy who in when you talk about what is they said this like the I who portrayed himself ass. He successful business man and executive who would bring business leadership principles to government this you're sick, How businesses are right, it is not how you do it could you imagine Azra they? The equivalent of this would be like you going on twitter and being like. Sarah cliff is like a very bad health policy report are like she is Not very good. At her job are beleaguered healthcare. Then he followed me bands
It really looks beleaguered these days. I don't know what's up with that, but can eat like that is the equivalent situation, and one of the things I think might be different about how Trump sees management versus others is that he seems to think of his cabinet professionals is like his guy. that a key brought an who, you know, should feel lucky to be there like ie is just, should, as is being done, a favour by like Trump allowing him to serve as attorney general, and not that just sessions is serving, the United States is attorney. General Jeff sessions is serving Donald, Trump is attorney, general dubbing said lake. I still think it's very you'd be an odd management tactic to blast your guy in public, but I think it's a distinction between. Do you feel like you're staff in the bedroom.
government is serving that might dictate how you treat those people. You ve lost your seen from the first weekend that the Trump served in office a profound frustration on the Trump administrations part with the idea of the career or civil surface right. This is they keep referring to career staff, as Obama Hold overruns, which is like a plan, Mental misunderstanding of what's going on in some of what you seeing like today while I was driving up trumpeted a couple tweets credit. eyes in sessions for not having fired Andrew Mikhail that the deputy director of the FBI, whose now acting director on the grounds of from Miss States this, but the true facts of the matter, is that Mikhail wife was a candidate for Virginia State legislative seat. Not this past,
year, but the year before that and she was supported, as you would expect, a Democrat trying to win a Virginia, say legislature, seed by a pack associated with Terry Mccall F. Oh you know, Republicans have been saying for years that this is an evidence of of some kind of bias and and over saving it, but the fact of the matter is, as we have some reason to believe that any Mackay, maybe a democrat at a minimum. His wife is a Democrat and he's also a career FBI agent. You know who just risen to senior level. in the organisations ranks just as the vast Geography of senior FBI officials are Republicans based on what we know and that's just kind of like the way it is right and presidents of both parties have dealt with this fact. Freons Tromp is one thing he's doing by being so weird about this is here destabilizing people's expectations right.
you now have to understand. If you work in it was attorney's office somewhere. If you work in the enforcement arm of the s he see, if you work for any of the other federal regulatory agencies who might take a look at this says that are owned or affiliated with Donald Trump or with some of his billionaire cabinet members or with his friends who pose with him for Auto is at the Morrow Logo Club. You might have thought in ordinary time. Look: you're professional! You have a job to do, there's the rule of law and the United States. It doesn't matter if a companies owned by a body of the presidents of the It was your subsisted enforced. The lie and ending them for it Trump is calling all of that into question by daily publicly for wanting contempt for the idea of the rule of law, and then we watch congressional Republicans and eclipse
makes them uncomfortable, but not like do something about it. Uncomfortable rightly the message is being heard. If you work in a regional office of the EPA and you're thinking, ok Will the institutions of the american government have my back if the present to the United States decides he wants to try to ruin my life because I enforce the law against one was golf courses. The answer is no right, if you are Jeff sessions right, if you re a iconic figure and conservative politics, they may kind assorted. Have your back! If you are James, call me right a Bush appointee rich well, connected media savvy guy, they make kind of,
we back, but if you're, some no body, if you like, actually a Democrat who you know, doesn't support republican causes like you're you're done for right and that to me is what Trump is is doing. I should say tromp I mean Trump is taking actions, but it's like Paul, Ryan and Mitch Mcconnell every day they wake up and they say no, I'm not gonna try to defend the legal order in the United States. That's all they do every day like that's their legacy. They are working about as hard as they possum good to like help, Donald Trump, just tear down the foundations of the american government, and what one thing I just add to that is the echoes of the other way too, because you're not done. For I mean this is a point that for that year, I think you're implying round the civil service. Donald Trump can't fire you. If you
if you are, that EPA person and you're enforcing something. It's golf course like Donald Trump. Can't fire you- and so one thing it's happening here is Donald Trump- is turning the entire federal bureaucracy hostile to him. Personally, like the sea, correctly that the President of United States in such a city he supposed to be there boss, but he's also their enemy and he doesn't like them and he doesn't trust them and he doesn't want to preserve the things I ve spent their lives building and he will try to attack them and that's actually are our position is about position for them, as you say that it's also, position for him, because one is harder for him to do things The bureaucracy right is a drag their feet. There are a lot of ways it can make life harder to its just there's a lot of things he can go. There's a lot of ways in which basing comment.
The meetings and whatever one of the interesting things, Georgia has been one of the few places which has really been getting things done, because sessions is. usual character and that he was both high level enough to run a cabinet agency in importing cabinet agency but he was also like a real trumpets sky. A very early endorse her Donald Trump, a very systematic and sustained support our trump throughout the election, and so I think that one of the few places were trumps agenda has really been coming through pretty cool We import assertions actually shares it now. Trump is turning the d o j and those ways against him. Just ass. He turned the FBI against him. Justice is done this system how Turkey and other places I saw one a back out to just say I mean we're. Looking, I think that we are very prime to think about the Saturday night massacre from from the next ten years as like this one thing and look for it to happen in the same way again were Nixon. You know demands that the special prosecutor independent prosecutors fired and then you know the ages has no said
Far as e g in the deputy Jesus NO said Nixon, far Zack I and goes on down the line. I think that away to imagine what were watching play out here is slow motion Saturday, I massacre where he fired, call me as way to try to stop the investigation that didn't work dependent prosecutor in Mahler got appointed so now he he, I think, he's been told you can just fire Jeff sessions. I think that what makes all this Sense is, somebody said to Donald Trump is not going to look good if you fired a general because he cannot protect you from the rush investigation. So not trumpets right turn up the heat, and make Jeff sessions resign? The word on the street right now is Jeff session is not going to resign. The trump has got sessions, backup and like sessions is like pissed off, and it's going to stay there and pick trump, or him, so maybe chum fires and maybe doesn't maybe chipped
answered the mauler. I mean all this comes back to the smaller investigation. What Trump wanted somebody to shut down the Mahler investigation, this same kind the Saturday night massacre? There were one king and one question is whether it successful right, whether not Trump is actually but to drive sessions from office either by firing him directly or by making it impossible for him to to be around his obviously not going to appoint Rosen steam that the deputy eighty two to run the organization Rosen Steen appointed Mahler, homage in one of these same interviews, raced packing sessions referred, arose, some guy from Baltimore, which link there are some encode it in that right. Just what trump been by just like dismissing him is like a Baltimore like City Democrat, you know, just like you could tell what was happening at Trump's head, but this is from trying to fire way out of legal trouble and indifferent
ways like there's been some obstruction for him. Like the first thing, you tried didn't quite work and then you know, I think that he feels pressure not to just fully like assault sessions and- and just do it himself, but we are very oh right now to the very much the same kind of thing that Nixon did. It was happening in a slower and weird our way. It also helps me number were like six months in the term presidency by copyright, I checked it. It is six months since January. You know just sessions that you set, as was this trumpets guy, like with him through the whole campaign who is going to want to come in. This administration like when you watch and it's like you said such a sessions at the boy This chamber, you into the very odd place to talk about this troublesome, often comment about health and Human Services Secretary Tom Pray, that will maybe I'll fire Tom Price if we can't get like Obamacare repeal done, even though Tom Prices
Congress. It doesn't really like in charge of that task is really like a pervasive part of working in the Trump administration. It seems a hard you get high quality members of your cabinet when they come, and usually you come in having a position thinking. This is like a high profile. Job it'll raise your profile. You will be able to do cool things that pay you a lot of money after you leave your cabinet positions, you take it it's a harder cell to take a cabinet position where you might have the president tweeting about how terrible you are a few months into serving in Canada position and like maybe, the pay off as you get to rights and, like salacious tell all after you leave, but it certainly, I imagine, gives folks who might consider serving pause to think about what they might be signing up for end. There's a lot of months left in the trunk presidency that very cabinet, you know shells were greater resign, maybe just because,
they're moving on that. Ideally by time to the end of the Obama first, There's been like a lot of turnover in the cabinet, because that's just how things go there intense high pressure jobs filling these time seems like it'll, be more challenging when people have a sense that this is the manager. I am ending up to work for an you, gonna wonder about you know. Some of these rules are being filled right now by people who you know had good good Things going might have been Rick's tellers inward, ceo of Ex I'm all right. You know he he took this job and secretary of state. It's it's a big job, but it wasn't an obvious, no brainer for a man, I don't take any one could say it's like worked out well for him in terms of his public liability. Jen, Jamaica and John Kelly were retired generals. It serves as a good life is a retired general. You could maybe do a little corporate board type work. I you don't necessarily need to be treated with a total lack of dignity, we had today Trump announced,
twitter a new policy, barring transgender of people from serving in the american military? Apparently nobody at the Defense Department had any idea. This was coming. You know that's just kind of the way Trump from does things it's going to make people not want to. Do this stuff and it's going to further of road the sort of capacity of the government to govern. But it's been clear, I think for a while that dumb Trump doesn't really care about that least for his for six months in office. That has been ok right. I mean Nothing has like happened objectively, where we are saying the erosion of the basic competency of the leadership in the american government, has caused a huge high profile. Catastrophe and maybe, in some ways like the Trump voters, were right and having people, know what they're doing does.
Actually matter and and all the experts are wrong. My intuition is that, like we will be tested as a country at some point, by problems either in the world or in the economy, and we are going to come too deeply deep. we regret that we have seen less guys like running around and not a real administration of talented and competent professionals. that's right and and and another thing here that I just things worth calling out. You guys are both mentioned. Will who would take these jobs? Will somebody will take these jobs or somebody will be attorney general, but what Trump is created and This is a way that authoritarian leaders work. This is a way that very dysfunction organisations. Work chump has made clear what kind of person should work and will work out in his administration, which is of a personal interest, and so without me the people who are gonna be willing to take. Let's eat trumpeted buyer Jeff sessions right the signal is
If you are a good attorney general candidate, who does it wants to run a really good, o J, you ve not fucking, want this job like you will be rendered sick. You will be asked to make decisions that you ve never make in order to retain a job. You humiliate yourself in public, but if you like no, but Rudy Giuliani, use. One of the poorest people have been know mentioned for this, and you just like, are totally cool being a absolute trouble loyalist at this point in order tat, you know then gone Trump tv later and I mean that version of this. It works out for people who are willing to mortgage enough of their preventive hangover. That's true! If you look at like shun spices leaving because he was willing to mortgage alive and he had this like humiliating exit from the Trump administration. This past week, garbage I agree I totally agree. Bits of this goes to the second point of vessels. Gonna say which is so. On the one hand, the only people now who makes sense come in or loyalists unlike hacks right and
should make all of us very uncomfortable, the F b I, Thomas Ray, I think the person Trump nominated to replace commies FBI directors, reasonably credit showed, but as matters ridden given what we know about what Europe wants from the FBI director theirs, reason we should trust anybody who has made it through the interview process with Trump summit. All these other people, so you're gonna have a administration overtime composed really of reach. Perhaps a boil ass, like really people, you do not want these organisations, because they they're on their loyalties, Donald Trump, not to the rule of law, not the competent Agnes. asian. But, on the other hand, they discuss your point about spice and others, as people leave what they have to somehow rescue their reputation, and what can they do to do that Well, one of the classic ways you ask your reputation after bad run and government is ready. a memoir embarrassing people. You just served wealth and showing that
All along, like you, were a voice for sanity and integrity on the inside and like the one of the great examples of this is Paulo kneel and the first Bush administration, Treasury secretary, like Rex tellers and came from, Businesses- and I was like a well known business guy, and he just I was ITALY, steam, ruled by the political side of the organization and then wrote this abbot work with run susskind to write this actually vicious memoir called, I think, is called the price of loyalty. If I'm not Miss Raiment and I think you can have a lot of that in the Trump administration in order for people like Sean Spice, her and much more to point like people, like Rex, tell us in to recapture the sort of integrity and their society standing after this they are going to have to make clear. They were one of the good guys, and the way we are going to do that to show like how bad the administration was, and you know how much they tried to make things better before their adrift.
Very very, very bad and sent a structure for the current White House right, because tromp and all that will then be receiving end of all of these highly credible leaks, highly credible memoirs in his business, I've trumpets made already signed non disclosure agreements. Programmes slide is Mozilla people signed, not discuss arguments. He had news. Are doing that in government. I dont believe he can do that, or at least has not done that, and so you're gonna get a stream of mammals, Is tat laws, big pieces, alot of people seeking an ongoing ways that, when they leave their friendly reporters, he can tell their side of the story too. It is very bad. Haven't administration with the pipeline in coming is folks who have no integrity, and the pipeline outgoing is folks have to somehow persuade the public that they actually have integrity, and the only way to do that is to show that they were part of this lake. garbage fire that they were just part of its very fucked up.
Sometimes hear. That means it's it's time for family vacations, for sons, green for four barbecues grilling in the back yard, Really. The most important thing to do this summer is prepare for families future with an estate plan from legal system, and quite is poisonous some other things you can do this summer, but its honestly more important than national make a well month is right round the corner and that's the perfect time to make sure you and your family prepared for the future, and it helps what your options are, because he was not a lot but that their network of independent attorneys is available in fifty states and they can work with make sure you can write estate. Storing National make a Wellman legal zooms point a bunch of helpful resources together all have one is to make it a little easier to ensure your family assets are protected. I so you know you ve been sort of delaying this you can. I know this is something you ought to do, which haven't gotten around to it. Illegals, who makes it really easy, is the perfect time to do it so keep listening but
information August and to find out more now check up legal zoomed com for special offers that are coming your way. You have family or own anything you care about How can one amiss in the meantime, save more by Andrew reads: a check out illegal zoom, dot com, that's illegals, whom cup. Hither, I'm Helen Rosner, one of the host of the iter Upso, another podcast, from the Vocs media podcast network. I know turning the main show over here, but I think you're gonna really like what my co host Gregg Mobutu and I are doing- and I want to make sure you know about it. The above all, is a weekly conversation with some of the smartest most successful most interesting people on earth about food use. But always about culture, creativity and being a human in the world on a recent greg- and I talked with David chain the man behind the global empire of Mamma, Fucker restaurants and one of the primary architects of the way we eat now in Secondly, candid conversation: king about coming to terms with this fame the rivalries and enemies that fuel him his quest to be
ass, angry dude and his fear of both failure and success you can find the eater Uppsala, Itunes accomplish eater or wherever great podcast can be found. We have our. We were white paper, it is in the end, be are working paper, as is our have it. So this is a Bert huddled check up before you check out retail clinics and emergency room use, Amazon, Diane Alexander at the Chicago fad Molly. Now on China, Currie at the Economics Department at Princeton, in with their exploring is what happens when you have all these retail clinics commented healthcare environment over the past five years, or so, as I'm sure you ve seen wherever it is, You live there's a lot more like clinics at Cps target at Rite aid usually staffed by practitioner open. Often longer hours open on the weekends end as these are really grown up over the past five years or so there's some kind of this question of what is due to how people use health care
you could do going either way. When you see a substitution is that Well, don't go to the emergency room as much because they, you know if they have an esprit de Gaulle, they have struck, throw they can just go to the retail clinic. They know exactly how much it will cost prices are usually posted there costs a lot less than emergency room. They get their care, they go home. So you could see a subsidy. in fact, or we have a lot of health research suggesting people just to use more health. Like when it is easier to get your sprained ankle checked out, maybe when gone to the emergency room because your terrified of a big emergency room bill. But if there's like guinea, fifty bucks you get gotta checked out at the minute clan. But maybe you will just decide to go to the minute clinic just to be safe. This is a paper looking at New Jersey and particular looking at the rise of retail, connects in New Jersey and what happened and the researchers find thing I
just sit in as they find that residents who live close to an open, clinic or twelve point, three percent less likely to go to the hour for the flu four point, one percent less likely to use ear for complications of diabetes there between four point, seven and eleven point four percent, less likely to go to the hour for common minor condition. These are things like sprains and, as the authors expected you as a control, they look at if people are less likely to go to the hour for things that clinic can't treat like like child birth or a fracture poisoning, and they find that those visits. Don't change those. Obviously, when people have legitimate emergencies, they are still going to be ye are at the same rights, and they estimate of this is happening all over New Jersey, that this suggests a potential savings as seventy million dollars of less spending on emergency care. So I was interested in this paper. Is I've? Had this quest about retail clan exit ages generate more healthcare spending hours. There actually substitution of fact, and my my hope in hunch was set
to end, I was excited. You see a paper that kind of had that finding that suggested people are doing a bit substituting that they're using the retail clinics to replace D. The emergency sperience. That was often the only option like at night or on weekends. Do we have any health outcomes data on the stuff nine in this particular paper? So I am conceptually prove minute, clinics and old up it. But the thing I know the people worry about a little bit is diagnostic, so you go in cause you thank you just have like a little flew. In fact you have strap and then it gets worse. The people who are worried about minute clinics becoming a sort of frontline care provider tend to worry about bigger things. Getting missed. That's a hard thing to pick up on the data
you need a very big sample size is, most things are just the flu where there is too cold or in a bail. I d be interested to see that date I mean in general. I I like us, because it backs at my intuitions that we should have more things like this, but I would love to see. Study would, like large scale, have health outcomes. All this It's interesting to me in looking at this study that, as Republicans, observe taken over the government and turn their eyes to health policy. Did they ve shown so little interest in this type of topic that I thought One of those smarter things that I heard from from conservatives are John Cochrane has when the lot about their sub, but so many people was that the affordable care ACT didn't really do that. Much to address like The supply side of the healthcare system like how can people in need of care not just financing by actually get someone who can
care of them, and we know you know they're there. These questions round regulation of many clinics, their questions, around scope of practice, nurse. Practitioners are allowed to to provide this questions around. You know how are hooters and more advanced, artificial intelligence gonna be able to enhance medical diagnostics, and it seemed like a promising area for people with straw. bias towards free market ology, but one to say they were gonna. Do something constructive to help people get health treatment would be to look at these kind of things Maybe we should change rules so that more states can explain their Binny clinic offerings, but this has been completely absent from their but will correct. You know repealed stop, even though every of research that that I've seen along these lines suggest that we really
do excessively restrict, who is able to provide healthcare services and in what kind of man, or are they able to provide them and in particular things like many? Lennox. You know they help address the sort of exactly the people who are not necessarily that helped. ach bike middle class issue. People who are not necessarily in need of like Hugh we are not in line four big kind of federal subsidies, but who benefit from convenience in and competition and lower costs. I mean
recapitulate our earlier conversation, but this seems to me to be part of the problem of not going through a real process in going through reconciliation and all the rest of it, though just wasn't, they didn't take time and have the flexibility to come up with the areas of cost control, and some one thing you would hope about legislating in America, even in a pretty partisan time, is that the left and the right both do have insights about how these things work and had to be focused a little bit on different problems, particularly that their policy wings of of the different it illogical movements. And so, as you cut a ping pong back and forth and control, you would get policy reflecting those insights and it Republicans have, in this case, decided to work in such a constrained. Quick and procedurally,
process, do not bring any of their more valuable insights to bear its just like total Calvin Ball. What can we do within the context of like the insurance regulations in subsidies within the affordable care act? Rhetoric, as you say that you really could have imagined a republican effort here that both restructured the affordable character and houses? but also a lot of stuff about occupational licensing and supply side constraints and How do you design insurance and an and there there are interesting ideas their bit in much awaited the Obama administration. Had this huge part of the immortal, the character is all about trying to move the system through Medicare through a paper performance, as opposed to a paper volume. pricing model, you know, Republicans have other versions of those more systemic critiques about delivery and Vienna, those
necessarily embodied in the affordable care actin- and it would have been probably valuable and have some of them thought through worked through and more embodied in this bill by recognise, has just taken this. bring it back to our, but it actually aiming at actually Thyssen dear question earlier about like what about the health outcomes is a risk of being seen and kind of Bio S. Experience practitioner anything the way these retail clinics, actually work best index of. Do you may think through in regulating them is when their integrated into a larger health systems are. One of the big concerns I hear from doctors is that retail connects are going to fragment care that their patient are. You know just gonna start going. The retail clinic doktor won't have like a complete sense of what actually going on in that person's life things that their being seen at this like kind of clinic they don't know about, but I know of a few expense
where these retail clinics are integrated into larger health systems that are working with local hospital system. They have a shared electronic medical record and then you get the sense. You really could deal with the health, comes issue. If you have some kind of new data sharing, we're someone's reviewing the stuff, that's been going on in the retail clinic or one of the things I mention this paper about New Jersey them mitigate some of the negative health outcomes. Is they their licensing works where the nurse practitioners they have to be supervised by the doctor, but the doktor doesn't necessarily need to be there. They have convict a protocol lest where, if some expires, anything happens, they are required to call this revising doctor and get kind of a consult with them and to increase integration with other parts of the healthcare system may think could mitigate the fragmentation of the concerns about help out.
and could be something you know a state legislature looks out when they think about how do we want these retail clinics to work like how can they best serve? The people who live in our state seems right. State legislators. If you listening Yes, and if you want to serve your friends best, I recognize that they listen to the weeds. Tell them leave us or of Itunes, you could join our Facebook group and become part of awesome growing community that talks about all sorts of nerdy policy things, are a lot of great threads happening about health policy. Lately that I have been really really enjoying, you could It also to yourself a service by listening to some other vocs media podcast such as the US. I shall or worldly are newborn falsified costs, which has been really excellently, or I think your interesting with tobacco, of which, if you want to stop thinking about politics and policy, all the time which I think is probably the thing to do is cultural interviews are really fantastic.
thanks to our producers of Peter Leonard, enjoying mine, Berger for producing thanks to our friends here that mean public radio in Bangalore who helped us out, we are going to be back on Friday. We will be talking about whatever it is that emerges from this mysterious Senate healthcare process, so think someone for listening and we'll see you in a couple days
Transcript generated on 2021-09-13.