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The Republicans’ Governance Problem

Donald Trump Paul RyanSpeaker Paul Ryan after last week’s legislative debacle:

“We were a 10-year opposition party, where being against things was easy to do,” Mr. Ryan said at a sheepish news conference shortly after the bill was pulled, adding with uncharacteristic candor that Republicans were not yet prepared to be a “governing party.”

“We will get there,” Mr. Ryan said, “but we weren’t there today.”

This statement ranked up there with the President’s statement about not getting any Democratic votes in terms of being both telling and ridiculous.  Any reasonably informed observer of US politics knew that the way Ryan approached the vote had the real chance to result, as it did, in a political disaster for his party.  And Ryan himself should know how the House works, having been first elected to the chamber almost 20 years ago (in 1998).

Beyond that, Ryan’s statement about being in the opposition is ludicrous insofar as while the Republicans have not controlled the White House for two terms, the reality is that they have been a majority party in one or both chamber of the congress for quite some time.  To wit: since the “Republican Revolution” of 1994 there have been twelve congresses.  Of those, the Republicans have controlled the House 10 out of 12 times.  The Democrats controlled the House for the 110th (2007-2009) and the 111th (2009-2011).  In Ryan’s own career the party has been in majority in the House for 16 of 20 years.  In the Senate, the Republicans controlled the chamber seven out of 12 congresses, the Democrats four of 12, and one (the 107th) both parties had control during some part of the session.  Hence, seven of 12 congresses from 1994 to the present were controlled by the GOP (and during the period of time the Republicans controlled the 107th Senate, they also controlled the entire legislature).  In terms of fully unified government (i.e., control of the congress and the White House), we find that over this period of time the Republicans have enjoyed pure unified government three times:  Bush twice (the 108th, and the 109th) and now Trump (the 115th).  Bush also had part of the 107th.  The Democrats have only only had pure unified government once:  Obama (the 11th).  In terms of pure divided government the cases were:  Clinton (104th, 105th, and 106th). Bush (110th), and Obama (114th).  The remaining cases have a split in the two chambers (part of the 107th, the 112th and the 113th).

All of the above should underscore that the Republicans have no reason to behave like a pure opposition party or to act as if they have somehow been socialized so that they don’t know how to govern.  Indeed, over that period of time they have had more time as the pure party of government than has the Democratic party.

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About Steven L. Taylor
Steven L. Taylor is Professor of Political Science and Dean of the College of Arts and Sciences at Troy University. His main areas of expertise include parties, elections, and the institutional design of democracies. His most recent book is the co-authored A Different Democracy: American Government in a 31-Country Perspective. He earned his Ph.D. from the University of Texas and his BA from the University of California, Irvine. He has been blogging since 2003 (originally at the now defunct Poliblog). Follow Steven on Twitter

Comments

  1. Daryl's other brother Darryl says:

    How many times did Ryan say he was coming out with a replacement for Obamacare…only to not come out with a replacement for Obamacare? They had 7 years to do it and they simply could not. They are incompetent. They are fundamentally incapable of governing.
    This…and all the other chaos that has happened in DC since Jan 20th…is of their own making.
    Now you have Putin and ISIS and Al Qaeda and N. Korea looking at the US and seeing a rudderless ship being captained by fools who are fundamentally unprepared to respond to any kind of crisis.
    This does not end well.

    Highly-rated. Helpful or Unhelpful: Thumb up 26 Thumb down 0

  2. Eric Florack says:

    As it turned out the problem with his experiment was that for the rest of his life, every time he heard a bell ring, Pavliv had to get up and feed the dogs.

    So it is with mr. Ryan He’s been trained to Lose.
    The better way to go would have been something along these lines…

    “Effective as of Dec. 31, 2017, the Patient Protection and Affordable Care Act is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted.”

    Poorly-rated. Helpful or Unhelpful: Thumb up 2 Thumb down 39

  3. KM says:

    “We were a 10-year opposition party, where being against things was easy to do,” Mr. Ryan said at a sheepish news conference

    “Doing stuff is hard, m’kay? We had *no* idea that we had to do more work then complaining because we’ve had like a decade to kick back and bitch at liberals. Do you know how long a decade is? As long as Big Bang Theory’s been around! That’s a long time to not give a damn and now you expect us to have this? We thought you voted for us because you liked us and we’re naturally awesome, not because you wanted us to make things work!”

    Like or Dislike: Thumb up 12 Thumb down 0

  4. Joe says:

    @Daryl’s other brother Darryl:

    Perhaps the only cohesion of the Republican Congress is what they can agree to hate (Obama/Democrats). Now that they actually have to do something, we learn they are not one party at all, but several competing smaller factions. Surprise!

    Like or Dislike: Thumb up 11 Thumb down 0

  5. Pch101 says:

    When the Republicans adopted the Southern Strategy, they changed the nature of US party politics from a split that was largely urban vs rural to one that was primarily cultural (white male vs everyone else.)

    Now we are seeing that same culture war occurring within the GOP between a group of semi-angry white males with some intellectual pretensions (the establishment) and a group of angrier white males that is aggressively anti-intellectual (the Tea Party). The culture war is now being waged on two fronts.

    I suspect Ryan will raise the white flag because he sees surrender as being preferable to a broken coalition that helps Democrats. He doesn’t appreciate that his entire wing of the party is under siege due to the establishment’s commitment to the 11th commandment (“thou shalt not speak ill of a fellow Republican”), a commitment that is not shared by the other side.

    That capitulation is convenient in the short run, but will only enable the other side to take over. The GOP may talk about not negotiating with terrorists, but they obviously don’t mean it.

    Like or Dislike: Thumb up 8 Thumb down 0

  6. Kylopod says:

    For better or worse, much of Bush’s agenda was relatively popular at the time he was in office. His tax cuts for the rich were mixed with middle class tax cuts, and he passed or attempted a lot of middle-of-the-road stuff such as Medicare D, NCLB, and immigration reform. Even the Iraq War resolution was initially popular. When he finally tried to do something highly unpopular–the Social Security privatization scheme in 2005–it went down in flames.

    It’s certainly possible for Congress to pass things that are unpopular (TARP, Obamacare), but it isn’t easy. A big part of the GOP’s problem is that much of their agenda today is simply unpopular. This is even truer today than it was a decade or two ago, partly because the public has moved left on some issues in that time (e.g. gay marriage), and partly because the GOP has moved rightward.

    Not surprisingly, the GOP Congress under Obama was one of the most unpopular Congresses in memory–and yet it didn’t stop that Congress from being reelected, again and again and again. That fact, coupled with the failure of most of their agenda to see the light of day due to a Democrat being at the top, helped cushion them from the consequences of an unpopular agenda. Now, they no longer have that protection.

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  7. MarkedMan says:

    The Republicans attempt to operate as if they had no opposition. They decided, essentially during Newt Gingrich’s time, that they would never compromise with Dems, but only within the party. This means they have to have near unanimity on everything. “But”, you might say, “That is an incredibly stupid way to try to accomplish anything”. The clever Republicans realize, however, that if they accomplish something they will be blamed for it. Much better to simply point out how bad everything is and do nothing. They can get unanimity on that.

    Highly-rated. Helpful or Unhelpful: Thumb up 15 Thumb down 0

  8. Neil Hudelson says:

    @Eric Florack:

    “Effective as of Dec. 31, 2017, the Patient Protection and Affordable Care Act is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted.”

    Sure. And then all the moderate Republicans who balked at the lack of coverage from the AHCA, their concerns would just dissipate in front of the awe-inspiring eloquence of two short sentences, and Washington would begin running smoothly again.

    Seriously, you just watched major legislation crash and burn because the leaders of the GOP thought that “tough talk+demonizing health coverage = easy governance” and your solution is “we need more tough talk and demonizing health coverage.”

    Highly-rated. Helpful or Unhelpful: Thumb up 30 Thumb down 1

  9. grumpy realist says:

    Well, considering that China is taking a 5% stake in Elon Musk’s electric car company….

    I suspect the Republicans will manage to get their beloved tax cuts by trashing the rest of the US infrastructure and continue to convince their supporters that If You’re Not Making It It’s Your Own Fault.

    And at some point, China WILL take over as being Numero Uno. They’ve got the population, they’re ramping up on the science and technology, and by the time the US gets around to figuring out what’s going on, we will discover that we would be trying to fight a war with fighter jets against an enemy who can take our entire electrical network down with one EMF burst. Not to mention other cyberwar tactics.

    Let the stupidity of the average American cause us to sink into the mud. We managed to take Alpha Dog position off the brains of the refugees from Europe who fled here before WWII broke out. But that was always something of a bad fit with the average American mentality, and now we’re seeing the result.

    Highly-rated. Helpful or Unhelpful: Thumb up 17 Thumb down 1

  10. Daryl's other brother Darryl says:

    OT…apparently Jared Kushner met with executives of Russian state development bank Vnesheconombank (VEB)…which is tantamount to meeting with Putin. Sergey Gorkov was appointed Putin after working for eight years at Russia’s biggest state-owned commercial bank. Gorkov attended the Russian academy of Federal Security Service, which trains people to work in Russia’s intelligence and security forces.
    This just keeps getting better.
    Putin is playing fools like Trump and Nunes like a piano.

    http://www.independent.co.uk/news/world/americas/jared-kushner-russia-bank-vnesheconombank-donald-trump-son-in-law-ukraine-ivanka-husband-us-senate-a7654156.html

    Like or Dislike: Thumb up 9 Thumb down 0

  11. al-Alameda says:

    @Eric Florack:

    “Effective as of Dec. 31, 2017, the Patient Protection and Affordable Care Act is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted.”

    Trouble is, that language and the consequences therein, appeals only to the 24 members of the Bircher-Freedom Caucus, and not to the other 180 or so members of the Republican delegation most of whom are NOT excited about campaigning in 2018 after having voted to un-insure 20 million people.

    Like or Dislike: Thumb up 9 Thumb down 0

  12. Slugger says:

    When Boehner resigned, there was no clear successor. Boehner agreed to defer his retirement till this issue could be settled. Ryan played the reluctant bride untill he finally accepted the job. I think that in part he wanted to be courted, but he also realized that there are real problems with the job. In our system, there are only two parties. The GOP is a coalition of interests that are frequently in opposition. The Main Street businessman, the Wall Streeter, the religious right, the defense hardliners, the fiscal conservative, etc have interests that simply do not align. On top of this we have an over the top culture of winner take all and debate by insult. It would take a real genius to resolve this situation; there are no geniuses out there.
    The Democrats are slightly better off by being largely the party of a single segment, the liberal urbanites, but that segment while the biggest segment in our society is not big enough to hold the government.
    This is our normal.

    Like or Dislike: Thumb up 6 Thumb down 0

  13. michael reynolds says:

    @Neil Hudelson:
    Republicans think the answer to every question is “more manliness.” Even Republican women think that. It’s never ‘be smarter’ or, ‘re-think’ it’s always about sounding tough. They’re very insecure about their manhood.

    Highly-rated. Helpful or Unhelpful: Thumb up 20 Thumb down 0

  14. Eric Florack says:

    @Neil Hudelson: you mean the Democrats.

    In case you haven’t noticed there were a number of supposed moderate Republicans who wouldn’t vote for Ryan’s piece of crap either. Like Ryan, you underestimate I think how unpopular Obamacare actually was

    Poorly-rated. Helpful or Unhelpful: Thumb up 0 Thumb down 17

  15. Neil Hudelson says:

    @Eric Florack:

    In case you haven’t noticed there were a number of supposed moderate Republicans who wouldn’t vote for Ryan’s piece of crap either.

    No no, I get that part. I think you are having trouble comprehending what that means, tactically.

    Highly-rated. Helpful or Unhelpful: Thumb up 16 Thumb down 0

  16. MarkedMan says:

    @Daryl’s other brother Darryl:

    apparently Jared Kushner met with executives of Russian state development bank Vnesheconombank (VEB)

    So – yet another of Trump’s inner circle met with sketchy Russians. I’ve honestly lost count at this point. Is anyone compiling a list of all the people we found out met with the oligarchs after Trump assured us that no one in his campaign/government had any contact with them? And, if I recall correctly, Kushner would have met after this had started blowing up in the press? What was so important that it would have been worth it?

    Like or Dislike: Thumb up 9 Thumb down 0

  17. Kylopod says:

    @Eric Florack:

    Like Ryan, you underestimate I think how unpopular Obamacare actually was

    RCP average: 48% for, 43.8% against.

    You’d better update your talking points, bro.

    Highly-rated. Helpful or Unhelpful: Thumb up 15 Thumb down 0

  18. @Kylopod: Not to mention that it has always been the case that certain parts of the bill, when polled individually, are quite popular. This is why repeal is difficult.

    Like or Dislike: Thumb up 12 Thumb down 0

  19. gVOR08 says:

    Hacker and Pierson, IIRC, talked about “drift”, the difficulty of pushing legislation in the U. S. system coupled with inaction favoring the status quo. Establishment GOPs would like the already low taxes on themselves to be lower. They’d also like fewer regulations on their businesses. But these aren’t urgent, must have this year, things. For the most part, the sponsors of the GOPs are content with not much getting done.

    Amongst other things, establishment GOPs recognize that their opposition to O’care was driven by politics, not economics. They don’t really care that much about repealing it.

    Like or Dislike: Thumb up 4 Thumb down 0

  20. @Eric Florack:

    The better way to go would have been something along these lines…

    “Effective as of Dec. 31, 2017, the Patient Protection and Affordable Care Act is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted.”

    But, in all seriousness, it is not that simple. Indeed, that kind of simplistic thinking about government and process in general is why the Republicans are in the mess they are in,

    That proposal is talk radio level politics–which ultimately has no bearing on how legislation works, either terms of the process (such as the fact that only some of the ACA can be repealed via the budget reconciliation process to avoid a filibuster) and basic politics (as per my previous comment, parts of the ACA are quite popular, which is why getting the needed votes is not easy).

    Highly-rated. Helpful or Unhelpful: Thumb up 23 Thumb down 0

  21. DrDaveT says:

    @Slugger:

    The Democrats are slightly better off by being largely the party of a single segment, the liberal urbanites

    I think you’re right that the Dems are better off, but that’s not the reason. Warren Buffet and Eleanor Holmes Norton do not speak for a single liberal urban cohort.

    The Dems are better off because they all agree on what the goal is, and only disagree on means. Republicans have fundamental internal disputes on what success looks like. For some, it has to do with enabling plutocracy. For some, it has to do with enforcing a particular flavor of Christian morality on everyone. For some, it has to do with minimal legal constraints on personal choices. (See the contradiction there?) For some, it has to do with reducing the deficit and protecting investment markets. For some, it has to do with keeping brown people away, or at least in their place, and keeping women from competing with men.

    Democrats agree on what success looks like; Republicans do not.

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  22. Tony W says:

    As every soldier and construction worker knows, it’s much harder to build something than to destroy it. Years of work can be destroyed by a simple bomb.

    Democrats, as usual, are loathe to play hardball, so I predict we’ll have the typical pattern of sending in the D’s to clean up this mess in a few years. The trouble is that uncertainty over health care hangs over our head – and will do so until the R’s settle on something.

    To leverage @KM‘s reference, the Republican party is Sheldon Cooper on Big Bang Theory. Everyone just tiptoes around them because there’s no point in arguing.

    Like or Dislike: Thumb up 6 Thumb down 0

  23. MBunge says:

    Sorry to be a jerk but I can’t decide which is dumber, Ryan’s statement or Dr. Taylor’s response. I’m leaning toward the latter because at least Ryan was speaking off the cuff. Dr. Taylor sat down, thought about it and then wrote out something so literal that it could have come from someone on the autism spectrum.

    Heck, the GOP’s refusal to be a responsible part of our governing process wasn’t even the main issue here. It ranks no higher than #4 behind…

    1. Ryan’s incompetence.
    2. The mindless refusal of most in our politics, GOP and Dem, to even consider single payer.
    3. Trump’s incompetence.

    Mike

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  24. Daryl's other brother Darryl says:

    @MBunge:

    it could have come from someone on the autism spectrum.

    Apparently your understanding of autism is on the same level as your understanding of politics and governance.

    Highly-rated. Helpful or Unhelpful: Thumb up 16 Thumb down 0

  25. al-Alameda says:

    @MBunge:

    The mindless refusal of most in our politics, GOP and Dem, to even consider single payer.

    I believe that most Democrats want single-payer, it’s that they do not see anything resembling broad political support for it.

    Or, if you like, they’re feeling somewhat burned by the scorched earth politics of health care reform in recent years and they definitely are wary of going to the mat on this one.

    Like or Dislike: Thumb up 11 Thumb down 0

  26. ...ig'nint... says:

    @Neil Hudelson: Well true enough, but Eric is part of the wing of the GOP who believe that governance is for the exclusive benefit of (insert own name here). His solution to the healthcare problem is that there is no healthcare problem. If someone doesn’t get healthcare, it’s their own dam’ fault–they should have lived someplace where healthcare is available and worked for a company that provides insurance.

    In his world, the people are waiting for the private enterprise street gutter and catch basin company to sell gutters and catch basins on their street.

    And storm sewers–don’t forget how much market there is for them.

    Like or Dislike: Thumb up 5 Thumb down 0

  27. Yank says:

    The Dems are better off because they all agree on what the goal is, and only disagree on means

    Bingo.

    This is the biggest difference between the two parties. Healthcare is the perfect example of this. Democrats may have disagreed on the method (ex. single payer, market-based etc.), but they all agreed that the goal was universal coverage. The GOP on the other hand, has two different factions when it comes to healthcare and their goals are irreconcilable (half of the party wants a market-based plan like the ACA, but more conservative, but others don’t want a healthcare system at all.)

    Honestly, this GOP controlled congress isn’t going to get anything of significance done. Even tax reform, which is something they want to do has major hurdles because of the many different factions inside the party.

    Like or Dislike: Thumb up 6 Thumb down 0

  28. teve tory says:

    Real tax reform is a heavy lift. These clowns couldn’t even bring to a vote their own healthcare bill. I expect they’ll futz around for a while, settle on some deficit-busting giveaways to the rich, and call it a day.

    Like or Dislike: Thumb up 6 Thumb down 0

  29. teve tory says:

    “Reagan proved that deficits don’t matter,” –Dick Cheney

    Like or Dislike: Thumb up 1 Thumb down 0

  30. teve tory says:

    Reagan–deficits go up.
    Clinton–deficits go down.
    GWB–deficits go up.
    Obama–deficits go down.
    Trump–?

    Like or Dislike: Thumb up 6 Thumb down 0

  31. S. Fields says:

    @MBunge:

    I should know better than to read further any comment that starts with “Sorry to be a jerk…” but I read your post anyway. I think Dr. Taylor is much closer to the mark than you, so maybe you might cool it with the personal insults.

    Chalking up the failure of the AHCA to individual incompetence in Ryan and Trump is dangerously misguided as it might encourage complacency as they move to other parts of the GOP agenda that won’t inspire the level of passionate resistance something as personal as health care garnered. False equivalence between the Democrats and Republicans on single payer is grossly disingenuous as well. The Dems may lack the courage to push hard for a truly progressive solution on health care, but the GOP wants badly to go the opposite direction. These are not the same positions and you know it.

    No, Dr. Taylor is right that the GOP’s seeming disarray at the moment is nothing new, but the continuation of a deliberate dismissal of good governance over 20 years in the making. Nonetheless, the Republicans continue to summon sufficient support to control the White House, both chambers of Congress and a majority of statehouses across the country. So, those of us who don’t want to see the country taken where Republicans would generally have it go had better hope that they keep holding good governance in contempt. Should the GOP realize how effectively they could use government to advance their agenda, they have the means and (dare I say) the competence to make it happen.

    Like or Dislike: Thumb up 5 Thumb down 0

  32. Kylopod says:

    @MBunge:

    The mindless refusal of most in our politics, GOP and Dem, to even consider single payer.

    There is nothing mindless about it. It comes from decades of political experience. Ever since Truman tried to pass single-payer in the 1940s, only to have his proposal go down in flames, all such attempts and even the more modest attempts at health-care reform from LBJ, Nixon, and Clinton have met with fierce resistance from the powerful medical lobby, which is an even bigger impediment to reform than the insurance companies. It’s the reason why Ted Kennedy (one of the most important players in the development of Obamacare), after years of advocating single-payer, concluded it was politically untenable in the United States. He was right.

    It’s easy enough to say the politicians should consider single-payer, but the simple fact is that our political system, at this time, is not open to it. And proposing it, therefore, is a nonstarter. Tell me, which Republicans in Congress would be open to voting for such a proposal? Which red-state Democrats?

    I’m not saying it’s totally out of the question that single-payer will one day happen in this country. But the reason it hasn’t happened is not for lack of trying.

    Like or Dislike: Thumb up 11 Thumb down 1

  33. Daryl's other brother Darryl says:

    @…ig’nint…:

    His solution to the healthcare problem is that there is no healthcare problem

    Right…that old fwcking racist is likely just a taker…living on SS and Medicare and the rest of “the others” be damned.

    Like or Dislike: Thumb up 3 Thumb down 0

  34. Yank says:

    @Kylopod: Yeah, single payer will never happen in America. Best case scenario is that the US eventually gets a multi-payer system like they have in the Netherlands, and they can do that by pushing for a public option.

    Like or Dislike: Thumb up 2 Thumb down 0

  35. Jim Brown 32 says:

    @Kylopod: Im curious, what do you believe the medical lobby’s beef with single payer is?

    Like or Dislike: Thumb up 3 Thumb down 0

  36. MarkedMan says:

    FWIW, a big, big trend in medicine is for more and more clinicians to forego the “small business” approach and get directly hired by a hospital or other provider. I’ve talked to dozens of clinicians about this and, whether they are contemplating it for themselves or not, they agree the major benefit is to avoid having to hire 5-10 people to handle the insurance and billing, and have to see twice as many patients in order to cover their salary and benefits, and therefore spend half as much time with each patient, and (for the really conscientious ones) spending an hour or more a day on the phone arguing with glorified clerks at the insurance companies about whether a treatment is medically necessary or not. Or on a different phone with a pharmacist trying to figure out a medicine that is covered by this specific patient’s almost unique health care plan from one of the hundreds (thousands) offered by each of the major insurers. And by the way, these clinicians are where much of medical innovation comes from, because a clinician can try just about any treatment, or use a medical device in any way they want, or prescribe a drug off label. All things the manufacturer’s employees would (justifiably) go to jail for. There are also good things that come out of large hospitals but in general they are less likely to rock the boat than an individual surgeon who has a great idea.

    To sum up, the Republicans “philosophy” of government leads to small businesses closing their doors and selling out to conglomerates. And less innovation. And more bureaucracy.

    Like or Dislike: Thumb up 5 Thumb down 0

  37. Ben Wolf says:

    From what I can see, Ryan wasn’t particularly concerned with anything but getting that $330 billion in “savings” to apply to his real goal, a massive tax cut entirely targeted toward the wealthy. I think he believed republicans would simply fall into with that regardless of how bad the bill was. Now that it has failed and those so-called savings won’t be realized, that tax cut and Trump’s faux infrastructure bill are looking mighty iffy.

    Like or Dislike: Thumb up 6 Thumb down 0

  38. the Q says:

    …..Democrats agree on what success looks like….WTF?

    I guess it looks like losing 1,500 seats the last 8 years in state houses…it looks like the most GOP Governors in history….it looks like the most GOP Congresspeople ever elected 2 years ago…it looks like a GOP Senate…it looks like losing the Supreme Court for a generation…..it looks like nominating a paranoid, centrist, unpopular corporatist as our nominee and a VP who couldn’t carry any of the four upper midwest blue collar states….it looks like an unhinged lunatic being elected, tax cuts for the rich and bloated military spending (again)….

    The GOP should be in ruins and a permanent minority party. The Dems should be destroying them on the repeal/replace fiasco and unmasking them for what they truly are – the party of property, privilege and the pampered

    But instead, we still get the sanctuary nonsense, the TG crusade…the feckless, tired duo of Schumer and Pelosi and the same middle of the road DLCers in charge (Perez).

    Maybe Obama could’ve called the CEO of Ford and played the game of actually giving a shiite about losing auto worker jobs in crucial swing states, or maybe played up the huge numbers of illegals his administration was actually deporting instead of keeping it hidden so as not to upset a small percentage of Dem voters.

    In short, absent POTUS, the Dems are in free fall and it took the election of a truly horrible narcissist to save the Dems from themselves.

    Like or Dislike: Thumb up 0 Thumb down 11

  39. Pylon says:

    @Jim Brown 32:

    At the risk of answering for Kylopod, single payer puts the medical industry at a bigger disadvantage in negotiating fees for various treatments.

    Like or Dislike: Thumb up 6 Thumb down 0

  40. the Q says:

    …..a big, big trend in medicine is for more and more clinicians to forego the “small business” approach and get directly hired by a hospital…

    And these hospitals can bill many times higher for outpatient services than can a doctor. Why didnt’ obamacare address this greed?

    “Across the country hospital systems are scouring the market in attempts to acquire physician groups,” said Medical Billing Advocates of America in an article on its website. “This has contributed to increased costs so far, because some of the services and procedures that were formerly billed as doctor visits are now being billed as outpatient services – even if it is the same office. In one year, this [facilities fee] added up to $1.5 billion more in charges to the Medicare program.”

    Medical Billing Advocates referred to this practice as “a real cash cow for hospital systems.”

    Like or Dislike: Thumb up 0 Thumb down 6

  41. Yank says:

    Maybe Obama could’ve called the CEO of Ford and played the game of actually giving a shiite about losing auto worker jobs in crucial swing states,

    You do realize it was Obama who signed the auto bailout in 2009?

    Also give me a break about the feckless leadership of Schumer and Pelosi. Schumer is trying to get the Democrats to force the nuclear option when it comes to Gorsuch. Pelosi, as usually, kept her caucus together, when some in Trump states could have helped themselves by teaming up with moderate Republicans to give him a “win” on healthcare.

    The congressional Democrats have been handling this just fine.

    Like or Dislike: Thumb up 8 Thumb down 0

  42. DrDaveT says:

    @the Q:

    Democrats agree on what success looks like….WTF?

    Seems like a simple enough concept to me. Which part of it confuses you?

    I guess it looks like losing 1,500 seats the last 8 years in state houses…it looks like the most GOP Governors in history….it looks like the most GOP Congresspeople ever elected 2 years ago…

    Ah, I see — you are confused by the difference between “knowing what an elephant looks like” and “being an elephant”, or “knowing what a back handspring looks like” and “being able to do a back handspring”.

    Democrats all agree on what outcomes they would prefer. They agree on what government is for. They agree on how to compare two systems and say which one is better. They agree on what ‘better’ means, and that we should be working to make things better.

    This does not in any way imply that they agree on how best to make things better, or on which changes have highest priority, or on what political tactics will be most effective, or on how to get elected in the first place. I didn’t say they were effectual; I said that they agree on what they would like to accomplish. Unlike Republicans.

    Like or Dislike: Thumb up 8 Thumb down 0

  43. grumpy realist says:

    @S. Fields: No, no, let MBunge and the Republicans totally misconstrue the situation and charge ahead for their great coming victory on tax reform. “Never interrupt your enemy when he is making a mistake.”

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  44. Just 'nutha ig'nint cracker says:

    @Jim Brown 32: I can’t speak for Kylopod, but my cousin the cardiologist’s objection to single payer was always that it would cause a leveling of income for physicians so that cardiologists and neurosurgeons, for example, would not be able to make several times what general practitioners and pulmonologists make on a per patient basis (and from much smaller sized practices). From what I can see from my time in Korea, he was right.

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  45. Surreal American says:

    @MBunge:

    …that it could have come from someone on the autism spectrum

    GDIAF

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  46. Barry says:

    @Eric Florack: “Effective as of Dec. 31, 2017, the Patient Protection and Affordable Care Act is repealed, and the provisions of law amended or repealed by such Act are restored or revived as if such Act had not been enacted.”

    One wing was unwilling to take ‘yes’ for an answer, the opposite wing was unwilling to take ‘we f*ck the people over, and you lose your seats’ for an answer.

    Your idea is even worse, as it screws over people and would lead to a clusterfrack of trying to figure out a zillion laws being reset to 2010, even though stuff will have changed since then.

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  47. An Interested Party says:

    Sorry to be a jerk…

    Actually it would have been preferable for you to be a jerk rather than being foolish with your silly analysis…that is what you should be apologizing for…

    From what I can see, Ryan wasn’t particularly concerned with anything but getting that $330 billion in “savings” to apply to his real goal, a massive tax cut entirely targeted toward the wealthy.

    This point can’t be stressed enough…this disaster of a bill was a tax cut for the wealthy cloaked in health care “reform”…it is no wonder that Ryan is so incompetent as all he seems to care about is cutting the taxes of rich people, with all other considerations being damned…

    But instead, we still get the sanctuary nonsense, the TG crusade…

    Oh yes, how terrible that Democrats would be worried about the rights of minorities and the protection of the marginalized…what could they be thinking…

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  48. @MBunge:

    then wrote out something so literal that it could have come from someone on the autism spectrum.

    Well, it is called a “recitation of facts” with which, of course, you are free to do as will. Why, however, you would take time out of your day to a) read what I wrote, and then b) negatively comment on it, is beyond me.

    And I find your usage of a linkage to the spectrum as though it is an insult to be rather revealing of your character.

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  49. Kylopod says:

    @Pylon:

    At the risk of answering for Kylopod, single payer puts the medical industry at a bigger disadvantage in negotiating fees for various treatments.

    That’s pretty much it, though I’ve heard other arguments as well, such as the idea that it will depress medical innovation (which I think is a load of BS). One way or another, a lot of physicians see single-payer (and to a lesser degree other forms of universal health care) as a threat to their financial security and professional independence.

    As a historical note, the AMA opposed even private health insurance when it first emerged in the 1930s. They eventually made peace with the private companies, realizing it was the only way to prevent the US from developing a national system as so many other countries had done.

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  50. Eric Florack says:

    @Neil Hudelson: it’s interesting you should mention that because the only way it makes sense is if you ignore the 60-plus times the house voted to overturn Obamacare since the Democrats rammed it through.

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  51. HarvardLaw92 says:

    @Eric Florack:

    It’s easy to vote for something nebulous, solely for the optics you want to sell to your idiot base, when you know that it has absolutely zero hope of actually being enacted. You’ve confused governance with theater.

    Like much of the Republican base these days, you’re evidently too stupid to be able to tell the difference.

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  52. @HarvardLaw92:

    You’ve confused governance with theater.

    Which is a good summation of much of the GOP approach these days.

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  53. (Which, I would add, should concern serious Republicans as much as it concerns serious Democrats–this is neither good for the party nor for the country at large).

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  54. teve tory says:

    @HarvardLaw92:

    Like much of the Republican base these days, you’re evidently too stupid to be able to tell the difference.

    74% of republicans now believe that Obama had Trump’s office wiretapped:

    CBS poll

    they’re just not good at figuring shit out, or separating truth from BS.

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  55. KM says:

    @Just ‘nutha ig’nint cracker:
    Awww poor widdle surgeons, not being treated like God’s gift to man and better then those nose-wipers down in the clinics.

    Sorry, worked in a hospital for too long to not have some serious schadenfreude at the thought. All doctors rack up huge education debts but for some reason certain fields get all the pay and others get all the crap. I respect surgeons for their skills but the idea that a GP should make less then an specialist is ridiculous. Do we tell every education major they should be a college professor since it pays more then teaching third grade? That’s how we end up with a shortage of elementary school teachers and a surplus of unemployed English majors who want to teach Chaucer.

    @Kylopod:

    as a threat to their financial security and professional independence.

    Oh hell yes it is. There’s some nice profit margins involved in saving people’s lives. A poor doctor is usually one that’s got serious life problems since even a crappy one will pull way more then then average American makes. Still, we talking about cutting into the margins, not dropping them down several tax brackets. It’s difficult to muster pity for someone who’s going to have to downgrade from a blinged-out BMV from someone who’s taking buses every day to pay be able to pay for that medical service. Your average voter won’t really care about the doctor’s plight since they are too concerned with their own.

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  56. Moosebreath says:

    This piece by Hacker and Pierson is a good post mortem on the Republicans governance problem. Since all Republican policies must have the goal of class warfare on behalf of the upper class (aka tax cuts for the rich and cutting social programs for the poor), this was a major constraint on what the plan needed to look like:

    “Postmortem analyses have stressed what a mess the bill was. Somehow, Republicans managed to craft a policy that simultaneously raised premiums and out-of-pocket costs, lowered the quality of insurance plans, increased the chances of insurance market death spirals, put new pressure on state budgets, and massively increased the ranks of the uninsured. Were these ugly outcomes evidence of sheer policymaking ineptitude? Incompetence was certainly a factor, but the main reason for the bill’s flaws was the overriding priority Republicans placed on repealing the taxes on high-income households and on health care companies— taxes that had financed the Affordable Care Act. The AHCA was, above all, intended to deliver a huge tax cut to a narrow set of beneficiaries. All else flowed from this central objective.”

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  57. Pch101 says:

    @teve tory:

    The Republican party is now a club for stupid people. Think of it as a sort of anti-Mensa.

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  58. teve tory says:

    Shortly after Bobby Jindal said “We’ve got to stop being the stupid party” he was kicked to the curb.

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  59. teve tory says:

    Shit, this very a.m. i opened up FB to see a friend-of-a-friend praise trump for being a “workaholic” on behalf of the American People. His post ended with “Thank You, Mr. President.”

    So yeah, if you’re a complete moron, there’s a party for that.

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  60. grumpy realist says:

    @teve tory: This is why I’m thinking that the main supporters of Donald Trump are the aggrieved who are looking for someone to blame.

    Trump? A”workaholic”? The man who has spent one out of three days since he was inaugurated playing golf?

    Yeah, that’s some “workaholism”.

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  61. HarvardLaw92 says:

    @grumpy realist:

    This is why I’m thinking that the main supporters of Donald Trump are the aggrieved who are looking for someone to blame.

    Agreed. It’s the prime example of a constituency of the disaffected.

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  62. DrDaveT says:

    @KM:

    A poor doctor is usually one that’s got serious life problems

    The chairman of the department where I used to teach ran a very profitable side business of community urgent-care clinics. His business model was to hire financially compromised MDs with e.g. gambling or shopping addictions, and escrow most of their pay against debt repayment and deferred compensation. He got good doctors for cheap, and had no trouble finding a replacement if somebody didn’t work out.

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  63. Monala says:

    @HarvardLaw92: A Republican congressman recently admitted it as much, calling those Obamacare repeal votes, “Fantasy football,” something they only did because they knew Obama would veto it. When it came time to repeal O’care with a Republican president, they weren’t so willing.

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