Pod Save America - "The dogs who caught the car."

Episode Date: March 9, 2017

Paul Ryan struggles to pass a tax cut for the rich disguised as health care reform, and Vox.com's Ezra Klein joins Jon and Dan to break down all the policy pitfalls of Trumpcare.

Welcome to Pod Save America. I'm Jon Favreau. I'm Dan Pfeiffer. On the pod today, we have the founder of Vox.com, Ezra Klein, as he's going to walk through all this healthcare stuff with us. Before we get going, check out, as always, Pod Save the World this week. Tommy interviews the Obama administration's former ambassador to Russia, Mike McFaul. It's a great interview. And also tomorrow, Annamarie Cox on With Friends Like These interviews Republican strategist Rick Wilson.

So Rick is pretty funny. So check that out tomorrow. Okay, so we got a lot of healthcare news to talk about today. But let's do all of our non-healthcare news first, if there's anything else in the news that we care to speak about. One thing you mentioned to me, Dan, was there was a little dinner at the White House last night. Yeah, can I run a hypothetical by you?

Please. All right, let's say that I went on national television and insulted Emily. And then I went on national television and suggested that your father was responsible for killing JFK. Would you accept my invite to dinner after that? After I called you a sniveling coward and a sociopath? And I called you a narcissist and a pathological liar? Yeah, sure. Let's break bread.

I hear there's great meatloaf at the White House. Let's go have it. Yes, Ted Cruz and Heidi Cruz went to the White House last night to dine with Donald and Melania Trump. No word on whether there was any apologies exchanged there, but there was a cute picture of Ted Cruz's kids at the Resolute desk in the Oval. So it looks like all has been forgotten. I'm sure there was an apology. I'm sure Ted Cruz apologized to Donald Trump.

I went back and looked. I forgot that. I remember the JFK assassination. I remember him calling Heidi Cruz, President Trump calling Heidi Cruz ugly. But I had forgotten that some super PAC used an inappropriate photo of Melania in an ad. And Donald Trump tweeted, I just heard Ted Cruz used photo of Melania. Be careful or I will spill the goods on Heidi Cruz. Yeah, spill the beans.

What are those? We don't know. Maybe they talked about that at dinner last night. I mean, in healthcare news, apparently Ted Cruz is there to speak on behalf of the House conservatives that didn't like the bill.

So I don't know if he probably continued poisoning the well there for Paul Ryan's ill-begotten health care bill, but who knows? At least they had a good time. Ted Cruz, big conscience. Remember his speech at the Republican conventions when he told everyone to vote their conscience? Yes. No one, no one debases themselves like Ted Cruzz it's basically the story of his life i don't

know there's a lot of people who debase themselves marco rubio sean spicer every day spicer paul ryan jason chaffetz there's a lot of republican politicians debasing themselves these days that's actually the root of our problems as a country. It's why we have Trump. It's why there's this awful health care bill moving through the Congress. It's Republican politicians debasing themselves and not even standing on their own principles. I would like to coin the term the dignity deficit. Oh, no. That's like a bad PowerPoint presentation

at like a David Brock retreat. No, that's going to be my TED Talk. Awesome. Speaking of conspiracies, since we got into the Ted Cruz's dad assassinated JFK conspiracy, you know, it's been, I don't know how many days since Donald Trump tweeted out that our old boss wiretapped Trump Tower. And still no evidence. No, none.

Absolutely nothing. So I don't know if you saw, there were a few stories about Obama's reaction to this. In the Wall Street Journal, Carol Lee said that he was livid. But then Jeff Zeleny of said that he was livid um but then uh jeff zeleny of cnn said he was more irked and peter alexander of nbc just said he rolled his eyes i would say that uh jeff and peter probably have better sourcing there yeah and i have not i mean maybe you have but i have not talked to the former president about since then since this happened um but i'm gonna get knowing him i'm

gonna live it is not how he would react to something like this he doesn't live it is how he gets when the health care website breaks i would go with eye roll or irked probably would be he's a pretty cool guy in i mean although it is fair to say that the president-elect uses twitter the president uses twitter account to accuse Barack Obama of a felony. But, I mean, he's got a – his life seems pretty good these days. Yeah, I think Barack Obama is going to save getting livid for if Obamacare is fully repealed and millions of people lose their health insurance or Donald Trump continues to deport undocumented immigrants or like things that are actually going to hurt people's lives. I think that Donald Trump being Donald Trump and lying about him is something he's dealt with for the last eight years since, you know, that's where the whole birther conspiracy

came from. Yeah, this is old hat. Okay. Healthcare. Healthcare. Last night, or rather this morning, at 4.30 a.m., the American Healthcare Act, a.k.a. Trumpcare, was voted out of committee in the House with no changes and no analysis of how much it costs or how many people it would cover.

17 hours of debate, and that was that. Yes. What do you think of that? Are we calling it Trumpcare? What hours of debate and that was that yes what do you think are we calling it trump care uh what do i think of that care i i called it i didn't i thought it was not health care but it was wealth care how's that dan oh that i decided to throw that on a day i was like i told love it i was like i realized this is something you'd see on a step and repeat at a house press conference. But nonetheless, I mean, we can get to the substance of the bill a lot more with Ezra because he knows these things and we do not. But I will say this is basically one giant – this legislation is one giant tax cut for rich people disguised as healthcare reform. And it is a very poor disguise

yes the i would say one note i would say that if we were working in the white house and someone had emailed you to suggest that we that we call it wealth care you would have thrown your computer on a wall you would have emailed to all of us to make fun of that person and then thrown your computer on a wall yeah like that would have been your reaction to wealth care. For sure. So you've changed. You've changed. Like I said, I did it in half-dance, but we're in tough times.

Right. Right. In Trump's defense, voters all across Michigan, Wisconsin, Pennsylvania flocked to the polls because they believed two things. Millionaires needed bigger tax cuts, and insurance companies could not deduct the massive salaries of their CEOs. And so he's really responding to his base with this bill. Do you think, before we get into this, I tweeted this yesterday, do you think Trump could spend three minutes, maybe I'll even give him two minutes explaining what was in this bill. I heard him at the pool spray yesterday when he was meeting, he's in some meeting and

the cameras were on and he was just like, this is going to be a great plan. You know what the plan is? It's the plan. It means everyone gets a choice. Everyone gets to see a doctor. It's great. Everyone gets a choice. Everyone gets to see a doctor. It's great. That's it. Like if a real journalist, meaning someone who's not on Fox or part of Breitbart or like LifeZet, if any real journalist sat with Donald Trump and sat with him for two minutes to ask him questions about what was in this bill, I guarantee you he could not tell you what was in it. No, he would be 100 wrong i'm also very glad you brought up that trump quote because the last thing hallie said to me before she left work today left for work was tell john to read the trump quote and then i forgot to text you so there you

go save me there channeling holly no it was absurd holly it was ridiculous he didn't know it didn't say anything he doesn't know what's in this fucking bill. No. He knows nothing about health care. Nothing. But that's because he watches. He doesn't even have a real doctor. That's because his news sources are down to Fox and Friends. Like, we used to be getting information from Morning Joe, which, yeah. And then he used to be getting information from CNN.

But now he hates CNN and he hates Morning Joe. So his only source of news in the morning is Fox and Friends. And like those people don't know what the fuck they're doing. So he doesn't, you know, he's certainly not reading his briefing papers. Basically what this bill does, and again, we're going to get into all the details later. It's Obamacare, but a lot less of it. It takes the money that the government used to help poor and middle class people buy health insurance. And it takes that money and it gives a $600 billion

tax cut to the rich. As you said, Dan, that includes a $500,000 tax cut for health insurance executives because they certainly need the money. And then it keeps most everything else in place, including all of the problems with the Affordable Care Act. And there are still – there are problems with the Affordable Care Act. It's not perfect legislation. But this reform bill or this replacement bill does not solve any of the problems that had the bill. So like after complaining that copays and deductibles were too high in Obamacare, copays and deductibles will be significantly higher under this bill. The costs for the average Obamacare enrollee go up by $1,500 a year.

In 2020, they go up by $2,500 a year. And the S&P has set up to $10 million would lose their health insurance. We are still waiting for a score from the Congressional Budget Office. from the Congressional Budget Office. For those of you who don't know, the Congressional Budget Office is a bunch of number-crunching nerds who are not Democrats or Republicans, but just number people.

And every bill that comes out of Congress, they try to tell you how much it costs, what it will do, and they do it in a nonpartisan way. And the Republicans decided they do not want the CBO looking at this bill before they vote on it. I wonder why.

Which is the opposite position. This is going to shock you. But Paul Ryan had the opposite position when we were trying to pass health care in 2009. He thought it was very important that the CBO write the bill. And then he didn't like what the CBO said because it said that health care was paid for and reduced the deficit. And that went counter to his beliefs that the only way to reduce the deficit is by taking money away from poor people i was like this is the way i think to best describe passing a major piece of

legislation without the cbo it was the equivalent of agreeing to buy a house without knowing what it costs or how many rooms were in it. You saw that. It's been going on Twitter, this screenshot of some Fox News show that was like, things still unknown about the bill, how much it costs, how many people it will cover. The things we know. Yeah, okay. It has a name. Yes. It has a name, and it's going to help rich people yeah i think it is worth like there is one of the things that there has been a wee bit of

criticism over the fact that they're trying to jam through this bill in three days and without a cbo score and it's worth noting that they there's there were a lot of process critiques of how the Democrats handled the passage of the Affordable Care Act. But it's worth noting that it took us more than a year to pass that bill through many open committee hearings, markups, CBO score, all of that. And these people are trying to jam it through in, I mean, 60 hours. It went through a markup with zero changes, not a single change. Is that because they wrote a perfect bill? No. It's because they're trying to jam it through as fast as they possibly can before anyone can find out what's in it, including the members of Congress who voted for it.

the members of Congress who voted for it. The number of times Republicans have used the term jamming it through to describe Obamacare, which like you said, took one miserable year of our lives. I remember like writing the first speech. It's like a 6,000 word fucking speech on Obamamacare in February, March of 2009. I think that was the speech. He talked all about bending the cost curve and all these reforms that Atul Gawande really likes and no one really understood anywhere else, but were really smart reforms. Good Atul Gawande name check.

Hey, man. I'm deep in the healthcare policy wonk community. I had to bone up on it because we have Ezra on today. I remember when you told us that, quote, unquote, bending the cost curve was going to be the new deal. It's part of the new foundation, Dan. Yeah, so that started in March. Then we had a full summer of tea party town halls town halls where tea party members protested uh and then obama gave a speech to

congress around labor day in september to try to get democrats on board it was a speech to the public the prime time address uh where joe wilson said he lied, shouted that you lie in the speech. And then we had like another fall. We had a special election where Scott Brown won after Ted Kennedy passed away. We thought the bill was dead. We kept going. I mean, it was a year-long drama. Compare that to 17 hours of debate in the Ways and Means Committee.

The bill introduced on Monday and they want to vote on it as soon as possible. And Mitch McConnell has promised a vote in the Senate by April. and the Ways and Means Committee. The bill introduced on Monday, and they want to vote on it as soon as possible. And Mitch McConnell has promised a vote in the Senate by April. And that's how fast they're going. It is unbelievable. Let's talk a little bit about the reaction to said bill. Sure. Do people like this bill, John?

I cannot find anyone who likes the bill. Here's who likes the bill. Donald Trump says he likes the bill, but again, we know he doesn't know what's in there. Paul Ryan certainly likes the bill. Although, you know what? Paul Ryan, House Speaker, likes the bill. If Paul Ryan, if John Boehner was Speaker still, and Paul Ryan was just the darling of intellectual conservatives everywhere, sitting in the House of Representatives,

you know that Paul Ryan would be against this bill too. But now he's Speaker, and so he has to do things like this. So Paul Ryan likes the bill. Donald Trump likes the bill. The Wall Street Journal editorial board likes the bill. And the U.S. Chamber of Commerce likes the bill. That's who you got. On the other side, people are opposed to the bill.

Healthcare groups, the American Health Association, the American Hospital Association, the American Medical Association, the AARP, nurses, doctors. On the right, American Freedom Works, Americans for Prosperity, Heritage, 100 members of the House Freedom Caucus who represent the most conservative members of the House. Four Republican senators said they couldn't support the Medicaid cuts. the house freedom caucus who represent the most conservative members of the house um four republican senators said they couldn't support the medicaid cuts three republican senators say it's too much like obamacare not conservative enough um no none of the wonks like it none of the liberal wonks none of the conservative wonks it's hard to find a constituency for this building you know who else doesn't like it people People? Breitbart. Breitbart. Ah, that's right.

Good call. I forgot about that. Yes. Breitbart is, the honeymoon's over. Yeah. Between Breitbart and the White House. I guess what we discovered

is that Breitbart's hatred for Paul Ryan exceeds its love for Donald Trump. Yeah, I mean, well, those, what a surprise. Those people are driven by hate.

Those people are driven, what a surprise. Bre people are driven by hate. What a surprise. White Bites are driven by opposition to things instead of being for something. Did you notice, too, that Tom Cotton this morning, who's like Donald Trump's wingman, basically. He's like the next Donald Trump from Arkansas, not exactly a liberal state. And Tom Cotton is anything but liberal. He started tweeting that the bill cannot pass the Senate. He told his colleagues in the House to start over. Now, if you remember a couple weeks ago when we had these town halls,

we were telling all these people to go to your town halls and to make noise and hold your representative accountable. Tom Cotton's town hall in Arkansas was particularly well attended. And a lot of people who signed up for MoveOn and Indivisible and all these different groups, they went to his town hall, a lot of people from Arkansas, and they told really moving stories about what losing coverage would mean to them with Tom Cotton there. And I'd like to think that had a little bit of an effect

on the senator from Arkansas. Do you, or do you just think it's bullshit? I want to believe that because I want to believe that the people who went to that town hall impacted the man, but I think it's more likely. I think that the town halls have made this very hard, and it's why this is going to be hard to pass the Senate. So shout out to everyone who went to the town halls. This was very important. Act to buy insurance is the state of Arkansas.

Like it is a particularly poor state. There are a lot of people on Medicaid in that state. There are a lot of people who can't afford their health care there. So this is his constituency too, you know um but you're right it's a win-win for him because Breitbart's against the bill and he needs the right and also his actual constituents need health care so probably works out well for him yeah yeah I guess we will know the answer to this when uh if something moves in the senate and he is for a more generous, less assholey version of healthcare, I suspect he's going to be on the side of assholey.

Yeah. It's a policy term. That's a, it's a term of art. Yeah. This is pod. Save America. Stick around.

There's more great show coming your way. So did you see, uh, Jonathan Chait tweeted this this morning? Because it's not like I watch Tucker Carlson's show on Fox News. But last night, Tucker Carlson had Paul Ryan on. And I think Paul Ryan was all prepped to talk about, you know, he thought he was going to have to defend this bill from the right. But at one point, Carlson asks him, like, why did you include this huge tax cut for the rich in this bill?

Like, why did you need to do that? And you can see Paul Ryan literally gulp. And basically all he said was, I'm not concerned about that. And this tax cut will help us do tax reform later on. So basically his answer was, this tax cut for the rich will help us provide more tax cuts for the rich later on down the road. Which is what America is yearning for. I mean, asking Paul Ryan why you include this tax cut for the rich is like asking someone why gravity exists. Like, you can't answer it. Like, it just is, right? I don't think there's any

politician more out of touch with what the American people want than Paul Ryan. There is no Republican. There is no – like Donald Trump is more in touch. Democrats are more in touch. Like Paul Ryan believes there is a constituency for tax cuts for rich people that just does not exist except among really rich people. I don't understand it. That's who he hangs out with i mean he prays to the ghost of anrand and jack kemp like that is his deal and so he did i

would give him credit for nothing actually take that back i'm not giving him credit for anything so here's my question why um they've had seven. Seven years ago this month, Obamacare passed. Affordable Care Act was signed into law. Why did this go so poorly? They've had seven years to come up with a replacement plan. The reason this went so poorly is the same reason it took them seven years to come up with a replacement plan is – and I think we'll probably talk to Ezra about this. There is no, I mean, Obamacare, the model of Obamacare was Romneycare in Massachusetts, which was the conservative alternative, or the Republican alternative to Hillarycare, the single payer Clinton administration plan in the 90s. And so there is no place to the right of

the Affordable Care Act that still gives people coverage. And so there's no answer to this, right? There is no – like the easier thing for them to do is to abide by our really sweet merch T-shirts and say repeal it. Repeal and go fuck yourself, right? Repeal it. Go back to where we were but trying to come up with an alt the replace part is the problem because they do not they understand the politics of having of taking health care away from people is bad so there has to be something that keeps gives people health care but you can't do it in any way that works that is not the affordable care act and

would also mollify the republican base who doesn't want people to have health care. So it's a moot point. Like, you can hear it in Tom Price, the Secretary of HHS, who was in the White House briefing room the other day, basically stalling as long as possible so Sean Spicer wouldn't have to answer uncomfortable questions about Donald Trump's wiretapping tweets. But the question, oh, no, I take that back. It was Mick Mulvaney, the former Freedom Caucus freedom caucus member now head of omb who was asked the question how many people it's like insurance is the wrong question it's not about how many people you cover it's about how many people get to go to a doctor well that's what how do you what that i saw that what the fuck are you talking about how do you think people go to the doctor?

Insurance lets you go to the doctor. You're the head of the Office of Management and Budget? Come on. Well, they know. They're in a box because whenever the CBO is let out from underneath Paul Ryan's desk and is allowed to give an estimate of the budget of this bill, it's going to mean that millions, maybe as many as 10 to 15 million people are going to lose health insurance under this plan. And so they are trying to shift the argument away from who has health insurance. But that is not, that's how our system works.

That's how you get health care. That's how it's paid for, is insurance. So they're kind of fucked. Like, that's where for is insurance. So yeah, they're kind of fucked like that. That's where it is. If, if Republicans were honest, when I say Republicans, I mean, most, most Republican politicians, there are conservative policy wonks who do believe that government should play a role in healthcare. Um, but you know, a lot of these Republican politicians, particularly those in the freedom caucus and those at the far right of the party, their belief is that the federal government should play no role in guaranteeing that people have basic health care. That's just what they believe.

They believe the market does it better and the government shouldn't do it. They cannot tell that truth because they know that it is an incredibly unpopular truth. And when Trump ran for president, Trump did not run for president in a campaign where he said, I want to get the government out of health care and I don't think everyone should have guaranteed access to health care. Trump's campaign was, I want to repeal Obamacare and replace it with something better. I want everybody to have health insurance. He promised he wouldn't touch Medicare or Medicaid. He promised he would not touch Medicare or Medicaid. He promised he would not touch Medicare or Medicaid. This bill seriously guts Medicaid. So he's already broken a key

campaign promise. But when you look at polls of how people think about Obamacare, there are a significant number of people who are against Obamacare, who are opposed to Obamacare. But when you ask them, people aren't opposed to Obamacare because it gives them too much health care. People are opposed because they either can't always see the doctor they want to see or their premiums are still too high or their deductibles are still too high. And, you know, for a long time, Republicans have been saying, oh, well, we'll fix that. When we get rid of Obamacare, we'll fix that. oh, well, we'll fix that. When we get rid of Obamacare, we'll fix that. And what they did, but the only way to fix that is to pump more money into the system or to have a public option or to increase Medicaid. You know, like all of the solutions to fix the problems of Obamacare

would cost more money or they would require more regulation. And Republicans are against those things. So they have been bullshitting people for seven years about what the problems of Obamacare really are. And now that they're in power, they have to do something about it and they can't. Yeah. Their problem with Obamacare is the Obama part of care. They made a political decision and it was not an unwise political decision in the short term to try to hang changes in the health care system around Barack Obama. So even the things that had nothing to do with the Affordable Care Act or Barack Obama, if you have employer-sponsored health care and your premiums go up, they were going up before the Affordable Care Act.

They were going up after the Affordable Care Act. It's not necessarily related to the Affordable Care Act. They wanted to hang everything in the health care system around Barack Obama. And they didn't come up with a, even though they promised every six weeks to come up with a quote unquote, replace bill. They never did because it was impossible and politically and politically unpalatable. So they didn't do it. And so now they are the dog that caught the car if you remember in after uh we won in 2012 john bainer said that this means the efforts to repeal obamacare are over i'm right screwing up his quote but he basically said obamacare the formal care act is here to stay and no one listened to him and they they got themselves all twisted up,

and they wanted to run on it one more time in 2016. Not really Trump, but the rest of the Republicans. And I think their thought was, well, Trump will lose, and Hillary Clinton will be there, and we can say we can't. Maybe we'll vote to repeal, but we won't ever have to do anything. But now they have to do something, and they're not very good at it. Also, they don't know how to legislate they're paul ryan kevin mccarthy and the rest of these doofuses are terrible at their jobs well look like there's a pretty good there's donald trump winning the presidency did not

change the problems that house republicans have had in passing bills that they've had since the john bainer days right like the calculus the problems they've had with we saw this with the debt ceiling we saw this with all the budgets, we saw this with everything else. Like they can't pass anything through that house, or at least they can't pass anything through that house that Republicans and Democrats can pass through the Senate. Like that's been a problem for the last eight years. Yeah. And there are still, they've basically killed off the moderates in the Republican house and there are still people in the Senate like Lisa Murkowski and Susan Collins who make this very challenging. And so they still need 50 – even if they get this through the House, which we should talk about whether we think they're going to do that or not.

But they still need 50 senators because they're using budget reconciliation, something they called deeply inappropriate and irresponsible when we use it to pass the Affordable Care Act. But what can you do? Hypocrisy is dead. Yes, as is irony. So yeah, let's talk about the politics of them passing this because I think some people are saying, oh, it's dead on arrival.

It's not going to go anywhere. I don't think Paul Ryan keeps pushing this and keeps talking about it if it's dead on arrival, right? So, yes, all of these – a lot of House Republicans, particularly conservative House Republicans, have said we're against this bill. The White House and Ryan have said, OK, well, it's an opening position. We're open for negotiation. So what do we think could happen to get this thing through? And we should put some numbers up for people here. The two numbers you should keep in mind are 3 and 22.

22 Republican defections in the House kill this bill. So if any more than 22 Republicans oppose it, it's over. And in the Senate, as you mentioned, all they need is three Republican defections kill this bill. So 22 in the House, three in the Senate. So what do you think happens in the House here? Well, I saw this story somewhere on the internet where it's like like ryan ryan uh paul ryan makes joe namath like pledge that this will pass meaning for people who are not 80 that like joe namath former football

quarterback guaranteed they would win the super bowl and then they won the super bowl right but the reason why that is basically ryan what ryan said was it when this comes to the floor, I guarantee you'll get 218 votes. Well, that would be like if Joe Namath swore they were going to win, but then could decide whether they were going to play or not based on whether he counted the touchdowns up in advance. This will not go to the floor if they don't have 218.

Right. He wants up for a defeat on the floor. Yeah. So they'll know in advance. So I think I would be surprised, and maybe even a little heartened, if they cannot get something through the house. Right. Right.

But you don't think they get the bill in this exact form through the house? Or do you? I think it seems. I mean, we're not in the prediction business, so you're trying to trick me here. I would be surprised. I guess we should lay out various scenarios of what could happen.

Yes. So one scenario is this bill being marked up passes with the exact right number, like basically 218. They get it through, send it to the Senate. And if that happens... Another scenario is... If that happens, basically it happened because all of these house Republicans who said they were against the bill got screamed at by Donald Trump, um, decided that they don't have

any principles of their own or afraid that he might tweet at them or like come to their districts. And so they just buckle under the pressure and say, yeah, even though I oppose the bill now, I'm supporting it anyway, because it's better than nothing. That's the scenario where it passes as is right now. Another scenario, and I think what Paul Ryan wants more than anything else is to get something out of the house, dump this turd burger in Mitch McConnell's lap, and then, you know, raise his hands up and say, I did what I did. It's up to you now, knowing that it probably does not get through there. Or what I think is very unlikely is you get this bill through the House and you get this exact bill through the Senate. The Senate does not like to rubber stamp House bills.

That's not a thing they really do. And so then the Senate passes something, they send it back. So the process goes on for a long time. So option one is he gets it through. Option two is he meets with the Freedom Caucus. They tell him like five things they need. He goes back. They make the changes.

They jam it through again, and they get it. It's hard to see, though, what – if you listen to the criticisms of the members of the Freedom Caucus, what they hate is the part of the bill that gives health care to people. I was going to say, if this bill gets through the House because of changes made to it, the changes do not make the bill better. It makes it worse. And when we say worse, I mean it means fewer people, basically more people will lose their coverage sooner. So like one of the things that the Freedom Caucus wants is, right now it's basically

saying Medicaid starts getting phased out in 2020. This would, you know, the the freedom caucus wants it to be cut by 2018 i just saw another freedom caucus proposal this morning that said freeze all enrollment in medicaid by 2017 right um which seems it's like just in time for the midterm elections brilliant political ploy um but anyway those are the kind of things that could happen to this bill to help make it more palatable to House conservatives and get it through the House. But like you said, if that happens, it makes it even more unpalatable to more moderate Republicans in the Senate. Yeah.

I mean this is – as you point out, this has been the problem for Republicans for a long time. Anything that gets 218 in the House can't get out of the Senate. Now that was certainly true with 60 senators. the House can't get out of the Senate, right? Now, that was certainly true with 60 senators. It may still be true if you need 50, as they would for this. The other alternative is Paul Ryan says, fuck it, and goes back and just passes the full repeal bill that they passed 112 times before and sends that to the Senate. And then Mitch McConnell just says, what, are you joking? It's not clear to me that you could even, I don't think you can pass that same full repeal bill on the 50 voter, right?

Right. Oh, you can't. I'm not sure that that is. No, because you can't, anything that changes regulations or anything that basically, any change to the bill that does not affect the budget meaning does not affect you know money that the government spends um you need 60 votes to pass in the senate so so who knows i don't know anything anything happened well so one more thing here is is trump basically was in a closed door meeting yesterday with conservatives and said he's fully behind this bill, wants it to pass, he wants it to be called Trumpcare. No, he actually doesn't, but we're going to do that anyway. But he did say if Trumpcare dies, his plan is to let Obamacare fail and then blame Democrats in 2018.

What do we think about that plan? Sign me up. I'm down for that. That's great. Yeah, I could see this. I mean, I can see the thinking behind this plan is that right now, you have some insurers saying that they want out of the Obamacare exchanges, and there were premium increases last year. A lot of healthcare experts think that these premium increases were like a one-time adjustment

so that the market sort of was working out how much healthcare is going to be actually priced at and that it won't happen again. Some of the biggest insurers are still on the market. But I guess what Trump would bet on then is he says, okay, that we had a bill, we tried to pass it. Uh, it got blocked in the Senate because of Democrats and weak Republicans, weak, bad Republicans like Susan Collins, you know, he's not afraid to attack Republicans. And in 2018, he goes out there and says, vote, vote more, uh, you know, vote Republican,

give me more Republicans in the house and Senate. So we can finally repeal this disaster of Obamacare and replace it with something incredible. Because you know right now that your premiums are up and you can't afford it and it's in a death spiral. So vote Republican and we'll finally replace it with something fantastic. What do you think of that argument? I think Trump has wanted to do this for a while. He's hinted at this idea several times that basically healthcare seems really hard. And therefore, what a brilliant plan.

We could do nothing and just blame Democrats. Now, you have to believe things that aren't true about the actual state of the Affordable Care Act. Which is not a problem. Yeah, I think, right. If you just listen been a problem, friends, you'll totally get it. I,

I'm not sure that would work because I'm not sure what they are. They are stuck between two suboptimal options. One is past this messy shit burger of a bill that hurts people. And it's filled with a bunch of like really great, like this would be a stimulus package for democratic ad makers it is filled with so much great stuff um to that are just they're made for ads basically the people who are affected most by this are older voters who voted for trump right right so you can you can do so much here about what their premiums are going to do remember people lose health coverage the tax breaks for the wealthy.

I mean it's tailor-made. It's basically like a political suicide pact. Yeah, and they're all going to take the vote on this bill or they're going to be on record supporting it. And so you can hit them with being in support of this really – this basically huge tax cut for rich people while stripping healthcare away for millions of others, whether it passes or not. I do think a lot of people,

I mean, the problem with Trump's argument there in 2018 is a lot of people will look at this whole situation, scratch their heads and say, wait a minute, Republicans control both houses of Congress and the presidency. They've been trying to say that they were going to replace Obamacare for seven years and they failed to do it and

they're saying it's the Democrats fault like yeah that I think that's the the question is impact on base enthusiasm I don't have any real sense of how much the like I understand how much the freedom caucus and heritage action and those groups care about this but But I don't know. Is this really the animating? Is this still the animating issue for the Republican-based voters they need in 2018? Or are there other things they're doing on the immigration front, getting rid of some of Obama? Are there other things they could do that could keep people fired up? Right. This was an interesting strategic choice to pick healthcare first, tax reform second.

Yeah. I don't know. I mean – Because the longer they wait on healthcare reform, the harder it's going to be to do tax reform because you sort of – like this is the way this order – I mean McConnell is saying, yeah, I'll have a vote in April. But like if we continue to delay this, stretch this out, fight this, try to improve the bill or Democrats or whatever it may be, you know, you start pushing this into May, June, July. Then like his whole agenda is trying to figure out health care unless unless he lets health care die a quick death. And then I don't know. I mean, the other problem for Trump is he hates losing. And there's no way to spin that this is anything but a loss if he can't get this through the Senate.

One of the advantages of being a delusional narcissist is you can convince yourself of anything. So maybe he'll just blame Paul Ryan or he'll blame Chuck Schumer, fake-tier Schumer, all-talk-no-action John Lewis, any of his favorite punching bags. Yeah, well, he's going to Kentucky on Saturday because Rand Paul is against this bill. or all talk, no action John Lewis, any of his favorite punching bags. Yeah. Well, he's going to Kentucky on Saturday because Rand Paul is against this bill. Rand Paul is not against this bill because it's too conservative, but because it's not conservative enough, of course. And so Trump is going to Kentucky on Saturday to, I don't know, to hang out with the governor of Kentucky, Matt Bevin,

and put pressure on Rand Paul, I guess? Yeah, there's some confusion here. I saw a reporting this morning in one of the premier tip sheets that said that it's actually Pence who's going to go, but then Trump's going to go a week or two later or something. But either way, whoever's going, this is, to me, a very strange strategy, because if you were to pick a list of members who are least likely to buckle to a Trump visit

to their state, it would be Rand Paul. He just got reelected. He has always been sort of somewhat outside the party establishment. He doesn't really like Trump. And he kind of gets off on this stuff. Like this is his thing is to be a quasi-independent-ish libertarian. And so you're going to go there. You're going to harangue him. And then he's going to have the same position as before. I don't understand the logic of it.

Some people have argued that this is a message to all those – and also the bill is in the house and Rand Paul's in the Senate. So that's another that's another small detail. Some people have argued the people who tend to view genius and all things Trump's does, which is a dwindling number, but they still exist and they still write morning tip sheets uh that he that is uh the one big goal that this is sending a message to conservative members of the house that if you oppose trump he will come to your district right i mean that required that is like be afraid like several logical leaps yeah one last question for you how do you you. How do you think Democrats are handling this? Do you think it's just sort of step back and watch this thing implode? I have to say before you answer, I'm a little concerned about us getting into a, oh, look, this is such a disaster. Look what Trump did. Look what Ryan did.

They can't agree on anything. This thing is going to implode or whatever and we sort of like step back because of that aka the whole 2016 campaign so I do want people they're like I think every you know I think by the April recess which is coming in a couple weeks this thing will not have been voted on the senate for sure so I think we have to like rev up the town hall machine again. People have to be calling their congressmen and congresspeople. People have to make a lot of noise about this. I don't think we can give an inch on this because, like I said,

betting on any outcome that requires Republicans to stand on principle is a loser. So you've got to actually make it happen. Yes, I totally agree. I think that this is a great – one, this is incredibly important. This is the – preserving the Affordable Care Act is the most important policy thing the Democrats have the opportunity to do over the next four years. 100 percent. It matters to actual people. People live and die based on access to health care, And if we fail at this, people will die. I know that sounds dramatic.

It's true. But it's true. It's not dramatic. It's true. It's dramatic and true. And right now we're fighting 1,000 fights. And I think we should fight all the fights. The base wants us to fight the fights.

These are fights worth having. But this is a great place to channel all of that energy into something really important. And we should not. you're exactly right. Let's not adopt the 2016 campaign strategy of let the Republicans defeat themselves. Like we have to be aggressively push our message here. We have to push the narrative on what this is. We have to hone the messages we'll be using on the campaign trail about this. Put as much pressure on people as possible, both in the House and in the Senate.

I'd like to see some Democrats go to some districts and give some big rally speeches with crowds and talk about why they're against this and what their vision of health care is. You know, like I don't don't stay in Washington and like issue statements. Get out there. Yeah. OK. I think the 2020 candidates like or the the people who are big name democrats

who draw crowds right like elizabeth warren or bernie sanders kamala harris sure or cory booker or whoever else should get out there go to some of these republican states and hold rallies right like i know it's it's you know, Senate etiquette to- Fuck Senate etiquette. You know, campaign. Yeah, exactly. Fuck Senate etiquette. It's also not Senate.

It's not proper etiquette to take healthcare away from people who need it. So get out there, you know, speak to the voters in those states, fire up the Democratic base. You know, I think that would be

very well-received and impactful. Agreed. Even if it makes lunch in the Senate dining room awkward. Oh, heaven forbid. Okay, when we come back, we will have the founder of Vox.com, Ezra Klein. This is Pods of America. Stick

around. There's this great stuff coming. Lots of great stuff. On the pod today, we have the founder of Vox.com and the host of the Ezra Klein Show podcast, Ezra Klein. Ezra, welcome to the pod. Good to be here. Glad we finally got you on. Haven't talked to you in a while.

Yeah, it's true. It has been a bit. Well, it's because nothing's been going on to talk about. It's been very quiet. That's right. There has not been a lot of policy. Very chill. So let's talk about the American Health Care Act, everyone's favorite.

A-cha. So you, I think yesterday or today, talked to Mitt Romney's former policy advisor, Lanhee Chen, about this bill, and he had tweeted out, this is a good start, right? So he was one of the few policy wonks on the conservative side to say, okay, I think this is not a bad bill. So what was his case for this legislation? Having done that interview, and I really appreciated Lonnie walking through it with me, I don't know that I can fully give you a, this is his case legislation.

Look, I think Lonnie and I think a lot of Republicans really, really love Obamacare. I think they see a lot of problems in it. And there are definitely things in this bill they like. So if you're running down the list of what Republicans are really happy about in ACHA, I think the list would look like this. ACHA. I think the list would look like this. Many aren't happy about, they don't like the fact that it allows more Medicaid enrollment until 2020. But the fact that it moves Medicaid to a per capita block grant, basically, after 2020, and begins to cut, we think, due to where they put the inflation measure, begins to cut spending on the program after that is a very big deal to

conservatives. And in case that's a little complicated, right now, the way Medicaid works is it pays what the state needs paid. So depending on, you know, if you get an unhealthy state, right, if Arkansas has a terrible flu epidemic and everybody in Arkansas needs a lot more care who's on Medicaid and prices rise, the federal government pays those prices, and it's matched with Arkansas. The way this would work is a state would get a set amount of money per person, or actually per type of person, something different for kids, different for disabled adults. And then that amount of money would not grow as fast as often health costs have.

So it's a way of cutting spending on the program. And then it's also, of course, a way of shrinking the program by attrition, by freezing its enrollment. A lot of conservatives like these age-based flat tax credits. I don't think actually Lonnie is one of them. I think that looking at things that he's been involved in before and some things he said to me, I think he would like to see a little bit more recognition of income problems at the bottom end. But overall, I think conservatives are happy about a move towards a flat age-based system away from income. Conservatives really do feel like it is a very strong thing. Paul Ryan is a very big believer that getting generous health care subsidies if you're poor

is a strong disincentive to working, like a strong, strong disincentive to working. It is part of the government hammock. And then there's just the general allure of beginning to move health care policy in a more conservative direction. I'll say finally, and we can go on any piece of this you want, but I was just watching Paul Ryan gave a PowerPoint presentation on this bill. I saw he was rolling up his sleeves before we started recording. He was rolling up his sleeves. It had a lot of clip art. There's a lot of fascinating things that happen in Congress,

but PowerPoint presentation design is not one of the fields they're on the forefront of. But the choice that he presented to conservatives at the end, and I thought this was interesting, and it's what a lot of Freedom Caucus folks are reacting to, was he said, look, this is our't. And he is presenting a process that makes it a binary choice, right? He's not really letting there be significant amendments. They're not opening up the bill. They're not giving people time to consider it. So what he is really trying to present his conference with, and then they want to do the same thing in the Senate, I believe,

is a yes or no, real quick, snap reaction vote on this. And I think that for a lot of conservative healthcare folks, if it comes down to yes or no, this or nothing, there is some appeal to this. Although I think that will end up being a, if they do it that way, I think they will end up regretting having made that decision pretty bitterly. And why do you think they would regret that politically, policy-wise? They will regret it because this bill is terribly put together. It is terribly put together. And they do not – this is one of those things I need to, like, actually – you guys know me.

Like, I'm a pretty calm person. I do not feel calm about this. I could tell that came through in your writing about this, but yeah. The way this bill is being designed and pushed, it's breathtaking. It is literally one of those things where I don't know how you can trust something any of these folks say again. This bill, after they complained that the 15-month process that led to Obamacare was a rush job, it was being jammed down the country's throat, nobody had time to figure out what it was, they complained endlessly that they only had preliminary CBO scores and not full CBO scores.

They jammed this through committee before they had anything from the Congressional Budget Office. And the reason I really focus on that for a second here is not that there's some magic thing about the Congressional Budget Office or that I am just standing on some point of procedural principle. It's because none of them know how this bill works. They have not seen any serious estimates of what it would do. And the seventh most senior Republican on the Energy and Commerce Committee has no clue what it would do in their district. They don't know how the different pieces of this would interact with each other.

They are moving this bill before they have not even not thought about how it works, but they haven't even tried to have somebody figure it out. The strangest thing, they do not seem to want to know. I have this line in a piece that makes them out later that they know not what they're doing and they like it that way. And this bill, the way it is structured, there is going to be so much chaos on the other end of this. I'll just give you one example. I don't think they've thought at all seriously enough about what the age-based tax credits actually do. So the way the tax credits work in Obamacare, as you guys both know, is they're not just tied to income. They're tied to the cost of plans in your local area.

So the tax credit covers a percentage of the cost of plans in your local area. So the tax credit covers a percentage of the cost of the plan, and then that percentage differs based on your income. The reason that's important is these plans are really, really differently priced depending on whether you live in Los Angeles, which is an urban area with a lot of plan competition, or rural Alaska, where there's a lot of difficulty in designing health care and delivering health care over such a large expanse of land. There's very little competition. So you're all of a sudden going to be giving people credits that are, one, non-responsive to their income. So if they are poor, it just is not in many places going to be enough to buy health insurance.

And two, non-responsive to the cost of plans in the local area. And it doesn't matter how fast you pass this thing. And it doesn't matter how many times you say you're appealing on place to volunteer. At some point, those cancellation notices go out. And if your administration found out, you can't hide from that. Well, so my question is timing on this, right? Because in my mind, one of the answers to why they're doing this and don't really give a shit is they're thinking, well, like, I mean, if you look at the Medicaid, you know, stopping the Medicaid expansion in 2020, right? Like they want to, as usual, like push the

problems that are going to happen off into the distance. But what, like, if they pass this bill in May, right? Like, what are some of the immediate effects that people would actually notice from the repeal of Obamacare or the replacement? It will depend on the part of Obamacare. So there's transition plans all throughout the bill. And I should say, I mean, this is something the Democrats did to Obamacare's pass in 2010 didn't really go into effect till 2014. Some of the taxes were pushed off until 2018. So this isn't fully a Republican innovation here. But I think if I remember the timing of the bill right, the subsidy changeover happens in 2018, which also to me is a little bit breathtaking because they're going to be in an election year. And all of these people are going to get subsidies that are going to say, actually, you can't afford health insurance anymore,

or the health insurance you can afford has a way higher deductible, way higher co-pays, covers way less, may not have your doctor in it. There's going to be a lot of angry people, and it's a much bigger thing with much less generosity than when your guys' cancellation of plans went out. So that will happen in 2018. 2020, you can't sign up for Medicaid anymore. So one thing people expect will happen is a rush of states. You could actually, as a state, sign up for Medicaid next year, sign up for the expansion, enroll people until 2020 and have those people covered going forward.

So there will be, people expect, a race to get people on the program until then. Then we have all these people on the program. They continue to get covered. It's just they cycle off of it at all. They get a job so their income goes up. They can't ever come back on it. But now 2020 is an election year. And so now Democrats are going to be running on a platform of both fixing, I think, a lot of this chaos and expanding the Medicaid and recreating the Medicaid expansion, which now more states are going to be bought into in a sort of vague way or in a sort of unusual way. So the times at which this is going to be bought into in a sort of vague way or in a sort of unusual way.

So the times at which this is going to affect us in different places, the other question that we just don't know is the insurance industry is an independent actor here. So far, we have seen very little positive comment on this bill. In fact, we've seen almost unified opposition from every major player in the healthcare industry. But insurers are going to look at this and they're going to say, okay, do we want to be in these markets? These markets have already not been particularly profitable for us, the Obamacare exchanges, and particularly in places like Arizona or Alaska where it's not been a great deal, it's about to get worse.

So do we want to stay into it? And it may be that a lot of them just leave. A lot of these markets collapse. One thing that was notable about the way Obamacare is structured, my colleague Matt Iglesias, he made this good point. We have a podcast, The Weeds, which is all about policy. And he made this good point on it that I haven't heard. But he noted the way Obamacare works is because the subsidies are tied to the cost of a plan.

Even if you only get one carrier in a market, it's usually very profitable for there to be at least one carrier, because that carrier can then do more or less monopoly pricing. Right. Because for the poor or the near poor, the federal government will cover really whatever it is the carrier is pricing at. So in places where it's not naturally profitable for carriers to be in there, there really is usually good reason for one carrier to be there.

That ends under this plan. So all of a sudden, it's not necessarily profitable for a carrier to be there because folks are getting a low, flat tax credit that is completely non-responsive to the local expenses. And so to sit there and lose money in the Alaska exchange or the Arizona exchange, you're going to see a lot of death spirals pretty quickly. So this legislation could lead to more insurance companies pulling out of markets, which is one of the problems. Yeah, I think it would almost certainly. Now, look, we'll have to see what kinds of deals and cajoling the Trump administration would try to put into play to keep them in there. I believe there's a $100 billion stabilization fund in here to try to pay off, more or less to pay off insurance companies and to do high-risk goals and to try to create a transition here that can work. But pretty much everybody I've

talked to who's looked at this, and this includes a number of conservative healthcare walks, have said, yeah, this is a recipe for, if not full-on death spirals, many of them think that you will have full-on death spirals where the markets become completely non-usable. At the very least, really, really significant pricing problems and very little competition. I know we don't know exactly the answer to these questions going to have CBO yet, but do you have any sense of how this is paid for and what that means for the deficit? So it isn't paid for. what that means for the deficit? So it isn't paid for. That's the first thing to know about it. So this bill, among others, is a $6.5 billion tax cut.

But you guys remember, I mean, this is one of these things. I don't like being in this position. I want to be coming here and telling you that Republicans are playing this on the level that, yeah, their ideas are different, but there's merit to them. You know, like, I would like to come off as a fair guy. Like, I enjoy that. I enjoy when people say, oh, that Ezra Klein. Like, he's a nice fellow. I was there when Paul Ryan stood up at the Blair House, like watching on television, not living in the Blair House, and explained all the ways in which Obamacare is fiscally irresponsible, despite the fact that it cut the deficit in the first 10 years, which has proved true, and then cut it by more in the out years. This plan begins with a $600 billion tax cut. There's no new revenue source anywhere in

the plan. So what we expect to happen is in the first 10 years, it will probably increase the deficit, with the only possible exception to that being if CBO expects such massive losses in coverage that it just cuts the expense of the plan that much, right? So unless the plan is really going to throw 15 or 20 million people off of health insurance, you're going to see a deficit increase in the first 10 years. Again, I have not seen a CBO score, so possibly there's something here going on that neither I nor anybody else has found, but that's what I'm hearing. The thing that they're going to try to do is say the first 10 years aren't really what matters. What matters is the long term, the second 10 years, the third 10 years. And what they're doing there is they're building into the Medicaid changes massive cuts. And the cuts take two forms. The first is they freeze

enrollment onto Medicaid starting in 2020. So all, you know, and on a 10-year timeframe, a 15-year timeframe, basically the Medicaid expansion disappears completely. So all of the expense around the Medicaid expansion is gone. The second is that they're tying Medicaid down to this per capita spending plan, and then they're tying the growth of those checks to, I think it's CPIM, which is the inflation index that tracks medical goods, which is not the same as how much health care actually costs. But you can get very complicated there, but we expect that will be a cut, too. So really, the way it's going to save money in the long term is it's going to have these big Medicaid cuts. And so it's going to be, in the end, a very large tax cut for rich people paid for by cutting health care for the poorest people. And I'll say, you don't have to listen to me on this. The guy named Obik Roy,

who's been one of Obamacare's most consistent and committed critics. He advised Mitt Romney on health care. He was Marco Rubio's policy guy. He was Rick Perry's policy guy. His conservative credentials are pretty good. And he said, you know, it is usually false when liberals accuse us of being, you know, like scroogey fat cats who are cutting taxes on the rich and paying for it by hurting the poor. But that's what this does. We really nailed it this time.

It's a raw mechanical math problem here. That's what they are doing. So in the interest of being fair, which I know you want to do, what would a plan that actually fixes the Affordable Care Act or improves the Affordable Care Act look like? That maybe, well, actually, this is two different questions. But one, I was going to say, what does a plan that fixes the Affordable Care Act look like? And two, what does a plan that fixes the Affordable Care Act look like that still hews somewhat to conservative principles?

So let me maybe answer the second first. The really big problem conservatives have on health care, and this is something Lonnie Chen said to me, it's something conservative healthcare people complain to about to me all the time, is that conservatives do not share goals on healthcare. There are some conservatives who, like Democrats, like most people, believe that the goals of healthcare are to get more people covered and to make it affordable. So you got them. Mitt Romney is maybe a person in this tradition, right? That's what the Massachusetts reforms are about. Then there are the folks who say, eh, coverage isn't that important. What really matters is controlling cost. They want to make a more market-based system,

but they don't really care about coverage. And they think coverage is a fool's game for them because progressive plans will always cover more people because they're just willing to spend money to do it. That's group two. And then group three does not want a federal role in health care at all. They're the folks who think any kind of tax credit is a new entitlement, any kind of regulations are probably unconstitutional. You put your sort of Rand Paul's, Justin Amash's in this category. So one problem is that there isn't among conservatives in the way there is among liberals an agreement this category. So one problem is that there isn't among conservatives in the way there is among liberals an agreement on goals. So when you say like, what would a conservative plan that fixes Obamacare look like? The problem is which conservatives? I can think of a lot of

plans that would appeal to the conservative wonk community, which tends to be interested in coverage, although not all of them are. And, you know, one thing that I thought was interesting, I wrote a piece about this, Tom Price and Tammy Baldwin, this was back in 2006, they co-sponsored a bill in the House. And Tammy Baldwin, who's now a senator from Wisconsin, is a very liberal member. Tom Price is obviously Donald Trump's HHS secretary. And what that bill did was create conditions for states to come up with their own health care plans and just said, hey, if you can improve coverage and lower costs, we'll let you do what you want. And I argued in this piece that one thing that they could do

is resuscitate a plan like that. And if they really believe in federalism, they could just say, hey, we are willing to give you the money Obamacare would give you. And we're willing to take down a lot of the regulations Obamacare has on how you spend that money. You don't have to have plans that are as generous. You don't have to have plans that cover as many things. You know, we'll give you a lot more freedom. Now go make your own health care system. You know, I think in conservative states could make very conservative ones. Blue states could make more liberal systems. But, you know, conservatives who argue often that as a principle, they believe in federalism, as a principle, they believe that policy is better made by people closer to the folks that policy is affecting could say, hey, we made the federal health care. We made the health care system, made it more state-based, made it along conservative principles. We got out of this one-size-fits-all federal approach and called it a day. I think that would have been a smarter way to go. So that's probably my answer on what they could have done. There are also other conservative plans that have come out

that are just more thoughtful, more serious, and better. The second thing, in terms of your original question, you could do a lot of things, right? Liberals have a lot of different views from single payer to there would have been ways to add a public option. I mean, Obamacare has problems, but it wouldn't have been tremendously hard to fix. The original sin of Obamacare is the subsidies are too low. And the subsidies are too low because you guys are all trying to get under a trillion dollars under 10 years to make Nancy Pelosi and folks feel like this bill was passable. And in the end, nobody got any credit on the Democratic side for trying to be more fiscally responsible. But when the subsidies were not high enough to get people the kind of health insurance with the premiums and deductibles and co-pays that they felt were reasonable, everyone paid for it. pays that they felt were reasonable, everyone paid for it. And so I think that if liberals,

next time liberals are in power, and they want to think about what to do with healthcare system, I think they'd be well, they would be smart to say, okay, we are just going to tax rich people enough to give the folks who want to give affordable healthcare to affordable healthcare, and not make it overly complicated, because they don't get credit for the other stuff yeah i mean that seems to me like if democrats are running in 2018 or in 2020 probably more likely 2020 like that's the kind of plan that you're going to run on right something much simpler than what we tried to uh what we had to go to reconciliation right right imagine a plan that what it said was simply this this plan which can pass with 51 votes in Senate, is not going to have a bunch of delivery system reforms. It is going to do three things. It's going to allow people it's going to allow Medicaid to cover anybody up to 300 percent of the poverty line and then a sliding scale up to 400 percent. people 50 years old and older to buy into Medicare, possibly with some subsidies, possibly not. And it will increase the, and it will add a public option to the Obamacare marketplaces.

Now you'd want to, like, there are things in that plan that would require smoothing. I'm not saying it's literally a three sentence plan, but you could pass that through reconciliation. It wouldn't be that hard. And you'd, you know, jack up taxes on the rich to do it. And then it's pretty done. You don't have to get – health care is complicated, and it should be, I think, if you're trying to remake the system and you're trying to save money on the delivery side. And look, I'm a wonk. I like doing that kind of thing. But I think in a world where the issue is this polarized and Republicans are this unwilling to play in a real way, it may be that that kind of that stuff is not worth it. I think I think folks like Ben Nelson and all those moderate Democrats who thought they would be better off pulling this plan to the right. In the end, we're quite wrong about that.

Last question. We'll let you go. Do you think that some of these more moderate Republicans in the Senate sort of hold their position on being against this House bill? Like, do you think, could you see a Susan Collins voting for this in the end if there's enough pressure? I have trouble. I don't know. We've not seen what happens when Donald Trump executes a full-on legislative pressure campaign. But so far, you have basically a pincer movement in the Senate of conservative senators, particularly Tom Cotton, Mike Lee, Rand Paul, and Ted Cruz, who are against this plan or saying they're against this plan. Now, it's always possible there's some amendment that will get them all on board, but they're saying they're

against this plan. And then you have a number of more moderate Republican senators, Susan Collins, Lisa Murkowski, Cassidy, you can name a couple others probably, who think the plan is not generous enough or worried about the Medicaid side of it, Dean Heller from Nevada. And one difficulty with this is that anything you do to satisfy one side infuriates the other side. Right. So anything you do to move the plan more towards the Mike Lees and Rand Pauls, moves it further away from the Dean Hellers and Susan Collins, and vice versa. I also think that, look, the thing that is true about this plan, as much as Ryan and others are pushing it,

as much as I'm a little bit surprised how smoothly they got it out of the committee, it has been panned by every major conservative group you can think of, pretty much. Club for Growth is against it. Heritage is against it. Americans for Prosperity are against it. The conservative healthcare world is against it. So these folks in the Senate are getting a lot of pressure not to do this. The American Hospital Association is against it.

Everybody's got hospitals in their state. So it faces an uphill battle. The question is just how much do Republicans end up buying Paul Ryan's now or never moment? The question is whether or not they get convinced like they do not want to be holding the bag on this when it actually – if it actually goes into law. And the question is how effective is Donald Trump at coming into their office or having them on Air Force One and saying, hey, unless you'd like a tweet from me every day at 6 a.m. for the rest of your lives, you better vote for the still. Well, we shall see as the shit show continues. Ezra, thank you so much for joining us and come back soon.

Not at all. Thank you, Gus. All right. Take care. Thanks, man. Thanks again to Ezra Klein for joining us today. Again, check out With Friends Like These tomorrow. Check out Pod Save the World. And we will see you next week. Bye, guys.

Bye.