“I'm here tonight because Obamacare is failing,” Lindsey Graham pleaded. The South Carolina senator joined his GOP health care proposal cosponsor, the Louisiana Senator Bill Cassidy, on stage at a Monday night CNN debate about health care reform. Graham and Cassidy sat alongside two opponents, Bernie Sanders and Minnesota Senator Amy Klobuchar, who represented the Democratic caucus in the Senate. CNN personalities Jake Tapper and Dana Bash moderated the forum, fielding questions from the audience and asking Sanders, Klobuchar, Cassidy, and Graham about their respective efforts to revise Obamacare in the Senate.
On Tuesday afternoon, after the town hall, Cassidy and Graham pulled their latest proposal from consideration, having lost support from several key GOP senators in recent days. The Republicans control Congress and the White House, but they have yet to outline a singular vision for U.S. health care beyond their determination to repeal Obamacare. After the GOP’s big, coordinated Obamacare repeal push failed in July, the fight fell to Cassidy and Graham, who, alongside former GOP senator Rick Santorum, led a scrappier, last-ditch effort to repeal Obamacare before a prohibitive September 30 deadline. Their 140-page health care reform bill, nicknamed Graham-Cassidy, initially met with pessimism and indifference among rank-and-file Republicans, before late support from President Donald Trump nudged the bill closer to a Senate floor vote. For a contentious few days, repeal was back on the table. But the Graham-Cassidy proposal effectively died just hours before the CNN town hall as Maine Senator Susan Collins announced her opposition, which Tapper read aloud as breaking news. Collins’s defection was the last straw. Cassidy and Graham pulling their bill less than 24 hours later was inevitable.
If Cassidy and Graham felt any animosity toward their colleagues in either party following Collins’s death blow to their proposal, you couldn’t tell from their performance at the town hall. Throughout the 90-minute debate, all four senators slapped each others’ backs and cracked friendly jokes. They spoke openly about a policy debate that GOP leaders in Congress have otherwise forced behind closed doors. Graham and Cassidy were as eager to discuss their own, ultimately doomed proposal as they were to expound on their opposition to Obamacare while also opposing Sanders’s radical, insurgent proposal—Medicare for all.
Sanders, who was characteristically loud and passionate on stage as he outlined his proposal Monday night, wants to establish a national single-payer health insurance program that would expand Medicare-type coverage from 65-year-olds to, well, everyone. Sanders has become the champion for an ambitious health care overhaul that prominent Democrats, including Hillary Clinton, had sworn off as recently as last year. In Congress, the Republican leadership has naturally opposed a single-payer health care system for much longer than that. The CNN town hall gave Sanders and Klobuchar a chance to speak extensively about their alternatives to repeal. Klobuchar has signed on to neither of the major overhaul proposals, as she has instead advocated for piecemeal Obamacare fixes, such as allowing Medicare to negotiate pricing with drug companies. On Monday, Klobuchar offered the least dynamic perspective on health care reform, but she represented the conventional wisdom among most Democrats who favor Obamacare but welcome modest reforms in place of total overhaul.
The eternal Obamacare repeal debate has split the left and the right into wide divergence over the future of U.S. health care. The Republicans have advocated repeal for nearly a decade now. Only since Trump took office have Democrats swung wide in the opposite direction, not only defending Obamacare from various repeal and defunding efforts, but entertaining the idea of using Obamacare as a stepping stone to true universal coverage. At the CNN town hall, several audience members observed that U.S. health care debates since Obamacare have become defined by radical reinventions and wild promises that go unfulfilled. Meanwhile, the current health care system is haunted by imperfections and the threat of perpetual change due to partisan grievance. It’s an unsettling political reality for a population that’s mostly just worried about seeing doctors in a timely, affordable manner. “It feels like all of the ideas getting traction right now are extreme measures,” one audience member observed. “You've got Graham-Cassidy, which would kind of strip the system down to the nubs and rebuild systems in 50 different states. And you've got Medicare for all, which [...] would take an entire population currently involved with the ACA and move it to another system.”
“I don’t think Medicare for all is an extreme idea,” Sanders answered.
Graham, too, insisted that his own proposal to convert Obamacare’s funding into block grants is a perfectly sensible diffusion of bureaucratic authority. Cassidy and Graham maintain that states are inherently better at managing health care services than the federal government. It’s a common conservative refrain, which Cassidy and Graham spent all evening repeating regardless of their bill’s dire fortunes. Their broader argument, which both senators presented as obviously true despite how counterintuitive this claim is on its face, is that 50 different states managing 50 different health care bureaucracies is certainly more efficient than a single federal system. “Everybody on this stage thinks the current system is broken,” Cassidy said. Republicans often speak of repeal, but Cassidy, Graham, Sanders, and Klobuchar all framed their proposals, large and small, in terms of repair. As if U.S. health care reform has ever been modest and simple.
With eight years of debate over Obamacare behind us, the Sisyphean effort to repeal Obamacare has become the definitive GOP policy priority of a generation. Under Trump, these repeals have brought nothing but failure and humiliation to the Republican Party, which has so far failed to translate its total dominance of the U.S. government into a single, meaningful legislative achievement. Trumpcare—a term that loosely incorporates various GOP attempts to dismantle Obamacare—died on the Senate floor in late July after a few GOP senators bucked their party’s congressional leadership.
Cassidy and Graham’s participation in the CNN town hall was the most transparently deliberative that the Republicans have been about health care all year. It is unclear whether the GOP leaders in the Senate and the House, Mitch McConnell and Paul Ryan, will embrace a slower, more deliberative process going forward, as John McCain has repeatedly demanded. For now, however, the Republicans are left licking their wounds and rethinking their priorities under a chaotic president who has scored no major legislative victories to date. That’s the state of Trumpcare, which, though undead as ever, seems as unlikely as ever to pass into law anytime soon.
Sanders’s proposal is even less likely than Graham-Cassidy ever was to reach the president’s desk. Still, Sanders has recently found several prominent Democratic cosponsors for his bill, including Elizabeth Warren, Cory Booker, Kirsten Gillibrand, and Kamala Harris. The Sanders proposal, titled the Medicare for All Act of 2017, outlines a universal health insurance program to be administered by the federal government. Sanders spent much of the 2016 Democratic presidential primaries touting Medicare for all, while his chief rival, Hillary Clinton, committed herself to extolling Obamacare over all possible alternatives.
Sanders first drafted his “Medicare-for-all” proposal as a 2013 bill with no cosponsors. His bill would, as Sanders promised again Monday night, “guarantee health care as a right” of all U.S. citizens.
More moderate Democrats, such as Klobuchar, have taken stances similar to Clinton’s cautious, corrective defense of Obamacare. Still, Klobuchar sharing a dais with Sanders—a socialist, as Cassidy dramatically noted throughout the debate Monday evening—illustrates a once unthinkable shift in the Democrats’ willingness to at least entertain socialized medicine, or something quite like it. While Sanders pitched universal health care access through a public system, Klobuchar instead pitched increased competition among private insurers. But both senators agreed that Obamacare has expanded access without alleviating many affordability concerns among consumers.
The CNN town hall, confined to a small soundstage, was an awkward forum, especially as it coincided with the Graham-Cassidy proposal’s death in real time, off stage. Cassidy, playing the wide-eyed pitchman, extolled the authority of patients and the supposed intimacy that state governments offer health care consumers compared to federal bureaucrats. Meanwhile, Graham would spend much of the debate simply unloading on Obamacare. “The only thing I can tell you for sure,” Graham said at one point, “is if you keep doing what we’re doing, it’s going to fail.” Sanders and Klobuchar were hardly so fatidic. Sanders, in particular, defended Obamacare more vigorously than many of his center-left detractors predicted.
Still, Sanders promised a better, implausible future that mainstream Democrats had resisted for a quarter century—until now. Republicans run the government, but the fortunes have radically turned. When Tapper briefed the audience on Susan Collins’s late-breaking opposition to Graham-Cassidy, Graham’s last rites for his own proposal scanned as words of encouragement for the Sanders coalition. “It’s OK to fall short, if you do, for an idea you believe in,” Graham concluded.