Al Franken, Giant of the Senate

by Al Franken

  Even after they failed to defeat President Obama in 2012, Republicans had gone too far down this path to turn back. They had trained their base to respect nothing and expect everything: While the GOP’s official post-election autopsy urged moderation on issues like immigration, the activists who ran the show concluded that Mitt Romney had lost because he wasn’t extreme enough.

  By the end of President Obama’s second term, Republicans had failed to keep any of the promises they had made to keep the Tea Partiers on board and engaged—they hadn’t repealed health care reform or defunded Planned Parenthood or proved that the president was born in Kenya.

  All they had done was break the damn government. With Republicans putting up a unified front of opposition, we made no real progress on big issues like immigration or tax reform. Even after the massacre at Sandy Hook Elementary School in Newtown, Connecticut, we couldn’t get an extremely mild gun safety bill through the Senate. And of course, they shut down the government for sixteen days in 2013, costing the U.S. economy $24 billion.*

  And the thing of it was, ordinary Americans who weren’t themselves rabid partisans saw all this happening and blamed both sides. I was always amazed when I would go around Minnesota and meet people who didn’t follow national politics that closely but who knew that Republicans had been extremely uncooperative during the Obama administration. “I know,” I’d say, “it’s awful.”

  “Yeah,” these people would often respond. “But that’s Washington for you.”

  I never fully understood this “a pox on both houses” mentality until I read an article by Jonathan Rauch in the Atlantic last summer. He was talking about a study by a pair of political scientists in which they’d found that “between 25 and 40 percent of Americans… have a severely distorted view of how government and politics are supposed to work.”

  Rauch calls these people “politiphobes”:

  [T]hey see the contentious give-and-take of politics as unnecessary and distasteful. Specifically, they believe that obvious, commonsense solutions to the country’s problems are out there for the plucking. The reason these obvious solutions are not enacted is that politicians are corrupt, or self-interested, or addicted to unnecessary partisan feuding.

  These folks didn’t reach that conclusion without some help. Many political reporters can’t seem to write a sentence about a problem without casting at least some blame onto both sides. Congressional Republicans knew that, and made hay with it. McConnell and his friends consistently blamed Obama for the partisanship of the Obama years, managing to suppress their giggles all the while.

  And too many journalists bought it. Take, for example, this bloodcurdling artifact of Operation Curdle—a piece in Time magazine by Mark Halperin from December 2009 identifying the root cause of Obama-era partisan rancor:

  Once the new President cast his lot with his party in passing an economic-stimulus measure rather than seeking bipartisan agreement, rival Republicans started digging in.

  Fortunately, the press cleaned up its act before 2016. Sigh.

  Speaking of which. As the 2016 presidential campaign unfolded and it became clear that Donald Trump might actually become the Republican nominee, pundits searched their pundit brains for answers to where the Trump phenomenon had come from, pinning the blame on everyone from Sarah Palin to Richard Nixon to Kim Kardashian.

  But the answer was right there in front of us the whole time. Yes, Donald Trump’s takeover of the Republican Party had roots in the fact-free right-wing media bubble and in Newt Gingrich’s pioneering of the politics of personal destruction in the 1990s. But his campaign grew directly out of the strategy Mitch McConnell implemented beginning at that retreat in West Virginia after Barack Obama won the White House in 2008, a strategy of total war against a Democratic president, a strategy in which no attack, no matter how false or outrageous, was out of bounds. When Republicans chose Door Number 3—when they chose to become “insurgent outliers”—they unwittingly opened the door for Trump.

  “For the fat-cat donors, special-interest lobbyists, and elected officials who usually run the Republican show,” wrote David Corn of Mother Jones, “Trump is an invasive species. But he has grown large and strong in the manure they have spread across the political landscape.”

  And after eight years of refusing to help the president govern—in fact, eight years of actively trying to make the country ungovernable—Republicans hadn’t just created a monster within their own ranks. All that inaction and gridlock helped to create a nation of politiphobes, people who (correctly) felt like they were being left behind in the economy and (correctly) felt that the political system was broken and rigged against people like them and (extremely incorrectly) felt that everyone who had anything to do with politics was more or less equally to blame.

  Rauch writes that these voters are inclined toward “leaders who will step forward, cast aside cowardly politicians and venal special interests, and implement long-overdue solutions.”

  These leaders “can be politicians, technocrats, or autocrats—whatever works,” Rauch adds. “Whether the process is democratic is not particularly important.”

  Chapter 33

  Health Care: Now What?

  Donald Trump’s health care plan, as expressed during his campaign, was as follows: “Repeal Obamacare and replace it with something terrific.”

  Okay, that’s not the entire plan. Trump later elaborated on “something terrific,” explaining that his plan would be “so much better, so much better, so much better.”

  When he was elected, it became clear that “repeal” was now a real possibility. The “replace” part, however, was as much of a mystery as it had always been. Over the previous six years, Republicans had voted more than sixty times to repeal the law. They had offered zero plans to replace it.

  That’s not to say they didn’t have ideas related to health care. For example, Republicans have always been big on “tort reform,” which means making it harder to sue for malpractice. Then there’s the one actual idea Trump offered during the campaign, which is to allow health insurance companies to sell insurance plans across state lines.

  Here’s the thing about that, by the way. There is no federal law that prevents it. It’s up to the states to decide which health insurance companies can sell within their borders. In fact, since the ACA passed, six states have allowed insurance companies from outside their borders to offer policies to their citizens.

  And guess what: No health insurance company has done it! Why? Because in order to offer coverage in a given state, you need more than a license to do so. You need to learn the state, assess the health care needs of its population, and set up a network of providers willing to accept your insurance.

  So that barely counts as an idea. And more important, it has nothing to do with the central challenge of health care reform, which is making sure that nobody in America goes bankrupt because they get sick or hurt—or, worse, goes without care they need because they can’t afford it.

  By the time you read this, Republicans may well have succeeded in repealing some or all of the Affordable Care Act. But I’m willing to bet they won’t have succeeded in replacing it. Because the truth is, they’ve never been interested in addressing that central challenge. And they’ve been proving just how uninterested they are since the very beginning of this debate.

  Let’s go back to 2008, when Barack Obama first ran for president and I first ran for the Senate. Getting to universal health care was at the center of our respective campaigns. And for good reason: Every developed country in the world had some form of universal health care except the United States, providing care for all their people and doing it at about half the cost and with better outcomes.

  During one of our debates, Norm Coleman had insisted that the United States already had the best health care system in the world, pointing to the Mayo Clinic in our home state.

  True, Mayo provides health care that is second to none on the planet, which is why Mayo is such a point of pride
in Minnesota. The problem was that great health care delivered by a number of world-class hospitals and clinics doesn’t make a health system.

  As T. R. Reid pointed out in his 2009 bestseller The Healing of America, the United States didn’t have a health system—we had a number of health systems. If you were in Medicare or Medicaid, you were in the Canadian system: single-payer. If you were in the military or the VA, you were in the British system: socialized medicine. If you got your insurance through your employer, as most Americans did, you were in the German system.

  But if you didn’t have any health insurance, you were in the Cambodian system, where one illness or injury could literally ruin or even end your life. More than half of all personal bankruptcies in America were caused, in part or entirely, by a health care crisis. And that statistic doesn’t even count all the people, like Margie Hogan’s young lupus patient, who were going without care they needed because they didn’t have insurance to pay for it.

  One reason so many people were trapped in the Cambodian system was that before Obamacare, insurance companies could turn you down (or charge you outrageous, impossible premiums) for coverage if you had a preexisting condition like cancer, heart disease, or diabetes.

  I know. It’s hard to believe. But way back in 2009, that’s the way it was.

  Nowadays, of course, pretty much everyone agrees that this is cruel and wrong. Even Donald Trump agrees! If you want everyone to have the security of health insurance, you can’t let insurance companies deny coverage to people who have preexisting conditions.

  But here’s the catch: If no one can be turned down (or charged more) for having a preexisting condition, then there’s no incentive to actually get health insurance until the moment you need to use it. You might as well wait until you develop lupus or get a light bulb stuck up your butt before buying a policy.

  This is known as the “free rider” problem: If only sick or light-bulbed people have insurance, then insurance becomes impossibly expensive to provide, and thus impossibly expensive to afford. So if you want sick people to be able to get insurance without the insurance market collapsing, then healthy people have to have insurance, too.

  Of course, some people in the Cambodian system didn’t have insurance not because they couldn’t get an insurance company to cover them, but rather because they didn’t have a job that provided insurance and didn’t have the money to buy a policy on their own. So if you’re going to require that everybody get insurance, you have to subsidize it for people who can’t afford it otherwise.

  Hey, wait a minute. A lifeline out of the Cambodian system for people who didn’t have insurance… an individual mandate to avoid the “free rider” problem… subsidies to make sure that people can afford the insurance they’re required to have—this sounds an awful lot like Obamacare! And of course, that’s exactly the three-legged stool that formed the foundation of the Affordable Care Act.

  Here’s what’s important to understand about this model: The stool only works with all three legs. Without the subsidies, you can’t have the mandate. Without the mandate, you can’t have the ban on discrimination against people with preexisting conditions. And without those protections for the most vulnerable Americans, you’re right back where you started.

  If this sounds like a complicated way to solve the problem, well, it is. A simpler solution would have been to just go to a national single-payer plan like Canada’s: Medicare for everyone. And many progressives, like Bernie Sanders, thought that’s what we should do back in 2009. Unfortunately, we needed sixty votes to pass anything, and we were, oh, about fifty votes short.

  What would a conservative solution to the “Cambodian system” problem look like? Well, actually, a lot like Obamacare. The three-legged stool model, in fact, had originated with the very conservative Heritage Foundation, and had been enacted in Massachusetts under a Republican governor with the improbable name of Mitt. Where, by the way, it worked extremely well: Romneycare now covers 97 percent of Bay Staters, and both Democrats and Republicans there intend to keep it intact, no matter what Trump and my Republican colleagues do to Obamacare between the time I finish this book and the time you read it.

  So if Republicans had had any interest in getting people out of the Cambodian system, they could have supported the conservative framework in the Affordable Care Act. Or they could have offered some other alternative plan. But they refused to do either.

  Max Baucus, chairman of the Senate Finance Committee, was determined to get a bipartisan bill, and in April 2009 he’d put together a Gang of Six (three Democrats, three Republicans) to start negotiating. Every Tuesday, when we met for our caucus lunch, he’d report that they were getting closer to an agreement. This went on for months.

  Finally, at a lunch in late September 2009, Max acknowledged that the Gang of Six was at a complete impasse, and that he had finally concluded that Republicans never had any intention of reaching an agreement, no matter what was in it.

  At this, former Republican Arlen Specter interjected, “Well, I could have told you that!”

  Then why didn’t you?! I thought to myself.

  By then, however, a tiny window had opened to allow us to get it done on our own without any help from the Republicans.

  Remember, when President Obama was sworn in, he had fifty-eight Democratic votes. In April, Arlen Specter made it fifty-nine. But by the time I got there in July to make it sixty, Ted Kennedy was bedridden in Hyannisport in the final stages of his battle with brain cancer, so we still really only had fifty-nine.

  Senator Kennedy passed away in late August. On September 24, Massachusetts governor Deval Patrick appointed Paul Kirk to fill his seat until a new senator could be picked in a special election the next January. Finally, for the first time, Democrats actually had the sixty votes we would need to move forward on health care.

  The bad news was that we would need every single one of those sixty votes. Which meant every single one of us had a veto. Good luck, Harry Reid!

  Fortunately, Harry was exactly the right guy for this impossible job. Harry grew up in the hardscrabble Nevada mining town of Searchlight. He put himself through law school as a Capitol Police officer. As chairman of the Nevada Gaming Commission, he had taken on the mob (his wife, Landra, once famously found a bomb attached to their car). Simply put, Harry Reid is a hardass.

  As a young man, he had been a boxer. I once heard President Obama repeat what Harry told him about his career in the ring: “I wasn’t the most talented guy. I wasn’t very fast. I wasn’t big, obviously. But I could take a punch.”

  Harry’s job on health care was to take punches—for President Obama, and for everyone who was counting on him to deliver on the promise of reform. And, boy did he take a lot of punches. But he got it done. And that’s why Harry Reid will always be a hero to me.*

  Still, the math was the math, and it forced us to make some tough compromises. A handful of moderate-to-conservative Democrats were opposed to the public option, which would have increased competition in the insurance market. Gone.

  Someone floated the idea of lowering the age for Medicare to fifty-five. Hmmm. Not a bad idea. Makes both pools healthier (Medicare adds some people between fifty-five and sixty-five who are, on average, healthier than people over sixty-five, while the private health insurance market loses its oldest members). Okay. Let’s do it! But then Joe Lieberman announced on Face the Nation that he was against it. Gone.

  In November, we hit another hurdle: Ben Nelson told us he had decided he needed tighter restrictions on federal funding for abortions. Great.*

  Barbara Boxer, the Senate’s staunchest supporter of a woman’s right to choose, bit the bullet and negotiated a compromise with Ben: Women would have to make a separate second payment to their insurer to get coverage for abortion. We didn’t like it, but we didn’t have a choice.

  Finally, on Christmas Eve, we passed the bill through the Senate. Phew.

  Then, suddenly, things got even harder. In January, the not wh
ip-smart Scott Brown, a Tea Party Republican, won the special election for Ted Kennedy’s seat in Massachusetts.

  Democrats freaked out. Many saw Brown’s victory as a sign that the Republican strategy was paying off so handsomely that it could give them control of Congress in that November’s midterms and set the president up for a defeat in his 2012 reelection campaign.

  On top of that, our math problem had just gotten a lot worse, because once Brown took office in early February, that would be the end of our sixty-vote, filibuster-proof supermajority.

  “Wait,” you’re thinking, “I thought you had already passed the bill.” We had. And so had the House. But there were some differences between the two bills.

  Ordinarily, this wouldn’t be a big deal. We’d convene a conference committee, hash out the differences, and then both chambers would vote to pass the unified bill that came out of the conference.* But Republicans were still hell-bent on stopping us from passing health care reform, and now that they once again had forty-one votes in the Senate, they could stop us from voting on that unified bill.†

  So a conference committee would be out of the question. There was only one solution: The House would have to pass the exact same bill we had just passed. Guess who didn’t like that idea? House Democrats. Liberals wanted provisions from the House’s more progressive bill, and Democrats from more conservative districts were now spooked by Brown’s victory in Massachusetts.

  We were stuck. And we needed the most important Democrat in the country to decide on a plan. No, not Rachel Maddow. President Obama! Unfortunately, many of the Democrats who were freaking out about Scott Brown’s victory worked for the president. And some, most notably Obama’s chief of staff, Rahm Emanuel, wanted to scale down the bill or even abandon health care reform altogether.