It's Called Monopoly Rents and Oligopolies

The good folks at the New York Times have noted that healthcare costs in the US started rising sharply relative to other developed nations around 1980.

Ignoring the obvious error (Dean Baker notes that the increase in US medical inflation started in the 1970s, not the 1980s) the history is clear: this began with a major push toward deregulation that began under the Carter administration, along with largely successful efforts to privatize what had been publicly owned research and development.

The walk-back from meaningful antitrust enforcement, and to deregulate many aspects of the market economy, along with efforts to privatize federally funded research progressed rapidly during the late 1970s, culminating with the disastrous Bayh-Dole act, which had the effect of handing government research to private entities.

Later, under the Reagan administration, the break-neck pace of these changes further accelerated.

It became the wild west, and a very opaque one at that, and to paraphrase former banking regulator Bill Black, if looting is possible, it has already happened.

What's more the proceeds of the looting are almost immediately reinvested in rent seeking activities like campaign donations, to embrace and extend the regime.

Rinse, lather, repeat.

Even by the Standards of Trump, This is Unbelievably Stupid

Donald Trump has a plan to lower drug prices in the United State.

Basically, he wants to force other countries to pay more, and then big pharma, out of the goodness of its heart, will lower prices in the USA, because the drug companies will only take as much money as they need, and won't waste it on excessive executive compensation or stock buybacks.

I'm not sure if they are being stupid, or if they think that we are this stupid, but in either case, the level of idiocy buggers the mind:

President Trump, poised on Friday to unveil his strategy to lower prescription drug prices, has an idea that may not be so popular abroad: Bring down costs at home by forcing higher prices in foreign countries that use their national health systems to make drugs more affordable.

On Tuesday, Mr. Trump rebuffed his European allies by withdrawing from the Iran nuclear deal. Threatened tariffs on steel and aluminum have strained relations with other developed nations. And now the administration is suggesting policies that could hit the pocketbooks of some of America’s strongest allies.

“We’re going to be ending global freeloading,” Mr. Trump declared at a meeting with drug company executives in his first month in office. Foreign price controls, he said, reduce the resources that American drug companies have to finance research and develop new cures.

The White House Council of Economic Advisers fleshed out the idea three months ago in a report that deplored the “underpricing of drugs in foreign countries.”

The council said that profit margins on brand-name drugs in the United States were four times as high as those in the more regulated markets of major European countries and Japan. The United States, it said, needs to “address the root of the problem: foreign, developed nations, that can afford to pay for novel drugs, free-ride by setting drug prices at unfairly low levels, leaving American patients to pay for the innovation that foreign patients enjoy.”

Most of pharma research funding already comes from the governmet and big pharma spends more on advertising and marketing than they do on research, but, according to Trump and his Evil Minions^™, the problem is that they can't rape consumers hard enough.

Great googly moogly.

Medical Data Point of the Day

It turns out that the average American birth costs more than the recent delivery of Prince William and Princess Catherine's 3^rd child at a luxury private hospital in London.

That hospital serves champagne and has an extensive wine list, and it still costs about the same as an average delivery in the USA:

………

Yet the price of delivering the new prince, who is fifth in line to the British throne, was probably slightly less than that of an average American baby. In 2015, the Lindo Wing charged £5,670 ($8,900) for 24 hours in a deluxe room and a non-Caesarean delivery. A survey in the same year by the International Federation of Health Plans found that the average fee for such a delivery in the United States was $10,808. ………

God bless our market driven health care system.

I Propose Renaming Goldman Sachs to "Sirius Cybernetics Corporation"

Because the latest bit of analysis on healthcare from these guys, basically says that, there is no money on curing disease, we need to work to make everything chronic.

I believe the phrase, "A bunch of mindless jerks who'll be the first against the wall when the revolution comes," should apply here:

One-shot cures for diseases are not great for business—more specifically, they’re bad for longterm profits—Goldman Sachs analysts noted in an April 10 report for biotech clients, first reported by CNBC.

The investment banks’ report, titled “The Genome Revolution,” asks clients the touchy question: “Is curing patients a sustainable business model?” The answer may be “no,” according to follow-up information provided.

Analyst Salveen Richter and colleagues laid it out:

The potential to deliver “one shot cures” is one of the most attractive aspects of gene therapy, genetically engineered cell therapy, and gene editing. However, such treatments offer a very different outlook with regard to recurring revenue versus chronic therapies... While this proposition carries tremendous value for patients and society, it could represent a challenge for genome medicine developers looking for sustained cash flow.

For a real-world example, they pointed to Gilead Sciences, which markets treatments for hepatitis C that have cure rates exceeding 90 percent. In 2015, the company’s hepatitis C treatment sales peaked at $12.5 billion. But as more people were cured and there were fewer infected individuals to spread the disease, sales began to languish. Goldman Sachs analysts estimate that the treatments will bring in less than $4 billion this year.

I want the guillotine concession on these rat-f%$#s.

I'd be a wealthy man.

Yeah, This Is Horrifying

It turns out that in addition to promiscuously sharing user data with anyone who would pay, Facebook was planning to use health data from hospitals for further refine their profiles of their users:

Facebook has asked several major U.S. hospitals to share anonymized data about their patients, such as illnesses and prescription info, for a proposed research project. Facebook was intending to match it up with user data it had collected, and help the hospitals figure out which patients might need special care or treatment.

The proposal never went past the planning phases and has been put on pause after the Cambridge Analytica data leak scandal raised public concerns over how Facebook and others collect and use detailed information about Facebook users.

"This work has not progressed past the planning phase, and we have not received, shared, or analyzed anyone's data," a Facebook spokesperson told CNBC.

But as recently as last month, the company was talking to several health organizations, including Stanford Medical School and American College of Cardiology, about signing the data-sharing agreement.

Let's be clear about this:  The data would not have been meaningfully anonymized, because you COULD NOT meaningfully anonymize the data.

The data itself would indicate who the individuals in question were, and in fact HAD TO, because otherwise it would serve no use, because it had to be target at SPECIFIC PATIENTS who might, "Need special care or treatment."

The business plan here was to take the data, merge it with other data to get personalized medical information, and then sell it back to doctors and hospitals.

If that does not chill you, figure that the next step would have been making it available to businesses to allow them to pre-screen applicants to exclude those who would likely have expensive health problems.

Think of it as a FICO score for your life.

Are you horrified yet?

Well, That Was Quick………

Former Department of Veterans Affairs David Shulkin was fired on Wednesday, and on Thursday he publishes an OP/ED in the New York Times claiming that it was because the barbarians in the Trump administration are trying to privatize the VA:

It has been my greatest professional honor to serve our country’s more than 20 million veterans. Almost three years ago, I left my private sector job running hospitals and came to Washington to repay my gratitude to the men and women who put their lives on the line for our country.

………

Until the past few months, veteran issues were dealt with in a largely bipartisan way. (My 100-0 Senate confirmation was perhaps the best evidence that the V.A. has been the exception to Washington’s political polarization.) Unfortunately, the department has become entangled in a brutal power struggle, with some political appointees choosing to promote their agendas instead of what’s best for veterans. These individuals, who seek to privatize veteran health care as an alternative to government-run V.A. care, unfortunately fail to engage in realistic plans regarding who will care for the more than 9 million veterans who rely on the department for life-sustaining care.

The private sector, already struggling to provide adequate access to care in many communities, is ill-prepared to handle the number and complexity of patients that would come from closing or downsizing V.A. hospitals and clinics, particularly when it involves the mental health needs of people scarred by the horrors of war. Working with community providers to adequately ensure that veterans’ needs are met is a good practice. But privatization leading to the dismantling of the department’s extensive health care system is a terrible idea. The department’s understanding of service-related health problems, its groundbreaking research and its special ability to work with military veterans cannot be easily replicated in the private sector.

I have fought to stand up for this great department and all that it embodies. In recent months, though, the environment in Washington has turned so toxic, chaotic, disrespectful and subversive that it became impossible for me to accomplish the important work that our veterans need and deserve. I can assure you that I will continue to speak out against those who seek to harm the V.A. by putting their personal agendas in front of the well-being of our veterans.

I gotta figure that the first draft of this hit the Times editors weeks ago, and that it was held until he was fired.

It's called keeping your powder dry, or getting your ducks in a row, and I approve.

You Would Know This If You Talked to Doctors

It appears that at least SOME of the mainstream media are beginning to notice that electronic health records are neither saving money nor improving the quality of health care:

We trust computer technology to solve problems, save time and money, and improve our lives. It has. Why didn’t it work with electronic health records?

EHRs are costly, clunky, error prone failures we seem unable to fix. It’s as if we took off in a hastily designed rocket, realize we need to come back, but are stuck in orbit without a reentry plan.

The Obama administration set aside tens of billions in 2009 to forcibly drag doctors and hospitals out of the Stone Age of paper into the brave new world of bites and bits. It promised a Nirvana of heath care quality, efficiency and cost savings. Hundreds of billions more were spent by hospital systems, too, under government mandates. In retrospect much of that money was wasted.

……… Snipping the example of automated check in at the airport.

Assuming [airline] employees get $30 an hour, that’s $1,500 saved for each and every flight. With hundreds of flights from each airport that’s big money. Employees cost a lot ongoing. Touch screens work for years on one investment. We, passengers, were the happy, healthy — and unpaid — labor that made it possible. The airline’s question had been, “How can computers save money and employee time on passenger check-in?” It got the right answer by asking the right question.

In medicine, the customer is the patient, not the passenger. If we could get patients to check into the medical office, hospital or emergency room, go to a touch screen, populate the computer screens with their correct diagnosis, order their tests and imaging and prescribe their own treatments that would be peachy, but unlike passengers, patients can’t do that on their best days. There is almost nothing in medicine that can be done, ordered or documented by the patient/customer. Doctors and nurses do all that.

Before the EHR, I dictated hospital admission histories on a phone and a typist getting $30 an hour typed them. I do that on an EHR now and it’s slower. It takes me triple the time it used to. There is a complex template used, not much like the way I think about care.

Similarly, I used to hand write orders and give them to a clerk. It took but a few minutes. Entering it all by computer is complex. The EHR does not allow me to just write what I want. It offers drop downs, many suggestions, and reminders, and pages of choices to click and to select options, not to mention all the time taken to just get in and out of the triple layer of security built into every such program. That alone takes more time than handwritten orders used to take.

So in the hospital I have become a very highly paid clerk. It is as if Qantas required the pilot to do the data entry for billing and boarding of each passenger. Insane, you say? But that’s exactly what current EHRs do in medicine.

This does not just happen with medicine.

Thanks, Obama………

One of the central tenets of the PPACA (Obamacare) was that the malefactors of healthcare, insurance companies, big pharma, corrupt medical coding, etc. needed a seat at the table.



The logical extension of this is the admission by Dr. Jay Ken Iinuma, former medical director for Aetna for Southern California, that he rejected claims without ever looking at medical records:

California's insurance commissioner has launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients' records when deciding whether to approve or deny care.
California Insurance Commissioner Dave Jones expressed outrage after CNN showed him a transcript of the testimony and said his office is looking into how widespread the practice is within Aetna.

"If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records, that's of significant concern to me as insurance commissioner in California -- and potentially a violation of law," he said.

………

The California probe centers on a deposition by Dr. Jay Ken Iinuma, who served as medical director for Aetna for Southern California from March 2012 to February 2015, according to the insurer.
During the deposition, the doctor said he was following Aetna's training, in which nurses reviewed records and made recommendations to him.

Jones said his expectation would be "that physicians would be reviewing treatment authorization requests," and that it's troubling that "during the entire course of time he was employed at Aetna, he never once looked at patients' medical records himself."

This is what happens when you fetishize the market, and decide that people need "Skin in the Game".

This is the natural consequence of keeping predators in our healthcare system.

I Think That's the Worst Thing I've Ever Heard, How Appalling

In what is most certainly not a Count Rugen^* moment, I give you the most depressing headline I've seen in quite a while.

It's about a man who just won the lottery, and decides that he can finally afford to see the doctor:

Man Uses $1m Win To Finally Visit Doctor, Gets Terminal Cancer Diagnosis, Dies Weeks Later

Clearly, the solution to our broken healthcare system is more capitalism.

^*The Princess Bride, watch it, watch it again, and then watch it again.

Maybe They Can Expand Medicaid Now

In Virginia, a recount of a House of Delegates race has has the Democrat winning the race by one vote, which creates a 50-50 tie in that body:

The balance of power in Virginia’s legislature turned on a single vote in a recount Tuesday that flipped a seat in the House of Delegates from Republican to Democratic, leaving control of the lower chamber evenly split.

The outcome, which reverberated across Virginia, ends 17 years of GOP control of the House and forces Republicans into a rare episode of power sharing with Democrats that will refashion the political landscape in Richmond.

It was the culmination of last month’s Democratic wave that had diminished Republican power in purple Virginia.

Democrat Shelly Simonds emerged from the recount as the apparent winner in the 94th House District, seizing the seat from Republican David Yancey. A three-judge panel still must certify the results, an event scheduled for Wednesday.

Of the 23,215 votes cast in the district on Election Day, Yancey held a lead of just 10 votes going into Tuesday’s recount.

But five hours later, after a painstaking counting overseen by local elections officials and the clerk of court, Yancey’s lead narrowed — and then reversed.

The final tally: 11,608 for Simonds to 11,607 for Yancey.

………

Power sharing in the House of Delegates is an awkward exercise; the last such arrangement was in 1998. Committee chairs have to be negotiated, as does the person who will serve as speaker. With the parties split 50-50, there is no mechanism to break ties, and any legislation short of 51 votes does not advance.

Republicans hold a slight 21-to-19 edge in the state Senate, but with a Democratic lieutenant governor to break ties and a Democratic governor with veto power, Republicans may be forced to advance a more bipartisan agenda.

It’s a dramatic shift that caught even top Democrats by surprise. Republicans have controlled the 100-seat House since 2000; even outgoing Gov. Terry McAuliffe (D), a cheerleader for his party, had thought the Republican edge was insurmountable.

………

The final makeup of the legislature is not settled. Recounts in two additional races are taking place this week: on Wednesday in Richmond’s District 68, where the Democrat leads by 336 votes, and on Thursday in Fredericksburg’s District 28, where the Republican leads by 82 votes. Democrats are seeking a new election in the latter because more than 100 voters were mistakenly given ballots for the wrong legislative district.

My bad, it appears that Ralph Northam, the Governor elect, appears to be determined to kowtow to Republicans as a part of any implementation of Medicaid expansion, despite his promises on the campaign trail.

Snatching defeat from the jaws of victory since 1976: The mainstream Democratic Party.

Best Political Tweet Ever

This encapsulates the Democratic establishment, and what needs to be done with it, in a nutshell:

Thanks To You Leftist Fucks Apparently I Am Proud To Support Medicare For All #AnitaApparently4All pic.twitter.com/80kZ2haHhj

— Anita Hawkins (@SenAnitaHawkins) December 7, 2017

This is brilliant.

My computer finally finished updating.

Really Classy, Dude

A patient with stage 4 cancer showed up to Dean Heller's (R-NV) town hall to ask about healthcare and Obamacare, he had her ejected.

Even by the standards of Republicans, this is remarkably cheesy.

Somehow or Other, They Are Going to Get Rat F%$%Ed

The Indian pharmaceutical company Laurus Labs is planning to start selling low cost HIV drugs in the US as they come off patent:

Among the coconut plantations and beaches of South India, a factory the size of 35 football fields is preparing to churn out billions of generic pills for HIV patients and flood the U.S. market with the low-cost copycat medicines.

U.S. patents on key components for some important HIV therapies are poised to expire starting in December and Laurus Labs Ltd. -- the Hyderabad, India-based company which owns the facility -- is gearing up to cash in.

Laurus is one of the world’s biggest suppliers of ingredients used in anti-retrovirals, thanks to novel chemistry that delivers cheaper production costs than anyone else. Now, its chief executive officer, Satyanarayana Chava, wants to use the same strategy selling his own finished drugs in the U.S. and Europe. He predicts some generics that Laurus produces will eventually sell for 90 percent less than branded HIV drugs in the U.S., slashing expenditures for a disease that’s among the costliest for many insurers.

………

"The savings for U.S. payers will be so huge when these generic combination drugs are available in the U.S.," he said in an interview at the factory outside the Southern Indian city of Visakhapatnam. Payers will save "billions of dollars," he said.

The patent expiries are starting this month when Bristol-Myers Squibb Co.’s Sustiva loses protection. Gilead Sciences Inc.’s Viread follows next month. Both companies didn’t respond to requests for comment.

Would expect to see another round of evergreening, along with regulatory and judiciary road blocks to stop this.

After all, it's only people's lives, and the profits must be protected.

Tweet of the Day

Centrists: US healthcare system is the best.

Me: Shooting victim needs fundraiser to pay medical bills

Centrists: Fundraisers are awesome! https://t.co/U51pgBXlGb

— Salam Morcos (@SalamMorcos) October 16, 2017

Yea, pretty much.

Tory Program to Destroy NHS Continues

The Conservative Party in Britain has been privatizing the National Health Service (NHS) one bit at at time, and now we are seeing the consequencesn.

Specifically, Virgin Care, a private management company running the NHS is Bath, instructed its staff to cover up health and safety at the institution:

Virgin Care asked staff in the Bath area not to report their safety concerns to the health watchdog.

Registered managers in health and social care have a legal obligation to report issues to the Care Quality Commission if they feel their service is unsafe.

But Virgin Care asked its managers in Bath and North East Somerset to “hold off” from contacting the CQC as they struggled with IT issues affecting community health and social care services.

Patients had appointments cancelled, letters and reports were not sent out, and nurses had problems updating patient records during Virgin Care’s first three months in charge of community care in B&NES.

......

Virgin Care said it had "shared comprehensive details with the CQC and they have not raised any concerns".

The private company said it had IT issues under control in its first report to the council in July.

But two weeks earlier, a senior manager had emailed service managers asking them to help “manage the situation” by not reporting their concerns to the CQC.

For the Tories, this is not a bug, it is a feature.

Their goal is slowly make the NHS worse and worse until it loses its overwhelming public support, and can then be terminated.

It's Naomi Klein's Shock Doctrine writ slow, and Britain's conservatives have created a constituency for this policy by allowing the malefactors of great wealth, including Richard Branson (Virgin Care), to profit from this.

Wah ……… Wah ……… Wah ……… Waaaaahhhhhh

Cue Sad Trombone Music

Mitch McConnell just threw in the towel in the last attempt to repeal Obamacare:

Senate Republican leaders on Tuesday abandoned their latest campaign to dismantle the Affordable Care Act, conceding that their plan lacked key support. But they showed little interest in moving swiftly to shore up the seven-year-old law with the crucial funding it needs.

The official collapse of the Cassidy-Graham health-care bill once again leaves the party short of fulfilling a signature promise, which some Republicans worried could inspire a backlash among their base heading into the 2018 midterm elections.

And the failure of that alternative to the ACA, combined with the GOP’s reluctance to fix weaknesses in the existing law, leaves states, insurers and millions of consumers who rely on its coverage with substantial uncertainty. Enrollment begins in barely a month for 2018 health plans in marketplaces created under the law.

The Senate leaders said they would turn their attention to their next major legislative undertaking. “Where we go from here is tax reform,” Majority Leader Mitch McConnell (R-Ky.) told reporters after holding a closed-door policy lunch with members of his caucus.

Republicans already are bracing for the political fallout from the measure proposed by Sens. Lindsey O. Graham (S.C.) and Bill Cassidy (La.)., which McConnell had hoped to bring to a vote this week. They said the pressure to pass a tax overhaul bill was higher than ever and hoped the Republican base would give them a bit more time to take another shot at repealing the ACA.

Sucks to be Mitch McConnell today, then again, it sucks to be Mitch McConnell EVERY day.

About the only thing that sucks worse is being Elaine Chao.

Time to Retire, Nancy

Nancy Pelosi is doing her level best to minimize the increased support for single payer healthcare.

I guess that she's too interested in campaign donations from the insurance companies.

It should be noted that Sanders got 16 co-sponsors on his bill, something that would have been unthinkable 2 years ago.

It's time for Nancy Pelosi to step aside.

Unfortunately, the likely successors (Hoyer, etc.) suck too.

Standing Up to Bullies

Recently there was a video of a police officer brutalizing a nurse at the University of Utah for notifying him of hospital policies.

The hospital has now banned police from their wards and forbidden them from having contact with nurses:

The University of Utah Hospital, where a nurse was manhandled and arrested by police as she protected the legal rights of a patient, has imposed new restrictions on law enforcement, including barring officers from patient-care areas and from direct contact with nurses.

Gordon Crabtree, interim chief executive of the hospital, said at a Monday news conference that he was “deeply troubled” by the arrest and manhandling of burn unit nurse Alex Wubbels on July 26. In accord with hospital policy and the law, she had refused to allow a Salt Lake City police officer to take a blood sample from an unconscious patient. Wubbels obtained a copy of the body cam video of the confrontation and, after consulting her lawyer, the hospital and police officials, released it last week.

“This will not happen again,” Crabtree said, praising Wubbels for “putting her own safety at risk” to “protect the rights of patients.”

Margaret Pearce, chief nursing officer for the University of Utah hospital system, said she was “appalled” by the officer’s actions and has already implemented changes in hospital protocol to avoid any repetition.

She said police will no longer be permitted in patient-care areas, such as the burn unit where Wubbels was the charge nurse on the day of the incident and from emergency rooms.

In addition, officers will have to deal with “house supervisors” instead of nurses when they have a request.

Seriously, today's law enforcement seems to attract more than their share of bullies.

I'm  friend of mine who was a counselor was rather more charitable about such behavior, he believed that that the overwhelming majority of cops had serious PTSD issues after 5 years on the force.

In either case, this guy should not be a peace officer.

Yeah, Not Heartbroken over This One

One of the programs of Obamacare, thankfully a minor one, were so called "Voluntary" wellness programs where employers were allowed to coerce private medical information out of their employees.

A federal judge has now struck down these programs:

A federal court on Tuesday threw out a rule allowing employers to call their workplace wellness programs “voluntary” when employees stand to lose thousands of dollars for not participating — a win for groups that challenged what they argue are coercive programs that have not been shown to improve employees’ health.

The ruling, a summary judgment for the group that challenged the federal rule, orders the U.S. Equal Employment Opportunity Commission to come up with a “reasoned explanation” for deeming workplace wellness programs voluntary even if the programs impose steep penalties on workers who opt out, calling the absence of such an explanation when the EEOC issued its rule last year “a serious failing.”

The U.S. District Court for the District of Columbia, in an opinion by Judge John Bates, allows the 2016 EEOC rules to stay in place for now, however. Immediately unwinding the penalties and incentives in workplace wellness programs, which are built into employer-based health insurance plans, would be too disruptive, he ruled, since those plans have been in effect for months.

………

Because the EEOC administers both ADA and GINA, it stepped in to define “voluntary” in the context of workplace wellness programs. The programs have become increasingly popular as employers seek ways to reduce their health care spending. In addition, the Affordable Care Act allows employers to offer even higher workplace-wellness incentives than had previously been permitted. Last year, the agency issued a rule saying that “use of a penalty or incentive of up to 30 percent of the cost of self-only coverage will not render ‘involuntary’ a wellness program that seeks the disclosure” of workers’ ADA- and GINA-protected medical or genetic information.”

(emphasis mine)

This program typifies the problem with so many of the social welfare initiatives put forward by "centrists".

It provides no documentable benefits, and it is predicated on a complete contempt for the agency of ordinary people, and so is both demeaning and ineffective.

This is not a surprise, as one of their goals of centrists is to provide jobs to their real base, highly credentialed professionals, or, as Lamberth Strether noted on Naked Capitalism, "Great! ObamaCare incentivizes wellness programs, but as the article points out, they have no proven health benefit (and hence, like so much of ObamaCare’s complex machinery, are really a jobs guarantee for the Democrats’ base in the 10%.)"

If You Are Suggesting that John McCain is Playing 3D Chess, You are an Imbecile

It appears that some people are suggesting that John McCain voted for allowing the motion to proceed before voting against the actual motion as some some sort of political Jujitsu.

Let's be clear: McCain is neither intelligent enough to come up with this, and he is far to vain and chatty to keep his mouth shut for the requisite 24 hours of so to make it work.

He did this, because he was upset that people were calling him out on the "straight shooter" myth that he has cultivated his entire political career, and I believe that acted in this manner because of his own self regard.

But in the interest fairness, I will quote the theory: (%$# mine)

I'm not sure if it's really being appreciated just how comprehensively the Republicans were just f%$#ed over.

See, the Republicans have been trying to pass these godawful healthcare bills through a process called budget reconciliation, which, among other things, protects the bill from being filibustered in the Senate and only requires a simple majority of 50 votes (rather than 60, which the Republicans don't have).

The thing is, the Senate can only consider one budget reconciliation bill per topic per year. Of course, if the bill dies in committee and never comes to an official vote, it doesn't count- which is why they've been able to keep hammering away at the issue.

This bill, though, was allowed to come to the Senate floor, because the Republicans thought they'd secured the votes. Collins, Murkowski and the Democrats would vote no, everyone else would vote yes, and Pence would break the tie. And then McCain completely f%$#ed them. And it was almost certainly a calculated move; he voted to allow the bill to come to the floor. Had McCain allowed it to die in committee, McConnell could have come back with yet another repeal bill; but he let it come to a vote, and now they can't consider another budget reconciliation bill for the rest of the fiscal year. The Senate needs 60 votes to pass any kind of healthcare reform now.

So now they're caught between a rock and a hard place. Either they concede defeat on the issue and try again later (causing a big, unpopular stink that could damage elections if they try it before the midterms, or risking losing the slim majority they already have if they wait) or they actually sit down with the democrats like adults and write a halfway decent healthcare bill.

This is amazing.

While I admit that his actions MAY have had the stated effect, I think that was a happy accident.

Simply put, this is not how John McCain plays the game.

Also, the idea that McConnell gives a flying f%$# about Senate procedure, and won't wreck 200+ years of dysfunction tradition to get his way is simply delusional.

H/t DC at the Stellar Parthenon BBS.