The Senate Health-Care Vote and John McCain’s Tragic Contradictions

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After seven years and four months, the Republican quest to repeal Obamacare has taken on vampiric qualities. A number of times since March, it has appeared to be dead, but each time it has resurrected itself. The latest occasion came on Tuesday afternoon, when Vice-President Mike Pence broke a tie in the Senate on a procedural motion that Mitch McConnell, the Senate Majority leader, had put forward.

If this motion, which called on the Senate to take up discussion of the health-care bill that the House of Representatives passed in May, had been defeated, the repeal effort would likely have been finished. But McConnell and his colleagues managed to cobble together just enough votes to keep their ambitions alive.

The swing vote was cast by Shelley Moore Capito, the junior senator from West Virginia, who, last week, had joined with two of her Republican colleagues, Maine’s Susan Collins and Alaska’s Lisa Murkowski, to block McConnell’s idea of having a vote solely on repealing the A.C.A., without putting in place any replacement measures. If Capito had stuck with Collins and Murkowski, both of whom voted against the procedural motion on Tuesday, it, too, would have failed. But, after meeting with Donald Trump in her home state on Monday, Capito put party loyalty before the interests of her constituents, about a third of whom are on Medicaid.

The vote was also marked by the dramatic appearance of John McCain, who returned to the Senate for the first time since being diagnosed with brain cancer. After receiving a standing ovation from his colleagues, McCain cast a vote in favor of McConnell’s motion, and then spoke from the floor of the Senate with great passion. After referring to his thirty-year career in the Senate, and his work with politicians of widely divergent views from both parties, he went on:

I hope we can again rely on humility, on our need to coöperate, on our dependence on each other to learn how to trust each other again and by so doing better serve the people who elected us. Stop listening to the bombastic loudmouths on the radio and television and the Internet. To hell with them. They don’t want anything done for the public good. Our incapacity is their livelihood.

Let’s trust each other. Let’s return to regular order. We’ve been spinning our wheels on too many important issues because we keep trying to find a way to win without help from across the aisle. That’s an approach that’s been employed by both sides, mandating legislation from the top down, without any support from the other side, with all the parliamentary maneuvers that requires.

We’re getting nothing done. . . . We’ve tried to do this by coming up with a proposal behind closed doors in consultation with the Administration, then springing it on skeptical members, trying to convince them it’s better than nothing, asking us to swallow our doubts and force it past a unified opposition. I don’t think that is going to work in the end. And it probably shouldn’t.

These were stirring words, and they contained a lot of truth. But what good did this verbal tour de force do? In voting for McConnell’s motion, McCain participated in precisely the sort of cynical partisan political maneuver that he inveighed against. For months now, McConnell has been scheming to shove through a monumentally consequential reform without any hearings, markups, or efforts to reach out to Democrats. After last week, when this scheming looked destined to fail, he called for Tuesday’s vote on the “motion to consider”—even though he had not made clear what sort of measure the members would be taking up.

McCain supported McConnell’s motion. In doing so, he helped enable the Majority Leader to pursue his fallback strategy: getting practically any sort of measure passed and tossing the details of reform over to a Senate-House conference, which would deliberate in secrecy, with little input from anyone outside the G.O.P. leadership.

The Senate is now set to vote on three bills that have practically no chance of getting fifty-one votes: a repeal-only bill; the “repeal-and-replace” bill that McConnell originally proposed; and a revised version of the McConnell bill that includes an amendment from Ted Cruz, of Texas, which would allow insurers to sell cheap catastrophic-insurance policies outside of the Obamacare exchanges. After these votes are held, McConnell is expected to propose a so-called “skinny” repeal bill, which calls for the repeal of the individual and employer mandates but leaves everything else to be decided by the House-Senate conference.

If he had been following his own advice, McCain would have broken with McConnell and voted against the motion. If the motion had failed, the Republican leadership would have had little choice but to start talks with the Democrats about patching up the Obamacare insurance exchanges and, perhaps, making modest changes to Medicaid. Indeed, earlier this month, after McConnell’s repeal-and-replace bill failed to garner the support of fifty-one Republicans, Lamar Alexander, the chairman of the Senate health committee, announced plans to convene bipartisan hearings on ways to stabilize the individual-insurance markets. Now that McConnell’s motion has passed, such plans are in abeyance.

To be sure, this is only an interim victory for the Republican leadership: the ultimate outcome of their repeal efforts remains uncertain. Even if McConnell succeeds in punting the ball over to a House-Senate conference, the full Senate will eventually have to vote on a final piece of legislation, which will have specific terms that can be analyzed and discussed. Getting a final bill passed won’t be easy.

For now, though, the G.O.P. campaign against Obamacare is still alive, and it owes its life to subterfuge. In the House, Speaker Paul Ryan managed to assemble a majority for his bill only by persuading his colleagues that any flaws it contained would be fixed in the Senate. That didn’t happen. Instead, McConnell now wants to abdicate the Senate’s deliberative responsibilities and kick things back to the House.

As McCain noted, these “responsibilities are important, vitally important, to the continued success of our Republic. And our arcane rules and customs are deliberately intended to require broad coöperation to function well at all. The most revered members of this institution accepted the necessity of compromise in order to make incremental progress on solving America’s problems and to defend her from her adversaries.”

For his long record of service to the country, his bravery, and his acerbic streak, McCain is himself widely revered. It is a great pity, indeed a tragedy, that he and many other Republican senators didn’t act upon his words.

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