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High-Risk Podcasting

Update: 2017-05-03
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Sarah, Ezra, and Matt talk about Congress's big spending deal, Republicans' newest Obamacare repeal idea, and research on what happens when abortion providers shut down.

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we've sponsored by The Great courses plus sign up today at The Great courses plus dot com slash weeds the sponsor my Helix sleep but he looks like that complex weeds get fifty dollars off your ear and eye wink wink is offering our listeners twenty dollars off your first order eager to try winked at com slash weeds have no idea what I was getting confused by this whole discussion attire here with Hello welcome to another episode of the weeds the policy podcast on the Vox Media podcast Network I met Yglesias at my colleagues here Cliff hear the studio and also by Ezra Klein from San Francisco how is it a day it's beautiful it doesn't just like smell like pee everywhere in the streets that's usually my experience no it smells like technology like bites flowing through the air are a few at the Cerro juice I have not I've heard a lot of juice or use jokes at her though there are a mixture of people think it's actually funny and also feel somewhat wounded by the coverage of it here in the nation's capital of course we're far too busy for for Jews and people have been talking this week about the big deal on government spending that was reached at a week late this is the sort of has an annual Appropriations process the government shuts down unless Congress affirmative Lee votes to continue spending money this year because of a number of continuing resolutions we have only a five month year that is going to end in September was a continuing resolution map in a continuing resolution Congress just says OK we're going to keep spending what we had said before for another little while during the lame duck the one that brought us to March when negotiations is a little bit more time they did one week CR so that there's no government shutdown but what members of Congress really really love to do is NOT pass continuing resolutions but instead pass a real Appropriations bill because that lets the different members of the Appropriations Committee mess around with things right and Optimizer that programs that they like it more money problems that they don't like get less money it's also in it in a weird like super inside the Beltway people just consider it like better you hear live school the talk like Congress hasn't done its work on time and stuff even though I think from a normal person's viewpoint nobody really cares if they're there CR is or if they're real Appropriations in this case the military had been getting pretty hot and bothered about the lot of other military yeah it was this is an important factor in there so the military brass have been saying for awhile now that they are annoyed by this sort of uncertainty that's inherent to the continuing resolution process and that it was difficult for them to like plan for their various wars and things actually all managers in all government agencies feel this way out but almost nobody in American politics cares about what civilian civil servants think about things and certainly nobody in the Republican Party cares but generals and Admirals have a lot of juice on Capitol Hill and say that motivated at John McCain in a bunch of other defense Hawks to really sort of want to get this done through regular order process and then in turn of it's reshaping a series of events that gave Democrats a fair amount of practical political leverage in in this whole process and so when you wound up seeing this week was a deal that was definitely a big win for the military they got out of continuing resolution land they got a hefty amount of extra defense my knee they got released from some of the terms of the sequester deal but beyond that he was like a huge defeat for the Trump administration stated priorities they put out this budget document that called for all kinds of huge cuts to this that the other thing basically none of that happened they wanted money to build a wall that featured heavily in the presidential campaign that didn't happen I heard a lot of paranoia during the negotiations from back bench liberals who were like Oh leadership they're going to stop the ball but they're going to sell us out on some other aspect of immigration enforcement that but that didn't happen either the guy you know there's some extra border money in there but really not much and not for anything that advocates are particularly concerned about Democrats got a bunch of extra money for scientific research they got the job by Cancer initiative funded and planned Parenthood got to keep its funding and who did not get the fun did he would be wrong to construed this as like this is what liberals would do if they ran the government but considering that you're talking about a Democratic Party that has not one that many elections recently they scored it a lot of substantive victories out of a relatively weak sort of electoral base and a pretty remarkable when things that's amazing to me about the CR is just how it does not have a White House footprint on it in any meaningful way the White House and you said that they put forward their priorities in Congress kind of like set those aside while I was a sort this out and was handed over T O and I was listening to great interview with Carl Hall says the New York Times is Emily there is there Capital Bureau Chief Hughes on the daily this morning I'm kind of talking about the backstory here he said one thing that surprised him when he's covering this is that Democrats Republicans were things about each other in the budget negotiation process if you don't hear a lot of write like there's a lot of yelling about Obamacare in the replacement plan but he was kind of surprise when you give Democrats the opportunity to trash the White House or trash Republicans they just wouldn't take the bait and you know they're parading his undoing suggests that they very much but together on Capitol Hill and worked out a budget deal that they could both live with and she just did not think the White House priorities were important in any way to really brush them aside like equate we present way when you actually look at what gets funding what I think is interesting about this budget deal is that it speaks to the path a Trump administration and this Republican Party did not take so this budget deal such as it is I think is evidence that there was a world in which Democrats in Congress would have been happy to work with the White House with Republican leadership to pass things that are not by any means liberal but are you know they get something Republicans get some thing I've been kind of goes home and has some kind of a wind that if this budget bills evidence that the opposition is not going to be lockstep instead we see on things like health care and some the other the other projects West and has been pushing forward on a real effort to not negotiate with Democrats from the beginning and so there's no reason for Democrats to come onboard and then they go into full mode of opposition but if I were the White House I would be looking at this and saying hey you know maybe this is not as intractable as we thought it was maybe this is actually a question of substantively giving them things we don't care about so we get things we do care about as opposed to what I've heard from them before which is a deed that they shouldn't even try negotiating with Democrats because of course Democrats are going to work with them in any way at any point or for any reason he was also an example of something that we've talked about before the show which is the way that presidential aloof ness can be useful right now and you know Washington cliche is always that it was like why doesn't Barack Obama lead and you know you could imagine versions of that with Trump but you know Trump put out the site budget plan and made these requests Congress ignored them and the fact that Trump did not make a serious effort on his own budget was critical to getting this done because you could imagine another world in which Donald Trump tried to demonstrate leadership on Donald Trump's priorities and spoke very heavily and very frequently and that was he wanted to do here and that would've made it hard for Republicans to ignore him and key points and made it hard for Democrats to give any kind of ground to him by creating this contract was like Trump really wants the wall but then like some kind of ignores the whole process and the negotiators just focus on Like dollars and cents for these various things you were able to go get it done right and if Donald Trump attract some attention and the attention polarizing that is hard for him or any modern president to like drive bipartisan compromise whereas on Capitol Hill there's just a lot of different stakeholders involved and is completely possible for politicians who have different philosophies and different priorities to sit together in a room and work out trades and work at deals and it's funny that Trump you know kind of portrayed himself in various times is some kind of master deal maker or something like that but hopefully the members of Congress are perfectly good at making deals with each other and they are better at it when there's less presidential engagement and one of Trump's great blessings for legislating maybe that he doesn't seem to really care that much about it and is at times willing to completely ignore stuff wears every time he intervenes in things it does not appear to be constructive in any way so to mention the one thing that surprised me as I was surprisingly about the deals are coming to and it is the fact is and we talked about on the last episode of the weeds the one we did live from the conversations about these Obamacare payments these cost sharing reductions which I had gotten into the budget negotiations thinking Democrats are going to go to the mat for like they're going to say you have to appropriate these that's a line in the sand in the did and they got reassurances from the White House that they would continue paying these Democrats backed off and essentially ends up where even the past two years where there's a lawsuit challenging these but the White House keeps paying them that already seems to be having a negative ripple effect on Obamacare and it looks like I was a big marketplace insurer is talking about playing out now that there's uncertainty around these fines and that would leave ninety four of Iowa's ninety nine counties about anime insurer on Obamacare so be like the Tennessee situation on steroids and I am looking back on it and loved surprise Democrats really didn't make this their thing at him and think what was going on as they felt like they were saying you know him from sucking explode the marketplace is not we take them away but the thing the administration has been doing is essentially waffling on it saying maybe we'll maybe we won't and that's making health insurance companies quite nervous so it's a little surprising to me when I look at the CR that um that they're going to not fund as part of the health care a lot actually seems quite damaging to the lie and I'm curious of your Democratic Hill staffer who listens this podcast is lots of As please email me and I am curious why Democrats didn't make that a priority in their negotiations for the US one thing is he to me to be a dynamic of these negotiations both sides did something they don't always do which is simply say OK if you've got a no go zone which is not going to go there so Democrats for instance will really go to the mat to protect Planned Parenthood funding and their law Republicans who that is really their key objective in these negotiations but that has been defending champ Aaron recently left out Republicans seem to have made a decision that can be a place for Democrats would go to complete all out war that is rocking this market and it looked to me to the CSR causing reduction negotiations that was sort of the dynamic there too that that was one of the sayings where Democrats were not going to get at this point to the chump administration Republicans in Congress to do something positive for pot care in these in these negotiations and going to war over it was probably just not going to leave them with much of those good decision or a bad decision but one reason that this seems so unusually smooth is it that we become use to in American politics in recent years both sides Party Republicans but but but sometimes Democrats to just deciding that even though they knew something was a absolute non starter for negotiations they were going to insist on it anyway this has been a constant thing with House Freedom Caucus but use it all over and here it just had a very unusual dynamic where they did what you do in a negotiation which is you just don't include those issues yeah I mean the other thing though is that I think that Trump administration's very public efforts to try to say that it's going to use the threat of sabotage as a tool to get Democratic votes for some kind of health care legislation has soured congressional Democrats I'm trying to do anything to say you've the Affordable Care Act they're committed to fighting the repeal bill but that they really want to maintain the construct that Donald Trump is the president of the United States and that Donald Trump should die of his own volition deliberately do things that will engineer worse health care outcomes specifically for residents in war areas and states that they don't want to make that I can ask right like Trump has as far as they are concerned the authority to make these payments and they want him to make the payments are happy to criticize him for waffling about it and things like that but they're not going to say that it's at it's a it's an ask of their son a favor to them for the Trump administration to do its job of administering the Department of Health and Human Services correctly because Trump has already tried to put it out there as a negotiating stick and I think you're seeing with what's happening in Iowa with what's already happened to see that they're going to be bad consequences of this white the Nexus of the administration's of maybe kind of deliberately self sabotaging of the marketplace is combined with the Democrats deciding that they're going to let Trump hang it from country if that's what he wants to do is going to make people's lives worse but it's also hard for me to see what's that other outcome if Democrats can't be sort of begging the trumpet to as a favor to them like to his hse do his job correctly or to put them in an untenable situation with their own constituents and with just they're they're needed to kind of bargain with things at a consistent basis and so you know I mean it's it's bad I mean I think we've seen a lot of the stories but we haven't yet seen the kind of human consequences of the stories but we're going to over the next year and it's one thing that's weird about this team isn't something like House to Republican and Democrat leaders agreed on going and are thus he saw lot of Republicans and Young vision appropriate this money and make sense of an awakening that fit with a lot of the other things are going on in the budget negotiations were wasn't Republicans versus Democrats is Congress versus the White House with the White House that disparities Congress lays out his priorities in Congress party seem to win here but even though this is on the Congress' priorities side I did not make it through it and in the negotiations and you move when I think of us from the point of view of a Democratic legislator I think when things are kind of banking on is that this is like a terrible strategy said one former Obama transition in a person's private to me as they're essentially handing Trump a suicide vest and betting that he's not going to detonate but you know he's busy saying mail that maybe I won't who knows of people obviously like standing back in August and super close to someone who's saying well we're not really sure yet and it seems like it was a risk year moved to give this up then they might have initially thought we got some more health care coming up some of the pulls back from the health care talk from it here I want to talk about what I think it sort of interesting emergent structure between the two parties and what they really in what their bottom lines are in negotiations now I can say that this will always be true but really it seems to me the basics underlying structure of the deal here was it turned out that what Republicans really want in budget negotiations is more money for the military and what Democrats really want to imagine ago Shay sianz is more money for like the basket of things you might call sites right it's not all hard science but but but it's there so Trump had wanted I think is a thirty billion dollar increase military funding and he got twelve point five with which can actually go up to fifteen if the military comes up with a plan to fight ISIS it's a pretty big increase of fifteen billion dollars increase on the other hand Democrats were really able to stop Chomsky was going to cut the National Institutes of Health in fact the National Institutes of Health and getting a two billion dollars funding increase is going to slash the EPA BP now gets a one percent decrease in funding which is a decrease but is nothing compared to what the Trump administration was pushing so I just think this is an outsider some of things that are used to seeing argued about and in politics I think are seeing here a little bit of a bottom line on what the two parties emotionally feel most passionate about finding which for public and they really do believe that Obama gutted the military and in some powerful way in the military needs more money not really yoke this to a strategy for what to do with that money as far as I can tell that they're giving the military more money and the other hand Democrats really feel strongly that the science and research functions of the government the NIH the EPA such a VAT is core I think Brock mom like these from seed corn like that is the future and they were able to hold to that in a pretty significant way and I think this is going to be I think there's something here in this line being drawn that is also useful because Democrats by the same token do not really oppose military spending and Republicans do not really opposed say the National Institutes of Health is one of those places where unlike a lot of parts of politics the two parties bottom line concerns are not necessarily contradictory they're just different and that's a place we can actually have positive some compromises it's worth remembering how we how we got here in the first place though which was that years ago House Republicans decided that they were not going to raise the statutory debt ceiling unless the Obama administration agreed to big spending cuts and the Obama administration decided not to use any of the many tools at their disposal that would have brushed this aside but to instead embrace the threat as part of a really hair brained scheme to get Republicans to agree to raise taxes and that didn't work and they wound up with this sequester deal in which you had the guts to dimension or discrediting the mesh no discussion could be the lead to exactly the programs that you were talking about as right so Republicans are taken to saying that Obama gutted the military but it was actually Republicans who got in the military as their price for raising the debt ceiling and then the Obama White House had held the line on the view that Republicans could only get their defense spending increases if they were matched dollar for dollar with domestic money to the big thing that Republicans did when this deal was that the military spending increase was bigger than the domestic spending increase which violated a conceptual framework that Barack Obama and his staff which sort of single handedly keeping in place because the Obama administration for reasons that frankly baffled me that feels that its whole series of tactical and strategic choices that lead down the sequester pipeline that made some kind of sense and so one of the big things that Congress is doing here is just finally throwing all that aside I say that Democrats are now saying that what they want is to spend money on things that they like and that they're not going to refuse to get that done as part of some like weird linkage with other kinds of concerns that Republicans who used to be insisting on big entitlement cuts as the only way to avoid economic catastrophe are now saying they don't want to cut Social Security Medicare either everybody back when the unemployment rate was high in the macro economic case for big budget deficits was really really solid at every body of both parties claim to be really concerned about the deficit that now over and decided they don't care and that's part of what makes these deals much much easier if everybody decides that they don't have any trade offs or things like that then you can even make a deal right wrong says I want money for Wall Democrats are like no no we really don't want to wall so you just make a deal on everything else at that when Obama was president we had a lot of structures where a lot of people who had a big red lines about deficits of that tax is about parity between defense and non defense and with Obama gun from the scene and Republicans going overboard all of their alleged ideological principles it's much easier to get things done the guys at this never been more important time to keep learning to stay informed about the world and that's what I am a big fan of The Great courses plus and I want you to sign and fourteen this is a fascinating series of video lectures presented by award winning experts all kinds of topics world history or economics or politics but also less serious have had a cook or how to get like more serious about your photography to click pictures 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you're really gonna like it and you're going to keep paying the money to sign up today at The Great courses plus com slash weeds It's The Great courses plus dot com slash we hate to talk about health care bill of health care in our time there I confess something to add to slow and our listeners so I have seen in the subject of high risk pools a lot in health care coverage I've seen a lot of tweets I'm aware that the smart high minded correct things that people who are like me are suppose to say about it is at high risk pools are no solution to the problem existing conditions but I have no freaking idea what high risk pool hey well that's the time your fire so high risk pools of kind of become the focus points of the republic and a debate over its on health care plan which is moving very quickly at this point any more recording Mass Wednesday early afternoon we've seen Fred Upton in the span of twenty four hours go from opposing the bill to supporting the bell and Republicans are actually inching towards a possible vote in the house so it and what a lot of it is centering on is more funding that states could spend on high risk pools high risk pools are actually pretty simple and they are basically just covering really expensive patients through a government subsidized program and there is nothing structurally problematic about that there's nothing inherent in high risk pool program that would stop it from working the problem with high risk pools historically before the Affordable Care Act and the thing that you people who would give you that talking point Matt would say that there is certainly very underfunded that they often do not have enough money these are incredibly sick people with very high medical bills and in order to pay them you either have to cap enrollment or buttons and lifetime limits not advertise the harvest was actually a very popular strategy to control costs and IRA schools so the concern is that you know people would be there have a place to go but there be treated quite differently and not everyone would get in and I think that is the reason why you hear a lot of the negative reaction and the fact that it doesn't seem like the American Health Care Act Republicans plan as written relief funds the high risk pools to the level they would need to be funded to work their estimates from the left leaning Center for American Progress in the right leaning American Enterprise Institute that both agree actually that there's not enough funding in those bell to satisfactorily set up these pools that surely before Fred Upton agreed that this amount of money was good enough to make him comfortable with the bill he checked with the experts of the Congressional Budget Office to it to see what what's what the math is way too hot of course this is one of the baffling things as me like a hurdle towards a vote of the American Health Care Act is there's still no Congressional Budget Office score on this so we have no idea how well they would bark and the CBO has scored something similar to the bill that they're looking at passing right now and things about this one of the reason they don't think the funding is strong enough is because the IRA school funding is in this fund that states could use for one of seven purpose as one of those high risk pools there's other stuff they can do it too it's like literally everything from offsetting the price of preventive care to reducing co pays to reinsurance programs CBO thinks that states aren't can choose the high risk pool option that they can put their money towards other programs but we don't know what they think about the new changes because there's not currently a CBO score of the revised bill so this is a lot dun care i was the high risk pool specifically one of the things that is peculiar about the conversation or on high risk pools is that if you have the kind of politics that would make them work you wouldn't need them the first place if you had a political consensus that was committed to spending enough money on covering health care for people who are sick and can't afford it there's a lot of different ways you can do it I probably wouldn't be having this argument they were having at all this with high risk pools is that in addition to them just being conceptually a little tricky to design well a lot of different states have tried them before and always always always fell and they always fail because what you're doing is you are for and keeping out sick people in the space which is with the needs and less government subsidy and one of the things that I think health care experts if you like like sticking a sodium penned the fall say about high risk pools is one reason people don't like them is that by segregated the sick out from the market they reduce or political power and so a situation where everybody or not everybody but a lot of people are in the Obamacare insurance marketplaces and healthy in the second year people were middling comedy people who are low income that's a situation where if those marketplaces are being badly run if the subsidies are underfunded if there's something wrong lot of political pressure to fix it over time maybe not immediately but over time certainly the issue if you just Paul the six people out over to this money pit over here and in a money pit is underfunded well maybe the sick people have some amount of political power but it's going to be a lot last and we've seen that again and again at some Formica bar least it does have not forgotten that came out as long ago but they did pretty good report on this and they've talked Francis about the California High Risk Pool which actually thinks a pretty good example because California is a state that has a political consensus is very pro universal health care in fact one thing California is trying to do before Republicans won the election was going to wave her so they could use their own money to extend Obama
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