Dear Republicans: America Wants Out of Your Suicide Pact

Why doing nothing on health policy in the next few months is political malpractice

We interrupt our more poetic topics on femininity and radical agency in healing, or our more technical paywalled pieces on health care mechanics, to bring you this rant on the epic fecklessness of the Republican Congress.

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You can usually count on Congress to do exactly nothing. But the nothing that is on the table for the next few months is nothing short of political malpractice.

As I’ve described elsewhere, the reconciliation process is how a party, when it controls both chambers of Congress, can enact policies with only 51 votes - rather than having to overcome the filibuster in the Senate with 60 votes. Given that Republicans may lose the House (and Senate) in November, the president may insist on a productive lame duck session after the elections to get whatever pieces of his agenda through before the more hostile Congress starts in January.

There is another option of course. Congressional leadership could try to, you know, not lose the elections.

That would require passing legislation that reflects the urgent priorities of the voters, like the affordability of health care, housing, and fuel.

Doing hard stuff because the people are counting on them is not exactly politicians’ strength, to be sure, but it’s not impossible, especially with the reconciliation process allowing for simple majority votes without a filibuster.

But if things continue as they are, your elected “representatives” have crafted a political suicide pact guaranteed to generate maximum voter fury - right before the election.

A reconciliation bill is apparently being planned - GREAT!

It’s going to have nothing but middle fingers to voters in it - wait, what?

Senate Majority Leader Thune has signaled that he doesn’t want to do health care or any of the other affordability issues like energy or housing that matter to the American people. Instead, he wants to just fund the Department of Homeland Security (DHS), including ICE and Border Patrol, which have been subject to a shutdown showdown that has defunded these functions and the federal workers that carry them out for months.

This would be the most colossal stupidity I have ever heard in my 25-year policy career, and that is truly saying something.

To carry out this epic face-plant, I have it on good authority that he has instructed Budget Committee chairman Senator Lindsey Graham to leave all committees out of the reconciliation bill that his committee is drafting except the one committee with jurisdiction over DHS. This would make it impossible for provisions on health care, housing, or energy to be included in reconciliation.

Apparently Thune and others in leadership are shaking in their boots about Minority Leader Schumer offering some amendment restoring Medicaid funding that was cut in the One Big Beautiful Bill last year (like kicking the illegals, millionaires and Somali fraudsters off the program). Because of that, they think that a “skinny” reconciliation bill will preclude painful amendment votes forced by Democrats. That’s because those amendments would be ruled out of order for reason of not being germane to the bill. The bigger the bill, the more you can amend it.

But this is crazy talk.

Of course, Schumer and anyone else can simply offer their amendment, it’ll get ruled non-germane and subject to a point of order, and then the amendment sponsor will call for a vote to waive the point of order. If they get 60 votes needed to waive, their amendment will still pass. If they don’t, they still get the campaign ads of Republicans voting against the measure. Thune knows this. He knows, because Republicans will also offer non-germane amendments and call for the waive-the-point-of-order vote to make Dems vote on stuff for campaign ads too.

So this can’t be the real reason to have a “skinny” bill with nothing in it for the voters.

And why even bother doing reconciliation, which takes weeks of “vote-a-ramas” with unlimited amendments on the floor, if you’re not doing anything useful? Most parties that control both chambers can’t wait to use the reconciliation process to swing for the fences - get as much of their agenda done as possible without having to face a Senate filibuster. That’s what the One Big Beauty was all about last year - when Republicans delivered Americans significant tax relief.

What’s more, using reconciliation to only fund DHS appropriations is catastrophically stupid because it will remind the voters that Congress didn’t do its most basic job - pay the guys keeping the bombs off planes and the narcoterrorists from crossing the border. While Congress has been cashing its own inflated paychecks, the guys in uniforms who have to hide their faces to keep their families from being assaulted are taking loans out to get through the week. But hey, let them eat cake.

What makes this even more inane, if that were possible, is that DHS funding doesn’t require reconciliation. It is already “paid for” by being included in the budget baseline. That means that Republicans are including measures that don’t need to be in reconciliation because they’re not costing or saving money. And instead, they’re leaving provisions out of reconciliation that do save money that could be used to address urgent voter concerns.

For example, the tariffs have brought in a ton of money to the Treasury - between $300-400 billion. But it’s off-budget money because the tariffs were enacted administratively rather than legislatively. The budget score-keepers initially allowed the tariffs to count on-budget, but when the Supreme Court struck them down a few months ago, that giant pile of cash went “off-budget” again. This means that they’re not in the baseline and if you “authorize” - codify - them in a reconciliation bill, you can count their revenue as new, and use it to pay for a bunch of other priorities that cost money, like health care reform, tougher health care price transparency rules, or banning Blackrock from buying up all the housing in your town.

Some might argue that these reforms wouldn’t pass the “Byrd rule” - a rule that applies solely to the reconciliation process that requires all provisions to be primarily fiscal rather than simply policy changes. But you can draft all these reforms in ways that create fiscal impact. After all - the point is to make life more affordable for Americans, so of course the impact will be primarily fiscal. Health care reform redistributes tax subsidies. Banning Blackrock housing-grabs or Chinese farmland-grabs changes the economics of the housing or agriculture industries, including mortgage rates, mortgage tax deductions, and other financial impacts.

What’s more, let’s say you fail on the Byrd rule. Big deal - all that means is that you need 60 votes to waive the Byrd rule. There are lots of policies that should be bipartisan. And if not, at least force the Democrats to vote for Blackrock and secret medical prices and higher fuel costs.

There are two other health care related policies that, if included in reconciliation, would create savings that could be directed toward affordability measures.

1. Site neutrality policy that ends the ever-growing problem of hospitals charging you extra for stuff you’re getting done in an outpatient, non-hospital setting just because the hospital system slapped its logo on the outside of the building.

2. Tackle the hospitals using AI to automatically (and often fraudulently) inflate billing codes so Medicare (and everyone else) pays more.

If these policies were put into a reconciliation bill, Republicans would have about $70-400 billion over 10 years (depending on how far you go). Along with hundreds of billions more in tariff revenue, that could be used to pay for policies that make everyday life more affordable for Americans.

So, what they should actually do with all this money?

School Choice for Health Care: the president’s policy announcement of last Fall was that he wanted to take money from Big Insurance Companies and give it to the people. I consider this like vouchers for education - where parents get the amount that the government would have spent on their kid in public school and are allowed instead to use it for private school or homeschooling.

If we monetize what the government and employers are already spending on health care and put it in individual accounts instead and expand the ability of people to make their own coverage or cash-pay choices, it would be like school choice for health care.

To break it down:

1. Put every dollar that the government is currently giving to Big Insurance on behalf of patients and put it into the patient’s own tax-advantaged health savings account instead. This would be budget neutral because the government’s already spending it: ACA subsidies, Medicare Advantage, Medicaid Managed Care, etc.

2. Allow employers to put every dollar they currently spend on their workers’ health coverage into the worker’s own health savings account instead. This is also budget neutral because all this spending is currently tax-free today.

3. Medical freedom for how HSA funds are used, meaning that the money doesn’t have to be used solely for the limited tools of allopathic medicine: drugs or cutting. These funds could also be used for health promotion, disease prevention, nutrition, and fitness, including spending on regeneratively farmed food for metabolic disorder prevention, red light therapy for arthritis, removal of mercury fillings by biological dentists, removal of microplastics from your brain (now that the STOMP initiative has been announced by the Trump administration to try to develop such techniques), water filters in your house, and other MAHA initiatives. You could even clarify that HSAs can’t be used on inpatient hospital stays that involve serving ultra-processed food to patients.

4. Ending secret health care prices, such as with the bipartisan Patients Deserve Price Tags Act, so that doctors and hospitals can no longer hide their prices through weaponized complexity and billing bureaucracy. There is no free market without transparent price information.

5. Ending anticompetitive contracts between network carriers and hospitals that prevent you, me, your employer, or your union from getting a better deal with a doctor or hospital and cutting the network out.

As I’ve described elsewhere, these measures would unleash a much more competitive insurance market that would offer more affordable premiums for coverage, as well as a cash-pay market that would dramatically drive down prices for care through significant expansion of the consumer base for cash prices. To facilitate that cash-pay at scale, you’d also need to require cash prices to be posted and accepted by providers, regardless of coverage status, and that the cash price must be equal to or lower than the lowest negotiated contract rate with a carrier. This is fair because an all-in, upfront cash price eliminates the billing bureaucracy and delayed reimbursement so it’s far less costly for a provider than sending post hoc claims pursuant to a network contract. That’s how you drive prices down for everyone.

So what is the real reason why Congress is sticking it to the American people with their “skinny reconciliation?”

The only reason I can think of? The White House is weak.

It pains me to say it, but the White House policy shop should be running this show, and it appears that they’re not involved.

Congress is always lazy. Republican leaders always claim they can’t whip enough votes for a consensus package, especially with tight margins in their razor-thin majority.

In a normal administration, when the president goes public with a sweeping health policy agenda like he did last Fall - his team would develop the plan and then hold a gun to Congress’ head and make them negotiate something resembling it and pass it into law. That didn’t happen. I have many theories about why, but suffice it to say that the fruit of this inaction is likely to be catastrophic electoral losses.

Without the White House’s boot on Congress’ neck forcing them to swing for the fences on reconciliation, Republicans will always choose to do nothing rather than something big or hard.

Democrats do not suffer from this affliction - they always go balls-to-the-wall when they get the reins of power - which I suspect we’re about to see in technicolor, starting in January, if our current “leaders” don’t change course, stat.