Sure sounds like a parallel to today. But consider: The 1988 act was an open and thoroughly bipartisan effort to fulfil one of Ronald Reagan’s promises, to protect seniors against financial disaster; it actually provided a substantial set of benefits for poorer seniors, but because it was financed entirely within Medicare, it included additional taxes on wealthier seniors, many of whom already had some of the benefits in the bill through their supplemental insurance. There was a lot of debate over the elements in the bill during its deliberations, but no real controversy at its passage. But after its enactment, the more well-to-do seniors, inflamed by a distorted attack by a rival group to AARP, reacted to the costs without considering the benefits, leading Congress the next year to repeal most of it. The repeal of its prescription drug benefit triggered another controversial law, President George W. Bush’s Medicare Part D, in 2003.
What about bills crafted in private? Take a look at the two-year spending deal reached in 2013 by House Budget Chair Paul Ryan, a Republican, and Senate Budget Chair Patty Murray, a Democrat. Many of the details were in fact worked out in private sessions between the two and their staffs. The deal averted a draconian sequester for both defense and domestic spending that neither side wanted. And they worked out a series of tradeoffs, avoiding the worst kinds of pain, keeping the government open, and adding a bit more to deficit reduction along the way, while also finding a two-year deal to keep the same crisis from emerging the next year.
To be sure, this was not a deal that followed the regular order of open conference committee deliberations. But it was a process that House and Senate leaders of both political parties endorsed. And it was one where at every step along the way, Murray and Ryan reported back to their party leaders, and their caucus members, what was going on. It was, especially for the time, a commendable effort to find bipartisan consensus. Which it did.
Now let’s look at BCRA. It started, of course, with McConnell bypassing the committees that deal with health policy, both Finance and Health, Education, Pensions, and Labor (HELP) by handpicking 13 Republican senators—all middle-aged and elderly white men—to work in complete privacy to draft the bill. Besides women like Senators Susan Collins and Lisa Murkowski, McConnell also left off Senator Bill Cassidy of Louisiana, a physician with deeper knowledge of health policy than nearly all of the 13 chosen. The gang of 13 kept their vow of omerta, leaving even their Republican colleagues at sea during their sessions. And of course, McConnell brushed aside peremptorily any notion that Democrats would be brought into deliberations, or consulted.
Nor were the groups representing those on the front lines of health policy and delivery, including doctors, hospitals, insurers, nurses, those with debilitating diseases, and more, consulted or included. One of the more striking, and embarrassing, moments came when McConnell—who had overcome polio as a child—refused to meet with the March of Dimes, the non-profit founded in the New Deal era to combat the disease.