As of today, six GOP Senators have signaled real reservations. There are 52 GOP senators, so if they lose only three, repeal-and-delay would go down to defeat — meaning, in Bloomberg’s words, that right now, there are “more than enough” senators expressing doubt to “scuttle efforts to deliver swiftly on a central promise from President-elect Donald Trump.”

Here’s something to keep an eye on: The overlap between Republicans who are balking at repeal-and-delay with Republicans from red states that have expanded Medicaid.

Numerous GOP Senators have, in some form or other, recently said they don’t want to vote to repeal the Affordable Care Act unless Republicans settle on a replacement first. Senator Tom Cotton said: “I think when we repeal Obamacare we need to have the solution in place moving forward.” Senator Rand Paul said: “I think it’s imperative that Republicans do a replacement simultaneous to repeal.” Senator Bill Cassidy also expressed reservations, pointing out that Donald Trump, too, had said he wants to see repeal and replace voted on “simultaneously.”

Senator Susan Collins today said that Republicans should have a detailed alternative blueprint of some kind in place before going forward with the repeal vote. Senator Lamar Alexander has also expressed serious reservations about repeal-and-delay with no guarantee of a replacement. So has Senator Bob Corker.

Senator Alexander’s reservations aren’t that surprising, because he’s the chair of the health and education committee, and probably wants (or so some Democrats believe) a big hand in a replacement bill. Senator Corker’s queasiness isn’t that surprising, either, because he prides himself on being a serious and deliberate lawmaker. Nor is Senator Collins’s reluctance, because she’s positioned herself as centrist-leaning in a bluish state.

But Senators Paul, Cotton, and Cassidy are surprising. They all come from deep red states, and aren’t known for exercising caution towards Obamacare. But all of them come from states that have expanded Medicaid.

–Greg Sargent
More Republicans Are Going Wobbly on Obamacare Repeal

Existential is a big word… I would use the word “historical.” It’s simpler. But the Democratic Party has been changing for a long time, and by the way, this is important when you’re talking about where they’re going to go because historical changes don’t just happen on a dime. They don’t just happen overnight. But the party that I grew up with and that I remember from the 1970s — Democrats have been drifting away from that for a very long time. And Hillary Clinton — Neera [Tanden] is absolutely right. On paper, she looked really excellent. The things she was saying were the right things to be saying, and she wasn’t able to make that sale.

Now, Trump — he’s done one massively important thing in this race, and that was when he went against the Republican Party stance on free trade. For decades in this city, Democrats and Republicans have had this kind of consensus on the trade issues. It was Democrats that got NAFTA. It was Barack Obama that was campaigning for the Trans-Pacific Partnership. It was Republicans that originally negotiated NAFTA. This was a consensus arrangement, and because it was a consensus arrangement, it allowed Democrats to do things like to get NAFTA passed and then go to organized labor — who were very bitter about that and are bitter to this day when you talk to them — and say, “You’ve got nowhere else to go.” If you go back and research the Bill Clinton era, this was a very common saying in Washington in the 1990s. Trump completely changed that dynamic. All of a sudden, these people did have somewhere to go, and it was kind of a genius move. But it’s not clear that he understands what he did or that the Democrats are going to play along with it.

–Thomas Frank
Everything Feels Relatively Existential Now

For seven years now, the mantra “repeal Obamacare” has been both a spasm of revanchist rage and a cynical ploy to keep a segment of the electorate motivated to vote for Republicans. It was also frequently deployed in the belief that the GOP would not be thrust into a position in which those voters could expect them to make good on the promise.

But Donald Trump’s Republican Congress convened only three days ago, and members are already finding that eliminating Obamacare will be far messier politically than devising and implementing it was for Democrats…

Republicans got themselves into this mess at least in part because of a broad, conservative failure to treat Obamacare on its true terms rather than as an evil abstraction conjured by a political foe. In an important sense, there is no Obamacare anymore; there’s just the health care system Republicans are inheriting, and the one they will leave behind…

When Democrats controlled the government in 2009, they could have theoretically passed legislation that opened an existing public insurance system like Medicare or Medicaid to working-age people. But that would have unspooled existing insurance markets, creating significant disruption for consumers and relentless opposition from carriers and other powerful interests.

Democrats instead struck bargains with stakeholders across the health industry, which created political and economic space for a major coverage expansion but left most existing arrangements untouched. They subjected insurers to more regulation, but guaranteed them millions of new customers; they cut reimbursement rates to hospitals, but with the understanding that a spike in insured patients would help them recoup lost revenues. Most of those patients were expected to be poor people who would be added to state Medicaid rolls, in an expansion paid for almost entirely by the federal government.

The political downsides to this approach were fairly obvious at the time, and have become more clear as the law’s been implemented. It’s complex and inequitable; it doesn’t cover everyone; it turns people into customers in an amoral and unpopular market, rather than into users of a simple public utility. But the upside was that it could be slowly blended into the existing fabric of the health system without rending the whole thing and starting over. It’s not a single patch in a strange patchwork. Removing the stitching won’t just re-create a hole, but leave the rest of the quilt more tattered than it was before.

–Brian Beutler
Republicans Want Revenge for Obamacare and It’s Making Them Do Stupid Things

The official line from US-based multinational corporations is that if they get a huge tax break, they’ll bring home the trillions of dollars in profits they’ve stashed overseas and use it to hire tons of Americans. (Nearly 3 million, says the US Chamber of Commerce!)

But now that Donald Trump’s election means it might really happen, corporate executives are telling Wall Street analysts what they’ll actually use that money for: enriching their shareholders and buying other companies.

—Jon Schwarz
Corporations Prepare to Gorge on Tax Cuts Trump Claims Will Create Jobs

Breaking the taxi industry cartel’s and promoting Uber has been somewhat of a cause célèbre among economists in recent years. Any card carrying economist can give you the two minute tirade on the evils of the taxi cartel and the benefits of Uber…

What is striking is that the enthusiasm for the virtues of competition seems to disappear when we switch the topic from the taxi cartel to the doctors’ cartel. Doctors actually have been far more effective than taxi companies in limiting competition. Doctors largely get to set standards of care, which not surprisingly requires twice as high a percentage of highly paid specialists as in other wealthy countries. They also restrict the number of doctors with a wonderfully protectionist rule that prohibits doctors from practicing in the United States unless they have completed a US residency program. This means that even well-established doctors in places like Germany, France, and Canada would face arrest if they attempted to practice medicine in the United States.

As a result of this cartel, doctors in the US earn on average more than $250,000 a year, putting the average doctor not far below the one percent threshold, even assuming no other family income. This is roughly twice the pay as the average doctor earns in other wealthy countries.

It is striking that the doctors’ cartel gets so much less attention from economists than the taxi cartel. After all, we spend close to $250 billion a year on doctors compared to $6 billion a year on taxis. I could suggest that the lack of interest is due to the fact that many economists have parents, siblings, or children who are doctors, but I wouldn’t be that rude.

–Dean Baker
Economists, Doctors’ Cartels, and Uber