Bernie Sanders introduced a very simple symbolic amendment Wednesday night, urging the federal government to allow Americans to purchase pharmaceutical drugs from Canada, where they are considerably cheaper. Such unrestricted drug importation is currently prohibited by law…

The Senate voted down the amendment 52-46, with two senators not voting. Unusually, the vote was not purely along party lines: 13 Republicans joined Sanders and a majority of Democrats in supporting the amendment, while 13 Democrats and a majority of Republicans opposed it.

One of those Democrats was New Jersey’s Cory Booker, who is considered a rising star in the party and a possible 2020 presidential contender.

In a statement to the media after the vote, Booker’s office said he supports the importation of prescription drugs but that “any plan to allow the importation of prescription medications should also include consumer protections that ensure foreign drugs meet American safety standards. I opposed an amendment put forward last night that didn’t meet this test.”

This argument is the same one offered by the pharmaceutical industry. The Pharmaceutical Research and Manufacturers of America (PhRMA), which lobbies against importation, maintains that it opposes importation because “foreign governments will not ensure that prescription drugs entering the US from abroad are safe and effective.”

The safety excuse has long been a refuge for policymakers who don’t want to assist Americans struggling with prescription drug costs. Bills to legalize importation passed in 2000 and 2007, but expired after the Clinton and Bush administrations refused to certify that it would be safe. The Obama administration also cited safety concerns when opposing an importation measure in the Affordable Care Act.

–Zaid Jilani and David Dayen
Cory Booker Joins Senate Republicans to Kill Measure to Import Cheaper Medicine From Canada

Reporters always complain about not having enough space to give the full story, which makes it a mystery as to why they so frequently add the word “free” to references to trade policy. We got an example of this wasteful wordiness in a NYT article on Donald Trump’s decision to ignore nepotism and conflict-of-interest rules and appoint his son-in-law Jared Kushner as a top adviser.

The piece told readers that Kushner, along with other responsibilities, would work on “matters involving free trade.” The use of “free” in this context is misleading since much of the US trade agenda is about increasing protectionism in the form of longer and stronger patent, copyright, and related protections. These protections are equivalent to tariffs of many thousand percent in the economic distortions they produce. They are 180 degrees at odds with free trade. There also has been little, if any, effort to remove protectionists barriers that benefit highly paid professionals, such as the ban on foreign doctors who have not completed a US residency program.

For these reasons, it is inaccurate to include the word “free” in reference to US trade policy. It is difficult to see why the NYT and other news outlets feel the need to do it.

—Dean Baker
Does NYT Require Reporters to Needlessly Add “Free” to References to Trade Policy?

After the election, I conducted a kind of exit interview with retiring Senate minority leader Harry Reid. I asked him what the Democratic Party stands for, and after speaking of his own upbringing in deep poverty in the rural town of Searchlight, Nevada, he said: “People have asked me the last year, ‘What message do you want to leave with people?’ And here’s the message: I want everyone in America to understand, if Harry Reid can make it in America, anyone can. And I want those young men and women out there who are looking for a way out to realize, if Harry Reid can make it, anybody can. That’s what America is all about.”

This is, in some ways, a perfect summation of the Democratic Party’s message in the Obama era: in America, anyone can make it out, anyone can rise to the highest heights. Immigrant, native-born, black, white, disabled, gay, straight, male, or female — no matter your background, there’s a place at the top for you. Even if this were perfectly true (and it’s not), we’re now seeing what happens when the Democratic Party is perceived, by white working-class people at least, as the party for those who make it out. But millions didn’t make it out — so who champions them?

The answer is that someone came along and more or less said, “Fuck all that. You won’t have to go to college to live your dreams; I’ll deliver them to you myself. I’ll reopen the coal mines. I’ll wave a magic wand, and this place that’s been pummeled will be restored. You can stay here and live your dreams. Your town can be great again.”

I think Obama recognized the need to speak to the dislocation and alienation of the Americans who didn’t make it out as well as anyone. There’s a reason he won all those counties that Trump flipped: it was Obama’s extraordinary political talent to connect with citizens from all walks of life that made him one of the greatest figures in American history. A century from now, schoolchildren will be celebrating his birthday.

But I’m left to wonder what it must be like inside his head now. Does he have a blissful moment every morning where he wakes up with no memory of what happened in November, a sweet morning calm before remembering the catastrophe? And I also wonder if that blissful moment before reality sets in is how we’ll remember his presidency.

–Chris Hayes
How Will History Judge Barack Obama?

Trump can enforce discipline on congressional Republicans almost effortlessly, with a combination of carrots and sticks that are fixed aspects of his relationship with them. The carrots are the points of policy consensus between Trump and Republican members of the House and Senate. The sticks are the ways that Trump can credibly threaten the careers of many House Republicans, and even some Senate Republicans, if they challenge him.

Set aside the frighteningly real concern that Republicans who cross Trump will see their emails plastered all over the Internet. Trump’s unpopularity masks the powerful effects of partisan polarization. His overall approval rating may be a dismal 37 percent, but in a polarized environment, that level of support means he is overwhelmingly popular among Republican voters and beloved by the GOP base. For most Republicans, opposing him would invite bigger political problems than they’ll willingly accept…

By abandoning even the pretense of congressional oversight, Republicans are leaving it almost entirely to reporters to scrutinize Trump’s ethical and legal conduct. But as he demonstrated on Wednesday, he has no misgivings about slandering news outlets (or any institutions really) that reveal unflattering things about him.

And the same polarization that makes him broadly unpopular, but enduringly popular with GOP voters, will insulate him from the political consequences of scandal. The result is that Trump will be able to operate with impunity for the foreseeable future. If he becomes so reviled that Republicans are no longer scared of him, they might finally arrest the damage — but we’ll have to wait until then to know the full toll.

–Brian Beutler
Trump Is Exactly the Monster We Feared, and Republicans Are Enabling Him

Public discussions of racism are notoriously frustrating, but there’s one especially aggravating related trend that took off during the election season and that I’d love for people to commit to eliminating in 2017: a push for vanity sizing.

Yes, vanity sizing for racism. The original term applies to the way clothing manufacturers have gradually adjusted their sizing in a way that appeases the growing number of large-bodied shoppers who, because of societal shame around weight, would rather see a label that says 6 than one that says 16…

As the vanity sizing debate proved, adjusting labels so that “bad” ones apply to fewer people is seductive. But even for people who associate thinness with health and virtue, it’s a superficial solution — it doesn’t change what we see when we look in the mirror.

We should all resolve to stop this vain, avoidant practice and focus on critiquing the beliefs and behavior that inspire the label “racist” instead of changing the rules so that the label doesn’t apply.

–Jenée Desmond-Harris
The Vain, Counterproductive Myth That There’s No Way Most Americans Can Be Racist

The Urban Institute studied the impact of the partial repeal of the ACA through the budget reconciliation process — precisely what Republicans are proposing to do. By 2019, the study found, this would increase the number of uninsured in Pennsylvania by 956,000 over what it would be if we simply kept the law…

In Tennessee, 526,000 more people would be uninsured… Senate Majority Leader Mitch McConnell is threatening to hike the uninsured figure in Kentucky by 200 percent, or 486,000 people.

In Arizona… the number without coverage would rise by 709,000. In West Virginia… the ranks of the uninsured would go up by 208 percent, more than twice the national average, from 88,000 if the ACA were left in place to 272,000.

These are real Americans, and they all live in states carried by Trump.

Now Republicans will dispute data of this sort and claim that their “replacement” of Obamacare will take care of these folks. It will be, Trump has said, “something terrific.” Okay, if it’s so terrific, let’s see it and discuss it before we threaten the insurance coverage of so many of our fellow citizens.

But they don’t want to do this because they have no plan to replace it with, only fragments of partial solutions and a lot of empty words. Their un-Jeffersonian haste is part of a coverup, a con game in which voters are told to give up something concrete in exchange for — well, we’ll tell you later, maybe.

–EJ Dionne
Republicans Don’t Want to Hurt “Real America.” By Repealing Obamacare, They Will.

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