In conversation with Matthew Boyle of Breitbart, Vice President JD Vance just said that the White House is working on a healthcare plan that the President plans to announce soon and that they believe will get Democrat votes.

Other reporting concurs that the White House is working on a plan, but that reporting says they're planning to use reconciliation to pass the bill, which would contradict the bipartisan aim.

What would the bill look like?

Well, the most plausible path is something very "normie": some extension of subsidies paid for with some further cuts in other places, expansion of HSAs, association-based plans, risk pools, and some deregulation stuff (if it can get past the parliamentarian).

But what if there was another way?

Here's a fundamental political reality as we head into the midterms: Republicans are more trusted than Democrats on virtually every issue, except for a big one, where Democrats kick our ass, and that is healthcare. Since 2008, Republicans have said nothing on healthcare, except "no."

That's not enough, given the byzantine nightmare that is the current US healthcare system (for all its virtues compared to Europe, which shouldn't be forgotten).

On the rare cases that the word is something other than "no", it is some libertarian never-never plan that can never pass and would be extremely unpopular.

Republicans have to accept the fact that Americans want universal coverage—especially if they can trust that it's universal coverage for Americans.

Avik Roy’s “Universal Exchange Plan,” later re-packaged as a “Universal Tax Credit” approach at FREOPP, is essentially a conservative way of accepting the ACA’s core social fact: universal (or near-universal) coverage is now the baseline expectation. Roy’s idea is to offer a refundable, age-adjusted tax credit for health insurance to every citizen who is not already well covered at work, usable on a liberalised individual market, with extra means-tested help for lower incomes. James Capretta and Yuval Levin have argued for pairing this with automatic enrollment into low-cost default plans and “continuous coverage” protection: keep insurance and you keep full protection for pre-existing conditions; let it lapse and you face penalties rather than a formal mandate. (Yes, we are linking to stuff from 2014, because that is how fossilized debate on healthcare has been on the Republican side.)

In other words: instead of trying to rip out Obamacare “root and branch”, Republicans would consolidate a new settlement. Citizens get a universal entitlement to some help buying coverage, channelled through markets rather than bureaucracies; lower-income citizens get more help, not less; those who fall through the cracks are auto-enrolled rather than lectured. For Democrats, the trade is clear: they give up some of the ACA’s regulatory micro-management, but keep its basic guarantee that citizens should not be one illness away from catastrophe.

Then there is the question of whether we are buying insurance or health care. Here the most interesting thinking on the right is coming from American Compass and Chris Emper. Emper argues, quite bluntly, that conservatives should “double down on the Health Center Program as an alternative to Obamacare,” shifting money from opaque insurance subsidies into bricks-and-mortar community health centres and the hospitals that actually treat working-class Americans. The United States already has a nationwide network of federally qualified health centres that treat tens of millions of patients on a sliding-fee basis; the OBBBA created a Rural Hospital Fund to soften the blow of Medicaid cuts. 

A more imaginative bill would build on this. Instead of simply reducing Medicaid and hoping that HSAs magically fill the gap, it would massively expand funding for community health centres and safety-net hospitals, and let a share of federal subsidy money “follow the patient” when a clinic doctor refers a citizen to a specialist or hospital. That is something a MAGA nationalist suspicious of insurers, a reformocon technocrat, and a Democratic senator from a rural state could all plausibly vote for.

Cost control is the other big issue. Here again the right has moved. Republicans should be willing to take on entrenched interests. A bill that took hospital monopolies seriously—with site-neutral payments, and a clear legal mandate for antitrust enforcement against hospital monopolies and private equity—might actually accomplish something, on top of being politically judicious. More rules on price transparency could also be included in such a bill.

Another big aspect of cost is, of course, drug pricing, on which the Trump administration has made a lot of noise and a few real moves, with TrumpRx, deals, and other executive actions. Codifying some action on drug pricing into legislation would be very helpful. Marry that to the reformocon agenda: faster approval and automatic substitution for generics and biosimilars, pruning patent games that delay competition, banning PBM “spread pricing” and forcing rebates to flow to patients at the pharmacy counter.

There's a lot of stuff that could be done in a very good healthcare bill that would make a real difference in Americans' lives, bring health to a broken market, and put wings into the sails of the Republicans into the midterms.

But you couldn't pass it through reconciliation.

Could you get Democrat votes? Enough to break a filibuster, in an election year, in a hyperpartisan environment? No way.

Of course: President Trump has pointed the way. Get rid of the filibuster. Then you can pass a real healthcare reform on partisan lines, do a lot of good, win the midterms, and set up the Party for victory in 2028.

Hey, a guy can dream…

Policy News You Need To Know

#BabyDrain — Over at his must-read National Populism Newsletter, political consultant Ryan James Girdusky writes of the current “baby drain” America is experiencing, as Millennials and Gen Z have fewer or no children and major Democratic-run cities quietly shed large shares of their under-five population even while headline numbers are propped up by immigration. He notes that Sun Belt metros such as Austin and Orlando are gaining young families, while blue-state hubs like New York, Boston, Chicago, Los Angeles and the San Francisco Bay Area have seen steep double-digit declines—often on the order of a third or more—in small children since 2005, a trend masked by inflows of foreign-born adults. A country cannot simply import its future: even mass immigration of more than a million entrants per year cannot compensate for collapsing native-born fertility, especially in jurisdictions where high costs, weak public order and expansive welfare states make it harder to marry, buy a home and raise several children.

#AI — The outlet Transformer News has obtained (what they claim is) a draft of President Trump's upcoming executive order on state AI. The order would launch an aggressive federal push to roll back blue-state attempts to regulate AI and instead impose a single, light-touch national framework. Framed in national-security terms, the order argues, correctly, that more than 1,000 state AI bills, led by California’s SB 53 and a new Colorado “algorithmic discrimination” statute, amount to a patchwork of hostile regulation driven by speculative doomsday fears and regulatory capture, and that this risks ceding the AI race to adversaries. It would direct the AG to create an “AI Litigation Task Force” charged with challenging state AI laws as unconstitutional burdens on interstate commerce or as preempted by federal rules, while the Secretary of Commerce would be told to treat onerous state AI regimes as a strike against eligibility for certain remaining Broadband Equity, Access, and Deployment (BEAD) funds. The draft further instructs FCC chairman Brendan Carr to explore a federal AI reporting and disclosure standard that would override conflicting state mandates, and asks the Federal Trade Commission to clarify that state laws forcing AI models to alter truthful outputs or embed ideological requirements can be preempted as “unfair or deceptive” interference in commerce. The intent is certainly to be lauded, but will it be enough? We probably need legislation for this.

#AI — Speaking of AI news, Saudi Arabia and the UAE have been authorized by Commerce to purchase Nvidia's top-tier Blackwell chips.

#Tariffs #Chyna — Chinese imports are down according to freight container volume at the port of Long Beach. Tariffs have affected a 16% decrease in Chinese imports according to the port.

#Welfare #Fraud #Immigration — Minnesota’s experiment in Scandinavian-style welfarism has curdled into something closer to a national-security scandal: according to a new detailed investigative report by the invaluable Chris Rufo at the Manhattan Institute, under Democrat governor Tim Walz billions of dollars worth of state and federal welfare funds have been siphoned off through blatantly fraudulent schemes in housing, child-nutrition, and autism services, many run by networks in the state’s large Somali diaspora, with federal counterterrorism officials warning that millions skimmed from Minnesota taxpayers have ultimately flowed, via hawala remittance channels, into the coffers of none other than Al-Shabaab, al-Qaida’s franchise in Somalia. Prosecutors describe “purely fictitious” Medicaid housing firms, a $250 million “Feeding Our Future” racket that invoiced phantom meals for poor children, and explosive growth in autism-billing tied to kickbacks, all under an administration that preferred to cry “racism” rather than police abuse of the welfare state. According to the report, the Minnesota taxpayer has become the largest funder of Al-Shabaab. Wonderful wonderful news.  

#Jorbs — The administration is touting a "beat" on the September jobs numbers (which have only arrived now after a six-week shutdown delay), but underneath the headline things are not so rosy. It paints a picture of a labour market that is cooling, not roaring: nonfarm payrolls rose by just 119,000, and July and August were revised down by a combined 33,000, leaving average job creation since spring barely above stall speed. Unemployment is up to 4,4 %, the highest in four years, while the employment-population ratio has slipped 0,4 point over the past year and labour force participation is stuck at 62,4 %, with 1,8 million long-term unemployed and 4,6 million workers stuck in part-time jobs they do not want. Job gains are concentrated in health care (+43 000), restaurants and bars (+37 000) and social assistance (+14 000), while transportation and warehousing shed 25 000 jobs and federal employment continued to drift down, with little or no growth in core private, goods-producing sectors such as construction and manufacturing.  Average hourly earnings are up 3,8 % over 12 months, only modestly ahead of roughly 3 % inflation, meaning real wage gains remain thin after years of price surges. 

#Immigration — A group of Senate Republicans led by Jim Banks of Indiana and Bill Cassidy of Louisiana has introduced the “Putting American Workers First Act,” a bill that would empower the National Labor Relations Board (NLRB) to investigate and prosecute employers who knowingly hire illegal immigrants, explicitly defining the hiring or unionizing of illegal immigrants as an unfair labor practice and granting safe-harbor protection to employers that use E-Verify to check work eligibility. The bill also insulates firms from unfair-labor-practice charges when they terminate workers later discovered to be in the country illegally. Taking on employers is the next step in immigration enforcement. So long as employers face little risk for hiring unauthorized workers, the wage-depressing pull of illegal immigration will continue to undercut lower- and middle-skill Americans. By routing enforcement through the NLRB and tying it to labor standards, this bill is smartly arguing that a serious pro-worker agenda must close off the long-standing loophole whereby corporate America benefits from illegal labor while taxpayers absorb the social costs. 

#Medicare — Medicare Advantage, sold for decades as the market-friendly alternative that would save taxpayers money, has in fact become a massive entitlement add-on, with private insurers now costing the Treasury an estimated 22% more than traditional fee-for-service Medicare through aggressive “upcoding” and favorable selection of healthier seniors, according to a new report by the group "Open The Books". By exploiting risk-adjustment, plans systematically overstate beneficiaries’ illness burden and target geographies where benchmark costs are high but actual treatment costs are low, allowing them to pocket the spread while paying physicians less than the traditional program and narrowing networks—precisely the opposite of the promised competition and choice. The piece notes that UnitedHealthcare alone received 42% of all documented MA overpayments in 2021 and that total excess costs from coding games and selection could reach $1–1.4 trillion between 2024 and 2033. Policy responses on offer so far come mainly from the left, including the Prompt and Fair Pay Act from Reps. Doggett and Casar, which would force MA plans to pay doctors at least traditional Medicare rates and partially blunt favorable selection but does nothing to fix the underlying benchmark and risk-adjustment architecture that invites coding inflation. The problem is that Medicare fraud has become so endemic that it's become its own industry, which would demonize reform as "cuts", which the new Republican Party is allergic to. Still, we should be aware of the scale of the problem.

#AI — Over at the Bush Center, Neil Chilson has a good article inweighing on the regulatory hurdles that make it harder for the US to maintain and extend its lead in AI.