The latest twist in the prolonged farce that is the Cassidy-Graham-Johnson-Heller-Dracula healthcare “reform” plan comes to us in the pixels of The Hill, where we learn that it may be possible that Drs. Cassidy, Barrasso, and Price are the only medical professionals on the planet who approve of this bill. (The opposition at this point probably also includes Doctor Jimmy, Doc Marten and Dr. John, The Night Tripper.) Here is an appeal from another group of people whose expertise on healthcare surpasses that of Lindsey Graham, and who are not a herd of goats, the expertise of which also would surpass that of Lindsey Graham.

"Taken together, the per-capita caps and the envisioned block grant would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history," NAMD's board of directors wrote in a statement Thursday. The NAMD, which is a coalition of Medicaid directors from every state, noted that while the proposal is intended to create maximum flexibility, it does not provide the statutory reforms necessary "commensurate with proposed funding reductions."

"The scope of this work, and the resources required to support state planning and implementation activities, cannot be overstated," the directors said. "States will need to develop overall strategies, invest in infrastructure development, systems changes, provider and managed care plan contracting, and perform a host of other activities. The vast majority of states will not be able to do so within the two-year timeframe envisioned here, especially considering the apparent lack of federal funding in the bill to support these critical activities."

This comes from the organization of the people in every state who are in charge of Medicaid programs. These people generally can’t agree on a breakfast order. Not that they know as much about it as a senator from South Carolina who argued for his dog’s breakfast of a bill with his customary blend of nuance and medical expertise. From Josh’s joint:

“You can have different opinions about the quality of this bill. At the the end of the day, this is the only process left available to stop a march toward socialism,” Graham, the lead author of the bill, told reporters in the Capitol. Asked whether the bill’s supporters planned to address Sen. John McCain’s (R-AZ) concerns about regular order, which sank Republicans’ last effort to repeal Obamacare, Graham said the Senate Finance Committee had a hearing scheduled for Monday to discuss the proposal. “There will be a public hearing, what John has been asking for,” he said. Graham said Republicans who vote against the bill are voting “against federalism.”

“At the end of the day we need 50 votes, and if you’re a Republican, chances are you believe in federalism, because if you don’t you probably are not a Republican,” he said. “If you’re a Republican and you vote against federalism, you’ve got to explain to people back home why Washington knows better.”

Today’s Question: Does Lindsey Graham know less about socialism than he does about federalism? Our lines are open. This is a free call.

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Graham is in the lead on this because he was perceived to be what passes for a reasonable Republican in the era of the prion disease. (This was always a crock. Graham made his bones originally as a torch-bearing anti-Clinton fanatic in the Great Penis Hunt of 1998. You don’t tamp those demons down forever.) They wanted what passed for a friendly face. The fact that this required Graham to double back on virtually everything he’d said about healthcare over the past seven years was irrelevant. Regular order? What’s that? Senator-specific carveouts? Hated them once, love them now.

(As to the latter, the state of Montana is getting the same deal that Alaska did. Namely, that it is getting a waiver to the bill that eliminates Obamacare that will allow Montana to keep Obamacare. Lewis Carroll died too soon.)

The other problem is, of course, that Graham doesn’t know fck-all about the subject. It also has not helped that Bill Cassidy, an actual doctor, regularly behaves as though the bill bearing his name has been written in Tagalog. And then there’s Dean Heller, Republican of Nevada, who took another shot below the waterline from his state’s Republican governor on Thursday night. From The Nevada Independent:

“Flexibility with reduced funding is a false choice,” Sandoval said in the statement. “I will not pit seniors, children, families, the mentally ill, the critically ill, hospitals, care providers, or any other Nevadan against each other because of cuts to Nevada’s health-care delivery system proposed by the Graham-Cassidy amendment.”

Sandoval isn’t going to have this dead raccoon hung around his neck without a fight.

A bad law, badly designed, and sold by people who don’t understand its ramifications, or who know them and don’t care about them. What could possibly go wrong? And this vote is still too damn close for comfort.

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Charles P. Pierce Charles P Pierce is the author of four books, most recently Idiot America, and has been a working journalist since 1976.

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