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Brainstorm Health Daily: June 23, 2017

June 23, 2017, 5:08 PM UTC

Senate Republicans finally revealed their super-secret healthcare bill yesterday. And while it’s too early to count votes, I’m guessing that it won’t get to 50. To me, though, the more provocative question isn’t whether it will pass the chamber, but rather whether GOP leaders intentionally crafted a bill to fail.

Let me start by saying that this is unadulterated Friday-morning musing—pure Colonel-Mustard-in-the-library-with-the-candlestick conjecture.

That said, here’s the primary motive: Republicans are learning the hard way that “owning” healthcare legislation isn’t fun. Generally, in politics, when someone attaches your name to something, it’s not in a complimentary way: See, for example, “Hoovervilles”—and for the first few years anyway—“Obamacare.” Even President Trump, a man who likes seeing his name on anything, can probably tell that the word “Trumpcare” isn’t often uttered with a smile.

Senator Mitch McConnell, the majority leader, understands this. McConnell is a savvy political wrangler and survivor (see Tory Newmeyer’s great 2014 profile of the fellow in Fortune). And he can masterfully parse the polls, which show that many in his own party, across a big red swath of America, hate this bill and the House bill before it. He can see how poorly it looks on national TV to have wheelchair-bound protestors arrested after staging a “die-in” outside your office. He also knows that in politics it’s easier to attack than defend. The last thing he wants is to have to spend the next few years publicly defending legislation that takes away health insurance from tens of millions of Americans and raises the premiums for tens of millions more (whether he believes in the merits of that legislation or not). In his mind, no doubt, the one appellation worse than “Trumpcare” right now is “McConnellcare.”

Beyond the primary motive is a secondary one: There’s a whole bunch of stuff—tax reform being at the top of the list—that McConnell does want. And he and his fellow GOP’ers can’t get it, or get it quickly, if they face a full-fledged civil war with Democrats in the Senate. Passing the GOP healthcare bill with a 50-50 vote (and a tiebreaking aye from Vice President Pence) would presumably set that war ablaze.

That’s what happened, after all, when Democrats pushed through the Affordable Care Act early in President Obama’s first term. The day after the House barely passed the Senate’s ACA bill—without a single Republican vote—the minority party introduced a bill to repeal it. McConnell, then in the Senate minority, led a fierce, relentless opposition to virtually everything President Obama’s party proposed. So, it’s fair to ask, what he would gain by pushing through health coverage reforms that would not just alienate, but also inflame, his Senate opposition and countless voters.

Next, in our Friday conjecture, we have an alleged weapon, discovered at the scene: McConnell in the Senate Chamber with the candlestick. (It’s always the candlestick.)

Benjy Sarlin at has a terrific and thorough examination of what McConnellcare would do—including cuts to Medicaid that may be more draconian even than what’s proposed in the House’s AHCA bill. But the proffered legislation does something more remarkable: It incorporates provisions that outrage not only the so-called “moderate” Republicans in the Senate, but also infuriates a hard-line conservative faction led by Kentucky’s Rand Paul. (Paul said yesterday the bill “does not repeal Obamacare,” and that he would oppose it in its current form.)

It should go without saying that McConnell (and the cabal of 13 Republican senators, who crafted the proposal behind closed doors for weeks) knew full well the red lines that both groups said they wouldn’t cross. But the bill does a fair amount of line-crossing, and seems even to make a point of it.

Why? Because that gives the Senate Majority Leader a way out of this mess. McConnell gets to claim credit with his base for putting through a (mostly) conservative bill that parallels much of what the House bill does. He can now rush it through a vote and wash his hands of it when it fails. “Hey, I tried.”

And that, at last, gives him and House Speaker Paul Ryan the chance to push through what they really want—tax reform. Now, all they have to do is hope that voters forgive and forget this debacle come the 2018 midterm elections.

Happy weekend, everyone. More news below.

Clifton Leaf, Editor in Chief, FORTUNE


Bluebird Bio's blood disorders gene therapy posts promising results. Gene therapy biotech Bluebird Bio is out with some new data for its experimental blood disorder treatment (for sickle cell disease and beta thalassemia). But the company's stock isn't exactly doing too hot—shares slid about 9% in early Friday trading. The reason? There are still some big unresolved issues surrounding the treatment, including whether or not it's effective for all patients. For instance, one trial participant (and these trials are rather small) no longer had to have regular blood transfusions; but another didn't react as positively, raising concerns that the company's revamped manufacturing process for the drug may not have solved all of its outstanding issues. (FierceBiotech)


Pfizer faces another rejection for its Amgen drug biosimilar. Sometimes, it's not enough to create a drug that works–you also have to make sure that the facilities where it's created hew to regulatory standards. That's the lesson for Pfizer in the Food and Drug Administration's second rejection of epoetin alfa biosimilar, a copycat version of Amgen's Epogen, which rings in more than $1 billion in sales each year. An FDA advisory committee nearly unanimously recommended approval of the treatment; yet it still failed to cross the regulatory finish line over concerns about a fill-finish plant in Kansas.


The early reviews for the Senate's health care bill are in. Cliff touches on some of the major issues and possible political wrangling surrounding the Senate's newly-released health care bill in his essay today. But what's the industry saying (so far)? Some groups have yet to release official statements; but one of the nation's most prominent lobbying organizations, the AARP, isn't mincing words. "This new Senate bill was crafted in secrecy behind closed doors without a single hearing or open debate—and it shows. The Senate bill would hit millions of Americans with higher costs and result in less coverage for them. AARP is adamantly opposed to the Age Tax, which would allow insurance companies to charge older Americans five times more for coverage than everyone else while reducing tax credits that help make insurance more affordable," writes the group. Medical trade groups like the AMA and American Hospital Association did not react kindly to the House-passed American Health Care Act. (Fortune)

Extreme measures: Executions in China for research fraud? Doctored research could soon cost scientists a lot more than their reputations in China. STAT News reports that new crackdowns in the country could come with capital punishment for researchers. The reason? A recent survey found that nearly 40% of biomedical papers by Chinese scientists were doctored or created via some form of misconduct. (STAT News)


How Business Leaders Are Embracing the Age of Disruptionby Kristen Bellstrom and Claire Zillman

Meet 5 of the World's Most Dangerous Hacker Groupsby Robert Hackett

YouTube Claims 1.5 Billion Users in Latest Ad Sales Pitchby Tom Huddleston, Jr.

Uber's Stock Was Sinking Before Investors Ousted CEO Travis Kalanickby Jen Wieczner

Produced by Sy Mukherjee

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