In particular, if you want to make care available to Americans who have pre-existing medical conditions — including the condition of being not rich and being relatively old, but not yet eligible for Medicare — you have to find some way to subsidize them.
Obamacare provides those subsidies in part with direct public funding, in part with regulations that implicitly use premiums paid by the healthy to cover the cost of caring for the less healthy.
.. The important thing to remember is that these problems don’t keep popping up because the people devising the plans are careless, and keep forgetting crucial issues. They’re popping up because the G.O.P. is trying to stuff a big balloon into a small box, and every time you squeeze it somewhere it inflates someplace else.
And because the task Republicans have set for themselves is basically impossible, their ongoing debacle over health care isn’t about political tactics or leadership. Even if Donald Trump were the great deal maker he claims to be, or Paul Ryan the policy wonk he poses as, this thing just can’t work.
.. There are some things we could do that would probably make it even cheaper, but they would all involve moving left — say, introducing a public option, or going all the way to single-payer.
.. If Republicans never had a plausible alternative to Obamacare, if this debacle was so inevitable, what was the constant refrain of “repeal and replace” all about?
The answer, surely, is that it began as a cynical ploy; at first, the Republicans hoped to kill health reform before it really got started. And now they’ve trapped themselves: They can’t admit that they have no ideas without, in effect, admitting that they were lying all along.
THE arrival of the “post-truth” political climate came as a shock to many Americans. But to the Christian writer Rachel Held Evans, charges of “fake news” are nothing new. “The deep distrust of the media, of scientific consensus — those were prevalent narratives growing up,” she told me.
.. She was taught to distrust information coming from the scientific or media elite because these sources did not hold a “biblical worldview.”
.. this conviction gives that natural human aversion to unwelcome facts a special power on the right.
.. Ever since the scientific revolution, two compulsions have guided conservative Protestant intellectual life: the impulse to defend the Bible as a reliable scientific authority and the impulse to place the Bible beyond the claims of science entirely.
.. The second impulse, the one that rejects scientists’ standing to challenge the Bible, evolved by the early 20th century into a school of thought called presuppositionalism.
.. Cornelius Van Til, a theologian who promoted this idea, rejected the premise that all humans have access to objective reality. “We really do not grant that you see any fact in any dimension of life truly,”
.. he doesn’t see “how you can teach ‘Christian journalism’ any more than you can teach ‘Christian mathematics.’ ”
.. a network of institutions and experts versed in shadow versions of climate change science, biology and other fields
.. Dr. Jeanson calls himself a “presuppositionalist evidentialist” — which we might define as someone who accepts evidence when it happens to affirm his nonnegotiable presuppositions.
.. “The skeptic looks at something and says, ‘I wonder,’ ” he said. “The cynic says, ‘I know,’ and then stops thinking.”
.. “cynicism and tribalism are very closely related. You protect your tribe, your way of life and thinking, and you try to annihilate anything that might call that into question.”
He’s not delivering Americans from cynicism about government. He’s validating that dark assessment, with a huge assist from Paul Ryan and a cast of House Republicans who had consistently portrayed themselves as sober-minded, mature alternatives to those indulgent, prodigal Dems, if only they had a president from their party who would let them work their magic.
.. It was pushed on lawmakers not as essential policy but as essential politics: The president needed a win, and the party had to make good on an incessantly repeated pledge.
.. “Because we said we would” became the motivating force for the legislation.
.. In one Quinnipiac poll, only 17 percent of them said that they favored the emerging Republican alternative to Obamacare, while 56 percent opposed it.
.. That Trump isn’t good at details and follow-through comes as no surprise. Ryan’s miscalculations are the greater revelation.
.. “Convenient how Trump flips from an all-powerful master negotiator to well-intentioned simpleton duped by Snidely Ryan at the drop of a hat,” tweeted the conservative columnist Ben Shapiro.
Republicans ran advertisements noting they had voted 70 or more times to repeal the Affordable Care Act, and they would do it as soon as they had control of Congress and the White House.
Voters gave them just that. And now Republicans, who had used the word “repeal” like a meditation chant, act like the proverbial dog that caught the car. The plan they all liked in 2015 — one that would have ended the law’s mandates, subsidies and Medicaid expansion — would not pass today.
.. Mr. Trump’s voters supported a man who promised a government-run health care plan that would provide universal coverage. In other words, he promised more than Obamacare. For that matter, Mr. Trump promised more government involvement in health care than Hillary Clinton did.
.. Mr. Trump’s voters want Obamacare, but they want Mr. Trump’s gold-plated branding on it.
.. Democrats were far more focused on expanding coverage and ensuring every American could get insurance than they were on making coverage affordable.
.. Instead, they should focus on cost.
.. Increasing competition and choice would lower prices for all kinds of insurance.
.. Watching many Americans demand repeal, while voting for a man who promised a government-run, universal coverage solution, only increases politicians’ cynicism about the American voter.