the most revealing thing in the interview may be Mr. Trump’s defense of Bill O’Reilly, accused of sexual predation and abuse of power: “He’s a good person.” This, I’d argue, tells us more about both the man from Mar-a-Lago and the motivations of his base than his ramblings about infrastructure and trade.
.. How much difference has it made, really, that Donald Trump rather than a conventional Republican sits in the White House?
.. the ignominious collapse of the effort to kill Obamacare — owed almost nothing to executive dysfunction. Repeal-and-replace didn’t face-plant because of poor tactics; it failed because Republicans have been lying about health care for eight years. So when the time came to propose something real, all they could offer were various ways to package mass loss of coverage.
.. Tax reform looks like a bust .. because nobody in the G.O.P. ever put in the hard work of figuring out what should change and how to sell those changes.
.. it’s clear that the administration has no actual infrastructure plan, and probably never will.
.. there are some places where Mr. Trump does seem likely to have a big impact — most notably, in crippling environmental policy. But that’s what any Republican would have done
.. Trumpist governance in practice so far is turning out to be just Republican governance with (much) worse management
.. Trumpism has brought is a new sense of empowerment to the ugliest aspects of American politics.
.. one thing the interviewees often say is that Mr. Trump is honest, that he tells it like is, which may seem odd given how much he lies about almost everything, policy and personal. But what they probably mean is that Mr. Trump gives outright, unapologetic voice to racism, sexism, contempt for “losers” and so on
.. Mr. Trump isn’t an honest man or a stand-up guy, but he is, arguably, less hypocritical about the darker motives underlying his worldview than conventional politicians are.
.. they provide a safe space for people who want an affirmation that their uglier impulses are, in fact, justified and perfectly O.K.
..
whether unapologetic ugliness is a winning political strategy.
Universal Healthare Access is Coming to the US. Stop Fighting It. Make it Work.
There are no countries where all health-related services, including optical and dental services, drugs, and long-term care, are entirely free to patients without co-pays or deductibles.
.. deductions and exclusions of health insurance premiums and related tax breaks cost the federal government some $250 billion in revenue in 2015 — a substantial burden on the federal budget.
.. If we categorize healthcare expenditures according to the ultimate source of funds rather than the primary payer, we find that government budgets account for over half of all spending, as this chart shows:
.. The individual insurance market is failing because too large a share of health care risks is inherently uninsurable. Two conditions must hold for a real insurance market to work. First, the risks in question must be fortuitous; that is, predictable statistically but not predictable for any particular individual.
.. the top 10 percent of households account for two-thirds of all personal healthcare spending, and the top 5 percent for half of all spending. The majority of these high spenders have one or more chronic conditions that keep their spending high year after year.
.. Ultimately, though, guaranteed issue is an unsustainable policy that threatens the whole individual insurance market with a “death spiral.”
.. economists believe that over time, employees end up bearing the cost of healthcare benefits through lower pay. Rising employer healthcare costs are thus a major contributor to the stagnation of wages.
.. from 1999 to 2014, the share of the nonelderly population covered by employer-sponsored insurance fell from 67 percent to 56 percent.
.. Even with the greatest administrative energy behind it, it would be hard to make the ACA’s private insurance market work well, and it is more likely that current administrators will work to undermine than to support its operation.
The Republican Health-Care Crack-Up
decided on a two-part strategy. Republicans would repeal much of Obamacare early, using “reconciliation” procedures to allow a simple majority of the Senate to act without being filibustered by the Democratic minority. Later, they would repeal the rest of Obamacare and enact a replacement.
Republicans had already passed a reconciliation bill repealing Obamacare’s taxes and subsidies when President Obama was in office. (He vetoed it, of course.) Replacement would, on the other hand, require Republicans to overcome their disagreements.
.. It became clear, however, that McConnell’s plan would not work, in large part because insurance markets could collapse in the interim.
.. The House leaders devised a bill that they said accomplished as much of both repeal and replacement as the parliamentarian would allow.
.. many of the conservative critics, at least by the end of the debate over the bill, were willing to accept that tax credits were necessary. What continued to concern them was that so many of Obamacare’s regulations were left in place.
.. That problem could have been addressed by being less aggressive in rolling back Obamacare’s expansion of Medicaid .. and by making the tax credits more generous to people with incomes a little too high for Medicaid and people nearing retirement.
.. Mike Lee of Utah, an ally of the Freedom Caucus, reported that the parliamentarian had told him that nobody had asked her about the permissibility of some specific deregulatory steps
.. What it really shows, above all, is that legislating is easier when you have 60 rather than 52 senators on your side. The Democrats had a much freer hand in making regulatory changes when they passed Obamacare
.. During the campaign he had a brief outline of a plan that made little sense, and he dropped it in favor of letting the Congress come up with something.
.. Nothing is stopping the Republicans from spending the next year hammering out a bill that they like better, refining it as they go so that it enables more people to buy coverage they actually want.
.. Most Republicans now embrace moving toward a market in which all Americans have the option to buy renewable catastrophic coverage and in which such coverage competes with more comprehensive plans on a level playing field.
In Defense of the Freedom Caucus
It’s wrong for Trump to blame the conservatives.
Yet in this latest episode, the Freedom Caucus was mostly in the right (and it wasn’t just them — members from all corners of the House GOP found it impossible to back the bill). The American Health Care Act was a kludge of a health-care policy.
.. it probably would have further destabilized the individual market, while millions fewer would have been insured.
.. White House sent adviser Steve Bannon to tell obstinate Freedom Caucus members that they “have no choice” but to vote for the bill. It’s hard to imagine a less effective pitch to a group that has long accused Republican leaders of trying to coerce conservatives into falling in line against their principles.
.. for all their reputed rigidity, most of the Freedom Caucus had accepted the inclusion in the Ryan bill of tax credits for people without access to Medicare, Medicaid, or employer-provided insurance — a policy that they had previously tended to oppose.
.. For all of the praise heaped on the president’s negotiating acumen, he has yet to demonstrate it in his dealings with Congress. Trump’s tweet has all the hallmarks of ineffectually blowing off steam, since it’s hard to imagine the president and his supporters following through with the organizing and funding it would take to try to take out conservative members representing deep-red districts.