For coal country isn’t really coal country anymore, and hasn’t been for a long time.
.. But the number of miners began a steep decline after World War II, and especially after 1980, even though coal production continued to rise. This was mainly because modern extraction techniques — like blowing the tops off mountains — require far less labor than old-fashioned pick-and-shovel mining. The decline accelerated about a decade ago as the rise of fracking led to competition from cheap natural gas.
.. it has been a quarter century since they accounted for as much as 5 percent of total employment.
.. Their Trump votes weren’t even about the region’s interests; they were about cultural symbolism.
.. Donald Trump successfully pandered to cultural nostalgia
Trump was right about health care for most of his life
President Trump could actually use the legislative collapse to fix health care if he went back to basics and to his core convictions on the topic, which are surprisingly intelligent and consistent.
.. in 1963, economist Kenneth Arrow, who later won a Nobel Prize, offered an explanation as to why markets would not work well in this area. He argued that there was a huge mismatch of power and information between the buyer and the seller. If a salesman tells you to buy a particular television, you can easily choose another or just walk away. If a doctor insists that you need a medication or a procedure, you are far less likely to reject the advice. And, Arrow pointed out, people think they don’t need health care until they get sick, and then they need lots of it.
Every advanced economy in the world has implicitly acknowledged his argument
.. Consider the 16 countries that rank higher than the United States on the conservative Heritage Foundation’s Index of Economic Freedom. All except Singapore (which has a unique state-driven approach) have universal health-care systems that can be described as single-payer (Medicare for all), government-run (the British model) or Obamacare-plus (private insurance with a real mandate that everyone opt in). Hong Kong, often considered the most unregulated market in the world, has a British-style government-run system. Switzerland, one of the most business-friendly countries, had a private insurance system just like the United States’ but found that, to make it work, it had to introduce a mandate.
..Taiwan, another free-market haven. In 1995, 41 percent of its population was uninsured and the country had very poor health outcomes. The government decided to canvass the world for the best ideas before instituting a new framework. It chose Medicare for all, a single government payer, with multiple private providers.
The road to single-payer health care
September might be the time for resurrecting repeal-and-replace. That’s when insurers recalibrate premiums for the coming year, precipitating our annual bout of Obamacare sticker shock.
.. stripping out the heavy-handed Obamacare coverage mandate that dictates what specific medical benefits must be included in every insurance policy in the country, regardless of the purchaser’s desires or needs.
Best to mandate nothing. Let the customer decide. A 60-year-old couple doesn’t need maternity coverage. Why should they be forced to pay for it? And I don’t know about you, but I don’t need lactation services.
.. Acceptance of its major premise — that no one be denied health care — is more widespread than ever.
.. A broad national consensus is developing that health care is indeed a right. This is historically new. And it carries immense implications for the future. It suggests that we may be heading inexorably to a government-run, single-payer system. It’s what Barack Obama once admitted he would have preferred but didn’t think the country was ready for. It may be ready now.
.. it won’t take much for Democrats to abandon that Rube Goldberg wreckage and go for the simplicity and the universality of Medicare-for-all.
.. I wouldn’t be terribly surprised if Donald Trump, reading the zeitgeist, pulls the greatest 180 since Disraeli “dished the Whigs” in 1867 (by radically expanding the franchise) and joins the single-payer side.
Why couldn’t Republicans who voted to repeal Obamacare so many times under Obama do it under a Republican president?
@tim has given a good answer in terms of the specific vote. However it’s also worth looking at the reason why the Republicans couldn’t get behind a replacement.
The problem that the Republicans face is that the key elements of Obamacare were actually Republican ideas. This paper from the Heritage Foundation outlines the main points which were later introduced into Obamacare. When Mitt Romney was Governor of Massachusetts he introduced a statewide health law based on these same ideas. (Edit: added link to list of similarities and differences)
When President Obama proposed the Affordable Care Act the Republican party was faced with a difficult choice. They could have supported the ACA while pointing out that Obama had merely pinched their best ideas, but this would have meant handing Obama a major political victory and an important historical legacy. Since they hated Obama they couldn’t stomach that, so instead they decided to airbrush out their own history and position themselves in opposition. They managed to make hatred of Obamacare a major mobilising point for their base, but now they have the opportunity to replace Obamacare they are in a bind: they can’t create the scheme they had planned because it would be too obviously Obamacare with a red paint job, but they don’t have any new ideas to replace it.
Trump isn’t helping. He promised to replace the “broken” and “unconstitutional” Obamacare, but never got around to saying what he would replace it with. Then he discovered (to his immense surprise) that it’s complicated.