Paul Ryan’s Health-Care Vise

As with the majority of House Republicans, most members of the Freedom Caucus have only ever served under a Democratic President. They were elected to oppose Obama and everything he stood for and they spent most of his Presidency attacking Republican leaders who they believed thwarted those efforts. They have no experience legislating.

.. An early version of the Ryan plan replaced these subsidies with less generous refundable tax credits, which many conservatives dislike because Americans who pay no taxes would still be eligible for the credits.

.. Ryan’s response was to leave the expansion in place until 2020

.. Proponents of the Medicaid expansion see the deadline as creating a health-insurance time bomb that will detonate in a few years.

.. Health-care reform has long been stymied by the insurance industry. Bill and Hillary Clinton took on the industry in 1994 and were badly defeated. In 2009, Obama decided to buy the industry off by including a provision forcing every American to buy its product—the dreaded individual mandate.

.. Ryan and Trump have insisted they would keep those popular regulations while killing the mandate, which forces the uninsured to pay a tax penalty. Their solution is that the uninsured would pay a penalty to insurance companies. Specifically, insurers would be allowed to charge anyone with a two-month gap in coverage up to a thirty-per-cent surcharge on a new policy. For many Americans, the surcharge in Trumpcare could end up being more than the current tax penalty in Obamacare.

.. When Lyndon Johnson created Medicare he essentially made up and lowballed the long-term costs of the program. Without a true estimate, it was difficult for fiscal conservatives, medical groups, and other opponents to attack the plan, and it sailed through Congress.

.. In 2009, Obama became so frustrated by the C.B.O., whose cost estimates had an enormous impact on the health-care debate, that during an Oval Office meeting he said he didn’t want to hear the C.B.O. mentioned, so his aides referred to it as “banana.”

.. Ryan needed to shape a bill that would survive this process, and as a result, he left out some of conservatives’ most long-standing health-care-policy ideas. (For instance, most conservatives support changing a law that prevents insurance from being sold across state lines, arguing it would make markets more competitive and bring down costs, but Ryan didn’t include the change in his plan.)

.. Ryan has produced a bill that nobody would ever propose as a sane solution to the problems with Obamacare. Its only chance is speed. If Ryan can rush and muscle it through the House and Mitch McConnell can do the same in the Senate, it might end up on Trump’s desk. But the more scrutiny this House bill is subject to, the more likely it is to share the fate of most efforts at health-care reform and die somewhere on its journey to the Senate

Is Donald Trump a Narcissist and Is He Fit for Office?

Mr. Trump is also a reality TV star, which is a high narcissism profession. In the show he played the role of the high status executive who challenges then fires people. His catch phrase, “you’re fired!” is both dominant and callous.

.. The big exception to this is Mr. Trump’s relationships with his children. These seem very strong and warm, which is not what you would expect from a narcissistic father.

.. “Show me someone without an ego, and I’ll show you a loser.” –How To Get Rich

This information is important because people who are narcissistic are typically aware of it – they will report being narcissistic and generally think that is a smart way to go through life.

.. And U.S. presidents as a group have estimated narcissism scores higher than even reality television stars.

..What I am saying is that the burden of proof should be on the people making the claim of NPD. It seems like a stretch to me, but there could be impairment that is hidden from view or is manifested primarily by the suffering experienced by others that is caused by Mr. Trump’s narcissism.This is not to say that Mr. Trump’s narcissism doesn’t appear to harm him at times. From my perspective he seems overly reactive in response to ego threats. I am not sure if he is taking advice as well as he should from others. But, on balance, his narcissism has probably been a bigger boost to Mr. Trump’s political success than a hindrance.

.. hypomanic personality, or a persistent low level of mania. Hypomanic personality is associated with high energy levels, social vitality, impulsivity, low need for sleep, and grandiose thought patterns.

.. most politicians also use an “attack dog” to say nasty things about their opponents. In the present race, for example, Senator Warren has been playing this role by attacking Mr. Trump on Twitter, for example
.. This strategy has kept Secretary Clinton from looking hostile. Mr. Trump is waging a different style of campaign where he is giving unfiltered speeches and being his own attack dog.
.. US presidents are, on average, rated as being high in narcissism, especially in the modern era when mass media and then social media became crucial for campaigns. Furthermore, the most narcissistic presidents tend to be pretty good at the job despite ethical lapses. And they are seen as highly charismatic leaders.
.. Andrew Jackson, a narcissistic early president, had the spine to take on the big banks — maybe one of the only presidents to do that successfully — but also sent Native Americans on the trail of tears. FDR was the other president willing to fight Big Banking and he also sent U.S. citizens of Japanese descent into internment camps. LBJ, one of the most narcissistic US presidents in history, got a tremendous amount of legislation passed. He was also in many ways a cruel and intimidating bully. And after reading about Mr. Trump and President Johnson, it is hard to imagine the former being more narcissistic than the latter.
.. My point here is not to say that everyone in politics is narcissistic, but that narcissism and political aspirations go together. This is partly because modern campaigns are basically celebrity marketing operations and partly because narcissistic individuals like power, status, admiration and control which is something that comes with political power.
.. narcissism works for becoming a leader. This is especially true in times of instability and crisis, when narcissistic leaders’ projected strength and confidence is even appealing.
.. In research on narcissistic CEOs, for example, you see a willingness totake big public risks. You see a similar overconfidence associated with narcissism generally. Sometimes this risk-taking pays off and sometimes it is a disaster, so you only want to risk having a narcissistic leader if you really want a change.