AHCA is a betrayal of all the GOP’s promises on health care

It does the opposite of what they say.

The American Health Care Act, passed today by the US House of Representatives, is a law that fundamentally does the reverse of what its proponents are promising.

Having run a campaign during which he promised to cover everyone, protect Medicaid from cuts, and replace Affordable Care Act plans with “terrific” coverage, Donald Trump is now behind a bill that cuts Medicaid, covers fewer people, and allows states to replace ACA plans with stingier coverage. Having promised repeatedly to protect patients with preexisting health conditions from insurance market price discrimination, Paul Ryan is pushing a plan that removes existing protections and replaces them with hand-wavy and inadequately funded high-risk pools. Having leveraged public discontent with high deductibles and rising premiums, Republicans are pushing a bill that will leave most patients with higher out-of-pocket costs for equivalent plans and bring back skimpy plans with even higher deductibles.

That’s all happening because the GOP is committed to rolling back the taxes that pay for the Affordable Care Act, delivering a financial windfall to high-income families even though Treasury Secretary Steve Mnuchin swore at his confirmation hearings that the Trump administration would not pursue tax cuts for the rich.

.. When Ryan initially rolled out the American Health Care Act, he accompanied it with a Frequently Asked Questions page that offered a firm statement of moral purpose regarding the treatment of patients with preexisting conditions:

That statement is now gone from the House leadership’s website. In search of additional Freedom Caucus votes, Ryan abandoned that commitment and signed on to the MacArthur Amendment that will, in fact, allow insurers to charge higher premiums to sick people.

.. “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid,” Trump told the conservative Daily Signal way back in May 2015. “Every other Republican is going to cut, and even if they wouldn’t, they don’t know what to do because they don’t know where the money is. I do.”

.. That fall, his promises got even bigger. “I am going to take care of everybody,” he told 60 Minutes. “I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

.. The bill his party is now pushing will cover fewer people, charge higher premiums, raise copayments, and raise deductibles.

The reason is that the AHCA takes a ton of money out of the health care system in order to provide a $600 billion tax cut,

.. While running for president, for example, Barack Obama promised that his health plan would lead to lower premiums for average families. When pressed, his policy team would gladly clarify that what he meant was premiums would increase at a lower-than-expected rate. That was a reasonable promise, but not nearly so politically appealing as the much grander promise the candidate made in his speeches. And the policy of misleading people worked well enough until he was actually in office, signed a major health care bill, and then people discovered that their premiums were not, in fact, going down.

Apple may have finally gotten too big for its unusual corporate structure

No management is happening in Omaha. Instead, the company’s various divisions — whether it’s a freight railroad or a mobile home manufacturer — have their own corporate functions, including things like HR and legal.

.. there’s no senior vice president for iPhone who works alongside a senior vice president for Mac. Nobody is in charge of Macs or iPhones or iPads or really anything else, because Apple is almost entirely functional.

.. In that divisional context, Ahrendts’s job would be to optimize for the profitability of Apple’s retail stores. But Apple doesn’t want its retail stores to be optimized for profitability. The stores do bring in money, but they are also important marketing statements whose existence, design, and operation is supposed to project the Apple brand in specific ways.

.. top executives are responsible for things like “software engineering” and “hardware technologies” (i.e., chip development) rather than for specific products.

.. But most CEOs do not attempt to manage enormous global companies with purely functional structures, because even though it sounds good, it’s extraordinarily difficult to make it work in practice.

.. Of course, it might be hard to bring radical redesigns and breakthrough innovations to the Mac. But what existing Mac customers really want is something more basic: confidence that Apple will regularly update the Mac to incorporate new chips as they become standard in the rest of the computer industry.

.. even though regularly updating desktop Macs should not be that difficult, objectively speaking, it tends not to happen in part because it’s not anyone’s job to make it happen.

Explaining it all to you: The persistence of Vox…

In fact, people nowadays have lots of information. Too much, even. No, your problem is the opposite. Your problem is that you cannotinterpret the information you have. You lack the guiding hand of expertise. You need a vox dei, a little Voice of God whispering in your ear, helping you along, telling you what it all means.

.. Klein rejects what he calls the “More Information Hypothesis,” the idea that a better-informed citizenry could have more productive political debates. In fact, because we see facts through partisan lenses, facts alone are useless. People are irresponsible with knowledge; facts just make them “better equipped to argue for their own side.”

.. Vox is therefore an exercise in the simultaneous having and eating of cake; it wishes to both make strong value-laden assertions and be trusted as neutral and dispassionate. This means that Vox inherently practices a crude and cruel form of rhetorical dishonesty: it treats matters of profound complexity as if they are able to be settled through mereexpertise. If anyone disagrees with what the wonks have concluded, they must be dumb, delusional, or both.

.. As Fredrik deBoer says in his critique of Vox, the “explainer” stance is insidious, because it disguises partisanship as objectivity, falsely assuming that there can be such a thing as a “view from nowhere.”

.. He shows how Vox used selective and highly unreliable empirical data in order to attack Bernie Sanders, while cultivating the illusion of rigor and neutrality. For example, by producing a calculator showing people how much each candidate’s policies would cost households in taxes, without disclosing how much these policies would save households elsewhere, Vox made it look as if Bernie Sanders was simply planning to drain families of all their money.

.. “The whole notion of ideology-free explanation of complex subjects is of course itself ideology-laden… The pretense of neutral explanation simply deepens the potential dangers of bias.”

.. It should be no surprise that the main thing these explainers love to explain is “policy,” the more complicated the better. Policy wonks love policies because they get to explain them. Everyone else hates complicated policies, because everyone else has to be subjected to them. The more inscrutable and byzantine the policy (and the more confusing and misery-inducing those policies are for ordinary people), the more jobs there are for wonks.

.. Whenever I meet a progressive wonk-type, I always make sure to ask them: “If you could wave a wand and fulfill your every political goal, what kind of world would you build?” The answers inevitably consist of more policy. “A nationwide jobs program,” “universal pre-K,” or “guaranteed annual income.” (And those answers are from the true dreamers and visionaries among the wonks. Frequently their utopias consist of things like “a 2% drop in the unemployment rate.”)

.. Focusing on “the weeds” is sly, because it carefully avoids having to discuss and defend your underlying moral assumptions. And by keeping the focus on “explanation” rather than “discussion,” one can avoid difficult questions that might force the interrogation of one’s preconceptions.

.. Vox’s factual unreliability is not merely a product of Klein’s sloppy oversight, however. It is in many ways inherent to the site’s model of content production, which depends entirely on having incredibly young writers assume a position of omniscient expertise.

.. James Fallows, in his deliciously scathing 1991 look at The Economist, suggested that the magazine’s intentionally anonymous bylines “conceal[ ] the extreme youth of much of the staff,” quoting Michael Lewis’ observation that “if American readers got a look at the pimply complexions of their economic gurus, they would cancel their subscriptions in droves.”

.. Yglesias is perhaps the man whose work is most synonymous with the “#SlatePitch,” the intentionally irritating, click-hungry denunciation of some perfectly innocuous truth or convention (hence “The Case Against Eating Lunch Outside“).

.. Immediately after the 2013 collapse of the Bangladesh garment factory that killed over 1,000 people, Yglesias took to Slate to explain why workplace safety regulations actually inhibited the operation of free markets. Yglesias explained that high-risk jobs have high compensation, and just like people might choose to be lumberjacks, they might choose to work in highly dangerous garment factories for a premium. Thus “it’s good that different people are able to make different choices on the risk–reward spectrum.” The article was accompanied by a photograph of Bangladeshis loading dead bodies onto a truck.

The column was classic Yglesias, in managing to be both ignorant and appalling.

.. I once attended a public talk Yglesias gave on housing policy to promote on his (62-page) book The Rent Is Too Damn High. Yglesias was placed in conversation with Yale Law School professor Robert Ellickson, a bona fide expert on housing and zoning with approximately four decades of experience in the field.

.. But watching Ellickson flay Yglesias, I was most struck by the fact that Yglesias was completely unfazed. Far from being ashamed at his humiliating defeat, Yglesias did not even seem to acknowledge that he was even being defeated or humiliated. He didn’t attempt to defend himself. He just… kept talking, as if the numerous arguments that had been made proving him wrong simply didn’t exist.

.. This refusal to back down or admit fault is apparently characteristic of Yglesias generally.

.. When confronted, instead of apologizing, Yglesias doubled down, falsely accusing others of twisting his words. Yglesias is an enthusiastic practitioner of one of the most obnoxious tendencies in the human character: the belief that if people hate you, it must be because you’re right rather than because you’re an asshole.

.. Thus when people criticize you for taking the opportunity of a deadly factory disaster to explain why workplace safety standards are Actually Not As Good As You Think, your default reaction is not contrition or self-doubt but annoyance that people fail to recognize your rationality.

.. It is the same tendency that afflicts mansplainers generally: the refusal to entertain the possibility that it could be you who is wrong. “Explanation” implies certitude. For the explainer, information flows in a one-way channel, from the mouth of the explainer to the ear of the explained-to. Vox does not need to listen; Vox knows.

.. and of course it will survive. It will survive because we are all insecure and confused, and promises of explanation and certitude are appealing in a chaotic world. Ezra Klein is right that we do not know what to do with the barrages of information we encounter every day, and his let-me-explain-it-to-you business model is savvy.

.. But the more Vox persists, the less hope there is for American politics. The Vox model is premised on the idea that people shouldn’t think for themselves, that the important parts of political thought and decision-making should be outsourced to experts. Inevitably, these experts will produce solutions nobody likes, because the moment one is convinced that all opposition must be founded in ignorance, one will always be right no matter how many people are hurt or how many people complain. The point of politics is no longer to help us live together and understand one another. The point is policy, and our job is to listen to the explainers. After all, they have the facts. They’ve got them here in 5 charts. It’s everything you need to know.