But the world is what it is, and a party that offers nothing, whose ideological sclerosis and internal contradictions allow it to offer nothing, might as well just go pass a tax cut and call it a day.
.. the Republican leadership in Congress persuaded itself that it could pull off a complicated fiscal maneuver, using health care reform to change the budget baseline in anticipation of a tax reform more comprehensive and enduring than George W. Bush’s tax cuts 15 years ago.
.. Republicans could just go ahead and cut taxes the way Bush did — without major offsets but with a 10-year expiration date, so that all you would need is 50 votes plus Mike Pence to do it.
.. there are still lots of clever and plausible ways to overhaul and improve the tax code without sacrificing revenue.
.. You could cap various perverse deductions that mostly benefit wealthy blue-state taxpayers, like the home-mortgage and state and local tax deductions, and use the savings to lower rates across the board. You could cut the corporate tax rate and raise the capital-gains tax rate to compensate, as Senator Mike Lee has proposed. You could even (gasp, heresy, gasp) raise the top income tax rate, as Steve Bannon reportedly wants to do, and use the savings to cut payroll taxes or fund a new child tax credit.
.. Republicans don’t seem equipped to pull off anything complicated, they don’t look united enough to take political risks, and they aren’t ideologically ready to pass anything heretical. So barring a sudden transformation in the party and its leadership, a temporary, deficit-financed tax cut is the only thing that has a decent chance of happening
.. One reason among many that Obamacare repeal has run aground is that the deficit picture doesn’t look as dire as it did when the health care law was passed — and Obamacare itself is not driving the kind of spending surge that many of its critics (myself included) feared.
.. Instead, the ugly years of fiscal cliffs and shutdowns and sequesters produced a certain amount of deficit reduction even without a grand bargain, Medicare spending has been coming in lower than expected, and interest rates have stayed historically low.
.. without doing much entitlement reform, we’re in much better shape than either the Simpson-Bowles commission or the deficit hawks of the 1990s projected.
.. I can live with a Trump administration that appoints conservative judges and fails at everything else, since judicial appointments are about the only thing I trust this G.O.P. to do.
AEI: Improving Health and Health Care: An Agenda for Reform
Those Americans without access to employer coverage should be given a refundable, age-adjusted tax credit that is set roughly equal to the average tax break for an employer plan.
.. This rule would protect persons with preexisting conditions from being charged more, or denied coverage, based on their health status so long as they have not experienced long breaks in insurance enrollment
.. States could also boost insurance enrollment by assigning persons who are eligible for the tax credits but have failed to pick an insurance policy to a default insurance plan. The upfront deductibles for these insurance plans would be set as necessary to ensure the premiums for enrollment would be equal to the federal tax credit, thus ensuring no additional premium would be required from a person assigned to a default plan.
.. Reform of Medicaid must start with changing how the federal government pays for its share of total cost. The program should be divided into its two distinct subparts, one for able-bodied adults and their children and the other for the disabled and elderly.
.. Medicare’s rules for paying hospitals, physicians, and other service providers heavily influence how care is delivered to all patients, not just Medicare enrollees. The program would improve if there were fewer regulations and more emphasis on market-based reforms. The starting point should be conversion of the program, on a prospective basis, to a premium support model
.. HSAs should be a central component of health care in the United States. The accounts provide strong incentives for their owners to seek the best value for their health care purchases, and they provide a ready vehicle for providing additional protection against high medical expenses.
.. A comprehensive reform plan should also reform the health insurance benefit for federal employees so that it operates like a defined contribution program.
Principles for Reform
- Citizens, not government, should control health care.
- Government subsidies should come in the form of defined contribution payments.
- Move power and control from the federal government to individuals, families, and states.
- Suppliers of medical services must have more freedom to innovate and provide better services to patients and consumers.
- Reform must improve the federal fiscal outlook by reducing long-term health obligations.
Political Divisions in 2016 and Beyond
Tensions Between and Within the Two Parties
One way to understand the 2016 election, then, is to note that by making questions of national identity more salient, Donald Trump succeeded in winning over “populists” (socially conservative, economically liberal voters) who had previously voted for Democrats.
.. Trump’s candidacy has brought more economic liberals into the Republican Party, moving the party’s center of gravity on these issues to the left. Trump has also moved the party to a much more nativist position on questions of national identity.
.. The View That Politics is a Rigged Game
- Elections today don’t matter; things stay the same no matter who we vote in.
- People like me don’t have any say in what the government does.
- Elites in this country don’t understand the problems I am facing.
.. The Importance of Social Security/Medicare
- How important is Social Security to the respondent?
- How important is Medicare to the respondent?
Attitudes on Foreign Trade A battery of questions on the costs/benefits of free trade.
Attitudes On Gender Roles A battery of questions on the role of women in society.
Pride in America
- How proud are you of America’s history?
- I would rather be a citizen of America than any other country in the world.
The Perception That “People Like Me” Are Losing Ground
- Life in America today for people like me is worse compared to 50 years ago.
- In America, the values and culture of people like me are becoming rarer and less accepted.
Attitudes Toward African-Americans A battery of racial resentment questions toward African-Americans.
Feelings Toward Muslims
- Favoring or opposing temporarily banning Muslims from other countries from entering
- the U.S.
- Feeling thermometer rating toward Muslims.
Attitudes on Immigration
- Whether illegal immigrants contribute to American society/are a drain.
- Favoring or opposing a legal way for illegal immigrants already in the United States to
- become U.S. citizens.
- Whether it should be easier/harder for foreigners to immigrate to the U.S. legally than it is
- currently.
Attitudes on Moral Issues
- View on abortion.
- View on gay marriage.
- View on transgender bathrooms.
Attitudes on Economic Inequality
- Whether our economic system is biased in favor of the wealthiest Americans.
- Whether we should raise taxes on the wealthy.
- Whether distribution of money and wealth in this country is fair.
Attitudes Toward Government Intervention
- Whether we need a strong government to handle complex economic problems.
- Whether there is too much/too little regulation of business by the government.
.. Divides get much wider as we move toward questions of race and national identity. Trump voters have more negative attitudes than Clinton supporters about African-Americans, are much less supportive of immigration, and have much more negative feelings toward Muslims.
.. To summarize, supporters of Clinton and Trump are very polarized on identity and moral issues. Views on economic issues are more of a mix. Both candidates’ supporters are generally supportive of the social safety net, and somewhat concerned about trade. Yet they diverge very much on how concerned they are about inequality, and how actively they want to see government regulate business and intervene in the economy.
.. The data suggest that the main divide within the Democratic Party electorate is about attitudes toward the establishment and the existing order than it is about specific issue positions (with the exception of trade policy).
.. For the most part, Trump and Cruz supporters look fairly similar, though Cruz supporters are considerably more conservative on moral issues, and notably less concerned about inequality and the social safety net, and more pro-free trade. In other words, Cruz voters were more likely to fit the description of traditional
conservatives... For the most part, Kasich supporters are the true moderates, caught in between the two parties on almost every issue, both economic and social. Kasich supporters come closest to Democrats on their feelings about immigration and about Muslims specifically.
.. Looking at the correlates of candidate favorability, we can more clearly see the potential divide in the Democratic Party. Again, it is more about disaffection than issue positions. The strongest predictor of Sanders support (holding all else constant) is a sense that the system is rigged. Clinton’s biggest boosters, by contrast, are more comfortable with the system as is, are less likely to see things getting worse, and are generally prouder about America. They are also more supportive of free trade. Interestingly, support for Muslims is noticeably more highly correlated with support for Clinton than for Sanders. This is somewhat surprising.
.. Still, to the extent that many of these divisions are establishment/antiestablishment divisions, they are somewhat muted by Democrats now being the opposition party. By contrast, had Hillary Clinton become president, these disagreements might have widened, since governing requires the kind of compromise and incrementalism that would be most likely to drive the Sanders wing of the party into rebellion.
.. we can see that Trump’s biggest enthusiasts within the party are Republicans who hold the most anti-immigration and anti-Muslim views, demonstrate the most racial resentment, and are most likely to view Social Security and Medicare as important.
.. By contrast, the strongest predictor of support for Ted Cruz is a set of strongly conservative views on moral issues, and somewhat pro-free trade views.
.. Notably, among Trump supporters, the age gap is nonexistent on resentment toward African-Americans, and very small on immigration. There is a wider gap on feeling toward Muslims, with old Trump voters being more anti-Muslim.
.. The widest within party variation by age cohort is within the Democratic Party on the indexes measuring pride in America and the perception that “people like me” are losing ground. Younger Democrats are both the most optimistic about their own future, but the least enthusiastic about America. To the extent that politics is increasingly organized around a conflict over ethnonationalism versus multicultural cosmopolitanism, the vanguard of this struggle is younger Clinton voters opposed to older Trump voters.
.. In both parties, this donor class is both more conservative on economic issues and more liberal on social issues, as compared to the rest of the party. However, there is a slight but notable asymmetry between the two parties on identity issues. Among Democrats, the donor class is notably to the left of the working class on these issues.
.. Already, we saw that in 2016, many of the party switchers appear to have been motivated by identity issues.
.. What Divides The Parties Now?
The parties are divided on both social/identity and economic issues, but more so on identity issues. The gaps between the Clinton and Trump voters on questions of racial resentment, immigration, attitudes toward Muslims, and moral issues are consistently wide. There is very little overlap between the two camps on these issues... By contrast, although the parties are divided on economic issues, there is more overlap. Particularly in the Republican Party, there are a wide range of views on economic issues, now that the party has expanded to include more and more populists who were formerly Democrats.
.. Many of the Romney voters who supported Clinton did so because they were uncomfortable with Trump’s far-right positions on immigration and other identity issues.
.. Early indications suggest that Trump was serious about his ethnonationalist agenda, which will keep identity issues, especially immigration, at the center of our politics. If this happens, it may put pressure on the remaining pro-immigration Republicans and the remaining anti-immigration Democrats (some remain in both camps), further realigning the parties.
.. Democrats may also be pressured to move further left on these issues, given that both younger voters and the party’s donor class are quite far to the left on identity issues. If so, American politics would become further polarized along questions of culture and identity.
.. Since Republicans have picked up more economically liberal voters (and may continue to do so since there are still some populists who vote for Democrats), it may be harder for Republicans to continue to push a traditional conservative free-market agenda. If so, this would leave conservatives with little place to go. Democrats might move right a little bit on economic issues, but they are limited by where their voters are on the issue. In addition, a move rightward might activate more of the anti-establishment sentiment that could potentially cause a rift in the Democratic Party.
The Limbaugh Health Care Reform Plan
Because I don’t think it really has anything to do with health care. I think it’s just the redistribution of wealth, the power.
.. Well, what do you think liberalism is, in part? About making these people feel good about the messes that they’ve made, all because they care and they have great compassion. And they’re great at using other people’s money, which is what Medicaid and Medicare are, to take care of people and keep ’em away from you. If put everyone on Medicaid and Medicare then you can assume they’re gonna have health care, problem solved. You don’t have to hear them complain anymore, you don’t see ’em, you don’t run into ’em.
.. it seems simple to fix this. Just use a little common sense, trust the free market, get the players that have made the mess out of the way
.. Trump is probably finding out just how deeply intertwined the tentacles of this are throughout our society.
.. And what happens when you remove one tentacle? Yeah. And then you find six more pop up that you didn’t know were there. That nobody knew were there, is how deeply embedded some of this stuff is.
.. Providing health care for people with preexisting conditions is the equivalent of selling somebody a homeowner’s policy for a hundred dollars while the fire is burning their house down. It just doesn’t happen, yet in health care we’re doing it. And it screws up all of the actuarials. It screws up all the calculations, it screws up all the numbers, it screws everything up.
.. I’m just saying that once you include people with preexisting conditions in the pool with everybody else and then you go get premiums based on that, it’s not gonna work. You just can’t do it because you’re not talking insurance on preexisting conditions; you’re talking welfare. And nobody in Washington has the guts to eliminate coverage for preexisting conditions.
.. I have no desire to run anybody else’s life. I don’t care whether somebody can run theirs or not; that’s their responsibility and their problem.
.. I do not live under any illusions that I should tell everybody how to live.
.. My health care reform plan is real simple. For everybody who can, and we would have to have a very, very honest assessment of that, you buy your own. You can either get it from your employer as part of your deal there, or you don’t and you go out and make your own deal. You’ll be able to make your own deal because the government’s not involved and there are insurance companies all over this country selling health insurance, and they’re competing with one another
.. “But Mr. Limbaugh, Mr. Limbaugh, what about the people that can’t afford it?”
.. Well, what’s made it different today than the way it was then? And I would argue it’s a bunch of people dipping their hands in it and being involved in it who are not in the business. Trying to buy votes with it, trying to insure and secure power with it and trying to basically tell people, “You know what? You don’t have to be responsible. We’ll do that for you. Just vote for us.”
.. if it’s this bad, how in the world can the people in charge of it not know it’s this bad? If it is this bad, then why do the Republicans want to hand power back to the Democrats? Why do the Republicans want to hurt Trump’s base?
.. this bill makes it illegal to check an enrollee’s immigration status. You ask why would they do that? Well, well, we’re talking about the open borders crowd. We’re talking about a party that’s been telling us for the last 10 years they don’t think they will ever become a political majority without paying homage to Hispanics.
.. They’ll hire actors to portray these old people and indigents who’ve been left behind. That’s just what they do.
.. to compare subsidies and tax credits is purposefully misleading, and you can’t compare the value. They each have different political values and so forth, but tax credits end up — that’s money you get a credit for on your tax, you don’t pay as much, so that leaves you with more money to spend theoretically shopping for a better deal on health care. Subsidies just help you pay for something. You never see the subsidy, somebody else writes the check or sends the money or what have you.
.. one of the new CEOs, it was either General Motors or Ford took over and after about six weeks this guy said, “I thought I was getting in the business to make and sell cars. I didn’t know I was getting into the health care business.”
Because his job, the number one cost at his automobile manufacturing company was health care for his employees.
.. make it single payer, where nobody worries about cost except they theoretically do as they ration and deny certain people, but in reality they don’
.. If employers are going to be given tax credits for the health insurance they buy for their employees, why shouldn’t individuals get it? Why shouldn’t it become a deductible item?
.. Tax credits end up you having a little bit more money in your back pocket, which, if we’re gonna start applying degrees of conservatism, that’s a pretty conservative thing to do, have a policy where people get to keep more of their money in this.
.. So how can the Democrats complain about tax credits for the self-employed? Poets, painters, and that’s who Pelosi talked about. Free from job lock so you can become a poet, so you could become a painter.
.. Job lock, as though everybody was locked in a job they didn’t want because they needed the health care. So Obamacare was gonna come along and free you from all that.
.. people like Obama, Hillary, they love subsidies because it makes you dependent. You never see the money.