The main risk is incoherence and accidents, not a foreign policy revolution.
The risk with Trump is less that he will pursue a grand strategy that causes problems than that he will have no coherent strategy at all.
.. Trump has few if any fixed policy positions or beliefs. To be sure, he has been fairly consistently opposed to free trade, in favor of greater “burden-sharing,” admiring of strongmen and obsessed with getting along with Russia. But beyond that—and probably even including that—everything for Trump is negotiable, if not disposable. Throughout his long public career, he has taken both sides of just about every conceivable position, from abortion, health care, and gun control to the merits of Bill and Hillary Clinton or even his own status as a Democrat or a Republican. On the invasion of Iraq—the biggest foreign policy decision in generations—he was initially in favor of the war, then passionately against the war, then in favor of a total and immediate withdrawal, and then deeply critical of such a withdrawal. On Libya, he recorded a video presentation in February 2011 strongly advocating in great detail the very sort of military intervention President Barack Obama undertook a month later, before making opposition to that intervention and its consequences a core campaign against Clinton.
.. Trump has few if any fixed policy positions or beliefs. To be sure, he has been fairly consistently opposed to free trade, in favor of greater “burden-sharing,” admiring of strongmen and obsessed with getting along with Russia. But beyond that—and probably even including that—everything for Trump is negotiable, if not disposable. Throughout his long public career, he has taken both sides of just about every conceivable position, from abortion, health care, and gun control to the merits of Bill and Hillary Clinton or even his own status as a Democrat or a Republican. On the invasion of Iraq—the biggest foreign policy decision in generations—he was initially in favor of the war, then passionately against the war, then in favor of a total and immediate withdrawal, and then deeply critical of such a withdrawal. On Libya, he recorded a video presentation in February 2011 strongly advocating in great detail the very sort of military intervention President Barack Obama undertook a month later, before making opposition to that intervention and its consequences a core campaign against Clinton.
.. Trump has few if any fixed policy positions or beliefs. To be sure, he has been fairly consistently opposed to free trade, in favor of greater “burden-sharing,” admiring of strongmen and obsessed with getting along with Russia. But beyond that—and probably even including that—everything for Trump is negotiable, if not disposable. Throughout his long public career, he has taken both sides of just about every conceivable position, from abortion, health care, and gun control to the merits of Bill and Hillary Clinton or even his own status as a Democrat or a Republican. On the invasion of Iraq—the biggest foreign policy decision in generations—he was initially in favor of the war, then passionately against the war, then in favor of a total and immediate withdrawal, and then deeply critical of such a withdrawal. On Libya, he recorded a video presentation in February 2011 strongly advocating in great detail the very sort of military intervention President Barack Obama undertook a month later, before making opposition to that intervention and its consequences a core campaign against Clinton.
.. will a President Trump really tell NATO allies—as he suggested during the campaign—that U.S. treaty commitments to their defense are not valid unless they all start spending more on their own defense, thus potentially putting in question all U.S. defense commitments all around the world? Or will he instead seek out harmony and popularity among allies at an early 2017 NATO summit and declare victory by pointing to the recent increases in European defense spending as the result of his brilliant diplomacy
.. If such flip-flops seem implausible, or impossible to sell to his supporters with a straight face, keep in mind that
- in the three weeks since his election Trump has already publicly concluded that humans might be responsible for climate change after all (having previously argued this was a “hoax”),
- that there were some parts of Obamacare worth preserving (something he discovered in a short conversation with President Obama),
- and that torture and waterboarding may not work after all (something he was “surprised” to learn in a discussion with Mattis, whose views were apparently not made available to candidate Trump when he was passionately arguing the opposite).
.. his lack of core convictions, choice of top advisers with different views, willingness to publicly contradict himself, and pathological craving for success and public approval give him both the incentive and the means to back away from some of his riskiest public positions.
.. his lack of core convictions, choice of top advisers with different views, willingness to publicly contradict himself, and pathological craving for success and public approval give him both the incentive and the means to back away from some of his riskiest public positions.
The First Victims of Repealing Obamacare will be the Sick and the Poor
he would roll back the expansion of Medicaid that has benefitted millions of poor families and return the country to a system where private insurers have little incentive to cover high-risk individuals.
.. If Trump’s real goal is to return to a market-based health-insurance system, with all the inequities and gaps in coverage that such a system inevitably entails, Price’s plan presents a possible blueprint for how to get there.
.. Under Price’s plan, reversing the post-2010 expansion of Medicaid alone would mean that about fifteen million people would lose their health-care coverage overnight. These people—members of families whose earnings are above the poverty line but less than forty thousand dollars a year
.. Even now, it is hard to see exactly how he will be able to both follow Price’s lead and keep his pledge to people with preëxisting conditions.
.. Under Price’s plan, insurers would still be legally obliged to offer coverage to sick people, but they could charge much higher premiums to anybody who hadn’t maintained continuous coverage—a loophole that could potentially affect millions.
.. The health-care economy that emerged from the Affordable Care Act is a Rube Goldberg contraption with many interlocking parts: laws, taxes, subsidies, public mandates, and administrative directives, along with the expansion of existing features, particularly Medicaid. Some of these pieces may have appeared to be superfluous, but they were designed to work together and support each other. If someone comes along and fiddles with one of them, such as the subsidies or the individual mandate, it can affect the entire system.
Tom Price’s radically conservative vision for American health care
President-elect Donald Trump sends a strong signal he may look beyond repealing and replacing Obamacare to try to scale back Medicare and Medicaid, popular entitlements that cover roughly 130 million people, many of whom are sick, poor and vulnerable. And that’s a turnabout from Trump’s campaign pledge — still on his campaign website — that he would leave Medicare untouched.
.. His vision for health reform hinges on eliminating much of the federal government’s role in favor of a free-market framework built on privatization, state flexibility and changes to the tax code. The vast majority of the 20 million people now covered under Obamacare would have far less robust coverage — if they got anything at all.
.. “Between this nomination of an avowed Medicare opponent to serve as HHS secretary and Republicans here in Washington threatening to privatize Medicare, it’s clear that Republicans are plotting a war on seniors next year.”
.. “To put in charge of the nation’s health care system and a trillion-dollar budget someone who has never overseen anything larger than a congressional committee ought to raise eyebrows when this position has historically been reserved for an individual with significant administrative experience,” said Rep. Steny Hoyer.
.. “In general they’re trying to shift risk from the government to individuals, and particularly to low-income individuals,” said Topher Spiro, who heads health policy at the left-leaning Center for American Progress. “It’s hard to see how that’s giving them a leg up, and how that’s improving the quality of their lives.”
Let’s Say Obamacare Is Repealed. What Then?
For years, they’ve been trying to change Medicaid funding to a block grant that they can then constrain over time. This will be enticing for them because it will allow them to reduce Medicaid spending in the future, while forcing states to make the tough decisions — and take the blame — for cuts in either beneficiaries or services.
Fixing the markets for those who are getting health insurance through the Obamacare exchanges, though, is a different story. Without some sort of market regulation, which they’ve generally been opposed to, the same problems that existed pre-A.C.A. with respect to pre-existing conditions and individual ratings will exist. Many people will become uninsured. Annual and lifetime limits could reappear. Lots of people will have problems getting insured.
.. Yes, I think Democrats would filibuster anything they could. The filibuster is not set in stone. A Senate majority can change it, and some are already calling for the G.O.P. to do so. But that doesn’t appear to be what the Senate will do — they’ll retain the filibuster. This could play to their favor, since they can propose things they like, let the Democrats filibuster them and take the blame when repeal kicks in with no replacement. Perhaps that’s another way for Republicans to get out of their political bind.