In particular, if you want to make care available to Americans who have pre-existing medical conditions — including the condition of being not rich and being relatively old, but not yet eligible for Medicare — you have to find some way to subsidize them.
Obamacare provides those subsidies in part with direct public funding, in part with regulations that implicitly use premiums paid by the healthy to cover the cost of caring for the less healthy.
.. The important thing to remember is that these problems don’t keep popping up because the people devising the plans are careless, and keep forgetting crucial issues. They’re popping up because the G.O.P. is trying to stuff a big balloon into a small box, and every time you squeeze it somewhere it inflates someplace else.
And because the task Republicans have set for themselves is basically impossible, their ongoing debacle over health care isn’t about political tactics or leadership. Even if Donald Trump were the great deal maker he claims to be, or Paul Ryan the policy wonk he poses as, this thing just can’t work.
.. There are some things we could do that would probably make it even cheaper, but they would all involve moving left — say, introducing a public option, or going all the way to single-payer.
.. If Republicans never had a plausible alternative to Obamacare, if this debacle was so inevitable, what was the constant refrain of “repeal and replace” all about?
The answer, surely, is that it began as a cynical ploy; at first, the Republicans hoped to kill health reform before it really got started. And now they’ve trapped themselves: They can’t admit that they have no ideas without, in effect, admitting that they were lying all along.
Why Don’t All Jobs Matter?
Why does public discussion of job loss focus so intensely on mining and manufacturing, while virtually ignoring the big declines in some service sectors?
.. the decline of traditional retailers in the face of internet competition
.. Even as Mr. Trump was boasting about saving a few hundred jobs in manufacturing here and there, Macy’s announced plans to close 68 stores and lay off 10,000 workers.
.. Overall, department stores employ a third fewer people now than they did in 2001. That’s half a million traditional jobs gone — about eighteen times as many jobs as were lost in coal mining over the same period.
.. newspaper publishing, where employment has declined by 270,000, almost two-thirds of the work force, since 2000.
Publicity Stunts Aren’t Policy
.. Around 75,000 U.S. workers are laid off or fired every working day,
.. how much did the strike actually accomplish? A few hours after the attack, Syrian warplanes were taking off from the same airfield, and airstrikes resumed on the town where use of poison gas provoked Mr. Trump into action.
In fact, if last week’s action was the end of the story, the eventual effect may well be to strengthen the Assad regime — Look, they stood up to a superpower! — and weaken American credibility.
.. Trump may like to claim that the media are biased against him, but the truth is that they’ve bent over backward in his favor. They want to seem balanced, even when there is no balance; they have been desperate for excuses to ignore the dubious circumstances of his election and his erratic behavior in office, and start treating him as a normal president.
.. Publicity stunts may generate a few days of favorable media coverage, but they end up making America weaker, not stronger, because they show the world that we have a government that can’t follow through.
Populism and the Politics of Health
Obamacare helped a large number of people at the expense of a small, affluent minority: basically, taxes on 2% of the population to cover a lot of people and assure coverage to many more. Trumpcare would reverse that, hurting a lot of people (many of whom voted Trump) so as to cut taxes for a handful of wealthy people. That’s a difference that goes beyond political strategy.
.. Obamacare was and is a truly populist law, while Trumpcare is anti-populist. That’s reflected in the legislative struggles.
.. what we call populism is really in large degree white identity politics, which can’t be addressed by promising universal benefits. Among other things, these “populist” voters now live in a media bubble, getting their news from sources that play to their identity-politics desires, which means that even if you offer them a better deal, they won’t hear about it or believe it if told.
.. Trumpism is faux populism that appeals to white identity but actually serves plutocrats. That fundamental contradiction is now out in the open.