Many have a distorted view of the numbers. For example, people have a vastly exaggerated view of how much we spend on foreign aid. Many also fail to connect their personal experience with public policy: Large numbers of Social Security and Medicare recipients believe that they make no use of any government social program.
.. But the reality is that the proposed cuts would have ugly, highly visible effects. Zeroing out the Community Development Block Grant program may sound good if you have no idea what it does (which Mr. Trump surely doesn’t); eliminating Meals on Wheels, an immediate consequence, not so much. Nor would coal country, which voted overwhelmingly for Mr. Trump, like the consequences if he eliminates the Appalachian Regional Commission.
.. Republicans’ budget promises, like their health care promises, have been based on an essentially fraudulent picture of what’s really going on. And now the bill for these lies is coming due.
The Politics of the AHCA
This is the party, after all, that just a few months ago lost the presidency to the most unsuitable, unfit, unappealing major-party candidate in American history, and has spent most of the time since then blaming Russia for its own ineptitude.
.. Neoliberal, managerial, centrist globalism is being challenged by populists of the anti-liberal right and left. Right now, the right-wing variant holds power in Washington. If Trump had the guts to combine his populist-nationalist appeals with support for a single-payer health-care system, he just might succeed in realigning both major American parties by scrambling their policy commitments.
.. Maybe he’s gambling that for the bulk of his voters, making sure they aren’t paying for insurance for the “undeserving” is precisely the point.
.. Meanwhile, by 2020 the state of the economy and job growth is what will really matter to voters, or at least an electoral college majority thereof.
.. It would normally be strange for a Republican president to want his own party’s majority to suffer a major black eye like that. But this is Ryan’s bill, and Trump has no love for Ryan.
.. Moreover, inasmuch as Bannon is in competition with Ryan-ally and Chief of Staff Reince Priebus for influence over the White House’s agenda, it’s very much in his interest specifically for Ryan to fail. The collapse of the AHCA would be a massive failure — and would likely invite a leadership challenge.
.. And if it failed quickly, it would be easy for Trump to blame Ryan for getting it wrong, tinker with ObamaCare around the edges (particularly in ways that could be done without even passing legislation), and then when the exchanges don’t collapse claim he fixed them.
.. Trump could yell at a bunch of insurance executives, watch premiums stabilize, and claim victory.
.. The most exotic possibility is that Trump not only wants the bill to fail and Ryan to take the blame, but that he wouldn’t be too upset to see the Freedom Caucus defanged
.. There are certainly people in Trump’s inner circle who see the big problem with ObamaCare as being its support of private insurers, and who would prefer a relatively stingy single-payer plan to either ObamaCare or ObamaCare light. Trump doesn’t have a legislative majority for a reform like that — but maybe after some strategic losses in 2018 he would?
.. it is important to recognize that Trump’s position is far less exposed than Ryan’s is.
.. the dominant political fact about the Trump presidency. He won by attacking his own party’s leadership. He can’t win again without retaining the support of the Republican base — which means he has to be supportive of any effort to repeal ObamaCare, because the base has demanded that for years. But he will take every opportunity to convince that same base that they should be more loyal to him than to a GOP leadership for which they have already demonstrated mistrust. Which means failures by that leadership can be turned to his advantage.
Deconstructing Frank Luntz’s Obstructionist Health Care Reform Memo
Luntz warns that “if the dynamic becomes ‘President Obama is on the side of reform and Republicans are against it,’ then the battle is lost and every word in this document is useless.’”
.. Luntz establishes a straw man argument against a non-existent health plan.
.. “Humanize your approach,” but argue that health care reform “will result in delayed and potentially even denied treatment, procedures and/or medications.” “Acknowledge the crisis” but ask your constituents “would you rather… ‘pay the costs you pay today for the quality of care you currently receive,’ OR ‘Pay less for your care, but potentially have to wait weeks for tests and months for treatments you need.”
.. “This plays into more favorable Republican territory by protecting individual care while downplays the need for a comprehensive national plan,” the memo states.
.. Readers are also instructed to conflate Obama’s fairly moderate hybrid approach to reform (i.e. building on the current private/public system of delivering health care) with “denial horror stories from Canada & Co.”
.. Republicans will provide “in a word, more: ‘more access to more treatments and more doctors…with less interference from insurance companies and Washington politicians and special interests.’”
.. pretending that the Republicans actually have some kind of health care solution (the memo instructs Republicans to focus on targeting waste, fraud and abuse).
Republicans Should Kill Obamacare or Let It Die
That very inflexibility is probably one reason that buildings like the Pantheon survived for us to admire them. Other ancient treasures were torn apart by the locals looking for building materials, but concrete buildings could not be repurposed stone by stone.
.. By the time Obamacare came on the scene, America already had government programs that were propping up health care for almost everyone in the country: tax-subsidized employer-sponsored health insurance, Medicare, Medicaid, the VA. No one was willing to shoulder the cost of knocking those things down and designing a rational, well-built structure to take their place
.. The base may rejoice when they hear that Obamacare has been “repealed” (sort of). But their cries of glee will be drowned out by their wailing when they find that they cannot buy individual insurance at all.
.. What do they think will happen after they proudly proclaim that they’ve repealed Obamacare—followed in short order by the complete implosion of the individual market? Do they really imagine that they will be allowed to leave the rubble-filled lot there and proclaim that they’ve undone President Obama’s mistake?
.. But insurers will start to submit their proposed rates for 2018 in a few months. That is likely to become the effective deadline for any further tweaks, because if insurers think the collapse of the individual market is imminent, they will decline to sell into that market, and then the collapse will no longer be a forecast, but a historical fact.
.. they should do nothing, and start preparing their rebuilding strategy while they wait for the flaws in Obamacare’s structure to bring down the individual market on its own.