Conservative health-care analysts on why the GOP couldn’t come up with a stronger replacement for Obamacare
.. outside groups—he implicated Heritage Action and Club for Growth—were urging Republicans to repeal Obamacare as quickly as possible. Because of that, House Republicans “didn’t give themselves enough time
.. “Repeal and replace” seemingly meant different things to different Republicans. Moderates wanted to protect the law’s more popular provisions while tweaking its subsidy structure.
.. the AHCA was authored in a way such that it would cut federal spending—the goal of conservative Republicans—not necessarily boost health-care coverage.
.. a 1989 plan from the Heritage Foundation—the one that started it all—also included tax credits and an individual mandate.
.. “The original outline was their idea!”
.. That’s because there are two basic models for health systems, Laszewski says: single-payer or Obama/Ryan/Trump/Heritage/PriceCare. One is a government-run system offers a rudimentary plan to everyone. The other one is a delicate Jenga tower of mandates, credits, and incentives, all balanced on the rickety table of the private-insurance industry.
.. Republicans had to go with the AHCA, that is, because there just aren’t that many other, non-socialist ways to do health insurance coverage... Ultimately they settled on Obamacare, helping the poor at the expense of the better-off, while the AHCA would have done the opposite... “We used to say Republicans didn’t have the health-care gene,”
In Defense of the Freedom Caucus
It’s wrong for Trump to blame the conservatives.
Yet in this latest episode, the Freedom Caucus was mostly in the right (and it wasn’t just them — members from all corners of the House GOP found it impossible to back the bill). The American Health Care Act was a kludge of a health-care policy.
.. it probably would have further destabilized the individual market, while millions fewer would have been insured.
.. White House sent adviser Steve Bannon to tell obstinate Freedom Caucus members that they “have no choice” but to vote for the bill. It’s hard to imagine a less effective pitch to a group that has long accused Republican leaders of trying to coerce conservatives into falling in line against their principles.
.. for all their reputed rigidity, most of the Freedom Caucus had accepted the inclusion in the Ryan bill of tax credits for people without access to Medicare, Medicaid, or employer-provided insurance — a policy that they had previously tended to oppose.
.. For all of the praise heaped on the president’s negotiating acumen, he has yet to demonstrate it in his dealings with Congress. Trump’s tweet has all the hallmarks of ineffectually blowing off steam, since it’s hard to imagine the president and his supporters following through with the organizing and funding it would take to try to take out conservative members representing deep-red districts.
Coal Country Is a State of Mind
For coal country isn’t really coal country anymore, and hasn’t been for a long time.
.. But the number of miners began a steep decline after World War II, and especially after 1980, even though coal production continued to rise. This was mainly because modern extraction techniques — like blowing the tops off mountains — require far less labor than old-fashioned pick-and-shovel mining. The decline accelerated about a decade ago as the rise of fracking led to competition from cheap natural gas.
.. it has been a quarter century since they accounted for as much as 5 percent of total employment.
.. Their Trump votes weren’t even about the region’s interests; they were about cultural symbolism.
.. Donald Trump successfully pandered to cultural nostalgia
The Trump Elite. Like the Old Elite, but Worse!
Legislation can be crafted bottom up or top down. In bottom up you ask, What problems do voters have and how can they be addressed. In top down, you ask, What problems do elite politicians have and how can they be addressed?
The House Republican health care bill is a pure top-down document. It was not molded to the actual health care needs of regular voters. It does not have support from actual American voters or much interest in those voters. It was written by elites to serve the needs of elites. Donald Trump vowed to drain the swamp, but this bill is pure swamp.
.. There was no core health care priority that Republicans identified and were trying to solve.
.. There were just some politicians who wanted a press release called Repeal.
.. They could have drafted a bill that addressed the perverse fee-for-service incentives that drive up health costs, or a bill that began to phase out our silly employment-based system, or one that increased health security for the working and middle class.
.. They were more concerned with bending, distorting and folding the bill to meet the Byrd rule, an arbitrary congressional peculiarity of no real purpose to the outside world. They were more concerned with what this internal faction, or that internal faction, might want.
.. It would boost the after-tax income for those making more than $1 million a year by 14 percent
.. this bill the Republican leadership sets an all-time new land speed record for forgetting where you came from.