When Republicans set out to repeal and replace Obamacare, they should keep political rules in mind. First, every major policy change has both losers and winners. Second you hear a lot more from the losers than the winners. That is why changing policy is so hard.
The first proposed Republican plan was an exception in producing no winners at all. Or rather, no winners in the field of healthcare. The relatively small number of people whose taxes fund Obamacare would be winners in seeing their taxes fall. But no one would see lower premiums or more coverage. Either there would be no change, or subsidies would be reduced and (often) premiums increased.
Anyone wanting to lock in a policy has to create winners as well as losers, because in winners one creates a constituency for the new policy who will resist changes to it. By ingeniously creating a policy with no winners (at least in terms of healthcare), Republicans assured that there would be no resistance to going back to something more like Obamacare. The House Freedom Caucus saw this as a problem and insisted on a new version.
The new version allows states to opt out of Obamacare's regulations requiring them to provide certain essential services, and forbidding them from charging more for pre-existing conditions. This was a very important matter to the Freedom Caucus, which opposes all economic regulations on general principle. The reason they gave for wanting this change was to lower premiums and, indeed, removing the regulations will lower premiums for young, healthy, male customers.
There is no doubt that healthy young men have been losers under Obamacare and have seen their premiums go up to subsidize women and older and sicker customers. For some time Republicans have been denouncing Obamacare for raising premiums for healthy young men. I was never quite sure whether these criticisms were sincere or opportunistic. On the one hand, it might just be like their claim to be upset about the high deductibles even as all Republicans plans proposed even higher. On the other hand, before the Obamacare regulations, individual insurance policies were largely unregulated and really did offer much lower rates to healthy young men. And, after all, basic Republican/libertarian dogma is that whatever outcome results from the unregulated workings of the free market is, by definition, optimal. And, indeed, the Freedom Caucus does appear to think that keeping down rates for healthy young men is the absolutely most important policy goal in replacing Obamacare.
So, the new policy, unlike the former one, will at least create winners and a constituency. Healthy young men will pay less. Granted, they will also have higher deductibles, but I am guessing that that will not create all that much opposition. Already under Obamacare the deductible is more than most healthy people pay in one year anyhow. That it goes from being not that much more to being a lot more will not be noticed by most people who don't spend all that much on health care anyhow.
But it will also create losers. Older people will pay higher rates. Because the subsidy does not change in proportion to the premium, people in rural areas will pay more, and people in Alaska will pay a lot more. In other words, a lot of Trump supporters will be losers. But not just Trump supporters. People with pre-existing conditions will find rates spiking, as will women who consider having a baby. In short, Trumpcare will make insurance a lot more affordable for people who don't actually need it, and less affordable for people who do.
And make no mistake, we will be hearing a lot more from the losers than from the winners.
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*Actually, there is one benefit. Providers charge much less to insurers than to individual consumers, so even if the insurance company does not pay for anything at all, the out-of-pocket expense for any care is less for an insured person and an uninsured person.
Monday, May 29, 2017
Sunday, May 21, 2017
Meanwhile, Back on the Healthcare Front (Remember That?)
But Donald Trump's flying circus is just entertainment t most Americans; it does not directly impact our lives. Healthcare policy, on the other hand, can have an immense impact on a lot of people.
When we last left the Obamacare repeal, House Republicans had rushed their bill to a narrow victory before its Congressional Budget Office (CBO) score was prepared, knowing that the score would be devastating and rile up public opinion against them. The flying circus mercifully took all the oxygen out of the news cycle last week, but in the meantime it appears that Senate reconciliation rules do not allow them to accept a bill until it is scored by the CBO and shown not to increase the long-term deficit. So the House is awaiting the score before passing the bill on to the Senate. The CBO score is expected to come in next week and will undoubtedly be devastating in what it shows happening to people's insurance. Worse yet, if the latest bill is estimated to increase the deficit, the House will have to modify it and pass the damn thing all over again, this time in the face of a CBO estimate showing just how many people it anticipates will either lose their health insurance or see premiums soar. And what will happen in the Senate is anyone's guess.
But Republicans should not despair. Even if nothing passes at all, Donald Trump appears to be well on his way toward crashing the exchanges all on his own. His inconsistent messages to the insurance industry and sheer incom
petence is leading many of them to flee the exchanges or raise their rates. No one knows whether anything will pass Congress and, if so, what it do. Trump has sent hopelessly confusing mixed signals about whether he intends to enforce the penalty for not having insurance, which is necessary to keep younger and healthier consumers in the mix. He has also sent mixed signals on whether he intends to keep the cost-sharing reductions or CSR's, a system for partially paying the deductible for low-income consumers. At one point one of his surrogates even offered to continue paying the CSR's if insurance companies would support repeal -- which would, of course, mean an end to the CSR's.
My guess would be that for many Republicans this would be, if not the ideal outcome, the best one they can realistically hope to achieve. By crashing the exchanges and stripping 10 million people of their health insurance it will, after all, destroy half of the hated Obamacare, and in a way much less politically damaging than if they had actually passed a bill.
After all, if Congress had actually passed a bill, it would own the consequences. Republicans have been doing their best to gloss over what all serious sources regard as the most likely outcome of their bill, and with some success. But if the bill passes and millions lose their health insurance the next year, there will be no glossing over that. Nor will there be any way to blame Obama since their bill, after all, passed with great fanfare. If, on the other hand, their bill fails and then the exchanges crash, that will be easy to blame on Obama. Republicans can always argue that they did their best to pass a bill to save the exchanges, but it failed, mostly due to resistance by those evil Democrats. It will be a blatant lie, of course. Their proposed bill would also strip millions of their health insurance, and Trump has been openly proclaiming his intent to sabotage the exchanges. But Trump followers will eagerly accept this story and low-information voters will find it at least plausible. Complete destruction of the exchanges will also prevent Democrats, should they return to power, from repairing them, and hopefully make the whole issue so toxic that Democrats will never attempt to expand health coverage again.
Of course, there will still be problems. For one thing, crashing the exchanges won't actually repeal,sthe taxes that support them. But once the exchanges crash, it will be easy to defend repealing a tax to fund a program that no longer exists. It will also leave the Obamacare regulations still in place, but only the Freedom Caucus really cares about that.
Since the regulations have not been repealed, crashing the exchanges may bring down the individual insurance market altogether. That, I believe, is something Republicans genuinely don't want to happen, as no government is involved in the individual market off the exchanges. But on the bright side, it will create a good argument for repealing the regulations and create more problems to blame on the Democrats. In other words crashing the individual market, though undesirable, might be acceptable collateral damage.
Finally, crashing the exchanges won't roll back the Medicaid expansion, so about half of Obamacare will still stand. But crashing the exchanges while leaving the Medicaid expansion in place should increase working class Trump supporters' resentment of poor people on Medicaid and increase the pressure to roll back the expansion eventually.
So all in all, I am inclined to think that Republicans may see crashing the exchanges as optimal.
Donald Trump's Flying Circus: Westworld
"You know what, this is not normal!"
"It's unacceptable!"
"This is crazy!"
"This is where we in the media have to draw the line."
"This isn't like [the previous outrage]. Yeah, fine, whatever, who cares about that. But this is different."
"We cannot let him off the hook this time."
TRUMP SUPPORTER: "Um, can we just remember that most Americans voted for Trump?"
"Actually, they didn't."
These same lines (except for what "this isn't like") are repeated over and over verbatim for each successive outrage, most of them real. The outrages named were Trump seeking security clearance for his children even though they were running his businesses (true), the entire KKK planning a parade to celebrate Trump's win (false, so far as I know), Trump proposing a Muslim registry (true, though never actually done), Trump naming Steve Bannon as his Chief Strategist (true), and Trump settling a fraud lawsuit for $25 million dollars (true). As the same script runs over and over, seeming more unreal each time, eventually Anderson Cooper has a strange sense that this has happened before. At this point the screen freezes and some technicians show up to remove the malfunctioning unit and replace him with Jake Tapper.
And that was just the first ten days of the transition! And yet the same thing is still going on, only now with a line or two about whether this will be the final outrage that leads Congressional Republicans to break with him. Congressional Republicans have developed their own Westworld script in which they tut-tut and express concern but nothing further happens. The current joke on Twitter is "Sen. McCain just raised his threat level to 'furrowed brow,' while Sen. Graham has gone from 'concerned' to 'very concerned.'"
Consider the latest outrages from our continuing Westworld script:
Trump's former National Security Adviser Michael Flynn determined to be an unregistered Turkish agent who also took money from the Russian government.**
Donald Trump fires Mike Comey, the head of the FBI who was probing connections between Donald Trump and the Russian government.
Donald Trump admits that he fired Comey to stop the investigation.
Comey reveals that Trump asked him to drop the investigation of Michael Flynn and to pledge loyalty to him personally instead of to his duties as law enforcement official.
Trump impulsively blurts out highly classified intelligence information to Russian diplomats that endangers an Israeli spy and our ongoing cooperation with Israel.
Trump bluntly tells the Russians that he fired Comey to put an end to the Russia probe.
Michael Flynn turns out to have persuaded the US government to change its military plans to please his Turkish patrons. Oh, yes, and it turns out the transition team knew he was in the pay of the Turkish government when they hired him as National Security Adviser.
"You know what, this is not normal!"Lather, rinse repeat.
"It's unacceptable!"
"This is crazy!"
"This is where we inthe mediaCongress have to draw the line."
"This isn't like [the previous outrage]. Yeah, fine, whatever, who cares about that. But this is different."
"We cannot let him off the hook this time."
And, in all fairness to Trump, at least he never sent State Department e-mails on a private server. We have to focus on what is truly important, after all.
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*I don't follow the talking heads well enough to recognize all of them, but they are all real people.
**Agent in this case does not mean spy. It means a paid lobbyist for a foreign government. So long as such agents register properly, it is perfectly legal, if not highly regarded. But it may not be legal for recently retired military personnel to be foreign agents. It is definitely not legal for current federal employees to be foreign agents. And for a National Security Adviser to be a paid agent of a foreign government was unthinkable until it actually happened.
Tuesday, May 16, 2017
Donald Trump's Flying Circus and the Fifth Avenue Watch
But I have come to the conclusion that my account of what would follow was inaccurate. It would be something more like this. Trump would shoot someone in the middle of Fifth Avenue. He would then send out a parade of spokespeople to deny that he had done any such thing. One of them would explain why we shouldn't believe the film showing him do it. Another would undermine the credibility of the witnesses. Another would attack the forensic evidence. And so forth. And then Trump would come out and cheerfully proclaim that shooting someone in the middle of Fifth Avenue was a glorious blow for the Real American against the Manhattan elite and besides, it was part of his prerogative as President. Republicans in Congress would make a lot of throat-clearing noises but not actually do anything. It would be poetic justice for Trump to be done in by one of the spokespeople who he has tricked into lying for him, but somehow it never seems to happen.
Sunday, May 14, 2017
A Partial Defense of Sean Spicer
I always thought it was a mistake to blame Sean Spicer for -- well, for being Sean Spicer. The problem clearly lies, not with Spicer, but with his boss and the job he is being asked to do. From day one, Spicer's basic job has been to stand in front of the White House press corps and ask them who they believe, him or their lying eyes. It doesn't really matter who gets the job of asking such a question; no one is going to look good doing it.
Of course, my intention is not to let Spicer off the hook. He choose to take the job, after all. No one forced him. If Spicer wants to hold a job that consists of telling outrageous and easily refutable lies, then he fully deserves all the mockery that goes with the office. Just don't have any illusions that anyone else will do any better.
What Would Happen If Donald Trump Really Did Shoot Somebody in the Middle of Fifth Avenue
But the latest uproar has led me to consider what would happen if he did. This is what I imagine:
First of all, Trump would indignantly, and to all appearances sincerely, deny having done anything of the kind. That footage showing him do it was all "fake news." All those witnesses who saw him are aid shills for Obama/Hillary/Soros/whoever. And the forensic evidence that traces the bullet to a gun registered to Trump and bearing his finger prints is not really the issue. The issue is New York's unconstitutional gun registration laws that violate the Second Amendment and without those laws there would be nothing.
Meanwhile, Steve Bannon would boast that shooting someone in the middle of Fifth Avenue was a glorious strike against the Manhattan elite and everyone in Real America appreciated it.
A massive cacophony of mutually contradictory accounts would emerge from the White House. Sean Spicer would hide
Fox New would do its best to poke holes in the case against Trump.
Mainstream reporters would fan out into Trump country and find that Trump's act of shooting someone in the middle of Fifth Avenue was widely popular among white, rural blue collar voters in the Midwest.
Polls would show that 70% of Trump voters believes that he never did it, while 70% approved of the shooting and an extraordinary 50% both believed that Trump never shot anyone and approved of his doing so.
Rush Limbaugh would cackle and rub his hands together with glee, pointing out how much shooting someone in the middle of Fifth Avenue offended liberals and broadly imply, without actually saying, that if murder offends liberals, it must be good.
The NRA would proclaim the whole thing a fine example of a good guy using a gun and therefore protected by the Second Amendment.
Alex Jones would spin an elaborate conspiracy theory that the whole incident was a false flag.
Outraged Congressional Democrats would demand his impeachment, saying that murder was an impeachable offense. Nervous Congressional Republicans would say that murder was purely a private indiscretion not affecting Trump's public duties and therefore not impeachable.
Paul Ryan would earnestly proclaim that, without going so far as to condone Trump's actions, he did not see how they affected his public duties and were therefore not an impeachable offense. Trump would indignantly tweet, "I stand up for regular Americans against the Manhattan elite and Paul Ryan doesn't 'condone' it. Sad!" Paul Ryan would quickly fall into line and insist that just because he said he didn't condone Trump's actions did mean he thought Trump did anything wrong.
But let's focus on what is really important. At least Donald Trump never sent State Department e-mails on a private server.
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