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At Least You Can’t Call It Trumpcare

The Senate’s Republicans unveiled their plan for America’s health care on Thursday, and although it’s an admirably short 142 pages there’s a lot consider about the policy and political implications. As President Donald Trump once infamously said, “Who knew health care could be so complicated?”
The policy implications alone will take weeks of debate among people who actually have some idea what they’re talking about to sort out, but the previously unannounced bill is currently scheduled for a vote early next week. So far as we can tell from the news reports that concern themselves with the boring policy stuff, the Senate Republicans’ repeal and replaces some elements of the existing unpopular Obamacare law, differs somewhat from the even more unpopular bill that was passed by the House of Representatives’ Republicans, and will predictably leave some people better off and others worse off. Calculating how likely it is that this all comes out according to the greatest good to the greatest number of people is pretty damned complicated, as even the most greenhorn politician by now knows, and it looks as if we’ll just have to wait until we’re old and sick and to see how all that turns out,
We like to think ourselves far more savvy about the political implications of any given policy, but in this case that’s also pretty darned complicated. That unpopular Obamacare law has been the metaphorical Moby Dick to the Republicans’ Captain Ahab ever since the Democrats took momentary advantage of Democratic majorities in the House and Senate and a Democratic president to force the hated legislation down the throats of a reluctant American populace without a single Republican vote. Now there’s a momentary majority of Republicans in the House and Senate and a Republican in the White, so that unpopular Obamacare should be right in the aim of the Republicans’ harpoon, but it’s unlikely they’ll join to pass and unpopular bill of their own.
So far as we can tell both the House and Senate bills allow people to choose a wider range of policy options from a more competitive insurance market, and after a couple of years they’ll let the rest of the country free from paying the subsidies to government-created high risk markets, which is fine with our free-market sensibilities. After that, though, hey’ll also cut loose the beneficiaries of those markets, some of whom voted a straight Republican ticket last time around, and we’re not sure hot they’ll take it.. Planned Parenthood won’t receive any funds for a year, which the right will love and the left will loathe, and certain insurance industry subsidies will continue for a while and a lot of spending will eventually be spent at the state level, and there’s something for every conservative Republican to hate and something that every liberal Democrat will have to admit could have been worse.
Which makes it a tough news cycle for the Republicans. As hated as the Obamacare still is, and well deserves to be, the Republican alternatives from both the House and Senate have even more unpopular. The House bill results in a tax break for wealthier Americans, which might make economic sense but is hard to explain in a headline, and there’s no getting around that some telegenically sympathetic Americans would wind up without health care and on national news as a result, so it will take a pretty noticeable decline in a lot of Americans’ insurance premiums to offset the Republicans’ public relations damage. Both the House and Senate bills retain the unsustainable rules about giving the same priced coverage to pre-existing conditions and for now provide the billions of dollars of subsidies that props that up, but no one on the left is going to give the Republicans credit for that nor acknowledge how unsustainable that will be over is the long run.
There’s a lot for an old-fashioned Republican to like in both the House and Senate bills, but there’s enough to hate that the House bill passed by despite numerous defections and the Senate bill might not get to a simple majority, and all the talk radio hosts were fuming that it wasn’t the full repeal and replacement of Obamacare that they’d been chasing after for eight long years. We’d have to see some district-level polling to decide how we’d vote if we were one of the entire House or that third of the Senate was up re-election. What with those Republican majorities in both the House and the Senate and a Republican in White House the Republicans should be able to ram anything they want down the American public’s throats in the same way the Democrats did with that damned Obamacare law, but of course that’s also complicated.
Trump ran for the president on a solemn pledge to repeal and a replacement that hated Obamacare law, but except for assurances that it would provide coverage for everyone at a far lower cost and be so great it would make your head spin he wasn’t very clear on what it would look. He spoke admiringly of Scotland’s fully nationalized health care system, seemed to endorse Canada’s slightly-less-socialized single payer system, and bragged that unlike every other Republican he wouldn’t make any cuts in in Medicaid or other entitlement programs. Unlike the previous scenario when Democratic majorities in the House and Senate and a president in the White House were ramming things down the American public’s throat, a sufficient number of traditionally conservative Republican senators are taking a principled stand and the president is going his populist ways.
Trump celebrated the passage of the House bill with a beer bash at the White House, even though he’s a tee-totaler himself and the House passing a bill isn’t even a halfway marker toward getting something done. After that budget-cutting bill was celebrated he “tweeted” that more federal money should be spent on health, and it was leaked from pretty much every traditional conservative that Trump had called the House bill “mean” in a tense meeting with the House Republicans, and it’s not yet clear how he’ll respond to a similar Republican bill,
On the night before the Senate Republicans unveiled their health care bill Trump was revving another enthusiastic campaign rally, some eight months after the campaign was supposed to have ended, Trump said he was hopeful would that it would have “heart.” A news cycle isn’t nearly long to discern Trump’s thinking, so for now we’ll have to see if the legislation as sufficient heart to satisfy Trump. All of Trump’s most strident defenders on talk radio and other outposts of the conservative media find it all too bleeding-heart, many of his voters find it potentially life-threatening, and we can only guess where Trump will wind up. We can’t imagine the Democrats seizing this golden opportunity to kiss up to Trump for that single payer system they’ve always dreamed of, or Trump abandoning that portion of the Republican party that’s all he’s got left at the moment, so we expect some desultory compromise on America’s health care.
We’ll hope that it somehow works out with that greatest good for the greatest number, and given how awful that Obamacare law was we wouldn’t be the least bit surprised if something better did somehow come to pass.

— Bud Norman

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Who Knew Health Care Was Hard?

President Donald Trump was speaking to a meeting of the National Governors Association about health care reform a couple of weeks ago, and he offered up yet another one of those occasional quotes of his that cause us slap to our foreheads. “I have to tell you, it’s an unbelievably complex subject,” he said. “Nobody knew that health care could be so complicated.”
Every sentient American already knew that health care is darned tricky, and certainly each of those governors hearing the speech were especially well aware of it, so it’s a sobering thought that pretty much the only person in the country who thought it was easy is the president. Even the minimal amount of regulation that a free-market purist would agree to for the ever-evolving and increasingly high-tech medical sector that comprises a full sixth of the nation’s $17.4 trillion economy is bound to be tricky, managing every aspect of it is beyond the ambitions of even the most arrogant Democrats, and any compromise you might find somewhere in between is bound to be exponentially more complicated. The policy questions are daunting enough, but as Trump as surely figured out by now, the politics involved are even more convoluted.
Trump and the Republicans running the two chambers Congress rolled out the first of three promised phases of their plan to repeal and replace the current Obamacare system earlier this week, and if they thought that getting it passed into law was going to be easy they should now be wised up. There are still enough Democrats left in Congress to make trouble for for any changes in Obamacare, although the law is unpopular enough throughout the districts and states that it’s largely responsible for a Republican White House and an electoral victory for a Republican president, and there are still enough pre-Trump sorts of Republicans left in both chambers who won’t stand for any aspect of Obamacare, even those several provisions that poll extremely well with the general public, and what with politics making strange bedfellows they can cause all sorts of complications together.
Unless you’ve been too busy with your reality television show or branding negotiations to have been paying attention, for the past seven years or so the repeal and replacement of the hated Obamacare has been the metaphorical Moby Dick to the Republican’s Captain Ahab. Not one single Republican, even though squishy ones that you still find up way up northeast, voted for the damn thing, everyone last one of them has cast meaningless votes for its repeals on a regular basis ever since. From the most staid conservative publications to the most shrieking talk radio shows the entirety of the party was opposed to Obamacare, which was forced on a resistant public with some procedural legerdemain and a variety of lies about lowered costs and keeping your plan and your doctor that were eventually exposed, and conferred unprecedented powers on the federal government, and had monogamous couples paying for sexually-transmitted disease coverage and Catholic nuns paying for contraception and otherwise permanently altered its social contract with citizens, and generally offended every old-fashion Republican principle. As the false promises about lower costs and freedom of choice were exposed the Republican majorities in Congress grew, and with a Republican president who wouldn’t have gotten his party’s nomination without an unequivocal promise to repeal and replace Obamacare it should have been easily accomplished.
Politics is always complicated, though, and Trump’s apparent belief that it’s actually all quite simple adds another layer of complexity. The parts of Obamacare that allow young people to remain on their parents’ plan until age 26 and let people sign up for insurance at the usual rate after a pre-existing condition have been discovered poll well with the public, the subsidies that are being provided to a reported 20 million or so people are even more more popular with that reported 20 million or so people, and among them are some folks who will have tear-jerking stories to tell on the nightly news, and at this point it’s hard to tell how the unpopular Trump will fare against the unpopular Obamacare. All the Republicans are taking care not to call the new policies Trumpcare, even Trump, who usually loves to put his name on things, because at the moment both Trump and Obamacare seem equally unpopular.
As the pre-Trump sorts of Republicans, we were hoping for that most minimal sort of regulation no matter how complicated that might prove. If the insurance wants to sell policies that allow include children to any old age we’d be happy to let them, and expect that many would find it profitable to do so, but we wouldn’t force them do so no matter what the polls have to say about it. The preexisting conditions thing about Obamacare comes with all those heartbreaking stories, but you could just as easily interview people who couldn’t get flood insurance after their house was underwater, and no matter how heartbreaking it just doesn’t make economic sense. We have some red-in-tooth-and-claw solutions to the whole matter of rising health care costs, too, but we acknowledge they won’t poll well, and admit that the ever-changing high-tech world of medical marvels makes it very complicated.
Interstate health insurance plans and no mandated coverage of unnecessary producers and much of what else we were hoping for wasn’t included in the latest proposal but is promised to come in phases two and three of the great Republican health care reform roll-out, and for now we’ll take their word for it. Still, we can’t help wondering why they’re dishing it out like that. Something in phase one might make sense if it were done in conjunction with something in phase two or three, but not otherwise, these things being very interrelated, and the uncertainty of what’s to come only complicates matters further. Coming up with something better than the undeniably disastrous Obamacare system should have been a relatively simple matter, but of course Trump complicated matters by promising something “wonderful,” which of course is a whole lot harder to achieve.
Trump was all over the place on the issue during his improbably victorious campaign, wowing the Republicans with the usual repeal and replace rhetoric, but also promising the broader public some spectacular but unspecified plan where everyone would be covered and the government would pay for it and the costs would go down and quality of care would go up, and he really should have expected that would prove complicated. He’s already abandoned a campaign position in favor of that stupid individual mandate that requires poor people to pay a penalty for not having insurance, but endorsed a plan that would allow insurance companies to charge a 30 percent fee on people whose insurance have lapsed, and he’s no longer talking about the government paying to insure everybody, but he has abandoned enough longstanding Republican positions about the proper role of free markets and individual liberty and meddling bureaucracies in the nation’s health care to lose some Republican support. On the other hand he’s still retreating from the Democrats’ positions on those very vital questions, and won’t likely get any support from a single one of them.
We’re hopeful that at the end of all this complicated fuss that’s going to consume the next several months we’ll wind up with something that’s at least better than that dreadful Obamacare, but we don’t expect that it’s going to wind up being something as wonderful as what was promised. Obamacare wasn’t altogether bad, otherwise its repeal and replacement wouldn’t be so thorny, but it’s dreadfulness was made all the more apparent in contrast to the sales pitch, and what’s likely to known as Trumpcare surely won’t be altogether good, so its promises should be made accordingly. That’s not the Trump style, of course, and some painful but necessary procedures will probably be left out of the care, and we expect the fuss over it will outlast us all.
One of the few old-fashioned Republicans who has somehow enthusiastically embraced this newfangled Trumpist party is Arkansas Sen. Tom Cotton, who has been surprisingly outspoken in his opposition to what’s thus-far been rolled out. He “tweeted” that the Democrats were too hasty in passing that darned Obamacare when they enjoyed a Democratic White House and majorities in both chambers of Congress, and urged that his own party not repeat the mistake. We like Cotton’s old-fashioned Republicanism, and despite our disappointment with his enthusiasm for Trump’s newfangled party we think his advice to slow down and get it right is sound. The Republicans should take at least enough time to hear all three phases of what they’re doing, gauge just how free-market the party can get away given the current political climate, do what’s doable, and be satisfied if the results are somewhat better than Obamacare even if it so wonderful that nobody dies.

— Bud Norman

The Exponential Complexities of the Middle East

A Russian fighter jet was shot down Tuesday over Syrian air space by an American-armed Turkmen militia group on orders from the Turkish government, further complicating what was already the most confusing conflict in the history of war. The situation will require the most wily and nimble and resolute response by America’s leadership, so we expect that things are about to become even more complicated.
The Turkmen are ethnic Turks living in Syria but loyal to Turkey, which is at odds with the regime of Syrian dictator Bashar Assad, whose efforts to remain in power through a long and bloody and confusingly multi-sided civil war have been much aided by the Russians, which is presumably why the Turkmen shot down the Russian fighter jet even though it had reportedly left Turkish air space after a brief and apparently uneventful incursion. Turkey is for some reason or another a member of the North Atlantic Treaty Organization, despite Prime Minister Recep Erdogan leading the country toward a more radically Islamic state, and Erdogan retains a “special friendship” with the Obama administration, probably because of Turkey’s increased radicalization, and the administration is also at odds with Assad, who has crossed “red lines” that changed the president’s calculus and now “has to go” to and is constantly subjected to similarly tough talk from the administration, but unlike the good old days of the Cold War it is no longer so simple as that. Another one of the many sides in the Syrian civil war is the Islamic State, which the administration insists is neither Islamic nor a state even though it has some pretty specific Koranic verses to explain what it’s doing in the Indiana-sized territory it now controls in former parts of Syria and Iraq, and at the moment they’re a bigger pain in the global posterior than even the Assad regime. Pretty much everyone at least claims to be opposed to the Islamic State, including Assad, whose sincerity on this matter is not to be doubted, and Russia, whose warplanes have been effectively targeting the Islamic State rather than the Turkmen and the other American-backed anti-Assad forces ever since the terror group shot down one of its jetliners, and the Assad regime’s sponsors in Iran, who as always are complicating matters further yet.
Which doesn’t begin to suggest the geo-political complexities, much less the domestic political implications, which together are exponential. The Syrian civil war has sent millions of refugees from all over the region into Europe and North America, with opportunist asylum seekers far from the conflict joining the flood, and the inevitable populist backlashes are brewing on both continents. The Islamic State’s terrorism has struck in Turkey and Lebanon as well as the heart of France, and Belgium seems to have been spared so far only by a complete lockdown of its capital city, and the groups threats against several countries including the United States can no longer be dismissed as the bluster of a “jayvee team” of terrorism, and there’s worldwide discontent and increased military action by formerly pacifist countries about that as well. Joining forces with Assad and his Russian and Iranian allies could quickly solve the Islamic State problem, but all those non-Islamic State sides would still be fighting a Syrian civil war and the refugee problem would continue and the rest of the Muslim world’s problems, such as the Yemen civil war that’s largely kept Saudi Arabia from asserting any Sunni power against the Shia Iranians and Alawite Assad in all this mess, or the Palestinians’ “stabbing intifada” against the Israelis, which has largely been overlooked amongst all the other complexities, so it seems unlikely that any country will have the region’s infectious woes solved by its next election.
One can only hope that the utter ineptitude of the current administration leading up to this sorry state of affairs will be well considered in this country’s next election, and that perhaps some correction will be made even before then. All that talk of Assad having to go and red lines being set and moderate forces being trained and air strikes being ordered was always accompanied by assurances of no American boots on the ground and little in the way of action, which emboldened Assad and his allies to use the red-lined tactics that sent the millions of refugees fleeing the region and the thousand of inspired western jihadists flooding into the region to fight for the Islamic State, and a similarly clumsy and irresolute response to Russia’s revanchism in Ukraine seems to have emboldened that country to fly over NATO airspace with impunity. In this case they seem to have made a miscalculation, failing to account for the fact that Turkmen militias armed with American weaponry don’t particularly care what American foreign policy prefers, and that despite its “special relationship” with American neither does Turkey, but once again they didn’t underestimate American resolve. The Iranians, who have been ratcheting up the “death to America” ever since they might or might not have agreed to America’s utter capitulation to its nuclear weapons program, which is eventually going to complicate things to a point that the current mess seems like the good old days, likely figures that it can maintain its puppet Assad regime and leave enough Islamic State to bedevil the infidel west and proceed with its master plan for the battle of Armageddon.
We’ll freely admit that we see no way out of this, but what worries us is that the administration won’t. Instead they insist that our policies have contained the Islamic State, that the refugees should welcomed with certainty that none will import the pathologies of the regions they are fleeing, that Russia’s seemingly expanding influence is a sign of its weakness, that all those “death to America” chants in Iran shouldn’t scuttle the deal we might or might have cut capitulating to their nuclear weapons program, and that climate change is still America’s greatest foreign policy challenge. There are reports that the American jets flying over Islamic State-controlled areas are at last dropping their bombs on the convoys of stolen oil that finance their operation, and that there are a few Americans boots actually on the ground helping to guide the missiles, and the administration did acknowledge Turkey’s right to defend its airspace, and we even read that we’re arming the Kurds, who seem to be among the more reasonable tiles in the vast and vibrant multi-cultural mosaic that is the war-torn Middle East, even though the administration denies it so as not to offend our special friends in increasingly radicalized Turkey, which has its own internal Kurdish problems, which is another one of those complexities, so perhaps there is some wising up going in the administration.
The most immediate concern is that an official if unaccountable NATO member has shot down a Russian fighter jet, and that the world will at long last come to the same ending as “Doctor Strangelove,” but we expect it will prove more complicated than that. We can easily imagine President Barack Obama sounding very much likely President Merkin Muffly as he apologizes to Russia’s Vladimir Putin, and although we despite Putin’s nakedly expansionist national ambitions we credit him with the shrewdness to be satisfied with a few carpet bombings of the offending areas and the west’s abject appeasement. This doesn’t seem like something we’ll be going into toe-to-toe nuclear combat with the Russkies over, as Slim Pickens might have said, but one never knows. Our only surety, alas, is that the whole wide world is now one very sticky wicket.

— Bud Norman

For a Few Billion Dollars More

The national nervousness regarding the Ebola virus seems to have gone up another notch with the latest case, but rest assured that the leading experts are all hard at work to limit the potential political consequences.
At first glance the disease’s introduction to the United States would seem a problem for the Democrats, who for multi-cultural rather than medical reasons have resisted a ban on travel from the countries where the Ebola virus has become epidemic. This and other missteps also undermine the Democrats’ argument on behalf of letting government handle every aspect of American life, bolster the Republicans’ argument that the government is a gargantuan fool, and distracts attention from free contraception and the recent availability part-time jobs and anything else the Democrats might prefer to talk about. Despite these obvious disadvantages, however, the Democrats are still hoping to score a few points with the Ebola virus.
The first small effort came from Van Jones, the former Obama administration “green czar” and a self-professed communist, who told his fellow panelists on the Cable News Network’s “Crossfire” program that “We can’t let the Republicans get away with some of the stuff they’re doing this week, just trying to bash Obama. Hey, you know, government is always your enemy until you need a friend. This Ebola thing is the best argument you can make for the kind of government we believe in.” We take this to mean that it is a legitimate function of government to protect the country from the outbreak of deadly diseases, which is such a reasonable argument that only the conservative straw men of Jones’ demented imagination would dispute it, and that the country should therefore rack up further debt to pay for the cell phone bills of Cleveland crack addicts and the phony-baloney “green energy” scams of the administration’s big contributors and all the rest of the pernicious nonsense that comprises the kind of government Jones believes in, which is complete non sequitur. The argument clearly needed some refinement, so the non-profit and allegedly non-partisan Agenda project has unveiled an advertisement in several states with close election races that explains how Republican budget-cutting is responsible for the Ebola virus’ arrival in the United States. The smart folks over at Reason persuasively makes the case the that funding for a variety of agencies devoted to preventing epidemics is hardly stingy, and we’d question the advertisements premises in any case. No evidence is presented that a few more billion would have made these programs any more effective, nor is the magic amount that would have kept the disease out of the country ever stated, and there’s always a conservative counter-argument that any necessary amount should have come out of the budget for the Cleveland crack addicts’ cell phones and those phony-baloney “green jobs” scams.
The argument that just a few more billion dollars of government spending would have the difference is growing less persuasive with each passing day and every billion added to the national debt, and is especially weak made on behalf to he current efforts to control an Ebola virus outbreak. A timely ban on travel from the infected countries would have prevented a brave young nurse from battling this usually deadly disease, and it would have been cost-effective.

— Bud Norman