Blow and Kristof

July 20, 2017

Mr. Blow says “Trump Is His Own Worst Enemy,” and there is a profound but predictable obstacle blocking Trump’s legislative agenda: His own incompetence.  In “If Dr. Trump Were Your Surgeon…” Mr. Kristof has come up with a nightmare scenario:  Imagine Republican leaders were in charge of your medical care.  Well, Nick, if you’re a woman they’re already meddling…  Here’s Mr. Blow:

I have finally found something about Donald Trump’s arrogation of the presidency in which to take comfort: his absolute ineptitude at legislative advancement.

The country may well be saved from some of Trump’s most draconian impulses by some of Trump’s most pronounced flaws: his lack of seriousness, his aversion to tedium and his gnat-like attention span.

The embarrassing faltering of the Republicans’ plan to repeal and replace the Affordable Care Act might be both history lesson and harbinger. Republicans in Congress weren’t prepared with a workable plan, and Trump never had any plan. He campaigned on applause-line policies: Anything that roused a response from his rabid adherents, he repeated and amplified. He never gave details because the details didn’t exist, and he wouldn’t have been able to understand and articulate them if they did.

Trump was simply a megaphone for the primal screams of Barack Obama-Hillary Clinton haters flipping out over the cultural anxiety accompanying the ascension of women and minorities.

He helped people find the language and the platform to disguise racial worry as economic worry. He helped people who inherently, in many cases maybe even subconsciously, loathe women, at least when they aspire to equality or power, to loathe Hillary Clinton, a woman aspiring to more power.

Trump has a habit of keeping company and confidence with the racially offensive. The fact that Steve Bannon is his chief strategist and has an office in the White House should be proof enough.

But there are other examples. Notably, last summer Trump claimed that Russian President Vladimir Putin had used a racial slur to refer to Barack Obama, but just seconds later Trump was hoping that Putin would like him. Trump said:

“I was shocked to hear him mention the N-word. You know what the N-word is, right? … He has a total lack of respect for President Obama. No. 1, he doesn’t like him and No. 2, he doesn’t respect him. I think he’s going to respect your president if I’m elected and I hope he likes me.”

Now of course this could all be a lie. Our president lies the way other people breathe — with a complete absence of effort. But true or false, it is a curious story to relay. The president claimed that he was “shocked” at the racial epithet, but not too shocked to abandon a desire for Putin’s favor. If you don’t unequivocally reject intolerance, you are passively — and in some cases, actively — encouraging it.

(Also, I thought Trump said he never met Putin. Oh, well …)

Anyway, this kind of base, dog-whistle anger-aggregation was the Trump campaign specialty, and it — in addition to Russia’s assistance, voter suppression and some folks’ heritage panic — propelled Trump to victory.

But now that Trump is in office, the real work of governing begins — not just the flash of rallies, the ovations of the obsequious, the thrilling one-liners. He now has to both focus on the big picture and fuss over the fine detail.

This is simply beyond him. For simpletons, things must be made simple. Bloomberg Businessweek’s Joshua Green, author of the new book “Devil’s Bargain,” told Anderson Cooper that building a border wall was just a framing device used by his advisers to get him to remember to discuss immigration.

According to Green:

“It’s one of Trump’s greatest hits but it wasn’t Trump’s idea. Two of his staffers, Sam Nunberg and Roger Stone, came up with it as a device to keep Trump, whose attention famously wanders, focused on the issue of immigration reform because they thought that was so important. So, Trump tried it out at a speech in Iowa, the crowd responded.”

Imagine that: We now have a “president” so incapable of linear thought that his own advisers had to give him a four-letter word to remind him of one of the most pressing issues facing the country.

It is possible that part of the reason Trump never developed many of his policies was because neither he nor anyone else thought in a million years that he would win. But another explanation is that Trump simply lacks the capacity for complex thought.

He is an instinctual creature, living on a steady diet of TV, Twitter and turpitude. There is no appetite for the intellectual. There is no desire for depth. There is no tolerance for truth.

Trump’s defect may be America’s defense.

Sure, there is much damage that Trump can do both domestically and abroad to diminish this country and its people. He has already said that he is willing to let Obamacare collapse because his policy impotence failed to score political victory. Yes, folks, we have traded “the buck stops here” leadership for Trump’s “I’m not going to own it” cowardice. (On Wednesday, at a lunch with Republican senators, Trump boomeranged back to his original insistence that lawmakers must pass a bill to repeal and replace Obamacare. Go figure.)

Trump is a cold shadow of the president Obama was.

Comforts are hard to come by in the age of Trump, but I believe that we can take some small solace in the fact that the man is simply too intellectually deficient, in both practice and policy, to impose all of the heartless directives his campaign rhetoric threatened.

I don’t know about you, but I’ll take whatever I can get.

Now here’s Mr. Kristof:

It’s a dark and stormy night, and the hospital corridor is eerily illuminated by lightning flashes as Dr. Trump and Dr. McConnell enter a patient’s room and approach the bed of a young woman, Janet.

“We have the best health care plan ever for you!” Dr. Trump says exultantly, to a thunderclap outside. “Tremendous! I’m the best! I take care of everybody.” He uses his stethoscope to listen to Janet’s heart, and frowns slightly.

“Er, doctor?” Janet says. “I think my heart is on my left side, not the right.”

“Let me double-check,” Dr. Trump replies, and he hurriedly moves the stethoscope over. “Who knew health could be so complicated?”

He looks into Janet’s eyes, holds her hand in his own, and says in a silky voice, “Beautiful Janet, you’re in such great shape.”

Janet, creeped out by the doctor’s inappropriate bedside manner, pulls back her hand and tightens her gown around her neck. Dr. Trump doesn’t notice and continues: “Your heart is a disaster. You need a new one, and that’s why we suggest a transplant. We don’t happen to have a replacement ready for you, but never mind.

“Normally we do ‘remove and replace,’” Dr. Trump adds. “But in this case, if we can’t settle on a replacement, we’ll just do a flat removal. Nothing to worry about. Huge benefits. Huge!”

Dr. McConnell tries to smile reassuringly, but succeeds only in looking constipated. “Once your heart is out,” he explains, “there’ll be new urgency to solve the problem.”

Janet’s eyes have grown wide, so Dr. McConnell attempts reassurance: “Anyway, I’ve never found a heart necessary.”

Janet bites her lip. “You know, you’re the only doctors who ever said my heart had to come out,” she says. “My previous cardiologist, Dr. Obama, tweaked my diet and medications, and it was ticking along fine.”

“NO, it’s a disaster!” Dr. Trump bellows. “That Obama — it’s all his fault. Don’t listen to any other doctors!”

“I just want to be informed,” she says softly.

“Horrible idea!” Dr. Trump says, and then he pats his pockets down. “What did I do with my phone? I have a thought for a great tweet: ‘A closed mind is a terrible thing to waste.’ I know I had my phone during my last surgery, because I tweeted, and then I set the phone down — oh, no! I bet I left it ——”

“In the operating room?” Janet asks.

“In the patient.”

Janet gulps, and her anxiety increases as a peal of thunder is followed by a shrill alarm sounding from a patient’s room somewhere down the corridor. Very politely, she explains that maybe she doesn’t want surgery after all.

“Fine!” replies Dr. Trump. “Go ahead and die. Your heart is failing. It’s a disaster. And it’s all their fault.”

“Pardon?”

“It’s the Democrats,” Dr. Trump says, and a flash of lightning captures his eyes rolling crazily. “We may be running the hospital, but they’re to blame.”

“Don’t you have any other patients you need to see?” she asks. “And maybe you should put that scalpel down?”

“Don’t you see?” Dr. Trump says, as a thunderclap shakes the hospital. “You’re going to die anyway. All Obama’s patients are dying. I’ve always said, let the patient fail.”

“But I’m not failing,” Janet replies firmly. “I’m fine. Just a little nervous watching you with that scalpel.”

Dr. Trump shakes his head. “No, you’re imploding,” he insists. “I can see it. You’re self-destructing.”

“Help!” Janet calls out. “I can’t breathe.”

Dr. McConnell looks sadly at Dr. Trump. “I knew this would happen. But maybe it’s time to move on so we can work on our hospital tax plan? You know, if we just make the medical assistants and custodians pay a surcharge, we can give a break to surgeons. The result will be a leap in innovation that will benefit everybody.”

“Help!” Janet cries weakly.

Dr. Trump looks down at her and shakes his head as she lies gasping. “So sad but inevitable,” he says. “She was bound to implode. Always going to fail. That’s what happens when you get a Kenyan-born doctor. The patient dies on her own.”

“But, but,” Janet tries to speak, “the problem is that you’re stepping on my oxygen hose. You’re the problem.”

Dr. Trump steps more firmly on the hose. “Poor Janet is imploding right in front of us. Democrats created the mess. We’re not going to own it. I’m not going to own it.” He checks for a pulse, finds none, and doesn’t realize he’s checking in the wrong spot. “O.K., Dr. McConnell, I’m just going to FaceTime my buddy Vladimir, and then on to the tax plan?”

“Take my heart,” Janet moans in her last breath, and a thunderclap drowns out her death rattle. “You need it.”

Krugman’s blog, 7/17/17

July 18, 2017

There was one post yesterday, “The Healthcare Debacle: The Roles of Ignorance and Evil:”

The important things to understand about the Republican health care bill are that it is (a) a cruel assault on the health and financial security of tens of millions of Americans (b) being sold via a campaign of lies that is unprecedented in US politics. Defeating this bill, and/or making its supporters pay a massive political price, is priority #1.

But there are a number of secondary questions, involving how Republicans got to this point. Some of these are big and long-term: how did a whole party succumb to such moral rot? Others are more tactical: how did they get into this immediate political mess?

So I was struck by today’s report in Politico suggesting that leading Republicans — in Congress as well as the Trump administration — thought repealing Obamacare would be quick and easy:

The longer Republican efforts to repeal Obamacare flounder, the clearer it becomes that President Donald Trump’s team and many in Congress dramatically underestimated the challenge of rolling back former President Barack Obama’s signature achievement.

The Trump transition team and other Republican leaders presumed that Congress would scrap Obamacare by President’s Day weekend in late February, according to three former Republican congressional aides and two current ones familiar with the administration’s efforts.

How could they have believed this? Anyone who paid the least attention to health issues knew that the ACA had dramatically reduced the number of uninsured, and that rolling it back would have devastating effects on many people — including many working-class whites. Never mind the morality: It should have been obvious that the political cost of repeal would be very high.

But apparently nobody with influence in the GOP saw the obvious. Why?

The answer, I think, is that they were living in a bubble created out of their own ignorance and cynicism.

They had spent years attacking Obamacare for things they had no intention of fixing — in fact, had every intention of making worse — like high deductibles. They appear never to have considered what would happen if they were called upon to deliver on their promises to make these things better.

They also appear to have been so wrapped up in their own propaganda that they never noticed the good Obamacare was doing. You saw that when the Indiana GOP asked for “Obamacare horror stories” and were flooded with testimonials instead.

Truly, Republicans, you know nothing. And it’s finally starting to matter.

 

Bobo. Just Bobo.

July 18, 2017

Today Bobo’s decided to wring his hands over inequality.  In “Getting Radical About Inequality” he babbles that a French philosopher looked at power struggles, and understanding his thinking might also provide some insight into President Trump.  “Socrates” from Verona, NJ will have something to say.  Here’s Bobo:

I’m not in the habit of recommending left-wing French intellectuals, but I’m beginning to think that Pierre Bourdieu is helpful reading in the age of Trump. He was born in 1930, the son of a small-town postal worker. By the time he died in 2002, he had become perhaps the world’s most influential sociologist within the academy, and largely unknown outside of it.

His great subject was the struggle for power in society, especially cultural and social power. We all possess, he argued, certain forms of social capital. A person might have academic capital (the right degrees from the right schools), linguistic capital (a facility with words), cultural capital (knowledge of cuisine or music or some such) or symbolic capital (awards or markers of prestige). These are all forms of wealth you bring to the social marketplace.

In addition, and more important, we all possess and live within what Bourdieu called a habitus. A habitus is a body of conscious and tacit knowledge of how to travel through the world, which gives rise to mannerisms, tastes, opinions and conversational style. A habitus is an intuitive feel for the social game. It’s the sort of thing you get inculcated with unconsciously, by growing up in a certain sort of family or by sharing a sensibility with a certain group of friends.

For example, in his surveys of French taste, Bourdieu found that manual laborers liked Strauss’s “The Blue Danube” but didn’t like Bach’s “The Well-Tempered Clavier.” People who lived in academic communities, on the other hand, liked the latter but not the former.

Your habitus is what enables you to decode cultural artifacts, to feel comfortable in one setting but maybe not in another. Taste overlaps with social position; taste classifies the classifier.

Every day, Bourdieu argued, we take our stores of social capital and our habitus and we compete in the symbolic marketplace. We vie as individuals and as members of our class for prestige, distinction and, above all, the power of consecration — the power to define for society what is right, what is “natural,” what is “best.”

The symbolic marketplace is like the commercial marketplace; it’s a billion small bids for distinction, prestige, attention and superiority.

Every minute or hour, in ways we’re not even conscious of, we as individuals and members of our class are competing for dominance and respect. We seek to topple those who have higher standing than us and we seek to wall off those who are down below. Or, we seek to take one form of capital, say linguistic ability, and convert it into another kind of capital, a good job.

Most groups conceal their naked power grabs under a veil of intellectual or aesthetic purity. Bourdieu used the phrase “symbolic violence” to suggest how vicious this competition can get, and he didn’t even live long enough to get a load of Twitter and other social media.

Different groups and individuals use different social strategies, depending on their position in the field.

People at the top, he observed, tend to adopt a reserved and understated personal style that shows they are far above the “assertive, attention-seeking strategies which expose the pretensions of the young pretenders.” People at the bottom of any field, on the other hand, don’t have a lot of accomplishment to wave about, but they can use snark and sarcasm to demonstrate the superior sensibilities.

Sometimes, the loser wins: If you’re setting up a fancy clothing or food shop you go down and adopt organic and peasant styles in order to establish the superior moral prestige that you can then use to make gobs of money.

Bourdieu helps you understand what Donald Trump is all about. Trump is not much of a policy maven, but he’s a genius at the symbolic warfare Bourdieu described. He’s a genius at upending the social rules and hierarchies that the establishment classes (of both right and left) have used to maintain dominance.

Bourdieu didn’t argue that cultural inequality creates economic inequality, but that it widens and it legitimizes it.

That’s true, but as the information economy has become more enveloping, cultural capital and economic capital have become ever more intertwined. Individuals and classes that are good at winning the cultural competitions Bourdieu described tend to dominate the places where economic opportunity is richest; they tend to harmonize with affluent networks and do well financially.

Moreover, Bourdieu reminds us that the drive to create inequality is an endemic social sin. Every hour most of us, unconsciously or not, try to win subtle status points, earn cultural affirmation, develop our tastes, promote our lifestyles and advance our class. All of those microbehaviors open up social distances, which then, by the by, open up geographic and economic gaps.

Bourdieu radicalizes, widens and deepens one’s view of inequality. His work suggests that the responses to it are going to have to be more profound, both on a personal level — resisting the competitive, ego-driven aspects of social networking and display — and on a national one.

Here’s what “Socrates” has to say:

“The true radicals in America remain the members of the Republican Party, who have flushed most of America down their Trumpian toilet by diabolically utilizing Bourdieu’s concepts of religious capital (Christian Shariah Law), language capital (“free-dumb!”) and social capital (Whites R Us) and symbolic violence (“repeal Obamacare!”) to transmogrify the USA into a hollow flag-waving, bible-thumping shell of clamoring ignorant masses dumb enough to fall for a Snake-Oil-Salesman-In-Chief like Donald Trump and an ethically dead Russian-Republican Congress hellbent on gilding the oligarchy in the symbolically violent names of God (Greed), Guns (Death) and Gays (Hatred, Spite, Punishment).

Fake News, Hate Radio and Christian Radicals all united to carefully till the American soil with pure poison and ignorance for 35 years until a giant tree of Trumpian stupidity suddenly sprouted from the toxic Grand Old Propaganda Superfund site; up rose a perfect tower of intellectual, moral and economic bankruptcy gracing the formerly dignified White House grounds.

Donald Trump, who “you know” is “like, a smart person” and who adores the poorly educated like himself, cashed in his Birther Liar capital, Fake News capital and fake religious capital with America’s stunted masses and became America’s Fake President, leaving his country utterly abandoned.

We will fix America with intellectual capital, not by collapsing its IQ by digging down deeper with Dumb Donald Trump and the Party of Stupid.”

Blow and Krugman

July 17, 2017

Mr. Blow says “Trump Savagely Mauls the Language,” and that listening to the president speak is a dizzying experience for anyone interested in candor, clarity or concision.  Prof. Krugman, in “Republicans Leap Into the Awful Known,” says the terrible truth about their health plans isn’t debatable.  Here’s Mr. Blow:

I know that there are things of graver consequence in Donald Trump’s regime than his diction, but as a person whose vocation concerns him with language, I am simply appalled by Trump’s savage mauling of that language.

His usage isn’t only idiosyncratic or some act of bungling idiocy, although it is surely both. But his usage is also a way of reducing language to the point that it is meaningless because the use of it is mindless, and in that compromised state, language becomes nearly worthless. As a consequence, truth becomes relative, if not altogether removed.

You see, Trump’s abuse of language isn’t simply a thing to blithely mock.

It is something with which we must all take great umbrage, because it has the power to degrade truth itself.

Yes, I could focus on the disastrous and callous Republican health care bill inching closer to a vote in the Senate.

Yes, I could use my energy and column inches to continue to catalog the thickening intrigue of the Russia investigation, and in particular, thegrowing number of people in the meeting where Donald Trump Jr., Jared Kushner and Paul Manafort met with a Russian lawyer.

The revelations keep coming, although Trump Jr., in an exchange with Fox News’s Sean Hannity last week, promised that what we knew at that time was “everything” there was to know. Either there is a new definition of “everything” of which I’m unaware, or Trump Jr. is doing what the Trumps do: lie until there is no alternative but to tell the truth, and even then only reveal as much truth as circumstances compel.

Trying to draw the truth out of these people is like trying to squeeze blood from a turnip — impossible.

I would submit that the Trumps lie in two ways: first, by directly and intentionally saying things they know well aren’t true, and second, by obfuscating with linguistic obtuseness, by overusing a nebulous relativism and by spouting an excess of superlatives to stand in for meaningful description and disclosure.

So, let’s take Trump’s responses during a press conference with President Emmanuel Macron of France last week. (By the way, that trip was marked by an embarrassingly pronounced inelegance by Trump, from the casual sexism of commenting on the French first lady’s bodyto the awkwardtestosterone-measuring handshakes.)

Trump has several verbal tics. One is that when he’s trying to flatter and finagle, everything is beautiful: countries, cities, people, bills, questions, even chocolate cake.

As The Washington Post pointed out last week:

“Beautiful” is one of President Trump’s favorite words. He’s used it at least 1,500 times on Twitter and in speeches since he began running for office, according to the database at Factbase. He uses it indiscriminately, the way a teenager might use ‘cool.’”

It is a device rather than a descriptor.

There was more: During the press conference with Macron, Trump twice referred to the 39-year-old Trump Jr. (who is the same age as the Macron, by the way) as a “young man.” That’s a stretch, but one used to make the Mini-Monster sound more innocent than his emails suggest he is.

At one point, Trump exclaimed: “France is America’s first and oldest ally. A lot of people don’t know that.” Actually, everyone who was awake in history class and reads books knows that. Alas, “a lot” is a relative term. More importantly, this is, I believe, projection, one of Trump’s compulsive traits. What he is guilty of is exactly what he accuses others of being guilty of. I would wager that Trump didn’t know that France was our oldest ally until preparing for this trip.

Trump complains endlessly about the media using anonymous sources, but Trump himself is addicted to anonymous sourcing, as demonstrated during the press conference. Trump discussed the Russian lawyer who met with his son:

“Somebody said that her visa or her passport to come into the country was approved by Attorney General Lynch. Now, maybe that’s wrong. I just heard that a little while ago. But a little surprised to hear that. So she was here because of Lynch.”

Who is “somebody”? Why are you repeating something at an official press conference with another head of state in another country that you freely admit may be wrong? And if you admit that it may be wrong, how can you state declaratively that “she was here because of Lynch”?

Trump also seemed to crack the door on revisiting his hugely reckless withdrawal from the Paris climate accord, but then added, “But we will talk about that over the coming period of time.” What does that mean? It means nothing, is what it means. It means, “I’m saying things amenable to the French while I’m in France because I’m like a chameleon: a lizard who can adjust his appearance for his environment.” That “coming period of time” will never come.

Listening to Trump speak is a dizzying experience for anyone interested in candor, clarity or concision. It’s as if he puts language through a meat grinder and what emerges is nearly unrecognizable, in either comprehension or certitude.

Covfefe.  Now here’s Prof. Krugman:

Sometime in the next few days the Congressional Budget Office will release its analysis of the latest version of the Republican health care plan. Senator Mitch McConnell is doing all he can to prevent a full assessment, for example by trying to keep the C.B.O. from scoring the Cruz provision, which would let insurers discriminate against people with pre-existing conditions. Nonetheless, everyone expects a grim prognosis.

As a result, White House aides are already attacking the C.B.O.’s credibility, announcing in advance that whatever it says will be “fake news.” So why should we believe the budget office, not the Trump administration? Let me count the ways.

First, this White House already has a record of constant, blatant lying about health care that is, as far as I can tell, without precedent in modern history. Just a few days ago, for example, Vice President Mike Pence made the completely false assertion that Ohio’s expansion of Medicaid led to a cutback in aid for the disabled — a lie that the state’s government had already refuted. On Sunday, Tom Price, the secretary of Health and Human Services, claimed that the Senate bill would cover more people than current law — another blatant lie. (You can’t cut hundreds of billions from Medicaid and insurance subsidies and expect coverage to grow!)

The point is that on this issue (and others, of course), the Trump administration and its allies have negative credibility: If they say something, the default assumption should be that they’re lying.

Second, the C.B.O. is hardly alone in its negative assessments of Republican health care plans. In fact, just about every group with knowledge of the issue has reached similar conclusions. In a joint letter, the two major insurance industry trade groups blasted the Cruz provision as “simply unworkable.” The American Academy of Actuaries says basically the same thing. AARP has condemned the bill, as has the American Medical Association.

Third, contrary to White House disinformation, the C.B.O. actually did a pretty good job of predicting the effects of the Affordable Care Act, especially when you bear in mind that the act was a leap into the unknown: We had very little experience of how an A.C.A.-type system would work.

True, the C.B.O. overestimated the number of people who would buy insurance on the exchanges the act created; but that was partly because it overestimated the number of employers who would drop coverage and send their workers to those exchanges. Overall gains in coverage have been reasonably well in line with what the C.B.O. projected — especially in states that expanded Medicaid and did their best to make the law work.

Finally — and this seems to me to be the most compelling argument of all — predicting the effects of destroying the A.C.A. is much easier than predicting the consequences when it was enacted, because what the Senate bill would do, pretty much, is return us to the bad old days. Or to put it another way, what McConnell and Senator Ted Cruz are selling is a giant leap into the known, taking us back to a system whose flaws are all too familiar from recent experience.

After all, before Obamacare, most states had more or less unregulated insurance markets, similar to those the Senate bill would create. Many of these states also had skimpy, underfunded Medicaid programs, which would be the effect of the bill’s brutal Medicaid cuts.

So while careful, nonpartisan modeling, the kind the C.B.O. excels in, is important, you don’t need a detailed analysis to know what American health care would look like if this bill passes. Basically, it would look like pre-A.C.A. Texas, where 26 percent of the nonelderly population was uninsured.

And lack of insurance wouldn’t be the only problem: Many people would have “junk insurance” — insurance with deductibles so large or coverage limitations so extensive as to be effectively useless when needed.

Now, some people might be satisfied with that outcome. Hard-core libertarians, for example, don’t believe making health care available to those who need it is a legitimate role of government; letting some citizens go bankrupt and/or die if they get sick is the price of freedom as they define it.

But Republicans have never made that case. Instead, at every stage of this political fight they have claimed to be doing exactly the opposite of what they’re actually doing: covering more people, making health care cheaper, protecting Americans with pre-existing conditions. We’re not talking about run-of-the-mill spin here; we’re talking about black is white, up is down, dishonesty so raw it’s practically surreal. This isn’t just an assault on health care, it’s an assault on truth itself.

Will this vileness prevail? Your guess is as good as mine about whether Mitch McConnell will hold on to the 50 senators he needs. But the mere possibility that this much cruelty, wrapped in this much fraudulence, might pass is a horrifying indictment of his party.

And you can bet your last dime that when the shit hits the fan with this thing the Democrats will be blamed.  It’s how the Republicans and their base (which is truly base) roll.

Krugman’s blog, 7/15/17

July 16, 2017

There was one post yesterday, “Ted Cruz’s Giant Leap Into the Known:”

When it comes to health care, there are lies, damned lies, and CBO-bashing.

Republicans are deploying all three strategies, with Mike Pence’s vile lie about the disabled – the utterly false claim that Medicaid expansion has actually hurt those most in need of help – drawing lots of justified outrage. But the really big push over the next couple of days will be the attempt to trash CBO estimates that are almost sure to show massive losses, even if the CBO is somehow prevented from considering the Cruz amendment.

One answer to this stuff is to notice that everyone, and I mean everyone, who knows something about insurance markets is declaring the same thing: that this proposed bill would be a disaster. We’ve got the insurance industry declaring it “simply unworkable”; the American Academy of Actuaries saying effectively the same thing; AARP up in arms; the Urban Institute forecasting disaster; and more.

But, say the usual suspects, CBO got the effects of the ACA all wrong. Actually, it didn’t. Yes, it overestimated the number of people who would sign up for the exchanges. But this was largely because it overestimated the number of employers who would drop coverage and send their workers to the exchanges. Overall, its estimates of coverage gains and premiums weren’t that far off, especially when you consider that this was a big leap into the unknown: aside from limited experience in Massachusetts, we didn’t have very good evidence on how an ACA-type system would work.

Which brings me to a point I haven’t seen emphasized: whereas the creation of the ACA was a leap into the unknown, Trumpcare – or maybe we should call it Cruzcare – is a leap into the known. Before the ACA, most states allowed insurers to discriminate based on medical history. Many also restricted access to Medicaid as much as they could. So we have a very good idea what health care in America would look like if the BCRA passes: it would look like health care in unregulated, low-aid states pre-ACA.

Or to not put too fine a point on it, it would look like health care in Texas circa 2010, with 26 percent of the nonelderly population uninsured.

So the burden of proof should lie completely with anyone who claims that this bill would NOT cause drastic coverage losses. It would establish a system very much like that which existed in those parts of America in which vast numbers of people lacked coverage in the past; why would this time be different?

 

Bruni, solo

July 16, 2017

In “Six Long Months of President Trump” Mr. Bruni says he’s right. He has been plenty busy — doing damage that won’t fade soon.  Here he is:

From the beginning, people around me talked nonstop about the end.

How long could Donald Trump’s presidency possibly last? Would impeachment or the 25th Amendment undo him? Before Trump, few of us even knew of the 25th Amendment, which allows the vice president and a majority of the cabinet to decree the president unfit. But suddenly everybody was up to speed, and no sooner had Trump been inaugurated than the “would you rather” question du jour became him versus Mike Pence. All-purpose lunacy or religious zeal: Choose your governance. Pick your poison.

Part of this, yes, reflected the company I keep. It doesn’t brim with Trump enthusiasts. But more of this came down to Trump himself — the lidless grandiosity, the bottomless vulgarity, the lies atop lies upon lies. I’ll never forget his second day in office, not just because he used an appearance at the C.I.A. to crow at great length about his many Time magazine covers and to insist, despite ready evidence to the contrary, that any beef of his with intelligence agencies was a media invention. It stays with me because of a text message I received from a journalist who covers him as well as any other, understands him better and was utterly flabbergasted by that display.

“We’re all going to die,” it said. While there was jest and hyperbole in that, there was also genuine alarm and the dark realization that Trump would not be transmogrified by the oath of office into anything approaching a dignified, responsible statesman. No, his extra power was just making him extra mean, and what we saw before Nov. 8 was what we got from Jan. 20 onward: a child in a man’s suit, a knave in a knight’s armor, a dangerous experiment with unforeseeable consequences.

They’re more seeable now. As of Thursday, July 20, Trump will have inhabited the presidency for a full six months, and we can reach certain conclusions with a measure of confidence.

No one can yet say how or when it ends. His dim namesake’s antics, evasions and omissions have reinvigorated talk of impeachment, but Republican lawmakers’ statements last week don’t support that scenario. With rare exception, the sternest words came from the most predictable quarters and hardly rose to the level of revolt. Maybe that’s a relief. Can you imagine Trump, with his thin skin and martyr complex, in the throes of impeachment? He’d wail and thrash and tear down everything around him. I mean, more than now.

We have to stop rolling our eyes when he brags about how much he has done, because he’s right. He has done plenty.

With his stances on climate change, trade and refugees and with all the air kisses blown at Vladimir Putin, he has altered our place in the world and splintered its postwar framework. Don’t be reassured by the recent pleasantries between him and Emmanuel Macron: Much of Western Europe is reeling from what it considers a surrender of American leadership. This, post-Trump, may be reparable. But I wonder if our sturdiest allies will ever feel quite the same way about this country again.

With his first Supreme Court appointment, he showed what he would almost surely do with a second and third: fully indulge the social conservatives who are one of the most dependable components of his base. If he lasts a full term and the Senate remains, as is likely, in Republican hands after the 2018 midterms, he could leave behind a court that leans sharply to the right for a generation to come.

With his sloppiness, scandals and inner circle ofarrogant neophytes, he is frittering away time. That’s hardly a singular accomplishment, but we can’t afford more government paralysis and procrastination. Infrastructure that’s no longer competitive (or safe), a tax code crying out for revision, a work force without the right skills: When do we fix this? How far behind do we fall?

And what, in the meantime, happens to Americans’ already shriveled faith in Washington? Trump’s election reflected many voters’ exasperation with the status quo and sense of permanent estrangement from some gilded clique of winners. He was their pyrrhic retort. How much hotter will their anger burn when they realize they got played?

I’m more likely to win a season of “The Bachelorette” than he is to build that incessantly promised wall. His professed disdain for Wall Street was a campaign-season pose, abandoned the minute he started assembling his administration. Health care that’s better, cheaper and more universal? Oh, please.

It’s possible that Trump’s fans will never blame him, because of one of his most self-serving and corrosive feats: the stirring of partisanship and distrust of institutions into the conviction that there’s no such thing as objective truth. There are only rival claims. There are always “alternative facts.” Charges of mere bias are the antiquated weapons of yesteryear; “fake news” is the new nullifier, and it’s a phrase so dear to him that his unprincipled acolytes are building on it. Last week a Trump adviser, Sebastian Gorka, lashed out at the “fake news industrial complex.” Trump reportedly swooned.

What happens to a democracy whose citizens not only lose common ground but also take a match to the idea of a common reality? Thanks in part to Trump, we may find out. He doesn’t care about civility or basic decency, and even if he did, he lacks the discipline to yoke his actions to any ideals. The Democratic strategist Doug Sosnik expressed it perfectly, telling me, “His presidency is what happens when you have road rage in the Oval Office.”

I was just 9 when Richard Nixon resigned and a teenager during the Jimmy Carter years. I began paying close attention only with Ronald Reagan. He and every one of his successors bent the truth, to varying degrees. He and every successor had a vanity that sometimes ran contrary to the public good. But none came close to Trump in those regards.

None shrugged off conflicts of interest the way he does. None publicly savaged women (and men) based on their looks or supposed cosmetic surgery. None made gloating a trademark of his public discourse. Two scoops for Trump, one for everybody else. He’s president and you’re not. The pettiness radiates outward, as does the viciousness and lack of ethics — to his lawyers, to his kin. And it’s more than just coarse spectacle. It’s an assault on what it means to be president and what the presidency means. The injury to the office won’t be quick to heal.

I can’t shake two incidents in particular. A few weeks before his inauguration, Trump tweeted a New Year greeting that was, instead, a spitball thrown at anyone who hadn’t genuflected before him. Last month, he coaxed his cabinet members to kiss his ring as the television cameras rolled. Those grotesque bookends affirmed that he is changeless and that he rules as he lives, for Trump and Trump alone.

Still I try for optimism: We won’t all die.

But suffer? Count on it.

Krugman’s blog, 7/14/17

July 15, 2017

There was one post yesterday, “The New Climate Of Treason:”

The title of this post comes from a once-famous book about the senior British officials who, it turned out, spied for Stalin. I found myself thinking about that book’s title while watching the conservative movement react to news that yes, the Trump campaign was in contact with Russian agents, and was willing, indeed eager, to engage in collusion.

With very few exceptions, this reaction has taken two forms: defining collusion down, or celebrating it. Some are arguing that saying “I love it!” when Russian agents offer damaging information about your opponent doesn’t count as collusion unless it’s sustained (which it might have been, by the way – we just don’t know yet), or unless it determined the election outcome. By that standard, of course, Kim Philby did nothing wrong, since the West ended up winning the Cold War.

Others are basically saying that cooperating with a foreign dictator is no big deal if it protects us against real threats, like universal health care.

The important thing to notice is that almost the entire conservative movement has bought into one or both of these arguments. After all the flag-waving, all the attacks on Democrats’ patriotism, essentially the whole GOP turns out to be OK with the moral equivalent of treason if it benefits their side in domestic politics. Which raises the question: what happened to these people?

One answer might be that right-wing ideology, the commitment to tax cuts for the rich and pain for the poor, has such a grip on conservative minds that nothing else matters. But while this is true for some apparatchiks, my guess is that it’s not nearly as true for many – certainly not for the Republican base in the general public. So why has partisanship become so extreme that it trumps patriotism?

Well, I have a thought inspired by something my CUNY colleague Branko Milanovic wrote recently about civil wars. Branko – who knows something about Yugoslavia! – argues against the view that civil wars are caused by deep divisions between populations who don’t know each other. The causation, he argues, goes the other way: when a civil war begins for whatever reason, that’s when the lines between the groups are drawn, and what may have been minor, fairly benign differences become irreconcilable gulfs.

My suggestion is that something like this happened to America, minus the mass bloodshed (so far, anyway.)

The radicalization of the GOP began as a top-down affair, driven by big-money interests that financed campaigns and think tanks, pushing the party to the right. But to win elections, the forces engaged in this push cynically appealed to darker impulses – racism first and foremost, but also culture war, anti-intellectualism, and so on. To make this appeal, they created a media establishment – Fox News, talk radio, and so on – which drew in many working-class whites. This meant that a large segment of the population was no longer hearing the same news – basically not experiencing the same account of reality – as the rest of us. So what had been real but not extreme differences became extreme differences in political outlook.

And political figures either adapted or were pushed out. There once were Republicans who would have reacted with horror to Trump’s embrace of Putin, but they’ve left the scene, or are no longer considered Republicans.

This has troubling implications for both the short and the long run. In the short run, it probably means that no matter how bad the Trump revelations get, most Republicans, both in the base and in Congress, will stick with him – because taking him down would be a victory for liberals, who are worse than anything.

In the long run, it makes you wonder whether and how we can get the country we used to be back. As Branko says, there was a time when Serbs and Croats seemed to get along fairly well, indeed intermarrying at a high rate. But could anyone now put Yugoslavia back together? At this rate, we’ll soon be asking the same question about America.

 

Bobo and Collins

July 15, 2017

Bobo has decided to ponder the “Moral Vacuum in the House of Trump” and tells us that it took generations to evolve to Donald Jr.’s lack of ethics.  “Socrates” from Verona, NJ will have something to say.  Ms. Collins plaintively asks “Couldn’t We Just Trade Presidents?”  She says American citizens watching Trump’s visit to Paris must have wondered how we got the wrong guy.  “Economic Anxiety” and ohmygod her emails…  Here’s Bobo:

Donald Trump’s grandfather Friedrich emigrated to the United States when he was 16, in 1885. He ventured west to seek his riches and finally settled in Seattle, where he opened a restaurant that, according to family historian Gwenda Blair, likely included a section for a bordello.

Gold fever hit the Pacific Northwest, and Grandfather Trump moved up to Bennett, British Columbia. It was a fast, raucous, money-grabbing atmosphere and Trump opened the Arctic Hotel, which had a bar, a restaurant and, according to an advertisement in the Dec. 9, 1899, edition of The Bennett Sun newspaper, “private boxes for ladies and parties.” Each box apparently came equipped with a bed and a scale to weigh the gold dust that was used to pay for the services offered in it.

Friedrich returned to Germany, married and was sent back to the U.S. by German authorities (he hadn’t fulfilled his military service requirement) and amassed a modest fortune.

Frederick, Donald’s father, began building middle-class housing. Profiles describe an intense, success-obsessed man who worked seven days a week and encouraged those around him to be killers in their field. “He didn’t like wimps,” his nephew told Philip Weiss of The Times. “He thought competition made you sharper.”

He cared deeply about appearances. “Freddy was always very neat, a Beau Brummell,” Sam LeFrak told Weiss. “He had a mustache, and that mustache was always right, perfect.” He was also remorseless. In an interview with Michael D’Antonio, Donald Trump described his father as “very tough” and “very difficult” and someone who “would never let anything go.”

Biographies describe a man intent on making his fortune and not afraid of skating near the edge to do so. At one point, according to Politico, federal investigators found that Frederick used various accounting measures to collect an extra $15 million in rent (in today’s dollars) from a government housing program, on top of paying himself a large “architect’s fee.” He was hauled before investigating committees on at least two occasions, apparently was arrested at a K.K.K. rally in Queens (though it’s not clear he was a member), got involved in a slush fund scandal with Robert Wagner and faced discrimination allegations.

I repeat this history because I don’t think moral obliviousness is built in a day. It takes generations to hammer ethical considerations out of a person’s mind and to replace them entirely with the ruthless logic of winning and losing; to take the normal human yearning to be good and replace it with a single-minded desire for material conquest; to take the normal human instinct for kindness and replace it with a law-of-the-jungle mentality.

It took a few generations of the House of Trump, in other words, to produce Donald Jr.

The Donald Trump Jr. we see through the Russia scandal story is not malevolent: He seems to be simply oblivious to the idea that ethical concerns could possibly play a role in everyday life. When the Russian government offer came across his email, there doesn’t seem to have been a flicker of concern. Instead, he replied with that tone of simple bro glee that we remember from other scandals.

“Can you smell money?!?!?!?!” Jack Abramoff emailed a co-conspirator during his lobbying and casino fraud shenanigans. That’s the same tone as Don Jr.’s “I love it” when offered a chance to conspire with a hostile power. A person capable of this instant joy and enthusiasm isn’t overcoming any internal ethical hurdles. It’s just a greedy boy grabbing sweets.

Once the scandal broke you would think Don Jr. would have some awareness that there were ethical stakes involved. You’d think there would be some sense of embarrassment at having been caught lying so blatantly.

But in his interview with Sean Hannity he appeared incapable of even entertaining any moral consideration. “That’s what we do in business,” the younger Trump said. “If there’s information out there, you want it.” As William Saletan pointed out in Slate, Don Jr. doesn’t seem to possess the internal qualities necessary to consider the possibility that he could have done anything wrong.

That to me is the central takeaway of this week’s revelations. It’s not that the Russia scandal may bring down the administration. It’s that over the past few generations the Trump family has built an enveloping culture that is beyond good and evil.

The Trumps have an ethic of loyalty to one another. “They can’t stand that we are extremely close and will ALWAYS support each other,” Eric Trump tweeted this week. But beyond that there is no attachment to any external moral truth or ethical code. There is just naked capitalism.

Successful business people, like successful politicians, are very ambitious, but they generally have some complementary moral code that checks their greed and channels their drive. The House of Trump has sprayed an insecticide on any possible complementary code, and so they are continually trampling basic decency. Their scandals may not build to anything impeachable, but the scandals will never end.

But I’ll bet you voted for him, Bobo…  Here’s what “Socrates” has to say:

“The modern Republican party’s great-grandfathers produced Abraham Lincoln and Theodore Roosevelt, two Presidents who fought for human decency, adored the common good and spoke truth to ugly moneyed power.

That same party then got hooked on 0.1% cash and millionaire public policy camouflaged by the smokescreens of religious fundamentalism, white supremacy, patriotism and Guns R Us anarchy.

This political party produced Ronald Reagan in 1980, a B-movie actor great at reading his script who introduced tax-cut dementia to America, demonized government, eliminated the Fairness Doctrine, and tripled the national debt by implementing the intellectual, moral and economic bankruptcy of right-wing tax cuts while eviscerating the safety net, good government and balanced budgets.

America has yet to recover from this immoral charlatan and right-wing stage actor.

Ever since the Reign of Reckless Reagan, the ethically dead Republican Party has pressed down hard on the ‘no new tax’ and ‘government is the problem’ accelerators and destroyed the common good while gilding the rich in tax cuts, free-market nihilism, and a refusal to engage in honest debate.

I repeat this history because I don’t think Republican moral bankruptcy was built in a day; it took 35 years of mindless Reaganism to produce the morally bankrupt Donald Trump and bankrupt Republican Congress.

It took a generation of Republican hacks to produce the Russian-Republican Party, but they finally succeeded.

Congratulations.”

Now here’s Ms. Collins:

Why can’t Emmanuel Macron be our president?

American citizens watching Donald Trump’s visit to Paris must have wondered how we got the wrong guy. Macron seemed so smart, so charming. The fact that he didn’t father any children would not normally be a big selling point, but right now we are yearning for a president with no offspring.

Speaking of which, the Paris journey was dogged by questions about that meeting Donald Trump Jr. took during the presidential campaign. The one at Trump Tower with a Russian lawyer who was advertised as the bearer of “information that would incriminate Hillary.”

Every day the meeting guest list grows larger. First Son-in-Law Jared Kushner was there. Paul Manafort, the Trump campaign manager, was there. Rob Goldstone, the British P.R. guy who likes to post pictures of himself in funny hats was there — representing a Russian pop singer whose dad is besties with Vladimir Putin.

Latest addition: Rinat Akhmetshin, a former Soviet military officer who’s currently a lobbyist in Washington. Akhmetshin is rather well known in our nation’s capital, where he was recently mentioned by the chairman of the Senate Judiciary Committee in a letter complaining about people who register as lobbyists when they really ought to be registering as foreign agents.

And Akhmetshin might have brought somebody else along. Possibly an interpreter. Or something. This information came from Donald Trump Jr.’s lawyer, who is not to be confused with Jared Kushner’s lawyer or President Trump’s lawyer.

Pop Quiz: Who else do you think might have been present for that Trump Tower meeting?

A) Ivanka

B) Tiffany

C) Ryan Seacrest

D) Boris and Natasha

Donald Trump was not at the meeting. Didn’t even know about it. Until later. Even then only barely. Lately, when he’s defending his son, Trump has taken to using terms that suggest Junior was accused of cheating on a Boy Scout swim test. Talking with reporters on his flight to Paris, Trump called his eldest “a good boy. He’s a good kid.” This was, as many people observed, while he was on his way to a meeting with the president of France, who is, at 39, exactly the same age as Donald Trump Jr.

On that plane ride, the president also took a question about whether he was really serious about building a Mexican wall with solar panels on top. The answer is, totally. Also, the wall is going to be transparent.

You heard me. This administration is very committed to transparency in everything from releasing Junior’s emails 10 minutes before The New York Times was going to publish them to the border barrier.

“You have to be able to see through it,” the president of the United States explained, because otherwise “when they throw the large sacks of drugs over, and if you have people on the other side of the wall, you don’t see them — they hit you on the head with 60 pounds of stuff. It’s over.”

Once he was back on the ground, Trump had a great time in Paris. Macron pulled out all the stops. Dinner at the Eiffel Tower. Big parade with lots of guns and airplanes. Although the French were celebrating Bastille Day, they added in the 100th anniversary of American troops’ entry into World War I. So you got the impression everything was really all about Trump, which is the best way to our president’s heart.

Trump was so touched he grabbed Macron in a handshake that evolved through so many expressions of affection it could have been featured on a dating site. He also attempted to compliment Macron’s glamorous 64-year-old wife by saying, “You’re in such good shape.”

We should note here that Melania Trump did fine. The Parisian press praised her wardrobe. Unlike her husband, she didn’t say anything weird. Nobody accused her of having sinister meetings with Russians. Give the woman some credit.

Macron was such a successful host that Trump seemed to develop second thoughts on the global warming thing. “And yeah, I mean, something could happen with respect to the Paris Accord. … And if it happens, that’ll be wonderful. …” Trump also took back his previous blasts at Paris, a city he’d claimed wasn’t safe because of the terrorists they’d let come in.

“You know what, it’s going to be just fine, because you have a great president,” he said. The sun rises and sets, and then a new reality is born.

The matter of Junior and the Russian meeting did come up during a brief press conference Trump and Macron held. (Trump, who was supposed to call on two American journalists, called on one American and one Chinese TV reporter.) “I will not interfere in U.S. domestic policy,” said Macron. Trump, who liked that answer a lot, said his son was “a great young man” who did something “a lot of people would do.”

It’s beginning to sound like a lot of people did do it. Of course, they were all either Russians and their associates or top members of the Trump inner circle. If only they’d met in a transparent room.

Krugman’s blog, 7/13/17

July 14, 2017

There was one post yesterday, “Takers and Fakers:”

While we wait to see exactly what’s in the latest version of the Senate health bill, a reminder: throughout the whole campaign against Obamacare, Republicans have been lying about their intentions.

Believe it or not, conservatives actually do have a more or less coherent vision of health care. It’s basically pure Ayn Rand: if you’re sick or poor, you’re on your own, and those who are more fortunate have no obligation to help. In fact, it’s immoral to demand that they help.

Specifically:

1.Health care, even the most essential care, is a privilege, not a right. If you can’t get insurance because you have a preexisting condition, because your income isn’t high enough, or both, too bad.

2.People who manage to get insurance through government aid, whether Medicaid, subsidies, or regulation and mandates that force healthy people to buy into a common risk pool, are “takers” exploiting the wealth creators, aka the rich.

3.Even for those who have insurance, it covers too much. Deductibles and copays should be much higher, to give people “skin in the game” and make them cost-conscious (even if they’re, um, unconscious.)

4.All of this applies to seniors as well as younger people. Medicare as we know it should be abolished, replaced with a voucher system that can be used to help pay for private policies – and funding will be steadily cut below currently projected levels, pushing people into high-deductible-and-copay private policies.

This is a coherent doctrine; it’s what conservative health care “experts” say when they aren’t running for public office, or closely connected to anyone who is. I think it’s a terrible doctrine – both cruel and wrong in practice, because buying health care isn’t and can’t be like buying furniture. Still, if Republicans had run on this platform and won, we’d have to admit that the public agrees.

But think of how Republicans have actually run against Obamacare. They’ve lambasted the law for not covering everyone, even though their fundamental philosophy is NOT to cover everyone, or accept any responsibility for the uninsured. They’ve denied that their massive cuts to Medicaid are actually cuts, pretending to care about the people they not-so-privately consider moochers. They’ve denounced Obamacare policies for having excessively high deductibles, when higher deductibles are at the core of their ideas about cost control. And they’ve accused Obamacare of raiding Medicare, a program they’ve been trying to kill since 1995.

In other words, their whole political strategy has been based on lies – not shading the truth, not spinning, but pretending to want exactly the opposite of what they actually want.

And this strategy was wildly successful, right up to the moment when Republicans finally got a chance to put their money – or actually your money – where their mouths were. The trouble they’re having therefore has nothing to do with tactics, or for that matter with Trump. It’s what happens when many years of complete fraudulence come up against reality.

 

Krugman, solo

July 14, 2017

In “The Cruelty and Fraudulence of Mitch McConnell’s Health Bill” Prof. Krugman says the latest Trumpcare bill still takes from the poor to give to the rich; it just does so with extra stealth.  Here he is:

A few days ago the tweeter in chief demanded that Congress enact “a beautiful new HealthCare bill” before it goes into recess. But now we’ve seen Mitch McConnell’s latest version of health “reform,” and “beautiful” is hardly the word for it. In fact, it’s surpassingly ugly, intellectually and morally. Previous iterations of Trumpcare were terrible, but this one is, incredibly, even worse.

Before I get to what makes it worse, let’s talk about the one piece of thenew bill that may sound like a step in the right direction, and why it’s largely a scam.

The original Senate bill got a lot of justified bad press for slashing Medicaid while offering big tax cuts for the rich. So this version rolls back some though by no means all of those tax cuts, which sounds like a concession to moderates.

At the same time, however, the bill would allow people to use tax-favored health savings accounts to pay insurance premiums. This effectively creates a big new tax shelter that mostly helps people with high incomes who (a) can afford to put a lot of money into such accounts and (b) face high marginal tax rates, and hence get big tax savings.

So this is still a bill that takes from the poor to give to the rich; it just does so with extra stealth.

Still, this tax shuffle does give McConnell a bit more money to play with. So how does he address the two big problems with the original bill — savage cuts to Medicaid and soaring premiums for older, less affluent workers? He doesn’t.

Aside from a few tweaks, those brutal Medicaid cuts are still part of the plan — and yes, they are cuts, despite desperate Republican attempts to pretend that they aren’t. The subsidy cuts that would send premiums soaring for millions are also still there.

The good stuff, such as it is, involves some new money for the opioid crisis, some (but not nearly enough) money for patients at especially high risk, and some additional aid for insurers — you know, the same thing Republicans denounced as outrageous corporate welfare when Democrats did it.

The most important change in the bill, however, is the way it would effectively gut protection for people with pre-existing medical conditions. The Affordable Care Act put minimum standards on the kinds of policies insurers were allowed to offer; the new Senate bill gives in to demands by Ted Cruz that insurers be allowed to offer skimpy plans that cover very little, with very high deductibles that would make them useless to most people.

The effects of this change would be disastrous. Don’t take my word for it: It’s what the insurers themselves say. In a special memo, AHIP, the insurance industry trade group, warned against adopting the Cruz proposal, which would “fracture and segment insurance markets into separate risk pools,” leading to “unstable health insurance markets” in which people with pre-existing conditions would lose coverage or have plans that were “far more expensive” than under Obamacare.

Or to put it another way, this bill would send insurance markets into a classic death spiral. Republicans have been predicting such a spiral for years, but keep being wrong: All indications are that Obamacare, despite having some real problems, is stabilizing, and doing pretty well in states that support it. But this bill would effectively sabotage all that progress.

And let’s be clear: Many of the victims of this sabotage would be members of the white working class, people who voted for Donald Trump in the belief that he really meant it when he promised that there would be no cuts to Medicaid and that everyone would get better, cheaper insurance. So why are Republican leaders pushing this? Why is there even a chance that it might become law?

The main answer, I’d argue, is that what would happen if this bill passes — a big decline in the number of Americans with health insurance, a sharp reduction in the quality of coverage for those who keep it — is what Republicans have wanted all along.

During the eight-year jihad against the Affordable Care Act, of course, the G.O.P. pretended otherwise: denouncing Obamacare for failing to cover everyone, attacking the high out-of-pocket expenses associated with many of its policies, and so on. But conservative ideology always denied the proposition that people are entitled to health care; the Republican elite considered and still considers people on Medicaid, in particular, “takers” who are effectively stealing from the deserving rich.

And the conservative view has always been that Americans have health insurance that is too good, that they should pay more in deductibles and co-pays, giving them “skin in the game,” and thus an incentive to control costs.

So what we’re seeing here is supposed to be the last act in a long con, the moment when the fraudsters cash in, and their victims discover how completely they’ve been fooled. The only question is whether they’ll really get away with it. We’ll find out very soon.