In “The Trump Elite, Like the Old Elite But Worse!” Bobo tells us that Republicans behind a health care bill found a new way to ignore regular people. And “gemli” from Boston will have a few words to say. Prof. Krugman’s “Scammers, the Scammed and America’s Fate” is on politicians who aren’t real leaders, but play leaders on TV. Here’s Bobo:
Legislation can be crafted bottom up or top down. In bottom up you ask, What problems do voters have and how can they be addressed. In top down, you ask, What problems do elite politicians have and how can they be addressed?
The House Republican health care bill is a pure top-down document. It was not molded to the actual health care needs of regular voters. It does not have support from actual American voters or much interest in those voters. It was written by elites to serve the needs of elites. Donald Trump vowed to drain the swamp, but this bill is pure swamp.
First, the new Republican establishment leaders needed something they could call Obamacare repeal — anything that they could call Obamacare repeal.
It became clear as the legislative process rushed forward that there was no overarching vision in this legislation on how to reform health care or even an organizing thought about how to improve the lives of voters. There was no core health care priority that Republicans identified and were trying to solve.
There were just some politicians who wanted a press release called Repeal.
Second, Donald Trump needed a win. The national effects of that win seemed immaterial to him.
His lobbying efforts for the legislation were substance-free. It was all about Donald Trump — providing Trump with a pelt, polishing a credential for Trump. His lobbying revealed the vapidity of his narcissism. He didn’t mind caving to the Freedom Caucus Wednesday night on policy because he doesn’t care about policy, just the publicity win.
Third, the bill was crafted by people who were insular and nearsighted, who could see only a Washington logic and couldn’t see any national or real-life logic.
They could have drafted a bill that addressed the perverse fee-for-service incentives that drive up health costs, or a bill that began to phase out our silly employment-based system, or one that increased health security for the working and middle class.
But any large vision was beyond the drafters of this legislation. They were more concerned with bending, distorting and folding the bill to meet the Byrd rule, an arbitrary congressional peculiarity of no real purpose to the outside world. They were more concerned with what this internal faction, or that internal faction, might want. The result was a pedantic hodgepodge that made no one happy.
In 24 hours of ugly machinations, the Trump administration was willing to rip out big elements of the bill and insert big new ones, without regard to substance or ramification.
House members were rushed to commit to legislation even while major pieces of it were still in flux, when nobody had time to read it, when the Congressional Budget Office had no time to score it, when the effect on health outcomes of actual Americans was an absolute mystery.
As the negotiating process has gone on you’ve seen rank-and-file House Republicans caught between the inside game and the outside game. The logic of the inside game says vote for the bill. Support Speaker Ryan. Don’t defeat a Republican president. But the outside game screams: Oppose This Bill. It’s bad for most voters, especially Republican voters. And nobody likes it.
I opposed Obamacare. I like health savings accounts, tax credits and competitive health care markets to drive down costs. But these free-market reforms have to be funded in a way to serve the least among us, not the most. This House Republican plan would increase suffering, morbidity and death among the middle class and poor in order to provide tax cuts to the rich.
It would cut Medicaid benefits by $880 billion between now and 2026. It would boost the after-tax income for those making more than $1 million a year by 14 percent, according to the Tax Policy Center. This bill takes the most vicious progressive stereotypes about conservatives and validates them.
It’s no wonder that according to the latest Quinnipiac poll this bill has just a 17 percent approval rating. It’s no wonder that this bill is already massively more unpopular that Hillarycare and Obamacare, two bills that ended up gutting congressional majorities.
If we’re going to have the rough edges of a populist revolt, you’d think that at least somebody would be interested in listening to the people. But with this bill the Republican leadership sets an all-time new land speed record for forgetting where you came from.
The core Republican problem is this: The Republicans can’t run policy-making from the White House because they have a marketing guy in charge of the factory. But they can’t run policy from Capitol Hill because it’s visionless and internally divided. So the Republicans have the politics driving the substance, not the other way around. The new elite is worse than the old elite — and certainly more vapid.
Now here’s what “gemli” had to say:
“For a populist revolt to work, Mr. Brooks says politicians should have listened to the people. Well, that didn’t happen. But neither did the people listen to the politicians.
The so-called president made it clear that he had no clue about anything, much less having the discipline, the experience, the subtlety of understanding or the interest to do anything for the people. He couldn’t form a coherent sentence, and what he did manage to say was a jumble of self-aggrandizing nonsense, vulgar boasting and utter falsehoods.
Likewise, Congressional Republicans had spent eight years leading by obstruction, shut-downs and filibuster. They voted sixty times to symbolically repeal Obamacare without offering anything to replace it. Who in their wildest dreams could have thought that a real “plan” was in the offing?
Mr. Brooks aided and abetted the frenzy, writing against Obamacare, and thinking that healthcare can be handled by competitive markets. Healthcare is not like buying shoes and soda pop. People don’t have a choice when they’re sick and dying.
The so-called populists may have been revolting, but that’s not the same as a populist revolt. This was a government and a people who were powered by hate and resentment. They overlooked the obvious warning signs, closed their ears to the bells and sirens that signaled danger, and voted for a crotch-groping ignoramus.
A sick government can’t provide healthcare for its people. And our government is at death’s door.”
And now here’s Prof. Krugman:
Many people are horrified, and rightly so, by what passes for leadership in today’s Washington. And it’s important to keep the horror of our political situation up front, to keep highlighting the lies, the cruelty, the bad judgment. We must never normalize the state we’re in.
At the same time, however, we should be asking ourselves how the people running our government came to wield such power. How, in particular, did a man whose fraudulence, lack of concern for those he claims to care about and lack of policy coherence should have been obvious to everyone nonetheless manage to win over so many gullible souls?
No, this isn’t a column about whatshisname, the guy on Twitter, who’s getting plenty of attention. It’s about Paul Ryan, the speaker of the House.
I’m writing this column without knowing the legislative fate of the American Health Care Act, Mr. Ryan’s proposed Obamacare replacement. Whatever happens in the House and the Senate, however, there’s no question that the A.H.C.A. is one of the worst bills ever presented to Congress.
It would deprive tens of millions of health insurance — the decline in the number of insured Americans would be larger than what would result from simple repeal of Obamacare! — while sharply raising expenses for many of those who remain. It would be especially punitive for lower-income, older, rural voters.
This is terrible stuff. It’s made worse by the lies Mr. Ryan has been telling about his plan.
He claims that it would lower premiums; it would actually increase them. He claims that it would end the Obamacare death spiral; there isn’t a death spiral, and his plan would be more, not less, vulnerable to a vicious circle of rising premiums and falling enrollment. He claims that it would lead to “patient-centered care”; whatever that is supposed to mean, it would actually do nothing to increase choice.
Some people seem startled both by the awfulness of Mr. Ryan’s plan and by the raw dishonesty of his sales pitch. But why? Everything we’ve seen from Mr. Ryan amid the health care debacle — everything, that is, except the press coverage — has been completely consistent with his previous career. That is, he’s still the same guy I wrote about back in 2010, in a column titled “The Flimflam Man.”
I wrote that column in response to what turned out to be the first of a series of high-profile Ryan budget proposals. While differing in detail, all of these proposals share a family resemblance: Like his health plan, each involved savage cuts in benefits for the poor and working class, with the money released by these cuts used to offset large tax cuts for the rich. All were, however, sold on false pretenses as plans for deficit reduction.
Worse, the alleged deficit reduction came entirely from “magic asterisks”: claims about huge savings to be achieved by cutting unspecified government spending, huge revenue increases to be achieved by closing unspecified tax loopholes. It was a con job all the way.
So how did Mr. Ryan reach a position where his actions may reshape the lives of so many of his fellow citizens, in most cases very much for the worse? The answer lies in the impenetrable gullibility of his base. No, not his constituents: the news media, who made him what he is.
You see, until very recently both news coverage and political punditry were dominated by the convention of “balance.” This meant, in particular, that when it came to policy debates one was always supposed to present both sides as having equally well-founded arguments. And this in turn meant that it was necessary to point to serious, honest, knowledgeable proponents of conservative positions.
Enter Mr. Ryan, who isn’t actually a serious, honest policy expert, but plays one on TV. He rolls up his sleeves! He uses PowerPoint! He must be the real deal! So that became the media’s narrative. And media adulation, more than anything else, propelled him to his current position.
Now, however, the flimflam has hit a wall. Mr. Ryan used to be able to game the Congressional Budget Office, getting it to produce reports that looked to the unwary like proper scores of his plans, but weren’t. This time, however, he couldn’t pull it off: The C.B.O. told the devastating truth about his plan, and his evasions and lies were too obvious to ignore.
There’s an important lesson here, and it’s not just about health care or Mr. Ryan; it’s about the destructive effects of false symmetry in reporting at a time of vast asymmetry in reality.
This false symmetry — downplaying the awfulness of some candidates, vastly exaggerating the flaws of their opponents — isn’t the only reason America is in the mess it’s in. But it’s an important part of the story. And now we’re all about to pay the price.