Blow and Krugman

In “The King of Crash and Burn” Mr. Blow says as the controlling party, they must move from the hissing audience to the sweltering spotlight.  Prof. Krugman considers “How to Build on Obamacare” but wonders whether Trump will prefer to make America suffer.  Here’s Mr. Blow:

In the movie “Iron Man 2” (yes, superhero films are my guilty pleasure, so just bear with me) the villain, a rogue Russian scientist, informs the hero, Iron Man, of his theory on how easily he could be brought down:

“If you could make God bleed, people will cease to believe in Him. There will be blood in the water, and the sharks will come. All I have to do is sit here and watch, as the world will consume you.”

The point is clear: Invincibility is an illusion constructed by false assurances. Puncture the fantasy, expose the mortal, and the dispirited faithful will destroy the false deity.

Last week, the House Freedom Caucus made the fabricated God of Chaos bleed.

Trump was a weak president further weakened. He was already unpopular on a historic scale. He was already being proven to be a complete liar and hypocrite. He was already being exposed as a blustery failure.

But the one thing that he could hold on to was the long-maintained mirage of personal success and deal-making. He was the master of tough with the Midas touch.

The failure of Republicans to come together behind their horrible plan to repeal and replace the Affordable Care Act — even though they now control both houses of Congress and the presidency — was a crushing blow to Trump’s brand.

Trump, as is his wont, did what Trump does: Let someone else do the work — in this case Paul Ryan — and then swoop in at the end to endorse, brand and promote the project, and of course claim it as another of his own successes.

But legislation isn’t the same as luxury rental. Legislators are not the same as an obedient board.

You don’t simply have to sell yourself to brand-thirsty aspirants; you must also sell a plan to everyday people for whom the belt you notch could become their noose. For these people, the choices aren’t about a life of luxury, but about life and death.

You have to sell the plan to the members of Congress who represent these people, members whose inclination toward philosophical dogma and impulse for self-preservation sours them to sweet talk.

The loss is likely also the downside of Republican gerrymandering.

In the redrawing of districts following the 2010 census, Republicans created incredibly safe, ideologically pure districts with fewer dissenters. This protected more seats, but it also meant that the people who hold those seats have little to no incentive to ever compromise.

Republicans created hard-line districts that produced hard-line congressmen: obstructionist absolutists are gerrymandering’s political offspring.

These people weren’t elected to govern, but to impede governance. Their mandate isn’t to generate ideas and solve problems by the effective exercise of government. Their singular crusade is that government is ineffective and the solution is to forever see government itself as the problem. Ideas for them are anathema.

For years they railed against the A.C.A. and the president who pushed it through, promising America that they would repeal and replace it with something better. Trump jumped on that train during his run for the White House, promising even more than anyone could ever deliver.

But when you are the controlling party, single-minded obstruction is insufficient. You move from the hissing audience to the withering, sweltering spotlight. You have to create and perform.

When the Republicans actually had their opening to present and pass their own idea, America found it severely deficient, because it was severely deficient. Not only that, but they tried to ram it through without doing the work to promote it. It was all a comedy of errors.

The Republicans were not ready for prime time. They are not cohesive and coherent.

Trump’s incompetence ran headlong into this impossibility.

He couldn’t dictate or strong-arm. He couldn’t charm or cajole. He was embarrassingly rebuffed. The self-proclaimed winner took a monumental loss.

It was the latest loss in a string of losses. Indeed, this president in his first two months in office is proving to be the king of crash and burn.

Now, the finger-pointing has commenced. People in the White House are trying desperately to hang this loss on Ryan (and the Democrats) and keep it away from Trump.

Trump even took the oddly-timed step of using his Twitter account to direct Americans to tune in to Jeanine Pirro’s show on Fox News, his administration’s propaganda arm, where Pirro pilloried Ryan, scolding that he “needs to step down as speaker of the House. The reason? He failed to deliver the votes on his health care bill.”

Maybe it was mere coincidence — yet another one — or maybe it was maleficent stratagem. If the bill had passed, he would have basked in the glory. But when it failed, he wanted to deflect the damage.

However, in the end, this may well be a disastrous move. You don’t throw under the bus one of the only people who would stand between you and members of your own party who may one day be asked to impeach you.

A wounded Ryan might well sit back and watch, as the world consumes Trump.

Now here’s Prof. Krugman:

Nobody knew that health care could be so complicated.” So declared Donald Trump three weeks before wimping out on his promise to repeal Obamacare. Up next: “Nobody knew that tax reform could be so complicated.” Then, perhaps: “Nobody knew that international trade policy could be so complicated.” And so on.

Actually, though, health care isn’t all that complicated. Basically, you need to induce people who don’t currently need medical treatment to pay the bills for those who do, with the promise that the favor will be returned if necessary.

Unfortunately, Republicans have spent eight years angrily denying that simple proposition. And that refusal to think seriously about how health care works is the fundamental reason Mr. Trump and his allies in Congress now look like such losers.

But put politics aside for a minute, and ask, what could be done to make health care work better going forward?

The Affordable Care Act deals with the fundamental issue of health care provision in two ways. More than half of the gains in coverage have come from expanding Medicaid — that is, collecting taxes and using the revenue to pay people’s medical bills. And that part of the program is working fine, except in Republican-controlled states that won’t let the federal government aid their residents.

But Medicaid only covers the lowest-income families. Above that level, the A.C.A. relies on private insurance companies, using a combination of regulations and subsidies to keep policies affordable. This has worked well in some places. For example, in California, which has tried hard to make health reform work, the number of people with health insurance has soared, while premiums are still well below expectations.

Overall, however, too few healthy people have purchased insurance, despite the penalty for failing to sign up; this is partly because many of the policies offered have high deductibles, making them less attractive. As a result, some companies have pulled out of the market. And this has left some areas, especially rural counties in small states, with few or no insurers.

No, it’s not a “death spiral” — subsidies keep insurance affordable for most people even if premiums rise sharply, and the Congressional Budget Office believes that markets will remain stable. But the system could and should be improved. How?

One important answer would be to spend a bit more money. Obamacare has turned out to be remarkably cheap; the Congressional Budget Office now projects its cost to be about a third lower than it originally expected, around 0.7 percent of G.D.P. In fact, it’s probably too cheap. A report from the nonpartisan Urban Institute argues that the A.C.A. is “essentially underfunded,” and would work much better — in particular, it could offer policies with much lower deductibles — if it provided somewhat more generous subsidies. The report’s recommendations would cost around 0.2 percent of G.D.P.; or to put it another way, would be around half as expensive as the tax cuts for the wealthy Republicans just tried and failed to ram through as part of Trumpcare.

What about the problem of inadequate insurance industry competition? Better subsidies would help enrollments, which in turn would probably bring in more insurers. But just in case, why not revive the idea of a public option — insurance sold directly by the government, for those who choose it? At the very least, there ought to be public plans available in areas no private insurer wants to serve.

There are other more technical things we should do too, like extending reinsurance: compensation for insurers whose risk pool turned out worse than expected. Some analysts also argue that there would be big gains from moving “off-exchange” plans onto the government-administered marketplaces.

So if Mr. Trump really wanted to honor his campaign promises about improving health coverage, if he were willing to face up to the reality that Obamacare is here to stay, there’s a lot he could do, through incremental changes, to make it work better. And he would get plenty of cooperation from Democrats along the way.

Needless to say, I don’t expect to see that happen. Improving Obamacare requires doing more, not less, moving left, not right. That’s not what Republicans want to hear.

And the tweeter-in-chief’s initial reaction to health care humiliation was, predictably, vindictive. He blamed Democrats, whom he never consulted, for Trumpcare’s political failure, predicted that “ObamaCare will explode,” and that when it does Democrats will “own it.” Since his own administration is responsible for administering the law, that sounds a lot like a promise to sabotage Americans’ health care and blame other people for the disaster.

The point, however, is that building on Obamacare wouldn’t be hard, and wouldn’t even be all that complicated.

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