Browsing the blog archivesfor the day Monday, February 27th, 2017.

Don’t Read This Without a Helmet

Health Care, Trump Maladministration

Helmet on? Okay, this happened today:

President Donald Trump told a bipartisan group of governors at a White House reception Monday morning that GOP tax reform would have to wait for lawmakers to move on repealing Obamacare, cautioning that, “Nobody knew that health care could be so complicated.”

“I have to tell you, it’s an unbelievably complex subject,” Trump said.

I’ll pause to let you pound your head on the desk for a while.

I take it somebody attempted to explain to Trump why Republicans just couldn’t kill the mandate but leave the pre-existing condition coverage.

This also tells me he is just now finding out what the issues are with health care. I’m sure he assumed anybody could write a health care bill that gave everybody what they wanted. What was the big deal?

Right now, the Republicans seem to be dividing between the kill-Obamacare-and-let-the-chips-fall crowd and those who suspect that suddenly depriving millions of people of health care might hurt their re-election chances.

And it has to be said that Trump pre-screwed the pooch for them by promising that no one currently covered would lose coverage. Republicans can come up with all kinds of great plans as long as people don’t actually have to be covered. The coverage thing, though, is an impossible hurdle. Jonathan Chait wrote,

Health-care reform is extremely complicated even under the best of circumstances. But when you combine the inherent complexities of the subject with the ideological rigidities of the conservative movement, the problem goes from hard to prohibitively impossible. Providing access to medical care to the tens of millions of Americans who can’t afford it on their own, because they’re too poor or too sick, is arithmetically futile if you’re bound by a dogma that opposes redistribution from the rich and healthy to the poor and sick.

But we know what’s really important, don’t we?

House Republicans have decided to resolve the contradiction between party dogma and the promise not to harm the public in favor of the former. A study prepared by the National Governors Association, and which leaked to the media Saturday evening, finds that the House Republicans leadership’s formative plan to replace Obamacare will deprive millions of people of their insurance.

Repealing Obamacare is more important to these people than finding ways to deliver health care to the American people. Many would prefer to repeal the law and blow up the health care system than to dedicate even one tax dollar to helping a poor person see a doctor. They have principles, you know.

But Trump promised better and less expensive coverage. Back when he was still pretending to be developing a plan himself, he promised this. This is from January 15:

President-elect Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Obama’s signature health-care law with the goal of “insurance for everybody,” while also vowing to force drug companies to negotiate directly with the government on prices in Medicare and Medicaid. …

…Trump’s declaration that his replacement plan is ready comes after many Republicans — moderates and conservatives — expressed anxiety last week about the party’s lack of a formal proposal as they held votes on repealing the law. Once his plan is made public, Trump said, he is confident that it could get enough votes to pass in both chambers. He declined to discuss how he would court wary Democrats….

…As he has developed a replacement package, Trump said he has paid attention to critics who say that repealing Obamacare would put coverage at risk for more than 20 million Americans covered under the law’s insurance exchanges and Medicaid expansion.

“We’re going to have insurance for everybody,” Trump said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”

Republican leaders have said that they will not strand people who gained insurance under the ACA without coverage. But it remains unclear from either Trump’s comments in the interview or recent remarks by GOP leaders on Capitol Hill how they intend to accomplish that.

For conservative Republicans dubious about his pledge to ensure coverage for millions, Trump pointed to several interviews he gave during the campaign in which he promised to “not have people dying on the street.”

“It’s not going to be their plan,” he said of people covered under the current law. “It’ll be another plan. But they’ll be beautifully covered. I don’t want single-payer. What I do want is to be able to take care of people,” he said Saturday.

Here’s a television news story from about the same time. So we’ve got him both in print and in video.

ABC Breaking News | Latest News Videos

Very smart people who have been wrestling with the health care issue for a long time understand that cost-effective, universal coverage can’t be done without going to a taxpayer-funded national health care system that includes price controls of all sorts. Short of that, there’s Obamacare or something like it, mandate and all.

But Trump promised everybody rainbows and ponies. People could get terrific, affordable coverage, and Republicans could nix the mandate and cut taxes. Everybody wins. Back to Jonathan Chait:

Trump held together the contradiction by simply pretending the solution would reveal itself over time and would be extremely easy. Quite likely Trump believed this himself — as a committed nonreader, and a narcissistic devotee of his own negotiating prowess, he surely believed that he could broker a deal that would satisfy both the moral objective of universal coverage and the specific ideological hang-ups that had prevented his party from ever supporting a plan that would accomplish it in the past.

The only thing that held Trump’s position together was a refusal to engage with the substance of the issue, and a magical belief that it could all be waved away. At best, he will keep either his promise to the Republican elite or his promise to the electorate. At worst he will keep neither. His offhand comment that the issue is hard is a window into the mind of a man who realizes the jig is almost up.

Maybe. Maybe he thinks that if he throws bigger tantrums someone will come up with the solution for him. I predict that eventually he will cave on his promise to voters and will blame them for it.

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