Healthcare Reform–Backing Paul Ryan’s handiwork

March 12, 2017

Healthcare ReformBacking Paul Ryan’s handiwork is a risky proposition for The White House and The Republicans

by John Cassidy*

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Affordable Care Act- A Disaster or Trump’s Politics?

Kevin McCarthy, the Republican House Majority Leader, went on Sean Hannity’s show on Thursday night and tried to talk up the awful health-care bill that his party had just rushed through two committees. His message was aimed at the ultra-conservative groups, such as the Freedom Caucus and Heritage Action for America, that have come out strongly against the proposed legislation. McCarthy didn’t try to claim that the bill would make health care more affordable or widely available. Instead, he defended its conservative bona fides, twice pointing out that it would repeal all the taxes that were introduced under the Affordable Care Act—taxes that mainly hit the one per cent.

Hannity, who is one of President Trump’s biggest boosters, didn’t hide his loyalties or his concern about the political firestorm that the bill has set off. “This has to work: there is no option here,” he said at one point. Later, he warned, “As soon as it passes, you own it.”

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Message to Mr. Trump and the Republicans– It is not Obamacare, but Affordable Care Act

Intentionally or not, Hannity summed up the political dilemma facing Trump and his Administration. The White House has embraced Paul Ryan’s handiwork—the House Speaker is the bill’s top backer—and they are now trying together to persuade the full House and the Senate to vote for at least some version of it. But if the bill does pass and Trump signs it into law, what happens then? The health-care industry will be thrown into turmoil; many millions of Americans will lose their coverage; many others, including a lot of Trump voters (particularly elderly ones), will see their premiums rise sharply; and Trump will risk being just as closely associated with “Trumpcare” as Barack Obama was with Obamacare.

Two questions arise: Why did Ryan and his colleagues propose such a lemon? And why did Trump agree to throw his backing behind it?

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House Speaker Paul  Ryan–A Healthcare Reformer or just another Politician

The first question is easier to answer. For seven years, promising to get rid of Obamacare has been a rallying cry for Republicans on Capitol Hill—one supported by both Party leaders and activists, as well as by big donors, such as the Koch brothers. It was inevitable that, if the G.O.P. ever took power, it would move to fulfill this pledge, despite the human costs of doing so.

What wasn’t anticipated was that the Republican leadership would run into hostility from the right. But that, too, is explainable. After November’s election, Ryan and his colleagues were forced to face the reality that fully repealing the A.C.A. would require sixty votes in the Senate, which wasn’t achievable. Many of the things that ultra-conservatives see as shortcomings in the bill now being considered—such as the retention of rules dictating what sorts of policies insurers can offer—are in there to make sure that the Senate can pass the bill as part of the budget-reconciliation process, which requires just fifty-one votes. As McCarthy explained to Hannity, “The challenge is the process of how we have to do this.”

The more interesting question is why Trump would stake his credibility on such a deeply regressive, and potentially unpopular, proposal. During the campaign, he frequently promised to repeal Obamacare—but it wasn’t one of his main issues. Clamping down on immigration, embracing economic protectionism, rebuilding infrastructure, and blowing a raspberry at the Washington establishment were much more central to his platform.

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Early in the campaign, in fact, Trump praised socialized medicine, and promised to provide everybody with health care. “As far as single-payer, it works in Canada. It works incredibly well in Scotland,” he said in August, 2015, during the first Republican debate. A month later, he told “60 Minutes,” “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

Part of what is going on is that Trump needs a quick legislative success. He is keenly aware that, by this stage in his Presidency, Obama had signed a number of important bills, including a big stimulus package. Trump also badly needs to change the subject from Russia. It might sound crazy to suggest that a President would embrace a bill that could do him great harm in the long term just for a few days’ respite, but these are crazy times. If nothing else, the political furor surrounding the House G.O.P. proposal has eclipsed the headlines about Trump claiming that Obama wiretapped him. For much of this week, Trump has ducked out of sight, letting Ryan and his bill take the spotlight.

That’s not the only way the Russian story may have played into this. As the pressure grows for a proper independent probe of Trump’s ties to Moscow, he must retain the support of the G.O.P. leadership, which has the power to block such an investigation. It has long been clear that the relationship between the Republican Party and Trump is based on a quid pro quo, at least tacitly: in return for dismissing concerns about his authoritarianism, self-dealing, and Russophilia, the Party gets to enact some of the soak-the-poor policies it has long been promoting. For a time, it seemed like Trump was the senior partner in this arrangement. But now Republicans like Ryan have more leverage, and Trump has more of an incentive to go along with them.>

Still, even if he had more leeway to speak out against the House G.O.P. bill, is there any reason to think he would? The thing always to remember about Trump—and this week has merely confirmed it—is that he is a sham populist. A sham authoritarian populist, even.

Going back to late-nineteenth-century Germany, many of the most successful authoritarian populists have expanded the social safety net. Otto von Bismarck, the first Chancellor, introduced health insurance, accident insurance, and old-age pensions. “The actual complaint of the worker is the insecurity of his existence,” he said in 1884. “He is unsure if he will always have work, he is unsure if he will always be healthy, and he can predict that he will reach old age and be unable to work.”

During the twentieth century, Argentina’s Juan Perón, Malaysia’s Tunku Abdul Rahman, and Singapore’s Lee Kuan Yew were among the authoritarian leaders who followed Bismarck’s example. Today, if you look at the election platform of Marine Le Pen, the leader of the French National Front, you see something similar. Like Trump, Le Pen is a nativist, a protectionist, and an Islamophobe. But she is not proposing to dismantle any of the many social benefits that the French state provides. Rather, she says she will expand child-support payments and reduce the retirement age to sixty.

Trump, on the other hand, has little to offer ordinary Americans except protectionist rhetoric and anti-immigrant measures. Before moving to gut Obamacare, he at least could have tried to bolster his populist credentials by passing a job-creating infrastructure bill or a middle-class tax cut. Instead, he’s staked his Presidency on a proposal that would hurt many of his supporters, slash Medicaid, undermine the finances of Medicare, and benefit the donor class. That’s not populism: it’s the reverse of it. And it might be a political disaster in the making.

*John Cassidy has been a staff writer at The New Yorker since 1995. He also writes a column about politics, economics, and more for

8 thoughts on “Healthcare Reform–Backing Paul Ryan’s handiwork

  1. Over to you, my friend LaMoy. This is up your street. I do not know enough to comment credibly. What is Fact and what is Fiction? This political game in Washington must be disturbing to Americans whose healthcare needs are at risk.

    We are talking about the Affordable Care Act. It is not about Obama. He is no longer President. It is law passed by the US Congress. Maybe, if politicians stop using the label “Obamacare”, the issue can perhaps be debated rationally. The Republicans must learn to use their legislative power wisely or lose it in due time. –Din Merican

  2. As millions lose their coverage, they will not call it Trumpcare, they will call it DUMBCARE and Elizabeth Warren do not even have to break a sweat to get to the White House..,

    Loud mouthed Elizabeth Warren must make sure she has an electable Democratic Party behind her after it has been rehabilitated and she wins the nomination. At this point of time, her chances are a best dodgy. Furthermore, she does have the personality to be POTUS.–Din Merican

  3. Din:
    No one really know what Trumpcare actually is at this moment. GOP leaders within the house released a draft of a bill that outlines the first proposed steps to repeal and replace Obamacare with the GOP and Trump’s alternative. But from the outset, it is clear that this isn’t the final bill. This document is not what is expected to actually get passed by both republicans and democrats. First of all, with respect to sweeping legislative change and the documents that outline any new laws, regulations and rules, this document is very succinct. It also spends a fair amount of time covering things that are not top of mind for most Americans.

    So all that said and what you read from the newspapers today, it doesn’t really matter at this point. Right now the more conservative part of the GOP is flipping out and calling the plan “Obamacare-Lite” or “Obamacare 2.0”. Democrats are saying it is going to result in 20 million people losing their health insurance coverage. As they say, the devil is in the details, and we don’t actually have all of the details yet because they have yet to be determined. Over the next couple of weeks or months, Trump and his cabinet along with republicans, democrats and insurance industry executives will all be forced to begin the painful process of understanding “compromise”. Because that is what is going to be required in order to draft a replacement to Obamacare that will actually get passed.

    I’m keeping a very close watch at this Trumpcare because it affects our pharmaceutical industry, but I’m not going to jump on every little bit of information that gets released in dramatic fashion by politicians. It’s great if you’re in the news business, because drama equals dollars, but for us, we’re in this to help people make good decisions with their health; we’re in this to save lives.

    You’re absolutely right that “if politicians stop using the label ‘Obamacare’, the issue can perhaps be debated rationally.” It’s all about Obama. I truly believe Trump is a racist. You might remember in 1973 federal government brought lawsuit against Donald Trump and his company for racial discrimination at Trump housing developments in New York. He has been picking on Obama from day one since he became the first black president.

    All I can tell you now is, I believe, the proposed Trumpcare is going to piss off a lot of Trump’s supporters. Trump and the Republicans have actually nothing to offer. They’re only making some revisions to the Obamacare. In fact, it’s an Obamacare 2.0. At the moment we are focusing on 7 points:

    (1) Repeals the Individual mandate (the tax penalty for not having health insurance coverage);

    (2) Provides coverage for those with pre-existing conditions;

    (3) Allows children to stay on parents plan until they are 26;

    (4) Medicaid expansion is not impacted until 2020;

    (5) Replaces subsidies with refundable tax credits;

    (6) Removes the 3.8% tax on individuals earning more than $250,000 a year;

    (7) Places more focus on encouraging people to open health savings accounts.

    Trump has promised to repeal all of things Obama. Mark my word, he will end up pissing all his white supremacist supporters by doing most of what Obama was doing. The one who is smiling and at the verge of laughing out loud is George W. Bush — he is highly likely doesn’t have to go into history as the worst president any more.

    Talking about Bush, if you have talked to him like I did, you would find him actually a very kind and nice man. Or else your dream girl Condi would not be still so loyal to him. He is certainly not a nasty person like Trump. But like Trump, he was surrounded by some very bad people in his administration, like Dick Chaney, Karl Rove, Donald Rumsfeld, Richard Perle, Paul Wolfowitz …. Karl Rove was to Bush like Steve Bannon to Trump today. And Bannon is worse than Rove, far worse and evil.
    I take your comments seriously. You know what is happening in Washington DC. To me, American democracy is an abject failure. The arrival of Trump in The White House is the litmus test. Impeachment awaits him if Americans can think more clearly and learn from the South Koreans who removed their President out The Blue House.–Din Merican

    • Abang Din:
      America is in a dark period of our existence. From a two-party democracy we have become a one-party dictatorship. The Republicans now control all three branches of government. The Republicans control the White House, the House of Representatives, the Senate, and with Trump’s nominees, the Supreme Court. Republicans also control most state assemblies. Sure, there are divisions within the GOP and Trumpland, but they are quickly mending before our eyes. This clamp by one political power on all the apparatus of state power represents an extremely dangerous situation for our freedoms.

      America has never quite been in this type of precarious situation as it is right now over the course of most of our life times. We’ve never been here before. Perhaps, the easiest analogy for us now is the model provided by the rise of Adolf Hitler in Germany during the 1920s and thirties. Hitler made all kinds of promises to the German working class, for jobs, to make Germany great again, he was a populist, and he was able to mobilize the masses, with many lies. Hitler was legally elected to power but by way less than a majority. But once in, he and his party grabbed the reins of the government apparatus, trampled the German constitution, jailed or killed all his opponents, and violently forged a one-party government. What he did after that is the most horrible period in human history. Murdering 6 million Jews, millions of others, starting World War II.

      But America is different from Germany in the thirties. America does have a democratic tradition that goes back 240 years. Germany had nothing like that. America does still have a Constitution and Bill of Rights that have weathered changes over time. Germany had nothing like that. We also have values of “fairness” and social justice and inclusivity. Not so Germany, although it had a huge left-wing. We also have a tradition of a military that does not engage in domestic politics. Not so in Prussian Germany.

      Most importantly, America still has a free press. We can still call things as we see them, for awhile more, at least. We can still say and write things like “Donald Trump is a fascist,” and remain content that police agents won’t be knocking on our doors or disrupting our internet connections. Now, more than ever, we will need that independent press for telling it like is – no matter what power is insulted or criticized, no matter what government official is taken to task. And it’s one of the ways we can resurrect our democracy.

  4. The problem is no one wants to listen to the professional medical staff. Hospital administrators, the insurance and drug companies ( re-packaging of wholesale consumer goods in individual retail packaging can increase the price of consumer goods up to four times) are having a field day. In many countries these are some of the key areas that need attention to improve medical care with the view to provide affordable services.

  5. // .,, Malaysia’s Tunku Abdul Rahman, … were among the authoritarian leaders who followed Bismarck’s example.

    I must say I am lost. I didn’t know Tunku Abdul Rahman as an auhoritarian. John Cassidy is teaching me something here that I didn’t know. In any case, how many in the New York knows who Tunku Abdul Rahman is?

  6. I also agree that La Moy’s comments are great to read, especially when anecdotes are used. They add a personal dimension that is quite touching.

    Well done mate.

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