By the standards of Republican legislators, Paul Ryan, Speaker of the House, is a whiz kid — smarter than the average and a policy wonk to boot. Compared to his colleagues, he is a serious thinker; the bar is set that low.
Nevertheless, he embarrasses himself each and every time he puts his thinking cap on.
Ryan’s deficiencies became glaringly apparent as House Republicans and Donald Trump dueled with each other over how to “repeal and replace” Obamacare.
Ryan and his co-thinkers bring muddled minds to the table. Trump’s mind is a blank slate; he is, by his own account, too busy to read or waste time thinking.
He is too busy to do much of anything except vacation weekends at taxpayer expense at his over-the-top cash cow, Mar-a-Lago; hold campaign rallies in friendly venues (even now, with the election over); repeat what he heard on Fox News and even sleazier sites like Breitbart and from Steven Bannon and his band of miscreants, and, of course, post tweets.
He is never too busy, though, to do what he claims to be good at: make deals. Whenever the situation calls for it, the Donald is there, locked and loaded.
He needed a deal with GOP leaders on health care insurance; they needed a deal as well. In both cases, the level of need was desperate.
They believe, with good reason, that if they don’t get rid of Obamacare soon, they are headed for disaster.
It is harder to say what the consequences will be for Trump. Until he resigns or is impeached, he has the institutional power of the presidency behind him. There is also the astonishing fact that most of his “base” still supports him.
And he has Democrats for opponents. They do seem to have learned from the shellacking they brought upon themselves last November that it is unwise to badmouth the people who fell for the Donald’s con. Beyond that they remain useless.
They don’t fight Trump; not really. Instead, they blame the Russians.
And so, disguised as a “populist” hero, the billionaire huckster fools enough people enough of the time to hold on by the skin of his teeth.
If Ronald Reagan was the Teflon President, Trump has been, so far, the Teflon President 2.0. Daily, sometimes hourly, he adds to an already long list of embarrassments and offenses that would have done in anybody else.
Can he keep it up until the voters get another say? It is hard to see how. But with the Donald, anything is possible; absurdity rules.
That repealing and replacing Obamacare would even matter to his base, much less become a life or death matter for the GOP establishment and the Trump administration, is itself absurd.
For this, the Tea Party deserves a lot of the blame; Tea Party people have always had it in for Obamacare. To be sure, their moment has passed, only the tail of the comet is left. Nevertheless, they still call the shots. Therefore Ryan and Trump really have no choice; if they want to lead, they must follow.
The odd – indeed, absurd — thing, though, is that, for the most part, Trump voters are fine with Obamacare – with its provisions, that is. This is becoming clearer all the time. Republicans worried about running for office in 2018 are finding that many of the people who voted for them in 2016 actually fear losing what they want to repeal and replace. This puts those Republicans between the proverbial rock and hard place. It would be wonderful if they were to perish there.
How could Obamacare have become such a lightening rod? The only plausible explanation is its association with Obama. Early on, he and his people decided to make the Affordable Care Act (ACA) their signature piece of legislation; that alone made it anathema to the Tea Party rank-and-file.
Tea Partiers hated Obama – not for his drones or his deportations or because he protected Bush era war criminals and continued their work (in a kinder gentler guise), or because he started a half-dozen undeclared wars. They hated him because he obtained the genes that regulate the color of his skin from a Kenyan man, and because his success in the world of white privilege made them anxious.
They revile the ACA, in turn, because Obama’s name is indissolubly linked to it. This is not much of an explanation, but it is as good as any. It is hard, after all, to make sense of an absurdity.
But how else can we account for such fierce Republican opposition to what is essentially a Republican program? The idea behind it was developed in think tanks close to the Republican Party and implemented by the Republican governor of Massachusetts, Mitt Romney.
Obama didn’t even do much of the minimal refashioning that Romneycare underwent. He did do all he could to get the ACA through Congress, but his role in tweaking its details was minimal. He delegated that task partly to his staff, but mainly to Clintonite Democrats in the House and Senate.
Because the ACA really is just a recycled Republican program, Ryan and Company can hardly help getting into trouble when they try to justify the animosities they and their constituents express. But this is not the main reason why the rationales they come up with are silly or confused or both. The explanation for that is that their thinking is flawed.
Trump got into trouble by linking his campaign promises to their rationales.
But he really had no choice – not if he wanted to hold fast to the idea that making health care an “entitlement,” a right all citizens enjoy, is out of the question. Trump did sometimes suggest otherwise, when he was selling his snake-oil in populist guise. That is ancient history now. On the Single-Payer Question, he, like Ryan, is currently as bad, or worse, than the Democrats.
If Ryan and the others had the sense they were born with, they would have just let the issue pass. There is a precedent for that: the 2012 election. When that was looming, Romney was their candidate for President; they therefore had little choice. Now that is ancient history too.
Obamacare aimed to reduce the number of Americans who are uninsured; at that, it did a tolerably good job. It also aimed to stave off efforts at more serious reforms that would make health care a right. It did a spectacularly good job at that.
It also enriched private insurers, Big Pharma, and the for-profit health care industry. This, presumably, was not one of its express objectives. It was, however, an inevitable, and foreseeable consequence.
It is unclear whether Obama and his people grudgingly went along with this, seeing it as necessary for buying off the opposition, or whether they actively favored it for the opportunities it provided them for feathering their own nests. For all practical purposes, it makes little difference.
In any case, when Obama decided to use the political capital he gained in the 2008 election to do at the national level what Romney had done in Massachusetts, he terminated the Republican purchase on the idea behind the ACA. From that point on, the Democratic Party owned it.
It owns it so thoroughly that, since being welcomed into the Party’s establishment, even Bernie Sanders, who had made single payer insurance a cornerstone of his campaign against Hillary Clinton, has become an Obamacare defender.
This is shameful and sad, but clearheaded to a fault. Sanders made a cold and calculated decision to turn against what he had campaigned for. The muddled thinking is all on the Republican side.
During the campaign, Trump would say pretty much anything to win over his marks. To keep them from bolting now, he knows that he has to honor at least some of those campaign promises — or at least to make a conspicuous display of trying to do so.
Too bad that the promises he is actually honoring are the “deplorable” ones, the low-hanging fruit, the ones that harm Muslims and people of color and that coarsen and degrade life in the United States for all but the super-rich.
Ryan and Company don’t mind that. They are fine with Trump stirring up nativist and Islamophobic animosities, though they would probably be happier if he would tone it down.
What they would mind very much would be efforts to honor those of his campaign promises that outflanked Hillary from the progressive side – for instance, his repeated insistence that he would see to it that everybody is insured. Therefore, don’t count on him going there. Because he needs to keep Ryan and the others on board, he couldn’t, even if he wanted to, which he almost certainly does not.
He would have had to sign on to the rationales Ryan and the others concocted – or, more precisely, appropriated and adapted. Those arguments are timeworn and unoriginal, and fatally flawed. But, as Donald Rumsfeld famously put it, “you go to war with the army you have.”
Ryan and the other ideologues giving the bad old arguments voice, are Trump’s army now; and their loyalty to the Donald is nil. Add this to the list of ways that the Donald is in way over his depth. But then it has been clear since long before Day One that the very idea of a President Trump is ridiculous.
From time immemorial, human communities have been organized around the principle that social solidarities of one kind or another take precedence over individualistic interests.
In one way or another, this deeply human sentiment helped shape views of what persons owe one another, giving rise to social practices and institutional arrangements that accord with these understandings.
High among the obligations of persons living in “moral economies,” as Karl Polanyi (1886-1964) called them, were duties to help community members in need.
Ryan et. al. oppose notions of a moral economy – for reasons that others, long before them, set out with far greater clarity and nuance. Those reasons appeal both to economic and, ironically, also to moral considerations.
The economic arguments reduce to the claim that redistributive state programs and their more decentralized communal antecedents are detrimental to economic development and therefore make outcomes worse.
The moral arguments appeal to the virtue of self-reliance.
In the Golden Age of the Tea Party, self-described conservatives would sometimes go on about how everything good, hard-working Americans have, they got entirely on their own. This was nonsense, of course — “no man is an island.” But with their babble they were able to fool themselves and other mindless folk.
Societal interdependence is an inexorable fact of the human condition. The founders of modern social theory, all the many strains of it, knew this as well as anybody. Consistent with this truism, most of them also maintained that a condition for the development of capitalist economies and the social and cultural forms built upon them was the replacement of the communal ties that held traditional societies together by contractual relations between individuals who were in theory, and increasingly in practice as well, radically independent of one another.
Because consciousness arises out of real social conditions – out of life, as Marx famously put it — the idea therefore took hold that individuals ought to make their way through life on their own, without the aid of the practices and institutional arrangements that constitute moral economies.
It then follows that persons in distressed circumstances who struggle on without aid are better, more virtuous people than those whom the community carries along.
Having taken this thought on board, the Scrooges satirized in Dickens novels tended mainly to advance moral arguments against helping others that apply not just to programs organized through states, but to private charity as well. If the idea is to advance a conception of virtue that accords preeminence to self-reliance and related virtues, help to others is problematic, no matter how it is provided.
Today’s libertarians are less hard-hearted than their counterparts a century and a half ago. Their opposition to the moral economy has more to do with its coercive aspects than with Scrooge-like objections to helping others.
The prevailing view today in libertarian circles is that if people want to be charitable, that is their business; so long as other identifiable individuals are not harmed, they can do whatever they want with resources that are rightfully theirs. Their position is just that the state cannot rightfully force anyone to use those resources to help others – whether or not it would be good or bad if they did.
This view has evidently found a way into Paul Ryan’s wheelhouse.
He is a little shaky on its rationale, however.
Ryan and his co-thinkers obsess over the importance of expanding choices – in a way that conflates libertarian arguments against the welfare state with a certain view of freedom.
It is a testament to the power and depth of the New Deal – Great Society settlement that, well into the Reagan era, conservatives were generally disinclined to appeal to Scrooge-like arguments. Their view then was that while the goals of liberal defenders of New Deal – Great Society institutions were beyond reproach, their ways of implementing their objectives were counter-productive– because they fostered a “culture of dependence” and otherwise tended to backfire, leaving the worst-off, worse-off still.
That “new Right” moment has passed. Conservative ideologues have gone back to siding with Dickens’ villains. This is evident in the rationales offered for the American Health Care Act (AHCA), Ryan’s proposed replacement for the ACA.
Insurance markets cannot exist unless risk is socialized – sellers must be able to get enough people to buy insurance at high enough rates to enable them to pay out the benefits they must, and to make a profit as well.
Because health care costs are high and getting higher – in part, thanks to the ways insurance markets are structured – and because it is hard to socialize this particular risk when the young and the healthy can reasonably conclude that they have better, or more urgent, things to do with their money than buy insurance — insurers will not be able to sell their policies at prices most people can afford.
Therefore, most people cannot be covered by private health insurance programs unless there are subsidies – either from employers, with the costs effectively deducted from wages and benefits, or from general state revenues or special taxes collected by the state for that purpose.
Republicans and Democrats, intent on addressing constituents’ demands for health care insurance, therefore have no choice: they must offer subsidies.
Single-payer systems avoid these problems – by bringing everyone into the risk pool, and by using their monopsony position to control costs. But, as we know, Republicans and Democrats will not consider single-payer options; the insurance, pharmacological, and for-profit health care industries they serve won’t hear of it.
This is why, to know what is going on in on-going debates over health insurance, one must follow the subsidies – to see who benefits and who is worse off.
Stereotypical Trump voters – white, middle aged, rural, less educated victims of the neoliberal turn – would have to be remarkably dense or stubborn or both not to see that they are not among the beneficiaries of Ryan’s – and therefore Trumps — plan.
For all its shortcomings, Obamacare did improve the lot of people in the Trump demographic; it provided affordable health care for some, though far from all, of them, and it did do something, not nearly enough, to keep costs down.
Trumpcare – or Ryancare, as Trump prefers to call it – would have made their lot worse. It would have left people in the Trump demographic high and dry – especially in the short run.
Ryan has wonkish reasons for denying this obvious point — for insisting, as his ideological forbearers did, that, in the long run, even the poor will be better off.
Even if the arguments he uses were worth taking seriously, which they are not in his version, we should remember that, as Keynes famously said: “in the long run we are all dead.” Keynes was speaking generally; with respect to health insurance, his words ring especially true.
Ryan and the others understand this at some level. Perhaps this is why they take every opportunity to turn the conversation in a different direction: away from the economic effects of sticking it to the poor – towards philosophical issues where their positions are less obviously wrongheaded.
It is easy, even natural, in this case, to steer discussion of the AHCA in that direction because, as already noted, the economic and philosophical views Ryan endorses converge on a certain muddled understanding of the importance of choice.
The more choices we have, Ryan and the others seem to think, the freer we are.
Their arguments, however, support a different claim: that the more choices we have, the better off we are, the more our welfare is enhanced.
Welfare and freedom are not the same.
The issue now is not the welfare state, except in a very attenuated way. By “welfare,” I mean what philosophers and political economists mean – well-being, as measured by happiness (or pleasure), or by want-satisfaction or by some ideal-regarding standard.
It is far from obvious but let’s stipulate anyway, that an effect of the AHCA would be to increase competition among health insurance providers, driving down costs at least in the short run. It would do so, presumably, by diminishing regulations: permitting insurers to cross state lines more easily and to offer watered-down products. Then, libertarians say, more of them would come into the marketplace; and the additional competition would drive down costs.
This is right in a sense: making cheaper products available arguably would increase welfare for a while – in the way that being able to shop at a Walmart does.
Before long, though, pressures for consolidation would set in, as they have with airlines and telecommunication companies. This is normally what happens in deregulated industries.
This consideration apart, would having more choices make people better off in any more robust sense?
The answer is that it all depends. Adding items to a menu doesn’t make the food better and, in most cases, beyond a certain point, it doesn’t make the experience of eating better either. Having more choices can be, and often is, burdensome.
This is especially true when the choices involve specialized knowledge, as they inevitably do where health care is concerned.
But there is no general rule. It is sometimes better to have more choices; sometimes not.
However, for those who don’t think too hard about the issue, what Ryan and the others say about expanding choice sounds good; their jibber jabber has its uses. No wonder Trump is able to get on board with them; conning people by making them think he will make their lives better is his stock-in-trade.
However, the muddle doesn’t stop there.
When Ryan and the others go on about how they want people to have more choices, they are alluding to a venerable, though antiquated, body of thought that, to this day, fuels important strains of libertarian theory.
The clue is the ease with which they shift from the claim that adding on choices enhances welfare to the idea that the more choices there are, the freer people become.
In the seventeenth century, as the nascent capitalism emerging in the Netherlands and the British Isles began the long process of replacing traditional social solidarities with contractual relations organized through markets, the idea took hold that freedom – a word with meanings that in the Western tradition harken back to the days of Greek and Roman antiquity – meant the absence of constraint.
People were free, in the sense in question, to the extent that others do not block them from doing what they want.
This is not quite the same as saying that they are freer the more choices they have, but it does suggest that this is the case – not perhaps to those who demand conceptual rigor, but to those, like Ryan, with a capacious tolerance for conceptual imprecision.
Their appropriation of this notion of freedom – it is sometimes called “negative liberty” – is plainly in need of refinement, even if only to take the moral importance of various restrictions on persons doing what they want, into account. Would Ryan and the others hold, for example, that the more parking restrictions there are, the less free automobile drivers are? And how would they view constraints that are unintended consequences of institutional arrangements? Would they say that unemployed workers are free to start their own factories? If so, theirs is a shallow freedom indeed.
In short, what Ryan says and seems to assume about freedom and choice could stand some serious elaboration and perhaps also a bit of “deconstruction” – to use that now thoroughly besmirched (Bannon-ized) word. This would be easier to do if Ryan’s thinking was more coherent to start with.
In any case, his confusions are Trump’s problem now, especially since not one of the four heavy-hitters (Trump, Bannon, Pence and Ryan) were able to pull off their insurance coup. The promises that the Donald made to voters on health care fell due and utterly failed — his base was not thoroughly mesmerized.
Couldn’t happen to a more deserving bunch of cretins! [afl]