Monday, March 27, 2017

Reflections On Trump's Failure With 'Ryancare'

Late last week, the abysmal healthcare 'reform' proposal of Paul Ryan's which Trump had inexplicably chosen to support ... failed fairly unequivocally. How badly did it flounder? It didn't even make it to First Reading, on grounds that even other Republicans could not bring themselves to vote for it. 

A full explication of the 'hows' and the 'whys' behind Ryan's seven-year political project imploding in such spectacular fashion is beyond the scope of this piece; but looking at this whole - seemingly Fawltian - situation, a number of insights presented themselves.

The first, unquestionably, is that this was a singularly ridiculous political area for Trump to decided to get directly involved any attempt to replace Obamacare - let alone with 'Ryancare' - as flagship policy. It has been said in response to the old adage about "Mussolini made the trains in Italy run on time" that "Even God Himself could not make the trains in Italy run on time." Looking at the benighted state of just about EVERY serious healthcare reform proposal at the national level over the last few decades of American political history (Remember what Hillary USED to be famous for?) ... I feel pretty confident in stating that "Even God Himself could not make healthcare workable and affordable in America for all". It's just a complete and total quagmire - where political capital goes to valiantly die in thousand-page reports and insurance industry tacit backhanders.

Opposition to "Obamacare" was, indeed, a Republican Party talking-point hot-button issue par-excellence for much of the last Presidency ... but it must have been patently obvious that both i) an improved healthcare affordability mechanism [within the idiotic insurance/market based paradigm which America for some reason continues to insist upon] was going to be incredibly difficult to deliver, let alone quickly; and ii) that the Paul Ryan MOAR MARKET LESS TAX approach was something vastly more amenable to the Republicans' elitist backers [well, some of them anyway] than it was to the millions of ordinary working class Americans who helped sweep Trump to Power.

In other words, the very decision to put all his Presidential weight and seemingly-mighty impetus behind RyanCare represents in the most tangible possible form evidence of a corruption and a co-option of what Trump's "I'll make the Republicans a Workers' Party" political project was supposed to be about.

Which leads me handily on to my SECOND point.

Namely, that there IS a better way of doing healthcare out there - one which a fairly vast swathe of the developed world [and, for that matter, the better parts of the developING world] have long been on board with, which tends to provide better care to more people for lower cost [to both individual, employer, and, at the rate things are going, in terms of actual service provision, it may even work out better for the taxpayer] - and that's the "Single Payer" model. Or, as we call it EVERYWHERE ELSE, the "Public Healthcare System". [the fact that Americans insist upon terming this "Single Payer" just shows how far-wedged and firmly wedded their conception of healthcare as a transactional service presumably bound up with some sort of profit-making private enterprise nonsense in the first place].

It would have taken some doing to get the American political system to actually look seriously at the proposal [and I note that Trump actually arguably started laying the groundwork for this by positively talking up 'Single Payer' in speeches and campaign appearances as much as seventeen years ago - during his previous Presidential run]; and it's frankly disheartening to see the number of people who self-identify as being on the 'left' of the American political spectrum that've been gearing up to apparently die in a ditch for a massive-scale Insurance Industry politically embedded profit-making rort [which is, effectively, what ObamaCare puts a delightful, smiling human face upon - of a reasonably popular, principled-seeming President, no less]. But given the fact that pretty much *everyone* other than a rather small slice of Republicans, and a broader swathe of Democrats [acting out of both party and ideological loyalty] seem to hate the Affordable Care Act ... surely it could have at least done with a shot? Trump had impressive political capital to pour into complete shakeups in other areas, why not with one of the areas he's passionately advocated for reform in for most of the time that I've been alive?

Of course, a cynic's answer to this is that it never would have worked. As we saw with the attempt to pass RyanCare, partisan folks would have come out of the woodwork [on both sides, for that matter] to try and torpedo what would no doubt have been derisively labelled "BernieCare". This is, again, partially due to the American political establishment's evient bewilderment that there can be any such thing as a public healthcare system which doesn't run through the insurance industry [seriously, this whole "unemployment insurance" thing they've got going even does social welfare that'd ordinarily be handled simply and directly by the state as an entitlement in an insurance-industry [if not always directly insurance firm] mold]; and also partially due to the fact, no doubt, that the absolutely HUGE insurance industry [truly, one of the last 'great' areas of economic activity within America not to have been completely hollowed out and downsized or shipped offshore] would have been lobbying so incredibly hard against any reform to their golden cash goose that the task of taking them OUT of the equation ought be described as less 'Sisyphean" [although given the way healthcare reform keeps rolling up and down the political slopes like the boulder from that story, perhaps it's not entirely inaccurate] and more 'Sommean'. As in, a huge expenditure of effort to achieve very little except pain for one's self


But out of all of this, there is perhaps one single bright lining. Namely, that there are escalating signs that the Trump era (and,in no small part the way his administration and allies do things) is beginning to Break the Republicans. After all, as we saw, RyanCare failed as a bill precisely because Republican hardliners couldn't agree on whether the proposal didn't go FAR ENOUGH on stripping away protections and cutting costs/taxes, or just right ... and, for that matter, the number of 'moderate' Republicans who saw the RyanCare legislation as being a worse option than today's Affordable Care Act.
There are, of course, other schism-points to be drawn out; and it's not hard to find areas - particularly in foreign policy - wherein the level of animosity internal to the leading lights of hte Republican Party is now even icier and more internecine than Clinton v Sanders was for the Democrats. But it is not so easy to think of an area of purely /domestic/ politics wherein the fault-lines of the GoP have been so readily on show, recently.

In any case - and this perhaps says more about my own mindset than it does Trump's - I cannot help but wonder whether the principled thing to do in such a situation would be to recognize that Republicans would never be united in support of ANY proposal to meaningfully (or, for thta matter, less meaningfully - incoherently, even) 'reform' Healthcare ... and just throw hands up in the air about doing things "the Washington way", and just push and drive incredibly hard for the actual institution of "Single Payer" healthcare.

As mentioned above, it might take a decent swathe of selling to both the American people, and I'd be genuinely surprised if such a proposal picked up serious legislative support [for reasons that are jus straight-out malefic given the evidence for such a policy-set's efficacy] ... but if anyone's demonstrated an inimitable ability to take the politics of 'consensus' and throw them out on their ear ... it's Trump.

It would have been inordinately good if he could have, on this occasion at least, used this power for Good rather than for ... well ... deeply held Republican talking points in lieu of gleaming principle.

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