Apr. 14th, 2017

hudebnik: (rant)
After the first attempt to repeal and "replace" Obamacare failed in the House of Representatives, President Trump suggested he would sit back and watch Obamacare fail, after which Democrats would fall on their knees begging him to rescue it. That hasn't happened yet, so he's made more noises about it this week, making clear with the subtlety of Al Capone that "I don't want anyone to get hurt. What I think should happen and will happen is the Democrats will start calling me and negotiating."

As Paul Krugman points out, this strategy is not only cruel (to all the people who will "get hurt") but stupid, in that it's not likely to work.

Let's put it in terms of deal-making, something the President claims to know something about. He's written in the past how important it is, when going into a deal, to show that you're willing to walk away from it. The same goes for the Democrats in Congress: they won't accept any deal that is worse than walking away. In fact, they won't even come to the negotiating table unless they hope to get something better than if they don't.

What do the Democrats get if they don't negotiate with Trump and/or Ryan? Medicaid expansion continues to work, at least in the states that have accepted it (and I gather several more red states have been considering that in the past few months, presumably because it puts hundreds of millions of dollars into their local economies without politically benefitting Barack Obama). Healthcare.gov, which has actually been working pretty well since its bad first few months, will collapse for lack of maintenance and P.R, which can be blamed directly on the Trump administration. Fewer young and healthy people will buy health insurance because the individual mandate isn't enforced, and fewer poor people will buy health insurance because the cost-sharing reductions are cut off, so health insurance companies will either drop out of many states completely or raise their rates much faster than at any time in the past eight years. Those rate changes will probably apply not only to people in the exchanges, but also to people with private or employer-based insurance, which means about 90% of Americans will see their insurance premiums jump, again as a direct result of Trump administration actions. State-run exchanges will continue to run, theoretically, but there will be few or no plans in them, so millions of people will completely lose the insurance that Obamacare gave them for the first time in their lives. Every health insurance company in the country will sue the Administration for breach of contract (and those are some DEEP pockets!) It will be painfully clear that the situation was "not perfect, but pretty good" in the Obama administration, and now that Republicans control all branches of government, it's gotten rapidly and dramatically worse -- especially for the demographics that voted for Trump. Bad for the American people, but pretty rosy for the party out of power.

What do they get if they do negotiate with Trump and/or Ryan? Well, that depends on what "negotiate" means. Since Trump is trying to force Democrats to the negotiating table with threats rather than luring them there with promises, he probably has no intention of offering very much. The Medicaid expansion goes out the window. All the rules saying "you must cover these things in order to be called 'insurance'" go out the window. The pre-existing conditions rule will be kept in name, but eviscerated so that if you ever miss an insurance payment and have a pre-existing condition, you'll never get insurance again in your life -- at least, not insurance that covers that condition. And they get their Democratic names on this mess. All in all, a worse deal for the Dems than "walking away".

Congressional Democrats have no incentive to negotiate away anything that's in current law unless the Republicans can offer them something they see as better, and they have no intention of doing that.

Unless... Trump can negotiate with the Democrats a collection of minor tweaks that stabilize the markets and make the system work better, but which Trump with his genius at branding and P.R. can describe as "repeal and replace" (or even as "the Democrats blinked"). Such a deal, if it happened, would serve as evidence that, however incompetent he may be at most tasks one expects of a President, Trump really is good at making deals. The question is, would Democrats accept such a deal, knowing it would make Trump look good with mainstream America? (Not with the Tea Partiers, but he has little of their love left to lose.)

If the teams were reversed, there's no doubt that Congressional Republicans would turn it down: they've made abundantly clear over the past eight years that they're willing to hurt the American people (extend the recession, sabotage health care, etc.) if that's what it takes to hurt President Obama and the Democrats.

I don't know what the current Democratic leadership would do if they were offered a deal that repealed a few inessential aspects of Obamacare (say, the employer mandate) and improved others, on the condition that Trump gets to say he won the negotiation. I don't even know what I would want them to do in that situation: is it worth improving the health care system if it lends credibility to an administration that is so corrupt and so malevolent on so many other issues?

But I very much doubt they'll be faced with that choice.

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