Wednesday, January 25, 2017

Repeal and punt

Image via Dodgers Way.
Monsignor Ross Douthat, Apostolic Nuncio to 42nd St. ("Repeal and Compete"), is publicizing a cunning variation on the "repeal and rename" strategy for keeping Trump's promise to get rid of Obamacare without alienating the hundreds of thousands of Trump voters who depend on it to get healthy, proposed by Senators Susan Collins (R-ME) and Bill Cassidy (R-LA):

The essence of Cassidy-Collins, and the reason that many Republicans don’t like it, is that it isn’t actually a full Obamacare replacement. Instead, it’s a federalist compromise. It lets individual state governments decide whether they want to stick with Obamacare or not, which would mean that the law would remain intact in most blue states for the time being, while redder states would have the opportunity to turn roughly the same amount of money (95 percent) to a different end.
That end would look like one of the more plausible conservative alternatives to Obamacare: a subsidy to cover the cost of a catastrophic health insurance plan, plus a directly funded health savings account to cover primary care.
Not exactly plausible; the health savings account won't work for the half of the population living paycheck to paycheck, assuming that the federal pay-in is as stingy as these proposals usually are (from their private school vouchers that won't pay a tenth of what private school costs onwards; there's a reason why Collins doesn't offer any numbers on this one)—just like Ivanka's scheme for giving a tax break to people who can afford to spend $10,000 a year on day care and other such typical Republican programs geared to the needs of the decent, god-fearing folks in the top income quintile who literally have never tried to imagine what it's like to live on less than $120,000 a year. (Of course to them being unable to save money is a moral failing, so when the plan doesn't work it will be our fault, not the Republicans'.)

This is why we need insurance, because the expense of the non-catastrophic crisis, if it comes, is as impossible for most of us to cope with if we don't have insurance as the catastrophic one would be. If they are willing to give us enough money to buy an insurance policy, why can't we have insurance? If it won't be enough for that (I'm pretty sure it won't), how are they going to be enough to take care of somebody with a chronic condition or a run of small-scale bad luck?

The beauty of the plan, anyhow, is that it permits Congress to not make any decision at all, which is exactly what they desperately want. It's all on the state governments to figure whether their voters' desire for the Affordable Care Act or their hatred for Obamacare is greater, while Congress can say they repealed it and didn't, at the same time. Congress votes ¯\_(ツ)_/¯.

There's some almost Brooks-level comedy in the way Ross summarizes the history of conservatism as a marriage—

Modern conservatism, at least in its pre-Donald Trump incarnation, evolved to believe in a marriage of Edmund Burke and Milton Friedman, in which the wisdom of tradition and the wisdom of free markets were complementary ideas. Both, in their different ways, delivered a kind of bottom-up democratic wisdom — the first through the cumulative experiments of the human past, the second through the contemporary experiments enabled by choice and competition.
I think that should perhaps read "bottoms-up" to reflect how much you have to drink to maintain the pretense that there's anything democratic about this arrangement, in which ancient patriarchy and modern nerdery conspire to make sure the actual demos has no voice at all.

(Brooks shows up, too, in the undocumented assertion that market solutions improve health care outcomes:

Which is not to say that the conservative health policy vision lacks empirical grounding. There is compelling evidence that markets in health care can do more to lower costs and prices than liberals allow, and good reasons to think that free-market competition produces more medical innovation than more socialized systems.
The first of those links is to a David Brooks column, not "compelling evidence" at all, but a reference to a report showing that competition can lead to quality improvements if prices are controlled, which is not a great test of market theory, and the other to some Tyler Cowen bullshit.)

But the big thing is how he makes it sound like an extremely uncomfortable marriage, between partners who remain together for appearance's sake but can't really remember what they used to have in common, back in the day. What is there in common, come to think of it, between them? Between the authoritarian conservatism of the 18th-century gentleman and the libertarian conservatism of the 20th-century institutional man?

What they have in common, as Douthat's formulation shows, is precisely their opposition to democracy, the suggestion that it's out of all our hands, that living people play no real role, that the issue is always between the old idea of our noble, but dead, ancestors and the new idea that produces itself, through the magic of the marketplace.

What differentiates them, in fact, is whose status they're meant to protect. Brooks's beloved Burkean theory for the landed aristocracy of ca. 1770, Friedman's worship of that Invisible Hand (operating anarchically on its own without the careful government management Adam Smith envisaged for it) for the corporate meritocracy of around 1975. (In the middle, I guess, the figure of the grand bourgeois of the 1880s keeps proclaiming the supremacy of the heroic risk-taker who doesn't sell his labor but rents his capital.) What they share is the demand for lowered taxes and reduced regulation on their special, unique selves. That's the conservative element, as it has been the whole time. Which is why Trump is a conservative too, for all their indignant protest.

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