A “monkey trap” is sprung when a victim is so reluctant to surrender a temporary gain it fixes him in place allowing his enemies to inflict long term destruction. He can escape by letting go but it never occurs to him; and so ‘the monkey is trapped not by anything physical, but by an idea, unable to see that a principle that served him well has become lethal’. The Patient Protection and Affordable Care Act, otherwise known as Obamacare, has been death on political monkeys. Its first victim was the Democratic Party which having hailed it as a step on the road to a single payer health care system, were so blinded to its financial and practical faults that they let it drag them to oblivion in the 2014 midterm and 2016 presidential elections rather than letting it go.
But its lethal career may not be over. Now it is Obamacare repeal-and-replace process which threatens to trap the administration of Donald Trump. If single-payer is the Holy Grail of liberal health policy, its conservative equivalent is a competitive health insurance market. In keeping with his election promises DJT must find some way to swap out the government-centric Obamacare engine with a completely different motor while keeping the car running — that is to say without disrupting the public’s health coverage. The public expects the administration to do radical things but without causing severe inconvenience. To do this Paul Ryan has devised a three step plan.
Proponents of the American Health Care Act [the GOP Obamacare replacement] claim that full repeal of Obamacare cannot be accomplished in one bill due to limitations imposed by the budget reconciliation process. House Speaker Paul Ryan, R-Wisc. made this point at length in a press conference held last week. Republican leadership in the House of Representatives insists that the best way to move forward on repeal is in a three-step process.
Step one is to use budget reconciliation to repeal Obamacare taxes, eliminate the individual and employer mandates, tweak the subsidies, and repeal some minor regulations. Step two is to let Department of Health and Human Services Secretary Tom Price take administrative action to repeal the rest of the regulations and administer free-market reforms via agency promulgation. Step three is for Congress to legislate further reforms that cannot be included in reconciliation.
It’s exactly the kind of procedure-centric plan Ryan would come up with. The trouble with this approach according to critics like Arkansas Senator Tom Cotton is that step one risks strengthening most of Obamacare’s most objectionable features (from the GOP viewpoint) before any progress from steps two and three even begin kick in. The Senator from Arkansas Tweeted his objections:
1. House health-care bill can’t pass Senate w/o major changes. To my friends in House: pause, start over. Get it right, don’t get it fast.
2. GOP shouldn’t act like Dems did in O’care. No excuse to release bill Mon night, start voting Wed. With no budget estimate!
3. What matters in long run is better, more affordable health care for Americans, NOT House leaders’ arbitrary legislative calendar.
To paraphrase the immortal Admiral Ackbar, Cotton is essentially warning that it’s a trap. Leaving aside bad faith from establishment GOP circles, the obvious danger to the conservative dream of a competitive health insurance market is that liberal opposition will let Ryan and Trump get far enough to wade into the swamp of partial Obamacare repeal but not far enough to replace it. To Ryan the bill may be the “American Health Care Act” but if Democrats have their way they will turn it into “Stalingrad” after the city in which the drive to Moscow was captured, starved and died.
The key problem the monkey must anticipate in such situations is whether he can complete the entire list of steps in the sequence not if he can succeed at any isolated step. The Trump administration must ascend the entire staircase to win; otherwise it loses. Whether that can be achieved through Ryan’s three little steps or Cotton’s one big leap is a calculation the GOP must make. Does it have the political capital and strategic focus to perform what is clearly a very ambitious goal? Should it take Paul Ryan’s installment approach? Or should it adopt Cotton’s now-or-never viewpoint, where everything must be risked and capital borrowed if necessary to snatch an opportunity that will never come again?
The American health insurance system is dysfunctional because it is so politically hard to change. Whole armies of idealists disappear into its endless spaces. The Obamacare monkey trap has already claimed one victim. It is now lying in wait for a second. Will Trump escape with the rice and coconut this time?
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Books:
The Vegetarian Flavor Bible: The Essential Guide to Culinary Creativity with Vegetables, Fruits, Grains, Legumes, Nuts, Seeds, and More, Based on the Wisdom of Leading American Chefs, by Karen Page. A comprehensive guide to maximizing flavor using vegetables based on insights from the chefs of such acclaimed restaurants as Crossroads and M.A.K.E. in Los Angeles; Cavendle 79, Dirt Candy, and Kajitsu in New York City; Green Zebra in Chicago; Greens and Millennium in San Francisco; Natural Selection and Portobello in Portland; Plum Bistro in Seattle; and Vedge in Philadelphia.
Inventing the Individual: The Origins of Western Liberalism, In a grand narrative spanning 1,800 years of European history, distinguished political philosopher Larry Siedentop firmly rejects Western liberalism’s usual account of itself as emerging in opposition to religion in the early modern era. He argues instead that liberal thought is, in its underlying assumptions, the offspring of the Church.
The Ransom of the Soul: Afterlife and Wealth in Early Western Christianity, by Peter Brown. Marking a departure in our understanding of Christian views of the afterlife from 250 to 650 CE, this much-acclaimed book explores a revolutionary shift in thinking about the fate of the soul that occurred around the time of the fall of Rome. Brown describes how this shift transformed the Church’s institutional relationship to money and set the stage for its domination of medieval society in the West. Some critics’ notes: “beautifully written” and “prodigiously original”.
The Day of Battle: The War in Sicily and Italy, 1943-1944 (Volume Two of The Liberation Trilogy), by Rick Atkinson. In the second volume of his epic trilogy about the liberation of Europe in World War II, Atkinson tells the harrowing story of the campaigns in Sicily and Italy. He follows the strengthening American and British armies as they invade Sicily in July 1943 and then, mile by bloody mile, fight their way north toward Rome.
For a list of books most frequently purchased by readers, visit my homepage.
Did you know that you can purchase some of these books and pamphlets by Richard Fernandez and share them with your friends? They will receive a link in their email and it will automatically give them access to a Kindle reader on their smartphone, computer or even as a web-readable document.
The War of the Words, Understanding the crisis of the early 21st century in terms of information corruption in the financial, security and political spheres
Rebranding Christianity, or why the truth shall make you free
The Three Conjectures, reflections on terrorism and the nuclear age
Storming the Castle, why government should get small
No Way In at Amazon Kindle. Fiction. A flight into peril, flashbacks to underground action.
Storm Over the South China Sea, how China is restarting history in the Pacific
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