Trumpcare may have gone away for the moment, but whatever happens next is going to involve the Republican Party in some shape or form. That they can’t be trusted with Americans’ healthcare is unlikely to change just because of a close Senate vote, so I think these first two pieces published in mid-week are still relevant. Both give lengthy histories of how we got where we at least were on Thursday, some of which I bet you didn’t know.
First, Marie-Astrid Langer in the NZZ, whose piece begins ”The disastrous health system is becoming an ever-increasing problem for the US…”:
As positive as this sounds in theory, Obamacare is in reality a complicated and expensive mechanism. The expansion of Medicaid tears another hole in the state budget. At the same time, the incentives for healthy people to insure themselves are too meager and the penalty fee for noncompliance is ridiculously low.
The Republicans are now in a dilemma: the arch-conservative wing wants to abolish Obamacare, government aid programs are only to be accessible to the poorest. The moderates, on the other hand, fear the consequences that would follow a rollback of the Medicaid expansion; in the end, the program also covers therapies for opiate addicts and psychiatric patients. This explains why the Republicans have tried crafting a reform in vain since January. In doing so they repeat the mistakes of the Democrats: behind closed doors and in solitude, they merely screw around the symptoms of the ailing health care system.
Switzerland succeeded where the US failed
This would better have been the moment for a fundamental, cross-party reform: this could build on Obamacare, but would have to actually enforce the insurance obligation. It should also abolish the tax subsidy for employer-based health insurance. Switzerland showed in 1994 that fundamental reformis possible. The then health insurance system was, according to the Americans, the most expensive in the world. Insurances could exclude pre-existing diseases, 5% of the population were without health protection. But in the same year, when Clinton’s bill failed, Switzerland began a reform in the face of resistance from industry.
I admit I hadn’t realized that the Swiss multi-payer system was less than 25 years old. Switzerland is a conservative country and had a system nearly as awful as America’s, so it might well pay to have a look at what they did. On the other hand, they didn’t have the Koch brothers.
Another Swiss publication, the Tages-Anzeiger, has Sacha Batthyany looking at the ideological history:
It began around 1910 when liberal circles debated in the US for the first time about the introduction of health insurance. The model was Germany, the country with the world’s oldest social health insurance law. In 1911 the British joined in when parliament passed a national insurance law. In America, there was an upsurge in optimism at this time, the climax of the so-called Progressive Era.
“The idea of a health insurance company really gained momentum in 1916,” says historian Jill Lepore, a professor at Harvard and author at the “New Yorker”. “A health insurance was being debated in the California parliament. They wanted to protect the workers of mass industrialization and the inhabitants of the booming cities, “Lepore said. The idea spread to other countries and won supporters across the country.
But then the US moved into the First World War, which gave the critics a casualty, because suddenly the idea of a universal health insurance was considered “too German”, Lepore said. It was the Americanization of America. The anxiety was that California could become “Prussian.” The political rhetoric, albeit completely out of thin air, worked: the opposite side carried the day, the topic was settled for the time being.
And just as a hundred years ago, the arguments of the opposing party are now based on a kind of social Darwinism. The stronger is said to survive, they said earlier. Today it is said, the market should determine it. But no universal health system can function on the market because the principle of supply and demand has no significance in the health system. Anyone suffering from cancer cannot choose from treatment methods and decide on the cheapest.
According to historian Lepore, however, it is not just because of the opponents that state health insurance in the United States is so unpopular. Rather, the advocates who have not yet worked out how to explain to people in simple words why medical protection is not an intervention in the freedom of the individual.
The fact that in America even today an idea that gives all people a better life is so aggressively debated, according to Lepore, can be understood only from this hundred years of history. However the current debate goes, Lepore says that this struggle is not over.
In The Independent, David Usborne considers the victory to be Hillary’s. Well, sort of, anyway.
But let’s give some due to the Democrats, who have almost been forgotten in all of this. “It’s been a long, long road. I suggest we turn the page,” Chuck Schumer, the Minority leader, offered minutes after McConnell’s so-called “Skinny Bill” at least to unwind parts of Obamacare fell to defeat. If the senator from New York was looking smug, you could hardly blame him.
Hillary Clinton wins! That was the headline we thought we were going to be reading last November. But maybe now she does. The one thing that most terrified her supporters about the unthinkable occurring – complete Republican control of Washington – was that the only really big thing Democrats had done in eight years with Barack Obama at the top would be destroyed.
Call it a vicarious victory for Clinton, at least. It comes thanks to Schumer who warned colleagues in January that Republicans would try to pick them off one by one in their quest to kill the health law. Only by sticking together would they thwart them. This wasn’t going to be easy. The Democrats are no more ideologically homogeneous than the Republicans are, ranging from Bernie Sanders on the left to Joe Manchin of West Virginia to the centre. But they did it.
They also coordinated with a fearsome army of grass-roots resisters, including groups like MoveOn.org, Indivisible and the Progressive Change Campaign Committee. Relations were sometimes tense, the anti-Trump factions not always convinced the Senate Democrats would stay strong. Indeed, Schumer was not always as obstructive on the Hill as they wanted. But his strategy of more constructive resistance – he allowed members to talk to Republicans about improving Obamacare but never, ever about repealing it outright – worked. Instead of Republicans exploiting Democrat disunity, it was Democrats who exploited theirs.
Given the much looser nature of American political parties, with Congresscritters often being keen to demonstrate that they only sometimes agree with the party they nominally represent, the unity of both the House and Senate Democrats was remarkable. Should Chuck Schumer or Nancy Pelosi fancy a new career, they could probably command enormous fees as cat-herders.
John McCain has been getting altogether too much credit for voting it down, with far too many people calling him the nation’s savior, and Sean O’Grady is as guilty as anyone, but this is quite a decent piece even so:
Was it McCain’s act of revenge? I hope so. Trump certainly deserved it. It isn’t a competition, but I found Trump’s denigration of McCain over being captured in Vietnam one of the most offensive things he has said or done over a lifetime. (“He’s not a war hero. He’s a war hero because he was captured. I like people who weren’t captured.”)
The remark is a living monument to offensiveness: the alternative Trump Tower of insults.
It’s worth comparing the two men’s war records. In brief: Trump hasn’t got one, McCain has.
Born in 1946, Trump was of prime military age when the Vietnam War was at its peak in the mid-1960s and early 1970s. The draft saw many young Americans of Trump’s generation, disproportionately poor and black, sent off to fight communism, and 58,220 of them didn’t come back. Trump had four draft deferrals, including for college and for a bone spur in his foot. While John Kerry also served with distinction (though his war record was also to come under unfair attack), Al Gore went on to become a forces journalist and even George W Bush did some time with the domestic National Guard (though well away from any whiff of napalm in the morning), the athletically built Trump sat the whole ugly episode out.
Imagine what a fine leader of men Trump would have been during the Tet Offensive or on an Apocalpyse Now-style expedition up the Mekong River to smash the Viet Cong. Or maybe he would have been like the good-hearted, old-fashioned hero portrayed by John Wayne in The Green Berets? Trump’s innate abilities could have seen him grow into the Eisenhower of his age. Or maybe Lieutenant Trump would have just spent his time bragging about his money, lounging around the officers’ mess, stuffing his face, chasing skirt and ridiculing the Vietnamese and men under him, more liability than asset in the struggle to win hearts and minds?
The healthcare vote was close. Not so the vote on the sanctions against Russia, which are widely seen in the US as a slap in the face for POUTS. The EU don’t agree, preferring to regard it as a slap in the face for the EU.
The USA is concerned with itself. Who has brain space for the complexity of the world when Donald Trump is sitting in the White House – and there is a lot to say that he would not have got there without help?
Both Democrats and Republicans see Russia’s influence on the US election in 2016 as what they are: an attack on the heart of the American state. The US House of Representatives has now launched new, very far-reaching sanctions against Russia.
It is worrying that the sanctions are not aligned with the traditional US allies, nor are their interests taken into account. From Trump one does not expect anything else, from Democrats and Republicans we used to.
US sanctions have already caused collateral damage. The already battered German-American relationship among it. More than a third of German gas supplies have come from Russia for decades. Even Federal Chancellor Angela Merkel (CDU), not someone usually suspected of Putin-friendly feelings, has protested…
The question is also whether it would actually be in the interests of America if Russia were to fall into a deep crisis as a result of the sanctions. The experience of the past years, however, speaks against it: In the ten years after Putin’s entry, Russia’s gross domestic product grew almost eightfold. At that time, for the first time a broader bourgeois middle class developed, especially in the big cities.
In the years 2011 and 2012, however, Putin’s poll ratings fell sharply for the first time – although economic output and average wages were higher than ever before.
At that time, the newly developed middle class rebelled in Moscow and Saint Petersburg. Millions of Russians had, at that time-their material survival seemed to be at last secured to them-free their heads for new targets. In surveys, they were increasingly showing how much they resented the interference in politics, the bad education, the lies on television. Growing prosperity and a growing population is a risk for Putin, not poverty.
In the logic of offense and retaliation, the sanctions may be comprehensible. They are not clever. Should the law come into force, the position of the hardliners around Putin will be further strengthened in Moscow. They preach the political and economic detachment from the West for years. Strictly speaking, since the turn of 2011/2012 – when Putin’s polls sagged.
At the heart of the dispute is energy supply. Jean-Pierre Stroobants and Benoît Vitkine explain in Le Monde:
The Commission refers to a “unilateral” act breaking with the tradition of consultation between Washington and the EU over the sanctions to be imposed on Russia, whose financial and defense sectors have been targeted for three years. Brussels, citing the necessary unity of the G7 and the Minsk agreements on the Ukrainian conflict, feared the collateral effects of the American initiative. It would allow fines to be imposed on firms participating in Russian energy exports or to prohibit them from accessing US tenders.
An opinion shared by Paris which denounced the consequences of these sanctions. “This bill, if promulgated, would allow the enactment of measures against European natural or legal persons . (…) As a result, the extra-territorial scope of this text appears illegal under international law , “ said the spokesman of the Quai d’Orsay Agnès Romatet.
The North Stream 2 pipeline project could be particularly targeted: estimated at some 9 billion euros, it should in principle link Russia to Germany via the Baltic Sea. The project, which was supposed to be launched in the spring of 2018, involves large companies: French Engie, Anglo-Dutch Shell, Austrian OMV and German groups Uniper (formerly ON) and Wintershall (BASF Group) Associated with the Russian giant Gazprom. The submarine pipeline – parallel to North Stream 1, which operates since 2012 – would have a capacity of 55 billion cubic meters.
Mobilizing “all its diplomatic channels” , Brussels evoked a possible “adequate response” on Tuesday. Europeans could theoretically restrict the access to credit of American firms from European banks or adopt a text preventing any American jurisdiction over companies in the Union. They could also lodge an appeal with the World Trade Organization.
In the FAZ, though, Klaus-Dieter Frankenberger takes a more optimistic view:
Perhaps one should look at the matter again and take a deep breath before blowing to counter-attack. It is explicitly stated in the drafts adopted by the two chambers that the new sanctions, which should be directed against Russian energy projects, the President should undertake only in “coordination with the allies” in Europe. There is no question of an politico-industrial go-it-alone. On the contrary, it is said that the president should maintain and seek unity with the Europeans and other partners in the sanctions policy against Russia.
One must keep in mind: in fact, the unity of sanctions policy is important, indeed indispensable. Anyone who, for whatever reason, consciously, negligently, or pure egoism, disturbs this closeness, is acting against Western interests – and rewards Russian power politics. At the moment, the American-European relationship is not free from small differences. The concern that trade-political differences of opinion might intensify and somehow turn into a trade war is not unjustified, even if the import tax is off the table.
Both sides should be clear about the priorities of their policy towards Russia, whose behavior in the Ukraine has not changed. The German Minister of Economic Affairs, Zypries (SPD), is right: a common approach is “more correct than if the United States is now going an isolated way”. The co-ordination mandate addressed to the president in the new law could be a starting point for this joint approach in the future. Now cool minds are in demand and not hysterical debates.
Who knew this stuff could be so complicated, eh?
Certainly not the occupant of the Orange House or his amazingly competent entourage, who have fascinated Feargal Keane:
Pondering the travails of President Trump and his entourage this morning, the title of John Kennedy Toole’s magnificent New Orleans comedy comes to mind. What we are watching is a political version of A Confederacy of Dunces. Out goes Sean Spicer, piqued and exasperated and, probably, a source of unending future mischief. In comes Anthony Scaramuccio who once called Trump a “hack politician” but has since drunk the Kool Aid of proximity to power, and who believes he can handle the President’s catastrophic image problem.
To see the unravelling of this administration simply through the prism of conspiracy is wide of the mark. There is no evidence on the American side of the political intelligence needed to master a plot that involves getting into bed with the Russians to ruin Hillary Clinton. This is not to say there was no conspiracy. Let’s wait until Robert Mueller reports before we decide on that. But the Trump campaign blundered into Russiagate. They were played by the Kremlin which had every interest in seeing Hillary defeated.
A word on Putin. He is usually portrayed in the western media as a dark genius, the master manipulator. In this case, that image is magnified by virtue of comparison with President Trump. But has Putin really proved a clever player in this? I would argue not. The tactics employed by a KGB officer in the Cold War are manifestly unsuited to the demands of national leadership in the 21st century world.
Putin has silenced the critics in his own country and surrounds himself with yes-men in the Kremlin. He may have convinced himself that he is indeed a genius. He may have won a short-term advantage but America’s woes will not last. And whatever transpires, no subsequent American President will trust a word or gesture of Vladimir Putin. The Russian leader has damaged his own country’s cause inestimably. All of this will come back to haunt Russian-American relations.
Scaramucci has been attracting some attention for reasons which are not entirely clear to me. I’m sure he’s bigly competent and an ideal fellow to be POUTS’s spokesthing. But Matthew Norman isn’t as impressed:
When most of the planet reckons you’re running a mafia crime family from the Oval Office, and things are beginning to fall apart, who better to hire to speak for you than someone by the name of Anthony Scaramucci?
The one disappointment about Donald Trump’s new consigliore is his nickname. “The Mooch”, which suggests indolence, lacks that authentic Sopranos flavour (Little Pussy Malanga, Paulie Walnuts, and so on). For reasons outlined below, Tony Two-Face would be stronger.
He may have zero experience in the field, but he was making his bones on the Street, selling incomprehensible hedge fund derivatives, while Spicey was running errands for the effete Republican establishment.
And he’s got some balls on him. Within hours of Friday’s allegiance-swearing ceremony, when he became a made man, he was burying the evidence. Admittedly, deleting tweets is futile in the age of the screenshot. But, by going through the motions, he showed proper respect and loyalty to the capo di tutti capi….As for the 2015 TV interview in which he called the godfather “a hack politician. I’ll tell you who he’s going to be president of – you can tell Donald I said this – the Queens County bullies association” – look, what matters isn’t what you believed yesterday, or indeed your whole adult life. What counts is what you sincerely believe this minute, and Tony Two-Face has changed his opinions about everything, including Trump.
Devotees of The Sopranos will definitely find the whole article worth a read. In fact, most people will find it so.
I’m going to finish by nicking Private Eye’s take on Scaramucci:
That White House Press Conference In Full
New WH Comms Director: OK, any questions?
1st Correspondent: Scaramucci! Scaramucci! Can you do the fandango?
Mr Scaramucci: What I will say is this… that I have th greatest respect for the president, although he was annoyed by my presious unsympathetic tweets.
2nd Correspondent: Thunderbolt and lightning?
Scaramucci: He was certainly quite cross.
3rd Correspondent: Very, very frightening?
Scaramucci: (laughs) Me?
4th Correspondent: Are there any other new appointments to Mr Trump’s rather bizarre Cabinet that you can tell us about?
Scaramucci: Galileo. Galileo…
5th Correspondent: Galileo? Galileo?
Scaramucci: Figaro magnifico
6th Correspondent: I am afraid we don’t recognise these names. Is this fake news?
Scaramucci: I’m just a poor boy, nobody loves me. I’m just a poor boy from a poor family.
7th Correspondent: You worked at Goldman Sachs, you are unbelievably rich, like the rest of the cabinet. What are you talking about?
Scaramucci: Spare me my life from this monstrosity.
8th Correspondent: Is that a reference to the president? What about the Trump financial empire?
Scaramucci: Easy come, easy go. Will you let me go?
Correspondents: Bismillah! No, we will not let you go. We’ve got more questions…
Scaramucci: Mamma mia, let me go (continues for rest of Bohemian Rhapsody)
Try not to need to call on your health insurance today.