Monday , December 11 2017
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Populism and the Politics of Health

Summary:
What’s next on health care? Truly, I have no idea. The AHCA is a real stinker, and now everyone knows it; ordinarily, that should doom the legislation. But everyone also knows that starting off the Trump legislative era with the crashing and burning of Obamacare repeal would deeply damage Trump; nobody believes what he says, but if he can’t even ram bills through, people will stop being afraid. So they will pull out all the stops. But why are Republicans having so much trouble? Health reform is hard; but why were the Dems able to pass the ACA in the first place? I’m seeing a lot of talk about Paul Ryan’s inadequacy and Republican lack of preparation as compared with Pelosi and the Dems in 2009, all of which is true. But there’s a more fundamental issue: who is being served? Obamacare helped a large number of people at the expense of a small, affluent minority: basically, taxes on 2% of the population to cover a lot of people and assure coverage to many more. Trumpcare would reverse that, hurting a lot of people (many of whom voted Trump) so as to cut taxes for a handful of wealthy people. That’s a difference that goes beyond political strategy. But one way to say this is that Obamacare was and is a truly populist law, while Trumpcare is anti-populist. That’s reflected in the legislative struggles.

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What’s next on health care? Truly, I have no idea. The AHCA is a real stinker, and now everyone knows it; ordinarily, that should doom the legislation. But everyone also knows that starting off the Trump legislative era with the crashing and burning of Obamacare repeal would deeply damage Trump; nobody believes what he says, but if he can’t even ram bills through, people will stop being afraid. So they will pull out all the stops.

But why are Republicans having so much trouble? Health reform is hard; but why were the Dems able to pass the ACA in the first place? I’m seeing a lot of talk about Paul Ryan’s inadequacy and Republican lack of preparation as compared with Pelosi and the Dems in 2009, all of which is true. But there’s a more fundamental issue: who is being served?

Obamacare helped a large number of people at the expense of a small, affluent minority: basically, taxes on 2% of the population to cover a lot of people and assure coverage to many more. Trumpcare would reverse that, hurting a lot of people (many of whom voted Trump) so as to cut taxes for a handful of wealthy people. That’s a difference that goes beyond political strategy.

But one way to say this is that Obamacare was and is a truly populist law, while Trumpcare is anti-populist. That’s reflected in the legislative struggles.

And yet, and yet: Trump did in fact win over white working-class voters, who thought they were voting for a populist; Democrats, who did a lot for those voters, got no credit — rural whites, in particular, who were huge beneficiaries of the ACA, overwhelmingly supported the man who may destroy their healthcare.

This ties in with an important recent piece by Zack Beauchamp on the striking degree to which left-wing economics fails, in practice, to counter right-wing populism; basically, Sandersism has failed everywhere it has been tried. Why?

The answer, presumably, is that what we call populism is really in large degree white identity politics, which can’t be addressed by promising universal benefits. Among other things, these “populist” voters now live in a media bubble, getting their news from sources that play to their identity-politics desires, which means that even if you offer them a better deal, they won’t hear about it or believe it if told. For sure many if not most of those who gained health coverage thanks to Obamacare have no idea that’s what happened.

That said, taking the benefits away would probably get their attention, and maybe even open their eyes to the extent to which they are suffering to provide tax cuts to the rich.

In Europe, right-wing parties probably don’t face the same dilemma; they’re preaching herrenvolk social democracy, a welfare state but only for people who look like you. In America, however, Trumpism is faux populism that appeals to white identity but actually serves plutocrats. That fundamental contradiction is now out in the open.

Paul Krugman
Paul Robin Krugman (born February 28, 1953) is an American economist, Distinguished Professor of Economics at the Graduate Center of the City University of New York, and an op-ed columnist for The New York Times. In 2008, Krugman won the Nobel Memorial Prize in Economic Sciences for his contributions to New Trade Theory and New Economic Geography.

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