… to the worst health insurance system in the industrialized world
JD Vance’s dance across the Sunday shows is one for the ages. We’ve already discussed his admission that they “create stories” (such as immigrants eating pets) in order to “draw attention” to the issues they think benefit them. But he said other things that are almost as interesting — and damning.
What asked about Trump’s “concept of a plan” about replacing Obamacare (which just demonstrated in living color the fact that Trump had no plan despite promising for 9 long years) Vance replied:
You want to make sure that preexisting coverage – conditions are covered, you want to make sure that people have access to the doctors that they need, and you also want to implement some deregulatory agenda so that people can choose a health care plan that fits them. Think about it: a young American doesn’t have the same health care needs as a 65-year-old American. A 65-year-old American in good health has much different health care needs than a 65-year-old American with a chronic condition. And we want to make sure everybody is covered. But the best way to do that is to actually promote some more choice in our health care system and not have a one-size-fits-all approach that puts a lot of people into the same insurance pools, into the same risk pools, that actually makes it harder for people to make the right choices for their families.
Maybe Vance was busy changing identities during the heath care debates of 2009, but anyone who was listening during that period knows that this is fatuous nonsense. You can’t guarantee that pre-existing conditions are covered without regulating the insurance market and that requires:
- Guaranteed issue: Carriers must sell to everyone in the market.
- Community rating: Everyone’s in the same risk pool, and plans come with the same premiums (or very similar premiums) no matter who’s buying them.
- Critical mass: The market needs to be big and diverse enough (particularly in age and health-status) to pool risk widely and bargain with providers.
- Subsidy: If monthly out-of-pocket expenses are too high, people will leave the marketplaces and they’ll become unviable.
That handy list comes from Brian Beutler who discusses this in his newsletter today pointing out that essentially what Vance was saying is a lie and a big one. He writes:
The Trump-Vance policy is to rip out the second and third tentpoles and go back to the old way. They intend, per Vance, to segregate young from old, and healthy from sick, so that people who don’t yet have costly medical needs can free ride, and those who already do will lose the benefits of risk pooling, sending their premiums soaring.
Vance wants people to believe that “pre-existing conditions are covered” under such a plan, and his fig leaf is that the law will still nominally require plans to cover treatment for pre-existing conditions. But that law will be meaningless to the millions of people who suddenly won’t be able to afford their coverage.
It would take us back to the time when I was denied health insurance because I had periodontal disease. (I’m not kidding.) When I finally found a health insurer who would cover me ( I was otherwise completely healthy) it cost well over a thousand dollars a month and it had a gigantic deductible. That’s the market we were living in if we didn’t have employer or government insurance. Vance wants to take us back to that and people really should know that.
I also like what Beutler said about Vance revealing this when Trump has been vague about specifics (mostly because he doesn’t understand them.)
Most of the MAGA politicians who want to take up Trump’s mantle have pickled their brains with racism. Unlike Trump, though, many of them have at least a touch of intellectual vanity.
Before entering politics, Trump never labored for the admiration of national political elites or legal elites or media elites. His neuroses attached to other forms of status—he wanted to be admired and accepted by the Manhattan upper crust, but his try-hard affect marked him as an interloper.
Below Trump on the political totem pole, aspiring MAGA leaders like Vance suffer from an analogous form of striving. They were groomed by elites. They want to oppress, but they also want smarty-pants cred. Trump will lie for passing advantage, and bluster when he doesn’t know what he’s talking about, but in a contest of intellect, he’ll simply claim superiority (“the best people” “Wharton school of finance”).
The people coming up behind him want to demonstrate it. They’ll lie with Trumpish insouciance, but then, like Vance, they’ll explain their true intent, as if to flaunt the intellectual scaffolding beneath the lies.
On Meet the Press that meant claiming to support pre-existing conditions protections, then describing a plan that would unravel them. On CNN it meant lying about immigrants, and then explaining, “If I have to create stories so that the American media actually pays attention to the suffering of the American people, then that’s what I’m going to do.”
This is not a disciplined con artist trying to conceal motive with distraction. It’s the conduct of someone too arrogant to be so calculating.
Beutler rejects the idea that Trump and Vance are consciously trying to distract (“deadcatting” ) and are instead just following their own insecurities. I kind of agree with him (despite writing about the distraction tactic earlier.) I know that Trump is rarely so calculating, at least to the extent that he sits down with his team and maps out a strategy. He has a feral survival instinct that he trusts implicitly and it often works for him. And Beutler makes an excellent point about Vance.
Maybe both of them really are just winging it.