Month: February 2017

Donald Trump has finally discovered that health policy isn’t easy. Speaking to reporters yesterday, he shared his revelation. “It’s an unbelievably complex subject. Nobody knew that health care could be so complicated.”

Nobody knew! Nobody, except, perhaps, President Obama, congressional legislators, health insurance executives, hospital administrators, doctors who manage practices, individual humans trying to navigate the system, or literally anyone who has ever interacted with American health care in any way whatsoever. The complexity of both the health care delivery and policy is the defining aspect of the system.

On the one hand, Trump’s statement is yet another reminder of both his deep aversion to specific policy knowledge, and his habit of describing any new piece of knowledge or understanding he gains as a unique personal revelation.

At the same time, it also reveals the very real problem that Republicans are encountering as they attempt to repeal, replace, and reform Obamacare. The policy issues are complex, and the politics are, if anything, even more complicated, and the interaction between the two creates an additional layer of complexity that Republicans have yet to really solve.

Just to take one example: One of the biggest parts of Obamacare was an expansion of Medicaid. A 2012 Supreme Court decision gave states a choice about whether to expand the program, which provides coverage for the poor and disabled, and 31 states said yes. A full repeal, or even a repeal of all the spending in the law, would roll back that expansion.

But Trump himself has repeatedly promised not to touch Medicaid, one of the nation’s biggest entitlements. And just this weekend, Trump’s Treasury Secretary, Steve Mnuchin, also said that the administration’s budget plan won’t touch entitlements. And as Trump found out at a meeting with state governors over the weekend, lots of governors, including some Republicans, are wary about rolling back or Medicaid as well. Hospitals, which get a lot of money from the Medicaid expansion, have also pushed for caution when it comes to repeal. And that’s just the inside-Washington forces.

In any case, if Trump agreed to a full repeal of Obamacare, he would be going back on his promise to not cut entitlements, and if he agreed to leave some version of the Medicaid expansion in place, he would be reneging on his promise to repeal Obamacare. Trump has stayed away from embracing any specific plan so far, allowing him to maintain this contradiction. But at some point, he’ll have to make a decision.

Of course, a full repeal isn’t really what’s on the table. That’s because Republicans are planning to use the reconciliation process to repeal the law, and that process only allows them to touch provisions with a non-trivial budgetary impact. That means that the subsidy spending and the mandate can go, but the rules prohibiting insurers from discriminating against people with preexisting conditions stay on the books.

Now, there are some reasonably strong arguments that the GOP could repeal the law’s insurance regulations through the reconciliation process if they wanted to. As the Mercatus Center’s Charles Blahaus recently pointed out, the Congressional Budget Office has said in the past that those provisions have a clear budgetary impact. In theory, Republicans could use this as evidence when making the case for including the repeal of those rules. At the very least, they could try. But so far they haven’t.

One problem is that those regulations are among the most popular parts of the law. Another related problem is that Trump said after the election that he wants to preserve Obamacare’s preexisting conditions protections. Even some Congressional Republicans are on board. GOP Sen. Chuck Grassley recently told a townhall questioner that, “There are a lot of consensus in Washington that the one issue that you brought up — pre-existing conditions — should not be changed.”

Trump and his top advisers have also said that he wants to preserve coverage for everyone who currently has it under Obamacare, but the GOP plans currently being drafted wouldn’t do that. And even if they eventually led to a system with roughly equivalent coverage numbers, there would be a huge amount of short-term disruption.

These sorts of difficulties are why the repeal effort has bogged down, and why Republican leadership is, according to a Wall Street Journal report, now intent on holding a vote on the reconciliation bill, and essentially daring their fellow Republicans to oppose it. That’s a high-risk strategy, because there isn’t much margin for error: The GOP can sustain just two defections in the Senate, and 22 in the House, so any sizeable opposition could derail the plan. In fact, it may already have been derailed: Last night, Rep. Mark Meadows, who heads the House Freedom Caucus, has said his faction cannot support the current legislative draft. Presuming no support from Democrats, the bill won’t survive without them.

The interlocking complexity of the system is one of the reasons that Obamacare is such a frustrating law: It built on top of an already-labyrinthine system that had been created and modified over years, and it was crafted and influenced by an array of factions with competing interests.

It’s also why, with Trump’s big address to the joint Congress looming, some Republicans are now looking to Trump to guide them out of this mess. “The president can play a major role in endorsing a plan he wants to sign into law, and I think it’s absolutely essential that he takes a lead role,” Rep. Chris Collins told Politico. Given Trump’s near total lack of engagement with the various policy mechanisms and trade-offs involved, I wouldn’t raise expectations too high. Even if he does endorse some specifics in his speech, it’s always possible he’ll reverse himself.

In any case, though, Trump’s essential point is right: Health care is indeed complicated. And not only is it complicated, Trump’s inconsistent and uninformed statements on the matter have made it even more so.

“There is a tradition of Islam that actually values enterprise and free trade,” says Mustafa Akyol, a New York Times columnist and author of Islam Without Extremes: A Muslim Case for Liberty. “Islam was born as a very trade-friendly religion. Prophet Muhammad was a merchant himself.”

Akyol says the current state of affairs in the Islamic world can lead people to feel pessimistic about its future and the prospect of a free society. But “to extrapolate this out to all Muslims and to say ‘this is what Islam probably is,’ would be the biggest mistake,” Akyol says. “What Islam can be, and what Islam was in the past, is a different discussion.”

While the historical basis for compatibility with the West exists, there are still many challenges that face the Islamic world. Akyol says a change to Islam along the lines of the Protestant Reformation isn’t necessarily what’s needed. “What we need is the Enlightenment…not Luther, but John Locke.”

Nick Gillespie sat down with Akyol at the International Students for Liberty Conference to discuss the historical relationship between Islam and free trade, how Islamists reshaped the religion into political authoritarianism, and whether or not Islam needs a reformation or an enlightenment.

Produced by Mark McDaniel. Cameras by McDaniel, Joshua Swain, and Todd Krainin.

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Donald Trump is famously prone to conspiracy theories, but that in itself isn’t unusual for a president. “Indeed, there’s a long history of presidents and their inner circles obsessing about malevolent cabals. What’s different about Trump isn’t the fact that he talks about dubious conspiracies. It’s the way he talks about them.”

Who am I quoting there? Why, I’m quoting myself! Yep, this is one of those Hit & Run posts where we promote a piece we published elsewhere. In this case, The New Republic asked me to write something about presidential paranoia, and I obliged with a story that hops from John Quincy Adams’ obsession with Masonic plots to Richard Nixon stewing about the Jews to Donald Trump’s dark speculations about the death of Antonin Scalia. What makes Trump stand out, I argue, isn’t the content of his theories so much as the fact that he spouts them without regard for elite mores:

Conspiracy theories tend to be disreputable. Indeed, in most circles of respectable opinion, the very phrase conspiracy theory is used as a pejorative. So when high-level officials embrace a position considered to be taboo, they often prefer not to talk about it. John Kerry has long rejected the official story about JFK’s assassination, but when Meet the Press brought up the subject in 2013, the secretary of state clammed up. “I just have a point of view,” Kerry demurred. “And I’m not going to get into that.”

Our new president, to the delight of his supporters, presents himself as a man unshackled by such mores of polite society. Richard Nixon may have been prone to seeing plots everywhere, but it’s hard to imagine him publicly promoting a transparently phony theory tying Rafael Cruz to Lee Harvey Oswald; it’s harder still to picture him backing up his claims by citing the National Enquirer. For Trump, neither the story nor the source is something to be ashamed of.

There’s a strong chance, of course, that Trump doesn’t actually believe the Enquirer story, and that he only brought it up because Ted Cruz happened to be his chief political foe that day. That’s where his cynicism comes in. Trump doesn’t just spout unsubstantiated accusations; he often drops them as quickly as he brings them up, as though it never really mattered if they were true.

The full article is here. My book on conspiracy theories is here. And the last article I wrote for The New Republic is here. It’s from March of 1998, so my appearances there, like the ancient Greek calendar, appear to be based on a 19-year cycle.

President Trump promised a “historic increase in defense spending” in remarks to the National Governor’s Association (NGA), suggesting concomitant cuts in non-defense spending (excluding entitlements) would cover the increase. Trump described what would be his first federal budget proposal as a “public safety and national security budget.”

The Trump budget is set to propose a $54 billion dollar increase (nearly 10 percent) in defense spending, to $603 billion, and a cut in non-defense discretionary spending to $462 billion, according to White House Office of Management and Budget (OMB) Director Mick Mulvaney.

Mulvaney described the budget, which will be submitted to Congress next month, as an expression of Trump’s campaign agenda. “It will show the president is keeping his promises and doing exactly what he said he was going to do,” Mulvaney said, according to The New York Times. “We are taking his words and turning them into policies and dollars.”

Mulvaney’s December appointment to lead OMB was hailed by budget hawks, as he had been a vocal advocate for spending cuts while a member of Congress. As recently as last summer, Mulvaney campaigned on the idea that military spending should not be exempt. “If we are going to balance the budget, then all spending needs to be scrutinized, including the Pentagon,” Mulvaney wrote in a Facebook post, according to the Greenville News. Mulvaney’s congressional Facebook page has since been deactivated.

Mulvaney’s 2016 Democratic opponent attacked him for his position on military spending cuts, saying the 2011 sequester that Mulvaney supported, which slowed down the rate of growth of military spending, meant Republicans had “gutted the military when it was needed the most.” The position illustrates the difficulty any remaining budget hawks will have in resisting Trump’s budget proposals or offering politically-feasible counter-proposals.

Trump’s proposed massive military spending increase cannot even be reasonably interpreted as an extreme first offer meant to spur negotiations, because there is little will in Congress for spending cuts of any kind, let alone those of the military. That’s unfortunate, because, as Benjamin Friedman wrote in Foreign Affairs in 2011, “austerity is the best auditor.” Responsible, managed cuts in military spending could improve military readiness by forcing much-needed reprioritizations. The president’s proposed military spending increase is unfortunate, especially given Trump’s early focus on a number of military contracts he considered overpriced. Those contracts are a kind of microcosm of the wider military budget. Increasing military spending will only make such contracts more bloated.

Outside of the military, Trump appears to understand the value of spending cuts in increasing government efficiency, or at least to have a grasp on the rhetoric. “We’re going to do more with less and make government lean and accountable to the people,” Trump said in his NGA remarks. “The government must learn to tighten its belt, something families all across the country have had to learn to do,” Trump said, “unfortunately, but they’ve had to learn to do it and they’ve done it well.”

As William Ruger, the Charles Koch Institute’s vice president of policy and research explained at a CPAC panel this weekend, conservatives have a tendency to treat the military bureaucracy as an “honorary member of the private sector,” ignoring that it was prone to the same waste and inefficiency as the rest of government. Throughout the presidential campaign, many conservatives questioned Trump’s credentials. He certainly shares the blind spot of many conservatives when it comes to military spending, and seems to have helped Mulvaney develop one of his own.