What should President Trump do about the defeat of RyanCare? After House Speaker Paul Ryan’s health-care bill stalled in the House, Trump suggested he might just leave Obamacare in place and let it explode
No one else seems to want that, though. Some conservatives are trying to revive the effort to repeal and replace, in May or maybe even sooner. Many on the Left have seized on the failure of Ryan’s American Health Care Act as a sign that it’s time for Democrats to work with Trump on a single-payer health care system that “takes care of everybody,” as Trump himself promised during his presidential campaign.
It’s not just the Left. Frank Buckley, the conservative law professor and author who helped organize “Scholars and Writers for Trump,” agrees: it’s time for Trump to embrace single-payer. In a recent column for the New York Post, Buckley doesn’t try to make a policy argument for a Canada-style national health-care system, he makes a political argument for it.
Buckley believes RyanCare’s defeat could be a triumph for the Trump agenda, “if used wisely as a means of reinventing the Republican Party as a party of working Americans of all races and ethnicities. Split the Republican Party, if need be.”
Trump’s Coalition Was Anti-Obamacare Republicans
He claims “the people who elected Trump” would support such a plan, then offers a caricature of those people that could have come straight from the New York Times editorial board: “They weren’t right-wing ideologues. They were people who had lost or who feared they’d lose their jobs. Many were but a few steps away from the diseases of despair, social isolation, drug and alcohol poisonings and suicide that Anne Case and her husband, Nobel laureate Sir Angus Deaton, tell us have lowered the life expectancy of white Americans.”
It will no doubt come as a surprise to the tens of millions of middle-class Republican voters who supported Trump that “many” of them “were but a few steps away” from “diseases of despair” like suicide and heroin addiction.
Trump did attract crucial support in parts of the Midwest and Appalachia where the manufacturing economy has been hollowed out and communities have been ravaged by drug abuse and suicide. But the relatively small numbers of rural and suburban voters that helped swing certain counties in Pennsylvania and Wisconsin for Trump hardly make up a powerful political constituency, especially when it comes to something as big and important as health care.
The fact is, Trump’s coalition was made up largely of regular old Republicans, the same voters who have been sending lawmakers to Washington for seven years on promises to repeal and replace Obamacare. The defeat of RyanCare exposed huge problems with GOP House leadership’s grasp of the political moment and what’s expected of them, but it didn’t redraw the national political map.
Upward Mobility Isn’t the Problem
Buckley’s argument for single-payer doesn’t amount to much. But his logic illuminates a divide in conservative circles between those who attribute Trump’s win to economic factors like income inequality and economic mobility, and those who attribute it to cultural factors like political correctness and the wholesale rejection of our political elites.
Buckley falls into the first camp. Last year in an essay for The American Conservative, based partly on his recent book, “The Way Back,” Buckley says that to win elections again, “conservatives should begin by admitting that income mobility is the defining political issue of our time, that we lost the 2012 election because we ignored it, that anger at the class society we have become explains the rise of Donald Trump, and that the way back lies in the pursuit of socialist ends through capitalist means.”
But is income mobility really the defining political issue of our time? In his 2014 State of the Union Address, President Obama made similar claims. Corporations were doing great, he said, “But average wages have barely budged. Inequality has deepened. Upward mobility has stalled.”
The problem is that such claims don’t bear close scrutiny. Much of Buckley’s argument, both in his essay and book, relies on a single study that has been soundly debunked by a number of economists like Scott Winship and Donald Schneider.
The so-called “Great Gatsby Curve,” which posits that the United States is one of the most economically immobile countries in the developed world, is deeply flawed. Winship wrote that it “is of practically no use” in trying to determine the future of economic mobility in America. The truth is, when measured properly, mobility in America is about the same as it is in Sweden and Canada.
Why is this important in the context of a health care debate? Because if you believe that Trump was elected to ameliorate income inequality and boost economic mobility, if you think his supporters want him to enact policies to those ends and build a coalition in Congress to realize them, then there’ll be no fine distinctions between “socialist ends through capitalist means.” In that case, we might as well have signed up for Obama’s third term.