>Any discussion of health care tends to favor Democrats because (except in the immediate wake of the ACA passing) most people are fundamentally morally aligned with progressives on this issue.<
And I strongly suspect most people are fundamentally *financially* aligned with progressives on this issue, too. Even quite high-salaried persons are pretty vulnerable to the costs associated with catastrophic illness.
"And I strongly suspect most people are fundamentally *financially* aligned with progressives on this issue, too. Even quite high-salaried persons are pretty vulnerable to the costs associated with catastrophic illness."
I honestly don't think most well off people with insurance think about this until it happens to them. If they're happy with their benefits and not spending much out of pocket routinely, I doubt catastrophic illness risk would make them want to tear up their health insurance and reform things.
If you are unemployed under ACA, then you are getting subsidies if not Medicaid. COBRA has value if you leave your job to become self-employed, but not if you simply lose your job.
I spent six months as a post-doc in Australia. The Australian government required me to prove I had health insurance, and I couldn't buy into Australian health insurance, so I had to go on COBRA. It was nearly $1000 a month as a healthy 28 year old man.
I'm semi-surprised COBRA worked for you. I would assume employer-based (or COBRA-based) coverage by US carriers is generally valid if one is a tourist, but I'd have guessed it normally doesn't cover a person who moves abroad for work or school.
Fortunately, I didn't test it by having a medical emergency during the time. I don't recall if I told the insurance company that I was going to be overseas, and the Australian government just needed me to show a certificate saying I had private insurance. I don't recall if they checked to verify that the insurance was valid while temporarily working in Australia.
I didn’t even know where to begin to look. Obamacare hadn’t been passed yet so I didn’t know where to buy private insurance outside of an employer, and since I was only in Australia for six months I couldn’t buy Australian insurance.
>I honestly don't think most well off people with insurance think about this until it happens to them.<
I agree they may not think about it with great frequency. But if it's a campaign issue that's attracting significant coverage, they're likely to...uh...think about it! Most affluent, PMC Americans are sufficiently smart or well-educated to be aware of the principal threats to their well-being, and among these are uninsured health disasters. It's perfectly understandable why Democrats tend to outperform Republicans on the issue of healthcare coverage.
>I doubt catastrophic illness risk would make them want to tear up their health insurance and reform things.<
Who said anything about "tearing up their health insurance"? I just think people in the main oppose big changes to the status quo on healthcare—including cuts to Medicaid and Medicare. Democrats could indeed take a political hit if they won a trifecta and embarked on a round of major reform (as they did in 1994 and 2010). The status quo seems to satisfy most Americans. Which is part of the reason they favor the Democratic Party's approach: Democrats want to defend that status quo.
I think the original idea of Medicaid was to insulate it from political meddling and rollback by getting the states bought into it, and it's turned out *exactly* the opposite. Eliminating Medicaid entirely and providing the same coverage to the same people through Medicare would be much better, much more politically sustainable. (Not to mention more efficient.)
Yeah. I'd repeal Medicaid outright and replace it with a federal program that includes a public option if if were up to me. Would be expensive for the federal government, sure, but on the other hand state governments would be able to slash their budgets significantly.
Yeah, I don't think anyone is talking about "ripping up their health insurance" if by that you mean going for some Medicare for all thing. What PMC folks like is lots of government back stop and rules that keep them safe from that catastrophic risk --- no penalties for preexisting conditions, keeping your kids on your plan until they're 26, no cuts to Medicare and Medicaid so your parents aren't wiped out by their costs, etc.
But you have to keep your job to keep your insurance. If you get sick, that can be tough. If you have a hundred grand in liquid assets, you don’t have too much to worry about paying for cobra, but having to pay cobra and the mortgage and basic expenses if you get sick and can’t work extends precarity needlessly far up the income ladder.
One of my parents got cancer at 55, had to leave their job because of being too sick to work, and tried to afford COBRA so they could continue cancer treatment.
There’s no individual mandate anymore, so Trump can easily strip away the exchange subsidies and Medicaid expansion while keeping guaranteed issue. The gymnastics that went into writing Obamacare always made it vulnerable to future changes.
>How so? The out of pocket max is likely a few $1,000 which shouldn’t be a problem.<
It shouldn't be a problem because of laws passed by Democrats.
No one has a lifetime guarantee of employment with health benefits. If they were to lose their health insurance, they would indeed be quite vulnerable. A battle with cancer could easily set a person back a couple of million or more. Once upon a time we lived in a country where it was quite common for people to be uninsurable. Then along came the ACA (and before that, Medicare).
Democrats don't want to weaken or repeal these programs. Many Republicans wish to repeal and voucherize them. Hence the advantage enjoyed by Democrats on this issue.
The Movement Conservatism approach to healthcare—glibertarianism—appeals to about three percent of the population.
I don't understand why American conservatism is like this while (for example) the British Tories got walloped in an election recently and peacefully left. It strikes me as an important question, really one of the most important questions.
>>I don't understand why American conservatism is like this while (for example) the British Tories got walloped in an election recently and peacefully left<<
Part of the reason is that conservatives in the US believe their views aren't just better for society, but are constitutionally legitimate in a way that liberal policies are not. This view was bubbling up long, long before the arrival of the MAGA movement. For years I've been reading conservatives opine that the United States Constitution as properly construed prohibits most liberal/left policies and mandates conservative ones. In other words, many people on the right in America believe the left doesn't possess a legitimate authority to govern, because the policies they'll implement aren't allowed by the Constitution (again, as properly construed—by them!).
If you believe that your political opponents are essentially engaged in an effort to subvert the constitution, it's not much of a stretch to arrive at the place where any and all tactics—including violence, including elections stealing—are justified to gain or hold onto power.
As to why this dynamic and over-arching belief system have become entrenched among American conservatives I cannot say, though it may flow from simply religiosity. I think it's fair to observe that millenarian, evangelical Christianity is a lot more common in the United States than in other wealthy democracies.
Isn't the answer Donald Trump? Whatever McConnell's other faults he didn't support this. Basically all Republicans besides Donald Trump would have left office more peacefully.
Yeah I agree that's a huge part of it. But the other part of it is that it wasn't just crazy Uncle Donald being dragged out of the White House -- he had support. He could assemble this mob, get it retroactively legitimized by the RW media afterward, keep the party's loyalty.
One guy's personal pathology is more important than it should be, but why is it getting this reception? (He ran for president before btw, in 2000 through the Reform Party, and it was such a complete flop that no one really remembers it. Something changed!)
The percentage of uninsured peaked at 16% in 2010 and was slightly less than 8% in 2023. I don't want to downplay the importance of ACA to those who had pre-existing conditions but it did not solve the main issue with US healthcare, which is cost. That requires fundamental changes in both regulation and supply side reforms, which neither side is running on.
Or just regular illness and procedures that are absurd. I'm early 30s and have a very good job in biotech, and I think I almost fainted when I got ambulance bill for $8000 *after* insurance. It was a non-emergency transfer from one ER to another with the service I needed but had to take an ambulance to show continuous care otherwise I'd have to start over and wait another 10 hours in that ER while in severe pain, 10 miles total distance, casual drive, I was chatting with the tech the whole time. Then a doctor who spoke to me for less than 60 seconds charged me for 2 hours of time, that was $500 after insurance. Then the hospital charged me for a 'room', $6000 which was actually just a bed in the hallway of the ER, just on the other side of the monitor of some nurse working on a computer all night. All my appeals got denied. And this was at a hospital in Lake Forest IL, median home price $1m. Nothing to do with wealth. Healthcare sucks
I don't want to be utterly fatalistic two weeks out, lord knows the polls could miss and we are all coconut pilled on November 6th. But in Matt's spirit of pre-logging a take for the sake of unbiased accuracy, I think if Trump wins, especially if he wins the popular vote, we are going to get a thousand think pieces and takes about America's latent blood thirst for authoritarianism, when I think it really is as simple as American's being directionally closer to his positions and vibes on the Economy, on Immigration, and on Foreign Policy. People will spill so many words on what this means when I really think it can be summed up in the mind of a low information swing voter as "eggs cost more" and nothing deeper than that. That is both promising, in the sense that voters are more elastic than we assume, but also frustrating in that it requires democrats to be consistently better than they have proven capable of lately.
"I actively want the authoritarian asshole" and "I don't care that the candidate is an authoritarian asshole, I support him because muh grocery prices" are distinct positions to be sure, but that doesn't make the latter *admirable*, and if our moral framework is consequentialism, the two positions collapse into the same thing.
I've said it before on this Substack and I'll say it again: I became an American citizen as an adult, which means I had to study for and take the citizenship test. One of the questions and answers I had to memorize was: "What does it mean that America is a nation of laws? No one is above the law/Everyone has to obey the law." The naturalization ceremony was a really emotional moment for me, I was proud to become an American.
And now I'm being told that only pointy-headed elitists care about trifles like "the rule of law" or "democracy," while red-blooded salt-of-the-earth Real Americans(TM) are happy to kiss the feet of any Caesar who promises them cheaper groceries and gasoline and illegal immigrant deportations.
In my lifetime, I've watched several "factions" within my family realign politically:
- The immigrant generation being super pro-America and big believers in the American Dream whose brains were slowly poisoned by right-wing talk radio and now engender a specific hatred of recent immigrants because "we did it the right way"
- The generation under them, benefiting from the aforementioned American Dream becoming Reaganites and voting Republican because they don't like taxes
- That same generation boomeranging back to viscerally anti-Trump voters
- Flag-waiving blue-collar Democrats who retired in front of FOX News and turned into angry, paranoid anti-Obama Republicans
- Lifelong Democrats / liberals who just support liberal causes and aren't sufficiently engaged with the media to notice or care about woke brainworms
Personally, I'm the only person in my household who was born in the US, so I can literally see how important the Rule of Law is when I look at the certificates from the Department of State that permit my family to exist here. But the trend I see in my family is that the pro forma flag-waivers who were outwardly "proud to be an American" tended to be sucked into the FOX News Trump vortex, while the "wouldn't be caught dead wearing an American flag apron" are all now anti-Trump rule-of-law people.
I strongly dislike the caricature of Real Americans (TM) as the ones driving around in jacked-up trucks stealing Harris signs (which is absolutely a thing that happens around my neck of the woods) and am sad that they really do seem to want an authoritarian asshole to smite their imagined enemies and restore them to prominence that never existed. But I also see plenty of people who are discovering that they are, in fact, proud Americans because they are suddenly afraid of losing their country.
To which I'd add: There have always been disengaged, low-information people too short-sighted to care about freedom and self-government. What's new in America is that there used to be *elite* structures -- the media, the parties, community groups and mass-membership orgs -- that kept that opinion from dominating, that cajoled or convinced or shamed people out of voting on it or running by pandering to it.**
And now all of those restraining institutions have been gutted. Local news is gone, parties (especially the Republican Party) are hollow shells, America is a "bowling alone" society where most people's days are dominated by hours of passive video consumption.
The termites have eaten the load-bearing timbers and now democracy is swaying.
** Sure, it wasn't perfect, Huey Long was popular in the 1930s -- but it took the Great Depression to make that happen. Now, the economy is roaring and Trump is more popular than Long was.
I’m more worried about Democrats reaction. I’m already seeing the predictable takes of “Harris is losing because she is not left wing enough! Or Harris is losing because she won’t stand up for Gaza!” just bad, dumb takes based on activist fantasy.
This is why if Trump is to win, I hope to god he just wins the popular vote outright. It will be so much harder for the left to argue that the problem was insufficient progressivism if you just lose straight up, something Democrats have not experienced in a non post 9/11 fever dream context since *checks notes* THE YEAR OF OUR LORD ONE THOUSAND NINE HUNDRED AND EIGHTY EIGHT(!!!!!!).
I genuinely think you're making a mistake if you think the left will care about harsh realities like a failure to win the popular vote in x years when making their arguments and considerations for the future. It took a very long time to get Labour members in the UK to vote for a centrist despite ample evidence of the failure of their political project at getting politicians that amped them up into power.
Democrats have been losing the House of Representatives way more often since the 90s and have become somewhat more socially progressive since then, so I don't see how it would change with one relatively close election, popular vote slightly to Trump or not. A real life example of this happening would be Democrats after three GOP pres. terms (1992) or Republicans after five Dem pres. terms (1952). But that just isn't how 2024 is going to be read by either party.
When leftist delusion was at its absolute peak we ended up with Biden. I think the Democratic establishment is fairly good at paying lip service to the left (and even picking up some of the less awful ideas) without actually making decisions based on their flawed thinking.
I disagree with describing the Afghanistan withdrawal as losing a war, and I worry that how it was framed in the media is going to discourage politicians from ending military commitments.
I'm worried you're too optimistic about the "don't lose a war" point. It isn't often that we start a war and lose it all within one 4-year term. There's Bay of Pigs, then you've got to go back to, what, War of 1812?
So the real lesson there isn't to avoid adventurism, it's that when you're bogged down in an unwinnable war, you should always just kick the can down the road to the next guy.
Point 1 definitely seems like the biggest missed opportunity for Democrat messaging — “tariffs means higher prices, Trump’s irresponsibile deficit spending proposals will make inflation higher!” — this doesn’t require anyone to adopt terminal values different than those they already hold.
The Afghanistan war can be divided into two missions -
1. The war on terrorism (Al Qaeda) - a huge success.
2. Nation building and installing a US friendly government as an alternative to Taliban - an unmitigated disaster.
Biden as President is responsible for neither. 1 happened under Bush and Obama. The surrender on 2 happened under Trump when his administration signed a treaty with the Taliban, excluding the Afghan government (something that I'm supportive of).
Republicans can’t all be so stupid as to miss the arrow from across-the-board tariffs and mass deportation of workers to higher prices. Everyone wants inflation for the right reasons, they just hate seeing it for the wrong ones.
When i've seen Trump supporters acknowledge that tariffs are paid by consumers, their ready answer is "well it's a good thing that imports will be more expensive so that people buy American made things instead", which, ok... presumes there's a ready American made product to purchase instead, for one, and completely misses the impact this will have on supply chains regardless, stuff that is "made in America" may still be impacted by the price push down if any supply input to that product was tariffed. And there is nothing stopping American manufacturers and sellers from just raising the price point on American made goods either to match the tariff priced foreign imports if they see people are still buying - this is a lot of what happened with inflation, corporations did raise and keep prices high mostly because consumers continued buying things anyway, so why lower the price until they have to?
Re. 1 - It depends on the level of unemployment vs inflation. If you look at 2012, unemployment was 5.6% which is not low, but not terrible. If unemployment had been reached what inflation hit under Biden, then I think Obama would have lost as well.
Of course the problem is that while I don't believe the most apocalyptic predictions about a victorious Trump canceling future elections, I do absolutely think they will take whatever steps they can to put future elections on as unlevel a playing field as possible. There would be many people in the new administration who have power and who openly admire Viktor Orban.
I think this is one of the more insidious parts of WW2 being a foundational part of most western nations national myths. The long shadow of Hitler's rise to power (and appeasement but thats a separate matter) means people frame democratic backsliding as the precursor to an imminent Enabling Act. When this doesn't happen people start to dismiss the claims that someone is a threat to liberal democracy as bunk because it didn't come to pass. When the insidious reality is you don't need anything as dramatic to undermine democracy: standard gerrymandering, voter suppression and other methods of democratic backsliding are a real threat. The rhetoric that Trump is going to end democracy probably does more harm than good under this while a culture more attuned to democratic backsliding would be receptive to moderate claims.
As an aside its also why I suspect some of the Project 2025 claims are counterproductive, the average voter inherently isn't going to believe that Trump is going to carry out trans genocide or whatever the front page of Reddit claims. But people would believe that Trump will end abortion and medicare and so on.
Is this really our moral standard now? "Well this guy isn't going to be literally as bad as Hitler, so that means it's ok"? Is this how far we've fallen in the world's oldest democracy?
My point is less "its bad as Hitler or its nothing" but rather that the cultural memory makes people frame it and perceive others framing as being comparisons to Hitler. Which doesn't really work because he likely isn't on the trajectory of Hitler and people know this and discount it. When the trajectory he is on, that of Orban or worse developing world flawed democracies is incredibly concerning in of itself. Slow Boring avoids this and correctly frames him as a serious threat to democracy in ways he actually is but a lot of places don't.
But also, Hitler held elections. They were rigged and fake but they were held.* Putin holds similar elections now for similar reasons. It takes an alternative legitimating ideology to simply dispense with elections entirely, as under Communism or, back in the day, the divine right of kings. Trump doesn't have that, he just has his cult of personality.
There will be elections regardless of who's in power, the question is just whether they'll be honest.
Trump won't cancel any elections. He doesn't need to. Assuming he wins and is still of sound mind in 2028 (a very big assumption, to be sure), he might well be able run the country as an old school political boss/kingmaker.
I could be wrong but he doesn't seem to have an interest in politics or running the country beyond staying out of jail. I'm guessing that if he wins, he'll let JD Vance do all the work while he takes credit for all the successes and throws him under the bus for the failures.
Probably true. I'm just not super interested in parsing the difference "pro-strongman" and "pro-strongman if it means cheaper eggs". Especially since it won't actually mean cheaper eggs.
There is definitely a segment of (male) voters who have erections over Trump’s face pasted on Rambo’s body draped in the American flag. True authoritarians. Probably 30-40% of the Republican party at this point. They don’t care about the price of eggs, they want a ”strong leader” who will make bad people suffer (immigrants, liberals, the childless etc) regardless of the costs.
Agree it is not a terminal value for anyone (even committed monarchists are not out here saying “well I disagree with his whole platform but he’s authoritarian and I’m a single issue voter on that issue”) but I do think there are people for whom, controlling for “generally agree with views” think it is a positive vs a negative. Tendency to like a guy who can “break the rules and really get things done” is not evenly distributed I don’t think.
I mean when it comes to building housing, rail transit, nuclear reactors, and computer chip factories, I want a guy who can break the rules and really get shit done!
Definitely agree. I am exceedingly confident that if trump actually implements his insane Tarriff war he will be at 2008 George Bush levels of popularity.
The best reason to expect a real authoritarian play from Trump II is how unpopular the actual consequences of this agenda would be. He (let's be real, he's not leaving as long as he's alive, whatever the constitution says) and his party would get thrown out of office handily. Given that he and they won't accept that, the answer is to rig the elections.
Explain to me how he just doesn't leave? POTUS 48 directs the secret service to evict him at Noon Jan 20, 2029. What other option is there? That person becomes president by operation of law there's nothing Trump could do any more than you or I at that point.
a) He very well might be dead (or too unhealthy) by 2028 and it’s moot. 78 is pretty old.
b) Allowing an election to take place involving other candidates, letting your own party consolidate behind one of them, and then at the last minute saying “whoops, no” would not work. He’d be out on schedule, with or without some disruption.
c) The play is instead to come up with some fig leaf — “it only bans >2 consecutive terms” perhaps — stand for election again, and have a compliant Supreme Court bless it.
This of course depends on getting enough elite support to ignore the plain meaning of the law, but if he has that support it won’t matter much that the outcome is illegal on a fair reading.
I've seen this concern about SCOTUS and "Consecutive Terms" so many times now and I honestly feel like I'm taking crazy pills. Not only is there literally zero chance that 5 SCOTUS justices just read past the "two," the plain unambiguous language of the statue contemplates a maximum time in office of 10 years! "...no person who has held the office of President, or acted as President, for more than two years of a term to which some other person was elected President shall be elected to the office of the President more than once." Such a rule would be utterly superfluous if there was not a hard cap on how many years you can serve in the ordinary course, as opposed to merely a cap on consecutive terms alone. Law is not just Harry Potter where you just say some magic words and get to play SIMS Politics while wearing robes.
It’s one thousand percent immigration and inflation. Trump is able to exploit those issues more relative to a baseline R because he doesn’t mind lying through his teeth and saying they are much worse than they are, perhaps, but those are the issues people are voting on, like, Globally. I don’t know how you can look at Europe and not see that immigration is Issue 1, 2, and 3 for a lot of folks.
It’s definitely interesting (though it’s an increase of an earlier and pretty long lasting gender split in the USA)! What’s your explanation, and is it in conflict with immigration and inflation being the core issues driving the majority of Trump supporter votes?
Immigration and inflation certainly don't help, but the Democrats have leaned into maximizing identify conflict during the Trump-era in a way that is clearly starting to hurt them with younger and less-informed male voters.
>Any discussion of health care tends to favor Democrats because (except in the immediate wake of the ACA passing) most people are fundamentally morally aligned with progressives on this issue.<
And I strongly suspect most people are fundamentally *financially* aligned with progressives on this issue, too. Even quite high-salaried persons are pretty vulnerable to the costs associated with catastrophic illness.
"And I strongly suspect most people are fundamentally *financially* aligned with progressives on this issue, too. Even quite high-salaried persons are pretty vulnerable to the costs associated with catastrophic illness."
I honestly don't think most well off people with insurance think about this until it happens to them. If they're happy with their benefits and not spending much out of pocket routinely, I doubt catastrophic illness risk would make them want to tear up their health insurance and reform things.
But what if you lose your job? It's not so bad now, but in the pre-ACA world it was absolutely something that well-off people would worry about.
COBRA coverage was signed into law by Ronald Reagan. Two generations of well-off people haven’t had to worry about losing coverage when leaving a job.
Lol COBRA. Sure that's great if you want to spend four figures on your monthly premiums while you're unemployed.
COBRA is definitely not as cheap as the ACA plans, but
1) You could wait a bit and buy COBRA retroactively if you need it
2) It still insures against catastrophic risk.
Point 1 is definitely the benefit of COBRA. Where else can you make a cost/benefit decision on insurance retroactively?
4 figures a month is just normal for a family plan if you aren't getting subsidies.
If you are unemployed under ACA, then you are getting subsidies if not Medicaid. COBRA has value if you leave your job to become self-employed, but not if you simply lose your job.
I was on COBRA, and it was very affordable, because my company had terrible health insurance. :)
And it’s only good for 18 months at that.
“Lol COBRA”
It predated ACA by a quarter-century. The problem you posited did not exist.
I don't think you understand either how COBRA worked or how ACA changed things.
I spent six months as a post-doc in Australia. The Australian government required me to prove I had health insurance, and I couldn't buy into Australian health insurance, so I had to go on COBRA. It was nearly $1000 a month as a healthy 28 year old man.
I'm semi-surprised COBRA worked for you. I would assume employer-based (or COBRA-based) coverage by US carriers is generally valid if one is a tourist, but I'd have guessed it normally doesn't cover a person who moves abroad for work or school.
Fortunately, I didn't test it by having a medical emergency during the time. I don't recall if I told the insurance company that I was going to be overseas, and the Australian government just needed me to show a certificate saying I had private insurance. I don't recall if they checked to verify that the insurance was valid while temporarily working in Australia.
Did you look elsewhere?
I didn’t even know where to begin to look. Obamacare hadn’t been passed yet so I didn’t know where to buy private insurance outside of an employer, and since I was only in Australia for six months I couldn’t buy Australian insurance.
>I honestly don't think most well off people with insurance think about this until it happens to them.<
I agree they may not think about it with great frequency. But if it's a campaign issue that's attracting significant coverage, they're likely to...uh...think about it! Most affluent, PMC Americans are sufficiently smart or well-educated to be aware of the principal threats to their well-being, and among these are uninsured health disasters. It's perfectly understandable why Democrats tend to outperform Republicans on the issue of healthcare coverage.
>I doubt catastrophic illness risk would make them want to tear up their health insurance and reform things.<
Who said anything about "tearing up their health insurance"? I just think people in the main oppose big changes to the status quo on healthcare—including cuts to Medicaid and Medicare. Democrats could indeed take a political hit if they won a trifecta and embarked on a round of major reform (as they did in 1994 and 2010). The status quo seems to satisfy most Americans. Which is part of the reason they favor the Democratic Party's approach: Democrats want to defend that status quo.
The main reform that needs to happen now is getting rid of Medicaid block grants and administering it federally to get around non-expansion states.
I think the original idea of Medicaid was to insulate it from political meddling and rollback by getting the states bought into it, and it's turned out *exactly* the opposite. Eliminating Medicaid entirely and providing the same coverage to the same people through Medicare would be much better, much more politically sustainable. (Not to mention more efficient.)
Yeah. I'd repeal Medicaid outright and replace it with a federal program that includes a public option if if were up to me. Would be expensive for the federal government, sure, but on the other hand state governments would be able to slash their budgets significantly.
Yeah, I don't think anyone is talking about "ripping up their health insurance" if by that you mean going for some Medicare for all thing. What PMC folks like is lots of government back stop and rules that keep them safe from that catastrophic risk --- no penalties for preexisting conditions, keeping your kids on your plan until they're 26, no cuts to Medicare and Medicaid so your parents aren't wiped out by their costs, etc.
But you have to keep your job to keep your insurance. If you get sick, that can be tough. If you have a hundred grand in liquid assets, you don’t have too much to worry about paying for cobra, but having to pay cobra and the mortgage and basic expenses if you get sick and can’t work extends precarity needlessly far up the income ladder.
One of my parents got cancer at 55, had to leave their job because of being too sick to work, and tried to afford COBRA so they could continue cancer treatment.
It didn't go well.
There’s no individual mandate anymore, so Trump can easily strip away the exchange subsidies and Medicaid expansion while keeping guaranteed issue. The gymnastics that went into writing Obamacare always made it vulnerable to future changes.
“ Even quite high-salaried persons are pretty vulnerable to the costs associated with catastrophic illness.”
How so? The out of pocket max is likely a few $1,000 which shouldn’t be a problem.
That is in the post-ACA world. But the Republican Party's goal is to take us back to the pre-ACA world.
>How so? The out of pocket max is likely a few $1,000 which shouldn’t be a problem.<
It shouldn't be a problem because of laws passed by Democrats.
No one has a lifetime guarantee of employment with health benefits. If they were to lose their health insurance, they would indeed be quite vulnerable. A battle with cancer could easily set a person back a couple of million or more. Once upon a time we lived in a country where it was quite common for people to be uninsurable. Then along came the ACA (and before that, Medicare).
Democrats don't want to weaken or repeal these programs. Many Republicans wish to repeal and voucherize them. Hence the advantage enjoyed by Democrats on this issue.
The Movement Conservatism approach to healthcare—glibertarianism—appeals to about three percent of the population.
"If conservatives become convinced that they cannot win democratically, they will not abandon conservatism. They will reject democracy." -- David Frum
He was right! About enough conservatives, anyway.
I don't understand why American conservatism is like this while (for example) the British Tories got walloped in an election recently and peacefully left. It strikes me as an important question, really one of the most important questions.
>>I don't understand why American conservatism is like this while (for example) the British Tories got walloped in an election recently and peacefully left<<
Part of the reason is that conservatives in the US believe their views aren't just better for society, but are constitutionally legitimate in a way that liberal policies are not. This view was bubbling up long, long before the arrival of the MAGA movement. For years I've been reading conservatives opine that the United States Constitution as properly construed prohibits most liberal/left policies and mandates conservative ones. In other words, many people on the right in America believe the left doesn't possess a legitimate authority to govern, because the policies they'll implement aren't allowed by the Constitution (again, as properly construed—by them!).
If you believe that your political opponents are essentially engaged in an effort to subvert the constitution, it's not much of a stretch to arrive at the place where any and all tactics—including violence, including elections stealing—are justified to gain or hold onto power.
As to why this dynamic and over-arching belief system have become entrenched among American conservatives I cannot say, though it may flow from simply religiosity. I think it's fair to observe that millenarian, evangelical Christianity is a lot more common in the United States than in other wealthy democracies.
Isn't the answer Donald Trump? Whatever McConnell's other faults he didn't support this. Basically all Republicans besides Donald Trump would have left office more peacefully.
Yeah I agree that's a huge part of it. But the other part of it is that it wasn't just crazy Uncle Donald being dragged out of the White House -- he had support. He could assemble this mob, get it retroactively legitimized by the RW media afterward, keep the party's loyalty.
One guy's personal pathology is more important than it should be, but why is it getting this reception? (He ran for president before btw, in 2000 through the Reform Party, and it was such a complete flop that no one really remembers it. Something changed!)
The percentage of uninsured peaked at 16% in 2010 and was slightly less than 8% in 2023. I don't want to downplay the importance of ACA to those who had pre-existing conditions but it did not solve the main issue with US healthcare, which is cost. That requires fundamental changes in both regulation and supply side reforms, which neither side is running on.
Or just regular illness and procedures that are absurd. I'm early 30s and have a very good job in biotech, and I think I almost fainted when I got ambulance bill for $8000 *after* insurance. It was a non-emergency transfer from one ER to another with the service I needed but had to take an ambulance to show continuous care otherwise I'd have to start over and wait another 10 hours in that ER while in severe pain, 10 miles total distance, casual drive, I was chatting with the tech the whole time. Then a doctor who spoke to me for less than 60 seconds charged me for 2 hours of time, that was $500 after insurance. Then the hospital charged me for a 'room', $6000 which was actually just a bed in the hallway of the ER, just on the other side of the monitor of some nurse working on a computer all night. All my appeals got denied. And this was at a hospital in Lake Forest IL, median home price $1m. Nothing to do with wealth. Healthcare sucks
I don't want to be utterly fatalistic two weeks out, lord knows the polls could miss and we are all coconut pilled on November 6th. But in Matt's spirit of pre-logging a take for the sake of unbiased accuracy, I think if Trump wins, especially if he wins the popular vote, we are going to get a thousand think pieces and takes about America's latent blood thirst for authoritarianism, when I think it really is as simple as American's being directionally closer to his positions and vibes on the Economy, on Immigration, and on Foreign Policy. People will spill so many words on what this means when I really think it can be summed up in the mind of a low information swing voter as "eggs cost more" and nothing deeper than that. That is both promising, in the sense that voters are more elastic than we assume, but also frustrating in that it requires democrats to be consistently better than they have proven capable of lately.
"I actively want the authoritarian asshole" and "I don't care that the candidate is an authoritarian asshole, I support him because muh grocery prices" are distinct positions to be sure, but that doesn't make the latter *admirable*, and if our moral framework is consequentialism, the two positions collapse into the same thing.
I've said it before on this Substack and I'll say it again: I became an American citizen as an adult, which means I had to study for and take the citizenship test. One of the questions and answers I had to memorize was: "What does it mean that America is a nation of laws? No one is above the law/Everyone has to obey the law." The naturalization ceremony was a really emotional moment for me, I was proud to become an American.
And now I'm being told that only pointy-headed elitists care about trifles like "the rule of law" or "democracy," while red-blooded salt-of-the-earth Real Americans(TM) are happy to kiss the feet of any Caesar who promises them cheaper groceries and gasoline and illegal immigrant deportations.
It makes me sick.
In my lifetime, I've watched several "factions" within my family realign politically:
- The immigrant generation being super pro-America and big believers in the American Dream whose brains were slowly poisoned by right-wing talk radio and now engender a specific hatred of recent immigrants because "we did it the right way"
- The generation under them, benefiting from the aforementioned American Dream becoming Reaganites and voting Republican because they don't like taxes
- That same generation boomeranging back to viscerally anti-Trump voters
- Flag-waiving blue-collar Democrats who retired in front of FOX News and turned into angry, paranoid anti-Obama Republicans
- Lifelong Democrats / liberals who just support liberal causes and aren't sufficiently engaged with the media to notice or care about woke brainworms
Personally, I'm the only person in my household who was born in the US, so I can literally see how important the Rule of Law is when I look at the certificates from the Department of State that permit my family to exist here. But the trend I see in my family is that the pro forma flag-waivers who were outwardly "proud to be an American" tended to be sucked into the FOX News Trump vortex, while the "wouldn't be caught dead wearing an American flag apron" are all now anti-Trump rule-of-law people.
I strongly dislike the caricature of Real Americans (TM) as the ones driving around in jacked-up trucks stealing Harris signs (which is absolutely a thing that happens around my neck of the woods) and am sad that they really do seem to want an authoritarian asshole to smite their imagined enemies and restore them to prominence that never existed. But I also see plenty of people who are discovering that they are, in fact, proud Americans because they are suddenly afraid of losing their country.
To which I'd add: There have always been disengaged, low-information people too short-sighted to care about freedom and self-government. What's new in America is that there used to be *elite* structures -- the media, the parties, community groups and mass-membership orgs -- that kept that opinion from dominating, that cajoled or convinced or shamed people out of voting on it or running by pandering to it.**
And now all of those restraining institutions have been gutted. Local news is gone, parties (especially the Republican Party) are hollow shells, America is a "bowling alone" society where most people's days are dominated by hours of passive video consumption.
The termites have eaten the load-bearing timbers and now democracy is swaying.
** Sure, it wasn't perfect, Huey Long was popular in the 1930s -- but it took the Great Depression to make that happen. Now, the economy is roaring and Trump is more popular than Long was.
Agree with everything you said, PLUS nowadays we have social media, which seems to bring out the worst in human nature.
Nothing has made me more sure that the vast majority of people are p-zombies than social media.
It’s not great!
Isn't deportation of an illegal immigrant the law?
I’m more worried about Democrats reaction. I’m already seeing the predictable takes of “Harris is losing because she is not left wing enough! Or Harris is losing because she won’t stand up for Gaza!” just bad, dumb takes based on activist fantasy.
This is why if Trump is to win, I hope to god he just wins the popular vote outright. It will be so much harder for the left to argue that the problem was insufficient progressivism if you just lose straight up, something Democrats have not experienced in a non post 9/11 fever dream context since *checks notes* THE YEAR OF OUR LORD ONE THOUSAND NINE HUNDRED AND EIGHTY EIGHT(!!!!!!).
I genuinely think you're making a mistake if you think the left will care about harsh realities like a failure to win the popular vote in x years when making their arguments and considerations for the future. It took a very long time to get Labour members in the UK to vote for a centrist despite ample evidence of the failure of their political project at getting politicians that amped them up into power.
That would be a tremendously sad day for our country.
Democrats have been losing the House of Representatives way more often since the 90s and have become somewhat more socially progressive since then, so I don't see how it would change with one relatively close election, popular vote slightly to Trump or not. A real life example of this happening would be Democrats after three GOP pres. terms (1992) or Republicans after five Dem pres. terms (1952). But that just isn't how 2024 is going to be read by either party.
And when the backlash comes for Trump and he's super unpopular, these left wing fantasies may well last into the Democratic primary in 2028.
When leftist delusion was at its absolute peak we ended up with Biden. I think the Democratic establishment is fairly good at paying lip service to the left (and even picking up some of the less awful ideas) without actually making decisions based on their flawed thinking.
I think the lesson will probably be 1. Inflation worse than unemployment
2. Don't lose a war on your watch.
3. Pandemics are too important to leave to the Public Health people.
If Trump enacts half his economic agenda we could get a 2nd test on point 1 very quickly.
Point 2 won't be all bad if it leads less foreign adventure.
And point 3 is probably just correct.
I disagree with describing the Afghanistan withdrawal as losing a war, and I worry that how it was framed in the media is going to discourage politicians from ending military commitments.
That was the point of how it was framed in the media.
I'm worried you're too optimistic about the "don't lose a war" point. It isn't often that we start a war and lose it all within one 4-year term. There's Bay of Pigs, then you've got to go back to, what, War of 1812?
So the real lesson there isn't to avoid adventurism, it's that when you're bogged down in an unwinnable war, you should always just kick the can down the road to the next guy.
Lincoln’s reelection did not look good until Sherman took Atlanta
Obama could have wound it down at the beginning of his second term
Honestly, his first. Killing Bin Laden would have been a great beginning to the end.
I agree that that's the optimistic take, which is why I wrote it won't be "all" bad "if" it leads to less adventurism.
Point 1 definitely seems like the biggest missed opportunity for Democrat messaging — “tariffs means higher prices, Trump’s irresponsibile deficit spending proposals will make inflation higher!” — this doesn’t require anyone to adopt terminal values different than those they already hold.
I think that is way way too complex and economically wonky for the uh cognitive level of the voters who are still undecided at this point in the game
I mean maybe, but Harris tried this in the debate(called it, accurately, a sales tax) and he just said "foreign companies pay this".
The Afghanistan war can be divided into two missions -
1. The war on terrorism (Al Qaeda) - a huge success.
2. Nation building and installing a US friendly government as an alternative to Taliban - an unmitigated disaster.
Biden as President is responsible for neither. 1 happened under Bush and Obama. The surrender on 2 happened under Trump when his administration signed a treaty with the Taliban, excluding the Afghan government (something that I'm supportive of).
Republicans can’t all be so stupid as to miss the arrow from across-the-board tariffs and mass deportation of workers to higher prices. Everyone wants inflation for the right reasons, they just hate seeing it for the wrong ones.
I think the mechanics of tariffs are absolutely above the pay grade of habitual partisan voters.
When i've seen Trump supporters acknowledge that tariffs are paid by consumers, their ready answer is "well it's a good thing that imports will be more expensive so that people buy American made things instead", which, ok... presumes there's a ready American made product to purchase instead, for one, and completely misses the impact this will have on supply chains regardless, stuff that is "made in America" may still be impacted by the price push down if any supply input to that product was tariffed. And there is nothing stopping American manufacturers and sellers from just raising the price point on American made goods either to match the tariff priced foreign imports if they see people are still buying - this is a lot of what happened with inflation, corporations did raise and keep prices high mostly because consumers continued buying things anyway, so why lower the price until they have to?
Re. 1 - It depends on the level of unemployment vs inflation. If you look at 2012, unemployment was 5.6% which is not low, but not terrible. If unemployment had been reached what inflation hit under Biden, then I think Obama would have lost as well.
Of course the problem is that while I don't believe the most apocalyptic predictions about a victorious Trump canceling future elections, I do absolutely think they will take whatever steps they can to put future elections on as unlevel a playing field as possible. There would be many people in the new administration who have power and who openly admire Viktor Orban.
I think this is one of the more insidious parts of WW2 being a foundational part of most western nations national myths. The long shadow of Hitler's rise to power (and appeasement but thats a separate matter) means people frame democratic backsliding as the precursor to an imminent Enabling Act. When this doesn't happen people start to dismiss the claims that someone is a threat to liberal democracy as bunk because it didn't come to pass. When the insidious reality is you don't need anything as dramatic to undermine democracy: standard gerrymandering, voter suppression and other methods of democratic backsliding are a real threat. The rhetoric that Trump is going to end democracy probably does more harm than good under this while a culture more attuned to democratic backsliding would be receptive to moderate claims.
As an aside its also why I suspect some of the Project 2025 claims are counterproductive, the average voter inherently isn't going to believe that Trump is going to carry out trans genocide or whatever the front page of Reddit claims. But people would believe that Trump will end abortion and medicare and so on.
Is this really our moral standard now? "Well this guy isn't going to be literally as bad as Hitler, so that means it's ok"? Is this how far we've fallen in the world's oldest democracy?
WTAF?
My point is less "its bad as Hitler or its nothing" but rather that the cultural memory makes people frame it and perceive others framing as being comparisons to Hitler. Which doesn't really work because he likely isn't on the trajectory of Hitler and people know this and discount it. When the trajectory he is on, that of Orban or worse developing world flawed democracies is incredibly concerning in of itself. Slow Boring avoids this and correctly frames him as a serious threat to democracy in ways he actually is but a lot of places don't.
But also, Hitler held elections. They were rigged and fake but they were held.* Putin holds similar elections now for similar reasons. It takes an alternative legitimating ideology to simply dispense with elections entirely, as under Communism or, back in the day, the divine right of kings. Trump doesn't have that, he just has his cult of personality.
There will be elections regardless of who's in power, the question is just whether they'll be honest.
* for example, https://en.wikipedia.org/wiki/1936_German_parliamentary_election_and_referendum
Republicans = Nazis, America is just more resistant to Nazis now than Weimar Germany was.
Trump won't cancel any elections. He doesn't need to. Assuming he wins and is still of sound mind in 2028 (a very big assumption, to be sure), he might well be able run the country as an old school political boss/kingmaker.
I could be wrong but he doesn't seem to have an interest in politics or running the country beyond staying out of jail. I'm guessing that if he wins, he'll let JD Vance do all the work while he takes credit for all the successes and throws him under the bus for the failures.
Probably true. I'm just not super interested in parsing the difference "pro-strongman" and "pro-strongman if it means cheaper eggs". Especially since it won't actually mean cheaper eggs.
I think understanding the difference is pretty important if you want to avoid strongmen (even though both are bad).
Fair enough, although I doubt there are any truly principled believers in strongmanism. It's always a means to an end.
There is definitely a segment of (male) voters who have erections over Trump’s face pasted on Rambo’s body draped in the American flag. True authoritarians. Probably 30-40% of the Republican party at this point. They don’t care about the price of eggs, they want a ”strong leader” who will make bad people suffer (immigrants, liberals, the childless etc) regardless of the costs.
Agree it is not a terminal value for anyone (even committed monarchists are not out here saying “well I disagree with his whole platform but he’s authoritarian and I’m a single issue voter on that issue”) but I do think there are people for whom, controlling for “generally agree with views” think it is a positive vs a negative. Tendency to like a guy who can “break the rules and really get things done” is not evenly distributed I don’t think.
I mean when it comes to building housing, rail transit, nuclear reactors, and computer chip factories, I want a guy who can break the rules and really get shit done!
See I want a guy that can build a deregulatory / YIMBY coalition to *repeal* the rules, not an executive who simply breaks them.
Definitely agree. I am exceedingly confident that if trump actually implements his insane Tarriff war he will be at 2008 George Bush levels of popularity.
The best reason to expect a real authoritarian play from Trump II is how unpopular the actual consequences of this agenda would be. He (let's be real, he's not leaving as long as he's alive, whatever the constitution says) and his party would get thrown out of office handily. Given that he and they won't accept that, the answer is to rig the elections.
Explain to me how he just doesn't leave? POTUS 48 directs the secret service to evict him at Noon Jan 20, 2029. What other option is there? That person becomes president by operation of law there's nothing Trump could do any more than you or I at that point.
Well, a few things I think:
a) He very well might be dead (or too unhealthy) by 2028 and it’s moot. 78 is pretty old.
b) Allowing an election to take place involving other candidates, letting your own party consolidate behind one of them, and then at the last minute saying “whoops, no” would not work. He’d be out on schedule, with or without some disruption.
c) The play is instead to come up with some fig leaf — “it only bans >2 consecutive terms” perhaps — stand for election again, and have a compliant Supreme Court bless it.
This of course depends on getting enough elite support to ignore the plain meaning of the law, but if he has that support it won’t matter much that the outcome is illegal on a fair reading.
I've seen this concern about SCOTUS and "Consecutive Terms" so many times now and I honestly feel like I'm taking crazy pills. Not only is there literally zero chance that 5 SCOTUS justices just read past the "two," the plain unambiguous language of the statue contemplates a maximum time in office of 10 years! "...no person who has held the office of President, or acted as President, for more than two years of a term to which some other person was elected President shall be elected to the office of the President more than once." Such a rule would be utterly superfluous if there was not a hard cap on how many years you can serve in the ordinary course, as opposed to merely a cap on consecutive terms alone. Law is not just Harry Potter where you just say some magic words and get to play SIMS Politics while wearing robes.
It’s one thousand percent immigration and inflation. Trump is able to exploit those issues more relative to a baseline R because he doesn’t mind lying through his teeth and saying they are much worse than they are, perhaps, but those are the issues people are voting on, like, Globally. I don’t know how you can look at Europe and not see that immigration is Issue 1, 2, and 3 for a lot of folks.
Immigration and inflation don't explain why Democrats are likely to face the greatest gender gap of any party in modern history.
Why not? Men tend to be more negative about immigration.
It’s inflation, immigration, and the feminization of the Democratic Party.
It’s definitely interesting (though it’s an increase of an earlier and pretty long lasting gender split in the USA)! What’s your explanation, and is it in conflict with immigration and inflation being the core issues driving the majority of Trump supporter votes?
Immigration and inflation certainly don't help, but the Democrats have leaned into maximizing identify conflict during the Trump-era in a way that is clearly starting to hurt them with younger and less-informed male voters.