The horizon is not so far as we can see, but as far as we can imagine

That Tax Cut Talking Point


The Republicans are working hard to pass an amendment to the ACA called the AHCA. Assuming it succeeds, which I wouldn’t take for granted, it would take Obamacare, with all the latter’s deficiencies and faults, and make it even worse. Meaning: It will probably kill a lot of people through health care denial due to pre-existing condition denials and the reinstatement of lifetime coverage limits. If they fail to pass it, it would be because Obamacare is designed to make itself hard to retract; as Obamacare contains the bare minimum required to improve the status quo ante, anything significant they take away from it renders it unworkable. If it passes, it would be because they had decided that it was the closest to the status quo ante that they could achieve.

The status quo ante was terrible, but contrary to the beliefs of many, it wasn’t “unsustainable” in some sort of fundamental way. It could be contained by gradually excluding more and more people from insurance coverage, and therefore, down the line, care. This is not a debate about health care, but about how to pay for health care.  It is about austerity, and the status quo ante was ultimately just a slow ratcheting-up of austerity. (Yes, I know, Obamacare is a ratcheting-up of austerity, but it is a slower one.)

One of the talking points against the AHCA is that it appears to be designed to give the rich a tax cut. However, the tax cut is, in proportion to many of its beneficiaries, quite small, even as it dwarfs the incomes of many. It’s not a giveaway that in itself should raise the political passions of its beneficiaries. Many of them won’t spend it or won’t notice the effect on their lives or wealth planning. Even the insurance industry is skeptical of key portions of the bill, and they’re not prone, as they say, to altruism.

The Republicans have invested a lot of political capital in the idea of undoing Obamacare. Instead of that small a tax cut, if they were rational political actors, they could easily have come up with a bill that targeted large swathes of their constituencies for a substantial improvement in their (bad) standard of coverage, even if they wanted to target Democratic constituencies for tribal reasons. They could have done this without even instituting single payer (aka public monopsony) and ruining their constituents among the insurance and corporate medical sector. It doesn’t appear that this is on order.

The picture only makes full political sense if you see the cutting of health insurance coverage as a political goal in itself, if not some kind of fundamental ideological “end.” Or for the symbolic appearance of trading coverage for a token tax cut, in a way that is likely to create further damage to the US economy. And that successful Republican politicians think that they can expel millions of people from the ability to pay for health care, including their own constituents, is a sign both of the significance of that symbolic appearance and the cultural limits of the US health insurance debate.


You Can’t Stay in the EU or Single Market And Be For Labour’s Manifesto


The Fall of the USSR


  1. StewartM

    And that successful Republican politicians think that they can expel millions of people from the ability to pay for health care, including their own constituents, is a sign both of the significance of that symbolic appearance and the cultural limits of the US health insurance debate.

    It’s a sign that we don’t have anything like a real democracy, and that the empiricism of the Enlightenment is dead. A whole ideology has taken over that is oblivious to actual facts, what “should” happen according to their air-castle fantasies is the only thing heeded. The rise of neoliberalism and the rise of the Religious Right in this point of history is no accident; they are both essentially corresponding fundamentalisms.

    As Marvin Harris said, if we were talking about physics or chemistry, people who believed that they could ignore tangible facts are only a temporary annoyance, after which they are swept out of the lab along with the rubble they created. It’s a tragedy of human social life that these have longer lives.

  2. Donald

    I don’t understand. That’s not meant as snark or criticism of this post –I don’t get it. Is the only point then to pass something that eliminates Obamacare even if it makes most people, including many of their own voters, miserable? How do they gain from this?

  3. bruce wilder

    Who are politicians dependent on? Clearly not well-informed voters who are willing and able to either reliably punish failure to deliver or able to discern trustworthy judgment and commitment in candidates and elect them in the first place.

    None of what we are witnessing would make sense if Members of Congress were actually powerful and could be held responsible for the exercise of power, but they are not powerful. They are essentially spokesmodels for business lobbyists. If business lobbyists demand tax cuts, they get tax cuts. And, there is no opposing power, representing the organized interests of massive numbers of people. There just isn’t.

    And, for the most part, the participants in this “system” — the journalists and Congressional staffers and thinktank lobbyists and civil servants and lobbyists and business executives — do not care, substantively or ethically. None of them owe anything to the mass of people, or expect any reward or recognition from them. No one imagines herself responsible for the functioning of the system, nor do any of them actually fear the system’s catastrophic failure, because those catastrophic failures will happen to other people with no consequence to themselves.

    People who voted for Hillary Clinton but didn’t care that she opposed single-payer, didn’t care that she’d taken millions from banks for “speeches”, didn’t care that her circumvention of campaign finance limits had taken the form of looting the Democratic Party, didn’t even know who their Representative in Congress was, really should not be bemoaning what goes on now in the Congress.

  4. Tom W Harris

    Oh, they’ll bemoaning alright – moaning in pain.

  5. I’m sorry BW but the tax cuts are too small beans for that explanation to fly. That’s the standard materialistic explanation for the US health care situation, and to me it has never rung entirely true nor explained all the observations. Here we are seeing what is most precious: the act of cutting health care from many ordinary patients in exchange for a minor tax shift.

    This is a sacrifice ritual.

  6. Hugh

    Karl Marx wrote in 1845:

    Each new class which displaces the one previously dominant is forced, simply to be able to carry out its aim, to represent its interest as the common interest of all members of society, that is, ideally expressed. It has to give its ideas the form of universality and represent them as the only rational, universally valid ones.

    Reinhold Niebuhr wrote in 1932:

    The moral attitudes of dominant and privileged groups are characterised by universal self-deception and hypocrisy. The unconscious and conscious identification of their special interests with general interests and universal values, which we have noted in analysing national attitudes, is equally obvious in the attitude of classes. The reason why privileged classes are more hypocritical than underprivileged ones is that special privilege can be defended in terms of the rational ideal of equal justice only, by proving that it contributes something to the good of the whole. Since inequalities of privilege are greater than could possibly be defended rationally, the intelligence of privileged groups is usually applied to the task of inventing specious proofs for the theory that universal values spring from, and that general interests are served by, the special privileges which they hold.

    Marx is talking about power and ideology while Niebuhr is talking about power and privilege. In both cases, the ruling classes equate their good with the good of society as a whole. Both explain why ruling classes often act contrary to reality and commonsense. You know those instances where we say, “If they had just done, this, a no-brainer really, they would have been so much more successful.” Our mistake is in not understanding that they think that their ideology is more important than reality (Marx) or that they simply come to believe their own propaganda (Niebuhr). I look upon both as exercises in bad faith because they place themselves, their propaganda, and ideologies above us the many who make up society and whom in theory, although almost never in practice, they are supposed to serve. But of course, it goes so much beyond all this because our ruling classes more and more are dropping their pretenses. They are out to loot us, plain and simple. Obamacare wanted to nudge us to go die in a ditch. Trumpcare uses a bulldozer. But either way, it is the same ditch, and that ditch, and not the differences in Democratic and Republican talking points is what we the many should keep our focus on.

  7. Mallam

    It’s almost as if the right wing has an ideology that doesn’t include providing health care for people whatsoever, and the “Obamacare is a Republican plan” talking point makes no sense.

    Anyway, I think they’d gladly take a tax cut without repealing Ocare, but they’re limited because of the Senate rules and the current baseline. If you can’t change that baseline you can’t get your tax cuts through reconciliation, or rather the tax cuts would be even lower than the sums you argue are already too low. Medicaid happens to be where “the money is”, and through accounting fiction and backloading the cuts, Paul Ryan and Mitch McConnell have made it someone else’s problem to deal with when the Medicaid cuts are scheduled to take effect.

  8. bruce wilder

    Mandos: I’m sorry BW but the tax cuts are too small beans for that explanation to fly.

    I have kinda gotten used to the fact that what you and I say to one another just goes right on by each of us. That seems to be your pattern with most commenters by the bye and results in a lot of commenter hostility.

    Your explanation is that a de minimus tax cut is not enough to motivate “the base” of the Republican Members of Congress. So, you turn to the “sacrifice ritual” as an alternative. But, you don’t explain why a “sacrifice ritual” is valuable enough to “the base” (maybe a somewhat differently construed and populated base than the one posited for the materialistic explanation).

    It seems to me that both explanations belong to the same basket of usual Republican motivations cum propagandistic explanations for what they are doing and why. Neither one really explains what they do. Both are part of the propaganda arsenal that they use to rationalize what they do (and what they attack the Dems for doing.)

    It is a pretty rare policy that ever gets enacted by acclamation. (OK, surprise attack at Pearl Harbor might be in the class of exceptions.) Any policy has to have supporting propaganda and rationalizations that appeal to a variety of interests and personalities, so you get an array of arguments. Whatever.

    My point is about the present context is 1) that the Republican Establishment generally, including the Members of Congress, respond almost exclusively on substance to the very, very rich and powerful. I think it would go without saying, but many of those people are fairly seriously pathological — they exercise little empathy in their daily lives, their greed knows no bounds, they want tax cuts ad infinitum even if they dodge taxes obsessively, and yes they enjoy spectacles of human sacrifice. Like Hillary Clinton, who could “earn” a $100,000 an hour for one of her scintillating little talks for the entertainment of banksters, they begrudge a fry cook or a janitor, $15 an hour.

    And, 2) there’s no effective opposition to the Republicans.

    It is number 2 that I think is the most important factor and that I think you unaccountably failed to acknowledge fully. Neither the tax cut nor the human sacrifice would be enough, if there was a credible opposition advocating effectively for single-payer socialism (and rallying erstwhile Fox News viewers instead of dismissing them as hopeless while watching Rachel Maddow, multimillionaire, melt down with Putin Derangement Syndrome).

    The political ecology has failed and the political class has been reduced to a few varieties of noxious weeds.

    The Republicans will do what Republicans always do, for the most minimal reasons, because there is no credible opposition to crowd them off the field for exposing what ought to be their terminal awfulness.

    This has to be pointed out, because so many identified with the Democratic Party refuse to acknowledge just how they were conned by Obama and Clinton. If you think Clinton is “normal” politics and Obamacare was, taken as a whole, great policy and great politics, you are both useless and hopeless.

    I am not saying Mandos has illusions about the goodness of Obamacare; I am sure Mandos recognizes it was very much a mixed-bag, directly affecting only a relatively small portion of actual voters, and many of those in a not-favorable way.

    I am saying that if you want to understand the otherwise unaccountable craziness of the Republican repeal campaign and its seemingly minimal motivators, you have to turn for an explanation to “the dog that didn’t bark” — what is missing from the picture. And, for those identified with the Democratic Party, that means recognizing just how horrible the Democratic Party has been for a generation.

  9. Ivory Bill Woodpecker

    The GOP rank and file [aka Stupid White Folks (TM)] will grit their teeth and accept being sodomized with baseball bats, as long as they believe Those Unworthy Others are being sodomized with utility poles.

  10. bob mcmanus

    Besides the other reasons above

    They do it because they can, to show that they can. It is a demonstration of power, an exercise of power, and I’m sure it feels freakinggood to confound and demoralize their enemies. Politics is a competition, the policies, programs and ideologies are only tools. I can’t think of a historical analogy, but the tax cut is like a monument, a statue, a Roman triumph, a victory parade.

    The emotional content of the “ideological” battle is maybe interesting, with Repubs standing for “Greed Rules. Life is Hard.” Lemieux has a picture of Ryan at a whiteboard “More for us. Fuck you.” And don’t we all prioritize our own over strangers? At what point does compassion begin, when do we make our kid wear old sport shoes so the kid in Bangladesh gets a meal?

    Clinton and Obama and Democrats say “Compassion and service rule, concern for the least of us, justice and fairness rule. Now let me count my millions.” Democrats are outraged by the dangerous and gauche lack of hypocrisy in Republican rule.

    I wrote a little play this summer: Clinton and Trump are sharing a telethon. Clinton is sitting on the floor, looks at us with tearful eyes:”Look at this cute kitten. If you don’t send the Democratic Party lots of money right now, this kitten will be killed on stage by Donald Trump. Only you can save this kitten, its life is in your hands. Don’t you care? At all?”

    Trump: “Shit, after that lugubrious blackmail, c’mon, fess up. You want the kitten to die, just to shut the guilt-tripping bitch up. Send your money to Republicans, the kitten will die, and you will show that you are free.”

    It ain’t about the fucking kitten.

  11. bob mcmanus

    Ya know, in the above I kinda understand the Trump voters. I have read and forgotten the Adorno and Altemeyer on authoritarianism, stuff about fascism but seems to me that the role and affect of disobedience, anti-authoritarianism is way underestimated. Cause maybe every submission to one authority is at the same time a rejection of another, the soldier who shoots the stranger is not just, or even primarily obeying an order as much as she is violating an internalized social norm and enjoying and grateful for permission. I think the latter more important. We are not yet fully domesticated.

    But the ones who scream and cry and empty their bank accounts for the kitten, and then condemn and hate those who do not, those are a little more difficult for me.

    But I am usually watching the audience not the Show. Although, as the red moves up the telethon thermometers, is the audience the Show?

  12. Bob gets it.

  13. bruce wilder

    the audience is the show

    I like it.

    But, is politics just the show, then?

  14. Patricia

    Some good points, Mandos. I see the Republicans to be in full flower of their ideology which is simply that money is power and when not interrupted (by laws & such), it comes to those who deserve it. They have both money and power right now, and intend to wield both as far as it’ll take them. Sure, the people behind Repub politicians won’t get much from this proposed set of tax breaks, but they spy more business on the horizon, filling the few gaps left by taking out the remaining government programs. That a lot of people will die doesn’t matter because they think there’s enough money to be made even if only half survive. They are without empathy and also operate from a peculiar religion, Evangelicalism.

    That religion revolves around authoritarianism and the Protestant Work-Ethic. It includes the belief that the US is a soft weak society, and needs toughening up. Evangelicals may not believe in evolution but are just fine with ‘survival of the fittest’. God will sort it out, see, and most people are going to hell, anyway, and they deserve it because they refuse to obey God (damn useless eaters, lazy heathen). It’s a circle!

    I suspect there’s also an element of payback for no longer being a “Christian nation”, which they truly think we were at some point. Some among them secretly long to install a fundamentalist Christian gov’t (a lot like that of Muslim fundamentalists), but most don’t hold much hope for that. More of them, although still not many, think we’re approaching Armageddon.

    But most of them, particularly the politicians, are simply personally greedy and self-righteous. Their ideology allows them to go full blast forward, even encourages sociopathic behavior “out in the world”.

    The Dem polticians are hardly different, veneered in culture rather than religion. But Clinton is a pious Methodist, and I think for her, at least, there’s not even that nuance to plead.

    As I see it, anyway.

  15. MojaveWolf

    I had no disagreement with this article until the last sentence or two. I have many disagreements with that. Hopefully something longer tomorrow but wanted to note said disagreement just in case I never get back to this.

    I do not understand why Mandos seems to think “what Republicans think they can sell with good enough propaganda to enough constituents in highly gerrymandered districts” is somehow a limit on what everyone else will accept, or even a limit on what those Republicans would accept.

  16. Theo

    You’ve missed the most important things, one of which is the destruction of Medicaid. See Robert Reich’s recent piece.

  17. Theo

    My comment was marked as duplicate, which it is not.

    Look up Robert Reich’s recent piece on the destruction of Medicaid by the Republicans.

  18. Ché Pasa

    Tax cut or “tax reform?” The ideological issue being pushed by the Donor Class (both Rs and Ds, though the Rs push it harder) is “tax reform” and that always, always, always involves “lowering the rates and broadening the base.”

    Always. Without exception.

    That’s basically the underlying approach to what to do with the health insurance law.

    The “tax cut for the wealthy” is real enough, and for some, it’s hardly small at all. The increase in costs for ever crappier insurance/health care for the masses is real, too. But you see, that’s what “tax reform” and nearly all of neoLiberal “reform” actions are all about.

    They enhance the wealth of the already rich partly by reducing the burden of taxation upon them, while simultaneously costing the middle and lower classes more for less by increasing the burden of taxation on them and reducing amount, kind, and quality of benefits and services they receive for what they pay.

    It’s been going on for decades, mostly unopposed by the so-called “left” whose interest in mitigating the bad effects of this “reform” seems to diminish year by year.

    The ultimate goal is clear enough: eliminate the tax burden on the wealthy altogether (they will of course volunteer to pay for selected charitable endeavors that serve to enhance their wealth further). All taxes, therefore, should be paid by the Lower Orders (as once was the case, after all), and a portion of those taxes should by right accrue to the benefit of the wealthy, in fact should be paid directly to them as a kind of tribute.

    Obamacare is a step toward the kind of “reform” the Donor Class has wanted for many years; for example, it requires payment from the masses and it assures profits for insurance companies, among other features. The benefits and services provided to those paying the charges have been slowly (in some markets quickly) declining, to the point where some people simply can’t use the benefits they supposedly have. Doing nothing at all to Obamacare ensures that trend continues.

    The Rs seek to accelerate the trendline exponentially. Not to do the right thing or correct the injustices. No. Not at all. Rather they seek to do the wrong thing, always, and enhance inhumanity and injustice.

    It’s an identity thing with them.

  19. NoPolitician

    If you write off the tax cuts as inconsequential and therefore not the motivation, then are you saying that instead, health care is being taken away from people because the Republican base just wants to fuck the hell out of poor (brown) people?

  20. The Republicans now apparently want to replace the Obamacare penalty for not getting coverage with a restriction from buying insurance for six months if you fail to maintain continuous coverage.

    This is presumably “better” than the Obamacare tax penalty because it is not a “tax”. Yay! Thing called tax removed! Ritual proceeds apace.

  21. See the point is that the appearance of cutting a tax-oriented penalty is more important than what it does. What they’re doing is actually eviller and crueler than the tax penalty and will badly hurt their own constituents, but they can tell those very constituents — look we got rid of a punishment tax see lower taxes…

  22. Like I said before, saying is doing. It’s commutative. Doing is saying. The Republicans are doing something, and they are doing that first and foremost to say something.

  23. Ché Pasa

    Lower the rate and broaden the base — or eliminate that bothersome tax altogether, assign the benefit or service to the private sector and charge use fees to generate profits. Or impose punishment. To generate profit.


  24. Hugh

    According to the CBO scoring of the Senate healthcare bill, the repeal of the Net Investment Tax would cost $172.2 billion over the next ten years (2017-2026) [from Table 2, Sec. 119 of the CBO report, page 44 of the PDF]. Total noncoverage provisions (the non-healthcare aspects of the bill) are estimated at $563.1 billion over ten years [from Table 1, page 41 of the PDF]. In my world, that’s real money. So I don’t get the argument that it is inconsequential.

    In other news, Medicaid spending would be cut by $772 billion over the ten year time period and other subsidies would be reduced by $408 billion [from Figure 1, page 5 of the PDF] and 22 million extra people would be left without healthcare insurance coverage. That is Obamacare would leave 28 million without insurance in 2026 and Trumpcare would increase that to 49 million.

  25. So I don’t get the argument that it is inconsequential.

    The point is not the absolute size of the effect but rather the relative effect on its recipients. 172.2 gigabuckaroos over ten years is peanuts. That’s only 17G$ a year. Say only 0.1%ers get it. That’s like 350K relatively high-wealth individuals. That back of the envelope calculation gives us 50K/yr for people making a million and exponentially more, leaving aside saved wealth. Chump change from their perspective, even from the perspective of people who like to make more money for the sake of making more money.

  26. Now consider that what they are doing with this is increasing the relative incidence of uninsurance approximately 1.5x-2x. Tens of millions more without insurance than Obamacare. For what? To ask that question is to answer it. The purpose *is* the uninsurance.

  27. Mallam

    I’ve seen their “wonks” argue today that Medicaid expansion made opioid epidemic worse. Avik Roy himself of course argues Medicaid is worse than no insurance at all. Of course, these hacks would never give up their own insurance that is supposedly worthless.

  28. Ché Pasa

    @ Mandos

    Exactly. If the Rabble want insurance, let them buy it without pesky gov’t interference, preferably the kind that covers nothing and is pure profit for the issuers.

    That’s the way it’s supposed to be.

  29. Hugh

    Only in Mandosland is $17 billion a year considered peanuts. And the total noncoverage provisions amounted to $563 billion. But as long as you have a point and aren’t willing to let the numbers get in your way, no problem. AmIright?

  30. Peter


    You seem to be overacting with this rant when you must know that insurers are required by law to pay out 80% of what they take in for medical services. The remaining 20% is divided between administration costs and profit. Insurance moguls are greedy bastards, just look at Warren Buffet, but they are limited in their theft.

    I’m surprised how meek the republicans have become, I expected them to kill Obamacare and not replace it. They’re hardly even trying to kill many poor people anymore.

  31. Carla

    I refer you all to this gem: Lee Camp on Why there is no legitimate healthcare debate in this country:

  32. Only in Mandosland is $17 billion a year considered peanuts.

    If you had taken my comment in good faith, you would have taken account of the context. From the perspective of the good that the total amount could do, $17billion a year is an enormous amount of money. From the perspective of the US federal budget, it’s large but not huge. From the perspective of dividing it up to give 1%ers a tax cut, it is indeed peanuts.

    If that tax cut had been targeted at ordinary wage-earners instead, it could have been something, because it would have been spent and represent some form of economic stimulus. In this form, it is nothing of the kind.

  33. Ché Pasa

    Our Rulers could be doing the right thing — providing a public sector structure and mechanism by which everyone has access to health care when and as needed without being subjected to endless bureaucratic wrangles and without going bankrupt to pay for health care.

    It’s not hard. But Our Rulers refuse outright to even consider such a thing. Absolutely. Not. Never. Ever. (This is true, btw, of both Clinton and Trump, Ds and Rs, the Ruling Class in its entirety.)

    This is only one of many matters Our Rulers are adamantly determined to do the wrong thing rather than the right thing about.

    We can vote all we want, we still get the same result– or worse, almost never better.

    Those we put in office almost always do what is wrong rather than what is right, ensuring that millions upon millions suffer.

    That is how they have been conditioned to rule, and they cannot for the life of them figure out how to do anything else.

    We can say it’s because they are bought and paid for — which they surely are — but it is also a matter of how rule itself is structured in this country and many others.

    Doing the right thing for the many rather than the few is simply not on the table for consideration. It simply isn’t done. Or thought of.

    So. We get what we get.

    Getting uglier every day.

  34. Peter


    I read a while ago that what growth there is in consumption in the US was driven by the wealthy’s conspicuous consumption. Any relief directed at the wage-earner would go to pay down debt or into savings so no stimulus would result.

    Aren’t these tax breaks actually a rolling back of new taxes recently imposed to pay for Obamacare?

  35. nihil obstet


    You seem to be overacting with this rant when you must know that insurers are required by law to pay out 80% of what they take in for medical services.

    The trick is, what’s a medical service? Insurers get to count “patient education” as a medical service. Did any of you notice that after the passage of the ACA, suddenly your insurance company started having free health seminars and sending you informational booklets? That’s because they can provide the “educational” service with a hefty little markup as a service and then count it as a payout for medical services. In effect, a lot of the insurers’ marketing expenditures get counted as medical services. There’s a lot to rant about in the sleezy insurance scams.

  36. By Peter’s logic we should be happy to give the rich more money and forget about bailing out indebted ordinary people. LOLity LOL.

  37. Peter


    That patient education was probably mandated by Obamacare but I don’t wish to excuse the insurance industry for any of their real actual evils. I don’t think exaggeration is necessary and I’ll provide an example.

    Some years ago my wife needed cataract surgery and one eye was operated on in the two part surgery. After the success of the first surgery the insurance company paid the bill but then refused to cover the second eye surgery apparently claiming she only needed one good eye. The eye surgeon wrote a terse reply to them and told them they were nuts and must pay.

    I think this type of behavior may be bean counter panic towards the end of a quarter when their returns fall short of their allotted 20% but I don’t think it happens much anymore.

  38. Robotpliers

    Cutting public health insurance expenditures and letting private insurance throw more people off their plans will free up a lot more money at the top of the economy. Mandos, I think you’re right that the tax cut is small potatoes to its intended recipients, but I also think this amendment puts a lot more money into play than just the tax cuts alone.

  39. nihil obstet


    “was probably”? No.

  40. Robotpliers: that is a much better point. Everything I’ve read suggests that the oddness and uncertainty of the health care system is an overall economic drag on most other sectors. It’s possible that there is something at the top end of this that is worth it to someone more powerful than everyone else, including most other industries.

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