Friday, September 29, 2017

What Puerto Rico disaster and ACA sabotage have in common: Trump's noxious narcissism

Paul Krugman connects those dots in Trump’s Deadly Narcissism.

According to a new Quinnipiac poll, a majority of Americans believe that Donald Trump is unfit to be president. That’s pretty remarkable. But you have to wonder how much higher the number would be if people really knew what’s going on.

For the trouble with Trump isn’t just what he’s doing, but what he isn’t. In his mind, it’s all about him — and while he’s stroking his fragile ego, basic functions of government are being neglected or worse.

Let’s talk about two stories that might seem separate: the deadly neglect of Puerto Rico, and the ongoing sabotage of American health care. What these stories have in common is that millions of Americans are going to suffer, and hundreds if not thousands die, because Trump and his officials are too self-centered to do their jobs.

Start with the disaster in Puerto Rico and the neighboring U.S. Virgin Islands.

When Hurricane Maria struck, more than a week ago, it knocked out power to the whole of Puerto Rico, and it will be months before the electricity comes back. Lack of power can be deadly in itself, but what’s even worse is that, thanks largely to the blackout, much of the population still lacks access to drinkable water. How many will die because hospitals can’t function, or because of diseases spread by unsafe water? Nobody knows.

But the situation is terrible, and time is not on Puerto Rico’s side: The longer this goes on, the worse the humanitarian crisis will get. Surely, then, you’d expect bringing in and distributing aid to be the U.S. government’s top priority. After all, we’re talking about the lives of three and a half million of our fellow citizens — more than the population of Iowa or metro San Diego.

So have we seen the kind of full-court, all-out relief effort such a catastrophe demands? No.

And then there’s health care.

Obamacare repeal has failed again, for the simple reason that Graham-Cassidy, like all the other G.O.P. proposals, was a piece of meanspirited junk. But while the Affordable Care Act survives, the Trump administration is openly trying to sabotage the law’s functioning.

This sabotage is taking place on multiple levels. The administration has refused to confirm whether it will pay crucial subsidies to insurers that cover low-income customers. It has refused to clarify whether the requirement that healthy people buy insurance will be enforced. It has canceled or suspended outreach designed to get more people to sign up.

Joan McCarter (at Daily Kos) documents the sabotage in her report that Trumpcare is dead for now, but Trump’s Obamacare sabotage is going full steam

Trump doesn’t really need Obamacare repeal, not when he has so much power to destroy it from the inside. He’s doing that with a vengeance ahead of this year’s open enrollment, set to begin November 1 and run through mid-December, already a shortened enrollment period. The administration has informed Mississippi that it will not be participating in enrollment preparation events in the region. Every year before enrollments began, Obama administration officials would go to the states and meet with groups that sign people up. That’s a thing of the past reports Vox’s Dylan Scott.

Up until Monday, Roy Mitchell, executive director of the Mississippi Health Advocacy Program, thought these events were going forward in the coming weeks as planned. He had even asked HHS just last week for biographies of the officials they’d be sending.

But then two days ago, he received a short message from an agency official, which Mitchell shared with Vox: HHS wouldn’t be doing any Obamacare marketplace events in the South this year. No further explanation was provided.

“HHS bailing out was the last straw for us,” Mitchell told me by phone Wednesday. “It’s clearly sabotage.” […]

HHS’s abrupt withdrawal from the events is part of a bigger story. The Trump administration has already cut this year’s open enrollment period in half. It slashed spending on advertising by 90 percent. Funding for the navigators program, which went to groups that helped people sign up for insurance, was reduced by 40 percent and then allowed to lapse entirely.

That’s just what’s happening around enrollments. Trump’s ongoing threats to end cost-sharing reduction payments, federal government reimbursements to insurance companies for subsidizing costs to lower-income customers as required by the law, is creating havoc for the insurers. The uncertainty is causing insurers to leave the markets altogether, and to jack up premiums to compensate for what they assume will be the end of those CSR payments.

What that means is a 45 percent increase in premiums in Florida, for example. More than 1 million of the 1.43 million Floridians with an ACA plan in 2017 received those CSR subsidies from insurers. That’s a major financial commitment on the part of insurers, again required by law, to make healthcare affordable.

With Trump continuing to insist that repeal is going to happen, and working hard to sabotage the law at every possible turn in the meantime, expect those kinds of premium hikes around the country. Most Obamacare enrollees won’t feel the brunt of those increases—somewhere around 80 percent of them have incomes that qualify them for premium subsidies from the federal government. So it will be all of us—the taxpayers—who pay those costs in the long run.

And all the blame for that is going to be on Trump.

Krugman winds up.

Why are the Trumpists doing this? Is it a cynical calculation — make the A.C.A. fail, then claim that it was already doomed? I doubt it. For one thing, we’re not talking about people known for deep strategic calculations. For another, the A.C.A. won’t actually collapse; it will just become a program more focused on sicker, poorer Americans — and the political opposition to repeal won’t go away. Finally, when the bad news comes in, everyone will know whom to blame.

No, A.C.A. sabotage is best seen not as a strategy, but as a tantrum. We can’t repeal Obamacare? Well, then, we’ll screw it up. It’s not about achieving any clear goal, but about salving the president’s damaged self-esteem.

The impression one gets is of a massively self-centered individual who can’t bring himself to focus on other people’s needs, even when that’s the core of his job.

In short, Trump truly is unfit for this or any high office. And the damage caused by his unfitness will just keep growing.

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