Subscribe via RSS Feed

Category: General

The Path to Universal Healthcare I: Let’s Clarify Our Terms

[ 280 ] May 23, 2017 |

The United States, as is well known, spends much more money to provide effective access to health care to fewer people than other comparable liberal democracies. This is an urgent moral issue. The Affordable Care Act was a major step in the right direction but is also not a satisfactory end point for health care reform. The energy surrounding “single payer” is therefore both justified and generally a good thing. But, in part because health care is — who knew? — complicated and in part because for some people invoking “single payer” are saying “the neoliberal Democrat Party sucks because neoliberalism” rather than thinking through a strategy for getting universal coverage through James Madison’s sausage factory, there’s a lot of sloppiness and conceptual confusion surrounding the discussion. Before discussing the political and policy barriers to universal health care, it’s worth making some distinctions.

Let’s start here. There is a strange tendency to use “Medicare for all” and “single payer” interchageably. But unless Medicare was very substantially altered, “Medicare for all” would not actually be “single payer”:

Medicare provides protection against the costs of many health care services, but traditional Medicare has relatively high deductibles and cost-sharing requirements and places no limit on beneficiaries’ out-of-pocket spending. Moreover, traditional Medicare does not pay for some services vital to older people and those with disabilities, including long-term services and supports, dental services, eyeglasses, and hearing aids.

In light of Medicare’s benefit gaps and cost-sharing requirements, most beneficiaries in traditional Medicare have some form of supplemental coverage to help cover cost-sharing expenses required for Medicare-covered services (Figure 12). Other beneficiaries—30 percent in 2014—are covered under Medicare Advantage plans. However, 14 percent of all Medicare beneficiaries had no supplemental coverage in 2010, including a disproportionate share of beneficiaries under age 65 with disabilities, the near poor (those with incomes between $10,000 and $20,000), and black beneficiaries.

Medicare for all would actually be more like a European hybrid system. This is not necessarily a criticism. Indeed, as I have argued I think this is actually a much more viable path to comprehensive health coverage in the United States than true single payer or nationalized medicine:

Many liberal democracies, including Switzerland, France and Germany, have achieved true universal coverage with hybrid public/private models. The Netherlands actually changed its single-payer system to a hybrid system in 2006. When compared to single-payer Canada, the hybrid models in general rank better in quality and efficiency and are as or more equitable. And like single-payer, they deliver better results for far less money than the US spends.

Particularly given that there’s no way that single-payer would be as cheap in the US as it is in Canada, single payer is probably less desirable than the hybrid model even if we ignore the former’s political unfeasibility.

But Sanders and Clinton are right that, in the long term, something at least approaching European-style universal healthcare is possible. Many countries have built excellent healthcare systems out of better versions of the ACA model: expanded (and in the case of Medicaid, improved) public insurance combined with better-regulated and subsidized private markets. Progress can be made towards this incrementally, as Clinton has proposed; it can be done in another big statute but it doesn’t have to be.

If we’re going to get to universal coverage, though, liberals need to get beyond conflating “single payer” and “European-style healthcare.” (And I’ve been as guilty of that as anyone.) Universal health coverage is a case in which Sanders’s idealism and Clinton’s realism can in fact end up in the same place.

Whether “Medicare for all” is the best hybrid approach is debatable. Michael Sparer makes a good case for building off Medicaid rather than Medicare. But I’m not sure we have to decide ex ante, particularly since the path to universal coverage is much more likely to be gradual expansions of both Medicare and Medicaid while individual private insurance is more heavily subsidized.

The key point is that, whatever the most useful shorthand for politicians trying to win elections, when we’re thinking about health care policy we really need to stop conflating “universal health coverage” with “single payer.” It’s not wise to close off viable paths is advance, particularly since there’s not really any reason to think that single payer models are inherently better than hybrid ones at providing equitable coverage. This is particularly true given the formidable political obstacles that still exist, but we’ll return to that in the next post.

FacebookTwitterGoogle+Share

Clarence Thomas’s Fatalism on Race In America

[ 56 ] May 23, 2017 |

In the wake of Clarence Thomas being the swing vote in yesterday’s case holding North Carolina’s racial gerrymanders unconstitutional, I have a piece in the New Republic about his jurisprudence on race:

In part because he rarely speaks at oral argument, there was a common perception that Thomas is just a clone of the late Antonin Scalia. This assumption—which, in some cases, carried the odor of racist condescension—is profoundly wrong. “What [Thomas] has done on the Court,” wrote Mark Tushnet, now a professor at Harvard Law School, in his 2005 book A Court Divided, “is certainly more interesting and more distinctive than what Scalia has done and, I think, has a greater chance of making an enduring contribution to constitutional law.” Thomas and the recently retired Justice John Paul Stevens are the two most idiosyncratic Supreme Court justices of the last 40 years, the most likely to stake out a unique position on a particular issue.

Thomas’s approach is particularly visible in cases involving race. Typical Republican nominees like Chief Justice John Roberts and Antonin Scalia combine a belief in formal colorblindness with the view that racism is no longer a major problem in American society. This willful optimism reached the point of self-parody with Roberts’s 2013 opinion gutting a section of the Voting Rights Act that required states with a history of discrimination to get approval from federal authorities for any changes to election law. Roberts held that because the Voting Rights Act had been so effective in addressing race discrimination in voting, Congress no longer had the power to enact its most important enforcement mechanism.

Thomas also generally believes in formal colorblindness, but for very different reasons rooted in (sometimes explicit) black nationalism. Thomas believes that the state should be race-neutral not because he has any illusions that racism has ended in the United States, but because he believes that color-blindness is the best that African-Americans can reasonably expect from the state.

Thomas’s fatalism can be seen even in opinions where he ends up in the same position as his conservative colleagues. His 2003 dissent from the Court’s opinion upholding the University of Michigan Law School’s affirmative action program is a powerful argument even if, like me, you ultimately disagree with the bottom line. Beginning by quoting Frederick Douglass, he makes a subtle, complex argument with pointed discussions about the fallacious assumptions that predominantly black institutions must be inferior; the dubious necessity of the state maintaining an elite law school; the disgrace of legacy admissions preferences; and the false “merit” reflected by standardized tests. Even if one ultimately finds it unpersuasive, it’s certainly not the boilerplate defense of American “meritocracy” that underlies Republican arguments against affirmative action.

British and American Media Digital Frontpages on Manchester Attack

[ 66 ] May 23, 2017 |

Living here in the UK, this is the closest I have ever physically been to a terrorist attack. I’ve never visited Manchester and so much of Europe still feels like a far away imaginary place to me. It is hard to comprehend the level and the proximity of the violence and I think it will take time for me to truly process it and offer any kind of perspective on what’s happening.

While I wait for more information and observe the reactions around me, I am following the images coming out of digital news. These screenshots were taken at roughly 2pm London time on May 23rd, the afternoon after the attack. There are some interesting differences. See if you can spot them.

BBC News

The Guardian

The Guardian is actually leading with a number of images, some photos of identified victims and first responder images, that rotate automatically within the top box.

CNN.com

Much more disturbing image is chosen for the lede.

MSNBC.com

Thanks for focusing in on the real star of the show, MSNBC. ‘preciate it.

New York Times

The Manchester attack is the first and only full story on the page. The other half of the page is a rotating box of the latest opinion pieces and a chronological list of stories published in other sections.

Washington Post

Like the NYT set up, the front page of WaPo shares about equal space horizontally with a story about Trump asking intelligence chiefs to deny collusion with Russia, but the Manchester story gets a lot more vertical space. Unlike the NYT set up though, the space designated has an editorial slant to it that has less to do with the user interface.

 

If anyone knows of a better way to take quality screenshots of digital front pages, be sure to let me know. And watch this space for more analysis of the way media coverage unfolds.

The Party of Ideas (TM)

[ 71 ] May 23, 2017 |

We’ve already discussed the absolutely savage cuts in the budget the resulted from populism beating neoliberalism. In addition to a thorough analysis of those, Dylan Mathews observes that there’s also the classic GOP crackpot magical thinking:

In the budget, Trump assumes that real GDP growth will reach 3 percent by 2020 and then stay there. In a press call, OMB Director Mulvaney castigated the Obama administration and the Congressional Budget Office for projecting 1.9 percent growth for the indefinite future.

“I think it’s sad that the previous administration was willing to admit they couldn’t get more than 1.9 percent,” Mulvaney told reporters. “I think it’s sad that the CBO assumes the same thing. That assumes a pessimism about America and its people and its country.”

What it actually assumes is that the US is an aging country, that we will not have enough immigrants to keep pace with older Americans leaving the workforce, and that there is a global slowdown in productivity across all rich countries. If the Trump administration were open to increasing immigration flows, that would be one thing. But their immigration crackdown actually makes this problem worse. As former Obama chief economist Jason Furman noted in a piece for Vox, the median estimate from both the CBO and the Fed’s Open Market Committee is 1.8 percent; private forecasters are a bit more optimistic at 2.2 percent. No one thinks 3 percent is plausible, and there’s no tax reform in the world so awesome as to close that gap.

Higher growth leads to higher tax receipts, which helps the Trump administration claim that their budget balances. In a memorandum, they estimate deficits under their budget assuming that growth continues at its current level rather than rocketing up to 3 percent. They find that in 2027, the deficit would reach $1.34 trillion. With their optimistic economic assumptions, they found that there would be a surplus. So Trump’s team is getting well over $1 trillion per year in new money to play with by making up overly optimistic growth numbers.

It gets worse, though. They’re double-counting those numbers. Treasury Secretary Steve Mnuchin has said that the tax reform plan the administration is pushing will be “deficit-neutral” only after you take into account their effect on economic growth. So he’s effectively using that growth to pay for tax cuts. But as the Washington Center for Equitable Growth’s Greg Leiserson notes, he then turns around and uses the growth to also pay for deficit reduction in the budget.

This is an area, of course, where Trump is no more of a bullshitter than the average Republican. Jeb! promised 4% growth — WHY DOES TRUMP LACK CONFIDENCE IN THE AMERICAN PEOPLE?!?!?!?!?!?!?!?!? The whole party is just a racket justifying the most upward redistribution of wealth that can pass Congress, justified with asinine back-of-a-cocktail-napkin crap.

The Obstruction of Justice Du Jour

[ 86 ] May 22, 2017 |

Another day, another scoop:

President Trump asked two of the nation’s top intelligence officials in March to help him push back against an FBI investigation into possible coordination between his campaign and the Russian government, according to current and former officials.

Trump made separate appeals to the director of national intelligence, Daniel Coats, and to Adm. Michael S. Rogers, the director of the National Security Agency, urging them to publicly deny the existence of any evidence of collusion during the 2016 election.

Coats and Rogers refused to comply with the requests, which they both deemed to be inappropriate, according to two current and two former officials, who spoke on the condition of anonymity to discuss private communications with the president.

Manchester

[ 46 ] May 22, 2017 |

As you’ve probably heard, at least 19 people were killed by a nail bomb at a concert tonight. Our thoughts to the victims, their families, and the city.

What’s the difference between ageism and a prudent regard for statistics?

[ 241 ] May 22, 2017 |

This very-much-not hypothetical question is raised in my mind by Scott’s observation earlier today that Bernie Sanders is at this point one of the two leading contenders (along with Kirsten Gillibrand) for the Democratic nomination in 2020.

I’m far from a Bernie-basher and in fact preferred him to Clinton in the 2016 primaries, but the man will be 80 in 2021.  Prevalence of Alzheimer’s and related conditions by age:

There are also rumblings that Joe Biden (79 in 2021) is considering a run.

And of course dementia is just one of many strongly age-related health risks, although it’s one that seems especially germane at the present moment, given Trump’s staggering incoherence (he does seem to have gotten worse relative to interviews he did 10-15 years ago).

Anyway, this seems to me to be a difficult issue in a number of ways.

 

 

 

 

 

“Trump has almost certainly engaged in obstruction of justice for the simple reason that there is a lot of justice to obstruct.”

[ 55 ] May 22, 2017 |

Julian Sanchez recently had a good post arguing that the focus on whether the FBI’s investigation will produce evidence of active collusion between the Trump campaign and the Russian state during the election is misplaced:

It therefore seems like a grave error to talk as though the two possible outcomes are that the FBI’s investigation—or that of a special counsel, if that’s the direction this ends up going—either finds clear evidence of knowing collusion or turns up nothing much worth talking about. The more we focus obsessively on that first unlikely alternative, the easier it becomes to sweep any other significant findings under the rug once the investigation concludes, by limiting public disclosure of those findings to a terse answer to the binary question of collusion. Probably James Comey would have been difficult to bully into complicity in such a whitewash, but he’s gone now, and the more the public is convinced that’s the only question worth answering, the easier his successor will find it to play ball.

And one of these significant findings is likely to be massive corruption on the part of Trump and his associates:

A week ago, it appeared that the probe would center around the activities of a handful of figures who are now marginal within Trumpworld: former campaign manager Paul Manafort, foreign policy adviser Carter Page, and deposed National Security Adviser Michael Flynn. That has changed. The Washington Post reported Friday that investigators have identified a current White House official as a person of interest in its financial probe. (The story hinted, and New York Magazine contributor Yashar Ali confirmed, that the person is Jared Kushner.)

Ominously for Trump, the Post reports that the FBI is “determining whether any financial crimes were committed by people close to the president.” While Kushner’s public persona differs wildly from that of the president in the functioning of his real-estate work, he is a kind of mini Trump. Inheriting an empire from his father, he has operated in gray areas of the world economy and positioned himself to gain handsomely from Trump’s election. Kushner has met with the head of a Russian bank functionally controlled by Vladimir Putin. He appears to be eager to use his proximity to Trump to make a buck; his family business is exploiting the familial connection to sell visas in China. Trump himself has a long, nontransparent history of business dealings with organs of the Russian state. (Last week, The Wall Street Journal dug up another case.)

All this implies that the probe is scrutinizing the financial aspects of Trump’s business, which is a family operation. While some Trump advisers opposed the firing of Comey, Kushner reportedly advocated for it. That fact may seem strange if one thinks of Kushner as a voice of pragmatism. But it is easier to understand if you think of him as a figure sitting near the heart of a financial scandal, who harbors a strong interest in suppressing the investigation.

An investigation can find an awful lot of damaging things about the Trump administration without finding smoking gun evidence of willful collusion. And almost certainly will.

Crying won’t help you, praying won’t do you no good

[ 81 ] May 22, 2017 |

Your daily reminder that the POTUS is quite literally a very stupid person, i.e., significantly below average, or what they used to call “dull normal” before every [white] kid became officially gifted and talented:

Just ahead of a meeting with Prime Minister Benjamin Netanyahu today, President Trump told a group of reporters several times that he “never mentioned the word, or the name, Israel,” in his Oval Office conversation with the Russian foreign minister and ambassador earlier this month. He then leaned over to Netanyahu, who is presumably fully aware of what they’re talking about, and told him, “they were all saying I did.”

Who is “they”? Neither the original Washington Post story about Trump’s disclosure of classified intelligence to the Russians, nor the New York Times story that identified Israel as the source of that intelligence, suggest that Trump identified the country by name. Rather, the concern, as the Times put it, was that he had “provided enough details to effectively expose the source of the information and the manner in which it had been collected” to the Russian government, an ally of Israel’s rival, Iran. It’s also worth pointing out that neither the U.S. or Israeli governments have officially confirmed that Israel was the source, something Trump didn’t bother to mention.

It’s hard to tell who comes off worse in this clip: Trump, who thinks he should get brownie points for not actually disclosing the name, address, and passport number of the spy who gathered the intelligence he was passing to the Russian government, or Netanyahu, who desperately wants this visit to go smoothly, and stands there grinning, saying that the state of intelligence cooperation between the two countries is “excellent.”

Here’s the clip.

We’ll be lucky to get out of this alive.

 

The Way To Save the ACA is to Fight For the ACA

[ 175 ] May 22, 2017 |

There was a controversy this weekend that ended up in the Twitter mentions of at least one LGM front pager in which Tom Perez was criticized for calling for unity after Jon Burton made a dumb comment telling protestors to shut up and go outside. I understand the criticism of Burton, but when it comes to Perez I don’t understand what I’m supposed to be upset about. He didn’t express any kind of opposition to single payer; he just made the rather banal point that the immediate focus should be on stopping Trump/Ryan/McConnell’s savage cuts to American health care.

Admittedly, I don’t most of the criticism of Perez is part of a considered strategy to either stop the AHCA or attain single payer; the sole point of the criticism is “Tom Perez is a shill imposing neoliberalism on the Democrat Party.” But the tactical questions are of considerable immediate interest. My friend Sam Bagnestos, a professor at the University of Michigan law school, agreed to let me publish an email he sent on this subject, which I fully endorse:

I’m for single payer (though I am open to any means that will get us to the goal of truly universal and really good health care coverage). And wonks on the left should be developing single payer proposals and building constituencies for them, so that we are prepared when there is an opening to get them passed.

But right now the president is proposing to cut Medicaid by $800 billion. That’s going to devastate millions of poor, working, and disabled people (overlapping categories). In every disability advocacy project I’m working in right now, this is the most important fact — the issue we all have to talk about, because if Trump gets his way we can forget about achieving whatever it is we want to achieve in the project.

So for me in the healthcare world, job one right now is fighting the Medicaid cuts, to protect the millions of poor, working, and disabled people who will have their lives devastated if the cuts go through. And I would hope that everyone who is pro single payer will join me in that defense right now. That might mean joining with a lot of people who don’t like single payer — at least not now — but can be persuaded to fight Medicaid cuts, and who, with some time fighting alongside single-payer advocates, might become allies in future offensive efforts.

I keep hearing, from a lot of people I like and respect, that we can’t do defense without agreeing on ambitious offensive goals. I don’t think that assertion is true as a practical matter. It’s often a lot easier to pull together a defensive coalition, among people who might disagree on what offensive goals to pursue next, then to pull together a coalition to pass new, expansive legislation. The Madisonian system is a big reason. So is basic psychology like the endowment effect and loss aversion.

I think the no-defense-without-offensive-goals line, in the healthcare context, really means one of two things: (1) Any political effort spent defending a non-universal system is counterproductive, because it cements in the public’s mind the association of government healthcare with welfare and other programs that many people will see as taking from “us” to give to “them.”  (2) Trump is probably going to get his way anyway, and when he does, the results will be so disastrous that we will finally have a real political opening for single payer.

As to (1), that’s really an empirical question.  But I think a lot of people who have an ideological preference for universalism in social programs treat the answer as obvious without engaging in any empirical analysis.  I, for one, would want to be damn sure that defending Medicaid was counterproductive before deciding to sacrifice the millions of poor, working, and disabled people who would lose out with Trump’s cuts.  And my own experience is that the example and testimony of people with disabilities and their families in relying on Medicaid opens up a nice solidaristic defense of the program that can lay the groundwork for future efforts to promote universalism.

As to (2), maybe.  And certainly that’s a reason for wonks on the left to be constructing and building support for single-payer proposals (and for political operators to strategize regarding how to exploit the opportunities that open up).  But none of that precludes fighting right now against Trump’s Medicaid cuts — and fighting alongside some folks who may not agree on single payer as a goal.  Trump may not get his way — there is a path, though hardly a certain one, to defeat those cuts.  And if he does get his way, even if the result is to open up more political space for single payer, that doesn’t make single payer certain or even likely to happen — and it certainly won’t happen before 2021.  Even after 2021, the problems Charles Gaba talked about are basically going to remain.  If the Medicaid cuts happen, and they create a political opening, let’s make the most of it.  But given the uncertainties regarding the political opening, and the certain devastation to lots of poor, working, and disabled people if the cuts go through, I see no reason not to fight like hell against those cuts.  And I certainly see no reason for single-payer advocates, who should be trying to expand the coalition, to be attacking people who think defense is job one right now.

I will admit to some frustration that, among many people I like and respect, the foregoing hundreds of words will confirm the conclusion that I am a neoliberal corporate shill.  But, honestly, I’ll even take the label if everyone can agree that we need to fight like hell against stuff like these Medicaid cuts.

This is exactly right. The way to save Medicaid from immediate attack is to…fight to save it and fight against the extremely unpopular AHCA, not to focus on attacking the ACA from the left. This is in no way inconsistent with preserving the ultimate goal of truly universal health care — the two most likely 2020 nominees right now, Sanders and Gillibrand, both have been longtime supporters and even if someone else is the nominee it’s nearly certain the Democratic nominee will support it too. There will be plenty of time to focus on advocating an affirmative plan for universal health care. But right now, the fight has to be to do whatever can be done to keep Republicans from destroying the ACA, which would both create a great deal of death and suffering and make attaining universal health care more difficult. And, by definition, the legislative coalition to stop the AHCA will require the votes of multiple people who don’t support single payer.

Hate speech, hate crimes and the illusion of plausible deniability

[ 214 ] May 22, 2017 |

On Saturday Richard Collins, III, came to the University of Maryland to visit friends and celebrate being commissioned as a second lieutenant in the Army. He was going to graduate from Bowie State on Tuesday.

Early Sunday morning he was stabbed to death by Sean Urbanski, a UMD student and member of a Facebook group called Alt Reich Nation.

Court documents obtained by News4 say Collins was waiting for the university’s shuttle bus with his friends when they realized the shuttle bus had stopped running for the night. The three decided to call an Uber and were waiting for one to arrive when they heard Urbanski screaming nearby, the documents said.

Collins and his friends watched Urbanski has he approached them. According to court documents, “Urbanski said, ‘Step left, step left if you know what’s best for you.’

“Collins said ‘No’ as Urbanski continue to approach,” the documents said.

One of Collins’ friends noticed Urbanski was holding a knife with a 3- to 4-inch silver blade as the suspect stabbed Collins once in the chest area, documents said. The friend ran toward Baltimore Avenue as she called 911 and asked the Uber driver to call 911. Other witnesses stayed with Collins and tried to help him until police and medics arrived.

Two Prince George’s County police officers found Urbanski sitting on a bench at a bus stop about 50 feet from where Collins had collapsed. Witnesses identified him as the suspect and he was taken into custody at the university’s police department, documents said.

Urbanski faces a number of charges including 1st and 2nd degree murder. The FBI is investigating to determine whether it was a hate crime.

The the chief of UMD’s police department noted that he wasn’t aware of any increase in threats on campus. I’ll take his word for it, but note there has been an increase in threatening activity.

Soon after tRump was elected white supremacist flyers started appearing on the campus and in nearby neighborhoods. A couple of weeks ago someone  placed a noose in the kitchen of one of the frats.

Is there a direct connection between the flyers or the noose or the Facebook group and Urbanski stabbing Collins in the chest? Unless Urbanski says so, that will remain an unknown known. Even if he says he was influenced by one or more of these things, it would fit the pattern that assists the spread of supremacist terror.

Marginalized groups know that soon or late the fire of violence will follow the smoke of hate speech. No matter how many people or organizations speak about the criminal brown savage or the Sharia spreading Muslim, slut and their non-stop abortions, or the gay man who wants to assault kids, the act of violence against marginalized people is always attributed solely to the individual. Where was he radicalized? people ask semi-ironically. Not here! And don’t try to take our guns! screams every human septic tank that’s been spewing filth everywhere.

Meanwhile the speech continues and keeps the potential victims nervous and miserable.

This ill-defined space between the speech acts and violent acts is also the headquarters of The Grand Brotherhood of Pundits and Tut-tutters who are deeply saddened when people protest the on-campus appearance of people like Charles Murray or Anne Coulter or Milo Y-didtheycancelmybook, because anything that hinders the Free and Open Exchange of Ideas is Bad.

I think inviting someone like Murray to take a nap in the path of a steam roller is a fine example of the free and open exchange of ideas, but that doesn’t count for some reason.

More importantly, these protest recognize that no matter how much someone might like to pretend, the interplay between speech and violence exists. Protesting the speech is one of the few ways people can prevent violence without resorting to violence themselves.

In Conclusion, Both Sides Do It, But the Democrats Are Worse

[ 61 ] May 22, 2017 |

With the neoliberal Hillary Clinton safely vanquished, we are getting a budget proposal from a genuine populist in Donald Trump. What’s in it — a trillion dollars for public transit? A generous maternity leave program? Single-payer? Well, funny thing about that:

President Trump’s first major budget proposal on Tuesday will include massive cuts to Medicaid and call for changes to anti-poverty programs that would give states new power to limit a range of benefits, people familiar with the planning said, despite growing unease in Congress about cutting the safety net.

For Medicaid, the state-federal program that provides health care to low-income Americans, Trump’s budget plan would follow through on a bill passed by House Republicans to cut more than $800 billion over 10 years. The Congressional Budget Office has estimated that this could cut off Medicaid benefits for about 10 million people over the next decade.

The White House also will call for giving states more flexibility to impose work requirements for people in different kinds of anti-poverty programs, people familiar with the budget plan said, potentially leading to a flood of changes in states led by conservative governors. Many anti-poverty programs have elements that are run by both the states and federal government, and a federal order allowing states to stiffen work requirements “for able-bodied Americans” could have a broad impact in terms of limiting who can access anti-poverty payments — and for how long.

Strange — it’s almost as if Donald Trump is a Republican or something. (Seriously, remember all the discussion about whether Democrats should be cutting deals with Trump? That was surreal.)

It won’t pass in this form, of course. But Trump has made it clear that as president he’s a Ryanite all the way.

Page 3 of 1,73412345...102030...Last »