The bear that caught the car: Republicans and ACA

I wrote a piece for describing the dilemma facing Republicans next year.

“Repeal and replace” is one of the few clear policy goals that unites President-elect Trump’s campaign with congressional Republicans. Something large is going to happen. Some triumphant Republican “repeal” seems foreordained…

What will Republicans actually do to replace the ACA? That is another matter. Seldom has a political party combined such comprehensive control over the practical levers of government with such limited public mandate for its policy agenda. President-elect Trump lost the popular vote by more than 2.5 million votes. His net favorability rating stands at minus six, which is about forty-nine points below the net favorability rating of President-elect Barack Obama eight years ago. According to the website, only 35 percent of Americans believe Trump has the temperament for the presidency. Fifty-nine percent“think he is not even somewhat qualified for the job.”


Some commentators suggest that Republican efforts to bend the health care system to their liking resemble the dog who chased the car and finally caught it on November 8. But that analogy isn’t quite right. Perhaps the better analogy is the bear who chased a car: the bear will likely regret catching up, but the car won’t escape unscathed, either.

More here.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

10 thoughts on “The bear that caught the car: Republicans and ACA”

  1. This is a request for some insights from people who know this stuff better than I. Sixty years ago, C. Wright Mills wrote of The Power Elite, one branch of which was the high reaches of corporate America. Back then it was big defense contractors and big industry. Today it is certain that big insurance and big health care are elements of today's power elite. They had major input into the ACA and they may not want this guy to come blundering in if they think that will hurt them.

    Is the work of C. Wright Mills relevant today? If Donald Trump tries to mess with them in ways they do not appreciate, can they get in his way and curtail his ability to pursue his own agendas? Can he continue to Tweet about Boeing and other powerful corporations with impunity? Is there still a power elite to which presidents still need to accommodate themselves?

    I hope this request makes sense. I am all ears for any information about it.

    1. I think the recent election had a lot to do with popular rejection of the "power elite". Van Jones recently sat for an interview with Salon in which he lucidly describes the problem of elitism. From the interview:

      We’re building Trump’s coalition for him by basically treating them all as if they’re all “deplorables” and irredeemables or stupid people who we need to fix, and that’s the problem. That’s the elitism. We are operating — listen, both parties suck right now because the liberals think we’re the party of the working people and the poor people and the downtrodden, but we have allowed a strain of very nasty elitism to take root in our party such that we don’t even see it anymore.

      The party that could have won would have been the party of underdogs of all races in red states and blue states. That frankly sounds a little bit more like Bernie Sanders has the better race analysis. That would have been an unstoppable freight train. It’s not that the party’s race politics were bad; it’s that the party’s class practice is horrible.

      The class practice of just having people with advanced degrees sitting around talking to each other all the time and then focus grouping and polling all these other people and trying to interpret them through data as opposed to talking to somebody.

      (emphasis mine)

      Sound familiar, RBC? With Brett Bellmore's recent exit stage right, it seems you've finally successfully repelled the last of the opposition party who was willing to frankly discuss issues with you from another perspective. You were never willing to treat him as an equal here, were you? You limited his comments, derided his opinions, accused him of arguing in bad faith when yours wasn't any better, and flat-out asked him to "please go away". Van Jones had another comment about that sort of elitist behavior in the interview:

      I’m not trying to get agreement. I don’t want everybody to agree. In a dictatorship everybody has to agree. I don’t want that. Democracy means nobody has to agree. I love that, but the disagreement needs to be constructive and not destructive and that requires an atmosphere of basic respect, which neither party is showing, and an atmosphere of a willingness to be surprised.

      My humble opinion is that you'd have more success heeding Jones' words than falling back on the sort of power elitism that declares "we are the experts, you lessers must listen to us and do as we say", because that dog just won't hunt in the political environment we find ourselves in today.

      1. My experience reading Bellmore's comments on many blogs for many years is that he is rhetorically skillful, and polite, and will endeavor to "win" any argument regardless of the merits by simply tiring out everyone else with a greater number of comments. He seems to be able to do this full-time, and he's perfected the evenness of tone that can lead a reader new to the discussion to believe that he's the good guy. But long-term, it's sort of like a subtle DDoS attack. Any forum on which he decides to concentrate eventually becomes The Brett Bellmore Show.

        He's not the only person who does this, and it seems to be a common tactic on the Internet right. The problem as a blog owner is that you're essentially forced to either behave like a tyrant, or let them eventually drive out all discussion that does not revolve around them. There is no middle ground.

      2. Your assumption is that this election wasn't basically all about "blackity-black blackity-black blackity-black". Oh, and "ladyparts ladyparts ladyparts". Show some evidence, man. B/c as far as I can tell, that was it. After all, if Obamacare, one of the best ways to help WWC people make ends meet (remember the data on medically-induced bankruptcy) is a partisan measure, well, I think we know what's going in, right? "Somewhere, a black man is getting something he didn't deserve, so let me cut off my nose to spite him".

        Oh yeah, and sure it wasn't great. But that wasn't for the Dems' trying. There were some conservatives who fought tooth-and-nail against every bit of it. Imagine if we had Medicare-for-all. Oh, but then, some black man would get health care. Can't have that.
        Can't have that.

      3. OTOH, and Ezra Klein, pointed this out, not a single Congressional or Senate seat of either party was put in danger by the charge of elitism. A Trump supporter ran against Paul Ryan in the primary, and had his ass handed to him. Ryan is as elite as you can get – son of a family who made a fortune out of Federal building contracts, just like Trump's old man.

        "Revolt against the elites" is not a very convincing primary explanation for Trump's victory, especially as Trump's line up of plutocrat businessmen for his cabinet has not brought a squeak of protest from his supporters. "Defence of white privilege" had a far more potent influence, and that is indeed deplorable.

      4. I agree that there was a populist revolt against what the electorate perceived as an elite. But my understanding of C. Wright Mills is that there are powerful institutions like corporations and the military who control many levers of power with their own agendas. For example, no president ever controls the Pentagon; Dwight Eisenhower recognized their games for what they were but none of his successors have been able to stand up to them. JFK was not able to control the CIA.

        Donald Trump will be controlled by the Pentagon, not the other way around. He will not be able to control the CIA, especially since he is already showing them such disrespect by blowing off his daily briefings and is contradicting a point on which they all agree regarding Russian interference in our election process. These guys were there before he came along and will be there after he is gone. And they do not give a damn what the voters want. They do not need to.

        I suspect that Mills' perspectives on power are still pertinent. I am not sure just how.

      5. I have spent more time than is wise arguing with Bellmore.

        I am not convinced I have gotten much benefit from it.

  2. What is the situation on gender discrimination? ACA requires IIRC equal premia for women and men, which is a cross-subsidy to younger women because their reproductive health is biologically more complicated, with the specific burdens of pregnancy and childbirth. Judging by blog comment threads, quite a few younger men with conservative or libertarian politics object to this socialisation. Trump's record of misogyny suggests he may be ready to pander to them. Does Price's old proposal go down this road?

  3. This "out of touch" narrative strikes me as odd. Isn't the fact just that we are a pretty culturally and ideologically divided country? What would it mean for us to be "in touch"? Am I any more out of touch with Trump supporters than they are with me? I have a pretty good idea how people who voted for Trump feel – and we simply disagree about things. Maybe Van Jones is out of touch in that he runs in rarified circles of the political class. But that's kind of what happens in any field, right? We the people have elected our politicians. Trump supporters have voted for people to represent them.

    1. Yep. Working class people of color vote Democratic in huge percentages. Dems get more support from the white working class than the Repubs do from POC's. Here in my hometown of Dallas, the pastor of First Baptist church, a very large church with a very rich congregation, endorsed Trump, and I'm pretty sure a lot of his well-heeled congregants voted for him. Economic issues are not the pastor's main concern. He's worried that Obama is Anti-Christ, that men are going to dress as women to sneak into bathrooms, that Black Lives Matter has declared war on cops, that gays are on the verge of wiping out religious freedom in the US (he said Christians are facing a holocaust, which drew a lot of backlash, some from the local newspapers and some from other religious leaders). He's said such extremely nasty things about Obama that Tim Tebow backed out of speaking appearance there. While I agree that liberals, especially Christian liberals like me, need to show concern and respect for everyone, WWC included, from my perspective, we do better than the man-of-God who runs First Baptist, and quite a few of his co-religionists. Sure, it's a low bar, but since we believe in tolerance, decency and human dignity for all humans, we need to always strive to do better.

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