Avik Roy is a graduate of Yale Medical School who has published extensively on the problems of America’s current health system and Health Care Reform.

Republican and conservative leaders failed the cause of free-market health reform in three principal ways. First, they failed to make a moral case for replacing Obamacare, as opposed to purely repealing it. As a result, they then failed to unite the hard-line and pragmatic wings of the GOP around a coherent health-care-reform proposal. And due to the ambitions of the 100-day legislative agenda, and the peculiar legislative calendar associated with the Senate’s reconciliation process, they chose not to invest the time in getting health-care reform right.

Conservatives intuitively understand the moral case for repealing Obamacare. The law significantly expands the role and scope of the federal government in determining Americans’ personal health-care choices. Its individual mandate is a constitutional injury. And its Rube Goldberg-like maze of insurance regulations has made health insurance unaffordable for millions.

But when it came to replacing Obamacare, Republicans usually presented the case in exclusively political terms: Replacement was necessary because the alternative would be daily front-page stories of the millions thrown off of their health-care plans by the GOP Congress. Conservatives rarely attempted to make a moral case for replacing Obamacare. Indeed, if you believe that the federal government has no legitimate role in helping the uninsured afford health coverage, your intuition is that there isn’t a moral case for replacing Obamacare. …

That intuition is understandable, but mistaken, because it is in fact the federal government that has made health insurance so costly through seven decades of unwise policies. Those policies include the exclusion from taxation of employer-sponsored health insurance, an outgrowth of World War II-era wage controls. They include the enactment of the Great Society entitlements, Medicare and Medicaid, in 1965. They include the EMTALA law, signed by President Reagan, that guaranteed free emergency-room coverage to everyone, including the uninsured and illegal immigrants. And they include Obamacare.

This seven-decade pileup of federal intervention in the health-care system is directly — and exclusively — responsible for the astronomical costs of the present-day American health-care system. It is not right, when confronted with such a state of affairs, to shrug our shoulders and say “tough luck” to those who can’t afford insurance. Indeed, we have an affirmative duty to reform federal policies so as to make health insurance once again affordable for the working poor.

Read the whole thing.

One of my Yale classmates forwarded this columnn, featuring Nicholas Kristof gloating over the Trump Administration’s failure on Friday to pass a new health care bill in the House, to the class email list:

The Trump administration is increasingly showing itself to be breathtakingly incompetent, and that’s the real lesson of the collapse of the G.O.P. health care bill. The administration proved unable to organize its way out of a paper bag: After seven years of Republicans’ publicly loathing Obamacare, their repeal-replace bill failed after 18 days.

Politics sometimes rewards braggarts, and Trump is a world-class boaster. He promised a health care plan that would be “unbelievable,” “beautiful,” “terrific,” “less expensive and much better,” “insurance for everybody.” But he’s abysmal at delivering — because the basic truth is that he’s an effective politician who’s utterly incompetent at governing. …

Whatever one thinks of Trump’s merits, this competence gap raises profound questions about our national direction. If the administration can’t repeal Obamacare — or manage friendly relations with allies like Mexico or Australia — how will it possibly accomplish something complicated like tax reform?

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I replied:

Personally, I thought Trump’s healthcare bill failure was endearing. It confirmed that this administration is being run by amateurs rather than (shudder) practiced professional pols. The question we can now all ask is: can Trump learn?

I was happy that solid ideological conservatives stood their ground and defeated attempt No. 1. I am optimistic enough to believe that the GOP cannot fail (Get-on-board-or-else rhetoric notwithstanding) to return to the inevitable duty of repealing Obamacare. The next try will be better, and hopefully will omit the “covering everyone” and the “free lunch at other people’s expense” coverage for existing conditions. If your house is burning down, sorry! you do not get to phone in and buy fire insurance.

Someone once observed that the legislative process is like the manufacturing of sausages. It can have desirable results, but you will be happier if you don’t watch.

Nicholas Kristof is perfectly correct in one respect, of course. The democrat party is made up of people like Hillary Clinton and Yale’s own John Kerry, consummate shits and professional political operators who would make Machiavelli seem like a naif and Rodrigo Borgia like a wimp. Republican pols tend to be aging Eagle Scouts and Rotarians playing out of their own league. Watching the Congressional GOP take on the democrats is often very much like watching the Washington Generals play the Harlem Globetrotters. Republicans are handicapped by Constitutional Fideism, and a respect for Process, and being afflicted with ordinary decency.

However, the World’s turned upside down. Eight years of economic suffering while Caliban strutted on the national stage enraged the democrat party’s traditional Working Class base. There was a Populist Revolution and the Revolution wasn’t knocking on my door with pitchforks and torches. The angry mob was after Progressivism and the National Establishment. The ideology of the national ruling class and the party that represents it has shown itself to be intellectually exhausted and degenerated into a host of pathologies. The more established any of our institutions, the more debased its morals and the more insane its poses and pronouncements. Nothing in America is more Establishment than Yale, and contemporary Yale has become a national laughing stock and disgrace. The American People are naturally unwilling any longer to be led by a class of nincompoops and demoniacs who hanker after their own eradication and replacement by a new, more melanistically-favored and questionably-gendered population, and whose first priority is apologizing on all of our behalfs.

Amusingly, partisan commentators from both sides are claiming victory. So the way to tell who really won is to check what the kind of commentator who can be counted to be found jumping on the winning bandwagon is saying. Let’s look at Peggy Noonan‘s analysis:

There were fireworks all the way, and plenty of drama. Each candidate could claim a win in one area or another, but by the end it looked to me like this: For the second time in two weeks, the Democrat came out and defeated himself. In both cases the Republican was strong and the Democrat somewhat disturbing.

Another way to say it is the old man tried to patronize the kid and the kid stood his ground. The old man pushed, and the kid pushed back.

Last week Mr. Obama was weirdly passive. Last night Mr. Biden was weirdly aggressive, if that is the right word for someone who grimaces, laughs derisively, interrupts, hectors, rolls his eyes, browbeats and attempts to bully. He meant to dominate, to seem strong and no-nonsense. Sometimes he did—he had his moments. But he was also disrespectful and full of bluster. “Oh, now you’re Jack Kennedy!” he snapped at one point. It was an echo of Lloyd Bentsen to Dan Quayle, in 1988. But Mr. Quayle, who had compared himself to Kennedy, had invited the insult. Mr. Ryan had not. It came from nowhere. Did Mr. Biden look good? No, he looked mean and second-rate. He meant to undercut Mr. Ryan, but he undercut himself. His grimaces and laughter were reminiscent of Al Gore’s sighs in 2000—theatrical, off-putting and in the end self-indicting.

Mr. Ryan was generally earnest, fluid, somewhat wonky, confident. He occasionally teetered on the edge of glibness and sometimes fell off. …

I have just realized the problem with the debate: it was the weird distance between style and content, and the degree to which Mr. Biden’s style poisoned his content.

In terms of content—the seriousness and strength of one’s positions and the ability to argue for them—the debate was probably a draw, with both candidates having strong moments. But in terms of style, Mr. Biden was so childishly manipulative that it will be surprising if independents and undecideds liked what they saw.

National Democrats keep confusing strength with aggression and command with sarcasm. Even the latter didn’t work for Mr. Biden. The things he said had the rhythm and smirk of sarcasm without the cutting substance.

And so the Romney-Ryan ticket emerged ahead. Its momentum was neither stopped nor slowed and likely was pushed forward.

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Another way to tell who’s winning is to watch the random omens. For instance, today Lindsay Lohan endorsed Romney.

Barack Obama told ABC News that the presidential debate didn’t go his way, because he was “just too polite.”

That’s not a problem Joe Biden is likely to experience.

Biden has gone astonishingly far in national politics for a blithering idiot, largely on the basis of his ability to shout down opponents using inflammatory language, unbridled emotionalism, and the most extravagant version of ultra-partisan talking points delivered as alleged facts. Biden is a verbal bully and a shameless liar who has successfully shrugged off a series of personal scandals (in which his false statements or plagiarism were exposed) rising all the way to the Vice Presidency. Paul Ryan had better be prepared tonight. Now that Ted Kennedy has gone to his reward, Joe Biden is the democrat party’s thug-in-chief.

Joe Biden debating Paul Ryan is going to be a battle of IQs reminiscent of George Custer taking on 6000 Cheyenne and Sioux warriors with just over 200 men.

Roger Kimball gloats over Paul Ryan’s acceptance speech and indulges in a just little schadenfreude with respect to the opposition.

I suspect that Joe Biden is feeling pretty awful this morning. For that matter, I’d wager Barack Obama has had better nights’ rest. Condi Rice’s speech was bad enough for the Democrats — it was serious, dignified, eloquent — but Paul Ryan hit it out of the park. They both must have watched Ryan’s speech. They both must have come away with an empty feeling in the pit of the stomach. And poor Joe has to debate Ryan in a little more than a month. I almost feel sorry for him. Almost. …

He read the speech, but he knows how to make it seem ex tempore, almost confidential. His manner is open, confident, but somehow also humble. There is nothing swaggering, nothing of the braggart or narcissist about him. He seems impressed not by the sound of his own voice but by the facts and observations he shares with his listeners. He also exuded the physical grace of youth. His iPod playlist, unlike Mitt Romney’s, started with AC/DC and went to Zepplin. The audience loved that.

Ryan’s obvious sincerity allows him to deliver devastating one-liners without seeming cruel:

President Obama is the kind of politician who puts promises on the record, and then calls that the record. But we are four years into this presidency. The issue is not the economy as Barack Obama inherited it, not the economy as he envisions it, but this economy as we are living it.

Ouch. But then came this:

College graduates should not have to live out their 20s in their childhood bedrooms, staring up at fading Obama posters and wondering when they can move out and get going with life.

That must have stung.

There’s been a great deal of positive female reaction to Mitt Romney selection of Paul Ryan as his running mate. On Facebook, I came across a couple of recent Yale grad chicks I know crushing over the photo of Paul Ryan with his compound bow. The liberal girl confessed: “I don’t like his policies, but I’m man enough to admit he’s pretty dreamy.”

Monica Crowley thinks the GOP has turned the tables on the democrats this time, by choosing the younger, hipper, more sexually attractive nominee, and the percentage of young people’s votes going each way will be very different this time from 2008.

In 2008, the Democrats did something ingenious. They found their first 21st century candidate for the presidency.

No more Al Gores or John Kerrys. No more Clintons. No more Cold War-era fossils. In fact, one of the biggest reasons Barack Obama was able to beat Hillary Clinton in the 2008 Democrat primaries was because he created a new brand based on the future. The Obama brand was able to smash the once-omnipotent Clinton brand because the Clinton brand was yesterday’s
newspaper while the Obama brand was tomorrow’s.

Obama was the quintessential 21st century candidate: a young, hip, and biracial man with a glamorous wife, adorable young children, and friendships with pop culture icons like Jay-Z. Obama’s campaign was equally 21st century: they used social media to great effect before most people even knew what it was. They were tweeting their followers at Kanye West concerts
while John McCain, God love him, was campaigning with smoke signals.

This time, the tables have turned. While Mitt Romney sort of straddles the 20th and 21st centuries, his running mate is most decidedly 21st century. Paul Ryan is 42 years old, making him almost a decade younger than the young whipper-snapper of the 2008 campaign, Barack Obama. He sleeps in his Capitol Hill office like it’s a dorm room. He does the insanely tough
workout P90X. He walks around wearing headphones, like NBA stars and Olympic athletes. He is cool.

This matters in a nation that has always been forward-looking, pioneering, innovative, and geared toward the future. Negativity and the past don’t win the big battles for the future. Obama knew that when he crushed the Clinton machine and later, the 20th century GOP machine. This time, the Republicans get it, and they’ve found a dynamic, fearless 21st century guy in Paul Ryan.
Even Mitt Romney has become cooler, tougher, looser, and more forward-looking since Ryan joined him on the trail.

Call it The Ryan Effect.

If anyone wonders why the Obama team is so unhappy about Mitt Romney’s Vice Presidential pick, just watch Obama’s face as Paul Ryan dissects the Obamacare bill. Obama looks like he’s about to turn into a giant snake, the same way Thulsa Doom (James Earl Jones) did in “Conan the Barbarian” (1982).

Ed Driscoll admires the left-wing media’s instant, almost pre-programmed and prepared-in-advance attacks on Paul Ryan, which poured out everywhere this weekend as soon as Mitt Romney announced his Vice Presidential pick.

Watching the hysterical reaction from the left [Saturday] over Romney choosing Paul Ryan as his veep makes you wonder how much was pre-written boilerplate, with the Republican candidate’s name simply dropped in at the last minute, once Romney formally made his announcement. It’s sort of the Bizarro World version of the riff brainwashed into the skulls of Frank Sinatra and the rest of Laurence Harvey’s troops by the Soviets and Communist China in The Manchurian Candidate: “Raymond Shaw is the kindest, bravest, warmest, most wonderful human being I’ve ever known in my life.” Instead this weekend, we’re getting “INSERT NAME OF REPUBLICAN TO BE DEMONIZED HERE is the worst, vilest, sexist, homophobic, God-worshiping, Second Amendment-supporting, budget cutting, evilest human being I’ve ever known in my life.” …

[A]t Commentary, John Podhoretz explored “Paul Ryan and Liberal Glee.” As Podhoretz wrote, “Doubtless, Ryan has provided some subject matter for Democratic attacks. But so, in different ways, would anyone else on Mitt Romney’s short list:”

More important is the quality of the glee itself. It’s an ongoing liberal political-character flaw. So insulated a are many, if not most, American liberals that they simply presume that which they despise is inherently despicable, and that what they fear is inherently fearful. As they gather in their echo chamber, all they hear are voices resounding with the monstrousness of redesigning Medicare and the parlousness of cutting the federal budget. They genuinely do not know that budget cutting is popular, even if only in theory, and that tens of millions of voters do understand the notion that the government is living far beyond its means. From what we can gather, in fact, these are exactly the sorts of ideas that speak to independent voters and have since the days of Ross Perot.

Ryan is a formidable presence in American politics. Generally speaking, formidable players do formidable things. The glee of the Left suggests its folk are so excited by what the Obama campaign can dish out that they are unprepared for what Ryan and Romney can dish out right back.

Paul Rahe observes that Mitt Romney’s selection of Paul Ryan as his running mate defines his campaign and justifies his candidacy.

In choosing Paul Ryan as his Vice-Presidential nominee, Mitt Romney has opted to go for broke, and he has indicated that he is a serious man — less concerned with becoming President of the United States than with saving the country from the disaster in store for it if we not radically reverse course, willing to risk a loss for the sake of being able to win a mandate for reform.

I have been unsparing in my criticism of Romney’s political record. I unsay not one word about that. If we were to judge him honestly by his conduct as a Senatorial candidate in Massachusetts and as that state’s Governor, I believe that we would find him sadly wanting.

I have also consistently been of the opinion that, of the declared Republican presidential aspirants, Mitt Romney was the least unacceptable. In his private capacity, he is a man of excellent character; as a businessman, he was accomplished in the extreme; and, as a candidate, he consistently displayed the discipline required. There were others in the race who had good qualities, but they lacked one or more of the crucial qualities that Romney possesses.

I also hazarded a guess — that current circumstances might make a genuine conservative of Mitt Romney, that his understanding of the fiscal crisis we face might very well force him to think more deeply about the moral roots of that fiscal crisis, which is to say, about the inner logic of the administrative entitlements state and the moral as well as the fiscal bankruptcy produced by that inner logic. I was accused of wishful thinking, and the accusation was just. For my wish was, indeed, father to the thought, but this does not mean that the thought was wrong.

Governor Romney’s choice of Paul Ryan as his running mate suggests, in fact, that my suspicions were correct. For by making this choice, Mitt Romney is declaring war. There will be no evasion, no triangulation, no attempt to mask what is at stake in this election. Instead, Romney and Ryan will directly confront Barack Obama and call him to account for putting us on a ruinous course.

This will alter radically the dynamics of the race. The money spent by Obama trying to demonize Governor Romney will prove to be money entirely wasted. The election is not going to be about Mitt Romney. It is not going to be about the sexual revolution. It is not going to be about Bain Capital. It is going to be about the failed policies of Barack Obama, about their dangerous character, and about the sober, sound alternative the Republicans represent.

This will help the Republicans in Senate and House races immeasurably, for it will give Romney and Ryan coattails — now, without a doubt, the candidates in these other races have something concrete on which to run: repeal Obamacare, pare back the entitlements state, reform our system of taxation, and put our fiscal house in order. No one will doubt the capacity of the Republicans to rule.

I have predicted that Romney will win by a landslide. The choice of Paul Ryan means that Romney has chosen the path that will maximize the significance of his victory and its impact on the races for seats in the House and Senate. As in 1980, this is going to be a national election — in which local particularities count for much less than usual.