I don’t usually pay much attention to Karl Rove’s predictable writing. But the one-time Boy Genius’ latest column just begged for a response, which I provided at New York.

[V]eteran spinner Karl Rove devoted a Wall Street Journal column to a baleful assessment of the reelection prospects of Senate Democrats running in states carried handily by Donald Trump last year.

There’s a certain dated quality to Rove’s analysis; he writes as though these senators are fresh from gazing in awe at Trump’s 2016 victory and are trying to decide whether to fight back or run for the hills. In reality, these pols have for the most part chosen to oppose every unpopular thing Trump and the congressional GOP have proposed this year, which fortunately for red-state Democrats is nearly their entire agenda. Still, the 2016 numbers are indeed daunting for some:

“The 25 Democratic senators who face re-election in 2018 are already gearing up for a fight. Their latest quarterly fundraising reports, released over the past two weeks, show impressive totals, ranging up to $3.1 million. But for the 10 Democrats from states carried by President Trump, a well-stuffed war chest may not be enough.

“This is especially true for six senators in states where Mr. Trump’s victory last November was huge. He won Joe Manchin’s West Virginia by an astonishing 42 points; Heidi Heitkamp’s North Dakota by 36 points; Jon Tester’s Montana by 20; Joe Donnelly’s Indiana and Claire McCaskill’s Missouri by 19, and Sherrod Brown’s Ohio by 8.”

Rove goes on to make a very dubious assertion that we are going to hear a lot from Republicans between now and November of 2018:

“They must all keep an eye on the president’s favorability ratings. On Election Day, Mr. Trump was viewed favorably by 37.5% of voters and unfavorably by 58.5%, according to the RealClearPolitics average. As of this Wednesday, his ratings stood at 40.4% favorable and 53.6% unfavorable.

“Mr. Trump is likely to be more popular in states he won than his national average: The larger his margin in those states last November, the better he stands now. If this trend holds through 2018, Democrats in states Mr. Trump won by double or nearly double digits could face stiff re-election contests.”

This argument ignores the rather pertinent fact that Trump was running against a rival who was almost as unpopular as he was. In 2018, Republicans won’t have the luxury of running against Hillary Clinton. Instead, they will be up against well-known Senate incumbents with their own public profiles, and in a midterm environment where there is usually a wind blowing against the party controlling the White House.

So while we should indeed “keep and eye on the president’s favorability ratings,” those of the senators in question are even more relevant. As it happens Morning Consult just released an update of its home-state favorability assessments for all 100 U.S. senators, and the very Democrats Rove thinks are in inherently deep trouble are actually doing quite well. Joe Manchin’s ratio is 57/31; Heidi Heitkamp’s is an even more impressive 60/28. Jon Tester (50/39), Joe Donnelly (53/25), and Sherrod Brown (50/29) are at or above the magic 50-percent level that often connotes future victory, with limited “unfavorables,” and Claire McCaskill (46/38) isn’t exactly plumbing the depths of unpopularity, either.

In fact, the one senator up in 2018 whose favorability numbers are underwater is a Republican, Jeff Flake of Arizona (37/45).

Another problem for the GOP is that it is struggling to find credible challengers to theoretically vulnerable Democrats in some states (as in Missouri, where consensus GOP favorite Representative Ann Wagner decided not to take on McCaskill), and is facing potentially fractious Republican primaries (as in Indiana, where Representatives Luke Messer and Todd Rokita are already attacking each other) in others.

There is plenty of time for things to change in the months ahead, and nobody on the Democratic side has any reason to feel complacent about holding onto Senate seats in one of the more lopsided landscapes in living memory. But for now, a Democratic red-state bloodbath in 2018 looks unlikely. And if congressional Republicans continue to flail around in the clumsy pursuit of an unpopular agenda, the odds of survival for Democrats in Trump Country will only go up.

As congressional Republicans continue to stumble around in search of a workable and politically non-toxic health care plan, it occurred to me, and not for the first time, that there’s something very old-school about their rhetoric on health insurance. I wrote up my ruminations at New York:

As Senate Republicans go through the valley of the shadow of death for their health-care plan, questions are again being raised about what they really want. Is it lower premiums for individual health insurance, particularly for the people (presumably many of them Republicans) who aren’t poor enough to qualify for Obamacare’s purchasing subsidies? Is it “entitlement reform,” focused on rolling back the Affordable Care Act’s Medicaid expansion and then capping that program’s growth forever as a government-shrinking exercise? Is all the talk about health policy really just a disguise, as many liberals suspect, for an agenda of high-end tax cuts and low-end spending cuts that have little or nothing to do with Obamacare?

The answers to these questions may be as various as the micro-factions of the GOP in Congress, and a lot of the answers most definitely lack coherence. But one policy impulse shared by some conservatives is important to understand because it encourages a very destructive attitude toward the existing health-care system. Some conservatives really just don’t like the idea of health insurance as we know it.

This has again become apparent in some of the senatorial reactions to the Congressional Budget Office’s estimates of how many Americans (22 million) would lose health insurance under the Better Care Reconciliation Act. Here’s the classic from the number-two Republican in the Senate, John Cornyn:

Not lose, choose. Apparently you believe freedom is optional https://t.co/WIUJz2Mxv7

— JohnCornyn (@JohnCornyn) July 6, 2017

He wants to celebrate the “freedom” of Americans to go without health insurance, though he surely understands most of the 22 million would not “choose” this option if affordable health insurance was available.

That’s not as exotic a belief as you might imagine.

Conservatives have long believed that “third-party” health insurance — health insurance provided by employers or the government — encourages over-utilization of health services and thus is responsible for high rates of medical inflation. And many believe the only legitimate purpose of health insurance should be to cover catastrophic costs, not the routine medical services that people used to pay out-of-pocket in the days before a combination of tax subsidies, collective bargaining, and employer competition made employer-sponsored comprehensive insurance plans common.

So, unsurprisingly, most conservatives who can be coaxed into a discussion of their actual aims propose getting rid of or expanding to individuals the tax subsidy for employer-sponsored health plans, to reduce the incentive to access care whenever you think you need it. And they envision a system in which everyone pays for routine care via a tax-preferred health savings account — basically paying the doc out-of-pocket the way Americans did back in the Good Old Days of individual responsibility — and has a relatively cheap catastrophic-care policy to cover life-threatening conditions.

Whether you find this vision frightening or invigorating, it is clearly very different not only from the Obamacare status quo, but from the status quo ante long before Obamacare. This longing for really old-school health-care policy causes all sorts of political problems for the Republicans that harbor it. For one thing, it cuts against the hatred of high out-of-pocket costs that unites most middle-class folks regardless of party or ideology. And for another, as Cornyn has learned, treating comprehensive health insurance as a socialistic vice corrosive of American values just does not accord with the actual values of actual Americans.

At the moment, Republicans clearly do not have the power or the popular support to impose an early-1950s vision of health care on the country. They nonetheless fight every feature of the health-care system that involves spreading the risk — and the cost — of poor health, which is the basic function of private as well as “government” health care.

When former Bill/Hillary Clinton pollster and strategist Mark Penn kicked up a storm with some controversial “lessons” from a campaign many of us graphically remember, I waited for the dust to settle a bit and then weighed in at New York.

Unlike many left-of-center commentators, I do not automatically begin to froth at the mouth when the name Mark Penn comes up….

I have actually written a semi-positive review of a Mark Penn book, and don’t necessarily think he has always exuded the smell of brimstone (though his Clinton White House colleague Dick Morris most definitely did), or that he personally doomed Hillary Clinton’s 2008 presidential campaign. But Penn’s trajectory into Fox Democrat hackery has been confirmed by a new op-ed [co-authored with Andrew Stein], principally because he’s now mischaracterizing the very 1996 Clinton-Gore campaign he helped engineer as the peak of his political career.

Here’s the Penn/Stein summation of what happened in 1996:

“After years of leftward drift by the Democrats culminated in Republican control of the House under Speaker Newt Gingrich, President Bill Clinton moved the party back to the center in 1995 by supporting a balanced budget, welfare reform, a crime bill that called for providing 100,000 new police officers and a step-by-step approach to broadening health care. Mr. Clinton won a resounding re-election victory in 1996 and Democrats were back.”

That is at best a massive oversimplification of what happened in 1996. For one thing, if Clinton “moved the party back to the center,” it was in 1992, when he billed himself as a “different kind of Democrat” and won a plurality victory that indeed broke a long Democratic losing streak. His “centrist” agenda alienated a lot of more-traditional Democrats, and the Donkey Party lost a historic landslide defeat in the 1994 midterms. In 1996, the Clinton-Gore campaign, as Mark Penn knows quite well, did not just “move to the center,” but fought and benefited from the GOP extremism that the “Republican Revolution” led by Newt Gingrich represented.

The signature mantra of the Clinton-Gore ’96 campaign was nicely presented by the vice-presidential candidate in a debate with his rival, Jack Kemp:

“The plan from Senator Dole and Mr. Kemp is a risky, $550-billion tax scheme that actually raises taxes on 9 million of the hardest pressed working families. It would blow a hole in the deficit, cause much deeper cuts in Medicare, Medicaid, education, and the environment.”

This mantra — Medicare, Medicaid, education, environment — was so formulaic that it was reduced, literally, to a formula: M2 E2. Perhaps the welfare-reform and community-policing initiatives helped make the election revolve around M2 E2. But the idea that this was how Democrats won is really sketchy. The more plausible theory of 1996 is that Gingrich’s Republicans overreached in attacking very popular New Deal–Great Society safety-net programs, and the Clinton-Gore campaign made them pay the price. This is exactly what the Democratic “resistance” to Donald Trump plans to do in 2018 and beyond, and it is more than a little ironic that Penn and Stein are touting the 1996 campaign in attacking them for it.

Beyond that, as many Penn/Stein critics have pointed out, a lot has changed since 1996, particularly in the Democratic Party’s own base.

But again, it’s not clear Mark Penn and Andrew Stein are really all that interested in influencing Democrats. If they offer dubious advice Democrats are sure to reject, then they are mainly recommending themselves as apostates ready to bash the donkey on conservative media. That’s a very profitable line of business, and if Mark Penn pursues it, his most adamant progressive critics will be entirely vindicated.

As Senate Republicans battled to get to 50 votes for their Obamacare repeal-and-replacement bill, a broader GOP problem suddenly appeared, as I discussed at New York:

Sen. Patrick J. Toomey offered a simple, remarkable explanation this week for why Republicans have struggled so mightily to find a way to repeal the Affordable Care Act.

“‘Look, I didn’t expect Donald Trump to win, I think most of my colleagues didn’t, so we didn’t expect to be in this situation,’the Pennsylvania Republican said Wednesday night during a meeting with voters hosted by four ABC affiliates across his state.”

According to the Washington Post’s Paul Kane, this is almost certainly why congressional Republicans agreed upon a “repeal and delay” strategy for dealing with Obamacare soon after the election: They had no real clue how to do anything else. But the lack of advance planning has also been evident in the inability of Republicans in the Executive and Legislative branches to reach any kind of agreement on how to proceed with other very basic agenda items — also achievable without Democratic votes — like “tax reform” and the federal budget. And the disarray extends beyond the legislative process:

“Perhaps nowhere did the surprise factor of Trump’s victory show its impact more than in the effort to fill top jobs inside the administration. Clinton’s campaign, fully expecting victory, was stocked with hundreds of volunteer advisers who were already angling for sub-Cabinet-level posts in key agencies including the departments of State, Justice and Defense. Many of them were current or former senior staff to congressional Democrats.

“But with Republicans, those connections were rare because few believed them to be worth the effort.”

It is hard to overstate the difference for Republicans between the “Trump wins” and “Clinton wins” scenarios. After all, the GOP had been rehearsing the politics of obstruction and enjoying the innocent pleasures of passing consequences-free legislation for six long years after Republicans retook the House in 2010 (and then the Senate in 2014). The transition from gesturing to governing was especially tough for the anti-government party, and it did not help that the new GOP president was so unorthodox, unpredictable, and inexperienced a figure. Republicans did not, as Toomey said, “expect to be in this situation,” so they did not go through the difficult process of airing their differences and putting together pre-vetted consensus plans. On issue after issue, they are doing that now, on the fly, using — as Toomey puts it— “live ammo.”

It’s not going very well.

When Donald Trump sent out a certain tweet about Medicaid this week, it brought back some distinct memories. I wrote about it at New York.

How does Trump justify supporting GOP health plans that violate his pledge during the campaign to oppose cuts in Medicaid spending?

Democrats purposely misstated Medicaid under new Senate bill – actually goes up. pic.twitter.com/necCt4K6UH

— Donald J. Trump (@realDonaldTrump) June 28, 2017

It seems POTUS does not understand how Medicaid funding works, and thus what constitutes a “cut.” He appears to think if any program’s funding goes up year-to-year, it hasn’t been “cut.”

This is rarely true, actually. Even with programs that are subject to annual appropriations, providing the same services from one year to the next usually costs more, thanks to inflation and population growth. Demographic changes and economic circumstances can aggravate or ameliorate the need for more funding. But you cannot point to a rise in funding and say, “That’s not a cut,” without knowing a lot more about the program, its services, and the specific population it serves.

With an entitlement program like Medicaid, moreover, in which defined categories of people receive defined benefits automatically, annual spending increases are virtually guaranteed unless the population is shrinking or the economy is really booming. As it happens, Medicaid spending under current policies is going up significantly in the immediate future thanks to at least three factors: the expansion of eligibility 31 states have elected to pursue under the Affordable Care Act; medical inflation, which generally exceeds consumer inflation; and the rapid growth in the senior population, adding to the number of Medicaid’s most expensive beneficiaries.

You can argue, as many Republicans do, that policy makers should act to curb Medicaid’s rising costs. But you can’t claim such efforts are not “a cut.” For the Medicaid expansion population at greatest risk of losing eligibility entirely under the House and Senate health-care bills, that would definitely represent “a cut.” The same is true of any Medicaid participants who may have to deal with reduced benefits or increased “cost-sharing” requirements as states adjust to a per capita cap on federal Medicaid payments.

Since we will never entirely agree on what the “normal” or “natural” funding levels for a program like Medicaid should be, the only rational way to look at Medicaid proposals is to compare how much money it would take to finance Medicaid under current law, and how much the proposals would change those costs. That is precisely what the Congressional Budget Office — who are not “Democrats,” mind you, but hires of a Republican-controlled Congress — did in describing the Better Care Reconciliation Act as “cutting” Medicaid spending by $772 billion over ten years. That does not mean reducing Medicaid spending by that much on a year-to-year basis. But it does mean that according to CBO’s best estimates BCRA will undershoot by $772 billion what it costs to provide the same Medicaid services to the people now deemed eligible. And that’s a “cut.”

Now it is entirely possible Donald Trump understands all this and is simply hoping readers of his tweets don’t. That was the calculation his friend Newt Gingrich made back in the 1990s when he perpetually insisted in a highly publicized argument with Bill Clinton that the Medicare and Medicaid cuts he was proposing weren’t cuts at all but simply “reductions in the rate of growth.” (Indeed, Gingrich is saying the same thing now, which may be where Trump got the idea.) He did not win that argument with Clinton then, and Trump is not likely to win it now, particularly since congressional Republicans, whether or not they support their party’s health-care plans, are not buying this line. When real, live people lose things they would otherwise have, they have been “cut.” Pretending otherwise represents ignorance at best and cynical demagoguery at worst.