Photo of the day

Atlantic gallery of flood and landslide in Peru.  Yowza.

Aerial view after a massive landslide and flood in the Huachipa district of Lima, Peru, on March 17, 2017.

Guadalupe Pardo / Reuters

The huge lie at the heart of the Republican’s health care efforts

Donald Trump constantly says Obamacare is falling apart and we have to do something now to avoid some sort of health care catastrophe.  Just not remotely true.  Of course, this whole “Obamacare is falling apart” is one of the central GOP talking points on the matter.  And it’s just not true.  I was especially intrigued listening to this NPR  interview yesterday.  Loved how they fact-checked in the middle of a recorded interview:

[Alabama Congressman Bradley] BYRNE: That turns out to be bogus. I was just going through a pretty detailed review of that CBO analysis. They say 24 million people will, quote, “lose insurance.” Eleven million of those people – and this is CBO’s analysis – won’t lose their insurance. They’re presently required to have insurance. And they’re going to elect to drop their insurance because they don’t want to have to have that insurance – 11 million out of the 24 million.

MCEVERS: And just a clarification here. We checked the congressman’s numbers. And he’s sort of right. If the requirement to have insurance goes away, a lot of people likely will drop their plans. But many will drop those plans because they won’t be able to afford them if subsidies shrink or disappear. OK. Now back to the interview.

Great.  Good journalism.  Here’s Byrne later, though:

MCEVERS: One more sort of big picture question. You know, what’s the rush to push this bill through tomorrow? You’ve got, you know, still some conservative Republicans who don’t like the bill, obviously Democrats who don’t like the bill. Why not wait until there’s a sense that more people would be onboard?

BYRNE: What we are hearing from people in the health insurance industry is that these plans are deteriorating so rapidly that we cannot wait. If we don’t get something going now, we’re not going to be in a position to try to repair these insurance markets before they fall apart. [emphasis mine]

Again, that’s grossly untrue.  I guess we can’t expect even NPR to fact check all the lies spilling out of Republicans on this.  For the record, here’s Vox on the non-implosion (as determined by the CBO].  It’s also worth noting that a huge part of the Republican “reform” is slashing Medicaid.  Nobody is actually suggesting Medicaid is imploding (okay, probably some Republicans are).  But the truth is they just want to do less to help poor people have health care.

Oh, and just before publishing this, I came across this Josh Barro column that fits the theme of Republican lies on health care (even though it is different lies):

The difference on healthcare is that Republicans never had an ideology about it. So they were willing to lie, and there are two facts about the healthcare debate that a liar can exploit quite effectively until he is actually expected to make policy. People are always upset about how much healthcare costs, and healthcare is very complicated, so it is hard for voters to tell whether a politician is actually able to keep his or her promises about it.

If you went around telling abortion opponents that you would ban abortion and abortion-rights advocates that you would give abortions out free, the two sides might notice you were promising two incompatible policies. But for years, Republicans were able to capitalize on public ignorance and get away with promises that amounted to “much less expensive and much better.”

Their political strategy was cynically brilliant until it led to their getting elected…

The need to actually make policy is exposing the fact that Republicans made many healthcare promises they never intended to keep.

Republicans have denounced insurance plans sold under Obamacare as insufficient, because the deductibles and co-payments under some plans are so high that many people feel they can’t afford care even if they are insured. But the AHCA would allow insurers to sell plans that would cover an even smaller fraction of insured people’s healthcare expenses.

The Kaiser Family Foundation estimates that deductibles for an individual-market insurance plan on average would rise by $1,550 under the AHCA.

Republicans complained that premiums were too high for people to afford, and then they proposed a law that would cut premium subsidies by hundreds of billions of dollars and would leave some people near retirement age with insurance premiums of more than half their income…

Through the years, healthcare experts on the right have allowed themselves to be used as window dressing for a party that was never actually interested in taking their policy advice.

The experts would write white papers about conservative approaches to healthcare. Republican politicians would indignantly wave the white papers around and insist that they had not only one plan for healthcare but many plans, and they involved high-risk pools and selling insurance across state lines and something something patient-centered mumble mumble mumble and whatever was in the paper was going to be way better than Obamacare.

Ryan even developed an undeserved reputation as a healthcare “wonk.”

But those white papers were always just paper. The plans described in them were never going to be implemented by an actual Republican government, which would not be interested in paying for the plans the papers described. The only thing Republicans ever intended to use them for was indignant waving.

It was all a lie. And the lie is finally about to be punished.

AHCA– the stripped-down Chevy Cruze of health care

Been reading lots of good stuff on the Republicans incredibly misguided repeal and replace efforts.  Here’s my tortured analogy.  Obamacare is a car.  Not a great one, say a Chevy Cruze.  Gets the job done, but surely much to be improved.  Problem is, lots of Republicans think the car should not exist.  Other Republicans are unwilling to take the whole care away because of the obviously negative political implications (and, maybe to some small degree, some of them actually care some little bit about human suffering of their fellow Americans).  But they’ve got to do something.  They’ve promised.  And, damnit, Trump needs a win.  So, what to do we get?  A Chevy Cruze where they’ve traded in the fuel injection for a carburetor.  Downgraded the 6-speed transmission to a 3-speed.  Replaced the automatic windows with old style cranks (like my beloved 1992 Geo Prizm).  Oh, yeah, and sold off the back seat so rich people can have a tax cut.  But, hey, it’s something, it’s “repeal and replace.”  There your Republican health care.

Some various good stuff…

1) The NYT Editorial nails it: a bill in search of a problem:

It also reflects a fundamental reality: Unlike President Barack Obama, whose clear objective was to expand access to medical care, the Republicans have no coherent idea or shared vision of what they want to achieve and what problem they mean to solve.

Do they want to cover nearly as many as are covered under the A.C.A.? A few senators, like Susan Collins of Maine and Bill Cassidy of Louisiana, say they do, but a majority from the party are not willing to spend the money that would be needed to do that. Or do they want to significantly reduce government spending and regulation of health care, leaving Americans to navigate the free market on their own? Conservatives like Senator Rand Paul of Kentucky and Representative Mark Meadows of North Carolina are arguing for that, but the rest of the congressional Republicans do not want to go down this treacherous path…

The bottom line: The Republican proposal would not increase “competition and consumer choice” as Mr. Ryan claims. It certainly wouldn’t deliver on President Trump’s promise of “insurance for everybody.” And it wouldn’t be the full repeal of the A.C.A., or Obamacare, that many Republicans have been promising their base for the last seven years. That is why some hard-liners say they will oppose the new bill, which the House is expected to vote on as early as Thursday.

2) Ezra Klein:

This is a trap for Republicans. Both the process and the substance of the American Health Care Act have revealed a political party that has lost sight of the fact that the true test of legislation isn’t whether it passes, but whether it works.

Republican leaders have moved this bill as fast as possible, with as little information as possible, and with no evident plan for what will happen if the bill actually becomes law and wreaks havoc in people’s lives. This is not the health reform package Donald Trump promised his voters, it’s not the health reform package conservative policy experts recommended to House Republicans, and it’s not the health reform package that polling shows people want.

About the only thing that can be said for the revised bill is this might be the health reform package that can pass the House. And that appears to be the only problem Republicans care to solve right now.

3) And this Ezra piece on the health care debate we should be having and are not is great and full of big picture stuff; you should read it:

Reason No. 1: The coherent conservative position on health care is extremely unpopular. The most telling line in Douthat’s column is this one: “Republican politicians may offer pandering promises of lower deductibles and co-pays, but the coherent conservative position is that cheaper plans with higher deductibles are a very good thing, because they’re much closer to what insurance ought to be.”

Consider how remarkable that sentence is. Douthat is saying, sympathetically, that Republicans routinely promise a policy outcome 180 degrees from the one they’re pursuing. As much as politicians are lambasted as spin artists, this level of misdirection is rare, and for good reason — if you build public support for the opposite of the changes you want to make, those changes are unlikely to endure.

There’s a reason Republicans offer such self-destructive promises. Sparer plans with higher deductibles and higher co-pays are extremely unpopular. They’re the most unpopular part of Obamacare, which is why so many Republicans — including Mitch McConnell and Donald Trump — have used high deductibles as a cudgel with which to attack the law.

Republicans have used this unpopularity to their advantage, instead of trying to sell Americans on the advantages of high deductibles and laying the groundwork for the day when they might move the health care system in a more conservative direction. They are paying for that decision now, and they will suffer dearly for it if their plan actually passes.

 

The politics of the judiciary

Excellent column from EJ Dionne on Gorsuch.  The man is surely qualified, but he is disingenuous as hell about this (kind of like Roberts and his ridiculous and no-relationship-to-reality “balls and strikes” line).  EJ:

With a shrewdly calculated innocence, Judge Neil Gorsuch told a big fat lie at his confirmation hearing on Tuesday. Because it was a lie everyone expected, nobody called it that.

“There’s no such thing as a Republican judge or a Democratic judge,” Gorsuch said.

Actually, allow me to first mention that Gorsuch said “Democrat judge” on several occassions.  That’s how Fox News viewers talk, not genuinely non-partisan people.  That’s a hell of a tell.  Anyway…

We now have an ideological judiciary. To pretend otherwise is naive and also recklessly irresponsible because it tries to wish away the real stakes in confirmation battles.

The best scholarship shows an increasingly tight fit between the party of the appointing president and how a judge rules. It’s a point made in “The Behavior of Federal Judges ,” by Lee Epstein, William Landes and Judge Richard Posner, and also in research by Neal Devins and Lawrence Baum. [Just for the record, Lawrence Baum is a hell of a guy]

Face it: If partisanship and ideology were not central to Supreme Court nominations, Gorsuch would be looking at more years in his beloved Colorado. Notice that I referred to the Supreme Court seat as belonging to Garland, the chief judge for the U.S. Court of Appeals for the District of Columbia Circuit, nominated by President Barack Obama to replace the late Antonin Scalia. In an appalling act of extreme partisanship, the Republican-led Senate would not even give Garland a hearing.

It’s frustrating that so many minimize opposition to Gorsuch as merely the payback for Garland the Democratic base yearns for. This content-free way of casting the debate misses what’s really going on: Thanks to aggressive conservative jurisprudence, we have a Supreme Court that, on so many issues, continues to push the country to the right, no matter which party controls Congress or the White House.

The reason Republicans wouldn’t even let the moderately liberal Garland make his case is that conservatives who regularly denounce “liberal judicial activism” now count on control of the Supreme Court to get results they could never achieve through the democratically elected branches of government.

They could not gut the Voting Rights Act in Congress. So Chief Justice John G. Roberts Jr.’s court did it for them. They could never have undone a century’s worth of legislation limiting big money’s influence on politics. So the Citizens United decision did it for them.

Preach it, EJ!

And, while I’m at it, I’ve always hated “originalism” and “textualism” is they are as inherently subjective as any other interpretive framework, and I think particularly ill-suited for interpreting a 200+ year old document for the moderm world.  Thus, loved this Op-Ed from law professor Ken Levy:

Originalism is just one of the theories that Judge Gorsuch shares with the late Justice Antonin Scalia; another is its closely related cousin, textualism. Textualism says that when interpreting the Constitution, judges should confine themselves to the words of the Constitution. Originalism says that if the words are at all unclear, then judges need to consult historical sources to determine their meaning at the time of ratification, and the correct application of these words to new cases should clearly follow…

But Justice Scalia failed to realize that textualism is actually self-undermining. Nowhere does the Constitution explicitly state that textualism, no less originalism or any other method, is the correct theory of constitutional interpretation. Justice Scalia also failed to realize — or at least admit — that textualism and originalism rarely determine a unique outcome for constitutional questions…

The meanings of many words and phrases in the Constitution are not at all obvious. Examples include “right,” “unreasonable,” “probable cause,” “due process,” “excessive,” “cruel and unusual” and “equal protection.” Even if we could find clear definitions of these terms in a dictionary, current or historical, applying these definitions to cases that the founders did not anticipate only expands the range of ambiguity (and therefore interpretive possibilities).

I’m a big fan of Levy’s argument for principled pragmatism:

Contrary to Justice Scalia and his many disciples, there is a third way to interpret the Constitution, beyond textualism (and originalism) and pure subjectivism: principled pragmatism. Principled pragmatism says that judges should consider not only the constitutional language as the ratifiers interpreted it but also the constitutional language as we moderns interpret it, the structure of the Constitution as a whole, the overall purposes of the Constitution as stated in its preamble and — yes — the public policy consequences of each possible decision. Once these additional factors are taken into account, they may still point in the same direction as the ratifiers’ intent. But they may also point in a very different direction.

Anyway, Gorsuch will surely regularly rule in keeping with his own conservative ideological priors and use “originalism” to justify it.

AHCA in one amazing chart

From a new Urban Institute report via Chait:

Image

I keep having various charts like this left up on my laptop when my 11-year old son gets on it and takes a look.  He is literally incredulous how anybody could be a Republican.  Even doing my best to be fair, he just cannot understand at all how this political party has any adherents except the very wealthy.  Then again, he’s also totally comfortable with minorities, empowered women, and gay people ;-).

No regrets

Some political scientists conducted a pretty interesting survey where they asked respondents if they would change their presidential vote if given the choice.  Among the Trump voters, very few regrets.  Via the Monkey Cage:

Who would vote differently?

On the next screen, we asked everyone, “Suppose you could go back in time and vote again in the November election. What would you do?”

Respondents were presented with the same choices — Trump, Clinton, Stein, Johnson, someone else, or not vote at all. Of the 339 poll participants who originally voted for Trump, only 12 (3½ percent) said they would do something different.

Only three individuals (fewer than 1 percent of Trump voters) said that, could they go back in time, they would cast their vote for Clinton. Seven said they would vote for one of the minor-party candidates.

When we asked why, most regretful Trump voters pointed specifically to his performance as president. (Misspellings are original.)

“He has moved kinda fast with the immagration ban, and abortion law.”

“I don’t like his decisions so far.”

“Trump’s actions since the inaugeration.”

“… Trump cannot get out of his own way. He won’t stop running his mouth and has no humility.”

These sentiments echo regrets highlighted in social media. But they are too few to conclude that Trump’s electoral coalition has somehow eroded. Moreover, of the already small number of Trump voters expressing regret, only one in four would have shifted their support to the Democratic nominee.

Cannot say I’m all that surprised.  As I’ve said time and time again, President Trump = Candidate Trump.  He’s horrible, but there’s not actually any surprises in it.  Trump voters either A) knew he was horrible and were willing to overlook it for tax cuts and the Supreme Court, or B) actually like the horribleness (and suffer from varying degrees of delusion as to how grossly incompetent he is).

Also, therefore, worth pointing out, that, overall, Trump remains quite popular among Republicans.  Drum with a nice graph:

This has been and remains the key dynamic.  Don’t expect much to change until this does.

Just win, baby

So, the Republicans in the House are doing their damndest to pass health care legislation that most of them hate (many, because they think it is still too generous to poor people).  And Trump is pushing really hard for it.  Of course, Trump repeatedlyChait promised better health care for less money for his supporters and this bill is the exact opposite (as I’ve mentioned many times, health care has always been about political expediency for Trump; his true passion is xenophobia).  But, clearly, Trump is so desperate for a “win” that he’s going to the mattresses for objectively bad legislation (literally nobody from anywhere on the political spectrum considers this a good and workable version of health care policy) that directly contravenes his promises.  on some of the illogic behind this:

Overpromising is common for politicians. But Republicans didn’t merely stretch the truth. They have promised something diametrical to their actual agenda. Republican plans would reduce coverage subsidies, foisting people onto cheaper plans with much higher deductibles. All the while, they promised the precise opposite. Whatever they do, they are going to break their promises…

2. Losing will embolden our enemies. “[Trump] told us if we don’t pass this bill on Thursday, it will put everything in jeopardy that he wants to do, his agenda,” Republican Representative John Duncan of Tennessee told The Hill. “If we are not able to move forward with health-care reform, it endangers tax reform,” Representative Bill Flores of Texas, a former chairman of a House conservative caucus, tells Sahil Kapur. “The folks that were able to tear this down would feel like they’re empowered to tear the next big project down.” This is, essentially, the domino theory of legislation. But, really, think about it rationally: The folks who are tearing down Trumpcare are fellow Republicans in Congress. If Trumpcare fails, are they going to turn against tax cuts? …

4. We’ll lose Congress if we fail. “If we get this done, and tax reform, [Trump] believes we pick up ten seats in the Senate and we add to our majority in the House,” says Republican Representative Chris Collins of New York. “If we don’t get it done, we lose the House and the Senate.” Trump has reportedly emphasized the same point to his party.

It is a bit strange to argue that a party can consolidate or even expand its base of support by passing a deeply unpopular bill. To be sure, if Republicans believe that the public has simply been misled about its bill, and will like the result once it has been enacted, they might have reason to think a vote could help them in the long run. But it is almost impossible to find a policy advocate of any ideological persuasion who believes that.

I think it still more likely than not this passes this House, though that’s far from a sure thing.  But, at this point, I truly am wondering what possible legislation pulls off 218 Republican votes in the House and 50 in the Senate.  Whatever legislation does manage to pull that off, will almost surely be abysmal from a cost/benefit public policy perspective.

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