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.

 

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 ;-).

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.

The motivating factor behind Obamacare repeal

This chart from CBPP (friendly version and commentary via Drum) is pretty damn telling:

You know what really gets me? Even among the millionaires, repeal will only net them about $50,000. That’s like finding spare change in the sofa cushions for this crowd. Is clawing back a few nickels and dimes really worth immiserating 20 million people?

Well, there you go, that’s the other motivating factor.  Damn if their tax dollars are going to subsidize health care for lazy poor people!

Quick hits (part II)

1) Dana Goldstein reviews a new book on the for-profit college scam.

2) Costs/benefit-wise, guns in the home–especially due to dramatically heightened suicide risk– fail miserably.

3) Love a good, negative review, like the one of the new book Convergence arguing that everything is all coming together:

Watson’s apparent mastery of the ingredients and recipes of all the sciences might stagger a general reader used to the works of mortals. What will stagger the knowledgeable is the confidence with which he presents nonsense.

4) When it comes to analyzing college basketball, I love Ken Pomeroy.  Slate This article on how the metrics the NCAA uses grossly discriminate against mid-major teams is really good.

5) Sticking with college sports… all the TV money flowing in for football and basketball means that coaches of even the lowliest sports teams now well out-earn full professors.

6) Liberals are turning to MSNBC in droves.  I’d prefer the NYT, but I’ll take political engagement with cable news channels with no political engagement.

7) How intellectual humility can make you a better person.  I think the constant rejection of trying to get articles published probably serves academics well in this regard.

8) Impossible Foods Impossible Burger is about to massively scale up.  I sure do hope this is the  beginning of the end of meat.

9) Democrats are divided on how to approach Gorsuch.  Here’s an idea– it’s Merrick Garland’s seat.

10) A looming future of antibiotic resistance?  Maybe.  But I’m actually an optimist on what scientists will be able to accomplish on this.

11) Kevin Drum is right that fiscal conservatives should love national healthcare.  The problem is, more than they like saving money, they hate giving government benefits to people they think do not deserve them.  Drum  with the key reason national health care saves money:

It’s ironic, but it turns out that central governments are a lot better at keeping a lid on health care costs than the private sector. The reason is taxes. National health care is paid for out of tax revenue, and the public pressure to keep taxes low is so strong that it universally translates into strong government pressure to keep health care costs low. By contrast, the private sector is so splintered that no corporation has the leverage to demand significantly lower costs. Besides, if health care costs go up, corporations can make up for it by keeping cash salaries low. This is part of the reason that median incomes have grown so slowly over the past 15 years. Corporations simply don’t care enough about high health care costs to really do anything about it.

12) Why do comedians laugh at their own jokes?

13) Chait with a great piece on Ryan, Trump, health care, and taxes:

Liberals have been warning for years that the “alternative” Republican plan that could actually pass Congress was a mirage. There was no plan that could be both acceptable to conservative anti-government ideology and to the broader public. The dilemma Republicans find themselves in now — a plan that subsidizes too little coverage to be acceptable to vulnerable members, and too much coverage for the party’s right wing — has always been unavoidable. Whoever had to write the first version of the Republican health-care bill that would have to be scored by the Congressional Budget Office and pass both chambers was given a task with impossible parameters. Ryan is being turned into the fall guy for eight years of lies that the entire Republican party, himself included, told the country and itself.

However, Ryan does appear to be the mastermind behind the legislative sequence Trump has agreed to. The plan is rooted in Ryan’s obsessive quest to pass a huge tax cut for the rich that will be permanent. That strategy requires a series of difficult steps, which — if carried out correctly at every turn — will ultimately culminate in a massive tax cut that can be scored by the Congressional Budget Office as revenue-neutral after ten years, and thus avoid the arcane budgetary requirement that caused the Bush tax cuts to expire automatically after a decade. This intricate calculation, based on complying with the Senate’s budget rules, is the linchpin of the entire Republican legislative strategy.

 

14) Sometimes it really takes just a little bit of money to get a college student over the finishing line.  Good to see that some colleges realize what a good investment this is.

15) Unlike the rest of Europe, anti-immigrant, right-wing parties are making little headway in Spain.  Read the NPR story to find out why.

16) A student recently shared this with me– I missed it last year.  How Denmark treats their prisoners well and it is a win for everybody:

Still, the value of Denmark’s example to a reform-minded public lies not in replicating its particular strategies or techniques but in adopting its broader ethos — one that grants prisoners dignity and allows room for error.

This is a lesson that the United States needs to learn. The United States has the highest incarceration rate in the world, yet we have little to show for either the money invested or the lives lost to this system. U.S. prisoners wear anonymous facility garb, eat mass produced food in assembly cafeteria lines, and spend hours on end in tiny, bleak cement cells. As President Obama noted this past week, as many as 100,000 prisoners across the United States are housed in solitary confinement. Hundreds of these prisoners are released directly to the streets every year, often with dangerous consequences: two went on shooting rampages upon release in 2013…

Officials say a zero tolerance policy is the only way to ensure safety in a facility full of felons. But in reality, such policies do little. Prisoners use drugs, escape and recidivate. In spite of invasive search routines for prisoners and visitors alike, prisons across the United States report problems with contraband from drugs to cellphones to prison-made knives. Even though U.S. prisoners are not permitted to have knives or prepare their own food for safety reasons, in 2011 the Supreme Court found that one California prisoner died unnecessarily every week — lives lost not to violence, but to medical negligence. And when a prisoner escaped from Clinton Correctional Facility in New York in June 2015, more than 60 prisoners complained of a backlash of abusive beatings. Danish prison officials say that their prisoners act out less because they are treated humanely; they, too, are allowed to make mistakes. [emphasis mine]

17) Should have had this last week.  No, smartphones are not luxury items.  Giving up your Iphone does not exactly save you enough to buy health insurance.  Only out-of-touch Republican legislators seem to think so.

18) Dahlia Lithwick on how Trump’s own words were a key in knocking down travel ban 2.o.

19) William Ayers on political conflict on campus:

20) Speaking of which, NC State students not particularly big fans of free speech:

21) Last, and certainly not least, the latest research strongly suggests that Voter ID laws do not reduce turnout.  If you are a liberal, you were probably too ready to believe the earlier research that they do.  To be clear, I still strongly oppose Voter ID laws because they are a solution to a problem that does not exist and do disproportionately impact minorities and young people.  Just because they are not as effective at demobilization as their Republican sponsors hoped, does not make them okay.

 

Quick hits (part I)

1) This Andrew Sullivan essay on intersectionality as religion is a definite must-read (in response to recent Charles Murray incident):

“Intersectionality” is the latest academic craze sweeping the American academy. On the surface, it’s a recent neo-Marxist theory that argues that social oppression does not simply apply to single categories of identity — such as race, gender, sexual orientation, class, etc. — but to all of them in an interlocking system of hierarchy and power. At least, that’s my best attempt to define it briefly. But watching that video helps show how an otherwise challenging social theory can often operate in practice.

It is operating, in Orwell’s words, as a “smelly little orthodoxy,” and it manifests itself, it seems to me, almost as a religion. It posits a classic orthodoxy through which all of human experience is explained — and through which all speech must be filtered. Its version of original sin is the power of some identity groups over others. To overcome this sin, you need first to confess, i.e., “check your privilege,” and subsequently live your life and order your thoughts in a way that keeps this sin at bay. The sin goes so deep into your psyche, especially if you are white or male or straight, that a profound conversion is required.

Like the Puritanism once familiar in New England, intersectionality controls language and the very terms of discourse. It enforces manners. It has an idea of virtue — and is obsessed with upholding it. The saints are the most oppressed who nonetheless resist. The sinners are categorized in various ascending categories of demographic damnation, like something out of Dante. The only thing this religion lacks, of course, is salvation. Life is simply an interlocking drama of oppression and power and resistance, ending only in death. It’s Marx without the final total liberation.

2) And Frank Bruni with his take on the “dangerous safety of college.”

3) Speaking of colleges… the ongoing fiasco and horrid waste of NJ taxpayer dollars that is Rutgers athletics.

4) As mentioned, I’m reading SapiensAustralians, where I learned that one of the unsolved mysteries in the study of prehistoric humans is how they managed to get to Australia around 50,000 years ago.  The latest on what scientists are learning about the original .

5) Speaking of humans…there really seems to be an increasing problem with male sperm.  And that’s a problem for all humans.  Mine have done their part, but I worry about my sons.

6) I’m not usually a big fan of the liberal rants, but this one against rural, white, conservatives is really, really good:

Here are the honest truths that rural Christian white Americans don’t want to accept; until they accept these truths, nothing is going to change:

  • Their economic situation is largely the result of voting for supply-side economic policies that have been the largest redistribution of wealth from the bottom/middle to the top in U.S. history.
  • Immigrants haven’t taken their jobs. If all immigrants, legal or otherwise, were removed from the U.S., our economy would come to a screeching halt and food prices would soar.
  • Immigrants are not responsible for companies moving their plants overseas. The almost exclusively white business owners are responsible, because they care more about their shareholders (who are also mostly white) than about American workers.
  • No one is coming for their guns. All that has been proposed during the entire Obama administration is having better background checks.
  • Gay people getting married is not a threat to their freedom to believe in whatever white god they want to. No one is going to make their church marry gays, have a gay pastor or accept gays for membership.
  • Women having access to birth control doesn’t affect their lives either, especially women they complain about being teenage single mothers.
  • Blacks are not “lazy moochers living off their hard-earned tax dollars” any more than many of their fellow rural neighbors. People in need are people in need. People who can’t find jobs because of their circumstances, a changing economy or outsourcing overseas belong to all races.
  • They get a tremendous amount of help from the government they complain does nothing for them. From the roads and utility grids they use to farm subsidies, crop insurance and commodities protections, they benefit greatly from government assistance. The Farm Bill is one of the largest financial expenditures by the U.S. government. Without government assistance, their lives would be considerably worse.
  • They get the largest share of Food Stamps, Medicaid, Medicare, and Social Security.
  • They complain about globalization, yet line up like everyone else to get the latest Apple products. They have no problem buying foreign-made guns, scopes and hunting equipment. They don’t think twice about driving trucks whose engines were made in Canada, tires made in Japan, radios made in Korea, and computer parts made in Malaysia.
  • They use illicit drugs as much as any other group. But when other people do it is a “moral failing” and they should be severely punished, legally. When they do it, it is a “health crisis” that needs sympathy and attention.
  • When jobs dry up for whatever reason, they refuse to relocate but lecture the poor in places like Flint for staying in failing towns.
  • They are quick to judge minorities for being “welfare moochers,” but don’t think twice about cashing their welfare checks every month.

And plenty more good ones in that list.

7) LeVar Ball— most insane sports dad ever?  I’m thinking so.

8) I saw “Into the Woods” at my son’s high school last night.   First time seeing it.  The kids were terrific– fabulous performance.  As for the musical itself, I’ve concluded that it’s hugely over-rated.  I agree with both these takes.

9) I love the Oxford comma.  Always use it.  It matters.

10) Helpful reminder: “learning styles” are a fiction.

11) Chuck Todd makes a ludicrous argument that big data led to polarization.  Seth Masket shoots him down.  Classic post hoc ergo propter hoc.

12) The British wiretap thing.  Seriously, just step back for a minute and think about how insane it is that somebody like Trump is a president!  The man is a toddler.

13) Are teenagers using smartphones instead of drugs?!  Maybe.  But see #11.

14) Just so we’re clear.  Steve King is a disgusting, deplorable human being.  And he’s mainstream in today’s Republican party.

15) Using artificial intelligence to prevent suicide.

16) For-profit colleges suck. They are basically a scam on poor people.  And taxpayers.  Oh, and, of course, they are making headway with the Trump administration.

17) North Carolina’s loss (HB2) is South Carolina’s gain.  Ugh.

18) Why does Trump hate cities?  Because they show that liberalism (and ethnic diversity) works.

19) Love the headline for this take on Trump’s budget, “Trump’s Budget Expands the G.O.P.’s War on Math.”

20) On how the internet is saving culture because people are willing to pay for good content (agree, says this subscriber to Netflix, HBO, NYT, etc.)

21) Since I’m just queuing this up anyway, and one of quick hits two biggest fans (DJC) is already up and 6:00, I’m moving the queue time up in his honor.

 

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