Why is Ryan happy with the CBO report while Trumpsters are calling it ‘absurd’?

Paul Ryan. Photo (cc) 2016 by Gage Skidmore.

This is truly one of the more bizarre after-effects of the Congressional Budget Office report that 24 million people will lose their health insurance if Obamacare is repealed and replaced: House Speaker Paul Ryan is very happy, saying that’s exactly what he intended, because, you know, freedom. But the Trump White House is denigrating the CBO, saying its numbers make no sense.

From The Washington Post:

Declaring that the plans would usher in “the most fundamental entitlement reform in a generation,” Ryan said the legislation “is about giving people more choices and better access to a plan they want and can afford. When people have more choices, costs go down. That’s what this report shows.”

And:

“Just absurd,” was the way Mick Mulvaney, director of the White House’s Office of Management and Budget, responded to the forecast, while Health and Human Services Secretary Tom Price said, “The CBO report’s coverage numbers defy logic.”

What this comes down to, of course, is who promised what. Ryan and his fellow Republicans have always promised needless pain and suffering (freedom!), and the alternative they’ve drafted to Obamacare would give people exactly that. Indeed, the CBO report is actually good news for Ryan, since it may impress Republicans like Sen. Rand Paul, who has complained that the Ryan plan doesn’t go far enough in returning us to John Locke’s state of nature.

President Trump, by contrast, promised repeatedly to replace Obamacare with something bigger and better. “We’re going to have insurance for everybody,” he said at one point. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

As ABC News’ “The Note” puts it: “There are tensions everywhere — between what Ryan has long planned, what tea partiers and outside conservative groups have yearned for, and, critically, what President Trump promised.”

There is a perception among some that, unpopular though Trump may be (and he is), he’s nevertheless fulfilling his promises. For instance, Boston Globe columnist Alex Beam writes:

This isn’t the world I would choose to live in, but it’s a world we may need to get used to. I can’t see any evidence that Trump has done anything other than deliver on almost every one of his hateful campaign promises. Sure the central press hates him, and is working long hours to bring him down, but they hated him well before he was elected, and it affected the election barely a whit.

In fact, repealing Obamacare and replacing it with anything like the Ryan plan would amount to a massive breach of one of Trump’s key promises, and it would harm his voters more than most Americans. Yet Trump and his minions appear to be paving the way for passage of the Ryan plan — let’s call it Trumpcare! — by deriding the CBO report as “fake news.” Unfortunately, it will actually accomplish exactly what Ryan is aiming for, which is to undermine the entire notion that government can make a meaningful difference in people’s lives.

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Understanding the legal challenge to health care

I’d be curious to know whether anyone has a good link explaining the reasoning behind the legal challenges to the federal health-care law. Every story I’ve seen — including this one, from the New York Times — reports that it might be unconstitutional to require people to buy medical insurance. But I haven’t seen anything that places it in context.

Here’s what I don’t understand. The courts clearly have no constitutional problem if the states impose such a requirement. Most states, after all, mandate that their residents buy auto insurance if they wish to drive. And Massachusetts — upon which the federal health-care law is based — requires that everyone buy medical insurance.

Moreover, under the 14th Amendment, states may not deprive their residents of liberties that they enjoy under the U.S. Constitution. If anyone has used the 14th Amendment to challenge state insurance mandates, I’m not aware of it.

If you’ve seen something that answers these questions, please post a link in the comments.

Insurer profits by denying needed care

My friend Clif Garboden, with whom I worked for many years at the Boston Phoenix, has written a compelling op-ed piece for the Boston Globe about his battles with Harvard Pilgrim Health Care, which refuses to cover a chronic condition caused by his successful treatment for cancer. Clif writes:

I have the right to appeal this rejection …, but frankly, I have better things to do with my remaining time on earth than play against a stacked deck with a bunch of bandits.

Garboden’s tale may provide some insight into how former chief executive Charlie Baker, now the Republican candidate for governor, engineered Harvard Pilgrim’s turnaround. As Clif observes, maybe we can move something better now that we have near-universal health care.

Three questions about those legal challenges

This isn’t fair — I’m going to be on the road until tonight, and I managed to mess up the WordPress app on my BlackBerry. So I won’t be able to approve comments for quite a while. But I do have three questions about legal challenges to the health-care law, and I’m hoping someone can answer them here.

1. Critics say the requirement that everyone must buy health insurance from a private company is unconstitutional. Yet no one to my knowledge has ever even raised that issue with regard to the Massachusetts law, which has the same requirement. Is there something different about the Massachusetts Constitution?

2. Under federal law, we are required to invest our money in a government-controlled retirement system (Social Security) and medical-insurance system (Medicare). Why is that constitutionally permissible if being required to buy insurance from private companies is not?

3. Is it even correct to call the insurance mandate a “requirement”? If you refuse to buy insurance, you simply pay a penalty of some sort, right? You’re not being branded as a criminal or even a civil offender as I understand it.

What health-care reform means to our family

In my latest for the Guardian, I write about what health-care reform means to our family — and, specifically, to our daughter, who will not have to worry being excluded from insurance because of her dwarfism.

Obama signs health-care bill

Who needs a press pass when you’ve got a BlackBerry and a television set?

Bush speechwriter: A “disaster” for Republicans

David Frum

Later this week I’ll be writing more about the historic health-care bill passed by the House on Sunday night. For now, though, a few semi-connected observations.

1. If you read nothing else on the politics of health-care reform, you must read this blog post by David Frum, a Republican strategist and former speechwriter for George W. Bush. Frum doesn’t like the bill; he thinks it’s too expensive and will harm businesses. But he is withering in his criticism of the Republican leadership for its take-no-prisoners approach to legislation that is, he asserts, moderate at its core and based on Republican ideas.

“Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s,” he begins. “It’s hard to exaggerate the magnitude of the disaster.” He continues:

At the beginning of this process we made a strategic decision: unlike, say, Democrats in 2001 when President Bush proposed his first tax cut, we would make no deal with the administration. No negotiations, no compromise, nothing. We were going for all the marbles. This would be Obama’s Waterloo — just as healthcare was Clinton’s in 1994.

Only, the hardliners overlooked a few key facts: Obama was elected with 53% of the vote, not Clinton’s 42%. The liberal block within the Democratic congressional caucus is bigger and stronger than it was in 1993-94. And of course the Democrats also remember their history, and also remember the consequences of their 1994 failure.

Every line is quotable, so by all means read the whole thing. But he is especially strong on the strategic error Republicans made in following the likes of Rush Limbaugh and Fox News, noting that not only do they want Democrats to fail, but, fundamentally, they want Republicans to fail, too. Why? It’s good for business.

2. New York Times columnist Paul Krugman today connects the dots between opposition to health-care reform and race. It’s not hard: All he has to do is quote former House speaker Newt Gingrich, who recently said passage would be as harmful to Democrats as civil-rights legislation was in the 1960s. [See correction below.]

Gingrich’s clear message was that white opposition to racial justice was good for the Republican Party, and happy days are here again. And Krugman offers a few other choice examples as well.

The racial subtext to health-care reform has been right below the surface all along. Let’s not forget that South Carolina congressman Joe Wilson, who bellowed “You lie!” at President Obama last September, has a long and foul history of involvement in Confederate causes. This weekend, the tea-party protesters included someone holding up a racially charged poster of Obama as a voodoo doctor (I’ve lost track of where I found it, but if you’ve got a link, send it along), and of some flinging the N-word at Congressman John Lewis, a legendary civil-rights leader. (Homophobic slurs were directed at Congressman Barney Frank as well.)

You can’t even bring this stuff up without being criticized for characterizing a group based on the actions of a few, and I do understand that argument. But if anyone on the scene tried to stop or shout down these knuckle-draggers, their efforts have gone unrecorded.

3. As the media play their favorite parlor game of picking winners and losers, they ought to consider that the biggest loser of all might prove to be Congressman Steve Lynch of South Boston.

Lynch, as we know, announced his opposition to the Senate bill last week. No surprise there — a lot of House Democrats didn’t like it, which is why they came up with the complex strategy of approving the Senate bill, then approving a set of amendments to send back to the Senate.

But Lynch backed himself into a corner with strong language that made it almost impossible for him to shift. By Sunday, the emotional momentum had clearly turned, and Lynch had nowhere to go. He wound up being one of just two House members to vote against the Senate bill and for the amendments — a move that may have put him on the “right” side both times, but that was transparently craven. (So why did the “yes” tally rise by just one, from 219 to 220? Believe it or not, someone voted “yes” on the Senate bill and “no” on the amendments. Go figure.)

The talk today is whether a progressive Democrat might challenge Lynch in the primary. That’s happened before without much effect. This time, though, Lynch could face an opponent who can raise money from the netroots, and without his erstwhile friends in organized labor to drag him over the finish line.

Sounded like a good idea at the time, eh, Congressman?

Correction: Krugman relied on a Washington Post story, and the Post has now published a correction. Gingrich says he was referring to Lyndon Johnson’s Great Society social programs and the Vietnam War, not to civil-rights legislation.

Photo of David Frum via Wikimedia Commons.

The Times’ not-so-full disclosure

The New York Times today commits a double failure to disclose in running an op-ed piece by the economist Douglas Holtz-Eakin, who claims that the health-care bill now moving toward final resolution would add $562 billion to the federal deficit.

First, the Times does not note that Holtz-Eakin was a close adviser to John McCain’s presidential campaign, and provided one of the few laugh lines of that dreadful effort by crediting McCain with the development of the BlackBerry.

Second, the Times identifies Holtz-Eakin as the president of the American Action Forum without noting that it is a partisan Republican organization founded by former senator Norm Coleman.

As for the merits of Holtz-Eakin’s argument, he repeats the familiar Republican talking point that the bill’s authors cynically claim savings by counting 10 years’ worth of revenues to pay for six years’ worth of benefits. The non-partisan site PolitiFact.com has pronounced that claim to be “half true.” Keep that in mind as you sift through his bill of particulars.

Abortion, health care and the media

John Boehner

While driving to work yesterday, I heard House Republican leader John Boehner on NPR, claiming — as he has on any number of occasions — that the health-care-reform bill now being considered by the House would allow for “taxpayer-funded abortions.”

Based on the best available evidence, what Boehner said was not true. That he and other health-bill opponents keep getting away with it exposes a flaw in the news media that goes back at least to the days of Joseph McCarthy. That is, journalists regularly report the words of powerful figures, but only rarely challenge them on the facts. It’s just one of the reasons that President Obama’s quest for near-universal health care is hanging by a thread, and could still be defeated.

A bit of review. Last year the House and the Senate both passed health-care-reform bills with language aimed at ensuring that the current ban on federal funding of abortions would remain in place. Pro-life activists claim the House language is tougher, but other observers say the two bills would accomplish the same thing. Here is Secretary of Health and Human Services Kathleen Sebelius in a recent appearance on ABC News’ “This Week”:

The president has said from the outset, we don’t want to change the status quo on abortion funding. Neither the Senate or the House bill has any federal funding for abortion, none. Yes, abortion services are provided, and people will pay out of their own pockets, in both the Senate and the House, but they do it in slightly different ways.

Now, I understand that Sebelius isn’t a neutral analyst. Rep. Bart Stupak, the Democrat who wrote the anti-abortion language that’s in the House bill, says he will oppose the Senate bill, which is under consideration by the House this week. So it’s complicated. Yet there are ample reasons to believe that the concerns Stupak has voiced are wrong, and that, therefore, Boehner and his ilk are exploiting the always-volatile issue of abortion rights for sheer political gain, knowing they can get away with it. Here are three compelling pieces of evidence:

1. The Pulitzer Prize-winning, nonpartisan Web site PolitiFact.com reports that Stupak is just plain wrong — as in “false” — in claiming that every enrollee in the government health-care exchanges that would be created by the proposal would be required to help fund abortion. In addition, PolitiFact notes that the Senate anti-abortion language was written by Sen. Ben Nelson, who’s pro-life. Finally, PolitiFact looks at a claim that a loophole would allow federally funded community health centers to provide abortions as “highly misleading” and “barely true.”

2. A serious pro-life Democrat, Rep. Dale Kildee, announced yesterday that he will support the Senate language after concluding that it will not lead to taxpayer funding of abortions. “I have listened carefully to both sides, sought counsel from my priest, advice from family, friends and constituents, and I have read the Senate abortion language more than a dozen times,” Kildee, who once studied for the priesthood, told the New York Times. “I am convinced that the Senate language maintains the Hyde Amendment, which states that no federal money can be used for abortion.”

3. A coalition representing more than 50,000 Catholic nuns released a letter yesterday supporting the health-care proposal, including the Senate language, thus contradicting a stand taken by the U.S. Conference of Bishops. Have the nuns suddenly become pro-choice? No, they have not, according to the Los Angeles Times. “We agree that there shouldn’t be any federal funding of abortion,” Sister Simone Campbell, the executive director of Network, is quoted as saying. “From our reading of the bill, there isn’t any federal funding of abortion.”

Legalisms aside, New York Times columnist Nicholas Kristof today predicts that the health-care bill, if it becomes law, will lead to a dramatic decrease in the number of abortions, since research has shown that access to health care correlates with fewer abortions.

Since the health-care debate began a year ago, Obama and the Democrats have done a miserable job of explaining the stakes, and the media have largely engaged in their typically mindless “he said/she said” horse-race coverage. When the media do attempt to tease out the truth (as in this CNN “Fact Check”), the results are often muddled with so much fake even-handedness that news consumers are left not knowing what to think.

Perhaps in examining just this small aspect of the debate, we can detect a larger pattern.

Photo (cc) by republicanconference and republished here under a Creative Commons license. Some rights reserved.

Wrong on reconciliation

ABC News’ Jake Tapper today did not challenge U.S. Sen. Lindsey Graham as Graham railed against the notion that Senate Democrats might use reconciliation to get around a Republican filibuster and pass health-care reform.

Yet it is a simple fact that reconciliation will not be used to pass the measure. It is a logical impossibility.

As we know, both branches of Congress have already approved near-universal health-care bills. Sometime this week, the House is expected to vote on whether to pass the Senate version. If it’s approved, the bill will go to President Obama’s desk for his signature, and it will become law. No further action will be needed.

If reconciliation is used, it will only be to give the Senate a chance to tweak the law so that it is more to the liking of House Democrats. But keep in mind that if the effort fails, the Senate bill will still be the law of the land.