It wasn’t the politics of health care that did in Trumpcare. It was the substance.

Nancy Pelosi and Chuck Schumer earlier this year. Photo (cc) 2017 by Lorie Scholl.

I find myself frustrated at the tone of much of the commentary following the humiliating withdrawal of the Trump-Ryan health-care bill Friday. I could find a bunch of stuff to link to, but we’ve all seen it. It’s all about winning. So much winning. And if the bill had been approved, most commentators would be hailing President Trump for his big victory.

Yes, Trump got the politics wrong. But of far greater significance is that he and House Speaker Paul Ryan got the substance wrong. There was nothing in their legislation other than a chest-thumping assertion that Obamacare is dead — and that we’re going to screw the poor, help the rich, and dismantle much of what was accomplished by the Affordable Care Act.

The two groups that defeated the legislation did so on principled grounds: Democrats and moderate Republicans who wanted Obamacare to remain entirely or mostly intact; and the House Freedom Caucus, whose extremist members don’t want any government involvement in health care whatsoever. On the other side, those who supported Trumpcare couldn’t point to a single provision that would have improved anyone’s lives other than the wealthy people who’d get a tax cut.

After the defeat, Trump blamed House minority leader Nancy Pelosi and Senate minority leader Chuck Schumer. He’s right — it’s on them. And we should thank them for saving the most important piece of social legislation since Medicare was approved in the 1960s. And these folks, too:

Any major new program needs technical fixes along the way. Unfortunately, after Obamacare was approved, congressional Republicans refused to consider any such legislation. That, along with attempts by many Republican governors to undermine it in their states, is responsible for the ACA’s not working as well as it should.

On Friday, the ACA was saved. It now must withstand at least two years of Republican attempts to starve it of funds. But as Jonathan Chait of New York magazine points out, it’s not likely to be repealed after the debacle of this week. Trump and congressional Republicans won’t be in power forever. At some point, we’ll have an opportunity to get this right.

Talk about this post on Facebook.

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.

Yes, Sen. Grassley, there are plenty of reasons to worry about the fate of Medicare

Keep your eyes open, journalists. Connect the dots. Sometimes it’s as easy as reading two stories in the same day’s newspaper — in this case, The Washington Post. A story on Republican efforts to come up with a repeal-and-replace plan for the Affordable Care Act includes this:

Some congressional Republicans have been more vocal in recent days about concerns that they are hearing from constituents on what comes after the law is repealed. Several also suggested that Democrats are deliberately spreading misinformation.

“I think you hear from two categories,” said Sen. Charles E. Grassley (R-Iowa). “One are people that think Medicare is going to be affected, and obviously we haven’t made very clear that there’s absolutely no connection with Medicare. And the other one is dealing with the people they think are going to lose their insurance as soon as we … repeal.”

Those dastardly lying Democrats! But wait. Elsewhere in the Post, we learn that Tom Price, who is Donald Trump’s choice to be the next secretary of health and human services, is in fact a sworn enemy of Medicare:

Starting early in his tenure on Capitol Hill, Price wrote a series of commentaries lambasting the popular Medicare program and exhorting changes along more conservative lines. “Its flawed structure increasingly fails our seniors on all counts — responsiveness, innovation, access, cost and quality,” he wrote in 2008 in the Washington Times. He has repeatedly introduced legislation that would have converted Medicare from the entitlement program it has been since its origins in the 1960s to a system of “defined contribution,” with the government giving older Americans fixed sums to help them purchase private health plans.

For what it’s worth, the bylines of Post reporters Julie Eilperin and Amy Goldstein appear on both stories.

And let’s not forget that House Speaker Paul Ryan spends most of his waking hours dreaming about doing away with Medicare.

I guess the most logical explanation for letting Grassley’s words stand without challenge  is that destroying Obamacare will not destroy Medicare. Instead, it will require a separate vote.

From the archives: How the Affordable Care Act will help people with disabilities

President Obama signs the Affordable Care Act. Photo is in the public domain.
President Obama signs the Affordable Care Act. Photo is in the public domain.

Now that congressional Republicans are shamefully dismantling the Affordable Care Act, I thought I would reprise this 2010 piece that I wrote for The Guardian shortly after President Obama signed the bill into law. (I have left the Britishisms intact.) The death of Obamacare is going to have a huge, negative effect on millions, including people with disabilities.

Previously published by The Guardian.

It was some years ago that my wife and I learned a crucial fact about living in America with a disability.

Our daughter, Rebecca, now 17, had been diagnosed at birth with achondroplasia, a genetic condition that is the most common form of dwarfism. At five months she ran into dwarfism-related breathing complications that required a tracheostomy, oxygen and home nurses for a good part of the day and night. It was a harrowing time in our lives — not to mention hers. But by the time she was three years old she was fully recovered.

One day when Becky was still a baby we found ourselves at a gathering of Little People of America, an organisation akin to Britain’s Restricted Growth Association. We were looking down — way, way down — at our soon-to-be-friend Ruth, the local LPA director. Ruth told us that Becky should focus on a career at either a large corporation or the federal government. That way, she said, Becky would never have to worry about having health insurance.

We were appalled. It’s not that working for a big company or a government agency is such a terrible fate. Ruth herself is a federal bureaucrat, and a good one. So, for that matter, was my father. But the idea that our daughter should shy away from launching a business or joining a small start-up company lest she lose her health coverage was offensive to us.

Those days are now behind us — and her. After Sunday night’s historic vote in the House of Representatives, we count Becky among the tens of millions of Americans who have been liberated. It’s long overdue.

Much of the attention over the past few days has rightly focused on the 32 million uninsured Americans who will be covered, and on new regulations that will prohibit insurance companies from denying benefits to people with pre-existing conditions.

What hasn’t been emphasised enough is that many of those folks with pre-existing conditions, like Ruth, have good jobs and great coverage — but that some of them might like to do something else with their lives. Maybe an accountant who’s recovered from cancer wants to try his hand at consulting. Maybe a mother with an autistic child has a killer idea for a restaurant. Maybe a wheelchair-using lawyer at a large firm would like to hang out her own shingle. Now there’s nothing to stop them.

It is the release of this pent-up entrepreneurialism that is among the most exciting aspects of healthcare reform. When Barack Obama has spoken about healthcare in the context of the economy, he has stressed the high cost of insuring employees. For instance, in the president’s address to a joint session of Congress last September, he described cost as the reason that “so many aspiring entrepreneurs cannot afford to open a business in the first place”. Obama was right, but he overlooked what happens when entrepreneurs themselves have medical conditions that prevent them from taking risks that could benefit society as a whole.

There are other reasons, of course, to get excited about healthcare reform, even if you’re a middle-class family with good coverage and no health issues. For many families, the ability to insure your adult children under your own plan until they are 26 is a change of enormous importance. Sticking with the personal theme of this commentary, our 19-year-old son, Tim, plans to spend the next several years establishing himself as a commercial photographer. Now he – and we – have one less thing to worry about.

We are hardly unusual. Across the country, in red states and blue, in households that voted for Obama and those who think he’s a “socialist”, folks are going to discover their lives have been made better in measurable ways. The idea that Republicans will repeal the healthcare law is laughable. Instead, as Republican strategist David Frum, a speechwriter for the second president Bush, wrote on Sunday, the GOP’s just-say-no strategy has led to a “disaster” for the party’s prospects.

What happened on Sunday restored some faith that our political leaders can work on behalf of the people who elected them. It was a great moment for Obama and House speaker Nancy Pelosi, who overcame odds that seemed insurmountable following Republican Scott Brown’s surprise election to the US Senate in January.

It was also a great moment for all of us.

Talk about this article on Facebook.

Myths and realities about Obamacare premium increases

If you’re trying to figure out what’s going on regarding claims that Obamacare costs are spiraling out of control, I recommend this piece by Jonathan Chait of New York magazine. Chait really understands this stuff. The key takeaways:

  • The premiums announced for next year are about what had been predicted when the Affordable Care Act first went into effect. The reason the jump is so high now is that insurance companies initially underpriced their policies in order to get more people to sign up. And the premiums are still lower than they would have been without the ACA.
  • There are 50 insurance exchanges—one in each state. They are working well in states that supported the law and accepted federal assistance to expand Medicaid, and not well at all in  states that didn’t. So it’s ongoing Republican resistance to the law, not the law itself, that is the source of some of the problems.
  • Complex legislation like the ACA often need fixes every now and again because there’s no way officials can predict with absolute certainty what’s going to happen. Unfortunately the ACA can’t be amended or fixed in the current political environment because the Republicans in Congress won’t allow it.

And thanks to Jonathan Cohn, a health-care expert in his own right, for flagging Chait’s article.

Headlines distort CBO report on Obamacare

The reaction to a Congressional Budget Office report released Tuesday demonstrated how easily politicians are able to game the media system.

The CBO, a respected source of nonpartisan data, found that the Affordable Care Act would lead to the disappearance of more than 2 million jobs — nearly all of them because people will choose to stop working or cut back on their hours now that their health insurance is no longer dependent on their continued employment. CBO director Douglas Elmendorf put it this way:

I want to emphasize that that reduction doesn’t mean that that many people precisely will choose to leave the labor force. We think that some people will chose to work fewer hours. Other people will choose to leave the labor force.

Of course, that didn’t stop Republican opponents from claiming that the CBO report proves the ACA is a job-killer. And why not? The media are so quick to go along. Let’s consider that this is Elmendorf’s report, and he said at a news conference precisely what it meant. Yet the very NPR story in which his remarks are quoted is headlined “Is Obamacare A Job Killer? New Estimates Suggest It Might Be.” Gah.

This morning I looked at the front pages of four major dailies. Here’s how they stack up, in order of disingenuousness.

Screen Shot 2014-02-05 at 10.22.25 AM

1. The Boston Globe. “Health law projected to put a dent in workforce; GOP calls analysis proof of act’s failings.” The clear impression is that people are going to lose their jobs because of the ACA. If you would like to believe that, go right ahead — but it’s not what the CBO said. The Globe headline is slapped atop a New York Times story (below) that isn’t nearly that bad.

Screen Shot 2014-02-05 at 10.20.05 AM

2. The New York Times. “Health Care Law Projected to Cut the Labor Force; Choosing Not to Work; G.O.P. Seizes On Data — Drop May Equal 2.5 Million Jobs.” Whew! Try saying it all without taking a breath. The Times’ headlines is slightly better than the Globe’s: the second deck, “Choosing Not to Work,” gets at the gist of the CBO report. But the rest of it makes it sound like Tuesday was a very bad day for the ACA. You’ve got to read the story to find out what’s really going on.

Screen Shot 2014-02-05 at 10.21.24 AM

3. The Washington Post. “New fuel for the health-law fight; CBO: More will quit jobs, cut hours; Estimates revive debate over economic effects.” Not bad. The impression given by the headline is that the fight is over the economic effect of people quitting their jobs. Not quite right, but we’re getting closer. Here’s the story.

Screen Shot 2014-02-05 at 10.21.57 AM

4. The Wall Street Journal. “Health Law to Cut Into Labor Force; Report Forecasts More People Will Opt to Work Less as They Seek Coverage Through Affordable Care Act.” Folks, we have a winner — a headline that accurately reflects what the CBO actually said. Good story, too. (To get around the Journal’s paywall, enter the headline at Google News. Don’t worry. Rupert knows about it and says it’s OK.)

The problem with deceptive or incomplete headlines is that few people get past them or the partisan attacks they reflect. What House Speaker John Boehner (quoted in the Times story) said is simply flat-out wrong: “The middle class is getting squeezed in this economy, and this CBO report confirms that Obamacare is making it worse.”

As U.S. Sen. Jeanne Shaheen, D-N.H., put it in a conversation with reporters (also quoted in the Times): “You guys are going to politicize it no matter what happens.”

Journalists need to resist the urge.

Headline images via the Newseum’s “Today’s Front Pages.”

Will heads roll after CNN meltdown? Should they?

Three quick items on the Supreme Court’s decision to (mostly) uphold the Affordable Care Act:

1. I was watching CNN while waiting for the ruling in the mistaken belief that the other cable nets would only be worse. I must admit, listening to Wolf Blitzer and John King trying to backtrack from their whopper made for riveting television. Will heads roll? Should they? People make mistakes, but good grief.

2. Wish I could remember who wrote this, but yesterday I read an analysis that attempted to prove Justice Anthony Kennedy would vote against the individual mandate. So far, so good. But the writer went on to argue that since it was unimaginable Chief Justice John Roberts would come out on Kennedy’s left, that was the end of Obamacare. Personally, I think Roberts looked into the abyss and saw there was no bottom.

3. I thought this was a good time to recycle what I wrote about garcinia cambogia extract for the Guardian after the ACA was approved in 2010. The law isn’t perfect, but it’s an enormous improvement over the status quo. It was — and is — a BFD.

Image via JimRomenesko.com.