BONFIRE OF REPUBLICAN VANITIES
On graduation, most medical students swear some version of the ancient Hippocratic oath — a promise to act morally in their role as physicians. Human nature being what it is, some will break their promise. But we still expect those who provide health care to behave more ethically than the average member of society.
When it comes to how political figures deal with health care, however, we’ve come to expect the opposite, at least on one side of the aisle. It often seems as if Republican politicians have secretly sworn a Hypocrite’s oath — a promise to mislead voters to the best of their ability, to claim to support the very protections for the sick they’re actively working to undermine.
To see what I mean, consider the case of Josh Hawley of Missouri, who is running for the Senate against Claire McCaskill.
Hawley is one of 20 state attorneys general who have brought a lawsuit attempting to repeal a key provision of the Affordable Care Act — the provision that protects people with pre-existing medical conditions, by requiring that insurance companies cover everyone of similar age at the same rate regardless of medical history. Kill that provision, and millions of vulnerable Americans will lose their insurance.
But here’s the thing: Protecting coverage for pre-existing conditions is overwhelmingly popular, commanding majority support even among Republicans. And McCaskill has been hammering Hawley over his role in that lawsuit.
So Hawley has responded with ads claiming that he, too, wants to protect those with pre-existing conditions, as supposedly shown by his support for a bill that purports to provide such protection.
I have to say, you almost have to admire the sheer brazenness of the dishonesty here. For the bill Hawley touts is a fraud: It’s full of loopholes allowing insurers to discriminate in ways that would end up making essential health care unaffordable for those who need it most. For example, while it would require that they offer insurance to, say, cancer patients, it would allow them to sell policies that don’t cover cancer treatment — which would mean that policies that did cover such treatment would become prohibitively expensive.
And the fraudulence of this bill aside, even serious, nonfraudulent regulation of insurance companies isn’t enough in itself to provide affordable coverage for pre-existing conditions. If that’s all you do, those who sign up for coverage will be a lot sicker than those who don’t, which means a bad risk pool, which means high premiums. That was New York’s experience: Before the ACA, it had strong regulations on insurers, but high premiums meant that only people with health problems bought insurance on the individual market (as opposed to getting it from their employers), and this in turn kept premiums high.
To make regulation work, you have to back it up with incentives for healthy people to sign up, including subsidies that help lower-income families afford insurance. In other words, if you really want to make essential care available for pre-existing conditions while continuing to rely on private insurance companies, you need a system that looks a lot like … Obamacare. Indeed, New York premiums dropped in half when the ACA went into effect.
Hence the Hypocrite’s oath. Republicans hate the idea of guaranteeing that all Americans receive essential health care, and they really, really hate the taxes on high incomes that help pay for Obamacare subsidies. And you can imagine an alternative political universe in which the GOP openly admitted its true goals, justifying them on the basis of economic freedom, or something.
But in this universe, Republicans have decided that they must conceal their intention of taking health care away from those who need it most. So they’re doing what Hawley is doing: resorting to a combination of sabotage and smoke screen. On one side, they’re hacking away at the edges of the Affordable Care Act in the hope that it will implode. On the other, they’re pretending to want the very things — like guaranteed coverage of pre-existing conditions — they’re trying to destroy.
By the way, this is why many Democrats are talking about Medicare for all. Obamacare was a market-friendly health insurance reform designed in part to mollify conservatives; their response was scorched-earth opposition, followed by a series of attempts to exploit public confusion about how the Affordable Care Act works and what it will take to sustain it. So there’s something to be said for a simpler system that would be harder to game politically.
For one has to admit that the GOP’s cynical strategy is working to some extent. True, polls show that Democrats hold a large edge over Republicans on the question of which party people trust more on health care. But that gap would surely be even bigger if more voters realized what the GOP is actually trying to do.
So let’s be clear about this: If you or anyone you care about suffers from a pre-existing medical condition, Republicans are trying to take away your insurance. If they claim otherwise, they’re lying.