Med­i­caid ‘blood money’

Los Angeles Times - - OPIN­ION - JONAH GOLD­BERG jgold­berg@la­timescolum­

Even by Wash­ing­ton stan­dards, this is a par­tic­u­larly dumb po­lit­i­cal mo­ment. Ear­lier this month a po­lit­i­cal zealot went to a baseball prac­tice with the in­ten­tion of killing as many Repub­li­can con­gress­men as he could. As often hap­pens after such horrible events, var­i­ous politi­cians and me­dia fig­ures sug­gested that we should tone down the rhetoric and not paint ev­ery­thing in apoc­a­lyp­tic terms, cast­ing Repub­li­cans or Democrats as vil­lains with trai­tor­ous or evil in­tent in their hearts. Words have con­se­quences, they sagely said into the TV cam­eras.

Two weeks later, many of the very same peo­ple are de­scrib­ing the Repub­li­cans as mur­der­ers for propos­ing changes to Med­i­caid. “For­get death pan­els,” Hil­lary Clin­ton tweeted. “If Repub­li­cans pass this bill, they’re the death party.” Sen. El­iz­a­beth War­ren said the tax cuts in the bill amount to “blood money.” These com­ments are re­strained com­pared with those of some ac­tivists, like the left-wing film­maker Josh Fox who pro­claimed, “Mitch McCon­nell is a ter­ror­ist. [Don­ald Trump] is a ter­ror­ist. This bill ter­ror­izes peo­ple and sen­tences poor peo­ple to death.”

I think the flawed Repub­li­can healthcare plan is very much open to crit­i­cism, from the left and the right, but this rhetoric is re­pug­nant and dan­ger­ously stupid. Both the House and Se­nate ver­sions would im­pose a per capita cap on Med­i­caid fund­ing (or states can take a block grant), leav­ing it up to the states how best to ad­min­is­ter the pro­gram. And they would re­duce Med­i­caid spend­ing by the fed­eral govern­ment com­pared with cur­rent trends. The hope is that this pres­sure and flex­i­bil­ity would en­cour­age states to im­pose ef­fi­cien­cies to the bloated, bu­reau­cratic and bud­get-bust­ing pro­gram (to­tal Med­i­caid spend­ing last year was $533 bil­lion). It also has pro­vi­sions for tax cred­its and other re­forms for those who would be knocked off the Med­i­caid rolls, so they could ob­tain in­sur­ance on the pri­vate mar­ket.

Would peo­ple die? De­spite a host of very spe­cific num­bers from peo­ple like Sen. Bernie San­ders, no one re­ally knows. The data is at best mixed about whether Med­i­caid im­proves mor­tal­ity rates or even health over­all (though it’s clear some peo­ple, like preg­nant women, do ben­e­fit). Still, it might be true that some peo­ple would die ear­lier than they would have if we kept the sta­tus quo.

This is not the damn­ing con­ces­sion it may ap­pear to be. Politi­cians like to de­fend some law on the grounds that “if it saves just one life, it’s worth it.” But by that logic we should make the speed limit 5 MPH. That would surely save lives. Are you a mur­derer if you op­pose such a move?

There’s no ev­i­dence Oba­macare saved lives ei­ther. Some peo­ple lost health in­sur­ance be­cause of it. Heck, life ex­pectancy went down for the first time in decades after Oba­macare went into ef­fect. Is Obama a mur­derer? Of course not.

Put aside the hypocrisy and danger im­plicit in say­ing elected lead­ers are mur­der­ers if they dare pare back the wel­fare state. Taken lit­er­ally, such rhetoric means that en­ti­tle­ment re­form is im­pos­si­ble, be­cause any at­tempt to get our fis­cal house in order would re­quire some peo­ple, some­where, to lose some ben­e­fits.

Now, ex­on­er­at­ing the Repub­li­cans from the charge of de­lib­er­ate ter­ror­ism is faint praise, in­deed. Even Pres­i­dent Trump called the House ver­sion “mean” — de­spite cel­e­brat­ing its pas­sage with an up­scale keg­ger in the Rose Gar­den

The truth is that healthcare “re­form” has been a story of bi­par­ti­san mal­prac­tice. Oba­macare was lied into pas­sage (“you can keep your doc­tor,” “you can keep your plan” etc.) on a strict party-line vote. The Repub­li­cans spent the bet­ter part of a decade vow­ing to tear it all down. When the dogs caught the car, they had no idea what to do next. They’ve half­heart­edly opted to keep the struc­ture in place but carve off a chunk of money to fund tax cuts (but not for the work­ing-class peo­ple most harmed by their bill).

Trump’s ir­re­spon­si­ble prom­ise to leave en­ti­tle­ments alone has been me­mory-holed by Repub­li­cans be­cause they want to claim they re­pealed Oba­macare to give the pres­i­dent a “win.” The Democrats, like­wise, are more con­cerned about keep­ing Obama’s healthcare “win” on the books for the sake of his legacy, than fix­ing Oba­macare’s dys­func­tion. And if that re­quires call­ing Repub­li­cans mur­der­ers, so be it. It’s just words.

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