Dishonesty And Healthcare

As the blizzard of political television ads becomes ever more annoying–and less informative–one thing about them has become very interesting. Even Republicans who have previously made it clear that they don’t want government involved in healthcare are airing advertisements touting support for Medicare and willingness to protect pre-existing conditions.

I’ve been particularly struck by the U Turn in Indiana’s Fifth District, where a radically-reactionary, pro-Trump Republican noted for opposing “socialism” (which she has defined to include pretty much anything done by government) has begun running commercials supportive of Medicare and coverage of pre-existing conditions. Evidently, her polling has overcome her previously expressed belief that government should have no role in health care.

She’s not alone.

When the Affordable Care Act (aka Obamacare) passed, several Republicans went on record with their concern that its trajectory would mirror that of Medicare and Medicaid: despite initial resistance, the public would come to expect/demand/approve of the program. Survey research has confirmed those fears, which is why GOP officeholders continue to pretend that they will protect access to healthcare at the same time as they are feverishly working to eviscerate it.

The Brookings Institution recently published a report detailing six ways Trump has sabotaged the ACA.The report began by stressing that its authors did not use the term “sabotage” lightly.

For analytic purposes, the term “sabotage,” should not be used lightly. Presidents upon taking office typically have priorities that trigger executive actions strengthening some programs while weakening others. The losing programs often face resource reductions, pressure to deemphasize certain goals, directives to alter their administrative approaches, and other measures that can undermine their effectiveness. In doing so, a president often pays lip service to the program, claiming it has been “modernized” or otherwise improved. In contrast, Webster’s defines “sabotage” as efforts to foster “destruction and obstruction” and to “cause the failure of something.” In the context of the administrative presidency, it reflects a commitment to program emasculation and termination through executive action. As such, it sharply departs from the constitutional requirement that the president “take care that the laws be faithfully executed.”

There were six actions detailed in the report.

1) The administration dramatically reduced outreach about, and opportunities for enrollment in, the ACA’s insurance exchanges. The administration sharply reduced support for advertising and exchange navigators and reduced the annual enrollment period to about half the number of days. 

2) Together with Congressional Republicans, it reneged on commitments to private insurance companies. Those insurers had been offered various subsidies that reduced the risks of participating in the exchanges. The GOP failed to honor those commitments.

3) The administration has constructed what the report calls “off-ramps to cheaper, lower-quality insurance.” One goal of the ACA was to improve the quality of health insurance by specifying essential benefits, guaranteeing coverage of those with preexisting conditions at reasonable rates, and prohibiting insurers from imposing certain spending caps. The Trump administration expanded access to coverage that was cheaper because it didn’t meet these standards and that siphoned off the healthier enrollees whose participation is needed to make the ACA work.

4) It allowed–indeed, promoted– a variety of state waivers that decreased ACA enrollments and undermined its regulatory structure.

5) It discouraged legal “aliens” from enrolling in Medicaid. In a particularly evil move, Homeland Security promulgated a “public charge” rule authorizing officials to treat Medicaid enrollment as a negative factor when reviewing the requests of legal non-citizens to extend their stays or change their status (e.g., from temporary to permanent resident).

6) And then there’s the existential threat. The Trump Administration brought the lawsuit that is now pending at the Supreme Court, attacking the constitutionality of the ACA. If that suit is successful–despite a legal argument that has been widely characterized as ridiculous, despite its endorsement by an appellate court composed of Trump-appointed judges– millions of Americans will lose access to health care.

As a student once reminded me, the United States doesn’t have a health-care system; we have a health-care industry. As a result, millions of Americans remain underinsured or completely uninsured, other millions are bankrupted each year by medical costs, and our health outcomes are among the absolute worst in the developed world. 

Deeply dishonest political rhetoric to the contrary, the current Republican Party wants to keep it that way.

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Blue In Red Indiana

This will be a crassly political post. (As if most aren’t…)

“Blue No Matter Who” is an easy slogan, and I endorse it for reasons I have repeatedly recited. That slogan does, however, have one unfortunate implication: “no matter who” makes it sound as if we should vote for the Democratic candidate no matter how unsatisfactory we find that candidate. I actually endorse that sentiment, too; however, in the vast majority of contests I follow, the Democratic candidate is genuinely admirable–certainly not a “best we can get under the circumstances” choice–and infinitely superior to his/her Republican opponent.

Take Indiana’s Fifth Congressional District–a district that abuts the 7th, where I live (and am blissfully happy with my own Congressman, Andre Carson.) The 5th is an open district, thanks to the retirement of the incumbent and major disappointment, Susan Brooks. It has been reliably Republican pretty much forever, but it is populated with educated suburbanites and has been showing some purplish–even bluish–tendencies. Brooks ran as a moderate and voted like an alt-Right puppet (98% support for Trump) and her constituents had noticed.

The Republican primary for the open seat was an ugly free-for-all, with several candidates contending to see who could most strenuously support Donald Trump. The victor–one Victoria Spartz–was notable for her “pro life” and “pro gun” emphases (a bit of cognitive dissonance there?) and for putting a lot of her own money into the campaign. Her TV spots and website are notable for their lack of specificity and candor. (She’s a mother and she’s “not a career politician.”)

Her website is, however, unintentionally revealing.

Spartz lists each of her “issues” in two to three sentence paragraphs, none of which identify specific bills or initiatives she would support. She’s “for” the Constitution, but mentions only the 2d Amendment. She wants to balance the budget (!) by cutting spending on welfare (no mention of corporate welfare, just the social safety net variety.) She’s an immigrant, but wants to “build the wall.” She wants to spend whatever it takes to keep the military strong, and she favors “consumer choice” in healthcare (code for “if you can afford it you can have it.”) The only thing she says about education is that she favors “flexibility” for the states (code for vouchers), and–surprise!–she wants to further limit the regulation of business.

There is no mention of either COVID or the environment. I guess those aren’t problems.

If you feel I am being unfair, please visit her site and double-check.

Now, in the interests of transparency, I will admit that I worked a bit with Victoria’s Democratic opponent, Christina Hale, when she was in the Indiana Statehouse, and I was impressed with her. She was a serious legislator, and absolutely passionate about protecting children. Her website is here.

Not only does Christina address COVID and the Environment, along with other issues, but you will immediately notice that she doesn’t just identify issues with generalities and ambiguous language. Under “healthcare” she lists–and explains– her support for a public option, her opposition to attempts to allow insurance companies to deny coverage to those with pre-existing conditions, and her support for requiring drug companies to negotiate for lower drug prices. Under “environment,” she underscores her support for clean energy infrastructure and technology, the creation of jobs to reduce carbon emissions, and improving Indiana’s water infrastructure.

There’s a lot more, but my point is that people in the 5th District who vote for Christina will do so knowing what sort of policy agenda she will pursue. (In all fairness, it’s pretty clear what sort of policy agenda Victoria will pursue, too–but that clarity sure isn’t a result of forthright labeling.) When I went to VoteSmart, I saw that during her single term in the legislature, Spartz voted against regulations for pesticides, and for allowing firearms on school grounds, among other interesting items…

This is one Congressional race among hundreds, and I’m not prepared to assume that the differences are this stark in every single one of them. Every political party has its losers (to appropriate one of Trump’s favorite terms), and I’m sure there are jerks out there with a D after their names. But the GOP has devolved into something approximating a  scary religious cult, and you can rest assured that virtually all Republican Senate and Congressional candidates are ideologues cut from the same cloth as Spartz– impervious to science and fact, suspicious of the government they want to join, and dismissive of climate change, COVID and people who can’t afford health insurance.

That’s why we need to vote Blue up and down the ballot, and in numbers sufficient to make the outcomes obvious on Election Night.

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