“Give Me Liberty And Give You Death”: How The GOP Embraced Being The Party Of Death
As part of their long-standing war on the Affordable Care Act, conservatives have filed a lawsuit willfully misreading the statute to deny upward of 10 million people subsidies to purchase insurance. This denial of insurance will almost certainly lead to significant amounts of preventable death and suffering.
Michael Strain of the American Enterprise Institute doesn’t deny any of this. Instead, he argues that some suffering and death may well be a price worth paying:
In a world of scarce resources, a slightly higher mortality rate is an acceptable price to pay for certain goals — including more cash for other programs, such as those that help the poor; less government coercion and more individual liberty; more health-care choice for consumers, allowing them to find plans that better fit their needs; more money for taxpayers to spend themselves; and less federal health-care spending. This opinion is not immoral. Such choices are inevitable. They are made all the time. [The Washington Post]
At a high enough level of abstraction, what Strain is saying isn’t wrong. Not all public policy can function on the basis of keeping mortality rates to the lowest possible number. Some lifesaving treatments might help so few people and cost so much that they might not be worth it. Even major infrastructure projects entail some risk of injury or death on the part of workers, but few people would argue that any such risk is unacceptable.
But the fact that the costs of the ACA might theoretically exceed the benefits doesn’t get us very far. What benefits, exactly, would accrue if millions of people were denied medical coverage because the ACA is seriously damaged or destroyed? It’s here that Strain’s argument falls apart.
One potential line against the ACA is the radical libertarian one, holding that any effort by the government to provide health care to the non-affluent represents an unacceptable level of state coercion. The problem here is that the “freedom” to die of preventable illnesses and injuries is not one the vast majority of people value very highly. A Republican Party committed to these principles would be transformed into an electoral coalition that would make Barry Goldwater’s 52 electoral votes in 1964 look robust.
Since the people responsible for the anti-ACA effort know this perfectly well, the constitutional arguments against the ACA have the advantage of not logically requiring the Supreme Court to rule the entire modern regulatory state unconstitutional. The disadvantage is that they ask the court to deny many millions of people health coverage based on liberty interests that are ludicrously trivial.
The litigants challenging the constitutionality of the ACA do not contend that the federal government cannot regulate national health-care markets. Rather, their constitutional argument boils down to an assertion that the government has the authority to assess a tax to compel people to purchase health insurance, but not a penalty. It’s pretty hard to argue that the fate of liberty in America hinges on this formal limitation on federal power.
The more successful federalist argument launched against the Affordable Care Act is similarly unattractive. Chief Justice John Roberts’ inept rewriting of the ACA’s Medicaid expansion allowed states to opt out. Republican-controlled states have eagerly rejected the large amounts of federal money on offer to insure more poor residents, something that is likely to result in the unnecessary deaths of more than 5,000 people a year.
I don’t think this particular protection of state autonomy is worth that many lives (or, indeed, a single life). But here’s the kicker: The Supreme Court’s decision does not even meaningfully protect state sovereignty. Under the court’s theory, Congress could have enacted the ACA’s Medicaid expansion by repealing the pre-existing Medicaid entirely. This, apparently, would be completely constitutional. There may be things worth 5,000 lives a year; an incoherent legal argument that doesn’t even really protect states’ rights isn’t one of them.
Strain’s arguments have similar problems. To his credit, he’s not a libertarian radical who asserts that the federal government cannot play any role in expanding health-care coverage. Rather, “universal coverage should concern itself with the catastrophic expenses associated with serious medical events that will affect a minority of the population.” The affluent, or people with good jobs, can get real medical coverage; the non-affluent might get some protection for disasters, but would have to pay through the nose for common medical procedures. Whether or not one prefers this policy alternative — which I think is far worse — there’s not a lot of meaningful protection of “freedom” going on here. The number of lives worth sacrificing so that people can choose between a few more insurance alternatives — or between the “freedom” to pay for checkups for their children or their electric bill — strikes me as “zero.”
And, of course, even this is too generous to the Republican reformers. The ACA isn’t unpopular because it provides subsidies that are too generous or because the exchanges offer insurance that cover too many things. The Republican alternatives Strain discusses will all disappear should the ACA be destroyed, because the trade-offs involved will outrage many voters. The actual Republican alternative Strain thinks it’s worth killing a lot of people for is “nothing.”
But, hey, the next upper-class Republican tax cut could be even larger, and it’s not going to be elite Republicans who pay the price. As the writer Roy Edroso puts it, Strain’s argument can be summarized as “give me liberty and give you death.” I think we can see why Republicans would prefer for the Supreme Court to do their dirty work.
By: Scott Lemieux, The Week, January 29, 2015
“What Happens If The Dog Catches The Car?”: GOP Faces Health Care Challenge It’s Totally Unprepared For
We don’t yet know what the Supreme Court will do in the King v. Burwell case, but we have a fairly good sense what will happen if the Supreme Court sides with Republicans. In effect, there will be chaos that could do considerable harm to insurers, families, state budgets, the federal budget, hospitals, and low-income children.
It sounds melodramatic, but the fact remains that if the GOP prevails, more Americans will literally go bankrupt and/or die as a result of this ruling.
With this in mind, I couldn’t help but find some sardonic humor in the House Republicans’ request for information from the Obama administration yesterday.
Senior House Republicans are demanding that the Obama administration reveal its contingency plans in the event that the Supreme Court scraps Obamacare subsidies in three dozen states. […]
“Specifically, we are examining the extent to which the Department of Health and Human Services (HHS), and other relevant agencies of the federal government, are preparing for the possible consequences of the Supreme Court’s decision in the case of King v. Burwell,” wrote the lawmakers.
The fact that the GOP lawmakers didn’t appreciate the irony was itself unfortunate, but the simple truth is that the underlying question – what happens if the Supreme Court takes this stupid case seriously and guts the American health care system? – is one Republicans should be answering, not asking.
If we had a normal, functioning political system, represented by two mainstream governing parties, the solution would be incredibly simple. If the Supreme Court said the language in the Affordable Care Act needed clarification, lawmakers would simply approve more specific language before Americans felt adverse consequences. The legislative fix would be quite brief and the whole process could be wrapped up in an afternoon.
No one, in this scenario, would actually suffer.
But in 2015, Americans don’t have the benefits of a normal, functioning political system, represented by two mainstream governing parties. On the contrary, we have a dysfunctional Congress led by a radicalized, post-policy party that has no use for governing, and which welcomes adverse consequences no matter how many Americans suffer.
And the question for them is what they intend to do if, like the dog that catches the car, Republican justices on the Supreme Court rule their way in the King v. Burwell case. Sahil Kapur had a terrific report on this overnight.
Many Republicans would view it as a dream come true if the Supreme Court were to slash a centerpiece of Obamacare by the end of June. But that dream could fade into a nightmare as the spotlight turns to the Republican Congress to fix the mayhem that could ensue.
“It’s an opportunity that we’ve failed at for two decades. We’ve not been particularly close to being on the same page on this subject for two decades,” said a congressional Republican health policy aide who was granted anonymity to speak candidly. “So this idea – we’re ready to go? Actually no, we’re not.”
Republican leaders recognize the dilemma. In King v. Burwell, they roundly claim the court ought to invalidate insurance subsidies in some three-dozen states, and that Congress must be ready with a response once they do. But conversations with more than a dozen GOP lawmakers and aides indicate that the party is nowhere close to a solution. Outside health policy experts consulted by the Republicans are also at odds on how the party should respond.
Republicans could approve a simple legislative fix, but they don’t want to. Republicans could introduce their ACA alternative, but they don’t want to do that, either. They could encourage states to create their own exchange marketplaces, largely negating the crisis, but they don’t want to do that, either.
So what do GOP lawmakers want? They haven’t the foggiest idea.
Kapur talked to a GOP aide who works on health care policy on Capitol Hill who said, “Our guys feel like: King wins, game over, we win. No. In fact: King wins, they [the Obama administration and Democrats] hold a lot of high cards. And we hold what?”
Millions of families who would be screwed by Republican victory in this case will be eager to hear an answer to that question.
By: Steve Benen, The Madow Blog, January 29, 2015
“He’ll Have Some Explaining To Do”: Another Republican Governor Has Accepted The Medicaid Expansion—And He Might Run For President
Indiana Governor Mike Pence announced Tuesday morning that the Obama administration had approved the state’s plan for accepting the Medicaid expansion. Starting February 1, 350,000 low-income Indianans will be enrolled in Healthy Indiana, the state’s Medicaid program. With the 2016 presidential cycle now underway, political analysts immediately are judging how Pence’s move affects his presidential odds.
The early consensus is that, if indeed Pence decides to run, this decision would cause him trouble in the GOP primary. But the issue poses a dilemma for the Republican Party more broadly, especially its hopes of recapturing the White House. As we saw during the midterms, the Medicaid expansion pits moderate Republicans versus conservatives, governors versus state legislators—and potentially undermines the party’s newfound interest in helping the poor and reducing inequality.
It’s up to governors to decide whether their state accepts the Medicaid expansion, and it’s hard to pass up. The federal government is offering states money to expand Medicaid so that people earning up to 138 percent of the federal poverty line are eligible for the program. The federal government covers all of the costs from 2014 through 2016 and then that coverage amount phases down slowly to 90 percent by 2022. Governors also face aggressive lobbying from the hospital industry, which is eager to accept the billions of dollars that the federal government transfers to states that expand Medicaid. As a result, 10 states with Republican governors have accepted the expansion over the past few years, and two more, in Tennessee and Wyoming, are considering it.
But some Republican governors have toed the party line, including two likely 2016 candidates: Wisconsin Governor Scott Walker and former Texas Governor Rick Perry both rejected the expansion. Medicaid, after all, is part of Obamacare, which must be “repealed and replaced.” That’s one reason why most potential Republican candidates—especially those in Congress, like senators Ted Cruz, Rand Paul, and Marco Rubio—are opposed to the expansion.
This makes for an interesting rift in the Republican primary.
If Pence runs for president, he’ll have some explaining to do. He would likely argue that he pushed Medicaid in a much more conservative direction through a waiver from the federal government that allows Indiana to require enrollees to contribute a monthly premium to a health savings account, a typical conservative health care idea. He would also likely appeal to his evangelical base by saying that Medicaid expansion is the compassionate thing to do. But he wouldn’t be alone in defending his decision: New Jersey Governor Chris Christie accepted the expansion, too. Not known to sidestep an issue or stay on the defensive, Christie could attack the other governors for not taking advantage of the program and hurting their poor constituents, and he might accuse Cruz et al of not understanding how governing works.
The general election is a different story altogether, which brings us to the GOP’s desire to appeal to lower-class voters.
Over the past few weeks, Republicans have begun emphasizing income inequality and stagnant wages. These are important issues, but the GOP’s economic platform still consists largely of deregulation, spending cuts, and lower taxes. That won’t appeal to the poor, particularly compared to the Democratic proposals of free community college and middle-class tax breaks.
That’s where the Medicaid expansion comes in. Denouncing it as Obamacare may work with the Republican primary electorate, but it won’t work in the general election. We saw as much in the midterms, when new Senate Majority Leader Mitch McConnell twisted himself into knots balancing his commitment to repealing Obamacare and promising not to alter the state’s health care exchange and expanded Medicaid program (both of which, of course, were the result of Obamacare). Granted, McConnell won reelection easily, but it does show how the expansion can be a political liability for Republican candidates.
If Christie or Pence emerge from the crowded field, it won’t be a problem. They can tout the expansion as evidence of their committment to fighting inequality. But the opposite is true for the rest of the field. For them, the expansion will be an even bigger liability if income inequality isn’t just Republicans’ flavor of the month, but a major part of their 2016 platform.
By: Danny Vinik, The New Republic, January 27, 2015
“Even If It Worked, I Would Oppose It”: Republicans Too Often Prioritize Partisan And Ideological Goals Over Practical Ones
As hard as it may be to perceive right-wing neurosurgeon Ben Carson as a credible presidential candidate, he received a very warm welcome at Steve King’s “Iowa Freedom Summit” over the weekend, and Carson arguably delivered one of the more polished presentations of the gathering.
But on the substance of Carson’s remarks, one thing jumped out at me.
On the Affordable Care Act – which Carson has on several occasions compared to slavery – the famous former surgeon said he opposed any government intrusion in health care. “Even if it worked, I would oppose it,” Carson said of Obamacare. “It doesn’t.”
“I don’t believe in taking the most important thing a person has, which is their health and their health care, and putting it in the hands of the government,” he later added….
For a brief argument in a speech, there’s quite a bit to this. We know, for example, that Carson’s mistaken when he says the Affordable Care Act isn’t working; the evidence to the contrary is simply overwhelming. We also know that when it comes to his preferred model, Carson used to believe largely the opposite of what he’s arguing now.
What’s more, when Carson argues that government shouldn’t have a hand in matters related to health care, it would seem to suggest the Republican candidate is against the VA health care system for active-duty and retired military personnel, Medicare, and Medicaid. That’s not too surprising – a guy who draws a parallel between modern American life and Nazis isn’t going to be a moderate – but it’s a pretty extreme position for even today’s GOP.
But the true gem is, in reference to the ACA, “Even if it worked, I would oppose it.”
Regular readers know that I’ve referenced the Republicans’ “post-policy” problem on several occasions, and Carson’s eight-word line seems to summarize the larger issue nicely. While Democrats focus heavily on policy outcomes and the efficacy of policy proposals – as one might expect from a governing party – Republicans too often prioritize partisan and ideological goals over practical ones.
Whether or not tax cuts work, for example, isn’t especially important. Whether the evidence supports climate change doesn’t matter, either. Pick the issue – national security, education, immigration, et al – and for much of today’s GOP, empiricism and efficacy just isn’t that important. What matters instead is an ideological drive to shrink government, regardless of policy outcomes.
I rather doubt Carson intended his comments to be so revealing, but the fact that he’d oppose a Democratic health care reform package built on a Republican model, regardless of whether or not it works, says a great deal.
What’s the basis for a serious policy debate when one side of the argument doesn’t care if policies are effective or not?
By: Steve Benen, The Maddow Blog, January 26, 2015
“Hint: Sarah Palin Has Lost Her Mind”: GOP Summit—The Good, The Bad And The Absolutely Crazy
You’re going to read a lot of analysis of this weekend’s Freedom Summit as the unofficial beginning of the Iowa caucus.
Whether that’s true depends entirely on how many of those who attended are still standing one long year from now—and how many of those who didn’t attend (Jeb Bush, Rand Paul) have campaigns that are still alive and well.
The event does serve as a gauge for a candidate’s willingness to pander, and it is the beginning of serious media scrutiny for all the candidates as 2016 candidates, not as quaint spectacles (Donald Trump, Ted Cruz) or interesting anomalies (Ben Carson, Carly Fiorina)…. or familiar former presidential candidates, who made up a non-shocking majority of the featured speakers (Rick Perry, Rick Santorum, Newt Gingrich, Sarah Palin).
What did we learn?
Palin is past her sell-by date.
It’s the unofficial policy of many serious political reporters (myself included) to not cover Palin speeches. So it’s entirely possible I missed a key stretch of her decline that would help make sense of, or have prepared me for, the word-salad-with-a-cup-of-moose-stew that she presented.
Sample passage: “Things must change for our government! It isn’t too big to fail, it’s too big to succeed! It’s too big to succeed, so we can afford no retreads or nothing will change, with the same people and same policies that got us into the status quo! Another Latin word, status quo, and it stands for, ‘Man, the middle class and everyday Americans are really gettin’ taken for a ride.’”
The speech (perhaps a generous description) went on 15 minutes past the 20 minutes allotted other speakers. And even as she ended it, one sensed less a crescendo than the specter of a gong, a hook to pull her off, or—a sincere thought I had—an ambulance to take her… somewhere.
No one else embarrassed themselves out of the race.
The event was organized by immigration hawk Rep. Steve “Cantaloupes” King (with the help of Citizens United) and many pundits fretted (or eagerly anticipated) 47-percent-style gaffes in the service of speakers trying to out-xenophobe each other. I may have missed something, but the anti-immigration rhetoric stayed on the “self-deport” side of offensive. Santorum did some under-the-breath dog whistling in reference to legal immigration, positing that the U.S. is home to more non-native citizens than ever before. He contrasted those non-native-born workers to, ahem, “American workers.” As far as I know, if you work in America, you are an “American worker.” Unless Santorum is thinking of something else.
The soft bigotry of low expectation works!
Scott Walker continues to clear the “not Tim Pawlenty” bar, but no one seems to realize how weak of a standard that is. National journalists cooed over Walker’s relatively energetic speech, apparently forgetting they were comparing it to other Walker speeches. In a similar vein, Chris Christie did not intentionally piss anyone off or bully the audience. Christie gave what seemed a lot like a national-audience speech—probably the only speaker that played it so safe.
Sen. Mike Lee gave some sensible, serious suggestions.
I may be engaging in more expectation management, but I was pleasantly surprised by Lee’s earnest and non-applause-line-ridden speech. He beseeched the audience to look for a candidate that was “positive, principled, and proven”—all while explicitly taking himself out of the running. In what could have been a direct jab at his fellow guests, he quipped, “The principled candidate is not necessarily the guy who yells ‘Freedom!’ the loudest.” He could have been quoting Elizabeth Warren when he softened typical GOP bootstrap rhetoric: “Freedom doesn’t mean ‘You’re all on your own,’” he said, “It means, ‘We’re all in it together.’” Elizabeth Warren would approve.
The GOP is going to need to figure out how to run against someone who is not Obama.
Even Lee, who gave what might be the most forward-looking speech, hung many of his arguments on the framework of undoing what Obama has done. Every other speaker followed suit, and some of the night’s biggest applause lines had to do with the same “fake scandals” that already proved insufficiently interesting to the American people: Benghazi, with a dash of IRS. They speak of repealing Obamacare with the zest of people who think of the House’s own fifty-plus attempts as mere warm-ups. Even their foreign policy script has Obama and the specter of American decline as its primary villains—foes that have defeated them twice before.
By: Ana Marie Cox, The Daily Beast, January 25, 2015
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