Does Anyone Really Know What ‘Medicare for All’ Means?
by Elizabeth Rosenthal and Shefali Luthra - NYT - October 19, 2018
After decades in the political wilderness, “Medicare for all” and single-payer health care are suddenly popular. The words appear in political advertisements and are cheered at campaign rallies — even in deep-red states. They are promoted by a growing number of high-profile Democratic candidates, like Alexandria Ocasio-Cortez in New York and Representative Beto O’Rourke in Texas.
Republicans are concerned enough that this month President Trump wrote a scathing op-ed essay that portrayed Medicare for all as a threat to older people and to American freedom.
It is not that. But what exactly these proposals mean to many of the people who say they support them remains unclear.
As a renegade candidate for the 2016 Democratic nomination for president, Bernie Sanders opened the door to such drastic reform. Now, with Republicans showing little aptitude for fixing an expensive, dysfunctional health system, more voters, doctors and politicians are walking through it.
More than 120 members of Congress have signed on as co-sponsors of a bill called the Expanded and Improved Medicare for All Act, up from 62 in 2016. And at least 70 have joined Capitol Hill’s new Medicare for All Caucus.
But some worry the terms “Medicare for all” and “single payer” are at risk of becoming empty campaign slogans. In precise terms, Medicare for all means bringing all Americans under the government’s insurance program now reserved for people 65 and over, while single-payer health care would have the government pay everyone’s medical bills. But few are speaking precisely.
Celinda Lake, a Democratic pollster, said, “People read into ‘Medicare for all’ what they want to read into it.”
For every candidate with a clear proposal in mind, another uses the phrases as a proxy for voter frustration. The risk, some critics say, is that “Medicare for all” could become a Democratic version of the Republican “repeal and replace” slogan — a vote-getter that does not translate to political action because there is neither agreement about what it means nor a viable plan.
“If you’re on the left, you have to have something on health care to say at town halls,” said David Blumenthal, president of the Commonwealth Fund. “So you say this and move on. That’s part of the motivation.”
Dr. Carol Paris, the president of Physicians for a National Health Program, an advocacy group, said she has fielded a number of calls from candidates asking for tutorials on Medicare for all.
“I’m heartened, but not persuaded” that all the high-profile talk will result in any action, she said. She worries about what she called “faux ‘Medicare for all’ plans” that don’t live up to the mantra.
Polling highlights health care as a top voter concern, and pressure is building for politicians to take meaningful action that could redress the pain caused by personal health care costs that continue to rise faster than inflation.
Maybe that action would be negotiating lower drug prices or fixing flaws in the insurance system that allow for surprise medical bills and high out-of-pocket costs. But more and more voters seem to think the country must go further.
In polling this year, 51 percent of Americans and 74 percent of Democrats said they support a single-payer plan. Surveys suggest growing enthusiasm among doctors, too, with more than half in favor.
Yet experts suggest voter support may not withstand warnings of tax increases or changes to employer-sponsored insurance. A 2017 poll from the Kaiser Family Foundation found that support for Medicare for all dropped when respondents were told that their taxes might increase or that the government might get “too much control over health care” — a common Republican talking point.
Despite initial enthusiasm, Vermont’s governor let a state single-payer plan die in part because it was calculated that it would require an 11.5 percent payroll tax on businesses and a state income tax of up to 9.5 percent.
The broader goal — affordable, universal health care — could be achieved by a range of strategies. For models, we can look to nations that have generally achieved better health outcomes, for less money, than the United States.
Canada and Britain come particularly close to true single-payer. Their governments pay medical bills with money raised through taxes and have monopolistic negotiating power over prices. But after that, the systems differ.
In Canada, which is Mr. Sanders’s inspiration, the government provides health insurance for most medical needs, with no out-of-pocket costs. People can, and often do, buy a second, private plan for any unmet health needs, such as prescription drugs.
Britain goes a step farther. Its government owns hospitals and employs many specialists via the National Health Service. A small private system exists, catering mainly to wealthier people seeking faster access to elective procedures.
Other countries achieve universal health care (or nearly so), but without single-payer. France and Germany have kept an insurance industry intact but heavily regulate health care, including by setting the prices for medical procedures and drugs, and requiring all citizens to purchase coverage.
These more incremental options have not captured the American imagination to the same extent as Medicare for all. But adopting such a system would require the biggest shift, with significant implications for taxes, patient choice, doctors’ salaries and hospital revenue.
Enthusiastic politicians sometimes gloss over those consequences. For example, Liz Watson, a Democrat running in Indiana’s Ninth Congressional District, suggested the impact on doctors’ income was not much of a concern, because they would see a “huge recovery” on expenses since they would no longer need to navigate the bureaucracy of insurance paperwork. But analysts across the board agree single-payer would cut revenue for doctors — many say by about 12 percent on average.
And many voters seem confused by the fundamentals. In polling by the Kaiser Family Foundation, about half of Americans said they believed they would be able to keep their current insurance under a single-payer plan, which is not the case.
Optimism without specifics carries risk, as Barack Obama learned after promising that people wouldn’t lose their doctors under the Affordable Care Act. That promise haunted the Obama administration — it was singled out as PolitiFact’s “Lie of the Year” in 2013 and is still mocked by members of the Trump White House.
There’s also the thorny issue of how Medicare for all would affect the thousands of jobs at private insurers. “We have an insurance industry in Omaha, and people say, ‘I worry about those jobs,’” said Kara Eastman, a Democrat running on Medicare for all in Nebraska’s Second District. She suggested people could be retrained, saying there would have to be “repurposing of positions.”
Critics of Medicare for all, on the other hand, tend to exaggerate the costs of single-payer: “Denmark’s top tax bracket is nearly 60 percent!” (True, although that’s largely not because of health care.) “Doctors’ incomes will drop 40 percent!” (True, specialists in private practice would probably see pay cuts, but primary care doctors could well see an increase.)
Canadians generally pay higher taxes than Americans do — specifically a goods and services tax, and higher taxes on the wealthy. In Germany, working people pay 7.5 percent of income as a contribution toward comprehensive insurance.
But many Americans pay far more than that when you count premiums, deductibles, co-payments and out-of-network charges. Estimates of the tax increases required to support a Medicare-for-all or single-payer system are all over the map, depending on how the plan is structured, the prices paid to providers and drug makers, and the generosity of benefits.
As a politician famously noted, “Nobody knew health care could be so complicated.”
Some candidates do have clear proposals in mind. Ms. Ocasio-Cortez, for example, running for the House from New York’s 14th District, is firm: a single, government-run health plan that covers everyone with no co-payments or deductibles and perhaps allows Americans to buy supplemental private coverage. It’s the Canadian approach, textbook single-payer.
But many who back Medicare for all are vague or open to incremental approaches, like a “public option” that maintains the current insurance structure while allowing people to buy into Medicare.
Mr. O’Rourke casts Medicare for all as a starting point for discussion. But he said that what matters most is “high-quality, guaranteed universal health care.” Getting there, he added, “will inevitably require some compromise” — like a public option. Notably, he has not signed on as a co-sponsor of the Medicare for all bill because that plan does not allow for-profit providers to participate.
Jared Golden, a Democratic House candidate from Maine’s Second District, says in his campaign materials that he favors “something like Medicare for all,” but he clarified that at least initially, he would argue to lower the Medicare eligibility age, a change that wonks often call “Medicare for more.”
And the Wisconsin Democrat Randy Bryce, who is running to replace Speaker Paul Ryan in the House, said he would support a public option or lowering the eligibility age for Medicare. “I don’t want to say that there’s only one way to go about it,” Mr. Bryce said.
But many other candidates — both for Congress and for governorships — who are talking “Medicare for all” on the campaign trail either did not acknowledge or declined multiple requests to be interviewed on the subject. They include Andrew Gillum, who is running for governor in Florida; Gina Ortiz Jones of the Texas 23rd; the California candidate for governor Gavin Newsom; the Massachusetts Seventh candidate Ayanna Pressley; and the Pennsylvania First District candidate Scott Wallace.
Ms. Lake, the pollster, suggested that policy details simply aren’t as relevant in a midterm year and that for now we shouldn’t expect a candidate’s support for Medicare for all to be anything more than a way to signal his or her values. But she suggested that will change in the run-up to 2020, adding, “When we head into the presidential election, people will probably be pickier and want more details.”
That gives politicians and voters a few years to decide what they mean and what they want when they say they support Medicare for all or single-payer health care. For now, it’s hard to read too much into promises.
Dr. Paris, who lives in Nashville, said she was surprised and excited to hear that her representative, Jim Cooper, a Blue Dog Democrat, had signed up as a co-sponsor of the Medicare for all bill.
“I told him, ‘I’m dumbfounded,’” she recalled.
His answer? “Don’t get too excited.”
1,495 Americans Describe the Financial Reality of Being Really Sick
‘Do you pay the hospital bill or do you pay the utility bill?’ Don’t count on your health insurance for serious illnesses, a new survey warns.
by Margot Sanger-Katz - NYT - October 17, 2018
The whole point of health insurance is protection from financial ruin in case of catastrophic, costly health problems. But a recent survey of people facing such problems shows that it often fails in that basic function.
The survey, of some of the country’s most seriously ill people, found that even with health insurance, more than a third of the respondents had spent all or most of their savings while sick. They are often faced with deductibles and co-payments; treatments their insurance won’t cover; and financial challenges — like lost work — that health insurance alone can’t address.
The New York Times, the Commonwealth Fund and the Harvard T.H. Chan School of Public Health used the survey to examine the sliver of the American population who use the health care system the most. To be included in the results, a respondent had to have been hospitalized twice in the last two years, and to have seen at least three doctors. In some cases, when patients had died or were too ill to answer questions, relatives who had taken care of them participated in their place.
Their experiences may serve as an early warning system for problems that all of us may face: Because the estimated 40 million people in this population visit doctors, hospitals, nursing homes and pharmacies the most, they are the likeliest to see the weak points in the health care system.
One of these is financial insecurity. Among people with health insurance, more than 20 percent had trouble paying for basic necessities. More than a quarter had bills in collection, and 13 percent had borrowed money as a result of their illness.
Health insurance provided some protection against such outcomes — those in the survey who were uninsured were even more likely to face mounting bills and debts — but the insurance was generally not enough. The intensity of care increased the number of co-payments those surveyed faced, and it increased the chances of receiving the kind of treatment that their insurance denied. And they were most likely to get stuck paying insurance deductibles, which have been steadily rising over the last two decades.
Thirty-one percent of people in the survey said they were unsure what their health insurance would pay for. Forty-two percent said they’d received a hospital bill that their insurance had not fully covered. Twenty-six percent said a treatment their doctor recommended was denied by their insurance.
“What’s staggering here is there’s no way people could know what they would be in for,” said Robert Blendon, a professor at Harvard who helped devise the survey. “They don’t know what their insurance covers. The consequences for people are quite extraordinary.”
Tristan Berger, 47, who was born with spina bifida, has had 16 reconstructive operations on his feet since age 13. A decade ago, he found himself too disabled to continue working, after a series of falls. His wife has health insurance through her job at Walmart, and he has some income from the Social Security disability program, but nearly all of it goes to his medical bills.
Mr. Berger, who lives in Tucson, said he spent $12,000 last year on care not covered by his health insurance. When we spoke recently, he had already spent a similar amount this year, after his latest orthopedic operation.
“You sit there every month trying to figure out what bill to pay: Do you pay the hospital bill or do you pay the utility bill?” he said. “There’s no savings. We’re part of that percentage of America that are one paycheck from being destitute.”
Sarah Miller, an assistant professor at the University of Michigan Ross School of Business, has studied how health insurance protects Americans from financial risk. The evidence is strong that coverage, particularly Medicaid, makes a difference. But she said it could still prove insufficient for people with complex needs.
“You’re kind of at a disadvantage as a consumer going against these big complicated systems that don’t always have your best interest at heart,” she said. “And I think that’s why there’s so much financial burden, even among people with private insurance.”
Health insurance, of course, provides little help for people who have to cut back on work because of their own illness or that of a family member. Mr. Berger had a steady income and good benefits when he worked as the housekeeping director for a retirement community. But once he became too ill to keep working, his income fell. Fifty-three percent of people in the survey said their work had been interrupted by illness, causing financial difficulties that can compound the burden of medical bills.
Research suggests that such work interruptions can have long-term consequences for people who become ill or are injured. A recent paper in the American Economic Review found that, for middle-aged Americans, going to the hospital could mean an average income reduction of 20 percent that persists for six years or more.
Illness can also put financial strain on family members who are not sick themselves. Dana Lewis thought she had become an expert at navigating the health care system after caring for twin daughters born with cerebral palsy. But when her husband’s dementia worsened and he needed nursing home care, she encountered new logistical and financial obstacles.
To qualify him for Medicaid in Oklahoma, where they live, she was required to spend down her assets, including liquidating her 401(k) retirement savings. “Now I’m 60 years old, and I have zero retirement,” she said. The survey found that those taking care of ill relatives can often face such challenges. Twenty-three percent of those surveyed said friends or family members caring for the ill person ran into financial strain as a result of this responsibility, and 15 percent of caregivers had to quit or change their jobs.
Maria Elena Flores, 64, had been working as a home health aide for seniors when she had to give up her job in 2012 to provide the same care to her husband, who was recovering from triple bypass heart surgery. Since then, his health has declined. He developed vascular dementia and was acting erratically last year when he caused Ms. Flores to fall and injure her back.
Even with her expertise, she has struggled to find the right care for her husband near their home in San Ysidro, Calif. He was discharged from one nursing home because of his behavior, she said, and her local hospital was unable to help her find another place to care for him.
“Because he was a headache for them,” she said. She continues to care for him at home.
More than two-thirds of people in the survey said their doctors had never discussed the cost of their care. Medical providers generally don’t, particularly among the most acutely ill. But some clinicians have started talking more about such matters, noting that the financial stress of unpaid medical bills should be seen as another kind of side effect of certain treatments.
Khurram Nasir, an associate professor of medicine at Yale, has adopted a phrase from cancer research, “financial toxicity,” as he realized many of his cardiac patients were struggling to pay for care and making tough choices like skipping pills or cutting back on food.
“When I started realizing this, I took it upon myself as a responsibility to talk to my patients about these issues,” he said. “It was very hard for patients to bring this topic to our attention.”
The survey included landline and cellphone telephone interviews with 1,495 adults who either had a serious illness or were caring for someone who did. Interviews were conducted in English and Spanish. The results are nationally representative. The margin of error is plus or minus 3.2 percentage points for most questions.
Republicans Are Suddenly Running Ads on Pre-existing Conditions. But How Accurate Are They?
It’s a sign of the issue’s importance that several candidates in close races are feeling pressure to respond.
by Margot Sanger-Katz - NYT - October 16, 2018
For months, Democratic candidates have been running hard on health care, while Republicans have said little about it. In a sign of the issue’s potency, Republicans are now playing defense, releasing a wave of ads promising they will preserve protections for Americans with pre-existing health conditions.
The ads omit the fact that the protections were a central feature of the Affordable Care Act and that the Republican Party has worked unceasingly to repeal the law, through legislation and lawsuits.
Republicans in Congress have recently come forward with limited legislative proposals to ensure some pre-existing conditions protections if the health law is overturned. One, a House resolution, would have no force of law, even if adopted. The other would contain a significant loophole: Insurers would have to cover those with pre-existing illnesses, but would not have to cover care for those particular illnesses. (Neither is on track to become law.)
As with some Democratic advertisements, several ads by Republicans feature family members with health problems. Some directly respond to criticisms offered by a Democratic rival. Many cite votes for Republican bills that would have overhauled large portions of Obamacare last year — the very same votes that Democrats have been using as evidence that Republicans want to limit health coverage.
Protection of pre-existing conditions is popular, and surveys suggest that voters trust Democrats more than Republicans on health care. A few months ago, Republican candidates were happy to focus their messages elsewhere — on the economy, or immigration policy. They are now defending themselves on less friendly territory.
Here are a few of this new crop of G.O.P. ads and some context.who have brought a lawsuit challenging the constitutionality of the Affordable Care Act. If the suit succeeds, the entire law, including its guarantees of affordable coverage for Americans with prior illnesses, could be eradicated. (The Trump administration has argued in court that most of the law should stand, but its pre-existing conditions protections, alone, should be invalidated.) Ms. McCaskill has been using Mr. Hawley’s participation in the suit as a central line of attack in her campaign, and has highlighted her personal experience with breast cancer.
Mr. Hawley says he supports protections for those with pre-existing conditions, but it’s not clear whether the policies he supports would provide the same protections that people like his son currently enjoy. If his lawsuit invalidated the entire health care law, it would return the country to a time when people with prior illness sometimes couldn’t buy coverage at all. Republicans could pass a law restoring Obamacare’s consumer protections, but Mr. Hawley has not yet explicitly endorsed such a strategy.
In an interview this summer, Mr. Hawley said he supported unspecified policies to protect such customers and to allow young adults to remain on their parents’ health plans. “We can do those things apart from the structure of Obamacare,” he said, recommending a less stringent set of regulations on insurance benefits.
Last year’s Republican repeal bills provided some protections for people who remained insured without interruptions in coverage. But they would have permitted insurance companies in some states to avoid covering certain types of medical treatments or to charge higher prices to sicker customers who had let their coverage lapse.
The Republican candidate: Dana Rohrabacher is an incumbent congressman from California’s 48th District who has served in the House since 1989. He is being challenged by a lawyer and real estate businessman, Harley Rouda, in a very close race.
The ad: Mr. Rohrabacher stands beside his wife, while his daughter, Annika, sits on a swing. Mr. Rohrabacher explains why health care is “personal” for his family: “When my daughter Annika was 8 years old, she was afflicted with leukemia. It was devastating for my family, but she got through of it.” Photos of Annika in a hospital bed and a wheelchair are replaced with video footage of the Rohrabacher family walking along a beach (Mr. Rohrabacher wears a wet suit and carries a surfboard).
“That’s why I’m taking on both parties and fighting for those with pre-existing conditions,” he says, shaking a fist. After Mr. Rohrabacher says he endorses the ad, Annika adds: “And so do I.”
The strategy: Mr. Rohrabacher really does have a novel strategy to try to protect Americans with pre-existing conditions, one that is at odds with the dominant approaches of both political parties. His proposal, explained in an op-ed this summer, would allow commercial plans to avoid covering pre-existing illnesses, but allow affected patients to get Medicare coverage for those ailments alone. The ad casts Mr. Rohrabacher as a creative and nonpartisan lawmaker, with a personal interest in health care, rather than one who follows Republican leaders.
But when it came to more realistic choices for managing the health care system, Mr. Rohrabacher also voted for the American Health Care Act last year, a bill that would have upended large parts of Obamacare. The bill would have made large cuts to the Medicaid program, which covers many American children, and weakened protections for patients with prior illnesses in states that pursued waivers of Obamacare’s usual rules. His unusual proposal appears to tie his support for that bill with his commitment to Americans like his daughter. But his commitment is an imperfect match with his legislative record.
The Republican candidate: Dean Heller, a Republican Senator from Nevada, is in a close race for re-election against Jacky Rosen, a congresswoman from the state’s Third District.
The ad: To understand this advertisement, you almost need to have seen Ms. Rosen’s attack ad against Mr. Heller, which compares him to an inflatable tube man, spineless and floppy, as it describes his shifting positions on last year’s Obamacare repeal effort.
Mr. Heller’s ad shows the tube man waving on a screen beside a television camera and a director’s chair labeled ROSEN. “Jacky Rosen’s idea of fixing health care: a campaign commercial,” Mr. Heller says, as the camera zooms out. Mr. Heller criticizes Ms. Rosen for failing to advance health care legislation, saying: “I’m fighting to protect pre-existing conditions and increase funding for Nevadans who need it most. Jacky, I’ll stack my record up against yours any day.” The commercial closes with another shot of the tube man.
The strategy: Mr. Heller found himself in a tough spot when Republican repeal bills came to the Senate floor last year. Republican leadership really needed his vote to advance a bill, and he had promised as a candidate to repeal Obamacare. But Nevada’s governor opposed the legislation, saying it would hurt the state. First, Mr. Heller opposed the Senate bill. Ultimately, he voted for a more stripped-down planthat would have kept pre-existing condition protections while eliminating other key parts of Obamacare. (He also noted his support for a bill that would have replaced Obamacare’s insurance markets with a block grant program to states that would have allowed them to eliminate pre-existing conditions protections altogether.)
It is true that Mr. Heller has advanced more pieces of health legislation in the last Congress than his opponent. He was, after all, part of the Republican majority that controlled the legislative agenda. But neither of the health care bills Mr. Heller cites in his ad has become law, and it’s questionable whether their effects would match his claims in the ad. These are the same bills and votes that Ms. Rosen has cited as evidence that Mr. Heller would pare back health coverage. The reference to Ms. Rosen’s ad suggests it has been memorable enough to voters to merit a response.
The Republican candidate: Kevin Cramer, North Dakota’s congressman, is running to unseat a Democratic senator, Heidi Heitkamp.
The ad: There are cows. “Come on, Heidi, the word’s out,” the ad’s narrator says, citing news reports fact-checking aspects of Ms. Heitkamp’s ads that criticized Mr. Cramer’s health care record. “It’s a stampede,” the voice says, as cows trot across the screen, pursued by a cowboy with a lasso. (Side note: Is this a stampede?) The narrator explains that “Kevin Cramer voted for guaranteed coverage for pre-existing conditions.” Ms. Heitkamp’s health care advertisements, the narrator says, “don’t pass the smell test.” Then a cow moos.
The strategy: Like Mr. Heller, Mr. Cramer is trying to characterize his votes to repeal Obamacare as efforts to preserve protections for pre-existing conditions — and he is responding to Democratic ads highlighting the issue. That claim is a bigger stretch for Mr. Cramer than it is for Mr. Heller, despite some quibbles with details of Ms. Heitkamp’s ads. Mr. Cramer voted to support the American Health Care Act, a bill that would have allowed states to weaken protections for Americans with pre-existing conditions. If the bill had become law, North Dakota might have preserved Obamacare’s rules, but that is different from “guaranteed coverage.”
Mr. Cramer also recently co-sponsored a nonbinding House resolution that argues that pre-existing condition protection should be in future health overhaul bills. That suggests Mr. Cramer is engaged on the issue, but that also is different from a guarantee.
The Trump Tax Scam, Phase II
Deficits are up? Cut Medicare and Social Security!
by Paul Krugman - NYT - October 18, 2018
When the Trump tax cut was on the verge of being enacted, I called it “the biggest tax scam in history,” and made a prediction: deficits would soar, and when they did, Republicans would once again pretend to care about debt and demand cuts in Medicare, Medicaid and Social Security.
Sure enough, the deficit is soaring. And this week Mitch McConnell, the Senate majority leader, after declaring the surge in red ink “very disturbing,” called for, you guessed it, cuts in “Medicare, Social Security and Medicaid.” He also suggested that Republicans might repeal the Affordable Care Act — taking away health care from tens of millions — if they do well in the midterm elections.
Any political analyst who didn’t see this coming should find a different profession. After all, “starve the beast” — cut taxes on the rich, then use the resulting deficits as an excuse to hack away at the safety net — has been G.O.P. strategy for decades.
Oh, and anyone asking why Republicans believed claims that the tax cut would pay for itself is being naïve. Whatever they may have said, they never actually believed that the tax cut would be deficit-neutral; they pushed for a tax cut because it was what wealthy donors wanted, and because their posturing as deficit hawks was always fraudulent. They didn’t really buy into economic nonsense; it would be more accurate to say that economic nonsense bought them.
That said, even I have been surprised by a couple of things about the G.O.P.’s budget bait-and-switch. One is the timing: I would have expected McConnell to hold his tongue until after the midterms. The other is the lying: I knew Donald Trump and his allies would be dishonest, but I didn’t expect the lies to be as baldfaced as they are.
What are they lying about? For starters, about the causes of a sharply higher deficit, which they claim is the result of higher spending, not lost revenue. Mick Mulvaney, Trump’s budget director, even tried to claim that the deficit is up because of the costs of hurricane relief.
The flimsy justification for such claims is that in dollar terms, federal revenue over the past year is slightly up from the previous year, while spending is about 3 percent higher.
But that’s a junk argument, and everyone knows it. Both revenue and spending normally grow every year thanks to inflation, population growth and other factors. Revenue during Barack Obama’s second term grew more than 7 percent a year. The sources of the deficit surge are measured by how much we’ve deviated from that normal growth, and the answer is that it’s all about the tax cut.
Dishonesty about the sources of the deficit is, however, more or less a standard Republican tactic. What’s new is the double talk that pervades G.O.P. positioning on the budget and, to be fair, just about every major policy issue.
What do I mean by double talk? Well, consider the fact that even as McConnell blames “entitlements” (that is, Medicare and Social Security) for deficits, and declares (falsely) that Medicare in particular is “unsustainable,” Paul Ryan’s super PAC has been running ads accusing Democrats of wanting to cut Medicare. The cynicism is breathtaking.
But then, it’s no more cynical than the behavior of Republicans like Dean Heller, Josh Hawley and even Ted Cruz who voted to repeal the Affordable Care Act, which protects Americans with pre-existing medical conditions, or supported a lawsuit trying to strip that protection out of the act, and are now running on the claim that they want to … protect people with pre-existing conditions.
The point is that we’re now in a political campaign where one side’s claimed position on every major policy issue is the opposite of its true position. Republicans have concluded that they can’t win an argument on the issues, but rather than changing their policies, they’re squirting out clouds of ink and hoping voters won’t figure out where they really stand.
Why do they think they can get away with this? The main answer is obviously contempt for their own supporters, many of whom get their news from Fox and other propaganda outlets that slavishly follow the party line. And even in appeals to those supporters who rely on other sources, Republicans believe that they can neutralize the deep unpopularity of their actual policies by misrepresenting their positions, and win by playing to racism and fear.
But let’s be clear: G.O.P. cynicism also involves a lot of contempt for the mainstream news media. Historically, media organizations have been remarkably unwilling to call out lies; the urge to play it safe with he-said-she-said reporting has very much worked to Republicans’ advantage, given the reality that the modern G.O.P. lies a lot more than Democrats do. Even the most blatant falsehood tends to be reported with headlines about how “Democrats say” it’s false, not that it’s actually false.
Anyway, at this point Republicans are proclaiming that war is peace, freedom is slavery, ignorance is strength and the party that keeps trying to kill Medicare is actually the program’s greatest defender.
Can a campaign this dishonest actually win? We’ll find out in less than three weeks.
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