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Why can’t Republicans give straight answers about their health care bill? Because the truth is ugly

My fondest wish for the next journalist who interviews Paul Ryan about the American Health Care Act, the Obamacare replacement Republicans are trying to jam through Congress, is that he or she asks the speaker of the House, “Are you an idiot, or are you just assuming the American people are idiots?”

Honestly, I am torn about which is the answer.

This theoretical journalist could ask the same question of just about any Republican proponent of the AHCA. Some even tried to over the weekend as members of Congress and the Trump administration fanned out across the networks to pitch the plan. Mostly what they got for their trouble were assertions without evidence that Obamacare is “collapsing,” interspersed with a blizzard of conservative buzzwords: “patient-centered,” “choice” and that ever-reliable standby, “freedom.”

Asked to consider that the AHCA might result in an increase in health insurance premiums or the loss of coverage for millions of people, Republicans simply refuse to acknowledge the possibility. Ryan, by all available evidence, does not appear even to understand how insurance works. I watched John Dickerson interview him on Sunday with the faint hope that the “Face the Nation” host would ask Ryan about his apparent unhappiness that in health insurance pools, “the people who are healthy pay for the people who are sick,” which of course is the entire point of health insurance.

The problem is that journalists like Dickerson are asking the wrong questions. The baseline assumption here is that the GOP is making a genuine, good-faith effort to solve some of the problems of the health care system. If you start with that premise, then the questions that flow from it become meaningless queries about optics or the process of passing the legislation.

That is how you get Dickerson asking Paul Ryan if President Trump has given him any help or advice on how to “sell” the AHCA to the public. You get Chuck Todd nibbling around the edges with Tom Price, asking the Health and Human Services secretary if he can guarantee that “nobody will be worse off financially when it comes to paying for health care.” You get George Stephanopoulos asking Mick Mulvaney, director of the Office of Management and Budget, how he squares Trump’s promises not to touch Medicaid and to give everyone health insurance with independent think-tank analyses showing the AHCA will result in the exact opposite of those outcomes.

The answer to Todd’s question, of course, is that Price can’t make such a guarantee. The answer to Stephanopoulos’ questions is that Mulvaney can’t square the two competing visions. In all the years this country has been having a public and loud debate about the fate of Obamacare, the reasons for such Republican doublespeak have become more and more clear.

Put simply, conservatives do not care about making sure everyone has access to affordable health insurance. They do not care if the poor and working classes have access to Medicaid, or financial subsidies sufficient enough to purchase insurance. If they did care, they would not be working so hard to scale back Obamacare, to reduce those subsidies and cut Medicaid while proclaiming that everything will somehow work out in access to affordable coverage for everyone, despite all available evidence to the contrary from every health policy wonk to the left of the Cato Institute.

What the Republican Party cares about is repealing all the tax increases from Obamacare, which will benefit the wealthiest members of our society while excluding millions of poorer citizens from access to affordable health insurance. It is really that simple.

The debate we as a society are having is not about whose plan will result in better or more affordable coverage, in lower premiums and lower deductibles. It is about whether we as a society value and benefit from all citizens having affordable health care, and whether we are going to take concrete steps to insure that they do, or put our faith in abstract concepts of “freedom” and “markets.”

Conservatives do not believe the former. But they are self-aware enough to know that they cannot say so without sounding insensitive to the large percentage of their base that stands to lose out under the ACHA. Ryan and Mulvaney have at least come close to admitting their real beliefs in recent days when confessing that insurance coverage for everyone is not really their goal. But they have then pivoted to talking about Obamacare’s failures, painting themselves as being on a heroic rescue mission to save insurance markets.

So when millions begin losing insurance under the ACHA, when premiums for comprehensive coverage do not decrease, do Republicans change anything? Do they re-impose some of Obamacare’s cost-containment measures or exchange subsidy levels? These are important questions. At the moment, Republicans are getting away with not having to answer them.

Gary Legum.

Source: Salon: in-depth news, politics, business, technology & culture > Politics

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