At some point in the last few days, key Republicans in the White House and Congress got together to figure out what their message would be on the health-care bill the Senate may pass this week. Perhaps the conversation happened in person, or on a conference call or over email—I don't know, but given the perfect harmony in which they were singing on the Sunday shows, there's no doubt it took place. And at the end of that discussion, a decision was made: The best way to defend the Senate bill is just to lie about it.
And so they did. Here, for instance, is Pennsylvania Senator Pat Toomey on Face the Nation, claiming that "the Senate bill will codify and make permanent the Medicaid expansion" (a lie), and that "no one loses coverage" (another lie). In fact, the bill phases out the Affordable Care Act's expansion of Medicaid, which will result in millions of Americans losing coverage. Not only that, it cuts hundreds of billions of dollars from Medicaid while fundamentally transforming the program to enable states to cut benefits and throw recipients off their coverage. Yet, "These are not cuts to Medicaid," claimed Kellyanne Conway on This Week. According to the Congressional Budget Office, the House bill will result in 23 million fewer Americans with health coverage, and the Senate bill will probably do something similar, yet Secretary of Health and Human Services Tom Price said on Fox News Sunday, "We believe that we will get more individuals covered than are covered right now." That's like saying, "We believe our plan to amputate your legs will make you taller."
As maddening as it is to see Republicans saying these things they know are simply false, it shouldn't surprise anyone. Lying has always been the central Republican strategy on health care.
That's because of two simple facts. The first is that Republicans know that if they told the truth, and if Americans truly understood this immensely complex issue, they could never win debates over health care legislation. The second is that they're willing to do it.
Ignorance and misperception have always been the most powerful forces aiding Republicans in health-care debates, so they do whatever they can to nurture them. This was true when the Clinton administration tried health-care reform in 1993, it was true when the Obama administration tried health-care reform in 2009, and it's true today.
The problem for Democrats is that because health care is an extraordinarily complex area of policy, serious attempts at reform are inevitably complex as well. Which makes it easy to make people fearful of what reform might bring or convince them that completely made-up things are in fact true, because it's all so confusing. Our recent history makes that unfortunate state of affairs clear. Back in 1994, The Wall Street Journal published an article about a poll they had taken called "Many Don't Realize It's the Clinton Plan They Like," which described how only 37 percent of respondents said they favored the Clinton plan, but when various plans were described to them without saying who supported which, 76 percent found the Clinton plan appealing.
Republicans and their allies in the insurance industry moved into that gap, terrifying people about what they would lose if the Clinton plan were enacted (most notably with the "Harry and Louise" ads starring a couple lamenting the awful state of their insurance in the future dystopia the Clinton reforms would create). But that was nothing compared with what they would do when Barack Obama made another attempt at reform 16 years later. Now it was "death panels," which if you don't recall, involved an insane claim that if the ACA passed, then elderly and disabled people would literally have to beg for their lives before a panel of government bureaucrats. "The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care," Sarah Palin wrote on Facebook. The quotation marks were a nice touch.
That was just one of innumerable falsehoods Republicans told about the ACA, which were circulated to millions; to take just one more colorful example, GOP pundit Betsey McCaughey, who is to lying about health care what Steph Curry is to shooting three-pointers, said, "Congress would make it mandatory—absolutely require—that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner." I'm tempted to write that "Needless to say, this was a lie," but it isn't needless to say, because an alarming number of people actually believed it.
And now we're here, with Republicans trying to figure out how they can fool the public into thinking their health-care bill is something other than the abomination it is. We should get a CBO score early this week, which will fill in some of the details about the effects, but here's what we know without question if the Senate bill passes: Millions will lose their coverage. Deductibles will skyrocket. While some young and healthy people will benefit by being able to get cheap, bare-bones plans, the suffering among those who aren't young and healthy will be wide and deep. Those now getting subsidies to afford health care will get stingier ones, leaving them only able to afford high-deductible plans. Middle-aged people could see their premiums soar. By eliminating the "essential health benefits" requirement, it could gut protections for those with pre-existing conditions. The opioid crisis will get dramatically worse as people now able to access treatment through Medicaid will be shut out. Rural hospitals which depend on Medicaid will be slammed; many will likely go out of business.
Oh, and the wealthy will get a huge tax cut. Because of course they will.
All that is why there is almost no one who cares about health care who supports this bill. The AARP is against it, doctors' groups are against it, associations of hospitals are against it, every patient advocacy group that has spoken out is against it.
In the face of all that opposition, what are Republicans to do? Their only salvation lies in public confusion and ignorance. For instance, in a Kaiser Family Foundation poll released last week, only 38 percent of respondents knew (or correctly guessed) that the GOP health-care bill makes major cuts to Medicaid. Since Medicaid is extremely popular, Republicans need to keep that number as low as possible. And how do you do that? You lie. You go on TV and say, Oh no, we're not cutting Medicaid! We want to, um, strengthen it! Yeah, that's what we're doing.
This is why the bill is being passed without a single hearing or committee markup, without any expert testimony, and with a laughably short floor debate. The idea is to create a fog of confusion so most Americans have no idea what your bill does, and pass it before anyone wises up. It's a pretty clever strategy, as long as you have no conscience. And it just might work.