Dispatches From the Conservative Bubble: GOP Health-Care Edition

Bill Clark/CQ Roll Call via AP Images

Senate Majority Leader Mitch McConnell meets with HHS Secretary Tom Price in his office in the Capitol. 

Poll after poll finds that a majority of Republicans disapprove of the GOP’s effort to repeal and replace the Affordable Care Act (ACA). But given that every analysis of the Republicans’ bills comes to the same broad conclusion—that it will result in millions of Americans losing coverage, won’t reduce premiums for anyone but young, healthy people, and will bestow a massive tax cut skewed toward those who don’t need the extra cash—one has to wonder what those 30-40 percent who approve of the legislation are thinking.

The simplest explanation is that they’re not. Most of us rely heavily on partisan cues to form a position on policy issues, especially when they’re complicated. Influencers—pundits, wonks, and politicians you like—play an important role.

One such pundit is Joel Pollak, a rigidly ideological editor at Breitbart. On Saturday, he published a piece entitled, “In Health Care Attacks, Democrats Risk Inciting Further Violence.” In it, he wrote, “Democrats have settled on a grisly theme in their attacks on the Republicans’ new legislation to repeal and replace Obamacare: death.”

That alarmist rhetoric is spreading throughout the party, from the top down, as if last week’s shooting attack against Republicans, in which House Majority Whip Steve Scalise was critically injured, never happened.

Democrats seem not to care that telling Americans that Republicans are trying to kill them might prompt others to act violently in what they may perceive to be their own self-defense.

Setting aside his simplistic view of the causes of political violence, and the brazenness with which Pollak waves the bloody shirt, it’s remarkable how he reduces an accurate assessment of the real-world consequences of the GOP’s efforts to strip insurance coverage from millions of people to mere political rhetoric.

Pollak is not alone. Across the right, a new theme has emerged: One can criticize the Republican bill, but discussing its inevitable consequences is a bridge too far, which might inspire another unbalanced person to resort to violence, as James Hodgkinson did in Alexandria two weeks ago. 

On Twitter, I pointed out that a meta-analysis of high-quality, peer-reviewed studies by Harvard researchers published in The New England Journal of Medicine found that stripping coverage from millions of Americans would indeed lead to “excess mortality” over the baseline established by the ACA. In plain language, that means the claim that passing the Republican bill would “kill people” is the judgment of the medical establishment, not a talking point conjured up by Democrats.

Pollak’s response: The New England Journal of Medicine has a liberal bias and it’s all fake news:

I was impressed—and, to be honest, just a bit envious—of Pollak’s ability to blithely dismiss information that conflicts with his worldview, even when it comes from the leading researchers in their field.

Besides, even if you do believe that all those egghead scientists are hard-core lefties bent on undercutting Republican reform efforts, the relationship between going without health insurance and mortality is pretty intuitive. If tens of millions lose coverage, some number among them won’t be able to afford to pay out-of-pocket and will inevitably put off care, including preventive care—think cancer screenings and the like—and as a result will have bad outcomes. 

On Monday, the much-anticipated Congressional Budget Office’s analysis of Senate Republicans’ health-care bill was released, and found that if passed, by 2026, 22 million fewer Americans would be covered than under current law. The bill includes deep reductions in spending on Medicaid—a program that serves some of the sickest and most vulnerable Americans. According to an analysis “using estimates of mortality rates from Massachusetts’s experience with health reform” conducted by The Center for American Progress, those reductions would result in around 26,500 additional deaths in 2026 alone.

In a 2014 interview, Stephen Bezruchka, a professor of public health at the University of Washington, told me that economic and health-care insecurity also lead to increased stress, which he called “our 21st-century tobacco.” He said that an increasing body of literature strongly suggests that the secretion of stress hormones probably shortens lifespans. But that argument seemed too quixotic for a Breitbart writer, so I sent Pollak links to four other peer-reviewed studies investigating the relationship between insurance coverage and premature death.

He parried with a conservative talking point, apparently unaware of the difference between some folks on the individual market having to switch policies and the overall coverage rate.

I pointed out the obvious, courtesy of the Congressional Budget Office and the Census Bureau (via a graphic from The Washington Post), and our exchange came to a close.

Perhaps I shouldn’t pick on Pollak, who’s just a cog in a larger disinformation machine—one that revved up this weekend as senior GOP officials apparently concluded that the only way to defend their bill was to blatantly misrepresent what it would do.

The point of all of this mendacity was to muddy the waters by creating an alternative set of “facts” that the GOP base can embrace. Motivated reasoning, or motivated cognition—the process of embracing certain information that conforms to one’s beliefs and rejects what conflicts with them—is something we all do. But it requires some minimally credible claims to latch onto. Nobody would have believed that smoking wasn’t bad for you 30 years ago—or would believe that climate change is a hoax today—if Big Tobacco and the fossil-fuels industry didn’t fund contrarian scientists who made those arguments.

And defending a package of high-end tax cuts financed by stripping health insurance from millions of Americans, some of whom will die as a result, the Republicans who did the rounds on the Sunday talk shows telling people that nobody would lose coverage under their bill—and Joel Pollak telling his followers that studies published in journals like The New England Journal of Medicine are fake news—were just serving the same purpose.  

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