Are Republicans So Frantic to Stop Obamacare Because They Fear It Will Work?
Ted Cruz by Mark Wilson/Getty Images.
What is it about Obamacare that compels seemingly intelligent people to explode in bubbling spasms of stupid? Are they misinformed? Unable to see past the rage-fueled partisan sweat dripping into their eyes? Or just plain dishonest?
No matter. At this point, it has become obvious that history will look back on the four-year war on Obamacare as one of the saddest, most bizarre, and most dishonestly embarrassing episodes of our time. I have given up trying to understand the vehement opposition of so many who cannot offer up truthful reasons for their objections, and instead fuel the hatred and fears of the uninformed with the most illogical, mendacious, and fundamentally bizarre arguments that have ever been marshaled. By comparison, Joe McCarthy’s McCarthyistic McCarthyism was an exercise in reason.
Let’s start with the obvious. We are three years into the adoption of Obamacare, with a few months to go before the next big step, when people are required to have health insurance. But no one has killed my mother yet. In fact, my wife—who is a geriatrician—is not preparing for her patient base to be wiped out in a series of “death panel” sessions. She has, however, been forced to assure patient after patient that they are not about to be murdered by Washington.
Not only that, but I’m allowed to see my own doctor—and that is not going to change. In fact, everyone who has the same insurance now that they had before won’t see any narrowing or revisions in their doctors available to them unless the insurance companies decide to make them. And guess what—that was always true.
I don’t have to contact the Oval Office to have a medical procedure. While the price of my family insurance has gone up—just like it does every year—the rate of annual increase has been lower than it has been for as long as we have had our policy.
None of this is to say there aren’t growing pains associated with Obamacare. But my question is: Where is the Armageddon that the G.O.P. has been promising will descend every year for the last few years?
Remember when Rick Santorum and his wife said they feared Americans with special needs—like their daughter—would suffer once Obama began rationing health care based on the “usefulness” of people? Does anyone believe that, now that Obama has been re-elected and Obamacare is about to take the next big step, Santorum is fleeing the country with his daughter to make sure she won’t be euthanized? Of course not—he was lying. Then again, this was the same fellow who, in one of his jeremiads against Obamacare, falsely proclaimed that 10 percent of all deaths in the Netherlands are from euthanasia and elderly folks there wear bracelets saying they do not want to be euthanized—two statements of “fact” that were simply made up. (Rick—for someone who proclaims his fidelity to the Bible, you sure do lie a lot. Perhaps you should read Psalm 101:7. “No one who practices deceit shall dwell in my house; no one who utters lies shall continue before my eyes.”)
For heaven’s sake, even the supposed “filibuster” of Ted Cruz this week was a falsehood. It was no such thing—his speaking won’t stop the continuing resolution to keep the government running from being picked up by the Senate. He engaged in just a form of verbal masturbation, a performance piece to make the legions already fooled into believing in the evils of Obamacare cheer him on—and maybe even sending him money for his campaign.
So, what accounts for the current, last-ditch, fumbling-fuming on the part of the G.O.P. to stop Obamacare, going so far as to threaten a shutdown of the government in an effort to overturn the clear voice of the American people that was expressed in the last election? It’s hard to say. But I think I have an answer:
The lies are about to be exposed. And the Republicans are terrified of what the country will think when the veil of mendacity is torn away.
Little else can explain the hysteria that has grown ever louder with each passing day. Take one simple example, this squirm-inducing ad where a pervy Uncle Sam turns up at a young woman’s gynecological exam. The message? Republicans are urging young people to forgo health insurance. Let me say that again: Republicans are urging young people to forgo health insurance. Not to vote against Democrats, not to lobby against Obamacare—to forgo health insurance. To risk catastrophic financial calamity in the event of a health crisis.
Why? And here, the lies begin. In what must be the creepiest political ad of all time—from Generation Opportunity, a group backed by billionaires Charles and David Koch—Obamacare is presented as a situation where the government, in the metaphorical form of the large-scale puppet-like Uncle Sam, will be giving people Pap smears and prostate exams. “Don’t let the government play doctor. Opt out of Obamacare,” the ads say.
Well, if that was what Obamacare did, maybe there would be a point. But, like death panels and their ilk, the “government takeover of healthcare” canard is a canard. Under Obamacare, people will have the opportunity to purchase private insurance. It’s a little more complex than that, which I’ll explain later, but the government will have nothing to do with the care anyone receives, any more than it would be rational to have an image of an insurance-company executive giving women Pap smears. (Actually, that would make a little more sense.)
What is particularly galling about this “the government wants to get between your legs” concept is that the Republicans really do want to get between your legs—and not metaphorically. After all, it is the conservatives who are pushing—and have required in some states—for doctors to perform invasive, unnecessary trans-vaginal ultrasounds on women seeking abortions. Yes, that means state governments are forcing doctors to insert a device inside of women, whether they want it or not. And then these people have the hutzpah to say that Obamacare is invasive, when it does nothing of the sort?
A new one came up the other day, and it went viral rapidly. Betsy McCaughey, the conservative think-tanker/commentator who has the distinction of being one of the first to invoke the bogus “death panel” bogey man, has brought forward a new attack that is so bizarre, so transcendent of reality, so “fill in the blank with your own term of disbelief,” that the time may well have come to reconsider whether she should ever be taken seriously again. That is, if you have in the past. In fact, McCaughey’s new diatribe suggests either she has a really bad doctor or she needs to see a good one.
In a recent column in the New York Post, McCaughey proclaimed that everyone’s privacy is now at risk because, under Obamacare, doctors will be required to ask patients about their sex lives. Boogie-boogie-boogie! Not only that, but since the administration is pushing for the wide-scale adoption of electronic medical records, people like the whistleblowers who disclose potential government military abuses can crack into files and publicly reveal your private health information. Boogety-boogety-boo!
How many levels of silly is this? Let’s start with the “ask about your sex life” horror story. I know that there are plenty of social conservatives who consider sex to be something icky that should never be discussed or something immaculate that shouldn’t be enjoyable, but the reality is, good doctors ask about sex. That is not an Obamacare requirement—it is something that medical students learn in their first year when studying how to take a history and physical of a patient.
This is part of what is called “social history,” and it is a critical part of any medical examination. That involves smoking history, use of alcohol, other drug use, and, yes, sex. The discussion of sexual matters is not so the doctor can run off into the next room and giggle about pee-pees. It is an essential part of any medical exam because it can be a key contributor to someone’s health. If a man is unable to gain an erection, or a woman has stopped engaging in intercourse, or a teenager is engaging in oral sex, a doctor is going to want to know about it—each of those can reflect or cause major changes in health status.
Had McCaughey done even basic research—I’m talking 10 seconds on Google—she would have learned that the basic rules for history and physicals demand that doctors ask about their patients’ sex lives. To give just one example, the University of California at San Diego, in A Practical Guide to Clinical Medicine, describes the areas of inquiry that go into taking a good medical history. After discussing how to ask about what it calls “the history of present illness”—in other words, what brought the patient to the doctor—the Guide suggests that a competent doctor should ask about sex lives. Understanding the significance of that is important, it suggests, because too many doctors avoid the topic out of embarrassment. Regarding questions about sexual activity, the Guide says,
This is an uncomfortable line of questioning for many practitioners. However, it can provide important information and should be pursued. As with questions about substance abuse, your ability to determine on sight who is sexually active (and in what type of activity) is rather limited. By asking all of your patients these questions, the process will become less awkward. Do they participate in intercourse? With persons of the same or opposite sex? Are they involved in a stable relationship? Do they use condoms or other means of birth control? Married? Health of spouse? Divorced? Past sexually transmitted diseases? Do they have children? If so, are they healthy? Do they live with the patient?
Not only are doctors taught to ask these questions, so are the nurses who are often relied upon to take a patient’s medical history. In fact, it is such a basic concept that it is included in the template of questions to ask that is used for students at the Western University of Health Sciences in Pomona, California. (I didn’t search far and wide for that. It was the first one to pop up on Google. Like I said, this research isn’t hard.) Under the heading “social history,” the template instructs the nursing hopefuls that they should ask about “birthplace, residence, education, occupation, marital status, ETOH (drinking alcohol), smoking, drugs, etc., sexual activity.’’
So, what McCaughey is holding up as her new Obamacare scare story is just a recitation of what doctors are supposed to do. Next thing, she’ll declare that Obamacare will force doctors to check your blood pressure or treat you when you’re sick or maybe even bill your insurance company.
As for the electronic medical records, this one really takes some hoops to get through. Like I said, my wife is a doctor. The company she works for has electronic medical records for the purpose of ensuring the most accurate information is available to the health professionals who need it. So does one of the world’s largest health-care companies, the Hospital Corporation of America, or HCA. (P.S.: For those conservatives who don’t know, HCA is a company. You know, private industry. Founded by the Frist family, of Bill Frist fame, the former Republican Senate Majority Leader.) So, what does HCA say is the reason it uses electronic health records, or E.H.R.’s?
EHR implementation is an innovative way to improve the safety, quality, effectiveness, and efficiency of the healthcare we provide. An EHR is also the most fundamental support system for optimizing the quality of healthcare and organizational performance. Within HCA, these improvements will add value, drive volume, and provide incentive to payors, employers, and patients to choose HCA when making discriminating healthcare decisions.
Safety, quality, effectiveness, and efficiency of health care? What a nightmare! Betsy, you better call HCA right now and let them know that their system to make medical care better does not have your stamp of approval because—hell, I don’t know. You never explain a reason other than to suggest that the next Edward Snowden will leak everyone’s health-care information before fleeing to Russia.
Now, let’s really point out the stupidity of this one. You know who came up with the idea of having a national system for electronic medical records? Come on—you can guess. I wouldn’t be telling you this way if you couldn’t figure it out.
Yup—it was George W. Bush, the only Republican president of the last two decades. In 2004, Bush signed an executive order creating a subcabinet-level position of health-information-technology coordinator for the purpose of creating the electronic-medical-records system. Just to thwart the folks who might come in lying about what Bush said, here are the relevant words from his April 2004 speech to the American Association of Community Colleges:
Within 10 years, every American must have a personal electronic medical record. That’s a good goal for the country to achieve. The federal government has got to take the lead in order to make this happen by developing what's called technical standards.
Let’s see—10 years. If we can add . . . 2004 plus 10 years equals three months from now. So, Obama is achieving exactly what Bush called for. And, as far as I can tell, no conservatives went nuts about it back then.
Another falsehood I have seen on a lot of conservative Web sites and tweets is that Obamacare, somehow or other, is going to cripple or harm Medicare. Usually, they cite the $716 billion being “cut” from Medicare—you know, the same amount “cut” from the G.O.P.-lauded budget by Representative Paul Ryan.
Unlike deceptions—“Obama is cutting $716 billion from Medicare!”—truth takes a little bit of time to explain. First, to make it clear, there is no cut to benefits from Obamacare. Not a single dime. So where does it come from?
About one-third of that amount comes from the amount Medicare reimburses plans called Medicare Advantage, which were set up to allow seniors to join private insurance plans with the intent of driving down health-insurance costs for the elderly. Sounds fine—except it didn’t work. By 2010, the average per-patient cost of participants in Medicare Advantage was 117 percent of standard fee-for-service. Get it? Private insurers were being paid to decrease costs and instead were increasing costs. So, when this fact is cited, make sure you ask your G.O.P. friend, “Are you saying that you support companies being paid your tax dollars for doing nothing?”
Medicare Advantage is not disappearing. Instead, the reimbursement rates are being cut so that they are more in line with traditional fee-for-service costs. In other words, the government is only going to pay for what it gets, not for what it is promised. However, the insurance providers can still get an increase in reimbursement rates, but that is tied to patient satisfaction and quality of care.\
Another large chunk of the $716 billion comes from reimbursements to hospitals. Let’s start off with one fact: hospitals agreed to these cuts. Here’s why: the current formula for Medicare reimbursement has within it an accounting for unreimbursed care—in other words, bills picked up by the hospitals for treating the uninsured. But, since under Obamacare more people will have insurance, the amount of uncompensated care will drop. As a result, the formula requires recalibration. Or do Republicans really want to pay hospitals money they aren’t owed?
I can go through each of the other items, but all of them are pretty small in comparison to those two. The bottom line will always be the same, though: the story of the $716 billion cut is a lie.
What will really happen to Medicare because of Obamacare? For the answer, let’s turn to the American Association of Retired Persons, the most important organization in the country that fights on behalf of the elderly and the one that has always been the biggest player in Medicare debates. Here is what they have to say about Obamacare:
The health care law strengthens Medicare and improves coverage. You can keep the coverage you already have for doctor and hospital visits. Primary care doctors and nurses who treat people with Medicare will get bonus payments for providing quality care. Medicare will give bonus payments to doctors and nurses who provide primary care in areas with doctor shortages. If you fall into the Medicare Part D prescription drug doughnut hole, the health care law helps reduce the cost of your prescription medicines while you are in the doughnut hole. Medicare now covers more preventive care health screenings and tests. Preventive care is important to catch health problems sooner and treat them more quickly.
How much of that have you heard from Republicans? If your answer is none, then you have been paying attention.
Perhaps one of the most stunning examples of intellectual tomfoolery appeared on the Forbes-magazine Web site on September 23. The piece—which maintained that Obamacare would add a total of $7,450 to the average health spending of a family of four over the next eight years—quickly went viral as conservatives grabbed onto it as proof that the health-insurance program would wreck America.
Sigh. Unfortunately, this piece may well be the silliest, most intellectually dishonest piece of drivel to be published since the adoption of Obamacare. Where to start? The author of the piece—Chris Conover, an adjunct scholar at the American Enterprise Institute—begins by quoting Obama as stating in 2008 that his administration would lower insurance premiums for Americans by up to $2,500 a year for a typical family. (I’m not going to defend Obama’s argument—it, too, was a silly assertion.) But then— ah hah!—Conover points out that health-care costs are predicted to go up by $621 billion in the first 10 years under Obamacare.
Let’s expose the first problem in the simplest way possible: insurance premiums are not the same as health-care expenditures. Perhaps an analogy will help: I am going to give you coupons to save you $250 in your food purchases over the next year. But then I decide not to because—ah hah!—the grocery store issuing the coupons is predicted to earn an additional $62,000 more in sales during that same time. Catch the trick? I start by talking about savings in premiums—the coupon—and then compare it with total amount people are spending on food at that location. And the two numbers have nothing to do with each other! While the coupon probably causes the increased sales in part by bringing in more customers, it doesn’t mean the average cost for all shoppers goes up. When more people get coupons—in this case, insurance—there are going to be more expenditures—in this case, health-care costs—as more people flood into the market.
So, saying “when more people get health insurance, the amount spent on health care will go up” is sort of like arguing that when you dip something in water, it will get wet. Yes, when there are more people who can get health care, more people will get health care, so the amount spent on health care will increase. But Conover pretends there is some link between the obvious and how much people will spend on premiums. People who currently have policies will not be affected at all by this increase in health-care spending.
Then, Conover engages in some truly eye-popping sleight of hand. He takes year-to-year healthcare spending projections, divides them by the projected United States population, and then multiplies that answer by four to see what the average family of four would spend. No, really—that is what he did. He makes no accounting for the fact that the entire market has changed—that tens of millions of people who were previously uninsured suddenly have full access to the health-care market. What matters is not the population of the United States, but the total number of insured and how the addition of these millions of insured will affect health-care usage—and believe me, the probability that health-care usage will increase as more and more people get accustomed to having insurance is 100 percent. And remember something else: using health-care services means more health-care services will be used. Medicine keeps people alive; the greater number of people who have access to it, the longer they will live, the more they will keep accessing health care.
Last, let me deal with that “multiply by four” malarkey. My mother is one of those four. So is my 16-year-old. My mother spends, at the very least, 20 times the amount on health care that my son does. Comparing that “usage” is nonsense—you can’t simply divide the total by two and say “on average, they spend this much.” On average, Bill Gates and I are worth $36 billion, a fact that means nothing.
O.K. No death panels. No government takeover of health care. No change in who your doctor can be unless the insurance company decides to change things. No change in anything for people who already have health insurance. Medicare is strengthened. The growth of health-care spending is a good, not bad, thing that will have no impact on the currently insured.
Now, we need to address a few things like insurance rates and the benefits to all Americans for having the uninsured covered with health-care policies. But that is perhaps the most complicated area of this discussion of all, because—you know—facts are hard, while lies are simple. So I will save that discussion for part two of this discussion, to be posted next week.
One admission: there are critiques I could offer about Obamacare, and there are undoubtedly some challenges the program faces. But none of them come even close to the storyline advanced by the spurious campaign being waged by the Republicans. So, I’ve decided, at least for now, to sidestep these comparative quibbles. There is no reason for me to add chocolate sprinkles to the G.O.P.’s big, steaming pile of manure.
