US Republican healthcare plan is cruelty wrapped in fraudulence

Paul Krugman: Black-is-white dishonesty over healthcare plan is an assault on truth

A meeting held in New York to protest at the Republicans’ plan to change Obamacare.

A meeting held in New York to protest at the Republicans’ plan to change Obamacare.


Sometime in the next few days the US congressional budget office (CBO) will release its analysis of the latest version of the Republican healthcare plan.

Senator Mitch McConnell is doing all he can to prevent a full assessment, for example by trying to keep the CBO from scoring the Ted Cruz provision, which would let insurers discriminate against people with pre-existing conditions.

Nonetheless, everyone expects a grim prognosis. As a result, White House aides are already attacking the CBO’s credibility, announcing in advance that whatever it says will be “fake news”.

So why should we believe the budget office, not the Trump administration? Let me count the ways. First, this White House already has a record of constant, blatant lying about healthcare that is, as far as I can tell, without precedent in modern history.


Just a few days ago, for example, vice-president Mike Pence made the completely false assertion that Ohio’s expansion of Medicaid led to a cutback in aid for the disabled – a lie that the state’s government had already refuted.

On Sunday, Tom Price, the secretary of health and human services, claimed that the Senate Bill would cover more people than current law – another blatant lie. (You can’t cut hundreds of billions from Medicaid and insurance subsidies and expect coverage to grow!)

The point is that on this issue (and others, of course), the Trump administration and its allies have negative credibility: if they say something, the default assumption should be that they’re lying.

Second, the CBO is hardly alone in its negative assessments of Republican healthcare plans. In fact, just about every group with knowledge of the issue has reached similar conclusions.

In a joint letter, the two major insurance industry trade groups blasted the Cruz provision as “simply unworkable”. The American Academy of Actuaries says basically the same thing. AARP has condemned the Bill, as has the American Medical Association.

Third, contrary to White House disinformation, the CBO actually did a pretty good job of predicting the effects of the Affordable Care Act, especially when you bear in mind that the act was a leap into the unknown: we had very little experience of how an ACA-type system would work.

True, the CBO overestimated the number of people who would buy insurance on the exchanges the act created; but that was partly because it overestimated the number of employers who would drop coverage and send their workers to those exchanges.

Overall gains in coverage have been reasonably well in line with what the CBO projected – especially in states that expanded Medicaid and did their best to make the law work.

Bad old days

Finally – and this seems to me to be the most compelling argument of all – predicting the effects of destroying the ACA is much easier than predicting the consequences when it was enacted, because what the Senate Bill would do, pretty much, is return us to the bad old days. Or to put it another way, what McConnell and Cruz are selling is a giant leap into the known, taking us back to a system whose flaws are all too familiar from recent experience.

After all, before Obamacare, most states had more or less unregulated insurance markets, similar to those the Senate Bill would create. Many of these states also had skimpy, underfunded Medicaid programmes, which would be the effect of the Bill’s brutal Medicaid cuts.

So while careful, nonpartisan modelling, the kind in which the CBO excels, is important, you don’t need a detailed analysis to know what American healthcare would look like if this Bill passes.

Basically, it would look like pre-ACA Texas, where 26 per cent of the non elderly population was uninsured. And lack of insurance wouldn’t be the only problem: many people would have “junk insurance” – insurance with deductibles so large or coverage limitations so extensive as to be effectively useless when needed.

Now, some people might be satisfied with that outcome. Hard-core libertarians, for example, don’t believe making healthcare available to those who need it is a legitimate role of government; letting some citizens go bankrupt and/or die if they get sick is the price of freedom as they define it.

But Republicans have never made that case. Instead, at every stage of this political fight they have claimed to be doing exactly the opposite of what they’re actually doing: covering more people, making healthcare cheaper, protecting Americans with pre-existing conditions.

We’re not talking about run-of-the-mill spin here; we’re talking about black-is-white, up-is-down dishonesty so raw it’s practically surreal. This isn’t just an assault on healthcare, it’s an assault on truth itself.

Will this vileness prevail? Your guess is as good as mine about whether Mitch McConnell will hold on to the 50 senators he needs. But the mere possibility that this much cruelty, wrapped in this much fraudulence, might pass is a horrifying indictment of his party.