The New York Times is supposed to be a newspaper of record, but its ostensibly-moderate conservative columnist, David Brooks, illustrates that not only does he have a right to his opinion, he thinks he has a right to make up his own facts. Such is the reality detachment that the right depends upon today.
I note Brooks because he is trying to sound civil and all that, not blustery like the talk radio blowhards, but the talking points are all the same. Brooks just presents them in a calmer tone, so that the more intellectual NYTimes audience members can have an excuse to oppose the PPACA and pretend that the Republicans have an alternative. His column A Choice, Not a Whine, sounds like he's laying in to the teabaggers, but he's just saying that they should use his made-up reality points instead of whining.
So let's examine them one by one to see how this faux-journalist distorts reality.
The case against Obamacare is pretty straightforward. In the first place, the law centralizes power. Representative Tom Price, a Republican of Georgia, counted 159 new federal offices, boards and councils, though nonpartisan researchers have had trouble reaching an exact tally. In the first six months after passage alone, federal officials churned out an awesome 4,103 pages of regulations.
Health care consumes almost 18% of the GDP and is regulated by all 50 states and more. What sounds like a large number of offices can boil down to an infinitesimal share of the total, especially compared to how many people work for the health insurance industry that they're regulating. This is just pandering to innumeracy.
The law also creates the sort of complex structures that inevitably produce unintended consequences. The most commonly discussed perverse result is that millions of Americans will lose their current health insurance.
A report by the House Ways and Means Committee found that 71 of the Fortune 100 companies have an incentive to drop coverage. But nobody really knows what’s going to happen. A Congressional Budget Office study this year estimated that 20 million could lose coverage under the law or perhaps 3 million could gain employer coverage. Or the number could be inside or outside the range.
That's a Republican-led committee devoted to fighting Obama no matter what he does. An "incentive" to drop coverage may be matched by incentives to keep it, but that's not counted here. Since the law subsidizes individual coverage and makes it available, which for most people it basically isn't today, loss of employer coverage is less catastrophic than it could have been. And many of these are on the "mini-med" plans that simply aren't worth much and thus don't count as real insurance under the PPACA. Best to get rid of that trash.
The law threatens to do all this without even fixing the underlying structures that make the American health care system so inefficient. It fails to fix the fee-for-service system that rewards people for the volume of services provided. It fails to fix the employer tax exemption that hides costs and encourages overspending.
Now he's warming up for the heart of the argument, that health care is a discretionary expenditure, like cars, so price incentives can control costs. Fee for service is a bad idea, to be sure -- the only really effective cost control is government-provided care, like in the UK, where providers don't have an incentive to do too much, something patients aren't usually qualified to judge. But he just wants more fee for service, just privately paid.
So he goes after the tax deduction for employer-paid care. Get rid of that and of course employers will drop coverage! Not that there's a substitute. He's essentially creating a massive tax increase on the working class, while the truly welathy will just demand more tax cuts to make up for the federal revenue increase from taxing the 99%'s health insurance. Welll, the half or so who might still have it under his plan.
Now Brooks unveils his plan, or the one that some nutcase right-wing economists are pushing as a way to further screw the 99%:
Despite what you’ve read, there is a coherent Republican plan. The best encapsulation of that approach is found in the National Affairs essay, “How to Replace Obamacare,” by James C. Capretta and Robert E. Moffit. (Mitt Romney has a similar plan, which he unveiled a little while ago and now keeps in a secret compartment in subsection C in the third basement of his 12-car garage).
In other words, Romney's campaign advisors have told him that the Capretta-Moffit type plan is such a nonstarter with the public that if he so much as mentions it, he'll lose votes by the million.
Now the first Big Lie begins. The whole idea of this plan is that the majority of Americans have Munchausen's Syndrome:
Capretta and Moffit lay out the basic Republican principles: First, patients should have skin in the game. If they are going to request endless tests or elaborate procedures, they should bear a real share of the cost.
Munchausen's is a mental illness wherein the patient wants needless medical care, surgery, procedures, etc. It is not the same as malingering, wherein a person feigns illness in order to get out of work. A Munchausen's patient really wants to be operated on.
Unless a person has Munchausen's, though, it is extremely unlikely that they're going to demand endless tests or elaborate procedures. They will generally get the tests and procedures that their physician orders. The HMO system already requires referrals for most things, and there are checks and balances to be sure that doctors don't order too much. So putting "skin in the game" merely invites patients to not get doctor-ordered tests and procedures. That is false economy! So according to Brooks' sooper-seekret Republican alternative plan, we're all mentally ill if we take our doctors' advice. Hmmm, didn't the John Birch Society say that mental health was a Communist plot?
Instead of relying on the current tax exemption that hides costs, the Republican plans would offer people a tax credit for use to purchase the insurance plan that suits their needs.
What is a plan that suits my needs? Do I know how sick I'm going to get next year? Do I plan cancer like a vacation in Davos? Do I get a new operation every five years like a pundit gets a new Mercedes-Benz? Since real-world need for medical care is unpredictable, the only difference between plans is risk aversion. Do I want to gamble that I'll lose my house if I get sick, or do I want to pay as much as a mortgage in order to have coverage with only $5000 at risk? It's all insane. If I don't want to gamble at the casino, why should I be gambling with health?
Second, Americans should be strongly encouraged to buy continuous coverage over their adulthood. Then insurance companies would not be permitted to jack up their premiums if a member of their family develops a costly condition.
Here Brooks takes a recent Romney line, supporting a watered-down provision of PPACA to prevent recission. But only if coverage has been continuous. Miss a month and the old pre-existing condition clause will be invoked nine ways to hell and you'll be paying in for years before you can make any real claims. Count on it. This makes the tiny "tax" part of Obamacare look dirt cheap indeed.
Third, the Republican approach would encourage experimentation in the states instead of restricting state flexibility.
How many years have we had to see nothing done? It is not a state-level problem, it's a national problem. Massachusetts took the lead and the leader behind that plan has disclaimed it for political reasons. That's encouraging. Not.
Fourth, instead of locking Medicaid recipients into a substandard system, the Republicans would welcome them into the same private insurance health markets as their fellow citizens. This would give them greater access to care, while reducing the incentives that encourage them to remain eligible for the program.
This one insults on multiple levels. Medicaid recipients are poor and don't have good high-paying jobs because they have an incentive to stay on Medicaid! Kick them off and they'll work, the lazy bums! Plus it considers the plan substandard. Well, it is, if the key standard is supporting corporate profits, maybe 25-30% off the top to insurance executives. And how would poor people pay for these policies? Family coverage costs $10k+. Would they get a $3000 off coupon from Blue Cross if they could bring only $7000 of their own nonexistent cash? That's how Ryan wants to do Medicare, after all.
Speaking of Ryan, Brooks is a big fan:
Fifth, this approach would replace Medicare’s open-ended cost burden with a defined contribution structure. Beneficiaries could choose from a menu of approved plans. If they wanted a more expensive plan, they could pay for it on top of the fixed premium.
Again, the Ryan plan takes away Medicare entirely, replacing it with a discount coupon that is only useful if you can pay the rest of the price out of pocket. Rather than get some coverage for everyone, it's private insurance for those accepted by the insurance industry (you're not covered unless you've never had a gap in private coverage any time in your life, under their view of pre-existing condition clauses). And since the coupon doesn't pay the full cost, those without the cash for the difference get zilch. Nada. A bottle of aspirin at BJ's Wholesale Club, maybe, and a pointer to a faith healer or cemetery plot.
Finally, under this approach, any new spending would be offset with cuts so that health care costs do not continue to devour more and more of the federal budget. This could be done, for example, by gradually raising the retirement age.
Again, it's all about saving tax money for the 1%. He wants to move 65-70 year olds onto private, individual insurance. As if they wanted us. It's easy for a columnist or pundit to work until 70, if they aren't laid off. But many normal American workers have to worry about being laid off when their job is outsourced by a Bain to India or Cameroon. And once you're over 50, finding a new job is not so easy for most people. Columnists being an exception.
It's all the same old stuff. If you get sick, die fast. It's not a plan. Brooks reveals how the "intellectual" opposition to Obamacare is based on economic falsehoods and accusations of mental illness on the part of the public. Well, anyone but a 1%er who votes for Mitt may well be mentally ill. Maybe that's the truth behind the story.